Reminder Cards Research Articles

FP7.10 - An audit assessing the documentation of antibiotic indication and course length on an acute surgical unit

Abstract Aims Documenting antibiotic indications and course lengths on drug charts at the time of prescription is recommended in numerous publications. A closed loop audit was therefore performed to assess the documentation of this information for acute general surgery patients in a district general hospital. Methods During the first cycle, drug charts from acute general surgery patients were reviewed and the rates of documentation for antibiotic indication and course length were assessed. To improve these measures, the results from this cycle were presented to junior doctors and cards reminding doctors to complete antibiotic documentation were made and attached to drug charts when necessary. The impact of these measures was examined during a re-audit. Results 50 patients were assessed during cycle one and antibiotic indication and course length were documented in 54.0% and 42.0% of cases respectively. Data from a further 50 patients were collected following the presentation to junior doctors working in general surgery and the introduction of the reminder cards. Following these interventions, antibiotic indication and course length were documented in 74.0% and 68.0% of cases respectively. Co-amoxiclav and Tazocin were the most common agents prescribed across cycle 1 (64.0% and 14.0% respectively) and cycle 2 (60.0% and 16.0% respectively). Conclusions The documentation of antibiotic indication and course length on drug charts needed improving in this cohort. Although the presentation of the data from cycle 1 and reminder cards achieved this outcome, further improvements are required and should be assessed during future re-audits.

Pretest-post-test evaluation with lay midwives in remote Guatemala after educational activities about COVID-19.

Guatemalan lay midwives are well-respected community leaders in a country that lacks the institutional capacity to meet healthcare needs related to pregnancy, newborns, and COVID-19. Thus, Guatemalan lay midwives, who attend the majority of births in their country and who attend most births at home, are in an optimal position to offer frontline support to pregnant women and newborns regarding the global pandemic. The primary objective of this program of study was to dispel myths about COVID-19 and to provide culturally relevant educational activities to low-literacy Guatemalan lay midwives about issues related to the virus, such as signs and symptoms, risks to the mother and fetus, which patients are most vulnerable, appropriate responses, benefits and side-effects of the vaccine, timing of the vaccine, how the virus interacts with breastfeeding, and breastfeeding recommendations. In a partnership among the Guatemalan Ministry of Health, expert faculty at the University of Utah College of Nursing, and Madre y Ni&ntilde;o, a non-profit organization from the US, evidence-based educational activities about COVID-19 were offered orally in the native language of participants. Two hundred and ten lay midwives attended educational sessions at 11 locations throughout the remote Peten department. Educational activities included repetition, storytelling, and role plays. A pretest-post-test evaluation of 10 questions with 24 correct answers was used to determine if the educational activities changed lay midwife knowledge about COVID-19. Participants were given essential birth supplies and laminated COVID Reminder Cards, which were designed to increase visual literacy, to encourage knowledge retention after the educational sessions. Participants showed a significant increase in knowledge scores (possible 0-24) from prescores 7.09 (standard deviation (SD)=3.06) to 15.20 (SD=4.61), Student's t-test p<0.001. In addition, a significantly higher proportion of participants mistakenly thought COVID-19 passed through breast milk on the pretest (70.1%) compared to post-test (8.4%) (McNemar test, p<0.001). Regarding breastfeeding, 12.6% of participants knew on the pretest that women with COVID-19 who breastfeed should wear a mask and wash their hands compared to 74.3% of participants who knew these recommendations on the post-test (Wilcoxon signed-rank test, p<0.001). Finally, 2% of participants knew on the pretest that pregnant women with COVID-19 should take a low-dose aspirin compared to 67% of participants on the post-test (χ&sup2; (1)=194.7, p<0.001). These essential primary care providers misunderstood many critical issues related to COVID-19, pregnancy, and newborns. Culturally relevant educational activities provided orally in the native language of participants dispelled myths about the virus and significantly improved lay midwife knowledge. Providing evidence-based educational activities in a culturally relevant format is critical to protecting remote, vulnerable populations, such as pregnant Guatemalan women and newborns, during a global pandemic.

Project to Improve FloTrac Cognition and Skill Accuracy in Nurses Working in the Intensive Care Unit

FloTrac is used to monitor hemodynamics in patients. Insufficient awareness of and inexperience with this machine put patients at risk. A project was developed to increase FloTrac cognitive accuracy from 57.6% to 85% and skill accuracy from 73.3% to 91% in ICU nurses. Also, FloTrac installation time was intended to be reduced to less than 8 minutes and 38 seconds. Create a pithy, easy-to-remember formula; make operation teaching videos, operation manuals, and reminder cards; arrange educational training; and monitor quality regularly. FloTrac cognitive accuracy increased from 57.6% to 90.4%; FloTrac skill accuracy increased from 73.3% to 99.7%; and installation time was shortened from 8 minutes and 38 seconds to 5 minutes and 42 seconds. After implementation of the project, nurses improved their professional knowledge and were better able to help doctors obtain hemodynamic data efficiently to provide patients with accurate and rapid treatment.

85 I DO, I CARE: implementing delirium screening for older people to improve care, awareness and recognition in the emergency department

Abstract Background Delirium is prevalent (7%–20%) in older patients in emergency departments (ED). The diagnosis is often missed (57%–83%). This Quality Improvement (QI) project aimed to improve delirium screening by 30% in the ED, in keeping with the HSE’s ‘Early Identification and Management of Delirium in ED (2021) and to identify barriers to sustain screening. Methods The Institute for Health Improvement Quality Improvement essentials toolkit was used. Patients ≥75 years with Manchester triage category of 2–5 were included. Plan Do Study Act cycles included auditing 110 patient charts in a weekly rapid cycle audit was performed. Actions included 1) formation of an organisational oversight group 2) triage nurses and healthcare assistants placed ‘Screen me with 4AT’ stickers on charts 3) ED Doctors screened with 4-AT 4) 4AT tool was incorporated into all adult proforma 5) 5 face to face information sessions with ED nurses 6) 8 individualised information sessions with ED nurses 7) EM registrar education of junior doctors 8) 4-AT lanyard reminder card 9) twice-weekly WhatsApp group sharing of results 10) Informal feedback invited from doctors who did not complete the 4AT. Data was entered onto Excel and analysis done using descriptive statistics. Results The mean (SD) age was 84 (5.6) years, the mean (SD) Manchester triage was 2.6 (0.6) and 56% were female. At baseline 1/20 (5%) charts contained a completed 4-AT. On average the 4-AT completion improved to 38% (42/110) (range 10% to 60%). Delirium was diagnosed in 38% (16/42). Barriers identified pre and post implementation included knowledge deficits, no out-of-hours referral pathway, low priority above competing demands, and fluctuations in ED staffing. Conclusion The QIP achieved the target but sustainability due to doctor’s rotations is questionable. Senior clinical leadership and role modelling, nursing team buy-in, education, and referral pathways are required to build on current progress.

Implementation of Depression Screening and Interventions Protocol in a Pediatric Neurology Residents’ Continuity Clinic: A Quality Improvement Project (P11-9.001)

<h3>Objective:</h3> We developed and implemented a depression screening and interventions (S&amp;I) protocol in our pediatric neurology residents’ continuity clinic. <h3>Background:</h3> The prevalence of depression in children with neurological disorders ranges from 10–30%. Co-morbid depression is an important factor in the care and quality of life of these patients. Early recognition of depression can lead to early engagement of mental health services and improvement of depressive symptoms. However, ubiquitous depression screening in pediatric neurology clinics remains a challenge. <h3>Design/Methods:</h3> A multidisciplinary team (resident leaders, program director, clinic manager, nurses, medical assistants, and social workers) developed the depression S&amp;I protocol. Patient Health Questionnaire-9 Adolescent (PHQ-9A) was administered to patients age 12 to 18 years, who were developmentally capable and agreed to complete the screening. Patients received individualized interventions based on our algorithm. Serial Plan-Do-Study-Act (PDSA) cycles were performed, over nine months, to improve efficacy and workflow. PDSA cycle 1 included protocol initiation and education of residents and clinic staff. PDSA cycle 2 included further promotion and addition of dotphrases in the electronic medical record (EMR) documentation. PDSA cycle 3 consisted of re-education and provision of reminder cards at workstations. Measures included percent of eligible patients screened and percent of screened patients who received appropriate interventions. <h3>Results:</h3> During PDSA cycle 1, 57% of eligible patients were screened, of which 79% received appropriate interventions. After PDSA cycle 2, screening and appropriate intervention rates remained stable at 58% and 81%, respectively. Following PDSA cycle 3, the screening rate increased by 13% while the appropriate intervention rate was relatively maintained (78%). During the study, 19% of patients had moderate and severe scores, and one patient endorsed active suicidal ideation. <h3>Conclusions:</h3> After implementation of the depression S&amp;I protocol, patient screening rates increased through education and EMR-based changes. Future research will include assessment of trends in patients’ scores and symptoms after protocol implementation. <b>Disclosure:</b> Dr. Choudhari has nothing to disclose. Dr. Lorenzo has nothing to disclose. Dr. Said has a non-compensated relationship as a Board of Directors, Representative of PCN with UCNS that is relevant to AAN interests or activities. Dr. Said has a non-compensated relationship as a Member, Professional Advisory Board with Epilepsy Foundation of Texas that is relevant to AAN interests or activities. Dr. Said has a non-compensated relationship as a Member, Diversity, Equity and Inclusion Committee with American Epilepsy Society that is relevant to AAN interests or activities.

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Using Team Resource Management and Situational Simulation to Improve the Resuscitation Performance Completion Rate

Cardiopulmonary resuscitation is an important issue in patient safety. After investigation, we identified the causes of the low rate of resuscitation completion in our emergency department as: incomplete utilization of available first-aid equipment, lack of standards related to task allocation, unclear moving line and instrument placement, lack of teamwork, and poor resuscitation-related communications during the COVID-19 pandemic. The project aimed to improve the resuscitation performance completion rate. The project included designing equipment reminder cards and an airway car, designating specific responsibilities for each team member, establishing standard layouts and traffic flows, and providing situational simulation and team resource management training. After the intervention, the resuscitation performance completion rate had risen to 91.6% from the pre-intervention rate of 69.1%. This has since further risen to a relatively constant completion rate of 98.1%. The implementation of the team resource management and situational simulation training intervention in our ED improved both the resuscitation completion rate and the rate of return of spontaneous circulation (ROSC).

Self-control training for school age children in internet addiction prevention effort

Internet addiction can occur in school-age children which has an impact on the inability of children to control themselves from using the internet, causing brain or mental functional problems in everyday life. Community service program is carried out according to the problem, namely educational activities and self-control training for students as an effort to prevent internet addiction. This self-control training was attended by 20 students of SDN 130 Pekanbaru. This program was preceded by health education about internet addiction, then trained students to exercise self-control in using gadgets and the internet and were evaluated after six days of self-control exercises. Programs were measured using a knowledge questionnaire and KDAI internet addiction diagnostic questionnaire as well as the results of a reminder card. The results of the pre-test showed that the average knowledge of the participants was 85.11 and the post-test was 90.82. This program proved to be successful where objectively there was an increase in participants' knowledge about Covid-19 and the use of gadgets.

Evaluating awareness, knowledge and practice of healthcare professionals following implementation of a revised pregnancy prevention programme for isotretinoin in Ireland: A multi-stakeholder cross-sectional study.

In 2018, following an EU-wide safety review, a revised pregnancy prevention programme (PPP) was introduced for isotretinoin (Roaccutane®). This study aimed to examine awareness, knowledge, and experience implementing the revised isotretinoin PPP in clinical practice across three healthcare professional (HCP) groups in Ireland. A cross-sectional study using anonymous online surveys among general practitioners (GPs), community pharmacists, and specialist consultants was undertaken. Descriptive analyses are presented. Across all HCP groups there was high (≥87%) awareness that oral isotretinoin is contraindicated in women of childbearing potential (WCBP) unless the conditions of the PPP are fulfilled, but varying awareness among GPs (54.9%) and community pharmacists (45.9%) that exposure during pregnancy can cause both severe fetal malformations and spontaneous abortions. Implementation of the PPP in clinical practice varied across HCP groups. When initiating isotretinoin in WCBP, 66.7% of specialists and 40.8% of GPs indicated they had considered alternative treatment options, and 71.4% of specialists and 31.6% of GPs reported they first requested a pregnancy test. There was limited provision of the patient reminder card to WCBP, where 26.1% of community pharmacists provide this at each dispensing, while 47.6% of specialists and 11.8% of GPs ensured WCBP had a copy of the card when initiating treatment. Across all HCP groups, there was high (≥81.6%) awareness of the need for urgent consultation and immediate cessation of isotretinoin in the event of an unplanned or suspected pregnancy. Reinforcement of the provision and utilisation of the isotretinoin patient reminder card may be required, and further targeted education on specific elements of the PPP should be considered for GPs and community pharmacists.

Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: a stepped wedge cluster randomised trial

IntroductionIron deficiency is the most prevalent micronutrient deficiency in pregnancy globally responsible for nearly 120 000 maternal deaths per year and a fifth of maternal mortality. Over 46% of pregnant...

Improving Ventilation Rates During Pediatric Cardiopulmonary Resuscitation

Excessive ventilation at rates of 30 breaths per minute (bpm) or more during cardiopulmonary resuscitation (CPR) decreases venous return and coronary perfusion pressure, leading to lower survival rates in animal models. A review of our institution's pediatric CPR data revealed that patients frequently received excessive ventilation. We designed a multifaceted quality improvement program to decrease the incidence of clinically significant hyperventilation (≥30 bpm) during pediatric CPR. The program consisted of provider education, CPR ventilation tools (ventilation reminder cards, ventilation metronome), and individual CPR team member feedback. CPR events were reviewed pre- and postintervention. The first 10 minutes of each CPR event were divided into 20 second epochs, and the ventilation rate in each epoch was measured via end-tidal carbon dioxide waveform. Individual epochs were classified as within the target ventilation range (<30 bpm) or clinically significant hyperventilation (≥30 bpm). The proportion of epochs with clinically significant hyperventilation, as well as median ventilation rates, were analyzed in the pre- and postintervention periods. In the preintervention period (37 events, 699 epochs), 51% of CPR epochs had ventilation rates ≥30 bpm. In the postintervention period (24 events, 426 epochs), the proportion of CPR epochs with clinically significant hyperventilation decreased to 29% (P < .001). Median respiratory rates decreased from 30 bpm (interquartile range 21-36) preintervention to 21 bpm (interquartile range 12-30) postintervention (P < .001). A quality improvement initiative grounded in improved provider education, CPR team member feedback, and tools focused on CPR ventilation rates was effective at reducing rates of clinically significant hyperventilation during pediatric CPR.

Improving knowledge, attitude, and compliance of hand hygiene of Iranian healthcare workers: A pilot study using Reminder Card

Background: Compliance rate of hand hygiene practice by healthcare workers has been observed to be universally low despite its importance, simplicity and cost-effectiveness in preventing the spread of infectious diseases in the healthcare settings. This study aimed to improve healthcare workers’ knowledge, attitudes, and compliance with hand hygiene by using reminder cards displayed by patients.

0198 Remote Saliva Sample Collection for Dim Light Melatonin Onset (DLMO) Measurement in Urban Children with Asthma During the COVID-19 Pandemic

Abstract Introduction The COVID-19 pandemic has challenged researchers to use remote data collection. Our project includes determining DLMO phase, requiring a family-friendly without face-to-face interaction. We describe here our protocol, experiences, lessons learned, and findings from the first 15 participants. Methods Fifteen urban-dwelling children with moderate to severe persistent asthma [7 girls, ages 7 (n=1) to 10 years; and 8 boys, 8 or 9 years] and caregiver (CG) participated. CG tracked bedtimes and risetimes in daily diaries for 10-14 days; average bedtimes from 5 nights preceding saliva collection were used to determine timing for 10 half-hourly samples. CG and child were oriented and then watched a demo video. A “spit-kit” was delivered to the home the afternoon of the study. Kits included a small cooler bag with bottle of water, 10 numbered and 5 spare Salivette tubes (Starstedt, Germany), plastic bag, dark wraparound glasses with securing strap, and log sheet. Data collection began with a zoom call with staff, CG, and child to reiterate the instructions, answer questions, and observe the first sample. Thereafter, a staff member telephoned the caregiver every 30 minutes to prompt the next sample and query whether glasses had been kept on. CG placed kit outside the home for morning pick up. Samples were centrifuged and frozen (-20°) until sending to the assay lab (SolidPhase, Portland, ME) for melatonin radioimmunoassay (Alpco, Windham, NH). Results DLMO phase was determined with a 4pg/ml threshold for 11 children. DLMO phases (mtime=21:46±68 min) and average bedtimes (mtime=20:40±88min) were positively correlated (r=.87). Challenges identified for missed DLMOs included: one child supervised by a teenaged sibling (not CG); one child/CG identified as potentially uncooperative. The other two “misses” likely arose from low saliva quantity, inconsistencies with staff training, and inadequate description of requirements for wearing glasses. Procedure modifications included strategies tailored to families’ needs, experiences, and home environment that can challenge adherence to protocol, greater emphasis on wearing glasses, and cartoon reminder card and scales added to kit. Subsequent samples were successful. Conclusion Our approach was effective for determining DLMO phase in children using a remote approach with careful application of methods. Support (If Any) R01HL142058, P20GM139743

Improving Capnography Use for Critically Ill Emergency Patients: An Implementation Study.

Capnography has established benefit during intubation and cardiopulmonary resuscitation (CPR). Implementation within emergency departments (EDs) has lagged. We sought to address barriers to improve documented capnography use for patients requiring intubation or CPR. A controlled before- and after-implementation study was performed in 2 urban EDs. The control site had an existing policy for capnography use. Interventions for the experimental site included a 5-minute informational video, placement of capnography monitors with a shortened warm-up period in all resuscitation rooms, laminated reminder cards, and feedback during staff meetings. Staff members were surveyed about knowledge before and after the intervention. Records were reviewed for documented capnography use for 3 months before and 6 months after the intervention. Change in documented use at the experimental site was compared with the control site. At the experimental site, 118 providers participated and 190 records were reviewed; 544 records were reviewed from the control site. There was a significant increase in the proportion of documented capnography use at the experimental site (8% versus 19%, P = 0.04) compared with the control site (64% versus 71%, P = 0.10). However, there was no significant trend over time at the experimental site after the intervention (P = 0.86). Despite high baseline knowledge about capnography, providers had improvements in survey responses regarding indications for intubation and CPR, normal values, and minimum effective values during CPR. Documented capnography use increased with simple interventions but with no positive trend. Additional work is needed to improve use, including further evaluation of capnography's implementation in the ED.

The success of behavioral economics in improving patient retention within an intensive primary care practice

BackgroundA minority of the U.S. population comprises a majority of health care expenses. Health system interventions for high-cost populations aim to improve patient outcomes while reducing costly over-utilization. Missed and inconsistent appointments are associated with poor patient outcomes and increased health care utilization. PEAK Health— Mount Sinai’s intensive primary care clinic for high-cost patients— employed a novel behavioral economics-based intervention to reduce the rate of missed appointments at the practice. Behavioral economics has accomplished numerous successes across the health care field; the effect of a clinic-based behavioral economics intervention on reducing missed appointments has yet to be assessed.MethodsThis was a single-arm, pre-post trial conducted over 1 year involving all active patients at PEAK Health. The intervention consisted of: a) clinic signage, and b) appointment reminder cards containing behavioral economics messaging designed to increase the likelihood patients would complete their subsequent visit; appointment cards (t1) were transitioned to an identical EMR template (t2) at 6 months to boost provider utilization. The primary objective, the success of scheduled appointments, was assessed with visit adherence: the proportion of successful over all scheduled appointments, excluding those cancelled or rescheduled. The secondary objective, the consistency of appointments, was assessed with a 2-month visit constancy rate: the percentage of patients with at least one successful visit every 2 months for 1 year. Both metrics were assessed via a χ2 analysis and together define patient retention.ResultsThe visit adherence rate increased from 74.7% at baseline to 76.5% (p = .22) during t1 and 78.0% (p = .03) during t2. The 2-month visit constancy rate increased from 59.5% at baseline to 74.3% (p = .01) post-intervention.ConclusionsA low-resource, clinic-based behavioral economics intervention was capable of improving patient retention within a traditionally high-cost population. A renewed focus on patient retention— employing the metrics described here— could bolster chronic care efforts and significantly improve the outcomes of high-cost programs by reducing the deleterious effects of missed and inconsistent appointments.

Enhancing acute flaccid paralysis surveillance through the use of pictorial surveillance reminder cards during supplementary immunization activities, December 2014: a survey in Jigawa State, Nigeria.

IntroductionAcute flaccid paralysis (AFP) pictorial surveillance reminder cards (AFP cards) could aid AFP case identification during supplementary immunization activities (SIAs). We assessed the availability and utilization of AFP cards among vaccination teams during the December 2014 polio SIAs in Jigawa State, Nigeria.MethodsWe conducted a cross-sectional survey of a convenience sample of 95 vaccination team supervisors. We used a semi-structured interviewer-administered questionnaire to collect information on socio-demographics, knowledge of AFP cases, availability and utilization of the AFP cards for case identification and investigation and non-compliance resolution by vaccination teams. Univariate and bivariate analyses were performed using Epi Info version 3.5.1.ResultsOf the 95 supervisors interviewed, 86 (91%) reported that vaccinators properly displayed the AFP cards, 90 (95%) reported use of cards for AFP case identification, 88 (93%) reported use of cards to resolve non-compliance with polio vaccination and 77 (81%) reported use of cards to ask caregivers six key questions to prevent missed children. Fifty-eight (61%) supervisors knew the AFP case definition. A total of 21 possible AFP cases were identified by vaccination team members with the aid of the cards, of which 17 (81%) were referred to the nearest health facility.ConclusionThe survey demonstrated usefulness of reminder cards for identification and follow-up of AFP cases. Based on these findings, use of AFP cards was implemented in all Nigerian States and similar cards were developed and implemented for measles surveillance during SIAs.

Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study.

BackgroundPublic health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases.ObjectiveThis study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities.MethodsOver 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns.ResultsOverall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days).ConclusionsThis study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research.

Effect of Reminder Tools on Drug Adherence among Patients on Anti-retroviral Drug in Specialist Hospital Yola, Adamawa State: A Randomized Field Trial

A Minimum Of 95% Drug Adherence Is Necessary To Achieve Immunological And Virological Success In Antiretroviral Therapy, And To Attain This Level; Patients Need To Be Assisted. The Study Therefore Aimed At Comparing The Effect Of Reminder Tools On Antiretroviral Drug Adherence Among People Living With Human Immunodeficiency Virus. The Study Was A Randomised Field Trial. Questionnaire And Adherence Assessment Forms Were Administered To Two Hundred, And Twenty-Five Patients, And Information Was Elicited On Socio-Demographic History, Antiretroviral Drug Usage, And Adherence Behaviour. Alarm Clocks And Counselling Were Given To One Group, Stickers, Reminder Cards, And Counselling To The Second Group, While Counselling Alone Was Given To The Third Group As Interventions. Three Months Later, Data Were Collected From The Same Patients In Order To Compare The Effect Reminder Tools Had On Antiretroviral Drug Adherence Among The Patients. Data Were Entered Into Epi Info Version 3.5.1 2008 Statistical Software And Analyzed. The Optimum Adherence Levels Were 78.7%, 80.0%, And 84.0% At Pre-Intervention Among Groups That Had Alarm Clock With Counselling, Sticker, Reminder Card With Counselling, And Those That Had Counselling Alone Respectively. The Drug Side Effect Was Negatively Associated With Adherence Level (P&lt; 0.05), While Pill Count Was Not Associated With Adherence Level (P&gt;0.05). At Post-Intervention, The Adherence Levels Increased By 18.5%, 6.8%, And 1.9%, Respectively, Among Groups That Had Alarm Clock With Counselling (P&lt;0.05), Sticker, Reminder Card With Counselling (P&gt;0.05), And Those That Had Counselling Alone (P&gt;0.05). The Alarm Clock Was More Effective Than Stickers And Hand-Held Cards In Improving Adherence.

Real-world Utilisation of the Rivastigmine Transdermal Patches Accompanying the Use of Risk Minimisation Tools in Patients with Dementia.

Transdermal patches are convenient to use, especially in Rotkreuz ZG Rotkreuz ZG patients with Alzheimer's disease (AD)-associated dementia. However, various identified risks of errors in administering the patches cannot be disregarded. Patient Reminder Cards (PRCs, included a Medication record sheet [MRS]) have been recently introduced as a risk minimisation tool to prevent incorrect patch use (IU). This study aimed to assess the effectiveness of PRCs to prevent IU and to investigate the dose titration pattern of rivastigmine patches in a real-world setting. This multinational, observational, 11-month study included patients with AD currently using rivastigmine patches (4.6 mg/day, 9.5 mg/day, 13.3 mg/day) accompanied by a caregiver. Study outcomes were IU, including multiple patch use (MPU), incorrect patch placement, other IUs, perceived usefulness of the PRCs, and titration patterns of the patches. Of the total 614 patients included, most were aged ≥ 65 years and had mild-to-moderate AD. Before and during the study, 27.7% and 18.0% of patients reported IU, respectively. Most patients used MRS, and 73.5% rated it 'helpful' and reported lower rates of IU than those who reported it 'not helpful' (13.9%-16.5% vs. 20.2%). Overall, 141 patients had dose titrations, with 75.8% being up-titrated from 4.6 mg/day to 9.5 mg/day after a mean duration of 58 days. Safety findings were consistent with the established profile for the rivastigmine patch. PRC was effective as a risk minimisation tool in limiting the inappropriate use of rivastigmine patches. The majority of patients requiring dose-change were up-titrated to 9.5 mg/day patches.

PENGARUH PMR DENGAN KARTU PENGINGAT TERHADAP KEPATUHAN DAN KESESUAIAN PENGOBATAN PASIEN TUBERKULOSIS

The duration of tuberculosis treatment affects patient adherence. The pharmacist monitors the patient's medication by providing an intervention in the form of a reminder card. The research objective was to use a reminder card to determine the compliance level of tuberculosis patients. The design of this study was a pre-experimental one group pretest-post test from December 2019 - January 2020. The study sample was 133 adult tuberculosis patients who received detached drugs and had undergone treatment &gt;1 month at the Pulmonary Poly Outpatient Waluyo Jati Kraksaan Hospital. The level of adherence with the reminder card intervention was calculated using the pill count method and analyzed using the Wilcoxon test. The result of tuberculosis patient adherence level increased significantly (p&lt;0.05) after giving the reminder card from 50.00% to 99.37%. Providing a reminder card is an effort that can improve adherence to treatment of tuberculosis patients.