Next-generation rheumatoid arthritis specialized telemedicine enabled by IoT and AI

Impact ◽  
2021 ◽  
Vol 2021 (8) ◽  
pp. 61-63
Author(s):  
Fumiaki Nonaka ◽  
Shinya Kawashiri ◽  
Atsushi Kawakami
Keyword(s):  
Rheumatoid Arthritis ◽  
Mixed Reality ◽  
Developed Countries ◽  
Healthcare Systems ◽  
Accurate Diagnosis ◽  
University Hospital ◽  
Small Islands ◽  
Remote Consultation ◽  
Medical Consultations ◽  
Ageing Populations

Ageing populations in developed countries place strain on healthcare systems and when ageing populations live far away from the specialists they require to treat their chronic diseases, the logistics can be challenging to say the least. This is a particularly acute issue in Japan, which is made up of small islands. The COVID-19 pandemic has served to emphasise the need for better systems for remote medical consultations. Dr Fumiaki Nonaka at Goto Chuou Hospital and Professor Atsushi Kawakami and Dr Shinya Kawashiri at Nagasaki University Hospital have collaborated with Microsoft to create the first remote consultation systems for rheumatoid arthritis (RA) that uses mixed reality. Early detection is crucial to managing RA but it is often difficult to make an accurate diagnosis and treatment of the disease in remote islands. This issue became particularly pressing in the context of COVID-19. Working with Microsoft, the researchers sought to develop a method of viewing and rendering the joints in 3D. Microsoft adapted their Azure Kinect DK cameras into a rig covering three different angles of any joint and an array of seven microphones was also installed. Using a reality headset called HoloLens2, the images of the joint can be rendered a 3D hologram to the user, enabling doctors to freely observe the joint from any direction. Combining this with Microsoft's Teams, a face-t-face consultation is facilitated.

Study of Serum and Synovial Fluid Levels of Calprotectin of Rheumatoid Arthritis Patients in Correlation with Disease Activity and Severity

2020 ◽  
Vol 29 (3) ◽  
pp. 47-51
Author(s):  
Dalia A. Elsayed ◽  
Samy E. Egila ◽  
Yaser A. Abd El-Hammed ◽  
Rasha A. Elsayed ◽  
Noha Hosni Ibrahim
Keyword(s):  
Rheumatoid Arthritis ◽  
Synovial Fluid ◽  
Disease Activity ◽  
Adult Population ◽  
Serum Levels ◽  
Developed Countries ◽  
University Hospital ◽  
Control Group ◽  
Prognostic Accuracy ◽  
Fluid Levels

inflammatory autoimmune disease with a frequency of 0.5–1.0% between the adult population of developed countries. It is marked by chronic inflammation of synovial tissue and accompianed by damage of the articular cartilage and adjecent bone, leading to substantial disability. Objectives: The aim of this study is to determine serum and synovial fluid levels of calprotectin in rheumatoid arthritis patients and to determine its relation with disease activity and severity. Methodology: This study was carried out on 40 rheumatoid arthritis patients who were admitted to Rheumatology, Rehabilitation and Physical Medicine Outpatient’ clinic and Inpatient Department of Benha University Hospital .Also Thirty age and sex matched( 28 females and 2 males ) apparently healthy volunteers were included in the study as a control group . All patients were assessed by full medical history, clinical examination, functional assessment, laboratory investigations including CBC, ESR ,CRP, liver functions, RF, Anticcp antibody, and Xrays were done to both hands. Serum and synovial levels of calprotectien were measured using the ELISA technique. Results: Serum levels of calprotectien were significantly higher in RA patients than healthy subjects [p<0.001], also there was a highly statistically significant increase in the mean synovial fluid calprotectin levels than mean serum calprotectien levels [p<0.001]. Local and systemic levels of calprotectin correlate with clinical, immunological and instrumental assessments of disease activity and the inflammatory degree of the joint. Conclusion: Calprotectin could be used as a new biomarker for monitoring the disease activity and severity of RA. Larger sets are needed to confirm the diagnostic and prognostic accuracy of calprotectin in RA

scholarly journals Early Atherosclerosis in Rheumatoid Arthritis: A case Control Study

JMS SKIMS ◽  
2012 ◽  
Vol 15 (2) ◽  
pp. 106-110
Author(s):  
Sonaullah Shah ◽  
Nitin Gupta ◽  
Feroze Shaheen ◽  
Fayaz Ahmad Sofi ◽  
Umar Hafeez ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Disease Activity ◽  
Tertiary Care ◽  
Developed Countries ◽  
University Hospital ◽  
Age Group ◽  
Serum Triglycerides ◽  
Accelerated Atherosclerosis ◽  
Intergroup Comparison

BACKGROUND: Atherosclerosis remains the major cause of death and premature disability in developed countries. OBJECTIVES: To assess the prevalence of early (accelerated) atherosclerosis in Rheumatoid Arthritis (RA) patients in the absence of traditional risk factors and influence of various other parameters on it. METHODS: The study was carried at a tertiary care university hospital in northern India (Kashmir) in year 2008-2009. Thirty nine patients in the age group of 25- 55 years with RA fulfilling the American College of Rheumatology (ACR) Modified criteria 1987 and a purposive sample of twenty healthy volunteers that served as controls were enrolled to judge any difference in the studied parameters. Subjects with other risk factors for atherosclerosis were excluded from the study. Disease Activity Score (DAS-28) was used to measure the disease activity. B-mode ultrasonography was used to measure carotid artery intima media thickness (CIMT) in both the groups. RESULTS: RA patients presented with elevated CIMT in the age group of 41-50 years (p = 0.665) whereas volunteers had such tendency in the 5th decade of life (p = 0.550). Duration of disease greater than 5 years also positively influenced the development of increased CIMT in the patient group (p 0.64).Patients in the RA group had a higher erythrocyte sedimentation rate (ESR) and mean CIMT as compared to the controls(p = 0.000). RA patients had lower hemoglobin concentration when compared to age and sex matched controls. Intergroup comparison in patients with normal and increased CIMT showed that increased BMI, elevated triglyceride (TG) concentration and raised ESR influenced the development of CIMT which on binary logistic regression showed that TG (p = 0.043) and BMI (p = 0.053) had influence in progression of CIMT. CONCLUSION: Rheumatoid Arthritis patients have definite evidence of early (accelerated) atherosclerosis due to inflammation even in this ethnic population. BMI and serum triglycerides even in normal range have noteworthy influence in acceleration of atherosclerosis in them. B-mode ultrasonography is simple, non-invasive, and one of the sensitive methods to detect earlier atherosclerotic changes in them. JMS 2012;15(2):106-110

scholarly journals POS1487-HPR NEXT-GENERATION ONLINE TELEMEDICINE SYSTEM UTILIZING MIXED REALITY FOR RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1028.1-1028
Author(s):  
S. Y. Kawashiri ◽  
F. Nonaka ◽  
S. Chiba ◽  
T. Honda ◽  
T. Nakajima ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mixed Reality ◽  
Three Dimensions ◽  
University Hospital ◽  
Next Generation ◽  
Research Support ◽  
Web Conferencing ◽  
Long Distance ◽  
Telemedicine System ◽  
Conferencing System

Background:Telemedicine can be performed using a conventional videophone or web conferencing system. Then, joint lesions can only be observed and inferred from two-dimensional images, and it is difficult to perform accurate joint assessments, which is essential for the management of rheumatoid arthritis (RA).Objectives:To develop the next-generation online telemedicine system utilizing mixed reality for RA.Methods:We have developed a system that can assess joints accurately in three-dimensions images in real-time, using Azure Kinect DK (depth sensor)/ HoloLens 2 (headset), which are mixed reality technologies, and Teams (online interview/chat) provided by Microsoft. Furthermore, by applying artificial intelligence (AI), we plan to implement additionally to this system 1) a function to quickly catch and automatically evaluate the patient’s anxiety and changes in facial expressions at the time of examination, 2) a function to record dialogue with the patient in chronological order, 3) a function to support the detection of swollen joints, and 4) function to automatically analyze the questionnaire.Results:This system remotely connects a rheumatologist in the Nagasaki University Hospital (Nagasaki City, urban area) and a patient with RA and a non- rheumatologist in the Goto Central Hospital (Goto Island, rural area). A three-dimensional hologram of the patient’s hand projected in front of a rheumatologist. Using this system, we are able to evaluate joints more accurately than using a conventional videophone or web conferencing system.Conclusion:It is expected that this system will enable remote medical care specializing in rheumatology, which is standardized at a high level even in areas without rheumatologists such as remote islands and remote areas. This system remotely connects Nagasaki City and Goto Island, but due to the performance of the system, it is not limited to these areas and it is possible to connect rheumatologists to any area that can be connected to the network. It is also effective for the purpose of avoiding the risk of infection during long-distance hospital visits under the epidemic of COVID-19 infection.References:[1]Mov Disord. 2020;35:1719-1720.Disclosure of Interests:Shin-ya Kawashiri Speakers bureau: Speaker fees from AbbVie, Asahi Kasei, Astellas, Chugai, Eisai, Eli Lilly, Mitsubishi Tanabe, Novartis, and ONO., Grant/research support from: Research grants from Pfizer., Fumiaki Nonaka: None declared, Shinji Chiba: None declared, Tomoyuki Honda: None declared, Tomohiko Nakajima: None declared, Tomoyuki Ishikawa: None declared, Atsushi Kawakami Speakers bureau: Speaker fees from AbbVie, Actelion, Asahi Kasei, Astellas, Boehringer Ingelheim, Celltrion, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, GSK, Janssen, Kowa, MedPeer, Mitsubishi Tanabe, Novartis, ONO, Pfizer, Taisho, and Takeda., Grant/research support from: Grants and research support from AbbVie, Actelion, Asahi Kasei, Astellas, AYUMI, Boehringer Ingelheim, Bristol-Myers Squibb, Celltrion, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, Kyowa Hakko Kirin, MSD, Neopharma, Novartis, ONO, Sanofi, Taisho, Takeda Science Foundation, and Teijin

scholarly journals Developing a Trauma Registry for the Emergency Department of a Tertiary Care Hospital in Egypt: A Step Toward Success

2020 ◽  
Author(s):  
Ahmed A. Khalil ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Mohamed El-Shinawi
Keyword(s):  
Emergency Department ◽  
Trauma Registry ◽  
Road Traffic ◽  
Tertiary Care ◽  
Eastern Mediterranean Region ◽  
Developed Countries ◽  
Healthcare Systems ◽  
University Hospital ◽  
World Health ◽  
Care Hospital

Abstract Background: Trauma continues to be a common problem affecting global healthcare systems. Accordingly, different types of trauma have been considered major causes of morbidity and mortality with approximately 5 million deaths per year. Road traffic injuries, in particular, have been recognized by the World Health Organization as the sixth leading cause of death in the eastern Mediterranean region. Developed countries have realized the importance of implementing registries across all healthcare systems in order to improve service quality. Unfortunately, Egypt has yet to establish a national trauma registry in its hospitals. Although data banks have been available in a few hospitals, they have been inconsistent. Purpose: The present study aimed at developing a trauma registry for a major tertiary hospital in Cairo. Methods: To this end, data from 202 patients admitted to the emergency department of Ain Shams University Hospital due to trauma were collected. Procedures and actions used were then described to create a trauma registry from January to December 2017. Results: The collected data were statistically analyzed, after which the epidemiological distribution of the trauma patients was described. Accordingly, our results showed that among the included patients, 65% were men, while most were single, illiterate, and unemployed. Thereafter, statistics regarding trauma circumstances were generated. In conclusion, the present study found that hospital trauma registries can be established, are essential for improving the quality of healthcare services, and should be utilized ubiquitously throughout the country’s hospitals in order to establish a national registry.

‘I’m an expert in me and I know what I can cope with’: Patient expertise in rheumatoid arthritis

2014 ◽  
Vol 10 (3) ◽  
pp. 249-261 ◽  
Author(s):  
Tessa Sanderson ◽  
Jo Angouri
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Healthcare Systems ◽  
Specific Knowledge ◽  
Active Involvement ◽  
Domain Specific ◽  
Access To Health ◽  
Patient Expertise ◽  
Domain Specific Knowledge ◽  
The Uk

The active involvement of patients in decision-making and the focus on patient expertise in managing chronic illness constitutes a priority in many healthcare systems including the NHS in the UK. With easier access to health information, patients are almost expected to be (or present self) as an ‘expert patient’ (Ziebland 2004). This paper draws on the meta-analysis of interview data collected for identifying treatment outcomes important to patients with rheumatoid arthritis (RA). Taking a discourse approach to identity, the discussion focuses on the resources used in the negotiation and co-construction of expert identities, including domain-specific knowledge, access to institutional resources, and ability to self-manage. The analysis shows that expertise is both projected (institutionally sanctioned) and claimed by the patient (self-defined). We close the paper by highlighting the limitations of our pilot study and suggest avenues for further research.

scholarly journals SAT0651-HPR BARRIERS IN DIAGNOSING RHEUMATOID ARTHRITIS – A FOCUS GROUP STUDY ON THE GENERAL PRACTITIONERS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1284.1-1285
Author(s):  
A. S. Lundberg ◽  
B. A. Esbensen ◽  
E. M. Hauge ◽  
A. De Thurah
Keyword(s):  
Rheumatoid Arthritis ◽  
General Practice ◽  
Focus Group ◽  
General Practitioners ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
University Hospital ◽  
Text Book ◽  
Clear Cut ◽  
Initial Symptoms

Background:Early treatment, before three months from symptom onset of rheumatoid arthritis (RA), is essential to increase the likelihood of remission and to prevent permanent joint damage (1). However, it has been shown that only 20% of the patients are seen within the first three months, and the median delay in general practice has been estimated to 4 months (range 2–9) (2).Objectives:To explore the barriers in diagnosing RA from the general practitioners’ (GPs) perspective.Methods:We conducted a qualitative study based on focus group interviews. We recorded the interviews digitally and transcribed verbatim. The transcribed interviews were analyzed based on content analysis (3), by using Nivo 12. Sample size was determined by thematic saturation.Results:In total ten GPs participated in three different focus groups. 40 % were female, mean age was 53 years (range 37-64), and mean year since specialist authorization as GP was 16 years (range 5-23). 60 % of the GPs worked in a practice located within the referral area of a university hospital; the remaining within the referral area of a regional hospital.Four themes emerged in the analysis: 1) When the patient is not a text book example, referring to the difficulty of identifying relevant symptoms among all clinical manifestations from the joints as described by the patients, 2)The importance of maintaining the gatekeeper function, referring to the societal perspective, and the GPs responsibility to refer the right patients to secondary care, 3)Difficulties in referral of patients to the rheumatologist,referring to perceived differences in the collaboration with rheumatologists. The GPs experienced that it was sometimes difficult to be assisted by rheumatologists, especially when the clinical picture was not ‘clear cut’. Finally, (4)Para-clinical testing, can it be trusted?referring to challenges on the evaluation of especially biomarkers.The overarching theme was:Like finding a needle in a haystack, covering the GPs difficulties in detecting RA among the many patients in general practice who appear to be well and at the same time have symptoms very similar to RA.Conclusion:The GPs experienced that RA was a difficult diagnosis to make. The immediate challenge was that RA patient’s initial symptoms often resembled those of more common and less serious conditions, and that investigative findings such as biomarkers can be negative at the early state of the disease. At the same time, the collaboration with rheumatologists was sometimes seen as a hurdle, when the clinical picture was not ‘clear cut’.In order to facilitate earlier diagnosis of RA in general practice, the GPs and rheumatologists need to focus on these barriers by strengthening mutual information and collaboration.Physicians should remain vigilant to patients who have conditions that do not resolve as expected with treatment, who have symptoms that persist, or who do not look well despite negative investigative findings.References:[1]Aletaha D, et al. JAMA, Oct 2018.[2]Kiely P, et al. Rheumatology, Jan 2009.[3]Braun V. Qualitative research in psychology. 2006, 3(2), 77-101Disclosure of Interests:Anne Sofie Lundberg: None declared, Bente Appel Esbensen: None declared, Ellen-Margrethe Hauge Speakers bureau: Fees for speaking/consulting: MSD, AbbVie, UCB and Sobi; research funding to Aarhus University Hospital: Roche and Novartis (not related to the submitted work)., Annette de Thurah Grant/research support from: Novartis (not relevant for the present study)., Speakers bureau: Lily (not relevant for the present study).

scholarly journals AB0186 AT WHAT LEVEL SHOULD WE MEASURE INTIMA-MEDIA THICKNESS IN RHEUMATOID ARTHRITIS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1117.3-1118
Author(s):  
L. Nacef ◽  
H. Ferjani ◽  
H. Riahi ◽  
K. Maatallah ◽  
Y. Mabrouk ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Internal Carotid ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
University Hospital ◽  
External Carotid ◽  
Media Thickness ◽  
The Mean ◽  
The Right ◽  
Score Index

Background:Rheumatoid arthritis (RA) is chronic inflammatory rheumatism characterized by an independent cardiovascular (CV) risk. The screening of carotid intima-media thickness (IMT) in the common carotid artery appears to be a marker of atherosclerosis and is used as a specific tool for CV risk assessment.Objectives:The main of this study was to determine the most associated US sites with CV risk in RA.Methods:The present study is a prospective study conducted on Tunisian RA patients in rheumatology department of Mohamed Kassab University Hospital (March and December 2020). The characteristics of the patients and those of the disease were collected. The measurement of cIMTwas done using high-resolution B-mode carotid US with a Philips machine with the patient in supine position, according to AmericanSociety of Echocardiography guidelines.The carotid bulb below itsbifurcation and the internal and external carotid arteries were evaluated bilaterally with gray scale, spectral and color Doppler ultra-sonography using proprietary software for carotid arterymeasurements.IMT was measured using the two inner layers of the commoncarotid artery and an increased IMT was defined as ≥0.9 mm. The CV risk at 10 years was calculated by the SCORE index.Results:Forty-seven patients were collected, of which 78.7% were women. The mean age was 52.5 ±11.06 years. The rheumatoid factor (RF) was positive in 57.8% of cases, and anti-citrullinated peptide antibodies (ACPA) were positive in 62.2% of cases. RA was erosive in 81.6% of cases. Hypertension (hypertension) was present in 14.9% of patients and diabetes in 12.8% of patients. Nine patients were active smokers. The mean IMT in the left common carotid (LCC) was 0.069 ±0.015, in the left internal carotid (LIC) was 0.069 ±0.015, in the left external carotid (LEC) was 0.060 ±0.023. The mean IMT was 0.068 ±0.01 in the right common carotid (RCC), 0.062 ±0.02 in the right internal carotid (RIC), and 0.060 ±0.016 in the right external carotid (REC). The mean SCORE index of CV risk was 2±2.81 [0-11.6]. CV risk was significantly associated with the IMTs for LIC (p=0.029; r=0.374), LEC (p=0.04; r=0.480), and REC (p=0.016; r=0.408). No association was found between the IMT in the LCC (p=0,361; r=0,162), neither in the RCC (p=0,438; r=0,140) nor the RIC (p=0,670; r=0,077).Conclusion:In our study, IMT is strongly associated with score index, especially in carotid bifurcation. However, IMT measured in common carotid does not reflect a cardiovascular risk at 10-years.References:[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and Experimental Rheumatology 2018; 36: Clinical E.xperimental.[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis. SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2017.[3]Martin I. Wah-Suarez and al, Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study. Int J Rheum Dis. 2018;1–7.Disclosure of Interests:None declared

scholarly journals Use of complementary and alternative therapies by patients with eye diseases: a hospital-based cross-sectional study from Palestine

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dania Jaber ◽  
Rafat Abu Ghannam ◽  
Waleed Rashed ◽  
Mohammad Shehadeh ◽  
Sa’ed H. Zyoud
Keyword(s):  
Patient Characteristics ◽  
Developed Countries ◽  
Cross Sectional Study ◽  
Alternative Therapies ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Complementary And Alternative Therapies ◽  
Source Of Information ◽  
Complementary And Alternative

Abstract Background Generally, complementary and alternative therapies (CAT) are accepted methods of treatment by patients with various types of conditions. Their use is becoming especially prevalent among patients with eye problems even in developed countries. Thus, we aimed to determine the pattern of use of CAT in this patient population, to identify the patient characteristics associated with the use of CAT, and to assess the types of CAT used. Methods A descriptive, cross-sectional study was conducted in Palestine at An-Najah National University Hospital between the time periods of October 2019 to May 2020, using questionnaire-based face to face interviews. Data were collected through convenience sampling. Patients responded to the questionnaire, which was focused on information adapted from previous research in this area, covering socio-demographic and clinical characteristics, types of CAT, source of information, and side effects on CAT use. Results A total of 86 patients were interviewed for our study. Over two thirds, 67% reported using CAT for the specific purpose of improving their eye condition, and about one third (29.1%) received more than one therapy. The most common therapies reported were duea’ (i.e. supplication) (47.1%) and herbal therapies (24.1%). It was shown that patients with bilateral involvement of their eyes were almost twice more likely to describe using CAT than patients with unilateral eye pathology (p = 0.006). Also, patients who underwent surgery as their route of treatment were significantly less likely to use CAT (p = 0.043). Most of our study participants mentioned a non-physician source as their source of information regarding CAT with family members being the most frequently mentioned (30.2%) followed by the internet (25.6%) and friends (19.8%). Conclusions The prevalence of CAT use among patients with eye disease is somewhat high in our study population. Because CAT may trigger adverse reactions, influence the progression of the disease, and interfere with conventional treatment, the ophthalmologist should frequently be asked patients with such diagnostics regarding the use of these therapies. Further work is required to analyze the mechanisms of action and to establish realistic guidelines for the use of these modalities.

Family Background and Psychiatric Disorders

1973 ◽  
Vol 18 (3) ◽  
pp. 209-214 ◽  
Author(s):  
J. A. S. Marriott
Keyword(s):  
Cultural Differences ◽  
West Indies ◽  
Family Background ◽  
Developed Countries ◽  
University Hospital ◽  
Racial Groups ◽  
The West ◽  
Parental Absence ◽  
Psychiatric Units ◽  
The University

The admissions to the Psychiatric Unit of the University Hospital of the West Indies during a 15-month period from September 1966 to January 1968 have been reviewed with special reference to family background. Despite cultural differences the pattern of admissions was very similar to that of psychiatric units in more highly developed countries. The various racial groups in the island were represented and included a high proportion of white alcoholics. Parental absence in childhood was largely related to social class but there was a definite association between parental absence in childhood and psychologically precipitated depression.

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