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1.
Pediatr Rheumatol Online J ; 18(1): 85, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129319

RESUMO

BACKGROUND: The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION: This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.


Assuntos
Infecções por Coronavirus , Pandemias , Pediatria/métodos , Exame Físico/métodos , Pneumonia Viral , Reumatologia/métodos , Telemedicina/métodos , Comunicação por Videoconferência , Betacoronavirus , Assistência à Saúde , Europa (Continente) , Humanos , Seleção de Pacientes , Pediatria/educação , Pediatria/organização & administração , Reumatologia/educação , Reumatologia/organização & administração , Telemedicina/legislação & jurisprudência , Telemedicina/organização & administração , Estados Unidos
3.
Z Rheumatol ; 79(9): 883-892, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33057786

RESUMO

Due to the outbreak of the COVID-19 pandemic, in recent months we have experienced deep changes in our daily and professional lives. In the context of pandemic containment, routine rheumatological procedures have changed in many areas. To guarantee sufficient protection against the infection for patients and staff, telemedicine (especially telephone and video consultation) has increasingly been used. Due to the Digital Healthcare Act (DiGAV), whereby patients will have a legal claim to specific digital health applications in Germany, medical apps and wearables will offer new opportunities for telemedical monitoring. This article provides an overview of telemedical care options in the field of rheumatology. Furthermore, opportunities and limitations of telemedicine in rheumatology are reviewed.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Reumatologia/tendências , Telemedicina/tendências , Betacoronavirus , Alemanha , Humanos , Aplicativos Móveis , Pandemias , Dispositivos Eletrônicos Vestíveis
4.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 897-901, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047726

RESUMO

OBJECTIVE: To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR). METHODS: Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features. RESULTS: (1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (χ2=43.641, P < 0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (χ2=0.446, P=0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (χ2=4.891, P=0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (χ2=0.044, P=1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (χ2=7.131, P=0.008; χ2=22.015, P < 0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (χ2=0.220, P=0.755; χ2=0.473, P=0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836). CONCLUSION: The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.


Assuntos
Artrite Reumatoide , Osteoartrite , Reumatologia , Adolescente , Adulto , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Sensibilidade e Especificidade , Estados Unidos
6.
Clin Rheumatol ; 39(12): 3535-3541, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33067772

RESUMO

The novel coronavirus disease (COVID-19) pandemic has significantly impacted the field of rheumatology, in both the delivery of clinical care and didactic education for our trainees. These changes have generated significant strain for program directors and clinical educators who have had to leverage technology and develop new systems to ensure continued trainee education and assessment. We aim to outline the impacts on formal education programs presented by these unprecedented disruptions, describe the development and deployment of online teaching, reflect on the challenges and opportunities for technology-enabled learning and use of social media for education, and give some international perspectives on impacts on postgraduate rheumatology training outside the USA. With the rapid dissolution of barriers in place during the pre-COVID-19 era, we have the opportunity to assess the efficacy of new methods of care and further integrate technology into teaching and assessment. We propose that a hybrid in-person and technology-enabled learning approach, so-called blended learning, is likely to remain the most desirable future model for supporting trainee learning.


Assuntos
Infecções por Coronavirus/epidemiologia , Educação a Distância/métodos , Educação de Pós-Graduação em Medicina/métodos , Pneumonia Viral/epidemiologia , Reumatologia/educação , Currículo , Humanos , Disseminação de Informação , Pandemias , Mídias Sociais
7.
Pediatr Rheumatol Online J ; 18(1): 78, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059714

RESUMO

Telehealth is an extraordinary advancement of modern medicine. It has increased access to care for underserved populations and, in the case of pediatric rheumatology, has expanded the reach of a limited work force. During the Coronavirus Disease 2019 (COVID-19) pandemic, telehealth has radically changed the way healthcare workers have been able to deliver care while maintaining social distance. In addition to the infectious havoc of COVID-19, the pandemic has further altered the psychosocial milleu of our society which directly impacts the wellness and safety of our pediatric rheumatology patients. These psychosocial factors may be difficult to assess and triage solely using telehealth. The objective of this short review is to educate practitioners on the psychosocial concerns exacerbated by the COVID-19 pandemic and to discuss the possible hurdles in utilization of telehealth to care for our vulnerable patient population.


Assuntos
Infecções por Coronavirus , Pandemias , Pediatria , Pneumonia Viral , Reumatologia , Telemedicina , Betacoronavirus , Criança , Maus-Tratos Infantis , Depressão , Humanos , Saúde Mental , Assistência Centrada no Paciente , Medição de Risco , Meio Social , Transtornos Relacionados ao Uso de Substâncias
8.
Rev Med Suisse ; 16(709): 1860-1864, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026728

RESUMO

Sjögren Syndrome is an autoimmune disorder presenting as Sicca syndrome (dry-eye, dry mouth) and most often multiorgan involvement with various clinical manifestations. The diagnostic criteria defined by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) include biologic, histologic parameters and functional measurements. Part of this workup can be performed by the ENT specialist. It encompasses minor salivary gland biopsy, sialometry, Schirmer lacrymal test and major salivary gland ultrasound. These tests and their performances are described. The growing importance of major salivary gland ultrasound as a follow-up and diagnostic tool is also discussed in this article.


Assuntos
Orelha , Nariz , Faringe , Papel do Médico , Reumatologia , Síndrome de Sjogren/diagnóstico , Biópsia , Humanos , Glândulas Salivares/diagnóstico por imagem , Glândulas Salivares/patologia , Síndrome de Sjogren/diagnóstico por imagem , Síndrome de Sjogren/patologia , Ultrassonografia
9.
Rheumatol Int ; 40(12): 2023-2030, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33048199

RESUMO

The evolving research landscape in the time of the Coronavirus disease 2019 (COVID-19) pandemic calls for greater understanding of the perceptions of scholars regarding the current state and future of publishing. An anonymised and validated e-survey featuring 30 questions was circulated among rheumatologists and other specialists over social media to understand preferences while choosing target journals, publishing standards, commercial editing services, preprint archiving, social media and alternative publication activities. Of 108 respondents, a significant proportion were clinicians (68%), researchers (60%) and educators (47%), with median 23 publications and 15 peer-review accomplishments. The respondents were mainly rheumatologists from India, Ukraine and Turkey. While choosing target journals, relevance to their field (69%), PubMed Central archiving (61%) and free publishing (59%) were the major factors. Thirty-nine surveyees (36%) claimed that they often targeted local journals for publishing their research. However, only 18 (17%) perceived their local society journals as trustworthy. Occasional publication in the so-called predatory journals (5, 5%) was reported and obtaining support from commercial editing agencies to improve English and data presentation was not uncommon (23, 21%). The opinion on preprint archiving was disputed; only one-third believed preprints were useful. High-quality peer review (56%), full and immediate open access (46%) and post-publication social media promotion (32%) were identified as key anticipated features of scholarly publishing in the foreseeable future. These perceptions of surveyed scholars call for greater access to free publishing, attention to proper usage of English and editing skills, and a larger role for engagement over social media.


Assuntos
Infecções por Coronavirus , Pandemias , Publicações Periódicas como Assunto/normas , Pneumonia Viral , Comunicação Acadêmica/normas , Adulto , Betacoronavirus , Humanos , Pessoa de Meia-Idade , Publicação de Acesso Aberto/normas , Reumatologia , Inquéritos e Questionários
15.
Clin Rheumatol ; 39(11): 3215-3222, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32939569

RESUMO

The coronavirus disease-2019 (COVID-19) pandemic has unsettled conventional medical education, hastening a switch to digital platforms and open-access publishing. Rheumatology is a fast evolving academic discipline that stands to gain by this switch. Most rheumatology textbooks are now available in digital formats, and these are complemented with live updating educational hubs such as UpToDate and ClinicalKey. Emerging topics of COVID-19 on these proprietary platforms are now freely available to all specialists. Social media channels, particularly Twitter, are becoming major players in the era of COVID-19 by offering online journal clubs, enabling fast dissemination of influential articles, and facilitating interactive education. Indexed rheumatology journals, in turn, aid online education by opening access to recommendations and other materials that are rapidly changing research and practice worldwide. Research peer review additionally offers learning experience to novice and seasoned researchers and authors. Global rheumatology societies have online learning resources, which are changing their format and geographic reach to meet the changing needs in the times of pandemic. While online teaching lacks emotional connections between mentors and mentees, switch to a more interactive format of education and regular contacts may partly solve the issue. Rheumatologists can take the lead in these challenging times and contribute more to online scholarly activities which are aimed to maintain and enrich education. Key Points • Disparities in rheumatology education are likely to be widened during the COVID-19 pandemic. • Barriers to rheumatology education include limited number of instructors and their limited experience in online teaching. • Online textbooks, didactic materials of indexed rheumatology journals, and frequently updated online educational hubs such as UpToDate serve as a foundation of online rheumatology education. • Online rheumatology education is enriched by peer review and social media activities, which are becoming major players in the time of the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Educação a Distância , Pandemias , Pneumonia Viral , Reumatologia/educação , Betacoronavirus , Humanos , Disseminação de Informação , Revisão da Pesquisa por Pares , Mídias Sociais , Sociedades Médicas
16.
Clin Rheumatol ; 39(11): 3205-3213, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32996071

RESUMO

OBJECTIVE: To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on rheumatology practice. METHOD: A cross-sectional web survey was designed by the members of the Arab League of Associations for Rheumatology (ArLAR), validated by its scientific committee and disseminated through e-mail and social media. It included close-ended questions about the impact of the pandemic on the rheumatology activities, including outpatient visits and hospitalizations (in percentage, 100% corresponds to complete suspension) and open-ended questions about unmet needs. Univariate and multivariable logistic regression analyses were used to evaluate the predictors of impact. Suggestions were developed to improve the practice. RESULTS: A total of 858 rheumatologists were included in the analysis (27.3% of registered in ArLAR), 37% were 35-44 years old, 60% were females, and 48% worked in the private sector. The impact of COVID-19 was a decrease of 69% in hospitalizations, 65% in outpatient clinic, 56% in infusion centers, and 43% in income. It was associated with the region (highest in the Gulf), use of telemedicine, impact on income and practice sector (lowest in private). There was a hydroxychloroquine shortage in 47%. Telemedicine was mostly based on traditional telephone contacts and e-mails and reimbursed in 12%. Fifteen rheumatologists (1.8%) were infected and 156 cases of COVID-19 were reported among patients. The top-cited unmet needs in rheumatology practice were access to drugs and a telemedicine platform. CONCLUSIONS: The negative impact of the COVID-19 pandemic on rheumatology practice may compromise rheumatic diseases control. Better access to drugs and providing telemedicine platforms are recommended to improve the practice. Key Points • The COVID-19 pandemic had a significant negative impact on the rheumatology practice, including access to outpatient clinic, hospitalization, and to anchor drugs. • The compromised access to rheumatology care may jeopardize the control of chronic rheumatic diseases and the long-term prognosis. • Better access to drugs and providing telemedicine platforms are strongly recommended.


Assuntos
Assistência Ambulatorial , Infecções por Coronavirus , Assistência à Saúde , Hospitalização , Pandemias , Pneumonia Viral , Reumatologia , Telemedicina , Adulto , Idoso , Antirreumáticos/provisão & distribução , Mundo Árabe , Betacoronavirus , Feminino , Humanos , Hidroxicloroquina/provisão & distribução , Renda , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Mecanismo de Reembolso , Inquéritos e Questionários , Telefone
17.
Z Rheumatol ; 79(8): 770-779, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32926218

RESUMO

Even in the era of modern guidelines, the treatment of rheumatic diseases is only as good as the framework of rheumatological care within which the treatment is carried out. The access to high-quality medical treatment for all patients is therefore essentially decisive for the prognosis of the patients. This article describes the current state of outpatient treatment in rheumatology and demonstrates which quality projects, such as treatment contracts, outpatient specialized medical treatment (ASV), digitalization and training as specialized rheumatological assistant (RFA), have been created in order to ensure the treatment of our patients. Furthermore, standards are defined that can guarantee a contemporary and guideline-conform treatment in outpatient rheumatological units. As an example it is an affirmation of the Professional Association of German Rheumatologists (BDRh) for ensuring optimal care for all rheumatology patients through early or emergency rheumatology clinics, treat to target, appropriate delegation of medical duties and diversification of treatment, thus an assurance of the quality and comprehensive treatment in rheumatology. The important topic of safeguarding the next generation of rheumatologists, which is indispensable for this, is also discussed.


Assuntos
Qualidade da Assistência à Saúde/normas , Doenças Reumáticas , Reumatologia , Assistência Ambulatorial , Objetivos , Humanos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia , Reumatologistas , Reumatologia/normas
18.
Rheumatol Int ; 40(12): 2031-2037, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32995894

RESUMO

Social media services, such as Twitter, offer great potential for a better understanding of rheumatic and musculoskeletal disorders (RMDs) and improved care in the field of rheumatology. This study examined the content and stakeholders associated with the Twitter hashtag #Covid4Rheum during the COVID-19 pandemic. The content analysis shows that Twitter connects stakeholders of the rheumatology community on a global level, reaching millions of users. Specifically, the use of hashtags on Twitter assists digital crowdsourcing projects and scientific collaboration, as exemplified by the COVID-19 Global Rheumatology Alliance registry. Moreover, Twitter facilitates the distribution of scientific content, such as guidelines or publications. Finally, digital data mining enables the identification of hot topics within the field of rheumatology.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Doenças Reumáticas/terapia , Mídias Sociais/estatística & dados numéricos , Betacoronavirus , Comportamento Cooperativo , Saúde Global , Humanos , Disseminação de Informação/métodos , Pandemias , Reumatologia
19.
Rev Soc Bras Med Trop ; 53: e20190517, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756797

RESUMO

Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients' quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner.


Assuntos
Febre de Chikungunya , Reumatologia , Adulto , Brasil , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/terapia , Consenso , Humanos , Qualidade de Vida
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