Patient Activation Scores Research Articles

Correlation of Paraoxonase Status with Disease Activity Score and Systemic Inflammation in Rheumatoid Arthritic Patients.

Despite, various preventive efforts on conventional cardiovascular disease (CVD) risk factors, the incidence of CVD in rheumatoid arthritis (RA) patients increases continuously. To solve this conundrum one needs more investigations. The present study was conducted to evaluate the plasma paraoxonase (PON) activity along with the markers of systemic inflammation, oxidative stress and disease activity score-28 (DAS28) in RA patients and clarify their role in determining the probability of RA patients to develop future CVD risk. Plasma PON, total antioxidant activity (TAA), C-reactive protein (CRP), synovial interleukin-6 (IL-6) and erythrocyte malondialdehyde (MDA) levels were estimated in 40 RA patients aged 40-55 years aged and 40 age-matched healthy controls. The data obtained were compared statistically by using Student's t-test and Pearson correlation test. Besides dyslipidaemia, marked reduction in plasma PON and TAA (p< 0.05) were observed in RA patients as compared with that of healthy controls. Erythrocyte MDA, plasma CRP and synovial IL-6 levels were increased significantly (p<0.05) in RA patients. PON was negatively correlated with MDA (r = - 0.672; p < 0.001), CRP (r = -0.458; p<0.05), IL-6 (r = -0.426; p<0.05) and DAS28 (r = -0.598; p < 0.001), and positively correlated with HDL cholesterol (r = 0.648; p<0.001) and TAA (r = 0.608; p< 0.001) levels in RA patients. Alteration in PON activity might contribute to the progression of future CVD risk in RA patients, which may result from interplay of several confounding factors, such as inflammation, oxidative stress and dyslipidaemia. Furthermore, plasma PON activity, CRP and TAA levels could be considered as non-traditional factors to predict CVD risk. Thus, it is suggested that future drugs could be developed to target the non-traditional risk factors in RA patients.

A Patient Portal With Electronic Messaging: Controlled Before-and-After Study.

BackgroundPatients’ access to their medical records, along with electronic messaging, offers an efficient means of information transition between patients and their caregivers. Easier access to information and interaction with health care professionals may reduce use of other services while increasing patients’ activation in the management of their own health. Patient portals may therefore have a favorable impact on the cost-effectiveness of care.ObjectiveThe aim was to assess the benefits and risks of providing electronic messaging services to patients with chronic conditions. Using cost-effectiveness analysis, the outcomes and costs of providing access to an electronic patient portal were evaluated in a real-life treatment process in primary care.MethodsA total of 876 chronically ill patients from public primary care were allocated to either an intervention group receiving immediate access to a patient portal that included their medical records, care plan, and secure messaging with a care team, or to a control group receiving standard care. Incremental direct heath care costs, health status based on the Short-Form Health Survey, version 2 (SF-36v2), and patient activation based on the short form of the Patient Activation Measure (PAM13) were compared to standard care in a 6-month follow-up. Incremental cost-effectiveness ratios were calculated using a sample of 80 patients in the intervention group and 57 patients in the control group; thus, a total of 137 patients were included in the final analysis. Propensity-score matching was used to assess the sensitivity of the results to the possible attrition bias.ResultsPatient activation improved more in the intervention group but the effect was not statistically significant. The effect on cost of care was ambiguous; costs decreased by an average of €91 in the unadjusted model, but increased by €48 in the adjusted model. Due to the controversial results on cost, the unadjusted analysis showed an 89% probability of cost-effectiveness with no willingness to pay for increased patient activation, whereas in the adjusted sample, the probability of the portal being more cost-effective than care as usual exceeded 50% probability at a willingness to pay €700 per clinically significant increase in patient activation score. There was no marked short-term impact on health status based on the SF-36v2 measure.ConclusionsOffering the possibility to substitute health care visits with less costly contacts using self-management tools did not seem to compromise the health status or treatment of chronic care patients. Patient activation increased, and this could be achieved with moderate costs in a short-term experiment. In the long term, increased activation is proposed to lead to better health outcomes and eventually cut down resource use. Future studies should assess the long-term effects of patient portals on patients’ health status and cost of care.

Brief report: enhancement of patient recruitment in rheumatoid arthritis clinical trials using a multi-biomarker disease activity score as an inclusion criterion.

ObjectiveRheumatoid arthritis (RA) clinical trials often exclude patients who have low C‐reactive protein (CRP) levels, which slows enrollment into the trial. The purpose of this study was to determine whether high Multi‐Biomarker Disease Activity (MBDA) scores (>44) in RA patients with low CRP levels (≤10 mg/liter) could be used as a complement to CRP levels >10 mg/liter to enhance patient recruitment without affecting clinical trial outcomes.MethodsWe evaluated patients from the Swedish Pharmacotherapy (SWEFOT) trial, which did not include any selection criteria for CRP levels. Clinical outcomes were assessed after 3 months of methotrexate (MTX) monotherapy in MTX‐naive RA patients (n = 220) and after 3–10 months of add‐on therapy in patients who were incomplete responders to MTX alone (MTX‐IR) (n = 127). Radiographic outcomes were assessed at 1 year in all patients. Within each cohort, the outcomes were compared between patients with a CRP level of ≤10 mg/liter and an MBDA score of >44 at the start of the respective treatment interval versus those with a CRP level of >10 mg/liter.ResultsPatients with both a CRP level of ≤10 mg/liter and an MBDA score of >44 at baseline had clinical and radiographic outcomes that were comparable to those in patients with a CRP level of >10 mg/liter at baseline. This broadened definition of the inclusion criteria identified an additional 24% of patients in the MTX‐naive cohort and 47% in the MTX‐IR cohort.ConclusionPatient recruitment into RA clinical trials may be substantially enhanced, without any decrease in clinical and radiographic outcomes, by using as an inclusion criterion “a CRP level of >10 mg/liter and/or an MBDA score of >44.”

Patient Activation: A Primary Care Tool to Tackle Overweight and Obesity.

A June 2015 report published in JAMA Internal Medicine found that, in the period between 2007 and 2012, 75% of U.S. men and 67% of U.S. women ≥25 years of age were overweight or obese (1). Because overweight and obesity are associated with type 2 diabetes and other chronic conditions, preventing weight gain and facilitating weight loss can do much to prevent type 2 diabetes and improve health outcomes in individuals with diabetes. Primary care providers (PCPs) provide care to the majority of individuals in the United States, meaning that they see more overweight and obese than normal-weight individuals in their practice every day. As a result, PCPs are crucial to efforts to stop or reverse this alarming trend. During the same time period, primary care patients were followed in a large, longitudinal study of the role of patient activation in improving health outcomes and reducing costs (2). Patient engagement and activation are central pillars of health policy, based on evidence that links better health outcomes with more engaged and activated patients (3). Higher patient activation scores at the beginning of the …

Compressive Optic Neuropathy and Repeat Orbital Decompression

To characterize the presenting characteristics, preoperative clinical activity score (CAS), surgical approach, and visual outcomes in patients with thyroid eye disease undergoing repeat orbital decompression for recurrent or recalcitrant compressive optic neuropathy (CON). The medical records of patients with recurrent or recalcitrant CON undergoing repeat orbital decompressions were retrospectively reviewed. The primary outcome measures included pre- and postoperative Humphrey visual field mean deviation, visual acuity (VA) measured in logarithm of the minimal angle of resolution, color vision measured by Ishihara plates, and presence of relative afferent pupillary defect. Details of the surgical procedure and each patient's CAS at presentation were also recorded. Six patients, 9 orbits, with a mean preoperative CAS of 3.8 were included in this review. The mean time between initial decompression and presentation to our center for recurrent or persistent CON symptoms was 8.6 years (range, 1 to 15 years). At presentation, the average Humphrey visual field mean deviation was -16.5 (standard deviation: 8.8), improving to -3.8 (2.4) postoperatively with a mean of 9.3 months follow up (mean improvement of 75%). Preoperative VA was 0.34 (0.23) LogMAR, improving to 0.05 (0.10) LogMAR with a mean follow up of 10.4 months. Pre- to postoperative comparisons of clinical measures all showed statistically significant improvement (p < 0.05). Eight eyes presented with decreased VA (any VA < 20/20), 4 with decreased color vision (any color vision < 11), and 1 with a relative afferent pupillary defect, and all these patients demonstrated improvement following repeat orbital decompression. In patients with thyroid eye disease, symptoms of recurrent CON occurred up to 15 years following initial orbital decompression underscoring the smoldering, progressive nature of the disease. Repeat decompression that focused on the orbital apex resulted in visual improvement in all 6 patients. Despite clinical evidence of CON, the mean CAS of these patients at presentation was only 3.8, highlighting the importance of close monitoring of patients with thyroid eye disease following decompression regardless of the external manifestations of disease activity.

The long-term effect on mental health symptoms and patient activation of using patient feedback scales in mental health out-patient treatment. A randomised controlled trial

ObjectiveTo investigate the long-term effect on mental health symptoms and patient activation, from using the Partners for Change Outcome Management System (PCOMS) feedback scales in out-patient mental health consultations, compared to not using feedback scales. MethodsAn open parallel-group randomised controlled trial was conducted in a mental health hospital in Norway. Eight therapists treated the intervention group, using two feedback scales, and seventeen therapists treated the treatment as usual group. ResultsSeventy-five patients participated. Six and twelve months after starting treatment there were no significant effects on the primary outcomes mental health symptoms or patient activation. Compared to baseline assessment the PCOMS group had significantly improved their patient activation scores after twelve months. ConclusionWe found no long-term effects from using the PCOMS scales on mental health symptoms or patient activation. Practice implicationsThis study shows that the use of a feedback system does not increase mental health outcomes or patient activation.

Association of neopterin as a marker of immune system activation and juvenile rheumatoid arthritis activity

ObjectiveTo evaluate neopterin plasma concentrations in patients with active juvenile idiopathic arthritis (JIA) and correlate them with disease activity. MethodsSixty patients diagnosed as active JIA, as well as another 60 apparently healthy age‐ and gender‐matched children as controls, were recruited from the Pediatrics Allergy and Immunology Clinic, Ain Shams University. Disease activity was assessed by the Juvenile Arthritis Disease Activity Score 27 (JADAS‐27). Laboratory investigations were performed for all patients, including determination of hemoglobin concentration (Hgb), erythrocyte sedimentation rate (ESR), and C‐reactive protein. Serum concentrations of tumor necrosis factor‐alpha (TNF‐α), interleukin‐6 (IL‐6), monocyte chemoattractant protein‐1 (MCP‐1), and neopterin were measured. ResultsSignificant differences were found between JIA patients and controls with regard to the mean levels of Hgb, ESR, TNF‐α, IL‐6, and MCP‐1 (p<0.05). A statistically significant higher mean level serum neopterin concentration (p<0.05) was found in JIA patients (20.43±8.73 nmol/L) than in controls (6.88±2.87 nmol/L) (p<0.05). Positive significant correlations were detected between serum neopterin and ESR, TNF‐α, IL‐6, MCP‐1, and JADAS‐27 (p<0.05). No correlation was found between serum neopterin and CRP (p>0.05). Multiple linear regression analysis showed that JADAS‐ 27 and ESR were the main variables associated with serum neopterin in JIA patients (p<0.05). ConclusionThe elevation of plasma neopterin concentrations in early JIA patients may indicate stimulation of immune response. Serum neopterin can be used as a sensitive marker for assaying background inflammation and disease activity score in JIA patients.

Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics.

Patient activation, often conceptualized as an individual trait, contributes to mental health outcomes. This study assessed the relational contributors to activation by estimating the longitudinal association of patient-provider communication and two factors of therapeutic alliance (agreement on tasks/goals and bond), with patient activation. Participants were patients (n=264) from 13 community-based mental health clinics across the United States. In multivariate models, controlling for patients' individual and clinical characteristics, the task/goal factor of therapeutic alliance emerged as a significant and independent predictor of greater change in patient activation scores. Improving patient activation may require addressing patient-provider interactions such as coming to collaborative agreement on the tasks/goals of care.

Su1442 Patient Related Factors (Patient Activation and Health Locus of Control) in Patients With Refractory Symptoms of Gastroparesis

Treatment of gastroparesis (GP) often requires long-term adherence to dietary modifications and medications. Patient beliefs on internal (self) and external (others) control of their health and patient empowerment (self activation) have been shown in other chronic diseases to impact disease presentation and outcome. AIMS: 1) Compare health locus of control and patient activation in patients with diabetic (DG) and idiopathic (IG) gastroparesis; and 2) Compare health locus of control and patient activation measure in patients with delayed gastric emptying to patients with similar symptoms but normal gastric emptying.METHODS: This prospective study evaluated patients from June 2014 to October 2014 referred for refractory symptoms of gastroparesis. Patients completed Patient Assessment of Upper GI Symptoms (PAGI-SYM), Multidimensional Health Locus of Control (MHLOC), and Patient Activation Measure (PAM-13). MHLOC measures three localizations of health control: internality (belief that health status depends only on personal decision and behaviors); chance externality (belief that health status is determined by chance, fate or luck), and externality (conviction that health depends on powerful people such as doctors, family members or close friends). RESULTS: 40 patients with refractory gastroparesis symptoms were evaluated. Of the 31 patients with delayed GES, 8 were diabetic and 19 idiopathic. Patient activation scores were similar between normal GES vs delayed GES (61.1±14.9 [SD] vs 57.9±12.1) and DG vs IG (58.6±12.7 vs 58.4±12) (Table 1). These activation scores translate to patient's beginning to take action to self-manage their own disease (Level 3). Abdominal pain was negatively correlated to PAM scores in patients with delayed gastric emptying (r=-0.30; p=0.09). When evaluating localization of health control, externality was higher in patients with delayed GES compared to normal emptying (3.4±0.9 vs 2.9±0.7; p=0.16) and DG compared to IG (3.9±0.9 vs 3.2±0.9; p= 0.11) (Table 2). The other localizations such as internality and chance externality were similar when comparing patients with normal GES to delayed GES and DG to IG. DISCUSSION: This study investigates the role of internal and external control and patient activation in patients with gastroparesis. Our study suggests higher abdominal pain severity scores were related to lower activation levels. Furthermore, patients with delayed gastric emptying tend to have higher scores for externality compared to patients with normal gastric emptying. Within the subset of GP, patients with DG had higher scores for externality. These results suggest a reliance of patients with gastroparesis, especially diabetic patients and those with abdominal pain, on others (including physicians), rather than themselves. Table 1. Patient Activation Measure in patients with normal GES vs delayed GES and diabetic GP vs idiopathic GP

Su1443 Gastric Neuromuscular Pathology and Therapeutic Outcome of Gastric Electric Stimulation in Patients With Refractory Gastroparesis

Treatment of gastroparesis (GP) often requires long-term adherence to dietary modifications and medications. Patient beliefs on internal (self) and external (others) control of their health and patient empowerment (self activation) have been shown in other chronic diseases to impact disease presentation and outcome. AIMS: 1) Compare health locus of control and patient activation in patients with diabetic (DG) and idiopathic (IG) gastroparesis; and 2) Compare health locus of control and patient activation measure in patients with delayed gastric emptying to patients with similar symptoms but normal gastric emptying.METHODS: This prospective study evaluated patients from June 2014 to October 2014 referred for refractory symptoms of gastroparesis. Patients completed Patient Assessment of Upper GI Symptoms (PAGI-SYM), Multidimensional Health Locus of Control (MHLOC), and Patient Activation Measure (PAM-13). MHLOC measures three localizations of health control: internality (belief that health status depends only on personal decision and behaviors); chance externality (belief that health status is determined by chance, fate or luck), and externality (conviction that health depends on powerful people such as doctors, family members or close friends). RESULTS: 40 patients with refractory gastroparesis symptoms were evaluated. Of the 31 patients with delayed GES, 8 were diabetic and 19 idiopathic. Patient activation scores were similar between normal GES vs delayed GES (61.1±14.9 [SD] vs 57.9±12.1) and DG vs IG (58.6±12.7 vs 58.4±12) (Table 1). These activation scores translate to patient's beginning to take action to self-manage their own disease (Level 3). Abdominal pain was negatively correlated to PAM scores in patients with delayed gastric emptying (r=-0.30; p=0.09). When evaluating localization of health control, externality was higher in patients with delayed GES compared to normal emptying (3.4±0.9 vs 2.9±0.7; p=0.16) and DG compared to IG (3.9±0.9 vs 3.2±0.9; p= 0.11) (Table 2). The other localizations such as internality and chance externality were similar when comparing patients with normal GES to delayed GES and DG to IG. DISCUSSION: This study investigates the role of internal and external control and patient activation in patients with gastroparesis. Our study suggests higher abdominal pain severity scores were related to lower activation levels. Furthermore, patients with delayed gastric emptying tend to have higher scores for externality compared to patients with normal gastric emptying. Within the subset of GP, patients with DG had higher scores for externality. These results suggest a reliance of patients with gastroparesis, especially diabetic patients and those with abdominal pain, on others (including physicians), rather than themselves. Table 1. Patient Activation Measure in patients with normal GES vs delayed GES and diabetic GP vs idiopathic GP

Increased serum alkaline phosphatase levels correlate with high disease activity and low bone mineral density in patients with axial spondyloarthritis

ObjectivesRecent studies report an association between serum alkaline phosphatase (ALP) levels and inflammation. The present study examined the relationship between ALP and disease activity, bone mineral density (BMD), and radiological damage in axial spondyloarthritis (SpA). MethodsA total of 115 patients who fulfilled the ASAS axial SpA criteria were enrolled. Serum ALP, bone-specific ALP (BALP), serum cross-linked telopeptide of type-I collagen (sCTX), and inflammatory markers were measured. Clinical parameters, BMD, grade of sacroiliitis, and the modified Stoke AS Spinal Score (mSASSS) were also assessed. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was also calculated. The associations between serum ALP, disease activity score, BMD, and radiologic damage were evaluated. ResultsThe mean serum ALP level was 77 ± 26U/l. Serum ALP levels increased in 14 patients (13%). Serum ALP levels increased along with ASDAS-CRP after adjusting for age and sex (p = 0.004), and were significantly correlated with ASDAS-ESR and ASDAS-CRP (p = 0.001 and p < 0.001, respectively), negatively correlated with BMD in the lumbar spine and femoral neck (p = 0.003 and 0.046, respectively), and positively correlated with sacroiliitis grade and the mSASSS (p < 0.001 and p < 0.002, respectively). BALP and sCTX were not associated with disease activity or BMD. Multivariate analysis showed that serum ALP was independently associated with ASDAS-CRP (p = 0.010). ConclusionsIncreased serum ALP levels were associated with high disease activity, low BMD, and higher structural damage scores in SpA patients.

Association of neopterin as a marker of immune system activation and juvenile rheumatoid arthritis activity

ObjectiveTo evaluate neopterin plasma concentrations in patients with active juvenile idiopathic arthritis (JIA) and correlate them with disease activity. MethodsSixty patients diagnosed as active JIA, as well as another 60 apparently healthy age- and gender-matched children as controls, were recruited from the Pediatrics Allergy and Immunology Clinic, Ain Shams University. Disease activity was assessed by the Juvenile Arthritis Disease Activity Score 27 (JADAS-27). Laboratory investigations were performed for all patients, including determination of hemoglobin concentration (Hgb), erythrocyte sedimentation rate (ESR), and C-reactive protein. Serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and neopterin were measured. ResultsSignificant differences were found between JIA patients and controls with regard to the mean levels of Hgb, ESR, TNF-α, IL-6, and MCP-1 (p<0.05). A statistically significant higher mean level serum neopterin concentration (p<0.05) was found in JIA patients (20.43±8.73 nmol/L) than in controls (6.88±2.87 nmol/L) (p<0.05). Positive significant correlations were detected between serum neopterin and ESR, TNF-α, IL-6, MCP-1, and JADAS-27 (p<0.05). No correlation was found between serum neopterin and CRP (p>0.05). Multiple linear regression analysis showed that JADAS- 27 and ESR were the main variables associated with serum neopterin in JIA patients (p<0.05). ConclusionThe elevation of plasma neopterin concentrations in early JIA patients may indicate stimulation of immune response. Serum neopterin can be used as a sensitive marker for assaying background inflammation and disease activity score in JIA patients.

Taking the long view: how well do patient activation scores predict outcomes four years later?

Patient activation is an important predictor of health outcomes and health care usage, yet we do not know how enduring the benefits of greater patient activation are. This study uses a large panel survey of people with chronic conditions (n = 4,865) to examine whether a baseline patient activation measure predicts outcomes 4 years later, and whether changes in patient activation measure scores are associated with changes in outcomes. The findings indicate that the benefits of health activation are enduring, yielding benefits in the form of better self-management, improved functioning, and lower use of costly health care services over time. Furthermore, the findings indicate that when activation levels change, many outcomes change in the same direction. Patient activation seems to be an important and modifiable factor for influencing chronic disease outcomes; health care delivery systems can use this information to personalize and improve care.

Fornix triamcinolone injection for thyroid orbitopathy.

In this pilot study we aimed to examine the association between eyelid fornices triamcinolone injections and clinical activity score in patients with active thyroid orbitopathy. Adult patients aged 18 years or older, diagnosed with active thyroid orbitopathy and a clinical activity score ≥ 3 were recruited to this interventional prospective pilot study between 2010 and 2013. Three upper and lower fornices injections of triamcinolone acetate 20 mg (40 mg/ml) were administered at 4-week intervals. Each patient included was followed up for a period of 6 months. Clinical activity score was estimated at each monthly visit. Extraocular muscle thickness was measured by ultrasound examination at entrance and at the last visit. Eleven eyes of seven patients were included in our study. Initial clinical activity score was 3.81 ± 1.80 and fell to 0.63 ± 0.72 during a 6-month follow-up. There was a significant difference in clinical activity score between the baseline examination and the following visits (p-value < 0.0001). Ultrasound examination showed a significant decrease in medial and lateral rectus muscle thickness following treatment; median difference -0.93 and -0.58, respectively (p-value < 0.005). Lid retraction was reduced by the treatment. Side effects included a transitory increase in intraocular pressure in one patient, which was controlled with topical medication. In this pilot study a series of three separate triamcinolone fornix injections at 4-week intervals reduces the inflammatory effects of thyroid orbitopathy, as measured by clinical activity score. The treatment was simple, effective, and safe eliminating the side effects associated with systemic corticosteroid use.

The relation of autologous serum and plasma skin test results with urticarial activity score, sex and age in patients with chronic urticaria.

IntroductionSome previous studies reported autoimmunity as an etiologic factor in chronic urticaria (CU), but the results of some autoimmunity tests in these studies are conflicting.AimTo concretize whether there was any relation of autologous serum skin test (ASST) and autologous plasma skin test (APST) results with sex, age and urticarial activity score (UAS) in patients with CU.Material and methodsFifty patients with CU and twenty healthy subjects admitted to our dermatology clinic were included in the present study. The ASST and APST were applied to all individuals.ResultsThe positiveness rates of ASST and APST were significantly higher in the patient group than controls (p = 0.027, p = 0.001, respectively). Among patients, the APST positiveness rate (72%) was significantly (p < 0.05) higher than ASST (46%). It was seen that 48% of patients with negative ASST results had positive APST. However, no patient with negative APST results had positive ASST. There were significant (p < 0.05) relations of the tests’ positiveness rates with sex and old age but with UAS. The diameter of the erythematous papule was remarkably (p < 0.05) larger in APST than ASST and also significantly (p < 0.05) larger in females compared to males in both tests (p < 0.05). It was positively increased with old age (p < 0.05).ConclusionsWe can suggest that APST is more sensitive than ASST in the assessment of autoimmunity in CU. A high positiveness rate of APST results may be attributed to high numbers of autoantibodies and coagulation factors present in plasma that might probably play a role in etiopathogenesis of CU.

Evaluation of the P Wave Axis in Patients With Systemic Lupus Erythematosus.

Introduction: P wave axis is one of the most practical clinical tool for evaluation of cardiovascular disease. The aim of our study was to evaluate the P wave axis in electrocardiogram (ECG), left atrial function and association between the disease activity score in patients with systemic lupus erythematosus (SLE). Methods: Standard 12-lead surface ECGs were recorded by at a paper speed of 25 m/s and an amplifier gain of 10 mm/mV. The heart rate (HR), the duration of PR, QRS, QTd (dispersion), the axis of P wave were measured by ECG machine automatically. Results: The P wave axis was significantly increased in patients with SLE (49 ± 20 vs. 40 ± 18, P = 0.037) and the disease activity score was found positively correlated with P wave axis (r: 0.382, P = 0.011). The LA volume and the peak systolic strain of the left atrium (LA) were statistically different between the groups (P = 0.024 and P = 0.000). The parameters of the diastolic function; E/A and E/e’ were better in the control group than the patients with SLE (1.1 ± 0.3 vs. 1.3 ± 0.3, P = 0.041 and 6.6 ± 2.8 vs. 5.4 ± 1.4, P = 0.036, respectively). Conclusion: P wave axis was found significantly increased in patients with SLE and positively correlated with SELENA-SLEDAI score. As the risk score increases in patients with SLE, P wave axis changes which may predict the risk of all-cause and cardiovascular mortality.

Relation between physical activity and depression score in patients with COPD, before and after outpatient pulmonary rehabilitation program.

Relation between physical activity and depression score in patients with COPD, before and after outpatient pulmonary rehabilitation program.

P-029 Severity of Inflammatory Bowel Disease Hospitalizations Varies According to Age and Gender

Hospitalizations for Inflammatory Bowel Disease (IBD) are frequent and vary in severity. We aimed to examine differences in the severity of IBD hospitalizations in relationship to age and gender. This was a retrospective cohort study reviewing the 2012 National Inpatient Sample (NIS) database in hospitalizations with a primary ICD-9-CM discharge diagnosis code of either Crohn’s Disease (CD, 555.x) or Ulcerative Colitis (UC, 556.x). Hospitalizations with a secondary diagnosis of CD or UC were also included if they had a primary diagnosis of a disease complication. Elective admissions and those with both a diagnosis of CD and UC were excluded. Our main severity measures included disease behavior (penetrating or obstructing), anemia, malnutrition, Clostridium difficile infection, surgery, length of stay (LOS), mortality and previously defined severity risk scores. Adjusted odds ratios (aOR) and 95% confidence intervals were calculated by comparing 1 demographic group against all others while adjusting for age, gender, region and major co-morbidities including diabetes, obesity, heart, lung, liver and kidney disease. From over 36 million weighted hospitalizations in the United States in 2012, we identified 68,790 hospitalizations for CD and 41,220 for UC. In both CD and UC, those 18-44 years old, males and those in New England were most likely to be hospitalized with IBD than any other demographic (Table 1). Anemia was most likely in males ≥85 and in females 18-44 (Tables 2 and 3). Clostridium difficile infection was most likely in patients <18. Surgery in patients with CD was most likely in male patients ≥85 and female patients <18. Surgery in patients with UC was most likely in male patients 45-64 and female patients <18. Female patients had longer LOS in younger patients, while male patients had longer LOS in older patients. Penetrating CD was most likely in patients 18-44 while obstructing disease was most likely in older patients. Older patients had the highest disease severity scores in CD patients, while younger patients had the highest scores in UC patients. Inflammatory Bowel Disease hospitalization severity varies with the age and gender of the patient. Patients 18–44 years old, males and those in New England were the most likely to be hospitalized with IBD. Females were more likely to have surgery and longer LOS at younger ages when compared to males for both CD and UC. Younger patients were more likely to have penetrating CD and higher disease severity scores in UC than older patients. Older patients were more likely to have obstructing CD and higher disease activity scores in CD patients than younger patients.

Developments in patient activation of people with chronic illness and the impact of changes in self-reported health: results of a nationwide longitudinal study in The Netherlands

ObjectiveTo explore how patient activation, i.e. patients’ perceived knowledge, skills and self-confidence to manage their health and healthcare, develops within chronically ill individuals over time, and to estimate the impact of self-rated health on this development. MethodsLinear regression analyses and structural equation modeling were conducted using longitudinal data from 751 people with chronic disease(s). Patient activation was assessed by the patient activation measure; self-rated health was assessed by the SF-36 general health scale. ResultsMean patient activation score at baseline was 60.6, and 18 months later 56.5. Baseline self-rated health had a positive, indirect effect on patient activation at 18 months. In addition, the change in self-rated health over one year (from baseline) was a significant predictor of patients’ activation scores. ConclusionPatient activation is not a stable characteristic of people who have been chronically ill for years. Within individuals both increases and decreases occur, but at group level patient activation slightly decreases over time. This may (partly) be due to the deterioration of health that many people with chronic illness experience in course of time. Practice implicationsClinical practitioners should assess the activation level of chronically ill patients regularly, especially when changes in health occur.

How well do patient activation scores predict depression outcomes one year later?

BackgroundThis study examines the relationship between patient activation, a measure of individuals׳ knowledge, skill, and confidence for managing their health, and rates of depression remission and response among patients with depression. MethodsPatients from Fairview Health Services in Minnesota with moderate to severe depression in 2011 and a PHQ-9 score in 2012 were included in the analysis (n=5253). Patient activation in 2011 and other health and demographic features were extracted from the electronic health record. We examined how patient activation predicted depression remission and response rates and changes in depression severity over one year using regression models. We also explored how activation predicted healthy behaviors among depressed patients. ResultsHigher baseline patient activation predicted lower depression severity and higher depression remission and response rates a year later. The most activated patients had PHQ-9 scores in 2012 two points lower than the lowest activated patients, and they had twice the odds of remission. Activation also predicted increase in healthy behaviors. LimitationsWe were unable to examine the use of mental health services or control for the number of prior depressive episodes and duration of the current depressive episode in the analysis. ConclusionsWe found that higher patient activation predicted better depression outcomes. While we are unable to explore the mechanism of this association, we observed that more activated patients are also engaged in more healthy behaviors, suggesting that the mechanism may be behavioral. Support of patient activation may be an effective approach for providers to reduce patients׳ depression severity.