Clinical Outcome of Transfemoral Direct Socket Interface (Part 2)

BACKGROUND

Amputation at the transfemoral (TF) level reduces the rate of successful prosthetic fitting, functional outcome, and quality of life (QoL) compared with transtibial amputation. The TF socket interface is considered the most critical part of the prosthesis, but socket discomfort is still the most common user complaint. Direct Socket for transfemoral prosthesis users is a novel interface fabrication process where the socket is shaped and laminated directly on the residual limb and delivered in a single visit.

OBJECTIVES

The aim of this study was to investigate if prosthetic users' quality of life (QoL), comfort, and mobility with a Direct Socket TF interface were comparable to their experience with their previous prostheses.

METHODOLOGY

The pre/post design prospective cohort study included 47 subjects. From this cohort, 36 subjects completed the 6-months follow-up (mean age 58 years, 27 males). Outcomes at baseline included EQ-5D-5L®, PLUS-M™, CLASS, ABC, AMPPRO, and TUG. At 6-weeks and 6-months, subjects repeated all measures. Seven Certified Prosthetist (CP) investigators performed observations and data collection at six different sites (from July 2018 to April 2020).

FINDINGS

Results showed significant improvement in all outcome measures for the 36 subjects that completed both 6-weeks and 6-months follow-ups. CLASS sub-scales showed significantly improved stability, suspension, comfort, and socket appearance. Improvement in K-Level and less use of assistive devices were observed with the AMPPRO instrument, indicating improved user mobility and performance. QoL was also increased, as measured in Quality-Adjusted-Life-Years (QALY) from the EQ-5D-5L.

CONCLUSIONS

Evidence from the findings demonstrate that the Direct Socket TF system and procedure can be a good alternative to the traditional method of prosthetic interface delivery.

POS0262 IDENTIFYING EROSIVE DISEASE FROM RADIOLOGY REPORTS OF VETERANS WITH INFLAMMATORY ARTHRITIS USING NATURAL LANGUAGE PROCESSING

Background:

The presence of erosive disease influences diagnosis, management, and prognosis in inflammatory arthritis (IA).Research of IA in large datasets is limited by a lack of methods for identifying erosions.

Objectives:

To develop methods for identifying articular erosions in radiology reports from veterans with IA.

Methods:

Included veterans had ≥2 ICD codes for ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) between 2005- 2019, in Veterans Affairs Corporate Data Warehouse. Chart review & annotation of radiology notes produced the reference standard, & identified erosion terms that informed classification rule development. A rule-based natural language processing (NLP) model was created & revised in training snippets. The NLP method was validated in an independent reference sample of IA patients at the snippet & patient levels

StepDescriptionNumber & example1 Radiology notesa.Select note titles potentially relevant to IAa. 35,141 notes titlesb.Extract notes with titles potentially related to IAb. 2,926,113 radiology notes2 Possible meaningful termsa.Compile list of root terms that may indicate erosiona. 11 root terms (i.e. ero*, pencil*cup, irreg*)b.Query radiology notes for root term variationsb. 1178 variations (i.e. erosion, erotic, erode)c.Select possible meaningful termsc. 179 possible terms (i.e. erosion, erode)3 Annotationa.Extract snippets^ containing possible meaningful termsa.5000 snippets from radiology notesb.Classify snippets according to: 1) Meaningful term, 2) Relevance to joint, 3) Attribution to IA, 4) Affirmationb.4068 classifications with 1017 snippets (in rounds of 50-417 snippets for NLP training & testing)4 Rule developmenta.Identify meaningful terms representing erosiona. 6 terms (pencil * cup, erosion, erosive, etc.)b.Exclude erosive processes irrelevant to joint(s)b. 28 irrelevant processes (i.e. gastric erosion)c. Exclude articular erosive processes not attributed to IAc. 5 non-IA processes IA (i.e. infection)d. Classify as affirmed/negated (erosion present/absent)d. 83 affirmation/negation rules5 NLP trainingDesign & revise NLP model until accuracy ≥90%6 rounds, 817 snippets (AS 417, RA 200, PsA 200)6 NLP testingTest NLP model200 snippets (AS 100, RA 50, PsA 50)7 Pt classificationa. Develop rules for classifying pts with discordant snippetsa. 5 rules developed in 368 ptsb. Build reference sample (pts classified as erosive or non-erosive via chart review)b. 30 IA pts (10 AS, 10 RA, 10 PsA)8 NLP validationValidate NLP model in reference sample at snippet level149 snippets (29 AS, 76 RA, 44 PsA)9 Method validationValidate methods (NLP+pt classification) at pt level30 IA pts (reference sample)

pt= patient. ^Snippets include text containing 30 words before & after meaningful terms

Results:

In 168,667 veterans with IA, the mean age was 63.1 & 90.3% were male. Method development involved radiology note & erosion term selection, rule development, NLP model building, & method validation. The NLP model accuracy was 94.6% at the snippet level & 90.0% at the patient level, for all IA patients.

Accuracy of methods.

Conclusion:

The methods accurately identify erosions from radiology reports of veterans with IA. They may facilitate a broad range of research involving cohort identification & disease severity stratification

References:

[1]Walsh JA, et al. J Rheumatol. 2020;47(1):42-49

Disclosure of Interests:

Gopi Penmetsa: None declared, Shaobo Pei: None declared, Brian Sauer Grant/research support from: I have been an investigator on research contracts supported by Abbvie., Jessica A. Walsh Consultant of: AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Merck, Pfizer, Bingjian Feng Grant/research support from: Bing-Jian Feng reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC, and Astra Zeneca (UK). The PERCH software, for which Bing-Jian Feng is the inventor, has been non-exclusively licensed to Ambry Genetics for clinical genetic testing services and research., Jodi Walker Shareholder of: Abbvie and mutual funds containing various pharmaceutical companies, Employee of: Abbvie, Kevin Douglas Shareholder of: employed by Abbvie, Employee of: employed by Abbvie, Jerry Clewell Shareholder of: Own Abbvie Shares and mutual funds that hold pharmaceutical and other health care stocks, Employee of: I am current Abbvie Inc employee and past employee of Eli Lilly co

2 IIH Pressure – a randomised, controlled, double blind physiology study of the effect of Exenatide on intracranial pressure

Introduction

Raised intracranial pressure (ICP) causes significant morbidity and mortality in a range of conditions including idiopathic intracranial hypertension (IIH) and traumatic brain injury (TBI). Exenatide is a GLP-1 receptor agonist; pre-clinical data demonstrates its ability to reduce ICP. GLP-1R agonists have also been shown to have neuro-protective properties in pre-clinical models of TBI. The objectives of this study are to assess the biological effect of a Glucagon-like Peptide 1 (GLP-1) agonist on ICP in a cohort of participants with IIH, a raised ICP model.

Methods

Randomised, placebo controlled, double-blind physiology study of Exenatide in women with active IIH (>25 cmCSF lumbar puncture opening pressure and papilloedema). Telemetric, intraparenchymal ICP monitors were implanted to enable gold standard, long-term ICP monitoring (Raumedic p-Tel, Helmbrechts, Germany). Participants were randomised 1:1 to receive Exenatide (10 mcg BD sub-cutaneous) or placebo for 12 weeks. ICP was recorded over a 24-hour baseline visit, at two weeks and 12 weeks. Monthly headache diaries were completed at baseline and 8–12 weeks. Significance was set at p<0.1 as an early phase trial.

Results

Of the 16 participants recruited, 15 were randomised and completed the study: age 29.5 ±9.5 years, BMI 38.1 ±6.2 kg/m2, ICP 30.6±5.1 cmCSF. All ICP monitor implants were well tolerated and allowed successful ICP quantification. A significant reduction in ICP was noted at all timepoints: at 2.5 hours -5.7 cm CSF (p=0.031), at 24 hours -6.3 cmCSF (p=0.095), and at 12 weeks -5.6 cmCSF (p=0.064).

Conclusions

We report the first human study to assess the biological effect of the GLP-1 agonist Exenatide on ICP in IIH utilising highly accurate implantable telemetric ICP monitors. Exenatide reduced ICP at all timepoints including acutely at 2.5 hrs and during chronic dosing. New therapies for ICP modulation are a significant un-met need in both military and civilian spheres.

P36 Consent for Orthopaedic Trauma Surgery during the COVID-19 Pandemic

Surgical services have been hugely disrupted by COVID-19 and have had to evolve rapidly in response. The best practice for consent mandates that risks associated with surgical treatment during a pandemic be discussed. This study aimed to assess whether patients undergoing orthopaedic operations were being consented for the risk of contacting COVID-19 and ITU care.

All orthopaedic consent forms from four-week periods in March, June and July were reviewed. Measures such as staff education were implemented after the second cycle.

Of consent forms for 37 operations performed in March, only 1 mentioned the risk of contracting COVID-19 and zero mentioned ITU. During June, 89 consent forms were reviewed, 32 mentioned COVID-19 and 10 discussed ITU admission. Following educational measures, the third cycle showed a significant improvement as of 100 consent form records available for review, 73 included risk of COVID-19 whilst 26 mentioned ITU.

The results show that earlier in the pandemic, surgeons at our centre were not counselling patients regarding COVID-19. This improved slightly between the first and second cycles, likely reflecting increased awareness of the nosocomial transmission of COVID-19. Educational measures contributed to a significant improvement in the third cycle. Planned interventions include use of electronic consent forms which incorporate COVID-19 infection and associated risks.

Verification and Validation of Digital Pathology (Whole Slide Imaging) for Primary Histopathological Diagnosis: All Wales Experience

Aims:

The study is aimed to verify Aperio AT2 scanner for reporting on the digital pathology platform (DP) and to validate the cohort of pathologists in the interpretation of DP for routine diagnostic histopathological services in Wales, United Kingdom.

Materials, Methods and Results:

This was a large multicenter study involving seven hospitals across Wales and unique with 22 (largest number) pathologists participating. 7491 slides from 3001 cases were scanned on Leica Aperio AT2 scanner and reported on digital workstations with Leica software of e-slide manager. A senior pathology fellow compared DP reports with authorized reports on glass slide (GS). A panel of expert pathologists reviewed the discrepant cases under multiheader microscope to establish ground truth. 2745 out of 3001 (91%) cases showed complete concordance between DP and GS reports. Two hundred and fifty-six cases showed discrepancies in diagnosis, of which 170 (5.6%) were deemed of no clinical significance by the review panel. There were 86 (2.9%) clinically significant discrepancies in the diagnosis between DP and GS. The concordance was raised to 97.1% after discounting clinically insignificant discrepancies. Ground truth lay with DP in 28 out of 86 clinically significant discrepancies and with GS in 58 cases. Sensitivity of DP was 98.07% (confidence interval [CI] 97.57–98.56%); for GS was 99.07% (CI 98.72–99.41%).

Conclusions:

We concluded that Leica Aperio AT2 scanner produces adequate quality of images for routine histopathologic diagnosis. Pathologists were able to diagnose in DP with good concordance as with GS.

Strengths and Limitations of this Study:

Strengths of this study – This was a prospective blind study. Different pathologists reported digital and glass arms at different times giving an ambience of real-time reporting. There was standardized use of software and hardware across Wales. A strong managerial support from efficiency through the technology group was a key factor for the implementation of the study.

Limitations:

This study did not include Cytopathology and in situ hybridization slides. Difficulty in achieving surgical pathology practise standardization across the whole country contributed to intra-observer variations.

AB0356 TARGETING THE RHEUMATOID ARTHRITIS SYNOVIAL FIBROBLAST VIA CYCLIN DEPENDENT KINASE INHIBITION (TRAFIC): A PHASE 1B STUDY TO DETERMINE THE MAXIMUM TOLERATED DOSE OF SELICICLIB FOR REPURPOSING IN RHEUMATOID ARTHRITIS

Background:

Current rheumatoid arthritis (RA) therapeutics target immune inflammation and are subject to ceiling effects, with non-response observed in a third of recipients together with low remission rates. Synovial fibroblasts (SFs) are stromal cells not yet targeted in RA, whose hyperplastic and proliferative properties drive inflammation and tissue destruction. Seliciclib (R-roscovitine) is an orally available cyclin-dependent kinase (CDK) inhibitor that suppresses SF proliferation and ameliorates inflammatory arthritis in rodents.

Objectives:

To determine the maximum tolerated dose (MTD) of seliciclib in patients with active RA despite anti-TNF, with or without background conventional disease modifying anti-rheumatic drugs (cDMARDs). Safety and pharmacokinetics (PK) were also evaluated.

Methods:

A restricted, one-stage Bayesian continual reassessment method (CRM) determined MTD based on a target dose-limiting toxicity (DLT) probability of 35%. RA patients (DAS28 ≥3.2) were recruited sequentially to cohorts of 3 subjects each. Cohort 1 received 400mg seliciclib daily for 4 consecutive days each week for 4 weeks, added to existing therapy. Each subsequent cohort received a dose determined by the toxicity-based CRM algorithm, calculated upon conclusion of the previous cohort. Safety was assessed through adverse event (AE) monitoring. Associations with relevant PK parameters were sought.

Results:

15 anti-TNF recipients were enrolled, 10 of whom were also taking cDMARDs (median DAS28 4.9). Application of the CRM algorithm prompted one dose increment during the study (to 600mg for cohort 2), but reversion to 400mg for subsequent cohorts (Figure 1A). After treatment of 5 cohorts, 400mg was determined the MTD, with a DLT probability of 0.35 (CI 0.18-0.52; Figure 1B). 6 patients experienced DLTs, of which two were classified as serious AEs (SAEs) in keeping with the safety profile of seliciclib; these are summarised in Table 1. Of 43/65 total AEs reported at any dose that didnotcontribute to a DLT, 26 were possibly, probably or definitely related to seliciclib; 19 of these 26 were mild, 7 moderate and none severe. The most frequent AE was mild nausea. No relationship of safety and/or tolerability with concomitant cDMARD use or PK was seen.

Table 1.

Characteristics of patients who developed HZ at initiation of baricitinib

DLTSeliciclib dose (mg)Doses receivedContributing AEsContributing SAEsDescriptionOutcomeA1400830Constipation, N+V, liver injury; fatigue.Resolved2600430Constipation, N+V.Resolved3600101BFever, N+V, renal injury.Resolved4400831BConstipation, N+V, jaundice, liver injury.Resolved5400840Fever, dizziness, liver injury.Resolved6400890Dizziness, N+V, liver injury, bilirubin rise.Persistent AST rise

Conclusion:

The MTD of seliciclib has been defined for RA. No unexpected safety concerns were identified to preclude ongoing evaluation in patients, which focuses on clinical, radiological and biological indicators of efficacy.

Disclosure of Interests:

Arthur Pratt Grant/research support from: Pfizer, GlaxoSmithKlein, Stefan Siebert Grant/research support from: BMS, Boehringer Ingelheim, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, Janssen, Novartis, Michael Cole: None declared, Deborah Stocken: None declared, Stephen Kelly: None declared, Muddassir Shaikh: None declared, Amy Cranston: None declared, Miranda Morton: None declared, Jennifer Walker: None declared, Sheelagh Frame Employee of: Cyclacel Ltd., Wan-fai Ng: None declared, Chris Buckley Consultant of: Janssen, Pfizer, GSK, Galapagos, Gillead, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Andrew Filer: None declared, John D Isaacs Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, Janssen, Merck, Pfizer, Roche

AB1360-HPR A MODEL TO IMPROVE MINORITY PATIENT RECRUITMENT IN LUPUS CLINICAL TRIALS - THE AMERICAN COLLEGE OF RHEUMATOLOGY MIMICT PROJECT EXPERIENCE

Background:

In the US, African Americans and Latinos are underrepresented in lupus clinical trials (LCTs),1despite experiencing the greatest lupus disease burden.2,3Low participation in LCTs results in inadequate data on treatment effectiveness for minority patients, and fewer opportunities for better care and treatment options.1Only one percent of minority patients are referred to clinical trials each year.4Provider barriers to making referrals include limited time and unfamiliarity with lupus and LCT opportunities.4Using US fedral grant funds, the American College of Rheumatology (ACR) developed MIMICT, a two-part model with associated materials to address provider-side LCT referral barriers. The materials include a toolkit for clinical trial sites and an educational toolkit for providers.

Objectives:

Our objectives are to:

•Describe the US LCTs disparities.

•Discuss the research methodology to evaluate the two-part MIMICT model.

•Assess the feasibility of the model to increase minority involvement in clinical trials.

Methods:

We designed two studies to evaluate the MIMICT model.The first study used an online, pretest/posttest, two-group evaluation approach to assess the extent to which the educational toolkit increased providers‘ knowledge, attitudes, self-efficacy, and behavioral intentions to refer minority patients to clinical trial. We conducted the study in 2018 with primary care providers (PCPs) and again in 2019/2020 with speciality providers. The second study used a longitudinal, mised methods, case-study approach to explore the real-world use of the toolkits with clinical trial site teams at two university medical centers.

Results:

In the first study,among MIMCT-exposed PCPs, mean scores indicated statistical significance at p≤0.001 with more knowledge about referring [55.84 (sd=23.51) vs 41.76 (sd=19.98)], more self-efficacy to refer [55.00 (sd=37.22) vs. 37.99 (sd=34.42)], and more intentions to refer [61.36 (43.85) vs. 33.41 (41.16)] African American patients to LCTs among the treatment group than the control group, respectively. This presentation will discuss additional data comparing the study in 2018 and the study in 2019/2020 and look comparatively at outcomes across provider type.

In the second study, we found that the driver for successful engagemetn of providers and their subsequent use of the educational toolkit was the development of a trusting relationship between the clinical trial site teams and providers in the community. The development of trust took repeated and varied modes of contact, which we will discuss in-depth.

Conclusion:

The MIMICT educational toolkit increase knowledge, self-efficacy, and intentions to refer lupus patients to LCTs. However, building trust between LCT sites and local providers takes time and repeated outreach, but the potential benefits to medicine and minority health are substantial.

References:

[1]The Society for Women’s Health Research. (2011). Dialogues on diversifying clinical trials: successful strategies for engaging women and minorities in clinical trials. Washington, DC: Food and Drug Administration, Office of Women’s Health.

[2]Falasinnu, T., Chaichian, Y., Bass, M. B., & Simard, J. F. (2018). The representation of gender and race/ethnic groups in randomized clinical trials of individuals with sytemic lupus erythematosus.Current Rheumatology Reports, 20(4).

[3]Pons-Estel, G. J., Alarcon, G. S., Scofield, L., Reinlib, L., & Cooper, G. S. (2010). Understanding the epidemiological progression of systemic lupus erythematosus.Seminars in Arthritis and Rheumatism, 39(4).

[4]Korieth, K. (2016). Engaging healthcare providers as research facilitators.The CenterWatch Monthly, 23,1-5.

Disclosure of Interests:

None declared

0178 The Cycle of Daily Stress and Sleep: Sleep Measurement Matters

Introduction

Disturbed sleep can be both a cause and a consequence of increased stress. Yet intensive longitudinal studies have demonstrated that sleep assessed via sleep diaries and actigraphy is inconsistently associated with daily stress. We expanded this research by examining daily associations between sleep and stress using a three-fold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography [EEG].

Methods

Participants were 80 adults (M age = 32.65 years, 63% female) who completed 7 days of sleep and perceived stress assessments in a naturalistic setting (resulting in 560 possible measurement occasions). Multilevel models were used to examine bidirectional associations between daily stressor occurrence (0 = stressor did not occur, 1 = stressor occurred) and stressor severity (0 = not at all severe to 3 = very severe) and sleep parameters assessed via diary, actigraphy, and EEG (e.g. total sleep time [TST], sleep efficiency [SE], and sleep onset latency [SOL], wake after sleep onset [WASO]).

Results

Participants reported at least one stressor on 37% of days. Compared to days without a stressor experienced, days with a stressor were associated with a 14.4-minute reduction in actigraphy-determined TST the subsequent night (β = -0.24, p = 0.030). Nights with greater sleep-diary determined WASO were associated with greater next-day stressor severity (β = 0.01, p = .026). No EEG-determined sleep parameters were associated with next-day stressor occurrence or severity, or vice versa.

Conclusion

Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary — not redundant — sleep measurement approaches.

Support

Funding for this study included NIH/NIAID R01AI128359-01; DoD-VA 1I01CU000144-01; the Foundation for Rehabilitation Psychology; and General Sleep Corporation.

Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam

Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.

A224 THE MANITOBA LIVING WITH IBD STUDY: MEDICATION ADHERENCE AND MARS-5 VALIDATION

Background

Medication non-adherence in IBD has previously been reported to be quite variable, ranging from 7 to 73%, and is considered to be an important contributor to disease flares. While there is currently no gold standard for medication adherence reporting in IBD, the Medication Adherence Reporting Scale 5 (MARS-5) has frequently been used in this population, but never validated.

Aims

This study aimed to analyze medication adherence rates in a cohort of persons with IBD in Manitoba, report predictors of medication non-adherence on self-reported symptoms, and validate the MARS-5 as a medication adherence tool.

Methods

55 subjects were prospectively followed with biweekly online surveys in the Manitoba Living with IBD Study. Subjects not taking any medications for IBD or only taking as needed, missing adherence data and those lost to follow-up were excluded, leaving 112 subjects. Descriptive data on demographics, surgeries, IBD medications, medication adherence, and measures of disease activity utilizing IBDSI-SF scores were collected. Mean annual medication adherence percentage, IBDSI-SF(&gt;14=active for Crohn’s,&gt;13=active for UC) and MARS-5 scores were calculated. Logistic regression analysis was performed to determine variables associated with medication adherence and to validate the MARS-5.

Results

Mean age was 42.9 years (SD 12.8), with 71.4% being female. Crohn’s disease (CD) was diagnosed in 67.9%, with 37.5% having undergone at least one abdominal surgery. 70.5% of patients were on 2 or more IBD medications. Mean IBDSI score was 15.5 and mean MARS-5 score was 22.5. 20 (17.9%) patients reported a mean adherence of &lt;90% across all medications- 18 were oral medication users, 1 was on an infusion biologic and 1 on subcutaneous adalimumab. 10 (9.8%) had adherence &lt;80%, all of which were to oral medications. Multivariate regression analysis revealed only a diagnosis of Crohn’s disease (OR 4.62; 95% CI 1.37–15.7; p=0.014) to be a predictor of adherence. Disease activity as defined by IBDSI (OR 0.43, 95% CI 0.13–1.45; p=0.139) and fecal calprotectin &gt;250ug/L (OR 1.04, 95% CI 0.35–3.11; p=0.724), age &gt;55 (OR 2.37, 95% CI 0.65–8.65; p=0.476), female sex (OR 0.38, 95% CI 0.097–1.52; p=0.150) and stress (OR 0.67, 95% CI 0.19–2.32; p=0.498) were not shown to be predictors. MARS-5 was compared to percentage adherence, showing moderate correlation (Pearson r=0.46). Logistic regression analysis showed each additional MARS-5 point was associated with a 1.7 times greater odds of &gt;90% adherence.

Conclusions

We report a highly adherent Manitoba IBD cohort. A diagnosis of CD was the only predicitor of adherence. MARS-5 showed moderate correlation with mean percentage adherence values, suggesting it is a valid assessment tool for determining medication adherence in an IBD population.

Funding Agencies

None

A169 DEVELOPMENT OF A DECISION TOOL TO IMPROVE UTILISATION OF RECOMMENDED SURVEILLANCE INTERVALS FOR INDIVIDUALS WITH COLORECTAL POLYPS: A FOCUS GROUP ANALYSIS

Background

Several studies have demonstrated a high utilization of colonoscopy at shorter and longer time intervals than guideline recommendations. Innovative methods are required to increase adherence to recommended timing.

Aims

1) Explore current approaches used by endoscopist (EPs) and primary care providers (PCPs) to determine and communicate colonoscopy surveillance intervals (SI) between EPs, PCPs, and patients.

2) Obtain feedback for refining a decision tool to facilitate recommended SI.

3) Determine participant agreement of recommended SIs with current guidelines.

Methods

We conducted 4 focus groups (FGs); 3 FGs included EPs (n=12) and EPs in training (n=6); 1 FG included PCPs (n=4). FG questions explored use of guidelines, communication and follow-up practices with PCPs, EPs and patients, and challenges to follow-up.

Participants were also asked for feedback about a prototype polyp SI decision tool that was developed using an algorithm synthesizing current Canadian Association of Gastroenterology, US Multisociety Task Force, and expert panel guidelines on SI. FGs were audio-recorded and transcribed for qualitative content analysis. FGs were analysed separately, then compared for similarities and differences. Finally, participants individually made interval recommendations for 7 common endoscopy scenarios. Responses were analyzed for agreement with the guidelines used to develop the decision tool.

Results

EPs reported not routinely referring to guidelines and were confident in their memory of the intervals although some reported checking occasionally. Many indicated they may use the tool in a web based or mobile application for more complicated scenarios, although some would never use it. Concerns regarding the tool included being up to date with research evidence and having required data to input on hand. PCPs reported the tool may be useful as a communication aid to involve patients in decision making. A challenge noted in all FGs was role confusion regarding communicating, tracking, and scheduling patients’ future procedures on time.

Analysis of EPs (n=9) responses to the 7 scenarios showed that percent agreement with guidelines was low: 44% scored below 50% correct. Participants with the highest agreement scored 6/7; responses with the lowest agreement scored 0/7. The most common score was 3/7.

Conclusions

EPs appeared to be overconfident in their recommendations, but many were open to trying a website or mobile application decision tool to make evidence-based colonoscopy SI recommendations. Understanding, among PCPs and EPs, regarding responsibility for communicating results and scheduling follow-up surveillance for patients was inconsistent. Participant feedback informed development of a mobile application that is currently being pilot tested.

Funding Agencies

Research Manitoba

Outcomes of metastatic colorectal cancer patients in relationship to prior and concurrent antibiotics use; individual patient data analysis of three clinical trials

BACKGROUND

Antibiotic use at the time of chemotherapy has been linked with inferior outcomes among a number of solid tumors. The current study aims at further assessing this observation among metastatic colorectal cancer patients treated with first-line systemic chemotherapy.

METHODS

This is a pooled analysis of three clinical trial datasets (NCT00384176; NCT00272051; NCT00305188) that were accessed from the Project Data Sphere platform. Kaplan-Meier survival estimates were used to evaluate the impact of antibiotic use on overall and progression-free survival and multivariable Cox regression models were employed to further assess this impact.

RESULTS

A total of 1446 patients were included in the current analysis. These include 108 patients who received antibiotics before the start of chemotherapy, 499 patients who received antibiotics after the start of chemotherapy, and 839 patients who did not receive antibiotics. Using Kaplan-Meier survival estimates, the use of antibiotics prior to the start of chemotherapy was associated with worse progression-free (P = 0.001) and overall survival (P < 0.001). Likewise, when multivariable Cox regression analyses were conducted, prior antibiotic use is associated with worse progression-free (HR for antibiotic use during chemotherapy versus antibiotic use prior to chemotherapy = 0.764; 95% CI 0.604-0.966; P = 0.024) and overall survival (HR for antibiotic use during chemotherapy versus antibiotic use prior to chemotherapy = 0.710; 95% CI 0.537-0.940; P = 0.017).

CONCLUSION

Antibiotic use before (but not following) the start of 5FU-based chemotherapy is associated with worse progression-free and overall survival among patients with metastatic colorectal cancer.