Identifying different typologies of experiences and coping strategies in men with rheumatoid arthritis: A Q-methodology study

Objective: To identify typologies of experiences and coping strategies of men with RA Design: Q-methodology (a qualitative and quantitative approach to grouping people according to their subjective opinion). Men with RA sorted 64 statements relating to their experience of living with RA according to level of agreement across a normal distribution grid. Data were examined using Q-factor analysis. Setting: Rheumatology outpatient departments in the UK Participants: 30 of 65 invited men with RA participated in this study (46%) Results: All participants ranked highly the need to be well informed about their medication and the importance of keeping a positive attitude. Two factors describing the experiences and coping strategies of male patients living with RA were identified: Factor A: “Acknowledge, accept and adapt” (n=14) take a pro-active approach to managing the impact of RA and find different ways of doing things; whilst Factor B: “Trying to match up to a macho ideal” (n=8) are determined to continue with their pre-RA lives, and therefore push themselves to carry on even if this causes them pain. They are frustrated and angry due to the impact of RA but they internalise this rather than directing it at others. Conclusion: Whilst some men adapt to their RA by renegotiating their masculine identity, others struggle to relinquish their traditional masculine roles. Further research is needed to identify whether the finding that there are two distinct groups of men with RA can be generalised, and if so whether the differences can be explained by clinical, social or psychological factors, which may inform different therapeutic approaches

Trees on K-12 School Campuses in Virginia

Trees and saplings growing on K-12 school campuses were investigated in 105 school districts across Virginia. There were 2812 trees (\u3e12.5 cm stem diameter at 1.4 m above ground level) inventoried across all campuses. The mean and median campus tree population was 27 and 18, respectively. Loblolly pine (Pinus taeda L.) was the most abundant species, accounting for 11% of all inventoried trees. Red maple (Acer rubrum L.) was the most frequently inventoried species, present on 44% of the campuses. Sapling (trees with 2.5-12.5 cm stem diameter at 1.4 m above ground level) populations were similar to tree populations. The mean and median campus sapling population was 23 and 13, respectively. Flowering dogwood (Cornus florida L.) and red maple were the most abundant sapling species, each accounting for about 10% of all inventoried saplings. Flowering dogwood, red maple, Bradford pear (Pyrus calleryana Decne. ‘Bradford’), willow oak (Quercus phellos L. ), and ornamental cherry (Prunus spp. ) were the most frequently inventoried sapling species, each present on more than 25% of the campuses. Across all campuses, species diversity was relatively low: less than 10 species accounted for over 50% of the inventoried trees and saplings. Prominent Virginia natives, in particular Carya and Quercus species, were under represented in the inventory

Clinical Judgment Analysis

SUMMARY Judgment is central to the practice of medicine and occurs between making clinical observations and taking clinical decisions. Clinical judgment analysis has developed as a method of making statistically firm models of doctors' judgments. Computed models reveal the differential importance attached to items of clinical, social, or other data which are determinants of clinical decisions. These models can both reveal the causes of conflicts of judgment and may help resolve them in a way that unaided discussion cannot. Revealing experts' models to students speeds learning of diagnostic skills. Clinical judgment analysis offers a method of probing the judgments not just of students and doctors but also of patients who have shown systematic differences in their perceptions of risk and benefit. The power and relevance of clinical trials can be improved by the consistent application of judgment policies generated from both the trialists and those who will use their result

Use of the Dexamethasone-Corticotrophin Releasing Hormone Test to Assess Hypothalamic-Pituitary-Adrenal Axis Function in Rheumatoid Arthritis

Objectives. Hypothalamic-Pituitary-Adrenal axis function may be abnormal in rheumatoid arthritis (RA). A pilot study in 7 patients suggested impaired glucocorticoid feedback in some patients after the dexamethasone-corticotrophin releasing hormone (CRH) test. This study aimed to investigate the dexamethasone-corticotrophin releasing factor test in a larger group of patients and relate the results to characteristics of the disease. Methods. Outpatients with active RA (≥3 swollen and tender joints and C-reactive protein > 10 mg/L) took dexamethasone (1.5 mg) at 23:00 hour in the evening. Next day, baseline saliva and plasma samples were collected, CRH was infused at 11:00 hour, and 4 serial blood and saliva samples were collected. Plasma samples were stored at −80°C and a radioimmunoassay performed for saliva and plasma cortisol. Results. All 20 participants showed normal dexamethasone suppression and mounted no response to the CRH challenge. In samples with measurable cortisol, there was a strong correlation between saliva and plasma values (r = 0.876, n = 26, P < .01). Conclusion. No abnormalities were found in the Dexamethasone-CRH test in RA patients in contrast to a previous pilot study. Salivary cortisol measurement may offer an alternative noninvasive technique to plasma cortisol in RA patients in future studies

Developing a group intervention to manage fatigue in rheumatoid arthritis through modifying physical activity

© 2019 The Author(s). Background: Fatigue is a major symptom of rheumatoid arthritis (RA). There is some evidence that physical activity (PA) may be effective in reducing RA fatigue. However, few PA interventions have been designed to manage fatigue and there is limited evidence of end-user input into intervention development. The aim of this research was to co-design an intervention to support self-management of RA fatigue through modifying PA. Methods: A series of studies used mixed methodological approaches to co-design a fatigue management intervention focused on modifying PA based on UK Medical Research Council guidance, and informed by the Behaviour Change Wheel theoretical framework. Development was based on existing evidence, preferences of RA patients and rheumatology healthcare professionals, and practical issues regarding intervention format, content and implementation. Results: The resulting group-based intervention consists of seven sessions delivered by a physiotherapist over 12 weeks. Each session includes an education and discussion session followed by supervised PA chosen by the participant. The intervention is designed to support modification and maintenance of PA as a means of managing fatigue. This is underpinned by evidence-based behaviour change techniques that might support changes in PA behaviour. Intervention delivery is interactive and aims to enhance capability, opportunity and motivation for PA. Conclusion: This study outlines stages in the systematic development of a theory-based intervention designed through consultation with RA patients and healthcare professionals to reduce the impact of RA fatigue. The feasibility of future evaluation of the intervention should now be determined