Several screening tools for early identification of psoriatic arthritis (PsA) have been developed. While these tools had high sensitivity and specificity during their development and initial validation, it remained to be determined how they would function with widespread use. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Stockholm, Sweden, these tools were compared for their utility when used to screen patients for PsA in clinics other than those in which they were developed. The screening tools did not perform as well as previously published, and members suggested new tools may need to be developed. An additional study of the prevalence of PsA in a large cohort of psoriasis patients, the PREPARE study, which investigated the use of screening questionnaires, was also presented.
At previous annual meetings of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members resolved to develop dactylitis and enthesitis ultrasound research projects. Sonography can depict many anatomic alterations in the digits of patients with dactylitis and can also study vascularity of these tissues noninvasively. At the 2012 GRAPPA meeting, the ultrasound workgroup outlined steps in developing a dactylitis outcome measure: determining sonographic elemental lesions; testing to see which of these are the most discriminant in separating dactylitic digits from normal digits; selecting final elements for a sonographic dactylitis index; and conducting validity and reliability testing. A brief update of the enthesitis project was also presented.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has developed online videos intended to provide training on the most commonly used physical examination measures for psoriasis and psoriatic arthritis (PsA). At the 2012 GRAPPA annual meeting, attendees were updated on the development, availability, use, and validation of these video modules. To date, 1300 users from 45 different countries have used the Psoriasis Area and Severity Index (PASI) module at least once. Results were presented from a recently completed study of pre- and post-video scoring of the PASI by experienced and naive physicians and patient assessors. Future modifications of the video collection were also discussed.
AIMS: Human epidermal growth factor receptor 2 (HER2) overexpression/amplification is implicated in the development of various solid tumour types. Validated methods and scoring systems for evaluating HER2 status exist in breast cancer, but not in gastric cancer. The aim was to establish a HER2 scoring system for gastric cancer to identify suitable patients for enrollment in a trial of trastuzumab (Herceptin) in advanced metastatic gastric cancer. METHODS AND RESULTS: Formalin-fixed paraffin-embedded gastric cancer samples were tested for HER2 status using the fluorescence in situ hybridization (FISH) pharmDxt kit (Dako Denmark A/S). Immunohistochemistry (IHC) was performed using the HercepTest (Dako). Concordance between FISH and IHC was 93.5% in 168 evaluable samples. Eleven samples were scored as FISH+ but IHC- or equivocal. CONCLUSIONS: IHC/FISH discrepancies were attributed to basolateral membranous immunoreactivity of glandular cells resulting in incomplete membranous reactivity and/or a higher rate of tumour heterogeneity in gastric cancer compared with breast cancer. With modifications to the IHC scoring system, the HercepTest is considered valid for the identification of HER2+ gastric tumours for this clinical trial. Correlation of HER2 scores with clinical outcomes will be needed to determine which patients might benefit from trastuzumab therapy.
Dermatologist and primary care clinicians are in an ideal position to identify the emergence of psoriatic arthritis (PsA) in patients with psoriasis. Yet these clinicians are not well trained to distinguish inflammatory musculoskeletal disease from other more common problems such as osteoarthritis, traumatic or degenerative tendonitis and back pain, or fibromyalgia. A simple set of clinical criteria to identify inflammatory disease would aid recognition of PsA. At its 2012 annual meeting, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) discussed development of evidence-based, practical, and reliable definitions of inflammatory arthritis, enthesitis, dactylitis, and spondylitis. This project will be a sequential process of expert clinician nominal-group technique, patient surveys and focus groups, and Delphi exercises to identify core features of inflammatory disease, testing these in a small group of patients with and without inflammatory disease, and finally validating these criteria in larger groups of patients.
Recently, Nordic protocols have been activated for the use of high-dose chemotherapy and radiotherapy to treat newly diagnosed young patients with multiple myeloma, breast cancer, and malignant lymphomas. The protocols include transplantation of autologous stem cells or progenitors as supportive therapy. This requires a safe number and optimal quality of the harvested cells. Consequently, the Nordic stem cell laboratories established a collaboration to optimize enumeration of CD34+ cells by flow cytometry. In the first workshop (WS-I) report, we addressed the issue of standardization of technical variables. Taking into consideration the variations in estimation of progenitors, a safe graft should contain > 2.0 x 10(6) CD34+ cells per kilogram patient weight, harvested by two or three leukaphereses. This report presents the results from the second workshop (WS-II). Twelve blood or leukapheresis products were shipped and analyzed in 24 stem cell laboratories, and all results were returned to a central database at Herlev Hospital, Copenhagen. The data documented a significant correlation between CD34+ cell enumerations of the 12 samples analyzed in each of the 24 different stem cell laboratories within the Nordic stem cell laboratory group (NSCL-G). At a practical workshop, the NSCL-G developed a standard for the performance of CD34 enumeration. This is based on the simple Milan Protocol, which uses the anti-HPCA-2PE marking of CD34+ (FL-2) nongranulated (lowSSC) cells. The NSCL-G has decided to hold a third workshop (WS-III) to establish working recommendations for double marking of CD34+ lineage-specific subsets and for handling cellular material for storage of RNA and DNA from blood and leukapheresis products.
Quantitative analysis of amino acids (AA) and acylcarnitines using tandem mass spectrometry is an emerging technology used to screen neonatal dried blood spot samples for disorders in the metabolism of AA, organic acids and fatty acids. This paper provides a brief review of some of the technically oriented issues which emerged at the 4th meeting of the International Society for Neonatal Screening in Stockholm, 1999. The information covers sample preparation, instrumentation, data acquistion modes, internal standards, interpretation, confounding factors and practical screening experience.
Several occlusal indexes are currently used to ascertain eligibility for orthodontic treatment. A comparison of 3 indexes of orthodontic treatment need was made with the consensus opinion of a panel of 15 experienced orthodontists. Sets of study casts (170) representing the full spectrum of malocclusions were selected. An examiner, calibrated in the Dental Aesthetic Index, the Handicapping Labiolingual Deviation with the California Modification, and the Index of Orthodontic Treatment Need, scored the casts. The panel of orthodontists individually rated the same casts for their degree of orthodontic treatment need. The mean rating of the panel on the need for treatment was used as the gold standard for evaluating the validity of the indexes. Intrarater and interrater reliability was high (kappa > 0.8). Overall accuracy of the indexes, as reflected in area under receiver-operating characteristic curves, was also high: Dental Aesthetic Index, 95%; Handicapping Labiolingual Deviation with the California Modification, 94%; and Index of Orthodontic Treatment Need, 98%. Cutoff points for the indexes that resulted in the closest agreement with the gold standard differed from the published cutoff points for the indexes. The indexes appear to be valid measures of treatment need as perceived by orthodontists. The published cutoff points for the indexes were more conservative in assigning patients for treatment than a panel of orthodontists. However, adjusting the cutoff points moved all 3 indexes into close agreement with the experts.
Comment In: Am J Orthod Dentofacial Orthop. 2002 Mar;121(3):12A11941333
To develop standards for polysomnography in Canada in order to assist in the uniform provision of diagnostic and therapeutic services related to sleep disorders.
Uniform testing versus no current Canadian standards.
Uniform delivery of health care; reduction in number of repeat studies and their attendant costs.
Availability of diagnostic laboratories and services, and survey responses (written and oral) from directors of sleep laboratories; the American Thoracic Society statement on indications and standards for cardiopulmonary sleep studies was used as a template.
Acceptable standards of practice were based on consensus opinion of the standards committees of the Canadian Sleep Society and the Canadian Thoracic Society. The committees comprised specialists in neurology, psychiatry, psychology, respirology and polysomnographic technology; family practitioners and otolaryngologists were also consulted. BENEFITS, HARMS, COSTS: Improved level of care and reduction in duplicate or unnecessary testing; establishment, with available resources, of diagnostic sleep laboratories by appropriately qualified physicians in areas where polysomnography is unavailable.
Health care practitioners involved in the diagnosis and treatment of sleep disorders should possess a minimum amount of training (both clinical and research) in sleep disorders medicine. The variables recorded and findings entered in a patient's report must be relevant to the sleep disorder under investigation. The recording equipment must provide reliable, accurate and reproducible data and lend itself to appropriate calibration and quality-control procedures. Facilities for sleep studies must meet patient care safety standards, with provisions for emergency or resuscitative measures when necessary; all personnel must be trained in basic cardiopulmonary resuscitation.
No previous standards concerning polysomnography in Canada exist. The recommended standards were reviewed by all members of the Canadian Sleep Society and a revised document was approved by the Standards Committee of the Canadian Sleep Society and by the Standards and Executive committees of the Canadian Thoracic Society.
These standards are endorsed by the Canadian Sleep Society and the Canadian Thoracic Society. The cost of preparing this statement was borne by the individual members of the standards committees; no external funding was provided.