1
|
Bürgisser N, Mongin D, Mehouachi S, Buclin CP, Guemara R, Darbellay Farhoumand P, Braillard O, Lauper K, Courvoisier DS. Development and validation of a self-updating gout register from electronic health records data. RMD Open 2024; 10:e004120. [PMID: 38663884 PMCID: PMC11043720 DOI: 10.1136/rmdopen-2024-004120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To develop an automatic gout register from electronic health records (EHRs) data. METHODS We analysed the EHR of all patients >18 years old from a tertiary academic hospital (2013-2022) based on six criteria: International Classification of Diseases 10 gout diagnosis, urate-lowering therapy prescription, monosodium urate crystals in joint aspiration and gout-related terms in problem lists, clinical or imaging reports. We assessed the positive and negative predictive value (PPV and NPV) of the query by chart reviews. RESULTS Of 2 110 902 outpatients and inpatients, 10 289 had at least one criterion for gout. The combination of joint aspiration OR diagnostic in the problem list OR≥2 other criteria created a register of 5138 patients, with a PPV of 92.4% (95% CI 88.5% to 95.0%) and an NPV of 94.3% (95% CI 91.9% to 96.0%). PPV and NPV were similar among outpatients and inpatients. Incidence was 2.9 per 1000 person-year and dropped by 30% from the COVID-19 pandemic onward. Patients with gout were on average 71.2 years old (SD 14.9), mainly male (76.5%), overweight (69.5%) and polymorbid (mean number of comorbidities of 3, IQR 1-5). More than half (57.4%) had received a urate-lowering treatment, 6.7% had a gout that led to a hospitalisation or ≥2 flares within a year and 32.9% received a rheumatology consultation. CONCLUSION An automatic EHR-based gout register is feasible, valid and could be used to evaluate and improve gout management. Interestingly, the register uncovered a marked underdiagnosis or under-reporting of gout since the COVID-19 pandemic.
Collapse
Affiliation(s)
- Nils Bürgisser
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- Division of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Denis Mongin
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Samia Mehouachi
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- Quality of Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Clement P Buclin
- Division of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Romain Guemara
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Olivia Braillard
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kim Lauper
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- Geneva Center for Inflammation research, University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Delphine S Courvoisier
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva Faculty of Medicine, Geneva, Switzerland
- Quality of Care Division, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
2
|
Goglin S, Kolfenbach J. The Impact of COVID-19 on Education and Training in Rheumatology: A Narrative Review. Arthritis Care Res (Hoboken) 2024; 76:32-39. [PMID: 37849427 DOI: 10.1002/acr.25258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
|
3
|
Hsieh E, Dey D, Grainger R, Li M, Machado PM, Ugarte-Gil MF, Yazdany J. Global Perspective on the Impact of the COVID-19 Pandemic on Rheumatology and Health Equity. Arthritis Care Res (Hoboken) 2024; 76:22-31. [PMID: 37277949 DOI: 10.1002/acr.25169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
Although the public health emergency associated with the COVID-19 pandemic has ended, challenges remain, especially for individuals with rheumatic diseases. We aimed to assess the historical and ongoing effects of COVID-19 on individuals with rheumatic diseases and rheumatology practices globally, with specific attention to vulnerable communities and lessons learned. We reviewed literature from several countries and regions, including Africa, Australia and New Zealand, China, Europe, Latin America, and the US. In this review, we summarize literature that not only examines the impact of the pandemic on individuals with rheumatic diseases, but also research that reports the lasting changes to rheumatology patient care and practice, and health service use. Across countries, challenges faced by individuals with rheumatic diseases during the pandemic included disruptions in health care and medication supply shortages. These challenges were associated with worse disease and mental health outcomes in some studies, particularly among those who had social vulnerabilities defined by socioeconomic, race, or rurality. Moreover, rheumatology practice was impacted in all regions, with the uptake of telemedicine and changes in health care utilization. While many regions developed rapid guidelines to disseminate scientific information, misinformation and disinformation remained widespread. Finally, vaccine uptake among individuals with rheumatic diseases has been uneven across the world. As the acute phase of the pandemic wanes, ongoing efforts are needed to improve health care access, stabilize rheumatology drug supplies, improve public health communication, and implement evidence-based vaccination practices to reduce COVID-19 morbidity and mortality among individuals with rheumatic diseases.
Collapse
Affiliation(s)
- Evelyn Hsieh
- Yale School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare System, West Haven, Connecticut
| | - Dzifa Dey
- Korle-bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana
| | | | - Mengtao Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, and Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Pedro M Machado
- University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, Northwick Park Hospital, and London North West University Healthcare NHS Trust, London, UK
| | - Manuel F Ugarte-Gil
- Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Perú
| | - Jinoos Yazdany
- San Francisco General Hospital and University of California, San Francisco
| |
Collapse
|
4
|
Jerome DC, Zhou AL. Addressing Rheumatology Resident Well-Being Is Critical to the Rheumatology Workforce and the Care of Our Patients. J Rheumatol 2023; 50:1100-1102. [PMID: 37263654 DOI: 10.3899/jrheum.2023-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Dana Cecilia Jerome
- D.C. Jerome, MD, MEd, Associate Professor of Medicine, A.L. Zhou, MD, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Alan Liang Zhou
- D.C. Jerome, MD, MEd, Associate Professor of Medicine, A.L. Zhou, MD, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Najm A, Alunno A, Machado PM. COVID - How will it continue to change our lives? Joint Bone Spine 2023; 90:105572. [PMID: 37028643 PMCID: PMC10126740 DOI: 10.1016/j.jbspin.2023.105572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Aurélie Najm
- Institute of Infection and Immunity, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alessia Alunno
- Department of Life, Health and Environmental Sciences, Internal Medicine and Nephrology Division, University of L'Aquila, L'Aquila, Italy
| | - Pedro M Machado
- Department of Rheumatology, London North West University Healthcare NHS Trust, London, United Kingdom; Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), University College London Hospitals (UCLH) NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
6
|
Chandwar K, Mukherjee S, Ekbote D, Kishor K, Dogga P, Dixit J, Kumar P, Dhakad U. Impact of COVID-19 pandemic on rheumatology trainees: an online survey. Rheumatol Int 2023; 43:59-68. [PMID: 36255483 PMCID: PMC9579629 DOI: 10.1007/s00296-022-05225-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/02/2022] [Indexed: 02/02/2023]
Abstract
To assess the impact of the COVID-19 pandemic on the training of rheumatology trainees. We conducted an observational cross-sectional study using an online survey-based questionnaire sent to rheumatology trainees in India. Rheumatology trainees from India, including DM/DNB residents and fellows, were included. A total of 78 trainees from 24 institutes in 12 states participated in the study. An overwhelming majority of residents (84%) felt COVID-19 Pandemic Negatively impacted their residency and their Physical (65%), Mental (74%) and Social well-being (80%); 79% of trainees felt burnt out. Majority of trainees felt the pandemic negatively impacted their training with clinical teaching (91%), Clinical examination skills (74%), current (80%) and future (70%) research opportunities suffering during the pandemic. Most had significant reduction in the overall footfall (72%) of patients in rheumatology including OPD (77%) and indoor (67%) admissions along with academics (35%), procedures (66%) and exposure to musculoskeletal ultrasound (71%). Almost 60% and 40% of trainees had OPDs, and indoor admissions stopped during COVID-19 pandemic of these 20% had OPDs, and Admissions closed for more than 6 months. 85% of participants had one or the other psychological symptoms with almost half experiencing anxiety (44%), low mood (47%) or lack of sleep (41%). We found The COVID-19 Pandemic has significantly affected the physical, social and mental well-being of Rheumatology trainees. Academic and clinical training reduced, current and future Research became difficult, disruptions in OPDs and Admissions, recurrent COVID postings and reduction in patient footfall, procedures and MSK-US have been detrimental to trainees.
Collapse
Affiliation(s)
- Kunal Chandwar
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Sayan Mukherjee
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Digvijay Ekbote
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Kriti Kishor
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Prasanna Dogga
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Juhi Dixit
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Puneet Kumar
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Urmila Dhakad
- grid.411275.40000 0004 0645 6578Department of Clinical Immunology and Rheumatology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| |
Collapse
|