bluuebunny/crossref_metadata_2025_split huggingface dataset:
P188 Frailty and its impact on patient-reported outcomes in polymyalgia rheumatica
Authors: Harkins Patricia , Cowley Sharon , Harrington Robert , Kane David , Conway Richard 
Published: April 2024

Abstract

Background/Aims
Frailty is an increasingly important construct in the field of rheumatology, aiding the identification of individuals with increased vulnerability to accelerated clinical decline, and overall worse disease outcomes. The aim of this research was to explore the prevalence of frailty and its potential associated impact on patient reported outcomes (PROs) in a cohort of patients with polymyalgia rheumatica (PMR).

Methods
Patients with a diagnosis of PMR (fulfilling the 2012 EULAR/ACR Provisional Classification Criteria), who were in clinical remission and on active treatment with glucocorticoids were recruited from two centres. Patients were &gt;3 months and &lt;12 months from diagnosis. Frailty was defined by the 5 criteria of the widely validated Fried Phenotypic Frailty Index. Patient-reported outcomes included anxiety, using the Generalised Anxiety Disorder Assessment (GAD-7), mood using the Patient Health Questionnaire (PHQ-9), fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), pain using the visual analogue scale (VAS) and overall health related quality of life using the Health Assessment Questionnaire-Disability Index (HAQ-DI). The associations between categorical variables were compared using the -test or Fishers exact test. The association between continuous variables and categorical variables was assessed using the Kruskal-Wallis test. Correlations were calculated using Pearson’s r. All analyses were conducted using R (R Core Team, 2022). A p-value of &lt; 0.05 was considered as statistically significant.

Results
51 consecutive patients were recruited, of which 56.9% (n = 29) were female. Using the Fried Phenotypic Index, 64.7% (n = 33) were classified as robust, 27.5% (n = 14) as pre-frail and 7.8% (n = 4) as frail. All patients classified as frail were female and had a statistically significantly higher BMI (p = 0.040) than those in the robust and pre-frail categories. Compared to robust individuals, those who were frail had statistically significant higher median GAD-7 (p = 0.003), PHQ-9 (p = 0.001), VAS (p = &lt;0.001) and HAQ-DI (p = &lt;0.001) scores. FACIT-F scores were also worse in those who were frail versus robust (p = 0.001).

Conclusion
Over one third of patients with PMR in this cohort were classified as pre-frail or frail. Increased frailty status was significantly correlated with worse PROs, including mood, pain, fatigue and overall quality of life. As frailty is a potentially reversible state, accurately identifying frailty, and implementing appropriate interventions is of utmost importance to ensure improved clinical outcomes in those with PMR.

Disclosure
P. Harkins: Grants/research support; British Society for Rheumatology. S. Cowley: None. R. Harrington: None. D. Kane: None. R. Conway: None.
E007 Novel signs to predict healthcare consumption following bone fracture: a clinical audit
Authors: Mudkavi Rohan , Shenker Nicholas 
Published: April 2024

Abstract

Background/Aims
Recovery following fracture is variable. Previously we have identified poor outcomes based upon baseline abnormal body scheme. We now aimed to determine whether these novel bedside tests measuring finger perception abnormalities and body scheme disruption can be used to predict healthcare utilisation post fracture.

Methods
We performed two bedside tests in patients who were in cast in the plaster room. We followed up clinical records for 2+ years and gathered data on the use of healthcare resources from both hospital and primary care electronic patient records. The novel tests were a finger perception (FP) and body scan (BS) assessment. The audit was approved by Cambridge University Hospitals (PRN8899).

Results
46 patients were included. 2 had incomplete data and were excluded from the final analysis. 25 patients (group 1) had no abnormalities in their body scheme at baseline in the fracture room. 16 had a single abnormality and 3/44 (group 2, 7%) had both FP and BS. This final group consumed more analgesics, took longer to discharge and had a greater utilisation of healthcare resources (Table 1). Comparing the cost difference using NHS 2020 Reference costs between groups 1 and 2 was around £530/patient. Annually this equates to £175,000 for CUH.

Conclusion
FS and BS are easy to assess in patients with a bone fracture and predict a cohort which expressed more pain and health care consumption. Upscaling the difference between the normal and abnormal groups would incur an annual trust and primary care cost of £175,000.

Disclosure
R. Mudkavi: None. N. Shenker: None.
E028 A differential diagnosis for treatment resistant psoriatic arthritis
Authors: Jacobs Alana , Callan Margaret 
Published: April 2024

Abstract

Background/Aims
This case involves a 45 year old gentleman with established psoriatic arthritis with axial and peripheral joint involvement. His disease was managed with subcutaneous methotrexate and etanercept. Despite improvement in axial symptoms and resolution of symptoms at other peripheral joints, he had ongoing severe monoarthritis of his right knee with significant pain and swelling.

Methods
In spite of several joint aspirations and intra-articular steroid injections [ten in total], escalation of dose of methotrexate, addition of sulfasalazine and switch of biologic to adalimumab, the patient’s right knee symptoms persisted. Further imaging was performed. An US scan showed chronic synovial hypertrophy with fatty metaplasia and an MRI scan showed frond like synovial thickening, suggestive of lipoma arborescens.

Results
The patient was referred to the orthopaedic surgeons and underwent excision synovectomy. The histopathology reported fibrofatty tissue with areas of chronic synovitis with presence of lymphoplasmacytic aggregates. The patient’s knee symptoms persisted for five years in total after clinical improvement at other joints; post-synovectomy, his right knee symptoms were improved. Lipoma arborescens is a benign progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium; it frequently affects the knee joint suprapatellar pouch. Villous proliferation of the synovium occurs, with subsequent replacement of synovial connective tissue by adipocytes.

Conclusion
Lipoma arborescens has been described occasionally in association with psoriatic arthritis. It is felt to occur as a reactive response to chronic synovial irritation; in this case from an inflammatory affront. Given the rarity of lipoma arborescens, coupled with the patient’s known underlying diagnosis of a seronegative arthritis, there was significant delay in his diagnosis. This case highlights the need to consider other causes of persistent joint pain and swelling when maximal therapeutic options have been unsuccessful.

Disclosure
A. Jacobs: None. M. Callan: None.
E057 International survey to evaluate current options and user needs for subcutaneous injection of methotrexate to inform development of a new injection device
Authors: Müller-Ladner Ulf , Edwards Christopher , Erkens Andreas 
Published: April 2024

Abstract

Background/Aims
Prefilled syringes (PFS) and various types of pens are available for subcutaneous injection of methotrexate (MTX) in patients with rheumatoid arthritis or moderate to severe psoriasis. To assess the needs of users and the relevance of features of a new MTX autoinjector succeeding the metoject®/metex® PEN, an international online survey was performed.

Methods
A structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Participants received illustrations of the three MTX devices currently available on the market and were informed about the new MTX autoinjector.

Results
In total, 189 rheumatologists, 111 dermatologists, 90 nurses, and 180 patients answered the questions. Specific reasons for a preference for the use of MTX pens over PFS could predominantly be assigned to the categories “dosing/administration” and “ease of use”. 82% of physicians, 87% of nurses, and 76% of patients stated a positive first impression of the new button-free MTX autoinjector, respectively. The features rated most relevant by the user groups were a) 2-step autoinjector mechanism (receiving a mean 14.1 to 18.1 points of a total of 100 points), b) small injection volume (9.7 to 11.7 points), c) short injection time below 5 seconds (8.5 to 11.1 points), and d) 10 different doses for dose flexibility (8.0 to 13.2 points).

Conclusion
Autoinjectors for MTX appear to be preferred over PFS in this international survey. In addition, important features of MTX autoinjectors for patients and healthcare professionals were identified including the autoinjector mechanism, volume of injection and injection time.

Disclosure
U. Müller-Ladner: Consultancies; U.M.-L. was advisor to medac GmbH. Member of speakers’ bureau; U.M.-L. was speaker to medac GmbH. C. Edwards: Member of speakers’ bureau; C.J.E. has been a speaker for medac. A. Erkens: Other; A.E. has performed strategic market research for medac GmbH.
E062 Nailfold capillaroscopy: its application in routine clinical practice
Authors: Tabassum Syeda A , Douglas Karen M J , Udeshika Erandi 
Published: April 2024

Abstract

Background/Aims
Nailfold capillaroscopy (NFC) is a non-invasive tool to evaluate the structural microvascular abnormalities found in systemic sclerosis (SSc). NFC allows for the visualization of the capillary bed at the nailfold, providing valuable insights into the structure and function of these capillaries. NFC helps differentiate primary from secondary Raynaud’s phenomenon (RP). Abnormal NFC is included in the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria and due to its predictive value of developing SSc is included in the Very Early Diagnosis of SSc (VEDOSS) criteria. Dudley Group NHS FT runs a consultant-led service supported by a specialty trainee where clinical review is carried out alongside NFC using video capillaroscopy. Patients can be referred to this clinic from rheumatology or respiratory colleagues.

Methods
We audited all patients who had attended a monthly NFC clinic between September 2021 and October 2023. We reviewed clinical letters and electronic patient record system and collected details of: demographics; immunology; clinical characteristics; reason for attending the clinic; NFC findings; and diagnosis. NFC findings were classified as normal or abnormal (to include scleroderma pattern and non-specific changes). Data was analysed using excel for individual variables and their comparison with nailfold capillaroscopy results.

Results
We identified 80 patients, of which 63 (79%) were females and median age was 54.5 years. ANA was positive in 64 (80%) patients, SSc and myositis immunology blots were positive in 41 (51%) and 4 (5%) respectively. Clinical characteristics included RP in 71 (89%) and interstitial lung disease (ILD) in 17 (21%). The reasons for attending the NFC clinic were categorised as: to exclude secondary causes of RP (52; 65%); to aid diagnosis of suspected SSc (23; 29%); surveillance of known SSc (5; 6%). NFC was normal in 42 patients. In the 38 patients where NFC was abnormal the clinical diagnosis was categorised as: primary RP (8; 10%); SSc spectrum of disease (17; 21%); and another CTD (20; 25%). Of patients with SSc spectrum of disease: 24% (4/17) had a diagnosis of VEDoSS; 47% (8/17) Limited Cutaneous SSc; and 29% (5/17) Diffuse SSc. The presence of RP and ANA was not significantly different in patients with abnormal NFC. There was a non-significant association between the presence of ILD and abnormal NFC. 9/17 (52%) patients with ILD had an abnormal NFC compared to 18/63 (29%) patients without ILD (p = 0.059).

Conclusion
NFC is a simple procedure in conjunction with a clinical review to enhance the early diagnosis of SSc and exclusion of secondary Raynaud’s. It supports education and training as a tool for learning as being part of the curriculum.

Disclosure
S.A. Tabassum: None. K.M.J. Douglas: None. E. Udeshika: None.
E074 Clinical features, disease activity and functional outcome of juvenile-onset, adult-onset and late-onset ankylosing spondylitis: a cross sectional study from India
Authors: Modadugu Krishna Pratheek , Thabah Molly M 
Published: April 2024

Abstract

Background/Aims
Ankylosing spondylitis (AS) or radiographic axial spondyloarthritis (axial SpA) is reported to present with peripheral arthritis, less spinal symptoms, and more radiographic damage in juvenile onset (age at onset ≤16 years) as compared to adult-onset AS(age at onset &lt;45 years). Functional outcome has varied depending on the population studied. In this cross-sectional study we compared clinical features, disease activity, and functional outcome among juvenile-onset AS (JoAS), adult-onset AS(AoAS), late-onset AS (LoAS).

Methods
Consenting patients fulfilling either the ASAS classification for axial SpA or 1984 modified New York criteria attending SpA clinic were included between May and June 2022. Data was collected by direct patient interview and clinical examination. Data collected: Clinical features, treatment, current disease activity by Bath AS disease activity index (BASDAI), current functional outcome by the Bath Ankylosing Spondylitis Functional Index (BASFI). Disease activity, functional outcome were compared among JoAS, AoAS, and LoAS. Study protocol was approved by the IEC.

Results
Of 73 patients (61 male), mean age 39.1±12.8 years, 10 (13.7%) were JoAS, 56 (76.7%) and 7 (9.6%) were AoAS and LoAS respectively. Only 30%, 59%, and 57% patients in JoAS, AoAS, and LoAS respectively were employed. There were no differences in the clinical presentation, namely back pain, neck pain, hip involvement, uveitis, and enthesitis among the three groups (Table 1). Majority received conventional-synthetic-DMARDs; only 2(20)%, 8(14.3), and 1(14.3) in the JoAS, AoAS, and LoAS group respectively had ever received TNF-inhibitors. Majority patients in all the groups had active disease (BASDAI&gt;4 and ASDAS&gt;1.3) and there was also no difference in the disease activity (at enrolment) between the groups. All patients with JoAS were positive for HLA-B27. Mean BASFI was not different between the groups, but poor functional outcome (BASFI &gt;6) was observed in 5/10 (50%), 28/56 (50%), 5/9 (71.4%) patients of JoAS, AoAS, and LoAS respectively.

Conclusion
In a study involving a homogeneous cohort of Indian AS, there were no marked differences in clinical features, disease activity between JoAS, AoAS, and LoAS. Majority patients have poor functional outcomes which could be a direct effect of poor disease control due to lack of access to TNF inhibitors.

Disclosure
K. Modadugu: None. M.M. Thabah: None.
Spock2 Functions as a Key Time-Series Gene of Endothelial Cells in Sepsis-Induced Cardiomyopathy
Authors: Zhang Jian , Lu Yao , Shen Yihui , Zhang Hui , Xu Yuchen , Wang Xuejun , Chen Yifan , He Xiaozhen , Lu Hao , Cheng Leilei 
Published: April 2024

Abstract:
The study aimed to investigate the pathogenesis of sepsis-induced cardiomyopathy, a leading cause of mortality in septic patients. Transcriptome data from cecal ligation and puncture–induced septic mice were analyzed at different time points (24, 48, and 72 hours) using GSE171546 data. Through weighted gene co-expression network analysis, time series, and differential expression analyses, key time-series differentially expressed genes were identified. In addition, single-cell sequencing data (GSE207363) were used for both differential and pseudotime analyses to pinpoint differentially expressed genes specific to endothelial cells. The study highlighted Spock2, S100a9, S100a8, and Xdh as differential genes specific to endothelial cells in a time-dependent manner. Immunofluorescence validation confirmed the increased expression of SPOCK2 in the endothelial cells of cecal ligation and puncture–induced septic mice. Furthermore, in vitrostudies showed that deletion of Spock2 significantly increased LPS-induced apoptosis and necrosis in human umbilical vein endothelial cells. In conclusion, SPOCK2 expression was increased in septic cardiac endothelial cells and LPS-induced human umbilical vein endothelial cells and may play a protective role.
Evaluating fluid overload in critically ill children
Authors: Bem Reinout A. , Lemson Joris 
Published: April 2024

Purpose of review
To review the evaluation and management of fluid overload in critically ill children.

Recent findings
Emerging evidence associates fluid overload, i.e. having a positive cumulative fluid balance, with adverse outcome in critically ill children. This is most likely the result of impaired organ function due to increased extravascular water content. The combination of a number of parameters, including physical, laboratory and radiographic markers, may aid the clinician in monitoring and quantifying fluid status, but all have important limitations, in particular to discriminate between intra- and extravascular water volume. Current guidelines advocate a restrictive fluid management, initiated early during the disease course, but are hampered by the lack of high quality evidence.

Summary
Recent advances in early evaluation of fluid status and (tailored) restrictive fluid management in critically ill children may decrease complications of fluid overload, potentially improving outcome. Further clinical trials are necessary to provide the clinician with solid recommendations.
Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care
Authors: Calihan Jessica B. , Matson Pamela 
Published: April 2024

Purpose of review
Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use.

Recent findings
There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use.

Summary
Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.
Update on Total Auricular Construction
Authors: Yamada Akira , Chwa Emily S. , Boctor Michael J. 
Published: April 2024

Learning Objectives:
After studying this article, the participant should be able to: 1. Understand principles of preoperative planning for microtia repair. 2. Understand key techniques for flap design, skin envelope dissection, framework creation, and donor-site reconstruction. 3. Describe important components of postoperative management.

Summary:
Total auricular construction remains a challenge for reconstructive surgeons. This article describes current surgical strategies and advancements for microtia construction. The authors’ focus is to describe the several keys for success that are useful for young surgeons who wish to train themselves to create satisfactory results.
Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center
Authors: House Sherita , Naim Ali Hebatallah A. , Stucky Christopher 
Published: April 2024

Background and Objectives:
High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center.

Methods:
We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other.

Results:
Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = −.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = −.01, P = .00), and participants with graduate degrees reported lower RC (β = −.62, P = .00).

Conclusions:
We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.