Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis.

OBJECTIVES: In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objectives were to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices. METHOD: Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (Yes/No) and to explain their decisions. RESULTS: The response rate was 26/105 (25%). Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the 10 hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decisions to prescribe biologics and also not to prescribe biologics were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or the social function of the patient. CONCLUSIONS: The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practicing at the same clinic. Treatment choices were motivated primarily by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.

Feasibility of a thermographic method for early detection of foot disorders in diabetes.

BACKGROUND: Foot complications due to diabetes impose a major economic burden to society and loss of health-related quality of life for the patients. Early diagnosis and intensified preventive measures have proved useful to limit the incidence of foot ulcers and lower limb amputations in diabetes, and the development of new tools for early diagnosis has therefore become an attractive option. This article covers a feasibility study of the SpectraSole (Linköping, Sweden) Pro 1000 foot indicator, an innovation based on liquid crystal thermography. The technology identifies increases in temperature, a known indicator of inflammation. METHODS: Sixty-five patients with diagnosed diabetes were examined with the foot indicator immediately after their ordinary foot examinations according to current practice, and findings from the two investigations were compared. RESULTS: Sixty-nine examinations were performed. The foot indicator identified increased temperature in 31 cases, of which six had not been detected in the preceding ordinary examinations. The instrument was perceived as easy to use, and the thermographs could be used to visualize problem areas of the foot, which might contribute to better compliance with therapeutic advice. CONCLUSIONS: The foot indicator detected a relatively high share of the different types of complications but not all. It can be used as a complement to current practices for foot examination. The instrument provides rapid imaging of the foot temperature, and the study indicates that it yields valuable diagnostic information in early stages of foot disease.

Volume changes of individual melanosomes measured by scanning force microscopy.

Black pigment cells, melanophores, e.g. located in the epidermis and dermis of frogs, are large flat cells having intracellular black pigment granules, called melanosomes. Due to a large size, high optical contrast, and quick response to drugs, melanophores are attractive as biosensors as well as for model studies of intracellular processes; e.g. organelle transport and G-protein coupled receptors. The geometry of melanosomes from African clawed toad, Xenopus laevis, has been measured using scanning force microscopy (SFM). Three-dimensional images from SFM were used to measure height, width, and length of the melanosomes (100 from aggregated cells and 100 from dispersed cells). The volumes of melanosomes isolated from aggregated and dispersed melanophores were significantly different (P < 0.05, n=200). The average ellipsoidal volume was 0.14+/-0.01 (aggregated) and 0.17+/-0.01 microm3 (dispersed), a difference of 18%. The average major diameter was 810+/-20 and 880+/-20 nm for aggregated and dispersed melanosomes, respectively. To our knowledge, this is the first time SFM has been used to study melanosomes. This may provide an alternative non-destructive technique that may be particularly suitable for studying morphological aspects of various melanin granules.