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Aims: To determine the minimal clinically important difference (MCID) of the Dermatology Life Quality Index (DLQI) and its responsiveness to change in inflammatory skin diseases. Methods: A longitudinal study: at stage 1, patients completed the DLQI and a disease severity global question; at stage 2, a global rating of change in quality of life (QoL; Global Rating of Change Questionnaire, GRCQ) was added and used as an anchor to measure the MCID of the DLQI. Results: 192 patients completed stage 1 and 107 completed stage 2. The mean DLQI score at stage 1 was 9.8 and 7.4 at stage 2 with a mean change of 2.4 (p < 0.0001). 31 patients experienced a ‘small change' in their QoL (±3 and ±2) on the GRCQ. The mean corresponding change in DLQI scores was 3.3, which is regarded as the approximate MCID. Conclusions: Previous estimates of the MCID of the DLQI have varied from 3 to 5. Although this study demonstrated a MCID of 3.3, we recommend that the MCID in inflammatory skin diseases should be 4.

Introduction: An anterior cruciate ligament (ACL) Registry was established at the Queensland Children’s Hospital (QCH) to investigate paediatric ACL injuries, supporting the International Olympic Committee’s recommendations for research priorities. [...]research will leverage this baseline information to determine independent and combined predictors of ACL injuries, and knee joint health into adulthood. Ongoing Registry longitudinal data collection will identify risk factors for primary and subsequent ACL injuries and influence decision making in the management of this challenging problem.

Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations. Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. Our results suggest that CO -assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.

The purpose of this study is to identify the relationship, if any, between the gain in the force concept inventory (FCI) and study level, gender, repeaters/non-repeaters, teaching style and the end-of-year mechanics result. The study focussed on all students (N = 395) admitted to a post-secondary institution in Malta in October 2015 and who participated in the pretest and posttest FCI exercise, studying physics at advanced (N = 162) or intermediate level (N = 233). There were 36 students at advanced level and 44 students at intermediate level who did not participate in the posttest FCI. In this study a multiple-choice test was used comprising of 30 questions about mechanics concepts and a questionnaire (by Centre for Occupational Research and Development (CORD)) was given to the lecturers to identify the teaching goals and methods used. The pretest was given on the second week of the academic year, October 2015, so that their response was not influenced by mechanics teaching and the posttest (identical to pretest) was given in the end of the scholastic year, May 2016. The results of the study suggest that only 13.7% of the participants exceeded the average-expected gain of 24%. The gain is higher for males, for participants studying advanced level physics and for participants who were taught by particular lecturers with particular teaching goals and methods. There is a positive correlation between the gain in the FCI and the end-of-year score in mechanics questions about forces and Newton's laws of motion.

BackgroundThermography has been utilised in a number of studies in rheumatoid arthritis (RA),1 however there is a paucity of evidence as regards to the possibility of applying this non-invasive technology to the detection of synovitis of the hands and wrists. With normative data having been already published,2 it is now possible to compare the thermographic characteristics of RA patients without active synovitis to those with a normal thermal distribution in order to determine the baseline characteristics of RA hands and wrists. This would consequently provide a foundation against which further studies investigating RA patients with synovitis can be compared.ObjectivesTo determine whether rheumatoid arthritis (RA) patients without active synovitis in their hands exhibit different baseline thermographic patterns of the fingers and palms when compared to healthy individualsMethodsData from 31 RA patients were compared to 51 healthy controls. Inclusion criteria were confirmed absence of synovitis by clinical examination and musculoskeletal ultrasound in rheumatoid patients. Thermographic imaging of the regions of interest (ROIs) were obtained as per established protocols2 ResultsSignificant differences were found between the mean temperatures of the palm regions and fingers of the healthy participants when compared to the palm regions and fingers of their RA counterparts (p=0.001), with the latter group exhibiting higher temperatures in all ROIs. No significant differences were found between ROIs of the palms and fingers of both hands in either group. Logistic regression models confirm that both palm and finger temperature increase significantly in RAConclusionsRA patients without active inflammation of the hands demonstrate a significantly higher mean temperature compared to healthy individuals. These findings provide evidence that baseline thermal data in RA differs significantly from healthy individuals. Thermal imaging may have the potential to become an adjunct assessment method of disease activity in patients with RA.References[1] Frize M, Adéa C, Payeur P, Di Primio G, Karsh J, Ogungbemile A. Detection of rheumatoid arthritis using infrared imaging. In: Dawant BM, Haynor DR, eds. 2011.[2] Gatt A, Formosa C, Cassar K, et al. Thermographic patterns of the upper and lower limbs: Baseline data. Int J Vasc Med. 2015.Disclosure of InterestNone declared

BackgroundPharmacists must adapt and evolve in order to face challenges and sustain the profession to continuously provide optimum personalised patient care to rheumatoid arthritis patients. Rheumatoid arthritis medication assessment tool, RhMAT is an innovative evidence-based instrument developed specifically to assess pharmacetherapy adherence to rheumatoid arthritis evidence-based guidelines and recommendations.ObjectivesThe objective of the study was to use the RhMAT within an outpatient rheumatology clinic to identify pharmaceutical care issues and assess therapeutic management of rheumatoid arthritis patients.MethodsRheumatoid arthritis patients regularly attending the rheumatology clinic at Mater Dei Hospital eligible to participate in the study were offered a pharmaceutical care session. The pharmacist screened each patients' pharmacetherapy using the RhMAT at two time points, Phase 1 (time =0 months) and Phase 2 (time = approximately 12 months).The RhMAT adherence rate for each patient was calculated at both time points. A score of 50% of less was determined as low adherence, a score between 51% and 74% showed intermediate adherence and a score of 75% or more was determined as high adherence to the RhMAT.Gaps in non-adherence to the RhMAT which led to pharmaceutical care issues were documented and discussed with the clinician. Data analysis of the mean score at both phases was analysed using Wilcoxon signed rank test, SPSS verion 22.ResultsA total of 78 patients (52 females) participated in the study. The mean age was 64 years (SD 12).The majority of the patients (55%) were prescribed at least one traditional disease modifying anti-rheumatic drug (tDMARD) whereas 45% were on biologic disease modifying anti-rheumatic drug (bDMARD). The most common tDMARD prescribed was methotrexate (n=52 patients). The mean RhMAT adherence rate at phase 1 was 81.7%. Following the pharmacist's contribution whereby the identified gaps leading to non-adherence such as lack of appropriate monitoring or lack of drug therapy counselling, were discussed as necessary with the respective clinician and the patient, the mean RhMAT adherence rate at the follow up session at Phase 2 statistically significantly increased to 85.2% (Wilcoxon signed rank test p value <0.05).ConclusionsThe RhMAT is an innovative tool which aids pharmacists to identify adherence of prescribed pharmacotherapy in accordance to established guidelines. At the same time, the RhMAT allows pharmacists to identify gaps in individual patients care which lead to pharmaceutical care issues. Through the RhMAT, pharmacists further improve the quality of care offered to rheumatoid arthritis patients.Disclosure of InterestNone declared

Thermal imaging has been applied to detect possible temperature variations in various rheumatic disorders. This study sought to determine whether rheumatoid arthritis (RA) patients without active synovitis in their hands exhibit different baseline thermographic patterns of the fingers and palms when compared to healthy individuals. Data from 31 RA patients were compared to that of 51 healthy controls. The RA patients were recruited upon confirmed absence of synovitis by clinical examination and musculoskeletal ultrasound. Participants underwent medical infrared imaging of the regions of interest (ROIs). Significant differences were found between the mean temperatures of the palm regions (29.37 °C (SD2.2); n = 306) and fingers (27.16 °C (SD3.2); n = 510) of the healthy participants when compared to the palm regions (31.4(SD1.84)°C; n = 186) and fingers (30.22 °C (SD2.4); n = 299) of their RA counterparts (p = 0.001), with the latter group exhibiting higher temperatures in all ROIs. Logistic regression models confirm that both palm and finger temperature increase significantly in RA without active inflammation. These innovative findings provide evidence that baseline thermal data in RA differs significantly from healthy individuals. Thermal imaging may have the potential to become an adjunct assessment method of disease activity in patients with RA.