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JCR Journal of Clinical Rheumatology
Journal Prestige (SJR): 0.727  Citation Impact (citeScore): 1 Number of Followers: 7  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1076-1608 - ISSN (Online) 1536-7355 Published by LWW Wolters Kluwer  [297 journals]
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- Interrater Reliability, Acceptability, and Practicality of Real-Time Video
Pediatric Gait, Arms, Legs, and Spine for Musculoskeletal Assessment of
Children During Telemedicine Visits-
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Authors: Giray; Esra; Kenis-Coskun, Ozge; Karadag-Saygi, Evrim; Ozyemisci-Taskiran, Ozden
Abstract:
Background/Objective With the COVID-19 (coronavirus disease 2019) pandemic, telemedicine applications gained momentum, and clinicians tried to develop various musculoskeletal examination methods to be used in telemedicine visits. The aim of this study is to investigate the interrater reliability, acceptability, and practicality of the real-time video Pediatric Gait, Arms, Legs, and Spine (v-pGALS) assessment used in the evaluation during the telemedicine visit.Methods The study was designed as cross-sectional. Twenty school-aged children who presented to outpatient clinics with musculoskeletal complaints were included. For interrater reliability, the children were evaluated by face-to-face examination with v-pGALS, and then the child was reevaluated by another physiatrist with real-time evaluation (online video call) with the help of a parent. For acceptability, the time taken and the discomfort caused were evaluated by patients/parents with the smiley face visual analog scale, whereas to assess practicality, the ratio of completeness to duration of examination completion was recorded.Results κ coefficient of the agreement was found to be 0.88 between the results of the face-to-face examination and online video examination, suggesting very good agreement between the 2 raters. Acceptability of v-pGALS by parents and patients was high; 60% of children and 80% of parents found the duration of examination acceptable, and 70% of the patients and 95% of parents reported no discomfort caused by examination. The duration of face-to-face examination was 5.75 ± 1.29 minutes, whereas the duration of online examination was 15.81 ± 4.9 minutes.Conclusions Video pGALS is a reliable, acceptable, and practical examination system that can be used for musculoskeletal assessment of children in telemedicine visits.
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- A Qualitative Analysis of Methotrexate Self-injection Education Videos on
YouTube: A Change in the Right Direction-
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Authors: Wilson; Hillary; Semaka, Amy; Katz, Steven Joseph
Abstract:
Background Patients are increasingly turning to the Internet for health guidance, requiring awareness from clinicians of constantly changing resources and quality of available information. A previous study demonstrated a minority of YouTube videos were useful for teaching methotrexate (MTX) self-injection; however, YouTube content constantly evolves, and previous results may not represent current videos. This study provides an update on previous work from 2014 evaluating the quality of YouTube videos demonstrating self-administered subcutaneous MTX injections. Our aim was to evaluate how YouTube videos on MTX injection have changed and evaluate the current video quality.Methods “Methotrexate injection” was searched on YouTube. The first 75 videos were analyzed independently by 2 reviewers. Videos were classified as useful, misleading/irrelevant, or a personal patient view and rated for reliability, comprehensiveness, and quality.Results Of the 75 videos reviewed, 12 were classified as useful (16%), 43 misleading/irrelevant (57.3%), and 20 personal patient views (26.7%). Although this represents a substantial increase from previous results in the proportion of videos deemed misleading/irrelevant (57.3% vs. 27.5%) (p = 0.0011), their reliability and global quality scores were higher.Conclusions Concordant with the previous study, only a small proportion of the total videos were deemed useful videos for MTX injection specifically. However, reliability and global quality scores for all videos increased from the previous study, suggesting more videos provide reliable information with regard to MTX overall, even if it does not speak to self-injection directly. Logistics of the YouTube algorithm may still impede access to the “best” videos for patient teaching; therefore, clinicians should be prepared to recommend strategies for patients to find high-quality videos.
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Impact of a Musculoskeletal “Mini-Residency” Professional Development
Program on Knee Magnetic Resonance Imaging Orders by Primary Care
Providers-
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Authors: Mulcaire-Jones; Erica; Barker, Andrea M.; Beck, J. Peter; Lawrence, Phillip; Cannon, Grant W.; Battistone, Michael J.
Abstract:
Background The US Department of Veterans Affairs has created a portfolio of educational programs to train primary care providers (PCPs) in the evaluation and management of common musculoskeletal (MSK) conditions. Appropriate resource utilization for evaluation of knee pain, including limiting unnecessary magnetic resonance imaging (MRI) studies, is an important theme of these initiatives. The objective of this study was to report the utilization of knee MRI by PCP providers before and after the MSK education program and to determine the appropriateness of these MRI orders.Methods Twenty-six PCPs participated in the MSK Mini-Residency educational program held in Salt Lake City between April 2012 and October 2014. Knee MRI orders submitted by these providers 12 months before and 12 months after their participation were reviewed. Magnetic resonance imaging orders were categorized as “inappropriate,” “probably inappropriate,” or “possibly appropriate,” based on accepted guidelines for knee MRI utilization. Differences in the numbers of precourse and postcourse MRI orders for each of these categories were compared using Student t test.Results Following our program, MRI orders decreased from 130 (precourse) to 93 (postcourse), a reduction of 28% (p = 0.04). This reduction was observed entirely within the “inappropriate” and “probably inappropriate” categories; the number of orders categorized as “possibly appropriate” increased, but not significantly.Conclusions The MSK Mini-Residency training program was a successful educational intervention and was associated with a reduction in inappropriate knee MRI utilization for some participants, while keeping appropriate MRI utilization stable.
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Psychological Stress Reported at the Start of the COVID-19 Pandemic and
Subsequent Stress and Successful Coping in Patients With Rheumatic
Diseases: A Longitudinal Analysis-
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Authors: Duculan; Roland; Jannat-Khah, Deanna; Wang, Xin A.; Mancuso, Carol A.
Abstract:
Objective In a cohort assembled during the height of mortality-associated coronavirus disease 2019 (COVID-19) in New York City, the objectives of this qualitative-quantitative mixed-methods study were to assess COVID-related stress at enrollment with subsequent stress and clinical and behavioral characteristics associated with successful coping during longitudinal follow-up.Methods Patients with rheumatologist-diagnosed rheumatic disease taking immunosuppressive medications were interviewed in April 2020 and were asked open-ended questions about the impact of COVID-19 on psychological well-being. Stress-related responses were grouped into categories. Patients were interviewed again in January–March 2021 and asked about interval and current disease status and how well they believed they coped. Patients also completed the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) measuring physical and emotional health during both interviews.Results Ninety-six patients had follow-ups; 83% were women, and mean age was 50 years. Patients who reported stress at enrollment had improved PROMIS-29 scores, particularly for the anxiety subscale. At the follow-up, patients reported persistent and new stresses as well as numerous self-identified coping strategies. Overall coping was rated as very well (30%), well (48%), and neutral-fair-poor (22%). Based on ordinal logistic regression, variables associated with worse overall coping were worse enrollment–to–follow-up PROMIS-29 anxiety (odds ratio [OR], 4.4; confidence interval [CI], 1.1–17.3; p = 0.03), not reporting excellent/very good disease status at follow-up (OR, 2.7; CI, 1.1–6.5; p = 0.03), pandemic-related persistent stress (OR, 5.7; CI, 1.6–20.1; p = 0.007), and pandemic-related adverse long-lasting effects on employment (OR, 6.1; CI, 1.9–20.0; p = 0.003) and health (OR, 3.0; CI, 1.0–9.0; p = 0.05).Conclusions Our study reflects the evolving nature of COVID-related psychological stress and coping, with most patients reporting they coped well. For those not coping well, multidisciplinary health care providers are needed to address long-lasting pandemic-associated adverse consequences.
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Identification and Prognosis of Patients With Interstitial Pneumonia With
Autoimmune Features-
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Authors: Jiwrajka; Nikhil; Loizidis, Giorgos; Patterson, Karen C.; Kreider, Maryl E.; Johnson, Cheilonda R.; Miller, Wallace T. Jr; Barbosa, Eduardo Jose Mortani Jr; Patel, Namrata; Beers, Michael F.; Litzky, Leslie A.; George, Michael D.; Porteous, Mary K.
Abstract:
Background/Objective Patients classified as interstitial pneumonia with autoimmune features (IPAF) have interstitial lung disease (ILD) and features of autoimmunity but do not fulfill criteria for connective tissue diseases (CTDs). Our goal was to identify patients classifiable as IPAF, CTD-ILD, and idiopathic pulmonary fibrosis (IPF) from a preexisting pulmonary cohort and evaluate the prognosis of patients with IPAF.Methods We reviewed the medical records of 456 patients from a single-center pulmonary ILD cohort whose diagnoses were previously established by a multidisciplinary panel that did not include rheumatologists. We reclassified patients as IPAF, CTD-ILD, or IPF. We compared transplant-free survival using Kaplan-Meier methods and identified prognostic factors using Cox models.Results We identified 60 patients with IPAF, 113 with CTD-ILD, and 126 with IPF. Transplant-free survival of IPAF was not statistically significantly different from that of CTD-ILD or IPF. Among IPAF patients, male sex (hazard ratio, 4.58 [1.77–11.87]) was independently associated with worse transplant-free survival. During follow-up, only 10% of IPAF patients were diagnosed with CTD-ILD, most commonly antisynthetase syndrome.Conclusion Despite similar clinical characteristics, most patients with IPAF did not progress to CTD-ILD; those who did often developed antisynthetase syndrome, highlighting the critical importance of comprehensive myositis autoantibody testing in this population. As in other types of ILD, male sex may portend a worse prognosis in IPAF. The routine engagement of rheumatologists in the multidisciplinary evaluation of ILD will help ensure the accurate classification of these patients and help clarify prognostic factors.
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Satisfaction With a Virtual Learning Collaborative Aimed at Implementing
Treat-to-Target in Rheumatoid Arthritis-
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Authors: Ellrodt; Jack; Pincus, Theodore; Shadick, Nancy A.; Stratton, Jacklyn; Santacroce, Leah; Katz, Jeffrey N.; Smolen, Josef; Solomon, Daniel H.; For the TRACTION Virtual Learning Collaborative
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Objective Limited information is available concerning experiences of participants in a virtual learning collaborative (LC), and little qualitative data or participant feedback on how this format can be improved. One prior in-person LC in rheumatology successfully improved adherence with treat-to-target (TTT) for RA. We conducted a virtual LC on TTT and herein report on participant satisfaction.Methods We conducted a virtual LC with 18 rheumatology practices from across the United States during 2020 to 2021. The LC included a virtual kickoff meeting and monthly videoconferences, accompanied by data submission and feedback. At the conclusion of the LC, we surveyed the 45 LC participants concerning individual experience and satisfaction.Results All sites and 78% of participants responded to the surveys. The LC included small and large practices, 14 academic and 4 nonacademic, and respondents ranged in their roles: 24 physicians, 5 nurses or nurse practitioners, 3 administrators, and 3 other roles. Overall, 94% of respondents indicated they were either somewhat or very satisfied with the LC, and 94% said they would recommend a similar LC to a colleague. Aspects of the LC described as “very useful” included a kickoff meeting, intersite discussion, and monthly speakers; however, digital tools such as the Web site and meeting recordings were not found useful.Conclusions Virtual LCs are feasible, and participants reported strong satisfaction. Virtual LCs were highly valued by rheumatologists, trainees, and their practice staffs. Potential topics were identified for future LCs that could improve the quality of care delivered to rheumatology patients.
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Efficacy and Safety of Intravenous Golimumab in Ankylosing Spondylitis
Patients With Early and Late Disease Through One Year of the GO-ALIVE
Study-
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Authors: Deodhar; Atul A.; Shiff, Natalie J.; Gong, Cinty; Hsia, Elizabeth C.; Lo, Kim Hung; Kim, Lilliane; Xu, Stephen; Reveille, John D.
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Background/Objective This post hoc analysis assessed efficacy and safety of intravenous (IV) golimumab in ankylosing spondylitis (AS) patients with early disease (ED) versus late disease (LD).Methods The phase 3, double-blind, GO-ALIVE study randomized patients to IV golimumab 2 mg/kg at weeks 0 and 4 and then every 8 weeks through week 52, or placebo at weeks 0, 4, and 12 with crossover to IV golimumab at week 16. Clinical efficacy was assessed by ≥20% improvement in Assessment of Spondyloarthritis International Society response criteria (ASAS20), ≥50% improvement in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50), and Ankylosing Spondylitis Disease Activity Score (ASDAS)
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- The Effect of the Fibrotherapy Intervention Program on the Coping Patterns
of Fibromyalgia Patients-
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Authors: Cohen-Biton; Liraz; Buskila, Dan; Nissanholtz-Gannot, Rachel
Abstract:
Background Fibromyalgia (FM) syndrome is characterized by physical symptoms such as pain, fatigue, and sleep disorders, as well as mental symptoms that include depression, mental exhaustion, and a sense of hopelessness. The current study focuses on 3 main strategies used by FM patients living in communities in the Gaza Envelope who are under constant security threat: problem-oriented, emotion-oriented, and avoidance.Methods The study introduces a groundbreaking intervention program based on a fibrotherapy intervention (FTI) program developed at the Rehabilitation Center “Ezra Le'Marpeh” led by Rabbi Avraham Elimelech Firer. The cohort study sample consists of 96 women who have been diagnosed with FM and have participated in the FTI program for 10 weeks. The study uses mixed methods of quantitative and qualitative analyses in which 16 women from the sample were interviewed. In addition to collecting demographic information and medical data, the study used the Brief Cope questionnaire.Results The findings corroborate the hypothesis and show a difference between the coping patterns of FM patients before and after the intervention.Conclusions The sharing experience as a part of the FTI program can lead FM patients to adopt positive disease management strategies, which may improve their quality of life.
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Rule Follower
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Abstract:
No abstract available
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Thrombi in Both Ventricles in a Systemic Lupus Erythematosus Patient
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Authors: Li; Yanmei; Wei, Wei
Abstract:
No abstract available
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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- Tuberculous Osteomyelitis: An Unusual Cause of Limping
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Authors: Kanjanaphan; Thiraporn; Tangcheewinsirikul, Sirikarn
Abstract:
No abstract available
PubDate: Mon, 01 Aug 2022 00:00:00 GMT-
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