Satisfaction assessment of patient with idiopathic inflammatory myopathies according to the PSQ-III questionnaire: cross-sectional study

Disciplina medicină internă-semiologie, Departamentul de medicină internă, Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chișinău, Republica MoldovaRezumat. Introducere. Miopatiile inflamatorii idiopatice (MII), reprezintă un grup eterogen de maladii autoimune rare, caracterizate prin slăbiciune musculară proximală, simetrică, lent-progresivă și fatigabilitate. Dat fiind faptul că miopatiile inflamatorii idiopatice sunt boli cronice cu implicare multiorganică, ce rezultă în numeroase consecințe și la care se asociază comorbidități, acești pacienți necesită o atenție sporită din partea medicilor ca timp și resurse medicale. Satisfacția pacienților este o noțiune complexă, fiind determinată de multiple variabile așa ca organizarea serviciilor de sănătate, dotarea tehnică a instituțiilor medicale dar, nu în ultimul rând, de abilitățile de comunicare, respect, explicații și informații clare, care sunt mai esențiale decât competențele tehnice ale personalului medical. Percepțiile pacienților, la rândul lor, sunt influențate de statutul socio-cultural, convingerile lor, atitudinile și nivelul lor de înțelegere. Material şi metode. A fost efectuat un studiu transversal, în cadrul Departamentului de medicină internă, Disciplina medicină internă-semiologie a Universităţii de Stat de Medicină şi Farmacie „Nicolae Testemiţanu’’ din Republica Moldova, la baza clinică a Institutului de Cardiologie, în perioada mai 2016 - septembrie 2018. În cadrul studiului, au fost incluși 67 de pacienţi cu MII, conform criteriilor de clasificare ACR/ EULAR 2017. Ulterior, pacienții cercetați au fost divizați în 2 loturi, în funcție de durata bolii: lotul <2 ani și lotul ≥2 ani. Gradul satisfacției pacienților faţă de serviciile medicale acordate a fost determinat prin utilizarea chestionarului Patient Satisfaction Questionnaire (PSQ-III), varianta III. Rezultate. Vârsta medie la momentul cercetării a constituit 53,1±12,5 ani, cu o durată medie a bolii de 99,1±72,6 luni. În lotul de studiu au predominat femeile, cu un raport femei:bărbați de 3,2:1. Nivelul educațional superior a prevalat atât în lotul <2 ani, cât și lotul ≥2 ani. Angajarea în câmpul muncii constatată la pacienții din lotul <2 ani a fost cu precădere prin angajare cu normă întreagă și persoane pensionate în baza atingerii vârstei de pensionare, versus în lotul ≥2 ani – persoane pensionate în baza atingerii vârstei de pensionare. La aplicarea chestionarului PSQ-III, a fost determinat un nivel al satisfacției redus față de media populației generale pe parcursul tuturor domeniilor, în ambele loturi. De asemenea, nu s-au identificat diferențe statistic semnificative între rezultatele pe domenii ale celor 2 loturi. Concluzii. Nivelul de satisfacție al pacienților cu miopatii inflamatorii idiopatice este redus, cele mai mici scoruri au fost pe domeniul de aspecte financiare, vizavi de scoruri mai mari la domeniul comunicare. Gradul de satisfacție pare sa nu fie influențat de durata bolii.Abstract. Introduction. Idiopathic inflammatory myopathies (IIM) represent a heterogeneous group of rare autoimmune diseases characterized by proximal, symmetrical, slow-progressive muscle weakness and fatigue. Given that idiopathic inflammatory myopathies are chronic diseases with multi-organic involvement that result in many consequences and associated with comorbidities, these patients require increased attention from physicians as time and medical resources. Patient satisfaction is a complex notion that is determined by multiple variables such as the organization of health services, the technical endowment of medical institutions, but not least the clear communication skills, respect, explanations and information that are more essential and also technical skills of the medical staff. Patient perceptions are influenced by their socio-cultural status, beliefs, attitudes and level of understanding. Material and methods. A cross-sectional study was conducted in the Department of internal medicine, Department of internal medicine and semiology of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, at the clinical base of the Institute of Cardiology, between May 2016 and September 2018. There were 67 patients with MII included in the study according to the ACR/ EULAR 2017 classification criteria. Subsequently, the investigated patients were divided into two groups depending on the duration of the disease, lot <2 years and lot ≥2 years. Patient satisfaction with medical services was determined using the Patient Satisfaction Questionnaire (PSQ III) version III. Results. The mean age at the time of the study was 53.1±12.5 years, mean disease duration was 99.1±72.6 months. Women prevailed in the study group with a 3.2:1 female: male ratio. The higher education level prevailed in both groups. The employment rate found among patients in the group <2 year was mainly by full-time employment and retired people versus in the group ≥2 years – retired people due to retirement age. Obtained scores at the application of PSQ-III questionnaire were lower than those of general population across all domains in both groups. Also, no statistically significant differences were found between the field results of the two lots. Conclusions. The level of satisfaction determined in patients with idiopathic inflammatory myopathies was reduced, the lowest scores were in the financial aspects subscale and highest in the communication domain. The degree of satisfaction does not seem to be influenced by the duration of the disease

Expresia consecințelor miopatiilor inflamatorii idiopatice

321.04 - Rheumatology Summary of Doctoral Thesis in Medical Sciences[...] THE CONCEPTUAL RESEARCH ITEMS Topicality. The holistic and complex approach of patients with idiopathic inflammatory myopathies (IIM) involves examining, from the perspective of disease activity, the organic damage and the quality of life, components that influence each other. Although IIMs are regarded as treatable conditions, their prognosis is not well known, therefore the disease outcomes available in the literature and prognostic factors vary greatly due to methodological imperfections [1,13].[...][...] REPERELE CONCEPTUALE ALE CERCETĂRII Actualitatea temei. Abordarea holistică și complexă a pacienților cu miopatii inflamatorii idiopatice (MII) presupune examinarea prin prisma activității bolii, lezării organice și calității vieții, componente ce se influențează reciproc. Cu toate că MII sunt considerate afecțiuni ce se supun tratamentului, prognosticul nu este bine cunoscut, în literatura de specialitate consecințele bolii și factorii de prognostic variază foarte mult datorită imperfecțiunilor metodologice 1,13. [...

Критерии классификации идиопатических инфляматорных миопатии ACR/EULAR 2017 в клинической практике.

Performance of clarifi cation criteria of idiopatic infl amatory miopathi ACR/EULAR 2017 in clinical practice.Diagnosticul miopatiilor infl amatorii idiopatice &ndash; boli autoimune cu afectarea primară a musculaturii scheletice proximale, a fost stabilit &icirc;n baza criteriilor Bohan și Peter, &icirc;nsă recent Grupul Internațional de Evaluare a Miozitelor și Studii Clinice (IMACS) a creat un nou set de criterii. Lotul de studiu a constituit 65 de pacienți,cu predominarea femeilor, v&acirc;rsta medie a fost de 52,9&plusmn;13,1 (iv 25 - 78) ani și durata bolii 113,8&plusmn;68,8 (iv 6-324) luni. Aplic&acirc;nd setul nou de criterii am determinat că &icirc;n mediu pacienții au &icirc;ntrunit 7,3&plusmn;1,4, variind de la 5 la 11 criterii, echivalent a 91,6 &plusmn; 14,5%, ceea ce constituie un diagnostic def nit de miopatie. &Icirc;n concluzie setul nou de criterii sunt ușor de aplicat și interpretat, fiind utile &icirc;n examinarea acestor pacienți. &nbsp;Критерии классификации идиопатических инфляматорных миопатии ACR/EULAR 2017 в клинической практике

Expresia consecințelor miopatiilor inflamatorii idiopatice

321.04 - Reumatologie Teză de doctor în științe medicale[...] INTRODUCERE Actualitatea temei. Miopatiile inflamatorii idiopatice (MII) reprezintă un grup heterogen de maladii autoimune rare, caracterizate prin slăbiciune musculară proximală, simetrică, lent-progresivă, asociate cu dureri articulare și fatigabilitate. Diagnosticul de MII se confirmă prin prezența autoanticorpilor specifici, infiltrate celulare inflamatorii la biopsia musculară și prin leziuni cutanate în caz de dermatomiozită 121.[...

Case report: the outcomes of idiopathic inflammatory myositis in a 43 oldwoman.

Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: We report a case of a 43 old woman with medical history of dermatomyositis for 8 years, and complaints of symmetrical muscle weakness, especially in lower extremities, low enduranceand fatigue. The patient’s medical history is remarkable by osteoporosis due to treatment with corticosteroids, bilateral hip artroplasty for avascular necrosis. The physical examination was remarkable by proximal muscular atrophy, calcinosis of gluteus muscles. The remainder of examination was normal. In this patient, our goal was to apply clinical tools in order to assess disease’s outcomes. Clinical case: Changes Associated with damage in MII are post-inflammatory, cumulative and irreversible, present at least 6 months despite prior immunosuppressive treatment or rehabilitation. In order to assess diseases outcomes in this patient we applied the next tools: patient’s questionnaire, Myositis Damage Index(MDI), Manual Muscle Test 8(MMT8), LifeSatisfaction 11, PATIENT GLOBAL MDGA). After analyzing the ACTIVITY ASSESSMENT(PGA), PHYSICIAN GLOBAL ACTIVITY ASSESSMENT( results we determined that MMT8 score was rather high 55 out of 80, due to the rehabilitation programs that the patient attended. There was an insignificant discrepancy between PGA and MDGA, with the trend from patient to diminish the role of the disease. We tried to measure life satisfaction by LiSat 11, in this patient, it was dissatisfied due to psychological health and leisure situations. The MDI score got 14 points out of 38, the most damage was found in muscular and skeletal systems. Conclusion: In order to determine how myositis patients' illnesses change over time we have to assess them using special established and validated tools and to have patient-reported outcome measures for myositis

Applicability of EULAR/ACR classification criteria for idiopathic inflammatory myopathies

Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Till recently, the most widely used criteria for the diagnosis of idiopathic inflammatory myopathies (IIM)-autoimmune diseases characterised by muscle weakness and muscle inflammation was done the Bohan and Peter criteria, which has a high sensitivity (94,3%), but low specificity (29,4%). The International Myositis of Assessment and Clinical Studies Group (IMACS) created a new criterion set that shows better performance than the existing ones

Cardiovascular impact assessed by score in patients with myopathies

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Riscul de morbiditate și mortalitate crescută din cauza bolii cardiovasculare (CV) este bine stabilită în afecțiuni reumatologice, așa ca lupusul eritematos sistemic și artrita reumatoidă. Studiile noi sugerează o tendință similară la pacienții cu miopatii inflamatorii idiopatice (MII). Scopul lucrării. Aplicarea instrumentului SCORE la pacienții cu miopatii. Material și metode. Au fost colectate date biografice, clinice și de laborator, ulterior aplicat instrumentul SCORE. Analiza statistică a fost efectuată cu ajutorul programului MedCalc. Rezultate. În studiu au fost incluși 20 pacienți cu vârsta medie 55,75±13,46 ani (32-78 ani). La aplicarea SCORE, riscul de a evenimente CV fatale în mediu a fost 3,25 % (0-15 %), 5 % din pacienți au avut risc moderat-înalt de evenimente CV (9 %), iar 40 % din subiecții nu au avut careva risc (0 %). Am stabilit un grad de corelare moderat-înalt direct (r = 0,67, p = 0,001), cu vârsta pacientului. Hipertensiune arterială (HTA) a fost în 60,0 % pacienți dintre care, 30,0 %-HTA gr I, 20,0 % și 10,0 %, HTA gr II și gr III, respectiv. Modificări ai lipidogramei au fost identificate la 10 (50,0 %) pacienți, cu valori a colesterolului total între 3,0 și 9,7 mmol/l (5,44±1,47 mmol/l), LDL colesterolul în mediu a fost 2,77±0,39 mmol/l (1,02-3,74 mmol/l). Concluzii. La aplicarea instrumentului SCORE am determinat un risc de dezvoltare a evenimentelor cardiovasculare fatale relative ușor , în mediu de 3,25%, însă putem afirma că această valoare crește odată cu înaintarea în vârstă a pacienților.Background. The risk of increased morbidity and mortality from cardiovascular (CV) disease is well established in rheumatologic conditions such as systemic lupus erythematosus and rheumatoid arthritis. New studies suggest a similar trend in patients with idiopathic inflammatory myopathies (IIM). Objective of the study. Application of the SCORE tool in patients with myopathies. Material and methods. Biographical, clinical and laboratory data were collected, and then the SCORE instrument was applied. Statistical analysis was performed using the MedCalc program. Results. In the study were included 20 patients, average age was 55.75±13.46 years (32-78 years). When applying SCORE, the mean risk of fatal CV events was 3.25% (0-15%), 5% of patients had moderate-high risk of CV events (9%), and 40% of subjects did not have had some risk (0%). We established a moderate-high degree of direct correlation (r = 0.67, p = 0.001) with the patient’s age. Arterial hypertension (AH) was present in 60.0% of patients of which, 30.0%AH gr I, 20.0% and 10.0%, AH gr II and gr III, respectively. Changes in the lipid profile was identified in 10 (50.0%) patients, with total cholesterol values between 3.0 and 9.7 mmol/l (5.44±1.47 mmol/l), mean LDL cholesterol was 2.77±0.39 mmol/l (1.02-3.74 mmol/l). Conclusion. When applying the SCORE tool, we determined a relatively slight risk of developing fatal cardiovascular events, on average 3.25%, but we can say that this value increases with the age of the patients

Clinical tools in idiopathic inflammatory myopathies

Introduction. Idiopathic inflammatory myopathies IIM are heterogenous group of autoimmune disorders with various manifestations that implies the need for specific tools to assess the patients. Purpose. To highlight the clinical tools used in the assessment of IIM patients from the OMERACTOutcomes Measurements in Rheumatology perspective. Material and methods. Data from scientific literature was selected and analyzed using databases such as PubMed Frontiers Scientific Research NIH BMJ Journals. Results. According to OMERACT IIM patients should be examined from patient and doctor point of view The main domains of interest related to patient are exhaustion degree of physical activity muscle symptoms pain and adverse events The International Myositis Assessment Clinical Study group has produced a core set of tools to measure disease activity like Patient and Medical Doctor Global Assessment also for its outcomes like Myositis Damage Index One of interest domain of IIM patient is the quality of life that is affected due to muscle weakness and can be measured using Short FormSF or its newest versions like SF or SF. Conclusions.Clinical tools play an important role in the objective examination of IIM patient and facilitates the results comparison in clinical studies

Поражение желудочно-кишечного тракта у больных с идиопатическими воспалительными миопатиями

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Conferința naţională de gastroenterologie şi hepatologie cu participare internaţională ”Actualităţi în gastroenterologie şi hepatologie” 16 iunie 2016 Chișinău, Republica MoldovaThe inflammatory myopathies collectively named myositis, encompass a group of heterogeneous muscle disorders, which share the common clinical features of slowly progressive, symmetrical muscle weakness, low endurance and fatigue. Idiopathic inflammatory myopathies are characterized by the involvement of muscles that can affect any system or organ, including the gastrointestinal tract. The most common digestive manifestation is dysphagia, proximal oesophageal skeletal muscle dysfunction is demonstrated by manometry with low amplitude/absent pharyngeal contractions. Myositis is also associated with coeliac disease and responds to a gluten-free diet. A variety of malignancies have been reported in dermatomyositis including colorectal and gastric adenocarcinomas. In patients with myositis gastrointestinal system may be affected throughout his trajectory and actual prevalence and prognosis associated with digestive symptoms are uncertain. Dysphagia wich is the most common manifestation in some patients may have severe impact on quality of life.Воспалительные миопатии, в общем называемые миозитами, охватывают группу гетерогенных мышечных расстройств, которые разделяют общие клинические особенности медленно прогрессирующей, симметричной мышечной слабости, низкой выносливости и усталости. Идиопатические воспалительные миопатии характеризуются вовлечением мышц, которые могут поражать любую систему или орган, в том числе желудочно-кишечный тракт. Наиболее распространенным проявлением поражения пищеварительного тракта является дисфагия, дисфункция проксимальных скелетных мышц пищевода, с малой амплитудой / отсутствием пищеводных сокращений, определяемая с помощью манометрии. Миозит также связан с целиакией и отвечает на безглютеновую диету. Множество злокачественных опухолей, включая колоректальную и желудочную аденокарциному, было зарегистрировано при дерматомиозитах. У больных с воспалительными миопатиями желудочно-кишечный тракт может быть поражен на протяжении всей своей траектории, и распространенность и прогноз связанные с пищеварительными симптомами являются неопределенными. Дисфагия, являющаяся самым распространенным симптомом, может иметь серьезное влияние на качество жизни пациентов

Early consequences of idiopathic infl ammatory myopathies

Departamentul Medicină Internă, USMF Nicolae Testemiţanu, Al III-lea Congres al medicilor interniști din Republica Moldova cu participare internațională 24–25 octombrie 2017 Chișinău, Republica MoldovaIdiopathic inflammatory myopathies (IIM) are a group of rare diseases characterized by asthenia of skeletal muscles. Early approach to disease leads to a favorable evolution of the disease and less outcomes. The aim of this study is to assess the short-term outcomes in patients with IIM. We conducted a transversal study enrolling 12 patients (7 women, 5 men) with IIM, the mean age was 54.1±12.1 (30–67) years and the follow–up period was 16±9.4, (7-25) months. Patients were assessed by aplying specific questionnaires and modern, validated clinical tools.We found in all patients muscle damage manifested by muscular dysfunction – 11 (91.7%) patients and atrophy in one (8,3%) patient, confirmed by moderate muscle strengh, which implies disability – 10 (83.3%) patients. Gastrointestinal damage was manifested by dysphagia in 3 (25.0%) patients, hepatic steatosis – 3 (25.0%), dismotility – 5 (41.7%) patients. Endocrine damage like dyslipidemia had 4 (33.3%), secondary amenorrhea – 4 (33.3%), diabetes mellitus in 2 (16.6%) patients. Despite moderate disease activity the most common disease outcomes obtained were muscular – 100% patients, gastrointestinal – 91.7% and endocrine – 83.3% patient