The pandemic has resulted in many changes to health services, one of these is the shift from face-to-face consultations to virtual ones across all specialities. As the pandemic continues with no end in sight it seems that virtual consultations will continue for the foreseeable future. In this article, we analyze the patient feedback so far to virtual consultations in a large tertiary center and use this opportunity to reflect on this new service. We have a particular interest in musculoskeletal services as this is largely an outpatient-based speciality and the pandemic has consequently resulted in significant changes in practice. We also consider whether virtual clinics is a sustainable service post-COVID-19 and the benefits and disadvantages of this.
BackgroundSystemic lupus erythematosus (SLE) is an autoimmune, multi-system, chronic inflammatory condition. It is managed with long-term immunosuppressive therapy which includes steroid use. SLE is therefore considered an independent risk factor for osteoporosis.ObjectivesThis clinical audit was undertaken to evaluate the screening of osteoporosis in patients diagnosed with SLE and assess adherence to national guidelines for the management of patients with low bone mineral density (BMD) on prolonged steroid therapy.MethodsWe studied 64 SLE patients seen at the Leicester Royal Infirmary. Demographic and clinical data was collected from the clinic letters. Steroid use for a cumulative period of over 4 weeks per year was considered significant and use of bisphosphonates or calcium and vitamin D supplements alone were taken into account for bone protection. BMD measurements by dual X-ray absorptiometry were performed. Osteoporosis was defined as a T score less than −2.5 SD in at least 1 region of measurement.ResultsOf the 64 patients studied, 54 (84.4%) were female and 10 (15.6%) male with an age range of 23 to 86 years and mean age of 47.45 years. Steroids were used in 46 (71.9%) patients while 18 (28.1%) patients did not receive any steroids. Twenty-one (32.8%) patients had DEXA scans and whilst 43 (67.2%) had not. Of those who had received steroids, 20 (43.4%) patients underwent DEXA scans and 26 (56.5%) did not. Osteoporosis was diagnosed in 3 (14.3%) patients out of the 21 scanned. The therapies used are summarised in figure 1.Abstract AB0529 – Figure 1Bone protection (n=64)ConclusionsStudies have shown that SLE is an independent risk factor for low BMD and use of corticosteroids is already a well-recognised risk for osteoporosis. Our study has shown that a large section of patients (43.8%) did not receive any form of bone protection although, a significant proportion (71.9%) were on oral steroids. Although a small section of those scanned demonstrated osteoporosis (14.3%), many patients were already initiated on bisphosphonates without a DEXA. There was also no exclusion criteria set for young patients (age <45 years) or those who were newly diagnosed. Despite this, our study demonstrates the need for robust guidelines for the screening and management of bone health in patients with SLE in order to improve morbidity and mortality rates in this patient cohort.References[1] Mosca M,1 C Tani,1 M Aringer, et al. European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies.[2] Almehed K, Forsblad d’Elia H, Kvist G, et al. Prevalence and risk factors of osteoporosis in female SLE patients-extended report. Rheumatology (Oxford)2007;46:1185–1190.[3] Bultink IE, Lems WF, Kostense PJ, et al. Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum2005;52:2044–2050.[4] NOGG 2017: Clinical guideline for the prevention and treatment of ost...
Background Cyclophosphamide is an effective treatment of lupus nephritis (LN) but have many side effects especially with high doses. Two regimens are used: monthly high dose pulses or biweekly low dose pulses (Eurolupus protocol). LN
Background Good medical practice for general practitioners, published by the Royal College of general practitioners in 2008, highlights the standard of practice for GPs in the delivery of care to patients. GPs need to have an adequate level of knowledge and competence about various specialties so that patients can be well managed at primary care level. Current changes in the NHS means management of long-term conditions such as Diabetes mellitus (DM) and Rheumatoid arthritis (RA) are moving into community settings. It is essential primary care physicians possess adequate knowledge and skills to manage these long-term conditions. More NHS trusts and GP surgeries within the United Kingdom are employing the use of “shared care protocols” for RA patients. These patients need optimal care in between outpatient follow up appointments. Objectives 1)To assess the confidence of GPs in the assessment, and management of RA compared to DM. 2)To explore the confidence of GPs in reviewing monitoring tests for RA compared to DM. 3)To explore the confidence of GPs in the practical use of newer drug therapy in RA and DM. Methods The survey was carried out using a questionnaire based proforma administered by the interviewer. Questionnaires were distributed to GPs across the east midlands during various GP educational study days over 6 months. The proforma had initially been piloted and redesigned. Data from 100 respondents were collected and analysed using online software. Results N=100. Over a third of GP respondents were experienced GPs with greater than 15years experience. 20%(20)of respondents were not confident in assessing patients with suspected RA compared to DM. All GPs were very confident in assessing patients with suspected DM. 50% of respondents reported that they were not confident in assessing for tight control and complications related to DM. Only 2% (2) were not confident in doing this when related to DM. Over half of the GPs were confident in reviewing monitoring tests related to DM compared to 19%(19) of GPs in reviewing monitoring tests related to RA. Regarding newer drug therapy 25%(25) were not confident in the use of recent drugs (gliptins) in patients with DM, compared to 83%(83) that were not confident in use of recent drugs (anti-TNFs) in patients with RA. 35%(35) of GPs were confident in using monitoring parameters such as HbA1c in DM compared to 16%(16) of the same cohort who reported that they were confident in the use of CRP for patients with RA. The remainder were not confident in the use of CRP as a monitoring tool in RA. Conclusions This study was the first of its kind comparing knowledge on managing two chronic autoimmune conditions managed in primary care. We found that overall GPs had less confidence in diagnosis, management and use of monitoring tests in RA when compared to DM. We recommended that GPs need continuous primary care education in rheumatology to update their in this rapidly developing specialty This can be either as web based learning or master classes in rheumatology delive...
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