Non-compliant Group Research Articles

Non-compliance in Pediatric Nephrotic Syndrome

Background: Non-compliance to medications and health advice significantly impact care of patients as well as impose financial burden in nephrotic syndrome (NS) patients. Aim: The aim of this article is to determine the cause and consequence of non-compliance in NS patients. Materials and Methods: This prospective study was conducted between March 2020 and February 2021 in the department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Seventy-seven NS patients were recruited randomly. In-person interviews were conducted with attendents of patients, along with patients if possible. Clinical and laboratory data were collected from medical records. Residence, financial constraints, educational status, health advices (daily bed side urine test), relapses of disease, different types of immunosuppressive medications, etc. were provided for the cause of non-compliance. Consequences of non-compliance were observed through the experience of relapses, asthma attack or infection, and drug toxicity. Data were analyzed using SPSS software version 20. Results: A total of 77 patients were analyzed and among them 74.02% were non-compliant and 25.98% were compliant. Among the non-compliant patients, non-compliance to asthma medication, prednisolone, second-line immunosuppressive drugs, and third-line immunosuppressive drugs were 43.87%, 31.57%, 14.03%, and 10.53%, respectively. About 56.14% of the patients did not do bed side urine for albumin (BSUA). Remote location (63.15%), financial constraints (36.84%), low parental education (35.09%), ignorance (17.54%), and undetermined cause (17.50%) were observed as main contributing factors for non-compliance. Among study populations, 77.19% experienced more relapses in comparison to compliance (10%). Non-compliant patients experienced more asthma attack (70.17%, 40/57), pneumonia (63.2%), and steroid toxicity (36.8%) in comparison to the compliance group (45%, 36.8%, and 10%, respectively). About 31.57% of the non-compliant group had spent 30,000–70,000 taka in comparison to 5% in the compliance group and it was statistically significant (P = 0.031). Conclusion: Poor compliance to medications and health-related advices have diverse effects including frequent relapse, drug toxicity, higher rates of complications and hence increased healthcare cost. Remote location, ignorance, and idiopathic causes were major contributing factors behind non-compliance issue. Appropriate counseling might change this prevailing non-compliance scenario in future.

Impact of the COVID-19 pandemic in patients with a previous history of premature myocardial infarction

ObjectivesThe coronavirus-disease-2019 (COVID-19) pandemic has led to the restructuring of health-services to prioritize the treatment of COVID-19. The severe restrictions on daily life affected the management of chronic diseases. Patients with a previous history of premature myocardial infarction (MI) are a vulnerable group requiring frequent and continued medical attention both in the pandemic and non-pandemic era. The present study was conducted to provide insight into the impact of COVID-19 outbreak on heart-healthy lifestyle and management of patients with a history of premature MI. MethodsThis cross-sectional study included 170 consecutive patients with a history of premature MI who were already in regular follow-up in a tertiary out-patient prevention clinic before the pandemic. Inclusion criteria included age ≥18 years and being on regular follow up with the diagnosis of premature MI (documented MI before the age of 55 years) at least for one year. All patients were contacted by phone-call and replied to a 23-item questionnaire measuring the impact of the pandemic on the management, healthy lifestyle habits, and anxiety level. ResultsOne patient died due to COVID-19 infection; therefore the analyses were conducted in 169 patients (age: 47.67 ​± ​11.84 years, 21.3% women). The median age at first MI was 39 (IQR 10) years and the median time elapsed since the first MI was 7 years (IQR 10). The study population was highly compliant with the follow-up visits (78.1%) and pharmacological therapy (97%) before the pandemic according to the medical files. The majority (82.2%) of the patients were aware that having a history of premature MI would increase the risk and harm of COVID-19. Anxiety level increased in 62.7% of the study patients. Overall, 65.7% of the patient group reported a disruption at least in ≥1 component(s) of healthy life-behaviors (non-compliance with the heart-healthy diet, an increase in alcohol intake, an increase in smoking, and/or reduced physical activity) since the emergence of the outbreak. The anxiety level (p ​= ​0.001) and the prevalence of appetite change (p ​< ​0.0001) and weight gain (p ​< ​0.0001) was lower in the lifestyle compliant group than the non-compliant group. Avoidance of seeking medical care was reported in 33.7% of the patients. Statin use was 99.4% before the pandemic and decreased to 89.9% (p ​< ​0.0001) ​despite the fact that medications were reimbursed and widely available. ConclusionsThe COVID-19 pandemic significantly affected the heart-healthy lifestyle and anxiety levels of patients with a history of premature MI who were already in regular follow-up in a tertiary prevention clinic and led to significant avoidance of medical care. More rigorous follow-up, education, and reassurance of these patients with telemedicine are necessary for the prevention of further increase in their risk.

The Atrial fibrillation Better Care (ABC) pathway is associated to a lower incidence of cardiac complications in patients with atrial fibrillation: a report from the ATHERO-AF study

Abstract Background The integrated management of atrial fibrillation (AF) patients according to the Atrial fibrillation Better Care (ABC, A, Avoid stroke with anticoagulation; B, better symptom management; C, Cardiovascular and comorbidity risk management) pathway has associated with a reduced incidence of thromboembolic events and mortality. However, whether this approach also results in a lower rate of cardiac complications is unknown. Purpose To investigate the rate of major adverse cardiovascular events (MACE) in AF patients according to compliance with the ABC pathway. Methods This prospective single-center cohort study included 1157 patients with nonvalvular AF from the ATHERO-AF study. The A, B, and C groups were defined as follows: “A” by a Time in Therapeutic Range ≥70% in vitamin K antagonists-treated patients or appropriate dose for patients on direct oral anticoagulants; “B” by a European Heart Rhythm Association (EHRA) symptom scale I-II (vs. III-IV), and “C” as optimized cardiovascular comorbidity management (i.e. use of ACE inhibitors in heart failure patients, blood pressure &amp;lt;140/90, use of statins and beta blockers in patients with prior ischemic heart disease). The primary end point was a composite of MACE including fatal/non-fatal myocardial infarction, coronary revascularization and cardiovascular death (progressive heart failure, sudden cardiac death and procedure-related death). Results Overall, 458 (39.6%) patients were optimally managed according to the ABC (ABC-compliant group), while the remaining 729 patients presented at least one uncontrolled component (ABC non-compliant group). During a mean follow up of 35 months, (2688 patient-years), 64 MACE were recorded 2.38%/year. Kaplan Meier curve analysis showed a significant higher rate of MACE in ABC non-compliant group compared to the ABC-compliant (54 and 10 MACE in each group, respectively, log-rank test p=0.006, figure). The risk of MACE increased by the number of uncontrolled ABC components: Hazard ratio HR) for 1 component 1.697, 95% Confidence Interval 95% CI 0.814–3.537, p=0.158; HR for 2 components 4.157, 95% CI 1.994–8.665, p&amp;lt;0.001); HR for 3 components 5.100, 95% CI 1.596–16.295, p=0.006. ABC non-compliant group remained associated with an increased risk of MACE using Cox proportional hazard regression analysis (HR 2.175, 95% CI 1.098–4.309, p=0.026) after adjustment for CHA2DS2VASc score, antiplatelet drugs and digoxin use. Conclusion The majority of AF patients is not currently optimally managed. An integrated care ABC approach is associated with a reduced risk of MACE in the AF population. Figure 1. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

Personality Types as Predictors of Breast Cancer Screening Compliance in Korean Patients: A Mixed-Method Approach.

ObjectiveThe purpose of this study is to identify personality types that can influence breast cancer screening (BCS) compliance among Korean women with breast cancer using a mixed-method approach. MethodsThe participants consisted of 93 women who underwent surgery for breast cancer between July 2010 and March 2012. The demographic and medical characteristics of the participants were evaluated through structured interviews. To identify personality types, in-depth interviews were performed and the transcribed interviews were evaluated using interpretive phenomenological analysis. The participants were categorized into two groups (compliance and non-compliance) based on compliance with the Korean Breast Cancer Society recommendations for BCS. ResultsFive personality types were identified through phenomenological analysis. There were significant differences in the chi-square test results for the BCS compliance and non-compliance groups according to age (p=0.048), cancer stage (p<0.001), and personality types (p=0.018). Logistic regression showed that the odds ratio for compliance with BCS was 9.35 (p=0.01) for individuals with a cautious-organized personality type, 9.38 (p=0.02) for those with a cautious-dependent personality, and 10.58 (p=0.04) for those with a sensitive-downcast personality compared to those with a cautious personality type. ConclusionParticipants with cautious-organized, cautious-dependent, and sensitive-downcast personality types were less likely to follow the BCS recommendations than those with a cautious personality type. This study provides a basis for the future development of an effective questionnaire to investigate the personality types of individuals with breast cancer in order to predict compliance with BCS.

Postoperative Noncompliance following Repair of Acute Achilles Tendon Ruptures

Category:Trauma; Ankle; Hindfoot; SportsIntroduction/Purpose:Patient compliance with postoperative instructions is an important aspect of the orthopaedic surgery treatment regimen and can be a substantial deciding factor in achieving good outcomes. The postoperative period following acute Achilles tendon repairs requires diligent patient compliance in order to achieve optimal outcomes. The purpose of this study was to report the incidence of postoperative noncompliance and determine independent predictive factors of noncompliance following surgical management of acute Achilles tendon ruptures.Methods:A retrospective review of patients undergoing primary open repair of acute Achilles tendon ruptures with a single fellowship-trained orthopaedic foot & ankle surgeon at a single surgical location from 2010-2017 was performed. Patients <18 years of age, those who underwent surgical repair >21 days from the date of injury, those whose repair required a V-Y advancement, or those with bilateral tendon ruptures were excluded. Patient records were reviewed for collection of patient data and postoperative chart notes were reviewed to document instances of noncompliance. Instances were subcategorized into non- accidental or accidental. Multivariable regression analysis was performed to determine independent predictors of noncompliance. Regression coefficients with 95% confidence intervals [95% CI] and p-values were reported for significant findings. Mann-Whitney U tests were used to compare Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports scores and Visual Analog Scale (VAS) pain scores between compliant and noncompliant groups.Results:Of 232 patients meeting the inclusion criteria, 19 (8.2%) patients had 21 documented instances of noncompliance during the first 12 postoperative weeks, with 7/21 (33.3%) occurring during the first 2 postoperative weeks, 8 (38.1%) between weeks 3- 6, and 6 (28.6%) between weeks 7 and 12. Sixteen of the 21 (76.2%) instances of noncompliance were determined to be non- accidental, while 5 (23.8%) were accidental. Multivariable analysis demonstrated male sex (0.10 [0.00, 0.19]; p=0.0498) to be an independent predictor of non-accidental noncompliance. Age, BMI, a history of depression or diabetes, mechanism of injury, and timing of surgery following injury were not predictive of postoperative compliance. At mean 4.7 (range, 2.0-8.3) years postoperatively, the groups did not differ in FAAM-ADL (p=0.4311), FAAM-Sports (p=0.4258), or VAS pain (p=0.5050) scores.Conclusion:Postoperative noncompliance following surgical Achilles tendon repair occurs in nearly 1 out of every 12 patients, based on our cohort. Males, who make up the majority of Achilles tendon ruptures, have increased rates of non-accidental noncompliance. Patient noncompliance is an issue for orthopaedic surgeons of all subspecialties, and further investigations of incidence and risk factors should take place across a variety of commonly performed surgeries.

Effect of long term CPAP therapy on cardiac parameters assessed with cardiac MRI

The obstructive sleep apnoea syndrome (OSAS) is a disorder with a high prevalence and is associated with an elevated cardiovascular risk and increased morbidity and mortality. For longitudinal studies and functional analysis cardiac MRI is regarded as the gold standard. Aim of this study was to evaluate the long-term effect of continuous positive airway pressure (CPAP) therapy on cardiac functional parameters with cardiac Magnetic Resonance Imaging (cMRI). 54 patients with OSAS (mean apnea hypopnea index-AHI: 31) were prospectively enrolled in this study and cMRI was performed before and after 7 months of CPAP therapy. Data were acquired on a 1.5 T MRI and right and left ventricular cardiac function were analysed. CPAP treatment was considered compliant when used ≥ 4 h per night. 24-h blood pressure was measured at baseline and follow up. 33 patients could be assigned to the compliance group. Left ventricular stroke volume (LV SV) and right ventricular ejection fraction (RV EF) improved significantly with CPAP therapy (LV SV from 93 ± 19 to 99 ± 20 ml, p = 0.02; RV EF from 50 ± 6 to 52 ± 6%, p = 0.04). All other cardiac parameters did not change significantly while mean systolic and diastolic blood pressure improved significantly (p < 0.01). 21 patients were assigned to the non-compliance group and were considered as a control group. There were no relevant differences in cardiac parameters between baseline and follow up examination in these patients. CPAP therapy seems to improve LV SV, RV EF, systolic and diastolic blood pressure in OSAS patients, but reproducibility of our results need to be confirmed in a larger patient population.

Efficacy of Unsupervised Home-Based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease.

PurposePulmonary rehabilitation (PR) is a well-established treatment for chronic obstructive pulmonary disease (COPD). The standard protocol for PR requires frequent hospital visits, which can be difficult for patients. We performed this study to assess whether unsupervised home-based PR (HBPR) is effective for patients with COPD.Patients and MethodsAfter assessing the outcome data, including the results of a COPD assessment test (CAT); the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index; a spirometry; the modified Medical Research Council (mMRC) dyspnea scale; and the 6-min walking test (6MWT), specialists imparted 1-hour education to patients regarding unsupervised HBPR at the baseline visit. This included methods for breathing, inhaler use, stretching, and exercise. On reviewing diaries after 8 weeks from the first visit, patients who exercised at least thrice per week were classified as the compliant group and the others were categorized as the noncompliant group. Changes in the outcomes were compared between the compliant and noncompliant groups.ResultsA total of 41 patients were enrolled in this study; for 8 weeks of unsupervised HBPR, there were significant improvements in CAT scores (−4.62±4.61 vs 2.40±6.73; P=0.002), BODE index (−1.00±1.06 vs −0.20±0.56; P=0.01), and forced expiratory volume in 1 s (0.05±0.19 vs −0.09±0.16; P=0.02) among patients in the compliant group, compared with the noncompliant group. Moreover, their CAT (16.46±7.80 vs 11.85±7.23; P=0.03) and mMRC scores (2.54±0.76 vs 1.81±0.63; P=0.001) improved significantly after 8 weeks, compared with those at baseline. On the other hand, patients in the noncompliant group showed no significant improvement in any of the outcomes.ConclusionIn this study, compliant patients with unsupervised HBPR achieved favorable outcomes in 8 weeks. Thus, we recommend unsupervised HBPR for patients with COPD, even when regular hospital visits for PR are not possible.Trial RegistrationNCT03754881.

Abstract 2354: Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania

Abstract Background: Colorectal cancer (CRC) is a leading cause of mortality in the US. There are racial and socioeconomic disparities in CRC incidence and mortality, in part due to underuse of CRC screening. The goal of this cross-sectional study was to examine multilevel factors associated with CRC screening in Southeastern PA. Methods: We conducted a cross-sectional study using the Public Health Management Corporation's Community Health Database household survey (2010-2015) and American Community Survey data (2010-2014) to examine multilevel factors related to CRC screening via sigmoidoscopy and colonoscopy. We compared adults age 50+ that received CRC screening within 10 years (N=12963) to non-compliant individuals (N=4585), according to American Cancer Society guidelines. We conducted descriptive analyses to compare individual and residential census tract characteristics of the compliant and non-compliant groups. Multilevel regression models including random intercepts for census tracts (CTs) and CT-level socioeconomic status (SES) were used to examine independent associations with CRC screening compliance. P-values &amp;lt;0.05 were considered statistically significant. Results: In bivariate analysis, we observed that individuals that did not comply with CRC screening recommendations were more likely to be younger, male, non-black, unmarried, less educated, uninsured, and current smokers than those in compliance. Non-compliant individuals were also more likely to live in areas with lower SES, shorter distance to public transportation, lower educational attainment, lower median income, and higher percentages of uninsured, unemployed, poverty and households on public assistance compared to those in compliance. In multilevel regression analysis, being unmarried (OR=1.49, 95% CI=1.34-1.65), uninsured (OR=1.65, 95% CI=1.30-2.10), or living in lower SES census tracts (below the first SES quartile: OR=1.48, 95% CI=1.30-1.69 and between the 2nd and 3rd quartile: OR=1.51, 95% CI=1.29-1.75 vs. above the highest quartile) were associated with non-compliance in CRC screening recommendations. There were no interactions detected between race and census tract SES in these models. Conclusions: We identified multilevel factors (marital status, health insurance status, and residential SES) significantly associated with non-compliance to CRC screening recommendations. Individuals and CTs with low levels of compliance can be identified and targeted for tailored interventions, such as peer support and community education about CRC in future studies. Future studies might examine how the availability and location of screening facilities may relate to CRC screening recommendation compliance rates in different neighborhoods. Citation Format: Charnita M. Zeigler-Johnson, Scott Keith, Kari Moore, Russell McIntire, Preethi Selvan, Steven Melly, Ana Diez-Roux. Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2354.

Implementation of a pulmonary thromboembolism prophylaxis program in Chinese lung surgery patients: compliance and effectiveness.

BackgroundMost studies on prophylaxis against pulmonary embolism (PE) after lung surgery have come from the West. Whether such prophylactic programs can be successfully developed in China has not been fully studied.MethodsA prospective observational trial included 581 Chinese patients receiving lung resection surgery between August 8 and September 12 of 2017. The Caprini score was assessed on the first postoperative day (POD1). For PE prophylaxis, patients with a low score (0–4, n=55) received early ambulation, and those with a high score (≥5, n=526) received early ambulation combined with low-molecular weight heparin (LMWH) injection. PE incidence and the compliance with this protocol was recorded.ResultsThree patients (0.52%) developed PE and all 3 were in the high-risk group, but LMWH was not given (non-compliance). Within the non-compliance patients (n=275), the incidence of PE was 1.09%, higher than that in the compliance patients (0%). The rate of non-compliance with the program was 47.3% (275/581) in the entire cohort. The factors associated with non-compliance were: extended lobectomy performed (9.2% vs. 1.0%, P<0.001); higher volume of postoperative chest drainages (278 vs. 239 mL, P=0.028). The non-compliance group had longer duration of ICU stay (mean of 1.3 vs. 1.1 days, P<0.001); and longer overall hospital stay (mean of 9.7 vs. 8.5 days, P<0.001).ConclusionsDeveloping a PE prophylaxis program for patients receiving lung surgery in China contributed to lowering the risk of PE. Failure of compliance in patients with high risk for PE after lung surgery may be linked to worse outcomes.

Reversibility of microalbuminuria with continuous positive airway pressure treatment in obstructive sleep apnea syndrome.

Microalbuminuria is an early marker of kidney damage and an early predictor and risk factor for cardiovascular diseases. We aimed to evaluate the association between albuminuria levels in different severity obstructive sleep apnea syndrome (OSAS) cases and to find out the efficacy of CPAP treatment on microalbuminuria. We conducted a prospective study on subjects who underwent polysomnography. The polysomnographic data were recorded to establish the presence and severity of OSAS. The blood and urine samples were taken both at the time of diagnosis and 3months after CPAP therapy. The relationship between the severity of OSAS and microalbuminuria and the effect of CPAP treatment on microalbuminuria were evaluated. The study population consisted of 449 subjects. Better compliance to CPAP was associated with significantly reduced levels of microlbuminuria. Urinary albumin/creatinine was increased in severe cases, but the difference was not statistically significant. In the non-compliant group, microalbumin/creatinine ratio was 25.24 prior to initiation of CPAP treatment and 28.36 at the third month control visit (p = 0.25). In the compliant group, microalbumin/creatinine ratio was 49.71 prior to initiation of CPAP treatment and 22.30 at the third month control visit (p = 0.04). Our study demonstrated that good compliance to CPAP therapy is associated with a decrease in microalbuminuria. Patients who used CPAP regularly had a significant decline in albumin/creatinine ratio after 3months of CPAP therapy.

Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: An analysis of 4501 consecutive patients

BackgroundMultidisciplinary team (MDT) discussions are widely held to facilitate the diagnosis and treatment of breast cancer, but patient compliance with the MDT recommendations and the impact of compliance on disease outcome are uncertain. MethodsWe conducted a retrospective review of data from a prospective database of breast cancer patients treated at Shanghai Ruijin Hospital between April 2013 and August 2018. MDT discussions were held for all patients before they started adjuvant therapy. The patients were classified into compliant and non-compliant groups according to whether they received the MDT-recommended regimens. We also analyzed which clinicopathological factors were associated with compliance and prognosis. ResultsOf 4501 breast cancer patients, 3681 (81.8%) and 820 (18.2%) were included in the compliant and non-compliant groups, respectively. Age >70 years (P < 0.001), invasive ductal carcinoma (P < 0.001), and histological grade III (P = 0.011) were independently associated with higher risk of non-compliance, whereas Ki-67 labeling index ≥14% and history of benign breast disease were independently associated with compliance. Disease-free survival (hazard ratio [HR] 1.813, 95% confidence interval [CI] 1.367–2.405, P < 0.001) and overall survival (HR 2.478, 95% CI 1.431–4.291, P < 0.001) were worse in the non-compliant group. ConclusionsSeveral clinicopathological factors were associated with non-compliance with MDT recommendations for early breast cancer patients. Non-compliance was associated with worse disease outcome.

Surgical Compliance and Survival Outcomes for Patients with Stage T1-2 Non-Small-Cell Lung Cancer.

IntroductionOur aim was to determine the relationship between surgical compliance and survival outcomes in patients with stage T1-2 non-small-cell lung cancer (NSCLC).MethodsPatients with T1-2 NSCLC who were diagnosed between 2004 and 2015 were identified from the SEER database. Multivariate logistic regression was used to analyse factors associated with surgical compliance. Kaplan–Meier curves and Cox regression were used to analyse the effects of surgical compliance on overall survival (OS) and cancer-specific survival (CSS).ResultsOf the 221,704 eligible T1-2 NSCLC patients, 106,668 patients recommended surgery. Among them, 99,672 (93.4%) patients were surgical compliance group, and 6996 (6.6%) were surgical noncompliance group. Poor surgical compliance was associated with earlier diagnosis time, old age, male, black race, unmarried status, main bronchus site, poor grade/stage, and lower household income. Patients’ compliance was an independent prognostic factor for OS and CSS of T1-2 NSCLC patients. Multivariate Cox regression showed that surgical noncompliance individuals showed lower OS (hazard ratio [HR] 2.494; 95% confidence interval [CI] 2.423–2.566, p < 0.001) and lower CSS (HR 2.877; 95% CI 2.782–2.974, p < 0.001) compared with surgical compliance patients. In addition, results in the non-surgical group were observed to be similar to those of the surgical noncompliance group.ConclusionWe found that patients’ compliance was an independent prognostic factor for survival in T1-2 NSCLC patients. Poor surgical compliance was associated with earlier diagnosis time, old age, male, black race, unmarried status, main bronchus site, poor grade/stage, and lower household income.

Effect of Comprehensive Lifestyle Modification and Meditation on Coronary Atherosclerosis and Its Risk Factors

Background: Comprehensive lifestyle modification has an effect on coronary atherosclerosis.&#x0D; Objective: This study was performed to determine the effect of comprehensive lifestyle modification and meditation on coronary atherosclerosis.&#x0D; Methodology: This cohort study was done by Quantum Foundation, Dhaka, Bangladesh during the period of January 2010 to December 2014. Patients who had attended the 2-days long orientation program on comprehensive lifestyle modification, meditation and overview of coronary artery disease were included in the study. Participants who had attended ≥10 monthly and ≤2 monthly follow up &amp; counseling session were defined as compliant and noncompliant group respectively. Patients were follow up for angiogram.&#x0D; Results: A total number of 32 patients were divided into compliant and noncompliant groups. Patient in the compliant group used to take heart healthy diet in 100.0% cases and avoided heart-unhealthy diet in 100.0% cases as well. Patients in the compliant group were also adherent to daily practice of meditation in 100.0% of cases and it was only 26.7% in case of non-compliant (P&lt;0.001). From baseline and repeat angiogram Gensini scoring was done to determine the regression of coronary blockage. Regression of coronary blockage was observed in 61.5% cases of compliant group and 10.5% in non-compliant group (P&lt;0.001).&#x0D; Conclusion: Comprehensive lifestyle modification and meditation can regress coronary atherosclerosis.&#x0D; Journal of Current and Advance Medical Research 2020;7(1): 24-29

Abstract TP415: Regular Home Blood Pressure Monitoring Reduces the Risk of Stroke Recurrence

Background: High blood pressure (BP) is a well recognized risk factor for ischemic stroke, and aggressive BP control is critical for secondary stroke prevention. However, hypertensive (HTN) outpatients are often found to have uncontrolled BP, in part due to poor compliance with daily at-home BP monitoring and consequent poor medication adherence. Here, we explore the association of patient home BP self-monitoring compliance with stroke recurrence. Method: Ischemic stroke patients with pre-existing HTN were prospectively recruited in accordance with IRB protocol for this observational study. All patients were trained on BP self-monitoring as per standard of care, and were asked to monitor BP at home daily consistently for 2 weeks. BP monitoring compliance, per completion of BP log, was assessed at each follow-up clinical visit by an investigator blinded to patient outcome. Stroke recurrence was followed for 5 years and independently adjudicated by two vascular neurologists. Result: In a total of 219 patients, only 36 patients (16.4%) were compliant in completing the home BP log as instructed. The compliant and non-compliant groups showed no baseline difference and no medication usage difference (p&gt;0.05) (Table 1). Compliance with at-home BP monitoring was associated with well controlled systolic (p&lt;0.001) and diastolic BP (p&lt;0.001). Of note, 30 patients (16.4%) had recurrent strokes in the non-compliant group, while there were no recurrent strokes in the compliant group. BP self-monitoring compliance is associated with reduced incidence of stroke recurrence (p=0.030) and the significance remains robust after adjusting for multiple confounders (p=0.029) (Table 2). Conclusion: Regular home BP monitoring is associated with lower risk of stroke recurrence in HTN stroke patients. Study in expanded patient cohort is ongoing to leverage technology for better home BP monitoring and to create incentives for compliant behavior for better secondary stroke prevention.

The effectiveness of a community-based exercise program on depression symptoms among people living with HIV

ABSTRACT HIV is a worldwide public health issue affecting millions of individuals, and people living with HIV (PLWH) are often affected by depression. Nonetheless, exercise can prevent and treat depression among PLWH. The aim of the present study was to investigate the effect of exercise on depression symptoms in PLWH. Using a prospective single-arm trial, a semi-supervised community-based exercise intervention was offered 3 times/week for 12 weeks to PLWH (n = 52; age: 49 ± 6 years; HIV diagnosis: 19 ± 15 years). Participants were divided into compliant (≥1 exercise session/week) and non-compliant (<1 exercise session/week) groups according to their attendance in the intervention. Depression symptoms were assessed using the Beck Depression Inventory (BDI), and the change in BDI from baseline to post-intervention was assessed with an analysis of covariance, adjusted for demographics. The post-intervention BDI score was significantly lower (p = 0.027) for the compliant group compared to the non-compliant group, and the rate of improvement from moderate/severe symptoms of depression to minimal symptoms of depression was four times greater in the compliant group. In conclusion, a community-based exercise program may be effective in reducing depression symptoms among PLWH.

Clinical Factors Associated with Adherence to the Follow-Up Examination after Positive Fecal Occult Blood Test in National Colorectal Cancer Screening.

Background: The compliance with the follow-up examination after a positive fecal occult blood test (FOBT) is lower than expected. We aimed to evaluate the adherence rate to the follow-up examination in patients with a positive FOBT and to identify the clinical factors associated with this adherence. Methods: The study population comprised adults aged ≥50 years who participated in the National Cancer Screening Program for colorectal cancer (CRC) in 2013. Compliance was defined as undergoing follow-up examination within 1 year of a positive FOBT. Results: From 214,131 individuals with a positive FOBT, 120,911 (56.5%) were in the compliance group and 93,220 (43.5%) were in the non-compliance group. On multivariate analysis, good compliance was associated with men (odds ratio (OR) = 1.12, 95% confidence interval (CI) (1.09–1.15)), younger ages (70–79 years, OR = 2.19 (2.09–2.31); 60–69 years, OR = 3.29 (3.13–3.46); 50–59 years, OR = 3.57 (3.39–3.75) vs. >80 years), previous experience of CRC screening (a negative FOBT, OR = 1.18 (1.15–1.21); a positive FOBT, OR = 2.42 (2.31–2.54)), absent previous experience of colonoscopy or barium enema (OR = 2.06 (1.99–2.13)), higher economic income (quartile, 75%, OR = 1.14 (1.11–1.17); 100%, OR = 1.22 (1.19–1.25)), current smokers (OR = 1.12 (1.09–1.15)), alcohol intake (OR = 1.03 (1.01–1.05)), active physical activity (≥3 times/week, OR = 1.13 (1.11–1.15)), depression (OR = 1.11 (1.08–1.14)), and present comorbidities (Charlson Comorbidity Index, ≥1). Conclusion: This study identified clinical factors, namely, male, younger ages, prior experience of fecal test, absent history of colonoscopy or double-contrast barium enema (DCBE) within 5 years, and high socioeconomic status to be associated with good adherence to the follow-up examination after a positive FOBT.

The impact of discontinuation of sacubitril-valsartan and shifting to angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in patients with heart failure with reduced ejection fraction.

Many trials confirmed the role of sacubitril-valsartan in the treatment of patients with heart failure with reduced ejection fraction (HFrEF). However, there is no sufficient data to register the effect of compulsory discontinuation of sacubitril-valsartan, either because of finan-cial shortage or adverse effects, and shifting to the standard therapy, including angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). The patients with HFrEF (LVEF ≤35%) were included in the study. They received treatment with sacubitril-valsartan as a replacement for an ACEI or ARB. The patients were divided into two groups: the compliant group (n=111). The non-compliant group (n=82), whose members discontinued sacubitril-valsartan after ≥5 months but <6 months since their enrollment in the study. Initially, 199 patients with HFrEF were included in the study. All the patients were started treatment with sacubitril-valsartan in addition to the evidence-based standard therapy of heart failure. Six patients were excluded at the first follow-up visit (at 6 months). The remaining 193 patients showed initial improvement of the New York Heart Association (NYHA) class, the end-diastolic volume (EDV), and the left ventricular ejection fraction (LVEF). Five patients were excluded at the 12 months' follow-up visit. The other 188 patients were divided into two groups: Group I (n=108) patients were compliant on sacubitril-valsartan for 12 months; Group II (n=80) patients were compliant on sacubitril-valsartan for ≥5 months, but stopped it at <6 months, and were shifted to ACEI or evidence-based ARB. Group II (n=80) patients showed worsening of their NYHA class, compared to the 6 months' follow-up visit (p=0.001). LVEF and EDV were also shown to be worsened in these patients when we compared them to the values of the 6 months' follow-up appointment with p=0.001 for both parameters. The discontinuation of sacubitril-valsartan in patients with HFrEF leads to deterioration of the LVEF as well as worsening of the functional class. The decline in LVEF and NYHA functional class occurs despite being compliant with the optimal conventional therapy with ACEI or evidence-based ARB.

1086: Retrospective application of the clark algorithm to cesarean sections for fetal intolerance to labor

Abnormal fetal heart rate tracings account for a significant number of cesarean sections (23% in 2016). Clark, et al. developed an algorithm for management of category II fetal heart rate tracings in labor (figure 1). We aim to determine the extent of compliance and noncompliance of fetal monitoring with the Clark algorithm and if differences lead to disparate neonatal outcomes. This is a retrospective observational study from the resident service at an academic-community tertiary care center from 2013-2018. We reviewed archived fetal heart rate tracings from patients with cesarean section (CS) performed for fetal intolerance to labor (FIL) and interpreted tracings against the algorithm. We assigned tracings to one of three categories: Group 1—compliant; Group 2—noncompliant too early (algorithm permits the patient to labor longer); Group 3—noncompliant too late (algorithm suggests performing the CS sooner). Maternal demographics, features of labor, and neonatal outcomes were compared among the compliant and noncompliant groups. Of the 110 cases, 27 (24.5%) had a CS called in group 1, 49 (44.5%) in group 2, and 34 (30.9%) in group 3. Baseline characteristics were similar. Of the 49 in group 2, 46 (93.9%) violated the algorithm at the same branchpoint (#6, figure 1). In group 3, cesarean sections would have been performed on average 244 minutes earlier had the algorithm been used. Neonatal outcomes were not significantly different among the groups (table 1), including 5-minute Apgar < 7 (2/27 for group 1, 2/49 for group 2, 1/34 for group 3; p=0.71), pH < 7.1 (3/27 for group 1, 4/49 for group 2, 5/34 for group 3; p=0.69), and NICU admit (13/27 for group 1, 26/49 for group 2, 17/34 for group 3; p=0.88). Our retrospective application of the algorithm showed that 44.5% of patients who have CS for FIL may be able to labor longer and that violation at a common decision point on the algorithm is responsible for nearly all such CS. More studies are needed to evaluate if CS rates for FIL can be reduced without impacting neonatal outcomes using the algorithm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Predicting medication noncompliance among patients with schizophrenia after hospital discharge

Background: Medication noncompliance(NC) after hospital discharge is the main reason for poor outcomes of the clinical course of the schizophrenics subjects. In the present study we assess the patients with diagnosis of schizophrenia and predict the reason for medication noncompliance after hospital discharge on follow up period. Methods: A total of 70 patients (C=35, NC=35) with schizophrenia at 1month follow-up were interviewed using self-designed tools to assess sociodemographic data, insight, clinical symptoms, attitudes, therapeutic alliance, side-effects experienced and substance use disorder were assessed at baseline and 6month follow-up. Results: Mean age with ± SD in compliance(C) and noncompliance(NC) group is 32.45 ± 11.07 and 35.29 ± 13.45 respectively. Significant correlation between C and NC group in education level, SES (p = 0.011). Majority of patients in both groups are male (C=72.7%, NC=70.3%). NC is higher in illiterate, unmarried, joint family and Low SES. At 1month follow up, in NC group most patients are need of treatment (45.9%), reports of difficulty relabeling their symptoms (18.9%). Clinical symptoms in Mean ± SD, BPRS Score differ in C and NC group(p=0.052). At 6month follow up, 66 no’s of subjects came (C=35, NC=31). Significant reduction in the severity of the psychopathology BPRS score(P=0.000) and perceived side-effects (P=0.015). Improved quality of therapeutic relationship. Substance abuse, lack of awareness, attitudes and belief system, social isolation are reason for noncompliance. Discussion: As inpatient care, medication taking behavior is closely supervised by hospital staff, so compliance is high. Post-discharge follow-up is important for continued medication compliance in schizophrenic patients.NC increase the risk of relapse, rehospitalization, self-harm, lower quality of life. Conclusion: Public awareness concerning stigma to illness and antipsychotic medicine noncompliance should be further studied. With the current available pharmacological and psychological approaches that lowers risk of medication noncompliance should be encouraged in every patient, family members and medical personnel.

Prophylactic antibiotic bundle compliance and surgical site infections: an artificial neural network analysis

BackgroundBest practice “bundles” have been developed to lower the occurrence rate of surgical site infections (SSI’s). We developed artificial neural network (ANN) models to predict SSI occurrence based on prophylactic antibiotic compliance.MethodsUsing the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) Tampa General Hospital patient dataset for a six-month period, 780 surgical procedures were reviewed for compliance with SSI guidelines for antibiotic type and timing. SSI rates were determined for patients in the compliant and non-compliant groups. ANN training and validation models were developed to include the variables of age, sex, steroid use, bleeding disorders, transfusion, white blood cell count, hematocrit level, platelet count, wound class, ASA class, and surgical antimicrobial prophylaxis (SAP) bundle compliance.ResultsOverall compliance to recommended antibiotic type and timing was 92.0%. Antibiotic bundle compliance had a lower incidence of SSI’s (3.3%) compared to the non-compliant group (8.1%, p = 0.07). ANN models predicted SSI with a 69–90% sensitivity and 50–60% specificity. The model was more sensitive when bundle compliance was not used in the model, but more specific when it was. Preoperative white blood cell (WBC) count had the most influence on the model.ConclusionsSAP bundle compliance was associated with a lower incidence of SSI’s. In an ANN model, inclusion of the SAP bundle compliance reduced sensitivity, but increased specificity of the prediction model. Preoperative WBC count had the most influence on the model.