Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers.

BACKGROUND: Care complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA. OBJECTIVES: We assessed the content validity of the INTERMEDS Self-Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted. METHODS: Patient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs. RESULTS: Three main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA. CONCLUSIONS: Despite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension. PATIENT OR PUBLIC CONTRIBUTION: Patient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.

"How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis.

OBJECTIVE: Patients with rheumatoid arthritis (RA) may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports secure two-way text-messaging between patients and their health care team. The objective of the present study was to explore perspectives and experiences of health care providers (HCPs) and patients related to the use of WelTel as an adjunct to routine care. METHODS: Seventy patients with RA were enrolled in a six-month WelTel pilot project launched in September 2021. Patients received monthly "How are you?" text message check-ins and could message their health care team during clinic hours to request health advice. The current project is a qualitative study of the WelTel pilot. A subgroup of pilot participants was purposively sampled and invited to participate in interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging quality of care domains. RESULTS: Thirteen patients (62% female, mean age 62 years, 10 White) completed interviews. Patients' views suggested that text messaging with the rheumatology team supported high-quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57.1% female, one pharmacist and six rheumatologists) completed interviews. HCPs' perspectives varied based on their experience with the WelTel platform. Additional themes reported by HCPs included perceived increased workload and burnout. CONCLUSIONS: Patients with RA perceived text-based messaging as supporting high-quality care. The impact of increased communications on HCP burnout and workload requires consideration, and future studies should evaluate the effect of texting on patient outcomes.

Protocol for the Study of Heart and Renal Protection-Extended Review: Additional 5-Year Follow-up of the Australian, New Zealand, and Malaysian SHARP Cohort.

BACKGROUND: There are limited studies on the effects of statins on outcomes in the moderate chronic kidney disease (CKD) population and their trajectory to end-stage kidney disease. OBJECTIVE: To examine the long-term effects of lipid-lowering therapy on all-cause mortality, cardiovascular morbidity, CKD progression, and socioeconomic well-being in Australian, New Zealand, and Malaysian SHARP (Study of Heart and Renal Protection) trial participants-a randomized controlled trial of a combination of simvastatin and ezetimibe, compared with placebo, for the reduction of cardiovascular events in moderate to severe CKD. DESIGN: Protocol for an extended prospective observational follow-up. SETTING: Australian, New Zealand, and Malaysian participating centers in patients with advanced CKD. PATIENTS: All SHARP trial participants alive at the final study visit. MEASUREMENTS: Primary outcomes were measured by participant self-report and verified by hospital administrative data. In addition, secondary outcomes were measured using a validated study questionnaire of health-related quality of life, a 56-item economic survey. METHODS: Participants were followed up with alternating face-to-face visits and telephone calls on a 6-monthly basis until 5 years following their final SHARP Study visit. In addition, there were 6-monthly follow-up telephone calls in between these visits. Data linkage to health registries in Australia, New Zealand, and Malaysia was also performed. RESULTS: The SHARP-Extended Review (SHARP-ER) cohort comprised 1136 SHARP participants with a median of 4.6 years of follow-up. Compared with all SHARP participants who originally participated in the Australian, New Zealand, and Malaysian regions, the SHARP-ER participants were younger (57.2 [48.3-66.4] vs 60.5 [50.3-70.7] years) with a lower proportion of men (61.5% vs 62.8%). There were a lower proportion of participants with hypertension (83.7% vs 85.0%) and diabetes (20.0% vs 23.5%). LIMITATIONS: As a long-term follow-up study, the surviving cohort of SHARP-ER is a selected group of the original study participants, which may limit the generalizability of the findings. CONCLUSION: The SHARP-ER study will contribute important evidence on the long-term outcomes of cholesterol-lowering therapy in patients with advanced CKD with a total of 10 years of follow-up. Novel analyses of the socioeconomic impact of CKD over time will guide resource allocation. TRIAL REGISTRATION: The SHARP trial was registered at ClinicalTrials.gov NCT00125593 and ISRCTN 54137607.

CONTEXTE: On trouve peu d'études faisant état de l'effet des statines sur les issues des patients atteints d'insuffisance rénale chronique (IRC) modérée et sur leur évolution vers l'insuffisance rénale terminale (IRT). OBJECTIF: Observer les effets à long terme d'un traitement hypolipidémiant sur la mortalité toutes causes, la morbidité cardiovasculaire, la progression de l'IRC et le mieux-être socioéconomique des participants australiens, néo-zélandais et malaisiens, à l'essai SHARP; un essai contrôlé à répartition aléatoire qui portait sur l'effet comparatif d'une combinaison de simvastatine et d'ézétimibe, ou d'un placebo, sur la réduction des événements cardiovasculaires en contexte d'IRC modérée à grave. PLAN DE L'ÉTUDE: Il s'agit d'un protocole pour un suivi prospectif et observationnel prolongé. CADRE: Les centres d'Australie, de Nouvelle-Zélande et de Malaisie traitant des patients atteints d'IRC de stade avancé et participant à l'essai SHARP. SUJETS: Tous les participants à l'essai SHARP encore vivants lors de la dernière visite de l'étude. MESURES: Les principaux résultats ont été mesurés par autodéclaration des participants et vérifiés auprès des données administratives de l'hôpital. Les résultats secondaires ont été mesurés à l'aide d'un questionnaire validé évaluant la qualité de vie liée à l'état de santé, une enquête économique de 56 questions. MÉTHODOLOGIE: Les participants ont été suivis tous les six mois en alternant les visites en clinique et les entretiens téléphoniques, jusqu'à cinq ans après la dernière visite prévue lors de l'essai SHARP. On a procédé au couplage des données avec les registres de santé d'Australie, de Nouvelle-Zélande et de Malaisie. RÉSULTATS: La cohorte SHARP-ER était constituée de 1 136 participants à l'essai SHARP et la durée de suivi médiane était de 4,6 ans. En comparaison de l'ensemble des patients ayant participé à l'essai SHARP en Australie, en Nouvelle-Zélande et en Malaisie, la cohorte SHARP-ER était plus jeune (57,2 [48,3-66,4] contre 60,5 [50,3-70,7] ans), comptait moins d'hommes (61,5 % contre 62,8 %) et présentait une plus faible proportion de patients hypertendus (83,7 % contre 85,0 %) ou diabétiques (20,0 % contre 23,5 %). LIMITES: Puisqu'il s'agit d'une étude de suivi à plus long terme, la cohorte de survivants (SHARP-ER) constitue un groupe choisi à partir de l'ensemble des participants à l'essai initial, ce qui pourrait limiter la généralisabilité des résultats. CONCLUSION: L'étude SHARP-ER, avec un suivi total sur dix ans, apportera des informations importantes sur les effets à long terme d'un traitement hypolipidémiant chez les patients atteints d'IRC de stade avancé. De nouvelles analyses des impacts socioéconomiques de l'IRC au fil du temps éclaireront l'affectation des ressources.

The metabolic demands of internal medicine residency.

BACKGROUND: North American and European accreditation bodies have legislated progressively more strict work hour restrictions for residents in light of evidence that sleep deprivation leads to increased medical errors and decreased wellbeing. The purpose of the study is to determine the physiologic demands of internal medicine training during residency as well as document average sleep (on- and off-call) and physical activity performed using accelerometers. METHODS: A total of 40 internal medicine residents working on the clinical teaching unit at a single center were enrolled in the study from November 2011 to March 2016. There were 22 subjects that completed the study and were included in the analysis. SenseWear PRO 2 armband monitors were worn for 5 consecutive days including one call day. The primary outcomes of the study were to quantify and compare the calories per day, steps per day, METs per hour, hours of activity, hours of sleep, and sleep efficiency for on call versus post-call and non-call days. RESULTS: The average activity per day, calories per day, steps per day and METs per hour for the call day were 7.6 ± 7.6 h, 2647.0 ± 541.1, 11,261.1 ± 2355.9, and 1.7 ± 0.2 respectively. Each of these parameters had a statistically significant F statistic compared to post-call and non-call days. The subjects had a mean of 1.8 ± 2.0 h of sleep per day with a sleep efficiency of 77.3 ± 23.8% for the call day. The F statistic for sleep per day was significant with a p value < 0.001. CONCLUSION: This study shows that overnight call has a substantial impact on multiple metabolic parameters. These findings have potentially important implications on future resident working hour restrictions.

Fast multichannel blind system identification using Laguerre filters.

Multiple channel blind system identification (MBSI) is often used in applications where the input signal cannot be measured and its statistical properties are unknown. Traditionally, the channel dynamics are modeled using finite impulse response filters. The number of model parameters can be significantly reduced if the filters are expanded onto a suitably chosen expansion basis, such as the discrete Laguerre filters, but several tuning parameters must be chosen correctly. This paper describes an efficient implementation of the Laguerre MBSI technique that allows for the rapid evaluation of many possible basis expansions, and hence tuning parameters. Monte-Carlo simulations compare the performances of the traditional and fast implementations.

Identification of Hammerstein models with cubic spline nonlinearities.

This paper considers the use of cubic splines, instead of polynomials, to represent the static nonlinearities in block structured models. It introduces a system identification algorithm for the Hammerstein structure, a static nonlinearity followed by a linear filter, where cubic splines represent the static nonlinearity and the linear dynamics are modeled using a finite impulse response filter. The algorithm uses a separable least squares Levenberg-Marquardt optimization to identify Hammerstein cascades whose nonlinearities are modeled by either cubic splines or polynomials. These algorithms are compared in simulation, where the effects of variations in the input spectrum and distribution, and those of the measurement noise are examined. The two algorithms are used to fit Hammerstein models to stretch reflex electromyogram (EMG) data recorded from a spinal cord injured patient. The model with the cubic spline nonlinearity provides more accurate predictions of the reflex EMG than the polynomial based model, even in novel data.

Using system identification to model the transmission of vibroarthrographic signals.

Vibroarthrographic signals have been proposed as a noninvasive tool for the diagnosis of joint injury. Models of VAG generation and transmission are required before application of this technique can begin. An experiment has been designed and performed to estimate sound transmission in the human knee at set joint angles. Linear frequency domain models and linear and nonlinear time domain models were estimated from the experimental data. Linear models with high accuracy were identified for knees at an angle of 90/ degrees . Models identified from angles below 90 degrees had relatively low accuracy.