Significant Differences In Adherence Research Articles

Music and Sleep Hygiene Interventions for Pregnancy-Related Insomnia: An Online Randomized Controlled Trial.

Approximately 50% to 60% of all pregnant women suffer from insomnia during pregnancy. Pregnancy-related insomnia has been associated with severe outcomes for both mother and child postnatally. Currently, the treatment of pregnancy-related insomnia is often neglected due to a lack of suitable treatments. This online assessor-masked randomized controlled trial aimed to evaluate the effectiveness of music listening and sleep hygiene for treating pregnancy-related insomnia. We recruited first-time pregnant women at the end of the second trimester with a report of poor sleep. Participants in the music and sleep hygiene (MSH) group received standard sleep hygiene advice and were instructed to listen to music daily at bedtime for 4 weeks. They could choose from 6 sleep playlists of different genres. Participants randomized to the sleep hygiene alone (SH) group received standard sleep hygiene only. Primary outcomes were sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) and insomnia severity measured with the Insomnia Severity Index. gov Identifier: NCT04633395. Among the 98 participants receiving the online intervention, 31 participants in the MSH group (62%) and 40 participants in the SH group (80%) completed the postintervention measurements. Both groups experienced improved sleep quality during the intervention period (PSQI change, -2.10; 95% CI, -3.27 to -0.93; P <.001), with no significant difference between the groups. Similarly, insomnia symptoms were reduced (Insomnia Severity Index change, -3.42; 95% CI, -5.02 to -1.83; P <.001) with no significant difference in the effect between groups. There was a significant difference in adherence to sleep hygiene between the MSH and SH groups (42% vs 8%; P =.007). Sleep quality and insomnia severity can be improved in pregnant women with relatively simple interventions like music listening and sleep hygiene advice. These results align with previous research, but larger trials are recommended to support introduction into clinical practice.

Clinical practice guideline supported administration of monoclonal antibody therapy for high-risk patients with COVID-19: Experience of a quaternary care centre

Background: Immunocompromised patients remain at risk of progression to severe COVID-19 disease. Methods: We describe clinical COVID-19-related outcomes after administration of anti-SARS-CoV-2 monoclonal antibodies (mAb) following institutional clinical practice guidelines (CPGs) in 205 high-risk patients between November 2021 and April 2022 at a Canadian quaternary care centre. Results: Median patient age was 59 years; 102 (50%) were female. Eighty-two (40%) were transplant recipients, 47 (23%) patients had hematologic malignancies, 25 (12%) had solid organ malignancies, and 51 (25%) had another indication. Forty-eight (23%) had received fewer than two doses of anti-SARS-CoV-2 vaccines. The majority (80%) had mild disease at presentation with 14% moderate and 6% severe. Median time from symptom onset to mAb administration was 3 days (IQR 2.0-5.5 days). Of those who received mAb as outpatients, 90 (93%) had favourable clinical outcomes (no COVID-19-related hospitalizations or death within 3 months). Of those who received mAb as inpatients, 93 (86%) had favourable outcomes (discharged without COVID-19-related re-admission or death), 4% were re-admitted, and 10% died. In logistic regression analysis, only disease severity at time of mAb administration was associated with unfavourable outcomes. Fewer than two vaccine doses was not associated with unfavourable outcomes, suggesting potential benefit among the under-vaccinated. There was a significant difference in adherence to CPGs between administration of mAb in outpatients versus inpatients (adherent for 85% versus 58%, p&lt;0.001), where non-adherence occurred in cases of severe disease. Conclusion: CPG-supported mAb administration for management of COVID-19 in high-risk patients was associated with favourable clinical outcomes and may be a useful model to guide future therapies.

Adherence to oral anticoagulants in patients with non-valvular atrial fibrillation: the role of patients’ characteristics and out-of-pocket payments

ABSTRACT Background Recent practice guidelines favor direct oral anticoagulants (DOACs) over warfarin for primary stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, challenges persist in Iraq’s private pharmaceutical sector. DOACs have been sold at high and inconsistent retail prices and lack insurance coverage, leading to significant out-of-pocket (OOP) costs. The objective of this study is to investigate the impact of OOP costs on oral anticoagulants (OAC) adherence among NVAF patients. Research design and methods This multicenter cross-sectional study interviewed 359 eligible patients attending three private cardiology clinics within Iraq’s southern region from December 2022 to February 2023. The 8-item Morisky Adherence Scale evaluated patient adherence. Statistical analyses, including descriptive analysis, ANOVA, and chi-square. p < 0.05 was considered statistically significant. Results The most frequently prescribed OAC were DOACs (62.8%). Patient adherence level to OAC was chiefly medium (54.6%) with no significant difference in adherence based on OAC type. Patient adherence was significantly associated with monthly income (p = 0.001), number of daily pills (p = 0.006), and OACs’ average monthly cost (p = 0.011). Conclusion Addressing the issue of cost-related non-adherence to OACs requires multiple actions. These include ensuring comprehensive health insurance coverage for OACs, increasing the use of affordable generic alternatives, and establishing effective cost-related discussions between healthcare providers and patients.

Influence of Educational-Intervention Program on Adherence to Workplace-Ergonomic Principles among Catering Staff of Selected Universities in Ogun State, Nigeria

Objective: Adherence to workplace-ergonomics principles preserves worker’s health, and productivity, negligence results in musculoskeletal disorders (MSDs). This study evaluated the influence of an educational intervention program on Adherence to ergonomic principles among Catering Staff of selected Universities in Nigeria. Methods: This was a quasi-experimental study. The study population was 423 catering staff of two purposively selected universities. Sixty consenting Staff were systematically derived by selecting every 7th person, using the normal distribution power formula for intervention studies and enrolled in an experimental group (EG: n=30) and a control group (CG n: =30). EG received the ergonomics-based educational intervention, one-hour/day/week for three weeks. CG received lectures on infection control. The study lasted twelve weeks. A validated, structured, pre-tested questionnaire with Cronbach’s alpha coefficients ranging from 0.78 to 0.93 was self-administered by respondents. EG and CG had a 100% response rate. Descriptive and inferential statistics were used to analyze baseline and 12th-week follow-up data at 5% significance level Results: The mean age of respondents was 41.52 ± 10.23. CG and EG showed a significant difference in adherence to ergonomics principles at the 12th-week follow-up (3.30 ± 0.37 and 9.97 ± 0.30; p &lt; 0.05). EG showed a significant difference in adherence to ergonomics principles between baseline and 12th-week follow-up. (7.53 ± 0.32 and 9.97 ± 0.03; ES 1.407(0.783 to 2.031) p - 0.001 respectively. Conclusion: The educational intervention program improved adherence to ergonomic principles. The study recommends routine training of university catering staff in ergonomics to sustain adherence.

Adherence to Supervised and Unsupervised Exercise Programmes in Ageing Population with Intermittent Claudication: A Randomized Controlled Trial.

Background: Intermittent Claudication symptomatic peripheral arterial disease (ICSPAD) is associated with reduced mobility, functional capacity, and quality of life. Physical exercise is an effective non-pharmacological intervention for the management of ICSPAD. Adherence to exercise programs is challenging, due to the nature of the disease and the complex comorbidities associated with it. This study aimed to determine adherence to three supervised physical exercise programs (a walking intervention, strength intervention, and concurrent intervention) and an unsupervised exercise program (standard advice) in individuals with ICSPAD. Methods: In this clinical trial, 122 patients were divided into four groups based on the type of exercise program they followed: standard advice, walking intervention, strength intervention, and concurrent intervention. Results: The results revealed that while the demographic characteristics were similar, the strength intervention group had a younger mean age, and the walking group had a higher prevalence of hypertension and increased usage of anti-hypertensive drugs. Adherence to physical exercise and pedometer wearing was highest in the standard advice group. Logistic regression analysis showed lower odds of adherence to exercise and pedometer wearing in the intervention groups compared to the standard advice group. Adherence did not significantly vary across ankle-brachial index categories. Furthermore, there was no significant difference in adherence between the severity levels of intermittent claudication, though mild cases tended to exhibit higher adherence. Conclusions: The results show that the standard advice from healthcare professionals positively influences treatment adherence.

Factors that impact aromatase inhibitor adherence in early-stage hormone receptor positive breast cancer.

e12524 Background: Despite efficacy of aromatase inhibitors (AI) in improving survival for patients with hormone receptor positive (HR+) breast cancer, adherence to AI remains suboptimal. The aim of this study is to evaluate factors that may affect patient adherence to first-line AI. Methods: We retrospectively reviewed records of 195 female patients with HR+, HER2 negative early-stage breast cancer who were started on first-line adjuvant AI between 2011-2020 at our academic institution. We collected information on recurrence risk (defined by Oncotype score, with low risk ≤ 15, moderate risk 16-25, high risk ≥ 26), AI-related side effects, supportive therapy use for side effects, and socioeconomic demographics (i.e. income, insurance type, and race). We linked median family income with zip codes based on national census data and sorted them based on the Pew Research Center categorization. The primary end point was the rate of first-line AI adherence at 4 years. The Kruskal-Wallis rank sum test, Fisher’s exact test, and Pearson’s chi-squared test were used to compare AI adherence when varying patient profiles. Results: In our cohort, 50% (n=98) were adherent to first-line AI at 4 years, 9% (n=17) were still taking first-line AI but have not yet reached 4 years, and 41% (n=80) discontinued first-line AI early. Of those who discontinued first-line AI early, 68% (n=54) switched to an alternate endocrine treatment due to side effects, 4% (n=3) stopped all endocrine treatment, and 28% (n=23) were lost to follow up. AI-related side effects were common; 83% (n=162) reported AI-related side effects, yet only 27% of those patients received supportive therapy. Supportive therapy use was not significantly different when varying patients’ recurrence risk and socioeconomic demographics. In addition, adherence did not differ based on side effect frequency or supportive therapy use. The population’s Oncotypes included 36% (n=70) low risk, 36% (n=70) moderate risk and 12% (n=24) high risk; the remaining had no Oncotype sent. There was no significant difference in adherence among the risk groups. In evaluating demographics, the cohort’s median age was 62 and it included 9% Asian, 13% Black, 5% Hispanic, 54% White, and 19% Other/Unknown. The majority (62%) of patients were of middle income ($52,000-145,000), followed by 29% in upper and 9% in lower income. The minority (22%) of patients were on Medicaid. Those with a lower discontinuation rate were older (64 vs. 61, p=0.019), while there was no significant difference based on race, income, or insurance. Conclusions: Despite the small sample, it is reassuring that at our institution, long term adherence to first-line AI and supportive therapy use did not vary among socioeconomic demographics. However, a gap persists between the prevalence of AI-related side effects and usage of proven supportive treatments. Further study on strategies to enhance AI tolerance and adherence is needed.

Nurses in Iraq Show Alarmingly Low Infection Control Adherence

This study assesses nurses' adherence to standard precautions and infection management at the Republican Hospital in Basrah through a descriptive cross-sectional survey of 50 nurses, using a WHO-guideline-based questionnaire. The results indicate poor practice among 86% of nurses, with significant differences in adherence across age groups and workplace settings. The findings highlight the necessity for regular, targeted education to improve infection control practices, thus enhancing patient safety and care quality. Highlights: High Non-Adherence: 86% of nurses show poor infection control practices. Demographic Differences: Age, workplace impact standard precaution adherence. Need for Education: Targeted training essential to enhance safety. Keywords: Nurses’ Commitment, Health Guidelines, Infection Control, Standard Precautions, Healthcare Safety

A Study of the Emotional and Cognitive Effects of Long-Term Exposure to Nature Virtual Reality (VR) Videos on Mobile Terminals

Research Highlights: This study examined the emotional and cognitive health benefits of nature in comparison with working memory training. It considered the long-term effects, the application of mobile terminal technology, and routine-based approaches with the aim of integrating nature’s health benefits into people’s daily lives. Background and Objectives: Infectious diseases and aging may limit people’s activities indoors; the recovery effect of nature has been widely recognized, and terminal technology is developing rapidly. In this context, we want to explore the emotional and cognitive effects of viewing nature (VR) videos on mobile devices for a long time. Materials and Methods: The experiment employed a between-subjects design, with participants being randomly assigned to one of four groups: a forest VR video group, a water VR group, a working memory training group, and a control group. The participants watched the video three times a week for 20 min each for four weeks. The number of valid participants for compliance, preference, and willingness was 136, and the number of valid participants for the study of emotional and cognitive effects was 62. Brief Profile of Mood States (BPOMS) scales, running memory accuracy, shifting cost, etc., were used as indicators to reflect emotions and cognition. A repeated measures analysis of variance was performed on these indicators at four groups × two time points (pretest/post-test). Results: ① There were no significant differences in the participants’ adherence, preferences, and willingness to watch different natural videos and perform working memory training. ② Long-term home training (e.g., watching VR nature videos or working memory training) may have had a minimal effect on emotional responses to mobile terminals. However, home training may be more conducive to the stabilization of anger. ③ Watching forest VR videos had a positive effect on the updating function of the brain; watching water VR videos was beneficial for the shifting function and automatic processing speed; and working memory training had a positive effect on the updating and shifting functions. Conclusions: There were no significant differences in adherence, preference, willingness, and effects on emotion and cognition between long-term forest VR video viewing, water VR video viewing, and working memory training on mobile terminals. All three types of home training may be beneficial for the stabilization of emotion (especially anger), and all can have some positive effects on cognition.

Abstract PO4-09-06: Area Deprivation Index (ADI) among Patients with Breast Cancer in Buffalo

Abstract Introduction: Socioeconomic and racial disparities can limit access to health care. Prior studies suggest that living in a disadvantaged neighborhood results in poorer outcomes in several malignancies. ADI is an index that categorizes areas based on socioeconomic variables. In this observational study, we aimed to investigate the ADI among patients (pts) with breast cancer (BC) seen at Roswell Park Comprehensive Cancer Center in Buffalo, New York, and study its association with clinical outcomes to identify the areas with the highest unmet need for possible intervention strategies. Methods: We reviewed data of 187 pts diagnosed with stages 1-3 and de-novo stage 4 BC between 2014 to 2018. We obtained information on ADI using pts’ home addresses via Neighborhood Atlas tool www.neighborhoodatlas.medicine.wisc.edu. ADI values were categorized into four quartiles Q1(80-100%), Q2(60-79%), Q3(40- 59%), and Q4(0-39%) from highest deprivation/poor social economic status areas to least disadvantaged areas, respectively. Demographic and clinicopathological characteristics including age, race, comorbidities, stage, type of insurance, duration on treatment were compared by ADI. Kruskal-Wallis and Chi-square was used for comparing continuous and categorical variables, respectively. Recurrence free survival (RFS), time to next treatment (TNT), and overall survival (OS) were estimated using Kaplan Meier method. Multivariate Cox regression model was used to analyze outcomes for pts with stage 4 in the most disadvantaged areas (ADI ≥60%) adjusting for relevant covariates. Analyses were performed using SAS v9.4 at a significance level of &amp;lt; 0.05. Results: 98% pts (183/187) were females, 85% (160/187) Whites, 9% (17/187) African Americans, and 3% (6/187) Asians. 62% (116/187) lived in the most disadvantaged areas: 37% (70/187) in Q1, and 24% (46/187) in Q2, while 27% (51/187) lived in Q3, and 11% (n=20/187) in Q4. 80% (150/187) pts were diagnosed with hormone receptor positive BC, 18% (34/187) HER2 positive, and 15% (28/187) triple negative BC. 45% of pts (83/187) had de novo stage 4, the rest were diagnosed with stages 1-3. There was no difference in the distribution of age, race, employment, insurance, comorbidities, substance use, smoking, access to contraception, screening mammogram, or adherence to anti-estrogen and radiation therapy by ADI. There was a significant difference in adherence to chemotherapy/anti HER2 therapy: 92% (36/39) in Q1,100% (24/24) in Q2 vs. 85% (24/28) in Q3 and 67% (6/9) in Q4, p=0.029. Among pts with stages 1-3, there was no difference in RFS (p= 0.700) or OS (p= 0.400) by ADI. Among stage 4 patients, there was an association between TNT and ADI, where patients living where there was a trend towards worse survival with increasingly disadvantaged neighborhoods, p=0.008 (Table 1). Moreover, there was a significant difference in OS by ADI, p=0.03 (Table 2). There was a significant association between ADI and both TNT and OS, even after adjusting to age, race, BC subtypes p= 0.004 and p= 0.034 respectively (Table 3). Conclusion: Our study in the Western New York region showed that BC pts living in disadvantaged areas had worse survival and shorter TNT despite being more adherent to chemotherapy/anti HER2 therapy. Our study validates prior studies showing that ADI is an important factor impacting BC outcomes. These data will help guide our future efforts to maximize resource allocation towards these disadvantaged areas to improve BC outcomes. Table 1 Table 2 Table 3 Citation Format: Malak Alharbi, Arya Mariam Roy, Archit Patel, Kayla Catalfamo, Kristopher Attwood, Angela Omilian, Elizabeth Bouchard, Ellis Levine, Tracey O'Connor, Amy Early, Shipra Gandhi. Area Deprivation Index (ADI) among Patients with Breast Cancer in Buffalo [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-06.

Matters of Fidelity: School Provider Adherence and Competence in a Clustered Study of Adaptive Implementation Strategies

ABSTRACT Schools are a promising access point for youth with mental health concerns, but school-based mental health professionals (SPs) often need ongoing support to provide high-fidelity cognitive behavioral therapy (CBT). Adherence and competence, two critical elements of fidelity, were examined in a cluster-randomized implementation trial. We evaluated CBT adherence and then triangulated CBT adherence with end-of-study competence. We then evaluated the effects of two implementation supports, Coaching and (for slower-responding schools) Facilitation, on adherence and competence. By the end of the 43-week study period, 27.8% of SPs met adherence criteria. Adherent SPs scored higher on the competence measure, the CBT Competence Scale (t(116.2) = 3.71, p < .001). No significant difference in adherence was found among SPs at schools assigned to Coaching vs. not (Δ = 6.0%, p = .385), however SPs at schools randomized to Coaching scored significantly higher on two of the four competence subscales (Non-Behavioral and Behavioral skills). Among slower-responder schools, SPs at schools assigned to Facilitation were more likely to demonstrate adherence (Δ = 16.3%, p = .022), but there was no effect of Facilitation on competence. Approximately one quarter of SPs met adherence criteria in the trial; adequate delivery of exposure was a primary obstacle to reaching adherence. Facilitation may be especially suited to help SPs overcome barriers to delivery, whereas Coaching may be especially suited to help SPs improve CBT competence. Both are likely needed to build a mental health work force with the competence and ability to deliver EBPs in schools.

Comparison of the adherence of nontypeable haemophilus influenzae to lung epithelial cells

ObjectiveNontypeable Haemophilus influenzae (NTHi) plays an important role in respiratory tract infections, and adherence to lung epithelial cells is the first step in lung infections. To explore the role of NTHi in childhood lung infections, a comparative study was conducted on the adherence of strains isolated from sputum culture and bronchoalveolar lavage fluid to A549 lung epithelial cells.MethodsHaemophilus influenzae strains were obtained from the sample bank of Shenzhen Children’s Hospital, and identified as NTHi via PCR detection of the capsule gene bexA. NTHi obtained from healthy children’s nasopharyngeal swabs culture were selected as the control group, and a comparative study was conducted on the adherence of strains isolated from sputum culture or bronchoalveolar lavage fluid of patients to A549 cells.ResultsThe adherence bacterial counts of NTHi isolated from the nasopharyngeal cultures of healthy children to A549 cells was 58.2 CFU. In patients with lung diseases, NTHi isolated from bronchoalveolar lavage fluid was 104.3 CFU, and from sputum cultures was 115.1 CFU, both of which were significantly higher in their adherence to A549 cells compared to the strains isolated from the healthy control group. There was no significant difference in adherence between the strains isolated from sputum cultures and bronchoalveolar lavage fluid (t = 0.5217, p = 0.6033).ConclusionNTHi played an important role in childhood pulmonary infections by enhancing its adherence to lung epithelial cells.

P896 You Can Lead a Horse to Water But You Can’t Make it Drink: A Study on Medication Adherence of Inflammatory Bowel Disease Patients in Ireland

Abstract Background Medication adherence is important in ensuring adequate treatment of Inflammatory Bowel Disease (IBD). The High Tech Hub (HTH) is an online system used in Ireland to prescribe and monitor the ordering of High-Tech Medication, specifically oral small molecules and subcutaneously-delivered biologics. We aimed to observe compliance rates of treatment in our centre, observe trends between different medication and identify factors associated with adherence. Methods We extracted prescribing and medication dispensing information from the HTH database for our centre between May and November 2023. We collected information on patient demographics such as age and gender, patient disease subtype, medication class and duration of prescription given against the duration of prescription collected by the patient with an 85% threshold as a marker of compliance to treatment. Statistical analysis was used to compare differences in adherence between subsets of the population and a multivariate regression model was used to identify factors associated with adherence. Results We extracted information from 824 prescriptions from 644 unique patients. The median age was 42 years (IQR 32-52) with 52.2% males. 60.7% (n=391) had Crohn’s Disease, 33.4% (n=215) had Ulcerative Colitis and 3.1% (n=20) had IBD-U. Majority of patients, 77.3% (n=498), were on Anti-TNF medication, followed by 13.2% (n=75) on anti-Interleukins, 6.2% (n=40) on JAK Inhibitors and 3.3% (n=21) Anti-Integrins. 6.5% (n=42) of patients required dose optimization during the 6-month observation and 1.7% (n=11) required a change of medication. 9.5% (n=61) of patients collected prescriptions for steroids. Further analysis demonstrated no significant difference in adherence within gender (Male: 61.0% vs. Female 53.6%, p=0.056), age (&amp;lt;25 years: 66.2%, 25-39 years: 55.0%, 40-54 years: 58.6%, ≥55 years: 54.6%, p=0.346), disease type (Crohn’s: 58.6%, Ulcerative Colitis: 56.7%, IBD-U: 50%, p=0.776), medication class (Anti-TNF: 56.4%, Anti-Interleukin: 65.9%, Anti-Integrin: 57.1%, JAK Inhibitor: 52.5%, p=0.378). However, we found significant lower adherence rates in patients who required dose optimization (21.4% vs. 60.0%, p&amp;lt;0.001) and those who required a change in medication (18.2% vs. 58.1%, p=0.008) in the observation window. There was also a lower rate of adherence noted in those who received prescriptions for steroids (45.9% vs 58.9%, p=0.051). Conclusion There was a high rate of non-adherence noted in our IBD population, worse in those who ended up requiring dose optimization or change in therapy. Addressing compliance by monitoring the online dispensing of medication may be a useful way to ensure adequate treatment and avoid unnecessary treatment escalation.

Assessment of Adherence and Self-Efficacy in a Sample of Iraqi Patients Receiving Warfarin or Direct Oral Anticoagulants

Background: While warfarin and direct oral anticoagulants (DOACs) are used to manage thromboembolic events, they possess several features that impact adherence. Objective: To assess medication adherence and self-efficacy in patients receiving warfarin or DOAC treatment. Methods: A cross-sectional study was performed at Ibn Al-Bitar Hospital in Baghdad from December 2022 to May 2023 on patients receiving either warfarin or DOACs. The Arabic version of the Adherence to Refills and Medications Scale (ARMS) questionnaire and the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C) questionnaire were used to assess adherence and self-efficacy. Results: 181 patients were enrolled in the study, of whom 56.9% received warfarin and 43.1% received DOACs. The mean ARMS score was 13.71, and 81.77% of the patients were adherent to anticoagulant therapy. There was a significant difference in adherence between the warfarin and DOAC groups. The mean SES6C score for the participants was 50.01. Patients in the DOAC group had significantly higher self-efficacy compared to those in the warfarin group. The adherence score correlated significantly with patients’ gender, education level, hospitalization and duration of anticoagulant use, while the SES6C score did not correlate with any of the independent variables. There was a significant negative correlation between self-efficacy scores and medication adherence scores. Conclusions: Patients receiving DOACs showed a higher self-efficacy to manage chronic diseases and lower medication adherence as compared to warfarin. Higher self-efficacy was associated with higher adherence to treatment.

Improving Glaucoma Patients' Quality of Life and Adherence With a Digital Health Application: [RETRACTED

Empowering glaucoma patients to access their individual glaucoma related health data by using a digital health application leads to a significant improvement in quality of life and adherence. Evaluate the effectiveness of improvement of glaucoma associated quality of life and adherence in patients using a digital health application. A prospective randomized monocentric controlled study of 77 patients with primary open angle glaucoma. Patients were recruited at the University Hospital Erlangen. Patients in the intervention group tracked their intraocular pressure, symptoms and therapy using a digital application. Based on the collected data the SmartTonoTracker® gave patients simple statistics and basic recommendations for further treatment. An increasing score on the GlauQol-36 item questionnaire and the MMAS-8 score, conducted at baseline and follow-up by the intervention group, was considered successful. Statistical analysis was conducted using the unpaired t-test, paired t-test, Man-Whitney-U test, frequency analysis, frequency distribution and Pearson-correlation. Significant difference in the patients´ glaucoma-associated quality of life between the intervention group (rate of improvement: 7.6%, P =0.047), and the control group (rate of improvement: 0.17%, P =0.047) was shown. Also, a significant difference in adherence between the intervention group, showing a 9.8% rate of improvement ( P =0.002), and the control group, showing a 3.8% rate of improvement ( P =0.002), was shown. Enabling patients to access individual health related glaucoma data by using a digital health application and supporting them with information on their disease led to an improvement in glaucoma-associated quality of life and adherence.

Adherence determination using urine-tenofovir point-of-care testing and pharmacy refill records: A cross-sectional study.

Pharmacy refill records (PRR), are an accessible strategy for estimating adherence in low- and middle-income countries (LMICs). However, the low-cost urine-tenofovir point-of-care test opens up the possibility of an objective metric of adherence that is scalable to LMICs. This study compared adherence to tenofovir-based regimens using urine-tenofovir point-of-care (POC) test with pharmacy refill records in a Nigerian population of HIV-positive persons. This was a cross-sectional study among 94 HIV-positive adults, which was conducted from June to August 2021, in a large outpatient clinic in Lagos, Nigeria. Adherence to pharmacy appointments was automatically calculated using a computerized pharmacy appointment system (FileMaker Pro™). Urine drops on the urine-tenofovir POC test strip developed 2 lines for a negative test (tenofovir absent) and one line for a positive test. Fisher's exact test was used to examine the association between pharmacy refill record and urine-tenofovir point-of-care test. Logistic regression was performed to predict viral suppression (<1000 copies/mL, based on WHO recommendations) using both methods of adherence determination. A Receiver Operating Characteristic (ROC) curve of the association between specificity and sensitivity was generated to evaluate the predictive value of adherence determined using pharmacy-refill record and urine-tenofovir point-of-care test in forecasting viral suppression. The statistical significance level was set at 0.05. Fisher's exact test showed no statistically significant difference in adherence using urine-tenofovir point-of-care test or pharmacy refill record. The logistic regression model showed that an increase in pharmacy-refill record of ≥ 95% was associated with viral suppression (P = .019). From the ROC curve, the sensitivity was same at 95.5% for both methods, but the specificity of the urine-tenofovir point-of-care test was greater (96.6% vs 95.5%) than pharmacy refill record (P = .837). Urine-tenofovir point-of-care test provided equivalent adherence data to pharmacy refill data.

SWAT 84: effects of same-day consent vs delayed consent on the recruitment and retention of trial participants—an observational SWAT

Background and aimThe recruitment process in a randomized trial can be challenging. Poor recruitment can have a negative impact on the allocated budget and estimated completion date of the study and may result in an underpowered study. We aimed to perform a Study Within A Trial (SWAT) to evaluate the impact of same-day consent or delayed consent on recruitment and retention in the host trial.MethodsThis SWAT is designed as a prospective cohort design. The host trial was a randomized controlled trial evaluating the effectiveness of an intensive lifestyle modification programme in participants with peripheral arterial disease. Researchers screened the participants for inclusion and exclusion criteria. Informed consents were obtained from the participants who were willing to participate in the study on a standardized consent form. Participants were given the option to consent on the same day or to delay their consent. Following the consent, the participants were allocated to two groups (same-day consent vs. delayed consent) based on pre-determined criteria for SWAT. One hundred sixteen participants were consented to take part in the host trial. Seventy-five participants were randomized to the host trial. The primary outcome was the proportion of participants who withdrew consent at the recruitment phase. Secondary outcomes were reasons for consent withdrawal and dropout, attrition rate, and adherence with the host trial intervention.ResultsThere was a significantly lower consent-withdrawal rate in same-day consent (17.4%, n = 8/46), compared to the delayed consent group (47.1%, n = 33/70), p = 0.001. There was a significantly lower dropout rate in participants randomized following same-day consent (10.5%, n = 4/38), compared to those randomized after delayed consent (29.7%, n = 11/37), p = 0.038. Transport was the main reason mentioned for consent withdrawal and dropout. In participants randomized to the host trial intervention arm, there was a significant difference in adherence (percentage of the 12-week programme completed) between same-day consent (96.7% ± 4.9) and delayed consent participants (86.4% ± 11.2), p = 0.003, as well as number of weeks completed (mean difference = − 1.547, 95% confidence intervals (− 2.237 to − 0.85)), p = 0.02.ConclusionThis SWAT found evidence that participants who gave consent on the same day seemed to have better adherence and fewer-withdrawal and dropout rates.SWAT registrationThe SWAT was registered on the Northern Ireland Network for Trials Methodology Research, SWAT 84.

P002 Positive airway pressure adherence in children with sleep apnea may be similar to adults

Abstract Introduction Most pediatric patients with obstructive sleep apnea (OSA) are known to be treated with adenotonsillectomy (AT). However, in some of them, positive airway pressure (PAP) can be used for underlying diseases or in case of AT failure. Thus, PAP adherence and compliance were compared in pediatric OSA to adult OSA. Methods A retrospective study was conducted on 17 children and 167 adults who had performed polysomnography (PSG) and were prescribed PAP and followed up for more than 3 months from July 2018 to January 2023. Adherence was defined as the percentage of patients continuing to use PAP after prescription and compliance was defined as an average of more than 4 hours per night usage of 70% of the monitoring days. Results There were 11 males (64.7%) in pediatric and 141 males (84.4%) in adult patients. The mean age was 8.0 years (6.50-12.50) in pediatric and 50.0 years (41.00-58.00) in adult patients. The mean apnea hypopnea index (AHI) (37.0 vs 50.7) and Lowest O2 saturation (79.4% vs 75.5%) did not show any differences in the 2 groups. Longest apnea showed considerable differences (25.9 sec vs 50.8 sec) (p=0.000). After 18 months of PAP usage, AHI dropped from 37.0 to 5.1 vs 50.7 to 2.6, adherence decreased from 94.1% to 41.2% vs 90.4% to 38.9% (p=0.944), compliance reduced from 64.7% to 28.9% vs 67.0% vs 29.3% (p=0.268) in pediatric and adults groups. Conclusions There were no significant differences in adherence and compliance with PAP in children compared to adults.

Surgical Excision Margins in Primary Care and Plastic Surgery for Keratinocytic Cancers Diagnosed via Teledermatology: Retrospective Observational Cross-Sectional Study

Background The incidence of keratinocytic cancers is increasing. In New Zealand, surgical treatment of skin cancers is often undertaken in primary care. In the Waikato district, general practitioners (GPs) are encouraged to confirm diagnoses via teledermatology. Histological examination should confirm clear surgical margins to reduce tumor recurrence. International guidelines recommend a lateral margin of ≥3 mm for basal cell carcinomas (BCCs) and ≥4 mm for squamous cell carcinomas (SCCs). Objective This study aimed to determine lateral and deep margins in keratinocytic cancer excisions performed by GPs (in a private setting) and plastic surgeons (in a private or public setting) after a teledermatologist had confirmed that excision was necessary. Demographic, clinical, and histological features were recorded. Methods A retrospective observational cross-sectional study was conducted. The sample in the electronic dermatology referral database included keratinocyte cancers recommended for excision from March to May 2022. Results Histological reports revealed that excision was complete in 186 of 201 confirmed cases of keratinocyte cancer. The lateral margins of resection were considered in 10 tumors and deep margins in 8 tumors. All incomplete excisions were carried out by GPs, 11 of which were on the head and neck. There were 133 BCCs, 100 of which were excised by a GP, 3 by a private plastic surgeon, and 30 by a public hospital surgeon. In total, 52 BCCs were present on the head and neck (25 excised by GPs, 25 by hospital plastic surgeons, and 2 by private plastic surgeons) and 81 were present on other sites (75 excised by GPs, 5 by hospital plastic surgeons, and 1 by a private plastic surgeon). Lateral margins were considered in 9 cases (of which 5 cases involved head and neck tumors). The minimum distance from the tumor to the lateral margin was &lt;3 mm in 80 tumors: 64 were excised by a GP, 2 by private plastic surgeons, and 14 by hospital plastic surgeons. This distance was ≥3 mm in 44 tumors (27 excised by GPs, 1 by a private plastic surgeon, and 16 by hospital plastic surgeons). These data show significant adherence to surgical margin recommendations among plastic surgeons compared to that among GPs (odds ratio 2.873, CI 1.274-6.477; P=.009). There were 68 SCCs: 57 were excised by a GP, 2 by a private plastic surgeon, and 9 by a public hospital surgeon. In total, 21 SCCs were on the head and neck (14 excised by GPs, 6 by hospital plastic surgeons, and 1 by a private plastic surgeon) and 47 were on other sites (43 excised by GPs, 3 by hospital plastic surgeons, and 1 by a private plastic surgeon). Lateral margins were considered in 1 head and neck SCC case and were not reported in others. The minimum distance from the tumor to the lateral margin was &lt;4 mm in 35 cases: 31 were excised by a GP, 1 by a private plastic surgeon, and 3 by a hospital plastic surgeon. This distance was ≥4 mm in 31 cases (24 excised by GPs, 1 by a private plastic surgeon, and 6 by hospital plastic surgeons). These data do not show significant difference in adherence to surgical margin recommendations between GPs and plastic surgeons (P&gt;.05). Conclusions Complete resection reduces the risk of recurrence of keratinocytic tumors. GPs in our study were less likely than specialist surgeons to respect surgical margin recommendations established in international guidelines for managing keratinocytic cancer. Conflicts of Interest None declared.

Factors affecting polysomnography compliance and delays to surgical treatment of obstructive sleep apnea.

To evaluate adherence to polysomnography in pediatric patients and determine if demographics, socioeconomic status, polysomnography indication, or prior otolaryngology intervention are associated with polysomnography adherence and time to definitive surgery. Retrospective review study. Tertiary-care children's hospital. Electronic medical record was queried to identify patients ordered for a sleep study between January and May 2019. Demographic information, time to sleep study, and time to surgery were collected and calculated. 304 patients were recommended to obtain polysomnography, with adherence rate of 65.4%. There was no significant difference in adherence or loss to follow-up rates based on patient sex, age, language, socioeconomic status, state of residence, single-parent status, or polysomnography indication. There was no difference between time to surgery for patients who did or did not obtain polysomnography (181 vs. 161 days, P=.51). Patients with prior otolaryngology intervention were more likely to obtain polysomnography and less likely to be lost to follow-up (P<.05). Median household income demonstrated a significant inverse relationship with time to polysomnography (P<.05) as well as time to surgery (P<.05). Medically complex patients tended to experience longer time to surgery compared with non-complex patients. Families with lower socioeconomic status or medically complex children may require assistance to obtain polysomnography and pursue surgery for sleep-disordered breathing. Patients without prior otolaryngology intervention may be less likely to follow up and may need assistance with navigating the polysomnography process.

Associations Between Provider Specialty and Use of Follow-up Testing Among Patients on Preventive Pharmacological Therapy for Urinary Stone Disease.

The AUA Medical Management of Kidney Stones guideline outlines recommendations on follow-up testing for patients prescribed preventive pharmacological therapy. We evaluated adherence to these recommendations by provider specialty. Using claims data from working-age adults with urinary stone disease (2008-2019), we identified patients prescribed a preventive pharmacological therapy agent (a thiazide diuretic, alkali citrate therapy, allopurinol, or a combination thereof) and the specialty of the prescribing physician (urology, nephrology, and general practice). Next, we identified patients who completed a 24-hour urine collection prior to their prescription fill. We then measured adherence to 3 recommendations outlined in the AUA guideline. Finally, we fit multivariable logistic regression models evaluating associations between prescribing provider specialty and adherence to recommended follow-up testing. Among 2,600 patients meeting study criteria, 1,523 (59%) adhered to ≥1 follow-up testing recommendation, with a significant increase over the study period. Nephrologists had higher odds of adherence to ≥1 follow-up test compared to urologists (odds ratio, 1.52; 95% confidence interval, 1.19-1.94; P < .01). Significant differences in adherence to the 3 individual guideline recommendations were also observed by specialty. Following initiation of preventive pharmacological therapy, adherence to guideline-recommended follow-up testing was low overall. There exist meaningful specialty-specific differences in the use of this testing.