Non-compliance Research Articles

Evaluation of the cycling infrastructure in a small town: a case study in Guaíra, São Paulo

The promotion of cycling, a sustainable and active way to travel, provides benefits to the environment and the health of users. However, as different factors influence the adoption of the bicycle, it is relevant that existing cycle structures are regularly evaluated. This enables to identify necessary improvements to the technical adequacy of the infrastructure. This issue is particularly important in the case of small towns, where there is no public transport. Considering this is the case of Guaíra, São Paulo, Brazil, this study aimed to evaluate the cycling infrastructure of this urban center. For this, a checklist composed of 15 items was developed. This items are related to quality indicators, divided into 5 themes, subject to audit according to conditions of Compliance (C), Partial Compliance (PC) and Non-Compliance (NC). After auditing the two existing cycling infrastructure in the town, a bike path (A) and a bike lane (B), problems were identified, especially regarding the usable width available for circulation and the lack of shading. Based on this information, proposals for improvement were formulated, such as increasing the width and planting trees. Due to its simplicity and practicality, the built instrument can be used in other small cities to identify interventions and also to support the design of new cycling spaces.

Wolverine cutting balloon in the treatment of stent underexpansion in heavy coronary calcification: bench test using a three-dimensional printer and computer simulation with the finite-element method.

Heavy coronary calcification hinders successful stent implantation, and cutting balloons can be used for post-dilation after stent deployment. However, evidence regarding its use is limited to case reports. Therefore, this study aimed to investigate in-stent dilation in circumferential coronary calcifications using Wolverine cutting balloons, compared with conventional non-compliance (NC) balloons. Circumferential coronary calcification models were designed based on the patient's intravascular ultrasound images. Three-dimensional printed models were subjected to bench tests and software analysis was performed using the finite-element method (FEM). As a result, the bench test showed that higher balloon pressure was needed to dilate the models with stent implantation, either using Wolverine (17.1 ± 2.7atm) or NC Emerge (18.9 ± 1.8atm), while lower pressure was needed in models without stents using Wolverine [11.7 ± 2.9atm, analysis of variance (ANOVA) p < 0.001]. Furthermore, models without stents were all successfully cracked by Wolverine at the first dilation, while models with stent implantation needed more dilations (ANOVA p = 0.0132). The FEM showed similar results that the first principal stress was the highest in Wolverine-dilated models without stents. In conclusion, implanted stents significantly increase the difficulty of balloon dilation and adequate pretreatment is critical for successful coronary stenting.

Abstract A098: Socioeconomic and geographic predictors for radiotherapy quality disparities in the Mid-Southern U.S.

Abstract Background: Approximately half of cancer patients are prescribed radiotherapy (RT) during their care. RT noncompliance (NC) is a well-studied quality measure associated with inferior survival. Cancer outcomes in the Mid-South (West Tennessee, Mississippi Delta, Eastern Arkansas) rank well below other U.S. regions. The purpose of this study is to benchmark RT NC rates, define socioeconomic predictors of RT NC, and geographically map NC across a large Mid-Southern catchment region served by a single academic cancer referral center. Methods: Demographic, clinical, and treatment information were collected for all patients treated with RT at the University of Tennessee West Cancer Center from January 1, 2015 to December 31, 2017. RT NC was defined as delay in 2 or more treatments. “Critically high” RT NC was defined as delay in 5 or more treatments. Patients with Medicaid or no insurance were categorized as “At Risk.” Patient predicted income (PPI) was modeled using 2016 US Census data for patient residence zip code and grouped by thirds into three (low, middle, and high) income categories. RT NC was compared by insurance type, race, and PPI, analyzed for significance using Pearson's Chi square testing, and geomapped by patient residence zip code and urban and rural status. Results: A total of 3,754 patients were included, of whom 1,981 (52.8%) were Caucasian, 1,582 African American (42.2%), and 217 (5.7%) other. Insurance status was defined as Commercial, Medicare, or At Risk in 1,803 (48%), 1,508 (40%), and 443 (12%) patients, respectively. Overall, RT NC was seen in 962 patients (25.6%) and critically high RT NC was seen in 422 patients (11.2%). At-risk patients experienced more RT NC (36.2% v 25.1% p=&amp;lt;0.001) and more than double the critically high RT NC compared to patients with commercial insurance (20.3% v 9.6% p=&amp;lt;0.001). African American patients in our population experienced higher rates of RT NC and critically high RT NC compared to Caucasian patients ([30.5% v 22.0% p=&amp;lt;0.001] and [14.9% v 8.8% p=&amp;lt;0.001]). Compared to patients with high PPI (&amp;gt;67k), patients with low PPI (&amp;lt;$34k) experienced higher RT NC (20.2% v 31.7% p=&amp;lt;0.001) and critically high RT NC (7.3% v 15.7% p=&amp;lt;0.001). High RT NC rates were geographically associated with patients living in rural zip codes, with critically high RT NC rates in urban zip codes with low PPI. Conclusion: In our high-volume academic radiotherapy practice, RT noncompliance correlates significantly with uninsured or Medicaid coverage status, African American race, and low predicted income. Noncompliance disproportionately impacts rural patients and inner-urban patients with low predicted income. Further studies are needed to understand causative mechanisms requiring intervention to help close gaps in radiotherapy quality. Citation Format: Daniel V. Wakefield, Matthew Carnell, Austin P.H. Dove, Elena Delavega, Esra Ozdenerol, Maria Pisu, Michelle Y. Martin, David L. Schwartz. Socioeconomic and geographic predictors for radiotherapy quality disparities in the Mid-Southern U.S. [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A098.

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.

2060. Evaluation of a Pharmacist’s Impact on Antimicrobial Prescribing in an Urgent Care Center

BackgroundThe urgent care center (UC) setting is an opportunity for pharmacists to promote antimicrobial stewardship (AS). The primary objective is to determine compliance with antibiotic prescribing recommendations for the treatment of urinary tract infections (UTIs), skin and soft-tissue infections (SSTIs), upper respiratory tract infections (URIs), and lower respiratory tract infections (LRTIs) before, during, and after the presence of an AS pharmacist in an UC.MethodsSingle-center, retrospective, observational, pre (December 10, 2018–January 6, 2019), intervention (January 7–February 3, 2019), and post-intervention (February 4–March 3, 2019) study. All non-pregnant, adult patients with a chief complaint consistent with UTI, SSTI, URI, or LRTI were included. Patients transferred to another facility, presented for a follow-up visit, with multiple sites of infection, or treated for a bite, wound, or surgical site infection were excluded. Noncompliance (NC) was a composite endpoint of non-guideline adherent antibiotic prescribing for viral infections, inappropriate empiric selection, duration, and/or dosage. Secondary outcomes include composite outcome components and subgroup analysis of disease states.ResultsA total of 1,930 patients were screened with 439,440, and 430 patients included in the pre, intervention, and post-intervention group. Demographics were similar between groups, except for age (P = 0.001) and influenza diagnoses (P < 0.001). NC decreased from 43.3% to 31.1% (P = 0.0002) pre-intervention to intervention and from 31.1% to 26.5% (P = 0.14) post-intervention. Pre-intervention to intervention resulted in a change in composite outcome components of non-compliant prescribing (18.9% to 13%, P = 0.02), empiric selection (8.7% to 5.9%, P = 0.12), duration (4.1% to 5.9%, P = 0.28), dosage (3.4% to 0.5%, P = 0.001), and multiple components for NC (8.2% to 6.4%, P = 0.3). Reductions in NC were seen for UTI (83.3% to 69.2%, P = 0.26), SSTI (45.7% to 42.9%, P = 1.0), URI (23.5% to 23.2%, P = 1.0), and LRTI (82.1% to 51.6%, P = 0.0004).ConclusionAn AS pharmacist’s presence in a UC significantly reduced NC to antibiotic prescribing recommendations. The largest impact was in reducing antibiotic treatment of viral infections and optimizing antibiotic dosing.Disclosures All authors: No reported disclosures.

The Value of Licensed Clinical Social Worker Pre-Implant Assessment in Predicting Non-Compliance in Durable Mechanical Circulatory Support Device Patients

Purpose Patient (pt) compliance is vital to the success of durable mechanical circulatory support (DMCS). During acute decompensation of heart failure, Advanced Heart Failure Centers are tasked with making timely decisions regarding candidacy for DMCS. History of non-compliance (NC) and predicting future NC can be difficult to assess during this acute phase. Licensed Clinical Social Workers (LCSW) assess pts pre-implant for possible NC after DMCS. The purpose of this study is to determine whether LCSW pre-implant assessment is effective in predicting NC after DMCS and whether this is affected by a history of substance abuse. Methods Between 2007-2018, our LCSWs evaluated 255 pts prior to DMCS and assessed them as low risk vs high risk for NC. After DMCS, NC was defined as exhibiting one of the following: Missed > 3 clinic appointments or 3 lab draws, or documentation of not taking medications correctly or not following MD instructions > 3 occasions. The DMCS pts were divided into Compliant vs Non-Compliant and compared by LCSW pre-implant risk assessment. In addition, the NC pts were divided by those with a history of substance abuse vs those without. Results Following DMCS, there were 219 Compliant pts and 36 NC pts. LCSWs pre-implant risk assessment (use of SIPAT tool in addition to adherence/substance abuse history) identified 41.7% of NC pts as high risk (for NC) while only 6.7% of Compliant pts were noted to be high risk pre-implant. For those NC pts, the additional risk of a history of substance abuse further increased the accuracy of the LCSW pre-implant risk assessment. (See Table) Conclusion Our current LCSW pre-implant risk assessment appears effective in predicting NC in our DMCS patient population. Advanced Heart Failure Centers can use this data (high risk for NC after DMCS) for decision making when considering pts for DMCS or for more aggressive interventional techniques to prevent NC after DMCS placement.

Prescription du paracétamol dans cinq centres hospitaliers français : quelles sont les pratiques ?

Acetaminophen is widely used in hospital settings and often considered as nontoxic. We conducted a multicentric study in order to evaluate its proper use. Prescriptions from five general hospitals were analyzed, according to dose adjustments required in renal or liver failure, weight or chronic alcoholism, determined using a literature review. Other criteria have been assessed: indication for parenteral access, accuracy of administration time and pain assessment. Among the 1256 analyzed prescriptions, 21% are non-compliants. The main causes of non-compliance (NC) are adjustments to weight and renal failure. Higher NC rates concern chronic alcoholism and liver failure. Misuse of acetaminophen seems related to a lack of official recommendations concerning dose adjustments. Hospital pharmacists have an important role to play in the promotion of proper use of acetaminophen. Therefore we established a prescribing aid.

Application of TRiMiCri for the evaluation of risk based microbiological criteria for Campylobacter on broiler meat

A potential solution for the reduction of consumer exposure to Campylobacter is establishing a microbiological criterion (MC) for Campylobacter on broiler meat. In the present study the freely available software tool TRiMiCri was applied to evaluate risk-based microbiological criteria by two approaches: the traditional one that implies a microbiological limit (ML-MC) and the second one which is based on the relative risk estimate (RRL-MC). A baseline risk was estimated based on the Belgian baseline data, whereas the data for the evaluated batches were Campylobacter counts from 28 Campylobacter positive batches sampled in six Belgian slaughterhouses. Results showed that approximately 60% of Campylobacter positive batches did not comply with ML criteria based on the n=5, m=1000 and c=0 for ML-MC and equivalently for RRL criteria when RRcrit=1. As expected, the less stringent MCs decreased the percentages of non-compliance (NC) but they are less effective, as reflected in increased minimum relative residual risks (MRRRs). When the Belgian baseline is used, more batches are found to be compliant than when the Danish baseline provided by TRiMiCri is used. Based on this, the application of microbiological criteria for Campylobacter in the EU is discussed. TRiMiCri provides user friendly software to evaluate the available data and can help risk managers in establishing risk based microbiological criteria for Campylobacter in broiler meat.

A study of the noncompliance of blood banks on safety and quality parameters in blood donation camps in Bengaluru.

Aims:The compliance of safety and quality parameters laid out by national and international guidelines in outdoor blood donation camps has not been studied in India. Our study aimed at identifying, monitoring, analyzing, and developing preventive strategies for several key parameters associated with the quality and safety of outdoor voluntary blood donation camps (VBDC).Settings:The study covered a total of 424 VBDCs at various locations in Bengaluru, Karnataka (South India) from 2009 to 2013. Seven government hospitals based blood banks, three private hospitals based blood banks and two voluntary standalone blood banks participated in the VBDCs included in the study.Materials and Methods:At the onset, the quality and safety standards to be followed were discussed and agreed upon. During the study, noncompliance (NC) to the agreed upon standards were recorded and shared. Periodic trainings were also organized to help minimize NC.Results:One or more instances of NC in 73% of the VBDCs. Highest NC were observed associated with punctuality (34%), wearing gloves (16%), hemoglobin (Hb) estimation (11%) and donor screening and selection other than Hb check (8-9%).Conclusion:For all 16 parameters under study, significant NC was observed. As a whole private hospital based blood banks were more noncompliant. The high degree of NC to matters relating to quality and safety in VBDCs is high and warrants for urgent attention and further study. Our study also shows that regular monitoring and systematic and strategic intervention can decrease the rate of NC.

Patient-Reported Compliance with Thromboprophylaxis Using an Oral Factor Xa Inhibitor (Rivaroxaban) Following Total Hip and Total Knee Arthroplasty

This prospective study examines patient non-compliance (NC) for an oral factor Xa inhibitor (Rivaroxaban) when used as venous thromboembolic (VTE) prophylaxis following lower limb arthroplasty. A total of 3145 patients underwent surgery from May 2010 to December 2011. At 6weeks patients completed an anonymous self-administered questionnaire. Postoperatively 2947 (94%, 2947/3145) received Rivaroxaban. 2824 (96%, 2824/2947) completed all in-hospital doses. Seven percent (203/2824) of patients did not attend the 6-week follow-up. Two thousand one hundred sixty-three (83%, 2163/2621) completed all prescribed doses, 98 (4%, 98/2621) were NC and 360 (14%, 360/2621) had incomplete data. Gender, age, body mass index and preoperative hemoglobin all correlated with NC (p<0.05). Type and side of surgery did not correlate with compliance (p>0.05). Patient-reported NC for Rivaroxaban is 4% which compares favorably to other VTE prophylaxis modalities.

(337) - Transplant Pharmacist Evaluation Prior To Heart Transplantation Uncovers Medication Noncompliance as a Common Issue

Many pharmacologic factors, such as compliance substantially impact outcomes after heart transplantation(HTX). With the recent mandate by the Center for Medicare and Medicaid Services, transplant pharmacists are now routinely evaluating patients prior to transplant. Beginning 1/1/2012, all potential adult HTX candidates undergoing initial evaluation at a single institution were evaluated by a transplant pharmacist. The pharmacist reviewed medical history, allergies, current medications, medical compliance, and medication compliance. A structured evaluation tool was administered. Patients were cleared for transplant if no pharmacological contraindications were identified. Contraindications were broken down as 1) medication noncompliance(NC) -defined as missing medications 2 more times weekly, 2) medical noncompliance(MNC) - defined as missing > 20% of appointments, 3) comorbid conditions(CM), 4) smoking(SM), 5) medication intolerance(MI), and 6) drug interactions(DI). Of the 91 patients evaluated (mean age 54, 81% male, and 52% ischemic), 51 (56%) were listed for transplant. Of the 40 declined for transplant by the committee 45% were for CM, 15% for SM, 12.5% were too well, 10% withdrew their candidacy, 10% for NC and 7.5% for miscellaneous reasons. The transplant pharmacist discovered 17(18.6%) patients had pharmacological contraindications. The number of contraindications per patient was: 12 patients with 1; 3 patients with 2; and 2 patients with 3. The most common contraindication was NC 14(82%), followed by MNC 3(17.6%), SM 2 (11.8%), CM 2 (11.8%), and DI 1(5.8%). All patients rejected by the overall committee for NC were identified by the transplant pharmacist. There were however, 5 patients listed for transplant with pharmaceutical contraindications, all meeting criteria for NC. Pharmacist evaluation of patients undergoing transplant evaluations are clearly impactful, with significant pharmaceutical contraindications identified in almost 20% of the evaluations. The most common contraindication (82%) was missing medications at least twice weekly, followed by (17.6%) missing at least 20% of prior medical appointments. Long-term follow up is needed to evaluate outcomes in patients receiving transplants whom were contraindicated by the pharmacist.

Effect of supportive periodontal therapy on the prevention of tooth loss in Korean adults.

The purpose of this retrospective study was to evaluate the effect of patient compliance with supportive periodontal therapy (SPT) on tooth loss in Korean adults. The periodontal records of 134 patients were reviewed for this study. They completed active periodontal treatment from 1999 to 2001 and were placed on a schedule of periodic follow-up visits for SPT. Patient compliance was classified into complete compliance (CC), erratic compliance (EC), and noncompliance (NC) groups. Re-examinations were carried out 11.0±0.8 years after the active periodontal treatment. The prognosis for each tooth was determined as good, questionable, or hopeless according to the bone loss observed in pretreatment radiographs. The rate of tooth loss of the CC group was significantly lower than that of the NC group. The tooth loss/patient and the tooth loss/patient/year were not significantly different between the three groups. The rates of tooth loss in the good, questionable, and hopeless prognosis groups were 6.7%, 9.5%, and 13.2%, respectively. For the teeth with a good prognosis, the rate of tooth loss of the CC group was significantly lower than that of the NC group (0.4% vs. 5.1%). For the teeth with a questionable prognosis, the CC group showed a significantly lower rate of tooth loss than did the EC group (4.1% vs. 30.7%) or the NC group (4.1% vs. 25.6%). For the teeth with a hopeless prognosis, the rates of tooth loss were not significantly different among the three groups. Within the limits of this study, the patients who showed a poor compliance with SPT were more likely to lose teeth than were the regularly compliant patients. However, the risk of tooth loss with a hopeless prognosis was high irrespective of the compliance.

Non-compliance and inertia in hypertensive Spaniards at high cardiovascular risk: CUMPLE study

Objective:To assess non-compliance (NC) and therapeutic inertia (TI) after 6 months of follow-up in hypertensive patients with poorly controlled blood pressure and high cardiovascular risk.Research design and methods:Longitudinal, multicentre study; 3900 uncontrolled hypertensive patients were recruited from 585 primary healthcare centres. Tablets were counted during visits at baseline, 1, 3 and 6 months. A tablet count between 80–100% was considered as compliant. Multivariate logistic regression was performed to determine variables associated with NC and TI.Results:A total of 3636 patients completed, mean age was 64.8 (SD 10.8) years, 53.7% being male. After one month, 61.8% (60.2–63.4) had uncontrolled blood pressure, 39.5% (37.9–41.1) were NC and 52.3% (50.2–54.4) had TI. At the end of follow-up, uncontrolled blood pressure was 34.6% (33.1–36.1) (p < 0.05), NC was 46.8% (45.2–48.4) (p < 0.05) and TI was 34.2% (31.6–36.8) (p < 0.05). The variable associated with NC was greatest number of antihypertensive treatments (OR 1.09, 95% CI 1.05–1.13, p < 0.001), and variables associated with TI were least number of antihypertensive drugs (OR 0.88, 95% CI 0.84–0.98, p < 0.001) and least number of diseases suffered (OR 0.95, 95% CI 0.92–0.98, p = 0.002).Limitations:Due to the complexity of measuring compliance, we have to assume measurement bias.Conclusions:Among uncontrolled hypertensive patients, after completing 6 months follow-up, approximately one out of two patients were NC and one out of three physicians committed TI.

Post Discharge Non-Compliance Increases Risk of Left Ventricular Assist Device (LVAD) Malfunction but Does Not Affect Survival

Purpose Pre-implant counseling of LVAD patients stresses the importance of following established protocols of medical, social and therapeutic behaviors. Failure to comply with protocols may affect transplant candidacy (BTT) however, it is unknown whether non-compliance (NC) affects survival or provokes adverse events. Methods and Materials A retrospective review of compliance behavior was carried out in 111 patients (38 Destination Therapy and 73 BTT) who were discharged home (5/2005 to 2/2012). A minimum of six months of follow-up was necessary for inclusion. Compliance with the care contract for the LVAD program was documented as were the incidence of cerebrovascular accident(CVA), device infection(INF), device malfunction, gastrointestinal bleeding(GIB), and readmission. Results Fifty-one of 111 patients had a total of 490 events of NC. The freedom from NC was 47% at one year. The most common cause of NC was failure to have ordered laboratory studies drawn (54% of cases). Six of 51 NC patients accounted for more than half (328) of the episodes of non-compliance. Other reasons for NC included: not following the medical plan (26%), self-medication (7%), failure to communicate with the VAD team (7%), failure to abstain from drugs, alcohol, or smoking (3%), failure to follow diet or exercise (2%), and poor VAD care and education (1%). Actuarial freedom from CVA, INF, and GIB was not significantly different between compliant and NC patients. Two year actuarial freedom from device malfunction was significantly higher (83%) in compliant patients versus those who were NC (63%) (p Conclusions Although NC with established protocols creates challenges when caring for LVAD patients, 2 year adverse event profiles appear unaffected by NC with medical guidelines. Long-term device reliability is significantly less when the program of care is not strictly followed.

Impact of patient characteristics on compliance to adjuvant chemotherapy in hormone receptor negative breast cancer: A single institution experience.

e19568 Background: Adherence to adjuvant chemotherapy (ACT) has been implicated in poor outcomes in early breast cancer (BC). We investigated factors that may contribute to non-compliance (NC) in hormone receptor (HR) negative BC. Methods: 310 HR- patients (pts) who received adjuvant chemotherapy (ACT) at Roswell Park Cancer Institute (RPCI) between 2002 and 2008 were eligible for this retrospective analysis. Patients were categorized as Compliant or Non Compliant (NC). Compliance was subdivided into adequate Tx (AT) and inadequate Tx due to Toxicity (ITT). NC was discontinuation or delays in ACT for reasons other than toxicities. The 3 groups were compared based on baseline characteristics, treatment-related toxicities, and survival. Fisher’s exact, logistic regression, Cox regression, and log-rank tests were used to analyze the data. A significant p value was assigned at ≤ 0.05. Results: 192 pts were included, with a median age of 55 (range 27-86), and median follow up of 4.9 yrs. NC was observed in 19 (10%) pts, ITT in 47 (24%), and AT in 126 (66%). ITT and NC pts were more likely to have a higher Charlson co-morbidity index (CCI) (p=.019), ECOG performance status (p=.048), more hospital stays (p=&lt;.001) and more heme/non-heme toxicities (p=&lt;.001). Comparing NC/ITT/AT groups; 63/94/100 % completed ≥ half of planned Tx (p=&lt;.001), 22/41/5 % had hematologic toxicity (p=&lt;.001). The groups did not differ by trastuzumab use. There were no statistically significant differences in OS and DFS among the 3 groups. Conclusions: Predictors of non-compliance among HR- breast cancer patients receiving ACT include co-morbidities, and performance status. Clinicians should be aware that this group of pts are likely to have problems completing adjuvant chemotherapy and should be proactive about managing toxicities.

High risk drugsÖ reorganising the European Institute of Oncology

BackgroundJC Standards impose at hospitals organisation to develop a method to improve high risk drugs safety.PurposeEuropean Institute of Oncology (EIO) decided to develop this method improving the safety of high-alert...

Compliance with Contact Lens Replacement in Canada and the United States

To assess eye care practitioners (ECPs) recommendations for replacement frequency (RF) of silicone hydrogel (SH) and daily disposable (DD) lenses in Canada and the U.S. and to compare noncompliance (NC) with manufacturer recommended RF by the ECP and patient, and the reasons given for NC. Invitations to participate were sent by e-mail to ECPs in Canada and the U.S. Twenty patient surveys were sent to 420 ECPs, and 2232 eligible surveys were received from 216 ECPs (26% Canada, 74% U.S.). Questions related to patient demographics, lens type, wearing patterns, ECP instructions for RF, and actual patient RF. ECPs provided lens information and their recommendation for RF after the surveys were completed and sealed in envelopes. Responses were anonymous. DD accounted for 18% (Canada) vs. 16% (U.S.) of wearers (p > 0.05); 35% (Canada) vs. 45% (U.S.) wore 2-week replacement SH (2WR; p = 0.011); and 47% (Canada) vs. 39% (U.S.) wore 1-month replacement SH (1MR) lenses (p = 0.025). Thirty-four percent (Canada) vs. 18% (U.S.) of ECPs recommended longer RFs than the manufacturer recommended RF for 2WR lens wearers (p < 0.001); 6% (Canada) vs. 4% (U.S.) for DD wearers; and 2% (Canada) vs. 1% (U.S.) for 1MR lens wearers. NC rates for actual RFs reported by patients were not different between countries (p > 0.05) and were lowest for DD (13% Canada, 12% U.S.), followed by 1MR (33% Canada, 28% U.S.). The highest NC rates were with 2WR (50% Canada, 52% U.S.). The most frequent reason for NC with 2WR and 1MR was "forgetting which day to replace lenses" (54% Canada, 53% U.S.) and in DD wearers "to save money" (56% Canada, 29% U.S., p < 0.001). 1MR lenses are more frequently prescribed in Canada. ECPs in Canada were NC with 2WR lenses more frequently than U.S. ECPs, but patient NC rates were the same in both countries for all lens types. ECP and patient NC rates were highest for 2WR lens wearers.

225: The Impact of Non-Compliance (NC) on Survival after Heart Transplantation (HT): A Multi-Institutional Study

225: The Impact of Non-Compliance (NC) on Survival after Heart Transplantation (HT): A Multi-Institutional Study

Rebound platelet activation after termination of prasugrel and aspirin therapy due to confirmed non-compliance in patient enrolled in the JUMBO Trial

Therapy with aspirin and/or adenosine diphosphate (ADP) receptor blockers is associated with better outcomes via inhibition of platelet activity, and subsequent reduction of ischemic vascular events. Non-compliance (NC) is a well-recognised hazard limiting the clinical utility of antiplatelet agents, and, probably worsening outcomes. However, comprehensive platelet characteristics of a confirmed NC patient after acute vascular event have never been reported within a major randomised trial with ADP-receptor antagonists. A 48-year-old male patient, well-educated, was among patients enrolled in the platelet sub-study for the JUMBO trial. He received 325 mg of aspirin daily for 9 months, presented with unstable angina for urgent coronary intervention, and was successfully reperfused with two intracoronary stents. The patient was randomised to a 60 mg prasugrel loading dose, and 10 mg of prasugrel daily for 30 days. Platelets were assessed at baseline, 4 and 24 h, and at 30 days after acute coronary event utilising ADP-, and collagen-induced conventional aggregometry, rapid cartridge-based analyser and flow cytometry. Loading with prasugrel resulted in significant inhibition of platelet activity during and after stenting. However, after assessing platelet biomarkers at 30 days, voluntary withdrawal from the antiplatelet agents was suspected. Based on the platelet activity characteristics, NC was later confirmed, and the patient admitted that he stopped taking both prasugrel and aspirin shortly after discharge due to minor bleeding episodes after shaving. Major platelet activity biomarkers of the index NC patient were compared with those from compliant prasugrel-, clopidogrel-treated patients, and healthy controls. The platelet tests uniformly revealed rebound activation by all platelet measures (at least twofold increase) while being especially high for ADP-, and collagen-induced aggregation, platelet/endothelial cell adhesion molecule-1 (PECAM-1), glycoprotein (GP)Ib, GPIIb/IIIa activity, P-selectin, protease activated receptor (PAR)-1 thrombin receptor (activated and intact epitopes), and thrombospondin expression. The clinical benefits of antiplatelet agents are not only denied in NC outpatients, but may put them at additional risk for worsened vascular outcomes due to the rebound platelet activation. Proclaimed 'resistance' to antiplatelet agents may at least in part be a result of NC, especially in the chronic uncontrolled setting. Enforcing compliance will improve outcomes in the clinical trials, and save lives of patients really receiving antiplatelet therapy.

Medikamenten-Compliance bei Epilepsie

Inadequate adherence to a prescribed medication regimen, so-called noncompliance (NC), occurs in 30-50% of patients with epilepsy and is thought to be a major cause of insufficient seizure control. This article gives an overview on how NC can be diagnosed, its causes, which patient groups are at risk, and which interventions are suitable to improve or maintain compliance.