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Refereed/Peer-reviewed Background: Colchicine may offer relief in osteoarthritis. This has never been investigated for hand osteoarthritis. Objectives: To investigate the effect of 1 mg daily colchicine vs placebo on hand pain and function over 12 weeks in older adults with hand osteoarthritis. Methods: Community-dwelling adults with diagnosed osteoarthritis of the hand aged 40–80 years were randomised to receive colchicine (0.5 mg twice daily) or matching placebo. Primary outcome measure was VAS hand pain score (0–100 mm). Secondary outcome measures included tender and swollen joint count, grip strength, C-reactive protein, and Michigan Hand Questionnaire total, function and pain scores. In an exploratory assessment, we compared synovial grade and power Doppler. All outcome measures were obtained at baseline and week 12. Stata v16 was used to perform constrained longitudinal data analysis models. Results: 64 adults (54 females, 10 males) aged 48–79 years of age were enrolled. 59 participants completed the study (N = 28 colchicine, N = 31 placebo) (withdrawal rate 8%). Adverse reactions to the study medication occurred in nine patients. VAS score was not significantly different at baseline (61 ± 17 mm in the colchicine, 64 ± 17 mm in the placebo group). Between-group difference for VAS score at week 12 was 7.6 mm (95% CI -3.5-18.7, p-value 0.18). There were no significant differences between groups for any secondary outcomes at baseline or week 12. Conclusions: 1 mg colchicine daily for 12 weeks was not effective for reducing pain, tender and swollen joint count or increasing grip strength in symptomatic hand osteoarthritis. Our results do not support the use of colchicine in hand osteoarthritis.

To explore the experience of healthcare transition from paediatric to adult health care for adults born with oesophageal atresia and tracheo-oesophageal fistula (OA/TOF) and parents.OA/TOF is a rare and chronic health condition that can require lifelong medical follow-up and management. There is evidence to suggest that transitioning from paediatric to adult health care can be problematic for people with rare and chronic conditions, including OA/TOF. The previous literature suggests that the experience of transitioning with a rare condition is more complex than transitioning with a common chronic condition.The current study was a qualitative, cross-sectional, survey-based study.Data were collected through an online survey. Parents of children born with OA/TOF (n = 23) and adults born with OA/TOF (n = 16) were recruited through a UK-based OA/TOF patient charity. Data from six open-ended questions were analysed using a hybrid approach combining elements of inductive and deductive thematic analyses. Throughout the research process, the SRQR were followed.Five themes were constructed during the analysis, reflecting the experience of parents and adults transitioning from paediatric to adult health care: thrown into the unknown; a cultural shift; stepping back and stepping up; 'no transition as such'; and living with uncertainty.The findings suggested that a formalised, managed healthcare transition is not commonly experienced by people born with OA/TOF and parents.We recommend a formalised healthcare transition process in OA/TOF, including preparation for transition and having a named key worker to manage the multidisciplinary transition process. The results also highlighted the need for adults born with OA/TOF to have access to a specialist health service with knowledge and understanding of issues related to OA/TOF.

Objective Despite advancing medical treatments, pain remains a significant outcome of adolescent cancer, as both a problematic and distressing symptom. With adolescents spending substantial periods of time at home during cancer treatment, parents perceive themselves as central to the experience and management of adolescents’ pain. The present study aimed to explore parental experiences of adolescent cancer-related pain during, and recently after, completing cancer treatment. Methods We interviewed 21 parents of adolescents (aged 12–18 years) with cancer, recruited through a hospital in South West England. Interviews were analyzed using reflexive inductive thematic analysis. Results Two themes were generated. The first theme, “Parental perceptions of being at the heart of pain management,” focused on the role of parents in adolescents’ pain journeys, and the vast knowledge they gained. The second, “Adapting and readjusting expectations,” captured parents’ journeys in learning to adjust their lives according to adolescents’ pain and difficulties they faced throughout this process. Conclusions Findings highlighted parents’ crucial role throughout adolescents’ pain experiences; learning how to manage adolescents’ pain, and supporting them with the detrimental impact on their lives. The findings emphasize the importance of a multidisciplinary approach to supporting families to manage pain. They also indicate a need for targeted research studies investigating parental experiences of adolescent cancer-related pain. This will help professionals understand how best to support parents and adolescents throughout the cancer journey and ultimately improve the physical and psychological outcomes of young people in the longer term.

PurposeThe purpose of this paper is to investigate whether the Stages of Change (SOC) model can be applied to working with offenders with learning disabilities (LD), and furthermore, to determine if it might be efficacious for this approach to be incorporated into a wider service model for this population.Design/methodology/approachThis paper reports on the results of a consultation to a specialist forensic LD service in the South West of England. A two-pronged approach was taken to consult to the service in relation to the research questions. First, a comprehensive literature review was undertaken, and second, other forensic LD teams and experts in the field were consulted.FindingsThere is a dearth of research that has examined the application of the SOC model to working with offenders with LD, and as such, firm conclusions cannot be drawn as to its efficacy in this population. The evidence base for the SOC model in itself is lacking, and has been widely critiqued. However, there are currently no other evidence-based models for understanding motivation to change in offenders with LD.Research limitations/implicationsThere is a clear clinical need for more robust theory and research around motivation to change, which can then be applied to clinical work with offenders with LD.Originality/valueThere has been a historical narrative in offender rehabilitation that “nothing works” (Burrowes and Needs, 2009). As such, it is more important than ever for the evidence base to enhance the understanding of motivation to change in offending populations.

Introduction: Pain accounts for the majority of attendances to the Emergency Department (ED), with insufficient alleviation of symptoms resulting in repeated attendance. People who frequently attend the ED are typically considered to be psychologically and socially vulnerable in addition to experiencing health difficulties. This service development study was commissioned to identify the defining characteristics and unmet needs of frequent attenders (FAs) in a UK acute district general hospital ED, with a view to developing strategies to meet the needs of this group. Methods: A mixed-methods multi-pronged exploratory approach was used, involving staff interviews, focus groups, business data and case note analysis. Results: Findings reflect an absence of a coherent approach to meeting the needs of FAs in the ED, especially those experiencing pain. FAs to this ED tend to be vulnerable, complex and report significant worry and anxiety. Elevated anxiety on the part of the patient may be contributing to a ‘better safe than sorry’ culture within the ED and is reported to bear some influence on the clinical decision-making process. Discussion: It is recommended that a systemic approach is taken to improve the quality and accessibility of individualised care plans, provision of patient education, psychological care and implementation of policies and procedures. Change on an organisational level is likely to improve working culture, staff satisfaction and staff relationships with this vulnerable group of patients. A structured care pathway and supportive changes are likely to lead to economic benefits. Further research should build on findings to implement and test the efficacy of these interventions.

Background: The common sense model (CSM) proposes that illness perceptions guide coping and illness management, which subsequently affects outcomes. Chronic fatigue syndrome (CFS) is associated with severe functional impairment. CFS is distinct from other physical health conditions in that individuals can experience high levels of uncertainty, stigma and disbelief from others. This study aimed to compare illness perceptions in adolescents with CFS with other physical health conditions, using a cross-sectional, between-groups design. Methods: Adolescents (aged 11–18) with CFS ( n = 49), type 1 diabetes ( n = 52) and juvenile idiopathic arthritis ( n = 42) were recruited through National Health Service (NHS) clinics and online, and completed a series of questionnaires. Results: Adolescents with CFS differed on the perceived consequences, timeline, personal control, treatment control, identity and understanding dimensions of illness perceptions. Except for identity, these dimensions were predicted by health condition even when accounting for age, gender, fatigue, physical functioning, anxiety and depression. Conclusions: Results offer preliminary evidence for the applicability of the CSM in adolescents, with implications for supporting adolescents with physical health conditions. Results suggest that psychological interventions targeting perceived control, understanding and identity may have particular utility for adolescents with CFS.

Background:Current pharmacotherapies to treat or prevent hand osteoarthritis are limited. Colchicine, an anti-inflammatory agent effective at reducing joint pain and swelling in gouty arthritis, may offer relief in hand osteoarthritis, though this has not been investigated before.1Objectives:To investigate the efficacy of colchicine compared to placebo on VAS pain scores over 12 weeks in adults with hand osteoarthritis in a randomised, double-blind controlled trial.Methods:64 community-dwelling adults with hand osteoarthritis (American College of Rheumatology criteria)2(54 females, 48-79 years) were randomised 1:1 to colchicine (0.5mg twice daily) or placebo for 12 weeks. VAS pain scores (worst affected hand) were obtained at baseline and weeks 6, 12, and after treatment withdrawal at week 16. Secondary outcome measures included grip strength, C-reactive protein (CRP) and tender and swollen joint count (TSJC). Grip strength, TSJC and CRP were obtained at baseline and week 12. Intention-to-treat analyses, adjusted for age and gender, were performed using constrained longitudinal data analysis models in Stata v16.3This study is registered with the Australia New Zealand Clinical Trials Registry, ACTRN12617001524381.Results:58 participants completed the study (N=27 colchicine, N=31 placebo, withdrawal rate 9%). Mean (S.D) VAS score of the affected hand at baseline was 71.4 (14.5) mm in the placebo and 65.4 (15.0) mm in the colchicine group (p = 0.11). VAS scores improved during treatment, but were comparable between groups at week 6, 12 and 16 (Table 1). There were no differences between groups at week 12 for CRP, TSJC or grip strength (Table 1). Adverse events related to study medications included nausea (n=4), diarrhoea (n=9), vomiting (n=3), bloating (n=1) and reflux (n=1).Table 1.COLAH study primary and secondary outcomes, from constrained longitudinal data analysis modelOutcomeTimepointColchicine (SE)Placebo (SE)Colchicine-Placebo(95% CI)p-valueVAS Pain (mm)6 weeks53.5 (4.5)53.9 (4.6)-0.4 (-12.3, 13.1)0.9512 weeks57.1 (4.4)48.4 (4.6)8.7 (-21.2, 3.9)0.1816 weeks62.0 (4.3)61.6 (3.7)-0.4 (-11.4, 10.5)0.94TSJC (0-20)12 weeks5.6 (0.7)3.8 (0.7)1.8 (-4.1, 0.5)0.13Grip strength (kg)12 weeks14.4 (0.8)15.3 (0.8)-0.9 (-0.2, 2.0)0.10CRP (mg/L)12 weeks4.5 (1.4)4.0 (1.3)0.5 (-3.8, 2.9)0.77Conclusion:Colchicine 1mg daily for 12 weeks was not effective in improving pain, tender and swollen joint count or grip strength in symptomatic hand osteoarthritis patients. This study does not support colchicine for treatment of symptoms of hand osteoarthritis.References:[1]Leung, YY, Hui, LLY, Kraus, VB 2015. Colchicine-Update on mechanisms of action and therapeutic uses.Seminars in Arthritis and Rheumatism; 45: 341-350.[2]Altman, R, Alarcon, G, Appelrouth, D et al, 1990. American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand.Arthritis Rheumatology;33(11): 1601-10.[3]Liu GF, Lu K, Mogg R, et al. 2009. Should baseline be a covariate or dependent variable in analyses of change from baseline in clinical trials?Stat Med; 28: 2509–30.Characters from table content including title and footnotes: 465Disclosure of Interests:None declared

Background Giant cell arteritis (GCA) is the commonest form of systemic vasculitis caused by inflammation of the blood vessels around the head and neck, with the highest incidence in women aged 70–79 years (7.4 per 10 000 person-years). Patients present with headache, jaw claudication and polymyalgia rheumatica with visual loss in 20%. Treatment is with high dose glucocorticoids. Objectives Identify and define the range of patient experiences in relation to GCA, and effects on health related quality of life in patients from the United Kingdom and Australia. Methods Semi-structured qualitative interviews with patients from the UK and Australia explored health-related quality of life and patient perspectives on the experience of GCA. Interviews were recorded, transcribed and analysed. Patients were purposively sampled to include both genders, a range of disease durations and organ involvement (visual loss and large vessel involvement). Data were analysed with inductive thematic analysis and managed using NVivo 10. The sample size was determined by the point at which no new substantive themes emerged. Results Thirty-one interviews were conducted. Demographics and disease features shown in table 1. Individual sub-codes were identified then grouped into overarching themes: “Anxieties around getting a diagnosis of GCA”, “Description of symptoms related to GCA and its treatment”, “Lack of bodily strength, stability and stamina; difficulties with completing daily tasks”, “Difficulties with participating in social activities, work and caring roles”, “Not feeling normal and impact on general perception of health”, “Anxiety and fear of the future”. Contextual factors impacted on how patients experienced GCA including “Response to treatment and adverse effects”, “Receiving support from family, friends and health care workers”, “Adopting successful self-management techniques, e.g. keeping fit and active” and “Presence of pre-existing co-morbidities and development of secondary conditions e.g. cardiovascular disease, osteoporosis or diabetes”. Conclusions Patients with GCA have described a range of themes of interest in relation to their disease. These data could be used as the basis of developing a patient reported measure of outcome in GCA. Disclosure of Interest None declared

BACKGROUND A multidisciplinary team, including critical care nurses?and specialists, critical care intensivist physicians and infection?preventionists developed and implemented a new care leadership model to direct the assessment of central venous catheters?and central line bloodstream infection (CLABSI) risk in a medical intensive care unit (MICU) within an academic quaternary care hospital. METHODS The MICU unit based clinical leadership (UBCL) introduced weekly multidisciplinary central line rounding that incorportated assessments at the bedside from physicians, nurses, advanced practice providers and infection preventionists. Each discipline assessed each patient's central access from his or her professional perspective. This new practice widened the scope of assessments to include proper insertion practices, choice of line location and discussions about line removal. Additionally, this allowed a forum for direct feedback and discussion at the bedside and provided an opportunity for caregivers to learn from these experts. Technology supported the function of this team by introducing the use of mobile devices and?sophisticated research software providing a communication and?auditing arena. REDCap was implemented to structure the information efficiently. This allowed data to be securely accessed and completed at the bedside using a mobile phone or IPad. The team also used photographs to track their progress. “Before” and “after” photos of problematic lines visually depicted their success, and also provided education to staff in the unit newsletter, Central Line Rewind. RESULTS The MICU compared its CLABSI performance over a five month period in 2017 to 2018 (7/1 to 11/30). In 2017, the MICU incurred six (6) CLABSIs. In 2018, it incurred three (3). CONCLUSIONS The MICU reduced the number of CLABSIs by 50%. A consistent, comprehensive, interdisciplinary approach to assessing the central lines has allowed the MICU to more effectively assess the central lines. In addition, implementing a technological solution has enabled real-time peer review, including results from effective interventions.

The effective reduction of delayed cerebral ischemia (DCI), a main contributor for poor outcome following aneurysmal subarachnoid hemorrhage (SAH), remains challenging. Previous clinical trials on systemic pharmaceutical treatment of SAH mostly failed to improve outcome, probably because of insensitive pharmaceutical targets and outcome measures, small sample size, insufficient subarachnoid drug concentrations and also detrimental, systemic effects of the experimental treatment per se. Interestingly, in studies that are more recent, intrathecal administration of nicardipine pellets following surgical aneurysm repair was suggested to have a beneficial effect on DCI and neurological outcome. However, this positive effect remained restricted to patients who were treated surgically for a ruptured aneurysm. Because of the favorable results of the preclinical data on DCI and neurological outcome in the absence of neurotoxicity or systemic side effects, we are initiating clinical trials. The PROMISE (Prolonged Release nimOdipine MIcro particles after Subarachnoid hemorrhage) trial is designed as an unblinded, nonrandomized, single-center, single-dose, dose-escalation safety and tolerability phase 1 study in patients surgically treated for aSAH and will investigate the effect of intracisternal EG-1962 administration. The NEWTON (Nimodipine microparticles to Enhance recovery While reducing TOxicity after subarachNoid hemorrhage) trial is a phase 1/2a multicenter, controlled, randomized, open-label, dose-escalation, safety, tolerability, and pharmacokinetic study comparing EG-1962 and nimodipine in patients with aneurysmal SAH.

In 2011, natural hazards caused over $52 billion in damages in the United States. Most of this cost occurred in the residential sector because a large number of houses were unable to withstand severe weather and geological activity. Th is is an investigation of construction methods and design characteristics applied to new and existing homes in order to better support residential wooden structures against natural hazards. Th e focus will be on two locations because of their affinity for natural hazards: Anchorage, Alaska and Houston, Texas. Anchorage is prone to flooding, heavy snow, permafrost, earthquakes, tsunamis, wildfires, coastal erosion, and nearby volcanoes. Houston standing at fourth on the list of cities with the greatest risk for natural disasters is subject to hurricanes, flooding, tornados, subsidence, hail, and wildfires. Having utilized online mitigation sources, government agencies, and specialists, I have compiled the information needed to understand the dangers of living in harzard-prone areas. Floor plans have been designed for these two U.S. locations to explain the techniques and products needed to create a hazard resistant home. Along with a floor plan, a list of materials and construction methods will be provided.