bluuebunny/crossref_metadata_2025 huggingface dataset:
P115 Thousands of rheumatoid arthritis & juvenile idiopathic arthritis patients benefit from interactive National Rheumatoid Arthritis Society broadcasts
Authors: Jacklin Clare B
Published: April 2024

Background/Aims

Pressures on NHS services results in many rheumatology patients missing out on vital information that can support them in understanding and managing their conditions. During the COVID pandemic, NRAS took to social media to host regular live interactive broadcasts to keep people informed on the latest regarding vaccines, staying safe and treatments etc. These proved such a successful way of communicating with people not just across the entire UK but often those from other countries that ‘NRAS Lives’ have become a monthly resource offering covering a multitude of relevant to RA and JIA topics.

Methods

Originally utilising just Facebook NRAS became aware that this particular platform wasn’t being accessed by all our beneficiaries. At the beginning of 2023 NRAS began to use a new streaming platform ‘StreamYard’ that opened up the opportunity to stream broadcasts on Facebook, Twitter, LinkedIn and YouTube simultaneously, hence reaching many more people living with RA or JIA and rheumatology health professionals. NRAS Lives are hosted on the last Wednesday of every month with usually a panel of guests presenting on a chosen topic and individuals having the ability to pre-submit questions to be addressed on the night relating to the topic as well as the opportunity to post live questions throughout the broadcast.

Results

As of September 2023 NRAS has hosted eight interactive educational broadcasts reaching almost 15,000 people. Providing people with inflammatory arthritis the opportunity to hear from key opinion leaders and experts regardless of where they are located in the UK or across the world, or their ability to access such opportunities locally. Topics covered include BSR’s new Pregnancy Guidelines; Foot Health & Orthotics; Mental Health & Wellbeing; Support for young adults with IA; Importance of Exercise; Rheumatology Research for All; Remote Monitoring explained with upcoming topics in 2023 being Stress & RA (uneasy bedfellows) and Men with RA ‘The Men’s Rheum’. All live broadcasts are recorded and then hosted on the NRAS YouTube channel and are being freely accessed for ongoing patient and health professional education.

Conclusion

With more and more patients being moved onto PIFU pathways as well as NHS resources being severely restricted in their ability to offer face to face patient education or indeed for health professionals to have access to experts from a wide variety of backgrounds, these NRAS Lives are bridging those increasing gaps in knowledge sharing. The NRAS YouTube channel is a developing accessible, free library of information which complements other NRAS and NHS resources for both patients and health professionals.

Disclosure

C.B. Jacklin: None.
P139 Self-assessment of scleroderma skin: validation of the PASTUL questionnaire
Authors: Spierings Julia , Ong Voon H , Welsing Paco M J , Hughes Michael , Pauling John D , Galdo Francesco Del , Herrick Ariane L , Denton Christopher P
Published: April 2024

Background/Aims

The PASTUL (Patient self-Assessment of Skin Thickness in Upper Limb) questionnaire was developed during the COVID pandemic to allow self-assessment of skin remotely in systemic sclerosis (SSc). The aim of this study was to validate PASTUL, evaluate responsiveness and assess impact of skin on quality of life.

Methods

SSc patients were included in four centres. The PASTUL questionnaire specifies a grading of skin (normal, mild, moderate, severe thickness (0-3)) at eight sites corresponding to the modified Rodnan Skin Score (mRSS) with maximum score assigned to each site. Validity was assessed by comparing PASTUL scores with mRSS assessed by trained rheumatologists. Health Related Quality of Life (EQ5D5L and SSc HRQoL) and Scleroderma Skin Patient reported Outcome (SSPRO) were collected for construct validity, using Pearson’s correlation coefficient (0-0.19 = negligible, 0.2-0.39 = weak, 0.4-0.59 = moderate, 0.6-0.79 = strong, 0.8-1.0 = very strong). Test-retest reliability was estimated using intraclass correlation coefficient (ICC). Patients were followed for six months.

Results

149 patients were included, mean age 56.6 years (SD 13.2), 79.7% female, 78 (56.1%) had limited cutaneous SSc (lcSSc) and 61 (43.9%) diffuse cutaneous SSc (dcSSc). Mean disease duration was 12.8 years (SD 9.2), mean mRSS was 9.2 (SD 6.2). At baseline and six months follow-up, PASTUL and mRSS were strongly correlated (r = 0.63 and r = 0.78, p < 0.001, respectively).

Test-retest reliability, assessed in 75 patients, was very good (ICC of 0.83, 95% CI 0.74-0.89, p < 0.001). Mean PASTUL scores were 9.3 (SD 6.2) at baseline and 8.5 (SD 6.6) at six months follow-up. In patients with >2 points increase in mRSS, change in PASTUL was significant (p = 0.042). The standardized response mean (SRM) of mRSS and PASTUL in patients with clinically significant change in HRQoL (>0.082) was 0.29 and 0.24, respectively. Correlation between PASTUL and mRSS was moderate in lcSSc and strong in dcSSc (r = 0.54 p < 0.001, and 0.63 p < 0.001, respectively). In patients with disease duration < 4 years, PASTUL was very strongly correlated with mRSS (r = 0.84, p < 0.001), and strongly correlated with HRQoL (EuroQoL, r= -0.67, p = 0.004).

SSPRO scores were not correlated with mRSS or PASTUL, but were moderatedly associated with SSc HRQoL scores (r = 0.425, p < 0.001).

Conclusion

Our preliminary results show that PASTUL is a valid and feasible outcome tool that adds a self-reported measure of skin severity to impact assessments like SSPRO. HRQoL was associated with skin thickening in patients with early disease. SRM was low and needs further assessment in a larger group.

Disclosure

J. Spierings: None. V.H. Ong: None. P.M.J. Welsing: None. M. Hughes: None. J.D. Pauling: None. F. Del Galdo: None. A.L. Herrick: None. C.P. Denton: None.
P164 Fracture risk in axial spondyloarthritis: a retrospective analysis of the use of the Fracture Risk Assessment Tool in a cohort of affected patients
Authors: Mulkerrin Patrick , O'Shea Finbar , Fitzgerald Gillian
Published: April 2024

Background/Aims

Fractures are common in axial spondyloarthritis (axSpA) patients. The FRAX (Fracture Risk Assessment Tool) score is a validated tool for the assessment of fracture risk. Unlike axSpA, rheumatoid arthritis (RA) is counted as a risk factor in FRAX. The primary aim was to calculate a FRAX score in a cohort of axSpA patients. In addition, a second FRAX score was determined by ticking the “RA risk” as positive on the second assessment.

Methods

Data were examined on a cohort of axSpA patients attending the St James’s Hospital Spondylitis service. Bone mineral density was assessed at the neck of femur on the patient’s dual x-ray absorptiometry (DXA). This, plus the individual patient’s risk factors, were added to the FRAX score calculator. The analysis was then repeated with the RA risk box ticked as positive. The effect of such an adjustment (taking account of their diagnosis of axSpA) on the fracture risk status of these patients was made to assess if this resulted in an additional number of patients within the cohort being at risk of fracture. A patient with a 10-year hip fracture risk of > 3% or 10-year major osteoporotic fracture risk of > 20% is high risk.

Results

Table 1 summarises the characteristics of the cohort. All (100%) of the patients met ASAS axSpA criteria and 85% met Modified New York (mNY) criteria for ankylosing spondylitis. Five patients had known osteoporosis and an additional 9 patients were classified as being at increased fracture risk using the FRAX Tool. A further 7 patients could be classified as being at increased fracture risk when the FRAX was adjusted for the axSpA diagnosis, by ticking the RA risk box as positive.

Conclusion

Fracture risk is a significant issue in patients with axSpA; however, this risk is frequently under-recognised. The use of the FRAX score improves the detection of those at fracture risk, and its use should be strongly encouraged in all rheumatology clinics managing axSpA patients. When the same weighting is given to axSpA as RA, there is a further increase in the identification of patients at risk of fractures.

Disclosure

P. Mulkerrin: None. F. O'Shea: None. G. Fitzgerald: None.
P175 The Psoriatic Arthritis Impact of Disease 12-item questionnaire can replace other patient-reported outcome measures to facilitate disease monitoring in clinical practice
Authors: Hum Ryan M , Hasanein Khaled , Hao Leow T , Williams Jacob C , Cheung Annie , Adhikarla Aditya , Choyce Annabel , Newton Alice , Clegg Caroline , Barton Anne , Ho Pauline
Published: April 2024

Background/Aims

The Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) was developed and validated to improve assessment of disease activity from the patient’s perspective. Several patient-reported outcome measures (PROMs) are relevant to PsA but completing several questionnaires at each clinic visit creates a time and administrative burden for patients and clinicians. Furthermore, the Minimal Disease Activity (MDA) for assessing disease activity in PsA requires the Health Assessment Questionnaire (HAQ) to be collected; however, a Canadian study found that PsAID-12 can replace HAQ in the MDA using a cut-off of < 3.7. A previous study also found sex-specific differences in PsAID-12 scores, with scores being higher in females. The aim of this study was to assess whether PsAID-12 correlates well and could replace other PROMs in clinical practice, and to validate previously published findings related to the use of PsAID-12 instead of HAQ in determining MDA, and sex-specific differences in PsAID-12 scores.

Methods

Clinical data were collected from 75 consecutive patients attending a PsA clinic in a tertiary centre at their first review in 2023. Clinical characteristics, PROMs, examination findings, and measures of disease activity were recorded. Correlation with PsAID-12 was assessed using Spearman’s rank correlation coefficient. Sex-specific differences were assessed using Mann-Whitney U tests. Bonferroni correction was used to adjust for multiple comparisons.

Results

PsAID-12 scores were significantly correlated with all PROMs, and with composite measures of disease activity (DAPSA, MDA), but not with clinical measures of disease activity (TJC, SJC, PASI, BSA), or acute-phase reactants (CRP, ESR). PsAID-12 scores were not affected by age or disease duration. There was no sex-dependent difference in PsAID-12 scores; however, female patients had significantly higher HAQ and HAD scores. MDA scores using PsAID-12 correlated significantly with MDA scores using HAQ.

Conclusion

PsAID-12 is a suitable replacement for other PROMs in clinical practice, and for HAQ when determining MDA status to reduce the time and administrative burden on patients and clinicians, and to facilitate monitoring of disease activity in patients with PsA regardless of age or disease duration. Contrary to previous studies, there were no sex-dependent differences in PsAID-12 scores.

Disclosure

R.M. Hum: None. K. Hasanein: None. L.T. Hao: None. J.C. Williams: None. A. Cheung: None. A. Adhikarla: None. A. Choyce: None. A. Newton: None. C. Clegg: None. A. Barton: None. P. Ho: None.
P187 Fatigue in people with polymyalgia rheumatica: a key unmet need?
Authors: Muller Sara , Belcher John , Hider Samantha , Helliwell Toby , Mallen Christian D
Published: April 2024

Background/Aims

Polymyalgia rheumatica (PMR) is common in older adults, causing severe pain and stiffness, particularly in the shoulder and hip girdles. Glucocorticoids treatment generally focusses on reducing pain and stiffness, but there are other aspects to quality of life. Fatigue is a well-recognised symptom in other inflammatory rheumatological conditions and has been highlighted by people with PMR as a neglected symptom.

Methods

People with newly diagnosed PMR in English general practice (2012-2014, n = 652) were recruited to a postally-administered cohort study. Surveys included items relating to PMR, general health and well-being. The FACIT-Fatigue questionnaire was included in the survey at diagnosis, 1, 12, 24 and (mean) 61 months follow-ups. Latent class growth analysis was used to define trajectories, based on FACIT-Fatigue scores over time. Trajectories were characterised and compared at baseline and over time.

Results

244 people participated at 24 months and 197 at 61 months. Individuals were allocated to one of five fatigue trajectories. Each represented a different average level of fatigue at diagnosis that remained stable over time (Table). From least to most fatigued, trajectory sizes were 111, 122, 211, 133 and 75. Two thirds of the cohort (the three “worst” trajectories) were, on average, more fatigued than reported in the general population. Worse fatigue trajectory was associated with female sex, higher pain and stiffness, higher levels of anxiety, depression, insomnia, and poorer physical function at baseline and throughout.

Conclusion

Fatigue is common in inflammatory conditions, but under-recognised in PMR. Fatigue severity at the time of diagnosis appears indicative of fatigue levels up to five years later and is associated with a broad range of health constructs at diagnosis and later. This represents an unmet need in a sizable proportion of those with PMR, who may need more help to manage their condition and allow them to return to full function. These findings also present a potential avenue for early identification of those with a poor prognosis related to their PMR.

Disclosure

S. Muller: None. J. Belcher: None. S. Hider: None. T. Helliwell: None. C.D. Mallen: None.
E008 Review of rheumatology care for women of childbearing age
Authors: Mohareb Marwa , Ahmed Sumaya , Bharadwaj Anurag , Nandagudi Anupama
Published: April 2024

Background/Aims

Autoimmune rheumatic diseases are frequently diagnosed in women of childbearing age. Managing these conditions during pregnancy is complex because commonly used disease-modifying antirheumatic drugs (DMARDs) can pose risks. Specialized care for this patient group is crucial, necessitating adherence to established rheumatology practice standards and British Society for Rheumatology (BSR) guidelines. Our main objective is to review management of childbearing age females with rheumatic diseases attending Basildon hospital as per BSR guidelines.

Methods

The data for this retrospective study was collected from the electronic records of female patients attending the rheumatology outpatient clinic at Basildon Hospital between September and December 2022. We reviewed age, the specific rheumatological diagnosis, disease duration, disease activity, current medications, and whether general advice or pregnancy-specific advice was provided.

Results

Out of the initial cohort of 63 female patients, 48 (76%) aged between 18-55 years were selected as women of childbearing age, The median age was 46 years, with 65% in the age groups of 31-50 years, 25% in group 51-55 years and 10% 18-30 years age group. 58% of patients had inflammatory arthritis, 18.7% had connective tissue disease, 18.7% had other conditions such as hypermobility, osteoarthritis, and regional pain syndrome, 2.3% were diagnosed with vasculitis and 2.3% with polymyalgia rheumatica. Breakdown of inflammatory arthritis patients revealed rheumatoid arthritis in 64%, psoriatic arthritis 15% and ankylosing spondylitis 12%. Axial spondyloarthropathy, palindromic rheumatism, and juvenile idiopathic arthritis, each accounted for 3%. Regarding prescribed medications, 66% of the individuals were on conventional DMARDs, biologics 24%, corticosteroids 6% and 4% were on other treatments. The DMARDs prescribed were methotrexate 27%, hydroxychloroquine 19%, sulfasalazine 13%, mycophenolate 3% and leflunomide 1%. The majority of patients had disease activity in remission or mild, each accounting for 23%. Moderate and severe disease activity were reported in 21% each of the audited sample. Patients received advice specifically related to pregnancy 29%, while 71% did not have documented pregnancy-related guidance. 70% of females of reproductive age received general advice.

Conclusion

The study highlights a gap in pregnancy-related advice among the childbearing age patients as only 29% received guidance on pregnancy. This underpins the need for proactive counselling and education for female patients in routine practice, work in partnership with obstetric teams, and primary care to reduce potential pregnancy related complications and improve outcomes.

Disclosure

M. Mohareb: None. S. Ahmed: None. A. Bharadwaj: None. A. Nandagudi: None.
E026 Severe odynophagia due to cricoarytenoid arthritis in a patient with rheumatoid arthritis and systemic lupus erythematosus
Authors: Berry Joe S , Robinson John , Ng Wan-Fai
Published: April 2024

Background/Aims

A 65-year-old man with a 20-year history of rheumatoid arthritis (RA) presented with dysphagia, odynophagia, polyarthralgia and significant weight loss.

Methods

- 

Results

In addition to raised markers of inflammation, he was anti-nuclear antibody, anti-dsDNA antibody, anti-chromatin antibody and rheumatoid factor positive. He was initiated on 20mg once daily prednisolone but reported continued dysphagia and odynophagia. Computerised tomography (CT) of the neck revealed sclerosis at both cricoarytenoid joints with positron emission tomography (PET-CT) imaging identifying focal FDG uptake in the right hemiglottis projected over the posterior right true cord. Direct visualisation showed reduced mobility of the arytenoids with incomplete glottic closure in the absence of other abnormalities. He was diagnosed with cricoarytenoid (CA) joint arthritis on a background of RA and systemic lupus erythematosus overlap, with the resolution of his symptoms following intravenous methylprednisolone.

Conclusion

CA arthritis is an increasingly rare manifestation of autoimmune disease, and severe ongoing odynophagia an atypical presentation. This case highlights the need for continued awareness of laryngeal manifestations of autoimmune disease and demonstrates the benefit of PET-CT in cases where the diagnosis is uncertain or delayed.

Disclosure

J.S. Berry: None. J. Robinson: None. W. Ng: Consultancies; Expert advice in the area of Sjogren’s syndrome to GlaxoSmithKline, MedImmune, UCB, Abbvie, Roche, Eli Lilly, Takeda, Resolves Therapeutics, Sanofi, Novartis and BMS.
E044 The role of patient education in a joint injection clinic. The most ‘cost effective’ approach for the management of your arthritis
Authors: Maunick Sheevam , Mullet Carl Manuel , Mccoll Tracy , Reed Michael , Gupta Monica , Hafeez Maira , Bawa Sandeep
Published: April 2024

Background/Aims

GGH operates a self-referral joint injection clinic where patients suffering from an acute arthritis flare, can call and book an appointment for review and possible joint injection. The self referral service applies to all the patients attending the GGH rheumatology service and are under the care of a rheumatologist. A screening questionnaire was originally designed to triage those requesting appointments last year. We have amplified this work further this year by raising awareness and educating patients about their rheumatological condition and specifically about steroid intra-articular joint injections. Their benefits, risks and their indications. Aims-1. Providing education and awareness of joint injections in the community aiding patients to participate in their joint care. 2. Help patient understand the indications, side effects and risks involved with repeated injection . 3. To know the difference between osteoarthritis and inflammatory arthritis.

Methods

Retrospective study of patients who self-referred for joint injection between 07/07/2022 and 22/05/2023. Total of 138 self referred via phone calls, emails or letters. All the self referral data was compiled, assessed by screening questions and reviewed. An education and awareness campaign was made possible through an improved waiting room, educational pamphlets, leaflets and 1:1 consultations.

Results

Two pools of patients who received joint injections were analysed. Group A (07/07/2022 - 08/12/2022) where 102 patients self-referred and 43 received a joint injection. Group B (04/01/2023 - 22/05/2023) 36 self-referred and 15 received injection. The table below shows the different demographics of the two groups.

Conclusion

Patient Education remains one of the most important cornerstones in management of arthritis patients. After an ongoing campaign of education/awareness, self referrals were reduced by 66 %.This audit demonstrates that patient education about joint injections allows for more effective management, allowing better informed shared care. It also reduces the waiting times for patients to be seen in the injection clinic - from 3 months to 2 weeks. A cost effective approach in service improvement. Population who still availed joined injection in the re- audit were more elderly, obese, female, and had more metabolic diseases however the self referral to injection ratio is almost the same both groups.

Disclosure

S. Maunick: None. C. Mullet: None. T. Mccoll: None. M. Reed: None. M. Gupta: None. M. Hafeez: None. S. Bawa: None.
E050 Angiotensin converting enzyme for the diagnosis of childhood sarcoidosis
Authors: Mackay Madeleine C , Deepak Samundeeswari , Warrier Kishore , Rangaraj Satyapal
Published: April 2024

Background/Aims

Childhood sarcoidosis is a rare multisystem inflammatory granulomatous disease. The prevalence of sarcoidosis in children is unknown due to its rarity. A review of sarcoidosis in Denmark found an incidence in children < 15 years of 0.22-0.27 per 100 000/year. Diagnosis can be challenging given the varied presentations due to multisystem involvement. There is no one laboratory test that is diagnostic for sarcoidosis. Angiotensin converting enzyme (ACE) has been shown to be elevated in 50% of late-onset childhood sarcoidosis. Reference levels are laboratory and age dependent, and healthy children can have levels that are 40-50% higher than in adults. Our aim was to gain a better understanding of the use of ACE in clinical practice and to review its role in diagnosis and management of sarcoidosis.

Methods

We collated the list of all patients under 18 years who had ACE levels done at our hospital between 1/12/2021 and 30/11/2022 via clinical pathology. Electronic patient records were reviewed for all patients to gather information on demographics, and clinical symptoms.

Results

We had a total of 98 ACE blood tests done for 58 patients. Clinical notes and results were available for 34 of these patients with a total of 48 ACE results. Age range of patients was 3-17 years with a mean age of 12 years. 19 (56%) patients were female, 15 (44%) were male. 50% were of white ethnicity, 12% of black ethnicity, 3% Indian ethnicity, 3% Pakistani ethnicity, 3% Chinese ethnicity and 29% ethnicity not recorded. 45 were requested by in hospital specialties, 2 from other hospitals and 1 from a GP. Of those requested in hospital 73% had been requested by ophthalmology, rheumatology or dermatology, with the remainder requested by a range of other paediatric specialties. Results ranged from 11-195 U/L, with a median of 76 U/L. Hospital reference range is 13-64 U/L and 18 patients had results >64 U/L. Reference ranges for paediatric patients in literature is 29-112 U/L. 6 patients had a result>112U/L. One patient had a diagnosis of sarcoidosis. Following the initial results a further 4 years of results were analysed from 02/01/2018-30/11/2022. 10 further patients had ACE results >112U/L. Of these, none had sarcoidosis.

Conclusion

These results support that the diagnosis of sarcoidosis is rare. ACE results need to be interpreted being mindful that normal childhood ACE levels may be higher than the reference ranges given by hospitals, which may be based on adult ranges. There is need for more research in this area to ascertain diagnostic ACE levels and role of ACE in disease monitoring. I plan to lead a trainee multicentre retrospective project looking at the diagnosis of paediatric sarcoidosis, and within this review the role of ACE levels.

Disclosure

M.C. Mackay: None. S. Deepak: None. K. Warrier: None. S. Rangaraj: None.
E054 Rituximab dose minimisation in rheumatoid arthritis, a retrospective outcome analysis
Authors: Butler Stephanie , Smith Helen
Published: April 2024

Background/Aims

Rituximab was originally developed as a non-Hodgkin lymphoma treatment and rheumatology adopted the same dosing for rheumatoid arthritis(RA); two 1000mg doses two weeks apart for each maintenance cycle. UHSussex utilises self-referral for maintenance rituximab dosing once disease control lessens. Evidence demonstrates patients treated with lower dose rituximab still enjoy good disease control with less immunosuppression, reduced hospital attendance and reduction in drug expenditure. Following one two-dose cycle, stable RA patients were prescribed a single 1000mg dose from 2020 onwards. A retrospective outcome analysis was completed in August 2022; however, results were highly impacted by Covid-19 and a repeat analysis was required. Aim: to assess impact of a single 1000mg dose rituximab regime on patient sustained outcomes, dose intervals, Disease Activity Scores (DAS) and drug expenditure.

Methods

The pharmacy database was used to identify RA patients receiving rituximab from March 2020 to August 2023. Patients received at least one standard two-dose cycle before switching to a single infusion. Patients were excluded if lost to follow up (under care of rheumatology for less than a year following dose switching) or considered clinically unstable. Patient letters and departmental records were accessed for disease scores and treatment intervals.

Results

Table1: Results from the two analysis periods

From the original cohort (31/59)53% remained on single dosing. Switch back tended to occur within 18 months of switching. DAS scores were not collected reliably and were omitted.

Conclusion

Covid-19 impacted services and attitudes during the initial study period. Many patients stopped treatment, particularly rituximab, due to the prolonged duration of effect, excluding them from analysis. The dose-interval increase during the first analysis was considered a result of the pandemic. Patients and clinicians delayed infusions; minimising immunosuppression due to perceived increased risk of Covid-19. The continued interval increase in the second analysis may identify a patient cohort in deep remission eligible for therapy review. The study highlights poor practice in collecting and recording DAS scores and appropriate patient-clinician interaction opportunities. 53% of patients remained on single infusions in August 2023 resulting in resource savings, reduced hospital attendance, immunosuppression and significant cost savings demonstrating the rationale for this option.

Disclosure

S. Butler: Honoraria; Abbvie, Janssen. H. Smith: Honoraria; Novartis, Abbvie.
E063 Discussion of contraception and family planning in the lupus clinic
Authors: Mashida Knievel , Benson Rosalind , Redfern Angela , Burton Christine , Mclaren Zoe
Published: April 2024

Background/Aims

Females with a diagnosis of systemic lupus erythematosus (SLE) have a higher risk of adverse pregnancy outcomes. Many medications used to treat SLE are teratogenic. Contraception counselling and discussion around family planning are essential to reduce pregnancy risks.

This service evaluation aimed to evaluate the appropriateness of contraceptive advice given to females of childbearing age with SLE in accordance with international guidelines and assess patient adherence to recommendations provided.

Methods

A retrospective evaluation of electronic medical records was undertaken. All females with a diagnosis of SLE seen in the preceding 12 months were identified. Any who were menopausal or trying to conceive were excluded. Based on BSR and EULAR guidance, five standards relating to contraceptive advice were assessed, primarily focusing on frequency of contraceptive discussions and the level of adherence to recommendations provided. For analysis of the established parameters, patients were stratified into different clinic groups; tertiary lupus clinic, vs. general clinic and whether the consultation was clinician or nurse led.

Results

42 females aged 16-55 were identified. 39/42 (93%) of patients had discussions regarding contraception and conception. 39/39 (100%) of females were recommended appropriate contraception methods. Only 3/42 (7.1%) received written information on family planning. Adherence to contraceptive advice was low. Only 10/39 (25.6%) of patients recommended non-barrier contraception were complying with advice. 29/42 (69%) patients were on teratogenic medication. 8/29 (27.6) were using long acting reversible contraceptives (LARC). Of those who were not, 2/29 (6.8%) were not sexually active, 1/29 (3.4%) relied on their partner’s vasectomy, 3/29 (10.3%) had alternative contraception preference and in 15/29 (51.7%) the reasons were unclear. Conception and family planning advice was given in all clinics, however those attending the tertiary lupus clinic were significantly more likely to receive follow up advice on contraception and conception advice compared to those attending general clinics (U = 44, P < 0.001). There was no difference between the frequency of nurse or clinician led advice.

Conclusion

Contraceptive advice in line with current guidelines is being delivered routinely in lupus clinics. There appears to be barriers to the uptake of LARC. To better understand this, exploration of patient experiences of contraception and conception discussions is underway.

Disclosure

K. Mashida: None. R. Benson: None. A. Redfern: None. C. Burton: None. Z. Mclaren: None.
Karyopherin α2 is a maternal effect gene required for early embryonic development and female fertility in mice
Authors: Rother Franziska , Depping Reinhard , Popova Elena , Huegel Stefanie , Heiler Ariane , Hartmann Enno , Bader Michael
Published: April 2024

The nuclear transport of proteins plays an important role in mediating the transition from egg to embryo and distinct karyopherins have been implicated in this process. Here, we studied the impact of KPNA2 deficiency on preimplantation embryo development in mice. Loss of KPNA2 results in complete arrest at the 2cell stage and embryos exhibit the inability to activate their embryonic genome as well as a severely disturbed nuclear translocation of Nucleoplasmin 2. Our findings define KPNA2 as a new maternal effect gene.
The Effect of SGLT2 Inhibitor Therapy on Endothelial Progenitor Cell Function in Patients With Heart Failure
Authors: Kakzanov Yana , Sevilya Ziv , Goldman Alexander , Cipok Michal , Hershkovitz Vera , Bryk Gabriel , Lev Eli I.
Published: April 2024

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been shown to reduce the risk of cardiovascular mortality and hospitalizations in patients with heart failure (HF) with preserved or reduced ejection fraction (HFpEF or HFrEF). The mechanism for this benefit is not clear. Endothelial progenitor cells (EPCs) are bone marrow–derived cells able to differentiate into functional endothelial cells and participate in endothelial repair. The aim of this study was to evaluate the effect of SGLT-2 inhibitors on the level and function of EPCs in patients with HF. We enrolled 20 patients with symptomatic HF, 12 with HFrEF and 8 with HFpEF (aged 73.3 ± 10.2 years, 95% men). Blood samples were drawn at 2 time points: baseline and ≥3 months after initiation of SGLT-2 inhibitor therapy. Circulating EPC levels were evaluated by expression of vascular endothelial growth factor receptor-2 (VEGFR-2), CD34, and CD133 by flow cytometry. EPC colony forming units (CFUs) were quantified after 7 days in culture. The proportion of cells that coexpressed VEGFR-2 and CD34 or VEGFR-2 and CD133 was higher following 3 months of SGLT-2 inhibitors [0.26% (interquartile range, IQR 0.10–0.33) versus 0.55% (IQR 0.28–0.91), P = 0.002; 0.12% (IQR 0.07–0.15) versus 0.24% (IQR 0.15–0.39), P = 0.001, respectively]. EPC CFUs were also increased following SGLT-2 inhibitor treatment [23 (IQR 3.7–37.8) versus 79.4 (IQR 25.1–110.25) colonies/106 cells, P = 0.0039]. In patients with symptomatic HF, both HFpEF and HFrEF, treatment with SGLT-2 inhibitors is associated with an increase in the level and function of circulating EPCs. This augmentation in EPCs may be a contributing mechanism to the clinical benefit of SGLT-2 inhibitors in patients with HF.
Ethical considerations for nurse practitioners conducting research in populations with opioid use disorder
Authors: St Marie Barbara J. , Bernhofer Esther I.
Published: April 2024

People with opioid use disorder (OUD) are a vulnerable population who face unique risks of harm when participating in research. Despite a long-standing dialogue, written research codes of ethics, and institutional review board oversight for the conduct of ethical research in vulnerable populations, protections for study populations with OUD is rarely mentioned. Nurse practitioners who conduct research using participants with OUD, especially when recruiting their own patients (i.e., dual role), must be aware of the unique ethical considerations necessary to protect their patients and participants from increased risks. This article explores vulnerabilities and influences that can affect participant recruitment and consent, imbalances in the distribution of risk and benefits to participants participating in research, and the concerns of coercions, undue influence, and unjustifiable pressure contributing to vulnerabilities. Strategies to reduce the risks of influences that are of concern in the vulnerable population of research participants with opioid disorder are suggested. The goal of this article was to raise awareness of the unique potential risks of harm when using people with OUD as research participants and to explore strategies to minimize potential risks of various levels of influence in this vulnerable population.
Current progress in international pediatric emergency medicine
Authors: Gutiérrez Camilo E. , Lim Rodrick , Chu Simon
Published: April 2024

Purpose of review

Over the past four decades, pediatric emergency Medicine (PEM) has witnessed significant global development, with a notable increase in training programs and official recognition by regulatory bodies. However, disparities persist in the recognition of PEM as an independent subspecialty, availability of training programs on a global scale, academic recognition, and the ability to provide high-quality care to children worldwide. There is paucity of published literature regarding development of PEM globally. This review explores the current trends and challenges in international pediatric emergency medicine.

Recent findings

Current trends in international pediatric emergency medicine encompass the provision of training in pediatric-focused emergency and acute care, increased propagation of evidence-based guidelines specific to the care of children, the growth of collaborative research networks and interest groups within national and international societies. Simultaneously, the field continues to face challenges such as the lack of recognition, inequities in access, and a lack of dissemination of global PEM initiatives.

While recent advancements have significantly enhanced the state of international pediatric emergency medicine, including pediatric specific research networks and training programs, barriers still hinder its overall quality. Many of these obstacles are not unique to pediatric emergency medicine but are directly affected by financial disparities and lack of governmental and public recognition of the essential role of pediatric emergency care.
Methods for Global Health Collaboration on Cardiovascular Disease: Vihiga 1
Authors: Shishani Kawkab , Kaduka Lydia , Olale Joanna , Mbuka Schiller , Mutai Joseph , Muniu Erastus , Ochieng Rodgers , Sivarajan Froelicher Erika
Published: April 2024

Background

Partnership building and understanding of context that addresses global health concerns is essential in global health research. However, limited knowledge is available on the practical experiences of building such relationships.

Objectives

The aim of this study was to provide a detailed description of the processes involved in establishing international collaboration, gain community involvement and cooperation with gatekeepers, and study populations of rural village areas in Western Kenya.

Results

Because of the limited information available in the published literature about the extremely important practical considerations, our experiences on the logistical aspects of planning and implementing global health research projects are presented.

Conclusion

Understanding the local collaborators and their communities and allocating adequate resources in time and money during the planning phase is paramount in ensuring the successful completion of global health research studies.
Mixed-Methods Study of Disability Self-Management in Mexican Americans With Osteoarthritis
Authors: Harrison Tracie C. , Blozis Shelley A. , Taylor Janiece , Mukherjee Nandini , Caudillo Ortega Lucia , Blanco Nancy , Garcia Alexandra A. , Brown Sharon A.
Published: April 2024

Background

Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients’ lives.

Objective

The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans.

Methods

In this sequential, two-phased, mixed methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored.

Results

First, a qualitative study of 19 adults of Mexican American descent born in Texas (U.S.) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety.

Discussion

This mixed methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.
H. pylori Infection and Hepatitis and Its Functional Abnormality in Ninawa Governorate Population, Iraq
Authors: Mohammed Mohammed Arafat , Salman Samira M. , Hasan Saif Y. , Ali Jassim Fatehi , Saeed Younis Saadi
Published: April 2024

The external gastric effect of H. pylori is not restricted to the liver. In this study, we will detect this fact through the effect of this bacterial infection on the normal physiological function of the liver. The passive negative effect of Helicobacter on the liver is reflected as hepatitis. Hepatitis causes alteration in the normal physiological function of the liver on different levels, starting from the normal enzyme secretion level to the hormonal level, which is secreted by the liver to regulate the normal function of other systems. The aim of this study was to find this fact by comparing some parameters from the patient (with gastric ulcer) with those of a normal noninfected individual. The parameter is icterus in the patient as a clinical sign that reflected hepatic abnormality and hepatitis detected by a highly skilled clinician. A recent study with a case-control design connected hepatitis and its functional abnormalities in a patient with gastric ulcer who was infected by H. pylori. A total of 382 patients were included as the sample from a community of 60,000 patients in a specific area of Mosul, Iraq. The total population of this city is around 1.5 million. According to a previous study, it is estimated that 0.02% of the city population suffers from gastric ulcers caused by H. pylori. The sample was collected by highly skilled staff along with specialist clinicians. The data were analyzed using SPSS 25 by the specialized staff. We monitored the negative effect of H. pylori on different aspects of infected patients, especially hepatic inflammation and its abnormal physiological function. In this study, icterus is used as a clinical indicator for hepatic abnormalities.
Correlating Evans Index, Callosal Angle, and Lateral Ventricle Volume With Gait Response Outcomes in Idiopathic Normal Pressure Hydrocephalus Diagnosis
Authors: Rohatgi Saurabh , Dua Amol , Diociasi Andrea , Buch Karen , Avesta Arman , Ford Jeremy , Gupta Rajiv
Published: April 2024

Objective

Radiological imaging is pivotal in diagnosing idiopathic normal pressure hydrocephalus (iNPH), given the similarity of its symptoms to other neurodegenerative diseases. We aimed to correlate the Evans index (EI), callosal angle (CA), and the volume of the lateral ventricles measured before cerebrospinal fluid removal with the resultant outcomes in gait response.

Methods

In our retrospective study, we identified 42 patients with a diagnosis of iNPH. These patients underwent gait analysis, imaging, and lumbar puncture. Radiological assessments included measurements of CA EI and lateral ventricular volume. Clinically, we assessed the following 4 gait parameters: cadence, gait speed, stride length, and timed up and go. Change in the 4 gait parameters was calculated, normalized, and compiled into a composite score, following which the group was divided into ‘responders’ and ‘nonresponders’ based on z score of 0.5. Our dependent variable was clinical improvement in gait, and our independent variables included lateral ventricular volume, EI, and CA. We performed a Wilcoxon rank-sum test to compare significant responder status using CA, EI, and lateral ventricle volume. A receiver operating characteristic analysis was employed to determine which volume measurement exhibited the strongest correlation with responder status. Determining the significant variables, a chi-square analysis was subsequently conducted.

A significance threshold was set at P < 0.05. All our statistical evaluations were conducted in the Spyder environment, which is compatible with Python 3.10.

Results

There was a significant difference for responder status in EI and lateral ventricle volume. Evan index showing a statistic of 2.202 (P value = 0.02) and lateral ventricle volume demonstrating a statistic of 2.086 (P value = 0.03). Subsequent exploration using receiver operating characteristic analysis, with area under the curve of 0.71, identified 105.40 cm3 as the most robustly correlated volume threshold with responder status.

Conclusions

The lateral ventricular volume demonstrates a stronger correlation with gait improvement compared to the CA or EI. These observations indicate that evaluating the lateral ventricle volume before lumbar puncture could serve as a predictor for gait response after lumbar puncture in individuals with normal pressure hydrocephalus.
Five-Year Outcomes from a Prospective Study on Safety and Efficacy of Phasix ST Mesh Use at the Hiatus During Paraesophageal Hernia Repair
Authors: McKay Sarah C , Dunst Christy M , Davila-Bradley Daniel , Reavis Kevin M , DeMeester Steven R
Published: April 2024

BACKGROUND:

Laparoscopic paraesophageal hernia (PEH) repair has a high hernia recurrence rate. The aim of this study was to assess the 5-year hernia recurrence rate after PEH repair using a combination of bioresorbable mesh and advanced surgical techniques to address tension as needed in a prospective group of patients.

STUDY DESIGN:

In 2016, a prospective database was established for 50 patients undergoing primary, elective PEH repair with a new bioresorbable mesh (Phasix ST). Intraoperatively, tension was addressed with Collis gastroplasty and diaphragm relaxing incisions as needed. All 50 patients from the initial study were tracked and asked to return for objective follow-up. Recurrence was considered present for any hernia more than 2 cm in size.

RESULTS:

Objective follow-up was conducted in 27 of the original 50 (54%) patients at a median of 5.25 years after their PEH repair. Before the 5-year follow-up, 5 patients had a known recurrent hernia. Objective evaluation at 5 years identified an additional 3 recurrences, for a total recurrence rate of 25% (8 of 32 patients). The hernia recurrence rate in patients with a Collis gastroplasty was significantly lower than in those without a Collis (7% vs 54%, p = 0.008). Two patients underwent reoperation for hernia recurrence. No patient had a mesh infection or mesh erosion.

CONCLUSIONS:

The combination of Phasix ST Mesh and tension-reducing techniques during PEH repair led to a 25% hernia recurrence rate at 5 years. The addition of a Collis gastroplasty led to significantly fewer hernia recurrences and is indicative of the potential for esophageal shortening in many patients with a PEH. The long-term safety and efficacy of Phasix ST Mesh in combination with surgical technique for PEH repair is confirmed.
Joint extension speed dictates bio-inspired morphing trajectories for optimal longitudinal flight dynamics
Authors: Harvey C.
Published: April 2024

Avian wing morphing allows dynamic, active control of complex flight manoeuvres. Previous linear time-invariant (LTI) models have quantified the effect of varying fixed wing configurations but the time-dependent effects of morphing between different configurations is not well understood. To fill this gap, I implemented a linear parameter-varying (LPV) model for morphing wing gull flight. This approach models the wing joint angles as scheduled parameters and accounts for nonlinear kinematic and gravitational effects while interpolating between LTI models at discrete trim points. With the resulting model, I investigated the longitudinal response associated with various joint extension trajectories. By optimizing the extension trajectory for four independent objectives (speed and pitch angle overshoot, speed rise time and pitch angle settling time), I found that the extension trajectory inherent to the gull wing does not guarantee an optimal response but may provide a sufficient response with a simpler mechanical implementation. Furthermore, the results indicated that gulls likely require extension speed feedback. This morphing LPV model provides insights into underlying control mechanisms, which may allow for avian-like flight in future highly manoeuvrable uncrewed aerial vehicles.