High Compliance Rates Research Articles

Implementation and Effectiveness of Opioid Prescribing Guidelines After Hiatal Hernia Repair

IntroductionWe defined institutional opioid prescribing patterns, established prescribing guidelines, and evaluated the adherence to and effectiveness of these guidelines in association with opioid prescribing after hiatal hernia repair (HHR). MethodsA retrospective chart review was completed for patients who underwent transthoracic (open) or laparoscopic HHR between January and December 2016. Patient-reported opioid use after surgery was used to establish prescribing recommendations. Guideline efficacy was then evaluated among patients undergoing HHR after implementation (August 2018 to June 2019). Data are reported in oral morphine equivalents (OMEs). ResultsThe initial cohort included n = 87 patients (35 open; 52 laparoscopic) with a 68% survey response rate. For open repair, median prescription size was 338 mg OME (interquartile range [IQR] 250-420) with patient-reported use of 215 mg OME (IQR 78-308) (P = 0.002). Similarly, median prescription size was 270 mg OME (IQR 200-319) with patient-reported use of 100 mg OME (IQR 4-239) (P < 0.001) for laparoscopic repair. Opioid prescribing guidelines were defined as the 66th percentile of patient-reported opioid use. Postguideline implementation cohort included n = 108 patients (36 open; 72 laparoscopic). Median prescription amount decreased by 54% for open and 43% laparoscopic repair, with no detectable change in the overall refill rate after guideline implementation. Patient education, opioid storage, and disposal practices were also characterized. ConclusionsEvidence-based opioid prescribing guidelines can be successfully implemented for open and laparoscopic HHR with a high rate of compliance and without an associated increase in opioid refills.

Prevalence and Predictors of Remission and Sustained Remission in Patients with Rheumatoid Arthritis from the United Arab Emirates: A Two-Year Prospective Study.

To estimate the prevalence of remission and sustained remission for more than 12 months in a cohort of patients with rheumatoid arthritis in the United Arab Emirates and explore predictors of remission and sustained remission in these patients. A two-year prospective study conducted in Dubai Hospital (January 1, 2018-December 31, 2019) included all consecutive patients with rheumatoid arthritis attending the rheumatology clinic. Patients with a Simplified Disease Activity Index ≤3.3 and/or Clinical Disease Activity Index ≤2.8 in December 2018 were considered in remission and followed until December 2019. Those who maintained remission through 2019 were considered in sustained remission. In this study, a total of 444 patients were followed for a 12-months period. The percentage of remission achieved in RA patients was 30.4% according to the Clinical Disease Activity Index, 31.1% according to Simplified Disease Activity Index, and 50.9% according to the Value of Disease Activity Score 28 (DAS28) remission criteria. The 12-months sustained remission rates ranged from 38.3% for the ACR-EULAR to 69.3% for the DAS28. Male gender, shorter disease duration, better functioning as evaluated by the Health Assessment Questionnaire Disability Index (lower HAQ scores), and higher compliance rates are among sustained remission predictors. Establishing "real-world" data and understanding local predictors to sustained remission is principal for implementing timely and appropriate patient-tailored strategies. These strategies include early detection, close monitoring, and enhancing treatment adherence among UAE patients.

Failure to Receive Specialty Concussion Care in Pediatric Patients (S28.002)

<h3>Objective:</h3> To identify and present risk factors for failure to follow-up with specialized concussion management in the pediatric population. <h3>Background:</h3> Analysis of subgroups with specific medical management needs, such as the pediatric population, provides important insights regarding the care of at-risk populations. We seek to add to the literature offering fuller understanding of the factors associated with modifiable differences in concussion management. <h3>Design/Methods:</h3> Using retrospective chart review from a dedicated work queue in the electronic medical record, analysis of 414 pediatric patients referred to the specialty concussion program at a large health system from 2019 through 2022 is underway. <h3>Results:</h3> Preliminary data indicates that more than 50% of patients were female, more than 50% of patients were between 15 and 17 years old. Fewer than 43% of patients receive the recommended evaluation and treatment. Risk factors for not accepting an appointment include living in a rural suburb and being referred from emergency services. Patients referred for specialty care who do not live geographically near a neurologist are more likely to accept specialty care. <h3>Conclusions:</h3> Our data suggests that the pediatric population mirrors certain socioeconomic disparities seen in literature and in the adult population in this concussion management network. Analysis implies that adherence to treatment for sport-related concussion and other mechanisms of injury follows stated socioeconomic and geographic lines. The high rate of compliance for very rural populations suggests that these populations would likely benefit from opportunities for more immediate care to prevent sequelae. There are opportunities to further reach special populations who would expressly benefit from early and consistent specialized concussion care. Ongoing research should emphasize the inequities in specialized neurological care and identify opportunities to provide excellent care to all children. <b>Disclosure:</b> Dr. Davidow has nothing to disclose. Ms. Singh has nothing to disclose. Mr. Neri has nothing to disclose. Paige Buddenhagen has nothing to disclose. Dr. Essad has nothing to disclose.

Quantification of Serum Metabolites in Early Colorectal Adenomas Using Isobaric Labeling Mass Spectrometry.

A major challenge in reducing the death rate of colorectal cancer is to screen patients using low-invasive testing. A blood test shows a high compliance rate with reduced invasiveness. In this work, a multiplex isobaric tag labeling strategy coupled with mass spectrometry is adopted to relatively quantify primary and secondary amine-containing metabolites in serum for the discovery of metabolite level changes of colorectal cancer. Serum samples from patients at different risk statuses and colorectal cancer growth statuses are studied. Metabolite identification is based on accurate mass matching and/or retention time of labeled metabolite standards. We quantify 40 metabolites across all the serum samples, including 18 metabolites validated with standards. We find significantly decreased levels of threonine and asparagine in the patients with growing adenomas or high-risk adenomas (p < 0.05). Glutamine levels decrease in patients with adenomas of unknown growth status or high-risk adenomas. In contrast, arginine levels are elevated in patients with low-risk adenoma. Receiver operating characteristic analysis shows high sensitivity and specificity of these metabolites for detecting growing adenomas. Based on these results, we conclude that a few metabolites identified here might contribute to distinguishing colorectal patients with growing adenomas from normal individuals and patients with unknown growth status of adenomas.

A study to assess the Nurses knowledge &amp; compliance to the protocol of adequate bowel preparation for colonoscopy

Introduction: Cleansing the colon before a colonoscopy is called bowel preparation, or “prep.” It involves taking medication that causes frequent, loose bowel movements to empty the colon. The medication is taken by mouth and typically comes in liquid form. Bowel cleansing is one of the most important parameters included in the evaluation of colonoscopy quality. The available evidence suggests that inadequate bowel preparation reduces the diagnostic yield of colorectal neoplasia and increases post-colonoscopy colorectal cancer risk. Nowadays, up to 30% of patients referred for colonoscopy have poor bowel cleansing. Recently, several studies have analyzed the risk factors for inadequate bowel cleansing as well as the strategies to optimize bowel preparation. Poor bowel preparation has been shown to be associated with low lower-quality dilators of colonoscopy performance. Patients with Personal History of Inadequate Bowel Preparation, Diabetes Mellitus, Chronic Constipation, and a History of Colorectal Resection are at risk of inadequate bowel preparation for colonoscopy. Methodology: In November 2022, there was an increase in consultant complaints about inadequate Bowel preparation for the patient in the ward &amp; ICU which impacted on proper diagnosis of the actual reason the patient took admitted at Apollo Hospitals, Bhubaneswar. So on basis of the complaints, a quasi-experimental group pre-test was conducted &amp; found the less compliance. To look forward to checking the compliances, training &amp; educational materials were prepared on basis of protocol of adequate bowel preparation for colonoscopy (education materials contained agents, methods (single/split) of preparation, dietary patterns, stool consistency assessment) &amp; started implement from December 2022 onwards in both one to one &amp; group teaching. And by end of February 2023, a post-test was conducted to assess the improvement of knowledge of Nurses. To collect the data of their practices on adequate bowel preparation a structured PIP (performance Improvement Project) tool was used &amp; total sample took 100 assigned Register Nurses who all were assigned the In-patients for Colonoscopy. Results: With constant reinforcement, educational materials on adequate Bowel preparation of Colonoscopy &amp; knowledge assessment of assigned nurses made an impact on the effective intervention in adequate Bowel preparation. The impact of compliance to assess the knowledge &amp; interventions of nurses in adherence to the protocol of Adequate Bowel preparation for colonoscopy. The knowledge of Nurses found less compliance in the Pre-Test which was conducted after consultant’s complaints in the month of November 2022 with 55.83% &amp; then after training &amp; educational materials were prepared on basis of protocol of adequate bowel preparation for colonoscopy {education materials contained agents, methods (single/split) of preparation, dietary patterns, stool consistency assessment)} &amp; started implement from December 2022 onwards in both one to one &amp; group teaching. And by end of February 2023, a post-test was conducted to assess the improvement of knowledge of Nurses &amp; found compliance percentage of 78.33%. And Compliance with adherence to the proper method of Bowel Preparation Protocol found compliances month on month, in December 2022 it was 30.29%, in January 2023 it improves to 55.26% &amp; reaches with compliances of 78.94% by the end of February 2023. Conclusion: In patients under the care of nurses who underwent enhanced education on bowel preparation had significantly better bowel preparation quality and higher compliance rates than those in inpatients of the control group. Nurses’ education was identified as an independent risk factor for bowel preparation quality. To make bowel preparation adequate &amp; sufficient frequent updating on knowledge of the recruited nurses need to be done on regular basis.

Revenue Leakages and Economic Growth in Nigeria: The Place of Forensic Accounting

In this study, the effect of revenue leaks on Nigeria's economic growth from 2011 to 2021 was examined. This was done in accordance with the metrics of Oil Revenue Leakage, Non-oil Revenue Leakage, and Total Revenue Leakage, as well as their effects on Nigeria's economy as measured by Real Gross Domestic Product. The World Bank Statistical Bulletin, the American National Bureau of Statistics and the websites of the Central Bank of Nigeria and the Federal Inland Revenue Service were used to create data for the years 2011–2021. The dataset for regression was defined using descriptive statistics, and the stationarity of the data was tested using the unit root method. Correlation analysis and a multiple regression analysis were employed to see how closely the independent variables moved in tandem with the relevant dependent variable. Findings revealed that non-oil revenue leakage had a beneficial impact on economic growth while oil revenue leakage had a negative impact but was not statistically significant. Accordingly, the study's findings on the connection between Nigeria's GDP growth and revenue leaks were inconclusive. The report suggests that to promote a high rate of tax compliance and reduce the twin problems of tax evasion and avoidance to a tolerable level, the government should generate job opportunities for everyone through the smart use of tax resources.

Improving Tax Compliance Risk Management of Large Businesses in Vietnam

Tax compliance risk management is a modern management method to improve the compliance of taxpayers in general and large enterprises in particular. Over the past 10 years, tax compliance of large enterprises has become a significantly concerned issue of policymakers and tax administrators over the world. Due to the goal of profit maximization, the complex nature of business operations and spread across many regions and countries, large enterprises, especially multinational corporations, are at the high risk rate of tax compliance. The article uses a set of compliance risk assessment criteria of enterprises and secondary data from 556 large enterprises in Vietnam to assess the level of risk, classified by economic sector and type of business. The results show that the foreign-invested economic sector and the type of limited liability company with 2 or more members have the highest level of compliance risk while the state sector and the 100% State owned enterprises have the lowest risk. Therefore, it recommends that improving tax compliance and reforming tax incentive policies, especially for FDI enterprises are of necessity.

Activists in international courts: Backlash, funding, and strategy in international legal mobilization

Activists in international courts: Backlash, funding, and strategy in international legal mobilization

Quality performance indicator compliance for the treatment of gastric adenocarcinoma.

Quality performance indicators (QPI) are objective measurements of aspects of patient care that affect clinical outcome. This study investigates the compliance rate to published QPIs of gastric adenocarcinoma (GA) management, in a single institution, to determine areas of strong performance and those requiring improvement. All patients with GA treated from 2010 to 2015, and 2020 to 2021 were included. Electronic data in the form of clinic letters, operation notes, and histology and radiology reports were reviewed with ethics approval. QPI adherence was collected in binary form. QPIs with high compliance rate include preoperative radiological staging and histological diagnosis, subspecialty surgeon training and pathology report documentation. QPIs with low compliance include perioperative chemotherapy (31.6%), postoperative radiological surveillance (32.5%) and minimally invasive approaches to surgical resection (12.5%). QPIs from the systematic review are variably implemented in clinical practice, thus informing on their relevance to real world clinical practice whilst also identifying the areas requiring focus for improvement.

Pengetahuan dan Kepatuhan Minum Obat Antidiabetik pada Pasien Diabetes Melitus Tipe II

This study aims to determine the relationship between patient knowledge about diabetes mellitus and adherence to taking antidiabetic medication. The method used in this research is quantitative non-experimental with a cross-sectional approach. The results showed that most respondents had a low knowledge of 77.1% and a high compliance rate of 47.9%. Based on the Spearman Rank correlation test, the correlation coefficient value was 0.354*. In conclusion, there is a significant relationship between the level of knowledge of diabetes mellitus and adherence to taking antidiabetic medication.&#x0D; &#x0D; Keywords: Diabetes Mellitus; Medication Compliance, Knowledge

GLP-1 receptor agonists for the treatment of obesity: Role as a promising approach.

Obesity is a complex disease characterized by excessive fat accumulation which is caused by genetic, environmental and other factors. In recent years, there has been an increase in the morbidity, disability rate,and mortality due to obesity, making it great threat to people's health and lives, and increasing public health care expenses. Evidence from previous studies show that weight loss can significantly reduce the risk of obesity-related complications and chronic diseases. Diet control, moderate exercise, behavior modification programs, bariatric surgery and prescription drug treatment are the major interventions used to help people lose weight. Among them, anti-obesity drugs have high compliance rates and cause noticeable short-term effects in reducing obese levels. However, given the safety or effectiveness concerns of anti-obesity drugs, many of the currently used drugs have limited clinical use. Glucagon-like peptide-1 receptor (GLP-1R) agonists are a group of drugs that targets incretin hormone action, and its receptors are widely distributed in nerves, islets, heart, lung, skin, and other organs. Several animal experiments and clinical trials have demonstrated that GLP-1R agonists are more effective in treating or preventing obesity. Therefore, GLP-1R agonists are promising agents for the treatment of obese individuals. This review describes evidence from previous research on the effects of GLP-1R agonists on obesity. We anticipate that this review will generate data that will help biomedical researchers or clinical workers develop obesity treatments based on GLP-1R agonists.

When do tax amnesties work?

Tax amnesties can raise short-term revenues but reduce long-term compliance by creating expectations of future amnesties and reducing tax morale. This paper uses a laboratory experiment in Bolivia to investigate the impact of a change in the duration of amnesties and other previously unexamined amnesty modalities. The experiment examines the behavior of 338 professional workers in order to compare tax compliance, debt payment, and revenues during and post-amnesty under four different amnesty rules: (1) a one-shot unannounced amnesty (one period in the middle of a 25-period game), (2) an extended amnesty (three periods in the middle of a 25-period game), (3) a change in the audit probability rule after an extended amnesty, and (4) deductions on tax debt for paying in the first or second rounds of the extended amnesty. Increasing amnesty’s duration reduces tax compliance and cannot outperform one-shot amnesty’s total revenues. Extended amnesties with debt deductions increase total tax compliance compared to extended amnesties without debt deductions with no effects on revenues. Effects on compliance come primarily from individuals with previously high compliance rates. Any kind of amnesty mostly unmotivates individuals with low compliance rates, thus impacting amnesties’ capability to raise revenues in the long term.

PREHABILITATION THROUGH A MOBILE APPLICATION (PREHAPP) IN MAJOR COLON CANCER SURGERY

Abstract Introduction Prehabilitation aims to optimise functional capacity before surgery. We present the prehabilitation programme through a mobile app (PREHapp). Methods Patients with resectable colon cancer, ≥18 years old, without comorbidities and with Android Smartphones are selected. The following programme is proposed through PREHapp during the 4 week pre- and postoperative period. Depending on the results of the 6-minute test and the initial ergospirometry, the programme would be individualised with different objectives. The app allows the patient to record their activities and synchronises with a website designed for the surgeon through which he/she can monitor compliance. Results The impact of prehabilitation on outcomes depended on compliance. Studies show that high compliance rates in ERAS programmes are associated with fewer postoperative complications. In this aspect, telemedicine could have great potential, as it has enabled the design of new health programmes that improve accessibility, including the creation of apps. The use of these apps favours therapeutic compliance and patient education, which enhances their empowerment in disease management. Conclusions There are few studies on the use of telemedicine in the field of prehabilitation. The PREHapp application could improve compliance and thus improve functional capacity before surgery.

Perceptions of Teamwork and Knowledge Attitudes of Hemodialysis Unit Nurses on Infection Prevention.

The Nurses of Hemodialysis Units: it is necessary to face HAIs (hospital-acquired infections) as a "well-tuned" teamwork. The aim of this study was to investigate the perceptions of the teamwork as well as the knowledge attitudes of the nurses of hemodialysis units on infection prevention in Greece. A cross-sectional survey was conducted with a sample of 1018 HCWs (health care workers) of hemodialysis units in Greece. The questionnaires used were: Teamwork Perceptions Questionnaire (T-TPQ) TeamSTEPPS®-Instructor Manual, and questionnaire APPENDIX A. The majority of them were nurses (69.45%) and nurse assistants (23.87%). About teamwork perceptions per factor, we observed uniformity in their responses with very high rates of agreement. The attitudes of nurses of hemodialysis units on the prevention of infections were distinguished in particularly high rates of compliance with a high perception of the risk of transmission of infections with better compliance being that of women. Also, women seem to be more knowledgeable about diseases that mostly affect the pediatric population. It seemed that level of knowledge between the two sexes did not differ regarding HBV (63.16% vs. 66.71%, p=0.430), HCV (63.91% vs. 66.71%, p=0.553), HIV infection (78.95% vs. 81.76%, p=0.471), and influenza (55.64% vs. 59.61%, p=0.394). This study highlighted for the first time the high level of perceptions of teamwork of the HCWs of the hemodialysis units in Greece. It is recommended to investigate the correct application of prevention measures and to detect the causes of deviation from good practices with subsequent investigations on hemodialysis units of Greece.

Comparison of oral iron replacement formulations for anemia in pregnancies with non-severe hemoglobinopathies

Non-severe hemoglobinopathies (H) in pregnancy often predispose patients to development of anemia requiring increased iron requirements. While ferrous sulfate remains a commonly chosen preparation, there remains uncertainty. This study sought to determine which iron formulation proved most effective for pregnant patients with non-severe hemoglobinopathies. We conducted a multi-center, prospective observational study from 7/2021 to 7/2022 and included all pregnant women with H diagnosed with anemia requiring iron supplementation between 24 0/7 through 36 6/7 weeks-gestation. Patients with any H were together compared with a control group of otherwise uncomplicated pregnancies. Iron formulations of twice-daily PO ferrous sulfate 325mg, ferrous gluconate 324mg, and ferrous bisglycinate 28mg were included as covariates. Medication choice was determined by physician preference, with supplementation being initiated uniformly in patients with hemoglobin < 10.0 g/dL or symptomatic. The primary outcomes included refractory anemia requiring either IV iron or blood transfusion, as a discrete event, and treatment effectiveness defined as an increase of at least 1.0 g/dL over a 2-3 week period. The study included 313 patients diagnosed with anemia requiring supplementation, with 151 patients with H pregnancies. Overall, patients who were given ferrous bisglycinate had higher rates of compliance (98% versus 74%, p = 0.02) and treatment effectiveness (81.3% v. 68.4%, p=0.04). Among H patients, patients taking ferrous sulfate had higher rates of needing IV supplementation (17.3% versus 8.5%, p = < 0.001). Among uncomplicated pregnancies, patients taking ferrous gluconate had higher compliance rates (p = 0.01), and ferrous bisglycinate having a higher rate of treatment effectiveness (p = 0.003). When adjusting for confounding factors these differences remained significant. Alternative formulations of iron supplementation such as ferrous gluconate or ferrous bisglycine may be more effective options in managing anemia in both uncomplicated and H pregnancies.

Usability of a wearable device for home-based upper limb telerehabilitation in persons with stroke: A mixed-methods study.

The use of wearable technology offers a promising home-based self-directed option for upper limb training. Although product usability is a crucial aspect of users' acceptance of a wearable device, usability studies in wearable devices are rare, with most studies focusing primarily on clinical validity. This study aimed to explore the usability of a wristwatch device called "Smart reminder" for home-based upper limb telerehabilitation for persons with stroke. Eleven stroke participants used the proposed wristwatch for at least two weeks and underwent a home-based telerehabilitation program. A mixed-methods design was used to explore the usability of the wristwatch. Quantitative data were collected through the System Usability Scale (SUS) questionnaire, and the participants' rate of therapy compliance (gathered from the device) was reported descriptively. In addition, qualitative data were collected through semi-structured interviews with the participants and were analyzed using thematic analysis. The results demonstrated that the usability of the proposed wristwatch and telerehabilitation system was rated highly by the participants, with a high SUS mean score of 84.3 (12.3) and high therapy compliance rate (mean = 91%). Qualitatively, all participants reported positive experiences with the wristwatch and indicated keenness to use it again. Participants reported physical improvements and felt motivated to exercise after using the wristwatch. They found the device easy and convenient and appreciated the remote monitoring function. Meanwhile, they highlighted critical considerations for the design of the device and program, including technical support, a wearable design of the device, graded exercise content according to ability, and flexibility in exercise schedules. Finally, they suggested that an interim review with the therapist on their progress might help them continue using the wristwatch. This study's results supported the proposed wearable device's usability and showed strong acceptance by the participants for using it as a home-based upper limb telerehabilitation intervention.

Off-label Use of ADO II® in the Closure of Various Congenital Heart Defects

Devices may be used for special purposes different than their production purpose. For instance, Amplatzer Ductal Occluder is actually designed for duct closure and its usage for closing defects other than ductus is named as off-label. The aim of this study is to emphasize off-label use of device: not only for PDA and VSD but also for other various defects. This study is designed retrospectively, performed by the evaluation catheterization records of patients in whom ADO II and ADO II-AS devices were used in Erciyes University Medical Faculty Children Hospital, Pediatric Cardiology Department between 2011 and 2018. Patients’ demographic criteria: age, weight at the time of procedure was gathered. The diagnosis, size of device, follow-up period and complications were also noted. From April 2011 to March 2018, a total of 121 patients underwent transcatheter closure by ADO II and 66 patients by ADO II AS. The number of PDA closure with ADO II was 48; with ADO II AS were 62. Rest of the procedures were all off-label. Types of off-label procedures performed were: VSD closure, residual mitral cleft closure, Aorta-Right atrium tunnel closure, pulmonary arteriovenous fistula occlusion, aorta-pulmonary window closure, and occlusion of the artery feeding accessory lobe in scimitar syndrome, Gerbode defect occlusion. Up to our knowledge; this study includes the largest pediatric case series with various different congenital heart defects which were closed with ADO-II. Also our ADO-II occluded VSD case series is one of the largest series in the literature with almost 6 years’ follow-up. We believe in that ADO-II device may be an alternative in percutaneous closure of various rare heart defects. It is used successfully for non-ductal defects with low complication and high compliance rates.

1006. High Adherence and Cost Savings with Home OPAT Provided through Infectious Disease Physician Office Infusion Centers

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be safe and effective for self-administration but can lead to non-adherence without supervision. A physician office infusion center (POIC) with pharmacy services provides a unique opportunity to impact adherence and OPAT management. Patients (pts) typically come to the POIC weekly for catheter care, laboratory collection, medication pick-up and as needed provider visits. Often, close provider oversight allows for de-escalation of OPAT. We evaluated adherence to therapy, visits and associated cost saving in pts receiving self-administered OPAT through POICs. Methods Pts receiving home OPAT in 2021 were randomly selected from participating sites based on annual pt volume. Adherence was assessed as % of OPAT doses dispensed vs. doses missed. Frequency of office visits for routine catheter care and labs along with OPAT completion were collected. Cost savings were calculated in days of OPAT saved due to therapy de-escalation and response to therapy, based upon published daily costs of OPAT. Pt characteristics, OPAT duration, infection type and regimen were captured. Results A total of 125 of 2180 pts from 13 POICs nationally were included (mean age 50±18 years, 52% male). Mean OPAT duration was 38±9 days. Predominant infections were bone and joint (38%), complicated skin (18%), intra-abdominal (15%) and bacteremia (14%). The most common antimicrobials were cephalosporins (54%) with 20 pts self-administering ≥2 drugs. Pts had a mean of 6±3 POIC visits during the therapy course with completion as scheduled in 703/706 visits (99.6%). OPAT was completed as planned in 118 pts (94%), with discontinuations for adverse events (n=3), hospitalization (n=2), or non-adherence (n=2). Overall adherence rate was 99.3% with 51 missed of 7315 doses dispensed. De-escalation during OPAT saved 533 doses equating to 307 days of OPAT (2.4 days/pt). Based on an average daily OPAT cost of $140, this saved $42,980 in the randomized cohort and an estimated $749,571 annually in the entire population. Conclusion Home OPAT through an ID POIC was associated with a very high rate of adherence and compliance to scheduled visits in pts. ID oversight resulted in healthcare cost savings through onsite antimicrobial stewardship and therapy management. Disclosures Lucinda J. Van Anglen, PharmD, Merck &amp; Co.: Grant/Research Support|Paratek: Grant/Research Support.

Efficacy of Tailor-Made Notched Music Training Versus Tinnitus Retraining Therapy in Adults With Chronic Subjective Tinnitus: A Randomized Controlled Clinical Trial.

Chronic subjective tinnitus can have a serious effect on daily life, even causing serious psychological disorders. Currently there are no specific effective solutions or cures. Tailor-made notched music training (TMNMT) is a recently proposed sound therapy that has simpler processes and a higher compliance rate than tinnitus retraining therapy (TRT), a widely used treatment for chronic subjective tinnitus. This study explores the therapeutic effect of TMNMT in comparison to TRT to highlight its clinical value. The study was a randomized controlled, single-blinded clinical trial. One hundred twenty eligible participants were randomly assigned to receive TMNMT (n = 60) or TRT (n = 60) for 3 mo with concurrent follow-up. It should be noted that the duration of sound treatment in TRT was modified to 2 hr per day for better feasibility in practice. The primary outcome was mean change in tinnitus handicap inventory (THI) measured at baseline ( T0 ), 1 mo ( T1 ) and 3 mo ( T2 ) after intervention. Change in visual analog scale (VAS) was measured as a secondary outcome. A comparison of therapeutic effectiveness between TMNMT and TRT was evaluated by repeated measure analysis of variance. One hundred and twelve (93%) of participants took part in the study, of which 64 were men and 48 women. Mean (SD) age was 42.80 (12.91) years. Fifty-eight were allocated to receive TMNMT and 54 to receive TRT. The between-group difference in primary outcome was -6.90 points (95% confidence interval [CI], -13.53 to -0.27) at T1 and -6.17 points (95% CI, -13.04 to 0.71) at T2 . These results closely reached to clinical significance of tinnitus-related effective relief. For the secondary outcome, the mean value in the TMNMT group was 0.83 points (95% CI, 0.12 to 1.54), significantly lower than the mean value of the TRT group. The differences in THI and VAS between the two groups were statistically significant after intervention. Further analysis showed that age and baseline THI and VAS scores were associated with change in THI and VAS scores after interventions. Both TMNMT and TRT were able to alleviate chronic subjective tinnitus effectively after a 3 month intervention. When the two forms of therapy were compared TMNMT appeared to be more effective and consequently potentially superior to TRT for reducing tinnitus loudness and functional and emotional disturbance associated with chronic subjective tinnitus.

A Rejected Hypothesis: Phenomenon of High Treatment Adherence in Direct-to-Consumer Teledermatology Despite Lack of Direct Physician-Patient Interaction.

Background: Adherence to dermatological treatment is described as poor. Empathy and open communication in the physician-patient relationship has been proven to improve adherence. As direct-to-consumer teledermatology enables patients to access dermatological consultations without in-person interactions, we hypothesized treatment adherence in teledermatology to be low. Methods: The objective of the study was to examine treatment adherence in teledermatology. This retrospective cross-sectional study used data from patients treated through a German direct-to-consumer teledermatology platform between July 2021 and April 2022. Additional information was collected through voluntary follow-up questionnaires provided to patients to assess individual treatment success, treatment-related adverse events, and treatment adherence. Results: Data collection included 771 patients; 61.6% (475/771) were women (mean age 35 years). In 46% (355/771), skin disease had been present for <3 months before teleconsultation. Of all patients who answered the follow-up questionnaire (n = 228), 28.5% (65/228) reported treatment-related adverse events, with skin dryness being the most common (56.9%, 37/65). Adverse events resulting in treatment discontinuation were reported in 1.3% (3/228) of all cases. Improvement in skin condition on therapy was described by 75.4% (172/228). In 85.5% (195/228), full treatment adherence was reported. Conclusion: This is the first study worldwide to examine data on treatment adherence in direct-to-consumer-teledermatology. Despite the lack of doctor-patient interaction, the results of our study demonstrate that most patients show high treatment adherence. Possible drivers contributing to high compliance rates could be the high proportion of new-onset skin diseases, the high treatment success of the prescribed therapies, and the low rate of serious adverse events.