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Duff D, Vyas N, Enderle J, Rajendran R. Evaluation of Antinuclear Antibody and Subserology Reflex Testing for the Diagnosis of Systemic Autoimmune Rheumatic Disorders in an Academic Teaching Hospital. Lab Med 2023; 54:489-494. [PMID: 36779504 DOI: 10.1093/labmed/lmac157] [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] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine appropriate utilization of antinuclear antibody (ANA) screening tests with follow-up subserology tests (reflex testing) for diagnosing systemic autoimmune rheumatic disorder (SARD). METHODS We conducted a retrospective chart review of 3003 SARD-test orders at an academic teaching hospital from January to December 2019. Testing patterns were categorized as American College of Rheumatology (ACR)-recommended reflex testing, panel testing, or single subserology testing. We described testing patterns, assessed their diagnostic accuracy, and explored factors associated with reflex testing. RESULTS Reflex testing accounted for 79.7% of SARD test-ordering, whereas improper testing (panel or single subserology) accounted for the other 20.3%. Reflex testing was associated with significantly more SARD diagnoses than improper testing (P = .004). Testing patterns were significantly associated with race/ethnicity (P = .008), with reflex testing being less frequent than improper testing in Hispanics and Whites. CONCLUSION In summary, one-fifth (20.3%) of testing patterns for suspected SARD did not follow the ACR-recommended guidelines for using reflex testing. Use of reflex testing was associated with an increased frequency of SARD diagnosis.
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Affiliation(s)
- Delicia Duff
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Niti Vyas
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Janet Enderle
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Rajkumar Rajendran
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, Texas, USA
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2
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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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3
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Forrest IS, Petrazzini BO, Duffy Á, Park JK, O'Neal AJ, Jordan DM, Rocheleau G, Nadkarni GN, Cho JH, Blazer AD, Do R. A machine learning model identifies patients in need of autoimmune disease testing using electronic health records. Nat Commun 2023; 14:2385. [PMID: 37169741 PMCID: PMC10130143 DOI: 10.1038/s41467-023-37996-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
Systemic autoimmune rheumatic diseases (SARDs) can lead to irreversible damage if left untreated, yet these patients often endure long diagnostic journeys before being diagnosed and treated. Machine learning may help overcome the challenges of diagnosing SARDs and inform clinical decision-making. Here, we developed and tested a machine learning model to identify patients who should receive rheumatological evaluation for SARDs using longitudinal electronic health records of 161,584 individuals from two institutions. The model demonstrated high performance for predicting cases of autoantibody-tested individuals in a validation set, an external test set, and an independent cohort with a broader case definition. This approach identified more individuals for autoantibody testing compared with current clinical standards and a greater proportion of autoantibody carriers among those tested. Diagnoses of SARDs and other autoimmune conditions increased with higher model probabilities. The model detected a need for autoantibody testing and rheumatology encounters up to five years before the test date and assessment date, respectively. Altogether, these findings illustrate that the clinical manifestations of a diverse array of autoimmune conditions are detectable in electronic health records using machine learning, which may help systematize and accelerate autoimmune testing.
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Affiliation(s)
- Iain S Forrest
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ben O Petrazzini
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Áine Duffy
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua K Park
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anya J O'Neal
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel M Jordan
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ghislain Rocheleau
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judy H Cho
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashira D Blazer
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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4
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González Rodríguez C, Fuentes Cantero S, Pérez Pérez A, Vázquez Barbero FJ, León Justel A. Comparison of the analytical and clinical performances of two different routine testing protocols for antinuclear antibody screening. J Clin Lab Anal 2021; 35:e23914. [PMID: 34347308 PMCID: PMC8418461 DOI: 10.1002/jcla.23914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022] Open
Abstract
Background The diagnosis of systemic autoimmune rheumatic diseases (SARD) is based on the detection of serum antinuclear antibodies (ANA) for which indirect immunofluorescence (IIF) is the golden standard. New solid‐phase immunoassays have been developed to be used alone or in combination with the detection of extractable antinuclear antibodies (ENA) to improve SARD diagnosis. The purpose of this study was to compare the clinical performances of different ANA screening methods alone or in combination with ENA screening methods for SARD diagnosis. Methods A total of 323 patients were screened for ANA by IIF, EliA™ CTD Screen, and ELISA methods. Agreements were calculated between the methods. Then, EliA™ CTD Screen positive samples were screened for ENA by line immunoassay (LIA) and fluorescence enzyme immunoassay (FEIA). Results The diagnostic accuracy of EliA™ CTD Screen (79% sensitivity and 91% specificity) was better than that of ELISA or IIF. The combination of EliA™ CTD plus IIF had the highest sensitivity (93%). ENA determination revealed that Ro52 and Ro60 were the most prevalent specificities. The use of IIF alone was not able of detecting up to 36% of samples positive for Ro52, and 41% for Ro60. Conclusions EliA™ CTD Screen has a better diagnostic performance when compared to IIF and ELISA. The combined use of EliA™ CTD Screen and IIF clearly improves the rate and accuracy of SARD diagnosis. The use of EliA™ CTD Screen as first‐line screening technique allows the detection of antibodies, which could not be detected by IIF alone.
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Affiliation(s)
| | | | - Antonio Pérez Pérez
- Department of Biochemistry, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Antonio León Justel
- Department of Biochemistry, Hospital Universitario Virgen Macarena, Seville, Spain
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5
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Rajendran R, Salazar JH, Seymour RL, Laposata M, Zahner CJ. Overutilization and underutilization of autoantibody tests in patients with suspected autoimmune disorders. ACTA ACUST UNITED AC 2021; 8:497-503. [PMID: 33675217 DOI: 10.1515/dx-2020-0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Diagnostic Management Teams (DMTs) are one strategy for reducing diagnostic errors. This study examined errors in serology test selection after a positive antinuclear antibody (ANA) test in patients with suspected systemic autoimmune rheumatic disorder (SARD). METHODS This retrospective study included 246 patient cases reviewed by our ANA DMT from March to August 2019. The DMT evaluated the appropriateness of tests beyond ANA screening tests (overutilization, underutilization, or both) based on American College of Rheumatology recommendations and classified cases into diagnostic error or no error groups. Errors were quantified, and patient and provider characteristics associated with diagnostic errors were assessed. RESULTS Among 246 cases, 60.6% had at least one diagnostic error in test selection. The number of sub-serology tests ordered was 2.4 times higher in the diagnostic error group than in the no error group. The likelihood of at least one diagnostic error was higher in males and African American/Black patients, although the differences were not statistically significant. Providers from general internal medicine, primary care, and non-rheumatology specialties were approximately two times more likely to make diagnostic errors than rheumatology specialists. CONCLUSIONS Diagnostic errors in test selection after a positive ANA for patients with suspected SARD were common, although there were fewer errors when ordered by rheumatology specialists. These findings support the need to develop strategies to reduce diagnostic errors in test selection for autoimmunity evaluation and suggest that implementation of a DMT can be useful for providing guidance to clinicians to reduce overutilization and underutilization of laboratory tests.
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Affiliation(s)
- Rajkumar Rajendran
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jose H Salazar
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Robert L Seymour
- Formerly of Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Michael Laposata
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Christopher J Zahner
- Department of Clinical Laboratory Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
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6
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Almeida-Brasil CC, Pineau CA, Vinet E, Hanly JG, Peschken CA, Clarke AE, Fortin PR, Abrahamowicz M, Bernatsky S. Predictors of unsuccessful hydroxychloroquine tapering and discontinuation: Can we personalize decision-making in systemic lupus treatment? Arthritis Care Res (Hoboken) 2020; 74:1070-1078. [PMID: 33369255 PMCID: PMC9544951 DOI: 10.1002/acr.24548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/16/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
Objective Hydroxychloroquine (HCQ) is a key systemic lupus erythematosus (SLE) drug, making concerns of drug shortages grave. Our objective was to evaluate factors associated with poor outcomes after HCQ taper or discontinuation in SLE. Methods We studied 5 Canadian SLE cohorts between 1999 and 2019, following patients from the date of HCQ tapering (cohort 1) or discontinuation (cohort 2). A composite outcome was defined as any of the following: a need for therapy augmentation, an increase (of at least 4 points) in the Systemic Lupus Erythematosus Disease Activity Index 2000 score, or hospitalization for SLE. In each cohort, multivariable Cox regression was used to identify demographic and clinical factors associated with time to the earliest of these events. A third cohort continuing to receive HCQ was also studied, to assess whether the same factors influenced the outcome even when the HCQ dose was unchanged. Results The poor outcome rate, per 100 person‐years, was 35.7 (95% confidence interval [95% CI] 31.6–40.3) in the HCQ taper cohort (n = 398), 29.0 (95% CI 25.5–33.0) in the discontinuation cohort (n = 395), and 16.1 (95% CI 13.2–19.6) in the maintenance cohort (n = 395). In patients tapering HCQ, baseline prednisone use was independently associated with greater risk of poor outcomes. In the discontinuation cohort, the risk of poor outcomes was greater for Black patients and those diagnosed with SLE at age ≤25 years. Among those maintaining HCQ, baseline immunosuppressive use and First Nations ethnicity were associated with poor outcomes. Conclusion We identified demographic and clinical factors associated with poor outcomes after HCQ taper/discontinuation. This information is critical in the current setting of potential shortages, but over the long term, such information could inform personalized therapies.
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Affiliation(s)
- Celline C Almeida-Brasil
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Christian A Pineau
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Evelyne Vinet
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - John G Hanly
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Christine A Peschken
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Ann E Clarke
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Paul R Fortin
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
| | - Sasha Bernatsky
- Department of Medicine, Division of Rheumatology and Division of Clinical Epidemiology and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Quebec, Canada
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7
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Kelly A, Tymms K, Wit M, Bartlett SJ, Cross M, Dawson T, De Vera M, Evans V, Gill M, Hassett G, Lim I, Manera K, Major G, March L, O’Neill S, Scholte-Voshaar M, Sinnathurai P, Sumpton D, Teixeira‐Pinto A, Tugwell P, Bemt B, Tong A. Patient and Caregiver Priorities for Medication Adherence in Gout, Osteoporosis, and Rheumatoid Arthritis: Nominal Group Technique. Arthritis Care Res (Hoboken) 2020; 72:1410-1419. [DOI: 10.1002/acr.24032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Ayano Kelly
- Australian National University and Canberra Rheumatology, Canberra, Australian Capital Territory, Australia, and Children’s Hospital at Westmead Sydney New South Wales Australia
| | - Kathleen Tymms
- Australian National University, Canberra Rheumatology, and Canberra Hospital Canberra Australian Capital Territory Australia
| | - Maarten Wit
- Amsterdam University Medical Centre Amsterdam The Netherlands
| | - Susan J. Bartlett
- McGill University, Montreal, Quebec, Canada, and Johns Hopkins School of Medicine Baltimore Maryland
| | - Marita Cross
- Institute of Bone and Joint Research Kolling Institute of Medical Research Sydney New South Wales Australia
| | - Therese Dawson
- Lord Street Specialist Centre, Port Macquarie, New South Wales, Australia, and Mayo Hospital Specialist Centre Taree New South Wales Australia
| | - Mary De Vera
- University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada Richmond British Columbia Canada
| | - Vicki Evans
- Clear Vision Consulting and University of Canberra, Canberra, Australian Capital Territory, Australia, and Outcome Measures in Rheumatology
| | - Michael Gill
- Dragon Claw, Sydney, New South Wales, Australia, and Outcome Measures in Rheumatology
| | - Geraldine Hassett
- Liverpool Hospital and Ingham Institute of Applied Medical Research Sydney New South Wales Australia
| | - Irwin Lim
- BJC Health Sydney New South Wales Australia
| | - Karine Manera
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
| | - Gabor Major
- John Hunter Hospital and University of Newcastle Newcastle New South Wales Australia
| | - Lyn March
- Institute of Bone and Joint Research Kolling Institute of Medical Research Royal North Shore Hospital, and Northern Clinical School Sydney University Sydney New South Wales Australia
| | - Sean O’Neill
- Liverpool Hospital and Ingham Institute of Applied Medical Research Sydney New South Wales Australia
| | - Marieke Scholte-Voshaar
- University of Twente, Enschede, The Netherlands, and Outcome Measures in Rheumatology Netherlands
| | - Premarani Sinnathurai
- Institute of Bone and Joint Research Kolling Institute of Medical Research Royal North Shore Hospital, and Northern Clinical School Sydney University Sydney New South Wales Australia
| | - Daniel Sumpton
- Children’s Hospital at Westmead University of Sydney, and Concord Hospital Sydney New South Wales Australia
| | - Armando Teixeira‐Pinto
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
| | | | - Bart Bemt
- Sint Maartenskliniek, Ubbergen, The Netherlands, and Radboud University Medical Centre Nijmegen The Netherlands
| | - Allison Tong
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
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Rodrigues L, Alves VLP, Sim-Simc MMF, Surita FG. Perceptions of women with systemic lupus erythematosus undergoing high-risk prenatal care: A qualitative study. Midwifery 2020; 87:102715. [PMID: 32447183 DOI: 10.1016/j.midw.2020.102715] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/23/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that often leads to situations of harm to the mother-fetus binomial. Given the potential for complications and morbidities in these pregnant women, it is essential that a multidisciplinary team be involved in pregnancy planning, as well as monitoring the course of the pregnancy and the postpartum period. Owing to the imminent risks of disease worsening along with consequent disabilities, these women may experience psychological and psychosocial impacts conflicting with the psychological demands of pregnancy. OBJECTIVE To understand the meanings attributed to pregnancy by women with SLE. DESIGN A qualitative design with face-to-face interview following a semi-structured script of open-ended questions. SETTING A specialized outpatient clinic where during prenatal care, women with stable disease undergo scheduled appointments. PARTICIPANTS The sample was intentionally composed of women visiting a specialized outpatient clinic from July 2017 to July 2018. The participants (N = 26) were interviewed in depth, with no refusal. Thematic analysis according to the 7 steps of qualitative analysis was conducted using NVivo 11. FINDINGS Four categories were identified: (1) unplanned pregnancy and nonuse of contraception, (2) feeling healthy despite a doctor's warning of the disease worsening because of pregnancy, (3) joy coupled with fear of the future and pregnancy, and (4) self-perception and straight perception. CONCLUSIONS The experiences of pregnant women with SLE are permeated by ambiguous feelings. These women feel healthy because they can bear a child despite the chronic disease diagnosis and, at the same time, experience fear and insecurity owing to the imminent possibility of disease-related disabilities and limitations. They especially wish to experience motherhood, and they strive for safety and support. IMPLICATIONS FOR PRACTICE Health teams must be structured to welcome and advise these women in planning relationships and pregnancy, as well as choosing the best contraceptive methods and making optimal reproductive decisions. The development of strategies to deal with changes in the perinatal period may be helpful, as these women are willing to take care of themselves.
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Affiliation(s)
- Larissa Rodrigues
- School of Medical Science, University of Campinas (UNICAMP), Brazil.
| | | | | | - Fernanda Garanhani Surita
- Department of Gynecology and Obstetrics, School of Medical Science University of Campinas (UNICAMP), Brazil. R. Alexander Fleming 101, ZIP: 13083-881, Campinas, SP, Brazil.
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