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Poor Adherence (poor + adherence)
Selected AbstractsPoor Adherence to Hypertension Therapy: Whose Responsibility Is It?JOURNAL OF CLINICAL HYPERTENSION, Issue 2 2001Marvin Moser MD Editor in Chief No abstract is available for this article. [source] The self-efficacy model of medication adherence in chronic mental illnessJOURNAL OF CLINICAL NURSING, Issue 11c 2008Terence V McCann BA Aim., In this position paper, the self-efficacy model of medication adherence in chronic mental illness is presented, and its application to antipsychotic medication adherence is considered. Background., Poor adherence to antipsychotic medications is common in chronic mental illness. Major implications of this are relapse and re-hospitalisation. Several conceptual frameworks have been developed about adherence and, in some instances, have been incorporated in medication taking studies, but have resulted in inconsistent outcomes. Method., This paper draws on a review of literature from databases to inform the development of the self-efficacy model of medication adherence. Inclusion and exclusion criteria were developed from primary and secondary research questions. Results., The model places the person with chronic mental illness as an active participant central to the process of medication taking. It has three components: core factors, contextual influences and a continuum. The factors comprise a central factor, self-efficacy and four interrelated supporting influences: perceived medication efficacy; access to, and relationships with, health professionals; significant other support and supported living circumstances. The factors are affected by three broad contextual influences , personal issues, medication side-effects and complexity, and social stigma , which affect the way individuals take their medications. A continuum exists between adherence and non-adherence. Conclusion., The model positions service users at the heart of adherence by giving prominence to self-efficacy, medication efficacy and to immediate social, psychological and environmental supports. Further work is needed to validate, refine and extend the model. Relevance to clinical practice., For practitioners involved in prescribing and medication management in people with chronic mental illness, the model provides a theoretical framework to strengthen adherence. It highlights the need to consider broader influences on medication taking. Moreover, it places the person with chronic mental illness as an active participant at the centre of strategies to enhance adherence. [source] Risk profiles for non-adherence to antipsychotic medicationsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2008T. V. MCCANN rmn rgn phd ma ba dipnurs (lond) rnt rcnt Poor adherence to medications is common in individuals with schizophrenia, and can lead to relapse and re-hospitalization. This paper presents the findings of an Australian study of the factors affecting antipsychotic medication taking in individuals with schizophrenia. The Factors Influencing Neuroleptic Medication Taking Scale was used with a non-probability sample of mental health service users. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using spss version 15. Most participants had insight into their illness and were aware of the stigma of mental illness. Around 70% experienced annoying side effects, while nearly half admitted alcohol consumption. About one-fifth admitted they had missed taking medications during the previous week. Significant others played a variable role in medication taking. Over 80% were satisfied with their relationships with health professionals, but were less satisfied with access to these professionals, especially psychiatrists. Logistic regression analysis showed that age, impact of medication side effects, and access to psychiatrists were independent predictors of medication omission. It is argued that medication taking is a complex issue, which needs to be taken into consideration in health professional training and measures to promote adherence. [source] Enhanced adherence to HCV therapy with higher dose ribavirin formulation: final analyses from the ADHERE registryALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010I. Alam Aliment Pharmacol Ther 2010; 32: 535,542 Summary Background, Poor adherence to Hepatitis C virus (HCV) treatment is an important cause of treatment failure. Traditional ribavirin 200 mg (RBV) treatment is associated with a significant daily pill burden. RibaPak (RBP), available as 400 mg and 600 mg ribavirin tablets, offers simplified dosing at two pills daily. Aim, To examine whether improved adherence was associated with RBP vs. RBV. Methods, Accurate Dosing in Hepatitis C: Examining the RibaPak Experience (ADHERE) was a U.S., multi-centre, prospective registry capturing data on adherence with RBP vs. RBV in adults with HCV. Adherence was measured by the proportion of subjects remaining on treatment at weeks 4, 12 and 24; by pill counts; and by the proportion of subjects who took ,80% of their prescribed dose. Results A total of 503 patients (RBP = 346, RBV = 157) from 33 sites were included. A greater proportion of RBV vs. RBP subjects prematurely discontinued treatment. At 12 and 24 weeks, a greater proportion of RBP vs. RBV subjects took ,80% of their prescribed doses (P < 0.05). For patients who remained on treatment, the mean milligrams missed per day was significantly greater for RBV vs. RBP at 24 weeks. Conclusions, First line treatment with RBP may offer the best prospect for less discontinuation and improved treatment adherence. [source] Variability in non-nucleoside reverse transcriptase and protease inhibitor concentrations among HIV-infected adults in routine clinical practiceBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 5 2006José Moltó What is already known about this subject ,,The concentration of protease and non-nucleoside reverse transcriptase inhibtors in plasma has been related to both efficacy and toxicity. ,,Most antiretroviral concentration data come from selected populations of patients undergoing therapeutic drug monitoring programmes, which may overestimate interindividual variability. What this study adds ,,Our study has demonstrated the large interindividual variability in antiretroviral drug concentrations in an unselected population of patients during routine clinical practice. ,,These results may provide interesting information to clinicians for the management of antiretroviral therapy in HIV-infected patients. Aims The objective of this study was to assess interindividual variability in trough concentrations of plasma of non-nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) among HIV-infected adults in a routine outpatient setting. Methods One hundred and seventeen patients who attended our clinic for routine blood tests, and who were receiving antiretroviral therapy which included NNRTI or PI were studied. Patients were not informed that drug concentrations were going to be measured until blood sampling. The times of the last antiretroviral dose and of blood sampling were recorded. Drug concentrations were considered optimal if they were above the proposed minimum effective value. In addition, efavirenz, nevirapine and atazanavir concentrations were considered potentially toxic if they were >,4.0 mg l,1, >,6.0 mg l,1 and >,0.85 mg l,1, respectively. Results Overall, interindividual variability of NNRTI and PI concentrations in plasma was approximately 50%, and only 68.4% of the patients had drug concentrations within the proposed therapeutic range. Poor adherence explained only 35% of subtherapeutic drug concentrations. Conclusion Interindividual variability in trough concentrations of NNRTI and PI among HIV-infected adults is large in routine clinical practice, with drug concentrations being outside the therapeutic window in a significant proportion of patients. These findings provide further evidence that therapeutic drug monitoring may be useful to guide antiretroviral therapy in clinical practice. [source] Parental knowledge of topical therapies in the treatment of childhood atopic dermatitisCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2003P. E. Beattie Summary Poor adherence with therapy is a major cause of treatment failure in atopic dermatitis. Reasons given are multifactorial, and include fear of real or imaginary side-effects, under-prescribing, failure to renew prescriptions on time, lack of time, and child refusal of therapy. Most important, however, is lack of knowledge about treatment, in particular the use of topical corticosteroid (TCS) therapy. We conducted a questionnaire-based study to determine the level of use and knowledge of commonly prescribed TCS preparations amongst parents or carers of 100 children attending paediatric outpatient clinics. Weakly potent TCSs were the most commonly used (86%), but poorly understood. Only 35 (41%) who had used hydrocortisone were aware that it was weakly potent, and 44% graded it as moderately potent. Of 65 who had used the moderately potent TCS clobetasone butyrate 0.05% (Eumovate®; Glaxo Wellcome, Uxbridge, UK), 19 (29%) graded it as potent and eight (12%) as weak. Of 50 who had used betamethasone valerate 0.1% (Betnovate®; Glaxo Wellcome, Uxbridge, UK), 42% did not grade it as potent. Understanding of TCS/antimicrobial combinations was generally worse. The hydrocortisone 1%/fusidic acid 2% combination (Fucidin H®; Leo, Risborough, Bucks, UK) was graded as moderate or strong by 88% of the 74 who had used it. Over half (53%) of the 34 using the combination of clobetasone butyrate 0.05%/nystatin 100 000 i.u./g tetracycline 3% (Trimovate®; Glaxo Wellcome, Uxbridge, UK) assumed that it was a potent TCS. Forty-nine had used Fucibet® (betamethasone valerate 0.1%, fusidic acid 2%; Leo, Risborough, Bucks, UK) but 34.5% did not grade it as potent. There was poor knowledge of the strengths of some of the most commonly used TCSs, and all steroid/antimicrobial combinations were perceived as being of greater potency than the constituent steroid alone. Fusidic acid was thought to be a steroid by almost half (46.9%) of the respondents. The packaging of the different products by some pharmaceutical companies is remarkably similar and labelling contains information on the compound and percentage rather than potency of the TCS. This may be a source of confusion. We recommend that manufacturers clearly label TCS products by potency as mild, moderate, potent or very potent and that packaging is sufficiently different for each strength of TCS or emollient to avoid confusion. In order to achieve optimal topical treatment for atopic dermatitis, patients and their carers must receive adequate information and training in how and when to use topical therapies in conjunction with written care plans. [source] Adherence to pharmacotherapy in patients with alcohol and opioid dependenceADDICTION, Issue 11 2004Roger D. Weiss ABSTRACT Aims An important factor that has thus far limited the effectiveness of pharmacotherapies for patients with alcohol and opioid dependence is poor adherence to medication regimens. This paper presents a review of issues related to medication adherence in patients with these substance use disorders. Design and methods A literature review was conducted of English language publications relating to medication adherence among patients with alcohol or opioid dependence. Findings The paper places the topic in the context of adherence difficulties among patients with a variety of chronic medical and psychiatric illnesses. Difficulties measuring adherence are discussed, and strategies to improve medication adherence are reviewed. These include specific interventions that prescribing clinicians can implement in their individual meetings with patients; the use of external reinforcers, such as positive and negative contingencies, and involvement of family members or significant others; and specific prescribing and dosing practices that may improve adherence. Conclusions As the use of pharmacotherapy for substance-dependent patients increases, rigorous and innovative approaches to encourage medication adherence should be sought. [source] Insights into reasons for discontinuation according to year of starting first regimen of highly active antiretroviral therapy in a cohort of antiretroviral-naïve patientsHIV MEDICINE, Issue 2 2010P Cicconi Objectives The aim of the study was to determine whether the incidence of first-line treatment discontinuations and their causes changed according to the time of starting highly active antiretroviral therapy (HAART) in an Italian cohort. Methods We included in the study patients from the Italian COhort Naïve Antiretrovirals (ICoNA) who initiated HAART when naïve to antiretroviral therapy (ART). The endpoints were discontinuation within the first year of ,1 drug in the first HAART regimen for any reason, intolerance/toxicity, poor adherence, immunovirological/clinical failure and simplification. We investigated whether the time of starting HAART (stratified as ,early', 1997,1999; ,intermediate', 2000,2002; ,recent', 2003,2007) was associated with the probability of reaching the endpoints by a survival analysis. Results Overall, the 1-year probability of discontinuation of ,1 drug in the first regimen was 36.1%. The main causes of discontinuation were intolerance/toxicity (696 of 1189 patients; 58.5%) and poor adherence (285 of 1189 patients; 24%). The hazards for all-reason change were comparable according to calendar period [2000,2002, adjusted relative hazard (ARH) 0.82, 95% confidence interval (CI) 0.69,0.98; 2003,2007, ARH 0.94, 95% CI 0.76,1.16, vs. 1997,1999; global P -value=0.08]. Patients who started HAART during the ,recent' period were less likely to change their initial regimen because of intolerance/toxicity (ARH 0.67, 95% CI 0.51,0.89 vs. ,early' period). Patients who started in the ,intermediate' and ,recent' periods had a higher risk of discontinuation because of simplification (ARH 15.26, 95% CI 3.21,72.45, and ARH 37.97, 95% CI 7.56,190.64, vs. ,early' period, respectively). Conclusions It seems important to evaluate reason-specific trends in the incidence of discontinuation in order to better understand the determinants of changes over time. The incidence of discontinuation because of intolerance/toxicity has declined over time while simplification strategies have become more frequent in recent years. Intolerance/toxicity remains the major cause of drug discontinuation. [source] Adherence to antiretroviral therapy: are we doing enough?INTERNAL MEDICINE JOURNAL, Issue 5-6 2003T. Read Abstract Adherence to antiretroviral therapy is a powerful predictor of response to therapy. For optimal antiretroviral therapy response, individuals need to take more than 95% of their prescribed medication. The most widely used method for measuring adherence is self-report of the number of missed doses and this should be done at every clinic visit. There are several well-recognized predictors of poor adherence, such as illicit drug use, depression, limited knowledge or ambivalence about starting treatment. Adherence can be improved by addressing these issues or through other means such as pill boxes or electronic reminders. (Intern Med J 2003; 33: 254,256) [source] Healthy babies for mothers with serious mental illness: A case management framework for mental health cliniciansINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 6 2008Yvonne Hauck ABSTRACT Women with a serious mental illness (SMI), notably schizophrenia, bipolar disorder, and personality disorders are considered high risk for adverse pregnancy and birth outcomes, which in turn, are associated with poor neurodevelopment in the child. Failure to access antenatal care, poor adherence with folate supplementation, an unhealthy lifestyle, and inappropriate health decisions can contribute to poor outcomes. Many women with SMI continue contact with mental health services while pregnant. This primary prevention project aimed to develop a framework for community mental health clinicians to improve the reproductive health outcomes for women with SMI. The consultation process involved discussions with key stakeholders, an environmental scan to determine current service delivery issues, a literature review, and individual and group interviews with community mental health clinicians, consumers, general practitioners, and midwives. Three key elements underpin the framework: early detection and monitoring of pregnancy, providing reproductive choices, and implementing a ,small known team approach' in the management of the pregnant client. Specific modules within the framework focus upon establishing a professional support network, assessing the risk of pregnancy, the early detection of pregnancy, monitoring during pregnancy, preparing for birth, and planning for the postnatal period. Implementation of the framework has the potential to significantly improve obstetric and neonatal outcomes for this high-risk group. [source] Bioactive and mechanically strong Bioglass®-poly(D,L -lactic acid) composite coatings on surgical suturesJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2006Q. Z. Chen Abstract New coating processes have been investigated for degradable (Vicryl®) and nondegradable (Mersilk®) sutures with the aim to develop Bioglass® coated polymer fibers for wound healing and tissue engineering scaffold applications. First, the aqueous phase of a Bioglass® particle slurry was replaced with a poly(D,L -lactic acid) (PDLLA) polymer dissolved in solvent dimethyle carbonate (DMC) to act as third phase. SEM observations indicated that this alteration significantly improved the homogeneity of the coatings. Second, a new coating strategy involving two steps was developed: the sutures were first coated with a Bioglass®,PDLLA composite film followed by a second PDLLA coating. This two-step process of coating has addressed the problem of poor adherence of Bioglass® particles on suture surfaces. The coated sutures were knotted to determine qualitatively the mechanical integrity of the coatings. The results indicated that adhesion strength of coatings obtained by the two-step method was remarkably enhanced. A comparative assessment of the bioactivity of one-step and two-step produced coatings was carried out in vitro using acellular simulated body fluid (SBF) for up to 28 days. Coatings produced by the two-step process were found to have similar bioactivity as the one-step produced coatings. The novel Bioglass®/PDLLA/Vicryl® and Bioglass®/PDLLA/Mersilk® composite sutures are promising bioactive materials for wound healing and tissue engineering applications. © 2005 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2006 [source] A systematic review of the efficacy of non-pharmacological treatments for depression on glycaemic control in type 2 diabeticsJOURNAL OF CLINICAL NURSING, Issue 19 2008Mei-Yeh Wang Aims and objectives., This paper reported a systematic review of three randomised controlled clinical trials evaluating the efficacy of non-pharmacological treatment of depression on glycaemic control in individuals with type 2 diabetes. Background., Depression is associated with poor adherence to self-care regimen in individuals with diabetes. A significant relationship between depression and poor glycaemic control has also been suggested. Hence, the management of depression becomes an important aspect of diabetes care. Design., Systematic review. Methods., Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words , depression, mood disorder, depressive symptoms, diabetes mellitus, glycaemic control, glycated haemoglobin, glucose, psychological therapy, psychotherapy, non-pharmacological therapy and cognitive behaviour therapy. The publication date was limited from 1996,2007. Studies were selected if they used a randomised controlled trial design, were written in English, used non-pharmacological treatments for treating depression, included individuals with type 2 diabetes mellitus as participants and included depressive symptoms and glycaemic control (determined by haemoglobin A1C) as outcomes. Results., Non-pharmacological treatments of depression reduce depressive symptoms in diabetic patients. However, cognitive behaviour therapy did not improve glycaemic control. The treatment effect sizes for glycaemic control in the two collaborative-care programmes were also small. Conclusions., The available evidence indicated that non-pharmacological treatment of depression had limited effect on glycaemic control in individuals with type 2 diabetes. Relevance to clinical practice., The depression-focused interventions might not achieve optimal diabetes-related outcomes. The beneficial effect of psychological treatment for glycaemic control may be strengthened by employing treatments tailored to each individual's diabetes self-care needs in addition to depression management. [source] Older patients with chronic heart failure within Swedish community health care: a record review of nursing assessments and interventionsJOURNAL OF CLINICAL NURSING, Issue 1 2004Anna Ehrenberg PhD Background., Older patients with chronic heart failure constitute a large group within community home care that is at high risk for re-hospitalization. However, hospital readmission can be prevented if early signs of deterioration are recognized and proper interventions applied. Aims and objectives., The aim of the study was to audit nursing care for older chronic heart failure patients within the Swedish community health care system. Design., The study adopted a retrospective descriptive design. Methods., In a Swedish urban municipality nursing documentation from 161 records on patients diagnosed with chronic heart failure was collected retrospectively from community nursing home care units. Patient records were reviewed for characteristics of nursing care and assessed for comprehensiveness in recording. Results., The main results showed that medical care of patients with chronic heart failure was poorly recorded, making it possible only to follow fragments of the care process. The nursing notes showed poor adherence to current clinical guidelines. Only 12% of the records contained notes on patients' body weight and only 4% noted patients' knowledge about chronic heart failure. When interventions did occur, they largely consisted of drug administration. Conclusions., The findings revealed flaws in the recording of specific assessment and interventions as well as poor adherence to current international clinical guidelines. Relevance to clinical practice., Supportive guidelines available at the point of care are needed to enhance proper community-based home health care for older patients with chronic heart failure. [source] Many asthma patients experience persistent symptoms despite appropriate clinical and guideline-based treatment with inhaled corticosteroidsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2007Joan Mogil MSN, NP-C (Nurse Practitioner) Abstract Purpose: To review possible reasons for persistence of asthma symptoms despite appropriate use of clinical and guideline-based treatments, including the use of inhaled corticosteroids. Data sources: Review of the worldwide scientific literature on factors related to persistent symptoms in patients with asthma. Conclusions: Patients with asthma may not respond as expected to therapy because of factors that include poor adherence, improper inhaler technique, persistent exposure to symptom triggers, and limitations of current standard therapy, including steroid insensitivity or the steroid plateau effect. Persistent symptoms may also be associated with IgE-mediated airway inflammation, as current standard asthma therapies do not directly address the IgE-mediated component of the inflammatory cascade. Asthma is a complex disease and its treatment requires the full cooperation and participation of the patient. Implications for practice: Healthcare professionals can play a key role by educating patients and their family members about the nature of asthma and rationale for treatment, supporting the importance of strict adherence to prevention measures and the prescribed treatment regimen. [source] Adherence to treatment in patients with psoriasisJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2006HL Richards Abstract Non-adherence to medication is a chronic problem that impacts on healthcare professionals and patients alike. In psoriasis, a condition that presents patients with frequent and disabling physical, psychological and social effects, studies consistently suggest that up to 40% of patients do not use their medication as directed. Thus it is probable that poor adherence contaminates the clinical picture of response effectiveness in everyday practice. This educational paper reviews research that investigates adherence to medication in patients with psoriasis. It provides an overview of contributing factors and mediating variables. It is proposed that three specific facets appear to optimize patient adherence: an effective doctor,patient relationship; optimism with the treatment prescribed; and a limited ,nuisance' value of treatment in terms of side-effects and hassle of use. Various strategies to address adherence are suggested and it is argued that in order to enhance our understanding of adherence in patients with psoriasis, there needs to be an increasing focus on patients' beliefs about their condition and its management. [source] Anti-tissue transglutaminase antibodies in the follow-up of adult coeliac diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009C. R. DIPPER Summary Background, The detection of auto antibodies directed against tissue transglutaminase (anti-tTG antibodies) has a well-established role in the diagnosis of coeliac disease, but the value of these antibodies in long-term follow-up is controversial. Aims, To determine if serial anti-tTG antibody measurements could confirm adherence to a gluten-free diet (GFD) and identify patients at risk of disease complications. Methods, In a 54-month cohort follow-up study, 182 adult patients were assessed. Data recorded included self-assessment of GFD adherence; anti-tTG antibody concentration and serum ferritin, vitamin B12 and folate. Where available, bone mineral density (BMD) and duodenal histology data were retrieved. Results, Persistently elevated anti-tTG antibody levels were significantly associated with abnormal duodenal histology (P < 0.001), low ferritin (P < 0.01) and poor adherence to the GFD (P < 0.001). The specificity was >85% while the sensitivity was 39,60%. Anti-tTG antibody concentrations fell rapidly following successful initiation of a GFD, and maintenance of normalization identified those who continued to be adherent to the diet. Conclusions, This study supports a strategy of using anti-tTG antibody concentrations to monitor newly diagnosed and established patients with coeliac disease, and to target dietetic intervention to reduce the risk of complication. [source] Adherence to recommendations for primary prevention of atopic disease in neonatology clinical practicePEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2010Annalisa Passariello Passariello A, Terrin G, Baldassarre ME, Bisceglia M, Ruotolo S, Berni Canani R. Adherence to recommendations for primary prevention of atopic disease in neonatology clinical practice. Pediatr Allergy Immunol 2010: 21: 889,891. © 2010 John Wiley & Sons A/S The prevalence and severity of atopic manifestations in children are increasing in western countries in the last decades. Specific nutritional intervention may prevent or delay the onset of atopic diseases in infants at high risk of developing allergy. These nutritional interventions should be applied early in the perinatal period to have a chance of success. Thus, we assessed adherence to the dietary management recommendations of the Committee on Nutrition and Section on Allergy and Immunology of the American Academy of Pediatrics (AAP) for the prevention of atopic diseases in neonatal age through an audit study. Questionnaire was administered to the chiefs of 30 maternity units (MU) with more than 1500 live births/yr to report the policy applied in their MU. Twenty-two MU returned the questionnaire. Identification of high-risk newborns was routinely performed only in 7/22 MU (31.8%). High-risk newborns were identified by the presence of at least two or one first-degree relative (parent or sibling) with documented allergic disease by 18.2% and 45.5% of MU, respectively. Specific maternal dietary restrictions during lactation were adopted in 7/22 MU (31.8%). Extensively or partially hydrolyzed formula was prescribed for bottle-fed high-risk infants in 22.7% of MU. Only 2/22 MU have a policy in complete agreement with the nutritional intervention proposed by the AAP. Our study suggest a poor adherence to dietary recommendations for primary prevention of atopic disease in neonatology clinical practice. Further efforts should be planned to improve the knowledge and the application of these preventive strategies. [source] Maturity and adherence in adolescent and young adult heart recipientsPEDIATRIC TRANSPLANTATION, Issue 3 2006Carol S. Stilley Abstract: Background: Pediatric transplant (txp) teams note high rates of non-adherence and risky behaviors linked to morbidity and mortality among adolescent and young adult recipients. Clinicians and parents alike report symptoms of social immaturity and failure to appreciate consequences of risky behavior; relationships between the two have not been studied in this population. Method: This two-phase mixed method study examined adherence, high-risk behaviors, and maturity in a sample of 27 heart recipients, aged 15,31, who underwent transplantation in childhood or adolescence at Children's Hospital of Pittsburgh. All subjects completed a projective ego development measure and a questionnaire about adherence to the post-txp regimen. Nine recipients, purposely selected for good or poor adherence according to criteria determined by the transplant team and matched on age, participated in phase 2 qualitative interviews and mood assessments. Results: Sixty-three percent of the phase 1 sample missed medications, 67% missed appointments, 11% smoked, 37% had difficulty with diet, 89% exercised infrequently, 33% had tattoos, 26% had more than two body piercings, and 11% used street drugs. Six themes and a core construct of maturity were identified with qualitative methodology. Poor adherers were less mature on every theme and consistently scored at a less mature level on the projective measure of ego development. Chronological age was not related to the level of maturity in qualitative or projective data. Most interview subjects reported high levels of anxiety, and two reported clinically significant levels of depression and anger; mood was not related to adherence. Conclusions: Non-adherence and high-risk behaviors are prevalent among adolescent and young adult heart recipients. Level of maturity appears to be associated with ability to adhere to the treatment regimen and avoid high-risk behaviors. [source] Valorization of poly(butylene terephthalate) wastes by blending with virgin polypropylene: Effect of the composition and the compatibilizationPOLYMER ENGINEERING & SCIENCE, Issue 8 2008Najoua Barhoumi Blends of recycled poly(butylene terephthalate) (PBT) parts obtained from scrapped cars, and virgin polypropylene (PP), were prepared in a twin-screw extruder at different compositions. Selected compositions were also prepared with the presence of ethylene- co -glycidyl methacrylate copolymer (E-GMA) and ethylene/methyl acrylate/glycidyl methacrylate terpolymer (E-MA-GMA) compatibilizers. The effect of the composition and the type of compatibilizer, as well as the mixing conditions, on the morphology phase, thermal, viscoelastic behavior, and mechanical properties of the blends has been investigated. Blends PP/PBT of various composition exhibit a coarse morphology and a poor adherence between both phases, resulting in the decrease of ductility, whereas at weak deformation, PBT reinforced the tensile properties of PP. Addition of E-GMA and E-MA-GMA to the PP/PBT blend exhibited a significant change in morphology and improved ductility because of interfacial reactions between PBT end chains and epoxy groups of GMA that generate EG- g -PBT copolymer. Moreover, thermal and viscoelastic study indicated that the miscibility of PP and PBT has been improved further and the reactions were identified. The E-MA-GMA results in the best improvement of ductility. POLYM. ENG. SCI., 2008. © 2008 Society of Plastics Engineers [source] Latest news and product developmentsPRESCRIBER, Issue 12 2008Article first published online: 14 JUL 200 Patients want to stop ,Z' drugs more than benzos A study from Lincolnshire has revealed that patients prescribed a ,Z' drug - zaleplon (Sonata), zolpidem or zopiclone - for insomnia are more likely to want to stop treatment than those prescribed a benzodiazepine (Br J Gen Pract 2008;58:417-22). The cross-sectional survey of 705 patients prescribed a hypnotic for insomnia found that more patients taking a Z drug wanted to stop (23 vs 12 per cent prescribed a benzodiazepine) and tried to stop treatment (52 vs 41 per cent). New NICE guidance NICE has published an updated clinical guideline for the management of type 2 diabetes, covering: the control of blood glucose with lifestyle modification, oral hypoglycaemic drugs and insulin; reducing blood pressure and lipids, antithrombotic therapy and estimating cardiovascular risk; and screening and treatment for long-term complications. There is also a new clinical guideline on cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. New technology appraisals include the use of erythropoietin analogues for cancer-associated anaemia, and adalimumab (Humira) and etanercept (Enbrel) for ankylosing spondylitis; infliximab (Remicade) is not recommended. See New from NICE (pages 13-14) for further details. Prescriber consultant editor wins award Professor Tony Avery, professor of primary care at Nottingham University and consultant editor for Prescriber, has won the John Fry Award for his work in promoting the discipline of general practice through research and publishing as a practising GP. The citation acknowledges Professor Avery as ,quite simply one of the best researchers we have had in general practice,' describing his output of original work and research as impressive. The award commemorates the work of the late Dr John Fry, perhaps the most prominent GP of his generation involved in research. Antihypertensive dose ignores adherence Clinicians take no account of poor adherence when they increase the dose of antihypertensive therapy due to apparent lack of effect, US researchers say (Circulation 2008; published online May 27; doi 10.1161/CIRCULATIONAHA.107.724104). Their retrospective analysis included reimbursement records for 38 327 patients with hypertension who presented with elevated BP (140-200/>90mmHg) in one year (mean 1.8 events per patient). After adjusting for potential confounders, they found that antihypertensive medications were added or the dose of medication increased in about one-third of patients regardless of the degree of nonadherence in the previous year. LABAs improve COPD Inhaled long-acting beta2-agonists (LABAs) improve COPD and do not increase the risk of death, a new safety review has concluded (Chest 2008;133:1079-87). The meta-analysis of 27 RCTs in patients with moderate to severe stable COPD found that LABAs reduced exacerbations by 22 per cent, improved lung function, reduced use of rescue medication and improved quality of life. There was no effect on respiratory deaths, though a combination of a LABA with an inhaled steroid reduced the risk by two-thirds compared with LABA monotherapy. Tiotropium (Spiriva) was associated with a 50 per cent lower risk of exacerbations than LABAs. These findings follow the MHRA's review of LABAs in the treatment of asthma, which found no increase in mortality provided they are used with an inhaled steroid (Drug Safety Update 2008;1:9). Naproxen as effective in acute gouty arthritis Naproxen is as effective as prednisolone in the treatment of acute gouty arthritis, say researchers from The Netherlands (Lancet 2008;371:1854-60). Their study in 118 primary care patients showed that five days' treatment with naproxen 500mg twice daily or prednisolone 35mg daily reduced pain scores to a similar extent with a comparable incidence of adverse effects. Copyright © 2008 Wiley Interface Ltd [source] Medicine taking behaviour in depression , part 1PROGRESS IN NEUROLOGY AND PSYCHIATRY, Issue 1 2009Celia Feetam MSc, MCMHP, MRPharmS In this,the first of two articles,poor adherence with antidepressant treatment and the effect on outcome are explored. The factors important in the selection of an antidepressant are also considered. In the second article, treatment variables that may affect adherence will be examined alongside various interventions that have been proposed to improve medicine taking behaviour in patients with depression. Copyright © 2009 Wiley Interface Ltd [source] Treatment adherence with antipsychotic medications in bipolar disorderBIPOLAR DISORDERS, Issue 3 2006Martha Sajatovic Objectives:, Atypical antipsychotic medications are a relatively new, increasingly prominent component of the treatment armamentarium for bipolar disorder. Information on adherence with antipsychotics among individuals with bipolar disorder in general, and atypical antipsychotics in particular, is currently quite limited. Using data from the VA National Psychosis Registry, we examined adherence with antipsychotic medications among patients with bipolar disorder (n = 73,964). Methods:, Antipsychotic medication adherence among veterans with bipolar disorder was evaluated using the medication possession ratio and categorizing patients into three groups: fully adherent, partially adherent and non-adherent. We compared characteristics of bipolar patients who received versus those who did not receive antipsychotic medication, and also identified predictors of poor adherence with antipsychotic medications. Results:, Approximately 45% (n = 32,993) of all individuals with bipolar disorder were prescribed antipsychotic medication. Individuals who were prescribed antipsychotic medications were younger and more often had comorbid substance abuse or post-traumatic stress disorder compared to individuals with bipolar disorder who were not prescribed antipsychotic medication. Just over half (51.9%) of individuals appear to be fully adherent with antipsychotic medications, while 48.1% of individuals are either partially adherent or non-adherent with antipsychotic medications. Factors associated with treatment non-adherence were younger age, minority ethnicity, comorbid substance abuse and homelessness. Conclusions:, Treatment non-adherence is a major issue for close to half of individuals with bipolar disorder prescribed antipsychotic medication. Additional studies are needed to better understand treatment adherence within the full range of pharmacologic therapies among individuals with bipolar disorder. [source] PERSONAL DIGITAL VIDEO: A METHOD TO MONITOR DRUG REGIMEN ADHERENCE DURING HUMAN CLINICAL INVESTIGATIONSCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 12 2006Chad C Carroll SUMMARY 1Maintaining patient adherence to a drug regimen has proven to be difficult. Missed doses can impact drug efficacy and disease control, leading to increased health-care costs. 2During clinical drug trials, poor adherence could lead to false conclusions regarding drug efficacy. Therefore, the purpose of the present study was to determine the feasibility of using personal digital video cameras to monitor adherence to a medication regimen during a clinical investigation. 3Older men and women (60,78 years) participated in a double-blind, placebo-controlled trial to determine the effect of ibuprofen or paracetamol on skeletal muscle adaptations to chronic resistance exercise training. Patients took three daily doses of either a placebo or the maximal daily over-the-counter dose of ibuprofen (1.2 g/day) or paracetamol (4.0 g/day) for 12 weeks. Prior to beginning the study, subjects were trained to use a personal digital video camera to record their drug consumption. 4Subjects correctly recorded 4956 of 5375 doses, resulting in an average camera compliance rate of 92% (71,100%). 5We describe a method of monitoring adherence to a prescribed drug regimen during a clinical investigation. Camera compliance rates, which directly confirm drug consumption, were higher than what is typically obtained with other methods of monitoring adherence. This camera compliance method provides the investigator with a simple and convenient means to generate direct evidence of drug consumption. [source] | ||||||||||||||||||||||||||||