Bad Adherence Research Articles

Psychological meanings reported by patients with Graves’ Disease in hyperthyroidism but without ophthalmopathy about their quotidian life: A qualitative study conducted in a Brazilian university specialized outpatient service

IntroductionTo handle well clinical treatments, it is crucial to know the expectations of patients who seek help. We need to ask ourselves: how do patients interpret subjectively their diagnosis, treatments, and self-care? Medical Psychology brings us theories for this understanding. Grave’s Disease is an autoimmune disorder, a form of hyperthyroidism with a goitre, affecting also the eyes and the skin, as well as emotional manifestations. Weight loss, sometimes psychologically welcome, although due to a disease, can mean a psychoanalytic secondary gain. So, the medicine that leads to clinical improvement can be taken with ambivalence and bad adherence to treatment. It is important to differentiate between disease, a scientific entity explained by the clinical professional, and illness as a patient’s subjective perception of an un-health.ObjectivesTo understand psychodynamically the fantasies, desires, and views related to Graves’ Disease as reported by patients in hyperthyroidism but without ophthalmopathy interviewed at an endocrinology-specialized outpatient clinic. (in the EPA-2023, it was presented the qualitative results of a sample in hyperthyroidism, with ophthalmopathy, studied at the same service).MethodsClinical-Qualitative Method designed by Turato. Data collected through Semi-Directed Interviews with Open-ended Questions in-Depth; and Field Notes, transcript fully. Treated by the Seven Steps of Clinical-Qualitative Content Analysis of Faria-Schützer, using psychodynamic concepts from Balintian Medical Psychology. Although we have extracted categories that permit us interesting discussions, we intend to close the sample (through the information saturation criterion by Fontanella) when we obtain other categories. The interviewer, a male psychologist, is the first author. The findings are validated by peer-reviewers of the Lab of Clinical Qualitative Research of the State University of Campinas.ResultsThree categories were chosen for this presentation: 1) “An atomic bomb in my life”: How drastic changes of a hormonal disease re-symbolize the patient’s life; 2) “I didn’t think the thyroid did that much”: the disease seen as a metaphor in a psychological blaming language to own disease and to himself as a sick person. 3) “I have so much medicine!”: a mode of referring to treatment that would justify an undisciplined use of medications.ConclusionsOur findings can help clinical professionals to have a better understanding of some psychological meanings which have sense in the patients’ conscience, often not verbalized clearly in the conversation, and so to handle better the patients and relatives. In this way, it can reduce the patient’s resistance to recommended treatment, as well as encourage the clinical team to construct empathy with them.Disclosure of InterestNone Declared

The analysis of factors affecting medication adherence in patients with myasthenia gravis: a cross-sectional study.

Clinically, patients with myasthenia gravis are generally treated with drugs to improve their physical condition, and poor medication adherence can hinder their recovery. Many studies have shown the importance of medication adherence for effective treatment. Various factors may affect a patient's medication adherence; however, studies concerning medication adherence in patients with myasthenia gravis are rare. This study aimed to identify the factors related to medication adherence in patients with myasthenia gravis, and determine the possibility of predicting medication adherence. This cross-sectional observational study was conducted among inpatients and outpatients with myasthenia gravis of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China. Data on patient demographics, disease-related characteristics, and medical treatment were collected. We evaluated medication adherence of the patients using the Morisky Medication Adherence Scale-8, Beliefs about Medicines Questionnaire, and the Self-efficacy for Appropriate Medication Use Scale. We distributed 200 questionnaires and finally retrieved 198 valid questionnaires. A total of 139 (70.2%) women participated in this study, and 81 (40.9%) among the 198 participants were aged 40-59 years. In total, 103 (52.0%) participants exhibited bad adherence to pharmacological treatment, and factors such as taking medication irregularly [odds ratio (OR) = 0.242, 95% CI = 0.093-0.627], the necessity of taking medicine (OR = 1.286, 95% CI = 1.142-1.449), the concerns of taking medicine (OR = 0.890, 95% CI = 0.801-0.988), and the self-efficacy for taking medications under difficult circumstances (OR = 1.194, 95% CI = 1.026-1.389) had statistically significant impacts on medication adherence. Our study shows that taking medication irregularly and concerns of taking medicine are the risk factors for medication adherence. Meanwhile, the necessity of talking medicine and self-efficacy for taking medications under difficult circumstances are the protective factors for medication adherence. Our findings can help medical staff to enhance patients' medication adherence by informing patients necessary medical knowledge, emphasizing the necessity for medication, relieving patients' concerns regarding medication, and improving the self-efficacy for taking medications under difficult circumstances.

Association Between Diabetic Control And Anti-Diabetic Medication Adherence Using 8-Point Morisky Medication Adherence Scale In Local Population Of Khyber Pakhtunkhwa

Abstract:
 Background: Drug adherence to medications in diabetes is very necessary for strict glycemic control. Many factors in diabetics are associated with low adherence to drugs resulting in complications.
 Methods: This research was conducted as an observational study with cross-sectional study design. It was scheduled between July 2022 to December 2022 in medical outpatient department of Combined Military Hospital, Peshawar
 Results: 115 individuals were inducted over a period of 6 months from medical OPD ex Combined Military Hospital Peshawar. Five patients failed to follow-up with research team resulting in a total of 110 participants included in results. Average age across the study sample was 50.25 ± 11.97 years with 58 (52.73%) males and 52 (47.27%) females. Most participant in our study sample were educated up to matriculation with BMI <25kg/m2.
 Average duration of diabetes across the sample was 6.1 ± 3.69 years. In treatment options, 53 (48.18%) individuals were only managed with oral therapy, 16 (14.55%) on insulin only while 41 (37.27%) were prescribed with both oral hypoglycemic drugs and insulin. Most common comorbid across study population was hypertension, seen in 59 (53.94%) diabetic patients, followed by cataract in 41 (37.47%) and IHD in 33 (30%) patients.
 In all 110 individuals, only 29 (26.36%) individuals had good glycemic control i.e., HbA1c <7% with average glycosylated hemoglobin percentage measuring 8.29% ± 1.59%. As per MMAS-8 score, 25 (22.73%) patients reported good adherence, 31 (28.18%) patients reported fair adherence while rest 54 (49.09%) were found to have bad adherence. Average MMAS-8 score was 5.17.
 Conclusion: There is a correlation between medication adherence as measured by MMAS-8 score with control of diabetes as measured by HbA1c score in the range of 1.824% across the range of MMAS-8 score from 0-8. Sleep quality, BMI and multiple comorbid conditions were also linked with raised HbA1c.
 Key words: Drug adherence, Morisky Medication Adherence Scale, Diabetes, Non-diabetes, diabetic medications

#2858 EXERCISE AND PREDIABETES AFTER RENAL TRANSPLANTATION: THE EXPRED I STUDY

Abstract Background and Aims Post-Transplant Diabetes Mellitus (PTDM) is a severe disease that may affect about 30% of renal transplant patients. PTDM beyond 12 months (late PTDM) mostly develops in subjects with prediabetes. Although exercise may have a potential role in preventing late PTDM, there is scarce evidence on the effect of exercise in renal transplantation. We designed a 12-month exploratory study to test the capacity of therapeutic exercise in reverting prediabetes to prevent the development of late-PTDM. Method This is a pilot study in which renal transplant patients with prediabetes were treated with exercise for 12 months. To detect prediabetes and to evaluate the reversibility, relapse, or persistence of prediabetes, the oral glucose tolerance test (OGTT) was performed at baseline and every 3 months to the end of the study. Prediabetes was defined by the presence of Impaired Fasting Glucose (IFG) in 100-125 mg/dl and/or Impaired Glucose Tolerance (IGT) between 140-199 mg/dL after the OGTT. The protocol included a stepped incremental plan of aerobic and/or strength training. The frequency, intensity, and duration of aerobic exercise, as well as the addition of strength training depended on the recovery, persistence, or recurrence of prediabetes. All patients started with moderate aerobic exercise (brisk walking), 30 min/day and 5 times per week and, based on that, changes in prescription were considered every 3 months. Additionally, we evaluated: (a) an active plan for promoting adherence to exercise (telephone calls, digital technology, and visits) and (b) improvements in metabolic risk factors: obesity, dyslipidaemia, and blood pressure. Since prediabetes may spontaneously revert to normal glucose metabolism in 25-30% [1], we assume that in 60 cases, the spontaneous reversibility could be of 30% (n = 18) and the reversibility induced by exercise may account for another 30% (n = 18), so the total reversibility will be 60%. Considering an expected drop out of 20%, the number of cases necessary to include was 72 patients. Results The study was early interrupted due to efficacy after the evaluation of 27 patients that reach 12 months of follow-up. Mean age was 54.2 ± 9.6 and 67% were men. Half of the patients were obese and most had overweight. At baseline IGT or IFG alone were found, respectively, in 13 (48%) and 5 (19%) patients, and the combination of both in 9 (33%). All patients were on prednisone and tacrolimus with the addition of mycophenolate on 20 subjects and 7 on everolimus. Of the group, 16 (60%) reverted to normal glucose levels (fasting and 120 min after an OGTT): this was two time higher than the 30% reversibility rate shown in a previous publication [1], p <0.05, assuming a potency of 85%. In parallel, 11 (40%) subjects had prediabetes (9) or developed PTDM (2). No significant changes were found in weight during follow-up in all groups whereas triglycerides diminished in patients on whom prediabetes reverted (154 mg/dL ± 61 to 96 ± 27; p = 0.016). At the end of follow up, adherence to exercise was good (≥70%) in 13 patients (∼50%), moderate (40-70%) in 9 (∼30%) and bad (≤40%) in 5 (∼20%). Finally, all patients with good adherence reverted to normoglycaemia, 3 out of 9 (33%) cases with moderate reverted to normal glucose metabolism and no cases with bad adherence improved on follow-up. No relevant injuries attributed to exercise were observed during the study. Conclusion Therapeutic exercise is safe and effective to improve glucose metabolism in renal transplant patients with prediabetes. Adherence is a crucial aspect to consider in the planification of exercise treatment.

Breaking bad news: Awareness and practice of the SPIKES protocol among general surgery residents at a tertiary care institute in northern India.

Background In general surgery, a clinician is commonly required to break bad news. However, training in communication is not a part of the formal curriculum either in medical school or in surgical residency and there is a paucity of data on awareness of the SPIKES (Setting up the interview, Perception, Invitation, Knowledge sharing, Emotion, Strategy and Summary) protocol among practising surgeons and residents in India. Methods We did a cross-sectional study in the Department of General Surgery at our institution. Junior residents were invited to take part in a one-on-one interview. Descriptive statistics were used to describe the findings of the study. Comparison for categorical data was done using Fisher exact test or chi-square test (whichever was applicable). Results A total of 82 residents with mean (SD) age of 27 (2.5) years (range 23-37 years) participated in the study. Only 31 (37.8%) had ever received training for breaking bad news, though 80 (97.6%) had broken bad news at least once. Twenty-one (26.3%) participants had a bad experience while breaking bad news. Seventy-seven (93.9%) participants felt the need for training in breaking bad news and 76 of them were willing to attend the same. Although the complete SPIKES protocol was followed only by 25 (31.3%) residents, 46 (56.1%) felt that it was practically possible to follow the SPIKES protocol. Conclusion Resident doctors in general surgery face situations of breaking bad news and adherence to the SPIKES protocol is poor. Formal training at every level may enhance their communication skills and enable better healthcare delivery.

Abstract P4-12-14: Assessing patients perceptions on hormone therapy for breast cancer: Insights from a Brazilian patient group

Abstract Introduction Breast cancer has a high incidence in the population, and it still is a major cause of mortality among women. About 2/3 of these tumors express hormone receptor which are important therapeutical targets for both adjuvant and metastatic settings. Hormone therapy (HT) is an important strategy for adjuvant treatment in breast cancer, enhancing disease-free and overall survival. But the side effects of this strategy are multiple, especially by mimicking or intensifying menopausal symptoms, which can substantially compromise quality of life of patients. Moreover, treatment of women with breast cancer is rising both in intensity and extension, maximizing hormone deprivation effects. Another major factor is patient adherence as it is known that about 50% of women don’t complete the whole treatment. Bad adherence occurs mainly because side effects are poorly controlled, either being neglected or less valued during medical check-ups. Outside clinical trials, there is not enough data of patients’ perceptions about HT. Objective To evaluate adherence, side effects and medical care perceptions of breast cancer patients in use of HT. Method A questionnaire was developed and applied online to users of Oncoguia, an NGO for cancer patient’s advocacy. The adhesion was volunteer and individual data were not identified. Primarily qualitative analysis was performed to identify patterns in no meeting needs of patients using HT for breast cancer. Results 310 answers were submitted from February to July of 2020. 84.1% of patients (261) referred having used HT. Tamoxifen was used in 47.5% of these, aromatase inhibitor in 29% and double blockage in 8.1%. Related to orientation about side effects, 43.2% consider they were properly orientated, 25% superficially and 11.2% weren’t oriented. 50% of women who previously didn’t exercise started physical activities after HT. Of those who were previously active, 73,4% kept regular exercises during HT. Considering weight gain, 63% of women who didn’t have prior problems experienced trouble with weight gain; and in those who already had issues with weight there were persistence in 71.7%. For patients with normal libido before HT, 42,9% noticed reduction and 36,4% of them considered the libido absent after onset of treatment. When vaginal dryness was addressed, 75% of women had it as a new symptom. Hot flashes onset on 86.5% of women who previously didn’t present it.Humor distress wise 67.9% of patients considered they developed irritability, prior inexistent, in use of HT. Depression or depressive episodes were related by 45.5% of patients without personal history of these disturbers and by 65.2% of patients with depressive personal history.When asked about how much the symptoms interfered in their daily lives, 45.2% consider a huge/considerable interference, 32% a little interference and only 5.8% of women considered symptoms didn’t interfere on their daily lives. Discussion Bringing patients to the center of treatment, more than aiming better therapeutic results, also includes listening to their needs and perceptions about it. Outside clinical trials, there is few information about adherence to HT and factors that leads to HT drop. Surveys applied to oncologic communities may reveal concerns and perceptions that can be differently influenced by local characteristics. This kind of survey can open a window of opportunity for actions directly focused on patients demands. Conclusion Real life data has the potential to direct educational actions for patients and health professionals, according to the specifics perceptions of patient community, aiming for adherence and consequent better treatment results. Citation Format: Marina S Montemor, Lycia TV Neumann, Anna CA Siqueira, Luciana HC Barros, Solange M Sanches. Assessing patients perceptions on hormone therapy for breast cancer: Insights from a Brazilian patient group [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-14.

Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe.

IntroductionAlthough several studies have shown that a simplified cardiovascular drug treatment leads to better treatment adherence, limited and conflicting findings have been reported on the separate or single-pill combination of the now recommended association between a statin and ezetimibe. We addressed this issue in a large cohort of patients newly treated with statins to whom ezetimibe was additionally administered, either separately or as a single-pill combination.MethodsA total of 256,012 patients (age 40–80 years) from the Lombardy Region (Italy) newly treated with statins during 2011–2013 were followed until 2018 to identify those to whom ezetimibe was added. The 2881 and 5351 patients who started a two-pill or a single-pill combination, respectively, of statin and ezetimibe were identified and matched for propensity score. Adherence to drug therapy at 1 year was measured as the ratio between the number of days in which the drug was available and the days of follow-up (the proportion of days covered; PDC). Patients who had a PDC > 75% or < 25% were, respectively, defined as highly and poorly adherent to drug therapy. Analysis was extended to the association between adherence and the risk of fatal/non-fatal cardiovascular events.ResultsCompared to those prescribed a two-pill combination, those prescribed a single-pill combination had an 87% (75–99%) greater odds of being highly adherent and a 79% (72–84%) lower odds of being poorly adherent to treatment. These advantages were manifest in all strata of age, sex, and clinical profile. The risk of cardiovascular outcomes decreased by 55% in patients with high adherence compared to those with low adherence.ConclusionPatients who were prescribed a single-pill combination of statin/ezetimibe more frequently exhibit a good adherence and less frequently bad adherence to treatment than those prescribed a two-pill combination of these drugs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01892-7.

Clinical and demographic factors associated with early relapse in patients with schizophrenia: a naturalistic observation study.

Schizophrenia is a chronic psychiatric disorder progressing in relapses. Identification of many factors that may potentially increase the risk of relapse will be an important step in preventing relapses. The aim of this study was to determine the rate of early relapse in patients with schizophrenia and possible risk factors related to early relapse. The sample of this prospective study with the naturalistic observation design consisted of 308 patients with schizophrenia. The cutoff value for early relapse was determined as 1 year. The mean age of participants was 37.38 ± 12.28 years and 66.6% of them were male (n = 205). The early relapse rate was 38.3%. The age younger than 35 [hazard ratio (HR) = 2.313; 95% confidence interval (CI), 1.518-3.526; P < 0.001], use of psychoactive substance (HR = 2.200; 95% CI, 1.407-3.440; P = 0.001), previous attempt of suicide (HR = 1.565; 95% CI, 1.028-2.384; P = 0.037), bad adherence to treatment (HR = 3.102; 95% CI, 1.358-7.086; P = 0.007), long-acting injectables (LAIs) antipsychotics in the treatment (HR = 0.534; 95% CI, 0.351-0.812; P = 0.003), combination typical-atypical antipsychotics (HR = 0.326; 95% CI, 0.131-0.807; P = 0.015), number of episodes (HR = 1.088; 95% CI, 1.043-1.134), and the score on the Side Effect factor of the Clinical Global Impressions Scale (HR = 1.826; 95% CI, 1.357-2.458; P < 0.001) were identified as the independent predictors of early relapse. It is remarkable that treatment bad adherence, use of psychoactive substance, no LAIs antipsychotics included in the treatment, and the no presence of the combination of typical and atypical antipsychotics are alterable predictors of early relapse.

Therapeutic adherence among chronic heart failure patients: A retrospective study on 147 patients

Despite improved treatment options, heart failure (HF) remains one of the most common causes of death worldwide. Therapeutic adherence is a major stake in the treatment of chronic heart failure patients. Several definitions of therapeutic adherence have been proposed and include treatment compliance. Analyzing patient's adherence to treatment is important to identify early strategies reducing crises of HF decompensation and consequent unplanned hospitalizations The aim of this study is to assess non-adherence risk factors and their clinical implications. It relies on a retrospective study conducted during September 2020 in the heart failure cardiology unit of IBN ROCHD University hospital. All the patients consulting in this unit were included. Morisky-Green survey has been translated to native to collect data. SPSS 20.0 was used to analyze data. One hundred and forty seven patients were included, with 61.2% of men. The mean age was 59.5 years old. Chronic heart failure major etiologies were ischemic cardiomyopathy (71.4%) and dilated cardiomyopathy (18.4%). Physical examination has revealed that 40.8% were NYHA I, 42.9% NYHA II, 14.3% NYHA III and 2% NYHA IV. The average Morisky Green score was 7.01. 42.9%, 36.7%, and 20.4% were respectively classified from having high to bad adherence to the treatment. Adherence degree and clinical state were significantly correlated ( P = 0.006) Interventions to improve medication adherence among HF patients have significant effects on their clinical state. Medication adherence should be assessed in regular follow-up visits with HF patients using a valid survey. Interventions are necessary for better adherence and should be a key part of HF self-care program.

Association between the Use of Alternative Medicine and Adherence to Treatment in Patients with Type 2 Diabetes

Background: Diabetes mellitus 2 (T2D) is the leading cause of morbidity and mortality in northern Mexico. Various treatments are used to control the disease; however, the cost of these and the difficulty of dietary management have as a consequence that the patient abandons them and looks for cheaper and easier-to-use alternatives. Aim: The purpose of this study is to determine the relationship between the use of alternative medicine and adherence to medical treatment in patients with T2D. Design and Setting: Analytic cross-sectional study. Methods: An analytical cross-sectional study was designed between March and July 2019 including 464 patients with T2D from the family medicine unit #48 Ciudad Juarez, Mexico. We used the Morisky-Green scale for adherence to treatment and the use of Alternative Medicine (CAM) was evaluated with a holistic complementary and alternative medicine questionnaire. The Chi-Square test was used for comparison of proportions and risk factors were calculated using odds ratio with 95% confidence intervals. Results: 53% of patients use CAM; biological therapy (herbs and supplements) is the most frequent (94%). The association between CAM use and adherence to medical treatment was 2.1 (95% CI 1.4-3.1, p= 0.001). The risk factors for the use of CAM were female sex, basic level education, uncontrolled disease and a time of evolution greater than 10 years. Conclusion: CAM users are 2.1 times more at risk of having a regular or bad adherence to medical treatment.

Self-rated health among people living with HIV in Spain in 2019: a cross-sectional study

BackgroundHIV infection has become a chronic disease and well-being of people living with HIV (PLHIV) is now of particular concern. The objectives of this paper were to describe self-rated health among PLHIV, on ART and on ART virally suppressed and to analyse its determinants.MethodsData were obtained from a second-generation surveillance system based on a cross-sectional one-day survey in public hospitals. Epidemiological and clinical data were collected among HIV-infected inpatients and outpatients receiving HIV-related care the day of the survey in 86 hospitals in 2019. Self-rated health was measured using a question included in the National Health Survey: “In the last 12 months, how would you rate your health status?” an ordinal variable with five categories (very good, good, moderate, bad and very bad). For the analysis, these responses were dichotomized into two categories: 1 = very good/good and 0 = moderate, bad or very bad health status. Factors associated with very good/good self-rated health were estimated using logistic regression.ResultsOf 800 PLHIV, 67.5% perceived their health as very good/good, 68.4% among PLHIV on ART and 71.7% of those virally suppressed. Having university education (adjusted odds ratio (aOR):2.1), being unemployed (aOR:0.3) or retired (aOR:0.2), ever being diagnosed of AIDS (aOR:0.6), comorbidities (aOR:0.3), less than 2 year since HIV diagnosis (aOR:0.3) and not receiving ART (aOR:0.3) were associated with good self-rated health. Moreover, among PLHIV on ART, viral load less than 200 copies (aOR:3.2) were related to better perceived health. Bad adherence was inversely associated with good self-rated health among PLHIV on ART (aOR:0.5) and of those virally suppressed (aOR:0.4).ConclusionsNearly seven in 10 PLHIV in Spain considered their health status as very good/good, being higher among virally suppressed PLHIV. Both demographic and clinical determinants affect quality of life.

Effect of platinum and pre-oxidation on the hot corrosion behavior of aluminide coating with NaCl at 1050 °C

The hot corrosion behaviors of the aluminide coatings with different treatments on the surface of Ni-based alloy at high temperature were investigated. The aluminide coating modified by three different methods (pretreatment, Pt-modification and both), and then all the specimens were oxidized in lab air with NaCl salt at 1050 °C. During cycle oxidation, oxide scales on the surface of the aluminide coatings presented different morphologies, composition and corrosion behaviors. The oxide scale on the surface of the as-received aluminide coating without any treatments showed a poor dense and a bad adherence. However, the oxide scale on the surface of the aluminide coating with both Pt-modification and pre-oxidation exhibited the best hot corrosion resistance. In the NaCl corrosion environment, different treatments resulted in different corrosion mechanisms. Without any treatments, the oxide scale with NaCl at high temperature occurred internal active oxidation, which could promote the corrosion process and form the pores in the oxide scale. The internal active oxidation also presented in the oxide scale on the surface of the aluminide coating with pre-oxidation.

The Effect Of Counseling On The Adherence Of Therapeutic Hypertension Patients

Failure of therapy is a result of bad adherence medication. Non-adherence to therapy is a major factor that is suspected to result in uncontrolled blood pressure in hypertensive patients resulting in more serious complications. Therefore it is important to increase the adherence rate of treatment in patients with hypertension in the treatment process. For this reason, the need for interventions to improve adherence with several aspects that can be changed. This study uses One Group Pretest-Posttest Design using 100 samples. Data derived from questionnaires containing 25 items of adherence to therapy, 5 items of knowledge, 4 items of trust, 3 items of motivation, 10 items of family support with nonparametric statistical tests used were Mc Nemar test. Mc Nemar test results indicate that there is a significant difference between adherence at the pre-test and at the post-test after counseling with a significance value (p = 0,000). The results also showed that there was a difference in knowledge with a significance value (p = 0.001), motivation with a value (p = 0.031) and family support with a value (p = 0,000). The education with counseling about knowledge, trust, motivation and family support is effective in increasing compliance. There are other changeable factors such as lifestyle education, patient doctor relationships, and the use of smartphone applications for self-reported therapy can improve adherence in patients thereby minimizing therapy failure. Other educational methods that can be used besides counseling are counseling and dissemination of social media information.

Assessment of adherence to disease-modifying anti-rheumatic drugs in rheumatoid arthritis.

This work aimed to assess treatment adherence in rheumatoid arthritis patients with several tools and to identify factors associated with poor adherence. Between February and December 2015, 183 patients were included in this cross-sectional study. A homemade 23-item self-questionnaire was filled by patients during an outpatient consultation or a day hospitalization stay. Morisky Medication Adherence Scale (MMAS)-4, MMAS-8 and Girerd scores were extracted from this homemade questionnaire. Medication possession ratio (MPR) was then calculated. For identification of factors associated with nonadherence, patients were divided in two groups according to MMAS-8 results differentiating patients with good or bad adherence to treatments. Of the 183 patients, 59% received a combination of biologic and conventional synthetic disease-modifying drugs, 22% a biological treatment alone, and 19% a conventional DMARD alone. Respectively, 3%, 10%, and 7% were considered as low adherent according to MMAS-4, MMAS-8, and Girerd scores. MPR was calculated for 84/183 patients; 23% were low adherent. The need for a help in preparing the drugs (p = 0.05; OR = 6.12; 95% CI: 0.86 to 268.90) and concomitant diabetes (p < 0.001; OR = 0.045, 95% CI: 0.001 to 0.299) was higher in patients with good adherence. Presence of a patient's relative reminding to take medications was associated with low adherence (p = 0.002; OR = 4.32, 95% CI: 1.41 to 13.11). This study highlighted the difficulty of assessing treatment adherence in rheumatoid arthritis patients despite four different tools. Objective measures by MPR indicated a higher proportion of poor adherent patients than self-questionnaires.Key Points• Proportion of patients considered as low adherent ranged from 3 to 27% according to the method of evaluation.• The use of a pillbox and/or the preparation of drugs by a patient's relative was associated with good adherence.• The presence of a patient's relative reminding to take medication was associated with low adherence.

Digital cognitive behavioral therapy for insomnia – The first Georgian version. Can we use it in practice?

Insomnia is a common sleep disorder which has a 5–6% prevalence rate and shows high social impact. At least 10% of patients with insomnia will see a medical specialist. Hence, 20,000–40,000 people in Georgia require medical help for insomnia. Treatment of insomnia is very effective. Pharmacotherapy is common, but it is recognized that cognitive behavioral therapy (CBT) is a better choice, since it is safe for patients and shows sustainable improvement. CBT of insomnia is not currently available in Georgia.The aim of our study was to evaluate a Georgian version of an innovative, internet-delivered digital CBT (dCBT) for insomnia in terms of therapeutic efficacy, adherence, and ease of handling.The Georgian digital cognitive behavioral therapy for insomnia was developed as an analogue of Dutch dCBT “i-Sleep.” All online materials were made applicable for the Georgian population through translation, validation by translation back to the original language, and adaptation to the Georgian reality, in order to avoid linguistic, cultural, and social pitfalls.Fifty-two adult patients with insomnia were recruited for the study: 34 women and 18 men, aged 18–64 years (mean: 33.5 years). Inclusion criteria included: age over 18, access to internet, and sufficient skills to use electronic devices. The patients who were treated pharmacologically continued their usual medication and received dCBT in addition to this treatment. DCBT was guided by a therapist. Clinical efficacy was evaluated on the basis of Insomnia Severity Index (ISI), measured before the dCBT and one month after its completion.25 out of 52 patients (48%) completed a full dCBT course. Mean ISI in this group dropped from 22.88 to 8.24 (P < 0.01), showing significant therapeutic effect one month after CBT completion. 27 patients (52%) stopped treatment for various reasons at different stages of dCBT. Sixteen patients dropped out from the first module (31%). 7 patients older than 50 years encountered problems with handling electronic devices and the platform itself. 9 patients stopped therapy, showing bad adherence for different reasons, mostly related to finding the sessions time-consuming and being disappointed by the absence of immediate therapeutic effect. Eleven more patients (21%) stopped at sleep restriction, finding it difficult to accomplish sleep restriction-related tasks. In general, patients found dCBT quite comprehensive and easy to handle.This data suggests that the Georgian version of dCBT for insomnia is a promising therapeutic tool, comparable with international analogues in terms of efficacy and adherence. Further studies, involving a greater number of patients and long-term follow-up are required for the final assessment of therapeutic efficacy and sustainability of results.

On the Adherence of Chemically Deposited CdS Films to Common Inorganic Substrates: Effect of Cd2+ Concentration in Solution, Substrate Surface Chemistry, and Reaction Temperature

AbstractThe bad adherence to the substrate of chemical‐solution‐deposited chalcogenide films in alkaline solution is a current technological problem. However, this issue is belittled since is commonly solved by employing pre‐sensitized substrates or by empirically changing the deposition parameters until “finding” the “proper” chemical formulation. For these reasons, the issue of the adherence has not been previously studied. The present research aims to properly discuss the issue of adherence by taking as example CdS. As a substrate, we used float glass sheets to take advantage of the surface duality of this interesting flat glass (different tin content). It was found that both the surface chemical composition of the substrate and the concentration of Cd2+ in the reaction solution play important roles in the adherence of the CdS thin films; an important effect of temperature was also found. The results were also consistent for indium tin oxide and silicon wafer surfaces. We propose a general surface reaction scheme which considers both the surface reactive sites and the hidroxo–cadmium–thiourea complexes of the reaction solution, as well as the formation of a surface intermediate entity which dissociates into a CdS molecule bonded to the surface and byproducts. The adherence depends on the quantity of surface intermediate entities formed, and therefore, the conditions that promote their formation contribute to the adherence: high reagent concentration, high‐reactive surface sites, and low reaction temperature.

Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study

BackgroundAsthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. ObjectiveDescribe clinical characteristics of children hospitalized for asthma exacerbation. MethodsObservational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. Results396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. ConclusionsAlmost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.

Adherence to oral therapies in metastatic castration resistance (m CRPC) prostate cancer patients: The ADOPTA study.

e18014 Background: With the increasing use of oral anticancer treatments understanding adherence patterns and patient’s information about therapy has become critical. Enzalutamide (ENZ) and Abiraterone acetate (AA) are orally administered drugs approved for the treatment of mCRPC widely prescribed; however, scarce information is available about treatment compliance and patient’s information about these compounds. This study aims to evaluate the adherence to AA and ENZ and the patient’s drug knowledge in mCRPC patients. Methods: A 20-question survey is being delivered to patients with mCRPC receiving either AA or ENZ in 8 centers across Spain. Questions cover items such as demographics, drug information, adherence and perceived benefits among other topics. Surveying is still ongoing. Results: Fifty patients have completed the survey at this time. Mean age is 72 years (range 58-87), educational level is basic in 56 %. Median duration of treatment was 9,5 months. Adherence reported is very high with 84% of the patients taking 100% of prescribed doses and 100% more than 75%. Treatment compliance does not seem to decrease over time despite only 42% of the patients reported the use of devices to secure adherence. A high compliance correlated with better symptom control. Nonetheless, many areas of improvement have been also identified. About a quarter of the patients (26%) ignored the name of the drug they were receiving and 24% whether or not they were in a clinical trial. Almost all patients were not aware of the planned duration of treatment and 70 % recognized that they did not know the consequences of a bad adherence. Eleven patients (22%) were taking AA with food outside of a clinical trial and three patients (6%) reported inadequate dosage (i.e q 12h). Conclusions: While in other diseases adherence to oral therapies has been identified as a potential limiting factor with impact in efficacy, in our series of mCRPC treatment compliance was high and maintained overtime. Yet, serious patient education pitfalls were identified. Data collection is ongoing and further analysis will be presented.

Effect of Nasal Continuous Positive Pressure on the Nostrils of Patients with Sleep Apnea Syndrome and no Previous Nasal Pathology. Predictive Factors for Compliance

ObjectiveTo evaluate the effect of continuous positive airway pressure (CPAP) on the nostrils of patients with sleep apnea–hypopnea syndrome and its impact on quality of life, and to identify predictive factors for compliance. MethodsLongitudinal prospective study. Thirty-six consecutive patients evaluated before and 2 months after CPAP using the following variables: clinical (eye, nose and throat [ENT] symptoms, Epworth test, anxiety/depression scales, general and rhinoconjunctivitis-specific quality of life); anatomical (ENT examination, computed tomography); functional (auditive and Eustachian tube function, nasal flow, mucociliary transport); biological (nasal cytology); and polisomnographics. The sample was divided into partients with good adherence (≥4h/d) and patients with bad adherence (<4h/d). ResultsA significant improvement was observed in daytime sleepiness (P=.000), anxiety (P=.006), and depression (P=.023). Nasal dryness (P=.000), increased neutrophils in nasal cytology (P=.000), and deteriorating ciliary function were evidenced, particularly in partients with good adherence. No significant differences were observed in the other variables. Baseline sleepiness was the only factor predictive of compliance. ConclusionsCPAP in patients without previous nasal pathology leads to an improvement in a series of clinical parameters and causes rhinitis and airway dryness. Some ENT variables worsened in partients with good adherence. Sleepiness was the only prognostic factor for poor tolerance.

Alexithymia and asthma

IntroductionAlexithymia refers to difficulties in verbal expression of emotions, commonly observed in patients with psychosomatic symptoms. In this context, asthma is described as one of psychosomatic diseases.ObjectivesIdentify clinical profile of asthmatic patients and assess the alexithymia level as well as associated factors.MethodsWe conducted a cross-sectional, descriptive and analytic study, including 30 patients followed for asthma at pulmonary outpatient department, Hedi Chaker Hospital, Sfax, Tunisia, during September and October 2015. We collected socio-demographic and clinical characteristics. Asthma control level was assessed by the Asthma Control Test (ACT). Alexithymia was measured using Toronto Alexithymia Scale (TAS 20).ResultsThe mean age was 51 ans. Sex-ratio F/M was 14. The mean duration of disease was 11 years. Long-term control medicines were: inhaled corticosteroids, long-acting beta agonists and theophylline respectively in 86.7%, 33.3% and 26.7%. Two thirds of our patients had a bad therapeutic adherence. The average ACT score was 16.8 points. Asthma was uncontrolled in 1/3 and well controlled in 1/3 of cases. The average TAS 20 score was 64.8 points. Twenty percent of patients were non-alexithymic, 13.3% had a probable alexithymia and 66.7% were alexithymic. This score was positively correlated to bad asthma control (P &lt; 0.001), long term evolution (P = 0.002) and use of inhaled corticoids (P &lt; 0.001). It was inversely correlated to ACT score (P &lt; 0.001).ConclusionOur study shows the high prevalence of alexithymia in patients with asthma and its negative impact in asthma control. Psychological support aiming specifically alexithymic dimension in these patients is indispensable.Disclosure of interestThe authors have not supplied their declaration of competing interest.