bluuebunny/crossref_metadata_2025_split huggingface dataset:
P73 Trends in ultrasound guided musculoskeletal injections at one tertiary care centre over 6 years
Authors: Lall Kunal , Ejindu Vivian , Kiely Patrick D. W 
Published: April 2020

Abstract

Background
Ultrasound (US) has brought many benefits into rheumatologic practice, delivery of targeted injections into joints, bursae and other structures. Whilst many joints may be accurately injected in clinic, guided by clinical landmarks, US permits injections into anatomically less accessible sites. We have assessed trends in the number and type of requests for US guided joint or soft tissue injections from the rheumatology department over the last 6 years, and the impact on waiting times.

Methods
Details of all requests for US guided joint or soft tissue injections were obtained from the St George’s PACS system from 1 January 2013 - 31 December 2018. Review of patient records was conducted to determine whether the referral was routine or urgent, the waiting time between referral and appointment, the joint or structure to be injected, and whether an injection into the requested site was actually performed.

Results
Table 1 shows the total number of out-patient attendances in rheumatology per year from 2013 - 2018, the number of referrals for US-guided injection, the proportion requested urgently and waiting times for routine and urgent cases. Over 6 years requests for US guided injections have risen 2.3-fold, from &lt;1% to nearly 2% of all out-patient attendances. Of 1834 requests, no injections were given in 420 instances (23%), due to patient preference or lack of indication at time of US. In 2018 of all joint or tendon/bursa injections initiated in rheumatology, 260 (38%) were given in routine clinic time without delay, and 420 (62%) were requested by US with a delay of over 2 months.

Conclusion
Over 6 years a 33% increase in out-patient clinic workload has been accompanied by a disproportionate 2.3-fold increase in requests for US guided injections, representing &gt;50% of injections initiated by the service. One explanation may be time pressure in clinic. This trend has not been matched by increased radiology capacity, with urgent requests now waiting &gt;6 weeks. This has implications for quality of care, staffing and effective service delivery. The trend to fewer injections in clinic will continue if clinicians become increasingly reliant on radiology colleagues.

Disclosures
K. Lall None. V. Ejindu None. P.D.W. Kiely None.
P74 Group counselling: a holistic care model
Authors: Nadesalingam Kavitha , Short Catherine 
Published: April 2020

Abstract

Background
Disease modifying anti rheumatic drugs (DMARDs) play a vital role in controlling autoimmune disease. They are complex medications requiring nurse counselling to initiate. Staff vacancies and increasing referrals led to 12-week waiting times from decision to treat in our Trust. We wanted to improve the efficiency of the medication counselling process, but at the same time use it as an opportunity to educate our patients on their disease, management and self-care.

Methods
We designed and delivered a successful group clinic to improve patient experience, reduce waiting times and improve efficiency. As well as covering the necessary DMARD information, the clinic includes patient education on general, physical and mental well-being, dietary advice as well as physiotherapy and occupational therapy input. The clinic format consists of a presentation/discussion, peer support and individual consultation, providing truly holistic care.

Results
Waiting times: reduction from 84 days to 7-14 days from decision to treat for our two main DMARDS and 56 days to 14 days for our anti TNF therapies. Clinical outcome/patient safety: Earlier initiation of DMARDs has been shown to reduce morbidity. Financial: Additional £444 income per clinic (compared with previous clinic process) at a tariff of £111 per patient. Group clinics currently run weekly. Patient feedback: 50 patient feedback forms have been collected and reviewed. Of these 50 patients 97.8% of questions asked were marked as agree or strongly agree to a positive experience. Shared learning: The clinic format was presented at a regional meeting and at our Trusts Quality Improvement Day. There is interest in adopting a similar approach in other departments in the Trust and in other rheumatology departments in the region.

Conclusion
Our group consultation model provides a holistic model to care that has been very popular with our patients. We have subjectively had an increase uptake in physiotherapy services and patients seem to be persevering and tolerating their medications better. Our group consultations have been running successfully for a year, and we have expanded the sessions to cover more drugs including our anti TNF therapies. It is yet early days to comment on the long-term impact our clinic has on patients, but with our clinic providing patient education and empowering patients through self management we are hopeful that we will be improving the long-term outcome of our patients.

Disclosures
K. Nadesalingam None. C. Short None.
P84 Implementation of advanced practice rheumatology clinics
Authors: Gotting Laura M 
Published: April 2020

Abstract

Background
Ashford and St Peters NHS Trust implement an iMSK Service with an aim to deliver biopsychosocial assessment and care across Orthopaedics, Pain and Rheumatology settings. Our impression was the Rheumatology Service could be assisted by the implementation of Advanced Clinical Practitioners Clinics considering the benefits that had been offered to Orthopaedic and Pain Services. The Rheumatology Service had high waiting times to see a Consultant, were understaffed in relation to national recommended ratio of Consultant to catchment population and were motivated to promote a biopsychosocial approach to patient care. There were poor links between Rheumatology and the MSK Triage Service as well as the Physiotherapy Service which were recognised as areas for improvement and integration for both patient and staff. The plan was to improve the efficiency of pathway into Rheumatology, reduce unnecessary contacts for the patient and offer best practice advice at first contact. An aim to reduce non-inflammatory referrals to consultants, in turn reducing overall waiting times for inflammatory presentations.

Methods
We researched and benchmarked against existing services, learning from experiences and various models of implementation. We audited our MSK triage process, to include numbers of referrals into the Rheumatology Service. We developed an ACP Triage Criteria as a multi-disciplinary team to highlight our skillset and best fit to the service needs. We observed the existing MDT in clinic to include consultant and nurse specialists as well as undertaking injection, bloods and radiology training. We collaborated with the service managers to implement ACP clinics for the assessment of non-inflammatory presentations and widespread pain. We are collecting PREM data with the 'CARE' patient satisfaction questionnaire, as well as clinical outcome data collection to include the Widespread Pain Index, Symptom Severity Score and evaluation of patient onward referral destination and management plan.

Results
We have seen over 60 patients and continue to collate our data. Over 50% of patients have been discharged at first appointment to confidently begin a self-management approach to their care. We have referred only 2 patients onto rheumatology consultant appointments - therefore saving a minimum of 35 Consultant Hours within our service in a 3-month period. We have had 100% positive feedback for patient's who have completed satisfaction questionnaires PREM data after appointment.

Conclusion
We continue to collect and analyse our data but can already highlight a positive trend for successful implementation of ACP's into the Rheumatology Service within only a 3 month period. We feel this is a starting point for the further development of a Widespread Pain Pathway across the MSK Service to further incorporate integration of Rheumatology, Pain and Physiotherapy Services in the prevention of duplicate or unnecessary appointments and reduction in the ‘revolving door patients’ across all 3 services.

Disclosures
L.M. Gotting None.
P93 Outcomes of enhanced triage of rheumatology referrals at a single point of access
Authors: Forgie Bethan , Garrood Toby 
Published: April 2020

Abstract

Background
With increasing pressure on rheumatology services there is a need to identify alternative pathways for patients which are better aligned to their needs. East Surrey CCG is formed of 17 GP practices serving an adult population of 137,000. First Community Health and Care acts as a single point of referral for patients with musculoskeletal conditions. In 2018 a triage service was established, run by a GP with an extended role (GPweR), for patients referred to rheumatology. Analysis of triaged patients was undertaken to explore the feasibility of diverting a subgroup of patients with non-inflammatory conditions into community-based care.

Methods
Referrals from February 2018 to March 2019 were analysed from the point of triage to confirmation of the diagnosis in secondary care. Triage was undertaken with additional reference to the primary care record in EMIS. For each referral it was recorded whether, according to the available information, this was more likely to be an inflammatory or non-inflammatory condition and whether they could have been seen first in a community GPwER rheumatology clinic. The final diagnosis after their hospital appointment was recorded. A pilot GPweR-led community clinic was established in April 2019 to see those patients selected by the process as suitable for community-based care.

Results
407 patients were triaged. 96% were triaged to secondary care. Of these, records from the subsequent rheumatology appointment(s) were available for 312. The final diagnosis was inflammatory in 120 (38%) and non-inflammatory in 192 (62%). 152 patients (49%) were thought to have a non-inflammatory condition at triage which was confirmed in 83% of cases after a consultant appointment. 160 patients (51%) were thought likely to have an inflammatory condition which was confirmed in 59%. Positive predictive value of the triage process for non-inflammatory conditions was 83%, negative predictive value 59%, sensitivity 66%, specificity 79%. 57 patients selected from triage were seen in the pilot community clinic. Final diagnoses were: 53% fibromyalgia, 19% osteoarthritis, 12% soft tissue rheumatism, 14% gout/inflammatory arthritis. 54% of patients needed blood tests and 39% imaging. 31% required a face to face follow up appointment and 47% were referred to physiotherapy. 7% were referred on to rheumatology.

Conclusion
Referrals to secondary care rheumatology are rising and putting increasing pressure on services and referral to treatment times. There is a need to develop alternative pathways for patients with non-inflammatory conditions who could be managed in community settings. Our work shows that a majority of these can be identified at the point of triage with good specificity. We have also shown that of those seen in a pilot community clinic few needed onward referral. Our work suggests that there is a substantial opportunity to develop alternative and potentially more cost-effective community-based pathways for patients.

Disclosures
B. Forgie None. T. Garrood None.
P94 Development of a methotrexate digital media card and methotrexate website
Authors: Martin Una E. S 
Published: April 2020

Abstract

Background
Methotrexate (MTX) remains the standard treatment for inflammatory arthritis. For patients prescribed MTX they tell us that they find it difficult to source correct information. Patients require this at different time points in their disease and in different formats that encompass literacy and language challenges. Patients are usually given instruction about MTX at the time of their diagnosis when they are faced with absorbing a lot of information in a very short time frame, yet the majority of patients are required to take MTX for the duration of their disease.

Methods
Following on from the development of the MTX patient education guide in Ireland in 2017 we looked at developing the content into a different format. In partnership with a digital media company and the pharmaceutical industry the content was converted into a digital media card and website for use in the clinical setting. The content was designed as an additional support to patients prescribed MTX. The animation consists of both audio and images and provides the viewer with essential information and key messages required when taking MTX. The animation guides the patient through MTX, outlines how it works, how to take MTX, and highlights the important safety issues and monitoring required when taking MTX. Audio content was written by the author and designed in collaboration with a digital media company. The digital media card and website was launched nationally in September 2018 with the support of the Irish Rheumatology Nursing Forum and Arthritis Ireland. Rheumatology departments nationally were provided with copies of the digital media card and details of the website. Patients can use the digital media card and be signposted patients to www.methotrexate.ie.

Results
Since the launch of both the website and the digital media card there has been 1.5 K sessions, and 1.4K users on the website. The website has been accessed globally with over 781 users from Ireland, 220 from the United States and 144 from the United Kingdom. The website is accessed predominately by mobile device followed by tablet device.

Conclusion
To date the website continues to be accessed by patients and we have received very positive feedback. The digital media card has been adopted nationally and has become incorporated as part of the education of patients about MTX. Both the website and the digital media card are designed to support and enhance the education about MTX and not replace the formal education that nurses give to patients about MTX. The next step is to survey both the patients and healthcare professionals using the tools and identify what additions may enhance these tools. For further information go to www.methotrexate.ie to access the website and view the animation.

Disclosures
U.E.S. Martin Honoraria; U.M has received honoraria from Novartis, Abbvie Ireland. Grants/research support; U.M has received educational grants from Novartis, Janssen, Abbvie, Pfizer.
P97 Implementation of a regional trainee-led leadership and management programme for rheumatology trainees
Authors: Benson Rosalind , Sharp Charlotte , Macphie Elizabeth 
Published: April 2020

Abstract

Background
We identified a lack of formal learning opportunities provided by Health Education England North West (HEE (NW)) to achieve the many leadership and management requirements stipulated by the Joint Royal College of Physicians’ Training Board Speciality Training (ST) rheumatology curriculum. This gap was highlighted through discussion at the HEE (NW) Specialty Training Committee by trainee representatives and regional Training Programme Directors (TPD), in 2017. Furthermore, the merger of two pre-existing Deaneries (Mersey and NW) into the NW Local Education and Training Board (LETB) created a pressing need to develop a network across the region.

Methods
Two regional ST representatives engaged with trainees across the new LETB through formal surveys and informal conversations regarding training to address this. Specialty trainees (STRs) elected a bi-annual half-day session in conjunction with an existing clinical regional event, the North West Rheumatology Club (NWRC). Sessions have covered a range of topics (Table 1) and provide an opportunity for networking across the deaneries. Learning objectives are mapped against ST curriculum. HEE (NW) TPDs support the programme, facilitating study leave. Meeting costs are supported by the NWRC. Trainees shape future sessions submitting topic ideas and have autonomy over content and speakers. Formal anonymous sessional feedback uses a Likert scale evaluating whether learning objectives have been met and quality of session delivery. Now entering its third year the scheme is well-established, with succession planning in place.

Results
With feedback response rates of 85% (mean across 4 sessions), median scores are 5 (IQR 4.9-5) for meeting learning objectives and 5 (IQR 5-5) for session delivery. Free text feedback is overwhelmingly positive. Six months after sessions trainees reported ‘feeling more encouraged to raise concerns’, ‘being more proactive in whistleblowing‘, ‘having a better understanding of conflict situations’, and ‘better awareness of reasons for difference in individual behaviours’.

Conclusion
Filling unmet training needs in leadership and management through trainee-led sessions provides an excellent learning opportunity for STRs both attending and leading the events, and facilitates cross-regional collaboration. This programme demonstrates the role of stakeholders to inform programme design successfully, showing excellent long-term impact in an important and previously underserved curriculum requirement.

Disclosures
R. Benson None. C. Sharp None. E. Macphie Grants/research support; EM is the Secretary of the North West Rheumatology Club; meetings are supported by an unrestricted educational grant from UCB.
P100 Factors associated with educational needs in patients with inflammatory arthritis
Authors: Johnston Alice R , Ndosi Mwidimi 
Published: April 2020

Abstract

Background
With an overarching aim to inform person-centred patient-education, this study had two objectives: (i) to identify factors that may be associated with educational needs in patients with inflammatory arthritis (IA) (ii) to assess whether educational needs and priorities differ between subtypes of inflammatory arthritis i.e. rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).

Methods
Secondary analysis of cross-sectional survey data originally used to validate the Educational Needs Assessment Tool (ENAT) was conducted. The outcome variable was educational needs, summarised as ENAT domain scores. The explanatory variables were: Age, gender, IA subtype, school leaving age and disease duration. ENAT scores were Rasch-transformed prior to analysis. Univariable analyses were conducted to explore differences between groups and multivariable analyses (multiple regression) to determine factors associated with educational needs. All explanatory factors were entered into a preliminary multivariable model. Factors that achieved statistical significance at the 10% level were entered into the final multivariable model. Those that achieved a statistical significance at the 5% level were associated with educational needs. To determine educational priorities, percentage contribution of each domain score to the total score was calculated and compared between factors with one-way analysis of variance.

Results
The evaluable population comprised 388 patients, 125 with RA, 133 with AS and 130 with PsA. Their mean (SD) age was 48 (13.95) years and male/female ratio 177/210. Those with early arthritis (disease duration &lt;2 years) were 36 (9.2%), RA = 15, AS = 3 and PsA=18, and 116 (29.7%) left school before the age of 16. Table 1 presents the final multi-variable models. The proportion of variance explained by the model varied across ENAT domains, the highest being movement (25%). Female gender was found to be an independent predictor of educational needs across all ENAT domains. Significant differences in educational priorities were observed between disease groups in all domains except disease process and support.

Conclusion
Female gender is independently associated with educational needs across all three sub-types of IA. Results of this secondary analysis are inconclusive due to limitations in the available data. Further research should include factors such as disease severity, treatments, disability and self-efficacy.

Disclosures
A.R. Johnston Other; Work conducted as part of Nurse and Allied Health Professional Internship Programme funded by versus Arthritis (Grant number 20867). M. Ndosi None.
P127 Factors associated with self-reported fatigue in hip and/or knee osteoarthritis: a systematic review
Authors: Fawole Henrietta O , Idowu Opeyemi A , Abaraogu Ukachukwu O , Riskowski Jody L , Dell'Isola Andrea , Steultjens Martijn P , Chastin Sebastien F. M 
Published: April 2020

Abstract

Background
Fatigue is an important, under-researched and poorly understood symptom among hip and/or knee osteoarthritis (OA) populations. To devise the best fatigue management strategy in these populations, it is necessary to evaluate the evidence on risk factors for fatigue. This study aimed to give an overview and evaluate the evidence on the factors associated with fatigue in hip and/or knee OA populations.

Methods
We conducted a systematic review using MEDLINE, AMED, CINAHL, ProQuest, and Web of Science Core Collections databases from inception to June 2019. Inclusion criteria comprised cross-sectional and longitudinal studies on patients with a diagnosis of hip and/or knee OA, included a measure of self-reported fatigue and studies that performed a subgroup analysis of hip/knee OA from other included populations. Two reviewers simultaneously screened articles for eligibility and extracted the following data: study design, fatigue outcome tool, follow-up time and association between factors and fatigue. The methodological quality of the included studies was assessed using the National Heart, Lung and Blood Institute quality appraisal tool. Study quality and study designs were combined to determine the level of evidence using best-evidence synthesis, which comprised six levels of evidence (Table 1).

Results
Eighteen studies (10 cross-sectional designs, 8 longitudinal designs) were included. A majority of the studies included were of good quality, whilst two had fair quality and one poor quality. Lower physical function, more pain, higher depressive symptoms, lower physical activity, older age, increased anxiety, greater pain catastrophizing, worse radiographic evidence, higher body mass index, greater comorbidity/illness burden, lower six minutes walk and increased joint stiffness were included in the best evidence synthesis. From the best evidence grading, most of these factors had limited or conflicting evidence on its association with fatigue within the hip/knee OA populations. However, lower physical function and higher depressive symptoms were graded as having strong evidence on their associations with fatigue while higher pain levels had moderate evidence.

Conclusion
Lower physical function levels, higher depressive symptoms and higher pain are related to fatigue in the hip/knee OA population. More longitudinal studies are warranted to investigate the potential association of other identified factors and fatigue.

Disclosures
H.O. Fawole None. O.A. Idowu None. U.O. Abaraogu None. J.L. Riskowski None. A. Dell'Isola None. M.P. Steultjens None. S.F.M. Chastin None.