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Killian MO, Mayewski S, Gupta D. A multi-centre randomised control trial of directly observed therapy to promote medication adherence in paediatric heart transplant recipients. Cardiol Young 2024:1-4. [PMID: 38606638 DOI: 10.1017/s1047951124000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Medication non-adherence remains a significant challenge for adolescent heart transplant recipients. Building on the success of a pilot intervention study, herein we describe the protocol for a follow-up randomised control trial using mobile video directly observed therapy, featuring several innovations, to promote medication adherence in a multi-centre sample of adolescent heart transplant patients.
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Affiliation(s)
- Michael O Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Sonnie Mayewski
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Dipankar Gupta
- Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL, USA
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Grant MC, Crisafi C, Alvarez A, Arora RC, Brindle ME, Chatterjee S, Ender J, Fletcher N, Gregory AJ, Gunaydin S, Jahangiri M, Ljungqvist O, Lobdell KW, Morton V, Reddy VS, Salenger R, Sander M, Zarbock A, Engelman DT. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS). Ann Thorac Surg 2024; 117:669-689. [PMID: 38284956 DOI: 10.1016/j.athoracsur.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.
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Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Cheryl Crisafi
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Adrian Alvarez
- Department of Anesthesia, Hospital Italiano, Buenos Aires, Argentina
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary E Brindle
- Departments of Surgery and Community Health Services, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Nick Fletcher
- Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, United Kingdom; St George's University Hospital, London, United Kingdom
| | - Alexander J Gregory
- Department of Anesthesia, Perioperative and Pain Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, United Kingdom
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kevin W Lobdell
- Regional Cardiovascular and Thoracic Quality, Education, and Research, Atrium Health, Charlotte, North Carolina
| | - Vicki Morton
- Clinical and Quality Outcomes, Providence Anesthesiology Associates, Charlotte, North Carolina
| | - V Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Sander
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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Killian MO, Little CW, Howry SK, Watkivs M, Triplett KN, Desai DM. Demographic Factors, Medication Adherence, and Post-transplant Health Outcomes: A Longitudinal Multilevel Modeling Approach. J Clin Psychol Med Settings 2024; 31:163-173. [PMID: 37589865 DOI: 10.1007/s10880-023-09970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Few studies in pediatric solid organ transplantation have examined non-adherence to immunosuppressive medication over time and its associations with demographic factors and post-transplant outcomes including late acute rejection and hospitalizations. We examined longitudinal variation in patient Medication Level Variability Index (MLVI) adherence data from pediatric kidney, liver, and heart transplant recipients. Patient and administrative data from the United Network for Organ Sharing were linked with electronic health records and MLVI values for 332 patients. Multilevel mediation modeling indicated comparatively more variation in MLVI values between patients than within patients, longitudinally, over 10 years post transplant. MLVI values significantly predicted late acute rejection and hospitalization. MLVI partially mediated patient factors and post-transplant outcomes for patient age indicating adolescents may benefit most from intervention efforts. Results demonstrate the importance of longitudinal assessment of adherence and differences among patients. Efforts to promote medication adherence should be adapted to high-risk patients to increase likelihood of adherence.
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Affiliation(s)
- Michael O Killian
- College of Social Work, University Center, Florida State University, 296 Champions Way, Building C - Suite 2500, Tallahassee, FL, USA.
- College of Medicine, Florida State University, Tallahassee, FL, USA.
| | - Callie W Little
- College of Social Work, University Center, Florida State University, 296 Champions Way, Building C - Suite 2500, Tallahassee, FL, USA
| | - Savarra K Howry
- College of Social Work, University Center, Florida State University, 296 Champions Way, Building C - Suite 2500, Tallahassee, FL, USA
| | - Madison Watkivs
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Kelli N Triplett
- Children's Health, Children's Medical Center of Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dev M Desai
- Children's Health, Children's Medical Center of Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Killian MO, Schelbe L, Lustria MLA, Watkivs M, Gupta D. Engaging Adolescent Heart Transplant Recipients Through In-App Messaging During Mobile Health Intervention. Prog Transplant 2023; 33:229-235. [PMID: 37491864 DOI: 10.1177/15269248231189862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Introduction: Adolescents heart transplant recipients experience difficulty with adherence to immunosuppressive medication leading to increased risk of organ rejection, hospitalization, and mortality. Few interventions have been successful to promote medication adherence in adolescent heart transplant patients as most fail to engage the patient in the behavioral change process and support patient-provider communication. The purpose of this study was to explore the nature and degree of in-app communication between adolescent heart transplant recipients and nursing staff during an asynchronous mobile video directly observed therapy intervention. Methods: A content analysis of 894 in-app messages exchanged between 10 adolescent patients and nurses during a 12-week mobile-based intervention was conducted. Two authors used an inductive, iterative process to guide a thematic analysis of the asynchronous in-app messages with high interrater reliability ranging from 81.5% to 100%. Findings: In-app messages fell under 3 broad content categories: (1) interpersonal support and rapport-building, (2) medically related questions and information, or (3) functional information about the intervention and the mHealth app. Results demonstrated the degree to which interpersonal engagement occurred during the intervention, the nature of these exchanges, and their relationship to medication adherence. Conclusions: The study provided insights into the feasibility and benefits of 2-way communication features of the directly observed therapy intervention in promoting engagement and in improving medication adherence among adolescent heart transplant patients. Continued research and clinical focus on patient engagement and impactful aspects of interpersonal communication could aid in the translation of this intervention into standard clinical care at pediatric transplant centers.
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Affiliation(s)
- Michael O Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Lisa Schelbe
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Mia Liza A Lustria
- College of Medicine, Florida State University, Tallahassee, FL, USA
- School of Information, College of Communication and Information, Florida State University, Tallahassee, FL, USA
- College of Social Sciences and Public Policy, Florida State University, Tallahassee, FL, USA
| | - Madison Watkivs
- Interdisciplinary Medical Sciences, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Dipankar Gupta
- UF Shands Children's Hospital, UF Health Congenital Heart Center, University of Florida, Gainesville, FL, USA
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McCrossan P, O'Donoghue D, McElnay JC, Shields MD. The use of remote video directly observed therapy to improve both inhaler technique and adherence to asthma medications. Front Public Health 2022; 10:965629. [PMID: 36276358 PMCID: PMC9581185 DOI: 10.3389/fpubh.2022.965629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023] Open
Abstract
Incorrect inhaler technique and non-adherence to inhaled preventer therapy often is the cause of poorly controlled asthma. Detecting and correcting non-adherence in asthma therapy has proven difficult. In addition, while patients may be able to demonstrate correct inhaler technique at the clinic recent evidence suggests that critical errors in inhaler technique occur in the home setting. Remote video directly observed therapy (vDOT) has recently been described as a potentially useful tool for addressing non-adherence while also allowing timely correction of inhaler technique errors. In this mini-review we describe the use of vDOT in asthma management.
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Affiliation(s)
- Paddy McCrossan
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom,Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dara O'Donoghue
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom,Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | | | - Michael D. Shields
- Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom,Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom,*Correspondence: Michael D. Shields
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Killian MO, Clifford S, Lustria MLA, Skivington GL, Gupta D. Directly observed therapy to promote medication adherence in adolescent heart transplant recipients. Pediatr Transplant 2022; 26:e14288. [PMID: 35436376 DOI: 10.1111/petr.14288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE HT recipients experience high levels of medication non-adherence during adolescence. This pilot study examined the acceptability and feasibility of an asynchronous DOT mHealth application among adolescent HT recipients. The app facilitates tracking of patients' dose-by-dose adherence and enables transplant team members to engage patients. The DOT application allows patients to self-record videos while taking their medication and submit for review. Transplant staff review the videos and communicate with patients to engage and encourage medication adherence. METHODS Ten adolescent HT recipients with poor adherence were enrolled into a single-group, 12-week pilot study examining the impact of DOT on adherence. Secondary outcomes included self-report measures from patients and parents concerning HRQOL and adherence barriers. Long-term health outcomes assessed included AR and hospitalization 6 months following DOT. FINDINGS Among 14 adolescent HT patients approached, 10 initiated the DOT intervention. Of these, 8 completed the 12-week intervention. Patients and caregivers reported high perceptions of acceptability and accessibility. Patients submitted 90.1% of possible videos demonstrating medication doses taken. MLVI values for the 10 patients initiating DOT decreased from 6 months prior to the intervention (2.86 ± 1.83) to 6 months following their involvement (2.08 ± 0.87) representing a 21.7% decrease in non-adherence, though not statistically significant given the small sample size. CONCLUSIONS Result of this pilot study provides promising insights regarding the feasibility, acceptability, and potential impact of DOT for adolescent HT recipients. Further randomized studies are required to confirm these observations.
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Affiliation(s)
- Michael O Killian
- College of Social Work, Florida State University, Tallahassee, Florida, USA.,College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Stephanie Clifford
- Congenital Heart Center, UF Health Shands Children's Hospital, University of Florida, Gainesville, Florida, USA.,College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Mia Liza A Lustria
- College of Medicine, Florida State University, Tallahassee, Florida, USA.,School of Information, College of Communication and Information, Florida State University, Tallahassee, Florida, USA
| | - Gage L Skivington
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Dipankar Gupta
- Congenital Heart Center, UF Health Shands Children's Hospital, University of Florida, Gainesville, Florida, USA.,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
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