POS0949 HIGH PREVALENCE OF ABDOMINAL OBESITY IN FEMALES WITH AXIAL SPONDYLOARTHROPATHY

Background:

Worldwide prevalence of obesity has been steadily increasing, despite significant public health campaigns to raise health awareness. In axial spondyloarthropathy (axSpA) obesity has been shown to be associated with higher levels of disease activity and decreased response to treatment. The waist to hip ratio (WtHpR) is a tool to screen for abdominal obesity. Abdominal deposition of adipose tissue is associated with increased risk of cardiovascular disease, type II diabetes and premature death. Abdominal obesity is more commonly found in males, while females are more prone to gluteal-femoral fat deposition. The Ankylosing Spondylitis Registry of Ireland (ASRI) is a source of epidemiological data of axSpA patients in Ireland.

Objectives:

To capture the prevalence of abdominal obesity in a large cohort of axSpA patients and assess for variation in prevalence between sexes.

Methods:

Participants were analysed on the basis of sex and presence of obesity by BMI and WtHpR. Obesity was defined by body mass index (BMI) with a result of >30 categorised as obese as per CDC definitions. Abdominal obesity was assessed by WtHpR and defined as per WHO guidelines. Categorical variables were recorded as frequencies, with a chi2 test for independence used to test for statistical significance. Numerical variables were recorded as means within each group and an independent t-test or Mann Whitney U test was used to test for statistical significance between groups. A p-value of <0.05 was deemed significant. IBM SPSS version 26 was used for statistical analysis of the patient population captured within the ASRI.

Results:

At the time of analysis, physical measurements were available on 692 patients in the ASRI made up of 96.2% (666) Caucasians with 22.3% (154) females and 77.7% (538) males. The average age was 45.9 years with a mean disease duration of 18.8 years (mean scores: BASDAI 4.09, BASFI 3.71, BASMI 3.99, HAQ 0.54, ASQoL 6.72). 80.9% (560) of patients had radiographic sacroiliitis while 49.1% (340) had sacroiliitis on MRI.

Overall 29.5% (215) patients were obese based on BMI results, while 37.5% (274) were centrally obese as per the WtHpR. Analysis on the basis of sex revealed no significant variation in mean BMI (28.1 vs 27.7, p=0.45) or prevalence of obesity as assessed by BMI (29.9% vs 28.6%, p=0.49) between males and females(table 1). As expected analysis of WtHpR revealed higher mean ratios in males compared to females (0.96 vs 0.89, p<0.01), however there was a significantly higher prevalence of abdominal obesity in females (29.9% vs 68.2%, p<0.01).

Table 1.

Assessment of Obesity by Sex

MalesFemalesp valuen77.7% (538)22.3% (154)Weight (kg)84.9872.76<0.01BMI28.0827.690.45Underweight0.9% (5)0.06% (1)0.49Normal Weight29.2% (157)36.4% (56)Overweight39.2% (211)34.4% (53)Obese29.9% (161)28.6% (44)Waist Circumference (cm)97.4390.03<0.01Hip Circumference (cm)102.11101.270.56Waist to Hip Ratio0.9560.8901<0.01Normal Weight23.8% (128)17.5% (27)<0.01Overweight46.3% (249)14.3% (22)Obese29.9% (161)68.2% (105)

Conclusion:

There is a high prevalence of abdominal obesity as assessed by WtHpR in axSpA, this is especially high in females with axSpA. Use of WtHpR should be considered when screening for obesity in this population.

Disclosure of Interests:

Sinead Maguire Grant/research support from: Recipient of the Gilead Inflammation fellowship grant, Phil Gallagher: None declared, Fiona Wilson: None declared, Finbar Barry O’Shea: None declared

POS0964 CHARACTERISTICS AND BURDEN OF DISEASE IN PATIENTS WITH RADIOGRAPHIC VERSUS NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS IN THE ANKYLOSING SPONDYLITIS REGISTRY OF IRELAND COHORT

Background:

Axial spondyloarthritis (axSpA) is an umbrella term for types of inflammatory arthritis that primarily affect the spine and the sacroiliac joints. It is comprised of patients with both radiographic (r-axSpA) and non-radiographic features (nr-axSpA). R-axSpA was historically known as Ankylosing Spondylitis. Previous studies have shown the burden of disease to be largely similar in patients with radiographic versus non-radiographic axial spondyloarthritis in cohorts both in the US and Europe [1]. The Ankylosing Spondylitis Registry of Ireland (ASRI) was formed with the objective to measure the burden of axial spondyloarthritis in the population and identify early predictors of a poor outcome. All patients in the registry are 18 years or older and meet Assessment of Spondyloarthritis International Society (ASAS) criteria for a diagnosis of SpA.

Objectives:

To compare the characteristics and burden of disease in patients with radiographic versus non-radiographic axial spondyloarthritis in the ASRI cohort.

Methods:

Patients with radiographic axial spondyloarthritis (r-axSpA) were defined as those with x-ray evidence of sacroiliitis. Patients with non-radiographic axial spondyloarthritis (nr-axSpA) were defined as having MRI evidence of sacroiliitis but no x-ray evidence of sacroiliitis. A standardised clinical assessment was performed on each patient and structured interviews provided patient-reported data. For each patient the following scores were captured: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Health Assessment Questionnaire (HAQ) assesses the self-reported functional status for performing activities of daily living, and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Categorical variables were summarized as percentages with frequency counts, and continuous variables with a mean and standard deviation. Statistical comparisons between subgroups were evaluated using 2 sample t-tests for continuous variables and chi-square tests for categorical variables.

Results:

764 patients were available for analysis. Analysis of radiographic status showed 88.1% (n=673) of patients with r-axSpA and 11.9% (n=91) with nr-axSpA. Patients with nr-axSpA were younger (41.3 vs. 46.6 years, p<0.01), had shorter disease duration (14.8 vs. 20.2 years, p<0.01), lower proportion of males (66.6% vs. 78.4%, p=0.02) with lower rates of HLA-B27 positivity (73.6% vs. 90.5%, p<0.01). The nr-axSpA group had lower BASDAI (3.37 vs. 4.05, p=0.01), BASFI (2.46 vs. 3.88, p<0.01), BASMI (2.33 vs. 4.34, p<0.01), ASQoL (5.2 vs. 6.67, p=0.02), and HAQ scores (0.38 vs. 0.57, p<0.01). There were no significant differences in the prevalence of extra-articular manifestations.

Conclusion:

This study provides evidence that the burden of disease is less in patients with non-radiographic axial spondyloarthritis than radiographic axial spondyloarthritis, as demonstrated by better BASDAI, BASFI, BASMI, HAQ and ASQoL scores.

References:

[1]López-Medina C, et al. Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: a comparison by systematic literature review and meta-analysis. RMD Open, 2019. 5(2) p1108.

Table 1.r-axSpAnr-axSpAp valuen67391Age (years)46.6 (+/-12.4)41.3 (+/-12.4)<0.01Disease duration (years)20.2 (+/-12.4)14.8 (+/-11.7)<0.01Delay to diagnosis (years)8.41 (+/-8.6)6.34 (+/-7.2)0.03Males78.8% (528)65.9% (60)0.02Females21.5% (145)34.1% (31)0.02HLA-B27+90.50%(440 of 486 available results)73.60%(53 of 72 available results)<0.01BASDAI4.05 (+/-2.39)3.37 (+/-2.31)0.01BASFI3.88 (+/-3.00)2.46 (+/-2.39)<0.01BASMI4.34 (+/-2.08)2.33 (+/-1.42)<0.01ASQoL6.67 (+/-5.55)5.2 (+/-5.53)0.02HAQ0.57 (+/-0.54)0.38 (+/-0.44)<0.01Psoriasis17.8% (120)15.4% (14)0.31IBD11% (74)8.8% (8)0.58Uveitis33.9% (228)34.1% (31)0.54

Disclosure of Interests:

Sean Quinn: None declared, Sinead Maguire: None declared, Finbar Barry O’Shea: None declared, Lorraine O’Neill: None declared, Eamonn Molloy: None declared, Ursula Fearon Speakers bureau: Abbvie, Grant/research support from: Janssen, Abbvie, Pfizer, UCB, Phil Gallagher: None declared, Douglas Veale Speakers bureau: AbbVie, BMS, Celgene, Pfizer, MSD, Roche, Consultant of: AbbVie, Actelion, BMS, Novartis, Pfizer, MSD, Roche, Regeneron/Sanofi, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Roche, Janssen.

Fatal acute hepatic failure secondary to thrombotic portal venopathy after commencing abemaciclib and fulvestrant treatment for advanced breast carcinoma: a unique autopsy finding

We present an autopsy case of hepatic thrombotic portal venopathy resulting in decompensated liver failure and death which occurred rapidly after commencing abemaciclib and fulvestrant chemotherapy for advanced invasive lobular carcinoma of the breast. The diagnosis was confirmed histologically. This is the first reported case of such a finding. We suggest that further cases displaying this previously unpublished pattern are collated in order that we may begin to investigate the underlying etiological mediators.

Awareness in severe Alzheimer's disease: a systematic review

Objective: There is limited understanding about how people in the severe stages of Alzheimer's disease (AD) experience and demonstrate awareness. We synthesised all available evidence with the aim of understanding how awareness is preserved or impaired in severe AD and what evidence there is for different levels of awareness according to the levels of awareness framework.Method: A systematic search of the following databases: Embase, PsycINFO, MEDLINE and Web of Science was carried out. A narrative synthesis and analysis was conducted of all included studies. All studies were assessed for quality using the AXIS and CASP tools.Results: Our findings suggest that lower level sensory awareness is relatively maintained in severe AD. Findings for higher level awareness are variable and this may be related to the diversity of methods that have been used to explore awareness in these circumstances.Conclusion: Awareness is complex, heterogeneous and varies significantly between individuals. Environmental and contextual factors have a significant impact on whether awareness is observed in people with severe AD. Adaptation of the environment has the potential to facilitate the expression of awareness while education of caregivers may increase understanding of people with severe AD and potentially improve the quality of care that is received.

Use of three-dimensional printing for simulation in ultrasound education: a scoping review

Background

There is a significant learning curve when teaching ultrasonography to medical trainees; task trainers can help learners to bridge this gap and develop their skills. Three-dimensional printing technology has the potential to be a great tool in the development of such simulators.

Objective

This scoping review aimed to identify what 3D-printed models have been used in ultrasound education to date, how they were created and the pros and limitations involved.

Design

Researchers searched three online databases to identify 3D-printed ultrasound models used in medical education.

Results

Twelve suitable publications were identified for inclusion in this review. The models from included articles simulated largely low frequency and/or high stakes events, with many models simulating needle guidance procedures. Most models were created by using patient imaging data and a computer-aided design software to print structures directly or print casting molds. The benefits of 3D-printed educational trainers are their low cost, reproducibility, patient specificity and accuracy. The current limitations of this technology are upfront investments and a lack of optimisation of materials.

Conclusions

The use of 3D-printed ultrasound task trainers is in its infancy, and more research is needed to determine whether or not this technology will benefit medical learners in the future.

SAT0382 THE SAME BUT DIFFERENT? ANALYSIS OF A COHORT OF PATIENTS WITH LATE ONSET ANKYLOSING SPONDYLITIS

Background:

Ankylosing spondylitis(AS) has long been described as presenting in the third decade of life with the onset rarely occurring over the age of 45 years old. Previous research has shown there are small numbers of patients being diagnosed with AS later in life. These studies have been limited to small numbers limiting the ability to detect patterns in disease. The Ankylosing Spondylitis Registry of Ireland (ASRI) is an epidemiological data source on patients with AS in Ireland. Large registries, such as this, are an opportunity to further study this subtype in large numbers with greater power to detect differences between late and typical onset.

Objectives:

The purpose of this study was to examine late onset AS in a large, well characterized cohort.

Methods:

Patient registered in ASRI were analysed on the basis of their age of symptom onset using IBM SPSS version 26. Patients were divided into two groups with an age over 45 years old at symptoms onset categorized at late onset. Mean BASMI, BASFI, BASDAI, HAQ, and ASQoL scores were compared between the two groups and tested for statistical significance using an independent two tailed t-test. Further analysis looking at differences in gender, HLA B27 status, sacroiliitis on MRI, medication use and extra-articular manifestations(EAMs) was also performed using a chi-squared test for independence.

Results:

A total of 851 patients with AS were included in the analysis. Of these patients 659(77.4%) were males, with 192(22.6%) females, mean age of 45.8 years and mean disease duration of 19.4 years (means: ASQoL 6.52, HAQ 0.54, BASDAI 4.03, BASFI 3.7, BASMI 4.03). Patient population was made up of 797 patients(93.7%) categorized as typical onset, 54 patients(6.3%) categorized as late onset(table 1). Males had a higher rate of late onset AS than females, but this did not reach significance (6.8% vs 4.7%, p=0.19). Patients with late onset AS were noted to have higher BASFI (5.53 vs 3.58, p<0.01), HAQ (0.75 vs 0.53, p<0.01) and ASQoL scores (7.68 vs 6.44, p<0.01). Late onset patients also had lower rates of HLA-B27 positivity (76.5% vs 91.2%, p<0.01). No significant difference was detected in BASDAI or BASMI scores. No difference was detected between groups regarding rates EAMs. The late onset AS patients were noted to have lower rates of biologic therapy use (50% vs 72%, p<0.01). No significant difference was detected in rates of NSAID use.

Table 1.Onset < 45 years (n=797)Late Onset (n=54)pvalueMales (n=659)93.2% (614)6.8% (83.3)0.19Females (n=192)23% (183)16.6% (9)HLA B27+ (n=580)90.5% (554)76.5% (26)<0.01Enthesitis (n=146)16.9% (135)20.4% (11)0.45Dactylitis (n=54)6% (48)11.1% (6)0.21Arthritis (n=256)29.7% (237)35.2% (19)0.4MRI Sacroiliitis (n=384)45.3% (361)42.6% (23)0.69Bilateral sacroiliits (n=668)79% (628)74% (40)0.07BASDAI4.024.190.6BASFI3.585.53<0.01BASMI3.964.970.12HAQ0.530.75<0.01ASQoL6.447.68<0.01Uveitis28.5% (227)24.1% (13)0.07IBD9.9% (79)14.8% (8)0.32Psoriasis16.4% (131)18.5% (10)0.54Smokers (ever)57.3% (457)64.8% (35)0.01Alcohol consumption (ever)82% (654)75.9% (41)0.53Biologic tx69.1% (551)48.1% (26)<0.01NSAID tx54.2% (432)61.1% (33)0.2Figure 1.

Conclusion:

This analysis shows that late onset AS does occur in up to 6.3% of patients with AS. Patients with late onset disease were noted to have similar patterns of disease, EAMs and radiological findings consistent with current classification criteria for AS. Less patients with late onset disease were HLA-B27 positive, the reason for this is unknow. These patients had worse functional outcomes, which could reflect the older age of symptom onset. It is notable that patients with late onset AS are being treated with less biologic agents, and have a slightly higher rate of NSAID usage. Additional registry studies into this subgroup would help to understand these variations in medication usage and prescribing practices.

Disclosure of Interests:

Sinead Maguire Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB, Phil Gallagher: None declared, Finbar Barry O’Shea Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB

SAT0381 UNDERSTANDING JOINT REPLACEMENT SURGERY IN AXIAL SPONDYLOARTHROPATHY

Background:

Axial spondyloarthropathy(axSpA) is a form of inflammatory arthritis that primarily affects the axial skeleton and sacroiliac joint, but can be associated with a peripheral arthritis. Rapid advances in the field of axSpA has led to faster detection, diagnosis and treatment of this disease. This improved management has led to improved level of function and quality of life for patients, despite this a proportion of patients are still requiring joint replacement surgery. The Ankylosing Spondylitis Registry of Ireland (ASRI) is a source of epidemiological data on patients with axSpA in Ireland. Given the large size of the ASRI to date, this is a prime opportunity to analyze patients with axSpA requiring joint replacement surgery.

Objectives:

Detailed analysis of a large cohort of patients with axSpA with a focus on those who underwent joint replacement to determine trends in disease and baseline demographics.

Methods:

The patient population registered in the ASRI was analysed using IBM SPSS version 26. Analysis was performed by comparing patients who underwent joint replacement surgery to the rest of the ASRI cohort. Mean age, disease duration, delay to diagnosis and scores of disease activity (BASDAI, BASFI, HAQ, ASQoL and BASMI) were compared between these two groups. Differences between the groups was tested for significance using an independent two tailed t-test. Further analysis on gender, HLA-B27 status, co-morbidities and medication exposure was done using a chi-squared test for independence. A p value of less than 0.05 was deemed significant.

Results:

At present 860 patients are currently enrolled in the ASRI with 76.6% (659) males and 23.4% (201) females. Average age of patients is 45.8 years, mean disease duration of 19.4 years with 95.5% (821) of patients listed as Caucasian. Mean scores were BASDAI 4.02, BASFI 3.7, BASMI4.02, HAQ 0.55, and ASQoL of 6.51. In total 33 (3.8%) of patients underwent joint replacement surgery. These patients were noted to be significantly older than the rest of the rest of the cohort (55.3 years old vs 45.1, p<0.01), with a longer disease duration (31.6 years vs 18.3, p<0.01) and higher rates of HLA-B27 positivity (94.7% vs 80.2%, p<0.01). No significant differences were noted between gender(table 1). No significant difference was found between medication exposure rates, although the joint replacement population did have higher rates of NSAID, sDMARD and biologic therapy usage than the rest of the population although this did not reach significance. These patients also scored worse in all measures of disease activity, although this only reached significance in the BASFI (5.67 vs 3.64, p<0.01), HAQ (0.9 vs 0.54, p<0.01) and the BASMI (6.07 vs 3.94, p<0.01).

Table 1.Joint replacement (n=33)No Joint Replacement (n=827)p valueAge55.345.1<0.01Disease duration31.618.31<0.01Delay to dx6.977.970.51HLA-B27+94.7% (18)71.9% (491)<0.01Males78.8% (26)64.7% (535)0.76Females21.2% (7)19.3% (160)0.76Mean ScoresBASDAI4.914.060.06BASFI5.673.64<0.01HAQ0.90.54<0.01ASQoL7.426.670.45BASMI6.073.94<0.01MedicationsNSAIDs51.5% (17)47% (389)0.21Bio tx72.7% (24)57.2% (473)0.9DMARDs33.3% (11)15.7% (130)0.1

Conclusion:

Patients requiring joint replacement surgery, although few in number, represent a cohort with significantly impaired function and quality of life. This is likely due to the fact that these patients were older with more established disease. It is therefore not surprising that this cohort had significantly worse spinal mobility. As registries continues to develop, it will be interesting to see if rates of joint replacement surgery will decline with increased use of biologic therapy at an earlier stage of disease. This will help to differentiate patients requiring joint replacement surgery due to underlying inflammatory arthritis and those with osteoarthritis.

Disclosure of Interests:

Sinead Maguire Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB, Phil Gallagher: None declared, Finbar Barry O’Shea Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB

AB0704 PRESCRIBING PRACTICES IN AXIAL SPONDYLOARTHROPATHY

Background:

Axial spondyloarthropathy(axSpA) treatment has undergone a number of significant developments over the past number of decades. Previously limited to non-steroidal anti-inflammatories (NSAIDs) and corticosteroids, treatment options now include synthetic disease modifying anti-rheumatic drugs(sDMARDs) and biologic agents. The development of national registries for inflammatory arthritis provides an opportunity to study medication usage in a large cohort of patients with axSpA. The Ankylosing Spondylitis Registry of Ireland (ASRI) is a source of epidemiological data on patients with axSpA in Ireland. The aim of this study was to examine medication exposure and outcomes.

Objectives:

To characterize a large cohort of patients with axSpA in terms of medications usage, burden of disease and patient reported outcomes.

Methods:

The patient population registered in the ASRI was analysed using IBM SPSS version 26. Patients were analyzed on the basis of medication exposure. The four treatment groups were classified as no treatment, NSAIDs only, biologics only, or biologics and NSAIDs. Mean age, duration of disease and delay to diagnosis was compared between groups. Burden of disease was assessed via mean BASDAI, BASFI, BASMI, HAQ and ASQoL between the four groups. Differences between groups was tested for statistical significance a one-way analysis of variance (ANOVA). A chi-squared test for independence was used to compare differences in rates of HLA-B27 positivity rates and gender. Results were deemed significant where p < 0.05.

Results:

At present 860 patients are currently enrolled in the ASRI with 76.6% (659) males and 23.4% (201) females. Average age of patients is 45.8 years, mean disease duration of 19.4 years with 95.5% (821) of patients listed as Caucasian. Mean scores were BASDAI 4.02, BASFI 3.7, BASMI 4.02, HAQ 0.55, and ASQoL of 6.51. Treatment groups were made up of 9.9%(85) on no treatment, 22.2%(191) NSAIDs treatment only, 34.8%(299) biologics treatment only and 32.1%(276) treated with both NSAIDs and biologics. Patients only on NSAIDs were noted to be older than patients on biologics, and those on both biologics and NSAIDs (p=0.02). Patients on NSAIDs were older at symptom onset than those on both biologic and NSAID treatment (p=0.02), however the effect size is small(0.012). No significant difference was noted between groups regarding disease duration, delay to diagnosis or distribution between genders (table 1). Difference in BASDAI scores between groups was significant between all groups, with patients on both biologics and NSAIDs having the highest scores and those on no treatment with the lowest scores(4.74 vs 3.37) possibly a reflection of disease severity(table 2).

Table 1.ASRINo txNSAIDs txBiologic txBiologic & NSAIDsp valueNumber8609.9% (85)22.2% (191)37.8% (299)32.1% (276)Age45.849.746.245.345.10.02Symptom onset26.427.528.226.125.20.02Disease duration19.422.21819.119.80.06Delay to dx89.88.17.480.13Table 2.ASRINo txNSAIDs txBiologic txBiologic & NSAIDsp valueEffect SizeBASDAI4.023.374.213.44.740.063.374.210.043.374.74<0.014.213.4<0.013.44.74<0.01

Conclusion:

A large proportion of patients in the ASRI were treated with either biologics only or both biologics and NSAIDs. No treatment was the least common treatment within this cohort. Patients not on treatment tended to be older than those on any type of treatment. Overall patients on biologics alone tended to have better patient reported outcomes as compared to all other treatment groups. The development of longitudinal data for the ASRI will help to further understand the reason behind these differences.

Disclosure of Interests:

Sinead Maguire Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB, Phil Gallagher: None declared, Finbar Barry O’Shea Grant/research support from: ASRI is supported by funding from Pfizer, AbbVie and UCB

Barriers and facilitators to discussing HPV with head and neck cancer patients: A qualitative study using the theoretical domains framework

OBJECTIVE

The incidence of human papillomavirus-associated head and neck cancers (HPV-HNC) is increasing worldwide. Research in other clinical contexts has shown that healthcare professionals (HCPs) can find discussing HPV with patients challenging. However, limited research has been conducted in HNC. This study aimed to investigate barriers and facilitators to, discussing HPV among HCPs caring for patients with HNC in Ireland.

METHODS

Semi-structured telephone/face-to-face interviews were conducted with HCPs. Barriers and facilitators to discussing HPV with patients were identified using the Theoretical Domains Framework (TDF).

RESULTS

20 HCPs (8 clinicians, 3 nurses, 9 allied healthcare professionals) were interviewed. Barriers to discussing HPV included professionals' lack of HPV knowledge, difficulties in talking about sexual issues with patients and lack of privacy to discuss HPV in busy clinic settings. Facilitators included increasing public and patient awareness of the link between HPV and HNC and professional education and skills development.

CONCLUSIONS

This is the first theoretically informed study to identify barriers and facilitators to discussing HPV with HNC patients. HCPs consider HPV discussions to be an essential part of HNC patient care.

PRACTICE IMPLICATIONS

Understanding the issues associated with patient-provider HPV communication will help develop effective interventions to support HCPs in their HPV discussions.

Parent and adolescent communication with healthcare professionals about Type 1 diabetes management at adolescents' outpatient clinic appointments

AIM

This study aimed to identify the ways in which adolescents living with Type 1 diabetes and their parents communicate about Type 1 diabetes management with healthcare professionals in a clinical setting.

METHODS

Twenty-nine adolescents (aged 11-17 years) and their parents were purposively recruited from two outpatient clinics for non-participant observations. Outpatient clinic appointments, which consisted of multiple consultations with healthcare professionals, were observed and audio-recorded. Outpatient clinic appointments were categorized based on the nature and extent of communication by the adolescent and their parent(s) in relation to Type 1 diabetes management activities.

RESULTS

Data from 29 outpatient clinic appointments, consisting of a total of 68 observed consultations, were analysed and a continuum consisting of three patterns of communication was identified (parent-led, collaborative and adolescent-led). Healthcare professionals should attend to the nature and extent of communication by adolescents and their parents in relation to Type 1 diabetes management activities because parent and adolescent engagement in communication during clinic appointments may also reflect their degree of involvement in daily Type 1 diabetes management.

CONCLUSIONS

This continuum provides a framework for healthcare professionals to use to identify communication patterns in consultations which in turn may allow healthcare professionals to encourage more effective communication about Type 1 diabetes management from adolescents and their parents in clinic consultations. This may have a positive impact on the sharing of Type 1 diabetes management responsibilities and adolescents' developing self-management skills as roles change during this developmental period.

A four-year naturalistic prospective study of cardiometabolic disease in antipsychotic-treated patients

The relationship between antipsychotic use and cardiovascular morbidity and mortality is controversial. There is a lack of long-term prospective studies investigating changes in cardiometabolic risk in patients treated with antipsychotic drugs. We report data from a 4-year prospective study. Patients (89) underwent detailed metabolic and cardiovascular risk assessment at 4-years which included anthropometric assessment, blood pressure, lipid profile, and an oral glucose tolerance test. We used the homeostatic model assessment to determine insulin resistance, and calculated 10-year cardiovascular risk scores. Mean age of subjects was 44.7 (±11.5) years, and 52% were male. The prevalence of type 2 diabetes was 8%, and 38.4% fulfilled diagnostic criteria for the metabolic syndrome. With the exception of increased central adiposity over the 4-year follow-up period (p < 0.001), other cardiometabolic parameters were generally unchanged. There was a high prevalence of dyslipidaemia, but only 16.9% were prescribed lipid-lowering treatment. Commencing lipid-lowering therapy was associated with a reduction in cardiovascular risk score (OR 7.9, 95% CI = 1.3 to 48.7; p = 0.02). Patients established on longer-term antipsychotic treatment show less dramatic metabolic changes than those occurring in the early stages of treatment, but have a high burden of cardiovascular risk. Lipid-lowering therapy is associated with a significant reduction in cardiovascular risk.

Communicating about HPV in the context of head and neck cancer: A systematic review of quantitative studies

OBJECTIVE

Rising incidence of HPV-positive head and neck cancers (HPV-HNC) means HPV infection is increasingly relevant to patient-provider consultations. We performed a systematic review to examine, in the context of patient-provider HNC consultations: discussions about HPV, attitudes towards discussing HPV and information needs.

METHODS

We searched Embase, PsychINFO, and CINAHL + for studies to August 2018. Eligible studies included: HNC healthcare professionals (HCPs) and/or HNC patients investigated HNC patient-provider communication about HPV.

RESULTS

Ten studies were identified: six including HCPs and four including HNC patients. HCPs varied in confidence in HPV discussions, which was related to their HPV knowledge. Both HCPs and patients acknowledged the need for reliable HPV information. Factors which facilitated HPV discussions included accessible HPV information for patients and HCPs and good HPV knowledge among HCPs. Barriers included the perception, among HCPs, that HPV was a challenging topic to discuss with patients.

CONCLUSIONS

Information deficits, communication challenges and barriers to discussing HPV were identified in HNC patient-provider consultations.

PRACTICE IMPLICATIONS

Appropriate HPV information is needed for HCPs and patients. Professional development initiatives which increase HCPs' HPV knowledge and build their communication skills would be valuable.

The association between sleep and cognitive abnormalities in bipolar disorder

BACKGROUND

Bipolar disorder (BD) is associated with attentional and processing abnormalities. Such abnormalities are also seen in healthy subjects with sleep disruption. We hypothesised cognitive abnormalities in BD patients would be worse in those with objectively verified sleep abnormalities.

METHODS

Forty-six BD patients and 42 controls had comprehensive sleep/circadian rhythm assessment over 21 days alongside mood questionnaires. Cognitive function was assessed with a range of tasks including Psychomotor Vigilance Test (PVT), Attention Network Task (ANT) and Digit Symbol Substitution Test (DSST). BD participants with normal and abnormal sleep were compared with age- and sex-matched controls.

RESULTS

BD patients had longer response times and made more lapses (responses >500 ms) than controls on the PVT (both p < 0.001). However, patients with normal sleep patterns did not differ from controls while those with sleep abnormalities did (p < 0.001). An identical pattern of effects were seen with the ANT response times, with the abnormality in bipolar abnormal sleepers related to the executive attentional network. Similarly, patients made fewer correct responses on the DSST compared with the controls (p < 0.001). Bipolar normal sleepers did not differ while those with abnormal sleep did (p < 0.001). All these differences were seen in bipolar abnormal sleepers who were euthymic (p < 0.01) and across the main abnormal sleep phenotypes.

CONCLUSIONS

We confirm impairment in attention and processing speed in BD. Rather than sleep abnormalities exacerbating such dysfunction, the impairments were confined to bipolar abnormal sleepers, consistent with sleep disturbance being the main driver of cognitive dysfunction.

Evaluation of long-term intravitreal anti-vascular endothelial growth factor injections on renal function in patients with and without diabetic kidney disease

Background

Administering anti-vascular endothelial growth factor (anti-VEGF) by intraocular injection has been shown to have a safe systemic profile. Nevertheless, incidents of acute kidney injury following anti-VEGF injection have been reported. We assessed the long-term effect of multiple intravitreal anti-VEGF injections on measures of renal function in patients with diabetes including rate of change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR).

Methods

A retrospective review of patients receiving diabetic macular oedema (DMO) treatment was undertaken. Serum creatinine, ACR, number of intravitreal anti-VEGF injections and clinical characteristics were collected from electronic healthcare records (EHR). A co-efficient of eGFR and ACR change with time was calculated over a mean duration of 2.6 years. Regression modelling was used to assess variation in the number of anti-VEGF injections and change in eGFR and ACR.

Results

The EHR of 85 patients with DMO (59% male, 78% type 2 diabetes mellitus [T2DM]) were reviewed. On average, 26.8 intravitreal anti-VEGF injections were given per patient over a mean duration of 31 months. No association between increasing number of anti-VEGF injections and rate of eGFR decline (beta = 0.04, 95% confidence intervals [CI]: − 0.02, 0.09; p = 0.22) or ACR change over time (beta = 0.02, CI: − 0.19, 0.23; p = 0.86) was detected, following adjustment for hypertension, cerebrovascular disease, T2DM, and medications taken.

Conclusion

Our data suggests regular long-term intravitreal VEGF inhibition does not significantly alter the rate of change in eGFR and/or ACR with increasing number of treatment injections.

Minority stress, intra-minority stress and social anxiety: Examining an extended psychological mediation framework among sexual minority men

Background

Compared to their heterosexual counterparts, sexual minority men (SMM) are at an increased risk of social anxiety disorder. Distal (i.e., everyday discrimination) and proximal (i.e., internalised homophobia, rejection sensitivity, concealment of sexual orientation) minority stress processes are associated with heightened social anxiety for SMM. Stressors emerging from within the sexual minority male community, termed intra-minority stress, and psychological processes that may foster resilience (i.e., a sense of coherence, connectedness to the LGBT community) are less explored in this area. This study examined potential pathways between everyday discrimination, intra-minority stress, proximal minority stressors, resilience and social anxiety.

Methods

Self-identified SMM (N = 255) residing in the Republic of Ireland completed an online survey containing measures of minority stress, intra-minority stress, resilience and social anxiety. Structural equation modelling was used to examine the model.

Results

The model yielded a good fit to the data, X2(16) = 26.61, CFI = .99, TLI = .97, RMSEA = .05, and SRMR = .03. Rejection sensitivity and a sense of coherence had a significant indirect effect in the relationships between both exogenous variables (i.e., discrimination and intra-minority stress) and social anxiety. There were no significant pathways to social anxiety involving concealment of sexual orientation, internalised homophobia or LGBT community connectedness.

Conclusions

For SMM, minority stress processes and intra-minority stress are important determinants of social anxiety. Our findings demonstrate that proximal minority stressors may operate differently in a social anxiety context for SMM in western European countries. A sense of coherence was an integral factor in the model and demonstrated the strongest association with social anxiety.

Signatures of tunable superconductivity in a trilayer graphene moiré superlattice

Understanding the mechanism of high-transition-temperature (high-T_c) superconductivity is a central problem in condensed matter physics. It is often speculated that high-T_c superconductivity arises in a doped Mott insulator¹ as described by the Hubbard model^2-4. An exact solution of the Hubbard model, however, is extremely challenging owing to the strong electron-electron correlation in Mott insulators. Therefore, it is highly desirable to study a tunable Hubbard system, in which systematic investigations of the unconventional superconductivity and its evolution with the Hubbard parameters can deepen our understanding of the Hubbard model. Here we report signatures of tunable superconductivity in an ABC-trilayer graphene (TLG) and hexagonal boron nitride (hBN) moiré superlattice. Unlike in 'magic angle' twisted bilayer graphene, theoretical calculations show that under a vertical displacement field, the ABC-TLG/hBN heterostructure features an isolated flat valence miniband associated with a Hubbard model on a triangular superlattice^5,6 where the bandwidth can be tuned continuously with the vertical displacement field. Upon applying such a displacement field we find experimentally that the ABC-TLG/hBN superlattice displays Mott insulating states below 20 kelvin at one-quarter and one-half fillings of the states, corresponding to one and two holes per unit cell, respectively. Upon further cooling, signatures of superconductivity ('domes') emerge below 1 kelvin for the electron- and hole-doped sides of the one-quarter-filling Mott state. The electronic behaviour in the ABC-TLG/hBN superlattice is expected to depend sensitively on the interplay between the electron-electron interaction and the miniband bandwidth. By varying the vertical displacement field, we demonstrate transitions from the candidate superconductor to Mott insulator and metallic phases. Our study shows that ABC-TLG/hBN heterostructures offer attractive model systems in which to explore rich correlated behaviour emerging in the tunable triangular Hubbard model.

Target Audience and Preferences Related to an Australian Coronary Heart Disease Specific Mobile App: A Mixed Methods Study

BACKGROUND

Widespread availability of mobile technologies offers the opportunity to support secondary prevention of coronary heart disease (CHD) via mobile apps, however, the target audience and their app preferences are unknown. This study aims to identify the potential audience for an Australian CHD specific app and their recommendations and preferences.

METHODS

A two-phase mixed methods study: Phase 1: CHD patients (n=282) were surveyed on mobile app engagement. Phase 2: Four focus groups with regular app users (n=12) identified preferences and recommendations generated after using a CHD-specific publicly available app (MyHeartMyLife) for 2 weeks. Data were thematically analysed.

RESULTS

Survey participants were aged ≥56 years (238/282, 84.4%) and male (204/282, 72.3%). More than one third (108/282, 38.3%) were regular app users, of whom 83/108, (76.9%) used health apps. Regular app users were more likely to be <56 years (versus ≥70 years; OR 4.70, 95% CI 1.92, 11.51), employed (OR 3.07, 95% CI 1.63, 5.77) and had completed high school education (OR 2.37, 95% CI 1.30, 4.34). Focus group participants using the CHD-specific app were aged 41-79 years (mean 62.2 SD 5.3 years) and 10/12 were male. Coronary heart disease specific app preferences generated included: immediate access to relevant and practical health information and records; behaviour change motivation; more experienced app users located and used app features readily and provided support for less experienced users. In addition, ensuring ease of reading and interpreting data, adding physical activity tracking, the ability to integrate and synchronise with other apps and devices, and capacity to store additional personal medical records were also recommended.

CONCLUSIONS

The target audience for CHD-specific apps is aged <56 years, employed, has completed high school and is an experienced app user. User preferences and recommendations identified features present in publicly available apps, but many features need development.

Quantum-critical conductivity of the Dirac fluid in graphene

Graphene near charge neutrality is expected to behave like a quantum-critical, relativistic plasma-the "Dirac fluid"-in which massless electrons and holes collide at a rapid rate. We used on-chip terahertz spectroscopy to measure the frequency-dependent optical conductivity of clean, micrometer-scale graphene at electron temperatures between 77 and 300 kelvin. At charge neutrality, we observed the quantum-critical scattering rate characteristic of the Dirac fluid. At higher doping, we detected two distinct current-carrying modes with zero and nonzero total momenta, a manifestation of relativistic hydrodynamics. Our work reveals the quantum criticality and unusual dynamic excitations near charge neutrality in graphene.

Telehealth interventions for the secondary prevention of coronary heart disease: A systematic review and meta-analysis

BACKGROUND

Coronary heart disease (CHD) is a major cause of death worldwide. Cardiac rehabilitation, an evidence-based CHD secondary prevention programme, remains underutilized. Telehealth may offer an innovative solution to overcome barriers to cardiac rehabilitation attendance. We aimed to determine whether contemporary telehealth interventions can provide effective secondary prevention as an alternative or adjunct care compared with cardiac rehabilitation and/or usual care for patients with CHD.

METHODS

Relevant randomized controlled trials evaluating telehealth interventions in CHD patients with at least three months' follow-up compared with cardiac rehabilitation and/or usual care were identified by searching electronic databases. We checked reference lists, relevant conference lists, grey literature and keyword searching of the Internet. Main outcomes included all-cause mortality, rehospitalization/cardiac events and modifiable risk factors. (PROSPERO registration number 77507.).

RESULTS

In total, 32 papers reporting 30 unique trials were identified. Telehealth was not significant associated with a lower all-cause mortality than cardiac rehabilitation and/or usual care (risk ratio (RR)=0.60, 95% confidence interval (CI)=0.86 to 1.24, p=0.42). Telehealth was significantly associated with lower rehospitalization or cardiac events (RR=0.56, 95% CI=0.39 to 0.81, p<0.0001) compared with non-intervention groups. There was a significantly lower weighted mean difference (WMD) at medium to long-term follow-up than comparison groups for total cholesterol (WMD= -0.26 mmol/l, 95% CI= -0.4 to -0.11, p <0.001), low-density lipoprotein (WMD= -0.28, 95% CI = -0.50 to -0.05, p=0.02) and smoking status (RR=0.77, 95% CI =0.59 to 0.99, p=0.04].

CONCLUSIONS

Telehealth interventions with a range of delivery modes could be offered to patients who cannot attend cardiac rehabilitation, or as an adjunct to cardiac rehabilitation for effective secondary prevention.