Poor Medication Knowledge Research Articles

Diabetes Mellitus and Its Therapy in Brunei Darussalam - A Critical Revisit.

Diabetes is becoming an increasingly common condition across the world including Brunei Darussalam. Bruneian population, although is relatively small, represents a miniature urban community of neighbouring Southeast Asian countries as they share similar dietary and ethnicity patterns. Thus, it would be valuable to examine the findings of studies conducted among Bruneians. This study aimed to identify and review research related to the practice of patients with DM in Brunei Darussalam in order to identify associated factors influencing diabetic medication knowledge and adherence. This narrative review analyzed literature related to DM and its therapy in Brunei Darussalam. Other issues consisting of knowledge and adherence related to DM were also explored. Databases (Scopus, PubMed, and Google Scholar) were used to search literature published up to May 2022. Search terms "diabetes mellitus", "Brunei" combined using Boolean operator were used. Conducting appropriate studies in Brunei Darussalam can benefit the government and policymakers to implement effective measures and programmes to combat the diabetes epidemic. Despite the government's efforts, additional relevant stakeholders must be included in order to work together and engage in these initiatives in order to increase diabetes awareness, give people the power to make healthy decisions, and ultimately reduce the prevalence of diabetes in Brunei Darussalam. Patients' medication knowledge proficiency plays a main component of ensuring appropriate and safe use of medication prescribed to them. Relatively poor medication knowledge and inappropriate diabetes-related practices were observed in studies conducted in Brunei Darussalam. However, no study has been done which directly measures both medication awareness and compliance among Brunei Darussalam T2DM patients. Future studies can focus on the relation between these two factors in different geographical locations of the world that are characterized by different diabetes-related practices and culture.

The impact of poor medication knowledge on health-related quality of life in people with Parkinson\u2019s disease: a mediation analysis

PurposeThis study aimed to determine how limited medication knowledge as one aspect of health literacy contributes to poorer health-related quality of life (HRQoL) in people with Parkinson’s disease (PD).MethodsDemographical data, PD-specific data (MDS-Unified Parkinson’s Disease-Rating Scale, Nonmotor symptom scale), and data about depressive symptoms (Beck’s depression inventory), cognition (Montreal cognitive assessment), HRQoL (Short-Form Health Questionnaire-36, SF-36), and medication knowledge (names, time of taking, indication, dosage) were assessed in 193 patients with PD. Multivariate analysis of variance (MANOVA), multivariate analysis of covariance, and mediation analyses were used to study the relationship between medication knowledge and HRQoL in combination with different mediators and covariates.ResultsOverall, 43.5% patients showed deficits in at least one of the 4 knowledge items, which was associated with higher age, number of medications per day and depression level, and poorer cognitive function, motor function, and lower education level. Using one-way MANOVA, we identified that medication knowledge significantly impacts physical functioning, social functioning, role limitations due to physical problems, and role limitations due to emotional problems. Mediation models using age, education level, and gender as covariates showed that the relationship between knowledge and SF-36 domains was fully mediated by Beck’s Depression Inventory but not by Montreal Cognitive Assessment.ConclusionsPatients who expressed unawareness of their medication did not necessarily have cognitive deficits; however, depressive symptoms may instead be present. This concomitant depressive symptomatology is crucial in explaining the contribution of nonadherence and decreased medication knowledge to poor quality of life.

Effects of medication knowledge on medication adherence among hypertensive patients at Matero level one hospital, Lusaka city, Zambia: a cross sectional study

Background: Medication adherence is the mainstay to good treatment outcomes. Failure to adhere to medication in hypertensive patients may lead to considerable deterioration of the disease resulting in increased costs of healthcare and mortality. Knowledge about the name of the drug, indications and side effects may enhance medication adherence. Therefore, the aim of this study was to assess effects of medication knowledge on medication adherence among hypertensive patients.Methods: This was a cross-sectional study that involved 120 hypertensive patients. A structured questionnaire was used to collect data on demographic characteristics. Adherence was assessed using the 8-item Morisky medication adherence scale while patient’s medication knowledge was assessed using a 7-item scale. Multiple logistic regression was used to assess factors associated with medication adherence.Results: The mean age of participants was 59 years (SD±14.9) and 10 (8.3%), 42 (35%) and 68 (56.7%) had adequate, average and poor medication knowledge respectively. The prevalence of adherence in this study was 37.5%. In multivariable logistic regression analysis, uncontrolled blood pressure (BP) (AOR: 0.38, CI: 0.16-0.90) was associated with lower likelihood of adhering to medication.Conclusions: The adherence level to treatment was low and medication knowledge of hypertensive patients was generally poor. Uncontrolled BP was associated with non-adherence. Patients with uncontrolled hypertension should be given health education and counselling regarding their condition to improve medication adherence.

The challenge of medication errors in the emergency department setting

Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In 2017, the World Health Organization launched Medication without Harm to reduce severe avoidable medication-related damage by 50%, globally in the next 5 years. Emergency Departments (EDs) are stressful care environments which making EDs more prone to MEs. Therefore, EDs need to be seriously considered to reduce MEs and increase patients' safety. In this regard, it is of great significance to know about the most common stage of error in pharmacotherapy, the most common type of medication error and the most common causes of MEs in the emergency department practice setting. in conclusion, the most common types of MEs in EDs include drug omission error, wrong dose and strong infusion rate. In addition, the administration and prescribing are the most common stages of MEs in EDs. Also, the most common causes of MEs in EDs in Iran include nursing shortage (fatigue) and poor medication knowledge .

The Pharmacist Role In Improving Medication Adherence In Dialysis Patients: A Systematic Review

End-stage renal disease (ESRD) is a worldwide concern in this latest generation as the prevalence had been in an increasing trend. This research aims to evaluate the impact of pharmacist interventions on medication adherence and factors related to medications non-adherence among hemodialysis (HD) patients. A literature search was conducted using search engines PubMed, Cochrane Library and ScienceDirect to identify studies that investigate the pharmacist interventions on medication adherence and factors related to medication non-adherence among HD patients. Based on the study objective a qualitative assessment of the final selected articles was made. The quality of the included studies was assessed using the Newcastle-Ottawa scale. Seven studies met the inclusion criteria. The summed overall quality using the Newcastle-Ottawa scale of all the selected paper was good. The majority of the studies were conducted as prospective study design. More than half of the studies (71%) utilized subjective measure which is self-reporting with a validated questionnaire such as Medication Adherence Report Scale (MARS), Brief Medication Questionnaire (BMQ) and Morisky 8-item Medication Adherence Scale (MMAS-8) to measure participants’ adherence. The selected papers have shown that poor medication knowledge as the main factor for non-adherence towards medications. The most common reported pharmaceutical care done by the pharmacist to improve medication adherence is by providing medication counselling. All the studies demonstrate the positive impact of pharmacist involvement in HD patients to enhance medication adherence. All identified studies prove that clinical pharmacists could play an important role in educating patients which helps them to have a positive attitude towards medications.

Determinants of understanding and satisfaction with health education by patients in primary healthcare

Objectives: The aim of the study is to measure the percentage of patients receiving health education services regarding diagnosis, treatment, prevention, health promotion, and its relation to the satisfaction level in primary healthcare (PHC) centers in Abu Dhabi, United Arab Emirates. Patients and Methods: This is a cross-sectional study using a questionnaire targeting the population aged 18 and above who attend PHC centers in Abu Dhabi Island. A total number of 333 participants were enrolled in this study. Results: About 89.6% of participants reported receiving health education regarding diagnosis, treatment, prevention, and health promotion. 81% of health education was delivered by the physician using verbal methods, 94.4% of the participants reported it to be the most preferred method. A relationship was found between health education and satisfaction level (P = 0.000). 86.4% were satisfied with the health education service they received. The main reasons of satisfaction included provider medical knowledge 43.6% and good communication skills 41.2% (P = 0.045). A correlation was found between patient satisfaction and the continuity of care of participants as 88.2% who are satisfied reported will revisit the same physician (P = 0.000). Conclusions: Majority of the patients received health education about diagnosis, treatment, prevention, and health promotion. Most of them preferred a verbal method to be delivered by a physician. Moreover, participants who received health education found to be more satisfied and complaint with their follow-up as well as recommend the physician to others. The main reason for dissatisfaction was the provider's poor medical knowledge and poor communication skills. Therefore, physicians may need training courses to achieve better communication skills and to improve medical knowledge delivered to patients.

Polypharmacy in the oldest old (\u226580\xa0years of age) patients in China: a cross-sectional study

BackgroundThe oldest old generally have worse health and more comorbidities than the general population of older adults, and they are more likely to be exposed to polypharmacy. Reliable investigation of polypharmacy among the oldest old (≥80 years of age) in China are lacking. So this study aims to describe the polypharmacy status of oldest old patients ≥80 years of age and to assess the factors influencing medication compliance.MethodsThis was a cross-sectional study of 258 oldest old patients ≥ 80 years of age and hospitalized at a tertiary hospital in Beijing between December 1, 2014 and June 30, 2015. They completed three validated questionnaires to assess their pre-admission status (general demographics, medication knowledge, and medication adherence). Potentially inappropriate medications (PIM) use was evaluated by physicians.ResultsThe majority of the patients (55.4%) took < 10 types of drugs. The numbers of drugs taken ranged from 8 to 60 drugs (median of 22.9). Patients taking 11–20 drugs accounted for 46.1% of the patients. Subjects with a history of adverse drug reactions accounted for 40.3%. The proportion of PIMs was 27.1%. Compliance was only 32.6% among the oldest old patients with polypharmacy. Age and medication classes were independently negatively associated with compliance, and medication knowledge was independently positively associated with compliance.ConclusionOldest old patients (≥ 80 years of age) had a poor medication knowledge. Age, medication classes, and medication knowledge were independently associated with medication compliance.

Prevalence, management, and outcome of problem residents among neurosurgical training programs in the United States.

OBJECTIVE: The challenging nature of neurosurgical residency necessitates that appropriate measures are taken by training programs to ensure that residents are properly progressing through their education. Residents who display a pattern of performance deficiencies must be identified and promptly addressed by faculty and program directors to ensure that resident training and patient care are not affected. While studies have been conducted to characterize these so-called "problem residents" in other specialties, no current data regarding the prevalence and management of such residents in neurosurgery exist. The purpose of this study was to determine the rate and the outcome of problem residents in US neurosurgical residency programs and identify predictive risk factors that portend a resident's departure from the program. METHODS: An anonymous nationwide survey was sent to all 108 neurosurgical training programs in the US to assess a 20-year history of overall attrition as well as the management course of problem residents, including the specific deficiencies of the resident, management strategies used by faculty, and the eventual outcome of each resident's training. RESULTS: Responses were received from 36 centers covering a total of 1573 residents, with the programs providing a mean 17.4 years' worth of data (95% CI 15.3-19.4 years). The mean prevalence of problem residents among training programs was 18.1% (95% CI 14.7%-21.6%). The most common deficiencies recognized by program directors were poor communication skills (59.9%), inefficiency in tasks (40.1%), and poor fund of medical knowledge (39.1%). The most common forms of program intervention were additional meetings to provide detailed feedback (93.9%), verbal warnings (78.7%), and formal written remediation plans (61.4%). Of the identified problem residents whose training status is known, 50% graduated or are on track to graduate, while the remaining 50% ultimately left their residency program for other endeavors. Of the 97 residents who departed their programs, 65% left voluntarily (most commonly for another specialty), and 35% were terminated (often ultimately training in another neurosurgery program). On multivariable logistic regression analysis, the following 3 factors were independently associated with departure of a problem resident from their residency program: dishonesty (OR 3.23, 95% CI 1.67-6.253), poor fund of medical knowledge (OR 2.54, 95% CI 1.47-4.40), and poor technical skill (OR 2.37, 95% CI 1.37-4.12). CONCLUSIONS: The authors' findings represent the first study to characterize the nature of problem residents within neurosurgery. Identification of predictive risk factors, such as dishonesty, poor medical knowledge, and/or technical skill, may enable program directors to preemptively act and address such deficiencies in residents before departure from the program occurs. As half of the problem residents departed their programs, there remains an unmet need for further research regarding effective remediation strategies.

A Systematic Review of Main Factors leading to Irrational Prescription of Medicine

Context: One of the serious global problems is the irrational prescribing of medicines that can be regarded as harmful or wasteful. Inappropriate use and overuse of medicines, waste resources and therefore lead to health and economic consequences in patients. The goal of this systematic review was to identify factors associated with irrational prescriptions of medicine. Evidence Acquisition: We searched the Cochrane database of systematic reviews (via Cochrane library), PubMed, Medline, Scopus, Science Direct, BMC, Scholar Google, and SID from 1980 up to October of 2016. Results: Of the 594 papers, 26 papers were finally included. The combined results of the 26 papers indicated 24 factors for unnecessary prescriptions of medicine. Factors related to the patient were expectations, demand to prescribe, and poor medical knowledge. Factors related to the physician were inaccurate diagnosis, inadequate awareness and knowledge, low experience, information asymmetry, poor medical education, and the physician’s attitude. Factors related to the institutional and political issues were fee-for-service, out-of-pocket payment, financial incentives, insurance reimbursements, insurance coverage, medicine subside, medicine advertisement, ineffective monitoring programs, regulation on prescription, prescription supervision, clinical guidance, and medicines near-expiry dates or expired. Conclusions: It can be concluded that the irrational/unnecessary prescription of medicine was influenced by many different factors, such as patient, physician, and institution. Thus to prevent irrational/unnecessary prescription, one needs to consider all the involved factors.

Demographic correlates of medication knowledge in Hong Kong early psychosis patients.

Patient knowledge of prescribed medications is important for accurate medication consumption. Not many studies have identified the demographic correlates of medication knowledge in psychiatric patients, and fewer have performed so for non-Western societies, which may present different results owing to distinct cultural factors. Our objective was to identify the demographic correlates of medication knowledge in early psychosis patients from Hong Kong. A short questionnaire comprising questions on six components of medication knowledge was administered to 105 consecutive early psychosis patients from an outpatient clinic in Hong Kong. A suite of patient demographics was assembled from clinicians' records. Poor medication knowledge was characterized by patients of older age (>30 years), low education level (≤Form 3), overall negative family relationships (as compared with overall positive ones) and shorter treatment duration (≤4 years). Shorter treatment duration most consistently predicted poor medication knowledge, displaying significant (P < 0.05) associations with four out of six knowledge components. Patients (54.3%) did not know the English names of their medication. Specific groups of early psychosis patients are at risk of having poor medication knowledge; these individuals should be identified to receive regular health education. Contrary to findings from non-psychosis groups, short treatment duration was unequivocally associated with poorer medication knowledge in patients with early psychosis. Local replacements for English medication names should be considered in non-English speaking societies, especially in areas of mental health treatment.

Pediatric Nurses' Medication Error: the Self-reporting of Frequency, Types and Causes

Background Medication errors (MEs) are the most common types of medical errors which effecting on pediatric safety. For decrease MEs, we should to have information about difference aspects of MEs. We have no study which assessed the frequency, types and causes of MEs made by pediatric nurses, in Iran. Material and Methods This was a cross-sectional study, which performed on 53 Pediatric Nurses. Data were collected by a self-structured questionnaire for assessment of MEs contained 3 parts: 1- one question about the fact that, do you had MEs in past 3 months; 2- types of MEs occurred (12 items); 3- causes of MEs from nurses’ perspective (20 items). The MEs in past 3 months gathered through pediatric nurses’ selfreport. Descriptive statistics and Chi-square test were used for analysis. Data were analyzed using the SPSS. Results The majority of participants were female (77.3%), and initial (novice) nurses (33.9%). The results showed that, 31 (58.4%) of nurses were reported at least one MEs history and totally, 131 MEs were occurred in past 3 months. Most prevalent of MEs types were reported: wrong dose (36.6%) and wrong drug preparation (14.5%). Also, most prevalent of MEs causes from Nurses’ perspective were reported: poor medication knowledge (96.2%) and poor calculation skills (73.5%). Conclusion With using of this study results, we can program for prevention/decrease MEs and enhancing pediatric safety. On the basis of this study, actually we should enhancing level of nurses knowledge by education and to carry out special courses for pediatric nurses.

Adult Transplant Hepatologists’ Perceptions of the Transition From Pediatric to Adult Care: A National Survey.

Background: Adult transplant hepatologists face challenges providing care to patients who received liver transplants during childhood. Understanding these challenges may identify opportunities to improve transition to adult care. Methods: We conducted a web-based, national survey of adult transplant hepatologists to assess factors that may impact the transition from pediatric to adult care. Results: 236/407 (58% participation rate) completed the survey. The sample was 75% male, 51% <45 years old, and 63% white. Most of their pediatric recipients at their first adult clinic visit had an average age ≥21 years (54%). A third noted that recipients came to visits without a parent or guardian (33%), and that recipients had inadequate knowledge of their condition (30%). Few (16%) respondents reported having a formal transition program. The majority of respondents identified patients’ poor medication adherence (70%), limited ability and knowledge to manage their own condition (54%), and inadequate knowledge of past medical/surgical history (51%) as the main challenges to caring for their newly transitioned patients. Respondents at centers with formal transition programs, compared to those without, reported that their patients were more knowledgeable and able to discuss issues of substance use (47% vs. 22%, p = 0.002) and sexuality and quality of life (38% vs. 21%, p = 0.03). Respondents with transition programs saw more patients 18-20 years old at initial referral (61% vs. 43%, p = 0.06) and were more likely to have adequate knowledge of pediatric transplant issues than respondents without transition programs (65% vs. 48%, p = 0.08). Conclusions: Adult hepatologists reported numerous challenges to caring for patients who have transitioned from the pediatric to the adult clinic. Given that current transition programs may be associated with enhanced provider and patient knowledge, early interventions may optimize this transition and thus require further study.

Medication use and knowledge in a sample of Indigenous and non‐Indigenous prisoners

To (a) characterise medication use and knowledge, according to Indigenous status, and (b) identify independent correlates of medication knowledge in a sample of adult prisoners. Cross-sectional survey of 1,231 adult prisoners in Queensland, interviewed within six weeks of release. Measures included self-reported demographic and health-related characteristics, self-reported use of medications, the Hayes Ability Screening Index (HASI) and the Short-Form Health Survey (SF-36). Objective medication data were abstracted from prison medical records. A medication knowledge score was calculated to reflect the agreement between self-reported and objective medication use. 46% of participants were taking at least one medication. The most common class of medication was Central Nervous System (30% of participants). Medication knowledge was generally poor, with one quarter of prisoners unable to accurately identify any of their medications. Independent correlates of poor medication knowledge included not taking Central Nervous System medications, identifying as Indigenous and age >54. Around half prisoners are taking medications in prison, but most have poor knowledge of what these medications are. Medication knowledge is associated with better adherence and may contribute to improved health outcomes post-release. Changes to prescribing and dispensing practices in prison may improve medication knowledge and health outcomes in this profoundly marginalised group.

State of Nutrition Support Teams

The incidence of malnutrition in hospitalized patients is relatively high (up to 55%) despite breakthroughs in nutrition support therapies. These patients have increased morbidity and mortality, extended hospital stays, and care that is associated with higher costs. These patients are often poorly managed due to inadequate nutrition assessment and poor medical knowledge and practice in the field of nutrition. Nutrition support teams (NSTs) are interdisciplinary support teams with specialty training in nutrition that are often comprised of physicians, dietitians, nurses, and pharmacists. Their role includes nutrition assessment, determination of nutrition needs, recommendations for appropriate nutrition therapy, and management of nutrition support therapy. Studies have demonstrated significant improvements in patient nutrition status and improved clinical outcomes as well as reductions in costs when patients were appropriately managed by a multispecialty NST vs individual caregivers. Despite this, there has been steady decline in the number of formal NST in recent years (65% of hospitals in 1995 to 42% in 2008) as hospitals and other healthcare organizations look for ways to cut costs. Given the importance of nutrition status on clinical outcomes and overall healthcare costs, a number of institutions have introduced and sustained strong nutrition training and support programs and teams, demonstrating both clinical and economic benefit. The benefits of NST, training and implementation strategies, and tips for justifying these clinically and economically beneficial groups to healthcare organizations and governing bodies are discussed in this review.

How much do elders with chronic conditions know about their medications?

BackgroundPatients with chronic diseases often undertake multiple medication regimes to manage their condition, prevent complications and to maintain their quality of life. A patient’s medication knowledge has been defined as the awareness of drug name, purpose, administration schedule, adverse effects or side-effects and special administration instructions. Poor medication knowledge can have a negative impact on medication adherence and patient safety and, in increasing the use of medical resources. The objective of the study is to assess the medication knowledge of elderly patients with chronic disease conditions and the factors affecting this knowledge.MethodsA cross-sectional survey was conducted in patients aged ≥60 with chronic disease conditions or their caregivers were recruited from two general outpatient clinics and two medical outpatient clinics in the public sector. Participants were approached by trained interviewers to complete a semi-structured questionnaire to assess their understanding of the instructions and information relating to their regular medications, which included medication name, regimen, purpose and common side-effects and precautions.ResultsA total of 412 patients were recruited with the mean age of 72.86 ± 7.70. Of those, 221 (54.2%) were male and 226 (55.4%) were of primary school educational level or below. The mean number of medications taken per patient was 3.75 ± 1.93. Overall, 52.7% of patients felt that healthcare staff or clinic pharmacists had very clearly explained the administration instruction of the prescribed medications whilst 47.9% had very clear explanations of drug purpose but only 11.4% felt they had very clear explanations of side-effects. 396 patients (96.1%) failed to recall any side effects or precautions of each of their prescribed medications, although 232 patients (58.4%) would consult a doctor if they encountered problems with their medications. Logistic regression analysis showed that for every additional medication prescribed, the likeliness of patients to recall side-effects of all the medications prescribed was significantly lowered by 35% (OR = 0.65; 95% CI = 0.44-0.94; P = 0.023). In addition, those who finished secondary school or higher education were likely to possess more knowledge of side-effects (OR = 9.88; 95% CI = 2.11-46.25; P = 0.004).ConclusionsPatients who take medications for their chronic diseases generally lack knowledge on side-effects of their medications which could potentially affect medication compliance and medication safety.

Knowledge of prescription medications among cancer patients aged 65years and above

Abstract Objectives Studies have repeatedly shown that older adults have poor medication knowledge and utilize a disproportionate share of medications. These put them at high risk for drug–drug interactions. This study aims to determine the knowledge of prescription medications among cancer patients aged ≥ 65 years and determine the extent of safe medication practices adopted by patients. Secondary objectives include determining potential drug–drug interactions and uncovering potential areas of risk in safe medication use. Materials and Methods This is a cross-sectional study of patients/caregivers attending outpatient clinics at the National Cancer Centre Singapore. Patients (≥ 65 years) taking ≥ 1 prescription medication at home were recruited. Patients were interviewed using structured questionnaires in a language understood by patients. Information was verified through the electronic prescription system and case notes. Results A total of 196 patients were included in the analysis. The mean age (S.D.) of patients was 71 (4.54) years. Patients were on an average of 4.09 medications. Seventy-four (37.7%) patients failed to report ≥ one of their medications. Few patients could name their medications (8.7%), were aware of precautionary instructions (23.5%) and keep a medication list (15.3%). A majority of patients correctly identified the indications for use (69.4%), prescribed doses (77.0%) and dosing frequencies (73.0%). Approximately half of the patients would read drug labels (51.0%), discard medication when no longer needed (60.7%) and check expiry dates (44.9%). About a third would check for any changes in medication/regimen associated with new prescriptions (37.8%). No clinically significant drug–drug interaction was detected. Conclusion Elderly patients do not possess a complete knowledge about their medications and lack practices for safe medication use.

Patient medication knowledge and adherence to asthma pharmacotherapy: a pilot study in rural Australia

Asthma is a chronic disease with both inflammatory and bronchoconstrictive elements and often requires multiple medications. Most asthma regimens include medications with different therapeutic modes of action and a number of different medication delivery devices. To effectively participate in their asthma management, patients need to recognize each of their medication types, understand their purpose, adhere to their treatment regimen, and be proficient in using the required delivery devices. This study evaluated patient knowledge of asthma pharmacotherapy and adherence. An interview study was undertaken in two rural locations, in Australia, to elicit participants' knowledge, use, and inhalation device technique. Of participants, 75.9% used preventer medication and the remaining 24.1% used reliever medication only. Of those using preventer medication, 82.5% could distinguish their preventer from a range of asthma medicines. Metered dose inhalers (MDIs) were used by 80% of participants; 23% used a Turbuhaler(R); 24% used an Accuhaler(R); and 5% used an MDI with a spacer device. The study established poor medication knowledge, suboptimal device technique, and disturbing levels of adherence with management recommendations. Asthma education strategies need to be modified to engage patients with low asthma knowledge to achieve improved patient outcomes. Further, strategies need to motivate patients to use preventer medication during times when they feel well.

Knowledge of antiretroviral regimen dosing and adherence: a longitudinal study.

In a cohort of 128 human immunodeficiency virus-infected patients, we found that patients' knowledge of antiretroviral dosing was suboptimal at regimen initiation but improved with time. Poor medication knowledge 8 weeks after regimen initiation was associated with lower adherence and with a lower level of literacy in a multivariate model (P=.03). Because knowledge deficits are common after antiretroviral regimen initiation, clinicians should assess patients' understanding of medication dosing soon after regimen initiation or change.

Medical multiparametric time course prognoses applied to kidney function assessments

In this paper, we describe an approach to utilize case-based reasoning methods for trend prognoses for the monitoring of the kidney function in an Intensive Care Unit (ICU) setting. Since using conventional methods for reasoning over time does not fit for course predictions with poor medical knowledge of typical course patterns, we have developed abstraction methods suitable for integration into our case-based reasoning system ICONS. These methods combine medical experience with prognoses of multiparametric courses. On the ICU, the monitoring system NIMON provides a daily report based on current measured and calculated kidney function parameters. Subsequently, we generate course-characteristic trend descriptions of the renal function over the course of time. Using case-based reasoning retrieval methods, we search in the case base for courses similar to the current trend descriptions. Finally, we present the current course together with similar courses as comparisons and as probable prognoses to the user. We applied case-based reasoning methods in a domain which seemed reserved for statistical methods and conventional temporal reasoning.

Circumstances around the Onset of a Myocardial Infarction

Psychosocial factors, experienced pain and anxiety in relation to patient delay were studied in 100 patients admitted for suspected acute myocardial infarction (AMI). More severe pain was reported by women, by those who had recently consulted a physician, who experienced severe anxiety, who fell ill away from their place of work, or who possessed little medical knowledge. These patients tried to get relief from pain by resting. Patients experiencing more severe anxiety were younger, had not consulted a physician recently, had poor medical knowledge, belonged to lower socio-economic groups or were impatient. These patients also sought relief from pain by resting. Pain, but not anxiety, was related to delay. Long delay was seen more often in patients who did not believe they had suffered an AMI and who were psychologically inactive prior to the onset of pain. Recent physician consultation, failure to call for help and belonging to lower socio-economic groups were also related to long delay. Medical knowledge was unrelated to patient delay. Patients with a low degree of pain rarely reported considerable anxiety, whereas several patients with severe pain had little or no anxiety.