Compliance Outcomes Research Articles

Comparative analysis of machine learning approaches for predicting the risk of vaginal laxity

This study develops predictive models for Chinese female patients with VL utilizing machine learning techniques. The aim is to create an effective model that can assist in clinical diagnosis and treatment of vaginal relaxation, thereby enhancing women’s pelvic floor health. In total, 1184 women with VL have been randomly selected and categorized into groups using the finger measurement method. Among them, there are 383 cases of mild VL, 405 cases of moderate VL, and 396 cases of severe VL. Concurrently, 396 healthy women without VL who underwent routine health examinations have been chosen at random and assigned to the non-VL group. Based on 1580 cases, we have established LightGBM, Random Forest, XGBoost, and AdaBoost models based on training dataset using 5-fold cross-validation and GridSearch, and analyzed the performance of the models on the hold-out test dataset. The confusion matrix, precision, recall, F1 score, overall accuracy, and ROC curve of the models on the hold-out test dataset are compared. The overall accuracy of LightGBM model, RF model, XGBoost model, and AdaBoost model are 0.8987, 0.8987, 0.8987, and 0.8457, respectively. The average AUC of LightGBM model is 0.976, the one of RF model is 0.9763, the one of XGBoost model is 0.9775, and the one of AdaBoost model is 0.928. The XGBoost model has the more comprehensive and reasonable performance among the four prediction models, which can accurately distinguish between healthy, mild VL, as well as moderate VL and severe VL, which can assist doctors in diagnosing persons’ conditions more accurately, devising personalized treatment plans, avoiding unnecessary surgeries, reducing persons’ psychological stress, improving patient compliance and treatment outcomes, thus enhancing overall treatment results.

The Application of Integrated Force and Temperature Sensors to Enhance Orthotic Treatment Monitoring in Adolescent Idiopathic Scoliosis: A Pilot Study

Orthosis-wearing compliance is crucial for achieving positive treatment outcomes in patients with adolescent idiopathic scoliosis (AIS), for whom 23 h of daily wear is typically prescribed. However, self-reported compliance is subjective and often based on patients’ memory, leading to inaccuracies. While portable electronic devices have been developed to objectively monitor compliance, relying solely on temperature or force data can be insufficient. This study introduced a novel method that integrated both force and temperature data to estimate orthosis-wearing compliance. Twelve patients (eight females and four males) diagnosed with moderate AIS were included. Each patient was prescribed a thoracic-lumbar-sacral orthosis equipped with an integrated force and temperature sensor system. After one month of orthotic treatment, self-reported wear time averaged 17.8 ± 6.2 h/day, while the sensor indicated an average wear time of 13.3 ± 5.0 h/day. Most patients overestimated their compliance. Nighttime was the most common period for orthosis wear (6.1 h/day), whereas compliance during school hours (2.8 h/day) and after-school hours (3.7 h/day) was lower. The integration of force and temperature sensors provides a more comprehensive understanding of orthosis compliance. Future studies with larger samples and longer monitoring periods are needed to investigate the correlation between compliance and treatment outcomes.

Development of Novel Fluticasone/Salmeterol/Tiotropium-Loaded Dry Powder Inhaler and Bioequivalence Assessment to Commercial Products in Rats.

Background/Objectives: Inhaler devices have been developed for the effective delivery of inhaled medications used in the treatment of pulmonary diseases. However, differing operating procedures across the devices can lead to user errors and reduce treatment efficacy, especially when patients use multiple devices simultaneously. To address this, we developed a novel dry powder inhaler (DPI), combining fluticasone propionate (FP), salmeterol xinafoate (SX), and tiotropium bromide (TB) into a single device designed for bioequivalent delivery compared to existing commercial products in an animal model. Methods: The micronized FP/SX/TB-loaded capsule was prepared by sieving, blending, and filling capsules. Capsule suitability of the drugs was investigated from the comparison of the stability of drugs within various capsule formulations to that of commercial products. The particle size of the drugs was adjusted using spiral air jet milling, and the ratio of lactose hydrate carriers was optimized by comparing the aerodynamic particle size distribution (APSD) with that of commercial products. To investigate the bioequivalence of micronized FP/SX/TB-loaded DPI to commercial products, the dissolution profile of FP/SX/TB particles and pharmacokinetics in rats were evaluated and compared to commercial products. Results: Capsules with hydroxypropyl methylcellulose (HPMC) without a gelling agent showed superior stability of the drugs compared to commercial products. The deposition pattern was influenced by the particle size of the drugs, and fine particle mass exhibited a significant correlation with the amount of fine carrier. Micronized FP/SX/TB-loaded DPI gave a similar APSD and dissolution profile compared to the commercial products and showed dose uniformity by the DPI device. Furthermore, micronized FP/SX/TB-loaded DPI exhibited bioequivalence to commercial products, as evidenced by no significant differences in pharmacokinetic parameters following intratracheal administration in rats. Conclusions: A novel triple-combination DPI containing FP/SX/TB was successfully developed, demonstrating comparable pharmacological performance to commercial products. Optimized FP/SX/TB-loaded DPI with HPMC capsule achieved bioequivalence in rat studies, suggesting its potential for improved patient compliance and therapeutic outcomes. This novel single-device DPI offers a promising alternative for triple therapy in pulmonary diseases.

Ensuring Data Accuracy and Compliance in Remote Healthcare Monitoring

Remote healthcare delivery and clinical trials have undergone a dramatic transformation, necessitating robust frameworks for ensuring data accuracy and regulatory compliance in virtual settings. This comprehensive article explores the intricate challenges healthcare organizations face when implementing remote monitoring systems while maintaining data integrity and adhering to stringent regulatory requirements. Through examination of current technological infrastructure, quality control methodologies, and regulatory frameworks, this article presents a structured approach to achieving reliable data collection in remote care environments. The article addresses critical aspects, including device validation protocols, HIPAA compliance in virtual settings, and standardized procedures for remote patient monitoring, while offering practical solutions for common challenges in technology adoption and data discrepancy management. This article indicates that the successful implementation of remote healthcare data systems requires a three-pronged approach: robust technical infrastructure, comprehensive staff training programs, and patient-centric education initiatives. Furthermore, this article identifies emerging trends in artificial intelligence and predictive analytics that promise to enhance data validation processes and compliance monitoring in remote healthcare settings. This article provides healthcare professionals and organizations with actionable insights for establishing and maintaining reliable remote data collection systems while ensuring regulatory compliance and optimal patient care outcomes.

Enhanced Recovery After Surgery Protocol Compliance and Early Outcomes for Elective Colorectal Procedures by Race/Ethnicity and Socioeconomic Status.

To explore the association of socioeconomic status (SES) and race/ethnicity with perioperative metrics within the Enhanced Recovery After Surgery (ERAS) framework to identify gaps for equity-informed improvements. Although ERAS pathways improve perioperative outcomes through standardized care, disparities in protocol adherence and postoperative outcomes persist, particularly for vulnerable populations. We conducted a retrospective cohort study using a single-institution database of elective colorectal surgeries (2018-2021). Patients were categorized and assessed by SES and race/ethnicity. Overall, 1,519 patients were analyzed: 180 had low SES (11.8%) and 1,339 - high SES (88.2%). Low SES patients had lower rates of bowel preparation completion, use of the electronic patient portal, and carbohydrate loading pre-surgery. Low SES was associated with a longer median length of stay (LOS) (4 vs. 3 days, P<0.001). Multivariate logistic regression analysis showed low SES was linked to higher odds of infectious (OR 2.46, 95%CI: 1.31-4.63) and all in-hospital complications (OR 1.50, 95%CI: 1.06-2.12). Among racial/ethnic cohorts, Black patients had lower rates of documented preoperative patient education, longer median LOS (5 vs. 3-4 days, P=0.002), and increased odds of respiratory complications (OR 4.11, 95%CI: 1.56-10.85). Low SES was linked to lower compliance with important process measures, higher infectious and all in-hospital complication rates, and longer LOS. Despite high rates of protocol compliance, Black race/ethnicity showed an association with increased odds of respiratory complications and extended LOS. Adjustments to perioperative protocols could address such disparities, helping to improve postoperative outcomes of colorectal surgeries.

Medication compliance by cat owners prescribed treatment for home administration.

Most veterinary literature examining medication compliance has described the phenomenon in dogs. The evidence available regarding factors affecting cat owner medication compliance is limited. Identify and describe factors associated with cat owners' noncompliance with veterinary recommendations for pet medications, as well as client-reported barriers and aids to administering medications prescribed by primary care veterinarians. Cat owners presenting their animals for veterinary examination and treatment. A cross-sectional survey of cat owners' compliance with veterinary medication recommendations was performed from January 9, 2019, to July 18, 2020. A convenience sample of owners prescribed medication for their pets by veterinarians during or after elective veterinary examination was recruited to respond to questions regarding medication administration experience and compliance. Follow-up was obtained from owners to determine if the course of medication had been completed. Compliance data were analyzed descriptively, and logistic regression was performed. Medication noncompliance was recorded for 39% (26/66) of cat owners. A quarter (16/66) reported challenges in administering medication to their pets; the most commonly cited reason was a resistant pet. Oral administration of antibiotics was significantly associated with noncompliance (P = .01). Clients with limited pet ownership experience were less likely to be noncompliant (P = .04). Clients' inability to medicate their cats PO may have implications for clinical outcomes and antimicrobial stewardship. Alternatives to direct PO administration of solid-form medications in cats should be considered. Demonstrating administration techniques to all clients may improve compliance and influence clinical outcome.

Design and Development of Saxagliptin Microparticles for Diabetes

This study investigates the design, development, and evaluation of sustained-release Saxagliptin microparticles, utilizing Eudragit L-100 and Eudragit S-100 as polymers to achieve prolonged drug release. A total of eight formulations were prepared, employing varying drug-to-polymer ratios (1:1, 1:2, 1:3, and 1:4) for both core and coat materials. This approach facilitated an assessment of the concentration of coating material influenced the drug release rate. The solvent evaporation method proved effective in producing discrete, spherical microparticles characterized by good flowability and minimal stickiness. The surfactant Span 80 was optimized at a concentration of 1.0% to ensure optimal emulsion stability and microparticle formation. Results demonstrated that Eudragit S-100 based microparticles exhibited a significantly slower drug release profile compared to those formulated with Eudragit L-100. Notably, the formulation with a 1:4 Saxagliptin-to-Eudragit S-100 ratio achieved sustained release for up to 12 hours, confirming the trend of decreasing release rates with increasing concentrations of coating material. Dissolution data analysis revealed that the release kinetics best fit a zero-order model, indicating a constant drug release rate over time. Furthermore, the Peppas model provided the most suitable framework for understanding the drug release mechanism. The exponential coefficient (n) values indicated a non-Fickian release pattern, signifying a complex interplay between diffusion and erosion processes, which are critical for maintaining the sustained-release profile. Additionally, FTIR spectroscopy was employed to assess the compatibility of Saxagliptin within the optimized formulation. The results confirmed that the drug retained its chemical identity, with no evidence of chemical interactions between Saxagliptin and the excipients. This comprehensive study underscores the potential of Eudragit S-100 as an effective polymer for developing sustained-release formulations of Saxagliptin, enhancing patient compliance and therapeutic outcomes.

Implementing Equality: State (Non)compliance With Judicial Revisions to Public Policy on Gay Rights

ABSTRACTBecause the civil rights movement accomplished many successes via litigation, advocacy communities regard courts as bulwarks against the legal enshrinement of oppression targeting vulnerable minorities. Advocates of LGBTQ equality are no different, identifying the judiciary as critical to eradicating discrimination on the basis of sexual orientation. Standing alone, however, Supreme Court holdings revising the scope of civil rights for sexual minorities represent a change in policy formulation rather than implementation. Judicially directed reformulations of public policy require cooperation by officials responsible for implementation, and compliance rates with judicial directives vary. Here, I analyze state responses to two Supreme Court decisions involving sexual minorities: Lawrence v. Texas, decriminalizing sodomy, and Obergefell v. Hodges, invalidating state same‐sex marriage bans. Although adherence to Obergefell was swift and nearly universal, compliance outcomes for Lawrence have been uneven, as some states continue to enforce statutes that are materially equivalent to the “homosexual conduct” law reviewed in Lawrence. I argue compliance with Lawrence has lagged compared to Obergefell for the following three reasons: (1) linguistic imprecision in Lawrence; (2) divergent views of the right(s) at issue in each case; and (3) the absence of a federal executive regime credibly committed to the case's outcome.

Experimental and Theoretical Design on the Development of Matrix Tablets with Multiple Drug Loadings Aimed at Optimizing Antidiabetic Medication.

Background: Diabetes is a growing global health crisis that requires effective therapeutic strategies to optimize treatment outcomes. This study aims to address this challenge by developing and characterizing extended-release polymeric matrix tablets containing metformin hydrochloride (M-HCl), a first-line treatment for type 2 diabetes, and honokiol (HNK), a bioactive compound with potential therapeutic benefits. The objective is to enhance glycemic control and overall therapeutic outcomes through an innovative dual-drug delivery system. Methods: The tablets were formulated using hydrophilic polymers, such as Carbopol® 71G NF and Noveon® AA-1. The release kinetics of M-HCl and HNK were investigated through advanced mathematical models, including fractal and multifractal dynamics, to capture the non-linear and time-dependent release processes. Traditional kinetic models (zero-order, first-order, Higuchi equations) were also evaluated for comparison. In vitro dissolution studies were conducted to determine the release profiles of the active ingredients under varying polymer concentrations. Results: The study revealed distinct release profiles for the two active ingredients. M-HCl exhibited a rapid release phase, with 80% of the drug released within 4-7 h depending on polymer concentration. In contrast, HNK demonstrated a slower release profile, achieving 80% release after 9-10 h, indicating a greater sensitivity to polymer concentration. At shorter intervals, drug release followed classical kinetic models, while multifractal dynamics dominated at longer intervals. Higher polymer concentrations resulted in slower drug release rates due to the formation of a gel-like structure upon hydration, which hindered drug diffusion. The mechanical properties and stability of the matrix tablets confirmed their suitability for extended-release applications. Mathematical modeling validated the experimental findings and provided insights into the structural and time-dependent factors influencing drug release. Conclusions: This study successfully developed dual-drug extended-release matrix tablets containing metformin hydrochloride and honokiol, highlighting the potential of hydrophilic polymers to regulate drug release. The findings emphasize the utility of advanced mathematical models for predicting release kinetics and underscore the potential of these formulations to improve patient compliance and therapeutic outcomes in diabetes management.

Real-World Clinical Utility of a Methylated DNA Biomarker Assay on Samples Collected with a Swallowable Capsule-Balloon for Detection of Barrett's Esophagus (BE).

Background: Barrett's Esophagus (BE) is the only known precursor for esophageal adenocarcinoma (EAC). Patients with multiple risk factors for BE/EAC are recommended for screening; however, few eligible patients undergo evaluation by endoscopy. EsoGuard® (EG) is a commercially available biomarker assay used to analyze esophageal cells collected non-endoscopically with EsoCheck® (EC) for the qualitative detection of BE/EAC. This study evaluates the real-world clinical utility of EG on cells collected with EC in patients defined by U.S. gastroenterology societies to be at-risk for BE and EAC. Methods: This multi-center, observational CLinical Utility of EsoGuard (CLUE) study enrolled screening-eligible patients as defined by the American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA). Clinical utility was evaluated by the provider decision impact of EG and additionally by assessing patient compliance outcomes with recommended follow-up testing. Results: There were 551 patients enrolled, with a mean age of 62.0 ± 12.4 years and 56.1% (309/551) meeting ACG guideline criteria for BE screening. EC cell collection was successful in 97.1% (535/551), among which the EG positivity rate was 27.3% (n = 146). The provider decision impact was high, with 100% of EG-positive patients being referred for esophagogastroduodenoscopy (EGD), while 98% of EG negative patients were not referred. Among the EG-positive patients, the overall compliance with follow-up EGD was 85.4%. Conclusions: Combining EC non-endoscopic esophageal cell collection with the EG biomarker assay is effective in guiding provider decision-making for the detection of BE and EAC. Patients with positive EG results demonstrate high compliance with recommended follow-up EGD.

Moving the Needle: Recommendation Precision and Compliance with Women’s Rights Recommendations

Abstracts International human rights institutions impose obligations on their member states that extend long past the ratification stage. Each year, states receive tens, or even hundreds, of recommendations from international human rights bodies. These recommendations demand that states change their human rights policies and practices. While recent scholarship has emphasized the important role of domestic institutions and civil society actors in facilitating compliance with these recommendations, comparatively little research examines how the quality of the recommendations themselves affects compliance outcomes. Using two novel datasets, this paper sets out to understand the nexus between recommendation quality and compliance. Our research suggests that highly precise recommendations move the needle away from inaction on international human rights institutions’ rulings and recommendations but make full compliance more difficult. This paper advances the existing literature on the dynamics of compliance and places some of the responsibility for compliance on the international human rights institutions themselves.

A Review on Role of Sustained Release Tablets in Improving Patient Compliance and Therapeutic Outcomes

Sustained release tablets represent a significant advancement in pharmaceutical drug delivery, offering controlled and prolonged release of active ingredients to enhance therapeutic outcomes. This novel approach addresses the limitations of conventional dosage forms by maintaining consistent plasma drug levels, reducing dosing frequency, and improving patient compliance. Sustained release systems utilize various technologies, including matrix systems, reservoir systems, and osmotic pumps, to regulate drug release over an extended period. This review provides a comprehensive analysis of the design, formulation strategies, and evaluation techniques for sustained release tablets. It highlights their applications in managing chronic diseases, improving bioavailability, and minimizing side effects. The potential challenges, such as variability in gastrointestinal conditions and cost- effectiveness, are also discussed. By integrating sustained release technology into holistic health management, this approach contributes to more effective, patient-centered therapies. Keywords-Sustained Release Tablets, Controlled Drug Delivery, Prolonged Release, Matrix Systems, Osmotic Pumps

Current Technological Advances in Mucoadhesive Buccal Drug Delivery Systems and Their Therapeutic Applications

Buccal drug delivery has emerged as a promising route of administration, offering distinct advantages over conventional oral delivery systems. The unique physiological characteristics of the buccal mucosa, including rich vascularity and relatively high permeability, make it an attractive site for both local and systemic drug administration. Bioadhesive formulations have revolutionized buccal drug delivery by ensuring prolonged contact with the mucosal surface, thereby enhancing drug absorption and bioavailability. Recent developments in polymer science have introduced novel mucoadhesive materials, including thiolated polymers, lectins, and stimuli-responsive systems, which demonstrate superior adhesion properties and controlled release characteristics. Various formulation approaches, such as films, tablets, patches, and hydrogels, have been developed to optimize drug delivery through the buccal route. These systems incorporate permeation enhancers, enzyme inhibitors, and novel drug carriers to overcome the biological barriers associated with buccal delivery. The application of nanotechnology has further advanced the field, introducing nanostructured formulations that exhibit enhanced mucoadhesion and improved drug permeation. Current research focuses on developing intelligent delivery systems that respond to physiological triggers and maintain therapeutic drug levels. Understanding the critical factors affecting bioadhesion, including polymer characteristics, environmental conditions, and physiological variables, has led to the development of more effective formulations. The integration of modern analytical techniques and quality control measures ensures the development of stable and efficient buccal delivery systems and improves patient compliance and therapeutic outcomes

Impact of Providing a Personalized Data Dashboard on Ecological Momentary Assessment Compliance Among College Students Who Use Substances: Pilot Microrandomized Trial.

The landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant compliance in the study protocol, representing a significant challenge for researchers. This study aimed to evaluate the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study. Participants (N=91; 61/91, 67% female and 84/91, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/d (EMA Group) or complete the same EMA protocol with 1 personalized message and a DD indicating multiple metrics of progress in the study, delivered at 1 randomly selected prompt/d (EMA+DD Group) via a microrandomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups. Levels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study (P=.047 and P=.03, respectively). Although nonsignificant, small-to-medium effect sizes were observed when comparing the groups in terms of compensation level (P=.08; Cohen w=0.19) and perceived burden (P=.09; Cohen d=-0.36). Qualitative findings revealed that EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment level did not significantly impact participants' likelihood of completing the EMA or completion time at that particular prompt (all P>.05), with the exception of the first prompt of the day (P=.01 and P<.001). Providing a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants' mobile devices. RR2-10.2196/57664.

Comparative Analysis of Government Regulatory Compliance: A Case of Kenya, China and USA

The importance of regulatory compliance in ensuring that laws and related public policies accomplish their intended goals, which include promoting social and economic development and protecting important aspects of public welfare in a nation cannot be gainsaid. Championing regulatory compliance is a crucial part of international development work, as much as it is frequently overlooked. Studies reveal that the "volume" and harshness of enforcement do not always correspond with compliance and regulatory outcomes, that compliance is not always the intended result of regulations, and that compliance is not always the automatic consequence of regulations. Robust data also indicates that regulations, regulatory administration, procedures, and systems that are not well-designed can impede economic expansion and serve as a breeding ground for corruption. This study digs into the complexities of government regulation compliance in the ever-evolving field of e-commerce, providing a comparative examination among three very different jurisdictions: Kenya, the United States and China. The purpose of the study is to clarify the constantly changing regulatory environment that oversees Internet commerce by investigating the legal frameworks, enforcement strategies, and commercial ramifications that arise for companies that operate in these various areas. The research endeavors to enable cross-border cooperation and enlighten policymakers on effective regulatory strategies to balance innovation, consumer protection, and industrial growth by identifying commonalities and discrepancies in regulatory approaches. This research offers a contemporary overview of the legislative frameworks driving the digital marketplace in various regions, as e-commerce continues to redefine global trade dynamics.

Transforming Supplier Audits with AI: A Risk-Based Approach in Medical Devices

The medical device industry, highly regulated and sensitive to quality standards, relies on rigorous supplier audits to ensure compliance and mitigate risks. However, traditional supplier audits are often resource-intensive, inconsistent in quality, and lack a clear focus on the most critical risk factors. This paper explores how Artificial Intelligence (AI) can revolutionize the supplier audit process by enabling a risk-based approach that enhances accuracy, efficiency, and regulatory compliance. AI technology, with its advanced data processing, predictive analytics, and machine learning capabilities, can analyze vast amounts of supplier data in real-time, generating risk scores that prioritize high-risk suppliers for more frequent and thorough audits. This shift allows medical device companies to better allocate resources, focusing on high-impact areas and enhancing overall supply chain security. By considering factors such as supplier compliance history, product criticality, regional compliance laws, and performance trends, AI provides a dynamic and data-driven assessment model that minimizes the reliance on subjective audit practices. The paper introduces an AI-powered risk-based audit framework specifically tailored for medical device companies. This framework utilizes a multi-faceted AI-driven risk scorecard, categorizing suppliers by risk levels (high, medium, low) and enabling targeted audit strategies. It also demonstrates how AI can process a wide array of audit-related data inputs—such as supplier compliance, regional geopolitical risks, supply volume, and product criticality—to generate a holistic and accurate risk assessment. Through case studies and industry examples, this research underscores the advantages of integrating AI into supplier audit processes, highlighting cost savings, improved compliance outcomes, and reduced risk of quality issues or product recalls. Furthermore, it examines future trends and ethical considerations of AI in supplier audits, advocating for industry-wide adoption of AI-powered tools to support more efficient and effective supplier management. This paper concludes that adopting a risk-based, AI-driven audit approach in the medical device sector not only supports regulatory compliance but also builds resilience within the supply chain, creating a safer and more efficient landscape for medical device production.

Characteristics of Side Effects in Non-Emergency Indications Using Computer-Controlled Pressurized Monoplace Hyperbaric Chambers: A Retrospective Multicenter Study.

Background: Hyperbaric oxygen therapy (HBOT) involves inhaling nearly 100% oxygen in a pressurized environment and is commonly used to treat various diseases and injuries. Despite its well-known safety, HBOT is associated with side effects, with frequent middle ear barotrauma (MEB) and oxygen toxicity. Understanding the characteristics and risk factors associated with these side effects is critical for improving patient compliance and treatment outcomes. Methods: This retrospective multicenter study aimed to analyze the characteristics and factors associated with side effects during HBOT using a computer-controlled pressurized monoplace hyperbaric chamber. We conducted a retrospective observational study across the two tertiary hospitals in Korea, involving patients who received HBOT from October 2016 for one hospital and October 2017 for another hospital to June 2020. Data were extracted from electronic medical records and hyperbaric chamber logs, including patient demographics, medical history, HBOT indications, and details of side effects. Statistical analyses, including chi-square and t-tests, were used to compare variables. Results: A total of 247 patients (mean age: 59.35 ± 15.05 years, 63.56% male) were included. The most common indications for HBOT were sudden sensorineural hearing loss (27.94%) and post-graft/flap (24.29%). Hypertension (46.15%) and diabetes mellitus (39.27%) were the most frequent comorbidities. Otalgia was the most prevalent side effect (33.20%), followed by chest discomfort (2.02%) and headache (1.62%). A significant proportion of patients (11.74%) terminated HBOT due to side effects, with most pauses occurring at pressures between 1.2 and 1.4 ATA (26.67%). Side effects, particularly otalgia, significantly impact patient compliance with HBOT. Conclusions: The incidence of side effects varies by pressure level during treatment, suggesting the need for tailored strategies to minimize side effects. This study highlights the importance of patient monitoring and education to improve the safety and efficacy of HBOT in monoplace chambers.

Enhancing Cannabinoid Bioavailability in Pain Management: The Role of Cyclodextrins.

Chronic pain (CP), including pain related to cancer, affects approximately 2 billion people worldwide, significantly diminishing quality of life and imposing socio-economic burdens. Current treatments often provide limited relief and may cause adverse effects, demanding more effective alternatives. Natural compounds from Cannabis sativa L., particularly cannabinoids like THC and CBD, exhibit analgesic and anti-inflammatory properties, but their therapeutic use is restricted by poor solubility and low bioavailability. Cyclodextrins (CDs) and cyclic oligosaccharides may encapsulate hydrophobic drugs in order to enhance their solubility and stability, offering a promising solution to these challenges. This study explores the formation of CD inclusion complexes with cannabinoids and specific terpenes, such as D-limonene (LIM), beta-caryophyllene (BCP), and gamma-terpinene (γ-TPN), aiming to improve pharmacokinetic profiles and therapeutic efficacy. We discuss analytical techniques for characterizing these complexes and their mechanisms of action, highlighting the potential of CDs to optimize drug formulations. The integration of CDs in cannabinoid therapies may enhance patient compliance and treatment outcomes in CP management. Future research should focus on innovative formulations and delivery systems to maximize the clinical applications of those compounds.

Adaptive emotion regulation might prevent burnout in emergency healthcare professionals: an exploratory study

BackgroundEmergency department (ED) professionals face a high risk of physical, mental, and emotional strain, which can lead to burnout. Burnout arises from chronic work-related stress, which negatively impacts ED professionals, the healthcare system, as well as patient outcomes. Effective adaptive emotion regulation strategies (ERS) are crucial for handling stress in healthcare workplaces and mitigating the risk of burnout. High-quality patient-professional relationships, including empathy, significantly improve patient compliance and disease outcomes. This cross-sectional exploratory study aims to investigate the relationship between mental distress, burnout, adaptive and maladaptive ERS among healthcare professionals in an ED.MethodsA total of 159 ED workers participated in an online survey. Emotion regulation was assessed using the Cognitive Emotion Regulation Questionnaire, while burnout and mental distress were measured using the Maslach Burnout Inventory and the Depression, Anxiety, and Stress Scale.ResultsThe findings revealed that more than 20% of participants displayed severe symptoms of stress (N = 35), anxiety (N = 36), and depression (N = 31), and only 10.7% (N = 27) had no signs of burnout. Despite these findings, it appears that the majority of ED professionals primarily utilise adaptive ERS (91.8%, N = 146). However, as burnout levels increased, the use of adaptive ERS declined compared to maladaptive strategies. Regression analysis identified several significant predictors of Emotional Exhaustion, Depersonalisation, and reduced Personal Accomplishment, including gender, age, physical exercise, smoking, sedative usage, stress, depression, maladaptive strategies and adaptive strategies such as positive reappraisal.ConclusionsThese study results highlight the urgent need to address workplace stress, burnout, and mental distress among healthcare professionals in EDs. Implementing effective strategies for adaptive emotion regulation and promoting a supportive work environment can help mitigate burnout and enhance the well-being of ED workers, ultimately benefiting patient care and outcomes.

A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial.

Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Approval was granted by the university's institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant's progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults' compliance and engagement in intensive longitudinal studies. DERR1-10.2196/57664.