bluuebunny/crossref_metadata_2025_split huggingface dataset:
P115 Improved reporting of vertebral fractures by radiologists: a success story!
Authors: Nazir Muhammad Amjad , Jamal Muhammad Safwan , Hart Darren , Shipley Jacqueline , Warren Susie , Hardcastle Sarah , Ahmed Tehseen 
Published: April 2021

Abstract
Background/Aims
Vertebral fractures (VF) are the most common type of osteoporotic fracture and affect &gt;20% women over the age of 80. However, the majority remain undiagnosed. Even when imaging has been performed, VF are under-reported by radiologists. This results in a missed opportunity for treatment to reduce fracture risk and morbidity. We conducted this project to improve the reporting of VF (incidental or symptomatic), thus enabling our fracture liaison service to identify cases more easily and optimise patient care.
Methods
Using SYNAPSE (imaging software), cohorts of patients aged more than 75 years of age who had CT scans of chest/abdomen/pelvis in 2012 and 2017 were selected. Images were reviewed by a single rheumatologist with an interest in osteoporosis, looking for the presence of VF. For patients with VF, radiology reports were reviewed to assess whether there was documentation of this.
Results
There was improvement in the reporting of VF between 2012 and 2017 (see Table 1) but identification remained suboptimal. Specific use of the term “fracture” remained in the minority. The data was presented to our radiologists in December 2017 along with information about the importance of identifying and treating patients with VF. Agreement was reached for the radiologists to include a code (FLS) in reports where a non-pathological VF was identified. Searches for the presence of the code through the hospital’s radiology information system have allowed easy identification of VF cases. Letters are sent to Primary Care teams informing them that we have identified an incidental VF along with suggested management advice. This project has substantially increased the number of VF identified (in patients aged &gt;50) by our fracture liaison service over time. 82 cases of VF were identified in 2017 (pre-intervention), 350 cases in 2018, and 848 cases in 2019. P115 Table 1:No. of patients, nVF identified in audit, n (%)Terminology alluding to fracture in radiology report, n (% of identified fractures)Use of the word “fracture” in radiology report, n (% of identified fractures)Mention of osteoporosis or osteopaenia, n (% of identified fractures)2012 cohort10315 (15)5 (33)1 (7)3 (20)2017 cohort10226 (25)18 (69)8 (31)4 (15)
Conclusion
Collaboration with our radiologists through education and the use of a code in radiology reports has resulted in a sustained and dramatic increase in the number of VF annually identified by our fracture liaison service. We strongly recommend that other services adopt this approach to help them achieve national audit targets and improve patient care.
Disclosure
M. Nazir: None. M. Jamal: None. D. Hart: None. J. Shipley: None. S. Warren: None. S. Hardcastle: None. T. Ahmed: None.
P147 Safety of AbatacePt in Rheumatoid arthritis associated Interstitial Lung disease (APRIL)
Authors: Gudu Tania , Stober Carmel , Fifield Maeve , Babar Judith , Ostor Andrew , Parfrey Helen , Hall Francess 
Published: April 2021

Abstract
Background/Aims
Interstitial lung disease (ILD) is the commonest extra-articular complication of rheumatoid arthritis (RA) and is associated with a median survival of 3-8 years. Although biologic therapies are effective for synovitis, they can exacerbate the ILD. RA patients with significant ILD but minimal synovitis have limited therapeutic options. Case reports and retrospective analyses suggest that Abatacept may have efficacy in RA-ILD. However, use of potent immunosuppression in patients with chronic lung disease may increase the incidence of lower respiratory tract infection (LRTI). The purpose of this prospective study was to evaluate the safety of Abatacept in patients with progressive RA-ILD.
Methods
This was a prospective, open-label, study of 19 RA patients (2010 ACR/EULAR criteria) with ILD. Patients were included if either serial thoracic computed tomography (CT) or pulmonary function tests (PFT) indicated progressive ILD over the preceding 14 months. Intravenous Abatacept was administered at baseline, 2, 4, 8, 12, 16 and 20 weeks. PFTs, thoracic CT scan and questionnaires were performed at baseline and week 20. The number of LRTI was recorded. Primary outcome: change in Forced Vital Capacity (FVC). Secondary outcomes: Transfer Factor (TLCOc), King’s Brief Interstitial Lung Disease (K-BILD) Questionnaire, the Leicester Cough Questionnaire (LCQ) and radiological scores (percentage involvement of lung fields scored separately for ground-glass opacification, fibrosis, honeycombing and consolidation).
Results
Preliminary data from the study are reported. Ten patients completed the study: 6 male, 6 ex-smokers, mean age 68±8.21 years, mean RA duration 6±5.4 years. The APRIL study was terminated due to safety concerns in the context of COVID-19 pandemic; nine patients were withdrawn for this reason. LRTI occurred in 4 patients (one patient had 2 LRTI). There were no serious adverse reactions. The mean FVC remained stable during the course of the study. There was a trend towards improvement in the LCQ and improvement in the K-BILD score. ILD-related changes on thoracic CT were stable in 9 of the patients.
Conclusion
Our data indicates that abatacept has an acceptable safety profile in progressive pulmonary fibrosis associated with RA-ILD. This small dataset also suggests that ILD has not progressed during the period of treatment. P147 Table 1:Summary of outcomes after 20 weeks’ treatment with Abatacept in RA patients with progressive interstitial lung diseaseN = 10Baseline20 WeekFVC (L)2.78 ± 0.903.0 ± 0.89TLCOc (mmol/min/kPa)3.75 ± 1.033.72 ± 1.00K-BILD49.10 ± 5.5054.40 ± 6.0LCQ4.78 ± 1.514.82 ± 1.32
Disclosure
T. Gudu: None. C. Stober: None. M. Fifield: None. J. Babar: None. A. Ostor: None. H. Parfrey: None. F. Hall: Grants/research support; FH has received a grant of £168k from Bristol Myers Squibb for the APRIL study.
P149 The intracellular chloride channel 4 (CLIC4) plays an important role in systemic sclerosis fibroblast activation
Authors: Wasson Christopher , Ross Rebecca , Morton Ruth , Mankouri Jamel , Del Galdo Francesco 
Published: April 2021

Abstract
Background/Aims
The intracellular chloride ion channel CLIC4 mediates the activation of cancer associated fibroblasts. Interestingly, systemic sclerosis (SSc) fibroblasts display a number of similar properties to cancer associated fibroblasts. Tissue fibrosis in SSc is driven by active fibroblasts (myofibroblasts). Therefore in this study we investigated the role of CLIC4 in SSc fibroblast activation.
Methods
Dermal fibroblasts were obtained from full thickness skin biopsies from SSc patients (early-diffuse). RNA and protein were collected from the fibroblasts and CLIC4 transcript and protein levels were assessed by qPCR and western blot. SSc patient fibroblasts were treated with the chloride ion channel inhibitors NPPB and IAA-94.
Results
CLIC4 was found to be expressed at significantly higher levels in SSc patients fibroblasts compared to healthy controls, at both the transcript (3.7 fold) and protein (1.7 fold) levels. Inhibition of the TGF-β signalling pathway led to reduced CLIC4 expression in SSc fibroblasts, confirming this pathway as the main driver of CLIC4 expression. Finally, treatment of SSc fibroblasts with small molecule inhibitors that target the channel led to reduced expression of the myofibroblast markers collagen type 1 and alpha-smooth muscle actin, suggesting a direct role for CLIC4 in SSc associated skin fibrosis.
Conclusion
We have identified a novel role for CLIC4 in SSc myofibroblast activation, which further strengthen the similarities between SSc fibroblasts and cancer associated fibroblasts. Furthermore this study highlights this channel as a novel target for therapeutic intervention.
Disclosure
C. Wasson: None. R. Ross: None. R. Morton: None. J. Mankouri: None. F. Del Galdo: None.
P166 Multimorbidity in SLE, a barrier to clinical trial eligibility: results from the BILAG-BR
Authors: Dyball Sarah , Collinson Sophie , Sutton Emily , McCarthy Eoghan , Parker Ben ,   British Isles Lupus Assessment Group Biologics Register (BILAG-BR) consortium, Bruce Ian 
Published: April 2021

Abstract
Background/Aims
Stringent inclusion and exclusion criteria are employed in SLE clinical trials. Organ dysfunction and co-morbidities are common exclusion criteria which may affect how representative trials are of real-world SLE populations. We aimed to apply published trial eligibility criteria to patients with SLE in a large national register.
Methods
A literature review of all major published double-blinded randomised phase III trials in non-renal SLE was performed. Common inclusion and exclusion criteria were applied to all patients recruited to the BILAG-Biologics Register (BILAG-BR), a large UK-wide register of SLE patients. Data on comorbidities for all patients registered was collected. The mean (SD) number of co-morbidities was calculated. Patients were then classified as being eligible or ineligible. Groups were compared initially using a chi-squared or Wilcoxon rank-sum test and logistic regression model was used to test the age and sex adjusted association between trial eligibility and comorbidities.
Results
Common inclusion and exclusion criteria were identified from 12 published trials. When applied to the 837 patients recruited to BILAG-BR, 562 (67%) patients would not be eligible for inclusion in these trials. Ineligible patients had a shorter disease duration (2.9 vs. 5.1 years, p &lt; 0.01), but were similar in age (P = 1.0), sex (P = 0.7) and ethnicity (p = 0.5) to those who were eligible. Of eligible patients, 128 (53%) had 1 or more comorbidities compared with 340 (60%) who were ineligible (p = 0.05). The mean (SD) number of comorbidities was 0.9 (1.2) vs 1.2 (1.3) for eligible and ineligible patients respectively. After adjusting for age and sex, inclusion in clinical trials was associated with fewer comorbidities (OR 0.81, 95% CI 0.70, 0.94, p &lt; 0.01).
Conclusion
Patients with multi-morbidity are more likely to be ineligible for SLE clinical trials. Evidence from real world studies and registers are therefore needed to fully understand the safety and effectiveness of new therapies. Our data also underscores the need to develop more pragmatic eligibility criteria for clinical trials.
Disclosure
S. Dyball: None. S. Collinson: None. E. Sutton: None. E. McCarthy: None. B. Parker: Consultancies; GSK, AstraZenica, UCB, Abbvie, Pfizer, BMS, Celltrion. Grants/research support; GSK, Sanofi Genzyme. I. Bruce: Consultancies; GSK, Medimmune, AstraZenica, Eli Lilly, Merck Serono, UCB, ILTOO. Member of speakers’ bureau; AstraZeneca, Medimmune, GSK, UCB. Grants/research support; GSK, Genzyme Sanofi, UCB.
P197 Evaluating the patient experience of the Barts Health MySpA app for axial spondyloarthritis and psoriatic arthritis
Authors: Adshead Rebecca , Donnelly Simon , Shaikh Maliha 
Published: April 2021

Abstract
Background/Aims
In 2018, MySpA App was developed and launched by the Rheumatology team at Whipps Cross Hospital to empower patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) in self-management of their condition. MySpA is an internationally available, free educational App providing instant access to evidence based medical information about axSpA and PsA. It includes a library of exercise videos created by specialist physiotherapists in axSpA, enabling patients and clinicians to build exercise programmes tailored to individual patient needs. Validated outcome measures can be completed by patients throughout the year, with the option of sharing those results with their rheumatology clinicians. Our objective was to evaluate patient opinion and usefulness of MySpA among our patients.
Methods
Two years since MySpA was launched at BSR, an online questionnaire was sent to 198 patients with axSpA and PsA from Whipps Cross Rheumatology Service. The questions enquired about awareness of MySpA for download and use amongst patients with managing their condition.
Results
Overall response was 36% (n = 72). 61% (n = 44) of the patients responded had downloaded MySpA with 64%(n = 28) of those patients using the app throughout the year. The majority that had not downloaded, were not aware the app existed (70%). All features within the app were used, with the axSpA and PsA Information section and exercise library most popular with comments “I use my exercise plan daily” and “great app.” 53% of patients used the app as an educational resource and 46% used the exercise library tailored to their own needs. The most common reason for not using the app was forgetting (29%). The majority (91%) would recommend MySpA to other patients with axSpA and PsA, with 63% reported MySpA supported them managing their condition.
Conclusion
MySpA is well received by patients with axSpA and PsA at Whipps Cross Hospital as a resource where they find specialist support, information and exercise guidance to empower management. It provides a useful virtual tool to assist patients take control of their arthritis and track and monitor their condition and has been particularly useful in this regard during the Covid pandemic. Patients used the facility to complete and share their assessment results and journal logs virtually with their healthcare team. However, continual awareness of MySpA amongst patients and clinicians is required to enable the opportunity to utilise instant specialist support and direction that may help patients manage their condition. The usefulness of the virtual monitoring feature of the app amongst clinicians should be explored in future research.
Disclosure
R. Adshead: None. S. Donnelly: None. M. Shaikh: None.
P199 The reliability of using ultrasound for the detection of hypoechogenicity of enthesitis in patients with spondyloarthropathies
Authors: Aldahes Asma S , Wakefield Richard , Smith Kate 
Published: April 2021

Abstract
Background/Aims
Enthesitis, which is the inflammation of the entheses area where the tendon or ligaments are attached into the bone, is considered a hallmark and pathological feature for spondyloarthropathies (SpA). The lower limb entheses are more prone to being affected than the upper extremity enthesis, the most common one is Achilles tendon where heel enthesitis is considered the most frequent finding in SpA patients. Ultrasound is widely used by rheumatologists because it has higher sensitivity and specificity in detecting enthesitis compared with clinical assessment. The abnormal characteristics of enthesitis in greyscale ultrasound includes the hypoechoic area at the insertion or body of the tendon due to the loss of the normal fibrillar pattern, increase in the tendon thickness, bone erosion, calcification and increase in Dopplar signals. Although ultrasound has many advantages compared with other imaging modalities, it is operator-dependent and the diagnosis is exposed to the subjectivity of the observer, which leads to the variability in defining the abnormal features of enthesitis. Using static ultrasound images of Achilles tendon entheses of patients with SpA, we first determined the intra- and inter-observer reliability of grading ‘hypoechogenicity’ using a panel of readers and second, compared a computerised pixel counting method against an expert consensus score to determine the level of agreement between approaches.
Methods
Six participants (rheumatologists and sonographer) with experience in ultrasound scored the presence of hypoechogenicity in 100 static images of Achilles tendon entheses of patients with SpA. Two scoring systems were used- an OMERACT derived SQ system (0-3) of the whole enthesis and binary score system of the distal 2mm (0-1). The intra-class correlation coefficient (ICC) and Cohen's kappa was used to assess inter-observer reliability. The ImageJ software was used to measure the mean grey values (MGV) of the pixels within the enthesis.
Results
The inter-observer reliability was good for using the SQ score (ICC 0.780 (95% CI 0.691-0.849) and moderate for the binary score (ICC 0.632 (95% CI 0.490-0.745)). There was no match between the results from the quantitative score of the pixels MGV and the expert semi-quantitative score.
Conclusion
This study is novel as in that it has specifically evaluated the scoring of hypoechogenicity within the entheses of patients with SpA. It has demonstrated variation in scoring between observers and highlighted the challenges of image interpretation. A lack of correlation of expert scoring with the manual pixel MGV was limited by the image artefacts and different machine settings which may have implications as we work towards future AI systems.
Disclosure
A.S. Aldahes: None. R. Wakefield: None. K. Smith: None.
Epidemiology of snakebites in Kuwait
Authors: Al-Sayegh Mohammed T , Hani Rihan Bani , Warrell David A , Amr Zuhair S 
Published: April 2021

Abstract
Fifty-two confirmed cases of snakebites in Kuwait were recorded during 2015–2019. The male:female ratio was almost 2:1 and 84.6% of the victims were between 1 and 20 y of age and 14.4% were &gt;30 y. Snakebites peaked in October (23.1%) and July (17.3%), with the lowest number of recorded cases in March.
Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System
Authors: Mooney Larissa J. , Zhu Yuhui , Yoo Caroline K. , Wolitzky-Taylor Kate , Hser Yih-Ing 
Published: April 2021

Objective:
Coprescription of opioids and benzodiazepines (BDZ) is associated with adverse outcomes, including greater healthcare utilization and overdose risk. This study aims to examine opioid and BDZ coprescription, dosing, and mortality among patients with and without opioid use disorder (OUD) in a large healthcare system.

Methods:
Using data from the California state Prescription Drug Monitoring Program during 2010 to 2014 linked with a large healthcare system electronic health record database and mortality records from the Centers for Disease Control National Death Index, this study examined 5202 patients (1978 with OUD, 3224 controls). Multiple logistic regression analyses were conducted to examine relationships between most recent BDZ and opioid prescription, and their interaction with respect to mortality.

Results:
About 10.5% of the sample died on or before December 31, 2014. About 17.7% were prescribed BDZ during the final month of observation. Individuals with OUD were prescribed higher average BDZ and opioid doses than those without OUD. After adjusting for covariates, increased prescribed doses of BDZ (odds ratio [OR]=1.34, 95%CI: 1.15–1.55 per 10 mg/d increment) and opioids (OR = 1.04, 95%CI: 1.02–1.05 per 10 mg/d increment) were positively associated with mortality. Non-OUD patients who received both BDZ and opioid prescriptions had a higher mortality than those who received only BDZ or opioids (The ratio of odds ratio (ROR) = 3.83, 95%CI: 1.78–8.21).

Conclusions:
Study findings highlight significant mortality associated with the coprescription of opioids and BDZ in a general healthcare setting. Further research is needed to elucidate factors associated with mortality among non-OUD patients who are co-prescribed opioids and BDZ.
Montage-related Variability in the Characteristics of Envelope Following Responses
Authors: Urichuk Matthew , Easwar Vijayalakshmi , Purcell David 
Published: April 2021

Objectives:
The study aimed to compare two electrode montages commonly used for recording speech-evoked envelope following responses.

Design:
Twenty-three normal-hearing adults participated in this study. EFRs were elicited by a naturally spoken, modified /susa∫i/ stimulus presented at 65 dB SPL monaurally. EFRs were recorded using two single-channel electrode montages: Cz-nape and Fz-ipsilateral mastoid, where the noninverting and inverting sites were the vertex and nape, and the high forehead and ipsilateral mastoid, respectively. Montage order was counterbalanced across participants.

Results:
Envelope following responses amplitude and phase coherence were significantly higher overall in the Cz-nape montage with no significant differences in noise amplitude. Post hoc testing on montage effects in response amplitude and phase coherence was not significant for individual stimuli. The Cz-nape montage also resulted in a greater number of detections and analyzed using the Hotelling’s T2.

Conclusions:
Electrode montage influences the estimated characteristics of speech-evoked EFRs.
The heterogeneity of population with high risk for melanoma and other skin cancer: a latent class analysis
Authors: Stojanović Larisa , Bajić Žarko 
Published: April 2021

Objective
To examine whether there is heterogeneity in the risk factors for skin cancer among the high-risk population in Slovenia, a Central European country with the second-largest age-standardized melanoma-related mortality rate in Europe.

Methods
We analyzed data collected during the ‘Euromelanoma Day’ 2010–2019. The outcome was the prevalence of newly suspected skin cancer. The independent variables were 17 known risk factors and protective behaviors. We performed a latent class analysis with skin cancer as a covariate.

Results
We analyzed data from 1711 participants with a median (interquartile range) age of 52 (39–63) years, 52% of whom were women. During the 10 years, 81 cases of melanoma and 213 cases of other skin cancers were suspected. The model with three latent classes had the best fit. Two latent classes had a high risk for melanoma and other skin cancer: 3 and 19% respectively in class 2; 14 and 29% in class 3. The largest significant differences between the two high-risk classes were the older age and lower frequency of sunscreen use in high-risk class 2 and the number of atypical nevi, a large number of common moles, many moles as the primary motive to participate in Euromelanoma examination and having a skin phototype I or II in the highest-risk latent class 3.

Conclusions
There is heterogeneity in the risk factors for skin cancer among the Euromelanoma high-risk population. This heterogeneity should be tested in other countries, and if the findings are consistent, they should be used to refine secondary prevention programs.
Patient Release and Instructions for Lutetium Dotatate Radiopharmaceutical Therapy
Authors: Underwood James , Sturchio Glenn , Arnold Susan 
Published: April 2021

Abstract
Lutetium Dotatate radiopharmaceutical therapy (Lutathera) was approved by the United States Food and Drug Administration in 2018 and is used to treat somatostatin receptor positive neuroendocrine tumors. With all new radiopharmaceutical therapies, the radiation exposure to members of the public from the patient who received the therapy must be within regulatory limits and safe. If the patient will expose members of the public to too much radiation, the therapy must be performed on an inpatient basis. This paper shows that the administration of Lutathera can be done on an outpatient basis and provides safety and travel restrictions that should be communicated to the patient prior to leaving. The guidance presented herein serves as a basis for medical institutions looking to use Lutathera to treat patients.