Low Persistence Rates Research Articles

Influence of patient and tumor characteristics on therapy persistence with letrozole in postmenopausal women with advanced breast cancer: results of the prospective observational EvAluate-TM study

BackgroundTreatment of postmenopausal, hormone receptor-positive metastatic breast cancer (MBC) patients varies despite clear therapy guidelines, favoring endocrine treatment (ET). Aim of this study was to analyze persistence of palliative aromatase inhibitor (AI) monotherapy in MBC patients.MethodsEvAluate-TM is a prospective, multicenter, noninterventional study to evaluate treatment with letrozole in postmenopausal women with hormone receptor–positive breast cancer. To assess therapy persistence, defined as the time from therapy start to the end of the therapy (TTEOT), two pre-specified study visits took place after 6 and 12 months. Competing risk survival analyses were performed to identify patient and tumor characteristics that predict TTEOT.ResultsOut of 200 patients, 66 patients terminated treatment prematurely, 26 (13%) of them due to causes other than disease progression. Persistence rate for reasons other than progression at 12 months was 77.7%. Persistence was lower in patients who reported any adverse event (AE) in the first 30 days of ET (89.5% with no AE and 56% with AE). Furthermore, patients had a lower persistence if they reported compliance problems in the past before letrozole treatment.ConclusionsDespite suffering from a life-threatening disease, AEs of an AI will result in a relevant number of treatment terminations that are not related to progression. Some subgroups of patients have very low persistence rates. Especially with regard to novel endocrine combination therapies, these data imply that some groups of patients will need special attention to guide them through the therapy process.Trial registrationClinical Trials Number: CFEM345DDE19

Retrospective Comparison of Pulmonary Arteriovenous Malformation Embolization with the Polytetrafluoroethylene-Covered Nitinol Microvascular Plug, AMPLATZER Plug, and Coils in Patients with Hereditary Hemorrhagic Telangiectasia

PurposeTo evaluate effectiveness of the polytetrafluoroethylene-covered nitinol mesh microvascular plug (MVP) and compare it with other devices in pulmonary arteriovenous malformation (PAVM) embolization in patients with hereditary hemorrhagic telangiectasia (HHT). Materials and MethodsTwenty-five patients (average age 35 y; range, 15–56 y) with hereditary hemorrhagic telangiectasia (HHT) and de novo PAVM embolization with at least 1 MVP between November 2015 and May 2017 were retrospectively evaluated. Retrospective data were also obtained from prior embolization procedures in the same patient population with other embolic devices dating back to 2008. Technical success, complications, PAVM persistence rates, and category of persistence were analyzed. ResultsIn 25 patients, 157 PAVMs were treated: 92 with MVP, 35 with AMPLATZER vascular plug (AVP), 6 with AVP plus coils, and 24 with coils. The per-PAVM technical success rates were 100% with MVP; 97%, AVP; 100%, AVP plus coils; and 100%, coils. PAVM persistence rates and median follow-up were as follows: MVP, 2% (1/92) (510 d); AVP, 15% (3/20) (1,447 d); AVP plus coils, 20% (1/5) (1,141 d); coils, 46.7% (7/15) (1,141 d). Persistence owing to recanalization for MVP, AVP, AVP plus coils, and coils was 2%, 15%, 0%, and 33%. No difference was found between persistence rates of MVP vs AVP (P = .098). Embolization with a vascular plug (MVP or AVP) with or without coils had a statistically significant lower persistence rate (5.4%) than embolization with coils alone (46.7%) (P = .022). ConclusionsPAVM embolization with MVP had a high technical success rate and a low persistence rate comparable to AVP and lower than coil embolization alone.

Community Colleges and Upward Mobility

Two-year community colleges enroll nearly half of all first-time undergraduates in the United States, but to ambiguous effect: low persistence rates and the potential for diverting students from 4-year institutions cast ambiguity over 2-year colleges' contributions to upward mobility. This paper develops a new instrumental variables approach to identifying causal effects along multiple treatment margins, and applies it to linked education and earnings registries to disentangle the net impacts of 2-year college access into two competing causal margins: significant value-added for 2-year entrants who otherwise would not have attended college, but negative impacts on students diverted from immediate 4-year entry.

A 48-Week, Multicenter, Open-Label, Observational Study Evaluating Oral Rivastigmine in Patients with Mild-to-Moderate Alzheimer's Disease in Taiwan.

Rivastigmine is a cholinesterase inhibitor, approved for the treatment of mild-to-moderate dementia of Alzheimer's type. This study assessed the short- and long-term effectiveness and safety of rivastigmine in patients with mild-to-moderate Alzheimer's disease (AD) in a real-world clinical setting in Taiwan. This was a 48-week, single-arm, open-label, prospective, observational, post-marketing surveillance, multicenter study. The primary outcomes were change from baseline to week 48 in the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) scores. One-year persistence to treatment, effect on activities of daily living, and incidence of adverse events (AEs) were also assessed. Overall, 151 patients were enrolled in the study, of which 91 (60.26%) completed this study. At the end of the study, the mean rivastigmine dose received by the patients was 6.59mg/day. At week 48, the changes in mean [standard deviation (SD)] MMSE and CDR scores in the intent-to-treat (ITT) population from baseline were -1.00 (3.8; p = 0.0344) and 0.07 (0.29; p = 0.0403), respectively. The most frequently reported AEs by preferred term were dizziness (12.58%) and nausea (9.27%). No new or unexpected AEs were observed, and 30 (20.13%) patients in the ITT population were on rivastigmine therapy for 1year without treatment discontinuation. Despite the low 1-year persistence rate, rivastigmine showed a stabilizing effect on declining cognition in patients with mild-to-moderate AD in a real-world scenario. Rivastigmine is well tolerated at 6.0-9.0mg/day with no unexpected safety concerns. Novartis Co. Ltd., Taipei, Taiwan.

Abstract 257: Adherence and Persistence to Direct Oral Anticoagulants in Patients with Atrial Fibrillation

Background: Direct oral anticoagulants (DOACs) are increasing in popularity for stroke prevention in atrial fibrillation (AF) due to ease of use. However, varying levels of DOAC adherence and persistence has been reported, which may result in poor clinical outcomes. We undertook a systematic review to characterize the real-world observational evidence for DOAC adherence and persistence. Methods: We searched MEDLINE, EMBASE, and CINAHL from inception to June 2018. We included studies that reported DOAC adherence and/or persistence rates in patients with AF. Two investigators independently screened abstracts and full text articles for inclusion, abstracted data from eligible studies, and assessed risk of bias using the Newcastle-Ottawa Scale. Prevalence rates of nonadherence were pooled using a DerSimonian and Laird random-effects model. Heterogeneity was assessed using I 2 . Results: We identified 48 studies including 576,360 patients in 40 countries. Seventeen studies (35%) reported proportion of days covered (PDC) as the adherence measure, 5 (10%) reported medication possession ratio (MPR), 36 (75%) reported persistence, and 6 (13%) evaluated clinical outcomes associated with DOAC adherence/persistence. Seventeen studies (35%) evaluated DOACs as a class, 11 (23%) evaluated apixaban, 35 (73%) evaluated dabigatran, and 28 (58%) evaluated rivaroxaban. The overall pooled proportion of patients who had good adherence (PDC/MPR≥80%) at all times was 66% (CI: 63%-70%) and at 1 year was 69% (CI: 63%-74%). There was wide variation in persistence definitions used in individual studies, with permissible gaps varying from 14 to 365 days. The overall pooled persistence rate was 71% (CI: 69%-74%) at all times and was 63% (CI: 58%-68%) at 1 year. Heterogeneity was high for all analyses. In subgroup analyses by agent, the pooled 1-year persistence rate was 72% (CI: 60%-83%) for apixaban, 54% (CI: 46%-62%) for dabigatran, and 67% (CI: 59%-75%) for rivaroxaban. Similar patterns were found for pooled adherence rates by agent. Conclusions: We found that DOAC adherence and persistence is low among patients with AF, with 1 in 3 patients not taking a DOAC after initiation. Clinicians need to be aware of the low real-world adherence and persistence rates when using DOACs in AF. High heterogeneity warrants further subgroup analyses.

Hanging In, Stopping Out, Dropping Out: Community College Students in an Era of Precarity

Background/Context Sociologists of education have documented community college students’ high postsecondary aspirations and low persistence and college completion rates. Recent research suggests that community colleges can improve student outcomes by developing structural reforms: streamlining curricula, expanding vocational programs, and improving advising. The emphasis on structural reform overlooks the ways in which community college students—who are disproportionately disadvantaged—are constrained from benefiting from even the most progressive structural reforms. This research builds on structural models by examining both the conditions and constraints under which students endeavor to succeed in the community college. Research Question The research questions guiding this analysis are: (a) What keeps students from moving in smooth and uninterrupted ways through community college? (b) Do structural reform efforts alone make sense for community college students in general and a more diverse student body in particular? Research Design This study draws on in-depth interviews with 45 community college students at two California community colleges. Students represent a range of racial/ethnic groups, ages, and traditional and nontraditional backgrounds. Findings/Results The findings revealed that forms of institutional instability identified in previous research interact with unpredictability in students’ lives, leading students to engage in “security work” (Cooper, 2014) intended to accommodate their educations to precarious circumstances. Students engage in security work across two dimensions: managing income flow (including paid work and financial aid) and managing care of families, food, housing, and transportation. Conclusions/Recommendations Findings revealed a feedback loop between precarity in community colleges and precarity in students’ lives. This article contributes to theories of student persistence by arguing that the framework of precarity importantly complements structural explanations for student outcomes in community colleges.

Adherence and persistence to hyperlipidemia medications in patients with atherosclerotic cardiovascular disease and those with diabetes mellitus based on administrative claims data in Japan

Background and aimsReal-world data on treatment patterns in Japanese hyperlipidemia patients with diabetes mellitus (DM) or prior atherosclerotic cardiovascular diseases (ASCVD) are lacking. MethodsThis is a retrospective, longitudinal cohort analysis of administrative claims data (Japan Medical Data Center [JMDC] and Medical Data Vision [MDV] databases) for patients prescribed a new hyperlipidemia medication between 2014 and 2015. Patients were followed for ≥12 months. Outcomes included prescribing patterns, persistence (discontinuations), and adherence (proportion of days covered). ResultsData were analyzed for 11,718 and 27,746 DM, and 4101 and 14,356 ASCVD patients from the JMDC and MDV databases, respectively. Among previously-untreated patients, index prescriptions were primarily for moderate statins in the DM (JMDC: 74.7%, MDV: 77.5%) and ASCVD (JMDC: 75.4%, MDV: 78.5%) sub-cohorts. Combinations were rarely prescribed (≤2.5%). Previously-treated patients were most frequently prescribed combinations in the DM (JMDC: 46.7%, MDV: 53.6%) and ASCVD (JMDC: 49.3%, MDV: 53.3%) sub-cohorts. Intensive statins were rarely used by previously-untreated (≤1%) or previously-treated (≤8%) patients in either sub-cohort. Approximately half of previously-untreated patients discontinued hyperlipidemia therapy within 12 months. Adherence was ≥80% across most drug classes. ConclusionsMany Japanese hyperlipidemia patients with DM or ASCVD are prescribed single-agent lipid-lowering therapy. Use of intensive therapy is lower than expected, and is suggestive of under-treatment. The low persistence rates are concerning, and warrant further study.

Pigmented Villonodular Synovitis of the Knee: An Underappreciated Source of Pain in Children and Adolescents.

Pigmented villonodular synovitis (PVNS) is a benign proliferative synovial disorder most commonly described in adults. The purpose of this study is to describe the presentation and management of a large single-center series of pediatric patients with PVNS of the knee. A retrospective review was performed of consecutive pediatric patients treated for PVNS at a single institution from 2001 to 2016. Inclusion criteria were patients below 20 years of age with surgical treatment of histologically proven PVNS of the knee. Review of the electronic medical record was utilized to gather demographic data, clinical presentation, affected joint, imaging findings, treatment, and disease persistence. Over the 16-year study period, 17 pediatric patients with an average age of 11 years (range, 3 to 19 y) were treated for PVNS of the knee. The average duration of symptoms before orthopaedic evaluation was 16 months. More than half of the children were misdiagnosed with a variety of rheumatologic or orthopaedic conditions before their diagnosis of PVNS. On the basis of magnetic resonance imaging (MRI), PVNS was included as a potential diagnosis in 12 of 17 patients (71%). A total of 27 surgeries were performed in 17 patients. Ten patients were treated with a single surgery and 2 patients were treated with staged biopsy followed by synovectomy. Five patients required ≥2 therapeutic surgeries. The majority of procedures were arthroscopic synovectomies (89%). One patient required open resection of a mass in the posterior compartment of the knee and 1 patient had a manipulation under anesthesia for arthrofibrosis. Ten patients were noted to have nodular disease, 4 diffuse, and 3 mixed. At an average 15-month follow-up, 15 patients (88%) were considered to be disease-free based on clinical examination and/or follow-up MRI. Two patients (12%) had MRI studies following their last surgery with findings consistent with persistent PVNS, but only a single patient had persistent symptoms. This case series of pediatric patients with PVNS of the knee represents the largest single-center cohort in the literature. Although previously considered a disease of young adult patients, PVNS should be considered in pediatric patients with an insidious onset of joint swelling with or without pain. Symptoms may be present for months to years before diagnosis. Patients are frequently misdiagnosed, most commonly with rheumatologic diseases, bleeding disorders, or septic arthritis. MRI with gradient echo sequences is the diagnostic imaging study of choice and arthroscopic synovectomy produces good outcomes with low rates of symptomatic disease persistence. Level IV.

Pulmonary Arteriovenous Malformations: Safety and Efficacy of Microvascular Plugs.

The purpose of this study is to assess the safety and efficacy of microvascular plugs for the treatment of pulmonary arteriovenous malformations (PAVMs). From July 2014 to March 2017, 22 consecutive patients with hereditary hemorrhagic telangiectasia underwent treatment of PAVMs using microvascular plugs. The number, location, and type (simple or complex) of PAVM and the diameter of the feeding artery were assessed at angiography. Safety was evaluated by successful detachment and absence of migration of the microvascular plug after deployment. Efficacy was assessed by technical success, defined as immediate stasis in the feeding artery above the microvascular plug at the time of angiography, and by the persistence rate at 1-year follow-up CT. Thirty-nine PAVMs (36 simple and three complex) were treated with 52 microvascular plugs in 22 consecutive patients. Thirty-three PAVMs were undergoing initial treatment and six were undergoing retreatment after previous embolotherapy. All microvascular plugs were successfully detached. No microvascular plug migration was observed. The mean (± SD) feeding artery diameter was 2.3 ± 0.7 mm. Technical success was achieved for 51 of 52 (98%) microvascular plug deployments. Follow-up CT, which was available for 20 of 22 (91%) patients, with a mean delay of 12.6 ± 3.1 months, showed two persistent PAVMs (persistence rate, 6%), one due to recanalization through the microvascular plug and the other due to reperfusion from an untreated adjacent pulmonary feeding artery. Microvascular plugs are safe and effective for treatment of PAVMs, with a low persistence rate (6%) 1 year after treatment.

Motivating Students in Massive Open Online Courses (MOOCs) Using the Attention, Relevance, Confidence, Satisfaction (ARCS) Model

Massive Open Online Courses (MOOCs) often have low persistence rates, which may be attributed to a learners’ lack of motivation. In this design-based research study, Keller’s Attention, Relevance, Confidence, Satisfaction (ARCS) motivational design model was integrated into two MOOCs as an initial exploration of how to design effective motivational interventions in MOOC environment. The Instructional Motivation Materials Scale (IMMS) was used to measure learners’ perceptions and reactions to the course components, in terms of the ARCS model, in both MOOCs. The whole design, implementation, and evaluation process was documented and reflected upon to provide practical guidance on designing motivational-enhanced materials in MOOC environments. The results revealed patterns of learners selectively paying attention, drawing relevance for self-determined reasons, having high confidence, and deriving satisfaction from multiple sources.

Persistence with brand versus generic oral bisphosphonates among newly treated osteoporosis patients: a retrospective cohort study in the French claims database

Introduction The first line of osteoporosis (OP) treatment is oral bisphosphonate (BP) and aims to reduce the risk of osteoporotic fracture. Although BP demonstrated his efficacy in preventing fractures, persistence with BP was estimated very low in previous studies in France and other countries. It has been proposed that persistence with generic BP formulations may be lower compared to brand formulations, due to changes of excipients reported to result in differences in disintegration time increasing the risk of upper gastrointestinal irritation. We aimed to compare the persistence with brand versus generic oral BPs. Methods We conducted a retrospective, comparative cohort study in the EGB (“Echantillon Generaliste des Beneficiaires”), a representative sample of the French Health Insurance claims database. We included all patients aged 50 and older, newly treated with oral BP (alendronic acid, ibandronic acid, risedronic acid or etidronic acid, without association with vitamin D) for primary osteoporosis between 01/01/2009 and 31/12/2015. Patients were followed from the initiation date until: switch (change from generic to brand drug and conversely, or change of BP molecule); discontinuation of BP (no new dispensation during a period greater than twice the expected duration of supply if taken as prescribed); or 12 months. Persistence was evaluated as time to discontinuation and as proportion of patients still on treatment at 6 and 12 months. Time to discontinuation and 6- and 12-month persistence were compared between patients who initiated treatment with generic and patients who initiated with brand BP, excluding patients who switched. Results In total, 3903 patients initiated an oral BP treatment for primary OP during the 7-year inclusion period, 1710 (44.0%) with generic BP and 2193 (56.0%) with brand BP. Mean age was comparable between the 2 groups: 70.8 (± 10.6) in “generic BP” group and 70.0 (± 10.4) in “brand BP” group. There were fewer women in the “generic BP” group than in “brand BP” group (respectively 87.8% and 90.3%; P = 0.01. 236 (13.8%) patients in “generic BP” group and 306 (14.0%) patients in “brand BP” group switched to the other BP group during the 12 months after initiation; 56 (3.3%) patients in the “generic BP” group and 175 (8.0%) patients in “brand BP” group have changed to another BP molecule, respectively. After exclusion of patients who switched, 6- and 12-month persistence were not statistically different between the 2 groups: respectively 43.9% and 33.8% in “generic BP” group and 41.7% and 31.3% in “brand BP” group (P = 0.22 and 0.14 respectively for 6- and 12-month persistence). Mean time to discontinuation was 185.6 days (± 138.3) in “generic BP” group and 183.1 days (± 138.1) in “brand BP” group. Conclusions There were no differences in persistence with brand or generic BP in this population. Low persistence rates in our analysis are consistent with results of other studies, and confirm that discontinuation of BP treatment is currently a public health concern. The reasons for discontinuation require further investigation, to inform shared decision-making in treatment choice and strategies to support long-term BP use.

Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review.

BackgroundSeveral drugs are available for the treatment of autoimmune rheumatic diseases; however, their effectiveness may be negatively influenced by inappropriate adherence. Low adherence and persistence rates have a significant impact on patient quality of life and are associated with health-related expenses.PurposeTo provide an up-to-date narrative review on treatment adherence and persistence rates, and discuss the factors that influence them, in patients with autoimmune rheumatic diseases.Materials and methodsWe searched the PubMed database for studies among patients with a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), or psoriatic arthritis (PsA), published from January 2015 to February 2017. Only studies with a well-defined measurement of adherence/persistence and those that carried out an evaluation of the influencing factors were included.ResultsFifteen relevant studies that evaluated adherence and/or persistence were included. Adherence rates varied between 9.3% and 94%, and persistence rates between 23% and 80%. Most of the studies used one method to evaluate adherence or persistence (different questionnaire scores, proportion of days covered, and mean treatment duration). A high concordance was found between the adherence measurements of the Medication Event Monitoring System and Visual Analog Scale. Factors of economic, demographic, and clinical nature were only moderately linked to treatment adherence or persistence. However, patient-related factors – such as positive and increased beliefs in medication necessity, strong views of the chronic nature of the diseases, and increased knowledge of the disease – were related to better treatment adherence.ConclusionOwing to the heterogeneity of the study results, we consider that the use of more than one method to assess adherence/persistence should yield more comprehensive and accurate data about patient adherence behavior. Patient-related factors should be included and analyzed more often in adherence studies as the former may be modified to improve patient adherence.

959 - Long term follow-up reveals a low persistence rate of abobotulinum toxin A and onabotulinum toxin A injections for neurogenic detrusor overactivity

959 - Long term follow-up reveals a low persistence rate of abobotulinum toxin A and onabotulinum toxin A injections for neurogenic detrusor overactivity

956 - Long term follow-up reveals a low persistence rate of abobotulinum toxin A injections for idiopathic OAB

956 - Long term follow-up reveals a low persistence rate of abobotulinum toxin A injections for idiopathic OAB

Persistence of contact allergy: a retrospective analysis.

Studies have shown that not all positive patch test reactions are reproducible upon retesting, that is, persistent. Non-persistent reactions might represent initial false-positive reactions, meaning that patients might unnecessarily avoid allergens. To investigate the occurrence of both persistent and non-persistent patch test reactions, to explore possible explanations, and to investigate whether allergen-specific differences exist. A retrospective analysis was performed on patients who were patch tested at least twice between 1 January 1995 and 31 October 2016, with at least one positive patch test reaction to an allergen that had been retested. Both univariable and multivariable analyses were performed to investigate the influence of several factors on persistence. Of 274 retested positive reactions in 119 patients, 183 (66.8%) reactions remained positive. The strongest predictor for non-persistence in both univariable and multivariable analyses was strength of the first patch test, with weak positive reactions being significantly less persistent. Regarding allergen groups, metals and fragrances were less persistent than other allergens. Weak positive reactions have a low persistence rate, and the dermatologist should be conservative in advising the patient on avoidance of these allergens, especially if clinical relevance is uncertain.

Student Attitudes toward Technology-Mediated Advising Systems

The literature on broad-access colleges suggests that low persistence and completion rates may be improved through better advising that employs a teaching-as-advising approach. While resource constraints have traditionally limited the ability of colleges to reform advising practices, technological advances have made it possible to implement technology-based advising tools, some of which can replace face-to-face services. Using focus group interview data from 69 students at six colleges, this study investigates students’ attitudes toward technology-mediated advising. More specifically, we seek to understand how students’ perceptions and experiences vary across different advising functions. We find that students are open to using technology for more formulaic tasks, such as course registration, but prefer in-person support for more complex tasks, such as planning courses for multiple semesters and refining their academic and career goals.

Real world persistence, adherence and switch-over across anticoagulants in atrial fibrillation-a national population-based study.

ABSTRACTBackgroundThe choice of oral anticoagulant(OAC) for stroke prevention in patients with atrial fibrillation(AF) is now between warfarin and four non-vitamin K anticoagulants(NOACs):dabigatran, rivaroxaban, apixaban and edoxaban. Although discontinuation rates were reported in clinical trials of the NOACs, real-world persistence, adherence and cross-over between therapies are unknown.
 MethodsPrescription data for OACs in adults with AF between April 2011 and December 2015 were analysed from a representative national primary care database in England(The Health Improvement Network, THIN). Edoxaban was approved for use in the UK in September 2015 and therefore insufficient numbers of prescriptions were available for analysis. Persistence(estimated by gap between prescriptions) and adherence(proportion of days covered, PDC) for OACs were assessed in individuals with AF newly treated with dabigatran, rivaroxaban, apixaban or warfarin with at least 365 days follow-up after the prescription date. For each NOAC, the proportion of cross-over to another OAC was analysed.
 ResultsAmong 4,354,740 individuals, 118,056 with AF were identified, of which 82,795 had available prescription data for OACs. Of these patients, 78,447 had at least 12 months data: warfarin (n=67781), dabigatran (n=2540), rivaroxaban (n=5666) and apixaban (n=2460). At 1 year, the crude persistence rates were 88.7% (95% CI 88.4-88.9) for warfarin, 59.1% (57.2-61.0) for dabigatran, 64.7% (63.4-65.9) for rivaroxaban and 67.0% (65.1-68.9) for apixaban. Persistence was significantly lower than in the clinical trials and was lower for NOACs than warfarin.
 The adherence rates (PDC>80%) were 87.5% (CI 87.3,87.6) for warfarin, 83.5% (CI 82.3,84.8) for dabigatran, 84.1% (CI 83.1,85.1) for rivaroxaban and 83.6% (CI 81.6,85.5) for apixaban. The proportion of NOAC users crossing over to another NOAC and to warfarin were 12.1% and 7.3% for dabigatran, 3.4% and 3.4% for rivaroxaban, and 1.9% and 1.5% for apixaban respectively.
 ConclusionsIn a large English population, NOACs exhibited lower persistence rates than in clinical trials, warranting further analyses of side effect profile and acceptability of OACs. Routinely collected data can be used to measure real-world persistence and adherence which are important in future studies of comparative effectiveness.

Real life persistence rate with antimuscarinic treatment in patients with idiopathic or neurogenic overactive bladder: a prospective cohort study with solifenacin

BackgroundSeveral studies have shown that the antimuscarinic treatment of overactive bladder is characterized by low long-term persistence rates. We have investigated the persistence of solifenacin in real life by means of telephonic interviews in a prospective cohort. We included both patients with idiopathic overactive bladder as well as neurogenic overactive bladder.MethodsFrom June 2009 until July 2012 patients with idiopathic or neurogenic overactive bladder who were newly prescribed solifenacin were included. In total 123 subjects were followed prospectively during one year by means of four telephonic interviews, which included questions about medication use and adverse events.ResultsAfter one year 40% of all patients included was still using solifenacin, 50% discontinued and 10% was lost to follow-up. In the neurogenic group 58% was still using solifenacin versus 32% in the idiopathic group after one year (p < 0,05). The main reasons to stop solifenacin were lack of efficacy, side effects and a combination of both.ConclusionsThis prospective cohort study showed a real life continuation rate of 40% after 12 months. This continuation rate is higher than found in most other studies.The use of regular telephonic evaluation might have improved medication persistence. The findings of this study also suggest that patients with neurogenic overactive bladder have a better persistence with this method of evaluation compared to patients with idiopathic overactive bladder.Trial registrationThis study was retrospectively registered on march 17, 2017 at the ISRCTN registry with study ID ISRCTN13129226.

In Pursuit of Success: Latino Male College Students Exercising Academic Determination and Community Cultural Wealth

Discourse about Latino male college students centers on their low enrollment, persistence, and graduation rates. Two asset-based theoretical frameworks were used to understand how 21 Latino males’ academic determination was nurtured and sustained by cultural wealth at selective institutions. Although most participants entered college with unclear educational goals, they aspired to become ideal college students who effectively balanced personal, academic, and social commitments. Most participants relied on peer networks instead of faculty and administrators to achieve their educational goals. Implications for research, policy, and practice focus on the role cultural wealth can play in Latino male college students’ academic determination.

Home Away From Home: Native American Students’ Sense of Belonging During Their First Year in College

ABSTRACTNative American students are an underrepresented population in higher education with discouraging low 1st-year persistence rates when compared with the general population. Using the peoplehood model, this analysis employed the Indigenous methodology sharing circles to explore Native American students’ sense of belonging (n = 24) and factors that influence it during their critical 1st year in college at Southwest University (pseudonym). Findings indicated that many Native students experienced racial microaggressions and structured disconnections from their home communities. Family and the Native student center on campus provided a “home away from home” environment. Although these were important in helping students create a localized sense of belonging, they only were necessary to the extent that the culture of the institution served to invalidate the Native students’ peoplehood. To support Native students’ sense of belonging, institutions must validate and incorporate Native culture and perspectives within the ingrained Eurocentric cultures of non-Native colleges and universities.