Clin Med
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ABSTRACT - The scale of pain intensity (SPIN)-screen is a simple visual tool for the screening and measurement of pain intensity, which is designed to be accessible by patients with cognitive and communication problems. It was applied prospectively in a consecutive cohort of 79 patients admitted to a tertiary specialist neurorehabilitation unit, of which 86% had significant cognitive/communicative disabilities. In all, 71 patients (90%) responded to the SPIN. ⋯ Repeat testing after 24 hours provided preliminary evidence for the stability and responsiveness of the SPIN-screen, but these require further evaluation. Of those who expressed a preference for one tool over the other, 70% preferred the SPIN. The study provides support for application of the SPIN-screen as a routine screening tool in this group of patients.
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Rheumatoid arthritis (RA) is a multisystem disease with high rates of morbidity and mortality. In recent years, there has been increasing focus on the growing rates of cardiovascular disease (CVD) in RA, over and above expected levels allowing for 'traditional' risk factors. In this paper the impact of CVD in RA, the relative contributions of traditional risk factors and novel risk factors (including homocysteine, oxidised low-density lipoprotein, high-sensitivity C-reactive protein and leptin), and the need to address cardiovascular risk in the fight against premature death from coronary artery and stroke disease in RA are discussed.
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Pulmonary embolism (PE) can be difficult to diagnose and manage. This paper examines recent national trends in admission rates and mortality for PE to help inform clinical practice. Admissions to NHS hospitals in England between 1 April 1996 and 31 March 2006 were studied. ⋯ Mortality decreased over time and was highest among the elderly. Pulmonary embolism is associated with a significant mortality although overall trends in mortality are improving in England. Age and comorbidities must be considered when developing guidelines and individual treatment plans.