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Objective: The aim of this study was to evaluate whether the heart drawings of patients with heart failure are associated with their psychological, functional, and clinical status., Methods: Sixty patients with heart failure completed a written questionnaire that included a heart drawing task, measures of psychological functioning, and illness perceptions., Results: Patients drew their heart significantly bigger in height when they depicted their heart with failure as compared with how they depicted their heart before their heart failure. Greater levels of heart-specific anxiety were associated with significantly larger drawings as measured by height and overall area. Compared with those who drew no damage, patients who drew damage had significantly higher levels of depression and more negative beliefs about their illness. Drawings also had a significant relationship with the clinical markers of illness severity, B-type natriuretic peptide level, and sodium level., Conclusions: Heart drawings of patients with heart failure are associated with important psychological and clinical indicators of health status. Drawings offer an innovative way to understand patients' perceptions of illness and personal models of heart failure.

Objectives. To develop a method of scoring bone erosion in the feet of patients with gout using CT as an outcome measure for chronic gout studies, consistent with the components of the OMERACT filter.Methods. Clinical assessment, plain radiographs and CT scans of both feet were obtained from 25 patients with chronic gout. CT scans were scored for bone erosion using a semi-quantitative method based on the Rheumatoid Arthritis MRI Scoring System (RAMRIS). CT bone erosion was assessed at 22 bones in each foot (total 1100 bones) by two independent radiologists. A number of different models were assessed to determine the optimal CT scoring system for bone erosion, incorporating the frequency of involvement and inter-reader reliability for individual bones.Results. An optimal model was identified with low number of bones required for scoring (seven bones/foot), inclusion of bones over the entire foot, high reliability and ability to capture a high proportion of disease. This model included the following bones in each foot: first metatarsal (MT) head, second to fourth MT base, cuboid, middle cuneiform and distal tibia (range 0–140). Scores from this model correlated with plain radiographic damage scores (r = 0.86, P < 0.0001) and disease duration (r = 0.42, P < 0.05). Scores were higher in those with clinically apparent tophaceous disease than in those without tophi (P < 0.0001).Conclusions. We have developed a preliminary method of assessing bone erosion in gout using conventional CT. Further testing of this method is now required, ideally in prospective studies to allow analysis of the sensitivity to change of the measure. [ABSTRACT FROM AUTHOR]

Purpose: To assess and compare glaucoma knowledge between patients with established glaucoma, newly diagnosed glaucoma and the general population. Methods: 208 glaucoma patients, 100 newly diagnosed glaucoma patients from three clinical centres and 100 controls from non-ophthalmology outpatient clinics, were recruited and completed a validated self-administered true/false questionnaire assessing glaucoma knowledge. Demographic data were also recorded. Glaucoma knowledge score, out of a maximum of 22, and odds ratios (OR) with 95% confidence intervals (CI) of survey characteristics associated with falling in the lowest quartile of the overall knowledge score was evaluated for each study group. Results: Established glaucoma patients had (median 17, interquartile range 15–19) marginally but significantly ( P < 0.05) greater glaucoma knowledge scores than new patients (median 16, interquartile range 13–18). Both of these groups scored significantly better than the control population (median 13, interquartile range 10–14, P < 0.05). Significant misconceptions regarding glaucoma include: 80% of all participants thought that topical medications could not have systemic side-effects, 48% of established glaucoma patients believed symptoms would warn them of disease progression. One-third of new patients considered blindness to be a common outcome of having glaucoma. For established patients, factors associated ( P < 0.05) with a lesser likelihood of scoring in the lowest quartile of the total score included having family (OR 0.33, 95% CI 0.11–0.98) or friends (OR 0.28, 95% CI 0.06–0.97) with glaucoma, being referred by an optometrist compared with general practitioner (OR 0.21, 95% CI 0.08–0.57), speaking English at home (OR 0.13, 95% CI 0.04–0.49) and being seen in the private health-care sector (OR 0.13, 95% CI 0.04–0.42). Conclusion: Patients with established glaucoma have only slightly greater knowledge than newly diagnosed patients, with both patient groups harbouring significant misconceptions regarding glaucoma. Educational programmes and material should be tailored to address these misconceptions. [ABSTRACT FROM AUTHOR]

Many patients are not reassured after receiving normal results following cardiac investigations. While previous studies have shown anxiety to be a contributing factor, little research has investigated the influence of patients’ illness perceptions on reassurance. In this study we investigated whether illness perceptions predicted patients’ reassurance following normal exercise stress test results. Sixty-two chest pain patients without prior diagnosed cardiac pathology completed questionnaires assessing anxiety and illness perceptions prior to exercise stress testing. Patients completed a reassurance questionnaire immediately following their appointment and again one month later. Illness perceptions (consequences, timeline, identity, illness concern, and emotional effect) but not anxiety, significantly predicted reassurance immediately following testing. We found both state anxiety and illness perceptions to predict reassurance one month later. After controlling for anxiety, longer timeline and lower treatment control beliefs predicted lower reassurance. The results suggest that an intervention targeting patients who have high anxiety and negative illness perceptions prior to testing may improve reassurance and decrease disability and the subsequent use of medical care. [ABSTRACT FROM AUTHOR]

The article discusses the results of a prospective study which examines the effects of long-term treatment with imatinib on bone metabolism of patients with chronic myeloid leukemia (CML). The study reveals that the bone mass density (BMD) was stable at baseline levels between 24 and 48 months of imatinib therapy. It also suggests that routine monitoring of calcium and phosphate would not be necessary after two years of therapy.

Objective To investigate whether providing information about normal findings before a diagnostic test improves patients' reassurance and reduces anxiety about symptoms. Design Randomised controlled trial. Setting Outpatient cardiology clinic. Participants 92 patients with chest pain referred for a diagnostic exercise stress test. Intervention Before undergoing testing patients were randomised to receive standard information (n=28; control group), a pamphlet explaining the function of the test and the meaning of normal test results (n=30; pamphlet group), or the pamphlet and a brief discussion about the meaning of normal test results (n=34; discussion group). Main outcome measures The primary outcome was patients' reported reassurance on a 5 item scale immediately after the test and at one month. Secondary outcomes were the proportion of patients still with chest pain and still taking cardiac drugs at one month. Results The mean levels of reassurance after testing and feedback from the doctor were significantly higher in the discussion group (42.0, 95% confidence interval 39.7 to 44.2) than in the pamphlet (39.2, 36.1 to 42.3) and control groups (35.8, 31.6 to 39.9). This difference was maintained at one month. The proportion of patients still reporting chest pain at one month decreased significantly in the discussion group (to 17%) and pamphlet group (to 28%) but not in the control group (to 36%). A trend was for fewer patients in the discussion group to be taking cardiac drugs at one month. Conclusion Providing patients with information about normal test results before testing can improve rates of reassurance and reduce the likelihood of future reports of chest pain. [ABSTRACT FROM AUTHOR]

Background Risk models play an important role in stratification of patients for cardiac surgery, but their prognostic utilities for post-operative complications are rarely studied. We compared the EuroSCORE, EuroSCORE II, Society of Thoracic Surgeon's (STS) Score and an Australasian model (Aus-AVR Score) for predicting morbidities after aortic valve replacement (AVR), and also evaluated seven STS complications models in this context. Methods We retrospectively calculated risk scores for 620 consecutive patients undergoing isolated AVR at Auckland City Hospital during 2005-2012, assessing their discrimination and calibration for post-operative complications. Results Amongst mortality scores, the EuroSCORE was the best at discriminating stroke (c-statistic 0.845); the EuroSCORE II at deep sternal wound infection (c=0.748); and the STS Score at composite morbidity or mortality (c=0.666), renal failure (c=0.634), ventilation>24 hours (c=0.732), return to theatre (c=0.577) and prolonged hospital stay >14 days post-operatively (c=0.707). The individual STS complications models had a marginally higher c-statistic (c=0.634-0.846) for all complications except mediastinitis, and had good calibration (Hosmer-Lemeshow test P-value 0.123-0.915) for all complications. Conclusion The STS Score was best overall at discriminating post-operative complications and their composite for AVR . All STS complications models except for deep sternal wound infection had good discrimination and calibration for post-operative complications. [ABSTRACT FROM AUTHOR]

Abstract: Nilotinib is a tyrosine kinase inhibitor (TKI) developed to manage imatinib-resistance in patients with chronic myeloid leukemia (CML). It inhibits similar molecular targets to imatinib, but is a significantly more potent inhibitor of Bcr-Abl. Nilotinib exhibits off-target effects in other tissues, and of relevance to bone metabolism, hypophosphataemia has been reported in up to 30% of patients receiving nilotinib. We have assessed the effects of nilotinib on bone cells in vitro and on bone metabolism in patients receiving nilotinib for treatment of CML. We firstly investigated the effects of nilotinib on proliferating and differentiating osteoblastic cells, and on osteoclastogenesis in murine bone marrow cultures and RAW264.7 cells. Nilotinib potently inhibited osteoblast proliferation (0.01–1uM), through inhibition of the platelet-derived growth factor (PDGFR). There was a biphasic effect on osteoblast differentiation such that it was reduced by lower concentrations of nilotinib (0.1–0.5uM), with no effect at higher concentrations (1uM). Nilotinib also potently inhibited osteoclastogenesis, predominantly by stromal-cell dependent mechanisms. Thus, nilotinib decreased osteoclast development in murine bone marrow cultures, but did not affect osteoclastogenesis in RAW264.7 cells. Nilotinib treatment of osteoblastic cells increased expression and secretion of OPG and decreased expression of RANKL. In 10 patients receiving nilotinib, levels of bone turnover markers were in the low-normal range, despite secondary hyperparathyroidism, findings that are similar to those in patients treated with imatinib. Bone density tended to be higher than age and gender-matched normal values. These data suggest that nilotinib may have important effects on bone metabolism. Prospective studies should be conducted to determine the long-term effects of nilotinib on bone density and calcium metabolism. [Copyright &y& Elsevier]

Purpose: To determine if an increased cup-to-disc ratio (CDR) and retinal nerve fiber layer (RNFL) loss occur after acute primary angle closure (APAC). Design: Prospective, observational case series. Participants: Twenty participants with unilateral APAC provided 20 affected eyes and 20 fellow eyes (controls) for analysis. Methods: After initial presentation, participants attended 3 further assessments over a 12-month period (visit 2, within 2 weeks; visit 3, 2–3 months; and visit 4, 6–12 months), in which they underwent the following investigations: Heidelberg Retinal Tomography (Heidelberg Engineering, Dossenheim, Germany), optical coherence tomography of the RNFL and macula, and automated perimetry. Main Outcome Measures: Cup-to-disc ratio, optic cup area, neuroretinal rim area, RNFL thickness, macular thickness, and volume. Results: There was no change from visits 2 to 4 in CDR (0.46±0.17 vs. 0.47±0.20; P = 0.94), neuroretinal rim area (1.64±0.55 vs. 1.64±0.57; P = 0.96), or other optic nerve head parameters analyzed in eyes with APAC. The mean overall RNFL thickness decreased from 106.6±17.9 μm to 92.9±18.3 μm between visits 2 and 3 (P<0.01) in affected eyes. The superior quadrant RNFL thickness decreased from 134.8±25.9 μm to 113±25.7 μm (P<0.01), and the inferior quadrant RNFL thickness decreased from 139.1±28.4 μm to 115.6±24.9 μm (P<0.01). There was no significant change in macular thickness or volume. Conclusions: This study demonstrated that an increase in CDR does not occur after APAC that is treated promptly, although RNFL loss does occur. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To further develop and trial a brief in-hospital illness perception intervention for myocardial infarction (MI) patients. Methods: One hundred and three patients admitted with acute MI were randomized to receive either standard care or standard care plus an illness perception intervention, which consisted of three half-hour patient sessions and one half-hour patient-and-spouse session delivered in hospital. Patients were followed up to 6 months. The main outcome was the difference between groups in rate of return to work. Results: The intervention group had a faster rate of return to work than the control group, and more patients in the intervention group had returned to full time work by 3 months than in the control group. At discharge, patients in the intervention group demonstrated changes in causal attributions regarding their MI and higher perceived understanding of their condition, which remained at the 6-month follow-up. They also reported a better understanding of the information given in hospital, higher intentions to attend cardiac rehabilitation classes, lower anxiety about returning to work, greater increases in exercise, and made fewer phone calls to their general practitioner about their heart condition at follow-up. Conclusion: This study replicates the findings of an earlier trial that a brief in-hospital illness perception intervention can change perceptions and improve rates of return to work in MI patients. It increases the generalizability of the intervention to the current broader definition of MI and to patients who have had previous infarcts. [Copyright &y& Elsevier]

Abstract: Objective: To investigate whether a brief in-hospital illness perception intervention for myocardial infarction (MI) patients and their spouses could change spouses'' illness perceptions and reduce spouses'' anxiety about the illness. Methods: Fifty-seven spouses participated in a randomized controlled trial of an illness perception intervention for MI patients. Spouses of patients randomized to the intervention attended one half-hour patient-and-spouse session with a psychologist in addition to standard care. Spouses completed measures of illness perceptions, expectations, and illness anxiety at admission and at 1 week following discharge, and spouses'' illness worry was rated by the patients at 3 months. The main outcome for spouses was differences in anxiety between intervention and control groups. Results: One week following discharge, spouses in the intervention group had higher illness understanding, lower concern, stronger causal attributions to hereditary factors, and fewer questions about their partner''s heart condition compared to the control group. Intervention group spouses reported more positive expectations about the ability of the patient''s heart to recover, and lower perceived likelihood of another MI. They had lower anxiety about the patient doing physical activity and about the patient''s medications, and lower distress about the patient''s symptoms. Spouses in the intervention group were rated as less worried about the illness at 3 months. Conclusion: Spouses of patients represent a new target for illness perception interventions and these results demonstrate that a brief illness perception intervention can change illness perceptions and reduce anxiety about the illness in spouses of MI patients. [Copyright &y& Elsevier]

Objective: Quantitative data are not available regarding the morphological appearance of optic nerve morphology after arteritic anterior ischemic optic neuropathy (AAION) and nonarteritic anterior ischemic optic neuropathy (NAION). The purpose of this study is to evaluate the appearance of the optic nerve head in patients after AAION and NAION with the Heidelberg Retina Tomograph (HRT). Design: Prospective comparative observational study. Participants: Thirty-eight patients with either unilateral AAION (15) or NAION (23). Methods: Heidelberg Retina Tomograph images were taken of both affected and unaffected eyes. The quantitative changes in the optic nerve head were morphologically evaluated and compared with those of the normal contralateral eyes. Main outcome measures: Heidelberg Retina Tomograph parameters were analyzed using the uninvolved contralateral eye as a control. Results: The ratio between cup area and disc area was 42% larger in the affected eyes in the NAION group than in the fellow eyes (P = 0.03, t test). In the AAION patients, the ratio between cup area and disc area was 116% larger in involved eyes than in their fellow eyes (P = 0.0003, t test). In addition, in the AAION group, relative to their fellow eyes, the rim area was 27% smaller (P = 0.0006), cup volume was 160% larger (P = 0.021, t test), mean cup depth was 29% larger, cup shape measure differed by 41% (suggesting more excavation), and mean retinal nerve fiber layer thickness was 30% less. Relative to the fellow eyes in the NAION group, the rim area was 6% smaller (P = 0.13, Student’s t test), and the cup shape measure was 13% different, although these were not statistically significant. When the uninvolved eyes of the NAION and AAION groups were compared directly, there was no statistical difference between any of the HRT parameters, except mean cup depth (0.09 vs. 0.14 mm, respectively; P = 0.02). Conclusions: This study is the first to demonstrate quantitatively an enlargement and excavation of the optic cup after an event of AAION, but not NAION. The eyes affected with AAION showed significant excavation and enlargement of the optic cup when compared with contralateral uninvolved eyes. All HRT-generated parameters showed changes consistent with increased enlargement and excavation of AAION-involved eyes. These changes were not observed in eyes that experienced an event of NAION. [Copyright &y& Elsevier]