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Asano M, Imai S, Shimizu Y, Kizaki H, Ito Y, Tsuchiya M, Kuriyama R, Yoshida N, Shimada M, Sando T, Ishijima T, Hori S. Factor Analysis of Patients Who Find Tablets or Capsules Difficult to Swallow Due to Their Large Size: Using the Personal Health Record Infrastructure of Electronic Medication Notebooks. J Med Internet Res 2024; 26:e54645. [PMID: 38657229 PMCID: PMC11079767 DOI: 10.2196/54645] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/22/2023] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Understanding patient preference regarding taking tablet or capsule formulations plays a pivotal role in treatment efficacy and adherence. Therefore, these preferences should be taken into account when designing formulations and prescriptions. OBJECTIVE This study investigates the factors affecting patient preference in patients who have difficulties swallowing large tablets or capsules and aims to identify appropriate sizes for tablets and capsules. METHODS A robust data set was developed based on a questionnaire survey conducted from December 1, 2022, to December 7, 2022, using the harmo smartphone app operated by harmo Co, Ltd. The data set included patient input regarding their tablet and capsule preferences, personal health records (including dispensing history), and drug formulation information (available from package inserts). Based on the medication formulation information, 6 indices were set for each of the tablets or capsules that were considered difficult to swallow owing to their large size and concomitant tablets or capsules (used as controls). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of each index. The index demonstrating the highest area under the curve of the ROC was selected as the best index to determine the tablet or capsule size that leads to swallowing difficulties. From the generated ROCs, the point with the highest discriminative performance that maximized the Youden index was identified, and the optimal threshold for each index was calculated. Multivariate logistic regression analysis was performed to identify the risk factors contributing to difficulty in swallowing oversized tablets or capsules. Additionally, decision tree analysis was performed to estimate the combined risk from several factors, using risk factors that were significant in the multivariate logistic regression analysis. RESULTS This study analyzed 147 large tablets or capsules and 624 control tablets or capsules. The "long diameter + short diameter + thickness" index (with a 21.5 mm threshold) was identified as the best indicator for causing swallowing difficulties in patients. The multivariate logistic regression analysis (including 132 patients with swallowing difficulties and 1283 patients without) results identified the following contributory risk factors: aged <50 years (odds ratio [OR] 1.59, 95% CI 1.03-2.44), female (OR 2.54, 95% CI 1.70-3.78), dysphagia (OR 3.54, 95% CI 2.22-5.65), and taking large tablets or capsules (OR 9.74, 95% CI 5.19-18.29). The decision tree analysis results suggested an elevated risk of swallowing difficulties for patients with taking large tablets or capsules. CONCLUSIONS This study identified the most appropriate index and threshold for indicating that a given tablet or capsule size will cause swallowing difficulties, as well as the contributory risk factors. Although some sampling biases (eg, only including smartphone users) may exist, our results can guide the design of patient-friendly formulations and prescriptions, promoting better medication adherence.
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Affiliation(s)
- Masaki Asano
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Shungo Imai
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Yuri Shimizu
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Hayato Kizaki
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | | | | | | | | | | | | | | | - Satoko Hori
- Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
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Trapl-Grundschober M, Schulz S, Sollereder S, Schneider L, Teuschl Y, Osterbrink J. Oral intake of solid medications in patients with post-stroke dysphagia. A challenge for nurses? J Clin Nurs 2024. [PMID: 38407372 DOI: 10.1111/jocn.17081] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
AIM To provide a comprehensive overview of how stroke nurses manage solid medication (SM) delivery to patients with post-stroke dysphagia. DESIGN Cross-sectional study. METHODS A self-administered online survey was carried out among nurses in German-speaking countries between September and December 2021. RESULTS Out of a total of 754 responses, analysis was conducted on 195 nurses who reported working on a stroke unit. To identify swallowing difficulties in acute stroke care, 99 nurses indicated routinely administering standardised screenings, while 10 use unvalidated screenings, and 82 are waiting for a specialist evaluation. Regardless of whether screening methods are used or not, most preferred a non-oral route of medication administration for patients with suspected dysphagia. None of the respondents reported administering whole SMs orally to patients. If screening methods indicate dysphagia, approximately half of the respondents would modify SMs. Participants who stated to use the Gugging Swallowing Screen managed the SM intake guided by its severity levels. One-third of the group who awaited assessment by the dysphagia specialist provided modified medication before the consultation. CONCLUSION Most of the nurses on stroke units use swallowing screens and avoid the administration of whole SMs in post-stroke dysphagia. In addition to the non-oral administration, SMs are modified if dysphagia is suspected. Precise guidance on the administration of SM is needed, based on screening tests and prior to expert consultation. TRIAL AND PROTOCOL REGISTRATION ClinicalTrials.gov: Registration ID: NCT05173051/ Protocol ID: 11TS003721. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The present paper serves to alert nurses to the issue of patient safety when administering medication for acute stroke-induced dysphagia. IMPACT SM delivery after acute stroke-induced dysphagia is often neglected. While nurses are aware of the risk associated with dysphagia and would not give whole SMs to patients, the modification of tablets and their administration with semisolids are common. REPORTING METHOD This study was reported according to the Checklist for Reporting of Survey Studies (CROSS).
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Affiliation(s)
- Michaela Trapl-Grundschober
- Karl Landsteiner University of Health Sciences, Krems, Lower Austria, Austria
- Division of Neurology, University Hospital Tulln, Tulln, Lower Austria, Austria
- Paracelsus Medical University, Institute for Nursing Science and Practice, Salzburg, Austria
| | - Steffen Schulz
- EUFH Campus Rostock, University of Applied Sciences, Rostock, Germany
| | - Simon Sollereder
- Division for Rehabilitation & Recovery, VASCage Center on Clinical Stroke Research, Innsbruck, Austria
| | - Lea Schneider
- Brothers of St. John of God Hospital Eisenstadt GmbH, Eisenstadt, Austria
| | - Yvonne Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, University for Continuing Education Krems, Krems, Austria
| | - Jürgen Osterbrink
- Paracelsus Medical University, Institute for Nursing Science and Practice, Salzburg, Austria
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Kofole Z, Haile D, Solomon Y. Fasting blood glucose, blood pressure and body mass index among combined oral contraceptive users in Chencha town Southern Ethiopia, 2019. Front Glob Womens Health 2023; 4:992750. [PMID: 37187593 PMCID: PMC10175825 DOI: 10.3389/fgwh.2023.992750] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Background The use of contraceptives has become prevalent among women in Ethiopia. Oral contraceptive use has been suggested to trigger changes in glucose metabolism, energy expenditure, blood pressure, and body weight, among various populations and ethnic groups. Objective To elucidate the pattern of fasting blood glucose, blood pressure, and body mass index among combined oral contraceptive pills users compared to controls. Methods An institution-based cross-sectional study design was employed. A total of 110 healthy women using combined oral contraceptive pills were recruited as cases. Another 110 healthy age and sex-matched women not using any hormonal contraceptives were recruited as controls. A study was conducted between October 2018 and January 2019. Data obtained was entered and analyzed using IBM SPSS version 23 software packages. One-way ANOVA was used to identify the variation of variables in relation to the duration of use of the drug. The P-value of < 0.05 at the 95% confidence level was statistically significant. Results Fasting blood glucose level among oral contraceptive users (88.55 ± 7.89 mg/dl) was higher than fasting blood glucose level among oral contraceptive non-users (86.00 ± 9.85 mg/dl) with a p-value of 0.025. The mean arterial pressure of oral contraceptive users (88.2 ± 8.48 mmHg) was relatively higher than their counterparts (86.0 ± 6.74 mmHg), with a p-value of 0.04. Comparatively the body weight and body mass index among oral contraceptive users were 2.5% and 3.9% higher than non-users with a p-value of 0.03 and 0.003, respectively(5). Utilization of oral contraceptive pills for prolonged period of time seemed to be a significant predictive factor for higher mean arterial pressure and body mass index with p < 0.001and p < 0.05 respectively. Conclusions Use of combined oral contraceptives was associated with higher fasting blood glucose (+2.9%), mean arterial pressure (+2.5%), and body mass index (3.9%) compared to controls.
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Affiliation(s)
- Zelalem Kofole
- Department of Biomedical Sciences, School of Medicine, College of Health Science, Arba Minch University, Arba Minch, Ethiopia
- Correspondence: Zelalem Kofole Yerukneh Solomon
| | - Diresbachew Haile
- Department of Physiology, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopian
| | - Yerukneh Solomon
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
- Correspondence: Zelalem Kofole Yerukneh Solomon
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Siddiqui M, Fatima K, Ali SN, Fatima M, Naveed W, Siddiqui F, Naqvi T, Khan S, Amin M, Liaquat A, Bibi Z. Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus 2020; 12:e11265. [PMID: 33274142 PMCID: PMC7707907 DOI: 10.7759/cureus.11265] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background Contraception, also known as family planning, refers to methods that intercept unwanted pregnancies. The modalities of contraception have evolved and multiplied over time to facilitate users. Despite enormous benefits, the contraceptive methods remain underutilized in developing countries such as Pakistan. Accordingly, the primary purpose of our study is to determine the prevalence, perception, and attitude of contraceptive usage in Karachi. The study further assesses the knowledge and core determinants of contraception. Methods A cross-sectional study was conducted in Karachi, Pakistan. The sample population comprised currently married males and females residing in Karachi, with females from 16 to 45 years of age and males of 16 years of age and forth. Pregnant females, divorcees, and widowed individuals were excluded. A pre-tested questionnaire was administered to record the demographics, knowledge, and frequency of contraceptive usage, and attitude and perception towards contraception. The data were analyzed using the Statistical Package for the Social Sciences (SPSS( v. 23.0 (IBM Corp. Armonk, NY). Results Results depicted that 93.4% (n=468) had knowledge of contraception while 49.7% (n=249) were currently using contraception. The most frequently employed contraceptive modality emerged as condoms (n=163, 65.5%), followed by withdrawal (n=71, 28.5%) and pills (n=62, 24.9%). The prevalence of contraceptive usage was more inclined towards the educated stratum and higher socioeconomic class. Potential predictors for contraceptive usage came out as the number of children, knowledge regarding contraception, spouse's support for usage, a desire for more children, and family planning counseling (p<0.05). Conclusion There is a drastic increase in the prevalence of contraceptive usage in Pakistan as compared to previous studies. Efforts must be made to further augment the knowledge and awareness regarding contraceptive modalities to increase acceptability and eliminate myths prevalent in society regarding contraception.
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Affiliation(s)
- Maheen Siddiqui
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Khunsha Fatima
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Syeda Nimrah Ali
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Mudebbera Fatima
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Wajeeha Naveed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Fatima Siddiqui
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Tahira Naqvi
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sehar Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Mehreen Amin
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Amna Liaquat
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Zainab Bibi
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Mundaca‐Uribe R, Esteban‐Fernández de Ávila B, Holay M, Lekshmy Venugopalan P, Nguyen B, Zhou J, Abbas A, Fang RH, Zhang L, Wang J. Zinc Microrocket Pills: Fabrication and Characterization toward Active Oral Delivery. Adv Healthc Mater 2020; 9:e2000900. [PMID: 32743976 DOI: 10.1002/adhm.202000900] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/28/2020] [Revised: 07/09/2020] [Indexed: 01/01/2023]
Abstract
Here the fabrication of a zinc (Zn) microrocket pill is reported, and its unique features toward active and enhanced oral delivery application are demonstrated. By loading Zn-based tubular microrockets into an orally administrable pill formulation, the resulting Zn microrocket pill can rapidly dissolve in the stomach, releasing numerous encapsulated Zn microrockets that are instantaneously activated and then propel in the gastric fluid. The released Zn microrockets display efficient propulsion without being affected by the presence of the inactive excipient materials of the pill. An in vivo retention study performed in mice clearly shows that the active pill dissolution and powerful acid-driven Zn microrocket propulsion greatly enhance the microrocket retention within the gastric tissue without causing toxic effects. By combining the active delivery feature of Zn microrockets with the oral administration of a pill, the Zn microrocket pill holds considerable potential for active oral delivery of various therapeutics for diverse medical applications.
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Affiliation(s)
- Rodolfo Mundaca‐Uribe
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | | | - Maya Holay
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | - Pooyath Lekshmy Venugopalan
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | - Bryan Nguyen
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | - Jiarong Zhou
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | - Amal Abbas
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | - Ronnie H. Fang
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | - Liangfang Zhang
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
| | - Joseph Wang
- Department of Nanoengineering Chemical Engineering Program University of California San Diego La Jolla CA 92093 USA
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Abstract
Recurrent Clostridium difficile infections constitute an important medical concern. Evidence has been provided showing that faecal microbiota transplantation is a more efficient treatment than antibiotics. Serious side effects are unusual, and acceptability is not an obstacle. Nevertheless, protocols are heterogeneous with respect to the selection of donors and the methodology used for the faecal transplantation. Regulations by both the Food and Drug Administration and the French authorities consider stool samples to be drugs, and suggest strict supervision in clinical trials. Donor screening by questionnaire or by blood and stool analysis, which is essential in eliminating pathogens or viruses before transplantation, is similar in different countries, with a few exceptions. The traceability of the faecal transplant and long-term follow-up of the patients in clinical trials are issues that may be difficult to organize. The use of frozen microbiota facilitates transplantation, and the nasogastric route seems to be at least as effective as other invasive methods and avoids the risk of anaesthesia. Synthetic microbiota is an approach that selects a mixture of bacteria, thereby eliminating the risk of transmissible disease; however, this approach is not yet evidence-based. The use of pills, which is currently being tested in clinical trials, will certainly be the starting point for the extensive use and wide industrialization of faecal microbiota transplantation.
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Affiliation(s)
- J-C Lagier
- URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Aix Marseille Université, Marseille, France; Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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