Good Medication Compliance Research Articles

Testicular Adrenal Rest Tumor

A 17-year-old boy with a history of classic congenital adrenal hyperplasia (CAH) secondary to 21-α hydroxylase deficiency on treatment with hydrocortisone and fludrocortisone presented to the endocrinology clinic with bilateral painful testicular masses. Previous urologic evaluation revealed no evidence of hydrocele or epididymitis. Semen analysis showed azoospermia. Physical examination demonstrated Tanner stage V and normal phallus; the left testicle measured approximately 8 cm, and the right testicle measured 7 cm in largest diameter (Fig. 1 and 2). Laboratory evaluation showed the following: (1) alfa-fetoprotein level, 1.4 (reference range, 0.0-10.0) ng/mL; (2) human chorionic gonadotropin level, <0.1 (reference range, 0.0-1.0) mU/mL; (3) total testosterone level, 541 (reference range, 250-1100) ng/dL; (4) follicle-stimulating hormone level, 11.4 (reference range, 1.5-12.4) mU/mL; (5) luteinizing hormone level, 1.7 (reference range, 1.7-11) mU/mL; (6) adrenocorticotropic hormone level, 86 (reference range, 6-50) pg/mL; and (7) inhibin A level, <1 (reference range, <21) pg/mL.Fig. 2The left testicle measuring approximately 8 cm in largest diameter.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Scrotal ultrasound revealed markedly enlarged testes (60 mL and 70 mL) with hyperemia and no discrete masses, findings consistent with testicular adrenal rest tumor (TART) (Fig. 3). Partial orchiectomy confirmed the diagnosis. TARTs are firm bilateral painful masses originating near the rete testes developed in men with poorly controlled classic 21-α hydroxylase deficiency under the influence of chronically elevated adrenocorticotropic hormone levels. In recent studies, an overall prevalence of 40% (14%-89%) has been reported in patients with classic CAH.1Engels M. Span P.N. van Herwaarden A.E. Sweep F.C.G.J. Stikkelbroeck N.M.M.L. Claahsen-van der Grinten H.L. Testicular adrenal rest tumors: current insights on prevalence, characteristics, origin, and treatment.Endocr Rev. 2019; 40: 973-987Crossref PubMed Scopus (53) Google Scholar Ultrasonography is the most sensitive method of diagnosis. This condition is the most common cause of infertility in male patients with CAH. Although surgery can relieve the pain associated with the mass, it does not lead to increased testosterone production and improved fertility. Intensified glucocorticoid therapy is sometimes, but not always, effective in decreasing TART size and restoring fertility.2Claahsen-van der Grinten H.L. Otten B.J. Stikkelbroeck M.M. Sweep F.C. Hermus A.R. Testicular adrenal rest tumours in congenital adrenal hyperplasia.Best Pract Res Clin Endocrinol Metab. 2009; 23: 209-220Crossref PubMed Scopus (111) Google Scholar Routine physical examination along with annual ultrasound screening is recommended for early detection of the disease. The importance of good medication compliance was discussed with the patient, and the dosage of glucocorticoids was increased. The plan was to proceed with microdissection of testicular sperm extraction with cryopreservation in case fertility is not achieved by medical approach. The authors have no multiplicity of interest to disclose.

An Epidemiological Study on the Relationship between Drug Control Program and Patient Compliance in Elderly Patients with Hypertension.

Objective To explore the relationship between medication control regimen and patient compliance in elderly hypertensive patients. Methods A retrospective analysis of 1432 elderly hypertensive patients in our hospital from February 2020 to February 2021 was conducted. The general data of patients, the drug control regimen, the occurrence of drug side effects, and blood pressure control of patients during hospitalization and outpatient follow-up were statistically analyzed. Results The first dose rate was higher in patients given a single dose during hospitalization than in patients followed up in outpatient clinics, and the discharge rate was lower than for single doses (P < 0.05). Patients had a lower first dose rate and a higher discharge rate for the two drug combinations during hospitalization compared to outpatient follow-up patients, while the first dose rate and discharge rate were significantly lower during hospitalization. Three drugs were administered (P < 0.05). A higher incidence of first-dose and discharge medication was observed in patients with four drug coadministration during hospitalization than in patients with outpatient follow-up. The incidence of angiotensin-converting enzyme inhibitors (dry cough) was higher and the incidence of diuretics (hypokalemia) was lower in patients during hospitalization compared with patients at outpatient follow-up (P < 0.05). Maximum systolic blood pressure and fluctuations in systolic and diastolic blood pressure were lower in well compliant patients than in poorly compliant patients (P < 0.05). First systolic, maximal systolic, first diastolic, maximal diastolic, systolic and diastolic fluctuations were higher in hospitalised patients than in patients with outpatient follow-up, regardless of treatment compliance (P < 0.05). Conclusion Elderly hypertensive patients with outpatient follow-up had the best discharge medication compliance, patients during hospitalization showed good medication compliance, and patients with outpatient follow-up had poor medication compliance.

Characteristic of medication compliance behavior in renal transplantation patients.

After renal transplantation, patients need to take various immunosuppressant, but the drug compliance is poor. The theory of planned behavior suggests that the past medication behavior and subjective norms of individuals are closely related to medication compliance. This study aims to explore the change of medication compliance behavior and its influenting factors for renal transplantation patients at different stages. This study was a prospective longitudinal study. The Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS), Medication Belief Scale, Social Support Scale and Quality of Life Scale were used to dynamically follow up renal transplantation patients at pre-operation and 1-month, 6-month, and 12-month after transplantation. A total of 300 patients completed the whole follow-up. The percentage of patients with good medication compliance was 97.60%, 87.30% and 84.30% at 1-month, 6-month and 12-month after transplantation respectively. The life quality of the patients was decreased at 6 months after the operation, and the patients with better self-reported life quality had poor medication compliance. After adjusting for demographic data, the risk of medication incompliance in patients with poor medication compliance before operation was 37.646 times than those with good compliance. Patients who did not use medication reminders had high risk (odds ratio=2.467) of drug non-adherence. The risk of drug non-adherence in patients with more postoperative misgivings was 1.265 times compared with that in patients with less postoperative misgivings. The medication compliance decreases with the time of transplantation, but the medication compliance of patients with good self-reported life quality is poor. Medication concerns reduce the compliance behavior. Preoperative medication behavior has a significant predictive effect on postoperative behavior. Medication reminder is a protective factor for promoting compliance. Medical staff should pay more attention to preoperative medication belief, behaviors and reminder of using drug so as to provide precise intervention in the renal transplantation patients.

Quality of life among those with diabetes mellitus type II attending a secondary outpatient facility in South India.

Diabetes mellitus (DM) can affect one's quality of life (QoL). Literature on the association of QoL among type II diabetics with drug compliance and diet quality among rural communities is poor. This study aimed to determine the QoL among those with type II DM attending an outpatient clinic at a secondary hospital in Tamil Nadu. A cross-sectional, interview-based study was carried out among those with type II DM. A questionnaire comprising the WHO-BREF tool, Diabetes Healthy Eating Index, Hill-Bone Medication Adherence Scale was administered to participants selected via systematic random sampling. The prevalence of good QoL was estimated to be 51.7% (n = 45, 95% CI: 41.20-62.20). There was no association between good QoL and medication compliance. None of the patients had a good diet quality. Bivariate analysis revealed significant association (p < 0.05) between good QoL and higher education (OR-2.70), those not on medication for complications (OR-2.81) and decreased frequency of general random blood sugar (GRBS) monitoring (OR-2.44). Multivariable analysis adjusting for gender, education, treatment/medication for complications, hospitalisation for DM and GRBS frequency demonstrated significant association between good QoL, lack of medication for complications/co-morbidities and decreased GRBS monitoring frequency with likelihood ratios of 3.25 and 3.44, respectively. The drop in QoL observed could be due to the aftermath of the COVID pandemic. Keeping in mind the impact of healthcare interventions on the QoL of type II DM patients, primary physicians must consider dietary and treatment plans suited to their socio-economic status.

Analysis of Influencing Factors of Medication Compliance in Patients with Recurrent Vertebral Fractures after Percutaneous Kyphoplasty and the Role of Family-Centered Education Intervention.

Objective To explore the influencing factors of medication compliance in patients with recurrent vertebral fractures after percutaneous kyphoplasty (PKP) and the role of family-centered education intervention. Methods From January 2018 to January 2021, the general disease-related data survey form and medication compliance questionnaire made by our hospital were used to evaluate the scores of 198 patients with recurrent vertebral fractures after PKP in the Department of Orthopedics of our hospital. Single-factor and multiple linear regression analyses were used to explore the influencing factors of medication compliance in patients with recurring vertebral fractures after PKP. From 198 patients, 80 eligible patients were selected for further research. According to a random number table method, they were divided into the control group (n = 40) given only antiosteoporosis drug treatment and care and the experimental group (n = 40) combined with family-centered education intervention. After 12 months of intervention, the two groups were evaluated for their knowledge of osteoporosis, medication compliance, and physical health. Results Of the 198 patients, only 65 had good medication compliance, 90 had poor medication compliance, and 43 were acceptable. Univariate analysis showed that the influencing factors of medication compliance in patients with recurrent vertebral fractures after PKP include the patient's education, living style, per capita monthly income, combined other diseases, number of hospitalizations, and time since the last hospitalization (P < 0.05). Multiple linear regression analysis showed that patients with recurring vertebral fractures after PKP with high education, living with spouse or children, combined with other diseases, frequent hospitalizations, and short time from the last hospitalization had higher medication compliance (P < 0.05). After the intervention, the disease knowledge mastery of the experimental group was significantly better than before and after the intervention in the control group (P < 0.0001). After the intervention, the medication compliance and health status of the experimental group were significantly better than those of the control group (P < 0.05). Conclusion The medication compliance of patients with recurrent vertebral fractures after PKP is generally poor, and medical staff need to take targeted interventions based on the main factors that affect the patients' medication compliance. Family-centered education intervention is an effective way to improve disease awareness, medication compliance, and health status of patients with recurring vertebral fractures after PKP.

Relationship of Psychosocial Factors towards Medication Adherence among Hypertension Patients in A Tertiary Hospital

INTRODUCTION: Hypertension is one of the invisible diseases causing heart failure and stroke, and responsible for death. This study aimed to determine the level of medication adherence and psychosocial factors among patients with hypertension, relationship between socio demographic and medication adherence, and relationship between psychosocial factors and medication adherence among patients with hypertension. MATERIALS AND METHODS: A cross-sectional descriptive study was performed at the Primary Health Clinic and Medical Clinic in one of the tertiary hospitals. There were 123 patients with hypertension who volunteered to participate using a validated adapted and modified questionnaire to assess the compliance and psychosocial factors. The data collected was analysed using IBM SPSS Statistics version 23. RESULTS: A hundred and twenty respondents were adherents to medication (97.6%) while respondents with non-adherence to medication were 3 (2.4%) with a mean adherence score of 42.2764 with SD ± 2.67134. Some of the psychosocial variables had good understanding, good emotional state, positive attitude, higher motivation, higher perception of severity, lower perception of susceptibility and less barrier to compliance. Emotional state was the only thing reported for the psychosocial factors as being statistically significant. The level of emotional state was found statistically significant differences with scores p=0.008 (p&lt; 0.05). CONCLUSION: The level of medication adherence was good which reflected the patients’ compliance towards medication taking. This study showed a good medication adherence and compliance among hypertension patients.

The association between diabetes and cancer in Mexico: Analysis using death certificate databases, 2009-2017.

Previous studies have shown that diabetes mellitus (DM) is a risk factor of some type-specific cancers. However, no data are available on the association between cancer and DM in Latin America. The aim of this study is to determine which type-specific cancers are associated with DM using multiple cause of death data. Whole country of Mexico, cross-sectional design. Analysis of all cancer deaths (2009-2017) using death certificate databases of Mexican adults aged ≥20 years. Multivariable logistic regression. There were 710,292 total cancer deaths. DM increased the risk of pancreatic (adjusted odds ratio [aOR] = 1.7), liver (aOR = 1.6), kidney (aOR = 1.4), gallbladder (aOR = 1.2) and endometrial (aOR = 1.1) cancers, all P < 0.05. Type 2 or unknown-type DM were associated with the same cancer types with little variation of estimates. Higher estimates were found in males than females (except for kidney cancer). Type 1 DM was associated with pancreatic cancer only (aOR = 1.9). DM in Mexico is associated with gastrointestinal (pancreatic, liver, gallbladder), kidney and endometrial cancers. Dissemination of knowledge to both health-care workers and diabetics regarding potential cancer risks including adequate diet, regular exercise, weight reduction if obese/overweight, cessation of smoking, and good glucose control and medication compliance should be reinforced. Specific cancer preventative measures should be implemented for patients with DM.

Factors Affecting Bisphosphonate Therapy Compliance In Patients With Osteogenesis Imperfecta

BACKGROUND: Osteogenesis imperfecta (OI) is a genetic disease with clinical manifestations in patients' bones. This study aims to investigate the factors that influence the compliance of bisphosphonate in patients with OI.&#x0D; METHODS: A cross-sectional analysis method was conducted and data were obtained from questionnaires answered by OI patients that received bisphosphonate. The data obtained were statistically analyzed using chi-square.&#x0D; RESULTS: There were 121 OI patients, age range 0-5 years (62%). Almost all patients have insurance from national health (BPJS). In this study, the average treatment compliance was 81.7%, and patients were reported to have good medication compliance of ≥80% of the treatment cycle, which was shown in 65 patients (53.7%). However, there is a relationship between parent education and treatment compliance (P = 0.046).&#x0D; DISCUSSION: It is a measurement of behavior related to treatment recommendations by medical professionals. On the contrary, the level of non-compliance patients with chronic disease to treatment is quite high.&#x0D; CONCLUSION: Good treatment compliance describes when the patient performs ≥80% of its cycle. Factors affecting it are the condition of the patient and the location of health services. Therefore, there is a relationship between compliance with the number of treatment cycles.

Medication compliance in outpatients with schizophrenia in one veterans hospital in Taiwan

Medication compliance is an important determinant in schizophrenia treatment outcomes. This study aimed to investigate medication compliance in cases of patients receiving a single antipsychotic medication among adult outpatients with schizophrenia, and examine whether their antipsychotic therapy and other factors may affect the medication compliance. Subjects with schizophrenia who had received any single outpatient first- or second-generation antipsychotic therapy from the Yuli Veterans Hospital, Taiwan, during August and November 2006 were identified from medical chart reviews. The selected subjects were surveyed for information including their medication compliance, sociodemographics, treatment-related side effects, social support, and perceived treatment-related benefits. Their physicians were also surveyed on their medication compliance, Clinical Global Impression (CGI) scores, and comorbid mental illness(es). Good medication compliance was defined as consumption of more than 75% of prescribed antipsychotics in the previous month. Subjects were categorized into this group when both their self-reported consumption and their physicians' estimation were higher than 75%. A logistic regression model was adopted to evaluate the association of each factor with medication compliance. Of the 76 subjects surveyed, 39 (51%) received second-generation antipsychotics (amisulpride, risperidone, or olanzapine), while 37 (49%) received first-generation antipsychotics (haloperidol or sulpiride). Thirty-eight (50%) consumed more than 75% of prescribed medications in the previous month. The average age was 41, and 62% of the sample was male. Education level and employment type were significantly different between individuals with good and poor medication compliance. The regression result indicated that education of above nine years was significantly associated with an increased likelihood of good medication compliance. Employment and perceived treatment benefits were marginally significantly correlated with good medication compliance. Second-generation antipsychotics, however, had no correlation with good medication compliance.

Analysis of the effect of early multi-dimensional cardiac rehabilitation nursing mode on patients after PCI

Objective To investigate the effect of early multi-dimensional cardiac rehabilitation (CR) nursing mode on patients after percutaneous coronary intervention (PCI). Methods From August 2017 to July 2018, 100 patients with coronary heart disease (CHD) underwent PCI in the Department of Cardiology, the Third Affiliated Hospital of Sun Yat-sen University were selected as subjects. According to the random number table, the patients were divided into control group and observation group, 50 in each group. The control group received routine CR nursing intervention, and the observation group was given early multi-dimensional CR nursing mode for intervention. All patients were followed up for 6 months. The incidence of major cardiovascular adverse events (MACE) was observed 1 month and 6 months of follow-up. Patients with somatization were evaluated on the 2nd day after PCI and in the first month of follow-up using the Somatic Self-rating Scale (SSS). In the first month and the 6th month of follow-up, patient compliance was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Results During the study period, 3 patients were detached from each group, and there were 47 patients in both groups who completed the study. The incidence of MACE in the control group in 1 month and 6 months was 8.51% (4/47) and 4.26% (2/47), respectively. The incidence of MACE in the observation group was 10.64% (5/47) and 4.26%, (2/47) respectively. There was no significant difference in the incidence of MACE between the two groups (χ2 value was 0.123, 0.000, P>0.05). In the first month of follow-up, the SSS scores of the control group (34.32±6.59) and the observation group (31.04±7.04) were lower than those of the second day after surgery (37.21±6.19, 37.43±7.29), and the difference was statistically significant (t value was 4.633, 2.660, P 0.05). In the 6th month of follow-up, the MMAS-8 score (5.72±0.62) in the control group was lower than the first month of follow-up (6.93±0.54), and the difference was statistically significant (t value was 10.028, P 0.05). Conclusion Early multi-dimensional CR nursing mode has a limited effect on improving the incidence of MACE in patients after PCI, but it can effectively reduce the somatization symptoms of patients and maintain good medication compliance. Key words: Cardiac rehabilitation; Major cardiovascular adverse events; Somatic symptoms; Medication compliance

Predictive factors of adherence to an association of glucosamine sulfate, copper, and ginger extracts in patients with symptomatic osteoarthritis: a prospective open-label French noninterventional study (the PREDOA study).

Background: Osteoarthritis (OA) management needs a combination of nonpharmacological and pharmacological modalities. However, as in many chronic conditions, the main concern with OA therapy is the difficulty in obtaining good medication compliance over a long period. The PREDOA study aimed to investigate the predictive factors of adherence to treatment in patients with OA treated with glucosamine sulfate (GS)–copper sulfate–ginger root (GCu), a symptomatic slow-acting drug for OA.Methods: Ambulatory patients with a clinical diagnosis of OA were included in a prospective (6 months) multicenter open-label observational study. All patients received two capsules of GS-GCu once daily for 6 months. Demographics, disease features (OA location, symptom duration, concomitant therapies, comorbidities), and patient self-assessment of pain (0–10) were obtained at baseline. At month 6, the investigator collected patient self-assessments of treatment observance, reasons for nonadherence, pain scores, patient perceptions of treatment efficacy, changes in analgesic intake, and occurrence of adverse events. Predictors of observance were studied in univariate and multivariate analyses.Results: A total of 2,030 patients were included in the study. At baseline, the average pain score was 6.4±1.7. Observance was good in 80% of patients. It was weaker in active than retired patients (P=0.005) in patients not taking concomitant treatment (P=0.008) or who had never been treated for OA (P=0.001). Observance was correlated with pain decrease (P<0.0001) and with lack of adverse effects (P<0.001). Age, sex, pain level at baseline, OA location, and number of painful joints were not related to treatment compliance.Conclusion: Medication compliance with GS-GCu depends both on the safety–efficacy balance and several patient related-factors. To improve adherence, detailed information about therapeutic objectives is necessary in active patients who do not get any other medications and for whom it is their first treatment for OA.Clinical trial identifier: CCTIRS 14-371 B.

Prevalence of and Factors Influencing Anti-Tuberculosis Treatment Non-Adherence Among Patients with Pulmonary Tuberculosis: A Cross-Sectional Study in Anhui Province, Eastern China.

BackgroundTo assess the non-adherence rate among pulmonary tuberculosis (TB) patients in Anhui Province, eastern China and to explore the influential factors, so as to identify targets for intervention.Matreial/MethodsA total of 339 TB patients were recruited from TB dispensaries in 8 counties of Anhui Province, eastern China using a stratified sampling method. All study subjects were surveyed using a structured questionnaire. Differences between groups involving categorical data were analyzed using the chi-square test.ResultsOverall, of the 339 patients, 33.63% missed medication. Divorced and widowed patients were more likely to miss medication compared with those who were married or unmarried (P<0.01). Regarding the knowledge related to topics such as transmission route, preventive measures, and suspicious symptoms, the awareness rate in the group with good medication compliance was higher than in the group with poor compliance (P<0.05). We found that compliance was not significantly associated with seeking medical treatment in professional institutions, the national free TB treatment policy, or discrimination (P>0.05). The rate of non-compliance under supervision (26.10%) was lower than that without supervision (64.18%) (P<0.001).ConclusionsThe anti-TB treatment non-adherence rate in TB patients is relatively high in Anhui Province, eastern China, and is associated with marital status, annual income, TB knowledge, and medical staff visits.

Effects of motivational interview on medication adherence and control level of asthma in adult patients with asthma

Objective To explore the effects of the motivational interview on medication adherence and control level of asthma in adult patients with asthma. Methods A total of 100 asthma patients who were hospitalized in the Respiration Department of Putuo People's Hospital in 2016 were selected in the study using convenience sampling. According to the random number table, the participants were divided into the observation group (n=50) and the control group (n=50) . Two cases from the observation group withdrew from the study due to personal reasons, leaving 48 patients in the observation group. Three cases from the control group withdrew from the study (i.e. two for disease changes and one for personal reasons) , leaving 47 cases in the control group. The control group received conventional health education while the observation group received education based on motivational interview. The asthma medication compliance scale (Chinese version) (MARS-A) and asthma control test (ACT) questionnaire were used to evaluate the medication compliance and asthma control level before the intervention and 1, 2 and 3 months after the intervention. Results None of the patients had good medication compliance before the intervention. However, patients in the observation group had significantly better adherence at 1, 2, and 3 months after the intervention compared with the control group (P 0.05) . But after the intervention, the repeated variance analysis showed that there were significant differences in both intervention effect and time effect for asthma control score, and the interaction effects existed between intervention and time (P<0.05) . Conclusions The health education based on motivational interview can effectively improve the medication adherence and the control level of asthma in adult patients with asthma. Key words: Asthma; Medication adherence; Motivational interview; Control level of asthma

The Palm-Heart Diameter: A Prospective Simple Screening Tool for Identifying Heart Enlargement.

BACKGROUND:Several speculations have linked the size of the fist to be equal to the size of the heart. However, the substantial scientific report still lacks to support this theory.AIM:This study aims to provide the validity of the fist-heart assumption by correlating the palm and heart diameters while benchmarking it as a reference tool for determining the normal heart size.MATERIALS AND METHOD:Volunteers from the public were recruited during a health fair organised by the school. A self-administered questionnaire for necessary information was distributed after the volunteers signed the consent forms. The palm of both hands was measured in duplicates using a flexible ruler. Ultrasound examination was used in measuring the diameter of the heart with the landmark being from the anterior fibrous pericardium to the lowest part of the posterior fibrous pericardium. The level of significance was kept at P < 0.05.RESULTS:A total of 275 people, consisting of 123 males and 152 females participated in the study. The age range was from 15 to 80 years with a mean age of 28.16 ± 16.18. The measurement showed that the size of both palms correlated with the heart diameter, p < 0.05. Other factors such as age and height showed a substantial level of correlation. However, this correlation ceased with older participants. Palm size did not correlate among participants with previously diagnosed prehypertension. However, participants with previously diagnosed hypertension with good medication compliance maintained the correlation.CONCLUSION:This study establishes the correlation between the palm and heart diameters. Since the heart tissue and the upper limb share a similar embryonic origin, being the mesoderm, this study prospects the fact that heart enlargement could be preliminarily identified by measuring the size of the hand.

Investigation and analysis on medication compliance and family care of patients with chronic hepatitis B

Objective To understand the medication compliance, family care and their correlation in patients with chronic hepatitis B. Methods From January to Decemeber 2016, two hundred and seventy-six chronic hepatitis B patients from a class III grade A infectious disease hospital in Nantong were selected as the research object by convenient sampling method. They were investigated by the medication compliance questionnaire and the family care index questionnaire. Results Chronic hepatitis B patients with good medication compliance accounted for 48.91%, the family care score was (7.82±2.38) points. Pearson correlation analysis showed negative correlation between the medication compliance of patients and family care (r=-0.173, P<0.05) . There were significance differences in medication compliance among different age, gender, occupation, cultural level, monthly income, medical payment (χ2=27.45, 8.42, 13.36, 24.76, 10.65, 18.38; P<0.05) . There were significant differences in family care scores among patients of different age, gender, occupation, marital status, monthly income and method of medical payment (t=7.41, 2.52, 4.96, 6.88, 5.65, 11.26; P<0.05) . Conclusions The medication compliance and family care of chronic hepatitis B patients still needs to be further improved. It is necessary to strengthen the multi family-oriented nursing intervention, and improve medication compliance and family care so as to delay progression and improve quality of life of patients. Key words: Hepatitis B, chronic; Medication compliance; Family care; Investigation and analysis

A Survey of Actual Clinical Practice Concerning Blood Pressure Control among Patients with Hypertension in Kanagawa 2014.

We performed a cross-sectional survey to investigate actual clinical practice concerning blood-pressure control among patients with hypertension in Kanagawa. The guidelines of the Japanese Society of Hypertension (JSH) for the management of patients with hypertension were revised in 2014. From October 1 to November 30, 2014, questionnaires on the care of patients with hypertension were sent via post to members of the Kanagawa Physicians Association in Kanagawa Prefecture, Japan. -Data on 1,105 patients (mean age: 68.4±12.3 years, 537 men and 568 women) were obtained. The overall mean systolic blood pressure (BP) of these patients was 128.7±12.1 mmHg for home monitoring and 132.9±12.6 mmHg for office monitoring; diastolic BP was 75.7±9.7 for home monitoring and 77.0±9.7 mmHg for office monitoring. According to the JSH 2014 guidelines, the target BP was achieved by 68.1% of all subjects; 89.2% of late-phase elderly patients (75 years or older); 69.1% of young, middle-aged, and early-phase elderly patients (younger than 75 years except in patients with diabetes mellitus [DM] or chronic kidney disease [CKD] with proteinuria); 9.3% of patients with DM except late-phase elderly patients; and 11.9% of CKD patients with proteinuria except DM. Cross-sectional analysis showed that the factors significantly associated with an increased likelihood of achieving the target BP were as follows: 1) good medication compliance even for a small number of antihypertensive agents at small amount of doses in patients 75 years and older; 2) good medication compliance in patients in younger than 75 years; 3) an older age, a larger proportion in the female-to-male ratio and a lower body mass index in patients with DM except late-phase elderly patients; and 4) usage of a large number of antihypertensive agents in CKD patients with proteinuria. Further follow-up surveys are necessary to investigate changes in clinical practice following the introduction of the revised guidelines.

Advanced large cell lung tumor with neuroendocrine differentiation in an HIV positive patient.

Sir, Human immunodeficiency virus (HIV) infection is well known to be associated with several cancers and respiratory complications. Lung cancer is one of the most common cancers in HIV-infected individuals. We report the case of a HIV-positive smoker male who was admitted with fever, cough and right-sided pleuritic chest pain. Imaging studies revealed the presence of right-sided pleural effusion with multiple pleural based nodules and right lower lobe mass. Histopathologic examination of the tissue showed large cell lung tumor with neuroendocrine differentiation (LCNEC). LCNEC is an extremely rare lung cancer with this being the only case reported in an HIV-positive patient. A 49-year-old HIV-positive male smoker on antiretroviral therapy (tenofovir, emtricitabine and efavirenz) with good medication compliance presented with cough and progressively worsening right-sided pleuritic chest pain for 2 weeks. He also stated having loss of appetite and 23 kg weight loss over the last 2 months. He denied having any hemoptysis, abdominal or neurologic symptoms at presentation. There was no history of preexisting lung disease, diabetes, illicit drug abuse or lung infections. Fifteen days ago his CD4 cell count was 750/μl with an undetectable viral load. Clinical examination showed stable vitals. Chest examination revealed decreased breath sounds on the right with decreased tactile vocal fremitus over the right middle and lower lung fields. Cardiovascular, abdominal, neurologic and skin examination failed to show any abnormality. Initial laboratory tests including complete blood counts and serum chemistries were within normal limits. Chest radiograph revealed a right-sided effusion without any mediastinal shift. Chest computed tomography (CT) scan confirmed the presence of a large right-sided pleural effusion with multiple pleural based soft tissue densities and a right lower lobe mass [Figure 1].Figure 1: CT chest showing right-sided effusion with pleural-based soft tissue (white arrow) density and a right lower lobe mass (red arrow)Thoracocentesis showed an exudative hemorrhagic fluid with no malignant cells on cytologic examination. The patient underwent video-assisted thoracoscopic examination (VATS) with biopsy of the pleural-based soft tissue mass. Histopathologic examination of the tissue showed large cells with organoid growth pattern, high mitotic index and areas of necrosis [Figure 2]. The neuroendocrine phenotype was confirmed by the presence of positive staining for synaptophysin and chromogranin A.Figure 2: Histopathologic examination of pleural masses showing large cell tumor of lung originDue to pleural involvement, the patient was diagnosed with a stage IV large cell lung cancer with neuroendocrine differentiation. The patient agreed for a trial of chemotherapy with carboplatin and etoposide. Initial work-up for metastatic spread of the disease failed to show any extra-thoracic involvement. Over the course of next 9 months, the patient's condition worsened with metastatic involvement of the liver and brain, ultimately leading to his death. Lung cancer, the leading cause of cancer-related deaths in the general population is the third most common malignancy in HIV-infected individuals, preceded only by Kaposi's sarcoma and non-Hodgkin's lymphoma.[123] The most common histologic variants of non-small cell lung cancer seen in the patients infected with HIV are adenocarcinoma (31-50%), squamous cell carcinoma (19-36%) and large cell carcinoma (9-19%).[45] Large cell lung tumors with neuroendocrine differentiation make up about 1.6-3.1% of all lung cancers in the general population.[6] The association of LCNEC with HIV infection is even rarer. Extensive literature review failed to reveal any case report of LCNEC in an individual infected with HIV. HIV infection is a well-known independent risk factor for lung cancer. The exact pathophysiology for increased incidence of lung cancer in the patients with HIV infection is unclear. HIV patients are diagnosed with lung cancer at earlier age (average age of diagnosis: 46 years) compared to HIV-negative patients who develop lung cancer.[56] HIV-positive patients with lung cancer are also thought to have more advanced stages of lung cancer at the time of diagnosis with severe pulmonary symptoms. The diagnostic and treatment approach to lung cancer in HIV-infected patients is similar to those with lung cancer without co-infection with HIV. In conclusion, HIV infection acts as an independent risk factor for lung cancer, with adenocarcinoma being the most common histopathologic variant and LCNEC being extremely rare. The diagnostic and treatment approach in the patients with lung cancer remains unaffected by their HIV status. The only area of concern is the potential interaction between certain chemotherapeutic agents and antiretroviral medications. The worsened outcomes and poorer prognosis in the lung cancer patients with HIV infection as compared to those without HIV infection are attributed to the weakened immune system in the former. ACKNOWLEDGEMENT We thank Dr. Sudheer Chauhan and Dr. Maximo Mora for their support and contribution in the diagnosis and management of the patient.

Oral anticancer agent medication adherence by outpatients.

In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21–85 years) and 73 years (range, 30–90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3–3,585 days) and 219 days (24–3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4–5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.

Investigation on medication compliance and its influencing factors in patients with stable COPD

Objective To evaluate the medication compliance and its influencing factors in patients with stable chronic obstructive pulmonary disease (COPD).Methods The intervening measures were taken in 100 patients with stable COPD,with a regular follow-up.A questionnaire method was used to investigate the medication compliance of patients in this study.The difference of medication compliance was compared between before and after intervention,and the influencing factors were analyzed.Results There were 34％ patients with good medication compliance before intervention,and 73％ after intervention,the difference was statistically significant (x2 =30.57,P ＜ 0.01).These factors which included inhalation technique mastery of medication,living alone,periodic review,and adverse drug reactions affected apparently medication compliance of patient,and these difference were statistically significant (x2 =22.99,15.52,17.94,10.04,respectively;P ＜ 0.01)between yes and no about above factors; also the medication adherence were different in patients with different age or educational level,and the difference was statistically significant (x2 =4.58,4.92,respectively; P ＜ 0.05).Conclusions The different intervening measures should be used in patients with stable COPD according to different patients' characteristics,which can enhance their medication compliance,reduce the frequency of exacerbations and improve their quality of life. Key words: Pulmonary disease, chronic obstructive; Medication therapy; Stable stage; Compliance ; Influencing factors

Demonstrating the effectiveness of less restrictive care pathways for the management of patients treated with clozapine

The purpose of this study was to measure the effectiveness of two alternative care pathways for managing patients treated with clozapine. Medical records for 90 clozapine patients managed via three care pathways were audited for a 24 month period (30 per group). The three care pathways established to manage patients prescribed clozapine include: (1) remaining in public mental health service case management; (2) transitioning to general practitioner-mental health service shared care; or (3) transitioning to private psychiatry sole care. Demographic, illness, medication compliance, service utilisation and performance on clinical outcome measures were collected in the 12 months prior to and following transition. Across both the private psychiatry and general practitioner (GP) shared care transitioned groups, only one patient had a psychiatric hospital admission in the 12 months following transition, and transitioned patients also had fewer mental health service clinician contacts. Good medication compliance, better skills of daily living, lower levels of illicit substance abuse and a lower intensity of case management history were seen in transitioned patients. Transitioning appropriate patients taking clozapine to less intensive care pathways like private psychiatrists and GP shared care can be effectively achieved if appropriate supports are in place for both the clinicians and their patients.