Adherence Criteria Research Articles

0524 Early CPAP Adherence as a Primary Predictor of CPAP Adherence at One Year

Abstract Introduction CPAP/APAP therapy remains the gold standard for treating OSA. Unfortunately, many patients struggle with long term CPAP/APAP adherence. Patients frequently have only 90 days to meet Medicare criteria for adherence to assure coverage of their CPAP/APAP therapy. Lack of adherence often leads to reevaluation, and a new trial of CPAP/APAP. Despite all of these efforts a significant number of patients are ultimately unsuccessful. When this process is drawn out over many months it can drain resources, time and patient motivation. We sought to determine if we could, during the first 30 days of CPAP/APAP therapy, identify those patients who were ultimately going to be unsuccessful. Methods A retrospective data analysis was completed on 7498 CPAP/APAP naive patients who began CPAP/APAP therapy in 2020-2021 with ResMed devices. Data was analyzed for percent of days with adherence (>4h/night) at 30 days, 60 days, 90 days, 180 days and 365 days. Additionally, AHI, sex, state, number of mask refits, and payor type (HMO, Medicare, self-pay, Medicare Advantage and Medicaid Advantage) were examined. Results Patients were 68% male. The age was 55.1±14.0 and AHI 29.8±25 (mean±SD). 1157 of the patients were < 10% adherent to CPAP/APAP (no more than 3 days >4h) during the first 30 days. Of the 1157, only 312 patients (27%) showed any use over 4h. The remaining 845 (73%) showed no CPAP/APAP use >4h during the first 30 days. At one year only 220 patients (19%) of the original 1157 showed any use over 4h. Of the 220 patients who showed any use >4h at year one, 83% were in the original 312 who showed any use >4h at 30 days. The other variables analyzed including AHI, sex, state, number of mask refits, and payor type were not independent predictors of long term adherence. Conclusion Patients with < 10% adherence at 30 days were unlikely to achieve adherence during one year of follow up. Identifying and intervening early in this population may facilitate ultimate CPAP/APAP adherence or the successful initiation of alternative therapies. Support (if any)

Experience With Adaptive Servo-Ventilation Among Veterans in the Post-SERVE-HF Era.

The sleep medicine community has struggled to identify the ideal role for adaptive servo-ventilation (ASV) therapy following a study that found increased mortality in patients with central sleep apnea (CSA) and heart failure with reduced ejection fraction who used ASV therapy. We aimed to identify characteristics of patients who benefit from ASV therapy. We performed a record review of all patients treated with ASV therapy at the Hampton Veterans Affairs Medical Center in Virginia from January 1, 2015, to April 30, 2020. Clinical and polysomnographic characteristics of patients adherent to therapy were compared with those that were not adherent. Our cohort of 31 patients was entirely male with a mean age of 67.2 years, body mass index of 34.0, and Epworth Sleepiness Scale score of 10.9. Primary CSA was initially diagnosed in 3 patients (10%), comorbid obstructive sleep apnea (OSA) and CSA in 9 (29%), and primary OSA in 19 (61%). Seventeen patients (55%) met minimal adherence criteria with ASV therapy. The obstructive apnea-hypopnea index (AHI), as a proportion of the total pretreatment AHI, was higher in adherent patients (81.5%) vs nonadherent patients (46.7%) (P = .02). The median residual AHI was lower in the adherent group, both as absolute values (1.7 vs 4.7 events/h; P = .004) and as a percentage of the pretreatment AHI (3.1% vs 10.2%; P = .002). Patients using ASV devices regularly have a larger component of obstructive sleep-disordered breathing and obtain greater objective benefit from ASV than those that do not. This understanding may help to identify patients that will most benefit from this debated form of therapy.

Abstract LB146: Imaging surveillance practice patterns among older adults with stage I/II non-small cell lung cancer

Abstract Background: Following completion of curative-intent treatment, patients with non-small cell lung cancer (NSCLC) are recommended to undergo routine imaging surveillance to detect potential cancer recurrence. We aimed to evaluate adherence to guideline recommended imaging surveillance and factors associated with either adherence or non-adherence. Methods: We utilized data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Program for the years 2003-2016. Participants were included if they were diagnosed with stage I/II NSCLC, survived for more than 2 years following completion of treatment, between the ages of 65-85, and received either surgical resection or stereotactic body radiotherapy (SBRT) as their primary treatment. Participants were considered to have received guideline-recommended imaging surveillance if there was record of receiving at least one computed tomography (CT) or chest x-ray (CXR) during the following four time windows following completion of curative intent treatment: 90-270 days, 360-450 days, 540-630 days, and 720-810 days. Logistic regression analysis was used to evaluate whether race/ethnicity, sex, age group, treatment type, stage of disease, histology, insurance status, marital status, and comorbidity burden were associated with adherence to guideline-recommended imaging surveillance. All analyses were performed using SAS 9.4. Results: A total of 14,296 NSCLC patients were included in the present analysis. Most participants were male (57.9%) and Non-Hispanic (NH) white (85.8%). Notably, only 21.9% of patients received guideline-recommended imaging surveillance during the entire 2-year follow-up period. When evaluating adherence within the first year of follow up only, 51.1% of participants met adherence criteria. Factors associated with receipt of guideline-recommended surveillance during the 2-year surveillance period include being married (OR: 1.17; 95% CI:1.06-1.29), receipt of neoadjuvant systemic therapy (OR: 1.76, 95% CI: 1.12-2.76), and a Charlson comorbidity score of >=3 (OR: 1.17, 95% CI: 1.03-1.33). Factors associated with not receiving guideline-recommended imaging surveillance included NH Black race (OR: 0.73, 95% CI: 0.59-0.91) and receipt of adjuvant systemic therapy (OR: 0.68, 95% CI:0.57-0.81), adjuvant radiotherapy (OR: 0.50, 95% CI: 0.40-0.61), or SBRT only (OR: 0.74, 95% CI: 0.63-0.87). Conclusion: Adherence to guideline-recommended imaging surveillance is low in this population. Strategies to increase compliance to imaging surveillance, particularly among NH black populations, are needed. Citation Format: Meghann Wheeler, Shama Karanth, Danting Yang, Caretia Washington, Livingstone Aduse-Poku, Hyung-Suk (Alex) Yoon, Jiang Bian, Yi Guo, Dejana Braithwaite. Imaging surveillance practice patterns among older adults with stage I/II non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB146.

Should testing for obstructive sleep apnea be offered routinely to older family medicine patients? A prospective cohort study

ABSTRACT In our previous studies, we offered older family medicine patients testing for obstructive sleep apnea (OSA) and discovered that 80% of patients who accepted, were later diagnosed with unsuspected OSA. In the present study, we followed such patients for 3 years of usual treatment. The goals were to (1) observe whether wider testing for OSA would increase case recognition and treatment uptake; (2) identify symptom and health characteristics associated with diagnosis and treatment efficacy. 101 women and 75 men (>45 years) recruited from family medicine clinics completed questionnaires, polysomnography and consented to chart review (Time 1). Participants with OSA were offered treatment and follow-up with a sleep medicine specialist. All were re-evaluated after 3 years (Time 2). At Time 1, 93% of participants received a diagnosis of OSA. Of these, 53 initiated treatment (46 PAP therapy); at Time 2, 24 PAP users met criteria for adherence. PAP-adherent participants had worse OSA and worse reported symptoms at Time 1 than non-adherent participants. At Time 2, PAP-adherent participants improved on insomnia and daytime symptoms compared to non-adherent participants who showed no change. Adherent and non-adherent participants showed no difference in health indices at Time 1 and no change at three-year follow-up. Benefits of treatment included improvements in co-morbid insomnia and daytime functioning; however, offering wider testing for OSA to older, family medicine patients yielded a high rate of diagnosis but low treatment adoption and adherence. Therefore, a cost-effective strategy would identify and support those likely to adopt and adhere to treatment.

Evaluation of Appropriateness of Red Blood Cell Transfusions

Background and Objectives: Red blood cells (RBC) transfusion is an important medical therapy in modern medicine. Blood is a scarce resource used in large numbers; therefore, it is very essential for its components to be used appropriately and judiciously. It is necessary to monitor, assess, and evaluate the existing trends and appropriateness of blood utilization. The establishment of criteria for blood transfusion and strict adherence to such criteria may be necessary to improve blood usage. The objective of this study was to understand the utilization pattern of RBC transfusions based on indications and to evaluate the appropriateness of RBC transfusion at a tertiary care oncology center. Methods: This was a prospective observational study conducted over a period of 4 months. A total of 4413 RBC transfusion events in 2012 adult oncology patients were analyzed for appropriateness as per institutional guidelines. Data were obtained from the blood requisitions, issue records of the Department of Transfusion Medicine and from the Electronic Medical Records of the patients. Results: Total of 83% of transfusion events were found to be appropriate with Anemia being the most common indication for RBC transfusion in medical and surgical oncology units. Appropriateness was significant (P < 0.05) in medical oncology as compared to surgical oncology units. Appropriateness was highest and statistically significant (P < 0.05) in operation theatres while inappropriateness was more and significant in the daycare facility (P < 0.05). Conclusion: Total 83% of RBC transfusions were found to be appropriate indicating that clinical practices of RBC transfusions in the hospital were rational with adherence to institutional guidelines.

Continuous Positive Airway Pressure Effect on Albuminuria Progression in Patients with Obstructive Sleep Apnea and Diabetic Kidney Disease: A Randomized Clinical Trial.

Rationale: Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic kidney disease (DKD). However, the effect of apnea-hypopnea suppression on DKD progression is unclear. Objectives: To assess the effect of continuous positive airway pressure (CPAP) on the urinary albumin-to-creatinine ratio (UACR) in patients with DKD and OSA. Methods: In a 52-week, multicentric, open-label, parallel, and randomized clinical trial, 185 patients with OSA and DKD were randomized to CPAP and usual care (n = 93) or usual care alone (n = 92). Measurements and Main Results: UACR, estimated glomerular filtration rate, serum concentrations of creatinine and glycated hemoglobin, insulin resistance, lipid concentrations, sleepiness, and quality of life. A 52-week change in UACR from baseline did not differ significantly between the CPAP group and the usual-care group. However, in per-protocol analyses that included 125 participants who met prespecified criteria for adherence, CPAP treatment was associated with a great reduction in UACR (mean difference, -10.56% [95% confidence interval, -19.06 to -2.06]; P = 0.015). CPAP effect on UACR was higher in nonsleepy patients with more severe OSA, worse renal function, and a more recent diagnosis of DKD. CPAP treatment also improved glycemic control and insulin resistance, as well as sleepiness and health-related quality of life. Conclusions: In patients with OSA and DKD, the prescription of CPAP did not result in a statistically significant reduction in albuminuria. However, good adherence to CPAP treatment in addition to usual care may result in long-term albuminuria reduction compared with usual care alone. Clinical trial registered with www.clinicaltrials.gov (NCT02816762).

Lack of Harmonized Adherence Criteria in Allergen Immunotherapy Prevents Comparison of Dosing and Application Strategies: A Scoping Review

Allergen immunotherapy (AIT) involves the application of increasing doses of allergen extract (as oral, sublingual, or subcutaneous immunotherapy) until immunologic tolerance is reached. Successful AIT relies on the consistent administration of allergen extract; therefore, adherence to these treatments is vital for compelling long-term results. Our review discusses the current terminology from adherence research in general, summarizes 25 current studies on adherence research in AIT in a scoping literature review, and delineates recommendations for tools and parameters for adherence research, aiming to improve outcomes in AIT. Almost every adherence study in AIT published to date used different tools, parameters, and data sources for measuring adherence and persistence rates. Unfortunately, an easily accessible, objective parameter or biomarker for monitoring treatment adherence and success has not yet been established for AIT. This situation calls for the development of an international core outcomes set for AIT that defines what is exactly meant by AIT adherence and how AIT adherence should be consistently measured. Therefore, we exemplarily present results and conclusions from adherence research in chronic diseases other than allergology. We aim to facilitate the development of advanced methods, considering the challenging disease specificities of these parameters in a routine care setting of AIT.

Digital Mental Health Interventions for Depression: Scoping Review of User Engagement.

BackgroundWhile many digital mental health interventions (DMHIs) have been found to be efficacious, patient engagement with DMHIs has increasingly emerged as a concern for implementation in real-world clinical settings. To address engagement, we must first understand what standard engagement levels are in the context of randomized controlled trials (RCTs) and how these compare with other treatments.ObjectiveThis scoping review aims to examine the state of reporting on intervention engagement in RCTs of mobile app–based interventions intended to treat symptoms of depression. We sought to identify what engagement metrics are and are not routinely reported as well as what the metrics that are reported reflect about standard engagement levels.MethodsWe conducted a systematic search of 7 databases to identify studies meeting our eligibility criteria, namely, RCTs that evaluated use of a mobile app–based intervention in adults, for which depressive symptoms were a primary outcome of interest. We then extracted 2 kinds of information from each article: intervention details and indices of DMHI engagement. A 5-element framework of minimum necessary DMHI engagement reporting was derived by our team and guided our data extraction. This framework included (1) recommended app use as communicated to participants at enrollment and, when reported, app adherence criteria; (2) rate of intervention uptake among those assigned to the intervention; (3) level of app use metrics reported, specifically number of uses and time spent using the app; (4) duration of app use metrics (ie, weekly use patterns); and (5) number of intervention completers.ResultsDatabase searching yielded 2083 unique records. Of these, 22 studies were eligible for inclusion. Only 64% (14/22) of studies included in this review specified rate of intervention uptake. Level of use metrics was only reported in 59% (13/22) of the studies reviewed. Approximately one-quarter of the studies (5/22, 23%) reported duration of use metrics. Only half (11/22, 50%) of the studies reported the number of participants who completed the app-based components of the intervention as intended or other metrics related to completion. Findings in those studies reporting metrics related to intervention completion indicated that between 14.4% and 93.0% of participants randomized to a DMHI condition completed the intervention as intended or according to a specified adherence criteria.ConclusionsFindings suggest that engagement was underreported and widely varied. It was not uncommon to see completion rates at or below 50% (11/22) of those participants randomized to a treatment condition or to simply see completion rates not reported at all. This variability in reporting suggests a failure to establish sufficient reporting standards and limits the conclusions that can be drawn about level of engagement with DMHIs. Based on these findings, the 5-element framework applied in this review may be useful as a minimum necessary standard for DMHI engagement reporting.

Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population.

To characterize the relationship of sociodemographic factors to adherence to provider recommendations for pediatric concussion. Primary care (PC) practices within the Children's Hospital of Philadelphia network. Patients aged 5 to 18 years old who presented to any PC site for concussion from September 26, 2019, to December 31, 2019. Retrospective medical record review. The primary outcome was adherence to follow-up recommendations as defined by (1) continued follow-up until provider clearance to return to full activity; (2) no more than 2 no-show visits; and (3) for those referred to specialty care (SC), attending at least 1 visit. We compared adherence by race/ethnicity, insurance, age, sex, injury mechanism, and repeat head injury using bivariate and multivariate analyses. A secondary outcome of referral to SC was compared by sociodemographic factors. A total of 755 patients were included. Overall, 80.5% of the patients met adherence criteria. Following adjustment, non-Hispanic Black patients and publicly insured/self-pay patients were less likely to adhere to recommendations than non-Hispanic White patients (adjusted odds ratio [AOR] = 0.60; 95% CI, 0.37-1.00) and privately insured patients (AOR = 0.48; 95% CI, 0.30-0.75), respectively. When assessing differences in referral to SC, non-Hispanic Black patients and publicly insured/self-pay patients were more likely to receive a referral than their non-Hispanic White peers (OR = 1.56; 95% CI, 1.00-2.45) and privately insured patients (OR = 1.56; 95% CI, 1.05-2.32), respectively. This study highlights disparities in adherence to concussion care recommendations, with non-Hispanic Black and publicly insured/self-pay patients less likely to adhere to follow-up recommendations than non-Hispanic White and privately insured patients, respectively. These disparities may impact recovery trajectories. Future studies should aim to identify specific individual- and system-level barriers preventing adherence to care in order to ultimately inform targeted interventions to achieve equity in care delivery and outcomes.

Proyecto INCLIASMA fase II - Inercia clínica en asma en España

ObjectivesEighty percent of patients with asthma are poorly controlled. Despite the availability of updated clinical practice guidelines, poor asthma control and treatment continue to be detected. The main objective of the INCLIASMA phaseII study (INercia CLInica en ASMA) is to analyze the reality of asthma management in Spanish primary care (PC) clinics. As a secondary objective, it was proposed to establish a series of key recommendations in the management of patients with asthma, based on the conclusions of the panelists. Material and methodsCross-sectional descriptive, multicenter and non-randomized study, which was developed in two rounds, following the Delphi methodology. A specific online questionnaire was developed for the project with 41 items and divided into 5 blocks (diagnosis, control, adherence, treatment and referral criteria) and a group of PC physicians who were experts in asthma were asked to express their level of agreement or disagreement with the set of items in the questionnaire. From the results, the main existing controversies in the management of asthma in Spain were identified and practical recommendations were elaborated. ResultsTwenty-four panelists participated. There was a final consensus in 92.68% (38/41) of all the items collected in the questionnaire. The panelists concluded that it takes too long to diagnose asthma, and there is a high percentage of asthmatic patients without proper treatment, and therefore, without adequate control. Lack of time, care overload or therapeutic inertia are some of the determining factors in this situation. ConclusionsThe INCLIASMA phaseII study highlights the controversies found in routine clinical practice in asthma management, highlighting the continued need for training and offering consensus recommendations that seek to improve asthma management in our country.

Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis.

BackgroundMarginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis.ObjectiveThis study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial.MethodsDigital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity).ResultsDigital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men.ConclusionsThis study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes.Trial RegistrationISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671

A multicenter prospective evaluation of owner medication adherence for feline cardiovascular disease in the referral setting

ObjectiveThe aim of this paper is to evaluate owners' chronic medication adherence for management of feline cardiovascular disease in the small animal referral setting. Animals, materials and methodsA questionnaire-based study of owners at five multispecialty, small animal referral centers was conducted. Owners completed a written survey evaluating demographics, degree of medication adherence, and difficulties encountered for medication adherence. Owners were free to decline participation in the study. ResultsFifty-four questionnaires were available for review. The most common diagnosis was hypertrophic cardiomyopathy (n = 31, 57.4%). Clopidogrel was the most cited medication that was difficult to administer consistently (n = 13, 24.0%) although twenty owners (37.0%) reported no difficulty consistently administering medications. “Taste of medication” (n = 14, 25.9%) was the most reported reason for difficulty medicating their cat, and most owners (n = 36, 66.7%) stated twice daily was the highest frequency of heart medications they feel they can consistently administer. Fifty owners (92.6%) met the criteria for medication adherence. ConclusionsChronic medication adherence in this study population was high. Clopidogrel was the most difficult medication to consistently administer, and twice a day dosing was the highest frequency of medication administration most owners could achieve. Cardiologists should be aware of these factors when determining optimal treatment protocols for the management of cardiovascular disease in cats.

LONG-TERM ADHERENCE TO POSITIVE AIRWAY PRESSURE THERAPY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND CARDIOVASCULAR DISEASES

Objective: to study long-term (more than 12 months) adherence to positive airway pressure (PAP) therapy and its effectiveness in OSA patients with arterial hypertension (AH) and to determine possible factors influencing adherence to PAP therapy Design and method: The study involved 194 patients with OSA and AH (156 men and 38 women), median age 64 [55; 69] years, who were on PAP therapy for more than 12 months. Patients had severe OSA (apnea-hypopnea index (AHI) - 49 [35,6; 63,2] events/h. The duration of the PAP-therapy usage - 2,0 years [1,0; 5,0]. Data from PAP therapy for the last year was downloaded from the device’s internal memory card, including effectiveness and adherence. The adherence criteria was the usage of PAP therapy for more than 4 hours per night for more than 70% of nights, effectiveness - residual AHI less than 5 events per hour. The main parameters of the disease and PAP-therapy were analyzed depending on the adherence to therapy. Results: All patients used PAP-therapy in auto regime with constant use of a humidifier. Average time of long-term PAP-therapy usage was 6,2 hours [4,8; 7,3] and 84,6% [61,2; 97,0] of nights. The criteria for adherence to PAP - therapy was met in 64,9% of patients. The residual AHI was 3,0 events/h [1,3; 6,0]. When comparing the clinical parameters of PAP-therapy, it was found that in the group of adherent patients, residual AHI was statistically significantly lower: 2,4 events/h [1,2; 5,0] versus 4,0 events/h [2,0; 6,4], p < 0,05. Usage of PAP therapy less than 70% of nights and less than 4 hours per night statistically significantly more often complained of daytime sleepiness (44%) and nocturia (19%) versus 24% and 8% respectively in the compared group. Adherent patients were statistically significantly more likely to use nasal masks in 81,7% of cases, compared with 64,7% of patients in the low-adherence group, p < 0,05. Conclusions: In patients with OSA and AH, 64,9% of patients meet the criteria for adherence to long-term PAP therapy. Residual daytime sleepiness and nocturia during prolonged PAP therapy are associated with low adherence.

0757 Cluster Analysis for Identifying Good CPAP Adherence Using the PSG Parameters and Patient Characteristics

Abstract Introduction CPAP is the standard treatment for obstructive sleep apnea (OSA). One of the important clinical issues to be solved is poor CPAP adherence. A growing body of studies has identified predictive factors for CPAP adherence including AHI, BMI, age, gender, symptoms, etc. When our sleep physicians prescribe CPAP, we would consider these known factors in multiple ways. One may want to know factors' combinations rather than each factor. In this case, cluster analysis might be useful since it is a powerful data-mining tool to sort various factors into meaningful groups. Recently, cluster analysis has been adopted for research of sleep breathing disorders. However, no one has adopted to predict CPAP adherence. In this study, we aimed to explore the usefulness of cluster analysis to predict CPAP adherence using the diagnostic PSG parameters and patients’ characteristics. Methods The study design was a retrospective observational multi-center study including 5 certified sleep centers in Japan. For 2 years from 2017, 1133 patients who were diagnosed with OSA with in-lab PSG and newly initiated CPAP therapy were enrolled. We performed cluster analysis using the K-means clustering. Variables for clustering were determined by several sleep physicians among PSG parameters and patients’ characteristics. We assessed CPAP adherence for 90 days and 365 days after CPAP initiation in each created cluster. We adopted CMS criteria for good CPAP adherence, which is, more than four hours of use on 70% of nights. Results Cluster analysis classified 5 clusters. A significant difference in CPAP adherence for 90 days and 365 days was seen among 5 clusters with a test of independence (p=0.001, p=0.005, respectively). The cluster presenting moderate obese, very high AHI and ODI, and apnea predominant indicated good adherence, whereas the cluster presenting morbid obese, very high AHI and ODI, sustained severe hypoxia, younger age, and daytime sleepiness indicated poor adherence according to the post-hoc Chi-square test. Conclusion Cluster analysis successfully distinguished the different CPAP adherence and identified a combination of OSA patients’ profiles. Thus, cluster analysis would be a useful tool for predicting long-term CPAP adherence. Support (If Any)

Patient-reported adherence to physical exercises of patients with ankylosing spondylitis

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

Evaluation of Guideline Adherence and Subsequent Follow-Up Outcomes for Incidental Thyroid Nodules Detected in Hybrid Academic-Community Practice.

Incidental thyroid nodules (ITNs) are common, and variability regarding follow-up and recommendation practices exist. The study purpose was to determine adherence to the American College of Radiology (ACR) ITN criteria and analyze recommendation outcomes. ITNs listed in the impression section on computed tomography, magnetic resonance imaging, and positron emission tomography studies over a 6-month period were included. Report recommendations were compared with ACR white paper criteria for adherence (concordant recommendation) or nonadherence (discordant recommendation). Reader characteristics, further ITN workup, and pathology were recorded. A P value less than 0.05 was used for significance. Three hundred fifty patients (mean age, 64.6 years) were included with a median ITN size of 18-mm. Most nodules (289/350) were reported on computed tomography and were identified for follow-up due to size (235/350). Only 39 of 350 reports (11.1%) did not follow ACR recommendations. Patient age was significantly related to recommendation adherence ( P < 0.05) as opposed to radiologist practice type (ie, community-based or academic) which was not. Nonadherence most often involved recommending ultrasound follow-up for nonactionable small ITNs. The rate of fine-needle aspiration biopsy from concordant ITNs was significantly higher than discordant ITNs ( P < 0.05). Six patients, all with concordant recommendations, had malignant final pathology results. Recommendation adherence to the ACR ITN criteria was high, approaching 90%. Nonadherence was mostly due to recommending thyroid ultrasound when not indicated and was correlated with a younger patient age. The rate of fine-needle aspiration biopsy stemming from nonindicated ultrasounds was significantly lower and did not result in the diagnosis of any malignancies.

Personalized Self-Monitoring of Energy Balance through Integration in a Web-Application of Dietary, Anthropometric, and Physical Activity Data

Self-monitoring of weight, diet and physical activity is a valuable component of behavioral weight loss treatment. The validation and user-friendliness of this approach is not optimal since users are selected from homogeneous pools and rely on different applications, increasing the burden and achieving partial, generic and/or unrelated information about their metabolic state. Moreover, studies establishing type, time, duration, and adherence criteria for self-monitoring are lacking. In this study, we developed a digital web-based application (ArmOnIA), which integrates dietary, anthropometric, and physical activity data and provides a personalized estimation of energy balance. Moreover, we determined type, time, duration, and adherence criteria for self-monitoring to achieve significant weight loss in a highly heterogeneous group. A single-arm, uncontrolled prospective study on self-monitored voluntary adults for 7 months was performed. Hierarchical clustering of adherence parameters yielded three behavioral approaches: high (HA), low (LA), and medium (MA) adherence. Average BMI decrease is statistically significant between LA and HA. Moreover, we defined thresholds for the minimum frequencies and duration of dietary and weight self-monitoring. This approach can provide the correct clues to empower citizens with scientific knowledge, augmenting their self-awareness with the aim of achieving long-lasting results when pursuing a healthy lifestyle.

Comparative antioxidant activity of various ophthalmic product types for artificial tears under different experimental conditions.

Artificial tears or lubricants is a developing category in pharmaceutical research, due to the permanent increasing incidence of dry eye syndrome caused by the extensive use of personal computers and other gadget screens, associated with global warming and pollution. Considering the role of inflammation in dry eye syndrome, characterized by the production of free radicals, it is imperative to determine which elements are more significant in forming an artificial tear more effectively and more comfortably for the eye state and for the quality of life. Thus, the aim of the present study was to examine the evolution of the total antioxidant capacity of some frequently commercialized artificial tears via the photochemiluminescence method, using an antioxidant capacity of lipid soluble substances procedure, prior and subsequent to the exposure of these therapy agents to some physical agents. This is a preliminary research aiming to evaluate the impact of various environmental factors on these ophthalmic products, to be continued by evaluating whether the effectiveness of these products, in terms of objective examination and patient preference and adherence criteria, is impacted by the conditions of use and storage. Thus, the total antioxidant capacity of the evaluated artificial tear samples after UVC irradiation at 254 nm wavelength was studied, in order to investigate whether their status suffered any change in terms of antioxidant potential. In addition to the findings obtained in the study, some recommendations were also made.

Duration of positive airway pressure adherence: how much PAP is enough?

Duration of positive airway pressure adherence: how much PAP is enough?

Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial.

Background: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients’ needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO—the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. Methods: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. Results: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. Conclusion: This pilot trial was successful, with minor modifications needed prior to a large trial.