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Raper AC, Weathers BL, Drivas TG, Ellis CA, Kripke CM, Oyer RA, Owens AT, Verma A, Wileyto PE, Wollack CC, Zhou W, Ritchie MD, Schnoll RA, Nathanson KL. Protocol for a type 3 hybrid implementation cluster randomized clinical trial to evaluate the effect of patient and clinician nudges to advance the use of genomic medicine across a diverse health system. Implement Sci 2024; 19:61. [PMID: 39160614 PMCID: PMC11331805 DOI: 10.1186/s13012-024-01385-5] [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: 05/20/2024] [Accepted: 07/14/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Germline genetic testing is recommended for an increasing number of conditions with underlying genetic etiologies, the results of which impact medical management. However, genetic testing is underutilized in clinics due to system, clinician, and patient level barriers. Behavioral economics provides a framework to create implementation strategies, such as nudges, to address these multi-level barriers and increase the uptake of genetic testing for conditions where the results impact medical management. METHODS Patients meeting eligibility for germline genetic testing for a group of conditions will be identified using electronic phenotyping algorithms. A pragmatic, type 3 hybrid cluster randomization study will test nudges to patients and/or clinicians, or neither. Clinicians who receive nudges will be prompted to either refer their patient to genetics or order genetic testing themselves. We will use rapid cycle approaches informed by clinician and patient experiences, health equity, and behavioral economics to optimize these nudges before trial initiation. The primary implementation outcome is uptake of germline genetic testing for the pre-selected health conditions. Patient data collected through the electronic health record (e.g. demographics, geocoded address) will be examined as moderators of the effect of nudges. DISCUSSION This study will be one of the first randomized trials to examine the effects of patient- and clinician-directed nudges informed by behavioral economics on uptake of genetic testing. The pragmatic design will facilitate a large and diverse patient sample, allow for the assessment of genetic testing uptake, and provide comparison of the effect of different nudge combinations. This trial also involves optimization of patient identification, test selection, ordering, and result reporting in an electronic health record-based infrastructure to further address clinician-level barriers to utilizing genomic medicine. The findings may help determine the impact of low-cost, sustainable implementation strategies that can be integrated into health care systems to improve the use of genomic medicine. TRIAL REGISTRATION ClinicalTrials.gov. NCT06377033. Registered on March 31, 2024. https://clinicaltrials.gov/study/NCT06377033?term=NCT06377033&rank=1.
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Affiliation(s)
- Anna C Raper
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Benita L Weathers
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Theodore G Drivas
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Colin A Ellis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colleen Morse Kripke
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Randall A Oyer
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anjali T Owens
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anurag Verma
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Paul E Wileyto
- Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin C Wollack
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wenting Zhou
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Marylyn D Ritchie
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert A Schnoll
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research on Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine L Nathanson
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Kurt T, Vossen D, Schumacher F, Strunk J, Fedkov D, Peine C, Lang F, Khalil A, Brinks R, Vordenbäumen S. Effect of Lifestyle Counselling via a Mobile Application on Disease Activity Control in Inflammatory Arthritis: A Single-Blinded, Randomized Controlled Study. Nutrients 2024; 16:1488. [PMID: 38794726 PMCID: PMC11123837 DOI: 10.3390/nu16101488] [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: 03/22/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Mobile applications (apps) are a resource for information on lifestyle and nutrition which are associated to improved outcomes in inflammatory arthritis. OBJECTIVE The aim of this study was to explore whether targeted lifestyle counselling via an app improves disease activity in arthritis patients. METHODS Patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) were randomized to 12 weeks of lifestyle counselling via an app (Mida, Midaia GmbH, Germany) pertaining to a healthy Mediterranean Diet, physical activity, and mental health. Disease activity was measured with specific instruments by a blinded physician and categorized (remission, low, moderate, high). Dietary adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS). Mixed effects logistic regression adjusted to baseline disease activity, age, and sex were calculated. RESULTS Of 158 patients included (73% female, 53.3 ± 11.7 years), 74 were in the active counselling group (ACG). All showed improvement in low disease activity or remission. ACG patients had an odds ratio (OR) of 2.8 (95%-CI 1.1-7.2, p = 0.035), while OR in the control group was not significant OR = 2.1 (0.9-5.0, p = 0.097). The control group was less likely to reach a MEDAS >= 4 (OR = 0.16 (0.03-0.77), p = 0.02), while this was not seen in the ACG (OR = 0.54 (0.06-4.63), p = 0.6). Patients in the ACG showed a tendency towards improved adhesion to a Mediterranean Diet (MEDAS) (β = 0.35 (-0.05-0.74), p = 0.086). This tendency was not observed in the control group (β = 0.09 (-0.29-0.46), p = 0.64). CONCLUSIONS Individualized lifestyle and dietary counselling via app may help to improve disease control in inflammatory arthritis patients.
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Affiliation(s)
- Türker Kurt
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Hauptstr. 74-76, 40668 Meerbusch, Germany
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Diana Vossen
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Falk Schumacher
- Department of Rheumatology, Krankenhaus Porz am Rhein, 51149 Cologne, Germany
- Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Johannes Strunk
- Department of Rheumatology, Krankenhaus Porz am Rhein, 51149 Cologne, Germany
| | - Dmytro Fedkov
- Midaia GmbH, 69123 Heidelberg, Germany; (D.F.)
- Department of Internal Medicine 3, Bogomolets National Medical University, 01601 Kyiv, Ukraine
| | | | - Felix Lang
- Midaia GmbH, 69123 Heidelberg, Germany; (D.F.)
| | | | - Ralph Brinks
- Medical Biometry and Epidemiology, University of Witten/Herdecke, 58448 Witten, Germany
| | - Stefan Vordenbäumen
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Hauptstr. 74-76, 40668 Meerbusch, Germany
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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Hashemi S, Bai L, Gao S, Burstein F, Renzenbrink K. Sharpening clinical decision support alert and reminder designs with MINDSPACE: A systematic review. Int J Med Inform 2024; 181:105276. [PMID: 37948981 DOI: 10.1016/j.ijmedinf.2023.105276] [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] [Received: 08/30/2023] [Revised: 10/07/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Clinical decision support (CDS) alerts and reminders aim to influence clinical decisions, yet they are often designed without considering human decision-making behaviour. While this behaviour is comprehensively described by behavioural economics (BE), the sheer volume of BE literature poses a challenge to designers when identifying behavioural effects with utility to alert and reminder designs. This study tackles this challenge by focusing on the MINDSPACE framework for behaviour change, which collates nine behavioural effects that profoundly influence human decision-making behaviour: Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitment, and Ego. METHOD A systematic review searching MEDLINE, Embase, PsycINFO, and CINAHL Plus to explore (i) the usage of MINDSPACE effects in alert and reminder designs and (ii) the efficacy of those alerts and reminders in influencing clinical decisions. The search queries comprised ten Boolean searches, with nine focusing on the MINDSPACE effects and one focusing on the term mindspace. RESULTS 50 studies were selected from 1791 peer-reviewed journal articles in English from 1970 to 2022. Except for ego, eight of nine MINDSPACE effects were utilised to design alerts and reminders, with defaults and norms utilised the most in alerts and reminders, respectively. Overall, alerts and reminders informed by MINDSPACE effects showed an average 71% success rate in influencing clinical decisions (alerts 73%, reminders 69%). Most studies utilised a single effect in their design, with higher efficacy for alerts (64%) than reminders (41%). Others utilised multiple effects, showing higher efficacy for reminders (28%) than alerts (9%). CONCLUSION This review presents sufficient evidence demonstrating the MINDSPACE framework's merits for designing CDS alerts and reminders with human decision-making considerations. The framework can adequately address challenges in identifying behavioural effects pertinent to the effective design of CDS alerts and reminders. The review also identified opportunities for future research into other relevant effects (e.g., framing).
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Affiliation(s)
- Sarang Hashemi
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia.
| | - Lu Bai
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Shijia Gao
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Frada Burstein
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
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Iversen AM, Hansen MB, Alsner J, Kristensen B, Ellermann-Eriksen S. Effects of light-guided nudges on health care workers' hand hygiene behavior. Am J Infect Control 2023; 51:1370-1376. [PMID: 37209875 DOI: 10.1016/j.ajic.2023.05.006] [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] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Hospital-acquired infections are the most frequent adverse events in health care and can be reduced by improving the hand hygiene compliance (HHC) of health care workers (HCWs). We aimed to investigate the effect of nudging with sensor lights on HCWs' HHC. METHODS An 11-month intervention study was conducted in 2 inpatient departments at a university hospital. An automated monitoring system (Sani NudgeTM) measured the HHC. Reminder and feedback nudges with lights were displayed on alcohol-based hand rub dispensers. We compared the baseline HHC with HHC during periods of nudging and used the follow-up data to establish if a sustained effect had been achieved. RESULTS A total of 91 physicians, 135 nurses, and 15 cleaning staff were enrolled in the study. The system registered 274,085 hand hygiene opportunities in patient rooms, staff restrooms, clean rooms, and unclean rooms. Overall, a significant, sustained effect was achieved by nudging with lights in relation to contact with patients and patient-near surroundings for both nurses and physicians. Furthermore, a significant effect was observed on nurses' HHC in restrooms and clean rooms. No significant effect was found for the cleaning staff. CONCLUSIONS Reminder or feedback nudges with light improved and sustained physicians' and nurses' HHC, and constitute a new way of changing HCWs' hand hygiene behavior.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
| | - Marco Bo Hansen
- Konduto ApS, Sani Nudge, Department of Medical & Science, Copenhagen, Denmark
| | - Jan Alsner
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Brian Kristensen
- National Center of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Curtis JR, Aletaha D, Burmester G, Ford K, van Hoogstraten H, Praestgaard A, Bykerk VP. Improvement or Worsening of Disease Activity After Switch to Sarilumab in Patients With Rheumatoid Arthritis With a Partial Response to Adalimumab. J Clin Rheumatol 2023; 29:196-201. [PMID: 36858816 DOI: 10.1097/rhu.0000000000001946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess the effect of switching from adalimumab to sarilumab monotherapy in partial responders with rheumatoid arthritis from the MONARCH randomized trial and its open-label extension (OLE). METHODS Partial response was defined as improvement in Clinical Disease Activity Index (CDAI) of 12 or 6 units (baseline score: >22 or >10 and ≤22, respectively). Proportions of adalimumab partial responders with meaningful worsening or improvement at OLE weeks 12 and 24 were evaluated using 2 CDAI thresholds (≥6 and ≥12 points), 28-joint Disease Activity Score using erythrocyte sedimentation rate (≥0.6 and ≥1.2 points), Health Assessment Questionnaire Disability Index (≥0.22 and ≥0.30 points), Simple Disease Activity Index (≥7 and ≥13 points), physician and patient global assessments (≥10 and ≥20), and 28-joint swollen and tender joint counts (≥1 and ≥2 joints). Outcomes were analyzed using mixed-effect models with repeated measures for observed cases. The p values were produced using Wilcoxon tests. RESULTS Of 369 enrolled patients, 320 (87%) entered the OLE and 155 switched from adalimumab to sarilumab; 59% (91/155) were partial responders. At week 24, 4%-17% and 2%-12% of partial responders experienced a worsening using the lower and higher thresholds, respectively, whereas 47%-78% and 27%-66% experienced improvement. CONCLUSIONS Partial responders to adalimumab who switched to sarilumab had a low likelihood of experiencing meaningful worsening, with most patients showing meaningful improvement or no change in disease activity. This may help alleviate patients' fears of worsening when considering switching to a treatment with a different mechanism of action.
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Affiliation(s)
- Jeffrey R Curtis
- From the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham, Birmingham, AL
| | - Daniel Aletaha
- Division of Rheumatology, Medical University Vienna, Vienna, Austria
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Vandenplas Y, Simoens S, Turk F, Vulto AG, Huys I. Applications of Behavioral Economics to Pharmaceutical Policymaking: A Scoping Review with Implications for Best-Value Biological Medicines. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:803-817. [PMID: 35972683 PMCID: PMC9379236 DOI: 10.1007/s40258-022-00751-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Pharmaceutical policies are generally based on the assumption that involved stakeholders make rational decisions. However, behavioral economics has taught us that this is not always the case as people deviate from rational behavior in rather predictable patterns. This scoping review examined to what extent behavioral concepts have already been applied in the pharmaceutical domain and what evidence exists about their effectiveness, with the aim of formulating future applications and research hypotheses on policymaking for best-value biologicals. METHODS A scoping literature review was conducted on the evidence of behavioral applications to pharmaceuticals. Scientific databases (Embase, MEDLINE, APA PsycArticles, and Scopus) were searched up to 20 October, 2021. RESULTS Forty-four full-text scientific articles were identified and narratively described in this article. Pharmaceutical domains where behavioral concepts have been investigated relate to influencing prescribing behavior, improving medication adherence, and increasing vaccination uptake. Multiple behavioral concepts were examined in the identified studies, such as social norms, defaults, framing, loss aversion, availability, and present bias. The effectiveness of the applied interventions was generally positive, but depended on the context. Some of the examined interventions can easily be translated into effective policy interventions for best-value biological medicines. However, some applications require further investigation in a research context. CONCLUSIONS Applications of behavioral economics to pharmaceutical policymaking are promising. However, further research is required to investigate the effect of behavioral applications on policy interventions for a more sustainable market environment for best-value biological medicines.
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Affiliation(s)
- Yannick Vandenplas
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Nadler MB, Corrado AM, Desveaux L, Neil-Sztramko SE, Wilson BE, Desnoyers A, Amir E, Ivers N. Determinants of guideline-concordant breast cancer screening by family physicians for women aged 40-49 years: a qualitative analysis. CMAJ Open 2022; 10:E900-E910. [PMID: 36257683 PMCID: PMC9616605 DOI: 10.9778/cmajo.20210266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although the current Canadian Task Force on Preventive Health Care guideline recommends that physicians should inform women aged 40-49 years of the potential benefits and harms of screening mammography to support individualized decisions, previous reports of variation in clinical practice at the physician level suggest a lack of guideline-concordant care. We explored determinants (barriers and facilitators) of guideline-concordant care by family physicians regarding screening mammography in this age group. METHODS We conducted qualitative semi-structured interviews by phone with family physicians in the Greater Toronto Area from January to November 2020. We structured interviews using the Theoretical Domains Framework to explore determinants (barriers and facilitators) of 5 physician screening behaviours, namely risk assessment, discussion regarding benefits and harms, decision or referral for mammography, referral for genetic counselling and referral to high-risk screening programs. Two independent researchers iteratively analyzed interview transcripts and deductively coded for each behaviour by domain to identify key behavioural determinants until saturation was reached. RESULTS We interviewed 18 physicians (mean age 48 yr, 72% self-identified as women). Risk assessment was influenced by physicians' knowledge of risk factors, skills to synthesize risk and beliefs about utility. Physicians had beliefs in their capabilities to have informed patient-centred discussions, but insufficient knowledge regarding the harms of screening. The decision or referral for mammography was affected by emotions related to past patient outcomes, social influences of patients and radiology departments, and knowledge and beliefs about consequences (benefits and harms of screening). Referrals for genetic counselling and to high-risk screening programs were facilitated by their availability and by the knowledge and skills to complete forms. Lack of knowledge regarding which patients qualify and beliefs about consequences were barriers to referral. INTERPRETATION Insufficient knowledge and skills for performance of risk assessment, combined with a tendency to overestimate benefits of screening relative to harms affected provision of guideline-concordant care. These may be effective targets for future interventions to improve guideline-concordant care.
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Affiliation(s)
- Michelle B Nadler
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont.
| | - Ann Marie Corrado
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Laura Desveaux
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Sarah E Neil-Sztramko
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Brooke E Wilson
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Alexandra Desnoyers
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Eitan Amir
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Noah Ivers
- Division of Medical Oncology & Hematology, Department of Medicine (Nadler, Wilson, Desnoyers, Amir), Princess Margaret Cancer Centre; Department of Medicine (Nadler, Wilson, Desnoyers, Amir), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado, Ivers), Women's College Hospital; Institute for Better Health (Desveaux), Trillium Health Partners; Institute of Health Policy, Management and Evaluation (Desveaux, Amir, Ivers), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Desveaux), Toronto, Ont.; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences (Neil-Sztramko), McMaster University, Hamilton Ont.; University of New South Wales (Wilson, Ivers), Sydney, Australia; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
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Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with a highly variable clinical presentation that does not have a validated molecular or imaging test, making accurate diagnosis a challenge. Consequences of diagnostic delay include irreversible joint damage and significant morbidity. Over the past few decades, there have been major advances in the understanding and treatment of PsA, leading to more targeted therapies. However, there is no current method to predict optimal treatment strategy to achieve minimal disease activity and prevent medication-related adverse events in the management of early disease. PsA is also associated with other comorbidities that include metabolic syndrome and psychosocial burden; two areas that are often unaddressed in the clinical setting and have associated sequelae. This chapter focuses on key domains of unmet needs, which include diagnostic challenges, delay in diagnosis, prognostication systems and stratified medicine approaches and precision medicine strategies for established and emerging therapies.
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Affiliation(s)
- Beverly Cheok Kuan Ng
- Clinical Research Fellow, Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK.
| | - Deepak Rohit Jadon
- Consultant Rheumatologist, Department of Medicine, University of Cambridge, Cambridge, UK.
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Bañuls-Mirete M, Ogdie A, Guma M. Micronutrients: Essential Treatment for Inflammatory Arthritis? Curr Rheumatol Rep 2020; 22:87. [PMID: 33104882 PMCID: PMC8078476 DOI: 10.1007/s11926-020-00962-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Synovial inflammation is characteristic of inflammatory chronic arthropathies and can cause progressive articular damage, chronic pain, and functional loss. Scientific research has increasingly focused on investigating anti-inflammatory micronutrients present in fruits, vegetables, spices, seeds, tea, and wine. This review aims to examine the anti-inflammatory effect of polyphenols (phytonutrients present in plants) and other micronutrients described in randomized clinical trials conducted in patients with chronic inflammatory arthropathies. RECENT FINDINGS There is an increasing evidence that differences in micronutrient intake might play an essential role in pathogenesis, therapeutic response, and remission of synovitis. Randomized clinical trials with specific micronutrient- or nutrient-enriched food intake show improvement of symptoms and modulation of both pro- and anti-inflammatory mediators. We found convincing evidence of the anti-inflammatory effect of several micronutrients in arthritis symptoms and inflammation. Although in clinical practice nutritional recommendations to patients with chronic joint inflammation are not consistently prescribed, the addition of these nutrients to day-to-day eating habits could potentially change the natural history of inflammatory arthritis. Future research is needed for a consensus on the specific nutritional recommendations for patients with chronic synovial inflammation.
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Affiliation(s)
- Marina Bañuls-Mirete
- Department of Medicine, School of Medicine, University of California, San Diego UCSD, 9500 Gilman Dr. MC 0663, La Jolla, CA, 92093-0663, USA
| | - Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monica Guma
- Department of Medicine, School of Medicine, University of California, San Diego UCSD, 9500 Gilman Dr. MC 0663, La Jolla, CA, 92093-0663, USA.
- Autonomous University of Barcelona, Barcelona, Spain.
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Freid LM, Ogdie A, Baker JF. Physical Activity Patterns in People With Inflammatory Arthritis Indicate They Have not Received Recommendation-Based Guidance From Health Care Providers. ACR Open Rheumatol 2020; 2:582-587. [PMID: 32985797 PMCID: PMC7571386 DOI: 10.1002/acr2.11183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022] Open
Abstract
Objective Objectives of this study were to describe exercise patterns among patients with inflammatory arthritis (IA) in four recommended domains (Aerobic, Resistance, Flexibility, Balance), identify exercise barriers and facilitators, and explore patients’ perceptions of interactions with rheumatology providers about exercise. Methods Patients with IA at a single academic medical center were invited to complete a survey about exercise. Patients were recruited for a paper‐based survey prior to appointments or a web‐based study through the electronic health record if they had been seen in the practice within the past year. Respondents reporting minimum aerobic exercise plus at least one other domain were categorized as “Active,” and the remaining as “Inactive.” Survey responses were compared between groups. Results Of 1113 invited, 108 completed the survey. Among these, 60 (56%) reported aerobic exercise, 44 (41%) flexibility, 42 (39%) resistance, and 18 (17%) balance. Forty‐three (40%) were categorized as active, 65 (60%) inactive. The active group had lower body mass index, lower reported disease activity, and fewer comorbidities. Active patients reported more self‐efficacy, prioritized exercise, improved energy, exercising for weight control, and exercise before arthritis diagnosis (all P < .05). The inactive group cited finances, pain, fatigue, and potentially worsening arthritis as barriers (all P < .05). Most understood the benefits of exercise. Few perceived that exercise recommendations were addressed by their providers. Conclusion Approximately half of patients reported regular aerobic exercise; fewer regularly engaged in other types of physical activity. Patients do not perceive they have received exercise guidance from providers, which suggests an opportunity for more prescriptive exercise discussions.
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Affiliation(s)
| | | | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Abstract
Patients with psoriatic arthritis (PsA) have a higher burden of cardio-metabolic comorbidities like obesity, hypertension, diabetes, and cardiovascular disease compared to the general population. Adipose tissue is thought to promote a chronic low grade inflammatory state through inflammatory mediators like tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), leptin, and adiponectin. A higher body mass index (BMI) is a risk factor for development of PsA and affects disease activity and response to therapy including both disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNFi). Obesity has an impact on the morbidity in PsA, particularly cardiovascular and/or metabolic. Patients with PsA have a higher cardiovascular risk and obesity may have an additive impact on morbidity and mortality. This review explores the relationship between obesity and PsA.
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Affiliation(s)
- Anand Kumthekar
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
| | - Alexis Ogdie
- University of Pennsylvania, Philadelphia, PA, USA
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Ingegnoli F, Schioppo T, Ubiali T, Bollati V, Ostuzzi S, Buoli M, Caporali R. Relevant non-pharmacologic topics for clinical research in rheumatic musculoskeletal diseases: The patient perspective. Int J Rheum Dis 2020; 23:1305-1310. [PMID: 32757261 DOI: 10.1111/1756-185x.13932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The research approach on rheumatic musculoskeletal diseases (RMDs) is challenging and patient involvement is an emerging issue to obtain relevant information to research. Despite growing interest in non-pharmacologic aspects of clinical research in RMDs, the patients' perspectives are currently poorly explored. METHODS A cross-sectional no-profit online survey was devised to identify and rank the priorities for clinical research in RMDs according to patients' perspectives. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, work activity, social participation, physical activity, emotional well-being/stress, alternative medicine, and patient-physician relationship. The survey was disseminated by ALOMAR (Lombard Association for Rheumatic Diseases) between June and October 2019. RESULTS Two hundred RMD patients completed the survey. The topic most rated 188 (94%) was the doctor-patient relationship, considered very or extremely important. Other topics rated as follows: psychological well-being 185 (92.5%), physical activity 155 (77.5%), nutrition, eating habits 150 (75%), alternative therapies 144 (72%), work activity 144 (72%), environmental pollution 134 (67%), social life 121 (60.5%) and cigarette smoke 119 (59.5%). The topics considered relevant were perceived to be able to influence disease symptoms. Environmental pollution and smoking were considered the most important for RMD prevention in 43.3% and 48.7% respectively. CONCLUSIONS This survey highlights the relevance of several unmet needs and indicates that active patient involvement is essential to design successful translational studies and improve clinical outcomes.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Tommaso Schioppo
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Tania Ubiali
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Valentina Bollati
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy.,EPIGET - Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Silvia Ostuzzi
- ALOMAR Lombard Association for Rheumatic Diseases, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
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