Compliance Factors Research Articles

A Meta-Analysis of Influencing Factors of Drug Therapy Compliance in Chinese Children with Bronchial Asthma

We systematically attempt to evaluate the influencing factors of drug treatment compliance in childhood asthma and to provide evidence for improving patient’s treatment compliance and improving treatment success rate. The Chinese literatures that met the inclusion and exclusion criteria, such as Wanfang Medical Database, China National Knowledge Infrastructure, VIP Chinese Science and Technology Periodical Database and Chinese Biomedical Database were systematically searched. Two researchers screened the literature, conducted strict quality evaluation, extracted data from literatures that met the quality standards and used RevMan5.3 statistical software to make forest charts for outcome indicators and analyze effects. A total of 13 literatures were included. Meta-analysis results showed that lack of asthma knowledge, bad psychology and parent’s trust in medical staff had no statistically significant effects on children’s treatment compliance, while the degree of illness had a statistically significant impact on compliance (p<0.1), the pooled odds ratio and 95 % confidence interval was 0.31 (0.22-0.43). The severity of illness is the main factor for drug treatment compliance in childhood asthma.

A cross-sectional study of epidemiological determinants for Covid-19 infection among nurses of a tertiary care hospital.

All health care workers including nurses are working in the frontline against coronavirus disease 2019 (Covid-19), which keeps them at high risk of getting infected. This study was conducted to identify risk factors for Covid-19 infection and compliance to Covid appropriate behavior among nurses. A cross-sectional study was conducted on 150 nurses in a tertiary care hospital attached to a medical college in Mumbai, from April 2020 to December 2020. Data were collected telephonically using an interviewer-administered pre-validated, semi-structured questionnaire. Data entry and analysis were performed using SPSS version 21.0. The mean age of the nurses was 38.19 ± 12.14 years. The majority (80.7%) were exposed to Covid-19 while taking active care of Covid patients; a total of 108 (72%) were symptomatic at the time of testing; dietary modifications because of fear of Covid were performed by 121 (80.2%); 92.77% used the appropriate personal protective equipment (PPE) category according to the workplace; 121 (80.77%) followed all steps of donning and doffing at all times, and 19 (12.77%) reported a breach in PPE. A greater proportion of nurses working in Covid duties opted for hospital isolation than home isolation (p = 0.003). Risk factors such as sleep, shift duty, shift pattern, food timing, mode of travel, and type of PPE during travel were also found to be significantly associated with work type - Covid versus non-Covid (p < 0.05). Use of workplace appropriate PPE, proper donning and doffing facilities, duty shifts with a fixed duration, adequate hand hygiene practices, and regular food intake with adequate sleep can prevent Covid-19 infection at the workplace among nurses.

Moderation of risk preferences on factors influencing MSME taxpayer compliance in Indonesian digital transactions

The advancement of digital technology encourages the growth of MSMEs transacting online. However, the phenomenon shows that the Indonesian tax ratio declines because the tax compliance increase rate does not accompany the potential tax base growth. This study analyzed the determining factors of tax compliance: tax knowledge, tax sanctions, peer influence, and the quality of tax authority services moderated by risk preferences. Because of the data analysis, it was discovered that only tax knowledge had a clear impact and risk preferences had no significant influence on the factors that influenced MSME tax compliance in digital transactions. Limited information circulating citizens about MSME-specific policies in digital commerce and rules that have not been communicated in online marketplaces are the main tasks for tax authorities in Indonesia. This study proposes a model of MSME's tax compliance in a digital transaction.

Power, Trust and Transparency as Determinant Factors of Tax Compliance: A Systematic Review

This systematic review emphasizes the importance of expanding and deepening the theoretical framework of research on individual taxpayer compliance, particularly through integrated models. The main objective of this article is to systematically review the literature on tax compliance based on three determinants: coercive power, trust in tax authorities and transparency; and provide a direction for future research. There are three review questions in this paper, namely: (1) What is the present situation of the literature on the connection between coercive power and tax compliance; (2) What is the present situation of the literature on the connection between trust in tax authorities and tax compliance; (3) What is the present situation of the literature on the connection between “relationship transparency” and tax compliance. A systematic review of the literature was used to perform this review, considering 66 studies published in several suggested databases. The results are a call for a more sophisticated understanding of not only how suggested factors (Coercive Power; Trust; Transparency) affect tax compliance, but also how they interact and change each other and then, influence tax compliance. This review implies that enhancing tax service, transparency, and government trust is more successful and relatively easier to proceed than encouraging positive behaviour among taxpayers. This review is the first to systematically analyse the literature on tax compliance based on three determinants (coercive power, trust and transparency), as found, no synthesis studies have comprehensively covered the issue. This results in unique, motivating, and relevant discoveries that may be used to direct future studies and serve as a tool for academics, practitioners, and policymakers. Furthermore, this study would aid governments and tax authorities to understand the motives and perceptions of taxpayers into taxes.

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INTRODUCTION:Atypical antipsychotics are widely used in treatment of many psychotic disorders. They are as effective as first generation antipsychotics and also causes lower incidence of EPS. Inspite of their uses, atypical antipsychotics do have some side effects. There is a high risk of metabolic syndrome. Current study highlights the patterns of weight gain in patients using second generation anti-psychotics.AIM:To compare the patterns of weight gain among the second generation antipsychotics.METHODOLOGY:A comparative study between weight gain due to second generation antipsychotics in a sample of 120, analyzed by recording kg/body weight of patients who were treated by Quetiapine, Olanzapine, Risperidon and Aripiprazole. Baseline weight was recorded before starting the drug and subsequent weight was recorded in a follow up period of 12 weeks after the drug was started.RESULTS:Mean weight of the patients on the drugs considered in the study with Olanzapine was 61.13±7.21.The mean change in bodyweight from baseline by the end of duration in patients on Olanzapine showed statistically significant weight gain of 5.8kg which was higher when compared to mean weight gain by Risperidone and Quetiapine. On contrary, patients on Aripiprazole (60.7±6.73) group had a weight loss of approximately 0.61kg though it was not statistically significant.CONCLUSION:Weight gain is an important factor in drug compliance. Combination of interventions may be helpful to maintain drug compliance. Preventing weight gain in patients treated with antipsychotics should be considered a priority by suggesting lifestyle modifications.

Compliance level and factors associated with iron-folic acid supplementation among pregnant women in Dangila, Northern Ethiopia: A cross-sectional study.

Objectives:Iron–folic acid non-compliance is a major problem in the study area. Therefore, this study aimed to assess the level of iron–folic acid supplementation compliance and associated factors among pregnant women.Methods:A community-based cross-sectional study design was conducted among pregnant women from 1 to 30 November 2018 in Dangila, Northern Ethiopia. A multi-stage sampling technique was used to select the participants. The data were collected using a structured questionnaire. For data entry and analysis, Epi Info 7 and Statistical Package for Social Science (SPSS) 23.0 were used, respectively. Bivariable and multivariable logistic regression analyses were done. Descriptive statistics like mean and standard deviation, and odds ratios with their respective confidence intervals were calculated. Statistically significant was declared at a p value of less than 0.05. The results were presented using text, tables, and figures.Results:A total of 589 pregnant women were involved, yielding a response rate of 91.2%. The average age of the participants in the study was 30.90 ± 5.93 years. The average weekly iron–folic acid pill intake was 5.3. The iron-folic acid compliance rate was 76.9% (95% confidence interval: 73.5–80.6). Women who had four or fewer alive children (adjusted odds ratio = 2.68, 95% confidence interval: 1.37–5.23), took less than 30 min to get to the health facility (adjusted odds ratio = 1.90, 95% confidence interval: 1.16–3.10), being a government employee (adjusted odds ratio = 0.16, 95% confidence interval: 0.03–0.81), attended antenatal care conferences (odds ratio = 2,95% confidence interval: 1.16–3.42), and started iron–folic acid tablets in the first trimester (odds ratio = 2.3, 95% confidence interval: 1.39–3.87) were associated with iron–folic acid compliance.Conclusion:The level of iron–folic acid supplementation compliance was low. Attending antenatal care training and starting to take iron-folic acid pills early in the first trimester were both factors associated with iron–folic acid supplementation compliance. Health care and health extension workers should emphasize and monitor the iron pill–taking habits of pregnant women in home-to-home visits.

Анализ психологических факторов приверженности терапии пациентов с мочекаменной болезнью

The issue of compliance to treatment is drawn a lot of attention to nowadays due to the shift to the bio-psycho-social paradigm. Multiple studies stress the role of psychological factors of compliance; in the clinic of the kidney stone disease though these factors are understudied. The study has found that at the hospital treatment stage persons have high and medium level of compliance to treatment. The factors influencing the level of compliance are the type of attitude to the disease and the level of health frustration. Thus, the patients with a high level of compliance tend to have adaptive reactions to a disease, while those with a medium level show maladaptive reactions. The patients with a high level of compliance show social frustration, which is significantly lower according to the indices of frustration of one’s own health and of socio-economic status.

Economic versus Non-Economic Factors: Which is More Relevant to an Individual's Tax Compliance Decisions in a Developing Economy?

Tax compliance study, which is linked with the study of human behavior, remains complex and evolving. The complex nature of taxpayers who are humans coupled with the inconsistencies in the methodologies and approaches used by tax compliance researchers have added to the complexity. Again, it remains unclear as to what motivates a typical taxpayer in a developing economy to honor their tax obligations voluntarily. To understand this complexity, a survey was conducted using questionnaires containing a list of economic and noneconomic tax compliance factors. A total of five hundred (500) respondents who are taxpayers located in four different developing economies were selected. The study found that understanding tax compliance decisions of taxpayers in developing economies requires at least some appreciation of the underlying factors which influence individual taxpayer's decision about whether to pay or evade taxes. The findings from this study prove that tax compliance decisions of individual taxpayers in developing economies are highly influenced by non-economic factors. However, to achieve improved tax compliance among individuals in a developing country, equal attention would be required for both factors. Further, the study provides some preliminary evidence that paying attention to the noneconomic factors could play a vital role in improving tax compliance level among individuals by up to 89% whereas compliance level could improve by only 11% if attention is paid to only the economic aspects of tax compliance decisions.

Topical Corticosteroids Utilisation and Cost Variation in Dermatology Outpatient of a Tertiary Hospital in Kathmandu

Introduction: Topical corticosteroids (TCs) are one of the important drugs prescribed in skin diseases. Cost is an important factor for compliance to treatment. Cost analysis provides the variation of costs which helps in economic benefit in the use of drugs. Thus the aim of the study was to assess the TC utilisation in Dermatology department and study its cost variation. Methods: A descriptive cross-sectional study was conducted in the out- patient of Department of Dermatology, Nepal Medical College Teaching Hospital. Patient demographic, disease, name of topical steroid, vehicle, strength, single or combination, cost of the different brands of TCs were analysed. Results: Out of 216 patients, 109 (50.5%) were females and 67 (31%) were of 21-30 years age group . Dermatitis was the most common skin condition encountered (106, 49.1%). Most common TC prescribed as single therapy was mometasone furoate 0.1%, (51, 23.6%) and betamethasone valerate 0.1% with fusidic acid, (48, 22.2%) as combination therapy. Mometasone furoate 0.1% cream, (15 gm) showed the maximum cost variation (94.7%) in single drug product while clobetasol propionate 0.05% with salicylic acid ointment (20 gm) showed the maximum cost variation (95.55%) in a combination product. Conclusion: The commonest indication of TCs use in Dermatology outpatient during our study was dermatitis, with commonest TCs prescribed being mometasone furoate. Cream was the most favoured vehicle. Cost variation was as high as 95% . Reduction in this cost variation would ease the financial burden on patients which will help in improving the patient compliance in a resource limited population.

Tuân thủ quy trình chuẩn bị người bệnh trước phẫu thuật của điều dưỡng tại khoa ngoại tổng hợp, bệnh viện Đa Khoa Trà Vinh năm 2020

Objective: This study aimed to identify nurse’s compliance in preoperative care procedures at the surgical department of Tra Vinh general hospital in 2020 and to demonstrate affected factors. Method: A cross-sectional descriptive survey was conducted on 26 registered nurses by observing 156 preoperative patient care at the General Surgery Department, followed by in-depth interviews with 7 health-care staffs. Main findings: The nurses’ compliance in preoperative care procedure was demonstrated at a moderate level (27.6%) and low level (72.4%). Associated factors of compliance included: organization, management and monitoring, humane resources, equipment and medicines, computer system and technology. Conclusions: Findings showed a low proportion of compliance regarding preoperative patient preparation procedures. Training, monitoring and education enhancement is crucially needed. Keywords: Follow the procedure, the patient before surgery, Tra Vinh General Hospital

State Compliance with International Law in Intelligence Matters: A Behavioural Approach

Abstract Decision-making in intelligence matters is often assumed to be an extra-legal process. This article however shows that the determining factor in compliance is a legal one: the likelihood of the state being held effectively accountable for a breach of international law. Through a behavioural analysis of state conduct in intelligence matters and the modelling of intelligence decision-making, the article demonstrates that state behaviour in intelligence matters can be explained and predicted. Taking compliance as the standard for assessing the effectiveness of regulation, this finding has strategic implications for the actors of the international legal order attempting to enhance compliance. Specifically, increasing the likelihood of effective accountability increases the probability of compliance and decreases the weight given to extra-legal and domestic considerations in decision-making, regardless of the activity and state considered. Hence, rather than focusing on the regulatory framework itself (international law), regulatory approaches aiming to enhance compliance should focus on improving accountability.

Prevention Practice of COVID-19 Using Personal Protective Equipment and Hand Hygiene Among Healthcare Workers in Public Hospitals of South Wollo Zone, Ethiopia.

Objective: The use of personal protective equipment and hand hygiene are often the most recommended line of defense against coronavirus disease-19 (COVID-19). The purpose of this study is to determine the magnitude of compliance and associated factors of personal protective equipment (PPE) utilization and hand hygiene practice among healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia.Methods: A hospital-based cross-sectional study was conducted among 489 healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia from June 15 to July 30, 2021. Proportional sample size allocation to each selected hospital followed by simple random sampling techniques were used to select the study participants using human resource records from each hospital. A pre-tested and structured self-administered questionnaire with WHO's standardized hand hygiene and PPE utilization observational checklist were used to collect data. Bivariate and multivariable analyses with 95% CI and p-value < 0.05 were employed to identify the associated factors of personal protective equipment utilization.Results: About 32 and 22.3% of healthcare workers were compliant with personal protective equipment utilization and hand hygiene practice, respectively. Feedback for safety (AOR = 2.05; 95% CI: 1.26–3.35), training on COVID-19 prevention (AOR = 3.43; 95% CI: 2.01–5.86), and perception to infection risk (AOR = 1.98; 95% CI: 1.18–3.33) were significant factors of good compliance with personal protective equipment utilization.Conclusion: The magnitude of good compliance with personal protective equipment utilization and hand hygiene was low. Interventions to promote personal protective equipment utilization and hand hygiene should focus on feedback for safety, training on COVID-19 prevention, and perception of infection risk.

Investigation and analysis of influencing factors of early activity compliance of patients after minimally invasive esophagectomy.

Unclear assessment content is the main reason for poor early postoperative ambulation compliance of patients. this study aimed to accelerate patients' recovery by investigating the influencing factors of the early activity compliance of patients with esophageal cancer (EC) undergoing minimally invasive esophagectomy (MIE). A total of 228 patients were investigated with a self-designed general information questionnaire, disease-specific questionnaire, early postoperative activity record, Social Support Rating Scale (SSRS), and the health belief model questionnaire from January 2019 to June 2020. The Mann-Whitney U test was used to analyze the influencing factors of patients with different degrees of compliance. Correlation analysis was used to analyze the relationship between social support and postoperative patient compliance. Among the 228 cases, 48 patients' compliance was good, 120 patients' compliance was moderate, and 60 patients' compliance was poor. The average score of compliance was 67.89±23.26. The analysis of influencing factors indicated educational level, intensity of postoperative activity pain, fatigue, dizziness, and social support could greatly predict the early activity compliance. Attention should be paid to alleviating the patients' pain, improving their nutrition, and increasing social support, which can promote patients to do the early postoperative activity and accelerate recovery.

Relationship of the Compliance Level of Antihypertensive Drug Use in First and Advanced Level Health Facilities

The adherence with therapy in hypertensive patients is important to note because hypertension is a disease that cannot be cured but can only be controlled. The success of controlling blood pressure in hypertensive patients influenced by compliance factors in taking antihypertensive drugs. The purpose of this study is to evaluate the relationship between the level of adherence of antihypertensive drugsuse in first and advanced health facilities.&#x0D; The study design was an observational cross sectional using subjects with hypertension patients older than or equal to 18 years old at Kotabunan Bolaang Mongondow Health Center (first level health facility) and outpatient installation of Robert Wolter Monginsidi Hospital in Manado (advanced health facilities) during the period from October to December 2019. The level of compliance with the use of antihypertensive drugs was assessed using the MMAS-8 questionnaire (Morisky 8-Item Medication Adherence Scale).&#x0D; The total patients in this study were 171 patients, as many as 73 patients in the first level health facilities and 98 patients in the advanced health facilities. The data of patient adherence in the use of antihypertensive drugs in the first level of health facilities showed 83.56% with low levels of adherence (MMAS score &lt;6), and only 16.44% with moderate to high levels of adherence (MMAS score 6-8). In the advanced level of health facilities were 85.71% of patients with low adherence and 14.29% with moderate to high adherence. Comparative statistical of adherence on the two health facilities was not significantly different, with p = 0.767 (95% confidence interval). The data shows that the average patient has a routine history of control as much as 91.8% in health facilities.&#x0D; Based on these results, recommended that each hospital and health center must require its pharmacists to do pharmaceutical practices, and each pharmacy must not provide drug services without the presence of a pharmacist.&#x0D; &#x0D;

Level of compliance of patients with alcohol dependence at the stages of active treatment of alcohol misuse

The article shows that one of the causes of relapses and re-hospitalizations is low compliance of patients, or non-compliance with their therapeutic regimen, especially at the end of anti-alcohol treatment. The author has developed some definitions, which specify the specifics of the phenomenon of compliance with patients with alcohol dependence; its levels in this group of patients were determined. Social and clinical-psychological factors that contribute to or hinder the formation of compliance are identified. Factors that increase compliance include: the presence of family support; motives for alcohol consumption, which are associated with the desire to neutralize negative emotional experiences (fear, anxiety, insecurity); therapeutic attitudes to understand the hidden causes of the disease and change painful stereotypes of behavior; ergopathic type of attitude to the disease; high level of subjective control in the professional field; emotional stability, social activity, as well as practicality and the ability to adequately assess their condition. Factors that reduce compliance are: young age of the patient; frequent relapses; repeated hospitalizations; addictive motivation to drink alcohol; therapeutic facilities for obtaining a "secondary gain" from the disease; apathetic type of attitude to the disease; overall low level of subjective control; conflict, negligence, rigidity of thinking. The selected psychological factors of compliance with alcohol dependence can be considered as targets of psychoprophylactic and psychocorrectional programs aimed at optimizing the process of adherence to the therapeutic regimen of patients with this pathology, which, in turn, will help prevent relapses and maintain remissions. This work is based on the results of the experience of psychodiagnostic and psychocorrectional work with alcohol-dependent patients who were under observation in the clinical databases of the Institute of Neurology, Psychiatry and Addiction of the Academy of Medical Sciences of Ukraine.

Description of on-farm treatment compliance and risk factors for culling in sows

BackgroundIn commercial pig farming, sick or injured sows are often treated by producers or hired staff. To date, limited quantitative data exists on treatment compliance and the possible effect on sow longevity post-treatment. The objective of the study was to quantify on-farm compliance of treatment selection, frequency, and dosage, as well as to investigate the association between body condition scores (BCS) and other sow-level factors on post-treatment cull risk.ResultsOn-farm treatment records, including culling reason or reason of death up to 6 months post-treatment, production records and sow characteristics were obtained for 134 sows over an 8-week period. Treatment compliance was based on the accuracy of recorded treatments compared to the herd veterinarian’s established treatment guidelines. Univariable and multivariable logistic regression models including treatment reason, treatment compliance, BCS, parity, production stage and production metrics, were constructed to investigate associations between those variables and sow culling or death. This study found low compliance for on-farm sow treatment protocols, with only 22.4% (30/134) of the sows receiving correct and complete treatment during the duration of the study. No effect of individual treatment components (drug, dosage, or frequency) on sow culling was observed. A trend for an interaction between treatment compliance and BCS was found, and parity and number of piglets born alive were identified as predictors for sow maintenance in the herd.ConclusionsOn-farm sow treatment compliance was low, resulting in that approximately 80% of the enrolled sows were not treated according to existing guidelines. Non-compliance of treatment guidelines did not seem to affect the risk of culling in treated sows but may have prolonged any associated pain, recovery time and negatively impacted the sow welfare during that time period.

Factors influencing post-screening visits of students to local vision centres in rural northwest China

ABSTRACT Clinical relevance Children with uncorrected visual impairment have lower scores on a variety of motor and cognitive tests. Exploring the influencing factors of low-income groups seeking vision care services is helpful for identifying relevant barriers and necessary measures to improve the utilization rate of vision care services. Background The community-based vision center (VC) is a popular model for solving vision problem of students in rural China. Compliance is the key factor to the success of the VC model. Factors determining compliance with visitations to VC among primary school students after screening were explored. Methods A cross-sectional study was conducted with 15,763 students from 228 primary schools. Information was collected through questionnaires and vision examinations. The determinants that affect visits of students to the VC were analyzed using logistic regression. Results Among the 15,763 sample, 5,361 (34%) students had a visual impairment. At baseline, only 962 (18%) of students with visual impairment sought vision care services. After a local VC was established, among the 5,163 students who needed to be referred, only 2,237 (43.33%) students visited the VC. Multivariate logistic regression models for predicting students visit the VC revealed that the following characteristics were significant predictors: poor uncorrected visual acuity (P < 0.001), a higher grade level (P = 0.008; P = 0.010), ‘left-behind’ children (P < 0.001), short living distance between home and the VC (P < 0.001), and the fact that these students lived in Gansu province (P < 0.001). Conclusions Establishing a VC that provides students with vision screening and free vision care services can increase the rate of seeking vision health services for students in rural areas, but the compliance rate still needs to be improved. The influencing factors for student compliance have been identified.

Patterns of physical activity and sedentary behavior and their associated factors among nondisabled stroke survivors

ObjectivesTo investigate the levels of physical activity and sedentary behavior, and the factors associated with these, in middle-aged and elderly stroke survivors who had no limitations to their physical activity. Study design and main outcome measuresWe analyzed physical activity and sedentary behavior patterns using data from 12,986 community-dwelling adults aged ≥50 years without activity limitation: 377 stroke survivors, 531 ischemic heart disease (IHD) survivors, and 12,078 healthy controls in the Korean National Health and Nutrition Examination Survey. The prevalence and associated factors of compliance to aerobic activity guidelines and prolonged sedentary time were investigated using complex-sample statistics. ResultsStroke survivors spent less time in transport-related activities and walking than healthy controls. Stroke survivors, despite having no restriction in daily and social activities, had lower rates of compliance with aerobic activity guidelines (32.4%) and a higher prevalence of long sedentary time (56.6%) than IHD survivors (aerobic activity, 36.3%; sedentary behavior, 55.1%) and healthy controls (aerobic activity, 42.4%; sedentary behavior, 46.2%). Stroke survivors with hypertension were less likely to engage in recommended aerobic activity. Higher levels of education were positively associated with both aerobic activity compliance and long sedentary time. Although older age was associated with long sedentary time, stroke survivors with hypercholesterolemia and those who were married and living with their spouses were less likely to have a long sedentary time. ConclusionsNondisabled stroke survivors tended to spend less time in aerobic activity and more time in sedentary behavior than IHD survivors and healthy controls, and environmental factors had a considerable impact on their levels of physical activity and sedentary behavior.

Beliefs in government benevolence can promote individuals' compliance with government‐issued guidelines: The role of positive affect and general construal level

AbstractAs the U.S. and the world continues to grapple with the health and economic damages caused by the COVID‐19 pandemic, it is vital to understand the correlates of individuals' compliance with the U.S. CDC's (Centers for Disease Control and Prevention) guidelines for this pandemic to aid the country's recovery from this crisis and shed light on risk mitigation in future crises. The present research examines why some individuals complied with the CDC's COVID‐19 guidelines to a greater extent than others during the first wave of the pandemic in the U.S. We propose the model grounded in the beliefs‐affect‐engagement framework and integrate research on benevolence and construal level theory to provide an explanation. In a two‐wave survey study conducted in March–April 2020, we found that the beliefs in the U.S. federal government's benevolence held by individuals with high general construal levels were positively related to the extent to which they complied with the CDC's COVID‐19 guidelines, in part due to their positive affect; however, among individuals with low general construal levels, their beliefs in the U.S. federal government's benevolence were not predictive of their compliance. Based on our findings, we discuss theoretical implications and practical insights about facilitative factors for public compliance with government‐issued guidelines during crises.

Assessing Clinical Outcomes in Patients Undergoing Splenectomy for Immune Thrombocytopenia: A Real World Perspective

Background:Immune thrombocytopenia (ITP) is an acquired immune-mediated disorder characterized by frequent relapses. Splenectomy was considered an integral part of ITP therapy until the inception of newer agents, namely rituximab and thrombopoietin receptor agonists (TPO-RA) over the last 20 years. Recently the role and timing of splenectomy have become an area of debate. Studies regarding optimal predictors of response have not demonstrated reliable clinical or laboratory factors. We chose to evaluate the most recent practices and outcomes at Montefiore Medical Center to assess the role of splenectomy in ITP treatment in our diverse, real world patient population.Methods:We conducted a retrospective cohort study of patients who had undergone splenectomy for ITP at Montefiore between January 1, 2015 and July 1, 2021. Collected data included demographics, comorbidities, prior lines of treatment, and splenectomy outcomes. Outcome data included mortality and need for post-splenectomy treatment. Response rates were assessed by American Society of Hematology (ASH) guidelines.Results:The study population comprised 29 patients who underwent splenectomy for ITP as primary indication. Patients were 59% (N=17) female, with a median age of 45 years. Our multi-ethnic cohort included 11 (40%) Hispanic, 7 (24%) African American, and 6 (21%) Caucasian patients. Five patients chose not to specify. Significant comorbidities prior to undergoing surgery were present in 79% (N=23) of patients, with the average number being two. Of these, 41% (N=12) had a comorbid autoimmune condition. Two were HIV positive.Initial treatment consisted of steroids, IVIG (or WinRho), or both for all patients. Only four patients failed to respond to these therapies; one of whom experienced remission following splenectomy and one of whom expired within 30 days of surgery. Fourteen patients (48%) continued to receive repeat doses of steroids and/or IVIG until surgery. Time to splenectomy was variable, range 0-9 years. Additional therapy following relapse on initial treatment consisted of TPO-RA (11/29, 38%); rituximab (11/29, 38%); immunosuppressive therapy (1/29, 3%); and danazol (3/29, 10%). Response rates for TPO-RA (8/11, 73%), danazol (2/3, 67%), and immunosuppressive therapy (1/1) were greater than that for rituximab infusion (4/11, 36%). Overall, the average number of unique lines of therapy was 2.8 (median=2) and average years from diagnosis to splenectomy was 2.8 (median=1, range 0-11).At a median time from splenectomy to last follow up (or time of death) of 971 days (median=876 days), 18 patients (62.1%) had remained off medical therapy with complete response (CR) following splenectomy. Three patients (10.3%) transiently required additional therapy but subsequently achieved CR and remained off medical therapy for greater than a year. Six patients (20.7%) continued to rely on medical therapy. Two patients (6.9%) died within 30 days of splenectomy; one of unknown causes and one of pulmonary embolism (despite thromboprophylaxis) in the setting of TPO-RA therapy. There was no difference in continued reliance on medical therapy in patients who underwent splenectomy earlier versus later in their ITP course. No differences in outcomes were noted in patients with underlying comorbidities. No differences in outcome were noted between Hispanic, African American, and Caucasian patients.Conclusion:Our review of ITP splenectomies in a real world patient population revealed significant differences in treatment practices and timing of surgical intervention. We did not note differences in splenectomy outcomes across patients of different backgrounds or with comorbidities, confirming that these should not play a role in treatment decisions. Patients who failed to respond to steroids and/or IVIG had lower response rates to splenectomy as has been previously hypothesized, though these represented a very small subset of our study population. Further evaluation of compliance, tolerance, and social factors (i.e. insurance, etc) may assist with understanding differences in response rates to various second line medical therapies. Splenectomy continues to offer high rates of sustained CR for a variety of patients, though reliable predictors of response remain elusive and should continue to be an area of active research. DisclosuresNo relevant conflicts of interest to declare.