Treatment Goal For Patients Research Articles

S374 Patient Burden and Treatment Goals in the Management of Erosive Esophagitis in the United States: Results From the Study of Acid-Related Disorders (SOARD)

S374 Patient Burden and Treatment Goals in the Management of Erosive Esophagitis in the United States: Results From the Study of Acid-Related Disorders (SOARD)

Exploring the role of pharmacists in improving blood pressure control among hypertensive patients at the workplace

Several hours of productivity are lost due to improper management of hypertension. Poor adherence and inadequate care due to weak healthcare systems contribute to the lack of effectiveness of anti-hypertensive therapy. Pharmaceutical care plays a vital role in achieving treatment goals for patients with chronic conditions such as hypertension. This study sought to ascertain the effectiveness of pharmaceutical care services provided at the workplace on adherence and blood pressure control among staff with hypertension. This was a prospective pre-post study conducted at the Kwame Nkrumah University of Science and Technology from September 2019 to September 2020. Staff with confirmed diagnosis of hypertension were offered individualized pharmaceutical care every month for six months. Outcome measures were changes in blood pressure measurement, adherence and the number of pharmaceutical care issues identified and resolved. Forty-three university staff participated in this study. Reductions in mean systolic and diastolic blood pressure and difference in mean adherence scores were statistically significant after 6 months of follow up (p ≤ 0.00). A medical diagnosis of diabetes (p ≤ 0.044) and Body Mass Index (p ≤ 0.038) were associated with control of hypertension. Adherence to medications improved after the follow up period. Participants and pharmacists involved in the study expressed satisfaction with the program's impact. Pharmaceutical care at the workplace can improve medication adherence and blood pressure control among hypertensive patients. Blood pressure control was also better among individuals with normal Body Mass Index or a medical history of diabetes.

The Society for Vascular Surgery Objective Performance Goals for Critical Limb Ischemia are attainable in select patients with ischemic wounds managed with wound care alone

To set therapeutic benchmarks, in 2009 the Society for Vascular Surgery defined objective performance goals (OPG) for treatment of patients with chronic limb threatening ischemia (CLTI) with either open surgical bypass or endovascular intervention. The goal of these OPGs are to set standards of care from a revascularization standpoint and to provide performance benchmarks for 1 year patency rates for new endovascular therapies. While OPGs are useful in this regard, a critical decision point in the treatment of patients with CLTI is determining when revascularization is necessary. There is little guidance in the comprehensive treatment of this patient population, especially in the nonoperative cohort. Guidelines are needed for the CLTI patient population as a whole and not just those revascularized, and our aim was to assess whether CLTI OPGs could be attained with nonoperative management alone. Our cohort included patients with an incident diagnosis of CLTI (by hemodynamic and symptomatic criteria) at our institution from 2013-2017. The primary outcome measured was mortality. Secondary outcomes were limb loss and failure of amputation-free survival. Descriptive statistics were used to define the 2 groups - patients undergoing primary revascularization and patients undergoing primary wound management. The risk difference in outcomes between the 2 groups was estimated using collaborative-targeted maximum likelihood estimation. Our cohort included 349 incident CLTI patients; 60% male, 51% white, mean age 63 +/- 13 years, 20% Rutherford 4, and 80% Rutherford 5. Most patients (277, 79%) underwent primary revascularization, and 72 (21%) were treated with wound care alone. Demographics and presenting characteristics were similar between groups. Although the revascularized patients were more likely to have femoropopliteal disease (72% vs. 36%), both groups had a high rate of infrapopliteal disease (62% vs. 57%). Not surprisingly, the patients in the revascularization group were less likely to have congestive heart failure (34% vs. 42%), complicated diabetes (52% vs. 79%), obesity (19% vs. 33%), and end stage renal disease (14% vs. 28%). In the wound care group, 2-year outcomes were 65% survival, 51% amputation free survival, 19% major limb amputation, and 17% major adverse cardiac event. The wound care cohort had a 13% greater risk of death at 2 years; however, the risk of limb loss at 2 years was 12% less in the wound care cohort. A comprehensive set treatment goals and expected amputation free survival outcomes can guide revascularization, but also assure that appropriate outcomes are achieved for patients treated without revascularization. The 2-year outcomes achieved in this cohort provide an estimate of outcomes for nonrevascularized CLTI patients. Although multi-center or prospective studies are needed, we demonstrate that equal, even improved, limb salvage rates are possible.

Mastery of type 2 diabetes prevention and treatment knowledge by general practitioners in Shanghai: a cross-sectional study

BackgroundTo study the competency of general practitioners (GPs) in Shanghai, China on prevention and management of type 2 diabetes, also understand factors that may prohibit it.MethodsA survey questionnaire with 25 questions was designed based on 2013 Chinese Type 2 Diabetes Prevention Guidelines and Chinese Type 2 Diabetes Prevention Guidelines (Grassroots Edition) and conducted among 789 GPs who work at 54 community healthcare centers (CHCs) within 16 districts at Shanghai, China. Excel 2016 and SPSS 24.0 were used for data analysis, and a difference of P < 0.05 was considered to be statistically significant.ResultsThe GPs did poorly on three aspect of diabetes prevention and treatment: (1) treatment goals in elderly patients, (2) screening methods for high-risk population, and (3) aspirin contraindications. The statistical analysis data showed that GPs who finished standardized training had correct answer on 13.58 ± 3.31 questions out of total 25, with mean accuracy rate of 54.32%. Except the questions for high-risk population screening method and the diagnostic criteria for type 2 diabetes, there was no difference in the accuracy of other questions between GPs with or without standardized training (P < 0.05). However, sex, educational level, and subspecialty experience are affective factors on their competency in type 2 diabetes prevention and treatment knowledge.ConclusionThe results indicated that communities should strengthen the training of GPs in diabetes management and bidirectional referral. Frequent continuing education and skills training should be provided among GPs at CHCs to ensure their competency of type 2 diabetes prevention and treatment knowledge after obtaining their GP license disregard of their standardized training. In addition, attention should be paid to GPs who had lower education background or non-clinical subspecialty experience to strengthen their clinical knowledge of type 2 diabetes.

Measuring treatment effect on psoriatic arthritis-related domains: insights from the SPIRIT-H2H study at weeks 24 and 52

IntroductionImprovements in both musculoskeletal and non-musculoskeletal manifestations are important treatment goals in psoriatic arthritis (PsA).ObjectiveThese post hoc analyses determined whether additional benefits related to various PsA domains are observed in patients simultaneously achieving 50% improvement in American College of Rheumatology criteria (ACR50) and 100% improvement in Psoriasis Area Severity Index (PASI100), the primary endpoint of the SPIRIT-H2H study.MethodsPatients with active PsA and psoriasis in SPIRIT-H2H (N = 566) were categorised into two sets of four response groups irrespective of treatment allocation (approved dosages of ixekizumab or adalimumab): patients who simultaneously achieved ACR50 and PASI100 response, achieved ACR50 response only, achieved PASI100 response only, or did not achieve ACR50 or PASI100 response after 24 and 52 weeks of treatment. Patients achieving simultaneous ACR50 and PASI100 response were compared with the other patient response groups at the corresponding time point for efficacy and health-related quality of life (HRQoL) outcomes.ResultsPatients simultaneously achieving ACR50 and PASI100 responses at week 24 or 52 showed higher rates of ACR70 response, minimal disease activity, Disease Activity in Psoriatic Arthritis ≤ 4, resolution of enthesitis and dactylitis, and HRQoL improvement at weeks 24 and 52, respectively, than the other corresponding response groups at both time points.ConclusionHigh levels of disease control, such as those obtained with simultaneous achievement of ACR50 and PASI100 response, were linked to better outcomes across a wide range of endpoints that are important for patients with PsA. Patients meeting this combined endpoint showed more comprehensive and thus greater control of disease activity.Trial registrationNCT03151551Key Points• Treatment goals for patients with psoriatic arthritis emphasise the importance of improving both musculoskeletal and non-musculoskeletal manifestations of the disease.• A combined endpoint considering both these manifestations, achievement of at least 50% improvement in American College of Rheumatology criteria and 100% improvement in Psoriasis Area Severity Index, was linked with achievement of a number of other endpoints relevant to psoriatic arthritis, including health-related quality of life that are important to patients with psoriatic arthritis.• Patients meeting the combined endpoint were more likely to achieve a disease state of remission, which is the stated aim of treatment for psoriasis.

Achieving remission or low disease activity is associated with better outcomes in patients with systemic lupus erythematosus: a systematic literature review

BackgroundRemission and low disease activity (LDA) have been proposed as the treatment goals for patients with systemic lupus erythematosus (SLE). Several definitions for each have been proposed in the literature.ObjectiveTo...

Ocular Manifestations of the Sturge-Weber Syndrome.

Sturge–Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40–50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient's visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.

Genetic and other associations with pain: a literature review of potential identifiers for significant pain after total knee arthroplasty

Osteoarthritis of the knee is one of the leading causes of disability and work limitations in the United States, resulting in significantly decreased work productivity and loss of work. The definitive treatment of choice for end-stage osteoarthritis is total knee arthroplasty. However, up to 34% of patients who undergo TKA experience chronic pain. Long-term pain continues to pose a significant burden and directly undermines the goal in treatment of patients with osteoarthritis, and persistent postoperative pain is a major concern to the orthopaedic community. Finding ways to reduce the number of patients experiencing persistent postoperative pain, as well as reducing the severity of the pain felt, is absolutely necessary. There is a growing cohort of evidence that suggests that the experience of pain is felt differently among patients, and there are many factors that may play a role in this experience. The difference in experience may have a genetic basis and, in the context of the growing opioid crisis in the United States, these genetic differences may explain variations in opioid effectiveness as well. This review examines the current literature that identifies specific factors responsible for the development of pain, including ethnicity, race, psychosocial, and, most notably, genetic factors.

SO-1 The impact of COVID-19 on daily practice patterns in the third-line setting for patients with metastatic colorectal cancer: Results of a real-world survey

The emergence of the COVID-19 virus in 2020 led to unprecedented challenges in the way oncologic care is organized to guarantee treatment continuation for patients with cancer. The SCOPE COVID-19 survey aimed to assess the impact of the COVID-19 pandemic on third-line treatment goals in patients with metastatic colorectal cancer (mCRC) and compare it with daily practice patterns from the pre–COVID-19 era. An expert panel of gastrointestinal oncologists developed the survey, which was undertaken between October 2020–January 2021. Questions were designed to evaluate the practice patterns during this time and assess the future impact of COVID-19 on treatment decisions. The survey was conducted online using FocusVision Decipher. Oncologists from 14 countries, the majority of which were in Europe, participated. As of 31 January 2021, there were 228 respondents. The majority were medical oncologists (89%), aged between 35–55 years (62%), practiced in a university hospital (49%), and saw between 10–29 patients with mCRC/month (53%). Overall, few restrictions affecting cancer patient management, such as staff being redeployed, were reported by the majority of oncologists (84%). That said, there were a number of changes to practice patterns: the most frequent were a reduction in the number of hospital visits (83%), increased use of virtual consultations/telemedicine (82%), increased frequency of prescribing oral versus intravenous (IV) treatments (73%), and an increase in follow-up/monitoring procedures done closer to home (73%). The third-line treatment goals remained similar to the pre-COVID era; preserving quality of life remained the singular most common primary goal (36%), while 42% of respondents cited efficacy-focused goals, such as prolonging overall survival and improving progression-free survival as their main aim. Overall, 93% of oncologists opined that treatment decisions over the next 12 months will be influenced by the pandemic. While 86% predicted a return to normal for the initial visits for new patients, thereafter and for ongoing patients, 83% foresee that there will be a continued increase in the use of virtual consultations/telemedicine, 80% envision reduced frequency of hospital visits, and 74% foresee the increased frequency of prescribing oral versus IV treatments to be maintained, as well as follow-up being undertaken closer to home. In total, 40% of oncologists believe that the changes to existing protocols, incurred as a result of the pandemic, will be in effect for at least a year. The main third-line treatment goals for patients with mCRC remained the same during the COVID-19 pandemic. However, there were changes to the daily practice patterns. There was an increased use of oral versus IV therapies, and more follow-up and monitoring procedures were undertaken closer to home. Patients visited hospitals less frequently, with a shift toward virtual consultations/telemedicine, practices that are thought to continue for the foreseeable future. The latter observation suggests there is a need to further develop and invest in all aspects of digital health.

Effects of Dual Task Exercises Training Program on Stroke Patients

Background: Stroke is a neurologic disorder considered the first cause of disability amongadults worldwide. The most important goal of treatment in stroke patients is to return the patients tosociety. Dual tasks have clinical significance in a number of areas in enhancement of the balance andmobility of patients. The aim of the current study was to evaluate the effects of dual task exercisestraining program on balance, mobility and risk of falling in stroke patients and its impact onActivities of Daily Living (ADL). Research design: A quasi-experimental research design wasutilized to conduct this study. Setting: This study was conducted at Neurological Department ofBenha University Hospital. Sample: A purposive sample of 104 adult stroke patients who dividedinto intervention and control groups equally. Tools of data collection: Five tools were used for datacollection. I: Structured neurological assessment sheet, II: Postural assessment scale for stroke, III:Timed up and go test, VI: Barthel index scale of ADL and V: Activities-specific balance confidencescale. Results: Hypertension is the most common risk factor among both groups, post intervention,BI (ADL dependency) of intervention group is significantly associated with their PASS score (levelof balance) Conclusion: Dual task exercises training program was effective in improving clinicaloutcomes in patients with stroke. Recommendations: Nurses should be encouraged to implement thedual task exercises training as a routine practice for stroke patients to improve balance, mobility, riskof falling and ADL.

P-137 Patient baseline characteristics in the PROMETCO study: A real-world, prospective longitudinal cohort on the continuum of care of metastatic colorectal cancer

Tumour shrinkage and disease control are the primary treatment goals for patients with metastatic colorectal cancer (mCRC). When not possible, emphasis lies in slowing disease progression and prolonging survival. Advances in the treatment of mCRC have improved survival to an average of 30 months, but there is still a paucity of data applicable to real-world patient populations. Here we present initial baseline patient characteristics from the PROMETCO trial (NCT03935763), the first international, prospective real-world study to investigate the continuum of care in the mCRC patient population, collecting data on all patients regardless of treatment.

Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: A Retrospective Cohort Study.

Restoration of ambulatory status is considered a primary treatment goal for older patients with intertrochanteric fractures. Several surgical-related parameters were reported to be associated with mechanical failure without focusing on the functional outcomes. Our study examines the roles of both clinical and surgical parameters as prognostic factors on 1-year postoperative ambulatory outcomes, reaching a good functional outcome (the New Mobility Score: NMS ≥ 5) and returning to preinjury functional status at one year, of older patients with intertrochanteric fracture. Intertrochanteric fractures patients age ≥65 years who underwent surgical treatment at our institute between January 2017 and February 2020 were included. Of 209 patients included, 149 (71.3%) showed a good functional outcome at one year. The pre-injury ambulatory status (OR 52.72, 95%CI 5.19–535.77, p = 0.001), BMI <23 kg/m2 (OR 3.14, 95%CI 1.21–8.13, p = 0.018), Hb ≥10 g/dL (OR 3.26, 95%CI 1.11–9.57, p = 0.031), and NMS at discharge ≥2 (OR 8.50, 95%CI 3.33–21.70, p < 0.001) were identified as independent predictors for reaching a good postoperative functional outcome. Only aged ≤80 (OR 2.34, 95%CI 1.11–4.93, p = 0.025) and NMS at discharge ≥2 (OR 6.27, 95%CI 2.75–14.32, p < 0.001) were significantly associated with an ability to return to preinjury function. To improve postoperative ambulatory status, orthopedic surgeons should focus more on modifying factors, such as maintaining the preoperative hemoglobin ≥10 g/dL and providing adequate postoperative ambulation training to maximize the patients’ capability upon discharge. While surgical parameters were not identified as predictors, they can still be used as guidance to optimize the operation quality.

Impact of Treatment Cessation on Overall Disease Outcomes in Patients with Chronic Myeloid Leukemia in Chronic Phase (CML-CP) Attempting Treatment-Free Remission (TFR): Findings from Enestfreedom and Enestop

Impact of Treatment Cessation on Overall Disease Outcomes in Patients with Chronic Myeloid Leukemia in Chronic Phase (CML-CP) Attempting Treatment-Free Remission (TFR): Findings from Enestfreedom and Enestop

Treatment Characteristics and Deep Molecular Response in Chronic Phase - Chronic Myeloid Leukemia Patients Treated with Second-Line Nilotinib or Dasatinib: A Multi-Country Retrospective Chart Review Study

BackgroundAchievement of deep molecular response (i.e., MR4.5, BCR-ABL1 ≤0.0032% on international scale, or 4.5-log reduction) is an important goal of tyrosine kinase inhibitor (TKI) treatment for patients (pts) with chronic myeloid leukemia (CML). Pts achieving a sustained MR4.5 are potential candidates for treatment-free remission. However, data on MR4.5 after TKI therapy outside of clinical trial setting are limited, especially in second-line TKI treatment setting.ObjectiveThis study aims to describe pt and treatment characteristics by regions and investigate frequency and time to achieving MR4.5 in pts with chronic phase (CP)-CML treated with second-line nilotinib or dasatinib in 10 countries, categorized into two regions, Europe [France, Germany, Italy, Netherlands]/Australia and Latin America - LATAM [Argentina, Brazil, Chile, Colombia, and Mexico]).MethodsOnline physician panel approach was used to recruit oncologists (N=172) globally to conduct physician-based chart reviews. To increase the representativeness of physician sample, each physician was allowed to review up to four patients, and was instructed to select these pts via randomization scheme. Eligible pts were diagnosed with CP-CML at age ≥18 years, initiated second-line nilotinib or dasatinib between 1/1/11 and 7/1/15, and had ≥12 months of follow-up since initiating the first-line or second-line TKI. A multivariate Fine and Gray's extension of Cox proportional hazards model was used to assess time to first recorded MR4.5 for nilotinib vs dasatinib as second-line therapy. The model accounted for competing-risk event of TKI resistance and random effect of country clustering of data, and was adjusted for age, gender, Sokal risk score at CML diagnosis, prior hydroxyurea use, first-line TKI agent (1st vs 2nd generation TKI), first-line TKI treatment duration, and reasons for first-line TKI discontinuation. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were reported.ResultsThe study included 285 pts treated with nilotinib (N=138[48%]) or dasatinib (N=147[52%]) as second-line TKI, including 111 nilotinib and 117 dasatinib pts from Europe/Australia (80%), and 27 nilotinib and 30 dasatinib pts from LATAM (20%). Median follow-up time was 19.5 and 18.9 months for nilotinib and dasatinib in both regions, respectively. In Europe/Australia, 85% of pts had received imatinib as first-line TKI, and in LATAM, 96% (Table 1). In Europe/Australia, 85% of pts discontinued first-line TKI due to ineffectiveness (per treating physician) and 16% due to toxicity; corresponding percentages were 79% and 23% in LATAM. Median (range) age at second-line TKI initiation was 58 (18-88) years in Europe/Australia vs 49 (22-77) in LATAM. In Europe/Australia, more second-line nilotinib (21%) than dasatinib (10%) pts had high-risk Sokal score at CML diagnosis. Compared to Europe/Australia, more pts in LATAM had a high-risk Sokal score in both the nilotinib (30%) and dasatinib (27%) cohorts.The raw proportion of pts achieving first recorded MR4.5 by 24 months of second-line TKI therapy was 34% for nilotinib and 31% for dasatinib. After controlling for country clustering effects and baseline covariates, adjusted multivariate Cox model showed that nilotinib was associated with a significantly higher rate of achieving MR4.5 (HR=1.37, 95% CI [1.12, 1.67], p<0.01) than dasatinib. Additionally, high-risk Sokal score was significantly inversely associated with achieving MR4.5 (HR=0.34, 95% CI [0.14, 0.81], p=0.01) while discontinuing first-line TKI due to resistance (HR=0.57, 95% CI [0.30, 1.08], p=0.08) reached borderline statistical significance at the two-sided α-level of <0.10 (Figure 1). MR4.5 outcome will be reported by regions in the presentation.ConclusionThis retrospective chart review study shows some variations in pt and treatment characteristics across regions. A significant percentage of second-line TKI pts can reach MR4.5 after failure to first-line TKI. In addition, this study suggests that second-line nilotinib may be associated with a higher rate of MR4.5 than dasatinib in this setting. Given its retrospective and observational nature, our results should be taken with caution as this study is susceptible to unmeasured confounding and biases. Rigorous clinical assessment in a prospective setting is needed to conclusively compare rates of achieving MR4.5 in ptstreated with nilotinib versus dasatinib. [Display omitted] DisclosuresCortes:ARIAD: Consultancy, Research Funding; Teva: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy, Research Funding; Sun Pharma: Research Funding; BMS: Consultancy, Research Funding; ImmunoGen: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding. Huynh:Novartis Pharmaceuticals Corporation: Research Funding. Mendelson:Novartis Pharmaceuticals Corporation: Employment. Brandt:Novartis Pharmaceuticals Corporation: Employment. Dalal:Novartis Pharmaceuticals Corporation: Employment. Dersarkissian:Novartis Pharmaceuticals Corporation: Research Funding; Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Research Funding. Cortina:Novartis Pharmaceuticals Corporation: Employment. Narkhede:Novartis Pharmaceuticals Corporation: Research Funding. Duh:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Research Funding; Novartis Pharmaceuticals Corporation: Research Funding.

Prospects of marketed hypoglycemic drugs in treatment of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the manifestation of metabolic syndrome in the liver and is closely associated with glucose and lipid metabolism disorders, and they interact as both cause and effect of each other, with insulin resistance as the common pathogenesis. About three quarters of patients with obesity and type 2 diabetes mellitus have NAFLD, and current guidelines recommend reducing metabolic risk factors and treating metabolic syndrome as the primary treatment goals for patients with NAFLD. Although there are no approved drugs for the treatment of NASH at present, the hypoglycemic drugs on the market can bring varying degrees of benefits to NAFLD patients while lowering blood glucose. This article reviews the prospects of three types of hypoglycemic drugs on the market (thiazolidinediones, GLP-1 receptor agonists, and SGLT-2 inhibitors) in the treatment of NAFLD.

Keeping the Balance, the True Major Goal in Advanced Sarcoma

Achieving a balance between long-term efficacy and good quality of life (QoL) is the main goal of treatment for patients with advanced soft tissue sarcoma, some of whom experience prolonged survival without progression. An awareness of the challenges particular to this complex set of diseases can help preserve patient QoL during treatment. Histology is among the main factors to consider when selecting treatment in advanced disease. Close attention to the toxicity profiles of available regimens is of particular importance, especially in more advanced lines where the population is usually more vulnerable. Surgical outcomes are significantly better in patients managed with expert care, and early referral to sarcoma reference centers is key to improving survival and QoL.

The Compatibility of the Treatment Modalities to the Recommendations of the Kidney Disease Outcomes Quality Initiative Guideline in Chronic Kidney Disease Patients with Diabetes.

Background:Diabetes mellitus (DM) and chronic kidney disease (CKD) are global growing health problems. Since DM is the major cause for CKD etiology, its development can be prevented with simple measures, like achievements of glycemic, lipid and blood pressure targets. This study aimed to evaluate whether the treatment goals for CKD patients with DM are achieved under the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline.Methods:Overall, 160 CKD patients with DM were enrolled in the study performed in Usak, Turkey from Jan 2016 to Jan 2018. Compatibility with treatment goals defined in KDOQI 2012 guideline for HbA1c levels, hypertension and dyslipidemia were evaluated retrospectively.Results:Of 160 CKD patients [15 (9.4%) in stage 3a, 53 (33.1%) stage 3b, 51 (31.9%) stage 4 and 41 (25.6%) stage 5], 23 patients in stage 5 were on hemodialysis. Total compliance rate to hyperglycemia treatment was 94 of 160 patients (58.8%). Compatibility rates between different stages of CKD were similar. Hypertension was detected only in 134 patients. Sixty-six (49.3%) patients were compatible with the treatment goals, and as the CKD stages progressed, the rate of patients achieving hypertension treatment goals was declined (P=0.001). One-hundred and thirty-seven patients were not on hemodialysis and fifty-four (39.9%) of 137 patients achieved dyslipidemia goal. There was no difference between different stages of CKD.Conclusion:Under KDOQI 2012 guideline, treatment goal for hyperglycemia was better achieved than the treatment goals for hypertension and dyslipidemia. In CKD patients with DM the physicians should be also focused on the treatment of hypertension and dyslipidemia.

PND59 Determining the Relationship of Seizures, Seizure-Free Days (SFDS) and Other Predictors of Health-Related Quality of Life (HRQOL) in Patients with Dravet Syndrome (DS) and Their Carers

DS is a rare, early onset, lifelong epileptic encephalopathy characterised by frequent and severe seizures. High seizure frequency is associated with behavioral and physical developmental comorbidities with a substantial burden to patients’ and carers’ HR-QoL. Reducing convulsive seizure frequency and increasing SFDs is a primary treatment goal for patients. This study explored the impact of increasing SFDs on patients’ and carers’ HR-QoL. In fenfluramine registration studies, patients (or proxies) completed the Pediatric Quality of Life Inventory. These patient HR-QoL data were mapped to EQ-5D-Y to provide patient utilities. Carer utilities were collected directly (EQ-5D) and mapped to EQ-5D-3L. A linear mixed effects regression model was developed to explore relationships between patient EQ-5D-Y, and clinically relevant variables: age group, frequency of SFDs per 28-days, motor impairment(s) and treatment dose. A linear panel regression model examined the relationship between SFDs and carer HR-QoL. Adjusting for age and underlying comorbidities, results from the patient regression model showed “frequency of SFDs per 28-days” was a significant predictor of HR-QoL (gain in EQ-5D utility of 0.005 per additional SFD, p<0.001). The carer linear panel model also showed “frequency of SFDs per 28-days” as a significant predictor of HR-QoL (gain in EQ-5D-3L utility of 0.014 per additional SFD, p<0.001). For example, a typical patient aged <6 years with 2 co-morbidities and 10 SFDs per 28-days would have an EQ-5D utility of 0.48. If on fenfluramine, SFDs increased to 20 or 28 (“seizure-free”) per 28 days, patient utility would rise 11.4% and 20.5%, and their carer’s utility by 27.7% and 49.8%, respectively. This regression framework provides a useful method in determining the HR-QoL impact that frequent seizures have on DS patients and their carers; highlighting that effective antiseizure treatments that durably increase SFDs, also improve patients’ and carers’ QoL in a directly quantifiable manner.

Irritable Bowel Syndrome and Coping Strategies: A Cross-sectional Study for Identifying Psychological Alarms and Factors Related to Coping in Riyadh, Saudi Arabia.

Psychological alarms including severity of pain, functional impairment, depression, and impaired coping strategies have been correlated with (IBS); however, these attributes, particularly coping strategies, have not been well studied. The aim of this study was to assess psychological alarms, life stressors, and coping strategies of adults diagnosed with IBS. A total of 806 participants completed a self-administered survey consisting of socio-demographic data and life stressors, the Rome IV criteria to diagnose IBS, the Psychological Alarm Questionnaire, and the Coping Strategies Questionnaire (CSQ 24). IBS diagnosis was established among 372 (46.15%) participants. Anxiety (OR = 1.81; 95% CI: 1.35-2.45), severe pain (OR = 1.92; 95% CI: 1.42-2.63), financial life stressors (OR = 1.98; 95% CI: 1.33-2.40), and coping strategies such as reinterpretation (OR = 1.92; 95% CI: 1.39-2.68) and diversion (OR = 2.01; 95% CI: 1.05-3.89) were all significantly and independently associated with IBS diagnosis. Giving the chronic nature of IBS, future research should focus on coping as a potential treatment goal for IBS patients.

DOP29 The Normalization and Transition of J-Pouch Phenotype in the Chicago Classification of Pouchitis

Abstract Background Pouchitis can develop in up to 70% of patients with inflammatory bowel disease (IBD) treated by proctocolectomy with ileal pouch-anal anastomosis (IPAA). In our recent work, we proposed the “Chicago classification of pouchitis” describing 7 main pouch phenotypes with differing outcomes. In this study, we assessed the transition of pouch phenotypes in our classification. Methods This is a retrospective study of IBD patients with IPAA who subsequently underwent pouchoscopies at the University of Chicago between June 1997 and December 2019. We reviewed all available reports of pouchoscopies after ileostomy takedown and classified the pouches into 7 main phenotypes: (a) normal, (b) afferent limb (AL) involvement, (c) inlet (IL) involvement, (d) diffuse, (e) focal inflammation of the pouch body, (f) cuffitis, and (g) pouch fistulas (Figure 1). A normal pouch was defined as a pouch without any abnormal findings including fistulas. AL, IL involvement, and cuffitis were defined as any type of endoscopic inflammation in the AL, IL, and rectal cuff, respectively. Diffuse inflammation was defined as two or more endoscopic inflammatory findings in all anatomical locations of the pouch body (the tip, proximal, and distal pouch). Focal inflammation was defined as pouchitis that did not meet the criteria for diffuse inflammation. Pouch fistulas included pouches with any type of fistulas noted ≥6 months from ileostomy takedown. Using a Kaplan-Meier curve, event-free survival (EFS) was assessed from the scope date when a primary phenotype was first identified to the date when a subsequent phenotype was described. We excluded patients if a subsequent phenotype was identified before or at the scope date when a primary phenotype was initially noted. Logistic regression analysis was performed with variables with a P-value &amp;lt;0.05 in a Fisher’s exact test. Results We reviewed 1,359 pouchoscopies from 426 patients (90% preoperative diagnosis of ulcerative colitis). The most common subsequent inflammatory phenotype was focal inflammation (55%-88%), followed by IL involvement (31%-67%), cuffitis (33%-46%), diffuse inflammation (20%-38%), AL involvement (21%-32%), and pouch with fistulas (9%-20%). The rate of subsequent normal pouch was 6%-25% with pouch fistulas having the lowest normalization rate (6%, 5-year EFS 93%) (Table 1, Figure 2). On multivariable analysis, pouch fistulas were negatively associated with pouch normalization (OR 0.17, 95% CI 0.06–0.48) (Table 2). Conclusion We demonstrated that pouch phenotype can change over time and pouch normalization is possible. Further studies are needed to determine if pouch normalization should be a goal of treatment for IBD patients with IPAA.