Carpe Diem Haiku Tan Renga Challenge No. 99 raindrops on bamboo

raindrops on bamboo

shimmer in the sunlight

little diamonds

© Chèvrefeuille

I’ve written two stanzas for Chèvrefeuille’s haiku.

Wind approaches suddenly

Gone is the thief with riches

And then they all disappear

The bamboo nods in beauty

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-tan-renga-challenge-99.html

Twitter at the ACR 2015 Meeting in San Francisco

There were four abstracts, posters or talks on Twitter at the ACR 2015 Meeting in San Francisco.

Christopher Collins and colleagues reported about: “#Rheumjc: Development, Implementation and Analysis of an International Twitter-Based Rheumatology Journal Club”. In results we read: “A qualitative content analysis (inter-rater agreement alpha =0.801) revealed that the majority of the conversation was relevant with 28% of the tweets addressing the article directly (in the spirit of a “traditional” journal club) and another 62% considered “on-topic” with tweets referencing personal experiences, opinions, and links to supporting literature.” Conclusion: “#RheumJC is a novel and popular approach to the traditional medical journal club which brings together people from around the globe and across specialties to discuss current medical literature in rheumatology utilizing Twitter as a medium for medical education.” I hope that #Rheumjc will continue and that even more participants will show up.

Ahmed Omar an colleagues looked at: “Twitter and Rheumatology: Significant and Incremental Growth in Usage“.The authors used the Symplur® healthcare analytics website to retrospectively examine traffic related to chosen Rheumatology-associated hashtags as #Rheum, #Lupus, #Fibro, #Arthritis, #Osteoporosis, #Spondylitis (AS), #RheumatoidArthritis, and #Vasculitis; and also #Diabetes, #IBD  (Inflammatory Bowel Disease), and #Psoriasis. The concluded: “Twitter usage in relation to Rheumatology has shown a dramatic growth over the last 5 years and continues to show sustained growth.” In 2014 tweets on rheumatology have hit the 500,000 mark.

To give comparable data on the 500,000 mark I consulted the Symplur® healthcare analytics website myself. Tweets using the ACR meeting’s hashtag #ACR15 amounted to about 6,179 for the peak days (08.-10. Nov. 2015). That’s nearly double of the EULAR Meeting’s hashtag #EULAR2015, where tweets amounted to 3,877 for the peak days (10.-12. June 2015)

Pari Delir Haghighi and colleagues reperted an "Investigation of Environmental Associations of Fibromyalgia Pain Using Twitter Content Analysis”. In methods they write: “We performed an automated search of Twitter between January 2008 and November 2014 using the hashtags #fibromyalgia, #fibro and #spoonie as keywords.” I’ll discuss this study together with other studies on fibromyalgia. No one would have thought a couple of years ago that tweets can be used scientifically.

Jonathan S. Hausmann and colleagues looked at: “Use of Social Media By Rheumatology Fellows in North America“. On Twitter we read in onclusion: “Twitter, for either personal or professional use, was reported by 18% of fellows, significantly less than surveys of adults with a college education, where the rates of use are 30%.”

Take home messages:

    - we can use Twitter to discuss new developments in medicine on a global level

    - Twitter may yield data for scientific research

    - Twitter has shown an incremental growth in rheumatology related hashtags

References:

Collins C, Sufka P, Hausmann JS, Jayatilleke A, Campos J, Bhana S. #Rheumjc: Development, Implementation and Analysis of an International Twitter-Based Rheumatology Journal Club [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/rheumjc-development-implementation-and-analysis-of-an-international-twitter-based-rheumatology-journal-club/. Accessed November 12, 2015.

Omar A, Sari I, Chan J, Haroon N, Inman RD. Twitter and Rheumatology: Significant and Incremental Growth in Usage [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/twitter-and-rheumatology-significant-and-incremental-growth-in-usage/. Accessed November 12, 2015.

Delir Haghighi P, Kang YB, Huynh T, Buchbinder R, Burstein F, Whittle S. Investigation of Environmental Associations of Fibromyalgia Pain Using Twitter Content Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/investigation-of-environmental-associations-of-fibromyalgia-pain-using-twitter-content-analysis/. Accessed November 12, 2015.

Hausmann JS, Doss J, Cappelli L. Use of Social Media By Rheumatology Fellows in North America [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/use-of-social-media-by-rheumatology-fellows-in-north-america/. Accessed November 12, 2015.

Fibromyalgia at the ACR 2015 Meeting in San Francisco / Diagnosis

There were quite a number of abstracts, posters, and talks on fibromyalgia at the ACR 2015 Annual Meeting in San Francisco. I’d like to comment on these abstracts concerning criteria and diagnosis.

Frederick Wolfe and colleagues looked at 514 patients in the ACR 2010 criteria study to compare physician based and patient based criteria. There was good agreement in physician and patient fibromyalgia diagnosis and other measures. “There is acceptable agreement in diagnosis and PSD [polysymptomatic distress scale] for research, but insufficient agreement for clinical decisions and diagnosis.”

Frederick Wolfe and Winfried Häuser looked at misclassifications of the Fibromyalgia 2010 Criteria as the elimination of wide spread pain could lead to the inclusion of patients without generalized pain and therefore could favour a bias for psychological symptoms. The authors concluded: “When used in settings where non-WSP and regional or psychiatric diagnoses are substantially increased, FM criteria will “misclassify” persons. This occurs because there is no reliable gold standard fibromyalgia definition. The solution to this type of misclassification is to use the most appropriate clinical diagnosis (e.g., regional arm pain or rheumatoid arthritis) and indicate the patient also satisfied fibromyalgia criteria.”

Gary J. Macfarlane and colleagues “have investigated whether associations with features are stronger in persons with chronic widespread pain (CWP) compared to multi-site pain (MSP).” They concluded: “We have found that a definition of MSP as at least 8 (of 35) pain sites consistently results in a similar population prevalence to that of CWP, and that the defined groups are similar but not the same. The results suggest that amongst persons with MSP, those with CWP are significantly more likely to exhibit features typical of fibromyalgia.”

Xenofon Baraliakos and colleagues “examined similarities and differences between axSpA and FM using different sets of classification criteria and to assess the severity of wide-spread pain in both diseases.” The authors concluded: “Importantly, no FM patients fulfilled ASAS classification criteria. Only a small proportion of patients with axSpA fulfilled any of the FM classification criteria. There was less overlap between patients with FM, axSpA and RA using the 1990 criteria as compared to the more sophisticated 2010 FM criteria. … Some patients with widespread pain may have underlying axSpA – this differential diagnosis needs to be taken into account when dealing with the diagnosis of FM in daily practice.”

All in all, these studies show, how difficult it still is to correctly diagnose fibromyalgia. There aren’t easy criteria that work like a cook book, so the expertise of rheumatologists is still warranted. The studies imply that the diagnosis should be weighed against other diseases or the possibility of concomitant diseases. And I think these studies also tell us not to diagnose fibromyalgia without chronic widespread pain.

References:

Wolfe F, Fitzcharles MA, Goldenberg D, Häuser W, Katz RS, Mease PJ, Russell A, Russell J, Walitt B. A Comparison of Physician Based and Patient Based Criteria for the Diagnosis of Fibromyalgia [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/a-comparison-of-physician-based-and-patient-based-criteria-for-the-diagnosis-of-fibromyalgia/. Accessed November 12, 2015.

Wolfe F, Häuser W. When Fibromyalgia Criteria Misclassify [abstract]. Arthritis Rheumatol.2015; 67 (suppl 10). http://acrabstracts.org/abstract/when-fibromyalgia-criteria-misclassify/. Accessed November 12, 2015.

Macfarlane GJ, Dean LE, Bennett R, Crofford LJ, Ayorinde A, Fluess E, Clauw DJ, Fitzcharles MA, Goldenberg D, Paiva E, Staud R, Arnold L. Defining Pain for Fibromyalgia Criteria: Multi-Site or Widespread? an Analysis of Data from Four UK Population-Based Studies [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/defining-pain-for-fibromyalgia-criteria-multi-site-or-widespread-an-analysis-of-data-from-four-uk-population-based-studies/. Accessed November 12, 2015.

Baraliakos X, Regel A, Kiltz U, Menne HJ, Dybowski F, Igelmann M, Kalthoff L, Krause D, Saracbasi E, Schmitz-Bortz E, Braun J. Patients with Fibromyalgia (FM) Do Not Fulfill Classification Criteria for Axial Spondyloarthritis (axSpA) but Patients with Axspa May Fulfill Classification Criteria for FM [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/patients-with-fibromyalgia-fm-do-not-fulfill-classification-criteria-for-axial-spondyloarthritis-axspa-but-patients-with-axspa-may-fulfill-classification-criteria-for-fm/. Accessed November 12, 2015.

Carpe Diem Haiku No. 886 Shepherds

He’s weather beaten

Onwards on his trusty horse

The good shepherd cares

No dreaming, shepherd

Of fires, smoke, or company

A rest on horseback

The wind keeps bruising

All grass up to the mountains

Where the shepherd rides

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-886-shepherds.html

Defekt und post-defekt

Ich habe vor einigen Tagen über einen Post-Defekt berichtet, und zwar schrieb ich über die argentinische Post. Das ist aber eine ganz andere Geschichte ...

Meine Geschichte beginnt mit einem Bild. Ja, Sie sehen richtig, Auf dem Zettel steht "defekt" - und das ist durchgestrichen. Unschwer ist zu erkennen, dass es sich um die Tür einer Toilette handelt. Und da war ein Defekt. Und der wurde behoben. Aber dann reißt man den Zettel nicht einfach ab, sondern streicht das Defekt durch, da sich die Toilette nun in post-defektem, also reparierten Zustand befindet. Sie mögen das verrückt finden, ich nenne es umsichtig ... allerdings finde ich es auch verrückt.

Carpe Diem Haiku Writing Techniques No. 18 Yugen

A pendulum clock

Aching with every tick-

Tock tick-tock tick-tock

After the harvest

The fields are left for resting

What about scarecrows?

In the netherworld

The pink Spring cherry blossoms

Will also be pink

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-haiku-writing-techniques-18.html

Carpe Diem Special Haiku No. 181 "a maple leaf" Ese's second haiku

The maple tree

Red leaves in the bright sun

No need for shame

Empty street

Lonely face behind curtains

Despite the rich colours

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-special-181-maple-leaf-eses.html