Good Helping Relationships in Child Welfare: Co-authored Stories of Success (FULL REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

Good Helping Relationships in Child Welfare: Co-authored Stories of Success (SUMMARY REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

Good Helping Relationships in Child Welfare: Co-authored Stories of Success (SUMMARY REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

Good Helping Relationships in Child Welfare: Co-authored Stories of Success (FULL REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

Symptom-based stratification of patients with primary Sjögren's syndrome: multi-dimensional characterisation of international observational cohorts and reanalyses of randomised clinical trials

Background Heterogeneity is a major obstacle to developing effective treatments for patients with primary Sjögren's syndrome. We aimed to develop a robust method for stratification, exploiting heterogeneity in patient-reported symptoms, and to relate these differences to pathobiology and therapeutic response. Methods We did hierarchical cluster analysis using five common symptoms associated with primary Sjögren's syndrome (pain, fatigue, dryness, anxiety, and depression), followed by multinomial logistic regression to identify subgroups in the UK Primary Sjögren's Syndrome Registry (UKPSSR). We assessed clinical and biological differences between these subgroups, including transcriptional differences in peripheral blood. Patients from two independent validation cohorts in Norway and France were used to confirm patient stratification. Data from two phase 3 clinical trials were similarly stratified to assess the differences between subgroups in treatment response to hydroxychloroquine and rituximab. Findings In the UKPSSR cohort (n=608), we identified four subgroups: Low symptom burden (LSB), high symptom burden (HSB), dryness dominant with fatigue (DDF), and pain dominant with fatigue (PDF). Significant differences in peripheral blood lymphocyte counts, anti-SSA and anti-SSB antibody positivity, as well as serum IgG, κ-free light chain, β2-microglobulin, and CXCL13 concentrations were observed between these subgroups, along with differentially expressed transcriptomic modules in peripheral blood. Similar findings were observed in the independent validation cohorts (n=396). Reanalysis of trial data stratifying patients into these subgroups suggested a treatment effect with hydroxychloroquine in the HSB subgroup and with rituximab in the DDF subgroup compared with placebo. Interpretation Stratification on the basis of patient-reported symptoms of patients with primary Sjögren's syndrome revealed distinct pathobiological endotypes with distinct responses to immunomodulatory treatments. Our data have important implications for clinical management, trial design, and therapeutic development. Similar stratification approaches might be useful for patients with other chronic immune-mediated diseases. Funding UK Medical Research Council, British Sjogren's Syndrome Association, French Ministry of Health, Arthritis Research UK, Foundation for Research in Rheumatology

Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.4

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Arthroscopic Treatment of Shoulder Instability With Glenoid Bone Loss Using Distal Tibial Allograft Augmentation: Safety Profile and Short-Term Radiological Outcomes.

The results of arthroscopic anterior labral repair have demonstrated high failure rates in patients with significant glenoid bone loss. Several reconstruction procedures using a bone graft have been developed to overcome bone loss. The primary objective of this study was to generate a safety profile for arthroscopic anatomic glenoid reconstruction using a distal tibial allograft. The secondary objective was to evaluate the radiological outcomes of patients who underwent this procedure. Case series; Level of evidence, 4. This retrospective review included the medical charts and diagnostic images of 42 consecutive patients who underwent arthroscopic shoulder stabilization by means of capsule-labral reattachment and bony augmentation with a distal tibial allograft. The safety profile was measured by detecting intraoperative or postoperative complications, including neurovascular (nerves and blood vessels) injuries, bleeding, infections, and dislocations. A radiological evaluation was conducted by assessing computed tomography (CT) scans obtained preoperatively and at approximately 6 months postoperatively. A total of 42 patients (29 male, 13 female) with a mean age of 26.73 ? 9.01 years were included. An excellent safety profile was observed, with no intraoperative complications, neurovascular injuries, adverse events, bleeding, or infections. CT bone scans were obtained for 31 patients, and the mean follow-up for CT scanning (to measure resorption and union) was 6.31 ? 1.20 months (range, 6-7.5 months). There were no cases of nonunion or partial union. Thirteen patients (42%) had no resorption, whereas 13 (42%) and 5 (16%) patents had <50% and ?50% resorption, respectively. Arthroscopic shoulder stabilization with distal tibial allograft reconstruction is a safe operative procedure with a minimal risk to neurovascular structures. Most patients had a healed allograft, but 16% of patients had ?50% resorption on CT at 6 months. Studies with a longer follow-up are recommended for better assessment of the safety profile