POS1483-HPR DYSFUNCTIONAL COPING CORRELATES WITH DEPRESSION AND ANXIETY AND PREDICTS WORSE OUTCOME IN PATIENTS WITH A HIGH DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS

Background

Disease flares of rheumatoid arthritis (RA) are important stressors for patients (pts) who may use coping for disease management. Some coping styles are thought to be beneficial and may help to improve disease outcome whereas others are thought to be harmful.

Objectives

We investigate the frequency and intensity of different coping styles in pts with an acute flare of seropositive RA and its impact on disease outcomes after 12 month of therapy.

Methods

Coping was analysed with the Brief-COPE (1) using a 4 point Likert scale in 222 pts participating in the ERFASS study (2). Coping styles were analysed by confirmatory and exploratory factor analysis (CFA, EFA). Disease activity was measured via DAS28 (CRP), depression and/or anxiety using Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire 9 (PHQ-9). Repeated measures ANOVA was used to identify the effect of different coping strategies on disease activity and Spearman-Rho to identify correlations.

Results

Factor analysis revealed five dominant coping styles (problem oriented, emotion oriented, dysfunctional, religion, alcohol/drugs) which were consistent during 6 and 12 months follow up. When analysing the relative intensity of each coping strategy over time there was no significant change during treatment (Table 1). The usage of only a single coping style at baseline (“I am doing this a medium amount” or “a lot”) was reported by 70 pts (31,5%). 65 pts (29,3%) reported the use of 2 coping styles simultaneously, 25 pts (11,3%) 3 coping styles and 4 pts (1,8%) four coping styles. Problem oriented coping was used by 125 pts (56,3%), emotional coping by 97 pts (43,7%), dysfunctional coping by 41 pts (18,5%), religion by 24 pts (10,8%) and alcohol/drugs by only 4 pts (1,8%). 58 pts (26,1%) reported not to use any of the coping styles (“I am doing this not at all” or “only a little bit”) and these pts had a lower DAS28 during the course of the study (p=0.036) as compared to pts who use one or more coping strategies. When analysing the group with high disease activity (DAS28 >5.1) at baseline (n=60), pts with medium or high dysfunctional coping had a significantly higher disease activity after 12 months as compared to those with no or little dysfunctional coping (U = 187,00, Z = -2.025, p = 0.043) (Figure 1). The other coping styles did not significantly predict the outcome of disease activity. We observed a strong correlation between dysfunctional coping and depression (PHQ9 r = 0.590; HADS depression r = 0.569) as well as anxiety (HADS anxiety r = 0.639) but not for the other coping strategies at baseline.

Figure 1.Table 1.

Development of disease activity (DAS28) and coping strategies over time

TimeBaseline mean (SD)Month 6 mean (SD)Month 12 mean (SD)DAS284.32 (1.14)2.79 (1.23)2.47 (1.05)Problem oriented53.10 (14.93)49.69 (14.10)47.43 (14.00)Emotion oriented49.94 (13.00)50.73 (12.76)50.46 (13.45)Dysfunctional40.25 (14.59)36.44 (11.76)36.00 (12.26)Religion36.15 (18.30)35.53 (17.02)34.68 (16.64)Alcohol / Drugs27.03 (7.81)27.15 (8.75)26.53 (6.07)

Conclusion

Different ways of coping may be used simultaneously during an acute flare of seropositive RA. In pts with high disease activity dysfunctional coping is the only coping strategy predicting a worse disease outcome after 12 months and dysfunctional coping correlates with depression and anxiety.

References

[1]Carver CS (1997) You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med 4(1):92–100.

[2]Hoeper JR, Zeidler J, Meyer SE, et al. Effect of nurse-led care on outcomes in patients with ACPA/RF-positive rheumatoid arthritis with active disease undergoing treat-to-target: a multicentre randomised controlled trial. RMD Open 2021

Disclosure of Interests

Juliana Rachel Hoeper: None declared, Ioana Iliadis: None declared, Marianne Richter: None declared, Sara Eileen Meyer: None declared, Kai Kahl: None declared, Torsten Witte: None declared, Kirsten Hoeper Speakers bureau: Abbvie, Novartis, Galapagos, Sandoz Hexal, Chugai, Lilly, Consultant of: Abbvie, Novartis, Galapagos, Sandoz Hexal, Dirk Meyer-Olson Speakers bureau: Bristol Myers Squibb, Celltrion, Chugai, Fresenius Kabi, Galapagos, Lilly, Sandoz Hexal

, Consultant of: Abbvie, Amgen, Astra Zeneca, Biogen, Novartis, Viatris

Radiotherapy Quality Assurance in the PORTEC-3 (TROG 08.04) Trial

AIMS

Quality assurance in radiotherapy (QART) is essential to ensure the scientific integrity of a clinical trial. This paper reports the findings of the retrospective QART assessment for all centres that participated in PORTEC-3; a randomised controlled trial that compared pelvic radiotherapy with concurrent chemoradiotherapy to the pelvis followed by adjuvant chemotherapy. The trial showed an overall survival benefit for the addition of the chemotherapy in the management of women with high-risk endometrial cancer.

MATERIALS AND METHODS

Clinicians were invited to upload a randomly selected case/s treated at each of the participating sites. Panel reviewers analysed the contours to certify that the target volumes and organ at risk structures were contoured according to guidelines. The results were categorised into acceptable, minor variation, major variation or unevaluable. The radiotherapy plans were dosimetrically evaluated using the well-established Trans-Tasman Radiation Oncology Group (TROG) protocol.

RESULTS

Between August 2010 and January 2018, data from 146 patients of 686 consecutively treated patients were retrospectively reviewed. All 16 Australia and New Zealand and 71 of 77 international centres uploaded data for evaluation. In total, 3514 dosimetric and contour variables were reviewed. Of these, 3136 variables were deemed acceptable (89.2%), with 335 minor (9.6%) and 43 major variations (1.2%). Major contour variations included the clinical target volume vaginal vault, clinical target volume parametria and differential planning target volume vault expansion.

CONCLUSION

The results of the QART assessment confirmed high uniformity and low rates of both minor and major deviations in contouring and dosimetry in all sites. This supports the safe introduction of the PORTEC-3 treatment protocol into routine clinical practice.

Cardiac adipose tissue, intra-abdominal adipose tissue, and risk for cardio-metabolic diseases in patients with schizophrenia

Introduction

Schizophrenia is associated with increased physical morbidity and mortality. In particular, cardio-metabolic diseases are more frequent. Several underlying reasons have been discussed, including adverse lifestyle behaviors, or adverse effects of neuroleptic treatment. However, little is known about changes of cardiac and intra-abdominal adipose tissue, both are risk factors for the development of cardio-metabolic diseases.

Objectives/aims

To compare, cardiac and intra-abdominal adipose tissue between patients with schizophrenia and healthy controls.

Methods

Ten physically healthy patients with schizophrenia according to DSM-V were included, and compared to healthy control subjects. Cardiac and intra-abdominal adipose tissue was quantified using magnetic resonance tomography. Further factors assessed comprise the metabolic syndrome, physical activity, smoking behavior, and scores for the assessment of cardio-metabolic diseases (FINDRISK score and modified ESC score).

Results

Cardiac adipose tissue and intra-abdominal adipose tissue was increased in patients with schizophrenia. Further findings were higher diastolic blood pressure, more smoking, less physical activity, and an increase for diabetes and cardiovascular disease risk according to the modified ESC and FINDRISK score.

Conclusions

The new finding in our study is an increase of cardiac adipose tissue, a risk factor for the development of cardiovascular disorders, in physically healthy patients with schizophrenia. Furthermore, the risk for the development of type-2 diabetes mellitus is increased, indicated by higher amount of intra-abdominal adipose tissue, and the results of the FINDRISK score. We conclude that lifestyle alterations, particularly exercise training that has been shown to reduce cardiac and intra-abdominal adipose tissue, should be recommended in patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Prevalence of the metabolic syndrome in patients with borderline personality disorders - results of a cross-sectional study

Introduction

The metabolic syndrome (MetS) is an important risk factor for the development of type-2 diabetes and coronary artery disease. However, little is known about the prevalence of the MetS in patients with borderline personality disorder (BPD).

Objectives, aims

We aimed to compare the MetS prevalence in patients with borderline personality disorder (BPD) with control subjects followed in primary care from a similar region.

Methods

One-hundred thirty five BPD patients according to DSM-IV diagnostic criteria were compared to 1009 subjects from primary care. We used the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHBLI) criteria to determine the rate of MetS and of each individual MetS criterion. For comparison purposes we calculated age-standardized rates of the MetS and their 95%-confidence intervals (CI).

Results

The age-standardized prevalence of MetS was more than double in patients with BPD compared to control subjects (23.3% vs. 10.6%, p < 0.05).

Within BPD patients, an increased rate of MetS was associated with higher BMI (Wald = 10.2; p = 0.004), age (Wald = 4.7; p = 0.03), treatment with second generation antipsychotics (quetiapine, olanzapine and clozapine) (Wald = 4.6; p = 0.032), dysthymia (Wald = 4.6; p = 0.031), panic disorder (Wald = 4.6; p = 0.032), benzodiazepine dependency (Wald = 5.9; p = 0.015), and binge-eating disorder (Wald = 5.4; p = 0.02).

Conclusions

Our results demonstrate an increased MetS rate, dysregulated glucose and lipid metabolism in patients with BPD. Independent predictors of MetS in BPD patients require further study to inform targeted prevention efforts in this population. Cardiometabolic monitoring and careful screening for physical health conditions among people with BPD is warranted.

[Heparin-induced thrombocytopenia with unfractionated heparin. A prospective study of inpatient treatment of internal medicine patients]

AIM

To investigate the influence of unfractionated heparin on heparin-induced thrombocytopenia (HIT) type II.

PATIENTS AND METHOD

In 162 patients with internal diseases treated therapeutically of prophylactically with unfractionated heparin (heparin sodium, heparin calcium), we carried out a prospective study to determine the incidence of HIT type I and II. 55.6% of the patients were female (n = 90) with an average age of 76.5 years (range: 25 to 96 years) and 44.4% male (n = 72) with an average age of 67.5 years (range: 17 to 93 years). A platelet count was taken regularly before the start of heparin treatment, on the first day of treatment and then every second day from day 5 to 20. Whenever HIT II was suspected, an HIPA test was performed.

RESULT

Type I HIT occurred in 10%, type II in 3% of the cases. Two of the 5 patients with type II developed severe thrombotic complications.

CONCLUSION

In view of the high incidence of HIT, regular platelet counts should always be carried out in patients receiving heparin treatment.

Bar code tracking system enhances record- and film-handling productivity

The bar coding system has proven to be highly successful. Use of the bar code label has already been added to the dictation system in medical record and medical imaging services departments for entry of patient identification of each dictated report. Other system enhancements under consideration include tracking ancillary department reports as they are forwarded to the medical record department for storage in the permanent patient record and tracking individual volumes of a patient's medical record.

Identifying the savings potential of bedside terminals

Savings estimates from using bedside terminal systems must be unit and shift-specific to properly determine which functional areas offer savings potential, the potential savings on different shifts, and which nursing units have the greatest savings potential.

Automated nursing documentation system provides a favorable return on investment

Severe competition for the limited investment capital available and the high acquisition cost of bedside terminal systems require that the full benefit potential they offer be identified and realized. The authors discuss a multiple-phase study process used to: 1) identify the savings potential offered (to cost-justify its acquisition); and 2) assure the savings potential offered was realized.

Characterization of the C5a receptor on guinea pig platelets

Guinea pig (gp) platelets react to nanomolar doses of the complement-derived anaphylatoxin C5a with a shape change, aggregation and release of biogenic amines and nucleotides from their granules. We have investigated the specific receptor for C5a on gp platelets which mediates these biological effects. Competitive binding studies with 125I-labeled guinea pig C5a (125I-gpC5a) revealed approx. 4000 binding sites/cell with Kd = 6 x 10(-9) M. The more than 60-fold higher biological activity (ATP-release from gp platelets) of gpC5a versus recombinant human C5a (rhuC5a) and the different binding behavior of gpC5a and rhuC5a point to a species restriction in the gp platelet system. Cross-linking of 125I-gpC5a to gp platelets (250 microM DSS) and analysis by SDS-PAGE under reducing conditions resulted in labeling of a single band with a molecular mass of 32 kDa (ligand-receptor complex). Because of these characteristics, the C5a receptor on gp platelets clearly differs from all previously described C5a receptors.

Use of care levels in the postanesthesia care setting

Most hospitals no longer charge a flat postanesthesia care rate, although many have only one charge code based on unit of time to cover all patients regardless of the level or intensity of their care. The author reports a mechanism developed to charge patients for PACU care based on both length of time and level or intensity of care required. Objectives of the project included a more accurate determination of cost of care provided to each patient, and provision of accurate data for productivity measurement and reporting on an ongoing basis. The installed system, based on four levels of care, provided the following results: more accurate cost of PACU care data reflecting both length and intensity of care; more accurate PACU workload units provided to hospital-wide productivity reporting system; patients charged based on both level and intensity of nursing care in the PACU; nurses feeling that their care efforts are recognized and appreciated; and estimation of overall workload for the next day along with when workload should peak.

Departmental productivity measurement/reporting in the medical record setting

True productivity management requires constant monitoring and adjusting of staff schedules so that established productivity goals/targets are consistently met or exceeded.

Attributes of healthcare productivity standards

While not an exact science, the development, installation and use of reasonable standards can be developed from an historical perspective on the quantity and quality of work produced, to allow the manager to measure the effects of changes on departmental productivity. Those seeking to develop and install standards in the interest of managing productivity improvement will find helpful hints in this article about the attributes of "good" standards.