Measuring performance in clinical rheumatology

Article Abstract:

Because of the increased costs and limited resources of health care, clinical practices, including those of rheumatologists, will be scrutinized. Due to developments in computerized information systems, the cost and effectiveness of treatments can be determined. Various measures of performance can be analyzed including: how many patients are seen and what procedures are done, effectiveness of treatment, quality of service, customer satisfaction, costs, and management of resources. The body of data that is currently available concerning the practice of rheumatology is very limited. Often the data that are collected are incomplete or inadequate. The United Kingdom is currently setting up a data collection system. The United States already has a data collection system which categorizes patients according to diagnostically related groups (DRGs). This system was originally devised to control hospital costs, and problems occur when these data are used for other purposes because the hospitals try to maximize their charges and base their principal diagnosis on the most expensive condition. The costs of treatment in rheumatology have already been examined in some hospitals in the United Kingdom and have been shown to vary depending upon hospital policies for treatment. There will be problems in defining costs and measuring performance, but guidelines can be set based on: patients' diagnoses; which interventions have met the patients' needs; and the outcome of treating various rheumatological conditions on both a long-term and a short-term basis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, United Kingdom, Analysis, Evaluation, Medical care, Rheumatologists, Rheumatology, editorial

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Septic arthritis complicating hip osteoarthritis

Article Abstract:

Septic arthritis is an arthritic condition that arises from infection of synovial (joint) tissues by bacteria or other agents. Rheumatoid arthritis and replacement of joints are risk factors for joint infection, which often develops insidiously. However, osteoarthritis is not similarly considered to increase the susceptibility to septic arthritis. The cases of four patients with osteoarthritis of the hip who developed joint infection are described. These cases demonstrate that infection should be considered in patients with osteoarthritis who develop new joint symptoms or symptoms of systemic involvement. Local symptoms included increased pain or burning sensation in the groin or thigh. Only one patient initially had a fever. The patients' conditions continued to worsen, often while they were being treated for a minor infection or inflammatory condition. The interval between the onset of symptoms and the time when the symptoms of hip infection were noticeable or septic arthritis of the hip was diagnosed was one week to one month. One patient died from pneumonia complicating septic arthritis of the hip, while the other three required surgical procedures two to six months after their initial symptoms developed. These cases indicate that septic arthritis in patients with osteoarthritis may initially cause mild symptoms and may be unnoticed. Significant illness or death may result from a delay in treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Infection, Diagnosis, Osteoarthritis, Arthritis, Infectious, Infectious arthritis, Hip joint

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A unifying hypothesis for the mechanism of NSAID related gastrointestinal toxicity

Article Abstract:

The action of non-steroidal anti-inflammatory drugs (NSAIDS) may occur in stages involving the mitochondria in tissue cells. Mitochondria are small organs within a cell that produce energy along a pathway that includes the action of an enzyme called cyclo-oxygenase (COX). Researchers outlined the chemical pathways and stages that may explain the harmful effects of NSAIDS in the stomach and intestines and may help guide future research into modifying the drugs to prevent these harmful effects. The first stage of NSAID action may operate at the chemical level by interrupting the COX activity within the mitochondria. This chemical interruption may allow bacteria, acids, food, and white blood cells to enter into the linings of the stomach and small intestines leading to damage in these organs. Drugs that act on a different form of the COX enzyme may prove to be less damaging to the stomach and intestine but effective in reducing inflammation.

Risk factors, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Nonsteroidal anti-inflammatory drugs, Nonsteroidal anti-inflammatory agents, Gastrointestinal system

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