Improve Patient Compliance Research Articles

Cost Variation Analysis of Branded Generics Used for Initial Treatment of Type 2 Diabetes, Hypertension and Dyslipidemia in India: A Pharmacoeconomic Perspective

Background: Branded generics are off-patent medications with proprietary names which are bioequivalent to the innovator medications. Cardiovascular diseases, driven by diabetes, hypertension, and dyslipidemia, are major health concerns, where patient compliance is crucial for long-term management. This analysis investigates cost variations of first-line branded generics for these conditions in Indian primary care settings.
 Methods: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia were identified through an online survey of prescribers. Data from 1mg.com, an Indian online pharmacy, was used to compile a list of available brands for each medication. The study compared the prices of the five most prescribed brands, the three lowest-cost and one highest-cost brand per medication, and calculated the percentage cost difference.
 Results: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia in India include Metformin 500mg, Enalapril 5mg, Telmisartan 40mg, Amlodipine 5 mg, and Atorvastatin 20mg. The analysis reveals significant cost disparities among commonly prescribed brands, with Metformin, Enalapril, Telmisartan, and Atorvastatin being notably more expensive (up to 1177%) than lower-cost alternatives, potentially placing a financial burden on patients. Amlodipine, however, exhibits modest cost variation (26-113%), with commonly prescribed brands leaning toward lower-cost options.
 Conclusion: Cost disparities among commonly prescribed brands could harm patient compliance and outcomes, emphasizing the need for cost-effective medication selection. This study offers crucial insights into cost variations in India's treatment of Type 2 Diabetes, Hypertension, and Dyslipidemia, underscoring the importance of cost awareness for improved patient compliance and healthcare system sustainability.

Formulation and evaluation of Glibenclamide loaded Nanosponges

Nanotechnology mediated drug delivery has been reported to enhance the drug efficacy, bioavailability, reduced toxicity and improve patient compliance by targeting the cells and tissues to elicit the desired pharmacological action. The main aim of the study was to formulate Glibenclamide loaded nanosponges and to evaluate them. Glibenclamide loaded nanosponges were prepared by Emulsion solvent diffusion method using different polymers (Ethyl cellulose, β- cyclodextrin, Hydroxy Propyl β- cyclodextrin, Pluronic F68). The FTIR test is conducted as the preliminary test, by this test there was no interaction between the drug and polymers. Then nanosponges were evaluated for particle size, PDI, zeta potential, SEM, entrapment efficiency and invitro drug release. The particle size ranged from 640.7 to 876.2 nm, PDI ranged from 0.456 to 0.707, zeta potential from -17.3 to -34.3 mV and entrapment efficiency was ranged from76.21 to 98.23% The cumulative percentage release from all nanosponges varied from 80.35 to 97.56% after 12 hours depending upon the drug and polymers ratio and F5 formulation showed highest drug release i.e., 97.53%. The release kinetic studies showed that the release first order diffusion controlled and the n value (0.8769) from the Korsmeyer- Peppa’s model indicated the release mechanism was non-fickian type.

Simplified Appliance for Lip Biting Habit—A Case Report

Lip biting habit can cause severe malocclusions and should be intercepted early in age. The lip bumper device is a helpful treatment as it can stop the habit and prevent the resulting malocclusion. Lip biting habit is intercepted by removable or fixed lip bumper. A simplified appliance for lip biting habit that is easy to fabricate and is more accepted and comfortable for the patient was designed. It consists of a thermoplastic sheet with a labial acrylic pad as in a conventional lip bumper appliance. Improved patient compliance was noted with added advantage of ability to maintain better oral hygiene.

The Application of Response Surface Methodology (RSM) In the Computational Optimization of Sustained Release (SR) For Phenothiazine Derivative Matrix Tablet

Introduction: This study explores the use of Response Surface Methodology (RSM), a statistical optimization technique, to optimize the SR properties of prochlorperazine maleate (PCM) matrix tablets. PCM is a phenothiazine derivative used for treating schizophrenia, nausea, and vomiting. Sustained-release formulations offer extended drug delivery, potentially improving patient compliance and reducing side effects. RSM helps identify optimal combinations of critical formulation factors influencing drug release, such as polymer type and concentration, filler type, and drug/polymer ratio. The study likely involves designing experiments based on chosen RSM designs (e.g., Box-Behnken) with varying factor levels. Formulate SR tablets with different factor combinations. Evaluating the drug release profiles of each tablet formulation. Analyzing data using RSM software to build mathematical models relating factors to drug release and identifying optimal factor combinations that maximize desired release characteristics. Objective: The ongoing research purpose to improve the advancement of a sustained release tablet containing Phenothiazine derivative PCM loaded matrix. This is achieved by utilizing DoE as a computational method to statistically validate the formulation. Methodology: Basically two methods involved in the formulation using direct compression; a simple and efficient method where all dry ingredients are blended and directly compressed into tablets. Results: The obtained outcomes closely matched the anticipated values derived from the experimental setup. The enhanced PCM matrix tablets demonstrated a prolonged and uniform discharge of PCM over a span of 6 hours. Conclusion: This study Based on a 23 FD, response surface methodology was used to successfully develop the current research of PCM matrix tablets for sustained release application. The corresponding contour plots and 3D response methodology represent the important variables for the optimisation process.

Opioid and the usage in chronic non cancer pain

The use of opioid in various guidelines for chronic non-cancer pain is controversial because evidence of their long-term benefits is weak. The potential for serious adverse effects and local regulations warrant caution in both prescribers and users. However, opioids have a role in the management of chronic non-cancer pain in carefully selected patients with regular monitoring and as a part of multimodal therapy. Common adverse effects should be treated promptly to improve patient compliance. We believe that opioid therapy at low doses is beneficial in some patients. It should not be denied but carefully considered on a case-by-case basis.

Formulation and Evaluation of Mouth Dissolving Tablet of Biperiden HCL for Treatments of Parkinson’s Disease

Seven formulations were developed using superdisintegrating substances like sodium starch glycolate, crospovidone, and cross-carmellose sodium at different concentrations. Three batches were created by employing varying concentrations of the super disintegration approach, utilizing sodium starch glycolate as the superdisintegrating agent. The batches underwent evaluation regarding sensory characteristics, firmness, breakability, weight consistency, disintegration time in a simulated environment, time is taken for wetting, laboratory tests on drug release within a controlled environment, and assessments of product stability. Fourier transform infrared spectroscopy (FTIR) studies confirmed the absence of drug-excipient interactions. In this examination, mouth-dissolve tablets of biperiden HCL were successfully ready with favorable parameters, including organoleptic properties, hardness (3.2 kg/cm3), friability (0.23%), weight variation (100 mg), disintegration time within a controlled laboratory environment (17 seconds), wetting time (11 seconds), and in-vitro drug release studies (99.80%). The study concluded that the biperiden hydrochloride mouth-dissolving tablet was effectively formulated using the direct compression method, demonstrating improved patient compliance.

Evaluating the pharmacokinetic parameters of a single dose of oral disintegrating tablets in elderly patients with hypertension and hyperlipidemia

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, particularly in underprivileged areas such as Pakistan. Hypertension and hyperlipidemia are major risk factors for CVDs and often require medication for effective management. This study aimed to develop and validate a high-performance liquid chromatography (HPLC) method to assess the bioavailability of orally disintegrating tablets (ODTs) of atenolol and atorvastatin in elderly volunteers with high blood pressure and cholesterol levels by comparing the pharmacokinetic parameters of these ODTs with those of conventional tablet formulations. The study was conducted in Sargodha, Punjab Province, Pakistan, by recruiting 30 male and female elderly volunteers aged 45-65 years and weighing 60-90 kilograms. Each participant was administered a single dose of atenolol (25 mg), atorvastatin (10 mg), or an ODT containing both drugs. Blood samples were collected at specific intervals up to 48 hours postadministration. The concentrations of atenolol, atorvastatin, and the ODTs were measured using HPLC, and various pharmacokinetic parameters, including the area under the curve (AUC), maximum plasma concentration (Cmax), and elimination half-life (t½), were analyzed. The maximum concentration (Cmax) of 10 mg atorvastatin occurred at 4 hours (9.50 ng/mL), while for 25 mg atenolol, it peaked at 4 hours (150.00 ng/mL). The ODTs showed comparable pharmacokinetic profiles, with the Cmax values for atorvastatin and atenolol at 4 hours being 4.00 ng/mL and 165.00 ng/mL, respectively. The elimination half-life (t½) for the ODTs was 4.62 hours for atorvastatin and 4.95 hours for atenolol. The pharmacokinetic analysis indicated that the AUC and Cmax of the ODTs met the bioequivalence criteria, demonstrating absorption and elimination properties similar to those of conventional tablet formulations. The study concluded that the pharmacokinetic parameters of the ODT formulations atenolol and atorvastatin are comparable to those of conventional tablets. ODTs offer a viable and effective alternative for delivering these medications, particularly for patients who have difficulty swallowing pills, thereby potentially improving patient compliance.

Eyedrop delivery of therapeutic proteins with zwitterionic polymers to treat dry age-related macular degeneration

In clinics, therapeutic proteins are commonly used to treat retinal diseases through intraocular injection, the treatment which suffers from rather low patient compliance. Topical administration (e.g. eye-drops) of large molecule drugs remains a major challenge due to the presence of various barriers in the eye. In this study, zwitterion-grafted chitosan (CS-ZW) was developed and then self-assembled with protein therapeutics including adalimumab (ADA) or catalase (CAT) for the treatment of dry age-related macular degeneration (dAMD) via topical eyedrops. Since CS-ZW can cross the mucus layer and open the tight junctions between epithelial cells, their delivered therapeutic proteins can be shuttled across the ocular barriers to reach the diseased site in the fundus. CS-ZW/ADA eyedrops delivering ADA to bind TNF-α in the fundus achieved a similar therapeutic effect to intravitreal ADA injection in a mouse dAMD model. In addition, the therapeutic effect was further improved by combining eyedrop formulations of CS-ZW/ADA and CS-ZW/CAT, the latter of which can clear reactive oxygen species (ROS) in the lesion to further assist dAMD treatment. Our work provides a simple and effective delivery vehicle that can non-invasively treat fundus diseases such as dAMD, showing potential advantages in reducing side effects associated with intraocular injection and improving patient compliance.

Development of Health Promotion with The Design of Heart Failure Patient Monitoring Instrument

Heart disease, particularly heart failure, is a prevalent chronic condition requiring regular monitoring to maintain patients' well-being. This study aims to develop and validate a monitoring instrument for heart failure patients. A pilot study was conducted in two main stages: instrument development and pre-test post-test on a sample of outpatient heart failure patients at RSU Muhammadiyah Ponorogo from March to May 2023. The validity test revealed 17 valid questionnaire items, with Cronbach’s Alpha values for routine examination, physical activity, and nutrition domains being 0.729, 0.829, and 0.786, respectively, indicating good reliability. Sample testing demonstrated a significant improvement in patient compliance (p < 0.005) and nutritional status (p < 0.05) after cardiovascular health promotion. However, there was no significant change in physical activity. With a combination of high construct validity, good reliability, and strong content validity, the questionnaire proved to be a robust and reliable measurement tool. The findings depict significant changes in compliance and nutritional status among heart failure patients following health promotion interventions, emphasizing the need for further focus on physical activity aspects. These results can contribute to the development of more effective monitoring and care strategies for heart failure patients.

Assessing the readability of online information about jones fracture.

Hand in hand with technological advancements, treatment modalities continue to grow. With the turn of the century, the internet has become the number one source of information for almost every topic. Thus, many patients look toward the internet as their primary source of information to learn about their respective medical conditions. The American Medical Association and National Institute of Health strongly recommend that online medical information be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds. To assess the readability of online information regarding Jones fracture. Our hypothesis is that the reading level of medical information published on websites far exceeds the recommended reading level of 6th-8th grade as proposed by the American Medical Associate and National Institute of Health. The result of this study can help us formulate improved recommendations for publishing more comprehensible material and, thus, eventually improve patient compliance and clinical outcomes. The exact phrase "Jones fracture" was queried on the three most common search engines, Google, Yahoo!, and Bing, on December 28, 2022. As of December 2022, Google held 84%, Bing held 9%, and Yahoo! held 2% of the worldwide search engine market share. Web pages uniform resource locator from the first three pages of search results were recorded from each search engine. These web pages were classified according to academic, physician-sponsored, governmental and non-government organizations (NGO), commercial, and unspecified as per formally defined categories. Websites associated with an educational institution or medical organization were classified as academic. Websites with products for sale, corporate sponsorship, or advertisements were classified as commercial. Governmental websites or NGOs comprised those that received government subsidies or grants. Webpages that were independently owned by physicians or physician groups were respectively classed as physician sponsored. The remainder of websites that did not fall under the above categories were classified as unspecified. A total of 93 websites were analyzed for reading assessment. A whopping 44% of websites were commercial, followed by 22% of physician-sponsored websites. Third place belonged to non-government organization websites holding a 15% share. The academic website held a meager 9% portion, while unspecified sites were 3%. The table illustrates mean readability scores, along with average cumulative grade level. The average grade level was 10.95 ± 2.28 for all websites, with a range of 6.18 to 18.90. Since P values were more than 0.05, there was not a significant statistical difference between the first page results and the results of all pages. Thus, we can rationalize that readability scores are consistent throughout all pages of a website. Hand in hand with technological advancements, treatment modalities continue to grow. With the turn of the century, the internet has become the number one source of information for almost every topic. Thus, many patients look towards the internet as the primary source of information to learn about their respective medical conditions. Our study demonstrates that current online medical information regarding Jones fracture is written at an extraordinarily high-grade level, with an average grade level of all websites at 10.95, nearly an 10th-grade educational level. The American Medical Association and National Institute of Health strongly recommend that online medical information should be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds. On the contrary, most of the medical information evaluated was at an 10th-grade level, which far exceeds recommendations by AMA and NIH. This is particularly relevant because readability scores are directly proportional to the level of comprehension attained by readers, thus directly impacting patient outcomes. In conclusion, we suggest and encourage that all online reading materials should be re-written at the 6th to 8th-grade level in a public service effort to increase compliance with treatment goals and raise awareness of preventive measures.

Design, Development and Evaluation of Tetracycline Controlled Release Microspheres

Microsphere drug delivery methods have been used to boost efficacy, reduce toxicity, and improve patient compliance. Additional benefits of using microspheres to deliver medications include controlled drug release, improved bioavailability, and targeted drug delivery to the desired location. In order to achieve the required therapeutic effect, hydroxypropyl methyl cellulose K4M and sodium alginate are used as a polymer in microsphere delivery system and different concentration of aluminium chloride is used as cross linking agent. The advantage of microsphere formulations over traditional tablet or capsule formulations is that they increase the surface area exposed to the absorption site, boosting medication absorption and reducing drug dose frequency. Tetracycline is a broad-spectrum antibiotic that is frequently used to treat illnesses like pneumonia and respiratory tract infections. The encapsulation effectiveness, particle size, in -vitro release analysis and release kinetics of the microsphere formulations was assessed.

Cubosomes as versatile lipid nanocarriers for neurological disorder therapeutics: a comprehensive review.

Cubosomes are novel vesicular drug delivery systems with lipidic liquid crystal nanoparticles formed of predetermined proportions of amphiphilic lipids. They have a honeycomb-like structure and are thermodynamically stable. These bicontinuous lipid layers are separated into two water-based channels internally that can be used by various bioactive substances, including drugs, proteins, and peptides. This complex structure is responsible for its high drug-loading capacity. Cubosomes are thought to be promising vehicles for various routes of administration because of their extraordinary characteristics, including bioadhesion, the capacity to encapsulate hydrophilic, and hydrophobic, as well as amphiphilic substances, high resistance to environmental stress, and their ability to achieve controlled release through modification. One of the essential elements for improving patient compliance is the ability of these well-defined nano-drug delivery systems to boost the effectiveness of targeting while lowering the side effects/toxicities of payloads. The large internal surface area, a sufficiently uncomplicated fabrication procedure, and biodegradability make it an attractive nano lipid carrier for drug delivery. This review outlines the recent advancement of cubosomes for managing various neurological disorders, highlighting their potential in this field.

Review on Spanule A New Method Drug Delivery System

Spensules are considered to be advanced drug delivery systems because they allow for long- term controlled and continuous release of drugs. Such transportation systems can provide a constant plasma concentration over a long period of time, improve treatment results and reduce the risk of side effects. In addition to maintaining release, spansules can also be used to supply multiple drugs in a single form of dosage. Spansule's multi-pharmaceutical capability is also beneficial, allowing multiple drugs to be administered in a single form. This can improve patient compliance with the drug plan, simplify the dose and reduce the risk of drug interaction. This is particularly useful for patients who need several drugs to manage complex diseases. Spansules can be used as a biphasic release system to provide immediate and long-term release of medicines. These systems are helpful for patients who need rapid treatment and long-term maintenance to manage their symptoms. Overall, Spantiles is a multi-faceted and effective drug delivery system, providing patients and health professionals with many advantages.

Cellulosic Textiles-An Appealing Trend for Different Pharmaceutical Applications.

Cellulose, the most abundant biopolymer in nature, is derived from various sources. The production of pharmaceutical textiles based on cellulose represents a growing sector. In medicated textiles, textile and pharmaceutical sciences are integrated to develop new healthcare approaches aiming to improve patient compliance. Through the possibility of cellulose functionalization, pharmaceutical textiles can broaden the applications of cellulose in the biomedical field. This narrative review aims to illustrate both the methods of extraction and preparation of cellulose fibers, with a particular focus on nanocellulose, and diverse pharmaceutical applications like tissue restoration and antimicrobial, antiviral, and wound healing applications. Additionally, the merging between fabricated cellulosic textiles with drugs, metal nanoparticles, and plant-derived and synthetic materials are also illustrated. Moreover, new emerging technologies and the use of smart medicated textiles (3D and 4D cellulosic textiles) are not far from those within the review scope. In each section, the review outlines some of the limitations in the use of cellulose textiles, indicating scientific research that provides significant contributions to overcome them. This review also points out the faced challenges and possible solutions in a trial to present an overview on all issues related to the use of cellulose for the production of pharmaceutical textiles.

Enhancement of antifungal activity and transdermal delivery of 5-flucytosine via tailored spanlastic nanovesicles: statistical optimization, in-vitro characterization, and in-vivo biodistribution study.

Aim and background: This current study aimed to load 5-flucytosine (5-FCY) into spanlastic nanovesicles (SPLNs) to make the drug more efficient as an antifungal and also to load the 5-FCY into a hydrogel that would allow for enhanced transdermal permeation and improved patient compliance. Methods: The preparation of 5-FCY-SPLNs was optimized by using a central composite design that considered Span 60 (X1) and the edge activator Tween 80 (X2) as process variables in achieving the desired particle size and entrapment efficiency. A formulation containing 295.79mg of Span 60 and 120.00mg of Tween 80 was found to meet the prerequisites of the desirability method. The optimized 5-FCY-SPLN formulation was further formulated into a spanlastics gel (SPG) so that the 5-FCY-SPLNs could be delivered topically and characterized in terms of various parameters. Results: As required, the SPG had the desired elasticity, which can be credited to the physical characteristics of SPLNs. An ex-vivo permeation study showed that the greatest amount of 5-FCY penetrated per unit area (Q) (mg/cm2) over time and the average flux (J) (mg/cm2/h) was at the end of 24h. Drug release studies showed that the drug continued to be released until the end of 24h and that the pattern was correlated with an ex-vivo permeation and distribution study. The biodistribution study showed that the 99mTc-labeled SFG that permeated the skin had a steadier release pattern, a longer duration of circulation with pulsatile behavior in the blood, and higher levels in the bloodstream than the oral 99mTc-SPNLs. Therefore, a 5-FCY transdermal hydrogel could possibly be a long-acting formula for maintenance treatment that could be given in smaller doses and less often than the oral formula.

Experience of Conducting a Group Patient Education Program at a Tertiary Hospital in Riyadh

Introduction: Patient education plays an essential role in improving patient compliance with treatment. Therefore, the study aimed to assess the healthcare educators’ and the patients’ and their companions’ satisfaction and experience with regard to the health education program conducted during their waiting period in the outpatient department (OPD) at King Fahad Medical City. Moreover, compliance with planned educational topics was also assessed. Methods: A pre-post interventional study, including patients and their companions as well as health educators in the waiting rooms of the various OPDs, was conducted. The pre-intervention phase involved group teaching sessions, followed by a survey that assessed patient and educator satisfaction and experience as well as compliance rate. Then, a loophole identification survey was conducted to determine the drawbacks based on which group teaching procedure was modified. Post-intervention, a modified teaching session was completed. Results: A total of 4,362 patients and their companions participated in this study, along with 22 health educators. During the pre-intervention phase, the patient and their companions reported a 78% satisfaction rate for the conducted patient and family educational activities. While, after improving the group teaching process, the satisfaction rates increased to 90% in the post-intervention phase. The health educators’ satisfaction rate improved remarkably from 27.3% to 86.4%. Discussion/Conclusion: By incorporating simple modifications in the educational activities, a higher satisfaction rate might be achieved among the participants and the health educators.

Effect of psychotherapy on the efficacy of treatment for chronic oral mucosal diseases

BACKGROUND: Psychological factors negatively affect the development and course of chronic oral mucosal diseases.
 AIM: To evaluate the effect of psychological support on the effectiveness of therapy for lichen planus and chronic recurrent aphthous stomatitis.
 MATERIALS AND METHODS: The cohort of a nonrandomized clinical trial involved 64 patients, including 46 women (71.8%) and 18 men (28.2%). The average patient age was 60.3±3.0 years. The patients were divided into groups based on their consent to work with a psychologist. The study group provided consent for psychological support, whereas the comparison group refused psychological support. Anamnestic examination included an assessment of the quality of life, severity of pain syndrome on a visual analog scale, and anxiety on the Beck anxiety inventory. Clinical examination was performed according to the standard method of dental examination.
 RESULTS: After treatment in the study group, a significant decrease in anxiety, a decrease in the severity of pain syndrome, and an improvement in the quality of life were observed. In the comparison group, a tendency to decrease the severity of pain syndrome, without a statistically significant change in the level of anxiety or an improvement in the quality of life, was noted.
 CONCLUSION: Psychological correction in the complex treatment of patients with chronic diseases of the oral mucosa increases patient compliance and the effectiveness of treatment of the underlying disease.

Preparation, Characterization and in vitro/vivo Evaluation of Long-Acting Rivaroxaban-Loaded Microspheres.

Rivaroxaban is widely used for long-term prevention and maintenance therapy of thromboembolic disorders. The existing oral dosage forms of rivaroxaban lead to poor patient adherence because of repeated daily administration. The aim of this study is to design long-acting rivaroxaban- loaded microspheres to reduce dosing frequency and improve patient compliance. Rivaroxaban-loaded microspheres were prepared using the emulsion-solvent evaporation method. The microspheres were evaluated in terms of morphology, particle size, drug loading and encapsulation efficiency, the physical state of the drug in the matrix, in vitro release/release mechanism, and in vivo pharmacokinetics in Sprague Dawley rats. Rivaroxaban-loaded microspheres presented spherical-shaped particles displaying a mean particle size of 89.3 μm, drug loading of 16.5% and encapsulation efficiency of 97.8%. The X-ray diffraction indicated that rivaroxaban existed in crystal form in the microspheres. in vitro release lasting approximately 50 days was characterized as a tri-phasic pattern: (1) an initial burst release, mainly due to the dissolution of drug particles with direct access to the microparticles' surface, (2) a "plateau" phase with a slow-release rate controlled by the diffusion and (3) a final, rapid drug release phase controlled by polymer erosion. Pharmacokinetic studies showed that rivaroxaban microspheres maintained a sustained release for more than 42 days. Rivaroxaban-loaded microspheres have great potential clinical advantages in reducing dosing frequency and improving patient compliance. The data obtained from this study could be used as scientific evidence for decision-making in future formulation development.

Novel High‐Donepezil Loaded One‐Month Release Microspheres for Alzheimer’s Disease Treatment

AbstractBackgroundDonepezil is the most commonly prescribed medication for treating Alzheimer’s disease. However, the most commonly used once daily oral formulation or recently developed once or twice weekly patch formulations have side effects such as nausea, vomiting and weight loss or skin irritation, and the patient’s compliance with these medications is very low. One month release injectable of donepezil microspheres can be a good alternative to increase patient compliance and reduce these side effects. The biggest obstacle in the development of one month donepezil microspheres is that patients tend to feel pain at the injection site due to the large volume of dosage. We have developed novel donepezil microspheres with high drug contents which can improve patient compliance and medication convenience by lowering dosage volume at the injection site.MethodMono‐dispersed and spherical shaped donepezil microspheres with different drug contents were manufactured by membrane emulsification method. The morphology of the microspheres was observed by electron microscope, and the particle size distribution was measured by laser diffraction analysis. The donepezil contents in the microspheres were analyzed using HPLC. Pharmacokinetic studies were performed after a single injection in male SD rats. The concentration of donepezil in the plasma samples was determined by LC‐MS/MS.ResultDonepezil microspheres with three different drug contents (27%, 45% and 60%) were prepared successfully with high drug encapsulation efficiency. All the donepezil microspheres regardless of high drug content have a spherical shape and smooth surface with a narrow side distribution. Despite the high content of donepezil, the initial release was well controlled to less than 5% during the first 24 hours after injection. In rat PK studies of donepezil microspheres after a single injection, plasma donepezil concentration of all three formulations was kept within the therapeutic range for more than one month.ConclusionWe have developed novel donepezil microspheres with high drug contents and without initial burst release. These high donepezil‐loaded microspheres can improve patient compliance and medication convenience by lowering dosage volume at the injection site. Currently, this novel donepezil formulation is planned for commercialization after clinical trials.

"Challenges to Normalcy"- Perceived Barriers to Adherence to Home-Based Cardiac Rehabilitation Exercise in Patients with Chronic Heart Failure.

The aim of this study was to explore perceived barriers to adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure. A qualitative descriptive study was conducted in this study from May to July 2023. A purposive sampling approach was adopted to select patients with chronic heart failure. Semi-structured interviews were completed to collect qualitative data for exploring the perceived barriers. In addition, information saturation and validation strategies were adopted to prove the adequacy of qualitative data. Transcripts were analysed using thematic analysis. A total of 16 patients with chronic heart failure were included in this study. Analysis of the data revealed five main barriers to adherence to home-based cardiac rehabilitation in patients with chronic heart failure. These include (1) lack of knowledge, (2) activity intolerance, (3) exercise fear, (4) role conflict, and (5) lower exercise self-efficacy. This study delved deeper into understanding the challenges faced by chronic heart failure patients in adhering to home-based cardiac rehabilitation exercise. The development of precise and effective management and intervention strategies based on these barriers is necessary to improve patient compliance with home-based cardiac rehabilitation exercise.