THU0582 EFFECTIVE MANAGEMENT OF REFRACTORY GOUT: EFFECT OF ONLINE CONTINUING EDUCATION ON RHEUMATOLOGISTS’ KNOWLEDGE

Background:

Gout is a chronic condition with a considerable effect on patient health and quality of life. Despite the availability of multiple pharmacologic treatments and evidence-based management guidelines, treatment targets are often not achieved in patients with gout. Identification and optimal management of patients with severe or refractory gout is specially challenging.

Objectives:

The objective of this study was to determine if an online, continuing education activity could improve knowledge of rheumatologists regarding strategies to ensure effective and safe use of urate-lowering therapies in the management of patients with refractory gout.

Methods:

Educational design included an online, 30-minute, video-based discussion among two faculty experts with synchronized slides. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design using 3 knowledge questions and 1 confidence question, in which each individual served as his/her own control. A chi-squared test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. Cramer’s V was used to calculate the effect size (<0.06 modest effect; 0.06-0.15 noticeable effect; 0.16-0.26 considerable effect; >0.26 extensive effect). The activity launched May 1, 2019, with data collected through December 30, 2019.

Results:

The analysis set consisted of responses from rheumatologists (n=300) who answered all assessment questions during the study period. Analysis of pre- vs post-intervention responses demonstrated a significant improvement in overall knowledge of rheumatologists with considerable educational impact (V = .201, P<.001). Average correct responses increased from 54% pre to 74% post education. Specific areas of improvement in knowledge include:

•Optimal strategies for reducing the risk for immunogenicity associated with the use of pegloticase in patients with refractory gout (40% pre, 73% post; P<.001; V = .326)

•Serum uric acid targets to optimize management of the patient with severe or refractory gout (45% pre, 57% post; P<.05; V = .120)

•Selection of pegloticase for rapid decreases in tophi and serum uric acid in patients with refractory gout (77% pre, 91% post; P<.001; V = .187)

Post-education, 32% of rheumatologists were more confident in their ability to manage patients with refractory gout.

Conclusion:

This study demonstrated the success of online, 30-minute, video-based discussion among two faculty experts with synchronized slides on improving the knowledge of rheumatologists regarding appropriate management of patients with refractory gout.

Disclosure of Interests:

None declared

Using Evidence-Based Dentistry in the Clinical Management of Methadone Maintenance Therapy Patients

AIMS AND OBJECTIVES

There is an increased interest to incorporate interprofessional educational models in the academic dental institutions to serve both student education and patient care. The aim of this report is to integrate evidence-based dentistry (EBD) with an interprofessional approach to treat methadone maintenance therapy (MMT) patients. Current example illustrates the case of a 26-year-old man receiving MMT who presented at Tufts University School of Dental Medicine with the chief complaint of "I want to fix my teeth." He presented with a collapsed vertical dimension of occlusion, extensive partial edentulism on both arches with bone loss, and a past history of drug abuse since the age of 16 years.

MATERIALS AND METHODS

The 5-step (ask, acquire, appraise, apply, assess) framework for the EBD process was used. First, the PICO (population, intervention, comparison, and outcome) question was asked, and then the literature was acquired and appraised. An expert librarian assisted in finding articles on the effects of methadone on the oral cavity and consequences that will affect dental treatment. The search was conducted on PubMed, using the following keywords: oral health, dentistry, dental health, and methadone. The search was performed from 1/1/2005 to 1/1/2018. After appraisal, the studies were applied in the clinical setting and treatment outcomes were assessed both subjectively and objectively.

RESULTS

The initial search identified there is sparse evidence on the topic. Only 34 articles were acquired. Based on the scientific evidence published, the interprofessional expertise of the clinical care team, and patient's perspective, 4 treatment plan options were proposed. The selected treatment plan was considered the best option considering an EBD person-centered approach. Progress of treatment, outcomes, and lessons learned were assessed.

CONCLUSIONS

This study demonstrates that incorporating EBD concepts and an interprofessional approach, MMT patients can be successfully treated. Future studies on this topic are recommended, specially considering the growth of the opioid epidemic in the past years and the need to treat the MMT patients and educate students.

Liver transplantation outcomes after transarterial chemotherapy for hepatocellular carcinoma

Background

Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation is widespread, although evidence that it improves outcomes is lacking and there exist concerns about morbidity. The impact of TACE on outcomes after transplantation was evaluated in this study.

Methods

Patients with HCC who had liver transplantation in the UK were identified, and stratified according to whether they received TACE between 2006 and 2016. Cox regression methods were used to estimate hazard ratios (HRs) for death and graft failure after transplantation adjusted for donor and recipient characteristics.

Results

In total, 385 of 968 patients (39·8 per cent) received TACE. Five-year patient survival after transplantation was similar in those who had or had not received TACE: 75·2 (95 per cent c.i. 68·8 to 80·5) and 75·0 (70·5 to 78·8) per cent respectively. After adjustment for donor and recipient characteristics, there were no differences in mortality (HR 0·96, 95 per cent c.i. 0·67 to 1·38; P = 0·821) or graft failure (HR 1·01, 0·73 to 1·40; P = 0·964). The number of TACE treatments (2 or more versus 1: HR 0·97, 0·61 to 1·55; P = 0·903) or the time of death after transplantation (within or after 90 days; P = 0·291) did not alter the outcome. The incidence of hepatic artery thrombosis was low in those who had or had not received TACE (1·3 and 2·4 per cent respectively; P = 0·235).

Conclusion

TACE delivered to patients with HCC before liver transplant did not affect complications, patient death or graft failure after transplantation.

P2842Sequential application of horizontal and vertical orientation on radiofrequency ablation lesions produced by thermocool smarttouch SF catheter

Background

Ablation lesions represent a complex interaction between the ablation catheter configuration and tissue anatomy. An understanding of each variable can assist in determination of the optimal lesion set. One such variable is the catheter orientation. With an irrigated radiofrequency ablation catheter with 6 pores (6P) near the distal tip, lesion surface area and volumes are smaller in the horizontal catheter orientation compared to the vertical catheter orientation. This finding is explained by the 6P irrigation catheter design, where irrigation fluid is discharged from six ports around the circumference of the electrode. Introduced in 2015, the ThermoCool SmartTouch® SF catheter has a 56-pore (56P) distribution to provide high density low volume irrigation settings. Irrigation catheters create smaller lesions in horizontal orientation compared to vertical orientation, however this has not been studied for the 56P irrigated catheter.

Purpose

Evaluate the impact of catheter orientation with sequential application of 56P catheter.

Methods

Ablation lesions were created on additive-free chicken model in a saline bath heated to 37°C using the 56P catheter under standard flow rate (8cc/min) conditions. Ablation energy of 20W and 30W was delivered twice for 30 seconds with 3 minutes interval between applications. Contact force (CF) of 5, 10, 15, and 20g was applied with the following conditions: horizontal catheter orientation followed by horizontal (HH), vertical by vertical (VV), horizontal by vertical (HV), and vertical by horizontal catheter orientation (VH). Measurements were obtained by lesion dissection through the midpoint by 3 independent operators. Kruskal-Wallis test was used for comparison of lesion depth, surface area and volume.

Results

Ninety-six lesions were analyzed. No coagulum or steam pops were included in the analysis. The minimum and maximum lesion depth, surface area and volume were 1.5 & 6.0 mm, 14.1 & 117.7mm2, 47.1 & 471.0 mm3 respectively. There was no significant difference in the lesion depth, surface area or volume in HH, VV, HV or VH orientation at different CF with 20W and 30W. (Fig 1)

Figure 1

Conclusion

Unlike other irrigated catheters, catheter orientation with sequential application with different CF and power did not impact lesion depth, surface area and volume with 56P catheter. This finding could be considered useful in situations where the catheter orientation could be challenging owing to tissue anatomy to achieve adequate lesion size.

Acknowledgement/Funding

UVA Health System

Synthesis and thermal characterization of novel phase change materials (PCMs) of the Se-Te-Sn-Ge (STSG) multi-component system: calorimetric studies of the glass/crystal phase transition

According to recent literature, germanium-containing chalcogenide glasses (ChGs) show improvement in thermal stability and glass-forming ability because of the self-organization of the glass network towards a more rigid structure. The Ge-containing ChGs play a potential role as PCMs in phase-change optical memory (PCOM) applications. This endeavor reports the synthesis of some novel PCMs with Ge as the chemical modifier to improve the kinetic parameters of glass/crystal phase transition. The compositional variation of the various kinetic parameters in the present STSG chalcogen-rich non-oxide glasses Se78-yGeyTe20Sn2 (0 ≤ y ≤ 6) has been studied by means of the state-of-the-art differential scanning calorimetric (DSC) technique in the non-isothermal mode. The thermally assisted glass transition and crystallization phenomena have been investigated by examining the variation in various kinetic parameters like the characteristic kinetic temperatures (glass transition temperature Tg, on-set crystallization temperature To and peak crystallization temperature Tc), the activation energies involved in both phenomena, the thermal stability factor S and the glass-forming ability (GFA). The thermal stability factor S and GFA increase appreciably at higher concentrations of Ge as a signature of stiffness transition followed by the self-organization of the corner-sharing and the edge-sharing arrangements of the GeSe4 phase.

Effect of incorporation of different plasticizers on structural and ion transport properties of PVA-LiClO4 based electrolytes

To date high ionic conducting polymer electrolytes are of great interest because of their potential applications in various electrochemical devices such as batteries, fuel cells, solar cells and super capacitors etc., as electrolytes. Ion conduction through polymer electrolytes can occur mostly in amorphous environment exists above their glass transition temperature (T_g). In order to improve ionic conductivity, many approaches such as addition of plasticizer, blending of polymers, nano composite have been employed. This paper reviews the influence of different plasticizers/additives on the ion transport mechanism of Poly(vinyl alcohol) (PVA)-LiClO₄ polymer electrolytes since poly vinyl alcohol is a semi crystalline, synthetic biodegradable polymer and lithium perchlorate is one of the most moisture resistant lithium salts. This review also reveals the relation between dynamical disorder in polymer electrolyte with ionic conductivity.

Unique supramolecular assembly through Langmuir - Blodgett (LB) technique

The Langmuir-Blodgett (LB) technique is a way of making supra-molecular assembly in ultrathin films with a controlled layered structure and crystal parameter, which have many envisioned technological applications for optical and molecular electronic devices as well as signal processing and transformation. Probably LB technique is the best method to manipulate materials at molecular level and provides a scope to realize the molecular electronics in reality. In this review article, we have discussed about the general introduction of LB technique and recent development on LB and related system including (i) LB methodology, (ii) characterizations of LB films, (iii) LB films and molecular electronics, (iv) historical review of LB films, (v) research and applications including fundamental research and application towards devices.

The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study: Design and methods to address mental healthcare gaps in India

INTRODUCTION

Depression and diabetes are highly prevalent worldwide and often co-exist, worsening outcomes for each condition. Barriers to diagnosis and treatment are exacerbated in low and middle-income countries with limited health infrastructure and access to mental health treatment. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study tests the sustained effectiveness and cost-effectiveness of a multi-component care model for individuals with poorly-controlled diabetes and depression in diabetes clinics in India.

MATERIALS AND METHODS

Adults with diabetes, depressive symptoms (Patient Health Questionnaire-9 score≥10), and ≥1 poorly-controlled cardiometabolic indicator (either HbA1c≥8.0%, SBP≥140mmHg, and/or LDL≥130mg/dl) were enrolled and randomized to the intervention or usual care. The intervention combined collaborative care, decision-support, and population health management. The primary outcome is the between-arm difference in the proportion of participants achieving combined depression response (≥50% reduction in Symptom Checklist score from baseline) AND one or more of: ≥0.5% reduction in HbA1c, ≥5mmHg reduction in SBP, or ≥10mg/dl reduction in LDL-c at 24months (12-month intervention; 12-month observational follow-up). Other outcomes include control of individual parameters, patient-centered measures (i.e. treatment satisfaction), and cost-effectiveness.

RESULTS

The study trained seven care coordinators. Participant recruitment is complete - 940 adults were screened, with 483 eligible, and 404 randomized (196 to intervention; 208 to usual care). Randomization was balanced across clinic sites.

CONCLUSIONS

The INDEPENDENT model aims to increase access to mental health care and improve depression and cardiometabolic disease outcomes among complex patients with diabetes by leveraging the care provided in diabetes clinics in India (clinicaltrials.gov number: NCT02022111).

Study of dielectric relaxation and thermally activated a.c. conduction in lead containing topological glassy semiconductors

Illustration of CBH model of the Coulombic well.