bluuebunny/crossref_metadata_2025_split huggingface dataset:
P048 A young girl with myocardial infarction
Authors: Janagan Shalini , Gunathilaka M. P. M. L , Rajagopala Lavanya , Jagoda J. D 
Published: April 2022

Abstract

Background/Aims
Takayasu arteritis is a chronic granulomatous inflammatory disease of the aorta and its major branches. It is commonly seen in young women but has been reported in children as young as 6 months. Acute myocardial infarction due to coronary artery involvement is a rare presentation in Takayasu’s arteritis.

Methods
A previously healthy 13-year-old girl presented with a history of five episodes of short lasting exertional tightening type chest pain with adrenergic symptoms over a week which was relieved by rest. She didn't have any history of shortness of breath, limb claudication or constitutional symptoms. However, on two of the occasions she felt faint. She denied any recreational drug use. There was no family history of cardiovascular disease, connective tissue diseases or sudden cardiac death. On examination she was of average build with no peripheral stigmata of connective tissue diseases or hypercholesterolemia. Apart from a tachycardia of 110 bpm, her cardiovascular examination was normal. There was no BP difference between the arms and no audible bruits. All her peripheral pulses were felt.

Results
Her ECG showed ST segment depressions in V1-V5. High sensitivity Troponin I was strongly positive. An urgent CT coronary angiogram revealed aortitis involving the ascending and arch of the aorta extending to the left subclavian artery with both coronary arteries showing smooth short segment narrowing at the origin. Doppler USS abdomen showed wall thickening of proximal and mid abdominal aorta. Blood investigations showed a leucocytosis of 14,100/µl and thrombocytosis of 532000/µl. Her ESR was raised at 31 mm/hr and CRP was 5 mg/l. While further awaiting investigations she was started on treatment as for non-ST elevation myocardial infarction according to standard guidelines. Screening for tuberculosis and VDRL were negative . A CT aortic angiogram showed wall thickening involving the aortic root, coronary arteries, ascending aorta and the abdominal aorta with involvement of the origins of coeliac axis and the superior mesenteric artery. Appearance were suggestive of Takayasu arteritis Type v. She was pulsed with intravenous methylprednisolone 30 mg/kg for 3 days followed by oral prednisolone 2 mg/kg. As a steroid sparing agent methotrexate was added. Despite treatment, while in hospital she developed chest pain with ECG showing new onset ST elevation in aVR. An urgent coronary angiogram done showed severe LMCA disease for which stenting was done.
At this stage Tocilizumab was initiated. A year later she remains well controlled in terms of her disease activity.

Conclusion
Though rare, Takayasu’s arteritis should be considered in any adolescent female presenting with ischemic type symptoms and positive inflammatory response. High index of suspicion can lead to early imaging and aggressive immunosuppression that will reduce the morbidity and mortality of this disease.

Disclosure
S. Janagan: None. M.P.M.L. Gunathilaka: None. L. Rajagopala: None. J.D. Jagoda: None.
P107 Improving care for people with chronic low back pain - ESCAPE-pain for back
Authors: Hurley Michael , Thompson Francesca , Sibley Fay , Carter Andrea ,   ESCAPE-pain Team Health Innovation Network
Published: April 2022

Abstract

Background/Aims
Chronic low back pain (cLBP) is extremely prevalent, difficult to manage and impinges and all aspects of an individual’s life and its socioeconomic impact is enormous. ESCAPE-pain is an effective rehabilitation programme for knee and hip pain that is now being rolled out across the UK and beyond. We adapted ESCAPE-pain making it relevant to people with cLBP to improve their management. This study evaluated the efficacy of the programme in improving pain, function and mental well-being for people with cLBP.

Methods
Participants attended 12 sessions (2/week over 6 weeks) in groups of ∼10. Each session lasted 60-90 minutes, comprised of education and supervised, progressive exercise regimen. It was delivered by physiotherapists and therapy assistants. Data collected before and after the programme on MSK-HQ, self-reported physical activity (days active for 30 minutes each week) and function (30 second sit-to-stand). Feasibility was established from the number of Trusts willing to deliver the programme, participant recruitment and attendance. Participant and clinician satisfaction with, acceptability and experiences of the programme was gleaned from qualitative feedback from the “friends and family test” and semi-structured interviews.

Results
Four NHS Trusts took up the offer to deliver the programme, 165 people (106 women), mean age 55yrs were recruited. On average 78% of participants attended 74% of the programme. All Trusts were planning the continue to deliver and expand the programme after the evaluation ended. This uptake by organisations and participants is a proxy measure of the acceptability of the programme to providers and participants. The average number of days each week participant’s undertook for more than 30 mins physical activity increased from 2.3 to 3.6, number of sit-to-stand participants could perform in 30 seconds increased from 8 to 12, and mean MSK-HQ score increased from 25.5 to 35.2 (9.97).
Participant feedback was very positive describing how they “⋯gained lots of information to help me manage my pain...”,“⋯when I started I could only walk for 10 minutes before the pain started. I can now walk a lot further and I do not need to stop...”,“⋯I received the knowledge to understand that it is not just rest that I need for my pains but also activity and exercise...”,“⋯helped me feel more motivated and confident to exercise⋯”,“⋯it has improved the quality of my life and I feel a whole lot better⋯”
Conclusion: ESCAPE-pain for backs was accepted, well liked and improved clinical outcomes. The programme delivered care in line with NICE guidelines. The organisations were planning to expand delivery across other sites within their Trusts. Following wide expressions of interest we are rolling out of ESCAPE-pain for backs in NHS, leisure and community centres across the UK.

Disclosure
M. Hurley: None. F. Thompson: None. F. Sibley: None. A. Carter: None.
P121 Using patient experiences to redesign health provision - is this the future of rheumatology services?
Authors: Shaikh Alizeh R , Crix Douglas , Earl Susannah 
Published: April 2022

Abstract

Background/Aims
Chronic conditions in Rheumatology place an increasing burden on healthcare services, with the prevalence of such conditions on the rise. It is important, therefore, for us to understand what determines a patient’s experience of care and what they might need from their health service to support them to manage their condition. This study used a survey to explore patient’s perception of both their health and service experiences, with the aim of reviewing and refining the care we provide.

Methods
A questionnaire was sent to 250 patients under the Rheumatology Department of the Royal Devon and Exeter Foundation Trust. Inclusion criteria included patients above 18 years of age who had a diagnosis of either of the following conditions: Rheumatoid Arthritis, Ankylosing Spondylitis, Systemic Lupus Erythematous, Juvenile Idiopathic Arthritis, or Psoriatic Arthritis. The survey consisted of 13 questions: eight of which required responses on a Likert scale, and a further five required responses with free writing. 93 responses were acquired, and analysis used multivariate models in addition to thematic analysis.

Results
Multivariate models revealed a statistically significant relationship between the Rheumatology team’s understanding of the overall impact of a patient’s condition on their life [Q6] and the team’s support in helping to reduce this impact on what matters to the patient [Q8], (p &lt; 0.01, SE = 0.10). Q6 also shared a significant association with positive patient relationships with the Rheumatology team [Q5], (p &lt; 0.01, SE = 0.11). In relation to improving health service for patients, most common recurring themes during analysis were: understanding of impact on life and emotional wellbeing, lifestyle and social support, and responsiveness. Secondary multivariate analyses showed significant relationships between patient’s emotional wellbeing [Q4] and their confidence in being able to manage their symptoms [Q3], (p &lt; 0.01, SE = 0.15), in addition to their overall quality of life [Q1], (p &lt; 0.01, SE = 0.16).

Conclusion
The data acquired has reiterated a need to incorporate stronger psychosocial frameworks into patient care. Re-designing resources in such a way could prove to be a cost-effective manner in which to increase patient activation, reduce disease burden, and manage ever-increasing service demands.

Disclosure
A.R. Shaikh: None. D. Crix: None. S. Earl: None.
P125 The advancement of digital health technology in the outpatient setting, is speech recognition software useful?
Authors: Crawshaw Helena , Jamal Safwan , Andev Rajinder 
Published: April 2022

Abstract

Background/Aims
Over the last 20 years, innovation in digital health technology have been propelling health systems forwards. With the advent of the electronic health record, digital prescribing and artificial intelligence and machine learning comes new opportunities. The use of voice recognition systems in the transcription of rheumatology clinics has the potential for cost and time effectiveness which is ever important within the NHS. Here we review the use, user-interface acceptability and potential cost savings.

Methods
In speech recognition software the speech is converted to a sequence of words in written text. This is not a new technology and in particular has been widely used within radiology departments across the UK. Rheumatology is largely a clinic-based specialty, with high output of clinic letters. Speech recognition software removes the need for transcription-based services. As a new technology we have reviewed its use within the rheumatology, dermatology, endocrinology, renal and paediatric departments at a large district general hospital.

Results
143 staff members have been provided with a license and on average 64% are regularly using the available software. Over 3 months an average of 14,843 minutes per month of dictation has been completed. It has been estimated that over 12 months’ use there has been £100,000 savings through administerial time saved. The average turnaround time for clinic letters from dictation to delivery (electronically) to GPs has improved from approximately 1-2 weeks (but delays up to 4 weeks seen) to an approximately 24-36 hours. Preliminary data from users of this software suggest that compared to traditional dictation devices: 33% found it ‘much better’, 33% ‘better’ and 33% ‘the same’. 67% of participants found it ‘easy, or very easy’ to use whilst 16% found it ‘difficult’. 50% of participants found it ‘usually’ saved time, 33% ‘sometimes’ and 16% ‘rarely’ saved time.

Conclusion
This preliminary data suggest potential time and cost savings with largely positive feedback from users. Further work is needed to assess potential patient safety issues including errors and inaccuracies compared to traditional dictation means. We aim to complete this work prior to presentation of this abstract should it be accepted.

Disclosure
H. Crawshaw: None. S. Jamal: None. R. Andev: None.
P131 Adult coeliac disease and bone mineral density at the femoral neck, total hip and lumbar spine: an age- and sex-matched case-control study
Authors: Shtarbanov Petko , Bukhari Marwan 
Published: April 2022

Abstract

Background/Aims
Coeliac disease (CD) is characterised by intestinal villous atrophy causing malabsorption. Decreased bone mineral density (BMD) has been reported in CD. To the best of our knowledge, no published paper has documented BMD comparisons in detail at different sites. We aim to determine the prevalence of osteoporosis and BMD values at multiple locations in a group of adult CD patients, and compare them to those of age and sex matched controls.

Methods
We analysed data of adult patients referred for BMD estimation at a district scanner from 2004 to 2018. Dual-energy x-ray absorptiometry was used for all subjects. Patients diagnosed with CD (cases) were age- and sex-matched with subjects referred with no reason for scanning (controls). Additional FRAX(TM) risk factors for osteoporosis were recorded. Comparison was made using chi-squared for categorical values, student's T test for continuous variables, then a univariate followed by a multivariate stepwise logistic model, adjusting for height, weight and body mass index (BMI), were fitted.

Results
645 (474 female) patients in the coeliac group were matched with 645 (474 female) controls. There was no significant difference in the mean age (years) at scan: cases 56.24 (SD 14.79) vs controls 56.24 (SD 14.80), p-value 1.00. The coeliac group had a significantly higher proportion of osteoporotic (T-score ≤-2.5 SD) patients at all locations compared to the control group. Cases had significantly lower mean BMD (gcm-2) and mean Z-scores at all locations than the controls. In the multivariate stepwise model, adjusted for height, weight and BMI, only the total hip, lumbar spine and their sub-sites revealed significant associations between having CD and a BMD (gcm-2) in the lowest tertile for the whole cohort. Key results are summarised in Table 1.

Conclusion
We confirmed that adult CD patients have higher prevalence of osteoporosis and lower BMD values compared to controls. Bone impairment was pronounced at the L1 and L2 vertebrae; least pronounced at the femoral neck. This might be due to CD preferentially damaging trabecular bone, which is predominant in the lumbar spine than femoral neck.

Disclosure
P. Shtarbanov: None. M. Bukhari: None.
P139 The impact of identifying poor adherence to bone protective treatment via postal questionnaire - Bath Fracture Liaison Service (FLS) audit
Authors: Warren Susie M , Webb Jackie L , Ahmed Tehseen 
Published: April 2022

Abstract

Background/Aims
As part of the Royal United Hospitals Bath FLS, postal questionnaires assessing adherence to treatment are sent to patients (aged 50 or above) in whom we had recommended initiation of bone protective treatment (BPT) following identification of a low-trauma fracture. Upon receipt by the FLS of a completed adherence questionnaire, correspondence is sent to the GP to report the outcome, with recommendations as appropriate. The aim of this audit was to assess how many patients started (or re-started) treatment after reporting poor adherence.

Methods
Patients sent an adherence questionnaire in 2019 were screened for inclusion in the audit. These patients had sustained a low-trauma fracture approximately 1 year prior. For those reporting poor adherence (defined as either BPT not prescribed, or non-adherence to treatment), our hospital electronic record system (Millennium) and primary care electronic records (SystmOne) were scrutinised to assess whether BPT was subsequently initiated.

Results
A total of 1164 questionnaires were sent and 684 (59%) were completed and returned to the FLS. Of the questionnaires returned, 366 (54%) reported good adherence and 257 (38%) reported poor adherence. 61 (9%) of patients reported a decision not to take treatment. 88 of the 257 patients who reported poor adherence were excluded from the audit for the following reasons: 5 patients excluded because an outcome letter was inadvertently not sent to the GP and therefore these patients were not directly comparable with the other patients. 25 subsequently deceased patients were excluded because we were unable to ascertain if they had started/re-started treatment following the poor adherence letter. 51 patients were excluded because the primary care electronic record was unavailable and therefore although there was no evidence on our hospital electronic record system that treatment had been prescribed, we could not be certain that this was the case. 7 patients reported that they had not been prescribed treatment but there was evidence that treatment had been prescribed at the time of the adherence check. This provided us with a final eligible cohort of 169 patients for further analysis. We found evidence that 65 (38%) of 169 patients were prescribed or re-prescribed bone protection treatment following our poor adherence letter to the GP. Treatment was ongoing in 40 (24%) patients at the time of this analysis.

Conclusion
Our FLS policy of sending outcome letters to GPs following patient-reported poor adherence to BPT is partially effective in prompting prescription/re-prescription of treatment where appropriate. Our FLS will need to employ additional/alternative methods to improve our performance.

Disclosure
S.M. Warren: None. J.L. Webb: None. T. Ahmed: None.
P142 Fracture risk in diabetes: to FRAX or not to FRAX?
Authors: Mathew Mekha , Dwivedi Shivangi , Buch Harit , Venkatachalam Srinivasan 
Published: April 2022

Abstract

Background/Aims
Diabetes mellitus is associated with decreased bone strength as well as increased fracture risk. The risk of fragility fracture increases with an increase in the duration of diabetes and worsening of glycemic control. However, this increased fracture risk often goes unidentified. Identifying patients at risk of fracture is fundamental in helping to prevent fractures. WHO FRAX (fracture risk assessment) tool computing the 10-year probability of hip fracture or a major osteoporotic fracture helps ascertain fracture risk. In Type 2 Diabetes Mellitus (T2DM), the diagnosis of osteoporosis by dual-energy X-ray absorptiometry (DXA) and the FRAX are only partially useful in assessing fracture risk. Our aims were: 1. To identify the fracture risk in patients with diabetes and 2. To assess the impact of adding diabetes as a risk factor in the calculation of FRAX score.

Methods
One hundred patients above the age of 50 years with duration of diabetes above a year who attended the diabetes clinic from December 2020 to June 2021 were included. Data was collected on demographics (age, sex, ethnicity), diabetes-related factors (the type, duration, complications and medications) and clinical risk factors for osteoporotic fracture (parental fracture, previous fracture, smoking, alcohol intake) from patient interviews and the FRAX score was calculated. FRAX tool was modified for diabetes by adding either 10 years of age or Rheumatoid arthritis as risk factor.

Results
Mean age of our cohort of patients was 67 years and their mean BMI was 33 kg/sq m. Duration of diabetes was over 5 years in 95% of the patients. T2DM was seen in 82% and Type 1 Diabetes mellitus (T1DM) in 18%. The mean HbA1c was 8.4%. Unadjusted mean FRAX score for a major osteoporotic fracture was 8.9% and hip fracture 2.3%. High risk of future fracture was seen in 4% of the patients and intermediate risk in 23% and low risk in 73%. Four patients had Rheumatoid arthritis and 21 had previous fragility fractures. Modifying the FRAX tool by adding 10 years to age moved 15% more patients to the intermediate-risk category needing DXA and 5% more to the high-risk category needing osteoporosis treatment. However, adding Rheumatoid arthritis changed 20% more patients to the intermediate-risk category needing DXA and 7% more to the high-risk category needing osteoporosis treatment.

Conclusion
Modifying FRAX tool in patients with diabetes mellitus will enable more patients to have a DXA scan and to receive osteoporosis treatment and the strategy using rheumatoid arthritis as a risk factor identified more patients than adding 10 years of age.

Disclosure
M. Mathew: None. S. Dwivedi: None. H. Buch: None. S. Venkatachalam: None.
P166 Working in partnership with the third sector to provide support for paediatric, adolescent patients and families throughout COVID-19 and beyond
Authors: Connor Klaire 
Published: April 2022

Abstract

Background/Aims
A youth work approach to the delivery of additional support for young people and families has been used for the past 2 years within the paediatric rheumatology service in Glasgow. The approach takes into consideration that young people choose to participate, it's person-centred and built from where the young people are, young people and staff are all part of the journey and learning process. During the COVID-19 pandemic the support for young people went virtual, linking young people with peer support and online support. Dedicated service and delivery model in partnership with pediatric clinical services, ensure specific support needs are met. The approach to working with young people is bespoke and delivered by teams that understand the needs of young people.

Methods
The youth work approach recognises that young people choose to participate, it's person-centred and bespoke to the specific needs of young people. Young people and specialist staff are equal parts of the journey. Listening to unmet needs of young people as well as sector best practice - from intense 121 support for families to digital tools to meet growing expectations post-COVID-19. Support in clinic is youth and family led: with unique peer model, youth empowerment, communities of support and co-production. With staff delivering 121 support, and peer volunteers delivering and leading group work out with clinical settings. Third sector staff are integrated with the paediatric rheumatology team, working together to support young people and families holistically.

Results
The youth work approach best fits with the unmet needs of the young people within clinical settings. Young people are supported to feel more confident, less isolated and more hopeful about the future. They are encouraged to build positive peer-to-peer relationships and feel they are taken seriously and supported through their journey alongside partners. The approach to delivery is based on well-grounded practical and experiential knowledge. This is proven to enhance the lives of young people and offers them effective tools to use throughout their development. Our approach is based on best practice youth work.

Conclusion
Early youth work intervention and integration is highly valued by young people and families, offers holistic, person-centred, and developmentally appropriate care with lifelong benefits. Integrated and localised delivery creates unique insight, offering bespoke support to young people within clinical settings and beyond. Quality relationships with youth workers and clinicians can lead to improvements in holistic care and support for young people. An effective way to reach young people at key points - diagnosis, treatment and transition to adult services. Integration ensures that there is an ‘in house' expertise in youth work and joined-up services and support for young people and families.

Disclosure
K. Connor: None.