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Asia-Pacific initiative for rheumatology nurse education: An impact survey in China
Abstract
Background/Objective: Asia-Pacific Initiative for Rheumatology nurse Education (ASPIRE) is a faculty-led initiative established to meet the educational needs of rheumatology nurses in Asia Pacific in recognition of the expanding role of nurses in daily rheumatology clinical practice. The objective of this study is to measure the impact of ASPIRE workshop training on nurses’ levels of knowledge, confidence, attitudes and beliefs using a Before-after-control-impact (BACI) survey.Methods: A total of 210 nurses who completed both pre- and post-surveys were included in the BACI analysis. The intervention group (n = 111) refers to nurses who attended the ASPIRE workshop training held during the China Chronic Disease Management Forum in Baotou, Inner Mongolia in September 2019 whereas the control group (n = 99) refers to Chinese nurses that have never attended the ASPIRE training. Results: Overall level of knowledge significantly increased by 30% (5.63 pre- vs. 8.34 post-survey; p < .001), and overall level of confidence significantly increased by 29% among nurses who attended ASPIRE training (5.83 pre- vs. 8.39 post-survey; p < .001). Nurses in the control group demonstrated no significant increase in knowledge (6.18 pre- vs. 6.50 post-survey; p = .097) or confidence (6.46 pre- vs. 6.71 post-survey; p = .169) over the same period.}Conclusions: Nurses who attended the ASPIRE training workshop reported a significant increase in their levels of knowledge and confidence compared with a control group of nurses who have never undergone ASPIRE training. Training rheumatology nurses to acquire more in-depth knowledge and skills can help optimize their role in clinical practice to meet the greater demands of disease monitoring and long-term management of rheumatology patients.
... 18 The success of ASPIRE workshop trainings was evaluated by a before-after-control-impact survey, and a significant increase in knowledge (by 30%) and confidence (by 29%) (p < 0.001 on a participant level was observed. 19 ...
A striking change in the external stakeholders' engagement due to unexpected scenarios as a result of COVID-19 pandemic has hurled the medical affairs (MA) function into innovative strategies of scientific engagements and patient-centric activities. Expansion of MA functions including rising regulatory and compliance inspections, an increased patient centricity and more requirements for RWE, have created the importance of medical affairs not just being the support function but as a trusted strategic pillar in the pharmaceutical and healthcare industry. There is certainly a silver lining due to strong digital transformation within these adverse times. The present review is focused on digital transformation for dissemination of medical information and its advantages over traditional ways. In today's pandemic era HCPs have embraced the idea of virtual CMEs and digital storytelling which has necessitated the MA function to become more agile, adapted and look for collaborations. Both the exponential and radical improvements are required to strengthen this transition, in the new normal of a post-COVID era. The digital innovation in three key vitals viz. HCP engagement, external partnerships and data generation will allow MA to become future fit as a strategic leadership function. Moreover, the recommendations from executive committees of renowned international societies such as APPA, IFAPP, MAPS and MSLS, who have contributed for MA function to create their own standard operating procedures (SOPs), policies which are relevant for industry, are also discussed.
... org/ educa tion_ page/ aspire/) [59]. To measure the success of ASPIRE workshop trainings on a participant level of knowledge, confidence, attitudes and beliefs using a before-after-control-impact survey was carried out, demonstrating a significant increase in knowledge and confidence [60]. ...
... org/ educa tion_ page/ aspire/) [59]. To measure the success of ASPIRE workshop trainings on a participant level of knowledge, confidence, attitudes and beliefs using a before-after-control-impact survey was carried out, demonstrating a significant increase in knowledge and confidence [60]. ...
A number of developments, including increasing regulatory and compliance scrutiny, increased transparency expectations, an increasingly vocal patient, patient centricity and greater requirements for real-world evidence, have driven the growth and importance of medical affairs as a trusted, science-driven partner over the past decade. The healthcare environment is shifting towards a digital, data-driven and payor-focused model. Likewise, medical affairs as a function within the pharmaceutical industry has become more “patient-centric” with strategic engagements embracing payers and patients apart from clinicians. The pandemic has impacted the healthcare industry as well as the function of medical affairs in numerous ways and has brought new challenges and demands to tackle. There is indeed a silver lining due to intense digital transformation within this crisis. The emerging digital innovation and new technologies in healthcare, medical education and virtual communications are likely to stay and advance further. In this review, we discuss how the digital transformation sparked by the pandemic has impacted the medical affairs function in pharmaceuticals and provide further insights and learnings from the COVID-19 era and beyond. Based on the learning and insights, digital innovation in three key strategic imperatives of medical affairs—HCP engagement, external partnerships and data generation will enable medical affairs to become future-fit as a strategic leadership function.
Objective
To measure long‐term knowledge gain after provision of nursing education in a low‐income country.
Design and Sample
Global health education research has often focused on the short‐ term effects of providing education and direct patient care. Assessment of long‐term knowledge gain is key for determining whether education knowledge transfer is sustainable.
Measurements
This prospective cohort study of educational training for nurses in Haiti tested knowledge gain before, immediately after, and 6 months after education.
Intervention
Quantitative assessments were obtained through multiple choice tests at 3 time points. Qualitative data were obtained through focus groups and self‐assessments.
Results
Knowledge gain was significant from pretest to immediate posttest, and knowledge retention was assessed at 6 months after the education. Qualitative data showed improvement in reported confidence levels and patient care activities. Short‐term knowledge gain was statistically significant for improvement; however, long‐term knowledge gain was statistically significant in only 4 of 19 lectures.
Conclusions
Reported qualitative improvements in patient care indicated added value of providing education to the nursing staff. Hands‐on learning techniques were important to long‐term retention, and building trust was vital to the completion of our study.
Background
A changing sociodemographic landscape has seen rising numbers of people with two or more long-term health conditions. Multimorbidity presents numerous challenges for patients and families and those who work in healthcare services. Therefore, the nursing profession needs to understand the issues involved in supporting people with multiple chronic conditions and how to prepare the future workforce to care for them.
Methods
A descriptive, exploratory study was used to examine the future of nursing in an age of multimorbidity. An hour-long Twitter chat was organised and run by the Florence Nightingale Foundation Chairs of Clinical Nursing Practice Research to discuss this important area of practice and identify what needs to be done to adequately upskill and prepare the nursing profession to care for individuals with more than one long-term illness. Questions were formulated in advance to provide some structure to the online discussion. Data were collected and analysed from the social media platform using NVivo and an analytics tool called Keyhole. Descriptive statistics were used to describe participants and thematic analysis aided the identification of key themes.
Results
Twenty-four people, from a range of nursing backgrounds and organisations, took part in the social media discussion. Five themes encompassing coping with treatment burden, delivering holistic care, developing an evidence base, stimulating learning and redesigning health services were seen as key to ensuring nurses could care for people with multimorbidity and prevent others from developing chronic health conditions.
Conclusions
Multimorbidity is a pressing health issue in today’s society. Changes in nursing research, education and practice are required to help the profession work collaboratively with patients, families and multidisciplinary teams to better manage and prevent chronic illness now and in the future.
Background
In the UK, gout management is suboptimum, with only 40% of patients receiving urate-lowering therapy, usually without titration to achieve a target serum urate concentration. Nurses successfully manage many diseases in primary care. We compared nurse-led gout care to usual care led by general practitioners (GPs) for people in the community.
Methods
Research nurses were trained in best practice management of gout, including providing individualised information and engaging patients in shared decision making. Adults who had experienced a gout flare in the previous 12 months were randomly assigned 1:1 to receive nurse-led care or continue with GP-led usual care. We assessed patients at baseline and after 1 and 2 years. The primary outcome was the percentage of participants who achieved serum urate concentrations less than 360 μmol/L (6 mg/dL) at 2 years. Secondary outcomes were flare frequency in year 2, presence of tophi, quality of life, and cost per quality-adjusted life-year (QALY) gained. Risk ratios (RRs) and 95% CIs were calculated based on intention to treat with multiple imputation. This study is registered with www.ClinicalTrials.gov, number NCT01477346.
Findings
517 patients were enrolled, of whom 255 were assigned nurse-led care and 262 usual care. Nurse-led care was associated with high uptake of and adherence to urate-lowering therapy. More patients receiving nurse-led care had serum urate concentrations less than 360 μmol/L at 2 years than those receiving usual care (95% vs 30%, RR 3·18, 95% CI 2·42–4·18, p<0·0001). At 2 years all secondary outcomes favoured the nurse-led group. The cost per QALY gained for the nurse-led intervention was £5066 at 2 years.
Interpretation
Nurse-led gout care is efficacious and cost-effective compared with usual care. Our findings illustrate the benefits of educating and engaging patients in gout management and reaffirm the importance of a treat-to-target urate-lowering treatment strategy to improve patient-centred outcomes.
Funding
Arthritis Research UK.
Background and purpose:
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation, pain, joint stiffness, and progressive joint destruction. An increased demand for rheumatology healthcare professionals is anticipated in coming years; utilizing more nurse practitioners (NPs) in rheumatology may help meet this demand, and improve early detection and diagnosis of RA.
Methods:
The American Association of Nurse Practitioners surveyed, via e-mail, members who were working in primary care settings to understand their educational and professional needs to help manage their patients with RA. Respondents were surveyed about their NP certifications, patient panel, information received from rheumatologists on shared patients, RA tools or resources that would be helpful, confidence in diagnosing and managing patients with RA, interest in learning about particular topics regarding RA medications, and preferences for exchanging educational information with their professional colleagues.
Conclusions:
The results from this survey indicate that the role of NPs in managing RA could be optimized by improved communication with treating rheumatologists, access to educational tools and resources, and further education and training in the management of RA.
Implications for practice:
NPs in primary care can fill a resource gap and provide access to health care for patients with RA.
One of the frequent questions by users of the mixed model function lmer of the lme4 package has been: How can I get p values for the F and t tests for objects returned by lmer? The lmerTest package extends the 'lmerMod' class of the lme4 package, by overloading the anova and summary functions by providing p values for tests for fixed effects. We have implemented the Satterthwaite's method for approximating degrees of freedom for the t and F tests. We have also implemented the construction of Type I - III ANOVA tables. Furthermore, one may also obtain the summary as well as the anova table using the Kenward-Roger approximation for denominator degrees of freedom (based on the KRmodcomp function from the pbkrtest package). Some other convenient mixed model analysis tools such as a step method, that performs backward elimination of nonsignificant effects - both random and fixed, calculation of population means and multiple comparison tests together with plot facilities are provided by the package as well.
Background:
Recommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients' disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy.
Methods:
Patients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care.
Results:
A total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated € 14107.7 per patient in the NLC compared with € 16274.9 in the RCL (p = 0.004), giving a € 2167.2 (13 %) lower annual cost for the NLC.
Conclusions:
Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity.
Trial registration:
The trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8, 2009.
Download a full text pdf http://ard.bmj.com/content/early/2015/03/03/annrheumdis-2014-206807.full.pdf+html
Objectives The task force aimed to: (1) develop evidence-based recommendations for patient education (PE) for people with inflammatory arthritis, (2) identify the need for further research on PE and (3) determine health professionals’ educational needs in order to provide evidence-based PE.
Methods A multidisciplinary task force, representing 10 European countries, formulated a definition for PE and 10 research questions that guided a systematic literature review (SLR). The results from the SLR were discussed and used as a basis for developing the recommendations, a research agenda and an educational agenda. The recommendations were categorised according to level and strength of evidence graded from A (highest) to D (lowest). Task force members rated their agreement with each recommendation from 0 (total disagreement) to 10 (total agreement).
Results Based on the SLR and expert opinions, eight recommendations were developed, four with strength A evidence. The recommendations addressed when and by whom PE should be offered, modes and methods of delivery, theoretical framework, outcomes and evaluation. A high level of agreement was achieved for all recommendations (mean range 9.4–9.8). The task force proposed a research agenda and an educational agenda.
Conclusions The eight evidence-based and expert opinion-based recommendations for PE for people with inflammatory arthritis are intended to provide a core framework for the delivery of PE and training for health professionals in delivering PE across Europe.
http://dx.doi.org/10.1136/annrheumdis-2014-206807
As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.
In order to target educational needs of patients more effectively, an Austrian-German educational needs assessment tool (OENAT) was developed, the educational needs of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and hand osteoarthritis (HOA) were described and the relationships between educational needs, gender, disease activity and function were explored.
The English ENAT was adapted into Austrian-German using Beaton's cross-cultural adaptation process. Internal construct validity was assessed by Rasch analysis. Educational needs across diagnostic groups and subgroups of patients were summarized descriptively and their relationship with disease activity and physical functioning explored.
The sample comprised 130 RA, 125 PsA and 48 HOA patients. Their mean ages ± SD were 56 ± 14, 51 ± 11 and 64 ± 7 years for RA, PsA and HOA; disease duration was 11 ± 9, 11 ± 11 and 14 ± 9 years, respectively. More than 70% in each patient group expressed interest in receiving education about their disease.
This study showed that educational needs vary with personal characteristics. Patient education may be more targeted and effective, if gender, age, educational background and disease duration are taken into account. Correlations with disease activity and function suggest that the OENAT could enable identification of 'intervention points', which can be ideal opportunities for effective patient education.
1. Uncovering the Knowledge Embedded in Clinical Nursing Practice. 2. The Dreyfus Model of Skill Acquisition Applied to Nursing. 3. An Interpretive Approach to Identifying and Describing Clinical Knowledge. 4. The Helping Role. 5. The Teaching-Coaching Function. 6. The Diagnostic and Monitoring Function. 7. Effective Management of Rapidly Changing Situations. 8. Administering and Monitoring Therapeutic Interventions and Regimens. 9. Monitoring and Ensuring the Quality of Health Care Practices. 10. Organizational and Work-Role Competencies. 11. Implications for Research and Clinical Practice. 12. Implications for Career Development and Education. 13. The Quest for a New Identity and New Entitlement in Nursing. 14. Excellence and Power in Clinical Nursing Practice. Epilogue: Practical Applications. References. Glossary. Appendix. Index.
Unlabelled:
The rheumatology nurse specialist (RNS) has become an integral and vital part of the multidisciplinary team and is valued by patients. Yet, a number of challenges regularly face all clinical nurse specialists (CNS) in the UK. The perception that CNS are an expensive and poorly defined nursing resource results in regular threats to their sustainability, particularly that of the RNS. This study examined return on investment of the RNS.
Method:
An interrelational Structured Query Language (SQL) database collected data on the day-to-day activities of the RNS based on previous models of CNS and RNS work, and qualitative narrative data were then subjected to data mining.
Results:
The RNS represented an excellent return on investment, in terms of income generation activity, patient safety and efficiency. These outcomes were achieved using key principles of proactive case management using vigilance, rescue work and brokering. The mean average per whole time equivalent (WTE) RNS per annum represents £ 175,168 in terms of income/savings to an employing NHS Trust. This figure is likely to be an underestimation, as calculations on reduction in bed days in hospital have not been included.
The development and deployment of physician assistants (PAs) and nurse practitioners (NPs) began in the late 1960s. This has been a social phenomenon that has spread to a number of countries. The original intention was to extend the role of the busy general/family practitioner in providing access and offloading some of the workload in primary care. Within a few years, PAs and NPs were to be found not only in primary care but dispersed through many medical and surgical subspecialties. Rheumatology is one such discipline where PAs and NPs are employed and have been so for 30 years. A survey by the American College of Rheumatology in 2003 found that more than one fifth of the responders employed a PA or NP in their practice. While their deployment in rheumatology may be more prevalent in the US, England has led in documenting their role. A role delineation of PAs in the US finds them working closely with rheumatologists and often providing similar care; the question of how efficient they are in these roles provides opportunities for further research. Understanding the various components of the health workforce is paramount in making estimates of future care needs. This chapter examines PAs and NPs in rheumatology settings to understand what they do and how they are utilized.
To assess whether OA patients attending a clinical nurse specialist (CNS) clinic gain 'additional benefit' compared with those attending a traditional junior hospital doctor (JHD) clinic.
A total of 100 patients with OA attending rheumatology clinics at a UK teaching hospital were randomly allocated to a CNS or JHD clinic and seen at 0, 16, 32 and 48 weeks. The study assessed (i) non-inferiority of the CNS with respect to clinical outcomes (pain, morning stiffness, self-efficacy, physical function and psychological status) and (ii) superiority of the CNS in terms of patient knowledge and satisfaction.
Average pain at follow-up was lower in the CNS group: unadjusted mean difference for the JHD group minus the CNS group was 5.3 (95% CI -4.6, 15.2); adjusted was 1.6 (95% CI -5.7, 8.9). The corresponding effect size estimates were 0.20 (95% CI -0.17, 0.57) and 0.06 (95% CI -0.21, 0.33), respectively. There were similar outcomes in morning stiffness, physical function and self-efficacy. Patient knowledge and satisfaction were statistically significant at the 5% level attaining moderate to large effect sizes in favour of the CNS.
Our findings demonstrate that the clinical outcome of CNS care is not inferior to that of JHD care, and patients attending CNS gain additional benefit in that they are better informed about their disease and significantly more satisfied with care than are their counterparts.
Background/objectives
To maintain and optimise the quality of care provided by health professionals in rheumatology (HPRs), adequate educational offerings are needed. This task force (TF) aimed to develop evidence-based recommendations for the generic core competences of HPRs, with specific reference to nurses, physical therapists (PTs) and occupational therapists (OTs) to serve as a basis for their postgraduate education.
Methods
The EULAR standardised operating procedures for the development of recommendations were followed. A TF including rheumatologists, nurses, PTs, OTs, patient-representatives, an educationalist, methodologists and researchers from 12 countries met twice. In the first TF meeting, 13 research questions were defined to support a systematic literature review (SLR). In the second meeting, the SLR evidence was discussed and recommendations formulated. Subsequently, level of evidence and strength of recommendation were assigned and level of agreement (LoA) determined (0–10 rating scale).
Results
Three overarching principles were identified and 10 recommendations were developed for the generic core competences of HPRs. The SLR included 79 full-text papers, 20 of which addressed the competences, knowledge, skills, attitudes and/or educational needs of HPRs from multiple professions. The average LoA for each recommendation ranged from 9.42 to 9.79. Consensus was reached both on a research and educational agenda.
Conclusion
Evidence and expert opinion informed a set of recommendations providing guidance on the generic core competences of HPRs. Implementation of these recommendations in the postgraduate education of HPRs at the international and national level is advised, considering variation in healthcare systems and professional roles.
To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.
Objective
Due to an aging population, increasing prevalence of rheumatic disease, and a growing supply and demand gap of rheumatology providers, innovative solutions are needed to meet the needs of persons with rheumatic conditions. Nurse practitioners (NPs) and physician assistants (PAs) have been identified as a group of health professionals who could help address the workforce shortage. The Executive Committee of the Association of Rheumatology Health Professionals (ARHP), a division of the American College of Rheumatology (ACR), charged a task force to facilitate the preparation of NPs/PAs to work in a rheumatology practice setting.
Methods
The task force, consisting of private practice and academic rheumatologists, and NPs and PAs, from both adult and pediatric settings, conducted a needs assessment survey of current NPs and PAs to identify mechanisms for acquiring rheumatology knowledge. Through face‐to‐face and webinar meetings, and incorporating stakeholder feedback, the task force designed a rheumatology curriculum outline to enrich the training of new NPs and PAs joining rheumatology practice.
Results
Informed by the needs assessment data and stakeholders, an NP/PA rheumatology curriculum outline was developed and endorsed by the ACR Board of Directors for use by community‐based and academic rheumatology practices, whether pediatric or adult, who desire to add NPs and PAs to their practice setting.
Conclusion
As rheumatology is facing workforce shortages, the ACR/ARHP rheumatology curriculum outline can be utilized to train NPs and PAs and create more efficient integration of NPs and PAs into rheumatology practice.
The ability to quickly and reliably detect a clinically deteriorating patient and intervene appropriately is a skill nurses are expected to bring into practice. Simulation education has been shown to improve nurses' knowledge, confidence and communication, especially when focused on deteriorating patients.
In a simulation center at a large tertiary level Canadian teaching hospital, a 4 h simulation based education session was developed for general medicine nursing staff. The education included a didactic lecture followed by four 40 min simulation scenarios focused on deteriorating patient.
This study was designed as a pre- and post-analytic design. It utilized a paper based survey completed at three separate time points to measure confidence and knowledge. The study also examined data from the Critical Care Outreach nurse audits and site code blue audit data. Results demonstrated statistically significant improvements in nursing confidence and knowledge, and were sustained over the three month follow-up period.
Introduction:
Methotrexate is routinely used to treat active disease in inflammatory arthritis. There have previously been patient safety concerns associated with methotrexate usage in practice. Most patients commencing methotrexate treatment are seen by the rheumatology nurse, to receive education (often referred to as drug counselling) on this agent prior to starting treatment. Yet, there are no recommended criteria regarding education or experience to ensure minimum competence of the rheumatology nurse. The objectives of the present survey were, firstly, to identify the relevant training experience of rheumatology nurses who provide methotrexate education and, secondly, to explore their confidence and competence in undertaking this role.
Method:
A national electronic survey of rheumatology nurses, identified via the Royal College of Nursing Rheumatology Forum, national meetings and personal contacts, in order to access nurses who counsel patients on methotrexate, was carried out.
Results:
A total of 104 nurses completed the survey. Reported training was highly variable, ranging from very little to having undertaken MSc courses. Knowledge of the drug was rated as the most important requirement. Confidence was largely very good and was reported to develop with experience, with 80% of participants reporting being confident after 1 year in the role. A small number of participants (four) indicated that they were 'not at all confident'. Aspects of competence and knowledge were assessed using questions on clinical situations; knowledge appeared to be good, with the exception of a question on shingles. Confidence correlated with knowledge (r = 0.21; p = 0.05), amount of training (r = 0.24; p = 0.03) and most strongly with time in the role (r = 0.74; p = 0.00001). The amount of training correlated with confidence but not with knowledge. All participants used written information, often using more than one source, with 87% of participants favouring the Arthritis Research UK information leaflet on methotrexate.
Conclusions:
There was a wide variety of training for this role. Confidence seemed to come with experience, training and knowledge, and took many months to develop. A training package in this area may be helpful. Reassuringly, confidence and knowledge were related.
Summary Background Early intervention and tight control of inflammation optimise outcomes in rheumatoid arthritis but these approaches have not yet been studied in psoriatic arthritis. We aimed to assess the effect of tight control on early psoriatic arthritis using a treat-to-target approach. Methods For this open-label multicentre randomised controlled trial, adult patients (aged ≥18 years) with early psoriatic arthritis ( vs polyarticular). The randomisation procedure was done through a central 24-h automated telephone system based at the Leeds Institute of Clinical Trials Research (Leeds, UK). This was an open-label study in which patients and clinicians were aware of treatment group assignment. Clinical outcomes were recorded by a masked assessor every 12 weeks. The primary outcome was the proportion of patients achieving an American College of Rheumatology (ACR) 20% (ACR20) response at 48 weeks, analysed by intention to treat with multiple imputation for missing ACR components. Cost-effectiveness was also assessed. This trial is registered with ClinicalTrials.gov, number NCT01106079, and the ISCRCTN registry, number ISCRCTN30147736. Findings Between May 28, 2008, and March 21, 2012, 206 eligible patients were enrolled and randomly assigned to receive tight control (n=101) or standard care (n=105). In the intention-to-treat patient population, the odds of achieving an ACR20 response at 48 weeks were higher in the tight control group than in the standard care group (odds ratio 1·91, 95% CI 1·03–3·55; p=0·0392). Serious adverse events were reported by 20 (10%) patients (25 events in 14 [14%] patients in the tight control group and eight events in six [6%] patients in the standard care group) during the course of the study. No unexpected serious adverse events or deaths occurred. Interpretation Tight control of psoriatic arthritis disease activity through a treat-to-target approach significantly improves joint outcomes for newly diagnosed patients, with no unexpected serious adverse events reported. Funding Arthritis Research UK and Pfizer.
Objective:
A recent workforce study of rheumatology in the US suggests that during the next several decades, the demand for rheumatology services will outstrip the supply of rheumatologists. Midlevel providers such as nurse practitioners and physician assistants may be able to alleviate projected shortages.
Methods:
We administered a nationwide survey of midlevel providers during 2012. Invitations with the survey were sent with one followup reminder. The survey contained questions regarding demographics, training, level of practice independence, responsibilities, drug prescribing, use of objective outcome measures, and knowledge and use of treat-to-target (TTT) strategies.
Results:
The invitation was sent to 482 eligible midlevel providers via e-mail and 90 via US mail. We received a total of 174 responses (30%). The mean age was 46 years and 83% were women. Nearly 75% had ≤10 years of experience and 53% had received formal training in rheumatology. Almost two-thirds reported having their own panel of patients. The top 3 practice responsibilities described were performing patient education (99%), adjusting medication doses (98%), and conducting physical examinations (97%). More than 90% felt very or somewhat comfortable diagnosing rheumatoid arthritis (RA) and a similar percentage prescribed disease-modifying antirheumatic drugs. Three-quarters reported using disease activity measures for RA and 56% reported that their practices used TTT strategies.
Conclusion:
Most respondents reported that they had substantial patient care responsibilities, used disease activity measures for RA, and incorporated TTT in their practice. These data suggest midlevel providers may help to reduce shortages in the rheumatology workforce and conform with recommendations to employ TTT strategies in RA treatment.
To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA).
In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D.
Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was -0.31 (-0.63 to 0.02) for PP and -0.15 (-0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (-£352, £1773) and -£128 (-£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher 'general satisfaction' scores than RLC in week 26.
The results provide robust evidence to support non-inferiority of NLC in the management of RA.
ISRCTN29803766.
The authors aim to develop European League Against Rheumatism recommendations for the role of the nurse in the management of patients with chronic inflammatory arthritis, to identify a research agenda and to determine an educational agenda.
A task force made up of a multidisciplinary expert panel including nurses, rheumatologists, occupational therapist, physiotherapist, psychologist, epidemiologist and patient representatives, representing 14 European countries, carried out the development of the recommendations, following the European League Against Rheumatism standardised operating procedures. The task force met twice. In the first meeting, the aims of the task force were defined, and eight research questions were developed. This was followed by a comprehensive, systematic literature search. In the second meeting, the results from the literature review were presented to the task force that subsequently formulated the recommendations, research agenda and educational agenda.
In total, 10 recommendations were formulated. Seven recommendations covered the contribution of nurses to care and management: education, satisfaction with care, access to care, disease management, psychosocial support, self-management and efficiency of care. Three recommendations focused on professional support for nurses: availability of guidelines or protocols, access to education and encouragement to undertake extended roles. The strength of the recommendations varied from A to C, dependent on the category of evidence (1A-3), and a high level of agreement was achieved. Additionally, the task force agreed upon 10 topics for future research and an educational agenda.
10 recommendations for the role of the nurse in the management of chronic inflammatory arthritis were developed using a combination of evidence-based and expert consensus approach.
This paper describes an initiative to develop Advanced Practice Nurses (APNs) in mainland China and evaluation of the outcomes of the described programme. The pioneer project was an APN postgraduate programme involving 38 students conducted in Guangzhou, China during 2004-2005. Data related to curriculum content and process, student performance, self-reported competence and programme effects were collected. Quantitative data such as demographic data, student performance were analysed using descriptive statistics and the pre and post self-reported practice of competence was compared using chi-square test. Qualitative data such as case reports and interviews were examined using thematic analyses. Reflective journals and case studies revealed the attributes of APNs in managing clinical cases at advanced level, applying theory into practice and exercising evidence-based practice. The relatively modest self-reported practice of competence suggested that the graduates were novice APNs and needed continued development after the completion of the programme. This study reports the experience of an initiative in China and suggests a useful curriculum framework for educating APNs.
Rheumatoid arthritis (RA) is a chronic disease with a complex underlying pathology and varied presentation in patients. Several novel biologic disease-modifying antirheumatic drugs have become available for the treatment of RA. Agents in late-stage clinical trials include golimumab and certolizumab, which are anti-tumor necrosis factor (TNF)-alpha agents; ocrelizumab, an anti-CD20 agent; and tocilizumab, an inhibitor of interleukin-6. As treatment options for RA expand, nursing care will play an increasingly important role in empowering patients through interventions such as patient education and adverse effect management.
To identify the current practices of rheumatology nurse practitioners and ascertain their perceptions of how their role could be enhanced.
A cross-sectional questionnaire study of currently employed nurse practitioners in rheumatology in the United Kingdom (UK) was undertaken.
200 questionnaires were distributed and 118 nurses responded. Ninety-five respondents met the inclusion criteria for undertaking an advanced nursing role. Typical conditions dealt with included: rheumatoid arthritis (96.8%); psoriatic arthritis (95.8%); osteoarthritis (63.2%); ankylosing spondylitis (62.8%); systemic lupus erythematosus (51.6%); and scleroderma (34.7%). Drug monitoring, education, counselling of patients and arranging basic investigations were routinely performed by more than 80% of respondents. A smaller proportion performed an extended role that included dealing with referrals, research and audit, the administration of intra-articular injections, and admission of patients. Specific attributes identified as being necessary for competence were: knowledge and understanding of rheumatic diseases (48.4%); drug therapy (33.7%); good communication skills (35.8%); understanding of the roles of the team (27.4%); working effectively (23.2%) as part of a multidisciplinary team; assessment of patients by physical examination (28.4%); teaching (26.3%), research (17.9%); organizational skills (14.7%); and the interpretation of investigations (9.5%). Factors that could enhance their role included: attendance at postgraduate courses (30.5%); obtaining further qualifications (13.7%); active participation in the delivery of medical education (41.1%); training in practical procedures (31.6%); protected time and resources for audit and research (11.6%); formal training in counselling (11.6%); and implementation of nurse prescribing (10.5%).
Nurse practitioners already have a wide remit and play an invaluable part in the delivery of modern rheumatology services. An extended role could improve patient care and enhance nursing career pathways in rheumatology.
Development of generic core competences of health professionals in rheumatology: a systematic literature review informing the 2019 EULAR recommendations
- G E Fragoulis
- L Edelaar
- Vliet Vlieland
Fragoulis GE, Edelaar L, Vliet Vlieland TPM, et al. Development
of generic core competences of health professionals in rheumatology: a systematic literature review informing the 2019 EULAR
recommendations. RMD Open. 2019; 5: 2001028. PMid:31749985
https://doi.org/10.1136/rmdopen-2019-001028
Rheumatology nurses: Adding value to arthritis care. Australia: Australian Healthcare and Hospitals Association
- Arthritis Australia
Arthritis
Australia.
Rheumatology
nurses:
Adding
value to arthritis care. Australia:
Australian Healthcare and Hospitals Association; 2017. Available from:
https://arthritisaustralia.com.au/wordpress/wp-con
tent/uploads/2017/09/Literature_review_-_Rheumato
ASPIRE initiative contributes to improvements in knowledge of rheumatology nurses. Poster session presented at: 20th Asia Pacific League of Associations for
- S Oliver
- K Yamamoto
- G Kwok
Oliver S, Yamamoto K, Kwok G, et al. ASPIRE initiative contributes
to improvements in knowledge of rheumatology nurses. Poster session presented at: 20th Asia Pacific League of Associations for
Rheumatology Congress; 2018; Kaohsiung, Taiwan.