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Qiu X, Liu Y, Shi W, Lin G, Rong M, Wang B. Hemorrhoidal disease among doctors from grade-A tertiary hospitals in big cities of China: results from web-based doctors as patients survey. BMC Gastroenterol 2024; 24:103. [PMID: 38481133 PMCID: PMC10935840 DOI: 10.1186/s12876-024-03166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Doctors are at high risk of developing hemorrhoidal disease (HD), but it is unclear whether doctors are aware of this risk. The OASIS (dOctors AS patIentS) study was performed to examine the prevalence, awareness, diagnosis, and treatment of HD among doctors in big cities in China. METHODS An online survey consisting of a structured questionnaire was carried out among doctors in grade-A tertiary hospitals in 29 provinces across China from August to October 2020. RESULTS A total of 1227 questionnaire responses were collected. HD prevalence was 56.8%, with a significant difference between internists and surgeons (P = 0.01). 15.6% of doctors with HD didn't have serious concerns about the recurrence and severity of HD. 91.5% of doctors adopted general treatments, and 83.0% considered oral medications only when topical medications were ineffective. Among the oral medications, Micronized Purified Flavonoid Fraction (MPFF) was most effective based on the scores from three important parameters, but only 17% of doctors received MPFF. CONCLUSIONS Doctors are at higher risk of developing HD with a high prevalence among Chinese doctors, but they are not fully aware or not concerned about HD. There is a deficiency in treatment recommendations and clinical management of HD even for doctors, including late initiation and inadequate oral drug therapy. Therefore, awareness and standardized treatment of HD should be improved among Chinese doctors, as well as in the general population.
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Affiliation(s)
- Xiaoyuan Qiu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Department of Surgery, Peking Union Medical College Hospital, (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yuxin Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Department of Surgery, Peking Union Medical College Hospital, (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Weikun Shi
- Department of Surgery, Peking Union Medical College Hospital, (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Guole Lin
- Department of Surgery, Peking Union Medical College Hospital, (Dongdan Campus), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Mei Rong
- Medical & Scientific Affairs, Servier, Beijing, 100020, China
| | - Bingjie Wang
- Medical & Scientific Affairs, Servier, Beijing, 100020, China
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Yadavalli T, Singh SK, Date AA, Shukla D. Tolerability, pharmacokinetics, and anti-herpetic activity of orally administered BX795. Biomed Pharmacother 2023; 165:115056. [PMID: 37406507 DOI: 10.1016/j.biopha.2023.115056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
Herpes simplex viruses type-1 (HSV-1) and type-2 (HSV-2) are ubiquitous human pathogens causing serious pathologies in the ocular, orofacial and anogenital regions. While current treatments such as nucleoside analogs are effective in most cases, the emergence of drug resistance necessitates the development of newer antivirals with different mechanisms of action. In this regard, BX795, a small molecule inhibitor has shown significant benefit in the treatment of herpesvirus infections previously when dosed topically. However, the efficacy of BX795's systemic dosage remains to be tested. In this study, we evaluated acute and short-term toxicity of orally administered BX795 at a concentration of 400 and 100 mg/kg respectively in mice. This was followed by an evaluation of pharmacokinetics and tissue distribution of BX795 on intravenous and oral administration. Based on these studies, we performed an in vivo antiviral study using murine models of ocular HSV-1 and genital HSV-2 infection. Our results indicate that orally administered BX795 is very well tolerated, had oral bioavailability of 56%, and reached ocular and genital tissues within the first 15 min of dosing. Our studies indicate that BX795 administered orally can significantly reduce herpesvirus replication in the ocular and genital tissue.
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Affiliation(s)
- Tejabhiram Yadavalli
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Sudhanshu Kumar Singh
- Department of Ophthalmology and Visual Sciences, Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
| | - Abhijit A Date
- Department of Pharmacology and Toxicology, Department of Ophthalmology and Vision Science, BIO5 Institute, The University of Arizona, Tucson, AZ, USA.
| | - Deepak Shukla
- Department of Ophthalmology and Visual Sciences, Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, USA.
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Johannesson J, Hansson P, Bergström CAS, Paulsson M. Manipulations and age-appropriateness of oral medications in pediatric oncology patients in Sweden: Need for personalized dosage forms. Biomed Pharmacother 2022; 146:112576. [PMID: 35062056 DOI: 10.1016/j.biopha.2021.112576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Due to the lack of age-appropriate formulations for children, healthcare professionals and caregivers frequently manipulate dosage forms to facilitate oral administration and obtain the required dose. In this study, we investigated drug manipulation and age-appropriateness of oral medications for pediatric oncology patients with the aim of identifying the therapeutic needs for personalized dosage forms. An observational study at a pediatric oncology ward, combined with analysis of the age-appropriateness of the oral medications, was performed. Nurses frequently manipulated solid dosage forms to administer them via enteral feeding tubes. Of the active pharmaceutical ingredients (APIs) assessed for age-appropriateness, 74% (29 of 39) were identified to need personalization, either because of lack of child-friendly dosage form, suitable dosage strength, or both. Most APIs, due to limited solubility, were sensitive to formulation changes, such as drug manipulation. This study demonstrates problems and therapeutic needs regarding oral dosage forms in treatment of children with cancer. Expertise in formulation design, new manufacturing technologies, and patient-centered information are needed to address age-appropriate formulations for children.
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Affiliation(s)
- Jenny Johannesson
- Department of Pharmacy, Uppsala University, Uppsala Biomedical Center, P.O Box 580, SE-751 23 Uppsala, Sweden
| | - Paula Hansson
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden
| | - Christel A S Bergström
- Department of Pharmacy, Uppsala University, Uppsala Biomedical Center, P.O Box 580, SE-751 23 Uppsala, Sweden
| | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden.
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Conley CC, McIntyre M, Pensak NA, Lynce F, Graham D, Ismail-Khan R, Lopez K, Vadaparampil ST, O'Neill SC. Barriers and facilitators to taking CDK4/6 inhibitors among patients with metastatic breast cancer: a qualitative study. Breast Cancer Res Treat 2022; 192:385-399. [PMID: 34997364 DOI: 10.1007/s10549-022-06518-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Most studies of adherence to treatment for breast cancer have focused on early-stage patients. Findings from these studies may not generalize to patients with metastatic breast cancer (MBC). The objective of this study was to identify barriers and facilitators of adherence to cyclin-dependent kinase 4/6 (CDK4/6) inhibitors among patients with MBC, guided by the social ecologic model (SEM). METHODS Patients with MBC (N = 25), their caregivers (N = 9), and oncology providers (N = 13) completed semi-structured qualitative interviews exploring their experiences with CDK4/6 inhibitors. Interviews were audio-recorded, transcribed verbatim, and analyzed by three raters using a combined deductive and inductive approach. RESULTS Qualitative analysis identified barriers and facilitators of adherence at each SEM level. Intrapersonal and interpersonal factors were most frequently discussed. Intrapersonal factors included knowledge/beliefs about CDK4/6 inhibitors, side effects, and establishing a routine. Interpersonal factors included effective communication with/coordination by the care team, support from family and friends, and information from other patients with MBC. Although less frequently discussed, policy factors (i.e., cost of CDK4/6 inhibitors) were of great concern to patients, caregivers, and providers. CONCLUSION Barriers to adherence to CDK4/6 inhibitors exist at multiple levels. Our results underscore the potential value of a multilevel intervention (e.g., patient education, evidence-based strategies for symptom management, tips for open and assertive communication with providers, information about financial resources/support available, and so on) to support adherence in this population.
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Affiliation(s)
- Claire C Conley
- Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA. .,Moffitt Cancer Center, Tampa, FL, USA.
| | | | | | | | - Deena Graham
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Katherine Lopez
- Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA
| | | | - Suzanne C O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA
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Zhou X, Guo Q, Guo M, Li B, Peng W, Wang D, Ming D, Zheng B. Nanoarmour-shielded single-cell factory for bacteriotherapy of Parkinson's disease. J Control Release 2021; 338:742-753. [PMID: 34517041 DOI: 10.1016/j.jconrel.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 01/15/2023]
Abstract
Cell-based therapy for Parkinson's disease (PD) is a novel and promising approach in recent years. However, exogenous cells are easy to be captured and destroyed by the harsh environment in vivo, so their application prospects have been severely limited. Here, a facile yet versatile approach for decorating individual living cells with nano-armor coatings is reported. By simply self-assembly with liposome under a cyto-compatible condition, the lipid bimolecular coating on the surface of each cell acts as armor to effectively protect it from the attack and destruction of strong acids and digestive enzymes during the oral treatment of PD. Our results demonstrated that the liposome coated B. adolescentis (LCB) could significantly improve the colonization rate in the intestinal tract. LCB, as a living cell factory, can self-regulate to produce a constant concentration of γ-aminobutyric acid and maintain a longer half-life for the treatment of PD. Then, we also explored the specific mechanism of LCB to improve the behavior of murine models of PD, including abating inflammatory effects, reducing neuronal apoptosis, regulating the activity of dopaminergic neurons and microglia. The simple nano-armor shielded single-cell factory can produce neurotransmitters-like drugs on demand in vivo, introducing novel strategies of integration of producing and using to the research of drug delivery field.
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Affiliation(s)
- Xin Zhou
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China; College of Medical Imaging, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Qinglu Guo
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China
| | - Mingming Guo
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China
| | - Bowen Li
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China
| | - Wenchang Peng
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China
| | - Deping Wang
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China; College of Medical Imaging, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China
| | - Bin Zheng
- Academy of Medical Engineering and Translational Medicine, Tianjin Key Laboratory of Brain Science and Neural Engineering, Xincheng Hospital of Tianjin University, Tianjin University, Tianjin 300072, China; Healthina Academy of Cellular Intelligence Manufacturing & Neurotrauma Repair, Beijing Tangyi Huikang Biomedical Technology Co., Ltd, Beijing 100010, China.
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Latheef F, Wahlgren H, Lilja HE, Diderholm B, Paulsson M. The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants. Neonatology 2021; 118:73-79. [PMID: 33567438 DOI: 10.1159/000513169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. METHODS A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. RESULTS A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. CONCLUSION The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.
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Affiliation(s)
- Faiza Latheef
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden, .,Department of Hospital Pharmacy, Region Västmanland, Västerås, Sweden,
| | - Hanna Wahlgren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Tao S, Yu F, Song Y, Zhou W, Lv J, Zhao R, Wang C, Hu F, Yuan H. Water/pH dual responsive in situ calcium supplement collaborates simvastatin for osteoblast promotion mediated osteoporosis therapy via oral medication. J Control Release 2021; 329:121-35. [PMID: 33279604 DOI: 10.1016/j.jconrel.2020.11.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/22/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022]
Abstract
Calcium supplement is the most commonly adopted treatment for osteoporosis but usually requires high dose and frequency. The modality of calcium supplement is therefore overlooked by current nanomedicine-based osteoporosis therapies without proper oral formulations. Herein, we proposed a tetracycline (Tc) modified and monostearin (MS) coated amorphous calcium carbonate (ACC) platform (TMA) as oral bone targeted and osteoporosis microenvironment (water/pH) responsive carrier for in situ calcium supplement. Moreover, current osteoporosis therapies also fall short of finding suitable molecular target and effective therapeutic regimen to further increase the therapeutic efficacy over available treatment means. As a result, the simvastatin (Sim) was loaded into TMA to construct drug delivery system (TMA/Sim) capable of synergistically activating the bone morphogenetic proteins (BMPs)-Smad pathway to provide a novel therapeutic regimen for osteoblast promotion mediated osteoporosis therapy. Our results revealed that optimized TMA showed high accessibility and oral availability with targeted drug delivery to bone tissue. Most importantly, benefit from the effective in situ calcium supplement and targeted Sim delivery, this therapeutic regime (TMA/Sim) achieved better synergetic effects than conventional combination strategies with promising osteoporosis reversion performance under low calcium dosage (1/10 of commercial calcium carbonate tablet) and significantly attenuated side effects.
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Abstract
Positron emission tomography/computed tomography (PET/CT) is a standard procedure for imaging cancer commonly used in the clinical practice for several diseases, in particular for cancer staging, restaging, treatment monitoring and radiation therapy planning. Despite the availability of many radiotracers, 18F-fluoro-2-deoxy-2-D-glucose ([18F]FDG) is the most used. International PET/CT guidelines propose protocols for patients' correct preparation before [18F]FDG injection, in particular with the regard of diabetic patients and therapy management. Hyperglycemic conditions and oral or insulin medication showed advantages and disadvantages on PET/CT scan accuracy: A correct knowledge of effects of these conditions on glucose metabolism assumes a fundamental role on patients management before [18F]FDG PET/CT scan.
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Affiliation(s)
- Monica Finessi
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Gianni Bisi
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Désirée Deandreis
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
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van der Vossen AC, Al-Hassany L, Buljac S, Brugma JD, Vulto AG, Hanff LM. Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions. Acta Paediatr 2019; 108:1475-1481. [PMID: 30632630 DOI: 10.1111/apa.14718] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 01/08/2019] [Indexed: 11/27/2022]
Abstract
AIM Due to a lack of age-appropriate formulations, administration of drugs to children remains a challenge. This study aimed to identify the problems experienced in both the outpatient setting and the clinical setting. METHODS Between June 2017 and January 2018, we performed a cross-sectional, prospective study at the Sophia Children's Hospital, The Netherlands. The study comprised of a structured interview on drug manipulations with parents visiting the outpatient clinic, and an observational study of drug manipulations by nurses at the wards. RESULTS A total of 201 questionnaires were collected, accounting for 571 drugs and 169 manipulations (30%). Drug substances that were most often mentioned as manipulated were macrogol (n = 23), esomeprazole (n = 15), paracetamol (n = 8), methylphenidate (n = 7) and melatonin (n = 7). Of all manipulated medicines, 93/169 (55%) were manipulated according to the instructions or recommendations of the Summary of Product Characteristics (SmPC) or patient information leaflet. During the observational study, manipulation was performed by 21/35 of observed nurses (60%), of whom 11 deviated from the hospital protocol for manipulation or SmPC (52%). CONCLUSION Manipulation was a widely used method to administer drugs to children. Validated information regarding manipulation of drugs for both parents and nursing staff is needed.
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Affiliation(s)
- Anna C. van der Vossen
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Linda Al-Hassany
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Sandra Buljac
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan-Dietert Brugma
- Department of Outpatient Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Arnold G. Vulto
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Lidwien M. Hanff
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Department of Hospital Pharmacy; Princess Maxima Center for Pediatric Oncology; Utrecht The Netherlands
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Abstract
BACKGROUND Non-adherence negatively affects the efficacy, safety and costs of therapies. Non-adherence is a multifactorial problem. This systematic review (SR) of SRs (overview) aims to identify factors that can influence the adherence of adult patients with chronic physical diseases. METHODS We performed a systematic literature search in MEDLINE and Embase on June 13, 2018. We included SRs on the factors that can influence adherence in adult patients taking oral medications for treating physical chronic diseases. Two reviewers independently selected studies according to pre-defined inclusion criteria. Two reviewers independently assessed the risk of bias with the ROBIS tool. Data were extracted in standardized tables previously piloted by one reviewer and verified by a second reviewer. We synthesized data in tables in a structured narrative manner. RESULTS We included 21 SRs on eight different conditions. We rated eight SRs to be at low risk of bias and 13 to be at high risk of bias. Although higher education, employment, higher financial status and marriage/partnership mostly showed a positive effect on adherence, the impact was unclear because of the high uncertainty of the underlying evidence. The evidence indicates that socioeconomic status and social support might have a positive impact on adherence and that belonging to an ethnic minority might have a negative impact on adherence. Therapy-related factors (e.g., intake regime) and disease-related factors (e.g., duration) mostly showed no impact on adherence. Analysis of gender showed inconsistent results. Age might have a concave relation to adherence, i.e., adherence is lowest in very young and very old people. Depression has a negative impact on adherence. Impacts of other mental and physical comorbidities were uncertain. Co-payments (any or higher) have a negative impact on adherence. In contrast, the impacts of medication costs and insurance status were uncertain. CONCLUSION This overview analyses factors that might impact adherence to oral therapies in adult patients with physical chronic diseases. Our overview suggests that there is a social gradient in adherence. However, for most factors, the evidence was not conclusive due to the risk of bias, inconsistency or imprecision.
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Affiliation(s)
- Alina Gast
- Institute for Research in Operative Medicine (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Tim Mathes
- Institute for Health Economics and Clinical Epidemiology of the University of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany.
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Thomas I, Alam M, Bergquist F, Johansson D, Memedi M, Nyholm D, Westin J. Sensor-based algorithmic dosing suggestions for oral administration of levodopa/carbidopa microtablets for Parkinson's disease: a first experience. J Neurol 2019; 266:651-8. [PMID: 30659356 DOI: 10.1007/s00415-019-09183-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
Objective Dosing schedules for oral levodopa in advanced stages of Parkinson’s disease (PD) require careful tailoring to fit the needs of each patient. This study proposes a dosing algorithm for oral administration of levodopa and evaluates its integration into a sensor-based dosing system (SBDS). Materials and methods In collaboration with two movement disorder experts a knowledge-driven, simulation based algorithm was designed and integrated into a SBDS. The SBDS uses data from wearable sensors to fit individual patient models, which are then used as input to the dosing algorithm. To access the feasibility of using the SBDS in clinical practice its performance was evaluated during a clinical experiment where dosing optimization of oral levodopa was explored. The supervising neurologist made dosing adjustments based on data from the Parkinson’s KinetiGraph™ (PKG) that the patients wore for a week in a free living setting. The dosing suggestions of the SBDS were compared with the PKG-guided adjustments. Results The SBDS maintenance and morning dosing suggestions had a Pearson’s correlation of 0.80 and 0.95 (with mean relative errors of 21% and 12.5%), to the PKG-guided dosing adjustments. Paired t test indicated no statistical differences between the algorithmic suggestions and the clinician’s adjustments. Conclusion This study shows that it is possible to use algorithmic sensor-based dosing adjustments to optimize treatment with oral medication for PD patients.
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Hansen K, Yee L, Lee J, Horeczko T, Saidinejad M, Padlipsky PS, Gausche-Hill M, Tanen DA. Parent and Nurse Satisfaction Using Pacidose® Oral Medication Delivery Device in the Pediatric Emergency Department: A Pilot Study. J Pediatr Nurs 2018; 42:100-3. [PMID: 29706299 DOI: 10.1016/j.pedn.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Administering oral medication to infants is challenging for caregivers, often resulting in incomplete delivery of the intended dose. Pacidose® is an oral medication delivery device that consists of a syringe attached to a tunneled pacifier. This study aimed to determine caregiver and nurse satisfaction and success rate of the Pacidose in the administration of acetaminophen to infants in the pediatric emergency department (ED). DESIGN AND METHODS This was a prospective trial involving a convenience sample of patients who presented to a pediatric ED between November 2015 and August 2016. Patients younger than 24 months with a physician order for acetaminophen were eligible. Each child received a single dose of acetaminophen delivered by the Pacidose. Nurses, parents, and observing investigators were surveyed with a standardized questionnaire regarding the effectiveness, satisfaction and success rate of Pacidose. RESULTS 61 patients were enrolled. The median age was 10 months and Pacidose was successful in 77% of patients. Those who required an alternative delivery route were older and no longer used pacifiers. Nurses reported that Pacidose helped administer the medication more easily in 66% of infants and 95% of parents preferred the Pacidose over standard delivery devices. CONCLUSIONS Pacidose was well tolerated by infants, and both parents and nurses were highly satisfied with this method of administering acetaminophen. PRACTICE IMPLICATIONS Pacidose is an easy to implement device that can help nurses with oral medication administration. It may have the greatest impact in younger children with recent pacifier use.
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Maroof SU, Shaukat F, Aslam J, Jawaid M. Use of Oral Vitamin-D Glass ampoule and tablet: Experience of patients and physicians. Pak J Med Sci 2017; 33:498-501. [PMID: 28523064 PMCID: PMC5432731 DOI: 10.12669/pjms.332.12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To ascertain patients and physician views regarding hazard and compliance of oral liquid Vitamin D glass ampoule and tablets. Methods: This cross sectional survey was conducted from November 1st 2016 to 15th December 2016. Patients who were prescribed Vitamin D glass ampoule from oral route in last three months were included along with physicians who routinely prescribe vitamin D after taking informed consent. The participants were asked about injuries related to the use of glass ampoule, ease of using this from, after taste preference of tablet or injectable form as well as demography. Data was analysed with SPSS version 24.0. Results: Total 182 patients were included in the study with mean ± SD age of 39.4 ± 12.4 years. Majority of patients, 80.2% (142) said they prefer oral tablet in preference to injectable ampule in oral form if given choice while prescribing Vitamin D. Moreover 66.7% (64) doctors prefer to prescribe tablet form of Vitamin D instead of injection as oral form for vitamin D deficiency among their patients. One third of patients, 33% (n=59) sustained injury while breaking the ampule which included minor self-controlled bleeding by glass particles in 50% (n=35). Less than half of doctors 46.9% (n=45) said they taught their patients about usage of injectable Vitamin D ampules. Conclusion: Majority of patients prefer Vitamin D tablet instead of Oral liquid in glass ampoule if they got the choice among two. The results of this study provide important implications for our doctors about patients concern of hazard, after taste and compliance with orally administered Vitamin D glass ampoules.
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Affiliation(s)
- Syed Umair Maroof
- Syed Umair Maroof, B-Pharm, MBA PharmEvo [Pvt] Limited, Karachi, Pakistan
| | - Faizan Shaukat
- Dr. Faizan Shaukat, MBBS Senior Executive, Medical Affairs, PharmEvo [Pvt] Limited, Karachi, Pakistan
| | - Junaid Aslam
- Junaid Aslam, MBA PharmEvo [Pvt] Limited, Karachi, Pakistan
| | - Masood Jawaid
- Dr. Masood Jawaid, MBBS, MCPS, MRCS (Glasg), FCPS, MHPE Consultant General Surgeon, Darul Sehat Hospital and Director Medical Affairs, PharmEvo [Pvt] Limited, Karachi, Pakistan
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Marras C, Monteagudo I, Salvador G, de Toro FJ, Escudero A, Alegre-Sancho JJ, Raya E, Ortiz A, Carmona L, Mestre Y, Cea-Calvo L, Calvo-Alén J. Identification of patients at risk of non-adherence to oral antirheumatic drugs in rheumatoid arthritis using the Compliance Questionnaire in Rheumatology: an ARCO sub-study. Rheumatol Int 2017; 37:1195-1202. [PMID: 28516236 DOI: 10.1007/s00296-017-3737-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/05/2017] [Indexed: 11/25/2022]
Abstract
The ARCO study (Study on Adherence of Rheumatoid Arthritis patients to SubCutaneous and Oral Drugs), a multicenter, non-interventional retrospective study, was primarily designed to assess the percentage of patients [aged ≥18 years with an established rheumatoid arthritis (RA) diagnosis] with non-adherence to prescribed subcutaneous biologicals. This paper reports data for the secondary objective from a subset of patients, namely to evaluate non-adherence to prescribed oral antirheumatic drugs in RA patients in Spain using the validated Compliance Questionnaire Rheumatology (CQR). Patients also completed the Morisky-Green Medication Adherence Questionnaire, Beliefs about Medicines Questionnaire, and a questionnaire (developed and validated in Spain) on patient satisfaction with RA treatment and preferences. A total of 271 patients (76.7% females; mean age 55.6 years) were being treated with oral drugs for RA, of which 234 completed the CQR questionnaire. Non-adherence was reported in 49/234 (20.9%) patients. The proportion of non-adherence in younger patients (aged ≤48 years; 37.5%) was double that recorded in patients aged >48 years (p = 0.006). Patients with a perception of lower efficacy also had a higher risk of non-adherence (p = 0.012). Multivariable analysis showed that younger age and male gender were independently associated with risk of non-adherence. There was only slight agreement between the CQR and Morisky-Green assessment tools (kappa coefficient = 0.186), possibly reflecting the fact that both questionnaires measure slightly different aspects of medication adherence. In conclusion, one out of five RA patients was identified as at risk for non-adherence with the CQR, and this was more frequent in younger patients and in males.
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Affiliation(s)
- Carlos Marras
- Hospital Universitario Virgen de Arrixaca, Calle Polideportivo, 5, 30120, Murcia, Spain.
| | | | | | | | | | | | - Enrique Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | - Ana Ortiz
- Hospital Universitario La Princesa, IIS La Princesa, Madrid, Spain
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Kuehhas FE, Weibl P, Georgi T, Djakovic N, Herwig R. Peyronie's Disease: Nonsurgical Therapy Options. Rev Urol 2011; 13:139-46. [PMID: 22110397 PMCID: PMC3221554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Peyronie's disease (PD) is a fibrous inelastic scar of the tunica albuginea, leading to penile deformity, penile curvature, shortening, narrowing, and painful erections that subsequently lead to painful or unsatisfying sexual intercourse. No consensus exists yet on the ideal management of PD. This fact is a result of our limited knowledge of its etiology and causative factors. The acute presentation of PD is treated conservatively, and surgical approaches are only attempted if severe curvature, narrowing, or indentation persists for more than 1 year; PD stability exists for at least 3 months; curvature impedes sexual intercourse; and severe penile shortening occurs. This review focuses on new developments for conservative treatment strategies for PD.
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