Poor Adherence Rates Research Articles

Medication adherence and blood pressure control in treated hypertensive patients: first follow-up findings from the PREDIcT-HTN study in Northern Bangladesh

IntroductionAdherence to antihypertensive medication is crucial to control blood pressure (BP) and hypertension management outcomes. In Bangladesh, as in many other countries, poor adherence to medication represents a challenge to effective hypertension management. This study aims to investigate the prevalence and relationship between medication adherence and BP management among hypertensive patients in Bangladesh.MethodsThe PREDIcT-HTN study in Northern Bangladesh aims to evaluate major adverse clinical events in treated hypertensive patients. The study involves 2643 hypertensive patients from a medical center, with data collected through baseline information and yearly follow-ups until 2025. The first follow-up visit was conducted between January and March 2021. Following the 2020 ISH-global hypertension guideline, patients were classified as having controlled BP, grade-I, or grade-II uncontrolled BP. Patients were divided into three groups (good, moderate, and poor) based on their 9-item Hill-Bone medication adherence scale. A multinomial regression analysis was conducted to identify the association between medication adherence and BP control after adjusting potential confounders.ResultsAnalysis of 2276 hypertensive patients (mean age 51.31 ± 11.58 years) revealed that 36.1% had grade-I and 24.2% had grade-II uncontrolled hypertension. Most patients (78%) displayed moderate adherence, and 15% showed poor medication adherence. Certain patient subgroups had higher rates of poor adherence: females (17.1%) compared to males (12.2%), rural residents (22.4%) compared to city-dwellers (12.2%), and newly diagnosed patients (17.2%) compared to those diagnosed 2–5 years earlier (12.6%). Multivariable analysis found a strong association between medication adherence and BP control. Compared to poor adherence, moderate adherence (relative risk ratio (RRR):0.50, 95%CI:0.36–0.68) and good adherence (RRR:0.56, 95%CI:0.35–0.91) were associated with better control. Increasing age, rural living, and uncontrolled hypertension were also linked. Comorbidities worsened BP control, and managing multiple medications contributed to poor adherence and grade-II hypertension in patients.ConclusionThe high prevalence of uncontrolled hypertension in Bangladesh underscores the need for improved treatment strategies. Addressing medication adherence is essential for better BP control, with particular attention needed for women, rural residents, and newly diagnosed individuals. A comprehensive approach is warranted, including strategies to enhance adherence, early diagnosis, personalized treatment, and simplified medication regimens. These efforts align with the UN's 2030 SDGs, emphasizing targeted interventions for equitable healthcare access and outcomes.

Antipsychotic medication non-adherence and its determinants among out-patients with schizophrenia.

While antipsychotics are key requirement in acute and long-term management of schizophrenia, medication adherence remains a major unmet need in its care. This paper assessed the prevalence of oral antipsychotic non-adherence among outpatients with schizophrenia and its associated clinico-demographic factors. Three hundred and ten adult outpatients (18-64 years of age) were cross-sectionally interviewed after being diagnosed of schizophrenia using ICD-10 criteria, and the diagnosis confirmed with the Mini International Neuropsychiatric Interview (MINI). The socio-demographic questionnaire, Morisky Medication Adherence scale (MMAS-8), Brief Psychiatric Rating Scale (BPRS), Liverpool University Neuroleptic Side Effects Scale (LUNSERS), Drug Attitude Inventory (DAI-10), Scale to Assess Unawareness of Mental Disorders (SUMD) were used to obtain participants' demographic profile, level of medication adherence, illness severity, attitude towards antipsychotics, and level of insight respectively. At least one in every two outpatients with schizophrenia (n=158; 51.0%) did not adhere to their antipsychotics as prescribed. The independent risk factors for poor oral antipsychotic adherence were illness severity (p= 0.001; AOR 1.13), psychoactive substance use (p= 0.009; AOR 1.87), young age (p= 0.014; AOR 2.09), perceived poor social support (p= 0.025; AOR 3.58), use of first generation antipsychotics alone (p= 0.006; AOR 17.99), use of second generation antipsychotics alone (p= 0.02; AOR 29.36), and awareness of symptoms (p= 0.025; AOR 1.18). The high rate of poor medication adherence should necessitate much emphasis on the highlighted modifiable risk factors and the need for continuous adherence assessments and education in clinical practice.

Efficacy of Panchakarma therapy and lifestyle modification in essential hypertensive patients to reduce anti-hypertensive dependency

Background: Anti-hypertensive drugs are associated with a plethora of adverse reactions which can lead to poor treatment adherence, increased morbidity and mortality rates, and significant economic burden. The blood pressure management program (BPMP) is an Ayurvedic treatment strategy that combines Panchakarma with diet management. Thus, the current study sought to assess the efficacy of the BPMP in essential hypertensive patients to reduce anti-hypertension dependency. Methods: A retrospective, observational, single-centre study was conducted between December 2018 and September 2023 in Maharashtra, India. Patients aged 30-75 years diagnosed with primary/essential hypertension regardless of gender participated in the BPMP and were included in the study. Follow-up was conducted after 90 days. Day 1 and day 90 data were compared. Results: A total of 59 patients were assessed. Daytime ambulatory blood pressure monitoring (ABPM) systolic blood pressure decreased (day 1: 123.71±11.83 mmHg and day 90: 123.12±12.36 mmHg), night-time ABPM systolic blood pressure decreased (day 1: 114.76±13.41 mmHg and day 90: 114.31±14.40 mmHg), daytime ABPM diastolic blood pressure decreased (day 1: 77.03±8.28 mmHg and day 90: 76.31±9.45 mmHg, and night-time ABPM diastolic blood pressure decreased (day 1: 69.53±8.32 mmHg and day 90: 68.42±8.85 mmHg). Nocturnal dipping decreased (day 1: 7.08±8.19 and day 90: 6.08±8.99). Dependency on allopathic medication also decreased. Conclusions: The Ayurveda-based BPMP effectively reduces blood pressure and dependency of allopathic medication. It also improves quality of life of patients diagnosed with primary/essential hypertension.

Pharmacogenetics of Toxicities Related to Endocrine Treatment in Breast Cancer: A Systematic Review and Meta-analysis.

Endocrine therapy is the standard treatment for hormone receptor-positive (HR+) breast cancer (BC). Yet, it is accompanied by treatment-related toxicities, leading to poor treatment adherence, high relapse, and low rates of survival. While pharmacogenomic variants have the potential to guide personalized treatment, their predictive value is inconsistent across published studies. To systematically assess the literature's current landscape of pharmacogenomics of endocrine therapy-related adverse drug effects, systematic searches in MEDLINE, Embase, Cochrane CENTRAL, Google Scholar and PharmGKB databases were conducted. We identified 87 articles. Substantial heterogeneity and variability in pharmacogenomic effects were evident across studies, with many using data from the same cohorts and predominantly focusing on the Caucasian population and postmenopausal women. Meta-analyses revealed Factor V Leiden mutation as a predictor of thromboembolic events in tamoxifen-treated women (p<0.0001). Meta-analyses also found that rs7984870 and rs2234693 were associated with musculoskeletal toxicities in postmenopausal women receiving aromatase inhibitors (p<0.0001 and p<0.0001, respectively). Overall, the current body of evidence regarding the potential role of pharmacogenomics in endocrine therapy-related toxicity in BC remains largely inconclusive. Key concerns include the heterogeneity in toxicity definitions, lack of consideration for genotype-treatment interactions, and the failure to account for multiple testing. The review underscores the necessity for larger and well-designed studies, particularly with the inclusion of premenopausal women and non-Caucasian populations.

Assessment of Medication Compliance and Follow-Up Clinic Attendance Among Patients With Cardiovascular Diseases in the Jazan Region.

Cardiovascular diseases are common causes of mortality in Saudi Arabia and the world. This study aims to assess medication compliance and regularity of follow-up for cardiovascular patients in the Jazan region. An analytical cross-sectional approach was used to target all registered cardiovascular patients attending the cardio clinic in a Jazan region hospital. Data were collected using an interview questionnaire developed by the researchers with the help of experts. The questionnaire included the patients' sociodemographic data, clinical characteristics, disease-related data, drugs, and appointments. The study included 259 patients diagnosed with cardiac disease. About 53.7% of the patients were males. All the cases had the disease for one year or more. About 56% of the patients hadno difficulty remembering their medications, while 44% had problems remembering to take them. More than half of the patients had good medication adherence, and 79.6% had good appointment adherence. Only 20.4% of patients had a poor adherence rate. The adherence rate for the patients' medication and appointments was satisfactory due to high patient awareness. On the other hand, poor adherence was related more to non-Saudi patients.

Evaluation of Pediatric HIV Postexposure Prophylaxis Guideline Following Child Sexual Assault in Western Australia.

HIV postexposure prophylaxis (PEP) following child sexual assault (CSA) is recommended in select cases. High rates of poor adherence to PEP are reported. We evaluated adherence to the recommended management of children following CSA at the tertiary pediatric facility in Western Australia and compared our approach with international guidelines. Medical records were reviewed for all children <16 years old assessed at Perth Children's Hospital between October 1, 2016 and November 30, 2020 following alleged CSA. Data, including exposure type, PEP adherence and follow-up, were collected. A review of contemporary national and international PEP guidelines was undertaken in parallel. There were 511 alleged CSA events over the study period; 62/511 (12%) were appropriately risk-assessed as requiring PEP by the treating clinician. PEP was not prescribed in 8/62 (13%) events, with a reason documented for 6/8 (75%). Overall, less than half of children who were eligible for PEP were adherent to the 28-day regimen (23/54, 43%). Gastrointestinal upset contributed to early cessation in 5/54 (9%). Final 3-month blood-borne virus serology results were available in less than one in 3 children. A review of international clinical practice revealed significant heterogeneity of criteria for the provision of PEP and a paucity of pediatric-specific data. We identified several areas of our PEP management that required strengthening, with limited direction available in current international guidelines. We have adopted a broader use of fixed drug combinations and implemented a multifaceted follow-up program. It will be essential to review the impact of these changes.

IJCM_188A: Exploring Factors Influencing Medication Non-Adherence Among Urban Residents with Non-Communicable Diseases in Chengalpattu District: A Descriptive Cross-Sectional Study

Background: Medication non-adherence is a modifiable risk factor for non-communicable diseases (NCDs). WHO estimated the average rate of medication adherence to be around 50% in developed countries and to be lower in the developing countries. Objectives: To find the factors influencing medication non-adherence among patients diagnosed with NCDs in the urban areas. Methodology: A cross sectional study was conducted among 200 patients visiting Urban Health Training Centre, MAPIMS. A structured questionnaire was used to collect data on socio-demographic characteristics, risk factors, self-care practices, access to health care and family support to medication adherence. The outcome of the study was medication adherence measured using the eight-item Morisky medication adherence scale (MMAS-8). Results: Among the 200 participants with one or more non-communicable diseases (NCDs), the result found the prevalence of poor medication adherence rate to be 53.5%. Poor medication adherence was more prevalent in the older age group (39%, n=78), female patients (57.5%, n=115), with primary education (49.5%, n=99), unemployed individuals (58.5%, n=117), those without regular physical activities (63.5%, n=127) and classified as obese (43%, n=86). Conclusion: The study concluded that the prevalence of poor medication adherence was more common among NCD patients and the need to develop effective strategies to enhance medication adherence according to patient’s requirements through a holistic approach, by strengthening the primary health care system to achieve better health outcomes.

Adherence to Growth Hormone Treatment in Children During the COVID-19 Pandemic

Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. This was a multicenter survey study that was sent to pediatric endocrinologists during the pandemic period (June-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, missed dose data and the causes in the recent year (after the onset of the pandemic) were questioned. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% non-adherence). The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and “others“ (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 μg/kg, the annual growth rate was 1.15 standard deviation score (minimum -2.74, maximum 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for non-adherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as non-adherence rate increased. During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.

Association between patient adherence and treat-to-target in gout: A cross-sectional study.

The implementation of a treat-to-target (T2T) approach has been widely recommended for achieving optimal outcomes in gout treatment, as substantiated by a wealth of compelling evidence. However, a paucity of knowledge exists regarding the barriers hindering effective T2T management in China. This study seeks to investigate the factors contributing to treatment failure within the context of the T2T strategy. A cross-sectional, multi-center investigation was conducted, involving the completion of electronic questionnaires by outpatients undergoing urate-lowering treatment for a duration exceeding 6 months. These questionnaires encompassed demographic information, disease-related conditions, comorbid conditions, and management. The study analyzed factors associated with serum uric acid levels exceeding 360 µmol/L, poor disease control, and poor medication adherence. A total of 425 valid questionnaires were collected, representing 90.8% of the patients. The T2T implementation rate was 26.82% (n = 114). Factors linked to serum uric acid levels surpassing 360 µmol/L included moderate medication adherence (odds ratio (OR) = 2.35; 95% confidence interval (CI) 1.17-4.77; P = .016), poor medication adherence (OR = 4.63; 95% CI 2.28-9.51; P < .001), and management by general practitioners (OR = 0.60; 95% CI 0.37-0.97; P = .036). The rate of well-controlled patients was 14.35% (n = 61). Predictors of not well controlled encompassed the presence of tophi (OR = 2.48; 95% CI 1.17-5.61; P = .023), general medication adherence (OR = 2.78; 95% CI 1.28-6.05; P = .009), poor medication adherence (OR = 6.23; 95% CI 2.68-14.77; P < .001), and poor patient's perception of gout (OR = 4.07; 95% CI 1.41-13.91; P = .015). A poor medication adherence rate of 55.29% (n = 235) was observed, with lower rates of poor medication adherence associated with the use of febuxostat (OR = 0.35; 95% CI 0.14-0.83; P = .02), uric acid levels exceeding 360 µmol/L (OR = 3.05; 95% CI 1.84-5.12; P = .00), moderate patient education (OR = 2.28; 95% CI 1.29-4.15; P = .01), moderate diet control (OR = 1.98; 95% CI 1.17-3.41; P = .01), and poor diet control (OR = 3.73; 95% CI 1.26-12.83; P = .02). The rate of T2T implementation in China is notably low among patients undergoing urate-lowering treatment of gout beyond 6 months. Importantly, medication adherence demonstrates a significant association with T2T outcomes.

Medication adherence and related psychosocial and clinical factors among schizophrenic patients: a cross - sectional analytical study in National Psychiatric Hospital 2, Vietnam

Background and Aims: Schizophrenia is a chronic and severe mental disorder. Treatment by antipsychotic medication is one of the main therapies to control the symptoms. Medication non/poor adherence is a one of the key factors leading to relapse and declined social and occupational function in patients. However, prevalence of schizophrenic patients with non/poor adherence to medication was quite high in previous studies. Therefore, this study aimed to identify the prevalence of medication non/poor adherence and its related psychosocial and clinical factors among schizophrenic patients. Subjects and Method: a cross - sectional analytical study of 126 schizophrenic patients at National Psychiatric Hospital 2 were conducted to evaluate the rate of medication non-adherence by Morisky Medication Adherence Scale 8 item (MMAS - 8). Data were collected on patients’ sociodemographic factors such as sex, age, marital and economic status, level of education and clinical factors including duration of schizophrenia, clinical symptoms evaluated by Positive and Negative syndrome scale (PANSS), type, and side effects of medication. Logistic regression was used to analyze the factors associated with medication non-adherence among schizophrenic patients. Results: Rate of poor medication adherence among participants was 78.57% by using MMAS – 8. The associated factors with poor medication adherence among schizophrenic patients were level of education under high school; unstable job/unemployment; poor insight about schizophrenia, poor family care/support, high scores of negative PANSS and general PANSS scale, duration of schizophrenia above 5 years, treated by typical antipsychotics and having more than two side effects of antipsychotics. Conclusion: The rate of poor medication adherence/ non - adherence among schizophrenic patients is high. Mental health staff should be aware of this risk and screening individuals for relevant risk factors is highly recommended Key words: medication adherence, schizophrenia, social - psycho - clinical factors.

Patients' Perceptions and Knowledge of Diabetes and Medications: Implications for Medication Adherence and Glycemic Control in Type 2 Diabetes Patients, Northern Ethiopia.

Globally, adherence to Type 2 diabetes mellitus (T2DM) medications remains suboptimal. There are limited insights, however, on this issue in the northern region of Ethiopia. This cross-sectional study at Alamata General Hospital investigated the interplay between patients' medication beliefs, diabetes knowledge, adherence, and glycemic control. Data collection was done using structured questionnaires and chart reviews, while descriptive and inferential statistics were for the analysis. Among 305 T2DM patients, poor medication adherence was prevalent (44.6%), alongside suboptimal glycemic control (75.7%). Patients diagnosed for over a decade had an adjusted odds ratio (AOR) of 3.87 for nonadherence, while high concern about medication side effects was associated with a 20.63-fold higher nonadherence risk (AOR = 20.63). Low disease awareness increased nonadherence risk by 4.54 times (AOR = 4.54), while a strong belief in medication necessity was protective (AOR = 0.21). Poor glycemic control was associated with educational background, diabetes awareness, monthly income, and treatment modality. Urgently needed are tailored diabetes education programs in Northern Ethiopia to counteract high rates of poor medication adherence (AOR = 3.87) and glycemic control among T2DM patients. Targeted interventions, emphasizing knowledge enhancement and reinforcing positive beliefs, are essential for improving outcomes in this population.

Efficacy and Safety of Combined Deferiprone and Deferasirox in Iron-Overloaded Patients: A Systematic Review.

Despite the established efficacy of iron chelation therapy in transfusion-induced iron-overloaded patients, there is no universal agreement regarding the choice of an optimal chelating regimen. Deferasirox (DFX) and deferiprone (DFP) are two oral iron chelators, and combination usage demonstrated effectiveness as an alternative to monotherapies in patients with a limited response to monotherapy. The present systematic review aimed to assess the evidence regarding the outcomes of combined DFP and DFX in iron-overloaded patients. An online search was conducted in PubMed, Scopus, Web of Science, and CENTRAL databases. Interventional and observational studies that assessed the outcomes of combined DFP and DFX in iron-overloaded patients were included. Eleven studies (12 reports) were considered in this meta-analysis. The studies included dual iron chelation strategies for a number of diagnoses. Single-arm studies (n =7) showed a reduction of serum ferritin, which reached the level of statistical significance in three studies. Likewise, most studies reported a numerical reduction in liver iron concentration (LIC) and increased cardiac MRI-T2* values after chelating therapy. Alternatively, comparative studies showed no significant difference in post-treatment serum ferritin between DFX plus DFP and DFX/DFP plus deferoxamine (DFO). The adherence to combination therapy was good to average in nearly 66.7-100% of the patients across four studies. One study reported a poor adherence rate. The combined regimen was generally tolerable, with no reported incidence of serious adverse events among the included studies. In conclusion, the DFP and DFX combination is a safe and feasible option for iron overload patients with a limited response to monotherapy.

Relationship-Oriented Recovery System for Youth (RORSY): Clinical Protocol for Transition-Age Youth with Opioid Use Disorders.

This article introduces the Relationship-Oriented Recovery System for Youth (RORSY) protocol, which is designed to increase uptake of Medications for Opioid Use Disorder (MOUD) and related services among adolescents and young adults. Youth exhibit alarmingly poor rates of MOUD initiation and adherence, OUD services involvement and long-term recovery success. RORSY attends to three developmentally unique recovery needs of this age group: assess and bolster youth recovery capital, prioritize involvement of concerned significant others, and use digital direct-to-consumer recovery supports. RORSY contains five evidence-informed intervention modules that can be flexibly tailored to meet the individual and relationship needs of a given youth: Relational Orientation, Youth Recovery Management Planning, Relational Recovery Management Planning, Relationship Skills Building, and Digital Recovery Support Planning. The article concludes with practice and policy recommendations for making relationship-building a top clinical priority for addressing youth OUD.

Asthma medication use and health care utilization evolution during pandemic times.

Pediatric asthma care was significantly impacted by the Coronavirus Disease (COVID-19) pandemic, with significant decline in asthma health care utilization noted early in the pandemic. We compared Emergency Department (ED) utilization rates and prescription fill rates of controller and quick relief asthma medications between March and December 2020 versus 2021 in a county-specific pediatric Medicaid population to evaluate for changes later in the pandemic. Our data showed an increase in ED utilization by 46.7% (p-.0371) in the second year of the pandemic. There was no significant change in prescription fills for reliever medications (p-.1309) during this time with increased ED utilization for asthma but there was a significant decline in controller medication fills (p-.0039). This data suggests a potential explanation for resurgence of asthma health care utilization because of decreased controller medication fill and use during a time frame that also saw increased viral positivity rates. The poor medication adherence rates despite this increase in ED visits suggests that new interventions may be needed to assist patients with asthma medication adherence.

Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism in Madinah, Saudi Arabia: A Cross-Sectional Study.

Hypothyroidism is one of the most prevalent chronic diseases worldwide. The key factor for a good clinical outcome for hypothyroidism is medication adherence, as the mainstay treatment of hypothyroidism is lifelong hormonal replacement therapy, Levothyroxine (LT4). Poor adherence to LT4 is not only linked to great healthcare costs but also to significant economic burdens. The aim of this study is to assess the medication adherence of patients on LT4 treatment in the Madinah region and its association with socio-demographic characteristics, participants' experience with hypothyroidism and taking LT4, and Morisky Medication Adherence Scale 8-Item (MMAS-8). A cross-sectional study was conducted on 420 hypothyroidism patients on LT4 for at least three months in the Madinah region using a self-administered electronic form. The variables in the questionnaire included socio-demographic characteristics, participants' experience with hypothyroidism and taking LT4, and MMAS-8. This study included a total of 420 patients with 81% being females, 52.1% aged 40 years and above, and 91% living in Madinah City. The study shows an overall poor adherence rate toward taking LT4, where the vast majority, 66.7% of the participants, had a low adherence level toward taking LT4, 23.3% had a moderate adherence level, and only 10% had a high adherence level. Results of the multivariate logistic regression showed that the following factors predicted a higher rate of a high level of adherence toward taking levothyroxine, being 50-59 years old, being 60 years or older, and following up regularly in the clinic. Patients with hypothyroidism showed low adherence to LT4.

Adherence to protocols for the use of reversal agents in patients treated with direct oral anticoagulants

Objectives This study aimed to evaluate the adherence to protocols for the use of reversal agents in direct oral anticoagulant (DOAC) users in Dutch hospitals. Methods A retrospective cohort study was conducted in seven hospitals in the Netherlands. Treatment protocols for bleeding and (urgent) procedures in patients on DOAC were collected from each hospital. All patient data on the use of reversal agents were retrospectively collected from September 2021 to April 2022 and compared to the protocols. The degree of per-protocol adherence (compliance score) was categorized into four levels as follows: poor (<45%), moderate (45–79%), high (80–89%), and full (> 90%) adherence rates. Results A total of 290 patients were included in our study. In patients with bleeding under DOAC, the protocol adherence for prothrombin complex concentrate (PCC) was “moderate” (61%). In the remaining cases (39%), non-adherence was mainly caused by underdosing (68%), overdosing (12%), and a lack of indication (14%). Furthermore, idarucizumab was administered for bleeding with “full” adherence (96%). For andexanet alfa, adherence to the hospital bleeding protocol was “moderate” (67%), with a lack of indication being the only reason for non-adherence. In case of reversal for an urgent procedure, the protocol adherence for PCC was “low” (45%), with underdosing, a lack of indication, and missing lab data being the main reasons for non-adherence. Missing lab data on dabigatran plasma concentration before reversal was the main reason for “low” adherence (26%) in idarucizumab. The adherence for andexanet alfa was also “low” (0%). Conclusion In case of reversal for bleeding under DOAC, overall adherence to the protocol was “moderate”; however, in patients needing an urgent procedure, it was “low.” The major reasons for non-adherence were underdosing, off-label use, and a lack of specific lab testing. The results of this study can assist in improving the implementation of hospital protocols.

Classical Ballet for Women Aged Over 50 Years: Investigating Balance, Strength, and Range of Motion

ABSTRACT Background: Regular exercise can mitigate the loss of strength, balance, and flexibility that contribute to age-related decline in physical function and mobility. However, traditional exercise interventions often report poor adherence rates. There is growing interest in classical ballet as an enjoyable exercise modality for adults in middle to late age. Classical ballet requires muscular strength, coordination, and flexibility. The current study investigated a classical ballet intervention on the balance, physical function, and range of motion of women aged over 50 years. Methods: Twenty-two healthy female participants (aged 56.2 (4.5) years (mean (SD)) completed a 10-week ballet intervention. Results: This single-arm study showed significant improvements (p<.05) in lower limb strength (measured by 5 times sit-to-stand and forward leap) and high adherence rates (95% adherence for participants who completed the intervention). No adverse events were reported. Improvements in balance were reported in the left leg only (as measured by center of pressure ellipse area in the parallel retiré condition). Conclusions: These results allude to the positive effects of ballet training on strength and balance in adults aged 50 years and over. High adherence rates suggest that ballet training was enjoyed and may thus be a long-term exercise modality for this population. Although this study was a single-arm design, it suggests promising results for future research wishing to evaluate the effectiveness of classical ballet training using randomized controlled trial designs.

The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients.

Gout is the most common type of inflammatory arthritis, and its impact on cardiovascular health and quality of life is often underestimated. The prevalence and incidence of gout are increasing globally. Further, ischemic heart disease (IHD) and chronic kidney disease (CKD) are prevalent in gout patients. Some unmet needs for gout management include physicians' low initiation rate of urate-lowering therapy (ULT) and poor treatment adherence in patients with gout. There is also a lack of randomized controlled trials that establish safe doses of acute and long-term treatment for gout, particularly in patients with IHD and stage 4 CKD and above (including end-stage renal failure).Furthermore, there is also a lack of studies showing optimal serum uric acid (SUA) target and validated clinical outcome measures, including disease activity and remission criteria for gout tailored to treat-to-target approaches and the high cost of newer gout medications. The causal relationship between asymptomatic hyperuricemia or gout with comorbidities such as IHD and CKD has yet to be fully elucidated. There is a pressing need for collaborative international efforts to address the overall suboptimal management of gout.

Accessibility of Psychological Treatments for Bulimia Nervosa: A Review of Efficacy and Engagement in Online Self-Help Treatments.

Bulimia nervosa is an eating disorder characterised by marked impairment to one's physical health and social functioning, as well as high rates of chronicity and comorbidity. This literature review aims to summarise existing academic research related to the symptom profile of BN, the costs and burden imposed by the illness, barriers to the receipt of care, and the evidence base for available psychological treatments. As a consequence of well-documented difficulties in accessing evidence-based treatments for eating disorders, efforts have been made towards developing innovative, diverse channels to deliver treatment, with several of these attempting to harness the potential of digital platforms. In response to the increasing number of trials investigating the utility of online treatments, this paper provides a critical review of previous attempts to examine digital interventions in the treatment of eating disorders. The results of a focused literature review are presented, including a detailed synthesis of a knowledgeable selection of high-quality articles with the aim of providing an update on the current state of research in the field. The results of the review highlight the potential for online self-help treatments to produce moderately sized reductions in core behavioural and cognitive symptoms of eating disorders. However, concern is raised regarding the methodological limitations of previous research in the field, as well as the high rates of dropout and poor adherence reported across most studies. The review suggests directions for future research, including the need to replicate previous findings using rigorous study design and methodology, as well as further investigation regarding the utility of clinician support and interactive digital features as potential mechanisms for offsetting low rates of engagement with online treatments.

Time-restricted eating and exercise training improve HbA1c and body composition in women with overweight/obesity: A randomized controlled trial

Diet modification and exercise training are primary lifestyle strategies for obesity management, but poor adherence rates limit their effectiveness. Time-restricted eating (TRE) and high-intensity interval training (HIIT) improve cardiometabolic health in at-risk individuals, but whether these two interventions combined induce superior improvements in glycemic control than each individual intervention is not known. In this four-armed randomized controlled trial (ClinicalTrials.gov NCT04019860), we determined the isolated and combined effects of 7weeks of TRE (≤10-h daily eating window, with ad libitum energy intake) and HIIT (three exercise sessions per week), compared with a non-intervention control group, on glycemic control and secondary cardiometabolic outcomes in 131 women (36.2± 6.2 years) with overweight/obesity. There were no statistically significant effects after isolated TRE, HIIT, or a combination (TREHIIT) on glucose area under the curve during an oral glucose tolerance test (the primary outcome) compared with the control group (TRE, -26.3mmol/L; 95% confidence interval [CI], -82.3 to 29.7, p= 0.36; HIIT, -53.8mmol/L; 95% CI, -109.2 to 1.6, p= 0.057; TREHIIT, -41.3mmol/L; 95% CI, -96.4 to 13.8, p= 0.14). However, TREHIIT improved HbA1c and induced superior reductions in total and visceral fat mass compared with TRE and HIIT alone. High participant adherence rates suggest that TRE, HIIT, and a combination thereof may be realistic diet-exercise strategies for improving markers of metabolic health in women at risk of cardiometabolic disease.