Adherence Rates Research Articles

"Lupus Doesn't Have Me, I Have Lupus": Using Patient-Centered Interviews to Understand Medication Nonadherence.

Lupus nephritis (LN) is the most common cause of kidney injury in systemic lupus erythematosus and associated with higher morbidity and mortality. Low medication adherence correlates with adverse clinical outcomes. In a large, integrated health system at Kaiser Permanente East Bay Area, the authors identified mycophenolate mofetil (MMF) prescriptions for LN and collected patient demographics, medication adherence, and copay data. They interviewed patients with low medication adherence rates to understand contributing factors, such as side effects, cost, refill processes, and laboratory draws. Adherence was defined as a proportion of days covered at > 80%. The proportion of days covered is the number of days covered by a medication divided by the number of days in a defined period. Between November 30, 2021, and November 30, 2022, the authors identified 36 patients with LN on MMF. Almost a third (11/36) of these patients were nonadherent to medication. More than half (7/11) of these patients agreed to be interviewed. They identified the following causes of medication nonadherence: forgetfulness (57%, or 4/7), incomplete laboratory work (28%, or 2/7), medication cost (14%, or 1/7), and intentionally missed doses (14%, or 1/7). No patients identified medication side effects as a cause. The median 30-day copay for MMF was $4.55, and 28% (2/7) of patients paid $0 for their medications. In the authors' integrated health system, 69% of their patients with LN on MMF were adherent to their medication regimen. Forgetfulness was a challenge for the nonadherent patients. Kaiser Permanente East Bay Area provides convenient refills and laboratory draws; this likely facilitates medication adherence.

THE IMPACT OF COLLABORATIVE CARE ON COST OF TREATMENT FOR THE MANAGEMENT OF HYPERTENSION- A SYSTEMATIC REVIEW

Introduction: For evaluation of the long term costs and benefits of physician-pharmacist collaboration associated with physician management for the treatment of essential hypertension. Around the world the major cause of death is hypertension. It is an incurable condition that requires proper therapeutic regimens for its life-long management. Due to this, hypertension therapy can be financially burdensome to the patient, and the rates of non-compliance are increased. Aims and Objectives: To observe the results of collaborative, clinical, and interventive approaches to hypertension management, on the cost-effectiveness of therapy, this study aimed to collect and compare cost information on hypertension management, mortality, and morbidity across different countries and cost groups. Using this information, future healthcare expenses can be better planned; for example, by initial emergency response or by changing the way money is distributed. This will lead to more high-pressure jobs. Therefore, it will be more costly to control blood pressure. Method: A systematic review was conducted using 6 major electronic databases that investigated the influence of collaborative care upon healthcare expenses in hypertensive patients and hypertension therapy costs, before and after the intervention of medical personnel, was observed. Conclusions: It was concluded that interventions provided by the collaboration of medical personnel, in the management of hypertension, made the therapy more cost-effective and hence the rate of patient compliance and adherence to the therapy were increased. Peer Review History: Received 18 May 2024; Reviewed 11 July 2024; Accepted 26 August; Available online 15 September 2024 Academic Editor: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, summitpharm@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension.

Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This analysis examined the association between adherence to antihypertensive and BD medications and clinical symptoms in patients with BD and comorbid hypertension (HTN) from an ongoing trial to optimize adherence. Inclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pillcap which captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over 1week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms. A total of 83 participants with BD and HTN were included. Adherence to BD and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than self-reported antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline; antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline. Adherence levels fluctuated over time and differed based on measurement method in people with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to change in self-reported adherence. BD symptom severity may indicate poor adherence in patients with BD and should be considered in treatment planning.

Advancements and Challenges in Exercise Training for Multiple Sclerosis: Comprehensive Review and Future Directions for Randomized Controlled Trials.

Exercise training represents a health behavior for the treatment and management of the multi-faceted manifestations of multiple sclerosis (MS). This paper provides a comprehensive overview of evidence from randomized controlled trials (RCTs) regarding benefits, safety, participation, and guidelines for exercise training in MS, based on systematic reviews and meta-analyses. The paper then provides our opinions based on extensive experience regarding challenges for improving and expanding future RCTs that will advance our understanding of exercise training in MS. The comprehensive review of evidence from RCTs indicates that exercise training yields substantial improvements in aerobic and muscle fitness, mobility, fatigue and depression, quality of life, and participation outcomes. There is a non-significant increase in the risk of adverse events or serious adverse events with exercise training compared with control conditions or healthy populations. Rates of adherence and compliance with exercise training (i.e., participation) approximate 80% and 70%, respectively. The current prescriptive guidelines suggest 2-3days per week of aerobic and resistance exercise training as the minimal dose for safely benefiting from exercise training in MS. We propose 10 important topics as avenues for expanding the body of research and improving its scope for evidence-based practice in MS. Overall, the research on exercise training in MS is strong, but it can get stronger. The expansion and advancement of evidence are critical for moving exercise training into the clinical armamentarium of MS disease treatment and management.

HPV self-collection for cervical cancer screening among survivors of sexual trauma: a qualitative study

Intimate partner violence affects 20–30% of women in the United States. Disparities in routine cervical cancer surveillance have been demonstrated in certain populations, including victims of intimate partner violence (IPV). This study examined and assessed the acceptability of high-risk HPV (hrHPV) self-collection among individuals who have experienced IPV. We conducted an observational study using qualitative data collection and analysis. We interviewed individuals with a history of IPV and who currently reside in Oregon. This study identified key themes describing knowledge and attitudes towards cervical cancer screening for individuals who have experienced IPV. They include: guideline knowledge, prior office-based cervical cancer screening experience, barriers to cervical cancer screening, at-home hrHPV self-collection experience, and testing confidence. Participants experienced fewer barriers and expressed increased comfort and control with hrHPV self-collection process. Individuals with a history of IPV have lower rates of cervical cancer screening adherence and higher rates of cervical dysplasia and cancer than other populations. The patient-centered approach of hrHPV self-collection for cervical cancer screening can reduce barriers related to the pelvic exam and empower patients to reduce their risks of developing cervical cancer by enabling greater control of the testing process.

Hand functioning in progressive multiple sclerosis improves with tDCS added to daily exercises: A home-based randomized, double-blinded, sham-controlled clinical trial

Background: Many individuals with progressive multiple sclerosis (PMS) are challenged by reduced manual dexterity and limited rehabilitation options. Transcranial direct current stimulation (tDCS) during motor training can improve rehabilitation outcomes. We developed a protocol for remotely supervising tDCS to deliver sessions of stimulation paired with training at home. Objective: This study evaluated the effectiveness of at-home tDCS paired with manual dexterity training for individuals with PMS. Methods: Sixty-five right-hand dominant participants with PMS and hand impairment were randomized to receive either active or sham M1-SO tDCS paired with manual dexterity training over 4 weeks. Clinical outcomes were measured by the changes in Nine-Hole Peg Test (9-HPT) and Dellon-Modified-Moberg-Pick-Up Test (DMMPUT). Results: The intervention had high rates of adherence and completion (98% of participants completed at least 18 of 20 sessions). The active tDCS group demonstrated significant improvement for the left hand compared with baseline in 9-HPT (−5.85 ± 6.19 vs −4.23 ± 4.34, p = 0.049) and DMMPUT (−10.62 ± 8.46 vs −8.97 ± 6.18, p = 0.049). The active tDCS group reported improvements in multiple sclerosis (MS)-related quality of life (mean increase: 5.93 ± 13.04 vs −0.05 ± −8.27; p = 0.04). Conclusion: At-home tDCS paired with manual dexterity training is effective for individuals with PMS, with M1-SO tDCS enhancing training outcomes and offering a promising intervention for improving and preserving hand dexterity.

Adherence to Clinical Practice Guidelines on the Management of Acute Infectious Gastroenteritis in Children as a Measure of Quality of Care Delivered by a Primary Care Facility in Rural Philippines: A Descriptive Retrospective Study.

This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH). A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low. There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%. Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.

Evaluation of a pharmacist-led multidisciplinary approach to the treatment of latent tuberculosis in refugee patients in the primary care setting

BackgroundTreatment of latent tuberculosis infection (LTBI) is essential for refugee patients who have been relocated to the United States to prevent progression to active infection. ObjectiveThis study aimed to determine the effectiveness of a multidisciplinary team approach, embedded within a primary care clinic, to treatment of LTBI in newly resettled refugee patients compared with a local health department. MethodsThis was a single-center, retrospective chart review of newly resettled refugee patients 18-89 years old with a diagnosis of LTBI. The primary objective was completion rate of LTBI therapy within 1 year of resettlement. Secondary objectives were incidence of adverse events, regimen switches, and adherence rate. ResultsA total of 58 patients were included in the study: 14 individuals through the multidisciplinary clinic and 44 individuals with the local health department. Completion of therapy within 1 year of resettlement was seen in 71.4% of patients (n = 10) in the multidisciplinary clinic compared with 72.7% (n = 32) at the health department. There were 7 patients who underwent a regimen switch, all of whom were in the health department arm. Adverse effects occurred in 14.2% of patients in the multidisciplinary clinic and 15.9% of patients in the health department arm. Treatment adherence was 98.6% in the multidisciplinary clinic and 90.5% in the local health department arm. ConclusionUse of a multidisciplinary team was successful in completion of LTBI treatment in refugee patients, helping to alleviate barriers to treatment completion by ensuring adherence and close follow-up.

Compliance Rate With Triage Test and Treatment for Participants Screening Positive in Cervical Cancer Screening Programs: A Systematic Review and Meta-analysis.

To assess the rates of adherence to triage testing after positive screening results and referral to treatment for precancerous lesions in global cervical cancer screening programs. We searched three electronic databases (Medline, EMBASE, and Web of Science) for articles published in the English language from January 1, 2018, to December 31, 2023. We included studies reporting the compliance rate of triage testing and precancer treatment in cervical cancer screening programs. ClinicalTrials.gov was reviewed, and no more studies were identified. The combined search strategies identified 1,673 titles, of which 858 titles and abstracts were screened and 113 full-text articles were assessed for eligibility. A total of 33 studies met the inclusion criteria and were included in the meta-analysis. Thirty-three studies were included in the systematic review and meta-analysis. The average compliance rate for women screening positive was 77.1% for triage testing and 69.4% for referral to treatment. Compliance varied by country income level, screening guideline approach, and target population. The current compliance rate was lower than the 90% target set by the World Health Organization's global strategy to eliminate cervical cancer. Inadequate follow-up of participants screening positive revealed a gap between the screening program and clinical care.

Trauma system management of adults with severe burns in Victoria, Australia.

The aim of the present study was to examine the profile, management and outcomes of adult patients with severe burns within the Victorian State Trauma System (VSTS). Data from the Victorian State Trauma Registry (VSTR) was analysed to characterise patient and injury characteristics and review pre-hospital management and clinical outcomes of adult patients with severe burns. There were 421 cases over 13 years of the study. Approximately 80% of cases were flame burns, and 5% were associated with other significant trauma. Approximately 75% were male; with 83% of patients under 65 years old, 40% of lower socioeconomic status, 25% having pre-existing drug and alcohol involvement, and 36% living with associated comorbidities. All but 11 patients (of 421) were managed definitively at the burns service. Around one-third of patients had interhospital transfer, with median (interquartile range (IQR)) time spent in the primary hospital 3.0 (1.9-4.3) h. Only five patients had multiple interhospital transfers. Nearly 75% of patients were admitted to an ICU. The median (IQR) length of definitive hospital stay was 27.2 (11.2-44.9) days. The mortality rate was 23.8%. Severe burns are uncommon injuries with high mortality. There is a high rate of adherence to VSTS guidelines for managing patients with severe burns, and a decrease in patients requiring transfer associated with an increase in acceptable time to a trauma-receiving hospital. The VSTS operates to deliver almost all patients with severe burns to the definitive burns service efficiently.

Implementing changing behaviour towards aerobic and strength exercise: Results of a randomised, phase I study determining the safety, feasibility, and consumer-evaluation of an online exercise program in persons with multiple sclerosis

BackgroundMany people with MS do not meet the recommended exercise regime to elicit health benefits. This study aimed to determine the feasibility, safety, acceptability, and appropriateness of an exercise intervention delivered online to persons with MS that meets current exercise recommendations and behaviour change principles. MethodsSeventy-two participants (age: 43.3 ± 13.3 years) with mild to moderate MS were stratified according to previous exercise behaviour and block-randomised into one of three groups: Control (CON; n = 24), General Exercise (GE; n = 24) who at screening did not meet current exercise recommendations, and Advanced Exercise, (AE; n = 24) who at screening met the current exercise recommendations. GE and AE groups received a four-month online-supervised, behaviour change theory-based exercise program and were assessed at baseline, four-months, five-months, and eleven-months for physical activity participation. The feasibility of process, resources, management, and scientific outcomes was assessed. ResultsOf 198 potential participants, 143 met the eligibility criteria (72 %), and 72 were randomised. Fifty-three participants completed the intervention (74 % immediate retention), and 44 were retained at the six-month follow-up (61 %). Personnel time was 369 h, and total per-participant cost was Au$1036.20. Adherence rate to ≥70 % of exercise sessions was 73 % (GE) and 38 % (AE). The GE group observed a small magnitude of improvement in physical activity (d = −0.23). ConclusionsAn online exercise program embedded with behaviour interventions for either GE or AE appears feasible, acceptable, appropriate and safe and may show long-term efficacy in increased exercise behaviours for persons with mild to moderate MS.Trial registration: ANZCRT number ACTRN12619000228189p.

The Impact of Home Medication Management Practices on Medication Adherence.

Medication adherence is a vexing challenge, with over 50% of US adults not adhering to their prescribed medication regimen. Most medications are self-administered by patients at home, requiring them to independently develop and manage their own medication routines. By understanding these home-based practices, such as where patients store their medications and how different storage locations impact adherence, we can develop targeted interventions to improve adherence rates. Our goal was to identify and categorize self-reported home medication management practices and determine which practices are associated with self-reported medication adherence. From the 1673 total survey respondents we learned that the most common places people store their medications at home are nightstand drawers (28%), on top of nightstands (27%), kitchen cabinets (22%), and bathroom medicine cabinets (20%). Kitchen cabinets and bathroom vanities were significantly associated with increased odds of having ever forgotten to take a medication. On the other hand, desks, dining room tables, and the inside of nightstand drawers were associated with the greatest statistically significant decrease in odds of having ever forgotten to take a medication. Almost all (96%) respondents were receptive to receiving guidance from healthcare providers on how to store medications. Patients are largely responsible for creating their own home medication management practices, including deciding where to store their medication at home. Understanding which home storage locations are associated with medication adherence can lead to innovative approaches to improve adherence, including personalized guidance to patients from their healthcare providers for patients.

The patient-reported outcomes for the new brand-generic teriflunomide in relapsing-remitting multiple sclerosis

BackgroundPatient-reported outcomes (PROs) provide valuable insights into the impact of disease-modifying therapies (DMTs) on patients' daily lives and disease progression. This study evaluates treatment satisfaction and tolerability among patients using a brand-generic Teriflunomide (Tebazio®, 14 mg tablet) manufactured by Zistdaru Danesh Biopharmaceuticals. Materials and MethodsA Phase IV observational study was conducted on patients with Relapsing-Remitting Multiple Sclerosis (RRMS) who were either initiated on or switched to Teriflunomide 14 mg. The primary focus was on the medication's safety. Patient satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication [Version 1.4] (TSQM-14). Additionally, medication adherence and discontinuation rates were monitored. ResultsOf the 235 RRMS patients enrolled, participated in this study, all received the Teriflunomide treatment orally on a daily basis. Over the 18-month follow-up period, 25.96 % of patients discontinued the treatment. Discontinuation was mainly due to adverse events (11 %), lack of patient willingness to continue (12.7 %), and disease progression (4.2 %). The most commonly reported adverse events included dermatologic disorders, elevated liver enzymes, and gastrointestinal issues. TSQM-14 scores demonstrated significant improvements over the 18-month period. A high medication adherence rate of 98.1 % was also recorded. ConclusionPatients reported notable satisfaction with Teriflunomide, as reflected in their TSQM scores, which suggests a likelihood of improved patient adherence. The 14 mg brand-generic Teriflunomide was well-accepted by Iranian RRMS patients, with no significant concerns arising during the study. These findings also highlight the significance of patient-reported outcomes in DMTs, with potential benefits for adherence and clinical practice.

The Impact of Social Support and Social Network Characteristics on Trauma Symptoms Among Violence-Exposed Women with Substance Use Disorders

Background: Women with substance use disorder (SUD) experience higher rates of violence exposure, post-traumatic stress disorder (PTSD), and post-traumatic stress symptoms (PTSS) than their non-substance-using peers. Exposure to violence in women with SUD is associated with PTSS symptom severity and leads to lower rates of treatment adherence, poorer treatment outcomes, and a higher risk for relapse. Little is known about the buffers to PTSS among violence-exposed women with SUD. Methods: A sample of 375 women with SUD were recruited from three inner-city intensive treatment centers, in a midwestern city. Using ordinary least squares regression models, we sought to identify the direct effects of violence, general social support, recovery-specific social support, and social network composition on PTSS. Moderation was also examined using the Bootstrapping function in PROCESS macro for SPSS. Results: General social support, recovery social support, and greater duration of network relationships were associated with lower trauma symptom scores. General social network composition variables were directly associated with lower trauma symptom severity. Recovery-specific social network variables moderated the association between violence exposure and PTSS for Black participants only. Conclusions: These data suggest that providers should target the quality of the client’s interpersonal relationships to reduce PTSS among violence-exposed women with SUD. Maintaining social network relationships should be the focus of treatment interventions for women with SUD who have experienced violence.

Factors Influencing the Practices and Adherence of Isoniazid Prophylactic Therapy Among Under 5 Years Children in Tb Referral Units, Peshawar

<i>Importance</i>: The under 5 years children of house hold contact with active tuberculosis cases is one of the main cause for the transmission of TB in pediatrics population, responsible for many complications and childhood mortality. <i>Objective</i>: To determine the factors influencing the practice and adherence of Isoniazid Prophylactic Therapy (IPT) among under 5 years children of house hold with cases of active pulmonary tuberculosis. <i>Design: </i>The study’s design was cross sectional. <i>Setting: </i>This study was conducted in TB referral units of the National Tuberculosis Control Program in Peshawar City. <i>Participants</i>: The study participants included patients with sputum-positive pulmonary TB having at least one under-5 years’ child in their household. Secondly, the doctors who were directly dealing with TB patients for diagnosis and treatments in referral units of the respective hospitals. <i>Results</i>: Most of the patients reported that doctors neither got some information about the under-5 years' children at their family nor to bring them for TB screening. Just 13.2% patients (36 out of 273) conceded that doctors mentioned them for prophylactic treatment with Isoniazid (INH) medication for their contact positive under-5years children. But only 4 of these 36 patients [(11.11%) 1.46%of the aggregate] completed the IPT course for their under-5 year children for 6 months duration. (Table 2) All the doctors claimed that they got information about the presence of under five years household contact in the family of TB patients. While the majority of the doctors/physicians (80%) had recognized that they neither requested the patients for screening from their family contact nor to give INH medication for their prophylaxis. This study showed that the practice of IPT was 13.2% and the adherence rate was just 11.11%, and the main factors for this poor result were poor healthcare system, lack of awareness, financial constraint and attitude of the patients. <i>Conclusion: </i>This study concludes that the extremely poor practice and adherence to isoniazid prophylactic therapy by doctors and patients in TB referral units in Peshawar city for under-5-year-old children of households with active tuberculosis patients was primarily caused by a lack of awareness, financial constraints, patient attitudes, and an inefficient healthcare system.

Clean intermittent catheterization in multiple sclerosis patients: An adherence and long-term follow-up study

IntroductionClean Intermittent Catheterization (CIC) is considered as a gold standard of treatment for bladder emptying disorders. A large amount of literature on CIC for patients suffering from neurological disorders is available, but there is a lack of research specifically concerning multiple sclerosis (MS) patients. Our primary outcome was to determine the characteristics of our population (sex, EDSS and age when CIC was introduced). Our secondary outcomes were to determine adherence of CIC. MethodAs part of a multicenter, observational, retro-prospective study, data was collected from neuro-urologist consultation reports, and extracted from bladder diaries between 01/01/2000 and 31/03/24. MS patients, over 18 years, with the indication of CIC were included. Results195 patients (72.3% women) were included, with a mean age of 49 years old. The median of follow-up was 9 years. Median EDSS at the start of the study was 5.5. There was an adherence rate of 65.1%. Urinary leakage was present in 74.2% of patients prior to CIC and 31.6% following CIC. ConclusionCatheterization is mainly offered to patients with an EDSS between 0 and 7. Rate of adhesion is encouraging, with most patients still continuing to use CIC by the end of follow-up. During the follow-up, we observed a reduced leakage rate but CIC alone can not explain this improvement. Following studies should include a list of constraints and reasons of halted CIC.

Use of EMPAgliflozin in the prevention of CARDiotoxicity: the EMPACARD – PILOT trial

BackgroundAnthracycline-based chemotherapy represents a cornerstone treatment for a number of common cancers, including breast cancer, lymphoma, and sarcoma. However, anthracycline-induced cardiotoxicity remains a significant concern, often presenting as a decline in cardiac function which can ultimately lead to heart failure (HF) or asymptomatic left ventricular dysfunction, in up to 10–15% of patients.Sodium-glucose transport protein 2 inhibitor (SGLT2i) therapies have been demonstrated to reduce the incidence of HF in high-risk non-cancer patients. Preliminary retrospective data suggest their role in mitigating the incidence of HF during or after anthracycline treatmentMethodsThe EMPACARD-PILOT trial was a prospective case‒control study involving breast cancer patients scheduled to undergo anthracycline-based chemotherapy in a 4-cycle protocol of 60 mg/m2 doxorubicin. We used the HFA/ICOS risk score to identify patients at high or very high risk of cardiotoxicity. Patients with diabetes mellitus or stable heart failure with preserved ejection fraction (HFpEF) were prescribed empagliflozin (10 mg per day), starting seven days before the administration of anthracyclines and continuing for a period of six months. Those not meeting these criteria served as controls. The primary endpoint was cancer therapy-related cardiac dysfunction (CTRCD) incidence. CTRCD was defined as either a decrease in left ventricular ejection fraction (LVEF) of at least 10% to a final value below 50% or a reduction in global longitudinal strain (GLS) of at least 15% from baseline at any point during the study. The secondary endpoints included mortality and hospitalization due to cardiovascular causes or clinical heart failure. Exploratory endpoints included increases in serum troponin and NT-proBNP levels and a decrease in the glomerular filtration rate (GFR). The safety endpoints tracked includedketoacidosis, hypoglycemia, sepsis, neutropenic fever, and urinary tract infections.ResultsDuring the enrollment period, 785 breast cancer patients were analysed. Of these, 107 met the inclusion criteria, and 76 subsequently provided informed consent. The study was conducted with comparable adherence rates of 81.5% in both the empagliflozin group (n = 38) and the control group (n = 38). The follow-up data from 62 patients revealed a significant reduction in the primary outcome within 6 months for the empagliflozin group compared with the control group (6.5% vs. 35.5%, p = 0.005), with a relative risk of 0.18 (95% CI: 0.04–0.75). Compared with the control treatment, treatment with empagliflozin also significantly preserved the ejection fraction at 6 months follow-up (56.8% ± 5.8% vs. 53.7% ± 6.7, p = 0.029). However, there were no significant differences between the groups in terms of NT-proBNP, cTnI, clinical heart failure, GFR, or mortality/hospitalization due to heart failure.ConclusionEmpagliflozin is associated with reduced incidence of CTRCD in high-risk patients treated with anthracyclines. These data should serve as the foundation for a clinical trial to test whether SGLT2 inhibitors can reduce the incidence of heart failure in this patient group.

The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.

Cost-effectiveness analysis of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective.

This study assessed the cost-effectiveness of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective. The analysis evaluated a 5-year care pathway using a Markov model, considering per-patient costs of treatment, health system cost savings of obstructive sleep apnea and attributed conditions, the effectiveness measured in disability-adjusted life years with a discount rate of 3% and a weighted 5-year continuous positive airway pressure adherence of 74.1% from Singapore studies. Per-patient costs of treatment were from a large public hospital in Singapore. Efficacy of continuous positive airway pressure treatment, health system costs and disability-adjusted life years were obtained from literature; costs are in US dollars. We conducted probabilistic sensitivity analysis, one-way sensitivity analysis and what-if analysis. Based on a willingness-to-pay threshold of US $50,000 per disability-adjusted life year in USA, continuous positive airway pressure therapy was highly cost-effective, with an incremental cost-effectiveness ratio of $13,822 per disability-adjusted life year averted. Compared with the annual total costs of $856 for patients with continuous positive airway pressure treatment diagnosed by an inpatient sleep study, the total costs for those diagnosed by a home sleep test were $625, resulting in a remarkable 27% reduction per patient per year. One-way sensitivity analysis indicated that costs of treatment, effectiveness of continuous positive airway pressure treatment and adherence had a higher impact on the cost-effectiveness of continuous positive airway pressure therapy. The what-if analysis suggested that for continuous positive airway pressure treatment to be cost-effective, adherence rate should be at least 16.1%. These findings provide valuable insights for policymakers in making informed decisions on funding diagnosis and continuous positive airway pressure therapy within Singapore's healthcare system.

The impact of different doses of oral iron supplementation during pregnancy: a pilot randomized trial

AbstractOral iron is first-line medication for iron deficiency anemia in pregnancy. We conducted a pilot randomized trial to investigate the impact of different doses of oral iron supplementation started early in pregnancy on women without anemia for 4 main outcomes: recruitment and protocol compliance, adherence, maintenance of maternal hemoglobin, and side effects. At antenatal clinic visits, participants were allocated to 1 of 3 trial arms in a 1:1:1 ratio: 200 mg ferrous sulfate daily, alternate days, or 3 times per week. The participants were followed to delivery. Baseline characteristics of 300 recruited participants were well matched between trial arms. The mean proportion of tablets taken as expected per participant was 82.5% overall (72.3%, 89.6%, and 84.5% for the daily, alternate days, and 3 times a week arm, respectively). There was a lower overall adherence rate in the daily arm (47%) than in the alternate days (62%) and the 3 times per week (61%) arms. A reduction in hemoglobin between randomization and 28 weeks’ gestation seemed smaller for the daily arm. A range of side effects were commonly reported at baseline before starting interventions and at later antenatal visits. Many side effects of iron overlapped with normal pregnancy symptoms. A daily iron dosing schedule might give the best opportunity for delivering an adequate iron load during pregnancy in women without anemia. Further randomized trials powered on clinical outcomes are needed to establish the clinical effectiveness of oral iron supplementation to prevent iron deficiency anemia. This study was registered (#ISRCTN12911644).