1
|
Parodis I, Girard-Guyonvarc'h C, Arnaud L, Distler O, Domján A, Van den Ende CHM, Fligelstone K, Kocher A, Larosa M, Lau M, Mitropoulos A, Ndosi M, Poole JL, Redmond A, Ritschl V, Alexanderson H, Sjöberg Y, von Perner G, Uhlig T, Varju C, Vriezekolk JE, Welin E, Westhovens R, Stamm TA, Boström C. EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. Ann Rheum Dis 2024; 83:720-729. [PMID: 37433575 DOI: 10.1136/ard-2023-224416] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). METHODS A task force comprising 7 rheumatologists, 15 other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A-D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0-10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting. RESULTS Four overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc. CONCLUSIONS The recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician-patient communication and improved outcomes.
Collapse
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
| | - Charlotte Girard-Guyonvarc'h
- Division of Rheumatology, Department of Medicine, University Hospital of Geneva, Geneve, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg, Centre National de Référence (RESO), INSERM UMR-S 1109, Strasbourg, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Domján
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Cornelia H M Van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kim Fligelstone
- Federation of European Scleroderma Associations (FESCA), Brussels, Belgium
| | - Agnes Kocher
- Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medical Specialties, ASL3, Genoa, Italy
| | | | - Alexandros Mitropoulos
- Department of Nursing and Midwifery, College of Health Wellbeing and Life Science, Sheffield Hallam University, Sheffield, UK
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Janet L Poole
- Occupational Therapy Graduate Program, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Anthony Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Helene Alexanderson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Till Uhlig
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilia Varju
- Department of Rheumatology and Immunology, Medical School of University of Pécs, Pécs, Hungary
| | | | - Elisabet Welin
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - René Westhovens
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Carina Boström
- Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Schwarz L, Ossmann V, Ritschl V, Stamm T, Jonke E, Bekes K. Influence of malocclusion on OHRQoL in adolescents in initial orthodontic treatment phase. Clin Oral Investig 2024; 28:286. [PMID: 38684531 PMCID: PMC11058762 DOI: 10.1007/s00784-024-05689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/24/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Besides correcting malocclusions, another main objective of orthodontic treatment is to improve patients' oral health-related quality of life (OHRQoL). This study aimed to assess changes in OHRQoL of children within the first six months of orthodontic therapy with fixed orthodontic appliances. METHODS 85 patients aged 11 to 14 years requiring fixed orthodontic appliance therapy were included. The children completed the German version of the Child Perceptions Questionnaire (CPQ-G-11-14) before (T0), 1 month (T1) and 6 months (T2) after the start of orthodontic treatment. The type of malocclusion was categorized according to the Index of Orthodontic Treatment Need (IOTN). RESULTS The initial type of malocclusion affected the children's OHRQoL, whereas gender and age did not. The IOTN dental health component (DHC) had a significant impact on the CPQ score (median CPQ of 15.00 for the group DHC 4 vs. 22.50 for DHC 5, p = 0.032). The onset of orthodontic treatment initially affected the CPQ domains "Oral symptoms" and "Functional limitations, with a change versus baseline of 2.00 (p = 0.001), but improved again after 6 months. Regression analysis demonstrated that children with an IOTN DHC 5 malocclusion experienced a greater impact on their ORHQoL, as indicated by a CPQ score 7.35 points higher than that of children with an IOTN DHC 4 malocclusion (p = 0.015). CONCLUSIONS At the beginning of orthodontic treatment, the OHRQoL slightly worsens, probably due to the discomfort and appearance of the appliances. However, 6 months after the start of orthodontic treatment, OHRQoL improved again in patients with severe malocclusion (IOTN 4 and 5), and approached baseline values. CLINICAL RELEVANCE The results help the clinician to better understand specific aspects of oral health that may be affected by different malocclusions, thereby improving the child's satisfaction and overall quality of life.
Collapse
Affiliation(s)
- Linda Schwarz
- Department of Orthodontics, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, Vienna, 1090, Austria
| | - Victor Ossmann
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, Vienna, 1090, Austria
| | - Valentin Ritschl
- Center for Medical Data Science, Institute for Outcomes Research, Medical University of Vienna, Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Spitalgasse 23, Vienna, 1090, Austria
| | - Tanja Stamm
- Center for Medical Data Science, Institute for Outcomes Research, Medical University of Vienna, Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Spitalgasse 23, Vienna, 1090, Austria
| | - Erwin Jonke
- Department of Orthodontics, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, Vienna, 1090, Austria
| | - Katrin Bekes
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, Vienna, 1090, Austria.
| |
Collapse
|
3
|
Geilen J, Kainz M, Zapletal B, Schweiger T, Jäger W, Maier-Salamon A, Zeitlinger M, Stamm T, Ritschl V, Geleff S, Schultz MJ, Tschernko E. Effects of Lung Inflammation and Injury on Pulmonary Tissue Penetration of Meropenem and Vancomycin in a Model of Unilateral Lung Injury. Int J Antimicrob Agents 2024:107180. [PMID: 38649034 DOI: 10.1016/j.ijantimicag.2024.107180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/23/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Timing and dosing of antimicrobial therapy is key in the treatment of pneumonia in critically ill patients. It is uncertain whether presence of lung inflammation and injury affects tissue penetration of intravenously administered antimicrobial drugs. We determined the effects of lung inflammation and injury on tissue penetration of two commonly used antimicrobial drugs for pneumonia in an established model of unilateral lung injury. METHODS In 13 healthy pigs, unilateral lung injury was induced in the left lung through cyclic rinsing - the right healthy lung served as control. After infusion of meropenem and vancomycin, lung tissue, blood, and epithelial lining fluid concentrations were monitored and compared over a period of 6 hours. RESULTS Median vancomycin lung tissue concentrations as well as penetration ratio were higher in inflamed and injured lungs compared to uninflamed and uninjured lungs (AUC0-6h: P = 0.003 and AUCdialysate/AUCplasma ratio: P = 0.003), resulting in higher AUC0-24/MIC. Median meropenem lung tissue concentrations as well as penetration were not different in inflamed and injured lungs compared to uninflamed and uninjured lungs (AUC0-6 P = 0.094 and AUCdialysate/AUCplasma ratio P = 0.173). Penetration ratio for both vancomycin and meropenem into epithelial lining fluid was not different between injured and uninjured lungs. CONCLUSION Vancomycin penetration into lung tissue is enhanced by acute inflammation and injury, a phenomenon barely evident with meropenem. Therefore, inflammation in lung tissue influences the penetration into interstitial lung tissue, depending on the chosen antimicrobial drug. Measurement of ELF levels alone might not detect impact of inflammation and injury.
Collapse
Affiliation(s)
- Johannes Geilen
- Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Kainz
- Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Zapletal
- Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Jäger
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | | | - Markus Zeitlinger
- Department of Clinical Pharmacology, Clinical Pharmacokinetics/Pharmacogenetics and Imaging, Medical University of Vienna, Vienna, Austria
| | - Tanja Stamm
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Silvana Geleff
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Marcus J Schultz
- Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria; Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, location 'AMC', Amsterdam, The Netherlands
| | - Edda Tschernko
- Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
4
|
Geilen J, Kainz M, Zapletal B, Naka A, Tichy J, Jäger W, Böhmdorfer M, Zeitlinger M, Schultz MJ, Stamm T, Ritschl V, Geleff S, Tschernko E. Antimicrobial Drug Penetration Is Enhanced by Lung Tissue Inflammation and Injury. Am J Respir Crit Care Med 2024; 209:829-839. [PMID: 38099833 DOI: 10.1164/rccm.202306-0974oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/15/2023] [Indexed: 04/04/2024] Open
Abstract
Rationale: Pneumonia is a frequent and feared complication in intubated critically ill patients. Tissue concentrations of antimicrobial drugs need to be sufficiently high to treat the infection and also prevent development of bacterial resistance. It is uncertain whether pulmonary inflammation and injury affect antimicrobial drug penetration into lung tissue.Objectives: To determine and compare tissue and BAL fluid concentrations of ceftaroline fosamil and linezolid in a model of unilateral acute lung injury in pigs and to evaluate whether dose adjustment is necessary to reach sufficient antimicrobial concentrations in injured lung tissue.Methods: After induction of unilateral acute lung injury, ceftaroline fosamil and linezolid were administered intravenously. Drug concentrations were measured in lung tissue through microdialysis and in blood and BAL fluid samples during the following 8 hours. The primary endpoint was the tissue concentration area under the concentration curve in the first 8 hours (AUC0-8 h) of the two antimicrobial drugs.Measurements and Main Results: In 10 pigs, antimicrobial drug concentrations were higher in inflamed and injured lung tissue compared with those in uninflamed and uninjured lung tissue (median ceftaroline fosamil AUC0-8 h [and interquartile range] = 26.7 mg ⋅ h ⋅ L-1 [19.7-39.0] vs. 16.0 mg ⋅ h ⋅ L-1 [13.6-19.9], P = 0.02; median linezolid AUC0-8 h 76.0 mg ⋅ h ⋅ L-1 [68.1-96.0] vs. 54.6 mg ⋅ h ⋅ L-1 [42.7-60.9], P = 0.01), resulting in a longer time above the minimal inhibitory concentration and in higher peak concentrations and dialysate/plasma ratios. Penetration into BAL fluid was excellent for both antimicrobials, but without left-to-right differences (ceftaroline fosamil, P = 0.78; linezolid, P = 1.00).Conclusions: Tissue penetration of two commonly used antimicrobial drugs for pneumonia is enhanced by early lung tissue inflammation and injury, resulting in longer times above the minimal inhibitory concentration. Thus, lung tissue inflammation ameliorates antimicrobial drug penetration during the acute phase.
Collapse
Affiliation(s)
- Johannes Geilen
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Matthias Kainz
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Bernhard Zapletal
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Asami Naka
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Johanna Tichy
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| | - Walter Jäger
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Michaela Böhmdorfer
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Clinical Pharmacokinetics/Pharmacogenetics, and Imaging
| | - Marcus J Schultz
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
- Department of Intensive Care, Amsterdam University Medical Centers, location "AMC", University of Amsterdam, Amsterdam, the Netherlands; and
| | - Tanja Stamm
- Institute of Outcomes Research, Center for Medical Data Science, and
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, and
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Silvana Geleff
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care, and Pain Management
| |
Collapse
|
5
|
Ritschl V, Stamm T, Selzer A, Boesendorfer A, Eibensteiner F, Kaltenegger L, Mosor E, Omara M, Vachuda N, Sperl L, Masel EK, Aufricht C, Boehm M. Life outcomes after paediatric kidney transplantation: a qualitative, biographical study in long-term survivors. Arch Dis Child 2024; 109:240-246. [PMID: 38212079 PMCID: PMC10894829 DOI: 10.1136/archdischild-2023-326432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The objective of this study was to analyse the narrative life stories of children with end-stage kidney disease (ESKD) and their families to determine how health professionals can effectively support these children to achieve better life outcomes. DESIGN Qualitative narrative biographic study. SETTING We invited every long-term survivor of paediatric kidney transplants and their families at the Medical University of Vienna between 2008 and 2013 to participate in this study. PARTICIPANTS Nineteen patients (women: n=8, 42%) and 34 family members (women: n=22, 65%) were interviewed. The patients had a mean age of 7.6 (SD±5.6) years at the time of transplantation and 22.2 (SD±5.4) at the time of interview. MAIN OUTCOMES MEASURES A qualitative narrative biographical analysis was combined with computational structured topic models using the Latent Dirichlet Allocation. RESULTS The overarching finding was the desire for normality in daily life in long-term survivors and their families but with different perceptions of what normality looks like and predominance of this aspect evolving. Different strategies were used by patients (focused on their advancement) and caregivers (normality for all family members). Siblings played a major role in supporting survivors' social inclusion. CONCLUSIONS The strong desire for normality confirms recent findings of the Standardised Outcomes in Nephrology Group initiative, which proposes survival and life participation as core outcomes in children with chronic kidney disease. Our study should be a starting point for an international effort to identify typologies and stratified interventions for children with ESKD and their families, particularly siblings.
Collapse
Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja Stamm
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Axana Selzer
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Wien, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Erika Mosor
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Maisa Omara
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Natalie Vachuda
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Eva K Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Wien, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| | - Michael Boehm
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Wien, Austria
| |
Collapse
|
6
|
Alunno A, Carubbi F, Ritschl V, Cornec D, Zenz S, Vieira A, Antonopoulou K, Chatzis L, Romão VC, Tzioufas A, Bandeira M, Stradner MH. "If I have Sjögren's syndrome, I want to know it as early as possible": The perspective of first-degree relatives of patients with Sjögren's syndrome from an international survey. Joint Bone Spine 2024; 91:105695. [PMID: 38290661 DOI: 10.1016/j.jbspin.2024.105695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Alessia Alunno
- Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, University of L'Aquila, ASL1 Avezzano-Sulmona-L'Aquila, Piazzale S. Tommasi 1, L'Aquila, Italy.
| | - Francesco Carubbi
- Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, University of L'Aquila, ASL1 Avezzano-Sulmona-L'Aquila, Piazzale S. Tommasi 1, L'Aquila, Italy
| | - Valentin Ritschl
- Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Divi Cornec
- Service de Rhumatologie, hôpital de la Cavale Blanche, Brest University, Brest, France
| | - Sabine Zenz
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, ePAG Representative for Sjögren's Syndrome, ERN-ReCONNET Lisbon, Portugal
| | | | - Loukas Chatzis
- Pathophysiology Department, Athens School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Athanasios Tzioufas
- Pathophysiology Department, Athens School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Martin H Stradner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
7
|
Dures E, Farisoğulları B, Santos EJF, Molto A, Feldthusen C, Harris C, Elling-Audersch C, Connolly D, Elefante E, Estévez-López F, Bini I, Primdahl J, Hoeper K, Urban M, van de Laar MAFJ, Redondo M, Böhm P, Amarnani R, Hayward R, Geenen R, Rednic S, Pettersson S, Thomsen T, Uhlig T, Ritschl V, Machado PM. 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis 2023:ard-2023-224514. [PMID: 38050029 DOI: 10.1136/ard-2023-224514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Fatigue is prevalent in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and recognised as one of the most challenging symptoms to manage. The existence of multiple factors associated with driving and maintaining fatigue, and the evidence about what improves fatigue has led to a multifaceted approach to its management. However, there are no recommendations for fatigue management in people with I-RMDs. This lack of guidance is challenging for those living with fatigue and health professionals delivering clinical care. Therefore, our aim was to develop EULAR recommendations for the management of fatigue in people with I-RMDs. METHODS A multidisciplinary taskforce comprising 26 members from 14 European countries was convened, and two systematic reviews were conducted. The taskforce developed the recommendations based on the systematic review of evidence supplemented with taskforce members' experience of fatigue in I-RMDs. RESULTS Four overarching principles (OAPs) and four recommendations were developed. OAPs include health professionals' awareness that fatigue encompasses multiple biological, psychological and social factors which should inform clinical care. Fatigue should be monitored and assessed, and people with I-RMDs should be offered management options. Recommendations include offering tailored physical activity and/or tailored psychoeducational interventions and/or, if clinically indicated, immunomodulatory treatment initiation or change. Patient-centred fatigue management should consider the individual's needs and preferences, their clinical disease activity, comorbidities and other psychosocial and contextual factors through shared decision-making. CONCLUSIONS These 2023 EULAR recommendations provide consensus and up-to-date guidance on fatigue management in people with I-RMDs.
Collapse
Affiliation(s)
- Emma Dures
- School of Health and Social Wellbeing at the University of the West of England (UWE) Bristol and Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | | | - Eduardo José Ferreira Santos
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | - Anna Molto
- Department of Rheumatology, Hospital Cochin, Paris, France
- Université Paris-Cité, INSERM U1153, Paris, France
| | | | - Claire Harris
- Department of Rheumatology, London North West University Healthcare NHS Trust, Harrow, UK
| | | | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fernando Estévez-López
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Education, Faculty of Education Sciences, SPORT Research Group and CERNEP Research Center, University of Almería, Almería, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ilaria Bini
- Anmar Young, Rome, Italy
- EULAR Young PARE, Zürich, Switzerland
| | - Jette Primdahl
- University Hospital of Southern Denmark, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kirsten Hoeper
- Department of Rheumatology and Immunology, Medizinische Hochschule Hannover Klinikum, Hannover, Germany
| | - Marie Urban
- Department of Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Mart A F J van de Laar
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
- Arthritis Center Twente, Medical Spectrum Twente, Enschede, The Netherlands
| | - Marta Redondo
- School of Psychology, Universidad Camilo José Cela, Madrid, Spain
| | - Peter Böhm
- Forschungspartner, Deutsche Rheuma-Liga Bundesverband e.V, Bonn, Germany
- Beratung und Begleitung, Deutsche Rheuma-Liga Berlin e.V, Berlin, Germany
| | - Raj Amarnani
- Department of Rheumatology, University College Hospital, London, UK
| | - Rhys Hayward
- Department of Rheumatology, London North West University Healthcare NHS Trust, Harrow, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Simona Rednic
- Clinica Reumatologie, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Susanne Pettersson
- Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Tanja Thomsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Valentin Ritschl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Department of Rheumatology, University College London Centre for Rheumatology, London, UK
| |
Collapse
|
8
|
Oviedo Flores K, Stamm T, Alper SL, Ritschl V, Vychytil A. Challenges to dialysis treatment during the COVID-19 pandemic: a qualitative study of patients' and experts' perspectives. Front Psychol 2023; 14:1185411. [PMID: 38034282 PMCID: PMC10686285 DOI: 10.3389/fpsyg.2023.1185411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Background The global COVID-19 pandemic transformed healthcare services in ways that have impacted individual physical and psychological health. The substantial health challenges routinely faced by dialysis-dependent patients with advanced kidney disease have increased considerably during the ongoing COVID-19 pandemic but remain inadequately investigated. We therefore decided to analyze and compare the perspectives of dialysis patients on their own needs and challenges during the COVID-19 pandemic with those of their professional healthcare providers through interviews with both groups. Methods Qualitative study of seven in-center hemodialysis patients, seven peritoneal dialysis patients, seven dialysis nurses, and seven physicians at the Medical University of Vienna between March 2020 and February 2021, involving content analysis of semi-structured interviews supported by a natural language processing technique. Results Among the main themes emerging from interviews with patients were: (1) concerns about being a 'high-risk patient'; (2) little fear of COVID-19 as a patient on hemodialysis; (3) questions about home dialysis as a better choice than in-center dialysis. Among the main themes brought up by physicians and nurses were: (1) anxiety, sadness, and loneliness of peritoneal dialysis patients; (2) negative impact of changes in clinical routine on patients' well-being; (3) telehealth as a new modality of care. Conclusion Preventive measures against COVID-19 (e.g., use of facemasks, distancing, isolation), the introduction of telemedicine, and an increase in home dialysis have led to communication barriers and reduced face-to-face and direct physical contact between healthcare providers and patients. Physicians did not perceive the full extent of patients' psychological burdens. Selection/modification of dialysis modality should include analysis of the patient's support network and proactive discussion between dialysis patients and their healthcare providers about implications of the ongoing COVID-19 epidemic. Modification of clinical routine care to increase frequency of psychological evaluation should be considered in anticipation of future surges of COVID-19 or currently unforeseen pandemics.
Collapse
Affiliation(s)
- Krystell Oviedo Flores
- Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
- Baxter Healthcare GmbH, Vienna, Austria
| | - Tanja Stamm
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Seth L. Alper
- Division of Nephrology, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
9
|
Lietz A, Kraller J, Hoffelner A, Ritschl V, Berger A, Wagner M. Dose-response of virtual reality training of paediatric emergencies in a randomised simulation-based setting. Acta Paediatr 2023; 112:1995-2005. [PMID: 37195147 DOI: 10.1111/apa.16847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
AIM To determine the effect of different virtual reality training intervals on individual performance to facilitate the optimal implementation of medical virtual reality training. METHODS Emergency scenarios in virtual reality were performed by 36 medical students from the Medical University of Vienna. After baseline training, the participants were randomised into three groups of equal size and underwent virtual reality training at different time intervals (monthly, one training after 3 months, and no further training) before undergoing final assessment training after 6 months. RESULTS Group A, with monthly training exercises, improved their performance score significantly by 1.75 mean score points compared with Group B, who repeated baseline training after 3 months. Statistically significant difference was indicated when comparing Group A with Group C, which was not further trained and served as the control group. CONCLUSION One-month intervals are associated with statistically significant performance improvements compared with additional training after 3 months and to a control group without regular training. The results show that training intervals of 3 months or longer are insufficient to achieve high performance scores. Virtual reality training is a cost-effective alternative to conventional simulation-based training for regular practice.
Collapse
Affiliation(s)
- Andrea Lietz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Julian Kraller
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Alexander Hoffelner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| |
Collapse
|
10
|
Bibl K, Eibensteiner F, Ritschl V, Steinbauer P, Berger A, Olischar M, Giordano V, Wagner M. NeoCheck: A New Checklist to Assess Performance during Newborn Life Support-A Validation Study. Children (Basel) 2023; 10:1013. [PMID: 37371245 DOI: 10.3390/children10061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The aim of this study was to design and validate a new checklist and standardized scenario for assessing providers' performance during Newborn Life Support (NLS). METHODS We invited twelve experts in Neonatology to take part in a three-step Delphi process. They rated the importance of each item of a newly designed assessment tool to evaluate participants' performance during Newborn Life Support independently on a numeric rating scale from 1 to 5 (1 = lowest; 5 = highest) and were able to give additional comments. All items achieving a mean rating below four after the third round were deleted. For the reliability of the checklist, we calculated interrater reliability. RESULTS Using a standardized Delphi process, we revised the initial checklist according to the experts' ratings and comments. The final assessment tool includes 38 items covering all relevant steps during NLS. The mean expert rating of all items was 4.40. Interrater reliability showed substantial agreement between the two raters in the first draft (κ = 0.80) as well as in the final draft of the checklist (κ = 0.73). CONCLUSION We designed a feasible assessment tool for evaluating performance during NLS. We proved the checklist to be valid and reasonable using a Delphi validation process and calculating interrater reliability.
Collapse
Affiliation(s)
- Katharina Bibl
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, 1090 Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| |
Collapse
|
11
|
Ritschl V, Sperl L, Andrews MR, Björk M, Boström C, Cappon J, Davergne T, de la Torre-Aboki J, de Thurah A, Domján A, Dragoi RG, Estévez-López F, Ferreira RJO, Fragoulis GE, Grygielska J, Kõrve K, Kukkurainen ML, Madelaine-Bonjour C, Marques A, Meesters J, Moe RH, Moholt E, Mosor E, Naimer-Stach C, Ndosi M, Pchelnikova P, Primdahl J, Putrik P, Rausch Osthoff AK, Smucrova H, Testa M, van Bodegom-Vos L, Peter WF, Zangi HA, Zimba O, Vliet Vlieland TPM, Stamm TA. Educational readiness among health professionals in rheumatology: low awareness of EULAR offerings and unfamiliarity with the course content as major barriers-results of a EULAR-funded European survey. RMD Open 2023; 9:e003120. [PMID: 37230762 PMCID: PMC10230966 DOI: 10.1136/rmdopen-2023-003120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings. METHODS AND PARTICIPANTS We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline. RESULTS The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were 'professional development', 'prevention and lifestyle intervention'. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers. CONCLUSIONS To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.
Collapse
Affiliation(s)
- Valentin Ritschl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Margaret Renn Andrews
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | - Mathilda Björk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Carina Boström
- Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Jeannette Cappon
- Department of Pediatric Rehabillitation, Reade Centre for Rehabillitation and Rheumatology, Amsterdam, The Netherlands
| | - Thomas Davergne
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Domján
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Razvan Gabriel Dragoi
- Department of Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Fernando Estévez-López
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Coimbra, Portugal
| | - George E Fragoulis
- Joint Rheumatology Programme, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Katti Kõrve
- Center of Rheumatology, East Tallinn Central Hospital, Tallinn, Estonia
| | | | | | - Andréa Marques
- Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Jorit Meesters
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Rikke Helene Moe
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ellen Moholt
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erika Mosor
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Wien, Austria
| | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Polina Putrik
- Department of Rheumatology, Internal Medicine, MUMC and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Anne-Kathrin Rausch Osthoff
- Institute of Physiotherapy, Zurich University of Applied Sciences; School of Health Professions, Winterthur, Switzerland
- Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Hana Smucrova
- Center of Medical Rehabilitation, Institute of Rheumatology, Prague, Czech Republic
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Heidi A Zangi
- NKRR, REMEDY, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Department of Rheumatology and Research, VID Specialized University, Oslo, Norway
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Tanja A Stamm
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
- Institute for Outcomes Research, Centre for Medical Data Science, Medical University of Vienna, Wien, Austria
| |
Collapse
|
12
|
Dvorsky R, Rings F, Bibl K, Roessler L, Kumer L, Steinbauer P, Schwarz H, Ritschl V, Schmölzer GM, Berger A, Werther T, Wagner M. Real-Time Intubation and Ventilation Feedback: A Randomized Controlled Simulation Study. Pediatrics 2023; 151:191044. [PMID: 37038898 DOI: 10.1542/peds.2022-059839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUNDS This study aimed to determine the best educational application of a respiratory function monitor and a video laryngoscope. METHODS This study was a randomized controlled simulation-based trial, including 167 medical students. Participants had to execute ventilation and intubation maneuvers on a newborn manikin. Participants were randomized into 3 groups. In group A (no-access), the feedback devices were not visible but recording. In group B (supervisor-access), the feedback devices were visible to the supervisor only. In group C (full-access), both the participant and the supervisor had visual access. RESULTS The two main outcome variables were the percentage of ventilations within the tidal volume target range (4-8mL/kg) and the number of intubation attempts. Group C achieved the highest percentage of ventilations within the tidal volume target range (full-access 63.6%, supervisor-access 51.0%, no-access 31.1%, P < .001) and the lowest mask leakage (full-access 34.9%, supervisor-access 46.6%, no-access 61.6%; A to B: P < .001, A to C: P < .001, B to C: P = .003). Overall, group C achieved superior ventilation quality regarding primary and secondary outcome measures. The number of intubation attempts until success was lowest in the full-access group (full-access: 1.29, supervisor-access: 1.77, no-access: 2.43; A to B: P = .001, A to C: P < .001, B to C: P = .015). CONCLUSIONS Our findings confirm that direct visual access to feedback devices for supervisor and trainees alike considerably benefits outcomes and can contribute to the future of clinical education.
Collapse
Affiliation(s)
- Robyn Dvorsky
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Franziska Rings
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Katharina Bibl
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Lisa Roessler
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Lisa Kumer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Hannah Schwarz
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Valentin Ritschl
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada and
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Tobias Werther
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics
| |
Collapse
|
13
|
Stamm TA, Partheymüller J, Mosor E, Ritschl V, Kritzinger S, Alunno A, Eberl JM. Determinants of COVID-19 vaccine fatigue. Nat Med 2023; 29:1164-1171. [PMID: 36973410 DOI: 10.1038/s41591-023-02282-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
There is growing concern that Coronavirus Disease 2019 (COVID-19) vaccine fatigue will be a major obstacle in maintaining immunity in the general population. In this study, we assessed vaccine acceptance in future scenarios in two conjoint experiments, investigating determinants such as new vaccines, communication, costs/incentives and legal rules. The experiments were embedded in an online survey (n = 6,357 participants) conducted in two European countries (Austria and Italy). Our results suggest that vaccination campaigns should be tailored to subgroups based on their vaccination status. Among the unvaccinated, campaign messages conveying community spirit had a positive effect (0.343, confidence interval (CI) 0.019-0.666), whereas offering positive incentives, such as a cash reward (0.722, CI 0.429-1.014) or voucher (0.670, CI 0.373-0.967), was pivotal to the decision-making of those vaccinated once or twice. Among the triple vaccinated, vaccination readiness increased when adapted vaccines were offered (0.279, CI 0.182-0.377), but costs (-0.795, CI -0.935 to -0.654) and medical dissensus (-0.161, CI -0.293 to -0.030) reduced their likelihood to get vaccinated. We conclude that failing to mobilize the triple vaccinated is likely to result in booster vaccination rates falling short of expectations. For long-term success, measures fostering institutional trust should be considered. These results provide guidance to those responsible for future COVID-19 vaccination campaigns.
Collapse
Affiliation(s)
- Tanja A Stamm
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.
| | | | - Erika Mosor
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | | | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | | |
Collapse
|
14
|
Mondal H, Parvanov ED, Singla RK, Rayan RA, Nawaz FA, Ritschl V, Eibensteiner F, Siva Sai C, Cenanovic M, Devkota HP, Hribersek M, De R, Klager E, Kletecka-Pulker M, Völkl-Kernstock S, Khalid GM, Lordan R, Găman MA, Shen B, Stamm T, Willschke H, Atanasov AG. Twitter-based crowdsourcing: What kind of measures can help to end the COVID-19 pandemic faster? Front Med (Lausanne) 2022; 9:961360. [PMID: 36186802 PMCID: PMC9523003 DOI: 10.3389/fmed.2022.961360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Crowdsourcing is a low-cost, adaptable, and innovative method to collect ideas from numerous contributors with diverse backgrounds. Crowdsourcing from social media like Twitter can be used for generating ideas in a noticeably brief time based on contributions from globally distributed users. The world has been challenged by the COVID-19 pandemic in the last several years. Measures to combat the pandemic continue to evolve worldwide, and ideas and opinions on optimal counteraction strategies are of high interest. Objective This study aimed to validate the use of Twitter as a crowdsourcing platform in order to gain an understanding of public opinion on what measures can help to end the COVID-19 pandemic faster. Methods This cross-sectional study was conducted during the period from December 22, 2021, to February 4, 2022. Tweets were posted by accounts operated by the authors, asking “How to faster end the COVID-19 pandemic?” and encouraging the viewers to comment on measures that they perceive would be effective to achieve this goal. The ideas from the users' comments were collected and categorized into two major themes – personal and institutional measures. In the final stage of the campaign, a Twitter poll was conducted to get additional comments and to estimate which of the two groups of measures were perceived to be important amongst Twitter users. Results The crowdsourcing campaign generated seventeen suggested measures categorized into two major themes (personal and institutional) that received a total of 1,727 endorsements (supporting comments, retweets, and likes). The poll received a total of 325 votes with 58% of votes underscoring the importance of both personal and institutional measures, 20% favoring personal measures, 11% favoring institutional measures, and 11% of the votes given just out of curiosity to see the vote results. Conclusions Twitter was utilized successfully for crowdsourcing ideas on strategies how to end the COVID-19 pandemic faster. The results indicate that the Twitter community highly values the significance of both personal responsibility and institutional measures to counteract the pandemic. This study validates the use of Twitter as a primary tool that could be used for crowdsourcing ideas with healthcare significance.
Collapse
Affiliation(s)
- Himel Mondal
- Saheed Laxman Nayak Medical College and Hospital, Koraput, Odisha, India
| | - Emil D. Parvanov
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | - Rajeev K. Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
- Rajeev K. Singla ;
| | - Rehab A. Rayan
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Faisal A. Nawaz
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Chandragiri Siva Sai
- Amity Institute of Pharmacy, Amity University, Lucknow Campus, Lucknow, Uttar Pradesh, India
| | | | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
- Headquarters for Admissions and Education, Kumamoto University, Kumamoto, Japan
| | - Mojca Hribersek
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Ronita De
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Elisabeth Klager
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Garba M. Khalid
- Pharmaceutical Engineering Group, School of Pharmacy, Queen's University, Belfast, United Kingdom
| | - Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Bairong Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University Vienna, Vienna, Austria
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzẹbiec, Poland
- *Correspondence: Atanas G. Atanasov
| |
Collapse
|
15
|
Puchner A, Rosenberg N, Valenta N, Ritschl V, Stamm T, Mandl P, Aletaha D, Rosta K. AB1177 SEXUALITY, FAMILY PLANNING AND MENTAL HEALTH AMONG REPRODUCTIVE-AGE WOMEN WITH RHEUMATIC DISEASE DURING THE COVID-19 PANDEMIC. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundWomen with rheumatic disease are more likely to suffer from sexual dysfunction, infertility, depression, and anxiety. The pandemic may have affected these constraints.ObjectivesTo investigate the effect of the Covid-19 pandemic on sexuality, family planning and mental health in a sample of women with rheumatic disease.MethodsWomen aged 18-50 with a rheumatic disease and women in an age-matched healthy control group received questionnaires featuring: 1) demographic information, sexual frequency, family planning; 2) the Female Sexual Function Index (FSFI); 3) the Depression, Anxiety and Stress Scale (DASS-21); and 4) the Coronavirus Anxiety Scale (CAS). Recruitment took place 3/21-12/21. Patients with rheumatic conditions were recruited at the Vienna University Clinic (AKH) and the control group through social media. Parameters were compared between the patients and the healthy control group, and with data on sexuality from women with rheumatic disease from 2019.ResultsA preliminary analysis was conducted with 83 patients with rheumatic disease and 124 healthy controls. The rheumatic disease group exhibited lower levels of stress (6.46 vs. 8.36 p<0.01) and Coronavirus Anxiety (6.27 vs 7.50 p<0.01) than the control group and was less likely to report that the pandemic led to a reduction of their sexual frequency (p<0.01). The control group cited “stress” frequently the decrease of sexual frequency. The FSFI analysis revealed that patients with rheumatic disease experienced higher levels of pain (p<0.001) during sex than the control group but were more satisfied with their relationships (p<0.05). In comparison to 58 patients with rheumatic conditions, whose data was collected in 2019, the 2021 cohort reported reduced FSFI values in the domains of desire (p<0.01), arousal (p<0.05), lubrication (p<0.05), and orgasms (p<0.01).ConclusionConsistent with research on female sexuality during the pandemic among healthy women, we found that patients with rheumatic conditions reported lower FSFI values in 2021, in comparison to 2019. Our finding that the pandemic had less impact on the patient group than a healthy control group, is consistent with research on MS and IBD patients, who showed surprising resilience in the face of the Covid-19 pandemic.Disclosure of InterestsNone declared
Collapse
|
16
|
Seidler Y, Jørgensen TS, Studenic P, Radner H, Nygaard T, Weibrecht N, Popper N, Kristensen LE, Wilhelmer TC, Rickmann J, Mosor E, Ritschl V, Stamm T. POS1470-HPR KNOWING WHAT TO DO WITH THE DATA - A QUALITATIVE STUDY ON CHALLENGES OF USING SMARTPHONE-BASED ePROs IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUsing patient-reported outcomes (PROs) has a long tradition in rheumatology, and PRO measurement is included in many composite indices evaluating disease progression and treatment response [1]. However, little is known about patients´ and health professionals´ (HPs) perceptions of using digitally collected PROs, the so-called ePROs, with a personal smartphone app.ObjectivesTo identify main challenges in utilising ePROs for management and treatment of rheumatoid arthritis from patients’ and HPs’ perspectives.MethodsWe interviewed 25 people with rheumatoid arthritis (RA) and 17 HPs (nurses, rheumatologists, and physiotherapists) from Austria and Denmark. We used the RheumaBuddy app as a practical example to illustrate the digital data collection and the feedback that patients would get from entering their self-reported outcomes. Interviews were recorded and transcribed. We applied a qualitative thematic analysis to identify major themes using a procedure of rigorous coding. Analysis was done by two researchers, and conflicts were solved by consensus. Ethical approval was obtained in both countries.ResultsThree main themes emerged: 1) Being simple yet comprehensive; 2) Resources to interpret, use and act upon the collected data; and 3) Being reminded of the disease. Within the first theme, many valued the intuitiveness and simplicity of ePROs, especially when used as a monitoring tool in between clinical visits. HPs were concerned about not to overwhelm the patients with too many questions. On the other hand, the short ePROs asked in the app were not comprehensive enough to capture psychosocial and lifestyle aspects of the disease which were considered important both by patients and HPs. Within the second theme, patients and HPs expressed that ePROs could be the basis for shared decision making. Nevertheless, some patients had clearer ideas on making use of the feedback they could get from their self-reported data than the others. Participants from Denmark, who experienced a higher level of digital health maturity in official institutions, expressed more proactive use of the data than participants from Austria who were on average younger than their Danish counterparts. One patient in Austria even asserted having no idea what to do with the collected data but believed that the “doctor will make good use of it”. HPs in both countries, however, indicated that they needed more resources, skills, and time to make sense of the ePRO data and act accordingly. Under the third theme, patients considered the collection of ePROs to be very important when pain and disease activity were high. HPs, on the other hand, were more concerned that the regular collection of ePROs might constantly remind patients that they are living with the disease.ConclusionThe potential adoption of ePROs in practice depends on both patients and HPs’ motivations and ideas to use the feedback they would get from the collected data. This might be influenced by the level of digital health maturity of a country, as well as available resources. In addition, ePROs need to be intuitive and simple, but at the same time comprehensive and reliable enough so that they can be used for shared decision making. Challenges remain for the ePROs to be used as supporting and empowering tools, and not as reminders of the disease and pain.Table 1.Demographic data of the participants (N=42)DemographicAustriaDenmarkTotalDataPatientHPPatientHPPatientHPN14101172517Women (%)10(71)6(60)7(64)5(71)17(68)11(65)Men (%)4(29)4(40)4(36)2(29)8(32)6(35)AgeMean (Range)54(30-76)41(29-63)65(37-77)47(31-59)60(30-77)44(29-63)References[1]T Stamm, I Parodis, and P Studenic. Patient-reported outcomes with anifrolumab in patients with systemic lupus erythematosus, Lancet Rheumatol, (2022), in Press.AcknowledgementsWe would like to express our particular thank you to all those who have taken part in the interview study and for their valuable inputs.Disclosure of InterestsYuki Seidler: None declared, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly., Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Paul Studenic: None declared, Helga Radner Speakers bureau: Gilead, Merck Sharp, Pfizer, Abbvie, Consultant of: Gilead, Merck Sharp, Pfizer, Abbvie, Thomas Nygaard: None declared, Nadine Weibrecht: None declared, Nikolas Popper Speakers bureau: Roche, Consultant of: dwh GmbH (as CSO), Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Grant/research support from: IIT research grants from Novo, UCB, Eli Lilly; Novartis and Abbvie, Tanita-Christina Wilhelmer: None declared, James Rickmann: None declared, Erika Mosor: None declared, Valentin Ritschl: None declared, Tanja Stamm Speakers bureau: AbbVie, Novartis, Roche, Sanofi, and Takeda., Consultant of: AbbVie and Sanofi Genzyme., Grant/research support from: AbbVie and Roche.
Collapse
|
17
|
Stamm TA, Partheymüller J, Mosor E, Ritschl V, Kritzinger S, Eberl JM. Coronavirus vaccine hesitancy among unvaccinated Austrians: Assessing underlying motivations and the effectiveness of interventions based on a cross-sectional survey with two embedded conjoint experiments. Lancet Reg Health Eur 2022; 17:100389. [PMID: 35475036 PMCID: PMC9023089 DOI: 10.1016/j.lanepe.2022.100389] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background To date, Austria is among the countries with the lowest coronavirus vaccination rates in Western Europe. It has announced the introduction of a general vaccine mandate but is experiencing an increasing societal polarization over this issue. We, therefore, aimed to provide evidence on the underlying motivations of vaccine hesitancy and evaluate what kinds of interventions – information, incentives, and rules – might increase vaccination readiness. Method We conducted a cross-sectional survey with a sample of 1,543 unvaccinated Austrian residents in October 2021, including two embedded conjoint experiments. Findings We screened 8,190 individuals to recruit the sample matching the Austrian micro-census. In experiment 1, easing rather than tightening of societal restrictions, a fixed monetary reward compared to a lottery and physicians’ recommendations were associated with significantly higher intentions to get vaccinated. In experiment 2, standard approval by European or national authorities and simple information had a significant positive effect on vaccination propensity. Among the unvaccinated, fear of side effects, beliefs that comorbidities or the desire to have children would not allow vaccination, the assumption that the own immune system would provide sufficient protection, conspirational thinking (e.g., the refusal to participate in a ‘large genetic experiment’), low trust in societal institutions, and spiritual beliefs were very common. Interpretation While many unvaccinated showed a low propensity to become vaccinated, we identified a cluster of 195 (23% of the participants without missing values) that could potentially be reached by information and incentives, including people with heightened comorbidity rates or a desire for children. Funding Vienna Science and Technology Fund
Collapse
|
18
|
Lang C, Ritschl V, Augustin F, Lang G, Moser B, Taghavi S, Murakoezy G, Lambers C, Flick H, Koestenberger M, Brooks R, Muhr T, Knotzer J, Mydza D, Kaufmann M, Staudinger T, Zauner C, Krenn C, Schaden E, Bacher A, Rössler B, Faybik P, Tschernko E, Anwar M, Markstaller K, Höfer D, Stamm T, Jaksch P, Hoetzenecker K. Clinical relevance of lung transplantation for COVID-19 ARDS: a nationwide study. Eur Respir J 2022; 60:2102404. [PMID: 35301249 PMCID: PMC8932280 DOI: 10.1183/13993003.02404-2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/13/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although the number of lung transplantations (LTx) performed worldwide for COVID-19 induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of most severly ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx to the pandemic are unknown. METHODS A retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-Cov-2) infection admitted between January 1, 2020 and May 30, 2021 in Austria. Patients referred to one of the two Austrian LTx centers were analyzed and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared to patients who underwent LTx for other indications. RESULTS Between January 1, 2020 and May 30, 2021, 39.485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation, 183 received extra-corporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. With a median follow-up of 134 (47-450) days, 14/19 patients are alive. CONCLUSIONS Early referral of ECMO patients to a LTx center is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.
Collapse
Affiliation(s)
- Christian Lang
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gyoergy Lang
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Moser
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriella Murakoezy
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Lambers
- Department of Pneumology, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Markus Koestenberger
- Department of Anaesthesiology and Intensive Care, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Roxane Brooks
- Intensive Care Unit 1, Clinic of Anesthesiology and Intensive Care Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Tina Muhr
- Intensive Care Unit, Division of Cardiology, Department of Internal Medicine, State Hospital (LKH) Graz II, Graz, Austria
| | - Johann Knotzer
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Wels - Grieskirchen, Wels, Austria
| | - Daniel Mydza
- 1st Medical Department, Klinik Favoriten, Vienna, Austria
| | - Marc Kaufmann
- Department of Anaesthesiology & Intensive Care Unit, Bozen Central Hospital, Bozen, Italy
| | - Thomas Staudinger
- Intensive Care Unit 13i2, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Intensive Care Unit 13H1, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claus Krenn
- Intensive Care Unit 13C1, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Intensive Care Unit 13C1, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety (LBI-DHPS), Medical University of Vienna, Vienna, Austria
| | - Andreas Bacher
- Intensive Care Unit 13C2, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Rössler
- Intensive Care Unit 9D, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Faybik
- Intensive Care Unit 13C3, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Maria Anwar
- Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Klaus Markstaller
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Höfer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
19
|
Stamm TA, Seidler Y, Andrews MR, Eghbali M, Kiguli J, Ritschl V, Omara M, Schaffer G, Mosor E. Patient Representatives' Perspectives on Healthcare at the Time of COVID-19 and Suggestions for Care Redesign After the Pandemic: A Qualitative Study in Twenty-Four Countries. J Multidiscip Healthc 2022; 15:247-258. [PMID: 35173439 PMCID: PMC8842642 DOI: 10.2147/jmdh.s341010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Several comments and recommendations called to embed better the patients' and public voice in healthcare policymaking. Still, no studies captured patients' bottom-up perspectives regarding healthcare at the time of COVID-19 at a micro-level in a range of different countries. We, therefore, explored the perspectives of patient representatives in all six World Health Organisation (WHO) regions and extracted suggestions for care redesign after the pandemic. Methods We conducted semi-structured interviews with patient representatives until saturation. Thematic analysis followed a modified form of meaning condensation. We established rigour by transcript checking, inter-coder agreement, quote variation and standardised reporting. Results Disadvantaged people experienced an unprecedented inequity in healthcare from limited access to physical violence. The narratives revealed the extent of this inequity, but also opportunities for health workers to act and improve. Stigmatisation from COVID-19 differed between cultures and countries and ranged from none to feeling "ashamed" and "totally bashed". While experienced as indispensable in the future, patients refused telehealth when they were given "bad news", such as having an eye removed because of melanoma, and in end-of-life care. Patient representatives redefined their role and became indispensable influencers throughout the pandemic and beyond. Conclusion We reached out to patient representatives with diverse perspectives, including those who represent minorities and marginalised patient populations. Since preferences and personal meanings drive behaviour and could be foundations for targeted interventions, they must be considered in all groups of people to increase society's resilience as a whole. Future healthcare should tackle inequity, address stigmatisation and consider patients' narratives to optimize telemedicine.
Collapse
Affiliation(s)
- Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Yuki Seidler
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Margaret R Andrews
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Mohammad Eghbali
- School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Juliet Kiguli
- Department Community Health & Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences, New Mulago Hospital Complex, Kampala, Uganda
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | | | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
20
|
Haugen IK, Felson D, Abhishek A, Berenbaum F, Edwards JJ, Herrero Beaumont G, Hermann-Eriksen M, Hill CL, Ishimori M, Jonsson H, Karjalainen T, Leung YY, Maheu E, Mallen CD, Moe RH, Ramonda R, Ritschl V, Stamm TA, Szekanecz Z, van der Giesen FJ, Ritt MJPF, Wittoek R, Kjeken I, Osteras N, van de Stadt LA, Englund M, Dziedzic KS, Marshall M, Bierma-Zeinstra S, Hansen P, Greibrokk E, Smeets W, Kloppenburg M. Development of radiographic classification criteria for hand osteoarthritis: a methodological report (Phase 2). RMD Open 2022; 8:e002024. [PMID: 35121640 PMCID: PMC8819785 DOI: 10.1136/rmdopen-2021-002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In Phase 1 of developing new hand osteoarthritis (OA) classification criteria, features associated with hand OA were identified in a population with hand complaints. Radiographic findings could better discriminate patients with hand OA and controls than clinical examination findings. The objective of Phase 2 was to achieve consensus on the features and their weights to be included in three radiographic criteria sets of overall hand OA, interphalangeal OA and thumb base OA. METHODS Multidisciplinary, international expert panels were convened. Patient vignettes were used to identify important features consistent with hand OA. A consensus-based decision analysis approach implemented using 1000minds software was applied to identify the most important features and their relative importance influencing the likelihood of symptoms being due to hand OA. Analyses were repeated for interphalangeal and thumb base OA. The reliability and validity of the proposed criteria sets were tested. RESULTS The experts agreed that the criteria sets should be applied in a population with pain, aching or stiffness in hand joint(s) not explained by another disease or acute injury. In this setting, five additional criteria were considered important: age, morning stiffness, radiographic osteophytes, radiographic joint space narrowing and concordance between symptoms and radiographic findings. The reliability and validity were very good. CONCLUSION Radiographic features were considered critical when determining whether a patient had symptoms due to hand OA. The consensus-based decision analysis approach in Phase 2 complemented the data-driven results from Phase 1, which will form the basis of the final classification criteria sets.
Collapse
Affiliation(s)
- Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - David Felson
- Rheumatology section, Boston University School of Medicine, Boston, Massachusetts, USA
- Arthritis Research UK Epidemiology Unit, National Institute for Health Research Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Francis Berenbaum
- INSERM CRSA, Sorbonne University, Paris, France
- Department of Rheumatology, Hopital Saint-Antoine, Paris, France
| | - John James Edwards
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Gabriel Herrero Beaumont
- Department of Rheumatology, Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Catherine L Hill
- Rheumatology Department, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mariko Ishimori
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Helgi Jonsson
- Department of Rheumatology, Landspitali, Reykjavik, Iceland
| | - Teemu Karjalainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Emmanuel Maheu
- Department of Rheumatology, Hopital Saint-Antoine, Paris, France
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Rikke Helene Moe
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | - Zoltan Szekanecz
- Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | | | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ruth Wittoek
- Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Osteras
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Lotte A van de Stadt
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Krysia S Dziedzic
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - M Marshall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Elsie Greibrokk
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Wilma Smeets
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
21
|
Schadler P, Lohberger B, Thauerer B, Faschingbauer M, Kullich W, Stradner MH, Leithner A, Ritschl V, Omara M, Steinecker-Frohnwieser B. The Association of Blood Biomarkers and Body Mass Index in Knee Osteoarthritis: A Cross-Sectional Study. Cartilage 2022; 13:19476035211069251. [PMID: 35094602 PMCID: PMC9137302 DOI: 10.1177/19476035211069251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Despite massive efforts, there are no diagnostic blood biomarkers for knee osteoarthritis (KOA). This study investigated several candidate diagnostic biomarkers and the metabolic phenotype in end-stage KOA in the context of obesity. DESIGN In this cross-sectional study, adult patients undergoing knee arthroplasty were enrolled and KOA severity was assessed using the Lequesne index. Blood biomarkers with an important role in obesity, the metabolic syndrome, or KOA (oxidized form of low-density lipoprotein [oxLDL], advanced glycation end product [AGE], soluble AGE receptor [sRAGE], fatty acid binding protein 4 [FABP4], phospholipase A2 group IIA [PLA2G2A], fibroblast growth factor 23 [FGF-23], ghrelin, leptin, and resistin) were measured using enzyme-linked immunosorbent assay (ELISA; n = 70) or Luminex technique (subgroup of n = 35). H1-NMR spectroscopy was used for the quantification of metabolite levels (subgroup of n = 31). The hip-knee-ankle angle was assessed. Multivariable and multivariate regression analysis was used to examine the relationship of biomarkers with body mass index (BMI) and KOA severity in complete case and multiple imputation analysis. RESULTS While most of the investigated biomarkers were not associated with KOA severity, FABP4 and leptin were found to correlate with BMI and gender. Resistin was associated with Lequesne index in complete case analysis. Using a targeted metabolomics approach, BMI-dependent changes in the metabolome were hardly visible. CONCLUSIONS Our findings confirm studies on FABP4, leptin, and resistin with regard to obesity and the metabolic syndrome. There was no association of the investigated biomarkers with KOA severity, most likely due to the patient selection (end-stage KOA patients). Based on this absence of BMI-dependent changes in the metabolome, we might assume that BMI is not correlated with KOA severity in this specific patient group.
Collapse
Affiliation(s)
- Paul Schadler
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Saalfelden, Austria,Birgit Lohberger, Head of the Research Laboratory, Research Laboratory, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5-7, Graz 8036, Austria.
| | - Bettina Thauerer
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Saalfelden, Austria
| | | | - Werner Kullich
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Saalfelden, Austria
| | - Martin Helmut Stradner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Valentin Ritschl
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Maisa Omara
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria,Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
22
|
Eibensteiner F, Ritschl V, Valent I, Schaup RM, Hellmann A, Kaltenegger L, Daniel-Fischer L, Oviedo Flores K, Brandstaetter S, Stamm T, Schaden E, Aufricht C, Boehm M. Targeted Training for Subspecialist Care in Children With Medical Complexity. Front Pediatr 2022; 10:851033. [PMID: 35652058 PMCID: PMC9149215 DOI: 10.3389/fped.2022.851033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children with medical complexity (CMC) are prone to medical errors and longer hospital stays, while residents do not feel prepared to provide adequate medical care for this vulnerable population. No educational guidance for the training of future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC exists. We investigated pediatric residents past educational needs and challenges to identify key learning content for future training involving care for CMC. METHODS This was a prospective mixed-methods study at a single pediatric tertiary care center. Qualitative semi-structured interviews with residents were conducted, submitted to thematic content analysis, linked to the American Board of Pediatrics (ABP) general pediatrics content outline, and analyzed with importance performance analysis (IPA). Quantitative validation was focused on key themes of pediatric nephrology within the scope of an online survey among pediatric residents and specialists. RESULTS A total of 16 interviews, median duration 69 min [interquartile range IQR 35], were conducted. The 280 listed themes of the ABP general pediatrics content outline were reduced to 165 themes, with 86% (theoretical) knowledge, 12% practical skills, and 2% soft skills. IPA identified 23 knowledge themes to be of high importance where improvement is necessary and deemed fruitful. Quantitative validation among 84 residents and specialists (response rate 55%) of key themes in nephrology yielded high agreement among specialists in pediatric nephrology but low interrater agreement among trainees and "trained" non-nephrologists. The occurrence of themes in the qualitative interviews and their calculated importance in the quantitative survey were highly correlated (tau = 0.57, p = 0.001). Two clusters of high importance for other pediatric specialties emerged together with a contextual cluster of frequent encounters in both in- and outpatient care. CONCLUSION Regarding patient safety, this study revealed the heterogeneous aspects and the importance of training future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC. Our results may lay the groundwork for future detailed analysis and development of training boot camps that might be able to aid the improvement of patient safety by decreasing preventable harm by medical errors, especially for vulnerable patient groups, such as CMC in tertiary care pediatrics.
Collapse
Affiliation(s)
- Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Isabella Valent
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Rebecca Michaela Schaup
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Axana Hellmann
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Lisa Daniel-Fischer
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Krystell Oviedo Flores
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Stefan Brandstaetter
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Boehm
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
23
|
SHAYESTEHPOUR SHIVA, SHARMA KARAN, MOSOR ERIKA, OMARA MAISA, Ritschl V, SHAYESTEHPOUR SHIMA, STAMM TANJA, BEKES KATRIN. PATIENT-REPORTED OUTCOME MEASURES FOR PEDIATRIC DENTAL PATIENTS: A METHODOLOGICAL REVIEW AND MAPPING EXERCISE. J Evid Based Dent Pract 2022; 22:101661. [DOI: 10.1016/j.jebdp.2021.101661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
|
24
|
Ritschl V, Eibensteiner F, Mosor E, Omara M, Sperl L, Nawaz FA, Siva Sai C, Cenanovic M, Devkota HP, Hribersek M, De R, Klager E, Schaden E, Kletecka-Pulker M, Völkl-Kernstock S, Willschke H, Aufricht C, Atanasov AG, Stamm T. Mandatory vaccination against COVID-19: A Twitter poll analysis on public health opinion (Preprint). JMIR Form Res 2021; 6:e35754. [PMID: 35617671 PMCID: PMC9217155 DOI: 10.2196/35754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. Objective The purpose of this study was to better understand the public’s perception of mandatory COVID-19 vaccination in real time using Twitter polls. Methods Two Twitter polls were developed (in the English language) to seek the public’s opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform’s (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. Results Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ. Conclusions Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the “echo chamber effect,” the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity.
Collapse
Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Erika Mosor
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Faisal A Nawaz
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | | | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
- Program for Leading Graduate Schools, Kumamoto University, Kumamoto, Japan
| | - Mojca Hribersek
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Ronita De
- Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases, West Bengal, India
| | - Elisabeth Klager
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Atanas G Atanasov
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Tanja Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| |
Collapse
|
25
|
Mosor E, Ritschl V, Andrews MR, Omara M, Studenic P, Schaffer G, Leitgeb E, Oppenauer C, Li LC, Stamm T. The lockdown and its consequences-Perspectives and needs of people at increased risk of severe illness from COVID-19 : Results from a qualitative longitudinal study. Wien Klin Wochenschr 2021; 133:1255-1264. [PMID: 34820699 PMCID: PMC8612388 DOI: 10.1007/s00508-021-01979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is a lack of knowledge on how people at increased risk of severe illness from Coronavirus disease 2019 (COVID-19) experienced the infection control measures. This study aimed to explore their perspectives and needs during the coronavirus outbreak. METHODS A qualitative longitudinal interview study was conducted in Austria during lockdown due to COVID-19 containment and afterwards. People older than 65 years of age and/or affected by a chronic medical condition participated in individual telephone interviews at two time points. Thematic analysis was used to analyze the data and saturation was defined as no new emerging concepts in at least 10 subsequent interviews. RESULTS Thematic saturation was reached when 33 individuals (75.8% female, mean age ± standard deviation [SD] 73.7±10.9 years) were included. A total of 44 lower level concepts were extracted and summarized into 6 higher level concepts. They included (i) a general positive attitude toward COVID-19 measures, (ii) challenges of being isolated from the community, (iii) deterioration of health status, (iv) difficulties with measures due to their health condition, (v) lack of physical contact and (vi) lack of information versus overload. Participants suggested environmental adaptations for strengthening resilience in people at increased risk of severe illness from COVID-19. CONCLUSION Strategies and interventions are needed to support people at risk under pandemic conditions. Their perceptions and needs should be addressed to reduce the potential deterioration of health conditions and ensure well-being even during prolonged periods of crisis.
Collapse
Affiliation(s)
- Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Margaret R Andrews
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Paul Studenic
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gertraud Schaffer
- Österreichische Rheumaliga (ÖRL), Dorfstraße 4, 5761, Maria Alm, Austria
| | - Ernst Leitgeb
- Austrian Association for Patient Advocacy and Support (AAPAS), Lamprechtgasse 5/7, 1040, Vienna, Austria
| | - Claudia Oppenauer
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| |
Collapse
|
26
|
Omara M, Salzberger T, Boecker M, Bekes K, Steiner G, Nell-Duxneuner V, Ritschl V, Mosor E, Kloppenburg M, Sautner J, Steinecker-Frohnwieser B, Stamm T. Improving the measurement of oral health-related quality of life: Rasch model of the oral health impact profile-14. J Dent 2021; 114:103819. [PMID: 34560224 DOI: 10.1016/j.jdent.2021.103819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The 14-item Oral Health Impact Profile (OHIP-14) is the most frequently used instrument to measure oral health-related quality-of-life (OHRQoL) in adults. Despite its popularity, its psychometric properties have been predominantly investigated based on the classical test theory while the fundamental principles of measurement have not been fully assessed. Therefore, our aim was to investigate to what extent the OHIP-14 meets the fundamental requirments of measurements. METHODS We used the Rasch model to explore person-item-targeting, unidimensionality, local independence of items, invariance (differential-item-functioning, DIF), and the order of thresholds between response-options in the German version OHIP-14. We used data from osteoarthritis patients because hand disabilities and joint pain might influence oral hygiene. Furthermore, osteoarthritis in the temporomandibular-joint directly affects oral functioning. RESULTS Five-hundred sixteen patients were included (mean age 66.5 years [±10.2; ranging from 34 to 89]; 71.3% [368] females). The OHIP-14 median total score was 0 (interquartile-range from 0 to 4), indicating a right-skewed distribution because many patients reported good OHRQoL. The instrument was found unidimensional. However, there was strong evidence of local dependency, disordered thresholds between response-options, and age-related DIF for item 5. A revised scoring scheme with three instead of five answer-options in all items and eliminating two items resolving local dependency, the newly adapted OHIP-12, showed better reliability and item-fit to the Rasch model than the original OHIP-14. CONCLUSIONS This study assesses, for the first time, the OHIP-14 in terms of fundamental principles of measurement and proposes an item-reduced OHIP-12 as a psychometrically more accurate version of the instrument. CLINICAL SIGNIFICANCE The Rasch model is essential to ensure instruments' precision and clinical meaningfulness when measuring OHRQoL in clinical practice and research. The OHIP-12, derived from the OHIP-14 by deleting two items due to local dependency, with a revised scoring scheme for all items distinguishing three answer-options instead of five, represents a psychometrically improved version of the instrument.
Collapse
Affiliation(s)
- Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria
| | - Thomas Salzberger
- Institute for Statistics and Mathematics, University of Economics and Business, Welthandelsplatz 1, 1020, Vienna, Austria
| | - Maren Boecker
- RWTH Aachen University, Institute for Medical Psychology and Medical Sociology, Pauwelsstrasse 19, 52074, Aachen, Germany
| | - Katrin Bekes
- Department of Paediatric Dentistry, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Guenter Steiner
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Valerie Nell-Duxneuner
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria; Klinikum Peterhof, Austrian Social Health Insurance Fund, Baden, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Judith Sautner
- LK Stockerau Korneuburg, 2. Med. Department, Lower Austria, Austria
| | | | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria.
| |
Collapse
|
27
|
Kroon FPB, van der Heijde D, Maxwell LJ, Beaton DE, Abishek A, Berenbaum F, Blanco FJ, Conaghan PG, Dziedzic K, Hill CL, Haugen IK, Ishimori M, Ritschl V, Stamm TA, Wittoek R, Kloppenburg M. Core outcome measurement instrument selection for physical function in hand osteoarthritis using the OMERACT Filter 2.1 process. Semin Arthritis Rheum 2021; 51:1311-1319. [PMID: 34538514 DOI: 10.1016/j.semarthrit.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Physical function is one of the Outcome Measures in Rheumatology (OMERACT) core outcome domains for hand osteoarthritis studies. Our aim was to select appropriate instrument(s) to measure this domain, as part of the development of a core outcome measurement set. METHODS Following the OMERACT Filter 2.1 instrument selection process, the (function subscale of) the Australian/Canadian Hand Osteoarthritis Index (AUSCAN), Functional Index for Hand Osteoarthritis (FIHOA) and Michigan Hand Outcomes Questionnaire (MHQ) were assessed for domain match, feasibility, truth and discrimination. Data gathered from available literature, working group and patient surveys, and additional analyses in two hand osteoarthritis cohorts were used to inform a consensus process. Results were summarized in Summary of Measurements Properties tables and reviewed by the OMERACT technical advisory group. RESULTS MHQ passed the assessment of domain match and feasibility by the working group and patient research partners. For AUSCAN important limitations in feasibility were noted, but domain match was good. FIHOA did not pass the assessment and was not taken through the follow-up assessment. Based on published literature, reliability and construct/longitudinal validity of both MHQ and AUSCAN fulfilled OMERACT standards. While clinical trial discrimination and thresholds of meaning were good for AUSCAN, results for MHQ were ambiguous. CONCLUSION MHQ was provisionally endorsed as OMERACT core outcome measure for the core domain physical function. While AUSCAN may have better metric properties than MHQ, it received provisional endorsement as a second measure of function due to important feasibility issues. A research agenda to merit full endorsement was set.
Collapse
Affiliation(s)
- Féline P B Kroon
- Department of Rheumatology, and Department of Rheumatology, Zuyderland Medical Center, Leiden University Medical Center, Leiden, Heerlen, the Netherlands.
| | | | - Lara J Maxwell
- University of Ottawa, and Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dorcas E Beaton
- Musculoskeletal Health and Outcomes Research, and Department of Occupational Science and Occupational Therapy, St. Michael's Hospital and Institute for Work and Health, Rehabilitation Sciences Institute, and the Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Abishek Abishek
- Academic Rheumatology, University of Nottingham, and National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM, Saint-Antoine hospital AP-HP, Paris, France
| | - Francisco J Blanco
- Grupo de investigación en Reumatología. Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC). As Xubias, 15006. A Coruña, España
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Keele, United Kingdom
| | - Catherine L Hill
- Discipline of Medicine, Adelaide, and Rheumatology Department, Queen Elizabeth Hospital, University of Adelaide, Woodville South, South Australia
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Mariko Ishimori
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Valentin Ritschl
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja A Stamm
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Ruth Wittoek
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Margreet Kloppenburg
- Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
28
|
Stamm TA, Ritschl V, Omara M, Andrews MR, Mevenkamp N, Rzepka A, Schirmer M, Walch S, Salzberger T, Mosor E. Rasch Model of the COVID-19 Symptom Checklist-A Psychometric Validation Study. Viruses 2021; 13:v13091762. [PMID: 34578343 PMCID: PMC8471978 DOI: 10.3390/v13091762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
While self-reported Coronavirus Disease 2019 (COVID-19) symptom checklists have been extensively used during the pandemic, they have not been sufficiently validated from a psychometric perspective. We, therefore, used advanced psychometric modelling to explore the construct validity and internal consistency of an online self-reported COVID-19 symptom checklist and suggested adaptations where necessary. Fit to the Rasch model was examined in a sample of 1638 Austrian citizens who completed the checklist on up to 20 days during a lockdown. The items' fatigue', 'headache' and 'sneezing' had the highest likelihood to be affirmed. The longitudinal application of the symptom checklist increased the fit to the Rasch model. The item 'cough' showed a significant misfit to the fundamental measurement model and an additional dependency to 'dry cough/no sputum production'. Several personal factors, such as gender, age group, educational status, COVID-19 test status, comorbidities, immunosuppressive medication, pregnancy and pollen allergy led to systematic differences in the patterns of how symptoms were affirmed. Raw scores' adjustments ranged from ±0.01 to ±0.25 on the metric scales (0 to 10). Except for some basic adaptations that increases the scale's construct validity and internal consistency, the present analysis supports the combination of items. More accurate item wordings co-created with laypersons would lead to a common understanding of what is meant by a specific symptom. Adjustments for personal factors and comorbidities would allow for better clinical interpretations of self-reported symptom data.
Collapse
Affiliation(s)
- Tanja A. Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (V.R.); (M.O.); (M.R.A.); (E.M.)
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090 Vienna, Austria
- Correspondence:
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (V.R.); (M.O.); (M.R.A.); (E.M.)
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090 Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (V.R.); (M.O.); (M.R.A.); (E.M.)
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090 Vienna, Austria
| | - Margaret R. Andrews
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (V.R.); (M.O.); (M.R.A.); (E.M.)
| | - Nils Mevenkamp
- Center for Social- & Health Innovation, MCI—The Entrepreneurial School, Universitätsstraße 15, 6020 Innsbruck, Austria; (N.M.); (S.W.)
| | - Angelika Rzepka
- Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Digital Health Information Systems, Reininghausstrasse 13/1, 8020 Graz, Austria;
| | - Michael Schirmer
- Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria;
| | - Siegfried Walch
- Center for Social- & Health Innovation, MCI—The Entrepreneurial School, Universitätsstraße 15, 6020 Innsbruck, Austria; (N.M.); (S.W.)
| | - Thomas Salzberger
- Institute for Statistics and Mathematics, University of Economics and Business of Vienna, Welthandelsplatz 1, 1020 Vienna, Austria;
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; (V.R.); (M.O.); (M.R.A.); (E.M.)
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090 Vienna, Austria
| |
Collapse
|
29
|
Ritschl V, Ferreira RJO, Santos EJF, Fernandes R, Juutila E, Mosor E, Santos-Costa P, Fligelstone K, Schraven L, Stummvoll G, Salvador M, Poole JL, van den Ende C, Boström C, Stamm TA. Suitability for e-health of non-pharmacological interventions in connective tissue diseases: scoping review with a descriptive analysis. RMD Open 2021; 7:rmdopen-2021-001710. [PMID: 34326205 PMCID: PMC8323400 DOI: 10.1136/rmdopen-2021-001710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Non-pharmacological interventions support patients with connective tissue diseases to better cope with and self-manage their diseases. This study aimed to map existing evidence on non-pharmacological interventions in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and mixed connective tissue diseases regarding content, feasibility and potential suitability in an e-health setting. Methods A literature search was performed in eight different databases in July 2020. The intervention’s content was extracted using the ‘Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide’. A Sankey diagram and descriptive statistics were used to analyse the data and illustrate the relationships between the interventions. Results Of 8198 identified records, 119 papers were eligible. One hundred and four of them (87.4%) were conducted between 2000 and 2020, mainly in the USA (SLE n=24 (21.2%), SSc n=16 (14.2%)), Brazil (SLE n=8 (7.1%), SSc n=5 (4.4%)) and Italy (SLE n=0 (0%), SSc n=12 (10.6%)). Fifty-two studies (SLE n=24 (21.2%), SSc n=28 (24.8%)) used multicomponent interventions. The single interventions were physical exercises (SLE n=16 (14.2%), SSc n=17 (15.0%)), coaching/counselling (SLE n=11 (18.0%), SSc n=0 (0%)) and education (SLE n=2 (1.8%), SSc n=3 (2.7%)). Primary outcomes focused on physical function (SLE n=1 (0.9%), SSc n=15 (13.3%)), mouth opening in SSc (n=4 (5.9%)) and physical capacity (SLE n=2 (1.8%), SSc n=1 (0.9%)). No interventions for mixed connective tissue disease were found. Conclusion There was a great variety in the intervention’s content due to differences in body structure, activity limitations and participation restrictions in SLE and SSc. These results highlight the need for personalised, multicomponent, non-pharmacological interventions, which could be delivered as e-health interventions.
Collapse
Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo José Ferreira Santos
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Rúben Fernandes
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Essi Juutila
- Metropolia University of Applied Sciences, Helsinki, Finland
| | - Erika Mosor
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | | | - Linda Schraven
- Federation of European Scleroderma Associations, Amsterdam, The Netherlands
| | | | - Maria Salvador
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria .,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| |
Collapse
|
30
|
Boukhobza S, Ritschl V, Stamm T, Bekes K. The COVID-19 Pandemic and Its Impact on Knowledge, Perception and Attitudes of Dentistry Students in Austria: A Cross-Sectional Survey. J Multidiscip Healthc 2021; 14:1413-1422. [PMID: 34163169 PMCID: PMC8214007 DOI: 10.2147/jmdh.s311535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Universities with dental schools are faced with complex problems during the COVID-19 pandemic. Dentistry students are at a higher risk of contracting infections, specifically COVID-19, due to direct contact with patients. The aim of this study was to assess the knowledge, perception and attitude regarding COVID-19 among dentistry students in Austria. Methods During the first lockdown in Austria, an online survey was distributed among 165 dentistry students in their clinical term at the Medical University of Vienna. The survey contained elaborative questions on the general knowledge and attitude towards COVID-19. A special focus of the questionnaire was set on the modification of the student’s curriculum regarding infection control. Results In total, 77 (47%) students replied; 68 questionnaires were included in the analysis. Dentistry students were found to have good general knowledge of COVID-19 during the early phase of the pandemic. Most students (89.6%) got their information regarding the COVID-19 infection from official sources; however, 58% would like to attend further lectures on COVID-19 to expand their knowledge. Discussion The current study finds good general knowledge on COVID-19 among dental students, but some gaps regarding hygienic protocols and infection control. Students’ preferences regarding modification in the curriculum suggest practical courses and lectures as a way to close COVID-19 related knowledge gaps.
Collapse
Affiliation(s)
- Sarra Boukhobza
- Department of Pediatric Dentistry, University Clinic of Dentistry, Medical University Vienna, Vienna, Austria
| | - Valentin Ritschl
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University Vienna, Vienna, Austria
| | - Tanja Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University Vienna, Vienna, Austria
| | - Katrin Bekes
- Department of Pediatric Dentistry, University Clinic of Dentistry, Medical University Vienna, Vienna, Austria
| |
Collapse
|
31
|
Loibner E, Ritschl V, Leeb B, Spellitz P, Eichbauer-Sturm G, Zwerina J, Herold M, Stetter M, Puchner R, Singer F, Fritsch-Stork R. POS0208 GENDER DIFFERENCES IN RESPONSE TO BIOLOGICALS. WOMEN FARE WORSE ACROSS INFLAMMATORY ARTHRITIS DISEASES - DATA FROM THE BIOREG. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Gender differences in prevalence and disease course are known in various rheumatic diseases; however, investigations of gender difference concerning therapeutical response have yielded variable results.Objectives:The aim of this retrospective study was to investigate, whether a gender difference in response rate to biological disease-modifying antirheumatic drugs (bDMARDs) and apremilast in bDMARD-naïve patients could be observed across the three most prevalent inflammatory arthritis diseases: rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriatic arthritis (PsA). Additionally, a response to individual TNF blockers was investigated in this respect.Methods:Data from bDMARD-naïve RA-, SpA- and PsA-patients from Bioreg, the Austrian registry for biological DMARDs in rheumatic diseases, were used. Patients with a baseline (Visit 1=V1) and follow-up visits at 6 months (Visit 2=V2) and 12 months (Visit 3=V3) were included and response to therapy with TNF-inhibitors (TNFi), furthermore to therapy with rituximab, tocilizumab and apremilast was analyzed according to gender. The remaining bDMARDs were not analyzed due to small numbers. Key response-parameter for RA was disease activity score (DAS28), whereas for PsoA the Stockerau Activity Score for Psoriatic Arthritis (SASPA) and for SpA the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were employed; in addition, the Health assessment Questionnaire (HAQ) was used. Data were analyzed in R Statistic stratified by gender using Kruskal-Wallis and Wilcoxon tests.Results:354 women and 123 men with RA (n=477), 81 women and 69 men with PsA (n=150), 121 women and 191 men with SpA (n=312) were included. No significant differences in biometrics was seen between female and male patients at baseline in all diseases.In RA patients overall DAS28 decreased from baseline (V1) to V2 and V3 (DAS28: V1: male: 4.38 [3.66, 5.11], female: 4.30 [3.68, 5.03], p(m/f) = 0.905; V2: male: 2.66 [1.73, 3.63], female: 3.10 [2.17, 3.98], p(m/f) = 0.015; V3: male: 2.25 [1.39, 3.36], female: 3.01 [1.87, 3.87], p(m/f) = 0.002). For TNF inhibitors (n=311), there was a significant difference between genders at V2 (Fig.1a). Patients receiving Rituximab (n=41) displayed a significantly higher DAS28 at baseline in females, which diminished in the follow up: V1: (p(m/f) p=0.002; V2: p=0.019; V3: p=0.13); response to tocilizumab (n=63) did not show any gender differences.In PsA patients overall SASPA decreased from baseline (V1) to V2 and V3 (SASPA: V1: male: 4.00 [2.80, 5.20], female: 4.40 [2.80, 5.80], p(m/f) = 0.399; V2: male: 2.20 [1.20, 3.50], female: 3.40 [2.00, 5.00], p(m/f) = 0.071; V3: male: 1.80 [0.80, 2.70], female: 3.01 [2.35, 4.80], p(m/f) = 0.001). For TNF inhibitors (n=79), there was a significant difference between genders at V3 (Fig 1a). For Apremilast (n=39), there was a significant difference between genders at V2 (Fig.1c).In SpA patients overall BASDAI decreased from baseline (V1) to V2 and V3 (BASDAI: V1: male: 4.70 [2.88, 6.18], female: 4.80 [3.30, 6.20], p(m/f) = 0.463; V2: male: 3.05 [2.00, 4.60], female: 3.64 [2.62, 5.41], p(m/f) = 0.039; V3: male: 3.02 [1.67, 4.20], female: 3.65 [2.18, 5.47], p(m/f) = 0.016). In V3 a differential BASDAI in response to TNFi (n=299) was observed (Fig.1a).Possible differences of response to individual TNFi (etanercept, infliximab, other TNFi) measured by HAQ were investigated in all diseases together. The difference between male and females was significant at baseline for all 3 TNFi; whereas with the use of ETA the significant difference was carried through to V2 and V3, it was lost with the use of IFX and was variable with the other TNFi (Fig.1b)Figure 1.Conclusion:Female patients showed a statistically lower response to TNFi in all three disease entities (RA, SpA and PsoA) to a variable degree in our homogenous central european population. Interestingly, the difference was not uniform across individual TNFi when measured by HAQ. Gender differences were also seen in response to Apremilast.Disclosure of Interests:Elisabeth Loibner: None declared, Valentin Ritschl: None declared, Burkhard Leeb Speakers bureau: AbbVie, Roche, MSD, Pfizer, Actiopharm, Boehringer-Ingelheim, Kwizda, Celgene, Sandoz, Grünenthal, Eli-Lilly, Grant/research support from: TRB, Roche, Consultancies: AbbVie, Amgen, Roche, MSD, Pfizer, Celgene, Grünenthal, Kwizda, Eli-Lilly, Novartis, Sandoz;, Peter Spellitz: None declared, Gabriela Eichbauer-Sturm: None declared, Jochen Zwerina: None declared, Manfred Herold: None declared, Miriam Stetter: None declared, Rudolf Puchner Speakers bureau: AbbVie, BMS, Janssen, Kwizda, MSD, Pfizer, Celgene, Grünenthal, Eli-Lilly, Consultant of: AbbVie, Amgen, Pfizer, Celgene, Grünenthal, Eli-Lilly, Franz Singer: None declared, Ruth Fritsch-Stork: None declared
Collapse
|
32
|
Wagner M, Jaki C, Löllgen RM, Mileder L, Eibensteiner F, Ritschl V, Steinbauer P, Gottstein M, Abulebda K, Calhoun A, Gross IT. Readiness for and Response to Coronavirus Disease 2019 Among Pediatric Healthcare Providers: The Role of Simulation for Pandemics and Other Disasters. Pediatr Crit Care Med 2021; 22:e333-e338. [PMID: 33350800 PMCID: PMC8162220 DOI: 10.1097/pcc.0000000000002649] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Early preparation for the training and education of healthcare providers, as well as the continuation or modification of routine medical education programs, is of great importance in times of the coronavirus disease 2019 pandemic or other public health emergencies. The goal of this study was to characterize these self-reported efforts by the pediatric simulation community. DESIGN This was a global, multicenter survey developed via a Delphi process. SETTING International survey study. SUBJECTS The survey was sent to 555 individual members of the three largest international pediatric simulation societies (The International Pediatric Simulation Society, International Network for Simulation-based Pediatric Innovation, Research & Education, and Netzwerk Kindersimulation e.V.) between April 27, 2020, and May 18, 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Description of coronavirus disease 2019 pandemic simulation-based preparation activities of pediatric acute and critical care healthcare providers. The Delphi process included 20 content experts and required three rounds to reach consensus. The survey was completed by 234 participants (42.2%) from 19 countries. Preparation differed significantly between the geographic regions, with 79.3% of Anglo-American/Anglo-Saxon, 82.6% of Indian, and 47.1% of European participants initiating specifically coronavirus disease 2019-related simulation activities. Frequent modifications to existing simulation programs included the use of telesimulation and virtual reality training. Forty-nine percent of institutions discontinued noncoronavirus disease 2019-related simulation training. CONCLUSIONS The swift incorporation of disease-specific sessions and the transition of standard education to virtual or hybrid simulation training modes occurred frequently. The approach used, however, depended heavily on local requirements, limitations, and circumstances. In particular, the use of telesimulation allowed education to continue while maintaining social distancing requirements.
Collapse
Affiliation(s)
- Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Christina Jaki
- Simulation Center STUPS Klinikum Stuttgart, Stuttgart, Germany
| | - Ruth M Löllgen
- Pediatric Emergency Department, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Kamal Abulebda
- Division of Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Aaron Calhoun
- Division of Critical Care Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Isabel T Gross
- Department of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
33
|
Eibensteiner F, Ritschl V, Nawaz FA, Fazel SS, Tsagkaris C, Kulnik ST, Crutzen R, Klager E, Völkl-Kernstock S, Schaden E, Kletecka-Pulker M, Willschke H, Atanasov AG. People's Willingness to Vaccinate Against COVID-19 Despite Their Safety Concerns: Twitter Poll Analysis. J Med Internet Res 2021; 23:e28973. [PMID: 33872185 PMCID: PMC8086789 DOI: 10.2196/28973] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND On January 30, 2020, the World Health Organization's Emergency Committee declared the rapid, worldwide spread of COVID-19 a global health emergency. Since then, tireless efforts have been made to mitigate the spread of the disease and its impact, and these efforts have mostly relied on nonpharmaceutical interventions. By December 2020, the safety and efficacy of the first COVID-19 vaccines were demonstrated. The large social media platform Twitter has been used by medical researchers for the analysis of important public health topics, such as the public's perception on antibiotic use and misuse and human papillomavirus vaccination. The analysis of Twitter-generated data can be further facilitated by using Twitter's built-in, anonymous polling tool to gain insight into public health issues and obtain rapid feedback on an international scale. During the fast-paced course of the COVID-19 pandemic, the Twitter polling system has provided a viable method for gaining rapid, large-scale, international public health insights on highly relevant and timely SARS-CoV-2-related topics. OBJECTIVE The purpose of this study was to understand the public's perception on the safety and acceptance of COVID-19 vaccines in real time by using Twitter polls. METHODS We developed 2 Twitter polls to explore the public's views on available COVID-19 vaccines. The surveys were pinned to the Digital Health and Patient Safety Platform Twitter timeline for 1 week in mid-February 2021, and Twitter users and influencers were asked to participate in and retweet the polls to reach the largest possible audience. RESULTS The adequacy of COVID-19 vaccine safety (ie, the safety of currently available vaccines; poll 1) was agreed upon by 1579 out of 3439 (45.9%) Twitter users. In contrast, almost as many Twitter users (1434/3439, 41.7%) were unsure about the safety of COVID-19 vaccines. Only 5.2% (179/3439) of Twitter users rated the available COVID-19 vaccines as generally unsafe. Poll 2, which addressed the question of whether users would undergo vaccination, was answered affirmatively by 82.8% (2862/3457) of Twitter users, and only 8% (277/3457) categorically rejected vaccination at the time of polling. CONCLUSIONS In contrast to the perceived high level of uncertainty about the safety of the available COVID-19 vaccines, we observed an elevated willingness to undergo vaccination among our study sample. Since people's perceptions and views are strongly influenced by social media, the snapshots provided by these media platforms represent a static image of a moving target. Thus, the results of this study need to be followed up by long-term surveys to maintain their validity. This is especially relevant due to the circumstances of the fast-paced pandemic and the need to not miss sudden rises in the incidence of vaccine hesitancy, which may have detrimental effects on the pandemic's course.
Collapse
Affiliation(s)
- Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Faisal A Nawaz
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Sajjad S Fazel
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Rik Crutzen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Elisabeth Klager
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Atanas G Atanasov
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
- Department of Pharmacognosy, University of Vienna, Vienna, Austria
| |
Collapse
|
34
|
Stamm TA, Andrews MR, Mosor E, Ritschl V, Li LC, Ma JK, Campo-Arias A, Baker S, Burton NW, Eghbali M, Fernandez N, Ferreira RJO, Gäbler G, Makri S, Mintz S, Moe RH, Morasso E, Murphy SL, Ntuli S, Omara M, Simancas-Pallares MA, Horonieff J, Gartlehner G. The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review. J Clin Epidemiol 2021; 135:125-135. [PMID: 33691153 PMCID: PMC7937325 DOI: 10.1016/j.jclinepi.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/15/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022]
Abstract
Objectives The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. Study Design and Setting Rapid systematic review from February 1 until April 27, 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting. Results There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline. Conclusion Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.
Collapse
Affiliation(s)
- Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria.
| | - Margaret R Andrews
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Jasmin K Ma
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Adalberto Campo-Arias
- Medicine Program, Faculty of Health Sciences, University of Magdalena, Santa Marta, Colombia
| | - Sarah Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Mt. Gravatt, Australia
| | - Mohammad Eghbali
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Natalia Fernandez
- Department of Physical Medicine and Rehabilitation, University of Michigan and VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Souzi Makri
- The Cyprus League Against Rheumatism and Platform Organization for People for Rheumatic Diseases in Southern Europe, Nicosia, Cyprus
| | - Sandra Mintz
- Office of Patient Experience, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rikke Helene Moe
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan and VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Simiso Ntuli
- Department of Podiatry, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, 1090, Vienna, Austria
| | - Miguel Angel Simancas-Pallares
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria; RTI International, Research Triangle Park, NC, USA
| |
Collapse
|
35
|
Eibensteiner F, Ritschl V, Stamm T, Cetin A, Schmitt CP, Ariceta G, Bakkaloglu S, Jankauskiene A, Klaus G, Paglialonga F, Edefonti A, Ranchin B, Shroff R, Stefanidis CJ, Vandewalle J, Verrina E, Vondrak K, Zurowska A, Alper SL, Aufricht C. Countermeasures against COVID-19: how to navigate medical practice through a nascent, evolving evidence base - a European multicentre mixed methods study. BMJ Open 2021; 11:e043015. [PMID: 33597140 PMCID: PMC7893209 DOI: 10.1136/bmjopen-2020-043015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/30/2020] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES In a previously published Delphi exercise the European Pediatric Dialysis Working Group (EPDWG) reported widely variable counteractive responses to COVID-19 during the first week of statutory public curfews in 12 European countries with case loads of 4-680 infected patients per million. To better understand these wide variations, we assessed different factors affecting countermeasure implementation rates and applied the capability, opportunity, motivation model of behaviour to describe their determinants. DESIGN We undertook this international mixed methods study of increased depth and breadth to obtain more complete data and to better understand the resulting complex evidence. SETTING This study was conducted in 14 paediatric nephrology centres across 12 European countries during the COVID-19 pandemic. PARTICIPANTS The 14 participants were paediatric nephrologists and EPDWG members from 12 European centres. MAIN OUTCOME MEASURES 52 countermeasures clustered into eight response domains (access control, patient testing, personnel testing, personal protective equipment policy, patient cohorting, personnel cohorting, suspension of routine care, remote work) were categorised by implementation status, drivers (expert opinion, hospital regulations) and resource dependency. Governmental strictness and media attitude were independently assessed for each country and correlated with relevant countermeasure implementation factors. RESULTS Implementation rates varied widely among response domains (median 49.5%, range 20%-71%) and centres (median 46%, range 31%-62%). Case loads were insufficient to explain response rate variability. Increasing case loads resulted in shifts from expert opinion-based to hospital regulation-based decisions to implement additional countermeasures despite increased resource dependency. Higher governmental strictness and positive media attitude towards countermeasure implementation were associated with higher implementation rates. CONCLUSIONS COVID-19 countermeasure implementation by paediatric tertiary care centres did not reflect case loads but rather reflected heterogeneity of local rules and of perceived resources. These data highlight the need of ongoing reassessment of current practices, facilitating rapid change in 'institutional behavior' in response to emerging evidence of countermeasure efficacy.
Collapse
Affiliation(s)
- Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Wien, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Asil Cetin
- Research Platform Data Science, University of Vienna, Vienna, Austria
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg University, Heidelberg, Germany
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Sevcan Bakkaloglu
- Division of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Günter Klaus
- Department of Pediatric Nephrology, KfH Children's Kidney Center, Marburg, Germany
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, London, UK
| | | | - Johan Vandewalle
- Department of Pediatric Nephrology, Utoped, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Enrico Verrina
- Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy
| | - Karel Vondrak
- Department of Pediatric Nephrology, University Hospital Motol, Prague, Czech Republic
| | - Aleksandra Zurowska
- Department of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
36
|
Bekes K, Ritschl V, Stamm T. COVID-19 Pandemic and Its Impact on Pediatric Dentistry in Austria: Knowledge, Perception and Attitude Among Pediatric Dentists in a Cross-Sectional Survey. J Multidiscip Healthc 2021; 14:161-169. [PMID: 33531814 PMCID: PMC7847384 DOI: 10.2147/jmdh.s285093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction The Novel Coronavirus Disease (COVID-19) outbreak is affecting people worldwide. Given the frequent production of aerosols, dentists are a high-risk group for infection. The aim of this study was to assess the knowledge, perception and attitude regarding COVID-19 among pediatric dentists in Austria. Methods An online survey was distributed among the 128 pediatric dentists that are members of the Austrian Society of Pediatric Dentistry. The questionnaire was divided into three sections: 1) dentists’ demographic characteristics, 2) general knowledge and attitude, 3) COVID-19 with a focus on pediatric dentistry. Results Seventy-five dentists replied; 58 questionnaires could be included in the analysis (93.1% female). Pediatric dentists were found to have good general knowledge of COVID-19. However, only 10% had attended training or lectures and 36.2% rated their role in teaching patients about COVID-19 as being very significant. At the beginning of the outbreak, 78.6% only offered emergency services. Currently, only 10.3% of the dentists work without FFP2/3 mask when producing aerosols. Discussion Austrian pediatric dentists were aware of the general aspects of COVID-19. Those, who had their practice open mostly followed national and international recommendations given and only offered emergency visits.
Collapse
Affiliation(s)
- Katrin Bekes
- Department of Pediatric Dentistry, University Clinic of Dentistry, Medical University Vienna, Vienna, Austria
| | - Valentin Ritschl
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Section for Outcomes Research, Vienna, Austria
| | - Tanja Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Section for Outcomes Research, Vienna, Austria
| |
Collapse
|
37
|
Ritschl V, Stamm TA, Aletaha D, Bijlsma JWJ, Böhm P, Dragoi RG, Dures E, Estévez-López F, Gossec L, Iagnocco A, Marques A, Moholt E, Nudel M, van den Bemt BJF, Viktil K, Voshaar M, de Thurah A, Carmona L. 2020 EULAR points to consider for the prevention, screening, assessment and management of non-adherence to treatment in people with rheumatic and musculoskeletal diseases for use in clinical practice. Ann Rheum Dis 2020; 80:707-713. [PMID: 33355152 DOI: 10.1136/annrheumdis-2020-218986] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-adherence to treatment could preclude reaching an optimal outcome. Thirty to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to the agreed treatment. OBJECTIVES The objective was to establish points to consider (PtCs) for the prevention, screening, assessment and management of non-adherence to (non-)pharmacological treatments in people with RMDs. METHODS An EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included healthcare providers (HCPs), comprising rheumatologists, nurses, pharmacists, psychologists, physiotherapists, occupational therapists and patient-representatives from 12 European countries. A review of systematic reviews was conducted in advance to support the TF in formulating the PtCs. The level of agreement among the TF was established by anonymous online voting. RESULTS Four overarching principles and nine PtCs were formulated. The PtCs reflect the phases of action on non-adherence. HCPs should assess and discuss adherence with patients on a regular basis and support patients to treatment adherence. As adherence is an agreed behaviour, the treatment has to be tailored to the patients' needs. The level of agreement ranged from 9.5 to 9.9 out of 10. CONCLUSIONS These PtCs can help HCPs to support people with RMDs to be more adherent to the agreed treatment plan. The basic scheme being prevent non-adherence by bonding with the patient and building trust, overcoming structural barriers, assessing in a blame-free environment and tailoring the solution to the problem.
Collapse
Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Wien, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Peter Böhm
- Deutsche Rheuma-Liga Bundesverband e.V, Bonn, Germany
| | - Razvan Gabriel Dragoi
- Rehabilitation, Physical Medicine and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Emma Dures
- Department of Nursing and Midwifery, University of the West of England, Bristol, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Fernando Estévez-López
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Andrea Marques
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | - Ellen Moholt
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Bart J F van den Bemt
- Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud Univiersity Medical Center, Nijmegen, The Netherlands
| | - Kirsten Viktil
- Hospital Pharmacy, Diakonhjemmet Hospital Pharmacy, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Marieke Voshaar
- Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| |
Collapse
|
38
|
Ritschl V, Stamm TA, Aletaha D, Bijlsma JWJ, Böhm P, Dragoi R, Dures E, Estévez-López F, Gossec L, Iagnocco A, Negrón JB, Nudel M, Marques A, Moholt E, Skrubbeltrang C, Van den Bemt B, Viktil K, Voshaar M, Carmona L, de Thurah A. Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews informing the 2020 EULAR points to consider. RMD Open 2020; 6:e001432. [PMID: 33161377 PMCID: PMC7856118 DOI: 10.1136/rmdopen-2020-001432] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs). METHODS An overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews. RESULTS After reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. The number of factors that may influence adherence exceed 700. Among 53 intervention studies, 54.7% showed a small statistically significant effect on adherence, and all three multicomponent interventions, including different modes of patient education and delivered by a variety of healthcare providers, showed a positive result in adherence to medication. No single assessment provided a comprehensive measure of adherence to either medication or exercise. CONCLUSIONS The results underscore the complexity of non-adherence, its changing pattern and dependence on multi-level factors, the need to involve all stakeholders in all steps, the absence of a gold standard for screening and the requirement of multi-component interventions to manage it.
Collapse
Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Peter Böhm
- Deutsche Rheuma-Liga Bundesverband e.V., Bonn, Germany
| | - Razvan Dragoi
- University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Emma Dures
- University of the West of England Bristol, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - José B Negrón
- Instituto de Investigación Social y Sanitaria, Puerto Rico
| | | | - Andréa Marques
- Centro Hospitalar e Universitário de Coimbra, Health Sciences Research Unit: Nursing, UICISA-E, Coimbra, Portugal
| | - Ellen Moholt
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway
| | | | - Bart Van den Bemt
- Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Kirsten Viktil
- University of Oslo, Oslo, Norway
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
39
|
Ritschl V, Stamm T, Aletaha D, Bijlsma JW, Boehm P, Dragoi R, Dures E, Estévez-López F, Gossec L, Iagnocco A, Nudel M, Marques A, Moholt E, Van den Bemt B, Viktil K, Voshaar M, De Thurah A, Carmona L. SAT0608-HPR EULAR POINTS TO CONSIDER FOR THE DETECTION, ASSESSMENT AND MANAGEMENT OF NON-ADHERENCE IN PEOPLE WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Non-adherence to medication and non-pharmacological interventions precludes reaching an optimal outcome. 30 to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to their recommended treatment regimens.Objectives:The objective of this EULAR task force was to establish recommendations/points to consider (PtC) for the detection, assessment and management of non-adherence in people with RMDs.Methods:A EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included rheumatologists, health professionals in rheumatology (HPRs), and patient-representatives from 12 countries. A systematic literature review of reviews was conducted in advance to support the TF in formulating the PtC. Agreement was obtained by Delphi technique in three rounds (0-10 rating scale).Results:A definition of adherence, 4 overarching principles and 9 PtC were formulated (table).Conclusion:The PtCs can help health-care providers to support people with RMDs to adhere to the agreed treatment plan.Table.Overarching principles and points to consider.Definition of AdherenceAdherence is defined as the extent to which a person’s behaviour corresponds with the agreed prescription.Overarching principlesAgreement1Adherence impacts the outcomes of people with RMDs.992Shared decision making is key, since adherence is a behaviour following an agreed prescription.963Adherence is influenced by multiple factors.984Adherence is a dynamic process that requires continuous evaluation.96Points to considerAgreement1All HCPs involved in the management of people with RMDs should take responsibility for promoting adherence.992Effective patient-health professional communication should be applied to enhance adherence.993Barriers and facilitators of adherence of a specific patient to a specific prescription should be appropriately evaluated.954Patient education should be provided for people with RMDs as an integral part of standard care.965Care should be tailored to patient preferences and goals to enhance adherence.986Adherence should be discussed regularly based on open questions and particularly when disease is not well controlled.997The HCP should explore which factors might negatively influence adherence, including: opportunity (e.g., availability or cost), capability, (e.g., memory problems), motivation (e.g., concerns).948Together with the patient, the HCP should tailor the approach to overcome individual barriers to adherence, e.g.,98- simplifying the regimen,- using reminders,- providing education,- discussing the patient’s beliefs on treatments.9When specific expertise or interventions for adherence are needed, they should be made available to patients.98HCP, health-care providers; RMDs, rheumatic and musculoskeletal diseasesDisclosure of Interests:Valentin Ritschl: None declared, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Daniel Aletaha Grant/research support from: AbbVie, Novartis, Roche, Consultant of: AbbVie, Amgen, Celgene, Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, Speakers bureau: AbbVie, Celgene, Lilly, Merck, Novartis, Pfizer, Sanofi Genzyme, UCB, Johannes WJ Bijlsma Grant/research support from: Roche, Speakers bureau: Roche, Lilly, Peter Boehm: None declared, Razvan Dragoi Speakers bureau: MSD, AbbVie, Novartis, Roche, Pfizer, Myllan, Sandoz, Emma Dures Grant/research support from: Independent Learning Grant from Pfizer, combined funding for a research fellow from Celgene, Abbvie and Novartis, Paid instructor for: A fee from Novartis to deliver training to nurses., Fernando Estévez-López: None declared, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi, Michal Nudel: None declared, Andrea Marques: None declared, Ellen Moholt: None declared, Bart van den Bemt Grant/research support from: UCB, Pfizer and Abbvie, Consultant of: Delivered consultancy work for UCB, Novartis and Pfizer, Speakers bureau: Pfizer, AbbVie, UCB, Biogen and Sandoz., Kirsten Viktil: None declared, Marieke Voshaar Grant/research support from: part of phd research, Speakers bureau: conducting a workshop (Pfizer), Annette de Thurah Grant/research support from: Novartis (not relevant for the present study)., Speakers bureau: Lily (not relevant for the present study)., Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)
Collapse
|
40
|
Rosta K, Mrak D, Valenta N, Stamm T, Ritschl V, Husslein P, Puchner A. Preliminary Results from the Nationwide Austrian Register for Reproduction and Rheumatic Disease (RhePro Register). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- K Rosta
- Abteilung für Geburtshilfe und fetomaternale Medizin, Universitätsklinik für Frauenheilkunde Medizinische Universität Wien
| | - D Mrak
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Rheumatologie, Medizinische Universität Wien
| | - N Valenta
- Abteilung für Geburtshilfe und fetomaternale Medizin, Universitätsklinik für Frauenheilkunde Medizinische Universität Wien
| | - T Stamm
- Zentrum für Medizinische Statistik, Informatik und Intelligente Systeme, Medizinische Universität Wien
| | - V Ritschl
- Zentrum für Medizinische Statistik, Informatik und Intelligente Systeme, Medizinische Universität Wien
| | - P Husslein
- Abteilung für Geburtshilfe und fetomaternale Medizin, Universitätsklinik für Frauenheilkunde Medizinische Universität Wien
| | - A Puchner
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Rheumatologie, Medizinische Universität Wien
| |
Collapse
|
41
|
Haugen IK, Felson DT, Abhishek A, Berenbaum F, Bierma-Zeinstra S, Borgen T, Herrero Beaumont G, Ishimori M, Jonsson H, Kroon FP, Maheu E, Ramonda R, Ritschl V, Stamm TA, van der Heijde D, Wittoek R, Greibrokk E, Smeets W, Kloppenburg M. Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis. RMD Open 2020; 6:e001265. [PMID: 32584781 PMCID: PMC7425183 DOI: 10.1136/rmdopen-2020-001265] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA. METHODS In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) were compared with controls with hand complaints due to inflammatory or non-inflammatory conditions (n = 70). We examined whether self-reported, clinical, radiographic and laboratory findings were associated with hand OA using logistic regression analyses. Discrimination between groups was assessed by calculating the area under receiver operating curves (AUC). RESULTS Strong associations with hand OA were observed for radiographic osteophytes (OR = 1.62, 95% CI 1.40 to 1.88) and joint space narrowing (JSN) (OR = 1.57, 95% CI 1.36 to 1.82) in the distal interphalangeal (DIP) joints with excellent discrimination (AUC = 0.82 for both). For osteophytes and JSN, we found acceptable discrimination between groups in the proximal interphalangeal joints (AUC = 0.77 and 0.78, respectively), but poorer discrimination in the first carpometacarpal joints (AUC = 0.67 and 0.63, respectively). Painful DIP joints were associated with hand OA, but were less able to discriminate between groups (AUC = 0.67). Age and family history of OA were positively associated with hand OA, whereas negative associations were found for pain, stiffness and soft tissue swelling in metacarpophalangeal joints, pain and marginal erosions in wrists, longer morning stiffness, inflammatory biomarkers and autoantibodies. CONCLUSIONS Differences in symptoms, clinical findings, radiographic changes and laboratory tests were found in patients with hand OA versus controls. Radiographic OA features, especially in DIP joints, were best suited to discriminate between groups.
Collapse
Affiliation(s)
- Ida K Haugen
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - David T Felson
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- Arthritis Research UK Epidemiology Unit and National Institute for Health Research Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR-BRC,Nottingham, UK
| | | | - Sita Bierma-Zeinstra
- Department of General Practice, Department of Orthopedics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Tove Borgen
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Frysja Medical Practice, Oslo, Norway
| | | | - Mariko Ishimori
- Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Féline Pb Kroon
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Emmanuel Maheu
- Faculty of Medicine Pierre & Marie Curie Paris VI, Hopital Saint-Antoine,Paris, France
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova School of Medicine and Surgery, Padova, Italy
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | | | - Ruth Wittoek
- Rheumatology, University Hospital Ghent, Gent, Belgium
| | | | - Wilma Smeets
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | | |
Collapse
|
42
|
Stamm T, Mosor E, Omara M, Ritschl V, Murphy SL. How can fatigue be addressed in individuals with systemic sclerosis? Lancet Rheumatol 2020; 2:e128-e129. [PMID: 38263648 DOI: 10.1016/s2665-9913(20)30027-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 01/25/2024]
Affiliation(s)
- Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna 1090, Austria; Ludwig Boltzmann Institute Arthritis and Rehabilitation, Vienna, Austria.
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna 1090, Austria
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna 1090, Austria; Ludwig Boltzmann Institute Arthritis and Rehabilitation, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna 1090, Austria
| | - Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, VA Ann Arbor Health Care System, Geriatric Research Education and Clinical Center, MI, USA
| |
Collapse
|
43
|
Eibensteiner F, Ritschl V, Ariceta G, Jankauskiene A, Klaus G, Paglialonga F, Edefonti A, Ranchin B, Schmitt CP, Shroff R, Stefanidis CJ, Walle JV, Verrina E, Vondrak K, Zurowska A, Stamm T, Aufricht C. Rapid response in the COVID-19 pandemic: a Delphi study from the European Pediatric Dialysis Working Group. Pediatr Nephrol 2020; 35:1669-1678. [PMID: 32418146 PMCID: PMC7230035 DOI: 10.1007/s00467-020-04584-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND COVID-19 was declared a global health emergency. Since children are less than 1% of reported cases, there is limited information to develop evidence-based practice recommendations. The objective of this study was to rapidly gather expert knowledge and experience to guide the care of children with chronic kidney disease during the COVID-19 pandemic. METHODS A four-round multi-center Delphi exercise was conducted among 13 centers in 11 European countries of the European Pediatric Dialysis Working Group (EPDWG) between March, 16th and 20th 2020. Results were analyzed using a mixed methods qualitative approach and descriptive statistics. RESULTS Thirteen COVID-19 specific topics of particular need for guidance were identified. Main themes encompassed testing strategies and results (n = 4), changes in use of current therapeutics (n = 3), preventive measurements of transmission and management of COVID-19 (n = 3), and changes in standard clinical care (n = 3). Patterns of center-specific responses varied according to regulations and to availability of guidelines. CONCLUSIONS As limited quantitative evidence is available in real time during the rapid spread of the COVID-19 pandemic, qualitative expert knowledge and experience represent the best evidence available. This Delphi exercise demonstrates that use of mixed methodologies embedded in an established network of experts allowed prompt analysis of pediatric nephrologists' response to COVID-19 during this fast-emerging public health crisis. Such rapid sharing of knowledge and local practices is essential to timely and optimal guidance for medical management of specific patient groups in multi-country health care systems such as those of Europe and the US.
Collapse
Affiliation(s)
- Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d’ Hebron, Barcelona, Spain
| | - Augustina Jankauskiene
- Pediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Günter Klaus
- Department of Pediatric Nephrology, KfH Children’s Kidney Center, Marburg, Germany
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Ranchin
- Department of Pediatric Nephrology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg, Germany
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital for Children NHS Foundation Trust, and Institute of Child Health, London, UK
| | | | - Johan Vande Walle
- Department of Pediatric Nephrology, Utoped, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Enrico Verrina
- Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy
| | - Karel Vondrak
- Department of Pediatric Nephrology, University Hospital Motol, Prague, Czech Republic
| | - Aleksandra Zurowska
- Department of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | | |
Collapse
|
44
|
Stamm T, Ritschl V, Platzer A, Omara M, Mosor E, Reichardt B, Schmitl L, Behanova M, Bekes K. Regional and gender differences in population-based oral health insurance data. Clin Oral Investig 2019; 24:2331-2339. [PMID: 31664593 DOI: 10.1007/s00784-019-03090-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early dental monitoring contributes substantially to good oral health in children. However, little is known on whether children from different geographical regions and gender are equally reached with current preventive and curative oral health strategies. The aim of our study therefore was to explore regional and gender differences in a population-based oral health dataset of Austrian children up to the age of 14. MATERIALS AND METHODS We extracted the first electronically available health insurance data of children aged up to 14 years on dental services within a 4-year observation period in Austria and performed a separate analysis in up to 6-year-old children. In addition, we used a smaller randomly selected sample dataset of 3000 children as the large numbers would result in significant, but very small effects. RESULTS In a total of 130,895 children, of whom 77,173 children (59%) were up to the age of six, we detected an east-west gradient: The eastern regions of Austria showed an older age at first contact and a higher number of dental services. A child aged up to 6 years who needed more than four dental services had a likelihood of 40% to be from Vienna, Austria's capital city located in the east. The smaller random sample did not show significant gender differences. CONCLUSIONS Even in regions with a high density of dentists, such as Vienna, we obviously did not reach young children in the same extent as in other regions. CLINICAL RELEVANCE Stratified interventions could be developed to overcome regional inequalities.
Collapse
Affiliation(s)
- Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Alexander Platzer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.,Ludwig Boltzmann Cluster Arthritis & Rehabilitation, Vienna, Austria
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | | | - Lina Schmitl
- Burgenländische Gebietskrankenkasse, Eisenstadt, Burgenland, Austria
| | - Martina Behanova
- Ludwig Boltzmann Institute for Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Vienna, Austria
| | - Katrin Bekes
- Department of Pediatric Dentistry, School of Dentistry, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
45
|
Najm A, Nikiphorou E, Kostine M, Richez C, Pauling JD, Finckh A, Ritschl V, Prior Y, Balážová P, Stones S, Szekanecz Z, Iagnocco A, Ramiro S, Sivera F, Dougados M, Carmona L, Burmester G, Wiek D, Gossec L, Berenbaum F. EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases. RMD Open 2019; 5:e001014. [PMID: 31565245 PMCID: PMC6744072 DOI: 10.1136/rmdopen-2019-001014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/24/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background Mobile health applications (apps) are available to enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health. However, guidance on the development and evaluation of such apps is lacking. Objectives The objective of this EULAR task force was to establish points to consider (PtC) for the development, evaluation and implementation of apps for self-management of RMDs. Methods A systematic literature review of app content and development strategies was conducted, followed by patient focus group and an online survey. Based on this information and along with task force expert opinion, PtC were formulated in a face-to-face meeting by a multidisciplinary task force panel of experts, including two patient research partners. The level of agreement among the panel in regard to each PtC was established by anonymous online voting. Results Three overarching principles and 10 PtC were formulated. Three PtC are related to patient safety, considered as a critical issue by the panel. Three are related to relevance of the content and functionalities. The requirement for transparency around app development and funding sources, along with involvement of relevant health professionals, were also raised. Ease of app access across ages and abilities was highlighted, in addition to considering the cost benefit of apps from the outset. The level of agreement was from 8.8 to 9.9 out of 10. Conclusion These EULAR PtC provide guidance on important aspects that should be considered for the development, evaluation and implementation of existing and new apps.
Collapse
Affiliation(s)
- Aurélie Najm
- Rheumatology Department, University Hospital Centre Nantes, Nantes, France
- INSERM UMR 1238, Universite de Nantes Ecole Doctorale Biologie-Sante, Nantes, France
| | - Elena Nikiphorou
- Department of Inflammation Biology, King's College London Academic, London, UK
| | - Marie Kostine
- Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Christophe Richez
- Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospital Bath NHS Trust, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Division of Occupational Therapy, University of Applied Sciences, FH Campus Wien, Wien, Austria
| | - Yeliz Prior
- Centre for Health Sciences Research, University of Salford, Salford, UK
- Mid Cheshire NHS Foundation Trust Hospitals, Crewe, UK
| | - Petra Balážová
- EULAR Young PARE, Zurich, Switzerland
- Slovak League Against Rheumatism, Piestany, Slovakia
| | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoltan Szekanecz
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy
| | - Sofia Ramiro
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisca Sivera
- Rheumatology, Hospital General Universitario de Elda, Elda, Spain
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | | | - Gerd Burmester
- Rheumatology, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM UMR S1136, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Francis Berenbaum
- Rheumatology Department, AP-HP, Hopital Saint-Antoine, Paris, France
- INSERM CRSA, Sorbonne Université, Paris, France
| |
Collapse
|
46
|
Edelaar L, Nikiphorou E, Fragoulis GE, Iagnocco A, Haines C, Bakkers M, Barbosa L, Cikes N, Ndosi M, Primdahl J, Prior Y, Pchelnikova P, Ritschl V, Schäfer VS, Smucrova H, Storrønning I, Testa M, Wiek D, Vliet Vlieland TPM. 2019 EULAR recommendations for the generic core competences of health professionals in rheumatology. Ann Rheum Dis 2019; 79:53-60. [DOI: 10.1136/annrheumdis-2019-215803] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/17/2022]
Abstract
Background/objectivesTo maintain and optimise the quality of care provided by health professionals in rheumatology (HPRs), adequate educational offerings are needed. This task force (TF) aimed to develop evidence-based recommendations for the generic core competences of HPRs, with specific reference to nurses, physical therapists (PTs) and occupational therapists (OTs) to serve as a basis for their postgraduate education.MethodsThe EULAR standardised operating procedures for the development of recommendations were followed. A TF including rheumatologists, nurses, PTs, OTs, patient-representatives, an educationalist, methodologists and researchers from 12 countries met twice. In the first TF meeting, 13 research questions were defined to support a systematic literature review (SLR). In the second meeting, the SLR evidence was discussed and recommendations formulated. Subsequently, level of evidence and strength of recommendation were assigned and level of agreement (LoA) determined (0–10 rating scale).ResultsThree overarching principles were identified and 10 recommendations were developed for the generic core competences of HPRs. The SLR included 79 full-text papers, 20 of which addressed the competences, knowledge, skills, attitudes and/or educational needs of HPRs from multiple professions. The average LoA for each recommendation ranged from 9.42 to 9.79. Consensus was reached both on a research and educational agenda.ConclusionEvidence and expert opinion informed a set of recommendations providing guidance on the generic core competences of HPRs. Implementation of these recommendations in the postgraduate education of HPRs at the international and national level is advised, considering variation in healthcare systems and professional roles.
Collapse
|
47
|
Stamm TA, Boesendorfer A, Omara M, Ritschl V, Štefanac S, Mosor E. Outcomes research in non-specific low back pain : Knowledge transfer in clinical practice. Wien Klin Wochenschr 2019; 131:550-557. [PMID: 31236662 PMCID: PMC6851208 DOI: 10.1007/s00508-019-1523-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/20/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
Abstract
Objective The aims of this article are to provide an overview and discuss current concepts and future trends in outcomes research in non-specific low back pain, specifically considering the perspective of patients, patient-reported outcomes and outcome measures as well as to facilitate knowledge transfer into clinical practice. Review strategy The breadth of this work and the required brevity of this article were not amenable to a formal approach, such as a systematic literature review or a formal scoping review. Literature sources were identified through medical databases but different sources of information and of various methodologies were also included. Furthermore, outcomes meaningful for patients and examples of outcome measures that are applicable in clinical practice were extracted. Areas for future research were identified and discussed. Results Patient-reported outcomes and outcome measures are essential in patient-centered care. The assessment of the patients’ perspective is important to ensure motivation, active involvement, self-management and adherence, especially in non-pharmacological interventions for low back pain. To facilitate the use of outcome measurements for low back pain in clinical practice, future studies should focus on a clinically feasible index, which includes patient-reported as well as clinician-reported or performance-based variables. Relationships between different types of outcomes and outcome measures as well as resource and outcome-based healthcare constitute important topics for future research. New digital technologies can support continuous outcome measurement and might enable new patient-driven models of care. Conclusion Active patient involvement is an essential part of non-pharmacological treatment in low back pain and needs to be considered in terms of outcomes and outcome measurement.
Collapse
Affiliation(s)
- Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Anna Boesendorfer
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Nußdorfer Straße 64, 1090, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Nußdorfer Straße 64, 1090, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Siniša Štefanac
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| |
Collapse
|
48
|
Mosor E, Waldherr K, Kjeken I, Omara M, Ritschl V, Pinter-Theiss V, Smolen J, Hübel U, Stamm T. An intergenerational program based on psycho-motor activity promotes well-being and interaction between preschool children and older adults: results of a process and outcome evaluation study in Austria. BMC Public Health 2019; 19:254. [PMID: 30823911 PMCID: PMC6397484 DOI: 10.1186/s12889-019-6572-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/20/2019] [Indexed: 12/01/2022] Open
Abstract
Background Limited evidence exists for intergenerational interventions to promote health and well-being in older adults and preschool children. We therefore aimed to evaluate the implementation, feasibility and outcome of an intergenerational health promotion program based on psycho-motor activity. Methods A multicenter mixed-methods study with preschool children and older adults as equivalent target-groups, and professionals and parents as additional informants was conducted in Austria. The study included a needs assessment, a pilot phase with a formative process evaluation and a subsequent rollout phase to evaluate the outcome and the adapted processes of the intervention program. To analyze the qualitative data, a modified form of the framework method was applied. Quantitative data were collected with a time-sampling method and were analyzed using descriptive and inferential statistical procedures. Results One hundred ninety-six participants (93 older adults [54 to 96 years old, 83% female], 78 children [2 to 7 years old, 58% female], 13 professionals and 12 parents) from 16 institutions (eight kindergartens and eight geriatric facilities) were included in the study. The qualitative process evaluation revealed several aspects for improvement of the intervention program. Well-being as measured by observing spontaneous intergenerational contacts (p < 0.001) and facial expressions (effect size r = 0.34; p < 0.001) showed a significant increase between the rollout baseline and follow-up assessments. Conclusions Professionals in geriatric institutions and kindergartens could facilitate interactions between members of the different generations by offering an intergenerational intervention program based on psycho-motor activities in the future. Electronic supplementary material The online version of this article (10.1186/s12889-019-6572-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Karin Waldherr
- FernFH Distance-Learning University of Applied Sciences, Zulingergasse 4, 2700, Wiener Neustadt, Austria
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Pb 23 Vinderen, 0319, Oslo, Norway
| | - Maisa Omara
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Veronika Pinter-Theiss
- AKMÖ - Aktionskreis Motopädagogik Österreich, Döblinger Hauptstr. 7a/2/43, 1190, Vienna, Austria
| | - Josef Smolen
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ursula Hübel
- Wiener Gesundheitsförderung - WiG, Gesunde Stadt - Gesunde Organisationen, Treustraße 35 - 43/6/1, 1200, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| |
Collapse
|
49
|
Oztek-Celebi FZ, Herle M, Ritschl V, Kaltenegger L, Stamm T, Aufricht C, Boehm M. High Rate of Living Kidney Donation to Immigrant Children Despite Disparities-An Epidemiological Paradox? Front Pediatr 2019; 7:25. [PMID: 30809513 PMCID: PMC6379308 DOI: 10.3389/fped.2019.00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Kidney transplantation is the preferred treatment modality for children with end-stage renal disease. In the adult population, migration-related modifiable factors were associated with low living donation rates; no such data are available on the pediatric population. This pilot study therefore compares donation modality, communication, knowledge, and attitudes/beliefs between families of immigrant and non-immigrant descent. Methods: Demographic and clinical characteristics of a cohort of children from 77 families of immigrant (32; 42%) and non-immigrant (45; 58%) descent who had undergone renal transplantation were assessed and related to donation modality at the Medical University of Vienna. In a representative subset, modifiable migration-related factors were assessed in a questionnaire-based study. Results: In immigrant families, information delay, limited communication, low knowledge levels, and self-reported conflicting beliefs were significantly more prevalent than in non-immigrants. The living kidney donation rate to children was high in both populations (immigrants: 63%, non-immigrants: 44%; p = 0.12). Living donation to children on dialysis was even significantly higher in immigrant families (immigrants: 13 out of 20; 57%, non-immigrants: 9 out of 33; 27%; p = 0.03). Conclusion: Contrary to expectations, migration-related disparities did not translate into decreased living donation rates in immigrant families, in particular to children on dialysis. Certain factors might therefore be less important for the living donation process in pediatric care structures and/or might be overcome by yet undefined protective factors. Larger pediatric studies including qualitative and quantitative methods are required to validate and refine current conceptual frameworks integrating the perspective of affected families.
Collapse
Affiliation(s)
- Fatma Zehra Oztek-Celebi
- Department of Pediatrics and Adolescent Medicine, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey
| | - Marion Herle
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Lukas Kaltenegger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Boehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
50
|
Ritschl V, Lackner A, Boström C, Mosor E, Lehner M, Omara M, Ramos R, Studenic P, Smolen JS, Stamm TA. I do not want to suppress the natural process of inflammation: new insights on factors associated with non-adherence in rheumatoid arthritis. Arthritis Res Ther 2018; 20:234. [PMID: 30340628 PMCID: PMC6235214 DOI: 10.1186/s13075-018-1732-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is estimated that 50-70% of patients with rheumatoid arthritis (RA) are non-adherent to their recommended treatment. Non-adherent patients have a higher risk of not reaching an optimal clinical outcome. We explored factors associated with nonadherence from the patient's perspective. METHODS Four hundred and fifty-nine RA patients (346 (75.4%) females; mean age 63.0 ± 14.8 years) who failed to attend follow-up visits in two rheumatology centres were eligible to participate in a qualitative interview study. We used this strategy to identify patients who were potentially non-adherent to medicines and/or non-pharmacological interventions. By means of meaning condensation analysis, we identified new and some already well known insights to factors associated with non-adherence. We used the capability, opportunity, and motivation model of behaviour (COM-B) model as a frame of reference to classify the factors. RESULTS Forty-three of 131 patients (32.8%) who agreed to participate in the qualitative interviews were found to be non-adherent. New insights on factors associated with non-adherence included strong opinions of patients, such as pain being considered as an indicator of hard work and something to be proud of, or inflammation being a natural process that should not be suppressed; feeling not to be in expert's hands when being treated by a physician/health professional; the experience of excessive self-control over the treatment; and rheumatologists addressing only drugs and omitting non-pharmacological aspects. The COM-B model comprehensively covered the range of our findings. CONCLUSIONS The new insights on factors associated with non-adherence allow a better understanding of this phenomenon and can substantially enhance patient care by helping to develop targeted interventions.
Collapse
Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- Division of Occupational Therapy, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Angelika Lackner
- Department of Rheumatology, Medical University of Graz, Styria, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Karolinska Institute, Care Sciences and Society (NVS), Huddinge, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Erika Mosor
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Michaela Lehner
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Romualdo Ramos
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Paul Studenic
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Josef Sebastian Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Tanja Alexandra Stamm
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| |
Collapse
|