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Zaini R, Alrehaily A, Alhazmi A, Halabi H, Mohamed H, Almoallim H. Future Directions of Rheumatology Training According to Saudi Vision 2030: Recommendations From a Saudi Experts Meeting. Open Access Rheumatol 2021; 12:347-355. [PMID: 33380845 PMCID: PMC7769142 DOI: 10.2147/oarrr.s286285] [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] [Received: 10/13/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Worldwide research anticipates that a current shortage of rheumatologists will exacerbate over the next decade, whereas the need for arthritis specialists will continue to escalate. Saudi Arabia (SA) also encounters a limited geographical distribution of rheumatologists and rheumatology fellowship training centres. Objective Reporting the Saudi rheumatologists’ advisory meeting conducted in Makkah, SA in January 2020 with the aim to discuss the “Saudi Vision 2030” for rheumatology training programs. Materials and Methods A meeting of Saudi rheumatology experts and consultants was conducted to address the future directions, challenges, and recommendations of rheumatology training. The 10th Rheumatology Practice Symposium was organised by Alzaidi Chair of Research in Rheumatic Diseases (ZCRD), and conducted in Makkah Commerce Chamber, Makkah, SA on January 28, 2020. More than 30 consultants and rheumatology fellows with five Saudi experts in the field of rheumatology assembled to form 10 recommendations that tackle rheumatology training challenges in SA. Results The meeting recommendations shed light on the clinical practice of rheumatology training in SA; challenges and opportunities in rheumatology fellowship programs; efforts of the Saudi Commission for Health Specialties (SCFHS) to design and implement a competent postgraduate rheumatology training; and challenges with trainers, trainee, and within training centres. Conclusion To address rheumatology challenges in SA, rheumatology consultants and fellows assembled to form 10 recommendations. The recommendations tackled the challenges of rheumatology fellowship programs and the efforts to implement a competent postgraduate rheumatology training. These recommendations are expected to lead us successfully to fulfil our ambition in the “Saudi Vision of 2030”.
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Affiliation(s)
- Rania Zaini
- Department of Medical Education, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Ali Alrehaily
- Department of Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia.,Chairman of the Scientific Committee of Adult Rheumatology Fellowship Program, Saudi Commission for Health Specialties (SCFHS), Riyadh, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, King Fahad Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia.,Chairman, Supervisory Committee for Saudi Board Adult Rheumatology Fellowship Program in Western Region, Saudi Commission For Health Specialties (SCFHS), Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital And Research Center, Jeddah, Saudi Arabia
| | - Heba Mohamed
- Pfizer Biopharmaceutical Group, Emerging Markets, Riyadh, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia.,Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia
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Saif S, Fida S, Mansoor H. Assessment of knowledge of junior doctors and non-specialists about musculoskeletal medicine. Pak J Med Sci 2020; 37:175-179. [PMID: 33437272 PMCID: PMC7794155 DOI: 10.12669/pjms.37.1.3148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives: To assess the knowledge and confidence of junior doctors and non-specialists in examining and making a diagnosis of patients with musculoskeletal (MSK) diseases. Methods: This was a Cross-sectional study of 121 doctors working in medical clinics at a tertiary hospital between October and December 2019. Data were collected using a questionnaire. Doctor’s awareness regarding different MSK examination methods including gait, arms, leg, spine (GALS), pediatric gait, arms, leg, spine (pGALS) and regional examination of musculoskeletal system (REMS) was noted. Undergraduate teaching of these methods and use in their daily practice was surveyed. Results: Majority of the doctors lacked awareness about different MSK examination techniques. Awareness about GALS, REMS and pGALS was 44.6%, 59.5% and 18.2% respectively. There was significant correlation of GALS/REMS awareness with the undergraduate teaching and doctor’s clinical experience (p-value <0.05). Confidence level of doctors in diagnosing patients with adult MSK pathologies was 55%. Only few doctors were satisfied with their musculoskeletal education (29%). Conclusion: The GALS examination is a useful screening tool for junior doctors and non-specialists in a direct access setting to rule out musculoskeletal problems.
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Affiliation(s)
- Saba Saif
- Dr. Saba Saif, FCPS. Rheumatology, FCPS Medicine. Assistant Professor, Department of Medicine, Division of Rheumatology Combined Military Hospital, Lahore, Pakistan
| | - Samina Fida
- Dr. Samina Fida, FCPS Medicine. Associate Professor, Department of Medicine, Division of Rheumatology Combined Military Hospital, Lahore, Pakistan
| | - Hala Mansoor
- Dr. Hala Mansoor, FCPS (Gastroentrol), FCPS Medicine, MRCP. Assistant Professor, Department of Medicine, Division of Rheumatology Combined Military Hospital, Lahore, Pakistan
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Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East. Rheumatol Int 2020; 41:529-542. [PMID: 32851423 PMCID: PMC7867556 DOI: 10.1007/s00296-020-04682-6] [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] [Received: 05/14/2020] [Accepted: 08/09/2020] [Indexed: 11/29/2022]
Abstract
Globally, increasing demand for rheumatology services has led to a greater reliance on non-physician healthcare professionals (HCPs), such as rheumatology nurse specialists, to deliver care as part of a multidisciplinary team. Across Africa and the Middle East (AfME), there remains a shortage of rheumatology HCPs, including rheumatology nurses, which presents a major challenge to the delivery of rheumatology services, and subsequently the treatment and management of conditions such as rheumatoid arthritis (RA). To further explore the importance of nurse-led care (NLC) for patients with RA and create a set of proposed strategies for the implementation of NLC in the AfME region, we used a modified Delphi technique. A review of the global literature was conducted using the PubMed search engine, with the most relevant publications selected. The findings were summarized and presented to the author group, which was composed of representatives from different countries and HCP disciplines. The authors also drew on their knowledge of the wider literature to provide context. Overall, results suggest that NLC is associated with improved patient perceptions of RA care, and equivalent or superior clinical and cost outcomes versus physician-led care in RA disease management. Expert commentary provided by the authors gives insights into the challenges of implementing nurse-led RA care. We further report practical proposed strategies for the development and implementation of NLC for patients with RA, specifically in the AfME region. These proposed strategies aim to act as a foundation for the introduction and development of NLC programs across the AfME region.
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Magliah R, Hafiz W, Alahmadi ZA, Siddiqui MI, Ahmed HM, Attar SM, Janoudi N, Almoallim H. Early Diagnosis Of Inflammatory Arthritis By Primary Care Physicians Following Training By A Rheumatologist. Open Access Rheumatol 2019; 11:315-321. [PMID: 31853204 PMCID: PMC6916703 DOI: 10.2147/oarrr.s222630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/01/2019] [Indexed: 01/02/2023] Open
Abstract
Background Early diagnosis and therapeutic management of inflammatory arthritis (IA) is crucial for minimizing disease progression and improving outcomes. We recently developed the New Early Arthritis Referral Criteria to help improve the detection of suspected early IA via musculoskeletal (MSK) examination. The present study aimed to evaluate the agreement between rheumatologists and primary care physicians (PCPs) trained by rheumatologists in detecting IA when applying the standardized MSK examination techniques used to develop this criteria in a real-world setting in Jeddah, Saudi Arabia. Methods This quasi-experimental study was conducted in 4 primary health centers and involved 30 PCPs and 3 rheumatologists. All PCPs were trained by rheumatologists to apply the standardized MSK examination techniques used to develop the New Early Arthritis Referral Criteria. Patients were eligible if they were >18 years of age and presented with small-joint pain that persisted for >6 weeks. Patients were excluded if they had prior diagnosis of osteoarthritis, hand fractures, or rheumatic disease associated with IA. All patients were examined separately by a PCP and a rheumatologist, with the findings compared via kappa statistics and the rheumatologist’s findings considered the “gold standard”. Results Data from 202 of the 203 enrolled patients were analyzed. There was fair-to-moderate agreement between PCPs and rheumatologists when assessing swelling of the small joints and wrist of the right side (range of kappa: 0.14–0.41) and low-to-moderate agreement in similar examinations of the left side (range of kappa: 0.04–0.42). Assessments of joint tenderness showed fair-to-moderate agreement for both the right side (range of kappa: 0.22–0.47) and left side (range of kappa: 0.24–0.45). P-values were significant for virtually all comparisons. Conclusion MSK examinations by PCPs showed a promising extent of agreement in detecting IA with those by rheumatologists following training. Refinement of the standardized training process could further improve accuracy and help PCPs to confidently identify cases of early IA, thus allowing earlier intervention than is typical in this setting.
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Affiliation(s)
- Rami Magliah
- Department of Medicine, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Waleed Hafiz
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.,Alzaidi Chair of Research in Rheumatic Diseases, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | | | - Suzan Mansour Attar
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nahed Janoudi
- Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.,Alzaidi Chair of Research in Rheumatic Diseases, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
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Fleischmann M, Vaughan B. The challenges and opportunities of using patient reported outcome measures (PROMs) in clinical practice. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lins CF, Lima de Sá Ribeiro D, Dourado Santos WG, Rosa G, Machicado V, Pedreira AL, Pimenta da Fonseca E, Mota Duque Sousa AP, Rodrigues Silva CB, Matos MAA, Santiago MB. Ultrasound Findings on Hands and Wrists of Patients with Systemic Lupus Erythematosus: Relationship with Physical Examination. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1764-1768. [PMID: 28602490 DOI: 10.1016/j.ultrasmedbio.2017.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
Diagnosis of synovitis/tenosynovitis by physical examination can be difficult. Ultrasound (US) can be an effective tool for the evaluation of joint involvement in systemic lupus erythematosus (SLE). This study will describe musculoskeletal findings by US in SLE patients and the evaluation of their correlation with physical examination. SLE patients underwent clinical/sonographic evaluation of hand/wrists. In total, 896 joints were evaluated: at least 1 change on physical examination was found in 136 joints and at least 1 US abnormality was found in 65 of 896 joints. Out of the 65 joints with US changes, only 13 had findings on physical examination. Conversely, 111 joints had tenderness on physical examination with no sonographic abnormalities. Tenosynovitis was statistically significant more frequently with joint edema (41%) (p = 0.0003). US can detect musculoskeletal changes in only a minority of symptomatic SLE patients. Clinical findings may be related to some reasons that cannot be explained using US.
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Affiliation(s)
| | | | | | - Genevievi Rosa
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | | | | | | | | | | | - Mittermayer Barreto Santiago
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Serviços Especializados em Reumatologia da Bahia, Salvador, Bahia, Brazil
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Barhamain AS, Magliah RF, Shaheen MH, Munassar SF, Falemban AM, Alshareef MM, Almoallim HM. The journey of rheumatoid arthritis patients: a review of reported lag times from the onset of symptoms. Open Access Rheumatol 2017; 9:139-150. [PMID: 28814904 PMCID: PMC5546831 DOI: 10.2147/oarrr.s138830] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Even after achieving tremendous advances in diagnosis and treatment of rheumatoid arthritis (RA), many of the patients undergo delays in diagnosis and initiation of treatment, which leads to worsening of the condition and poor prognosis. OBJECTIVE The objective of this study was to perform a literature review to quantify the lag times in diagnosis and treatment of RA and study the reported factors associated with it. METHODS The authors searched literature published until September 2016 in electronic full-text and abstract databases and hand-searched the suitable articles. RESULTS The weighted average of median lag time from symptom onset to therapy was 11.79 months (12 studies, 5,512 patients, range 3.6-24.0 months). Lag1 was 3.14 months (onset of symptoms to first physician consultant; 12 studies, 6,055 patients, range 0-5.7 months); lag2 was 2.13 months (physician visit to RA specialist referral; 13 studies, 34,767 patients, range 0.5-6.6 months); lag3 was 2.91 months (consultation with rheumatologist to diagnosis; 3 studies, 563 patients, range 0-5 months), lag4 was 2.14 months (diagnosis to initiation of disease-modifying antirheumatic drug therapy; 5 studies, 30,685 patients, range 0-2.2 months). Numerous patient-and physician-related factors like gender, ethnicity, primary care physician knowledge of the condition, availability of diagnostics, and so on were responsible for the delays. CONCLUSION This review estimated the delay times and identified the main factors for delay in RA patients in diagnosis and initiation of treatment. A most plausible solution to this is coordinated effort by the rheumatology and primary care physicians.
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Affiliation(s)
| | | | | | | | | | | | - Hani M Almoallim
- Department of Medicine, Faculty of Medicine
- Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah
- Department of Medicine, Dr Soleiman Fakeeh Hospital, Jeddah, Saudi Arabia
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Almoallim H, Janoudi N, Attar SM, Garout M, Algohary S, Siddiqui MI, Alosaimi H, Ibrahim A, Badokhon A, Algasemi Z. Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study. Open Access Rheumatol 2017; 9:81-90. [PMID: 28490909 PMCID: PMC5414613 DOI: 10.2147/oarrr.s134780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Early diagnosis and initiation of treatment for inflammatory arthritis can greatly improve patient outcome. We aimed to provide standardized and validated criteria for use by primary care physicians (PCPs) in the identification of individuals requiring referral to a rheumatologist. Patients and methods We analyzed the predictive value of a wide variety of demographic variables, patient-reported complaints, physical examination results, and biomarkers in order to identify the most useful factors for indicating a requirement for referral. Patients for this cross-sectional study were enrolled from various centers of the city of Jeddah, Saudi Arabia, if they were ≥18 years of age and presented to a PCP with small joint pain that had been present for more than 6 weeks. A total of 203 patients were enrolled, as indicated by the sample size calculation. Each patient underwent a standardized physical examination, which was subsequently compared to ultrasound findings. Biomarker analysis and a patient interview were also carried out. Results were then correlated with the final diagnosis made by a rheumatologist. Results A total of 9 variables were identified as having high specificity and good predictive value: loss of appetite, swelling of metacarpophalangeal joint 2 or 5, swelling of proximal inter-phalangeal joint 2 or 3, wrist swelling, wrist tenderness, a positive test for rheumatoid factor, and a positive test for anti-citrullinated protein antibodies. Conclusion Nine variables should be the basis of early referral criteria. It should aid PCPs in making appropriate early referrals of patients with suspected inflammatory arthritis, accelerating diagnosis and initiation of treatment.
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Affiliation(s)
- Hani Almoallim
- Department of Medicine, Medical College, Umm Alqura University, Makkah.,Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah.,Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | - Nahid Janoudi
- Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah
| | - Suzan M Attar
- Department of Medicine, King Abdulaziz University, Jeddah
| | - Mohammed Garout
- Department of Community Medicine and Public Health, Umm Alqura University, Makkah
| | - Shereen Algohary
- Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | | | - Hanan Alosaimi
- Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | - Ashraf Ibrahim
- Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah
| | - Amira Badokhon
- Administration of Public Health, Ministry of Health, Jeddah
| | - Zaki Algasemi
- Joint Program of Family and Community Medicine, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
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