Patient and retina specialists’ preferences in neovascular age-related macular degeneration treatment. A discrete choice experiment

Introduction and objective Neovascular age-related macular degeneration (nAMD) leads to severe and permanent visual impairment, significantly impacting patients’ quality of life and functional independence. Although treatment with anti- vascular endothelial growth factor (VEGF) prevents and, in some cases, reverses visual damage, the need for frequent monitoring visits and intravitreal injections represents a significant burden on patients, caregivers and retina specialists. Objective To elicit preferences for nAMD treatment characteristics from the perspectives of patients and retina specialists. Method A discrete choice experiment was conducted. Participants (patients > 50 years with nAMD receiving anti-VEGF drugs for at least 2 years and without previous experience with anti-VEGF and retina specialists working in the Spanish National Healthcare System) were asked to select one of two hypothetical treatments resulting from the combination of five attributes (effects on visual function, effects on retinal fluid, treatment regimen, monitoring frequency, and cost); their levels were identified by reviewing the literature and two focus groups. The relative importance (RI) given to each attribute was estimated using a mixed logit model. The marginal rates of substitution (MRS) were calculated taking cost as the risk attribute. Results A total of 110 patients (P) [aged 79.0 (SD:7.4) years; 57.3% women; 2.3 (SD:0.7) years with nAMD; 2.1 years (SD:0.1) in treatment] and 66 retina specialists (RS) participated in the study. Participants gave greater RI to improvements in their visual function [60.0% (P); 52.7% (RS)], lower monitoring frequency [20.2% (P); 27.1% (RS)] and reduction in retinal fluid [9.8% (P); 13.0%(RS)]. Patients and retina specialists would agree to an increase in cost by 65.0% and 56.5%, respectively, in exchange for improvements of visual function; and 25.5% and 43.3% on delaying monitoring frequency by one month. Conclusions Efficacy of treatment, in terms of visual function improvements, is the main driver for treatment election for both patients and retina specialists. Treatment monitoring requirements are also considered, mainly from the retina specialist’s perspective. These results suggest that the use of more efficacious anti-VEGF agents with a longer duration of action may contribute to aligning treatment characteristics with patients/specialists’ preferences. A better alignment would facilitate better disease management, fulfilling the unmet needs of patients and retina specialists.

EP.FRI.98 Perioperative blood glucose monitoring and handover in Post-Laparotomy Diabetic patients admitted to Intensive Care

Aim To identify the percentage of diabetic laparotomy patients admitted to ITU who had a pre-operative blood glucose check, and the frequency of post-operative blood glucose checks in the immediate 24 hours post-operatively, with any association with 30 day mortality Method We identified diabetic post-laparotomy patients admitted to a large tertiary hospital ICU, identifying handover between medical and critical care teams and perioperative blood glucose monitoring up to the first 24 hours of ICU admission post-operatively using both physical and electronic notes. Results We identified 79 diabetic laparotomy patients admitted to ICU of which 49.3% (39/79) did not have diabetes recorded as a comorbidity in nursing handover charts. We found that 27.8% of these patients did not have an intra-day pre-operative blood glucose recorded and that frequency of post-operative glucose monitoring in the first 24 hours ranged from 0.5 to 10 hourly. ITU monitoring charts could only be found for 69 of the 79 patients, out of which 40.7% of patients had at least one hyperglycaemic episode while 11.6% of patients had a hypoglycaemic episode. We found no correlation between incidences of hyperglycaemia and hypoglycemia or handover with 30 day mortality (13.9%). Conclusion 72.2 percent of post laparotomy diabetic patients admitted to ICU have a preoperative blood glucose recorded, with considerable variance in blood glucose monitoring frequency 24 hours post-laparotomy from half hourly to 10 hours between blood glucose monitoring but we found no association between hyperglycaemic and hypoglycaemic events in the first 24 hours post-laparotomy with 30 day mortality.

Monitoring and Maintenance of CP System in MGL

Mahanagar Gas Limited is a City Gas distribution (CGD) company based out of the city of Mumbai and around. MGL currently has around 480 Kms of Steel gas pipelines for transportation of natural gas. The diameters of these pipelines are ranging from 2” to 18” and almost all are coated with 3 layer Poly Ethylene coating (3LPE). We are installing Permanent Cathodic Protection (PCP) for all commissioned pipelines and Temporary Cathodic Protection (TCP) having a design life of 5 years for un-commissioned pipelines during the projects stage itself. This paper shall basically outline the CP system in MGL along with various practices being followed in MGL to ascertain the effectiveness of CP. MGL has installed various CP assets like CP stations, Diode stations, external ER probes, corrosion coupons to ascertain the CP effectiveness. This paper shall outline the detailed monitoring procedure along with monitoring frequency of all the assets. MGL is also carrying out health adequacy surveys like DCVG, CIPL etc over the steel pipeline network. Few case studies arising out of these monitoring results shall be presented in this paper. (1) Casing carrier short at Taloja Railway crossing. The detailed procedure of monitoring and rectification shall be presented. (2) Case study on CP under-protection at Andheri which was resolved using a flange isolation kit.

AB0913-PARE METHOTREXATE FOR RHEUMATOID ARTHRITIS: PATIENT PERSPECTIVES ON MONITORING IN PRIMARY CARE

Background:Monotherapy with methotrexate (MTX) is one first-line option for newly diagnosed Rheumatoid Arthritis (RA)1. Although treatment is usually commenced by a specialist, repeat prescribing and monitoring responsibilities often lie with primary care. While inadequate monitoring is a safety concern, unnecessary duplication of monitoring invariably has cost implications for General Practice (GP).Objectives:To ensure that patients in one South-West GP practice who are taking oral MTX for RA are appropriately monitored in line with current guidance from the British Society of Rheumatology (BSR). Current guidance recommends that once a stable MTX dose is maintained for six weeks, followed by monthly bloods for the next three months, that at least twelve weekly blood monitoring is sufficient from then on1.Methods:A randomised sample of 50 patients registered in one South-West GP practice that were taking a stable dose oral MTX for RA; for at least 6 months; was collected. The length of time between the patient’s two most recent blood tests was recorded. A random selection of ten patients with more frequent monitoring than BSR guidance suggest were asked a series of questions to determine patient perspectives on reasons for monitoring frequency.Results:58% of patients had more frequent monitoring bloods than current BSR guidelines recommend. Within this group, the mode frequency of monitoring was four weeks, in line with the previous National guidance which was superseded in 20172.The most common themes in patient’s perspectives on monitoring frequency were:a.Previous abnormal blood results requiring close monitoringb.Multiple disease modifying anti-rheumatoid drug (DMARD) regimes that included MTXc.Patient preferenced.Unclear or unknown reasonThe purported increased monitoring for multiple DMARD regimes were not in line with current national guidelines1.Conclusion:This audit demonstrates that over half of patients taking MTX for RA in one GP practice are having more frequent blood monitoring than BSR guidance suggests is necessary. Furthermore, it demonstrates that patient’s understanding of their perceived need for increased monitoring is largely inaccurate or unclear to them. There is a clear deficit in patient education surrounding monitoring frequency which must be addressed in order to empower patients, as well as reducing unnecessary duplication of blood tests. As a result of this audit, patient education on MTX monitoring frequency was formally introduced as part of the RA annual patient review. An information sheet with these monitoring requirements was produced to aid practitioners in the education process.References:[1]J, Ledingham et al | BSR/ BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs | Rheumatology 2017; 56: 865-8.[2]Chakravarty K etc al | BSR/BHPR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists | Rheumatology 2008; 47: 924–5.Disclosure of Interests:None declared

Long-Term and Emergency Monitoring of Zhongbao Landslide Using Space-Borne and Ground-Based InSAR

This work presents the ideal combination of space-borne and ground-based (GB) Interferometric Synthetic Aperture Radar (InSAR) applications. In the absence of early investigation reporting and specialized monitoring, the Zhongbao landslide unexpectedly occurred on 25 July 2020, forming a barrier lake that caused an emergency. As an emergency measure, the GB-InSAR system was installed 1.8 km opposite the landslide to assess real-time cumulative deformation with a monitoring frequency of 3 min. A zone of strong deformation was detected, with 178 mm deformation accumulated within 15 h, and then a successful emergency warning was issued to evacuate on-site personnel. Post-event InSAR analysis of 19 images acquired by the ESA Sentinel-1 from December 2019 to August 2020 revealed that the landslide started in March 2020. However, the deformation time series obtained from satellite InSAR did not show any signs that the landslide had occurred. The results suggest that satellite InSAR is effective for mapping unstable areas but is not qualified for rapid landslide monitoring and timely warning. The GB-InSAR system performs well in monitoring and providing early warning, even with dense vegetation on the landslide. The results show the shortcomings of satellite InSAR and GB-InSAR and a clearer understanding of the necessity of combining multiple monitoring methods.