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Rheumatic Diseases Clinics of North America

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https://read.qxmd.com/read/30447751/best-practices-and-challenges-to-the-practice-of-rheumatologists
#1
EDITORIAL
Daniel J Wallace, R Swamy Venuturupalli
No abstract text is available yet for this article.
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447750/best-practices-and-challenges-to-the-practice-of-rheumatologists
#2
EDITORIAL
Michael H Weisman
No abstract text is available yet for this article.
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447749/challenges-in-having-an-infusion-center
#3
REVIEW
Karen Marie Mullen
This article presents a comprehensive overview of the model, care, costs, and considerations necessary in having an outpatient infusion suite in a practice. It provides a real-life assessment of the challenges infusion centers face, including financial and clinical impacts. It is also patient centric, showing how a comfortable patient experience can improve care and increase patient compliance in an outpatient setting. Also included is a list of specialty infusions and indications, medication procurement options, an internal process for outside referrals, using nurse practitioners and physician assistants, and the complexities of working with insurance companies and the regulations and requirements necessary...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447748/clinical-trials-in-rheumatology
#4
REVIEW
Christine H Lee, Daniel J Wallace
Clinical trials evaluate the benefits and harms of medical interventions with the ultimate goal of establishing an evidence-based regimen that contributes to clinical decision making. Physicians benefit greatly from clinical research because it provides a greater understanding of epidemiology and health outcomes, and patients are given opportunities to participate in such trials. In this review, we discuss the challenges of conducting clinical trials investigating rheumatic diseases, including that of recruitment, finding the right trial, designing a budget, and performing a study in a timely manner...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447747/challenges-to-practicing-pediatric-rheumatology
#5
REVIEW
Nora G Singer, Karen Brandt Onel
Pediatric rheumatology is an exciting and rewarding career area. However, challenges when attracting trainees to this field include practice often occurring in smaller groups compared with general pediatrics, available positions requiring relocation, and fluctuation in funding resulting in uncertainty regarding training positions. Having critical mass in pediatric divisions is important to ensure adequate mentoring and people power to produce scholarly work, reduce on-call frequency and mitigate faculty absences that result in unplanned addition of clinical work...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447746/the-focused-musculoskeletal-factory
#6
REVIEW
Gerald M Eisenberg
Rheumatology has evolved rapidly over the past 20 years. The availability of numerous treatment interventions has dramatically altered patient outcomes and revitalized the specialty. At the same time, the economics of medical practice is challenging the practicing rheumatologist to seek more efficient and more attractive models of care delivery. These models of care must be attractive not only to rheumatologists and their patients but also to other interested parties as well, such as payers, government agencies, and accreditation bodies...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447745/challenges-of-practicing-rheumatology-in-a-government-setting-a-county-hospital-and-veterans-affairs-hospital-perspective
#7
REVIEW
Gopika D Miller, Jasvinder A Singh
In this article, we review the challenges and opportunities afforded by working in a government setting by providing the perspective of the Veterans Affairs experience as well as the county/public hospital experience from Los Angeles County Department of Health Services. This article highlights processes and services that are unique to practicing rheumatology in a government setting, specifically, resource allocation with clinic space and staffing; protocols for access to conventional and biologic disease modifying antirheumatic drugs; and research opportunities for rheumatologists working in a government setting...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447744/challenges-to-practicing-rheumatology-in-an-academic-center
#8
REVIEW
Sobia Hassan, Meghan M Smith, Joel A Block, Meenakshi Jolly
Rheumatologists working in academics participate in patient care, teaching, and research. There are several challenges associated with the pursuit of these academic missions, and these are the focus of this article. Additionally, how financial pressures faced by academic institutions have led to greater emphasis on the generation of revenue from clinical activities to the detriment of other academic pursuits is discussed. In an era of greater physical burnout and with the looming shortages of the rheumatology workforce, the importance of addressing these issues is stressed and potential solutions discussed...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447743/the-challenges-of-approaching-and-managing-gout
#9
REVIEW
Theodore R Fields
Despite many effective treatments for gout, its management remains a challenge internationally. Options for optimizing gout management may differ in different practice sizes and settings. Gout incidence is rising and it continues to be associated with increased mortality. Education of patients and medical providers is essential, and newer gout medications need to be used in the most appropriate ways for cost-effective therapy. Special consideration needs to be given to such populations as the elderly and those with renal and cardiovascular disease in gout management...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447742/workforce-trends-in-rheumatology
#10
REVIEW
Adam Kilian, Laura A Upton, Daniel F Battafarano, Seetha U Monrad
The United States is facing a rheumatology provider shortage over the next decade, which will negatively affect care for patients with rheumatic disease across the nation if this deficit is not thoughtfully addressed. The increasing numbers of retiring rheumatology specialists, women entering the workforce, and rheumatology graduates seeking part-time employment were identified as the most significant factors driving the projected decline in supply of providers. The major factors driving the projected increase in demand include an aging and growing population and improved treatment options, both of which increase disease prevalence and the challenge of managing chronic rheumatologic diseases...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447741/challenges-in-optimizing-medical-education-for-rheumatologists
#11
REVIEW
Sian Yik Lim, Marcy B Bolster
The field of rheumatology has expanded rapidly in recent years, and innovations in immunology, epigenetics, and bone metabolism continue at an astonishing pace. In this fast changing field, optimizing medical education for rheumatologists is vital for maintaining a competent workforce to meet the needs of patients with rheumatic diseases. Several key challenges lie ahead and efforts to optimize medical education for rheumatologists are discussed in this article.
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447740/digital-medicine-in-rheumatology-challenges-and-opportunities
#12
REVIEW
R Swamy Venuturupalli, Paul Sufka, Suleman Bhana
The exponential growth in technology has had a significant effect on the practice of medicine and will likely transform the practice of medicine. In this article, the authors review select technologies that are already influencing the practice of rheumatology. Social media Websites such as Twitter are now important sources of information and discussion for health care professionals interested in rheumatology. Virtual reality is an innovative technology with great potential for acute and chronic pain management...
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447739/challenges-in-implementing-treat-to-target-strategies-in-rheumatology
#13
REVIEW
Julia A Ford, Daniel H Solomon
Despite evidence that treat-to-target (TTT) approaches lead to better disease outcomes in RA, TTT is not widely implemented in rheumatology clinics in North America. This article discusses the barriers (including access to care, patient and physician factors, and systems issues) to implementing TTT in the clinic, and proposes possible solutions and future research directions.
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30447738/the-economics-of-rheumatology-practice-in-the-united-states
#14
REVIEW
Jon Glaudemans
The current environment shaping rheumatology practice economics, with a focus on revenues, is described. The policies and practices of private and public insurance companies, pharmaceutical manufacturers, and pharmacy benefit managers (PBMs) are summarized, identifying economic implications for rheumatologists. The role of rebates in shaping practice economics is discussed, along with the central role of payers in defining PBM policies.
February 2019: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30274633/a-three-headed-approach-to-kidney-involvement-in-rheumatic-diseases
#15
EDITORIAL
Andrew S Bomback, Meghan E Sise
No abstract text is available yet for this article.
November 2018: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30274632/renal-involvement-in-rheumatic-diseases
#16
EDITORIAL
Michael H Weisman
No abstract text is available yet for this article.
November 2018: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30274631/renal-manifestations-of-inflammatory-bowel-disease
#17
REVIEW
Josephine M Ambruzs, Christopher P Larsen
Renal and urinary involvement has been reported to occur in 4% to 23% of inflammatory bowel disease (IBD) patients. Parenchymal renal disease is rare and most commonly affects glomerular and tubulointerstitial compartments. The most common findings on renal biopsy of IBD patients are IgA nephropathy and tubulointerstitial nephritis. Overall morbidity of IBD-related renal manifestations is significant, and there is often only a short window of injury reversibility. This, along with subtle clinical presentation, requires a high index of suspicion and routine monitoring of renal function...
November 2018: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30274630/autoimmune-kidney-diseases-associated-with-chronic-viral-infections
#18
REVIEW
Joshua D Long, Stephanie M Rutledge, Meghan E Sise
Autoimmune kidney diseases triggered by viruses are an important cause of kidney disease in patients affected by chronic viral infection. Hepatitis B virus (HBV) infection is associated with membranous nephropathy and polyarteritis nodosa. Hepatitis C virus (HCV) infection is a major cause of cryoglobulinemic glomerulonephritis. Patients with human immunodeficiency virus (HIV) may develop HIV-associated nephropathy, a form of collapsing focal segmental glomerulosclerosis, or various forms of immune-complex-mediated kidney diseases...
November 2018: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30274629/anti-glomerular-basement-membrane-disease
#19
REVIEW
Kavita Gulati, Stephen P McAdoo
Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune small vessel vasculitis characterized by autoreactivity to antigens in type IV collagen chains expressed in glomerular and alveolar basement membrane. The detection of circulating anti-GBM antibodies, which are shown to be directly pathogenic, is central to disease diagnosis. Clinically, anti-GBM disease usually presents with rapidly progressive glomerulonephritis with or without alveolar hemorrhage. Rapid diagnosis and early treatment are required to prevent mortality and to preserve renal function...
November 2018: Rheumatic Diseases Clinics of North America
https://read.qxmd.com/read/30274628/thrombotic-microangiopathies-with-rheumatologic-involvement
#20
REVIEW
Faizan Babar, Scott D Cohen
Thrombotic microangiopathies are heterogeneous disorders characterized by microangiopathic hemolytic anemia with thrombocytopenia and renal injury. There are a variety of causes, including metabolic disorders, infections, medications, complement disorders, pregnancy, malignancy, and autoimmune disorders. This review focuses on renal thrombotic microangiopathy in the setting of rheumatologic diseases. Systemic lupus erythematosus is the most common autoimmune disease associated with thrombotic microangiopathy...
November 2018: Rheumatic Diseases Clinics of North America
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