Objective: To determine the proportion of axial psoriatic arthritis (axPsA), describe how it is diagnosed in clinical practice, and identify clinical and demographic characteristics independently associated with axPsA. Methods : A multicentre retrospective observational study was conducted using data from patients registered in the Rheumatic Diseases Portuguese Registry (Reuma.pt) with a diagnosis of PsA or spondyloarthritis with psoriasis. Peripheral involvement was defined as the presence of peripheral joint disease. Axial involvement was defined by the presence of physician-reported spondylitis and/or imaging findings suggestive of axial disease. Patients were divided into four non-exclusive groups: axPsA, axial involvement with or without peripheral joint disease; ax-PsA_only, axial involvement exclusively; peripheral PsA (pPsA)_only, peripheral joint disease, without axial involvement; pPsA, peripheral joint disease with or without axial disease. Results : This study included 2,304 patients. axPsA was present in 37.1% of patients and axPsA_only in 8.1%. The diagnosis was made based on suggestive imaging findings in 30.1%, and on physician judgement in 69.9%. axPsA was independently associated with HLA-B27 positivity (odds ratio [OR]=2.90; p<0.001), enthesitis (OR=1.64; p<0.001), and younger age at symptom onset (OR=0.97; p<0.001); pPsA_only with dactylitis (OR=1.89; p<0.001) and nail dystrophy (OR=1.42; p=0.010). axPsA_only was independently associated HLA-B27 positivity (OR=3.35; p<0.001) and uveitis (OR=2.56; p=0.004); pPsA with nail dystrophy (OR=2.11; p=0.002), dactylitis (OR=18.18; p<0.001), and enthesitis (OR=1.74; p=0.031). Conclusion : Axial involvement is present in over one-third of PsA patients, often in association with peripheral joint disease. ax-PsA patients demonstrate distinct clinical and demographic characteristics compared to those without axial disease.
RESUMEN Objetivo: Evaluar la percepción de la carga de trabajo individual entre el personal de enfermería del Servicio de Urgencias Médico-Quirúrgicas de una Unidad de Salud Local en el norte de Portugal y explorar la relación entre la percepción de la carga de trabajo y las variables sociodemográficas y profesionales. Método: Este es un estudio transversal descriptivo-correlacional y cuantitativo. Se utilizó la Individual Workload Perception Scale-Revised para evaluar la percepción de la carga de trabajo. El análisis se realizó mediante la prueba t de Mann-Whitney o la prueba U, el análisis de varianza o la prueba de Kruskal-Wallis. Resultados: La puntuación media global en la escala fue de 73,73 (DE=9,21), lo que indica una percepción moderadamente positiva. La dimensión “Apoyo de la jefatura de enfermería” obtuvo la puntuación media más baja por ítem (3,01). Se encontraron diferencias estadísticamente significativas en función de la experiencia profesional (p=0,001) y el tiempo de permanencia en el servicio actual (p < 0,001). Conclusión: La percepción de la carga de trabajo puede mejorarse mediante entornos más positivos y sostenibles.
ABSTRACT Objective: To assess the perception of individual workload among nurses in the Medical-Surgical Emergency Service of a Local Health Unit in Northern Portugal and to explore the relationship between the perception of workload and sociodemographic and professional variables. Method: This is a descriptive-correlational and quantitative cross-sectional study. The Individual Workload Perception Scale-Revised was used to assess workload perception. The analysis used the Mann-Whitney t-test or U test, analysis of variance, or Kruskal-Wallis test. Results: The mean overall score on the scale was 73.73 (SD=9.21), indicating a moderately positive perception. The “Nurse manager support” dimension had the lowest mean score per item (3.01). Statistically significant differences were found based on professional experience (p=0.001) and current job experience (p < 0.001). Conclusion: The perceived workload has room for improvement through more positive and sustainable environments.
Background: Integrating electronic patient-reported outcome measures (ePROMs) into routine hemodialysis (HD) care offers a way to enhance patient-centered decision-making. Methods: This prospective matched cohort study involved adults on in-center HD followed for 6 months. The intervention group completed monthly ePROMs (SF-VAQ and SF-36v2), while the control group received standard care. Outcomes included changes from baseline in Vascular Access (VA) related interventions, hospitalizations, SF-VAQ domain scores, and Health-Related Quality of Life (HRQoL). Results: Integrating ePROMs did not significantly impact the frequency of VA-related interventions or hospitalizations during the study period. Significant improvements were observed in the SF-VAQ domains, including reductions in perceived VA-related burden in the Physical (p = 0.002), Social (p = 0.001), and Dialysis-Related Complication (p = 0.001) domains. The Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36v2 also improved significantly (PCS: p = 0.001; MCS: p = 0.000). A total of 31 (55%) of patients in the ePROM group achieved the Minimal Clinically Important Difference. Conclusions: Implementation of an ePROM-guided care pathway is feasible and associated with improved patient-reported well-being and reduced VA-related burden. While these results suggest a benefit, the absence of longitudinal process data in the control arm means further research is required to distinguish ePROM-induced changes from standard care evolution.
A 63-year-old male was admitted with a 2-week-history of chest wall swelling with no accompanying symptoms, except for chronic lumbago. He had been diagnosed with bladder urothelial carcinoma and underwent transurethral-resection and BCG-instillation the year before. Physical examination and lab work was unremarkable except for an ovaloid-lump of approximately 9cm on the anterior-left chest wall[Figure-1] and elevated C-reactive protein and erythrocyte-sedimentation-rate. A CT-scan revealed other abscesses: on the right cardiophrenic recess[Figure-2] and prevertebral at L4-L5 level[Figure-3]. MRI confirmed the diagnosis of spondylodiscitis[Figure-4]. HIV-serology was non-reactive, blood-cultures were negative, abscess’ pus was amicrobian but Ziehl–Neelsen stain and M.tuberculosis detection by molecular biology were positive. The diagnosis of Pott’s disease with multiple cold abscesses was stablished. Anti-tuberculosis treatment with isoniazid, rifampin, ethambutol and pyrazinamide was started. Surgical treatment was not considered due to his stability. He was discharged and referred to the national tuberculosis control program for continuation of treatment. On the follow-up consultation, within four weeks, he had clinical improvement[Figure-5]. Pott’s disease is a severe form of extrapulmonary tuberculosis, affecting vertebrae and intervertebral discs with potential to permanent neurological sequelae.1 It accounts for 2% of all tuberculosis cases, being the thoracolumbar column most commonly affected (80-90% of cases).1,2 The diagnosis tends to be delayed because of low degree of suspicion and nonspecific manifestations (such as lombalgia).1 Cold abscesses may be the first presentation and typically they are paravertebral thoracolumbar abscesses or localized over the chest wall. Early diagnosis and treatment are of utmost importance to ensure a good outcome.3
