Call for action: incorporating wellness practices into a holistic management plan for rheumatoid arthritis—going beyond treat to target

This expert opinion article explores the strategy of adopting a holistic approach to the management of rheumatoid arthritis (RA) by incorporating the wellness practices of exercise, optimised sleep, optimised nutrition, mindfulness, social connectedness and positive emotions into the management plan. The aim is to attain optimal health for each patient beyond that achievable by limiting disease management to pharmacological treatment to attain the lowest achievable composite scores of disease activity, as recommended with the current treat-to-target approach, and addressing the recent recognition of pain control as a key patient-reported outcome. Incorporating wellness practices into a busy clinical setting requires creativity and customisation based on the individual practice setting and the individual needs of each patient. Such practices can help people living with RA to achieve optimum wellness through the introduction of measures—according to individual need—designed to improve the aspects of life most impacted for that person, thereby complementing treat-to-target and pain control strategies with pharmacological agents. Clinicians must consider wellness practices in addition to treat-to-target pharmacological agents for the holistic management of people with RA.

Subjective Versus Quantitative Methods of Assessing Breast Density

In order to find a consistent, simple and time-efficient method of assessing mammographic breast density (MBD), different methods of assessing density comparing subjective, quantitative, semi-subjective and semi-quantitative methods were investigated. Subjective MBD of anonymized mammographic cases (n = 250) from a national breast-screening programme was rated by 49 radiologists from two countries (UK and USA) who were voluntarily recruited. Quantitatively, three measurement methods, namely VOLPARA, Hand Delineation (HD) and ImageJ (IJ) were used to calculate breast density using the same set of cases, however, for VOLPARA only mammographic cases (n = 122) with full raw digital data were included. The agreement level between methods was analysed using weighted kappa test. Agreement between UK and USA radiologists and VOLPARA varied from moderate (κw = 0.589) to substantial (κw = 0.639), respectively. The levels of agreement between USA, UK radiologists, VOLPARA with IJ were substantial (κw = 0.752, 0.768, 0.603), and with HD the levels of agreement varied from moderate to substantial (κw = 0.632, 0.680, 0.597), respectively. This study found that there is variability between subjective and objective MBD assessment methods, internationally. These results will add to the evidence base, emphasising the need for consistent, simple and time-efficient MBD assessment methods. Additionally, the quickest method to assess density is the subjective assessment, followed by VOLPARA, which is compatible with a busy clinical setting. Moreover, the use of a more limited two-scale system improves agreement levels and could help minimise any potential country bias.

Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission

Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting. Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared. Results: The bias of 15 seconds of observations was 1.85 breaths per minute and 0.11 breaths per minute for the algorithm derived rate, which took 16.2 SD 8.1 seconds. The algorithm assigned 88% of respiratory rates their correct National Early Warning Score points, compared with 80% for rates from 15 seconds of observation. Conclusion: The respiratory rates of acutely ill patients are measured nearly as quickly and more reliably by a computer algorithm than by observations over 15 seconds.

Referral rates and supportive care metrics for a first-year community oncology AYA program.

63 Background: Adolescent and young adult (AYA) oncology patients have a unique set of needs compared to younger and older patients that are often not addressed by primary providers in a busy clinical setting. Genetic counseling, fertility preservation, clinical trial enrollment and psychosocial support are a few of the key needs to address in this group. The AYA Cancer Program was created to specifically address these issues and mitigate the disparity in care and outcomes often seen in the AYA cohort. This study examines the number of patients referred to the AYA Cancer Program in its first year and evaluates the role of the program in addressing the supportive care needs of AYA patients. Methods: The study assessed patients actively under treatment between ages 15-39 from September 1, 2016 to September 1, 2017. The number of referrals to the AYA program, participation in the AYA program, and met supportive care needs (fertility, genetics, clinical trial participation) were examined. Results: During the first year of the clinic, 63 (22%) of the 288 AYA patients seen throughout the whole institution were seen in the AYA clinic. An additional 34 (12%) patients were referred but did not come to the appointment. 192 (69%) patients were not referred. Compared to non-referred patients, AYA clinic patients were more likely to be enrolled on a clinical trial (54% vs. 18%), have a documented fertility counseling discussion (94% vs. 16%) and receive a genetics referral (69% vs. 43%). Patients that were referred to the clinic but did not come were slightly more likely than non-referred patients to be offered the above services as well but still trailed the group of patients seen in the AYA clinic. Conclusions: Patients that were seen in the AYA program were more likely to receive fertility referrals, genetic referrals and had increased clinical trial participation compared to patients that were not referred. This highlights the essential role of the AYA clinic in meeting these under addressed needs in the AYA population. [Table: see text]

Linguistic and Psychometric Validation of the Thai Version of Simplified Diabetes Knowledge Scale: A Measure of Knowledge of Diabetes in a Thai Population

Purpose To develop a linguistically and psychometrically validated Thai version of the Simplified Diabetes Knowledge Scale (T-SDKS) for adults with Type 2 diabetes mellitus (T2DM). Design A cross-sectional study was carried out among people with T2DM. Methods Consecutive sampling was undertaken to recruit participants at the outpatient diabetes clinic of a hospital in Northern Thailand. Results A total of 502 patients with T2DM were recruited. The mean age of the participants was 60.2 years, and 60.5% were female. The T-SDKS attained a reliability coefficient of .79. The item-total correlation value was greater than 0.20 for each item, and the inter-item correlation ranged between 0.03 and 0.49. Respondents attained a mean percentage knowledge score of 42.39% ± 15.45 on T-SDKS. Discussion/conclusions The T-SDKS has demonstrated to be a brief and simple diabetes knowledge assessment tool to use in a busy clinical setting. Implication for practice The findings can be used to improve health education interventions.

Depression and anxiety in people with epilepsy: Why should we identify?

Summary Introduction. People with epilepsy (PWE) have a higher risk of developing depression and anxiety than people without epilepsy. However, understanding and management of that issue remain under-recognized. Aim. To emphesize: a) the relationship between depression, anxiety, and epilepsy, and b) to suggest practical strategies for their identification by clinicians. Methods. The current literatures was reviewed investigating the impact of depression and anxiety in PWE and those examining the validity of simple screening tools for the detection of depression and anxiety. Review. Approximately one quarter of PWE have been known to be suffered from depression. The frequency of depression and anxiety was closely related to poor seizure control. Depression and anxiety have been reported to have a bidirectional relationship with epilepsy. The higher degree of depression and anxiety was more likely to elicit the suicidal ideation and attempt, adverse events and poor compliance of antiepileptic drugs, poor surgical outcome, and eventually, poor quality of life. Furthermore, depression and anxiety were closely associated with perceived stigma, obsessive-compulsive symptom, aggression, fatigue, and perceived stress. Conclusions. Clinicians who take care of PWE in a busy clinical setting should identify their psychiatric problems by brief screening tools and treat them instantly to minimize their negative impacts.

Perceived Quality Improvements Using Daily Allocation of Surgical Residents to the Operating Room and Outpatient Clinics

Introduction. Balancing efficiency and quality in resident education and clinical care is challenging, particularly in a large tertiary center with resident work hour restrictions. This study investigates the use of daily allocation of surgical residents to operative cases and clinics with the goal of improving patient care, resident education, and coverage. Methods. Surgical residents were allocated to cases and clinic activities a day ahead, with a central email generated and sent to all surgical staff the day prior to the procedures and duties. A ten-item questionnaire was administered to the staff on the surgery service before and after this intervention, evaluating perceptions of educational experience, patient care, and coverage of operative cases, clinic, and floor duty. Results. A total of 28 staff members participated. No significant difference was found in the perception of stress at work, coverage of OR cases, or clinic attendance after the intervention. However, a statistically significant increase () was noted in the perception of resident’s educational experience in the clinic (39% vs. 94%), appropriate case distribution (54% vs. 94%), and quality of patient care (50% vs. 100%). Conclusions. Daily allocation of surgical residents to operative cases and clinic activities improves perceptions of resident educational experience and quality of patient care in a busy clinical setting.