High Number Of Pills Research Articles

Pain management in outpatient urologic procedures: A prospective randomized trial of oxycodone versus ketorolac

Objectives: The objectives of the study were to evaluate the efficacy of ketorolac for pain control compared to oxycodone after routine outpatient urologic procedures and to characterize medication overprescription and disposal. Materials and Methods: A prospective randomized trial of 150 adults (75 in the ketorolac arm and 75 in the oxycodone arm) who underwent outpatient urologic procedures over 12 months was performed. Baseline and follow-up pain scores were elicited from 55 of these patients (30 ketorolac patients and 25 oxycodone patients), and improvement in pain scores was calculated. Wilcoxon rank-sum test was used to analyze changes in pain scores within and between groups. Pill disposal methods were also recorded. Results: Pain significantly decreased in both oxycodone (5/10 at baseline and 3/10 at follow-up) and ketorolac (4/10 at baseline and 3/10 at follow-up) groups. No statistically significant differences in pain improvement were found between groups, despite patients in the oxycodone group taking a higher number of pills (one ketorolac pill vs. four oxycodone pills). A large portion of patients in both groups also did not fill their analgesics (14.7% of oxycodone and 38.7% of ketorolac). Patients in the oxycodone group were more likely to keep surplus pills than ketorolac patients (61.3% vs. 38.7%). Conclusion: Ketorolac is a noninferior alternative to oxycodone following outpatient urologic procedures. Patient and physician education is necessary to curtail the indiscriminate prescription, use, and disposal of opioids.

Long-Term Effects of Renal Artery Denervation.

Background and Objectives: Renal artery denervation (RDN) procedure is a broadly discussed method in the treatment of resistant hypertension. Many studies report short-term (3–12 months) results for blood pressure and arterial stiffness. The primary endpoints were changes in 24 h mean systolic blood pressure (BP) and office systolic BP 48 months after RDN. The secondary endpoints were changes in aortic pulse wave velocity and impact of polypharmacy on these variables. Materials and Methods: Renal artery denervation was performed in 73 patients treated for resistant hypertension; 49 patients remained in final analysis. Patient examination was carried out before the procedure, and subsequently at 3, 6, 12, 24, and 48 months later. Patients’ antihypertensive and overall medication regimens were carefully analysed. Results: Mean 24 h arterial blood pressure lowered and was sustained at lower levels for up to 48 months; median (interequartile range—IQR) from 158(23.5)/100(14.2) to 140(26.5)/86(16.2) mmHg. Mean reduction in 24 h ambulatory systolic BP was −11 ± 25 mmHg (95% CI, −20 to −2; p < 0.001), while office systolic BP reduced by −7 ± 23 mmHg (95%CI, −24 to −1; p < 0.02). A significant reduction in median aortic pulse wave velocity 12 months after the procedure (drop from baseline 11.2 [3.15] m/s (95%CI 6.1 to 16.2) to 9.8 [2.1] m/s (95%CI 6.1 to 13.7; p = 0.002)). After 48 months, there was no worsening compared to the baseline level of 10.3 [4.0] m/s (95% CI 6.9 to 17.8) (p > 0.05). The total mean number of antihypertensive drugs remained unchanged: 5.97(±1.1) vs. 5.24 (±1.45). A higher number of pills after 48 months was associated with higher aortic pulse wave velocity (1–5 pill group: 8.1 ± 1.6 m/s; 6–10 pill group: 10.9 ± 1.8 m/s; >11 pill group: 15.1 ± 2.6 m/s) (p = 0.003). Conclusions: Antihypertensive effect after renal denervation lasts up to 48 months with no worsening of arterial stiffness compared to baseline. In our study, polypharmacy was associated with increased arterial stiffness 48 months after the procedure.

Medication adherence among Nigerian patients with rheumatoid arthritis: a two instruments survey

Abstract Objectives Medication adherence is still a significant problem in chronic diseases management and rheumatoid arthritis (RA) is not an exception. There is very little information regarding the level and influencing factors of medication adherence among Nigerian patients with RA. This study evaluated the level and determinants of medication adherence among patients with RA in a Nigerian referral hospital. Methods Using a questionnaire based cross sectional survey, 169 patients with RA were evaluated for their medication adherence using two validated instruments namely; five-item Medication Adherence Report Scale and five-item Compliance Questionnaire for Rheumatology. The two instruments were subjected to descriptive (mean and frequencies) and mean difference (chi-square, t-test, Pearson correlation) analysis, and their reliability (Cronbach alpha) in a Nigerian setting was also established. Key findings The level of non-adherence reported in this study was high and ranged from 48.5% for the CQR to 63.9% for the Medication Adherence Report Scale questionnaires respectively. Being of a male gender, of an older age, the higher number of pills taken, better education and the duration of the disease all significantly contributed to higher adherence measures among these RA patients (P &amp;lt;0.05 for all). Both questionnaires used were correlated and reliable for use among patients with rheumatoid arthritis in Nigeria. Conclusion Findings from this study show that non adherence to medications among RA patients were high and factors such age, gender, education, pill burden could have been responsible.

Patients' perspectives on medication for inflammatory bowel disease: a mixed-method systematic review.

Inflammatory bowel disease (IBD) is a lifelong chronic disease that frequently requires long-term medical treatment to maintain remission. Patient perspectives on IBD medication are important to understand as nonadherence to IBD medication is common. We aim to synthesize the evidence about patients' perspectives on medication for IBD. A mixed-method systematic review was conducted on Scopus, EMBASE, Web of Science, and CINAHL. The convergent integrated approach to synthesis and integration of qualitative and quantitative findings was used for data analysis. Twenty-five articles from 20 countries were included in this review (20 quantitative, 3 qualitative, and 2 mixed-method studies). Patients have identified a lack of knowledge in the areas of efficacy, side effects, and characteristics of medications as key elements. Some negative views on IBD medication may also be present (e.g. the high number of pills and potential side effects). Lack of knowledge about medication for IBD was identified as a common issue for patients. Health services delivery for IBD should take into consideration these patients' perspectives. A focus on improving patient education in these areas could help empower patients and alleviate doubts resulting in better disease management and improved healthcare outcomes.

Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring

We used an electronic monitoring system to quantify adherence to prescribed oral therapies by patients with systemic lupus erythematosus (SLE). Participants were included from a larger longitudinal study cohort of 110 patients recruited from publicly-funded rheumatology clinics, 78 of whom agreed to have their SLE drug therapy electronically monitored for two years with the Medication Events Monitoring System (MEMS®, AARDEX Group). Adherence was determined as the percentage of days (weeks for methotrexate) the patient took the medication as prescribed by the physician. Collected data included SLEDAI; SLICC damage index for SLE (SDI); medical outcome study social support survey (MOS-SSS); Center for Epidemiologic Studies depression scale (CESD); and quality of life (SF-12). Ninety percent of the cohort was female, 45% were Hispanic, and 49% were African-American. Mean age was 36.3 years, disease duration was 5.9 years, SLEDAI score was 3.2, and SDI score was 0.9. Adherence was 62% for all drugs combined and did not differ significantly for individual medications. Patients with more depression (p < 0.02), and higher number of pills taken daily (p < 0.02) were more likely to be non-adherent. Only one-fourth of the patients had an average adherence of ≥80%; these patients had a better mental component score (SF-12) at 24 months than non-adherent patients (p < 0.01). Electronic monitoring demonstrated that only one-fourth of the patients had an adherence rate ≥80%. Polypharmacy and depression were associated with non-adherence.

Balsalazide in treating colonic diseases

Balsalazide is the newer 5-aminosalicylic acid (5-ASA) prodrug which releases active 5-ASA only into the colon with minimal systemic absorption. The onset of action of this drug is variable, and it may take at least some days to reach clinical effectiveness. Clinical studies found balsalazide faster than mesalazine in the induction of remission, but balsalazide has no benefit compared with mesalazine in preventing relapse in the population selected. However, the high number of pills to take may affect the adherence to the treatment. This 5-ASA prodrug may be effectively used also in patients unable to tolerate other mesalamine compounds for non-hypersensitivity reasons. The costs of balsalazide capsules seem to be lower for the health system, both considering total direct healthcare costs and better outcomes, compared with patients treated with oral mesalazine. Finally, there is also some recent evidence that balsalazide may be effectively used, in combination with probiotics, in treating acute uncomplicated diverticulitis is the colon.

Future of HIV-1 Therapy: New Drugs, New Targets and New Strategies

New drugs During the past 2 years several new antiretroviral agents targetting ‘old’ HIV-1 targets have been introduced and are already commercially available, or are at least accessible through expandedaccess programs [1]. Other compounds are in relatively advanced stages of their clinical development; some are totally new compounds, but others are newer formulations or fixed-dose combinations of older drugs. Among the family of protease inhibitors (PIs), atazanavir, fosamprenavir, tipranavir [2] and darunavir [3] and the newer formulations of saquinavir and lopinavir/ritonavir deserve to be mentioned. Atazanavir, unboosted [4] or boosted with ritonavir, is the most lipid-friendly PI and quickly became widely used in initial therapy or to replace more toxic PIs in virologically suppressed patients [5]. Meltrex technology [6] has facilitated a newer formulation of lopinavir/r with a higher dose per pill (daily dose now consists of four pills instead of the six pills required with the older formulations). The new tablets are potentially associated with a better tolerance and, even more importantly, do not require refridgerated storage (this will facilitate for the first time the access to a ritonavir-boosted PI in the developing world). Darunavir/r [3] is a very potent PI with a high genetic barrier; it is reasonably well tolerated and without unexpected interactions or side effects. Its introduction has contributed to a change in the paradigm of salvage therapy. When combined with an optimized background containing at least one additional active drug, the response rate (<50 copies of HIV-1 RNA/ml of plasma at 6 months) may approach 70%. Among the nonnucleoside reverse transcriptase inhibitors (NNRTIs), etravirine (TMC 125) may remain active against viral strains that have selected one resistance mutation to nevirapine or efavirenz [7]. Its activity, in general, decreases when the number of mutations is equal or above two. It is a twice-daily drug, which requires a relatively high number of pills per day; it has been associated with rash but not, at least, with CNS side effects or teratogenicity. Phase III studies with TMC 125 are still ongoing. Finally, rizpivirine (TMC 278) [8], despite still being in the early stages of development, looks very promising. Again, it requires more than one NNRTI mutation to select resistance, it is a once-daily drug but with a lesser number pills and again, at present, has not been associated with CNS side effects or teratogenicity in animal models. Finally, the fixed-dose combinations of abacavir + lamivudine and tenofovir + emtricitabine have became the standard of care backbone regimen for initial antiretroviral therapy [1].

Antiretroviral therapy adherence in Brazil.

This study evaluated the adherence to antiretroviral therapy (ART) in 322 Brazilian outpatient services located in seven states providing care to 87,000 patients (72%) under ART. A previous study classified the 322 health services into four levels of quality of care. Sixty of them were randomly chosen on the basis of these levels. A cross-section of 1972 patients under ART visiting these services was interviewed using a structured questionnaire. Patients who reported taking more than 95% of the prescribed antiretroviral pills in the past 3 days were considered adherent. The chi-square test was first used to compare the prevalence of non-adherence among two or more categories of variables. A chi-square test for linear trend was used for ordinal variables. Three multivariate models were applied using health services predictors, treatment predictors, and personal characteristics predictors. The predictors were fitted into logistic regression models using backward elimination procedures. The adherence prevalence was 75% (95% confidence interval 73.08-76.95). The level of quality of care was not associated with non-adherence. The models showed the following predictors of non-adherence: related to health services: services with 100 patients or less and missed appointments; related to treatment: more complex regimens and a high number of pills; related to personal characteristics: under 2 years of formal education. The adherence prevalence was similar to the rates currently obtained in developed countries. However, services with few patients need to be carefully monitored to maintain high rates. Care planning that prioritizes patients at risk also needs to be improved.

Simpler Regimens May Enhance Adherence to Antiretrovirals in HIV-Infected Patients

Background: Optimal adherence to highly active antiretroviral therapy (HAART) is necessary to achieve the best and the most durable benefit. Many factors may influence compliance to such demanding regimens, and their identification may help in the design of strategies to enhance adherence. Purpose: To assess the factors associated with lower compliance to therapy, the causes of nonadherence, and the relation of nonadherence with virologic response. Method: We performed an observational, cross-sectional study on HIV-infected patients (pts) receiving unrestricted HAART and attending our clinic from January to May 2002. Pts completed a self-administered (ACTG modified) questionnaire on adherence to their therapy. Virologic response was defined as undetectable viral load at the time of interview. A regression model was used to determine predictors of adherence. Results: 597 out of 623 pts (95.8%) completed the survey. Mean age was 38.2 years (range, 18-79). A total of 448 pts (75.0%) were men, 323 (54.1%) were intravenous drug users, 196 (32.8%) were heterosexuals, 76 (12.7%) were men who have sex with men. Mean time on therapy was 49.3 months (range, 4-145). All pts were on stable therapy (>4 months), 173 pts (29%) were on their first HAART regimen, 309 pts (51.7%) were on NNRTI-based regimen, and 288 pts (48.2%) were on a PI-containing treatment. A total of 304 pts (50.9%) were categorized as adherent (p = .024). Multiple logistic regression showed that older age (p = .002), lower number of pills (p = .024), fewer daily doses (p = .002), and shorter time on therapy (p < .001) were factors associated with adherent behavior. Forgetfulness (59.3%), being away from home (50.2%), and problems with schedule (37.6%) were the most frequent causes of nonadherence. Adherent pts were more likely to have undetectable viral load than nonadherent pts (76.5% vs. 55.3%; p < .0001). Conclusion: Younger age, higher number of pills, higher frequency of doses, and longer time on therapy were predictors of nonadherent behavior. Optimal adherence correlated with the best virologic response. Simpler regimens with a lower number of pills and doses may help patients' compliance to therapy.

Simpler Regimens May Enhance Adherence to Antiretrovirals in HIV-Infected Patients

Background: Optimal adherence to highly active antiretroviral therapy (HAART) is necessary to achieve the best and the most durable benefit. Many factors may influence compliance to such demanding regimens, and their identification may help in the design of strategies to enhance adherence. Purpose: To assess the factors associated with lower compliance to therapy, the causes of nonadherence, and the relation of nonadherence with virologic response. Method: We performed an observational, cross-sectional study on HIV-infected patients (pts) receiving unrestricted HAART and attending our clinic from January to May 2002. Pts completed a self-administered (ACTG modified) questionnaire on adherence to their therapy. Virologic response was defined as undetectable viral load at the time of interview. A regression model was used to determine predictors of adherence. Results: 597 out of 623 pts (95.8%) completed the survey. Mean age was 38.2 years (range, 18-79). A total of 448 pts (75.0%) were men, 323 (54.1%) were intravenous drug users, 196 (32.8%) were heterosexuals, 76 (12.7%) were men who have sex with men. Mean time on therapy was 49.3 months (range, 4-145). All pts were on stable therapy (>4 months), 173 pts (29%) were on their first HAART regimen, 309 pts (51.7%) were on NNRTI-based regimen, and 288 pts (48.2%) were on a PI-containing treatment. A total of 304 pts (50.9%) were categorized as adherent (p = .024). Multiple logistic regression showed that older age (p = .002), lower number of pills (p = .024), fewer daily doses (p = .002), and shorter time on therapy (p < .001) were factors associated with adherent behavior. Forgetfulness (59.3%), being away from home (50.2%), and problems with schedule (37.6%) were the most frequent causes of nonadherence. Adherent pts were more likely to have undetectable viral load than nonadherent pts (76.5% vs. 55.3%; p < .0001). Conclusion: Younger age, higher number of pills, higher frequency of doses, and longer time on therapy were predictors of nonadherent behavior. Optimal adherence correlated with the best virologic response. Simpler regimens with a lower number of pills and doses may help patients' compliance to therapy.