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Teaching the musculoskeletal examination: are patient educators as effective as rheumatology faculty?

https://arctichealth.org/en/permalink/ahliterature179093
Source
Teach Learn Med. 2004;16(2):175-80
Publication Type
Article
Date
2004
Author
Susan Humphrey-Murto
C Douglas Smith
Claire Touchie
Timothy C Wood
Author Affiliation
Division of General Internal Medicine, University of Ottawa, Ontario, Canada. shumphrey@ottawahospital.on.ca
Source
Teach Learn Med. 2004;16(2):175-80
Date
2004
Language
English
Publication Type
Article
Keywords
Adult
Clinical Competence
Curriculum
Faculty, Medical
Humans
Musculoskeletal Diseases - diagnosis
Ontario
Patient Education as Topic
Physical Examination - standards
Problem-Based Learning
Rheumatology - education
Students, Medical
Teaching - methods
Abstract
Effective education of clinical skills is essential if doctors are to meet the needs of patients with rheumatic disease, but shrinking faculty numbers has made clinical teaching difficult. A solution to this problem is to utilize patient educators.
This study evaluates the teaching effectiveness of patient educators compared to rheumatology faculty using the musculoskeletal (MSK) examination.
Sixty-two 2nd-year medical students were randomized to receive instruction from patient educators or faculty. Tutorial groups received instructions during three, 3-hr sessions. Clinical skills were evaluated by a 9 station objective structured clinical examination. Students completed a tutor evaluation form to assess their level of satisfaction with the process.
Faculty-taught students received a higher overall mark (66.5% vs. 62.1%,) and fewer failed than patient educator-taught students (5 vs. 0, p = 0.02). Students rated faculty educators higher than patient educators (4.13 vs. 3.58 on a 5-point Likert scale).
Rheumatology faculty appear to be more effective teachers of the MSK physical exam than patient educators.
PubMed ID
15276895 View in PubMed
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Neuropsychiatric lupus: the prevalence and autoantibody associations depend on the definition: results from the 1000 faces of lupus cohort.

https://arctichealth.org/en/permalink/ahliterature124285
Source
Semin Arthritis Rheum. 2012 Oct;42(2):179-85
Publication Type
Article
Date
Oct-2012
Author
Alan M Borowoy
Janet E Pope
Earl Silverman
Paul R Fortin
Christian Pineau
C Douglas Smith
Hector Arbillaga
Dafna Gladman
Murray Urowitz
Michel Zummer
Marie Hudson
Lori Tucker
Christine Peschken
Author Affiliation
Western University, London, Ontario, Canada.
Source
Semin Arthritis Rheum. 2012 Oct;42(2):179-85
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
American Native Continental Ancestry Group - ethnology - statistics & numerical data
Antibodies, Antiphospholipid - blood
Autoantibodies - blood
Canada - epidemiology
Cohort Studies
Female
Health status
Humans
Lupus Vasculitis, Central Nervous System - diagnosis - epidemiology - immunology
Male
Prevalence
Seroepidemiologic Studies
Severity of Illness Index
Terminology as Topic
Abstract
The (ever) prevalence of neuropsychiatric systemic lupus erythematosus (NPSLE) can vary widely depending on the definition used. We determined the prevalence of NPSLE in 1000 Faces of Lupus, a large multicenter Canadian cohort.
Adults enrolled at 10 sites who satisfied the American College of Rheumatology (ACR) classification for systemic lupus erythematosus (SLE) were included. NPSLE was defined as (i) NPSLE by ACR classification criteria (seizures or psychosis), (ii) ACR, SLEDAI (seizure, psychosis, organic brain syndrome, cranial nerve disorder, headache, and cerebrovascular accident (CVA)), SLAM (CVA, seizure, cortical dysfunction, and headache), and SLICC (cognitive impairment, psychosis, seizures, CVA, cranial or peripheral neuropathy, and transverse myelitis) with and (iii) without minor nonspecific NPSLE manifestations (including mild depression, mild cognitive impairment, and electromyogram-negative neuropathies), and (iv) by ACR and SLEDAI neuropsychiatric (NP) indexes alone. Factors associated with NPSLE were explored using regression models.
Cohort size was 1253, with mean disease 12 ± 10 years, mean age 41 ± 16 years, and 86% female. Subgroup size was dependent on the specific definition of NPSLE. Prevalence of NPSLE was 6.4% in group (i), n = 1253 (n = 80); 38.6% in group (ii), n = 681(n = 263); 28.7% in group (iii), n = 586 (n = 168); and 10.2% in group (iv), n = 1125 (n = 115). In univariate analysis, Aboriginals had a nearly 2-fold increase in frequency of NPSLE in all groups. Education level and income were not associated with NPSLE (P = 0.32 and 0.03, respectively). As well, number of ACR criteria, SLAM, age at diagnosis, disease duration, and gender were not associated with NPSLE. Anti-Ro was significantly associated in groups (i) and (iv) and antiphospholipid antibodies (aPL) were increased in groups (i), (ii), and (iii); however, this lost significance when thromboembolic events were excluded from SLICC, SLEDAI, and SLAM indexes. In group (iv), absence of anti-Sm was significant. In multivariate analysis, anti-Ro and aPL (i) and anti-Ro+ and lack of anti-Sm (iv) were significant. NPSLE was not increased in those with +anti-DNA, La, or ribonucleoprotein (RNP), lupus anticoagulant (LAC), or anticardiolipin (aCL) antibody.
The prevalence and factors associated with NPSLE varied depending on the definition used, was highest in Aboriginals, and may be higher if +anti-Ro or aPL are present. SLAM and SLICC include mild subjective disease manifestations, which contributed to a 10% higher prevalence of NPSLE compared to a more strict definition. NPSLE may be less in this database than other publications as its overall prevalence may be decreasing, or because of selection bias inherent to those who enter an observational cohort. NPSLE was associated with aPL and often anti-Ro and varied by ethnicity.
PubMed ID
22595642 View in PubMed
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Medication Use in Systemic Lupus Erythematosus.

https://arctichealth.org/en/permalink/ahliterature100061
Source
J Rheumatol. 2010 Nov 15;
Publication Type
Article
Date
Nov-15-2010
Author
Sasha Bernatsky
Christine Peschken
Paul R Fortin
Christi A Pineau
Murray B Urowitz
Dafna D Gladman
Janet E Pope
Marie Hudson
Michel Zummer
C Douglas Smith
Hector O Arbillaga
Ann E Clarke
Author Affiliation
From the Division of Clinical Epidemiology, McGill University Health Centre (MUHC); Division of Rheumatology, MUHC; Division of Clinical Immunology/Allergy, MUHC; Jewish General Hospital and McGill University; Hopital Maisonneuve-Rosemont and University of Montreal, Montreal, Quebec; University of Manitoba, Winnipeg, Manitoba; University Health Network, Toronto Western Hospital, Toronto Western Research Institute, Toronto; University of Western Ontario, London; University of Ottawa, Ottawa, Ontario; and Lethbridge Regional Hospital, Lethbridge, Alberta, Canada.
Source
J Rheumatol. 2010 Nov 15;
Date
Nov-15-2010
Language
English
Publication Type
Article
Abstract
OBJECTIVE: To evaluate factors affecting therapeutic approaches used in clinical practice for the management of systemic lupus erythematosus (SLE), in a multicenter cohort. METHODS: We combined data from 10 clinical adult SLE cohort registries in Canada. We used multivariate generalized estimating equation methods to model dichotomized outcomes, running separate regressions where the outcome was current exposure of the patient to specific medications. Potential predictors of medication use included demographic (baseline age, sex, residence, race/ethnicity) and clinical factors (disease duration, time-dependent damage index scores, and adjusted mean SLE Disease Activity Index-2K scores). The models also adjusted for clustering by center. RESULTS: Higher disease activity and damage scores were each independent predictors of exposure to nonsteroid immunosuppressive agents, and for exposure to prednisone. This was not definitely demonstrated for antimalarial agents. Older age at diagnosis was independently and inversely associated with exposure to any of the agents studied (immunosuppressive agents, prednisone, and antimalarial agents). An additional independent predictor of prednisone exposure was black race/ethnicity (adjusted RR 1.46, 95% CI 1.18, 1.81). For immunosuppressive exposure, an additional independent predictor was race/ethnicity, with greater exposure among Asians (RR 1.39, 95% CI 1.02, 1.89) and persons identifying themselves as First Nations/Inuit (2.09, 95% CI 1.43, 3.04) than among whites. All of these findings were reproduced when adjustment for disease activity was limited to renal involvement. CONCLUSION: Ours is the first portrayal of determinants of clinical practice patterns in SLE, and offers interesting real-world insights. Further work, including efforts to determine how differing clinical approaches may influence outcome, is in progress.
PubMed ID
21078722 View in PubMed
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The 1000 Canadian faces of lupus: determinants of disease outcome in a large multiethnic cohort.

https://arctichealth.org/en/permalink/ahliterature151515
Source
J Rheumatol. 2009 Jun;36(6):1200-8
Publication Type
Article
Date
Jun-2009
Author
Christine A Peschken
Steven J Katz
Earl Silverman
Janet E Pope
Paul R Fortin
Christian Pineau
C Douglas Smith
Hector O Arbillaga
Dafna D Gladman
Murray Urowitz
Michel Zummer
Ann Clarke
Sasha Bernatsky
Marie Hudson
Author Affiliation
Department of Medicine, University of Manitoba Arthritis Center, RR149-800 Sherbrook Street, Winnipeg, Manitoba R3A 1M4, Canada. cpeschken@exchange.hsc.mb.ca
Source
J Rheumatol. 2009 Jun;36(6):1200-8
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Continental Population Groups
Female
Health status
Humans
Income
Lupus Erythematosus, Systemic - economics - ethnology - physiopathology
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Prospective Studies
Questionnaires
Severity of Illness Index
Social Class
Abstract
To describe disease expression and damage accrual in systemic lupus erythematosus (SLE), and determine the influence of ethnicity and socioeconomic factors on damage accrual in a large multiethnic Canadian cohort.
Adults with SLE were enrolled in a multicenter cohort. Data on sociodemographic factors, diagnostic criteria, disease activity, autoantibodies, treatment, and damage were collected using standardized tools, and results were compared across ethnic groups. We analyzed baseline data, testing for differences in sociodemographic and clinical factors, between the different ethnic groups, in univariate analyses; significant variables from univariate analyses were included in multivariate regression models examining for differences between ethnic groups, related to damage scores.
We studied 1416 patients, including 826 Caucasians, 249 Asians, 122 Afro-Caribbeans, and 73 Aboriginals. Although the overall number of American College of Rheumatology criteria in different ethnic groups was similar, there were differences in individual manifestations and autoantibody profiles. Asian and Afro-Caribbean patients had more frequent renal involvement and more exposure to immunosuppressives. Aboriginal patients had high frequencies of antiphospholipid antibodies and high rates of comorbidity, but disease manifestations similar to Caucasians. Asian patients had the youngest age at onset and the lowest damage scores. Aboriginals had the least education and lowest incomes. The final regression model (R2=0.27) for higher damage score included older age, longer disease duration, low income, prednisone treatment, higher disease activity, and cyclophosphamide treatment.
There are differences in lupus phenotypes between ethnic populations. Although ethnicity was not found to be a significant independent predictor of damage accrual, low income was.
PubMed ID
19369456 View in PubMed
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Clinical and serologic factors associated with lupus pleuritis.

https://arctichealth.org/en/permalink/ahliterature145759
Source
J Rheumatol. 2010 Apr;37(4):747-53
Publication Type
Article
Date
Apr-2010
Author
Shikha Mittoo
Allan C Gelber
Carol A Hitchon
Earl D Silverman
Janet E Pope
Paul R Fortin
Christian Pineau
C Douglas Smith
Hector Arbillaga
Dafna D Gladman
Murray B Urowitz
Michel Zummer
Ann E Clarke
Sasha Bernatsky
Marie Hudson
Lori B Tucker
Ross E Petty
Christine A Peschken
Author Affiliation
Department of Medicine, University of Manitoba, Manitoba, Canada. shikha.hopkins@gmail.com
Source
J Rheumatol. 2010 Apr;37(4):747-53
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Age of Onset
Autoantibodies - immunology
Canada - epidemiology
Cohort Studies
Female
Humans
Lupus Erythematosus, Systemic - complications - epidemiology - immunology
Male
Middle Aged
Multivariate Analysis
Pleurisy - complications - epidemiology - immunology
Prevalence
Regression Analysis
Severity of Illness Index
Abstract
Pleuritis is a common manifestation and independent predictor of mortality in systemic lupus erythematosus (SLE). We examined the prevalence of pleuritis and factors associated with pleuritis in a multicenter Canadian SLE cohort.
We studied consecutive adults satisfying the American College of Rheumatology (ACR) classification criteria for SLE who had a completed Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) score, at least 1 evaluable extractable nuclear antigen assay, and either a SLE Disease Activity Index (SLEDAI) or a SLE Activity Measure score. Pleuritis was defined as having pleuritis by satisfying the ACR criteria or the SLEDAI. Factors related to pleuritis were examined using univariate and multivariate logistic regression.
In our cohort of 876 patients, 91% were women, 65% Caucasian, mean age (+/- SD) was 46.8 +/- 13.5 years, and disease duration at study entry was 12.1 +/- 9.9 years; the prevalence of pleuritis was 34% (n = 296). Notably, greater disease duration (p = 0.002), higher SDI score (p
PubMed ID
20110526 View in PubMed
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