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Background & Objective: HSG was performed to determine tubal patency of nulliparous and primiparous patients without contraception who underwent a pregnancy program. The contrast used can cause allergies, although the incidence of post-HSG allergy is rare. The clinicians need to be aware of this to remain vigilant. Case Presentation: The Presented case is report of a patient P1A0 who had an allergy after HSG. Hysterosalpingography was performed as the patient wanted another pregnancy, after a long wait without contraception, while the first child was 12 years old. A P1A0 woman with a 12-year-old first child wanted a second pregnancy, who was diagnosed bronchial asthma without regularly taking asthma medications. The patient received analgesic drugs and underwent an HSG examination on the 10th day of menstruation. Thirty minutes later, she complained of itching that started on the face and spread to the whole body, including the arms and legs. The whole body then appeared to be bumped. An hour later, an asthma attack occurred in the form of short breaths. HSG examination was a routine examination carried out in patients undergoing a pregnancy program. Incidence of allergies after HSG is a rare thing. Thus, this case report needs to be submitted to consider that allergic events such as those in this case report can occur. Conclusion: Allergic reactions after HSG are rare. HSG examination is performed on patients with bronchial asthma, and drug allergy (antalgin) must be noted carefully. The two allergy risk factors can trigger an allergic reaction to the contrast used during HSG examination. [ABSTRACT FROM AUTHOR]

The opioid epidemic has had a strong impact on West Virginia, due to various social, economic, cultural, and environmental hardships. To aid users, Needle Exchange Programs (NEPs) were created to exchange used needles for new sterile ones and provide awareness of treatment and rehabilitation options. This study aimed to assess the effectiveness of NEPs in reducing HIV and Hepatitis C infections in West Virginia, and the subsequent decrease in healthcare costs. In 2018 and 2019, there was an HIV outbreak in Cabell County, with 85 cases requiring CDC intervention in 2019. This occurred after the county-run needle exchange was reduced. Kanawha County also shut down its NEPs in 2018, followed by another HIV outbreak between 1 January 2019 and 13 March 2021, with 65 people testing positive for HIV linked to injection drug use, which required CDC intervention. To rehabilitate the opioid addict population, research on relapse, quality of life, social inclusion, stable housing, habilitation, and treatment adherence should be conducted. Policymakers should also revise existing policies surrounding the provision of harm reduction services to document adequate procedures for SSP procedures. This research suggests that suspending and scaling down NEPs in West Virginia has increased HIV/HCV incidence. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify behavioral factors that affect patient attendance in outpatient clinics, especially those related to rescheduling. Methods: A retrospective study was conducted on 20,386 appointment records for 6,252 patients in an outpatient specialty clinic at a women's and children's hospital in Singapore over 34 months (January 2012–October 2014). Multivariate logistic regression was used to analyze the influence of independent variables on appointment no-shows. Results: The average no-show rate of the study population was 28.87%. Patient historical behaviors were significantly associated with appointment attendance. In particular, a larger number of previous visits, more historical no-shows, more historical rescheduling events initiated by patients, and more reschedulings initiated by the clinic for the current appointment were positively associated with no-shows. Notably, the number of previous visits was found to exhibit a significantly diminishing marginal effect on no-show rates. Further analyses suggested that for appointments rescheduled by the clinic, subsequent rescheduling by patients was associated with a reduced risk of no-shows. Conclusions: No-shows were more common in patients who missed more historical appointments or had their appointments rescheduled more frequently. Encouraging patients to reschedule their own appointments could be an effective measure to reduce no-shows. However, the benefit of patient-rescheduling decreased if patients rescheduled appointments repeatedly. [ABSTRACT FROM AUTHOR]

Background: Post‐treatment surveillance recommendations for oropharyngeal cancer do not vary with p16 status despite the differences in outcomes. The optimal algorithm personalizing follow‐up for these patients remains undefined. Here, we evaluate the feasibility and utility of incorporating electronic patient‐reported outcomes (ePROs) and circulating tumor DNA (ctDNA) into routine surveillance for patients treated for p16+ oropharynx cancer. Methods: A prospective registry was developed in which ePROs and ctDNA were incorporated into routine surveillance among patients with oropharynx cancer. ePROs were emailed monthly for 1 year and blood HPV ctDNA testing was performed every 3–6 months. The primary objective was to assess patient compliance with ePRO‐based surveillance with adequate compliance defined as ≥85% of patients completing monthly ePROs. Sensitivity, specificity, and positive/negative predictive values to detect recurrence were calculated for ePROs, HPV ctDNA, or the combination. Results: Of 122 patients who initially expressed interest, 76 completed the electronic consent process and 44/76 (58%) were compliant with monthly surveys over 1 year; thus adequate compliance was not achieved. Technical difficulties associated with ePRO receipt through email largely limited participation. Provider feedback was significantly associated with heightened ePRO compliance. One hundred and six patients had ctDNA testing with a mean number of three tests per patient. Sensitivity to detect recurrence was 75% for the combination of ePROs and ctDNA. Conclusion: Despite lower than anticipated compliance with ePROs, our findings show promise for incorporation of HPV ctDNA into surveillance paradigms for HPV‐related oropharynx cancer with suggestions of methods to optimize ePRO formats for personalized surveillance. [ABSTRACT FROM AUTHOR]

Background: While preventive swallowing exercises reduce the risk of radiation‐associated dysphagia in patients with head and neck cancer, strategies are needed to improve patient adherence. Methods: Before radiation, all participants were taught preventive swallowing exercises and randomized to either an adherence intervention or enhanced usual care. During radiation, all participants met twice with a speech pathologist for swallowing assessment and reinforcement of exercises. Intervention participants met weekly with a counselor in‐person or by phone. At 6‐week post‐radiation follow‐up, all participants completed a follow‐up assessment of self‐reported adherence, which was then corroborated with medical record documentation. Results: Newly diagnosed pharyngeal and laryngeal cancer patients without distant metastases were randomized (n = 265; 135 to intervention, and 130 to usual care). Intervention participants were more likely to adhere to exercises during radiation compared to the control group (p < 0.0001). Conclusion: The weekly in‐person adherence intervention program significantly increased patient's adherence to preventive swallowing exercises during radiation. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancer treatment often leads to trismus, a condition characterized by limited mouth opening. Exercise‐based therapy is the most common intervention but there are no clear guidelines as to the optimal exercise regimen. Restorabite™ is a portable and force‐regulated trismus device designed to enhance exercise adherence. This study explores the adherence to exercises using Restorabite™ in head and neck cancer patients with trismus and identifies facilitators and barriers to exercise therapy. Materials and methods: Mixed‐methods, prospective cohort study undertaken at a quaternary oncology hospital, in Sydney Australia involving participants diagnosed with head and neck cancer diagnosed with trismus (maximal incisal opening under 35 mm). Patients underwent a 10‐week individualized trismus program using Restorabite™ with weekly speech pathology reviews. Exercise adherence was tracked through categorized descriptors. Data were collected prospectively at baseline, during 10 weeks of therapy with Restorabite™, and at 6‐ and 12‐month post‐trismus exercise. Participants described facilitators of trismus therapy, and barriers to completing the prescribed exercises. Clinical documentation of these responses was then analyzed using content analysis. Results: One‐hundred and thirty‐five participants were recruited. During the intervention 69% (n = 93) exercised as recommended, 24% (n = 32) exercised less, and 7% (n = 10) exercised more than recommended. At 6 months post‐intervention, 55.5% (n = 75) exercised as recommended, 38.5% (n = 52) exercised less, and 4% (n = 6) exercised more. At 12 months, 36% (n = 49) exercised as recommended, 48% (n = 62) exercised less, and 11% (n = 15) exercised more. MIO increased from a mean of 18.6 mm at baseline, to 30.1 mm at the end of the 10‐week intervention. This was maintained at 6 and 12 months (31.7 and 32.1 mm, respectively). Adherence to the exercise program was associated with greater improvement in maximum interincisal opening (p < 0.001). Facilitators of adherence included intrinsic motivation, device portability, perceived functional change, and external support tools. Barriers included cancer treatment toxicities, competing priorities, and health challenges. Positive outcomes included functional improvements, while negative outcomes included increased pain. Conclusions: Seventy‐six percent of patients prescribed Restorabite™ performed trismus exercises at or more than the recommended frequency. Facilitators and barriers identified provide insights into factors influencing adherence. Future research should involve comparative studies that compare the adherence and effectiveness of different exercise programs. [ABSTRACT FROM AUTHOR]

In Jamaica, stigma experiences of sex workers (SW), gay men and other men who have sex with men (MSM), and transgender women living with HIV remain understudied. To address this gap, we explored experiences of stigma and linkages with the HIV care cascade among key populations living with HIV in Jamaica, including cisgender women SW, MSM, and transgender women. This qualitative study involved n = 9 focus groups (FG), n = 1 FG per population living with HIV (SW, MSM, transgender women) in each of three sites (Kingston, St. Ann, Montego Bay). We also conducted key informant (KI) interviews. We applied thematic analysis informed by the Health Stigma and Discrimination (HSD) Framework. FG participants (n = 67) included SW (n = 18), MSM (n = 28), and trans women (n = 21); we interviewed n = 10 KI (n = 5 cisgender women, n = 5 cisgender men). Participant discussions revealed that stigma drivers included low HIV treatment literacy, notably misinformation about antiretroviral therapy (ART) benefits and HIV acquisition risks, and a lack of legal protection from discrimination. Stigma targets health (HIV) and intersecting social identities (sex work, LGBTQ identities, gender non-conformity, low socio-economic status). Stigma manifestations included enacted stigma in communities and families, and internalized stigma—including lateral violence. HIV care cascade impacts included reduced and/or delayed HIV care engagement and ART adherence challenges/disruptions. Participants discussed strategies to live positively with HIV, including ART adherence as stigma resistance; social support and solidarity; and accessing affirming institutional support. In addition to addressing intersecting stigma, future research and programing should bolster multi-level stigma-resistance strategies to live positively with HIV. [ABSTRACT FROM AUTHOR]

Product adherence is critical to obtaining objective estimates of efficacy of pre-exposure prophylactic interventions against HIV-1 infection. With imperfect adherence, intention-to-treat analyses assess the collective effects of complete, sub-optimal and non-adherence, providing a biased and attenuated estimate of the average causal effect of an intervention. Using data from the MTN-020/ASPIRE phase III trial evaluating HIV-1 efficacy of the dapivirine vaginal ring, we conducted per-protocol, and adherence-adjusted causal inference analyses using principal stratification and marginal structural models. We constructed two adherence cut offs of ≥ 0.9 mg (low cutoff) and > 4.0 mg (high cutoff) that represent drug released from the ring over a 28-day period. The HIV-1 efficacy estimate (95% CI) was 30.8% (3.6%, 50.3%) (P = 0.03) from the per-protocol analysis, and 53.6% (16.5%, 74.3%) (P = 0.01) among the highest predicted adherers from principal stratification analyses using the low cutoff. Marginal structural models produced efficacy estimates (95% CIs) ranging from 48.8 (21.8, 66.4) (P = 0.0019) to 56.5% (32.8%, 71.9%) (P = 0.0002). Application of adherence-adjusted causal inference methods are useful in interpreting HIV-1 efficacy in secondary analyses of PrEP clinical trials. [ABSTRACT FROM AUTHOR]

A cohort of individuals in care for HIV infection who were identified as being recently out-of-care (OOC) was recruited for a trial using a data-to-care approach and an intervention to facilitate re-engagement and retention in care. This allowed for analysis of demographic and clinical characteristics correlated with recently being OOC, re-engagement, and successful retention in care and viral suppression. Recently OOC persons with HIV infection (PWH) were identified for enrollment in the Cooperative Re-engagement Controlled Trial (CoRECT). CoRECT employed a data-to-care strategy, using both clinical and surveillance data, and an active public health re-engagement intervention. We estimated relative risks (RRs), unadjusted and with multivariate log binomial regression models, to analyze associations between sociodemographic and clinical predictors of being OOC, re-engagement, retention in care, and viral suppression. Of the 630 OOC PWH enrolled in CoRECT, most were male (72.7%) and over 30 years old (91.3%). Almost 40.0% were Black non-Hispanic, 29.7% were non-US born, and 41.6% were men who have sex with men (MSM). Possible predictors of re-engagement, retention in care, and viral suppression included younger age, Hispanic race/ethnicity, birth in a US dependency, AIDS status, and HIV exposure mode. Viral suppression status within 1-year pre-enrollment was significantly associated with all outcomes: re-engagement (aRR 1.28), retention (aRR 1.72), viral suppression (aRR 1.81), and durable viral suppression (aRR 3.30). Findings elucidate factors associated with care engagement and continuity for recently OOC PWH which can be used to inform targeted re-engagement activities for priority populations and guide future data-to-care interventions. [ABSTRACT FROM AUTHOR]

Sexually minoritized men (SMM) with HIV who use stimulants experience difficulties achieving and maintaining an undetectable viral load (VL). Home-based VL monitoring could augment HIV care by supporting interim, early identification of detectable VL. We describe implementation challenges associated with a home-collection device for laboratory-based VL testing among SMM with HIV who use stimulants. From March-May 2022, cisgender SMM with HIV reporting moderate-to-severe stimulant use disorder and suboptimal (< 90%) past-month antiretroviral therapy (ART) adherence were recruited via a consent-to-contact participant registry. Eligible men completed teleconference-based informed consent and were mailed a HemaSpot-HD blood collection device (volume capacity 160 µL; lower limit of detection 839 copies/mL) with detailed instructions for home blood self-collection and return shipment. Implementation process measures included estimated blood volume and VL quantification. Among 24 participants, 21 (88%) returned specimens with a median duration of 23 days (range: 10–71 days) between sending devices to participants and receiving specimens. Of these, 13/21 (62%) included enough blood (≥ 40 µL) for confidence in detectable/undetectable results; 10/13 (77%) had detectable VL, with 4/10 (40%) were quantifiable at ≥ 839 copies/mL. The remaining 8/21 had low blood volume (< 40 µL), but 3/8 (38%) still had detectable VL, with 1/3 (33%) quantifiable at ≥ 839 copies/mL. Home blood collection of ≥ 40 µL using HemaSpot-HD was feasible among this high-priority population, with > 50% having a VL detected. However, interim VL monitoring using HemaSpot-HD among those experiencing difficulties with ART adherence may be strengthened by building rapport via teleconferencing and providing detailed instructions to achieve adequate sample volume. [ABSTRACT FROM AUTHOR]

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Adherence drives efficacy in PrEP clinical trials. We compared drug concentrations and self-reported adherence in HPTN069/ACTG5305, a double-blinded, randomized trial of the safety and tolerability of candidate PrEP regimens that included maraviroc (MVC), tenofovir (TDF), and emtricitabine (FTC). Plasma drug concentrations and self-reported adherence by computer-assisted self-interview (CASI) were assessed at study weeks 24 and 48. Descriptive statistics and a generalized linear model were used to assess the association between selected demographic factors, self-report of daily medication adherence and plasma drug concentrations consistent with daily adherence. Among 718 paired observations from 370 participants, 43% (306/718) reported daily adherence by CASI, 65% (467/718) had drug concentrations consistent with daily adherence and 11% (81/718) had CASI responses that reported daily adherence despite having drug concentrations consistent with less-than-daily adherence. In adjusted analyses, participants who were assigned male at birth (aOR 1.42 [95% CI 1.02, 1.97]), older (5-year increments aOR 1.10 [95% CI 1.09, 1.11]), White (aOR 2.2 [95% CI 1.88, 2.56]), had advanced education (aOR 3.89 [95% CI 2.97, 5.09]), were employed (aOR 1.89 [95% CI 1.50, 2.40]), or partnered/married (aOR 2 [95% CI 1.72, 2.32]) were more likely to have drug concentrations consistent with daily adherence. Participants who were not employed (aOR 2.7 [95% CI 1.31, 5.55]) or who were single/not partnered (aOR 2.33 [CI 95% 1.25, 4.34]) were more likely to have drug concentrations that did not reflect daily adherence despite self-reported PrEP adherence. These findings support the need for ongoing adherence counseling in clinical trials of new PrEP regimens. [ABSTRACT FROM AUTHOR]

We assessed whether symptomatic neurocognitive impairment (NCI) and asymptomatic NCI -of which the clinical relevance is debated- affect HIV control and the role of ART adherence in this relationship. Observational study on the relationship between NCI and viral control during the 2 years before and the 2 after the neurocognitive evaluation (NCE) of 322 PLWH on ART. Viral load (VL) was defined as undetectable, very low-level (VLLV), low-level (LLV), or high-level viremia (HLV), and classified overtime as persistent (p; ≥2 consecutive values in the same worst category), viral failure (VF; ≥1 HLV requiring ART changes), or optimal control. Adherence was the proportion of days covered by ART. Frascati criteria were used. Adjusted models were performed for factors associated with viral control. Mediation analyses informed causality in the path from NCI to viral control through adherence. Sensitivity analyses were focused on the year following NCE for only participants with optimal viral control before. Among the participants (53 ± 10 years, CD4 + T-cells 630/µL), 41.6% and 10.8% presented asymptomatic and symptomatic NCI. Over 3,304 VLs, 8.4% and 22.1% of participants had VF and pLLV/pVLLV. Both symptomatic and asymptomatic NCI were independently associated with VF (aRRR = 8.5; aRRR = 4.3) and pVLLV/pLLV (aRRR = 4.3; aRRR = 2.1). Specific cognitive domains showed independent associations with VL categories (models' P < 0.001). Adherence partially mediated these relationships (models' P < 0.001). Sensitivity analysis confirmed these findings. Prevalence and severity of poor viral control increased as the severity of NCI increased, with ART adherence mediating this relationship. The current "asymptomatic" attribution used by Frascati's criteria could overlook clinical risks. [ABSTRACT FROM AUTHOR]

The potential efficacy of psychosocial interventions in the treatment of borderline personality disorder (BPD) is impacted by significant treatment non‐completion (TNC), with meta‐analytic studies reporting rates of attrition of between 25% and 28%. Increasing patient retention could facilitate outcomes and improve resource utilization, given limited healthcare services. A systematic search of PsycINFO, CINAHL, EMBASE, CENTRAL, and Web of Science Core Collection identified 33 articles that met the criteria for inclusion. Although substantial heterogeneity in terms of methodology and quality of analysis limited conclusions that could be drawn in the narrative review, a few consistent patterns of findings were elucidated, such as Cluster B personality disorder comorbidities and lower therapeutic alliance were associated with TNC. Interestingly, the severity of BPD symptoms was not a predictor of TNC. These findings are discussed in terms of their potential theoretical contribution to TNC. Clinically, there may be value in applying mindfulness and motivational interviewing strategies early on in treatment for individuals who present uncertainty about engaging in treatment. Further research to develop this empirical landscape includes focusing on high‐powered replications, examining burgeoning lines of research, and investigating dynamic predictors of TNC. [ABSTRACT FROM AUTHOR]

Context Current clinical guidelines recommend a drug holiday after extended use of oral bisphosphonates. However, no studies have investigated the effect of drug holidays before hip fractures on postfracture mortality. Objective This work aimed to investigate the effect of a drug holiday on postfracture mortality in patients with extended use of oral bisphosphonates. Methods This retrospective, population-based cohort study took place among all patients with hip fractures in Victoria, Australia, from 2014 to 2018. Patients were adherent to oral alendronate or risedronate for 5 years or more prior to hip fracture. Group-based trajectory modeling categorized patients into different bisphosphonate usage after 5-year good adherence. The main outcome measure was postfracture mortality. Results We identified 365 patients with good adherence (medication possession ratio ≥80%) to oral alendronate/risedronate for 5 years or more. Most patients (69%) continued to use oral bisphosphonates until admission for hip fracture; 17% had discontinued for 1 year and 14% had discontinued for 2 years. Postfracture mortality was higher in patients who had discontinued risedronate for 1 year (hazard ratio [HR] 2.37; 95% CI, 1.24-4.53) and 2 years (HR 3.08; 95% CI, 1.48-6.41) prior to hip fracture. No increase or decrease in postfracture mortality was observed in patients who had discontinued alendronate for 1 year (HR 0.59; 95% CI, 0.29-1.18) or 2 years (HR 1.05; 95% CI, 0.57-1.93) prior to hip fracture. Conclusion Postfracture mortality is higher in people who discontinue risedronate, but not alendronate, for 1 or 2 years after being adherent to treatment for at least 5 years. The type of bisphosphonate may be a factor to consider when planning drug holidays. [ABSTRACT FROM AUTHOR]

Access to solid organ transplantation in patients with intellectual disability is associated with health inequities due to concerns about treatment adherence, survival rates, and post-transplant quality of life. This systematic literature review aims to compare outcomes after organ transplantation in patients with intellectual disability compared to patients without intellectual disability. Embase, Medline Ovid, PsycINFO, Web of Science, Cochrane Central Register of Trials, and Google Scholar databases were systematically searched for studies concerning pediatric or adult solid organ transplantation in recipients with a diagnosis of intellectual disability prior to transplantation. Primary outcomes were patient and graft survival rates. Secondary outcomes were acute rejection rate, adherence rates, and quality of life. Nine studies were included, describing kidney (n = 6), heart (n = 4) and liver (n = 1) transplantation. Reported graft survival rates were non-inferior or better compared to patients without intellectual disability, while patient survival was reportedly slightly lower in two studies reporting on kidney transplantation. Although current evidence has a potential selection bias based on including patients with a sufficient support network, intellectual disability alone should not be regarded a relative or absolute contra-indication for solid organ transplantation. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled blood pressure is a major risk factor for cardiovascular diseases. Fixed-dose combination (FDC) therapy offers a promising approach to addressing this challenge by providing a convenient single-tablet solution that enhances the effectiveness of blood pressure control. In our systematic review, we assess the effectiveness of perindopril/amlodipine FDC in managing blood pressure. Methods: We conducted a comprehensive search across four primary electronic databases, namely, PubMed, Virtual Health Library (VHL), Global Health Library (GHL), and Google Scholar, as of 8 February 2022. Additionally, we performed a manual search to find relevant articles. The quality of the selected articles was evaluated using the Study Quality Assessment Tools (SQAT) checklist from the National Institute of Health and the ROB2 tool from Cochrane. Results: Our systematic review included 17 eligible articles. The findings show that the use of perindopril/amlodipine FDC significantly lowers blood pressure and enhances the quality of blood pressure control. Compared to the comparison group, the perindopril/amlodipine combination tablet resulted in a higher rate of blood pressure response and normalization. Importantly, perindopril/amlodipine FDC contributes to improved patient adherence with minimal side effects. However, studies conducted to date have not provided assessments of the cost-effectiveness of perindopril/amlodipine FDC. Conclusion: In summary, our analysis confirms the effectiveness of perindopril/ amlodipine FDC in lowering blood pressure, with combination therapy outperforming monotherapy and placebo. Although mild adverse reactions were observed in a small subset of participants, cost-effectiveness assessments for this treatment remain lacking in the literature. [ABSTRACT FROM AUTHOR]

Background: Seventy percent of epileptic patients may not experience seizures if they receive proper treatment with antiepileptic drugs (AEDs). However, many children and adolescents face poor seizure control (PSC). Therefore, the purpose of this review is to systematically and quantitatively summarize the pooled prevalence of PSC and its predictors among children with epilepsy in Ethiopia. Methods: The following databases were used to conduct a thorough literature search: Africa Journal of the Online Library, Hinari, Google Scholar, PubMed, Science Direct, EMBASE, Cochrane Database, Sci-Hub, and Scopus. To evaluate the quality of the studies, Newcastle‒Ottawa Scale (NOS) checklists were utilized. The data on study characteristics and prevalence estimates were then combined via random effects meta-analysis, followed by subgroup and sensitivity analyses. Both visual and statistical analyses were employed to assess for any potential publication bias. Results: This review analyzed a total of 12 main studies and reported that the overall prevalence of PSC was 42.42% (95% CI: 33.42–51.42). However, there was significant heterogeneity in the results based on the study region, design, and seizure-free period. The subgroup analysis revealed that the highest prevalence of PSC was found in Southern Nations, Nationalities, and Peoples' (SNNPs) studies (61.88%; 95% CI: 35.91–87.85), studies with a cross-sectional design (46.73%; 95% CI: 36.83–56.62), and studies with a seizure-free period < 6 months (44.69%; 95% CI: 34.51–54.86). However, the lowest prevalence was observed in the Amhara region (35.54%; 95% CI: 27.40–43.67), cohort studies (29.53%; 95% CI: 21.26–38.21), and studies with a seizure-free duration of six months or more (41.64%; 95% CI: 29.94–53.35). The results also revealed a significant correlation between PSC and medication nonadherence (4.64, 95% CI: 2.84–7.58), comorbidities (2.08, 95% CI: 1.01–4.26), and seizure type (3.59, 95% CI: 1.18–10.8). Conclusion: Based on this review, the findings suggest a notable prevalence of poorly controlled seizures (PSC) among children with epilepsy who are receiving antiepileptic drugs (AEDs) in Ethiopian outpatient epilepsy clinics. Seizures of tonic‒clonic status, comorbidities, and medication nonadherence were associated with poor seizure control. [ABSTRACT FROM AUTHOR]

Background: Infliximab therapy is effective in controlling symptoms and attaining clinical remission of immune-mediated inflammatory diseases. However, treatment adherence is essential to achieve the therapeutic objective. This study aimed to determine the rate of adherence to infliximab treatment in patients treated at a referral center at a university hospital. Method: This ambispective cohort study included patients treated at the Professor Edgard Santos University Hospital (HUPES) referral center of our university hospital between March 2022 and February 2023. Sociodemographic, clinical, and pharmacotherapeutic data were collected from 101 patients through interviews and medical record reviews using a structured form. The adherence rate was defined as the proportion of days covered in a year. Patients who achieved an adherence rate > 80% were considered adherent. Results: The treatment adherence rate was 91.04%. Individuals with inflammatory bowel diseases had a 39.1% higher risk of non-adherence to treatment compared with other patients in our sample (p < 0,05). Most patients achieved remission or control of the underlying disease activity and had good functional capacities. The main reason for absence on the scheduled date was difficulty traveling to the referral center. Conclusions: Despite the reported difficulties, treatment adherence was observed to be high. As the study was conducted in a reference unit with multidisciplinary care and continuous monitoring for treatment effectiveness, safety, and adherence, welcoming and good communication between professionals and patients may have contributed to the high adherence rate. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia and substance use disorders (SUDs) are often comorbid conditions that present clinical challenges due to their heterogeneity and the difficulties associated with poor physical health, low medication adherence, high relapse and hospitalization rates, and increased risk of mortality. This is often exacerbated by a fragmented health care system that treats addiction and mental illness separately, leading to delays in proper diagnosis and treatment. Main text: The aim of this narrative review, based on an extensive literature search and experts' clinical experience, is to synthesize evidence on the psychopathological and clinical characteristics of patients, the burden and management at the level of healthcare system, and possible gaps in the treatment of schizophrenia with comorbid SUD in order to understand and address the needs of patients. Treatment options, differences between antipsychotic medications, and the benefits of long-acting formulations and partial dopaminergic agonists are described. Partial dopamine agonists (aripiprazole, cariprazine, and brexpiprazole) have demonstrated good control of psychotic symptoms and SUDs with a favorable safety profile. Conclusion: Pharmacological interventions should be accompanied by psychosocial support within an integrated and multidisciplinary approach that promotes shared decision-making and a good therapeutic alliance between the entire medical team and the patient. [ABSTRACT FROM AUTHOR]

Objective: This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity. Methods: The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD). Results: The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25–0.40) with adherent patient rates (PDC ≥0.80) between 8.0–17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7–11.4% of patients were adherent. Conclusions: PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence. [ABSTRACT FROM AUTHOR]

Background: Transfusion-dependent β-thalassemia (TDT) is a severe inherited disorder. Without regular treatment, patients with TDT experience complications that can significantly shorten life expectancy and severely impact both their quality of life and that of their families. The condition has attracted significant attention in global health discussions. Due to the challenges of blood supply shortages, the high costs of iron chelation therapy, and hematopoietic stem cell transplantation (HSCT), TDT presents a serious health risk to patients and imposes a substantial burden on families and society. However, research on the health-related quality of life (HRQoL) of thalassemia patients in China remains limited. This study evaluated the factors affecting the HRQoL of these patients, with the goal of developing strategies to improve their quality of life. Methods: In this cross-sectional study, children with TDT were recruited from five treatment centers in Guangxi, a province with a high prevalence of thalassemia in China. Structured questionnaires were employed to gather relevant data on sociodemographic variables, disease characteristics, treatments, and associated costs. The HRQoL was assessed using the Transfusion-Dependent Quality of Life (TranQoL) questionnaire, with a proxy version for patients aged 0–11 years and a child version for those aged 12–18 years. Results: The study included 418 participants, yielding an overall TranQoL score of 60.6 ± 16.3 among thalassemia patients. Multiple linear regression analysis revealed a negative correlation (P < 0.05) between overall TranQoL scores and several factors: increasing patient age, the presence of multiple thalassemia patients within a family, and undergoing HSCT. Conversely, adherence to regular treatment was positively correlated with higher TranQoL scores (P < 0.05). Conclusion: The study demonstrates that HRQoL among Chinese patients with TDT is at a low level. Age, treatment adherence, family support, and socioeconomic status were identified as key determinants influencing HRQoL. It is essential to further enhance and optimize health insurance policies and medical services to support comprehensive treatment strategies for these patients. [ABSTRACT FROM AUTHOR]

Quetiapine myristate (QM), an ester‐bonded lipophilic prodrug of quetiapine (QTP), is synthesized and converted into an amphiphilic structure in acidic pH to trigger a novel self‐assembled QM nanosuspension (QMN). Following injection, this QMN rearranges within physiological pH to form nanoaggregates in structure, resulting in enhanced physicochemical properties and in vivo therapeutic performance without an initial burst release. The 200‐nm‐sized QMN exhibits less invasive injection, higher drug content, and better storage stability profile than conventional poly(lactide‐co‐glycolide) (PLGA) nanosuspensions containing QTP or QM. Following a single intramuscular injection to beagle dogs (35 mg kg−1 QTP), QMN undergoes pH‐responsive nanoaggregation to form the lipophilic prodrug, providing esterase‐oriented sustained release for five weeks compared with the two‐week period of PLGA nanosuspensions. Notably, QMN exhibits improved in vivo pharmacokinetic performance with long‐acting delivery while minimizing issues associated with polymeric PLGA formulations, including the initial massive burst release, cellular toxicity, and adverse side effects. These results support the further development of QMN as a novel long‐acting injectable to improve patient compliance and dosing frequency. [ABSTRACT FROM AUTHOR]

Background: Family support in patients with tuberculosis (TB) in a concept that does not have definition and attributes that clarify the evolution of the concept, its usefulness, and practicality in the context of science. Objective: To clarify the progress of the concept of family support in patients with TB in the nursing area through the concept analysis technique. Data Source: We searched the databases MEDLINE (via PubMed), EMBASE, Google Scholar, ScienceDirect, Ovid Nursing, and Scopus. The keywords used were "family support," "tuberculosis," and "nursing" combined with the Boolean operator "AND" as follows: ((family support) AND (tuberculosis)) AND (nursing). Method of Revision: The method of concept analysis proposed by Hupcey and Morse was used, which consists of four principles: epistemological, linguistic, logical, and pragmatic. Results and Discussion: Epistemologically, it was established that family support offers a positive influence that facilitates and strengthens interrelationships with the other; linguistically, it was found that its definition as support and trust is consistent with the literature; logically, it was determined that there are theories that address family support and family interrelationships as a priority source for treatment; and in the pragmatic, the maturity of the concept is not declared, but the presence of empirical indicators that validate the attributes in science is declared. Conclusion: The use of the methodology contributed to the identification of the attributes of the concept and some definitions, instruments, and usefulness in different disciplines. [ABSTRACT FROM AUTHOR]

Background: Youths with HIV/AIDS encounter a variety of unique challenges that impact their physical, mental, emotional, and social well-being. These challenges and experiences differ across settings, populations, cultures, and the broader socio-economic and political contexts. This study focuses on exploring the life challenges, experiences, and coping mechanisms of youths living with HIV/AIDS in public hospital facilities in southwest Ethiopia. Methods and study approach: The study was conducted in two regional states of Ethiopia. Using a phenomenological study approach, researchers focused on purposefully selected youths living with HIV/AIDS in public hospital facilities. Data were gathered through life history and in-depth interview techniques, delving deeply into the participants' lived experiences and feelings about the challenges of living with HIV/AIDS. The study population consisted of youths with HIV/AIDS who were currently using antiretroviral medication in two selected public hospitals. A total of 12 participants were employed and completed the study. Results: The findings indicated that youths with HIV/AIDS face complex life challenges, influenced by psychological, emotional, and social factors. These intertwined challenges impact their self-management, treatment adherence, and ability to create and maintain healthy social relationships and roles. Many youths avoid social interactions and do not seek the necessary social support, believing they are unworthy of respect and care. Consequently, they may live in despair and constant fear of rejection, lacking the social support they desperately need. Substance abuse is prevalent among these youths due to the psychosocial, biological, emotional, and material aspects of their experiences. [ABSTRACT FROM AUTHOR]

Background Aim Method Results Conclusion Venous thromboembolism is among the main causes of maternal morbidity and mortality, with caesarean section (CS) delivery carrying greater risk. Outpatient thromboprophylaxis, such as enoxaparin, is administered subcutaneously and prescribed as an outpatient; raising the issue of medication adherence.This study aimed to evaluate women's adherence to enoxaparin administration after CS delivery, explore the reasons for non‐adherence, and assess the factors associated with patients' adherence to enoxaparin.Women after CS delivery, who had been given enoxaparin at discharge were included in the study. Eligible patients were contacted via telephone at the middle and the end of the enoxaparin treatment. Syringe count determined the main outcome of adherence during direct telephone interviews with the patient. Optimal adherence was defined as all the doses of enoxaparin being administered and suboptimal adherence was at least one dose not administered. Ethical approval was granted by the Malaysian Registry Ethics Committee belonging to National Medical Research Registry (Reference no: NMRR ID‐22‐02859‐P41) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants through completion of written consent forms, after an explanation of the study was provided by investigators.Out of 201 women included, the majority (91.5%) were fully adherent to enoxaparin, while 8.5% missed at least one dose. Most patients administering at home missed the dose due to reporting they were unwell (n = 6), busy (n = 4), or forgot to administer (n = 2). Among missed doses in patients administered in a healthcare setting, all participants (n = 5) forgot to bring their medication to the appointment. Only medication knowledge had a significant association with adherence to enoxaparin administration (p = 0.008).The study raised concern about the substantial percentage of patients missing at least one dose of enoxaparin, particularly among patients injecting at home. Initiatives should focus on customised enoxaparin administration counselling and providing educational materials. [ABSTRACT FROM AUTHOR]

Introduction: Squamous cell carcinoma of the head and neck (SCCHN) is a multifactorial disease involving genetic and environmental factors representing one of the most frequent cancer-related deaths worldwide. Tobacco and alcohol use account for most SCCHN, while a growing subset of oropharyngeal cancers is causally associated with human papillomavirus (HPV) infection. Despite improvements in overall survival, patients with HPV-negative locally advanced (LA) SCCHN continue to have a poor prognosis. For these patients, the standard of care is radiotherapy with concurrent chemotherapy (RCT). Methods: This retrospective, multicenter, and observational study analyzed the treatment compliance of 326 patients with LA-SCCHN who underwent RCT between January 1st, 2014, and June 30th, 2017. This study also evaluated the potential factors associated with treatment compliance, the compliance impact on clinical response, and the main toxicities experienced by patients. Results: A total of 274 (84%) patients were compliant and received the planned dose of cisplatin. Overall, 957 adverse events were reported in 98.2% of patients during the study. The overall response rate was 80.2%, with 60.4% of patients achieving a complete response. Discussion: Despite the high treatment compliance, 62.6% of adverse events reported were related to cisplatin. Identifying risk factors associated with non-compliance could enable physicians to identify ineligible patients for cisplatinbased RCT and prevent patients from receiving inadequate treatment leading to severe adverse events.. [ABSTRACT FROM AUTHOR]

Introduction: Long-acting injectable (LAI) antipsychotic medications and clozapine are effective yet underutilized medical therapies in early intervention services. The purpose of this study was to conduct a pre-implementation evaluation of contextual determinants of early intervention programs to implement innovations optimizing LAI antipsychotic and clozapine use within a shared decision-making model. Methods: Semi-structured interviews explored barriers and facilitators to implementing LAI antipsychotics and clozapine in early intervention services. Participants were: prescribers (n = 2), non-prescribing clinicians (n = 5), administrators (n = 3), clients (n = 3), and caregivers (n = 3). Interviews were structured and analyzed using the Consolidated Framework for Implementation Research (CFIR 2.0). Results: Participants were supportive of using LAI antipsychotics, despite barriers (e.g., transportation, insurance coverage), while most were unfamiliar with clozapine (Innovation). Critical incidents (e.g., COVID-19) did not interfere with implementation, while barriers included lack of performance measures; stigma affecting willingness to take medication; and clozapine considered to be a "last resort" (Outer Setting). Treatment culture was described as clientcentered and collaborative, and most participants indicated LAI antipsychotic use was compatible with clinic workflows, but some were in need of resources (e.g., individuals trained to administer LAI antipsychotics; Inner Setting). Participants on the healthcare team expressed confidence in their roles. Family education and collaborative decision-making were recommended to improve client/family engagement (Individuals). Participants related the importance of tracking medication compliance, addressing client concerns, and providing prescribers with updated guidelines on evidence-based treatment (Implementation Process). Discussion: Results may guide implementation strategy selection for future programs seeking to optimize the use of LAI antipsychotics and clozapine for early-phase schizophrenia, when appropriate. [ABSTRACT FROM AUTHOR]

The need for a comprehensive patient experience model across healthcare sectors is crucial. This study introduces IEXP's five-dimension model: physical, emotional, social, cultural, and healthcare. Unlike hospital-centric frameworks, this model acknowledges holistic experiences, vital for chronic conditions. Applied to chronic obstructive pulmonary disease (COPD) and spinal cord injury (SCI), it showcases its adaptability. This model benefits healthcare, patient groups, pharmaceuticals, and medical tech, optimizing care, policy support, adherence, and patient-focused tech. Despite limitations and a chronic condition focus, the model adds value in shaping patient experience cross-sector. [ABSTRACT FROM AUTHOR]

Background: Assessing pain in critically ill patients who cannot communicate verbally poses significant challenges. Traditional self-report measures are ineffective for these patients, making the need for reliable observational tools crucial. Objective: To evaluate the effectiveness, reliability, and clinical applicability of the Critical Care Pain Observation Tool (CPOT) in various intensive care unit (ICU) settings and to explore potential innovations for improving its use and integration into clinical practice. Methods: A narrative review evaluated the Critical Care Pain Observation Tool (CPOT) for non-communicative ICU patients, comparing it to the Behavioral Pain Scale (BPS) and the FLACC scale. The review assessed CPOT's effectiveness across different ICU settings, identified limitations and challenges, and explored potential enhancements such as electronic scoring, additional physiological indicators, and improved training protocols. Results: The CPOT has been validated as an effective pain assessment tool for non-verbal ICU patients. It evaluates pain through facial expressions, body movements, muscle tension, and ventilator compliance. The CPOT shows superior sensitivity at 76.5% compared to 62.7% for the BPS and offers a more comprehensive assessment of pain indicators like muscle tension and ventilator compliance than the FLACC scale. Despite its strengths, the CPOT has limitations, including inter-rater variability and challenges in certain patient populations. Barriers to implementation include resource constraints and the need for extensive training. Conclusion: The Critical Care Pain Observation Tool (CPOT) is a highly effective instrument for assessing pain in non-verbal ICU patients, demonstrating superior accuracy and reliability compared to other tools like the Behavioral Pain Scale (BPS) and FLACC scale. Its detailed approach, covering facial expressions, body movements, muscle tension, and ventilator compliance, offers a detailed measure of pain. However, challenges such as inter-rater variability and limitations in specific patient populations highlight the need for ongoing refinement and research. [ABSTRACT FROM AUTHOR]

Introduction: Noninvasive ventilation (NIV) is widely used for sequential extubation in patients with chronic obstructive pulmonary disease (COPD). However, NIV may cause many adverse events such as claustrophobia, facial skin compression, air leakage, bloating, and even reflux aspiration, resulting in poor patient compliance/tolerance and high failure rate, especially for older adults who are at high risk of communication difficulties and consciousness disorder. High-flow nasal cannula (HFNC) oxygen therapy is a new alternative support to NIV, but whether it can effectively reduce the rate of re-intubation after extubation in elderly patients with COPD remains controversial. The purpose of this study is to explore the safety and efficacy of HFNC versus NIV for elderly COPD patients after extubation. Methods and analysis: This study is an investigator-initiated, single-center, prospective, non-inferior, randomized controlled trial. Elderly patients (age > 65 years) who have received invasive ventilation and was diagnosed with COPD will be randomly assigned to HFNC group or NIV group immediately after extubation with a planned enrollment of 168 patients. The primary outcomes will be reintubation rates at 72 h and 7 days after extubation. Secondary outcomes will include treatment failure, post-extubation vital signs and arterial blood gases, the scores of compliance and comfort of patients, duration of respiratory support after extubation, respiratory support related adverse events, sleep quality scores, usage of sedative and analgesic drugs after extubation, and the incidence of delirium. Additionally, clinical outcomes such as ventilator-free days at 28 days post-randomization, tracheotomy rate, duration of intensive care unit (ICU) and hospital stay, ICU and hospital mortality will be evaluated. Ethics and dissemination: This study has been approved by the Ethics Committee of West China Hospital of Sichuan University (2023–2284). Informed consent is required. It is expected that a follow-up randomized controlled trial will be conducted. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. Trial registration: The study was retrospectively registered at ClinicalTrials.gov (ChiCTR2400087312). [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Comprehensive eye exams are recommended at least every 2 years for people with diabetes for early identification and treatment of diabetic eye disease, but screening rates remain suboptimal. Our objective was to qualitatively assess barriers and facilitators to completing recommended eye exam screening for patients with diabetes among providers and practice staff. Methods: As part of a larger initiative, we conducted discussion groups with healthcare providers and practice staff to evaluate factors related to referral and screening for diabetic eye disease at 2 sites, a safety-net healthcare system and a specialty clinic. Discussions were audio-recorded and transcribed. Combined inductive, deductive thematic content analysis was conducted, applying the Practical Robust Implementation and Sustainability Model to organize themes and subthemes. Results: Two discussion groups with 28 participants were conducted in August 2023. Themes included existing processes for referrals, scheduling, and tracking; patient-level determinants including transportation and financial barriers and other competing demands to receiving recommended eye screening; clinic or system-related factors, and considerations for process improvement for eye exam referrals and appointments. Conclusions: These findings can be applied to determine the most effective strategies to improve the rates of recommended eye exam referral and screening rates in people with diabetes. [ABSTRACT FROM AUTHOR]

Virtual community-based programming for people with disabilities has become a popular method for advocating for health promotion, specifically exercise, for people with disabilities (PWD). Using theoretical frameworks to better understand the perspective of PWD who participate in virtual exercise programs allows strategies of implementation following completion of virtual exercise programs. The objective of this study was to examine the effect adherence had on perceptions, experiences, and post-program exercise maintenance in participants with disabilities. Eight qualitative interviews were conducted in highly adherent participants using the Social Cognitive Theory (SCT). Interviews were recorded on Zoom, transcribed using Microsoft 365, and analyzed using NVivo software. Data were analyzed by the primary author and an independent coder to increase rigor and reduce bias. Thirty-five unique codes were generated from transcribed interviews. Member-checking was employed to increase internal validity; 100% of participants agreed with the findings. Results demonstrate an overall positive experience in the virtual exercise program, noting specific facilitators (i.e., knowledgeable instructor, program provided equipment, etc.) and barriers (i.e., limited physical space at home to exercise, other participant's attitudes, etc.) of participating. Impressionably, 100% of participants maintained exercise following their time within the virtual exercise program. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety is a global problem in the realm of pediatric dentistry. The use of procedural sedation is recommended to avoid substandard or unsafe dental treatment in preschoolers. This study aimed to compare the effect sedation with Dexmedetomidine with or without Midazolam in terms of sedation level, analgesic effect and ease of treatment completion in preschool children. Methods: A triple blind randomized controlled clinical trial comprised 72 healthy uncooperative children, 4–6 years old, were randomly allocated into three groups of 24 patients each: Group I patients were sedated with nebulized 5 μg/kg Dexmedetomidine (DEX), Group II with nebulized 3 μg/kg DEX followed by nebulized 0.3 mg/kg Midazolam (MID), and Group III with nebulized 0.5 mg/kg MID. Along the session, the three regimens were assessed and compared during the sedation level (children responsiveness) using the Modified Observer's Assessment of Alertness/Sedation Scale, the analgesic effect using the Face, Leg, Activity, Cry, Consolability scale and ease of treatment completion using a separate 5-point scale. Vital signs were recorded before and during sedation, until full recovery. Results: A significant difference was detected regarding children responsiveness during operative procedure in favour of DEX in comparison to MID and DEX/MID groups (P = 0.045). Within the DEX group, a significant difference was recorded regarding children responsiveness at optimum sedation and during the operative procedure (P = 0.04). Although, the analgesic effects of sedative drugs showed no statistically significant difference among the study groups (P = 0.20), the ease of treatment completion was statistically higher in the DEX than MID and DEX/MID groups (P = 0.03). Conclusion: Dexmedetomidine provides a moderate level of sedation, that allowed better patient cooperation, and easy completion of performed dental procedures. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness of different pain mitigation methods during orthodontic debonding and to evaluate pain sensitivity across various regions of the dentition. A total of 144 participants (50 males and 94 females) with metal brackets were randomly assigned to one of four groups: High-Frequency Vibration (V), Cotton Roll (CR), Elastomeric Wafer (EW), and Open Mouth group (OM). Pain levels were measured using the Visual Analog Scale (VAS) across different sextants of the dentition. The Kruskal-Wallis test and post hoc analyses were conducted to compare VAS scores between groups. The Mann-Whitney test was used to analyse sex-based differences. The V group, utilizing high-frequency vibration, had the lowest total VAS score, indicating superior pain relief compared to CR, EW, and OM groups. No significant difference was observed between the CR and EW groups. Median VAS scores were highest in the lower front sextant, followed by the upper front sextants, and lowest in the posterior regions, indicating greater pain sensitivity in the anterior regions during debonding. High-frequency vibration was the most effective method for reducing pain during orthodontic debonding, particularly in the anterior dental regions. Both CR and EW methods were also effective but to a lesser extent. These findings suggest that high-frequency vibration could significantly improve patient comfort during orthodontic procedures. Utilizing high-frequency vibration for orthodontic debonding can enhance patient comfort, especially in the more sensitive anterior dental regions, thereby potentially improving treatment compliance and experience. Trial registration: NCT05904587. [ABSTRACT FROM AUTHOR]

Background: Protease inhibitor (PI)-based Antiretroviral Therapy (ART) regimens are key drugs in HIV management, especially when used as second line drugs. However, some PI-based ART have high adherence demands or tolerable adverse effects which may affect adherence and subsequently viral suppression. We assessed the extent of viral suppression, its determinants, and the experiences of clients on PI-based ART undergoing intensive adherence counselling (IAC) in a public HIV clinic. Methods: Mixed methods sequential explanatory study involving a quantitative retrospective chart review for clients on PI-based ART who had received IAC from Dec 2016 to May 2023 and qualitative interviews for clients on PI-based ART who had received IAC in the past six months at an urban public HIV clinic in Uganda. Results: In this study, a total of 189 client charts were included. The median number of IAC sessions received was three (interquartile range, IQR, of 3 to 4) with median time of receiving IAC of three (IQR, of 2 to 4). One half (51%, 95/186) of the clients had achieved viral suppression and the odds of suppression increased by 30% for every additional month on IAC. Respondents perceived the effectiveness of PI-based ART and IAC in achieving and supporting viral suppression, respectively. Conclusion: Despite the perceived effectiveness of PI-based ART and IAC, suboptimal levels of viral suppression were observed among clients on PI-based ART who had received IAC. Therefore, it is important to provide IAC for optimal duration as it increases the chances of viral suppression. Further investigation of the barriers of viral suppression for clients on PI-based ART undergoing IAC is needed. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the impact of Mobile health (M-health) on medication time adherence among people living with HIV/AIDS (PLWHA). Methods: The study included all PLWHA who were receiving care at the Federal University Teaching Hospital Owerri (FUTH) and Imo State Specialist Hospital (ISSH) Umugumma during the study duration. The test group (FUTH) received a 2-way text message sent three times a week and a once-a-week phone call, while the control group (ISSH) received only the standard care. Findings: The result shows that the adherence was higher among PLWHA in the test group compared to those in the control group (P = 0.000, χ2 = 168.62, 95% confidence interval (CI): 7.22 to 16.19). Conclusion: M-health intervention significantly improved the medication time adherence among the participants in the test group compared to those in the control group. [ABSTRACT FROM AUTHOR]

Background: Peer support is a promising and significant way for people living with HIV (PLWH) to improve their health outcomes. Matching PLWH with HIV peer volunteers can effectively stimulate and mobilize the function of peer support in health management. We develop the online platform Aspark, which features a precision matching function for PLWH and volunteers. This protocol provides a comprehensive overview of the randomized controlled trial design based on Aspark. Method: A parallel randomized controlled trial using block randomization will be conducted at the Beijing YouAn Home of Loving Care. The intervention group (n = 70) will have access to all 12 features of Aspark, including precise volunteer matching, health management tools, drug interaction queries, and medication reminders. The control group (n = 70) will have access to two features of informational support on Aspark. The outcomes of both groups will be evaluated at baseline and at 3, 6, 9, and 12 months after platform registration. The primary outcome is perceived social support. The secondary outcomes include mental symptoms, quality of life, self-efficacy, medication adherence, and health behaviors. Linear mixed models or generalized linear mixed models will be applied to test the intervention effects. Discussion: The Aspark trial is a randomized controlled trial designed to examine the influence of a mobile health (mHealth) application that integrates peer support and precision matching to strengthen social support for PLWH in China. This trial has the potential to significantly enhance social support for PLWH while also optimizing the delivery of peer support services and fully mobilizing the role of peer support in the overall health management of PLWH. Trial registration: Clinical registration number: ChiCTR2300077454. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the health-related quality of life (HRQOL) and investigate the variables contributing to reduced HRQOL in patients with rheumatoid arthritis. Methods: The present cross-sectional study was conducted on patients diagnosed with rheumatoid arthritis at two teaching hospitals in Jordan using a convenience sampling technique. The participants were interviewed face-to-face during the scheduled appointment at the outpatient rheumatology clinic. The HRQOL was evaluated by the validated EuroQol-5 Dimension (EQ-5D) questionnaire, which included the EQ-5D utility index that evaluated HRQOL in terms of 5 domains, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and the EQ-5D visual analogue scale (EQ-5DVAS), which evaluated HRQOL on a vertical scale ranging from 0 (worst imaginable health) to 100 (best imaginable health). The validated short version of the 19-item Compliance Questionnaire for Rheumatology (CQR-5) was used to evaluate medication adherence. The Clinical Disease Activity Index (CDAI) was used to assess disease activity among the study participants. A stepwise quantile regression model (q = 0.5) was conducted to explore the factors associated with the EQ-5DUtility Index and EQ-5DVAS scores. Results: In total, 261 patients with RA participated in the study. The median (interquartile range) of the EQ-5DUtility Index and EQ-VAS scores was 0.552 (0.006–0.726) and 0.506 (0.233–0.690), respectively. Regression analysis results demonstrated that medication non-adherence (regression coefficient (β) = -0.348, P<0.01), not performing regular physical activity (β = -0.209, P<0.01), and higher disease activity as measured by the CDAI score (β = -0.015, P<0.01) were significant predictors of a lower EQ-5DUtility Index score. In addition, medication non-adherence (β = -0.199, P<0.01), not performing regular physical activity (β = -0.117, P<0.01), increased body mass index (BMI) (β = -0.009, P<0.01), and higher CDAI score (β = -0.009, P<0.01) were significant predictors of low EQ-5DVAS score. Conclusions: Patients with RA experienced significantly impaired HRQOL. Medication non-adherence, not performing regular physical activity, increased body weight, and increased disease activity were identified as determinants of poor HRQOL among patients with RA in the present study. Treating physicians should encourage regular physical activity, maintaining a healthy body weight, and controlling disease activity to improve HRQOL in patients with RA. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Aims Methods Results Discussion Implications for Practice It is known that treatment compliance is low and aggression is higher in individuals diagnosed with schizophrenia compared to the normal population. Cognitive behavioural therapy (CBT) is known to reduce relapse and hospitalisation and increase well‐being in individuals diagnosed with schizophrenia. However, there are almost no studies on increasing treatment compliance and decreasing aggression.This study was conducted to determine how CBT–based psychoeducation affects medication adherence and aggression in individuals diagnosed with schizophrenia.The study was conducted as a quasi‐experimental model with the pre‐test–post‐test control group with 73 schizophrenic patients (33 experimental, 40 control) between June 2022 and July 2023. Data were collected using the Descriptive Characteristics Form, Morisky Medication Adherence Scale (MMAS) and Buss–Perry Aggression Questionnaire (BPSQ). The schizophrenic patients in the experimental group were given eight sessions of CBT‐based psychoeducation, while the schizophrenic patients in the control group were not given any training. The data were analysed using mean, standard deviation, chi‐squared test, dependent samples t‐test and independent samples t‐test.It was determined that the aggression level of the experimental group before the training was 80.51 ± 19.38, and after the CBT‐based psychoeducation, it was 73.12 ± 15.28. It was determined that the aggression level of the control group before the training was 84.22 ± 12.13, and after the post‐test, it was 85.60 ± 11.72. It was determined that the medication adherence level of the experimental group before the training was 2.75 ± 1.25, and after the CBT‐based psychoeducation, it was 3.57 ± 0.67. It was determined that the medication adherence level of the control group before the training was 2.05 ± 1.33, and after the post‐test, it was 2.17 ± 1.36. The psychoeducation based on CBT caused a statistically significant difference (p = 0.001) in medication adherence and aggression levels in the experimental group.It was determined that CBT applied to individuals diagnosed with schizophrenia was effective on increasing their medication adherence and reducing their aggression. It is recommended for psychiatric nurses to include CBT‐based psychoeducation in their nursing practices in order to increase medication adherence and reduce aggression in individuals with schizophrenia.The findings emphasise that CBT‐based psychoeducation increases treatment adherence and significantly decreases the level of aggression in individuals diagnosed with schizophrenia. Psychiatric nurses should include CBT‐based psychoeducation in their treatments. [ABSTRACT FROM AUTHOR]

Background Objective Method Results Conclusions Preventing errors associated with medication administration is achievable through nurses’ adherence to correct principles.This study aims to investigate the relationship between nurses’ adherence to medication administration principles and their attitudes toward patient safety.This study adopts a descriptive and relationship‐seeking research design. A total of 310 nurses who met the inclusion criteria participated in the study. Data collection tools included the “Nurse Information Form,” “Medication Administration Principles Adherence Form,” and “Patient Safety Attitude Scale”.Among the participating nurses, 32.9% (n = 102) reported experiencing a medication administration error, and 77.7% (n = 241) witnessed such an error. The study revealed a statistically significant positive relationship between nurses’ adherence to medication administration principles and their attitudes toward patient safety (p < 0.001).This study underscores the importance of nurses’ adherence to medication administration principles in ensuring patient safety. [ABSTRACT FROM AUTHOR]

Background: Mediterranean diet (MD) adherence is critical for an individual's physical and mental health. Cardiovascular diseases (CVDs) are the leading cause of death in Bangladesh and are closely associated with diabetes mellitus (DM) and dyslipidemia. This study aims to determine the level of adherence to the MD among patients with type 2 diabetes mellitus (T2DM) and identify any association between poor adherence to the MD and dyslipidemia. Methods: This facility-based cross-sectional study was conducted in the outpatient department of a tertiary care hospital from March to May 2021. A total of 251 T2DM patients were interviewed. Bivariate and multivariate analyses were carried out using a logistic regression model with SPSS 23 statistical package software. Results: The prevalence of dyslipidaemia was 83% among T2DM patients. There was a high prevalence of hypertension (61%), overweight or obesity (57%), cardiovascular problems (30%), kidney disease (19%), and sleep problems (28%). Low adherence to MD was highly prevalent (49%) among participants, and another 28% had medium adherence. Patients with poor MD adherence had higher odds of developing dyslipidaemia (AOR: 2.8, 95% CI 1.18–6.63). Normal-weighted patients had lower odds of developing dyslipidaemia (AOR: 0.40, 95% CI 0.18–0.89) compared to overweight or obese individuals. Conclusions: There was a relatively low adherence to MD among T2DM patients, which is a significant predictor of dyslipidemia. Therefore, T2DM patients should be more conscious of their dietary habits to control dyslipidemia and cardiovascular diseases effectively. [ABSTRACT FROM AUTHOR]

Background: Patient education is a crucial strategy for promoting prevention and diabetes self-management since glycemic control achievement involves taking medications, medical nutrition therapy, physical exercise, and behavior changes. However, patient education programs are still barely implemented in low- and middle-income countries. This trial aims to investigate whether a lifestyle education intervention added to physical exercising is superior to sole physical exercising regarding functional capacity, disease-related knowledge, health behaviors, cardiometabolic health parameters, quality of life, depression, and diet quality in individuals with prediabetes or diabetes. Methods: Multicenter double-blinded randomized controlled trial with two parallel arms involving 12-week intervention and 6-month follow-up. The eligible individuals (≥ 18 years, living with prediabetes or diabetes, literate, no clinical decompensation and/or physical and/or mental limitations that contraindicate physical exercising, written physician permission for exercise, no cognitive impairment, no vision limitations for reading, no confirmed diagnosis of unstable coronary disease or heart failure, no pacemaker and/or implantable cardioverter-defibrillator, no complex ventricular arrhythmias, no intermittent claudication, no recent cardiovascular event or cardiac surgery, and no currently enrolled in a structured exercise program) were recruited from two Brazilian cities and randomized to either (1) an Exercise and Lifestyle Education Program (ExLE) or (2) an Exercise Program (Ex), which can be delivered on-site or remotely based on the participants' internet access and technology literacy. The primary outcomes will be changes in functional capacity and disease-related knowledge. The secondary outcomes will involve changes in health behaviors (health literacy, physical activity level, exercise self-efficacy, and medication adherence) and cardiometabolic health parameters (glycemic control, anthropometric measures, and cardiac autonomic control). Program adherence, satisfaction with the program, diabetes-related morbidity, and changes in quality of life, depression, and diet quality will be the tertiary outcomes. Assessments will occur at baseline, post-intervention, and after 6-month follow-up. Discussion: If superior effectiveness of ExLE compared to Ex program to improve the outcomes measures is found, this program could be delivered broadly in the Brazilian health system, especially in the primary care facilities where most individuals living with prediabetes and diabetes in our country are assisted. Trial registration: ClinicalTrials.gov, NCT03914924. Registered on April 16, 2019. [ABSTRACT FROM AUTHOR]

Introduction: In recent decades, an increase in the incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has been observed. Pediatric‐onset T2DM differs from the adult‐onset form, particularly regarding the durability of glycemic control and earlier appearance of complications. However, the scarcity of approved treatments and comprehensive studies on T2DM management in youth persists. Ongoing clinical trials seek to ascertain the efficacy and safety of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) in patients aged between 10 and 24 years with T2DM. Therefore, we aimed to perform a meta‐analysis exploring the efficacy and safety of SGLT2i in pediatric patients and young adults with T2DM. Methods: We searched PubMed, Embase, Cochrane, and Web of Science for randomized controlled clinical trials on the efficacy and safety of SGLT2i in children, adolescents, and young adults with T2DM compared with placebo. Statistical analysis was performed using RevMan 5.4 and R statistical software 4.2.1. Heterogeneity was assessed with I2 statistics. Results: We included three studies totaling 334 patients followed for 37.79 weeks. Reduction in HbA1C (MD = −0.93; 95% CI = −1.36 to −0.49; p < 0.0001; I2 = 0%) was significantly higher in SGLT2i group compared with placebo. The proportion of patients requiring rescue or discontinuation of study medication due to lack of efficacy was statistically lower in SGLT2i group compared with placebo (RR = 0.64; 95% CI = 0.43–0.94; p = 0.02; I2 = 0%). SGLT2i and placebo were similar in terms of any adverse event (RR = 1.10; 95% CI = 0.96–1.27; p = 0.17; I2 = 0%), serious side effects (RR = 1.06; 95% CI = 0.44–2.57; p = 0.90; I2 = 0%), and individual adverse effects. Conclusion: In children, adolescents, and young adults with T2DM, SGLT2i appears to be effective and safe for glycemic control. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Long‐acting injectable antipsychotics (LAIs) are not routinely offered to patients living with bipolar disorder type I (BP‐I), despite widespread evidence that supports their benefits over oral antipsychotics, particularly in early disease.A round‐table meeting of psychiatrists convened to discuss barriers and opportunities and provide consensus recommendations around the early use of LAIs for BP‐I.LAIs are rarely prescribed to treat BP‐I unless a patient has severe symptoms, sub‐optimal adherence to oral antipsychotics, or has experienced multiple relapses. Beyond country‐specific accessibility issues (e.g., healthcare infrastructure and availability/approval status), primary barriers to the effective use of LAIs were identified as attitudinal and knowledge/experience‐based. Direct discussions between healthcare providers and patients about treatment preferences may not occur due to a preconceived notion that patients prefer oral antipsychotics. Moreover, as LAIs have historically been limited to the treatment of schizophrenia and the most severe cases of BP‐I, healthcare providers might be unaware of the benefits LAIs provide in the overall management of BP‐I. Improved treatment adherence associated with LAIs compared to oral antipsychotics may support improved outcomes for patients (e.g., reduced relapse and hospitalization). Involvement of all stakeholders (healthcare providers, patients, and their supporters) participating in the patient journey is critical in early and shared decision‐making processes. Clinical and database studies could potentially bridge knowledge gaps to facilitate acceptance of LAIs.This review discusses the benefits of LAIs in the management of BP‐I and identifies barriers to use, while providing expert consensus recommendations for potential solutions to support informed treatment decision‐making. [ABSTRACT FROM AUTHOR]

The prospective of percutaneous drug delivery (PDD) mechanisms to address the limitations of oral and injectable treatment for rheumatoid arthritis (RA) is increasing. These limitations encompass inadequate compliance among patients and acute gastrointestinal side effects. However, the skin's intrinsic layer can frequently hinder the percutaneous dispersion of RA medications, thus mitigating the efficiency of drug delivery. To circumvent this constraint, we developed a strontium ranelate (SrR)-loaded alginate (ALG) phototherapeutic hydrogel to assess its effectiveness in combating RA. Our studies revealed that this SrR-loaded ALG hydrogel incorporating photoelectrically responsive molybdenum disulfide nanoflowers (MoS2 NFs) and photothermally responsive polypyrrole nanoparticles (Ppy NPs) to form ALG@SrR-MoS2 NFs-Ppy NPs demonstrated substantial mechanical strength, potentially enabling delivery of hydrophilic therapeutic agents into the skin and significantly impeding the progression of RA. Comprehensive biochemical, histological, behavioral, and radiographic analyses in an animal model of zymosan-induced RA demonstrated that the application of these phototherapeutic ALG@SrR-MoS2 NFs-Ppy NPs effectively reduced inflammation, increased the presence of heat shock proteins, regulatory cluster of differentiation M2 macrophages, and alleviated joint degeneration associated with RA. As demonstrated by our findings, treating RA and possibly other autoimmune disorders with this phototherapeutic hydrogel system offers a distinctive, highly compliant, and therapeutically efficient method. [ABSTRACT FROM AUTHOR]

Background: We conducted a prospective, randomized, controlled, two-group parallel trial investigating the effectiveness of a care management program employing cardiac care navigators providing post-discharge support to patients compared to standard care. Methods: The intervention commenced in 2019/2020 for 2862 patients hospitalized with heart failure, coronary heart disease, or cardiac arrhythmias in departments of cardiology across eight participating sites of a hospital group in Berlin, Germany. We analyzed the results using an intention-to-treat approach. The primary outcome was the all-cause rehospitalization rate after 12 months. Secondary outcomes included rehospitalizations due to one of the qualifying cardiac diagnoses, duration of rehospitalization, mortality, health-related quality of life, and several process indicators. Trial data were collected from a combination of face-to-face and phone interviews conducted by hospital staff throughout the 12-month follow-up period using standardized questionnaires. Administrative claims data were provided by a large statutory health insurer. Outcomes for the intervention and control groups were compared using logistic regression, generalized linear models (GLMs) with a negative binomial distribution, ordinary least squares, and Cox proportional hazards regression. Results: Compared to the control group (N = 1294), the intervention group (N = 1256) had a lower rate of all-cause rehospitalizations (62.6% vs. 66.4%, p = 0.05) and shorter lengths of stay (14.49 vs. 16.89 days, p = 0.02) during the 12-month follow-up period. These differences were also present for rehospitalizations due to the cardiac diseases qualifying for study recruitment, with rehospitalization rates for the intervention and control groups being 58.0% vs. 61.4% (p = 0.08) and particularly pronounced for lengths of rehospitalization stay of 12.97 vs. 15.40 days (p = 0.01), respectively. Subgroup analyses indicated positive effects of the intervention for patients 70 years and older (p = 0.05), females (p = 0.06), and those with little or no German language proficiency (p = 0.03). Furthermore, we found positive effects on patients' adherence to health-related behavioral recommendations (81.91% vs. 73.95%, p = 0.000). Conclusions: This study adds to the body of evidence indicating that care management interventions supporting patients as they transition from the inpatient to the outpatient sector can lower rehospitalizations, decrease length of rehospitalization stays, and improve adherence to post-discharge recommendations. Trial registration: German Clinical Trial Register, DRKS00020424. Registered 2020-06-18. (retrospectively registered). [ABSTRACT FROM AUTHOR]

Minocycline is a commonly used drug for adjunctive therapy in periodontal disease. However, the current mainstream local medications primarily rely on intra‐pocket administration, which, while avoiding the side effects of traditional systemic drugs, presents challenges such as inconvenience, discomfort, and the need for professional assistance, thus affecting patient compliance. Herein, we introduce a minocycline‐loaded dissolvable microneedle (Mino‐DMN) patch that allows for local and efficient delivery of minocycline to gingiva for the treatment of periodontitis. A two‐step casting micro‐molding process involving vacuum drying and freeze drying is employed to concentrate minocycline in the microneedle part and limit its diffusion into the patch backing. The resulting Mino‐DMN patch features an array of minocycline‐enriched gelatin MNs with a porous HA patch backing. The microneedles can penetrate into gingiva with enough mechanical strength and quickly release minocycline into the gingival tissue, ensuring prolonged local residence of the drug and minimizing its loss to saliva. In vivo experiments show Mino‐DMN inhibits pro‐inflammatory factors, promotes anti‐inflammatory factors, and stimulates bone formation, surpassing topical application and comparable to the inconvenient and discomfort administration of Periocline®. This proposed Mino‐DMN offers a simple, efficient, user‐friendly strategy for the adjunctive treatment of periodontal disease. [ABSTRACT FROM AUTHOR]

To meet legislative requirements in Australia, the balance of controlled drugs (CDs) must be confirmed after completion of each transaction. This is particularly challenging for liquid CD formulations, and over the years, health organisations have implemented various methods of performing this task, including the use of visual aids or conversion of bulk formulations to individual unit doses. These methods have a number of limitations. Therefore, this study aimed to evaluate the accuracy and feasibility of a weight‐based method for confirming oral liquid CD balances packed in multidose containers. This study was conducted in a palliative care ward of a metropolitan hospital over a 41‐day period. Morphine mixture 5 mg/1 mL transactions and balance checks were confirmed using weight calculations of the product bottle. The weights were then converted to volume using a locally developed electronic application, which was recorded in the relevant CD registers. The acceptable tolerance per transaction (±0.1 mL) was determined prior to commencement based on 80 test transactions. Throughout the trial period, 407 transactions were undertaken, among which there were no CD discrepancies. Nine nurses provided feedback via an anonymous online survey after the trial, mostly reporting that the new method was more accurate. However, participants also reported that it took on average 3 min longer to complete each transaction. In conclusion, utilising a weight‐based method of confirming liquid CD balances may present a feasible method of meeting legislative requirements related to the recording and accountability of CDs. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Office of Research and Ethics (Reference no: QA24‐100‐111698). The justification for this ethics exemption was as follows: the study conformed with the National Health and Medical Research Council (NHMRC) Ethical considerations in quality assurance and evaluation activities and did not directly affect patient care; written consent was not required from participants per local requirements, however staff were provided verbal and written project information and were informed their participation in the survey was voluntary and anonymous. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Sample Measurements Results Conclusions To measure healthy life awareness, blood pressure awareness and insight levels, along with their predisposing factors among adult individuals.A population‐based cross‐sectional study.The population consisted of adult individuals in a rural district of a city in Türkiye. Voluntary individuals who visited the population screening, organized as the May Measurement Month activity, were invited to the study (n = 290).The data were collected by a questionnaire, the Healthy Life Awareness Scale (HeLAS), and the Blood Pressure Awareness and Insight Scale (BASIS). Descriptive statistics, Pearson Correlation, and multiple linear regression were used to analyze the data.The mean scores of the HeLAS and the BASIS were 49.62 ± 8.30 and 2.89 ± 1.43, respectively. Income level, regular physical activity habits, and formerly being diagnosed with hypertension were positively associated with a healthy life awareness level. Former diagnosis of hypertension, regular medication usage, and being unemployed were the significant predisposing factors of blood pressure awareness and insight level.Most adult individuals displayed a moderate level of healthy life awareness and a low level of blood pressure awareness and insight. Nurses could take on the leading role in developing healthy lifestyle habits among individuals, ensure medication treatment adherence, and prevent hypertension prevalence. [ABSTRACT FROM AUTHOR]