scholarly journals Clinical inertia in rheumatology practice

2021 ◽  
Vol 51 (4) ◽  
pp. 402-406
Author(s):  
Arkiath Veettil Raveendran ◽  
Vinod Ravindran
Keyword(s):  
Clinical Inertia ◽  
Rheumatology Practice

‘Clinical Inertia’ Hampers Diabetes Management

2006 ◽  
Vol 39 (13) ◽  
pp. 12
Author(s):  
MIRIAM E. TUCKER
Keyword(s):  
Diabetes Management ◽  
Clinical Inertia

Clinical Inertia and Outpatient Medical Errors

2005 ◽  
Author(s):  
Patrick J. O'Connor ◽  
◽  
JoAnn M. Sperl-Hillen ◽  
Paul E. Johnson ◽  
William A. Rush ◽  
...  
Keyword(s):  
Medical Errors ◽  
Clinical Inertia

1496-P: Clinical Inertia in Relation to Sociodemographic Factors among Patients with Type 2 Diabetes (T2D) in the United States

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1496-P
Author(s):  
GAIL FERNANDES ◽  
BAANIE SAWHNEY ◽  
HAKIMA HANNACHI ◽  
TONGTONG WANG ◽  
ANN MARIE MCNEILL ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
The United States ◽  
Sociodemographic Factors ◽  
Clinical Inertia

1194-P: Unbinding Constraints on Clinical Inertia and Improving Practices: A Novel Comprehensive Primary Care Approach that Grew a Single Practice of 2,000 Patients to 40,000 Patients in Less than 4 Years

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1194-P
Author(s):  
RICHARD B. AGUILAR ◽  
MERLIN OSORIO ◽  
JOHN MCGOOHAN ◽  
MARLOW HERNANDEZ ◽  
MARY HERMAN ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Inertia ◽  
Care Approach

scholarly journals AB0460 THE UTILITY OF USB CAPILLAROSCOPE FOR ASSESSMENT OF RAYNAUD’S PHENOMENON PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1256.3-1257
Author(s):  
S. Lambova
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Raynaud’S Phenomenon ◽  
Phase 1 ◽  
Late Phase ◽  
Capillary Density ◽  
Raynaud's Phenomenon ◽  
Normal Pattern ◽  
Important Conclusion ◽  
Rheumatology Practice

Background:Videocapillaroscopy is the gold standard for evaluation of nailfold capillaries and the major tool used for differentiation of primary and secondary Raynaud’s phenomenon (RP) in rheumatology practice. However, nowadays, there are also accessible alternatives such as USB capillaroscopes, which offer the opportunity to apply capillaroscopic examination at a significantly lower price.Objectives:The aim of the current study was to study the utility of USB capillaroscope (Dinolite) via assessment of capillaroscopic images obtained by patients with primary and secondary RP in rheumatic diseases.Methods:The study represents analysis of capillaroscopic images of 32 patients with RP – primary and secondary in the context of SSc or other rheumatic diseases i.e., undifferentiated connective tissue disease (UCTD) and systemic lupus erythematosus (SLE). All the patients had signed an informed consent for participation in a study of their capillaroscopic, laboratory and clinical associations. The study represents retrospective analysis of the capillaroscopic images obtained from 8 fingers (II-V bilaterally) using USB capillaroscope (Dinolite) at magnification 200x. Capillary diameters were measured (arterial, venous and apical loop) as well as the number of capillaries per millimeter. The capillaroscopic images were categorized into the following groups i.e., I. Absence of microangiopathy: i) normal pattern, ii) nonspecific changes (dilated capillaries with arterial diameter > 0.015mm, venous > 0.020mm; haemorhhages and/or other nonspecific changes), II. Presence of microangiopathy i.e., “scleroderma”/”scleroderma-like” pattern. Presence of giant capillaries with capillary diameter >0.050mm was considered as a sufficient criterion for classifying the image as “scleroderma”/”scleroderma-like” pattern. For “scleroderma” type images in SSc patients staging of Cutolo et al (2000) was used i.e., “early”, ”active”, ”late” phase (1).Results:Images suitable for analysis with good visibility that permits analysis of the major capillaroscopic parameters were available in all patients. Among 32 included patients, 9 patients were with SSc, 12 cases with primary RP, and 10 patients with secondary RP in other CTD (7 patients with UCTD and 3 patients with SLE). „Scleroderma“ pattern was detected in 6 patients with SSc and in all these cases the capillaroscopic images were classifiable into one of the three distinct phases i.e., “early”, ”active” and ”late” phase. Presence of microvascular changes (“scleroderma-like” pattern) was detected also in 5 among the 10 patients with other CTD i.e., UCTD and SLE. In primary RP patients capillaroscopy revealed either normal pattern or nonspecific findings but without features of microangiopathy.Conclusion:Good capillaroscopic images, which could be analyzed and interpreted, are usually obtained using USB capillaroscope. This permits evaluation of the major capillaroscopic parameters. The available software although less sophisticated vs those of videocapillaroscopes, gives the opportunity for measurement of capillary diameters, mean capillary density, etc. The images received from USB capillaroscope are easily classified into “scleroderma”, “scleroderma-like”, non-specific changes and normal pattern. The most important conclusion from capillaroscopy is about presence or absence of microangiopathy. This was easily detected via USB capillaroscope that could be suggested as an ideal alternative for videocapillaroscopes in every day rheumatology practice especially at low budget cases. Measurements of capillary diameters and capillary density provide quantitative data that make these devises also appropriate for scientific research.References:[1]Cutolo M, Sulli A, Pizzorni C AS. Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol. 2000;27(1):155–60.Disclosure of Interests:None declared.

scholarly journals FRI0445 HLA-B27 IN POSTSTREPTOCOCCAL REACTIVE ARTHRITIS WITH ENTHESITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 820.1-820
Author(s):  
I. Naishtetik ◽  
L. Khimion ◽  
O. Yashchenko ◽  
P. Dolinskiy
Keyword(s):  
Rheumatic Fever ◽  
Reactive Arthritis ◽  
Streptococcal Infection ◽  
Joint Involvement ◽  
Hla B27 ◽  
Aseptic Inflammation ◽  
Beta Hemolytic Streptococcus ◽  
Common Diagnosis ◽  
Poststreptococcal Reactive Arthritis ◽  
Rheumatology Practice

Background:Poststreptococcal reactive arthritis (PSRA) is a very common diagnosis in rheumatology practice, which develops after recent pharyngeal streptococcal infection and characterized by aseptic inflammation in one or more joints and periarticular involvement. Now no diagnostic criteria have been agreed [2,4]; association of the expression of HLA-B27 and PSRA is not clear [1,3].Objectives:In our study we analyzed the features of PSRA in presence of HLA-B27.Methods:88 patients (48 female and 40 male) aged between 18-55 years with complains of pain, tender and swollen joints developed after recent pharyngeal streptococcal infection underwent standard physical and laboratory rheumatological examinations. Acute rheumatic fever and other inflammatory arthritis were excluded.Results:60 patients (68,2%) had oligo-polyarthralgia, 10 patients (11,4%) - monoarthritis, 24 patients (27,3%) had asymmetrical olygoarthritis, 4 patients (4,5%) had polyarthritis, enthesitis was found in 4 (4,5%) patients, tenosynovitis of the palmar flexor tendons in 10 cases (11,4%) and the peroneal tendons of the ankles in 5 patients (5,7%), one-sided sacroiliitis (confirmed by MRI) in 5 patients (5,7%).The mean level of ASL-O was 542 U/ml, CRP -15 mg/L, ESR - 34 mm/H; HLA-B27 was present in 24 (30,7%) patients. HLA-B27 positivity was connected to enthesitis, sacroiliitis, more joint involvement with higher levels of ESR and CRP.Conclusion:30% of patients with poststreptococcal reactive arthritis are HLA-B27 positive, the presence of HLA-B27 leads to more frequent development of enthesitis, polyarthritis and sacroiliitis with higher level of inflammatory activity which dictate the need for longer supervision of such patients for possible triggering of ankylosing spondylitis development.References:[1]Ahmed S, Ayoub EM, ScorniK JC, Wang C-Y, She J-X. Poststreptococcal reactive arthritis. Clinical characteristics and association with YLA-DR alleles. Arthritis Rheum 1998; 41:1096-102.9[[2]Gibofsky A, Khanna A, Suh E, et al. The genetics of rheumatic fever: Relationship to streptococcal infection and autoimmune disease. J Rheumatol Suppl. 1991;30:1–5. [PubMed] [Google Scholar][3]Leitch DN, Holland CD/ Reactive arthritis, beta-hemolytic Streptococcus and Staphylococcus aureus. Br J Rheumatol 1996;35:912.[4]Mackie SL, Keat A. Poststreptococcal reactive arthritis: what is it and how do we know? Rheumatology (Oxford) 2004;43:949–54. 10.1093/rheumatology/keh225 [PubMed].Disclosure of Interests:None declared

scholarly journals Benefit of Digital Tools Used for Integrated Personalized Diabetes Management: Results From the PDM-ProValue Study Program

2019 ◽  
Vol 14 (2) ◽  
pp. 240-249
Author(s):  
Lutz Heinemann ◽  
Wendelin Schramm ◽  
Helena Koenig ◽  
Annette Moritz ◽  
Iris Vesper ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Diabetes Management ◽  
Intervention Group ◽  
Digital Tools ◽  
Clinical Inertia ◽  
Control Group ◽  
Traffic Light ◽  
Study Program ◽  
Therapeutic Concept ◽  
Cluster Randomized

Background: Integrated personalized diabetes management (iPDM) is a digitally supported therapeutic concept to improve patient-physician interaction to overcome the aspects of clinical inertia. Integrated personalized diabetes management can support decision making and improve therapeutic outcomes of suboptimally controlled persons with insulin-treated type 2 diabetes (T2D). In this paper, we report the results of an analysis of the PDM-ProValue study program on the effectiveness and perceived benefit of this approach, with a focus on how physicians used and assessed the digital tools provided for the iPDM process. Materials and Methods: The study program included two 12-month, prospective, controlled, cluster-randomized multicenter trials. A total of 101 practices participated with 907 patients. Practices were cluster-randomized to an intervention group and a control group. Digital tools for data visualization and analysis applied were used. HCP were asked to assess the use, relevance, and usefulness of the tools. Results: A clear preference was stated for the visual overview over more statistically complex analyses. A total of 83% of the participants rated a high relevance of the “daily profile,” 81% of the “total profile,” and 68% the “risk illustrated by traffic light symbols” for the therapy decision. The overall iPDM process was very favorably rated with respect to structuredness and potential for personalized treatment and well accepted among health care professionals (HCP). Conclusions: Embedding digital tools in a structured process (iPDM) were proved to provide a benefit for insulin-treated T2D patients and their physicians. These results offer insight for further development and improvement of the tools and add information on how to overcome clinical inertia.

scholarly journals SAT0539 MUCKLE-WELLS SYNDROME IN RHEUMATOLOGY PRACTICE, FAMILY CASES: FEDERAL CENTER EXPERIENCE.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1227.1-1227
Author(s):  
S. Salugina ◽  
E. Fedorov ◽  
K. Elena ◽  
E. Zakharova ◽  
S. Palshina
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Autoinflammatory Disease ◽  
Family Members ◽  
Sensorineural Hearing ◽  
Nlrp3 Gene ◽  
Oral Ulcers ◽  
Family Medical History ◽  
Wells Syndrome ◽  
Rheumatology Practice

Background:Muckle-Wells syndrome (MWS) is a monogenic autoinflammatory disease caused by a NLRP3 gene mutation. It is the most common variant of cryopyrin-associated periodic syndromes (CAPSs) and can be observed in rheumatology practice. It manifests itself in fever, urticaria-like rash, arthralgias/arthritides, conjunctivitis/uveitis, sensorineural hearing loss, acute-phase markers (ESR, CRP). The disease’s onset usually takes place in infancy. There are examples of family cases. Targeted therapy: interleukin-1 inhibitors (anakinra, canakinumab).Objectives:to provide characteristics of MWS patients, family cases in the rheumatology practice of the Federal Rheumatology Center in Russia.Methods:in a 10-year period (2009 to 2019), MWS was diagnosed in 42 outpatient and inpatient patients, among them were 24 children, 18 adults, and 9 family cases. All of them underwent a standard rheumatology examination, including a ECR, CRP, ophthalmologist examination, and an audiogram. A molecular genetic test of the NLRP3 gene was carried out for all patients, the diagnosis was confirmed in all of them.Results:Out of 18 adult patients aged between 19 and 59 years, women were prevalent (16 to 2), the onset age was 0 to 53 years, in 88,9% cases the onset took place before a patient was 18 years old. When diagnosed, the disease duration varied from 6 to 46 years. Most patients demonstrated fever, urticarial-like rash, arthralgias/arthritides, which were observed in 16 patients (88.9%), conjunctivitides were observed in 15 patients (83,3%), sensorineural hearing loss – in 8 patients (44,4%), abdominal pain, nausea, vomiting – in 4 patients, headache, dizziness – in 6 patients. There also were rare manifestations, such as: recurrent oral ulcers (8), genital ulcers (3), erythema nodosum (3), sore throat and raids on the tonsils (PFAPA-like phenotype) was observed in 2 patients. In 3 patients manifestations were triggered by cold temperature. All patients had an increased ESR and C-reactive protein concentration. Eight family cases of MWS were identified (in total 26 family members aged between 2.5 and 62 years) with a number of affected in one family ranging from 2 to 6 people of different age (8 children, 18 adults, out of which 20 were female, and 6 were male). Most patients had fever (17), urticarial-like rash (18), conjunctivitides (12), oral ulcers (7), articular syndrome (14), sensorineural hearing loss (5), and 2 patients died of renal insufficiency (probably due to amyloidosis of the kidneys). The heterozygous mutations in NLRP3 have been identified in pts: T348M (3 families), R262W (2 families), A439V (1), V198M (1), Pro294Ser (1). Ten patients received canakinumab for a period of 6 months to 6.5 years, and 5 patients received anakinra before canakinumab.Conclusion:MWS is an orphan autoinflammatory disease, however it sometimes can be observed in rheumatology practice. It is very important to acquire family medical history to identify affected family members and prescribe therapy in a timely manner. IL-1 inhibitors are an effective and safe treatment option for MWS patients.Disclosure of Interests:None declared

scholarly journals Addressing Clinical Inertia in Type 2 Diabetes Mellitus: A Review

2018 ◽  
Vol 35 (11) ◽  
pp. 1735-1745 ◽  
Author(s):  
Jennifer Okemah ◽  
John Peng ◽  
Manuel Quiñones
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Clinical Inertia
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