bluuebunny/crossref_metadata_2025_split huggingface dataset:
P202 Impact of ‘moderate' active RA on patient lives
Authors: Jacklin Clare , Nikiphorou Elena , Kiely Patrick , Jacklin Hannah , Bosworth Ailsa 
Published: April 2022

Abstract

Background/Aims
The objective of this survey was to highlight the everyday impact of living with active Rheumatoid Arthritis for people not meeting the eligibility criteria (pre-July 2021), to be treated with advanced therapies.

Methods
NRAS wanted to reach people living with RA for more than 2 years but not being treated with any advanced therapies with a national survey to gauge if they had active disease that was not well controlled and the impact of that active disease on their lives. The survey was designed to capture demographics, current treatment, frequency of RA flares, impact of disease (utilising the validated tool of RAID) as well as work status and restrictions on lifestyle. The national online survey was distributed via all NRAS social media platforms as well as email.

Results
612 responses from across the UK with a mean age of 59 years were gathered. 88% were female and 37.7% had a disease duration of 2-5 years with a further 27.9% with disease duration of 5-10 years. 90% declared having RA flare in the previous 12 months with 23% reporting having had six or more flares within the year. A total RAID score was calculated for 611 respondents. A RAID patient acceptable state was recorded in only 12.4%. 74.3% scored sleep problems and 72% fatigue in the high range. Working hours alteration was reported by 70% of respondent. The RAID scores were significantly predictive of number of flares.

Conclusion
Patients not currently treated with biologics/biosimilars or targeted synthetic DMARDs experience profound difficulties affecting their health, emotional state, work and families. NRAS advocate that patient reported measures be used to facilitate holistic care, addressing inflammation and other consequences of RA on everyday life. Since this piece of work was carried out the threshold for accessing some advanced therapies has been lowered by NICE meaning that in England and Wales many of these people will now have access to being treated on an advanced therapy however there still exists issues in Scotland and Northern Ireland in being able to offer such treatments to those with RA disease activity score of less than 5.1 as well as cost barriers.

Disclosure
C. Jacklin: None. E. Nikiphorou: None. P. Kiely: None. H. Jacklin: None. A. Bosworth: None.
P215 In a treatment-naïve, early rheumatoid arthritis cohort, baseline ultrasound power Doppler synovitis and tenosynovitis are highly associated with remission when treated with first line etanercept + methotrexate (MTX) but not MTX alone
Authors: Shukla Rudresh , Hum Ryan , Ho Pauline , Wakefield Richard J , Emery Paul , Buch Maya H 
Published: April 2022

Abstract

Background/Aims
Clinical remission is the treatment target in rheumatoid arthritis (RA). In a treatment-naïve, early RA trial (VEDERA: ‘Very early Etanercept and Methotrexate versus Methotrexate with/without Delayed Etanercept in RA’), we previously reported the presence of ultrasound power Doppler synovitis (PDUS) at diagnosis that improved in the majority with treatment. For this study, we aimed to investigate specifically for an association of baseline PDUS and PD tenosynovitis (PDTS) with subsequent clinical remission (DAS28ESR ≤ 2.6) in VEDERA, also comparing the two treatment groups.

Methods
The ‘VEDERA’ trial randomised 120 treatment-naïve, new-onset RA patients to either first-line etanercept+methotrexate (ETN+MTX) or methotrexate treat-to-target (MTX-TT) regime with escalation to ETN+MTX if not in DAS28ESR remission at week 24. Clinically symptomatic and dominant hand (MCP 1-5, wrist, flexor tendons 1-5 and extensor carpii ulnaris tendon) ultrasound assessments were completed at baseline, weeks 12, 24 and 48. PDUS and PDTS were assessed semi-quantitatively and converted to dichotomous (absent = total score 0, present = total score ≥ 1) for this logistic regression analysis.

Results
At baseline, 68% (81/120) demonstrated PDUS and 68% also demonstrated PDTS overall. In the MTX-TT group, 63% (38/60) had PDUS and 62% (37/60) had PDTS at baseline. In ETN+MTX group, 72% (43/60) had PDUS and 75% (45/60) had PDTS at baseline. As per randomised trial, there were no differences in baseline demographics, DAS28ESR and HAQ between the groups.
Overall, baseline PDUS was associated with week 24 remission and baseline PDTS was associated with week 24 and 48 remission (table 1).
Baseline PDUS was particularly associated with week 24 remission in the ETN+MTX group, with a high OR (95% CI) of 6.83(1.2 - 38.91) compared to the MTX-TT group [1.75(0.5 - 6.14)]. Baseline PDTS was also associated with a high OR for week 48 remission in the ETN+MTX group (OR [95% CI] 9.13[1.77 - 47.02]) in contrast to an absence of association in the MTX-TT group.

Conclusion
Baseline PDUS and PDTS are associated with remission in early RA patients treated with TNF-inhibitor treatment. These measures may be useful to stratify patients early for TNF bDMARD to attain the target of clinical remission in RA.

Disclosure
R. Shukla: None. R. Hum: Other; R.H holds an Academic Clinical Fellowship funded by the National Institute for Health Research (NIHR) through the Integrated Academic Training (IAT) Programme. P. Ho: None. R.J. Wakefield: None. P. Emery: None. M.H. Buch: None.
P259 Survey of diagnostic delay in axial spondyloarthritis across two NHS rheumatology services
Authors: Pandhal Jasmin K , Gregory William J , Tahir Hasan , Bamford Sian 
Published: April 2022

Abstract

Background/Aims
Diagnostic delay is an ongoing challenge in axial spondyloarthritis (axSpA), with a recent, comprehensive literature review suggesting an 8.7-year delay between symptom onset and formal diagnosis in the UK. The aim of this study was to ascertain the axSpA delay in diagnosis and explore contributing factors locally within two major NHS trusts.

Methods
A 13-question survey was created to identify the delay in diagnosis and contributing factors across two urban NHS axSpA services, from onset of symptoms to diagnosis and commencement of treatment. Participants were recruited from clinic visits.

Results
A cohort of 88 patients with a diagnosis of axSpA who attended the axSpA service at either Royal Free NHS Foundation Trust or Salford Royal NHS Foundation Trust responded between August and September 2021. See Table 1 for survey results. The average time from onset of symptoms to diagnosis was similar across centres despite the differences in demographics. Across the two sites, prior to diagnosis 89% of patients saw a general practitioner (GP), of which 68% of patients saw a GP one to five times, 16% five to ten times and 13.25% more than ten times. Many patients also saw other healthcare professionals (HCPs) (see Table 1) aside from the GP and rheumatologist prior to diagnosis. 31.9% saw one other HPC, 20.7% two other HPCs, 12.4% three, 2.4% four and 1.19% five other HCPs prior to diagnosis. 87.5% of patients received adequate axSpA education at diagnosis and 76.5% of patients were aware of who to contact in the event of a flare.

Conclusion
These data highlighted that the mean time to diagnosis for both trusts was less than six years, somewhat lower than the 8.7 years national UK average. However, despite being specialist centres, we are a long way away from the NASS gold standard of 1 year time to diagnosis. Contributors to this include lack of awareness about axSpA, its recognition and appropriate onwards referral. There is a need for concerted ways of working, development of patient pathways, and education to reduce this delay and allow the ambitious NASS gold standard of 1 year time to diagnosis to be achieved.

Disclosure
J.K. Pandhal: None. W.J. Gregory: Honoraria; W.G. has received speaker, conference registration and advisory board fees from Abbvie, Pfizer Novartis and UCB. H. Tahir: None. S. Bamford: None.
P267 Engaging with electronic PROMs in axial spondyloarthropathy
Authors: Fish Sarah J , Brazendale Jane , Greenall Carol , MacPhie Elizabeth 
Published: April 2022

Abstract

Background/Aims
Patient reported outcome measures (PROMs) engage and empower patients and are a powerful tool in helping clinicians understand the impact healthcare interventions make to a person’s quality of life. Where PROMs are embedded in clinical practice, trends can be recognised and used in shared decision-making conversations. In August 2020, the British Society for Rheumatology launched its ePROMs platform and recruitment of our axial spondyloarthritis (axSpA) patients to the platform commenced. One year on we were keen to explore patient engagement and determine if patients felt that ePROMs had enhanced their consultation and care.

Methods
The ePROMs platform was discussed with each patient attending the physiotherapy-led axSpA clinic. 222 of 321 axSpA patients consented to register on ePROMs and were sent an immediate BASDAI to complete followed by quarterly BASDAIs. In September 2021, an ePROMs survey was created on SurveyMonkey® and emailed to all axSpA patients registered on the ePROMs platform. The survey gathered: age, employment status, disease duration, clinical pathway, previous use of apps to record BASDAI, ePROM utilisation to record BASDAI, response times to BASDAI completion requests, time taken to complete BASDAI electronically, preference for ePROMs or paper PROMs, experience of clinician discussing ePROM data in consultation, perspective on ePROMs and the perceived influence on consultation and care.

Results
The response rate was 32.4% (n = 72), with 69.4% (n = 50) of respondents having completed a BASDAI ePROM. The below table displays the ePROM questionnaire results. There was a representative distribution of respondents across all age groups, disease duration and treatment options; 88% of patients reported that the BASDAI took less than 5 minutes to complete. Of the patients who had an appointment post-ePROM completion, 91% felt that the health professional discussed their scores, with over one third reporting appointment enhancement and improved care.

Conclusion
The results demonstrate that a good proportion of our axSpA patients have engaged with the ePROMs platform and are completing their BASDAI prior to their appointment. When a BASDAI is completed prior to the clinic appointment, time in clinic can be better utilised to enhance patient discussion, supporting a shared decision-making approach.

Disclosure
S.J. Fish: None. J. Brazendale: None. C. Greenall: None. E. MacPhie: Other; EM is the North West Rheumatology Club secretary and meetings have been sponsored by MSD, UCB, Abbvie and Lilly.
P279 Prevalance of frailty in patients with ankylosing spondylitis: a cross-sectional study
Authors: Öztürk Özgül , Feyzioğu Özlem 
Published: April 2022

Abstract

Background/Aims
Frailty is characterised by increased fatigue and vulnerability, which leads to adverse health outcomes. Although common in older adults, recent studies have reported the increased prevalence of frailty in various rheumatological diseases regardless of age. However, there are very few studies of the prevalence of frailty in people with ankylosing spondylitis (AS). Thus, this study aims to address this gap in the literature by investigating frailty prevalence in a group of AS patients and assessing the disease-specific outcome measures.

Methods
50 AS patients aged between 40 and 65 were included in this monocentric cross-sectional study. The study protocol was approved by the university ethics committee and all participants provided written informed consent. Patients were grouped as pre-frail, frail and robust according to the Kihon Checklist; &lt;4 was accepted as robust, ≥4 pre-frail, and 8≥frail. Grip strength, walking speed, pain during activity and rest were determined. Nutritional status, disease activity, functional level and quality of life were assessed using the Mini Nutritional Assessment (MNA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) respectively. One-way ANOVA was conducted to compare the patients in groups with post-hoc comparisons.

Results
26% of patients were robust, 32% were pre-frail and 42% were frail. Compared to robust individuals, the pre-frail and frail individuals had significantly higher BASFI, BASDAI, ASQoL scores and a higher level of pain severity during rest. Pain during activity and walking speed were not significant between frail and pre-frail individuals.

Conclusion
Our preliminary findings indicate that frailty or pre-frailty is common in working-age AS patients. Being frail resulted in higher disease activity and pain severity, and especially worse self-reported outcome measure scores. Since frailty is a reversible condition, identifying the pre-frailty and frailty status of AS patients may help to prevent further decline in functional level and to design appropriate treatment interventions.

Disclosure
Ö. Öztürk: None. Ö. Feyzioğu: None.
P304 Performance of the Southend GCA Probability Score on the NHS Lanarkshire fast track pathway
Authors: Melville Andrew R , Donaldson Karen , Ciechomska Anna 
Published: April 2022

Abstract

Background/Aims
Fast track GCA pathways (GCA FTP) with use of confirmatory ultrasound are growing in popularity, but the burden of referrals can overwhelm services and represents a barrier to timely assessment. The Southend GCA Probability Score (GCAPS) has shown promise in determining pre-test probability and may have a role in triage, but there is limited data supporting its use in external cohorts. We evaluated the performance of GCAPS in patients assessed on the NHS Lanarkshire GCA FTP.

Methods
Consecutive patients assessed on the GCA FTP between November 2018 and August 2021 were included. All underwent GCAPS assessment as part of routine care. GCAPS risk groups were defined as follows: low risk ≤8, medium risk 9-12, high risk ≥13. GCA diagnoses were supported by USS +/- TAB and confirmed at 6 months. Overall performance of GCAPS in distinguishing GCA / non-GCA final diagnoses was assessed by ROC analysis. Test characteristics for different GCAPS binary cut-offs were also determined.

Results
176 patients were included in total; mean age 69.0 years (SD 9.8), 63.6% female, median GCAPS 10 (IQR 8, 14). 54 patients were diagnosed with GCA, including 0/57 low risk patients, 3/60 medium risk patients (5.0%), and 51/59 high risk patients (86.4%). ROC analysis for total GCAPS in distinguishing GCA/non-GCA gave an AUC of 0.973 (95% CI 0.951 - 0.999). A GCAPS cut-off of ≥ 13 had the highest accuracy for GCA diagnosis (93.8%), with 94.4% sensitivity and 93.4% specificity. A GCAPS cut-off of ≥ 10 captured all cases of GCA (100.0% sensitivity), with 64.8% specificity.

Conclusion
Performance of GCAPS as a risk stratification tool in our cohort was excellent. GCAPS may have additional roles in screening FTP referrals and guiding empirical glucocorticoid therapy. No patients with GCAPS &lt;10 had GCA; this is consistent with previously published data and suggests specialist review and/or USS may not be required in this group. By contrast, most patients with GCAPS ≥13 had GCA, and this group is most likely to benefit from empirical glucocorticoid treatment while awaiting confirmation. Patients with GCAPS between these values should undergo prompt assessment to minimise the risk of missed diagnoses, or overtreatment.

Disclosure
A.R. Melville: Other; Dr Melville is a Medical Research Council and GlaxoSmithKline Experimental Medicine Initiative to Explore New Therapies clinical training fellow, with project funding outside the submitted work. K. Donaldson: Other; Speaker fees from Menarini Pharma UK. A. Ciechomska: Other; Speaker, travel and registration fee sponsorship from Novartis, Abbvie, Chugai Pharma, Colgene, Roche and Lilly.
Cortical and Subcortical Structural Morphometric Profiles in Individuals with Nonaffective and Affective Early Illness Psychosis
Authors: Hua Jessica P Y , Mathalon Daniel H 
Published: April 2022

Abstract
Research has found strong evidence for common and distinct morphometric brain abnormality profiles in nonaffective psychosis (NAff-P) and affective psychosis (Aff-P). Due to chronicity and prolonged medication exposure confounds, it is crucial to examine structural morphometry early in the course of psychosis. Using Human Connectome Project-Early Psychosis data, multivariate profile analyses were implemented to examine regional profiles for cortical thickness, cortical surface area, subcortical volume, and ventricular volume in healthy control (HC; n = 56), early illness NAff-P (n = 83), and Aff-P (n = 30) groups after accounting for normal aging. Associations with symptom severity, functioning, and cognition were also examined. Group regional profiles were significantly nonparallel and differed in level for cortical thickness (P &lt; .001), with NAff-P having widespread cortical thinning relative to HC and Aff-P and some regions showing greater deficits than others. Significant nonparallelism of group regional profiles was also evident for cortical surface area (P &lt; .006), with Aff-P and N-Aff-P differing from HC and from each other (P &lt; .001). For subcortical volume, there was significant profile nonparallelism with NAff-P having an enlarged left pallidum and smaller accumbens and hippocampus (P &lt; .028), and Aff-P having a smaller accumbens and amygdala (P &lt; .006), relative to HC. NAff-P also had larger basal ganglia compared to Aff-P. Furthermore, NAff-P had enlarged ventricles (P &lt; .055) compared to HC and Aff-P. Additionally, greater ventricular volume was associated with increased manic symptoms in NAff-P and Aff-P. Overall, this study found common and distinct regional morphometric profile abnormalities in early illness NAff-P and Aff-P, providing evidence for both shared and disease-specific pathophysiological processes.
Investigating the veracity of a sample of divergent published trial data in spinal pain
Authors: O'Connell Neil E. , Moore R. Andrew , Stewart Gavin , Fisher Emma , Hearn Leslie , Eccleston Christopher , Williams Amanda C de C 
Published: April 2022

Abstract
Evidence-based medicine is replete with studies assessing quality and bias, but few evaluating research integrity or trustworthiness. A recent Cochrane review of psychological interventions for chronic pain identified trials with a shared lead author with highly divergent results. We sought to systematically identify all similar trials from this author to explore their risk of bias, governance procedures, and trustworthiness. We searched OVID MEDLINE, EMBASE, CENTRAL, and PEDro from 2010 to December 22, 2021 for trials. We contacted the authors requesting details of trial registration, ethical approval, protocol, and access to the trial data for verification. We used the Cochrane risk-of-bias tool and the Cochrane Pregnancy and Childbirth group's Trustworthiness Screening Tool to guide systematic exploration of trustworthiness. Ten trials were included: 9 compared cognitive behavioural therapy and physical exercise to usual care, exercise alone, or physiotherapy and 1 compared 2 brief cognitive behavioural therapy programmes. Eight trials reported results divergent from the evidence base. Assessment of risk of bias and participant characteristics identified no substantial concerns. Responses from the lead author did not satisfactorily explain this divergence. Trustworthiness screening identified concerns about research governance, data plausibility at baseline, the results, and apparent data duplication. We discuss the findings within the context of methods for establishing the trustworthiness of research findings generally. Important concerns regarding the trustworthiness of these trials reduce our confidence in them. They should probably not be used to inform the results and conclusions of systematic reviews, in clinical training, policy documents, or any relevant instruction regarding adult chronic pain management.
Repeated Measures of Cognitive and Affective Learning Outcomes in Simulation Debriefing
Authors: Tawfik Andrew A. , Bradford Jacque , Gish-Lieberman Jaclyn , Gatewood Jessica 
Published: April 2022

Introduction.
To better support the development of domain expertise, there has been considerable interest in the instructional strategies that afford opportunities for problem solving. Simulation-based learning includes case-based activities that support learners' transition into practice through experience and reflective debriefing.

Review of the Literature.
Simulation-based learning serves as a means for learners to practice psychomotor, affective, and cognitive skills. Although the literature suggests this is an effective strategy for supporting problem-solving skills, much of the literature is focused on measuring cognitive outcomes within a single case. As such, very few studies have simultaneously investigated (a) how debriefing in simulation-based education supports problem solving and (b) the degree to which cognitive and affective learning outcomes are variable throughout the problem-solving process.

Methodology.
To address this gap, this repeated-measures study examined the role of debriefing strategies in simulation-based learning experiences, which was designed to practice both cognitive and affective skills. In the control condition, participants were given 2 simulation-based laboratory instructional sessions and then assessed on cognitive (problem representation and solution generation) and affective learning (perceived self-efficacy) outcomes. In the comparison condition, participants engaged in debriefing sessions after each of the 2 simulation-based laboratory instructional sessions. For the cognitive outcomes, participants were assessed using the Think-Aloud Standardized Patient Examination instrument, which measured problem representation and solution generation. Acute care confidence survey was used to measure perceived self-efficacy.

Results.
The study found statistically significant gaps in early-stage measures of cognitive problem representation, but no difference was found in solution generation or perceived self-efficacy measures.

Conclusion.
This study reinforces the importance of debriefing in simulation-based education. Specifically, this study suggests that cognitive learning outcomes are variable during the problem-solving process, but affective learning outcomes are more fixed and may need more targeted debriefing.