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Pfeil A, Klemm P, Hueber AJ, Hoffmann T, Weise T, Oelzner P, Knop S, Müller-Ladner U, Lange U, Wolf G, Schett G, Simon D, Kleyer A. Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial. Rheumatology (Oxford) 2024; 63:1949-1956. [PMID: 37740288 DOI: 10.1093/rheumatology/kead508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 09/02/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students' perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymized patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO! app. All participants evaluated the course after completion, assessing the benefit of the app from a student's perspective using a questionnaire with 16 questions covering six subject areas. RESULTS The use of the AR-based app Rheumality GO! improved the understanding of pathologies in RA, PsA and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach. CONCLUSION The results of our survey showed that from the medical students' perspective, an AR-based concept like the Rheumality GO! app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Axel J Hueber
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Tobias Hoffmann
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | | | - Peter Oelzner
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Stefan Knop
- Department Internal Medicine 5, Hemato-Oncology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ulf Müller-Ladner
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Uwe Lange
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
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2
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Hoeper JR, Schuch F, Steffens-Korbanka P, Gauler G, Welcker M, Wendler J, von Hinüber U, Meyer SE, Schwarting A, Zeidler J, Witte T, Meyer-Olson D, Hoeper K. [Delegation of medical duties to qualified rheumatology assistants : Effect on depression and anxiety in patients with rheumatoid arthritis]. Z Rheumatol 2024; 83:407-415. [PMID: 37648932 PMCID: PMC11147826 DOI: 10.1007/s00393-023-01403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND At least 1 comorbidity occurs in 80% of patients with rheumatoid arthritis (RA). In addition to cardiovascular comorbidities psychological comorbid conditions are common. The prevalence of depression and anxiety is higher in patients than in the general population. Screening for comorbidities is crucial. A shortage of outpatient specialist care barely allows resources for this. The implementation of team-based care holds the potential to improve the standard of care while simultaneously working against the shortage of care. OBJECTIVE The aim of the study was to examine the effects of care on the course of depression and anxiety in patients with seropositive RA and active disease. MATERIAL AND METHODS A multicenter pragmatic randomized controlled trial was conducted over the course of 1 year with 224 patients. After baseline, five more visits followed. In the intervention group (IG), three were initially carried out by qualified rheumatological assistants. Depression, anxiety and patient satisfaction with outpatient care were looked at in detail. RESULTS In the IG the anxiety symptoms significantly improved over 12 months (p = 0.036). The proportions of patients with anxiety also significantly changed in the IG (p < 0.001), while there was no change in the control group between baseline and month 12. The values of the depression scale did not differ significantly (p = 0.866). In terms of the information dimension of the satisfaction questionnaire, patients in the IG felt significantly better informed after 6 months (p = 0.013) and 12 months (p = 0.003). CONCLUSION A positive effect of team-based care on the course of depression and anxiety in patients with seropositive RA and active disease could be shown.
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Affiliation(s)
- Juliana Rachel Hoeper
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Deutschland
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
| | - Florian Schuch
- Rheumatologie, Internistische Praxisgemeinschaft, Erlangen, Deutschland
| | | | - Georg Gauler
- Rheumapraxis an der Hase, Osnabrück, Deutschland
| | | | - Jörg Wendler
- Rheumatologie, Internistische Praxisgemeinschaft, Erlangen, Deutschland
| | | | - Sara Eileen Meyer
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
| | - Andreas Schwarting
- Klinik für Rheumatologie und klinische Immunologie, Universitätsmedizin Mainz, Mainz, Deutschland
- ACURA Kliniken Rheuma-Akutzentrum Rheinland-Pfalz, Bad Kreuznach, Deutschland
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Deutschland
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
| | - Dirk Meyer-Olson
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland
- Rheumatologie, m&i Fachklinik Bad Pyrmont, Bad Pyrmont, Deutschland
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
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Proft F, Vossen D, Baraliakos X, Berliner MN, Fleck M, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Raspe M, Krusche M, Pfeil A. [Survey on the working, training, and research conditions of resident physicians in internistic and rheumatological continuing education-BEWUSST]. Z Rheumatol 2024; 83:257-268. [PMID: 37566120 PMCID: PMC11058970 DOI: 10.1007/s00393-023-01395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Data on the training and continuing education situation of residents in the field of internal medicine and rheumatology are not available for Germany. For this reason, the Commission for Education and Training of the German Society of Rheumatology (DGRh) initiated the BEWUSST survey on the working, training and research conditions of residents in rheumatology. METHODS A total of 102 questions on the topics of working conditions in everyday professional life, continuing medical education and training, compatibility of career and family, compatibility of work and research, perspectives as a rheumatologist and practical activities were included in an online questionnaire. RESULTS A total of 102 participants took part in the survey. Of the respondents 48.1% were satisfied with their professional situation, 40.2% of the participants were supervised by a specialist mentor and 54.9% were working as scientists during their work as a physician. A compatibility of family and career was possible for 34.7%. After completion of the residency 52.9% of the respondents aspired to a combined clinical and outpatient activity. CONCLUSION Half of the trainee rheumatologists are satisfied with their professional activities, although mentoring of the assistants in training should be further improved. With respect to the desired combined clinical and outpatient activity, the existing options should be expanded or new professional fields of activity should be established, so that the specialty remains attractive for the upcoming generations.
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Affiliation(s)
- Fabian Proft
- Abteilung für Rheumatologie, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Diana Vossen
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | | | - Michael N Berliner
- Rheumatologie und Geriatrie, Helios Klinikum Berlin-Buch, Berlin, Deutschland
| | - Martin Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regenburg, Deutschland
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland
| | - Gernot Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - Andreas Krause
- Klinik für Innere Medizin, Abteilung Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Bernhard Manger
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Florian Schuch
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Deutschland
| | | | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - Matthias Raspe
- Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin Charité - Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Deutschland
| | - Martin Krusche
- Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Schuster L, Valor-Méndez L, Wacker J, Dannhardt-Thiem V, Schmidt A, Knitza J, Simon D, Manger B, Schett G, Kleyer A. ["Rheuma (be-)greifen"- A multimodal teaching concept to improve rheumatology education for medical students]. Z Rheumatol 2024; 83:186-193. [PMID: 37505294 PMCID: PMC10973034 DOI: 10.1007/s00393-023-01391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in the future. OBJECTIVE To assess whether a combination of traditional and innovative educational methods provide both an improvement in the quality of teaching and an increase in the attractiveness of rheumatology as a discipline. MATERIAL AND METHODS Establishment of the teaching concept "Rheuma (be-)greifen" consisting of five modules on patient history taking with acting patients, musculoskeletal ultrasound, arthrocentesis, 3D printing of pathological joints and virtual reality applications based on real patient cases in the curricular teaching of medical students. RESULTS The evaluation of the teaching concept with 93 students of medicine showed a consistently high acceptance of all modules, which were rated as very effective or rather effective. Direct patient-related modules, such as history taking with acting patients, musculoskeletal ultrasound and arthrocentesis, received even higher acceptance than the visualization methods utilizing 3D printing and virtual reality. CONCLUSION Innovative teaching methods can help to improve the acceptance of teaching in the field of rheumatology, especially when combined with classical teaching contents.
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Affiliation(s)
- L Schuster
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland.
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland.
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland.
| | - L Valor-Méndez
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J Wacker
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - V Dannhardt-Thiem
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Schmidt
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Knitza
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - D Simon
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Manger
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - G Schett
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Kleyer
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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5
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Alberti C, Dreher M, Triantafyllias K, Schwarting A. [Current patient care of systematic lupus erythematosus in Rhineland-Palatinate and Saarland]. Z Rheumatol 2024:10.1007/s00393-024-01491-1. [PMID: 38509358 DOI: 10.1007/s00393-024-01491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease that is associated with great suffering for those affected, as well as high socioeconomic costs. Early diagnosis and adequate medical care are essential for a mild course of the disease. However, there is a lack of current figures and data on the care situation of patients in the area. METHODOLOGY A total of 1546 general practitioners, rheumatologists, neurologists, nephrologists and dermatologists in Rhineland-Palatinate and Saarland were interviewed by fax or mail using a questionnaire regarding epidemiology, symptoms, therapy and therapy success. In addition, there was the possibility of making suggestions for improvement. RESULTS Five out of six of the 635 reported SLE patients were female. The most common main symptoms were arthralgia, fatigue, myalgia, and skin changes. Of the patients, 68% received antimalarials (AMs), whereas 46% were treated with glucocorticoids (GCs) and 50% with an immunosuppressant (IS), mainly methotrexate. In terms of comorbidities, patients suffered mainly from cardiovascular disease, fibromyalgia syndrome and depression. Rheumatologists also frequently described anaemia, diabetes mellitus and osteoporosis. DISCUSSION Compared with guideline recommendations, the low rate of AMs in therapy was particularly striking in patients not treated by rheumatologists (35% on average compared with 81% for rheumatologists). Additionally, (sustained) high doses of GCs are not in line with literature recommendations. In the free text field, the main requests were for more rheumatologists in private practice and faster appointment scheduling, as well as better communication and networking. In addition, the desire for more training and education was frequently expressed..
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Affiliation(s)
- Ciaran Alberti
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Matthias Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
- Universitäres Centrum für Autoimmunität, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Konstantinos Triantafyllias
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
- RZ Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland
| | - Andreas Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
- RZ Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland.
- Universitäres Centrum für Autoimmunität, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland.
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Hirsch S, Hoeper K, Meyer-Olson D, Schwarting A, Gente K, Dreher M, Hoeper J, Witte T, Thiele T. [The subanalysis of Rheuma-VOR demonstrates a considerable need for rheumatological care]. Z Rheumatol 2024:10.1007/s00393-024-01490-2. [PMID: 38456907 DOI: 10.1007/s00393-024-01490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Early diagnosis and treatment of inflammatory rheumatic diseases can prevent consequential damage such as permanently limited mobility and joint or organ damage. Simultaneously, there is an increasing deficit in medical care owing to the lack of rheumatological capacity. Rural regions are particularly affected. OBJECTIVES The available unconfirmed diagnoses of the study Rheuma-VOR were analysed regarding another definitive inflammatory rheumatic disease. MATERIALS AND METHODS The returned questionnaires of the rheumatologists participating in Rheuma-VOR were screened for definitive inflammatory rheumatic diseases other than the required diagnosis of rheumatoid arthritis, psoriatic arthritis or spondyloarthritis. RESULTS Of 910 unconfirmed diagnoses, in 245 patients another definitive diagnosis could be confirmed. A total of 29.8% of the diagnoses corresponded to degenerative joint changes or chronic pain syndrome, whereas 26.1% involved different forms of inflammatory arthritis. The majority of diagnoses (40.5%) were collagenosis or vasculitis, DISCUSSION: The available data show that a rheumatological presentation was indicated for the majority of patients. Owing to the increasing deficits in medical care a prior selection of the patients is crucial to make optimal use of restricted rheumatological capacities.
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Affiliation(s)
- Stefanie Hirsch
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - K Hoeper
- Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - D Meyer-Olson
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
- m&i Fachklinik Bad Pyrmont und MVZ Weserbergland, Bad Pyrmont, Deutschland
| | - A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - K Gente
- Innere Medizin V- Sektion Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - J Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Deutschland
| | - T Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - T Thiele
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
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Proft F, Vossen D, Baraliakos X, Berliner MN, Fleck M, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Raspe M, Krusche M, Pfeil A. Survey on the working, training, and research conditions of resident physicians in internistic and rheumatological continuing education-BEWUSST. Z Rheumatol 2024; 83:31-39. [PMID: 37847298 PMCID: PMC10879383 DOI: 10.1007/s00393-023-01433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Data on the training and continuing education situation of residents in the field of internal medicine and rheumatology are not available for Germany. For this reason, the Commission for Education and Training of the German Society of Rheumatology (DGRh) initiated the BEWUSST survey on the working, training and research conditions of residents in rheumatology. METHODS A total of 102 questions on the topics of working conditions in everyday professional life, continuing medical education and training, compatibility of career and family, compatibility of work and research, perspectives as a rheumatologist and practical activities were included in an online questionnaire. RESULTS A total of 102 participants took part in the survey. Of the respondents 48.1% were satisfied with their professional situation, 40.2% of the participants were supervised by a specialist mentor and 54.9% were working as scientists during their work as a physician. A compatibility of family and career was possible for 34.7%. After completion of the residency 52.9% of the respondents aspired to a combined clinical and outpatient activity. CONCLUSION Half of the trainee rheumatologists are satisfied with their professional activities, although mentoring of the assistants in training should be further improved. With respect to the desired combined clinical and outpatient activity, the existing options should be expanded or new professional fields of activity should be established, so that the specialty remains attractive for the upcoming generations.
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Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Diana Vossen
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany
| | | | - Michael N Berliner
- Rheumatology and Geriatrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Martin Fleck
- Clinic and Polyclinic for Internal Medicine I, University Hospital Regensburg, Regenburg, Germany
- Clinic and Polyclinic for Rheumatology/Clinical Immunology, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Gernot Keyßer
- Department of Internal Medicine, Clinic for Internal Medicine II, University Hospital Halle, Halle (Saale), Germany
| | - Andreas Krause
- Clinic for Internal Medicine, Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Bernhard Manger
- Medical Clinic 3, Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian Schuch
- Internal Practice Group Rheumatology-Nephrology, Erlangen, Germany
| | - Christof Specker
- Clinic for Rheumatology and Clinical Immunology, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Matthias Raspe
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Krusche
- Section for Rheumatology and Inflammatory Systemic Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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8
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Braun J, Krause A, Schulze-Koops H, Haase I, Kötter I, Hoyer BF, Aringer M, Krusche M, Voormann AJ, Wagner U, Schwarting A, Specker C. [Discipline-specific assessment of the report of the German Society of Internal Medicine e.V. (DGIM) on depiction of the treatment landscape in the field of internal medicine in Germany by the German Society for Rheumatology e.V. (DGRh)]. Z Rheumatol 2023; 82:798-813. [PMID: 37493709 DOI: 10.1007/s00393-023-01375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Jürgen Braun
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- c/o Praxis Dr. Karberg, Schlossstr. 110, 12163, Berlin, Deutschland
- Ruhr Universität Bochum, Bochum, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Deutschland
| | - Isabell Haase
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ina Kötter
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - Bimba Franziska Hoyer
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Exzellenzzentrum für Entzündungsmedizin des Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Martin Aringer
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Martin Krusche
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - Anna Julia Voormann
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland.
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Bereich Rheumatologie an der Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Andreas Schwarting
- Abteilung Rheumatologie und klinische Immunologie, I. Medizinische Klinik der Universität Mainz, Mainz, Deutschland
| | - Christof Specker
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, KEM | Evangelische Kliniken Essen-Mitte gGmbH, Essen, Deutschland
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9
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Braun J, Specker C, Schulze-Koops H, Haase I, Kötter I, Hoyer B, Aringer M, Krusche M, Voormann A, Wagner U, Krause A. [Position paper of the German Society of Rheumatology e.V. (DGRh) regarding the situation of advanced training in the discipline of rheumatology in Germany]. Z Rheumatol 2023; 82:615-620. [PMID: 37335384 DOI: 10.1007/s00393-023-01349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/21/2023]
Affiliation(s)
- J Braun
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- c/o Praxis Dr. Karberg, Schlossstr. 110, 12163, Berlin, Deutschland
- Ruhr Universität Bochum, Bochum, Deutschland
| | - C Specker
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, KEM | Evangelische Kliniken Essen-Mitte gGmbH, Essen, Deutschland
| | - H Schulze-Koops
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Deutschland
| | - I Haase
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - I Kötter
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - B Hoyer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Exzellenzzentrum für Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität, Kiel, Deutschland
| | - M Aringer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - M Krusche
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - A Voormann
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland.
| | - U Wagner
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Bereich Rheumatologie an der Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - A Krause
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
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10
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Ribeiro AL, Dullius L, Sartori NS, Azeredo-da-Silva A, Kohem CL, Coates L, Monticielo OA, Palominos P. Challenges in the Management of Psoriatic Arthritis in Latin America: A Systematic Review. Clin Ther 2023; 45:860-867. [PMID: 37198042 DOI: 10.1016/j.clinthera.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE In 2020, the International League of Associations for Rheumatology published recommendations for managing psoriatic arthritis (PsA), aiming to adapt the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the European Alliance of Associations for Rheumatology recommendations to low-income countries. At that time, the paucity of clinical studies examining the management of patients with PsA in Latin America was remarked on by the international working group. Therefore, the primary objective of this systematic literature review was to investigate the main challenges in managing PsA in Latin America as described in recent publications. METHODS A systematic literature review of trials reporting at least one challenge/difficulty in the management of PsA in Latin America was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. References published in the PubMed, EMBASE, and LILACS (Latin American and Caribbean Health Sciences Literature) databases between 1980 and February 2023 were included. The selection of references was conducted independently by 2 researchers in the Rayyan Qatar Computing Research Institute program. Two other reviewers independently extracted data. All challenges were noted and categorized into domains. Data analysis was descriptive. FINDINGS The search strategy yielded 2085 references, with 21 studies included in the final analysis. Most studies were conducted in Brazil (66.6%; n = 14) and were observational studies (100%; N = 21). Difficulties faced by PsA patients and physicians included the high incidence of opportunistic infections (described in 42.8% of the publications; n = 9), followed by nonadherence to therapy, discordance between patients and physicians regarding remission rates, low drug persistence, limited access to disease-modifying antirheumatic drugs, issues related to the storage of biologic drugs, elevated cost of biologic drugs, limited access to medical care, diagnostic delay, and the individual- and country-level impact of socioeconomic factors on work- and health-related outcomes. IMPLICATIONS Challenges in the management of PsA in Latin America extend beyond the care of opportunistic infections, encompassing several other socioeconomic factors. More research is needed to better understand the peculiarities of treating PsA in Latin America to improve patient care. PROSPERO identifier: CRD42021228297.
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Affiliation(s)
- Andre Lucas Ribeiro
- Hospital de Clínicas de Porto Alegre, Rheumatology Department, Porto Alegre, Brazil.
| | - Larissa Dullius
- Hospital de Clínicas de Porto Alegre, Rheumatology Department, Porto Alegre, Brazil
| | | | | | | | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Rheumatology, Oxford, United Kingdom
| | | | - Penelope Palominos
- Hospital de Clínicas de Porto Alegre, Rheumatology Department, Porto Alegre, Brazil
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11
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Fuchs F, Morf H, Mohn J, Mühlensiepen F, Ignatyev Y, Bohr D, Araujo E, Bergmann C, Simon D, Kleyer A, Vorbrüggen W, Ramming A, Distler JHW, Bartz-Bazzanella P, Schett G, Welcker M, Hueber AJ, Knitza J. Diagnostic delay stages and pre-diagnostic treatment in patients with suspected rheumatic diseases before special care consultation: results of a multicenter-based study. Rheumatol Int 2023; 43:495-502. [PMID: 36214864 PMCID: PMC9968271 DOI: 10.1007/s00296-022-05223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
Early and effective discrimination (triage) of patients with inflammatory rheumatic diseases (IRD) and other diseases (non-IRD) is essential for successful treatment and preventing damage. The aim of this study was to investigate diagnostic delays and pre-diagnosis treatment in patients newly presenting to rheumatology outpatient clinics. A total of 600 patients newly presenting to one university hospital and two non-academic centers were included. Time from onset of symptoms to rheumatology consultation "total delay" as well as medical treatment before consultation were recorded. Median time from symptom onset to rheumatologist appointment (total delay) was 30 weeks. Median time to online search, first physician appointment request and first physician appointment was 2, 4 and 5 weeks, respectively. Total delay was significantly shorter for IRD patients compared to non-IRD patients, 26 vs 35 weeks (p = 0.007). Only 17.7% of all patients and 22.9% of IRD patients had a delay of less than 12 weeks. Total delay was significantly lower in patients seen in non-academic centers compared to the university center, 20 vs 50 weeks (p < 0.0001). 32.2% of IRD patients received medical treatment that eased their symptoms prior to the rheumatology appointment. These findings highlight the persistent diagnostic delays in rheumatology; however, they also suggest that current triage strategies effectively lead to earlier appointments for IRD patients. Improvement of triage methods and pre-diagnosis treatment could decrease overall burden of disease in IRD patients.
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Affiliation(s)
- Franziska Fuchs
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Harriet Morf
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jacob Mohn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Felix Mühlensiepen
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Neuruppin, Germany
| | - Yuriy Ignatyev
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Neuruppin, Germany
| | - Daniela Bohr
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Elizabeth Araujo
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wolfgang Vorbrüggen
- Verein Zur Förderung Der Rheumatologie E.V, Würselen, Germany.,RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter Bartz-Bazzanella
- RheumaDatenRhePort (rhadar), Planegg, Germany.,Klinik Für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Welcker
- Klinik Für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany.,MVZ Für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
| | - Axel J Hueber
- Division of Rheumatology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany.,Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. .,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
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12
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[How many patients with inflammatory rheumatic diseases have the technical prerequisites for video consultations and are also willing to use this to carry out visits by medical specialist visits?]. Z Rheumatol 2023; 82:102-107. [PMID: 34152435 PMCID: PMC8215311 DOI: 10.1007/s00393-021-01026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The currently disseminating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and limited capacities in outpatient rheumatological care, pose questions about possible alternatives to clinical visits, also in view of the digital revolution. It is unclear whether and to what extent patients with inflammatory rheumatic diseases are willing and in a position to deal with the new media, such as video consultation. METHODS In the middle of the pandemic in May 2020 outpatients were surveyed using a standardized questionnaire in order to document their possibilities and willingness to participate in a video consultation. The treating physicians were asked whether carrying out a video consultation was considered to be a possible and meaningful option. RESULTS Overall, 232 patients with inflammatory rheumatic diseases were surveyed (64.7% female, average age 54.0 ± 15.2 years), seropositive (n = 58) and seronegative (n = 51) rheumatoid arthritis (RA), spondyloarthritis (SpA, n = 77) including axial SpA (axSpA) and psoriatic arthropathy (PsA) as well as collagenosis and vasculitis (CoV, n = 46). The mean duration of disease was 5.5 ± 8.2 years, whereby in 75 patients (32.3%) it was the first diagnosis. The mean disease activity (0-10, subjective patient self-estimation) was 4.7 ± 2.5. Overall, 176 patients were basically aware of the possibility to carry out video consultations (75.9%) and 166 considered that they were technically capable to participate (71.6%) but only 131 were principally willing to participate (56.5%). Logistic regression analyses showed that the willingness to participate in video consultations decreased with increasing age (β = 0.28, p = 0.01). According to the medical estimation video consultations were thought to be principally possible for 161 patients for technical reasons (69.4%) and for 127 for medical reasons (54.7%); however, a video consultation within the framework of treatment was only considered to be meaningful by the physician for 76 patients (32.8%). CONCLUSION Not all patients can or want to participate in video consultations and the willingness declines with increasing age. The estimation of the meaningfulness of video consultations by physicians was also limited to approximately one third of the patients surveyed. This must be taken into consideration for the future planning of video consultations.
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13
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Kiltz U, Buschhorn-Milberger V, Albrecht K, Lakomek HJ, Lorenz HM, Rudwaleit M, Schneider M, Schulze-Koops H, Aringer M, Hasenbring MI, Herzer P, von Hinüber U, Krüger K, Lauterbach A, Manger B, Oltman R, Schuch F, Schmale-Grede R, Späthling-Mestekemper S, Zinke S, Braun J. [Development of quality standards for patients with rheumatoid arthritis for use in Germany]. Z Rheumatol 2022; 81:744-759. [PMID: 34652486 PMCID: PMC9646547 DOI: 10.1007/s00393-021-01093-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Despite a qualitatively and structurally good care of patients with rheumatoid arthritis (RA) in Germany, there are still potentially amendable deficits in the quality of care. For this reason, the German Society for Rheumatology (DGRh) has therefore decided to ask a group of experts including various stakeholders to develop quality standards (QS) for the care of patients with RA in order to improve the quality of care. The QS are used to determine and quantitatively measure the quality of care, subject to relevance and feasibility. The recently published NICE and ASAS standards and a systematic literature search were used as the basis for development. A total of 8 QS, now published for the first time, were approved with the intention to measure and further optimize the quality of care for patients with RA in Germany.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
- Ruhr-Universität Bochum, Bochum, Deutschland.
| | | | - K Albrecht
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - H-J Lakomek
- Johannes-Wesling-Klinikum Minden, Universitätsklinik für Geriatrie, Minden, Deutschland
| | - H-M Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - M Rudwaleit
- Universitätsklinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Universität Bielefeld, Bielefeld, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, LMU-Klinikum München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Aringer
- Medizinische Klinik und Poliklinik III, Rheumatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M I Hasenbring
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - P Herzer
- Medicover München MVZ, München, Deutschland
| | - U von Hinüber
- Praxis für Rheumatologie und Osteologie, Hildesheim, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum St. Bonifatius, München, Deutschland
| | - A Lauterbach
- Physiotherapieschule Friedrichsheim, Friedrichsheim, Deutschland
| | - B Manger
- Medizinische Klinik 3 Rheumatologie und Immunologie, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen/Nürnberg, Erlangen, Deutschland
| | - R Oltman
- Hochschule für Gesundheit Bochum, Bochum, Deutschland
| | - F Schuch
- Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Deutschland
| | | | | | - S Zinke
- Rheumatologische Schwerpunktpraxis Zinke, Berlin, Deutschland
- Bundesverband Deutscher Rheumatologen e. V. (BDRh), Grünwald, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland
- Ruhr-Universität Bochum, Bochum, Deutschland
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14
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Kuhlmann E, Bruns L, Hoeper K, Witte T, Ernst D, Jablonka A. [Health workforce development in rheumatology : A mapping exercise and wake-up call for health policy]. Z Rheumatol 2022; 81:717-729. [PMID: 34003376 PMCID: PMC8129704 DOI: 10.1007/s00393-021-01012-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Health workforce shortage in German rheumatology has been identified as a healthcare service and delivery problem. Health policy has increased staffing targets, yet effective intervention strategies are lacking. This research aimed to systematically map the rheumatology workforce to improve the evidence for interventions and explore possibilities for more effective health workforce management. METHODS The WHO National Health Workforce Accounts provided a conceptual framework for the mapping exercise. Four major sets of indicators were selected, comprising staffing levels, health labor market flows, composition and education/training. A comparison of age groups and time series was applied to explore trends. Public statistics and other secondary sources served our analysis using descriptive methodology. RESULTS In Germany there are 1076 physicians specialized in internal medical rheumatology. Absolute numbers have nearly doubled (91%) since 2000 but with a strong demographic bias. Between 2000 and 2019 numbers markedly increased in the group aged 50 years and older but only by 9% in the younger group under 50 years; since 2010 the group aged 40-50 years even faces a decrease. In 2019, the absolute numbers of rheumatologists in retirement age exceeded those aged 40 years and under. Since 2015 an expanding workforce trend has overall flattened but this was strongest in the hospital sector; the numbers in resident training did not show any relevant growth. CONCLUSION Health workforce trends reveal that an available number of rheumatologists cannot meet new health policy planning targets. There is a need for effective health workforce management, focusing on innovation in resident training, improved task delegation and gender equality.
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Affiliation(s)
- Ellen Kuhlmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Luzia Bruns
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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15
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Pachowsky ML, Morf H, Simon D, Schönau V, Valor-Mendez L, Knitza J, Fagni F, Engel K, Uder M, Hueber A, Schmidkonz C, Schett G, Kleyer A. Cinematic rendering in rheumatic diseases—Photorealistic depiction of pathologies improves disease understanding for patients. Front Med (Lausanne) 2022; 9:946106. [PMID: 35991672 PMCID: PMC9387553 DOI: 10.3389/fmed.2022.946106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatient education is crucial for successful chronic disease management. Current education material for rheumatic patients however rarely includes images of disease pathologies, limiting patients’ disease understanding. Cinematic rendering (CR) is a new tool that allows segmentation of standard medical images (DICOMs) into pictures that illustrate disease pathologies in a photorealistic way. Thus CR has the potential to simplify and improve the explanation of disease pathologies, disease activity and disease consequences and could therefore be a valuable tool to effectively educate and inform patients about their rheumatic and musculoskeletal disease (RMD).ObjectivesTo examine the feasibility of creating photorealistic images using CR from RMD patients depicting typical rheumatic disease pathologies and, in a second step to investigate the patient-perceived educational potential of these photorealistic images in clinical routine.MethodsWe selected conventional, high-resolution (HR) and positron emission tomography (PET) computed tomography (CT) images of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), and giant cell arteritis (GCA) that showed typical respective disease pathologies. These images were segmented using CR technique. In a prospective study, physicians used CR-enhanced and conventional original images to explain the depicted pathognomonic pathologies to patients with the respective rheumatic disease. Patients were then asked to complete a questionnaire evaluating the perceived usefulness of being presented with CR-enhanced images to better understand their underlying disease.ResultsCR images were successfully generated from above mentioned CT methods. Pathologies such as bone erosions, bony spurs, bone loss, ankylosis, and PET-based inflammation could be visualized in photorealistic detail. A total of 79 patients (61% females) with rheumatic diseases (RA 29%, PsA 29%, axSpA 24%, GCA 18%) were interviewed and answered the quantitative questionnaire. Mean age was 55.4 ± 12.6 years. Irrespective of disease, all patients agreed or highly agreed that CR-based images help to improve disease understanding, should be shown at disease onset, provide a rationale to regularly take medication and would like to have access to their own CR-enhanced images.ConclusionConventional disease images can successfully be turned into photorealistic disease depictions using CR. Patients perceived CR images as a valuable addition to current patient education, enabling personalized disease education and potentially increased medication adherence.
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Affiliation(s)
- Milena L. Pachowsky
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Harriet Morf
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Verena Schönau
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Larissa Valor-Mendez
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Michael Uder
- Institute of Radiology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel Hueber
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Industrial Engineering and Health, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- *Correspondence: Arnd Kleyer,
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16
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Benesova K, Hansen O, Sander O, Feuchtenberger M, Nigg A, Voigt A, Seipelt E, Schneider M, Lorenz HM, Krause A. [Further development of regional early care-Many roads lead to Rome : Developmental stages of four established rheumatological early care concepts in different regions of Germany]. Z Rheumatol 2022; 81:445-462. [PMID: 35670879 PMCID: PMC9171475 DOI: 10.1007/s00393-022-01220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
In order to shorten the prognostically relevant waiting time until diagnosis and initiation of appropriate treatment in inflammatory rheumatic diseases, rheumatological centers in many regions across Germany have established and continuously developed specific early care concepts. Evaluated models from Altötting·Burghausen, Berlin Buch, Düsseldorf and Heidelberg and their developmental stages as a response to internal and external challenges are presented in this overview. The transparent publication of the developmental steps and the exchange of experiences aim at promoting new early care concepts in other regions and continuing the joint dialogue for improvement of the early detection and quality of care of inflammatory rheumatic diseases in Germany.
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Affiliation(s)
- K Benesova
- Innere Medizin V, Sektion Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - O Hansen
- Innere Medizin V, Sektion Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - O Sander
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Feuchtenberger
- MVZ MED|BAYERN OST Altötting·Burghausen, Burghausen, Deutschland
| | - A Nigg
- MVZ MED|BAYERN OST Altötting·Burghausen, Burghausen, Deutschland
| | - A Voigt
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - E Seipelt
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H-M Lorenz
- Innere Medizin V, Sektion Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
- ACURA Rheumazentrum Baden-Baden, Baden-Baden, Deutschland
| | - A Krause
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
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17
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Pfeil A, Schuch F, Fleck M. [Further training in rheumatology-Current status 2022]. Z Rheumatol 2022; 81:482-486. [PMID: 35394195 DOI: 10.1007/s00393-022-01196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
For the continued existence of the specialty of internal medicine and rheumatology and the assurance of a qualitative patient care, attractive further education for motivated resident physicians is of central importance. Continuing training in rheumatology takes place primarily in the inpatient setting, although reliable figures on outpatient and inpatient further education positions are not yet available. Further training in rheumatology is predefined by the model further training regulations (Musterweiterbildungsverordnung; MWBO) 2018, which have now been implemented by most state medical associations, in some cases with state-specific changes. Based on the MWBO of 2018, a model curriculum was developed by the German Society of Rheumatology (DGRh) for further training in the specialty of internal medicine and rheumatology. This model curriculum is intended to provide orientation for trainees and trainers as well as to facilitate structured rheumatology training in inpatient and outpatient settings.
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Affiliation(s)
- Alexander Pfeil
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie und Osteologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Florian Schuch
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - Martin Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regenburg, Deutschland.,Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland
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18
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Fiori W, Lakomek HJ, Strunk J, Klemann A. [Rheumatologic inpatient treatment-more than a complex treatment : Data reflecting services and structures]. Z Rheumatol 2022; 81:472-481. [PMID: 35364743 PMCID: PMC8974805 DOI: 10.1007/s00393-022-01190-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
Zur Bestandsaufnahme und Vorbereitung auf bevorstehende Reformen wurden Daten aus dem Institut für das Entgeltsystem im Krankenhaus(InEK)-Datenbrowser und den strukturierten Qualitätsberichten für die akutstationäre Rheumatologie ausgewertet. Die Versorgung ist sowohl in Bezug auf die Diagnosen als auch die Strukturen sehr vielschichtig. Unterschiedliche Formen der Spezialisierung können identifiziert werden. Dabei ist die rheumatologische Komplexbehandlung (RKB) nur eine davon, die im Mittel in knapp über 10 % der Fälle durchgeführt wird. 2020 gingen die Fallzahlen bei ausgewählten rheumatologischen Diagnosen um mehr als 20 % im Vergleich zu 2019 zurück. Bei der RKB war der Rückgang mit über 30 % noch ausgeprägter. Hinweise auf eine höhere Krankheitsschwere fanden sich in den verfügbaren Daten nicht. Es bleibt abzuwarten, ob das Fallzahlniveau der Vor-Corona-Zeit in den nächsten Jahren wieder erreicht wird. Es wurden 146 Organisationseinheiten (OE) mit mehr als 20 Hauptdiagnosen (HD) einer rheumatoiden Arthritis (RA) im Jahr 2019 identifiziert; 47 (32 %) davon haben mehr als 10-mal, 29 (20 %) mehr als 100-mal eine RKB kodiert. Alle 23 OE mit mehr als 300 HD RA sind Mitglieder im Verband rheumatologischer Akutkliniken (VRA); 15 davon nahmen am KOBRA-Qualitätsprojekt teil und tragen das VRA-Gütesiegel. Von den 116 internistischen OE weisen nur 55 (47 %) einen spezifischen rheumatologischen Fachabteilungsschlüssel nach § 301 SGB V auf. Angaben zur fachärztlichen Ausstattung waren zum Teil widersprüchlich. Wie viele Fälle mit entzündlich-rheumatischen Erkrankungen in fachlich spezialisierten Strukturen behandelt werden, kann mit den verfügbaren Daten nicht beantwortet werden. Dennoch können die verfügbaren Daten für die fachlichen, strukturellen und organisatorischen Weiterentwicklungen in der akutstationären Rheumatologie genutzt werden.
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Affiliation(s)
- Wolfgang Fiori
- DRG-Research-Group, Roeder & Partner Ärzte PartG, Am Dorn 10, 48308, Senden, Deutschland.
| | - Heinz-Jürgen Lakomek
- Verband rheumatologischer Akutkliniken e. V., Berlin, Deutschland.
- Universitätsklinik für Geriatrie, Johannes Wesling Klinikum Minden, Universitätsklinikum der Ruhr-Universität Bochum, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - Johannes Strunk
- Verband rheumatologischer Akutkliniken e. V., Berlin, Deutschland
- Klinik für Rheumatologie, Krankenhaus Porz am Rhein, Köln, Deutschland
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19
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Krause* D, Mai* A, Denz R, Johow J, Reese JP, Westerhoff B, Klaaßen-Mielke R, Timmesfeld N, Rittstieg A, Saracbasi-Zender E, Günzel J, Klink C, Schmitz E, Fendler C, Raub W, Böddeker S, Dybowski F, Hübner G, Menne HJ, Lakomek HJ, Sarholz M, Trampisch U, J. Trampisch H, Braun J. The Structured Delegation of Medical Care Services for Patients With Inflammatory Rheumatic Diseases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:157-164. [PMID: 35101166 PMCID: PMC9215273 DOI: 10.3238/arztebl.m2022.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In some areas of Germany, there is a shortage of specialist physicians for patients with inflammatory rheumatic diseases. Delegating certain medical care services to qualified, specialized rheumatological assistants (SRAs) might be an effective way to supplement the available capacity for specialized medical care. METHODS Patients under stable treatment for rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were included in this trial, which was designed to demonstrate, in a first step, the non-inferiority of a form of care involving delegation of physicians' tasks to SRAs (team-based care), in comparison to standard care, with respect to changes in disease activity at one year. "Non-inferiority," in this context, means either superiority or else an irrelevant extent of inferiority. In a second step, in case non-inferiority could be shown, the superiority of team-based care with respect to changes in patients' health-related quality of life would be tested as well. Disease activity was measured with the Disease Activity Score 28, and health-related quality of life with the EQ-5D-5L. This was a randomized, multicenter, rater-blinded trial with two treatment arms (team-based care and standard care). The statistical analysis was performed with mixed linear models (DRKS00015526). RESULTS From September 2018 to June 2019, 601 patients from 14 rheumatological practices and 3 outpatient rheumatological clinics in the German states of North Rhine-Westphalia and Lower Saxony were randomized to either team-based or standard care. Team-based care was found to be non-inferior to standard care with respect to changes in disease activity (adjusted difference = -0.19; 95% confidence interval [-0.36; -0.02]; p <0.001 for non-inferiority). Superiority with respect to health-related quality of life was not demonstrated (adjusted difference = 0.02 [-0.02; 0.05], p = 0.285). CONCLUSION Team-based care, with greater integration of SRAs, is just as good as standard care in important respects. Trained SRAs can effectively support rheumatologists in the care of stable patients with RA or PsA.
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Affiliation(s)
- Dietmar Krause*
- *The authors contributed equally to this paper
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Anna Mai*
- *The authors contributed equally to this paper
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Robin Denz
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Johannes Johow
- Coordination Center for Clinical Trials of Philipps University Marburg
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, Julius Maximilian University Würzburg
| | | | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Annette Rittstieg
- *The authors contributed equally to this paper
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | | | - Judith Günzel
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Claudia Klink
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Elmar Schmitz
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Claas Fendler
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Wolf Raub
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Stephanie Böddeker
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Friedrich Dybowski
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Georg Hübner
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Hans-Jürgen Menne
- Specialist rheumatology practices in North Rhine–Westphalia and Lower Saxony
| | - Heinz-Jürgen Lakomek
- Johannes Wesling Minden Hospital, Germany, Department of Rheumatology and Physical Medicine
| | | | - Ulrike Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Hans J. Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum
| | - Jürgen Braun
- The Ruhr District Rheumatology Center, Ruhr University Bochum
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20
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Edelmann E, Schuch F. [Rheumatology in private practice: yesterday-today-tomorrow]. Z Rheumatol 2021; 80:801-818. [PMID: 34709435 DOI: 10.1007/s00393-021-01107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Rheumatologic practices were still rare in the early 1990s and rheumatologic treatment took place mainly in the rheumatology clinics and university rheumatology clinics. In the following decades, the number of the rheumatologists in private practices increased and in the year 2004 about two thirds of the outpatient care were already carried out in private practices. In 2020 a total of 597 rheumatologists out of 1106 nationwide worked in private practices, including 203 who were employed. Since 2008, the number of rheumatologists in medical care centers increased more than the number of rheumatologists in private practice. In 2020 only 75% of panel rheumatologists in private practice were in full-time employment. This development to an altered work mentality of the incoming generation and an age structure in which approximately 30% of panel rheumatologists are older than 60 years, threatens a further deterioration of the anyway insufficient outpatient care. In contrast, there are developments that strengthen the outpatient care especially in practices, such as the outpatient specialist medical care and quality-oriented selective contracts as well as rheumatological and immunological laboratory diagnostics. These cornerstones give rheumatology a special position in the panel medical care within the group of specialties in internal medicine and an attractive economic basis. In addition to the medically and scientifically interesting discipline, this could be a further incentive for young trainees to choose rheumatology as a specialty and working in a private practice.
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Affiliation(s)
- Edmund Edelmann
- Rheumazentrum Bad Aibling Erding, Lindenstr. 2, 83043, Bad Aibling, Deutschland.
| | - Florian Schuch
- Internistische Praxisgemeinschaft Rheumatologie Nephrologie, Erlangen, Deutschland
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21
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Meyer-Olson D, Hoeper K. [Rehabilitation in Rheumatoid Arthritis]. REHABILITATION 2021; 60:339-354. [PMID: 34655068 DOI: 10.1055/a-1275-2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Die rheumatoide Arthritis stellt unter den Erkrankungen des Bewegungssystems eine
besondere Herausforderung für die Rehabilitationsmedizin dar 1. Eine genaue Kenntnis der Erkrankung,
inklusive der medikamentösen und der nicht medikamentösen
Behandlungsoptionen, ist die wesentliche Voraussetzung für einen
nachhaltigen Rehabilitationserfolg und um den berechtigen Anspruch der
Erkrankten auf berufliche und soziale Partizipation umzusetzen.
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22
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Froschauer S, Muth T, Bredow L, Feist E, Heinemann-Dammann SP, Zinke S, Fiehn C. [Care atlas rheumatology : Approaches and concepts for improving care in outpatient rheumatology]. Z Rheumatol 2021; 80:819-826. [PMID: 34535817 DOI: 10.1007/s00393-021-01072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
Inflammatory rheumatic diseases affect 1.5 million adults and an estimated 20,000 children and adolescents throughout Germany. The successful treatment of these patients is largely based on the availability of high-quality medical care. To be able to provide sufficient care and prevent long waiting times even though the number of rheumatologists is below demand, efficient practice structures and approaches that go beyond standard care play an important role. The present study takes a look at the current state of rheumatological outpatient care as well as innovative care initiatives to support the service provision structures and to improve the care situation in rheumatology and points out: to ensure guideline-based care despite scarce resources, selective contracts, integrated outpatient specialist care (ASV), early or emergency consultation hours, disease management programs (DMP) and appropriate delegation of medical services play an important role. New care concepts increasingly focus on interdisciplinary cooperation (DMP and ASV), strengthened self-management through structured patient training (DMP) and targeted patient management through screening tools. To ensure an up to date and high-quality treatment in the long term, an increase in further training in rheumatology is necessary. This should be achieved by attracting more students and, if necessary, adjusting the training system.
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Affiliation(s)
- Sonja Froschauer
- Berufsverband Deutscher Rheumatologen e. V., Dr.-Max-Str. 21, 82031, Grünwald, Deutschland.
| | | | | | - Eugen Feist
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | | | - Silke Zinke
- Rheumatologische Schwerpunktpraxis, Berlin, Deutschland
| | - Christoph Fiehn
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie, Medical Center Baden-Baden, Baden-Baden, Deutschland
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23
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Hoeper JR, Zeidler J, Meyer SE, Gauler G, Steffens-Korbanka P, Welcker M, Wendler J, Schuch F, von Hinüber U, Schwarting A, Witte T, Meyer-Olson D, Hoeper K. Effect of nurse-led care on outcomes in patients with ACPA/RF-positive rheumatoid arthritis with active disease undergoing treat-to-target: a multicentre randomised controlled trial. RMD Open 2021; 7:rmdopen-2021-001627. [PMID: 33863842 PMCID: PMC8055148 DOI: 10.1136/rmdopen-2021-001627] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To determine the non-inferiority of nurse-led care (NLC) in patients with anticitrullinated protein antibody (ACPA)-positive and/or rheumatoid factor (RF)-positive rheumatoid arthritis (RA) with active disease who are starting disease-modifying antirheumatic drug therapy, following treat-to-target (T2T) recommendations. Methods A multicentre, pragmatic randomised controlled trial was conducted to assess clinical effectiveness, anxiety, depression and patient satisfaction following a non-inferiority design. The participants were 224 adults with ACPA/RF-positive RA who were randomly assigned to either NLC or rheumatologist-led care (RLC). The primary outcome was the Disease Activity Score in 28 Joints measured with C reactive protein (DAS28-CRP) assessed at baseline and after 3, 6, 9 and 12 months. A DAS28-CRP difference of 0.6 was set as the non-inferiority margin. Mean differences between the groups were assessed following per-protocol and intention-to-treat strategies. Results Demographic data and baseline characteristics of patients in the NLC group (n=111) were comparable to those of patients in the RLC group (n=113). The improvement in disease activity (change in DAS28-CRP, primary outcome) over the course of 12 months was significant in both groups (p<0.001). No significant differences were observed between the NLC and RLC groups (p=0.317). Non-inferiority of NLC was shown for the primary outcome and all secondary outcomes. Conclusion This study supported the non-inferiority of NLC in managing T2T and follow-up care of patients with RA with moderate to high disease activity and poor prognostic factors in addition to RLC. Trial registration number DRKS00013055.
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Affiliation(s)
- Juliana Rachel Hoeper
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Germany.,Rheumatologie and Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover, Germany
| | - Sara Eileen Meyer
- Rheumatologie and Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | | - Jörg Wendler
- Internistische Praxisgemeinschaft, Rheumatologie, Erlangen, Germany
| | - Florian Schuch
- Internistische Praxisgemeinschaft, Rheumatologie, Erlangen, Germany
| | | | - Andreas Schwarting
- Division of Rheumatology and Clinical Immunology, University Hospital Mainz, Mainz, Germany.,ACURA Rheumatology Center Rhineland-Palatinate, Bad Kreuznach, Germany
| | - Torsten Witte
- Rheumatologie and Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Dirk Meyer-Olson
- Rheumatologie and Immunologie, Medizinische Hochschule Hannover, Hannover, Germany.,Rheumatologie, m&i Fachklinik Bad Pyrmont, Bad Pyrmont, Germany
| | - Kirsten Hoeper
- Rheumatologie and Immunologie, Medizinische Hochschule Hannover, Hannover, Germany
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24
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Lakomek HJ, Rudwaleit M, Hentschel A, Broge B, Abrolat J, Bessler F, Hellmich B, Klemann A, Krause A, Klass M, Strunk J, Fiori W, Roeder N, Braun J. [Quality in acute inpatient rheumatology 2021 : Current aspects of the KOBRA quality label of the Association of Rheumatological Acute Care Clinics]. Z Rheumatol 2021; 80:758-770. [PMID: 33999267 PMCID: PMC8127451 DOI: 10.1007/s00393-021-01015-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 12/02/2022]
Abstract
Mit einer umfassenden gesundheitspolitischen Qualitätsoffensive ab 2021 sollen die Qualität und Transparenz in der Versorgung von Menschen mit Krankheiten in Krankenhäusern in Deutschland verbessert werden. Gesetzliche Vorgaben zu Mindestmengen und die Ausweitung von Qualitätsverträgen zwischen Kostenträgern und Krankenhäusern sowie die Verwendung von planungsrelevanten Qualitätsindikatoren für eine bedarfs- und qualitätsorientierte Weiterentwicklung der stationären Versorgung werden den Wettbewerb in der Versorgungsqualität zwischen den Krankenhäusern verstärken. Dem Thema „Entwicklung und Definition von Qualität in der Medizin“ hat sich auch der Verband der Rheumatologischen Akutkliniken e. V. (VRA) schon früh nach der Gründung im Jahr 1998 umfassend angenommen. Im Zentrum der akutstationären Qualitätssicherung stehen verbindlich festgelegte Strukturkriterien in Verknüpfung mit dem 2003 in der Rheumatologie gestarteten und bis heute kontinuierlich durchgeführten KOBRA-Projekt (Kontinuierliches Outcome Benchmarking in der Rheumatologischen Akutversorgung) mit der Messung von Prozess- und Ergebnisqualität. Auf der Basis dieses Rahmenkonzeptes (Erfüllung der Strukturkriterien und Durchführung des KOBRA-Projektes) können erfolgreich teilnehmende rheumatologische Einrichtungen für jeweils 2 Jahre das KOBRA-Label erwerben, welches von der Projektleitung – dem aQua-Institut – vergeben wird. Die herausragende Stellung des KOBRA-Projektes wird beispielhaft anhand von Datenauswertungen des Projektzyklus 2018 gezeigt mit Auswertungen zum Therapiestrategiewechsel bei aktiver rheumatoider Arthritis, Diagnosesicherung von Kollagenosen und Vaskulitiden während des stationären Aufenthaltes sowie zur partizipativen Entscheidungsfindung bei rheumatoider Arthritis. Auf den gesundheitspolitisch geforderten „Paradigmenwechsel – weg vom Bett, hin zu einer leistungs-, bedarfs- und qualitätsorientierten Planung“ – ist die akutstationäre Rheumatologie mit der Verankerung von Projekten zur Struktur‑, Prozess- und Ergebnisqualität sehr gut vorbereitet. Für die in der vom Gemeinsamen Bundesausschuss (G-BA) erstellten Richtlinie zu „Rheumatologischen Zentren“ geforderten Qualitätssicherung ist das KOBRA-Projekt ebenfalls eine sehr gute Voraussetzung.
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Affiliation(s)
- H-J Lakomek
- Universitätsklinik für Geriatrie, Johannes-Wesling-Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - M Rudwaleit
- Universitätsklinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Bielefeld, Deutschland
| | - A Hentschel
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
| | - B Broge
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
| | - J Abrolat
- Klinik an der Weißenburg, Uhlstädt-Kirchhasel, Deutschland
| | - F Bessler
- Geschäftsbereich Medizin, Ev. Stiftung Volmarstein, Wetter, Deutschland
| | - B Hellmich
- Innere Medizin, Rheumatologie und Immunologie, medius Klinik Kirchheim, Kirchheim unter Teck, Deutschland
| | - A Klemann
- St.-Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - A Krause
- Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin-Wannsee, Deutschland
| | - M Klass
- Rheumatologie und Physikalische Therapie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - J Strunk
- Abteilung Rheumatologie, Krankenhaus Porz am Rhein, Köln, Deutschland
| | - W Fiori
- Roeder & Partner, Ärzte Partnerschaftsgesellschaft, Senden, Deutschland
| | - N Roeder
- Roeder & Partner, Ärzte Partnerschaftsgesellschaft, Senden, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Deutschland
- Ruhr-Universität Bochum, Herne, Deutschland
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25
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Fleck M, Hoyer BF. [The path to rheumatology]. Z Rheumatol 2021; 80:1. [PMID: 33559735 DOI: 10.1007/s00393-020-00958-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland. .,Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland.
| | - B F Hoyer
- Klinik für Innere Medizin I, Rheumatologie/klinische Immunologie und Exzellenzzentrum Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
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26
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Mucke J, Hoyer BF, Leipe J. [Paths to academic rheumatology]. Z Rheumatol 2020; 80:14-21. [PMID: 33337533 DOI: 10.1007/s00393-020-00942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The development of rheumatology into one of the most progressive medical disciplines is mainly based on the enormous scientific knowledge gained in recent decades. Physician scientists have played a substantial role in this development. With respect to the ongoing challenges, physician scientists will be urgently needed in the future. Therefore, young physicians need to be attracted to scientific research in rheumatology. OBJECTIVE This article describes possible paths into academic rheumatology, highlights facilitators and barriers to a scientific career and discusses ideas for the recruitment of young scientists for rheumatology based on the existing literature. RESULTS AND DISCUSSION It is without doubt that young scientists are urgently needed in rheumatology; however, the number of young physician scientists seems to be declining. The paths to academic rheumatology are manifold and variable but setting the course early on during medical school by science-oriented teaching, research internships and doctoral theses, appears to be advantageous. Favorable factors for the decision to pursue an academic career in rheumatology are enjoyment in research, recognition of research rotations for rheumatology training and improved career opportunities. The greatest barriers are considered to be the exemption from clinical duties as well as lack of experience with scientific methods and acquisition of research funding. Therefore, it is important to make potential scientists enthusiastic about the research underlying modern rheumatology and to encourage research during medical school in order to attract young people to academic rheumatology.
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Affiliation(s)
- J Mucke
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - B F Hoyer
- Abteilung für Rheumatologie und klin. Immunologie, Exzellenzzentrum Entzündungsmedizin, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - J Leipe
- Sektion Rheumatologie, V. Medizinische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. .,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.
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27
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Lakomek HJ, Krause A, Braun J, Hellmich B, Klass M, Lorenz H, Schneider M, Schulze-Koops H, Specker C. [Future of acute inpatient rheumatology in Germany : Statement of the Boards of the German Society for Rheumatology and the Association of Rheumatological Acute Clinics on hospital planning North-Rhine/Westphalia 2019 for the discipline rheumatology]. Z Rheumatol 2020; 80:103-106. [PMID: 33313964 PMCID: PMC7872996 DOI: 10.1007/s00393-020-00939-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/03/2022]
Abstract
Im September 2019 wurde vom Ministerium für Arbeit, Gesundheit und Soziales (MAGS) in NRW ein Gutachten zur Krankenhausplanung veröffentlicht. Hierin wurde eine grundlegende Reform der Krankenhausplanung empfohlen, indem zukünftig eine Bedarfsplanung auf der Grundlage einer detaillierten Ausweisung von Leistungsbereichen und Leistungsgruppen erfolgen soll. Nach Aufforderung durch das MAGS NRW hat auch die Deutsche Gesellschaft für Rheumatologie (DGRh) mit Unterstützung des Verbandes Rheumatologischer Akutkliniken (VRA) hierzu Stellung genommen.
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Affiliation(s)
- H-J Lakomek
- Universitätsklinik für Geriatrie, Mühlenkreiskliniken, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - A Krause
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet und Ruhr-Universität Bochum, Herne, Deutschland
| | - B Hellmich
- Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken - Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim u. Teck, Deutschland
| | - M Klass
- Klinik für Rheumatologie und Physikalische Therapie, Helios St. Johannes Klinik, Duisburg, Deutschland
| | - H Lorenz
- Sektion Rheumatologie, Med. Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,ACURA-Rheumazentrum Baden-Baden, Baden-Baden, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Evang. Krankenhaus Essen-Werden, Kliniken Essen-Mitte, Essen, Deutschland
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28
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[Regional cooperative rheumatology centers : Networking of rheumatology in Germany for over 25 years]. Z Rheumatol 2020; 79:969-974. [PMID: 33258974 PMCID: PMC7705428 DOI: 10.1007/s00393-020-00903-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 12/25/2022]
Abstract
Over the last 25 years the regional collaborative rheumatology centers have become established throughout Germany as "catalysts" for improving rheumatological care at many different levels. With campaigns and a multitude of activities they have promoted the visibility of rheumatology in Germany together with rheumatological alliance partners and, on the scientific side, together with the German Rheumatism Research Center have contributed to the improvement of rheumatological care research in Germany. The regional cooperative rheumatology centers have become an important partner in the rheumatology network in their association as a working group of the German Society for Rheumatology and they will continue to face new tasks in the future to further improve rheumatological care in Germany.
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29
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Aringer M, Baerwald C, Bergner R, Feuchtenberger M, Gebhardt C, Hagen M, Keyßer G, Lorenz HM, Witte T. [Rheumatology in German MD curricula]. Z Rheumatol 2020; 80:2-8. [PMID: 33269410 PMCID: PMC7709903 DOI: 10.1007/s00393-020-00933-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
Transmitting a substantial amount of basic knowledge in Rheumatology to all medical students is essential for the future medical care of patients with rheumatic diseases for two reasons: on the one hand, future general practitioners will need to master the patterns of rheumatic diseases to recognize them fast enough in new-onset patients and to refer them in time and directly to rheumatologists. On the other hand, the shortage of rheumatologists can only then be relieved in the future when we are able to inspire enthusiasm for our specialty. Adequate rheumatological structures are established only in some of the German faculties of medicine. Structural improvements happen in small steps only but were achieved at several sites. The better the local structures, the higher the chances of committed university teachers in rheumatology to reach all medical students. Probably from 2026 onwards, the learning objectives relevant for examinations will be defined by the national competence-based catalogue of learning objectives in medicine (NKLM), which is currently in the final stages of completion together with the German Federal Institute for Medical and Pharmaceutical Examinations (IMPP). It now appears that systemic autoimmune diseases and inflammatory rheumatic diseases are adequately depicted in this catalogue. If this is achieved, students will know more about these diseases in the future and will diagnose them faster in patients. Work on the NKLM is therefore of highest importance. In addition to the work on the learning objectives, up to date learning materials are required, which have to be available throughout Germany. A Rheumatology script just finished by the committee for medical student education of the German Society of Rheumatology (DGRh) and now available on the DGRh homepage should close this gap.
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Affiliation(s)
- M Aringer
- Bereich Rheumatologie, Medizinische Klinik und Poliklinik III und UniversitätsCentrum für Autoimmun- und Rheumatische Erkrankungen (UCARE), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Baerwald
- Rheumatologie, Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - R Bergner
- Sektion Rheumatologie, Medizinische Klinik A, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Deutschland
| | - M Feuchtenberger
- InnKlinikum Altötting und Mühldorf, Standort Burghausen, Burghausen, Deutschland
| | - C Gebhardt
- Medizinische Klinik IV, Sektion Rheumatologie und klinische Immunologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Hagen
- Medizinische Klinik 3, Klinik für Rheumatologie und Immunologie, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - G Keyßer
- Arbeitsbereich Rheumatologie, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle/Saale, Deutschland
| | - H-M Lorenz
- Sektion Rheumatologie, Med. Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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30
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Schmale-Grede R, Faubel U. [The patient at the center of health services research]. Z Rheumatol 2020; 79:996-1002. [PMID: 33258977 DOI: 10.1007/s00393-020-00905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
The article gives an overview of how health services research helps to plan and optimize patient-centered health services. The decision-making processes on the micro-level (individual treatment decisions) and the macro-level (decisions about structuring of the healthcare system) are examined. Examples from the field of rheumatology illustrate how results of health services research can help to improve decisions about treatment by providing relevant information about quality of health services which helps in the joint decision-making process. Furthermore, it becomes clear that political decisions to improve health care service structures can be better achieved if scientific proof of deficits in existing health service structures can be provided. The article also shows how health services research helps to describe and redefine the roles of patients and patient-doctor communication. Additionally, the active role of patients in (health services) research is addressed.
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Affiliation(s)
- R Schmale-Grede
- Deutsche Rheuma-Liga Bundesverband e. V., Welschnonnenstr. 7, 53111, Bonn, Deutschland.
| | - U Faubel
- Deutsche Rheuma-Liga Bundesverband e. V., Welschnonnenstr. 7, 53111, Bonn, Deutschland
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31
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Rautenstrauch J. [Translational healthcare research : Show what is-Angela Zink, the grande dame of public health research in rheumatology]. Z Rheumatol 2020; 79:975-982. [PMID: 33258975 DOI: 10.1007/s00393-020-00904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND As director of the program area epidemiology and health care research at the German Rheumatism Research Center, Angela Zink established the German National Database, a national register for the care of people with inflammatory rheumatic diseases and other important registers for public health research in rheumatology. OBJECTIVE This publication summarizes Angela Zink's life work and sheds light on the national significance of this extraordinary achievement from the background of the research results achieved. MATERIAL AND METHODS The available literature and personal memories of the author formed the basis of this summary. RESULTS The German National Database, which regularly collects data from more than 15,000 patients with inflammatory rheumatic diseases per year, shows that the prognosis has steadily improved in many areas, disease activity has decreased, the burden of illness due to pain or functional limitations has decreased, the incidence of incapacity for work and early retirement has decreased and those affected can nowadays participate to a much greater extent in social and working life; however, the data also revealed existing shortcomings, regional differences and differences between treatment by specialists or general practitioners. This made the database a central instrument of quality assurance. The biologics register RABBIT, in which side effects of biologics were registered and used for risk management, has also gained great importance. CONCLUSION The registers which were set up and systematically developed in the program area epidemiology under the leadership of Angela Zink, are a treasure trove of national importance. A continuation, even after the retirement of Angela Zink from active professional life, seems urgently necessary if the healthcare research of German rheumatology does not want to lose the international connection.
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Affiliation(s)
- Julia Rautenstrauch
- European League Against Rheumatism (EULAR), Seestr. 240, 8802, Kilchberg, Schweiz.
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32
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Pfeil A, Fleck M, Keyßer G. [Specialist training situation in rheumatology from a trainer's perspective]. Z Rheumatol 2020; 80:22-26. [PMID: 33231737 DOI: 10.1007/s00393-020-00922-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/26/2022]
Abstract
This article focuses on the training situation of rheumatologists from the perspective of trainers regarding the existing and potentially increasing deficits of specialists for internal medicine and rheumatology. According to the new regulations defining the rheumatologist training, a substantial part of the training schedule is required to be completed in a hospital setting in order to become a specialist rheumatologist. In this context, the increased training capacity necessitates additional hospital training positions. In addition, the rheumatology residents desire a structured training program. Significantly, the work-life balance is an important factor to make working as a specialist for internal medicine and rheumatology more attractive.
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Affiliation(s)
- A Pfeil
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - M Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Keyßer
- Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland
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33
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Editorial. Z Rheumatol 2020; 79:39-40. [DOI: 10.1007/s00393-020-00858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Fiehn C, Baraliakos X, Edelmann E, Froschauer S, Feist E, Karberg K, Ruehlmann JM, Schuch F, Welcker M, Zinke S. [Current state, goals and quality standards of outpatient care in rheumatology: position paper of the Professional Association of German Rheumatologists (BDRh)]. Z Rheumatol 2020; 79:770-779. [PMID: 32926218 DOI: 10.1007/s00393-020-00872-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- C Fiehn
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland.
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Bochum, Deutschland
| | - E Edelmann
- Rheumazentrum Bad Aibling-Erding, Bad Aibling, Deutschland
| | - S Froschauer
- Berufsverband Deutscher Rheumatologen e. V., Grünwald, Deutschland
| | - E Feist
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | - K Karberg
- Praxis für Rheumatologie und Innere Medizin, Berlin, Deutschland
| | - J M Ruehlmann
- Praxis für Kinderheilkunde und Kinderrheumatologie, Göttingen, Deutschland
| | - F Schuch
- Rheumatologische Schwerpunktpraxis, Erlangen, Deutschland
| | - M Welcker
- MVZ für Rheumatologie, Planegg, Deutschland
| | - S Zinke
- Rheumatologische Schwerpunktpraxis, Berlin, Deutschland
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35
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Pfeil A, Baerwald CGO, Sieburg M, Boche K, Kupka TA, Linde T, Heldmann F, Unger L, Oelzner P, Aringer M, Keyßer G. [Future of rheumatologists: what are the perspectives? : Survey of resident physicians in rheumatology in middle Germany]. Z Rheumatol 2020; 79:168-174. [PMID: 31570975 DOI: 10.1007/s00393-019-00713-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The work environment for rheumatologists has significantly changed over the last years. The healthcare of patients with rheumatic diseases is at risk due to the age structure of specialized rheumatologists in middle Germany and the limited availability of training positions for rheumatologists. In this context, it is important to have detailed information on the resident physicians in rheumatology concerning their own visions regarding their future professional career. MATERIAL AND METHODS A questionnaire was sent to resident physicians in 25 rheumatology training hospitals in the middle of Germany (Saxony, Saxony-Anhalt and Thuringia). The questionnaire was completed and returned by 27 participants (17 women and 10 men). RESULTS Most of the participants (60%) aimed to qualify as a specialist in internal medicine followed by a specialization in rheumatology (altogether training for a minimum of 8 years). After finishing training 44% would prefer to work in an outpatient setting while 30% planned to work in a combined outpatient and clinical setting. Of the participants 48% would prefer to work as part-time rheumatologists and 74% (women 94% and men 40%) were interested in employment in an outpatient medical healthcare center. The compatibility of family and work as well as the work-life balance was considered to be highly relevant for the future professional life. CONCLUSION Less than half of the participants intended to work exclusively in an outpatient setting after completing the training in rheumatology. In addition, the participants preferred a part-time employment with compatibility of professional and private life. Consequently, alternative models of employment should be created in rheumatology to be attractive for future physicians. On the other hand, the study revealed that the independent rheumatological practice has a lower priority for the young rheumatologists taking part in this survey.
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Affiliation(s)
- A Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - C G O Baerwald
- Department für Innere Medizin, Neurologie und Dermatologie, Sektion Rheumatologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Sieburg
- Rheumatologische Facharztpraxis, Domplatz 11, 39104, Magdeburg, Deutschland
| | - K Boche
- Praxis für Internistische Rheumatologie, Dres. Boche, Hamann, Teich, Käthe-Kollwitz-Straße 9, 04109, Leipzig, Deutschland
| | - T A Kupka
- Rheumazentrum Kupka, Johann-Sebastian-Bach-Str. 2, 04600, Altenburg, Deutschland
| | - T Linde
- Rheumatologische Gemeinschaftspraxis Dr. med. Linde, Dr. med. Wagner, Dr. med. Wilke, Ludwig-Wucherer-Str. 10, 06108, Halle, Deutschland
| | - F Heldmann
- Klinik für Rheumatologie, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstr. 101, 09130, Chemnitz, Deutschland
| | - L Unger
- I. Medizinische Klinik, Städtisches Klinikum Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland
| | - P Oelzner
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - M Aringer
- Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Medizinische Klinik und Poliklinik III, Rheumatologie, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - G Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland
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Krusche M, Klemm P, Grahammer M, Mucke J, Vossen D, Kleyer A, Sewerin P, Knitza J. Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study. JMIR Mhealth Uhealth 2020; 8:e18117. [PMID: 32390592 PMCID: PMC7400039 DOI: 10.2196/18117] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists. Objective This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified. Methods Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey. Results A total of 119 rheumatologists completed the survey, of which 107 (89.9%) reported collecting PROs in routine practice and 28 (25.5%) already used ePROs. Additionally, 44% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs. Conclusions The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.
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Affiliation(s)
- Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Philipp Klemm
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, Immunology, Osteology and Physical Medicine, Justus Liebig University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | | | - Johanna Mucke
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Vossen
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Rheinisches Rheumazentrum Meerbusch, St Elisabeth Hospital, Meerbusch, Germany
| | - Arnd Kleyer
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Sewerin
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes Knitza
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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37
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[Online ultrasound learning modules in rheumatology : Innovative elective course increases student interest in the discipline of rheumatology]. Z Rheumatol 2020; 79:276-279. [PMID: 32103342 DOI: 10.1007/s00393-020-00757-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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38
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Schneider E, Petersen JJ, Schulz-Rothe S, Gerlach FM, Rossmanith T, Siebenhofer A, Mergenthal K. [Interprofessional Care of Patients with Rheumatoid Arthritis from the Perspective of a General Practitioner Perspective: Results of a Cross-sectional Study]. DAS GESUNDHEITSWESEN 2020; 83:e1-e8. [PMID: 32557446 DOI: 10.1055/a-1152-4576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND General practitioners, specialists, occupational and physical therapists, nursing services and other professional groups are all involved in the treatment of patients with rheumatoid arthritis. This study aims to describe interprofessional cooperation in daily ambulatory care from the perspective of a general practitioner. METHODS The cross-sectional study investigated cooperation between general practitioners (n=121 in 68 medical practices) and several other health care providers in Hesse and Rhineland Palatinate, Germany, from February to September 2017. It was part of the prospective cohort study PANORA (Prevalence of anti-cyclic citrullinated peptide (anti-CCP) positivity in patients with new onset of non-specific musculoskeletal symptoms). The questionnaire that was used contained closed-ended questions on socio-demographics and frequency of contact, and asked physicians to assess and weigh existing collaboration. Descriptive statistics were used for data analysis. RESULTS When caring for patients with rheumatoid arthritis, 70%, of the physicians often took responsibility for synchronizing medications, and discussing diagnoses and test results. The most frequent cooperation was with rheumatologists and was considered as highly important but the least satisfactory. The second most frequent cooperation was with physical therapists and this was also rated as very important. Physicians had highest level of satisfaction with their collaboration with the nursing services. CONCLUSION This study shows that general practitioners perform several medical tasks when treating patients with rheumatoid arthritis. During the process, they work together with several health care providers to various degrees. Cooperation with rheumatologists and physical therapists is particularly important to general practitioners; cooperation with rheumatologists is considered inadequate and in need of improvement.
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Affiliation(s)
- Elke Schneider
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Juliana J Petersen
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Sylvia Schulz-Rothe
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | | | - Tanja Rossmanith
- Institutsteil Translationale Medizin und Pharmakologie TMP, Fraunhofer Institut für Molekularbiologie und angewandte Ökologie IME, Frankfurt am Main
| | - Andrea Siebenhofer
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main.,Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
| | - Karola Mergenthal
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
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Christensen ABH, Just SA, Andersen JKH, Savarimuthu TR. Applying cascaded convolutional neural network design further enhances automatic scoring of arthritis disease activity on ultrasound images from rheumatoid arthritis patients. Ann Rheum Dis 2020; 79:1189-1193. [PMID: 32503859 DOI: 10.1136/annrheumdis-2019-216636] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES We have previously shown that neural network technology can be used for scoring arthritis disease activity in ultrasound images from rheumatoid arthritis (RA) patients, giving scores according to the EULAR-OMERACT grading system. We have now further developed the architecture of this neural network and can here present a new idea applying cascaded convolutional neural network (CNN) design with even better results. We evaluate the generalisability of this method on unseen data, comparing the CNN with an expert rheumatologist. METHODS The images were graded by an expert rheumatologist according to the EULAR-OMERACT synovitis scoring system. CNNs were systematically trained to find the best configuration. The algorithms were evaluated on a separate test data set and compared with the gradings of an expert rheumatologist on a per-joint basis using a Kappa statistic, and on a per-patient basis using a Wilcoxon signed-rank test. RESULTS With 1678 images available for training and 322 images for testing the model, it achieved an overall four-class accuracy of 83.9%. On a per-patient level, there was no significant difference between the classifications of the model and of a human expert (p=0.85). Our original CNN had a four-class accuracy of 75.0%. CONCLUSIONS Using a new network architecture we have further enhanced the algorithm and have shown strong agreement with an expert rheumatologist on a per-joint basis and on a per-patient basis. This emphasises the potential of using CNNs with this architecture as a strong assistive tool for the objective assessment of disease activity of RA patients.
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40
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Puchner R, Vavrovsky A, Pieringer H, Hochreiter R, Machold KP. The Supply of Rheumatology Specialist Care in Real Life. Results of a Nationwide Survey and Analysis of Supply and Needs. Front Med (Lausanne) 2020; 7:16. [PMID: 32083088 PMCID: PMC7002545 DOI: 10.3389/fmed.2020.00016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives: To study the balance between the supply and need for rheumatology care in Austria. In addition, to investigate rheumatologists' work-hours, the amount of time rheumatologists dedicate to care for patients with rheumatic and musculoskeletal diseases (RMD), with non-RMD problems, and other professional activities such as research, teaching, and administration. Methods: A questionnaire covering aspects of professional activities was sent to all 215 rheumatologists registered with the Austrian Medical Association. The data collected was set in relation to the need calculated on the basis of recommendations put forward by the German society of rheumatology. Results: 149 of the 215 rheumatologists (69.0%) responded. Median weekly working time was 50 h (IQR 45-60). 47.4% of the working time was spent for care of patients with RMD. The remaining time was dedicated to patients with non-rheumatic diseases (19.6%), research and teaching (8.4%), and administration (24.5%). The number of full-time equivalents (FTE, based on a 40-h work-week) available for rheumatology care, thus, was calculated to be 178.5. Based on disease prevalence/incidence estimates and on the time allocation results of this survey, our study resulted in a need of 4.29 rheumatologists per 100.000 adult inhabitants (301.79 for an adult population of 7.03 × 106). Conclusion: The study demonstrated a substantial mismatch between the available supply and the need for rheumatology care. The results of our study are a conservative estimate, which should be taken into consideration for future healthcare workforce planning. In particular, the rising need for rheumatologists should be met by increasing the numbers of those specialists.
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Affiliation(s)
| | | | | | - Ronald Hochreiter
- Department of Finance, Accounting and Statistics, Institute for Statistics and Mathematics, Vienna University of Economics and Business, Vienna, Austria
| | - Klaus P Machold
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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41
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Mai A, Braun J, Reese JP, Westerhoff B, Trampisch U, Klaassen-Mielke R, Timmesfeld N, Trampisch HJ, Krause D. Nurse-led care versus physician-led care in the management of rheumatoid arthritis and psoriatic arthritis (StaerkeR): study protocol for a multi-center randomized controlled trial. Trials 2019; 20:793. [PMID: 31888706 PMCID: PMC6937804 DOI: 10.1186/s13063-019-3808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/18/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In Germany, the care of patients with inflammatory arthritis could be improved. Although specialized rheumatology nurses could take over substantial aspects of patient care, this hardly occurs in Germany. Thus, the aim of the study is to examine structured nursing consultation in rheumatology practices. METHODS/DESIGN In total, 800 patients with a stable course of rheumatoid arthritis or psoriatic arthritis in 20 centers in North Rhine-Westphalia and Lower Saxony will be randomized to either nurse-led care or standard care. Participating nurses will study for a special qualification in rheumatology and trial-specific issues. It is hypothesized that nurse-led care is non-inferior to standard care provided by rheumatologists with regard to a reduction of disease activity (DAS28) while it is hypothesized to be superior regarding changes in health-related quality of life (EQ-5D-5L) after 1 year. Secondary outcomes include functional capacity, patient satisfaction with treatment, and resource consumption. DISCUSSION Since there is insufficient care of rheumatology patients in Germany, the study may be able to suggest improvements. Nurse-led care has the potential to provide more efficient and effective patient care. This includes a more stringent implementation of the treat-to-target concept, which may lead to a higher percentage of patients reaching their treatment targets, thereby improving patient-related outcomes, such as quality of life, functional capacity, and participation. Additionally, nurse-led care may be highly cost-effective. Finally, this project may form the basis for a sustainable implementation of nurse-led care in standard rheumatology care in Germany. TRIAL REGISTRATION German Clinical Trials Register, DRKS00015526. Registered on 11 January 2019.
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Affiliation(s)
- Anna Mai
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | | | - Jens-Peter Reese
- Coordinating Center for Clinical Trials of the Philipps-University of Marburg, 35043 Marburg, Germany
| | | | | | - Renate Klaassen-Mielke
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Hans J. Trampisch
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Dietmar Krause
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University Bochum, 44780 Bochum, Germany
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42
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Haibel H, Redeker I, Zink A, Callhoff J, Marschall U, Hoffmann F, Sieper J, Poddubnyy D. [Health care and disease burden in persons with axial spondyloarthritis in Germany]. Z Rheumatol 2019; 78:865-874. [PMID: 31172266 DOI: 10.1007/s00393-019-0650-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Only very few data are available on the comprehensive care in patients with axial spondylarthritis (axSpA), one of the most frequent inflammatory rheumatic disease. OBJECTIVE Description of the comprehensive care and common prescription patterns of medications and other therapies in patients with axSpA depending on the type of medical care by rheumatologists or nonrheumatologists. METHODS A cross-sectional analysis was performed based on claims data of the BARMER health insurance company (in 2015) and a questionnaire, which was sent to a representative sample of patients with axSpA (International Classification of Diseases, 10th revision, German modification, ICD-10-GM, code M45) aged 18-79 years. A stratified sample of 5000 patients was used. The patients received a postal questionnaire including questions regarding the disease, health-related and psychological parameters and socioeconomic factors. Claims data consisted of demographic factors, medicinal and nonmedicinal treatment and the extra-articular manifestations inflammatory bowel disease, psoriasis and uveitis. RESULTS A total of 1741 patients (mean age 55.9 years, female 46.4%, 86.2% Human Leucocyte Antigen[HLA]-B27 positive) confirmed the diagnosis and answered the questionnaire. The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.5 and the mean Bath Ankylosing Spondylitis Functional Index (BASFI) 4.1. Of the patients 46% were treated by rheumatologists. There was a substantial difference between patients in rheumatological care and those who were not in rheumatological care regarding prescriptions for drug treatment of axSpA (91.8% versus 66.4%). This difference was especially prominent for prescriptions of biologic disease-modifying antirheumatic drugs: 34.1% of patients in rheumatological care versus 3.1% of patients treated by nonrheumatologists (p < 0.0001), despite similar disease activity in both groups. CONCLUSION The data show that the majority of patients diagnosed with axSpA did not receive regular care from rheumatologists. This seemed to be associated with insufficient medicinal care at least in some of these patients.
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Affiliation(s)
- H Haibel
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - I Redeker
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland.,Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - A Zink
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - U Marschall
- Forschungsbereichsleitung BARMER Institut für Gesundheitssystemforschung, Wuppertal, Deutschland
| | - F Hoffmann
- Abteilung für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - J Sieper
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - D Poddubnyy
- Abteilung für Rheumatologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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Benesova K, Lorenz HM, Lion V, Voigt A, Krause A, Sander O, Schneider M, Feuchtenberger M, Nigg A, Leipe J, Briem S, Tiessen E, Haas F, Rihl M, Meyer-Olson D, Baraliakos X, Braun J, Schwarting A, Dreher M, Witte T, Assmann G, Hoeper K, Schmidt RE, Bartz-Bazzanella P, Gaubitz M, Specker C. [Early recognition and screening consultation: a necessary way to improve early detection and treatment in rheumatology? : Overview of the early recognition and screening consultation models for rheumatic and musculoskeletal diseases in Germany]. Z Rheumatol 2019; 78:722-742. [PMID: 31468170 DOI: 10.1007/s00393-019-0683-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.
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Affiliation(s)
- K Benesova
- Sektion Rheumatologie, Innere Medizin V, Universitätsklinik Heidelberg, Heidelberg, Deutschland.
| | - H-M Lorenz
- Sektion Rheumatologie, Innere Medizin V, Universitätsklinik Heidelberg, Heidelberg, Deutschland.,ACURA Rheumazentrum Baden-Baden, Baden-Baden, Deutschland
| | - V Lion
- Sektion Rheumatologie, Innere Medizin V, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - A Voigt
- Abteilung Rheumatologie, klinische Immunologie und Osteologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - A Krause
- Abteilung Rheumatologie, klinische Immunologie und Osteologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - O Sander
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | | | - A Nigg
- MVZ MED
- BAYERN OST Altötting·Burghausen, Burghausen, Deutschland
| | - J Leipe
- Sektion Rheumatologie, V. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
| | - S Briem
- Innere Medizin und Rheumatologie, Alb-Donau Klinikum Langenau, Langenau, Deutschland
| | - E Tiessen
- Innere Medizin und Rheumatologie, Alb-Donau Klinikum Langenau, Langenau, Deutschland
| | - F Haas
- Rheumatologische Facharztpraxis, Tübingen, Deutschland
| | - M Rihl
- Rheumatologische Schwerpunktpraxis, Traunstein, Deutschland
| | - D Meyer-Olson
- m&i Fachklinik Bad Pyrmont und MVZ Weserbergland, Bad Pyrmont, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Bochum, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Bochum, Deutschland
| | - A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland.,ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T Witte
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - G Assmann
- Rheumatologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - K Hoeper
- Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - R E Schmidt
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - P Bartz-Bazzanella
- Klinik für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Deutschland
| | - M Gaubitz
- Interdisziplinäre Diagnostik und Therapie - Akademie für Manuelle Medizin, WWU Münster, Münster, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Evang. Krankenhaus Essen-Werden, Kliniken Essen-Mitte, Essen, Deutschland
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Abstract
BACKGROUND In May 2018 a revision of the training regulations for German doctors (MWBO) was passed which will significantly impact the medical training for German rheumatologists. The goal of this paper was to create an overview of the status quo in advanced medical training in this field. METHODS A quantitative and qualitative analysis was conducted to identify the strengths and weaknesses of the current continuous education in the field of rheumatology in Germany. The number of newly trained specialists in rheumatology in the years 2015 to 2017 was determined from the regional medical associations. Furthermore, an online survey assessing the training conditions of assistant physicians was conducted. 71 physicians participated in the nationwide survey. RESULTS In 2015 (53 specialists), in 2016 (43 specialists) and in 2017 (43 specialists) completed their training in the field of rheumatology. The online survey of assistant physicians found that the medical training was graded 3.1 on a scale of 1 to 6 (SD ± 1.1). 19.4% of respondents reported that they had regular mentoring, and 41.7% had on-the-job evaluations. Deficits were evident concerning practical diagnostic skills: 22.8% of the physicians were not practicing joint ultrasonography and another 20% performed it only once a month. As points of criticism 46.6% mentioned a missing structure in training programme and 33.3% noted a lack of supervision. The majority of respondents wanted more training options, supervision and better practical training in ultrasound diagnostics. CONCLUSION The nationwide number of newly acquired specialist qualifications (between 2015 and 2017) showed a decreasing trend. It is to be feared that the numbers will continue to stagnate, which increases the importance to invest further in medical education. The online survey also showed that the current medical training in Germany has deficits. Here, the new MWBO could create better guidelines for a structured training, which should be guided by the principle of "Teach to Target".
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Affiliation(s)
- M Krusche
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - P Sewerin
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Universitätskliniken Düsseldorf, Heinrich-Heine-Universität Düsseldorf (HHU), Düsseldorf, Deutschland
| | - A Kleyer
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - J Mucke
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Universitätskliniken Düsseldorf, Heinrich-Heine-Universität Düsseldorf (HHU), Düsseldorf, Deutschland
| | - D Vossen
- Rheinisches Rheumazentrum Meerbusch, St. Elisabeth-Hospital, Meerbusch, Deutschland
| | - H Morf
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
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[Rheumatological care in the Rheumazentrum Ruhrgebiet Rheumatism Center-a model for conurbations]. Z Rheumatol 2019; 78:753-764. [PMID: 31286192 DOI: 10.1007/s00393-019-0663-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Ruhrgebiet Rheumatism Center, which is highly specialized for rheumatic diseases, is the largest of its kind in Germany. For many years it has fulfilled all the requirements for structural quality required by the Association of Rheumatological Acute Clinics (VRA) including regular participation in the KOBRA benchmarking project. Therefore, the center regularly receives the VRA seal for quality of care. In 2018 more than 7500 patients were treated as inpatients. Within the framework of care according to §116b (ASV since May 2019) there were nearly 25,000 outpatient patient contacts. Furthermore, an early screening program (triage) was established 5 years ago in order to be able to identify patients with musculoskeletal complaints on a potentially inflammatory rheumatic basis. This functions in the sense of an early diagnosis and treatment in accordance with the treat-to-target concept within less than 4 weeks (initially) on an outpatient basis with respect to the required urgency, in order to subsequently provide sound diagnostic support. In the last 2 years 2017 and 2018, this deadline was met in more than 90% of cases. Within the scope of inpatient care approximately one third of patients were treated in recent years with a defined rheumatological complex therapy and 10% with pain complex therapy. Approximately 3% were treated with geriatric complex therapy and 65% were short-stay patients (<4 days), i.e. patients who received the necessary diagnostics and treatment on an inpatient basis at short notice. The overall structure of the rheumatism center, the cooperation with rheumatologists in private practice, many cooperation partners, referring physicians and patients represents a model for rheumatological care in large conurbations. The care of large numbers of patients also enables the further training of many assistants and this is essential for the future of good rheumatological medicine.
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Abstract
BACKGROUND Early detection of patients with axial spondylarthritis (axSpA) in primary care is difficult. The combination of various parameters indicative of inflammatory back pain (AWARE criteria) was found to be beneficial in an initial study. OBJECTIVE Review of the criteria for the identification of young patients with axSpA and chronic back pain (≥3 months of back pain). MATERIAL AND METHODS In adult patients with chronic back pain and age at onset of symptoms <45 years, orthopedic surgeons documented various possible axSpA characteristics before referral to the rheumatologist. RESULTS Overall, the data from 1306 patients were recorded. Of these, ultimately 500 patients were also seen by rheumatologists, 199 patients (39.8%) were diagnosed with axSpA while 301 (60.2%) had non-specific back pain. A total of 87 patients had ankylosing spondylitis (44%) and 112 non-radiographic axSpA (56%). The ASAS classification criteria were fulfilled by 226 patients (45.2%). The mean age of axSpA patients was 38 years, 56% were male with a mean duration of back pain of 98 months. The AWARE criteria had a sensitivity and specificity of 69.3% and 40.3% (n = 343), respectively, when ≥4/5 criteria were chosen. Positive imaging for sacroiliitis using magnetic resonance imaging (MRI) or X‑ray was present in 77% of patients and positive HLA-B27 was identified in 59% of axSpA patients. The combination of positive imaging and HLA-B27 had the highest likelihood ratio for diagnosis of axSpA. CONCLUSION Although the study design used here led to a preselection and thus to a bias in the statistical evaluation, the study confirmed the benefit of the AWARE criteria for the early detection of patients with axSpA. In further studies, the 2‑stage approach with initially 3 clinical questions and then an optional HLA-B27 test is currently being investigated further.
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Sander O, Korfmacher W, Ostendorf B, Schneider M. [Rheumatology in the mirror of media and advertising exemplified by the Rheumazentrum Rhein-Ruhr]. Z Rheumatol 2019; 77:300-308. [PMID: 29654390 DOI: 10.1007/s00393-018-0461-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- O Sander
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, Universitätsklinikum Düsseldorf Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, Düsseldorf, Deutschland.
| | - W Korfmacher
- Fachbereiche Architektur und Design, Peter Behrens School of Arts, Hochschule Düsseldorf, Düsseldorf, Deutschland
| | - B Ostendorf
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, Universitätsklinikum Düsseldorf Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, Düsseldorf, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, Universitätsklinikum Düsseldorf Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, Düsseldorf, Deutschland
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Schwarting A, Dreher M, Assmann G, Witte T, Hoeper K, Schmidt RE. [Experiences and results from Rheuma-VOR]. Z Rheumatol 2019; 78:743-752. [PMID: 31468168 DOI: 10.1007/s00393-019-00694-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis are the most common chronic autoimmune rheumatic diseases. For all three diseases an early diagnosis and initiation of treatment is crucial. The proof of concept network study "Rheuma-VOR" is a further developed version of the predecessor project ADAPTHERA and was extended to several federal states. The aim of this prospective study is to improve the early diagnosis of rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis and thus positively impact the quality of care for patients with the help of multidisciplinary coordinating centers. To date 3710 disease-specific questionnaires from patients with the suspected diagnosis of rheumatoid arthritis, psoriatic arthritis or axial spondylarthritis from 1298 different primary care providers were registered in the multidisciplinary coordination centers. A total of 1958 appointments were made with 1 of the 53 participating rheumatology specialists. In 876 patients, 1 of the 3 rheumatic diseases was diagnosed in an early stage. The waiting period was on average 42.5 days depending on the federal state, which is well below the nationwide average. It should also be noted that the coordinated cooperation and risk stratification of the Rheuma-VOR coordination centers relieved the capacity of rheumatology specialists by 1281 appointments (34.5%). In addition, the 2‑week Rheuma Bus Tour and the accompanying initiatives in Rhineland-Palatinate (Rheuma-VOR screening app and the triage consultation) are showing first promising positive results.
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Affiliation(s)
- A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland. .,ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland.
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - G Assmann
- Rheumatologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T Witte
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Hoeper
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - R E Schmidt
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Hoffmann T, Oelzner P, Böttcher J, Wolf G, Pfeil A. [Analysis of referral diagnoses to the rheumatology department]. Z Rheumatol 2019; 79:160-167. [PMID: 31388735 DOI: 10.1007/s00393-019-0672-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The initial presentation of patients with symptoms indicative of a rheumatic disease is in most cases not directly to a rheumatologist. This study evaluated the following questions: I. Which medical specialists refer patients to a department of rheumatology? II. Evaluation of the accordance of the presumptive referral diagnosis and the final diagnosis by a rheumatologist. METHODS A total of 947 patients (279 men and 668 women) who initially presented to a university hospital for rheumatological diagnostics were included in the study. The referring medical specialist fields were identified. Furthermore, a kappa analysis was performed to evaluate the accordance of the presumptive referral diagnosis and the final diagnosis generated after a rheumatological evaluation of the patients. RESULTS Of the referrals 73% were initiated by general practitioners or internists functioning as general practitioners. The other referrers were 5% specialists in internal medicine (excluding rheumatology), 4% orthopedic/trauma surgeons, 1% other surgeons and 4% other specialist fields. A rheumatological diagnosis was made in 58% of the patients and rheumatological inflammatory joint diseases (26%), collagenosis (14%) and vasculitides (5%) were the most frequently diagnoses. The accordance of the presumptive diagnosis of the general practitioners and the final diagnosis after rheumatological evaluation was a kappa coefficient of κ = 0.304. Lower kappa values were evaluated for orthopedic surgeons (κ = 0.277) and other specialists (κ = 0.200). CONCLUSION The referrals to a rheumatology institution were frequently initiated by general practitioners and internists functioning as general practitioners. In this context the presumptive diagnosis of general practitioners showed a low accordance with the final rheumatological diagnosis. In contrast, a detailed presumptive diagnosis is desirable for optimal use of the limited resources for rheumatological care.
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Affiliation(s)
- T Hoffmann
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - P Oelzner
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - J Böttcher
- Institut für Diagnostische und Interventionelle Radiologie, SRH Wald-Klinikum Gera, Gera, Deutschland
| | - G Wolf
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - A Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Lauter A, Triantafyllias K, Leiß R, Amberger C, Engels J, Hesse M, Jendro M, Gilly J, Stadelmann ML, Ziese W, Wollschläger D, Dreher M, Pfeiff B, Weinmann-Menke J, Panholzer T, Schwarting A. [ADAPTHERA-Statewide cross-sectoral care network for patients with early rheumatoid arthritis shows sustained remission in standard care]. Z Rheumatol 2019; 78:660-669. [PMID: 31165251 DOI: 10.1007/s00393-019-0653-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVE The majority of patients in Germany miss out on the necessity of early diagnosis and initiation of therapy for rheumatoid arthritis (RA) caused by considerable structural deficits in the health care system. The challenge is to reconcile the individual demand for the best possible therapy result with a sustainable expenditure of resources. METHODS The cross-sectoral regional care network ADAPTHERA aims to improve early RA diagnosis and treatment in Rhineland-Palatinate. The retrospective triage analyses of suspected early onset RA patients was performed by tracing the selection process of all available enquiries (n = 1045). For analysis of the clinical course of the disease, a subset comprising 143 patients with a minimum observation time of 12 months (5 consecutive visits) was available. Clinical and laboratory parameters were collected quarter yearly, self-administered questionnaires were filled out and the treatment was adapted if necessary. RESULTS A total of 454 patients were included. The mean waiting time was 23.9 (SD = 18) days. The mean observation period in the subcohort was 29.2 (SD = 12.7) months, with about 50% of the patients presenting within 3 months. Almost 75% of the patients were in remission after 2 years. A sustained remission could be described for 74.8% (6 months) and 53.5% (12 months), respectively. Especially patients with rapid remission induction benefited in terms of longer remissions (p = 0.03). A very early stage of the disease (VERA) was associated with a rarely necessary biologic therapy (p = 0.022). DISCUSSION The approach of a supply network is not a panacea, but it might improve healthcare for patients with early onset RA. In order to minimize resource utilization, a pinpoint referral and accurate triage of potential cases are crucial.
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Affiliation(s)
- A Lauter
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - K Triantafyllias
- ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland
| | - R Leiß
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - C Amberger
- Rheumatologische Schwerpunktpraxis, Bad Neuenahr, Deutschland
| | - J Engels
- Rheumatologische Schwerpunktpraxis, Koblenz, Deutschland
| | - M Hesse
- Rheumatologische Schwerpunktpraxis, Bad Kreuznach, Deutschland
| | - M Jendro
- Rheumatologische Schwerpunktpraxis, Kaiserslautern, Deutschland
| | - J Gilly
- Rheumatologische Schwerpunktpraxis, Landau, Deutschland
| | - M-L Stadelmann
- Rheumatologische Schwerpunktpraxis, Wittlich, Deutschland
| | - W Ziese
- Rheumatologische Schwerpunktpraxis, Trier, Deutschland
| | - D Wollschläger
- Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - B Pfeiff
- ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland
| | - J Weinmann-Menke
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - T Panholzer
- Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
- ACURA Rheumakliniken Rheinland-Pfalz GmbH, Bad Kreuznach, Deutschland.
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