Date Of Use Research Articles

Abstract 4131439: Routine Social Isolation Screening Among Adults with Cardiovascular Disease: A Survival Analysis

Background: Evidence linking social isolation to cardiovascular disease morbidity and mortality has grown in recent years. Still, information on how this may manifest in real world settings and its implications for screening practices is limited. In 2019, our large national integrated health care system implemented screening for social isolation as part of a broader universal social risk assessment. This repository of screening data was joined to administrative claims to test these associations in real world data and explore differences by demographic and medical factors. Methods: Social isolation responses recorded from 2019-2022 were included for a cohort of adult health plan members with documented atherosclerotic cardiovascular disease (ASCVD). We selected a single random assessment for each member and retained any other responses for sensitivity analyses. Cohort members had at least 10 months of enrollment surrounding assessment date for use as the baseline period and were followed for 365 days. We used cox proportional hazards regression with right censoring for coverage gaps to estimate the risk of all-cause mortality conferred by social isolation. We used Poisson regression to model the rate of inpatient stays. Results: There were 881 deaths among 7,484 members (18% of those with social isolation; 11% of those without). The isolated group skewed less male (54% vs. 65%, p <0.001) and older (68.4 [SD 12.7] vs. 67.5 [SD 12.6] years, p <0.05) than those not isolated. At baseline, the isolated group had higher rates of mean inpatient stays (2.3 [SD 1.9] vs. 1.9 [SD 1.6], p <0.001), ED visits (1.2 [SD 1.9] vs. 0.9 [SD 1.6], p < 0.001), and smoking (50% vs. 44%, p < 0.05), and a higher mean Charlson Comorbidity Index (CCI) (3.6 [SD 2.6] vs. 3.0 [SD 2.4], p < 0.001). Adjusted survival models suggested an independent 33% increase in all-cause mortality risk among those screening positive for social isolation (1.33 HR 95% CI 1.10, 1.62). Adjusted Poisson models found a similar increase in inpatient stays (1.36 IRR 95% CI 1.14, 1.62). Conclusions: Our findings corroborate the association between social isolation and morbidity and mortality among those with known ASCVD. The effect for social isolation was similar in magnitude to clinical comorbidities and smoking, suggesting that routine screening for social isolation may provide valuable information for assessing and managing the risk of death among patients with ASCVD.

Real world prescription of beta-blockers in patients with asthma.

This study aimed to investigate the prescription of beta-blockers (β-blockers) for patients with asthma. In this retrospective cross-sectional study using the National Patient Sample (NPS) of the Health Insurance Review and Assessment Service (HIRA) of South Korea, β-blockers and asthma medications were investigated using generic name codes provided by HIRA. Concomitant administration was identified when a β-blocker and an asthma medication were co-prescribed in one billing statement or when separate β-blocker and asthma prescriptions had overlapping dates of use. In the 1027 patients with asthma who were prescribed non-selective β-blockers (non-SBs), 3087 non-SB prescriptions were identified, of which 62.3% and 37.3% were for carvedilol and propranolol, respectively. Of the 906 patients with asthma prescribed selective β-blockers (SBs), 2942 SB prescriptions were identified, of which 48.5%, 28.3%, and 20.3% were for bisoprolol, atenolol, and nebivolol, respectively. Overall, 2149 non-SB and 2124 SB prescriptions with overlapping use dates with asthma medications were identified, which were prescribed to 726 and 657 patients, accounting for 70.7% and 72.5% of the patients receiving non-SBs and SBs, respectively. β2-agonists accounted for 39.9% of the concomitant asthma medications with overlapping dates of use with non-SBs. Co-prescribing of bronchodilators occurred at a rate of 38.7% and 45.1% for the 3087 non-SB prescriptions and 2942 SB prescriptions, respectively. Carvedilol and propranolol accounted for half of all β-blockers prescribed to asthma patients. Prescribing β-blockers to patients with asthma requires caution to prevent exacerbation of asthma and drug interactions between β-blockers and co-prescribed asthma medications.

The treatment of refractory periorbital dermatitis.

Refractory periorbital dermatitis has a chronic course with exacerbations leading to discomfort and cosmetic issues, yet characterization of treatment options is limited. The objective was to present comprehensive demographic data and medical management of a series of patients with refractory periorbital dermatitis. Retrospective review identified patients treated at a single institution from January 2010 to August 2020. Descriptive analyses were performed. Demographic data and treatment history were reviewed and data including medication, use, date of use and discontinued use, reason for discontinuation (if applicable), refractory status, formulation, concentration, and dose frequency were extracted. Descriptive analyses. Forty-five patients were included. The average age at first diagnosis was 60.3 years (sd 14.9). 82.2% were women and 84.4% identified as Caucasian. Triamcinolone cream was most frequently used followed by tobramycin-dexamethasone, tacrolimus, and neomycin-polymyxin-dexamethasone. Less than 30% of patients on triamcinolone were refractory. 13.3% of patients used topical hydrocortisone, with over 80% of these patients experiencing refractory episodes of persistent irritation and erythema. Most patients were refractory during initial use or the first recurrence of periorbital dermatitis flare. By better characterizing the diverse treatment regimens in a unique subset of refractory patients, we hope to better inform potential courses of medical management for periorbital dermatitis.

The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study.

This study explored whether participants with substance use disorder (SUD) would adopt and use a smart-phone app with a cognitive behavioral therapy program, weekly Brief Addiction Monitor (BAM) assessments, daily check-ins, tools to track sobriety and treatment, and other patient-centered resources. In addition, participants with SUD could access a social worker and peer support specialists. The study sought participants from two groups: those referred by a justice-related agency and participants who responded to outreach from the Addiction Policy Forum (APF). The Connections smart-phone app was offered to both groups. The study examined use of the app and social worker/peer recovery support services by participants who downloaded and used the app; those referred by a justice-related agency and those who self-referred through APF. The app provided primary data, including socio-demographics, referral status, dates of use, activities completed, and BAM scores. The app was offered to 1973 participants, 40% of whom downloaded it. Three groups emerged from among the 350 who used the app: those who used only the cognitive behavioral aspects of the app, those who used only the recovery support services offered, and those who used both the app and recovery support services. Looking at the two referral groups, the justice-referred group preferred telehealth recovery support services with the social worker; the self-referred group used the app and the app plus the recovery support services equally. Scores on the BAM improved across time. Justice-referred participants' protective behaviors improved more than those of the self-referred participants while self-referred participants' risk behaviors improved more than those of justice-referred participants. Older participants were more likely to use the app, and to report fewer risky behaviors, as measured by the BAM. Use of a digital therapeutic appears to support recovery of participants with SUD although many clients need and want the integration of social worker-driven recovery support services. Basically, the app can be an extension to personal services, but many people with SUD (particularly during COVID-19) crave human interaction. It also appears that those who seek assistance on their own, rather than being referred by a justice-related agency, may be more likely to benefit from digital therapeutics such as the Connections app.

Study of post-opening stability of active ingredients in hand sanitizers

IntroductionHand disinfection plays an important role in infection control. Currently, hand sanitizers containing ethanol and chlorhexidine gluconate as active ingredients are widely used. Most of hand sanitizers have a defined expiration date for use. However, there was no rule about the expiration date after opening defined with the evidence. Therefore, we examined the fluctuation of active ingredients and disinfection effect after opening the bottle. MethodTwelve hand sanitizers from 44 to 921 days after opening set in different places in the hospital were examined and unopened hand sanitizer used as a control. Chlorhexidine gluconate and ethanol of each samples were measured by high performance liquid chromatography and gas chromatography, respectively. The correlation between the concentration of each ingredient obtained and the number of days after opening, bottle weight, storage temperature and humidity was analyzed. A time-kill test based on ASTM E2315-03 was performed to confirm the actual disinfection effect. ResultsIt was observed that active ingredients had not been decreased up to 921 days after opening and were not affected by storage conditions after opening. In addition, a decrease of disinfection effect was not observed in any sample. ConclusionsWe found that hand sanitizers do not need to be discard after a number of days have passed because the active ingredients are retained even after opening in it.

Healthcare resource utilization and medical costs in patients with terminal cancer during best supportive care.

Patients with terminal cancer have different physical symptoms, prognoses, emotional distress, and end-of-life care plans from those receiving aggressive chemotherapy; few studies have assessed healthcare resource use in these patients. Therefore, this study aimed to assess healthcare resource utilization and medical costs incurred during best supportive care after the last anticancer drug treatment in patients with terminal cancer. This retrospective observational study was conducted using national sample cohort data from the National Health Insurance Service in South Korea. Only patients with cancer who were treated with the last anticancer drugs from January 1, 2006, to June 30, 2015, were included in the study. The period of best supportive care was defined as the time from the date of use of the last anticancer drug to death. Healthcare resource utilization and medical costs were estimated during the best supportive care. A generalized linear model with a log-link function and gamma distribution was used to evaluate the impact of demographic and healthcare utilization factors on total medical costs. Among the 2,480 patients in the study, 93.9% were hospitalized, and hospitalization days (30.8 days) accounted for 39.7% of the surviving period (77.5 days). The proportions of intensive care unit admissions and emergency department visits were 15.8% and 18.9%, respectively. The average total medical cost per patient was $6,310, with the inpatient cost ($5,705) being approximately 9.4 times higher than the outpatient cost ($605). The length of hospitalization had the greatest impact on the total medical costs. Pancreatic cancer had the highest proportion of patients who were hospitalized (97.4%) and the highest medical cost ($7,702). Hospital-based resources were utilized by most patients with terminal cancer, and hospitalization was a major driver of the total medical cost. An alternative system for hospitalization should be developed to support patients with terminal cancer, both clinically and financially.

Epidemiology of Antibiotic Use and Drivers of Cross-Border Procurement in a Mexican American Border Community.

BackgroundThe U.S.-Mexico Border is an area of opportunity for improved health care access; however, gaps remain as to how and where U.S. border residents, particularly those who are underinsured, obtain care. Antibiotics are one of the most common reported drivers of cross-border healthcare access and a medication of particular concern since indiscriminate or inappropriate use is associated with antimicrobial resistance. In addition, many studies assessing preferences for Mexican pharmaceuticals and healthcare in U.S. border residents were done prior to 2010 when many prescription medications, including antibiotics, were available over the counter in Mexico.MethodsData used in this study were collected during the baseline examination of an ongoing longitudinal cohort study in Starr Country, Texas, one of 14 counties on the Texas-Mexico border. Participants self-reported the name, date of use, and the source country of each antibiotic used in the past 12 months. Logistic regression was used to determine social, cultural, and clinical features associated with cross-border procurement of antibiotics.ResultsOver 10% of the study cohort reported using antibiotics in the past 30 days with over 60% of all rounds used in the past 12 months sourced from Mexico. A lack of health insurance and generation score, a measure of acculturation, were the strongest predictors of cross-border procurement of antibiotics.ConclusionsFactors previously associated with cross-border acquisition of antibiotics are still present despite changes in 2010 to prescription drug regulations in Mexico. These results may be used to inform future public health initiatives to provide culturally sensitive education about responsible antibiotic stewardship and to address barriers to U.S. healthcare and pharmaceutical access in medically underserved, impoverished U.S.-Mexico border communities.

Towards a historical dictionary for Arabic language

A historical dictionary is a language dictionary which studies the evolution of the construction of words and their meanings through the chronological stages the language has undergone. However, despite its richness, Arabic does not yet have a historical dictionary which helps to monitor its semantic development throughout history and to understand its knowledge and scientific heritage properly. The creation of such a dictionary should pass through several stages and requires a lot of effort. The most important step consists in determining a particular word sense in a given context which basically identifies the relevant meaning of a word according to the historical period in which it appeared. In this work, we suggest a dictionary of meanings that allows us to capture the semantic evolution of each Arabic word by focusing on the date of its first appearance and the way their meanings have evolved. Our method aims to provide relevant information about the oldest date of use of a given word, as well as its meanings, users, and sources. So, one of our major contributions of this paper is to determine the meaning of Arabic words according to where they appeared based on precise documents and contexts.

PRS65 ADHERENCE AND PERSISTENCE TO ROFLUMILAST AMONG ADULT PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Roflumilast is a non-first-line medication for adults with Chronic Obstructive Pulmonary Disease (COPD) and is associated with multiple side effects, which can affect its long-term use. This study aims to describe the persistence and adherence of roflumilast in patients with COPD. A cohort of patients aged ≥40 years diagnosed with COPD who newly initiated roflumilast from March 2011 to September 2015, were identified from the Truven MarketScan database. We measured demographic and clinical characteristics in the 12-month period prior to first date of use, the index date. Adherence was measured using prescription days covered (PDC) ≥ 80% threshold over a 6-month period. We calculated persistence as the proportion of patients that did not discontinue roflumilast, defined as a gap of >30 days. A total of 9919 patients were included with a mean age of 67.7 years (±10.1) and 4972 (50.1%) were female. Inhaled corticosteroids (ICS) and long-acting beta agonists (LABA), single inhaler use or in combination, were frequently used, 7300 (73.6%) and 7073 (71.3%) respectively, in the baseline period. We also captured multiple COPD medication use prior to the index date. Accordingly, LABA and ICS 6903 (69.6%) were commonly prescribed followed by long acting muscarinic antagonists (LAMA) and ICS (5112, 51.5%). The overall PDC over a 6-month period was 69% with only 3104 (48.8%) patients being adherent (PDC≥ 80%). Over the same 6-month period, only 2581 (26.0%) were persistent. We also measured PDC over 3-month (81%) and 12-month (56%). In addition, persistence to roflumilast was 4899 (49.4%) and 1196 (12.1%) over a 3- and 12-month period respectively. A substantial number of adult patients with COPD have sub-optimal adherence and persistence to roflumilast. Reasons for low adherence or discontinuation such as prevalence of treatment-related adverse effects deserve further investigation.

Evaluating energy efficiency and economic effect of heat transfer in copper tube for small solar linear Fresnel reflector

An experimental and numerical investigation of a small linear Fresnel for water heating application has been carried out in Blida, Algeria. The numerical simulation with a 1D modeling in transient mode was performed by using the finite difference method. The thermal evaluation is based on the energy assessments characterized by the differential equations of pure water with a flow mass rate equal to 0.015 kg s−1 and copper absorber tube temperature. Moreover, the Fluent code has been developed in order to conduct the CFD modeling at the absorber tube of the solar collector. SolTrace software has been used to determine the optical behavior of the linear reflector. The average optical efficiency of the device is about 42.97%, but the average value of the experimental thermal efficiency reached 29.21% for 22/01/2015 and 29.20% for 19/02/2015. The average value of pure water temperature for 22/01/2015 is 67.28 °C, while its value for 19/02/2015 is 70.99 °C. This solar experimental setup will reduce the consumption of liquefied natural gas by 88.9 m3, which will reduce the CO2 emission by 187.93 kg. In addition, its manufacturing cost will be recovered 16 years from the date of use of this heater.

Hydroxychloroquine: the story of one drug during the COVID-19 pandemic

<h3></h3> Новый коронавирус (SARS-CoV-2) представляет собой серьезную угрозу для общественного здравоохранения во всем мире. С момента обнаружения вируса до настоящего времени наблюдается рост заболеваемости. До сих пор не найдено ни одного препарата с доказанной противовирусной эффективностью. Многие препараты уже прошли этапы от <i>in vitro</i> исследований до рандомизированных клинических испытаний <i>in vivo</i>. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Выполнить обзор литературы по применению гидроксихлорохина для профилактики и лечения новой коронавирусной инфекции (COVID-19) за период с момента применения препарата до июня 2020 г.

THE PESTICIDES TOXIC IMPACT ON THE HUMAN HEALTH CONDITION AND THE ECOSYSTEM

Over the years, pesticides have been accumulated, particularly in the ecosystem of the developing countries. Most of them are with the expiate date of use though constitutes and are a serious threat with its toxic impact on the human health and environment. Besides, the stockpiles of obsolete pesticides are stored in the open air or in inappropriate storage conditions. Containers are often inadequate and leaking or corroded, though contaminated the drinking water sources and irrigation schemes. There are various methods for adequate disposal of obsolete pesticides but are generally costly and require expert knowledge. The Food and Agriculture Organisation (FAO) of the United Nations (UN) is implementing a Programme on Prevention and Disposal of Obsolete in ecosystem of the developing countries to provide them with the adequate tools to sound management of pesticides. The management of pesticides in developing countries need to be improved trough an effective control over the agricultural and public health pesticides, their application in agriculture and public health, the disposal of obsolete stocks and empty pesticide containers, storage facilities, public information, environmental protection, regulation and its enforcement. The present study provides an overview of the disposal of obsolete pesticides in the ecosystem of the developing countries and means of prevention its accumulation in order to decrease their toxic impact on the human health. Keywords: toxic impact, human health condition, pesticides, ecosystem.

Ethnopharmacological study of the mixtures of Rass El Hanout and Lmssakhn used for therapeutic purposes in the region of Souk Sebt, Morocco

In Morocco, medicinal plants have been used for a long time against diseases. In the great majority of cases, plants are part of a more complex preparation. Traditional herbal mixtures could well yield new clues to the treatment of a wide variety of disease. Several preparations are commercially available with no indication at the species, the quantities, composition or the date of use. The current work focuses on the study of the mixtures of Rass El Hanout and Lmssakhn used for therapeutic purposes in the region of Souk Sebt, Morocco. Information on the two mixtures was obtained through interviews with inhabitants in the study region. We identified frequencies of use of each mixture. Then, we obtained four samples of each mixture from different vendors. Results showed that the mixtures of Rass El Hanout and Lmssakhn are used mainly against colds, sexual and reproductive dysfunctions, to treat many digestive disorders and they are used as an aphrodisiac. Plant composition of each mixture differs among vendors and the sampling results show that there is not a standard composition for these mixtures. The total weight of the four samples and the percentage of each plant in each mixture varies among vendors. This article retains a written record of the mixtures Rass El Hanout and Lmssakhn whose transmission is based on the oral tradition. This work can also be exploited in scientific research in the field of pharmacology, phytochemistry and biochemistry.

The Use of Non-insulin Agents in Gestational Diabetes: Clinical Considerations in Tailoring Therapy.

To assess evidence to date for use of non-insulin agents in treatment of gestational diabetes mellitus. There has been increasing interest in the use of non-insulin agents, primarily metformin and glyburide (which both cross the placenta). Metformin has been associated with less maternal weight gain; however, recent studies have shown a trend toward increased weight in offspring exposed to metformin in utero. Glyburide has been associated with increased neonatal hypoglycemia. Glycemic control during pregnancy is essential to optimize both maternal and fetal outcomes. There are a myriad of factors to consider when designing treatment programs including patient preference, phenotype, and glucose patterns. While insulin is typically recommended as first-line, some women refuse or cannot afford insulin and in those cases, non-insulin agents may be used. Further studies are needed to assess treatment in pregnancy, perinatal outcomes, and particularly long-term metabolic profiles in mothers and offspring.

Alternative approach to evaluation of efficiency of medicamental abortion in early stages

Objective. To determine the effectiveness of alternative methods for assessing abortion using the drug method at an early date for use in the interests of patients.The main provisions. 35 literary sources published in the MEDLINE, PubMed, and other databases were analyzed. It has been shown that the woman’s independent use of semi-quantitative or multi-level tests for determining the content of β-hCG in the urine at home, combined with telephone control by a physician, has high sensitivity and specificity in diagnosing pregnancy termination, is not inferior in terms of the effectiveness of ultrasound, and excludes the likelihood of overdiagnosis of abortion.Conclusion. Routine clinical examination and ultrasonography are not required after medical abortion, and self-testing for β-hCG in the urine can be used to confirm the complete termination of pregnancy in the early stages.

Navigating Through Electronic Health Records: Survey Study on Medical Students' Perspectives in General and With Regard to a Specific Training.

BackgroundAn electronic health record (EHR) is the state-of-the-art method for ensuring all data concerning a given patient are up to date for use by multidisciplinary hospital teams. Therefore, medical students need to be trained to use health information technologies within this environment from the early stages of their education.ObjectiveAs little is known about the effects of specific training within the medical curriculum, this study aimed to develop a course module and evaluate it to offer best practice teaching for today’s students. Moreover, we looked at the acceptance of new technologies such as EHRs.MethodsFifth-year medical students (N=104) at the University of Tübingen took part in a standardized two-day training procedure about the advantages and risks of EHR use. After the training, students performed their own EHR entries on hypothetical patient cases in a safe practice environment. In addition, questionnaires—standardized and with open-ended questions—were administered to assess students’ experiences with a new teaching module, a newly developed EHR simulator, the acceptance of the health technology, and their attitudes toward it before and after training.ResultsAfter the teaching, students rated the benefit of EHR training for medical knowledge significantly higher than before the session (mean 3.74, SD 1.05). However, they also had doubts about the long-term benefit of EHRs for multidisciplinary coworking after training (mean 1.96, SD 0.65). The special training with simulation software was rated as helpful for preparing students (88/102, 86.2%), but they still did not feel safe in all aspects of EHR.ConclusionsA specific simulated training on using EHRs helped students improve their knowledge and become more aware of the risks and challenges of such a system. Overall, students welcomed the new training module and supported the integration of EHR teaching into the medical curriculum. Further studies are needed to optimize training modules and make use of long-term feedback opportunities a simulated system offers.

Information Security Of Estonia: Experience For Ukraine

The article deals with features of information security in the Republic of Estonia. It is noted that the main factors that have helped to increase the level of information security in Estonia are the developed information infrastructure, effective cybersecurity policy and reliable protection of personal data. Cybersecurity depends on a combination of cybercrime, provision of critical infrastructure and e-services, and national defense.&#x0D; In the area of personal data protection, it is reasonable to create a private data market where companies and researchers propose to submit a date of use and license / lease / sale related to offers or license, lease, sell or withdraw their data from use.&#x0D; Analyzing the experience of the Republic of Estonia in information security, there are several factors that have become the basis for the creation of a secure information environment. First, only a comprehensive information policy enables the security of enterprises, institutions, organizations and the state as a whole.&#x0D; Secondly, Estonia has made every effort to ensure cybersecurity (as a component of information security) and has created favorable conditions for the arrival of foreign IT companies with significant capital and innovation.&#x0D; Third, in the context of information security, considerable attention in Estonia is given to the protection and use of personal data, which is carried out as transparently as possible, using digital signatures and encrypted messages.&#x0D; Practical recommendations for Ukraine’s acquisition of Estonia’s information security experience are provided. We believe that raising the level of information security will help a number of the following activities: 1) Create a working group with the involvement of international experts to develop the concept of information security and regulatory support for its activities 2) Ensure the creation of a single national electronic information resource in the concept of information security. 3) Enter a unique national ID for the individual. 4) Create a single secure web portal for electronic services with the possibility of creating electronic offices of individuals for receiving administrative services. Keywords: information security, cybersecurity, information infrastructure, personal data.

The Pesticides Toxic Impact on the Human Health Condition and the Ecosystem

Over the years, pesticides have been accumulated, particularly in the ecosystem of the developing countries. Most of them are with the expiate date of use though constitutes and are a serious threat with its toxic impact on the human health and environment. Besides, the stockpiles of obsolete pesticides are stored in the open air or in inappropriate storage conditions. Containers are often inadequate and leaking or corroded, though contaminated the drinking water sources and irrigation schemes. There are various methods for adequate disposal of obsolete pesticides but are generally costly and require expert knowledge. The Food and Agriculture Organisation (FAO) of the United Nations (UN) is implementing a Programme on Prevention and Disposal of Obsolete in ecosystem of the developing countries to provide them with the adequate tools to sound management of pesticides. The management of pesticides in developing countries need to be improved trough an effective control over the agricultural and public health pesticides, their application in agriculture and public health, the disposal of obsolete stocks and empty pesticide containers, storage facilities, public information, environmental protection, regulation and its enforcement. The present study provides an overview of the disposal of obsolete pesticides in the ecosystem of the developing countries and means of prevention its accumulation in order to decrease their toxic impact on the human health.

FREQUENCY OF IMPROPER INHALER TECHNIQUE IDENTIFIED BY ELECTRONIC MEDICATION MONITOR (EMM) ACTUATION TIMING

Introduction Inadequate inhalation technique from metered dose inhalers (MDIs) is common. Up to 90% of patients with asthma use techniques that may negatively impact MDI efficacy. Based on guidelines and patient information leaflets >30 seconds are needed between two inhalations to achieve proper MDI use that includes shaking the canister, exhaling completely before inhalation, inhaling slowly, and breath-holding after use. This study aimed to detect inadequate inhalation technique by quantifying the time between two consecutive actuations using EMMs that passively collected time and date of use. Methods Data were collected from patients ≥4 years old with asthma who were using EMM-equipped rescue and/or controller MDIs (2012-18). In patient-days with two actuations within 120 seconds(s), the interval between the first two actuations was quantified and then classified as acceptable (>30s), fair (15 to ≤30s), or poor (≤15s) based on guideline criteria. This study was exempted from IRB approval. Results Of the 7,558 patients, 6,616 used rescue MDIs on 120,882 days, and 3,220 used controller MDIs on 157,492 days. The median (interquartile range) interval between actuations was 9s (16s), and 16%, 17%, and 67% of actuations were classified as acceptable, fair and poor, respectively (Figure 1). Results were similar between rescue and controller MDIs. Conclusions This study demonstrates that most patients have inadequate intervals between MDI actuations. EMMs can be useful to detect inadequate inhalation technique by examining the interval between actuations as a determinant. This information can be used to inform patients and providers that inhalation technique education is needed to improve treatment. Figure 1. Seconds between 1st and 2nd actuation, n = 278,374 patient-days from 7,558 patients.

Effect of a patient-support program on once-daily teriparatide adherence and persistence in the Japan Fracture Observational Study (JFOS)

SummaryJapanese patients with osteoporosis prescribed once-daily teriparatide for 24 months could enroll in a patient-support program designed to aid adherence and persistence. Patients enrolled in the program had higher adherence and persistence rates than those who did not enroll, highlighting the value of patient-support programs for improving adherence and persistence.ObjectiveTo assess the effect of a patient-support program on once-daily teriparatide adherence and persistence of patients who did and did not enroll.MethodsIn the 24-month Japan Fracture Observational Study, patients with osteoporosis prescribed teriparatide 20 μg/day (N = 1996) could freely enroll in a patient-support program (call center support, monthly calendar, certificates of recognition). Outcome measures were medication adherence (investigator assessed) and persistence (first date of teriparatide use to last date of use or study end). Multivariate logistic models were applied for adherence, and Kaplan-Meier survival curve for persistence.ResultsOverall, mean ± standard deviation (SD) age was 76.9 ± 7.9 years, and the proportion of female patients was 90.1%. Program enrollment status was 39.6% yes (n = 790), 22.9% no (n = 458), and 37.5% unknown (n = 748). In the analysis sample (1248 patients), adherence (> 75%) to teriparatide was more likely for patients enrolled in the support program (54.2 vs. 48.3%; adjusted odds ratio 1.44 [95% confidence intervals 1.04–2.00], p = 0.030). Good to very good (> 75%) adherence was also associated with smoking (negative association) and previous osteoporosis therapy (marginal positive association). Persistence rates were greater for patients enrolled in the support program than not enrolled (12 months 77.2 vs. 69.6%; 24 months 63.2 vs. 54.8%).ConclusionsOnce-daily teriparatide adherence and persistence rates were higher among patients who enrolled in a patient-support program than among those who did not, highlighting the value of patient-support programs for improving adherence and persistence.