Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

ObjectivesTo investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases.MethodsForty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0–3) and a continuous quantitative measurement (“VAS echogenicity,” 0–100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall’s Tau and Pearson’s Rho coefficients.ResultsThe semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57–0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68–0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. “VAS echogenicity” showed a high reliability both in the inter-observer [ICC = 0.80 (0.75–0.85)] and intra-observer [ICC = 0.88 (0.88–0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and “VAS echogenicity” [ICC = 0.52 (0.50–0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively).ConclusionThe results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases

How normal is the enthesis by ultrasound in healthy subjects?

To explore the prevalence of the ultrasound (US) findings of enthesitis in a group of healthy subjects

Business Model-I, Passionate IT Professional. Methodology of conducting classes using the Design Thinking, Visual Thinking, and Storytelling methods

The aim of this handbook is to provide guidance to those teachers who are willing to run the “Business Model – I, Passionate IT Professional” course in their University. Why? This is both a human-centered and interaction-based course. The human-centered course means that IT students, the course’s recipientes, are considered and understood in a more holistic way. In fact, the course relies on “design methods” that employ both divergent and convergent thinking concerned with how the students themselves attribute and reflect on meanings, values, and beliefs. Interaction-based means that the main aim of the facilitators is not about providing content (even though this role is not revoked from them! Facilitators are still expert professionals whose individual perspective is precious for students), it is instead about creating an the environment in which students can create a dialogue around the different topics that, every time, are brought in class. It is through the establishment of various sorts of interactions and approaches that contents are learned: peer-to-peer interaction, individual reflections and, last but not least, hands-on experience. Facilitating the conversation instead of helding one: It may sound like an easy task, but it is not. Encouraging the conversation between students, building a learning environment to reflect upon the future is not an easy task. This is the reason why this handbook is here for you, the facilitator, in order to share with you the experience gained through the different meetups of the “BE Aware Student - BEAST” project (funded by Erasmus+ Programme, Key Action 2: Strategic Partnerships for higher education) such as the “International Academy of Innovative Educational Methods and Techniques”, held in Modena in March 2019, and in three Summer Schools organized by the three partners of the ‘BEAST’ project, the University of Information Technology and Management in Rzeszow (PL), Polytechnic Institute of Portalegre (PT), and University of Modena and Reggio Emilia (IT), along with contribution from other experts. During this course, you’ll be asked to set up an environment that enables your students to engage in group presentation, collective discussion, individual reflection, 1 to 1 interaction, individual and group work. Every time you can rely on this guide, and benefit from the guidelines, the tips and the attention points collected from the previously gained experience by the BEAST community. The methodology will show how the methods of Design Thinking, Visual Thinking and Storytelling can be used during classes: in fact, all those methods can work with IT subjects, and they can increase the effectiveness of teaching in the context of promoting student’s creativity, entrepreneurial thinking and the ability to use innovative ideas in practice. Along with the general course structure, this handbook covers in detail each step of the course including objectives and methods, comments to the teaching materials (material characteristics, technical and organizational requirements, didactic potential, application options, problem questions for students, inspiration to work with course participants, etc.) as well as instruction on the use of these methods

Hip involvement in patients with calcium pyrophosphate deposition disease: potential and limits of musculoskeletal ultrasound

OBJECTIVES: To preliminarily explore the diagnostic potential of ultrasound (US) in detecting calcium pyrophosphate crystal (CPP) deposits at the hip joint in a cohort of patients with calcium pyrophosphate deposition disease (CPPD) which were previously evaluated by conventional radiography (CR); to assess the sensitivity and specificity as well as the agreement between US and CR in the evaluation of hip CPP crystal deposits. DESIGN: Fifty consecutive patients with "definite" CPPD and 40 age/sex/body mass index-matched disease controls who had undergone hip CR within the previous six months were enrolled. Bilateral hip US examination was carried out by one of the authors (A.D.M) to assess the presence of CCP crystal deposits at the acetabular labrum fibrocartilage and at femoral head's hyaline cartilage. Two independent radiologists evaluated the presence of hip CPP crystal deposits on CR in both groups. RESULTS: US findings indicative of CPP crystal deposits were found in at least one hip in 45 out of 50 (90.0%) patients with CPPD, in 73 out of 100 (73.0%) hips. CPP crystal deposits were more frequently found at the acetabular labrum fibrocartilage than at femoral head's hyaline cartilage (72% and 17% of the hips in CPPD patients, respectively). US and CR sensitivity was 90% and 86% whereas US and CR specificity was 85% and 90%, respectively. Total agreement between the US and CR findings was 77.8%. CONCLUSIONS: Our results provide new evidence supporting US as a first-line, sensitive, safe and reliable imaging technique in detecting CPP crystal deposits at hip level

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Objectives: To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods: Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. Results: The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion: The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases

Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international web-based study

Objectives: To investigate the reliability of the OMERACT ultrasound (US) Task Force definition of US enthesitis in spondyloarthritis (SpA). Methods: In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA [hypoechoic areas, entheseal thickening, power Doppler signal (PD) at the enthesis, enthesophytes/calcifications, bone erosions] were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries.Inter and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence and Bias Adjusted Kappa (PABAK) and their 95% confidence intervals. Results: Bone erosions and PD showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. Conclusions: The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, PD, and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Clinical Severity, Age, and Sex Overcome Cardiometabolic Morbidities but Not Stroke as Predictors of Mortality in Elderly Inpatients: Data From the REgistro POliterapie Società Italiana di Medicina Interna Registry.

Cardiometabolic multimorbidity is an increasing burden in Western countries. Diabetes mellitus, stroke, and ischemic heart disease (IHD) are the prevailing conditions, and each has a high mortality risk. Information on diabetes mellitus, stroke, and IHD was entered into the multivariable logistic model together age, sex, and severity of illness (computed using the Cumulative Illness Rating Scale).In an elderly inpatient population, logistic analysis indicated that diabetes mellitus, IHD, and stroke were not independent predictors of in-hospital and or 3-month mortality. Only stroke had an independent association with mortality at 1- year follow-up. Age, sex, and severity index were strong predictors of mortality, excluding male sex, which was not associated with in-hospital mortality

Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI

The dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient