Prolonged, widespread, disabling musculoskeletal pain of adolescents among referrals to the Pediatric Rheumatology Outpatient Clinic from the Päijät-Häme Hospital District in southern Finland

2018 ◽  
Vol 18 (4) ◽  
pp. 621-628
Author(s):  
Heini Pohjankoski ◽  
Maiju Hietanen ◽  
Leena Leppänen ◽  
Heli Vilen ◽  
Hannu Kautiainen ◽  
...  
Keyword(s):  
Musculoskeletal Pain ◽  
Outpatient Clinic ◽  
Pediatric Rheumatology ◽  
Functional Disability ◽  
Screening Tool ◽  
Screening Tools ◽  
Rapid Screening ◽  
Hospital District ◽  
Pain Patients ◽  
Rheumatology Outpatient

Abstract Background and aims Musculoskeletal pain among adolescents is a problem for the patients and their families and has economic consequences for society. The aim of this study is to determine the incidence of prolonged disabling musculoskeletal pain of adolescents among referrals to a pediatric rheumatology outpatient clinic and describe the patient material. The second aim is to find proper screening tools which identifies patients with a risk of pain chronification and to test whether our patients fit the Pediatric Pain Screening Tool (PPST) stratification according to Simons et al. Methods We selected adolescent patients with disabling, prolonged, musculoskeletal pain and calculated the incidence. Furthermore, after the patient collection, we adjusted our pain patients to PPST. Results The incidence of prolonged musculoskeletal pain patients at our clinic was 42/100,000 patient years (pyrs) (age 13–18; 95% CI: 29–60) during years 2010–2015. A nine-item screening tool by Simons et al. proves to be valid for our patient group and helps to identify those patients who need early, prompt treatment. The functional risk stratification by Simons et al. correlates with our patients’ functional disability. Conclusions and implications In order to prevent disability and to target intervention, it is necessary to have proper and rapid screening tools to find the appropriate patients in time.

scholarly journals Evaluation of Children Referred to Pediatric Rheumatology Outpatient Clinic with Suspicious Laboratory Test Results

2021 ◽  
Author(s):  
Şerife Gül Karadağ ◽  
Hafize Emine Sönmez ◽  
Ayşe Tanatar ◽  
Nuray Aktay Ayaz
Keyword(s):  
Rheumatic Disease ◽  
Laboratory Test ◽  
Rheumatic Diseases ◽  
Outpatient Clinic ◽  
Pediatric Rheumatology ◽  
Connective Tissue Diseases ◽  
Test Results ◽  
Laboratory Findings ◽  
Laboratory Test Results ◽  
Rheumatology Outpatient

INTRODUCTION: We aimed to evaluate the patients who were referred to the pediatric rheumatology outpatient clinic with suspicious laboratory test results. METHODS: All patients who were referred to our outpatient clinic with suspicious laboratory test results between March 2018 and March 2019 were evaluated. RESULTS: A total of 273 new patients who were referred with suspicious laboratory test results were evaluated. Among them; 48% were girls and 52% were boys and they were referred mostly from the clinics of child health and diseases (70.3%). The most frequent indications for referrals were anti-streptolysin O (ASO) elevation (n=86) and anti-nuclear antibody (ANA) positivity (n=47), while 66% of the patients were not diagnosed with rheumatic disease. None of the patients without complaints but with suspicious laboratory test results (n=49) were diagnosed with rheumatic disease. While 64.6% of those diagnosed with rheumatic diseases had periodic fever syndrome, 17.1% had juvenile idiopathic arthritis, 8.5% had postinfectious arthritis, and the remaining 9.8% had connective tissue diseases, vasculitis and uveitis. DISCUSSION AND CONCLUSION: Laboratory findings alone in childhood rheumatic diseases are not significant in patients without complaints. The diagnosis of rheumatic diseases should be made with the patient’s complaints, history, family history and physical examination findings and supported by laboratory findings. With the rational use of laboratory tests; unnecessary health expenses can be prevented and referrals of patients with nonrheumatic diseases to pediatric rheumatology outpatient clinics can be prevented.

Development of a screening tool to assess prostate cancer health literacy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 127-127
Author(s):  
Ashwin A. Kotwal ◽  
Viraj A. Master ◽  
Ashesh B. Jani ◽  
Gertrude Fraser ◽  
Andrew M Wolf ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Literacy ◽  
Screening Tool ◽  
Screening Tools ◽  
Rapid Screening ◽  
Vaginal Intercourse ◽  
Low Literacy ◽  
Poor Comprehension ◽  
Education Groups ◽  
Item Scale

127 Background: Poor comprehension of prostate cancer (PCa) related terms can create barriers to informed discussions on screening, treatment, and measuring outcomes, and contribute to disparities in African American (AA) men. We developed a screening tool to assess for low PCa-related health literacy. Methods: We assessed PCa-related literacy in a sample of 189 AA men, age >40 years from diverse socioeconomic status (SES) using a 27-item scale derived comprehension of commonly used terms for urinary, bowel and sexual function. Using item-response models we examined differential item functioning by education. We developed rapid screening tools based on understanding of 1 or 2 words to predict overall comprehension. Receiver operating characteristic curves assessed the sensitivity and specificity for individuals understanding less than a pre-specified threshold of 70% on the overall scale, defined as “low literacy.” Results are being tested in an independent sample of 110 AA men. Results: The 27-item scale had good internal reliability (Cronbach alpha = 0.93). 47% of the sample met criteria for low literacy. Lower education groups had relatively poor comprehension of sexual function terms compared to higher education groups. 1-item scales using comprehension of the term “rectal urgency” had a sensitivity of 95% for identifying low literacy, “erection” had a specificity of 98%, and “vaginal intercourse” had a sensitivity of 91% and specificity of 81%. Combining “vaginal intercourse” and “rectal urgency” yielded a 2-item scale with strong characteristics (sensitivity 88%, specificity 89%), as did combining “vaginal intercourse” and “erection” (sensitivity 94%, specificity 81%). Conclusions: Rapid screening tools assessing PCa-related literacy performed well in a community sample of AA men with varied SES. Providers can use these tools to identify those at risk of poor comprehension to tailor outcome measurement and shared decision making. [Table: see text]

scholarly journals The spectrum of pediatric amplified musculoskeletal pain syndrome

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
David D. Sherry ◽  
Maitry Sonagra ◽  
Sabrina Gmuca
Keyword(s):  
Musculoskeletal Pain ◽  
Pediatric Rheumatology ◽  
Functional Disability ◽  
Wide Spectrum ◽  
Pediatric Population ◽  
Pain Syndrome ◽  
Pain Clinic ◽  
Cross Sectional ◽  
Body Regions ◽  
Constant Pain

Abstract Background Children presenting with musculoskeletal pain to pediatric rheumatology clinics are very heterogeneous and on a continuum from those with localized pain to total body pain. Many report intermittent, rather than constant, pain. We examined clinical and psychological characteristics of these children at presentation and specifically those who fulfilled the criteria for fibromyalgia. Methods We performed a retrospective, cross-sectional cohort study of children under ≤18 years old presenting to the pediatric rheumatology pain clinic between January 2015 and July 2019 and enrolled in a patient registry. We included children diagnosed with amplified pain, excluding those fulfilling criteria for complex regional pain syndrome. Abstracted data included clinical characteristics, pain symptoms, functional disability inventory (FDI), widespread pain index, and symptom severity scale. Results We analyzed 636 subjects, predominantly non-Hispanic Caucasian females. Using median split method, 54% had diffuse pain (≥ 5 body regions involved), but, of these, only 58% met criteria for fibromyalgia. Subjects with diffuse pain, compared to those with localized pain had a longer duration of pain (24 vs 12 months, p < 0.01), reported greater pain intensity (6/10 vs 5/10, p < 0.001), greater mental health burden, and poorer function (FDI 25 vs 19, p < 0.0001). Subjects with limited pain more often reported a history of trigger event (34% vs 24%, p < 0.01) but not autonomic changes (14% vs 14%, p = 0.94). The presence of adverse childhood experiences did not differ among those with limited versus diffuse pain except for parental divorce (16% vs 23%, p = 0.03). Intermittent pain was reported in 117 children (18%) and, compared to subjects with constant pain, they reported less pain (0/10 vs 6/10) and were more functional (FDI 13 vs 25) (both p < 0.0001). Conclusions There exists a wide spectrum of pain manifestations among children with amplified pain including limited or diffuse and constant or intermittent pain. Most children who presented to our clinic did not fulfill criteria for fibromyalgia but nonetheless had significant symptoms and disability. Studies focusing on fibromyalgia may miss the full extent of childhood amplified pain. Additionally, research limited to those meeting the fibromyalgia criteria likely underestimate the significant impact of amplified pain among the pediatric population.

Risk severity moderated effectiveness of pain treatment in adolescents

2019 ◽  
Vol 19 (2) ◽  
pp. 287-298 ◽  
Author(s):  
Hanna Vuorimaa ◽  
Leena Leppänen ◽  
Hannu Kautiainen ◽  
Marja Mikkelsson ◽  
Maiju Hietanen ◽  
...  
Keyword(s):  
Musculoskeletal Pain ◽  
Acceptance And Commitment Therapy ◽  
Screening Tool ◽  
Pediatric Pain ◽  
Acceptance And Commitment ◽  
Medium Risk ◽  
Pain Frequency ◽  
Risk Patients ◽  
Pain Patients

Abstract Background and aims A targeted pain program may prevent the progression and subsequent occurrence of chronic pain in adolescents. This study tested the effectiveness of a new acceptance and commitment therapy -based pain management intervention, using physical and psychological functions as the outcomes. The objective was also to determine whether Pediatric Pain Screening Tool risk profiles function as outcome moderator in the current sample. A valid screening tool would enable the program development. Methods Thirty-two consecutive adolescent patients (13–17 years old) with idiopathic recurrent musculoskeletal pain completed the study. The intervention comprised acceptance and commitment therapy-oriented multidisciplinary treatment. Pediatric Pain Screening Tool, pain frequency, functional disability, school attendance, physical endurance, depressive symptoms, and catastrophizing coping style were measured before treatment (baseline) and again at 6 and 12 months after the initiation of treatment. To test the effectiveness of the new program, we also determined whether the original risk classification of each patient remained constant during the intervention. Results The intervention was effective for high-risk patients. In particular, the pain frequency decreased, and psychosocial measures improved. In post-intervention, the original risk classification of seven patients in the high-risk category changed to medium-risk. PPST classification acted as a moderator of the outcome of the current program. Conclusions The categorization highlighted the need to modify the program content for the medium-risk patients. The categorization is a good tool to screen adolescent patients with pain. Implications The results support using the Pediatric Pain Screening Tool in developing rehabilitation program for pediatric musculoskeletal pain patients. According to the result, for adolescent prolonged musculoskeletal pain patients the use of ACT-based intervention program is warranted.

Developing a screening tool for offenders with intellectual disabilities – the RAPID

2016 ◽  
Vol 7 (3) ◽  
pp. 161-170 ◽  
Author(s):  
Salma Ali ◽  
Scott Galloway
Keyword(s):  
Intellectual Disability ◽  
Screening Tool ◽  
Screening Tools ◽  
Rapid Screening ◽  
Extensive Literature ◽  
Statistical Validation ◽  
Initial Development ◽  
Effective Measure ◽  
Content Type ◽  
Screening Measures

Purpose The purpose of this paper is to outline and report on the initial development of a screening tool for offenders with suspected intellectual disability (ID) known as the rapid assessment of potential intellectual disability (RAPID). Design/methodology/approach This paper summarises the wider literature in relation to screening tools and methodology, indicating that quick and easy screening measures for this population are sparse. It outlines the processes involved in the early stages of developing an evidence-based screening tool for ID offenders, and an overall pathway approach to the identification, assessment and diagnosis of ID. Findings It is possible to develop a tool that can be used to identify potential ID with relative ease. The RAPID screening tool provided practitioners with a simple and easy measure to identify such individuals so that they may be referred for further specialist assessment. It has also demonstrated that it is an effective measure in identifying offenders with a possible ID. Research limitations/implications Formal statistical validation of this tool will serve to establish and measure its overall effectiveness and utility, further encouraging the timely identification of ID offenders. Originality/value This paper responds to current extensive literature about the variability of screening measures, and provides an effective solution to the identification of vulnerable offenders. Those who may benefit from an assessment of ID, and thereafter reasonable adjustments and alternatives to custodial sentencing are considered.

scholarly journals Translation and validation of an extended German version of ID Migraine™ as a migraine screening tool

2020 ◽  
Vol 3 ◽  
pp. 251581632096277
Author(s):  
Anne Thiele ◽  
Sebastian Strauß ◽  
Anselm Angermaier ◽  
Martin Kronenbuerger ◽  
Robert Fleischmann
Keyword(s):  
Diagnostic Accuracy ◽  
Outpatient Clinic ◽  
Screening Tool ◽  
Diagnostic Yield ◽  
Care Center ◽  
Tertiary Care ◽  
Screening Tools ◽  
German Version ◽  
Predictive Values ◽  
Id Migraine

Background and purpose: Diagnosing a patient with headache as a migraineur is critical for state-of-the-art migraine management. Screening tools are imperative means to improve the diagnostic yield in the primary care settings and specialized clinics. This study aims to translate and assess the diagnostic accuracy of a German version of the ID Migraine™ as a widely used and efficient screening instrument. Methods: The Functional Assessment of Chronic Illness Therapy translation methodology was used to translate the original three-item ID Migraine™, including a fourth question for aura, from the English language into the German language. Diagnostic accuracy of the German ID Migraine™ and predictors of false screening results were assessed among patients presenting to a headache outpatient clinic of a tertiary care center in Germany over a 6-month period. Results: The translation procedure yielded a harmonized German ID Migraine™ and its diagnostic accuracy was assessed in 105 patients (80 female, 46.5 ± 17.2 years of age), including 79 patients (75.2%) with migraine. The three-item German ID Migraine™ provides a sensitivity of 99%, specificity of 68%, and positive and negative predictive values of 90% and 95%, respectively, using a cutoff of ≥2. Positive and negative predictive values in a general headache population are estimated to be 74% and 98%, respectively. The aura question identified 18 out of 20 migraineurs with aura. Conclusions: The German ID Migraine™ is an accurate screening tool for migraine even in a challenging population of a specialized outpatient clinic. Its diagnostic accuracy indicates a potential utility for screening in primary health care.

scholarly journals Healthcare Provider Perspectives on Bipolar I Disorder Screening and the Rapid Mood Screener (RMS), a Pragmatic, New Tool

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 181-183
Author(s):  
Michael E. Thase ◽  
Stephen M. Stahl ◽  
Roger S. McIntyre ◽  
Tina Matthews-Hayes ◽  
Mehul Patel ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Screening Tool ◽  
Positive Impact ◽  
Screening Tools ◽  
Predictive Values ◽  
Bipolar I Disorder ◽  
Provider Perspectives ◽  
Patient Reported

AbstractIntroductionAlthough mania is the hallmark symptom of bipolar I disorder (BD-I), most patients initially present for treatment with depressive symptoms. Misdiagnosis of BD-I as major depressive disorder (MDD) is common, potentially resulting in poor outcomes and inappropriate antidepressant monotherapy treatment. Screening patients with depressive symptoms is a practical strategy to help healthcare providers (HCPs) identify when additional assessment for BD-I is warranted. The new 6-item Rapid Mood Screener (RMS) is a pragmatic patient-reported BD-I screening tool that relies on easily understood terminology to screen for manic symptoms and other BD-I features in <2 minutes. The RMS was validated in an observational study in patients with clinically confirmed BD-I (n=67) or MDD (n=72). When 4 or more items were endorsed (“yes”), the sensitivity of the RMS for identifying patients with BP-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. To more thoroughly understand screening tool use among HCPs, a 10-minute survey was conducted.MethodsA nationwide sample of HCPs (N=200) was selected using multiple HCP panels; HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the widely recognized Mood Disorder Questionnaire (MDQ). Results were reported by grouped specialties (primary care physicians, general nurse practitioners [NPs]/physician assistants [PAs], psychiatrists, and psychiatric NPs/PAs). Included HCPs were in practice <30 years, spent at least 75% of their time in clinical practice, saw at least 10 patients with depression per month, and diagnosed MDD or BD in at least 1 patient per month. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence interval.ResultsAmong HCPs, 82% used a tool to screen for MDD, while 32% used a tool for BD. Screening tool attributes considered to be of the greatest value included sensitivity (68%), easy to answer questions (66%), specificity (65%), confidence in results (64%), and practicality (62%). Of HCPs familiar with screening tools, 70% thought the RMS was at least somewhat better than other screening tools. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. Most HCPs (81%) preferred the RMS to the MDQ, and the RMS significantly outperformed the MDQ across valued attributes; 76% reported that they were likely to use the RMS to screen new patients with depressive symptoms. A total of 84% said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.DiscussionThe RMS was viewed positively by HCPs who participated in a brief survey. A large percentage of respondents preferred the RMS over the MDQ and indicated that they would use it in their practice. Collectively, responses indicated that the RMS is likely to have a positive impact on screening behavior.FundingAbbVie Inc.

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