Demographic and clinical correlates of suicidal ideation in individuals with at-risk mental state (ARMS): A study from Pakistan

BACKGROUND

Suicide is a major public health concern and one of the leading causes of mortality worldwide. People with an at-risk-mental-state (ARMS) for psychosis are more vulnerable to psychiatric co-morbidity and suicide, however, there are limited data from low-middle-income countries. The present study aimed to identify the prevalence of depressive symptoms and suicidal ideation along with sociodemographic and clinical correlates of suicidal ideation in individuals with ARMS from Pakistan.

METHOD

Participants between the age of 16 and 35 years who met the criteria for ARMS based on the Comprehensive Assessment of At-Risk Mental State (CAARMS), were recruited from the community, general practitioner clinics and psychiatric units across Pakistan (n = 326). Montgomery and Asberg Depression Rating Scale (MADRS) and Social-Occupational-Functional-Assessment-Scale (SOFAS) were administered to participants.

RESULTS

The prevalence of depressive symptoms and suicidal thoughts in the sample at baseline were 91.1% (n = 297) and 61.0% (n = 199), respectively. There were significant mean differences between groups (mean difference [95% CI]; p-value) without suicidal ideation and with suicidal ideation on measures of MADRS (-5.47 [-7.14, -3.81]; p < .001), CAARMS non-bizarre ideas (-0.29 [-0.47, -0.11]; p = .002) and perceptual abnormalities (-0.23 [-0.41, -0.04]; p = .015).

CONCLUSION

These findings indicate that suicidal ideation and depressive symptoms are highly prevalent in individuals with ARMS in Pakistan. Given the pivotal developmental stages that ARMS presents, and the poor outcomes associated with co-morbid depression, there is an urgent need to prioritize the development of low-cost and scalable evidence-based interventions to address psychiatric comorbidity and suicidality in the ARMS population in Pakistan.

Four-dimensional ultrasound guided embryo transfers improve live birth rates when compared to the clinical touch technique: a randomised controlled trial

Most aspects of in-vitro fertilisation (IVF) have changed dramatically since introduction, but embryo transfer (ET) technique remains largely unaltered. We aimed to determine whether four-dimensional ultrasound guided embryo transfers (4D UGET) could improve pregnancy rates when compared with clinical touch technique (CTT). This was a single centre open labelled randomised controlled trial in a tertiary fertility centre in the UK. 320 women were randomised on the day of single ET. The primary outcome was clinical pregnancy rate (CPR), secondary outcomes included live birth rate (LBR), biochemical pregnancy rate (BPR), miscarriage, pregnancy of unknown location (PUL) and ectopic pregnancy. 4D-UGET resulted in significantly higher CPR [50% vs 36% p = 0.02, OR 1.78 (1.12-2.84)] and LBR [41% vs 28%, p = 0.02, OR 1.77 (1.09-2.87)] when compared to CTT technique. Miscarriage (p = 0.49), PUL (p = 0.14) and ectopic pregnancy (p = 0.96) were similar between the two groups. LBR, from this trial, are significantly higher than the current UK average (41% vs 24%). 4D UGET allows for superior imaging of the uterine cavity, whilst tailoring the embryo deposition point specifically to the patient. Further RCTs are required to determine if these results can be replicated in other units and whether 4D UGET is superior to 2D UGET.

Cross-sectional quantitative validation of the pediatric Localized Scleroderma Quality of Life Instrument (LoSQI): A disease-specific patient-reported outcome measure

BACKGROUND

The Localized Scleroderma Quality of Life Instrument (LoSQI) is a disease-specific patient-reported outcome (PRO) measure designed for children and adolescents with localized scleroderma (LS; morphea). This tool was developed using rigorous PRO methods and previously cognitively tested in a sample of pediatric patients with LS.

OBJECTIVE

The purpose of this study was to evaluate the psychometric properties of the LoSQI in a clinical setting.

METHODS

Cross-sectional data from four specialized clinics in the US and Canada were included in the analysis. Evaluation included reliability of scores, internal structure of the survey, evidence of convergent and divergent validity, and test-retest reliability.

RESULTS

One-hundred ten patients with LS (age: 8-20 years) completed the LoSQI. Both exploratory and confirmatory factor analysis supported the use of two sub-scores: Pain & Physical Functioning and Body Image & Social Support. Correlations with other PRO measures were consistent with pre-specified hypotheses.

LIMITATIONS

This study did not evaluate longitudinal validity or responsiveness of scores.

CONCLUSION

Results from a representative sample of children and adolescents with LS continue to support the validity of the LoSQI when used in a clinical setting. Future work to evaluate the responsiveness is ongoing.

Sleep, Sensory Integration and Processing, and Autism: A Scoping Review

Date Presented 04/02/2022

Sleep is a crucial occupation, yet difficulties are pervasive across neurodivergent populations. Similarly, sensory integration differences are also highly prevalent in this group. More specifically, autistic individuals have a high probability of both sensory integration differences and sleep problems. Although both can interfere with occupational participation and performance, little is known about the relationship between these factors. Here we present preliminary results from a scoping review.

Primary Author and Speaker: Marco A. Leao

Additional Authors and Speakers: Shelly Lane, Virginia Spielmann

P–306 Premenopausal women with a diagnosis of endometriosis have a significantly higher prevalence of a diagnosis or symptoms suggestive of restless leg syndrome; prospective cross-sectional study

Study question

Are women who report a previous surgical diagnosis of endometriosis more likely to have a diagnosis or symptoms suggestive of restless leg syndrome (RLS)? Summary answer: Women who reported a prior surgical diagnosis of endometriosis, have a significantly higher prevalence of prior formal diagnosis of RLS or symptoms suggestive of RLS.

What is known already

Endometriosis and RLS are both chronic conditions that can negatively affect a woman’s quality of life. A higher prevalence of RLS is seen in women and particularly in those who are pregnant, suggesting a possible ovarian hormonal influence. Endometriosis is a common (affecting 1 in 10 women) oestrogen driven gynaecological condition, and the prevalence of RLS in women with symptoms or a diagnosis of endometriosis is unknown.

Study design, size, duration

This was a prospective, cross-sectional, observational self-completed questionnaire study. Questionnaires were distributed to 650 women under 50 years of age attending the gynaecology out patient’s department at the Liverpool Women’s hospital from October 2017 to January 2018.

Participants/materials, setting, methods

584 women returned the voluntary, anonymous questionnaires, which assessed RLS-associated (The International Restless Leg Syndrome Study Group rating scale) and endometriosis-associated (modified-British Society of Gynaecological Endoscopists pelvic pain questionnaire) symptoms. The final dataset included 465 completed questionnaires.

Main results and the role of chance

The overall response rate for this study was high (90%, 584/650). Women who reported a prior surgical diagnosis of endometriosis had a greater risk of having a prior formal diagnosis of RLS (OR 4.82, 95% CI 1.66,14.02) and suffering RLS symptoms (OR 2.13, 95% CI 1.34–3.39) compared with those without a diagnosis. Women with either a formal diagnosis or symptoms associated with endometriosis have a significantly increased risk of having either a formal diagnosis or symptoms suggestive of RLS (OR 2.49, 95% CI 1.30, 3.64).

In women suffering with endometriosis-associated symptoms, the cumulative endometriosis-associated symptom scores demonstrated a modest positive correlation with RLS severity scores (r = 0.42 95% CI 0.25 to 0.57).

Limitations, reasons for caution

The anonymous, voluntary self-completed questionnaire findings were not confirmed directly using medical records. However, our questionnaire that was piloted for acceptability prior to the study, allowed collation of information directly from women, regarding their clinically relevant symptoms that are important in diagnosing RLS.

Wider implications of the findings: This is the first study highlighting an association between the symptoms relevant to these two chronic conditions, which may help in facilitating the discovery of novel therapeutic targets relevant to both. The simultaneous treatment of these conditions could potentially lead to improvement in overall quality of life for these women.

Trial registration number

NA

Improved preservation of ovarian tissue morphology that is compatible with antigen detection using a fixative mixture of formalin and acetic acid

STUDY QUESTION

Can ovarian tissue morphology be better preserved whilst enabling histological molecular analyses following fixation with a novel fixative, neutral buffered formalin (NBF) with 5% acetic acid (referred to hereafter as Form-Acetic)?

SUMMARY ANSWER

Fixation with Form-Acetic improved ovarian tissue histology compared to NBF in multiple species while still enabling histological molecular analyses.

WHAT IS KNOWN ALREADY

NBF fixation results in tissue shrinkage in various tissue types including the ovary. Components of ovarian tissue, notably follicles, are particularly susceptible to NBF-induced morphological alterations and can lead to data misrepresentation. Bouin’s solution (which contains 5% acetic acid) better preserves tissue architecture compared to NBF but is limited for immunohistochemical analyses.

STUDY DESIGN, SIZE, DURATION

A comparison of routinely used fixatives, NBF and Bouin’s, and a new fixative, Form-Acetic was carried out. Ovarian tissue was used from three different species: human (n = 5 patients), sheep (n = 3; 6 ovaries; 3 animals per condition) and mouse (n = 14 mice; 3 ovaries from 3 different animals per condition).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Ovarian tissue from humans (aged 13 weeks to 32 years), sheep (reproductively young i.e. 3–6 months) and mice (10 weeks old) were obtained and fixed in 2 ml NBF, Bouin’s or Form-Acetic for 4, 8, and 24 h at room temperature. Tissues were embedded and sectioned. Five-micron sections were stained with haemotoxylin and eosin (H&E) and the percentage of artefact (clear space as a result of shrinkage) between ovarian structures was calculated. Additional histological staining using Periodic acid-Schiff and Masson’s trichrome were performed on 8 and 24 h NBF, Bouin’s and Form-Acetic fixed samples to assess the compatibility of the new fixative with stains. On ovarian tissue fixed for both 8 and 24 h in NBF and Form-Acetic, immunohistochemistry (IHC) studies to detect FOXO3a, FoxL2, collagen IV, laminin and anti-Müllerian hormone (AMH) proteins were performed in addition to the terminal deoxynucleotidyl transferase nick end labelling (TUNEL) assay to determine the compatibility of Form-Acetic fixation with types of histological molecular analyses.

MAIN RESULTS AND THE ROLE OF CHANCE

Fixation in Form-Acetic improved ovarian tissue morphology compared to NBF from all three species and either slightly improved or was comparable to Bouin’s for human, mouse and sheep tissues. Form-Acetic was compatible with H&E, Periodic acid-Schiff and Masson’s trichrome staining and all proteins (FOXO3a, FoxL2, collagen IV and laminin and AMH) could be detected via IHC. Furthermore, Form-Acetic, unlike NBF, enabled antigen recognition for most of the proteins tested without the need for antigen retrieval. Form-Acetic also enabled the detection of damaged DNA via the TUNEL assay using fluorescence.

LARGE SCALE DATA

N/A

LIMITATIONS, REASONS FOR CAUTION

In this study, IHC analysis was performed on a select number of protein types in ovarian tissue thus encouraging further studies to confirm the use of Form-Acetic in enabling the detection of a wider range of protein forms in addition to other tissue types.

WIDER IMPLICATIONS OF THE FINDINGS

The simplicity in preparation of Form-Acetic and its superior preservative properties whilst enabling forms of histological molecular analyses make it a highly valuable tool for studying ovarian tissue. We, therefore, recommend that Form-Acetic replaces currently used fixatives and encourage others to introduce it into their research workflow.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the Oxford Medical Research Council Doctoral Training Programme (Oxford MRC-DTP) grant awarded to B.D.B. (Grant no. MR/N013468/1), the Fondation Hoffmann supporting R.A. and the Petroleum Technology Development Fund (PTDF) awarded to B.V.A.

Fathers Raising Children on the Autism Spectrum: Lower Stress and Higher Self-Efficacy Following SMS (Text2dads) Intervention

This study explored potential influence of a text-based program for fathers of children on the autism spectrum. Fathers (N = 184) were recruited through autism services across Australia. Participants received messages focusing on five domains: (a) relationships with parenting partner; (b) formal support; (c) father-child interaction; (d) understanding autism; and, (e) coping. Surveys explored parenting stress, co-parenting quality and autism-specific parenting self-efficacy. Eighty-eight percent completed the program, 43.6% completed pre and post surveys. There was significant reduction in parenting stress (p < .01) and increase in autism-specific parenting self-efficacy (p < .01). Effect sizes indicate these may be clinically meaningful. This highly scalable intervention has potential to influence factors that shape and sustain relationships fathers share with their children on the autism spectrum, families and services.

Ataxia and mobility in children following surgical resection of posterior fossa tumour: A longitudinal cohort study

PURPOSE

To report the course of ataxia in children up to 2 years post-operatively, following surgical resection of a posterior fossa tumour (PFT).

METHODS

Thirty-five children, (median age 9 years, range 4-15) having resection of PFT, were assessed using the Scale for the Assessment and Rating of Ataxia (SARA), Brief Ataxia Rating Scale (BARS) and the mobility domain of the Paediatric Evaluation of Disability Index (PEDI-m) at initial post-operative period (baseline), 3 months, 1 year and 2 years post-operatively.

RESULTS

Baseline median scores of the SARA and BARS were 8.5 (range 0-35.5), and 7 (0-25) respectively. Ataxia improved at 3 months (median SARA and BARS reduction 3.5 and 4, respectively). Additional gradual improvements in SARA were recorded at 1 (median reduction 2) and 2 years post-operatively (median reduction 0.5). Median baseline PEDI-m was 54.75 (range 15.2-100) with improvement at 3 months (median increase 36.95) and small improvement at 1 year (median increase 2.5) and 2 years (median increase 5.8). Children with medulloblastoma and midline tumours (median baseline SARA 10 and 11, respectively) demonstrated more severe ataxia than children with low-grade gliomas and unilateral tumours (median baseline SARA 7.5 and 6.5, respectively).

CONCLUSION

The largest improvement in ataxia scores and functional mobility scores is demonstrated within the first 3 months post-operatively, but ongoing gradual improvement is observed at 2 years. Children with medulloblastoma and midline tumour demonstrated higher ataxia scores long term.

Examination of preliminary behavioral and effective connectivity findings from treatment response to citalopram in cocaine use disorder: A dynamic causal modeling study

We sought effective (directional) connectivity parameters associated with response to citalopram in cocaine use disorder (CUD) by conducting a functional magnetic resonance imaging (fMRI) experiment with participants diagnosed with CUD (n = 13) and matched healthy controls (HC; n = 17). CUD participants showed a positive correlation between bilateral DLPFC-to-putamen effective connectivity and treatment effectiveness score. These preliminary results support further investigation of prefrontal-striatal interactions in response to treatment in CUD.

Effectiveness of an Intensive Occupational Therapy Camp for Children

Date Presented 03/28/20

Camp Jabiru (CJ) is a naturalistic camp that provides OT through a replicable fidelity process for children with developmental differences. Campers improved their functional performance as measured by the Canadian Occupational Performance Measure (COPM) from both parent and OT ratings. COPM positive change remained stable three months postintervention. The findings suggest the OT intervention provided at CJ via a replicable process has a positive and lasting impact on occupational performance.

Primary Author and Speaker: Tracy Stackhouse

Additional Authors and Speakers: Hannah Burke, Shelly Lane

Contributing Authors: Caroline Hui, Lynette Burke, Beth Osten, Colleen Hacker

Examining Hyper-Reactivity to Defecation-Related Sensations in Children With Functional Defecation Disorders (FDD)

Date Presented 03/27/20

This study investigated the relationship between sensory reactivity and FDD. Parents of three- to six-year-old children with and without FDD completed two questionnaires: the Toileting Habit Profile Questionnaire-Revised and the Short Sensory Profile. Children with FDD had higher levels of sensory hyper-reactivity. Screening for sensory hyper-reactivity may be important when working with children with FDD who have difficulty participating in toileting routines.

Primary Author and Speaker: Isabelle Beaudry-Bellefeuille

Additional Authors and Speakers: Shelly Lane

Contributing Authors: Alison Lane, Eduardo Ramos-Polo

Fertility preservation in boys: recent developments and new insights †

BACKGROUND

Infertility is an important side effect of treatments used for cancer and other non-malignant conditions in males. This may be due to the loss of spermatogonial stem cells (SSCs) and/or altered functionality of testicular somatic cells (e.g. Sertoli cells, Leydig cells). Whereas sperm cryopreservation is the first-line procedure to preserve fertility in post-pubertal males, this option does not exist for prepubertal boys. For patients unable to produce sperm and at high risk of losing their fertility, testicular tissue freezing is now proposed as an alternative experimental option to safeguard their fertility.

OBJECTIVE AND RATIONALE

With this review, we aim to provide an update on clinical practices and experimental methods, as well as to describe patient management inclusion strategies used to preserve and restore the fertility of prepubertal boys at high risk of fertility loss.

SEARCH METHODS

Based on the expertise of the participating centres and a literature search of the progress in clinical practices, patient management strategies and experimental methods used to preserve and restore the fertility of prepubertal boys at high risk of fertility loss were identified. In addition, a survey was conducted amongst European and North American centres/networks that have published papers on their testicular tissue banking activity.

OUTCOMES

Since the first publication on murine SSC transplantation in 1994, remarkable progress has been made towards clinical application: cryopreservation protocols for testicular tissue have been developed in animal models and are now offered to patients in clinics as a still experimental procedure. Transplantation methods have been adapted for human testis, and the efficiency and safety of the technique are being evaluated in mouse and primate models. However, important practical, medical and ethical issues must be resolved before fertility restoration can be applied in the clinic.Since the previous survey conducted in 2012, the implementation of testicular tissue cryopreservation as a means to preserve the fertility of prepubertal boys has increased. Data have been collected from 24 co-ordinating centres worldwide, which are actively offering testis tissue cryobanking to safeguard the future fertility of boys. More than 1033 young patients (age range 3 months to 18 years) have already undergone testicular tissue retrieval and storage for fertility preservation.

LIMITATIONS REASONS FOR CAUTION

The review does not include the data of all reproductive centres worldwide. Other centres might be offering testicular tissue cryopreservation. Therefore, the numbers might be not representative for the entire field in reproductive medicine and biology worldwide. The key ethical issue regarding fertility preservation in prepubertal boys remains the experimental nature of the intervention.

WIDER IMPLICATIONS

The revised procedures can be implemented by the multi-disciplinary teams offering and/or developing treatment strategies to preserve the fertility of prepubertal boys who have a high risk of fertility loss.

STUDY FUNDING/COMPETING INTERESTS

The work was funded by ESHRE. None of the authors has a conflict of interest.

AB0839 RELIABILITY OF COMPOSITE MEASURES FOR THE ASSESSMENT OF PSORIATIC ARTHRITIS

Background:

Composite measures of disease activity have been developed for use in Psoriatic Arthritis (PsA) to capture the wide spectrum of disease but there is a lack of consensus regarding which to adopt for routine practice. It is recognised that more data is required to understand the measurement properties of existing instruments and consider the impact of modifications that may improve face validity, responsiveness or feasibility. It is important to have an estimate of a measurement instrument’s reliability in the setting of stable disease in order to understand measurement error and responsiveness. To our knowledge no data exists on the stability of composite measures in PsA.

Objectives:

To measure test re-test reliability of composite measures of disease activity in PsA.

Methods:

Clinical and patient reported outcomes to enable the calculation of composite measures were administered to 141 patients with PsA at five time points in a UK multicentre observational study. All patients fulfilled the CASPAR criteria. Twenty-nine patients with clinically stable disease and receiving no treatment intervention underwent repeat assessment by the same examiner within 2 weeks. Patients in high and low disease were included. Reliability was evaluated by intra-class correlation coefficient (ICC) and Bland Altman plots.

Results:

Of the 29 patients included 15 were male, the mean age was 52.4 years (SD 13.39), mean disease duration at T0was 9.2yrs (SD 8.11). The mean swollen joint count was 3.4 (SD 5.1), tender joint count 11.3 (SD 15.03) and PASI 1.0 (SD1.04). The ICC (95% CI) for tender and swollen joint counts were 0.94 (0.87-0.97) and 0.91 (0.80-0.96) respectively. The ICC for PASI was 0.95 (0.90-0.98). All composite measures demonstrated high levels of test-retest reliability with ICC >0.85, table. The most reliable measure was the PADAS ICC 0.98 (95% CI 0.954-0.991). The individual ICC for each composite measures are reported in the table and Bland Altman plots, figure.

Conclusion:

All composite measures show high levels of test-retest reliability in this cohort. The PASDAS was the most stable measure. Modifications to these instruments can now be tested and the impact compared to the original versions.

Table.

Funding:

This report is independent research funded by the National Institute for Health Research, Programme Grants for Applied Research [Early detection to improve outcome in patients with undiagnosed PsA (‘PROMPT’), RP-PG-1212-20007]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Disclosure of Interests:

William Tillett Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc, UCB, Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc, UCB, Philip Helliwell: None declared, Oliver FitzGerald: None declared, Robin Waxman: None declared, Anna Antony: None declared, Laura C Coates: None declared, Deepak Jadon: None declared, Paul Creamer: None declared, Suzanne Lane: None declared, Marco Massarotti: None declared, Charlotte Cavill: None declared, Mel Brooke: None declared, Jonathan Packham: None declared, Eleanor Korendowych: None declared, Anya Lissina: None declared, Neil McHugh: None declared

Systematic review of the impact of unstructured play interventions to improve young children's physical, social, and emotional wellbeing

This review aimed to examine the effectiveness of unstructured play interventions on young children's physical, emotional and social wellbeing in various community settings. Eligibility criteria of articles included (1) studies which included young children aged three to seven years; (2) intervention studies which involved unstructured, free or loose parts play; (3) experimental or randomized controlled trial designs, with or without random allocation to groups; and (4) target variables of the study should include measurable physical, social or psychological constructs as modifiable outcomes. Electronic searches were conducted from June 2018 to March 2019 in ERIC, MEDLINE, PubMed, ProQuest, Sage Publications, Web of Science, Scopus, and Sociological Abstracts. Data were extracted from the included studies independently by using a pilot form. The study outcome measures of unstructured play in the eight selected articles were categorized into three aspects of children's physical health, social skills and emotional wellbeing. All studies reported positive impacts on children's physical activity level, social engagement and emotional wellbeing. We conclude that our review with identified impacts would assist future research directions and policy implementation in this promising field..

Correction to: Development of a new reproductive tissue cryopreservation clinical service for children: the Oxford programme

In the published version, the Acknowledgements section was missing a funding note of co-author Dr C Verrill. The corrected version should read as follows.

Clinical relevance of findings in trials of CBT for depression

Cognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression – Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD.

A novel patient-reported outcome for paediatric localized scleroderma: a qualitative assessment of content validity

BACKGROUND

According to current standards, no existing patient-reported outcome (PRO) measures have high-quality validity evidence for use with individuals diagnosed with paediatric localized scleroderma (LS). This severely hinders patient-centred LS-focused research, including much needed clinical trials.

OBJECTIVES

To develop a valid health-related quality of life measure for individuals with paediatric LS and to qualitatively evaluate its content validity using a patient-centred approach.

METHODS

Previously collected qualitative data from youth with LS and their caregivers was used to develop items. The resulting item set was administered in a clinical setting to participants aged 8-18 years old. Cognitive interviews were used to evaluate time to survey completion, readability/understanding of the items, appropriateness of the recall period and construct representation.

RESULTS

Seventeen children and adolescents with LS participated in the study. Interviews supported readability, understanding of the items and appropriateness of the recall period in individuals > 10 years old. Revisions were made to simplify the instructions and to be more inclusive of different subtypes of LS. Three items were added to improve content representation.

CONCLUSIONS

Content validity was supported by the patient-centred development process of the outcome measure and via direct feedback from individuals with LS and their families. Although an important first step, the resulting PRO, termed the Localized Scleroderma Quality of Life Instrument, should be further evaluated in a larger sample before being implemented. What's already known about this topic? No current health-related quality of life (HRQoL) measures have been created using direct input from children and adolescents with localized scleroderma (LS). When compared with qualitative reports of HRQoL impact in youth with all LS subtypes, no existing patient-reported outcome (PRO) measures have appropriate content validity for individuals with paediatric LS. What does this study add? This study proposes a novel LS-specific PRO and is the first qualitative assessment of content validity for any PRO measure in this population. Results from cognitive interviews with children and adolescents support the content validity of the newly developed item set and its ability to capture HRQoL impact in a clinical context. What are the clinical implications of this work? Incorporating a content-valid PRO of HRQoL impact into clinical practice would allow for the valid, ongoing capture of patient experience in LS. Although content validity is an important and necessary step in the process of evaluating validity, items within this novel measure will undergo additional psychometric evaluation before implementation in research and clinical settings.

Development of a new reproductive tissue cryopreservation clinical service for children: the Oxford programme

PURPOSE

This article describes the development of a new reproductive tissue cryopreservation clinical service for children at high risk of infertility in the NHS during times of severe financial constraints in the health service.

METHOD

A development plan with two phases was drawn up. Phase 1 restricted the service to childhood cancer patients referred to the Oxford Paediatric Oncology and Haematology Principle Treatment Centre. It was estimated that there would be 10 patients/year and used existing staff and facilities from paediatric oncology, surgery, anaesthetics radiology, pathology, psychology, teenage-young adult gynaecology, and an existing Human Tissue Authority tissue bank with a licence for storage of tissue under a Human Sector Licence. Phase 2 extended the service to include children and young adults across England, Wales and Ireland-patients from Scotland having access to a research programme in Edinburgh. The main challenge in phase 2 being resources and the need for patients to be able to be treated as close to home as safely as possible.

RESULTS

The Oxford team developed information resources and eligibility criteria based on published best practice, referral and treatment pathways, multidisciplinary team meetings, a network of third party sites, and a dedicated case management and database. As the programme expanded, the Oxford team was able to justify to management the need for a dedicated theatre list. Patient feedback through questionnaires, qualitative work conducted as part of a Ph.D. thesis as well as direct patient stories and interviews in TV, and radio features underpins the positive impact the programme has on patients and their families.

CONCLUSION

The Oxford Reproductive Cryopreservation programme delivers fertility preservation treatment to children and young adults at high risk of infertility safely, effectively and as close to home as possible. The onward view is to apply for national funding for this programme for recognition and sustainability.

A comparison of angina symptoms reported by clinicians and patients, pre and post revascularisation: Insights from the Stent or Surgery Trial

BACKGROUND

There are limited data comparing the consistency of angina reporting by patients and clinicians.

METHODS

We performed a retrospective analysis of data from the randomised Stent or Surgery (SoS) trial. The trial required reporting of angina using the Canadian Cardiovascular Society (CCS) classification by both patients and clinicians at baseline and twelve months. We compared paired observations to describe the magnitude and direction of differences in clinician and patient reporting. The difference in CCS grade was expressed as the clinician minus patient value. We also examined the proportion of trial subjects reported as being free from angina (CCS = 0) in clinician and patient reporting.

RESULTS

Paired CCS data was available for 912 and 887 cases at baseline and 12 months respectively. At baseline, clinicians reported freedom from angina in a single case (1/912 = 0.1%) compared to 70/912 (7.7%) patients (Delta 7.6% 95% CI 5.8 to 9.3, P ≤0.001). At 12 months, the position was reversed, with clinicians reporting 639/887 (72%) angina free compared to 449/887 (50.6%) for patients (Delta -21.4 95% CI -17.1 to -25.8 P ≤ 0.001). For the reported CCS grade at follow-up, the weighted linear kappa for overall agreement was 0.312. Discordant reporting involved the clinician suggesting less angina rather than more (36% v 8% of cases).

CONCLUSIONS

These findings have implications for our perception of previous research which has, in the main, focussed on clinician reporting. This emphasises the importance of patient reporting and a need to better understand reasons for discordance.

Development of the Scale of Parental Playfulness Attitude (PaPA) During the Co-occupation of Play

Date Presented 04/06/19

Initial development of the Scale of Parental Playfulness Attitude during the co-occupation of play (PaPA, or Escala AJugar in Spanish) will be detailed. The PaPA is the first self-report measure, developed with the purpose of evaluating whether the approach of parents playing with their children between 2.5 and 6 years 11 months, reflects a playful attitude. It is expected to serve as a useful tool for professionals working on play with families of children with developmental challenges.

Primary Author and Speaker: Rosa Roman-Oyola

Additional Authors and Speakers: Chastiti Vazquez-Gual

Contributing Authors: Itzamar Dasta-Valentin, Graciela Diaz-Lazzarini, Glorian Collazo-Aguilar, Coraly Yambo-Martinez, Anita Bundy, Shelly Lane, Victor Bonilla-Rodriguez

The Toileting Habit Profile Questionnaire Revised (THPQ-R): Examining Discriminative and Concurrent Validity

Date Presented 04/06/19

Reports indicate that sensory issues may be related to atypical defecation habits in some children. Practice in this area is limited by the lack of validated measures. The THPQ-R appears to capture defecation behaviors related to sensory over-reactivity. While preliminary studies regarding the THPQ-R are promising, further examination of its validity is warranted. In this study, we examined discriminative and concurrent validity.

Primary Author and Speaker: Isabelle Beaudry-Bellefeuille

Contributing Authors: Shelly Lane, Simon Chiu, Alison Lane, Eduardo Ramos-Polo

The Toileting Habit Profile Questionnaire (THPQ): Examining Construct Validity Using the Rasch Model

Date Presented 04/06/19

Reports support the hypothesis that sensory issues may be related to atypical defecation habits in children. Practice in this area is limited by the lack of validated measures. We used Rasch analysis, directed content analysis, and expert review to validate the Toileting Habit Profile Questionnaire (THPQ). After adjusting items, we examined the construct validity of the revised version (THPQ-R). The THPQ-R appears to capture challenging defecation behaviors related to sensory over-reactivity.

Primary Author and Speaker: Isabelle Beaudry-Bellefeuille

Contributing Authors: Shelly Lane, Anita Bundy, Alison Lane, Eduardo Ramos-Polo

SURF-COPD: the recording of cardiovascular risk in patients with chronic lung disease

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic obstructive pulmonary disease (COPD) and such patients tend to carry a heavy burden of risk factors for CVD. There is little information on the documentation and management of CVD risk factors in COPD patients.

AIM

To audit the recording and management of CVD risk factors in 200 COPD patients attending the respiratory out-patient clinics at two University teaching hospitals.

DESIGN

Retrospective analysis of hospital records.

RESULTS

While there was reasonable recording of a history of CVD risk factors such as hypertension and hyperlipidaemia, the actual recording of risk factor levels was poor-blood pressure and heart rate were recorded in less than half of subjects; lipids, waist circumference, HbA1c and height were essentially not recorded at all.

CONCLUSIONS

Best practice guidelines and standard operating procedures for CVD risk factor recording and control require to be developed if the major cause of death in COPD subjects, CVD, is to be addressed. An outline for a standard operating procedure is presented in the Appendix. Serial audits will be required to assess the efficacy of such measures.

The efficacy and safety of bronchial thermoplasty in severe persistent asthma on extended follow-up

BACKGROUND

Asthma is a common condition and there remains a subset of patients who are poorly controlled on maximal therapy. Bronchial thermoplasty (BT) is a bronchoscopic therapy using radiofrequency energy to reduce airway smooth muscle, which has been shown to improve asthma control although further evidence regarding long-term efficacy and safety is required.

AIM

We aimed to demonstrate safety and efficacy of BT on extended follow-up. Our initial experience with this group was previously reported in 2016, where patients were shown to have a significant improvement in asthma control test (ACT) scores 1-year post-treatment.

DESIGN

We carried out a retrospective observational study of seven patients who underwent BT between 2012 and 2013 in an Irish severe asthma centre. The primary endpoint was change in ACT scores from baseline to present.

METHODS

Seven patients underwent BT at a tertiary referral centre in Ireland. ACT scores and data on hospital admissions, exacerbations, maintenance corticosteroid requirements, rescue bronchodilator use and forced expiratory volume for 1 s (FEV1) prior to the procedure and on extended follow-up were collected. Mean follow-up was 49.42 months.

RESULTS

A trend towards improvement was seen in median hospitalisations (respective values for median over 12 months 3, 1 P = 0.059) and ACT scores, from 9 to 13 (P = 0.249). Mean FEV1 was 1.68 l prior to treatment and 1.46 l 4 years post-treatment (P = 0.237). There was no mortality among the group.

CONCLUSIONS

These data support the safety of BT and suggest extended efficacy.

Wide-gamut lasing from a single organic chromophore

The development of wideband lasing media has deep implications for imaging, sensing, and display technologies. We show that a single chromophore can be engineered to feature wide-gamut fluorescence and lasing throughout the entire visible spectrum and beyond. This exceptional color tuning demonstrates a chemically controlled paradigm for light emission applications with precise color management. Achieving such extensive color control requires a molecular blueprint that yields a high quantum efficiency and a high solubility in a wide variety of liquids and solids while featuring a heterocyclic structure with good steric access to the lone pair electrons. With these requirements in mind, we designed a lasing chromophore that encloses a lasing color space twice as large as the sRGB benchmark. This record degree of color tuning can in principle be adapted to the solid state by incorporating the chromophore into polymer films. By appropriately engineering the base molecular structure, the widest range of lasing wavelengths observed for a conventional gain medium can be achieved, in turn establishing a possible route toward high-efficiency light emitters and lasers with near-perfect chromaticity.

Effects of Deep Pressure on Arousal and Performance in Adults With Autism: Examining the Efficacy of the Vayu Vest

Date Presented 3/30/2017

Adults with autism have impairments in autonomic nervous system regulation that impact their ability to engage socially and perform functional tasks. This study tested the efficacy of a sensory-based technology, the Vayu Vest, as a means of altering autonomic arousal and increasing performance.

Primary Author and Speaker: Stacey Reynolds

Additional Authors and Speakers: Shelly Lane

Contributing Authors: Brian Mullen, Caitlin Boulware, Holly Timberline, Michelle Norris, Caitlin McDaniel, Kaitlyn Baumann, Anthony Guarriello