High Compliance Group Research Articles

Treatment compliance and uric acid control rate in patients with primary gout

Objective To investigate the treatment compliance and uric acid control rate in patients with primary gout. Methods One hundred primary gout patients with disease duration >6 months treated in our hospital from June 2015 to June 2016 were enrolled in the study. The treatment compliance and disease control rate were evaluated with revised Chinese Compliance Questionnaire-Rheumatology (CCQR). Results Eighty four valid questionnaires was recovered for analysis. Among 84 patients there were 46 cases of high compliance(54.8%)and 38 cases of poor compliance(45.2%). The CCQR score in high compliance group was significantly higher than that in poor compliance group (73.48±15.62 vs. 48.37±10.96, t=8.352, P 0.05). The duration of gout was shorter in high compliance group than that in low compliance group [(6.12±1.79)y vs. (13.24±4.56)y, P<0.001]. The uric acid control rate in high compliance group was higher than that in poor compliance group (76.1% vs. 36.8%, χ2=13.186, P=0.000 3); and the serum uric acid levels were(369.82±35.67)μmol/L and (497.46±63.49)μmol/L in two groups, respectively(t=11.606, P<0.001). Conclusion It is necessary to strengthen health education for gout patients to improve the treatment compliance and to achieve the high uric acid control rate. Key words: Gout; Patient compliance; Questionnaires

Compliance with ERAS protocols improves overall and disease free survival after pancreaticoduodenectomy

Background: Compliance with Enhanced Recovery After Surgery (ERAS) protocols has yielded improved oncologic outcomes in the colorectal literature. There is little data to illustrate the effect of ERAS compliance on oncologic outcomes after pancreaticoduodenectomy (PD) for adenocarcinoma. This study seeks to evaluate whether ERAS compliance at our institution has had a positive impact on overall and disease-free survival after PD. Methods: We used the ERAS Interactive Audit System (EIAS) to compile a list of all patients who underwent PD at our institution since September of 2015, at which point an ERAS pathway was implemented. We then case-matched those patients to others who underwent PD prior to ERAS introduction. We analyzed differences between these two cohorts in postoperative and oncologic outcomes, with a focus on overall and disease-free survival. We then subcategorized the ERAS patients into two tiers of protocol item compliance (>85% and 65%–85%), and subjected them to similar analysis. Results: The median follow-up for the ERAS cohort was 19 months. Overall survival at 19 months was significantly higher for ERAS patients when compared to pre-ERAS patients (65% versus 39.8%; p 0.003). Disease-free survival was also significantly higher at 19 months (50% versus 21.4%; p 0.017). Among ERAS patients, the high-compliance group had an overall survival of 80% (versus 60% in the low-compliance group) and disease free survival of 70% (versus 43%). Conclusion: Adherence to ERAS protocols has resulted in a significant improvement in oncologic outcomes after PD. These benefits seem to correspond to the degree of ERAS compliance.Table 1Demographics, perioperative data, and outcomes for FD patientsCharacteristicPre-ERAS®ERAS®p-ValueTotal, no.4040 Male, no. (%)22 (55%)25 (62.5%) Female, no. (%)18 (45%)15 (37.5%)Age in years, median (range)64.5 (32–86)63.5 (32–83)Perioperative data EBL in mL, median (range)625 (75–2500)600 (200–2400) Length of stay in days, median (range)9.5 (6–81)8 (5–27)0.065 30-day mortality, no. (%)2 (5%)1 (2.5%)0.556Oncologic factors Tumor size in mm, median (range)32 (15–68)35 (13–71) R0 resection27 (67.5%)12 (30%) R1 resection13 (32.5%)28 (70%) Lymphovascular invasion25 (62.5%)27 (67.5%) Positive lymph nodes, no. (%)30 (75%)30 (75%) Number of positive nodes, median (range)3 (0–23)3 (0–15) Neoadjuvant chemotherapy used, no. (%)12 (30%)12 (30%)19 month Overall survival39.8%65%0.00319 month disease free survival21.4%50%0.017Relationship between ERAS® item compliance and oncologie outcomesCharacteristicCompliance 65–85%Compliance >85%p-Value19 month overall survival60%80%0.2519 month disease free survival43%70%0.14Abbreviations; ERAS, enhanced recovery after surgery; PD, pancreaticoduodenectomy; EBL, estimated blued loss Open table in a new tab Abbreviations; ERAS, enhanced recovery after surgery; PD, pancreaticoduodenectomy; EBL, estimated blued loss

The importance of dose in land-based supervised exercise for people with hip osteoarthritis. A systematic review and meta-analysis.

To compare effects of land-based exercise programmes with high vs low or uncertain compliance with dose recommendations among people with hip osteoarthritis (OA). A systematic review with meta-analyses of supervised exercise programmes in people with symptomatic hip OA was conducted. Dose of the exercise interventions was evaluated according to the American College of Sports Medicine's (ACSM) recommendations for developing and maintaining cardiorespiratory fitness, muscular strength and flexibility in healthy adults. Compliance ratios with the recommendations were calculated. Standardized Mean Differences (SMDs) were calculated in meta-analyses for the outcomes pain and self-reported physical function. Outcome effects were compared between the sub-groups of studies with interventions with "high" vs "uncertain" compliance with the ACSM recommendations. Twelve studies including 1202 participants were included. Seven were categorized with "high" and five with "uncertain" compliance with the ACSM recommendations. Ten studies had an overall low risk of bias. Comparing exercise with no exercise, the pooled SMD for pain was-0.42 (95% CI-0.58,-0.26) in the high compliance group, favouring exercise. In the uncertain compliance group the pooled SMD was 0.04 (95% CI-0.24, 0.31). For physical function the SMD was-0.41 (95% CI-0.58,-0.24) in the high compliance group and-0.23 (95% CI-0.52, 0.06) in the uncertain compliance group. The results show that land-based supervised exercise interventions with high compliance to the ACSM recommendations result in significantly larger improvements in pain and non-significantly larger improvement in self-reported physical function compared with land-based supervised exercise interventions with uncertain compliance.

Optimizing Value of Colon Surgery in Michigan.

To assess the value of bundling perioperative care measures in colon surgery. Surgical site infections (SSI) in colectomy are associated with increased morbidity and cost. Perioperative care bundling has been designed to improve processes of care surrounding colectomy operations. Retrospective cohort study performed by the Michigan Surgical Quality Collaborative (MSQC) of patients who underwent elective colon surgery from 2012 to 2015. We identified 3,387 patients in the MSQC database who underwent colon surgery. Of these cases, 332 had associated episodic cost data. High compliance (3-6 bundle elements) and low compliance (0-2 bundle elements) had a risk-adjusted SSI rate of 8.2% (95% confidence interval, CI, 7.2-9.2%) and 16.0% (95% CI, 12.9-19.1%), respectively (P < 0.01). When compared with low compliance, the high compliance group had an absolute risk reduction of 3.6% (P < 0.01), 2.9% (P < 0.01) and 1.3% (P < 0.01) for SSI rates in superficial space, deep space, and organ space, respectively. Low compliance had an average episodic cost of $20,046 (95% CI, $17,281-$22,812) whereas high compliance had an episodic cost of $15,272 (95% CI, $14,354-$16,192). This showed a $4,774 (95% CI, $1,859-$7,688) and 23.8% cost reduction (P < 0.01). Facility base payments decreased 14.8% ($13,444; $11,458), professional payments decreased 43.9% ($5,180; $2,906), and other payments decreased 36.2% ($1,422; $908). A colectomy perioperative care bundle in Michigan is associated with improved value of surgical care. We will expand efforts to implement perioperative care bundles in Michigan to improve outcomes and reduce costs.

The effects of low tidal ventilation on lung strain correlate with respiratory system compliance

BackgroundThe effect of alterations in tidal volume on mortality of acute respiratory distress syndrome (ARDS) is determined by respiratory system compliance. We aimed to investigate the effects of different tidal volumes on lung strain in ARDS patients who had various levels of respiratory system compliance.MethodsNineteen patients were divided into high (Chigh group) and low (Clow group) respiratory system compliance groups based on their respiratory system compliance values. We defined compliance ≥0.6 ml/(cmH2O/kg) as Chigh and compliance <0.6 ml/(cmH2O/kg) as Clow. End-expiratory lung volumes (EELV) at various tidal volumes were measured by nitrogen wash-in/washout. Lung strain was calculated as the ratio between tidal volume and EELV. The primary outcome was that lung strain is a function of tidal volume in patients with various levels of respiratory system compliance.ResultsThe mean baseline EELV, strain and respiratory system compliance values were 1873 ml, 0.31 and 0.65 ml/(cmH2O/kg), respectively; differences in all of these parameters were statistically significant between the two groups. For all participants, a positive correlation was found between the respiratory system compliance and EELV (R = 0.488, p = 0.034). Driving pressure and strain increased together as the tidal volume increased from 6 ml/kg predicted body weight (PBW) to 12 ml/kg PBW. Compared to the Chigh ARDS patients, the driving pressure was significantly higher in the Clow patients at each tidal volume. Similar effects of lung strain were found for tidal volumes of 6 and 8 ml/kg PBW. The “lung injury” limits for driving pressure and lung strain were much easier to exceed with increases in the tidal volume in Clow patients.ConclusionsRespiratory system compliance affected the relationships between tidal volume and driving pressure and lung strain in ARDS patients. These results showed that increasing tidal volume induced lung injury more easily in patients with low respiratory system compliance.Trial registrationClinicaltrials.gov identifier NCT01864668, Registered 21 May 2013.

Factors associated with changes over time in medication-taking behavior up to 12 months after initial mild cerebral infarction onset.

The aim of this study was to clarify the changes in medication-taking behavior and related factors over time in patients with initial mild cerebral infarction up to 12 months after onset. Thirty-one patients with initial mild cerebral infarction were surveyed a total of four times: on admission to hospital, 3 months after onset, 6 months after onset, and 12 months after onset. Patients were surveyed regarding medication compliance, awareness of taking medication, perceived behavioral control, lifestyle risk factors, and subjective norms. Medication compliance improved over time from the time of admission, but no changes were seen in awareness of taking medication. A cluster analysis based on changes in medication compliance over time revealed a "Persistently high compliance group" and a "Persistently low compliance group" for medication compliance. The health locus of control in the "Persistently high compliance group" was perceived as the result of chance and fate. Assessing the current state of medication compliance and the health locus of control during hospitalization permitted an understanding of patient characteristics, and indicated a need for recurrence prevention education and medication guidance tailored to each patient's cognitive and behavioral characteristics. J. Med. Invest. 64: 85-95, February, 2017.

Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study

BackgroundAlthough the relation between adherence to the ERAS protocol and clinical outcomes was extensively studied, there is still ongoing discussion on the need and feasibility of full compliance in laparoscopic colorectal surgery. In this study, we aimed to verify whether a strict adherence to the protocol (>90%) leads to further improvement in clinical outcomes compared to high (70–90%) and low (<70%) compliance groups. Materials and methodsThe analysis included consecutive prospectively registered patients operated laparoscopically for colorectal cancer between January 2012 and December 2015. Patients were divided into three groups depending on the compliance with the ERAS protocol: <70% (Group 1), 70–90% (Group 2), >90% (Group 3). The measured outcomes were: complication rate, readmission rate, recovery parameters (tolerance of early oral diet on 1st postoperative day and mobilization of a patient on the day of surgery), length of stay (LOS). ResultsGroup 1 consisted of 70, Group 2 of 65 and Group 3 of 116 patients. There were no statistical differences between the groups based on demographic parameters, stage of cancer and operative parameters (operative time, blood loss, conversion rate). The overall compliance with the protocol in the study group was 85.6 ± 11.9%. There was a significant decrease in complication rate with increasing compliance (35.7% vs. 36.4% vs. 16.4%, p = 0.0024) and severity of complications according to the Clavien-Dindo classification (p = 0.0198). Moreover, we observed differences in recovery parameters between the groups: tolerance of oral diet on the 1st postoperative day (52.8% vs. 79.5% vs. 87.9%, p < 0.0001), mobilization of a patient on the day of surgery (68.6% vs. 92.3% vs. 99.1%, p < 0.0001), respectively. We also observed that with compliance increase, the median LOS decreased (6 vs. 4 vs. 3 days, p < 0.0001). ConclusionFull implementation of the ERAS protocol significantly improves short term outcomes both in comparison to the high- and low-compliant groups.

Patterns and Predictors of Compliance in a Prospective Diary Study of Substance Use and Sexual Behavior in a Sample of Young Men Who Have Sex With Men.

Behavioral diaries are used for observing health-related behaviors prospectively. Little is known about patterns and predictors of diary compliance to better understand differential attrition. An analytic sample of 241 young men who have sex with men (YMSM) from a 2-month diary study of substance use and sexual behavior were randomized to complete daily or weekly timeline followback diaries. Latent class growth analyses were used to analyze data. Weekly and daily diary groups produced similar compliance patterns: high, low, and declining compliance groups. Black YMSM were more likely to be in the declining compared with the high compliance group. YMSM who were randomly assigned to receive automated feedback about risk behaviors did not differ in compliance rate compared with those who did not. Risk behavior engagement did not predict compliance in the daily condition, but some substances predicted compliance in the weekly condition. Implications for observational and behavior change methods are discussed.

Low Left Atrial Compliance Contributes to the Clinical Recurrence of Atrial Fibrillation after Catheter Ablation in Patients with Structurally and Functionally Normal Heart.

Stiff left atrial (LA) syndrome was initially reported in post-cardiac surgery patients and known to be associated with low LA compliance. We investigated the physiological and clinical implications of LA compliance by estimating LA pulse pressure (LApp) among patients with atrial fibrillation (AF) and structurally and functionally normal heart. Among 1038 consecutive patients with LA pressure measurements before AF ablation, we included 334 patients with structurally and functionally normal heart (81.7% male, 54.1±10.6 years, 77.0% paroxysmal AF) after excluding those with hypertension, diabetes, and previous ablation or cardiac surgery. We measured LApp (peak-nadir LA pressure) at the beginning of the ablation procedure and compared the values with clinical parameters and the AF recurrence rate.AF patients with normal heart were younger and more frequently male and had paroxysmal AF, a lower body mass index, and a lower LApp compared to others (all p<0.05).Based on the median value, the low LA compliance group (LApp≥13mmHg) had a smaller LA volume index and lower LA voltage (all p<0.05) compared to the high LA compliance group. During a mean follow-up of 16.7±11.8 months, low LA compliance was independently associated with two fold-higher risk of clinical AF recurrence (HR:2.202; 95%CI:1.077–4.503; p = 0.031).Low LA compliance, as determined by an elevated LApp, was associated with a smaller LA volume index and lower LA voltage and independently associated with higher clinical recurrence after catheter ablation in AF patients with structurally and functionally normal heart.

Impact of Self-Efficacy on Medication Adherence among People Living with Human Immunodeficiency Virus

Background/Aims: It is very important that people living with HIV (PLWH) maintain 95% medication adherence to increase health-related quality of life and prevent transmitting HIV. In this study, we analyzed factors influencing medication adherence among PLWH and used the basic data for practical interventions to increase medication adherence. Methods: A total of 190 PLWH, who were taking highly active antiretroviral therapy (HAART) from nine hospitals in South Korea, were included. The data were collected by self-administered questionnaire between April 1 and June 31, 2014. Results: About 92% of the subjects were male and 72.9% of the subjects belonged to the high compliance group. Medicationtaking self-efficacy was significantly related to compliance. Efficacy expectancy, which is a subscale of medication-taking selfefficacy, indicated that a score of 1 point higher on a 10-point scale increased compliance by 2.63 times. Conclusions: Medication adherence is associated with increased medication-taking self-efficacy. Therefore, it is necessary to promote self-efficacy to improve compliance considering the infection period and adverse reactions to HAART among PLWH. (Korean J Med 2015;89:305-311)

The Relations between Diabetic Dietary Compliance, Dietary Intake, and Physical Activity and the Prevalence of Metabolic Syndrome (MS) in Type 2 Diabetic Patients

Objectives: The purpose of this study was to investigate the relations between diabetic dietary compliance and dietary intake, physical activity and prevalence of metabolic syndrome (MS) in type 2 diabetic patients. Methods: Seventy five subjects diagnosed with type 2 diabetes visiting the D hospital in Dongducheon from May 2014 to Dec 2014 were included in this study. The subjects were divided into two groups according to their diabetic dietary compliance score (median 39); low diabetic dietary compliance (LDDC) group (n=44) and high diabetic dietary compliance (HDDC) group (n=31). Survey data collection was carried out by direct interview method. The nutrient intake, food intake and KDDS (Korean’s dietary diversity score), DVS (dietary variety score) and GMVDF (grain, meat, vegetable, dairy and fruit) were analyzed using data from the 24-recall method. Metabolic parameters were obtained from the hospital records. Data was analyzed using Chi-square test and general linear model adjusted for sex. Results: The prevalence of MS was 59.7% in the participating diabetic patients. The prevalence of MS of the HDDC (39.3%) was significantly lower than that of the LDDC (72.7%). The distribution of physical activity showed a significant difference between the groups (p=0.006). The intakes of seeds and nuts of the HDDC were significantly lower than those of the LDDC. Fat and vegetable fat intakes and % fat of energy in the HDDC were significantly lower than those in the LDDC. But, carbohydrate (CHO) and potassium intake and %CHO of energy in the HDDC were significantly higher than those in the LDDC. KDDS and GMVDF showed significant differences between groups (p=0.033; p=0.012). Conclusions: Continuous intervention by specialized nutritionists for long-term selfregulation is needed for diabetic patients, and the high compliance to diabetic diet and increasing physical activity may be effective in the prevention of metabolic syndrome.

Compliance with a massive transfusion protocol (MTP) impacts patient outcome

BackgroundAbout 5% of civilian trauma requires massive transfusion. Protocolized resuscitation with blood products to achieve high plasma:RBC ratio has been advocated to improve survival. Our objectives were to measure compliance to our institutional MTP, to identify quality assurance activities that could improve protocol compliance and to determine if protocol compliance was related to patient outcome. MethodsThe investigators determined 13 compliance criteria based upon our institutional protocol. We measured compliance in 72 consecutive MTP activations between January 2010 and September 2011 at a Level I trauma centre. Data elements were retrospectively retrieved from blood bank, trauma registry and clinical records. Patients were stratified into three groups based on compliance level, and mortality differences were compared. ResultsAverage compliance for the cohort (n=72) was 66%. The most common cause of non-compliance was failure to send a complete haemorrhage panel from the trauma bay (96%). Failure to monitoring blood work every 30min occurred in 89% of cases. Delay in activation and deactivation occurred in 50% and 50% respectively. Non-compliance to protocol-based administration of blood products happened in 47%.The cohort was stratified into three groups based on compliance, A: <60%, B: 60–80% and C: >80% (low, moderate and high compliance groups). There was no statistical significance with regard to median age, median ISS, ED SBP, ED GCS and AIS of the head/spine, chest and abdomen. The mortality rates in each group were 62%, 50% and 10% in the low, moderate and high compliance groups respectively. Mortality differences were compared using adjusted logistic regression. The OR for mortality between Groups A and B=1.1 [95% CI 0.258–4.687 (P=0.899)] while the OR for mortality between Groups C and B=0.02 [95% CI <0.001–0.855 (P=0.041)]. ConclusionsMeasures should be directed towards provider and system factors to improve compliance. In this study, there was an association between survival and higher level of compliance.

Comparison of the peritoneal dialysis treatment outcome and quality of life on end-stage renal disease patients with high and low clinical compliance

Objective To analyze the correlation between clinical compliance and peritoneal dialysis treatment outcome and quality of life on end-stage renal disease patients with high and low clinical compliance. Methods Total of 137 continuous ambulatory peritoneal dialysis (CAPD) patients of end-stage renal disease were collected in second-class hospital in Weifang by convenience sampling, and divided into high and low clinical compliance group(68 patients in each)according to ESA score. SF-36, dropout rate, fatality rate, infection rate and rehospitalization rate were used to estimated, and Cox multi-factor regression model was used to analyze correlation between therapy outcome and risk factors. Results 61 CAPD patients(44.52%) were dropout, with 23 cases (37.70%) by death. The dropout rate without death(11.8%, 44.12%), fatality rate(7.4%, 26.5%) and infection rate(8.8%, 38.2%)had significant difference between high and low clinical compliance group (P<0.05). The SF-36 scores of 8 dimension also had significant difference between the two groups. Cox multi-factor regression model showed that clinical compliance was an important risk factor of therapy outcome and death(HR=1.68, P<0.05). Conclusion Clinical compliance is an important risk factor of therapy outcome, and should be listed as efficacy monitoring index of peritoneal dialysis and the target of improving the curative effect of the intervention. Key words: End-stage renal disease; Peritoneal dialysis; Clinical compliance; Quality of life; Therapy outcome

Comparison of health outcomes according to intervention compliance in male Korean workers with metabolic syndrome

This study examined how achievement of session goals contributes to outcomes of subjects after participation in a 12-week lifestyle intervention program in men with metabolic syndrome (MetS). Thirty office workers with MetS, aged 47.2 ± 6.6 years, participated in this study, from March to July, 2011. The intervention program included face-to-face counseling five times during the 12-week period. Counselors and subjects designed session goals for each round. The average of the goal achievement rate was calculated based on compliance for each round. The subjects were divided into three groups according to their tertiles of achievement rate: Low-compliance group (LC, 70%). Anthropometry, biochemical index, and nutrient intake were examined at baseline and at the end of the 12-week intervention program. After the intervention, diastolic blood pressure (DBP) showed a significant decrease in the LC group, and waist circumference (WC) showed a signifi - cant decrease in the MC group. Systolic blood pressure (SBP), DBP, and low-density lipoprotein cholesterol (LDL) showed a significant decrease in the HI group. Changes in SBP and DBP were significantly lower in the HC group than in the MC group (p < 0.05, p < 0.01). Changes in LDL were significantly lower in the HC group than in the MC group (p < 0.05). Results for intake of total energy, protein, fat, and sodium, as well as rates of carbohydrate and fat intake, showed a significant decrease in all participants (p < 0.05). The change in fiber was significantly higher in the HC group than in the MC group (p < 0.05). The change of fruit serving size showed a significant increase in the HC group (p < 0.01). The number of risk factors for MetS showed a significant decrease in the LC and HC groups (p < 0.05), however, no significant mean differences were observed among the three groups. In conclusion, participation in this interven - tion program resulted in positive effects on risk factors for MetS, nutrient intake, and dietary habits, especially in the High-compliance group. (Korean J Nutr 2013; 46(2): 156 ~ 165)

Factors Influencing Compliance With Early Resuscitation Bundle in the Management of Severe Sepsis and Septic Shock

The Surviving Sepsis Campaign guidelines recommend implementing a 6-h resuscitation bundle, which has been associated with reduced mortality of patients presenting with severe sepsis or septic shock. However, this resuscitation bundle has not yet become a widely implemented treatment protocol. It is still unclear what factors are associated with the rate of compliance with the resuscitation bundle. In this study, we evaluated the potential factors associated with implementation and compliance of a 6-h resuscitation bundle in patients presenting with severe sepsis or septic shock in the emergency department. We conducted a retrospective observational study involving adult patients presenting with severe sepsis or septic shock in the emergency department of a tertiary care hospital during the period between August 2008 and July 2010. The resuscitation bundle consisted of seven interventions according to the Surviving Sepsis Campaign guidelines. The primary outcome measure was the rate of high compliance with the 6-h resuscitation bundle, defined as implementation of more than five of seven interventions. Multivariable logistic regression analysis was used to adjust for the confounding factors. A total of 317 patients were enrolled into the study. One hundred seventy-two patients (54.3%) were assigned to the high compliance group, and 145 patients (45.7%) to the low compliance group. Significant factors associated with high compliance of the 6-h resuscitation bundle were hyperthermia (adjusted odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.10-1.70), care from experienced nurses who had 3 or more years of clinical experience (adjusted OR, 1.69; 95% CI, 1.10-2.58), and care from senior residents or board-certified emergency physicians (adjusted OR, 3.68; 95% CI, 1.68-6.89). Factors related with lower compliance were cryptic shock (adjusted OR, 0.26; 95% CI, 0.13-0.52) and higher serum lactate levels (adjusted OR, 0.90; 95% CI, 0.82-0.98). Furthermore, we found several potential factors that influence compliance with the sepsis resuscitation bundle. To improve the compliance with the resuscitation bundle, interventions focusing on those factors will be needed.

P1-08-12: Hormonal Therapy Compliance and Mortality in Metastatic Breast Cancer.

Abstract Methods: A retrospective analysis was conducted using linked pharmacy claims and cancer registry data from the population-based National Cancer Registry Ireland (NCRI). Women with stage IV breast cancer at initial diagnosis (2004-2006), who received HTx as 1st line treatment for ≥90 days were identified (tamoxifen, toremifene, fulvestrant, anastrozole, letrozole, exemestane). Compliance was calculated over the time that patients remained on HTx i.e. from the date of treatment initiation to the earliest of either HTx discontinuation or end of follow up (31/12/07, 3 years or death). Patients discontinuing HTx were assigned their compliance rate at this time for the remainder of follow-up. In the primary analysis Cox proportional hazard models with late entry at 90 days post HTx initiation and time varying compliance (defined dichotomously as: low &amp;lt; 80%, high ≥ 80%), were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and breast cancer specific mortality. Secondary analyses of (a) time to treatment discontinuation and (b) compliance in the first 90 days of treatment were conducted. All models were adjusted for age, tumor grade, number/site of metastases, estrogen, progesterone and human epidermal growth factor 2 receptor status. Results: 359 women with stage IV breast cancer at diagnosis were identified. Of these, 151 received HTx as 1st line treatment. Median HTx compliance was 84.8%, (range 19.4%-100%; interquartile range 75.5%-100%). Demographic, tumor and treatment characteristics were similar between low (n=51) and high (n=100) compliance groups. The number and distribution of metastatic sites at diagnosis was also similar (low/high compliance: bone only 70.6%/70.0%, lung only 17.6%/18.0%, liver only 11.8%/14.0%, brain only 0.0%/0.0%, other 13.7%/17.0%, multiple sites 15.7%/18.0%). Compliance rates for both compliance groups increased marginally over time. Unadjusted all-cause mortality rates were 143 and 359 deaths/1000 woman years for low and high compliance respectively. Low compliance was associated with a 90% increased risk of all-cause (HR 1.90; 95%CI 1.06, 3.41) and breast cancer specific (HR 1.91; 95%CI 1.03, 3.55) mortality. In the secondary analyses low compliance was associated with a shorter time to HTx discontinuation (HR 1.97; 95%CI 1.01, 3.84). Low compliance within the first 90 days of treatment was associated with non-significantly increased mortality (all-cause HR 1.57; 95%CI 0.88, 2.80; breast cancer specific HR 1.58; 95%CI 0.85, 2.93). Discussion: This study demonstrates, for the first time to our knowledge, a significant association between low HTx compliance and increased mortality in patients with MBC. In addition, the observed association between compliance and treatment duration is consistent with a reduced time to disease progression in low compliance patients. The findings do not appear to be related to either the burden of metastatic disease at diagnosis or to increasing disease severity causing lower compliance over time. These results suggest that the development and evaluation of effective interventions to support HTx compliance in patients with MBC is warranted. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-12.

Effect of medication compliance of primary open angle glaucoma （POAG） patients by retinal nerve fiber layer thickness acquired by stratus

Objective To investigate the affect of medication compliance on retinal nerve fiber layer thickness acquired by stratus OCT in primary open angle glaueoma （POAG） patients. Methods 100 eyes of 53 POAG outpatients from 2007 to 2010 were recruited in outpatient service. All the patients were sorted into 2 groups according to their medication compliance： high medication compliance （group A） and low medication compliance （group B）. Both global and retinal nerve fiber layer （RNFL） thickness in the four quadrants （superior, inferior, nasal and temporal） were detected by OCT in both groups during 1 year follow-up and the changes were statistically analyzed. Results The changing value of RNFL thickness in global average and in the four quadrants （ superior, inferior, nasal and temporal） is （ 3.13 ± 6.64） μm, （ - 4.7 ± 12.95 ）μm, （ -2.54±9.75）μm, （ -3.28 ±14.86） μm, （ - 1.84 ± 11.94） μm in group A, and （7.74 ± 8.14） μm, （15.82±22.10）μm, （4.94±13.96）μm, （8.42±13.64）μm, （ 4. 38 ±19. 63 ）μm in group B. The data presented striking difference between group A and group B in average, in the superior and in the nasal （ t = 7.32, 5. 663, 4. 10 ; P 〈 0. 001 ）, as while as in the inferior （ t = 3. 105, P 〈 0. 05 ）, while not showed statistical difference in the temporal （ t = 1. 914, P 〉0. 05 ）. Conclusions OCT was a test method with objective, specific, sensitive and quantitative characteristics. OCT can be used to evaluate the medication compliance of POAG patient which facilitate monitoring RNFL lesion. Key words: Primary open angle glaucoma; Retina; Retinal nerve fiber layer; Medication compliance; Optical coherence tomography

Following cancer prevention guidelines may lower risk of death from all causes

Nonsmokers who followed cancer prevention guidelines lowered their risk of death from cancer, cardiovascular disease, and all causes, according to a study of more than 100,000 men and women that was conducted over 14 years. The study, led by Marjorie McCullough, ScD, of the ACS, was published in Cancer Epidemiology, Biomarkers & Prevention.1 Few studies to date have examined the impact of following prevention guidelines on all 3 causes of death, and the majority of those previously conducted used tobacco avoidance as one of the recommendations; however, because 8 in 10 Americans are never or former smokers, investigators wanted to better understand the effect of following other recommendations. McCullough and colleagues used results from diet and lifestyle questionnaires completed in 1992 and 1993 by 111,966 nonsmoking men and women in the Cancer Prevention Study II Nutrition Cohort. They were scored on a scale ranging from 0 to 8 in terms of adherence to all recommendations. After 14 years, men with high compliance scores (7 or 8) had a 42% lower risk of death compared with those with low scores (0-2). The risk of death from cardiovascular disease was 48% lower among men and 58% lower among women in the high-compliance group, whereas the risk of cancer death was 30% lower in high-compliance men and 24% lower in high-compliance women. Similar, although not statistically significant, associations were observed for never and former smokers. As a result, researchers summarized that adhering to cancer prevention guidelines for obesity, diet, physical activity, and alcohol consumption is associated with a lower risk of death from cancer, cardiovascular disease, and all causes in nonsmokers and may substantially lower the risk of premature mortality in older adults. Correction In the August 1, 2011 issue of “CancerScope,” Jill O'Donnell- Tormey, PhD, was incorrectly identified as the executive director of the Cancer Vaccine Acceleration Fund. She is the executive director of the Cancer Research Institute

Consumers’ Motivations for Consumption of Foreign Products: An Empirical Test in the People’s Republic of China

This study seeks to examine the purchasing motives of young Chinese consumers for foreign products in the People’s Republic of China. Specifically, it offers empirical results of young Chinese consumers’ perceptions of brand prestige, brand quality, and brand value as motives for purchasing foreign products. To collect data, a convenience sample of 400 respondents was recruited across four major campuses in a large, major university in Zhejiang, China. Surveys were administrated using personal interviews to ensure quality of data collection. The empirical evidence provides insights into the impact of product category (conspicuous versus inconspicuous products) on consumers’ susceptibility to social influence (high versus low social compliance groups). The results of the analysis are reported, the implications for marketing communications on consumer acceptance for foreign brands are discussed, and suggestions for future research are derived.

Patients' experiences of homework tasks in cognitive behavioural therapy for psychosis: a qualitative analysis

AbstractThis paper examines the experiences of individuals who agreed to undertake homework as part of cognitive behavioural therapy for psychosis. It attempts to identify factors that individuals believe influence homework compliance and thereby alert therapists to their possible impact, and, using grounded theory, dispel the myth that individuals with psychosis cannot meaningfully express their experiences and views. Ten participants, who either did (six) or did not (four) comply with homework were interviewed and a grounded theory approach was used to understand and generate theories relating to their completion of homework assignments. The factors cited as affecting homework compliance were motivation, recall of the assignment, difficulty, putting off, understanding of the rationale, perceived benefits, insight, effort and relevance. The most cited theme was insight, with four of the high compliance group accounting for 21 references and three of the low compliance group accounting for nine references. However, the high compliance group gained insight into problem development, maintenance and the use of effective strategies to realize goals whereas the low compliance group gained only an identification of their problems and an understanding of their development. Three participants in the low compliance group believed that their assignments were sometimes irrelevant to their needs but this was true of only one out of the six in the high compliance group. Further research into assessing and addressing non‐acceptance of treatment rationale may be indicated. Copyright © 2002 John Wiley &amp; Sons, Ltd.