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To explore individual and community factors associated with adherence to physician recommended urgent eye visits via a tele-triage system during the COVID-19 pandemic.We retrospectively reviewed acute visit requests and medical exam data between April 6, 2020 and June 6, 2020. Patient demographics and adherence to visit were examined. Census tract level community characteristics from the U.S. Census Bureau and zip code level COVID-19 related death data from the Cook County Medical Examiner's Office were appended to each geocoded patient address. Descriptive statistics, t-tests, and logistic regression analyses were performed to explore the effects of individual and community variables on adherence to visit.Of 229 patients recommended an urgent visit, 216 had matching criteria on chart review, and 192 (88.9%) adhered to their visit. No difference in adherence was found based on individual characteristics including: age (We found that as community unemployment rate increases, adherence to urgent eye visits decreases, after controlling for relevant neighborhood characteristics. Unemployment rates were highest in predominantly Black neighborhoods early in the pandemic, which may have contributed to existing racial disparities in eye care.

BACKGROUND AND AIM Existing interventions promoting positive airway pressure (PAP) adherence focus only on the diagnosed individual, despite the fact that partners are often the most impacted by obstructive sleep apnea (OSA), and are delivered mostly by health professionals, with limited success. The goal of this work is to develop a prototype of OurSleepKit, a couple-focused mobile health (mHealth) tool to coach mutual engagement and promote adherence to PAP treatment. METHODS We used an iterative participatory approach working with future end users of OurSleepKit to support the development of this prototype. We conducted a total of 14 semi-structured in-depth open-ended dyadic interviews with OSA patients and their partners. Phase 1 of the development was to inform key functions of an engaging tool. Phase 2 focused on developing functions to engage positive conversation in the dyad and obtained feedback for this initial prototype. RESULTS The OurSleepKit prototype was developed and demonstrated high acceptability and engagement. Three key functions included periodic assessments based on developmental stages of PAP treatment, a Coaching Board which provides customized and dynamically updated support content - primarily brief story-telling videos featuring real-life couples' experiences - and timely tailored prompts (for action, learning, and conversation) through push notifications in the evening to facilitate positive conversation in the dyad and offer in-the-moment support for PAP use. CONCLUSIONS Going beyond the traditional and prevailing view of PAP use as an individual phenomenon, OurSleepKit is a novel mHealth intervention engaging both the patient and partner holding great promise to promote PAP adherence.

Educational interventions have been proposed to improve continuous positive airway pressure (CPAP) adherence; however, studies to date have not demonstrated robust effectiveness, due to methodological issues. Furthermore, these educational interventions have not specifically targeted low health literacy communication techniques, which have been demonstrated to improve outcomes in numerous other chronic diseases. We hypothesized that the addition of low-cost audio-visual educational videos (EVs) to usual standard-of-care (SC) education would improve CPAP adherence in adults with obstructive sleep apnea (OSA) syndrome.At CPAP initiation, treatment-naïve adults with OSA syndrome were randomized to (1) usual SC or (2) SC + 5 EVs showing a patient's journey, designed with low health literacy communication techniques to teach patients about OSA and CPAP therapy. The primary endpoint was CPAP usage at 2 months (hours/night) and secondary endpoints were CPAP usage at 12 months and percentage of patients with ≥ 4 hours/night use at 2 months and 12 months.One hundred and ninety-five patients were randomized (SC 99, EV 96), with a mean age of 57 years (interquartile range [IQR] 44.1-64.8 years). There were no statistically significant differences in patient characteristics at baseline between the SC vs EV groups, with the diagnostic apnea-hypopnea index of 34 events/h (IQR 21-59 events/h) vs 30 events/h (IQR 20-50 events/h) and Epworth Sleepiness Scale score of 12.8 ± 6 vs 11.7 ± 5. At 2 months, there was no significant difference in hours of CPAP usage (SC: 3.45 hours/night [95% confidence interval (CI): 2.76 to 4.13] vs EV: 3.75 hours/night [95% CI: 3.14 to 4.37]) nor in proportion with adequate usage or overall commencement rate. However, at 12 months, there was a significant difference in hours of CPAP usage (SC: 2.50 hours/night [95% CI: 1.94 to 3.06] vs EV: 3.66 hours/night [95% CI: 2.92 to 4.40]). The probability of adequate CPAP usage at 12 months was higher in the intervention arm (odds ratio: 1.33; 95% CI: 1.04 to 1.7;Low health literacy-designed EVs improve CPAP adherence at 12 months compared with SC, with the greatest impact in patients with a low educational background.Registry: Australian New Zealand Clinical Trials Registry; Name: Randomised controlled trial on the efficacy of audio-visual health educational materials on sleep health literacy and continuous positive airway pressure (CPAP) adherence in Sleep Clinic patients; URL: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619000523101; Identifier: ACTRN12619000523101.Ellender CM, Samaranayake C, Reid N, et al. Randomized controlled trial on the efficacy of audio-visual health educational materials on CPAP adherence: the AHEAD trial.

About half of continuous positive airway pressure (CPAP)-treated patients are adherent, substantially affecting efficacy. A limitation to understanding predictors of adherence is the lack of a singular definition. Univariate analyses have suggested an array of factors that are statistically significant and reflect disease pathophysiology, clinical features, demographic characteristics, device-related variables, and psychological factors, but whether differences are clinically meaningful is unclear. There have been limited applications of multiple regression to compare the relative influence of multiple variables. This review article considers categories of variables that have been explored and suggests those that may be labeled "best" predictors in understanding CPAP use.

Introduction Iron chelation therapy (ICT) is essential to prevent complications of iron overload in patients with transfusion-dependent thalassaemia. However, there is currently no standard for how to best measure adherence to ICT, nor what level of adherence necessitates concern for poor outcomes, especially in paediatric patients. The objectives of this review are to identify rates of adherence to ICT, predictors of adherence, methods of measurement, and adherence-related health outcomes in children and adolescents. Methods This review covers the literature published between 1980 and 2020 on ICT in thalassaemia that assessed adherence or compliance. Included studies reflect original research. The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and the findings were critically appraised with the Oxford Centre for Evidence-based Medicine criteria. Results Of the 543 articles, 37 met the inclusion criteria. The most common methods of assessing adherence included patient self-report (n = 15/36, 41.7%), and pill count (n = 15/36, 41.7%), followed by subcutaneous medication monitoring (5/36, 13.8%) and prescription refills (n = 4/36, 11.1%). Study sizes ranged from 7 to 1115 participants. Studies reported adherence either in “categories” with different levels of adherence (n = 29) or “quantitatively” as a percentage of medication taken out of those prescribed (n = 7). Quantitatively, the percentage of adherence varied from 57% to 98.4% with a median of 89.5%. Five studies focussed on interventions, four of which were designed to improve adherence. Studies varied in sample size and methods of assessment, which prohibited performing a meta-analysis. Conclusions Due to a lack of clinical consensus on how adherence is defined, it is difficult to compare adherence to ICT in different studies. Future studies should be aimed at creating guidelines for assessing adherence and identifying suboptimal adherence. These future efforts will be crucial in informing evidence-based interventions to improve adherence and health outcomes in thalassaemia patients.Key messagesPredictive factors associated with ICT adherence in the paediatric population include age, social perception of ICT, social support, and side effects/discomfort.Increased adherence in the paediatric population is associated with decreased serum ferritin and improved cardiac, hepatic, and endocrine outcomes.Inadequate adherence to ICT is associated with increased lifetime health costs.There are few studies that focussed on interventions to increase adherence in the paediatric population, and the studies that do exist all focussed on different types of interventions; successful interventions focussed on consistent, long-term engagement with patients.

To assess the relationship between sociodemographic factors and adherence rates in patients with a BI-RADS 3 assessment.This retrospective cohort study reviewed data from all patients with a BI-RADS 3 assessment on mammography and ultrasound examinations at a single, multisite academic institution, which serves a diverse urban-suburban population, from January 1, 2015, to December 13, 2017. Appropriate follow-up was defined as returning for the first follow-up examination 3 to 9 months after the index examination. Associations between BI-RADS 3 adherence rates and patient sociodemographic characteristics were evaluated using logistic regression.There were 4,038 patients in our study period; 2,437 patients (60%) had appropriate follow-up, 765 (19%) patients had delayed follow-up, and 836 patients (21%) were lost to follow-up. The overall malignancy rate was 1.4% (46 of 3,202). Older age, retired employment status, and Medicare insurance status were associated with increased adherence to BI-RADS 3 follow-up recommendations. Black race, single relationship status, Medicaid and self-pay insurance status, and living in a top 15% disadvantaged zip code were associated with decreased adherence. On multivariate analysis, older age remained associated with increased adherence and Medicaid insurance status with decreased adherence. Time between index examination and cancer diagnosis was shorter in patients who had timely follow-up (202 days [interquartile range 183-358] versus 392 days [interquartile range 365-563], P ≤ .001), although there was not a significant difference in stage at diagnosis (P = .46).Multiple sociodemographic factors are associated with low adherence to BI-RADS 3 follow-up recommendations suggesting that more frequent and targeted interventions are needed to close disparity gaps.

Obstructive sleep apnea (OSA) is underdiagnosed and undertreated among patients hospitalized with comorbid cardiovascular disease (CVD). Treatment of OSA may reduce health care utilization, but benefits of continuous positive airway pressure (CPAP) therapy are related to adherence. Benefits of CPAP among hospitalized individuals with OSA and CVD have not been well studied. We evaluated the effect of CPAP adherence on 30-day hospital readmission among Medicare beneficiaries hospitalized with OSA and CVD.We conducted a retrospective cohort study of Medicare beneficiaries aged ≥ 65 years with pre-existing CVD who were newly diagnosed with OSA between 2009 and 2013, initiated CPAP, and were hospitalized. CPAP adherence was defined as nonadherent, partially adherent, or highly adherent based on the number of machine charges (4, 4-12, and12, respectively) over 25 months of follow-up. The primary outcome was 30-day hospital readmission.Among 1,301 beneficiaries meeting study criteria, the 30-day readmission rate was 10.2%. In adjusted models and compared to patients with low CPAP adherence, those with high adherence had lower odds of 30-day readmission (odds ratio 0.41; 95% confidence interval 0.24-0.70). The protective effect of high CPAP adherence on 30-day readmission was significant among beneficiaries with heart failure (odds ratio 0.50; 95% confidence interval 0.16, 0.79), but not among those with other CVD.In this nationally representative sample of older adults with CVD and comorbid OSA, high CPAP adherence was associated with lower odds of 30-day readmission. These results highlight the importance of screening for and treating OSA among individuals with CVD.Bailey MD, Wickwire EM, Somers VK, Albrecht JS. Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission among older adults with comorbid obstructive sleep apnea and cardiovascular disease.

High-frequency monitoring of psychological variables has been recommended to monitor and manage psychotherapeutic processes. However, high-frequency monitoring might be regarded as burdensome for participating patients. This feasibility study applied the concept of high-frequency treatment monitoring in patients with seizures and psychiatric comorbidities in an outpatient neurology service. The treatment monitoring entailed the development of a personalized process questionnaire, daily online monitoring, and regular reflection of the current time series graphs. Participants' feedback on user-friendliness and usefulness of this treatment monitoring was evaluated quantitatively and qualitatively. Participants' compliance rates (CRs) of daily self-assessments after 6 months were correlated with their quantitative feedback on user-friendliness and usefulness and the number of scheduled treatment sessions during this time period. Twenty patients, 15 women/5 men, median age 48 years (range: 23-73 years), were recruited. The median number of scheduled sessions was 11 sessions (range: 6-22). Participants reported a high overall satisfaction with the user-friendliness and usefulness of treatment monitoring. No notable correlations could be found between CRs and quantitative feedback nor between CRs and the number of scheduled treatment sessions. Personalized high-frequency monitoring of psychological variables seems to be feasible to monitor and manage process-oriented psychotherapeutic care in patients with seizures and psychiatric comorbidities. The results support the user-friendliness and usefulness of high-frequency monitoring and suggest that high-frequency monitoring may be suitable for monitoring of low-frequent treatment sessions and patients with attendance issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Although data are limited, studies suggest on average lower positive airway pressure use in Black, indigenous, and people of color (BIPOC) compared with Whites in most but not all studies. Most of these observational studies are certainly limited by confounding by socioeconomic status and other unmeasured factors that likely contribute to differences. The etiology of these observed disparities is likely multifactorial, due in part to financial limitations, differences in sleep opportunity, poor sleep quality due to environmental disruptions, and so forth. These disparities in sleep health are likely related to chronic inequities, including experiences of racism, neighborhood features, structural, and contextual factors. Dedicated studies focusing on understanding adherence in BIPOC are lacking. Further research is needed to understand determinants of PAP use in BIPOC subjects and identify feasible interventions to improve sleep health and reduce sleep apnea treatment disparities.

Significance: Frequent and effective patient-practitioner communication is essential to ensure instructions regarding contact lens use, care and maintenance are understood and followed. Given the relevance of good patient compliance, the responsibility of practitioners to provide adequate information may not be neglected. Purpose: To determine the content and type of information Licensed Optometrists in Spain provide their patients during the first contact lens fitting and at follow-up visits. Methods: A self-reported ad hoc survey was distributed to Licensed Optometrists in Spain to investigate, amongst other factors, whether practitioners provided information on several aspects of contact lens use and maintenance, how was this information provided and whether in-office practical demonstrations were conducted at all contact lens appointments. Results: Respondents of 321 surveys had a median of 20 years of contact lens fitting experience and worked on independent practices (67.6%), national (29.0%) and regional chains (3.4%). Type of practice influenced continuous education habits (P = .03). Overall, 28.0% of participants did not always instruct patients on the need to rub contact lenses, 34.3% did not always address contact lens replacement and 6.8% did not always explain storage case hygiene and replacement. At the follow-up visit, only 8.4% of respondents asked their patients to demonstrate their care routines. Information was mostly oral (48.6%) or oral and written (43.0%). Contact lens-related complications were reported more frequently by participants with less continuous education training (P = .01), by those not always recommending rubbing (P = .002) and by those not providing written information about storage case hygiene and replacement (P = .002). Conclusion: Patient-practitioner communication was good, albeit several areas were identified were information was insufficient or not provided in a correct and timely format. Precise, written information on rubbing and storage case hygiene and replacement may improve compliance and assist in avoiding complications and drop-out.

Restriction of mouth opening (RMO) is a common manifestation of head and neck cancer (HNC) and a poor prognostic factor following concurrent chemoradiotherapy (CCRT) of patients. This study aimed to explore whether the Mallampati score, a visual assessment of the distance from the tongue base to the roof of the mouth, can be used as a surrogate for RMO in predicting treatment outcomes in patients with HNC undergoing CCRT.A total of 461 consecutive patients who received definitive CCRT for the treatment of locally advanced HNC between August 2016 and December 2017 at Chang Gung Memorial Hospital in Taiwan (Linkou, Keelung, and Kaohsiung branches) were enrolled in this prospective study. Patients were allocated by the pre-treatment Mallampati score of 1 or 2 (n=24) vs. 3 or 4 (n=207) to compare treatment compliance and treatment-related complications.Patients in the Mallampati score of 3 or 4 group had a higher prevalence of betel quid chewing, oral cavity and oropharynx cancers, advanced tumor stage, poorer performance status, and were more likely to receive platinum monotherapy during CCRT. Patients in the Mallampati score of 3 or 4 group had a 2.08-fold (p=0.002) hazard ratio (HR) for overall survival compared to those in the score of 1 or 2 group in the univariate analysis, the difference remained significant in multivariate analysis (adjusted HR=1.61; 95% CI=1.02-2.61; p=0.047). Patients in the Mallampati score 3 or 4 group had a 2.36-fold (95% CI=1.07-5.19; p=0.033) increased likelihood of incomplete chemotherapy, 2.44-fold (95% CI=1.17-5.06; p=0.017) increased likelihood of incomplete radiotherapy, and 1.84-fold (95% CI=1.18-2.87; p=0.007) risk of unexpected hospitalization compared to those with a Mallampati score of 1 or 2 in multivariate analysis.Patients with HNC with higher pre-treatment Mallampati scores had poorer survival outcomes and were at a higher risk of treatment incompletion and treatment-related toxicities when undergoing CCRT. Our results support the utility of Mallampati score as a surrogate for measuring RMO to predict survival outcomes, treatment compliance, and safety profiles in patients with HNC undergoing CCRT.

Aims: This study was carried out to investigate fear levels, treatment compliance, and metabolic control of type II Diabetes Mellitus patients during the COVID-19 pandemic.Methods: The study employed a single-center, observational design and was conducted between January and April 2021. The study consisted of 303 patients who attended the internal medicine outpatient clinic of a uni-versity hospital in Turkey. For data collection, the Patient Identification Form, COVID-19 Fear Scale, and the Type II Diabetes Treatment Compliance Scale were used. The study complied with the Helsinki Declaration criteria. IBM SPSS v25.0 statistics package program was used for data analysis.Results: The mean age of the patients was 45.8 +/- 7.5 years, the mean duration of illness was 8.2 +/- 3.6 years. Moreover, 40.6% of patients presented with poor levels of treatment compliance. In addition, the mean FCV-19S score of the patients was 29.1 +/- 3.05. It was noticeable that those with high mean scores of FCV-19S had poor compliance with treatment and metabolic control during the pandemic (p < 0.05). Practice implications: Fear of COVID-19 negatively affects treatment compliance and metabolic control of type II diabetes patients. The patients avoided attending their regular follow-ups at the hospital due to fear of con-tracting COVID-19. In order to reduce the fear of COVID-19 it is paramount to maintain optimum metabolic control and treatment compliance.

BACKGROUND: Good adherence is essential in the treatment of TB. The aim of this study was to describe medication consumption patterns and to assess factors associated with adherence to TB treatment among TB patients in Lomé, Togo.METHODS: A cross-sectional study was conducted among TB patients in 10 health structures in Lomé from September 2019 to January 2020. TB patients aged ≥18 years and under treatment for at least 2 months were eligible for this study. Adherence to TB treatment was assessed using the Girerd compliance test.RESULTS: A total of 195 TB patients (61.5% male) with a median age of 35 years (IQR 27–44) were recruited. TB-HIV coinfection was 11.3%. Polypharmacy (≥5 medications/day) and using medicinal plants were observed in respectively 6.2% and 42.6% of patients. Prevalence of TB treatment adherence problems was 68.2% (95% CI 61.2–74.7). Being P = 0.005) and taking medicinal plants (aOR 4.31; P < 0.001) were associated with TB treatment adherence problems.CONCLUSION: Treatment adherence problems, a major obstacle to TB elimination, are highly prevalent in TB patients in Lomé, and were associated with the use of medicinal plants. Reasons for the use of medicinal plants should be documented in order to propose appropriate interventions to reinforce adherence to TB treatment.

This paper explores patient use of excuses to better understand the patient experience during clinical interactions.A content analysis of 32 residents treating 99 different patients was used to reveal accounts of nonadherence. Using grounded theory, these accounts were coded into types and then reduced using a Q-sort.Analysis revealed 163 accounts of nonadherence. When questioned about their adherence to treatment, 68% of patients offered at least one account for nonadherence during the visit. These accounts were coded into fourteen types and then the Q-sort identified four types of accounts: healthcare system failures, treatment failure, situational exigencies, and self-directed. Of the accounts offered, 7% of the patients provided 6 or more accounts and 25% provided between 3 and 5 accounts.The examination of excuses provides a unique way to gain insight into how patients communicate with their physicians. Patient accounts ranged from those where patients indicated adherence was within their control (self-directed) and accounts outside their control (healthcare system failure, treatment failure, and situational exigency).The types of accounts of nonadherence patients could provide doctors insight into the patient experience. Recognizing these types could allow opportunities for doctors to develop communication strategies for encouraging patient adherence.

Resumo Introdução A doença renal crônica apresenta-se como um problema de saúde pública por causa de sua prevalência, dos custos envolvidos no tratamento e da alta taxa de morbimortalidade. Objetivo Avaliar a não adesão ao regime terapêutico de pacientes em hemodiálise e fatores associados. Método Estudo transversal com pacientes que realizam hemodiálise em um hospital universitário e duas clínicas privadas conveniadas ao Sistema Único de Saúde. Padrões para avaliação da não adesão ao regime terapêutico hemodialítico tiveram como base os indicadores estabelecidos pelo The Dialysis Outcomes and Practice Patterns Study: restrição hídrica, regime dietético, regime medicamentoso e terapia hemodialítica. Não conformidade em pelo menos um dos aspectos do tratamento foi considerada não aderência à terapêutica. Resultados Indivíduos com idade inferior a 60 anos tiveram maior probabilidade de não aderir à restrição hídrica, à terapêutica e aos regimes dietético e medicamentoso. Pacientes anúricos tiveram maior chance de não adesão à restrição hídrica e à terapêutica. Indivíduos com hipoalbuminemia e hipoemoglobinemia tiveram maior probabilidade de não aderir à restrição hídrica, enquanto pacientes que se autodeclararam não brancos apresentaram maior chance de não aderir à terapêutica. Nenhuma variável explicativa da adesão à terapia hemodialítica se manteve significativa no modelo final da regressão logística. Conclusão A inconformidade relacionada aos aspectos do tratamento pode resultar em aumento de hospitalização e gastos com saúde, piora do estado clínico, maiores intercorrências no tratamento e aumento da taxa de mortalidade. Abstract Background Chronic kidney disease presents itself as a public health problem because of its prevalence, the costs involved in treatment and the high rate of morbidity and mortality. Objective To evaluate non-adherence to the therapeutic regimen of hemodialysis patients and associated factors. Method A cross-sectional study with patients undergoing hemodialysis at a University Hospital and two private clinics agreed to the Unified Health System. Standards for non-adherence to the hemodialysis regimen were based on indicators established by The Dialysis Outcomes and Practice Patterns Study: water restrictions, dietary, drug regimen, and hemodialysis therapy. Non-compliance in at least one aspect of treatment was considered non-adherence to therapy. Results Individuals younger than 60 years were more likely to be non-adherent to water restriction, dietary and drug regimens, and therapy. Anuric patients were more likely to be non-adherent to water restriction and therapy. Individuals with hypoalbuminemia and hypohemoglobinemia were more likely not to adhere to water restriction, while patients who self-declared themselves to be non-whites had a higher chance of not adhering to therapy. No explanatory variables of adherence to hemodialysis therapy remained significant in the final logistic regression model. Conclusion Non-conformity related to treatment aspects can result in increased hospitalization and health expenses, worsening of clinical status, greater intercurrences in treatment and increase in mortality rate.

Nonadherence to recommended health behaviors reportedly correlates with the prevalence and health outcomes of COPD, but the factors contributing to multiple health promotions are not well understood.To examine the factors associated with nonadherence to health behaviors, specifically focusing on COPD severity.We conducted a secondary data analysis with data from the 2016-2019 Korea National Health and Nutrition Examination Survey. The analyzed data were from 1,627 individuals aged over 40 years who had a FEV1/FVC ratio70% measured via spirometer. In this study, nonadherence to health behaviors is the sum of seven health-promoting behaviors in terms of smoking cessation, alcohol abstinence, regular exercise, weight control, recommended sleep time, influenza vaccination, and medical check-up.COPD patients' nonadherence to health behaviors was significantly associated with comorbidity (p=0.017), stress (p=0.002), and COPD severity (moderate, severe; p=0.010, p=0.039, respectively). In addition, the moderate and severe COPD groups showed a higher nonadherence rate than the mild COPD group. Specifically, nonadherence to weight control was the most significantly different behavior according to COPD severity levels, based on the GOLD classification of airflow limitation.Our study findings support that those with higher levels of stress, comorbidities, and severe disease conditions are less likely to adhere to health behaviors. Thus, healthcare providers and policymakers should provide tailored approaches according to COPD severity to educate and support appropriate health behaviors for individuals with COPD.

Nonsurgical cosmetic treatments have significantly increased over the last decade. Therefore, this study aims to review the features that should be considered in orofacial esthetic procedures, thorough of a proposal of a new concept called the tissue mimicry concept (MIMT concept) and filling techniques. The MIMT concept described in this article comprises knowledge about anatomy of the face and associated structures, understanding of aging and how this process affects the facial tissues interactions (skin, subcutaneous tissues, muscles, and bones), interpretation of facial analysis, comprehension of dermal fillers characteristics and discernment of the correct filling technique for each region. Based on these variables the MIMT concept proposes the implantation of the minimum-effective quantity of acid hyaluronic fillers (HA) with different physical, chemical and rheological properties (complex viscosity and elastic modulus) in the correct layers; in order to optimize their performance resulting in a natural appearance with fewer risks of adverse events. the versatility, acceptable safety profile, biocompatibility and greater patient compliance presented in the Restylane® line (by Galderma) should be taken in consideration, since the use of a proper HA is noteworthiness. The Non-Animal Stabilized Hyaluronic Acid Tecnology (NASHA®) and the Optimal Balance Technology (OBT®), which make up this line of fillers, allow us to have very firm to very flexible gels, with different particle sizes, with an optimal concentration of HA and with viscoelastic and biocompatible characteristics according to the region of the treated face.

Rationale: Clear definition of optimal positive airway pressure therapy usage in patients with obstructive sleep apnea is not possible because of scarce data on the relationship between usage hours and major clinical outcomes. Objective: To investigate the dose-response relationship between positive airway pressure usage and healthcare resource utilization and determine the minimum device usage required for benefit. Methods: A linked data set combined deidentified payer-sourced administrative medical/pharmacy claims data from more than 100 U.S. health plans and individual patient positive airway pressure usage data. Eligible adults (age ⩾18 yr) had a new obstructive sleep apnea diagnosis between June 2014 and April 2018. All received positive airway pressure therapy (AirSense 10; ResMed) with claims data for ⩾1 year before, and 2 years after, device setup. Healthcare resource utilization was determined on the basis of the number of all-cause hospitalizations and emergency room visits over 3, 12, and 24 months after positive airway pressure initiation. Results: Data from 179,188 patients showed a clear dose-response relationship between daily positive airway pressure usage and healthcare utilization. Minimum device usage required for benefit was 1-3 hours per night. There was a statistically significant decrease in hospitalizations and emergency room visits at all time points (all Ps

Studies in adults have suggested that high-resolution technology increases the diagnostic yield of antroduodenal manometry (ADM). However, there is no study comparing high-resolution with low-resolution ADM recordings as well as comparing the 2 types of high-resolution display [conventional line plot (CLP) and pressure topographic plots (PTP)]. We hypothesized that high-resolution ADM is a superior diagnostic modality with higher inter-observer and intra-observer agreement compared with low-resolution recordings.Twenty-four anonymized ADM studies were blindly analyzed by 3 experienced pediatric neurogastroenterologists. All studies had been performed using a low-compliance water-perfused system with a 20-channels catheter. Data were displayed as CLP, as both high-resolution and low-resolution, and PTP in different sessions with at least 6-week interval. Accuracy was evaluated using previous established diagnosis and specific pre-prandial and post-prandial manometric patterns. Inter-observer and intra-observer agreements were calculated.Analysis with high-resolution CLP revealed a substantial inter-observer agreement among the 3 observers regarding the diagnosis (Krippendorff's alpha: 0.832; average pairwise percentage agreement: 88.9%). Conversely, PTP and low-resolution CLP showed poor agreement for diagnoses (Krippendorff's alpha: 0.600; average pairwise percentage agreement: 75.3%; Krippendorff's alpha: 0.390; average pairwise percentage agreement: 60.2%, respectively). For the intra-observer agreement, Krippendorff's alpha ranges were 0.891-1 for CLP and 0.19393-0.34621 for PTP.Our study demonstrated higher diagnostic accuracy for high-resolution ADM compared to the low-resolution recordings. However, although it is well established for other motility investigations, PTP is not yet reliable in assessing foregut motor patterns. Advanced and more sophisticated software are clearly required for analyzing PTP display.

Carole Bandiera,1– 3 Jérôme Pasquier,3 Isabella Locatelli,3 Anne Niquille,2,3 Grégoire Wuerzner,4 Jennifer Dotta-Celio,3 Anna Hachfeld,5 Gilles Wandeler,5 Anna Dorothea Wagner,6 Chantal Csajka,1,2,7 Anne Zanchi,4,8 Matthias Cavassini,9 Marie P Schneider1,2 1School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; 2Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland; 3Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland; 4Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; 5Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; 6Service of Oncology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; 7Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; 8Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; 9Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, SwitzerlandCorrespondence: Marie P Schneider, School of Pharmaceutical Sciences, University of Geneva, Rue Michel Servet 1, Geneva, 1211, Switzerland, Tel + 41 22 379 53 16, Email Marie.Schneider@unige.chBackground: During the 2020 COVID-19 lockdown, patients included in the Interprofessional Medication Adherence Program (IMAP) in Switzerland continued to use electronic monitors (EMs) that registered daily drug-dose intake. We aimed to understand to what extent patients’ medication implementation (ie, the extent to which the patient took the prescribed medicine), measured with EMs, was impacted by the lockdown.Methods: Patients participating in the IMAP were diagnosed with diabetic kidney disease (DKD), solid cancer, human immunodeficiency virus (HIV) and miscellaneous long-term diseases (MLTD). Patient implementation was defined through a proxy: if all patient EMs were opened at least once daily, implementation was considered active (=1), and no implementation was considered (=0) otherwise. Implementation before (from December 2019 to March 2020), during (March to June 2020) and after (June to September 2020) the lockdown was compared. Subanalyses were performed according to the patients’ diseases. Subanalyses were performed in patients who used at least one EM in 2018– 2019 during the same periods (defined as winter, spring and summer). The logistic regression models used to estimate medication implementation according to the period were fitted using generalized estimating equations.Results: In 2020, patient implementation (n = 118) did not differ significantly before versus during (OR = 0.98, 95% CI: 0.84– 1.15, p = 0.789) and before versus after (OR = 0.91, 95% CI: 0.79– 1.06, p = 0.217) the lockdown. These findings remained stable when separately analyzing the implementation of patients with HIV (n = 61), DKD (n = 25) or MLTD (n = 22). Too few patients with cancer were included (n = 10) to interpret the results. In 2019, the implementation of 61/118 (51.7%) patients was significantly lower during summertime versus wintertime (OR = 0.73, 95% CI: 0.60– 0.89, p = 0.002).Conclusion: Medication implementation remained steady before, during and after the lockdown in 2020. The IMAP before, during and after the lockdown may have supported the adherence of most patients, by ensuring continuity of care during periods of routine disturbances.Keywords: SARS-CoV-2, COVID-19, medication adherence, patient compliance, implementation adherence, electronic adherence monitoring, interprofessional adherence intervention

The impact of direct mail order sales of positive airway pressure (PAP) devices, accentuated by the coronavirus disease 2019 (COVID-19) pandemic, on PAP adherence in patients with obstructive sleep apnea remains unclear. In this study we compared the impact of different modes of continuous positive airway pressure delivery on adherence and daytime symptoms. We hypothesized that adherence would not be affected by remote PAP setup, aided by telehealth technology.Three groups were studied: 1) standard group PAP setup (3-4 people); 2) direct home shipment of PAP, followed by telehealth interactions; 3) direct home shipment of PAP, during the COVID-19 pandemic where delivery choice was removed. Demographics, sleepiness, PAP data, and insurance information were also compared.A total of 666 patients were studied in 3 groups. 1) Standard group PAP setup had 225 patients and adherence with PAP (% of nights used more than 4 hours) was 65.3 ± 2.1%. 2) Direct home shipment of PAP group had 231 patients, and adherence was 54.2 ± 2.4%. 3) Direct mailed PAP units during the COVID-19 pandemic group had 210 patients, and adherence was 55.9 ± 2.5%. Adherence was lower in both groups receiving home shipments compared to those in groups in-center (analysis of variance, Tukey,Patients receiving direct home PAP shipments had lower adherence and were more likely to discontinue PAP compared to standard in-person setup.Stanchina M, Lincoln J, Prenda S, et al. The impact of different CPAP delivery approaches on nightly adherence and discontinuation rate in patients with obstructive sleep apnea.

Patient compliance with perioperative protocols is paramount to improving outcomes and reducing adverse events in total joint arthroplasty (TJA) of the hip and knee. Given the widespread use of smartphones, mobile applications (MAs) may present an opportunity to improve outcomes in TJA. We aim to determine whether the use of a mobile application platform improves compliance with standardized pre-operative protocols and outcomes in TJA.A non-randomized, prospective cohort study was conducted in adult patients undergoing primary elective TJA to determine whether the use of an MA with timed reminders starting 5 days pre-operatively, to perform a chlorhexidine gluconate (CHG) shower and oral hydration protocol improves compliance with these protocols.compliance, length of stay (LOS), surgical site infection (SSI), 90-day readmission.App-users had increased adherence to the hydration protocol (odds ratio [OR] = 3.17 [95% confidence interval {CI} = 1.42, 7.09: P = .003]). App-use was associated with shorter LOS (Median Interquartile ranges [IQR] 2.0 days [1.0, 2.0 days]) for App-users vs 2.0 days ([1.0, 3.0] for non-App users, P = .031), younger age, (63.3 vs 67.9 years, P = .0001), Caucasian race (OR = 3.32 [95% CI = 1.59, 6.94 P = .0009]) and male gender (48.2% vs 35.0%, P = .02). There was no difference in adherence to chlorhexidine gluconate (CHG), readmission, or surgical site infection (SSI) (2.2% App-users vs 2.9% non-App users; P = .74).Use of a mobile application was associated with increased compliance with a hydration protocol and reduced LOS. App-users were more likely to be younger, male and Caucasian. These disparities may reflect inequity of access to the requisite technology and warrant further study.

Background The ketogenic diet is a therapeutic option to control drug-resistant epileptic seizures and has difficult compliance standards due to adverse effects, psychosocial factors, or dietary restriction. Objective To create and validate a ketogenic diet compliance questionnaire. Methods Methodological study, convergent care. The instrument was analyzed (construct validation) by five judges during two cycles of the Delphi technique. The judges assessed the relevance and clarity by using the Likert scale with three levels and made suggestions. The validation of the instrument was calculated using the agreement rate and content validity index (CVI). The application by two nutritionists made it possible to test reproducibility using the Kappa coefficient. When comparing the classification with a template developed by the health professionals who cared for the patients in question, the Pearson correlation and Fisher exact tests were used. For the reliability test, self-applied data were collected and evaluated using Cronbach Alpha coefficient. Results The questionnaire initially created with 11 multiple choice questions on a Likert scale was reduced to 10 questions with an agreement rate and the CVI classified as excellent after two rounds with judges. In the application of the tool, a kappa of 0.6087 was obtained, a Pearson that showed no significant difference between evaluators and a Cronbach α of 0.6483, with substantial consistency. Conclusions This work resulted in the creation of an unprecedented and reliable questionnaire on adherence to the national ketogenic diet. Further studies should be performed to extrapolate the use of this questionnaire in different populations. Resumo Antecedentes A dieta cetogênica é um tratamento para epilepsia refratária e tem difícil adesão devido aos efeitos adversos, fatores psicossociais ou à própria restrição alimentar. Objetivo Criar e validar um questionário de adesão à dieta cetogênica. Métodos Estudo metodológico, convergente assistencial. O instrumento foi analisado (validação de constructo) por cinco juízes durante dois ciclos da técnica Delphi. Os juízes avaliaram a pertinência e a clareza com respostas na escala Likert com três níveis, além de sugestões. A validação do instrumento foi calculada pela taxa de concordância e índice de validade de conteúdo (IVC). Posteriormente, houve aplicação por duas nutricionistas (reprodutibilidade), sendo analisada a concordância pelo coeficiente de Kappa. Ao comparar a classificação com um gabarito, elaborado pelos profissionais da saúde responsáveis pelos pacientes em questão, foram utilizados os coeficientes de correlação de Pearson e teste exato de Fisher. Para teste de fidedignidade, a coleta de dados auto-aplicados foi avaliada pelo coeficiente de Alpha de Cronbach. Resultados O questionário inicialmente criado com 11 questões de múltipla escolha em escala Likert foi reduzido para 10 questões com taxa de concordância e IVC excelentes após 2 rodadas com juízes. Na aplicação da ferramenta obteve-se coeficiente de Kappa de 0,6087, o coeficiente de Pearson não demostrou diferença significativa entre avaliadores, e o coeficiente α de Cronbach de 0,6483, com consistência substancial. Conclusões Este trabalho resultou na criação do inédito questionário nacional de adesão à dieta cetogênica, válido e fidedigno. Outros estudos devem ser realizados para extrapolar a utilização deste questionário em diferentes populações.

Oral nutritional supplements (ONS) are a clinically effective and relatively inexpensive way to supplement the diet of patients with, or at risk of, undernutrition. Good adherence is a primary determinant of the effectiveness of ONS. However adherence can be problematic for those with the greatest clinical need, such as undernourished older adults. This review aimed to appraise the available literature for the factors (contextual, personal and product related) affecting patient adherence and perceived palatability of ONS, identify areas requiring improvement and uncover gaps in the evidence to guide the focus of future research. Contextual factors identified were healthcare staff and the timing of administration. Personal factors included sensory changes and motivation which alter experience of and desire to consume ONS. The product’s sensory characteristics determined palatability and intake, but undesirable attributes, such as off-flavours, can stem from nutritional ingredients. The contribution made by aroma to older adults’ experience of ONS was a comparatively under-researched area. Further research should address this evidence gap to optimise the flavour, aroma profile and palatability for undernourished older consumers, thereby optimising intake. A combined multidisciplinary effort involving strategic expansion of research, industry development and clinical practice should simultaneously address the factors identified, to provide the best approach to improve adherence.

It is aimed in this study to evaluate the relationship between COVID-19 anxiety and treatment compliance in hemodialysis patients.This study was conducted descriptively with 128 hemodialysis patients treated in the hemodialysis unit of a district state hospital between September and December 2021.It was observed that there was a significant relationship between the dialysis duration as well as the variable of forgetting to take their medicines while traveling and the coronavirus anxiety scores according to the multiple regression analysis regarding the variables affecting the coronavirus anxiety levels of the participants, and that these two variables were 25% determinant in the mean score of the coronavirus anxiety (RIt was found, as a conclusion, that the majority of the patients were compliant to the treatment and such variables as gender, education, profession, and dialysis duration were related to the coronavirus anxiety.

BACKGROUND: Low muscle mass increases the risk of developing type 2 diabetes mellitus (DM 2) and prediabetes. Nutrition is an important factor in the study of the relationship between low muscle mass and the development of glucose metabolic disorders.AIM: The present study was conducted to assess the relationship between prediabetes and low muscle mass on the basis of serum creatinine levels, taking into account patient nutrition.MATERIALS AND METHODS: The study included 551 patients aged 18–69 years without DM 2. The glucose level was determined based on fasting glucose and after an oral glucose tolerance test (OGTT). Hyperglycemia is assessed according to the classification of the World Health Organization. The MedDietScore questionnaire was used to assess the nutritional factor, which determines the adherence of patients to the Mediterranean diet. In order to assess odds ratios (OR) and 95% confidence interval (CI), a binary logistic regression was performed.RESULTS: The prevalence of prediabetes in the group with the lowest and highest blood creatinine level was 31.9% and 17.5% respectively (p=0.016). As a result of the conducted regression analysis, a statistically significant relationship was found between low creatinine levels and the chances of having prediabetes (crude OR 2,07, 95% CI 1,21; 3,56), which persisted after adjusting for socio-demographic, anthropometric factors, stress level and physical activity as well as muscle strength. After adding the data on MedDietScore to the statistical model, the revealed relationship was lost (p = 0.187).CONCLUSION: Low serum creatinine increases the chances of the presence of prediabet regardless of gender, age, body weight index, the volume of the hips, the ratio of the volume of the waist to growth, as well as physical activity, the level of stress and muscular power. However, the chances of the presence of prediabet do not differ in persons with low creatinine blood depending on the commitment to the Mediterranean diet among the population of those living in the Turkestan region.

To compare the levels of compliance with care routines of orthokeratology (ortho-k) wearers and their parents and to identify factors affecting compliance in a hospital setting in Chengdu, China.Patients who had worn ortho-k lenses for at least one month were invited to participate in a survey on compliance. Wearers or their parents were required to complete a questionnaire to determine their compliance with hand hygiene, ortho-k lenses and accessory care procedures.A total of 200 wearers, 78 male wearers and 122 female wearers, median age 12 (range 8-18) years were enrolled. Except for use of lens solution, the percentage of participants reporting total compliance with all procedures did not differ significantly between lens wearers and their parents. However, compliance for some items was significantly higher when performed by parents p 0.001-0.01). 'Eye care practitioner provided instructions' was a significant protective factor for most procedures (p 0.001-0.04). Age and sex were significant risk factors for some items (p 0.001-0.04; p = 0.03-0.04, respectively), with girls having higher compliance than boys. 'Parental supervision' was a significant protective factor for some items (p = 0.02-0.04) when wearers performed the procedures themselves. When parents performed lens care procedures, only 'eye care practitioner provided instructions' was a significant variable (p = 0.001-0.04).Some degree of non-compliance was noted in the majority of ortho-k wearers, particularly for the care of the lens case and suction holder. Compliance with care of some items was higher when performed by parents. Regular reinforcement of care procedures by practitioners is important, especially for older and male lens wearers. Parental supervision is necessary when children perform lens care procedures themselves, even for older wearers.

Objective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. Methods: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. Results: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p = .8), significantly and weakly correlated to decisional conflict (rho = -0.28, p = .002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. Conclusion: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. Practice Implications: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options. (c) 2021 The Authors. Published by Elsevier B.V. CC_BY_NC_ND_4.0

AIMS: One of the factors influencing the cost-effectiveness of population screening for Type 2 diabetes may be uptake. We examined attendance and practice- and individual-level factors influencing uptake at each stage of a diabetes screening programme in general practice. METHODS: A stepwise screening programme was undertaken among 135, 825 people aged 40-69 years without known diabetes in 49 general practices in East England. The programme included a score based on routinely available data (age, sex, body mass index and prescribed medication) to identify those at high risk, who were offered random capillary blood glucose (RBG) and glycosylated haemoglobin tests. Those screening positive were offered fasting capillary blood glucose (FBG) and confirmatory oral glucose tolerance tests (OGTT). RESULTS: There were 33 539 high-risk individuals invited for a RBG screening test; 24 654 (74%) attended. Ninety-four per cent attended the follow-up FBG test and 82% the diagnostic OGTT. Seventy per cent of individuals completed the screening programme. Practices with higher general practitioner staff complements and those located in more deprived areas had lower uptake for RBG and FBG tests. Male sex and a higher body mass index were associated with lower attendance for RBG testing. Older age, prescription of antihypertensive medication and a higher risk score were associated with higher attendance for FBG and RBG tests. CONCLUSIONS: High attendance rates can be achieved by targeted stepwise screening of individuals assessed as high risk by data routinely available in general practice. Different strategies may be required to increase initial attendance, ensure completion of the screening programme, and reduce the risk that screening increases health inequalities.

Background Obstructive sleep apnea (OSA) is a common comorbidity in patients with heart failure, although current evidence is equivocal regarding the potential benefits of treating OSA with positive airway pressure (PAP) therapy in patients with heart failure. This study assessed the impact of adherence to PAP therapy on health care resource utilization in patients with OSA and heart failure with reduced ejection fraction. Methods and Results Administrative insurance claims data linked with objective PAP therapy use data from patients with OSA and heart failure with reduced ejection fraction were used to determine associations between PAP adherence and a composite outcome of hospitalizations and emergency room visits. One-year PAP adherence was based on an adapted US Medicare definition. Propensity score methods were used to create groups with similar characteristics across PAP adherence levels. The study cohort included 3182 patients (69.9% male, mean age 59.7 years); 39% were considered adherent to PAP therapy (29% intermediate adherent, 31% nonadherent). One year after PAP initiation, adherent patients had fewer composite visits than matched nonadherent patients, driven by a 24% reduction in emergency room visits for adherent patients. Composite visit costs were lower in adherent versus nonadherent patients ($3500 versus $5879, P=0.031), although total health care costs were not statistically different ($13 028 versus $14 729, P=0.889). Conclusions PAP therapy adherence in patients with OSA with heart failure with reduced ejection fraction was associated with a reduction in health care resource utilization. This suggests that greater emphasis should be placed on diagnosing and effectively treating OSA with PAP in patients with heart failure with reduced ejection fraction.

Background Lifestyle factors such as physical fitness, dietary habits, mental stress, and sleep quality, are strong predictors of the occurrence, clinical course, and overall treatment outcomes of common cardiovascular diseases. However, these lifestyle factors are rarely monitored, nor used in daily clinical practice and personalized cardiac care. Moreover, non-adherence to long-term self-reporting of these lifestyle factors is common. In the present study, we evaluate adherence to a continuous unobtrusive and patient-friendly lifestyle monitoring system using evidence-based assessment tools. Methods In a prospective observational trial (N = 100), the project investigates usability of and adherence to a monitoring system for multiple lifestyle factors relevant to cardiovascular disease, i.e., daily physical activity levels, dietary habits, mental stress, smoking, and sleep quality. Patients with coronary artery disease, valvular disease and arrhythmias undergoing an elective intervention are asked to participate. The monitoring system consists of a secured online platform with a custom-built conversational interface—a chatbot—and a wrist-worn wearable medical device. The wrist-worn device collects continuous objective data on physical activity and the chatbot is used to collect self-report data. Participants collect self-reported lifestyle data via the chatbot for a maximum of 4 days every other week; in the same week physiological data are collected for 7 days for 24 h. Data collection starts one week before the intervention and continues until 1-year after discharge. Via a dashboard, patients can observe their lifestyle measures and adherence to self-reporting, set and track personal goals, and share their lifestyle data with practitioners and relatives. The primary outcome of the trial is adherence to using the integrated platform for self-tracking data. The secondary outcomes include system usability, determinants of adherence and the relation between baseline lifestyle behaviour and long-term patient-relevant outcomes. Discussion Systematic monitoring during daily life is essential to gain insights into patients’ lifestyle behaviour. In this context, adherence to monitoring systems is critical for cardiologists and other care providers to monitor recovery after a cardiac intervention and to detect clinical deterioration. With this project, we will evaluate patients’ adherence to lifestyle monitoring technology. This work contributes to the understanding of patient-centered data collection and interpretation, to enable personalized care after cardiac interventions in order to ultimately improve patient-relevant outcomes and reduce health care costs. Trial registration Netherlands Trial Registry (NTR) NL9861. Registered 6th of November 2021.

Background Because heart failure (HF) is a debilitating chronic cardiac condition and increases with age, most patients with HF experience a broad range of coexisting chronic morbidities. Comorbidities present challenges for patients with HF to successfully perform self-care, but it is unknown what types and number of comorbidities influence HF patients’ self-care. The purpose of this study was to explore whether the number of cardiovascular and non-cardiovascular conditions are associated with HF self-care. Methods Secondary data analysis was performed with 590 patients with HF. The number of cardiovascular and non-cardiovascular conditions was calculated using the list of conditions in the Charlson Comorbidity Index. Self-care was measured with the European HF self-care behavior scale. Multivariable linear regression was performed to explore the relationship between the types and number of comorbidities and self-care. Results Univariate analysis revealed that a greater number of non-cardiovascular comorbidities was associated with poorer HF self-care(β=-0.103), but not of more cardiovascular comorbidities. In the multivariate analysis, this relationship disappeared after adjusting for covariates. Perceived control and depressive symptoms were associated with HF self-care. Conclusion The significant relationship between the number of non-cardiovascular comorbidities and HF self-care was not independent of perceived control and depressive symptoms. This result suggests a possible mediating effect of perceived control and depressive symptoms on the relationship between HF self-care and the number and type of comorbidities.

In the last decades, we have been watching a remarkable increase in survival of children with congenital heart disease (CHD), due to advances in surgical and medical management, leading to a significant growth in the number of adolescents and young adults with the disease. In developed countries, the number of adults with CHD surpasses the number of children with CHD. Unfortunately, prolonged survival has been achieved at a high cost, as an expressive number of patients continue to suffer from [...]

This study was performed to review which mHealth apps that improve brace-wearing compliance are currently available, and to carry out their quality assessments by listing their functionalities. We found ten mHealth apps in the literature review and commercial mHealth apps market (Google Play and App store). Then, the quality of these apps was evaluated by their transparency, health content, excellent technical content, security/privacy, issues of usability, and subjective ratings (THESIS) scale, and the functionalities of the included apps were reviewed. Regarding these functionalities, four categories (data acquisition, compliance enhancement, educational components, and additional functionalities) and twelve subcategories were identified. The mean overall quality of the apps was 3.00 out of 5. Although four of the apps achieved a score of 3.0 or more for their overall quality, indicating an acceptable quality, none of the apps scored higher than 4.0, which indicated a high or excellent quality. According to the sections, the transparency section had the highest rating (3.92) and the security/privacy section received the lowest rating (2.02). Given that the overall quality of current mHealth apps was not high, and their potential to motivate patients with idiopathic scoliosis to adhere to their bracing treatment, it is necessary to develop high-quality apps with appropriate functionalities for supporting brace treatment.

Rates of adherence to positive airway pressure (PAP) for sleep apnea are suboptimal. Though previous studies have identified individual factors associated with PAP nonadherence, few projects have investigated a wide range of possible barriers directly from the patient perspective. We examined the range of factors that patients identify as barriers to optimal use of PAP as well as the solutions most commonly offered by providers. We employed a mixed methods design including semistructured interviews and medical record review at a US Department of Veterans Affairs Medical Center. Thirty patients identified as nonadherent to PAP participated. Patients were asked to report on current sleep problems, reasons for nonadherence, and solutions proposed by providers. Chart review was used to identify untreated apnea severity, Epworth Sleepiness Scale score, therapy hours, and residual apnea severity. Patients described physical and psychological barriers to adherent use at approximately equal rates: Mask leaks and dry throat/nose were common physical barriers, and anxiety/claustrophobia and worsening insomnia were common psychological barriers. Untreated apnea severity, residual apnea severity, and daytime sleepiness were not associated with therapy hours. Solutions offered by providers most frequently addressed physical barriers, and solutions to psychological barriers were rarely proposed. The most common solution offered by providers was trying different masks. We recommend individualized assessment of each patient's barriers to use as well as increased involvement of behavioral health providers in sleep medicine clinics.Positive airway pressure (PAP) is an effective treatment for sleep apnea, but many patients have trouble tolerating it. We interviewed 30 veterans at a Department of Veterans Affairs Medical Center who do not use their PAP every day. We interviewed them to identify the most common barriers to use. We also reviewed their medical records to investigate whether other factors, such as the severity of their apnea or their daytime sleepiness, were associated with number of hours of PAP use. In addition, we asked patients what their providers recommended to improve their PAP adherence. We categorized all reported barriers to PAP use into four main groups: physical, psychological, situational, and knowledge. Physical problems and psychological barriers were most commonly reported and were endorsed at approximately equal rates. None of the factors reviewed during chart review were associated with the number of hours PAP was used. The most common solution providers recommended was trying a different mask. Providers rarely suggested solutions to psychological barriers, such as insomnia or claustrophobia. We recommend that sleep medicine clinics involve behavioral health providers in sleep apnea care to help address psychological barriers to PAP use.

Objective. Poor metabolic control and low treatment adherence remain major issues for many pediatric patients with type 1 diabetes. Important risk factors for both include psychosocial variables such as stress. To date, stress in type 1 diabetes patients and their parents has been investigated at an individual level. The present study tested the hypothesis that patients’, mothers’, and fathers’ perceived stress is positively related to each other and therefore is a factor common to the family. This factor was then hypothesized to be related to patients’ poorer treatment adherence behavior and metabolic control. Research Design and Methods. This cross-sectional study at the University Children’s Hospital Zurich included 190 type 1 diabetes patients (age: 7–18 years; illness duration: ≥1 year) and their families. The Perceived Stress Scale was used to measure the self-reported stress of patients, mothers, and fathers. Patients’ treatment adherence was rated by their endocrinologists. HbA1c served as indicator of metabolic control. A structural equation model (SEM) was conducted for analysis. Results. The SEM showed adequate model fit. Patients’ ( β = .567 , p ≤ .001 ), mother’s ( β = .621 , p ≤ .001 ), and father’s ( β = .585 , p ≤ .001 ) perceived stress loaded all on a single factor, perceived family stress. This factor was significantly associated with treatment adherence ( β = − .384 , p ≤ .001 ) and with HbA1c ( β = .210 , p = .012 ) of patients. Conclusions. Results confirmed perceived family stress to be a common family construct. Because perceived family stress might have a negative impact on patients’ treatment adherence and HbA1c, subjective stress appraisals of patients and both parents should be considered when counseling children and adolescents with type 1 diabetes.

While it is known that psoriasis patients have poor adherence to both topical and systemic medications, adherence to methotrexate is not well-characterized, and ways to improve methotrexate adherence have not been addressed.The aim of this study was to evaluate whether a digital intervention improved adherence to oral methotrexate as measured by electronic monitoring.Twenty-nine patients were randomized to receive either weekly digital interventions assessing treatment adherence or no intervention for 24 weeks. Patients received medication bottles with electronic monitoring, and returned at weeks 4, 12, and 24 to evaluate disease severity.The intervention group took methotrexate correctly 77.1% of the weeks observed compared to the control group which averaged 64.5%. More intervention patients took methotrexate as directed compared to the control group (78.3% vs 64.2%,Low cost, scalable digital interventions may have the potential to increase psoriasis patient adherence to methotrexate, although the mechanism for the improvement is not yet well defined.

Background/Aims The quality of the evidence used to evaluate a drug’s safety and efficacy depends, in part, on how well participants adhere to the prescribed drug-taking regime. There are multiple approaches to measure adherence in clinical trials, varying in their cost and accuracy. We demonstrate a method for evaluating the cost-effectiveness of common adherence monitoring methods, considering the costs and data quality for drugs that differ in how forgiving they are of nonadherence. Methods We propose a simulation approach to estimate the value of evidence about adherence, considering both costs of collection and potential errors in interpreting clinical trial results. We demonstrate the approach with a simulated clinical trial of nitrendipine, a common calcium channel blocker. We consider two trial designs, one using pretrial adherence to “enrich” the trial sample and one without an enrichment strategy. We use scenarios combining high and low values of two key properties of a clinical trial: participant adherence and drug forgiveness. Results Under the conditions of these simulations, the most cost-effective adherence monitoring approach depends on both trial participant adherence and drug forgiveness. For example, the enrichment strategy is not cost-effective for the base scenario (high forgiveness and high adherence), but is for other scenarios. We also estimate the effects of evaluable patient analysis, a controversial procedure that excludes nonadherent participants from the analyses, after a trial is completed. Conclusions Our proposed approach can guide drug regulators and developers in designing efficient clinical trials and assessing the impact of nonadherence on trial results. It can identify cost-effective adherence-monitoring methods, given available knowledge about the methods, drug, and patients’ expected adherence.

In some cluster randomized trials, subjects may not comply with their assigned treatment status. Such treatment noncompliance can create opportunities for spillover effects within clusters. Little research has focused on what can be learned in such context. This article provides a non-technical review of recent work on the complications that arise in cluster randomized trials where some units within treated clusters do not comply with treatment but the treatment spillovers over to these units. We motivate concepts using a hypothetical vaccine cluster randomized trial. We review that standard instrumental variable methods cannot recover the complier average causal effect in the presence of these spillovers. In fact, we review that without additional assumptions, little can be learned about compliance effects or spillover effects. We discuss one additional assumption that allows for bounds on a key causal effect. We also outline an estimator for these bounds.

Introduction Studies on adherence to exercise therapy of patients with ankylosing spondylitis (AS) are rare, and the criteria for adherence to exercise are inconsistent. This study aimed to quantify patient-reported adherence to exercise therapy of Chinese outpatients with AS and investigate the factors related to poor adherence. Methods The subjects’ sociodemographic, disease-related, radiographic, and laboratory parameters were collected. Patients’ adherence to exercise therapy was assessed using the Exercise Attitude Questionnaire (EAQ) with a 4-point Likert scale. All cases were grouped as good adherence and poor adherence using a cutoff score of 60, according to a previous study. Univariate analysis was conducted to assess the intergroup differences. Then, we built a multivariate logistic regression model to identify possible significant factors related to poor adherence to exercise therapy. Results A total of 185 outpatients completed the questionnaire. The mean EAQ score was 49.4 (IQR, 40.7–59.3) and 146 patients (78.9%) were considered to have poor adherence, and 39 patients (21.1%) were considered to have good adherence. The rates of current nonsteroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and tumor necrosis factor-α inhibitor (TNF-i) use were significantly higher in the poor adherence group (p=0.001, p=0.027, p=0.018, respectively). Our multivariate logistic regression model revealed that the only significant associated factor was current use of NSAIDs (OR=3.517; p=0.016; 95% CI, 1.259–9.827). Conclusions Outpatients with AS had an unacceptable level of adherence to exercise therapy, and current use of NSAIDs was a significantly associated factor. Key Points• Outpatients with AS had an unacceptable level of adherence to exercise therapy.• Current use of NSAIDs exerted a negative impact on patients’ adherence to exercise therapy.

Purpose: This article describes the first four steps of the intervention mapping framework used to design a programme aimed at increasing adherence to prescribed exercise by people with persistent musculoskeletal pain. Method: In Step 1, a systematic review and qualitative study was completed to inform Step 2 and the identification of the Health Action Process Approach as an appropriate theoretical framework for establishing two programme objectives: enhancing self-management and providing tailored and accessible exercise instructions. Step 3 encompassed the selection of the programme methods, and the programme is described in Step 4. The resulting programme provides virtually delivered motivational interviewing and an app-based exercise programme to support individuals’ adherence to exercise. Results: The resulting intervention was assessed in a proof-of-concept feasibility and acceptability study and was shown to be feasible and acceptable. Refinements to the programme included additional tailoring of the exercise app and modifying the motivational interviewing schedule. Conclusions: Using the intervention mapping approach enabled us to successfully develop an intervention aimed at supporting the development of self-management behaviours and addressing maladaptive beliefs as a means of enhancing individuals’ adherence to exercise. Evaluation and implementation of the intervention should now be carried out.\ud \ud Objectif : décrire les quatre premières étapes du cadre de modélisation d’une intervention, utilisé pour concevoir un programme visant à accroître l’adhésion à une prescription d’exercices chez les personnes souffrant de douleurs musculosquelettiques persistantes. Méthodologie : à la première étape, les chercheurs ont effectué une analyse systématique et une étude qualitative pour étayer la deuxième étape et déterminer le processus d’action en santé dans un cadre théorique approprié qui permettrait de formuler les deux objectifs du programme : améliorer l’autogestion et fournir des directives d’exercices adaptées et accessibles. L’étape trois englobait le choix de la méthodologie du programme, décrite à l’étape quatre. Le programme qui en découle comprend des entrevues motivationnelles virtuelles et un programme d’exercices fondé sur une application pour renforcer l’adhésion à l’exercice. Résultats : l’intervention obtenue, évaluée dans une étude de validation de la faisabilité et de l’acceptabilité, s’est révélée faisable et acceptable. Les améliorations au programme ont inclus de nouvelles adaptations à l’application d’exercices et des modifications au calendrier d’entrevues motivationnelles. Conclusion : grâce à la démarche de modélisation de l’intervention, il a été possible d’élaborer une intervention visant à promouvoir l’acquisition de comportements d’autogestion et à corriger des convictions mésadaptées pour accroître l’adhésion à l’exercice. Il reste maintenant à évaluer et à mettre en œuvre l’intervention.

The world health organisation (WHO) recommends at least one ultrasound scan amidst eight antenatal care visits, however, most pregnant women in low and middle-income countries do not achieve this. This study aims to assess the impact of limited obstetrics ultrasound (LOUS) within primary healthcare centres in northern Nigeria.A cross sectional study was conducted across selected primary healthcare centres in Bauchi and Kano States (northern Nigeria). The study protocol was approved by the Ministry of Health in each State. Within each State a total of nine primary healthcare centres were randomly selected. Information on all complete antenatal care (ANC) records of women who used the primary healthcare facility for 12 months prior to introduction of ultrasound (January 2016 to December 2016) and 12 months after (January 2018 to December 2018) were collected. Study data were analysed using descriptive (mean, standard deviations) and inferential statistics. Independent sample t-test were used to find out if there was a statistical difference between the pre and post-intervention data on women compliance to ANC visits, facility based delivery, maternal and child mortality. Data were analysed using the Statistical Package for Social Sciences and significance was set at p ≤ 0.05.There was a significant increase in the number of ANC visits and supervised facility delivery after introduction of ultrasound services (LOUS) in the primary healthcare centres. The number of ANC visits in Kano State was 2637.6 ± 972.0 before and 3793.0 ± 517.5 after the introduction of ultrasound services. The number of ANC visits in Bauchi State was 1866.6 ± 488.3 before and 2854.0 ± 631.3 after the introduction of ultrasound services. The number of supervised facility deliveries in Kano state was 520.1 ± 128.7 before and 1021.1 ± 217.0 after the introduction of LOUS. The number of supervised facility deliveries for Bauchi state was 553.1 ± 309.9 before and 1056.3 ± 295.4 after introduction of LOUS. A total of 2486 (11.0%) women were referred for further imaging due to equivocal ultrasound findings. A total of 2185 (9.7%) pregnant women were referred for appropriate care due to multiple gestations.This study found that LOUS, in resource scarce settings, has the potential of improving ANC visits, facility delivery rates and reduce maternal and child mortality. It also leads to change in patient management plans resulting in referrals for appropriate care.Technological interventions using ultrasound have the potential to motivate pregnant women to attend ANC, give birth in a healthcare facility and thus reduce maternal and child morbidity and mortality. This is in line with the global drive to reduce maternal and child death by 2030 to less than 70 maternal deaths in 100,000 live births and neonatal mortality reduction to 12 in 1000 live births and under 5 mortality reduction to 25 in 1000 live births.

Individuals with psychiatric disorders often struggle to initiate and engage in treatment. Financial incentives improve treatment engagement, including treatment attendance, medication adherence, and abstinence from substance use. The U.S. Department of Veterans Affairs (VA) recently made the first large-scale, successful effort to implement incentive-based interventions in substance use disorder treatment. Health care systems, including the VA, can increase the impact of these interventions by extending them to target a range of psychiatric disorders, adapting them for specific clinical contexts, using insights from behavioral economics, and partnering with corporations to fund incentives and implement interventions.

Resumo Introducao: A insuficiencia cardiaca (IC) descompensada esta associada a mau prognostico a curto e longo prazo. A monitorizacao remota invasiva da pressao na arteria pulmonar (PAP) possibilita a detecao precoce da descompensacao da IC, previamente ao inicio dos sintomas, podendo melhorar os resultados clinicos. Descrevemos a experiencia inicial com a utilizacao do sistema de monitorizacao remota CardioMEMS™ em doentes com IC, incluindo a sua seguranca e eficacia. Metodos e resultados: Foram incluidos prospectivamente, 5 doentes com IC em classe III da New York Heart Association, com pelo menos uma hospitalizacao por IC descompensada nos ultimos 12 meses, submetidos a implantacao de sistema de monitorizacao remota invasiva da PAP. A mediana de idades foi de 66.0 anos (intervalo interquartil [IIQ] 50.5–77.5 anos), 80.0% eram do sexo masculino e todos apresentavam IC com fracao de ejecao reduzida. O sensor de PAP foi colocado num ramo da arteria pulmonar esquerda em todos os doentes, nao tendo ocorrido complicacoes major. Durante o follow-up mediano de 40 dias (IIQ 40-61 dias), foram transmitidas um total de 271 leituras, verificando-se uma adesao dos doentes de 100% e taxa de transmissao bem sucedida de 98.1%. A PAP manteve-se dentro do objetivo em tres doentes durante o follow-up. Apesar de continuarem assintomaticos, dois doentes apresentaram valores das PAP acima do alvo. Foi realizado ajuste dietetico e da dose de diuretico, sem necessidade de visitas clinicas presenciais, objetivando-se uma reducao efetiva das PAP. Durante o seguimento, nao se registaram hospitalizacoes por IC ou obitos. Conclusao: A monitorizacao da IC guiada pela hemodinâmica demonstrou ser segura e eficaz, podendo assumir-se como uma ferramenta util no manejo de doentes com IC, particularmente no contexto da pandemia COVID-19, quando e desejavel uma reducao do numero de consultas presenciais hospitalares. Background: Decompensated heart failure (HF) is associated with poor short- and long-term prognosis. Remote invasive monitoring of pulmonary artery pressures (PAP) enables early detection of HF decompensation, before symptoms occur, and may improve clinical outcomes. We aimed to describe our initial experience with the use of the CardioMEMS™ remote monitoring system in patients with HF, including its safety and effectiveness. Methods and results: Five patients with HF in New York Heart Association class III and at least one hospitalization due to decompensated HF in last 12 months, who underwent invasive remote monitoring of PAP, were included in this prospective registry. The median age was 66.0 years (interquartile range [IQR] 50.5–77.5 years), 80.0% were men and all had HF with reduced ejection fraction. The pulmonary artery (PA) sensor was placed in a left PA branch in all patients and no major procedural complications occurred. In median follow-up of 40 days (IQR 40–61 days), a total of 271 pressure readings were transmitted, patient compliance was 100% and freedom from sensor failure 98.1%. In three patients, PAP remained within the goal during follow-up. Two patients presented an increase in PAP to values above the targets, despite the absence of symptoms worsening. These required dietary and diuretic dose adjustment, without the need for outpatient clinic visits, which reduced PAP. No hospitalizations for HF or deaths occurred during follow-up. Conclusion: Hemodynamic-guided HF monitoring was safe and effective and may be a useful adjunctive tool to the standard-of-care management in selected HF patients, particularly in the context of the COVID-19 pandemic, where a reduction in the number of health care visits may be desirable.

The failure of many patients with chronic conditions to correctly follow medical advice that they hope or intend to follow is a major concern, especially as effective long-term therapies for chronic conditions materialize. Some US healthcare providers have responded with strategies that involve implementing contracts with their patients, including provisions that may deny future treatments after continued nonadherence. This is among the first articles to explicitly discuss the ethics of patient contracts.

Purpose: This systematic review aimed to determine the rate and identify correlates of adherence and persistence over five years of treatment with adjuvant endocrine therapy in female breast cancer patients. Methods: Relevant articles were identified from Medline, Embase, AMED, PsycINFO, International Pharmaceutical Abstracts, and APA PsycArticles. Studies that measured patient adherence in the implementation or persistence phase for a period of at least five years using objective or multiple measures of adherence and investigated correlates of adherence were included. The titles, abstracts and full articles were screened and reviewed by two authors and any discrepancies were discussed with a third author. Results: Twenty-six studies were included. Mean rate of adherence at five-year for implementation phase was 66.2% (SD = 17.3%), and mean persistence was 66.8% (SD = 14.5%). On average, adherence decreased by 25.5% (SD = 9.3%) from the first to fifth year. Higher rate of adherence was observed through self-report in comparison to database or medical record. Older age, younger age, higher comorbidity index, depression and adverse effects were associated with lower adherence. Treatment with aromatase inhibitors, received chemotherapy, and prior medication use were associated with improved adherence. Conclusion: Adherence to adjuvant endocrine therapy decreased from the first to fifth year of treatment. On average, one-third of patients were not adherent to treatment by the fifth year. Nineteen recurring factors were found to be significantly associated with long-term adherence in multiple studies. Further research using objective or multiple measures of adherence are needed to improve validity of results.

STUDY OBJECTIVES: To determine whether adherence to continuous positive airway pressure (CPAP) in adults with uncomplicated obstructive sleep apnea differs by rural vs urban residential address. METHODS: In this prospective cohort study, we recruited adults who initiated CPAP for uncomplicated obstructive sleep apnea that was diagnosed by a physician using sleep specialist-interpreted diagnostic testing. Participants were classified as urban (community size > 100,000) or rural (community size < 100,000) by translating residential postal code into geographic census area. The primary outcome was mean daily hours of CPAP use compared between rural and urban patients. Secondary outcomes included the proportion of patients who were adherent to CPAP, change in Epworth Sleepiness Scale score, change in EuroQOL-5D visual analog score, and Visit-Specific Satisfaction Instrument score. All outcomes were measured 3 months after CPAP initiation. RESULTS: We enrolled 242 patients (100 rural) with a mean (standard deviation) age of 51 (13) years and a respiratory event index of 24 (18) events/h. The mean (95% confidence interval) CPAP use was 3.19 (2.8–3.58) hours/night and 35% were CPAP-adherent, with no difference between urban and rural patients. Among the 65% of patients who were using CPAP at 3 months, the mean CPAP use was 4.89 (4.51–5.28) hours/night and was not different between rural and urban patients. Improvement in the Epworth Sleepiness Scale score and patient satisfaction was similar between groups, but the EuroQOL-5D score improved to a greater extent in rural patients. Urban or rural residence was not associated with CPAP adherence according to multivariable regression analysis. CONCLUSIONS: Rural vs urban residence was not associated with differences in CPAP adherence among patients with uncomplicated OSA diagnosed by a physician using specialist-interpreted sleep diagnostic testing. CITATION: Corrigan J, Tsai WH, Ip-Buting A, et al. Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study. J Clin Sleep Med. 2022;18(4):1013–1020.