Combining nurse-led care with patient self-assessment could enhance tight control of rheumatoid arthritis and management of comorbidities

Implications for practice and researchPatient self-monitoring of disease activity can improve tight control of rheumatoid arthritis (RA).Nurse-led care can be used in the monitoring and management of comorbidities associated with RA.Further research should assess wider acceptability, as well as the clinical and cost-effectiveness of a patient self-monitoring approach

Locally manufactured wheelchairs in Tanzania : Do they meet the needs of Tanzanian wheelchair users?

Access to suitable wheelchairs may seriously impact the ability of people with physical disabilities to integrate into regular community life. The overall aim of this study was to determine the extent to which the needs of users of wheelchairs manufactured locally in Tanzanian are met. The specific objectives of the study were to determine users' satisfaction with the wheelchairs manufactured in Tanzania, their satisfaction with services associated with the provision, repair and maintenance of these wheelchairs, and the extent to which these wheelchairs enabled them to carry out their daily activities. A quantitative descriptive cross-sectional study was carried out among 75 users of locally manufactured manual wheelchairs, aged 18-65 years and residing in Dar es Salaam, Arusha and the Kilimanjaro regions of Tanzania. Data was collected using a questionnaire consisting of demographic items and two existing instruments, the Functioning Everyday with a Wheelchair (FEW) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0. Data were analysed with the Statistical Package for the Social Sciences (SPSS) software program version 20.0. Descriptive analysis was performed using frequencies and proportions for categorical data or median and ranges for numerical data. The chi-square test was conducted to determine whether there were significant difference between gender and place of residence (rural/urban) and satisfaction with functional needs, wheelchair and activity and participation

The educational needs of patients with undifferentiated spondyloarthritis: Validation of the ENAT questionnaire and needs assessment

Copyright © 2018 John Wiley & Sons, Ltd. Objectives: The aim of the present study was to validate the Swedish version of the educational needs assessment tool (SwENAT) in undifferentiated spondyloarthritis (USpA) and use it to study the educational needs of patients with USpA. Methods: This was a cross-sectional study, recruiting a random sample of patients with USpA from a hospital register in Sweden. Educational needs data were collected, together with disease activity and function indices (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Bath Ankylosing Spondylitis Functional Index [BASFI]). Rasch analysis was utilized to evaluate the construct validity, internal consistency and unidimensionality of the SwENAT before studying differences in educational needs between patient subgroups (gender, age and disease severity). Results: Complete responses were obtained from 77 patients (48 women), with a mean age (standard deviation [SD]) of 50 (12) years, a disease duration of 16 (11) years, a BASDAI score of 4.9 (1.9) and a BASFI score of 3.1 (2.3). The SwENAT satisfied the requirements of the Rasch model (χ 2 = 11.488; p = 0.119), including strict unidimensionality. Overall, the mean (SD) SwENAT score was 86 (32). Women reported higher needs than men in the domains of pain (mean [SD] 13.1 [6.8] versus 10.1 [6.0]; p = 0.05); movement (mean [SD] 13.0 [5.5] versus 9.9 [5.7]; p = 0.02) and self-help (mean [SD] 17.0 [5.8] versus 14.1 [5.0]; p = 0.03). Higher disease activity (BASDAI >4) was associated with higher educational needs (mean [SD] 92.6 [31.9] versus 73.7 [29.4]; p = 0.02). Conclusions: These data suggest that the SwENAT is valid in USpA. Women and patients with higher disease activity are more likely to have high levels of educational needs, so special attention and strategies to target patient education are warranted

Developing a rheumatology team to meet a growing need in Africa: Let’s not forget to feed the cow

In many African countries the burden of preventable communicable diseases such as HIV/AIDS, lower respiratory infections, malaria and diarrhoeal diseases is overwhelming

A Política Monetária Angolana no contexto da economia internacional

Dissertação de mestrado em Economia Monetária, Bancária e FinanceiraOs principais objetivos da Política Monetária de Angola enquadram-se nos objetivos da política económica em geral dos quais destacamos o crescimento económico, a estabilidade dos preços, o pleno emprego e o equilíbrio da Balança de Pagamentos. O objetivo principal da política monetária do Banco Nacional de Angola é a estabilidade de preço e o controlo da taxa de câmbio para a melhorar a performance económica com o resto do mundo. Utilizando taxas de câmbio flexível fomenta as exportações onde 95% dependem do petróleo. Este facto associado á excessiva volatilidade do preço do petróleo no marcado internacional implica grande flutuante nas receitas das exportações, sendo utilizada a desvalorização cambial (efeito de crowling peg). Por outro lado, controla a política monetária expansionista no sentido da estabilidade do preço como se verificou de 2000 a 2014, dinamizando a política económica de Angola, através de redução de taxa de juros do Kwanza de 14.3% em 2009 para 4,9 % em 2014. Depois foi aplicada uma política monetária restritiva de 2014 a 2018, o que implicou a taxa de juro mais elevada, registando 16,1% em 2018, e também uma taxa de câmbio mais alta em 2018. Desta forma, a economia angolana tem beneficiada de um nível de inflação média mas baixa registando um pouco acima de 20%, valores considerados baixos para a economia angolana. O presente trabalho faz uma breve análise á economia angolana, onde é referida a evolução da taxa de crescimento do PIB, da taxa de juro, bem como a evolução de taxa de câmbio e da taxa de inflação. Adicionalmente, procura explicar a evolução da taxa de inflação de 2000 a 2018 utilizando informação estatística do BNA, FMI e Banco Mundial, através de um modelo de regressão múltipla. Neste modelo a inflação é a nossa variável a explicar ou variável dependente, e variáveis explicativas ou independentes são o défice, as exportações gerais, as exportações petrolíferas e a taxa de câmbio. Concluímos que as exportações gerais e exportações petrolíferas são significativas na explicação da volatilidade da taxa de inflação.The main objectives of the Angolan Monetary Policy fall within the objectives of economic policy in general, of which highlight economic growth, price stability, full employment and balance of payments balances. The main objective of the monetary policy of national bank of Angola is the price stability and control of the exchange rate to improve the economic performance with the rest of world. Using flexible exchange rates encourages exports, which 95% depend on oil. This fact associated with the excessive volatility of the oil price in the international market implies a large fluctuation in the export revenues, being used the exchange devaluation (effect of crowling peg). On the other hand, it controls the expansionary monetary policy towards price stability, as verified from 2000 to 2014, boosting Angola´s economic policy by reducing the kwanza´s interest rate from 14,3% in 2009 to 4,9% in2014. A tight monetary policy was applied from 2014 to 2018, implying the highest interest rate, registering 16,1%, and also a higher exchange rate in 2018. In this way, the Angolan economy has benefiting from an average but lower lever of inflation, slightly above 20%, which are considered low for the Angolan economy. This paper gives a brief analysis of the Angolan economy, where the evolution of the GDP growth rate, the interest rate, as well as the evolution of the exchange rate and the inflation rate are mentioned. In addition, it seeks to explain the evolution of the inflation rate from 2000 to 2018 using statistical information from the BNA, IMF and World Bank, though a multiple regression model. In this model, inflation is our variable to be explained or dependent variable, and explanatory or independent variables are the deficit, general exports, oil exports and the exchange rate. We conclude that general exports and oil exports are significant in explaining the volatility of the inflation rate

Specialist nursing in rheumatology: The state of play

Rheumatology nurse specialist-led care is effective and safe, and leads to higher patient satisfaction rates than in comparable services. Rheumatology nurse specialists are at the forefront of patient care; in addition to their clinical work, they provide emotional support, promote self-management, and lead advice lines. They play an integral role in helping patients address the impact of theircondition on their family and work life. Their value is not only apparent in patient’s clinical outcomes, but is also demonstrable in cost savings. The RCN calculated that outpatient work by rheumatology nurse specialists saves the NHS up to £175,168 per nurse each year in freeing up consultant appointments

The outcome and cost-effectiveness of nurse-led care in the community for people with rheumatoid arthritis:a non-randomised pragmatic study

To determine the outcome and cost-effectiveness of nurse-led care in the community for people with rheumatoid arthritis (RA)

Chronic Serratiaodorifera Infra-vesical, Extra-peritoneal Pelvic Abscess: an Unexpected Finding in a Healthy 18 year Old Girl

Background: Serratiaodorifera (S. odorifera), a rare nosocomial human pathogen, is responsible for a few cases and outbreaks of sepsis in very sick hospitalized patients.Case Report: We report the case of an 18 year old healthy female patient with a chronic, deep, extra-peritoneal pelvic infection by S. odorifera in a Human Immunodeficiency Virus (HIV) endemic region. She had no  constitutional symptoms. In the Serratia genus, Serratiamarcescens is the most pathogenic, infecting virtually all human organ systems, where-as S. odoriferararely infects healthy patients. Our patient presented with chronicmild pelvic pain. Radiological evaluation revealed a cystic mass lesion of 80mm diameter which was thought to be an ovarian cyst. The mass could not be found at laparotomy. Repeat radiological evaluation revealed that the mass was extra-peritoneal with very thick walls. It was located para-vaginally, below and in front of the urinary bladder. Laparoscopic exploration nine months after laparotomy revealed an abscess with 200ml of pus. She was treated with antibiotics. Anaerobic culture yielded a profuse growth of S.odorifera. Histopathological tissue review confirmed a chronic suppurative abscess. We believe this was a community acquired S.  odorifera infection affecting an otherwise healthy patient. The patient was discharged home well eight days later.Key words: chronic pelvic abscess, community acquired, HIV infection, immunodeficiency, Serratiaodorifer

Effect of target controlled propofol infusion versus intermittent boluses during oesophagogastroduodenoscopy: a randomized controlled trial

Background: Propofol is administered as intermittent boluses to achieve deep sedation to facilitate oesophagogastroduodenoscopy. Target controlled infusion (TCI) can be employed for this purpose. Methods: 176 adults were randomly allocated into two groups of 88 patients. Control group: Received an initial bolus of propofol 1mg/kg, with repeat boluses of 0.25mg/kg. Intervention group: Received an initial target effect-site concentration of 4mcg/ml, followed by maintenance target effect-site concentration of 2.5mcg/ml, titrated by 0.5mcg/ml from baseline infusion rate as needed. Oxygen saturation, blood pressure and heart rate were evaluated immediately before administering the sedative and at 2.50, 5.00, 7.50 and 10.00 minutes. Oxygen desaturation below 90% in both study groups was recorded. Sedation starting time, stopping time, waking up time and overall duration of time to recovery of participants in each study arm was recorded. Results: More hypoxic episodes were observed in the intermittent bolus group with statistically significant association between control and the incidence of hypoxia: Chi square test, p=0.037. There were more hypotensive episodes in the TCI group but not achieving statistical significance: Chi square test for association X2(1) = 0.962, p=0.327.The time to recovery between the two groups was comparable, with 18.84 ± 10.76 minutes in the bolus group and 19.72 ± 9.27 minutes in the TCI group; no statistically significant difference was shown: Student’s t-test, p=0.0564. Conclusion: TCI of propofol was associated with fewer episodes of hypoxia compared to intermittent bolus administration. Similar hemodynamic profiles and comparable time to recovery were demonstrated by these two sedation techniques