bluuebunny/crossref_metadata_2025_split huggingface dataset:
P89 Can we manage osteoporosis without patients ever seeing a consultant?
Authors: Fourmy Joanne , Begum Julie , Nisar Muhammad K 
Published: April 2020

Abstract

Background
Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver a high-quality and safe service.

Methods
All stakeholders involved in the management of osteoporosis at our unit were engaged. Following extensive discussions, a new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation and assess the suitability of parenteral treatment. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to everyone. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. If all checks were satisfactory, the treatment was commenced, and individuals advised to contact the advice line for any concerns. There was no face-to-face appointment in the service unless explicitly requested by the users.

Results
In the proof-of-concept phase, 38 patients were triaged into the new service. It was a combination of sixteen new referrals and 22 patients pulled from the consultants’ waiting list. Mean age of participants was 77.2 years (65-92). Referral to virtual triage took median 20 days (0-62). Median time for triage to new patient CNS telephone consultation was 18 days (6-87). Time to virtual MDT for treatment authorisation was median zero days (0-76 days). 17 patients had anabolic therapy commenced via home care. Remaining had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. 38 new patient consultant appointments were saved and median delay in treatment commencement was reduced from 84 to 38 days.

Conclusion
To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to thinly stretched health care needs of people with chronic conditions.

Disclosures
J. Fourmy None. J. Begum None. M.K. Nisar None.
P111 Should standing consultations be offered throughout the NHS? An investigation into patient attitude towards standing consultations in a rheumatological department
Authors: Oliver Andrew , Raftery Graham , Coady David 
Published: April 2020

Abstract

Background
Britain is becoming an increasingly sedentary society; public health statistics tell us our health is being affected by our everyday lifestyle choices with reduced levels of physical activity and increasing levels of obesity contributing to increased demands on health and social care systems. On average, the UK workforce spends 9 hours sitting down per day. This is particularly prominent amongst GPs and certain senior physician roles in hospital, where clinics contribute to a large amount of the workload. Standing has been shown to put less stress on the lower back and other joints, burn more energy than sitting down and increase productivity and energy levels. Thus, evidence shows it is healthier to stand more during the day, but is it feasible in a healthcare setting? The aim of this study was to investigate whether patients would prefer to sit or stand for their consultations and the reasoning behind their choices.

Methods
A consultation room within the rheumatology outpatient department in Sunderland Royal Hospital was fitted with an adjustable standing desk. During clinics, patients were offered a standing consultation on entry to the room. A focused questionnaire was created and given to patients, consisting of 6 questions on the demographics of the patients, whether they wanted a standing consultation or not and what their reasoning was for their decision. This was an opportunistic study that included 39 patients over a 3-week period.

Results
In total, 39 questionnaires were given out, with each patient being offered a standing consultation. The results found that 13 patients opted for a standing consultation and 23 patients preferred to sit down. Not wanting to stand due to an MSK problem was the most prevalent answer with 16 patients using that as their reasoning.

Conclusion
In an increasingly sedentary population, the introduction of standing desks could help to reduce this behaviour in healthcare professionals and contribute positively to health. This study also highlights the question of positive modelling of patient behaviours, by healthcare professionals demonstrating the benefits of standing, it could encourage patients to begin to integrate it into their own lives. If we remove the 16 patients that did not want to stand due to an MSK problem, then the results show that 13/23 (56%) of patients wanted a standing consultation, so why not offer the choice? Increasing the sample size and trialling the desk in another department, where MSK problems are less prevalent, is the logical next step to develop this research. Following further investigation, the implementation of standing desks throughout more healthcare departments could help to reduce sedentary behaviour, increase productivity, lessen sick days amongst staff and demonstrate healthy living to patients.

Disclosures
A. Oliver None. G. Raftery None. D. Coady None.
P126 An analysis of the quality and readability of online information for osteoarthritis
Authors: Murray Kieran , Murray Timothy , Low Candice , O'Rourke Anna , Veale Douglas J 
Published: April 2020

Abstract

Background
Osteoarthritis is the most common cause of disability in people over 65 years old. The readability of of online osteoarthritis information has never been assessed. A 2003 study found the quality of online osteoarthritis information to be poor. This study reviews the quality of online information regarding osteoarthritis in 2018 using three validated scoring systems. Readability is reviewed for the first time, again using three validated tools.

Methods
The term osteoarthritis was searched across the three most popular English language search engines. The first 25 pages from each search engine were analysed. Duplicate pages, websites featuring paid advertisements, inaccessible pages (behind a pay wall, not available for geographical reasons) and non-text pages were excluded. Readability was measured using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) and Gunning-Fog Index (GFI). Website quality was scored using the the Journal of the American Medical Association (JAMA) benchmark criteria and DISCERN criteria. Presence or absence of HONcode certification, age of content, content producer and author characteristics were noted.

Results
37 unique websites were suitable for analysis. Readability varied by assessment tool from 8th to 12th grade level. This compares with the recommended 7- 8th grade level. One (2.7%) website met all four JAMA Criteria. Mean DISCERN quality of information for OA websites was “fair”, comparing favourably with the “poor” grading of a 2003 study. HONCode endorsed websites (43.2%) were of a statistically significantly higher quality.

Conclusion
Quality of online health information for OA is “fair”. 2.7% of websites met JAMA benchmark criteria for quality. Readability was equal to or more difficult than recommendations. HONcode certification was indicative of higher quality, but not readability.

Disclosures
K. Murray None. T. Murray None. C. Low None. A. O'Rourke None. D.J. Veale None.
P142 Factors associated with change in health-related quality of life in people living with gout: a three-year prospective cohort study in primary care
Authors: Watson Lorraine , Belcher John , Nicholls Elaine , Chandratre Priyanka , Blagojevic-Bucknall Milisa , Hider Samantha , Lawton Sarah A , Mallen Christian D , Muller Sara , Rome Keith , Roddy Edward 
Published: April 2020

Abstract

Background
Gout affects 2.5% of adults in the UK but is often poorly managed. It can impair health-related quality of life (HRQOL), yet little is known about which people with gout are at risk of worse outcomes. We investigated factors associated with change in HRQOL over a three-year period in people living with gout in primary care.

Methods
People with gout registered with 20 general practices in the West Midlands completed the Gout Impact Scale (GIS), Short-Form-36 Physical Function subscale (PF10) and health assessment questionnaire disability index (HAQ-DI) at five time-points (baseline & 6, 12, 24 and 36 months) via postal questionnaire. Linear mixed modelling (LMM) with multivariate adjustment for baseline and time-varying covariates was used to investigate gout-specific, comorbid and socio-demographic factors associated with change in the Concern Overall (GIS-CO), PF10 and HAQ-DI over three years. Higher scores are worse for GIS-CO and HAQ-DI, but better for PF10.

Results
Of 1,184 baseline respondents, 818 (80%), 721 (73%), 696 (75%), 605 (68%) responded at 6, 12, 24 and 36 months respectively. Mean age (SD) at baseline was 65.6 (12.5) years. 990 (84%) were male, 494 (42%) reported &gt;2 gout flares in the previous year, 624 (54%) were taking allopurinol and 318 (27%) had an eGFR&lt;60mL/min/1.73m2. Factors identified as being associated with a deterioration in HRQOL over three years (table), were gout flare frequency (GIS-CO, PF10), history of oligo/polyarticular flares (GIS-CO, HAQ-DI), having a flare currently (GIS-CO), allopurinol use (PF10), having body pain (GIS-CO, PF10, HAQ-DI), higher pain severity (GIS-CO, PF10, HAQ-DI), number of comorbidities (PF10), eGFR &lt;60mL/min/1.73m2 (PF10, HAQ-DI), anxiety (GIS-CO), depression (PF10, HAQ-DI), and older age (PF10, HAQ-DI). Factors associated with an improvement in HRQOL were longer gout duration (GIS-CO), older age (GIS-CO), lower socioeconomic deprivation (PF10, HAQ-DI) and more frequent alcohol consumption (PF10, HAQ-DI).

Conclusion
Gout-specific, comorbid and socio-demographic factors associated with change in HRQOL over a three-year period in people living with gout in primary care were identified, highlighting people at risk of worse outcomes over three years and at greatest need of urate-lowering therapy and other targeted interventions.

Disclosures
L. Watson None. J. Belcher None. E. Nicholls None. P. Chandratre None. M. Blagojevic-Bucknall None. S. Hider None. S.A. Lawton None. C.D. Mallen None. S. Muller None. K. Rome None. E. Roddy None.
P151 Forced vital capacity in patients with systemic sclerosis associated pulmonary fibrosis: predictors of meaningful decline
Authors: Nihtyanova Svetlana I , Derrett-Smith Emma C , Fonseca Carmen , Ong Voon H , Denton Christopher P 
Published: April 2020

Abstract

Background
Pulmonary fibrosis (PF) is common in systemic sclerosis (SSc) and serial pulmonary function tests (PFTs) are used for routine PF monitoring. Forced vital capacity (FVC) decline reflects progression in PF and FVC is frequently used as an endpoint in clinical trials. We explore the changes in FVC over time in patients with SSc-PF, receiving standard management, including immunosuppression.

Methods
Only SSc patients with CT-confirmed PF were included. FVC changes over the first 10 years from onset and their associations were assessed using linear mixed effects models. Predictors of time from first PFT to development of threshold FVC (FVC&lt;70% and FVC&lt;50%) were analysed using Cox regression.

Results
We identified 505 SSc-PF subjects, 21.6% were male, average age at onset was 47 years and 49.3% had diffuse cutaneous subset (dcSSc). The most common autoantibody was anti-Scl70 in 40.4%, followed by anti-RNA polymerase (ARA) in 11.7% and anti-centromere (ACA) in 7.1%. In 16.4% of the patients, ANA was positive, but no ENAs were identified (ANA+ENA-). Average FVC at 12 months from onset was 80.1% (SD 19.3) and this declined by 0.32% per year (p = 0.007) at a group level. There was no significant correlation between baseline FVC and subsequent change (correlation coefficient -0.13; 95%CI -0.26, 0.01). For every year older age at onset, average FVC increased by 0.32%, p &lt; 0.001. Males had 3.3% lower FVC at 1 year from onset (p &lt; 0.001) and 0.6% faster decline per year (p = 0.034) compared to females. DcSSc subjects had 5.6% lower FVC compared to limited disease (p = 0.003). Average FVC at 1 year from onset in ARA+ subjects were higher than any other antibody (15.1% v. ANA+ENA-, p &lt; 0.001; 14.6% v. ATA, p &lt; 0.001 and 12.5% v. ACA, p = 0.010). Nevertheless, ARA+ subjects had FVC decline rates similar to ATA+ and ANA+ENA- subjects, while ACA+ patients had a small but significant increase in FVC over time. Factors that increased the risk for FVC drop below the thresholds were male sex, ATA and low baseline FVC (Table 1).

Conclusion
This study provides insight into long-term patterns of FVC change and develops a model that may help predict those most at risk of significant decline.

Disclosures
S.I. Nihtyanova None. E.C. Derrett-Smith None. C. Fonseca None. V.H. Ong None. C.P. Denton None.
P159 Current patient reported outcomes (PROs) poorly reflect changes in lung function in patients with systemic sclerosis
Authors: Danzo Fiammetta , Gjeloshi Klodian , Abignano Giuseppina , Dean Anne-Maree , Masini Francesco , Cuomo Giovanna , del Galdo Francesco 
Published: April 2020

Abstract

Background
In a recent clinical trail the reduction of FVC was not accompanied by a benefit with respect to health-related quality of life and patient-reported outcomes (PROs). The aim of this study is to assess how the change in Pulmonary Function Test (PFTs) parameters correlates with the patient reported outcomes (PROs) in an observational cohort of patients with systemic sclerosis (SSc).

Methods
We conducted a retrospective study of 330 clinic episodes from 121 unselected patients diagnosed with systemic sclerosis according to EULAR/ACR 2013 criteria, in annual follow-up (for a total of 165 patients/year) with PFTs, Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma Health Assessment Questionnaire (sHAQ), Modified Borg Dyspnea Scale (Borg) and Cochin Hand Function Score (CHFS). We assessed the correlation between the HAQ and the Visual Analogical Scale 1-7 at baseline (VAS1 pain, VAS2 disease severity, VAS3 arthritis activity, VAS4 intestinal problems, VAS5 dyspnea, VAS6 Raynaud’s phenomenon, VAS7 digital ulcers). We evaluated the correlation of PFTs with PROs at every time period and the correlation between the change of PFTs parameters (δFVC, δDLCO) with the change of the PROs over a year of follow-up. Following analysis of distribution, Spearman or Pearson Test were used to determine correlation coefficients, as appropriate (Prism 7).

Results
The median disease duration was 5 years (IQR 3-10). The median of 12 months δFVC% and δDLCO% were 0 (IQR -5.81 to 3.28) and -2.439 (IQR -8.76 to 5.98), respectively. The analysis evidenced a strong positive correlation between VAS1-7 and HAQ. We observed also significant correlation between FVC%, DLCO% and HAQ-DI (r= -0.355 and -0.266, respectively; p &lt; 0.0001 for both), Borg (r= -0.403 and -0.379, respectively; p &lt; 0.0001) and CHFS (r = -0.355 and -0.256, respectively; p &lt; 0.0001). Nevertheless, in longitudinal setting there was no significant correlation between δPROs and changes lung function, as continuous variables, neither there was any significant PROs difference in patients that did or did not lose more than 10% of FVC and DLCO over a year of follow-up.

Conclusion
This analysis of a monocentric non-selected population evidenced that the current commonly used PROs in SSc while showing a good correlation with lung function are poorly sensitive to change or to reflect changes in lung function over 12 months. In this sense, prudent interpretation of the lack of correlation between FVC and patient-reported outcomes in studies of phase 3 is warranted.

Disclosures
F. Danzo: None. K. Gjeloshi: None. G. Abignano: None. A. Dean: None. F. Masini: None. G. Cuomo: None. F. del Galdo: None.
P173 Progression of subclinical cardiovascular disease in SLE: a five year follow up study
Authors: Bakshi Jyoti , Griffin Maura , Croca Sara , Farhina Filipa , Isenberg David , Nicolaides Andrew , Rahman Anisur 
Published: April 2020

Abstract

Background
Patients with SLE have 5-10-fold increased risk of developing CVD compared to age and sex-matched controls. The average age of developing a first CVD event in patients with SLE is only 49. In this study we aimed to describe the rate and determinants of carotid plaque progression in a cohort of SLE patients who were asymptomatic of CVD at baseline.

Methods
We carried out vascular ultrasound studies of 100 patients with SLE asymptomatic of CVD at baseline. Sixty-nine patients were rescanned over a median of 5 years of follow up. Ninety-four percent who were re-scanned were women and the mean overall age was 46 years (SD 11). Clinical and CVD risk was assessed at baseline and follow up. The same protocol for assessment at baseline using B-mode Doppler ultrasound to measure intimal media thickness and plaque was used at follow up to assess progression. We also assessed total plaque area (TPA), a more sensitive measure of plaque, and echolucency expressed as gray scale median (GSM) which is linked to plaque lipid content.

Results
Of the 100 patients with a baseline scan, 69 patients had a second scan at a median of 5 years follow up. New plaque developed in 9% and 26% had an increase in plaque number. The mean overall IMT (0.111 vs 0.064, p &lt; 0.01) and common carotid IMT (0.065 vs 0.055, p &lt; 0.01) were significantly raised in plaque vs non-plaque patients. In a multi -variable analysis CIMT at follow-up was independently associated with age (beta 0.415, p &lt; 0.001) and diastolic blood pressure (beta 0.285, p &lt; 0.021). Independent predictors of plaque at follow-up scan on multi-variable analysis were age at scan&gt;52 years (OR 10.41, CI 2.66-40.80) and systolic BP &gt; 133 (OR 5.26, CI 1.396 - 19.862). In contrast, total cholesterol was negatively correlated with TPA (beta = -1.167, p = 0.002) and with GSM (beta = -0.513, p = 0.012).

Conclusion
Amongst these 69 patients, 26% had increased plaque and none had decreased plaque over a median of five years follow-up. Measurement of novel ultrasound variables such as TPA and echolucency may identify more modifiable risk factors that can be used to improve CVD outcomes in patients with SLE.

Disclosures
J. Bakshi: None. M. Griffin: None. S. Croca: None. F. Farhina: None. D. Isenberg: None. A. Nicolaides: None. A. Rahman: None.
P177 Art in dialogue: art and voice in an ANCA-associated vasculitis workshop
Authors: Perera Shanali , Krafcsik Dijana , Rutherford Peter 
Published: April 2020

Abstract

Background
Using art to facilitate 'expressions of illness experience’ can provide new ways of helping healthcare professionals and others gain a deeper understanding of the impact that illnesses can have. Using art as a non-verbal communication tool may provide a voice for people with ANCA-associated vasculitis (AAV), as well as a space for their carer to reveal lived experiences of AAV. This can open communication channels in the patient-clinician or carer/support interview. Furthermore, art could be used as a coping mechanism for rare diseases such as AAV and could have therapeutic effects.

Methods
A workshop for people with AAV was held for participants to express their individual AAV using digital art, as either a patient, a carer or healthcare provider (n = 6). We employed a personal narrative inquiry and a digital art exercise focusing on patients', carer's and the clinicians' perceptions on what pain, fatigue, change and support look like in colour and shape.

Results
As an artist, the first author presented her own dialogue and agency of being an artist, patient and retired rheumatologist. We invited a collective understanding of ‘how people make sense of key life experiences and what it means to them’. For all participants, using a digital art workshop to express the patient journey and experiences with pain and fatigue was a new experience. The participants used different types of expressions in their art. Some individuals used art for storytelling, some used more abstract art with different digital brush techniques to express their feelings of pain, fear or hope. The colour theme was discussed with the participants. Red/orange was intuitively used to represent pain whereas green/blue was used to represent periods of calm. People who said they were less expressive could also use this form of non-verbal communication. Participants expressed their feelings and experiences and highlighted when painting with digital art that using the finger was easier and less tiring than holding a brush. Others found that while concentrating on creating the picture, they found some relief from illness-related symptoms.

Conclusion
This workshop used colour and shape to portray different energies surrounding adaptations and transitions that AAV had for patients, carer and clinicians. Digital art helped to express illnesses and emotions that AAV patients or carers experience and could be used as a method for coping. It may open up channels in the patient-clinician or carer/support dialogue and break communication barriers in healthcare encounters, leading to better monitoring results. Art encourages self-reflection, and can influence, inspire and enable individuals. It helps us to see more of the face behind the illness, not just the person with an illness.

Disclosures
S. Perera None. D. Krafcsik Corporate appointments; Employee of Vifor Pharma. P. Rutherford Corporate appointments; Employee of Vifor Pharma. Shareholder/stock ownership; Vifor Pharma.