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Blood Transfusion = Trasfusione Del... Jul 2021Although the widespread use of factor VIII/IX replacement therapy has significantly reduced the severity of arthropathy in persons with haemophilia (PWH), some develop...
BACKGROUND
Although the widespread use of factor VIII/IX replacement therapy has significantly reduced the severity of arthropathy in persons with haemophilia (PWH), some develop degenerative joint changes, associated with significant pain. The aim of this survey was to investigate the management and perception of pain among Italian physicians who treat PWH.
MATERIALS AND METHODS
Between September and October 2017, a questionnaire was distributed to 35 Italian haemophilia treatment centres (60 physicians).
RESULTS
Fifty-three haemophilia specialists completed the survey. We found that there was good agreement (98.1%) on the need to investigate pain at each clinical visit, but there was heterogeneity in the opinions of haemophilia specialists with regards to the availability of validated guidelines (35.8%) and whether pain specialists should be a part of the comprehensive care team in daily clinical practice (58.5%). Haemophilia specialists also agreed pain should be evaluated using a rating scale validated in PWH (88.7%). Pain was mainly managed by the haemophilia specialists themselves, supported by a physiatrist and physiotherapist, while a pain specialist was only involved in 26.4% of cases. The combination of paracetamol with tramadol or codeine was the most common first-line treatment, while cyclo-oxygenase-2 inhibitors, non-steroidal anti-inflammatory drugs, and opioids were less commonly used.
DISCUSSION
There are some unmet needs in Italy regarding pain management for PWH and the management of pain in these patients by haemophilia specialists. There is a lack of evidence-based guidelines for these specialists to use, as well as a reluctance to involve pain specialists. The lack of spontaneous reporting of pain by PWH, despite using pain relief, highlights the need for clinicians to actively ask patients about any pain they may be experiencing.
Topics: Factor IX; Hemophilia A; Humans; Italy; Pain Management; Pain Measurement
PubMed: 33263519
DOI: 10.2450/2020.0085-20 -
International Journal of Environmental... Sep 2021Burnout is an emerging critical issue facing specialists and trainees in all disciplines and not particularly studied among physiatry specialists and trainees in Saudi...
BACKGROUND
Burnout is an emerging critical issue facing specialists and trainees in all disciplines and not particularly studied among physiatry specialists and trainees in Saudi Arabia during the COVID-19 pandemic.
OBJECTIVE
To assess physiatrist burnout, depression, anxiety, and stress during the current COVID-19 pandemic crisis in Saudi Arabia.
DESIGN
Cross-sectional study.
SETTING
By distributing an electronic survey, the researcher assessed burnout using the Maslach Burnout Inventory (MBI) Human Services Survey (HSS) in the midst of the curfew that Saudi authorities imposed.
PARTICIPANTS
One hundred one participating trainees, specialists, and consultants.
RESULTS
Of the 101 study participants, the majority (73.3%) were between the ages of 24 and 34 years old, with the rest distributed within the age group ranging from 35 to 65 years old. Junior residents represented 34.7%, senior residents 22.8%, physiatrist specialists 26.7%, and consultants 15.8%. The sample included 55.4% males and 44.6% females; 64.4% of the participants were married, 29.7% were still single, and 5.9% were divorced. Among the total group participating, 25.7% were handling COVID-19 patients. In the total participant sample, 80.2% reported experiencing burnout, 10.9% experienced stress, and 22.8% and 6.9% experienced anxiety and depression, respectively.
CONCLUSION
Burnout in Saudi Arabia exists among more than two-thirds of practicing physiatrists in Physical Medicine & Rehabilitation (PM&R), and that did not appear to have a statistically significant influence on stress, anxiety, or depression ( > 0.05). The current COVID-19 global pandemic might escalate burnout and influence mental health outcomes. The healthcare authority and administration should take the lead in identifying the challenges, overcoming the obstacles, and optimizing clinician well-being, delivering up-to-date solutions, and promptly checking their effectiveness.
Topics: Adult; Burnout, Psychological; COVID-19; Cross-Sectional Studies; Depression; Female; Humans; Male; Pandemics; Physiatrists; SARS-CoV-2; Saudi Arabia; Young Adult
PubMed: 34574546
DOI: 10.3390/ijerph18189621 -
Journal of Multidisciplinary Healthcare 2023Idiopathic inflammatory myopathies (IIM) are a rare heterogeneous group of diseases characterised by chronic skeletal muscle inflammation, but other organs are also...
BACKGROUND
Idiopathic inflammatory myopathies (IIM) are a rare heterogeneous group of diseases characterised by chronic skeletal muscle inflammation, but other organs are also frequently involved. IMM represent a diagnostic challenge and a multidisciplinary approach is important to ensure successful diagnosis and adequate follow-up of these patients.
OBJECTIVE
To describe the general functioning of our multidisciplinary myositis clinic, highlighting the benefits of multidisciplinary team management in patients with confirmed or suspected IIM and to characterise our clinical experience.
METHODS
Description of the organization of a dedicated multidisciplinary myositis outpatient clinic, supported by IMM specific electronic assessment tools and protocols based on our Portuguese Register - Reuma.pt. In addition, an overview of our activity between 2017 and 2022 is provided.
RESULTS
An IIM multidisciplinary care clinic, based on a close collaboration between Rheumatologists, Dermatologists and Physiatrist is detailed in this paper. One hundred and eighty-five patients were assessed in our myositis clinic; 138 (75%) of those were female, with a median age of 58 [45-70] years. At the last appointment, 130 patients had a confirmed IIM diagnosis, and the mean disease duration was 4 [2-6] years. The most frequent diagnosis was dermatomyositis (n = 34, 26.2%), followed by antisynthetase syndrome (n = 27, 20.8%) and clinically amyopathic/paucimyopathic dermatomyositis (n = 18, 13.8%). Twenty-four patients (18.5%) were on monotherapy and 94 (72.3%) were on combination therapy.
CONCLUSION
A multidisciplinary approach is important to ensure the correct diagnosis and follow-up of these patients. A myositis clinic, with a standardised practice at a tertiary hospital level, contributes to a standardization of care and opens research opportunities.
PubMed: 37131932
DOI: 10.2147/JMDH.S404017 -
Medicine Aug 2016This study was intended to determine if there is variation among physiatrists in referral preferences for postacute rehabilitation for stroke patients based on physician...
This study was intended to determine if there is variation among physiatrists in referral preferences for postacute rehabilitation for stroke patients based on physician demographic characteristics or geography.A cross-sectional survey study was developed with 5 fictional case vignettes that included information about medical, social, and functional domains. Eighty-six physiatrist residents, fellows, and attendings were asked to select the most appropriate postacute rehabilitation setting and also to rank, by importance, 15 factors influencing the referral decision. Chi-square bivariate analysis was used to analyze the data.Eighty-six surveys were collected over a 3-day period. Bivariate analysis (using chi-square) showed no statistically significant relationship between any of the demographic variables and poststroke rehabilitation preference for any of the cases. The prognosis for functional outcome and quality of postacute facility had the highest mean influence ratings (8.63 and 8.31, respectively), whereas location of postacute facility and insurance had the lowest mean influence ratings (5.74 and 5.76, respectively).Physiatrists' referral preferences did not vary with any identified practitioner variables or geographic region; referral preferences only varied significantly by case.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Physiatrists; Practice Patterns, Physicians'; Referral and Consultation; Stroke; Stroke Rehabilitation; Surveys and Questionnaires
PubMed: 27537563
DOI: 10.1097/MD.0000000000004356 -
Federal Practitioner : For the Health... Nov 2019While current approaches to treatment focus on surgery, opiates, and other medications, health care providers may also consider ketamine infusion, electrostimulation,...
While current approaches to treatment focus on surgery, opiates, and other medications, health care providers may also consider ketamine infusion, electrostimulation, and perineural injections.
PubMed: 31892777
DOI: No ID Found -
Clinical Medicine Insights. Arthritis... 2022Osteoarthritis is a prevalent degenerative disease affecting a large portion of the world's aging population. Currently, nonsteroidal anti-inflammatory drugs and... (Review)
Review
Osteoarthritis is a prevalent degenerative disease affecting a large portion of the world's aging population. Currently, nonsteroidal anti-inflammatory drugs and acetaminophen are first-line medications for treating osteoarthritis patients' pain. However, several studies have noted that while these medications control pain they do not halt progressive degeneration and tend to have an unfavorable side-effect profile with prolonged use. Recently, due to their more favorable side-effect profiles, herbal alternatives for controlling osteoarthritis symptoms and for alleviating the progression of the disease are being increasingly studied. Synogesic is a newly developed herbal supplement blend by renowned orthopedic surgeons and physiatrists consisting of turmeric, rutin, ginger root, vitamin C, vitamin D, and boswellia extracts. A study by Sharkey et al. has commented on the efficacy of the blend on the patients with knee osteoarthritis. So far, a review on the ingredients of the blend has not yet carried outbeen. By exploring prominent literature databases including PubMed and ScienceDirect, our aim is to write a narrative review to explore the individual ingredients of this blend and delve into their characteristics, as well as the most recent literature on their mechanism and efficacy in patients with osteoarthritis. Through this, we hope to inform clinicians and patients alike on relevant up-to-date research on the supplement and provide insight on the potential for this supplement for alleviating the disease course of patients with osteoarthritis.
PubMed: 35360183
DOI: 10.1177/11795441211063365 -
International Journal of Environmental... Aug 2021Occupational-specific classifications of musculoskeletal disorders (MSD) are scarce and do not answer specific clinical questions. Thus, a specific classification was...
Occupational-specific classifications of musculoskeletal disorders (MSD) are scarce and do not answer specific clinical questions. Thus, a specific classification was developed and proposed, covering criteria applicable to daily clinical activity. It was considered that the disorder development process is the same across all work-related MSDs (WRMSDs). Concepts of clinical pathology were applied to the characteristics of WRMSDs pathophysiology, cellular and tissue alterations. Then, the correlation of the inflammatory mechanisms with the injury onset mode was graded into four levels (MSDs 0-3). Criteria of legal, occupational and internal medicine, semiology, physiology and orthopaedics, image medicine and diagnostics were applied. Next, the classification was analysed by experts, two occupational physicians, two physiatrists and occupational physicians and one orthopaedist. This approach will allow WRMSD prevention and improve therapeutic management, preventing injuries from becoming chronic and facilitating communication between occupational health physicians and the other specialities. The four levels tool relate aetiopathogenic, clinical, occupational and radiological concepts into a single classification. This allows for improving the ability to determine a WRMSD and understanding what preventive and therapeutic measures should be taken, avoiding chronicity. The developed tool is straightforward, easy to understand and suitable for WRMSDs, facilitating communication between occupational physicians and physicians from other specialities.
Topics: Humans; Musculoskeletal Diseases; Occupational Diseases; Occupational Health; Occupational Medicine; Physicians
PubMed: 34360516
DOI: 10.3390/ijerph18158223 -
Progress in Rehabilitation Medicine 2023: To ease the burden on care facilities, there is a need to reduce the number of frail older people with multiple chronic and non-communicable diseases (multimorbidity)...
OBJECTIVES
: To ease the burden on care facilities, there is a need to reduce the number of frail older people with multiple chronic and non-communicable diseases (multimorbidity) that require long-term care. We investigated the effects of therapeutic exercise in rehabilitation treatment for older individuals with frailty and multimorbidity.
METHODS
: We performed 4 weeks of inpatient rehabilitation treatment for frail older patients with multimorbidity. The therapeutic exercise was performed based on whole-body evaluations by qualified physiatrists and physiotherapists. Sixty-minute sessions were conducted twice a day and six times a week in accordance with the American College of Sports Medicine guidelines. Physical functions (grip strength, isometric lower muscle strength, 10-m walking test, and 6-min walking test) were measured at admission and discharge.
RESULTS
: Of the 33 patients, 8 were unable to complete physical function evaluations, and 1 patient had a stress fracture of the right calcaneus beyond the rehabilitation time. Twenty-four patients were included in the analysis. Compared to the admission period, significant improvements were observed for all evaluated parameters post-therapy (P < 0.05). However, no significant correlation was found between the number of chronic diseases and changes to physical function (P > 0.05).
CONCLUSIONS
: Physical function of frail older individuals with multimorbidity improves through rehabilitation treatments supervised by physiatrists and physiotherapists. The number of chronic illnesses and the improvements in physical function were not related. Therefore, rehabilitation treatments for older patients may target both frailty and multimorbidity. Our results will aid in the rehabilitation treatment plans for this demographic.
PubMed: 37020723
DOI: 10.2490/prm.20230012 -
Missouri Medicine 2022Falls occur at staggering rates across the country, with 25% of Americans over 65 reporting annual falls. The fall rate in Missourian older adults is 27.3%. Eighty-six... (Review)
Review
Falls occur at staggering rates across the country, with 25% of Americans over 65 reporting annual falls. The fall rate in Missourian older adults is 27.3%. Eighty-six percent of fall-related deaths happen over the age of 65. There are many intrinsic and extrinsic factors that contribute to falls, with some factors that can be targeted and optimized by physicians. There are nuances to the history and physical that can help physicians identify these risk factors.
Topics: Accidental Falls; Aged; Demography; Humans; Risk Assessment; Risk Factors
PubMed: 36036034
DOI: No ID Found