Alleviate Patient Anxiety Research Articles

Implementasi Aromaterapi Mawar Untuk Mengurangi Kecemasan Pre Operasi Pada Pasien Sectio Caesarea Dengan Anestesi Spinal

Introduction: A cesarean section is a risky operation that could make some people anxious. Failure to alleviate patient anxiety during a cesarean section might compromise the patient's ability to undergo the procedure since it affects their circulatory, gastrointestinal, respiratory, and muscular systems. Rose aromatherapy is one of the non-pharmacological methods that may be used to manage anxiety prior to surgery. Objective: Patients undergoing spinal anesthesia for a caesarean section might benefit from this community service project's non-pharmacological methods of anxiety reduction, which included the use of rose aromatherapy. Method: As a community service project, we inhale rose aromatherapy for four minutes after placing a cotton ball about two centimeters from the patient's nose and adding six drops of rose aromatherapy to it. Result: According to the findings of this community service project, thirteen participants (43.3%) reported moderate anxiety and seventeen (56.7%) reported severe anxiety prior to the use of rose aromatherapy. A total of 11 subjects (36.7%) reported mild anxiety, 18 reported moderate anxiety (60%) and 1 reported severe anxiety (3.3%) after receiving rose aromatherapy. Conclusion: Based on the results of this Community Service activity, it can be concluded that rose aromatherapy can reduce preoperative anxiety in patients who will perform sectio caesarea.

Study on the application of segmented nursing pathway in daytime anorectal surgery patients.

Standardised management of day surgery for haemorrhoids and achieving standardised nursing in the painless ward of colorectal surgery are important. To explore the role of segmented nursing pathways in patients undergoing day surgery for anorectal procedures and to provide theoretical and practical guidance for day surgery nursing. A total of 146 patients undergoing anorectal surgery in our day surgery ward between April 2023 and July 2023 were selected as the study participants, with 74 patients in the control group receiving routine nursing and 72 patients in the experimental group receiving segmented nursing. The preoperative preparedness, preoperative anxiety, complication rate, discharge preparedness and nursing satisfaction were compared between the two groups. The experimental group had higher rates of admission before 8:30 am (77.78% vs 45.95%), awareness of the day surgery process (63.89% vs 24.32%), completion rate of preoperative preparation (81.94% vs 59.46%), satisfaction with preoperative preparation (94.44% vs 74.32%), discharge preparedness (112.42 ± 3.28 vs 95.82 ± 3.41) and nursing satisfaction (97.22% vs 70.27%) compared with the control group (P< 0.05). After the intervention, the self-rating anxiety scale score (43.14 ± 12.44 vs 52.51 ± 13.21) and the self-rating depression scale score (45.03 ± 11.37 vs 55.37 ± 10.14) were lower in the experimental group than in the control group (P< 0.05). Segmented nursing pathways can improve the preoperative preparedness of patients undergoing day surgery for anorectal procedures, alleviate patient anxiety, enhance discharge preparedness, improve the quality of nursing care and increase nursing satisfaction.

Evaluating psychological anxiety in patients receiving radiation therapy using smartwatch.

Patients undergoing radiation therapy (RT) often experience psychological anxiety that manifests as muscle contraction. Our study explored psychological anxiety in these patients by using biological signals recorded using a smartwatch. Informed consent was obtained from participating patients prior to the initiation of RT. The patients wore a smartwatch from the waiting room until the conclusion of the treatment. The smartwatch acquired data related to heart rate features (average, minimum, and maximum) and stress score features (average, minimum, and maximum). On the first day of treatment, we analyzed the participants' heart rates and stress scores before and during the treatment. The acquired data were categorized according to sex and age. For patients with more than three days of data, we observed trends in heart rate during treatment relative to heart rate before treatment (HRtb) over the course of treatment. Statistical analyses were performed using the Wilcoxon signed-rank test and paired t-test. Twenty-nine individuals participated in the study, of which 17 had more than 3 days of data. During treatment, all patients exhibited elevated heart rates and stress scores, particularly those in the younger groups. The HRtb levels decreased as treatment progresses. Patients undergoing RT experience notable psychological anxiety, which tends to diminish as the treatment progresses. Early stage interventions are crucial to alleviate patient anxiety during RT.

Comparison of Sonographic Findings with Diagnostic Mammography.

Breast cancer is the leading female cancer worldwide with a high mortality rate. Early detection of the suspicious lesion is crucial for better prognosis. Higher breast density decreases the sensitivity of mammogram. Ultrasound can differentiate between cystic and solid masses and further characterize these as benign or possibly malignant. Our objective was to compare the findings of sonography with diagnostic mammography. This was a cross sectional study including 125 females who underwent diagnostic mammogram in a tertiary care center. The mammograms were evaluated and the patients were scanned by ultrasound and categorized as per ACR- BIRADS category. The findings of diagnostic mammography were compared with that of ultrasonography using SPSS version 25. The heterogeneously dense breast in diagnostic mammography corresponded to the heterogenous- fibroglandular breast in ultrasonography. In majority, ultrasound increased the BIRADS category for the lesion than designated by the diagnostic mammography. It was particularly useful for category 0 and 3 lesions which were indeterminate and required further imaging. Ultrasound was useful in evaluation of dense breasts with ACR-BIRADS 0 and 3 in diagnostic mammogram. For category 3 and 4 in diagnostic mammogram, ultrasound showed category 1 or 2 lesions which aided to alleviate patient anxiety and avoid unnecessary biopsies. With emerging technological advances in ultrasound, it can used as a powerful tool for breast lesion detection and patient management.

Hypoparathyroidism update.

Since the release of the 2022 Second International Workshop Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines, updates and advances are now available in the cause, complications, and treatment of adult chronic hypoparathyroidism (hypoPTH). This review aims to highlight these new findings and implications to patient care. Postsurgical hypoparathyroidism remains the most common cause, immune-related hypoparathyroidism from checkpoint inhibitors is an emerging autoimmune cause. In a large retrospective cohort study of thyroidectomies, incident fracture was lower, particularly in the vertebra, in the hypoPTH cohort, compared with postthyroidectomy control group. Hypercalciuria increases risk for renal calculi in hypoPTH independent of disease duration and treatment dose. Quality of life is impaired in hypoPTH patients on conventional therapy, improvement was noted post-PTH replacement. TranCon PTH phase 3 RCT reported eucalcemia with reduced renal calcium excretion, normalization of bone turn-over markers, stable BMD and improved quality of life. HypoPTH is a chronic disease associated with significant morbidity and poor Quality of Life. Awareness of treatment targets and follow-up investigations can alleviate patient anxiety regarding over-treatment and under-treatment. Progress in long-acting PTH replacement strategies might provide accessible, feasible alternatives to conventional therapy in brittle hypoPTH patients.

Microjet wound therapy versus sharp debridement on wound size reduction: a pilot randomised controlled trial.

There are several methods of treating hard-to-heal (chronic) wounds, each differing in terms of efficiency, selectivity, speed, cost and pain. The objective is to activate a wound to initiate the healing cascade. For this pilot study we assessed the feasibility of a new microjet wound therapy technology compared to standard sharp debridement in wound outcomes. A randomised, controlled, open-label pilot study was conducted in one outpatient wound clinic in Western Switzerland from March 2022 to May 2023. A total of 13 consecutive patients were randomly assigned to receive either microjet wound therapy (n=5) or standard mechanical debridement with instruments (n=8). As a feasibility study, there was insufficient power to detect significant differences between the groups. However, in the intervention group, our analysis may indicate a modestly faster reduction in wound area. Microjet wound therapy appears to alleviate patient anxiety and offer cost savings due to the potential for reduced time, as well as the number of required treatments. This meant fewer overall consultations. This study highlights a trend that may indicate that microjet therapy holds value in promoting faster healing of hard-to-heal wounds, and it provides a feasibility basis for a sufficiently powered multicentre trial.

Pharmacokinetics, Pharmacodynamics, and Side Effects of Midazolam: A Review and Case Example.

Midazolam, a short-acting benzodiazepine, is widely used to alleviate patient anxiety, enhance compliance, and aid in anesthesia. While its side effects are typically dose-dependent and manageable with vigilant perioperative monitoring, serious cardiorespiratory complications, including fatalities and permanent neurological impairment, have been documented. Prolonged exposure to benzodiazepines, such as midazolam, has been associated with neurological changes in infants. Despite attempts to employ therapeutic drug monitoring for optimal sedation dosing, its efficacy has been limited. Consequently, efforts are underway to identify alternative predictive markers to guide individualized dosing and mitigate adverse effects. Understanding these factors is crucial for determining midazolam's suitability for future administration, particularly after a severe adverse reaction. This article aims to elucidate the factors influencing midazolam's pharmacokinetics and pharmacodynamics, potentially leading to adverse events. Finally, a case study is presented to exemplify the complex investigation into the causative factors of midazolam-related adverse events.

Personal versus therapist perioperative music intervention: a randomized controlled trial.

Music interventions can alleviate patient anxiety and improve post-surgical satisfaction. However, it remains uncertain whether personal music preferences affect efficacy. The authors tested whether personal music intervention with patient-selected songs played ad libitum is more effective than standard therapist-designed treatment with classical music. A prospective, parallel-group, single-blinded, randomized controlled trial with 229 participants (aged 18-60years) previously scheduled for elective surgery. Data analyses followed a modified intention-to-treat principle. The patients were randomized into three groups: Standard care without music (Control), therapist-designed classic music treatment (TT), or personal music intervention with patient-selected songs played ad libitum by the patient (PI). All patients received standard post-anaesthesia care, and music intervention was started upon arrival at the post-anaesthesia care unit. Primary outcomes were anxiety and overall satisfaction at discharge. In contrast, secondary outcomes were systolic blood pressure during music intervention, the sleep quality of the night after surgery, and the occurrence of postoperative nausea and vomiting within the first 24 h after surgery. Compared with therapist-designed music treatment, personal intervention decreased systolic blood pressure (T 0 : 124.3±13.7, 95% CI:121-127.7; T 20min : 117.6±10.4, 95% CI:115-120.1; T 30min : 116.9±10.6, 95% CI:114.3-119.4), prevented postoperative nausea and vomiting (Control: 55.9%, TT: 64.6%, PI: 77.6%), including severe postoperative nausea (VAS score>4; Control: 44.1%; TT: 33.8%; PI: 20.9%) and severe emesis (Frequency≥3, Control: 13.2%; TT: 7.7%; PI: 4.5%). None of the treatments affected sleep quality at night after surgery (Median, Q1-Q3, Control: 3, 1-3; TT: 3, 1-4; PI: 3, 1-3.5). Personal, but not therapist, music intervention significantly prevented anxiety (Control: 36.4±5.9, 95% CI:35.0-37.9; TT: 36.2±7.1, 95% CI: 34.4-37.9; PI: 33.8±5.6, 95% CI: 32.4-35.2) and emesis (Control: 23.9%; TT: 23.4%; PI: 13.2%) and improved patient satisfaction (Median, Q1-Q3, C: 8, 6-8; TT: 8, 7-9; PI: 8, 7-9). Personal music intervention improved postoperative systolic blood pressure, anxiety, nausea, emesis, and overall satisfaction, but not sleep quality, as compared to therapist-designed classic intervention.

Biomarker combination predicting imminent relapse after discontinuation of biological drugs in patients with rheumatoid arthritis in remission.

Compared to conventional disease-modifying antirheumatic drugs (DMARDs), biological DMARDs demonstrate superior efficacy but come with higher costs and increased infection risks. The ability to stop and resume biological DMARD treatment while maintaining remission would significantly alleviate these barriers and anxieties. The objective of this study was to identify biomarkers that can predict an imminent relapse, hopefully enabling the timely resumption of biological DMARDs before relapse occurs. Forty patients with rheumatoid arthritis who had been in remission for more than 12 months were included in the study. The patients discontinued their biological DMARD treatment and were monitored monthly for the next 24 months. Out of the 40 patients, 14 (35%) remained in remission at the end of the 24-month period, while 26 (65%) experienced relapses at different time points. Among the relapse cases, 13 patients experienced early relapse within 6 months, and another 13 patients had late relapse between 6 months and 24 months. Seventy-three cytokines in the sera collected longitudinally from the 13 patients with late relapse were measured by multiplex immunoassay. Using cytokines at two time points, immediately after withdrawal and just before relapse, volcano plot and area under the receiver operating characteristic curves (AUC) were drawn to select cytokines that distinguished imminent relapse. Univariate and multivariate logistic regression analyses were used for the imminent relapse prediction model. IL-6, IL-29, MMP-3, and thymic stromal lymphopoietin (TSLP) were selected as potential biomarkers for imminent relapse prediction. All four cytokines were upregulated at imminent relapse time point. Univariate and multivariate logistic regression showed that a combination model with IL-6, MMP-3, and TSLP yielded an AUC of 0.828 as top predictors of imminent relapse. This methodology allows for the prediction of imminent relapse while patients are in remission, potentially enabling the implementation of on- and off-treatments while maintaining remission. It also helps alleviate patient anxiety regarding the high cost and infection risks associated with biological DMARDs, which are the main obstacles to benefiting from their superb efficacy.

Penile dermatology for the general practitioner: A pragmatic approach to diagnosis and management.

Genital skin conditions are rare and posea diagnostic challenge due to their diverse pathology. Patient anxiety and referral decisions add complexity for primary caregivers. Demographics and overlapping symptoms complicate diagnosis, causing anxiety for both patients and clinicians. Social stigma and apprehension to seek healthcare might delay treatment. Accurate differentiation between benign and potentially serious conditions is crucial. We aim to provide clinicians with a clear and concise framework to assist them in risk stratification, treatment decisions and referral pathways for common genital skin conditions. Differentiating normal variations is crucial to minimise unnecessary investigations and alleviate patient anxiety. Circumcision status, pigmentation and genetics influence disease presentation. We highlight benign conditions for reassurance. Inflammatory genital lesions might arise from various causes. Biopsies remain essential for accurately diagnosing uncertain cases. Sexually transmitted infections (STIs) should be promptly diagnosed and treated. Neoplastic conditions can evolve rapidly, requiring an urgent specialist referral.

Biopsy or no biopsy? Risk of Malignancy in Thyroid Nodules Based on TI-RADS Criteria

Purpose: To assess the risk of malignancy in thyroid nodules recommended for biopsy using the American College of Radiology (ACR) Thyroid Imaging Reporting &amp; Data System (TIRADS).&#x0D; Methods: We conducted a retrospective review of ultrasound (US) guided thyroid biopsies performed from 2018- 2023 at IU Health hospitals for nodules which were recommended for biopsy based on ACR TI-RADS criteria and compared with histopathology results. The research was conducted at University and Methodist Hospital radiology reading rooms.&#x0D; Results: Of the total 210 thyroid nodules recommended for biopsy, only 8.57% of nodules biopsied were malignant. Positive malignancy rate for TR-3 was 10.2%, TR-4 was 7.1%, and TR-5 was 12.5%. TR-3 nodules less than 2.9 cm were all benign on histopathology. TR-4 nodules less than 1.5 cm were all benign on histopathology. TR-5 nodules were all benign on histopathology. The most common malignancy was papillary thyroid carcinoma.&#x0D; Conclusion: ACR TI-RADS is currently the standard of care for guidelines and lexicon for radiologists for characterizing thyroid nodules. Our results demonstrate that all TR-3 nodules less than 2.9 cm were all benign and most of the TR-4 and TR-5 nodules biopsied were benign on histopathology. The lower biopsy rate for positive malignancy even for TR-4 and TR-5 nodules respectively raises the need for revision for existing TI-RADS criteria, as more nodules could be followed up with ultrasound rather than percutaneous biopsy, which will alleviate patient anxiety as well as decrease overall healthcare costs.

Robust evidence reveals the reliable rate of normal/balanced embryos for identifying reciprocal translocation and Robertsonian translocation carriers.

We aimed to evaluate the reliable rate of normal/balanced embryos for reciprocal translocation and Robertsonian translocation carriers and to provide convincing evidence for clinical staff to conduct genetic counselling regarding common structural rearrangements to alleviate patient anxiety. The characteristics of 39,459 embryos that were sourced from unpublished data and literature were analyzed. The samples consisted of 17,536 embryo karyotypes that were not published and 21,923 embryo karyotypes obtained from the literature. Using the PubMed, Cochrane Library, Web of Science, and Embase databases, specific keywords were used to screen the literature for reciprocal translocation and Robertsonian translocation. The ratio of normal/balanced embryos in the overall data was calculated and analyzed, and we grouped the results according to gender to confirm if there were gender differences. We also divided the data into the cleavage stage and blastocyst stage according to the biopsy period to verify if there was a difference in the ratio of normal/balanced embryos. By combining the unpublished data and data derived from the literature, the average rates of normal/balanced embryos for reciprocal translocation and Robertsonian translocation carriers were observed to be 26.96% (7953/29,495) and 41.59% (4144/9964), respectively. Reciprocal translocation and Robertson translocation exhibited higher rates in male carriers than they did in female carriers (49.60% vs. 37.44%; 29.84% vs. 27.67%). Additionally, the data for both translocations exhibited differences in the normal/balanced embryo ratios between the cleavage and blastocyst stages of carriers for both Robertsonian translocation and reciprocal translocation (36.07% vs 43.43%; 24.88% vs 27.67%). The differences between the two location types were statistically significant (P < 0.05). The normal/balanced ratio of embryos in carriers of reciprocal and RobT was higher than the theoretical ratio, and the values ranged from 26.96% to 41.59%. Moreover, the male carriers possessed a higher number of embryos that were normal or balanced. The ratio of normal/balanced embryos in the blastocyst stage was higher than that in the cleavage stage. The results of this study provide a reliable suggestion for future clinic genetic consulting regarding the rate of normal/balanced embryos of reciprocal translocation and Robertsonian translocation carriers.

Surgical sensation during caesarean section: a qualitative analysis

BackgroundCaesarean section (CS) is a major abdominal surgery performed usually on a young and healthy population under neuraxial anesthesia with little to no sedation. This creates a distinct surgical experience whereby patients are aware of the surgical process, physical sensations, and their environment. This study aimed to provide an in-depth descriptive assessment of subjective surgical experience during CS under regional anaesthesia. We expected the information gained would enhance our current understanding and better alleviate patient anxiety through informed counselling. MethodsThis qualitative descriptive study was conducted at a Canadian academic centre. Twenty patients participated in semi-structured interviews within a week of CS, using an interview guide developed for this study. Patient medical records were reviewed to collect demographic and surgical information. Thematic analysis was conducted using an inductive approach to determine common themes. ResultsNine themes were identified. Five themes were identified in the category of surgical sensation and four themes were identified in the category of peri-operative education. ConclusionsPatients commonly experienced pressure and movement sensations at varying intensity, and most did not experience pain. Environmental factors, including sounds and distraction by the newborn, affected perception of surgical sensation. Patients wish to receive pre-operative counselling regarding potential surgical sensations, as well as ongoing communication from their anaesthesiologist. These results can be used to guide informed discussions with patients and direct further investigation in this area.

Role of detailed information about anaesthesia during PAC to reduce patient’s anxiety during the perioperative period

ABSTRACT Background: Perioperative anxiety may adversely influence anaesthetic induction and patient’s recovery. Pharmacological interventions include the use of narcotics, sedatives and anxiolytics. However, such drug interventions are typically accompanied by adverse reactions. Perioperative anxiety experienced by patients can be significantly diminished through the provision of comprehensive information regarding the anaesthesia procedure, surgical procedure and perioperative events during the pre-anaesthetic assessment conducted in an outpatient consultation clinic. Aims: This prospective study was conducted to assess the impact of providing comprehensive information on alleviating patient anxiety throughout the perioperative period. Materials and Methods: This prospective observational study was conducted on 60 patients to assess patient’s perioperative anxiety for anaesthesia and surgery. All study participants were asked to mark their pre-operative anxiety on the Visual Analogue Scale-Anxiety (VAS-A) and asked to fill the questionnaire of Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Results: During the pre-information evaluation, patient’s mean VAS-A score was 4.73 ± 2.75 which decreased to 3.65 ± 2.53 in post-information evaluation (P = 0.027). The overall APAIS score during pre-information and post-information evaluation was 17.4 ± 8.06 and 13.18 ± 7.06 (P = 0.002). The mean APAIS score for anaesthesia and surgery during the pre-information evaluation was 2.67 ± 1.46 and 3.13 ± 1.54, respectively, which decreased to 2.04 ± 1.18 and 2.35 ± 1.30, respectively, in post-information evaluation. This difference in APAIS score evaluation during pre-information and post-information evaluation for anaesthesia (P = 0.0105) and surgery (P = 0.003) was statistically significant. Conclusion: Perioperative anxiety experienced by patients can be effectively mitigated by providing comprehensive information pertaining to anaesthesia procedures, surgical procedures and perioperative events during the pre-anaesthetic assessment conducted within an outpatient consultation clinic.

WTP8.8 Granulomatous Mastitis: A Service Evaluation

Abstract Introduction Granulomatous mastitis (GM) is a benign, recurrent, inflammatory disease affecting the breast. There is a lack of strong evidence to support guidelines for management of this distressing condition. We performed an exploratory review of assessment and management of GM over a five-year period in a large teaching hospital breast unit. Methods This retrospective, observational cohort study included all cases of GM diagnosed from 2015-present. Data collection included patient demographics, presentation, assessment and management. Patient breast clinic attendance, total time spent in outpatient appointments related to GM, and other speciality input was also noted. Results 19 patients were identified with GM on tissue biopsy (median age 41 years). 53% belonged to black and other ethnic minorities, 47% were Caucasian. 63% had no co-morbidities. 90% were non-smokers. 10% had bilateral and 38% multifocal disease. Most patients scored R3/ U3 or above on imaging. 58% of the cohort attended outpatients for a period greater than 7 months. There was also considerable heterogeneity in both assessment and management approaches. Conclusion The results demonstrate the significant morbidity and burden of care associated with Granulomatous Mastitis. Multidisciplinary care is necessary for both diagnosis and management. Bespoke, individualised patient information including a record of all medical input into assessment and management may help to alleviate patient anxiety and streamline care between multiple medical teams.

Clinical Significance of Action Research-Based Seamless Care to Improve Imaging Efficiency and Patients' Cognition, and Alleviate Patient Anxiety.

The present study was undertaken to assess the clinical significance of action research-based seamless care to improve imaging efficiency and alleviate patient anxiety. A total of eighty patients who underwent imaging examinations in our hospital between May 2019 and November 2020 were recruited for this study. The patients were randomly assigned to two groups: the control group receiving routine care and the observation group receiving seamless care based on action research. The random assignment was conducted using a simple random sampling technique, ensuring an equal allocation of participants to each group at a 1:1 ratio, resulting in 40 cases in each group. Outcome measures included imaging examination duration, mean nursing duration, examination cognition, and negative emotion scores. Seamless care provided shorter imaging examination duration and nursing duration, and better ensured uneventful examinations than routine care (P<0.05). Patients given seamless care exhibited higher examination cognition versus those receiving routine care (P<0.05). Seamless care offered more mitigation of negative emotions for patients than routine care (P<0.05). Action research-based seamless care effectively improves imaging efficiency and patients' awareness of imaging examinations and contributes to alleviating patients' adverse events.

Clinical Significance of Action Research-Based Seamless Care to Improve Imaging Efficiency and Patients' Cognition, and Alleviate Patient Anxiety [Letter

Clinical Significance of Action Research-Based Seamless Care to Improve Imaging Efficiency and Patients' Cognition, and Alleviate Patient Anxiety [Letter

BH04 Review of a dermatology nurse-led hair service

Abstract In 2017, our department was faced with a significant delay in new patient waiting times for the tertiary hair and nails clinic. A nurse-led service was developed to relieve this pressure. Within 18 months, the waiting list was much more manageable at less than 12 weeks, an improvement that has been maintained. The nurse-led service was designed predominantly to see and treat patients with alopecia areata. We present details of the nurse training and clinic setup. Three years after the setup of the nurse-led hair clinic, we reviewed this service. The aims of this review were to assess the capacity of the nurse-led hair clinic, the clinical outcome and the psychological impact. A review of all patients seen between November 2021 and October 2022 is presented. The total number of patients seen was 130. The majority had focal alopecia areata (90%). Clinical outcome measures were recorded using the Severity of Alopecia Tool score and Alopecia Areata Investigator Global Assessment. Psychological outcome measures were assessed using the Dermatology Life Quality Index and a patient questionnaire. The majority (72%) were treated with intralesional triamcinolone; 5% received a wig. The aim is to treat and discharge, while enabling easy access back into the service. It was hoped that this pathway would alleviate patient anxiety on discharge. All patients reported that they found it easy/very easy to be referred correctly by their general practitioner. The majority of returning patients had been given a clear explanation of the rereferral process on discharge. All reported an excellent or good service. More than 90% answered positively when asked whether the nurse listened, addressed fears/concerns and provided adequate verbal and written information. Sixty-two per cent remember being signposted to a relevant support group and all were satisfied with their treatment. We will present written information provided by the patients on what they found most useful about the clinic and how the clinic could be improved. We show the success of a nurse-led service that has addressed capacity issues and clinical management and provides emotional support. The detail presented will be sufficient to guide other departments on training and clinic setup when developing such a service.

P003 A dedicated short MRI protocol for assessing synovitis: evaluating patient acceptability and rheumatologist perceptions

Abstract Background/Aims Magnetic resonance imaging (MRI) plays an increasingly important role in diagnosing and monitoring patients with inflammatory arthropathies due to its ability to detect early, sometimes subclinical, inflammatory changes, including synovitis. It is a sensitive, accurate and relatively non-operator dependent modality. However, it is typically perceived as expensive and time-consuming, and is used infrequently for evaluation of synovitis in clinical care. MRI is thought to be generally well-tolerated by patients, however, there is a paucity of research on patient experience of MRI, particularly in rheumatology where patients may have complex and/or chronic pain. To improve the acceptability, cost-effectiveness and overall utility of MRI for clinicians and patients, we introduced a short synovitis MRI protocol (MRI-SSP) for rapid assessment of synovitis in the hands and feet. Here, we evaluated the acceptability of MRI-SSP to patients and the perceived utility of the protocol for rheumatologists. Methods Different structured questionnaires were designed for patients and rheumatologists which contained qualitative (free-text) and quantitative (five-point Likert-scale) questions. All patients undergoing MRI-SSP of the hand or wrist at University College London Hospital (UCLH) between 01/02/22 to 01/07/22 were prospectively invited to participate and completed the questionnaire via telephone within four weeks of their scan. All rheumatologists at our centre were invited to respond to an online questionnaire. Likert scores were analysed quantitatively and thematic analysis was performed on free-text comments. Results Patient experience - 30 patients agreed to participate (mean age 48 years, range 21-74; 87% female). Average patient Numerical Pain Rating Scale score was 5.1/10 (range 1-10). We found that: 90% found the scan length acceptable; 90% had no or mild side-effects from intravenous contrast; 40% had no pain during the scan; 57% had no anxiety during the scan; 97% found the scan acceptable overall; 97% would be happy to have the scan again; scan length and comfort were important for patients; good radiographer communication helped to alleviate patient anxiety. Rheumatologist perception - 10 rheumatologists responded. Of these, 40% perform ultrasound to assess for synovitis in clinic. We found that: 90% strongly agreed that the MRI-SSP report was helpful in answering clinical questions; 90% strongly agreed that the MRI-SSP influenced clinical decision making; there was a mixed response regarding which modality rheumatologists preferred for assessing synovitis (40% no preference, 30% MRI, 30% ultrasound) and this was independent of which rheumatologists performed ultrasound in clinic. Conclusion Overall, patients found MRI-SSP to be an acceptable investigation, and rheumatologists felt it helpful in clinical decision-making. Important factors affecting patient acceptability were scan length and comfort. In general, our results suggest that dedicated short MRI scanning protocols have the potential to improve the acceptability and accessibility of MRI for rheumatology patients. Disclosure N. Thorley: None. L. Dwyer-Hemmings: None. S. Singh: None. T.J.P. Bray: None. L. Bida: None. M.A. Hall-Craggs: None.

Prostate-specific Antigen Levels Following Brachytherapy Impact Late Biochemical Recurrence in Japanese Patients With Localized Prostate Cancer.

Evaluation of long-term outcomes is essential for the successful treatment of localized prostate cancer; however, the risk of late recurrence following brachytherapy is still not clear. This study aimed to evaluate the long-term outcomes of low-dose-rate brachytherapy (LDR-BT) for localized prostate cancer in Japanese patients and identify factors associated with late recurrence after treatment. This single-center, cohort study included patients who underwent LDR-BT at the Tokushima University Hospital in Japan between July 2004 and January 2015; 418 patients, who were followed-up at least 7 years after LDR-BT, were included in the study. Biochemical progression free survival (bPFS) was defined according to the Phoenix definition (nadir PSA+2 ng/ml) and bPFS and cancer specific survival (CSS) were calculated using Kaplan-Meier survival curves. Univariate and multivariate analyses were performed using Cox proportional hazard regression models. Approximately half of the patients with PSA >0.5 ng/ml at 5 years after LDR-BT had a recurrence within the next 2 years. However, only 1.4% of the patients with a PSA ≤0.2 ng/ml at 5 years post-treatment showed tumor recurrence, including those at high risk of treatment failure according to the D'Amico classification. In multivariate analysis, PSA level at 5 years post-treatment was the only predictor of late recurrence after 7 years of treatment. PSA levels at 5 years post-treatment were associated with long-term recurrence of localized prostate cancer, which can help alleviate patient anxiety concerning prostate cancer recurrence if PSA levels remain low at 5 years after LDR-BT.