Eliciting patients’ healthcare goals and concerns: Do questions influence responses?

There is increasing interest in asking patients questions before their visits to elicit goals and concerns, which is part of the move to support the concept of coproducing care. The phrasing and delivery of such questions differs across settings and is likely to influence responses. This report describes a study that (i) used a three-level model to categorize the goals and concerns elicited by two different pre-visit questions, and (ii) describes associations between responses elicited and the phrasing and delivery of the two questions. The questions were administered to patients with rheumatic disease, and patients with inflammatory bowel disease (IBD). Paper-based responses from 150 patients with rheumatic disease and 338 patients with IBD were analyzed (163 paper, 175 electronic). The goals and concerns elicited were primarily disease or symptom-specific. The specific goal and concern examples featured in one pre-visit question were more commonly reported in responses to that question, compared to the question without examples. Questions completed electronically before the visit were associated with longer responses than those completed on paper in the waiting room. In conclusion, how and when patients’ goals and concerns are elicited appears to have an impact on responses and warrants further investigation.

Pneumocystis pneumonia and rheumatic disease: diagnostic potential of circulating microbial cell-free DNA sequencing

Objectives This study aimed to explore the clinical utility of circulating microbial cell-free DNA (cfDNA) sequencing as a non-invasive approach for diagnosing Pneumocystis jirovecii pneumonia (PJP) in immunocompromised patients with rheumatic disease (RD). Methods The study included 72 RD patients with suspected lung infections admitted to Renji hospital. Eighteen individuals were diagnosed with PJP, and 54 patients without PJP were enrolled as control group. All patients had undergone pulmonary computed tomography scans, and blood and respiratory tract specimens had been subjected to metagenomic next-generation sequencing (mNGS) and conventional microbiological tests. The clinical and laboratory parameters were collected and efficacy of circulating microbial cfDNA of PJP was evaluated. Results Of the 18 patients with PJP, the average age was 53.0 years and the median time between RD diagnosis and PJP presentation was 126 days (IQR 84.0–176.3). Low circulating CD4+ cell counts and a lack of PJP prophylaxis were observed in the patients. Metagenomic NGS of circulating microbial cfDNA was performed in 69 patients including 15 cases with PJP and 54 controls. Twelve (80%) of 15 analysed blood samples contained Pneumocystis jirovecii (PJ) sequences in PJP group with PJ not detected among controls. There was a significant difference between PJP and non-PJP groups (p < 0.001) with a sensitivity of 83.3% and specificity of 100% when using plasma cfDNA sequencing. Higher β-D-glucan levels were found in patients with positive results for PJ in plasma cfDNA sequencing. Conclusion Metagenomic NGS of circulating microbial cfDNA is a potential tool for diagnosing PJP in RD patients.

Awareness and Knowledge of Oral Diseases Associated with Rheumatic Patients Among Dentists in Saudi Arabia

Rheumatic diseases are autoimmune and inflammatory conditions that make the immune system attack the body’s joints, muscles, bones, and organs. Oral health is proven to be associated with overall systemic health. Patients with rheumatic diseases present with multiple oral manifestations that might be the first clinical signs and symptoms of a systemic disease. The aim of this study was to assess the awareness and knowledge of dentists of the oral diseases associated with rheumatic patients in Saudi Arabia. A self-administered questionnaire was distributed aimed at the different specialties and degrees of dentistry. The total number of participants in this study was 235. The majority of participants (68.1%) agreed that there is a relationship between oral health and rheumatic disease, but only 31.1% agreed (or strongly agreed) that they have sufficient information about this association. Additionally, 34.9% agreed that there was enough information about medications that can be used in rheumatic patients and their possible side effects on the oral cavity. Almost half of the participants (46.8%) disagreed that rheumatic disease lecture(s) that have been covered at the undergraduate and postgraduate levels, enough to manage rheumatic patients. The majority (64.7%) never attended any form of continuous education lecture(s) or course(s) regarding the management of oral conditions in rheumatic patients. We concluded that most of the participants agreed that there is a relation between oral health and rheumatic diseases. At the same time, they think that they do not have enough information on the association between oral health and rheumatic diseases. This is in addition to information on the medication used in rheumatic patients and their possible side effects in the oral cavity.