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Best Practice & Research. Clinical Rheumatology

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https://www.readbyqxmd.com/read/27886946/building-multidisciplinary-health-workforce-capacity-to-support-the-implementation-of-integrated-people-centred-models-of-care-for-musculoskeletal-health
#1
REVIEW
M J Chehade, T K Gill, D Kopansky-Giles, L Schuwirth, J Karnon, P McLiesh, J Alleyne, A D Woolf
To address the burden of musculoskeletal (MSK) conditions, a competent health workforce is required to support the implementation of MSK models of care. Funding is required to create employment positions with resources for service delivery and training a fit-for-purpose workforce. Training should be aligned to define "entrustable professional activities", and include collaborative skills appropriate to integrated and people-centred care and supported by shared education resources. Greater emphasis on educating MSK healthcare workers as effective trainers of peers, students and patients is required...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886945/implementation-of-models-of-care-for-secondary-osteoporotic-fracture-prevention-and-orthogeriatric-models-of-care-for-osteoporotic-hip-fracture
#2
REVIEW
Paul Mitchell, Kristina Åkesson, Manju Chandran, Cyrus Cooper, Kirtan Ganda, Muriel Schneider
As the world's population ages, the prevalence of osteoporosis and its resultant fragility fractures is set to increase dramatically. This chapter focuses on current frameworks and major initiatives related to the implementation of fracture liaison services (FLS) and orthogeriatrics services (OGS), Models of Care designed to reliably implement secondary fracture prevention measures for individuals presenting to health services with fragility fractures. The current evidence base regarding the impact and effectiveness of FLS and OGS is also considered...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886944/osteoarthritis-models-for-appropriate-care-across-the-disease-continuum
#3
REVIEW
Kelli D Allen, Peter F Choong, Aileen M Davis, Michelle M Dowsey, Krysia S Dziedzic, Carolyn Emery, David J Hunter, Elena Losina, Alexandra E Page, Ewa M Roos, Søren T Skou, Carina A Thorstensson, Martin van der Esch, Jackie L Whittaker
Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Despite the existence of evidence-based treatments and guidelines, substantial gaps remain in the quality of OA management. There is underutilization of behavioral and rehabilitative strategies to prevent and treat OA as well as a lack of processes to tailor treatment selection according to patient characteristics and preferences. There are emerging efforts in multiple countries to implement models of OA care, particularly focused on improving nonsurgical management...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886943/use-of-ehealth-technologies-to-enable-the-implementation-of-musculoskeletal-models-of-care-evidence-and-practice
#4
REVIEW
Helen Slater, Blake F Dear, Mark A Merolli, Linda C Li, Andrew M Briggs
Musculoskeletal (MSK) conditions are the second leading cause of morbidity-related burden of disease globally. EHealth is a potentially critical factor that enables the implementation of accessible, sustainable and more integrated MSK models of care (MoCs). MoCs serve as a vehicle to drive evidence into policy and practice through changes at a health system, clinician and patient level. The use of eHealth to implement MoCs is intuitive, given the capacity to scale technologies to deliver system and economic efficiencies, to contribute to sustainability, to adapt to low-resource settings and to mitigate access and care disparities...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886942/models-of-care-for-addressing-chronic-musculoskeletal-pain-and-health-in-children-and-adolescents
#5
REVIEW
Jennifer Stinson, Mark Connelly, Steven J Kamper, Troels Herlin, Karine Toupin April
Chronic musculoskeletal pain among children and adolescents is common and can negatively affect quality of life. It also represents a high burden on the health system. Effective models of care for addressing the prevention and management of pediatric musculoskeletal pain are imperative. This chapter will address the following key questions: (1) Why are pediatric-specific models of pain care needed? (2) What is the burden of chronic musculoskeletal pain among children and adolescents? (3) What are the best practice approaches for early identification and prevention of chronic musculoskeletal pain in children and adolescents? (4) What are the recommended strategies for clinical management of chronic pain, including pharmacological, physical, psychological and complementary, and alternative approaches? (5) What are the most effective strategies for implementing models of pain care across different care settings? (6) What are the research priorities to improve models of care for children and adolescents with chronic musculoskeletal pain?...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886941/management-of-musculoskeletal-pain-in-a-compensable-environment-implementation-of-helpful-and-unhelpful-models-of-care-in-supporting-recovery-and-return-to-work
#6
REVIEW
Darren Beales, Kal Fried, Michael Nicholas, Fiona Blyth, Damien Finniss, G Lorimer Moseley
Models of Care (MoCs) for injured workers in the compensation environment recommend adoption of biopsychosocial management approaches. Still, widespread dominance of biomedical constructs at the system, organisational and individual levels of the compensation system prevails, contributing to suboptimal management practices and outcomes for injured workers. Efforts to implement contemporary MoCs in the compensation environment show some promise in improving outcomes. Areas of promise at the organisational level, particularly in the workplace, and at the system level are discussed...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886940/harnessing-and-supporting-consumer-involvement-in-the-development-and-implementation-of-models-of-care-for-musculoskeletal-health
#7
REVIEW
Louisa Walsh, Sophie Hill, Anita E Wluka, Peter Brooks, Rachelle Buchbinder, Ainslie Cahill, Leonila F Dans, Dianne Lowe, Michael Taylor, Peter Tugwell
Consumer involvement in the design and delivery of their healthcare is an integral strategy to ensure that health services and systems meet consumers' needs. This is also true for the design and delivery of Models of Care. This chapter presents the identified healthcare needs of people with musculoskeletal conditions and focuses on the current systematic review evidence for consumer involvement interventions in musculoskeletal Models of Care across the micro, meso and macro levels of healthcare. This chapter also presents three case studies of consumer involvement in different aspects of healthcare, offers a series of practice points to help translate the systematic review evidence into practice, and also provides direction to available resources, which support the implementation of consumer involvement within Models of Care...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886939/development-and-implementation-of-models-of-care-for-musculoskeletal-conditions-in-middle-income-and-low-income-asian-countries
#8
REVIEW
Keith K Lim, Madelynn Chan, Sandra Navarra, Syed Atiqul Haq, Chak Sing Lau
This chapter discusses the challenges faced in the development and implementation of musculoskeletal (MSK) Models of Care (MoCs) in middle-income and low-income countries in Asia and outlines the components of an effective MoC for MSK conditions. Case studies of four such countries (The Philippines, Malaysia, Bangladesh and Myanmar) are presented, and their unique implementation issues are discussed. The success experienced in one high-income country (Singapore) is also described as a comparison. The Community Oriented Program for Control of Rheumatic Diseases (COPCORD) project and the role of Asia Pacific League of Associations for Rheumatology (APLAR), a professional body supporting MoC initiatives in this region, are also discussed...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886938/implementation-of-musculoskeletal-models-of-care-in-primary-care-settings-theory-practice-evaluation-and-outcomes-for-musculoskeletal-health-in-high-income-economies
#9
REVIEW
Krysia S Dziedzic, Simon French, Aileen M Davis, Elizabeth Geelhoed, Mark Porcheret
Musculoskeletal conditions represent one of the largest causes of years lived with disability in high-income economies. These conditions are predominantly managed in primary care settings, and yet, there is a paucity of evidence on which approaches work well in increasing the uptake of best practice and in closing the evidence-to-practice gap. Increasingly, musculoskeletal models of service delivery (as components of models of care) such as integrated care, stratified care and therapist-led care have been tested in primary health care pathways for joint pain in older adults, for low back pain and for arthritis...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886937/models-of-care-for-musculoskeletal-health-moving-towards-meaningful-implementation-and-evaluation-across-conditions-and-care-settings
#10
REVIEW
Andrew M Briggs, Madelynn Chan, Helen Slater
Models of Care (MoCs) are increasingly recognised as a system-level enabler to translate evidence for 'what works' into policy and, ultimately, clinical practice. MoCs provide a platform for a reform agenda in health systems by describing not only what care to deliver but also how to deliver it. Given the enormous burden of disease associated with musculoskeletal (MSK) conditions, system-level (macro) reform is needed to drive downstream improvements in MSK healthcare - at the health service (meso) level and at the clinical interface (micro) level...
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886936/extending-evidence-to-practice-implementation-of-models-of-care-for-musculoskeletal-health-conditions-across-settings
#11
EDITORIAL
Andrew M Briggs, Madelynn Chan, Helen Slater
No abstract text is available yet for this article.
June 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886804/sarcoidosis-rheumatology-perspective
#12
REVIEW
Arthur M F Yee
Sarcoidosis is a systemic inflammatory granulomatous disease for which rheumatologists are uniquely trained and qualified to treat. Historically, sarcoidosis has been managed within silos of medical subspecialties, but with increased appreciation of the systemic nature of this disorder and the availability of more therapeutic options, it is clear that a multidisciplinary approach, with the rheumatologist as a key component, can offer more optimal care. This manuscript reviews clinically relevant immunology and pathophysiology, diagnostic issues, management decision-making, and therapeutics in the care of patients with sarcoidosis...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886803/relapsing-polychondritis-a-2016-update-on-clinical-features-diagnostic-tools-treatment-and-biological-drug-use
#13
REVIEW
Alexis Mathian, Makoto Miyara, Fleur Cohen-Aubart, Julien Haroche, Miguel Hie, Micheline Pha, Philippe Grenier, Zahir Amoura
Relapsing polychondritis (RP) is a very rare autoimmune disease characterised by a relapsing inflammation of the cartilaginous tissues (joints, ears, nose, intervertebral discs, larynx, trachea and cartilaginous bronchi), which may progress to long-lasting atrophy and/or deformity of the cartilages. Non-cartilaginous tissues may also be affected, such as the eyes, heart, aorta, inner ear and skin. RP has a long and unpredictable course. Because no randomised therapeutic trials are available, the treatment of RP remains mainly empirical...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886802/advancements-in-the-management-of-uveitis
#14
REVIEW
Sergio Schwartzman
Uveitis may exist as a clinical manifestation of an underlying systemic disease or may represent an idiopathic entity, sometimes with a very characteristic pattern. Different forms of uveitis have been defined on the basis of three important variables: chronicity, anatomic location, and underlying etiology. The evolving understanding of the immune system has resulted in a more targeted approach to manage patients with different forms of uveitis, although clearly this approach is at a very early stage. Altered patterns of cellular processing and different cytokine expression, including TNF, IL-1, IL-2, IL-6, and IL17, have been defined in uveitis, and this has laid the pathway for targeted therapy...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886801/approach-to-the-patients-with-inadequate-response-to-colchicine-in-familial-mediterranean-fever
#15
REVIEW
Ahmet Gül
Familial Mediterranean fever (FMF) is the most common form of monogenic autoinflammatory conditions, and response to colchicine has been considered as one of its distinctive features among other hereditary periodic fever disorders. Prophylactic colchicine has been shown to be effective in the prevention of inflammatory attacks and development of amyloidosis. However, the highest tolerable doses of colchicine may not be adequate enough to manage these goals in approximately 5% of FMF patients. Inadequate response to colchicine in fully compliant FMF patients may be associated with genetic and/or environmental factors affecting disease severity and colchicine bioavailability...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886800/beh%C3%A3-et-s-disease-how-to-diagnose-and-treat-vascular-involvement
#16
REVIEW
Emire Seyahi
Behçet's disease is a multisystem disorder with unknown etiology and a unique geographic distribution. The disease is characterized by recurrent skin-mucosa lesions and sight-threatening panuveitis. Vascular involvement, which is more common and more severe among males, has also equally characteristic features such as affecting mostly veins, having a significant tendency for thrombosis, and running a relapsing course. Lower extremity vein thrombosis (LEVT) is the most frequent manifestation, followed by vena cava inferior thrombosis...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886799/igg4-related-disease-advances-in-the-diagnosis-and-treatment
#17
REVIEW
Pilar Brito-Zerón, Xavier Bosch, Manuel Ramos-Casals, John H Stone
IgG4-related disease is a rare immune-mediated systemic disease with the capability of involving essentially any organ. Although the presenting clinical features vary substantially according to the speciality to which patients present first, perhaps the most common clinical presentation is that of single or multiple organ enlargement, arousing suspicion of cancer. The disease is frequently diagnosed unexpectedly in pathological specimens or on imaging studies. The diagnostic approach is complex and includes not only IgG4-related tests (serum levels, circulating plasmablasts, and specific immunohistochemical studies), but also clinical, laboratory, and imaging tests as well as the typical histopathological features (lymphocytic infiltration, storiform fibrosis, eosinophilic infiltration, and obliterative phlebitis)...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886798/multicentric-reticulohistiocytosis-rheumatology-perspective
#18
REVIEW
Bahtiyar Toz, Nesimi Büyükbabani, Murat İnanç
Multicentric reticulohistiocytosis (MRH) is a rare, multisystemic non-Langerhans cell histiocytosis characterized by skin and articular involvement, and rarely involves various other organs. There are no specific laboratory findings for MRH. Diagnosis is based on clinical findings and skin or synovial biopsy results. There is currently no consensus for the treatment of MRH. Here, we review the differential diagnosis and treatment options of MRH from the rheumatologist's perspective. We also report an index case of MRH associated with Sjögren's syndrome and pulmonary embolism...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886797/catastrophic-antiphospholipid-syndrome-the-current-management-approach
#19
REVIEW
Ignasi Rodriguez-Pintó, Gerard Espinosa, Ricard Cervera
The current recommendation for catastrophic antiphospholipid syndrome (CAPS) management is the standard triple therapy with anticoagulation (AC), glucocorticoids (GCs), plasma exchange (PE), and/or intravenous immunoglobulins (IVIGs). Of note, only AC has a significant effect on the prognosis of these patients. However, from the experimental or basic point of view, there is only indirect evidence to advocate the use of these immunomodulatory therapies (GC, PE, and IVIG) in CAPS. Recently, there have been reports of severe or refractory CAPS patients treated with the monoclonal antibodies rituximab and eculizumab...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886796/adult-onset-still-s-disease-advances-in-the-treatment
#20
REVIEW
Santos Castañeda, Ricardo Blanco, Miguel A González-Gay
Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder mainly characterized by persistent high spiking fevers, evanescent rash, and joint involvement. The pathogenesis of AOSD is only partially known, but pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, IL-18, and IFN-γ seem to play a major role in this disorder. AOSD is at the crossroad of auto-inflammatory syndromes and autoimmune diseases. It is diagnosed by exclusion to determine the presence of high serum ferritin levels, which is usually >1000 μg/L...
April 2016: Best Practice & Research. Clinical Rheumatology
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