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Objectives: To investigate the impact of European Scleroderma Trials and Research (EUSTAR) standardized training on the accuracy of modified Rodnan skin score (mRSS) in patients with systemic sclerosis (SSc). Methods: Eight SSc patients (four diffuse, four limited) and 10 physicians (4 fellows, 6 professors) were included. Gold‐standard mRSS was performed by a senior instructor. Training comprised a video presentation and a live demonstration. Each physician performed mRSS with no clinical information in all patients: (a) before training; (b) after video session; and (c) after live demonstration. Primary outcome was the change in scoring accuracy, which was defined as the difference from the gold‐standard skin score, as analyzed using a linear mixed model. Results: Mean (standard deviation) difference from the gold‐standard score in all measurements by participants before the training was 7.7 (9.5). Completion of training significantly enhanced mRSS accuracy (adjusted β = −7.61; 95% CI: −11.91 to −3.32). This was largely attributable to the video presentation (adjusted β = −5.47; −9.16 to −1.78), although the live demonstration was associated with numerical reduction in the difference from the gold‐standard score (adjusted β = −2.15; −5.84 to 1.55). Effect of training was prominent in fellows whereas professors showed an increase in the difference from gold‐standard score after training (P value for interaction <0.001). The intraclass correlation coefficient for physician skin scores was acceptable. However, no significant change was observed after training. Conclusion: New EUSTAR standardized mRSS training significantly enhanced mRSS accuracy, especially in participant with less previous experience in skin scoring. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Cardiac autonomic dysfunction (CAD) is frequently found in patients with fibromyalgia (FM). Thus, we evaluated whether heart rate variability (HRV) is superior to the Ewing tests in detecting CAD in FM patients. Methods: We studied 35 females with FM and 25 age‐matched healthy females. In Ewing tests, results were added to yield an overall score. An abnormal result on deep breathing, the Valsalva maneuver, or orthostatic standing was counted as 1 point. A change in systolic blood pressure (SBP) of > 10 mmHg while standing counted as 1 point, and a change of > 20 mmHg as 2 points. A score of 0 was regarded as no CAD, a score of ≥ 2 as severe CAD and a score of 1 as mild CAD. HRV was measured in two ways: by R‐R intervals (time‐domain analysis) and by spectral analysis of a series of successive R‐R intervals (frequency‐domain analysis). Results: FM patients had significantly lower expiratory/inspiratory (E/I) ratios, lower Valsalva ratios and higher SBP values than healthy controls (P < 0.05, P < 0.05, P < 0.01, respectively). In the frequency domain, very low‐frequency and low‐frequency bands were also lower in FM patients than controls (both P < 0.05). Based on the discriminant analysis of the Ewing tests, 54.4% of cases were correctly classified. The addition of HRV parameters did not improve the reclassification. Conclusion: HRV does not improve detection of CAD in FM patients over classic autonomic testing. [ABSTRACT FROM AUTHOR]