SummaryBackground-Itching is a subjective and multidimensional experience which is difficult to quantify. Most methodologies to assess itching suffer from being unidimensional, for example only measuring intensity without impact on quality of life, or only measuring scratching activity. None has actually been demonstrated to be able to detect change over time, which is essential to using them as an outcome measure of response to an intervention. The 5-D itch scale was developed as a brief but multidimensional questionnaire designed to be useful as an outcome measure in clinical trials. The five dimensions are degree, duration, direction, disability and distribution.

Background: Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. Results: Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84–0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72–0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. Conclusions: Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

Objective Musculoskeletal disorders are the second-leading cause of years lived with disability globally. Total Knee Replacement (TKR) offers patients with advanced arthritis relief from pain and the opportunity to return to physical activity. We investigated the impact of TKR on physical activity for patients in a developing nation. Methods We interviewed 18 Dominican patients (78% female) who received TKR as part of the Operation Walk Boston surgical mission program about their level of physical activity after surgery. Qualitative interviews were conducted in Spanish, and English transcripts were analyzed using content analysis. Results Most patients found that TKR increased their participation in physical activities in several life domains such as occupational or social pursuits. Some patients limited their own physical activities due to uncertainty about medically appropriate levels of joint use and post-operative physical activity. Many patients noted positive effects of TKR on mood and mental health. For most patients in the study, religion offered a framework for understanding their receipt of and experience with TKR. Conclusions Our findings underscore the potential of TKR to permit patients in the developing world to return to physical activities. This research also demonstrates the influence of patient education, culture, and religion on patients’ return to physical activity. As the global burden of musculoskeletal disease increases, it is important to characterize the impact of activity limitation on patients’ lives in diverse settings, and the potential for surgical intervention to ease the burden of chronic arthritis.

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Objective To determine the reliability of radiographic assessment of knee osteoarthritis (OA) by non-clinician readers compared to an experienced radiologist. Methods The radiologist trained three non-clinicians to evaluate radiographic characteristics of knee OA. The radiologist and non-clinicians read preoperative films of 36 patients prior to total knee replacement. Intra- and inter-reader reliability was measured using the weighted kappa statistic and intra-class correlation coefficient (ICC). Kappa <0.20 indicated slight agreement, 0.21 – 0.40 fair, 0.41 – 0.60 moderate, 0.61 – 0.80 substantial, and 0.81 – 1.0 almost perfect agreement. Results Intra-reader reliability among non-clinicians (kappa) ranged from 0.40 to 1.0 for individual radiographic features and 0.72 to 1.0 for Kellgren-Lawrence (K-L) grade. ICCs ranged from 0.89 to 0.98 for the Osteoarthritis Research Society International (OARSI) Summary Score. Inter-reader agreement among non-clinicians ranged from kappa of 0.45 to 0.94 for individual features, and 0.66 to 0.97 for K-L grade. ICCs ranged from 0.87 to 0.96 for the OARSI Summary Score. Inter-reader reliability between non-clinicians and the radiologist ranged from kappa of 0.56 to 0.85 for KL grade. ICCs ranged from 0.79 to 0.88 for the OARSI Summary Score. Conclusion Intra- and inter-rater agreement was variable for individual radiograph features but substantial for summary KL grade and OARSI Summary Score. Investigators face trade-offs between cost and reader experience. These data suggest that in settings where costs are constrained, trained non-clinicians may be suitable readers of radiographic knee OA, particularly if a summary score (K-L grade or OARSI Score) is used to capture radiographic severity.