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Auyezkhankyzy D, Khojakulova U, Yessirkepov M, Qumar AB, Zimba O, Kocyigit BF, Akaltun MS. Nurses' roles, interventions, and implications for management of rheumatic diseases. Rheumatol Int 2024; 44:975-983. [PMID: 38693254 PMCID: PMC11108871 DOI: 10.1007/s00296-024-05603-7] [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: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Nurses have become integral members of multidisciplinary teams in managing rheumatic diseases, departing from their traditional patient care roles. This article provides a comprehensive review of nurses' roles, interventions, and impacts in several rheumatic diseases, including rheumatoid arthritis, osteoarthritis, spondyloarthritis, gout, systemic lupus erythematosus, and polymyalgia rheumatica. It has been demonstrated that care under nursing supervision is effective and safe, with benefits including disease management, quality of life, and treatment adherence. In addition, nurses play a crucial role in promoting health, educating patients, and administering biological disease-modifying anti-rheumatic drugs. The COVID-19 pandemic has highlighted the significance of telehealth services and nurses' role in delivering remote care. However, nursing education and training challenges persist, particularly in standardization and access to postgraduate education. Efforts to enhance the role of nurses in rheumatology care are necessary to optimize patient outcomes and meet the evolving needs of individuals with rheumatic diseases. Collaboration across healthcare institutions, professional groups, and educational facilities is necessary for promoting the continual growth and advancement of rheumatology nurse practice. By equipping nurses with the requisite knowledge, expertise, and resources to deliver top-notch care, we can enhance the well-being of individuals with rheumatic diseases and foster improved overall health outcomes.
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Affiliation(s)
- Dana Auyezkhankyzy
- Department of Emergency Medicine and Nursing, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Umida Khojakulova
- Department of Emergency Medicine and Nursing, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Ainur B Qumar
- Department of Health Policy and Management, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Olena Zimba
- Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Kraków, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Burhan Fatih Kocyigit
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Türkiye
| | - Mazlum Serdar Akaltun
- Faculty of Medicine, Department of Physical Medicine and Rehabilitaton, Gaziantep University, Gaziantep, Türkiye.
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Tyler N, Hodkinson A, Planner C, Angelakis I, Keyworth C, Hall A, Jones PP, Wright OG, Keers R, Blakeman T, Panagioti M. Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2344825. [PMID: 38032642 PMCID: PMC10690480 DOI: 10.1001/jamanetworkopen.2023.44825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ioannis Angelakis
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Institute of Population Health, Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Alex Hall
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | | | | | - Richard Keers
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Tom Blakeman
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
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Schletzbaum M, Sweet N, Astor B, Yu A, Powell WR, Gilmore-Bykovskyi A, Kaiksow F, Sheehy A, Kind AJ, Bartels CM. Associations of Postdischarge Follow-Up With Acute Care and Mortality in Lupus: A Medicare Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:1886-1896. [PMID: 36752354 PMCID: PMC10406973 DOI: 10.1002/acr.25097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/06/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus experience the sixth highest rate of 30-day readmissions among chronic diseases. Timely postdischarge follow-up is a marker of ambulatory care quality that can reduce readmissions in other chronic conditions. Our objective was to test the hypotheses that 1) beneficiaries from populations experiencing health disparities, including patients from disadvantaged neighborhoods, will have lower odds of completed follow-up, and that 2) follow-up will predict longer time without acute care use (readmission, observation stay, or emergency department visit) or mortality. METHODS This observational cohort study included hospitalizations in January-November 2014 from a 20% random sample of Medicare adults. Included hospitalizations had a lupus code, discharge to home without hospice, and continuous Medicare A/B coverage for 1 year before and 1 month after hospitalization. Timely follow-up included visits with primary care or rheumatology within 30 days. Thirty-day survival outcomes were acute care use and mortality adjusted for sociodemographic information and comorbidities. RESULTS Over one-third (35%) of lupus hospitalizations lacked 30-day follow-up. Younger age, living in disadvantaged neighborhoods, and rurality were associated with lower odds of follow-up. Follow-up was not associated with subsequent acute care or mortality in beneficiaries age <65 years. In contrast, follow-up was associated with a 27% higher hazard for acute care use (adjusted hazard ratio [HR] 1.27 [95% confidence interval (95% CI) 1.09-1.47]) and 65% lower mortality (adjusted HR 0.35 [95% CI 0.19-0.67]) among beneficiaries age ≥65 years. CONCLUSION One-third of lupus hospitalizations lacked follow-up, with significant disparities in rural and disadvantaged neighborhoods. Follow-up was associated with increased acute care, but 65% lower mortality in older systemic lupus erythematosus patients. Further development of lupus-specific postdischarge strategies is needed.
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Affiliation(s)
- Maria Schletzbaum
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Nadia Sweet
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Brad Astor
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Ang Yu
- Department of Sociology, University of Wisconsin – Madison, Madison, WI, US
- Center for Demography and Ecology, University of Wisconsin – Madison, Madison, WI, US
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Andrea Gilmore-Bykovskyi
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- School of Nursing, University of Wisconsin – Madison, Madison, WI, US
| | - Farah Kaiksow
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Ann Sheehy
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Amy J Kind
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Christie M Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
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Parodis I, Gomez A, Tsoi A, Chow JW, Pezzella D, Girard C, Stamm TA, Boström C. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. RMD Open 2023; 9:e003297. [PMID: 37532469 PMCID: PMC10401222 DOI: 10.1136/rmdopen-2023-003297] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Denise Pezzella
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard
- Division of Rheumatology, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Wojeck RK, Arcoleo K, Hathaway EC, Somers TJ. Nurse-led interventions in systemic autoimmune rheumatic diseases: a systematic review. BMC Nurs 2023; 22:232. [PMID: 37400809 DOI: 10.1186/s12912-023-01393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Nurses play an important role in the management of patients with systemic autoimmune rheumatic diseases. Little is known about the effectiveness of nurse-led interventions on patient-reported outcomes in this population. The aim of this systematic review was to examine the evidence of nurse-led interventions in systemic autoimmune rheumatic diseases. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Embase for studies published from database inception to September 2022. Studies were included if they were published in a peer-reviewed journal in English and evaluated the effectiveness of a nurse-led intervention using a randomized controlled trial design in adults with a systemic autoimmune rheumatic disease. Screening, full-text review, and quality appraisal were conducted by two independent reviewers. RESULTS A total of 162 articles were identified for possible inclusion, of which five studies were included. Four of five studies (80%) were conducted in systemic lupus erythematosus. There was significant variability in the types of nurse-led interventions; the majority included educational sessions and follow up counseling by a nurse (n = 4). The most common patient-reported outcomes were health-related quality of life (n = 3), fatigue (n = 3), mental health (including anxiety and depression) (n = 2), and self-efficacy (n = 2). The duration of the interventions varied from 12 weeks to 6 months. All studies included a nurse with specialized training and education and showed significant improvements in their primary outcomes. The majority of the studies (60%) were considered high methodological quality. CONCLUSION This systematic review provides emerging evidence for the use of nurse-led interventions in systemic autoimmune rheumatic diseases. Our findings emphasize the important role of nurses in providing nonpharmacological strategies to help patients better manage their disease and improve health outcomes.
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Affiliation(s)
- Robyn K Wojeck
- College of Nursing, University of Rhode Island, 350 Eddy St, Providence, RI, USA.
| | - Kimberly Arcoleo
- College of Nursing, University of Rhode Island, 350 Eddy St, Providence, RI, USA
| | - Elizabeth C Hathaway
- College of Nursing, University of Rhode Island, 350 Eddy St, Providence, RI, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, 2400 Pratt St, Durham, NC, USA
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Najjar R, Alexander SA, Hughes GC, Yazdany J, Singh N. Predictors of Thirty-Day Hospital Readmissions in Systemic Lupus Erythematosus in the United States: A Nationwide Study. Arthritis Care Res (Hoboken) 2023; 75:989-997. [PMID: 35439363 PMCID: PMC9579214 DOI: 10.1002/acr.24900] [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: 12/07/2021] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate independent risk factors for readmission and to determine the major reasons for readmission in a nationally representative sample of patients with systemic lupus erythematosus (SLE). METHODS We used the Nationwide Readmissions Database to identify adults with SLE who were discharged from hospital to home during January-November of 2016 and 2017. Thirty-day all-cause readmissions were identified. A multivariable adjusted survey-specific logistic regression model was used to identify factors associated with readmission. RESULTS A total of 132,400 hospitalized adults with SLE were discharged home during the study period; 88.3% were female, with a median age of 51.0 years (interquartile range 38.7-61.9 years). Of these, 18,973 individuals (14.3%) were readmitted within 30 days of discharge from their index hospitalization. In multivariable analyses, the factors associated with the highest odds for readmission were autoimmune hemolytic anemia (odds ratio [OR] 1.86 [95% confidence interval (95% CI) 1.51-2.29]), glomerular disease (OR 1.27 [95% CI 1.19-1.36]), pericarditis (OR 1.35 [95% CI 1.14-1.60]), heart failure (OR 1.34 [95% CI 1.24-1.44]), age 18-30 years (OR 1.28 [95% CI 1.17-1.41] versus age ≥65 years), and Medicare (OR 1.20 [95% CI 1.13-1.28]) and Medicaid insurance (OR 1.26 [95% CI 1.18-1.34]). Sepsis (7.6%), SLE (7.4%), heart failure (3.5%), and pneumonia (3.2%) were among the most common causes for readmission. CONCLUSION In this nationally representative study of SLE readmissions, the strongest risk factors for 30-day readmission were younger age, SLE-related manifestations, and public insurance. These results identify patient groups with SLE that would benefit from postdischarge interventions designed to reduce hospitalizations and improve health outcomes.
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Affiliation(s)
- Rayan Najjar
- University of Washington, Division of Rheumatology
| | | | | | - Jinoos Yazdany
- University of California San Francisco, Division of Rheumatology
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Idolor O, Edigin E, Eseaton PO, Trang A, Kichloo A, Shaka H, Bazuaye EM, Okobia NO, Eboma JE, Uwumiro F, Sandhu VK, Manadan A. Systemic lupus erythematous readmissions have reduced: a 9-year longitudinal study of the nationwide readmission database. Clin Rheumatol 2023; 42:377-383. [PMID: 36534352 DOI: 10.1007/s10067-022-06476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/19/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Longitudinal data on the trends in systemic lupus erythematous (SLE) readmissions are limited. We aimed to study trends in 30-day readmissions of patients admitted for SLE flares and all SLE hospitalizations in the USA from 2010 to 2018. MATERIALS AND METHODS Data were obtained from the nationwide readmission database (NRD). We performed a retrospective 9-year longitudinal trend analysis using the 2010-2018 NRD databases. We searched for index hospitalizations of adult patients diagnosed with SLE using the International Classification of Diseases (ICD) codes. Elective and traumatic readmissions were excluded from the study. Multivariable logistic and linear regression analyses were used to calculate the adjusted p value trend for categorical and continuous outcomes, respectively. RESULTS The 30-day readmissions following index admissions of all SLE patients and for SLE flares decreased from 15.6% in 2010 to 13.3% in 2018 (adjusted p trend < 0.0001), and 20.3% in 2010 to 17.6% in 2018 (adjusted p trend = 0.009) respectively. Following SLE-flare admissions, hospital length of stay (LOS) decreased from 6.7 to 6 days (adjusted p trend = 0.045), while the proportion with a Charlson comorbidity index (CCI) score ≥ 3 increased from 42.2 to 54.4% (adjusted p trend < 0.0001) during the study period. SLE and its organ involvement, sepsis, and infections were common reasons for 30-day readmissions. CONCLUSION About 1 in 5 SLE-flare admissions resulted in a 30-day readmission. The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have decreased in the last decade. Although the readmission LOS was reduced, the CCI score increased over time. Key Points • The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have reduced in the last decade although the CCI score increased over time. • SLE, its organ involvement, and infections are common reasons for readmission. • Infection control strategies, optimal management of SLE and its complications, and emphasis on an ideal transition of care are essential in reducing SLE readmissions.
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Affiliation(s)
- Osahon Idolor
- Department of Internal Medicine, Piedmont Athens Regional, Athens, GA, USA.
| | - Ehizogie Edigin
- Division of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Amy Trang
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL, USA
| | | | | | | | - Fidelis Uwumiro
- Department of Internal Medicine, Our Lady of Apostles Hospital, Akwanga, Nigeria
| | - Vaneet Kaur Sandhu
- Division of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Warchoł-Biedermann K, Mojs E, Sikorska D, Kotyla P, Teusz G, Samborski W. Psychological Implications to the Therapy of Systemic Lupus Erythematosus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16021. [PMID: 36498095 PMCID: PMC9737561 DOI: 10.3390/ijerph192316021] [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: 10/07/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic and multi-systemic autoimmune disease, which has a deleterious impact on patients' psychological well-being. This paper aims to review the existing literature on empirical research on psychological outcomes of SLE and psychological interventions to improve well-being in SLE patients. A search of significant English language articles was conducted in PubMed, Medline, ScienceDirect, Scopus, and ResearchGate databases. Titles and abstracts were screened for the relevant terms, including "systemic lupus erythematosus", "childhood-onset systemic lupus erythematosus", "juvenile systemic lupus erythematosus", "lupus nephritis", and their respective synonyms along with "depression", "anxiety", "fatigue", "medical adherence", "health-related quality of life", "self-management" or "intervention". The articles were evaluated by independent reviewers and the lists of eligible publications were compared whilst disagreements were settled by discussion. Of the 59 publications sought for retrieval, 35 papers were shortlisted based on predefined inclusion/exclusion criteria. They were classified according to their content and the methodology applied. Research topics including "anxiety and depression in SLE" and "self-management interventions for SLE patients" were identified and are presented in this review. As the prognosis and life expectancy of SLE patients are improving, further research on the psychological outcomes of SLE and the evidence-based psychological interventions to improve patients' well-being are justified.
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Affiliation(s)
| | - Ewa Mojs
- Department of Clinical Psychology, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Dorota Sikorska
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-545 Poznan, Poland
| | - Przemysław Kotyla
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia Katowice, 40-635 Katowice, Poland
| | - Grażyna Teusz
- Faculty of Educational Studies, Adam Mickiewicz University, 61-712 Poznan, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-545 Poznan, Poland
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Lin J, Jiang M, Liu J, Yao L. The efficacy of transitional care services in patients with transient ischemic attack: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e30872. [PMID: 36181073 PMCID: PMC9524928 DOI: 10.1097/md.0000000000030872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Transient ischemic attack (TIA) carries a particularly high short-term risk of stroke, which is associated with brain dysfunction caused by a regional reduction in blood flow. Transitional care services present benefits in improving ischemic neurological function and decreasing the recurrence in patients with TIA. The purpose of this study was to investigate the effects of transitional care on clinical outcomes in patients hospitalized for TIA. We retrospectively collected data about 1288 patients with TIA from May 2017 to June 2019. Patients were divided into mild (n = 438), moderate (n = 420) and severe group (n = 430) accessed by age, blood pressure, type of TIA, and duration (ABCD2) score. Participants were patients hospitalized due to TIA, assigned to transitional care (n = 643) or usual care (n = 645), and followed up for 24 months. Physical function of patients was evaluated using the 6-minute walk test. We evaluated patient reach, implementation using hospital quality measures, hospital-level sustainability physical function, ischemic neurological score, composite quality indicator score, and recurrence of TIA between transitional care or usual care group. TIA patients in transitional care group had better physical function and quality indicator score, lower ischemic neurological score and recurrence of TIA, and shorter hospital stay than patients in usual care group. Results demonstrated that transitional care significantly improved the patients' satisfaction compared to usual care. Patients in mild, moderate, and severe group presented more benefits than usual care clinical outcomes in patients hospitalized for TIA. Transitional care is associated with better functional status for patients with TIA.
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Affiliation(s)
- Jing Lin
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
| | - Meiling Jiang
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
| | - Jinmiao Liu
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
| | - Lan Yao
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
- *Correspondence: Lan Yao, No. 5, Tongxiang Road, Aimin District, Mudanjiang City, Heilongjiang Province 157001, China (e-mail )
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Sumpter IJ, Phillips SM, Magwood GS. Approaches to reducing fragmented care in systemic lupus erythematosus (SLE) and other multimorbid conditions: A realist review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221121068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Fragmented care overwhelmingly affects populations with multimorbid chronic conditions, like systemic lupus erythematosus (SLE). However, strategies to mitigate care fragmentation typically focus on singular disease frameworks with insufficient evidence regarding approaches for individuals with two or more concurrent chronic conditions (multimorbidity). This review explores the literature to identify the (C)ontextual influences, underlying (M)echanisms, and associated (O)utcomes of fragmented care prevention in SLE and other multimorbid conditions. Methods A realist review was applied to systematically examine literature, including the search of >1300 published articles focused on SLE and multimorbidity, continuity of care, and approaches to mitigate fragmented care. The analysis was guided by care continuity elements and organized by fragmented care concepts explicated by the MacColl Institute for Healthcare Innovations Care Coordination Model and further grouped for context–mechanism–outcome (CMO) configurations. Results Fourteen articles met inclusion/exclusion criteria and were included in the sample to illustrate the relationship between C-M-O for approaches focused on fragmented care prevention. Favorable outcomes in mechanisms that produced positive responses to resources relevant to fragmented care prevention included 1) opportunities for exposure and negotiation within professional teams, 2) structured health education, role clarity, and access to adherence services for patients, and 3) awareness of workflow waste and use of clinical algorithms. Discussion Review findings suggest using a multidimensional approach to mitigate fragmented care in SLE and other multimorbid conditions. Multidimensional approaches should focus on shared decision-making, social support, social–cultural–economic factors, patient engagement, and technological infrastructure to support the complex care needs of the multimorbid patient.
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Affiliation(s)
- IJ Sumpter
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - SM Phillips
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - GS Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Effects of a continuous nursing care model on elderly patients with total hip arthroplasty: a randomized controlled trial. Aging Clin Exp Res 2022; 34:1603-1611. [PMID: 34476774 DOI: 10.1007/s40520-021-01965-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/14/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Continuous nursing care (CNC) is an extended service based on meeting the needs of discharged patients for post-discharge treatment and rehabilitation. This research aimed to investigate the effects of CNC on older patients with total hip arthroplasty and to offer a scientific basis for improving the prognosis. METHODS A total of 134 patients with total hip arthroplasty were randomly divided into the control group (n = 67) and the intervention group (n = 67). The control group was treated by conventional nursing care and the intervention group was treated by CNC. Harris hip score, Barthel index, the activities of daily living (ADL) scale, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) in these two groups were evaluated. Demographic characteristics between groups were analyzed by unpaired t test. The observation indexes between groups were assessed by two-way ANOVA test followed by Tukey's multiple comparisons test. RESULTS The scores of Harris hip score, Barthel index, ADL, SDS and SAS in the intervention group after intervention and after follow-up were better than the intervention group before intervention (all p < 0.01). Meanwhile, the scores of Harris hip score, Barthel index, ADL, SDS and SAS in the intervention group were better than the control group both after intervention and after follow-up (all p < 0.01). CONCLUSION In conclusion, CNC showed better efficacy than conventional nursing care in promoting hip joint function recovery, improving quality of life and alleviating anxiety and depression for older patients with total hip arthroplasty.
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Radin M, El Hasbani G, Barinotti A, Roccatello D, Uthman I, Taher A, Sciascia S. Quality of life measures in Systemic Lupus Erythematosus: A systematic review. Reumatismo 2022; 73. [DOI: 10.4081/reumatismo.2021.1447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
In this study we systematically investigated the health-related quality of life (HRQoL) tools, which have been most often used over the last five years to evaluate the QoL in patients with systemic lupus erythematosus (SLE), focusing on their items and applications. A detailed literature search was conducted: the inclusion criteria were as follows: 1) studies including at least 50 patients; 2) studies including at least 25 patients with SLE; 3) quality of life testing with validated measures. The systematic review was based on 119 studies for a total of 32,449 SLE patients and 3092 controls. A total of 35 different patients-reported quality of life measures, applied in cohorts of patients with SLE, were retrieved with the 36-item Medical Outcome Short Form (SF-36) (63 studies of 119 =52.95%), Lupus Quality of Life (LupusQoL) (17 studies =14.3%) and Lupus Patient-Reported Outcome (LupusPRO) (12 studies =10%) being the most commonly used tools. Overall, this systematic review of the literature indicated that quality of life in patients with SLE appears to be poor and generally lower compared to both the general population and patients with other chronic conditions, as was shown by a few studies that used SF-36 and LupusPRO. The use of HRQoL scoring in SLE is gaining increasing interest and is used both in randomized controlled trials and in real-life. Future efforts are needed to improve the understanding of the impact of the disease burden on quality of life from the patient’s perspective.
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Liu J, Ruan L, Gong B. Analysis of differences of ultrasound features in different courses of thyroid carcinoma. Am J Transl Res 2021; 13:3582-3590. [PMID: 34017539 PMCID: PMC8129287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the changes of ultrasound features in patients with different courses of thyroid carcinoma, so as to provide a theoretical basis for the clinical treatment and diagnosis of thyroid carcinoma. METHODS A total of 160 patients with thyroid carcinoma treated in our hospital were enrolled and divided into the early stage group (n=76) and the advanced stage group (n=84) according to the results of pathological examination, and further grouped into the lymph node metastasis group (n=78) and the non-metastasis group (n=82). Another 80 patients with benign thyroid disease were enrolled as the benign group. All the enrolled subjects were subjected to ultrasound examination, and the differences of ultrasound features were compared between the different groups. RESULTS The average diameter of tumour and the proportion of nodular calcification and heterogeneous echo in the advanced stage group were significantly higher than those in the early stage group (P<0.05). The proportions of nodular calcification, heterogeneous echo, unsmooth margins, the aspect ratio of 1 or above, and irregular shapes in the malignant group were significantly higher than those in the benign group (P<0.05). The proportions of nodular calcification, heterogeneous echo, unsmooth margins, the aspect ratio of 1 or above, irregular shapes, multiple nodules, the largest diameter greater than 10 mm, rich blood flow, and absent halo in the lymph node metastasis group were significantly higher than those in the non-metastasis group (P<0.05). CONCLUSION There were significant differences of ultrasound features in the different courses of thyroid carcinoma. Ultrasound examination can provide important reference for later clinical diagnosis and treatment.
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Affiliation(s)
- Jidong Liu
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong UniversityXi’an 710061, Shaanxi Province, P. R. China
- Department of Ultrasonics, Jilin City Central HospitalJilin 132001, Jilin Province, P. R. China
| | - Litao Ruan
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong UniversityXi’an 710061, Shaanxi Province, P. R. China
| | - Bing Gong
- Department of Ultrasonics, Jilin City Central HospitalJilin 132001, Jilin Province, P. R. China
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Sönmez HE, Koç R, Karadağ ŞG, Aktay Ayaz N. The readiness of pediatric rheumatology patients and their parents to transition to adult-oriented treatment. Int J Rheum Dis 2021; 24:397-401. [PMID: 33452739 DOI: 10.1111/1756-185x.14050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Transition is a planned process of pediatric patients from child-centered to adult-oriented treatment. Transitional care for patients with chronic diseases is essential. The present study aimed to evaluate the readiness of patients with rheumatic diseases and their parents for transition process. METHOD This is a cross-sectional, single-center study. All patients and their parents were questioned about their awareness of and willingness to undergo transitional care. Transition Readiness Assessment Questionnaire (TRAQ) was applied to all the participants. TRAQ is a tool for measuring readiness for transitional care in adolescents with chronic diseases. TRAQ includes 20 items that are divided into 2 domains: self-management and self-advocacy. RESULTS A total of 157 (87 girls/70 boys) patients and their parents were enrolled. Of them 64 were diagnosed with familial Mediterranean fever, 52 with juvenile idiopathic arthritis, 21 with systemic lupus erythematosus, and 20 with Behçet's disease. The median age of the patients was 16 years (15-18). However, all patients and parents accepted that transition to adult-oriented care is necessary; only one-third of them were aware about transitional care. Eighty (50.9%) patients and 147 (93.6%) of the parents stated that they were wishing to continue pediatric rheumatology treatment. The mean TRAQ self-management domain and self-advocacy domain total scores in the patients were 1.76 ± 0.51 and 1.72 ± 0.49, respectively (P = .48). The mean TRAQ total score was not different between patients and parents. When we assessed the factors affecting transition process, the TRAQ score was lower among patients with active disease, and requiring hospitalization during the previous year. CONCLUSION Assessment od the readiness of patients with chronic rheumatic diseases for transition care will increase the awareness of patients and their parents as well, and provide determination of the optimal time for transition.
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Affiliation(s)
| | - Rahime Koç
- Department of Pediatric Rheumatology, University of Health Sciences, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatric Rheumatology, University of Health Sciences, Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University Medical School, Istanbul, Turkey
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Bowers E, Griffith M, Kolfenbach J, Pearson D, Hammes A, Weinstein E. A Quality Improvement Intervention to Reduce 30-Day Hospital Readmission Rates among Patients with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 74:126-130. [PMID: 32860731 DOI: 10.1002/acr.24435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/26/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) has one of the highest 30-day hospital readmission rates among chronic diseases in the United States. This quality improvement initiative developed and assessed the feasibility of a multidisciplinary post-discharge intervention to reduce 30-day readmission rates among SLE patients. METHODS A retrospective study was performed using electronic health records of patients with SLE admitted to a university hospital prior to (non-intervention group) and after initiation of the study intervention (intervention group). The study population included patients with a diagnosis of SLE who were admitted to the hospital for any reason during an eight month time period. The intervention involved sending a templated message at the time of discharge to the rheumatology clinic nurses which prompted the nurses to call the patient to coordinate future visits and provide education. The primary outcome was the 30-day hospital readmission rate. Data was analyzed using a multivariate mixed binomial regression model. RESULTS There were 59 hospitalizations in the non-intervention group and 73 hospitalizations in the intervention group during the eight-month study period. The 30-day readmission rate was 29% in the non-intervention group and 19% in the intervention group. The difference in readmission rates between the two groups was not statistically significant based on the multivariate model. CONCLUSION Our study demonstrates the feasibility of implementing a multi-disciplinary post-discharge intervention to reduce readmission rates for patients with SLE in a large academic medical center. Further investigation is warranted to determine if this approach reduces the unacceptably high hospital readmission rates among SLE patients.
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Affiliation(s)
- Emily Bowers
- Department of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa Griffith
- Department of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jasonason Kolfenbach
- Department of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Duane Pearson
- Department of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew Hammes
- Department of Biostats and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Elena Weinstein
- Department of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
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