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Elizalde-Torrent A, Trejo-Soto C, Méndez-Mora L, Nicolau M, Ezama O, Gualdrón-López M, Fernández-Becerra C, Alarcón T, Hernández-Machado A, Del Portillo HA. Pitting of malaria parasites in microfluidic devices mimicking spleen interendothelial slits. Sci Rep 2021; 11:22099. [PMID: 34764379 PMCID: PMC8585870 DOI: 10.1038/s41598-021-01568-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/19/2021] [Indexed: 11/09/2022] Open
Abstract
The spleen is a hematopoietic organ that participates in cellular and humoral immunity. It also serves as a quality control mechanism for removing senescent and/or poorly deformable red blood cells (RBCs) from circulation. Pitting is a specialized process by which the spleen extracts particles, including malaria parasites, from within circulating RBCs during their passage through the interendothelial slits (IES) in the splenic cords. To study this physiological function in vitro, we have developed two microfluidic devices modeling the IES, according to the hypothesis that at a certain range of mechanical stress on the RBC, regulated through both slit size and blood flow, would force it undergo the pitting process without affecting the cell integrity. To prove its functionality in replicating pitting of malaria parasites, we have performed a characterization of P. falciparum-infected RBCs (P.f.-RBCs) after their passage through the devices, determining hemolysis and the proportion of once-infected RBCs (O-iRBCs), defined by the presence of a parasite antigen and absence of DAPI staining of parasite DNA using a flow cytometry-based approach. The passage of P.f.-RBCs through the devices at the physiological flow rate did not affect cell integrity and resulted in an increase of the frequency of O-iRBCs. Both microfluidic device models were capable to replicate the pitting of P.f.-RBCs ex vivo by means of mechanical constraints without cellular involvement, shedding new insights on the role of the spleen in the pathophysiology of malaria.
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Affiliation(s)
- Aleix Elizalde-Torrent
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Claudia Trejo-Soto
- Instituto de Física, Pontificia Universidad Católica de Valparaíso, 4059, Casilla, Chile
| | - Lourdes Méndez-Mora
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain
| | - Marc Nicolau
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Oihane Ezama
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain
| | - Melisa Gualdrón-López
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,IGTP Institut d'Investigació Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Carmen Fernández-Becerra
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,IGTP Institut d'Investigació Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Tomás Alarcón
- ICREA: Catalan Institution for Research and Advanced Studies, Barcelona, Spain.,Centre de Recerca Matemàtica (CRM), Bellaterra, Barcelona, Spain.,Departament de Matemàtiques, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Aurora Hernández-Machado
- Department of Condensed Matter Physics, University of Barcelona (UB), Barcelona, Spain. .,Centre de Recerca Matemàtica (CRM), Bellaterra, Barcelona, Spain. .,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona (UB), Barcelona, Spain.
| | - Hernando A Del Portillo
- ISGlobal Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,IGTP Institut d'Investigació Germans Trias I Pujol, Badalona, Barcelona, Spain. .,ICREA: Catalan Institution for Research and Advanced Studies, Barcelona, Spain.
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Ampadu HH, Asante KP, Bosomprah S, Akakpo S, Hugo P, Gardarsdottir H, Leufkens HGM, Kajungu D, Dodoo ANO. Prescribing patterns and compliance with World Health Organization recommendations for the management of severe malaria: a modified cohort event monitoring study in public health facilities in Ghana and Uganda. Malar J 2019; 18:36. [PMID: 30736864 PMCID: PMC6368732 DOI: 10.1186/s12936-019-2670-9] [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: 08/23/2018] [Accepted: 02/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injectable artesunate (AS) is the World Health Organization (WHO) recommended medication for the treatment of severe malaria followed with an oral artemisinin-based combination therapy (ACT). There are few studies indicating how physicians prescribe injectable AS, injectable quinine (Q) or injectable artemether (AR) and ACT for severe malaria. This study was undertaken to evaluate prescription compliance to the WHO recommendation in 8 public health facilities in Ghana and Uganda. This was a modified cohort event monitoring study involving patients who were administered with injectable anti-malarial for treatment of presumed or confirmed severe malaria. Patients prescribed at least one dose of injectable artesunate, artemether or quinine qualified to enrol in the study. Patients were recruited at inpatient facilities and followed up in the hospital, by phone or at home. Following WHO recommendations, patients are to be prescribed 3 doses of injectable AS, Q or AR for at least 24 h followed with oral ACT. Compliance rate was estimated as the number of patient prescriptions that met the WHO recommendation for treatment of severe malaria divided by the total number of patients who completed the study by end of follow up. Log-binomial regression model was used to identify predictors for compliance. Based on the literature and limitations of available data from the patients' record, the diagnosis results, age, gender, weight, and country were considered as potential predictors of prescriber adherence to the WHO recommendations. RESULTS A total of 1191 patients completed the study, of which 93% were prescribed injectable AS, 3.1% (injectable AR or Q) with 32.5% prescribed follow-on oral ACT and 26% on concomitant antibiotics. 391 (32.8%) were in Ghana and 800 (67.2%) in Uganda. There were 582 (48.9%) women. The median age was 3.9 years (IQR = 2, 9) and median weight was 13 kg (IQR = 10, 20). Of the 1191 patients, 329 of the prescriptions complied with the WHO recommendation (compliance rate = 27.6%; 95% CI = [25.2, 30.2]). Diagnostic results (Adjusted prevalence ratio (aPR) = 4.56; 95% = [3.42, 6.08]; p < 0.0001) and weight (20 + kg vs < 10 kg: aPR = 0.65; 95% = [0.44, 0.96]; p = 0.015) were identified as factors independently associated with compliance. CONCLUSION Injectable AS is the most commonly prescribed medicine in the management of severe malaria in Ghana and Uganda. However, adherence to the WHO recommendation of at least 3 doses of injectable anti-malarial in 24 h followed by a full course of ACT is low, at less than 30%.
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Affiliation(s)
- H Hilda Ampadu
- The African Collaborating Centre for Pharmacovigilance & Surveillance, Accra, Ghana. .,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Samuel Bosomprah
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Pierre Hugo
- Medicines for Malaria Venture, Geneva, Switzerland
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Dan Kajungu
- Makerere University Centre for Health and Population Research (MUCHAP), Iganga/Mayuge Health and Demographic Surveillance Site (IMHDSS), Kampala, Uganda
| | - Alexander N O Dodoo
- The African Collaborating Centre for Pharmacovigilance & Surveillance, Accra, Ghana
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Vicuña B, Delaney HD, Flores KG, Ballinger L, Royce M, Dayao Z, Pal T, Kinney AY. Preferences for multigene panel testing for hereditary breast cancer risk among ethnically diverse BRCA-uninformative families. J Community Genet 2018; 9:81-92. [PMID: 28971318 PMCID: PMC5752653 DOI: 10.1007/s12687-017-0322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/04/2017] [Indexed: 12/21/2022] Open
Abstract
Until recently, genetic testing for hereditary breast cancer has primarily focused on pathogenic variants in the BRCA1 and BRCA2 (BRCA) genes. However, advances in DNA sequencing technologies have made simultaneous testing for multiple genes possible. We examined correlates of interest in multigene panel testing and risk communication preferences in an ethnically diverse sample of women who tested negative for BRCA mutations previously but remain at high risk based on their family history (referred to as "BRCA-uninformative") and their at-risk female family members. Two-hundred and thirteen women with a previous breast cancer diagnosis and a BRCA-uninformative test result and their first-degree relatives completed a survey on interest in multigene panel testing, communication preferences, and sociodemographic, psychological, and clinical factors. Stepwise logistic regression was used to identify factors associated with testing interest. Chi-square analyses were used to test differences in risk communication preferences. Interest in multigene panel testing was high (84%) and did not considerably differ by cancer status or ethnicity. In multivariable analysis, factors significantly associated with interest in genetic testing were having had a mammogram in the past 2 years (odds ratio (OR) = 4.04, 95% confidence interval (CI) 1.80-9.02) and high cancer worry (OR = 3.77, 95% CI 1.34-10.60). Overall, the most commonly preferred genetic communication modes were genetic counselors, oncologists, and print materials. However, non-Hispanic women were more likely than Hispanic women to prefer web-based risk communication (p < 0.001). Hispanic and non-Hispanic women from BRCA-uninformative families have a high level of interest in gene panel testing. Cancer-related emotions and communication preferences should be considered in developing targeted genetic risk communication strategies.
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Affiliation(s)
- Belinda Vicuña
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Robert Wood Johnson Foundation, Center for Health Policy, University of New Mexico, Albuquerque, NM, USA
| | - Harold D Delaney
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kristina G Flores
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Lori Ballinger
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Melanie Royce
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Zoneddy Dayao
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Anita Y Kinney
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA.
- Robert Wood Johnson Foundation, Center for Health Policy, University of New Mexico, Albuquerque, NM, USA.
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
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Evidence To Support Continuation of Statin Therapy in Patients with Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother 2017; 61:AAC.02228-16. [PMID: 28069650 DOI: 10.1128/aac.02228-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022] Open
Abstract
In addition to cholesterol-lowering capabilities, statins possess anti-inflammatory and immunomodulatory effects. We sought to quantify the real-world impact of different statin exposure patterns on clinical outcomes in Staphylococcus aureus bacteremia. We conducted a retrospective cohort study among hospitalized patients with positive S. aureus blood cultures receiving appropriate antibiotics within 48 h of culture collection (Veterans Affairs hospitals, 2002 to 2013). Three statin exposure groups were compared to nonusers: pretreated statin users initiating therapy in the 30 days prior to culture and either (i) continuing statin therapy after culture or (ii) not continuing after culture, and (iii) de novo users initiating at culture. Nonusers included patients without statins in the year prior to culture through discharge. Propensity score-matched Cox proportional hazards regression models were developed. We were able to balance significantly different baseline characteristics using propensity score matching for pretreated without continuation (n = 331), pretreated with continuation (n = 141), and de novo (n = 177) statin users compared to nonusers. We observed a significantly lower 30-day mortality rate (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.25 to 0.84; number needed to treat [NNT], 10) among pretreated and continued statin users, while protective effects were not observed in de novo (HR, 1.04; 95% CI, 0.60 to 1.82; NNT, undefined) or pretreated but not continued (HR, 0.92; 95% CI, 0.64 to 1.32; NNT, 47) users. In our national cohort study among patients with S. aureus bacteremia, continuation of statin therapy among incident statin users was associated with significant beneficial effects on mortality, including a 54% lower 30-day mortality rate.
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Granger BB, Moser D, Germino B, Harrell J, Ekman I. Caring for Patients with Chronic Heart Failure: The Trajectory Model. Eur J Cardiovasc Nurs 2016; 5:222-7. [PMID: 16616643 DOI: 10.1016/j.ejcnurse.2006.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 01/28/2006] [Accepted: 02/08/2006] [Indexed: 11/30/2022]
Abstract
The purpose of this paper is to examine gaps in our understanding of the heart failure experience and describe the use of Trajectory of Chronic Illness Theory to bridge these gaps. New pharmacotherapeutic strategies have improved survival in heart failure, but research has consistently shown that clinical outcomes in these patients do not depend on physiologic variables alone. Psychological, behavioral, environmental, social and socioeconomic variables also contribute to a patient's ability to manage chronic illness. However, we have not yet identified the essential elements in helping patients engage in self-management and adhere to increasingly complex medical regimens. Theoretical models facilitate disciplinary integration, providing a comprehensive and cohesive foundation for building better science. The Trajectory of Chronic Illness Theory is particularly salient for heart failure because of its emphasis on patients' ability to manage a chronic illness. By using theory to explore gaps in our understanding of the heart failure experience, investigators may be able to develop more targeted interventions to help patients manage heart failure.
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Affiliation(s)
- Bradi B Granger
- Duke University Health Systems, Duke University School of Nursing, Durham, NC, USA.
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Abstract
Despite evidence-based interventions, coronary heart disease (CHD) remains a leading cause of global mortality. As therapies advance, patient non-adherence to established treatments is well recognized. Non-adherence is a powerful confounder of evidence-based practice and can affect daily patient management, resulting in inappropriate therapeutic escalation with greater costs and potential for harm. Moreover, it increases risk for adverse cardiac events, including mortality. Yet, non-adherence is complex, remains difficult to define, and provider ability to identify its presence accurately remains limited. Improved screening tools are needed to detect at-risk patients, enabling appropriate targeting of interventions. Given the rapidly expanding global population with CHD and emerging clinical and cost-benefits of adherence, addressing non-adherence to prescribed therapies is a top priority.
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Affiliation(s)
- Kumaran Kolandaivelu
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave. Bldg. E25-201, Cambridge, MA 02139, USA Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Benjamin B Leiden
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave. Bldg. E25-201, Cambridge, MA 02139, USA
| | - Patrick T O'Gara
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
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Guillou Landreat M, Sebille-Rivain V, Victorri Vigneau C, Foucher Y, Venisse JL, Jolliet P. Buprenorphine Prescription Compliance: An Original Observational and Longitudinal Study. J Psychoactive Drugs 2014; 46:162-7. [DOI: 10.1080/02791072.2014.904061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ho TH, Caughey GE, Shakib S. Guideline compliance in chronic heart failure patients with multiple comorbid diseases: evaluation of an individualised multidisciplinary model of care. PLoS One 2014; 9:e93129. [PMID: 24714369 PMCID: PMC3979669 DOI: 10.1371/journal.pone.0093129] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/02/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the impact of individualised, reconciled evidence-based recommendations (IRERs) and multidisciplinary care in patients with chronic heart failure (CHF) on clinical guideline compliance for CHF and common comorbid conditions. DESIGN AND SETTING A retrospective hospital clinical audit conducted between 1st July 2006 and February 2011. PARTICIPANTS A total of 255 patients with a diagnosis of CHF who attended the Multidisciplinary Ambulatory Consulting Services (MACS) clinics, at the Royal Adelaide Hospital, were included. MAIN OUTCOME MEASURES Compliance with Australian clinical guideline recommendations for CHF, atrial fibrillation, diabetes mellitus and ischaemic heart disease. RESULTS Study participants had a median of eight medical conditions (IQR 6-10) and were on an average of 10 (±4) unique medications. Compliance with clinical guideline recommendations for pharmacological therapy for CHF, comorbid atrial fibrillation, diabetes or ischaemic heart disease was high, ranging from 86% for lipid lowering therapy to 98% anti-platelet agents. For all conditions, compliance with lifestyle recommendations was lower than pharmacological therapy, ranging from no podiatry reviews for CHF patients with comorbid diabetes to 75% for heart failure education. Concordance with many guideline recommendations was significantly associated if the patient had IRERs determined, a greater number of recommendations, more clinic visits or if patients participated in a heart failure program. CONCLUSIONS Despite the high number of comorbid conditions and resulting complexity of the management, high compliance to clinical guideline recommendations was associated with IRER determination in older patients with CHF. Importantly these recommendations need to be communicated to the patient's general practitioner, regularly monitored and adjusted at clinic visits.
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Affiliation(s)
- Tam H. Ho
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Gillian E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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The effect of placebo adherence on reducing cardiovascular mortality: a meta-analysis. Clin Res Cardiol 2013; 103:229-35. [PMID: 24264475 DOI: 10.1007/s00392-013-0642-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We aim to demonstrate the effect of placebo adherence on reducing CV mortality. BACKGROUNDS Good adherence, whether to drug or placebo treatment, is associated with lower CV mortality. However, current evidence for the positive effect of placebo adherence on reducing CV mortality is relatively weak. METHODS We conducted a fixed-effect meta-analysis of eight randomized clinical trials to evaluate the effect of placebo adherence on reducing CV mortality. We made a comparison between good placebo adherence and poor drug adherence. RESULTS Compared with poor adherence to drug treatment, good adherence to placebo treatment was associated with lower CV mortality (OR = 0.68, 95% CI 0.60-0.77). CONCLUSION Good adherence to placebo has a positive effect on reducing CV mortality. The effect of adherence on reducing CV mortality may be independent of the drug effect.
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Ownby RL, Hertzog C, Czaja SJ. Relations between cognitive status and medication adherence in patients treated for memory disorders. ACTA ACUST UNITED AC 2012; 3:e2. [PMID: 24575293 DOI: 10.4081/ar.2012.e2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Medication adherence has been increasingly recognized as an important factor in elderly persons' health. Various studies have shown that medication non-adherence is associated with poor health status in this population. As part of a study of the effects of two interventions to promote medication adherence in patients treated for memory problems, information on medication adherence and cognitive status was collected at 3-month intervals. Twenty-seven participants (16 men, 11 women, age 71-92 years) were assigned to control or treatment conditions and adherence was evaluated with an electronic monitoring device. Cognitive status was evaluated at 3-month intervals beginning in April of 2003 and continuing through September of 2006. We have previously reported on the effectiveness of these interventions to promote adherence. In this paper, we examine the relations of cognitive status and adherence over time using a partial least squares path model in order to evaluate the extent to which adherence to cholinesterase medications was related to cognitive status. Adherence predicted cognitive status at later time points while cognition did not, in general, predict adherence. Results thus suggest that interventions to ensure high levels of medication adherence may be important for maintaining cognitive function in affected elderly people.
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Kauf TL, Davis KL, Earnshaw SR, Davis EA. Spillover adherence effects of fixed-dose combination HIV therapy. Patient Prefer Adherence 2012; 6:155-64. [PMID: 22399848 PMCID: PMC3295624 DOI: 10.2147/ppa.s28482] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The impact of fixed-dose combination (FDC) products on adherence to other, non-fixed regimen components has not been examined. We compared adherence to a third antiretroviral (ART) component among patients receiving a nucleoside reverse transcriptase inhibitor (NRTI) backbone consisting of the FDC Epzicom(®), GlaxoSmithKline Inc, Research Triangle Park, NC (abacavir sulfate 600 mg + lamivudine 300 mg; FDC group) versus NRTI combinations taken as two separate pills (NRTI Combo group) using data from a national sample of 30 health plans covering approximately 38 million lives from 1997 to 2005. Adherence was measured as the medication possession ratio (MPR). Multivariate logistic regression compared treatment groups based on the likelihood of achieving ≥95% adherence, with sensitivity analyses using alternative thresholds. MPR was assessed as a continuous variable using multivariate linear regression. Covariates included age, gender, insurance payer type, year of study drug initiation, presence of mental health and substance abuse disorders, and third agent class. The study sample consisted of 650 FDC and 1947 NRTI Combo patients. Unadjusted mean adherence to the third agent was higher in the FDC group than the NRTI Combo group (0.92 vs 0.85; P < 0.0001). In regression analyses, FDC patients were 48% and 39% more likely to achieve 95% and 90% third agent adherence, respectively (P ≤ 0.03). None of the other MPR specifications achieved comparable results. Among managed care patients, use of an FDC appears to substantially improve adherence to a third regimen component and thus the likelihood of achieving the accepted standard for adherence to HIV therapy of 95%.
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Affiliation(s)
- Teresa L Kauf
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
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Bhandari S, Sarma PS, Thankappan KR. Adherence to antihypertensive treatment and its determinants among urban slum dwellers in Kolkata, India. Asia Pac J Public Health 2011; 27:NP74-84. [PMID: 22087037 DOI: 10.1177/1010539511423568] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cross-sectional study was conducted to determine the prevalence and predictors of adherence to modern antihypertensive pharmacotherapy among slum dwellers in Kolkata, India. Prevalence of adherence based on patient self-reports of consuming ≥80% of the prescribed medications over a recall period of 1 week was found to be 73% (95% confidence interval = 68%-78%). Compared with their counterparts, the following patients were more likely to be adherent to treatment: patients hypertensive for ≥5 years (2.98 times), those whose hypertension was detected during checkups for conditions related to hypertension (2.35 times), those living with ≤4 family members (2.01 times), those with family income of ≥3000 rupees (2.56 times), those who were getting free drugs (4.16 times), patients perceiving current blood pressure to be under control (2.23 times), and those satisfied with current treatment (3.77). Those adherent to their prescribed medications were 1.71 times more likely to achieve adequate control of hypertension compared with those who were not adherent.
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Affiliation(s)
- Subhasis Bhandari
- Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Kerala, India
| | - P Sankara Sarma
- Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Kerala, India
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Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: Challenges and potential ways forward. Glob Public Health 2011; 6:83-97. [PMID: 20509066 DOI: 10.1080/17441691003796387] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Structural barriers to antiretroviral therapy (ART) adherence are economic, institutional, political and cultural factors, that collectively influence the extent to which persons living with HIV follow their medication regimens. We identify three sets of structural barriers to ART adherence that are salient in Southern Africa: poverty-related, institutional, and political and cultural. Examples of poverty-related barriers are competing demands in the context of resource-constrained settings, the lack of transport infrastructure, food insecurity, the role of disability grants and poor social support. Examples of institutional factors are logistical barriers, overburdened health care facilities, limited access to mental health services and difficulties in ensuring adequate counselling. Examples of political and cultural barriers are controversies in the provision of treatment for AIDS, migration, traditional beliefs about HIV and AIDS, poor health literacy and gender inequalities. In forging a way forward, we identify ways in which individuals, communities and health care systems may overcome some of these structural barriers. Finally, we make recommendations for further research on structural barriers to ART adherence. In all likelihood, enhancing adherence to ART requires the efforts of a variety of disciplines, including public health, psychology, anthropology, sociology and medicine.
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Affiliation(s)
- A Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
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Patrick AR, Shrank WH, Glynn RJ, Solomon DH, Dormuth CR, Avorn J, Cadarette SM, Mogun H, Brookhart MA. The association between statin use and outcomes potentially attributable to an unhealthy lifestyle in older adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:513-520. [PMID: 21669377 PMCID: PMC5059150 DOI: 10.1016/j.jval.2010.10.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/17/2010] [Accepted: 10/12/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore the "healthy user" and "healthy adherer" effects-hypothetical sources of bias thought to arise when patients who initiate and adhere to preventive therapies are more likely to engage in healthy behaviors than are other subjects. METHODS The authors examined the association between statin initiation and adherence, and the subsequent use of preventive health services and incidence of clinical outcomes unlikely to be associated with the need for, or use of, a statin among older enrollees in two state-sponsored drug benefit programs. RESULTS After adjustment for demographic and clinical covariates, patients who initiated statin use were more likely to receive recommended preventive services than noninitiators matched on age, sex, and state (hazard ratio [HR]: 1.10, 1.06-1.14 for males, HR: 1.09, 1.07-1.11 for females) and appeared to have a lower risk of a range of adverse outcomes (HR: 0.87, 0.85-0.89) thought to be unrelated to statin use. Adherence to a statin regimen was also associated with increased rates of preventive service use and a decreased rate of adverse clinical outcomes (HR: 0.93, 0.88-0.99). CONCLUSIONS These results suggest that patients initiating and adhering to chronic preventive drug therapies are more likely to engage in other health-promoting behaviors. Failure to account for this relationship may introduce bias in any epidemiologic study evaluating the effect of a preventive therapy on clinical outcomes.
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Affiliation(s)
- Amanda R Patrick
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Placebo interventions in practice: a questionnaire survey on the attitudes of patients and physicians. Br J Gen Pract 2011; 61:101-7. [PMID: 21276337 DOI: 10.3399/bjgp11x556209] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Few studies have investigated whether patients and physicians differ in their attitudes regarding placebo interventions in medical practice. AIM To compare the proportions of patients and physicians who would accept therapies that do not work through specific pharmacological or physiological action but by enhancing self-healing capacities and by exploiting contextual factors. DESIGN OF STUDY Survey of a random sample of GPs and patients consecutively attending in primary care practices. SETTING Four hundred and seventy-seven patients and 300 GPs from primary care practices of the Canton Zurich of Switzerland were approached. METHOD Two questionnaires on responders' attitudes regarding non-specific therapies. RESULTS The response rates were 87% for patients and 79% for GPs. Eighty-seven per cent of patients and 97% of GPs thought that physical complaints can get better by believing in the effectiveness of the therapy. Overall there was more support for placebo interventions among patients than among GPs, yet 90% of the physicians admitted to actively proposing treatments intended to take advantage of non-specific effects. Seventy per cent of the patients wanted to be explicitly informed when receiving a non-specific intervention, whereas physicians thought this was the case for only 33% of their patients. Fifty-four per cent of patients would be disappointed when learning they had unknowingly been treated with pure placebo ('sugar pill'), while only 44% would feel that way after treatment with impure placebo (for example, herbal medicine). CONCLUSION GPs rather underestimate the openness of their patients to non-specific therapies. However, patients want to be appropriately informed. Developing specific professional standards could help physicians to harness the 'power of the placebo', while remaining authentic and credible.
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Aujoulat I, Deccache A, Charles AS, Janssen M, Struyf C, Pélicand J, Ciccarelli O, Dobbels F, Reding R. Non-adherence in adolescent transplant recipients: the role of uncertainty in health care providers. Pediatr Transplant 2011; 15:148-56. [PMID: 21199207 DOI: 10.1111/j.1399-3046.2010.01429.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To optimize self-management and adherence in adolescent patients, HCPs need to discuss not only medical and treatment-related issues, but also general health and psychosocial concerns. Our study aimed to explore how the members of the paediatric team in our programme understand NA in adolescents, and how they define their own role regarding self-management education. We used a sequential mixed methods design and conducted a qualitative observational and in-depth interview study (n=22) and a quantitative descriptive study through self-administered questionnaires (n=31). Our results show a discrepancy between the HCPs' understanding of the complex psychosocial factors impacting on long-term adherence, and their current limited practice of patient education. A number of uncertainties were found to explain the HCPs' perceived difficulty to engage in comprehensive patient education activities: uncertainty regarding (i) the health status of transplant recipients; (ii) a shared operational definition of adherence and the cause of organ rejection in some cases; (iii) the extent to which adherence is a shared responsibility which involves the HCPs as patient educators; (iv) the long-term impact of a LRD. To avoid the risk of conveying incongruent messages, multidisciplinary health care teams need to explicitly acknowledge and discuss the various areas of uncertainty, some of which are inherent to transplantation.
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Affiliation(s)
- Isabelle Aujoulat
- Institute of Health and Society, Université Catholique de Louvain Paediatric Surgery and Transplant Unit, Saint-Luc University Clinics, Université Catholique de Louvain, Bruxelles, Belgium.
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Brookhart MA, Rassen JA, Schneeweiss S. Instrumental variable methods in comparative safety and effectiveness research. Pharmacoepidemiol Drug Saf 2010; 19:537-54. [PMID: 20354968 DOI: 10.1002/pds.1908] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Instrumental variable (IV) methods have been proposed as a potential approach to the common problem of uncontrolled confounding in comparative studies of medical interventions, but IV methods are unfamiliar to many researchers. The goal of this article is to provide a non-technical, practical introduction to IV methods for comparative safety and effectiveness research. We outline the principles and basic assumptions necessary for valid IV estimation, discuss how to interpret the results of an IV study, provide a review of instruments that have been used in comparative effectiveness research, and suggest some minimal reporting standards for an IV analysis. Finally, we offer our perspective of the role of IV estimation vis-à-vis more traditional approaches based on statistical modeling of the exposure or outcome. We anticipate that IV methods will be often underpowered for drug safety studies of very rare outcomes, but may be potentially useful in studies of intended effects where uncontrolled confounding may be substantial.
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Affiliation(s)
- M Alan Brookhart
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA 27599-7435, USA.
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REGNIER DENOIS V, POIRSON J, NOURISSAT A, JACQUIN JP, GUASTALLA JP, CHAUVIN F. Adherence with oral chemotherapy: results from a qualitative study of the behaviour and representations of patients and oncologists. Eur J Cancer Care (Engl) 2010; 20:520-7. [DOI: 10.1111/j.1365-2354.2010.01212.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Epidemiologic studies are increasingly used to investigate the safety and effectiveness of medical products and interventions. Appropriate adjustment for confounding in such studies is challenging because exposure is determined by a complex interaction of patient, physician, and healthcare system factors. The challenges of confounding control are particularly acute in studies using healthcare utilization databases where information on many potential confounding factors is lacking and the meaning of variables is often unclear. We discuss advantages and disadvantages of different approaches to confounder control in healthcare databases. In settings where considerable uncertainty surrounds the data or the causal mechanisms underlying the treatment assignment and outcome process, we suggest that researchers report a panel of results under various specifications of statistical models. Such reporting allows the reader to assess the sensitivity of the results to model assumptions that are often not supported by strong subject-matter knowledge.
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Validating studies of adherence through the use of control outcomes and exposures. Am J Hypertens 2010; 23:110. [PMID: 20087324 DOI: 10.1038/ajh.2009.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Masełbas W, Chabik G, Członkowska A. Persistence with treatment in patients with Wilson disease. Neurol Neurochir Pol 2010; 44:260-3. [DOI: 10.1016/s0028-3843(14)60040-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harmon G, Lefante J, Krousel-Wood M. Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications. Curr Opin Cardiol 2008; 21:310-5. [PMID: 16755199 DOI: 10.1097/01.hco.0000231400.10104.e2] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of recent research assessing the role of physicians and other healthcare providers in facilitating improvements in patient adherence to antihypertensive medications, to provide a framework for addressing patient adherence to antihypertensive therapy, and to propose future directions for assessing the risk of poor adherence in clinical settings. RECENT FINDINGS Several recent studies have highlighted the role of the healthcare provider in improving patient adherence to antihypertensive therapy. Opportunities exist for providers to improve communication that enhances patients' understanding of their disease and its treatment, to tailor interventions based on whether patients are intentionally or unintentionally non-adherent, to assess and treat side-effects such as erectile dysfunction, to switch to less costly generic alternatives, and to reduce the complexities of medication regimens. SUMMARY Poor adherence to prescribed therapies is common in patients with hypertension, and should be considered in the evaluation of the hypertensive patient with poor blood pressure control. When initiating treatment in patients newly diagnosed with hypertension and when monitoring patients with existent disease, providers should identify barriers to medication adherence and actively engage patients in shared decision-making regarding their treatment. These activities will facilitate adherence, which may lead to improved outcomes for patients with hypertension and other chronic cardiovascular diseases.
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Affiliation(s)
- Gary Harmon
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70121, USA
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Briesacher BA, Andrade SE, Yood RA, Kahler KH. Consequences of poor compliance with bisphosphonates. Bone 2007; 41:882-7. [PMID: 17707710 DOI: 10.1016/j.bone.2007.07.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 06/29/2007] [Accepted: 07/10/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prior research on the ability of bisphosphonates to prevent fractures and related health care utilization has been based on high levels of compliance achievable in clinical trial settings. This study was undertaken to assess rates of osteoporotic fractures and health care utilization as a function of bisphosphonate compliance in usual clinical practice. METHODS This retrospective cohort study used 2000-2004 pharmacy and medical claims data from 45 large U.S. employers. Our sample included persons diagnosed with osteoporosis, aged 40 years or older, and who initiated use of either alendronate or risedronate. Main outcome measures were medication compliance, rates of osteoporotic fracture, and costs for inpatient care, outpatient services, and prescription drugs. RESULTS We identified 17,988 new users of bisphosphonate therapy. After 1 to 3 years of follow-up, only 30.6% to 42.9% of patients could achieve high compliance (80%-100%), 17.4%-23.0% moderate compliance (79%-40%), and 33.8%-52.0% had low compliance (0%-39%). Multivariate models of fracture risk showed benefits (p<10) with compliance levels of at least 60%, after which no risk benefit could be detected. Multivariate models of health care costs showed statistically significant (p<.05) total costs savings of $859 to $366 per year with high to moderate compliance levels. However, individuals achieving less than 40% compliance had no detectable decrease in inpatient or outpatient costs to offset the increase in drug costs. CONCLUSIONS Reductions in fracture risk and overall health costs can be detected in individuals achieving as little as 60% to 40% compliance with bisphosphonates. However, as many as 34% of patients in the first year of therapy and 52% by the third year will not reach even the minimal compliance levels required to receive benefits.
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Affiliation(s)
- Becky A Briesacher
- University of Massachusetts Medical School, Division of Geriatric Medicine, Biotech Four, Worcester, MA 01605, USA.
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Severe sepsis due to severe falciparum malaria and leptospirosis co-infection treated with activated protein C. Malar J 2007; 6:42. [PMID: 17428347 PMCID: PMC1950478 DOI: 10.1186/1475-2875-6-42] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 04/12/2007] [Indexed: 11/10/2022] Open
Abstract
Co-infection with falciparum malaria and leptospirosis is uncommon. The aim of this study is to report a case of severe sepsis secondary to dual infection with falciparum malaria and leptospirosis. The literature is also reviewed on the clinical course of such co-infections, and the possible mechanisms and treatment of patients with life-threatening malaria and leptospirosis with activated protein C. The patient was a 25-year old male admitted in the Respiratory Intensive Care Unit (RICU) with fever, haemolysis, acute renal failure, hepatitis, acute lung injury (ALI) and altered sensorium. A syndromic evaluation was done and investigations revealed falciparum parasitaemia. He was treated with parenteral artesunate, ceftriaxone and doxycycline, and adjunctive therapies as for severe sepsis. Infusion of activated protein C was started 20 hours after onset of organ dysfunction, and intensive haemodialysis was instituted. Over the next four days the patient became afebrile with progressive resolution of ALI, renal failure and hepatitis. His Leptospira serology (requested as part of the evaluation) was reported positive on day 5. Dual infections are common and under-recognized in the tropics. Failure to treat potential co-infections may lead to poor outcomes. Acute lung injury in falciparum malaria has high mortality rates and therapy as for severe sepsis may improve survival. Adjunctive therapies, including activated protein C, cannot replace source eradication.
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