POS1415 A MACHINE LEARNING ANALYSIS OF FACTORS PREDICTING ORGAN DAMAGE PROGRESSION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS USING THE SPANISH SOCIETY OF RHEUMATOLOGY LUPUS REGISTRY (RELESSER)

Background

Evidence shows that around half of the patients with systemic lupus erythematosus (SLE) develop irreversible organ damage due to the disease itself or to other factors (e.g., steroid treatment). It is essential to have a comprehensive understanding of factors that predict organ damage progression to identify at-risk patients and inform clinical decision making.

Objectives

To develop an algorithm, using machine learning (ML) methodology, that predicts organ damage progression in SLE patients.

Methods

The Spanish Society of Rheumatology Lupus Registry (RELESSER) with patient records from 45 Rheumatology Units across Spain was used. RELESSER data were collected from 2011 to 2021 and captured demographic and comprehensive clinical information. In this analysis, a sample of 2,676 patients was used. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to measure organ damage progression between 2015 (start of the prospective data collection in RELESSER) and 2020.To predict the risk of an increase in the SDI, 102 variables were identified as potential predictors. A ML model (gradient boosting trees) was developed and validated by a simple logistic regression (LG) model. The area under the receiver operating characteristic curve (AUCROC) was used to quantify the improvement over random chance (an AUCROC of 0.5). Shapley Additive Explanation (SHAP) values were used in the ML model to identify predictors and their contribution to damage progression.

Results

Of all patients, 13% experienced organ damage progression, with 2-year patient follow-up. The ML algorithm was better at identifying these patients (AUCROC 0.68) than the LG model (AUCROC 0.63) (Figure 1). ML model performance can be contextualized using a random sample of 100 SLE patients of whom 13 suffered organ damage progression, the model would successfully identify 12. However, 66 additional patients would be incorrectly identified (True Positive 90%; False Positive 79%). The top 5 predictors of damage progression, across all patients, were patient age >49 years,

Figure 1.

ROC AUC plot

Creatinine > 0.9 mg/dl, cardiovascular-related disease complications (> 3 complications), low hematocrit level recorded recently (<41.9 months ago), and triglycerides > 81.5 mg/dl. At the patient level, the 5 patients with the highest predicted risk had strong predictors of progression, with key predictors being patient age at study entry >49 years, age at diagnosis >40 years, cardiovascular-related disease complications, and increased creatinine >0.9 mg/dl. The 5 patients with the lowest predicted risk had strong predictors of no change with key predictors being not having a low hematocrit level recorded recently, triglycerides <81.5 mg/dl and patient age at study entry <49 years.

Conclusion

We developed a machine learning model, using an exhaustive set of variables in RELESSER which successfully predicted short-term organ damage progression in SLE patients, and outperformed a standard regression model. If the model were to be used as a clinical tool, only light-touch interventions should be carried out due to high false positive rate. Further model optimizations, including exposing the model to longer follow-up data and testing it in non-Spanish patients is needed.

Disclosure of Interests

Jose M Pego-Reigosa Speakers bureau: Eli Lilly, GSK, Consultant of: AstraZeneca, GSK, MSD, Eli Lilly, Grant/research support from: The RELESSER registry was funded by grants from GSK, UCB, Roche and Novartis, WALID FAKHOURI Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Silvia Díaz-Cerezo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Aidan Cooper Consultant of: Salaried employee of IQVIA while conducting the analyses for this study, Anne-Marie Saunders Consultant of: Salaried employee of IQVIA while conducting the analyses for this study, Grace Segall Consultant of: Salaried employee of IQVIA throughout conceptualization, design and execution of analysis for this study, Employee of: Eli Lilly and Company throughout finalization of analysis and abstract development for this study, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Sebastian Moyano Employee of: Eli Lilly and Company, Iñigo Rua-Figueroa Grant/research support from: The RELESSER registry was funded by grants from GSK, UCB, Roche and Novartis

Perceptions on HIV Pre-Exposure Prophylaxis Among Urgent Care Clinicians in the Southern United States

Background:

Underutilization of HIV pre-exposure prophylaxis (PrEP) in the Southern United States (US) is well-documented. Urgent care (UC) centers are positioned as community-facing access points to PrEP, but the feasibility of integrating PrEP services into this setting is unclear. We conducted a survey of UC clinicians in the Southern US to better understand their perceptions of the feasibility of providing PrEP in their practice setting.

Objective:

The study aims to determine the feasibility and acceptability of providing PrEP services in the UC setting through a cross-sectional survey of UC clinicians.

Methods:

We conducted a 48-item cross-sectional survey of UC clinicians in the Southern US, between July and September 2020. The survey was distributed through the Urgent Care Association (UCA) and American Academy of Urgent Care Medicine (AAUCM) professional listservs as well as directly to publicly listed e-mail addresses.

Results:

Eighty-two clinicians responded to the survey. Most clinicians had familiarity with PrEP (97%). All respondents rated PrEP as an effective way to prevent HIV. However, less than half felt UC facilities were an appropriate place to prescribe PrEP. Few respondents (8%) expressed doubts that expansion of PrEP access would decrease the incidence of HIV in their community.

Conclusion:

These findings show UC clinicians are familiar with PrEP, and many believe it would benefit their patients; however, provider opinions on the appropriateness of providing PrEP in the UC setting differ. Further studies on PrEP implementation in UC centers are needed.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Creating Guidance for Canadian Dataverse Curators: Portage Network’s Dataverse Curation Guide

Purpose: This paper introduces the Portage Network’s Dataverse Curation Guide and the new bilingual curation framework developed to support it. Brief Description: Canadian academic institutions and national organizations have been building infrastructure, staffing, and programming to support research data management. Amidst this work, a notable gap emerged between requirements for data curation in general repositories like Dataverse and the requisite workflows and guidance materials needed by curators to meet them. In response, Portage, a national network of data experts, organized a working group to develop a Dataverse curation guide built upon the Data Curation Network’s CURATED workflow. To create a bilingual resource, the original CURATE(D) acronym was modified to CURATION—which has the same meaning in both French and English—and steps were augmented with Dataverse-specific guidance and mapped to three conceptualized levels of curation to assist curators in prioritizing curation actions. Methods: An environmental scan of relevant deposit and curation guidance materials from Canadian and international institutions identified the need for a comprehensive Dataverse Curation Guide, as most existing resources were either depositor-focused or contained only partial workflows. The resulting Guide synthesized these guidance materials into the CURATION steps and mapped actions to various theoretical levels of data repository services and levels of curation. Resources: The following documents are supplemental to the Dataverse Curation Guide: the Portage Dataverse North Metadata Best Practices Guide, the Scholars Portal Dataverse Guide, and the Data Curation Network CURATED Workflow and Data Curation Primers.

Data in the Time of COVID-19: How Data Library Professionals Helped Combat the Pandemic

As the world struggled to respond to the COVID-19 pandemic, researchers worked around the clock to understand what was going on, medically, socially, and economically. At the same time, usual research processes were disrupted: campuses were closed and normal government data collection and dissemination went haywire. Data professionals in academic libraries sprang into action to help. They shared resources, developed workshops, helped find alternative methods of carrying out research, and found ways of coping with the influx of COVID-related data. Social crises are fought on the front lines by medical professionals and service providers, but they are also fought with research, with information, with data. Libraries are at the nexus of information and communication and library professionals were able to play an important supporting role in helping researchers combat the effects of the pandemic.

Decisional conflict among couples seeking specialty treatment for infertility in the USA: a longitudinal exploratory study

STUDY QUESTION

What are couples' decisional conflicts around family-building approaches before and after seeking a specialty consultation for infertility?

SUMMARY ANSWER

Decisional conflict is high among couples before an initial specialty consultation for infertility; on average, women resolved decisional conflict more quickly than men.

WHAT IS KNOWN ALREADY

Couples have multiple options for addressing infertility, and decisional conflict may arise due to lack of information, uncertainty about options and potential risks or challenges to personal values.

STUDY DESIGN, SIZE, DURATION

We conducted a total of 385 interviews and 405 surveys for this longitudinal, mixed-methods cohort study of 34 opposite-sex couples who sought a new reproductive specialty consultation (n = 68), who enrolled before the initial consultation and were followed over 12 months.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The in-depth, semi-structured interviews included questions about information gathering, deliberation and decision-making, and self-administered surveys included the Decisional Conflict Scale (DCS), at six time points over 12 months. A DCS total score of 25 is associated with implementing a decision, and higher scores indicate more decisional conflict. A systematic content analysis of interview transcripts identified major themes. Paired t tests identified differences in DCS between women and men within couples. Linear mixed models predicted changes in DCS over time, adjusting for sociodemographic and fertility-related factors.

MAIN RESULTS AND THE ROLE OF CHANCE

The major qualitative themes were communication with partners, feeling supported and/or pressured in decision (s), changing decisions over time and ability to execute a desired decision. Average DCS scores were highest before the initial consultation. Within couples, men had significantly higher decisional conflict than women pre-consultation (48.9 versus 40.2, P = 0.037) and at 2 months (28.9 versus 22.1, P = 0.015), but differences at other time points were not significant. In adjusted models, predicted DCS scores declined over time, with women, on average, reaching the DCS threshold for implementing a decision at 2 months while for men it was not until 4 months.

LIMITATIONS, REASONS FOR CAUTION

This is a convenience sample from a single center, and generalizability may be limited.

WIDER IMPLICATIONS OF THE FINDINGS

Understanding how couples discuss and make decisions regarding family-building could improve the delivery of patient-centered infertility care. Our findings are the first to prospectively explore decisional conflict at multiple time points in both men and women; the observed gender differences underlie the importance of supporting both partners in clinical decision-making for infertility.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the National Institute of Child Health and Human Development under Grant [R21HD071332], the Research and Education Program Fund, of the Advancing a Healthier Wisconsin endowment at Medical College of Wisconsin, the National Research Service Award under Grant [T32 HP10030] and the use of REDCap for data collection from the National Center for Advancing Translational Sciences, National Institutes of Health under Grant through [8UL1TR000055]. The authors have no competing interests.

Hybridisation capture allows DNA damage analysis of ancient marine eukaryotes

Marine sedimentary ancient DNA (sedaDNA) is increasingly used to study past ocean ecosystems, however, studies have been severely limited by the very low amounts of DNA preserved in the subseafloor, and the lack of bioinformatic tools to authenticate sedaDNA in metagenomic data. We applied a hybridisation capture 'baits' technique to target marine eukaryote sedaDNA (specifically, phyto- and zooplankton, 'Planktonbaits1'; and harmful algal bloom taxa, 'HABbaits1'), which resulted in up to 4- and 9-fold increases, respectively, in the relative abundance of eukaryotes compared to shotgun sequencing. We further used the bioinformatic tool 'HOPS' to authenticate the sedaDNA component, establishing a new proxy to assess sedaDNA authenticity, "% eukaryote sedaDNA damage", that is positively correlated with subseafloor depth. We used this proxy to report the first-ever DNA damage profiles from a marine phytoplankton species, the ubiquitous coccolithophore Emiliania huxleyi. Our approach opens new avenues for the detailed investigation of long-term change and evolution of marine eukaryotes over geological timescales.

Advanced Care Planning and End-of-life Outcomes in Hematopoietic Stem Cell Transplant Patients

AIM/PURPOSE

This integrative review addresses whether the presence and timing of advanced care planning (ACP) with or without a palliative care (PC) consultation affect place of death and use of high-intensity medical care at end-of-life (EOL) in adolescent and young adult and adult cancer patients receiving hematopoietic stem cell transplant (HSCT) therapy.

METHODS AND RESULTS

A literature search was completed in the Scopus and PubMed databases. The search was not restricted by date but was restricted to English language. A total of 1,616 articles were found, and after exclusion of duplicates and irrelevance, 79 articles were available to review. After reviewing inclusion and exclusion criteria, 9 articles related to ACP with HSCT were found, and 4 were eliminated after further review, resulting in 5 viable articles for review related to EOL outcomes. EOL outcomes reviewed were place of death and high-intensity medical care. Factors noted to influence these measures included the presence or absence of ACP, the timing of ACP, and PC consultation. Overall survival also emerged as an EOL outcome affected by ACP.

CONCLUSION

Although there have been many barriers identified to ACP discussions in the HSCT population, the findings from the integrative literature review support the use of early ACP with patients who have hematologic malignancies undergoing HSCT to address patient EOL goals and reduce healthcare utilization at the EOL. The data also suggest that identification of patients who would most benefit from early engagement in ACP may positively impact outcomes.

Relationship between country income, socioeconomic factors and control of cardiovascular disease risk factors in patients with type 2 Diabetes: insights from the global DISCOVER registry

Background

In patients with type 2 diabetes (T2D), optimal management of cardiovascular (CV) risk factors is critical for primary prevention of CV disease.

Purpose

To describe the association of country income and patient socioeconomic factors with risk factor control in patients with T2D.

Methods

DISCOVER is a 37-country, prospective, observational study of 15,983 patients with T2D enrolled between January 2016 and December 2018 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. In patients without known CV disease with sub-optimally controlled risk factors at baseline, we examined achievement of risk factor control (HbA1c &lt;7%, BP &lt;140/90 mmHg, appropriate statin) at the 3 year follow-up. Countries were stratified by gross national income (GNI)/capita, per World Bank report. We explored variability across countries in risk factor control achievement using hierarchical logistic regression models and examined the association of country- and patient-level economic factors with risk factor control.

Results

Among 9,613 patients with T2D but without CV disease (mean age 57.2 years, 47.9% women), 83.1%, 37.5%, and 66.3% did not have optimal control of glucose, BP, and statins, respectively, at baseline. Of these, 40.8%, 55.5%, and 28.6% achieved optimal control at 3 years of follow-up. There was substantial variability in achievement of risk factor control across countries (Figure) but no association of country GNI/capita on achievement of risk factor control (Table). Insurance status, which differed substantially by GNI group, was strongly associated with glycemic control, with no insurance and public insurance associated with lower odds of patients achieving HbA1c &lt;7%.

Conclusions

In a global cohort of patients with T2D, a substantial proportion do not achieve risk factor control even after 3 years of follow-up. The variability across countries in risk factor control is not explained by the GNI/capita of the country.

Proportion of patients at goal

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): The DISCOVER study is funded by AstraZeneca

AB1059 A RANDOMIZED, PLACEBO-CONTROLLED STUDY OF ANAKINRA IN PATIENTS WITH STILL´S DISEASE

Background:

Adult-onset Still’s disease (AOSD) and systemic juvenile idiopathic arthritis (SJIA) are rare autoinflammatory disorders associated with an activated IL-1 pathway, characterized by spiking fever, rash, arthritis, lymphadenopathy, hepatosplenomegaly and serositis. There is a growing understanding that SJIA and AOSD are one disease with different ages of onset, i.e. Still’s disease. The anaSTILLs study (anakinra inStill´sdisease) was designed to further evaluate efficacy and safety of anakinra in patients with Still´s disease across all age groups.

Objectives:

The primary objective was to demonstrate efficacy of anakinra versus placebo as assessed by ACR30 response with absence of fever at Week 2. Secondary objectives included: early onset of efficacy, sustained efficacy, time to study drug discontinuation, safety, pharmacokinetics, clinical signs and biomarkers.

Methods:

‘anaSTILLs’ was a randomized, double-blind, placebo-controlled, 12-week study including patients with active and newly diagnosed (6 months) Still´s disease according to adapted ILAR criteria if <16, or Yamaguchi criteria, if ≥16 years of age at disease onset. Patients were randomized to anakinra 2 mg/kg (max 100 mg/day), 4 mg/kg (max 200 mg/day) or placebo.

Results:

12 patients were randomized and received study drug: 6 anakinra (2 mg/kg n=2, 4 mg/kg n=4) and 6 placebo, the study was terminated early due to slow recruitment. 1 patient on placebo had lymphoma, not Still’s disease, and was excluded; thus in total 11 patients were analyzed for efficacy, 8 were children [median (range) age=4.0 (1-11) years] and 3 were adults [median (range) age=32.0 (25-51) years]. 55% were male and the mean symptom duration was 74.2 days. All patients on anakinra but none on placebo achieved ACR30 response with absence of fever at Week 2 (p-value=0.0022). The efficacy of anakinra was further demonstrated by superiority to placebo in ACR50/70/90 responses with absence of fever at Week 2. All placebo patients discontinued the study within 6 weeks, 2 due to progressive disease, 2 due to lack of efficacy and 1 due to withdrawal by patient. There was a numerically higher proportion with early onset of efficacy (Week 1) in the anakinra group compared to placebo. The ACR30/50/70/90 responses in the anakinra group were sustained throughout the study period. Patients in the anakinra group had a prompt and persistent decrease in CRP and ferritin levels at Week 1, which was not observed in the placebo group. There were no unexpected safety findings. All anakinra patients developed anti-drug antibodies (ADAs) at some timepoint during the study. ADAs were persistent throughout the treatment period, except in one patient. Titers were low to moderate. One placebo patient had low ADA titers at one occasion. No neutralizing antibodies were observed and the ADAs did not appear to impact clinical efficacy or safety.

Conclusion:

Anakinra is superior to placebo in the treatment of Still’s disease. ADAs occur frequently but do not appear to adversely impact efficacy or safety. These results confirm the benefits of anakinra treatment in patients with active, newly diagnosed Still´s disease across ages.

Disclosure of Interests:

Laura Schanberg Grant/research support from: Sobi, BMS, Consultant of: Aurinia, UCB, Sanofi, Peter Nigrovic Grant/research support from: Novartis, BMS, Pfizer, Consultant of: Novartis, BMS, Pfizer, Sobi, Miach Orthopedics, Simcere, XBiotech, Quench Bio, Ashley Cooper: None declared, Winn Chatham Grant/research support from: Sobi, Consultant of: Sobi, Shoghik Akoghlanian: None declared, Namrata Singh: None declared, Egla Rabinovich Grant/research support from: AbbVie, UCB Pharma, Janssen Research & Development, Akaluck Thatayatikom: None declared, Alysha Taxter: None declared, Jonathan Hausmann Consultant of: Novartis, Milan Zdravkovic Shareholder of: Sobi, Employee of: Sobi, Sven Ohlman Shareholder of: Sobi, Employee of: Former employee of Sobi, Henrik Andersson Employee of: Sobi, Susanna Cederholm Shareholder of: Sobi, Employee of: Sobi, Margareta Wikén Shareholder of: Sobi, Employee of: Former employee of Sobi, Rayfel Schneider Grant/research support from: Roche, Novartis, Sobi, Pfizer, Consultant of: Sobi, Novartis, Novimmune, Fabrizio De Benedetti Grant/research support from: AbbVie, Pfizer, Novartis, Novimmune, Sobi, Sanofi, Roche, Speakers bureau: AbbVie, Novartis, Roche, Sobi

Modified Immunodiffusion Method for Detection of Salmonella in Raw Flesh and Highly Contaminated Foods: Collaborative Study

A total of 19 government and private industry laboratories in Canada and the United States participated in the collaborative study. Naturally contaminated ground poultry and animal meals, as well as inoculated raw shrimp, were examined for presence of Salmonella by both the modified immunodiffusion method and the Bacteriological Analytical Manual culture method, resulting in an agreement rate of 93.1%. The 2 methods are statistically equivalent for all food types at each inoculation level and for all lots of naturally contaminated foods evaluated in this study. The modification of the AOAC Official Method 989.13, immunodiffusion (1–2 TEST) method for detection of motile Salmonella in all foods, has been adopted revised first action by AOAC INTERNATIONAL.

'We've made the best of it. But we do not have a normal life': families' experiences of tuberous sclerosis complex and seizure management

BACKGROUND

Tuberous sclerosis complex (TSC) is a complex multisystem genetic disorder. Approximately 84% of people with TSC have epilepsy. However, there is little literature available regarding families' experiences with TSC and seizure management. Therefore, the aim of the current study was to explore families' positive and negative experiences, and attitudes towards TSC, epilepsy and medical management of seizures.

METHODS

Framework analysis informed an open exploration of families' experiences with TSC, epilepsy and medical management of seizures. Using structured interviews, 11 parents of people with TSC and 2 people with TSC were interviewed, providing the data set for transcription and thematic analysis.

RESULTS

'TSC rules our life' overarched three subordinate themes: 'Our normal', 'Burnout' and 'Seizure management has given us our life back'. Families had to adapt to the normality of needing to constantly supervise their child even as they become an adult. They express a feeling of fear particularly of seizures, and this has impact throughout the family. There are frequent expressions of exhaustion and struggling to fight for access and support. There are some positives and cautious hope with the gaining of control from seizures as being able to predict or plan improves activity and participation. These interviews provided a rich insight into the lives of those with TSC and their families.

CONCLUSION

There are exciting developments with respect to scientific understanding of the pathophysiology of TSC, which opens opportunity for new treatments. Holistic family centred health care and practical support (e.g. opportunities for parental respite) is as important as medical intervention. As TSC is such a complex condition, there is a need for specialist clinics and TSC-specific research.

Too much time? Time use and fertility-specific quality of life among men and women seeking specialty care for infertility

Background

There are known gender differences in the impacts infertility has on quality of life and well-being. Less is known about how infertile couples spend time on fertility-related tasks and associations with quality of life. The purpose of this study is to evaluate whether time spent on tasks related to family-building decision-making (including research, reflection, discussions with partner, discussions with others, and logistics) were associated with fertility-specific quality of life or anxiety among new patients.

Methods

Couples or individuals (N = 156) with upcoming initial consultations with a reproductive specialist completed the Fertility Quality of Life (FertiQoL) tool, which produces a Core (total) score and four subscales: Emotional, Relational, Social, and Mind-Body. We developed questions to measure time spent in the previous 24 h on tasks related to family-building. We tested for differences by gender in time use (McNemar’s Test) and used ordinary least squares regression to analyze the relationship between time use and FertiQoL scores.

Results

In the week before a new consultation, a higher percentage of women reported time spent in the past 24 h in research, reflecting, discussion with others, and logistics compared to male partners (all p < 0.05). In adjusted models, more time spent reflecting was associated with worse FertiQoL scores for both men and women, as well as with higher anxiety for men. Time spent in discussion with others was associated with higher anxiety for women but better Social FertiQoL scores for men.

Conclusions

Couples seeking infertility consultation with a specialist reported spending time on tasks related to family-building before the initial visit. There were gender differences in the amount of time spent on these tasks, and time was associated with fertility-specific quality of life and anxiety.

Comparison of peer-tutor and librarian feedback for the literature search component of a medical school research course

Introduction: The aim of this study is to compare the peer tutor and librarian feedback on second year medical students’ literature search skills as part of a research course at Queen’s University, Kingston, Ontario, Canada. Methods:  Student peer tutors and medical librarians each assessed a sample of literature searches for a culminating project. Two separate student cohorts were evaluated, and the marked rubrics were compared. Students also participated in focus groups. An online survey was sent to a third cohort of students who did not work with peer tutors, but instead met with librarians one-on-one to discuss their literature searches. Results: There was a measurable difference in the mark agreement between the peer tutors and the librarians. Unsurprisingly, librarians identified important errors and omissions unseen by the peer tutors. Peer tutors found the process of peer assessment very useful for their own learning and teaching skill development, however, the non-peer tutor students did not appreciate the value of this methodology. After peer tutoring was discontinued, the survey feedback was very positive about the value of the individual librarian consultations. Discussion: Medical students conducting a research project need to perform thorough literature searches. Although librarians found the consultations time-consuming, they found that the consultations improved searches more than having students receive help from peer tutors in the same class. The surveyed students were positive about the librarian consultation.   Author keywords:  Medical students; critical enquiry; student research; Peer tutoring; Assessment; Program evaluation; Librarian consultations; Information literacy; Focus groups, Online survey.

Language matters. Addressing the use of language in the care of people with diabetes: position statement of the English Advisory Group

The language used by healthcare professionals can have a profound impact on how people living with diabetes, and those who care for them, experience their condition and feel about living with it day-to-day. At its best, good use of language, both verbal and written, can lower anxiety, build confidence, educate and help to improve self-care. Conversely, poor communication can be stigmatizing, hurtful and undermining of self-care and can have a detrimental effect on clinical outcomes. The language used in the care of those with diabetes has the power to reinforce negative stereotypes, but it also has the power to promote positive ones. The use of language is controversial and has many perspectives. The development of this position statement aimed to take account of these as well as the current evidence base. A working group, representing people with diabetes and key organizations with an interest in the care of people with diabetes, was established to review the use of language. The work of this group has culminated in this position statement for England. It follows the contribution of Australia and the USA to this important international debate. The group has set out practical examples of language that will encourage positive interactions with those living with diabetes and subsequently promote positive outcomes. These examples are based on a review of the evidence and are supported by a simple set of principles.