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Zídka M, Džupa V. Pavlik harness and Frejka pillow: compliance affects results of outpatient treatment. Arch Orthop Trauma Surg 2019; 139:1519-1524. [PMID: 30937524 DOI: 10.1007/s00402-019-03179-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE OF THE STUDY Outpatient treatment of hip dysplasia in newborns has excellent results. A combination of general screening with early treatment with a functional abduction device works well. Treatment with the Frejka pillow and the Pavlik harness is frequently used in our region. The aim of the study is to compare efficiency and treatment duration, related to the brace used, and to prove that the choice of an abduction device implies parental compliance with the treatment protocol. MATERIALS AND METHODS Data of 286 treated children were analyzed. The diagnosis was made in the first weeks of life by clinical and sonographic examinations during general screening. The choice of treatment device was expert dependent and was involved by many variables. The experience, type of clinical finding and sonographic pathology according to Graf, availability of a treating facility, and the potential cooperation of individual parents were major parameters. The Frejka pillow was used to treat 145 children and the Pavlik harness was used in 137 children. The treatment duration and percentage of infants lost from follow-up in relation to the device used was documented. RESULTS The success rate of outpatient treatment was 98.6%. In six patients, the type of device had to be changed during the treatment period. Physiological sonographic findings were achieved in all hips by the end of the treatment. The Frejka pillow was used as the preferred device in milder stable dysplastic hips, while unstable and decentered hips were treated more frequently with the Pavlik harness. Treatment lasted, on average, 95 days and 119 days in the Frejka and in the Pavlik group, respectively; there was no statistical significance in treatment duration of comparable sonographic pathologies. We observed statistically greater parental non-compliance with the treatment protocol in the Pavlik harness group (p = 0.0279; OR 2.7; 95% CI 1.07; 8.5). CONCLUSIONS Neither of the abduction devices was inferior with regard to treatment efficiency. We found that parental cooperation was an important factor during screening and treatment. The treatment decision and the choice of the brace must be made with full consent of the parents, keeping in mind that comfort during the nursing care may have a significant influence on compliance with the treatment protocol.
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Gadapani B, Rahini S, Manapurath RM. Noncompliance of the postexposure prophylactic vaccination following animal bites reporting to a rural primary health center. J Family Med Prim Care 2019; 8:3258-3262. [PMID: 31742152 PMCID: PMC6857378 DOI: 10.4103/jfmpc.jfmpc_592_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Man lives in close harmony with animals and so the chances of injuries and diseases contracted from them. Effective preventive measure such as vaccination is to be ensured following harmful bites resulting in Rabies. AIM The aim is to assess the proportion of rabid animal bite cases and non-compliance of post exposure prophylaxis vaccination following bites, reporting to a rural primary health care centre. SETTING AND DESIGN This is a retrospective cross sectional study from records of animal bite cases attending a rural primary health centre from January 2017 to December 2017. MATERIALS AND METHODS A pre-designed case record form was used to estimate the proportion of animal bite cases leading to Rabies and Non-compliance of post exposure prophylaxis attending the health centre. STATISTICAL ANALYSIS Data analysis was done in SPSS 2016. Chi square was used to find the significance. RESULTS Around 448 animal bites were found over a span of one year, out of which 222 (49.5%) were found to be rabid animal bites. 46.65% (209) were dog bites and 2.9% (13) were cat bites. Statistical significance (P < 0.05) was seen between age and compliance of vaccination following dog bites. 1.14% of the study subjects who had completed the 5 dose post prophylaxis vaccination belonged to the elderly age group. Among the cat bite cases, 2 of the study subjects had received 1 dose of PEP with anti-rabies vaccine. CONCLUSION Only 1.14% of the study subjects had taken the complete dose of PEP. This suggests the lack of awareness among public and lack of services and supervision for rabid animal bites in rural areas. It is the duty of every physician to counsel people, co-ordinate with veterinary physician and maintain proper records so as to ensure completion of PEP to prevent rabies related deaths in humans.
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Abstract
The word ‘compliance' comes from the Latin word complire, meaning to fill up and hence to complete an action, transaction, or process and to fulfil a promise. In the Oxford English Dictionary, the relevant definition is ‘The acting in accordance with, or the yielding to a desire, request, condition, direction, etc.; a consenting to act in conformity with; an acceding to; practical assent”. Compliance with therapy is simply patients understanding of medication, motivation toward having this medication is a prescribed manner with the belief that the prescriber and prescribed medicine will be beneficial for his well-being. Although this is often the case, in a number of situations, the physician and pharmacist have not provided the patient with adequate instructions or have not presented the instructions in such a manner that the patient understands them. Nothing should be taken for granted regarding the patient's understanding of how to use medication, and appropriate steps must be taken to provide patients with the information and counseling necessary to use their medications as effectively and as safely as possible. 20% to 30% of new prescriptions are never filled at the pharmacy. Medication is not taken as prescribed 50% of the time. For patients prescribed medications for chronic diseases, after six months, the majority take less medication than prescribed or stop the medication altogether. There are both federal and state laws that make using or sharing prescription drugs illegal. If someone take a pill that was prescribed to someone else or give that pill to another person, not only is it against the law, it's extremely dangerous.
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Bhogal N, Dhaliwal A, Lyden E, Rochling F, Olivera-Martinez M. Impact of psychosocial comorbidities on clinical outcomes after liver transplantation: Stratification of a high-risk population. World J Hepatol 2019; 11:638-645. [PMID: 31528246 PMCID: PMC6717712 DOI: 10.4254/wjh.v11.i8.638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/23/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy. There are currently over 13000 candidates on the liver transplant waiting list emphasizing the importance of rigorous patient selection. There are few studies regarding the impact of additional psychosocial barriers to liver transplant including financial hardship, lack of caregiver support, polysubstance abuse, and issues with medical non-compliance. We hypothesized that patients with certain psychosocial comorbidities experienced worse outcomes after liver transplantation.
AIM To assess the impact of certain pre-transplant psychosocial comorbidities on outcomes after liver transplantation.
METHODS A retrospective analysis was performed on all adult patients from 2012-2016. Psychosocial comorbidities including documented medical non-compliance, polysubstance abuse, financial issues, and lack of caregiver support were collected. The primary outcome assessed post-transplantation was survival. Secondary outcomes measured included graft failure, episodes of acute rejection, psychiatric decompensation, number of readmissions, presence of infection, recidivism for alcohol and other substances, and documented caregiver support failure.
RESULTS For the primary outcome, there were no differences in survival. Patients with a history of psychiatric disease had a higher incidence of psychiatric decompensation after liver transplantation (19% vs 10%, P = 0.013). Treatment of psychiatric disorders resulted in a reduction of the incidence of psychiatric decompensation (21% vs 11%, P = 0.022). Patients with a history of polysubstance abuse in the transplant evaluation had a higher incidence of substance abuse after transplantation (5.8% vs 1.2%, P = 0.05). In this cohort, 15 patients (3.8%) were found to have medical compliance issues in the transplant evaluation. Of these specific patients, 13.3% were found to have substance abuse after transplantation as opposed to 1.3% in patients without documented compliance issues (P = 0.03).
CONCLUSION Patients with certain psychosocial comorbidities had worse outcomes following liver transplantation. Further prospective and multi-center studies are warranted to properly determine guidelines for liver transplantation regarding this high-risk population.
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Yotebieng KA, Fakult N, Awah PK, Syvertsen JL. Precarious hope and reframing risk behavior from the ground up: insight from ethnographic research with Rwandan urban refugees in Yaoundé, Cameroon. Confl Health 2019; 13:18. [PMID: 31139249 PMCID: PMC6530091 DOI: 10.1186/s13031-019-0206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Theoretical and methodological research on risk-taking practices often frames risk as an individual choice. While risk does occur at individual level, it is determined by aspirations which are connected to others and society. For many displaced women globally, these aspirations are often linked to the well-being of their children and other household members. This article explores the links between aspirations for the future, gendered household dynamics, and health risk-taking behavior among the Rwandan urban refugee community. METHODS This analysis drew from participant observation, focus group discussions, and in-depth interviews with 49 male and 42 female household members from 36 Rwandan refugee households in Yaoundé, Cameroon. The fieldwork was conducted over 12 months between May-August 2016, May-August 2017, and February-August 2018. RESULTS We observed that while there was considerable convergence among household members in aspirations, there was considerable difference in risk-taking practices engaged to achieve them with women often assuming the greatest risks. These gendered realities of risk were not only related to structural concerns including access to different forms of capital, but also to socio-cultural gendered expectations of women, how risks were defined and justified, and household dynamics that drove the gendered reality of observed risk-behavior. CONCLUSIONS Humanitarian programs and policies are distinctly finite in nature; focused on the short-term needs of persons affected by conflict. However, many humanitarian situations in the world are protracted. In the midst of these challenges, themes of future-orientation, possibilities, and shared aspirations for a better future emerge. These aspirations and the practices, including risk-taking practices that stem from them are central to understand if we are to ensure a just peace and stability in displaced communities throughout the developing world. Our analysis highlights the need to examine sociocultural dimensions related to hopes for the future, gender, and household dynamics as a way to understand risk behavior. We propose this can be done through a framework of precarious hope which we put forward in this paper, in which hope, agency, sociocultural and political economic contexts situate risk as a gendered practice of hope amidst constraint.
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Zasimova L. Analysis of non-compliance with smoke-free legislation in Russia. Int J Public Health 2019; 64:413-422. [PMID: 30734060 DOI: 10.1007/s00038-018-1198-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/08/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The study examined the smokers' non-compliance rates in indoor public places in Russia and the sociodemographic factors associated with non-compliance. METHODS Univariate analysis and logistic regression models were performed using cross-sectional data from a representative sample of Russian adults (N = 4006). RESULTS 27.2% of Russian smokers did not comply with smoke-free bans. Non-compliance was attributed to sociodemographic characteristics of smokers, mainly to the number of cigarettes smoked per day, regular alcohol consumption, being aged between 15 and 34 years, being in the highest income group and living in an urban area. Neither the sex, nor the family status of smokers exerted a statistically significant affiliation with non-compliance. Higher rates of non-compliance were observed in restaurants, cafes, bars and nightclubs, common domestic premises of apartment buildings and indoor workplaces. Violations on public transport, in governmental buildings, health and sport facilities, colleges and universities were less common. CONCLUSIONS There is a need to revise the methods of enforcement with respect to sociodemographic characteristics of smokers associated with non-compliance in public places where violations are widespread.
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Tadesse T, Zawdie B. Non-compliance and associated factors against smoke-free legislation among health care staffs in governmental hospitals in Addis Ababa, Ethiopia: an observational cross-sectional study. BMC Public Health 2019; 19:91. [PMID: 30660180 PMCID: PMC6339307 DOI: 10.1186/s12889-019-6407-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background In 2014, the Ethiopian government passed a new smoking legislation that banned smoking in public and workplaces including health care facilities. However, data’s on level of non-compliance and associated factors with non-compliance towards smoke-free legislation in hospital settings of the country has not been studied yet. Methods Hospital-based Cross-sectional study design triangulated with observational study was conducted in five hospitals. Data were collected through direct observation and interviews using checklist, structured and pre-tested questionnaires for observational study and survey of hospital employee respectively. Nine data collectors and one supervisor were involved in data collection. Three hundred fifty (350) health care staffs were interviewed. Fifteen (15) buildings were purposively observed for observational non-compliance in the selected hospitals. Data were entered by Epi Info and analyzed using SPSS version 21 software. Logistic regression was used to compute the crude and adjusted odds ratios for the factors affecting employee non-compliance with the legislation. A p-value of < 0.05 at 95% CI was considered to be statistically significant. Results Anti-smoking signs were absent from a high proportion of hospital areas (97% overall) although visible cigarette butts were generally not observed in most areas of the hospitals. Non-compliance level among health care staffs was 50(10.3%).Associated factors affecting to the non-compliance level of the staff were: being male (AOR = 5.89, p value = 0.001), having poor knowledge (AOR = 2.71, p-value = 0.022) and having Unfavorable attitudes (AOR = 6.15, p-value = 0.000). Conclusions Non-compliance level was high and needs careful implementation for 100% smoke-free legislation in addressing knowledge and attitudes of health care staffs.
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Tandon N, Mao J, Shprecher A, Anderson AJ, Cao F, Jiao X, Brown K. Compliance with clinical guidelines and adherence to antiretroviral therapy among patients living with HIV. Curr Med Res Opin 2019; 35:63-71. [PMID: 30173561 DOI: 10.1080/03007995.2018.1519499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Evaluation of provider compliance with antiretroviral (ARV) treatment guidelines and patient adherence to ARVs is important for HIV care quality assessment; however, there are few current real-world data for guideline compliance and ARV adherence in the US. This study evaluated provider compliance with US Department of Health and Human Services (DHHS) guidelines and patient adherence to ARVs in a US population of patients with HIV.Methods: This was a retrospective claims study of adults with HIV-1 receiving ARV treatment between January 2010-December 2014. Follow-up began at first ARV treatment and ended at health plan disenrollment or study end. ARV regimens for treatment-naïve patients were categorized as "preferred/recommended", "alternative", or "non-preferred/recommended/alternative" according to DHHS guidelines. ARV adherence was evaluated using proportion of days covered (PDC) and medication possession ratio (MPR).Results: The analysis included 25,320 patients (84.4% male, mean age 45.3 years) and 39,071 regimens. Preferred/recommended regimens were most common during each study year, but the proportion of non-preferred/recommended/alternative regimens was substantial (15.9-20.6%). Only 53.6% of patients had optimal adherence by PDC ≥0.95, and 57.9% by MPR ≥0.95. Guideline non-compliance and sub-optimal adherence were more prevalent among female vs male patients (22.6% vs 14.8% [in 2014] and 65.9% vs 53.7%, respectively).Conclusions: Provider non-compliance with DHHS guidelines and sub-optimal ARV adherence among patients with HIV remain common in real-world practice, particularly for female patients. Healthcare providers should follow the latest clinical guidelines to ensure that patients receive recommended therapy, and address non-adherence when selecting ARV regimens.
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Knight A, Jarrad GA, Schrader GD, Strobel J, Horton D, Bidargaddi N. Monte Carlo Simulations Demonstrate Algorithmic Interventions Over Time Reduce Hospitalisation in Patients With Schizophrenia and Bipolar Disorder. BIOMEDICAL INFORMATICS INSIGHTS 2018; 10:1178222618803076. [PMID: 30302053 PMCID: PMC6170953 DOI: 10.1177/1178222618803076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/02/2018] [Indexed: 11/29/2022]
Abstract
Non-adherence with pharmacologic treatment is associated with increased rates of relapse and rehospitalisation among patients with schizophrenia and bipolar disorder. To improve treatment response, remission, and recovery, research efforts are still needed to elucidate how to effectively map patient’s response to medication treatment including both therapeutic and adverse effects, compliance, and satisfaction in the prodromal phase of illness (ie, the time period in between direct clinical consultation and relapse). The Actionable Intime Insights (AI2) application draws information from Australian Medicare administrative claims records in real time when compliance with treatment does not meet best practice guidelines for managing chronic severe mental illness. Subsequently, the AI2 application alerts clinicians and patients when patients do not adhere to guidelines for treatment. The aim of this study was to evaluate the impact of the AI2 application on the risk of hospitalisation among simulated patients with schizophrenia and bipolar disorder. Monte Carlo simulation methodology was used to estimate the impact of the AI2 intervention on the probability of hospitalisation over a 2-year period. Results indicated that when the AI2 algorithmic intervention had an efficacy level of (>0.6), over 80% of actioned alerts were contributing to reduced hospitalisation risk among the simulated patients. Such findings indicate the potential utility of the AI2 application should replication studies validate its methodologic and ecological rigour in real-world settings.
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Analysis of randomised trials with long-term follow-up. BMC Med Res Methodol 2018; 18:48. [PMID: 29843614 PMCID: PMC5975460 DOI: 10.1186/s12874-018-0499-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 04/30/2018] [Indexed: 11/26/2022] Open
Abstract
Randomised trials with long-term follow-up can provide estimates of the long-term effects of health interventions. However, analysis of long-term outcomes in randomised trials may be complicated by problems with the administration of treatment such as non-adherence, treatment switching and co-intervention, and problems obtaining outcome measurements arising from loss to follow-up and death of participants. Methods for dealing with these issues that involve conditioning on post-randomisation variables are unsatisfactory because they may involve the comparison of non-exchangeable groups and generate estimates that do not have a valid causal interpretation. We describe approaches to analysis that potentially provide estimates of causal effects when such issues arise. Brief descriptions are provided of the use of instrumental variable and propensity score methods in trials with imperfect adherence, marginal structural models and g-estimation in trials with treatment switching, mixed longitudinal models and multiple imputation in trials with loss to follow-up, and a sensitivity analysis that can be used when trial follow-up is truncated by death or other events. Clinical trialists might consider these methods both at the design and analysis stages of randomised trials with long-term follow-up.
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O'Nions E, Happé F, Evers K, Boonen H, Noens I. How do Parents Manage Irritability, Challenging Behaviour, Non-Compliance and Anxiety in Children with Autism Spectrum Disorders? A Meta-Synthesis. J Autism Dev Disord 2018; 48:1272-1286. [PMID: 29222612 PMCID: PMC5861158 DOI: 10.1007/s10803-017-3361-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although there is increasing research interest in the parenting of children with ASD, at present, little is known about everyday strategies used to manage problem behaviour. We conducted a meta-synthesis to explore what strategies parents use to manage irritability, non-compliance, challenging behaviour and anxiety in their children with ASD. Approaches included: (1) accommodating the child; (2) modifying the environment; (3) providing structure, routine and occupation; (4) supervision and monitoring; (5) managing non-compliance with everyday tasks; (6) responding to problem behaviour; (7) managing distress; (8) maintaining safety and (9) analysing and planning. Results suggest complex parenting demands in children with ASD and problem behaviour. Findings will inform the development of a new measure to quantify parenting strategies relevant to ASD.
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Makis W, Hudson EW. Unilateral Muscle Artifacts due to Non-compliance During Uptake Phase of 18F-FDG PET/CT in an Oncologic Patient. Mol Imaging Radionucl Ther 2018; 27:32-36. [PMID: 29393052 PMCID: PMC5790972 DOI: 10.4274/mirt.02419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 49-year-old male patient with a prior history of poor compliance with medical appointments was referred for an 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for the staging of a rectal squamous cell carcinoma. The PET/CT showed unilateral diffuse skeletal muscle 18F-FDG uptake as well as bilateral salivary gland uptake artifacts, suggestive of non-compliance with patient preparation instructions. The PET/CT nurse noted that during the 18F-FDG uptake phase, the patient appeared intoxicated, and she found two beer cans hidden in the waste disposal beside his chair just prior to imaging. The patient only admitted to eating a cookie approximately 30 minutes after the injection of 18F-FDG PET/CT and denied consuming alcohol during the uptake phase. We present the imaging findings of non-compliance with patient instructions during the uptake phase of 18F-FDG.
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Dodd S, White IR, Williamson P. A framework for the design, conduct and interpretation of randomised controlled trials in the presence of treatment changes. Trials 2017; 18:498. [PMID: 29070048 PMCID: PMC5657109 DOI: 10.1186/s13063-017-2240-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/06/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND When a randomised trial is subject to deviations from randomised treatment, analysis according to intention-to-treat does not estimate two important quantities: relative treatment efficacy and effectiveness in a setting different from that in the trial. Even in trials of a predominantly pragmatic nature, there may be numerous reasons to consider the extent, and impact on analysis, of such deviations from protocol. Simple methods such as per-protocol or as-treated analyses, which exclude or censor patients on the basis of their adherence, usually introduce selection and confounding biases. However, there exist appropriate causal estimation methods which seek to overcome these inherent biases, but these methods remain relatively unfamiliar and are rarely implemented in trials. METHODS This paper demonstrates when it may be of interest to look beyond intention-to-treat analysis for answers to alternative causal research questions through illustrative case studies. We seek to guide trialists on how to handle treatment changes in the design, conduct and planning the analysis of a trial; these changes may be planned or unplanned, and may or may not be permitted in the protocol. We highlight issues that must be considered at the trial planning stage relating to: the definition of nonadherence and the causal research question of interest, trial design, data collection, monitoring, statistical analysis and sample size. RESULTS AND CONCLUSIONS During trial planning, trialists should define their causal research questions of interest, anticipate the likely extent of treatment changes and use these to inform trial design, including the extent of data collection and data monitoring. A series of concise recommendations is presented to guide trialists when considering undertaking causal analyses.
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Jasinski PT, Labropoulos N, Christoforatos OG, Tassiopoulos AK. Factors Affecting Follow-Up Compliance in Patients After Endovascular Aneurysm Repair. AORTA (STAMFORD, CONN.) 2017; 5:148-156. [PMID: 29657953 PMCID: PMC5890765 DOI: 10.12945/j.aorta.2017.17.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/15/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate potential factors affecting patient non-compliance after endovascular aneurysm repair. METHOD We performed a retrospective review of patients undergoing elective or emergency endovascular repair for thoracic, abdominal aorta, or iliac artery aneurysm at a single institution from November 2007 to March 2014. Compliance to follow-up at 1, 6, and 12 months was assessed. Factors evaluated included patient demographics, size of aneurysm, distance between the patient's residence and outpatient clinic, urgency of surgery, and time of year in which the follow-up visits were scheduled. RESULTS During the study period, 205 patients (75% male and 25% female) fulfilled the inclusion criteria. One-month mortality was 1.1% for elective procedures and 16.1% for emergency procedures (p = 0.001). Overall mortality at 12 months was 6.3% and 32.3% for elective and emergency procedures, respectively (p = 0.0002). Highest compliance was observed at 1 month, with 184 patients (93%) attending. A significant decrease was seen at 6 (n = 102, 54%) and 12 (n = 89, 48%) months. At the 12-month mark, a larger proportion of minority patients were non-compliant compared with Caucasian patients. Confounders for non-compliance were analyzed using multivariate analysis, and statistical significance was found for widowed marital status (p = 0.008), travel distance >25 miles to the outpatient clinic (p = 0.032), and emergency repair of aneurysms (p = 0.022). CONCLUSION Despite emphasizing the importance of follow-up after endovascular aortic procedures, almost half of the treated patients were non-compliant. Our study identified travel distance, marital status, and urgency of surgery as factors that may affect patients' compliance to scheduled follow-up visits.
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Givehchi S, Hemmativaghef E, Hoveidi H. Association between safety leading indicators and safety climate levels. JOURNAL OF SAFETY RESEARCH 2017; 62:23-32. [PMID: 28882271 DOI: 10.1016/j.jsr.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/29/2016] [Accepted: 05/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the association of leading indicators for occupational health and safety, particularly safety inspections and non-compliances, with safety climate levels. METHODS Nordic Occupational Safety Climate Assessment Questionnaire was employed to evaluate safety climate in cross-sectional design. The geographically diverse population of the inspection body made it possible to conduct the survey across 10 provinces in Iran. 89 completed questionnaires were obtained with a response rate of 47%. Except for management safety justice, the internal consistency of other six dimensions was found to be acceptable (α≥0.7). RESULTS Mean scores of dimensions ranged from 3.50 in trust in the efficacy of safety systems (SD=0.38) to 2.98 in workers' safety priority and risk non-acceptance (SD=0.47). Tukey HSD tests indicated a statistically significant difference of mean scores among groups undergoing different number of safety inspections and those receiving different number of non-compliances (p<0.05), with no significant differences based on safety training man-hours and sessions (p>0.05). Spearman's rank-order correlation showed no relationship between work experience and number of non-compliances (correlation coefficient=-0.04, p>0.05) and between safety training man-hours and number of non-compliances (correlation coefficient=-0.15, p>0.05). CONCLUSIONS Our results indicate that safety climate levels are influenced by number of safety inspections and the resultant non-compliances. PRACTICAL APPLICATIONS Findings suggest that safety non-compliances detected as a result of conducting safety inspections could be used to monitor the safety climate state. Establishing plans to conduct scheduled safety inspections and recording findings in the form of safety non-compliance and monitoring their trend could be used to monitor levels of safety climate.
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Matsouaka RA. Instrumental variable estimation of causal odds ratios using structural nested mean models. Biostatistics 2017; 18:465-476. [PMID: 28334061 PMCID: PMC5862265 DOI: 10.1093/biostatistics/kxw059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/03/2016] [Accepted: 12/15/2016] [Indexed: 11/14/2022] Open
Abstract
We consider estimating causal odds ratios using an instrumental variable under a logistic structural nested mean model (LSNMM). Current methods for LSNMMs either rely heavily on possible "uncongenial" modeling assumptions or involve intricate numerical challenges, which have impeded their use. In this article, we present an alternative method that ensures a congenial parametrization, circumvents computational complexity of existing methods, and is easy to implement. We illustrate the proposed method to (1) estimate the causal effect of years of education on earnings using data from the NLSYM and (2) assess the impact of moving families from high to low-poverty neighborhoods had on lifetime major depressive disorder among adolescents in the "Moving to Opportunity (MTO) for Fair Housing Demonstration Project" from the Department of Housing and Urban Development.
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Rameau A, de With E, Boerma EC. Passive leg raise testing effectively reduces fluid administration in septic shock after correction of non-compliance to test results. Ann Intensive Care 2017; 7:2. [PMID: 28050895 PMCID: PMC5209308 DOI: 10.1186/s13613-016-0225-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/08/2016] [Indexed: 11/27/2022] Open
Abstract
Background Fluid resuscitation is considered a cornerstone of shock treatment, but recent data have underlined the potential hazards of fluid overload. The passive leg raise (PLR) test has been introduced as one of many strategies to predict ‘fluid responsiveness.’ The use of PLR testing is applicable to a wide range of clinical situations and has the potential to reduce fluid administration, since PLR testing is based upon (reversible) autotransfusion. Despite these theoretical advantages, data on the net effect on fluid balance as a result of PLR testing remain scarce. Methods We performed a prospective single-center multi-step interventional study in patients with septic shock to evaluate the effect of implementation of PLR testing on the fluid balance (FB) 48 hours after ICU admission. All patients were equipped with a PiCCO® device for pulse contour analysis to guide fluid administration. An increase in stroke volume (SV) ≥ 10% was considered a positive test result. Results Before introduction of PLR testing, 21 patients were prospectively included in period 1 with a median FB of 4.8 [3.3–7.8]L. After an extensive training program, PLR testing was introduced and 20 patients were included in period 2. Median FB was 4.4 [3.3–7.5]L and did not differ from period 1 (p = 0.72). Further analysis revealed that non-compliance to the PLR test result was 44%. These findings were discussed with all ICU doctors and nurses. By consensus, non-compliance to the PLR test result was identified as the main reason for unsuccessful implementation of PLR testing. After this evaluation, 19 patients were included in period 3 under equal conditions as in period 2. In this period, median FB was 3.1 [1.5–4.9]L and significantly reduced in comparison with periods 1 and 2 (p = 0.016 and p = 0.023, respectively). Non-compliance was 9% and significantly lower than in period 2 (p = 0.009). Conclusion Implementation of PLR testing in patients with septic shock reduced fluid administration in the first 48 hours of ICU admission significantly and substantially. To achieve this endpoint, substantial non-compliance of ICU team members had to be addressed. Fluid administration despite a negative PLR test was the most common form of non-compliance. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0225-6) contains supplementary material, which is available to authorized users.
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Mutua EN, Bukachi SA, Bett BK, Estambale BA, Nyamongo IK. Lay knowledge and management of malaria in Baringo county, Kenya. Malar J 2016; 15:486. [PMID: 27653949 PMCID: PMC5031295 DOI: 10.1186/s12936-016-1542-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/16/2016] [Indexed: 02/03/2023] Open
Abstract
Background Malaria, a disease caused by protozoan parasites of the genus Plasmodium and transmitted by female anopheline mosquitoes, is a major cause of morbidity, mortality and loss in productivity in humans. Baringo County is prone to seasonal transmissions of malaria mostly in the rainy seasons. Methods This cross-sectional study used a mixed methods approach to collect data on knowledge and lay management of malaria. A questionnaire survey was administered to 560 respondents while qualitative data was collected through 20 focus group discussions in four ecological zones covering Baringo North, Baringo South and Marigat sub-Counties of Baringo County. Analyses were done through summary and inferential statistics for quantitative data and content analysis for qualitative data. Results The study communities were knowledgeable of malaria signs, symptoms, cause and seasonality but this biomedical knowledge co-existed with other local perceptions. This knowledge, however, did not influence their first (p = 0.77) or second choice treatments (p = 0.49) and compliance to medication (p = 0.84). Up to 88 % of respondents reported having suffered from malaria. At the onset of a suspected malaria case community members reported the following: 28.9 % visited a health facility, 37.2 % used analgesics, 26.6 % herbal treatments, 2.2 % remnant malaria medicines, 2.2 % over the counter malaria medicines, 1 % traditional healers and 1.8 % other treatments. Nearly all respondents (97.8 %) reported visiting a health facility for subsequent treatments. Herbal treatments comprised of infusions and decoctions derived from roots, barks and leaves of plants believed to have medicinal value. Compliance to conventional malaria treatment regime was, however, identified as a challenge in malaria management. Quick relief from symptoms, undesirable qualities like drug bitterness and bad smell, undesirable side-effects, such as nausea and long regimen of treatment were some of the contributors to non-compliance. Men and women exhibited different health-seeking behaviours based on the cultural expectations of masculinity, femininity, gender roles and acceptability of health services. Conclusions While knowledge of malaria is important in identifying the disease, it does not necessarily lead to good management practice. Treatment-seeking behaviour is also influenced by perceived cause, severity of disease, timing, anticipated cost of seeking treatment and gender, besides the availability of both traditional and conventional medicines.
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Evidence-based practice and barriers to compliance: Face bow transfer. J Prosthodont Res 2015; 60:20-2. [PMID: 26481058 DOI: 10.1016/j.jpor.2015.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/24/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To recapitulate a 2003 study inquiring of US dental schools whether they teach the face bow transfer by means of a survey in order to determine if compliance with clinical evidence has improved. METHODS The same 54 dental schools surveyed in 2003 were asked the same question regarding whether they teach the use of the face bow transfer in the complete denture curriculum. RESULTS Teaching of the face bow transfer has increased in prevalence from 84% of surveyed schools in 2003 to 93.75% of surveyed schools in 2015. CONCLUSIONS This finding is especially interesting in light of the fact that there is no compelling evidence supporting the use of the face bow transfer with regard to improving patient outcomes. With respect to the continued unjustified teaching of the face bow transfer, some possible reasons for non-compliance with best available evidence are presented using the medical literature for reference.
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Caprioglio A, Cafagna A, Fontana M, Cozzani M. Comparative evaluation of molar distalization therapy using pendulum and distal screw appliances. Korean J Orthod 2015; 45:171-9. [PMID: 26258063 PMCID: PMC4524956 DOI: 10.4041/kjod.2015.45.4.171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/07/2014] [Accepted: 12/27/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To compare dentoalveolar and skeletal changes produced by the pendulum appliance (PA) and the distal screw appliance (DS) in Class II patients. METHODS Forty-three patients (19 men, 24 women) with Class II malocclusion were retrospectively selected for the study. Twenty-four patients (mean age, 12.2 ± 1.5 years) were treated with the PA, and 19 patients (mean age, 11.3 ± 1.9 years) were treated with the DS. The mean distalization time was 7 months for the PA group and 9 months for the DS group. Lateral cephalograms were obtained at T1, before treatment, and at T2, the end of distalization. A Mann-Whitney U test was used for statistical comparisons of the two groups between T1 and T2. RESULTS PA and DS were equally effective in distalizing maxillary molars (4.7 mm and 4.2 mm, respectively) between T1 and T2; however, the maxillary first molars showed less distal tipping in the DS group than in the PA group (3.2° vs. 9.0°, respectively). Moreover, significant premolar anchorage loss (2.7 mm) and incisor proclination (5.0°) were noted in the PA group, whereas premolar distal movement (1.9 mm) and no significant changes at the incisor (0.1°) were observed in the DS group. No significant sagittal or vertical skeletal changes were detected between the two groups during the distalization phase. CONCLUSIONS PA and DS seem to be equally effective in distalizing maxillary molars; however, greater distal molar tipping and premolar anchorage loss can be expected using PA.
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Seth P, Kaur H, Kaur M. Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital. J Clin Diagn Res 2015; 9:OC01-4. [PMID: 26266145 DOI: 10.7860/jcdr/2015/8586.5995] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/09/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diabetic ketoacidosis, a well-known and major acute metabolic complication classically occurs in young patients with type 1 diabetes. However, it may occur in patients with type 2 Diabetes Mellitus too. OBJECTIVE Aim of this study was to look into the clinical profile, precipitating factors and clinical outcome in the patients presenting with Diabetic ketoacidosis in the Emergency of a Tertiary care hospital. DESIGN The study was a prospective study conducted over a period of two years in Kasturba Medical College, Manipal Karnataka, India. MATERIALS AND METHODS Clinical profile of 60 diabetic patients admitted in the Emergency with the diagnosis of Diabetic ketoacidosis were analysed. RESULTS Out of 60 patients, 12 were of Type 1 and 48 were Type 2 Diabetes Mellitus. Mean duration of diabetes was 8.65 years. Only 14 (23.3%) patients were taking regular treatment for Diabetes Mellitus whereas 32 (53.33%) patients were on irregular treatment and eight (13.33%) were not on any treatment at all. Among 12 Type 1 Diabetic patients, six patients were freshly diagnosed to be diabetic when they presented with Diabetic ketoacidosis complication. Nausea and vomiting (63.33%) were the most common symptoms of these patients. Infections (73.33%) were the most common precipitating factor for Diabetic ketoacidosis. Mean fluid requirement on first day of therapy was 3.51 liters. Mortality of 10% was seen. CONCLUSION Diabetic ketoacidosis is a fatal acute metabolic complication of Diabetes Mellitus with heterogeneous clinical presentation. Early diagnosis and treatment can avoid morbidity & mortality.
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Guercio JM, Cormier RJ. Blending Stimulus Fading Procedures with Forward Chaining to Address Treatment Resistance in an Adult with an Autism Spectrum Disorder. Behav Anal Pract 2015; 8:215-218. [PMID: 27703922 DOI: 10.1007/s40617-015-0060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The following paper details the implementation of a program to address the high-risk physical aggression and property destruction behavior of an adult male with an autism spectrum disorder (ASD) and severe aggressive behavior. A task analysis (TA) and forward chaining were combined with a stimulus fading procedure to allow the subject to be able to participate in van rides when prompted with no displays of aggressive or self-injurious behavior. A follow-up probe completed at 1-year post intervention demonstrated the maintenance of the gains that were made during treatment.
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Shah N, Castro-Sánchez E, Charani E, Drumright LN, Holmes AH. Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices. J Hosp Infect 2015; 90:126-34. [PMID: 25820128 DOI: 10.1016/j.jhin.2015.01.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and understanding the determinants of healthcare workers' (HCWs) behaviour is fundamental to develop effective and sustained behaviour change interventions. AIM To identify behaviours of HCWs that facilitated non-compliance with IPC practices, focusing on how appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working environment that may explain inconsistencies in IPC practices. METHODS Clinical staff at a National Health Service hospital group in London, UK were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework. FINDINGS Three ways in which HCWs appraised their behaviour were identified through accounts of IPC policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged work relationships. CONCLUSIONS Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of local normative practices, individual preferences and a degree of professional isolation.
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Pandey KC, Revannasiddaiah S, Pant NK. Evaluation of Factors in Relation with the Non-Compliance to Curative Intent Radiotherapy among Patients of Head and Neck Carcinoma: A Study from the Kumaon Region of India. Indian J Palliat Care 2015; 21:21-6. [PMID: 25709180 PMCID: PMC4332121 DOI: 10.4103/0973-1075.150161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Radiotherapy (RT)-based curative regimens for head and neck squamous cell carcinomas (HNSCC) deliver a dose of 66-70 Gray (Gy) over a period of 6-7 weeks, and incomplete treatments are unlikely to result in cure. Non-compliance to RT is major contributory factor to treatment failure. AIMS To assess the proportion of patients who do not complete planned treatment after initiation of curative RT. This study also aims to explore a possible relationship of non-compliance due to socio-economic, disease-related and treatment-related factors. MATERIALS AND METHODS The records of HNSCC patients treated from January 2012-December 2013 were audited. Data from the treatment records were to collect patient-related, disease-related, and social demographic parameters. Of the patients who had not completed treatment, the reasons behind the same were investigated. RESULTS Of the 324 patients of HNSCC who were initiated on radical RT, a total of 76 patients were found to have discontinued treatment without authorization of the treating clinician. There was no significant predilection for treatment non-compliance with regards to patient age, educational status, religion, site of the disease, use of neoadjuvant chemotherapy, or use of concurrent chemotherapy. There tended to be a higher association of treatment non-compliance among patients residing >100 km away from the treatment center, patients hailing from hilly regions, patients without the below poverty line (BPL) card, unemployed patients, and patients with stage IV-A/B disease. Of the 76 patients who did not complete treatment, telephonic questionnaire could be obtained from 54 patients. Causes for non-compliance included preference for traditional healers (22.2%), fear of toxicity (7.4%), logistic reasons (18.5%), financial reasons (24.1%), and lack of interest/faith in RT (5.6%). CONCLUSION There is a high incidence of treatment default among patients of HNSCC during RT in this region. The revelation of the higher propensity for treatment default among patients from distant, hilly regions, unemployed, patients without BPL cards, and stages-IVA/IVB highlights the need for specific interventions for these special populations.
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Toh MR, Teo V, Kwan YH, Raaj S, Tan SYD, Tan JZY. Association between number of doses per day, number of medications and patient's non-compliance, and frequency of readmissions in a multi-ethnic Asian population. Prev Med Rep 2014; 1:43-7. [PMID: 26844038 PMCID: PMC4721491 DOI: 10.1016/j.pmedr.2014.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate whether number of doses per day and number of medications are significantly associated with the number of readmissions and to study the association of readmission frequency with other medical and socio-demographic variables. Methods Retrospective cross-sectional study involving 432 patients who were readmitted within 15 days of previous hospital discharge between January 1, 2013 and March 31, 2013. Relevant medical records were collected from the national electronic databases of every public tertiary hospital in Singapore. Significant variables (p < 0.05) were identified using forward selection and modeled using generalized linear mixed models. Results A total of 649 unplanned readmissions were reviewed. At a multivariable level, number of readmission was significantly associated with the number of medications (p = 0.002) and number of doses per day (p = 0.003) after adjusting for race, liver disease, schizophrenia and non-compliance. Conclusion Complex medication regimen (i.e. multiple medications and multiple doses per day) is a statistically significant predictor of number of readmissions. Simplifying therapeutic regimens with alternatives such as longer-acting or fixed-dose combination drugs may facilitate better patient adherence and reduce costly readmissions. Patient's non-compliance can increase risk of unplanned readmissions. The number of doses per day is a positive predictor of unplanned readmissions. Higher number of medications is associated with more frequent readmissions.
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