Connolly Hospital Blanchardstown

About: Connolly Hospital Blanchardstown is a healthcare organization based out in Dublin, Ireland. It is known for research contribution in the topics: Population & Ambulatory blood pressure. The organization has 302 authors who have published 213 publications receiving 3858 citations. The organization is also known as: James Connolly Memorial Hospital.

OP0081-HPR Physiotherapist's Accuracy in Recognising and Diagnosing Inflammatory Joint Disease While Working in A New Patient Rheumatology Clinic

Abstract: Background Physiotherapists working in triage roles are well established in orthopaedic and spinal clinics, but there is less literature available on their role in rheumatology. Physiotherapy clinical specialist posts were established in Ireland in 2012 to reduce waiting times to see a consultant rheumatologist. One such post had already been in existence in Connolly Hospital, Dublin, Ireland since December 2010. Objectives The aim of this audit was to assess the accuracy of a physiotherapist in recognising and diagnosing inflammatory joint disease. Methods Data was collected consecutively on all patients assessed by the Physiotherapist at the Rheumatology New Patient Clinic from December 2010 to July 2013. Patients with a suspected inflammatory diagnosis were assessed and appropriate initial diagnostic tests were ordered. These patients had follow up appointments scheduled with a consultant rheumatologist in order to confirm or refute the initial diagnosis. Medical charts were reviewed to ascertain if the Physiotherapist9s initial diagnosis concurred with that of the Consultant Rheumatologist. Results A total of 223 patients were assessed over the time period. Fifty two patients were suspected of having an inflammatory arthritis. Data was unavailable on 5 of these patients at time of audit as these patients were pending review and diagnosis by the Rheumatologist. Forty two of the remaining 47 patients (89%) were confirmed by the Rheumatologist as having an inflammatory arthritis. Five patients, accounting for 11% of the sample, were given alternative diagnoses upon review by the Consultant Rheumatologist. The Physiotherapist accurately diagnosed 42 of the 47 patients with inflammatory joint disease seen, accounting for an 89% accuracy, or alternatively a 11% error. It is worth noting that the Rheumatologist had, at the follow up appointment, the results of all diagnostic tests which would have aided in making an accurate diagnosis, whereas the Physiotherapist9s diagnoses were made based on the patients9 clinical presentation and occasionally with accompanying test results. Of the 223 patients assessed by the Physiotherapist in the Rheumatology New Patient clinic, 171 patients (77%) presented with non-inflammatory musculoskeletal pain. An audit of the diagnoses/outcomes of these patients is ongoing. Conclusions The data indicate that a physiotherapist with specialist training in rheumatology can work effectively and safely in a rheumatology new patient clinic. It also highlights the high number of non-inflammatory conditions seen in a rheumatology new patient clinic, thereby confirming the importance of having a physiotherapist present to assist in managing the large number of mechanical and/or degenerative conditions that present to a rheumatology new patient clinic. References Dakker-White G, Carr AJ, et al.A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient departments. J Epidemiol Community Health 1999;53:643-650 Heywood JW. Specialist Physiotheraists In Orthopaedic Triage – The Results of a Military Spinal Triage Clinic. J R Army Med Corps 2005;151-156 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1117

The Association Between 25 Hydroxyvitamin D and Airway Obstruction in Asthma.

Abstract: Since Vitamin D has anti-inflammatory effects we wondered whether the association between low serum 25OHD and airway obstruction in moderate persistent asthma might be explained by inflammatory pathways that worsen asthma. All subjects examined were Irish Caucasians with moderate persistent asthma and none took systemic steroid therapy. In addition to computerized spirometry, we measured BMI, serum 25-hydroxyvitamin D (25OHD), total IgE, Eosinophil Cationic Protein (ECP), and high sensitive C- reactive protein (hs-CRP). One hundred (47 male) subjects completed the testing. Within single level of asthma severity, 25OHD levels were related to post-bronchodilator FEV1/FVC (r = 0.26, p< 0.01), but multiple linear regression analysis demonstrated that the association was not explained by obesity or inflammatory markers. We find a relationship exists between airway obstruction and 25OHD levels in asthmatic adults, and the effect is not explained by the presence of potential confounders such as obesity, allergy and systemic inflammation.

THU0635-HPR Do Physiotherapists Working in New Patient Rheumatology Clinics Miss Inflammatory Arthritis: A Retrospective Review of 296 Patients

Abstract: Background Physiotherapists working in triage roles are well established in orthopaedic and spinal clinics, but there is less literature available on their role in rheumatology. We have shown previously that a physiotherapist can diagnose inflammatory arthritis with an accuracy of 89% (Kirwan and Duffy, 2014). Objectives This audit set out to ascertain whether a physiotherapist working in a rheumatology new patient clinic, as a first point of contact clinician, misses inflammatory arthritis. Methods Data was collected consecutively on all patients assessed by the Physiotherapist at the Rheumatology New Patient Clinic from December 2010 to June 2014. Patients who were diagnosed with an inflammatory condition were omitted from this review. The remaining patients were given non-inflammatory diagnoses. Medical charts were reviewed to establish whether any of these patients subsequently developed an inflammatory arthritis. Results A total of 294 patients were assessed over the time period. 233 patients were diagnosed with a non-inflammatory condition. Seven charts were unavailable at time of review. Of the 226 charts reviewed, none of these patients had developed an inflammatory arthritis . This review did not set out to establish if this group had resolution of their presenting complaint but instead focused on whether any patients presenting with non-inflammatory symptoms were misdiagnosed by the Physiotherapist. Over a 3 and a half year period and upon completing assessments on 294 patients, our previous study (Kirwan and Duffy, 2014) revealed the Physiotherapist displayed high accuracy when diagnosing inflammatory joint disease. This review highlighted that the Physiotherapist did not miss inflammatory arthritis upon assessment and diagnosis of 226 patients with non-inflammatory conditions. Conclusions This study highlights the high number of non-inflammatory conditions (79%) seen in a new patient rheumatology clinic. Patients presented with a wide spectrum of symptoms indicating a range of clinical assessments skills are required. The data indicate that a physiotherapist with specialist training in rheumatology does not miss inflammatory arthritis, and can safely and effectively assess inflammatory (Kirwan and Duffy, 2014) and non-inflammatory conditions, while working in a new patient rheumatology clinic. The findings from this review confirm the value, and benefit, in having a physiotherapist present in rheumatology new patient clinics, to assist in diagnosing and managing the large number of mechanical/degenerative conditions seen. References Kirwan P, Duffy T. Physiotherapist9s accuracy in recognizing and diagnosing inflammatory joint disease while working in a new patient rheumatology clinic. (Abstract). In: Ann Rheum Dis 2014;73(Suppl2); 2014 Jun 11-14; Paris, France. Disclosure of Interest None declared

Supplemental dietary nitrate for chronic obstructive pulmonary disease: a randomized, double-blind, placebo-controlled, crossover trial

Abstract: Nitric oxide (NO) is an important systemic and pulmonary arterial vasodilator. The conversion of nitrite (derived from dietary nitrate) to nitric oxide can occur independent of nitric oxide synthase (Lundberg & Govoni 2004) in a process that is upregulated in hypoxic conditions (Lundberg et al., 2008). Since patients with chronic obstructive pulmonary disease (COPD) commonly suffer hypoxaemia during exercise, we hypothesized that dietary nitrate supplementation might acutely improve exercise capacity in hypoxic COPD patients through enhanced production of NO. We compared the acute effect of beetroot juice (containing14 mmol of nitrate) on exercise capacity and arterial systolic blood pressure in COPD patients compared to a matched placebo drink (containing less than 0.5 mmol of dietary nitrate). Twelve subjects (6 male) with COPD were recruited. Resting blood pressure was assessed in duplicate (manual sphygmomanometer). Heart rate and arterial oxygen concentration (pulse oximetry) as well as self-reported breathlessness (Borg dyspnea scale) were assessed preand post-incremental shuttle walk test. Subjects were then randomized to drink beetroot juice or a matched placebo and the protocol was repeated 3 hours later. The 3h rest period was to allow for sufficient recovery from baseline testing and has been found to correspond with peak plasma nitrite concentrations following oral consumption of dietary nitrate (Webb et al., 2008). After a 7-day washout period, the protocol was repeated with the crossover beverage. There were no significant differences in heart rate, arterial oxygen concentrations, or breathlessness at any time point. However, COPD subjects who took dietary nitrate walked significantly further than when they took placebo ( + 23 vs. 13 metres; p<0.01) and had a reduction in both systolic blood pressure ( 13 vs. 0 mmHg; p<0.05) and diastolic blood pressure ( 3.2 vs. + 7.8 mmHg; p<0.05). Acute consumption of dietary nitrate can improve exercise tolerance and lower blood pressure in COPD patients.