Treatment Adherence In Patients Research Articles

The impact of teach-back training method (TBTM) on treatment adherence in hemodialysis patients: a randomized controlled trial.

Ensuring adherence to treatment is vital for individuals undergoing haemodialysis. The demanding treatment frequency and duration often present challenges for patients in maintaining a consistent routine. Non-adherence can result in adverse health effects and an increased risk of hospitalization. This study aimed to evaluate the impact of teach-back training on treatment adherence among haemodialysis patients. A randomized controlled trial involved 60 end-stage kidney disease patients undergoing haemodialysis. Participants were randomly assigned to either the control or intervention group. Data were collected using the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), assessing adherence in four dimensions: HD incidence, medication use, fluid restriction, and diet recommendations. The intervention group received feedback-based training on diet and fluid restriction during four 45-60-min sessions, while the control group received regular indoor training. Following the intervention, significant differences in mean scores for HD frequency, medication use, and fluid restriction were observed between the two groups (P<0.001). However, there was no significant difference in the mean score for food recommendations (P=0.108). The teach-back training method (TBTM) is an effective communication strategy that enhances treatment adherence in haemodialysis patients. This intervention has the potential to improve patient outcomes and overall quality of life by simplifying medical information and encouraging patient engagement.

Factors Affecting Treatment Adherence Among Patients with Tuberculosis in Indonesia: Literature Review

Introduction: Tuberculosis (TB) is the leading cause of death from infectious diseases in the world and Indonesia is the second largest contributor to TB cases after India. Treatment adherence problems are a major obstacle to TB elimination. The purpose of this Literature Review is to determine the factors that affect treatment adherence among TB patients in Indonesia.&#x0D; Methods: Literature obtained from Science Direct, PubMed, and Google Scholar; published from 2018 – 2023, research from reputable international journals and from national journals at least with SINTA 3, located in Indonesia. Indonesian and English with full text of all types of research designs. Article selection was carried out using the method "Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and analyzed using descriptive analysis techniques.&#x0D; Results: A total of 225 articels were deemed appropriate for the topic, but only 15 articles were included based on inclusion criteria. It was found that there are several factors that affect treatment adherence in tuberculosis patients in Indonesia, namely: predisposing factors as many as 11 articles (age, education, occupation, knowledge, self-efficacy, concordance, health behavior, motivation, marital status, income level, drug side effects, already feeling cured, and duration of treatment). Reinforcing factors as many as 2 articles (family support). Enabling factors as many as 5 articles (the role of officers, reminder SMS messages from officers, health counseling, and distance of residence to health services).&#x0D; Conclusion: The most dominant factor affecting treatment adherence among tuberculosis patients in Indonesia is the Predesposising factors, namely education and sefl-efficacy.

Sustained Disease Control in DME Patients upon Treatment Cessation with Brolucizumab.

Background: Treatment cessation due to a dry retina has not been systematically addressed in diabetic macular edema (DME). In three out of four patients receiving 6 mg of brolucizumab in the KITE study, treatment was terminated after the study ended. Methods: The KITE study was a double-masked, multicenter, active-controlled, randomized trial (NCT03481660) in DME patients. Per protocol, patients received five loading injections of Brolucizumab at 6-week intervals, with the option to adjust to 8 weeks in case of disease activity or to extend in the second year to a maximum of 16 weeks in the absence of retinal fluid. Results: After two years, one patient required eight weekly injections, while three patients reached a maximal treatment interval of 16 weeks. The severity of diabetic retinopathy improved in all patients with no dye leakage according to fluorescein angiography (FA) and no retinal fluid according to OCT in three patients. Treatment was paused in these three patients for >36 months, while the fourth patient required continuous treatment at 5-week intervals after switching to other licensed anti-VEGF agents. Conclusions: The adoption of treatment according to individual needs, including considering treatment cessation, may contribute to improved treatment adherence in many patients and be more frequently possible than expected.

Mental Health May Affect the Health Outcomes of Cancer Patients

Cancer is a complex disease that can have a significant impact on a patient's mental health. This paper examines the interplay between mental health and cancer outcomes, focusing on the impact of social networks, the patient-doctor relationship, and mental health professionals. Specifically, the positive effects of social support, including emotional, informational, and tangible support, on patients' coping strategies, treatment adherence, and overall well-being will be highlighted. This paper will also highlight negative social interactions and stigma, which can have adverse effects on patients’ mental health and physical outcomes. The patient-doctor relationship plays a vital role in patients' treatment experiences, with effective communication, shared decision-making, and empathy enhancing treatment adherence, psychological well-being, and overall outcomes. On the other hand, a strained relationship can lead to increased patient distress and dissatisfaction with care. The inclusion of mental health professionals in cancer care has shown promising results, with psychosocial interventions reducing depression, anxiety, and distress. Mental health professionals also assist patients in addressing treatment-related concerns and managing mental health disorders. Future directions in cancer treatment include adopting a biopsychosocial approach in cancer therapy, developing effective screening tools for mental health disorders, integrating mental health care into routine cancer treatment, and exploring the long-term effects of mental health on survivorship care. By understanding the complex relationship between mental health and cancer outcomes, healthcare providers can develop targeted interventions and support strategies to improve the overall well-being and outcomes of cancer patients.

Deciphering the Digital Healthscape: Unveiling the Intricacies of the Internet of Medical Things (IoMT)

Through the integration of networking, data analytics, and medical devices, the Internet of Medical Things (IoMT) has revolutionized patient care and healthcare administration. Presented here is extensive study on IoMT that sheds light on its impact on healthcare settings, including its origins, technical foundations, uses, security worries, interoperability problems, and potential future developments. The evolution of IoMT began with the integration of internet connection with medical devices and continues with the complex and linked environment of today. This shift in thinking makes possible preventative healthcare, individualized treatment plans, and remote patient monitoring. Technologies for data storage, networking, and sensors are the backbone of IoMT. Streamlined connection, real-time data transmission, and a robust IoMT architecture for healthcare applications are all described in the article. Remote patient monitoring and the management of chronic illnesses are two areas where IoMT finds application in healthcare. Literature show how IoMT describes a data-driven, proactive, and personalized healthcare delivery strategy that improves patient outcomes, treatment adherence, and resource utilization. The research addresses important topics related to IoMT, such as healthcare privacy and security. Securing IoMT and bolstering trust in connected healthcare are the goals of research into encryption, access controls, and data protection regulations. To implement IoMT, interoperability concerns must be addressed. The essay delves into the difficulties of integrating IoMT devices and systems, as well as the necessity of standardized frameworks to facilitate data sharing and interoperability. Future advances in the IoMT, such as the integration of AI and blockchain for security, are predicted in the research. The paper highlights the potential of IoMT to impact healthcare delivery and address global healthcare concerns. This study demonstrates the transformation of IoMT to academics, healthcare professionals, and policymakers. Keyword :Internet of Medical Things (IoMT), Digital Healthscape, Remote Patient Monitoring, Data Analytics, Security, Interoperability, Future Trends

Exploring the Impact of Artificial Intelligence on Patient Care: A Comprehensive Review of Healthcare Advancements

Artificial Intelligence (AI) is revolutionizing healthcare by transforming disease identification, treatment, and management. Healthcare organizations are rapidly adopting AI technologies to improve patient outcomes, streamline operations, and optimize costs. Utilizing a broad toolkit comprising Robotics, Computer Vision, Natural Language Processing, and Machine Learning, AI has made significant advancements across various healthcare domains. AI-driven diagnostic systems are showcased for their precision in analyzing medical images, enabling early detection of diseases such as cancer. Personalized treatment plans and preventive treatments are made possible by predictive analytics, which uses large amounts of patient data to predict the course of a disease and identify those who are at risk. This leads to an improvement in patient care. Beyond clinical applications, AI is reshaping healthcare delivery through solutions like telemedicine, virtual consultations, and remote monitoring. Virtual Health Assistants, empowered by AI, deliver personalized health information, medication reminders, and lifestyle guidance, enhancing patient engagement and treatment adherence. Telemedicine systems employ Artificial Intelligence (AI) algorithms to enhance resource allocation, expedite appointment scheduling, and supply superior medical services to remote and isolated populations. Hence, AI’s potential to improve productivity, encourage creativity, and solve difficult problems through sophisticated data analysis and automation is what has made it so important in revolutionizing many sectors.

The impact of hope levels on treatment adherence in psychiatric patients

PurposeIn this study, aimed to determine the status of hope and treatment adherence in psychiatric patients and the relationship between the two. Material and methodThe sample of the study consisted of participants (n = 103) in a university hospital psychiatric clinic. Research data were collected using personal information form, Morisky treatment adherence scale and Herth Hope Index (HHI). Statistical analysis of the data was carried out with SPSS 22.0 program using descriptive tests, student t-test, one-way variance analysis, chi-square test and Spearman correlation analysis. ResultsThe average score of the patients' hope scale is 34.23 ± 9.59 and is above the intermediate level. 43.7 % of patients have low adherence with treatment. It was found that as patients' hope scores increased (r = −0.417) non-adherence with treatment decreased; as annual hospitalization increased non-adherence increased (r = 0.274); as the duration of disease increased score of hope (r = −0.271), non-adherence with therapy (r = 0.353) and annual hospitalization increased (r = 0.211) (p < .05). Among the patients who took part in the study, 36.9 % were diagnosed with bipolar disorder, 33.0 % with schizophrenia and other psychotic disorders, 20.4 % with depression. Patients with bipolar disorder had higher treatment non-adherence scores. It was determined that 29.1 % of the patients stopped taking medication thinking they had recovered and 28.2 % did not adhere to the treatment due to drug side effects. ConclusionThe findings underscore the crucial role of hope in influencing treatment adherence among psychiatric patients. Clinicians should consider strategies to bolster hope as a potential avenue for improving adherence rates.

Geographical distance predicts psychiatric treatment retention for Hispanic women with comorbid major depression and breast cancer.

Depression is among the most common comorbid psychiatric disorders of patients with breast cancer. Depression decreases patient quality of life and, if untreated, can adversely affect cancer treatment. We sought to identify treatment barriers for women with breast cancer receiving psychotherapy for depression. Findings may help policy makers and researchers determine funding and design of future studies involving this population, especially in communities with high rates of health disparities. We used data from a randomized trial for women with breast cancer and current DSM-IV non-psychotic unipolar major depressive disorder (MDD). Patients were randomly assigned to 12weeks of one of three psychotherapies and attrition was assessed by whether subjects completed 12 weekly treatment sessions. We used descriptive analyses and logistic regression to identify treatment barriers. R shiny was used to determine study patient residences. Of 134 randomized patients, 84 (62.7%) were Hispanic. Fifty-nine patients (44%) either did not start or dropped out of treatment, 49 (83.1%) of them being Hispanic. Being a Hispanic woman, less educated, and geographically distant from treatment significantly predicted attrition. Single Hispanic mothers had significantly higher attrition risk than married and/or childless women. Identifying barriers to treatment is important to improve treatment adherence for patients with concurrent diagnoses of breast cancer and MDD, especially for traditionally underserved minorities. Additional support such as affordable tele-medicine, multi-language assistance, financial aid for transportation and child-care, and allocation of more funds to address some identified barriers deserve consideration to improve treatment adherence and outcomes.

Examining patterns of patient adherence to Cognitive Behavioural Therapy in chronic physical illnesses and comorbid mental health disorders: a scoping review protocol

Objective To examine the patient adherence patterns to Cognitive Behaviour Therapy (CBT) intervention in persons living with long term physical illness and co-occurring mental health conditions. Introduction Current literature on patient treatment adherence is mostly focused on the medical/pharmacological treatment or is disorder/ therapy specific and does not address co-occurring or comorbid mental health disorders with physical health disorders in general. The objective of this scoping review is to provide insights into adherence behaviours and patterns outside of pharmacological intervention focusing on psychotherapeutic intervention specifically Cognitive Behaviour Therapy (CBT) in persons living with long-term medical conditions with co-existing mental health disorders/ conditions. The results of the review will highlight different aspects of adherence to CBT including facilitating and impeding factors influencing adherence, and variations across comorbid mental and physical health conditions. These results will aid in developing targeted CBT interventions and strategies to improve adherence rates. Furthermore, identifying gaps in the existing literature will guide future research to optimise health outcomes in this population. Inclusion Criteria Using the Population, Concept, and Context (PCC) criteria, studies will be included if they reported on patient adherence patterns of CBT in persons living with chronic medical conditions and co-occurring mental health conditions. Methods The scoping review will follow the Joanna Briggs Institute (JBI) guidelines for scoping review and reported according to the PRISMA-ScR checklist. A systematic search of PubMed, CINAHL Plus (including full academic search, APA PsychInfo, and Medline), Scopus, Cochrane library, EMBASE, Google Scholar, and University College Cork (UCC) library’s one search platform will be conducted. The JBI standard data extraction tool will be tailored to the review objectives. The findings will be presented using a descriptive and narrative approach.

Effectiveness of Online Mindfulness-Based Intervention on Systolic Blood Pressure, Diastolic Blood Pressure, and Heart Rate in Patients with Diagnosed Hypertension: A Randomized Clinical Trial

ABSTRACT Background Hypertension (HTN) is a serious medical disease and the main cause of cardiovascular diseases and premature death worldwide. Purpose The purpose of this study was to investigate the effectiveness of online mindfulness-based stress reduction (OMBSR) on systolic blood pressure (BP), diastolic blood pressure (BP), and heart rate (HR) in patients with diagnosed hypertension. Methods The present study was a randomized clinical trial based on the pretest, posttest, and follow-up design. Thirty-four patients were included in the study by the Purposive Sampling method and randomly assigned to two groups of OMBSR and control. SBP, DBP and HR were measured the research data were analyzed using repeated measures ANOVA and Bonferroni test using SPSS26 software. Results The results showed that the “posttest” and “follow-up” scores of SBP, DBP, and HR in the mindfulness group decreased significantly compared to the pretest scores (P < . 001); while there was no significant difference between the scores of the control group at different times. Discussion OMBSR may have the potential to affect SBP, DBP, and HR, via treatment adherence in patients with hypertension. Translation to Health Education Practice Health educators may want to use OMBSR as a supplement to drug therapy solving problems related to patients with hypertension.

Outcomes with ibrutinib in patients with chronic lymphocytic leukaemia: Results from the German multicentre REALITY study.

To assess treatment adherence, effectiveness and safety outcomes of patients with chronic lymphocytic leukaemia (CLL) receiving ibrutinib in a real-world setting. Patients enrolled in REALITY were ≥18 years with a confirmed diagnosis of CLL and were receiving ibrutinib as a first-line (1L), 2L or ≥3L therapy. Treatment retention, adherence, progression-free survival (PFS), overall survival (OS) and time to next therapy were assessed at 1 and 2 years overall, by typology and by cytogenetic subgroups. PFS and OS were analysed using Kaplan-Meier methods. Exactly 302 patients were enrolled across 57 sites in Germany, from January 2017 to July 2021. One-year retention rates were 69.9% overall (primary endpoint), 77.9% for 1L patients, and 77.6%/78.8% for high-risk patients with del17p/TP53. At 2 years, PFS/OS rates were 77.8%/90.7% overall (1L, 82.7%/90.4%), and were consistent across cytogenetic subgroups. PFS rates were higher for 1L versus ≥3L patients. Patients with the low-acceptance/low-control typology at baseline were less likely to retain treatment at 1 year versus the high-acceptance/high-control typology. No new safety signals were observed. The REALITY study provides further evidence of the effectiveness and safety of ibrutinib in patients with CLL in a real-world setting, particularly in earlier treatment lines.

504 - Investigator- and patient-rated local tolerability in phase 3 trials of topical roflumilast in patients with psoriasis, seborrheic dermatitis, and atopic dermatitis

Abstract Introduction Formulating a topical medication that does not irritate the skin is an important factor contributing to patient treatment adherence and satisfaction. Many topical prescription products use penetration enhancers (including propylene glycol, polyethylene glycol, and ethanol) to overcome barrier properties of the skin. However, these excipients may irritate the skin causing tolerability reactions such as burning and stinging, which can reduce patient treatment adherence. Topical roflumilast is a highly potent (Kd∼0.7 nM) phosphodiesterase 4 inhibitor formulated as a water-based cream or foam that does not contain penetration enhancers or fragrances. Objectives We present prospectively assessed investigator- and patient-rated local tolerability from Phase 3 trials of topical roflumilast for patients with psoriasis (DERMIS-1, DERMIS-2, ARRECTOR) seborrheic dermatitis (SD; STRATUM), and atopic dermatitis (AD; INTEGUMENT-1, INTEGUMENT-2). Methods Patients were randomized to apply topical roflumilast (DERMIS: 0.3% cream; ARRECTOR and STRATUM: 0.3% foam; INTEGUMENT: 0.15% cream) or vehicle once daily for 8 weeks (DERMIS, ARRECTOR, and STRATUM) or 4 weeks (INTEGUMENT). Investigators assessed local tolerability on an 8-point scale (0 [no evidence of irritation] to 7 [strong reaction spreading beyond application site]) in the clinic before investigational product (IP) application. Patients reported local tolerability on a 4-point scale (0 [none: no sensation] to 3 [severe: hot, tingling/stinging sensation that has caused definite discomfort]) in the clinic 10-15 minutes after IP application. Tolerability was also assessed by reviewing documented adverse events. Results As assessed by investigators, ≥96.5% of patients in the roflumilast-treated groups had no evidence of irritation at the application site across all trials at all timepoints. Patient-rated local tolerability was favorable and improved with treatment: across all trials, 1% of roflumilast-treated patients reported a score of 3 (severe; defined as a “hot tingling/stinging sensation that has caused definite discomfort”) after the first application (day 1) and &amp;lt;1% at each subsequent assessment. Rates of adverse events, including those at the application site, were low for all trials. Conclusions Roflumilast cream and foam formulations demonstrated favorable local tolerability based on investigator- and patient-rated assessments in patients with psoriasis, SD, and AD, including application to sensitive areas such as the face and intertriginous areas. ClinicalTrials.gov Identifiers: DERMIS-1: NCT04211363; DERMIS-2: NCT04211389; ARRECTOR: NCT05028582; STRATUM: NCT04973228; INTEGUMENT-1: NCT047​73587; INTEGUMENT-2: NCT04773600.

(318) Factors Influencing Compliance with Trimix, an Intracavernosal Injection for Erectile Dysfunction: A Retrospective Analysis

Abstract Introduction Trimix, an intracavernosal injection therapy, is an effective treatment for erectile dysfunction. However, patient compliance with Trimix use is crucial for treatment success, and factors influencing compliance are not well understood. Objective This retrospective analysis aimed to identify factors that influence compliance with Trimix therapy among patients with erectile dysfunction. Additionally, the study aimed to investigate the impact of comorbidities, specifically diabetes and prostate cancer, on the duration of Trimix treatment. Methods Patient data from pharmacy records between 2017 and 2022 was analyzed. Custom Python code was used to calculate the duration of Trimix use based on the first and last prescription refill events. A comprehensive chart review was conducted to collect additional patient-related data, including demographics and comorbidities. Cox Proportional Hazards Regression models were employed to assess the effects of predictor variables on the duration of Trimix use. Simple linear regression was used to compare the presence of diabetes, prostate cancer, or both on time spent on Trimix treatment. Results The analysis included a total of 4,072 patients. Age was identified as a significant predictor of Trimix therapy discontinuation, with every additional year of age associated with an increased hazard ratio of 1.007 (p &amp;lt; 0.001). Preferred language also emerged as a significant predictor, with patients preferring Spanish exhibiting a higher hazard ratio of 1.163 compared to patients preferring English (p = 0.004). In terms of comorbidities, the presence of prostate cancer significantly differed from other organic causes of erectile dysfunction on time spent on Trimix treatment (p = 0.002), resulting in 80 fewer days of Trimix treatment. Conclusions This retrospective analysis revealed that age and preferred language are important factors influencing compliance with Trimix therapy. Older patients and those preferring Spanish were more likely to discontinue Trimix treatment. Additionally, the presence of prostate cancer significantly impacted the duration of Trimix treatment. These findings emphasize the need for age-specific counseling, language-concordant interventions, and tailored approaches to address comorbidities such as prostate cancer. Understanding these factors is vital for optimizing treatment adherence and efficacy in patients with erectile dysfunction. Disclosure No.

The Effect of an Educational Program on Treatment Adherence of Chronic Obstruction Pulmonary Disease: A Randomized Controlled Trial

Purpose: this study evaluates the effectiveness of a health education intervention program on treatment adherence of COPD outpatients.&#x0D; Methodology: This randomized controlled trial was conducted in 2022 with 90 COPD outpatient people. Self-management education was developed on the basis of the Theory of Planned Behavior. Medication adherence was assessed using Test of Adherence to Inhalers (TAI-10), and the practice checklist of breathing exercises, respectively.&#x0D; Findings: At beginning, there were no significant differences between-group regarding participants’ medication adherence. After 3 months’ intervention, the rates showed a significant increasing for treatment adherence in intervention group (P &lt; 0.05).&#x0D; Unique contribution to theory, practice, and policy (recommendations): Health education interventions have proven effective in increasing treatment adherence of outpatients with COPD. So, an intervention program should be conduct on a larger scale to improve treatment adherence for COPD patients in the future.

Acceptability of home-based transcranial direct current stimulation (tDCS) in major depression: a qualitative analysis of individual experiences

PurposeThe purpose of this paper was to gain a qualitative view of the participant experience of using home-based transcranial direct current stimulation (tDCS). Acceptability impacts patient preference, treatment adherence and outcomes. However, acceptability is usually assessed by rates of attrition, while multifaceted constructs are not reflected or given meaningful interpretations. tDCS is a novel non-invasive brain stimulation that is a potential treatment for major depressive disorder (MDD). Most studies have provided tDCS in a research centre. As tDCS is portable, the authors developed a home-based treatment protocol that was associated with clinical improvements that were maintained in the long term.Design/methodology/approachThe authors examined the acceptability of home-based tDCS treatment in MDD through questionnaires and individual interviews at three timepoints: baseline, at a six-week course of treatment, and at six-month follow-up. Twenty-six participants (19 women) with MDD in a current depressive episode of at least moderate severity were enrolled. tDCS was provided in a bifrontal montage with real-time remote supervision by video conference at each session. A thematic analysis was conducted of the individual interviews.FindingsThematic analysis revealed four main themes: effectiveness, side effects, time commitment and support, feeling held and contained. The themes reflected the high acceptability of tDCS treatment, whereas the theme of feeling contained might be specific to this protocol.Originality/valueQualitative analysis methods and individual interviews generated novel insights into the acceptability of tDCS as a potential treatment for MDD. Feelings of containment might be specific to the present protocol, which consisted of real-time supervision at each session. Meaningful interpretation can provide context to a complex construct, which will aid in understanding and clinical applications.

Patient Power: A feasibility study on the impact of providing a bedside notepad to encourage patients to ask questions following surgery

ObjectiveThis study aimed to evaluate a behaviour change strategy to enhance the patient voice in the early post-operative setting. MethodsThe Patient Power notepad was evaluated in an uncontrolled, single-group, mixed-methods trial including a patient evaluation survey and staff phone interviews. ResultsPatients thought that the notepad was well-designed and prompted them to think of and ask questions. They strongly agreed that healthcare practitioners answered health-related questions fully and carefully. Staff reported that the notepad not only provided an easy mechanism through which patients and their families could communicate with their healthcare team, but it also created a permissive environment where questions were encouraged. ConclusionThe Patient Power notepad provided an easy, acceptable and scalable intervention to encourage patients to engage more in their healthcare and specifically to ask questions about their care. By providing a structured tool for capturing patient concerns, symptoms, and questions, this innovation holds the potential to enhance patient satisfaction, treatment adherence, and overall healthcare outcomes. InnovationBy facilitating comprehensive information exchange and the potential to promote shared decision-making, this innovation has the potential to improve patient satisfaction, treatment adherence, and overall healthcare outcomes.

Investigator- and Patient-Rated Local Tolerability in Phase 3 Trials of Topical Roflumilast in Patients With Psoriasis, Seborrheic Dermatitis, and Atopic Dermatitis

Investigator- and patient-rated local tolerability in phase 3 trials of topical roflumilast in patients with psoriasis, seborrheic dermatitis, and atopic dermatitis&#x0D; &#x0D; Christopher G. Bunick1 on behalf of the authors&#x0D; &#x0D; INTRODUCTION: Formulating a topical medication that does not irritate the skin is an important factor contributing to patient treatment adherence and satisfaction. Many topical prescription products use penetration enhancers (including propylene glycol, polyethylene glycol, and ethanol) to overcome barrier properties of the skin. However, these excipients may irritate the skin causing tolerability reactions such as burning and stinging, which can reduce patient treatment adherence. Topical roflumilast is a highly potent (Kd~0.7 nM) phosphodiesterase 4 inhibitor formulated as a water-based cream or foam that does not contain penetration enhancers or fragrances. We present prospectively assessed investigator- and patient-rated local tolerability from Phase 3 trials of topical roflumilast for patients with psoriasis (DERMIS-1, DERMIS-2, ARRECTOR) seborrheic dermatitis (SD; STRATUM), and atopic dermatitis (AD; INTEGUMENT-1, INTEGUMENT-2).&#x0D; METHODS: Patients were randomized to apply topical roflumilast (DERMIS: 0.3% cream; ARRECTOR and STRATUM: 0.3% foam; INTEGUMENT: 0.15% cream) or vehicle once daily for 8 weeks (DERMIS, ARRECTOR, and STRATUM) or 4 weeks (INTEGUMENT). Investigators assessed local tolerability on an 8-point scale (0 [no evidence of irritation] to 7 [strong reaction spreading beyond application site]) in the clinic before investigational product (IP) application. Patients reported local tolerability on a 4-point scale (0 [none: no sensation] to 3 [severe: hot, tingling/stinging sensation that has caused definite discomfort]) in the clinic 10-15 minutes after IP application. Tolerability was also assessed by reviewing documented adverse events.&#x0D; RESULTS: As assessed by investigators, ≥96.5% of patients in the roflumilast-treated groups had no evidence of irritation at the application site across all trials at all timepoints. Patient-rated local tolerability was favorable and improved with treatment: across all trials, 1% of roflumilast-treated patients reported a score of 3 (severe; defined as a “hot tingling/stinging sensation that has caused definite discomfort”) after the first application (day 1) and &lt;1% at each subsequent assessment. Rates of adverse events, including those at the application site, were low for all trials and &lt;0.5% of roflumilast-treated patients discontinued due to adverse events at the application site across all trials.&#x0D; CONCLUSION: Roflumilast cream and foam formulations demonstrated favorable local tolerability based on investigator- and patient-rated assessments in patients with psoriasis, SD, and AD, including application to sensitive areas such as the face and intertriginous areas.&#x0D; Sponsored by Arcutis Biotherapeutics, Inc.&#x0D; ClinicalTrials.gov Identifiers: DERMIS-1: NCT04211363; DERMIS-2: NCT04211389; ARRECTOR: NCT05028582; STRATUM: NCT04973228; INTEGUMENT-1: NCT04773587; INTEGUMENT-2: NCT04773600

Influencing Factors and Care Strategies of CPAP Treatment Adherence in Patients with Co-Morbid Insomnia and Sleep Apnea

The number of patients with chronic insomnia combined with Obstructive Sleep Apnea (OSA) has gradually increased recently, however, the adherence of CPAP therapy was suboptimal for Co-Morbid Insomnia and Sleep Apnea (COMISA) individuals. The purpose of our review was to assess the factors of poor adherence of CPAP therapy and provide the nursing care strategies for good adherence. In our review, cognitive behavioural therapy and continuous positive airway pressure treatment, individualized and continuum care measures were introduced for good adherence for CPAP therapy.

Understanding the role of the primary care physician in the management of patients with Crohn’s perianal fistulas

ABSTRACT Objectives To understand the role of primary care physicians (PCPs) in the recognition, diagnosis, and management of Crohn’s perianal fistulas (CPF) and their referral patterns and treatment expectations. Methods This survey-based study was conducted between September 2020 and October 2020. US-based PCPs managing at least one patient with Crohn’s disease per week were included. Participants were presented with two case vignettes relevant to primary care practice; Case Vignette 1 comprised three parts and focused on initial CPF presentation and progression to partial response; Case Vignette 2 focused on recurrent CPF. Survey questions elicited the physician’s clinical approach to each case. Data were presented as descriptive statistics. Results Overall, 151 PCPs (median 23 years in practice) who saw about three patients per month with new/existing CPF responded. For Case Vignette 1, upon identification of a fistulous tract, 89% of respondents would refer the patient, mostly to a colorectal surgeon or gastroenterologist. Most PCPs (69%) would begin the patient on medication; 46% would conduct a diagnostic/imaging study. Treatment expectations after referral varied: 55% of respondents believed surgeons would place a seton or use one prior to surgery; 23% expected medical management only; 23% were unsure. Case Vignette 2 revealed that 98% of PCPs preferred to be involved in patient care after referral; however, only 49% were. Of these, 76% considered reinforcing patient treatment adherence as their primary role. While 80% of PCPs were at least moderately satisfied with communication and care coordination with multidisciplinary teams, 52% considered lack of access to specialists as at least a moderate barrier to multidisciplinary team management. Conclusion PCPs want more involvement in multidisciplinary management of patients with CPF. Continuing education providing PCPs with up-to-date information on diagnostic modalities, treatment options, early diagnosis, the role of PCPs within a multidisciplinary team, and effective initial CPF care is required.

The effectiveness of acceptance and commitment therapy on clinical symptoms and treatment adherence in dialysis patients.

Clinical symptoms and treatment adherence are one of the most important problems in dialysis patients. Psychological treatments can be effective in reducing the problems of these patients. Therefore, this study aimed at investigating the effectiveness of acceptance and commitment therapy (ACT) on clinical symptoms and treatment adherence in these patients. This study was a quasi-experimental study with the experimental and control groups in the dialysis clinic of Torbat-e Heydarieh City in 2012. The sample consisted of 40 people who were referred to the dialysis clinic, and the available sampling method was used to randomly assign participants to the experimental and control groups. In the experimental group, ACT was performed in eight sessions of 90 minutes. Questionnaires of Depression, Anxiety, and Stress Scale (DASS-21) and general adherence scale were used. Data were analyzed using Statistical Package for the Social Sciences (SPSS 21) software and multivariate analysis of covariance (MANCOVA) test. There was a significant difference between the mean scores of clinical symptoms and treatment adherence variables in the experimental and control groups (P < 0.05). The effect of this treatment on reducing the clinical symptoms score was 48%, and on increasing the treatment, the adherence score was 44%. ACT can reduce clinical symptoms and increase treatment adherence in dialysis patients, so it is suggested to use this intervention in the design of treatment plans for dialysis patients.