bluuebunny/crossref_metadata_2025_split huggingface dataset:
E011 Magnetic resonance imaging in axial spondyloarthritis: usage, reporting times and scanning times - a service evaluation in a large tertiary centre
Authors: Weddell Jake , Shah Rahul , Robinson Philip , Barr Andrew , Vandevelde Claire , Freeston Jane , McGonagle Dennis , Marzo-Ortega Helena 
Published: April 2024

Abstract

Background/Aims
Rapid access to magnetic resonance imaging (MRI) of the spine and sacroiliac joints is essential for the timely diagnosis of axial spondyloarthritis (axSpA). A recent NASS/BRITSpA national FOI survey highlighted deteriorating waiting times to access MRI for the assessment of inflammatory back pain in the UK, with only 73% of Trusts reporting access within 8 weeks, compared to 90% in 2017. In addition, NHS England and the Royal College of Radiologists have recently published a target of 28 days for turn-around time (TAT) for a verified report to be provided after image acquisition in any circumstance. Aims: To evaluate the usage of MRI performed under the “inflammatory back pain protocol” at a large tertiary centre, including the time from MRI request to scan being performed, TAT for reporting and whether this has changed over time.

Methods
A service evaluation audit was conducted at Leeds Teaching Hospitals Trust (LTHT). MRIs of the spine and sacroiliac joints requested between December 2021 and May 2023 under the local “inflammatory back pain protocol” were identified by the radiology department. Data extracted from medical records included: indication for MRI request, time elapsed from request to scan, and from scan to verified report.

Results
A total of 668 MRI requests were identified. The commonest reason for MRI request was to aid the diagnosis of axSpA 75% (n = 501); followed by disease activity monitoring in established axSpA (16.7%, n = 111) and assessment of axial involvement in peripheral psoriatic arthritis, i.e. diagnosis of axPsA (8.5% n = 57 scans). The majority (92%) had a request to scan time of 8 weeks, with a TAT to report of 4 weeks (77%). However, a greater delay in TAT to verified report was seen from December 2022 to May 2023 with &lt;45% of reports issued within 28 days, despite no change in scanning time. Causes identified were related to local workforce issues including delays in appointing new radiographers and radiology consultants.

Conclusion
The main reason for request of an MRI under the inflammatory back pain protocol at LTHT is to support making a diagnosis of axSpA. A significant number of patients were scanned for treatment monitoring and to diagnose axial psoriatic arthritis, although data on the utility of MRI for these indications are limited. Whilst nearly all patients were scanned within 2 months at all time periods, the TAT to report has significantly deteriorated since December 2022 in our region, due to workforce issues. Further understanding of the impact of workforce factors on service delivery in rheumatology is required.

Disclosure
J. Weddell: None. R. Shah: None. P. Robinson: None. A. Barr: None. C. Vandevelde: None. J. Freeston: None. D. McGonagle: None. H. Marzo-Ortega: None.
E021 Patient initiated follow-up long term condition pathway audit
Authors: Ellis Jessica , King Callum , Loganathan Aravinthan , Sengupta Raj 
Published: April 2024

Abstract

Background/Aims
In October 2022 we created a PIFU Long Term Condition (PIFU-LTC) pathway for our department in line with guidance issued by GIRFT for rheumatological patient initiated follow-up. Entry and exclusion criteria for the pathway were agreed by clinicians. Entry criteria included presence of a relevant diagnosis and established disease (≥ 12-month duration). Exclusion criteria included significant cognitive impairment and/or communication difficulties. Guidance regarding documentation standards, follow- intervals and responses to patient contacts were formalised in the standard operating procedure. We undertook an audit of the pathway to evaluate successes and identify areas for improvement.

Methods
Between 3/10/22 and 30/3/2023 520 patients had been added to the pathway. A random sample of 10% (n = 52) were audited. Data was extracted onto a bespoke data collection proforma. Data collected included: entry and exclusion criteria for the pathway, current medications, subsequent flares and time to review.

Results
33 female and 19 male patients were audited. 86% (n = 45) were of White ethnicity. Mean age was 61 (range 20-83). 81% (n = 42) of patient diagnoses met entry criteria for the pathway. Other diagnoses included osteoarthritis, gout and undifferentiated arthralgia. 92% (n = 48) joined ≥12 months since initial diagnosis. 1 patient had significant cognitive difficulties. Documentation regarding information provision was poor. 40% (n = 21) of patients had no record of being provided a PIFU-LTC information leaflet. 33% (n = 17) had no documentation regarding action to take in case of a flare. 15% (n = 8) of patients had contacted the department since entering the pathway (range 21 to 288 days after joining). 6 of these patients reported a disease flare. Duration between patient contact and telephone review by a clinician ranged between 1- 3 days. 4 patients were also offered a face-to-face clinic appointment, with a range of 2-22 days from first contact until this review. As of October 2023, only 3 patients had been taken off the PIFU pathway.

Conclusion
This audit had highlighted successes, included the numbers of patients moved onto the pathway and limited inclusion of patients meeting exclusion criteria. Key areas for improvement include improving documentation standards in clinic letters, ensuring adequate information provision to patients and reducing delays to face-face clinic follow up. Further development of the pathway may include expansion of the pathway to other diagnostic groups.

Disclosure
J. Ellis: None. C. King: None. A. Loganathan: None. R. Sengupta: None.
E027 A rare cause of shoulder pain: calcific tendonitis at the pectoralis major humeral insertion
Authors: Quinlan Eavan M , Kazmi Muhammad 
Published: April 2024

Abstract

Background/Aims
Shoulder pain in the elderly is very common and often caused by calcific tendonitis of the rotator cuff muscles. We report the case of a lady presenting with unilateral shoulder pain who had an X-Ray which showed calcification over the proximal humerus. This calcification turned out to be due to calcific tendonitis of the humeral insertion of the pectoralis major, which is very rare. Unfamiliarity with this unusual condition could lead to inappropriate investigation, such as invasive biopsy, and possible mismanagement.

Methods
A 61-year-old lady of Pakistani origin with dual antibody positive rheumatoid arthritis, well controlled on methotrexate, reported new and severe right shoulder pain during her outpatient appointment. Her past history included coeliac disease, osteoarthritis, hypertension, iron and vitamin D deficiency, and she was not currently taking any calcium supplements. The pain had rapidly progressed over weeks to months without any trauma history and was significantly limiting all shoulder movements, particularly shoulder abduction and rotation. Her rheumatoid arthritis was in remission. Concerningly, she reported nocturnal pain, which alongside the rapidly progressive nature of the pain raises suspicions of a more sinister cause like malignancy.

Results
Blood tests showed a normal CRP, calcium profile and ALP. An X-Ray of the right shoulder showed no calcification or osteoarthritis affecting the glenohumeral joint, but demonstrated the unusual finding of a prominent focus of calcification close to the lateral aspect of the proximal humerus. An MSK radiologist advised further imaging to confirm nature of lesion. Subsequent USS confirms a focus of calcification (14mm x 18mm) in the pectoralis major humeral insertion, adjacent to the long head of the biceps tendon. Features that are suggestive of benign calcification rather than neoplasm include the characteristic location of the calcification and absence of an overlying soft tissue mass. The patient was reassured regarding the benign nature of the calcification and was managed conservatively with simple analgesia and physiotherapy.

Conclusion
Calcific tendinopathy is a common disease, but calcification of the pectoralis major at its humeral insertion point is very rare. This case highlights the importance of familiarity with this condition to enable the clinician to make an accurate diagnosis, and reduce the likelihood of unnecessary investigations and stress for the patient. Conservative management, such as simple analgesia and physiotherapy, is very effective for the majority of patients and should be used as first-line treatment. Steroid injection can be considered with orthopaedic intervention advised for those who have not responded to conservative management.

Disclosure
E.M. Quinlan: None. M. Kazmi: None.
E053 The use of online platforms in the treatment of chronic musculoskeletal disease
Authors: Wall Amanda J W , Kelleher Eoin , Wanigasekera Vishvarani , Irani (nee Soni) Anushka 
Published: April 2024

Abstract

Background/Aims
Persistent pain is a common feature of rheumatic diseases, and has a significant impact on the emotional, physical and social wellbeing of individuals. Despite pharmacological treatment for inflammatory arthritis, such as rheumatoid arthritis (RA), 10-20% have features suggestive of co-existing centralised pain. These patients have worse pain, mood and sleep despite DMARD therapy. Similar to fibromyalgia (FM), non-pharmacological treatments are likely to be useful for this problem. Evidence supports cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) for the management of chronic musculoskeletal pain. Unfortunately, access to services is poor for many people. This has driven the development of online treatment programmes and apps. The current study explores willingness of patients with rheumatic diseases to use online platforms in this context.

Methods
An observational cohort study of patients with a clinical diagnosis of either RA or FM were recruited from NHS outpatient clinics. Data collection was via the online platform Redcap. Analysis compared demographic and clinical features of those with past use of online platforms or apps for health purposes using Student’s t-test and chi squared tests. A similar comparison was conducted for future use of online platforms or apps.

Results
Of 343 patients 177(52%) FM, 166(48%) RA), 264 (77%) were female with mean (SD) age 48 (13.6). Past use of online platforms is summarised in Table 1. Significantly more patients with FM (70%) would be willing to try an online platform in future, compared to those with RA (30%). Those with future interest are more likely to be younger (mean age 46), have lower mood (mean PHQ-9 13), worse sleep (mean ISI 14.6) and less pain (mean VAS 6.6) compared to those who would not (mean age 60, PHQ-9 12, ISI 12.6 and VAS 7.0 respectively).

Conclusion
Those with FM are more likely to engage with online platforms or apps for health purposes than those with RA. In this analysis, users were more likely to be younger and experience more severe anxiety and depression but further work is needed to evaluate the contributing factors which will be essential when optimising the impact of online healthcare initiatives.

Disclosure
A.J.W. Wall: None. E. Kelleher: None. V. Wanigasekera: None. A. Irani (nee Soni): None.
E077 Evaluation of group education for patients with large vessel vasculitis prescribed subcutaneous methotrexate
Authors: Ducker Georgina , Mukhtyar Chetan B 
Published: April 2024

Abstract

Background/Aims
Patient education in rheumatology is of proven value to educate as well as to reduce demand on health care services. This can be delivered in a multitude of ways, in person and more recently with the use of multi-media modalities. There is limited evidence to specifically demonstrate the benefit of patient education for patients with vasculitis. Education needs to be adapted to meet patient needs. In addition to one-to-one appointments, we have been conducting in-person group education for this patient group. We present our experience.

Methods
Patients prescribed subcutaneous methotrexate for large vessel vasculitis were given the opportunity to attend a group education session run by the specialist nurse. The sessions were held over a 4-month period, in groups of 3-5 individuals. Patients were provided with written information including the links to online resources prior to attending the group education session which consisted of a verbal presentation and a short video. Patients also had the opportunity to ask questions during the group session. If patients were happy to proceed with the planned treatment, a prescription for the subcutaneous methotrexate was provided and initial blood monitoring commenced. After attending the group session, patients were given an evaluation form to complete

Results
The responses from the evaluation forms are shown in the following table:

Conclusion
Group education has proved to be a successful way of providing education to patients with large vessel vasculitis needing to learn about the indications for use, along with the safe handling and administration of subcutaneous methotrexate.

Disclosure
G. Ducker: None. C.B. Mukhtyar: None.
The Microbiome and Gynecologic Cancer: Cellular Mechanisms and Clinical Applications
Authors: Chalif Julia , Wang Heather , Spakowicz Daniel , Quick Allison , Arthur Elizabeth K. , O'Malley David , Chambers Laura M. 
Published: April 2024

(Abstracted from Int J Gynecol Cancer 2023:ijgc-2023-004894
The microbiome, the collective microbiota and their associated genetic material colonizing mucosal surfaces, produces compounds that impact immunologic response, cell proliferation and signaling, gene expression, and metabolism of nutrients and hormones. Alterations to the microbiota-host relationship are linked to diseases, including cancer.
What Do LGBTQ+ Medical Students Experience and Need in Medical School? A Multicenter Qualitative Study in Thailand
Authors: Srifuengfung Maytinee , Wiwattarangkul Teeravut , Vadhanavikkit Papan , Wiwattanaworaset Pakawat , Chiddaycha Mayteewat , Oon-arom Awirut , Wainipitapong Sorawit 
Published: April 2024

Abstract

Purpose
This study evaluated the experiences and needs of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities (LGBTQ+) attending medical schools in Thailand.

Method
Medical students from 4 medical schools in Thailand were recruited in 2022. LGBTQ+ participants were selected via purposive sampling and invited for semistructured interviews. Verbatim transcripts were analyzed using reflexive thematic analysis.

Results
Interviews were conducted with 39 students identifying as lesbian, gay, bisexual, transgender, queer, questioning, nonbinary, asexual, or androgynous, with a mean age of 21. The experiences of these LGBTQ+ individuals in medical school had 4 themes: (1) normalization of LGBTQ+ identity among friends, or not openly identifying as LGBTQ+ (because it was viewed as unnecessary), facilitated everyday life; (2) fear of negative judgments from being LGBTQ+ by attending physicians and patients; (3) authenticity to sexual or gender identity provided relief; and (4) personal histories of discrimination affected self-disclosure and social dynamics. Overall, approximately 17% of reported stressors were directly associated with participants’ LGBTQ+ identity. The identified needs within medical schools comprised 2 themes: (1) treat each other with equal respect (with 3 subthemes: nonjudgmental attitudes supported by effective discrimination reporting systems, more LGBTQ+-related education and extracurricular activities, and activities driven by voluntariness without gender-based selection); and (2) abolishment or amendment of regulations that strictly enforce gender binaries. These amendments could include implementing flexible dress codes, establishing gender-neutral restrooms and dormitories, and introducing gender-neutral titles. Transgendered participants reported experiencing the most significant disparities due to binary regulations and infrastructures.

Conclusions
LGBTQ+ medical students in Thailand reported fear of negative perceptions by attending physicians and patients. Exposing everyone, particularly attending physicians, to examples of unintentional discrimination is recommended. There is also a need to promote LGBTQ+-related education and extracurricular activities and to ensure activities and regulations are not gender divided.
Increasing the Threshold to Perform Preperitoneal Pelvic Packing Decreases Morbidity Without Affecting Mortality
Authors: Pesante Benjamin D. , Moore Ernest E. , Pieracci Fredric M. , Kim Ye Joon , Mauffrey Cyril , Parry Joshua A. 
Published: April 2024

OBJECTIVES:
To determine the effectiveness of an updated protocol that increased the transfusion threshold to perform preperitoneal pelvic packing in patients with pelvic ring injuries and hemodynamic instability (HDI).

METHODS:

Design:
Retrospective review.

Setting:
Urban level 1 trauma center.

Patients Selection Criteria:
Severely injured (injury severity score > 15) patients with pelvic ring injuries treated before and after increasing the threshold to perform preperitoneal pelvic packing from 2 to 4 units of red blood cells (RBCs). HDI was defined as a systolic blood pressure <90 mm Hg.

Outcome Measures and Comparisons:
Mortality from hemorrhage, anterior pelvic space infections, and venous thromboembolisms before and after increasing preperitoneal pelvic packing threshold.

RESULTS:
One hundred sixty-six patients were included: 93 treated under the historical protocol and 73 treated under the updated protocol. HDI was present in 46.2% (n = 43) of the historical protocol group and 49.3% (n = 36) of the updated protocol group (P = 0.69). The median age of patients with HDI was 35.0 years (interquartile range 26.0–52.0), 74.7% (n = 59) were men, and the median injury severity score was 41.0 (interquartile range 29.0–50.0). Patients with HDI in the updated protocol group had a lower heart rate on presentation (105.0 vs. 120.0; P = 0.004), required less units of RBCs over the first 24 hours (6.0 vs. 8.0, P = 0.03), and did not differ in age, injury severity score, systolic blood pressure on arrival, base deficit or lactate on arrival, resuscitative endovascular balloon occlusion of the aorta, resuscitative thoracotomy, angioembolization, or anterior pelvis open reduction internal fixation (P > 0.05). The number of PPPs performed decreased under the new protocol (8.3% vs. 65.1%, P < 0.0001), and there were fewer anterior pelvic infections (0.0% vs. 13.9%, P = 0.02), fewer VTEs (8.3% vs. 30.2%; P = 0.02), and no difference in deaths from acute hemorrhagic shock (5.6% vs. 7.0%, P = 1.00).

CONCLUSIONS:
Increasing the transfusion threshold from 2 to 4 units of red blood cells to perform pelvic packing in severely injured patients with pelvic ring injuries decreased anterior pelvic space infections and venous thromboembolisms without affecting deaths from acute hemorrhage.

LEVEL OF EVIDENCE:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials*
Authors: D’Amico Filippo , Pruna Alessandro , Putowski Zbigniew , Dormio Sara , Ajello Silvia , Scandroglio Anna Mara , Lee Todd C. , Zangrillo Alberto , Landoni Giovanni 
Published: April 2024

OBJECTIVES:
Hypotension is associated with adverse outcomes in critically ill and perioperative patients. However, these assumptions are supported by observational studies. This meta-analysis of randomized controlled trials aims to compare the impact of lower versus higher blood pressure targets on mortality.

DATA SOURCES:
We searched PubMed, Cochrane, and Scholar from inception to February 10, 2024.

STUDY SELECTION:
Randomized trials comparing lower versus higher blood pressure targets in the management of critically ill and perioperative settings.

DATA EXTRACTION:
The primary outcome was all-cause mortality at the longest follow-up available. This review was registered in the Prospective International Register of Systematic Reviews, CRD42023452928.

DATA SYNTHESIS:
Of 2940 studies identified by the search string, 28 (12 in critically ill and 16 in perioperative settings) were included totaling 15,672 patients. Patients in the low blood pressure target group had lower mortality (23 studies included: 1019/7679 [13.3%] vs. 1103/7649 [14.4%]; relative risk 0.93; 95% CI, 0.87–0.99; p = 0.03; I
2 = 0%). This corresponded to a 97.4% probability of any increase in mortality with a Bayesian approach. These findings were mainly driven by studies performed in the ICU setting and with treatment lasting more than 24 hours; however, the magnitude and direction of the results were similar in the majority of sensitivity analyses including the analysis restricted to low risk of bias studies. We also observed a lower rate of atrial fibrillation and fewer patients requiring transfusion in low-pressure target groups. No differences were found in the other secondary outcomes.

CONCLUSIONS:
Based on pooled randomized trial evidence, a lower compared with a higher blood pressure target results in a reduction of mortality, atrial fibrillation, and transfusion requirements. Lower blood pressure targets may be beneficial but there is ongoing uncertainty. However, the present meta-analysis does not confirm previous findings and recommendations. These results might inform future guidelines and promote the study of the concept of protective hemodynamics.