Background and Purpose Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of the joints and other body organs, which 1 % of the human population is affected. RA induced in the fourth and fifth decades of... more
Background and Purpose Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of the joints and other body organs, which 1 % of the human population is affected. RA induced in the fourth and fifth decades of life and in women is more common. Kelussiao doratissima contains compounds such as flavonoids, mainly aggregated in the inflorescence and stems of Kelussia, has anti-inflammatory effects. Present study aimed to investigate the anti-inflammatory effect of Kelussia odoratissima on rheumatoid arthritis induced in Wistar rats. Materials and Methods A total of 30 female Wistar rats using subcutaneous injection of complete Freund's adjuvant has been induced and were randomly divided into five groups containing negative control (no treatment), positive control (receiving indomethacin (3mg/ Kg) and three rheumatoid arthritis group receiving three different doses (100,200and 300mg/kg) of hydroalcoholic Kelussia odoratissima extract. material injection were tested in the animals for 10 days. The symptomsof Rheumatoid arthritis were evaluated according to standardized scoring method at paw and double-blind for the different categories daily. CRP levels were measured and Data were analyzed using the SPSS statistical program (version 17 for Windows). In all the cases for comparison between different groups, Mann-Whitney U-test was used. Results The symptoms indicating disease severity was observed in the treated group compared to the negative control so that decreasing trend in disease severity in the group receiving300 mg / kg of Kelussia extract was significant However these verity of the disease was increasingly in the negative control. Serum CRP levels in groups () were significantly decreased. Conclusions Kelussia odortissima has a anti-inflammatory effects and can reduce the inflammation and morbidity in rheumatoid arthritis. Thusit can be used as a drug for reducing and controlling inflammation in Rheumatoid arthritis.
Background: Patient-initiated dialogue is insightful into the patients understanding of their consultation, the information given and shared clinical decision making. However, little attention has been paid to identifying patients’... more
Background: Patient-initiated dialogue is insightful into the patients
understanding of their consultation, the information given and shared clinical decision making. However, little attention has been paid to identifying patients’ verbal initiations and this study aims to address this anomaly.
Methods: Non-participant observation of a clinical nurse specialist
(CNS) and consultant rheumatologist (CR) consultation was undertaken (KV) at 5 different rheumatology outpatient clinics in the UK. Field notes and audio recordings were made and Roter’s Interaction Analysis Scale (RIAS) was used to code the communication. Patient initiations are defined as ‘speech unprompted by direct practitioner questioning’.
Results: 5 female CNS and 5 CR (3 female) were each observed for an entire clinic and one patient per practitioner was randomly chosen for analysis. The CR cohort comprised 1 RA patient, 2 undiagnosed, 1 RA with SLE and 1 undiagnosed back and leg pain. Their median age was 63 (56-77); median disease duration¼24.5yrs (range >1-40) and 4 were female. The CNS cohort comprised 3 RA patients, 1 PsA and 1 SLE. Median disease duration was 12yrs (range 2-20) and median age 59 (35-73). 4 were female. CNS consultations lasted a median of 18mins (6-30); CR 17mins (8-22). Patients initiated dialogue on a median of 13 (3-24) occasions in CNS consultations and 11 (7-19) in the CR consultations. More initiations are seen early on in CNS consultations than in the CR (45:37). More medical information was volunteered by the patient in history taking in the CNS consultations than the CR, 45 and 24 respectively. Patients also initiated more personal remarks/social conversation with the CNS 19:5 CR; volunteered more therapeutic information (CNS 13: CR 4) and information about lifestyle (CNS 8: CR 0). Across practitioners, the greatest proportion of unprompted patient initiations were in volunteering clinical information (14CR: 15CNS) and raising concerns about disease, therapeutic plan and lifestyle impact (14CR: 13CNS). Patients also sought information about therapeutic their regimen CR 6: CNS 4, and 2 (CR) sought reassurance towards the end of the consultation.
Conclusions: During their consultation, patients demonstrated a
desire to talk about their disease and its problems and volunteered
information not requested by the practitioners. Patients provided the CNS with far more information during history taking, information about lifestyle and personal and social conversation. These categories fit well with the holistic, psychosocial model of nursing. Information seeking behaviours revolved around therapeutic regimen and occurred towards the end of the consultation suggesting that patients want to make sure that they understand the therapeutic plan. It is of interest that there was no difference in the consultation time of the CNS and CR which is at odds with the literature but it is acknowledged that this study has a small sample size.
Background: Interaction between patients and clinicians is a key part of building a therapeutic relationship. Whilst it is anticipated there are similarities and differences between patient interaction with clinical nurse specialists... more
Background: Interaction between patients and clinicians is a key part of building a therapeutic relationship. Whilst it is anticipated there are similarities and differences between patient interaction with clinical nurse specialists (CNS) and consultant rheumatologists (CR) there is a paucity of research in this area.
Objectives: To compare communication with patients in CNS and CR rheumatology clinics.
Methods: Direct observation of CNS and CR clinics at 9 rheumatology outpatients departments in the UK was undertaken by a non-participant observer (KV). Field notes and audio recordings were made of the consultations. Roter’s Interaction
Analysis Scale (RIAS) was used to code the communication into categories (table1). Kruskal-Wallis test was used to assess the difference between CR and CNS according to speaker (significance ≤p=0.025 Bonferonni adjusted).
Results: CR saw 63 patients (43 female), mean age 60 (SD16), median disease duration 10.5 yrs (IQR 2.8-25). 40% had RA, 44% other rheumatic diseases and 16% undiagnosed.CNS saw 44 patients (24 female), mean age 58 (SD15), median disease duration 5 yrs (IQR 2-14.5). 71% had RA, 11% PsA, 18% other diagnoses. Rapport building positive and social differed significantly across groups (table 1). Both the CNS and their patients engaged in more social rapport building (non-medical conversation) implying a relaxed/established relationship which is less medically driven. The CR consultations demonstrate rapport-building positive, encompassing a lot of social niceties which is more indicative of new/building relationships. CRs engaged in more patient education and instructions about disease and its progression than CNS. However, there is more patient activation and engagement with CNS;requests for services; seeking reassurance/understanding. Coupled with the higher incidence of social rapport building this may indicate a less formal environment in which the patient is more likely to engage in shared clinical decision making, express uncertainty and seek reassurance.
Conclusions: Consultations with CNS contained more social interaction, and were more relaxed with a less medically driven agenda which allowed more patient activation & engagement. Surprisingly the CR provided more biomedical information than the CNS, even though the CNS consultation times were longer.
