Medication Compliance Research Articles

Assessment of Knowledge About High Blood Pressure Among Syrians

Hypertension, often referred to the silent killer, is a prevalent health issue that impacts more than a billion individuals worldwide. The purpose of this study was to investigate the understanding of hypertension among Syrian individuals. 104 individuals filled out surveys. Females made up 64.4% of the group that was surveyed. 28.8% of the participants in the study were between the ages of 46 and 60. More than half of the participants had a study or a work related to the medicinal field. The participants showed good medication adherence where the score of accurate responses to the questions regarding medication compliance was very high. Most participants were familiar with the normal values of blood pressure levels and were optimistic about the possibility of treating the condition. A good percentage of individuals surveyed stated that smoking and obesity are contributing factors to developing high blood pressure. Most participants believed that consuming fatty foods raises plasma cholesterol levels. Participants had a good overall understanding of high blood pressure. However, they still need improvement in medical information about high blood pressure to enhance compliance with treatments.

Effect of Low Glycemic Index Diet on Type 2 Diabetes

The rising incidence of type 2 diabetes (T2D) is seriously affecting the quality of life of individuals worldwide. Patients with T2D need to take medication to control blood sugar level for a lifetime, but the problem of poor medication compliance has always troubled clinical workers, and the role of diet improvement as a treatment of diabetes “five carriages” is particularly important. In recent years, the importance of food glycemic index (GI) has been extensively studied, and an increasing number of studies advise using low-GI foods as the main source of carbohydrates rather than high-GI foods. In addition to improving a person’s quality of life on a daily basis, a low-GI diet can help prevent and treat type 2 diabetes and lower the risk of its consequences, through controlling the amount of blood sugar and blood lipids. However, there are still some limitations about low GI diet, for example the complex calculating process results in a small number of clinical uses. Through a review of the literature, analysis of experimental data, and expansion of the research on the benefits of a low-GI diet in reducing T2D problems, this report validates the use of a low-GI diet.

Control of arterial hypertension in the context of metabolically-associated disease: challenges and opportunities in Ukraine

Abstract Background/Introduction Arterial hypertension is a prevalent, but modifiable cardiovascular (CV) risk factor. Effective control of blood pressure (BP) is associated with decreased rates of CV morbidity and mortality, as was convincingly demonstrated in randomized clinical trials. There is a substantial gap between BP control in clinical trials and real clinical practice due to multiple factors – e.g. lack of awareness, low medication compliance, side effects of medications, and insufficient availability of medical care – to name the few. The association between poor BP control and metabolically associated disease (MAD) like diabetes and obesity is widely acknowledged and considered the key challenge in effective management of arterial hypertension. Purpose To determine patterns of awareness and control of arterial hypertension in the context of MAD in Ukrainian outpatient patient sample. Methods We enrolled 309 subjects (108 with MAD and 201 without MAD). MAD was defined as the presence of type 2 diabetes and/or overweight/obesity. All subjects were consented for the structured interview and triple sitting BP measurement with an automated device. Results MAD-positive and MAD-negative groups were comparable by age (54.4±1.34 vs 51.8±1.2 years, p=0.29), systolic BP (141.3±2.0 vs 137.4±1.6 mm Hg, p=0.082), diastolic BP (85.2±1.2 vs 82.5±0.9 mm Hg, p=0.13). Presence of MAD was associated with increased odds of having BP>139/89 mm Hg (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.04-2.67, p=0.035), better awareness on hypertension (OR 2.65, CI 1.64-4.28, p=0.0001), and less prevalent normotension (OR 0.51, CI 0.31-0.84, p=0.008). Among MAD-positive patients without history of HTN, 50% actually had elevated office BP, although it did not reach statistical significance as compared to MAD-negative subjects (OR 1.32 CI 0.68-2.56, p=0.42, see Picture 1). Less MAD-positive patients did not take any antihypertensive drugs (37.0% vs 56.7%, difference -19.7%, CI -8.03 to -30.51%, p=0.001), and more of them were taking 3 antihypertensive drugs (17.6% vs 7.5%, difference 10.1% CI 2.58-18.85. p=0.007). Only 53.7% of MAD-positive subjects and 39.8% of MAD-negative subjects claimed they were taking BP-lowering medications on a regular basis (p=0.02). There was no difference in achievement of BP control between MAD-positive and MAD-negative groups (39.2 vs 38.7% for subjects who were aware of HTN, 31.9 vs 31.3% of all hypertensive individuals, p=NS for both). More MAD-positive than MAD-negative subjects admitted they consume alcohol several times per week or daily (22.2 vs 12.4%, p=0.025). Conclusions MAD disease is associated with more prevalent HTN and better awareness on elevated BP. MAD requires more intensive BP-lowering therapy to achieve target BP, but the compliance to medications is suboptimal.Patterns of awareness and BP control

Eliciting medication preferences of patients with type 2 diabetes under different insurance coverages in China

ObjectiveTo understand the medication preference of type 2 diabetes mellitus (T2DM) patients with different insurance coverages, and to provide reference for improving the patient-centered clinical treatment decision.MethodsThis study used Discrete Choice Experiment (DCE) to elicit preferences of T2DM patients with different insurance coverages in China. A multistage stratified cluster-sampling procedure for data collection and a total of 1,409 valid respondent were conducted.ResultsSeven attributes have significant influence on the preference of T2DM patients with Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) (p < 0.05). T2DM patients with UEBMI pay the most attention to Gastrointestinal adverse events, while T2DM patients with URRBMI pay the most attention to the Treatment efficacy/reduction in HbA1c. Patients with different medical insurance have different willingness to pay for Cardiovascular benefits, Mode of administration and Weight change. When Gastrointestinal adverse events is changed from higher (40%) to none (0%), patients with UEBMI are willing to pay ¥523.49 more per month, while patients with URRBMI are only willing to pay ¥266.62; When the Treatment efficacy/reduction in HbA1c changes from poor (0.5%) to Highest (2.5%), patients with UEBMI are willing to pay ¥518.44 more per month, while patients with URRBMI are willing to pay ¥328.33 more per month. The Gastrointestinal adverse events and the Treatment efficacy/reduction in HbA1c are the primary factors for T2DM patients with UEBMI and URRBMI, followed by the Hypoglycemic risk.ConclusionPhysicians should consider patients’ medication preferences in clinical medication treatment of T2DM patients with different insurance coverages, make targeted treatment decisions, and improve patients’ medication compliance to achieve better treatment results.

Quality of Life Effects of Renal Artery Stenting Versus Medical Therapy for Atherosclerotic Renal-Artery Stenosis: Results from the Randomized CORAL Trial.

Renal-artery stenosis can be associated with difficult to control hypertension, although renal-artery stenting has not been shown to improve clinical outcomes. Alternative antihypertensive medications could potentially result in quality of life benefits with renal-artery stenting. We performed a pre-specified quality of life sub-study of the CORAL trial-multicenter, randomized, open-label trial of renal-artery stenting versus medical therapy in patients with atherosclerotic renal-artery stenosis. Longitudinal growth curve models were used to compare the Physical Symptoms Distress Index (PSDI), SF-36, and EQ-5D scores over time between treatment groups. We also sought to validate the approach of assessing quality of life in hypertension studies. Among 906 patients (mean age 69.2±9.1years, 49.7% men), symptom frequency and distress due to side effects from antihypertensive medications changed minimally over time, with no significant differences between treatment groups. There were also no clinically significant differences between treatment groups for the SF-36 and its subscales or the EQ-5D. In internal validation of the quality of life measures, the PSDI correlated well with number/type of antihypertensive medications, and generic health status measures correlated with late clinical events. In a large, multicenter, randomized clinical trial, we found no significant benefit of routine renal-artery stenting over medical management for the treatment of atherosclerotic renal-artery stenosis in terms of disease-specific or generic quality of life measures. As these quality of life measures are important to patients and are associated with medication compliance, future studies of antihypertensive treatments should consider including these quality of life measures as secondary outcomes. Trial registration: ClinicalTrials.gov: NCT00081731.

Impact of Co-Management Mode on Diagnosis and Treatment Compliance in Community-Level Diabetic Patients with Retinopathy.

Aims/Background To implement a co-management mode among community-level diabetes patients and analyze its impact on diagnosis and treatment compliance and diabetic retinopathy of the patients. Methods A total of 80 patients who underwent diabetic retinopathy examination in Lanxi People's Hospital from January 2021 to March 2022 were retrospectively selected as the study objects. The clinical data of the patients were analyzed, including 40 patients who adopted the conventional diabetes management mode from January 2021 to August 2021 as the control group. From September 2021 to March 2022, 40 patients in the county medical service community diabetes management team model were adopted as the management group. The two groups of patients were compared in terms of diabetic retinopathy indictors, biochemical examination indicators, self-management ability, and nursing management satisfaction. Results Number of patients complying with treatment protocols in the management group was higher than that in the control group (p < 0.05). The blood spot area, macular thickness, hemangioma volume, and visual-field grayscale value in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The levels of diastolic blood pressure (DBP), systolic blood pressure (SBP), fasting blood glucose (FBG), hemoglobin A1C (HbA1c), total cholesterol (TC), and triglyceride (TG) in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The scores of disease cognition ability, self-management ability, and nursing management satisfaction in the management group were all higher than those in the control group (p < 0.05). Conclusion By changing management concept and implementing the whole-process management and treatment mode for diabetic patients within the scope of the county medical service community, the diagnosis and treatment compliance of the patients can be improved, and the effective control of blood glucose, blood pressure, and blood lipid levels can be achieved, thereby improving the self-management ability and nursing management satisfaction of the patients and providing a new nursing mode for chronic disease management.

Multi-level barriers and facilitators to implementing evidence-based antipsychotics in the treatment of early-phase schizophrenia.

Long-acting injectable (LAI) antipsychotic medications and clozapine are effective yet underutilized medical therapies in early intervention services. The purpose of this study was to conduct a pre-implementation evaluation of contextual determinants of early intervention programs to implement innovations optimizing LAI antipsychotic and clozapine use within a shared decision-making model. Semi-structured interviews explored barriers and facilitators to implementing LAI antipsychotics and clozapine in early intervention services. Participants were: prescribers (n = 2), non-prescribing clinicians (n = 5), administrators (n = 3), clients (n = 3), and caregivers (n = 3). Interviews were structured and analyzed using the Consolidated Framework for Implementation Research (CFIR 2.0). Participants were supportive of using LAI antipsychotics, despite barriers (e.g., transportation, insurance coverage), while most were unfamiliar with clozapine (Innovation). Critical incidents (e.g., COVID-19) did not interfere with implementation, while barriers included lack of performance measures; stigma affecting willingness to take medication; and clozapine considered to be a "last resort" (Outer Setting). Treatment culture was described as client-centered and collaborative, and most participants indicated LAI antipsychotic use was compatible with clinic workflows, but some were in need of resources (e.g., individuals trained to administer LAI antipsychotics; Inner Setting). Participants on the healthcare team expressed confidence in their roles. Family education and collaborative decision-making were recommended to improve client/family engagement (Individuals). Participants related the importance of tracking medication compliance, addressing client concerns, and providing prescribers with updated guidelines on evidence-based treatment (Implementation Process). Results may guide implementation strategy selection for future programs seeking to optimize the use of LAI antipsychotics and clozapine for early-phase schizophrenia, when appropriate.

Bipolar disorder and early childhood trauma

Case Background There is a reported 48.8 million case of bipolar disorder (BD) world- wide. It can also be one of the most challenging disorders to manage clinically as patients often have poor medical compliance and numerous relapses throughout their lifetime. The etiology of this illness is still poorly understood, but it is recognized to compromise both genetic and environmental factors. Regarding the latter, abuse and instability in childhood and adolescence was reported as an important area of consideration in regard to the development and prognosis of bipolar disorder. We report here the case of a female who exemplifies the significance of early childhood experience in this disorder. Case Presentation Isabelle is a 21 year old, female, with a background history of bipolar disorder. She presented to the Cork University Hospital accident and emergency 2 weeks after discharge after a 4 week admission for a depressive episode. Isabelle was referred from the home-based team with an acute episode of mania and was detained involuntarily under the Mental Health Act. Her history is significant for childhood neglect, physical, emotional and sexual abuse, along with multiple foster care placements. She was managed as an inpatient with antipsychotics and a mood stabilizer before being discharged after a lengthy, arduous, admission. Conclusion Childhood trauma is an important consideration in BD. Therefore, practitioner awareness of the role of such trauma with regard to its etiology and prognosis is of great importance. It is also essential to the practice of preventive medicine. Patient Consent Obtained: Yes

Application of Alfalfa App in the management of oral anticoagulation in patients with atrial fibrillation: a multicenter randomized controlled trial

BackgroundIn recent years, mobile medical technology has made great progress in chronic disease management, but its application in patients with atrial fibrillation (AF) still needs to be clarified.ObjectiveThis study aims to determine whether the newly developed smartphone app for patients with AF (Alfalfa App) can improve anticoagulation knowledge, drug treatment compliance, and satisfaction of AF patients.MethodsAlfalfa App integrates the functions of patient education, remote consultation, and medication reminder through a simple user interface. From June 2020 to December 2020, patients with AF were recruited in five large tertiary hospitals in China. Patients were randomly divided into the Alfalfa App or routine nursing groups. Patients’ knowledge, medication adherence, and satisfaction with anticoagulation were assessed using validated questionnaires at baseline, 1 month, and 3 months.ResultsIn this randomized controlled trial, 113 patients with AF were included, 57 patients were randomly assigned to the Alfalfa App group, and 56 patients were randomly assigned to the routine nursing group. Forty-eight patients in the Alfalfa App group completed a three-month follow-up, and 48 patients in the routine nursing group completed a three-month follow-up. Basic demographic data were comparable between the two groups. The average age of AF patients was 61.65 ± 11.01 years old, and 61.5% of them were male. With time (baseline to 3 months), the knowledge scores of the Alfalfa App group (P<.001) and the routine nursing group (P = .002) were significantly improved, the compliance scores of the routine nursing group(P<.001) and Alfalfa App group(P<.001) significantly improved. Compared with the routine nursing group, patients’ knowledge level and medication compliance using the Alfalfa App at 1 month and 3 months were significantly higher (all P < .05). There were significant differences in knowledge and compliance scores between the two groups with time (all P < .05). The satisfaction degree of drug treatment in the Alfalfa App group was significantly better than that in the routine nursing group (all P < .05).ConclusionsAlfalfa App significantly improved the anticoagulation knowledge, drug treatment compliance, and satisfaction of AF patients. In oral anticoagulation management for AF patients, mobile medical technology that integrates the functions of patient education, remote consultation, and medication reminder may be helpful.Trial registrationRegistration number, ChiCTR1900024455. Registered on July 12, 2019.

Medication Adherence and Its Relationship With Quality of Life and Functionality in Individuals With Bipolar Disorder: A Cross-Sectional Correlational Study.

The current cross-sectional correlational study aimed to determine the relationship of medication adherence with functionality and quality of life in individuals with bipolar disorder (BD). The research was conducted with 141 individuals with BD followed as outpatients. Data were collected using an information form, Morisky Medication Adherence Scale (MMAS), Quality of Life in Bipolar Disorder Scale (QoL.BD), and Bipolar Disorder Functioning Questionnaire (BDFQ). A significant positive correlation was found between participants' MMAS total score and QoL.BD (p < 0.001) and BDFQ (p < 0.05) scores. A significant positive correlation was also found between QoL.BD and BDFQ scores (p < 0.001). Medication compliance positively affects quality of life and social functionality in individuals with BD. Thus, interventions to increase medication adherence are recommended. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Immunosuppressive medication adherence and affecting factors in solid organ transplantation patients: a mixed-methods study

Objectives: Transplantation is a form of treatment that requires long-term pharmacotherapy. After transplantation, patients may have difficulty adapting to medication use for various reasons, and this may result in rejection. The aim of this study is to determine participants’ medication compliance and the factors affecting it. Methods: The research was conducted with a sequential explanatory mixed method. In the study, quantitative data were collected using the Turkish Immunosuppressive Medication Adherence Scale, and qualitative data were collected using the In-Depth Individual Interview Guide. Quantitative data were analyzed using statistical methods, and qualitative data were examined according to Braun and Clarke's thematic analysis framework. Results: In this study, 62.3% of the participants were male, 37.0% were 50 years old and over, 71.3% lived with their spouse, 54.0% had primary and secondary school education, and 42.0% could not work due to their current health condition. From a clinical perspective, it was determined that 78% of the transplants were kidney transplants, and 41.3% were more than 4 years after transplantation. 74.3% of the transplants were from living donors. The mean score of the immunosuppressive medication compliance scale was determined to be 40.91±4.09. In the qualitative data analysis of the study, factors affecting medication adherence were examined and the themes of "individual factors", "complexity of the regimen" and "social support resources" were obtained. The sub-themes of the individual factors theme are reluctance, hopelessness and addiction; Sub-themes of the complexity of the regimen theme are drug side effects and polypharmacy; The sub-themes of the social support resources theme are loneliness and family pressure. Conclusions: The factors influencing medication adherence among organ transplant recipients have been investigated, revealing that adherence levels vary significantly depending on various factors. These findings underscore the importance of tailored care strategies and individualized support approaches.

Barriers to Cardiac Rehabilitation Enrollment and Secondary Prevention Adherence in Patients with Coronary Heart Disease Following Percutaneous Coronary Intervention: A Cross-sectional Survey.

This study aimed to evaluate adherence to secondary prevention measures and to identify barriers to cardiac rehabilitation enrolment among patients with coronary heart disease after percutaneous coronary intervention. An observational cross-sectional survey was conducted through computer-assisted telephone interviews to assess recently treated percutaneous coronary intervention patients at the Prince Sultan Cardiac Center in Saudi Arabia. Out of 104 surveyed patients with coronary heart disease, 85 (82%) were male, with an average age of 59.5 years. The obesity rate was 28% (n = 29), with a high prevalence of comorbidities: 82 (79%), 63 (61%), and 62 (60%) patients had hyperlipidemia, diabetes, and hypertension, respectively. Despite high medication compliance (97%), adherence to secondary prevention measures was low (21%). Adherence to physical exercise and weight monitoring for fluid body build-up was notably poor at 35% and 9%, respectively. Only 11 (10.6%) patients were referred for cardiac rehabilitation, of whom only four (36.4%) attended. Significant barriers such as a lack of staff contact, insufficient physician support, and distance to cardiac rehabilitation facilities were particularly noted by 69% of rural patients. This study underscores the significant cardiac risk factors and low adherence to secondary prevention measures among post revascularization patients with coronary heart disease in Saudi Arabia. Low referral and other organizational barriers, as well as the travel distance to hospital-based cardiac rehabilitation, hinder program enrolment. To improve cardiac rehabilitation accessibility, it is crucial to revise the discharge plans, implement automated referral systems, expand the services across all regions, and utilize alternative delivery models.

Discrepancy between Subjective and Objective Measurements for the Evaluation of Medication Adherence-A Cross-Sectional Study in Patients with Cardiovascular Diseases.

Medication adherence is important for the appropriate drug-based treatment in patients with chronic diseases, especially those with cardiovascular diseases (CVDs). The purpose of the present study was to evaluate medication adherence among patients with CVDs using subjective and objective measurements. We enrolled outpatients who visited Fukuoka University Chikushi Hospital from June to December 2022. As a subjective measurement, we used a self-reported questionnaire developed by Ueno et al., which consists of 12 questionnaire items grouped into the following four domains: medication compliance (subjective compliance), collaboration with health care providers (collaboration), willingness to access and use information about medication (willingness), and acceptance to take medication and how taking medication fits a patient's lifestyle (acceptance). The pill counting method was used as an objective measurement to calculate the medication adherence rate; Poor Adherence was defined as a medication adherence rate of <100%. Ninety-four patients were analyzed. No statistically significant differences were observed between the patients in the Good and Poor Adherence groups classified by pill counting, an objective indicator; in the subjective evaluation index Ueno scale scores of subjective compliance, collaboration, willingness, and acceptance domains; and in the total score. A multivariate analysis revealed that obesity (odds ratio, 3.527; 95% confidence interval, 1.387-9.423; p = 0.008) was an independent factor associated with Poor Adherence. In conclusion, we found a discrepancy between subjective and objective measurements for the evaluation of medication adherence. Furthermore, obesity was an independent factor associated with poor medication adherence assessed by the pill counting method; thus, patients with CVD and obesity require a careful follow-up.

The practice and effect of multi-disciplinary cooperative mobile devices in improving the satisfaction of inpatients on drug education

Objective: To explore the effect of multi-disciplinary cooperative mobile device-assisted drug education on the satisfaction of inpatients drug education. Methods: Mobile nursing vehicle, IPAD, and mobile phone were used to scan QR code to play drug propaganda videos and distribute drug propaganda materials. Doctors, nurses and pharmacists cooperated to complete drug education for inpatients. The satisfaction on drug education of inpatients was collected through a third-party satisfaction survey. Results: Before implementation, the four satisfactions of communicating about the drug, understanding the purpose of the drug, informing the role of the drug and informing the side effect of the drug were 83.9%, 80.4%, 83.8% and 83.9%, respectively, and after the implementation increased to 88.2%, 86.4%, 89.6% and 87.3% (P&lt;0.05). The effective rate of drug education among inpatients increased from 95% before the implementation to 99.4%, and the medication compliance of inpatients increased from 93.1% before the implementation to 98.75%. Conclusion: Multi-subject cooperative mobile device-assisted drug education can improve the satisfaction of inpatients drug education, the efficiency of drug education and drug compliance. Keywords: Multidisciplinary collaboration; mobile devices; drug education; patient satisfaction.

7647 Myxedema Coma- A Rare and Fatal Manifestation of Severe Hypothyroidism

Abstract Disclosure: B.K. Ray: None. R. Kaur: None. L. Kaur: None. M. Thakur: None. Introduction: Myxedema coma is a severe and life-threatening form of hypothyroidism. It is a rare occurrence with an incidence of 0.22 per million per year, associated with a high mortality rate ranging from 30 to 60% even with early diagnosis and treatment. This condition arises when the body's response to hypothyroidism is overwhelmed by factors like infection, surgery, and medication noncompliance. The definitive management is with thyroid hormones but supportive measures and identification and treatment of the precipitating factors is also vital. The case discussed concerns an elderly woman with myxedema coma due to noncompliance to Levothyroxine. This case stresses the importance of consistent medical follow-ups. Case Presentation: A 73 year old female presented to the hospital with altered mental status for about 32 hours. Vital signs at presentation showed hypotension (80/50 mmHg), bradycardia (54 beats per minute), tachypnea (32 breaths per minute) and hypothermia (33.2 °C). A computed tomography scan of the brain and Computed tomography angiography of the head/neck showed no stenosis or large vessel occlusion of the vasculature. Initial pertinent laboratory test results revealed a white blood cell count of 6.1 (3.7–11.0×103/uL), hemoglobin level of 14.3 (11.5–16.0 g/dL), sodium level of 131 (136–145 mmol/L), glucose level of 142 (65–125 mg/dL). Troponin, lactate and procalcitonin were normal. She was intubated and transferred to the Intensive care unit. Thyroid function tests revealed a markedly elevated TSH of 37.9 (0.4 to 4.0 mIU/L) and a decreased T4 of 0.3 (0.9-1.7 ng/dL). She was immediately started on hydrocortisone 100 mg Three times daily and initiated on intravenous levothyroxine monotherapy with a loading dose of 200 mcg followed by 100 mcg daily. Her T4 level was trended daily and she demonstrated gradual improvement. She was successfully extubated. On discussion she reported noncompliance with her medications. Hydrocortisone was tapered and she was started on her home dose of oral Levothyroxine (200 mcg) after four days of Intravenous levothyroxine. She was counselled on medication compliance and discharged to home. Conclusion: Myxedema, an extreme form of hypothyroidism, is life-threatening and requires immediate admission to intensive care. Symptoms are usually vague, and require a high degree of suspicion. Treatments include thyroid hormone supplementation, steroid replacement and supportive care. Early detection and quick intervention are crucial for survival. Patient education on medication compliance, regular testing, and reporting new medication to prevent interference with thyroid metabolism is crucial. Presentation: 6/1/2024

12397 Predictors Of Hospital Readmission Within Three Months Among Patients Admitted For Diabetic Ketoacidosis (dka)

Abstract Disclosure: O. Onwudiwe: None. L. Yerashevich: None. C. Onwudiwe: None. B. Baral: None. A. Acharya: None. H. Nguyen: None. Purpose: Diabetic ketoacidosis (DKA) represents a critical, life-threatening complication of diabetes, with higher rates of re-admission noted among individuals from lower socioeconomic backgrounds, those lacking insurance coverage, and those with suboptimal follow-up care. This study seeks to identify predictors of hospital readmission within three months among patients admitted for DKA in a community hospital setting. Methods: Patient data were extracted from electronic medical records from 2019 to 2021 for individuals admitted due to DKA using ICD codes. DKA diagnosis was based on the presence of hyperglycemia, high anion gap metabolic acidosis, and ketonemia. Demographic information, results of routine biochemical tests, insurance status, follow-up with primary care providers (PCP) or endocrinologists, and clinical progression were retrospectively collected from patients' records. Multivariable logistic regression analyses were conducted to identify predictors of readmission. Results: A total of 222 unique DKA admission visits were analyzed. The mean age (standard deviation) of the patients was 48 (16) years, and 58% of them were male. Among these visits, 39% had type 1 diabetes, 43% had type 2 diabetes, and 18% were newly diagnosed diabetes cases. The majority of patients were overweight, with a mean body mass index (BMI) of 27, and the mean glycated hemoglobin level was 10.8. Common triggers for DKA included insulin non-adherence (52%), infection (37.8%), and alcohol use (8.6%). Logistic regression analysis revealed that lack of follow-up significantly increased the odds of readmission within three months (B = 2.025, p = .003, Exp(B) = 7.576, 95% CI [1.952, 29.401]), as did having type 1 diabetes (B = 1.473, p = .019, Exp(B) = 4.364, 95% CI [1.272, 14.978]). However, the association between insulin adherence and readmission was not statistically significant at the conventional alpha level of 0.05 (B = 1.329, p = .112, Exp(B) = 3.777, 95% CI [0.733, 19.458]). Other demographic (age, gender, employment status, insurance status, medication compliance,) and clinical [insulin adherence, presence of infection, blood glucose level at diagnosis of DKA, and level of glycated hemoglobin (Hba1c)] variables did not significantly predict readmission within 3 months. Conclusion: DKA, being preventable with adequate insulin adherence, is also influenced by factors such as infection and lifestyle choices. The findings highlight the critical role of post-discharge follow-up care in reducing readmission rates among DKA patients. Healthcare providers should prioritize ensuring timely and comprehensive follow-up, particularly for patients with type 1 diabetes, to optimize post-hospitalization management and prevent avoidable readmissions. Presentation: 6/3/2024

8380 Pituitary Stalk Interruption Syndrome, A Rare Cause of Panhypopituitarism

Abstract Disclosure: F. Abdulkarim: None. E. Alshdifat: None. P. Henriquez Feliz: None. J. Vargas-Jerez: None. T. Zahra: None. Pituitary Stalk Interruption Syndrome, A Rare Cause of Panhypopituitarism Faridat Abdulkarim, MD. Esra’a Alshdifat, MD. Pamela Henriquez Feliz, MD. Julia Vargas- Jerez, MD. and Tasneem Zahra, MD. Introduction: Pituitary stalk interruption syndrome (PSIS) is a rare congenital pituitary anatomical abnormality with reported incidence of 0.5 per 100,000 live births. It is characterized by the triad of thin or interrupted pituitary stalk, absent or ectopic posterior lobe and hypoplastic or aplastic anterior lobe seen on MRI. The anterior pituitary function is usually impaired however the posterior pituitary is usually intact and normal. We report a case of a Now 34-year-old Female who presented to the endocrine clinic with underdeveloped sexual characteristics. MRI done was consistent with PSIS. This is the second case of PSIS we report from our Institution. Case Presentation: A Now 34-year -old Hispanic American Female presented to our endocrine clinic with underdeveloped secondary sexual characteristics. She had panhypopituitarism, including Growth hormone deficiency and was treated with growth hormone from early childhood until age 13-14 years. She re-presented to our clinic at the age of 28 years after being lost to follow up for many years. On physical examination, she was 175cm tall, weighed 89.4kg and BMI 29.1kg/m2Patient has pre-pubertal breast, tanner stage 1, no axillary hair, small external genitalia with scanty pubic hair. Hormonal analysis revealed Estradiol &amp;lt;5 pg/mL (low), FSH 0.4 IU/L (low), LH &amp;lt;0.3 IU/L (low), Progesterone 0.1ng/mL (Low), Testosterone &amp;lt;2.5 ng/dL (8.4- 48.1ng/dl) Prolactin 22.3ng/mL (3.4-24.1 ng/ml), TSH 0.88uIU/mL (0.27-4.20), Free T4 0.5ng/dl (0.9-1.8) , ACTH 7.7pg/mL (7.2-63.3), Baseline AM Cortisol 0.7ug/dL (6.0-18.4) and 5.5 ug/dL after Cosyntropin test, IGF-1 17ng/mL (83-280). Urinalysis revealed normal specific gravity. Chromosome analysis with Normal Karyotype 46XX. Pelvic US revealed Markedly diminutive uterus and ovaries. MRI of the pituitary was highly suggestive of PSIS. She is currently being treated with levothyroxine and hydrocortisone Conclusion: PSIS is a rare congenital abnormality. Fortunately has good prognosis, however if left undiagnosed/untreated has high mortality mainly from Adrenal insufficiency and Myxedema coma. The patient discussed above, has underdeveloped sexual characteristics and primary amenorrheaLaboratory finding consistent with Panhypopituitarism with Normal prolactin which is the case in most patient with PSIS. Imaging revealed atrophic uterus and ovaries, and MRI revealed Findings which are highly suggestive of PSISShe previously had problems with outpatient clinic visits and medication compliance. However, she is currently compliant with hormonal replacement therapy which is the mainstay of treatment. Presentation: 6/3/2024

12475 Revisiting Myxedema Coma

Abstract Disclosure: M.H. Islam: None. D.R. Jimenez Corado: None. S. Siddiqui: None. M.F. Aquino Camey: None. S. Yeasmin: None. Background: Myxedema coma is a rare and life-threatening complication of hypothyroidism.Although it is rare in the era of better diagnostics and treatment modalities, its life-threatening nature mandates its timely recognition and better understanding. Case:81-year-old female with a history of hypothyroidism (unclear medication compliance) and alcohol use disorder was admitted due to alcohol withdrawal and treated with benzodiazepines. A few days prior to the presentation, she was found to have worsening confusion, unsteady gait, and multiple falls. On presentation, she was hemodynamically stable, tremulous, anxious, and oriented to person only. Blood work was remarkable for mild transaminitis. CT scan of the head revealed sequelae of microvascular disease. The day after admission, she was noted to be lethargic, and benzodiazepines were held. Later, she became hypothermic, hypotensive, bradycardic, and hyponatremic. Further investigation was pursued, revealing a TSH of 55 (normal 0.27 to 4.2 mlU/L), free T4 of &amp;lt;0.10 ng/dL (normal 0.8-1.7 ng/dL), free T3 of &amp;lt;1.0 pg/mL (normal 2.2-4 pg/mL), and cortisol of 10.7 ug/dL. Due to concerns of myxedema coma, she was started on stress dose steroids and IV levothyroxine. She was transferred to the ICU as her mental status continued to deteriorate; she underwent endotracheal intubation and received additional doses of IV levothyroxine and liothyronine. After a few days, her clinical condition and her cortisol, free T4, and free T3 levels improved; she was extubated and later discharged with an adjusted levothyroxine dose. Conclusion: It is of absolute importance to keep myxedema coma as a differential diagnosis when evaluating encephalopathic elderly patients, especially those with a history of thyroid disorders.There is a paucity of evidence to suggest a clear benefit of combining levothyroxine-liothyronine over levothyroxine alone. Treating initially with intravenous levothyroxine over oral is beneficial, as GI absorption and bioavailability are likely variable and unpredictable. In this case, oral liothyronine was used with IV levothyroxine to speed up clinical and biochemical recovery.Adrenal insufficiency often coexists with hypothyroidism, with considerable overlap in clinical features like hypotension, hypoglycemia, and hyponatremia. Administration of levothyroxine before steroids can lead to a rapid increase in metabolic rate and subsequent depletion of the existing reserves. Considering this, it can be said with fair confidence that patients need prior or concomitant stress doses of corticosteroids on an emergent basis. Later, biochemical testing can be done to evaluate the functioning of the hypothalamic-pituitary-adrenal axis and then adjust steroid doses accordingly. Presentation: 6/1/2024

A conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression

Background: Medication non-compliance is a significant healthcare issue that is widespread. Extensive research has identified factors that contribute to medication non-compliance in different healthcare settings. As a result, there was a need to develop a conceptual framework to facilitate medication compliance among adults living with depression.Objectives: The purpose of this study was to develop a conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression.Method: A qualitative, exploratory, descriptive and contextual research design was utilised to investigate the experiences of adults living with depression who are non-compliant with medication. The study consisted of three phases: an empirical phase, a classification of concepts and a development phase. Following the empirical phase, a conceptual framework was developed based on the classified concepts.Results: Three sets of results were merged for the cross-validation analysis, combining findings from the systematic review, the researcher’s previously conducted and published minor dissertation and the current study.Conclusion: A conceptual framework was developed to assist psychiatric nurses in effectively promoting an internal locus of control among adults living with depression. The resulting conceptual framework provides valuable insights and serves as a valuable tool for future research endeavours aimed at enhancing medication compliance among adults living with depression.Contribution: This framework serves as a valuable guide for future studies that aim to explore medication compliance among adults living with depression, specifically by focussing on the concept of internal locus of control.

Left atrioventricular valve regurgitation repair with concomitant outflow obstruction release on repaired atrioventricular septal defect case

BackgroundLeft ventricular outflow tract stenosis and atrioventricular valve regurgitation are often problems encountered in adulthood after complete atrioventricular septal defect repair. The surgical approach and indications for managing long-term outcomes such as left atrioventricular valve regurgitation and left ventricular outflow tract stenosis after complete atrioventricular septal defect repair have been discussed.Case presentationA 23-year-old woman with intellectual disability was diagnosed with complete atrioventricular septal defect and underwent two-patch repair without cleft closure in childhood. Follow-up examination in adulthood demonstrated moderate left-sided atrioventricular valve regurgitation and left ventricular outflow tract stenosis with a circumferential ridge (peak velocity, 3.7 m/s; pressure gradient, 54 mmHg). Intraoperative findings showed a circumferential ridge under the aortic valve, and we removed the ridge. In addition, a cleft was present at the anterior leaflet, and we completely closed the cleft. Anticoagulation therapy was not initiated, and no embolic complications occurred. Follow-up echocardiography demonstrated no ridge under the aortic valve and only mild-range left AVVR.ConclusionsWe successfully performed surgical treatment without valve replacement or anticoagulation therapy in a patient with poor medical compliance. Delayed reoperation leads to degeneration of the valve structure and makes more difficult to repair. Atrioventricular valve regurgitation should be evaluated in combination with based on the etiology of the regurgitation especially cleft related or not, in addition to the dilatation annulus, cleft size, and depth of the leaflet coaptation depth, and associated other valve diseases.