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  • 1
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    Online Resource
    Using Clinical Characteristics and Patient‐Reported Outcome Measures to Categorize Systemic Lupus Erythematosus Subtypes
    Wiley ; 2021
    In:  Arthritis Care & Research Vol. 73, No. 3 ( 2021-03), p. 386-393
    Details
    In: Arthritis Care & Research, Wiley, Vol. 73, No. 3 ( 2021-03), p. 386-393
    Abstract: The type 1 and type 2 systemic lupus erythematosus (SLE) categorization system was recently proposed to validate the patients’ perspective of disease and to capture a more comprehensive spectrum of symptoms. The objective of this study was to characterize the clinical manifestations of SLE subtypes and to determine the correlation between the patient‐ and physician‐reported measures used in the model. Methods This was a cross‐sectional study of patients with SLE in a university clinic. Patients completed the Systemic Lupus Activity Questionnaire (SLAQ) and 2011 American College of Rheumatology fibromyalgia (FM) criteria. Active SLE was defined as Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ≥6, clinical SLEDAI score ≥4, or active lupus nephritis. We identified 4 groups: type 1 SLE (active SLE without FM), type 2 SLE (inactive SLE with FM), mixed SLE (active SLE with FM), and minimal SLE (inactive SLE without FM). Results In this cohort of 212 patients (92% female, mean age 45 years), 30% had type 1 SLE, 8% had type 2 SLE, 13% had mixed SLE, and 49% had minimal SLE. Regardless of SLE disease activity, patients with FM (21%), reported higher SLAQ scores, patient global assessment scores, and self‐reported lupus flare that resulted in discordance between patient‐ and physician‐reported measures. Conclusion Fatigue, widespread pain, sleep dysfunction, and mood disorders are common symptoms in SLE. Identifying these symptoms as type 2 SLE may be a method to improve patient communication and understanding. The level of type 2 SLE impacts patients’ perception of disease and self‐reported symptoms. The SLAQ may need to be reinterpreted based on the FM severity scale.
    Type of Medium: Online Resource
    ISSN: 2151-464X , 2151-4658
    URL: Issue
    URL: Article
    DOI: 10.1002/acr.v73.3
    DOI: 10.1002/acr.24135
    RVK:
    XA 30325
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2016713-1
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  • 2
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    Pilot Intervention to Improve Medication Adherence Among Patients With Systemic Lupus Erythematosus Using Pharmacy Refill Data
    Wiley ; 2023
    In:  Arthritis Care & Research Vol. 75, No. 3 ( 2023-03), p. 550-558
    Details
    In: Arthritis Care & Research, Wiley, Vol. 75, No. 3 ( 2023-03), p. 550-558
    Abstract: Despite high rates of medication nonadherence among patients with systemic lupus erythematosus (SLE), effective interventions to improve adherence in SLE are limited. We aimed to assess the feasibility of a pilot intervention and explore its effect on adherence. Methods The intervention used pharmacy refill data to monitor nonadherence and prompt discussions surrounding SLE medications during clinic encounters. Over 12 weeks, the intervention was delivered through routine clinic visits by providers to patients with SLE who take SLE‐specific medications. We measured acceptability, appropriateness, and feasibility using provider surveys. We also measured acceptability by patient surveys and feasibility by medical record documentation. We explored change in adherence by comparing percent of patients with medication possession ratio (MPR) ≥80% 3 months before and after the intervention visit using the McNemar's test. Results Six rheumatologists participated; 130 patients were included in the analysis (median age 43, 95% female, and 59% racial and ethnic minorities). Implementation of the intervention was documented in 89% of clinic notes. Provider surveys showed high scores for feasibility (4.7/5), acceptability (4.4/5), and appropriateness (4.6/5). Among patient surveys, the most common reactions to the intervention visit were feeling determined (32%), empowered (32%), and proud (19%). Proportion of patients with MPR ≥80% increased from 48% to 58% ( P  = 0.03) after the intervention visit. Conclusion Our intervention showed feasibility, acceptability, and appropriateness and led to a statistically significant improvement in adherence. Future work should refine the intervention, assess its efficacy in a controlled setting, and adapt its use among other clinic settings.
    Type of Medium: Online Resource
    ISSN: 2151-464X , 2151-4658
    URL: Issue
    URL: Article
    DOI: 10.1002/acr.v75.3
    DOI: 10.1002/acr.24806
    RVK:
    XA 30325
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2016713-1
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  • 3
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    Virtual Learning and Assessment in Rheumatology Fellowship Training: Objective Structured Clinical Examination Revisited
    Wiley ; 2023
    In:  Arthritis Care & Research
    Details
    In: Arthritis Care & Research, Wiley
    Abstract: With the onset of the COVID‐19 pandemic, an annual multi‐institutional face‐to‐face rheumatology objective structured clinical examination (ROSCE) was transformed into a virtual format. The educational goals of the virtual ROSCE (vROSCE) were to reproduce the educational value of the previous in‐person ROSCE, providing a valuable formative assessment of rheumatology training activities encompassing the 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies for fellows‐in‐training (FITs). This article describes the novel design, feasibility, and stakeholder value of a vROSCE. Methods Through an established collaboration of 5 rheumatology fellowship training programs, in February 2021, a vROSCE was created and conducted using a Zoom platform. Station development included learning objectives, FIT instructions, faculty proctor instructions, and a checklist by which to provide structured formative feedback. An anonymous, optional web‐based survey was sent to FIT participants to evaluate the experience. Results Twenty‐three rheumatology FITs from 5 institutions successfully rotated through 6 stations in the vROSCE. Immediate feedback was given to each FIT using standardized rubrics structured around ACGME core competencies. A total of 65% of FITs (15 of 23) responded to the survey, and 93% of survey respondents agreed or strongly agreed that the vROSCE was a helpful educational activity and identified individualized opportunities for improvement. Conclusion A vROSCE is an innovative, feasible, valuable, and well‐received educational technology tool. The vROSCE enriched rheumatology FITs’ education and offered collaborative learning experiences across institutions.
    Type of Medium: Online Resource
    ISSN: 2151-464X , 2151-4658
    URL: Article
    DOI: 10.1002/acr.25170
    RVK:
    XA 30325
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2016713-1
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  • 4
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    Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic
    BMJ ; 2018
    In:  BMJ Open Quality Vol. 7, No. 3 ( 2018-07), p. e000269-
    Details
    In: BMJ Open Quality, BMJ, Vol. 7, No. 3 ( 2018-07), p. e000269-
    Abstract: Teratogenic medications are often prescribed to women of childbearing age with autoimmune diseases. Literature suggests that appropriate use of contraception among these women is low, potentially resulting in high-risk unintended pregnancies. Preliminary review in our clinic showed suboptimal documentation of women’s contraceptive use. We therefore designed a quality improvement initiative to target three process measures: documentation of contraception usage and type, contraception counselling and provider action after counselling. We reviewed charts of rheumatology clinic female patients aged 18–45 over the course of 10 months; for those who were on teratogenic medications (methotrexate, leflunomide, mycophenolate and cyclophosphamide), we looked for evidence of documentation of contraception use. We executed multiple plan-do-study-act (PDSA) cycles to develop and evaluate interventions, which centred on interprofessional provider education, modification of electronic medical record (EMR) templates, periodic provider reminders, patient screening questionnaires and frequent feedback to providers on performance. Among eligible patients (n=181), the baseline rate of documentation of contraception type was 46%, the rate of counselling was 30% and interventions after counselling occurred in 33% of cases. Averaged intervention data demonstrated increased provider performance in all three domains: documentation of contraception type increased to 64%, counselling to 45% and provider action to 46%. Of the patients with documented contraceptives, 50% used highly effective, 27% used effective and 23% used ineffective contraception methods. During this project, one unintentional pregnancy occurred in a patient on methotrexate not on contraception. Our interventions improved three measures related to contraception counselling and documentation, but there remains a need for ongoing quality improvement efforts in our clinic. This high-risk population requires increased provider engagement to improve contraception compliance, coupled with system-wide EMR changes to increase sustainability.
    Type of Medium: Online Resource
    ISSN: 2399-6641
    URL: Article
    DOI: 10.1136/bmjoq-2017-000269
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2952859-8
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  • 5
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    The use of patient-reported outcome measures to classify type 1 and 2 systemic lupus erythematosus activity
    SAGE Publications ; 2022
    In:  Lupus Vol. 31, No. 6 ( 2022-05), p. 697-705
    Details
    In: Lupus, SAGE Publications, Vol. 31, No. 6 ( 2022-05), p. 697-705
    Abstract: We developed a model that categorizes systemic lupus erythematosus (SLE) activity into two dimensions: Type 1 SLE consists of inflammatory activity, including arthritis, nephritis, and rashes; Type 2 SLE includes fatigue, myalgia, mood disturbance, and cognitive dysfunction. Patient-reported outcome (PRO) measures have received attention as a way to capture symptomatology of SLE. The objective of this study was to explore the use of existing PRO measures to classify Type 1 and 2 SLE activity. Methods Systemic lupus erythematosus patients completed three questionnaires: Systemic Lupus Activity Questionnaire (SLAQ), Polysymptomatic Distress Scale (PSD), and Patient Health Questionnaire (PHQ-2). SLE Disease Activity Index (SLEDAI) and physician global assessments (PGA; 0–3) for Type 1 and Type 2 activity were also recorded. High Type 1 SLE activity was defined as cSLEDAI ≥4 (scored without labs), SLEDAI ≥6, active nephritis, or Type 1 PGA ≥1.0. High Type 2 SLE activity was defined as Type 2 PGA ≥1.0. Patients with both high Type 1 and 2 activity were defined as Mixed SLE, and patients with low Type 1 and 2 activity were defined as Minimal SLE. Data were reduced with a factor analysis. Using a reduced set of 13 variables, multinomial logistic regression models estimated the probability of Minimal, Type 1, Type 2, and Mixed SLE classification. Results The study included 208 patients with SLE. The model accurately predicted the clinician-based Type 1 and 2 SLE classification in 63% of patients; 73% of patients had their Type 1 SLE activity accurately predicted; and 83% had their Type 2 SLE activity accurately predicted. Performance varied by group: 87% of Minimal patients were correctly predicted to be in the Minimal SLE group, yet only about one-third of patients in the Type 1 group were correctly predicted to be in the Type 1 group. Conclusions Our findings indicate Type 2 SLE activity can be identified by patient-reported data. The use of PROs was not as accurate at predicting Type 1 activity. These findings highlight the challenges of using PROs to categorize and classify SLE symptoms since some manifestations of Type 1 activity (e.g., nephritis) may be essentially clinically silent while other Type 1 manifestations may cause severe symptoms.
    Type of Medium: Online Resource
    ISSN: 0961-2033 , 1477-0962
    URL: Article
    DOI: 10.1177/09612033221090885
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2008035-9
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  • 6
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    Predictors of preterm birth in patients with mild systemic lupus erythematosus
    BMJ ; 2013
    In:  Annals of the Rheumatic Diseases Vol. 72, No. 9 ( 2013-09), p. 1536-1539
    Details
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 72, No. 9 ( 2013-09), p. 1536-1539
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    URL: Article
    DOI: 10.1136/annrheumdis-2012-202449
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2013
    detail.hit.zdb_id: 1481557-6
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  • 7
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    Impact of a Multifaceted Educational Program to Improve Provider Skills for Lupus Pregnancy Planning and Management: A Mixed‐Methods Approach
    Wiley ; 2020
    In:  ACR Open Rheumatology Vol. 2, No. 6 ( 2020-06), p. 378-387
    Details
    In: ACR Open Rheumatology, Wiley, Vol. 2, No. 6 ( 2020-06), p. 378-387
    Abstract: To bring recent advances in pregnancy management in lupus to women nationwide, this multidimensional educational intervention sought to equip community rheumatologists with the needed skills, attitudes, and confidence to manage contraceptive decisions and pregnancy planning for women with lupus. Methods The program included an in‐person didactic, training in use of a comprehensive handout to guide contraception and pregnancy conversations, a simulated clinical experience, and access to an innovative website ( www.lupuspregnancy.org ). The program was analyzed using mixed methods, which included a quantitative survey by e‐mail before and after program completion and multiple qualitative interviews about attendees’ experiences integrating created resources into practice. Results The analysis included 68 preintervention surveys and 55 postintervention surveys. For qualitative analysis, eight interviews were completed until thematic saturation was achieved. After completion of the program, there was an increase in providers reporting a systematic approach to preparing a woman with lupus for pregnancy (from 45.6% to 94.6%; P 〈 0.0001). Confidence in choosing both appropriate contraception and pregnancy‐compatible medications improved significantly. As expected, change in knowledge about contraception was limited. Qualitative themes included the utility of the printable handouts, enthusiasm for the program, increased confidence and, importantly, increased empathy for the patients. Conclusion We created a valuable implementation tool that improves self‐reported provider skills and confidence in managing women with lupus who desire pregnancy. Providers now have access to a unique curriculum and resources that encourage providers to have open and accurate conversations about pregnancy, thus creating lasting clinical change.
    Type of Medium: Online Resource
    ISSN: 2578-5745 , 2578-5745
    URL: Issue
    URL: Article
    DOI: 10.1002/acr2.v2.6
    DOI: 10.1002/acr2.11147
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2971160-5
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  • 8
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    Online Resource
    What motivates residents to teach? The Attitudes in Clinical Teaching study
    Wiley ; 2016
    In:  Medical Education Vol. 50, No. 7 ( 2016-07), p. 768-777
    Details
    In: Medical Education, Wiley, Vol. 50, No. 7 ( 2016-07), p. 768-777
    Type of Medium: Online Resource
    ISSN: 0308-0110
    URL: Issue
    URL: Article
    DOI: 10.1111/medu.2016.50.issue-7
    DOI: 10.1111/medu.13075
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2019583-7
    SSG: 5,3
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  • 9
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    Development and Initial Validation of a Systemic Lupus Erythematosus–Specific Measure of the Extent of and Reasons for Medication Nonadherence
    The Journal of Rheumatology ; 2022
    In:  The Journal of Rheumatology Vol. 49, No. 12 ( 2022-12), p. 1341-1348
    Details
    In: The Journal of Rheumatology, The Journal of Rheumatology, Vol. 49, No. 12 ( 2022-12), p. 1341-1348
    Abstract: Medication nonadherence is common in patients with systemic lupus erythematosus (SLE) and negatively affects outcomes. To better recognize and address nonadherence in this population, there is a need for an easily implementable tool with interpretable scores. Domains of Subjective Extent of Nonadherence (DOSE-Nonadherence) is a measure that captures both extent of and reasons for nonadherence. We refined and evaluated DOSE-Nonadherence for patients with SLE. Methods We refined the reasons for the nonadherence domain of DOSE-Nonadherence through rheumatologist feedback and patient cognitive interviewing. We then administered the refined instrument to patients prescribed oral SLE medications and compared the results to the Beliefs About Medicines Questionnaire (BMQ), the Medication Adherence Self-Report Inventory (MASRI), medication possession ratios (MPRs), and hydroxychloroquine (HCQ) blood levels using Pearson correlations. Results Five rheumatologists provided feedback; 16 patients (median age 43 yrs, 100% female, 50% Black) participated in cognitive interviews and 128 (median age 49 yrs, 95% female, 49% Black, 88% on antimalarials, and 59% on immunosuppressants) completed the refined instrument. Items assessing extent of nonadherence produced reliable scores (α 0.89) and identified 47% as nonadherent. They showed convergent validity with MASRI (r = −0.57), HCQ blood levels (r = −0.55), to a lesser extent MPRs (r = −0.34 to −0.40), and discriminant validity with BMQ domains (r = −0.27 to 0.32). Nonadherent patients reported on average 3.5 adherence barriers, the most common being busyness/forgetting (62%), physical fatigue (38%), and pill fatigue (33%). Conclusion Our results support the reliability and validity of DOSE-Nonadherence for SLE medications. This refined instrument, DOSE-Nonadherence-SLE, can be used to identify, rigorously study, and guide adherence intervention development in SLE.
    Type of Medium: Online Resource
    ISSN: 0315-162X , 1499-2752
    URL: Article
    DOI: 10.3899/jrheum.220399
    RVK:
    XA 10000
    Language: English
    Publisher: The Journal of Rheumatology
    Publication Date: 2022
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  • 10
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    The Type 1 & 2 systemic lupus erythematosus model: Perspectives of people living with systemic lupus erythematosus
    SAGE Publications ; 2024
    In:  Lupus
    Details
    In: Lupus, SAGE Publications
    Abstract: In the new Type 1 & 2 model for systemic lupus erythematosus (SLE), Type 1 SLE represents classic inflammatory manifestations, such as arthritis, while Type 2 SLE encompasses symptoms such as pain and fatigue where the relationship to inflammation is less clear. The objective of this study was to interview individuals living with SLE to determine the content and face validity of the Type 1 & 2 SLE model. Methods We conducted a qualitative study using semi-structured interviews with a purposeful sample of participants who met classification criteria for SLE. Participants were asked to describe their experiences with Type 1 & 2 SLE symptoms and treatments, and they indicated if and how their personal experiences aligned with the Type 1 & 2 SLE model. All interviews were audio-recorded and transcribed; applied thematic analysis identified the most frequent and salient themes. Results We interviewed 42 participants with SLE. Type 2 SLE symptoms, such as pain and fatigue, were very common, with almost all participants experiencing some Type 2 symptoms at some point during their disease course. Participants described Type 1 SLE symptoms as being acute flares and life-threatening and Type 2 SLE symptoms as “everyday lupus” that affected their daily lives and were a dominant part of their SLE disease experience. Most participants stated they want their rheumatologists to discuss Type 2 symptoms during clinical appointments in order to address their full symptom experience. Conclusion We demonstrated content and face validity of the Type 1 & 2 SLE model with people living with SLE. Participants in our study largely understood the model and felt it accurately reflected their experience living with SLE. Type 2 SLE symptoms are very common in individuals with SLE and impact patients’ quality of life. Using the model to address Type 2 SLE symptoms allows the rheumatologist to incorporate the patient’s perspective and provide patient-centered care.
    Type of Medium: Online Resource
    ISSN: 0961-2033 , 1477-0962
    URL: Article
    DOI: 10.1177/09612033241228343
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2024
    detail.hit.zdb_id: 2008035-9
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