bluuebunny/crossref_metadata_2025_split huggingface dataset:
P069 A phone survey on the acceptance of COVID-19 vaccination amongst adolescents in a rheumatology centre in Malaysia
Authors: Ng Chun Ruh , Ho Tze Hau 
Published: April 2022

Abstract

Background/Aims
According to newspaper Bernama, 6.5% of adolescents in Malaysia aged between 12 and 17 have completed their vaccination and 89.7% of the adult population have completed theirs as of 9th October 2021. The acceptance of patients with rheumatic diseases on Covid-19 vaccination are crucial in the successful long-term protection against COVID-19 infection. We conducted a phone survey to determine the acceptance of COVID-19 vaccination amongst adolescents with underlying rheumatic disease.

Methods
This was a phone survey. The electronic medical records of all rheumatology patients follow up in rheumatology clinic Hospital Sultan Ismail, Malaysia from 2019 to 2021 were reviewed and patients with the age group between 12 to 21 were identified. Demographic data, diagnosis of the disease and outcome of the survey were collected and analysed.

Results
Phone survey was done after data extracted from medical records. For those under the age of 18, guardian of the patients was interviewed. A total of 50 patients were identified. Most of the patients were female (46/50) and majority of them were Malay (33/50). This was followed by Chinese (10/50), Indian (4/50) and others (3/50). The mean age group was 18 (range from 13 to 21).
36 of them were having systemic lupus erythematosus (SLE), 5 of them were having juvenile idiopathic arthritis (JIA) ,2 of them were having psoriatic arthritis (PSA) and another 2 of them were having rheumatoid arthritis (RA), followed by RA overlapped SLE, juvenile dermatomyositis, Henoch-Schönlein purpura, SLE overlapped with JIA and mixed connective tissue disease about 1 each respectively. Majority of them patients are keen or already completed COVID-19 vaccination with the acceptance rate of as high as 92% (46/50). Only 8% of them are not keen for vaccination with the only reason of worrying the risk of myocarditis post vaccination (1 SLE patient and 1 PSA patient).

Conclusion
The overall acceptance rate of COVID-19 vaccination amongst adolescents with rheumatic diseases are very encouraging with the percentage of &gt; 90% despite lacking knowledge about vaccination for COVID-19. This result can assist our Ministry of Health in planning for future battles to improve vaccine uptake that hopefully can lead to herd immunity against COVID-19 infection.

Disclosure
C. Ng: None. T. Ho: None.
P082 Informal opportunities for education about lifestyle factors in inflammatory arthritis
Authors: Robinson Sandra , Bourke Maurice , Scrafton Nicola , Walker David 
Published: April 2022

Abstract

Background/Aims
Education of patients about their disease and treatments are a central part of the Nursing and AHP roles especially in chronic diseases such as arthritis. Different patients will require different approaches; layering and repetition of information are usually necessary. Recommended advice will also change over time with increased understanding and research, requiring updates for existing patients. In this situation any contact with the Rheumatology team is an opportunity to get health messages to patients. There is increasing data confirming the effect of obesity, exercise and smoking on response to treatment and outcomes in inflammatory arthritis. We were interested to explore if these messages had been delivered to established patients by our team.

Methods
We designed a short, self-complete, questionnaire for patients asking about information they had received from the team on lifestyle advice. We included questions on drug education as a positive control as we were confident that all patients would have received education about this. 50 consecutive patients with either rheumatoid or psoriatic arthritis seen by one consultant were included.

Results
The population was of 38 RA and 12 Psoriatic arthritis. Average duration of disease was 15yrs (Range 2-60). Average BMI was 28.4 (19.7-42.8). 29% were normal, 33% overweight and 38% obese. Only 59% said that they had moderate or a lot of education about their DMARDs and 11% reported having had none. However, 83% were moderately or very confident that they had sufficient information about the drug. No one reported no confidence. The most useful sources of information included the Doctors (50%) Nurses (37%) internet (24%) and booklets (9%). There was a strong correlation between amount of education and duration of disease (p &lt; 0.001). Responses about how much information they had received from the team about lifestyle factors are shown in the table. There was a large range for all topics.

Conclusion
It appears that patients do not always remember education about their drugs, but all have confidence that they know about the drugs. Messages about lifestyle factors are being given by the “Team”, but around 50% of patients reported receiving little or no information on each topic. A more structured approach to these opportunities for education would be appropriate.

Disclosure
S. Robinson: None. M. Bourke: None. N. Scrafton: None. D. Walker: Consultancies; Galapagos, Eli Lilly.
P088 Utilising virtual reality for remote joint injection training for the post-pandemic rheumatologist
Authors: Clarke Benjamin D , Balachandran Sathiyaa , Nagra Deepak , Russell Mark D , Bechman Katie , Adas Maryam , Hope-Smith Anthony , Yates Mark , Barrow Alastair , Smith Tom , Galloway James 
Published: April 2022

Abstract

Background/Aims
The impact of dealing with COVID-19 for rheumatology higher specialist trainees has been profound. Sacrifices were made to their training to support the UK's pandemic response. Virtual Reality (VR) has long been used as a solution for specific surgical skills; providing a hands-on experience to enable specific delivery of outcomes. We utilised existing technology alongside a specialist VR and haptics team to review ways at delivering a valid and reliable training tool to administer joint injections, beginning with the review of this procedure specific to the knee. We aimed to describe this process.

Methods
A qualitative study using focus groups was undertaken, one medical student, four higher specialty trainees and two consultants were convened in a focus group to review existing mannequin-based training with the purpose of identifying a skill to develop in virtual reality. A story board was developed through collaboration with a graphic designer. The scenario was imbedded into a virtual reality environment in collaboration with a virtual reality partner.

Results
The focus group identified intra-articular knee injection as the most appropriate rheumatology skill to develop. Storyboarding built a series of scenarios around clinical situations which would require injection or aspiration. Working with the engineering team we successfully mapped knee joint anatomy and rendered an authentic clinical environment for the storyboards to run inside.

Conclusion
Virtual reality training scenarios are complex to develop but have enormous potential to create immersive training and assessment experiences which are not boundaried by the challenges of social distancing and COVID-19 risks.

Disclosure
B.D. Clarke: Honoraria; Abbvie. Grants/research support; Innovate UK. S. Balachandran: None. D. Nagra: None. M.D. Russell: Honoraria; Lilly, Pfizer, Janssen, UCB, Menarini. K. Bechman: None. M. Adas: None. A. Hope-Smith: None. M. Yates: Honoraria; Abbvie, UCB. A. Barrow: Grants/research support; Innovate UK. T. Smith: Grants/research support; Innovate UK. J. Galloway: Honoraria; Abbvie, Biovitrum, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB.
P115 Remote clinical management: incorporating electronic assessment of patients with rheumatic diseases into standard clinical pathways and comparison to in-person assessment
Authors: Soni Anushka , Jackman John , Manderson Sarah , Pena Larissa Saldana , Barrett Joseph , Luqmani Raashid 
Published: April 2022

Abstract

Background/Aims
The aim of this project was to develop generalisable digital solutions to deliver safe, efficient and effective care for patients with long-term rheumatic conditions. We have previously demonstrated that this method is feasible and acceptable to patients with RA and AxSpA. We evaluated the outcomes of remote assessment across a further range of conditions; making comparisons with corresponding in-person assessments.

Methods
We developed online questionnaires, using readily available software, to conduct remote assessments in 806 patients awaiting follow-up. Questionnaires contained: measures of disease activity; patient reported outcomes; patient preferences regarding the urgency and type of appointment required; and any other recent problems or changes in medication highlighted by the patient. The information was imported into a bespoke clinical database allowing clinicians to conduct an asynchronous assessment, integrated within electronic health records (EHR). Report letters were sent to patients and their GP. EHRs were reviewed in a subset of patients, requiring urgent in-person assessments (within 1-month) following remote assessment, to evaluate overall agreement with in-person assessment of disease activity and treatment changes. Chi-square test was used to investigate for significant differences by condition. We defined “stable” disease as patients classified as in remission or partial remission, on or off immunosuppressive therapy.

Results
Table 1 summarises all the patients assessed remotely, by condition, and subsequent follow-up requested. Agreement between remote and in-person assessment was evaluated in 56 patients (25 RA; 14 PsA; 17 AxSpA). Agreement between remote and in-person assessment was present in 21/25 (84%), 9/14 (65%) and 12/17 (71%) of patients with RA, PsA and AxSpA respectively, p = 0.35. Treatment changes were made in 21/25(84%), 9/14(65%), 11/17(65%) of patients with RA, PsA and AxSpA respectively, p = 0.26).

Conclusion
We have developed and implemented a system of remote clinical management for patients with rheumatic conditions. Following remote assessment only 284/806 (35%) required a subsequent in-person assessment and 351/806 (44%) had stable disease. Concordance with in-person assessment was highest for patients with RA, but not significantly different to outcomes for PsA and AxSpA. Further work is needed to validate this mode of assessment, including patients with vasculitis/CTD and those declared as having “stable” disease.

Disclosure
A. Soni: None. J. Jackman: None. S. Manderson: None. L. Saldana Pena: None. J. Barrett: None. R. Luqmani: None.
P117 Nailfold capillaroscopy: a survey of current UK practice and ‘next steps’ to facilitate generalised uptake
Authors: Eden Martin , Wilkinson Sarah , Murray Andrea , Bharathi Praveen Gurunath , Taylor Chris , Payne Katherine , Herrick Ariane L 
Published: April 2022

Abstract

Background/Aims
Nailfold capillaroscopy has a key role in the assessment of patients with Raynaud’s phenomenon (RP) providing a window of opportunity for the early diagnosis of systemic sclerosis (SSc). Anecdotal evidence indicates that this opportunity is not being fully realised across UK rheumatology centres. Reasons for apparent discrepancies in use of capillaroscopy may relate to a lack of expertise, confidence or equipment. Exploratory work has demonstrated the potential for an internet-based standardised system for clinical reporting of nailfold capillaroscopy images to mitigate current inequities in care provision. The overall aim of this study was to understand current practices in the diagnosis of SSc in UK rheumatology centres with specific reference to identifying barriers to the use of nailfold capillaroscopy. A secondary aim was to understand rheumatologists’ views on a standardised system to facilitate the timely diagnosis of SSc.

Methods
An online survey comprising closed and free-text questions was developed using expert (n = 7) opinion from clinicians, scientists and health service researchers. The survey was piloted (n = 5) and sent to UK-based rheumatologists using established electronic mailing lists between 2nd October 2020 and 8th March 2021. Respondents were asked to describe workloads and practices typically seen before the COVID-19 pandemic. Data were analysed using descriptive statistics and thematic analysis.

Results
Survey responses were received from 104 rheumatologists representing centres across the UK. Wide variation in terms of workloads and practices were described (See Table 1). Only 41% (n = 43) of respondents reported using nailfold capillaroscopy provided at their centres. Key barriers were access to equipment and a lack of expertise in terms of acquiring and analysing images. Respondents indicated that a centralised internet-based system for storing images and sharing diagnoses would provide access to expertise and the possibility of timely diagnoses.

Conclusion
Substantial variation in approaches to the diagnosis of SSc across the UK was identified. Potential benefits of a standardised system were described by respondents including the improved diagnosis and management of SSc, realising potential patient benefits and reducing current health inequalities. Survey findings provide evidence to help develop future studies to develop and evaluate the proposed new system.

Disclosure
M. Eden: None. S. Wilkinson: None. A. Murray: None. P. Gurunath Bharathi: None. C. Taylor: None. K. Payne: None. A.L. Herrick: None.
P124 Disease modifying anti-rheumatic drug (DMARD) therapy monitoring and evaluation of patient progress as part of standard clinical care in rheumatology patients
Authors: Luqmani Raashid A , Escudero Alexa , Driver Krystie , Mirza Maria , Jackman John , Manderson Sarah , Soni Anushka 
Published: April 2022

Abstract

Background/Aims
Review of blood results for monitoring DMARDs is performed manually in our department and subject to human error with up to 200 starters per month. In the last 6 months at least three patients have had abnormalities which were missed, highlighting a significant clinical risk. The aim of the project was to develop, test and implement an automated algorithm to detect and act on significant blood abnormalities in patients starting DMARD therapy.

Methods
We created a system to automatically analyse laboratory results supplied by our laboratory. We imported data into a specifically designed database to provide analysis based on BSR guidelines. The data is immediately ready for review by a clinician, grouped as: normal, mildly abnormal (exceeding the upper or lower limit of normal), missing (individual values not recorded), or abnormal (outside the threshold values); records with consecutive results showing a trend towards abnormality are also recorded. The clinician has the responsibility to review all records and endorse them after taking appropriate action where required.

Results
We tested the system on two cohorts of 100 and 227 sets of blood tests respectively and confirm that it is more rapid and robust than a manual process. We compared each of record with a manual evaluation of the data on a spreadsheet. We identified more abnormalities using the new system than were found on manual inspection (29% vs 10%, Chi square P &lt; 0.001). The manual system took 3 hours to prepare the data for evaluation; the new system performed the same task in under 1 minute. Table 1 shows the summary data for 100 test records, assessed manually and then using the algorithm, followed by real data using 570 records from 160 patients initiating DMARD. Subsequent manual inspection of the test records defined as abnormal by the algorithm confirmed that the new system had correctly identified abnormalities in every case.

Conclusion
We have developed a blood monitoring system for patients initiating DMARDs, capable of processing up to 10,000 results per session. The system is practical, more efficient and more accurate than a manual process for DMARD monitoring.

Disclosure
R.A. Luqmani: None. A. Escudero: None. K. Driver: None. M. Mirza: None. J. Jackman: None. S. Manderson: None. A. Soni: None.
P127 Disrupting the cartilage mechanostat: the role of the ciliary protein IFT88 in the adolescent growth plate
Authors: Chang Emer , Coveney Clarissa , Wann Angus 
Published: April 2022

Abstract

Background/Aims
As long bone elongation draws to a close, the cartilaginous growth plate begins to ossify in preparation of growth plate fusion. Previous embryonic developmental in vivo work has identified the crucial Parathyroid Hormone-related Protein-Indian hedgehog (PTHrP-Ihh) feedback loop that is responsible for the proliferation of chondrocytes at the epiphysis, whilst also allowing for the hypertrophic differentiation of chondrocytes before ossification at the diaphysis. Indian hedgehog signalling relies upon the microtubule-based organelle the primary cilium, as disruption to either results in similar musculoskeletal phenotypes. Here, we asked for the first time whether juvenile and adolescent primary cilia disruption affected chondrocyte differentiation in the growth plate.

Methods
We used a chondrocyte-specific conditional knockout (AggrecanCreERT2; Ift88fl/fl, cKO) of a key primary ciliary protein (Ift88) administering tamoxifen at (4, 6, 8 weeks-of-age) to both cKO and control (Ift88fl/fl) animals, collecting two weeks later (6, 8, 10-weeks-of-age). Immunohistochemistry was performed using type X collagen (ColX), a specific marker of hypertrophic chondrocytes.

Results
Deletion of IFT88 resulted in large bi-lateral cartilaginous regions filled with disorganised ColX positive hypertrophic chondrocytes, indicating failed ossification. Our results indicate that deletion of IFT88 does not impact hypertrophic differentiation, but disrupts ossification processes downstream at the chondro-osseous junction, such as matrix remodelling and angiogenesis, necessary for growth plate closure. Interestingly, this phenotype was observed only in the bi-lateral most loaded regions of the tibia whilst the middle was unaffected.

Conclusion
This observation indicates that the primary cilium could be involved in transducing mechanically regulated biophysical and signalling cues in the adolescent growth plate.

Disclosure
E. Chang: None. C. Coveney: None. A. Wann: None.
P128 Double-blind randomized pilot study to evaluate diamagnetically enhanced transdermal ibuprofen in comparison to placebo on pain and function in individuals with knee osteoarthritis
Authors: Summers Jill , Wright Tony , Benson Heather , Moss Penny , Tsadilas George , Edwards Jeff , Will Rob 
Published: April 2022

Abstract

Background/Aims
Treatment of knee osteoarthritis (OA) focuses on reducing pain and improving function. Transdermal NSAID formulations have been developed as an alternative approach to reduce pain and sensitisation around the OA affected joint whilst avoiding some of the risks associated with oral NSAID administration. The aim of the study was to evaluate clinical outcomes following short-term (48 hours) administration of transdermal ibuprofen (5% w/v) from a wearable patch that incorporated a patented diamagnetic repulsion technology to enhance drug delivery, in comparison to placebo.

Methods
Double-blind, repeated measures, crossover design. Two study periods (48 hr each); diamagnetically enhanced ibuprofen or placebo, randomised. Participants: 24 (6 male: 18 female, mean age 66) people with painful knee OA. Patch applications: 6 x 4-5 hour patch applications over a 48 hour period. Active patches contained 5% ibuprofen in a gel reservoir with magnetized backing. Placebo patches had identical appearance but no ibuprofen and non-magnetized backing. Primary outcome measures: VAS for pain on movement (STS X3), WOMAC pain score, WOMAC function score.
Results:

Conclusion
The active device containing ibuprofen (5%) and magnetophoresis technology produced a significantly greater reduction in pain and improvement in function than the placebo device. This was particularly the case for movement related pain. The reduction in pain was apparent with both VAS pain ratings and WOMAC pain score. There was also a clear improvement in function based on the WOMAC function score. The number needed to treat (NNT) for a 50% reduction in movement related pain was 2.2 and for resting pain 3.4. There were no major adverse events recorded during the study.

Disclosure
J. Summers: None. T. Wright: None. H. Benson: None. P. Moss: None. G. Tsadilas: None. J. Edwards: None. R. Will: None.
P130 Pharmacist-led osteoporosis telephone service
Authors: Rusby Nathan Karl , Bridges Matthew 
Published: April 2022

Abstract

Background/Aims
The COVID-19 pandemic has made finding ways to consult suitable patients remotely a priority. We have introduced a telephone assessment clinic, run by our departmental pharmacist, to assess and treat patients with osteoporosis who have been referred from primary care for consideration of parenteral bone sparing therapy.

Methods
Patients with osteoporosis who have been referred from primary care were triaged electronically into a fortnightly telephone assessment clinic, according to pre-specified criteria. Prior to the appointment, information leaflets about osteoporosis, and treatments for this condition were posted to the patients. The telephone consultation was carried out and patient demographics, risk factors for fracture, bone density results, FRAX / NOGG assessment, treatment decisions, and other clinical details were recorded on a pro-forma. A satisfaction survey was sent out to each patient following consultation.

Results
Sixty patients were assessed between July 2020 and April 2021. Fifty-seven (95%) were female, and the mean age was 71 years. Following consultation, twenty-one were commenced on zoledronic acid, eighteen on denosumab, three on teriparatide and eighteen no treatments /other. Average time from referral to consultation was 1.75 months. Thirty-four patient satisfaction surveys were returned. Twenty-nine (85%) patients said they would be happy for consultations via telephone in the future, with twenty-five patients (74%) either likely or highly likely to recommend telephone consultation to family or friends. When asked to compare their experience of telephone to face-to-face consultations; twenty (58%) reported being indifferent, four (12%) said their experience was poorer or significantly poorer than face-to-face, and ten (29%) said their experience was better or significantly better. Mean saving on travel expenses was £0-£5 (41% of patients) with four patients (12%) saving £21+. Mean mileage saved was &lt; 5 miles (33% of patients), with seven patients (21%) saving 30+ miles on travel.

Conclusion
This study reveals that patients, overall, had a positive experience with a pharmacist-led telephone consultation. Such clinics could be implemented across other areas of our rheumatology service, if clinically appropriate; reducing unnecessary patient contact, reducing consultant work load and optimally utilizing skills of the wider multi-disciplinary team. Face-to-face consultations still have an essential role where physical examination may be required, or patients have communication barriers. Our sample size was small, and data collection is on-going.

Disclosure
N. Rusby: None. M. Bridges: None.