Ability and willingness to utilize telemedicine among rheumatology patients-a cross-sectional survey.

INTRODUCTION/OBJECTIVES: This study aims to assess the patients' ability and willingness to utilize telemedicine (TM) along with identifying some of the barriers to a more widespread adoption of TM in rheumatology. METHODS: An observational, cross-sectional study of patients visiting a rheumatology clinic was conducted in 2018. We used a survey to assess patients' attitude on the perceived effectiveness when comparing TM versus in-person visits, as well as patients' access to technology, distance traveled by the patient to attend the clinic visit, and demographic parameters. RESULTS: A total of 214 patients were included. Negative correlations were found between the increase in age and access to technologies (front-facing camera (mean age difference - 12.8), telephone (mean age difference - 14.4), and stable internet connection (mean age difference - 15.1)), as well as believing that their needs could be met through TM (r - .224, p < 0.001) and thinking that TM could be an appropriate alternative method of healthcare (r - .298, p < 0.001). Younger patients reported more conflict between appointments and work hours (mean age difference - 11.73). Follow-up patients were more likely to feel that their visit could have been possible over the phone (mean difference - 1.13) or video conferencing (mean difference - 1.13) compared to new patients. Older patients were less likely to think that the purpose of their rheumatology visits could be achieved over the phone (r - .207, p = 0.003) or video conferencing (r - .331, p = 0.001). The further the distance traveled, the more the patients were willing to utilize TM compared to in-person visits (r 0.167, p = 0.019). CONCLUSION: Out of necessity due to the COVID-19 pandemic, rheumatology clinics are increasingly turning to TM. The results of this study suggest that access and familiarity with technology may still be limited in certain demographics, particularly the elderly. Furthermore, this study helps to understand some of the additional barriers to more widespread adoption and patients' perceived limitations of TM. Key Points • This study aimed to assess rheumatology patients' willingness to utilize telemedicine (TM) while determining the factors and barriers that may exist for a more widespread adoption of TM, using a cross-sectional survey in the setting of a rheumatologic clinic. • The age of the patient was the most significant contributing factor in a patient's perception of TM, with older patients being less likely to think that the purpose of their rheumatology visits could be achieved over the phone or via videoconferencing. • The social trend of limited access to technology among the elderly population was reinforced by the results in this study. • Patients who had a greater commute to the clinic were more likely to willing to utilize TM consultations. • The results of this study highlight the elevated difficulty elderly patient populations have in utilizing TM. • With the current outbreak of COVID-19, the importance of utilizing TM specifically among the elderly population could prove vital. Future studies to focus on the elderly population and methods for helping these patients become familiar with TM would be beneficial. • Studies such as this can help to orchestrate future guidelines for TM in the field of rheumatology. Based on our study results, the new-patient encounter should be an in-person face-to-face encounter whenever possible, followed by TM visits for established patients who are able and open to using it, depending on the diagnosis and symptoms of the individual patients.

Dairy Consumption: Does It Make an Impact on Self-Reported Disease Activity of Inflammatory Arthritis?

Background As researchers and the public become more cognizant of the impacts of diet and nutrition on health, continued research is needed to provide evidence to support dietary claims. At present, there exists mixed reporting on the effects of dairy consumption and disease activity of inflammatory arthritis (IA). Objective This study attempts to advance current research on the relationship between dairy consumption and self-reported disease activity in patients with IA and to investigate whether dietary modifications can be helpful as a conservative, cost-effective, and accessible supplement to established treatments. Methods Participants completed a modified diet history questionnaire (DHQ), which assessed dairy consumption over the past year, and a Routine Assessment of Patient Index Data 3 (RAPID3) questionnaire, which assessed a participants' self-reported inflammatory disease activity. DHQ and RAPID3 were analyzed using a Pearson product-moment partial correlation to assess variables' relationships. Participants completed the questionnaire in the setting of a rheumatology clinic. Two hundred and four participants were recruited for this study. All of the participants were at least 18 years of age, capable of giving informed consent, and were formally diagnosed with either rheumatoid arthritis or psoriatic arthritis by a board-certified rheumatologist.  Results The results from the questionnaires found that dairy consumption does not contribute to self-reported IA disease activity. While 11 of the 16 DHQ variables maintained a positive correlation with the overall RAPID3 scores, none of these possessed statistical significance. Only when controlling for age and sex did the study find two statistically significant variable correlations between the quantity of milk consumed as a beverage (r=0.147, n=193, p=0.043) and milk added to cereal (r=0.170, n=189, p=0.019) with the RAPID3 scores. Conclusion In summation, the study found no notable correlation between dairy consumption and patients' self-reported IA disease activity.

Yoga as a Novel Adjuvant Therapy for Patients with Idiopathic Inflammatory Myopathies.

CONTEXT: Recent studies have demonstrated that physical activity is well tolerated by patients with idiopathic inflammatory myopathies (IIMs) and can have additional benefits as an adjuvant therapy to pharmacologic agents, especially if started early. To date, no studies have examined the effects of yoga on patients with IIMs. AIMS: The aim of this study was to evaluate the effects of yoga on self-reported difficulty in performing activities of daily living (ADL) and muscle strength in patients with mild-to-moderate IIMs. SUBJECTS AND METHODS: A longitudinal cohort study in which participants were assessed using the Myositis Activities Profile (MAP) and manual muscle testing (MMT) before and after the completion of an 8-week instructor-guided yoga course was performed. STATISTICAL ANALYSIS USED: Wilcoxon signed-ranked test was performed for statistical analysis. RESULTS: The average posttreatment MAP scores of six participants demonstrated an increase of 2.51 points, while the average MMT score of four participants demonstrated an increase of 11 points. CONCLUSIONS: This study is the first study to date to examine the effect of yoga as an adjuvant complementary therapy for patients with IIM. Continued research should be done on the effect of yoga as an adjuvant therapy, for in addition to increase in muscle strength and ability to perform ADL, yoga may offer potential improvements in mood, mental health, and sleep.

Sneddon syndrome: under diagnosed disease, complex clinical manifestations and challenging diagnosis. A case-based review.

Herein, we report a case-based review of the Sneddon Syndrome (SS), a rare chronic condition which affects small to medium blood vessels. It is known by its skin presentation, livedo racemosa (LRC), and the relapsing cerebrovascular events. However, neither LRC nor cerebrovascular events are exclusive to SS. A 36-year-old female with history of mitral valve prolapse, hypothyroidism, Raynaud phenomenon, hypertension, migraines, and four episodes of transient ischemic attacks (TIA), presented to our clinic with new skin findings, suggestive of LRC. Based on her previous history, current presentation and skin biopsy results, she was diagnosed with SS secondary to antiphospholipid syndrome. The present report illustrates the difficulty in recognizing SS and how the heterogeneity of the disease may be contributing to the difficulty making a distinct diagnosis.

Awareness and Attitudes Towards Telemedicine Among Medical Students in the United States.

INTRODUCTION:  Telemedicine (TM) or telehealth is defined as the delivery of healthcare services at a distance using electronic means. It is a rapidly growing field of medicine that uses telecommunication to provide healthcare services to patients such as the elderly and those in rural locations who may otherwise be unable to make it to the hospital or physician's office. With the rise in the popularity of TM, educating future physicians on this technology will become vital. This study aimed to explore medical students' experiences and opinions regarding TM. METHODS:  An online survey was sent to 287 medical students in 20 different allopathic medical schools in the United States. The survey consisted of 14 questions that included demographic information, information regarding TM exposure, interest in TM, and plans for future utilization. RESULTS:  The result of this study indicated that only 17.4% of medical students had prior exposure to TM. However, the increased exposure to TM helped not only to increase awareness of the technology but also helped students form opinions on TM. Lastly, students in all intended specialties had interests in utilizing TM in the future with specialties such as pathology, psychiatry, ophthalmology, and dermatology indicating the highest levels of interest. CONCLUSION:  As medicine continues to incorporate technology into the care of patients, training institutions need to expose future physicians to the modalities of care they will be utilizing. The results of this survey suggest that the development of education and exposure to TM will become increasingly important as more medical students indicate interest in utilizing this technology.

Improving Screening for Latent Tuberculosis Infection in a Student-run Free Clinic.

Introduction Latent tuberculosis infection (LTBI) screening with targeted treatment has been successful in eradicating tuberculosis (TB) as an endemic infection in the United States. The Centers for Disease Control and Prevention (CDC) recommends screening for high-risk patients. The aim of this study was to increase LTBI screening, detection, and treatment in our student-run free clinic while providing an innovative platform for education in primary care topics. Methods A questionnaire for screening for LTBI was adapted from CDC guidelines. Medical students and providers received education on the screening process and administered questionnaires to patients. We analyzed the rate of performed LTBI screening, the rate of diagnostic testing for patients with positive screening, and the feasibility of implementing a preventive screening initiative. Results Fifty-two patients completed primary care visits. Forty patients were screened for LTBI. Of those screened, 42.5% were positive for the screening. Of those with positive screening, 70.6% were followed up via diagnostic testing, with the rest of them being lost for follow-up due to not attending the clinic for care. Conclusions This educational intervention combined with a screening tool was effective in increasing LTBI screening rates amongst patients in a student-run free clinic.