Publications by authors named "Lesley Jackson"

Objective: Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post-COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post-COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort.

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Falls and osteoporosis are risk factors for fragility fractures. Bone mineral density (BMD) assessment is associated with better preventative osteoporosis care, but it is underutilized by those at high fracture risk. We created a novel electronic medical record (EMR) alert-driven protocol to screen patients in the Emergency Department (ED) for fracture risk and tested its feasibility and effectiveness in generating and completing referrals for outpatient BMD testing after discharge.

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Osteoporosis and fragility fractures are managed by clinicians across many medical specialties. The key competencies of clinicians delivering bone health care have not been systematically established. We aimed to develop a decision rule to define the threshold of adequate skills and attributes associated with clinical competency in bone health for a clinician serving as a referral source for bone health care.

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(1) Background: Some severe COVID-19 patients develop hyperinflammatory cytokine storm syndrome (CSS). We assessed the efficacy of anakinra added to standard of care (SoC) in hospitalized COVID-19 CSS patients. (2) Methods: In this single-center, randomized, double-blind, placebo-controlled trial (NCT04362111), we recruited adult hospitalized patients with SARS-CoV-2 infection, evidence of pneumonia, new/increasing oxygen requirement, ferritin ≥ 700 ng/mL, and at least three of the following indicators: D-dimer ≥ 500 ng/mL, platelet count < 130,000/mm, WBC < 3500/mm or lymphocyte count < 1000/mm, AST or ALT > 2X the upper limit of normal (ULN), LDH > 2X ULN, C-reactive protein > 100 mg/L.

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Article Synopsis
  • The objective is to update recommendations for preventing and treating glucocorticoid-induced osteoporosis (GIOP) in patients on glucocorticoids for more than three months at doses of 2.5 mg daily or higher.
  • A systematic review was conducted to address various treatment approaches, assessing the quality of evidence and reaching a consensus on recommendations for fracture risk assessment and appropriate therapies.
  • The guidelines emphasize early assessment of fracture risk, strongly advise pharmacologic treatment for high-risk individuals, and provide tailored recommendations for specific populations, while ensuring these guidelines do not restrict access to necessary therapies.
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Article Synopsis
  • The text aims to update guidelines for preventing and treating glucocorticoid-induced osteoporosis (GIOP) in patients using glucocorticoids for over three months at daily doses of 2.5 mg or more.
  • A systematic review of literature was conducted, and recommendations were developed with consensus from a panel, focusing on both medication and non-medication strategies for managing GIOP.
  • Strong recommendations include early fracture risk assessments for patients starting glucocorticoids and pharmacologic treatment for those at medium to very high fracture risk, along with specific guidance for certain populations.*
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Article Synopsis
  • The study aimed to evaluate COVID-19 vaccine uptake, reasons for hesitancy, and self-reported disease flare in a large network of rheumatology practices.
  • Out of 61,158 patients surveyed, 89% had received at least one vaccine dose, but those with autoimmune and inflammatory rheumatic diseases (AIIRDs) were less likely to be vaccinated and more hesitant compared to those without AIIRDs.
  • Main reasons for hesitancy included safety concerns and side effects, while a lack of physician recommendation was a key factor for booster hesitancy; however, having AIIRD did not lead to higher rates of self-reported disease flare after vaccination.
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Background: "Storytelling" interventions influence knowledge, attitudes and behavior to promote chronic disease management. We aimed to describe the development of a video "storytelling" intervention to increase gout knowledge and promote adherence to medications and follow-up care after an acute gout flare visit in the emergency department.

Methods: We developed a direct-to-patient storytelling intervention to mitigate modifiable barriers to gout care and promote outpatient follow-up and medication adherence.

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Objective: Patients with acute gout are frequently treated in the emergency department (ED) and represent a typically underresourced and understudied population. A key limitation for gout research in the ED is the timely ability to identify acute gout patients. Our goal was to refine a multicriteria, electronic medical record alert for gout flares and to determine its diagnostic characteristics in the ED.

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Objectives: Gout prevalence is reportedly ∼20% higher in US Black adults than Whites, but racial differences in emergency department (ED) visits and hospitalizations for gout are unknown. We evaluated the latest US national utilization datasets according to racial/ethnic groups.

Methods: Using 2019 US National Emergency Department Sample and National Inpatient Sample databases, we compared racial/ethnic differences in annual population rates of ED visits and hospitalizations for gout (primary discharge diagnosis) per 100 000 US adults (using 2019 age- and sex-specific US census data).

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Objective: The COVID-19 pandemic led to a sudden uptake of telemedicine in rheumatology. We analyzed the recent published literature on telemedicine for the diagnosis and management of inflammatory, non-inflammatory and/or autoimmune rheumatic diseases.

Methods: We performed a registered systematic search (CRD42020202063) for interventional or observational studies published between August 2015 and January 2022.

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Background: Little is known about satisfaction with different modes of telemedicine delivery. The objective of this study was to determine whether patient satisfaction with phone-only was noninferior to video visits.

Methods: We conducted a parallel group, randomized (1:1), single-blind, noninferiority trial in multispecialty clinics at a tertiary academic medical center.

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A 40-year-old woman with a history of poorly controlled HIV presented to a district referral hospital in rural Botswana for a generalized skin rash of several months duration. The highly pruritic rash predominantly involved her hands and feet and was associated with bullae that were present for days at a time before rupturing without drainage or discharge. The patient endorsed night sweats, periodic fevers, occasional cough productive of blood-tinged sputum, fatigue, and weight loss.

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Purpose Of Review: We summarize the recent literature published in the last 2 years on healthcare disparities observed in the delivery of rheumatology care by telemedicine. We highlight recent research dissecting the underpinnings of healthcare disparities and identify potentially modifiable contributing factors.

Recent Findings: The COVID-19 pandemic has had major impacts on care delivery and has led to a pronounced increase in telemedicine use in rheumatology practice.

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Background: The diagnosis of preterm labour is challenging. False-positive diagnoses are common and result in unnecessary, potentially harmful treatments (e.g.

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Background: Timely interventions in women presenting with preterm labour can substantially improve health outcomes for preterm babies. However, establishing such a diagnosis is very challenging, as signs and symptoms of preterm labour are common and can be nonspecific. We aimed to develop and externally validate a risk prediction model using concentration of vaginal fluid fetal fibronectin (quantitative fFN), in combination with clinical risk factors, for the prediction of spontaneous preterm birth and assessed its cost-effectiveness.

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Background: Infants with gastrointestinal conditions and poor weight gain are administered sodium supplementation based on urinary sodium concentrations. However, the reference range of urinary electrolytes is unknown. The aim of this study was to ascertain the normal values of urinary electrolytes in healthy, term infants.

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Adrenal abscesses due to disseminated nocardiosis are exceedingly rare in clinical practice, and to date only 8 cases have been reported in the literature, most of which were confined to a single adrenal gland. These infections often occur in patients with underlying immune deficiency. We report a rare case of bilateral nocardial adrenal abscesses in an intravenous drug-using splenectomized patient that presumably originated from direct inoculation using intravenous opana, as his admission chest radiograph was normal.

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Introduction: The aim of the QUIDS study is to develop a decision support tool for the management of women with symptoms and signs of preterm labour, based on a validated prognostic model using quantitative fetal fibronectin (fFN) concentration, in combination with clinical risk factors.

Methods And Analysis: The study will evaluate the Rapid fFN 10Q System (Hologic, Marlborough, Massachusetts, USA) which quantifies fFN in a vaginal swab. In QUIDS part 2, we will perform a prospective cohort study in at least eight UK consultant-led maternity units, in women with symptoms of preterm labour at 22 to 34 weeks gestation to externally validate a prognostic model developed in QUIDS part 1.

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Introduction: The aim of the QUIDS study is to develop a decision support tool for the management of women with symptoms and signs of preterm labour, based on a validated prognostic model using quantitative fetal fibronectin (qfFN) concentration, in combination with clinical risk factors.

Methods And Analysis: The study will evaluate the Rapid fFN 10Q System (Hologic, Marlborough, Massachusetts) which quantifies fFN in a vaginal swab. In part 1 of the study, we will develop and internally validate a prognostic model using an individual participant data (IPD) meta-analysis of existing studies containing women with symptoms of preterm labour alongside fFN measurements and pregnancy outcome.

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Background: Infants <32 weeks' gestation should not be exposed to topical iodine and its avoidance is recommended during pregnancy and breast feeding. Exposure to contrast media and topical iodine is frequently used in many preterm neonates.

Aim: To determine whether thyrotropin levels in preterm infants are affected by exposure to intrapartum/neonatal topical iodine and/or the use of iodinated contrast media.

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