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Aggarwal A, Fernandes TAP, Migowa A, Smith EMD, Hanif M, Webb K, Lewandowski LB. Childhood-Onset Systemic Lupus Erythematosus (cSLE): An International Perspective. Curr Allergy Asthma Rep 2024; 24:559-569. [PMID: 39145903 PMCID: PMC11377481 DOI: 10.1007/s11882-024-01169-3] [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: 07/25/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE OF REVIEW Childhood-onset systemic lupus erythematosus (cSLE) is a severe and potentially life-threatening chronic autoimmune disease. cSLE is more aggressive and has poorer outcomes than adult-onset disease. The global burden of cSLE is poorly understood, with most publications on cSLE originating from high-resourced settings. The reports from less resourced settings indicate high morbidity and mortality in these populations. RECENT FINDINGS In this article, we review the disparities in global access to rheumatology care and research for patients with cSLE. We highlight recent cSLE advances from all regions of the globe. We describe current obstacles to cSLE clinical care and research in all settings. Finally, we propose a path forward for high quality, equitable and accessible care to individuals with cSLE everywhere. Individuals with cSLE are at risk for morbidity and death, yet patients worldwide face challenges to adequate access to care and research. Sustained, collaborative efforts are needed to create pathways to improve care and outcomes for these patients.
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Affiliation(s)
- Amita Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Taciana A P Fernandes
- Department of Pediatrics, Medical School, São Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil
| | - Angela Migowa
- Department of Paediatrics and Child Health, Aga Khan University, 3Rd Parklands Avenue, P.O.BOX 30270 00100 GPO, Nairobi, Kenya
| | - Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Maria Hanif
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Kate Webb
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Laura B Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
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Scolnik M. Stressed Healthcare Systems: The Impact on the Care of Patients With Rheumatic Diseases. J Rheumatol 2024; 51:953-954. [PMID: 39147417 DOI: 10.3899/jrheum.2024-0755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Affiliation(s)
- Marina Scolnik
- M. Scolnik, MSc, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina.
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Sautner J, Puchner R, Reisch M, Alkin A, Duftner C, Dejaco C. Professional development is the key to securing a future rheumatology workforce. Long term evaluation of a summer school for medical students-a national scientific society's educational initiative. Front Med (Lausanne) 2024; 11:1413544. [PMID: 39296892 PMCID: PMC11409003 DOI: 10.3389/fmed.2024.1413544] [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: 04/09/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
Objectives A cumulative imbalance between rheumatologic need and an inadequate number of young colleagues entering the field leads to a dearth of rheumatologists in the near future. The Austrian Society for Rheumatology and Rehabilitation (ÖGR) has been organizing an annual Rheumatology Summer School (RSS) for medical students since 2017. The aim of this study was to analyze the annual RSS evaluations, the RSS' overall effects on attracting new talent into the field and the lasting promotion of rheumatology. Methods A questionnaire was distributed immediately after each RSS meeting. Additionally, we conducted an electronic survey among RSS participants (2017-2022) to assess their career development trajectories. Results From 2017-2023, a total of 220 students attended the RSS. They all completed the annual evaluation. Accordingly, students' expectations were met in 80% (2017) to 97% (2023) of cases. The electronic survey was completed by 64/133 (48%) students; 49 (77%) indicated that the RSS had markedly increased their desire to specialize in rheumatology. Among the 36 graduates, 10 (28%) had already been working in the field of rheumatology and 6 (17%) were considering this specialty but had not decided yet. RSS attendees in their 6th study year were influenced to a greater extent by the RSS to choose rheumatology as their primary specialty than 4th or 5th year students. The participants indicated that they benefited most from the RSS in terms of knowledge gain, personal awareness of rheumatology, networking among fellow students as well as gaining access to RSS faculty. Conclusion The RSS enhanced students' intention to choose rheumatology, particularly in those close to graduation, and led to increased awareness and deeper knowledge about rheumatology.
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Affiliation(s)
- Judith Sautner
- Department of Medicine II, Lower Austrian Centre for Rheumatology, Karl Landsteiner Institute for Clinical Rheumatology, State Hospital Korneuburg-Stockerau, Stockerau, Austria
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Stockerau, Austria
| | - Rudolf Puchner
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Stockerau, Austria
- Danube Private University, Krems, Austria
| | - Myriam Reisch
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Stockerau, Austria
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Alois Alkin
- Medical Association of Upper Austria, Quality Management, Linz, Austria
| | - Christina Duftner
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Stockerau, Austria
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck/Tirol Kliniken GmbH, Innsbruck, Austria
| | - Christian Dejaco
- Austrian Society for Rheumatology and Rehabilitation (ÖGR), Stockerau, Austria
- Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck/Tirol Kliniken GmbH, Innsbruck, Austria
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Peeler J. Addressing musculoskeletal curricular inadequacies within undergraduate medical education. BMC MEDICAL EDUCATION 2024; 24:845. [PMID: 39107718 PMCID: PMC11304564 DOI: 10.1186/s12909-024-05849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Musculoskeletal (MSK) injuries and diseases place a significant burden on the health care system. Despite this, research indicates that physician training in the area of MSK medicine has historically been inadequate, with a majority of medical students feeling that their training in MSK medicine is lacking. The goal of this investigation was to evaluate the efficacy of a new preclinical MSK curriculum that was implemented within a nationally accredited allopathic medical program. METHODS Retrospective analysis was completed on five consecutive years (2017-2021) of preclinical MSK curricular data for 549 medical students, including mid and end-of-course examinations and end-of-course student satisfaction surveys. Both parametric and non-parametric methods of analysis were used to examine within and between class differences (P < 0.05). RESULTS The new MSK curriculum covered 15 of 16 "core or must know" topics in MSK medicine, and academic performance was consistently high over the 5-year period of analysis (final course marks ranged from 76.6 ± 7.1 to 81.4 ± 8.1; failures/year: range from 0 to 4), being equal or above levels of student performance observed for other courses delivered during preclinical studies. Likert data from end-of-course surveys demonstrated that feedback was overwhelmingly positive (overall course satisfaction ranged from a low of 3.07/4.00 to a high of 3.56/4.00) and indicated that students felt that the new preclinical MSK curriculum did effectively support medical student learning and knowledge retention. CONCLUSION Results are expected to help advance the current body of knowledge that is dedicated to improving physician learning and knowledge retention in the area of MSK medicine and provides a curricular model that could be used by other nationally accredited medical programs to help enhance MSK learning at the preclinical levels of physician training.
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Affiliation(s)
- Jason Peeler
- Department of Human Anatomy and Cell Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 745 Bannatyne Ave, Winnipeg, MB, Canada.
- Pan Am Clinic Foundation, Winnipeg, MB, Canada.
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Firman N, Homer K, Harper G, Robson J, Dezateux C. Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records. Arch Dis Child 2024; 109:414-421. [PMID: 38471744 DOI: 10.1136/archdischild-2023-326407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/04/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To assess whether there is a higher incidence of musculoskeletal consultations in general practice among children with obesity. DESIGN Longitudinal SETTING: 285 north-east London general practitioners (GPs). PARTICIPANTS 63 418 (50.9% boys) Reception and 55 364 (50.8% boys) Year 6 National Child Measurement Programme (NCMP) participants, linked to GP electronic health records (EHRs). MAIN OUTCOME MEASURE A GP consultation with a recorded musculoskeletal symptom or diagnosis. METHODS We calculated proportions with a musculoskeletal consultation by ethnic-adjusted weight status (underweight <2nd; overweight ≥91st; obese ≥98th centile), sex, ethnicity, and area-level deprivation. We estimated mutually-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) using Cox's proportional regression models stratified by school year and sex. RESULTS We identified 1868 (3.0%) Reception and 4477 (8.1%) Year 6 NCMP participants with at least one musculoskeletal consultation. In adjusted analyses, Reception year girls with a body mass index (BMI) classified as overweight (HR 1.24, 95% CI 1.02 to 1.52) or obese (HR 1.67, 95% CI 1.35 to 2.06) were more likely to have at least one musculoskeletal consultation. Year 6 girls with obesity were more likely (HR 1.20, 95% CI 1.07 to 1.35), and boys with a BMI in the underweight range were less likely (HR 0.39, 95% CI 0.21 to 0.73), to have a musculoskeletal consultation. CONCLUSIONS Girls living with obesity at the start or end of primary school are more likely to attend their GP for a musculoskeletal consultation. Routine linkage of NCMP data to EHRs provides useful insights into childhood health conditions related to excess weight in early childhood. Recognition of obesity as a contributing factor for musculoskeletal symptoms may inform clinical management, particularly in girls.
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Affiliation(s)
- Nicola Firman
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Gill Harper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - John Robson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Denq W, Tomesch AJ, Jackson T, Lane AD, Waterbrook A. Development and National Validation of a Musculoskeletal Emergency Medicine Assessment Tool. Cureus 2024; 16:e57632. [PMID: 38707067 PMCID: PMC11069614 DOI: 10.7759/cureus.57632] [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] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Musculoskeletal (MSK) complaints and injuries are the fourth most common primary diagnosis in the emergency department in the United States (US). Despite the prevalence and economic impact on the US healthcare system, new emergency medicine (EM) residency graduates report feeling unprepared to treat MSK complaints. Currently, there are no reported means to assess MSK knowledge in EM resident physicians. The purpose of this study is to develop a validated and peer-reviewed multiple-choice assessment tool focused on MSK knowledge relevant to EM to allow us to better assess the knowledge of resident physicians. Methods A group of EM/Sports Medicine subject-matter experts (SMEs) created an initial list of the most important MSK topics in EM to generate a relevant question bank. The questions were validated by a different group of SMEs using a three-round modified Delphi method to obtain consensus on the importance of each question. Based on these results, the assessment was formed. Results From a list of 99 MSK topics, SMEs developed a final list of 37 MSK topics relevant to EM. Following round one, free-marginal kappa was 0.58, 95% CI [0.50, 0.66], with a moderate overall agreement of 71.95%. Following round two, the calculated free-marginal kappa increased to 0.88, 95% CI [0.83, 0.92], with an overall agreement of 91.79%. Using a five-point Likert scale, a threshold of an average score less than four was used to exclude questions in round three of validation and to create a final 50-question assessment tool. Conclusion Our proposed exam, titled Musculoskeletal Emergency Medicine Assessment Tool (MEAT), was successfully validated by experts in our field. It evaluates clinically important topics and offers a tool for assessing MSK knowledge in EM resident physicians. Future studies are needed to determine the feasibility of administering the tool and to establish a baseline score among different populations within the practicing field of EM.
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Affiliation(s)
- William Denq
- Emergency Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | - Alexander J Tomesch
- Emergency Medicine/Sports Medicine, University of Nebraska Medical Center, Lincoln, USA
| | - Tyler Jackson
- Emergency Medicine, Hospital for Special Surgery, New York, USA
| | - Allison D Lane
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | - Anna Waterbrook
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
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Dey D, Katso B, Baah A, Isaaka S, Amoako E. Exploring paediatric rheumatology care: a ten-year retrospective analysis of the patient population in Ghana. Pediatr Rheumatol Online J 2024; 22:40. [PMID: 38515165 PMCID: PMC10956341 DOI: 10.1186/s12969-024-00975-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Rheumatic diseases can seriously impact children's general health, development, and growth. However, due to a lack of resources, paediatric rheumatology is a largely underdeveloped speciality in many African nations. Children with rheumatic disorders face obstacles in accessing specialized medical care, including lack of specialists, care centres, medication access, and limited research and education to increase understanding of paediatric rheumatic disease among healthcare practitioners. This study described the disease characteristics, prevalence, and challenges faced by paediatric rheumatic disease patients receiving care at a teaching hospital in Accra, Ghana. METHODS A retrospective record-based study was conducted among all paediatric cases presenting to the rheumatology clinic of the Korle Bu Teaching Hospital (KBTH) from January 2011 to December 2021. Data collected include clinical features, laboratory findings at disease presentation, andtherapeutic regimens prescribed per standard guidelines and experiences. RESULTS A total of 121 cases were identified as of 2021, indicating a point prevalence of 0.0011%. The majority (73%) were females with a mean age of 13.4 ± 3.2 years. The mean duration of symptoms in months experienced by patients before being successfully referred to a rheumatologist was 18 months. There were significant differences between referred and confirmed diagnoses, especially in cases involving mixed connective tissue diseases (MCTD), systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM), suggesting that these conditions may be under-recognised. Arthralgia and arthritis were the most common presenting symptoms. More than three-quarters (86.8%) of the cases studied were treated with steroids (oral or intravenous). In cases requiring immunosuppressive therapy, methotrexate was the most commonly prescribed in 33.9% of instances. Mortality was recorded at 8.3%, with the majority involving SLE cases. Most (95.7%) of the primary caregivers expressed positive experiences regarding care received at the adult rheumatology clinic. CONCLUSION There were significant delays in diagnosis and diagnostic accuracy for patients with paediatric rheumatic disease (PRD). This highlights the pressing need for strengthening paediatric rheumatology services in Africa, including increasing awareness about these conditions among the public and healthcare providers to improve early diagnosis and quality of life for children with these conditions.
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Affiliation(s)
- Dzifa Dey
- Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School Legon-Accra, Accra, Ghana.
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana.
| | - Bright Katso
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Afia Baah
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Saudatu Isaaka
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
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Sukharomana M, Charuvanij S. Implementation and assessment of a structured curriculum for a 4-week pediatric rheumatology rotation for pediatric residents. BMC MEDICAL EDUCATION 2024; 24:83. [PMID: 38263148 PMCID: PMC10804586 DOI: 10.1186/s12909-024-05043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND General pediatricians often initially address children's musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients' rheumatologic conditions. This study assessed the effectiveness of a structured curriculum in enhancing pediatric residents' knowledge, MSK examination skills, and confidence during a 4-week pediatric rheumatology rotation. METHODS Pediatric residents in their either second or third year who participated in the 4-week rheumatology rotation once across three academic years (July 2020-June 2023) were enrolled. Residents' knowledge, MSK examination skills, and confidence were assessed at pre- and post-rotation by using 25 multiple-choice questions, the Thai pediatric Gait Arms Legs Spine examination, and a questionnaire, respectively. The curriculum comprised instruction on MSK examinations, interactive lectures, case-based discussion, topic reviews, MSK radiology conference, clinical experience in rheumatology clinic and consultations, with self-guided learning with educational resources. RESULTS Fifty-eight pediatric residents (48 females, 10 males) with a mean age of 28.9 ± 0.8 years participated. Significant improvements were noted postrotation. Knowledge scores rose from 63.0 ± 12.2 to 79.7 ± 9.1 (mean difference 16.7 ± 10.3, p < 0.001). Similarly, MSK examination scores increased from 67.5 ± 14.4 to 93.6 ± 8.7 (mean difference 26.1 ± 14.6, p < 0.001). Residents also reported a marked increase in confidence across all evaluated areas, including history taking, MSK examination, arthrocentesis, and diagnosing and treating rheumatologic conditions (p < 0.001). CONCLUSIONS The 4-week structured curriculum in the pediatric rheumatology rotation significantly enhanced pediatric residents' knowledge, MSK examination skills, and confidence. These findings support the integration of pediatric rheumatology rotations into pediatric residency training programs.
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Affiliation(s)
- Maynart Sukharomana
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand.
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Kibone W, Nansubuga AL, Okot J, Buule R, Bongomin F, Kaddumukasa M. Rheumatology Training for Undergraduate Medical Students in Uganda: A Need Assessment Survey. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231222989. [PMID: 38204974 PMCID: PMC10775743 DOI: 10.1177/23821205231222989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
Objectives Despite the rise in the common rheumatological and musculoskeletal disorders (RMDs) in Africa, rheumatology remains an under recognized field with limited training and exposure of medical students. We assessed the knowledge of undergraduate medical students in Uganda on RMDs occurring in our settings. Methods A descriptive cross-sectional study was conducted among clinical year medical students at 9 universities in Uganda offering undergraduate medical degrees in March and April 2022. A self-administered, semistructured questionnaire was used to collect data on sociodemographic characteristics and basic knowledge on RMDs online using KoboToolbox. Sufficient knowledge was defined as a score of ≥50% (pass mark for undergraduate students in Uganda). Multivariable logistic regression was performed using STATA 16 to determine factors associated with knowledge acquisition on RMDs. Results We enrolled 359 medical students from 9 medical training institutes across Uganda. Overall, 126 (35.1%) participants had sufficient knowledge and the overall mean score for all participants was 41.2%. Factors independently associated with sufficient knowledge were: being in fourth (adjusted odds ratio [aOR]: 2.6, 95% confidence interval [CI]: 1.49-4.64, P < .001) and fifth year (aOR: 2.2, 95% CI: 1.18-4.18, P = .013) compared to third year of study, awareness of the speciality of rheumatology (aOR: 4.0, 95% CI: 1.96-8.06, P < .001), formal classes on rheumatology (aOR: 2.0, 95% CI: 1.15-3.35, P = .012), prior bedside teaching on RMDs (aOR: 2.3, 95% CI: 1.49-3.69, P < .001), awareness of common RMDs (aOR: 3.2, 95% CI: 1.67-6.04, P < .001), and having seen a patient with an RMD (aOR: 1.8, 95% CI: 1.14-2.77, P < .01). Conclusion There was a significant knowledge gap among undergraduate medical students nationwide on rheumatology. There is an urgent need to increase exposure to RMDs for undergraduate medical students to address the rising burden of RMDs in Uganda.
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Affiliation(s)
- Winnie Kibone
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Angel Lisa Nansubuga
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jerom Okot
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Richard Buule
- Faculty of Clinical Medicine and Dentistry, Kampala International University, Ishaka, Uganda
| | | | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Xiang L, Yoon S, Low AHL, Leung YY, Fong W, Lau TC, Koh DR, Thumboo J. Social cognitive theory to improve symptom appraisal and help-seeking among patients with autoimmune rheumatic diseases: A qualitative study. Int J Rheum Dis 2023; 26:2258-2266. [PMID: 37740602 DOI: 10.1111/1756-185x.14923] [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: 05/05/2023] [Revised: 08/11/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
AIM Social cognitive theory (SCT) has been successfully employed to improve symptom appraisal and help-seeking among patients with various conditions but is yet to be applied in the context of autoimmune rheumatic diseases (ARDs). This study aimed to explore the applicability of SCT in and possible approaches to improving symptom appraisal and help-seeking of patients with ARDs, one of the key barriers to earlier diagnosis. METHODS Semi-structured interviews were conducted with 33 ARD patients with a prolonged pre-diagnosis interval (>3 months). We coded the transcripts deductively using SCT as the overarching framework and inductively for approaches identified from the interviews. RESULTS All six main concepts of SCT (behavioral capacity, expectations, self-efficacy, observational learning, reinforcements, and reciprocal determinism) were observed in the three stages of symptom appraisal and help-seeking (detection, interpretation, and response) of patients with ARDs. While many participants reported that they were able and confident to detect their symptoms, they lacked the behavioral capacity and self-efficacy to interpret symptoms correctly, which resulted in delayed help-seeking and diagnosis. Possible approaches to address this suggested by participants (such as education of the general population) could improve behavioral capacity and self-efficacy in symptom interpretation and enhance expectations, observational learning, reinforcements, and reciprocal determinism in symptom response. CONCLUSION Lack of behavioral capacity and self-efficacy was observed in symptom interpretation of patients with ARDs, which resulted in delayed help-seeking. Approaches could target the behavioral capacity and self-efficacy for symptom interpretation to facilitate early help-seeking and, in turn, earlier diagnosis among individuals with possible ARDs.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Andrea H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Dow Rhoon Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Makeen HA, Meraya AM, Alqahtani SS, Hendi A, Menachery SJ, Alam N, Banji D, Banji OJ, Sadili AEY, Hadi Daghriri S, Ali Alameer E. Exploring the awareness, attitude, and inclination of healthcare students towards interprofessional education: A cross-sectional study in Saudi Arabia. Saudi Pharm J 2023; 31:101784. [PMID: 37818251 PMCID: PMC10561119 DOI: 10.1016/j.jsps.2023.101784] [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] [Received: 04/02/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Background Interprofessional education (IPE) is acknowledged to enhance understanding between professionals and to facilitate learning. Healthcare professionals may be better equipped to accept and esteem other healthcare professionals, if interprofessional education is incorporated into undergraduate curricula. The management of challenging patient issues may also significantly benefit from this. As a result, the current study examined interprofessional education in their institutions and students' knowledge of and attitudes toward it. Methodology We conducted a cross-sectional questionnaire-based study among students from a university in the southwest of Saudi Arabia, who were enrolled in courses in medical, pharmacy, nursing, dentistry, allied health, and public health. Following validation, the questionnaire included six questions to probe their knowledge, ten questions to gauge their attitude, and eleven questions to inquire about the growth and use of IPE in their institutions. Multiple regression and the Kruskal-Wallis test were used to examine the data. Results The survey involved 600 students, and 66.8% of the respondents were male. Less than one-third of students studying medicine replied to the survey, while students in the public health department had the lowest response rate. Compared to students in other programs, pharmacy students achieved a higher mean attitude score toward IPE (P < 0.001). Additionally, nursing and pharmacy students' mean IPE awareness scores were higher than those of medical students (P < 0.001). However, all program participants firmly agreed that integrating IPE into the curriculum was a good idea. Conclusions The study found that students of a few programs had awareness and a positive attitude toward interprofessional education. Nonetheless, all of them favored its inclusion in their curriculum. They also stressed the need to educate teaching faculty on interprofessional education, to develop skilled facilitators within their institutions.
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Affiliation(s)
- Hafiz A. Makeen
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Abdulkarim M. Meraya
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Saad S. Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Ali Hendi
- Department of Radiology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Santhosh J. Menachery
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Nawazish Alam
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - David Banji
- Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Otilia J.F. Banji
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Ali Essa Y. Sadili
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Sakr Hadi Daghriri
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
- Pharmacy Care Department, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia
| | - Essam Ali Alameer
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
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12
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Denq W, Tomesch AJ, Lane AD, Thomas A, McNinch NL, Waterbrook A. National Needs Assessment of Emergency Medicine Residencies for Musculoskeletal Knowledge. Cureus 2023; 15:e43638. [PMID: 37719484 PMCID: PMC10504909 DOI: 10.7759/cureus.43638] [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: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Musculoskeletal (MSK) complaints and injuries account for a large percentage of presenting chief complaints to the emergency department in the United States (US). Despite the prevalence and economic impact on the US healthcare system, there is a documented deficiency in MSK education at all training and practicing levels in the US medical system. The purpose of this needs assessment is to better determine the state of MSK education in Emergency Medicine residency programs. Methods An online needs assessment form was sent to Emergency Medicine program directors in the US. Summary statistics were performed followed by an exploratory analysis. Results Data from 43 of 272 Emergency Medicine program directors that responded to this needs assessment were analyzed. Respondents ranked the importance of MSK education in Emergency Medicine on a Likert scale of 1-5 (very unimportant to very important) at a mean of 4.2. Additionally, 97.6% of respondents believe that their MSK curriculum could be improved. Seventy-nine percent of respondents were somewhat likely or highly likely to use a standardized method or tool to assess MSK knowledge. Of the top three barriers to MSK education implementation, 94.9% cited time, 56.4% cited interdepartmental relations, and 46.2% cited funding. Conclusion MSK knowledge is taught and assessed in highly variable methods across Emergency Medicine residency programs. Although efforts are being made to address the known deficiency in MSK knowledge, further research is needed to perform a larger needs assessment, study innovative MSK education modalities, and develop a standardized MSK assessment for Emergency Medicine residency training.
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Affiliation(s)
- William Denq
- Emergency Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | | | - Allison D Lane
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | - Aaron Thomas
- Emergency Medicine/Sports Medicine, Mayo Clinic, Phoenix, USA
| | | | - Anna Waterbrook
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
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McNeill K, Reyes N, Choe S, Peterson D, Bryant D, Sonnadara RR. A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education. MEDICAL SCIENCE EDUCATOR 2023; 33:777-790. [PMID: 37501799 PMCID: PMC10368607 DOI: 10.1007/s40670-023-01782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 07/29/2023]
Abstract
Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.
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Affiliation(s)
- Kestrel McNeill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Natasha Reyes
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Stella Choe
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Dianne Bryant
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Ranil R. Sonnadara
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1 Canada
- Compute Ontario, Toronto, ON Canada
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14
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Migowa A, Bernatsky S, Ngugi A, Foster HE, Muriuki P, Lusambili A, Luchters S. An iceberg I can't handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya. Pediatr Rheumatol Online J 2023; 21:6. [PMID: 36681840 PMCID: PMC9862847 DOI: 10.1186/s12969-023-00790-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/15/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to non-specialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management. PURPOSE We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya. METHODS We conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software. RESULTS A total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31-40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities. CONCLUSION There is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients.
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Affiliation(s)
- Angela Migowa
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. .,Department of Paediatrics and Child Health, Aga Khan University, Medical College East Africa, Nairobi, Kenya.
| | - Sasha Bernatsky
- grid.63984.300000 0000 9064 4811Department of Medicine (Division of Rheumatology and Epidemiology) McGill University Health Centre (MUCH), Montreal, Canada
| | - Anthony Ngugi
- grid.470490.eDepartment of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Population and Health Institute, Newcastle University, Newcastle, UK
| | - Peter Muriuki
- grid.413355.50000 0001 2221 4219African Population and Health Research Centre, Nairobi, Kenya
| | - Adelaide Lusambili
- grid.470490.eDepartment of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Stanley Luchters
- grid.5342.00000 0001 2069 7798International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ,grid.463169.f0000 0004 9157 2417Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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15
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Gorczyca D, Iwańczyk P, Staś K, Postępski J. Knee pain as a reason for referral to a paediatric rheumatologist: A retrospective study. J Paediatr Child Health 2023; 59:439-444. [PMID: 36627832 DOI: 10.1111/jpc.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023]
Abstract
AIM Knee pain is the most frequently reported type of lower extremity pain among children and adolescents. The objective of this study was to establish the features distinguishing inflammatory knee pain from non-inflammatory knee pain and to determine the specific variables to consider in suspected juvenile idiopathic arthritis (JIA). METHODS A retrospective chart review was performed among children with knee pain evaluated through paediatric rheumatology consultations at a single centre between 2012 and 2019. RESULTS Among the 262 children, 32 patients (12.2%) were diagnosed with JIA, 46 patients (17.6%) presented with inflammatory knee pain (IP) of an origin different than JIA, and 57 patients (21.7%) with non-inflammatory knee pain (NIP). In 127 cases (48.5%), no musculoskeletal disorder was diagnosed (NDD). The presence of limping, joint swelling, decreased passive range of motion and decreased active range of motion of the knee joint were registered more frequently in the JIA group compared to the other three groups. Multivariate analysis showed that a family history of autoimmune diseases and pain in other joints were associated with inflammatory pain. Increased pain after physical activity, pain only in the knee joint and absence of limping were predictors of NIP. The risk factors of JIA were limping and an erythrocyte sedimentation range of ≥10 mm after an hour. In the NDD group, the risk factors included no increase in pain after physical activity, serum C-reactive protein level < 5 mg/L and normal musculoskeletal ultrasound image. CONCLUSIONS The majority of children with knee pain referred to a paediatric rheumatologist do not have arthritis. Knee pain alone, as a chief complaint, rarely leads to a final JIA diagnosis. Further studies are necessary in order to design the appropriate diagnostic and therapeutic algorithms.
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Affiliation(s)
- Daiva Gorczyca
- Center for Chronically Sick Children Berlin, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Patrycja Iwańczyk
- Neonatology Department, The Institute of Mother and Child, Warsaw, Poland
| | - Karolina Staś
- Paediatric Department, Public Autonomous Health Care Hospital, Sulechów, Poland
| | - Jacek Postępski
- Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, Lublin, Poland
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Semaka A, Katz SJ. Rheumatology Image of the Month: A Low Resource Innovation With Measurable Results. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231164027. [PMID: 36936181 PMCID: PMC10021094 DOI: 10.1177/23821205231164027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Strategies to increase confidence in rheumatology knowledge are valuable for medical trainees and residents. A web-based teaching innovation was implemented in an attempt to increase rheumatology exposure for internal medicine residents. METHODS An Image of the Month webpage was established, where a practicing rheumatologist would post a new image that could be answered online by internal medicine residents. Cumulative data was analyzed to determine the extent and change in rheumatology exposure. RESULTS The Image of the Month webpage posted images for a total of 76 months between July 2010 to May 2017, with a total of 1326 submitted responses. The proportion of residents who only participated in Image of the Month and only did a rheumatology rotation averaged 36.1% and 16.5%, respectively. The proportion of residents who only participated in Image of the Month was higher than the proportion who only did a rheumatology rotation for all of the 7 time periods assessed. A total of 491 residents participated in Image of the Month, with an average of 54.9% of residents participating each year. Overall, on average, 52 residents had 1 or more submissions, 3.6 entries were submitted per resident, and 17.4 entries were submitted per month. Junior residents (PGY1) participated more often than senior residents (PGY3). CONCLUSIONS The Image of the Month webpage successfully improves internal medicine resident exposure to rheumatology with minimal resources and manpower required. Further study is necessary to determine the impact this exposure may have on the abilities and confidence levels of internal medicine residents.
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Affiliation(s)
- Amy Semaka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton,
Canada
| | - Steven J Katz
- Division of Rheumatology, Department of Medicine, University of
Alberta, Edmonton, Canada
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17
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Kandwal P, Barik S, Maini L. Orthopedic Undergraduate Education in India: Need for a Change. Indian J Orthop 2022; 56:1843-1846. [PMID: 36310557 PMCID: PMC9561498 DOI: 10.1007/s43465-022-00735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Pankaj Kandwal
- All India Institute of Medical Sciences, Rishikesh, India
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18
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Williams CM, Menz HB, Lazzarini PA, Gordon J, Harrison C. Australian children's foot, ankle and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data. BMJ Open 2022; 12:e062063. [PMID: 35896301 PMCID: PMC9335039 DOI: 10.1136/bmjopen-2022-062063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore children's foot, ankle and leg consultation patterns and management practices in Australian primary care. DESIGN Cross-sectional, retrospective study. SETTING Australia Bettering the Evaluation and Care of Health program dataset. PARTICIPANTS Data were extracted for general practitioners (GPs) and patients <18 years from April 2000 to March 2016 inclusive. MAIN OUTCOME MEASURES Demographic characteristics: sex, GP age groups (ie, <45, 45-54, 55+ years), GP country of training, patient age grouping (0-4, 5-9, 10-14, 15-18 years), postcode, concession card status, indigenous status, up to three patient encounter reasons, up to four encounter problems/diagnoses and the clinical management actioned by the GP. RESULTS Children's foot, ankle or leg problems were managed at a rate of 2.05 (95% CI 1.99 to 2.11) per 100 encounters during 229 137 GP encounters with children. There was a significant increase in the rate of foot, ankle and leg problems managed per 100 children in the population, from 6.1 (95% CI 5.3 to 6.8) in 2005-2006 to 9.0 (95% CI 7.9 to 10.1) in 2015-2016. Management of children's foot, ankle and leg problems were independently associated with male patients (30% more than female), older children (15-18 years were 7.1 times more than <1 years), male GPs (13% more) and younger GPs (<45 years of age 13% more than 55+). The top four most frequently managed problems were injuries (755.9 per 100 000 encounters), infections (458.2), dermatological conditions (299.4) and unspecified pain (176.3). The most frequently managed problems differed according to age grouping. CONCLUSIONS Children commonly present to GPs for foot, ankle and leg problems. Presentation frequencies varied according to age. Unexpectedly, conditions presenting commonly in adults, but rarely in children, were also frequently recorded. This data highlights the importance of initiatives supporting contemporary primary care knowledge of diagnoses and management of paediatric lower limb problems to minimise childhood burden of disease.
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Affiliation(s)
- Cylie M Williams
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Julie Gordon
- WHO-CC for Strengthening Rehabilitation Capacity in Health Systems, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Parramatta, New South Wales, Australia
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19
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Song Y, Jorgensen C. Mesenchymal Stromal Cells in Osteoarthritis: Evidence for Structural Benefit and Cartilage Repair. Biomedicines 2022; 10:biomedicines10061278. [PMID: 35740299 PMCID: PMC9219878 DOI: 10.3390/biomedicines10061278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/15/2022] Open
Abstract
Osteoarthritis (OA) presents a major clinical challenge to rheumatologists and orthopedists due to the lack of available drugs reducing structural degradation. Mesenchymal stromal cells (MSCs) may represent new therapeutic approaches in cartilage regeneration. In this review, we highlight the latest knowledge on the biological properties of MSC, such as their chondrogenic and immunomodulatory potential, and we give a brief overview of the effects of MSCs in preclinical and clinical studies of OA treatment and also compare different MSC sources, with the adipose tissue-derived MSCs being promising. Then, we focus on their structural benefit in treating OA and summarize the current evidence for the assessment of cartilage in OA according to magnetic resonance imaging (MRI) and second-look arthroscopy after MSC therapy. Finally, this review provides a brief perspective on enhancing the activity of MSCs.
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20
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Power JD, Perruccio AV, Paterson JM, Canizares M, Veillette C, Coyte PC, Badley EM, Mahomed NN, Rampersaud YR. Healthcare utilization and costs for musculoskeletal disorders in Ontario, Canada. J Rheumatol Suppl 2022; 49:740-747. [PMID: 35365584 DOI: 10.3899/jrheum.210938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the magnitude and costs of ambulatory primary and specialist physician care and hospital service use for musculoskeletal disorders (MSDs) in Canada's largest province, Ontario. METHODS Administrative health databases were analyzed for fiscal year 2013-2014 for adults 18+ years, including data on physician services, emergency department (ED) visits and hospitalizations. ICD diagnostic codes were used to identify MSD services. A validated algorithm was used to estimate direct medical costs. Person visit rates and numbers of persons and visits were tabulated by care setting, age and sex, and physician specialty. Data were examined for all MSDs combined as well as specific diagnostic groupings. RESULTS Overall, 3.1 million adult Ontarians (28.5%) made 8 million outpatient physician visits associated with MSDs. These included 5.6 million primary care visits. MSDs accounted for 560,000, 12.3%, of all adult ED visits. Total costs for MSD-related care were $1.6 billion, with 12.6% of costs attributed to primary care, 9.2% to specialist care, 8.6% to ED care, 8.5% to day surgery and 61.2% of total costs associated with inpatient hospitalizations. Costs due to arthritis accounted for 40% of total MSD care costs ($639 million). MSD-related imaging costs were $169 million. Including these costs yields a total estimate of $1.8 billion for all MSDs combined. CONCLUSION MSDs place a significant and costly burden on the health care system. Health system planning needs to consider the large and escalating demand for care to reduce both the individual and population burden.
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Affiliation(s)
- J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - J Michael Paterson
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Christian Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Peter C Coyte
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Nizar N Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Support: This study was financially supported by the Toronto General & Western Hospital Foundation through the University Health Network Arthritis Program. The funding source had no involvement in study design or manuscript preparation. Conflict of Interest: There are no potential conflicts of interest relevant to this work. Corresponding Author: J. Denise Power, 399 Bathurst Street MP10-326, Toronto, Ontario, Canada, M5T 2S8.
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Medical students' perspective on incorporating a rheumatology expert patient program in their curriculum: a cross-sectional survey-based study. Rheumatol Int 2022; 42:899-903. [PMID: 35262774 PMCID: PMC8905006 DOI: 10.1007/s00296-022-05105-4] [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] [Received: 12/20/2021] [Accepted: 02/21/2022] [Indexed: 11/01/2022]
Abstract
To evaluate the rheumatic diseases patient expert program and assess the students' perspective on its implementation into the medical school's curriculum. During the 4th year, small groups of medical students participated in a 2-h session with a rheumatic disease patient expert and a rheumatologist. The students had the opportunity to learn about the patient's journey, manifestations, shared thoughts, and asked questions. The patient demonstrated the hand musculoskeletal exam. At the end of the academic year, an online survey was sent to 88 students and they were asked to fill out a 19-item questionnaire using a Likert-scale response. The voluntary response rate was 67%, and 64.4% were females. Overall, most participants had a favorable experience with the program (strongly agree/agree response). 93% were satisfied with the communication they had with the patient, 93% felt the patient was active in their teaching, and 89% were engaged in meaningful learning. The vast majority of the students would recommend the program to their fellow students and they strongly believe that it should be a part of the medical school's curriculum. The findings of this study indicate the patient expert program is a novel educational activity that had a favorable impact on medical students' education and a positive perspective of implementing it to the medical school curriculum. The program's implementation will raise awareness for RMD, attract more students in the field of rheumatology, and promote the patient-centered care approach.
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Pediatric Rheumatic Disease in Lower to Middle-Income Countries: Impact of Global Disparities, Ancestral Diversity, and the Path Forward. Rheum Dis Clin North Am 2021; 48:199-215. [PMID: 34798947 DOI: 10.1016/j.rdc.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pediatric rheumatology subspecialists treat chronic autoimmune diseases with onset in childhood. Prompt diagnosis and ongoing management of these conditions are imperative to prevent damage from ongoing inflammation. Here, we aim to describe the current landscape of pediatric rheumatic disease in lower to middle-income countries (LMICs) and explore current barriers to understanding global disease burden. We then examine innovative strategies to promote a more equitable future for children and young people living with rheumatic diseases worldwide.
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23
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Chowichian M, Sonjaipanich S, Charuvanij S. Attitudes toward pediatric rheumatology among residency-trained pediatricians. Pediatr Int 2021; 63:1162-1169. [PMID: 33512045 DOI: 10.1111/ped.14621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/30/2020] [Accepted: 01/15/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pediatric rheumatology (PR) is a relatively new and rare subspecialty in emerging countries. This study aimed to investigate physicians' attitudes toward and real-life clinical practice in PR among residency-trained pediatricians in Thailand. METHODS An electronic questionnaire was developed and sent via email to pediatricians from Thailand who completed their residency training between 2007 and 2015. Confidence in treating and managing children with rheumatic diseases was rated using a 5-point Likert scale. RESULTS The response rate was 281 out of 902 (31%), and the mean ± standard deviation age of respondents was 33.8 ± 2.7 years. Confidence was rated as adequate for history taking of children with rheumatic diseases (mean 2.76, 95% confidence interval [CI]: 2.66-2.91), but low for musculoskeletal (MSK) examination (2.42, 95% CI: 2.29-2.54), arthrocentesis (2.01, 95% CI: 1.91-2.11), and rheumatology investigation (2.49, 95% CI: 2.39-2.60). Confidence was high for diagnosis and management of Henoch-Schönlein purpura (3.83, 95% CI: 3.74-3.92) and Kawasaki disease (3.46, 95% CI: 3.38-3.55), but low for juvenile idiopathic arthritis (JIA) (2.41, 95% CI: 2.30-2.52) and chronic systemic vasculitis (1.97, 95% CI: 1.85-2.08). Confidence to perform an MSK examination and arthrocentesis was significantly higher in respondents who had a full-time pediatric rheumatologist working in their pediatric residency training center (P = 0.02, P = 0.01, respectively), and in those who had experienced a PR rotation (P < 0.001, P = 0.01, respectively). Most respondents agreed that more teaching in PR is essential (95.3%) and that case-based discussion was the preferred teaching method. CONCLUSION The self-rated confidence of pediatricians was low in MSK examination, arthrocentesis, and rheumatology investigation and therefore, teaching on PR is needed.
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Affiliation(s)
- Monthira Chowichian
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suprapath Sonjaipanich
- Division of Ambulatory Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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24
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Rheumatology education in India: a survey-based cross sectional study. Rheumatol Int 2021; 41:1773-1783. [PMID: 34357454 PMCID: PMC8343210 DOI: 10.1007/s00296-021-04962-9] [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: 06/17/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022]
Abstract
This study aimed at understanding the perception and perspectives of rheumatology trainees about specialist training in India. Rheumatology trainees (Doctorate of Medicine, Diplomate of National Board) in Indian universities (2010 onwards) were contacted to complete a validated e-survey consisting of 41 questions to evaluate the current rheumatology training in India. Of 53 respondents (M:F 3.4:1, mean age 37 years ± 12.7), 81.1% trained at government hospitals, and 15.1% trained at private hospitals. During training period, 37.5% respondents were exposed to 6–7 h of didactics/week. They treated nearly 175 patients (175 ± 35.4) per week and reported a reasonable level of independence in management of patients with common rheumatic diseases (RDs) during their training (7.5 ± 0.7 SD). However, nearly one-third of the trainees were not exposed to basic immunology and laboratory techniques. Similarly, placement in the radiology department was not a part of the curriculum for nearly half of the trainees, 80% were not confident to manage paediatric RDs and soft tissue rheumatism. Almost 60% did not feel comfortable in addressing ancillary care including patient counselling as they had not received formal training. Among the participants, 59% were not satisfied by the current system of assessment, 86.8% suggested for multiple time point-based assessment systems and 45.3% preferred objective and subjective assessment in final examinations. Rheumatology training in India offers notable exposure to patients and independence in managing cases. However, there is an unmet need for improvement in training in the field of laboratory, radiology and ancillary care, and to overhaul assessment system by including objective evaluation.
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25
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Smith N, Foster HE, Jandial S. A mixed methods evaluation of the Paediatric Musculoskeletal Matters (PMM) online portfolio. Pediatr Rheumatol Online J 2021; 19:85. [PMID: 34108019 PMCID: PMC8188761 DOI: 10.1186/s12969-021-00567-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The PMM Portfolio is comprised of the Paediatric Musculoskeletal Matters (PMM) website, the paediatric Gait, Arms, Legs and Spine (pGALS) app and e-learning modules (ELM). The target audiences are non-specialists in paediatric musculoskeletal medicine. Our study aimed to evaluate impact on learning and clinical practice. METHODS Mixed methods (analytics, online survey, interviews) were used with PMM and ELM registered users and purposive sampling of users using international contacts within paediatrics and paediatric rheumatology. Data was analysed using descriptive statistics and qualitative techniques. A Paired T-Test compared self-rated confidence before and after use of the PMM Portfolio. RESULTS There has been wide reach for all the e-resources; PMM website (662,827 hits, 262,476 users, 214 countries, data 31st July 2020); pGALS app (12,670 downloads, 70 countries, data 31st July 2020); ELM (150 users, 30 countries, data 30th May 2019). There were 164 responses (students, trainees and health care professionals) to the survey from 25 countries. Most responders deemed the PMM Portfolio useful / very useful for their learning with significantly increased self-rated confidence in their clinical examination and reasoning skills following access to the PMM website, p = < 0.01, pGALS app, p = < 0.01 and ELM, p = < 0.01. The most popular PMM website pages related to clinical assessment techniques (especially pGALS). There was high uptake of the pGALS app and pGALS ELM especially from trainees and allied health professionals. Many clinicians reported the PMM Portfolio to be useful when used to teach others. User feedback reported that easy navigation, open access, clinical images and cases were the most valued features. User feedback highlighted need to increase awareness of the e-resources through training programmes. CONCLUSIONS The PMM Portfolio was developed to aid learning for clinicians who are not specialists in paediatric MSK medicine. Our evaluation demonstrates wide international reach and positive feedback on learning. The PMM Portfolio is a highly useful e-resource for paediatric rheumatologists in their teaching of others to raise awareness, facilitate early diagnosis and referral of children with suspected disease. The wide user engagement informed future PMM Portfolio development and the mixed method of evaluation is transferable to other e-resources.
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Affiliation(s)
- Nicola Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Population and Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK ,grid.459561.a0000 0004 4904 7256Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UK
| | - Sharmila Jandial
- grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK ,grid.459561.a0000 0004 4904 7256Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UK
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26
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Matta C, Lewis R, Fellows C, Diszhazi G, Almassy J, Miosge N, Dixon J, Uribe MC, May S, Poliska S, Barrett-Jolley R, Fodor J, Szentesi P, Hajdú T, Keller-Pinter A, Henslee E, Labeed FH, Hughes MP, Mobasheri A. Transcriptome-based screening of ion channels and transporters in a migratory chondroprogenitor cell line isolated from late-stage osteoarthritic cartilage. J Cell Physiol 2021; 236:7421-7439. [PMID: 34008188 DOI: 10.1002/jcp.30413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Chondrogenic progenitor cells (CPCs) may be used as an alternative source of cells with potentially superior chondrogenic potential compared to mesenchymal stem cells (MSCs), and could be exploited for future regenerative therapies targeting articular cartilage in degenerative diseases such as osteoarthritis (OA). In this study, we hypothesised that CPCs derived from OA cartilage may be characterised by a distinct channelome. First, a global transcriptomic analysis using Affymetrix microarrays was performed. We studied the profiles of those ion channels and transporter families that may be relevant to chondroprogenitor cell physiology. Following validation of the microarray data with quantitative reverse transcription-polymerase chain reaction, we examined the role of calcium-dependent potassium channels in CPCs and observed functional large-conductance calcium-activated potassium (BK) channels involved in the maintenance of the chondroprogenitor phenotype. In line with our very recent results, we found that the KCNMA1 gene was upregulated in CPCs and observed currents that could be attributed to the BK channel. The BK channel inhibitor paxilline significantly inhibited proliferation, increased the expression of the osteogenic transcription factor RUNX2, enhanced the migration parameters, and completely abolished spontaneous Ca2+ events in CPCs. Through characterisation of their channelome we demonstrate that CPCs are a distinct cell population but are highly similar to MSCs in many respects. This study adds key mechanistic data to the in-depth characterisation of CPCs and their phenotype in the context of cartilage regeneration.
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Affiliation(s)
- Csaba Matta
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Veterinary Preclinical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Rebecca Lewis
- Department of Veterinary Preclinical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Christopher Fellows
- Department of Veterinary Preclinical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Gyula Diszhazi
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Janos Almassy
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nicolai Miosge
- Department of Prosthodontics, Tissue Regeneration Work Group, Georg August University, Göttingen, Germany
| | - James Dixon
- Wolfson Centre for Stem Cells, Tissue Engineering and Modelling, Centre of Biomolecular Sciences, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Marcos C Uribe
- The Nottingham Arabidopsis Stock Centre (NASC), School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Sean May
- The Nottingham Arabidopsis Stock Centre (NASC), School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Szilard Poliska
- Genomic Medicine and Bioinformatic Core Facility, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Richard Barrett-Jolley
- Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Janos Fodor
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Szentesi
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tibor Hajdú
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Aniko Keller-Pinter
- Department of Biochemistry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Erin Henslee
- Department of Mechanical Engineering Sciences, Centre for Biomedical Engineering, University of Surrey, Guildford, UK
| | - Fatima H Labeed
- Department of Mechanical Engineering Sciences, Centre for Biomedical Engineering, University of Surrey, Guildford, UK
| | - Michael P Hughes
- Department of Mechanical Engineering Sciences, Centre for Biomedical Engineering, University of Surrey, Guildford, UK
| | - Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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27
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Abstract
PURPOSE OF THE REVIEW To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide. RECENT FINDINGS Recent studies and reports demonstrate a paucity of studies on epidemiology, outcomes, and management guidelines from many regions of the world. There have been noteworthy efforts to bridge the gap in under resourced areas. An analysis of the global burden of rheumatic disease has demonstrated that while understudied, musculoskeletal diseases are prevalent and increasingly contribute to loss of years of healthy life. In juvenile idiopathic arthritis, two milestone publications in global pediatric rheumatology have recently been published. An international study evaluated the epidemiology, treatment, and outcomes of juvenile idiopathic arthritis and demonstrated global diversity in both clinical manifestations and outcomes. Notably, the first guidelines for managing pediatric rheumatic disease in a less resourced setting have been published for juvenile idiopathic arthritis. This document offers the first publication targeted to address challenges faced by pediatric rheumatology caregivers in low-resourced settings. These documents serve as exemplars for international collaboration in pediatric rheumatology and can be used as models for other pediatric rheumatic disease research. Other efforts are making progress in various arenas towards increasing access to care, education, and training in pediatric rheumatology. SUMMARY The global burden of rheumatic disease in the pediatric population is poorly understood but unrecognized disease greatly impacts the overall morbidity and mortality in this population. More studies in lesser resourced regions are needed to prioritize access to pediatric rheumatology care and prioritize a further increase in research capacity and education moving forward.
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28
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Pichard L, Brondello JM, Becker F, Desprat R, De Ceuninck F, Pastoureau P, Noel D, Jorgensen C, Lemaitre JM. Establishment of a collection of human pluripotent stem cell lines (iPSC) from mesenchymal stem cells (MSC) from three healthy elderly donors. Stem Cell Res 2021; 53:102297. [PMID: 33780731 DOI: 10.1016/j.scr.2021.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/17/2021] [Accepted: 03/14/2021] [Indexed: 11/27/2022] Open
Abstract
The study of molecular mechanism driving osteoarticular diseases like osteoarthritis or osteoporosis is impaired by the low accessibility to mesenchymal stem cells (MSC) from healthy donors (HD) for differential multi-omics analysis. Advances in cell reprogramming have, however, provided both a new source of human cells for laboratory research and a strategy to erase epigenetic marks involved in cell identity and the development of diseases. To unravel the pathological signatures on the MSC at the origin of cellular drifts during the formation of bone and cartilage, we previously developed iPSC from MSC of osteoarthritis donors. Here we present the derivation of three iPSCs from healthy age matched donors to model the disease and further identify (epi)genomic signatures of the pathology.
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Affiliation(s)
- Lydiane Pichard
- SAFE-iPSC Facility INGESTEM, Univ Montpellier, CHU de Montpellier, Montpellier, France; Institute for Regenerative Medicine and Biotherapy, INSERM UMR1183, Univ Montpellier, Montpellier, France
| | - Jean-Marc Brondello
- Institute for Regenerative Medicine and Biotherapy, INSERM UMR1183, Univ Montpellier, Montpellier, France
| | - Fabienne Becker
- SAFE-iPSC Facility INGESTEM, Univ Montpellier, CHU de Montpellier, Montpellier, France
| | - Romain Desprat
- SAFE-iPSC Facility INGESTEM, Univ Montpellier, CHU de Montpellier, Montpellier, France
| | - Frédéric De Ceuninck
- Institut de Recherches Servier, Center for Therapeutic Innovation, Immuno-inflammatory Disease, Croissy sur Seine, France
| | - Philippe Pastoureau
- Institut de Recherches Servier, Center for Therapeutic Innovation, Immuno-inflammatory Disease, Croissy sur Seine, France
| | - Daniele Noel
- Institute for Regenerative Medicine and Biotherapy, INSERM UMR1183, Univ Montpellier, Montpellier, France
| | - Christian Jorgensen
- Institute for Regenerative Medicine and Biotherapy, INSERM UMR1183, Univ Montpellier, Montpellier, France
| | - Jean-Marc Lemaitre
- SAFE-iPSC Facility INGESTEM, Univ Montpellier, CHU de Montpellier, Montpellier, France; Institute for Regenerative Medicine and Biotherapy, INSERM UMR1183, Univ Montpellier, Montpellier, France.
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29
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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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30
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Ahmed S, Zimba O, Gasparyan AY. Moving towards online rheumatology education in the era of COVID-19. Clin Rheumatol 2020; 39:3215-3222. [PMID: 32939569 PMCID: PMC7494363 DOI: 10.1007/s10067-020-05405-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/06/2020] [Accepted: 09/12/2020] [Indexed: 12/28/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has unsettled conventional medical education, hastening a switch to digital platforms and open-access publishing. Rheumatology is a fast evolving academic discipline that stands to gain by this switch. Most rheumatology textbooks are now available in digital formats, and these are complemented with live updating educational hubs such as UpToDate and ClinicalKey. Emerging topics of COVID-19 on these proprietary platforms are now freely available to all specialists. Social media channels, particularly Twitter, are becoming major players in the era of COVID-19 by offering online journal clubs, enabling fast dissemination of influential articles, and facilitating interactive education. Indexed rheumatology journals, in turn, aid online education by opening access to recommendations and other materials that are rapidly changing research and practice worldwide. Research peer review additionally offers learning experience to novice and seasoned researchers and authors. Global rheumatology societies have online learning resources, which are changing their format and geographic reach to meet the changing needs in the times of pandemic. While online teaching lacks emotional connections between mentors and mentees, switch to a more interactive format of education and regular contacts may partly solve the issue. Rheumatologists can take the lead in these challenging times and contribute more to online scholarly activities which are aimed to maintain and enrich education. Key Points • Disparities in rheumatology education are likely to be widened during the COVID-19 pandemic. • Barriers to rheumatology education include limited number of instructors and their limited experience in online teaching. • Online textbooks, didactic materials of indexed rheumatology journals, and frequently updated online educational hubs such as UpToDate serve as a foundation of online rheumatology education. • Online rheumatology education is enriched by peer review and social media activities, which are becoming major players in the time of the COVID-19 pandemic.
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Affiliation(s)
- Sakir Ahmed
- Department of Clinical Immunology & Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024 India
| | - Olena Zimba
- Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Russells Hall Hospital, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Pensnett Road, Dudley, West Midlands DY1 2HQ UK
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31
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Abstract
This chapter describes the musculoskeletal (MSK) context in children and young people as an important contributor to the global non-communicable disease burden. Through selected MSK conditions, we describe the impact on patients, families and communities and highlight the challenges that need to be addressed. We focus on opportunities for better working together and describe exemplar initiatives to raise awareness, workforce capacity building, models of care and research agendas to have a greater global context.
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32
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Foster HE, Scott C, Tiderius CJ, Dobbs MB. The paediatric global musculoskeletal task force - 'towards better MSK health for all'. Pediatr Rheumatol Online J 2020; 18:60. [PMID: 32664961 PMCID: PMC7359433 DOI: 10.1186/s12969-020-00451-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/03/2020] [Indexed: 12/14/2022] Open
Abstract
There is increasing concern about the emerging global non-communicable diseases (NCDs) burden. The focus has mainly been on NCDs in adults but it is important that MSK morbidity in both children and adults is included in strategic planning. There have been considerable advances in the understanding and treatment options for children and young people (CYP) and clinical outcomes are improving for those who can access such high quality care. However vast inequity exists and there are many CYP who live in areas of the world with high burden of health care challenges, compounded by paucity of specialist care and limited access to treatments. The Paediatric Global Musculoskeletal Task Force aims to raise awareness about unmet needs for CYP with MSK conditions, promotion of MSK health through lifestyle and the avoidance of injury. We aim to leverage change through 'working together better'.
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Affiliation(s)
- Helen E Foster
- Newcastle University, UK and Newcastle University Medicine Malaysia, Newcastle upon Tyne, UK.
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33
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Aggarwal A, Haq SA. Rheumatology workforce issues in South Asia: Challenges and solutions. Int J Rheum Dis 2020; 23:443-447. [PMID: 31960604 DOI: 10.1111/1756-185x.13793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Syed Atiqul Haq
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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34
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Micelli ML, Sequeira G, Fara N, Abbas L, Estrella N, Acevedo M, Kerzberg E. Description of the resources for rheumatology training and speciality certification and recertification requirements in Argentina. Rheumatol Int 2020; 40:243-249. [PMID: 31894352 DOI: 10.1007/s00296-019-04505-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
The objective of the study was to analyse resources for rheumatology training, and speciality certification and recertification requirements in Argentina. Information was gathered regarding vacancies, entry requirements, duration and validity of the specialist degree in every residency and postgraduate course in adult rheumatology. The following aspects were analysed: monitoring authority, certification and recertification requirements, and mandatory recertification. Six out of 36 universities offer rheumatology postgraduate courses. Out of 65 vacancies, 36 (55%) are implemented by a National Public University in the Autonomous City of Buenos Aires (CABA), and 46 (70%) are in CABA. There are 32 vacancies for rheumatology residencies in 7 out of 24 districts, 16 of them (50%) in CABA. There are 2- to 3-year postgraduate courses; entry requirements range from 1-year experience in internal medicine to either complete residency or specialist degree in internal medicine. Training formats vary from full-time university residency to either university-based courses with part-time dedication in a rheumatology service without residency or non-university courses with part-time dedication. Not every specialist degree is automatically homologated in every jurisdiction. Provincial governments and colleges of physicians are the certification and recertification authorities; medical school was included in one district. Recertification is mandatory in only 8 districts; 40-50% of the process is achieved by merely practising as a rheumatologist. Most of the training resources are concentrated in CABA. Although there are various options, not all of them are automatically homologated. Recertification is not mandatory nationwide, and a significant part of the process involves practising as a rheumatologist.
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Affiliation(s)
- Marina Laura Micelli
- Servicio de Reumatologia. Hospital J. M. Ramos Mejia, Urquiza 609, 1221, Ciudad Autonoma de Buenos Aires, Argentina
| | - Gabriel Sequeira
- Servicio de Reumatologia. Hospital J. M. Ramos Mejia, Urquiza 609, 1221, Ciudad Autonoma de Buenos Aires, Argentina.
| | - Nauan Fara
- Clínica La Pequeña Familia, Provincia de Buenos Aires, Junín, Argentina
| | - Leila Abbas
- Asociación Mutual Obreros Y Empleados Municipales de La República Argentina, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | - Eduardo Kerzberg
- Servicio de Reumatologia. Hospital J. M. Ramos Mejia, Urquiza 609, 1221, Ciudad Autonoma de Buenos Aires, Argentina
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