Lower Initial Scores Research Articles

Randomized double blinded placebo controlled trial comparing diclofenac and piroxicam in management of acute renal colic and its clinical implications.

To compare the efficacy of sublingual piroxicam 40 mg with intramuscular diclofenac 75 mg in treatment of acute renal colic. The secondary objective was to look for factors that can affect the severity of the pain and pain relief in acute renal colic. One hundred patients with acute renal colic were randomized into two groups. Group A (n = 50) received intramuscular diclofenac and sublingual methylcobalamin. Group B (n = 50) received sublingual piroxicam 40 mg and intramuscular distilled water. Pain severity was measured using Visual Analog Scale (VAS) and verbal and facial response scales. They were followed up for 3 h. Intramuscular injection of pentazocine 30 mg with promethazine 25 mg were used as rescue drugs. Both groups were comparable for age, sex distribution, body mass index (BMI), and pain duration before presentation. Significant pain relief was noticed in both groups. Sixteen percent in group A and 18% in group B had complete pain relief within 30 min (P = .75). Fifteen patients in group A and 13 patients in group B needed rescue drugs, 84% of group A and 76% of group B had complete pain relief at the end of 3 hours (P = .25). Decrease in pain by each scoring method was also comparable (P = .75). In multiple regression analysis, increasing age, positively affects the severity of pain and pain relief while increasing BMI negatively affect the initial pain relief. Acute renal colic seems to affect men more commonly than women, 81% of the study population were men. Patients with low initial pain score did not require any additional pain relief. Average pain duration before presenting to hospital is 260 min. Sixty percent of renal colics are due to stones below pelvic brim. The results show that sublingual piroxicam is as effective as intramuscular diclofenac. It can be easily self-administered and it overcomes the morbidity and time delay in getting intramuscular diclofenac.

Making use of an existing questionnaire to measure patient-centred attitudes in undergraduate medical students: A case study

Background. Patient-centred care is widely acknowledged as important to achieve improved patient outcomes in healthcare. Therefore, it is vital that medical schools should foster this attitude in their students. Studies report that students are becoming less patient-centred in the period between entry to medical school and graduation. Objective. To determine the shift in attitude towards patient-centredness in a group of South African undergraduate medical students. Simultaneously, the reliability and validity of the Patient-Practitioner Orientation Scale (PPOS) in our context were measured. Methods. A cross-sectional survey was undertaken by asking all the medical students from year 1 to year 6 to complete the PPOS. The mean PPOS score for each cohort was calculated using SPSS for Windows. Reliability and validity testing was conducted using Cronbach’s alpha and confirmatory and exploratory factor analysis. Results. The average return rate across the 6 years of study was 81%. The results indicated low initial scores on the PPOS and a decrease in scores over the years of study, with the most dramatic drop being from year 1 to year 2. The PPOS showed poor validity and reliability in our context. Conclusion. The study appears to indicate the same decrease in patient-centredness in our students as has been shown in other studies using this tool. However, the low reliability and validity of the PPOS in our environment means that the result should be interpreted with caution. Factors such as our medical students’ not having had first-hand experience of the doctor-patient relationship and second-language issues may play a role. It is recommended that the PPOS not be used in our context without further exploration of the factors contributing to this loss of reliability and validity.

Colistin nephrotoxicity increases with age.

Colistin (COL) has become the backbone of the treatment of infections due to extensively drug-resistant (XDR) Gram-negative bacteria. The most common restriction to its use is acute kidney injury (AKI). We conducted a retrospective cohort study to evaluate risk factors for new-onset AKI in patients receiving COL. The cohort consisted of 198 adults admitted to 9 referral hospitals between January 2010 and October 2012 and treated with intravenous COL for ≥ 72 h. Patients with no pre-existing kidney dysfunction were compared in terms of risk factors and outcomes of AKI graded according to the RIFLE criteria. Logistic regression analysis was used to identify associated risk factors. A total of 198 patients met the inclusion criteria, of whom 167 had no pre-existing kidney dysfunction; the mean patient age was 58.77 (± 18.98) y. Bloodstream infections (34.8%) and ventilator-associated pneumonia (32.3%) were the 2 most common indications for COL use. New-onset AKI developed in 46.1% of the patients, graded as risk (10%), injury (15%), and failure (21%). Patients with high Charlson co-morbidity index (CCI) scores (p = 0.001) and comparatively low initial glomerular filtration rate (GFR) estimations (p < 0.001) were more likely to develop AKI, but older age (p = 0.001; odds ratio 5.199, 95% confidence interval 2.684-10.072) was the major predictor in the multivariate analysis. In-hospital recovery from AKI occurred in 58.1%, within a median of 7 days. COL-induced nephrotoxicity occurred significantly more often in patients older than 60 y of age and was related to low initial GFR estimations and high CCI scores, which were basically determined by age.

Practice effects in medical school entrance testing with the undergraduate medicine and health sciences admission test (UMAT)

BackgroundThe UMAT is widely used for selection into undergraduate medical and dental courses in Australia and New Zealand (NZ). It tests aptitudes thought to be especially relevant to medical studies and consists of 3 sections – logical reasoning and problem solving (UMAT-1), understanding people (UMAT-2) and non-verbal reasoning (UMAT-3). A substantial proportion of all candidates re-sit the UMAT. Re-sitting raises the issue as to what might be the precise magnitude and determinants of any practice effects on the UMAT and their implications for equity in subsequent selection processes.MethodsBetween 2000 and 2012, 158,909 UMAT assessments were completed. From these, 135,833 cases were identified where a candidate had sat once or more during that period with 117,505 cases (86.5%) having sat once, 14,739 having sat twice (10.9%), 2,752 thrice (2%) and 837, 4 or more times (0.6%). Subsequent analyses determined predictors of multiple re-sits as well as the magnitude and socio-demographic determinants of any practice effects.ResultsIncreased likelihood of re-sitting the UMAT twice or more was predicted by being male, of younger age, being from a non-English language speaking background and being from NZ and for Australian candidates, being urban rather than rurally based. For those who sat at least twice, the total UMAT score between a first and second attempt improved by 10.7 ± 0.2 percentiles, UMAT-1 by 8.3 ± 0.2 percentiles, UMAT-2 by 8.3 ± 0.2 percentiles and UMAT-3 by 7.7 ± 0.2 percentiles. An increase in total UMAT percentile score on re-testing was predicted by a lower initial score and being a candidate from NZ rather than from Australia while a decrease was related to increased length of time since initially sitting the test, older age and non-English language background.ConclusionsRe-sitting the UMAT augments performance in each of its components together with the total UMAT percentile score. Whether this increase represents just an improvement in performance or an improvement in understanding of the variables and therefore competence needs to be further defined. If only the former, then practice effects may be introducing inequity in student selection for medical or dental schools in Australia or NZ.

The Effect of Injuries on Health Measured by Short Form 8 among a Large Cohort of Thai Adults

IntroductionWe investigate the links between health and injury in Thailand. This is important because of the high burden of injury in transitional countries and limited information for public health.MethodsWe analyse 2005 baseline and 2009, 4-year follow-up data from distance learning students of Sukhothai Thammathirat Open University residing nationwide (n = 60569). Injury was reported for the past year in both periods. Medical Outcome Study Short-Form (SF-8™) health status was reported and Physical and Mental Component Summary Scores (PCS and MCS) were calculated. Analyses used covariate-adjusted multivariate linear regression.ResultsIn 2009, increasing numbers of traffic injuries (0, 1, 2, 3, 4+) associated with declining PCS scores (49.8, 48.4, 46.9, 46.2, 44.0), along with a similar monotonic decline for MCS scores (47.6, 46.0, 44.2, 42.7, 40.6). A similar (but smaller) dose-response gradient was found between non-traffic injuries and SF-8 scores. Longitudinal analyses showed those with incident injury (no injury 2005, injury 2009) had lower PCS and MCS scores compared to those with no injury in both periods. Individuals with reverting injury status (injury 2005, no injury 2009) reported improvement in PCS and MCS scores over the four-year period.ConclusionWe found significant and epidemiologically important associations between increasing injury frequency and worse health in the past year, especially traffic injuries. Longitudinal 2005–2009 results were supportive and revealed statistically significant adverse 4-year effects of incident injury on health. If injury reverted over four years, low initial scores improved greatly. Findings highlight the importance of injury prevention as a public health priority.

Effects of Stigmatized Identities on Interpersonal Influence and Social Distance

In order to reveal the processes through which status differentiation and stigmatization occur in daily interactions between migrant workers and out-groups, the present study investigated the effects a stigmatized status characteristic had on influence in the interaction and on the social rejection suffered during this process. This is a multiple site experimental study. Participants were 151 undergraduate students from freshman to senior level. The participants included seventy three male students and seventy eight female students in YanTai. In the experiment, the participants cooperated with a fictitious partner through a local area network to answer questions described as measuring "contrast sensitivity ability." On the task, participants had the opportunity to be influenced by the partners. Participants then chose partners for the next period task. In accordance with the different identities of the partners, the study has five conditions that differentiated the participants' partners(all partners were in fact fictitious). In the control condition, the partners are described as male college students just like the participants. In two conditions, the partners are high school students with either a low or high score on an initial contrast sensitivity task. In the remaining two conditions, the partners are migrant workers with either low or high initial test scores. In the study, influence and social distance were the indicators of social status and the degree of stigmatization respectively. Influence was measured as how often participants switched answers to correspond to answers provided by partners, and social distance was measured by whether participants selected the same or a new partner for the future session., The study expects to find out that education level and task ability are status markers that affect influence. It also predicts that migrant workers identity will act as a status marker and stigma, affecting both influence and social distance. The study also predicts that the influence effects of task ability can imply a strategy to decrease the legitimacy of the existing status order. The status measurement results turned out to be that, ① in cooperative tasks, participants in the migrant workers partner group were more inclined to underestimate the partners' performance and were less influenced by them than the participants in control group and low education partner group, ②the participants who found out that their partners were migrant workers and the partners' score were higher than them, referred to the partners' answers more frequently than those who were only informed of their partners' migrant worker identity. The stigma measurement results indicated that, ① participants in the migrant workers partner group obviously intended to keep longer social distance with the partners, than the participants in control group and low education partner group, ② emphasizing partners' significant skills in the task did not decrease the social distance that participants sought from migrant workers. The results indicate that "migrant worker" is a status characteristic and a stigmatized identity that indicates a person's inferior position in the social hierarchy. The low performance expectation and weak influence brought about by status characteristics can be counterpoise and changed by introducing new status characteristics of the partners. However, this method did not attenuate the social distance that accompanies stigma.

Evaluation of the International Child Development Programme (ICDP) as a community-wide parenting programme

Background: Many parenting programmes lack proper evaluation, especially under community-wide implementation. Objective: Examining the effectiveness of the eight-week International Child Development Programme (ICDP), implemented as a general programme. Methodology: Non-clinical caregivers attending ICDP (N = 141) and a non-attending community comparison group (N = 79) completed questionnaires on parenting, psychosocial functioning, and child difficulties before and after ICDP course. Analyses compare changes in scores for both groups over time. Results: The ICDP group showed more positive attitudes towards child management and reported better child management, improved parental strategies and less impact of child difficulties. Caregivers with low initial scores benefited most. The comparison group showed little change with a significant decrease in scores on the caregiver–child activity scale. Discussion: The results suggest that caregivers in the community who do not show clinical signs or have children with behaviour or other disorders, may benefit from participating in parent training based on ICDP.

Repeated evaluations of the quality of clinical teaching by residents.

Many studies report on the validation of instruments for facilitating feedback to clinical supervisors. There is mixed evidence whether evaluations lead to more effective teaching and higher ratings. We assessed changes in resident ratings after an evaluation and feedback session with their supervisors. Supervisors of three medical specialities were evaluated, using a validated instrument (EFFECT). Mean overall scores (MOS) and mean scale scores were calculated and compared using paired T-tests. 24 Supervisors from three departments were evaluated at two subsequent years. MOS increased from 4.36 to 4.49. The MOS of two scales showed an increase >0.2: ‘teaching methodology’ (4.34–4.55), and ‘assessment’ (4.11–4.39). Supervisors with an MOS <4.0 at year 1 (n = 5) all demonstrated a strong increase in the MOS (mean overall increase 0.50, range 0.34–0.64). Four supervisors with an MOS between 4.0 and 4.5 (n = 6) demonstrated an increase >0.2 in their MOS (mean overall increase 0.21, range −0.15 to 53). One supervisor with an MOS >4.5 (n = 13) demonstrated an increase >0.02 in the MOS, two demonstrated a decrease >0.2 (mean overall increase −0.06, range −0.42 to 0.42). EFFECT-S was associated with a positive change in residents’ ratings of their supervisors, predominantly in supervisors with relatively low initial scores.

The Sitting-Unsupported Balance Score as an Early Predictor of Functional Prognosis in Stroke Patients: A Pilot Study

ObjectiveTo evaluate the impact of initial "sitting-unsupported" Berg Balance Scale (SUB), the specific trunk control parameter, on patients' functional outcome, Korean version of Modified Barthel Index (K-MBI) at 6 months.MethodsThe charts of 30 patients retrospectively reviewed reviewed. The initial Korean version of Berg Balance Scale (K-BBS) including SUB along with patients' Korean version of Mini-Mental State Examination (K-MMSE), Glasgow Coma Scale (GCS), and other functional parameters that affect functional outcome were recorded. Cases were divided into low (group I) and high (group II) initial SUB score groups. Correlation and regression analysis were performed to assess the relationship between the initial SUB on the K-MBI at 6 months.ResultsThe mean±standard deviation score of initial SUB/K-MBI at 6 months of groups I and II were 0.056±0.236/26.89±32.48, 3.58±0.515/80.25±18.78, respectively, and showed statistical significant differences to each other (p<0.05). K-MBI at 6 months was highly correlated with initial GCS, SUB, K-BBS, K-MMSE, and initial K-MBI (p<0.05). In multiple linear regression analysis, initial SUB and GCS scores remained significantly associated with K-MBI at 6 months. A logistic regression model revealed that initial SUB (p=0.004, odds ratio=16), initial K-MBI, GCS, and K-MMSE were all significant predictors of K-MBI scores at 6 months.ConclusionInitial SUB scores could be helpful in predicting patient's potential functional recovery at 6 months. Further studies with concurrent controls and a larger sample group are required to fully establish this tool.

Incidence et impact clinique des crises comitiales périopératoires pour les hématomes sous-duraux chroniques

Background and purposeSeizures can occur in patients who have surgery for a chronic subdural hematoma. However, the incidence of seizures and their impact on the clinical course of patients in the perioperative period is not well known. MethodsIn this retrospective study, we reviewed 161 cases of patients treated for chronic subdural hematoma in our institution. The surgical procedures consisted in trephine craniotomy in 156 cases, burr-hole craniotomy in three cases, and bone flap craniotomy in two cases. All the patients had systematic antiepileptic drug prophylaxis. ResultsIn our patients’ population, the incidence of seizures was 10.6% before surgery and 14.9% after surgery. Low initial score on the Glasgow Coma Scale (P<0.001) and preoperative cognitive impairment (P=0.005) were associated with a higher rate of postoperative seizures. In our study, the mortality rate was 14.9%. Low initial score on the Glasgow Coma Scale (P=0.068) and postoperative seizures (P=0.002) were associated with a higher mortality rate. ConclusionsWe have shown that patients suffering from seizures may have worse outcome. The benefit of a systematic perioperative prophylaxis using antiepileptic drugs has to be evaluated.

Initial Mini-Mental State and Cerebral Perfusion in Alzheimer’s Disease

The relationship between the initial mini-mental state examination (MMSE) score and cerebral perfusion was evaluated in patients with Alzheimer's disease (AD). In the study single photon emission computed tomography (SPECT) images of the brains of 40 AD patients were compared with the brain scans of 10 healthy controls. Each patient underwent MMSE analysis at initial evaluation as well as Tc-99 m hexamethylpropyleneamine oxine (HMPAO) brain SPECT. The patients were followed up for at least 42 months. The regional cerebral blood flow (rCBF) values for patients were found to be significantly decreased for all cerebral lobes compared to the control subjects and p-values were calculated to be less than 0.001 except for occipital lobes. The most statistically significant correlation between the MMSE scores and rCBF values was determined for the left temporal lobe (p < 0.0001). A significant correlation was also found for the right temporal lobe (p < 0.005). A minimal statistically significant correlation was found for the frontal lobes and the left parietal lobe (p < 0.05). The overall cerebral perfusion was decreased except in the occipital lobes in AD cases with low initial MMSE scores and there was a significant relationship between the decrease in perfusion of the temporal/frontal lobes and the left parietal lobe with the decrease in the initial MMSE scores. The most significant relationship between the decrease in the initial MMSE scores and the rCBF values was determined for the temporal lobes (especially for the left temporal lobe). It was also found that the left frontal lobe was affected from the beginning of the disease.

Studying children's early literacy development: Confirmatory multidimensional scaling growth modeling

There has been considerable debate over the ways in which children's early literacy skills develop over time. Using confirmatory multidimensional scaling (MDS) growth analysis, this paper directly tested the hypothesis of a cumulative trajectory versus a compensatory trajectory of development in early literacy skills among a group of 1233 kindergarteners over a three-year period. Based on age-sensitive subscales of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS), the finding supported the hypothesis of compensatory trajectory of development in early literacy skills. The results indicated a slower growth rate for children who had a higher initial score than those who had a lower initial score so that those who started at a lower point caught up by the end of the second grade. In addition, reading achievement at the end of the second grade did not show a statistically significant difference between these two groups of children. We discussed some substantively important questions in light of the theoretical articulations of constrained skills proposed by Paris (2005). The study also illustrated confirmatory MDS growth analysis as a viable alternative for theory testing.

Construction of graphic symbol sequences by preschool-aged children: Learning, training, and maintenance

ABSTRACTThe use of augmentative and alternative communication systems based on graphic symbols requires children to learn to combine symbols to convey utterances. The current study investigated how children without disabilities aged 4 to 6 years (n = 74) performed on a simple sentence (subject–verb and subject–verb–object) transposition task (i.e., spoken model into graphic symbol sequence). Scores were obtained on initial testing, after training, and 1 month later. Error patterns were examined. Four-year-olds obtained significantly lower initial scores and were the only ones showing training effects and lower performance a month later. The distribution of error types was similar across age groups. These results suggest that the age of 4 may represent an important stage in the use of graphic symbol communication.

Variation in personality and behavioural plasticity across four populations of the great tit Parus major

1. Interest in the evolutionary origin and maintenance of individual behavioural variation and behavioural plasticity has increased in recent years. 2. Consistent individual behavioural differences imply limited behavioural plasticity, but the proximate causes and wider consequences of this potential constraint remain poorly understood. To date, few attempts have been made to explore whether individual variation in behavioural plasticity exists, either within or between populations. 3. We assayed 'exploration behaviour' among wild-caught individual great tits Parus major when exposed to a novel environment room in four populations across Europe. We quantified levels of individual variation within and between populations in average behaviour, and in behavioural plasticity with respect to (i) repeated exposure to the room (test sequence), (ii) the time of year in which the assays were conducted and (iii) the interval between successive tests, all of which indicate habituation to novelty and are therefore of functional significance. 4. Consistent individual differences ('I') in behaviour were present in all populations; repeatability (range: 0.34-0.42) did not vary between populations. Exploration behaviour was also plastic, increasing with test sequence - but less so when the interval between subsequent tests was relatively large - and time of year; populations differed in the magnitude of plasticity with respect to time of year and test interval. Finally, the between-individual variance in exploration behaviour increased significantly from first to repeat tests in all populations. Individuals with high initial scores showed greater increases in exploration score than individuals with low initial scores; individual by environment interaction ('I × E') with respect to test sequence did not vary between populations. 5. Our findings imply that individual variation in both average level of behaviour and behavioural plasticity may generally characterize wild great tit populations and may largely be shaped by mechanisms acting within populations. Experimental approaches are now needed to confirm that individual differences in behavioural plasticity (habituation) - not other hidden biological factors - caused the observed patterns of I × E. Establishing the evolutionary causes and consequences of this variation in habituation to novelty constitutes an exciting future challenge.

Change in Thigh Muscle Cross-Sectional Area Through Administration of an Anabolic Steroid During Routine Stroke Rehabilitation in Hemiplegic Patients

The aim of this study was to clarify the effect of administration of an anabolic steroid (AS) without the addition of specific training in stroke patients by measuring the cross-sectional area (CSA) of the thigh. Twenty-six hemiplegic stroke patients during subacute rehabilitation were randomly assigned to a metenolone enanthate (ME) administration group or a control group (CT group). In the ME group, ME (100 mg) was injected intramuscularly weekly for 6 wks in the ME group. The CSA of the bilateral thigh muscles was measured using computed tomography. Motor subscore of the Functional Independence Measure (FIM-M) was assessed before the experimental period. At the end of 6 wks, the CSA increase in the ME group (13.4%, affected side; 14.5%, unaffected side) was significantly larger than that in the CT group (3.3%, affected side; 5.2%, unaffected side). Correlation coefficients between the initial FIM-M score and the CSA increase at 6 wks were -0.754 for the affected side and -0.567 for the unaffected side in the ME group and 0.199 for the affected side and 0.431 for the unaffected side in the CT group. ME administration is effective for improving muscle CSA and, thus, muscle strengthening in stroke rehabilitation. The CSA increase in the ME group was most prominent in patients with a low initial FIM-M score.

Development of phonological awareness during the preschool year: the influence of gender and socio-economic status

Phonological awareness is a critical enabling skill in learning to read, often developed outside the context of formal reading instruction. More than 2,000 6-year-old children were tested on phonological awareness at two occasions during the preschool year in two cohorts. Between the assessments, a training program was implemented. A two-level path model was applied. More frequent training sessions were connected to higher gains of test scores especially for children with low initial scores in the first cohort. A clear gender effect was also observed. There were more boys with very low initial scores and more girls among the top scorers. A clear SES-effect indicated the influence of early language stimulation. Children who already at the beginning of the preschool year had grasped the alphabetic code had the highest initial scores on the test.

CANDIDATE PERSISTENCE AND PERSONALITY TEST PRACTICE EFFECTS: IMPLICATIONS FOR STAFFING SYSTEM MANAGEMENT

Candidates persist in selection settings for numerous reasons, prompting several concerns regarding staffing‐system management. Predictors of the propensity to retest and personality test practice effects were investigated among a sample of 15,338 candidates who applied for supervisory positions (and 357 who repeated the selection process) over a 4‐year period with a large organization in the service industry. Results reveal greater likelihood of retesting among internal candidates and overall evidence of small‐to‐moderate personality test practice effects. Compared to passing candidates who retested for various reasons, failing candidates pursued alternative response strategies upon retesting and generated dimension‐level practice effects that reached .40 to .60, whereas passing candidates generally replicated their initial profiles. For several subscales, low initial scores were associated with practice effects that exceeded a full standard deviation. Implications for research, practice, and policy are discussed.

The natural history of brain contusion: an analysis of radiological and clinical progression

Although brain contusions are a common neurosurgical condition, surprisingly little has been written about their natural history. The purpose of this study was to identify factors that predict radiological and clinically significant progression of this pattern of traumatic brain injury in patients who did not initially require surgery. On the basis of their results and the available literature, the authors suggest a management algorithm. The authors performed a retrospective review of clinical and radiological records of consecutive patients with brain contusions who initially underwent conservative treatment. Significant radiological progression was defined as a 30% increase in contusion size on CT scans. Statistical analysis was performed to identify clinical and radiological predictors of CT contusion progression, the significance of progression, and predictors of clinical outcome. Of 98 patients identified with brain contusions who initially received conservative treatment, 44 (45%) had significant progression on CT, and 19 (19%) required surgical intervention. The initial size of the contusion and the presence of subdural hematoma were the only statistically significant predictors of CT progression in the multivariate analysis (p = 0.0212 and 0.05, respectively). Four patients required delayed contusion evacuation (3 had radiological progression on follow-up scans). Good Glasgow Coma Scale (GCS) scores on presentation and younger age were predictors of eventual discharge from the hospital (OR 1.471, CI 1.233-1.755, p < 0.001 and OR 0.949, CI 0.912-0.988, p = 0.011, respectively). No patients with an initial GCS score of 15 or an initial contusion size < 14 ml required delayed evacuation. Contusion progression is a common phenomenon that is seen more commonly in larger contusions. Patients with large contusions and low initial GCS scores are at risk for delayed deterioration. A proposed management algorithm for patients with contusions initially treated conservatively may help practitioners identify the best course of treatment.

Can Teaching Research Methodology Influence Students' Attitude Toward Science? Cohort Study and Nonrandomized Trial in a Single Medical School

BackgroundMedical teaching aims to develop attitudes and behaviors underlying professional competence of future physicians. We investigated whether a mandatory course on scientific methodology in the second study year could affect...

Medication Apprehension and Compliance among Dialysis Patients – A Comprehensive Guidance Attitude

Background: Compliance with treatment regimens is a continuing challenge for chronic dialysis patients and their medical caregivers. Poor patient adherence to prescribed medications can adversely affect treatment outcome. Study Design: In this pre- versus post-intervention study, 89 chronic dialysis patients [75 hemodialysis (HD), 14 continuous ambulatory peritoneal dialysis (CAPD); mean age 62.7 ± 12.39 years, 34 females] responded to a written questionnaire designed to assess knowledge about and compliance with 5 groups of prescribed medications: metabolic drugs, antihypertensives, cardiac-supporting agents, peptic disease therapy and hematological replacement therapy. Mode of intake, storage, means of supply and source of information for each class of drug were also assessed. Patients then received both oral and written instructions regarding their prescribed medications (intervention). This information was repeated 3 months later. Six months after the intervention, patients were re-administered the questionnaires. Response to the questionnaires and laboratory data were compared prior to and following the intervention. Results: Overall, compliance with prescribed medications significantly improved following the intervention, from 89 to 95.7%, p = 0.0007. This relative improvement was greater in HD than CAPD patients (27 vs. 2%, p < 0.0001). Improvement in compliance was associated with lower initial scores, fewer years of education, and longer dialysis vintage. Compared to baseline values, post-intervention blood hemoglobin, hematocrit, mean corpuscular volume, ferritin and Ca levels were significantly improved. Conclusions: Dialysis patients appear to benefit from receiving comprehensive guidance about medications, in terms of compliance with medications and blood chemistry and hematology measures.