Background/Aims Patient and public involvement (PPI) initiatives are important to ensure patient-centered research. However, traditional focus groups can present challenges including the recruitment and retention of patient partners. Additional challenges to patient involvement have also arisen due to the coronavirus pandemic (COVID-19). The University College London (UCL) Patient Partners in Rheumatology Research initiative has been developed to explore novel ways to boost patient involvement and foster an active collaboration between basic researchers and patient partners. Methods Two online surveys were designed to obtain information with regards to the expectations and practicalities of this initiative. One survey was sent to patients who had registered an interest in being patient partners and the other survey to rheumatology researchers at UCL and University College London Hospital (UCLH). Results We received responses from 25 researchers and 21 patients. The majority of patients who responded (71%) had not previously been involved in PPI. Most of the researchers (84%) had previously utilised PPI, however 20% of those had some difficulty accessing it. Most patients (86%) were interested in becoming a patient partner. Amongst those with reservations, one stated that “I don't think I have the qualifications to be involved with scientists and researchers”. Over half of patients (52%) were happy to participate in PPI more than five times a year and most researchers (84%) expressed that five times a year was acceptable. Patients favoured (52%) conducting PPI meetings after office hours (5-8pm) during the working week. Due to social restrictions because of COVID-19, we asked both patients and researchers their preferred mode of meeting. Both groups favoured a mixed (virtual and face to face) meeting arrangement (81% for patients and 68% for researchers). A third of patients (38%) expressed that they would need technical assistance accessing a virtual meeting. Almost all patients (95%) were happy to contribute to lay summary reviews remotely via email. Conclusion Based on the insights gained from the survey results, our PPI initiative meetings will be hosted in a hybrid virtual/face to face format. These will be held at a time and frequency that is convenient for the patient partners to increase participation across wider demographics. This survey has highlighted that we have to be mindful of certain patient perceptions of PPI which creates a barrier to patient involvement and that some individuals may require further support in accessing virtual meetings. By designing a PPI initiative that creatively addressed the needs of both the researchers and patient partners we hope to create a platform for productive dialogue and collaboration to ensure patient-centred research, despite the changes brought about by the COVID-19 pandemic. Disclosure E. Hawkins: Other; funded by National Institute of Health Research, Clinical Research Network. T. Hyndman: None. R. Amarnani: None. J. Kimpton: None. S. Yeoh: Other; University College London Hospital National Institute of Health Research Biomedical Research Centre, UCLH Charities, Royal College of Physicians and Rosetrees Trust. M. Castelino: Other; University College London Hospitals National Institute for Health Research Biomedical Research Centre.
Background/Aims The role of highly differentiated T effector memory re-expressing CD45RA (Temra) in rheumatoid arthritis (RA) is unclear, including whether they can be used as a marker of persistent disease activity. Our aim was to investigate whether peripheral blood Temra frequency can be used to identify RA patients with active disease refractory to anti-TNF therapy. As cytomegalovirus (CMV) has been reported to be associated with the expansion of Temra as well as implicated in RA pathogenesis, we also explored the relationship between serum CMV immunoglobulin (IgG) status, Temra, and remission status. Methods A cross-sectional cohort of RA patients on anti-TNF therapy were recruited. Patients were stratified based on remission status. Remission was defined as no recorded DAS28-CRP≥2.4, no swollen joints, no C-reactive protein (CRP) >5mg/L, and on a stable DMARD dose and no reported disease flare/loss of remission in the last 6 months before recruitment. Patients on abatacept or on conventional DMARDs only were recruited as comparison groups. Peripheral blood mononuclear cells (PBMC) were analysed by flow cytometry. Serum CMV IgG was analysed by ELISA. Two-tailed Mann-Whitney U test or unpaired t-test were used to obtain unadjusted values, analysis of variance (ANOVA) of log-transformed data to obtain age-adjusted values, Spearman’s rank correlation to compare correlation between two variables, Fisher’s exact test to compare proportions. Results Thirty-six anti-TNF, 12 abatacept, and 16 patients on conventional synthetic DMARDs (csDMARDs) only were recruited. A higher proportion of CD4 and CD8 Temra (age-adjusted p = 0.004 and p = 0.0007 respectively) was observed in RA patients on anti-TNF with persistent disease compared to those in remission. This difference in Temra frequency was not observed in patients treated with csDMARDs only or abatacept. CD4 and CD8 Temra frequency correlated positively with CMV IgG levels (Spearman r = 0.8987, p < 0.0001 and Spearman r = 0.7211, p < 0.0001 respectively). There was a strikingly high proportion of anti-TNF patients with persistent disease who were CMV seropositive compared to anti-TNF patients in remission (93% versus 42%, Fisher’s exact test, p = 0.009). This difference was less marked and not significant in the other treatment groups. Conclusion The increased CMV seropositivity and Temra frequency in the context of persistent disease only in anti-TNF treated patients may provide a causal link between Temra and RA pathogenesis refractory to anti-TNF treatment. Disclosure S. Yeoh: Grants/research support; S.A.Y. has received funding for research from Versus Arthritis, Royal College of Physicians, Rosetrees Trust, University College London Hospitals NIHR BRC and UCLH charities. J. Kimpton: None. M. Shipa: Grants/research support; M.S. has received funding for research from Versus Arthritis and GSK. E. Hawkins: None. A. Akbar: Grants/research support; A.A. has received funding for research from the Medical Research Council and the Leo Skin Foundation (Denmark). M. Ehrenstein: None.
Background/Aims Over three million people in the UK have osteoporosis; and are at a substantially increased risk of fragility fractures. There are approximately 536,000 new fragility fractures each year in the UK, with substantial associated morbidity and health service burden. Preventing fragility fractures is thus clinically and economically important and will result in substantial savings for health and social care. The aim of this audit was to assess and improve falls and bone health assessments in a high-risk patient group at a central London hospital. Methods Data was collected over a 2-month period (02/05/2019-28/06/2019) of consecutive patients over the age of 50 admitted to hospital following a fall and fracture. We used the 2017 National Osteoporosis Guidelines Group, NICE clinical guideline on falls in older people (CG161) and the local hospital osteoporosis screening policy as the audit standards. Patient notes were reviewed to assess for evidence of bone health assessment and key falls assessment domains having taken place. Results 43 patients were included; 8 of which had a neck of femur fracture (NOF). Table 1 demonstrates the different components that we included in the falls assessment. Only 5 (12%) of all of the patients had a full falls assessment recorded. In all domains, patients with a NOF were more likely to have a more complete falls assessment than patients with other fractures, especially fundamental components such as osteoporosis risk assessment. P014 Table 1:Number of patients who had each aspect of the falls and bone health assessment completedNOF (N = 8, mean age=80.3)Non-NOF (N = 35, mean age=75.3)YesNoPartialYesNoPartialFalls Assessment3 (37.5%)0 (0%)5 (62.5%)2 (5.7%)15 (42.9%)18 (51.4%)Medical diagnosis of aetiology7 (87.5%)1 (12.5%)18 (51.4%)17 (48.6%)Lying/standing BP3 (37.5%)5 (62.5%)5 (14.3%)30 (85.7%)Therapies assessment?8 (100%)0 (0%)24 (68.6%)11 (31.4%)Medication review?6 (75%)2 (25%)10 (28.6%)25 (71.4%)Osteoporosis assessment?8 (100%)0 (0%)9 (25.7%)26 (74.3%)FRAX completed3 (37.5%)5 (62.5%)3(8.6%)32 (91.4%)Referred to falls clinic1 (12.5%)7 (87.5%)1 (2.9%)34 (97.1%)Referred to post discharge falls prevention5 (62.5%)3 (37.5%)3 (8.6%)32 (91.4%)Referred to bone health clinic1 (12.5%)7 (87.5%)0 (0%)35 (100%)Patients divided into groups of neck of femur (NOF) and non-NOF fractures Conclusion Key aspects of falls and bone health assessment are simple and quick to do, yet often not done in patients admitted with a fracture following a fall. These measures are highly valuable in the long term to mitigate future fragility fracture risk. Our results show that post fall assessment, including bone health, are performed more often in patients with NOF than non-NOF fractures. There is large scope for improvement in practice for this at-risk cohort of patients. Therefore, going forward, our next steps are to create an education programme and embed a standardised, simple proforma into electronic healthcare records to guide post fall bone health assessment. Disclosure J. Kimpton: None. B. Wong: None. R. Amarnani: None. M. Loader: None. C. Fong: None. I. Mannan: None.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.