Immediate access rheumatology clinic: efficiency and outcomes.

OBJECTIVE AND METHODS: In order to facilitate access and shorten waiting times to rheumatologist assessment, an immediate access clinic (IAC) was established. Patients were assessed at presentation in the clinic and after 6-12 months, either in the clinic or by telephone. Data regarding diagnostic accuracy, pain levels and care were analysed. RESULTS: From February to December 2009, 1036 patients were assessed. 223 (21.5%) patients had symptoms for 3 months or less. 660 were available for re-assessment after 6-12 months. Initial tentative diagnoses were confirmed in over 75% of patients suspected of having rheumatoid arthritis (RA), spondylarthropathy and osteoarthritis. Men suspected of having spondylarthropathy had a significantly longer symptom duration than women (median (IQR) 54.0 (18.0-120.0) vs 24.0 (6.0-66.0) months; p=0.0082). There was no significant gender difference regarding pain. At follow-up, the visual analogue scale for pain in RA patients admitted to further care in the clinic (n=61) had significantly decreased by a median (IQR) of 37.5 mm (10.5-50.5), whereas this improvement was only 6 mm (-26-33.5) in the 22 RA patients followed outside the clinic (p=0.0083). CONCLUSIONS: The IAC resulted in considerable waiting time reduction for rheumatology assessment. A substantial minority was seen before 3 months' symptom duration. 'Positive predictive correctness' of the assessing rheumatologists regarding the presence of inflammatory rheumatic conditions was over 75%. Patients with RA cared for in the clinic had substantially lower pain levels after 6-12 months' follow-up than patients treated elsewhere.

Apparently no sedative benzoflavone moiety in passiflorae herba.

Due to the fact that an Indian group had reported a benzoflavone moiety (BZF) as an active principle in the herb of Passiflora incarnata L. (Passifloraceae), this study was performed to isolate the compound for analytical purposes. In Passiflorae herba from three different origins (cultivations in India, Italy and France) a compound with the published TLC characteristics was detected in trace amounts only in the Italian material. No traces of the substance were found in the drugs from India and France. In a commercial extract two compounds with the respective TLC characteristics were detected. One was identified as a phytol isomer. Due to the very small amounts of the second compound its structure elucidation was not successful. The amount of extract for the isolation corresponded to approximately the 10-fold amount of the drug, from which the isolation of 332 mg "BZF" had been reported. The detection of only trace amounts of a BZF-like compound in one of three commercial samples of Passiflorae herba and in an extract suggests for the first time that BZF is not the active principle in this drug and should not serve as an active marker.