A78 “CHALLENGING PERSPECTIVES:” UNDERSTANDING CLINICIANS VIEWS ON MANAGING ALCOHOL USE DISORDER AND CIRRHOSIS

Background

Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of anti-relapse pharmacotherapies. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis.

Aims

The aim of this project is to summarize these findings to inform the development of an educational intervention.

Methods

We used a qualitative descriptive approach to explore the experiences of clinicians who provide care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes.

Results

Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified three themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, and (iii) Acknowledging the complexity of patients who have cirrhosis and AUD.

Conclusions

This research presents the perspectives of clinicians who manage people who have AUD and cirrhosis. Our results indicate that significant barriers exist that affect how clinicians manage AUD in the context of cirrhosis, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered in this investigation will be used to develop an accredited educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.

Funding Agencies

Alberta Innovates Health Solutions

A87 CHANGES IN CLINICIAN KNOWLEDGE, COMFORT, PREPAREDNESS, AND ATTITUDES ABOUT ALCOHOL USE DISORDER AND CIRRHOSIS AFTER A BRIEF EDUCATIONAL INTERVENTION

Background

Alcohol use disorder (AUD) is increasing in prevalence and has a substantial impact on morbidity and mortality in people with cirrhosis. The use of screening, brief intervention and referral to treatment (SBIRT) and relapse prevention medications (e.g. acamprosate) are recommended by recent guidelines. Unfortunately, many clinicians report insufficient training to feel confident using these interventions

Aims

We aimed to compare the effect of a brief educational intervention on AUD knowledge, comfort, attitudes, and preparedness in clinicians who provide care to patients with cirrhosis.

Methods

Clinicians were invited to participate in a 1.5-hour educational session conducted by a hepatologist and addiction medicine specialist. The session included information about SBIRT and pharmacotherapy. Pre-training knowledge, comfort, and practice behaviors were assessed using previously published questions. Baseline attitudes were measured using the Short Alcohol and Alcohol Problems Perception Questionnaire. Participants were invited to repeat the questionnaires immediately post-training and statistical analysis conducted.

Results

Eighty-two clinicians attended the session. Among the 38 attendees who completed both the pre- and post-questionnaires, 34% were GIs/internists, 45% were family medicine physicians, and the remainder (21%) did not specify or were not prescribers. Scores for self-reported intention and preparedness to treat AUD, comfort, and knowledge improved significantly from the pre-training phase. Attitudes also improved from the pre-training phase, with significant improvements in the SAAPPQ subscales of role adequacy (p=0.03) and motivation (p=0.04).

Conclusions

Recognizing the small sample size, a brief educational session demonstrated promising results in the promotion of knowledge, attitudes, preparedness, and comfort for clinicians managing AUD in patients with cirrhosis. Feedback from these sessions will be used to design an accredited educational series for roll-out in 2022.

Funding Agencies

Alberta Innovates Health Solutions

A novel approach for estimation of aboveground biomass of a carbon-rich mangrove site in India

Mangroves can play a crucial part in climate change mitigation policies due to their high carbon-storing capacity. However, the carbon sequestration potential of Indian mangroves generally remained unexplored to date. In this study, multi-temporal Sentinel-1 and 2 data-derived variables were used to estimate the AGB of a tropical carbon-rich mangrove forest of India. Ensemble prediction of multiple machine learning algorithms, including Random Forest (RF), Gradient Boosted Model (GBM), and Extreme Gradient Boosting (XGB), were used for AGB prediction. The multi-temporal dataset was used in two different ways to find the most suitable method of using them. The results of the analysis showed that the modeling field measured AGB with individual date data values results in estimates with root mean square errors (RMSE) ranging from 149.242 t/ha for XGB to 151.149 t/ha for the RF. Modeling AGB with the average and percentile metrics of the multi-temporal image stack improves the prediction accuracy of AGB, with RMSE ranging from 81.882 t/ha for the XGB to 74.493 t/ha for the RF. The AGB modeling using ensemble prediction showed further improvement in accuracy with an RMSE of 72.864 t/ha and normalized RMSE of 11.38%. In this study, the intra-seasonal variation of Sentinel-1 and 2 data for mangrove ecosystems was explored for the first time. The variations in remotely sensed variables could be attributed mainly to soil moisture availability and rainfall in the mangrove ecosystem. The efficiency of Sentinel-1 and 2 data-derived variables and ensemble prediction of machine learning models for Indian mangroves were also explored for the first time. The methodologies established in this study can be used in the future for accurate prediction and repeated monitoring of AGB for mangrove ecosystems.

Serious neutropenia following etanercept administration in a 62 years female patient of rheumatoid arthritis

Tumor necrosis factor (TNF) plays an important role in the inflammatory process of RA and the resulting joint pathology. Etanercept is a member of anti TNF family which is indicated in patients with moderate to severe active rheumatoid arthritis either alone or in combination with MTX. Very few cases of neutropenia with etanercept treatment have been reported worldwide so far. The mechanism of etanercept induced neutropenia is not yet established. We report a case of 62 year female patient, developing etanercept induced neutropenia after 1 month of starting treatment. The absolute neutrophil count (ANC) came down to 150/microl on the 6th day of diagnosis. Bone marrow examination revealed a maturation arrest of granulocytic cells. Other marrow components were normal. Causality assessment of adverse drug reactions was done as per Naranjo's Algorithm. It was a probable ADR. We propose the possible mechanism of neutropenia is bone marrow toxicity. This is contrary to a previous case report which suggested peripheral consumption of neutrophil as a cause of neutropenia. Recently, there are some reports of leukemia and other hematological malignancies associated with the use of etanercept and in those conditions neutropenia could be the first manifestation. Neither product label of the drug nor US FDA warns for periodic blood investigation during etanercept therapy. There is a definite need for total and differential count estimation at the beginning and regular interval during etanercept treatment to rule out possibilities of neutropenia.

Percutaneous transtracheal jet ventilation as a guide to tracheal intubation in severe upper airway obstruction from supraglottic oedema

We report two cases of severe upper airway obstruction caused by supraglottic oedema secondary to adult epiglottitis and Ludwig's angina. In the former case, attempts to intubate with a direct laryngoscope failed but were successful once percutaneous transtracheal jet ventilation (PTJV) had been instituted. In the case with Ludwig's angina, PTJV was employed as a pre-emptive measure and the subsequent tracheal intubation with a direct laryngoscope was performed with unexpected ease. In both cases recognition of the glottic aperture was made feasible with PTJV by virtue of the fact that the high intra-tracheal pressure from PTJV appeared to lift up and open the glottis. The escape of gas under high pressure caused the oedematous edges of the glottis to flutter, which facilitated the identification of the glottic aperture. We believe that the PTJV should be considered in the emergency management of severe upper airway obstruction when this involves supraglottic oedema.