scholarly journals P05 Involving patients in the discussion about results from the National Early Inflammatory Arthritis Audit

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Oliver Wade ◽  
Jack Loh ◽  
Joshua Withers ◽  
Sarah Fish ◽  
Elizabeth MacPhie
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
First Year ◽  
Quality Improvements ◽  
North West ◽  
Patient Support Group ◽  
Patient Pathway ◽  
The North ◽  
Early Inflammatory Arthritis

Abstract Background The National Early Inflammatory Arthritis Audit (NEIAA) has provided the opportunity for rheumatology services to benchmark the care they provide. It provides a mechanism to identify where services can make improvements and to raise awareness about inflammatory arthritis. We felt it important to share our results with patients and involve patients in the discussion about how we improve the service we deliver. This project outlines how we went about doing this. Methods Data submitted to the NEIAA online tool were downloaded for analysis. This included all patients recruited during the first year of the audit. Results were presented initially to the Rheumatology Multi-Disciplinary Team. Driver diagrams were developed by the team and areas for improvement identified. A patient poster for the waiting area was also developed. This provided information about our performance in the audit and what changes we were looking to make. Results, driver diagrams and the patient poster were then presented to our National Rheumatoid Arthritis Society (NRAS) patient support group at one of their lunchtime meetings. We met again two weeks later with members from the patient group to get feedback on the driver diagrams and patient poster. Results Results from the first year of the audit demonstrated that there was significant room for improvement across all seven quality standards. Driver diagrams identified areas for improvement across the whole patient pathway. Forty-five patients and carers attended the lunchtime meeting presentation. Patients identified various areas where they could get involved with improving the patient pathway. These included putting up posters in the community to raise awareness about rheumatoid arthritis and running another Rheumatoid Arthritis Awareness Day. Other proposals were to provide more lunchtime meetings to improve understanding about the condition and management and promote aspects of self-management and developing the role of the Expert Patient locally to support newly diagnosed patients. The patient poster received lots of positive comments, it was suggested that we remove any statistics which might cause alarm and be difficult to interpret and to focus on what quality improvements had already happened locally. Conclusion Involving patients in the discussion has been a fascinating and rewarding experience. Patients have been empowered and their input has been valued. Patients have provided additional suggestions as to how they can get involved to support the service and improve the patient pathway. The patient poster now tells a positive story and acknowledges our unsatisfactory performance in the first year of the audit and more importantly focuses on what we are doing to improve the service we deliver. Disclosures O. Wade None. J. Loh None. J. Withers None. S. Fish None. E. MacPhie Other; EM is the secretary of the North West Rheumatology Club; meetings are supported by an unrestricted educational grant from UCB.

scholarly journals P06 Driving up quality: local observations from the National Early Inflammatory Arthritis Audit

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Jack Loh ◽  
Joshua Withers ◽  
Sarah FIsh ◽  
Elizabeth MacPhie
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
First Year ◽  
Drug Education ◽  
Dmard Therapy ◽  
North West ◽  
Patient Pathway ◽  
The North ◽  
Early Inflammatory Arthritis

Abstract Background The National Early Inflammatory Arthritis Audit (NEIAA) provides the opportunity for rheumatology services to benchmark the care they provide against NICE quality standards (QS) 33. It provides a mechanism to identify where improvements can be made. This project assessed compliance against QS2: patients are seen in a rheumatology clinic within 3 weeks of referral and QS3: patients with newly diagnosed RA should be offered short-term glucocorticoids and a combination of DMARDs within 6 weeks of referral. Methods Data submitted to the NEIAA online tool during the first year of the audit were downloaded for analysis. Results were presented to the Rheumatology Multi-Disciplinary Team. The patient pathway was mapped, driver diagrams were developed by the team and areas for improvement identified. Results In total 246 patients were recruited to the audit, 71(29%) had confirmed rheumatoid arthritis (RA) and were included in the follow-up cohort. All patients had a baseline form completed, and 61 (86%) had a 3-month follow-up form completed. The mean patient age in the RA cohort was 62 years (range: 26-88). Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) status was recorded in 69 (97%) and 63 (88%) respectively with, 33 (52%) positive for RF and 26 (38%) for ACPA. Twenty-two patients (8.9%) were seen within 3 weeks of being referred and 5 patients (7%) started DMARD therapy within 6 weeks of referral. On average, patients waited 66 days (range: 5-138) to be seen and diagnosed, and if sent for investigations on average a further 50 days (range: 37-69) to diagnosis. There was an additional wait for drug education, with patients waiting a mean of 25 days and 39 days if they had been sent for investigations to confirm diagnosis. Prior to starting DMARD therapy 65 (90%) patients were given bridging steroids. Sixty-five (92%) patients started DMARDs, and in those that didn’t there was justification. A higher proportion of patients >65years started DMARD monotherapy in sero-positive patients and those with a high DAS28 we found more use of combination DMARD therapy. Process mapping and driver diagrams highlighted areas for improvement, both clinician and patient in origin. Regarding QS2 these include developing referral guidelines for primary care, increasing triage capacity, simplifying the booking process, increasing new appointment capacity (additional consultant, upskilling extended scope practitioner and specialist nurse) and introducing text reminders. In relation to QS3 these include: one-stop clinic with access to ultrasound, increasing drug education and monitoring clinic capacity, improve sign-posting to National Rheumatoid Arthritis Society. Conclusion The NEIAA has provided detailed information about the patient pathway which has enabled the team to identify priority areas for improvement. The prospective nature of the audit will allow the team to determine if changes are improving performance. Disclosures J. Loh None. J. Withers None. S. FIsh None. E. MacPhie Other; EM is the secretary of the North West Rheumatology Club; meetings are supported by an unrestricted educational grant from UCB.

scholarly journals P017 Out of outlier status: local observations from the National Early Inflammatory Arthritis Audit

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Elizabeth MacPhie ◽  
Lesley Ashcroft ◽  
Jane Brazendale ◽  
Nicola Foreman ◽  
Sharon Gilbert ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Low Disease Activity ◽  
North West ◽  
The North ◽  
Initial Combination Therapy ◽  
Improve Compliance ◽  
Early Inflammatory Arthritis

Abstract Background/Aims  The National Early Inflammatory Arthritis Audit (NEIAA) provides a powerful lever for driving up quality. Rheumatology services benchmark care against NICE quality standards (QS) 33. Notifications are sent out quarterly to Trusts at risk of being an outlier and outliers are identified in the annual report. After being named as an outlier, this project describes our journey to improve compliance against QS2 (patients are seen in a rheumatology clinic within 3 weeks of referral and QS3 (patients with rheumatoid arthritis (RA) are started on DMARDs within 6 weeks of referral). Methods  Data submitted to the NEIAA online tool during year one were downloaded for analysis. Results were presented to the Rheumatology Multi-Disciplinary Team, the patient pathway was mapped, driver diagrams were developed by the team and areas for improvement identified and changes implemented. Data from year two were downloaded for comparison. Results  In total 530 patients were recruited to the audit: 262 in year 1 and 268 in year 2. 77 (29%) in year 1 and 73 (27%) in year 2 had confirmed RA and were included in this analysis. All patients had a baseline form completed, and 61 (86%) and 56 (77%) had a 3-month follow-up form completed for year 1 and 2, respectively. The demographics were very similar for years 1 and 2. In year 1, 10% of all patients were seen within 3 weeks of being referred and 7% in the RA cohort started DMARD therapy within 6 weeks of referral. This compared to 54% and 56%, respectively, in year 2. Changes implemented relating to QS2 included referral guidelines for primary care, prompts when requesting rheumatoid factor and CCP antibodies and changes to the wording of antibody reports, increased triage capacity, simplifying the booking process and increased new appointment capacity (additional consultant, upskilling extended scope practitioner). QS3 changes implemented included increasing drug education and monitoring clinic capacity and improved sign-posting to National Rheumatoid Arthritis Society. Initial combination therapy was more prevalent in sero-positive patients and those with a high DAS28 during both years. In year 1, disease activity at baseline vs. 3 months was: remission/low disease activity in 8% vs. 54%, moderate in 45% vs. 39% and high in 47% vs. 7%. In year 2, rates at baseline vs. 3 months were: remission/low disease activity 12% vs. 69%, moderate in 60% vs. 25% and high in 28% vs. 6%. Conclusion  Significant changes have been made which have resulted in an improvement in performance against QS2 and 3. Disease activity at baseline was lower, potentially as a result of seeing patients sooner and this has resulted in better outcomes for patients at 3 months. Ongoing data collection will allow the team to determine outcomes at 12 months. Disclosure  E. MacPhie: Other; EM is the secretary of the North West Rheumatology Club, these regional meetings have been funding by an unrestricted educational grant from UCB and are now sponsored by Abbvie. L. Ashcroft: None. J. Brazendale: None. N. Foreman: None. S. Gilbert: None. C. Greenall: None. S. Horton: None. I. Lewis: None. A. Madan: None. C. Rao: None. S. Fish: None.

scholarly journals P016 When and how to deliver advice about self-management: local observations from the National Early Inflammatory Arthritis Audit

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Elizabeth MacPhie ◽  
Lesley Ashcroft ◽  
Jane Brazendale ◽  
Nicola Foreman ◽  
Sharon Gilbert ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Information Needs ◽  
Waiting Times ◽  
Patient Activation ◽  
Self Management ◽  
Valuable Insight ◽  
North West ◽  
Patient Support Group ◽  
Early Inflammatory Arthritis

Abstract Background/Aims  The National Early Inflammatory Arthritis Audit (NEIAA) provides the opportunity for rheumatology services to benchmark the care they provide against NICE quality standards (QS) 33. During the first year of the audit our focus, after being identified as an outlier, was on improving performance against QS2 and specifically reducing waiting times. This project assessed compliance against QS4: patients with rheumatoid arthritis (RA) are offered educational and self-management activities within 1 month of diagnosis. Methods  Data submitted to the NEIAA online tool during the second year of the audit were downloaded for analysis. Results were presented initially to our National RA Society (NRAS) Patient Support Group and then together with feedback from the patients, to the Rheumatology Multi-Disciplinary Team. Driver diagrams were developed and areas for improvement identified. Results  In total, 268 patients were recruited to the audit in year 2; 73 (27%) had confirmed RA and were included in this analysis. Follow-up data at 3 months was available for 56 patients (77%). Characteristics were: mean age 58 years (range: 19-88), 47 (64%) female, 34 (47%) working and 11 (15%) smoked. Forty-one patients (56%) started DMARD therapy within 6 weeks of referral. All patients with RA received written information at baseline about their condition. However, only 39 patients (71%) were documented to have been provided with advice about self-management at their 3-month follow-up. Feedback from the NRAS Group highlighted a number of important considerations. Firstly, that information about self-management needs to be given to the patient at the right time. Patients need to be ready to take advice on board and to have come to terms with their diagnosis. For many, trying to do this in the first 3 months of diagnosis was felt too soon. Information needs to be made available in different formats and tailored to the individual. Patients valued speaking to someone with a lived experience and felt this was more powerful than speaking to a healthcare professional to understand about self-management. Driver diagrams highlighted areas for improvement which included the importance of the team agreeing what is meant by self-management, using a patient activation measure to determine if the patient is ready to take on board this information, exploring different formats of delivery and utilising expert patients. Conclusion  The NEIAA has again enabled the team to identify further areas for improvement. Involving patients in the discussion has provided a valuable insight into how we look to support our patients to live with their condition. It has also led us to question whether the QS is right to support that self-management advice is offered to patients within 1 month of diagnosis. Disclosure  E. MacPhie: Other; EM is the secretary of the North West Rheumatology Club, these regional meetings have been funding by an unrestricted educational grant from UCB and are now sponsored by Abbvie. L. Ashcroft: None. J. Brazendale: None. N. Foreman: None. S. Gilbert: None. C. Greenall: None. S. Horton: None. I. Lewis: None. A. Madan: None. C. Rao: None. S. Fish: None.

scholarly journals THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 497.2-497
Author(s):  
J. Arroyo Palomo ◽  
M. Arce Benavente ◽  
C. Pijoan Moratalla ◽  
B. A. Blanco Cáceres ◽  
A. Rodriguez
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Statistical Tests ◽  
Median Number ◽  
Painful Joint ◽  
Significant Difference ◽  
The Mean ◽  
Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

scholarly journals The role of accommodation environments in student mental health and wellbeing

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne D. Worsley ◽  
Paula Harrison ◽  
Rhiannon Corcoran
Keyword(s):  
Mental Health ◽  
First Year ◽  
Student Mental Health ◽  
North West ◽  
Human Element ◽  
Health And Wellbeing ◽  
Physical Attributes ◽  
Attachment To Place ◽  
Pastoral Staff

Abstract Background Due to the increasing concern over student mental health and wellbeing, attention has turned to the matter of creating environments, communities, and institutions which enable students to flourish. Methods To explore the role of accommodation environments in first year student mental health and wellbeing, eight focus groups were conducted in two universities in North West England and analysed using thematic analysis. Results Three overarching themes were identified: ‘The betwixt space’; ‘Accommodations as vessels to cultivate friendships and communities’; and ‘The importance of accommodation-based pastoral staff’. As attachment to place and relationships with significant others are disrupted by the transition, this leaves young people vulnerable whilst they go through a process to re-attach to new people and a new environment, and loneliness and social isolation were keenly felt during this period. Physical attributes of place that prevent social cohesion further exacerbated feelings of loneliness. Conclusions As it is common for students to withdraw physically and psychologically when they do not form friendships within their flat, accommodation-based pastoral staff have an important role to fulfil. Although these findings demonstrate the importance of the human element within accommodation, designing places that facilitate community, a sense of we-ness, and belonging is crucial.

Conditional and Other Functions of Forms in /-(zα(.))r/ in Abkhaz

2008 ◽  
Vol 12 (1) ◽  
pp. 57-71
Author(s):  
George Hewitt
Keyword(s):  
Historical Development ◽  
Semantic Feature ◽  
Finite Form ◽  
North West ◽  
Verbal Noun ◽  
The North ◽  
Morphological Segmentation ◽  
The Future

AbstractProtases ('if'-clauses) in the North West Caucasian language Abkhaz are mostly marked by either /-r/ or /-zα.r/, depending on the tense and/or type of verb (Stative or Dynamic) concerned. The article presents examples of this conditional usage and the role of protasis-type forms in both temporal and interrogative expressions as well as in complementiser-function. The complementisers in question share the semantic feature of irrealis with conditionals. A rhotic element is also found in the non-finite form of the Future I tense, in the Masdar (verbal noun), and in such converbs as the Purposives, the Resultative and the Future Absolute. The article attempts to link the semantic notions of futurity, potentiality, indefiniteness or general irrealis to the rhotic element and asks what might have been the historical development resulting in the forms attested today and thus their original morphological segmentation.

NORTH WEST SHELF 3-D SEISMIC—A DECADE OF DEVELOPMENTS

1993 ◽  
Vol 33 (1) ◽  
pp. 315
Author(s):  
P.S. Vaughan
Keyword(s):  
Joint Venture ◽  
Spatial Sampling ◽  
Seismic Surveys ◽  
North West ◽  
The North ◽  
Technological Developments

Woodside as Operator, on behalf of three Joint Venture groups, over the last decade has acquired eight 3-D seismic surveys covering some 4 600 km2 over the Rankin Trend and Dampier Sub-Basin Production Licences and Exploration Permits on the North West Shelf of Australia. This area represents approximately 45 per cent coverage of the present Woodside operated acreage in the area. The acquisition, processing and interpretation technology and also the benefits derived from the 3-D technique have changed remarkably since the first North West Shelf 3-D survey in 1981. This paper focusses on the main technological developments in 3-D seismic, particularly involving multi-source and streamer technology, increased spatial sampling and interpretation techniques which have changed the role of 3-D seismic in Exploration strategies through the 1980s and into the 1990s.

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