Specialty management differences of syphilis and toxoplasmosis surrounding pregnancy: a prospective cross-sectional study

Abstract Background Syphilis and toxoplasmosis are two infectious conditions that can occur during pregnancy. Both these diseases can have ocular manifestations and thus are treated by ophthalmologists and obstetricians. We hypothesized that specialty training would affect the way physicians selected therapy. Results A total of 209 uveitis specialists and approximately 2500 obstetricians across the USA were surveyed using an online questionnaire distributed via listserv and social media posts. Survey respondents were given a series of clinical vignettes containing case examples of a female patient who was either contemplating pregnancy or in the first trimester and was diagnosed with either syphilis or toxoplasmosis. The questionnaire included a total of four case scenarios with questions relating to the management of these diseases, as well as pregnancy counseling. For the syphilis vignette, a total of 97 physicians responded to the survey questions. Choices of therapy between physician specialty differed significantly (p = 0.0001); however, pregnancy status did not seem to affect therapy choice in syphilis. A total of 96 physicians responded to the survey questions pertaining to the toxoplasmosis vignette. For a non-pregnant patient diagnosed with toxoplasmosis, the differences in therapy choice between specialties were not significant; however, when the patient was pregnant, therapy choice was significantly different between specialties (p = 0.0001). Conclusions Differences exist between ophthalmologists and obstetricians concerning the therapy for syphilis and toxoplasmosis during pregnancy. Inter-specialty collaboration is needed to develop consistent criteria to improve the management of these patients

Incorporating Telemedicine in Rheumatology Fellowship Training Programs: Needs Assessment, Curricular Intervention, and Evaluation

OBJECTIVE: To increase rheumatology fellows\u27 in training (FITs) confidence in delivering virtual care (VC) and prepare them for independent practice, we developed educational materials addressing gaps in their skills. METHODS: We identified gaps in telemedicine skills based on FIT performance in a virtual rheumatology observed structured clinical examination (vROSCE) station on VC delivery using videoteleconference technology and survey (Survey1) responses. We created educational materials including videos of mediocre and excellent VC examples, discussion/reflection questions, and a document summarizing key practices. We measured change in FITs\u27 confidence levels for delivering VC with a post-intervention survey (Survey2). RESULTS: Thirty-seven FITs (19 first-year, 18 second + third-year fellows) from seven rheumatology fellowship training programs participated in a vROSCE and demonstrated gaps in skills mapping to several Rheumatology Telehealth Competency domains. FITs\u27 confidence levels improved significantly from Survey1 to Survey2 for 22 of 34 (65%) questions. All participating FITs found the educational materials helpful for learning and reflecting on their own VC practice; 18 FITs (64%) qualified usefulness as moderately or a lot . Through surveying, 17 FITs (61%) reported implementing skills from the instructional videos into VC visits. DISCUSSION: Continually assessing our learners\u27 needs and creating educational materials addressing gaps in training is requisite. Using a vROSCE station, needs assessments, and targeted learning with videos and discussion-guidance materials enhanced the confidence level for FITs in VC delivery. It is imperative to incorporate VC delivery into fellowship training program curricula to ensure breadth in skills, attitudes, and knowledge of new entrants into the rheumatology workforce. This article is protected by copyright. All rights reserved

Anti-carbamylated Protein Antibodies Are Present Prior to Rheumatoid Arthritis and Are Associated with Its Future Diagnosis

OBJECTIVE: Anti-carbamylated protein (anti-CarP) antibodies could further elucidate early RA pathogenesis and predict clinical disease. We compared diagnostic accuracy of anti-CarP antibodies for future RA to other RA-related antibodies in military personnel. METHODS: Stored pre-RA diagnosis serum samples from 76 RA cases were tested for anti-CarP Fetal Calf Serum (FCS), anti-CarP Fibrinogen (Fib), anti-CCP2, RF-Neph, and RF-isotypes (IgM, IgG, and IgA). Positivity for all antibodies was determined as ≥2SD of log-transformed means from controls. Relationships between autoantibodies and future RA were assessed in prediagnosis serum for all RA cases compared to controls using sensitivity, specificity, and logistic regression. Differences in diagnostic accuracy between antibody combinations were assessed using comparisons of area under the curves (AUCs). RESULTS: Anti-CarP-FCS was 26% sensitive and 95% specific for future RA, where anti-CarP-Fib was 16% sensitive and 95% specific for future RA. Anti-CarP-FCS positivity was associated with future RA, while anti-CarP-Fib trended towards association. The antibody combination of anti-CCP2 and/or ≥2 RFs (RF-Neph and/or RF-isotypes) resulted in an AUC of 0.72 for future RA, where the AUC was 0.71 with the addition of anti-CarP-FCS to this prior combination. CONCLUSION: Adding anti-CarP-FCS to antibody combinations did not improve AUC. However, anti-CarP-FCS was associated with future onset of RA, and was present in prediagnosis serum in ~10% of RA cases negative for anti-CCP2, but positive for RF

Multiple cytokines and chemokines are associated with rheumatoid arthritis-related autoimmunity in first-degree relatives without rheumatoid arthritis: Studies of the Aetiology of Rheumatoid Arthritis (SERA)

U radu su opisane verzije SQL Server-a , naglasak na SQL Server 2017. Spomenute su glavne karakteristike pojedinačne verzije te promijene s obzirom na prijašnju verziju. Nakon toga je opis o sustavu za upravljanje podataka (SUBP) i SQL jeziku koji služi za manipulaciju podataka. Nakon opisa navedenih alata dalje u radu je opisana aplikacijska domena, model baze podataka koja je implementirana u Microsoft SQL Server-u te tehnologije koje su korištene pri izradi aplikacije i na kraju opis funkcionalnosti same aplikacije