Adherence Criteria Research Articles

Understanding the complexity of barriers and facilitators to adherence to oral nutritional supplements among patients with malnutrition: a systematic mixed-studies review.

The aim of this systematic mixed-studies review is to summarise barriers/facilitators to adherence to and/or consumption of oral nutritional supplements (ONS) among patients with disease-related malnutrition. In March 2022, the Cochrane CENTRAL, PUBMED, PsycINFO (Ovid) and CINAHL were searched for articles with various study designs, published since 2000. Articles were identified on the basis of 'population' (patients ≥18 years with malnutrition/at nutritional risk), 'intervention' (ONS with ≥2 macronutrients and micronutrients), 'comparison' (any comparator/no comparator) and 'outcome' (factors affecting adherence or consumption) criteria. A sequential exploratory synthesis was conducted: first, a thematic synthesis was performed identifying barriers/facilitators; and second, the randomised controlled trials (RCTs) were used to support these findings. The five WHO dimensions of adherence guided the analysis. Study inclusion, data extraction, analysis and risk-of-bias assessment (MMAT 2018) were carried out independently by two researchers. From 21 835 screened articles, 171 were included with 42% RCTs and 20% qualitative studies. The two major populations were patients with malignancies (34%) and older adults (35%). In total, fifty-nine barriers/facilitators were identified. Patients' health status, motivation, product tolerance and satisfaction as well as well-functioning healthcare routines and support were factors impacting ONS consumption. Few barriers/facilitators (n = 13) were investigated in RCTs. Two of those were serving a small ONS volume and integrating ONS into ward routines. Given the complexity of ONS adherence, non-adherence to ONS should be addressed using a holistic approach. More studies are needed to investigate the effect of different approaches to increase adherence to ONS.

Impact of diet adherence on weight and lipids among African American participants randomized to vegan or omnivorous diets.

Prior research has found that plant-based diets (PBDs) are rated as acceptable and have similar levels of adherence as compared to other therapeutic dietary approaches; however, previous studies were mostly among white populations. Plant-based diets can produce clinically meaningful weight loss, but outcomes may vary by level of adherence. The goal of this study was to examine the differences in weight and lipids among participants in the Nutritious Eating with Soul study based on adherence to their diet assignment. African American adults (n=159; 79% female) with overweight or obesity (mean BMI 36.9±6.9kg/m2) were recruited to participate in a 24-month intervention. Participants were randomized to a plant-based vegan (n=77) or a low-fat omnivorous (n=82) diet, both emphasizing soul food cuisine. Participants attended nutrition classes and had dietary intake/adherence (three 24-h recalls; adherence score 1-5), body weight, lipids, and other secondary outcomes assessed at baseline, 6-, 12-, and 24 months. Participants who met at least half of the adherence criteria (≥2.5 out of 5) were categorized as adherents. At 24months, adherent vegans lost 5% of their body weight, non-adherent vegans lost -0.005%, adherent omnivores lost -0.03%, and non-adherent omnivores lost -0.02%. Adherent vegans lost more weight (kg) than all other participants at both 6- (-3.32±0.92 (-5.14, -1.49), p<0.001) and 24 months (-3.27±1.49 (-6.23, -0.31), p=0.03). Adherent vegans also lost more weight than less adherent vegans (-3.74±1.05 (-5.82, -1.65)), adherent omnivores (-4.00±1.27 (-6.51, -1.48)), and less adherent omnivores (-2.22±0.98 (-4.15, -0.28)) at 6months and lost more weight than less adherent vegans at 24months (-4.96±1.8 (-8.54, -1.37)) (all p<0.05). Adherent vegans had greater improvements in cholesterol-to-HDL ratio at 24months (-0.47±0.22 (-0.92, -0.03), p=0.04) and greater decreases in insulin (-4.57±2.16 (-8.85, -0.29), p=0.04) at 6months than all other participants combined. The study points to the benefit of the use of a PBD for reducing weight, lipids, and insulin in African American adults, but also highlights the importance of supporting adherence to the PBD. Nutritious Eating With Soul (The NEW Soul Study); NCT03354377.

Impact of mental disorders on low adherence to antiretroviral therapy in people living with HIV in Spain

ABSTRACT The relationship between mental disorders other than depression or anxiety, and low adherence to both antiretroviral treatment (ART) and linkage to HIV care are unclear. The aim of our study was to compare the prevalence of mental disorders in people living with HIV (PLHIV) in Spain who present low versus high adherence to ART. We performed a cross-sectional study comparing two groups of PLHIV: 20 PLHIV with low adherence and 80 PLHIV with high adherence to ART. PLHIV who met at least one of the following criteria were included in the low-adherence group: virological failure (HIV-VL > 50 copies/mL in two consecutive blood samples); low attendance to scheduled clinical visits (≥2 missed visits in last year); irregular administration of ART (≥10 forgotten doses in the last month); and interruption of ART for more than 1 week. Inclusion criteria for high adherence were: PLHIV who had been on stable ART for more than 1 year with an HIV-VL below 50 copies/mL and without missed visits over the previous 12 months. The Millon Clinical Multiaxial Inventory was administered to participants. PLHIV with low adherence showed higher scores for all mental disorders compared with those with high adherence. And, in the multivariate binary logistic regression analysis, drug dependence and post-traumatic stress disorder were independently associated with low adherence (Nagelkerke R2 = 0.0686). In conclusion, PLHIV with poorly controlled HIV infection presented important psychological vulnerabilities. Mental health should be checked at the beginning of ART and during follow-up, especially in PLHIV with low adherence or low linkage to the health care system.

Evaluation of continuous positive airway pressure adherence and its contributing factors

BackgroundContinuous positive airway pressure (CPAP) adherence may vary based on the study design and country. ObjectivesTo investigate long-term CPAP adherence and elucidate associated factors. MethodsA multicenter retrospective observational cohort study was conducted over two years. The study included patients diagnosed with obstructive sleep apnea who were prescribed CPAP (n = 1261). Adherence was assessed for 90 days and 365 days. Centers for Medicare and Medicaid Services (CMS) criteria (≥4 h/night on ≥70 % of nights) and research adherence criteria (≥4 h/night during the observational period) were used. Factors influencing CPAP adherence (CMS criteria) during 90 and 365 days were also evaluated. Continuous variables were categorized into low, middle, and high classes, and logistic regression analysis with interaction was performed. ResultsCPAP adherence to CMS criteria for 90 and 365 days was 45.6 % and 44.7 %, respectively, whereas adherence to research criteria was 57.0 % and 54.1 %, respectively. Middle age, high age, and high apnea ratio independently increased CPAP adherence. Conversely, a high rapid eye movement apnea-hypopnea index ratio decreased CPAP adherence. Although high body mass index (BMI) had no independent effect on adherence, its interaction with high 3 % oxygen desaturation index increased 90-day CPAP adherence. However, high BMI decreased 90-day CPAP adherence in males. The interaction between middle age and high BMI was associated with decreased CPAP adherence over 365 days. ConclusionsAdherence to CPAP in real-world settings is modest. Various factors influence CPAP adherence. BMI may exert varied effects on CPAP adherence depending on the accompanying factors.

Sarcopenia interventions in long-term care facilities targeting sedentary behaviour and physical inactivity: A systematic review.

Sedentary behaviour and physical inactivity are independent risk factors for sarcopenia for long-term care facility residents. Understanding the components, mechanisms and context of interventions that target change in these risk factors can help optimize sarcopenia management approaches. This study aimed to identify, appraise and synthesize the interventions targeting sedentary behaviour and physical inactivity, construct a Theory of Change logic model, inform complex sarcopenia intervention development and identify areas for improvement. Eight electronic databases, including Embase and Web of Science, were searched for eligible interventional studies from inception until February 2024. Narrative synthesis was used. The Theory of Change was applied to develop a logic model presenting the synthesized results. A Cochrane risk of bias assessment tool was used for quality appraisal. The study included 21 articles involving 1014 participants, with mean ages ranging from 72.5 to 90.4years. The proportion of female participants ranged from 8.0% to 100.0%. The applied sarcopenia diagnosis criteria varied, including those of the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People. The overall risk of bias in the included studies was moderate. Interventions primarily targeted physical inactivity, with resistance training being the most common intervention type. The reporting of intervention adherence was insufficient (only 11 out of 21 included studies provided adherence reports), and adherence overall and by intervention type was not possible to discern due to inconsistent criteria for high adherence across these studies. Four categories of intervention input were identified: educational resources; exercise equipment and accessories; monitoring and tailoring tools; and motivational strategies. Intervention activities fell into five categories: determining the intervention plan; educating; tailoring; organizing, supervising, assisting and motivating; and monitoring. While sarcopenia-related indicators were commonly used as desired outcomes, intermediate outcomes (i.e., sedentary time and physical activity level) and other long-term outcomes (i.e., economic outcomes) were less considered. Contextual factors affecting intervention use included participant characteristics (i.e., medical condition and education level) and intervention provider characteristics (i.e., trustworthiness). The findings led to the development of a novel logic model detailing essential components for interventions aimed at managing sarcopenia in long-term care facilities, with a focus on addressing sedentary behaviour and physical inactivity. Future sarcopenia interventions in long-term care facilities should fully attend to sedentary behaviour, enhance adherence to interventions through improved education, monitoring, tailoring and motivation and establish an agreed standard set of outcome measures.

Does continuous glucose monitoring influence adherence to time-restricted eating?

Obesity is a significant health issue in Aotearoa; effective and pragmatic strategies to facilitate weight loss are urgently required. Growing recognition of the circadian rhythm’s impact on metabolism has popularised diets like time-restricted eating (TRE)(1). The 16:8 TRE method involves limiting food intake to an 8-hour daily eating window and can lead to weight loss without other substantial changes to diet(2). Nonetheless, TRE requires accountability and tolerating hunger for short periods. Continuous glucose monitors (CGM) are small wearable biofeedback devices that measure interstitial glucose levels scanned via smartphones. By providing immediate feedback on the physiological effects of eating and fasting, CGM use may promote adherence to TRE(3). This pilot study aimed to 1) investigate how CGM affects adherence to TRE and 2) assess the feasibility of CGM use while undertaking TRE. This two-arm randomised controlled trial enrolled healthy adults from Dunedin, assigning them to TRE-only or TRE+CGM groups for 14 days. Successful adherence to TRE was defined a priori as maintaining an 8-hour eating window on 80% of days. CGM feasibility was defined a priori as scanning the glucose monitor thrice daily on 80% of days. Secondary outcomes included well-being, anthropometry, glucose levels, and overall TRE and CGM experiences via semi-structured interviews. Twenty-two participants were randomised into two groups: TRE-only (n = 11) and TRE+CGM (n = 11, with n = 2 excluded from analysis post-randomisation for medical reasons). Participants had a diverse range of ethnicities, the mean age was 32 (+/-14.9) years, and 55% were female. The TRE+CGM group adhered to the 8-hour eating window for an average of 10.0 days (range 2-14) compared with 8.6 days (range 2-14) in the TRE-only group. Both groups had similar mean eating window durations of 8.1 hours. Five (56%) participants in the TRE+CGM group achieved the a priori criteria for TRE adherence, compared to 3 (27%) in the TRE-only group. Participants in the TRE+CGM group performed an average of 8.2 (+/-5.6) daily scans, with n = 7 (78%) of participants meeting the a priori CGM feasibility criteria. Neither group reported consistent adverse psychological impacts in DASS-21 and WHO-5 scores. Interviews highlighted that CGM increased hunger tolerance during fasting as participants felt reassured by their normal glucose levels. CGM aided TRE accountability by acting as a biological tracker of food intake. Participants reported that TRE led to improved energy and self-efficacy, a more productive daily routine, and healthier food choices. Promisingly, 72% of participants would use CGM and undertake TRE in future. This study demonstrates that using CGM while undertaking TRE is feasible and can improve adherence by enhancing hunger tolerance and accountability. Overall, participants experienced increased awareness of eating habits and physiological mechanisms. Over the longer term, this simple and synergistic approach may be a helpful weight loss strategy.

Feasibility, safety, and adherence of a remote physical and cognitive exercise protocol for older women.

Population aging and the consequences of social distancing after the COVID-19 pandemic make it relevant to investigate the feasibility of remote interventions and their potential effects on averting functional decline. (1) To investigate the feasibility, safety, and adherence of a remote protocol involving physical and cognitive exercises for older women with normal cognition; (2) to examine its effects on cognitive and well-being variables. Twenty-nine women (age ≥ 60 years old) were randomized into experimental group (EG; n = 15) and control group (CG; n = 14). The EG performed a 40-minute session of cognitive and physical exercises, and CG performed a 20-minute stretching session. Both groups performed 20 sessions via videoconference and 20 on YouTube twice a week. The Mini-Mental State Examination, Verbal Fluency Test, Digit Span (direct an inverse order), Geriatric Depression Scale (GDS), and Well-being Index (WHO-5) were applied in pre- and post-interventions by phone. Overall adherence was 82.25% in EG and 74.29% in CG. The occurrence of adverse events (mild muscle pain) was 33.3% in EG and 21.4% in CG. The EG improved verbal fluency and attention (p ≤ 0.05); both groups had improved depressive symptoms. The present study met the pre-established criteria for feasibility, safety, and adherence to the remote exercise protocol among older women. The results suggest that a combined protocol has more significant potential to improve cognitive function. Both interventions were beneficial in improving the subjective perception of well-being.

Automated Personalized Self-care Program for Patients With Type 2 Diabetes Mellitus: A Pilot Trial

PurposeProviding continuous self-care support to the growing diabetes population is challenging. Strategies are needed to enhance engagement in self-care, utilizing innovative technologies for personalized feedback. This study aimed to assess the feasibility of the Automated Personalized Self-Care program among type 2 diabetes patients and evaluate its preliminary effectiveness. MethodsA parallel randomized pilot trial with qualitative interviews occurred from May 3, 2022, to September 27, 2022. Participants aged 40–69 years with type 2 diabetes and HbA1c ≥ 7.0% were recruited. The three-month program involved automated personalized goal setting, education, monitoring, and feedback. Feasibility was measured by participants’ engagement and intervention usability. Preliminary effectiveness was examined through self-care self-efficacy, self-care behaviors, and health outcomes. Qualitative interviews were conducted with the intervention group. ResultsA total of 404 patients were screened. Out of the 61 eligible patients, 32 were enrolled, resulting in a recruitment rate of 52.5%. Retention rates at three months were 84.2% and 84.6% in the intervention and control groups, respectively. Among the intervention group, 81.3% satisfied adherence criteria. Mobile application’s usability scored 66.25, and participants’ satisfaction was 8.06. Intention-to-treat analysis showed improvements in self-measured blood glucose testing, grain intake, and HbA1c in the intervention group. Qualitative content analysis identified nine themes. ConclusionsFeasibility of the program was verified. A larger randomized controlled trial is needed to determine its effectiveness in self-care self-efficacy, self-care behaviors, and health outcomes among type 2 diabetes patients. This study offers insights for optimizing future trials assessing clinical effectiveness. Trial registrationClinical Research Information Service, KCT0008202 (registration date: 17 February 2023).

Hospital Is Not the Home: Lessons From Implementing Remote Technology to Support Acute Inpatient and Transitional Care in the Home in the United States and United Kingdom.

The COVID-19 pandemic, patient preference, and economic opportunity are shifting acute care from the hospital to the home, supported by the transformation in remote monitoring technology. Monitoring patients with digital medical devices gives unprecedented insight into their physiology. However, this technology does not exist in a vacuum. Distinguishing pathology from physiological variability, user error, or device limitations is challenging. In a hospital, patients are monitored in a contrived environment. Monitoring at home instead captures activities of daily living alongside patients' trajectory of disease and recovery. Both settings make for "noisy" data. However, we are familiar with hospital noise, accounting for it in our practice and perceptions of normal. Home monitoring as a diagnostic intervention introduces a new set of downstream consequences, dependent on device, cadence of collection, adherence, duration, alarm thresholds, and escalation criteria. We must accept greater ambiguity and contextualize vital signs. All devices balance accuracy with acceptability, so compromises are inevitable and perfect data should not be expected. Alarms must be specific as well as sensitive, balancing clinical risk with capacity for response. By setting expectations around data from the home, we can smooth the adoption of remote monitoring and accelerate the transition of acute care.

Matters of Fidelity: School Provider Adherence and Competence in a Clustered Study of Adaptive Implementation Strategies

ABSTRACT Schools are a promising access point for youth with mental health concerns, but school-based mental health professionals (SPs) often need ongoing support to provide high-fidelity cognitive behavioral therapy (CBT). Adherence and competence, two critical elements of fidelity, were examined in a cluster-randomized implementation trial. We evaluated CBT adherence and then triangulated CBT adherence with end-of-study competence. We then evaluated the effects of two implementation supports, Coaching and (for slower-responding schools) Facilitation, on adherence and competence. By the end of the 43-week study period, 27.8% of SPs met adherence criteria. Adherent SPs scored higher on the competence measure, the CBT Competence Scale (t(116.2) = 3.71, p < .001). No significant difference in adherence was found among SPs at schools assigned to Coaching vs. not (Δ = 6.0%, p = .385), however SPs at schools randomized to Coaching scored significantly higher on two of the four competence subscales (Non-Behavioral and Behavioral skills). Among slower-responder schools, SPs at schools assigned to Facilitation were more likely to demonstrate adherence (Δ = 16.3%, p = .022), but there was no effect of Facilitation on competence. Approximately one quarter of SPs met adherence criteria in the trial; adequate delivery of exposure was a primary obstacle to reaching adherence. Facilitation may be especially suited to help SPs overcome barriers to delivery, whereas Coaching may be especially suited to help SPs improve CBT competence. Both are likely needed to build a mental health work force with the competence and ability to deliver EBPs in schools.

A randomized feasibility trial of the modified Atkins diet in older adults with mild cognitive impairment due to Alzheimer's disease.

Alzheimer's disease (AD) is increasing in prevalence, but effective treatments for its cognitive impairment remain severely limited. This study investigates the impact of ketone body production through dietary manipulation on memory in persons with mild cognitive impairment due to early AD and explores potential mechanisms of action. We conducted a 12-week, parallel-group, controlled feasibility trial of a ketogenic diet, the modified Atkins diet (MAD), compared to a control diet in patients with cognitive impairments attributed to AD. We administered neuropsychological assessments, including memory tests, and collected blood samples at baseline and after 12 weeks of intervention. We performed untargeted lipidomic and targeted metabolomic analyses on plasma samples to detect changes over time. A total of 839 individuals were screened to yield 38 randomized participants, with 20 assigned to receive MAD and 18 assigned to receive a control diet. Due to attrition, only 13 in the MAD arm and nine in the control arm were assessed for the primary endpoint, with two participants meeting ketosis levels used to define MAD adherence criteria. The average change from baseline in the Memory Composite Score was 1.37 (95% CI: -0.87, 4.90) points higher in the MAD group compared to the control group. The effect size of the intervention on baseline MAD change was moderate (Cohen's D = 0.57, 95% CI: -0.67, 1.33). In the 15 participants (nine MAD, six control) assessed for lipidomic and metabolomic-lipidomics and metabolomics, 13 metabolites and 10 lipids showed significant changes from baseline to 12 weeks, including triacylglycerols (TAGs, 50:5, 52:5, and 52:6), sphingomyelins (SM, 44:3, 46:0, 46:3, and 48:1), acetoacetate, fatty acylcarnitines, glycerol-3-phosphate, and hydroxy fatty acids. Attrition was greatest between baseline and week 6. All participants retained at week 6 completed the study. Despite low rates of adherence by criteria defined a priori, lipidomic and metabolomic analyses indicate significant changes from baseline in circulating lipids and metabolites between MAD and control participants at 12-week postrandomization, and MAD participants showed greater, albeit nonsignificant, improvement in memory.

Factors Anticipating Adolescents’ Adherence and Dropout in an Online ACT Intervention During the COVID-19 Pandemic

This study examined factors anticipating adolescents’ (N = 232) adherence and dropout in an online acceptance and commitment therapy (ACT) intervention targeted at promoting well-being during the COVID-19 pandemic. First, results showed that adolescents with high academic achievement and educational expectations were more likely to participate in the induction meeting and start the program. Second, adolescents in the human-supported model fulfilled the adherence criteria more often than adolescents supported by virtual coach only. Finally, though male participants were less likely to participate in the study, participants who started the online program were likely to adhere to it regardless of gender.

Comparing the use of midline catheters versus peripherally inserted central catheters for patients requiring peripherally compatible therapies: A pilot randomised controlled trial (the compact trial).

Midline catheter (MC) use has increased in acute-care settings, particularly for patients with difficult venous access or requiring peripherally compatible intravenous therapy for up-to 14 days. Our aim was to assess feasibility and generate clinical data comparing MCs with Peripherally Inserted Central Catheters (PICCs). A two-arm parallel group pilot randomised controlled trial (RCT), comparing MCs with PICCs, was conducted in a large tertiary hospital in Queensland between September 2020 and January 2021. The primary outcome was study feasibility, measured against rates of eligibility (>75%), consent (>90%), attrition (<5%); protocol adherence (>90%) and missing data (<5%). The primary clinical outcome was all-cause device failure. In total, 25 patients were recruited. The median patient age was 59-62 years; most patients were overweight/obese, with ≥2 co-morbidities. The eligibility and protocol adherence criteria were not met; of 159 screened patients, only 25 (16%) were eligible, and three patients did not receive their allocated intervention post-randomisation (88% adherence). All-cause failure occurred in two patients allocated to MC (20%) and one PICC (8.3%). Our study found that a fully powered RCT testing MCs compared with PICCs is not currently feasible in our setting. We recommend a robust process evaluation before the introduction of MCs into clinical practice.

Value Judgments in Criminal Law Interpretation

Criminal law interpretation in China faces two primary challenges in terms of value judgments. Normative interpretations often fall into circular and inadequate reasoning, while judges, the key figures in applying interpretive principles, frequently lack the necessary value judgment engagement and proficiency. Traditional criminal law interpretation is ensnared in a subjective-objective dichotomy, resulting in a misalignment with the aim of “legitimate and rational” interpretation practices in China. To rectify this, a philosophical shift is required to allow intersubjective value judgments while maintaining subjectivity-objectivity as the prerequisite. Criminal law interpretation ensures the completeness of value judgments through a combination of specialized knowledge and public discourse. This involves the creation of systematic criteria for value judgments and adherence to legal principles. The former necessitates defining the internal and external standards of value judgments, formulating rules for the resolution of conflicting standards, and underlining the practical importance of criminalization under law, or “no crime or punishment without law” (the principle that only the law can define a crime and prescribe a penalty) and “Where no law applies, it is permissible to redefine a crime as non-criminal or minor” (decriminalization). The latter involves three perspectives: logical reasoning and theoretical arguments; positive and negative judgments; and formal and substantive rationality. Moreover, it should be approached from four dimensions: normative orientation, individual case promotion, reverse exclusion, and constitutional guidance.

Impact of adherence to disease modifying therapies on long-term clinical and economic outcomes in multiple sclerosis: A claims analysis of real-world data.

Multiple sclerosis (MS) is a chronic neurodegenerative inflammatory disease that requires long-term commitment to treatment for optimal outcomes. A variety of disease-modifying therapies (DMTs) are now available that reduce relapses and delay disease progression in people with MS. However, adherence remains a significant issue, with a variety of mental, physical, and emotional factors contributing to non-adherence. In a large number of studies, non-adherence has been associated with worse clinical outcomes (relapses and disease severity), a higher economic burden, and loss of work productivity. However, many of these studies were short-term (1-2 years) or cross-sectional studies; thus, more data are needed on the long-term clinical and economic impacts of DMT non-adherence. The objective of this study was to determine the longer-term impact of adherence to DMTs on disease activity and healthcare resource utilization (HCRU) in people with MS. The study hypothesis was that non-adherence to DMTs would be associated long-term with worse clinical outcomes and a higher economic burden. A retrospective administrative claims analysis of the US MarketScan® Commercial database (2011-2017) in individuals (18-65 years) with MS (based on International Classification of Disease coding) was conducted. Adherence was classified by proportion of days covered (PDC) ≥0.8 and non-adherence by PDC <0.8; sensitivity analyses helped further categorize as moderately (PDC ≥0.6-<0.8) or highly (PDC <0.6) non-adherent. Cohorts were matched using propensity score matching. Time to first relapse, annualized relapse rate (ARR), time to use of assistive devices (cane/walker or wheelchair), and annual HCRU (inpatient, emergency room [ER], outpatient, and MRI visits and costs) were compared between cohorts. 10,248 MS cases were identified; 58% met adherence criteria, and 42% met non-adherence criteria. Mean follow-up from diagnosis or first DMT claim was 5.3 years. Adherent individuals had a longer time to first relapse (hazard ratio [HR] 0.83; 95% confidence interval [CI]: 0.77-0.90; p<0.0001), a lower ARR (0.13vs. 0.18, respectively; rate ratio [RR] 0.75 [95% CI: 0.71-0.79]; p<0.0001), and longer lag times to cane/walker use (HR 0.79 [95% CI: 0.66-0.94]; p=0.0067) and wheelchair use (HR 0.68 [95% CI: 0.55-0.83]; p=0.0002) than non-adherent individuals. Adherent individuals had fewer annual inpatient and ER visits and lower total costs than those who were non-adherent (p<0.0001). Sensitivity analyses showed that differences in disease activity and HCRU were generally more pronounced between matched adherent and highly non-adherent pairs than between matched adherent and moderately non-adherent pairs. Significant differences in MS disease activity and HCRU were observed based on adherence to DMTs. Our study underscores the negative impact of non-adherence to DMTs on long-term clinical and economic outcomes in MS.

HAPI Fit: An Exercise Intervention to Improve Peak Aerobic Capacity in Young Adults Born Very Preterm.

Individuals born preterm have reduced aerobic capacity, which could be related to impaired organ development. Their capacity to improve aerobic capacity with exercise training could therefore be limited but this remains unknown. We aimed to test an exercise intervention to improve cardiorespiratory fitness in adults born preterm. 21 very preterm and 37 full-term individuals, aged 18-33 years, took part in a 14-week supervised exercise intervention of cardiovascular, resistance and flexibility training (2 groups and 1 individual sessions/week). Adherence and compliance to intervention was recorded. Primary outcome was change in peak oxygen consumption (peak O2) measured pre- and post-intervention. Within and between-groups differences were estimated using non-parametric tests. Of 219 eligible individuals, 58 were enrolled and 14 participants dropped out over the course of the intervention. Among the 44 who completed the intervention, mean adherence was 82% and 66% for group and individual sessions, respectively. Compliance with training requirement varied between 71-100%. There was no difference in adherence between the preterm and full-term groups. Because only one preterm male met adherence criteria, subsequent analyses were done exclusively on females. Both the term and preterm groups achieved higher peak O2 following the intervention [term = +4.2 (standard deviation 4.3) mL·min-1·kg-1, P < 0.01; preterm = +4.7 (2.9) mL·min-1·kg-1, P < 0.01]. There was no between-group difference in the response to the intervention (P = 0.729). Recruitment and adherence to an exercise intervention are challenging. Results could indicate improvements in cardiorespiratory fitness in young women born preterm following current exercise program. Adaptation of this intervention is needed for wider uptake.

Evaluation of Nationwide Trends in Nodal Sampling Guideline Adherence for Gastric Cancer: 2005-2017

IntroductionSurgical resection is the primary curative treatment for localized gastric cancer. A multitude of research supports surgical nodal sampling guidelines. Though there are known disparities in adherence to nodal sampling, it is unclear how hospital program-level disparities have changed over time. The purpose of this study is to evaluate trends in program-level disparities in adherence to gastric cancer nodal sampling guidelines. MethodsPatients who underwent resection of gastric cancer from 2005 to 2017 were identified in the National Cancer Database. Patients treated at academic programs were compared to those treated at nonacademic programs, and rates and trends of adherence to nodal sampling guidelines (defined as ≥15 lymph nodes) were determined. Adjusted multivariable analysis was used to determine likelihood of nodal sampling adherence while controlling for sociodemographic, clinical, hospital, and travel distance characteristics. ResultsA total of 55,421 patients were included with 27,201 (49.1%) of patients meeting adherence criteria for lymph node sampling. Academic programs treated 44.4% of the total cohort. Overall, lymph node sampling criteria were met in 59.2% of patients treated at high-volume academic programs and 37.0% of patients treated at low-volume nonacademic programs (incidence rate ratios 0.67, 95% confidence interval 0.63-0.72 versus high-volume academic programs). Adherence rates improved from 2005 to 2017 for both low-volume nonacademic programs (27.8% in 2005 to 50.1% in 2017) and high-volume academic programs (46.0% in 2005 to 69.8% in 2017, P < 0.001). ConclusionsThough adherence rates have improved from 2005 to 2017, high-volume academic programs were more likely to adhere to lymph node sampling guidelines for gastric cancer.

Assessment of chemotherapy-induced nausea and vomiting in pediatrics: Adequacy of control and adherence to guidelines

BackgroundChemotherapy-induced nausea and vomiting (CINV) is one of the most common side effects of chemotherapy in patients. Although sufficient evidence regarding its assessment and treatment in adults exists, CINV is more complicated in children. There are established guidelines for its prevention and treatment endorsed by several reputable organizations; however, their adherence varies between institutions. Therefore, this study aimed to assess the incidence and severity of CINV in pediatric patients receiving any form of chemotherapy in the acute and delayed phases and evaluated our institution's adherence to published guidelines by the Pediatric Oncology Group of Ontario. Material and methodThis was a prospective longitudinal single-center study. A structured assessment was administered twice to patients or their caregivers during the acute and delayed phases. Baxter Animated Retching Faces scale was used. ResultsA total of 186 patients completed 236 surveys, including those for acute and delayed phases. Incidence of nausea was reported in 33% patients in both phases, while vomiting was observed in 20.3% and 18.8% of the acute and delayed phases, respectively. A total of 31% patients met the criteria for proper adherence in case of prescribed appropriate antiemetic agent(s)/class irrespective of the dose. ConclusionCINV is a major adverse effect among children who receive high and moderate emetogenic chemotherapy compared to those receiving minimal and low emetogenic regimens. Despite the low rate of adherence to the guidelines, the incidence and severity of CINV reported in our study were consistent with previous studies. Further research should seek strategies to better implement and standardize the guidelines.

1001-P: Adherence and Persistence to Basal Insulin Therapy Is Associated with Decreased Health Care Utilization in Adults with Type 2 Diabetes

Objectives: Lack of adherence and persistence to prescribed therapy impact achievement of glycemic goals. This study aimed to assess the association between adherence and persistence to basal insulin therapy with healthcare resource utilization (HCRU) among adults with type 2 diabetes (T2D). Methods: This was an observational, retrospective cohort study of commercially insured US patients using IQVIA PharMetrics® Plus claims data. We identified adults with T2D initiating basal insulin therapy between January 1, 2016 and December 31, 2018. Adherence/non-adherence and persistence/non-persistence were assessed per established definitions. Demographic and clinical characteristics were assessed over the one-year baseline period (prior to initiation). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding by adherence and persistence status. Post-IPTW, all-cause medical HCRU and costs in the one-year follow-up period were compared across cohorts. Results: The final sample consisted of 64,953 patients: 42% and 58% met criteria for adherence and non-adherence, respectively; 57% and 43% met criteria for persistence and non-persistence, respectively. The proportion of patients with ≥1 hospitalization was lower for the adherence and persistence cohorts compared to their reference groups (adherence: 12.2% vs. 13.8%; persistence: 12.5% vs. 14.2%, both P&amp;lt;0.0001); for these patients, mean hospitalization days were lower among adherence and persistence cohorts (adherence: 10.1 vs. 13.2; persistence: 10.4 vs. 13.8, both P&amp;lt;0.0001). Total mean medical costs were also lower (adherence: $16,118 vs. $17,991; persistence: $16,459 vs. $18,399, both P&amp;lt;0.0001), driven by lower acute care costs (adherence: $6,210 vs. $7,775; persistence: $6,385 vs. $8,171, both P&amp;lt;0.0001). Conclusions: In this study, adherence and persistence to basal insulin therapy was associated with lower HCRU and costs, particularly for acute care. Disclosure N.F.Nielsen: Employee; Novo Nordisk A/S, Coloplast A/S. V.R.Aroda: Consultant; Applied Therapeutics Inc., Fractyl Health, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Other Relationship; Janssen Pharmaceuticals, Inc., Research Support; Applied Therapeutics Inc., Eli Lilly and Company, Fractyl Health, Inc., Novo Nordisk, Sanofi. K.K.Mangla: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. V.Divino: Employee; IQVIA Inc. T.Namvar: None. J.R.Rajpura: Employee; Novo Nordisk.

0463 Deep Learning Classification of Future PAP Adherence based on CMS and other Adherence Criteria

Abstract Introduction Improving positive airway pressure (PAP) adherence is crucial to sleep apnea therapy success. Although behavioral interventions may be deployed to increase PAP adherence, operationalization remains an ongoing clinical challenge. Treatment outcomes may be optimized by forecasting PAP use to identify patients at risk for non-adherence enabling early intervention. We build upon our previous work by leveraging a larger dataset, additional metadata, and new Deep Learning approaches to forecast future PAP adherence. Methods We collected a cohort of N=21,397 subjects with daily PAP usage recorded during 2015-2021. We defined the input to models as the number of minutes the PAP machine was used during each day for the first 30-days. The ground truth was defined as the PAP adherence of the patients at the 3-month, 6- month, and 1-year endpoints. Adherence was calculated based on a 30-day window as ≥4-hours of usage for ≥70% of nights. We evaluated a Deep Neural Network (DNN) model with 10-fold cross- validation to forecast future adherence by leveraging previous daily usage information. Results were compared to a naive method which assumes adherence at each time point equals adherence during the first 30-days. Results The DNN models predicted adherence with a sensitivity of 90%, 81%, 77% and a specificity of 90%, 81%, 77%, for 3-month, 6-month, and 1-year endpoints, with ROC-AUC values of 0.97, 0.89, and 0.84 respectively. The models converged to ROC-AUC performance &amp;gt;0.90 for the first 90-days within the first 7 to 14-days of PAP use. Conclusion DNN models demonstrated strong predictive performance for PAP adherence, as defined by the CMS adherence criteria, measured by sensitivity, specificity, and overall ROC-AUC results at clinically relevant 90-day, 6-month, and 1-year timepoints. AI approaches show promise as early predictors of the likelihood to meet key therapy utilization thresholds within the first 1-2 weeks of therapy, enabling early PAP intervention or transition to alternative therapies. Support (if any) AASM Foundation SRA205-SR-19