Echocardiographic Characterization of Postnatal Development in Mice with Reduced Arterial Elasticity

PURPOSE

Decreased expression of elastin results in smaller, less compliant arteries and high blood pressure. In mice, these differences become more significant with postnatal development. It is known that arterial size and compliance directly affect cardiac function, but the temporal changes in cardiac function have not been investigated in elastin insufficient mice. The aim of this study is to correlate changes in arterial size and compliance with cardiac function in wildtype (WT) and elastin haploinsufficient (Eln^+/- ) mice from birth to adulthood.

METHODS

Ultrasound scans were performed at the ages of 3, 7, 14, 21, 30, 60, and 90 days on male and female WT and Eln^+/- mice. 2-D ultrasound and pulse wave Doppler images were used to measure the dimensions and function of the left ventricle (LV), ascending aorta and carotid arteries.

RESULTS

Eln^+/- arteries are smaller and less compliant at most ages, with significant differences from WT as early as 3 days old. Surprisingly, there are no correlations (R² < 0.2) between arterial size and compliance with measures of LV hypertrophy or systolic function. There are weak correlations (0.2 < R² < 0.5) between arterial size and compliance with measures of LV diastolic function.

CONCLUSIONS

Eln^+/- mice have similar cardiac function to WT throughout postnatal development, demonstrating the remarkable ability of the developing cardiovascular system to adapt to mechanical and hemodynamic changes. Correlations between arterial size and compliance with diastolic function show that these measures may be useful indicators of early diastolic dysfunction.

Clinical features of patients on home oxygen therapy due to chronic respiratory failure at one university hospital

BACKGROUND/AIMS

Home oxygen therapy (HOT) costs a great deal every year and demand for the service is growing. In Korea, health insurance has covered HOT since November 1, 2006. The objective of this study was to evaluate clinical features of patients who used long-term HOT due to chronic respiratory failure and to determine the appropriateness of oxygen prescriptions.

METHODS

Between November 2006 and April 2010, patients prescribed long-term HOT were enrolled in the study at a tertiary university referral hospital and their medical records and telephone survey information were evaluated. In total, 340 patients were evaluated retrospectively.

RESULTS

Regarding the initial indications for HOT, their mean PaO(2) was 49.8 mmHg and mean SpO(2) was 82.2%. Underlying diseases included chronic obstructive pulmonary disease (COPD, 19.8%), lung cancer (12.6%), and interstitial lung disease (11.2%). The admission rate within 1 year was 53.4% and the average number of admissions was 1.64/patient. Other underlying diseases for which oxygen was prescribed, despite not meeting the insurance coverage criteria, were lung cancer (36.6%) and interstitial pneumonia (16.6%).

CONCLUSIONS

Home oxygen prescriptions have increased since health insurance coverage was extended. However, cases of oxygen prescriptions frequently do not meet the coverage criteria. It is important to discuss extending the coverage criteria to other disease groups, such as interstitial lung disease and lung cancer, in terms of cost-effectiveness. Further, physicians prescribing oxygen therapy should be educated regarding the criteria.

Evaluation of anxiety level changes during the first three months of orthodontic treatment

Objective

To determine the changes in dental anxiety, state anxiety, and trait anxiety levels of patients and their parents after 3 months of active orthodontic treatment.

Methods

We evaluated 120 patients and one parent of each patient. State Anxiety (STAI-S), Trait Anxiety (STAI-T), and Corah's Dental Anxiety Scale (DAS) were administered before orthodontic treatment (T1) and after 3 months of treatment (T2). Differences in scores between T1 and T2 were compared using paired-sample t-tests and the relationship between the scores of the DAS and the STAI were analyzed using a bivariate two-tailed Pearson correlation test.

Results

Dental anxiety and state anxiety levels decreased among the patients after adjustment to orthodontic treatment (p < 0.001). However, 3 months of treatment was not sufficient to decrease the anxiety levels of parents (p > 0.05). Patient trait anxiety affected patient state anxiety and dental anxiety (p < 0.01). Additionally, a significant correlation was found between patient dental anxiety and parent dental anxiety (p < 0.05).

Conclusions

Dental anxiety and state anxiety levels decrease after patients become familiar with their orthodontist and they became accustomed to orthodontic treatment. However, 3 months is not a sufficient length of time to decrease parental anxiety levels.

Improving the compliance of the recurrent stone-former

Objective

To provide an overview of aspects of compliance by the recurrent stone-former, and to give recommendations for its improvement. About half of all stone-formers have one recurrence during their lifetime. To avoid recurrent stone formation it is necessary to use metaphylaxis, based on individual risks. However, all general and specific efforts are meaningless if patients are not willing or are incapable of following the proposed therapy in the long-term.

Methods

PubMed was searched for articles on urolithiasis, metaphylaxis, compliance and adherence, and relevant papers were reviewed.

Results

Compliance is a multidimensional phenomenon which is determined by the interaction of different factors, i.e. social and economic, therapy-related, patient-related, condition-related, and healthcare team and system-related factors. Subsequently there are several different interventional possibilities at the urologist’s disposal to effect better compliance by the patient.

Conclusions

The treatment and metaphylaxis of the recurrent stone-former present a particularly pertinent challenge. Patient compliance has an immense influence on the success of the treatment with respect to metaphylaxis, which is the decisive factor for preventing stone recurrence.

The Role of Context-Specific Norms and Group Size in Alcohol Consumption and Compliance Drinking During Natural Drinking Events

Using experience sampling methods we examined how group size and context-specific drinking norms corresponded to alcohol consumption and compliance with drinking offers during natural social drinking events. For 30 days, 397 college students reported daily on their alcohol consumption during social events, the size of the group they were with, the average alcohol consumption of its' members, and the number of drinks they accepted that came directly from the group they were with during these social drinking events. Larger groups corresponded with greater alcohol consumption, but only when context-specific norms were high. Furthermore, larger groups increased compliance with drinking offers when context-specific norms were high, but decreased compliance with drinking offers when context-specific norms were low. Thus, subtle features of the social-context may influence not only overall consumption behavior, but also compliance with more overt forms of social influence.

Consequences and potential problems of operating room outbursts and temper tantrums by surgeons

Background:

Anecdotal tales of colorful temper tantrums and outbursts by surgeons directed at operating room nurses and at times other health care providers, like residents and fellows, are part of the history of surgery and include not only verbal abuse but also instrument throwing and real harassment. Our Editor-in-Chief, Dr. Nancy Epstein, has made the literature review of “Are there truly any risks and consequences when spine surgeons mistreat their predominantly female OR nursing staff/colleagues, and what can we do about it?,” an assigned topic for members of the editorial board as part of a new category entitled Ethical Note for our journal. This is a topic long overdue and I chose to research it.

Methods:

There is no medical literature to review dealing with nurse abuse. To research this topic, one has to involve business, industry, educational institutions, compliance standards and practices, and existing state and federal laws. I asked Dr. Rosanne Wille to co-author this paper since, as the former Dean of Nursing and then Provost and Senior Vice President for Academic Affairs at a major higher educational institution, she had personal experience with compliance regulations and both sexual harassment and employment discrimination complaints, to make this review meaningful.

Results:

A review of the existing business practices and both state and federal laws strongly suggests that although there has not been any specific legal complaint that is part of the public record, any surgeon who chooses to act out his or her frustration and nervous energy demands by abusing co-workers on the health care team, and in this case specifically operating room personnel, is taking a chance of making legal history with financial outcomes which only an actual trial can predict or determine. Even more serious outcomes of an out-of-control temper tantrum and disruptive behavior can terminate, after multiple hearings and appeals, in adverse decisions affecting hospital privileges.

Conclusions:

Surgeons who abuse other health care workers are in violation of institutional bylaws and compliance regulations and create a hostile environment at work which adversely affects efficient productivity and violates specific State and Federal laws which prohibit discrimination based on race, color, sex, religion, or national origin.

[Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events]

BACKGROUND AND OBJECTIVE

To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension.

PATIENTS AND METHODS

An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥ 11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs.

RESULTS

We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P<.001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P<.001), compliance (71.4 vs. 69.9 and 67.1%, P=.017), persistence (50.1 vs. 45.5 and 46.2%, P=.044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P<.001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P<.001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p<.001).

CONCLUSIONS

Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs.

Relationship between symptoms and proximal stomach function in patients with functional dyspepsia

AIM: To investigate the prevalence of impaired proximal stomach function and its relationship to symptoms in patients with functional dyspepsia (FD).

METHODS: Fifty-nine patients with FD and 32 healthy subjects (HS) were enrolled in this study. After an overnight fast of at least 12 h, a double-lumen polyvinyl tube with an adherent plastic bag that was finely folded was introduced through the patient's mouth. A gastric barostat was used to evaluate proximal stomach function (sensitivity, accommodation and compliance). After an overnight fast, gastric emptying was measured by single photon emission computerized tomography (SPECT). The gastric emptying curve was plotted to calculate the gastric emptying half-time. Individual dyspepsia symptom scores were obtained for all patients and their relationship with proximal stomach function was assessed. Logistic regression analysis and χ² statistics were used to identify the association between proximal stomach function and symptoms.

RESULTS: Visceral hypersensitivity to gastric distention was found in 44.07% of the patients, and their gastric emptying half-time did not significantly differ from that of patients with normal sensitivity. Epigastric pain was significantly more prevalent in patients with visceral hypersensitivity than in those with normal sensitivity (P < 0.01). Epigastric pain was independently and significantly associated with hypersensitivity to gastric distention (OR = 4.430, P < 0.05). Impaired gastric accommodation was found in 37.29% of the patients, and their gastric emptying half-time did not differ from that of other patients. Impaired gastric accommodation to gastric distention was associated with a higher prevalence of early satiety (P < 0.05). The presence of early satiety was the only symptom that was independently associated with impaired accommodation to gastric distention (OR = 3.231, P < 0.05). Reduced compliance was found in 54.24% of the patients; however, no relationship was found between reduced compliance and dyspeptic symptoms.

CONCLUSION: Symptoms are associated with impaired proximal stomach function in patients with FD. Epigastric pain and early satiety can be used to predict the presence of hypersensitivity and impaired accommodation, respectively.

Metaphylaxis, diet and lifestyle in stone disease. Arab J Urol. 2012;10:240-249. [PMID: 26558032 PMCID: PMC4442949 DOI: 10.1016/j.aju.2012.03.003]

Objective

The most common urinary stones (calcium salts, uric acid) form due to genetic factors and lifestyle. This review describes why, if and how medication and lifestyle changes can reduce the risk of formation.

Methods

Previous reports were reviewed to obtain information on three aspects of urolithiasis, i.e. epidemiology, mechanisms linking lifestyle and urolithiasis and lifestyle intervention for preventing urolithiasis.

Results

Epidemiological evidence links the prevalence of urinary stone formation to general lifestyle factors. Detailed analysis has identified individual lifestyle elements that affect the risk of urinary stone formation. Currently there are several concepts that explain the mechanism of stone formation. Urinary markers like calcium, oxalate, phosphate, uric acid and urinary pH are involved in all these concepts. Many studies show that changing (combinations of) specific lifestyle elements has a favourable effect on these urinary markers. Based on this evidence, protocols have been developed that use a combination of these lifestyle changes and medication to prevent stone formation. In well-controlled studies where patients are optimally informed and continuously motivated, these protocols clearly reduce the stone formation rate. In general practice the result is less clear, because the time and tools are insufficient to maintain long-term patient compliance in the use of medication and lifestyle advice.

Conclusion

The risk of stone formation can be reduced in general practice when the patient’s compliance is optimised by providing individualised advice, continuous information, and feedback and incorporation of the advice into a regular lifestyle. The use of ‘e-tools’ might enable this without increasing the time required from the physician.

Effect of sociodemographic variables on complete denture satisfaction

PURPOSE

The objective of this study was to evaluate the effect of sociodemographic factors on quality of satisfaction towards denture treatment.

MATERIALS AND METHODS

One hundred subjects (filling inclusion criteria) who were wearing a denture for at least two months were enrolled and divided into five groups on the basis of sociodemographic variables (age, gender, literacy level, socio-economic and marital status). Questionnaires consisting of 38 questions (positive and negative attitude towards denture satisfaction) related to patients' perception of clinical outcome in different domains such as mastication, appearance, speech, comfort, health, denture care and social status were scored by the subjects. Questions reflecting positive attitude were scored as 2, 1, or 0 (yes, uncertain and no, respectively) and reversely for the negative questions. Statistical analysis was done by using Statistical Package for Social Sciences (α = .05).

RESULTS

Level of denture satisfaction was higher in age subgroup belonging to 45 - 65 years of age in relation to comfort, health and denture care. Female and male showed significant priority for denture treatment because of esthetic and function respectively. Level of satisfaction was statistically significant with literacy level. Upper high income group showed significantly higher level of satisfaction only in case of social status. Married group showed significantly higher satisfaction level only with comfort.

CONCLUSION

Patients' sociodemographic variables were influential factors on denture satisfaction.

"Barriers to Cognitive Behavioral Therapy Homework Completion Scale- Depression Version": Development and Psychometric Evaluation

We conducted a two-phase study to develop and evaluate the psychometric properties of an instrument to identify barriers to Cognitive Behavioral Therapy (CBT) homework completion in a depressed sample. In Phase I, we developed an item pool by interviewing 20 depressed patients and 20 CBT therapists. In Phase II, we created and administered a draft instrument to 56 people with depression. Exploratory Factor Analysis revealed a 2-factor oblique solution of "Patient Factors" and "Therapy/Task Factors." Internal consistency coefficients ranged from .80 to .95. Temporal stability was demonstrated through Pearson correlations of .72 (for the therapist/task subscale) to .95 (for the patient subscale) over periods of time that ranged from 2 days to 3 weeks. The patient subscale was able to satisfactorily classify patients (75 to 79 %) with low and high adherence at both sessions. Specificity was .66 at both time points. Sensitivity was .80 at sessions B and .77 at session C. There were no consistent predictors of assignment compliance when measured by the Assignment Compliance Rating Scale (Primakoff, Epstein, & Covi, 1986). The Rating Scale and subscale scores did, however, correlate significantly with assignment non-compliance (.32 to .46).

Hand hygiene compliance in the intensive care units of a tertiary care hospital

Context:

Hand hygiene (HH) is the most important measure to prevent hospital-acquired infections but the compliance is still low.

Aims:

To assess the compliance, identify factors influencing compliance and to study the knowledge, attitude and perceptions associated with HH among health care workers (HCW).

Settings and Design:

Cross-sectional study conducted in 42 bedded Medical (Pulmonary, Medicine and Stroke) intensive care units (ICU) of a tertiary care hospital.

Materials and Methods:

HCWs (doctors and nurses) were observed during routine patient care by observers posted in each ICU and their HH compliance was noted. Thereafter, questionnaire regarding knowledge, perception and attitudes toward HH was filled by each HCW.

Statistical Analysis:

Percentages and χ² test.

Results:

The overall compliance was 43.2% (394/911 opportunities). It was 68.9% (31/45) in the intensivists, 56.3% (18/32) in attending physicians, 40.0% (28/70) in the postgraduate residents and 41.3% (301/728) in the nurses. Compliance was inversely related to activity index. Compliance for high, medium and low risk of cross-transmission was 38.8% (67/170), 43.8% (175/401) and 44.7% (152/340), respectively.

Conclusions:

Compliance of the study group is affected by the activity index (number of opportunities they come across per hour) and professional status. The HCWs listed less knowledge, lack of motivation, increased workload as some of the factors influencing HH.

Patterns and predictors of self-medication amongst antenatal clients in Ibadan, Nigeria

Background:

Self-medication is widely practiced in the study area, as many drugs are available over-the-counter, in addition to the use of local herbal preparations. Also, apprehension about the dangers of drug use in pregnancy appears to affect the compliance of prescribed medication. This study assess the drug use profile of an antenatal population.

Materials and Methods:

This was a questionnaire-based descriptive study of 410 antenatal clients attending primary, secondary and tertiary centers in Ibadan, Nigeria. The variables analysed were demographic data of respondents and level of health care received. Outcome measures were use of prescribed drugs, self-medication or herbal preparations. Chi-tests and logistic regression were used for statistical analysis.

Results:

All patients on prescribed medication for medical conditions claimed to be compliant with their drugs. Exactly 19.2% admitted to self-medication, mostly hematinics and pain-relieving pills (acetaminophen). No one admitted to alcohol or tobacco use, but 46.3%, especially attendees of the rural center (OR 5.79; 95% CI 2.56-13.10), ingested herbal concoctions while pregnant. Married women (OR 0.2; 95% CI 0.05-0.75) or those whose spouses had higher education (OR 0.43; 95% CI 0.21-0.89) were less likely to practice self-medication, while hypertensive women were more likely to practice it (OR 22.54; 95% CI 3.81-133.49).

Conclusions:

Social support has a role in safe drug use practices. This should be used to advantage by encouraging partners’ attendance at antenatal sessions. Patients need counseling on the dangers of procuring their usual prescription drugs without consultation. Use of herbal concoctions needs to be explored in the community.

Comparison of clinical characteristics of patients with gastroesophageal reflux disease who failed proton pump inhibitor therapy versus those who fully responded

Background/Aims

Refractory gastroesophageal reflux disease (GERD) is very common, affecting up to 40% of the patients receiving proton pump inhibitor (PPI) therapy. However, there is not much information about the clinical characteristics of these patients. The aim of the study is to compare the clinical characteristics of PPI responders vs non-responders.

Methods

Consecutive GERD patients receiving PPI once or twice daily were evaluated by a questionnaire and a personal interview regarding their demographics, habits, clinical characteristics and endoscopic findings. The patients were divided into 3 groups: Patients who fully responded to PPI once daily (Group A, n = 111), patients who failed PPI once daily (Group B, n = 78) and patients who failed PPI twice daily (Group C, n = 56).

Results

A total of 245 patients (59.3% females, 52 ± 17.2 years of age) were included in this study. Cross-group differences (A vs B vs C) were detected for hiatal hernia (33% vs 51% vs 52%, P = 0.011); erosive esophagitis (19% vs 51% vs 30%, P < 0.0001); cough (24% vs 44% vs 43%, P = 0.007); sleep disturbances (19% vs 30% vs 38%, P = 0.033); chest symptoms (21% vs 35% vs 41%, P = 0.010); Helicobacter pylori status (25% vs 33% vs 48%, P < 0.0001), disease duration (1.6 ± 0.8 vs 1.9 ± 1.0 vs 2.0 ± 1.1 years, P = 0.007), performed lifestyle interventions (68.5% vs 46.7% vs 69.6%, P = 0.043) and compliance (84% vs 55% vs 46%, P < 0.0001).

Conclusions

PPI failure (either once or twice daily) appears to be significantly associated with atypical GERD symptoms, disease duration and severity, H. pylori status, obesity, performed lifestyle interventions and compliance as compared with PPI responders.

Arterial stiffness in female patients with fibromyalgia and its relationship to chronic emotional and physical stress

BACKGROUND AND OBJECTIVES

In patients with fibromyalgia (FM) syndrome, stress and pain may chronically enhance sympathetic activity, altering cardiovascular responses and inducing the arterial wall-stiffening process. We investigated arterial stiffness in FM patients using pulse wave velocity (PWV) and analyzed whether arterial stiffness was affected by the clinical parameters of FM.

SUBJECTS AND METHODS

This study included 108 female FM patients (51.5±8.9 years) without any known cardiovascular diseases and 76 healthy female controls (50.1±8.9 years). FM patients underwent a manual tender point survey for tender point counts, and completed the visual analogue scale (VAS) of pain and fibromyalgia impact questionnaire (FIQ), which were composed of a physical and feel score. Brachial-ankle pulse-wave velocity (baPWV) was measured with an automated device. The study participants were subdivided into 2 groups based on the sum of the FIQ score (group A: FIQ ≥50, group B: <50).

RESULTS

Patients with FM had significantly higher baPWV than the controls, and significant increase were noted in baPWV values of group A compared with those of group B. BaPWV showed a significant positive correlation (correlation coefficient=6.83, p=0.022) with severity of disease assessed by FIQ.

CONCLUSION

The patients with FM showed significantly increased arterial stiffness, suggesting a pathophysiologic link between FM and endothelial dysfunction. This study provides a basis for clarifying the mechanism by which chronic pain syndrome is associated with an increased risk of vascular stiffness.

Morphological and biomechanical remodelling of the hepatic artery in a swine model of portal hypertension

OBJECTIVES

To obtain the biomechanical and morphological remodelling of hepatic arteries in swine with portal hypertension.

METHODS

A number of 20 white pigs was used, of which 14 were subjected to liver cirrhosis and portal hypertension (PHT) induced by carbon tetrachloride and pentobarbital; the rest were used as the control group. The biomechanical remodelling of the hepatic arteries was measured, namely, the incremental elastic modulus (E inc), pressure-strain elastic modulus (E p), volume elastic modulus (E v), the incremental compliance (C), the opening angle and the stained microstructural components of the vessels.

RESULTS

The percentages for the microstructural components and the histologic data significantly changed in the experimental group, three incremental elastic moduli (E inc, E p, and E v) of the experimental group were significantly larger than those of the control group (P < 0.05); the compliance of hepatic arteries decreased greatly (P < 0.05) too. The opening angle (OA) was considerably larger than that of control group (P < 0.05).

CONCLUSIONS

The study suggests that the morphological and biomechanical properties of swine hepatic arteries have changed significantly during the process of portal hypertension and that from biomechanical aspects, the hepatic arteries have also suffered from extensive remodelling, which in turn deteriorates the existing portal hypertension.

Antiglaucoma drugs: The role of preservative-free formulations

Hypersensitive reactions to eyedrops are a common finding in clinical practice and represent a frequent cause of discontinuation of the therapy. Moreover, experimental and clinical studies show that long term use of topical drugs may induce ocular surface changes causing discomfort and potentially negatively affecting the compliance to the treatment as well as the success rate of filtering procedures. The exact mechanism involved and the roles of the active compound and the preservatives in inducing such detrimental effects of ophthalmic solutions are unclear. During the last years several antiglaucoma agents have been marketed as either preservative-free or benzalkonium chloride-free formulations in an attempt to reduce the adverse effects related to preservatives. This paper summarizes the body of evidence from existing studies about preservatives in antiglaucoma eyedrops, focusing on the latest compounds commercially available. A systematic review of the literature was performed. Current research is focusing not only on the efficacy of the drugs but also on their tolerability. Based on the existing data, there is a rationale to support the use of benzalkonium-free solutions whenever possible, especially in patients suffering from concomitant ocular surface diseases, experiencing local side effects and in those expected to need multiple and prolonged topical treatments.

Physicians' therapeutic practice and compliance of diabetic patients attending rural primary health care units in Alexandria

OBJECTIVES

The objectives of the study were to investigate physician's therapeutic practice and the compliance of diabetic patients attending rural primary health units in Alexandria.

MATERIAL AND METHODS

A cross-sectional study was conducted and a multistage stratified random sample method was used for the selection of 600 diabetic patients. Data were collected by means of an interviewing questionnaire, an observation checklist, review of prescriptions and laboratory investigations. A scoring system was made for a diabetic patient's knowledge and skills, patient's compliance, doctor-patient relationship, and glycemic control.

RESULTS

About 57% always took their medication as prescribed by doctor and on time, only 2.2% always complied with dietary regimen while no one reported regular compliance with exercise regimen. Complications of the regimen was the commonest cause (63.3%) of noncompliance. A highly statistically significant difference was found between compliance with all regimens and patient's knowledge of diabetes. The scores for doctor-patient relationship were all unsatisfactory. Results of glycosylated hemoglobin (HbA1c) revealed that metabolic control of four-fifth of the patients was satisfactory, 12% had fair and 8% had poor metabolic control.

CONCLUSIONS

Patient's compliance with most of the diabetes regimen was low. Doctor-patient relationship and patient's compliance should be improved by conducting educational and training programs.

Compliance to recall visits by patients with periodontitis - Is the practitioner responsible?

Context:

Compliance to recall visit is directly related to the medium and long-term success of active periodontal therapy.

Aims:

To determine the percentage of patients who were compliant to recall visits by the practitioner and to find out the reasons for noncompliance by noncompliant patients.

Settings and Design:

Cross-sectional study was carried out in the Department of Periodontology, Amrita School of Dentistry. The study participants were former patients of the Department of Periodontology.

Patients and Methods:

A total of 216 patients were selected for the study — 116 males and 100 females. They were divided according to their socioeconomic status — professionals and nonprofessionals. Nonprofessionals were divided into those who had completed high school education and those who had not. They were followed up to find out how many were compliant to recall visits and the reasons for noncompliance by noncompliant patients.

Statistical Analysis:

The data was entered into SPSS version 11.5. Descriptive statistics were used. The frequencies of responses were calculated.

Result:

Of the total study population, 48.1% was compliant, of which 58.6% and 37.6% of males and females were compliant, respectively. In terms of percentage, 60.6% of professionals, 52.4% of those who had completed high school education and 31.3% of those who had not completed high school education were compliant.

Conclusion:

Compliance to recall visits by the periodontitis patients depends largely on the practitioner. Inadequate motivation by the practitioner and inadequate education in general are responsible for noncompliance to periodontal treatment.

The impact of requiring completion of an online infection control course on health professionals' intentions to comply with infection control guidelines: A comparative study

BACKGROUND

Ensuring good infection control practice in health care facilities is a constant concern, yet evidence shows that the compliance of health care professionals with proper procedures is lacking, despite the existence of guidelines and training programs. An online infection control module was developed to provide ready access to training. Controversy exists about whether successfully completing such a course should be mandatory or strongly encouraged for all health care professionals. The objective of the present study was to compare the perception of safety culture and intention to comply with infection control guidelines in professionals who were required by their supervisors to take the course, and those who did so voluntarily.

METHODS

Survey responses on learning environment, safety climate and intention to comply with infection control guidelines in health care professionals who were required to take the course (supervisor-required group [n=143]) and those who took the same course voluntarily (voluntary group [n=105]) were compared. Because randomization was thought to be too difficult to implement in the policy context in which the study was conducted, significant differences between the two groups were taken into account in the analysis.

RESULTS

Those required to take the course had a significantly better perception of the institutional safety climate (P<0.001), and had a higher reported intention to comply with infection control guidelines (P=0.040) than those who took the course voluntarily.

DISCUSSION

Requiring that staff complete a 30 min interactive online infection control module increased their intention to comply with infection control guidelines compared with those who voluntarily accessed this material based on promotional material. Consideration should be given to making the successful completion of an online infection control module a requirement for all health care professionals.

Cultural adaptation of a compliance questionnaire for patients with rheumatoid arthritis to a Korean version

BACKGROUND/AIMS

The Compliance Questionnaire-Rheumatology (CQR) is a validated scale to evaluate patient compliance for anti-rheumatic medications. We developed a Korean version of the CQR (KCQR) and confirmed its reliability and validity.

METHODS

We prepared the KCQR by translating and back-translating the original CQR with modifications to adapt it to Korean culture. Fifty Korean patients with rheumatoid arthritis (RA) were enrolled in this study. The test-retest reliability of the KCQR was evaluated at a 2-week interval using the intraclass correlation coefficient (ICC). The validity of the KCQR was assessed by identifying associations between KCQR scores and patient compliance, measured using pharmacy refill data.

RESULTS

The reliability of the KCQR was adequate, with an ICC of 0.71 for test-retest reliability. With respect to validity, the summed score of the weighted KCQR showed a significant correlation with pharmacy refill data (r² = 0.57) on multiple regression analysis.

CONCLUSIONS

Our results indicate that the KCQR is a reliable, valid instrument to evaluate compliance of Korean patients for RA medications.

Rheological behaviors of doughs reconstituted from wheat gluten and starch

Hydrated starch-gluten reconstituted doughs were prepared and dynamic rheological tests of the reconstituted doughs were performed using dynamic strain and dynamic frequency sweep modes. Influence of starch/gluten ratio on rheological behaviors of the reconstituted doughs was investigated. The results showed that the reconstituted doughs exhibited nonlinear rheological behavior with increasing strain. The mechanical spectra revealed predominantly elastic characteristics in frequency range from 10(-1) rad s(-1) to 10(2) rad s(-1). Cole-Cole functions were applied to fit the mechanical spectra to reveal the influence of starch/gluten ratio on Plateau modulus and longest relaxation time of the dough network. The time-temperature superposition principle was applicable to a narrow temperature range of 25°C ~40°C while it failed at 50°C due to swelling and gelatinization of the starch.

Effectiveness of and Adherence to Dietary and Lifestyle Counselling: Effect on metabolic control in type 2 diabetic Omani patients

OBJECTIVES

The Nutritional Advice Protocol, established by the Department of Health to combat diabetes, has been implemented in primary health care throughout Oman since 2003. This study aimed to assess the effectiveness of dietary and lifestyle advice and determine the perception and attitudes of Omani adults with type 2 diabetes to diabetes management.

METHODS

A cross-sectional epidemiological survey was conducted on 98 patients diagnosed with type 2 diabetes in Al-Buraimi Governorate, Oman. Metabolic parameters, dietary intake and exercise levels were evaluated in 2005 and re-evaluated in 2008.

RESULTS

A total of 43% of the patients (male = 16, female = 27) had received no formal education. A significant reduction in fasting glucose and enhanced high density lipoprotein cholesterol were achieved in both male and female patients. However, in men, no changes were noted, other than in anthropometric and metabolic measurements and macronutrient intake. Conversely, women's macronutrient intakes reduced significantly leading to considerable improvement in body weight, body mass index, blood glucose and total cholesterol levels. Eleven patients (11.6%) admitted that they did not adhere at all to the diet advised by the dietician; 63.2% (n = 62) reported they followed their diet sometimes, and 25.2% (n = 25) stated they strictly followed the diet.

CONCLUSION

Counselling largely illiterate diabetic patients about the impact of food, nutrition and exercise on diabetes shifted the patients from "Poor" to "Good" control in terms of metabolic outcome (glycosylated haemoglobin, fasting glucose and total cholesterol). This minor improvement could be further enhanced by more health education.

Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Type 2 Diabetes

Depression is one of the most common psychological problems among individuals diabetes, and it is associated with worse treatment adherence and clinical outcomes. As part of a program of treatment research aimed at integrating interventions for depression and treatment nonadherence, five depressed patients with suboptimally controlled type 2 diabetes were treated with 10-12 sessions of individual cognitive behavioral therapy for adherence and depression (CBT-AD) in a case-series design. The intervention was delivered in a hospital setting by a collaborative team consisting of a psychologist, a nurse educator, and a dietitian. Post-treatment, all participants demonstrated a decrease in depression severity and demonstrated improvements in diabetes self-care. Four of the five demonstrated improved glycemic control. These preliminary results provide evidence for the acceptability, feasibility, and potential utility of CBT-AD for patients with type 2 diabetes and depression.

Bright light therapy: Minimizing light induced side effects with an innovative light setup

Abstract Objective. Bright light therapy (BLT) is regarded to be an effective treatment against seasonal depression (SAD). Conventional BLT devices are reported to evoke few, but inconvenient symptoms. This study evaluated side effects associated with a new technology for BLT in a healthy population. Methods. In an uncontrolled study design 20 healthy Caucasians received 30 min light exposures on three consecutive mornings. Immediate side effects were evaluated using questionnaires. The new light cabin was equipped with fluorescent lamps (light colour 965 = 6,500 K, CRI >90) with a maximum illumination of 5,000 lux and a maximum luminance of 1,500 cd/m(2). Occurrence of headache was determined to be the main objective. Results. Nineteen volunteers completed the study. No headache was reported at any time. With a prevalence of 21.1% blurring was observed to occur more often after light exposure. Conclusion. With the evaluated light cabin the most prominent short-term side effects of BLT can be minimized, enhancing patients' adherence.

Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace

PURPOSE

Dynamic SpineCor was designed to overcome the disadvantages of rigid orthoses-bulkiness, physical constraint and warming-and to improve the acceptance and compliance as limiting factors of brace treatment. Those theoretical benefits have not been proved by compliance studies yet.

METHODS

SpineCor braces of 12 adolescent scoliotic girls were equipped with flexible temperature loggers, which were sandwiched between gel foam and the brace's pelvic base. Patients and parents were blinded for the observation period of 14 days and gave post-hoc consent. The logger yielded 672 time-stamped values at 30-min intervals. Pilot testing revealed values beyond the 30°C threshold as indicative for brace wear.

RESULTS

The average overall compliance (% wearing hours/prescribed 23 h) was 54% ± 22.3 (range, 11.8-95.8%). The youngest patients (aged 10-12 years) were significantly more compliant than the others (P < 0.05). Most patients had a scattered wearing pattern: one was a day-wearer, one a night-wearer and only the two high adherers showed a consistent daily pattern. There was no significant difference between weekdays, weekdays and weekends, nor between day and night wear.

CONCLUSION

The current study showed that the compliance of patients in a dynamic SpineCor is as limited as in a conventional brace. This is in line with earlier data on patients' SpineCor and rigid brace acceptance evaluated by a questionnaire and on temperature logging in rigid braces.

The Effects of Breast Self-examination Program Enriched Environmentally among Healthy Women

PURPOSE

The purpose of this study was to determine the effects of an environmental enrichment program on barrier, benefit, confidence, and compliance of breast self-examination in women at 3 months after instruction.

METHODS

Nonequivalent control group pretest-posttest design was conducted among 62 healthy women. Data were collected through the self-reported questionnaires from December 2008 to March 2009. Women were assigned to one of two treatment groups: (a) no-support of environmental enrichment with the instruction control group; (b) the support of environmental enrichment with the instruction experimental group. All women received the same instruction on breast self-examination once a week for two weeks. Data were analyzed with paired t-test, McNemar test and ANCOVAs of controlling for age run using SPSS/WIN 17.0.

RESULTS

The experimental group was significantly lower than control group on perceived barrier (F=5.91, p=.02) and higher than control group on compliance of breast self-examination (F=4.57, p=.04) after environmental enrichment program. However the environmental enrichment program did not make significant differences on benefit (F=0.01, p=.91) and confidence (F=0.77, p=.38).

CONCLUSION

Findings suggest that the environmental enrichment should be needed to support women's breast self-examination and expanded for compliance of breast self-examination to promote the secondary prevention of women breast cancer.

The value of brachial-ankle pulse wave velocity as a predictor of coronary artery disease in high-risk patients

BACKGROUND AND OBJECTIVES

Arterial stiffness has been known as an independent contributory factor for coronary artery disease (CAD). Brachial-ankle pulse wave velocity (baPWV) is widely used as a simple noninvasive measure of arterial stiffness. The aim of our study was to test whether baPWV had predictive value for CAD in the subset of patients with high pretest probability.

SUBJECTS AND METHODS

We enrolled 174 consecutive patients who were referred for evaluation of suspected CAD, and who underwent both baPWV measurement and computed tomography (CT) for coronary artery calcium scoring (CACS) as part of a diagnostic work-up. Subsequently, 160 of those patients underwent invasive coronary angiography. The CAD indices consisted of 1) CACS, 2) modified Gensini scoring system, and 3) presence of obstructive CAD and 4) multi-vessel obstructive CAD.

RESULTS

baPWV correlated with CACS (r=0.25, p=0.001), but not with modified Gensini scoring (r=0.10, p=0.19). However, after adjustment for factors influencing PWV, baPWV no longer correlated with CACS (r=0.14, p=0.14). By receiver operating characteristic (ROC) curve analysis, baPWV was neither a sensitive nor specific index for predicting the presence of obstructive CAD or multi-vessel obstructive CAD (sensitivity: 53% and 59%; specificity: 50% and 55%, respectively).

CONCLUSION

Our findings demonstrated that baPWV is associated with CACS, however, this may be primarily attributed to common risk factors, such as age. Furthermore, baPWV may be of limited value in identifying patients at risk for CAD.

Initial adherence to autotitrating positive airway pressure therapy: influence of upper airway narrowing

Objectives

There is still debate concerning the reason for the high initial failure rate of positive airway pressure (PAP) treatment. The objective of this study is to investigate the factors of the initial adherence to PAP, with an emphasis on the role of upper airway narrowing.

Methods

The patients were divided into two groups according to the continuation of therapy within the first three months of treatment. The demographic and polysomnographic findings, the minimal nasal cross sectional area (MCA), the degree of palatine tonsilar hypertrophy (PTH) and the modified Mallampati grade of the oropharynx inlet (Orophx) were compared between the study groups.

Results

Among 36 patients, 23 continued the auto-adjusting positive airway pressure (APAP) therapy (the adherent group) and 13 discontinued APAP within three months (the non-adherent group). The apnea-hypopnea index (AHI) was significantly higher in the adherent group than in the non-adherent group (P<0.001). The AHI distributions of the two groups are extremely different. Thirteen of the 23 patients in the adherent group had an AHI of more than 60/hr, while none of the patients in the non-adherent group had an AHI of more than 60/hr. In the patients with an AHI from 15 to 60/hr, the MCA at the wide side of the nasal cavity and the sum of the MCAs of both sides were significantly larger in the adherent group than those values in the non-adherent group (P=0.004). The PTH and the Orophx were not significantly different between the two groups.

Conclusion

AHI is a definite significant factor of adherence to APAP therapy. The dimension of the nasal cavity has an influence on initial APAP adherence in the patients who have a not too high level of AHI.

Early compliance and efficacy of sublingual immunotherapy in patients with allergic rhinitis for house dust mites

OBJECTIVES

Sublingual immunotherapy (SLIT) has recently received much attention around the world as a treatment for allergic rhinitis. This study aimed to investigate the efficacy and adverse effects of SLIT in Korean patients with allergic rhinitis caused by house dust mites. The treatment compliance and the patient satisfaction with SLIT were also assessed.

METHODS

The patients who were sensitized to Dermatophagoides pteronyssinus and Dermatophagoides farinae and who started SLIT between November 2007 and July 2008 were included in this study. The symptom questionnaires, which included items on rhinorrhea, sneezing, nasal obstruction, itchy nose, olfactory disturbance, eye discomfort and sleep disturbance, were obtained before and 6 months after SLIT. The patient satisfaction and the adverse effects were also investigated.

RESULTS

One hundred forty-two patients started SLIT and 98 of them continued SLIT for 6 months or more. Ninety-two of the 98 patients completed the questionnaires. The duration of receiving SLIT was 9.8 months on average (range, 6 to 13 months). All the symptoms of allergic rhinitis were improved with SLIT. Forty-five percent of the patients were satisfied for SLIT, while 12% were unsatisfied. The incidence of adverse effects was 12% during maintenance therapy, although it was 48% during the up-dosing phase. The drop-out rate of SLIT was 31.0%.

CONCLUSION

The subjective symptoms were improved with SLIT in Korean patients with allergic rhinitis for house dust mites. Yet the drop out rate was high despite of the symptomatic improvement.

Prevalence, predictors, and clinical consequences of medical adherence in IBD: How to improve it?

Inflammatory bowel diseases (IBD) are chronic diseases with a relapsing-remitting disease course necessitating lifelong treatment. However, non-adherence has been reported in over 40% of patients, especially those in remission taking maintenance therapies for IBD. The economical impact of non-adherence to medical therapy including absenteeism, hospitalization risk, and the health care costs in chronic conditions, is enormous. The causes of medication non-adherence are complex, where the patient-doctor relationship, treatment regimen, and other disease-related factors play key roles. Moreover, subjective assessment might underestimate adherence. Poor adherence may result in more frequent relapses, a disabling disease course, in ulcerative colitis, and an increased risk for colorectal cancer. Improving medication adherence in patients is an important challenge for physicians. Understanding the different patient types, the reasons given by patients for non-adherence, simpler and more convenient dosage regimens, dynamic communication within the health care team, a self-management package incorporating enhanced patient education and physician-patient interaction, and identifying the predictors of non-adherence will help devise suitable plans to optimize patient adherence. This editorial summarizes the available literature on frequency, predictors, clinical consequences, and strategies for improving medical adherence in patients with IBD.

Proximal gastric function in volunteers with different types of simple obesity: an analysis of 67 cases

AIM: To analyze the characteristics of changes in proximal gastric function in volunteers with different types of simple obesity.

METHODS: Sixty-seven volunteers with simple obesity were divided into three groups, namely, group A (volunteers with binge eating), group B (volunteers with normal diet) and group C (volunteers with functional dyspepsia). Thirty-two non-obese healthy volunteers formed the control group (group D). Gastric barostat studies were then performed to record the changes in gastric capacity, intragastric pressure and gastric compliance in response to mechanical distension.

RESULTS: The initial volume (IV) and maximal tolerance volume (MV) in group A were significantly larger than those in group D (t = -6.63 and -5.20, respectively; both P < 0.01), whereas these two parameters in group C were significantly lower than those in group D (t = 3.48 and 2.11, respectively; both P < 0.01). The initial intragastric pressure (IP) and the maximal tolerance pressure (MP) in group C were significantly lower than those in group D (t = 2.09 and 2.08, respectively; both P < 0.05). The initial gastric compliance (IC) and the maximal tolerance compliance (MC) in group A were significantly higher than those in group D (t = 2.44 and -5.56, respectively; both P < 0.01), whereas these two parameters in group C were significantly than those in group D (t = 2.44 and 2.32, respectively; both P < 0.05).

CONCLUSION: The main reason for the development of obesity in binge eaters is due to an increase in gastric capacity, compliance and accommodation as well as a delay in satiety.

Compliance with positive airway pressure treatment for obstructive sleep apnea

Objectives

Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients.

Methods

We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7® of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors.

Results

After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other.

Conclusion

The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.

Use of new once-daily 5-aminosalicylic acid preparations in the treatment of ulcerative colitis: Is there anything new under the sun?

5-aminosalicylate (5-ASA) agents remain the mainstay treatment in ulcerative colitis (UC). A number of oral 5-ASA agents are commercially available, including azobond pro-drugs, as well as delayed- and controlled-release forms of mesalazine. However, poor adherence due to frequent daily dosing and a large number of tablets has been shown to be an important barrier to successful management of patients with UC. Recently, new, once-daily formulations of mesalazine, including the unique multi-matrix delivery system and mesalazine granules, were proven to be efficacious in inducing and maintaining remission in mild-to-moderate UC, with a good safety profile comparable to that of other oral mesalazine formulations. In addition, they offer the advantage of a low pill burden and might contribute to increased long-term compliance and treatment success in clinical practice. This editorial summarizes the available literature on the short- and medium-term efficacy and safety of the new once-daily mesalazine formulations.

How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study

PURPOSE

There is a need to study compliance with surgical antibiotic prophylaxis guidelines in India.

METHODS

In this prospective study, 100 consecutive surgical procedures performed at a tertiary care private hospital in Mumbai, India were observed. The choice of antibiotic, timing and duration of administration were recorded and compared to the hospital guidelines.

RESULTS

Appropriateness of choice of antibiotic was seen in 68%, timing in 89%, dose in 75% and duration in 63% of cases. Hundred percent compliance to all criteria was observed in 52% of cases. The SSI rate was 3.3%.

CONCLUSIONS

These compliance rates though suboptimal are similar to those reported in world literature. There is an urgent need to improve compliance with optimal surgical antibiotic prophylaxis guidelines so as to reduce risk of SSI and to prevent resistance and costs potentially associated with antibiotic misuse.

Will the evolution of overactive bladder delivery systems increase patient compliance?

The negative impact of overactive bladder (OAB) on daily quality of life drives the large market of pharmacotherapy targeted at symptoms of urinary frequency and urgency, with or without urinary urge incontinence. Currently, the primary pharmacologic treatment modality is aimed at modulation of the efferent muscarinic receptors (M2 and M3) predominant in detrusor smooth muscle and responsible for involuntary or unwanted bladder contractions. However, due to drug effects in the muscarinic receptors of the salivary glands and intestinal smooth muscle, as well as extensive first-pass metabolism in the liver and intestinal tract yielding parent drug metabolites, adverse side effects are common and can be quite bothersome. These issues, encountered with many of the oral antimuscarinic formulations, limit their tolerability and affect long-term patient compliance and satisfaction. Thus, the benefit of pharmacotherapy for OAB must be a balance between efficacy and tolerability, also known as therapeutic index. This article reviews the current pharmacologic delivery systems available for the treatment of OAB, patient compliance, and reasons for discontinuation of medication.

Antipsychotic Adherence Intervention for Veterans over Forty with Schizophrenia: Results of a Pilot Study

This pilot study tested the feasibility, acceptability, and effect sizes of a multimodal, individual intervention designed to optimize antipsychotic medication use in patients ≥40 years of age with schizophrenia or schizoaffective disorder. Methods: We randomized forty patients into two groups: usual care (UC) versus a nine-session, manualized antipsychotic adherence intervention (AAI). The AAI attempted to improve adherence by combining three psychosocial techniques: 1) education; 2) skills training; and, 3) alliance building. Sessions employed a semistructured format to facilitate open communication. The primary outcome was antipsychotic adherence at study end. We obtained qualitative data regarding patient preferences for the duration and modality for receiving the adherence intervention. Results: Compared to the UC group, a greater proportion of the AAI group was adherent post intervention based on medication possession ratio, a commonly used measure of medication adherence (85% vs. 66.6%; OR=2.64), a difference that was statistically not significant. The entire AAI group reported that they intended to take medications, and 75% were satisfied with the intervention. Conclusions: The AAI was feasible and acceptable. Preliminary data on its effectiveness warrant a larger study. Qualitative data show that patients prefer brief adherence interventions and accept telephone strategies.

Understanding patient management: the need for medication adherence and persistence

Poor patient adherence to medication is one of the major factors contributing to poor disease control, in particular in asymptomatic chronic diseases like hypertension and dyslipidaemia. The physical and economic burden on patients and the health care system as a result of non-adherence is great. It is estimated that poor adherence to hypertension medication accounts for as many as 7.1 million preventable deaths annually. Hence recognising and identifying non-adherence is the first step to addressing this problem. Medication adherence can be measured in various ways including self-report to electronic monitoring. In order to be more successful in managing non-adherence, attention must be paid to barriers to adherence, namely the interplay of patient factors, the health care providers themselves and the health care system itself. Taking these into account will probably have the greatest impact on improving medication adherence. Consequently strategies to help overcome these barriers are of paramount importance. Some of these strategies will include education of patients, improving communication between patients and health care providers, improving dose scheduling, providing drugs with less adverse effects, and improving accessibility to health care. Poor mediation adherence continues to be a huge challenge. While the patient is ultimately responsible for the taking of medication, good communication, involving the patient in decision making about their care and simplifying drug regimens go a long way in improving it.

Adherence to treatment in adolescents

Health care professionals must be alert to the high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors to consider in teens are their developmental stage and challenges, emotional issues and family dysfunction. Direct and indirect methods have been described to assess adherence. Eliciting an adherence history is the most useful way for clinicians to evaluate adherence, and could be the beginning of a constructive dialogue with the adolescent. Interventions to improve adherence are multiple - managing mental health issues appropriately, building a strong relationship, customizing the treatment regimen if possible, empowering the adolescent to deal with adherence issues, providing information, ensuring family and peer support, and motivational enhancement therapy. Evaluation of adherence at regular intervals should be an important aspect of health care for adolescents.

Values of ultrathin gastroscope in implantation of esophageal metal stents

AIM: To evaluate the values of ultrathin gastroscope in the implantation of esophageal metal stents.

METHODS: Thirteen patients suffering dysphagia from late-stage esophageal or cardiac carcinomas (one of which was complicated with esophagotracheal fistula) and 1 patient with cardiac achalasia received the implantation of esophageal metal stents under Fujinon EG-270N5 ultrathin gastroscope. Following the strictrue was pre-dilated to 9 mm, the stent was implanted to an accurate level ensured by both controlling the calculated inserting depth of the stent conveyor and regulating the position of the upper end of the stent in conveyor under ultrathin gastroscopy without X-ray monitoring. The success rate, accuracy, self-expanding, and complications of the implantation were observed.

RESULTS: The implantation of the stents was successfully performed in the accurate position with satisfactory self-expanding in all the patients, and the shortest diameter of the strictures was expanded from 2.73 ± 3.18 to 13.65 ± 1.66 mm. The esophagotracheal fistula was occluded by the stents. The grades of dysphagia were lowered from 3.15 ± 0.68 to 0.91 ± 0.49.

CONCLUSION: The implantation of esophageal metal stents under ultrathin gastroscope without X-ray monitoring is simple, accurate, safe, and effective, with good compliance of patients.

Formative evaluation using checklists to improve research proposals

Developing research proposals that protect human participants and understanding the institutional review board (IRB) approval process require high-level application of many skills. The purpose of this article is to describe how faculty can use formative evaluation techniques and checklists to guide students to build skills in writing research proposals for studies that involve human participants or their data. Formative evaluation, the process of critically reviewing work to improve it, is emphasized, and checklists that summarize IRB criteria and standards and present the critical content of research proposals for studies involving human participants are provided. Teaching principles that can guide faculty in using the checklists to give feedback and help students develop high-quality research proposals are discussed.

How to measure (or not) compliance to eradication therapy

This study aimed to test a novel method of compliance measurement in Portuguese community pharmacy in Helicobacter pylori patients. A case series design was used where compliance indicators were electronically measured, aside with patients' reports. Experienced adverse drug reactions, perceived benefit of therapy and quality of life were also measured. Mean compliance proportion was 56% and a positive impact on patients' perceived health status was found. The method used was welcomed by community pharmacists, albeit having an influence on patients' normal behaviour.

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Schizophrenic psychoses are among the most severe psychiatric illnesses and, in the majority of cases require several years of treatment, sometimes even for the rest of the patient's life. Of decisive importance for successful treatment is the involvement of all those concerned in a combined treatment strategy that includes pharmacological, psychotherapeutic and rehabilitative measures. The therapeutic aims are the reduction of symptoms, the prevention of relapses, and social and occupational reintegration.In pharmacotherapy, the latest antipsychotic agents have proven beneficial for relapse prophylaxis. Inadequate compliance, which is quite common, endangers the success of treatment. Psycho-educative measures that include family members can improve the acceptance of the illness and the readiness to undergo treatment and, together with psycho- and sociotherapeutic methods, can reduce symptoms and relapses.

Feasible economic strategies to improve screening compliance for colorectal cancer in Korea

AIM: While colorectal cancer (CRC) is an ideal target for population screening, physician and patient attitudes contribute to low levels of screening uptake. This study was carried out to find feasible economic strategies to improve the CRC screening compliance in Korea.

METHODS: The natural history of a simulated cohort of 50-year-old Korean in the general population was modeled with CRC screening until the age of 80 years. Cases of positive results were worked up with colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Baseline screening compliance without insurance coverage by the national health insurance (NHI) was assumed to be 30%. If NHI covered the CRC screening or the reimbursement of screening to physicians increased, the compliance was assumed to increase. We evaluated 16 different CRC screening strategies based on Markov model.

RESULTS: When the NHI did not cover the screening and compliance was 30%, non-dominated strategies were colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). In all scenarios of various compliance rates with raised coverage of the NHI and increased reimbursement of colonoscopy, COL10, COL5 and COL3 were non-dominated strategies, and COL10 had lower or minimal incremental medical cost and financial burden on the NHI than the strategy of no screening. These results were stable with sensitivity analyses.

CONCLUSION: Economic strategies for promoting screening compliance can be accompanied by expanding insurance coverage by the NHI and by increasing reimbursement for CRC screening to providers. COL10 was a cost-effective and cost saving screening strategy for CRC in Korea.

Susceptibility of five strains of Cryptosporidium parvum oocysts to UV light

Previous evaluations of the effect of ultraviolet (UV) light on Cryptosporidium parvum oocysts have been limited to a single strain—the Iowa strain. This study investigated the response of five strains of C. parvum to UV. A collimated beam apparatus was used to apply controlled doses of monochromatic (254 nm) UV to oocysts of the Iowa, Moredun, Texas A&M, Maine, and Glasgow strains. Irradiation was measured using a calibrated radiometer and sensor. Inactivation was quantified through animal infectivity by inoculation of cohorts of CD‐1 neonatal mice with UV‐treated and untreated control oocysts of each strain followed by examination of intestinal sections for infection using hemotoxylin and eosin staining. A UV light dose of 10 mJ/cm² achieved at least 4‐log₁₀ inactivation of all strains evaluated. All five strains of C. parvum were shown to be highly susceptible to low levels of UV light.

Compliance of spectacle wear and its determinants among schoolchildren of Dhakhiliya region of Oman: A descriptive study

OBJECTIVE

To determine the degree of compliance of spectacle wear and some of its determinants among school children of Dhakhiliya region of Oman.

METHODS

This was a cross-sectional descriptive study of a sample of 663 students who had been prescribed spectacles for constant wear. After one year, experienced field staff conducted a follow-up visit where 571 of these students were examined. Information on age, gender, type and severity of refractive error was collected from the school health records and refractionist's report and analyzed to associate them to the compliance of spectacle wear.

RESULTS

The majority (71.6%) of students were using spectacles at the time of follow up. The compliance rate was 65.1% in boys and 78.3% in girls. Agewise, it was 66.7% in 6-7-year-olds, 66.7% in 12-13-year-olds and 79.1% in 16-17-year olds. The rate was 72.5% among students with myopia and 67.9% among those with hypermetropia. The compliance of spectacle wear was significantly higher among students with myopic refractive error of 2.5 D or more compared to those with less than 2.5 D. The difference in the compliance rates among students with hypermetropia of different grades was not significant.

CONCLUSIONS

The study identifies the factors of high-risk of non compliance as (a) male gender, (b) younger age, and (c) low myopic refractory error. The eye health care program of Oman should focus on these high risk groups to further improve the compliance for visual aids.

Olanzapine oro-dispersible (Velotab TM ) - an alternative to depot?

INTRODUCTION

Olanzapine oro-dispersible (Velotab TM ) was introduced to the United Kingdom in May 2000. It rapidly dissolves in the mouth, and therefore patients may find it preferable to swallowing tablets. Another advantage is that the opportunity to hide the medication is much reduced. The study examined the usage of Velotab TM in a forensic psychiatry setting.

METHOD

Drug expenditure for different classes of antipsychotic was examined for 6 months before and 7 months after the introduction of olanzapine Velotab TM .

RESULTS

The results showed a change in prescribing practice, with a significant inverse correlation between the use of Velotab TM and depot medication.

CONCLUSION

This suggests that forensic psychiatrists, who may have particular concerns about compliance, had confidence in oro-dispersible administration as an alternative to depot medication. It is suggested that making other neuroleptics available in an oro-dispersible form would allow for a wider choice of atypicals in populations in whom there are significant compliance problems. (Int J Psych Clin Pract 2002; 6: 163-165).