Immediate access rheumatology clinic: efficiency and outcomes

2011 ◽  
Vol 71 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Miriam Gärtner ◽  
Julia P Fabrizii ◽  
Elisabeth Koban ◽  
Martin Holbik ◽  
Lorenz P Machold ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Waiting Times ◽  
Symptom Duration ◽  
Rheumatology Clinic ◽  
Clinic Efficiency ◽  
Lower Pain ◽  
Rheumatic Conditions

Objective and MethodsIn order to facilitate access and shorten waiting times to rheumatologist assessment, an immediate access clinic (IAC) was established. Patients were assessed at presentation in the clinic and after 6–12 months, either in the clinic or by telephone. Data regarding diagnostic accuracy, pain levels and care were analysed.ResultsFrom February to December 2009, 1036 patients were assessed. 223 (21.5%) patients had symptoms for 3 months or less. 660 were available for re-assessment after 6–12 months. Initial tentative diagnoses were confirmed in over 75% of patients suspected of having rheumatoid arthritis (RA), spondylarthropathy and osteoarthritis. Men suspected of having spondylarthropathy had a significantly longer symptom duration than women (median (IQR) 54.0 (18.0–120.0) vs 24.0 (6.0–66.0) months; p=0.0082). There was no significant gender difference regarding pain. At follow-up, the visual analogue scale for pain in RA patients admitted to further care in the clinic (n=61) had significantly decreased by a median (IQR) of 37.5 mm (10.5–50.5), whereas this improvement was only 6 mm (−26–33.5) in the 22 RA patients followed outside the clinic (p=0.0083).ConclusionsThe IAC resulted in considerable waiting time reduction for rheumatology assessment. A substantial minority was seen before 3 months' symptom duration. ‘Positive predictive correctness’ of the assessing rheumatologists regarding the presence of inflammatory rheumatic conditions was over 75%. Patients with RA cared for in the clinic had substantially lower pain levels after 6–12 months' follow-up than patients treated elsewhere.

Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases

2012 ◽  
Vol 37 (7) ◽  
pp. 605-609 ◽  
Author(s):  
A. Klahn ◽  
M. Nygaard ◽  
R. Gvozdenovic ◽  
M. E. H. Boeckstyns
Keyword(s):  
Rheumatoid Arthritis ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Revision Rate ◽  
Gradual Increase ◽  
Biomechanical Properties ◽  
Fast Recovery ◽  
Trapeziometacarpal Osteoarthritis ◽  
The Mean

We present a prospective follow-up of 39 Elektra prostheses in 37 patients (32 women and five men), with a mean age of 56.5 (range 46–71) years; 34 patients had osteoarthritis and three had rheumatoid arthritis. Patients were followed using clinical examination, including measurement of pain on a visual analogue scale, mobility, and strength, after 6, 12, 26, and 52 weeks, and annually thereafter. Radiological examination was done preoperatively and after 6, 26, and 52 weeks, and annually thereafter. The mean follow-up time was 48 (range 3–91) months. Although we observed a fast recovery, including maintenance of mobility and a gradual increase in grip strength, there was a revision rate of 7/38 (24%) after 36 months, increasing to 17/38 (44%) after 72 months. The main reason for revision was loosening of the trapezial component, and biomechanical properties of the trapezial fixation may be the key problem in treating trapeziometacarpal osteoarthritis using a total prosthesis.

Oral Analogue Scale as an Outcome Measure After Displaced Intra-articular Calcaneal Fractures

1998 ◽  
Vol 19 (10) ◽  
pp. 694-697 ◽  
Author(s):  
Paul Morin ◽  
Rick Buckley ◽  
Rena Stewart ◽  
Rob Vandey Gutche
Keyword(s):  
Visual Analogue Scale ◽  
Health Surveys ◽  
Analogue Scale ◽  
Outcome Measure ◽  
Calcaneal Fractures ◽  
Written Form ◽  
Functional Outcome Measures ◽  
Disease Specific ◽  
Specific Health

Functional outcome measures of displaced intra-articular calcaneal fractures have been documented using general health surveys (SF36) and disease-specific health surveys (Visual Analogue Scale). A simple oral analogue scale (OAS) was collected on 115 patients with 124 displaced intra-articular calcaneal fractures at 2 years or more after fractures. There was a high correlation ( r = 0.72, P < 0.0001) between the verbal OAS and the written Visual Analogue Scale. We believe that the OAS may assist in follow-up outcome assessment and management in this difficult trauma patient population. Outcomes may be accomplished verbally rather than in written form.

Comparison between customised foot orthoses and insole combined with the use of extracorporeal shock wave therapy in plantar fasciitis, medium-term follow-up results: A randomised controlled trial

2020 ◽  
pp. 026921552097661
Author(s):  
Manuel Coheña-Jiménez ◽  
Manuel Pabón-Carrasco ◽  
Ana Juana Pérez Belloso
Keyword(s):  
Shock Wave ◽  
Visual Analogue Scale ◽  
Plantar Fasciitis ◽  
Analogue Scale ◽  
Extracorporeal Shock Wave Therapy ◽  
Foot Orthoses ◽  
Shock Wave Therapy ◽  
Extracorporeal Shock Wave ◽  
Custom Made

Objective: To determine the clinical results of custom-made foot orthoses versus placebo flat cushioning insoles combined with an extracorporeal shock wave therapy on pain and foot functionality in patients with plantar fasciitis. Design and setting: A randomised controlled clinical trial with follow-up at six months. Faculty of Podiatry and Centre Clinical private of Physiotherapy, Seville, Spain. Subjects and interventions: Patients with plantar fasciitis were randomly assigned to either group A ( n = 42), which received custom-made foot orthoses, or group B ( n = 41), which received placebo insoles. All the participants received active extracorporeal shock wave therapy including stretching exercises. Recruitment period was from Mach 2019 to July 2020. Main measurements: The main outcome was foot pain, measured by visual analogue scale and the secondary outcome measures were recorded by Roles and Maudsley scores respectively, at the beginning and at one week, one month and six months. Results: Eighty-eight patients were assessed for eligibility. Eighty-three patients were recruited and randomised. This study showed significant differences between both groups according to the visual analogue scale. In control group, the difference was at baseline ( P 0.01) and, in the experimental group was at the one- and six-month follow-up ( P 0.001). The mean (SD) visual analogue scale at baseline were Control group 6.31 (1.69) and Experimental group 5.27 (1.64); and at six months were 7.52 (3.40) and 3.29 (4.26), respectively. The custom-made foot orthosis was perceived as ‘good’ (85%) and ‘excellent’ (97.5%) at medium-long term. Conclusion: Wearing a custom-made foot orthosis leads to a improvement in patients with plantar fasciitis; it reduced foot pain and improved foot functionality.

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

2019 ◽  
Vol 44 (8) ◽  
pp. 845-849 ◽  
Author(s):  
Angela A. Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
The Mean ◽  
Scar Score

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

One-Year Outcome Study of Anatomic Reconstruction of Lesser Metatarsophalangeal Joints

2019 ◽  
Vol 13 (4) ◽  
pp. 286-296 ◽  
Author(s):  
Jeremy J. Cook ◽  
Emily A. Cook ◽  
Daniel D. Hansen ◽  
Michael Matthews ◽  
Timothy Karthas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Visual Analogue Scale ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Analogue Scale ◽  
Anatomic Repair ◽  
Plantar Plate ◽  
One Year ◽  
Radiographic Alignment

Background: Lesser metatarsophalangeal joint (MTPJ) and plantar plate pathologies are commonly seen forefoot conditions. Traditional rebalancing techniques are commonly used but can have concerning adverse effects. The purpose of this study was to analyze the 1-year outcomes of a new technique consisting of anatomic repair of the plantar plate and collateral ligaments involving lesser MTPJs. Methodology: A retrospective cohort study of 50 consecutive patients treated with anatomic plantar plate and collateral ligament reconstruction were evaluated for lesser MTPJ imbalances between 2013 and 2016. The primary outcome was postoperative digital stability defined as a normal dorsal drawer test and normal paper pull-out test. Secondary outcomes included pre- and postoperative visual analogue scale pain measurements, MTPJ radiographic alignment, and ACFAS Forefoot module scores. Results: All patients had digital instability prior to the surgical intervention. Final follow-up revealed that 92% of patients showed improved digital stability, P = .0005. Multivariate regression found statistically significant improvement in pain reduction via the visual analogue scale of 51.2 mm ( P < .0001) and ACFAS Forefoot module scores improved to 92 ( P < .0001). The 45 joints with preoperative abnormal transverse plane deformity, had either complete (n = 29) or partial (n = 16) radiographic MTPJ correction. Conclusion: These results suggest that anatomic repair of lesser MTPJ improved digital stability, pain, function and radiographic alignment with greater than one year of follow-up. Levels of Evidence: Level IV: Retrospective cohort study

Efficacy of HA Block Kyphoplasty for Old Osteoporotic Spine Fractures

2006 ◽  
Vol 309-311 ◽  
pp. 1371-1374
Author(s):  
Taichi Nishimura ◽  
Hiromi Matsuzaki ◽  
Akihiro Okawa ◽  
Masashi Oshima
Keyword(s):  
Visual Analogue Scale ◽  
Vertebral Fractures ◽  
Neurological Disorder ◽  
Analogue Scale ◽  
Final Evaluation ◽  
Spine Fractures ◽  
Correction Loss ◽  
Pulmonary Infarction ◽  
The Mean

We have successfully treated osteoporotic spine fractures for about three years, by using transpedicular kyphoplasty with hydroxyapatite blocks (HA Block: PENTAX) (refer with: Fig. 1), The 13 patients, four men and nine women, ranged from 61 to 86 years in age (mean, 73 years). The mean Visual Analogue Scale (VAS) was 8.5 points before operation, improved to 2.7 points on the next day of operation, and improved significantly to 1.8 points at the final evaluation. The mean deformity rate (Anterior height / Posterior height x 100) was 66.3% before operation, but improved to 91.7% immediately after operation. At the time of follow-up, this rate was 78.6%, indicating that the correction loss was 13.1%. This procedure caused none of serious complications such as neurological disorder and pulmonary infarction. Kyphoplasty with HA blocks may be safe and effective in the treatment of chronic vertebral fractures.

Assessment of pain, depression, and anxiety by visual analogue scale in Japanese women with rheumatoid arthritis

2002 ◽  
Vol 16 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Nanako Tamiya ◽  
Shunichi Araki ◽  
Gen Ohi ◽  
Katsuhiko Inagaki ◽  
Naoko Urano ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Japanese Women ◽  
Depression And Anxiety

Waiting times during the management of head and neck tumours

2002 ◽  
Vol 116 (4) ◽  
pp. 275-279 ◽  
Author(s):  
T. M. Jones ◽  
O. Hargrove ◽  
J. Lancaster ◽  
J. Fenton ◽  
A. Shenoy ◽  
...  
Keyword(s):  
Head And Neck ◽  
Waiting Times ◽  
Symptom Duration ◽  
Head And Neck Tumours ◽  
Magnetic Resonance Scan ◽  
Primary Radiotherapy ◽  
The Mean ◽  
Mean Time ◽  
Referral Letters

The waiting times incurred during the management of 75 consecutive head and neck oncology patients attending for post-treatment follow-up were reviewed. Data were gleaned from general practitioner (GP) referral letters, patient case-notes as well as radiology and histology reports. The mean time for GP referral to ENT was 5.1 weeks. From ENT to endoscopy was 3.1 weeks, to histology 3.5 weeks, to computed tomography (CT) scan 5.6 weeks, to magnetic resonance scan (MR) 4.1 weeks, to primary radiotherapy 10.3 weeks and to surgery 5.5 weeks. The mean symptom duration prior to referral was 4.9 months.Our results compare unfavourably with the standards recommended by the BAO-HNS. Local modifiations may improve matters, but significant increases in funding, manpower and equipment are required to achieve the stipulated standards. Moreover, criteria for referral have to be re-emphasized and patient education has to be addressed as these appear to contribute the longest delay in the diagnosis of head and neck tumours.

scholarly journals Pain in the Emergency Department with One-Week Follow-Up of Pain Resolution

2005 ◽  
Vol 10 (2) ◽  
pp. 67-70 ◽  
Author(s):  
C Celeste Johnston ◽  
Anita J Gagnon ◽  
Carolyn J Pepler ◽  
Patricia Bourgault
Keyword(s):  
Emergency Department ◽  
Visual Analogue Scale ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Analogue Scale ◽  
Attitudes And Beliefs ◽  
Post Discharge ◽  
Residual Pain ◽  
Normal Functions

OBJECTIVES: To determine the intensity of pain in the emergency department (ED), the use of analgesics in relation to pain intensity, which patients are at risk for unresolved pain at one week post-discharge, and the postdischarge treatment of pain.METHODS: Patients (n=871) admitted to two urban, university-affiliated EDs who were experiencing any pain were recruited on different shifts over the summer months of 1997. Pain intensity was self-reported, and chart reviews of the assessment, immediate treatment and follow-up prescriptions were conducted. Patients (n=699) were contacted one week later, and reports of pain intensity, activity, resuming normal functions and patient attitudes toward pain were documented. Descriptive and regression analyses were performed on the results of patients with complete data (n=585).RESULTS: Mean pain intensity on admission was 6.0 (SD=2.5) on a zero to 10 visual analogue scale, and 5.0 (SD=2.9) at discharge (n=871). One-quarter (23%) of patients were given analgesics while in the ED; their mean pain intensity was 7.0 (95% CI 6.7 to 7.3) versus 5.7 (95% CI 5.5 to 5.9) for those who were not given analgesics (P<0.001). At one week, the mean intensity for worst pain in the past 24 h was 5.2 (SD=2.9) and the usual pain intensity was 3.7 (SD=2.6). Using a cutoff point of pain greater than three on the zero to 10 visual analogue scale as residual pain at one week, 35% (n=207) remained in pain, with musculoskeletal pain accounting for half (n=102) of those cases. Logistic regression showed that the following patients were most likely to have pain at one week: women; those with pain present longer than 48 h before ED visit; those with a high discharge pain rating; those who were taking analgesics; and those who had pain of musculoskeletal origin. Both the attitudes and beliefs about pain and the treatment of pain while in the ED or on discharge were unrelated to the presence of residual pain at one week. An examination of the same factors in relation to the return to normal activities found that they were similar, with the exception that admission and not discharge pain intensity was predictive of not returning to normal activities.CONCLUSIONS: More than one-third of patients presenting to the ED with pain do not experience resolution of their pain. Women presenting with severe musculoskeletal pain of more than a week in duration are less likely to have resolution of their pain and to return to normal activities within a week of the ED visit.

The Early Results of the Brunelli Procedure for Trapeziometacarpal Instability

1998 ◽  
Vol 23 (6) ◽  
pp. 758-761 ◽  
Author(s):  
S. N. J. ROBERTS ◽  
J. N. BROWN ◽  
M. G. HAYES ◽  
A. SAIES
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Joint Surface ◽  
Carpometacarpal Joint ◽  
Trapeziometacarpal Joint ◽  
Independent Observer ◽  
Abductor Pollicis Longus ◽  
Early Results ◽  
The Mean

We report the results of Brunelli’s abductor pollicis longus transfer for symptomatic instability of the trapeziometacarpal joint in 15 hands (14 patients) at a mean follow-up of 21 months. Patients were assessed subjectively, and objectively by an independent observer. All but one of the patients were very satisfied with the result of the operation, including the six patients who had significant degeneration of the carpometacarpal joint surface preoperatively. Four patients said they had no pain and the mean pain score overall on a visual analogue scale was 1.2 (out of a maximum of 10). Overall the outcome was rated good or excellent in 11 of the 15 thumbs.

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