bluuebunny/crossref_metadata_2025_split huggingface dataset:
P091 Who do we risk leaving behind? A survey of digital access and e-health literacy in people with inflammatory conditions
Authors: Hider Samantha , Muller Sara , Gray Lauren , Manning Fay , Brooks Mike , Heining Dominic , Menon Ajit , Packham Jonathan , Raghuvanshi Subhra , Roddy Edward , Ryan Sarah , Scott Ian , Paskins Zoe 
Published: April 2022

Abstract

Background/Aims
The COVID-19 pandemic led to an overnight shift in healthcare delivery and rapid uptake of digital technology. Such approaches risk digital exclusion for people without access to or not confident in their use of technology. We sought to examine digital access and e-health literacy in people with inflammatory conditions.

Methods
People (n = 2,024) were identified from their electronic health record and invited to participate in a survey, using SMS and postal approaches. Data were collected on age, gender, self-reported arthritis diagnosis (RA, PsA, AS, SLE and other), access to an internet-enabled device and frequency of internet access, health literacy (single-item literacy screener) and self-perceived e-health literacy (eHEALs). Ethical approval was obtained (Ref 21/PR/0867).

Results
639 people completed the survey, of whom 287 (44.9%) completed it online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. 98.3% were white. Approximately 20% of people did not have access to an internet enabled device (Table). 93 (15.3%) of patients reported never accessing the internet, this proportion was higher in people with RA. Approximately 19% had low health literacy. In those reporting internet use, eHealth literacy was moderate. The most popular options for accessing arthritis advice were telephone helplines or appointments.

Conclusion
Low health literacy, lack of digital access and low reported internet use was common, especially in people with RA, leading to high use of telephone advice and rheumatology appointments. Digital roll-out needs to take account of people requiring extra support to enable them to access care or risks excluding many patients with inflammatory conditions.

Disclosure
S. Hider: None. S. Muller: None. L. Gray: None. F. Manning: None. M. Brooks: None. D. Heining: None. A. Menon: None. J. Packham: None. S. Raghuvanshi: None. E. Roddy: None. S. Ryan: None. I. Scott: None. Z. Paskins: None.
P113 The prevalence of depression and anxiety at first presentation to rheumatology outpatients
Authors: Arumalla Nikita , Littlewood Rebecca , Chen Winnie , Garrood Toby 
Published: April 2022

Abstract

Background/Aims
Depression and anxiety are more common in patients with rheumatic diseases and have been associated with higher levels of fatigue, pain and levels of physical disability. Although this has been described in distinct rheumatic conditions, the burden of psychological morbidity across the diseases presenting to rheumatology outpatients is not as well known. The prevalence of anxiety and depression in the UK was reported to be 5.9% and 3.3% respectively. Here, we report rates of depression and anxiety in a cross-section of new patients referred to rheumatology outpatients.

Methods
All new patients referred to a rheumatology outpatient clinic in London, UK for a 10-week period in February to May 2019 received a digital pre-appointment questionnaire which included Patient Health Questionnaire (PHQ8) and Generalised Anxiety Disorder Questionnaire (GAD7) questionnaire for detecting depression and anxiety respectively. A retrospective analysis was performed to assess the prevalence of significant depression and/or anxiety in various rheumatic diseases, defined as PHQ8 or GAD7 ≥ 10, signifying at least moderate depression or anxiety respectively.

Results
464 patients completed the questionnaire, 338 female (73%), with a mean ± SD age of 44.3 ± 13.6 years. 41.2% of patients screened positive for depression and 26.5% for anxiety, with 24.4% screening positive for both. Of the patients screening positive for anxiety, 91.9% were also depressed. The four most prevalent conditions were rheumatoid arthritis (RA, 8.6%), osteoarthritis (OA, 15.3%), psoriatic arthritis (PsA, 8.4%) and fibromyalgia (FM, 24.4%). The prevalence of at least moderate depression and/or anxiety in RA, OA, PsA and FM was 22.5%, 35.2%, 46.1% and 77% respectively. Logistic regression determined odds ratios relative to RA for significant depression and/or anxiety as follows: OA 1.89 (95% CI 0.76-4.67), PsA 2.75 (1.02-7.41), FM 11.80 (4.91-28.36).

Conclusion
The burden of psychological illness is high across the population of patients presenting to rheumatology outpatients. Our findings show significant prevalence of psychological illness at first presentation. Early identification of psychological distress is important as it can predict adverse long-term outcomes in patients with rheumatic conditions. These results justify an integrated approach between rheumatology and mental health services.

Disclosure
N. Arumalla: None. R. Littlewood: None. W. Chen: None. T. Garrood: None.
P120 A collaborative approach to rolling out advice and guidance
Authors: MacPhie Elizabeth , Horton Sarah , Madan Ayesha , Rao Chandini , Fish Sarah 
Published: April 2022

Abstract

Background/Aims
Advice and Guidance (A&G) is a key priority for out-patient transformation, provides primary care with an immediate specialist opinion and negates patients waiting several months to see a specialist in clinic. During the last year we have taken incremental steps to embed and promote A&G. The importance of seeking the views of primary care colleagues has been paramount to increasing engagement and understand any unintended consequences.

Methods
A&G was switched on through e-Referral Service in July 2019. Information was provided as to what was appropriate for A&G. In December 2020 an alternative A&G system was rolled out providing an opportunity to promote the use of A&G and we started to redirect appropriate referrals at triage. In July 2021, we took a further step to return referrals where appropriate with an immediate specialist opinion. Both A&G systems record activity and a spreadsheet is kept of all triage outcomes. The new A&G system collects feedback from primary care. There have been regular opportunities to speak to primary care colleagues.

Results
During the first year of implementation of A&G we received on average three queries a week. Following the roll-out of the new A&G system we saw a steady rise in the number of queries. In April to June 2021, received 56 direct A&G queries. Of 669 referrals received, 33 were redirected to A&G. In July to September 2021, we received 58 direct A&G queries. Of 549 referrals received, 12 were redirected to A&G and 19 were returned with immediate advice. Routine waiting times have reduced from 12 to 7 weeks over the last 12 months. Feedback from primary care regarding 169 A&G queries has been very positive with 98% finding advice helpful. In partnership with the CCG we have developed a Top Tips Guide for Primary Care and delivered an evening workshop to promote the use of A&G. Feedback from GPs resulted in a letter being sent to patients when we respond to a referral with immediate advice and a leaflet is being developed to help patients understand the triage process and the different means by which a specialist opinion may be provided.

Conclusion
A&G has most importantly provided patients with an immediate specialist opinion and reduced the waiting times for those patients who still need to be assessed in clinic. Small incremental changes have allowed the team to appropriately job plan the workload and colleagues in primary care adapt to a new way of working. Regular discussions with primary care have helped understand any frustrations and to adopt a solution-focused approach. We recognise the importance of involving patients in the discussion, supporting them to understand an alternative way of working and change their mind-set on how specialist advice can be delivered.

Disclosure
E. MacPhie: Other; EM is the secretary of the North West Rheumatology Club, meetings have been supported by UCB, MSD, Abbvie and Lilly. S. Horton: None. A. Madan: None. C. Rao: None. S. Fish: None.
P126 GCA Hospital Standards (GHOST) - making a map of specialised services for the care of giant cell arteritis across England
Authors: Coath Fiona L , Bukhari Marwan , Ducker Georgina , Griffiths Bridget , Hamdulay Shahir , Hingorani Melanie , Horsbrugh Candy , Jones Colin , Lanyon Peter , Mackie Sarah , Mollan Susan , Mooney Janice , Nair Jagdish , O’Sullivan Eoin , Patil Ajay , Robson Joanna , Saravanan Vadivelu , Whitlock Madeline , Mukhtyar Chetan 
Published: April 2022

Abstract

Background/Aims
The objective of this project is to map services essential to delivering high quality care in giant cell arteritis (GCA) across England, identifying gaps in provision and thereby help to remove inequalities. To do this however, there must first be agreement on what these best practice services and standards are.

Methods
A steering committee was formed comprising 18 expert representatives from the 13 clinical regions in England, including rheumatology, ophthalmology, allied health professional and patient representation. A modified Delphi process was commenced with each member initially providing five aspects of service they felt were essential for best practice GCA care. From the 90 answers, common themes were identified by creation of a word cloud and then condensed into domains of practice. These domains were then ranked by each member in order of perceived importance. The top 10 domains taken forward for further review were clinical pathways, patient access, Rheumatology involvement, Ophthalmology involvement, ultrasonography provision, temporal artery biopsy provision, PET-CT scan provision, glucocorticoid treatment, patient education and multi-disciplinary team working. Domains identified as separate areas but not quite making it into the top 10 were Tocilizumab provision, audit and governance and research. With the latter two in particular, it was felt these are overarching principles which should run through all aspects of clinical work. Group consultation was undertaken to discuss the relevant aspects, and from this, three quality metrics and one summary statement were devised for each domain. Rheumatology and Ophthalmology provision were amalgamated, as it was felt these were equally as important, with similar requirements. On the first pass of voting all except ‘patient access’ achieved over 75% agreement amongst the steering committee members. After group consultation and amendment, ‘patient access’ also achieved the minimum 75% agreement cut-off. The final statements can be seen in the table below.
Results:

Conclusion
By devising specific quality metrics in addition to the recommendation statements above, it is envisaged these standards can be easily used as an audit tool to identify gaps and development needs in GCA services.

Disclosure
F.L. Coath: None. M. Bukhari: None. G. Ducker: None. B. Griffiths: None. S. Hamdulay: None. M. Hingorani: None. C. Horsbrugh: None. C. Jones: None. P. Lanyon: None. S. Mackie: None. S. Mollan: None. J. Mooney: None. J. Nair: None. E. O’Sullivan: None. A. Patil: None. J. Robson: None. V. Saravanan: None. M. Whitlock: None. C. Mukhtyar: None.
P133 NICE Guidance 41: Is it applicable to a real-world cohort of cervical spine fractures in older people?
Authors: Mony Damien , Gilbert Ffion 
Published: April 2022

Abstract

Background/Aims
Current guidance for the assessment and management of cervical spine fractures (CSFracs) in the UK is governed by NICE Guidance 41 (NG41). The guidance is based on the Canadian C-Spine Rule (CCR) which dictates whether spine imaging is necessary following trauma. There is little research into the reliability of NG41, notably on low energy impacts resulting in CSFracs in the elderly. The consequence of weaknesses in NG41 may result in delayed or missed CSFracs. Therefore, this report will deconstruct NG41 to identify potential areas of improvement.

Methods
Data were collected from medical notes on mechanism of injury and self-reported symptoms at The Royal Devon and Exeter Hospital in 84 patients &gt;50 years old with confirmed CSFracs over a 4-year period. Quantitative and thematic analysis of data was used to compare with this cohort with NG41. The comparison focussed on age, symptoms and the mechanism of injury.

Results
Of the 84 patients, 32.1% were reported as having a dangerous mechanism of injury. 74.6% of patients aged ≥65 were considered low risk for CSFracs. Neck pain was reported by 74.5% of patients. Only 6.0% presented with paraesthesia as a predominant symptom.

Conclusion
The significant proportion of patients aged ≥65 considered low risk for CSFracs emphasises changes are required to NG41 to include low energy impacts in the guidance. Age remains to have the strongest correlation with CSFracs. Neck pain is the predominant symptom in the data but has no mention in NG41. Larger scale research and modified guidance testing is required before changes to NG41 can be made.

Disclosure
D. Mony: None. F. Gilbert: None.
P141 What are the predictors of fragility fracture in patients with low body mass index: an observational cohort study
Authors: Sharma Seema D , Bukhari Marwan 
Published: April 2022

Abstract

Background/Aims
Low body mass index (BMI) is known to be associated with increased risk of fracture and therefore measurements of height and weight contribute towards the Fracture Risk Assessment Tool (FRAX) score, an estimation tool used to calculate approximate risk of fracture to guide therapy decisions. However, data is lacking on which measurement of bone mineral density is best in those that are underweight. Using a large population of patients with low BMI, we aimed to determine which measurement of bone mineral density (BMD) is the most accurate predictor of fragility fracture in this group of patients. We also aimed to explore the relationship of other traditional risk factors for fracture in this subpopulation.

Methods
Data on risk factors for osteoporosis and fragility fractures was collected on patients presenting for BMD estimation at a district general hospital in North West England between June 2004 and October 2016. All analysis was performed on those with low BMI, defined as &lt; 18.5kg/m2. Firstly, univariate logistic regression was performed to assess risk of fracture using BMD for lumbar spine, femoral neck and total hip; as well as smoking, alcohol use, presence of rheumatoid arthritis, history of steroid use and history of hip fracture in a parent. Risk factors were defined as per FRAX. This was followed by multivariate regression of available risk factors, using the best BMD predictor identified from univariate analysis. All models were controlled for sex and age at first scan. Results for continuous variables are reported as beta coefficients and for categorical variables as odds ratios. All results are reported with 95% confidence intervals. Area under ROC curve for each model was calculated.

Results
921 of 35,759 patients had a BMI of under 18.5 and were included in analysis. Of these, 88.4% were female, mean age at time of scan was 58.6 years. Results are shown in the table.

Conclusion
In those with low BMI, BMD of left total hip was the best predictor of fragility fracture. Smoking, alcohol use and history of hip fracture were also associated, but previous steroid use and diagnosis of rheumatoid arthritis was not.

Disclosure
S.D. Sharma: None. M. Bukhari: None.
P146 Hepatitis E infection in rheumatic disease: no evidence of chronicity
Authors: Zollinger-Read Caroline A , Raza Mohammad , Kazmi Muhammad F 
Published: April 2022

Abstract

Background/Aims
Hepatitis E virus [HEV] is the most common cause of acute hepatitis in developing countries but rare in the industrialised world. In the vast majority it causes an acute self-limiting infection which is often asymptomatic. It is usually detected due to raised transaminases in liver function tests [LFTs] which are checked as part of DMARD monitoring. There is increasing literature that immunocompromised patients with human immunodeficiency virus or transplant recipients are at risk of developing chronic HEV infection, which can progress to liver failure. It is unclear that immunosuppressed patients who have a rheumatological conditions have similar issues, which we have looked into locally. Chronic infection is defined as having detectable RNA for over 3 months.

Methods
Retrospective review of patients attending rheumatology outpatient clinic for blood monitoring, who had positive Hepatitis E serology between 2010 and 2021.

Results
We identified nine patients attending the rheumatology clinic in Sheffield, confirmed as having acute infection with HEV as Hep E IgM antibody was positive. They were all on immunosuppression and hence having regular monitoring bloods and were receiving either prednisolone, DMARDS or biologics or in combination. There were five males and four females, with an age range of 38 to 71 years. Eight patients had acutely abnormal LFTs with a peak ALT [normal &lt;41 IU/L] ranging from 59 to 1651 while in one the LFTs remained normal. Eight out of nine patient's LFTs recovered to baseline over a period ranging from 3 to 6 weeks (one moved out of area). Five patients had HEV RNA tested after the positive IgM. Two patients had HEV RNA detected initially, the rest had undetectable RNAs. Repeat RNA testing 2 months later was undetectable in both patients, suggesting no chronic HEV infection in all patients. No patients were given HEV antiviral treatment. Almost all patients had their immunosuppressant treatment paused, which was recommenced once their LFTs normalised. In all patients LFTs have remained normal even after 5 years with no evidence of reactivation in spite of ongoing immunosuppression. We plan to check HEV RNA if the LFTs were to become abnormal.

Conclusion
Our case series raises awareness that rheumatologists should consider HEV as a differential in patients with a marked unexpected rise in transaminases. We observed that all our patients cleared HEV infection and there was no evidence of chronicity even with ongoing immunosuppression, which is different from Hepatitis B & C. We recommend that immunosuppressant treatment should be stopped initially following HEV infection and reintroduced once LFTs have normalised and HEV RNA is undetectable.

Disclosure
C.A. Zollinger-Read: None. M. Raza: None. M.F. Kazmi: None.
P147 Venous fibrosis and stenosis in IgG4-related disease
Authors: Baslas Rohit , Condurache Dorina , Greenstein David , Patrone Lorenzo , Hamdulay Shahir 
Published: April 2022

Abstract

Background/Aims
IgG4-related disease (IgG4-RD) is a multi-system fibro-inflammatory disease. Common presentations involve salivary and lacrimal glands, orbital disease, autoimmune pancreatitis, retroperitoneal fibrosis and tubulointerstitial nephritis. The main histopathological features are a dense, polyclonal, lymphoplasmacytic infiltrate rich in IgG4+ plasma cells, storiform fibrosis and obliterative phlebitis. Cases of retroperitoneal fibrosis resulting in venous compression with DVT are well described, however to our knowledge venous fibrosis and stenosis confirmed with IVUS in IgG4-RD RPF has never been described.

Methods
An 82-year-old lady presented with bilateral lower leg oedema. She had a past diagnosis of IgG4 disease made on the basis of retroperitoneal fibrosis (confirmed on PET-CT), raised serum IgG4 levels (IgG4 2.38; normal 0.04-0.86 g/l) a supportive tissue biopsy (fibro-lymphocytic tissue with non-diagnostic IgG4 plasma cells) and raised inflammatory markers (CRP 104, ESR 120). Disease responded well to prednisolone and azathioprine, resulting in regression of RPF. She presented with left leg pitting oedema 4 months after presentation which progressed to chronic leg venous ulceration. D-dimer testing, albumin, liver function, and renal function tests were normal. There were no signs of lymphoedema. Venous Doppler studies of the left lower leg showed a patent and compressible left common femoral, superficial femoral and popliteal vein excluding a DVT and Baker’s cyst. A repeat CT pelvis showed no compressive mass. An intravascular ultrasound showed that the wall of the IVC was stiff and of dampened amplitude with respiratory motion. There was also increased echogenicity of the left common and external iliac vein wall with significant stenosis of the distal left common iliac vein and the external iliac veins. On the right side, there was increased echogenicity of the right common iliac vein, but the lumen was well preserved.

Results
These findings indicated fibrosis of the IVC wall and left common iliac vein with resulting venous stenosis. The patient underwent bilateral iliac vein stenting with improvement of leg swelling and eventual healing of the venous ulcer.

Conclusion
This case demonstrates that venous fibrosis and stenosis may occur in the absence of compressive lesions leading to leg swelling. Further diagnostic information may be identified by IVUS and radiological intervention with venous stents may be required.

Disclosure
R. Baslas: None. D. Condurache: None. D. Greenstein: None. L. Patrone: None. S. Hamdulay: None.
P151 Assessing the impact of a family day for young people and their families living with juvenile dermatomyositis in the Northwest of England
Authors: Cuthbert Verna J 
Published: April 2022

Abstract

Background/Aims
JDM is a rare, autoimmune disease affecting primarily the muscles and skin. There are approximately 2-4 cases per million children and young people. JDM can have a huge impact on the lives of the young people, their siblings and families and many young people and families have never met others with the condition. Aims: To organise the first family day for young people and families living with JDM in the Northwest of England, and to assess the impact of the day. For Young people and their families to feel less isolated living with JDM; for young people and siblings to get to take part in an activity to build their confidence; for young people and their families to receive information about JDM and living with the condition.

Methods
Invitations were sent out to young people and families with JDM who attended Alder hey Children’s Hospital, Manchester Royal Children’s Hospital, Sheffield Children’s Hospital and Leeds Children’s Hospital. The family day was organised outside of a hospital setting at the Chill Factor in Manchester. The young people were invited to enjoy snow activities, a science workshop, arts and crafts and soft play, as well as enjoy a fabulous lunch! A programme of speakers was organised and included a specialist nurse from GOSH discussing her current JDM research; a Manchester patient talked about the lived experience of having JDM and entering adulthood. A question and answer session was organised for young people and families to ask questions to a multi-professional panel.

Results
Feedback from questionnaires filled out on the day and email responses suggest the young people and families found the day beneficial and benefited from meeting up with other families and sharing experiences. The feedback suggested they found the education sessions and tips gained helpful and would aid management of the condition. Feedback suggested that the young people and their siblings had fun! Meeting other young people with the same condition was frequently mentioned in the feedback as very beneficial and helped to reduce feelings of isolation. Feedback suggests that the majority of young people and families would like to keep in touch with other JDM families.

Conclusion
The feedback received from the families and young people suggested that the aims of the day were met and there was considerable interest in further such events in the Northwest and/or keeping in touch with other families living with JDM.

Disclosure
V.J. Cuthbert: None.