Working Group Research Articles

Application of Narrative Therapy in a Social Work Group of Caregivers with Mental Health Disorders

Social workers from China found in their community service and interview: Caregivers of individuals with people with mental disorders Lack of sense of meaning in life. They showed simple narration content, narration style, pessimism, low identity recognition. Caregivers think Causing their life stress, family economic difficulties. the psychological pressure is because of their have a mental illness person in. family. Social workers follow the concept of helping people to help themselves, hoping to improve the sense of meaning of life for these caregivers and change their perception. Thirty family carers of the mentally disabled have been chosen to receive life narration treatment in a social work group. this is the main content of social work practice research. In practice, Social worker which has adopted various kinds of narration methods such as life narration, sand table narration, story narration, drawing narration, etc. The practice of This social work group helps carers discover their life meaning from the experiences of care mental illness. this is a valuable practice of social work service for families with mental disorder. This is done with application value of promotion.

Evolution of public funding since primary care research was considered as a priority research domain in france

PurposeAnnually, the French Ministry of Health funds clinical research projects based on a national call for projects. Since 2013, the Ministry has prioritized funding of primary care. Projects selected for funding are made public without distinguishing the specific area of research. The objective of this study was to identify and describe the evolution of the primary care research projects funded by the Ministry of Health between 2013 and 2019.MethodWe reviewed all of the 1796 medical research projects funded between 2013 and 2019 and categorized projects as primary care projects by using a list of specific keywords. This list was established through two approaches: (1) selected by an expert committee, the RECaP primary care working group, and (2) using an automated textual analysis of published articles in the field. The keywords were used to screen the titles of the medical research projects funded. The abstracts (at www.clinicaltrials.gov) or details (from project leaders) were then analyzed by two independent reviewers to determine true primary care projects.ResultsFinally, 49 primary care projects were identified, representing 2.7% of all medical research projects funded, without any significant change over the period. These projects were predominantly interventional (69%), with a median number of patients expected per project of 902.ConclusionDespite the prioritization of primary care research in 2013 by the French ministry of health, the number and proportion of projects funded remains low, with no significant change over the years.Trial registrationNot applicable.

Differences in the neural correlates of schizophrenia with positive and negative formal thought disorder in patients with schizophrenia in the ENIGMA dataset.

Formal thought disorder (FTD) is a clinical key factor in schizophrenia, but the neurobiological underpinnings remain unclear. In particular, the relationship between FTD symptom dimensions and patterns of regional brain volume loss in schizophrenia remains to be established in large cohorts. Even less is known about the cellular basis of FTD. Our study addresses these major obstacles by enrolling a large multi-site cohort acquired by the ENIGMA Schizophrenia Working Group (752 schizophrenia patients and 1256 controls), to unravel the neuroanatomy of FTD in schizophrenia and using virtual histology tools on implicated brain regions to investigate the cellular basis. Based on the findings of previous clinical and neuroimaging studies, we decided to separately explore positive, negative and total formal thought disorder. We used virtual histology tools to relate brain structural changes associated with FTD to cellular distributions in cortical regions. We identified distinct neural networks positive and negative FTD. Both networks encompassed fronto-occipito-amygdalar brain regions, but positive and negative FTD demonstrated a dissociation: negative FTD showed a relative sparing of orbitofrontal cortical thickness, while positive FTD also affected lateral temporal cortices. Virtual histology identified distinct transcriptomic fingerprints associated for both symptom dimensions. Negative FTD was linked to neuronal and astrocyte fingerprints, while positive FTD also showed associations with microglial cell types. These results provide an important step towards linking FTD to brain structural changes and their cellular underpinnings, providing an avenue for a better mechanistic understanding of this syndrome.

Podcast on the IWGDF 2023 Guidelines on the Prevention of Foot Ulcers in Persons with Diabetes.

In this podcast, we discuss the 2023 update of the International Working Group on the Diabetic Foot (IWGDF) Guidelines on the prevention of foot ulcers in people with diabetes. Prevention of foot ulcers is paramount, to reduce their large burden on patients and society. Nevertheless, many clinical guidelines do not cover prevention as a topic. The IWGDF Guidelines ensure that a full chapter is dedicated to ulcer prevention. In that chapter, the key cornerstones of prevention are outlined, as well as the importance of integrated preventative foot care. With this podcast, we aim to highlight the importance of ulcer prevention and the opportunities to incorporate recommendations into clinical practice. This hopefully stimulates clinicians and researchers to increase focus on ulcer prevention in diabetic foot disease.A podcast audio is available with this article.

Enhancement of Learners’ Attentiveness in ESL Classroom with CGW Using Web 2.0 Tools: An Intervention Study

Students’ attentiveness in the classroom especially in ESL classrooms is an inevitable alignment of effective learning as well as teaching English as a second language. However, students are erratic in their attendance, and even when they do show up, they lack their attentiveness and are not focused on the lessons taught in the classroom. As a result, their ability to learn is being hindered more than ever. This is a significant issue in teaching and learning in tertiary-level education at most colleges and universities around the world. The research aims at reducing the lack of learners’ attention to learning in ESL classrooms and enhancing students’ attentiveness through the intervention of collaborative group work (CGW). The study was conducted in a mixed method that included a questionnaire survey, observation and some previous relevant Content Analysis (CA). The settings of the research were the departments of English of a College of the National University in Bangladesh and three colleges of the King Khalid University in Saudi Arabia. The study found that before an intervention, 62.75% of students were not paying attention, while only 31.75% were paying attention in their ESL classroom. But after the intervention, 63.50% of ESL students were more attentive, while 32.50% were no longer attentive. This indicated a significant change. So, the study successfully proved that if the collaborative group work (CGW) using web 2.0 tools were well performed among the students in the ESL classroom, the present and future learners could be capable of enhancing their attentiveness in the classroom and flexibly learning English as a Second Language than before.

INDONESIAN L2 LEARNERS’ ATTITUDES TOWARDS GROUP WORK: A SURVEY STUDY ON GENDER DIFFERENCES

This study was conducted to investigate the possible interaction between the attitudes of Indonesian learners from non-English majors towards group work in the English as second/foreign (L2) classes and their gender. The study employed an online survey. In this study, 187 learners from various regions in Indonesia participated. The study found that learners generally reported positive attitudes towards group work to facilitate a better learning atmosphere, for their self-improvement, and a medium of learning with their classmates. Furthermore, this study found no statistically significant difference in their attitudes towards group work seen from their gender. The no significant difference indicates that both male and female learners reported relatively similar attitudes towards group work. Limitations are acknowledged, and the possible contributions and pedagogical implications are stated alongside suggested directions for future studies in the fields of gender and group work in L2 classes.

Translating assessment for learning to work in groups of students with intellectual disabilities

ABSTRACT The potential of using Assessment for Learning (AfL) is well established, but studies of AfL practice in groups of students with intellectual disabilities (ID) are rare. The respondents in this study were assistants and teachers working in compulsory school for students with ID. In a two-year project they had worked with translating five AfL key strategies (KSs) to fit their context. The study aimed at exploring this translation to depict the use of AfL KSs in the classes of students with ID and reveal opportunities and challenges. The AfL KSs were used to structure interviews and classroom observations, and an ensuing thematic data analysis. The overall conclusion confirms the potential of using AfL in this context. Three themes depict the overall use of AfL: a whole-class focus, a team approach, and the integrated use of the AfL KSs. Various themes characterise the implementation of each KS, and the opportunities and challenges. The findings implicate benefits for the students, and advantages as well as concerns for the staff. The findings are expected to be of value inside and outside the study’s context. The study demonstrates how contextual variation can contribute to new insights and questions for the AfL research field.

Student-active lectures in legal education

ABSTRACT This mixed methods study examined the experiences of first-year law students attending online and on-campus lectures. Interviews with six students and a survey completed by 261 students revealed a preference for on-campus lectures, citing higher lecture quality, better focus and better retention. Online lectures faced technical challenges and disengagement, although students found the use of instant messaging for questions beneficial. In on-campus lectures, students favoured some form of student involvement, such as digital multiple-choice questions or digital open questions with short peer discussions, as opposed to lectures without student activity. Group work was deemed more suitable for other course components. The findings suggest that incorporating well-designed digital questions combined with peer discussions can enhance student engagement, attention, self-assessment and learning. Additionally, the study emphasises the importance of holistic planning when designing a course, ensuring alignment between different components.

IMPLEMENTATION OF PRINCIPLES OF INDIVIDUALIZATION AND DIFFERENTIATION IN FOREIGN LANGUAGE CLASSES IN HIGH SCHOOL

The article examines the system and approaches of individualization and differentiation in the process of learning a foreign language in higher education. Determined factors that affect their functioning in the process of working in classes. Separate problems and ways to overcome them are analyzed. Certain opportunities for creating favorable conditions for the development of the creative potential of an individual, development of his thinking and understanding of the ultimate goal and task of learning a foreign language have been identified. Methods and techniques for increasing students’ cognitive activity in classes and strengthening their motivation are illustrated. The article examines the views of scientists N.P. Volkova, G.R. Havryshchak, O.M. Shparyk on individualization and differentiation as dominant and organic components of the educational process. Various approaches to the concepts of differentiation and individualization, as well as concepts related to them, are summarized. The works of these scientists became the theoretical and methodological basis of the conducted research. These principles help to find effective means for teaching a foreign language and learning it effectively. We must not forget that in higher education, the main influence on a student is his mood, curiosity, drive, concentration, surprise. The ability to stimulate the mental states we desire requires a process of individualization and differentiation of each student. A unique approach should be the whole system of education and training of the individual. This article describes the technology of implementing the abovementioned principles in English language classes in higher education. The use of internal differentiation for working in groups and the cluster method for strengthening the cognitive development of each individual when learning a foreign language in higher education are illustrated. The problem of a wide range of possibilities of these principles in the conditions of changes in the system of social relationships, rules of student behavior in the new realities of life is raised. Emphasis is placed on the importance of new requirements for the education system: flexibility, adaptability, feedback, quick response to changes in the social environment, cooperation with psychologists. Considered possible means of organizing students’ work in groups and individually, determined prospects for further research in this direction.

The influence of premenstrual syndrome on the quality of life of women engaged in intellectual work

Currently, the role of intellectual work in the overall structure of professional activity has increased. Women suffering from premenstrual syndrome, as part of their professional activities, often engage in mental labor, which is reflected in increased fatigue, decreased performance. In order to assess the impact of premenstrual syndrome on the quality of life of women engaged in mental work, 237 women were surveyed about the course of premenstrual syndrome and quality of life according to the SF-36 questionnaire. As a result of the study, a significant decrease in indicators of physical functioning, pain intensity, vital activity, and social functioning was revealed. The total jinzi quality index in the group of mental work is the lowest of all considered. The severity of premenstrual syndrome is also the highest in comparison with the group of physical labor

Blood profiles of community-dwelling people with sarcopenia: analysis based on the China Health and Retirement Longitudinal Study.

Introduction Routine blood factors can be economic and easily accessible candidates for sarcopenia screening and monitoring. The associations between sarcopenia and routine blood factors remain unclear. This study aimed to examine sarcopenia and blood factor associations based on a nation-wide cohort in China. Methods 1307 participants and 17 routine blood indices were selected from two waves (Year 2011 and Year 2015) of the China Health and Retirement Longitudinal Study (CHARLS). The diagnosis of sarcopenia was based on the criteria proposed by Asian Working Group for Sarcopenia (AWGS 2019). Generalized mixed-effects models were performed for association analyses. A logistic regression (LR) model was conducted to examine the predictive power of identified significant blood factors for sarcopenia. Results A higher sarcopenia risk was cross-sectionally associated with elevated blood concentrations of high-sensitivity C-reactive protein (hsCRP) (OR = 1.030, 95%CI [1.007, 1.053]), glycated hemoglobin (HbA1c) (OR = 1.407, 95%CI [1.126, 1.758]) and blood urea nitrogen (BUN) (OR = 1.044, 95%CI [1.002, 1.089]), and a decreased level of glucose (OR = 0.988, 95%CI [0.979, 0.997]). A higher baseline hsCRP value (OR = 1.034, 95%CI [1.029, 1.039]) and a greater over time change in hsCRP within four years (OR = 1.034, 95%CI [1.029, 1.039]) were associated with a higher sarcopenia risk. A higher BUN baseline value was related to a decreased sarcopenia risk over time (OR = 0.981, 95%CI [0.976,0.986]), while a greater over time changes in BUN (OR = 1.034, 95%CI [1.029,1.040]) and a smaller over time change in glucose (OR = 0.992, 95%CI [0.984, 0.999]) within four years were also related to a higher sarcopenia risk. LR based on significant blood factors (i.e., hsCRP, HbA1c, BUN, and glucose), and sarcopenia status in Year 2015 yielded an area under the curve (AUC) of 0.859 (95% CI 0.836-0.882). Conclusion Routine blood factors involved in inflammation, protein metabolism, and glucose metabolism are significantly associated with sarcopenia. In clinical practice, plasma hsCRP, BUN, blood sugar levels, sex, age, marital status, height, and weight might be helpful for sarcopenia evaluation and monitoring.

Hippocampal subfields in remitted schizophrenia.

Current evidence of volume changes in hippocampal subdivisions in schizophrenia remains inconsistent, and few studies have investigated the relationship between regional hippocampal volumes and symptom remission. In this cross-sectional study, we recruited 31 patients with schizophrenia and 31 healthy controls (HCs). Symptomatic remission in schizophrenia was determined according to Remission in Schizophrenia Working Group criteria. The volumes of hippocampal longitudinal subregions and transverse subfields were measured using manual and automatic techniques, respectively. Between-group regional hippocampal volume differences were analyzed using multivariate analysis of covariance followed by univariate analysis of covariance. Compared with the HCs, the patients with schizophrenia had smaller bilateral heads and tails along the longitudinal axis; they also had reduced volumes of the bilateral CA1, CA3, CA4, GC-ML-DG, molecular layer, tail, left subiculum, left HATA, and right parasubiculum along the transverse axis in the hippocampus (all corrected p < 0.05). Furthermore, compared with the HCs and patients with remitted schizophrenia, the patients with non-remitted schizophrenia had smaller bilateral hippocampal tail subfields (corrected p < 0.05). Our results indicated that the pathophysiology and symptomatic remission of schizophrenia are related to changes in the volumes of hippocampal subdivisions. These volume changes might be clinically relevant as biomarkers for schizophrenia identification and treatment.

Technical, gating and interpretation recommendations for the partitioning of circulating monocyte subsets assessed by flow cytometry.

The monocyte subset partitioning by flow cytometry, known as "monocyte assay," is now integrated into the new classifications as a supporting criterion for CMML diagnosis, if a relative accumulation of classical monocytes above 94% of total circulating monocytes is observed. Here we provide clinical flow cytometry laboratories with technical support adapted for the most commonly used cytometers. Step-by-step explanations of the gating strategy developed on whole peripheral blood are presented while underlining the most common difficulties. In a second part, interpretation recommendations of circulating monocyte partitioning from the dedicated French working group "CytHem-LMMC" are shared as well as the main pitfalls, including false positive and false negative cases. The particular flow-defined inflammatory profile is described and the usefulness of the nonclassical monocyte specific marker, namely slan, highlighted. Examples of reporting to the physician with frequent situations encountered when using the monocyte assay are also presented.

E065 Disagreement between patient and physician global assessment over time in psoriatic arthritis: insight into treatment priorities

Abstract Background/Aims The psoriatic arthritis (PsA) core domain set developed by the outcome measures in rheumatology working group includes musculoskeletal disease, fatigue, physical function, and structural damage, of which arthritis activity, pain, and fatigue were identified as essential by both patients (Pts) and physicians (Phs). Assessing agreement between Pt and Ph global assessments (GA) may provide valuable insight into differential importance of specific PsA manifestations to Pts vs Phs. Although previous studies have assessed Pt/Ph disagreement, they have not evaluated potential variation over time. This research sought to assess agreement of PtGA and PhGA through week (W) 24 and identify factors driving disagreement between PtGA and PhGA using pooled data (N = 1120) from the phase 3 DISCOVER (D)-1 &amp; -2 studies of the fully human IL-23p19 subunit inhibitor (i), guselkumab (GUS). Methods Pts with active PsA despite standard therapies (D1: ≥3 swollen/tender joint counts [SJC/TJC], CRP ≥0.3 mg/dL, ∼30% with prior TNFi; D2: ≥5 SJC/TJC, CRP ≥0.6 mg/dL, biologic-naïve) were randomized 1:1:1 to GUS 100 mg every 4 weeks (Q4W); GUS 100 mg at W0, W4, Q8W; or placebo. Pt/Ph agreement was defined as a difference of -15&amp;lt;phga-ptgaPtGA) and PtGA exceeding PhGA by ≥ 15 (PtGA&amp;gt;PhGA) among pts with PtGA/PhGA disagreement were assessed with the same logistic regression model considering pt demographics, disease characteristics, and pt-reported outcomes (PROs). The effect of GUS on disease parameters identified as determinants of PtGA vs PhGA disagreement was assessed with repeated measures mixed models adjusting for treatment group, baseline (BL) levels, prior TNFi use, and BL DMARD use.&amp;lt;/phga-ptga Results At BL, mean (SD) SJC=11.5 (7.4), TJC=20.6 (13.3), FACIT-Fatigue score=29.9 (10.0), PtGA=66.9 (19.9), and PhGA=64.8 (15.9) were consistent with moderate to high disease activity. Agreement between PtGA and PhGA was seen in most instances (61.2%); 23.2% of cases were characterized by PtGA&amp;gt;PhGA and 15.7% by PhGA&amp;gt;PtGA. The proportion of pts with PtGA&amp;gt;PhGA increased to 39.1% at W24, while that with PhGA&amp;gt;PtGA decreased to 11.2%. The main determinant of PtGA&amp;gt;PhGA was higher Pt Pain (all time points); additional factors included worse physical health-related quality of life at BL and worse fatigue at W24. Conversely, Phs emphasized objective disease measures, namely higher SJC (all time points) and TJC (W8 to W24), and elevated CRP (BL to W16). GUS treatment was associated with prompt and sustained significant improvements in all identified determinants, including those driving PtGA&amp;gt;PhGA. Conclusion PtGA and PhGA were aligned in most encounters. PtGA&amp;gt;PhGA disagreement was driven by pain, fatigue, and physical health being weighed more by Pts than Phs. These findings have important implications in shared decision making and highlight the need to prioritize treatments addressing the full spectrum of PsA symptoms, including PROs. Disclosure W. Tillett: Consultancies; AbbVie; Amgen; Eli Lilly; Janssen; MSD; Novartis; Pfizer and UCB. Member of speakers’ bureau; Abbvie; Amgen; Eli Lilly; Janssen; MSD; Novartis; Pfizer and UCB. Grants/research support; AbbVie; Amgen; Eli Lilly; Janssen and UCB. P. Rahman: Consultancies; AbbVie; Amgen; Bristol Myers Squibb; Celgene; Eli Lilly; Janssen; MSD; Novartis; Pfizer and UCB. Grants/research support; Janssen and Novartis. L.C. Coates: Consultancies; AbbVie; Amgen; Boehringer Inelheim; Bristol Myers Squibb; Celgene; Eli Lilly; Gilead; Galapagos; Janssen; Novartis; Pfizer and UCB. Member of speakers’ bureau; AbbVie; Amgen; Biogen; Celgene; Eli Lilly; Galapagos; Gilead; Janssen; Medac; Novartis; Pfizer and UCB. Grants/research support; AbbVie; Amgen; Celgene; Eli Lilly; Janssen; Novartis; Pfizer and UCB. P. Nash: Grants/research support; AbbVie; Boehringer Ingelheim; Bristol Myers Squibb; Celgene; Eli Lilly; Gilead; Janssen; Pfizer; Novartis; Roche; Sandoz; and Sun Pharmaceutical Industries. A. Deodhar: Consultancies; AbbVie; Amgen; Aurinia; Bristol Myers Squibb; Celgene; Eli Lilly; GlaxoSmithKline; Janssen; MoonLake; Novartis; Pfizer and UCB. Member of speakers’ bureau; AbbVie; Eli Lilly; Janssen; Novartis; Pfizer and UCB. Grants/research support; AbbVie; Eli Lilly; GlaxoSmithKline; Novartis; Pfizer and UCB. F. Nantel: Consultancies; Janssen. Shareholder/stock ownership; Johnson &amp; Johnson. E. Rampakakis: Corporate appointments; Employee of JSS Medical Research. Consultancies; Janssen. L. Bessette: Consultancies; AbbVie; Amgen; Bristol Myers Squibb; Eli Lilly; Fresenius Kabi; Gilead; Janssen; MSD; Novartis; Pfizer; Sandoz; Sanofi; Teva and UCB. Member of speakers’ bureau; AbbVie; Amgen; Bristol Myers Squibb; Eli Lilly; Fresenius Kabi; Janssen; MSD; Novartis; Pfizer; Sandoz; Sanofi; Teva; and UCB. Grants/research support; AbbVie; Amgen; Bristol Myers Squibb; Celgene; Eli Lilly; Janssen; MSD; Novartis; Pfizer; Sanofi and UCB. M. Marrache: Corporate appointments; Employee of Janssen Inc. Toronto, Cananda. Shareholder/stock ownership; Johnson &amp; Johnson. F. Lavie: Corporate appointments; Employee of Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson &amp; Johnson. Shareholder/stock ownership; Johnson &amp; Johnson. M. Shawi: Corporate appointments; Employee of Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson &amp; Johnson. Shareholder/stock ownership; Johnson &amp; Johnson.

E061 Attitudes and barriers to pulmonary arterial hypertension screening in systemic sclerosis patients: a survey of UK-based rheumatologists

Abstract Background/Aims Pulmonary arterial hypertension (PAH) affects approximately 10% of patients with SSc and is a major cause of morbidity and mortality. PAH is often asymptomatic, and therefore, proactive screening is crucial for early detection and improved survival, including through early treatment intervention. Although there are various proposed international guidelines for screening, there is currently no dedicated UK-based guidance. Our aim is to explore current UK screening practices for SSc-PAH patients, including identifying barriers and potential solutions. Methods A survey of 31 questions was developed and included six sections: clinician demographics, the importance of screening, screening practices, barriers to screening, treatment, and patient education. The survey was disseminated among rheumatologists working in the UK. Results Forty-four rheumatologists working in the UK participated in the study, and the majority completed all the questions. Around one-third (37.0%) worked in specialised SSc units (university or general hospitals [54.5% and 45.4%, respectively]). The majority recognised that SSc-PAH is a major cause of morbidity and mortality. Over half (60.0%) reported using the DETECT algorithm to screen for SSc-PAH, although other algorithms were also sometimes used. All of the respondents utilised transthoracic echocardiogram, and almost all (95.0%) performed pulmonary function tests for screening purposes. Various challenges and barriers were identified relating to SSc-PAH screening (Figure 1A), with the difficulty in interpreting results from other hospitals and extended wait times for diagnostic tests being the most reported (76.0% and 74.0%, respectively). Most respondents agreed that access to key investigations (87.0%), ongoing clinician education (82.0%), multidisciplinary meetings (79.5%) and a better understanding of proposed screening algorithms (79.5%) could be potential solutions (Figure 1B). Conclusion Rheumatologists recognise that SSc-PAH screening is crucial to improve outcomes including survival; however, variable practices exist. There are various barriers to SSc-PAH screening and we have identified a number of practical potential solutions. Disclosure M.P. Álvarez Hernández: None. Y. Allanore: Honoraria; Speaking fees from Janssen outside the submitted work. I. Andrade: Other; Honoraria (speaker) fees, scientific board member for EchoRight™and advisory board participant for ‘Pulmonary hypertension in the primary care setting’ for Janssen, outside the submitted work. M.H. Buch: Other; Speaker fees from Boehringer Ingelheim, outside the submitted work. G. Coghlan: Other; Consultancy and working groups fees from Janssen and MSD; honoraria from Inari and Janssen; grants from Janssen. F. Del Galdo: Other; Consulting fees and research support from Janssen, outside the submitted work. C. Denton: Honoraria; Consulting fees and research support from Janssen, outside the submitted work. D. Khanna: Honoraria; Consultant: Amgen, Abbvie, BI, AZ, Merck, Horizon, Prometheus, Janssen, GSK. Grants- Pfizer, BI, Horizon. D.G. Kiely: Honoraria; Participation in advisory boards, steering committees, speaker fees and support to attend educational meetings from Acceleron, Gossamer, GSK, Janssen, Ferrer, MSD and United Therapeutics. Other; grant funding from GSK and Janssen. His work is supported by a grant from the NIHR Biomedical research Centre Sheffield. J. Pauling: Honoraria; Consultancy work for AstraZeneca, Boehringer Ingelheim, IsomAb, Janssen, Permeatus and Sojournix; speaker honoraria and educational support from Janssen. S. Ramjug: Consultancies; Consulting fees from Janssen, outside the submitted work. M. Hughes: Other; Speaking fees from Actelion, Eli Lilly, Janssen and Pfizer, outside the submitted work; research funding from Janssen; member of a data and safety monitoring board for Certa Therapeutics.

OA23 Time to address the challenge of difficult-to-treat psoriatic arthritis: results from an international survey

Abstract Background/Aims The term difficult-to-treat psoriatic arthritis (D2TPsA) is increasingly used to describe a small but growing number of patients who fail to respond to multiple biological disease-modifying treatments (bDMARDs). There is, however, no consensus on the scope and treatment of so-called D2TPsA. This study aimed to explore international rheumatologists’ emerging perceptions of the terminology, scope and treatment of D2TPsA Methods A web-based survey consisting of 19 questions, including multiple choice and free text responses was designed, peer-reviewed and piloted by a team of expert rheumatology consultants with a special interest in PsA. The purpose of the survey was to characterise rheumatologist opinions of D2TPsA. The survey was distributed internationally via professional organisations, mailing lists and social media between 1st June - 31stJuly 2023. Results were analysed using R Studio. Results Two-hundred and forty-four (244) rheumatologists responded to the survey across 5 continents (Europe=79.4%, South America=11.5%, Asia=3.7%, North America=3.3%, Australia=0.8%). The majority (96.2%) were aged 30-69, therefore reflecting opinions spanning the entirety of the workforce, including junior trainees and senior consultants. Most (72.5%) worked in academic/teaching institutions and 37.5% cared for &amp;gt;300 PsA patients in their service. Despite this, only 20.5% of clinicians worked in a combined rheumatology/dermatology service.[HMO1] There was a range of opinion on what constituted D2TPsA, the most popular definition being failure of ≥ 2 b/tsDMARD classes (34.8%) with 68.3% wanting failure of ≥ 1 csDMARD to be included. Considering the subgroup with true resistant or refractory disease, 74.3% supported a more pragmatic definition, that being “failure of all available bDMARD classes”. Nearly all respondents felt that “low disease activity” was a more realistic target to achieve than “remission” (86.5%). There was disagreement on use of single (38.1%) vs. composite measures (40.6%) for the assessment of disease activity, and thus treatment response. Of note, 41% preferred the term “difficult-to-manage” as opposed to “difficult-to-treat” as this would encompass factors other than drug non-response such as presence of comorbidities, mental health and lack of efficacy. Others suggested that a holistic approach to the diagnosis and management of D2TPsA was important. Yet, most physicians felt that the diagnosis and treatment of D2TPsA should include reference to relevant physical and psychosocial comorbidities such as cardiometabolic disease, mental health, infection and malignancy. Conclusion This survey showcases the breadth of rheumatologist opinions of what may constitute D2T PsA, highlighting commonalities and disagreements in the terminology. These now require further discussion and debate in a consensus working group including allied specialties and patient representatives in order to agree a standardized definition for D2TPsA to be used in the clinical and research settings and enable guidelines and management pathways to be developed. Disclosure H. Marzo-Ortega: Honoraria; HMO recieved honoraria/speaker fees from AbbVie, Biogen, Eli-Lily, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB. Grants/research support; HMO received grant support from Janssen, Novartis and UCB. S.R. Harrison: Honoraria; SRH recieved fees from Novartis and Janssen to give a non-promotional educational lecture. Other; SRH received support from UCB and Janssen to attend EULAR conference. G. Nagy: Honoraria; •GN has received consulting/speaker’s fees from Abbvie, Amgen, Astra Zeneca, Lilly, Janssen, Miltényi, Novartis, Pfizer, Richter, Roche, Sobi and Swixx. P.M. Machado: Honoraria; PMM has received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB. D.G. McGonagle: None. S.Z. Aydin: Consultancies; SZA received consultancy feeds from: AbbVie, Janssen, Lilly, Novartis, Pfizer, Fresenius-Kabi, UCB. Grants/research support; SZA received research grants from AbbVie, Lilly, Novartis, UCB, Pfizer, Fresenius-Kabi. R. Almodovar: Honoraria; RA has received consulting/speaker’s fees from Abbvie, Almirall, Amgen, Galápagos, Gebro, Janssen, Lilly, MSD, Nordic, Novartis, Pfizer, UCB. W. Bautista-Molano: None. L. Gossec: Consultancies; LG recieved consultancy fees from: AbbVie, Amgen, BMS, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB. Grants/research support; LG received research grants from: AbbVie, Biogen, Lilly, Novartis, UCB. E. Lobrano: None. P. Nash: None. F. Pimentel dos Santos: None. E. Soriano: Consultancies; ERS has received consulting/speaker’s fees and/or grant support from Abbvie, Amgen, BMS, Lilly, Janssen, Novartis, Pfizer, Roche and UCB. S. Siebert: Consultancies; SS has recieved consultancy/ speakers fees from: consultancy/speaker fees from AbbVie, Amgen, AstraZeneca, Eli Lilly, GSK, Janssen, UCB. Grants/research support; SS has received institutional research grants from Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, GSK, Janssen and UCB.

Skin cancers are the most frequent cancers in fair-skinned populations, but we can prevent them.

Cancers of the skin are the most commonly occurring cancers in humans. In fair-skinned populations, up to 95% of keratinocyte skin cancers and 70–95% of cutaneous melanomas are caused by ultraviolet radiation and are thus theoretically preventable. Currently, however, there is no comprehensive global advice on practical steps to be taken to reduce the toll of skin cancer. To address this gap, an expert working group comprising clinicians and researchers from Africa, America, Asia, Australia, and Europe, together with learned societies (European Association of Dermato-Oncology, Euromelanoma, Euroskin, European Union of Medical Specialists, and the Melanoma World Society) reviewed the extant evidence and issued the following evidence-based recommendations for photoprotection as a strategy to prevent skin cancer. Fair skinned people, especially children, should minimise their exposure to ultraviolet radiation, and are advised to use protective measures when the UV index is forecast to reach 3 or higher. Protective measures include a combination of seeking shade, physical protection (e.g. clothing, hat, sunglasses), and applying broad-spectrum, SPF 30 + sunscreens to uncovered skin. Intentional exposure to solar ultraviolet radiation for the purpose of sunbathing and tanning is considered an unhealthy behaviour and should be avoided. Similarly, use of solaria and other artificial sources of ultraviolet radiation to encourage tanning should be strongly discouraged, through regulation if necessary. Primary prevention of skin cancer has a positive return on investment. We encourage policymakers to communicate these messages to the general public and promote their wider implementation.

AN ANALYSIS OF THE IMPACT OF PEER SUPPORT GROUPWORK ON THE PSYCHOLOGICAL WELLBEING OF THE LIMB RECONSTRUCTION PAEDIATRIC PATIENTS ATTENDING THE NATIONAL ORTHOPAEDIC HOSPITAL CAPPAGH, DUBLIN

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