THU0578 ONLINE CME IMPROVES CLINICAL DECISION-MAKING IN THE MANAGEMENT OF PATIENTS WITH PSORIATIC DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 530-530
Author(s):  
E. Bell ◽  
A. B. Gottlieb ◽  
P. J. Mease ◽  
G. Littman ◽  
M. Via
Keyword(s):  
Folic Acid ◽  
Patient Education ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Skin Lesions ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Research Support ◽  
Research Grants ◽  
Evidence Based Therapy

Background:Psoriatic arthritis can be a challenging condition for rheumatologists to manage.Objectives:We assessed whether an online, virtual patient simulation (VPS) activity could improve the performance of rheumatologists in ordering appropriate tests, tailoring treatment options and selecting an evidence-based treatment for patients with PsA.Methods:This CME-certified VPS consisted of 2 patient cases presented in a platform that allowed physicians to assess the patients and complete open-field entries, choosing from an extensive database of diagnostic and treatment options reflecting the scope and depth of actual practice. After each decision, learners received clinical guidance (CG) based on current evidence and faculty recommendations. Clinical decisions were compared pre- and post-CG using a 2-tailed paired t-test to determinePvalues (P<.05 is significant). Rationales for clinical decisions were collected in real time. Data were collected between 28 February 2019 and 16 May 2019 and reported here as % relative improvement,Pvalue.Results:Case 1 (n=48 rheumatologists):45 yr old female patient diagnosed with PSO 5 years ago. Current treatment with MTX 15mg & folic acid once weekly plus ibuprofen. Experiencing nausea and increasing skin lesions. Recently showing signs and symptoms of PsA.Statistically significant changes were observed for:•Ordering appropriate tests to evaluate the patient (chemistry panel, 11%,P=.04; full blood count [FBC], 10%,P=.04; IFNƴ release assay for TB, 22%,P=.01; liver function tests [LFTs],13%,P=.02; rheumatology consult, 19%,P=.01 and viral hepatitis panel, 52%,P<.001)•Tailoring treatment options based on individual patient characteristics and available evidence (discontinue MTX [46%]and folic acid [140%], bothP<.001; order patient education, 24%,P=.006; guidance on lifestyle changes, 20%,P=.01; preventative vaccines prior to ant-TNF therapy, 38%,P=.002 and a followup appointment at an appropriate timescale, 26%,P=.006)•Selecting an evidence-based therapy for a patient newly diagnosed with PsA while on MTX therapy (adalimumab, 138%,P<.001)Case 2 (n=116 rheumatologists):55 yr old male who has had PSO for 9 years. Developed joint symptoms 1 year ago. Diagnosed with PsA & treated with MTX/folic acid. Elevated liver enzymes noted after 9 months; treatment switched to adalimumab. Skin lesions much improved but ongoing issues with pain and stiffness in hands. Current medications are citalopram, adalimumab, simvastatin and triamcinolone for skin flares.Statistically significant changes were observed for:•Ordering appropriate tests to evaluate the patient (C-reactive protein [9%], erythrocyte sedimentation rate [9%] and FBC [17%], all P<.01; Beck depression inventory [51%], BSAxPGA [21%], chemistry panel [15%], Global QoL 13%], Leeds enthesitis index [25%], LFTs [32%], PGA [21%], RAPID3 [63%], total BSA [137%]and X-ray of hands and feet [27%], allP<.001)•Tailoring treatment options based on individual patient characteristics and available evidence (discontinue biologic DMARD [67%], order patient education [22%], physical therapy [31%] and occupational therapy 27%], preventative vaccines [35%], psychosocial counselling [31%] and a follow-up appointment at an appropriate timescale [32%], allP<.001)•Selecting an evidence-based therapy for a patient with inadequate control of PsA on adalimumab (secukinumab, 152%,P<.001; ixekizumab, 167%,P=.01)Conclusion:These results demonstrate the success of immersive, online VPS education that engages physicians in a practical learning experience in improving their performance in managing patients with PsA.References:[1]https://www.medscape.org/viewarticle/902369Disclosure of Interests:Elaine Bell: None declared, Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Gwen Littman: None declared, Mark Via: None declared

scholarly journals Harmonisation of Outcome Parameters and Evaluation (HOPE) for actinic keratosis: protocol for the development of a core outcome set

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Markus V. Heppt ◽  
Theresa Steeb ◽  
Lutz Schmitz ◽  
Claus Garbe ◽  
Lars E. French ◽  
...  
Keyword(s):  
Literature Search ◽  
Core Outcome Set ◽  
Treatment Options ◽  
Skin Lesions ◽  
Evidence Based ◽  
Invasive Squamous Cell Carcinoma ◽  
Core Outcome ◽  
Structured Interviews ◽  
Common Skin ◽  
Randomised Controlled

Abstract Background Actinic keratoses (AK) are common skin lesions that can progress to invasive squamous cell carcinoma of the skin. A variety of lesion- or field-targeted treatment options exist and their efficacy has been demonstrated in numerous randomised controlled trials (RCTs). However, the reported endpoints are highly heterogeneous, making it difficult to assess and compare distinct treatment options and to reach an evidence-based choice of therapy. Methods A systematic literature search will be conducted to analyse which endpoints are reported in RCTs. The focus will be on effectiveness, tolerability, cosmesis, and patient satisfaction. The reported endpoints of these studies, as well as their frequency and data collection times, will be documented in a standardised way to generate a comprehensive list of reported endpoints. In order to complete the identified outcomes in the literature search, focus groups on affected patients and structured interviews with board-certified dermatologists will be conducted to identify both patient- and practice-relevant endpoints. After the identification phase, the evaluation of the endpoints follows. In a two-stage Delphi procedure, experts including patient representatives will evaluate the endpoints in a standardised and transparent manner. A final face-to-face consensus meeting will be conducted after the last Delphi round in which a final list of core outcomes will be consented. Discussion The development of a standardised endpoint set for the treatment of AK will contribute to improving the comparability of therapeutic options. Our catalogue will enhance the synthesis of evidence for the future by reducing heterogeneity in outcomes between RCTs and hence contribute to improving the quality of research, evidence-based and patient-centred treatment. Trial registration Core Outcome Measures for Effectiveness (COMET) database. Registered in December 2018.

scholarly journals Development and Evaluation of Evidence Based Patient Education Booklet in Hindi Language for Prevention of Shoulder Pain in Paraplegia

2021 ◽  
Vol 6 (4) ◽  
pp. 166-169
Author(s):  
Taniya Verma ◽  
Chitra Kataria
Keyword(s):  
Patient Education ◽  
Shoulder Pain ◽  
Weight Bearing ◽  
Treatment Options ◽  
Evidence Based ◽  
Suitability Assessment ◽  
Education Material ◽  
Informal Interview ◽  
Hindi Language ◽  
Evaluation Of Evidence

Background: Shoulder pain is one of the most frequent complaints of Paraplegia with a prevalence reported to range from 50% to 60%.It has been attributed to the increase in upper extremity (UE) weight bearing following lower extremity paralysis. Purpose of the study: To develop and Evaluate an Evidence Based Patient Education Booklet in Hindi Language for Prevention of Shoulder Pain in Paraplegia along with pictorial presentation. Design: A methodological study Method: It consist of 4 steps. 1) Literature review and informal interview of 2 doctors, 7 physiotherapists, 5 occupational therapists and 10 patients were used to determine the domains of the education booklet. 2) Development of content of the evidence based patient education booklet according to domains found in step 1 and develop a rough draft of booklet in Hindi Language. 3) Evaluation of the evidence based booklet by expert panel using SAM and to modify the booklet to produce the final booklet draft. 4) Pilot study on patients to take their views regarding the booklet developed. Results: The domains found in step 1 were: Education about pain, Education about the treatment options, Ergonomics modifications, Positioning, Wheel chair selection and transfer techniques, Exercises, General precautions. The content was developed in step 2. In step 3 the SAM score is- 88.13% and final booklet was produced after modification. In step 4 the patient rated the booklet easy to read and understand with an overall rating of 9/10 Conclusion: The developed patient education booklet came out to be easy to read and understand and of superior quality according to Suitability assessment of material questionnaire and hence should be made a part of patient education. Keywords: Patient education booklet, Shoulder pain in paraplegia, Suitability assessment of material questionnaire, booklet in Hindi language, Pain prevention and management, Health education material

scholarly journals Personality Traits and Annual Income Determine the Willingness to Pay for a Single Tooth Implant

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 952
Author(s):  
Shirlene Foo Yih Ting ◽  
Kimberley Chew Wen Chien ◽  
Nurul Hanis Ramzi ◽  
Allan Pau ◽  
Rohit Kunnath Menon
Keyword(s):  
Patient Education ◽  
Willingness To Pay ◽  
Personality Traits ◽  
Treatment Options ◽  
Health Centre ◽  
Evidence Based ◽  
Annual Income ◽  
Single Tooth ◽  
Significant Difference ◽  
Single Tooth Implant

The objective of this study was to evaluate the factors influencing the willingness to pay for a single tooth implant in Malaysia and to assess if an additional evidence-based patient education video increases the willingness to pay. A total of 100 subjects seeking single tooth replacement at the Oral Health Centre, International Medical University (IMU), Kuala Lumpur, Malaysia, were asked to complete questionnaires about personal demographics and personality traits. Subsequently, they were randomly allocated into two groups. Group C received a conventional patient–dentist interaction on treatment options for missing teeth, while Group EV received the same content with an additional evidence-based video on the survival rate and complications for each option from recent meta-analyses. Willingness to pay the median price and the highest price that the subjects were willing to pay were assessed by a structured bidding process. A higher annual income was significantly associated with willingness to pay the median price for a single tooth implant (χ2 = 6.91, p = 0.03). Dominant personality traits of openness (r = −0.25), conscientiousness (r = −0.30) and agreeableness (r = −0.20) were negatively correlated with the highest price that the patients were willing to pay for a single tooth implant (Pearson’s correlation test, p < 0.05). No significant difference in willingness to pay was found between Group C and Group EV (χ2 = 0.05, p > 0.05). In conclusion, patient education strategies for single tooth replacements with dental implants should be customized based on a patient’s personality and income to maximize effectiveness.

Impact of Tobacco Quitlines on Smoking Cessation in Persons With Mental Illness: A Systematic Review

2017 ◽  
Vol 47 (1-2) ◽  
pp. 68-81 ◽  
Author(s):  
Rhonda Schwindt ◽  
Karen Suchanek Hudmon ◽  
Mitchell Knisely ◽  
Lorie Davis ◽  
Caitlin Pike
Keyword(s):  
Systematic Review ◽  
Mental Illness ◽  
Smoking Cessation ◽  
Positive Impact ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
The Impact ◽  
The U.S

Persons with mental illness smoke at rates two to four times higher than do persons without mental illness and comprise 30.9% of the U.S. tobacco market. Given the prevalence of mental illness and the known detrimental effects of tobacco, concerted efforts are needed to promote the use of evidence-based treatment options. We conducted a systematic review of studies that examined the impact of tobacco quitline interventions in this population. Results revealed an overall positive impact of cessation services delivered via a tobacco quitline. More research is needed to determine intervention components and patient characteristics that are associated with cessation success.

scholarly journals Isolated Dysphagia in a Patient with Medial Medullary Infarction – Effects of Evidence-Based Dysphagia Therapy: A Case Report

2021 ◽  
pp. 190-199
Author(s):  
Samra Hamzic ◽  
Patrick Schramm ◽  
Hassan Khilan ◽  
Tibo Gerriets ◽  
Martin Juenemann
Keyword(s):  
Case Report ◽  
Vascular Occlusion ◽  
Evidence Based ◽  
Severe Dysphagia ◽  
First Case ◽  
Jaw Opening ◽  
Medial Medullary Infarction ◽  
Dysphagia Therapy ◽  
Evidence Based Therapy ◽  
Medullary Infarction

Medial medullary infarction (MMI) is a vascular occlusion in the medulla oblongata leading to certain constellations of neurological symptoms and seriously affecting the patient. Effective evidence-based treatment of severe dysphagia as sole symptom of MMI has not yet been reported. This case study aims to report successful effects of evidence-based therapy based on findings of dysphagia symptoms and pathophysiology of swallowing by flexible endoscopic evaluation of swallowing (FEES) in severe isolated dysphagia after MMI. FEES was performed to evaluate swallowing pathophysiology and dysphagia symptoms in a 57-year-old male with severe dysphagia after MMI. On the basis of FEES findings, simple and high-frequent evidence-based exercises for improvement of swallowing were implemented: thermal stimulation of faucial arches, Jaw Opening Exercise, and Jaw Opening Against Resistance. After 7 weeks of high-frequent evidence-based therapy and regular FEES evaluation the patient was set on full oral diet with no evidence of aspiration risk. In a first case report of isolated dysphagia in MMI our case illustrates that high-frequent evidence-based dysphagia therapy in combination with FEES as the method to evaluate and monitor swallowing pathophysiology can lead to successful and quick rehabilitation of severely affected dysphagic patients.

scholarly journals 1186. Cefazolin inoculum effect predicts reduced susceptibility to other antibiotics and patient outcomes in MSSA endovascular infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S617-S617
Author(s):  
Dan Smelter ◽  
Sue McCrone ◽  
Warren Rose
Keyword(s):  
Infective Endocarditis ◽  
Mortality Rate ◽  
Patient Outcomes ◽  
Treatment Options ◽  
Fold Increase ◽  
Specific Mechanism ◽  
Research Support ◽  
High Burden ◽  
Low Toxicity ◽  
Inoculum Effect

Abstract Background MSSA Infective endocarditis (IE) is inherently a high-burden infection with up to a 30% mortality rate. Cefazolin is an appealing treatment option for IE with low toxicity and a favorable dosing scheme. However, cefazolin has been associated with treatment failure in IE, attributed to an inoculum effect. The specific mechanism underlying the cefazolin inoculum effect (CIE) remains undetermined, but CIE has been linked to both blaZ expression and agr dysfunction. This study aims to determine whether CIE is linked to reduced susceptibility to other antibiotics and worse outcomes regardless of therapy in MSSA endovascular infections. Methods Sixty-four MSSA strains were collected from patients with endovascular infections not treated with cefazolin. To determine CIE phenotype, strains were cultured and MICs assayed for cefazolin, nafcillin, and vancomycin at 107 CFU/mL for high-inocula (HI) and 105 CFU/mL for standard-inocula (SI). This study defined CIE as a ≥ 4-fold increase in MIC at HI compared to SI, with at least an MIC of 4 mg/L at HI. Nitrocefin disks identified blaZ expression, and beta lysin disks were used to determine hemolysin type and agr function. Patient outcomes of mortality and bacteremia duration were assessed across cohorts. Results Twenty-four strains exhibit a CIE (38%), with 10 strains having an MIC of ≥ 32mg/L at HI. Nafcillin and vancomycin also had an inoculum effect, uncoupled from the CIE and occurring at a lower frequency and amplitude at HI. Presence of CIE had a greater association with blaZ expression (71% vs 25%) than agr dysfunction (38% vs 20%). 50% (9/18) of CIE infections were cleared within 48 hours while 77% (20/26) of CIE-negative infections were cleared within 48 hours (P=0.106). However, presence of CIE was not associated with increased mortality (25% CIE-positive vs 35%; P=0.578) Conclusion Previous studies for CIE failed to enrich for isolates from endovascular sources, where inocula are known to be high. This study presents one of the largest endovascular source cohorts for CIE evaluation. It identifies that CIE prevalence (38%) is higher than reports from diverse infection sources (10-36%). CIE appears to predict bacteremia duration with other MSSA treatment options, suggesting mechanisms independent of blaZ and agr function for this phenomenon. Disclosures Warren Rose, PharmD, MPH, Merck (Grant/Research Support)Paratek (Grant/Research Support)

Explaining the causal links between illness management and symptom reduction: Development of an evidence-based patient education strategy

2017 ◽  
Vol 100 (6) ◽  
pp. 1169-1176 ◽  
Author(s):  
Karen M. Zhang ◽  
Leora C. Swartzman ◽  
Robert J. Petrella ◽  
Dawn P. Gill ◽  
John Paul Minda
Keyword(s):  
Patient Education ◽  
Symptom Reduction ◽  
Evidence Based ◽  
Illness Management ◽  
Education Strategy

scholarly journals COVID-19: Before the Fall, An Evidence-Based Narrative Review of Treatment Options

2021 ◽  
Author(s):  
Nicholas Rebold ◽  
Dana Holger ◽  
Sara Alosaimy ◽  
Taylor Morrisette ◽  
Michael Rybak
Keyword(s):  
Treatment Options ◽  
Narrative Review ◽  
Evidence Based

scholarly journals 168. Efficacy of the Novel gwt1 Inhibitor APX2039 in a Rabbit Model of cryptococcus Meningitis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S213-S213
Author(s):  
Karen J Shaw ◽  
Charles D Giamberardino ◽  
Quinlyn A Soltow ◽  
Jennifer Tenor ◽  
Dena Toffaletti ◽  
...  
Keyword(s):  
Brain Tissue ◽  
Oral Treatment ◽  
Treatment Options ◽  
Rabbit Model ◽  
Experimental Period ◽  
Control Group ◽  
Log10 Reduction ◽  
Research Support ◽  
Rapid Reduction ◽  
Geographical Regions

Abstract Background Cryptococcal meningitis (CM), caused primarily by Cryptococcus neoformans, is uniformly fatal if not treated. Treatment options are limited especially in resource-poor geographical regions, and mortality rates remain high despite current therapies. New oral treatment options are needed that demonstrate rapid reductions in CFU in CSF and brain tissue. APX2039 is a novel inhibitor of the fungal Gwt1 enzyme, which catalyzes an early step in glycosylphosphatidyl inositol (GPI) anchor biosynthesis. It is highly active against both C. neoformans and C. gattii and has previously demonstrated significant efficacy in a mouse delayed-treatment model of CM. CSF Fungal Burden in Rabbits Methods Male New Zealand White rabbits were inoculated with C. neoformans H99 (1.4 ×106 CFU) directly into the cisterna magna. Rabbits were immunosuppressed with cortisone acetate at 7.5 mg/kg (i.m.), starting on Day -1 relative to inoculation and then administered drug daily throughout the 14-day experimental period. Treatment was initiated on Day 2 postinfection and continued through Day 14 consisting of: 50 mg/kg APX2039 PO (BID), 80 mg/kg fluconazole (FLU) PO (QD), c) 1 mg/kg amphotericin B deoxycholate (AMB) IV (QD); and vehicle control. CSF was removed via an intracisternal tap on Days 2, 7, 10 and 14 post-infection and CFU/ml was assessed. Animals were sacrificed on Day 14 and CFU/g brain tissue was assessed. Results APX2039 demonstrated rapid reduction in CFU in both CSF and brain tissue. The range in CFU values in rabbit CSF is shown (Figure). Reductions in CFU were statistically different from the control group for all treatment groups. APX2039 was also different from both FLU and AMB and resulted in sterilization in CSF by Day 10. Brain harvested on Day 14 demonstrated a reduction in CFU/g tissue vs control of 1.8 log10 and 3.4 log10 for FLU and AMB, respectively, while a &gt; 6 log10 reduction (tissue sterilization) was observed for APX2039. Conclusion APX2039 demonstrated potent efficacy in a rabbit model of CM. The more rapid clearance in CSF than either AMB or FLU, as well as &gt; 6 log10 reduction in brain CFU highlights the unique properties of this drug, warranting further investigation of this molecule for the treatment of CM. Disclosures Karen J. Shaw, PhD, Amplyx (Consultant)Forge Therapeutics (Consultant) Charles D. Giamberardino, Jr., MR, Box (Shareholder) John R. Perfect, MD, amplyx (Grant/Research Support)astellas (Grant/Research Support)astellas (Grant/Research Support)

scholarly journals THU0652-HPR ONLINE EDUCATION YIELDS SIGNIFICANT GAINS IN RHEUMATOLOGISTS’ KNOWLEDGE OF BIOLOGICS AND BIOSIMILARS BUT A SUBSTANTIAL GAP REMAINS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 570.2-571
Author(s):  
A. Stan ◽  
E. Bell ◽  
P. Schoonheim ◽  
E. Mysler
Keyword(s):  
Online Education ◽  
Statistical Significance ◽  
Treatment Options ◽  
Educational Activity ◽  
Round Table Discussion ◽  
Knowledge Gain ◽  
Regulatory Requirements ◽  
Research Support ◽  
Significance Level ◽  
Post Assessment

Background:Biologics are complex proteins which have revolutionized the treatment of many serious diseases. Due to their complexity and manufacturing which involves living organisms, it is not possible to create identical versions of reference biologics, but it is possible to create biosimilar drugs. Biosimilars have the potential to yield high cost savings and expand treatment options to meet the growing demand for biological therapies.Objectives:This study assessed whether the online CME-accredited round-table-discussion titled “Understanding Biologics: from protein to clinical practice” improved physicians’ understanding of the inherent variability of biologics and what similarity means in the context of biologics as well as the analytical assessment of quality that applies to both biologics and biosimilars.Methods:Rheumatologists participated in an online CME activity (www.medscape.org/viewarticle/900121) consisting of a 30-minute video discussion between 4 experts with accompanying slides. Educational effect was assessed using a 4-question repeated pairs, pre-/post-assessment. A chi-square test was used to determine if a statistically significant improvement (P<.05 significance level) existed in the number of pre-/post-test correct responses. Cramer’s V was used to estimate the level of impact of the education. The CME activity launched on 22 Aug 2018, and the data were collected through 9 Oct 2018.Results:A total of 622 rheumatologists participated in the educational activity, and 87 completed the pre- and postassessment. Overall the activity had a signficiant impact (P<.001) on rheumatologists’ understanding of the inherent variability of biologics and the regulatory requirements for approval of a biosimilar. The Cramer’s V value of 0.186 indicates a considerable effect of the education. The average perecentage of correct responses rose from 33% pre-activity to 51% post-activity. A linked learning assessment (individual responses matched pre- and post-education) showed that 25% of learners improved their knowledge and 26% reinforced their knowledge. The change in percentage of correct responses from pre- to post-assessment achieved statistical significance (P<.05) in 2 of the 3 questions presented: (i) understanding the type of studies needed to demonstrate comparability of a biosimilar to an originator (11% at baseline; 45% post activity), (ii) understanding the type of variability considered acceptable for a biologic (46% at baseline; 63% post activity). However, no knowledge gain was observed regarding basic analytic attributes evaluated to ensure batch to batch consistency (37% at baseline; 38% post activity). Almost 45% of rheumatologists gained confidence in their ability to describe the regulatory requirements for approval of a biosimilar.Conclusion:This online CME activity significantly improved rheumatologists’ understanding of the inherent variability of complex biologic medicines and the role of analytical studies in the regulatory approval of biosimilars. However, there is room for further improving physicians’ knowledge, especially of basic analytics of biologics and biosimilars.Acknowledgments:This CME-certified activity was supported by independent funding from Sandoz.Disclosure of Interests:Adriana Stan Grant/research support from: The CME-certified activity was supported by anindependent educational grant from Sandoz., Elaine Bell: None declared, Peter Schoonheim Grant/research support from: This CME-certified activity was supported by independent funding from Sandoz., Eduardo Mysler Grant/research support from: AbbVie, Lilly, Pfizer, Roche, BMS, Sandoz, Amgen, and Janssen., Consultant of: AbbVie, Lilly, Pfizer, Roche, BMS, Sandoz, Amgen, and Janssen.

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