Nadia Ahmad

Background/Aims Giant cell arteritis (GCA) is a common form of vasculitis, but sometimes this condition can manifest as aortitis. Diagnosis of aortitis is trickier than the cranial presentation of GCA. It often leads to prolonged treatment and can cause complications such as aortic dissection. Here we report our centre’s experience of managing patients with aortitis. Methods We retrospectively analysed patients that were diagnosed with aortitis between 2006 and 2019. They were identified by their diagnosis code on a locally developed database. This work was approved within our department and registered with the audit team. Microsoft Excel was used for both data collection and analysis. Results 94 patients were included in this analysis. There was a female preponderance at 55.3% (n = 52), with an average age of 70 at the time of diagnosis (range 40-90). The most commonly presenting features were systemic inflammatory response syndrome (51.1%, n = 48), giant cell arteritis-like symptoms (41.2%, n = 39) and polymyalgia rheumatica-like symptoms (38.3%%, n = 36). Importantly, 14.9% (n = 14) of patients presented with claudication and 5.2% (n = 5) were diagnosed after an acute aortic dissection. The median CRP and ESR levels were 63 and 69 respectively at presentation. Most (78.7%, n = 74) had diagnostic changes on CT-PET. Those with GCA-like symptoms were diagnosed on average 3.5 months before those without them (9.8 months versus 13.4). Most were treated with prednisolone (94.7%, n = 89), with a median duration of 36 months. Only 3 patients did not receive an adjunctive DMARD. The most commonly used DMARD was methotrexate (90.4% n = 85). Leflunomide was used in 23.4% (n = 22) with a median treatment length of 1 year. Azathioprine was used in 19.1% (n = 18) of patients with cyclophosphamide used in 28.7% (n = 27) of the cohort. Tocilizumab (9.6%, n = 9) and rituximab (2.1%, n = 2) were the biologic agents used. Several (39.4% n = 37) were treated with at least 2 DMARDs in addition to prednisolone during their treatment course. Most patients (60.6%, n = 57) were on treatment at the time of analysis, with the most common drug being methotrexate (49.1%, n = 28) and prednisolone (47.3%, n = 27). The most common treatment complication was GI upset, leading to a drug change in 24.5% (n = 23). Relapsing disease was common (47.9%, n = 45) despite being on treatment. Vascular complications were prevalent at 40.4% (n = 38). The majority were related to ischaemic complications such as stroke, although 13.8% (n = 13) developed aneurysms or dissections. Conclusion Systemic inflammatory response syndrome was the commonest presenting feature. Those without GCA-like symptoms received a delayed diagnosis, which increases the risk of preventable vascular events. CT-PET remained the main diagnostic tool. Prednisolone treatment was prolonged with burdensome side-effects. Methotrexate remained the DMARD of choice, but leflunomide also showed good results. Vascular complications are common and need attention. Disclosure R.S. Andev: None. N. Ahmad: None. R. Luqmani: None. S. Dubey: None.

Well-organized conversation can improve people's ability to comprehend and retain information. As part of a long-term effort to adapt Quality Improvement techniques for communication, we developed an explicit criteria method to assess usage of three organizing behaviors (OBs): ‘opening behaviors’ to establish goals; ‘structuring behaviors’ to guide patients through conversation; and ‘emphasizing behaviors’ that signal a need for attention. Pairs of abstractors independently reviewed transcripts in a demonstration sample of conversations between physicians and standardized parents after newborn screening identifies carrier status for sickle cell disease. Criteria for at least one OB were identified in 50/84 transcripts (60%), including 27 with at least one opening behavior (32%), 5 with at least one structuring behavior (6%), and 38 with at least one emphasizing behavior (45%). The limited number of OBs raises concern about communication after newborn screening. Assessment and improvement of OB usage may improve understanding and allow parents to more actively participate in health care.

We built upon previous laboratory studies by examining the independent and interactive effects of restitution and apology on behavioral and self-reported measures relevant to forgiveness. Undergraduates (N = 155) received two of 10 tickets in a distribution. Some thought another participant was the distributor; others thought it was random. Later, some participants received restitution as nine tickets from the artificial participant, whereas others received nine tickets by chance. Some also received an apology. Participants then distributed 10 tickets to the artificial participant, the behavioral measure of forgiveness. Participants also self-reported forgiveness by rating the motivations underlying their distribution, including the motive, ‘to express forgiveness’. Results indicated restitution increased behavioral expressions of forgiveness, but apology increased self-reported forgiveness. The restitution effect was partially mediated by empathy and the desire to help the transgressor. This study underscores the importance of both restitution and apology and of using multiple measures of forgiveness.

Recently, social psychologists have given considerable attention to the possibility that empathy can be used to improve intergroup attitudes and relations. For this possibility to bear practical fruit, it is important to know what is meant by empathy because different researchers use the term to refer to different psychological states. It is also important to understand how each of these empathy states might affect intergroup relations by reviewing theory and research on the psychological processes involved, and it is important to consider the limitations of each form of empathy as a source of improved intergroup relations. Finally, it is important to consider the role of different empathy states in existing programs designed to improve intergroup relations, whether in protracted political conflicts, in educational settings, or via media. In this article, we pursue each of these goals.

Do we humans ever, in any degree, care about others for their sakes and not simply for our own? Psychology has long assumed that everything humans do, no matter how nice and noble, is motivated by self-interest. However, research over the past three decades suggests that this assumption is wrong. This research has focused on the empathy—altruism hypothesis, which claims that empathic concern—an other-oriented emotional response elicited by and congruent with the perceived welfare of a person in need—produces altruistic motivation—motivation with the ultimate goal of increasing another's welfare. Results of the over 30 experiments designed to test this hypothesis against various egoistic alternatives have proved remarkably supportive, leading to the tentative conclusion that feeling empathic concern for a person in need does indeed evoke altruistic motivation to see that need relieved. Sources of altruistic motivation other than empathy also have been proposed, but as yet, there is not compelling research evidence to support these proposals. Two additional forms of prosocial motivation have also been proposed: collectivism and principlism. Collectivism—motivation with the ultimate goal of benefiting some group or collective as a whole—has been claimed to result from group identity. Principlism—motivation with the ultimate goal of upholding some moral principle—has long been advocated by religious teachers and moral philosophers. Whether either is a separate form of motivation, independent of and irreducible to egoism, is not yet clear. Research done to test for the existence of empathy-induced altruism may serve as a useful model for future research testing for the existence of collectivism and principlism. Theoretical and practical implications of the empathy-altruism hypothesis are briefly considered.