Recommendations for early referral of individuals with suspected polymyalgia rheumatica: An initiative from the international giant cell arteritis and polymyalgia rheumatica study group

Objective To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). Methods A task force including 29 rheumatologists/ internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1–5 scale) and agreement (LOA) (0–10 scale) were evaluated. Results Two overarching principles and five recommendations were developed. LOE was 4–5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. Conclusions These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR

Severe flares are associated with a poorer health-related quality of life (HRQoL) in patients with SLE: data from the Almenara Lupus Cohort

Background Flares in patients with SLE, regardless of their severity, have been associated with damage accrual. However, their impact on health-related quality of life (HRQoL) has not been fully evaluated. In fact, disease activity is only minimally associated with HRQoL.Objective To determine the association between flares and HRQoL.Methods Patients from the Almenara Lupus Cohort were included. Visits occurring between December 2015 and February 2020 were evaluated. Flares were defined as an increase on the SLE Disease Activity Index 2000 (SLEDAI-2K) of at least 4 points; severe flares were those with a final SLEDAI-2K ≥12 and mild-moderate flares all the others. HRQoL was measured using the LupusQoL. Univariable and multivariable generalised estimating regression equations were performed, adjusting for possible confounders. Confounders were determined at one visit, whereas the outcome was determined on the subsequent visit; flares were determined based on the variation of the SLEDAI-2K between these visits.Results Two hundred and seventy-seven patients were included; 256 (92.4%) were female, mean age at diagnosis was 36.0 (SD: 13.3) years and mean disease duration at baseline was 9.1 (SD: 7.1) years. Patients had mean of 4.8 (SD: 1.9) visits and a mean follow-up of 2.7 (1.1) years. Out of 1098 visits, 115 (10.5%) flares were defined, 17 were severe and 98 mild-moderate. After adjustment for possible confounders, only severe flares were associated with a poorer HRQoL in planning, pain, emotional health and fatigue.Conclusions Severe flares, but not mild-moderate, flares are associated with poorer HRQoL

A better self-efficacy is predictive of better health-related quality of life (HRQoL) in patients with systemic lupus erythematosus: data from the Almenara Lupus Cohort

Objective To determine the possible predictive value of self-efficacy on health-related quality of life (HRQoL) in patients with SLE.Methods Patients with SLE from the Almenara Lupus Cohort were included. Self-efficacy was ascertained with the six domains from the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing chronic conditions. For PROMIS domains, a score of 50 is the average for a clinical population (people with a chronic condition), a higher score indicates that the respondent has greater self-efficacy. HRQoL was ascertained with the physical and mental component summary (PCS and MCS) measures of the Short-Form 36 (SF-36). Generalised estimating equations were performed, using as outcome the PCS or MCS in the subsequent visit, and the self-efficacy domain in the previous visit; multivariable models were adjusted for possible confounders. The confounders were measured in the same visit as the self-efficacy domain.Results Two-hundred and nine patients for a total of 564 visits were included; 194 (92.8%) patients were women and mean age at diagnosis was 36.4 (14.0) years. In the multivariable models, a better PCS was predicted by a better self-efficacy for managing symptoms, managing medications and treatments and managing social interactions and general self-efficacy; a better MCS was predicted by a better self-efficacy for managing daily activities, managing symptoms, managing medications and treatments and managing social interactions.Conclusion A better self-efficacy is predictive of subsequent better HRQoL, even after adjustment for possible confounders. These results should encourage clinicians to develop strategies to improve self-efficacy in patients with SLE

Cleantech insinöörikoulutuksessa

Cleantech-insinoorit -projekti on Lahden ammattikorkeakoulun tekniikan alan hallinnoima ja Hameen ELY-keskuksen osarahoittama Euroopan Sosiaalirahaston hanke, jonka tavoitteena on parantaa Paijat-Hameen cleantech-osaamista seka insinoorikoulutuksen tyoelamavastaavuutta. Projektin tavoitteena on tuottaa uudenlainen koulutuksen toimintamalli, joka luo aitoja edellytyksia cleantech-innovaatioiden syntymiselle seka uusille tuotteille ja palveluille ymparistoliiketoiminnan alueella. Uuden yhteistyo- ja toimintamallin kehittaminen tekniikan alan koulutukseen perustuu yhteistyohon yrityselaman ja muiden toimijoiden kanssa. Yhteistyota on toteutettu erilaisissa opiskelija- ja T&K-projekteissa, opinnaytetoissa, koulutuksissa, tyopajoissa, seminaareissa, opintomatkoilla ja benchmarkkaamalla erilaisia kaytantoja koti- ja ulkomailla. Uusi yhteistyo- ja toimintamalli kasittaa lisaksi CDIO-/PBL-pedagogiikkaan (CDIO = Conceive – Design – Implement – Operate- / PBL = Problem Based Learning) perustuvan oppimismallin tuomisen tekniikan alan koulutukseen perinteisten insinooritietojen ja -taitojen ohella seka cleantech-osaamisen sisallyttamisen opintosuunnitelmiin. Myos tyoelamalta saadut tiedot tyoelamaosaamisen osaamis- ja muista tarpeista sisallytetaan opintosuunnitelmiin. Lahden ammattikorkeakoulu haluaa osaltaan seka kehittaa insinoorikoulutusta vastaamaan alueen cleantech-yritysten osaamistarpeita etta osallistua alueen yritysten tuotteiden, palvelujen ja prosessien kehittamiseen. Cleantech-insinoorit -projektin tarkoituksena on tunnistaa puhtaan teknologian suunnittelemisessa ja hyodyntamisessa tarvittavia tietoja ja taitoja ja integroida ne insinoorien koulutukseen. Lahden ammattikorkeakoulun tekniikan alalla on viisi koulutusohjelmaa, joista jokaisen cleantech-tarpeita on projektissa tarkasteltu. Lisaksi projektissa selvitettiin olemassa olevan tiedon avulla cleantech-sektorin tarpeita. Cleantech-osaamisen koulutustarvekartoitus tehtiin syksylla 2011, josta tarkempi koulutussuunnitelma cleantech-osaamisen parantamiseksi Paijat-Hameessa valmistui joulukuussa 2011. Kartoituksen ja yritysten haastattelujen pohjalta projektissa toteutettiin cleantech-osaamisen parantamiseksi koulutuksia vuosina 2012 – 2013. Koulutukset pureutuivat ajankohtaisiin teemoihin, kuten vihreaan ICT:hen, energia- ja materiaalitehokkuuteen, kestaviin hankintoihin seka ajankohtaisiin lainsaadannon vaatimuksiin. Tassa artikkelikokoelmassa kerrotaan Lahden ammattikorkeakoulun tekniikan alan koulutusohjelmien toimenpiteista, joilla alueen ja insinoorikoulutuksen cleantech-osaamista ja tyoelamavastaavuutta on parannettu. Raportin suomenkielisessa osassa on tarkasteltu cleantech-liiketoiminnan globaaleja markkinoita ja tulevaisuuden nakymia seka Suomen ja Lahden seudun cleantech-osaamista ja osaamistarpeita. Materiaalitekniikan koulutusohjelman artikkeleissa on kasitelty opintosuunnitelman muutostyota, joka kasittaa myos cleantech-nakokulman ja CDIO- / PBL-pedagogiikan sisallyttamisen opintosuunnitelmaan. Mekatroniikan koulutusohjelman artikkelissa on kasitelty CDIO- / PBL-pedagogiikan lahestymistapaa ja toteutumista kone- ja tuotantotekniikan koulutusohjelmassa. Raportin englanninkielinen osuus kasittelee ymparistoteknologian koulutusohjelman opintosuunnitelman muutosta, joka sisaltaa myos englanninkielisen ylemman ammattikorkeakoulututkinnon. Lisaksi englanninkieliset artikkelit kasittelevat tietotekniikan koulutusohjelman cleantech-nakokulmaa Green ICT -moduuleissa

Factors predictive of high disease activity early in the course of SLE in patients from a Latin-American cohort

To determine the factors predictive of disease activity early in the course of SLE (baseline visit). Patients from GLADEL, a multi-national, multi-ethnic, Latin-American lupus cohort were included. Disease activity was evaluated at baseline with the SLEDAI score. Demographic characteristics (age at diagnosis, gender, ethnicity, marital status, educational level, medical coverage and socioeconomic status) were assessed. Disease duration was defined as the time between the fourth ACR criterion and baseline. Time to criteria accrual was defined as the interval between the first and fourth ACR criterion. Use of glucocorticoids was recorded as the highest dose received before the baseline visit. Antimalarials and immunosuppressive drugs were recorded as use or not use. Univariable and multivariable analysis were performed. Model selection was based on backward elimination. One thousand two hundred sixty-eight patients were included; 1136 (89.6%) of them were female. Mean age at diagnosis was 29.2 (SD: 12.3) years. Five hundred sixty-five (44.6%) were Mestizo, 539 (42.5%) were Caucasians and 164 (12.9%) were African-Latin-Americans. The mean SLEDAI at baseline was 10.9 (SD: 8.4). Longer time between first and fourth ACR criterion, medical coverage, a dose of prednisone between 15 and 60 mg/d, and the use of antimalarials were factors protective of disease activity, while Mestizo and African-Latin-American ethnicities were predictive factors. Mestizo and African-Latin-American ethnicities were predictive whereas antimalarial use, medical coverage, and longer time to criteria accrual were protective of higher disease activity early in the disease course.47219920

Pensamiento Novohispano 20

El presente libro reúne 26 trabajos de investigación que tienen como objetivo mantener viva la relación cultural del presente con nuestro pasado histórico. Partimos del hecho de que somos seres históricos, es decir, pensamos y reconocemos la historia como parte constitutiva de nuestra existencia vital, razón que viene a consolidar el estudio y la investigación de nuestro pasado. El sentido que fortalece cada una de las colaboraciones aquí presentadas se convierte en un homenaje a la memoria histórica que recupera los hechos “pequeños”, los aparentemente “insignificantes”, para clarificar la “grandes” intervenciones. Cada uno de los trabajos aquí expuestos tiene el propósito de contribuir al estudio y difusión de la cultura novohispana.El número 20 de Pensamiento Novohispano ha quedado integrado por 26 trabajos de investigación distribuidos de la siguiente manera: 11 corresponden al siglo xvi; 5 al siglo XVII y 10 al siglo XVIII. Como en números anteriores, la diversidad de temas sigue presente, pues es una característica de este libro, que busca mantener viva la relación cultural de nuestro pasado histórico con el presente. Partimos del hecho de que somos seres históricos, es decir, pensamos y reconocemos la historia como parte constitutiva de nuestra existencia vital, razón que viene a consolidar el estudio y la investigación de nuestro pasado

An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists

Objectives: To explore current management practices for PMR by general practitioners (GPs) and rheumatologists including implications for clinical trial recruitment.Methods: An English language questionnaire was constructed by a working group of rheumatologists and GPs from six countries. The questionnaire focused on: 1: Respondent characteristics; 2: Referral practices; 3: Treatment with glucocorticoids; 4: Diagnostics; 5: Comorbidities; and 6: Barriers to research. The questionnaire was distributed to rheumatologists and GPs worldwide via members of the International PMR/Giant Cell Arteritis Study Group.Results: In total, 394 GPs and 937 rheumatologists responded to the survey. GPs referred a median of 25% of their suspected PMR patients for diagnosis and 50% of these were returned to their GP for management. In general, 39% of rheumatologists evaluated patients with suspected PMR &gt;2 weeks after referral, and a median of 50% of patients had started prednisolone before rheumatologist evaluation. Direct comparison of initial treatment showed that the percentage prescribing &gt;25 mg prednisolone daily for patients was 30% for GPs and 12% for rheumatologists. Diagnostic imaging was rarely used. More than half (56%) of rheumatologists experienced difficulties recruiting people with PMR to clinical trials.Conclusion: This large international survey indicates that a large proportion of people with PMR are not referred for diagnosis, and that the proportion of treatment-naive patients declined with increasing time from referral to assessment. Strategies are needed to change referral and management of people with PMR, to improve clinical practice and facilitate recruitment to clinical trials.</p

Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group

Objective: To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR).Methods: A task force including 29 rheumatologists/internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1-5 scale) and agreement (LOA) (0-10 scale) were evaluated.Results: Two overarching principles and five recommendations were developed. LOE was 4-5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care.Conclusions: These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.Keywords: Giant Cell Arteritis; Polymyalgia Rheumatica; Vasculitis