This systematic review examines the representation in rheumatoid arthritis randomized clinical trials of racial/ethnic minority groups compared with the representation of these populations in the United States and the representation of women and elderly people with the prevalence of rheumatoid arthritis among these groups nationally.

BackgroundThe Kidney Awareness Registry and Education (KARE) trial examined the impact of a multilevel intervention on blood pressure control among patients with chronic kidney disease (CKD) in a public health care delivery system. KARE consisted of a clinic-based intervention (a primary care CKD registry with point-of-care provider notifications and quarterly feedback related to CKD management) and a patient-directed intervention [a CKD self-management support (CKD-SMS) program that included low literacy educational materials, automated telephone-administered self-management modules and telephone health coaching]. We explored the acceptability of these interventions among end users.MethodsAt trial conclusion, we surveyed 39 primary care providers (PCPs) to identify preferences about components of the clinic intervention, conducted two focus groups among non-PCP staff to elicit in-depth attitudes and experiences with operationalizing the team-based CKD registry, and conducted eight focus groups with English- and Spanish-speaking patients to hear about their experiences with the CKD-SMS program. Focus group transcripts were analyzed using thematic analysis. Self-reported participation and data from the automated telephone program were used to evaluate patient engagement.ResultsMost PCPs (94%) believed that the point-of-care notifications benefited clinic workflow and agreed that quarterly feedback enhanced their ability to identify (89.5%) and manage (73.7%) CKD. Staff confirmed usefulness of point-of-care notifications. Patients suggested the automated telephone system was impersonal, though easy to use; that frequent automated calls were helpful to reinforce self-management behaviors; and that telephone health coaching was convenient. Nearly 40% of patients completed >80% of automated phone calls, 95% participated in calls with their health coach and 77% created at least one action plan.ConclusionsA CKD registry is acceptable to primary care health care teams and has potential to enhance identification and management of CKD in primary care. Low-income patients appreciated and engaged with a telephone-based CKD-SMS program, demonstrating its potential for increasing awareness and health engagement among populations with CKD within a public health care delivery system.

To characterize the representation of dark skin color in clinical images across 4 major rheumatology training resources.Methods. We gathered images of patients with rheumatic diseases from the American College of Rheumatology Image Library, UpToDate, the New England Journal of Medicine Images in Clinical Medicine and Clinical Cases filtered by "Rheumatology," and the 9th edition of Kelley's Textbook of Rheumatology. Investigators used Fitzpatrick's skin phototypes to independently code images depicting visible skin as "light" (skin types I to IV), "dark" (skin types V to VI), or "indeterminate." The representation of dark skin in clinical images was compared to the representation of Asian, Native American, and Black individuals within the US Census population and within lupus cases nationally.Results. Of the 1,043 patient images included in the study, 13.4% had dark skin, 84.0% light skin, and 2.6% indeterminate skin color. Dark skin was underrepresented significantly in rheumatology educational materials and lupus images when compared with the representation of Asian, Native American, and Black individuals within the US Census population (13.4% versus 20.6%; χ 2 = 32.8, P < 0.001) and in published studies of patients with systemic lupus erythematous (22.6% versus 44.2%; χ 2 = 20.0, P < 0.001).Conclusion. Darker skin tones are significantly underrepresented in major rheumatology clinical image banks. Improving representation of racial and ethnic minorities in rheumatology education materials can better equip trainees to recognize and diagnose cutaneous manifestations of rheumatic diseases in these groups.

a soft, non-distended abdomen without tenderness or guarding. The white blood cell count (WBC) was 14,060 cells/μL with an absolute neutrophil count of 11,260 cells/ μL. Other laboratory tests included normal liver biochemical tests and lipase, creatinine 0.95 mg/dL, C-reactive protein 100 mg/L (0.2-7.5), carbon dioxide 20 mmol/L (24-32), lactate 3.6 mmol/L (0.5-2.2), and troponin 0.05 (0.00-0.03). An electrocardiogram showed normal sinus rhythm with left ventricular hypertrophy. His tachycardia and lactic acidosis resolved with fluid administration, and his pain decreased after 4 mg of intravenous morphine and intravenous ondansetron. A fecal PCR assay for 22 enteric pathogens was negative.The team ordered an abdominal contrast CT on admission, but there were logistical barriers to obtaining the study afterhours. Given the concern for chronic, but not acute, mesenteric ischemia, as well as the improvement in his lactic acidosis, tachycardia, and pain, the team planned to obtain imaging the next morning. The patient received 2 mg of intravenous morphine for his abdominal pain overnight.The following day (hospital day 2), the patient reported resolution of his abdominal pain and had a soft, non-tender abdomen. He ate a clear liquid diet and asked to go home. His WBC had decreased to 11,780 cells/μL. A contrast CT of the abdomen and pelvis (Fig. 1) showed a distended gallbladder with mild wall enhancement and dilated loops of the small bowel in the left upper quadrant; a discussion with the radiologist revealed there were no signs of mesenteric ischemia. General surgery was consulted. Later in the evening, an additional finding of occlusive atherosclerotic disease at the origin of a combined celiac/superior mesenteric artery (SMA) trunk was noted on the CT report (Fig. 2); a non-urgent consultation with vascular surgery was planned for the next day.Overnight, his abdominal pain recurred. On the morning of hospital day 3, he had a newly distended abdomen with diffuse tenderness and guarding. The WBC was 9,980 cells/μL and the aspartate aminotransferase was newly elevated at 79 U/L (5-35). An abdominal ultrasound showed a sludge-filled gallbladder with no stones or surrounding fluid. The vascular surgery service was consulted. That afternoon, the oxygen saturation decreased to 70%. His arterial blood gas (ABG) was 7.18/23/75/8.2 on a non-rebreather mask, and he was emergently intubated for acute hypoxic respiratory failure. A

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