AB1523-HPR USABILITY AND ACCEPTABILITY OF A NEW AUTOINJECTOR DEVICE AND ITS ASSOCIATED APP IN AUSTRALIAN, FRENCH, GERMANY AND JAPANESE RHEUMATOLOGY PATIENTS

Background

Smartclic/ClicWise is a new reusable autoinjector with a dose-dispensing cartridge for subcutaneous self-administration of biotherapeutics in development for patients with rheumatoid arthritis (RA) and other diseases. The device can connect to an optional mobile phone app (Smartclic, or ClicNote in Japan) to aid in tracking injections and other treatment or symptom data.

Objectives

The study objective was to collect ease of use and usability data on the Smartclic injector and companion app from experienced patients.

Methods

After completing a patient profiling questionnaire, adult patients (≥18 yrs) from Australia, France, Germany, and Japan with RA, psoriatic arthritis, or an original diagnosis of juvenile idiopathic arthritis who were prescribed an injectable biologic were enrolled in this study. For Japan, only patients with RA were enrolled. Each patient received training individually on the use of the Smartclic injector device and insertable cartridge and gained experience by performing simulated injections. Participants completed a questionnaire with evaluations of the device categories (number of questions): ‘ease of use’ (14), ‘usability effectiveness’ (11), ‘benefit of features’ (8), and ‘form factor’ (7). Participants also separately received a storyboard presentation summarizing the key features of the app, during which patients could explore the app (on a phone with either an android or iOS operating system), and completed 16 questions on the connectivity, usability, and benefit. Responses were recorded as Likert scale ratings from 1 (‘extremely negative’) to 7 (‘extremely positive’). Respondents also provided an estimate of patient training time for the device. Mean values were reported. The percentage of negative (Likert scale rating 1-2), neutral (3-5), and positive (6-7) responses for each category were determined.

Results

A total of 139 patients (mean age [range], 52 [18-84] yrs; 73% female) participated in the study (Table 1). Mean scores (percentage of positive responses) for the device were: ease of use 6.43 (86.2%), usability effectiveness 6.39 (86.5%), benefit of features 6.46 (89.4%), form factor 6.10 (77.2%); and 6.06 (74.2%) for connectivity and benefit of the app (Figure 1). Mean estimated time for training a patient to effectively use the device/cartridge was just under 9.5 min (range, 0-30 min).

Table 1.

Participant characteristics

CharacteristicPatients(N=139)Sex, n (%)Male38 (27)Female101 (73)Mean age (range), yrs52 (18-84)Age groups, n (%)18-30 yrs11 (8)31-59 yrs85 (61)>60 yrs43 (31)Diagnosis, n (%)Rheumatoid arthritis104 (75)Psoriatic arthritis34 (24)Juvenile idiopathic arthritis*1 (1)Handedness, n (%)Right-handed128 (92)Left-handed9 (6)Ambidextrous2 (1)

*Originally diagnosed with juvenile idiopathic arthritis, but now aged ≥18 yrs.

Conclusion

Rheumatology patients responded positively on the new autoinjector device and app across all categories, indicating its suitability for self-administration of biotherapeutics.

Acknowledgements

Medical writing support was provided by Jacob Evans, of Engage Scientific Solutions.

Disclosure of Interests

Rieke Alten Consultant of: AbbVie, Bristol-Myers Squibb, Gilead, Lilly, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Galapagos, Gilead, Janssen, Lilly and Pfizer, Mark Latymer Shareholder of: Pfizer, Employee of: Pfizer, David C Gruben Shareholder of: Pfizer, Employee of: Pfizer, Lisa Gunther-LaVergne Employee of: Farm Design, Simon Moss Shareholder of: Pfizer, Employee of: Pfizer, Hideto Kameda Speakers bureau: AbbVie, Asahi-Kasei, Bristol-Myers Squibb, Chugai, Eisai, Janssen, Lilly, Mitsubishi-Tanabe, Novartis and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Novartis, Sanofi and UCB, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer Ingelheim, Chugai, Eisai and Mitsubishi-Tanabe

Treating children with disinhibited social engagement disorder symptoms: Filial therapy

Introduction

Children affected by social neglect and other forms of abuse are at significant risk of developing mental health problems as well as social, academic, and behavioral functioning difficulties. Some studies have assessed the effectiveness of treatment for children with trauma-attachment disorder. Nevertheless, some questions remain to be answered regarding appropriate treatment.

Objectives

Aim This research identified how filial therapy affects the extent to which foster parents are responsive, sensitive, and attentive to the needs of their children in their care. Subsequently, the study explored how this bond, influenced during filial therapy, affects the signs and symptoms of disinhibited social engagement disorder.

Methods

Method This study used case study as the methodology to research the influence of filial therapy (CPRT) in foster children who show the symptoms of disinhibited social engagement disorder- aged three to six. Two sets of foster parents received a 10-session filial therapy model (CPRT) across 10 weeks. Pre and post measures of the parent-child relationship were analyzed.

Results

Result The findings indicate that filial therapy greatly enhances the bond between foster parents and children with DSEDs. Moreover, these improvements in the bond diminished the symptoms of disinhibited social engagement disorder.

Conclusions

Conclusion The impact of filial therapy as a responsive intervention reduced the symptoms of disinhibited social engagement disorder. The symptoms have declined very likely as a result of rebuilding, regenerating, and enhancing the relationship between foster children and foster parents.

Disclosure

No significant relationships.

Benchmarking nurse outcomes in Australian Magnet® hospitals: cross-sectional survey

Background

Positive reports of nursing-related outcomes such as quality nursing care, nursing engagement with work and good practice environment are crucial in attaining and maintaining Magnet® designation. The majority of Magnet®-designated organisations (N = 482) are in the USA, with their aggregate nursing outcomes widely published as benchmark data. Australian Magnet® outcomes have not been aggregated or published to date.

Methods

The aims are to benchmark educational preparation, occupational burnout, job satisfaction, intention to leave and working environment of nurses in Australian Magnet®-designated facilities and to determine the reliability of the Practice Environment Scale-Australia.

The design is a cross-sectional multisite survey set in all three Australian Magnet®-designated organisations.

The demographics included age, gender, level of education, years in practice, level of seniority and position title. Two items measured job satisfaction and intent to stay in current employment. The Maslach Burnout Inventory explored the three domains of nursing engagement: depersonalisation, personal achievement and emotional exhaustion. The Australian version of the Practice Environment Scale interrogated participants’ perceptions of their work environments.

Results

2004 nurses participated (response rate 45.9%). Respondents’ mean age was 39.2 years (range 20–72). They were predominantly female and had worked in their current facility for more than 5 years. Eighty five percent had a minimum of a Bachelor’s degree. Eighty-six percent of respondents were satisfied or very satisfied with their current position. Eighty eight percent had no intention of leaving their current employer within the next 12 months. Participants rated their hospitals highly in all domains of the practice environment. Respondents reported less burnout in the personal accomplishment and depersonalisation domains than in the emotional exhaustion domain, in which they reported average levels of burnout. The internal consistency of the Practice Environment Scale-Australia was confirmed in this sample (Cronbach α’s 0.87–0.9 for subscales and 0.89 for composite score).

Conclusion

In this paper, we present nursing outcome data from all Australian Magnet® hospitals for the first time. This provides a benchmark that facilitates comparison with nursing outcomes published by Australian non-Magnet® hospitals and with international Magnet® organisations.

Final Results of the Prospective FH02 Mammographic Surveillance Study of Women Aged 35-39 at Increased Familial Risk of Breast Cancer

BACKGROUND

Many women who are at increased risk of breast cancer due to a mother or sister diagnosed with breast cancer aged under 40 do not currently qualify for surveillance before 40 years of age. There are almost no available data to assess whether mammography screening aged 35-39 years would be effective in this group, in terms of detection of breast cancer at an early stage or cost effective.

METHODS

A cohort screening study (FH02) with annual mammography was devised for women aged 35-39 to assess the sensitivity and screening performance and potential survival of women with identified tumours.

FINDINGS

2899 women were recruited from 12/2006-12/2015. These women underwent 12,086 annual screening mammograms and were followed for 13,365.8 years. A total of 55 breast cancers in 54 women occurred during the study period (one bilateral) with 50 cancers (49 women) (15 CIS) adherent to the screening. Eighty percent (28/35) of invasive cancers were ≤ 2 cm and 80% also lymph node negative. Invasive cancers diagnosed in FH02 were significantly smaller than the comparable (POSH-unscreened prospective) study group (45% (131/293) ≤ 2 cm in POSH vs 80% (28/35) in FH02 p < 0.0001), and were less likely to be lymph-node positive (54% (158/290, 3 unknown) in POSH vs 20% (7/35) in FH02: p = 0.0002. Projected and actual survival were also better than POSH. Overall radiation dose was not higher than in an older screened population at mean dose on study per standard sized breast of 1.5 mGy.

INTERPRETATION

Mammography screening aged 35-39 years detects breast cancer at an early stage and is likely to be as effective in reducing mortality as in women at increased breast cancer risk aged 40-49 years.

Budner's Intolerance of Ambiguity: A Note concerning Intelligence

Budner's measure of intolerance of ambiguity has been applied as an explanatory device for a wide variety of behavioral phenomena. Data from 100 high school girls, given several scales, indicate a strong component of ability in the scores. The role of intelligence in studies of intolerance of ambiguity has been neglected; conceptual clarification of the issue appears warranted.

GPs views and understanding of PSA testing, screening and early detection; survey

BACKGROUND

There is currently no national prostate cancer screening programme in the UK. However, patients 50 years and older are entitled to a prostate specific antigen (PSA) test, if informed on the advantages and disadvantages of testing and their risk of cancer. The Prostate Cancer Risk Management Programme (PCRMP) provides this guidance.

AIM

The aim of this study was to access GPs' views and understanding of PSA testing, prostate cancer screening and early detection.

METHOD

A total of 708 questionnaires were returned by GPs across two English regions in 2013 and the GP questionnaire responses were quantitatively analysed.

RESULTS

In the 699 completed questionnaires, the majority of GPs were well informed about PSA testing, screening and early detection. Only 32% used guidelines for referral, 14% knew all age-specific PSA referral levels, 71% that Black men have a higher prostate cancer risk than White men (22% correctly answered threefold increase) and 82% that family history is a risk factor. A further 78% thought electronic prompts during consultation would encourage PCRMP guideline usage and 75% had never been offered a PSA test and prostate cancer educational course, of which 73% would like to attend a course. Only 23% were aware of the latest PSA screening evidence and 94% would like an update.

CONCLUSIONS

Participating GPs seem to be well informed but need more information and tools to help follow recommended guidance. In particular, increased awareness of PCRMP guidelines especially by automated methods, further educational courses and evidence updates would be beneficial.

Prostate-specific antigen testing rates and referral patterns from general practice data in England

BACKGROUND

There is currently no national screening programme for prostate cancer in England, but eligible men can request a prostate-specific antigen (PSA) test from their general practitioner (GP). There are no routinely available data to monitor the extent of PSA testing and referral.

AIM

The aim of this study was to investigate the rate of PSA testing in general practice and subsequent patterns of referral.

DESIGN AND SETTING

Data obtained from the Clinical Practice Research Datalink (CPRD) for men aged 45-84 years who had a PSA test during 2010-2011, registered in practices in England with linked Hospital Episode Statistics (HES) data.

METHOD

Patient data were linked to previous tests and consultations. Rates of PSA testing and proportions of men retested and referred to secondary care were calculated.

RESULTS

Overall, 8.74 (95% CI 8.67-8.82) of men per 100 person-years were tested at least once in 2010, and 9.45 (95% CI 9.37-9.53) in 2011. Rates increased with age and decreased with increasing level of deprivation. Of the 53,069 men tested in 2010, 11,289 (21.3%) had a previous PSA test within the past 12 months. Of men with raised PSA according to age specific guidelines, 22.4% (2113/9425) were referred to secondary care within 14 days, with 36% of the remainder retested within 6 months.

CONCLUSIONS

Rates of PSA testing have increased compared with earlier studies; the data suggest that many GPs are retesting men with raised PSA rather than referring immediately. More routine data on PSA testing, including reasons for testing, and subsequent management and outcomes, are required.

Equine grass sickness, but not botulism, causes autonomic and enteric neurodegeneration and increases soluble N-ethylmaleimide-sensitive factor attachment receptor protein expression within neuronal perikarya

REASONS FOR PERFORMING STUDY

Equine grass sickness (EGS) is of unknown aetiology. Despite some evidence suggesting that it represents a toxico-infection with Clostridium botulinum types C and/or D, the effect of EGS on the functional targets of botulinum neurotoxins, namely the soluble N-ethylmaleimide-sensitive factor attachment receptor (SNARE) proteins, is unknown. Further, while it is commonly stated that, unlike EGS, equine botulism is not associated with autonomic and enteric neurodegeneration, this has not been definitively assessed.

OBJECTIVES

To determine: 1) whether botulism causes autonomic and enteric neurodegeneration; and 2) the effect of EGS on the expression of SNARE proteins within cranial cervical ganglion (CCG) and enteric neuronal perikarya.

STUDY DESIGN

Descriptive study.

METHODS

Light microscopy was used to compare the morphology of neurons in haematoxylin-eosin stained sections of CCG and ileum from 6 EGS horses, 5 botulism horses and 6 control horses. Immunohistochemistry was used to compare the expression of synaptosomal-associated protein-25, synaptobrevin (Syb) and syntaxin within CCG neurons, and of Syb in enteric neurons, from horses with EGS, horses with botulism and control horses. The concentrations of these SNARE proteins in extracts of CCG from EGS and control horses were compared using quantitative fluorescent western blotting.

RESULTS

EGS, but not botulism, was associated with autonomic and enteric neurodegeneration and with increased immunoreactivity for SNARE proteins within neuronal perikarya. Quantitative fluorescent western blotting confirmed increased concentrations of synaptosomal-associated protein-25, Syb and syntaxin within CCG extracts from EGS vs. control horses, with the increases in the latter 2 proteins being statistically significant.

CONCLUSIONS

The occurrence of autonomic and enteric neurodegeneration, and increased expression of SNARE proteins within neuronal perikarya, in EGS but not botulism, suggests that EGS may not be caused by botulinum neurotoxins. Further investigation of the aetiology of EGS is therefore warranted.

Mammographic surveillance in women aged 35-39 at enhanced familial risk of breast cancer (FH02)

Although there have been encouraging recent studies showing a potential benefit from annual mammography in women aged 40-49 years of age with an elevated breast cancer risk due to family history there is little evidence of efficacy in women aged <40 years of age. A prospective study (FH02) has been developed to assess the efficacy of mammography screening in women aged 35-39 years of age with a lifetime breast cancer risk of ≥ 17 % who are not receiving MRI screening. Retrospective analyses from five centres with robust recall systems identified 47 breast cancers (n = 12 in situ) with an interval cancer rate of 15/47 (32%). Invasive tumour size, lymph node status and current vital status were all significantly better than in two control groups of unscreened women (including those with a family history) recruited to the POSH study. Further evaluation of the prospective arm of FH02 is required to assess the potential added value of digital mammography and the cancer incidence rates in moderate and high risk women in order to inform cost effectiveness analyses.

Physical and physiological characteristics in male team handball players by playing position - Does age matter?

AIM

The purpose of this study was to examine the variation in physical and physiological characteristics according to playing position in adolescent and adult male team handball (TH) players.

METHODS

Adolescent (N.=57, aged 14.9±1.4 yr) and adult (N.=39, 26.6±5.7 yr) players were examined for anthropometric characteristics, somatotype and body composition, and performed the physical working capacity test, a force-velocity test, the Wingate anaerobic test (WAnT), sit-and-reach test, handgrip strength test, squat jump (SJ), countermovement vertical jump without (CMJ) and with arm-swing, and a 30-s Bosco test. Eccentric utilization ratio (EUR) was calculated as the ratio CMJ to SJ.

RESULTS

In adult players, there were significant differences between wings and the other positions with regard to anthropometric and body composition parameters (body mass, -17.9% to -13.2%; height, -5.3% to -4.3%; and fat-free mass, -13.7% to -9.9%) and anaerobic power assessed by WAnT (peak power, -20.5% to -15.2%; and mean power, -20% to -14.8%); however, these characteristics did not differ significantly in adolescents, in which the only statistically significant difference was found between goalkeepers and the other positions in EUR (+8.1%).

CONCLUSION

Therefore, the differences in physical and physiological characteristics between playing positions are age-dependent. As adult players in this study were taken from players competing in the top Greek league, findings could serve as a base for talent identification and development for future studies. Moreover, knowledge about positional differences might enhance the ability to make tailored position-specific training programs among adult and adolescent players in the future.