Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children.

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Jochmann, Anja; Artusio, Luca; Jamalzadeh, Angela; Nagakumar, Prasad; Delgado-Eckert, Edgar; Saglani, Sejal; Bush, Andrew; Frey, Urs; Fleming, Louise J

2017-12-01

International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic. Copyright ©ERS 2017.

Sticker charts: a method for improving adherence to treatment of chronic diseases in children.

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Luersen, Kara; Davis, Scott A; Kaplan, Sebastian G; Abel, Troy D; Winchester, Woodrow W; Feldman, Steven R

2012-01-01

Poor adherence is a common problem and may be an underlying cause of poor clinical outcomes. In pediatric populations, positive reinforcement techniques such as sticker charts may increase motivation to adhere to treatment regimens. To review the use of sticker charts to improve adherence in children with chronic disease, Medline and PsycINFO searches were conducted using the key words "positive reinforcement OR behavior therapy" and "adherence OR patient compliance" and "child." Randomized controlled retrospective cohort or single-subject-design studies were selected. Studies reporting adherence to the medical treatment of chronic disease in children using positive reinforcement techniques were included in the analysis. The systematic search was supplemented by identifying additional studies identified through the reference lists and authors of the initial articles found. Positive reinforcement techniques such as sticker charts increase adherence to medical treatment regimens. In several studies, this effect was maintained for months after the initial intervention. Better adherence correlated with better clinical outcomes in some, but not all, studies. Few studies examining the use of sticker charts were identified. Although single-subject-design studies are useful in establishing the effect of a behavioral intervention, larger randomized controlled trials would help determine the precise efficacy of sticker chart interventions. Adherence to medical treatments in children can be increased using sticker charts or other positive reinforcement techniques. This may be an effective means to encourage children with atopic dermatitis to apply their medications and improve clinical outcomes. © 2012 Wiley Periodicals, Inc.

The therapeutic relationship and adherence to antipsychotic medication in schizophrenia.

Directory of Open Access Journals (Sweden)

Rosemarie McCabe

Full Text Available OBJECTIVE: Previous research has shown that a better therapeutic relationship (TR predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia. METHODS: 134 clinicians and 507 of their patients with schizophrenia or a related psychotic disorder participated in a European multi-centre study. A logistic regression model examined how the TR as rated by patients and by clinicians is associated with medication adherence, adjusting for clinician clustering and symptom severity. RESULTS: Patient and clinician ratings of the TR were weakly inter-correlated (r(s = 0.13, p = 0.004, but each was independently linked with better adherence. After adjusting for patient rated TR and symptom severity, each unit increase in clinician rated TR was associated with an increase of the odds ratio of good compliance by 65.9% (95% CI: 34.6% to 104.5%. After adjusting for clinician rated TR and symptom severity, for each unit increase in patient rated TR the odds ratio of good compliance was increased by 20.8% (95% CI: 4.4% to 39.8%. CONCLUSIONS: A better TR is associated with better adherence to medication among patients with schizophrenia. Patients' and clinicians' perspectives of the TR are both important, but may reflect distinct aspects.

Predictors of parents' adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design.

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Medina-Mirapeix, Francesc; Lillo-Navarro, Carmen; Montilla-Herrador, Joaquina; Gacto-Sánchez, Mariano; Franco-Sierra, María Á; Escolar-Reina, Pilar

2017-08-01

.75); justifying their usefulness (OR=2.17); giving advice on how to include them into the daily routine (OR=2.54); checking skills during follow-up (OR=2.21) and asking about home adherence (OR=2.20). Providing information during clinical encounters, advising how to include exercises into the daily routine, and checking skills and adherence during follow-up represent practical targets for clinicians aiming to improve the frequency of HEP for children with developmental disabilities. This study contributes to the knowledge of physicians and therapists regarding how their interventions (in particular, information, instructions for HEP and follow-up) influence parents regarding their adherence to HEP.

Predicting adherence to eye patching in children with amblyopia: an application of protection motivation theory.

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Norman, Paul; Searle, Aidan; Harrad, Richard; Vedhara, Kav

2003-02-01

This study reports an application of protection motivation theory (PMT) to the prediction of parental adherence to eye patching recommendations for children with amblyopia over a 2-month period. The study also considered the role of past behaviour in PMT. A total of 151 parents of children with amblyopia who were attending follow-up appointments for orthoptic treatment participated. They completed questionnaires based on PMT to assess their beliefs about amblyopia and eye patching. Of the parents, 105 were contacted again at 2-month follow-up to obtain a measure of adherence to the recommended treatment for their child. PMT was found to be predictive of adherence intentions and behaviour at 2-month follow-up. Regression analyses revealed perceived vulnerability, response efficacy and self-efficacy to be significant predictors of protection motivation, whereas perceived vulnerability and response costs were significant predictors of adherence behaviour. Past adherence behaviour was found to have a direct effect on future adherence behaviour over and above the influence of PMT. The results are discussed in relation to the sufficiency of PMTas a model of adherence behaviour. The practical implications for attempts to increase adherence to eye patching among children with amblyopia are outlined.

Effect of MP4 Therapy Videos on Adherence to Voice Therapy Home Practice in Children With Dysphonia.

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Braden, Maia N; van Leer, Eva

2017-01-01

Voice disorders in children are often treated with behavioral voice therapy, which requires home practice of exercises. Previous studies with adults demonstrated increased practice frequency when patients were given videos of a clinician and patient performing therapy tasks. The purpose of this study was to determine whether videos of practice exercises would increase adherence to therapy in children. The study used a randomized double crossover research design. Twenty-eight patients, aged 6-18, referred for voice therapy were included in the study. Two conditions were alternated on a weekly basis: standard-of-care therapy and standard-of-care therapy with video models added. Participants recorded practice frequency and participated in semi-structured interviews, which were analyzed for themes. Participants practiced an average of 1.79 times per day without videos and 1.72 with videos (P = 0.743), indicating no significant difference between conditions. There was also no age group effect (P = 0.314). Qualitative analysis of interview responses established the following themes: (1) I knew how to do my exercises, (2) I didn't like seeing/hearing myself, (3) Videos helped me remember to practice, (4) I didn't like the video player itself, (5) The videos didn't make a difference with practice, and (6) Practicing was no fun. Video models of therapy tasks do not appear to influence adherence to home practice frequency in children with voice disorders, in contrast to findings in adults. Videos were found useful by several participants as reminders to practice. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Multiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Children

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Haberer, Jessica E.; Kiwanuka, Julius; Nansera, Denis; Ragland, Kathleen; Mellins, Claude; Bangsberg, David R.

2012-01-01

Background Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood. Methodology/Principal Findings To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2–10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of ≥48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = −0.25, p = 0.04). Multivariable regression found the following to be associated with liquid formulation use (AOR 1.4, 95%CI 1.0–2.0; p = 0.04), and caregiver’s alcohol use (AOR 3.1, 95%CI 1.8–5.2; passets (AOR 0.7, 95%CI 0.6–0.9; p = 0.0007) were protective against these interruptions. Conclusions/Significance Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development. PMID:22590600

Factors associated with low adherence to a Mediterranean diet in healthy children in northern Spain.

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Arriscado, Daniel; Muros, José J; Zabala, Mikel; Dalmau, José M

2014-09-01

There is a tendency in Mediterranean countries to abandon the characteristic Mediterranean diet. This is especially apparent within younger populations. This could have negative consequences for health such as, cardiovascular diseases, obesity or metabolic syndrome. The aim of this study was to describe adherence to the Mediterranean diet within a population of school children and to examine the influence of different socio-demographic factors and lifestyle habits. The study was conducted on a representative sample of 321 school children aged 11-12 years from 31 schools in the city of Logroño (La Rioja). Socio-demographic variables, anthropometric variables, blood pressure, level of development, aerobic fitness, lifestyle, physical activity habits and adherence to the Mediterranean diet were recorded. High adherence to the Mediterranean diet was reported by 46.7% of school children, with low adherence being reported by 4.7% of them. Children attending state schools, immigrants and families from low-to-medium socio-economic strata reported significantly lower adherence to the Mediterranean diet (p = .039), but the results did not reveal any significant differences in terms of body composition. Correlations were found between adherence to the Mediterranean diet and other lifestyle habits, especially level of physical activity (r = .38) and screen time (r = -.18). Adherence to a Mediterranean diet differs according to the type of school attended by children, and the child's nationality and socio-economic status. Children who attended state schools, immigrants and those from families with a medium-to-low socio-economic status were less likely to follow healthy diets. Copyright © 2014 Elsevier Ltd. All rights reserved.

Long-term adherence to inhaled corticosteroids in children with asthma : Observational study

NARCIS (Netherlands)

Klok, Ted; Kaptein, Adrian A.; Duiverman, Eric J.; Brand, Paul L.

Introduction: Non-adherence to daily controller medication in childhood asthma is strongly dependent on potentially modifiable factors such as parental illness perceptions and medication beliefs. The extent to which adherence in children can be improved by addressing modifiable determinants of

A theoretical approach to medication adherence for children and youth with psychiatric disorders.

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Charach, Alice; Volpe, Tiziana; Boydell, Katherine M; Gearing, Robin E

2008-01-01

This article provides a theoretical review of treatment adherence for children and youth with psychiatric disorders where pharmacological agents are first-line interventions. Four empirically based models of health behavior are reviewed and applied to the sparse literature about medication adherence for children with attention-deficit/hyperactivity disorder and young people with first-episode psychosis. Three qualitative studies of medication use are summarized, and details from the first-person narratives are used to illustrate the theoretical models. These studies indicate, when taken together, that the clinical approach to addressing poor medication adherence in children and youth with psychiatric disorders should be guided by more than one theoretical model. Mental health experts should clarify beliefs, address misconceptions, and support exploration of alternative treatment options unless contraindicated. Recognizing the larger context of the family, allowing time for parents and children to change their attitudes, and offering opportunities for easy access to medication in the future are important ways of respecting patient preferences, while steering them toward best-evidence interventions. Future research using qualitative methods of inquiry to investigate parent, child, and youth experiences of mental health interventions should identify effective ways to improve treatment adherence.

Application of Rasch analysis to the parent adherence report questionnaire in juvenile idiopathic arthritis.

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Toupin April, Karine; Higgins, Johanne; Ehrmann Feldman, Debbie

2016-07-28

Adherence to treatment in children with juvenile idiopathic arthritis (JIA) is associated with better outcomes. Assessing patient adherence in JIA, as well as attitudes and beliefs about prescribed treatments, is important for the clinician in order to optimize patient management. The objective of the current study was to evaluate the psychometric properties of the Parent (proxy-report) Adherence Report Questionnaires (PARQ), which assesses beliefs and behaviors related to adherence to treatments prescribed for JIA. A Rasch analysis was conducted on data collected with parents of children with JIA from two studies in which the PARQ was used as a measure of adherence. The PARQ showed preliminary evidence of multidimensionality with two factors, accounting for 38 % and 27 % of the variance respectively. The PARQ in its original version does not adhere to expectations of the Rasch model. A transformed version of the PARQ obtained by deletion of the general adherence scale and modification of visual analog scales into 5-point likert scales improved fit to the model and showed preliminary evidence of unidimensionality. The PARQ was transformed based on the results of the Rasch analysis. The transformed version of the PARQ shows preliminary evidence of unidimensionality and may allow computation of a total score, although further testing is needed to verify these findings.

Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians.

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Chung, Esther K; Siegel, Benjamin S; Garg, Arvin; Conroy, Kathleen; Gross, Rachel S; Long, Dayna A; Lewis, Gena; Osman, Cynthia J; Jo Messito, Mary; Wade, Roy; Shonna Yin, H; Cox, Joanne; Fierman, Arthur H

2016-05-01

Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources. Copyright © 2016 Mosby, Inc. All rights reserved.

Principles, practices and knowledge of clinicians when assessing febrile children: a qualitative study in Kenya.

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Hooft, Anneka M; Ripp, Kelsey; Ndenga, Bryson; Mutuku, Francis; Vu, David; Baltzell, Kimberly; Masese, Linnet N; Vulule, John; Mukoko, Dunstan; LaBeaud, A Desiree

2017-09-20

Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya. A total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes. The following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing

Treatment adherence with the easypod™ growth hormone electronic auto-injector and patient acceptance: survey results from 824 children and their parents

Directory of Open Access Journals (Sweden)

Larroque Sylvain

2011-02-01

Full Text Available Abstract Background Accurately monitoring adherence to treatment with recombinant human growth hormone (r-hGH enables appropriate intervention in cases of poor adherence. The electronic r-hGH auto-injector, easypod™, automatically records the patient's adherence to treatment. This study evaluated adherence to treatment of children who started using the auto-injector and assessed opinions about the device. Methods A multicentre, multinational, observational 3-month survey in which children received r-hGH as part of their normal care. Physicians reviewed the recorded dose history and children (with or without parental assistance completed a questionnaire-based survey. Children missing ≤2 injections per month (92% of injections given were considered adherent to treatment. Adherence was compared between GH treatment-naïve and treatment-experienced children. Results Of 834 recruited participants, 824 were evaluated. The median (range age was 11 (1-18 years. From the recorded dose history, 87.5% of children were adherent to treatment over the 3-month period. Recorded adherence was higher in treatment-naïve (89.7%, n = 445/496 than in treatment-experienced children (81.7%, n = 152/186 [Fisher's exact test FI(X = 7.577; p = 0.0062]. According to self-reported data, 90.2% (607/673 of children were adherent over 3 months; 51.5% (421/817 missed ≥1 injection over this period (mainly due to forgetfulness. Concordance between reported and recorded adherence was 84.3%, with a trend towards self-reported adherence being higher than recorded adherence. Most children liked the auto-injector: over 80% gave the top two responses from five options for ease of use (720/779, speed (684/805 and comfort (716/804. Although 38.5% (300/780 of children reported pain on injection, over half of children (210/363 considered the pain to be less or much less than expected. Given the choice, 91.8% (732/797 of children/parents would continue using the device. Conclusions

Caregivers' beliefs associated with medication adherence among children and adolescents with epilepsy.

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Miner, Patricia Johnson; Alexander, Jeffrey; Ewing, Helen; Gerace, Laina

2013-08-01

The purpose of this study was to determine the association between adherence to prescribed antiepileptic medication in a convenience sample of caregivers (n = 100) of children diagnosed with epilepsy, ages 2-14 years, and caregivers' beliefs about the medication. Using the Beliefs about Medication Questionnaire and Medication Adherence Report Scale, caregivers were questioned about beliefs of necessity and concerns associated with medication adherence. Using bivariate linear regression, no significant correlation was found between necessity for antiepileptic drug treatment or caregiver's concerns and medication adherence. Nevertheless, although only 28% of the respondents reported complete adherence, the majority of caregivers perceived their child's medication was necessary to maintain good health. Educational aspects and social desirability in this setting may have contributed to the discordance between adherence and caregivers' beliefs.

Uninformed Clinical Decisions Resulting From Lack of Adherence Assessment in Children with New Onset Epilepsy

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Modi, Avani C.; Wu, Yelena P.; Guilfoyle, Shanna M.; Glauser, Tracy A.

2012-01-01

This study examined the relationship between non-adherence to antiepileptic drug (AED) therapy and clinical decision-making in a cohort of 112 children with newly-diagnosed epilepsy. AED adherence was monitored using electronic monitoring over the first six months of therapy. The primary outcome measure was rate of uninformed clinical decisions as defined by number of participants with AED dosage or drug changes to address continued seizures who demonstrated non-adherence prior to the seizure. Among the 52 (47%) participants who had an AED change for continued seizures, 30 (27% of the overall cohort) had imperfect medication adherence prior to their seizures. A quarter of children with new onset epilepsy had uninformed medication changes because adherence was not rigorously assessed in clinical practice. Results highlight the importance of routinely assessing medication adherence in this population. PMID:23159375

Which adherence measure - self-report, clinician recorded or pharmacy refill - is best able to predict detectable viral load in a public ART programme without routine plasma viral load monitoring?

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Mekuria, Legese A; Prins, Jan M; Yalew, Alemayehu W; Sprangers, Mirjam A G; Nieuwkerk, Pythia T

2016-07-01

Combination antiretroviral therapy (cART) suppresses viral replication to an undetectable level if a sufficiently high level of adherence is achieved. We investigated which adherence measurement best distinguishes between patients with and without detectable viral load in a public ART programme without routine plasma viral load monitoring. We randomly selected 870 patients who started cART between May 2009 and April 2012 in 10 healthcare facilities in Addis Ababa, Ethiopia. Six hundred and sixty-four (76.3%) patients who were retained in HIV care and were receiving cART for at least 6 months were included and 642 had their plasma HIV-1 RNA concentration measured. Patients' adherence to cART was assessed according to self-report, clinician recorded and pharmacy refill measures. Multivariate logistic regression model was fitted to identify the predictors of detectable viremia. Model accuracy was evaluated by computing the area under the receiver operating characteristic (ROC) curve. A total of 9.2% and 5.5% of the 642 patients had a detectable viral load of ≥40 and ≥400 RNA copies/ml, respectively. In the multivariate analyses, younger age, lower CD4 cell count at cART initiation, being illiterate and widowed, and each of the adherence measures were significantly and independently predictive of having ≥400 RNA copies/ml. The ROC curve showed that these variables altogether had a likelihood of more than 80% to distinguish patients with a plasma viral load of ≥400 RNA copies/ml from those without. Adherence to cART was remarkably high. Self-report, clinician recorded and pharmacy refill non-adherence were all significantly predictive of detectable viremia. The choice for one of these methods to detect non-adherence and predict a detectable viral load can therefore be based on what is most practical in a particular setting. © 2016 John Wiley & Sons Ltd.

Problems and solutions: accounts by parents and children of adhering to chest physiotherapy for cystic fibrosis.

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Williams, Brian; Mukhopadhyay, Somnath; Dowell, Jon; Coyle, Joanne

2007-07-30

Although chest physiotherapy is central to the management of cystic fibrosis (CF), adherence among children is problematic. This study explores accounts by parents and children of the difficulties of adhering to chest physiotherapy for cystic fibrosis, and identifies strategies used by families to overcome these. A qualitative study based on in-depth interviews with 32 children with a diagnosis of cystic fibrosis aged 7 - 17 years, and with 31 parents. Physiotherapy was frequently described as restrictive, threatening to identity and boring, giving rise to feelings of unfairness, inequality, 'difference', and social stigma. Motivation to adhere was influenced by perceptions of effectiveness that depended on external signs evident during or after the physiotherapy. Motivation was enhanced where parents and children visualized the accumulation of mucus. Some parents had developed distraction techniques that improved the experience of chest physiotherapy but had few opportunities to share these with other parents. The experience of physiotherapy is problematic to some parents and children. Furthermore, motivation to overcome these problems may be undermined by perceptions of ineffectiveness. Distraction techniques that change the value that the child places on the time spent doing physiotherapy and that reduces their perception of its duration may improve experience and adherence. The potential of visualization techniques to promote adherence should be investigated further.

Communication techniques for improved acceptance and adherence with therapeutic footwear.

Science.gov (United States)

van Netten, Jaap J; Francis, Anthony; Morphet, Ashley; Fortington, Lauren V; Postema, Klaas; Williams, Anita

2017-04-01

Clients' acceptance and adherence with orthoses can be influenced by a clinician's communication skills. In this clinical note, we describe two communication techniques, in the context of therapeutic footwear. Person-centred communication involves engaging with and listening to the attitudes of the client towards their condition, as well as discussing acceptance and expectations, in a structured consultation. Building a relationship is crucial and requires clients to feel heard and understood. An important influence on the acceptance and adherence is that a client makes a conscious decision to receive their device. This active receipt can be facilitated through shared decision making, wherein clinicians give clear, relevant and meaningful examples, based on clinical evidence, and ensure this is understood. Two communication techniques for clinicians providing therapeutic footwear are described. These can be adapted for use with provision of other assistive technologies to improve client acceptance and adherence. Clinical relevance Small changes in how clinicians communicate to their clients in daily practice can have a big influence on the subsequent acceptance and adherence with therapeutic footwear and indeed other prescribed assistive technologies.

Increasing daily water intake and fluid adherence in children receiving treatment for retentive encopresis.

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Kuhl, Elizabeth S; Hoodin, Flora; Rice, Jennifer; Felt, Barbara T; Rausch, Joseph R; Patton, Susana R

2010-11-01

To examine the efficacy of an enhanced intervention (EI) compared to standard care (SC) in increasing daily water intake and fluid goal adherence in children seeking treatment for retentive encopresis. Changes in beverage intake patterns and fluid adherence were examined by comparing 7-week diet diary data collected during participation in the EI to achieved data for families who had previously completed the SC. Compared to children in SC (n = 19), children in the EI (n = 18) demonstrated a significantly greater increase in daily water intake from baseline to the conclusion of treatment ( p ≤ .001), and were four and six times more likely to meet fluid targets in Phases 1 (Weeks 3-4) and 2 (Weeks 5-6) of fluid intervention, respectively (both p ≤ .001). Enhanced education and behavioral strategies were efficacious in increasing children's intake of water and improving fluid adherence. Future research should replicate the findings in a prospective randomized clinical trial to discern their effectiveness.

How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care.

Science.gov (United States)

Richter, Jason; Mazurenko, Olena; Kazley, Abby Swanson; Ford, Eric W

2017-11-04

Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.

Radiology services for children in HIV- and TB-endemic regions: scope for greater collaboration between radiologists and clinicians caring for children

International Nuclear Information System (INIS)

Dramowski, Angela; Morsheimer, Megan M.; Schaaf, H.S.; Rabie, Helena; Sorour, Gillian; Cotton, Mark F.; Frigati, Lisa

2009-01-01

There is limited literature documenting the interaction between radiologists and clinicians caring for children, especially in regions where HIV and tuberculosis (TB) are endemic. The dual burden of these diseases in resource-limited settings creates unique challenges for radiographic interpretation and utilization. This review aims to heighten awareness of issues confronting radiologists and clinicians caring for children and to encourage greater collaboration between these two disciplines in HIV- and TB-endemic regions. The Child-Friendly Healthcare Initiative is discussed, emphasizing opportunities to promote child friendliness in radiology services. (orig.)

Preparation of Mental Health Clinicians to Work with Children with Co-Occurring Autism Spectrum Disorders and Mental Health Needs

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Williams, Marian E.; Haranin, Emily C.

2016-01-01

Up to 70% of children with autism spectrum disorders (ASD) have a co-occurring mental health disorder; however, many clinicians feel unprepared to serve children with complex co-occurring conditions. This study surveyed 64 mental health clinicians working in 21 publically-funded mental health agencies in a large urban setting to explore their…

Long-term adherence to daily controller medication in children with asthma : The role of outpatient clinic visits

NARCIS (Netherlands)

Keemink, Yvette S.; Klok, Ted; Brand, Paul L. P.

2015-01-01

ObjectiveTo investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program. Study designOne-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to

It's hard work, but it's worth it: the task of keeping children adherent to isoniazid preventive therapy.

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Skinner, D; Hesseling, A C; Francis, C; Mandalakas, A M

2013-09-21

Isoniazid preventive therapy (IPT) offers children protection against tuberculosis (TB), but it has been difficult to implement, particularly in developing countries. To understand what encourages or inhibits children from adhering to IPT. In-depth interviews were conducted with two parents of children adherent to IPT and two staff members from three primary health care clinics in high TB prevalence communities. Themes explored were knowledge and attitudes towards IPT, problems in accessing and adhering to treatment, and community responses. Parents administering treatment valued it positively, realised their children's risk of TB, and were positive about the clinic. Nurses acknowledged that resistance to treatment remained, with some parents not wanting to acknowledge risk nor willing to make the effort for their children; there was also considerable misinformation about IPT. Clinic nurses acknowledged problems of staff shortages, lengthy waiting times and conflict between staff and community members. Adherence was affected by social problems, stigma about TB and its link to the human immunodeficiency virus, and the extended treatment period. Parents who maintained adherence to the IPT regimen showed that it was possible even in very difficult circumstances. Further effort is required to improve some of the clinic services, correct misinformation, reduce stigma and provide support to parents.

Adherence to pharmacotherapy improves school performance in children with rhinitis and asthma.

Science.gov (United States)

Sánchez, J; Sánchez, A; Cardona, R

2018-03-17

Adherence to pharmacotherapy reduces symptoms of asthma and rhinitis, however, little is known of its impact on school performance. To evaluate the impact of pharmacotherapy in absenteeism and school performance in a child population. A cross-sectional study, carried out in eight schools. All participants and their parents were given a questionnaire assessing parameters related to respiratory diseases and pharmacotherapy. Data on school performance was obtained from the academic history of each child who participated in the study. Adherence to pharmacotherapy was classified as a correct use of therapy for more than five days per week. 1109 children agreed to participate. Students were divided into two groups: symptomatic (36%) and asymptomatic (63%). The symptomatic group had a higher frequency of school absenteeism (1 vs. 3.1days/year/patient pperformance (failed: 20% vs. 33% pperformance to the asymptomatic group and it was significantly different from the no-adherent group. Respiratory symptoms are associated with poor school performance and with an increase in school absenteeism, but adherence to pharmacotherapy can reduce these negative impacts in children. Copyright © 2018 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children.

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Jessica E Haberer

Full Text Available Adherence to HIV antiretroviral therapy (ART among children in developing settings is poorly understood.To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2-10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS. Interruptions in MEMS adherence of ≥ 48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = -0.25, p = 0.04. Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6-5.5; p = 0.001, liquid formulation use (AOR 1.4, 95%CI 1.0-2.0; p = 0.04, and caregiver's alcohol use (AOR 3.1, 95%CI 1.8-5.2; p<0.0001. Child's use of co-trimoxazole (AOR 0.5, 95%CI 0.4-0.9; p = 0.009, caregiver's use of ART (AOR 0.6, 95%CI 0.4-0.9; p = 0.03, possible caregiver depression (AOR 0.6, 95%CI 0.4-0.8; p = 0.001, and caregiver feeling ashamed of child's HIV status (AOR 0.5, 95%CI 0.3-0.6; p<0.0001 were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5-11.5; p = 0.009 and caregiver's alcohol use (AOR 5.5, 95%CI 2.8-10.7; p<0.0001 were associated with ≥ 48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1-0.99; p = 0.049 and increasing assets (AOR 0.7, 95%CI 0.6-0.9; p = 0.0007 were protective against these interruptions.Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for

Optimizing Patient Management and Adherence for Children Receiving Growth Hormone.

Science.gov (United States)

Acerini, Carlo L; Wac, Katarzyna; Bang, Peter; Lehwalder, Dagmar

2017-01-01

Poor adherence with growth hormone (GH) therapy has been associated with worse clinical outcomes, which in children relates specifically to their linear growth and loss of quality of life. The "360° GH in Europe" meeting, held in Lisbon, Portugal, in June 2016 and funded by Merck KGaA (Germany), examined many aspects of GH diseases. The three sessions, entitled " Short Stature Diagnosis and Referral ," " Optimizing Patient Management ," and " Managing Transition ," each benefited from three guest speaker presentations, followed by an open discussion and are reported as a manuscript, authored by the speakers. Reported here is a summary of the proceedings of the second session, which reviewed the determinants of GH therapy response, factors affecting GH therapy adherence and the development of innovative technologies to improve GH treatment in children. Response to GH therapy varies widely, particularly in regard to the underlying diagnosis, although there is little consensus on the definition of a poor response. If the growth response is seen to be less than expected, the possible reasons should be discussed with patients and their parents, including compliance with the therapy regimen. Understanding and addressing the multiple factors that influence adherence, in order to optimize GH therapy, requires a multi-disciplinary approach. Because therapy continues over many years, various healthcare professionals will be involved at different periods of the patient's journey. The role of the injection device for GH therapy, frequent monitoring of response, and patient support are all important for maintaining adherence. New injection devices are incorporating electronic technologies for automated monitoring and recording of clinically relevant information on injections. Study results are indicating that such devices can at least maintain GH adherence; however, acceptance of novel devices needs to be assessed and there remains an on-going need for innovations.

Optimizing Patient Management and Adherence for Children Receiving Growth Hormone

Directory of Open Access Journals (Sweden)

Carlo L. Acerini

2017-11-01

Full Text Available Poor adherence with growth hormone (GH therapy has been associated with worse clinical outcomes, which in children relates specifically to their linear growth and loss of quality of life. The “360° GH in Europe” meeting, held in Lisbon, Portugal, in June 2016 and funded by Merck KGaA (Germany, examined many aspects of GH diseases. The three sessions, entitled “Short Stature Diagnosis and Referral,” “Optimizing Patient Management,” and “Managing Transition,” each benefited from three guest speaker presentations, followed by an open discussion and are reported as a manuscript, authored by the speakers. Reported here is a summary of the proceedings of the second session, which reviewed the determinants of GH therapy response, factors affecting GH therapy adherence and the development of innovative technologies to improve GH treatment in children. Response to GH therapy varies widely, particularly in regard to the underlying diagnosis, although there is little consensus on the definition of a poor response. If the growth response is seen to be less than expected, the possible reasons should be discussed with patients and their parents, including compliance with the therapy regimen. Understanding and addressing the multiple factors that influence adherence, in order to optimize GH therapy, requires a multi-disciplinary approach. Because therapy continues over many years, various healthcare professionals will be involved at different periods of the patient’s journey. The role of the injection device for GH therapy, frequent monitoring of response, and patient support are all important for maintaining adherence. New injection devices are incorporating electronic technologies for automated monitoring and recording of clinically relevant information on injections. Study results are indicating that such devices can at least maintain GH adherence; however, acceptance of novel devices needs to be assessed and there remains an on

Optimizing patient management and adherence for children receiving growth hormone

DEFF Research Database (Denmark)

Acerini, Carlo L.; Wac, Katarzyna; Bang, Peter

2017-01-01

© 2017 Acerini, Wac, Bang and Lehwalder. Poor adherence with growth hormone (GH) therapy has been associated with worse clinical outcomes, which in children relates specifically to their linear growth and loss of quality of life. The "360° GH in Europe" meeting, held in Lisbon, Portugal, in June...... and are reported as a manuscript, authored by the speakers. Reported here is a summary of the proceedings of the second session, which reviewed the determinants of GH therapy response, factors affecting GH therapy adherence and the development of innovative technologies to improve GH treatment in children....... Response to GH therapy varies widely, particularly in regard to the underlying diagnosis, although there is little consensus on the definition of a poor response. If the growth response is seen to be less than expected, the possible reasons should be discussed with patients and their parents, including...

Usefulness of a Clinician Rating Scale in Identifying Preschool Children with ADHD

Science.gov (United States)

Gopin, Chaya; Healey, Dione; Castelli, Katia; Marks, David; Halperin, Jeffrey M.

2010-01-01

Objective: To ascertain the psychometric properties and clinical utility of the Behavioral Rating Inventory for Children (BRIC), a novel clinician inventory for preschoolers. Method: Completion of the BRIC for 214 preschoolers follows 2 evaluation sessions, generally separated by less than 2 weeks. Items are submitted to a Principal Components…

Effects of antiretroviral drug recall on perception of therapy benefits and on adherence to antiretroviral treatment in HIV-infected children.

Science.gov (United States)

Giannattasio, Antonietta; Barbarino, Alessandro; Lo Vecchio, Andrea; Bruzzese, Eugenia; Mango, Carmela; Guarino, Alfredo

2009-09-01

In June 2007, the European Medicines Agency announced the recall by Roche of nelfinavir from European Union markets because of contamination of tablets with ethyl mesylate. Based on this event, we investigated the effect of switching therapy because of nelfinavir recall or for other reasons on the perception of therapy benefits and adherence to treatment in HIV-infected children and their caregivers. Thirty-eight children (mean age 12.1+/-6.7 years) were enrolled. A 35-item questionnaire was administered to the caregivers of enrolled children. Adherence was evaluated through a 4-day recall adherence instrument. Enrolled children were divided into 3 groups: patients who were shifted because of nelfinavir recall (group A, 8 patients); patients who were shifted for other reasons (group B, 12 patients); patients who were not shifted in the last 6 months (group C, 18 patients). All caregivers considered antiretroviral therapy necessary and effective for their children. However, drug shifting generated anxiety in most of them, irrespective of the reason for shifting. At baseline, 74% patients adhered to therapy. Adherence rate was related to the type of caregivers being higher in children cared for by foster parents than in children cared for by biological parents or second-degree relatives. Adherence rates did not change significantly in groups A and B after switching. Drug-switching raises concern in caregivers of HIV-infected children and induces a negative feeling irrespective of the reason for switching. However, switching, including the shift due to nelfinavir recall, did not affect adherence rates.

Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV nondisclosure, and paradoxical income effects.

Directory of Open Access Journals (Sweden)

Jessica E Haberer

2011-04-01

Full Text Available A better understanding of pediatric antiretroviral therapy (ART adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence.Adherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9 initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26 with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS. HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4% (IQR 96.1,98.4% by visual analog scale, 94.8% (IQR 86,100% by caregiver-reported last missed dose, 96.9% (IQR 94.5,98.2% by clinic pill count, 93.4% (IQR 90.2,96.7% by unannounced home-based pill count, and 94.8% (IQR 87.8,97.7% by MEMS. At 48 weeks, 72.6% of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013. Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income.Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty.

Self-Efficacy and Short-Term Adherence to Continuous Positive Airway Pressure Treatment in Children.

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Xanthopoulos, Melissa S; Kim, Ji Young; Blechner, Michael; Chang, Ming-Yu; Menello, Mary Kate; Brown, Christina; Matthews, Edward; Weaver, Terri E; Shults, Justine; Marcus, Carole L

2017-07-01

Infants, children, and adolescents are increasingly being prescribed continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea syndrome (OSAS), yet adherence is often poor. The purpose of this study was to examine the relationship between caregiver and patient-reported health cognitions about CPAP prior to starting CPAP and CPAP adherence at 1 month. We hypothesized that greater caregiver-reported self-efficacy would be positively associated with CPAP adherence in children. We also evaluated patient-reported self-efficacy and caregiver- and patient-reported risk perception and outcome expectations as they related to adherence, as well as how demographic factors influenced these relationships. A pediatric modification of the Self-Efficacy Measure for Sleep Apnea Questionnaire was administered to children and adolescents with OSAS-prescribed CPAP and their caregivers during the clinical CPAP-initiation visit. The primary outcome variable for adherence was the average total minutes of CPAP usage across all days from the date that CPAP was initiated to 31 days later. Unadjusted ordinary least-square regression showed a significant association between caregiver-reported self-efficacy and adherence (p = .007), indicating that mean daily CPAP usage increased by 48.4 minutes when caregiver-reported self-efficacy increased by one point (95% confidence interval 13.4-83.4 minutes). No other caregiver- or patient-reported cognitive health variables were related to CPAP use. This study indicates that caregiver CPAP-specific self-efficacy is an important factor to consider when starting youth on CPAP therapy for OSAS. Employing strategies to improve caregiver self-efficacy, beginning at CPAP initiation, may promote CPAP adherence. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Diffuse and enteroaggregative patterns of adherence of Escherichia coli isolated from stools of children in northeastern Brazil

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Scaletsky Isabel Cristina Affonso

2001-01-01

Full Text Available Childhood diarrheal diseases remain highly endemic in northeastern Brazil. The attributable fraction of all diarrheal diseases among children less than 2 years of age due to Escherichia coli was examined in a 2-year prospective study in two large urban centers of Brazil. Between May 1997 and June 1999, fecal E. coli isolates from 237 children with diarrhea (217 acute and 20 persistent cases and 231 children without diarrhea (controls attending two hospitals in Northeast Brazil were tested for their pattern of adherence to HEp-2 cells and for colony hybridization with DNA probes specific for the six pathotypes of diarrheagenic E. coli. Enteroinvasive E. coli, enterotoxigenic E. coli and enterohemorrhagic E. coli were not isolated from any children. Diffusely adherent E. coli (DAEC and enteroaggregative E. coli (EAEC were the most frequent isolates with similar frequencies from children with or without diarrhea. Atypical EPEC (EAF-negative strains were isolated with similiar frequency from both cases (5.5% and controls (5.6%. Enteropathogenic E. coli (typical EPEC strains, characterized by localized adherence pattern of adherence, hybridization with the EAF probe, and belonging to the classical O serogroups, were significantly associated with diarrhea (P = 0.03. These E. coli strains associated with diarrhea accounted for 9% of all children with diarrhea. Collectively, in Northeast Brazil, E. coli strains comprise a small proportion of severe diarrhea prevalence in children.

Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

Science.gov (United States)

McDougall, Rosalind J; Gillam, Lynn; Delany, Clare; Jayasinghe, Yasmin

2018-01-01

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. PMID:29084865

Eradication rate of Helicobacter Pylori infection is directly influenced by adherence to therapy in children.

Science.gov (United States)

Kotilea, Kallirroi; Mekhael, Joyce; Salame, Assaad; Mahler, Tania; Miendje-Deyi, Veronique Yvette; Cadranel, Samy; Bontems, Patrick

2017-08-01

Current commonly accepted strategies to eradicate Helicobacter pylori in children are a 10-day sequential treatment or a triple therapy for 7-14 days. To avoid further expensive and possibly risky investigations as well as induction of secondary antimicrobial resistance, a success rate of elimination strategies over 90% in a per-protocol analysis is the target goal but rates observed in clinical trials are lower. Antimicrobial resistance is a well-recognized risk factor for treatment failure; therefore, only a treatment tailored to susceptibility testing should be recommended. Adherence to therapy is also a risk factor for treatment failure but that has been poorly studied. The purpose of this study was to evaluate the influence of adherence to therapy on the elimination rates obtained with different treatment regimens. Cohort study analysis of children, aged 2-17 years, treated for Helicobacter pylori infection between October 2011 and December 2013. As a routine clinical practice, children infected with a strain susceptible to clarithromycin and to metronidazole received either a sequential regimen or a 10-day triple therapy while children infected with a strain resistant to clarithromycin or metronidazole received a 10-day triple regimen tailored to antimicrobial susceptibility. The eradication rate was assessed by a negative 13 C-urea breath test performed at least 8 weeks after the end of the treatment and adherence evaluated using a diary. One hundred forty-five children (67 girls/78 boys, median age 9.7 years) fulfilled the inclusion criteria, 118 being infected with a strain susceptible to both clarithromycin and metronidazole, 10 with a clarithromycin resistant, and 17 with a metronidazole resistant strain. A sequential regimen was prescribed in 44, a triple therapy containing clarithromycin in 84 and containing metronidazole in 17. Follow-up data were available for 130/145 and clearance of the infection observed in 105 of them. A concordance of more than

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

Directory of Open Access Journals (Sweden)

Sandra Scivoletto

Full Text Available OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%; those with substance abuse disorders alone had the lowest (40%; and those with both disorders had an intermediate rate of adherence (50%. Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively. Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth

Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

Science.gov (United States)

McDougall, Rosalind J; Gillam, Lynn; Delany, Clare; Jayasinghe, Yasmin

2018-01-01

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. 'Fertility preservation' for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such 'experimental' procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents' decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children's Hospital in Melbourne, Australia. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Clinician Perceptions of the Importance of Hospital Discharge Components for Children.

Science.gov (United States)

Blaine, Kevin; Rogers, Jayne; OʼNeill, Margaret R; McBride, Sarah; Faerber, Jennifer; Feudtner, Chris; Berry, Jay G

Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians. March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states. The DCE consisted of 14 discharge care components randomly presented two at a time for a total of 28 choice tasks. Best-worst scaling of participants' choices generated mean relative importance (RI) scores for each component, which allowed for ranking from least to most important. Participants, regardless of field or practice setting, perceived "Discharge Education/Teach-Back" (RI 11.1 [95% confidence interval, CI: 11.0-11.3]) and "Involve the Child's Care Team" (RI 10.6 [95% CI: 10.4-10.8]) as the most important discharge components, and "Information Reconciliation" (RI 4.1 [95% CI: 3.9-4.4]) and "Assigning Roles/Responsibilities of Discharge Care" (RI 2.8 [95% CI: 2.6-3.0]) as least important. A diverse group of pediatric clinicians value certain components of the pediatric discharge care process much more than others. Efforts to optimize the quality of hospital discharge for children should consider these findings.

Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial.

Science.gov (United States)

Priebe, Stefan; Bremner, Stephen A; Lauber, Christoph; Henderson, Catherine; Burns, Tom

2016-09-01

Poor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence. To test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives. A cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months' follow-up. The unit of randomisation was mental health teams in the community. Community teams in secondary mental health care. Patients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (intervention n = 78 and control n = 63) were included. Participants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual. adherence to LAI medication (the percentage of received out of those prescribed). percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians. outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%; p = 0.003]. Secondary outcome: patients in the intervention group showed statistically significant improvement in adherence of at least 95% (adjusted odds ratio 8.21, 95% CI 2.00 to 33

Understanding Engagement in Mental Health Services for Preschool Children: An Analysis of Teacher, Clinician, and Parent Perspectives

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Koivunen, Julie; Van Alst, Donna; Ocasio, Kerrie; Allegra, Christine

2017-01-01

The purpose of this study was to examine the experiences of mental health clinicians in providing services in the preschool setting. Clinicians provided services for 3 years in urban, northern New Jersey preschools, in order to expand access to mental health services for vulnerable children. At the conclusion of the three-year period, focus groups…

Controller adherence following hospital discharge in high risk children: A pilot randomized trial of text message reminders.

Science.gov (United States)

Kenyon, Chén C; Gruschow, Siobhan M; Quarshie, William O; Griffis, Heather; Leach, Michelle C; Zorc, Joseph J; Bryant-Stephens, Tyra C; Miller, Victoria A; Feudtner, Chris

2018-02-13

To assess the feasibility of a mobile health, inhaled corticosteroid (ICS) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high-risk urban children with persistent asthma. Children aged 2-13 with persistent asthma were enrolled in this pilot randomized controlled trial during an asthma emergency department (ED) visit or hospitalization. Intervention arm participants received daily text message reminders for 30 days, and both arms received electronic sensors to measure ICS use. Primary outcomes were feasibility of sensor use and text message acceptability. Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories. Group-based trajectory modeling was used to examine adherence trajectories. Forty-one participants (mean age 5.9) were randomized to intervention (n = 21) or control (n = 20). Overall, 85% were Black, 88% had public insurance, and 51% of the caregivers had a high school education or less. Thirty-two participant families (78%) transmitted medication adherence data; of caregivers who completed the acceptability survey, 25 (96%) chose to receive daily reminders beyond that study interval. Secondary outcome analyses demonstrated similar average daily adherence between groups (intervention = 36%; control = 32%, P = 0.73). Three adherence trajectories were identified with none ever exceeding 80% adherence. Within a high-risk pediatric cohort, electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants, but there was no signal of effect. Adherence trajectories following severe exacerbation were suboptimal, demonstrating an important opportunity for asthma care improvement.

Adherence to and outcome of isoniazid chemoprophylaxis among household contact children of adults having pulmonary tuberculosis in Alexandria, Egypt.

Science.gov (United States)

Mohamed, Aida M

2012-08-01

Current international guidelines recommend 6-9 months of isoniazid (INH) preventive chemotherapy to prevent the development of active tuberculosis (TB) in susceptible children exposed to Mycobacterium tuberculosis. However, this is dependent on good adherence, as shown by previous studies. This study was conducted to describe the outcome of screening of contact children aged 5 years or less with household exposure to an adult pulmonary TB index case to determine the prevalence and possible risk factors of infection among contact children and to determine the extent and outcome of adherence of contact children to unsupervised INH chemoprophylaxis for 6 months. A descriptive facility-based cross-sectional study was conducted from March 2009 to August 2010. Research settings were three of the National TB control program chest dispensaries (primary care facilities) in Alexandria, Egypt. Facility-based TB treatment registers of the previous 3 months were used to identify all new adult pulmonary TB cases. All children aged 5 years or less living in the same house as the index cases were identified and screened for TB. The contact children were given unsupervised INH preventive chemotherapy once active TB was excluded. Adherence to and outcome of preventive chemotherapy were followed up. Preventive chemotherapy consisted of unsupervised INH monotherapy for 6 months with monthly collection of tablets from the clinic. Adherence was documented after completion of the 6-month preventive treatment period. Adherence was considered reasonable if tablets were collected for more than 4 months, poor if collected for 2-4 months, and very poor if collected for less than 2 months. (a) Prevalence of infection and disease and the possible risk factors among contacts. (b) The extent and outcome of adherence to unsupervised INH chemoprophylaxis among contact children. (c) Factors behind poor adherence. In total, 197 adult TB index cases from 187 households were identified. In all, 297

A cross-cultural validation of the Clinician Administered PTSD Scale for Children and Adolescents in a Dutch population

NARCIS (Netherlands)

Diehle, Julia; de Roos, Carlijn; Boer, Frits; Lindauer, Ramón J. L.

2013-01-01

Background: Trauma-focused interventions for children could be administered more efficiently and effectively if posttraumatic stress disorder (PTSD) and related symptoms were first investigated by a reliable and valid instrument. The Clinician Administered PTSD Scale for Children and Adolescents

adherence to antiretroviral regimens

African Journals Online (AJOL)

to macro- and microeconomic costs.' What soon became evident, however, was the vital importance of patient adherence with prescribed medication in order to garner the benefits that were so rapidly becoming available. As a result, much attention has recently been paid to this aspect of management. Both clinicians and ...

An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial.

Science.gov (United States)

Kronish, Ian M; Moise, Nathalie; McGinn, Thomas; Quan, Yan; Chaplin, William; Gallagher, Benjamin D; Davidson, Karina W

2016-11-01

To appropriately manage uncontrolled hypertension, clinicians must decide whether blood pressure (BP) is above goal due to a need for additional medication or to medication nonadherence. Yet, clinicians are poor judges of adherence, and uncertainty about adherence may promote inertia with respect to medication modification. We aimed to determine the effect of sharing electronically-measured adherence data with clinicians on the management of uncontrolled hypertension. This was a cluster randomized trial. Twenty-four primary care providers (12 intervention, 12 usual care; cluster units) and 100 patients with uncontrolled hypertension (65 intervention, 35 usual care) were included in the study. At one visit per patient, clinicians in the intervention group received a report summarizing electronically measured adherence to the BP regimen and recommended clinical actions. Clinicians in the control group did not receive a report. The primary outcome was the proportion of visits with appropriate clinical management (i.e., treatment intensification among adherent patients and adherence counseling among nonadherent patients). Secondary outcomes included patient-rated quality of care and communication during the visit. The proportion of visits with appropriate clinical management was higher in the intervention group than the control group (45 out of 65; 69 %) versus (12 out of 35; 34 %; p = 0.001). A higher proportion of adherent patients in the intervention group had their regimen intensified (p = 0.01), and a higher proportion of nonadherent patients in the intervention group received adherence counseling (p = 0.005). Patients in the intervention group were more likely to give their clinician high ratings on quality of care (p = 0.05), and on measures of patient-centered (p = 0.001) and collaborative communication (p = 0.02). Providing clinicians with electronically-measured antihypertensive adherence reports reduces inertia in the management of

Dietary assessment in children adhering to a food allergen avoidance diet for allergy prevention.

Science.gov (United States)

Vlieg-Boerstra, B J; van der Heide, S; Bijleveld, C M A; Kukler, J; Duiverman, E J; Wolt-Plompen, S A A; Dubois, A E J

2006-12-01

The purpose of this investigation was to verify if avoidance of allergenic foods in children adhering to a food allergen avoidance diet from birth was complete and feasible, and whether dietary assessment can be used as a tool in predicting the outcome of double-blind, placebo-controlled food challenges (DBPCFCs). Children adhering to an allergen avoidance diet from birth underwent DBPCFCs. The investigator-dietician verified whether the elimination was complete, using food frequency questionnaires for common allergenic foods. University Medical Centre Groningen, the Netherlands. Thiry-eight children aged 1-13 years, who were consecutively referred to the University Medical Centre Groningen for DBPCFC between January 2002 and February 2004. Among the 38 children undergoing DBPCFCs, there were 15 challenges with egg, 15 with peanut, five with hazelnut and three with soy. Fifteen food challenges (39%) were positive. Small quantities of allergenic foods were inadvertently present in the diets of 13 patients (34%), were possibly present in the diets of 14 patients (37%) and could not be identified in the diets of 11 patients (29%). Seven patients (54%) who had inadvertently ingested small quantities of allergenic foods without sequelae had a positive DBPCFC. Dietary avoidance was incomplete and not feasible in most cases. Tolerance of small amounts of allergenic foods does not preclude positive challenge reactions. Dietary assessment does not seem a useful tool in predicting the outcome of DBPCFC in children adhering to an elimination diet. The Stichting Astma Bestrijding (Foundation for the Prevention of Asthma), The Netherlands.

Acute lymphoblastic leukemia: Are Egyptian children adherent to maintenance therapy?

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Elhamy Rifky Abdel Khalek

2015-01-01

Full Text Available Background, Aims, Settings and Design: Poor adherence to oral maintenance chemotherapy can cause relapse of acute lymphoblastic leukemia (ALL. A multicenter study for the evaluation of adherence to oral 6-mercaptopurine (6-MP maintenance chemotherapy for childhood ALL in Egypt to identify contributing factors and possible steps to promote adherence. Materials and Methods: The study included 129 children with ALL in complete remission receiving 6-MP single daily oral dose in the evening. Evaluation was done through specific questionnaires for the patients as well as serum 6-MP measurements. Results: Nonadherence was detected in around 56% by questionnaires and around 50% by serum 6-MP level measurement. There was a highly significant correlation between nonadherence as found by the questionnaire and 6-MP level (P - 0.001. Nonadherence was significantly associated with low socioeconomic standard, noneducation and low educational level and large family size by both methods. High cost to come for follow-up visits was significant by questionnaire but not by 6-MP measurement. Adolescent age, the higher number of siblings, lack of written instructions, long time spent per visit, were all associated with higher rates of nonadherence, although none reached statistical significance. Conclusions: Nonadherence is a real problem in pediatric patients. Specific questionnaires can be an excellent reliable method for the routine follow-up of these children, and drug level assay can be requested only for confirmation. This protocol is especially effective in developing countries where financial resources may be limited. Every effort should be made to uncover its true incidence, contributing factors, and best methods of intervention.

Preschool children with high adherence to inhaled corticosteroids for asthma do not show behavioural problems

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Quak, Wouter; Klok, Ted; Kaptein, Adrian A.; Duiverman, Eric J.; Brand, Paul L. P.

Aim: To assess prevalence of behavioural problems in preschool children with asthma with electronically verified exposure to inhaled corticosteroids (ICS). Methods: Cross-sectional study of 81 children 25 years of age using daily ICS for persistent asthma. During 3 months follow-up, adherence to ICS

Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

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Perrier Lionel

2012-03-01

Full Text Available Abstract Background Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET comparing costs and outcomes when clinicians adhered to CPGs and when they did not. Methods Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006 or in the Veneto region of Italy (in 2007. Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach. All costs were expressed in euros (€ at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. Results A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%. Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. Conclusions Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of

Association Between Adherence to the Mediterranean Diet and Asthma in Peruvian Children.

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Rice, Jessica L; Romero, Karina M; Galvez Davila, Rocio M; Meza, Carla Tarazona; Bilderback, Andrew; Williams, D'Ann L; Breysse, Patrick N; Bose, Sonali; Checkley, William; Hansel, Nadia N

2015-12-01

Adherence to a Mediterranean diet pattern may be associated with lower asthma prevalence in children. We sought to corroborate these findings in Peruvian children. This case-control study included children of ages 9-19 years living in Lima, Peru. A food frequency questionnaire (FFQ) was completed and diet pattern was analyzed using a modified Mediterranean diet score (MDS). Primary analysis investigated the relationship between MDS and asthma status. Maternal education, age, sex, and body mass index category were included in multivariate model. Secondary outcomes included asthma control, forced expiratory volume in 1 s (FEV1), allergic rhinitis, and atopic status. 287 participants with asthma and 96 controls without asthma completed a FFQ. Mean age was 13.5 years. According to the asthma control test (ACT), 86 % of those with asthma were controlled (score >19). MDS scores ranged 6-18 (median 15). In adjusted analysis, being above the median MDS scores was associated with decreased odds of asthma [OR = 0.55, 95 % CI (0.33, 0.92), p = 0.02]. Among children whose mothers completed secondary education, being above the median MDS significantly decreased the odds of asthma [OR = 0.31, 95 % CI (0.14, 0.71), p education there was no protective effect [OR = 0.86, 95 % CI (0.43, 1.7), p = 0.66]. There was no association between MDS scores and asthma control, FEV1, allergic rhinitis, or atopic status. Adherence to the Mediterranean diet was inversely associated with having asthma among children in Lima, Peru. This effect was strongest among children with better educated mothers.

Factors influencing adherence to referral advice following pre-referral treatment with artesunate suppositories in children in rural Tanzania.

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Simba, Daudi O; Warsame, Marian; Kimbute, Omari; Kakoko, Deodatus; Petzold, Max; Tomson, Goran; Premji, Zul; Gomes, Melba

2009-07-01

WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers' adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories. The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions taken post-referral: taking their children to a drug shop, a traditional healer, or not seeking further treatment, and added to a random selection of patients who complied with referral advice. Caretakers of the children were interviewed about their socio-economic status (SES), knowledge about malaria, referral advice given and actions they took following pre-referral treatment. Interview data for 587 caretakers were matched with symptoms of the children, the time of treatment, arrival at a health facility or other actions taken post-pre-referral treatment. The majority (93.5%) of caretakers reported being given referral advice by the community drug dispenser. The odds of adherence with this advice were three times greater for children with altered consciousness and/or convulsions than for children with other symptoms [odds ratio (OR) 3.47, 95% confidence interval (CI) 2.32-5.17, P < 0.001]. When questioned, caretakers who remembered when (OR 2.19, 95% CI 1.48-3.23, P < 0.001) and why (OR 1.77, 95% CI 1.07-2.95, P = 0.026) they were advised to proceed to health facility - were more likely to follow referral advice. Cost did not influence adherence except within a catchment area of facilities that charged for services. In these areas, costs deterred adherence by

Behavioral and Pharmacological Adherence in Pediatric Sickle Cell Disease: Parent-Child Agreement and Family Factors Associated With Adherence.

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Klitzman, Page H; Carmody, Julia K; Belkin, Mary H; Janicke, David M

2018-01-01

This study aimed to evaluate agreement between children and parents on a measure of behavioral and pharmacological adherence in children with sickle cell disease (SCD), and the associations among family factors (i.e., problem-solving skills, routines, communication) and adherence behaviors. In all, 85 children (aged 8-18 years) with SCD and their parents completed questionnaires assessing individual and family factors. Overall parent-child agreement on an adherence measure was poor, particularly for boys and older children. Greater use of child routines was associated with better overall child-reported adherence. Open family communication was associated with higher overall parent-reported adherence. While further research is needed before definitive conclusions can be drawn, results suggest the need to assess child adherence behaviors via both child and parent reports. Findings also suggest that more daily family routines and open family communication may be protective factors for better disease management. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Adherence to Polyethylene Glycol Treatment in Children with Functional Constipation Is Associated with Parental Illness Perceptions, Satisfaction with Treatment, and Perceived Treatment Convenience.

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Koppen, Ilan Jasper Nader; van Wassenaer, Elsa A; Barendsen, Rinse W; Brand, Paul L; Benninga, Marc A

2018-05-10

To assess treatment adherence in children with functional constipation and to evaluate the association with parental beliefs about medication, illness perceptions, treatment satisfaction, and satisfaction with information about medication. A cross-sectional survey was administered among parents of children with functional constipation treated with polyethylene glycol. Adherence was measured via the Medication Adherence Report Scale (MARS-5, score 5-25), with greater scores indicating better adherence (scores ≥23 were defined as adherent). Beliefs about medication, illness perceptions, satisfaction with treatment, and satisfaction with information about treatment were measured with the Beliefs about Medication Questionnaire, the Brief Illness Perception Questionnaire, the Treatment Satisfaction Questionnaire for Medication (TSQM), and the Satisfaction with Information about Medication Questionnaire. Associations between the questionnaire scores and adherence (MARS-5 score as a continuous variable) were analyzed with regression analyses. In total, 43 of 115 included children (37%) were adherent (MARS-5 ≥23). Spearman rank correlation test revealed a statistically significant correlation between TSQM-convenience, TSQM-satisfaction, Brief Illness Perception Questionnaire question 8 (emotions), and the MARS-5 score (r s 0.342, P = .000; r s 0.258, P = .006; r s -0.192, P = .044), which suggests that parental perceived treatment convenience, satisfaction with treatment, and illness perceptions may affect adherence in children with functional constipation. In the hierarchical multivariate regression model, 22% of the variability of the MARS-5 score could be explained by the selected predictors. The TSQM-convenience score contributed the most to the model (β: 0.384, P = .000). Parents reported low adherence rates in their children with functional constipation. Treatment inconvenience, dissatisfaction with treatment, and the emotional impact of

Poor adherence to U.S. dietary guidelines for children and adolescents in the NHANES population

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Banfield, Emilyn C.; Liu, Yan; Davis, Jennifer S.; Chang, Shine; Frazier-Wood, Alexis C.

2015-01-01

Background Poor diet quality in childhood and adolescence is associated with adverse health outcomes throughout life, yet the dietary habits of American children and how they change across childhood and adolescence are unknown. Objectives This study sought to describe diet quality among children and adolescents by assessing adherence to the Dietary Guidelines for Americans (DGA) and to determine whether any differences in adherence occurred across childhood. Design, Setting, and Participants We employed a cross-sectional design using data from the National Health and Nutrition Examination Survey (NHANES). Of 9,280 children ages 4-18 who participated in NHANES from 2005-2010, those with insufficient data on dietary recall (n=852) or who were pregnant or lactating during the time of interview (n=38) were excluded from the final study sample (n=8,390). Main Outcome Measures We measured adherence to the DGA using the Healthy Eating Index 2010 (HEI-10) and stratified participants into three age groups (4-8, 9-13 and 14-18 years of age). We analyzed each of twelve HEI-10 components, and total HEI-10 score. Results The youngest children had the highest overall diet quality due to significantly greater scores for total fruit, whole fruit, dairy, and whole grains. These children also had the highest scores for sodium, refined grains, and empty calories. Total HEI-10 scores ranged from 43.59 to 52.11 out of 100, much lower than the minimum score of 80 thought to indicate a diet associated with good health. Conclusions Overall, children and adolescents are failing to meet the DGA and may be at an increased risk of chronic diseases throughout life. By analyzing which food groups show differences between age groups, we provide data which may inform the development of dietary interventions to promote specific food groups targeting specific ages, thus improving diet quality among children and adolescents. PMID:26391469

Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under–five in Uttar Pradesh, India

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Laura M Lamberti

2015-12-01

Full Text Available There is limited evidence on adherence to the recommended dose and duration of zinc supplementation for diarrheal episodes in children under five years of age. In selected districts of Uttar Pradesh, India, we sought to assess adherence to the nationally advised zinc treatment regimen (ie, 10 mg/day for ages 2–6 months and 20 mg/day for ages 7–59 months for 14 days among caregivers of zinc–prescribed children. We identified and conducted follow–up visits to children advised zinc for the treatment of diarrhea. At the initial visit, we collected data on the treatment instructions received from providers. Caregivers were asked to record treatments administered on a pictorial tracking form and were asked to retain all packaging for collection at follow–up. We quantified the average dose and duration of zinc therapy and built logistic regression models to assess the factors associated with caregiver adherence to national guidelines. Caregivers administered zinc for an average of 10.7 days (standard deviation (SD = 3.9 days; median = 13 days, and 47.8% continued treatment for the complete 14 days. Among children receiving zinc syrups and tablets respectively, the age appropriate dose was received by 30.8% and 67.3%. Adherence to age appropriate dose and continuation of zinc for 14 days were highly associated with having received appropriate provider instructions. Our results indicate moderate–to–good adherence to national zinc treatment guidelines for diarrhea among caregivers in rural India. Our findings also highlight the importance of provider guidance in ensuring adherence to zinc dose and duration. Programs aiming to scale–up zinc treatment for childhood diarrhea should train providers to successfully communicate dosing instructions to caregivers, while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents

NARCIS (Netherlands)

Kontogianni, Meropi D; Vidra, Nikoletta; Farmaki, Anastasia-Eleni; Koinaki, Stella; Belogianni, Katerina; Sofrona, Stavroula; Magkanari, Flora; Yannakoulia, Mary

2008-01-01

Data from studies in pediatric samples exploring adherence to the Mediterranean diet are scarce. The aim of the present work was to explore adherence to a Mediterranean diet pattern in a representative sample of Greek children and adolescents. The study sample (n = 1305, 3-18 y) was representative

Adherence of randomized trials within children's surgical specialties published during 2000 to 2009 to standard reporting guidelines.

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Blakely, Martin L; Kao, Lillian S; Tsao, Kuojen; Huang, Eunice Y; Tsai, Anthony; Tanaka, Stacy; Younas, Shiraz; Lu, Zengqi; Lally, Kevin P

2013-09-01

Randomized clinical trials (RCTs) are uncommon in pediatric surgical specialties and the quality of reporting is unknown. Our primary purpose was to analyze published surgical RCTs involving children to measure adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Published RCTs from January 1, 2000 through December 31, 2009 were reviewed. The trials were evaluated for the presence of 7 CONSORT guidelines and also graded according to the Jadad scale. Two hundred and twenty-eight trials were included. Five trials met all 7 CONSORT criteria (2%) and 53 had a Jadad score of ≥3 (23%). Slightly more than 50% of all trials specified primary outcomes and guidelines for allocation concealment, randomization description, and attrition details was even lower. There were significant differences between surgical specialties with regard to CONSORT adherence to the majority of the guidelines. Pediatric general surgery had the largest number of published RCTs. Pediatric orthopaedic surgery had the highest proportion of trials with a Jadad score ≥3 (40%). Adherence to CONSORT guidelines is low across the spectrum of children's surgical specialties, although significant differences do exist. Future RCTs in children's surgical specialties should specifically focus on areas of low adherence to reporting guidelines. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The role of electronic assessment of adherence in the education and counseling of children taking growth hormone: progress and challenges.

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Haverkamp, Fritz; Norgren, Svante; Horne, Rob; Gasteyger, Christoph

There are numerous issues surrounding adherence in children taking recombinant human growth hormone (rh-GH). New technologies capable of accurately recording/monitoring may highlight some of these issues, and have value in optimizing adherence levels through education and counseling. The intention of this review is to guide healthcare professionals (HCPs). PubMed, Google Scholar and citations in published papers were used to substantiate the views expressed by the authors. Both perceptional and practical factors influence the adherence levels of children taking rh-GH. Understanding such factors may help to identify the characteristics of ideal rh-GH devices and their potential impact on adherence. New technologies, such as electronic monitors, may facilitate patient-provider discussions on adherence, and help identify barriers that are amenable to change. Monitoring adherence may also help differentiate nonadherence from biological low response to rh-GH therapy. However, the medical, psychological, social and ethical aspects of electronic assessment require further investigation.

Psychosocial adjustment and adherence to dialysis treatment regimes.

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Brownbridge, G; Fielding, D M

1994-12-01

Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P adherence than younger children, P dialysis (P treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.

Factors associated to acceptable treatment adherence among children with chronic kidney disease in Guatemala.

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Brooke M Ramay

Full Text Available Pediatric patients with Chronic Kidney Disease face several barriers to medication adherence that, if addressed, may improve clinical care outcomes. A cross sectional questionnaire was administered in the Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City from September of 2015 to April of 2016 to identify the predisposing factors, enabling factors and need factors related to medication adherence. Sample size was calculated using simple random sampling with a confidence level of 95%, confidence interval of 0.05 and a proportion of 87%. A total of 103 participants responded to the questionnaire (calculated sample size was 96. Independent variables were defined and described, and the bivariate relationship to dependent variables was determined using Odds Ratio. Multivariate analysis was carried out using logistic regression. The mean adherence of study population was 78% (SD 0.08, max = 96%, min = 55%. The mean adherence in transplant patients was 82% (SD 7.8, max 96%, min 63%, and the mean adherence in dialysis patients was 76% (SD 7.8 max 90%, min 55%. Adherence was positively associated to the mother's educational level and to higher monthly household income. Together predisposing, enabling and need factors illustrate the complexities surrounding adherence in this pediatric CKD population. Public policy strategies aimed at improving access to comprehensive treatment regimens may facilitate treatment access, alleviating economic strain on caregivers and may improve adherence outcomes.

Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success

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Lisanna Lamb

2018-03-01

Full Text Available Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the

Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success.

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Lamb, Lisanna; Affenzeller, Nadja; Hewison, Lynn; McPeake, Kevin James; Zulch, Helen; Mills, Daniel S

2018-01-01

Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the application of the instrument

Relationship between viral load and behavioral measures of adherence to antiretroviral therapy in children living with human immunodeficiency virus in Latin America

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Horacio A. Duarte

2015-05-01

Full Text Available Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of human immunodeficiency virus-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with human immunodeficiency virus viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable’ viral load ( 0.3. Last time missed any antiretroviral therapy dose was reported as “never” for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p < 0.001 for test of trend. The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p ≤ 0.005, but not at the 6-month visit (p = 0.2. While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in this population.

Do clinicians adhere to practice guidelines? A descriptive study at a ...

African Journals Online (AJOL)

Background: Clinical guidelines when implemented correctly have shown to improve disease outcomes. This study describes utilization of Kenya National guidelines in managing ante partum haemorrhage (APH) in 3rd trimester. Objective: To describe adherence to clinical guideline in management of antepartum ...

A comparison of clinicians' racial biases in the United States and France.

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Khosla, Natalia N; Perry, Sylvia P; Moss-Racusin, Corinne A; Burke, Sara E; Dovidio, John F

2018-04-13

Clinician bias contributes to racial disparities in healthcare, but its effects may be indirect and culturally specific. The present work aims to investigate clinicians' perceptions of Black versus White patients' personal responsibility for their health, whether this variable predicts racial bias against Black patients, and whether this effect differs between the U.S. and France. American (N = 83) and French (N = 81) clinicians were randomly assigned to report their impressions of an identical Black or White male patient based on a physician's notes. We measured clinicians' views of the patient's anticipated improvement and adherence to treatment and their perceptions concerning how personally responsible the patient was for his health. Whereas French clinicians did not exhibit significant racial bias on the measures of interest, American clinicians rated a hypothetical White patient, compared to an identical Black patient, as significantly more likely to improve, adhere to treatment, and be personally responsible for his health. Moreover, in the U.S., personal responsibility mediated the racial difference in expected improvement, such that as the White patient was seen as more personally responsible for his health, he was also viewed as more likely to improve. The present work indicates that American clinicians displayed less optimistic expectations for the medical treatment and health of a Black male patient, relative to a White male patient, and that this racial bias was related to their view of the Black patient as being less personally responsible for his health relative to the White patient. French clinicians did not show this pattern of racial bias, suggesting the importance of considering cultural influences for understanding racial biases in healthcare and health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Adherence to active play and electronic media guidelines in preschool children: gender and parental education considerations.

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Loprinzi, Paul D; Schary, David P; Cardinal, Bradley J

2013-01-01

The primary purpose of the present study was to examine adherence to current active play and electronic media use guidelines in a sample of US preschool-aged children and to examine whether differences occurred across gender and parental education. 164 parents completed an on-line survey to estimate preschool children's active play and sedentary behaviors. For weekdays, 50% of the sample met the active play guideline with this increasing to 65% during the weekend. With respect to electronic media use, 90% of the sample met guidelines during the week, with the percentage meeting guidelines dropping to 78% during the weekend. A greater percentage of preschool children from high parental education families (83.4 ± 3.3) met electronic media use guidelines on the weekends, compared to preschool children from low parental education families (59.4 ± 8.1) (p = 0.002). Our findings indicate that a substantial portion of preschool children are not meeting active play guidelines and that adherence to active play and electronic media use guidelines may be influenced by parental education.

An Analysis of Patient Adherence to Treatment during a 1-Year, Open-Label Study of OROS[R] Methylphenidate in Children with ADHD

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Faraone, Stephen V.; Biederman, Joseph; Zimmerman, Brenda

2007-01-01

Objective: Treatment adherence is an important aspect of ADHD symptom management, but there are many factors that may influence adherence. Method: This analysis assessed adherence to OROS methylphenidate during a 1-year, open-label study in children. Adherence was defined as the number of days medication was taken divided by the number of days in…

Usefulness of pharmacy dispensing records in the evaluation of adherence to antiretroviral therapy in Brazilian children and adolescents.

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Ernesto, Aline Santarem; Lemos, Renata Muller Banzato Pinto de; Huehara, Maria Ivone; Morcillo, André Moreno; Dos Santos Vilela, Maria Marluce; Silva, Marcos Tadeu Nolasco da

2012-01-01

Adherence, which is crucial to the success of antiretroviral therapy (HAART), is currently a major challenge in the care of children and adolescents living with HIV/AIDS. To evaluate the prevalence of nonadherence to HAART using complementary instruments in a cohort of children and adolescents with HIV/AIDS followed in a reference service in Campinas, Brazil. The level of adherence of 108 patients and caregivers was evaluated by an adapted standardized questionnaire and pharmacy dispensing records (PDR). Non-adherence was defined as a drug intake lower than 95% (on 24-hour or seven-day questionnaires), or as an interval of 38 days or more for pharmacy refills. The association between adherence and clinical, immunological, virological, and psychosocial characteristics was assessed by multivariate analysis. Non-adherence prevalence varied from 11.1% (non-adherent in three instruments), 15.8% (24-hour self-report), 27.8% (seven-day self-report), 45.4% (PDR), and 56.3% (at least one of the outcomes). 24-hour and seven-day self-reports, when compared to PDR, showed low sensitivity (29% and 43%, respectively) but high specificity (95% and 85%, respectively). In multivariate analysis, medication intolerance, difficulty of administration by caregiver, HAART intake by the patient, lower socioeconomical class, lack of virological control, missed appointments in the past six months, and lack of religious practice by caregiver were significantly associated with non-adherence. A high prevalence of HAART non-adherence was observed in the study population, and PDR was the most sensitive of the tested instruments. The instruments employed were complementary in the identification of non-adherence. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

Usefulness of pharmacy dispensing records in the evaluation of adherence to antiretroviral therapy in Brazilian children and adolescents

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Aline Santarem Ernesto

Full Text Available INTRODUCTION: Adherence, which is crucial to the success of antiretroviral therapy (HAART, is currently a major challenge in the care of children and adolescents living with HIV/AIDS. OBJECTIVE: To evaluate the prevalence of nonadherence to HAART using complementary instruments in a cohort of children and adolescents with HIV/AIDS followed in a reference service in Campinas, Brazil. METHODS: The level of adherence of 108 patients and caregivers was evaluated by an adapted standardized questionnaire and pharmacy dispensing records (PDR. Non-adherence was defined as a drug intake lower than 95% (on 24-hour or seven-day questionnaires, or as an interval of 38 days or more for pharmacy refills. The association between adherence and clinical, immunological, virological, and psychosocial characteristics was assessed by multivariate analysis. RESULTS: Non-adherence prevalence varied from 11.1% (non-adherent in three instruments, 15.8% (24-hour self-report, 27.8% (seven-day self-report, 45.4% (PDR, and 56.3% (at least one of the outcomes. 24-hour and seven-day self-reports, when compared to PDR, showed low sensitivity (29% and 43%, respectively but high specificity (95% and 85%, respectively. In multivariate analysis, medication intolerance, difficulty of administration by caregiver, HAART intake by the patient, lower socioeconomical class, lack of virological control, missed appointments in the past six months, and lack of religious practice by caregiver were significantly associated with non-adherence. CONCLUSION: A high prevalence of HAART non-adherence was observed in the study population, and PDR was the most sensitive of the tested instruments. The instruments employed were complementary in the identification of non-adherence.

Palatability, adherence and prescribing patterns of antiretroviral drugs for children with human immunodeficiency virus infection in Canada.

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Lin, Daren; Seabrook, Jamie A; Matsui, Doreen M; King, Susan M; Rieder, Michael J; Finkelstein, Yaron

2011-12-01

To assess the impact of perceived palatability of antiretroviral drugs on adherence to therapy of children infected by human immunodeficiency virus and on prescribing patterns by their caring physicians. Two arms--retrospective chart review and a cross-sectional survey. Tertiary-care pediatric human immunodeficiency virus clinic during a 17-year period. Children with human immunodeficiency virus infection and physicians actively caring for children with human immunodeficiency virus infection in seven provinces in Canada were surveyed regarding their perception of the palatability of 8-liquid and 15 non-liquid antiretroviral medications and its effect on drug selection. Effect of taste preferences of antiretroviral drugs on adherence to treatment by infected children and on drug selection by their caring physicians. Forty of 119 children (34%) refused at least once to an antiretroviral medication. In 5%, treatment was discontinued because of poor palatability. Ritonavir was the least palatable drug (50% of children; p = 0.01). Ritonavir use (OR 4.80 [95%CI 1.34-17.20]) and male gender (OR 7.25 [95%CI 2.30-22.90]) were independent predictors of drug discontinuation because of poor taste. Physicians also perceived liquid ritonavir as the least palatable (p = 0.01) and the most likely to be discontinued (p = 0.01). However, they commonly prescribed it as first-line therapy (p = 0.06). A third of children infected with human immunodeficiency virus fail to adhere to their treatment because of poor drug taste. Physicians are aware of that, but this does not prevent them from selecting the least palatable drugs as first-line therapy. Copyright © 2011 John Wiley & Sons, Ltd.

Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department.

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Nigrovic, Lise E; Bennett, Jonathan E; Balamuth, Fran; Levas, Michael N; Chenard, Rachel L; Maulden, Alexandra B; Garro, Aris C

2017-12-01

To make initial management decisions, clinicians must estimate the probability of Lyme disease before diagnostic test results are available. Our objective was to examine the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease. We assembled a prospective cohort of children aged 1 to 21 years who were evaluated for Lyme disease at 1 of the 5 participating emergency departments. Treating physicians were asked to estimate the probability of Lyme disease (on a 10-point scale). We defined a Lyme disease case as a patient with an erythema migrans lesion or positive 2-tiered serology results in a patient with compatible symptoms. We calculated the area under the curve for the receiver operating curve as a measure of the ability of clinician suspicion to diagnose Lyme disease. We enrolled 1021 children with a median age of 9 years (interquartile range, 5-13 years). Of these, 238 (23%) had Lyme disease. Clinician suspicion had a minimal ability to discriminate between children with and without Lyme disease: area under the curve, 0.75 (95% confidence interval, 0.71-0.79). Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1-3), 65 (12%) had Lyme disease, and of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8-10), 39 (31%) did not have Lyme disease. Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis. Copyright © 2017 by the American Academy of Pediatrics.

KIDMED TEST; PREVALENCE OF LOW ADHERENCE TO THE MEDITERRANEAN DIET IN CHILDREN AND YOUNG; A SYSTEMATIC REVIEW.

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García Cabrera, S; Herrera Fernández, N; Rodríguez Hernández, C; Nissensohn, M; Román-Viñas, B; Serra-Majem, L

2015-12-01

during the last decades, a quick and important modification of the dietary habits has been observed in the Mediterranean countries, especially among young people. Several authors have evaluated the pattern of adherence to the Mediterranean Diet in this group of population, by using the KIDMED test. the purpose of this study was to evaluate the adherence to the Mediterranean Diet among children and adolescents by using the KIDMED test through a systematic review and meta-analysis. PubMed database was accessed until January 2014. Only cross-sectional studies evaluating children and young people were included. A random effects model was considered. eighteen cross-sectional studies were included. The population age ranged from 2 to 25 years. The total sample included 24 067 people. The overall percentage of high adherence to the Mediterranean Diet was 10% (95% CI 0.07-0.13), while the low adhesion was 21% (IC 95% 0.14 to 0.27). In the low adherence group, further analyses were performed by defined subgroups, finding differences for the age of the population and the geographical area. the results obtained showed important differences between high and low adherence to the Mediterranean Diet levels, although successive subgroup analyzes were performed. There is a clear trend towards the abandonment of the Mediterranean lifestyle. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Impact of the Kenya post-election crisis on clinic attendance and medication adherence for HIV-infected children in western Kenya

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Sang Edwin

2009-04-01

Full Text Available Abstract Background Kenya experienced a political and humanitarian crisis following presidential elections on 27 December 2007. Over 1,200 people were killed and 300,000 displaced, with disproportionate violence in western Kenya. We sought to describe the immediate impact of this conflict on return to clinic and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH in western Kenya. Methods We conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. Eligible patients were HIV-infected children, less than 14 years of age, seen in the AMPATH HIV clinic system between 26 October 2007 and 25 December 2007. We extracted demographic and clinical data, generating descriptive statistics for pre- and post-conflict antiretroviral therapy (ART adherence and post-election return to clinic for this cohort. ART adherence was derived from caregiver-report of taking all ART doses in past 7 days. We used multivariable logistic regression to assess factors associated with not returning to clinic. Interview dialogue from was analyzed using constant comparison, progressive coding and triangulation. Results Between 26 October 2007 and 25 December 2007, 2,585 HIV-infected children (including 1,642 on ART were seen. During 26 December 2007 to 15 April 2008, 93% (N = 2,398 returned to care. At their first visit after the election, 95% of children on ART (N = 1,408 reported perfect ART adherence, a significant drop from 98% pre-election (p Conclusion During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique program strengths may have minimized these disruptions.

Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures.

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Gau, Susan S F; Shen, Hsin-Yi; Chou, Miao-Churn; Tang, Ching-Shu; Chiu, Yen-Nan; Gau, Churn-Shiouh

2006-06-01

The aim of this study was to examine the association between adherence to immediate-release methylphenidate (IR MPH) and maternal psychological distress, parenting style, parent- child relationship, and perceived family support. The sample consisted of 307 children with attention-deficit hyperactivity disorder (ADHD) (271 boys and 36 girls), 6-17 years of age, who had been treated with IR MPH for the past 6 months. The measures included the Chinese Health Questionnaire, Parental Bonding Instrument, Family APGAR, and Home Behaviors of the Social Adjustment Inventory for Children and Adolescents. Reasons for poor adherence (n = 79; 25.7%) included forgetting medication (72.7%), the medication having no effect (20.0%), and refusing medication (12.7%). Increased age and three-times-daily administration were the major predictors for poor adherence to IR MPH. Poor adherence was associated with increased degree of maternal psychological distress, indifferent parenting, maternal overprotection/control, poor family support, decreased interaction with parents, and increased problems at home. Findings indicate that multiple daily dosing of MPH increases the likelihood of poor adherence, particularly in adolescents, and that poor adherence is associated with impaired maternal/family process. Once-daily administration of MPH is necessary to improve adherence and to decrease the possible exacerbation of tense parent-child relationships caused by poor drug adherence.

Maintaining persistence and adherence with subcutaneous growth-hormone therapy in children: comparing jet-delivery and needle-based devices

Directory of Open Access Journals (Sweden)

Spoudeas HA

2014-09-01

Full Text Available Helen A Spoudeas,1 Priti Bajaj,2 Nathan Sommerford3 1London Centre for Paediatric Endocrinology, University College London, London, 2Ferring Pharmaceuticals, London, 3Health Informatics Research, Sciensus Ltd, Brighton, UK Purpose: Persistence and adherence with subcutaneous growth hormone (GH; somatropin therapy in children is widely acknowledged to be suboptimal. This study aimed to investigate how the use of a jet-delivery device, ZomaJet®, impacts on medication-taking behaviors compared to needle-based devices.Materials and methods: A retrospective cohort study of children aged ≤18 years was conducted using a UK-based, nationwide database of GH home-delivery schedules. Data were evaluated for the period between January 2010 and December 2012 for 6,061 children receiving either Zomacton® (somatropin via the ZomaJet jet-delivery device or one of six brands of GH all administered via needle-based devices. Persistence was analyzed for patients with appropriate data, measured as the time interval between first and last home deliveries. An analysis of adherence was conducted only for patients using ZomaJet who had appropriate data, measured by proportion of days covered. Brand switches were identified for all patients.Results: Persistence with GH therapy was significantly longer in patients using ZomaJet compared to needle-based devices (599 days versus 535 days, respectively, n=4,093; P<0.001; this association was observed in both sexes and across age subgroups (≤10 and 11–16 years. The majority (58% of patients using ZomaJet were classed as adherent (n=728. Only 297 patients (5% switched GH brand (n=6,061, and patients tended to use ZomaJet for longer than other devices before switching.Conclusion: It appears important that the choice of a jet-delivery device is offered to children prescribed daily GH therapy. These devices may represent a much-needed effective strategy for maintaining persistence with subcutaneous GH administration in

Improving adherence to antiretroviral therapy

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Nischal K

2005-01-01

Full Text Available Antiretroviral therapy (ART has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen′s pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression, lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.

A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy.

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Picha, Kelsey J; Howell, Dana M

2018-03-01

Patient adherence to rehabilitation programmes is frequently low - particularly adherence to home exercise programmes. Home exercise programmes have been identified as complementary to clinic-based physical therapy in an orthopaedic setting. Barriers to patient adherence have previously been identified within the literature. Low self-efficacy is a barrier to adherence that clinicians have the ability to have an impact on and improve. The theory of self-efficacy is defined as a person's confidence in their ability to perform a task. This theory examines the ability of a person to change through exerting control over inner processes of goal setting, self-monitoring, feedback, problem solving and self-evaluation. If clinicians are able to identify patients with low self-efficacy prior to the prescription of a home exercise programme, adjustments to individualized care can be implemented. Individualized care based on improving self-efficacy for home exercise programmes may improve patient adherence to these programmes. The purpose of this article was to use the theory of self-efficacy to direct clinicians in providing individualized programmes to patients with varying levels of self-efficacy. Copyright © 2017 John Wiley & Sons, Ltd.

Understanding clinicians' attitudes toward a mobile health strategy to childhood asthma management: A qualitative study.

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Hollenbach, Jessica P; Cushing, Anna; Melvin, Emilie; McGowan, Bryanna; Cloutier, Michelle M; Manice, Melissa

2017-09-01

Mobile technology for childhood asthma can provide real-time data to enhance care. What real-time adherence information clinicians want, how they may use it, and if the data meet their clinical needs have not been fully explored. Our goal was to determine whether pediatric primary care and pulmonary clinicians believe if a sensor-based mobile intervention is useful in caring for patients with asthma. We recruited participants from 3 urban, primary care and 1 pulmonary practice from July to September 2015 in Hartford, CT. Forty-one participated in four focus groups, which included a demonstration of the technology. Participants were probed with open-ended questions on the type, frequency, and format of inter-visit patient information they found useful. 41 participants (mean age 49 (±13.7) years) were board-certified clinicians (41% MDs and 20% mid-level practitioners), practiced medicine on an average of 19 (±14) years, were primarily white (59%) and women (78%). Clinicians wanted 1) adherence to prescribed inhaler therapy and 2) data on inhaler technique. Clinicians wanted it at the time of a scheduled clinic visit but also wanted inter-visit alerts for excessive use of rescue therapy. Pulmonologists liked the mobile spirometer's provision of inter-visit lung function data; pediatricians did not share this view. Concerns with data accuracy were raised due to families who shared inhalers, access to smartphones, and protection of health information. Overall, clinicians view an asthma mobile health technology as enhancing the patient-centered medical home. Pediatric primary care clinicians and pulmonologists want different information from a mobile app.

Prevalence and correlates of treatment failure among Kenyan children hospitalised with severe community-acquired pneumonia: a prospective study of the clinical effectiveness of WHO pneumonia case management guidelines.

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Agweyu, Ambrose; Kibore, Minnie; Digolo, Lina; Kosgei, Caroline; Maina, Virginia; Mugane, Samson; Muma, Sarah; Wachira, John; Waiyego, Mary; Maleche-Obimbo, Elizabeth

2014-11-01

To determine the extent and pattern of treatment failure (TF) among children hospitalised with community-acquired pneumonia at a large tertiary hospital in Kenya. We followed up children aged 2-59 months with WHO-defined severe pneumonia (SP) and very severe pneumonia (VSP) for up to 5 days for TF using two definitions: (i) documentation of pre-defined clinical signs resulting in change of treatment (ii) primary clinician's decision to change treatment with or without documentation of the same pre-defined clinical signs. We enrolled 385 children. The risk of TF varied between 1.8% (95% CI 0.4-5.1) and 12.4% (95% CI 7.9-18.4) for SP and 21.4% (95% CI 15.9-27) and 39.3% (95% CI 32.5-46.4) for VSP depending on the definition applied. Higher rates were associated with early changes in therapy by clinician in the absence of an obvious clinical rationale. Non-adherence to treatment guidelines was observed for 70/169 (41.4%) and 67/201 (33.3%) of children with SP and VSP, respectively. Among children with SP, adherence to treatment guidelines was associated with the presence of wheeze on initial assessment (P = 0.02), while clinician non-adherence to guideline-recommended treatments for VSP tended to occur in children with altered consciousness (P < 0.001). Using propensity score matching to account for imbalance in the distribution of baseline clinical characteristics among children with VSP revealed no difference in TF between those treated with the guideline-recommended regimen vs. more costly broad-spectrum alternatives [risk difference 0.37 (95% CI -0.84 to 0.51)]. Before revising current pneumonia case management guidelines, standardised definitions of TF and appropriate studies of treatment effectiveness of alternative regimens are required. © 2014 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

Psychosocial Determinants of Adherence to Preventive Dental Attendance for Preschool Children Among Filipino Immigrants in Edmonton, Alberta.

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Badri, Parvaneh; Wolfe, Ruth; Farmer, Anna; Amin, Maryam

2018-06-01

Barriers to accessing oral healthcare are public health concerns faced by minorities and immigrants due to socioeconomic marginalization. Therefore, we explored how immigrant parents in Alberta-Edmonton's Filipino community experience adherence to preventive dental attendance (PDA) for their preschool children and the psychosocial factors influencing parental adherence. We employed a qualitative focused ethnography design. Data were collected through interviews and focus groups. Audiotapes of sessions were transcribed verbatim and concurrent thematic data analysis was performed. Stressors, resources, paradox and structural barriers comprised emergent psychosocial themes. Upon arriving in Canada, most Filipino parents held low-priority attitudes and perceptions toward PDA. After migration, however, they embraced new knowledge about the importance of PDA for their children. Filipino parents were open to the Western model of preventive oral healthcare, with the duration of their time in Canada playing a key role in promoting regular dental visits for their children.

Evaluation of Adherence to a Convulsion management Protocol for Children in Rwanda

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kaputu-kalal-malu, Célestin; D'Amour Birindabagabo, Jean; Walker, Timothy David; Mafuta-Musalu, Eric; Ntumba-Tshitenge, Olga; Preux, Pierre-Marie; MISSON, Jean-Paul

2014-01-01

Inappropriate seizure management may result in high morbidity and mortality. We assessed the adherence of health professionals in southern Rwanda to a national protocol for pharmacological management of seizures in children. A questionnaire featuring a 5-year-old child with generalized prolonged seizures was administered. The questions focused on the choice of initial treatment and the sequence of management following failure of the initial treatment choice. Benzodiazepine was cho...

Effectiveness of a focused, brief psychoeducation program for parents of ADHD children: improvement of medication adherence and symptoms.

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Bai, Guan-Nan; Wang, Yu-Feng; Yang, Li; Niu, Wen-Yi

2015-01-01

To evaluate the efficacy of a psychoeducation program for parents of children with ADHD in enhancing adherence to pharmacological treatment and improving clinical symptoms. We developed a psychoeducation program based on the theory of planned behavior (TPB). Eighty-nine children with ADHD were cluster randomly assigned for their families to receive 3 months of well-structured psychoeducation (intervention group, n=44) or only general clinical counseling (control group, n=45). Parents in the intervention group were given an expert lecture (with slides and a parent manual), attended two expert-guided parent group sessions, and were invited to join a professional-guided online community. Measurement of parents' knowledge about ADHD, components of the TPB model, and child ADHD symptoms were taken before and after intervention. Medication adherence was assessed thoroughly at the end of the first and third months. Satisfaction with the psychoeducation program was assessed only in the intervention group. Two-independent-samples t-test, ANOVA, and chi-square test were employed to compare differences between groups. Compared to the control group, medication adherence in the intervention group was significantly higher after 1 and 3 months (97.7% intervention vs 75.6% control, P=0.002, and 86.4% intervention vs 53.3% control, P=0.001, respectively). Accordingly, the ADHD rating scale scores were lower in the intervention group than the control group after intervention (33.7±5.4 vs 45.1±7.9, P=0.008). Greater improvements in parents' knowledge about ADHD and many components of the TPB model were observed in the intervention group, especially increased intention to adhere to medication, compared to the control group (P<0.001). This psychoeducation program had a positive impact on both medication adherence and clinical symptoms of ADHD children. It could be considered as a potential beneficial supplement to clinical practice.

Evaluation of adherence to national treatment guidelines among ...

African Journals Online (AJOL)

to guidelines for standard treatment regimens and DOT has not been investigated previously. Knowledge of the impact of non-adherence to standard regimens and DOT on treatment outcomes will allow programmes and clinicians to recognise practices essential to treat and manage patients with TB effectively. We aimed to ...

Parents of children with physical disabilities perceive that characteristics of home exercise programs and physiotherapists' teaching styles influence adherence: a qualitative study.

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Lillo-Navarro, Carmen; Medina-Mirapeix, Francesc; Escolar-Reina, Pilar; Montilla-Herrador, Joaquina; Gomez-Arnaldos, Francisco; Oliveira-Sousa, Silvana L

2015-04-01

What are the perceptions of parents of children with physical disabilities about the home exercise programs that physiotherapists prescribe? How do these perceptions affect adherence to home exercise programs? Qualitative study using focus groups and a modified grounded theory approach. Parents of children with physical disabilities who have been prescribed a home exercise program by physiotherapists. Twenty-eight parents participated in the focus groups. Two key themes that related to adherence to home exercise programs in young children with physical disabilities were identified: the characteristics of the home exercise program; and the characteristics of the physiotherapist's teaching style. In the first theme, the participants described their experiences regarding their preference for exercises, which was related to the perceived effects of the exercises, their complexity, and the number of exercises undertaken. These factors determined the amount of time spent performing the exercises, the effect of the exercises on the family's relationships, and any sense of related burden. In the second theme, participants revealed that they adhered better to prescribed exercises when their physiotherapist made an effort to build their confidence in the exercises, helped the parents to incorporate the home exercise program into their daily routine, provided incentives and increased motivation. Parents perceive that their children's adherence to home-based exercises, which are supervised by the parents, is more successful when the physiotherapist's style and the content of the exercise program are positively experienced. These findings reveal which issues should be considered when prescribing home exercise programs to children with physical disabilities. [Lillo-Navarro C, Medina-Mirapeix F, Escolar-Reina P, Montilla-Herrador J, Gomez-Arnaldos F, Oliveira-Sousa SL (2015) Parents of children with physical disabilities perceive that characteristics of home exercise programs and

Accurate reporting of adherence to inhaled therapies in adults with cystic fibrosis: methods to calculate normative adherence

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Hoo ZH

2016-05-01

Full Text Available Zhe Hui Hoo,1,2 Rachael Curley,1,2 Michael J Campbell,1 Stephen J Walters,1 Daniel Hind,3 Martin J Wildman1,2 1School of Health and Related Research (ScHARR, University of Sheffield, 2Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, 3Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK Background: Preventative inhaled treatments in cystic fibrosis will only be effective in maintaining lung health if used appropriately. An accurate adherence index should therefore reflect treatment effectiveness, but the standard method of reporting adherence, that is, as a percentage of the agreed regimen between clinicians and people with cystic fibrosis, does not account for the appropriateness of the treatment regimen. We describe two different indices of inhaled therapy adherence for adults with cystic fibrosis which take into account effectiveness, that is, “simple” and “sophisticated” normative adherence. Methods to calculate normative adherence: Denominator adjustment involves fixing a minimum appropriate value based on the recommended therapy given a person’s characteristics. For simple normative adherence, the denominator is determined by the person’s Pseudomonas status. For sophisticated normative adherence, the denominator is determined by the person’s Pseudomonas status and history of pulmonary exacerbations over the previous year. Numerator adjustment involves capping the daily maximum inhaled therapy use at 100% so that medication overuse does not artificially inflate the adherence level. Three illustrative cases: Case A is an example of inhaled therapy under prescription based on Pseudomonas status resulting in lower simple normative adherence compared to unadjusted adherence. Case B is an example of inhaled therapy under-prescription based on previous exacerbation history resulting in lower sophisticated normative adherence compared to unadjusted adherence and simple normative adherence

Assessment of Salient Beliefs Affecting Mothers' Intention to Adherence to Dietary Diversity in their Children's Complementary Feeding.

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Karimi-Shahanjarini, Akram; Rahmani, Fatemeh; Roshanei, Ghodratollah; Mahdi Hazavehei, Seyyed M

2017-01-01

Providing a variety of foods has been emphasized as one of the most important features of optimal complementary feeding. This study investigated key beliefs that guide mothers' intention to adherence to dietary diversity in their 1-2-year-old children's complementary feeding. This was a cross-sectional study involving 290 mothers (mean age = 27, standard deviation = 5.32) with child 1-2-year-old attending maternal and child health section of health centers in Rasht, Iran. To represent the socioeconomic status of the participants, 6 centers out of 15 were selected from three different socioeconomic areas (low-, middle-, and high-income areas). Mothers completed a questionnaire assessing intention and belief-based items of theory of planned behavior. Correlations and multiple regression analyses were performed. The mean age of mothers was 27 ± 5.33 (27-43 years). Regression analyses revealed that among behavioral beliefs, the perception that adherence to dietary diversity would lead to improve children's growth was the significant predictor of intention (β = 0.13, P = 0.04). Regarding normative beliefs, perceived social pressure from health-care professionals to adherence to dietary diversity significantly predicted intention (β = 0.15, P = 0.01). Among control beliefs, the perception that daily pressures made difficult adherence to dietary diversity was the key determinant (β = 0.19, P = 0.01). Findings of this study represent the important beliefs that can be addressed in development planning aimed at modifying mothers' child complementary feeding practices.

Adherence of pediatric patients to automated peritoneal dialysis.

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Chua, Annabelle N; Warady, Bradley A

2011-05-01

Little information is available on adherence to a home automated peritoneal dialysis (APD) prescription for children with end-stage renal disease. We have therefore retrospectively reviewed HomeChoice PRO Card data from patients Adherence was characterized as occurring ≥ 95%, 90-94%, or treatment adherence and patient age, gender, race and if the patient had received training, respectively, was assessed. Of the 51 patients (57% male), with a mean age at peritoneal dialysis (PD) onset of 11.8 ± 5.3 years, 28 (55%) were adherent for all variables. No difference in mean age or if patients were trained existed between the two groups. Males were more likely to be non-adherent (p = 0.026) as were African Americans (p = 0.048). The majority of patients were adherent to duration (96%) and number of cycles (92%), whereas non-adherence was more common with number of sessions (82%) and dialysate volume (78%). In conclusion, 45% of the pediatric patients in our study cohort exhibited some non-adherence to their prescribed APD regimen, emphasizing the value of closely monitoring the performance of home dialysis in children.

An Algorithm-Based Approach for Behavior and Disease Management in Children.

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Meyer, Beau D; Lee, Jessica Y; Thikkurissy, S; Casamassimo, Paul S; Vann, William F

2018-03-15

Pharmacologic behavior management for dental treatment is an approach to provide invasive yet compassionate care for young children; it can facilitate the treatment of children who otherwise may not cooperate for traditional in-office care. Some recent highly publicized procedural sedation-related tragedies have drawn attention to risks associated with pharmacologic management. However, it remains widely accepted that, by adhering to proper guidelines, procedural sedation can assist in the provision of high-quality dental care while minimizing morbidity and mortality from the procedure. The purpose of this paper was to propose an algorithm for clinicians to consider when selecting a behavior and disease management strategy for early childhood caries. This algorithm will not ensure a positive outcome but can assist clinicians when counseling caregivers about risks, benefits, and alternatives. It also emphasizes and underscores best-safety practices.

Dietary Calcium Intake and Adherence to the Mediterranean Diet in Spanish Children: The ANIVA Study

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Nuria Rubio-López

2017-06-01

Full Text Available The aim of this study was to evaluate the relationship of dietary calcium intake with anthropometric measures, physical activity and adherence to the Mediterranean diet (MedDiet in 1176 Spanish children aged 6–9 years. Data were obtained from “Antropometría y Nutrición Infantil de Valencia” (ANIVA, a cross-sectional study of a representative sample. Dietary calcium intake assessed from three-day food records was compared to recommended daily intakes in Spain. Anthropometric measures (weight and height were measured according to international standards and adherence to the MedDiet was evaluated using the Mediterranean Diet Quality Index (KIDMED test. For the total sample of children, 25.8% had inadequate calcium intake, a significantly higher prevalence in girls (p = 0.006 and inadequate calcium intake was associated with lower height z-score (p = 0.001 for both sexes. In girls, there was an inverse relationship between calcium intake and body mass index (p = 0.001 and waist/hip ratio (p = 0.018. Boys presented a polarization in physical activity, reporting a greater level of both physical and sedentary activity in comparison with girls (p = 0.001. Children with poor adherence to MedDiet, even if they consume two yogurts or cheese (40 g daily, adjusted by gender, age, total energy intake, physical activity and father’s level of education, are at risk of inadequate total calcium intake (odds ratio adjusted [ORa]: 3.36, 95% confidence interval [CI]: 1.13–9.94, p = 0.001. The intake of these dairy products was insufficient to cover calcium intake recommendations in this age group (6–9 years. It is important to prioritize health strategies that promote the MedDiet and to increase calcium intake in this age group.

Mental models of adherence: parallels in perceptions, values, and expectations in adherence to prescribed home exercise programs and other personal regimens.

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Rizzo, Jon; Bell, Alexandra

2018-05-09

A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients

Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

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Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

2017-09-08

Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

Agreement between clinicians' and care givers' assessment of intelligence in Nigerian children with intellectual disability: 'ratio IQ' as a viable option in the absence of standardized 'deviance IQ' tests in sub-Saharan Africa.

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Bakare, Muideen O; Ubochi, Vincent N; Okoroikpa, Ifeoma N; Aguocha, Chinyere M; Ebigbo, Peter O

2009-09-15

There may be need to assess intelligent quotient (IQ) scores in sub-Saharan African children with intellectual disability, either for the purpose of educational needs assessment or research. However, modern intelligence scales developed in the western parts of the world suffer limitation of widespread use because of the influence of socio-cultural variations across the world. This study examined the agreement between IQ scores estimation among Nigerian children with intellectual disability using clinicians' judgment based on International Classification of Diseases, tenth Edition(ICD - 10) criteria for mental retardation and caregivers judgment based on 'ratio IQ' scores calculated from estimated mental age in the context of socio-cultural milieu of the children. It proposed a viable option of IQ score assessment among sub-Saharan African children with intellectual disability, using a ratio of culture-specific estimated mental age and chronological age of the child in the absence of standardized alternatives, borne out of great diversity in socio-cultural context of sub-Saharan Africa. Clinicians and care-givers independently assessed the children in relation to their socio-cultural background. Clinicians assessed the IQ scores of the children based on the ICD - 10 diagnostic criteria for mental retardation. 'Ratio IQ' scores were calculated from the ratio of estimated mental age and chronological age of each child. The IQ scores as assessed by the clinicians were then compared with the 'ratio IQ' scores using correlation statistics. A total of forty-four (44) children with intellectual disability were assessed. There was a significant correlation between clinicians' assessed IQ scores and the 'ratio IQ' scores employing zero order correlation without controlling for the chronological age of the children (r = 0.47, df = 42, p = 0.001). First order correlation controlling for the chronological age of the children showed higher correlation score between clinicians

Pilot study of a smartphone application designed to socially motivate cardiovascular disease patients to improve medication adherence.

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Fujita, Saki; Pitaktong, Isaree; Steller, Graeme Vosit; Dadfar, Victor; Huang, Qinwen; Banerjee, Sindhu; Guo, Richard; Nguyen, Hien Tan; Allen, Robert Harry; Martin, Seth Shay

2018-01-01

Social support received by patients from family and community has been identified as a key factor for success in improving medication adherence in those patients. This pilot study aimed to investigate the usability and feasibility of PillPal, a smartphone application that uses video-chatting as a social motivation medium to encourage medication adherence in cardiovascular disease (CVD) patients. We additionally gathered feedback on the Physician Calendar, an accompanying web platform that allows clinicians to view patient adherence data generated from the app. Thirty patients were recruited from the Johns Hopkins Hospital (JHH) Lipid Clinic (n=14) and Inpatient Cardiology Service (n=16) to pilot test the app. Data were obtained through in-person interviews in which patients tested out the app and answered standardized questions regarding the app's feasibility as a means to enhance social support, as well as its usability measured in terms of ease of use and patient comfort level with the video-chat technology. Cardiologists (n=10) from JHH were interviewed to gain feedback on the Physician Calendar. We recorded 43.4% participants who stated that PillPal would increase their motivation to take their medications; 96.7% stated the app was easy to use; and 70% stated they were comfortable with video-chatting while taking their medications. Patient factors such as current adherence level, disease severity, and personality were more predictive of positive app reviews than the perceived level of social support. Clinicians generally approved of the Physician Calendar, as they would be able to quickly screen for non-adherence and begin conversations with patients to address the root cause of their non-adherence. Based on pilot testing and interviews, using a smartphone app for video-chatting as a social support medium to improve patient medication adherence is feasible and has potential to increase medication adherence depending on certain patient characteristics. The

Clinicians and journalists responding to disasters.

Science.gov (United States)

Newman, Elana; Shapiro, Bruce

2014-02-01

Mass casualty events pose dilemmas for community clinicians, often challenging their existing clinical toolkits. However, few clinicians were trained to be experts in explaining the unfolding events to the community, creating resources, and interacting with journalists. The objective of this article is to explain knowledge, skills, and attitudes that mental health professionals need to consider when working with journalists, especially those covering children affected by disaster. In service of these objectives, this article reviews controversies, evidence, and best practices to facilitate effective collaborations and consultations with journalists. Advice includes information on how to be a good source to journalists. Clinicians can ethically and effectively help journalists tell accurate and compelling stories about the psychological effects of disasters when they understand and respect the aims, culture, and ethics of journalism.

A study of the dietary intake of Cypriot children and adolescents aged 6-18 years and the association of mother's educational status and children's weight status on adherence to nutritional recommendations.

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Tornaritis, Michael J; Philippou, Elena; Hadjigeorgiou, Charalambos; Kourides, Yiannis A; Panayi, Adamos; Savva, Savvas C

2014-01-08

A balanced diet is fundamental for healthy growth and development of children. The aim of this study was to document and evaluate the dietary intake of Cypriot children aged 6-18 years (y) against recommendations, and to determine whether maternal education and children's weight status are associated with adherence to recommendations. The dietary intake of a random sample of 1414 Cypriot children was assessed using a 3-day food diary. Adherence to recommendations was estimated and the association of their mother's education and their own weight status on adherence were explored. A large percentage of children consumed less than the minimum of 45% energy (en) of carbohydrate (18.4%-66.5% in different age groups) and exceeded the recommended intakes of total fat (42.4%-83.8%), saturated fatty acids (90.4%-97.1%) and protein (65.2%-82.7%), while almost all (94.7%-100%) failed to meet the recommended fibre intake. Additionally, a large proportion of children (27.0%-59.0%) consumed >300 mg/day cholesterol and exceeded the upper limit of sodium (47.5%-78.5%). In children aged 9.0-13.9y, there was a high prevalence of inadequacy for magnesium (85.0%-89.9%), in girls aged 14.0-18.9y, of Vitamin A (25.3%), Vitamin B6 (21.0%) and iron (25.3%) and in boys of the same group, of Vitamin A (35.8%). Children whose mother was more educated were more likely to consume >15%en from protein, Odds Ratio (OR) 1.85 (95% CI:1.13-3.03) for mothers with tertiary education and exceed the consumption of 300 mg/day cholesterol (OR 2.13 (95% CI:1.29-3.50) and OR 1.84 (95% CI:1.09-3.09) for mothers with secondary and tertiary education respectively). Children whose mothers were more educated, were less likely to have Vitamin B1 (pchildren were more likely to consume >15%en protein (OR 1.85 (95% CI:1.26-2.71) and have a children consume a low quality diet. Maternal education and children's own weight status are associated with children's adherence to recommendations. Public health policies

Assessment of salient beliefs affecting mothers' intention to adherence to dietary diversity in their children's complementary feeding

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Akram Karimi-Shahanjarini

2017-01-01

Full Text Available Background: Providing a variety of foods has been emphasized as one of the most important features of optimal complementary feeding. This study investigated key beliefs that guide mothers' intention to adherence to dietary diversity in their 1–2-year-old children's complementary feeding. Methods: This was a cross-sectional study involving 290 mothers (mean age = 27, standard deviation = 5.32 with child 1–2-year-old attending maternal and child health section of health centers in Rasht, Iran. To represent the socioeconomic status of the participants, 6 centers out of 15 were selected from three different socioeconomic areas (low-, middle-, and high-income areas. Mothers completed a questionnaire assessing intention and belief-based items of theory of planned behavior. Correlations and multiple regression analyses were performed. Results: The mean age of mothers was 27 ± 5.33 (27–43 years. Regression analyses revealed that among behavioral beliefs, the perception that adherence to dietary diversity would lead to improve children's growth was the significant predictor of intention (β = 0.13,P= 0.04. Regarding normative beliefs, perceived social pressure from health-care professionals to adherence to dietary diversity significantly predicted intention (β = 0.15,P= 0.01. Among control beliefs, the perception that daily pressures made difficult adherence to dietary diversity was the key determinant (β = 0.19,P= 0.01. Conclusions: Findings of this study represent the important beliefs that can be addressed in development planning aimed at modifying mothers' child complementary feeding practices.

Assessment of Salient Beliefs Affecting Mothers’ Intention to Adherence to Dietary Diversity in their Children's Complementary Feeding

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Karimi-Shahanjarini, Akram; Rahmani, Fatemeh; Roshanei, Ghodratollah; Mahdi Hazavehei, Seyyed M.

2017-01-01

Background: Providing a variety of foods has been emphasized as one of the most important features of optimal complementary feeding. This study investigated key beliefs that guide mothers’ intention to adherence to dietary diversity in their 1–2-year-old children's complementary feeding. Methods: This was a cross-sectional study involving 290 mothers (mean age = 27, standard deviation = 5.32) with child 1–2-year-old attending maternal and child health section of health centers in Rasht, Iran. To represent the socioeconomic status of the participants, 6 centers out of 15 were selected from three different socioeconomic areas (low-, middle-, and high-income areas). Mothers completed a questionnaire assessing intention and belief-based items of theory of planned behavior. Correlations and multiple regression analyses were performed. Results: The mean age of mothers was 27 ± 5.33 (27–43 years). Regression analyses revealed that among behavioral beliefs, the perception that adherence to dietary diversity would lead to improve children's growth was the significant predictor of intention (β = 0.13, P = 0.04). Regarding normative beliefs, perceived social pressure from health-care professionals to adherence to dietary diversity significantly predicted intention (β = 0.15, P = 0.01). Among control beliefs, the perception that daily pressures made difficult adherence to dietary diversity was the key determinant (β = 0.19, P = 0.01). Conclusions: Findings of this study represent the important beliefs that can be addressed in development planning aimed at modifying mothers’ child complementary feeding practices. PMID:28479970

Poor Adherence to US Dietary Guidelines for Children and Adolescents in the National Health and Nutrition Examination Survey Population.

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Banfield, Emilyn C; Liu, Yan; Davis, Jennifer S; Chang, Shine; Frazier-Wood, Alexis C

2016-01-01

Poor diet quality in childhood and adolescence is associated with adverse health outcomes throughout life, yet the dietary habits of American children and how they change across childhood and adolescence are unknown. This study sought to describe diet quality among children and adolescents by assessing adherence to the 2010 Dietary Guidelines for Americans (DGA) and to determine whether any differences in adherence occurred across childhood. We employed a cross-sectional design using data from the National Health and Nutrition Examination Survey (NHANES). Of 9,280 children aged 4 to 18 years who participated in NHANES from 2005 to 2010, those with insufficient data on dietary recall (n=852) or who were pregnant or lactating during the time of interview (n=38) were excluded from the final study sample (n=8,390). We measured adherence to the DGA using the Healthy Eating Index 2010 (HEI-2010) and stratified participants into three age groups (4 to 8, 9 to 13, and 14 to 18 years of age). We analyzed each of 12 HEI-2010 components and total HEI-2010 score. The youngest children had the highest overall diet quality due to significantly greater scores for total fruit, whole fruit, dairy, and whole grains. These children also had the highest scores for sodium, refined grains, and empty calories. Total HEI-2010 scores ranged from 43.59 to 52.11 out of 100, much lower than the minimum score of 80 that is thought to indicate a diet associated with good health. Overall, children and adolescents are failing to meet the DGA and may be at an increased risk of chronic diseases throughout life. By analyzing which food groups show differences between age groups, we provide data that can inform the development of dietary interventions to promote specific food groups targeting specific ages and improve diet quality among children and adolescents. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Adherence to Treatment in a Behavioral Intervention Curriculum for Parents of Children with Autism Spectrum Disorder

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Moore, Timothy R.; Symons, Frank J.

2011-01-01

Parents (N = 21) of children with autism spectrum disorders responded to a survey on adherence to skills instruction and problem behavior management strategies they had previously been observed to master in a standardized training curriculum based on the principles of applied behavior analysis. Survey items were guided by existing models of and…

Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context

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Cruz, Maria Letícia Santos; Cardoso, Claudete A. Araújo; Darmont, Mariana Q.; Dickstein, Paulo; Bastos, Francisco I.; Souza, Edvaldo; Andrade, Solange D.; Fabbro, Marcia D’All; Fonseca, Rosana; Monteiro, Simone

2016-01-01

Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors. PMID:27338431

Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context

Directory of Open Access Journals (Sweden)

Maria Letícia Santos Cruz

2016-06-01

Full Text Available Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV. Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.

Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context.

Science.gov (United States)

Cruz, Maria Letícia Santos; Cardoso, Claudete A Araújo; Darmont, Mariana Q; Dickstein, Paulo; Bastos, Francisco I; Souza, Edvaldo; Andrade, Solange D; Fabbro, Marcia D'All; Fonseca, Rosana; Monteiro, Simone

2016-06-21

Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers' role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.

Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by Electronic Monitoring: The Adherence in Migraine (AIM) Study.

Science.gov (United States)

Kroon Van Diest, Ashley M; Ramsey, Rachelle; Aylward, Brandon; Kroner, John W; Sullivan, Stephanie M; Nause, Katie; Allen, Janelle R; Chamberlin, Leigh A; Slater, Shalonda; Hommel, Kevin; LeCates, Susan L; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; Hershey, Andrew D; Powers, Scott W

2016-07-01

The purpose of this investigation was to examine treatment adherence to medication and lifestyle recommendations among pediatric migraine patients using electronic monitoring systems. Nonadherence to medical treatment is a significant public health concern, and can result in poorer treatment outcomes, decreased cost-effectiveness of medical care, and increased morbidity. No studies have systematically examined adherence to medication and lifestyle recommendations in adolescents with migraine outside of a clinical trial. Participants included 56 adolescents ages 11-17 who were presenting for clinical care. All were diagnosed with migraine with or without aura or chronic migraine and had at least 4 headache days per month. Medication adherence was objectively measured using electronic monitoring systems (Medication Event Monitoring Systems technology) and daily, prospective self-report via personal electronic devices. Adherence to lifestyle recommendations of regular exercise, eating, and fluid intake were also assessed using daily self-report on personal electronic devices. Electronic monitoring indicates that adolescents adhere to their medication 75% of the time, which was significantly higher than self-reported rates of medication adherence (64%). Use of electronic monitoring of medication detected rates of adherence that were significantly higher for participants taking once daily medication (85%) versus participants taking twice daily medication (59%). Average reported adherence to lifestyle recommendations of consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended levels of a minimum of 8 cups per day. Participants on average also reported skipping 1 meal per week despite recommendations of consistently eating three meals per day. Results suggest that intervention focused on adherence to preventive treatments (such as medication) and lifestyle recommendations may provide more optimal outcomes for children and adolescents with

Prevalence and correlates of treatment failure among Kenyan children hospitalised with severe community-acquired pneumonia: a prospective study of the clinical effectiveness of WHO pneumonia case management guidelines

Science.gov (United States)

Agweyu, Ambrose; Kibore, Minnie; Digolo, Lina; Kosgei, Caroline; Maina, Virginia; Mugane, Samson; Muma, Sarah; Wachira, John; Waiyego, Mary; Maleche-Obimbo, Elizabeth

2014-01-01

Objective To determine the extent and pattern of treatment failure (TF) among children hospitalised with community-acquired pneumonia at a large tertiary hospital in Kenya. Methods We followed up children aged 2–59 months with WHO-defined severe pneumonia (SP) and very severe pneumonia (VSP) for up to 5 days for TF using two definitions: (i) documentation of pre-defined clinical signs resulting in change of treatment (ii) primary clinician's decision to change treatment with or without documentation of the same pre-defined clinical signs. Results We enrolled 385 children. The risk of TF varied between 1.8% (95% CI 0.4–5.1) and 12.4% (95% CI 7.9–18.4) for SP and 21.4% (95% CI 15.9–27) and 39.3% (95% CI 32.5–46.4) for VSP depending on the definition applied. Higher rates were associated with early changes in therapy by clinician in the absence of an obvious clinical rationale. Non-adherence to treatment guidelines was observed for 70/169 (41.4%) and 67/201 (33.3%) of children with SP and VSP, respectively. Among children with SP, adherence to treatment guidelines was associated with the presence of wheeze on initial assessment (P = 0.02), while clinician non-adherence to guideline-recommended treatments for VSP tended to occur in children with altered consciousness (P grupos en la distribución de las características clínicas de base de los niños con NMS, se observó que no existían diferencias en FT entre aquellos tratados con el régimen recomendado por las guías versus alternativas más costosas de amplio espectro (diferencias de riesgo 0.37 (IC 95% -0.84 a 0.51). Conclusión Antes de revisar las actuales guías de manejo de casos de neumonía, se requieren definiciones estandarizadas de FT y estudios apropiados de la efectividad del tratamiento de regímenes alternativos. PMID:25130866

Child Health Disparities: What Can a Clinician Do?

OpenAIRE

Cheng, Tina L.; Emmanuel, Mickey; Levy, Daniel J.; Jenkins, Renee R.

2015-01-01

Pediatric primary and specialty practice has changed with more to do, more regulation and more family needs. Similarly, the needs of patients have changed with more demographic diversity, family stress and continued health disparities by race, ethnicity and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This paper outlines specific, practical, actionable and evidence-based activities for clinicians t...

Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

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Kyokunzire C

2018-03-01

Full Text Available Catherine Kyokunzire,1 Nicholas Matovu2,3 1Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Community Health, Division of Noncommunicable Diseases, Ministry of Health – Uganda, Kampala, Uganda; 3Global Health Corps Fellowship Program 2017/2018, New York, NY, USA Purpose: The purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda.Research design and methods: A facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs at the 95% confidence interval (CI were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0.Results: The overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78, being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71, being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14 and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27, taking three or less tests of blood glucose per day (APRR: 0

“Doing Our Part” (Taking Responsibility): A Grounded Theory of the Process of Adherence to Oral Chemotherapy in Children and Adolescents with Acute Lymphoblastic Leukemia

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Landier, Wendy; Hughes, Cynthia B.; Calvillo, Evelyn R.; Anderson, Nancy L.R.; Briseño-Toomey, Deborah; Dominguez, Leticia; Martinez, Alex M.; Hanby, Cara; Bhatia, Smita

2011-01-01

Children and adolescents with acute lymphoblastic leukemia (A.L.L.) receive treatment that relies on daily self- or parent/caregiver-administered oral chemotherapy for approximately two years. Despite the fact that pediatric A.L.L. is uniformly fatal without adequate treatment, non-adherence to oral chemotherapy has been observed in up to one-third of patients. Little is known about the reasons for non-adherence in these patients. This study employed Straussian grounded theory methodology to develop and validate a model to explain the process of adherence to oral chemotherapy in children and adolescents with A.L.L. Thirty-eight semi-structured interviews (with 17 patients and 21 parents/caregivers) and four focused group discussions were conducted. Three stages were identified in the process of adherence: (1) Recognizing the Threat, (2) Taking Control, and (3) Managing for the Duration. Doing Our Part was identified as the core theme explaining the process of adherence, and involves the parent (or patient) taking responsibility for assuring that medications are taken as prescribed. Understanding the association between taking oral chemotherapy and control/cure of leukemia (Making the Connection) appeared to mediate adherence behaviors. PMID:21653911

A clinician-administered observation and corresponding caregiver interview capturing DSM-5 sensory reactivity symptoms in children with ASD.

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Siper, Paige M; Kolevzon, Alexander; Wang, A Ting; Buxbaum, Joseph D; Tavassoli, Teresa

2017-06-01

Sensory reactivity is a new criterion for autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, there is no consensus on how to reliably measure sensory reactivity, particularly in minimally verbal individuals. The current study is an initial validation of the Sensory Assessment for Neurodevelopmental Disorders (SAND), a novel clinician-administered observation and corresponding caregiver interview that captures sensory symptoms based on DSM-5 criteria for ASD. Eighty children between the ages of 2 and 12 participated in this study; 44 children with ASD and 36 typically developing (TD) children. Sensory reactivity symptoms were measured using the SAND and the already validated Short Sensory Profile (SSP). Initial psychometric properties of the SAND were examined including reliability, validity, sensitivity and specificity. Children with ASD showed significantly more sensory reactivity symptoms compared to TD children across sensory domains (visual, tactile, and auditory) and within sensory subtypes (hyperreactivity, hyporeactivity and seeking). The SAND showed strong internal consistency, inter-rater reliability and test-retest reliability, high sensitivity (95.5%) and specificity (91.7%), and strong convergent validity with the SSP. The SAND provides a novel method to characterize sensory reactivity symptoms based on DSM-5 criteria for ASD. This is the first known sensory assessment that combines a clinician-administered observation and caregiver interview to optimally capture sensory phenotypes characteristic of individuals with neurodevelopmental disorders. The SAND offers a beneficial new tool for both research and clinical purposes and has the potential to meaningfully enhance gold-standard assessment of ASD. Autism Res 2017, 10: 1133-1140. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Helping military children cope with parental deployment: role of attachment theory and recommendations for mental health clinicians and counselors.

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Miller, Laurence; Miller, Halle B; Bjorklund, David

2010-01-01

Military deployment of a parent carries with it a number of stresses for children, all centering around uncertainty, instability and unpredictability. This article conceptualizes military deployment and relocation stress in the context of attachment theory, and describes the types of adverse outcomes that can occur as the result of impaired attachment. It then presents a set of practical recommendations for mental health clinicians and counselors for helping children and families cope productively and negotiate the developmental hurdles associated with maintaining healthy attachment and family stability in the face of military deployment.

Agreement between clinicians' and care givers' assessment of intelligence in Nigerian children with intellectual disability: 'ratio IQ' as a viable option in the absence of standardized 'deviance IQ' tests in sub-Saharan Africa

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Aguocha Chinyere M

2009-09-01

Full Text Available Abstract Background There may be need to assess intelligent quotient (IQ scores in sub-Saharan African children with intellectual disability, either for the purpose of educational needs assessment or research. However, modern intelligence scales developed in the western parts of the world suffer limitation of widespread use because of the influence of socio-cultural variations across the world. This study examined the agreement between IQ scores estimation among Nigerian children with intellectual disability using clinicians' judgment based on International Classification of Diseases, tenth Edition (ICD - 10 criteria for mental retardation and caregivers judgment based on 'ratio IQ' scores calculated from estimated mental age in the context of socio-cultural milieu of the children. It proposed a viable option of IQ score assessment among sub-Saharan African children with intellectual disability, using a ratio of culture-specific estimated mental age and chronological age of the child in the absence of standardized alternatives, borne out of great diversity in socio-cultural context of sub-Saharan Africa. Methods Clinicians and care-givers independently assessed the children in relation to their socio-cultural background. Clinicians assessed the IQ scores of the children based on the ICD - 10 diagnostic criteria for mental retardation. 'Ratio IQ' scores were calculated from the ratio of estimated mental age and chronological age of each child. The IQ scores as assessed by the clinicians were then compared with the 'ratio IQ' scores using correlation statistics. Results A total of forty-four (44 children with intellectual disability were assessed. There was a significant correlation between clinicians' assessed IQ scores and the 'ratio IQ' scores employing zero order correlation without controlling for the chronological age of the children (r = 0.47, df = 42, p = 0.001. First order correlation controlling for the chronological age of the children

Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity.

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Kunin-Batson, Alicia S; Seburg, Elisabeth M; Crain, A Lauren; Jaka, Meghan M; Langer, Shelby L; Levy, Rona L; Sherwood, Nancy E

2015-01-01

To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence. Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children. A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95). Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall). Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance. Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment). Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Dietary and fluid adherence among haemodialysis patients ...

African Journals Online (AJOL)

comparison with major infectious diseases such as AIDS, tuberculosis ... dietary and fluid adherence is of crucial importance to the quality of life and survival of ... behaviours such as medication adherence among psychiatric ... or nursing sister and introduced to one of the study personnel who .... Children per household. 61.

How is adult patient adherence recorded in orthodontists’ clinical notes? A mixed-method case-note study

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Al Shammary N

2017-10-01

Full Text Available Nawaf Al Shammary,1 Koula Asimakopoulou,1 Fraser McDonald,2 Jonathon T Newton,1 Sasha Scambler1 1Division of Population and Patient Health, 2Craniofacial Development and Stem Cell Biology Department, King’s College London Dental Institute, London, UKBackground: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients’ medical records by orthodontists working in a large National Health Service (NHS London hospital.Materials and methods: A mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87 provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature.Results: The term “adherence” did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were “oral hygiene,” “appointment attendance” and “breakages of appliances.” Qualitative analysis not only confirmed these factors but also showed that 1 the clinical aspects of treatment, 2 clinician–patient interaction factors and 3 patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded.Conclusion: Adherence as a term does not feature in the clinical case notes of clinician-identified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency. Keywords: adherence, adults, orthodontic treatment

Educational intervention to improve adherence to the Mediterranean diet among parents and their children aged 1-2 years. EniM clinical trial.

Science.gov (United States)

Roset-Salla, Margarita; Ramon-Cabot, Joana; Salabarnada-Torras, Jordi; Pera, Guillem; Dalmau, Albert

2016-04-01

The objective of the present study was to evaluate the effectiveness of an educational programme on healthy alimentation, carried out in day-care centres and aimed at the parents of children from 1 to 2 years of age, regarding the acquisition of healthy eating habits among themselves and their children. We performed a multicentre, multidisciplinary, randomized controlled study in a community setting. The EniM study (nutritional intervention study among children from Mataró) was performed in twelve day-care centres in Mataró (Spain). Centres were randomized into a control group (CG) and an intervention group (IG). IG received four or five educational workshops on diet, CG did not have workshops. Children, not exclusively breast-fed, from 1 to 2 years of age, in the participating day-care centres and the persons responsible for their alimentation (mother or father). Thirty-five per cent of the IG did not attend the minimum of three workshops and were excluded. The CG included seventy-four children and seventy-two parents and the IG seventy-five children and sixty-seven parents. Both groups were comparable at baseline. Basal adherence to the Mediterranean diet was 56·4 % in parents (Gerber index) and 7·7 points in children (Kidmed test). At 8 months, Mediterranean diet adherence had improved in the IG by 5·8 points in the Gerber index (P=0·01) and 0·6 points in the Kidmed test (P=0·02) compared with the CG. This educational intervention performed in parents at the key period of incorporation of a 1-2-year-old child to the family table showed significant increases in adherence of the parents to the Mediterranean diet, suggesting future improvement in different indicators of health and an expected influence on the diet of their children.

What makes orphans in Kigali, Rwanda, non-adherent to antiretroviral therapy? Perspectives of their caregivers.

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Kikuchi, Kimiyo; Poudel, Krishna C; Muganda, John; Sato, Tomoko; Mutabazi, Vincent; Muhayimpundu, Ribakare; Majyambere, Adolphe; Nyonsenga, Simon P; Sase, Eriko; Jimba, Masamine

2014-01-01

Every year, approximately 260,000 children are infected with HIV in low- and middle-income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV-positive children. We need to develop a better understanding of the background of children's ART non-adherence because it is not well understood. The purpose of this study is to explore the background related to ART non-adherence, specifically in relation to the orphan status of children in Kigali, Rwanda. We conducted 19 focus group discussions with a total of 121 caregivers of HIV-positive children in Kigali. The primary data for analysis were verbatim transcripts and socio-demographic data. A content analysis was performed for qualitative data analysis and interpretation. The study found several contextual factors that influenced non-adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans. The factors promoting adherence also were unique to each orphan status, such as the positive attitude about disclosing serostatus to the child by double orphans' caregivers, and feelings of guilt about the child's condition among non-orphaned caregivers. Knowledge of orphan status is essential to elucidate the factors influencing ART adherence among HIV-positive children. In this qualitative study, we identified the orphan-related contextual factors that influenced ART adherence. Understanding the social context is important in dealing with the challenges to ART adherence among HIV-positive children.

Randomized Trial of a Children's Book Versus Brochures for Safe Sleep Knowledge and Adherence in a High-Risk Population.

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Hutton, John S; Gupta, Resmi; Gruber, Rachel; Berndsen, Jennifer; DeWitt, Thomas; Ollberding, Nicholas J; Van Ginkel, Judith B; Ammerman, Robert T

Sleep-related infant deaths have plateaued in the past decade, disproportionately affecting low socioeconomic status (SES) families. Printed materials are widely used for anticipatory guidance, yet none for safe sleep has been studied. We tested the efficacy of a specially designed children's book compared to brochures for safe sleep knowledge and adherence, which we hypothesized would be greater due to superior readability and engagement. This randomized controlled trial involved low-SES mothers (n = 282) enrolled in a home visiting program. Home visitors (n = 56) were randomly assigned to perform safe sleep teaching and assessments during 3 visits: third trimester, 1 week old, and 2 months old, exclusively utilizing a specially designed children's book or brochures, and surveys incorporating the American Academy of Pediatrics' safe sleep recommendations. Outcomes were safe sleep knowledge, adherence, and usefulness of materials, controlling for maternal health literacy. Safe sleep knowledge increased across all time points with no overall group difference, though gains for sleep-evocative and general health items varied. Odds of bed sharing were higher and exclusive crib use lower for the brochure group (P book and mothers in the book group reported more book sharing with their baby. While a specially designed children's book and brochures were equally effective conveying aggregate safe sleep knowledge in low-SES mothers, adherence to exclusive crib use and avoiding bed sharing were greater in the book group, attributable to enhanced dialogue, readability and emotional engagement. Children's books are a promising mode of anticipatory guidance, warranting further investigation. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Reasons for non-adherence to obesity treatment in children and adolescents

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Thaïs Florence D. Nogueira

2013-09-01

Full Text Available OBJECTIVE To analyze the reasons for non-adherence to follow-up at a specialized outpatient clinic for obese children and adolescents. METHODS Descriptive study of 41 patients, including information from medical records and phone recorded questionnaires which included two open questions and eight closed ones: reason for abandonment, financial and structural difficulties (distance and transport costs, relationship with professionals, obesity evolution, treatment continuity, knowledge of difficulties and obesity complications. RESULTS Among the interviewees, 29.3% reported that adherence to the program spent too much time and it was difficult to adjust consultations to patientsâ€(tm and parentsâ€(tm schedules. Other reasons were: childrenâ€(tms refusal to follow treatment (29.3%, dissatisfaction with the result (17.0%, treatment in another health service (12.2%, difficulty in schedule return (7.3% and delay in attendance (4.9%. All denied any relationship problems with professionals. Among the respondents, 85.4% said they are still overweight. They reported hurdles to appropriate nutrition and physical activity (financial difficulty, lack of parentsâ€(tm time, physical limitation and insecure neighborhood. Among the 33 respondents that reported difficulties with obesity, 78.8% had emotional disorders such as bullying, anxiety and irritability; 24.2% presented fatigue, 15.1% had difficulty in dressing up and 15.1% referred pain. The knowledge of the following complications prevailed: cardicac (97.6%, aesthetic (90.2%, psychological (90.2%, presence of obesity in adulthood (90.2%, diabetes (85.4% and cancer (31.4%. CONCLUSIONS According to the results, it is possible to create weight control public programs that are easier to access, encouraging appropriate nutrition and physical activities in order to achieve obesity prevention.

The clinician factor: Personality characteristics of clinicians and their impact upon clinical outcomes in the management of children and adolescents with type 1 diabetes.

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Cameron, Fergus J; Russell, Ellyn; McCombe, Julia; O'Connell, Michele A; Skinner, Timothy

2018-06-01

The purpose of this study was to estimate clinician qualities that influence metabolic outcomes in youth with type 1 diabetes. Data were gathered over two 3 month periods in a large tertiary diabetes center (1500 patients, 8 clinicians) from patients with type 1 diabetes who received continuous care from each clinician. Data included sex, age, diabetes duration, insulin regimen, body mass index (BMI), insulin dose and episodes of severe hypoglycemia. Clinician data included target blood glucose levels, target glycated hemoglobin (HbA1c), Diabetes Attitude Scale and Big 5 Personality Inventory Scale. Mean HbA1c per clinician was the primary outcome variable. The 8 clinicians saw a total of 464 patients during the first time period, and 603 in the second time period. Lowest to highest mean HbA1c per clinician varied by 0.7%. There were small but statistically significant differences between clinicians with their patients' age at diagnosis, duration of diabetes, age, gender, treatment type and BMI SD score. After controlling for these differences, the clinician characteristics that were associated with lower mean HbA1c were having no lower limit in target HbA1c and being self-reportedly "less agreeable." The impact of these clinician attitudinal traits was equivalent to the combined effects of patient characteristics and treatment type. There was a significant variation in metabolic outcomes between treating clinicians. After controlling for patient clinical differences, clinician mean HbA1c was associated with lower limit in target HbA1c and being "less agreeable." Clinicians who were more demanding and dogmatic appeared to have better outcomes. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Adherence in children with growth hormone deficiency treated with r-hGH and the easypod™ device.

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Loche, S; Salerno, M; Garofalo, P; Cardinale, G M; Licenziati, M R; Citro, G; Caruso Nicoletti, M; Cappa, M; Longobardi, S; Maghnie, M; Perrone, R

2016-12-01

Poor adherence to recombinant human growth hormone (r-hGH) therapy is associated with reduced growth velocity in children with growth hormone deficiency (GHD). This twelve-month observational study was to assess adherence in r-hGH patients treated with the easypod ™ , an electronic, fully automated injection device designed to track the time, date and dose administered. Ninety-seven prepubertal patients receiving r-hGH therapy were included in the study from ten Italian clinical sites and 88 completed the study. To avoid possible confounding effects, only GHD patients (79/88; 89.7 % of the overall study population) were considered in the final analysis. The primary endpoint-adherence to treatment-was calculated as the proportion of injections correctly administered during the observational period out of the expected total number of injections. The relevant information, tracked by the easypod ™ , was collected at months 6 (V1) and 12 (V2) after baseline (V0). At study termination, adherence data were partially available from 16 patients and fully available from 53 patients. As secondary endpoints, serum IGF-1 levels, fasting serum glucose and insulin levels and key anthropometric characteristics (height, waist circumference and BMI) were also determined. The easypod ™ data showed that 56.7 % of the patients were considered to be fully (≥92 %) adherent to their treatment throughout the period V0-V2. Treatment improved stature, significantly increased IGF-1 and produced a non-significant increase in blood glucose and insulin levels. The injection-recording system and other characteristics of easypod ™ could enhance the ability of physicians to monitor adherence to r-hGH treatment.

International Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates

DEFF Research Database (Denmark)

Diez-Perez, Adolfo; Naylor, K E; Abrahamsen, B

2017-01-01

Adherence to oral bisphosphonates is low. A screening strategy is proposed based on the response of biochemical markers of bone turnover after 3 months of therapy. If no change is observed, the clinician should reassess the adherence to the treatment and also other potential issues with the drug....

A Systematic Review of CPAP Adherence Across Age Groups: Clinical and Empiric Insights for Developing CPAP Adherence Interventions

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Sawyer, A.M.; Gooneratne, N.; Marcus, C.L.; Ofer, D.; Richards, K.C.; Weaver, T.E.

2011-01-01

Continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA) but adherence to the treatment limits its overall effectiveness across all age groups of patients. Factors that influence adherence to CPAP include disease and patient characteristics, treatment titration procedures, technological device factors and side effects, and psychological and social factors. These influential factors have guided the development of interventions to promote CPAP adherence. Various intervention strategies have been described and include educational, technological, psychosocial, pharmacological, and multi-dimensional approaches. Though evidence to date has led to innovative strategies that address adherence in CPAP-treated children, adults, and older adults, significant opportunities exist to develop and test interventions that are clinically applicable, specific to subgroups of patients likely to demonstrate poor adherence, and address the multifactorial nature of CPAP adherence. The translation of CPAP adherence promotion interventions to clinical practice is imperative to improve health and functional outcomes in all persons with CPAP-treated OSA. PMID:21652236

Time perspective and medication adherence among individuals with hypertension or diabetes mellitus.

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Sansbury, Brittany; Dasgupta, Abhijit; Guthrie, Lori; Ward, Michael

2014-04-01

The study determined if time perspective was associated with medication adherence among people with hypertension and diabetes. Using the Health Beliefs Model, we used path analysis to test direct and indirect effects of time perspective and health beliefs on adherence among 178 people who participated in a community-based survey near Washington, D.C. We measured three time perspectives (future, present fatalistic, and present hedonistic) with the Zimbardo Time Perspective Inventory and medication adherence by self-report. The total model demonstrated a good fit (RMSEA=0.17, 90% CI [0.10, 0.28], p=0.003; comparative fit index=0.91). Future time perspective and age showed direct effects on increased medication adherence; an increase by a single unit in future time perspective was associated with a 0.32 standard deviation increase in reported adherence. There were no significant indirect effects of time perspective with reported medication adherence through health beliefs. The findings provide the first evidence that time perspective plays an under-recognized role as a psychological motivator in medication adherence. Patient counseling for medication adherence may be enhanced if clinicians incorporate consideration of the patient's time perspective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Photovoice and Clubfoot: Using a Participatory Research Method to Study Caregiver Adherence to the Ponseti Method in Perú.

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Pletch, Alison; Morcuende, Jose; Barriga, Hersey; Segura, Jose; Salas, Alexandro

2015-01-01

The Ponseti Method of casting and bracing is the gold-standard treatment for congenital clubfoot in young children. Despite its many advantages, outcomes depend heavily on caregiver adherence to the treatment protocol. Our study explored the experience caregivers had with the Ponseti method using a photography-based participatory research method known as Photovoice. Five adult caregivers were recruited from families pursuing clubfoot treatment at the Children's Hospital in Lima, Perú, during June, 2013. Each was provided a digital camera and training and agreed to photograph their experiences caring for a child undergoing Ponseti Method clubfoot treatment. Participants held four to five weekly one-on-one meetings with the researcher to discuss their photos. They also attended a group meeting at the end of the study to view and discuss photos of other participants. Using photos collected at this meeting, participants identified themes that summarized their experiences with treatment and discussed ways to improve delivery of care in order to support caregiver adherence to treatment. These results were presented to clinicians in Lima who use the Ponseti Method. The Photovoice method allowed researchers and participants to study the experience caregivers have with the Ponseti Method, and results can be used to inform the design of patient-based care models.

Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

Zara Shubber

2016-11-01

Full Text Available Maintaining high levels of adherence to antiretroviral therapy (ART is a challenge across settings and populations. Understanding the relative importance of different barriers to adherence will help inform the targeting of different interventions and future research priorities.We searched MEDLINE via PubMed, Embase, Web of Science, and PsychINFO from 01 January 1997 to 31 March 2016 for studies reporting barriers to adherence to ART. We calculated pooled proportions of reported barriers to adherence per age group (adults, adolescents, and children. We included data from 125 studies that provided information about adherence barriers for 17,061 adults, 1,099 children, and 856 adolescents. We assessed differences according to geographical location and level of economic development. The most frequently reported individual barriers included forgetting (adults 41.4%, 95% CI 37.3%-45.4%; adolescents 63.1%, 95% CI 46.3%-80.0%; children/caregivers 29.2%, 95% CI 20.1%-38.4%, being away from home (adults 30.4%, 95% CI 25.5%-35.2%; adolescents 40.7%, 95% CI 25.7%-55.6%; children/caregivers 18.5%, 95% CI 10.3%-26.8%, and a change to daily routine (adults 28.0%, 95% CI 20.9%-35.0%; adolescents 32.4%, 95% CI 0%-75.0%; children/caregivers 26.3%, 95% CI 15.3%-37.4%. Depression was reported as a barrier to adherence by more than 15% of patients across all age categories (adults 15.5%, 95% CI 12.8%-18.3%; adolescents 25.7%, 95% CI 17.7%-33.6%; children 15.1%, 95% CI 3.9%-26.3%, while alcohol/substance misuse was commonly reported by adults (12.9%, 95% CI 9.7%-16.1% and adolescents (28.8%, 95% CI 11.8%-45.8%. Secrecy/stigma was a commonly cited barrier to adherence, reported by more than 10% of adults and children across all regions (adults 13.6%, 95% CI 11.9%-15.3%; children/caregivers 22.3%, 95% CI 10.2%-34.5%. Among adults, feeling sick (15.9%, 95% CI 13.0%-18.8% was a more commonly cited barrier to adherence than feeling well (9.3%, 95% CI 7.2%-11.4%. Health

Personal barriers to antiretroviral therapy adherence: Case studies ...

African Journals Online (AJOL)

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort. ... Journal Home > Vol 13, No 2 (2013) > ... should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

Clinician and Parent Perspectives on Parent and Family Contextual Factors that Impact Community Mental Health Services for Children with Behavior Problems

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Baker-Ericzen, Mary J.; Jenkins, Melissa M.; Brookman-Frazee, Lauren

2010-01-01

The present study employed qualitative methods to examine multiple stakeholder perspectives regarding the role of parent and family contextual factors on community child mental health treatment for children with behavior problems. Findings suggest agreement between clinicians and parents on the number, types and importance of parent and family…

A clinical nurse specialist-led intervention to enhance medication adherence using the plan-do-check-act cycle for continuous self-improvement.

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Russell, Cynthia L

2010-01-01

A clinical nurse specialist-led intervention to improve medication adherence in chronically ill adults using renal transplant recipients as an exemplar population is proposed. Meta-analyses and systematic reviews of chronically ill and transplant patients indicate that patient-specific characteristics not only are poor and inconsistent predictors for medication nonadherence but also are not amenable to intervention. Adherence has not meaningfully improved, despite meta-analyses and systematic narrative reviews of randomized controlled trials (RCTs) dealing with medication nonadherence in acutely and chronically ill persons and RCTs dealing with transplant patients. Interventions with a superior potential to enhance medication adherence must be developed. Use of a clinical nurse specialist-led continuous self-improvement intervention with adult renal transplant recipients is proposed. Continuous self-improvement focuses on improving personal systems thinking and behavior using the plan-do-check-act process. Electronic medication monitoring reports, one of several objective measures of medication adherence, are used by the clinician to provide patient feedback during the check process on medication-taking patterns. Continuous self-improvement as an intervention holds promise in supporting patient self-management and diminishing the blame that clinicians place on patients for medication nonadherence. Using an objective measure of medication adherence such as an electronic monitoring report fosters collaborative patient-clinician discussions of daily medication-taking patterns. Through collaboration, ideas for improving medication taking can be explored. Changes can be followed and evaluated for effectiveness through the continuous self-improvement process. Future studies should include RCTs comparing educational and/or behavioral interventions to improve medication adherence.

Effectiveness of a focused, brief psychoeducation program for parents of ADHD children: improvement of medication adherence and symptoms

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Bai GN

2015-10-01

Full Text Available Guan-nan Bai,1 Yu-feng Wang,2,3 Li Yang,2,3 Wen-yi Niu1 1Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, People’s Republic of China; 2Peking University Sixth Hospital/Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health, Beijing, People’s Republic of China; 3National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, People’s Republic of China Objective: To evaluate the efficacy of a psychoeducation program for parents of children with ADHD in enhancing adherence to pharmacological treatment and improving clinical symptoms. Methods: We developed a psychoeducation program based on the theory of planned behavior (TPB. Eighty-nine children with ADHD were cluster randomly assigned for their families to receive 3 months of well-structured psychoeducation (intervention group, n=44 or only general clinical counseling (control group, n=45. Parents in the intervention group were given an expert lecture (with slides and a parent manual, attended two expert-guided parent group sessions, and were invited to join a professional-guided online community. Measurement of parents’ knowledge about ADHD, components of the TPB model, and child ADHD symptoms were taken before and after intervention. Medication adherence was assessed thoroughly at the end of the first and third months. Satisfaction with the psychoeducation program was assessed only in the intervention group. Two-independent-samples t-test, ANOVA, and chi-square test were employed to compare differences between groups. Results: Compared to the control group, medication adherence in the intervention group was significantly higher after 1 and 3 months (97.7% intervention vs 75.6% control, P=0.002, and 86.4% intervention vs 53.3% control, P=0.001, respectively. Accordingly, the ADHD rating scale scores were lower in the intervention group than the control group after

Monitoring and evaluating the adherence to a complementary food supplement (Ying Yang Bao) among young children in rural Qinghai, China: a mixed methods evaluation study.

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Wu, Qiong; Zhang, Yanfeng; Chang, Suying; Wang, Wei; Helena van Velthoven, Michelle; Han, Huijun; Xing, Min; Chen, Li; Du, Xiaozhen; Scherpbier, Robert W

2017-06-01

Large investments are currently made in community-based complementary food supplement (Ying Yang Bao, YYB) programs to improve nutrition of young children in rural areas in China. However, there is a lack of knowledge about the experience and challenges of implementing YYB programs in China. We aimed to: 1) monitor distribution of YYB; 2) assess children's adherence to and acceptability of YYB; and 3) evaluate community-based strategies to improve the program. This mixed methods evaluation study combined data from surveys and focus groups that took place during a controlled interventional evaluation trial. The trial aimed to evaluate the effectiveness of community-based YYB distribution on improving children's health status in rural areas in China. We conducted five cross-sectional surveys with caregivers of children aged 6-23 months (baseline survey (N = 1804) in August 2012 and four follow-up cross-sectional surveys: 1) N = 494 in January 2013; 2) N = 2187 in August 2013; 3) N = 504 in January 2014; and 4) N = 2186 in August 2014) in one rural county in Qinghai Province. We used a two-stage cluster sampling technique to select mothers with eligible children for each survey. Information was collected from caregivers on household characteristics, YYB consumption and acceptability in the surveys. High adherence in each survey was defined as children who consumed at least four YYB sachets during the previous week. A logistic regression model was developed to obtain odds ratios (OR) with 95% confidence intervals of factors associated with high adherence. Also, we conducted 10 focus groups with73 caregivers and health workers involved in the YYB distribution. Content analysis was used to explore qualitative findings, which were used to gain deeper insight into the quantitative results. Around 90% of caregivers had ever received YYB and more than 80% of children ever took YYB. Caregivers mainly knew about YYB through their village doctors. High

CBT-I Coach: A Description and Clinician Perceptions of a Mobile App for Cognitive Behavioral Therapy for Insomnia.

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Kuhn, Eric; Weiss, Brandon J; Taylor, Katherine L; Hoffman, Julia E; Ramsey, Kelly M; Manber, Rachel; Gehrman, Philip; Crowley, Jill J; Ruzek, Josef I; Trockel, Mickey

2016-04-15

This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176). VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released. Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p CBT-I practices (β = 0.286, p CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes. Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value. © 2016 American Academy of Sleep Medicine.

A systematic review exploring therapist competence, adherence, and therapy outcomes in individual CBT for children and young people.

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Rapley, Hannah A; Loades, Maria E

2018-04-22

Whilst the evidence base for cognitive behavioural therapy (CBT) with children and young people is growing, the mechanisms through which these beneficial effects occur are still unclear. This systematic review seeks to appraise the relationship between therapeutic outcomes in CBT and therapist adherence and competence, within the child and adolescent literature. A systematic review was carried out, with five studies identified as meeting the inclusion criteria. The literature is currently small and inconclusive. Amongst the studies reviewed, there were inconsistent findings, with minimal-to-no effect sizes found between adherence, competence, and outcomes. The current paucity of research in this area means that conclusions are currently limited. The role and impact of adherence and competence on therapeutic outcomes remains unclear within individual CBT in a child population. This is comparable with the current adult literature, where findings also remain inconclusive. Further research avenues are discussed.

Caregiver's Health Locus of Control and Medication Adherence in Sickle Cell Disease.

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Viswanathan, Kusum; Swaminathan, Neeraja; Viswanathan, Ramaswamy; Lakkaraja, Madhavi

2015-03-01

The authors would like to thank Dr. Morisky for giving us permission to use the Morisky Medication Adherence Scale To explore caregivers' Health Locus of Control's relationship to self-reported adherence to penicillin prophylaxis or hydroxyurea in children with sickle cell disease (SCD). A questionnaire-based study was conducted of caregivers of children with SCD who visited a comprehensive sickle cell center in an inner city hospital, who were either on penicillin prophylaxis or hydroxyurea or both. Multidimensional Health Locus of Control Scale (MHLC) and the Morisky Medication Adherence Scale (MMAS-8) questionnaires were used for the study. Caregivers of 43 children (27 on penicillin prophylaxis, 13 on hydroxyurea, and 3 on both) completed the MHLC and the MMAS-8. There was no significant difference in adherence between the penicillin and the hydroxyurea groups. The mean Powerful Others score of caregivers of the hydroxyurea only group (25.5+5.6) was higher than that of the penicillin only group (21.2+6.1, p=0.043). Regression analysis revealed an inverse relationship of Chance Locus of Control to adherence in the entire group (Beta = -0.306, R2=0.093, F[1,40]=4.12, p=0.049). Chance Locus of control may identify caregivers of children with SCD at risk for non-adherence to treatment. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

The right care, every time: improving adherence to evidence-based guidelines.

Science.gov (United States)

Runnacles, Jane; Roueché, Alice; Lachman, Peter

2018-02-01

Guidelines are integral to reducing variation in paediatric care by ensuring that children receive the right care, every time. However, for reasons discussed in this paper, clinicians do not always follow evidence-based guidelines. Strategies to improve guideline usage tend to focus on dissemination and education. These approaches, however, do not address some of the more complex factors that influence whether a guideline is used in clinical practice. In this article, part of the Equipped Quality Improvement series, we outline the literature on barriers to guideline adherence and present practical solutions to address these barriers. Examples outlined include the use of care bundles, integrated care pathways and quality improvement collaboratives. A sophisticated information technology system can improve the use of evidence-based guidelines and provide organisations with valuable data for learning and improvement. Key to success is the support of an organisation that places reliability of service delivery as the way business is done. To do this requires leadership from clinicians in multidisciplinary teams and a system of continual improvement. By learning from successful approaches, we believe that all healthcare organisations can ensure the right care for each patient, every time. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Lyme disease testing in children in an endemic area.

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Al-Sharif, Bashar; Hall, Matthew C

2011-10-01

The purpose of this study was to determine clinician adherence to recommendations regarding diagnostic testing for Lyme disease (LD). The specific aims were to determine the rate of inappropriate test ordering for a diagnosis of erythema migrans and tack of confirmatory test ordering for positive LD screening tests. Using the data warehouse of Marshfield Clinic Research Foundation's Bioinformatics Research Center, cases were identified from 2002 through 2007. A retrospective chart abstraction was performed using Marshfield Clinic's electronic medical record. The study involved children (testing occurred after a clinical diagnosis of erythema migrans was made. Patients with any symptom in addition to erythema migrans were more likely to have testing (odds ratio (OR) = 3.52, 1.75-7.08). A positive LD screening test was not confirmed 24% of the time. Lack of ordering confirmatory testing was not associated with any clinical factors or site of the evaluation. This study found that some clinicians in an LD-endemic area do not follow guidelines for diagnosing children suspected to have Lyme disease.

Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: patients' and clinicians' perspectives after a 12-month randomized controlled trial.

Science.gov (United States)

Noordraven, Ernst L; Schermer, Maartje H N; Blanken, Peter; Mulder, Cornelis L; Wierdsma, André I

2017-08-29

A randomized controlled trial 'Money for Medication'(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. This study assessed the attitudes and ethical considerations of patients and clinicians who participated in this trial. Three mental healthcare institutions in secondary psychiatric care in the Netherlands participated in this study. Patients (n = 169), 18-65 years, diagnosed with schizophrenia, schizoaffective disorder or another psychotic disorder who had been prescribed antipsychotic depot medication, were randomly assigned to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received (intervention group) or treatment as usual alone (control group). Structured questionnaires were administered after the 12-month intervention period. Data were available for 133 patients (69 control and 64 intervention) and for 97 clinicians. Patients (88%) and clinicians (81%) indicated that financial incentives were a good approach to improve medication adherence. Ethical concerns were categorized according to the four-principles approach (autonomy, beneficence, non-maleficence, and justice). Patients and clinicians alike mentioned various advantages of M4M in clinical practice, such as increased medication adherence and improved illness insight; but also disadvantages such as reduced intrinsic motivation, loss of autonomy and feelings of dependence. Overall, patients evaluated financial incentives as an effective method of improving medication adherence and were willing to accept this reward during clinical treatment. Clinicians were also positive about the use of this intervention in daily practice. Ethical concerns are discussed in terms of patient autonomy, beneficence, non-maleficence and justice. We conclude that this intervention is ethically acceptable under certain conditions, and that further research is necessary to clarify issues of benefit

Examining the relation between the therapeutic alliance, treatment adherence, and outcome of cognitive behavioral therapy for children with anxiety disorders

NARCIS (Netherlands)

Liber, Juliette M.; McLeod, Bryce D.; van Widenfelt, Brigit M.; Goedhart, Arnold W.; van der Leeden, Adelinde J. M.; Utens, Elisabeth M. W. J.; Treffers, Philip D. A.

2010-01-01

Little is known about the contribution of technical and relational factors to child outcomes in cognitive behavioral therapy (CBT) for children with anxiety disorders. This study investigated the association between treatment adherence, the child-therapist alliance, and child clinical outcomes in

"Trying, But Failing" - The Role of Inhaler Technique and Mode of Delivery in Respiratory Medication Adherence.

Science.gov (United States)

Braido, Fulvio; Chrystyn, Henry; Baiardini, Ilaria; Bosnic-Anticevich, Sinthia; van der Molen, Thys; Dandurand, Ronald J; Chisholm, Alison; Carter, Victoria; Price, David

2016-01-01

Inhaled therapies are the backbone of asthma and chronic obstructive pulmonary disease management, helping to target therapy at the airways. Adherence to prescribed treatment is necessary to ensure achievement of the clinician's desired therapeutic effect. In the case of inhaled therapies, this requires patients' acceptance of their need for inhaled therapy together with successful mastery of the inhaler technique specific to their device(s). This article reviews a number of challenges and barriers that inhaled mode of delivery can pose to optimum adherence-to therapy initiation and, thereafter, to successful implementation and persistence. The potential effects on adherence of different categories of devices, their use in multiplicity, and the mixing of device categories are discussed. Common inhaler errors identified by the international Implementing Helping Asthma in Real People (iHARP) study are summarized, and adherence intervention opportunities for health care professionals are offered. Better knowledge of common errors can help practicing clinicians identify their occurrence among patients and prompt remedial actions, such as tailored education, inhaler technique retraining, and/or shared decision making with patients regarding suitable alternatives. Optimizing existing therapy delivery, or switching to a suitable alternative, can help avoid unnecessary escalation of treatment and health care resources. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Adherence to inhaled corticosteroids in children with asthma and their parents

NARCIS (Netherlands)

Dellen, Q.M. van; Stronks, K.; Bindels, P.J.E.; Öry, F.G.; Aalderen, W.M.C. van

2006-01-01

Poor adherence to inhaled corticosteroids (ICSs) may contribute to the recent rise in asthma morbidity. In general, appropriate adherence to ICSs is a complex process that is influenced by various determinants. The purpose of this study was to identify factors that were associated with adherence to

Associations between patients' risk attitude and their adherence to statin treatment - a population based questionnaire and register study

DEFF Research Database (Denmark)

Barfoed, Benedicte Marie Lind; Paulsen, Maja Skov; Christensen, Palle Mark

2016-01-01

the risk-averse patients, OR 0.80 (95 %-CI 0.68-0.95) and OR 0.83 (95 %-CI 0.71-0.98), respectively. No significant association was found between adherence and financial risk attitude. Further, patients in the youngest age group and patients with no CVD were less adherent to statin treatment. CONCLUSION......: We find some indication that risk attitude is associated with adherence to statin treatment, and that risk-neutral and risk-seeking patients may have poorer adherence than risk-averse patients. This is important for clinicians to consider when discussing optimal treatment decisions...... on the association between risk attitude and adherence. The aim of the present study was to estimate associations between patients' adherence to statin treatment and different dimensions of risk attitude, and to identify subgroups of patients with poor adherence. METHODS: Population-based questionnaire and register...

Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

Directory of Open Access Journals (Sweden)

Sun Lee

2017-09-01

Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy.

Science.gov (United States)

Levita, Liat; Salas Duhne, Paulina Gonzalez; Girling, Carla; Waller, Glenn

2016-02-01

Psychological therapists commonly fail to adhere to treatment protocols in everyday clinical practice. In part, this pattern of drift is attributable to anxious therapists being less likely to undertake some elements of evidence-based therapies - particularly the exposure-based elements. This study considers what facets of anxiety (cognitive, behavioral, physiological) are related to junior clinicians' reported use of cognitive-behavioral therapy techniques. Thirty-two clinicians (mean age = 28.9 years; mean length of CBT experience = 1.5 years; 23 female, nine male) who offered CBT were assessed for their cognitive, behavioral and physiological characteristics (Intolerance of Uncertainty scale; risk taking; skin conductance response and heart rate variability). While the three different facets of anxiety were relatively poorly associated with each other, as is usual in this literature, each facet was linked differently to the reported delivery of CBT techniques (P behavioral or cognitive methods. Of the three facets of anxiety, only physiological reactivity showed an association with the clinicians' temporal characteristics, with more experienced therapists being more likely to have greater skin conductance responses to positive and negative outcomes. These findings suggest that clinicians who are more anxious are less likely to deliver the full evidence-based form of CBT and to focus instead on less challenging elements of the therapy. Potential ways of overcoming this limitation are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps

DEFF Research Database (Denmark)

Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe

2015-01-01

BACKGROUND: Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether...... or not app contents adhere to current medical evidence. OBJECTIVE: To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. METHODS: We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE......), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. RESULTS: Based on inclusion criteria, 52 studies were included...

Adherence to oral rehydration therapy among in-patient children aged 1-59 months with some or no dehydration.

Science.gov (United States)

Migowa, A N; Gatinu, B; Nduati, R W

2010-04-01

To determine adherence to oral rehydration solution (ORS) among in-patients aged 1-59 months suffering from gastroenteritis and having some dehydration (SD) or no dehydration (ND) in two rural hospitals in Kenya. Children aged 1-59 months suffering from acute gastroenteritis with (SD) or (ND) were enrolled into the study, examined and medical records reviewed. On the second and third day of follow up, children were re-examined to ascertain hydration status and care-takers interviewed. Ninety-nine children were enrolled. Forty-five (75%) of the 60 children with SD received a correct prescription for ORS but only 12 (20%) received the correct amount. Among the 39 children with ND, 23 (59%) received a correct prescription for ORS, however only 16 (41%) received the correct amount. On the 3rd day, 9 (15%) of the 60 children with SD at baseline and 2 (5%) of the 39 with ND were classified as having SD. Four in five children with SD and 6 in 10 children with ND fail to receive the correct amounts of ORS.

Factors influencing rural and urban emergency clinicians' participation in an online knowledge exchange intervention.

Science.gov (United States)

Curran, Janet A; Murphy, Andrea L; Sinclair, Douglas; McGrath, Patrick

2013-01-01

Rural emergency departments (EDs) generally have limited access to continuing education and are typically staffed by clinicians without pediatric emergency specialty training. Emergency care of children is complex and the majority of children receive emergency care in non-pediatric tertiary care centers. In recent decades, there has been a call to action to improve quality and safety in the emergency care of children. Of the one million ED visits by children in Ontario in 2005-2006, one in three visited more than once in a year and one in 15 returned to the ED within 72 hours of the index visit. This study explored factors influencing rural and urban ED clinicians' participation in a Web-based knowledge exchange intervention that focused on best practice knowledge about pediatric emergency care. The following questions guided the study: (i) What are the individual, context of practice or knowledge factors which impact a clinician's decision to participate in a Web-based knowledge exchange intervention?; (ii) What are clinicians' perceptions of organizational expectations regarding knowledge and information sources to be used in practice?; and (iii) What are the preferred knowledge sources of rural and urban emergency clinicians? A Web-based knowledge exchange intervention, the Pediatric Emergency Care Web Based Knowledge Exchange Project, for rural and urban ED clinicians was developed. The website contained 12 pediatric emergency practice learning modules with linked asynchronous discussion forums. The topics for the modules were determined through a needs assessment and the module content was developed by known experts in the field. A follow-up survey was sent to a convenience sample of 187 clinicians from nine rural and two urban Canadian EDs participating in the pediatric emergency Web-based knowledge exchange intervention study. The survey response rate was 56% (105/187). Participation in the knowledge exchange intervention was related to individual

Medication adherence as a learning process: insights from cognitive psychology.

Science.gov (United States)

Rottman, Benjamin Margolin; Marcum, Zachary A; Thorpe, Carolyn T; Gellad, Walid F

2017-03-01

Non-adherence to medications is one of the largest contributors to sub-optimal health outcomes. Many theories of adherence include a 'value-expectancy' component in which a patient decides to take a medication partly based on expectations about whether it is effective, necessary, and tolerable. We propose reconceptualising this common theme as a kind of 'causal learning' - the patient learns whether a medication is effective, necessary, and tolerable, from experience with the medication. We apply cognitive psychology theories of how people learn cause-effect relations to elaborate this causal-learning challenge. First, expectations and impressions about a medication and beliefs about how a medication works, such as delay of onset, can shape a patient's perceived experience with the medication. Second, beliefs about medications propagate both 'top-down' and 'bottom-up', from experiences with specific medications to general beliefs about medications and vice versa. Third, non-adherence can interfere with learning about a medication, because beliefs, adherence, and experience with a medication are connected in a cyclic learning problem. We propose that by conceptualising non-adherence as a causal-learning process, clinicians can more effectively address a patient's misconceptions and biases, helping the patient develop more accurate impressions of the medication.

Examining the Relation between the Therapeutic Alliance, Treatment Adherence, and Outcome of Cognitive Behavioral Therapy for Children with Anxiety Disorders

Science.gov (United States)

Liber, Juliette M.; McLeod, Bryce D.; Van Widenfelt, Brigit M.; Goedhart, Arnold W.; van der Leeden, Adelinde J. M.; Utens, Elisabeth M. W. J.; Treffers, Philip D. A.

2010-01-01

Little is known about the contribution of technical and relational factors to child outcomes in cognitive behavioral therapy (CBT) for children with anxiety disorders. This study investigated the association between treatment adherence, the child-therapist alliance, and child clinical outcomes in manual-guided individual- and group-based CBT for…

Non-adherence to prescribed home rehabilitation exercises for musculoskeletal injuries: the role of the patient-practitioner relationship.

Science.gov (United States)

Wright, Bradley James; Galtieri, Nicholas Justin; Fell, Michelle

2014-02-01

To identify which factors best explain non-adherence to home rehabilitation exercises (HRE) for patients with musculoskeletal injuries. Cross-sectional study. Participants (n = 87) aged 17-91 years completed questionnaires measuring demographic and injury-related information, self-efficacy, personality, health locus of control, patient-practitioner relationship, optimism, health value and adherence to HRE. In addition, each participant's attending physiotherapist assessed the participant's adherence and effort during the appointment. A hierarchical regression with 3 steps (step 1: disposition; step 2: cognitive factors; step 3: patient-practitioner relationship) and adherence to HRE as the dependent variable was conducted. The factors in step 3 were the most significant and explained 16% (p HRE. In addition, a high score for patient neuroticism was found to correlate with poor adherence to HRE. These preliminary results suggest that the patient-practitioner relationship is the best predictor of adherence to HRE, and that improving patient perception of the clinician's productivity, communication of information and trust during consultations may improve adherence to HRE.

Effect of medication-related factors on adherence in people with schizophrenia: a European multi-centre study

NARCIS (Netherlands)

Meier, Johanna; Becker, Thomas; Patel, Anita; Robson, Debbie; Schene, Aart; Kikkert, Martijn; Barbui, Corrado; Burti, Lorenzo; Puschner, Bernd

2010-01-01

To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment. The sample comprised 409 outpatients (ICD-10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands; Verona,

Does pre-hospital telephone communication with a clinician result in more appropriate medication administration by parents during childhood asthma exacerbations?

Science.gov (United States)

Garro, A C; Fearon, D; Koinis-Mitchell, D; McQuaid, E L

2009-11-01

The National Heart, Lung and Blood Institute asthma guidelines recommend that parents communicate with a clinician during childhood asthma exacerbations when symptoms worsen or do not improve with initial therapy. This study tested the hypothesis that communication by parents with a clinician before an Emergency Department visit was associated with more appropriate medication administration for children with asthma exacerbations. This was a retrospective cohort study using data gathered from parents of children presenting with an asthma exacerbation to the emergency department. The communicating cohort included parents who communicated by telephone with a clinician during the exacerbation and the non-communicating cohort included parents who did not. Multivariate logistic regression models were used to test three hypotheses; communication with a clinician is associated with (1) administration of short-acting beta-agonists (SABAs), (2) increased dosing frequency of SABAs, and (3) administration of an oral corticosteroid. A total of 199 subjects were enrolled, with 104 (52.3%) in the communicating and 95 (47.7%) in the non-communicating cohort. There was an association between communication and provider practice type, with children who received routine care from a private practice provider more likely to communicate with the clinician than children in hospital-based clinics or community health centers (Adjusted OR 1.9, 95% CI 1.0-3.7). Impoverished children and children insured by Medicaid were less likely to communicate with a clinician (controlling for provider type). Parents who communicated with a clinician were more likely to administer a SABA (adjusted OR 3.6, 95% CI 1.3-9.4) and an oral corticosteroid (adjusted OR 3.3, 95% CI 1.3-8.4) but were not more likely to administer a SABA with increased dosing frequency (adjusted OR 0.9, 95% CI 0.5-1.6). Parents of children with asthma exacerbations who communicated with clinicians were more likely to administer SABAs

Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD

DEFF Research Database (Denmark)

Mäkelä, Mika J; Backer, Vibeke; Hedegaard, Morten

2013-01-01

Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age...... and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation......, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD...

Suboptimal treatment adherence in bipolar disorder: impact on clinical outcomes and functioning

Directory of Open Access Journals (Sweden)

Montes JM

2013-01-01

Full Text Available Jose Manuel Montes1, Jorge Maurino2, Consuelo de Dios3, Esteban Medina21Department of Psychiatry, Hospital Universitario del Sureste, 2AstraZeneca Medical Department, 3Department of Psychiatry, Hospital Universitario La Paz, Madrid, SpainBackground: The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes.Methods: A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication.Results: Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively.Conclusion: A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions.Keywords: bipolar disorder, treatment adherence, functioning, polarity, subsyndromal symptoms

At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study.

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Kivelä, Laura; Kaukinen, Katri; Huhtala, Heini; Lähdeaho, Marja-Leena; Mäki, Markku; Kurppa, Kalle

2017-04-01

To assess whether children at risk for celiac disease should be screened systematically by comparing their baseline and follow-up characteristics to patients detected because of clinical suspicion. Five hundred four children with celiac disease were divided into screen-detected (n = 145) and clinically detected cohorts (n = 359). The groups were compared for clinical, serologic, and histologic characteristics and laboratory values. Follow-up data regarding adherence and response to gluten-free diet were compared. Subgroup analyses were made between asymptomatic and symptomatic screen-detected patients. Of screen-detected patients, 51.8% had symptoms at diagnosis, although these were milder than in clinically detected children (P celiac disease had symptoms unrecognized at diagnosis. The severity of histologic damage, antibody levels, dietary adherence, and response to treatment in screen-detected cases is comparable with those detected on a clinical basis. The results support active screening for celiac disease among at-risk children. Copyright © 2017 Elsevier Inc. All rights reserved.

[Mothers' adherence to "maternal love" influences emotional expression toward children: relation to maternal occupational status and satisfaction in the workplace].

Science.gov (United States)

Egami, Sonoko

2007-06-01

This study examined the impact of mothers' adherence to "maternal love" on maternal emotional expression toward their children. It was postulated that adherence to "maternal love" (defined as the tendency to accept and obey blindly the traditional maternal role and sociocultural belief in "desirable mothers") would have both positive and negative effects on maternal emotional expression, depending on the mothers' occupational status and satisfaction in workplace. The results showed an interaction between mothers' adherence to "maternal love" and the mothers' satisfaction in the workplace, which affected their expression of emotion. When satisfaction in the workplace was rated in the middle, it was positively associated with positive emotional expression. When satisfaction in the workplace was rated as high, it was both positively and negatively associated with positive emotional expression for full-time workers. Moreover, when satisfaction in the workplace was rated as in the middle, it was negatively associated with negative emotional expression, and when satisfaction in the workplace was rated as low or high, it was positively associated with negative emotional expression for all workers. These findings confirmed that mothers' adherence to "maternal love" is "the double-edged sword".

Improving Adherence to Web-Based and Mobile Technologies for People With Psychosis: Systematic Review of New Potential Predictors of Adherence.

Science.gov (United States)

Killikelly, Clare; He, Zhimin; Reeder, Clare; Wykes, Til

2017-07-20

Despite the boom in new technologically based interventions for people with psychosis, recent studies suggest medium to low rates of adherence to these types of interventions. The benefits will be limited if only a minority of service users adhere and engage; if specific predictors of adherence can be identified then technologies can be adapted to increase the service user benefits. The study aimed to present a systematic review of rates of adherence, dropout, and approaches to analyzing adherence to newly developed mobile and Web-based interventions for people with psychosis. Specific predictors of adherence were also explored. Using keywords (Internet or online or Web-based or website or mobile) AND (bipolar disorder or manic depression or manic depressive illness or manic-depressive psychosis or psychosis or schizophr* or psychotic), the following databases were searched: OVID including MedLine, EMBASE and PsychInfo, Pubmed and Web of Science. The objectives and inclusion criteria for suitable studies were defined following PICOS (population: people with psychosis; intervention: mobile or Internet-based technology; comparison group: no comparison group specified; outcomes: measures of adherence; study design: randomized controlled trials (RCT), feasibility studies, and observational studies) criteria. In addition to measurement and analysis of adherence, two theoretically proposed predictors of adherence were examined: (1) level of support from a clinician or researcher throughout the study, and (2) level of service user involvement in the app or intervention development. We provide a narrative synthesis of the findings and followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for reporting systematic reviews. Of the 20 studies that reported a measure of adherence and a rate of dropout, 5 of these conducted statistical analyses to determine predictors of dropout, 6 analyzed the effects of specific adherence

Predictors of Symptomatic Change and Adherence in Internet-Based Cognitive Behaviour Therapy for Social Anxiety Disorder in Routine Psychiatric Care.

Directory of Open Access Journals (Sweden)

Samir El Alaoui

Full Text Available A central goal of health care is to improve patient outcomes. Although several studies have demonstrated the effectiveness of therapist guided internet-based cognitive behaviour therapy (ICBT for social anxiety disorder (SAD, a significant proportion of patients do not respond to treatment. Consequently, the aim of this study was to identify individual characteristics and treatment program related factors that could help clinicians predict treatment outcomes and adherence for individuals with SAD.The sample comprised longitudinal data collected during a 4-year period of adult individuals (N = 764 treated for SAD at a public service psychiatric clinic. Weekly self-rated Liebowitz Social Anxiety Scale (LSAS-SR scores were provided. Rates of symptomatic change during treatment and adherence levels were analysed using multilevel modelling. The following domains of prognostic variables were examined: (a socio-demographic variables; (b clinical characteristics; (c family history of mental illness; and (d treatment-related factors.Higher treatment credibility and adherence predicted a faster rate of improvement during treatment, whereas higher overall functioning level evidenced a slower rate of improvement. Treatment credibility was the strongest predictor of greater adherence. Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD-like symptoms, male gender, and family history of minor depression predicted lower adherence. Also, the amount of therapist time spent per treatment module was negatively associated with adherence.Results from a large clinical sample indicate that the credibility of ICBT is the strongest prognostic factor explaining individual differences in both adherence level and symptomatic improvement. Early screening of ADHD-like symptoms may help clinicians identify patients who might need extra support or an adjusted treatment. Therapist

The relationship between maternal fear of hypoglycaemia and adherence in children with type-1 diabetes.

Science.gov (United States)

Freckleton, Evril; Sharpe, Louise; Mullan, Barbara

2014-01-01

Regular blood glucose monitoring is important for children with type-1 diabetes; however, the relationship between maternal fear of hypoglycaemia and glycaemic control is not well understood. The relationship between maternal beliefs about diabetes, concerns about glycaemic control and adherence to recommended blood glucose levels in young children with type-1 diabetes were examined in this study. Seventy-one mothers with children under 13 were recruited, and a prospective design was used. Demographics, maternal self-reported hypoglycaemic fear and illness perceptions were measured at baseline. Self-report daily blood sugar levels were recorded over 1 week, and glycosylated haemoglobin (HbA1c) blood glucose levels were collected at baseline and 3 months later. High maternal fears of hypoglycaemia were predictive of suboptimal daily glycaemic control (elevated blood glucose levels), irrespective of illness duration or age at diagnosis. The results suggest that mothers who worry most about hypoglycaemia compensate by maintaining their child's blood glucose levels above recommended levels. Elevated blood glucose levels have important consequences for long-term health, and further research could explore ways to target maternal fear of hypoglycaemia.

The clinical impact of the radiology report in wheezing and nonwheezing febrile children: a survey of clinicians

International Nuclear Information System (INIS)

Spottswood, Stephanie E.; Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H.; Liaw, Kevin; Moore, Paul E.; Patterson, Barron; Chen, Heidi

2009-01-01

The chest radiograph is commonly used in the diagnosis and management of patients presenting with respiratory illness. The language used to describe the findings is important to ensure appropriate communication with the referring clinician and thereby optimize patient management. In this study we attempted to determine how clinicians interpret specific terms commonly used in a chest radiograph report, and to assess how these terms impact the management of children with respiratory symptoms. An online survey was distributed to 562 pediatric practitioners asking their interpretation of the terms ''peripheral airway disease (PAD),'' ''focal airspace consolidation,'' and ''focal infiltrate'' in a febrile child with or without wheezing. There were 112 respondents. Most practitioners defined the term ''PAD'' as viral pneumonia (61.5%) or asthma (56.9%), ''consolidation'' as atelectasis (83%) followed by pneumonia (69.6%), and ''infiltrate'' as pneumonia (100%), followed by atelectasis (22.3%). Practitioners were more likely to treat a nonwheezing child with antibiotics if the report stated ''focal airspace consolidation'' (80%) or ''focal infiltrate'' (100%; P=0.001). Some radiologic descriptors may lead to diverse and sometimes unintended diagnostic conclusions. Our findings support continued effort to structure and standardize the radiology report and our descriptive terminology. (orig.)

Adherence to vitamin supplementation following adolescent bariatric surgery.

Science.gov (United States)

Modi, Avani C; Zeller, Meg H; Xanthakos, Stavra A; Jenkins, Todd M; Inge, Thomas H

2013-03-01

Adolescents with extreme obesity, who have undergone bariatric surgery, must adhere to many lifestyle and nutritional recommendations, including multivitamin therapy. Little is known about multivitamin adherence following adolescent bariatric surgery. The present study aims to document self-reported and electronically-monitored adherence to multivitamins, determine convergence between self-report and electronic monitoring adherence for multivitamins, and identify barriers to multivitamin adherence for adolescents who have undergone bariatric surgery. The study used a prospective, longitudinal observational design to assess subjective (self-reported) and objective (electronic monitors) multivitamin adherence in a cohort of 41 adolescents (Mean age = 17.1 ± 1.5; range = 13-19) who have undergone bariatric surgery at Cincinnati Children's Hospital Medical Center. Mean adherence as derived from electronic monitoring for the entire 6-month study period was 29.8% ± 23.9. Self-reported adherence was significantly higher than electronically monitored adherence across both the 1 and 6-month assessment points (z = 4.5, P bariatric surgery, high rates of nonadherence to multivitamin therapy were observed in adolescents who had undergone bariatric surgery with forgetting and difficulty swallowing pills as reported barriers to adherence. These high rates of nonadherence to multivitamin therapy should be considered when devising treatment and family education pathways for adolescents considering weight loss surgery. Copyright © 2012 The Obesity Society.

Ethical implications of digital communication for the patient-clinician relationship: analysis of interviews with clinicians and young adults with long term conditions (the LYNC study).

Science.gov (United States)

Ignatowicz, Agnieszka; Slowther, Anne-Marie; Elder, Patrick; Bryce, Carol; Hamilton, Kathryn; Huxley, Caroline; Forjaz, Vera; Sturt, Jackie; Griffiths, Frances

2018-02-23

digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to.

Managing challenging behaviour in preschool children post-traumatic brain injury with online clinician support: protocol for a pilot study.

Science.gov (United States)

Taylor, Kaitlyn; Catroppa, Cathy; Godfrey, Celia; McKinlay, Audrey; Ponsford, Jennie; Matthews, Jan; Anderson, Vicki

2017-01-01

Traumatic brain injury (TBI) in children is associated with a range of poor long-term outcomes, including behavioural disturbances. Parents can experience high levels of stress and injury-related burden, and evidence suggests that distressed parents are less likely to adopt positive parenting styles to manage their child's behaviour. The 'Signposts for Building Better Behaviour' program is a parenting programme that was originally developed to assist parents of children with an intellectual disability in managing their child's behaviour. More recently, it has been adapted to include a TBI module, to assist parents in managing post-TBI behaviour. However, geographical and financial barriers remain, preventing many parents from accessing the programme in the standard face-to-face modality. This project aims to investigate the feasibility and acceptability of the programme when delivered with clinician support via videoconferencing. The sample for this feasibility study will be recruited from the Royal Children's Hospital, Melbourne, and the Victorian Paediatric Rehabilitation Service. Participants will be the parents of a child who sustained a TBI between the ages of 2.0 and 6.11, within the previous 2 years. The parents of 15 children will complete the programme, with clinician support via videoconferencing, while the parents of a further 15 children will form a treatment as usual wait-list control group. Parents complete questionnaires assessing their child's behaviour, as well as assessing their own mental health, sense of parenting competency, disciplinary style, and family functioning. These will be completed upon enrolment in the study regarding their child's pre-injury behaviour and then again pre-intervention, immediately post-intervention, and 4 months post-intervention. Parents who complete the intervention will also complete questionnaires assessing their satisfaction with the programme and its delivery. Information will be collected on the feasibility

Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson's disease

NARCIS (Netherlands)

Lakshminarayana, R.; Wang, D.; Burn, D.; Chaudhuri, K.R.; Galtrey, C.; Guzman, N.V.; Hellman, B.; Ben, J.; Pal, S.; Stamford, J.; Steiger, M.; Stott, R.W.; Teo, J.; Barker, R.A.; Wang, E.; Bloem, B.R.; Eijk, M. van; Rochester, L.; Williams, A.

2017-01-01

The progressive nature of Parkinson's disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with Parkinson's disease patients, making it difficult to

Clinician or Witness? The Intervener's Relationship with Traumatized Children

Science.gov (United States)

Steele, William

2008-01-01

To heal the hurt child, one begins not as a clinician but as a person trying to witness how the child experiences trauma. This requires more than just talking since the child's terrifying memories are stored in the brain's senses and visual imagery, not in rational thoughts and words. The goal is to change these frightening sensory experiences…

Predicting and influencing voice therapy adherence using social-cognitive factors and mobile video.

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van Leer, Eva; Connor, Nadine P

2015-05-01

Patient adherence to voice therapy is an established challenge. The purpose of this study was (a) to examine whether adherence to treatment could be predicted from three social-cognitive factors measured at treatment onset: self-efficacy, goal commitment, and the therapeutic alliance, and (b) to test whether the provision of clinician, self-, and peer model mobile treatment videos on MP4 players would influence the same triad of social cognitive factors and the adherence behavior of patients. Forty adults with adducted hyperfunction with and without benign lesions were prospectively randomized to either 4 sessions of voice therapy enhanced by MP4 support or without MP4 support. Adherence between sessions was assessed through self-report. Social cognitive factors and voice outcomes were assessed at the beginning and end of therapy. Utility of MP4 support was assessed via interviews. Self-efficacy and the therapeutic alliance predicted a significant amount of adherence variance. MP4 support significantly increased generalization, self-efficacy for generalization, and the therapeutic alliance. An interaction effect demonstrated that MP4 support was particularly effective for patients who started therapy with poor self-efficacy for generalization. Adherence may be predicted and influenced via social-cognitive means. Mobile technology can extend therapy to extraclinical settings.

Effects of a communication course for clinicians on parents' perception of care

DEFF Research Database (Denmark)

Ammentorp, Jette; Sabroe, Svend; Kofoed, Poul-Erik

2009-01-01

. The intervention group completed a 5-day communication course, whereas the control group had no intervention. The intervention was evaluated using questionnaires measuring parents' perception of the communication and their satisfaction. The questionnaires were filled out by parents to children consulting....... There were no significant differences between the satisfaction of parents visiting clinicians from the intervention group and those visiting clinicians from the control group; however, the proportion of parents who had a positive perception of the communication was up to 9.8% higher in the intervention group...... compared with the control group. For example: 'the clinician told my child what he/she could do in order to feel better'. Discussion: Although no statistically significant differences were found, the study indicates that parents who had visited a clinician from the intervention group have experienced...

In patients with severe uncontrolled asthma, does knowledge of adherence and inhaler technique using electronic monitoring improve clinical decision making? A protocol for a randomised controlled trial.

LENUS (Irish Health Repository)

Mokoka, Matshediso C

2017-06-15

Many patients with asthma remain poorly controlled despite the use of inhaled corticosteroids and long-acting beta agonists. Poor control may arise from inadequate adherence, incorrect inhaler technique or because the condition is refractory. Without having an objective assessment of adherence, clinicians may inadvertently add extra medication instead of addressing adherence. This study aims to assess if incorporating objectively recorded adherence from the Inhaler Compliance Assessment (INCA) device and lung function into clinical decision making provides more cost-effective prescribing and improves outcomes.

In-depth analysis of patient-clinician cell phone communication during the WelTel Kenya1 antiretroviral adherence trial.

Directory of Open Access Journals (Sweden)

Mia L van der Kop

Full Text Available The WelTel Kenya1 trial demonstrated that text message support improved adherence to antiretroviral therapy (ART and suppression of HIV-1 RNA load. The intervention involved sending weekly messages to patients inquiring how they were doing; participants were required to respond either that they were well or that there was a problem.1 Describe problems participants identified through mobile phone support and reasons why participants did not respond to the messages; 2 investigate factors associated with indicating a problem and not responding; and 3 examine participant perceptions of the intervention.Secondary analysis of WelTel Kenya1 trial data.Reasons participants indicated a problem or did not respond were extracted from the study log. Negative binomial regression was used to determine participant characteristics associated with indicating a problem and non-response. Data from follow-up questionnaires were used to describe participant perceptions of the intervention.Between 2007 and 2009, 271 participants generated 11,873 responses; 377 of which indicated a problem. Health issues were the primary reason for problem responses (72%. Rural residence (adjusted incidence rate ratio [IRR] 1.96; 95%CI 1.19-3.25; p=0.009 and age were associated with indicating a problem (adjusted IRR 0.63 per increase in age group category; 95%CI 0.50-0.80; p<0.001. Higher educational level was associated with a decreased rate of non-response (adjusted IRR 0.81; 95%CI 0.69-0.94; p=0.005. Of participants interviewed, 62% (n=129 stated there were no barriers to the intervention; cell phone issues were the most common barrier. Benefits included reminding patients to take medication and promoting a feeling that "someone cares".The WelTel intervention enabled frequent communication between clinicians and patients during the WelTel Kenya1 trial. Many patients valued the service for the support it provided, with health-related concerns comprising the majority of problems

Adherence to the Mediterranean diet and academic performance in youth: the UP&DOWN study.

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Esteban-Cornejo, Irene; Izquierdo-Gomez, Rocio; Gómez-Martínez, Sonia; Padilla-Moledo, Carmen; Castro-Piñero, Jose; Marcos, Ascensión; Veiga, Oscar L

2016-04-01

To examine the association between adherence to the Mediterranean diet and academic performance in children and adolescents. This is a cross-sectional study conducted with 1371 youth aged 12.04 ± 2.50 years (685 girls) in Spain during 2011-2012. Adherence to the Mediterranean diet was assessed using the KIDMED index (Mediterranean Diet Quality Index in children and adolescents), which includes 16 questions on specific dietary patterns. Levels of adherence were classified into three groups: poor adherence (0-3), average adherence (4-7), and good adherence (8-12). Academic performance was assessed through school records using four indicators: math, language, an average of math and language, and grade point average score. Adherence to the Mediterranean diet was related to academic performance (β ranging from 0.107 to 0.148; all P Mediterranean diet had significantly higher scores in all of the academic indicators compared with the poor group (ranging from +0.429 to 0.464; all P ≤ 0.001); as well as the group of average adherence to the Mediterranean diet had significantly higher scores in all of the academic indicators compared with the poor group (ranging from +0.292 to 0.344; all P ≤ 0.06). There were no differences between the groups of good and average adherence to the Mediterranean diet. Adherence to the Mediterranean diet may have a beneficial influence on academic performance in youth. Importantly, the benefits of adherence to the Mediterranean diet on academic performance may be stronger as youth adhered to the optimal Mediterranean diet levels.

Preditores de não aderência ao tratamento na psicoterapia psicanalítica de crianças Predictors of treatment non-adherence in child psychoanalytic psychotherapy

Directory of Open Access Journals (Sweden)

Marina Bento Gastaud

2011-01-01

assess associations between social, demographic, and clinical variables and adherence/non-adherence to treatment in child psychoanalytic psychotherapy. METHOD: This is a retrospective study based on the analysis of medical records of all children who received treatment at two psychological clinics in Porto Alegre, southern Brazil, between 1979 and 2007. RESULTS: A total of 2,106 records were analyzed, and 1,083 children were included in the final sample. Of these, 21.5% did not adhere to treatment. The variable referral source was associated with the outcome, i.e., referral to psychotherapy by psychiatrists was a protective factor to non-adherence to treatment, whereas referral by the family was a risk factor for non-adherence. CONCLUSION: Knowing the profile of children who do not adhere to psychotherapy enables therapists to establish intervention techniques in the early stages of treatment, so as to facilitate family adherence to child psychotherapy. Because dropout and non-adherence to therapy have different predictive factors, they should be considered as distinct phenomena by clinicians and investigators.

Clinicians' preventive strategies for children and adolescents identified as at high risk of developing caries.

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Sarmadi, Roxana; Gahnberg, Lars; Gabre, Pia

2011-05-01

Clinicians handle diagnosis and treatment planning of caries in different ways, and the underlying factors leading to management of risk and choice of treatment strategies are poorly understood. The aim of this study was to investigate dentists' and dental hygienists' choices of preventive strategies for children and adolescents identified as at high risk of developing caries. A sample of dental records from 432 of a total of 3372 children in a Swedish county identified as at high risk of developing caries, aged 3-19 years, was randomly selected for analysis in the study. Information of importance for the therapists' choice of caries management strategies were obtained from the dental records. The results showed that therapists considered tooth brushing instruction and fluoride treatment at the clinic to be of primary importance as treatment given in 60% of the cases, respectively. Fluoride treatment at home and diet counselling were both chosen in half of the cases. Fissure sealant therapy was used in 21% of the cases, and 15% of the patients did not receive any preventive treatment at all. The results also showed that girls more often received fluoride treatment, tooth brushing instruction and oral hygiene information than boys. In the majority of the children and adolescents, several preventive measures were given. The more background factors included in the risk assessment, the more preventive measures were given. The differences between the treatments given to girls and the boys need to be further investigated. © 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.

A robotic home telehealth platform system for treatment adherence, social assistance and companionship - an overview.

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Oddsson, Lars I E; Radomski, Mary V; White, Matthew; Nilsson, Daniel

2009-01-01

Well-known difficulties of making patients adhere to assigned treatments have made engineers and clinicians look towards technology for possible solutions. Recent studies have found that cell phone-based text messaging can help drive positive changes in patients' disease management and preventive health behavior. Furthermore, work in the area of assistive robotics indicates benefits for patients although robotic solutions tend to become expensive. However, continued improvement in sensor, computer and wireless technologies combined with decreases in cost is paving the way for development of affordable robotic systems that can help improve patient care and potentially add value to the healthcare system. This paper provides a high-level design overview of SKOTEE, the Sister Kenny hOme ThErapy systEm, an inexpensive robotic platform system designed to provide adherence support for home exercise programs, taking medication, appointment reminders and clinician communication. SKOTEE will also offer companionship as well as entertainment and social networking opportunities to the patient in their home. A video of the system is presented at the conference.

Motivational interviewing: a tool for increasing psychotropic medication adherence for youth.

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Hamrin, Vanya; McGuinness, Teena M

2013-06-01

There are serious outcomes to nonadherence to psychotropic medications in children and adolescents, including poor school performance, prolonged duration of illness, increased psychopathology, poor interpersonal relationships, increased psychiatric episodes, and suicide attempts. Medication treatment has demonstrated improved psychiatric functioning and a 50% reduction in suicidal behavior. more than 50% of youth with mental health problems are nonadherent with psychiatric medications. A review of literature examining motivational interviewing (MI) for the problem of treatment adherence in children and adolescents is discussed. MI has great potential to improve psychiatric medication adherence in adolescents. An example of how to implement MI with youth is provided.

'The apple doesn't fall far from the tree': the role of parents in chronic disease self-management.

Science.gov (United States)

Orrell-Valente, Joan K; Cabana, Michael D

2008-12-01

Medical nonadherence has been termed the "Achilles' heel of modern healthcare." In considering the need to improve medical adherence among chronically ill children, it is necessary to understand parent adherence. Parents have long been acknowledged to be the primary socialization agents in children's development across the various domains of functioning. Through communication of their beliefs, the behavior they model, and direct training, parents exert a powerful influence on the development of children's beliefs and behavior. Adherence may be similarly conceptualized as a socialization process, in which parents influence the development of children's beliefs and behavior regarding their eventual disease self-management. Given this perspective, it is important for clinicians to emphasize the need for parental adherence to a child's treatment regimen. An increased focus on parental adherence will require an investment of time and effort that will pay dividends in the long term.

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians.

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Haik, Josef; Brown, Stav; Liran, Alon; Visentin, Denis; Sokolov, Amit; Zilinsky, Isaac; Kornhaber, Rachel

2017-01-01

Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory), depression (PRIME-MD), health-related quality of life (SF-8), and compassion fatigue (Professional Quality of Life version 5). Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2%) among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P =0.017). Additional factors contributing to compassion fatigue were those without children ( P =0.016), divorced ( P =0.035), of a younger age ( P =0.019), and a registered nurse ( P =0.05). Burnout increased clinicians' risk of adverse professional and personal outcomes and correlated with less free time ( P work-home disputes ( P =0.05), increased depression ( P =0.001) and decreased career satisfaction ( P =0.01). Burnout was also associated with higher physical (mean difference =3.8, P <0.001) and lower mental (mean difference =-3.5, P <0.001) Quality of Life scores. Caring for burn survivors can lead to burnout, compassion fatigue, and vicarious trauma. Identifying strategies to abate these issues is essential to ensure improved clinicial environments and patient outcomes.

Medication adherence in schizophrenia: The role of insight, therapeutic alliance and perceived trauma associated with psychiatric care.

Science.gov (United States)

Tessier, Arnaud; Boyer, Laurent; Husky, Mathilde; Baylé, Franck; Llorca, Pierre-Michel; Misdrahi, David

2017-11-01

Medication non adherence in schizophrenia is a major cause of relapse and hospitalization and remains for clinicians an important challenge. This study investigates the associations between insight, therapeutic alliance, perceived trauma related to psychiatric treatment and medication adherence in patients with schizophrenia. In this multicenter study, 72 patients were assessed regarding symptomatology, self-reported adherence with medication, insight, medication side-effects, therapeutic alliance and perceived trauma related to psychiatric treatment. Structural Equation Modeling (SEM) was used to test predicted paths among these variables. The data fit a model in which medication adherence was directly predicted by insight, therapeutic alliance and perceived trauma related to psychiatric treatment. Perceived trauma moderates the role of insight on medication adherence. The final model showed good fit, based on four reliable indices. Greater adherence was correlated with higher insight, higher therapeutic alliance and lower perceived trauma. These three variables appear to be important determinants of patient's medication adherence. Medication adherence could be enhanced by reducing perceived trauma and by increasing insight. The need for mental health providers to acknowledge patients' potentially traumatic experience with psychiatric treatment and the need to encourage greater involvement in care are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation.

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Yang, Chris P; Hunt, Elizabeth A; Shilkofski, Nicole; Dudas, Robert; Egbuta, Chinyere; Schwartz, Jamie M

2017-07-01

Children transferred from community hospitals lacking specialized pediatric care are more seriously ill than those presenting to pediatric centers. Pediatric consultation and adherence to management guidelines improve outcomes. The aims of the study were (1) to assess whether telemedicine consultation in critical situations is feasible and (2) to compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines through a randomized controlled telemedicine trial. In situ, high-fidelity simulation scenarios of critically ill children presenting to a community hospital and progressing to cardiopulmonary arrest were performed. Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention). Primary outcome measure was proportion of teams who successfully defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia. The following 30 scenarios were completed: 15 control and 15 intervention. Only 11 (37%) of 30 teams, defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia; control: 6 (40%) of 15 versus intervention: 5 (33%) of 15, P = 0.7. Request for or use of backboard during cardiopulmonary resuscitation occurred in 24 (80%) of 30 scenarios; control: 9 (60%) of 15 versus intervention: 15 (100%) of 15, P = 0.006. Request for or use of stepstool during cardiopulmonary resuscitation occurred in 6 (20%) of 30 scenarios; control: 1 (7%) of 15 versus intervention: 5 (33%) of 15, P = 0.07. This study demonstrates the feasibility of using telemedicine to support acute management of children who present to community hospitals. Neither study arm adhered to current resuscitation guidelines and telemedicine consultation with PCCM experts was not associated with improvement. However, further research on optimizing telemedicine impact on the quality of pediatric care at

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

Science.gov (United States)

Ferris, Rosie; Blaum, Caroline; Kiwak, Eliza; Austin, Janet; Esterson, Jessica; Harkless, Gene; Oftedahl, Gary; Parchman, Michael; Van Ness, Peter H; Tinetti, Mary E

2018-06-01

To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.

Adherence to multiple micronutrient powders and associated factors in children aged 6 to 35 months treated in sentinel health facilities, Ministry of Health of Peru.

Science.gov (United States)

Munares-García, Oscar; Gómez-Guizado, Guillermo

2016-01-01

Anemia in children is a public health issue, and the current strategies include treatment and iron supplementation, but their level of adherence or compliance is unknown. To consider the adherence to multiple micronutrient powders and the associated factors. Epidemiological study of active surveillance through sentinel facilities in 2,024 children aged 6 to 35 months treated in health facilities of the Ministry of Health of Peru, from October to December 2014. Household visits were conducted in which counting of multiple micronutrient powders was applied and determined an adherence of consumption ≥ 90% envelopes, besides a form on the associated factors (anemia knowledge, iron-rich food, side effects, dosage regimen, drugs used, and motivation) was applied. Descriptive statistics, χ² test, Odds Ratio with a 95% confidence interval (CI), and binary logistic regression or adjusted Odds Ratio (aOR) were used. Of all, 79.1% participants were aged 6 to 23 months; 75.9% received multiple micronutrient powders; and the adherence was equivalent to 24.4% (95%CI 22.3 - 26.6). The factors: continue supplementation (OR = 3.5; 95%CI 1.7 - 7.5); no nausea (OR = 3.0; 95%CI 2.0 - 4.3); no use of antibiotics (OR = 2.5; 95%CI 1.7 - 3.6); and intention to continue treatment (OR = 2.3; 95%CI 1.3 - 4.1) were associated with adherence. The variables: thought of continuing treatment (aOR = 2.6; 95%CI 1.1 - 6.1); presence of side effects, but no discontinuation of the treatment (aOR = 2.5; 95%CI 1.4 - 4.3); no use of antibiotics (aOR = 2.0; 95%CI 1.1 - 3.4); and belief that not only drugs cure anemia (aOR = 1.6; 95%CI 1.0 - 2.6) were associated in the multivariate analysis. There was a low prevalence of adherence to a demanding cut-off point (≥ 90% of envelopes of multiple micronutrient powders), and the associated factors are associated with absence of infections, side effects, and mother's beliefs.

The clinical impact of the radiology report in wheezing and nonwheezing febrile children: a survey of clinicians

Energy Technology Data Exchange (ETDEWEB)

Spottswood, Stephanie E.; Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H. [Vanderbilt University, Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children' s Hospital, Nashville, TN (United States); Liaw, Kevin [Vanderbilt University School of Medicine, Nashville, TN (United States); Moore, Paul E. [Vanderbilt University, Department of Pediatric Pulmonary, Allergy and Immunology, Monroe Carell Jr. Children' s Hospital, Nashville, TN (United States); Patterson, Barron [Vanderbilt University, Department of Pediatrics, Monroe Carell Jr. Children' s Hospital, Nashville, TN (United States); Chen, Heidi [Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN (United States)

2009-04-15

The chest radiograph is commonly used in the diagnosis and management of patients presenting with respiratory illness. The language used to describe the findings is important to ensure appropriate communication with the referring clinician and thereby optimize patient management. In this study we attempted to determine how clinicians interpret specific terms commonly used in a chest radiograph report, and to assess how these terms impact the management of children with respiratory symptoms. An online survey was distributed to 562 pediatric practitioners asking their interpretation of the terms ''peripheral airway disease (PAD),'' ''focal airspace consolidation,'' and ''focal infiltrate'' in a febrile child with or without wheezing. There were 112 respondents. Most practitioners defined the term ''PAD'' as viral pneumonia (61.5%) or asthma (56.9%), ''consolidation'' as atelectasis (83%) followed by pneumonia (69.6%), and ''infiltrate'' as pneumonia (100%), followed by atelectasis (22.3%). Practitioners were more likely to treat a nonwheezing child with antibiotics if the report stated ''focal airspace consolidation'' (80%) or ''focal infiltrate'' (100%; P=0.001). Some radiologic descriptors may lead to diverse and sometimes unintended diagnostic conclusions. Our findings support continued effort to structure and standardize the radiology report and our descriptive terminology. (orig.)

Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA Guidelines.

Science.gov (United States)

Martin, Seth S; Sperling, Laurence S; Blaha, Michael J; Wilson, Peter W F; Gluckman, Ty J; Blumenthal, Roger S; Stone, Neil J

2015-04-07

Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informed choice aligned with personal values and preferences. Dedicating sufficient time to high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Perception Towards the Use of Smartphone Application (Apps to Enhance Medication Adherence Among Saudi Pediatrics

Directory of Open Access Journals (Sweden)

Renad Alsalamah

2018-03-01

Full Text Available Objectives: The aim of this study was to measure the importance of smartphone applications (Apps in medication adherence in children to help parents and caregivers in giving medication to children to maintain a good health and quality of life, and to improve current clinical practices in adherence to medications among Saudi pediatrics. Methodology: Cross sectional survey to Saudi Arabia population was conducted from March to April 2017(n=405. Data were collected, tabulated and analyzed using Survey Monkey. We present design requirements for building medication reminders that support the routine aspect of medication-taking by linking children’s concerns, (such as games on taking medications at time. Results: Of the 405 survey participants, the majority of participants 72.5% were not aware by applications of smart device that make easier to take medicines regularly. Eighty percent of participants preferred a mobile app to help their children take the medicine easily and regularly, and 39.8% of them thought that the child will interact with this game, the majority of them 88.6% don’t have any obstacle hinders the use of these updated applications. Fifty percent of them will encourage young patients, to use such applications (App to help them in their medication adherence. Conclusion: Nonadherence to medication is still represents a fundamental health care challenge. The presence of an application makes it easier for parents to give medication to their sick children. Most children love playing games, there is a high probability of their attachment to this application (App and it will promote children’s medication adherence. Key words: Patient adherence, Pediatric, Smartphone, Applications, Apps.

Post-traumatic stress disorder and medication adherence: results from the Mind Your Heart study.

Science.gov (United States)

Kronish, Ian M; Edmondson, Donald; Li, Yongmei; Cohen, Beth E

2012-12-01

Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk. We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders. A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, Pversus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications). PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD. Copyright © 2012 Elsevier Ltd. All rights reserved.

Adherence to antiretroviral therapy and its determinants in AIDS patients: review article

Directory of Open Access Journals (Sweden)

Hajiabdolbaghi M

2008-10-01

known to overestimate adherence. Some determinants are associated with adherence include: age, gender, addiction specially injection drug users, alcohol consumption, depression, social support, level of education, work situation, adverse antiretroviral effects, pregnancy, type of antiretroviral drug regimen, number of pills and daily doses received, severe traumas, social and psychological factors, and relationship between clinician and patient.0 "nKeywords: Adherence, antiretroviral therapy, AIDS, treatment.

Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

Directory of Open Access Journals (Sweden)

Veronika van der Wardt

2017-09-01

Full Text Available Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories, individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.

Disparities in Health Supervision for Children With Down Syndrome.

Science.gov (United States)

Williams, Katie; Wargowski, David; Eickhoff, Jens; Wald, Ellen

2017-12-01

Increasing evidence suggests children with Down syndrome do not receive recommended health care services. We retrospectively assessed adherence to the 2001 American Academy of Pediatrics health supervision guidelines for 124 children with Down syndrome. Cervical spine radiographs were completed for 94% of children, often preoperatively. Adherence to complete blood count recommendations was 55% (95% CI 44% to 66%); lower for males ( P = .01) and children with private medical insurance ( P = .04). Adherence to thyroid function recommendations was 61% (95% CI 54% to 67%); higher for children seen by a pediatrician ( P = .002) and with known thyroid disease ( P < .0001). Adherence to audiology and ophthalmology recommendations was 33% (95% CI 27% to 40%) and 43% (95% CI 37% to 50%), respectively. Adherence rates were higher for children referred to an otolaryngologist ( P = .0002) and with known eye disease ( P < .0001). Future efforts should identify barriers to care and improve adherence to recommended screening.

Interventions combining motivational interviewing and cognitive behaviour to promote medication adherence: a literature review.

Science.gov (United States)

Spoelstra, Sandra L; Schueller, Monica; Hilton, Melissa; Ridenour, Kimberly

2015-05-01

This article presents an integrative review of the evidence for combined motivational interviewing and cognitive behavioural interventions that promote medication adherence. We undertook this review to establish a scientific foundation for development of interventions to promote medication adherence and to guide clinical practice. The World Health Organization has designated medication adherence as a global problem. Motivational interviewing and cognitive behaviour interventions have been found to individually promote medication adherence. However, there is a gap in the literature on the effect of combined motivational interviewing and cognitive behavioural approaches to promote medication adherence. Integrative review. COCHRANE, PubMed and CINAHL were searched to access relevant studies between 2004-2014. Inclusion criteria were interventions combining motivational interviewing and cognitive behavioural therapy with medication adherence as the outcome. Articles were assessed for measures of adherence and methodological rigour. Analysis was performed using an integrative review process. Six articles met the inclusion criteria. A randomised controlled trial reported pretreatment missed doses of 5·58 and post-treatment of 0·92 and trended towards significance. Four cohort studies had effect sizes of 0·19-0·35 (p motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed. This review provides clinicians with the state of the science in relation to combined motivational interviewing and cognitive behavioural therapy interventions that promote medication adherence. A summary of intervention components and talking points are provided to aid nurses in informing decision-making and translating evidence into practice. © 2014 John Wiley & Sons Ltd.

Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory.

Science.gov (United States)

Hamrin, Vanya; McCarthy, Erin M; Tyson, Veda

2010-08-01

Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications. Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated. International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources. Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence

Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa.

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Adeniyi, Oladele Vincent; Ajayi, Anthony Idowu; Ter Goon, Daniel; Owolabi, Eyitayo Omolara; Eboh, Alfred; Lambert, John

2018-04-13

Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa. This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence. A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART. Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.

Tackling medication non-adherence in severe mental illness: where are we going wrong?

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Brown, E; Gray, R

2015-04-01

beliefs is an important observation. Our findings suggest that to support clinicians to more effectively help patients manage their medication, it may be first necessary to challenge pre-existing beliefs about adherence. © 2015 John Wiley & Sons Ltd.

Moving beyond 'not enough time': factors influencing paediatric clinicians' participation in research.

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Paget, Simon P; Caldwell, Patrina H Y; Murphy, Joyce; Lilischkis, Kimberley J; Morrow, Angie M

2017-03-01

Increasing the amount of clinical research that occurs in healthcare settings has been identified as an important mechanism to improve healthcare outcomes. While clinicians are key persons in achieving this aim, research participation amongst clinicians is generally limited. To identify the factors (barriers and facilitators) influencing clinician research participation and determine how professional culture impacts on these factors. Forty clinicians working at a tertiary children's hospital participated in six discipline-specific focus groups. Thematic analysis was performed using an inductive process based in grounded theory. Four major themes (cultural factors, personal factors, resources and solutions) and 16 subthemes were identified. Participants described how the current health system discourages clinician research. They reported that their research participation requires personal sacrifice of their own time; income or career progression. Research participation was seen to compete with other priorities in clinicians' workload and is disadvantaged because of the primacy of clinical work and the lack of immediate tangible benefit from research projects. Solutions suggested by our participants included better alignment of clinical and research goals, improved availability of research mentors and collaborative opportunities. Nurses and allied health professionals reported a changing professional culture that values research. Only doctors identified research participation to be important for career progression. For clinician research participation to flourish, significant changes in healthcare structure and priorities will be required that result in research becoming more embedded in healthcare delivery. Initiatives to improve collaboration between clinicians and universities may also support these aims. © 2016 Royal Australasian College of Physicians.

Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective.

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Coetzee, Bronwyne; Kagee, Ashraf; Bland, Ruth

2015-01-01

Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance. HIV-infected children, especially those 5 years and under, are dependent on a caregiver to adhere to ART. However, characteristics of the caregiver, child, regimen, clinic and social context affect clinic attendance and medication-taking, both of which constitute adherent behaviour. We conducted nine interviews and three focus groups to determine how doctors, nurses, counsellors, traditional healers and caregivers understood the barriers and facilitators to ART adherence among children residing in rural South Africa. The data were transcribed, translated into English from isiZulu where necessary, and coded using Atlas.ti version 7. Results were interpreted through the lens of Bronfenbrenner's Ecological Systems Theory. We found that at the micro-level, palatability of medication and large volumes of medication were problematic for young children. Characteristics of the caregiver including absent mothers, grandmothers as caregivers and denial of HIV amongst fathers were themes related to the micro-system. Language barriers and inconsistent attendance of caregivers to monthly clinic visits were factors affecting adherence in the meso-system. Adherence counselling and training were the most problematic features in the exo-system. In the macro-system, the effects of food insecurity and the controversy surrounding the use of traditional medicines were most salient. Increased supervision and regular training amongst lay adherence counsellors are needed, as well as regular monitoring of the persons attending the clinic on the child's behalf.

MedAd-AppQ: A quality assessment tool for medication adherence apps on iOS and android platforms.

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Ali, Eskinder Eshetu; Teo, Amanda Kai Sin; Goh, Sherlyn Xue Lin; Chew, Lita; Yap, Kevin Yi-Lwern

2018-02-02

With the recent proliferation of smartphone medication adherence applications (apps), it is increasingly more difficult for patients and clinicians to identify the most useful app. To develop a quality assessment tool for medication adherence apps, and evaluate the quality of such apps from the major app stores. In this study, a Medication Adherence App Quality assessment tool (MedAd-AppQ) was developed and two evaluators independently assessed apps that fulfilled the following criteria: availability in English, had at least a medication reminder feature, non-specific to certain disease conditions (generic apps), free of technical malfunctions and availability on both the iPhone Operating System (iOS) and Android platforms. Descriptive statistics, Mann-Whitney U test, Pearson product moment correlation and Spearman rank-order correlation were used for statistical analysis. MedAd-AppQ was designed to have 24 items (total 43 points) categorized under three sections: content reliability (11 points), feature usefulness (29 points) and feature convenience (3 points). The three sections of MedAd-AppQ were found to have inter-rater correlation coefficients of 0.801 (p-value apps (27 iOS and 25 Android), quality scores ranged between 7/43 (16.3%) and 28/43 (65.1%). There was no significant difference between the quality scores of the Android and iOS versions. None of the apps had features for self-management of side effects. Only two apps in each platform provided disease-related and/or medication information. MedAd-AppQ can be used to reliably assess the quality of adherence apps. Clinicians can use the tool in selecting apps for use by patients. Developers of adherence apps should consider features that provide therapy-related information and help patients in medications and side-effects management. Copyright © 2018 Elsevier Inc. All rights reserved.

Primary care clinicians' experiences prescribing HIV pre-exposure prophylaxis at a specialized community health centre in Boston: lessons from early adopters.

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Krakower, Douglas S; Maloney, Kevin M; Grasso, Chris; Melbourne, Katherine; Mayer, Kenneth H

2016-01-01

An estimated 1.2 million Americans have indications for using antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. For many of these at-risk individuals, the best opportunity to learn about and receive PrEP will be during routine visits to their generalist primary care clinicians. However, few generalist clinicians have prescribed PrEP, primarily because of practical concerns about providing PrEP in primary care settings. The experiences of specialized primary care clinicians who have prescribed PrEP can inform the feasibility of PrEP provision by generalists. During January to February 2015, 35 primary care clinicians at a community health centre in Boston that specializes in the care of sexual and gender minorities completed anonymous surveys about their experiences and practices with PrEP provision. Responses were analyzed with descriptive statistics. Thirty-two clinicians (response rate=91%) completed the surveys. Nearly all clinicians (97%) had prescribed PrEP (median 20 patients, interquartile range 11-33). Most clinicians reported testing and risk-reduction counselling practices concordant with U.S. Centers for Disease Control and Prevention guidelines for PrEP. Clinicians indicated that patients using PrEP experienced medication toxicities infrequently and generally reported high adherence. However, some clinicians' practices differed from guideline recommendations, and some clinicians observed patients with increased risk behaviours. Most clinicians (79%) rated PrEP provision as easy to accomplish, and 97% considered themselves likely to prescribe PrEP in the future. In a primary care clinic with specialized expertise in HIV prevention, clinicians perceived that PrEP provision to large numbers of patients was safe, feasible and potentially effective. Efforts to engage generalist primary care clinicians in PrEP provision could facilitate scale-up of this efficacious intervention.

Unearthing how, why, for whom and under what health system conditions the antiretroviral treatment adherence club intervention in South Africa works: A realist theory refining approach.

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Mukumbang, Ferdinand C; Marchal, Bruno; Van Belle, Sara; van Wyk, Brian

2018-05-09

Poor retention in care and suboptimal adherence to antiretroviral treatment (ART) undermine its successful rollout in South Africa. The adherence club intervention was designed as an adherence-enhancing intervention to enhance the retention in care of patients on ART and their adherence to medication. Although empirical evidence suggests the effective superiority of the adherence club intervention to standard clinic ART care schemes, it is poorly understood exactly how and why it works, and under what health system contexts. To this end, we aimed to develop a refined programme theory explicating how, why, for whom and under what health system contexts the adherence club intervention works (or not). We undertook a realist evaluation study to uncover the programme theory of the adherence club intervention. We elicited an initial programme theory of the adherence club intervention and tested the initial programme theory in three contrastive sites. Using a cross-case analysis approach, we delineated the conceptualisation of the intervention, context, actor and mechanism components of the three contrastive cases to explain the outcomes of the adherence club intervention, guided by retroductive inferencing. We found that an intervention that groups clinically stable patients on ART in a convenient space to receive a quick and uninterrupted supply of medication, health talks, counselling, and immediate access to a clinician when required works because patients' self-efficacy improves and they become motivated and nudged to remain in care and adhere to medication. The successful implementation and rollout of the adherence club intervention are contingent on the separation of the adherence club programme from other patients who are HIV-negative. In addition, there should be available convenient space for the adherence club meetings, continuous support of the adherence club facilitators by clinicians and buy-in from the health workers at the health-care facility and the

Evaluating adherence to ocular hypotensives using the Travatan dosing aid

Directory of Open Access Journals (Sweden)

O'Dell L

2012-01-01

, an objective tool has not been available to the clinician to identify individual patients' rate of adherence. The TDA is an accurate, adjunctive tool available for assessing patient adherence on an individual level.Keywords: Glaucoma, adherence, therapy, travatan, medication, travoprost, monitoring

Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review.

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Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe; Skou Thomsen, Ann Sofia; Konge, Lars

2015-07-27

Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence. Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence.

Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.

Directory of Open Access Journals (Sweden)

Edith Patouillard

Full Text Available Intermittent preventive treatment of malaria in children (IPTc involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy.A community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs or facility-based nurses working at health centres' outpatient departments (OPD or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective.The economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$ 5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc.VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana.ClinicalTrials.gov NCT00119132.

Parents' Attitudes and Adherence to Unintentional Injury Prevention Measures in Ankara, Turkey.

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İnce, Tolga; Yalçın, Songül; Yurdakök, Kadriye

2017-08-04

Childhood unintentional injuries are perceived as a leading public health issue since they are one of the preventable causes of paediatric mortality and morbidity. Whether and how parental factors are related to childhood injury has been researched insufficiently. To investigate parents' attitudes to preventive measures of unintentional childhood injury, and the parental adherence to these measures. Cross-sectional, descriptive study. The data were collected from the parents of children younger than ten years of age admitted to university hospital outpatient clinics for any reason and who agreed to be involved in the study. The first part of the questionnaire included sociodemographic profiles of participating children. Serious injuries were considered to be any injury that requires hospital admission. The second part of the questionnaire was prepared to evaluate parents' adherence to injury prevention rules. A total score calculation about the adherence of the parents to the injury prevention rules was worked out the addition of the scores of each answer given in each age group. Answers for each item given by the parents were scored as wrong (0), sometimes (1) or correct (2). The score for each item was added and the result normalized to 100 points. Only complete questionnaires were used for analysis. A total of 1126 children and parent pairs agreed to participate in the survey. It was found that 13.8% of the participating children had experienced at least one serious injury. Although three-quarters of the parents had received information about injury prevention, the overall injury prevention scores were found to be low. As children's age increased, the total injury prevention scores of parents decreased significantly. Injury prevention scores were shown to increase significantly with high education and maternal occupation. However, scores were shown to decrease significantly with increased child age and family size. Our study shows that parental adherence to the

Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

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Dayabandara M

2017-08-01

Full Text Available Madhubhashinee Dayabandara, Raveen Hanwella, Suhashini Ratnatunga, Sudarshi Seneviratne, Chathurie Suraweera, Varuni A de Silva Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Abstract: Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other

Agreement between Rheumatologist and Patient-reported Adherence to Methotrexate in a US Rheumatoid Arthritis Registry.

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Curtis, Jeffrey R; Bharat, Aseem; Chen, Lang; Greenberg, Jeffrey D; Harrold, Leslie; Kremer, Joel M; Sommers, Tanya; Pappas, Dimitrios

2016-06-01

Rheumatologists have limited tools to assess medication adherence. The extent to which methotrexate (MTX) adherence is overestimated by rheumatologists is unknown. We deployed an Internet survey to patients with rheumatoid arthritis (RA) participating in a US registry. Patient self-report was the gold standard compared to MTX recorded in the registry. Response rate to the survey was 44%. Of 228 patients whose rheumatologist reported current MTX at the time of the most recent registry visit, 45 (19.7%) had discontinued (n = 19, 8.3%) or missed ≥ 1 dose in the last month (n = 26, 11.4%). For the subgroup whose rheumatologist also confirmed at the next visit that they were still taking MTX (n = 149), only 2.6% reported not taking it, and 10.7% had missed at least 1 dose. MTX use was misclassified for 13%-20% of patients, mainly because of 1 or more missed doses rather than overt discontinuation. Clinicians should be aware of suboptimal adherence when assessing MTX response.

Prospective analysis of LDL-C goal achievement and self-reported medication adherence among statin users in primary care.

LENUS (Irish Health Repository)

Bermingham, Margaret

2011-09-01

Improvements in the control of LDL-C levels have occurred in the past decade due to the introduction of increasingly potent statins, such as atorvastatin and rosuvastatin. Many patients, however, do not achieve their LDL-C goals, which presents a practical dilemma for clinicians and highlights the need to identify adherence problems in a clinically relevant manner.

Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients.

Directory of Open Access Journals (Sweden)

Hans Wouters

Full Text Available Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences.To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations.Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data.Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2, 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13-2.10, P < 0.01, whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17-3.08, P < 0.01. Higher 'perceived self-efficacy' did not moderate these associations.Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient alliance.

Family factors affect clinician attitudes in pediatric end-of-life decision making: a randomized vignette study.

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Ruppe, Michael D; Feudtner, Chris; Hexem, Kari R; Morrison, Wynne E

2013-05-01

Conflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children. We hypothesized that family factors might influence clinician decision making in these circumstances. We presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed. Three hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the "involved family" vignette were more likely to agree to continue medical care indefinitely (Pfamilies had nonreligious objections to withdrawal (P=0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI=0.6-0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided "futile" care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7-1). In this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Child Health Disparities: What Can a Clinician Do?

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Cheng, Tina L; Emmanuel, Mickey A; Levy, Daniel J; Jenkins, Renee R

2015-11-01

Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity. Copyright © 2015 by the American Academy of Pediatrics.

The effects of mothers' musical background on sedentary behavior, physical activity, and exercise adherence in their 5-6-years-old children using movement-to-music video program.

Science.gov (United States)

Tuominen, Pipsa P A; Raitanen, Jani; Husu, Pauliina; Kujala, Urho M; Luoto, Riitta M

2018-01-01

The purpose of this study was to examine whether mothers' musical background has an effect on their own and their children's sedentary behavior (SB) and physical activity (PA). The aim was also to assess children's and their mothers' exercise adherence when using movement-to-music video program. Sub-group analysis of an intervention group in a randomized controlled trial (ISRCTN33885819). Seventy-one mother-child-pairs were divided into two categories based on mothers' musical background. Each pair performed 8 weeks exercise intervention using movement-to-music video program. SB and PA were assessed objectively by accelerometer, and exercise activity, fidelity, and enjoyment were assessed via exercise diaries and questionnaires. Logistic regression model was used to analyze associations in the main outcomes between the groups. Those children whose mothers had musical background (MB) had greater probability to increase their light PA during the intervention, but not moderate-to-vigorous PA compared to those children whose mothers did not have musical background (NMB). SB increased in both groups. Mothers in the NMB group had greater probability to increase their light and moderate-to-vigorous PA and decrease their SB than mothers in the MB group. However, exercise adherence decreased considerably in all groups. Completeness, fidelity, and enjoyment were higher among the NMB group compared to the MB group. The present results showed that mothers without musical background were more interested in movement-to-music exercises, as well as their children. For further studies it would be important to evaluate an effect of children's own music-based activities on their SB and PA.

Disseminating effective clinician communication techniques: Engaging clinicians to want to learn how to engage patients.

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Pollak, Kathryn I; Back, Anthony L; Tulsky, James A

2017-10-01

Patient-clinician communication that promotes patient engagement enhances health care quality. Yet, disseminating effective communication interventions to practicing clinicians remains challenging. Current methods do not have large and sustainable effects. In this paper, we argue that both top-down approaches (mandated by institutions) should be coupled with bottom-up approaches that address clinician motivation, confidence, and barriers. We need to engage clinicians in the same way we ask them to engage patients - strategically and with empathy. We discuss potentially innovative strategies to integrate top-down and bottom-up approaches in ways that fit clinicians' busy schedules and can inform policy. Copyright © 2017. Published by Elsevier B.V.

Parent-reported and clinician-observed autism spectrum disorder (ASD) symptoms in children with attention deficit/hyperactivity disorder (ADHD): implications for practice under DSM-5.

Science.gov (United States)

Grzadzinski, Rebecca; Dick, Catherine; Lord, Catherine; Bishop, Somer

2016-01-01

Children with attention deficit/hyperactivity disorder (ADHD) often present with social difficulties, though the extent to which these clearly overlap with symptoms of autism spectrum disorder (ASD) is not well understood. We explored parent-reported and directly-observed ASD symptoms on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) in children referred to ASD-specialty clinics who received diagnoses of either ADHD (n = 48) or ASD (n = 164). Of the ADHD sample, 21 % met ASD cut-offs on the ADOS and 30 % met ASD cut-offs on all domains of the ADI-R. Four social communication ADOS items (Quality of Social Overtures, Unusual Eye Contact, Facial Expressions Directed to Examiner, and Amount of Reciprocal Social Communication) adequately differentiated the groups while none of the items on the ADI-R met the criteria for adequate discrimination. Results of this work highlight the challenges that clinicians and researchers face when distinguishing ASD from other disorders in verbally fluent, school-age children.

The interplay between teamwork, clinicians' emotional exhaustion, and clinician-rated patient safety: a longitudinal study.

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Welp, Annalena; Meier, Laurenz L; Manser, Tanja

2016-04-19

Effectively managing patient safety and clinicians' emotional exhaustion are important goals of healthcare organizations. Previous cross-sectional studies showed that teamwork is associated with both. However, causal relationships between all three constructs have not yet been investigated. Moreover, the role of different dimensions of teamwork in relation to emotional exhaustion and patient safety is unclear. The current study focused on the long-term development of teamwork, emotional exhaustion, and patient safety in interprofessional intensive care teams by exploring causal relationships between these constructs. A secondary objective was to disentangle the effects of interpersonal and cognitive-behavioral teamwork. We employed a longitudinal study design. Participants were 2100 nurses and physicians working in 55 intensive care units. They answered an online questionnaire on interpersonal and cognitive-behavioral aspects of teamwork, emotional exhaustion, and patient safety at three time points with a 3-month lag. Data were analyzed with cross-lagged structural equation modeling. We controlled for professional role. Analyses showed that emotional exhaustion had a lagged effect on interpersonal teamwork. Furthermore, interpersonal and cognitive-behavioral teamwork mutually influenced each other. Finally, cognitive-behavioral teamwork predicted clinician-rated patient safety. The current study shows that the interrelations between teamwork, clinician burnout, and clinician-rated patient safety unfold over time. Interpersonal and cognitive-behavioral teamwork play specific roles in a process leading from clinician emotional exhaustion to decreased clinician-rated patient safety. Emotionally exhausted clinicians are less able to engage in positive interpersonal teamwork, which might set in motion a vicious cycle: negative interpersonal team interactions negatively affect cognitive-behavioral teamwork and vice versa. Ultimately, ineffective cognitive

How can clinician-educator training programs be optimized to match clinician motivations and concerns?

Science.gov (United States)

McCullough, Brendan; Marton, Gregory E; Ramnanan, Christopher J

2015-01-01

Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Review of medical education literature using the terms "attitudes", "motivations", "physicians", "teaching", and "undergraduate medical education" resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education.

Age-specific antibiotic prescribing and adherence to guidelines in pediatric patients in primary care.

NARCIS (Netherlands)

Ivanovska, V.; Hek, K.; Mantel-Teeuwisse, A.K.; Leufkens, H.G.M.; Dijk, L. van

2018-01-01

Background: Most antibiotics in children are used to treat viral and self-limiting conditions. This study aims to compare physicians' adherence to guidelines on antibiotic prescribing in fever and in ear and respiratory infections to children in different age groups in the Netherlands. Methods: Data

Adherence to antidepressants

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Abimbola Farinde

2013-01-01

Full Text Available While major depression is considered a frequent mental illness there are ongoing reports of high non-adherence to antidepressant medications which places suffers at high risk for relapse, recurrence, or greater impairment,. The World Health Organization (WHO defines adherence as the extent to which a person′s behavior (e.g. taking medications can align with the agreed recommendations of a health care provider. Unfortunately while patient may recognize the importance of adherence to antidepressant medications the majority of patients do not adhere to their prescribed antidepressants. Some of the factors that may contribute to or lead to non-adherence include knowingly or unknowingly missing doses, taking extra doses, delaying administration times, or taking drug holidays. Pharmacists have the unique ability to deter non-adherence through the performance of continuous assessment and monitoring of adherence in this population given these accessibility. Additionally, pharmacists are able to develop therapeutic alliances with patients that can help to increase the likelihood of achieving positive patient outcomes. Antidepressant non-adherence can be viewed as a significant public health concern so it is important for patients to be educated about the importance of adherence, and health care professionals should be aware of factors or patient characteristics that can serve as barriers to non-adherence.

Facilitating and inhibiting factors related to treatment adherence in women with polycystic ovary syndrome: A qualitative study

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Fatemeh Bazarganipour

2017-09-01

Full Text Available Background: Adherence issues in polycystic ovary syndrome (PCOS patients have not been examined thoroughly. Patients report prolonged periods of treatment and side effects of the drug as the most common reason for withdrawal from treatment. To improve the effective management of PCOS patients, it is fundamental to understand facilitating and inhibiting factors to treatment adherence. Objective: To explore facilitating/inhibiting factors related to treatment adherence among PCOS patients. Materials and Methods: This was a qualitative study with a purposive sample of women with confirmed diagnosis of PCOS. The data were collected via 20 in-depth semi-structured interviews with women aged between 21-34 yr. A qualitative content analysis was used to analyze the data. Results: Five themes were identified which described different types of facilitating/ inhibiting factors to treatment adherence. Inhibiting factors included financial issues, patient-related, disease-related, and health care provider-related factors; while social factors were found to be both facilitating and inhibiting. Conclusion: The findings suggest that successful adherence to PCOS treatment is highly dependent on patients recognizing and adapting to financial, social, and health care related inhibiting factors. It is also crucial for clinicians and policy makers to recognize these key inhibiting factors in order to improve treatment outcomes.

How can clinician-educator training programs be optimized to match clinician motivations and concerns?

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McCullough B

2015-01-01

Full Text Available Brendan McCullough, Gregory E Marton, Christopher J Ramnanan Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Background: Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Methods: Review of medical education literature using the terms “attitudes”, “motivations”, “physicians”, “teaching”, and “undergraduate medical education” resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. Results: A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Conclusion: Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education. Keywords: clinician-educators, teaching, undergraduate medical

Assessing the Medication Adherence App Marketplace From the Health Professional and Consumer Vantage Points.

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Dayer, Lindsey E; Shilling, Rebecca; Van Valkenburg, Madalyn; Martin, Bradley C; Gubbins, Paul O; Hadden, Kristie; Heldenbrand, Seth

2017-04-19

ratings are positively but weakly correlated with user-testing scores suggesting that our rating tool has some validity but that consumers and clinicians may assess adherence app quality differently. ©Lindsey E Dayer, Rebecca Shilling, Madalyn Van Valkenburg, Bradley C Martin, Paul O Gubbins, Kristie Hadden, Seth Heldenbrand. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 19.04.2017.

Medical adherence in young adolescents with spina bifida: longitudinal associations with family functioning.

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Stepansky, Mona A; Roache, Caitlin R; Holmbeck, Grayson N; Schultz, Karen

2010-03-01

The purpose of this study was 2-fold: (1) to explore the transfer of responsibility of medical tasks from parent to child during the transition to adolescence, and (2) to examine the associations between family functioning and medical adherence in youth with spina bifida. Seventy families of children with spina bifida participated in this study. Data were collected during family interaction sessions by using questionnaires completed by mothers, fathers, youth, teachers and health professionals. Findings suggest that responsibility for medical regimens transfers gradually from parent to child over time. Additionally, family conflict and cohesion were correlated with medical adherence. Finally, family conflict over medical issues was related to a decrease in medical adherence over time. Results suggest that as youth take more responsibility over their medical regimens, family conflict regarding medical issues becomes a contributor to their adherence behaviors. Interventions that target family conflict may facilitate adherence behaviors.

Mediterranean diet adherence is associated with lifestyle, physical fitness, and mental wellness among 10-y-olds in Chile

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Muros, José Joaquín; Cofre-Bolados, Cristian; Arriscado Alsina, Daniel (UNIR); Zurita, Félix; Knox, Emily

2017-01-01

Objective: The aim of this study was to assess adherence to the Mediterranean diet (MD) within a population of children from Santiago, Chile. A secondary aim was to examine the relationship between MD adherence, body composition, physical fitness, self-esteem, and other lifestyle factors. Methodology: A cross-sectional study of a sample of children (N = 515; 10.6 +/- 0.5 y) was conducted. Weight, body mass index, skinfolds, and waist circumference were measured. Physical fitness was dete...

[Effects in the adherence treatment and psychological adjustment after the disclosure of HIV/AIDS diagnosis with the "DIRE" clinical model in Colombian children under 17].

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Trejos, Ana María; Reyes, Lizeth; Bahamon, Marly Johana; Alarcón, Yolima; Gaviria, Gladys

2015-08-01

A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). No significant differences in adherence to treatment (p=0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.

Vicarious Trauma: Predictors of Clinicians' Disrupted Cognitions about Self-Esteem and Self-Intimacy

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Way, Ineke; VanDeusen, Karen; Cottrell, Tom

2007-01-01

This study examined vicarious trauma in clinicians who provide sexual abuse treatment (N = 383). A random sample of clinical members from the Association for the Treatment of Sexual Abusers and American Professional Society on the Abuse of Children were surveyed. Vicarious trauma was measured using the Trauma Stress Institute Belief Scale…

Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso.

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Schoeps, A; Ouédraogo, N; Kagoné, M; Sié, A; Müller, O; Becher, H

2013-12-17

To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso. This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression. Mothers' education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24-2.58 (proximity to health facility), OR=3.02, 95%CI=2.18-4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother's education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06-1.89). There was no effect of household size or the age of the mother. Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers' own initiative to get vaccinated, urban mothers should be

Adherence to Combined Lifestyle Factors and Their Contribution to Obesity in the IDEFICS Study

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Kovács, Eva; Hunsberger, Monica; Reisch, Lucia

2015-01-01

to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all......). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between.......65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight...

To give or not to give: Parental experience and adherence to the Food and Drug Administration warning about over-the-counter cough and cold medicine usage

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Talya Miron-Shatz

2010-10-01

Full Text Available The Food and Drug Administration (FDA warned against administering over-the-counter cough and cold medicines to children under 2. This study evaluated whether experienced parents show poorer adherence to the FDA warning, as safe experiences are predicted to reduce the impact of warnings, and how adherence can be improved. Participants included 218 American parents (mean age: 29.98 (SD = 6.16, 82.9% female with children age 2 or less who were aware of the FDA warning. We compared adherence among experienced (N=142; with other children > age 2 and inexperienced parents (N=76; only children 2 or yess. We also evaluated potential moderating variables (amount of warning-related information received, prevalence of side effects, trust in the FDA, frequency of coughs and colds, trust in drug packaging and quantified the impact of amount of information. Logistic regression assessed the ability of experience alone, and experience combined with amount of information, to predict adherence. 53.3% of inexperienced but 28.4\\% of experienced parents were adherent (p = 0.0003. The groups did not differ on potential moderating variables. Adherence was 39.5% among experienced parents receiving ``a lot of information'', but 15.4% for those receiving less (p = 0.002; amount of information did not affect adherence in inexperienced parents (p = 0.22 but uniquely predicted adherence compared to a model with experience alone (p = 0.0005. Experienced parents were also less likely to mistrust drug packaging (p = 0.03. Targeting FDA information to experienced parents, particularly via drug packaging, may improve their adherence.

Strategies to improve adherence to treatment in adolescents and young adults with cancer: a systematic review

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Robertson EG

2015-07-01

Full Text Available Eden G Robertson,1,2 Claire E Wakefield,1,2 Kate H Marshall,2 Ursula M Sansom-Daly1–3 1Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, University of New South Wales, Kensington, NSW, Australia; 2Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, 3Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital, Randwick, NSW, Australia Purpose: Adolescents and young adults (AYAs with cancer have higher rates of nonadherence to treatment relative to younger and older cancer patients. Efforts to improve adherence in this population are therefore increasing. This review aimed: 1 to synthesize recommendations and strategies used to improve treatment adherence in AYAs with cancer, and 2 to summarize the available evidence supporting the efficacy of adherence-promoting strategies for AYAs with cancer.Methods: We conducted a systematic review with two stages: 1 a narrative stage, to analyze expert recommendations, and 2 an evaluative stage, to summarize quantitative evidence for interventions. Four electronic databases were searched for studies involving AYAs, aged 10–39 years, with cancer, published from 2005 to 2015. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA guidelines were used to ensure quality of the review. The Delphi list was used to assess study quality.Results: Nine articles were identified in the narrative stage of the review. For the evaluative stage, out of 113 screened abstracts, only one eligible intervention was identified. Common themes of adherence-promoting strategies were grouped into five domains: developmental, communication, educational, psychological well-being, and logistical/management strategies. Strategies to address developmental stage and to improve communication were the most highly recommended to improve adherence. Few strategies focused on the role of the patient in adherence. One

Understanding factors associated with early therapeutic alliance in PTSD treatment: adherence, childhood sexual abuse history, and social support.

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Keller, Stephanie M; Zoellner, Lori A; Feeny, Norah C

2010-12-01

Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline. At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures. Early alliance was associated with PE adherence (r = .32, p history was not predictive of a lower early alliance. Given the associations with adherence, clinicians may find it useful to routinely assess alliance early in treatment. Positive trauma support, not CSA history, may be particularly important in the development of a strong early therapeutic alliance. (c) 2010 APA, all rights reserved.

A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure.

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Wu, Jia-Rong; DeWalt, Darren A; Baker, David W; Schillinger, Dean; Ruo, Bernice; Bibbins-Domingo, Kristen; Macabasco-O'Connell, Aurelia; Holmes, George M; Broucksou, Kimberly A; Erman, Brian; Hawk, Victoria; Cene, Crystal W; Jones, Christine DeLong; Pignone, Michael

2014-09-01

failure. It is important for clinicians to assess patients' medication adherence on a regular basis at their clinical follow-ups. © 2013 John Wiley & Sons Ltd.

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT).

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Foster, Bethany J; Pai, Ahna L H; Zelikovsky, Nataliya; Amaral, Sandra; Bell, Lorraine; Dharnidharka, Vikas R; Hebert, Diane; Holly, Crystal; Knauper, Baerbel; Matsell, Douglas; Phan, Veronique; Rogers, Rachel; Smith, Jodi M; Zhao, Huaqing; Furth, Susan L

2018-03-15

Poor adherence to immunosuppressive medications is a major cause of premature graft loss among children and young adults. Multicomponent interventions have shown promise but have not been fully evaluated. Unblinded parallel-arm randomized trial to assess the efficacy of a clinic-based adherence-promoting intervention. Prevalent kidney transplant recipients 11 to 24 years of age and 3 or more months posttransplantation at 8 kidney transplantation centers in Canada and the United States (February 2012 to May 2016) were included. Adherence was electronically monitored in all participants during a 3-month run-in, followed by a 12-month intervention. Participants assigned to the TAKE-IT intervention could choose to receive text message, e-mail, and/or visual cue dose reminders and met with a coach at 3-month intervals when adherence data from the prior 3 months were reviewed with the participant. "Action-Focused Problem Solving" was used to address adherence barriers selected as important by the participant. Participants assigned to the control group met with coaches at 3-month intervals but received no feedback about adherence data. The primary outcomes were electronically measured "taking" adherence (the proportion of prescribed doses of immunosuppressive medications taken) and "timing" adherence (the proportion of doses of immunosuppressive medications taken between 1 hour before and 2 hours after the prescribed time of administration) on each day of observation. Secondary outcomes included the standard deviation of tacrolimus trough concentrations, self-reported adherence, acute rejection, and graft failure. 81 patients were assigned to intervention (median age, 15.5 years; 57% male) and 88 to the control group (median age, 15.8 years; 61% male). Electronic adherence data were available for 64 intervention and 74 control participants. Participants in the intervention group had significantly greater odds of taking prescribed medications (OR, 1.66; 95% CI, 1

A therapist-focused knowledge translation intervention for improving patient adherence in musculoskeletal physiotherapy practice.

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Babatunde, Folarin Omoniyi; MacDermid, Joy Christine; MacIntyre, Norma

2017-01-01

Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. An active knowledge translation (KT) strategy may be an effective strategy to support practice change. The purpose of this study was to deliver a brief, interactive, multifaceted and targeted KT program to improve physiotherapist knowledge and confidence in performing adherence enhancing activities related to risk, barriers, assessment and interventions. We utilised a 2-phase approach in this KT project. Phase 1 involved the development of an adherence tool kit following a synthesis of the literature and an iterative process involving 47 end-users. Clinicians treating patients with musculoskeletal conditions were recruited from two Physiotherapy and Occupational therapy national conferences in Canada. The intervention, based on the acronym SIMPLE TIPS was tested on 51 physiotherapists in phase 2. A pre- and post-repeated measures design was used in Phase 2. Graham's knowledge-to-action cycle was used as the conceptual framework. Participants completed a pre-intervention assessment, took part in a 1-h educational session and completed a post-intervention assessment. A questionnaire was used to measure knowledge of evidence-based treatment adherence barriers, interventions and measures and confidence to perform evidence-based adherence practice activities. Data was analysed using descriptive statistics (frequency and percentage), Fisher's exact test and Wilcoxon Sign-Ranked tests. Barriers and facilitators of adherence were identified under three domains (therapist, patient, health system) in phase 1. Seventy percent of the participants completed the questionnaire. Results indicated that 46.8% of respondents explored barriers including the use of behaviour change strategies and 45.7% reported that they measured adherence but none reported the use of validated outcomes. A significant improvement in

Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations

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Blaine, Rachel E.; Fisher, Jennifer Orlet; Taveras, Elsie M.; Geller, Alan C.; Rimm, Eric B.; Land, Thomas; Perkins, Meghan; Davison, Kirsten K.

2015-01-01

Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012–2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2–12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD)) for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2) or satisfying hunger (x̄ = 2.4; SD 2.1) almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5) or celebrating events/holidays (x̄ = 0.8; SD 1.1). Parents reported giving young children (2–5 years) more snacks to reward behavior (1.9 vs. 1.1, p parents of older children (6–12 years). Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR) = 0.83; 95% Confidence Interval (CI) 0.70–0.99), celebrate events/holidays (OR = 0.72; 95% CI 0.52–0.99), or achievements (OR = 0.82; 95% CI 0.68–0.98). Parental intentions around child snacking are likely important targets for obesity prevention efforts. PMID:26197335

Long-Term Follow-Up of Children after Venom Immunotherapy: Low Adherence to Anaphylaxis Guidelines.

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Fiedler, Claudia; Miehe, Ulrich; Treudler, Regina; Kiess, Wieland; Prenzel, Freerk

2017-01-01

Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status. For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. We included patients who were treated with a 3-year VIT between 1993 and 2009 and had completed a questionnaire. Forty of the 311 patients were included. Mean VIT duration was 3.1 years. Of the 40 patients included, 29 children (72.5%) received VIT with vespid venom, 9 with bee venom, and 2 patients with both venoms. During a mean follow-up period of 13 years, 20/40 patients (50%) suffered re-stings. Six of the 20 (30%) patients developed again anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2 were allergic to vespid and 4 to bee venom. Of the entire cohort, only 5/40 (12.5%) had appropriate emergency kits according to the guidelines of the European Academy of Allergy and Clinical Immunology. Among the patients who had emergency kits available, one third (5/15) felt uncertain about the correct application of the medication. Less than two thirds of our population (25/40) affirmed that they have been educated in emergency management. The vast majority (95%; 38/40) of our patients did not have allergy follow-ups after VIT completion. Anaphylactic relapses are not uncommon, and there are considerable deficits in the emergency management of patients. Hence, comprehensive standardized anaphylaxis education programs as well as regular follow-ups of the allergy status are crucial. © 2017 S. Karger AG, Basel.

The presence of radiological features on chest radiographs: How well do clinicians agree?

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Edwards, M. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Lawson, Z. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Morris, S.; Evans, A.; Harrison, S.; Isaac, R. [Department of Paediatric Radiology, University Hospital of Wales, Cardiff (United Kingdom); Crocker, J. [Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Powell, C., E-mail: powellc7@cardiff.ac.uk [Department of Child Health, School of Medicine, Cardiff University (United Kingdom)

2012-07-15

Aim: To compare levels of agreement amongst paediatric clinicians with those amongst consultant paediatric radiologists when interpreting chest radiographs (CXRs). Materials and methods: Four paediatric radiologists used picture archiving and communication system (PACS) workstations to evaluate the presence of five radiological features of infection, independently in each of 30 CXRs. The radiographs were obtained over 1 year (2008) from children with fever and signs of respiratory distress, aged 6 months to <16 years. The same CXRs were interpreted a second time by the paediatric radiologists and by 21 clinicians with varying experience levels, using the Web 1000 viewing system and a projector. Intra- and interobserver agreement within groups, split by grade and specialty, were analysed using free-marginal multi-rater kappa. Results: Normal CXRs were identified consistently amongst all 25 participants. The four paediatric radiologists showed high levels of intraobserver agreement between methods (kappa scores between 0.53 and 1.00) and interobserver agreement for each method (kappa scores between 0.67 and 0.96 for PACS assessment). The 21 clinicians showed varying levels of agreement from 0.21 to 0.89. Conclusion: Paediatric radiologists showed high levels of agreement for all features. In general, the clinicians had lower levels of agreement than the radiologists. This study highlights the need for improved training in interpreting CXRs for clinicians and the timely reporting of CXRs by radiologists to allow appropriate patient management.

Interpersonal Factors Are Associated with Lower Therapist Adherence in Cognitive-Behavioural Therapy for Panic Disorder.

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Zickgraf, Hana F; Chambless, Dianne L; McCarthy, Kevin S; Gallop, Robert; Sharpless, Brian A; Milrod, Barbara L; Barber, Jacques P

2016-05-01

The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive-behavioural treatment (CBT) manual were tested. Thirty-eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24-session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the structured clinical interview for DSM-IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory-short form. The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence. Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd. Patients' behavioural resistance to therapy may make it more difficult for cognitive-behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians

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Haik J

2017-06-01

Full Text Available Josef Haik,1–3 Stav Brown,1,2 Alon Liran,1 Denis Visentin,4 Amit Sokolov,2 Isaac Zilinsky,1,2 Rachel Kornhaber1,4 1Department of Plastic and Reconstruction Surgery, The National Burns Center, Sheba Medical Center, Tel Hashomer, 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 3Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel; 4School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia Abstract: Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory, depression (PRIME-MD, health-related quality of life (SF-8, and compassion fatigue (Professional Quality of Life version 5. Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2% among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P=0.017. Additional factors contributing to compassion fatigue were those without children (P=0.016, divorced (P=0.035, of a younger age (P=0.019, and a registered nurse (P=0.05. Burnout increased clinicians’ risk of adverse professional and personal outcomes and correlated with less free time (P<0.001, increased risk of experiencing work-home disputes (P=0.05, increased depression (P=0

Perspectives Regarding Adherence to Prescribed Treatment in Highly Adherent HIV-Infected Gay Men.

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Brion, John M; Menke, Edna M

2008-01-01

Focus group methodology was used to describe the medication adherence experience of 24 HIV-infected gay men who reported being adherent to their medication regimens. A conceptualization of medication adherence as an evolving process consisted of challenges to adherence (learning the diagnosis, starting the medications, struggling with the medications, dealing with side effects, coping with stigma) as well as those factors supportive of adherence (believing in medications, finding motivating factors, using reminders, depending on others, owning the disease). Themes associated with challenges to adherence focused on diagnosis and the physical and emotional adjustments individuals made to incorporate antiretroviral medications into their daily lives and move toward medication adherence. The factors supportive of adherence were related to the ongoing behaviors identified with establishing and maintaining adherence behaviors. What can be taken from the study is that adherence is a complex and dynamic process rather than a static behavior.

African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

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Christina M. Pettey

2016-01-01

Full Text Available More than 80 million Americans have hypertension (HTN, and African Americans (AAs are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs’ perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs’ perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, in-person interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years. Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments “passed down,” increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group.

Virtual community centre for power wheelchair training: Experience of children and clinicians.

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Torkia, Caryne; Ryan, Stephen E; Reid, Denise; Boissy, Patrick; Lemay, Martin; Routhier, François; Contardo, Resi; Woodhouse, Janet; Archambault, Phillipe S

2017-11-02

To: 1) characterize the overall experience in using the McGill immersive wheelchair - community centre (miWe-CC) simulator; and 2) investigate the experience of presence (i.e., sense of being in the virtual rather than in the real, physical environment) while driving a PW in the miWe-CC. A qualitative research design with structured interviews was used. Fifteen clinicians and 11 children were interviewed after driving a power wheelchair (PW) in the miWe-CC simulator. Data were analyzed using the conventional and directed content analysis approaches. Overall, participants enjoyed using the simulator and experienced a sense of presence in the virtual space. They felt a sense of being in the virtual environment, involved and focused on driving the virtual PW rather than on the surroundings of the actual room where they were. Participants reported several similarities between the virtual community centre layout and activities of the miWe-CC and the day-to-day reality of paediatric PW users. The simulator replicated participants' expectations of real-life PW use and promises to have an effect on improving the driving skills of new PW users. Implications for rehabilitation Among young users, the McGill immersive wheelchair (miWe) simulator provides an experience of presence within the virtual environment. This experience of presence is generated by a sense of being in the virtual scene, a sense of being involved, engaged, and focused on interacting within the virtual environment, and by the perception that the virtual environment is consistent with the real world. The miWe is a relevant and accessible approach, complementary to real world power wheelchair training for young users.

Addressing adherence to treatment: a longstanding concern. The health care professional

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Farrukh Shah

2014-12-01

Full Text Available Today a patient born with thalassaemia major can expect to have a near normal life expectancy and remain free of complications of iron overload with good monitoring and excellent transfusion and chelation regimes. Unfortunately patients still develop complications as a consequence of iron overload including endocrinopathies and cardiac failure. The main reason behind this failure of effective treatment is inadequate treatment. This can be due to either clinician related factors, patient related factors or lack of adequate provision of medicines and services. In this short paper I will highlight where the challenges lie with regards adherence to treatment and suggest approaches to manage this.

Total, Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007–2010

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Diewertje Sluik

2016-01-01

Full Text Available A high sugar intake is a subject of scientific debate due to the suggested health implications and recent free sugar recommendations by the WHO. The objective was to complete a food composition table for added and free sugars, to estimate the intake of total sugars, free sugars, and added sugars, adherence to sugar guidelines and overall diet quality in Dutch children and adults. In all, 3817 men and women (7–69 years from the Dutch National Food Consumption Survey 2007–2010 were studied. Added and free sugar content of products was assigned by food composition tables and using labelling and product information. Diet was assessed with two 24-h recalls. Diet quality was studied in adults with the Dutch Healthy Diet-index. Total sugar intake was 22% Total Energy (%TE, free sugars intake 14 %TE, and added sugar intake 12 %TE. Sugar consumption was higher in children than adults. Main food sources of sugars were sweets and candy, non-alcoholic beverages, dairy, and cake and cookies. Prevalence free sugar intake <10 %TE was 5% in boys and girls (7–18 years, 29% in women, and 33% in men. Overall diet quality was similar comparing adults adherent and non-adherent to the sugar guidelines, although adherent adults had a higher intake of dietary fiber and vegetables. Adherence to the WHO free sugar guidelines of <5 %TE and <10 %TE was generally low in the Netherlands, particularly in children. Adherence to the added and free sugar guidelines was not strongly associated with higher diet quality in adults.

Services for children with developmental co-ordination disorder: an evaluation against best practice principles.

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Pentland, Jacqueline; Maciver, Donald; Owen, Christine; Forsyth, Kirsty; Irvine, Linda; Walsh, Mike; Crowe, Miriam

2016-01-01

The National Health Service in Scotland published a best practice framework to support occupational therapists and physiotherapists to deliver effective services for children with developmental co-ordination disorder (DCD); however, adherence is variable. To highlight areas for development, this study compared the care pathway within a paediatric DCD service against the NHS Scotland framework. A partnership of researchers and clinicians based in the United Kingdom conducted a qualitative study with 37 participants (N = 13 interview participants, N = 24 workshop participants). In-depth interviews and/or workshops were used to map the DCD service against the NHS framework. Identified gaps were aligned with four key stages of the care pathway. Qualitative analysis software was used to analyse the data. Core principles to guide future development were identified for each phase of the pathway. These core principles related to the NHS framework and focused on issues such as involving the family, defining clear pathways and enhancing children's participation. Participants identified potential strategies for service improvement such as developing community-based interventions and information provision. Challenges when providing services for children with DCD include confusing service pathways and poor partnership working. It is, therefore, important that clinicians utilise collaborative working strategies that support children's participation. There are numerous challenges related to the implementation of best practice principles into the provision of therapy services for children with developmental coordination disorder (DCD). It is important that AHPs seek ways of engaging parents and educational professionals at all stages of the care pathway in order to ensure optimum service provision for the child. Addressing participation is an important aspect and community-based strategies may be particularly beneficial, both as a preventative activity and as an

Enhancing group cognitive-behavioral therapy for hoarding disorder with between-session Internet-based clinician support: A feasibility study.

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Ivanov, Volen Z; Enander, Jesper; Mataix-Cols, David; Serlachius, Eva; Månsson, Kristoffer N T; Andersson, Gerhard; Flygare, Oskar; Tolin, David; Rück, Christian

2018-02-07

Hoarding disorder (HD) is difficult to treat. In an effort to increase efficacy and engagement in cognitive-behavioral therapy (CBT), we developed and evaluated a novel intervention comprising group CBT combined with between-session Internet-based clinician support for people with HD. Twenty participants with HD received group CBT combined with an Internet-support system enabling therapist-participant communication between group sessions. The treatment was associated with a significant reduction on the Saving Inventory-Revised (SI-R) and a large effect size (Cohen's d = 1.57) was found at posttreatment. Treatment gains were maintained at the 3-month follow-up. Group attendance was high and no participants dropped out from treatment prematurely. Between-session motivational support from the therapist was most frequently mentioned as the main strength of the system. The results of this study support adding Internet-based clinician support to group CBT for HD to increase treatment adherence and, potentially, improve the overall efficacy of CBT. © 2018 Wiley Periodicals, Inc.

The effects of training mental health practitioners in medication management to address nonadherence: a systematic review of clinician-related outcomes

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Bressington D

2013-05-01

Full Text Available Daniel Bressington,1 Esther Coren,1 Douglas MacInnes21Department of Health, Well-Being and Family, 2Centre for Health and Social Care Research, Canterbury Christ Church University, Canterbury, UKBackground: Nonadherence with medicine prescribed for mental health is a common problem that results in poor clinical outcomes for service users. Studies that provide medication management-related training for the mental health workforce have demonstrated that improvements in the knowledge, attitudes, and skills of staff can help to address nonadherence. This systematic review aims to establish the effectiveness of these training interventions in terms of clinician-related outcomes.Methods: Five electronic databases were systematically searched: PubMed, CINAHL, Medline, PsycInfo, and Google Scholar. Studies were included if they were qualitative or quantitative in nature and were primarily designed to provide mental health clinicians with knowledge and interventions in order to improve service users' experiences of taking psychotropic medications, and therefore potentially address nonadherence issues.Results: A total of five quantitative studies were included in the review. All studies reported improvements in clinicians' knowledge, attitudes, and skills immediately following training. The largest effect sizes related to improvements in clinicians' knowledge and attitudes towards nonadherence. Training interventions of longer duration resulted in the greatest knowledge- and skills-related effect sizes.Conclusion: The findings of this review indicate that training interventions are likely to improve clinician-related outcomes; however, due to the methodological limitations of the current evidence base, future research in this area should aim to conduct robust randomized controlled trials with follow-up and consider collecting qualitative data to explore clinicians' experiences of using the approaches in clinical practice.Keywords: staff training

Coding paediatric outpatient data to provide health planners with information on children with chronic conditions and disabilities.

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Craig, Elizabeth; Kerr, Neal; McDonald, Gabrielle

2017-03-01

In New Zealand, there is a paucity of information on children with chronic conditions and disabilities (CCD). One reason is that many are managed in hospital outpatients where diagnostic coding of health-care events does not occur. This study explores the feasibility of coding paediatric outpatient data to provide health planners with information on children with CCD. Thirty-seven clinicians from six District Health Boards (DHBs) trialled coding over 12 weeks. In five DHBs, the International Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD-10-AM) and Systematised Nomenclature of Medicine Clinical Terms (SNOMED-CT) were trialled for 6 weeks each. In one DHB, ICD-10-AM was trialled for 12 weeks. A random sample (30%) of ICD-10-AM coded events were also coded by clinical coders. A mix of paper and electronic methods were used. In total 2,604 outpatient events were coded in ICD-10-AM and 693 in SNOMED-CT. Dual coding occurred for 770 (29.6%) ICD-10-AM events. Overall, 34% of ICD-10-AM and 40% of SNOMED-CT events were for developmental and behavioural disorders. Chronic medical conditions were also common. Clinicians were concerned about the workload impacts, particularly for paper-based methods. Coder's were concerned about clinician's adherence to coding guidelines and the poor quality of documentation in some notes. Coded outpatient data could provide planners with a rich source of information on children with CCD. However, coding is also resource intensive. Thus its costs need to be weighed against the costs of managing a much larger health budget using very limited information. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Once a clinician, always a clinician: a systematic review to develop a typology of clinician-researcher dual-role experiences in health research with patient-participants

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E. Jean C. Hay-Smith

2016-08-01

Full Text Available Abstract Background Many health researchers are clinicians. Dual-role experiences are common for clinician-researchers in research involving patient-participants, even if not their own patients. To extend the existing body of literature on why dual-role is experienced, we aimed to develop a typology of common catalysts for dual-role experiences to help clinician-researchers plan and implement methodologically and ethically sound research. Methods Systematic searching of Medline, CINAHL, PsycINFO, Embase and Scopus (inception to 28.07.2014 for primary studies or first-person reflexive reports of clinician-researchers’ dual-role experiences, supplemented by reference list checking and Google Scholar scoping searches. Included articles were loaded in NVivo for analysis. The coding was focused on how dual-role was evidenced for the clinician-researchers in research involving patients. Procedures were completed by one researcher (MB and independently cross-checked by another (JHS. All authors contributed to extensive discussions to resolve all disagreements about initial coding and verify the final themes. Results Database searching located 7135 records, resulting in 29 included studies, with the addition of 7 studies through reference checks and scoping searches. Two overarching themes described the most common catalysts for dual-role experiences – ways a research role can involve patterns of behaviour typical of a clinical role, and the developing connection that starts to resemble a clinician-patient relationship. Five subthemes encapsulated the clinical patterns commonly repeated in research settings (clinical queries, perceived agenda, helping hands, uninvited clinical expert, and research or therapy and five subthemes described concerns about the researcher-participant relationship (clinical assumptions, suspicion and holding back, revelations, over-identification, and manipulation. Clinician-researchers use their clinical skills in health

A clinician-driven home care delivery system.

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August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R

1993-12-01

The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal.

Medication Adherence After Renal Transplantation-a Review of the Literature.

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Rebafka, Anne

2016-12-01

Whether or not patients follow the advice given by their healthcare professional is commonly referred to as adherence. In the case of kidney transplantation, transplant recipients need to take immunosuppressive drugs on a regular basis to prevent rejection of their transplant. However, medication adherence can be problematic for many patients. This critical appraisal of evidence aimed to gain insights into factors contributing to adherence and non-adherence in recipients of kidney transplants, and to explore patients' perceptions regarding adherence to immunosuppression. A comprehensive literature search was performed using Medline, PsycInfo, the Joanna Briggs Institute, CINAHL and the Cochrane Library. Included were primary research studies or reviews of primary research, independent of their research paradigms, on adult kidney or kidney/pancreas transplant recipients published in English or German. Children or adolescents were not considered. No time-frame was applied RESULTS: Fifty-two papers were included in the review. All extracted findings of included papers were organised according to the five factors influencing medication-taking behaviour as defined by the World Health Organisation: social and economic factors; therapy-related factors; patient-related factors; condition-related factors; healthcare team and system-related factors. Reasons for non-adherence after kidney transplantations are diverse. Attention is attracted by the fact that potentially modifiable factors such as social support, experiences on dialysis, side effects, features of the treatment regimen, intentions and beliefs, forgetfulness and mental health issues play a greater role than other factors in the development of medication non-adherence. Factors not related to patient characteristics seem to be under researched. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

A new intervention for people with borderline personality disorder who are also parents: a pilot study of clinician acceptability.

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McCarthy, Kye L; Lewis, Kate L; Bourke, Marianne E; Grenyer, Brin F S

2016-01-01

Engaging parents who have a personality disorder in interventions designed to protect children from the extremes of the disorder supports both parenting skills and healthy child development. In line with evidence-based guidelines, a 'Parenting with Personality Disorder' brief intervention was developed, focusing on child safety, effective communication and parenting strategies. Ratings of acceptability for the brief intervention model were given by 168 mental health clinicians who attended training. Changes in clinician attitudes, knowledge and skills were also assessed following training. Providing clinicians treating personality disorder clients with additional skills to address parenting was well received and filled a gap in service provision. Clinicians reported improvements in clinical skills, knowledge, willingness and confidence to intervene in parenting issues with clients. Qualitative responses endorsed three major modes of learning: case study analysis, reflective learning activities, and skills-based intervention practices. Current treatment guidelines emphasise addressing parenting, but no evidence-based therapy includes specific parenting skills. This brief intervention model improved skills, efficacy and willingness to intervene. This approach can be readily added to current evidence-based therapy protocols and promises to improve client functioning and protect children from the extremes of the disorder. Clinical trials are now required to validate the approach in the field.

Adherence to the guidelines of paediatric cervical spine clearance in a level I trauma centre: A single centre experience

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Slaar, Annelie; Fockens, M. Matthijs; van Rijn, Rick R.; Maas, Mario; Goslings, J. Carel; Bakx, Roel; Streekstra, Geert J.; Beenen, Ludo F. M.; Schep, Niels W. L.

2016-01-01

International guidelines define if and what type of radiography is advised in children to clear the cervical spine (C-spine). However, adherence to these guidelines has never been evaluated in a paediatric population. Therefore, we wanted to assess the adherence to the guidelines for C-spine

Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development.

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Fishbein, Joel Nathan; Nisotel, Lauren Ellen; MacDonald, James John; Amoyal Pensak, Nicole; Jacobs, Jamie Michele; Flanagan, Clare; Jethwani, Kamal; Greer, Joseph Andrew

2017-04-20

Oral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer. While oral chemotherapy includes benefits such as ease of administration, convenience, and minimization of invasive infusions, patients receive less oversight, support, and symptom monitoring from clinicians. Additionally, adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens. With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology, we created a mobile health intervention for medication and symptom management. The objective of this study was to develop and evaluate the usability and acceptability of a smartphone app to support adherence to oral chemotherapy and symptom management in patients with cancer. We used a 5-step development model to create a comprehensive mobile app with theoretically informed content. The research and technical development team worked together to develop and iteratively test the app. In addition to the research team, key stakeholders including patients and family members, oncology clinicians, health care representatives, and practice administrators contributed to the content refinement of the intervention. Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the randomized controlled trial. We incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing. App components included medication reminders, self-reporting of medication adherence and symptoms, an education library including nutritional information, Fitbit integration, social networking resources, and individually tailored symptom management feedback. We are conducting a randomized controlled trial to determine the effectiveness of the app in improving adherence to oral chemotherapy, quality of life, and burden of

The role of technology in clinician-to-clinician communication.

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McElroy, Lisa M; Ladner, Daniela P; Holl, Jane L

2013-12-01

Incomplete, fragmented and poorly organised communications contribute to more than half the errors that lead to adverse and sentinel events. Meanwhile, communication software and devices with expanding capabilities are rapidly proliferating and being introduced into the healthcare setting. Clinicians face a large communication burden, which has been exacerbated by the additional challenge of selecting a mode of communication. In addition to specific communication devices, some hospitals have implemented advanced technological systems to assist with communication. However, few studies have provided empirical evidence of the specific advantages and disadvantages of the different devices used for communication. Given the increasing quantities of information transmitted to and by clinicians, evaluations of how communication methods and devices can improve the quality, safety and outcomes of healthcare are needed.

Using protection motivation theory and formative research to guide an injury prevention intervention: increasing adherence to the North American Guidelines for Children's Agricultural Tasks.

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Ashida, Sato; Heaney, Catherine A; Kmet, Jennifer M; Wilkins, J R

2011-05-01

The North American Guidelines for Children's Agricultural Tasks (NAGCAT) were developed to reduce childhood agricultural injuries by assisting adults in assigning appropriate chores and providing needed supervision and training. To develop an effective intervention to increase adherence to NAGCAT among farm parents, formative research (focus groups and pilot-testing) was conducted. Protection motivation theory (PMT) was used to guide this research and inform intervention development. Focus group results suggested how PMT constructs might be addressed to increase adherence. A home visit intervention, using a standardized presentation in POWERPoint™, was developed to (a) introduce NAGCAT, (b) increase motivation to use NAGCAT and enhance safe work behaviors, and (c) ultimately reduce agricultural work-related injuries among youth. Process evaluation data suggests that the intervention was well received by farm parents. Conducting theory-guided formative research identified motivational barriers and strategies for overcoming these barriers that might not have been otherwise apparent.

Adherence to the Gluten-free Diet and Health-related Quality of Life in an Ethnically Diverse Pediatric Population With Celiac Disease.

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Mager, Diana R; Marcon, Margaret; Brill, Herbert; Liu, Amanda; Radmanovich, Kristin; Mileski, Heather; Nasser, Roseann; Alzaben, Abeer; Carroll, Matthew W; Yap, Jason; Persad, Rabin; Turner, Justine M

2018-06-01

Celiac disease (CD) is an autoimmune disease that requires lifelong adherence to a gluten-free diet (GFD). Adherence to the GFD in childhood may be poor and adversely influence health-related quality of life (HRQOL). The study purpose was to determine sociodemographic and socioeconomic factors influencing adherence to the GFD and HRQOL in a multiethnic cohort of youth with CD. A multisite (Edmonton, Hamilton, Toronto) study examining child-parent HRQOL in youth with CD (n = 243) and/or mild gastrointestinal complaints (GI-CON; n = 148) was conducted. Sociodemographic (age, child-parental age/education/ethnicity/place of birth), anthropometric (weight, height, body mass index), disease (diagnosis, age at diagnosis, duration, Marsh score, serology), household characteristics (income, family size, region, number of children/total household size), HRQOL (Peds TM/KINDL and Celiac Disease DUX), GI Complaints (PedsQL: Gastrointestinal Symptom Scale) and gluten intake were measured. Younger age (children (P children (parent/child) had higher HRQOL (average, composite domains) than GI-CON (P children were comparable to healthy children. Lack of GI symptoms, non-Caucasian ethnicity and age (<10 years) were associated with increased HRQOL in composite/average domains for CD (P < 0.05). Child-parent perceptions of HRQOL in a multiethnic population with CD are comparable to healthy reference populations, but significantly higher than in parent/child GI-CON. Adherence to the GFD in ethnically diverse youth with CD was related to GI symptoms, age of the child, and ethnicity of the parent-child.

Looking for trouble: Adherence to late-effects surveillance among childhood cancer survivors.

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Reppucci, Marina L; Schleien, Charles L; Fish, Jonathan D

2017-02-01

Childhood cancer survivors (CCSs) are at high risk of morbidity and mortality from long-term complications of their cancer treatment. The Children's Oncology Group developed screening guidelines to enable the early identification of and intervention for late effects of cancer treatment. There is a paucity of data on the adherence of CCSs to screening recommendations. A retrospective analysis of medical records to evaluate the rate of adherence of CCSs to the personalized, risk-based recommendations provided to them in the context of a structured long-term follow-up program over a 3-year period. Two hundred eighty-six CCSs visited the survivorship clinic 542 times during the 3-year study period. The overall rate of adherence to recommended screening was 74.2%. Using a univariate model and greater age at diagnosis and at screening recommendation were associated with decreased screening adherence. Gender, cancer diagnosis, radiation therapy, anthracycline exposure, and hematopoietic stem cell transplant were not significantly associated with adherence. In a multivariate model, age over 18 years at the time of the visit was significantly associated with decreased adherence (P < 0.0329) (odds ratio: 1.53, 95% confidence interval: 1.04-2.25). Adherence to recommended screening tests is suboptimal among CCSs, with lower rates of adherence in CCSs older than 18 years of age compared with those younger than 18 years of age. Given the morbidity and mortality from the late effects of therapy among young adult CCSs, it is critically important to identify and remove barriers to late-effects screening among CCSs. © 2016 Wiley Periodicals, Inc.

Adherence to hydroxyurea medication by children with sickle cell disease (SCD) using an electronic device: a feasibility study.

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Inoue, Susumu; Kodjebacheva, Gergana; Scherrer, Tammy; Rice, Gary; Grigorian, Matthew; Blankenship, Jeremy; Onwuzurike, Nkechi

2016-08-01

Adherence to hydroxyurea (HU) is a significant modifying factor in sickle cell vaso-occlusive pain. We conducted a study using an electronic medication container-monitor-reminder device (GlowCap™) to track adherence and determine whether use of this device affected rates of HU adherence. Subjects were regular attendees to our clinic. They were given a 37-item questionnaire and were asked to use a GlowCap containing HU. When the device cap is opened, it makes a remote "medication taken" record. The device also provides usage reminder in the form of lights and alarm sounds if the cap opening is delayed. Nineteen subjects participated in the survey, and 17 in the intervention phase. Of the 17, 12 had reliable adherence data. Seventeen caregivers of patients and two patients completed the survey. Two most common barriers to adherence identified were lack of reminders and absence of medicine home delivery. The intervention component of this study, which used both the electronic (GlowCap) method and medication possession ratio showed that the median adherence rate for the 12 patients evaluated was 85 %. The GlowCap device accurately kept a record of adherence rates. This device may be an effective tool for increasing HU medication adherence.

Beliefs related to adherence to oral antidiabetic treatment according to the Theory of Planned Behavior.

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Jannuzzi, Fernanda Freire; Rodrigues, Roberta Cunha Matheus; Cornélio, Marilia Estevam; São-João, Thaís Moreira; Gallani, Maria Cecília Bueno Jayme

2014-01-01

to identify salient behavioral, normative, control and self-efficacy beliefs related to the behavior of adherence to oral antidiabetic agents, using the Theory of Planned Behavior. cross-sectional, exploratory study with 17 diabetic patients in chronic use of oral antidiabetic medication and in outpatient follow-up. Individual interviews were recorded, transcribed and content-analyzed using pre-established categories. behavioral beliefs concerning advantages and disadvantages of adhering to medication emerged, such as the possibility of avoiding complications from diabetes, preventing or delaying the use of insulin, and a perception of side effects. The children of patients and physicians are seen as important social references who influence medication adherence. The factors that facilitate adherence include access to free-of-cost medication and taking medications associated with temporal markers. On the other hand, a complex therapeutic regimen was considered a factor that hinders adherence. Understanding how to use medication and forgetfulness impact the perception of patients regarding their ability to adhere to oral antidiabetic agents. medication adherence is a complex behavior permeated by behavioral, normative, control and self-efficacy beliefs that should be taken into account when assessing determinants of behavior.

Recruiting a representative sample in adherence research-The MALT multisite prospective cohort study experience.

Science.gov (United States)

Shemesh, Eyal; Mitchell, Jeffrey; Neighbors, Katie; Feist, Susan; Hawkins, Andre; Brown, Amanda; Wanrong, Yin; Anand, Ravinder; Stuber, Margaret L; Annunziato, Rachel A

2017-12-01

Medication adherence is an important determinant of transplant outcomes. Attempts to investigate adherence are frequently undermined by selection bias: It is very hard to recruit and retain non-adherent patients in research efforts. This manuscript presents recruitment strategies and results from the MALT (Medication Adherence in children who had a Liver Transplant) multisite prospective cohort study. MALT sites recruited 400 pediatric liver transplant patients who agreed to be followed for 2 years. The primary purpose was to determine whether a marker of adherence, the Medication Level Variability Index (MLVI), predicts rejection outcomes. The present manuscript describes methods used in MALT to ensure that a representative sample was recruited, and presents detailed recruitment results. MALT sites were able to recruit a nationally representative sample, as determined by a comparison between the MALT cohort and a national sample of transplant recipients. Strategies that helped ensure that the sample was representative included monitoring of the outcome measure in comparison with a national sample, drastically limiting patient burden, and specific recruitment methods. We discuss the importance of a representative sample in adherence research and recommend that future efforts to study adherence pay special attention to sample characteristics. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status.

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Ferrer, Robert L

2007-01-01

Long-term shifts in specialty choice and health workforce policy have raised concern about the future of primary care in the United States. The objective of this study was to examine current use of primary and specialty care across the US population for policy-relevant subgroups, such as disadvantaged populations and persons with chronic illness. Data from the Medical Expenditure Panel Survey from 2004 were analyzed using a probability sample patients or other participants from the noninstitutionalized US population in 2004 (N = 34,403). The main and secondary outcome measures were the estimates of the proportion of Americans who accessed different types of primary care and specialty physicians and midlevel practitioners, as well as the fraction of ambulatory visits accounted for by the different clinician types. Data were disaggregated by income, health insurance status, race/ethnicity, rural or urban residence, and presence of 5 common chronic diseases. Family physicians were the most common clinician type accessed by adults, seniors, and reproductive-age women, and they were second to pediatricians for children. Disadvantaged adults with 3 markers of disadvantage (poverty, disadvantaged minority, uninsured) received 45.6% (95% CI, 40.4%-50.7%) of their ambulatory visits from family physicians vs 30.5% (95% CI, 30.0%-32.1%) for adults with no markers. For children with 3 vs 0 markers of disadvantage, the proportion of visits from family physicians roughly doubled from 16.5% (95% CI, 14.4%-18.6%) to 30.1% (95% CI, 18.8%-41.2%). Family physicians constitute the only clinician group that does not show income disparities in access. Multivariate analyses show that patterns of access to family physicians and nurse-practitioners are more equitable than for other clinician types. Primary care clinicians, especially family physicians, deliver a disproportionate share of ambulatory care to disadvantaged populations. A diminished primary care workforce will leave

Patrones de adherencia de cepas de Escherichia coli Difusamente adherente (DAEC provenientes de niños con y sin diarrea Adhesion patterns in diffusely adherent Escherichia coli (DAEC strains isolated from children With and without diarrhea

Directory of Open Access Journals (Sweden)

Maribel Riveros

2011-03-01

Full Text Available Introducción. Las E. coli de adherencia difusa (DAEC son el sexto grupo de E. coli diarrogénicas reconocidas. Su asociación con diarrea es controversial. No se conoce la variabilidad en los patrones de adherencia de cepas clínicas. Objetivos. Comparar los patrones de adherencia entre cepas aisladas de niños con y sin diarrea. Materiales y métodos. Se analizó 31 cepas DAEC, 25 de diarrea y 6 de niños asintomáticos (control aislados de un estudio de cohorte de niños menores de 12 meses en el cono sur de Lima. Las DAEC fueron identificadas por PCR (gen daaD. Se evaluó el patrón y grado de adherencia en cultivos de células HEp-2; la polimerización de actina se evaluó por la prueba de coloración de fluorescencia de actina (FAS; y la motilidad se evaluó por métodos convencionales microbiológicos. Resultados. El patrón de adherencia difusa se encontró en el 88% de muestras de diarrea y en el 100% de muestras control. La cantidad de bacterias adheridas por célula fue significativamente menor en las muestras de diarrea (pIntroduction. Diffusely adherent E. coli (DAEC is the sixth recognized group of diarrheagenic E. coli. However, its association with diarrhea remains controversial. Variability in the adherence patterns of clinical strains is unknown. Objectives. To compare the adherence patterns between strains isolated from children with and without diarrhea. Materials and methods. A total of 31 DAEC strains were analyzed, 25 from children with diarrhea and 6 from asymptomatic (control children, isolated from a cohort study of children under one year of age in the southern districts of Lima. DAEC were identified by PCR (daaD gene. The pattern and adherence score in HEp-2 cell culture were evaluated, Actin polimerization was determined by fluorescence actin staining (FAS and motility was evaluated by conventional microbiology methods. Results. Diffuse adherence pattern was found in 88% of diarrhea samples and in the total of

A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia.

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Stip, Emmanuel; Vincent, Philippe D; Sablier, Juliette; Guevremont, Catherine; Zhornitsky, Simon; Tranulis, Constantin

2013-01-01

Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5% in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill(®) improved AAR of schizophrenic patients. Furthermore, we compared AAR obtained by the DoPill(®) and the BARS, in order to verify whether the DoPill(®) provides reliable assessment of medication adherence. The DoPill(®) is a smart pill dispenser that beeps and flashes at the appropriate time of the day. Each of its 28 compartments is covered by a plastic lamina that, when taken off, sends a signal to the pharmacist. Patients were randomized to the DoPill(®) or treatment as usual groups for 6 weeks. The BARS was used as a reference measure. Forty-six percent of patients were deemed to be non-adherent with antipsychotic medication. The mean AAR was 67% after 6 weeks. DoPill(®) recorded better AAR than some of those found in the literature and were lower than the BARS estimate we found. These results suggest that DoPill(®) is a valid tool that provides more reliable and objective data for the clinician about their patient's adherence, than existing assessment tools like the BARS. Furthermore, the device may help patients successfully manage their medication regimen.

Audiometric Testing Guideline Adherence in Children Undergoing Tympanostomy Tubes: A Population-Based Study.

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Beyea, Jason A; Rosen, Emily; Stephens, Trina; Nguyen, Paul; Hall, Stephen F

2018-02-01

Objective Tympanostomy tube (TT) insertion is the most common ambulatory surgery performed on children. American Academy of Otolaryngology-Head and Neck Surgery Founda-tion (AAO-HNSF) Clinical Practice Guidelines (CPGs) recommend hearing testing for all pediatric TT candidates. The aim of this study was to assess audiometric testing in this population. Study Design Retrospective population-based cohort study. Setting All hospitals in the Canadian province of Ontario. Subjects and Methods All patients 12 years of age and younger who underwent at least 1 TT procedure between January 1993 and June 2016. The primary outcomes were the percentage of patients who underwent a hearing test within 1 year before and/or 1 year after surgery. Results A total of 316,599 bilateral TT procedures were performed during the study period (1993 to 2016). Presurgical hearing tests increased from 55.7% to 74.9%, and postsurgical hearing tests increased from 42.2% to 68.9%. Younger surgeons demonstrated a greater adherence to the CPGs (relative risk [RR], 1.22; 95% CI, 1.08-1.38; P = .001). Remarkably, there was not a spike in preoperative hearing tests following the introduction of the CPGs in 2013 (RR, 1.12; 95% CI, 0.85-1.47; P = .432). Presurgical hearing testing ranged from 26.1% to 83.5% across health regions. Conclusion In this cohort of children who underwent TT placement, the trends of preoperative and postoperative audiometric testing are increasing but are still lower than recommended by the CPGs, despite a tripling of practicing audiologists. This study describes the current state of testing in Ontario and highlights issues of access to audiology services, possible parent preferences, and the importance of ongoing continuing medical education for all health care practitioners.

A preliminary RCT of CBT-AD for adherence and depression among HIV-positive Latinos on the U.S.-Mexico border: the Nuevo Día study.

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Simoni, Jane M; Wiebe, John S; Sauceda, John A; Huh, David; Sanchez, Giselle; Longoria, Virginia; Andres Bedoya, C; Safren, Steven A

2013-10-01

We conducted a preliminary RCT among 40 HIV-positive Latinos of Mexican descent on the U.S.-Mexico border who indicated imperfect adherence and depressive symptomatology. Participants were randomly assigned to culturally adapted cognitive-behavioral therapy for adherence and depression with an alarmed pillbox or usual care. Outcomes were depressive symptoms (self-report and blind clinician ratings), adherence (self-report and electronic pillbox), and biological markers. The intervention, delivered in English and Spanish, proved feasible and acceptable. Generalized estimating equations in intent-to-treat analyses showed some effects of "moderate" to "large" size, with maintenance over time. For example, intervention (vs. control) participants demonstrated at post-intervention a greater drop in BDI scores (OR = -3.64, p = 0.05) and greater adherence according to the electronic pillbox (OR = 3.78, p = 0.03). Biological markers indicated some relative improvement for CD4 count but not VL. The promising results suggest a larger trial to determine efficacy is warranted.

Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations

Directory of Open Access Journals (Sweden)

Rachel E. Blaine

2015-07-01

Full Text Available Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012–2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2–12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2 or satisfying hunger (x̄ = 2.4; SD 2.1 almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5 or celebrating events/holidays (x̄ = 0.8; SD 1.1. Parents reported giving young children (2–5 years more snacks to reward behavior (1.9 vs. 1.1, p < 0.001, keep quiet (1.0 vs. 0.5, p < 0.001, and celebrate achievements (1.7 vs. 1.0, p < 0.001 than parents of older children (6–12 years. Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR = 0.83; 95% Confidence Interval (CI 0.70–0.99, celebrate events/holidays (OR = 0.72; 95% CI 0.52–0.99, or achievements (OR = 0.82; 95% CI 0.68–0.98. Parental intentions around child snacking are likely important targets for obesity prevention efforts.

Best Clinical Practice Guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD Policy Document.

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Lygidakis, N A; Wong, F; Jälevik, B; Vierrou, A-M; Alaluusua, S; Espelid, I

2010-04-01

The European Academy of Paediatric Dentistry (EAPD) has long recognised the necessity of promoting further research and knowledge regarding the dental defect described as molar-incisor-hypomineralisation (MIH). Following the establishment by EAPD of the defect diagnostic criteria in 2003, the publication of various papers and a whole issue assigned to the defect in the European Archives of Paediatric Dentistry (2008), an Interim Seminar and Workshop on MIH was organized in Helsinki in 2009. The outcome of this event is the present consensus paper on the prevalence, diagnosis, aetiology and treatment for children and adolescents presenting with MIH. A clear diagnostic proposal and a treatment decision-making guide are presented together with suggestions on aetiology and guidance for future research. MIH is an important clinical problem that often concerns both the general dental and specialist paediatric dentists; the present 'best clinical practice guidance' aims to further help clinicians dealing with the condition.

Effect of respiratory syncytial virus (RSV) infection on the adherence of pathogenic bacteria to human epithelial cells

Energy Technology Data Exchange (ETDEWEB)

Faden, H.; Hong, J.J.; Ogra, P.L.

1986-03-01

The effect of RSV infection on the adherence of Streptococcus pneumoniae (SP), Haemophilus influenzae (HI) and Staphylococcus aureus (SA) to human epithelial cells was determined. RSV-infected Hep-2 cell cultures at different stages of expression of surface viral antigens and bacteria labeled with /sup 3/H-thymidine were employed to examine the kinetics of bacterial adherence to virus-infected cells. RSV infection did not alter the magnitude of adherence of HI or SA to HEp-2 cells. However, adherence of SP to HEp-2 cells was significantly (P < 0.01) enhanced by prior RSV infection. The degree of adherence was directly related to the amount of viral antigen expressed on the cell surface. The adherence was temperature dependent, with maximal adherence observed at 37/sup 0/C. Heat-inactivation of SP did not alter adherence characteristics. These data suggest that RSV infection increases adherence of SP to the surface of epithelial cells in vitro. Since attachment of bacteria to mucosal surfaces is the first step in many infections, it is suggested that viral infections of epithelial cells render them more susceptible to bacterial adherence. Thus, RSV infection in vivo may predispose children to SP infections, such as in otitis media, by increasing colonization with SP.

Children of Alcoholics.

Science.gov (United States)

Krois, Deborah Helen

Although alcoholism has long been considered a serious problem, the impact of parental alcoholism on children has only recently begun to receive attention from researchers and clinicians. A review of the empirical literature on children of alcoholics was conducted and it was concluded that children raised in an alcoholic family are at increased…

A Pedagogical Note: Use of Telepractice to Link Student Clinicians to Diverse Populations.

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Cassel, Stacy Gallese; Hadley Edd, Amy J

2016-01-01

Telepractice is the application of telecommunications technology to the delivery of telehealth services via the online connection of clinicians, clients, and patients for assessment, intervention, or consultation. This article describes a pilot project in which speech-language pathology students in a university training program gained experience in working with culturally diverse preschool students using telepractice technology. The preschool students benefited by making gains in communication skills, while the university students acquired competency in the use of telepractice and in working with children whose cultural and linguistic backgrounds were outside of their experience. To assess the training experience, a Likert-scale survey administered to student clinicians revealed a high degree of satisfaction and improved familiarity with the use of telepractice, and an increased comfort level working with multi-cultural populations.

A Pedagogical Note: Use of Telepractice to Link Student Clinicians to Diverse Populations

Directory of Open Access Journals (Sweden)

Stacy Gallese Cassel

2016-07-01

Full Text Available Telepractice is the application of telecommunications technology to the delivery of telehealth services via the online connection of clinicians, clients, and patients for assessment, intervention, or consultation.  This article describes a pilot project in which speech-language pathology students in a university training program gained experience in working with culturally diverse preschool students using telepractice technology. The preschool students benefited by making gains in communication skills, while the university students acquired competency in the use of telepractice and in working with children whose cultural and linguistic backgrounds were outside of their experience.  To assess the training experience, a Likert-scale survey administered to student clinicians revealed a high degree of satisfaction and improved familiarity with the use of telepractice, and an increased comfort level working with multi-cultural populations.

TDM in psychiatry and neurology: A comprehensive summary of the consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology, update 2017; a tool for clinicians.

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Schoretsanitis, Georgios; Paulzen, Michael; Unterecker, Stefan; Schwarz, Markus; Conca, Andreas; Zernig, Gerald; Gründer, Gerhard; Haen, Ekkerhard; Baumann, Pierre; Bergemann, Niels; Clement, Hans Willi; Domschke, Katharina; Eckermann, Gabriel; Egberts, Karin; Gerlach, Manfred; Greiner, Christine; Havemann-Reinecke, Ursula; Hefner, Gudrun; Helmer, Renate; Janssen, Ger; Jaquenoud-Sirot, Eveline; Laux, Gerd; Messer, Thomas; Mössner, Rainald; Müller, Matthias J; Pfuhlmann, Bruno; Riederer, Peter; Saria, Alois; Schoppek, Bernd; Silva Gracia, Margarete; Stegmann, Benedikt; Steimer, Werner; Stingl, Julia C; Uhr, Manfred; Ulrich, Sven; Waschgler, Roland; Zurek, Gabriela; Hiemke, Christoph

2018-04-01

Therapeutic drug monitoring (TDM) combines the quantification of drug concentrations in blood, pharmacological interpretation and treatment guidance. TDM introduces a precision medicine tool in times of increasing awareness of the need for personalized treatment. In neurology and psychiatry, TDM can guide pharmacotherapy for patient subgroups such as children, adolescents, pregnant women, elderly patients, patients with intellectual disabilities, patients with substance use disorders, individuals with pharmacokinetic peculiarities and forensic patients. Clear indications for TDM include lack of clinical response in the therapeutic dose range, assessment of drug adherence, tolerability issues and drug-drug interactions. Based upon existing literature, recommended therapeutic reference ranges, laboratory alert levels, and levels of recommendation to use TDM for dosage optimization without specific indications, conversion factors, factors for calculation of dose-related drug concentrations and metabolite-to-parent ratios were calculated. This summary of the updated consensus guidelines by the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie offers the practical and theoretical knowledge for the integration of TDM as part of pharmacotherapy with neuropsychiatric agents into clinical routine. The present guidelines for TDM application for neuropsychiatric agents aim to assist clinicians in enhancing safety and efficacy of treatment.

Community health workers adherence to referral guidelines

DEFF Research Database (Denmark)

Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

2016-01-01

artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs......Background Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs...

The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence.

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Ebersole, Barbara; Soni, Resha S; Moran, Kathleen; Lango, Miriam; Devarajan, Karthik; Jamal, Nausheen

2018-05-01

Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence. A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk. Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P 40 is a significant cutoff point for predicting therapy nonadherence (P demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Moving toward quality palliative cancer care: parent and clinician perspectives on gaps between what matters and what is accessible.

Science.gov (United States)

Kassam, Alisha; Skiadaresis, Julia; Habib, Sharifa; Alexander, Sarah; Wolfe, Joanne

2013-03-01

The National Consensus Project (NCP) published a set of standards for quality palliative care delivery. A key step before applying these guidelines to pediatric oncology is to evaluate how much families and clinicians value these standards. We aimed to determine which elements of palliative care are considered important according to bereaved parents and pediatric oncology clinicians and to determine accessibility of these elements. We administered questionnaires to 75 bereaved parents (response rate, 54%) and 48 pediatric oncology clinicians (response rate, 91%) at a large teaching hospital. Outcome measures included importance ratings and accessibility of core elements of palliative care delivery. Fifteen of 20 core elements were highly valued by both parents and clinicians (defined as > 60% of parents and clinicians reporting the item as important). Compared with clinicians, parents gave higher ratings to receiving cancer-directed therapy during the last month of life (P involvement of a spiritual mentor (P = .03). Of the valued elements, only three were accessible more than 60% of the time according to clinicians and parents. Valued elements least likely to be accessible included a direct admission policy to hospital, sibling support, and parent preparation for medical aspects surrounding death. Parents and clinicians highly value a majority of palliative care elements described in the NCP framework. Children with advanced cancer may not be receiving key elements of palliative care despite parents and clinicians recognizing them as important. Evaluation of barriers to provision of quality palliative care and strategies for overcoming them are critical.

Relationship of adherence determinants and parental spirituality in cystic fibrosis.

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Grossoehme, Daniel H; Opipari-Arrigan, Lisa; VanDyke, Rhonda; Thurmond, Sophia; Seid, Michael

2012-06-01

The course of cystic fibrosis (CF) progression in children is affected by parent adherence to treatment plans. The Theory of Reasoned Action (TRA) posits that intentions are the best behavioral predictors and that intentions reasonably follow from beliefs ("determinants"). Determinants are affected by multiple "background factors," including spirituality. This study's purpose was to understand whether two parental adherence determinants (attitude towards treatment and self-efficacy) were associated with spirituality (religious coping and sanctification of the body). We hypothesized that parents' attitudes toward treatment adherence are associated with these spiritual constructs. A convenience sample of parents of children with CF aged 3-12 years (n = 28) participated by completing surveys of adherence and spirituality during a regular outpatient clinic visit. Type and degree of religious coping was examined using principal component analysis. Adherence measures were compared based on religious coping styles and sanctification of the body using unpaired t-tests. Collaborative religious coping was associated with higher self-efficacy for completing airway clearance (M = 1070.8; SD = 35.8; P = 0.012), for completing aerosolized medication administration (M = 1077.1; SD = 37.4; P = 0.018), and for attitude towards treatment utility (M = 38.8; SD = 2.36; P = 0.038). Parents who attributed sacred qualities to their child's body (e.g., "blessed" or "miraculous") had higher mean scores for self-efficacy (airway clearance, M = 1058.6; SD = 37.7; P = 0.023; aerosols M = 1070.8; SD = 41.6; P = 0.020). Parents for whom God was manifested in their child's body (e.g., "My child's body is created in God's image") had higher mean scores for self-efficacy for airway clearance (M = 1056.4; SD = 59.0; P = 0.039), aerosolized medications (M = 1068.8; SD = 42.6; P = 0.033) and treatment utility (M�

Effect of respiratory syncytial virus (RSV) infection on the adherence of pathogenic bacteria to human epithelial cells

International Nuclear Information System (INIS)

Faden, H.; Hong, J.J.; Ogra, P.L.

1986-01-01

The effect of RSV infection on the adherence of Streptococcus pneumoniae (SP), Haemophilus influenzae (HI) and Staphylococcus aureus (SA) to human epithelial cells was determined. RSV-infected Hep-2 cell cultures at different stages of expression of surface viral antigens and bacteria labeled with 3 H-thymidine were employed to examine the kinetics of bacterial adherence to virus-infected cells. RSV infection did not alter the magnitude of adherence of HI or SA to HEp-2 cells. However, adherence of SP to HEp-2 cells was significantly (P 0 C. Heat-inactivation of SP did not alter adherence characteristics. These data suggest that RSV infection increases adherence of SP to the surface of epithelial cells in vitro. Since attachment of bacteria to mucosal surfaces is the first step in many infections, it is suggested that viral infections of epithelial cells render them more susceptible to bacterial adherence. Thus, RSV infection in vivo may predispose children to SP infections, such as in otitis media, by increasing colonization with SP

Relationship among chelator adherence, change in chelators, and quality of life in thalassemia.

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Trachtenberg, Felicia L; Gerstenberger, Eric; Xu, Yan; Mednick, Lauren; Sobota, Amy; Ware, Hannah; Thompson, Alexis A; Neufeld, Ellis J; Yamashita, Robert

2014-10-01

Thalassemia, a chronic blood disease, necessitates life-long adherence to blood transfusions and chelation therapy to reduce iron overload. We examine stability of health-related quality of life (HRQOL) in thalassemia and adherence to chelation therapy over time, especially after changes in chelator choice. Thalassemia Longitudinal Cohort participants in the USA, UK, and Canada completed the SF-36v2 (ages 14+) and the PF-28 CHQ (parents of children health status) at baseline who made a single change in chelator, but declined among participants with multiple changes and/or high iron burden (worse health status). Mental health improved among participants with lower iron burden, but iron overload was negatively associated with social functioning. Adherence did not significantly change over follow-up except for an increase after a change from deferoxamine (DFO) infusion to oral deferasirox (p = 0.03). Predictors of lower adherence for adults/adolescents at follow-up included side effects, smoking, younger age, problems preparing DFO, increased number of days per week DFO prescribed, and lower physical quality of life . Strategies to balance medical needs with family, work, and personal life may assist in adherence.

Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy.

Science.gov (United States)

Al-Aqeel, Sinaa; Gershuni, Olga; Al-Sabhan, Jawza; Hiligsmann, Mickael

2017-02-03

Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials and quasi-randomised controlled trials to assist people with adherence to antiepileptic medication. This is an updated version of the original Cochrane review published in the Cochrane Library, Issue 1, 2010. To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. For the latest update, on 4 February 2016 we searched the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO), MEDLINE (Ovid 1946 to 4 February 2016), CINAHL Plus (EBSCOhost 1937 to 4 February 2016), PsycINFO (EBSCOhost 1887 to 4 February 2016), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. We also searched the reference lists of relevant articles. Randomised and quasi-randomised controlled trials of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to the GRADE working group scale.The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. We included 12 studies reporting data on 1642 participants (intervention = 833, control = 809). Eight studies targeted adults with epilepsy, one study included participants

Electronic Adherence Monitoring in a High-Utilizing Pediatric Asthma Cohort: A Feasibility Study.

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Kenyon, Chén Collin; Chang, Joyce; Wynter, Sheri-Ann; Fowler, Jessica C; Long, Jin; Bryant-Stephens, Tyra C

2016-06-22

Inner-city, minority children with asthma have the highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. Some recent electronic medication monitoring interventions demonstrated dramatic improvements in adherence in lower-risk populations. The feasibility and acceptability of such an intervention in the highest-risk children with asthma has not been studied. Our objective was to assess the feasibility and acceptability of a community health worker-delivered electronic adherence monitoring intervention among the highest utilizers of acute asthma care in an inner-city practice. This was a prospective cohort pilot study targeting children with the highest frequency of asthma-related emergency department and hospital care within a local managed care Medicaid plan. The 3-month intervention included motivational interviewing, electronic monitoring of controller and rescue inhaler use, and outreach by a community health worker for predefined medication alerts. We measured acceptability by using a modified technology acceptability model and changes in asthma control using the Asthma Control Test (ACT). Given prominent feasibility issues, we describe qualitative patterns of medication use at baseline only. We enrolled 14 non-Hispanic black children with a median age of 3.5 years. Participants averaged 7.8 emergency or hospital visits in the year preceding enrollment. We observed three distinct patterns of baseline controller use: 4 patients demonstrated sustained use, 5 patients had periodic use, and 5 patients lapsed within 2 weeks. All participants initiated use of the electronic devices; however, no modem signal was transmitted for 5 or the 14 participants after a mean of 45 days. Of the 9 (64% of total) caregivers who completed the final study visit, all viewed the electronic monitoring device favorably and would recommend it to friends, and 5 (56%) believed that the device helped to improve asthma control. ACT

Adherence to medical treatment in relation to pregnancy, birth outcome & breastfeeding behavior among women with Crohn's disease.

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Julsgaard, Mette

2016-07-01

Crohn's disease (CD) is common among women of fertile age, and it often requires maintenance medical treatment. Adherence to medical treatment among women with CD prior to, during, and after pregnancy has, however, never been examined. Although CD women have increased risk of adverse pregnancy outcomes, little is known about predictors for these outcomes in women with CD. In addition, the impact of breastfeeding on disease activity remains controversial. The aims of this PhD thesis were to determine adherence to treatment and to investigate predictors for and prevalence rates of non-adherence to maintenance medical treatment among women with CD prior to, during, and after pregnancy; to assess pregnancy outcomes among women with CD, taking medical treatment, smoking status, and disease activity into account; to assess breastfeeding rates and the impact of breastfeeding on the risk of relapse. We conducted a population-based prevalence study including 154 women with CD who had given birth within a six-year period. We combined questionnaire data, data from medical records, and medical register data. Among 105 (80%) respondents, more than half reported taking medication with an overall high adherence rate of 69.8%. Counselling, previous pregnancy, and planned pregnancy seemed to decrease the likelihood of non-adherence, whereas smoking seemed to predict non-adherence prior to pregnancy, although our sample size prevented any firm conclusions. During pregnancy, the vast majority (95%) of CD women were in remission. The children's birth weight did not differ in relation to maternal medical treatment, but mean birth weight in children of smokers in medical treatment was 274 g lower than that of children of non-smokers in medical treatment. In our relatively small study CD women in medical treatment were not at increased risk of adverse pregnancy outcomes compared with untreated women with CD. In total, 87.6% of CD women were breastfeeding, and rates did not vary by

Managing childhood eczema: qualitative study exploring carers' experiences of barriers and facilitators to treatment adherence.

Science.gov (United States)

Santer, Miriam; Burgess, Hana; Yardley, Lucy; Ersser, Steven J; Lewis-Jones, Sue; Muller, Ingrid; Hugh, Catherine; Little, Paul

2013-11-01

To explore parents and carers' experiences of barriers and facilitators to treatment adherence in childhood eczema Childhood eczema is common and causes significant impact on quality of life for children and their families, particularly due to sleep disturbance and itch. Non-adherence to application of topical treatments is the main cause of treatment failure. Qualitative interview study. Qualitative interviews were carried out with 31 carers from 28 families of children with eczema. Participants were recruited through primary care and included if they had a child aged 5 or less with a diagnosis of eczema. Interviews were carried out between December 2010-May 2011. Data were analysed using a constant comparative approach. Barriers to treatment adherence included carer beliefs around eczema treatment, the time consuming nature of applying topical treatments, and child resistance to treatment. Families employed a range of strategies in an attempt to work around children's resistance to treatment with varying success. Strategies included involving the child in treatment, distracting the child during treatment, or making a game of it, using rewards, applying treatment to a sleeping child or, in a few cases, physically restraining the child. Some carers reduced frequency of applications in an attempt to reduce child resistance. Regular application of topical treatments to children is an onerous task, particularly in families where child resistance develops. Early recognition and discussion of resistance and better awareness of the strategies to overcome this may help carers to respond positively and avoid establishing habitual confrontation. © 2013 Blackwell Publishing Ltd.

Correlates of Pediatric CPAP Adherence

Science.gov (United States)

Hawkins, Stephen M.M.; Jensen, Emily L.; Simon, Stacey L.; Friedman, Norman R.

2016-01-01

Study Objectives: Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. Methods: A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ2 test. Results: Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20–4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27–5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Conclusions: Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the

Pattern of prescription of antibiotics among dental practitioners in ...

African Journals Online (AJOL)

Background: Inappropriate use of antibiotics by clinicians leads to antibiotic resistance, and is a serious global health concern. Aim: The aim of this study was to determine antibiotic prescription practices of dental practitioners and their adherence to professional guidelines while treating oral health problems among children.

The effect of core clinician interpersonal behaviours on depression.

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Barnicot, K; Wampold, B; Priebe, S

2014-01-01

It is well-established that core clinician interpersonal behaviours are important when treating depression, but few studies have evaluated whether outcome is determined by clinicians׳ general behaviour rather than by the perception of the individual being treated. In the NIMH TDCRP, 157 patients rated their clinician׳s genuineness, positive regard, empathy and unconditional regard during cognitive behavioural therapy, interpersonal therapy or clinical management with placebo. The association between averaged ratings for each of 27 clinicians and their patients׳ self- and observer-rated depression outcomes was evaluated, adjusting for the deviation of individual patient ratings from the average for their clinician and other potential confounders. Clinicians in the clinical management condition were rated on average as less genuine and less empathic than those in the psychotherapy conditions. Clinicians׳ average genuineness, positive regard and empathy were significantly associated with lower depression severity during treatment, but not with recovery from depression, after adjusting for the deviation of the individual patient׳s rating of their clinician from the average for that clinician, treatment condition and baseline depression severity. Clinician unconditional regard was not significantly associated with outcome. Using averaged ratings of clinician behaviour likely reduced statistical power. Clinicians׳ ability to demonstrate genuineness, positive regard and empathy may represent a stable personal characteristic that influences the treatment of depression beyond the individual clinician-patient relationship or an individual patient׳s perception of their clinician. However, clinicians׳ ability to demonstrate these behaviours may be poorer when delivering an intervention without a specific rationale or treatment techniques. Copyright © 2014 Elsevier B.V. All rights reserved.

Smartphone- and internet-assisted self-management and adherence tools to manage Parkinson's disease (SMART-PD): study protocol for a randomised controlled trial (v7; 15 August 2014).

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Lakshminarayana, Rashmi; Wang, Duolao; Burn, David; Chaudhuri, K Ray; Cummins, Gemma; Galtrey, Clare; Hellman, Bruce; Pal, Suvankar; Stamford, Jon; Steiger, Malcolm; Williams, Adrian

2014-09-25

Nonadherence to treatment leads to suboptimal treatment outcomes and enormous costs to the economy. This is especially important in Parkinson's disease (PD). The progressive nature of the degenerative process, the complex treatment regimens and the high rates of comorbid conditions make treatment adherence in PD a challenge. Clinicians have limited face-to-face consultation time with PD patients, making it difficult to comprehensively address non-adherence. The rapid growth of digital technologies provides an opportunity to improve adherence and the quality of decision-making during consultation. The aim of this randomised controlled trial (RCT) is to evaluate the impact of using a smartphone and web applications to promote patient self-management as a tool to increase treatment adherence and working with the data collected to enhance the quality of clinical consultation. A 4-month multicentre RCT with 222 patients will be conducted to compare use of a smartphone- and internet-enabled Parkinson's tracker smartphone app with treatment as usual for patients with PD and/or their carers. The study investigators will compare the two groups immediately after intervention. Seven centres across England (6) and Scotland (1) will be involved. The primary objective of this trial is to assess whether patients with PD who use the app show improved medication adherence compared to those receiving treatment as usual alone. The secondary objectives are to investigate whether patients who receive the app and those who receive treatment as usual differ in terms of quality of life, quality of clinical consultation, overall disease state and activities of daily living. We also aim to investigate the experience of those receiving the intervention by conducting qualitative interviews with a sample of participants and clinicians, which will be administered by independent researchers. ISRCTN45824264 (registered 5 November 2013).

Beliefs related to adherence to oral antidiabetic treatment according to the Theory of Planned Behavior1

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Jannuzzi, Fernanda Freire; Rodrigues, Roberta Cunha Matheus; Cornélio, Marilia Estevam; São-João, Thaís Moreira; Gallani, Maria Cecília Bueno Jayme

2014-01-01

OBJECTIVE: to identify salient behavioral, normative, control and self-efficacy beliefs related to the behavior of adherence to oral antidiabetic agents, using the Theory of Planned Behavior. METHOD: cross-sectional, exploratory study with 17 diabetic patients in chronic use of oral antidiabetic medication and in outpatient follow-up. Individual interviews were recorded, transcribed and content-analyzed using pre-established categories. RESULTS: behavioral beliefs concerning advantages and disadvantages of adhering to medication emerged, such as the possibility of avoiding complications from diabetes, preventing or delaying the use of insulin, and a perception of side effects. The children of patients and physicians are seen as important social references who influence medication adherence. The factors that facilitate adherence include access to free-of-cost medication and taking medications associated with temporal markers. On the other hand, a complex therapeutic regimen was considered a factor that hinders adherence. Understanding how to use medication and forgetfulness impact the perception of patients regarding their ability to adhere to oral antidiabetic agents. CONCLUSION: medication adherence is a complex behavior permeated by behavioral, normative, control and self-efficacy beliefs that should be taken into account when assessing determinants of behavior. PMID:25296135

'So you want to be a clinician-educator...': designing a clinician-educator curriculum for internal medicine residents.

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Heflin, Mitchell T; Pinheiro, Sandro; Kaminetzky, Catherine P; McNeill, Diana

2009-06-01

Despite a growing demand for skilled teachers and administrators in graduate medical education, clinician-educator tracks for residents are rare and though some institutions offer 'resident-as-teacher' programs to assist residents in developing teaching skills, the need exists to expand training opportunities in this area. The authors conducted a workshop at a national meeting to develop a description of essential components of a training pathway for internal medicine residents. Through open discussion and small group work, participants defined the various roles of clinician-educators and described goals, training opportunities, assessment and resource needs for such a program. Workshop participants posited that the clinician-educator has several roles to fulfill beyond that of clinician, including those of teacher, curriculum developer, administrator and scholar. A pathway for residents aspiring to become clinician educators must offer structured training in each of these four areas to empower residents to effectively practice clinical education. In addition, the creation of such a track requires securing time and resources to support resident learning experiences and formal faculty development programs to support institutional mentors and leaders. This article provides a framework by which leaders in medical education can begin to prepare current trainees interested in careers as clinician-educators.

Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity.

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Williams, Nathaniel J; Glisson, Charles; Hemmelgarn, Anthony; Green, Philip

2017-03-01

The development of efficient and scalable implementation strategies in mental health is restricted by poor understanding of the change mechanisms that increase clinicians' evidence-based practice (EBP) adoption. This study tests the cross-level change mechanisms that link an empirically-supported organizational strategy for supporting implementation (labeled ARC for Availability, Responsiveness, and Continuity) to mental health clinicians' EBP adoption and use. Four hundred seventy-five mental health clinicians in 14 children's mental health agencies were randomly assigned to the ARC intervention or a control condition. Measures of organizational culture, clinicians' intentions to adopt EBPs, and job-related EBP barriers were collected before, during, and upon completion of the three-year ARC intervention. EBP adoption and use were assessed at 12-month follow-up. Multilevel mediation analyses tested changes in organizational culture, clinicians' intentions to adopt EBPs, and job-related EBP barriers as linking mechanisms explaining the effects of ARC on clinicians' EBP adoption and use. ARC increased clinicians' EBP adoption (OR = 3.19, p = .003) and use (81 vs. 56 %, d = .79, p = .003) at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced job-related EBP barriers. A combined mediation analysis indicated the organizational culture-EBP intentions mechanism was the primary carrier of ARC's effects on clinicians' EBP adoption and use. ARC increases clinicians' EBP adoption and use by creating proficient organizational cultures that increase clinicians' intentions to adopt EBPs.

Association of religion with delusions and hallucinations in the context of schizophrenia: implications for engagement and adherence.

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Gearing, Robin Edward; Alonzo, Dana; Smolak, Alex; McHugh, Katie; Harmon, Sherelle; Baldwin, Susanna

2011-03-01

The relationship of religion and schizophrenia is widely acknowledged, but often minimized by practitioners and under investigated by researchers. In striving to help fill this gap, this paper focuses on examining four aims: 1) how research has investigated the association between religiosity and schizophrenia; 2) how is religiosity associated with delusions and hallucinations; 3) what are the risk and protective factors associated with religiosity and schizophrenia; and 4) does religion influence treatment adherence with individuals diagnosed with schizophrenia. A systematic literature search of PsycINFO and MEDLINE databases from January 1, 1980 through January 1, 2010 was conducted using the terms schizophrenia, schizoaffective, schizophreniform, psychotic disorder not otherwise specified (NOS) and religion, religiosity, spirituality, or faith. Seventy (n=70) original research studies were identified. Religion can act as both a risk and protective factor as it interacts with the schizophrenia symptoms of hallucination and delusions. Cultural influences tend to confound the association of religion and schizophrenia. Adherence to treatment has a mixed association with religiosity. The relationship between religion and schizophrenia may be of benefit to both clinicians and researchers through enhancing adherence to treatment, and enhancement of the protective aspects while minimizing associated risk. The relationship of religion and schizophrenia needs further research that is more nuanced and methodologically rigorous, specifically concerning its influence on engagement and adherence to treatment. Copyright © 2010 Elsevier B.V. All rights reserved.

The Effect of Rapid Antigen Detection Test on Antibiotic Prescription Decision of Clinicians and Reducing Antibiotic Costs in Children with Acute Pharyngitis.

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Kose, Engin; Sirin Kose, Seda; Akca, Deniz; Yildiz, Kerem; Elmas, Cengizhan; Baris, Mustafa; Anil, Murat

2016-08-01

We aimed to investigate the effect of rapid antigen detection test (RADT) in the diagnosis of streptococcal pharyngitis, its impact on antibiotic prescription decision of pediatricians and influence on reduction of antibiotic treatment costs in children with pharyngitis. The study group consisted of 223 patients who were diagnosed with pharyngitis by pediatricians. The sensitivity and specificity of RADT were 92.1% (95% Cl: 78.6-98.3%) and 97.3% (95% Cl: 93.8-99.1%), respectively. In the first assessment, before performing RADT, pediatricians decided to prescribe antibiotics for 178 (79.8%) patients with pharyngitis. After learning RADT results, pediatricians finally decided to prescribe antibiotics for 83 (37.2%) patients with pharyngitis, and antibiotic prescription decreased by 42.6%. Antibiotic costs in non-Group A streptococcus pharyngitis, Group A streptococcus pharyngitis and all subjects groups decreased by 80.8%, 48%, and 76.4%, respectively. Performing RADT in children with pharyngitis has an important impact on treatment decision of clinicians, reduction of unnecessary antibiotic prescriptions and antibiotic costs. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Childhood agricultural injuries: an update for clinicians.

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Wright, Suzanne; Marlenga, Barbara; Lee, Barbara C

2013-02-01

Every three days a child dies in an agriculture-related incident, and every day 45 children are injured in the United States. These tragedies should not be regarded as "accidents," as they often follow predictable and preventable patterns. Prevention is not only possible, but vital, since many of these injuries are almost immediately fatal. Major sources of fatal injuries are machinery, motor vehicles, and drowning. Tractor injuries alone account for one-third of all deaths. The leading sources of nonfatal injuries are structures and surfaces, animals (primarily horses), and vehicles (primarily all-terrain vehicles [ATVs]). Children living on farms are at a higher risk than hired workers, and are unprotected by child labor laws. Preschool children and older male youth are at the highest risk for fatal injury, while nonfatal injury was most common among boys aged 10-15 years. Multiple prevention strategies have been developed, yet economic and cultural barriers often impede their implementation. Educational campaigns alone are often ineffective, and must be coupled with re-engineering of machines and safety devices to reduce fatalities. Legislation has the potential to improve child safety, yet political and economic pressures often prohibit changes in child labor laws and mandated safety requirements. Clinicians play a pivotal role in injury prevention, and should actively address common rural risk-taking behaviors as part of the routine office visit in order to help prevent these tragedies. Copyright © 2013 Mosby, Inc. All rights reserved.

Total, Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007-2010.

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Sluik, Diewertje; van Lee, Linde; Engelen, Anouk I; Feskens, Edith J M

2016-01-28

A high sugar intake is a subject of scientific debate due to the suggested health implications and recent free sugar recommendations by the WHO. The objective was to complete a food composition table for added and free sugars, to estimate the intake of total sugars, free sugars, and added sugars, adherence to sugar guidelines and overall diet quality in Dutch children and adults. In all, 3817 men and women (7-69 years) from the Dutch National Food Consumption Survey 2007-2010 were studied. Added and free sugar content of products was assigned by food composition tables and using labelling and product information. Diet was assessed with two 24-h recalls. Diet quality was studied in adults with the Dutch Healthy Diet-index. Total sugar intake was 22% Total Energy (%TE), free sugars intake 14 %TE, and added sugar intake 12 %TE. Sugar consumption was higher in children than adults. Main food sources of sugars were sweets and candy, non-alcoholic beverages, dairy, and cake and cookies. Prevalence free sugar intake diet quality was similar comparing adults adherent and non-adherent to the sugar guidelines, although adherent adults had a higher intake of dietary fiber and vegetables. Adherence to the WHO free sugar guidelines of sugar guidelines was not strongly associated with higher diet quality in adults.

A randomized-controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

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Emmanuel eStip

2013-08-01

Full Text Available Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR is about 49.5 % in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improved AAR of schizophrenic patients. Furthermore, we compared AAR obtained by the DoPill® and the BARS, in order to verify whether the DoPill® provides reliable assessment of medication adherence. Methods: The DoPill® is a smart pill dispenser that beeps and flashes at the appropriate time of the day. Each of its 28 compartments is covered by a plastic lamina that, when taken off, sends a signal to the pharmacist. Patients were randomized to the DoPill® or Treatment As Usual group (TAU for six weeks. The BARS was used as a reference measure. Results: Forty-six percent of patients were deemed to be non-adherent with antipsychotic medication. The mean AAR was 67 % after six weeks. DoPill® recorded better AAR than some of those found in the literature and were lower than the BARS estimate we found. Conclusion: These results suggest that DoPill® is a valid tool that provides more reliable and objective data for the clinician about their patient’s adherence, than existing assessment tools like the BARS. Furthermore, the device may help patients successfully manage their medication regimen.

Importance ratings on patient-reported outcome items for survivorship care: comparison between pediatric cancer survivors, parents, and clinicians.

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Jones, Conor M; Baker, Justin N; Keesey, Rachel M; Eliason, Ruth J; Lanctot, Jennifer Q; Clegg, Jennifer L; Mandrell, Belinda N; Ness, Kirsten K; Krull, Kevin R; Srivastava, Deokumar; Forrest, Christopher B; Hudson, Melissa M; Robison, Leslie L; Huang, I-Chan

2018-04-18

To compare importance ratings of patient-reported outcomes (PROs) items from the viewpoints of childhood cancer survivors, parents, and clinicians for further developing short-forms to use in survivorship care. 101 cancer survivors, 101 their parents, and 36 clinicians were recruited from St. Jude Children's Research Hospital. Participants were asked to select eight items that they deemed useful for clinical decision making from each of the four Patient-Reported Outcomes Measurement Information System Pediatric item banks. These item banks were pain interference (20 items), fatigue (23 items), psychological stress (19 items), and positive affect (37 items). Compared to survivors, clinicians rated more items across four domains that were statistically different than did parents (23 vs. 13 items). Clinicians rated five items in pain interference domain (ORs 2.33-6.01; p's important but rated three items in psychological stress domain (ORs 0.14-0.42; p's important than did survivors. In contrast, parents rated seven items in positive affect domain (ORs 0.25-0.47; p's important than did survivors. Survivors, parents, and clinicians viewed importance of PRO items for survivorship care differently. These perspectives should be used to assist the development of PROs tools.

Engaging clinicians in health informatics projects.

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Caballero Muñoz, Erika; Hullin Lucay Cossio, Carola M

2010-01-01

This chapter gives an educational overview of: * The importance of the engagement of clinicians within a health informatics project * Strategies required for an effective involvement of clinicians throughout a change management process within a clinical context for the implementation of a health informatics project * The critical aspects for a successful implementation of a health informatics project that involves clinicians as end users * Key factors during the administration of changes during the implementation of an informatics project for an information system in clinical practice.

Classroom interventions for children with ADHD

NARCIS (Netherlands)

Groen, Yvonne; Gaastra, Geraldina F.; Tucha, Lara I.; Tucha, Oliver

2016-01-01

In a typical classroom, children are instructed to remain seated, perform independent seatwork and follow teachers’ instructions. Children with attention deficit hyperactivity disorder (ADHD) may find these classroom demands particularly difficult to adhere to because, by definition, children with

Turning attention to clinician engagement in Victoria.

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Jorm, Christine; Hudson, Robyn; Wallace, Euan

2017-11-16

The engagement of clinicians with employing organisations and with the broader health system results in better safer care for patients. Concerns about the adequacy of clinician engagement in the state of Victoria led the Victorian Department of Health and Human Services to commission a scoping study. During this investigation more than 100 clinicians were spoken with and 1800 responded to surveys. The result was creation of a clear picture of what engagement and disengagement looked like at all levels - from the clinical microsystem to state health policy making. Multiple interventions are possible to enhance clinician engagement and thus the care of future patients. A framework was developed to guide future Victorian work with four elements: setting the agenda, informing, involving and empowering clinicians. Concepts of work or employee engagement that are used in other industries don't directly translate to healthcare and thus the definition of engagement chosen for use centred on involvement. This was designed to encourage system managers to ensure clinicians are full participants in design, planning and evaluation and in all decisions that affect them and their patients.

Improving clinicians' access to cost data.

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Kenagy, John; Shah, Ben

2014-08-01

Bringing clinical and financial data together is critical to effectively running and operating service lines. Helping clinicians use cost data to make decisions requires a shared vision and a partnership between finance leaders and physicians. Hosting a "jam session" of technical, financial, and clinical experts can accelerate an organization's business intelligence strategy. Labor and supply costs represent the most actionable cost data for clinicians. Clinician buy-in hinges on education and support. It is important to focus on easy wins at the beginning of the project.

Patterns of Adherence to Oral Atypical Antipsychotics Among Patients Diagnosed with Schizophrenia.

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MacEwan, Joanna P; Forma, Felicia M; Shafrin, Jason; Hatch, Ainslie; Lakdawalla, Darius N; Lindenmayer, Jean-Pierre

2016-11-01

abuse (OR = 1.46; 95% CI = 1.26-1.66; P aged 35-54 years (OR = 0.66; 95% CI = 0.46-0.85; P different groups may warrant different types of clinical interventions to prevent hospitalizations, longer hospital stays, and increased clinical complexity. For example, clinicians may consider regular home visits, assertive community treatment, and other related interventions for patients at high risk of immediate discontinuation. Health plans should consider supplementing claims-based adherence measures with new technologies that are able to track patient adherence patterns over time. Otsuka Pharmaceutical Development & Commercialization provided support for this research. MacEwan and Shafrin are employees of Precision Health Economics, which was contracted by Otsuka Pharmaceutical Development & Commercialization to conduct this study. Lakdawalla is the Chief Scientific Officer and a founding partner of Precision Health Economics. Forma is an employee of Otsuka Pharmaceutical Development & Commercialization. Hatch is a former employee of Otsuka Pharmaceutical Development & Commercialization and is a current employee of ODH, Inc. Lindenmayer has received grant/research support from Janssen, Lilly, AstraZeneca, Johnson & Johnson, Pfizer, BMS, Otsuka, Dainippon, and Roche and is a consultant for Janssen, Lilly, Merck, Shire, and Lundbeck. Portions of this study were presented as a poster at the American Society of Clinical Psychopharmacology Annual Meeting in Miami Beach, Florida; June 23, 2015; and at the 28th Annual U.S. Psychiatric and Mental Health Congress; San Diego, California; September 12, 2015. Study concept and design were contributed by Forma, Ladkawalla, MacEwan, and Shafrin, along with Hatch and Lindenmayer. MacEwan, Shafrin, Forma, and Lakdawalla collected the data, along with Hatch and Lindenmayer. Data interpretation was performed by Hatch, Lindenmayer, MacEwan, and Shafrin, assisted by Forma and Lakdawalla. The manuscript was written and revised by MacEwan, Forma

Barriers to adherence to highly active antiretroviral therapy as expressed by people living with HIV/AIDS.

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Proctor, V E; Tesfa, A; Tompkins, D C

1999-09-01

The primary objective of this study was to gain a clearer understanding of the barriers to adherence to highly active antiretroviral therapy (HAART) faced by people living with HIV/AIDS (PLWHIV/AIDS) on Long Island, New York. Focus group, a qualitative research method, was used to study these barriers. The study was conducted in 1998 on Long Island, NY, at five institutions that provide services to 1700 PLWHIV/AIDS. Five focus groups were conducted with 6 to 13 PLWHIV/AIDS in each group, a total of 39 subjects. PLWHIV/AIDS identified eight common barriers to adherence to HAART. In descending order, the barriers include: (1) frequency and severity of side effects, (2) conflicts with daily routines, (3) dietary requirements, (4) frequency of taking medications, (5) number and dosage of medications, (6) psychosocial factors (i.e., stress, feeling good, and bad news), (7) pharmacy refills, and (8) physiological needs (i.e., sleep, hunger, or thirst). Many factors play a role in the success or failure of HAART, including preexisting drug resistance, drug-drug interactions, and the ability of PLWHIV/AIDS to adhere to a rigid and frequently changing medication regimen. The information gleaned from focus groups is limited in that it may not be generalized to a larger population with any known reliability. However, clinicians sensitive to barriers to adherence to HAART, including those identified by PLWHIV/AIDS in this study, may play a more proactive role in supporting adherence to the medication regimen, increasing the durability of effective viral suppression, decreasing morbidity and mortality, and decreasing the selection and transmission of resistant strains of HIV.

Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial.

Science.gov (United States)

Guralnick, Amy S; Balachandran, Jay S; Szutenbach, Shane; Adley, Kevin; Emami, Leila; Mohammadi, Meelad; Farnan, Jeanne M; Arora, Vineet M; Mokhlesi, Babak

2017-12-01

Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. ClinicalTrials.gov Identifier: NCT02553694. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Challenges and Priorities for Pediatric Critical Care Clinician-Researchers in Low- and Middle-Income Countries

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Amelie O. von Saint André-von Arnim

2017-12-01

Full Text Available IntroductionThere is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC. Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high.Materials and methodsTo inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis.ResultsThe majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation.ConclusionLMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success.

Postoperative Pain Management: Clinicians' Knowledge and ...

African Journals Online (AJOL)

Postoperative Pain Management: Clinicians' Knowledge and Practices on Assessment and Measurement at Moi Teaching and Referral Hospital. ... A standardized questionnaire was administered to 236 hospital – based clinicians including medical doctors, nurses and clinical officers. The questionnaire consisted of ...

A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient-Clinician Interactions.

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Ng, Stella L; Phelan, Shanon; Leonard, MaryAnn; Galster, Jason

2017-06-01

Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients' needs, and attentive to society's influence. The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. "Connected" refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. The clinician case highlighted clinicians' heuristic-based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed

Interventions to increase adherence in patients taking immunosuppressive drugs after kidney transplantation: a systematic review of controlled trials.

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Mathes, Tim; Großpietsch, Kirsten; Neugebauer, Edmund A M; Pieper, Dawid

2017-11-29

Immunosuppressive drugs have to be taken through the whole duration of kidney transplant survival to avoid rejection. Low adherence can increase the risk of allograft rejection. The objective was to evaluate the effectiveness of adherence-enhancing interventions (AEI) in kidney transplantation recipients taking immunosuppressive drugs. A search was performed in Medline, Embase, CINAHL, and PsycINFO. The search was performed in May 2016. We included comparative studies on AEI for kidney transplant recipients taking immunosuppressive drugs. The primary outcome was medication adherence. All identified articles were screened according to the predefined inclusion criteria. The risk of bias was assessed with the Cochrane risk of bias tool. Study selection and risk of bias assessment were performed by two reviewers independently. Data were extracted in standardized tables. Data extraction was verified by a second reviewer. All discrepancies were resolved through discussion. Data were synthesized in a structured narrative way. There is no registered or published protocol for this systematic review. We identified 12 studies. The number of participants ranged from 24 to 1830. Nine studies included adults, two children, and one adults and children. Risk of bias was high. The main reasons for high risk of bias were inadequate allocation sequence (confounding) and that studies were not blinded. Eleven studies evaluated AEI consisting of educational and/or behavioral components. All these studies showed an effect direction in favor of the intervention. Intervention effect was only moderate. Most adherence measures in studies on educational and behavioral interventions showed statistically significant differences. Studies that combined educational and behavioral intervention components showed larger effects. All studies that were statistically significant were multimodal. Studies that included an individualized component and more intensive interventions showed larger effects. One

Attitudes toward antipsychotic treatment among patients with bipolar disorders and their clinicians: a systematic review

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Sajatovic M

2017-08-01

Full Text Available Martha Sajatovic,1 Faith DiBiasi,2 Susan N Legacy3 1Departments of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 2US Medical Affairs, Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA; 3US Medical Affairs, Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA Introduction: Antipsychotics are recommended as first-line therapy for acute mania and maintenance treatment of bipolar disorder; however, published literature suggests their real-world use remains limited. Understanding attitudes toward these medications may help identify barriers and inform personalized therapy. This literature review evaluated patient and clinician attitudes toward the use of antipsychotics for treating bipolar disorder. Materials and methods: A systematic search of the Cochrane Library, Ovid MEDLINE, Embase, and BIOSIS Previews identified English language articles published between January 1, 2000, and June 15, 2016, that reported attitudinal data from patients, health care professionals, or caregivers; treatment decision-making; or patient characteristics that predicted antipsychotic use for bipolar disorder. Results were analyzed descriptively. Results: Of the 209 references identified, 11 met the inclusion criteria and were evaluated. These articles provided attitudinal information from 1,418 patients with bipolar disorder and 1,282 treating clinicians. Patients’ attitudes toward antipsychotics were generally positive. Longer duration of clinical stability was associated with positive attitudes. Implementation of psychoeducational and adherence enhancement strategies could improve patient attitudes. Limited data suggest clinicians’ perceptions of antipsychotic efficacy and tolerability may have the greatest impact on their prescribing patterns. Because the current real-world evidence base is inadequate, clinician attitudes

Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators.

Directory of Open Access Journals (Sweden)

Edward J Mills

2006-11-01

effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity.We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations.

Rehabilitation following pediatric traumatic brain injury: variability in adherence to psychosocial quality-of-care indicators.

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Ennis, Stephanie K; Jaffe, Kenneth M; Mangione-Smith, Rita; Konodi, Mark A; MacKenzie, Ellen J; Rivara, Frederick P

2014-01-01

To examine variations in processes of pediatric inpatient rehabilitation care related to family-centered care, management of neurobehavioral and psychosocial needs, and community reintegration after traumatic brain injury. Nine acute rehabilitation facilities from geographically diverse areas of the United States. A total of 174 children with traumatic brain injury. Retrospective chart review. Adherence to care indicators (the number of times recommended care was delivered or attempted divided by the number of times care was indicated). Across facilities, adherence rates (adjusted for difficulty of delivery) ranged from 33.6% to 73.1% (95% confidence interval, 13.4-53.9, 58.7-87.4) for family-centered processes, 21.3% to 82.5% (95% confidence interval, 6.6-36.1, 67.6-97.4) for neurobehavioral and psychosocial processes, and 22.7% to 80.3% (95% confidence interval, 5.3-40.1, 68.1-92.5) for community integration processes. Within facilities, standard deviations for adherence rates were large (24.3-34.9, family-centered domain; 22.6-34.2, neurobehavioral and psychosocial domain; and 21.6-40.5, community reintegration domain). The current state of acute rehabilitation care for children with traumatic brain injury is variable across different quality-of-care indicators addressing neurobehavioral and psychosocial needs and facilitating community reintegration of the patient and the family. Individual rehabilitation facilities demonstrate inconsistent adherence to different indicators and inconsistent performance across different care domains.

Total, Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007–2010

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Sluik, Diewertje; van Lee, Linde; Engelen, Anouk I.; Feskens, Edith J. M.

2016-01-01

A high sugar intake is a subject of scientific debate due to the suggested health implications and recent free sugar recommendations by the WHO. The objective was to complete a food composition table for added and free sugars, to estimate the intake of total sugars, free sugars, and added sugars, adherence to sugar guidelines and overall diet quality in Dutch children and adults. In all, 3817 men and women (7–69 years) from the Dutch National Food Consumption Survey 2007–2010 were studied. Added and free sugar content of products was assigned by food composition tables and using labelling and product information. Diet was assessed with two 24-h recalls. Diet quality was studied in adults with the Dutch Healthy Diet-index. Total sugar intake was 22% Total Energy (%TE), free sugars intake 14 %TE, and added sugar intake 12 %TE. Sugar consumption was higher in children than adults. Main food sources of sugars were sweets and candy, non-alcoholic beverages, dairy, and cake and cookies. Prevalence free sugar intake diet quality was similar comparing adults adherent and non-adherent to the sugar guidelines, although adherent adults had a higher intake of dietary fiber and vegetables. Adherence to the WHO free sugar guidelines of sugar guidelines was not strongly associated with higher diet quality in adults. PMID:26828518

Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment.

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Baker-Ericzén, Mary J; Jenkins, Melissa M; Park, Soojin; Garland, Ann F

2015-02-01

Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. The present study explored the role of prior training in evidence-based treatments on clinicians' assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog "think aloud" method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. MANOVA results were significant for EBT training status such that EBT trained clinicians' displayed cognitive processes more closely aligned with "expert" decision-makers and non-EBT trained clinicians' decision processes were more similar to "novice" decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians' decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice.

Problem behaviours and parenting in preschool children with cystic fibrosis.

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Ward, C; Massie, J; Glazner, J; Sheehan, J; Canterford, L; Armstrong, D; Jaffe, A; Hiscock, H

2009-05-01

Problems with sleep, eating and adherence to therapy may adversely affect health outcomes in children with cystic fibrosis (CF). Data on the prevalence of such problems, associated parenting styles and caregiver mental health are limited. To determine: (a) the prevalence of sleep, mealtime, therapy adherence and externalising and internalising behavioural problems in preschool children with CF; (b) the prevalence of caregiver mental health problems and poor sleep quality; and (c) associations between child behavioural problems and parenting styles. This was a cross sectional survey of caregivers of children aged 6 months to 5 years attending CF outpatient clinics at Royal Children's Hospital (Melbourne), Monash Medical Centre (Melbourne) and Sydney Children's Hospital. Main outcome measures were child externalising and internalising behaviours, sleep, eating and adherence with therapy; the predictor was parenting styles (harsh, inconsistent, overprotective). 117 of 139 families participated. Problems were common with child sleep (small 31.6%; moderate/large problem: 21.9%), eating (32.4%) and adherence with physiotherapy (50.4%). Compared to normative data, sleep and mealtime problems were more prevalent. Caregivers reported high rates of symptoms indicating depression (33.3%), anxiety (16.4%) and stress (34.2%). Harsh parenting was associated with internalising behaviours (adjusted OR 3.9, 95% CI 1.16 to 13.17, p = 0.03). Problems with sleeping, eating and physiotherapy adherence were common in preschool children with CF. Caregivers reported high rates of symptoms indicative of mental health problems. Harsh parenting was associated with internalising problems. An intervention targeting child problem behaviours and parental mental health would be appropriate for CF families.

Examining the interaction of parental involvement and parenting style in predicting adherence in youth with type 1 diabetes.

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Landers, Sara E; Friedrich, Elizabeth A; Jawad, Abbas F; Miller, Victoria A

2016-03-01

This study examined whether aspects of parenting style (specifically, warmth, autonomy support, and coercion) moderated the association between parental involvement and adherence in youth with type 1 diabetes. Children ages 8 to 16 years with type 1 diabetes and a parent completed assessments of parental involvement, parenting style, and adherence. Parent autonomy support and coercion were associated with adherence but warmth was not. Child report of more parental involvement was associated with better adherence. Warmth, autonomy support, and coercion were not moderators. The findings underscore the importance of parental involvement, operationalized as responsibility for diabetes tasks, and parenting style, specifically coercion and autonomy support, for adherence in pediatric chronic illness management. Longitudinal research is needed to better understand how and why dimensions of involvement (e.g., responsibility, monitoring, support) vary over time and whether they impact outcomes differentially. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes.

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Khanderia, Ujjaini; Townsend, Kevin A; Erickson, Steven R; Vlasnik, Jon; Prager, Richard L; Eagle, Kim A

2008-02-01

The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs play a role in adherence. To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG. Adults were surveyed 6-24 months following CABG. The validated Beliefs about Medicines Questionnaire (BMQ) assessed attitudes concerning the Specific Necessity, Specific Concerns, General Harm, and General Overuse of medicines. The validated medication adherence scale assessed self-reported adherence. Analysis included univariate comparison (BMQ scales) and multivariate logistic regression (identification of adherence predictor variables). Of 387 patients surveyed, 132 (34%) completed the questionnaire. Nonparticipants were more likely to be female and have undergone 1- or 2-vessel CABG procedures compared with 3- or 4-vessel procedures. Subjects were primarily English-speaking, white, and male. Adherent behavior was reported in 73 of 132 patients (55%). The average period between CABG and the survey was 16 months. Nonadherent patients were in stronger agreement on the General Overuse (p = 0.01) and General Harm (p = 0.04) scales. The adjusted odds of adherent behavior were significantly lower, with an increasing General Overuse score (OR 0.83; 95% CI 0.72 to 0.95; p = 0.007); an annual income of $50,000 to $100,000 relative to less than $20,000 (OR 0.36; 95% CI 0.14 to 0.91; p = 0.031), and a living status of "alone" compared with "with adults and no children" (OR 0.20; 95% CI 0.06 to 0.65; p = 0.007). The odds ratio of self-reported adherence was higher with increasing age (OR 1.05; 95% CI 1.01 to 1.09; p = 0.023). In summary, patient beliefs and attitudes regarding medications, along with other social, economic, and demographic factors, help

Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework.

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Rob Horne

Full Text Available BACKGROUND: Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs and concerns about the potential adverse consequences of taking it. OBJECTIVE: To assess the utility of the NCF in explaining nonadherence to prescribed medicines. DATA SOURCES: We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles. STUDY ELIGIBILITY CRITERIA: Studies using the Beliefs about Medicines Questionnaire (BMQ to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication. PARTICIPANTS: Patients with long-term conditions. STUDY APPRAISAL AND SYNTHESIS METHODS: Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models. RESULTS: We identified 3777 studies, of which 94 (N = 25,072 fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used. LIMITATIONS: Few prospective longitudinal studies using objective adherence measures were identified. CONCLUSIONS: The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in

The Prevalence of Disclosure of HIV Status to HIV-Infected Children in Western Kenya.

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Turissini, Matthew L; Nyandiko, Winstone M; Ayaya, Samuel O; Marete, Irene; Mwangi, Ann; Chemboi, Victor; Warui, Lucy; Vreeman, Rachel C

2013-06-01

As antiretroviral therapy (ART) allows the world's 2.3 million human immunodeficiency virus (HIV)-infected children to grow and thrive, these children need to be informed of their HIV status. Neither the prevalence of disclosure to children nor its impact has been evaluated in most resource-limited settings. We conducted a prospective assessment of a random sample of HIV-infected children ages 6-14 years enrolled in HIV care at a large referral clinic in Eldoret, Kenya. Clinicians administered questionnaires to children and caregivers independently at routine clinic visits to assess disclosure status, ART adherence, stigma, and depression. Children's demographic and clinical characteristics were extracted from chart review. We calculated descriptive statistics and performed logistic regression to assess the association between disclosure and other characteristics. Two hundred seventy children-caregiver dyads completed questionnaires. The mean child age was 9.3 years (standard deviation 2.6); 49% were male, and 42% were orphans. 11.1% of children had been informed of their HIV status (N = 30). Of those under 10 years, 3.3% knew their status, whereas 9.2% of 10- to 12-year-olds and 39.5% of 13- to 14-year-olds knew they had HIV. Only age was significantly associated with disclosure status in both bivariate analyses (P processes should be a key facet of long-term pediatric HIV management. © The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Decision-Making Involvement and Prediction of Adherence in Youth With Type 1 Diabetes: A Cohort Sequential Study.

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Miller, Victoria A; Jawad, Abbas F

2018-05-17

To assess developmental trajectories of decision-making involvement (DMI), defined as the ways in which parents and children engage each other in decision-making about illness management, in youth with type 1 diabetes (T1D) and examine the effects of DMI on levels of and changes in adherence with age. Participants included 117 youth with T1D, enrolled at ages 8-16 years and assessed five times over 2 years. The cohort sequential design allowed for the approximation of the longitudinal curve from age 8 to 19 from overlapping cohort segments. Children and parents completed the Decision-Making Involvement Scale, which yields subscales for different aspects of DMI, and a self-report adherence questionnaire. Mixed-effects growth curve modeling was used for analysis, with longitudinal measures nested within participant and participants nested within cohort. Most aspects of DMI (Parent Express, Parent Seek, Child Express, and Joint) increased with child age; scores on some child report subscales (Parent Express, Child Seek, and Joint) decreased after age 12-14 years. After accounting for age, Child Seek, Child Express, and Joint were associated with overall higher levels of adherence in both child (estimates = 0.08-0.13, p < .001) and parent (estimates = 0.07- 0.13, p < .01) report models, but they did not predict changes in adherence with age. These data suggest that helping children to be more proactive in T1D discussions, by encouraging them to express their opinions, share information, and solicit guidance from parents, is a potential target for interventions to enhance effective self-management.

A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis.

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Egerton, T; Diamond, L E; Buchbinder, R; Bennell, K L; Slade, S C

2017-05-01

Primary care management of osteoarthritis (OA) is variable and often inconsistent with clinical practice guidelines (CPGs). This study aimed to identify and synthesize available qualitative evidence on primary care clinicians' views on providing recommended management of OA. Eligibility criteria included full reports published in peer-reviewed journals, with data collected directly from primary care clinicians using qualitative methods for collection and analysis. Five electronic databases (MEDLINE, Cochrane Central Register, EMBASE, CINAHL and PsychInfo) were searched to August 2016. Two independent reviewers identified eligible reports, conducted critical appraisal (based on Critical Appraisal Skills Programme (CASP) criteria), and extracted data. Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive new themes. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach was used to determine a confidence profile for each finding. Eight studies involving approximately 83 general practitioners (GPs), 24 practice nurses, 12 pharmacists and 10 physical therapists, from Australia, France, United Kingdom, Germany and Mexico were included. Four barriers were identified as themes 1) OA is not that serious, 2) Clinicians are, or perceive they are, under-prepared, 3) Personal beliefs at odds with providing recommended practice, and 4) Dissonant patient expectations. No themes were enablers. Confidence ratings were moderate or low. Synthesising available data revealed barriers that collectively point towards a need to address clinician knowledge gaps, and enhance clinician communication and behaviour change skills to facilitate patient adherence, enable effective conversations and manage dissonant patient expectations. PROSPERO (http://www.crd.york.ac.uk/PROSPERO) [4/11/2015, CRD42015027543]. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Treatment acceptance and adherence in HIV disease: patient identity and the perceived impact of physician–patient communication

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Laws MB

2012-12-01

Full Text Available M Barton Laws,1 Gary S Rose,2 Tanya Bezreh,1 Mary Catherine Beach,3 Tatiana Taubin,1 Laura Kogelman,4 Marcia Gethers,3 Ira B Wilson11Department of Health Services Policy and Practice, Brown University, Providence, RI, USA; 2Massachusetts School of Professional Psychology, Boston, MA, USA; 3Johns Hopkins University School of Medicine, Baltimore, MD, USA; 4Tufts Medical Center, Boston, MA, USAAbstract: Studies have found that physician–patient relationships and communication quality are related to medication adherence and outcomes in HIV care. Few qualitative studies exist of how people living with HIV experience clinical communication about their self-care behavior. Eight focus groups with people living with HIV in two US cities were conducted. Participants responded to a detailed discussion guide and to reenactments of actual physician–patient dialogue about antiretroviral adherence. The 82 participants were diverse in age, sex, and ethnicity. Most had been living with HIV for many years and had stable relationships with providers. They appreciated providers who knew and cared about their personal lives, who were clear and direct about instructions, and who were accessible. Most had struggled to overcome addiction, emotional turmoil, and/or denial before gaining control over their lives and becoming adherent to medications. They made little or no causal attribution for their transformation to any outside agency, including their providers. They generally saw medication adherence as a function of autonomous motivation. Successful coping with HIV with its prevalent behavioral comorbidities, stigma, and other challenges requires a transformation of identity and internalization of motivation to maintain health. Effective methods for clinicians to support such development are needed.Keywords: HIV, physician–patient communication, treatment adherence

Investigating self-efficacy, disease knowledge and adherence to treatment in adolescents with cystic fibrosis.

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Faint, Nicholas R; Staton, Janelle M; Stick, Stephen M; Foster, Juliet M; Schultz, André

2017-05-01

Patient adherence is integral to the effectiveness of prescribed treatment, and is associated with beneficial disease outcomes, yet in adolescents with cystic fibrosis, adherence is often sub-optimal. Multiple factors may contribute to treatment adherence, including disease knowledge and self-efficacy. In adolescents with cystic fibrosis: (i) to compare the disease knowledge of adolescents and their parents before transition to adult care; (ii) to determine the relationship between disease knowledge (adolescent, parent) and adherence; and (iii) to evaluate self-efficacy and its association with disease knowledge and adherence. Adolescents with cystic fibrosis and their parents were recruited from a tertiary children's hospital. Disease knowledge and self-efficacy was assessed using the Knowledge of Disease Management-CF and General Self-Efficacy Scales respectively. Using pharmacy records, medication possession ratio was calculated to measure treatment adherence in the preceding year. Thirty-nine adolescent (aged 12-17 (median 14) years) and parent pairs were recruited. Adherence to hypertonic saline, but not other medications, was significantly associated with disease knowledge in adolescents (r 2  = 0.40, P = 0.029). Mean (SD) adolescent self-efficacy was 30.8 (4.0), and not associated with disease knowledge or adherence. Mean (SD) disease knowledge was less in adolescents than parents (55 (16)% and 72 (14)% respectively, P < 0.001). Disease knowledge is sub-optimal in adolescents with cystic fibrosis, even in the 2 years immediately before transition to adult care. Given that adherence with some treatments has been associated with disease knowledge our results suggest the need for educational interventions in adolescents with cystic fibrosis to optimise self-management and health outcomes. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

A Genome-Wide Association Study Primer for Clinicians

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Tzu-Hao Wang

2009-06-01

Full Text Available Genome-wide association studies (GWAS use high-throughput genotyping technology to relate hundreds of thousands of genetic markers (genotypes to clinical conditions and measurable traits (phenotypes. This review is intended to serve as an introduction to GWAS for clinicians, to allow them to better appreciate the value and limitations of GWAS for genotype-disease association studies. The input of clinicians is vital for GWAS, since disease heterogeneity is frequently a confounding factor that can only really be solved by clinicians. For diseases that are difficult to diagnose, clinicians should ensure that the cases do indeed have the disease; for common diseases, clinicians should ensure that the controls are truly disease-free.

Depression longitudinally mediates the association of appearance concerns to ART non-adherence in HIV-infected individuals with a history of injection drug use.

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Blashill, Aaron J; Gordon, Janna R; Safren, Steven A

2014-02-01

Appearance concerns are common among HIV-infected individuals, and previous cross-sectional and longitudinal data indicate that these concerns are associated with antiretroviral therapy (ART) non-adherence. However, to date, no known prospective data have explored the mechanism behind this relationship. Thus, the aim of the current study was to test depression severity as a prospective mediator of the relationship between appearance concerns and ART non-adherence in HIV-infected individuals with a history of injection drug use (IDU). Participants were 89 HIV-infected individuals with a history of IDU who participated in a prospective, randomized controlled trial of cognitive behavioral therapy for depression and medication adherence. Clinician-administered measures of depression severity and appearance concerns, along with electronic monitoring of ART non-adherence were included. Data were analyzed using longitudinal linear mixed-level modeling, and mediation was tested via the Monte Carlo Method of Assessing Mediation. Appearance concerns were predictive of depression severity, γ = .31, SE = .076, 95 % CI [.16, .46], t = 4.1, p = .0001, and depression severity was predictive of ART non-adherence, γ = 3.3, SE = 1.3, 95 % CI [.8, 5.8], t = 2.6, p = .01. The effect of appearance concerns on ART non-adherence, however, was significantly mediated by depression severity, γ = 1.02, 95 % CI [.21, 2.1]. Appearance concerns are associated with depression severity, which in turn is associated with ART non-adherence. Integrative interventions addressing appearance concerns, depression and ART adherence are needed, as this is one potential pathway towards worse health outcomes in HIV-infected individuals.

Strict adherence to malaria rapid test results might lead to a neglect of other dangerous diseases: a cost benefit analysis from Burkina Faso

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Tinto Halidou

2011-08-01

Full Text Available Abstract Background Malaria rapid diagnostic tests (RDTs have generally been found reliable and cost-effective. In Burkina Faso, the adherence of prescribers to the negative test result was found to be poor. Moreover, the test accuracy for malaria-attributable fever (MAF is not the same as for malaria infection. This paper aims at determining the costs and benefits of two competing strategies for the management of MAF: presumptive treatment for all or use of RDTs. Methods A cost benefit analysis was carried out using a decision tree, based on data previously obtained, including a randomized controlled trial (RCT recruiting 852 febrile patients during the dry season and 1,317 in the rainy season. Cost and benefit were calculated using both the real adherence found by the RCT and assuming an ideal adherence of 90% with the negative result. The main parameters were submitted to sensitivity analysis. Results and discussion At real adherence, the test-based strategy was dominated. Assuming ideal adherence, at the value of 525 € for a death averted, the total cost of managing 1,000 febrile children was 1,747 vs. 1,862 € in the dry season and 1,372 vs. 2,138 in the rainy season for the presumptive vs. the test-based strategy. For adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. At the subsidized policy adopted locally, assuming ideal adherence, the RDT would be the winning strategy for adults in both seasons and for children in the dry season. At sensitivity analysis, the factors most influencing the choice of the better strategy were the value assigned to a death averted and the proportion of potentially severe NMFI treated with antibiotics in patients with false positive RDT results. The test-based strategy appears advantageous for adults if a satisfactory adherence could be achieved. For children the presumptive strategy remains the best choice for a wide range of scenarios. Conclusions For RDTs to be preferred, a positive result

Modulation of Kingella kingae adherence to human epithelial cells by type IV Pili, capsule, and a novel trimeric autotransporter.

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Porsch, Eric A; Kehl-Fie, Thomas E; St Geme, Joseph W

2012-10-23

Kingella kingae is an emerging bacterial pathogen that is being recognized increasingly as an important etiology of septic arthritis, osteomyelitis, and bacteremia, especially in young children. Colonization of the posterior pharynx is a key step in the pathogenesis of K. kingae disease. Previous work established that type IV pili are necessary for K. kingae adherence to the respiratory epithelium. In this study, we set out to identify additional factors that influence K. kingae interactions with human epithelial cells. We found that genetic disruption of the gene encoding a predicted trimeric autotransporter protein called Knh (Kingella NhhA homolog) resulted in reduced adherence to human epithelial cells. In addition, we established that K. kingae elaborates a surface-associated polysaccharide capsule that requires a predicted ABC-type transporter export operon called ctrABCD for surface presentation. Furthermore, we discovered that the presence of a surface capsule interferes with Knh-mediated adherence to human epithelial cells by nonpiliated organisms and that maximal adherence in the presence of a capsule requires the predicted type IV pilus retraction machinery, PilT/PilU. On the basis of the data presented here, we propose a novel adherence mechanism that allows K. kingae to adhere efficiently to human epithelial cells while remaining encapsulated and more resistant to immune clearance. Kingella kingae is a Gram-negative bacterium that is being recognized increasingly as a cause of joint and bone infections in young children. The pathogenesis of disease due to K. kingae begins with bacterial colonization of the upper respiratory tract, and previous work established that surface hair-like fibers called type IV pili are necessary for K. kingae adherence to respiratory epithelial cells. In this study, we set out to identify additional factors that influence K. kingae interactions with respiratory epithelial cells. We discovered a novel surface protein called

Mediterranean diet adherence is associated with lifestyle, physical fitness, and mental wellness among 10-y-olds in Chile.

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Muros, José Joaquín; Cofre-Bolados, Cristian; Arriscado, Daniel; Zurita, Félix; Knox, Emily

2017-03-01

The aim of this study was to assess adherence to the Mediterranean diet (MD) within a population of children from Santiago, Chile. A secondary aim was to examine the relationship between MD adherence, body composition, physical fitness, self-esteem, and other lifestyle factors. A cross-sectional study of a sample of children (N = 515; 10.6 ± 0.5 y) was conducted. Weight, body mass index, skinfolds, and waist circumference were measured. Physical fitness was determined using aspects of the Assessing Levels of Physical Activity health fitness test battery for children. Adherence to the MD was assessed using the Mediterranean Diet Quality Index for children and adolescents questionnaire. Self-esteem was evaluated using the Rosenberg scale and the Five-Factor Self-Concept Questionnaire measured self-concept. Participants completed the Physical Activity Questionnaire for Older Children and also were asked to report the number of hours per day they spent watching various screen-based devices. All findings were significant at the level P PAQ-C (r = 0.277), self-esteem (r = 0.301) and self-concept (r = 0.234), and for physical fitness, especially for explosive power of the legs (r = 0.355). Positive correlations with handgrip strength were found in boys (r = 0.323), whereas negative correlations with screen time were found in girls (r = -0.511). Given its relation to a healthier body composition, physical fitness, healthier lifestyle behaviors, and mental wellness, the MD should be promoted amongst youngsters. Copyright © 2016 Elsevier Inc. All rights reserved.

Moving Forward with School Nutrition Policies: A Case Study of Policy Adherence in Nova Scotia.

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McIsaac, Jessie-Lee D; Shearer, Cindy L; Veugelers, Paul J; Kirk, Sara F L

2015-12-01

Many Canadian school jurisdictions have developed nutrition policies to promote health and improve the nutritional status of children, but research is needed to clarify adherence, guide practice-related decisions, and move policy action forward. The purpose of this research was to evaluate policy adherence with a review of online lunch menus of elementary schools in Nova Scotia (NS) while also providing transferable evidence for other jurisdictions. School menus in NS were scanned and a list of commonly offered items were categorized, according to minimum, moderate, or maximum nutrition categories in the NS policy. The results of the menu review showed variability in policy adherence that depended on food preparation practices by schools. Although further research is needed to clarify preparation practices, the previously reported challenges of healthy food preparations (e.g., cost, social norms) suggest that many schools in NS are likely not able to use these healthy preparations, signifying potential noncompliance to the policy. Leadership and partnerships are needed among researchers, policy makers, and nutrition practitioners to address the complexity of issues related to food marketing and social norms that influence school food environments to inspire a culture where healthy and nutritious food is available and accessible to children.

Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8.

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Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Furue, Masutaka; Onozuka, Daisuke; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Saeki, Hidehisa; Shintani, Yoichi; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Hagihara, Akihito; Morisky, Donald E; Katoh, Norito

2015-11-01

Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence. © 2015 The Authors. The Journal of Dermatology published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Dermatological Association.

Evaluation of adherence to the treatment of type 1 diabetes mellitus: Literature review

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Luziane Fatima Kirchner

2014-08-01

Full Text Available This work aimed to identify methods, objectives and type of studies that assessed adherence to the treatment of type 1 Diabetes Mellitus, published from 2000 to 2013. We analyzed 111 articles, collected in the survey by the Web of Science database. The results indicated that 95 studies are descriptive, with prevalence of adolescents (74 studies and children (34 studies. It was also found that those studies that have prevailed: Used an informer (67 studies, the carrier of the disease who reported more data (72 studies, evaluated one (35 studies or five (25 studies treatment medical, by means of an instrument (68 studies, being standardized instruments the most used procedures in this assessment (40 studies. Data leaded to the conclusion that the methods used to assess adherence, in the studies analyzed, do not comply with the suggestions made in Literature to make the results in adherence more reliable. Discussions about this subject need to be further developed.

The Adherence Estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease.

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McHorney, Colleen A

2009-01-01

To conceptualize, develop, and provide preliminary psychometric evidence for the Adherence Estimator--a brief, three-item proximal screener for the likelihood of non-adherence to prescription medications (medication non-fulfillment and non-persistence) for chronic disease. Qualitative focus groups with 140 healthcare consumers and two internet-based surveys of adults with chronic disease, comprising a total of 1772 respondents, who were self-reported medication adherers, non-persisters, and non-fulfillers. Psychometric tests were performed on over 150 items assessing 14 patient beliefs and skills hypothesized to be related to medication non-adherence along a proximal-distal continuum. Psychometric tests included, but were not limited to, known-groups discriminant validity at the scale and item level. The psychometric analyses sought to identify: (1) the specific multi-item scales that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters) and, (2) the single best item within each prioritized multi-item scale that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters). The two rounds of psychometric testing identified and cross-validated three proximal drivers of self-reported adherence: perceived concerns about medications, perceived need for medications, and perceived affordability of medications. One item from each domain was selected to include in the Adherence Estimator using a synthesis of psychometric results gleaned from classical and modern psychometric test theory. By simple summation of the weights assigned to the category responses of the three items, a total score is obtained that is immediately interpretable and completely transparent. Patients can be placed into one of three segments based on the total score--low, medium, and high risk for non-adherence. Sensitivity was 88%--of the non-adherers, 88% would be accurately classified as medium

Patient adherence with COPD therapy

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C. S. Rand

2005-12-01

Full Text Available Although there are very few published studies on adherence to treatment regimens in chronic obstructive pulmonary disease (COPD, the evidence that exists suggests that, as with asthma therapy, adherence is poor. Patient beliefs about COPD, as well as their motivation and expectations about the likelihood of success of medical interventions, can influence adherence rates. Other critical factors include the patient's understanding of their illness and therapy, and the complexity of the prescribed treatment regimen. Incorrect inhaler technique is also a common failing. When prescribing in primary or specialist care, healthcare professionals should address adherence as a vital part of the patient consultation. Improved patient education may also increase adherence rates.

Medication adherence in inflammatory bowel disease

Directory of Open Access Journals (Sweden)

Webber Chan

2017-10-01

Full Text Available Inflammatory bowel disease (IBD is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

Discrepancies in mother and child perceptions of spina bifida medical responsibilities during the transition to adolescence: associations with family conflict and medical adherence.

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Psihogios, Alexandra M; Holmbeck, Grayson N

2013-09-01

This study investigated mother-child discrepancies over perceptions of who is responsible for spina bifida (SB) medical tasks in relation to family conflict and medical adherence. 140 youth with SB and their mothers completed questionnaires regarding who is responsible for specific SB medical tasks, family conflict, and medical adherence. An observational measure was also used to assess family conflict. Although children viewed themselves as more responsible for medical management than mothers did, mother-child discrepancies were not associated with family conflict or medical adherence. Interaction effects revealed that adherence was better when family conflict was low and when parents were responsible for medical tasks. Parental involvement in SB medical care is essential for optimal medical adherence during adolescence. The presence of family conflict also plays an influential role on SB medical adherence. Future research should evaluate the relations between discrepancies, family conflict, and medical adherence across time.

Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning

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Angelos P. Kassianos

2017-10-01

impact on non-adherence. Theories like social cognition models can be useful in ensuring that patients' education, motivation, skills, beliefs, and type of adherence are taken into consideration when developing the apps. Findings from this study can help clinicians and patients make informed choices and pursue policy-makers to integrate evidence when developing future apps. Quality-assurance tools are needed to ensure the apps are systematically evaluated.

Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning.

Science.gov (United States)

Kassianos, Angelos P; Georgiou, Giorgos; Papaconstantinou, Electra P; Detzortzi, Angeliki; Horne, Rob

2017-01-01

. Theories like social cognition models can be useful in ensuring that patients' education, motivation, skills, beliefs, and type of adherence are taken into consideration when developing the apps. Findings from this study can help clinicians and patients make informed choices and pursue policy-makers to integrate evidence when developing future apps. Quality-assurance tools are needed to ensure the apps are systematically evaluated.

System for integrated adherence monitoring: real-time non-adherence risk assessment in pediatric kidney transplantation.

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Pai, Ahna L H; Rausch, Joseph; Tackett, Alayna; Marsolo, Keith; Drotar, Dennis; Goebel, Jens

2012-06-01

This study reports initial results of the development of the SIAM, a non-adherence risk assessment system for tacrolimus and sirolimus for the pediatric kidney transplant population. Forty-eight youths between 10 and 25 yr of age diagnosed with chronic kidney disease or a kidney transplant used an electronic pill bottle (EM; time stamps each bottle opening) to dispense their medication for at least 30 days or until their next clinic appointment. Youth also completed a self-report adherence measure, and standard deviations were calculated for the last four medication serum trough levels obtained for each patient. Estimation models were developed for each medication (i.e., SIAM(TACRO) and SIAM(SIRO) ) to assign weights to these clinically available adherence measures (self-report and trough levels) for the calculation of a non-adherence risk composite score. SIAM(TACRO) models included both self-report and tacrolimus trough levels and significantly predicted EM. For sirolimus, the model predictive of adherence as measured by EM consisted of the standard deviation of sirolimus trough levels only (SIAM(SIRO) ). Non-adherence risk can be effectively assessed using clinically available assessment tools. However, the best methods for using self-report and trough levels to predict non-adherence likely differ based on the medication for which adherence is being assessed. © 2012 John Wiley & Sons A/S.

Asthma medication adherence: the role of God and other health locus of control factors.

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Ahmedani, Brian K; Peterson, Edward L; Wells, Karen E; Rand, Cynthia S; Williams, L Keoki

2013-02-01

Medication adherence is an important determinant of disease outcomes, yet medication use on average tends to be low among patients with chronic conditions, including asthma. Although several predictors of non-adherence have been assessed, more research is needed on patients' beliefs about God and how these relate to medication use. To examine the relationship between perceptions about "God's" role in health and other locus of control factors with inhaled corticosteroid (ICS) adherence among asthma patients. Participants were from a clinical trial to improve ICS adherence and were 5-56 years old, had a diagnosis of asthma, and were receiving ICS medication. Baseline adherence was estimated from electronic prescription and pharmacy fill records. Patients were considered to be adherent if ICS use was ≥80% of prescribed. A baseline survey with the Multidimensional Health Locus of Control scale was used to assess five sources (God, doctors, other people, chance, and internal). Medication adherence was low (36%). Patients' who had a stronger belief that God determined asthma control were less likely to be adherent (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.96). This relationship was stronger among African American (OR 0.68, 95% CI0.47-0.99) compared to white patients (OR 0.89, 95% CI 0.75-1.04), and among adults (OR 0.81, 95% CI 0.69-0.96) compared to children (OR 0.84, 95% CI 0.58-1.22). Patients' belief in God's control of health appears to be a factor in asthma controller use, and therefore should be considered in physician-patient discussions concerning course of treatment. ClinicalTrials.gov: NCT00459368. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Adherence to the Obesity-related Lifestyle Intervention Targets in the IDEFICS Study

DEFF Research Database (Denmark)

Kovács, Eva; Siani, Alfonso; Konstabel, Kenn

2014-01-01

Background/objectives: To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children’s health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study...... such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. Methods: The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar......-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. Results...

Adherence with Preventive Medication in Childhood Asthma

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Scott Burgess

2011-01-01

Full Text Available Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.

Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence.

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Sieverink, Floor; Kelders, Saskia M; van Gemert-Pijnen, Julia Ewc

2017-12-06

In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as "the more use, the better," whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to determine adherence to the technology. The

Randomised clinical trials with clinician-preferred treatment.

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Korn, E L; Baumrind, S

1991-01-19

The standard design for randomised clinical trials may be inappropriate when the clinician believes that one of the treatments being tested is superior for the patient, or when the clinician has a preference for one of the treatments. For such instances the suggestion is that the patient is randomly allocated to treatment only when there is clinical disagreement about treatment of choice for that patient, and then the patient is assigned to a clinician who had thought that the regimen allocated is the one most appropriate for that patient.

Medication adherence in patients with psychotic disorders: an observational survey involving patients before they switch to long-acting injectable risperidone

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Baylé FJ

2015-09-01

Full Text Available Franck Jean Baylé,1 Arnaud Tessier,2,3 Sophie Bouju,4 David Misdrahi2,3 1Sainte-Anne Hospital (SHU, Paris V-Descartes University, Paris, 2Hôpital Charles Perrens, Pôle de Psychiatrie Adulte, 3CNRS UMR 5287-INCIA, Bordeaux University, Bordeaux, 4Janssen-Cilag France, Issy Les Moulineaux, Paris, France Background: Maintaining antipsychotic therapy in psychosis is important in preventing relapse. Long-acting depot preparations can prevent covert non-adherence and thus potentially contribute to better patient outcomes. In this observational survey the main objective is to evaluate medication adherence and its determinants for oral treatment in a large sample of patients with psychosis.Methods: In this cross-sectional survey medication adherence for oral treatment was assessed by patients using the patient-rated Medication Adherence Questionnaire (MAQ. Data were collected by physicians on patients with a recent acute psychotic episode before switching to long-acting injectable risperidone. Other evaluations included disease severity (Clinical Global Impression – Severity, patients’ insight (Positive and Negative Syndrome Scale item G12, treatment acceptance (clinician-rated Compliance Rating Scale, and therapeutic alliance (patient-rated 4-Point ordinal Alliance Scale.Results: A total of 399 psychiatrists enrolled 1,887 patients (mean age 36.8±11.9 years; 61.6% had schizophrenia. Adherence to oral medication was “low” in 53.2% of patients, “medium” in 29.5%, and “high” in 17.3%. Of patients with psychiatrist-rated active acceptance of treatment, 70% had “medium” or “high” MAQ scores (P<0.0001. Medication adherence was significantly associated with therapeutic alliance (4-Point ordinal Alliance Scale score; P<0.0001. Patient age was significantly associated with adherence: mean age increased with greater adherence (35.6, 36.7, and 38.6 years for patients with “low”, “medium”, and “high” levels of adherence

HIV-infected adolescents have low adherence to antiretroviral therapy: a cross-sectional study in Addis Ababa, Ethiopia.

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Firdu, Naod; Enquselassie, Fikre; Jerene, Degu

2017-01-01

For antiretroviral therapy (ART) to work effectively, adherence is very crucial. However, most studies done on ART adherence are either on children or on adults. There is limited information on the level of adherence among adolescents. Using a cross-sectional study design, we interviewed 273 HIV-infected adolescents receiving ART from three hospitals in Addis Ababa. We used a structured questionnaire to measure adherence levels using patient self-reports. Bivariate and multivariate methods were used for analysis. We interviewed 273 adolescents aged 13 to 19 years, and 144 (52.7%) of the participants were girls. Their mean age was 15.4 years (SD± 1.75). The self-reported adherence rate of the respondents was 79.1% (216/273). On bivariate analysis, variables like WHO clinical stage, being on Cotrimoxazole Prophylactic Therapy (CPT), marital and living status of the parent, whether parent was on ART or not and having special instructions for ART medications were associated with optimum adherence. However of those, only WHO stage IV (adjusted OR, 12.874 95% CI, 2.079-79.706), being on CPT (adjusted OR, 0.339 95% CI, 0.124-0.97) and adolescents with widowed parent (adjusted OR, 0.087 with 95% CI, 0.021-0.359) were found to be significantly associated with optimum ART adherence. The level of self-reported ART adherence among HIV-infected adolescents at the three hospitals was below the recommended threshold. Though earlier presentation of adolescents to care should be encouraged, more targeted adherence support should be planned for those who present at an early stage of their illness.

Corporal diagnostic work and diagnostic spaces: clinicians' use of space and bodies during diagnosis.

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Gardner, John; Williams, Clare

2015-06-01

An emerging body of literature in sociology has demonstrated that diagnosis is a useful focal point for understanding the social dimensions of health and illness. This article contributes to this work by drawing attention to the relationship between diagnostic spaces and the way in which clinicians use their own bodies during the diagnostic process. As a case study, we draw upon fieldwork conducted with a multidisciplinary clinical team providing deep brain stimulation (DBS) to treat children with a movement disorder called dystonia. Interviews were conducted with team members and diagnostic examinations were observed. We illustrate that clinicians use communicative body work and verbal communication to transform a material terrain into diagnostic space, and we illustrate how this diagnostic space configures forms of embodied 'sensing-and-acting' within. We argue that a 'diagnosis' can be conceptualised as emerging from an interaction in which space, the clinician-body, and the patient-body (or body-part) mutually configure one another. By conceptualising diagnosis in this way, this article draws attention to the corporal bases of diagnostic power and counters Cartesian-like accounts of clinical work in which the patient-body is objectified by a disembodied medical discourse. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness.

Clinician perspectives of an intensive comprehensive aphasia program.

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Babbitt, Edna M; Worrall, Linda E; Cherney, Leora R

2013-01-01

Intensive comprehensive aphasia programs (ICAPs) have increased in number in recent years in the United States and abroad. To describe the experiences of clinicians working in an ICAP. A phenomenological approach was taken. Seven clinicians from 3 ICAPs were interviewed in person or on the phone. Their interviews were transcribed and coded for themes relating to their experiences. Clinicians described 3 major themes. The first theme related to the intensity component of the ICAP that allowed clinicians to provide in-depth treatment and gave them a different perspective with regard to providing treatment and the potential impact on the person with aphasia. The second theme of rewards for the clinicians included learning and support, seeing progress, and developing relationships with their clients and family members. Third, challenges were noted, including the time involved in learning new therapy techniques, patient characteristics such as chronicity of the aphasia, and the difficulty of returning to work in typical clinical settings after having experienced an ICAP. Although there is a potential for bias with the small sample size, this pilot study gives insight into the clinician perspective of what makes working in an ICAP both worthwhile and challenging.

Clinician preferences and the estimation of causal treatment differences

OpenAIRE

Korn, Edward L.; Baumrind, Sheldon

1998-01-01

Clinician treatment preferences affect the ability to perform randomized clinical trials and the ability to analyze observational data for treatment effects. In clinical trials, clinician preferences that are based on a subjective analysis of the patient can make it difficult to define eligibility criteria for which clinicians would agree to randomize all patients who satisfy the criteria. In addition, since each clinician typically has some preference for the choice of treatment for a given ...

Managing HIV-infected children in a low-resource, public clinic: a comparison of nurse vs. clinical officer practices in ART refill, calculation of adherence and subsequent appointments.

Science.gov (United States)

Weigel, Ralf; Feldacker, Caryl; Tweya, Hannock; Gondwe, Chimwemwe; Chiwoko, Jane; Gumulira, Joe; Kalulu, Mike; Phiri, Sam

2012-01-01

In Malawi, as in other sub-Saharan African countries, nurses manage patients of all ages on antiretroviral treatment(ART). Nurse management of children is rarely studied.We compare ART prescribing between nurses and clinical officers during routine clinic visits at an urban, public clinic to inform policy in paediatric ART management. Caregivers of children on first-line ART provided information about visit dates, pill counts, ART dosage and formulation to a nurse and, subsequently, to a clinical officer. Nurses and clinical officers independently calculated adherence, dosage based on body weight, and set next appointment date. Clinical officers, but not nurses, accessed an electronic data system that made the calculations for them based on information from prior visits, actual and expected pill consumption, and standard drug supplies. Nurses calculated with pen and paper. For numerical variables, Bland-Altman graphs plot differences of each nurse clinical officer pair against the mean, show the 95% limits of agreement (LoA), and also show the mean difference across all reviews. Kappa statistics assess agreement for categorical variables. A total of 704 matched nurse clinical officer reviews of 367 children attending the ART clinics between March and July 2010 were analyzed. Eight nurses and 18 clinical officers were involved; two nurses and five clinical officers managed 100 visits or more. Overall, there was a good agreement between the two cadres. Differences between nurses and clinical officers were within narrow LoA and mean differences showed little deviation from zero, indicating little skewing towards one cadre. LoA of adherence and morning and evening ART dosages varied from -24% to 24%, -0.4 to 0.4 and -0.41 to 0.40 tablets,respectively, with mean differences (95% CI) of 0.003 (-0.9, 0.91), -0.005 (-0.02, 0.01) and -0.009 (-0.02, 0.01). Next appointment calculations differed more between cadres with LoA from -40 to 42 days [mean difference: 0.96 days (95

The Relationship between Clinicians' Confidence and Accuracy, and the Influence of Child Characteristics, in the Screening of Autism Spectrum Disorder

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Hedley, Darren; Brewer, Neil; Nevill, Rose; Uljarevic, Mirko; Butter, Eric; Mulick, James A.

2016-01-01

The study examined the confidence accuracy relationship, and the influence of child characteristics on clinician confidence, when predicting a diagnosis of Autism Spectrum Disorder during screening of 125 referred children aged under 3.5 years. The diagnostic process included observation, interview, language and developmental testing. Clinical…

Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective.

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Frederick, Natasha N; Campbell, Kevin; Kenney, Lisa B; Moss, Kerry; Speckhart, Ashley; Bober, Sharon L

2018-04-26

Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients with cancer as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to investigate the attitudes and perceptions of pediatric oncology clinicians towards discussing SRH with AYAs, and to understand perceived barriers to effective communication in current practice. Pediatric oncology clinicians (physicians, certified nurse practitioners, and physician assistants) participated in semi-structured qualitative interviews investigating attitudes about SRH communication with AYAs and barriers to such conversations. Twenty-two clinicians participated from seven institutions in the Northeastern United States. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Interviews with pediatric oncology clinicians revealed the following five primary themes: the role for pediatric oncology clinicians to discuss SRH, the focus of current SRH conversations on fertility, the meaning of "sexual health" as safe sex and contraception only, clinician-reported barriers to SRH conversations, and the need for education and support. Communication barriers included lack of knowledge/experience, lack of resources/referrals, low priority, parents/family, patient discomfort, clinician discomfort, time, and lack of rapport. Clinicians identified resource and support needs, including formal education and SRH education materials for patients and families. Although the study participants identified a role for pediatric oncology clinicians in SRH care for AYA patients with cancer, multiple barriers interfere with such discussions taking place on a regular basis. Future efforts must focus on resource development and provider education and training in SRH to optimize the care provided to this unique patient population. © 2018 Wiley Periodicals, Inc.

Integrating virtual reality video games into practice: clinicians' experiences.

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Levac, Danielle E; Miller, Patricia A

2013-10-01

The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

Adherence of Pseudomonas aeruginosa to contact lenses

International Nuclear Information System (INIS)

Miller, M.J.

1988-01-01

The purpose of this research was to examined the interactions of P. aeruginosa with hydrogel contact lenses and other substrata, and characterize adherence to lenses under various physiological and physicochemical conditions. Isolates adhered to polystyrene, glass, and hydrogel lenses. With certain lens types, radiolabeled cells showed decreased adherence with increasing water content of the lenses, however, this correlation with not found for all lenses. Adherence to rigid gas permeable lenses was markedly greater than adherence to hydrogels. Best adherence occurred near pH 7 and at a sodium chloride concentration of 50 mM. Passive adhesion of heat-killed cells to hydrogels was lower than the adherence obtained of viable cells. Adherence to hydrogels was enhanced by mucin, lactoferrin, lysozyme, IgA, bovine serum albumin, and a mixture of these macromolecules. Adherence to coated and uncoated lenses was greater with a daily-wear hydrogel when compared with an extended-wear hydrogel of similar polymer composition. Greater adherence was attributed to a higher concentration of adsorbed macromolecules on the 45% water-content lens in comparison to the 55% water-content lens

[Extensive cranioplasty for sagittal synostosis in young children by preserving multiple cranial bone flaps adhered to the dura mater: experience with 63 cases].

Science.gov (United States)

Bao Nan; Chu Jun; Wang Xue; Yang, Bo; Song, Yunhai; Cai, Jinjing

2016-01-01

This study aimed to evaluate the effort of applying frontal and occipital bones in extensive cranioplasty and preserving multiple cranial bone flaps adhered to the dura mater in the treatment of sagittal synostosis. From April 2008 to June 2013, sixty-three children with sagittal synostosis, aged 5 months to 3 years, were included in the study. The frontal bone flap was removed using an air drill. The occipital and bilateral temporal bone flaps were cut open but not detached from the dura mater or fixed to produce floating bone flaps. The skull bone was cut into palisade-like structures. Brain compression from both sides and the base of the skull was released and the brain expanded bilaterally through the enlarged space. Only a long strip-shaped bone bridge remained in the central parietal bone. Subsequently, the frontal bone flaps and occipital bone flap were pushed towards the midline and fixed with the parietal bone bridge to shorten the anteroposterior diameter of the cranial cavity and allow the brain to expand bilaterally to correct scaphocephaly. The CT images showed that both sides of the parietal bone of artificial sagittal groove gradually merged postoperative 1 year, and skull almost completely normal healing after operation 2 or 3 years, without deformity recurrence within 5 years. Among them all, 61 children's intelligence is normal and 2 children's lagged behind normal level, no further improvement. Patients were followed up 1 - 5 years (an average of 43 months). Skull growth was excellent in all patients, the anteroposterior diameter was shortened by 14.6 mm averagely, the transverse diameter was increased by 12.3 mm averagely, the prominent forehead was corrected, and scaphocephaly improved significantly. There were no complications such as death and skull necrosis. The application of frontal and occipital bones in extensive cranioplasty and preserving multiple cranial bone flaps adhered to the dura mater can be used in the treatment of sagittal

Adherence to 24-Hour Movement Guidelines for the Early Years and associations with social-cognitive development among Australian preschool children

Directory of Open Access Journals (Sweden)

Dylan P. Cliff

2017-11-01

M performance (3 vs. 2, p = 0.03. Conclusions Strategies to promote adherence to the 24-Hour Movement Behaviour Guidelines for the Early Years among preschool children are warranted. Supporting preschool children to meet all guidelines or more guidelines, particularly the sleep and screen time guidelines, may be beneficial for their social-cognitive development.

Clustering based on adherence data.

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Kiwuwa-Muyingo, Sylvia; Oja, Hannu; Walker, Sarah A; Ilmonen, Pauliina; Levin, Jonathan; Todd, Jim

2011-03-08

Adherence to a medical treatment means the extent to which a patient follows the instructions or recommendations by health professionals. There are direct and indirect ways to measure adherence which have been used for clinical management and research. Typically adherence measures are monitored over a long follow-up or treatment period, and some measurements may be missing due to death or other reasons. A natural question then is how to describe adherence behavior over the whole period in a simple way. In the literature, measurements over a period are usually combined just by using averages like percentages of compliant days or percentages of doses taken. In the paper we adapt an approach where patient adherence measures are seen as a stochastic process. Repeated measures are then analyzed as a Markov chain with finite number of states rather than as independent and identically distributed observations, and the transition probabilities between the states are assumed to fully describe the behavior of a patient. The patients can then be clustered or classified using their estimated transition probabilities. These natural clusters can be used to describe the adherence of the patients, to find predictors for adherence, and to predict the future events. The new approach is illustrated and shown to be useful with a simple analysis of a data set from the DART (Development of AntiRetroviral Therapy in Africa) trial in Uganda and Zimbabwe.

Medication adherence among adult patients on hemodialysis

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Abdulmalik M Alkatheri

2014-01-01

Full Text Available Medication adherence was assessed in 89 patients on hemodialysis (HD at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8. The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012, being married (P = 0.012 increased the level of adherence, being of medium level of education (P = 0.024 decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence.

Singing by speechless (aphasic) children: Victorian medical observations.

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Lorch, Marjorie Perlman; Greenblatt, Samuel H

2015-01-01

In the second half of the nineteenth century, British clinicians made observations regarding the ability of individuals with impaired language abilities to sing or hum. One notable publication was of two cases of children briefly observed by John Hughlings Jackson (1835-1911) in 1871. These children were speechless but could produce some musical expression. Other such cases attracted the attention of Victorian clinicians who were actively pursuing theoretical questions regarding the organization of brain function and laterality. The presence of musical expression in children who failed to develop spoken language was seen as a notable symptom for early practitioners of pediatric neurology. © 2015 Elsevier B.V. All rights reserved.

Adherence as a language game.

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Kolberg, Espen Skarstein

2017-04-01

Non-adherence, i.e. medication intake behavior not corresponding with agreed recommendations, is associated with increased morbidity and death, and it has been estimated that as many as 50% of patients in developed countries are not taking their medications as prescribed. But even as efforts in improving medication adherence over the years have increased, results are inconsistent, with only a minority of clinical trials showing any improvement in both adherence and clinical outcome. Since patient education is central to promoting good medication adherence, and language is integral to education, perhaps an exploration of the meaning and use of language, using the philosophy of Ludwig Wittgenstein, is in order.

Social position, gender role, and treatment adherence among Colombian women living with HIV/AIDS: social determinants of health approach.

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Arrivillaga, Marcela; Ross, Michael; Useche, Bernardo; Alzate, Martha Lucia; Correa, Diego

2009-12-01

To assess and analyze the associations between adherence to treatment and social position in women living with HIV/AIDS. A cross-sectional, descriptive, correlational study among 269 Colombian women was conducted. Participants completed three questionnaires: a socio-demographic and clinical characteristics survey, a treatment adherence scale, and a social position survey. Women of low social position had a significantly higher probability of low treatment adherence (OR = 5.651, P effect on adherence. A general model considering the variables 'type of national health care plan' ('contributive,' 'subsidized,' or, in the case of vinculadas or the uninsured, 'none'); 'having HIV-positive children'; and 'level of viral load' was statistically reliable in predicting study participants' treatment adherence. Membership in the subsidized plan or being uninsured had a greater effect on the probability of low adherence than membership in the contributive plan (OR = 3.478, P 400 copies/ml were more likely to have low adherence than women without those characteristics (OR = 2.395, P = 0.0274 and OR = 2.178, P = 0.0050, respectively). Improving women's adherence to HIV/AIDS treatment in Colombia would require eliminating barriers to national health care system and comprehensive health care services and implementing programs that take into account women's role as maternal caregivers The findings underscore the need to integrate variables related to gender inequality and social position in treatment adherence analysis, as advocated in the social determinants of health approach.

Clinician search behaviors may be influenced by search engine design.

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Lau, Annie Y S; Coiera, Enrico; Zrimec, Tatjana; Compton, Paul

2010-06-30

Searching the Web for documents using information retrieval systems plays an important part in clinicians' practice of evidence-based medicine. While much research focuses on the design of methods to retrieve documents, there has been little examination of the way different search engine capabilities influence clinician search behaviors. Previous studies have shown that use of task-based search engines allows for faster searches with no loss of decision accuracy compared with resource-based engines. We hypothesized that changes in search behaviors may explain these differences. In all, 75 clinicians (44 doctors and 31 clinical nurse consultants) were randomized to use either a resource-based or a task-based version of a clinical information retrieval system to answer questions about 8 clinical scenarios in a controlled setting in a university computer laboratory. Clinicians using the resource-based system could select 1 of 6 resources, such as PubMed; clinicians using the task-based system could select 1 of 6 clinical tasks, such as diagnosis. Clinicians in both systems could reformulate search queries. System logs unobtrusively capturing clinicians' interactions with the systems were coded and analyzed for clinicians' search actions and query reformulation strategies. The most frequent search action of clinicians using the resource-based system was to explore a new resource with the same query, that is, these clinicians exhibited a "breadth-first" search behaviour. Of 1398 search actions, clinicians using the resource-based system conducted 401 (28.7%, 95% confidence interval [CI] 26.37-31.11) in this way. In contrast, the majority of clinicians using the task-based system exhibited a "depth-first" search behavior in which they reformulated query keywords while keeping to the same task profiles. Of 585 search actions conducted by clinicians using the task-based system, 379 (64.8%, 95% CI 60.83-68.55) were conducted in this way. This study provides evidence that

Medicine non-adherence in kidney transplantation.

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Williams, Allison Fiona; Manias, Elizabeth; Gaskin, Cadeyrn J; Crawford, Kimberley

2014-06-01

The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims.

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Ratanawongsa, Neda; Quan, Judy; Handley, Margaret A; Sarkar, Urmimala; Schillinger, Dean

2018-04-06

Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments. As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: "In the last 7 days, how many days did you MISS taking your …" diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview. Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01). Language-concordant ATSM demonstrated modest potential

AphasiaBank: a resource for clinicians.

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Forbes, Margaret M; Fromm, Davida; Macwhinney, Brian

2012-08-01

AphasiaBank is a shared, multimedia database containing videos and transcriptions of ~180 aphasic individuals and 140 nonaphasic controls performing a uniform set of discourse tasks. The language in the videos is transcribed in Codes for the Human Analysis of Transcripts (CHAT) format and coded for analysis with Computerized Language ANalysis (CLAN) programs, which can perform a wide variety of language analyses. The database and the CLAN programs are freely available to aphasia researchers and clinicians for educational, clinical, and scholarly uses. This article describes the database, suggests some ways in which clinicians and clinician researchers might find these materials useful, and introduces a new language analysis program, EVAL, designed to streamline the transcription and coding processes, while still producing an extensive and useful language profile. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Immunosuppressive medication adherence in kidney transplant patients.

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Lalić, Jelena; Veličković-Radovanović, Radmila; Mitić, Branka; Paunović, Goran; Cvetković, Tatjana

2014-01-01

To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine if there is a difference in the rate of adherence to tacrolimus (Tac), cyclosporine (CsA) and sirolimus (Sir). From a total of 63 KTPs treated at the Clinic of Nephrology, Clinical Centre Niš, Serbia, 60 participated in the study by responding to questionnaires. They were divided into the adherence group (n = 43) and the nonadherence group (n = 17) according to their degree of adherence which was measured using a validated survey form, the simplified medication adherence questionnaire. The KTP adherence to the different immunosuppressive regimens (Tac, CsA and Sir) was compared. Statistical analysis was performed using the Student t test. Adherence was observed in 43 (71.7%) patients, and only 17 (28.3%) did not follow the prescribed therapy. The estimated glomerular filtration rate was significantly lower in the nonadherence group (38.52 ± 18.22 ml/min) than in the adherence group (52.43 ± 16.91 ml/min, p adherers and the nonadherers (6.30 ± 2.06 vs. 5.0 ± 1.52 ng/ml, p adherence. Nonadherence was associated with worse graft function and a lower Tac level. Knowledge about the degree of adherence could help the early identification of nonadherent patients and the development of strategies to improve this. © 2014 S. Karger AG, Basel

Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting.

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Michelle T Hecker

Full Text Available To evaluate adherence to uncomplicated urinary tract infections (UTI guidelines and UTI diagnostic accuracy in an emergency department (ED setting before and after implementation of an antimicrobial stewardship intervention.The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18-65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1, and after audit and feedback (period 2.Adherence to UTI guidelines increased from 44% (baseline to 68% (period 1 to 82% (period 2 (P≤.015 for each successive period. Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline to 14% (period 1 to 13% (period 2 (P<.001 and P = .7 for each successive period. Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period. For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods.A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.

Periodontal diseases in children and adolescents: a clinician's perspective part.

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Masamatti, Sujata Surendra; Kumar, Ashish; Virdi, Mandeep Singh

2012-10-01

Contrasting forms of periodontal disease can affect children and adolescents with varying prevalence, severity and extent, leading to a diverse prognosis in these age groups. For an early diagnosis and treatment of periodontal conditions in young patients, it is essential for the dental practitioner to be able to identify and classify the disease correctly at the earliest opportunity, applying basic principles along with understanding of aetiology and risk factors. The first part of this article discusses the classification, plaque-induced and non-plaque-induced gingival diseases, localized and generalized forms of chronic, as well as aggressive, periodontitis. Knowledge of different forms of periodontal diseases affecting children and adolescents may help to distinguish between different forms of diseases and have value in screening and early diagnosis of the disease.

Characteristics of depressed and non-depressed children and their parents.

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Magnussen, M G

1991-01-01

A sample of 186 outpatient children considered by both clinicians and parents as depressed or non-depressed were compared in terms of child and parent variables. Parents of depressed children appeared to be more overinvolved with their children, more overprotective, more likely to have communication difficulties in the family and more apt to undermine the child's learning. More girls were depressed than boys and depressed children exhibited more somatic complaints and coexisting phobic or anxiety disorders. The results of the present study need to be replicated with a broader group of depressed and non-depressed children and their families from other regions of the country. Further research in this area is indicated in order to provide clinicians who work with depressed children with a better understanding of their symptoms and parental characteristics.

Patient non-adherence: an interpretative phenomenological analysis.

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Dalvi, Vidya; Mekoth, Nandakumar

2017-04-18

Purpose While interpretative phenomenological analysis (IPA) has been used in health psychology research, it has so far not been applied to seek deeper insights into the patients' experiences about treatment. The purpose of this paper is to address this gap by using IPA to understand patient non-adherence. Design/methodology/approach In total, 18 patients with chronic conditions seeking healthcare services in Goa and Karnataka, India, were selected by using the snowball sampling method. In-depth interviews were conducted face to face. A semi-structured questionnaire developed by the researchers was used to collect the data. IPA was used to explore the themes to predict patient non-adherence. Findings The study results indicate that economic factors, health system related factors, social factors and psychological factors impact patient non-adherence. Patient non-adherence includes medication non-adherence and lifestyle modification non-adherence. Research limitations/implications Being cross sectional in design, the results may not be as appropriate as the results derived from a longitudinal study given that non-adherence occurs over time. Practical implications Patient non-adherence is a global health issue. Multidisciplinary approach to enhance patient adherence to treatment should form part of public healthcare policy. Social implications Exploring the factors influencing patient non-adherence will help the health-care industry stakeholders to reduce healthcare cost and improve patient's quality of life. Originality/value Although there is extensive quantitative research on the prevalence of non-adherence, qualitative research is limited. This paper addresses this gap by using IPA to understand patient non-adherence and its factors and dimensions.

Qualitative evaluation of adherence therapy in Parkinson’s disease: a multidirectional model

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Daley DJ

2015-07-01

total of 175 codes were generated, which formed eleven subthemes. These could be grouped under three overarching themes, ie, perceptions prior to AT, positive effects of AT, and attributes of AT. Conclusion: This randomized controlled trial is the first to investigate AT in PD. The acceptability and underlying mechanism of the intervention suggest a new multidirectional model of AT in PD which future research should seek to confirm. The findings provide a deeper understanding of AT and will allow clinicians to modify the delivery of the intervention by acknowledging various pathways to improved outcomes.Keywords: Parkinson’s disease, medication, adherence therapy, acceptability, mechanisms

Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS.

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Cruess, Dean G; Kalichman, Seth C; Amaral, Christine; Swetzes, Connie; Cherry, Chauncey; Kalichman, Moira O

2012-04-01

Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS. We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence. We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African-American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation. Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence. This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.

Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions.

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Poost-Foroosh, Laya; Jennings, Mary Beth; Cheesman, Margaret F

2015-03-01

Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. A cross-sectional approach was used to obtain online and paper-based concept ratings. Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. There was a significant difference in the mean ratings for clients and clinicians for

Association Between Adherence to Glasses Wearing During Amblyopia Treatment and Improvement in Visual Acuity.

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Maconachie, Gail D E; Farooq, Shegufta; Bush, Glen; Kempton, Julie; Proudlock, Frank A; Gottlob, Irene

2016-12-01

Occlusion dose monitors have helped establish that better adherence to occlusion is associated with improved visual outcomes in patients undergoing amblyopia treatment. However, the role of adherence to glasses wearing is unknown. To establish the feasibility and reliability of objectively monitoring adherence to glasses wearing using age-based norms, establish the association between adherence to glasses wearing and improvement in visual acuity (VA) after optical treatment and occlusion therapy, and analyze the effect of age, sex, refractive errors, type of amblyopia, and adherence to glasses wearing on improvement in VA. A prospective, observational, nonmasked, cohort study was conducted between June 8, 2008, and June 30, 2013, among patients at a pediatric ophthalmology clinic of a tertiary care hospital who were newly diagnosed with anisometropic and/or strabismic amblyopia and had not undergone previous treatment. The study consisted of a glasses phase (18 weeks) and a patching phase (glasses and occlusion for 10 hours per day for 12 weeks). Reliability of the glasses monitors was assessed by comparing diary entries and monitor recordings in adults. Objective monitoring of glasses wearing and occlusion. Adherence to glasses wearing (hours per day) and effect on VA. Among 20 children with anisometropia (mean [SD] age, 6.20 [2.16] years; 11 boys and 9 girls) and 20 with strabismic or mixed amblyopia (mean [SD] age, 4.90 [1.36] years; 10 boys and 10 girls), adherence to glasses wearing was successfully monitored in all but 1 patient. Agreement between diaries and monitored times wearing glasses in adults was high (intraclass correlation coefficient, 1.00; 95% CI, 0.999-1.00). Median (SD) adherence to glasses wearing was 70% (25.3%). A moderate correlation was observed between adherence to glasses wearing and percentage improvement in VA during the glasses phase (r = 0.462; P = .003). Multiple regression revealed that age (β = -0.535; P = .001

Mentoring for clinician-educators.

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Farrell, Susan E; Digioia, Natalie M; Broderick, Kerry B; Coates, Wendy C

2004-12-01

Mentorship has been shown to have a positive impact on academic faculty members in terms of career advancement. The guidance of a mentor has been shown to increase academic outcome measures such as peer-reviewed publications and grant support for junior academic faculty. In addition, career satisfaction of mentored faculty is greater than those with no mentorship. There is little research on the effects of mentorship on the careers of clinician-educators. This group has also been reported to have a lower scholarly productivity rate than the typical research-based faculty. This article addresses the current state of mentorship as it applies specifically to clinician-educators, offers advice on how a potential protégé might seek out a potential mentor, and finally, suggests a possible mentoring system for academic emergency physicians who are focusing on careers in medical education.

Self-reported Medication Adherence and CKD Progression

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Esteban A. Cedillo-Couvert

2018-05-01

Full Text Available Introduction: In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD. We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD. Methods: In this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease and all-cause death were measured using multivariable Cox proportional hazards. Results: Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54 after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47. Conclusion: Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence. Keywords: CKD, death, medication adherence, progression

Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

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Scanlon ML

2013-01-01

Full Text Available Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART significantly reduced human immunodeficiency virus (HIV-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a

"I honestly believe god keeps me healthy so i can take care of my child": parental use of faith related to treatment adherence.

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Grossoehme, Daniel H; Cotton, Sian; Ragsdale, Judy; Quittner, Alexandra L; McPhail, Gary; Seid, Michael

2013-01-01

A limited number of studies address parental faith and its relationship to their children's health. Using cystic fibrosis as a disease exemplar in which religion/spirituality have been shown to play a role and parental health behaviors (adherence to their child's daily recommended home treatments) are important, this study explored whether parents with different levels of adherence would describe use of faith differently. Twenty-five interviews were completed and analyzed using grounded theory methodology. Some parents described no relationship between faith and treatment adherence. However, of those who did, higher-adherence parents believed God empowered them to care for their child and they used prayer to change themselves, while lower-adherence parents described trusting God to care for their child and used prayer to change God. Clinical implications for chaplains' differential engagement with parents are presented.

Development and psychometric properties of the Suicidality: Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents.

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Flamarique, I; Santosh, P; Zuddas, A; Arango, C; Purper-Ouakil, D; Hoekstra, P J; Coghill, D; Schulze, U; Dittmann, R W; Buitelaar, J K; Lievesley, K; Frongia, R; Llorente, C; Méndez, I; Sala, R; Fiori, F; Castro-Fornieles, J

2016-12-13

To create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents. As part of the EU project 'Suicidality: Treatment Occurring in Paediatrics' (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTracker TM platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTracker TM , allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS. The STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children's version. Good internal consistency was found for adolescents (Cronbach's alpha: 0.965), children (Cronbach's alpha: 0.922), parents (Cronbach's alpha: 0.951) and clinicians (Cronbach's alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians' (0.917), adolescents' (0.834) and parents' (0.756) versions but only fair (0.683) for children's version. The STOP-SAS is a comprehensive, web

Poor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome.

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Ward, Shan L; Quinn, Carson M; Valentine, Stacey L; Sapru, Anil; Curley, Martha A Q; Willson, Douglas F; Liu, Kathleen D; Matthay, Michael A; Flori, Heidi R

2016-10-01

To determine the frequency of low-tidal volume ventilation in pediatric acute respiratory distress syndrome and assess if any demographic or clinical factors improve low-tidal volume ventilation adherence. Descriptive post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies. Twenty-six academic PICU. Three hundred fifteen pediatric acute respiratory distress syndrome patients. All patients who received conventional mechanical ventilation at hours 0 and 24 of pediatric acute respiratory distress syndrome who had data to calculate ideal body weight were included. Two cutoff points for low-tidal volume ventilation were assessed: less than or equal to 6.5 mL/kg of ideal body weight and less than or equal to 8 mL/kg of ideal body weight. Of 555 patients, we excluded 240 for other respiratory support modes or missing data. The remaining 315 patients had a median PaO2-to-FIO2 ratio of 140 (interquartile range, 90-201), and there were no differences in demographics between those who did and did not receive low-tidal volume ventilation. With tidal volume cutoff of less than or equal to 6.5 mL/kg of ideal body weight, the adherence rate was 32% at hour 0 and 33% at hour 24. A low-tidal volume ventilation cutoff of tidal volume less than or equal to 8 mL/kg of ideal body weight resulted in an adherence rate of 58% at hour 0 and 60% at hour 24. Low-tidal volume ventilation use was no different by severity of pediatric acute respiratory distress syndrome nor did adherence improve over time. At hour 0, overweight children were less likely to receive low-tidal volume ventilation less than or equal to 6.5 mL/kg ideal body weight (11% overweight vs 38% nonoverweight; p = 0.02); no difference was noted by hour 24. Furthermore, in the overweight group, using admission weight instead of ideal body weight resulted in misclassification of up to 14% of patients as receiving low-tidal volume ventilation when they actually were not. Low

Breast-feeding and human immunodeficiency virus infection: assessment of knowledge among clinicians in Kenya.

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Murila, Florence; Obimbo, Moses M; Musoke, Rachel; Tsikhutsu, Isaac; Migiro, Santau; Ogeng'o, Julius

2015-02-01

In Kenya, human immunodeficiency virus (HIV) prevalence ranks among the highest in the world. Approximately 60 000 infections yearly are attributed to vertical transmission including the process of labour and breast-feeding. The vast of the population affected is in the developing world. Clinical officers and nurses play an important role in provision of primary health care to antenatal and postnatal mothers. There are a few studies that have explored the clinicians' knowledge on breast-feeding in the face of HIV and in relation to vertical transmission this being a vital component in prevention of maternal-to-child transmission. The aim of this study was to evaluate clinicians' knowledge on HIV in relation to breast-feeding in Kenya. A cross-sectional survey was conducted to assess knowledge of 161 clinical officers and nurses serving in the maternity and children' wards in various hospitals in Kenya. The participants were derived from all district and provincial referral facilities in Kenya. A preformatted questionnaire containing a series of questions on HIV and breast-feeding was administered to clinicians who were then scored and analyzed. All the 161 participants responded. Majority of clinicians (92%) were knowledgeable regarding prevention of mother-to-child transmission. Regarding HIV and breast-feeding, 49.7% thought expressed breast milk from HIV-positive mothers should be heated before being given. Majority (78.3%) thought breast milk should be given regardless of availability of alternatives. According to 74.5% of the participants, exclusive breast-feeding increased chances of HIV transmission. Two-thirds (66.5%) would recommend breast-feeding for mothers who do not know their HIV status (66.5%). This study observes that a majority of the clinicians have inadequate knowledge on breast-feeding in the face of HIV. There is need to promote training programmes on breast-feeding and transmission of HIV from mother to child. This can be done as in

Scalable decision support at the point of care: a substitutable electronic health record app for monitoring medication adherence.

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Bosl, William; Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

2013-07-22

of future adherence on a clinician-facing Web interface. The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the "MPR Monitor", where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality.

Cough quality in children: a comparison of subjective vs. bronchoscopic findings

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Cox Nancy C

2005-01-01

Full Text Available Abstract Background Cough is the most common symptom presenting to doctors. The quality of cough (productive or wet vs dry is used clinically as well as in epidemiology and clinical research. There is however no data on the validity of cough quality descriptors. The study aims were to compare (1 cough quality (wet/dry and brassy/non-brassy to bronchoscopic findings of secretions and tracheomalacia respectively and, (2 parent's vs clinician's evaluation of the cough quality (wet/dry. Methods Cough quality of children (without a known underlying respiratory disease undergoing elective bronchoscopy was independently evaluated by clinicians and parents. A 'blinded' clinician scored the secretions seen at bronchoscopy on pre-determined criteria and graded (1 to 6. Kappa (K statistics was used for agreement, and inter-rater and intra-rater agreement examined on digitally recorded cough. A receiver operating characteristic (ROC curve was used to determine if cough quality related to amount of airway secretions present at bronchoscopy. Results Median age of the 106 children (62 boys, 44 girls enrolled was 2.6 years (IQR 5.7. Parent's assessment of cough quality (wet/dry agreed with clinicians' (K = 0.75, 95%CI 0.58–0.93. When compared to bronchoscopy (bronchoscopic secretion grade 4, clinicians' cough assessment had the highest sensitivity (0.75 and specificity (0.79 and were marginally better than parent(s. The area under the ROC curve was 0.85 (95%CI 0.77–0.92. Intra-observer (K = 1.0 and inter-clinician agreement for wet/dry cough (K = 0.88, 95%CI 0.82–0.94 was very good. Weighted K for inter-rater agreement for bronchoscopic secretion grades was 0.95 (95%CI 0.87–1. Sensitivity and specificity for brassy cough (for tracheomalacia were 0.57 and 0.81 respectively. K for both intra and inter-observer clinician agreement for brassy cough was 0.79 (95%CI 0.73–0.86. Conclusions Dry and wet cough in children, as determined by clinicians and

A Review of NEPA, a Novel Fixed Antiemetic Combination with the Potential for Enhancing Guideline Adherence and Improving Control of Chemotherapy-Induced Nausea and Vomiting

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Paul J. Hesketh

2015-01-01

Full Text Available Combination antiemetic regimens targeting multiple molecular pathways associated with emesis have become the standard of care for prevention of chemotherapy-induced nausea and vomiting (CINV related to highly and moderately emetogenic chemotherapies. Antiemetic consensus guidelines from several professional societies are widely available and updated regularly as new data emerges. Unfortunately, despite substantial research supporting the notion that guideline conformity improves CINV control, adherence to antiemetic guidelines is unsatisfactory. While studies are needed to identify specific barriers to guideline use and explore measures to enhance adherence, a novel approach has been taken to improve clinician adherence and patient compliance, with the development of a new combination antiemetic. NEPA is an oral fixed combination of a new highly selective NK1 receptor antagonist (RA, netupitant, and the pharmacologically and clinically distinct 5-HT3 RA, palonosetron. This convenient antiemetic combination offers guideline-consistent prophylaxis by targeting two critical pathways associated with CINV in a single oral dose administered only once per cycle. This paper will review and discuss the NEPA data in the context of how this first combination antiemetic may overcome some of the barriers interfering with adherence to antiemetic guidelines, enhance patient compliance, and offer a possible advance in the prevention of CINV for patients.

Asthma and Adherence to Inhaled Corticosteroids

DEFF Research Database (Denmark)

Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

2015-01-01

Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means...... was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, ... prescribed fixed-combination therapy (ICS and long-acting β2 agonists). Good adherence was associated with higher FEV1, a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthma...

Patients' Adherence in the Maintenance Therapy of Children and Adolescents with Acute Lymphoblastic Leukemia.

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Kremeike, K; Juergens, C; Alz, H; Reinhardt, D

2015-11-01

Acute lymphoblastic leukemia (ALL) is the most common form of paediatric cancer. Maintenance therapy as last treatment phase includes oral chemotherapy with methotrexate (MTX) and mercaptopurine (6-MP), self- or parent-administered at home, given for about 1 ½ years, and qualified as decisive for an optimum therapy outcome. The aim of our study was to analyze factors influencing the adherence of patients with ALL undergoing maintenance therapy and their families. A multi-method study was undertaken between 11/2011 and 10/2014 with patients surveyed by the Hannover Medical School outpatient clinic, including a questionnaire survey and qualitative interviews with parents as well as blood samples of the patients. 33 questionnaires, 27 interviews and blood samples of 26 patients could be analyzed. Only one third of the blood samples showed concentrations of the 6-MP active metabolite within the therapeutic reference range. Parents named the clinical doctor as their main advisor on medication intake. 36% (12/33) of the participants stated that medication intake has not always occurred the way medication was prescribed. Drug formulation and drug intake information could be identified as determinants of adherence. Parents' problems to obtain information are partly caused by different study results concerning the correct timing of the drug intake and drug interactions with milk products. Parents' information on drug therapy should be more consistent and the pharmaceutical formulations have to be adapted to patients' needs to improve adherence and thereby the chance of long-term remission. © Georg Thieme Verlag KG Stuttgart · New York.

Predictors of Vitamin Adherence After Bariatric Surgery.

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Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

2017-02-01

Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Current Situation of Medication Adherence in Hypertension.

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Vrijens, Bernard; Antoniou, Sotiris; Burnier, Michel; de la Sierra, Alejandro; Volpe, Massimo

2017-01-01

Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension.

Clinicians' perception of the preventability of inpatient mortality.

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Nash, Robert; Srinivasan, Ramya; Kenway, Bruno; Quinn, James

2018-03-12

Purpose The purpose of this paper is to assess whether clinicians have an accurate perception of the preventability of their patients' mortality. Case note review estimates that approximately 5 percent of inpatient deaths are preventable. Design/methodology/approach The design involved in the study is a prospective audit of inpatient mortality in a single NHS hospital trust. The case study includes 979 inpatient mortalities. A number of outcome measures were recorded, including a Likert scale of the preventability of death- and NCEPOD-based grading of care quality. Findings Clinicians assessed only 1.4 percent of deaths as likely to be preventable. This is significantly lower than previously published values ( p<0.0001). Clinicians were also more likely to rate the quality of care as "good," and less likely to identify areas of substandard clinical or organizational management. Research limitations/implications The implications of objective assessment of the preventability of mortality are essential to drive quality improvement in this area. Practical implications There is a wide disparity between independent case note review and clinicians assessing the care of their own patients. This may be due to a "knowledge gap" between reviewers and treating clinicians, or an "objectivity gap" meaning clinicians may not recognize preventability of death of patients under their care. Social implications This study gives some insight into deficiencies in clinical governance processes. Originality/value No similar study has been performed. This has significant implications for the idea of the preventability of mortality.

Towards reinforcing telemedicine adoption amongst clinicians in Nigeria.

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Adenuga, Kayode I; Iahad, Noorminshah A; Miskon, Suraya

2017-08-01

Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has received little academic attention is the provision of suitable encouragement for clinicians to adopt telemedicine, in the form of rewards, motivation or incentives. A further consideration for telemedicine usage in developing countries, especially sub-Saharan Africa and Nigeria in particular, are to the severe shortage of available practising clinicians. The researchers therefore explore the need to positively reinforce the adoption of telemedicine amongst clinicians in Nigeria, and also offer a rationale for this using the UTAUT model. Data were collected using a structured paper-based questionnaire, with 252 physicians and nurses from six government hospitals in Ondo state, Nigeria. The study applied SmartPLS 2.0 for analysis to determine the relationship between six variables. Demographic moderating variables, age, gender and profession, were included. The results indicate that performance expectancy (ptelemedicine systems, as predicted using the extended UTAUT model. Our results showed that the use of telemedicine by clinicians in the Nigerian context is perceived as a dual responsibility which requires suitable reinforcement. In addition, performance expectancy, effort expectancy, facilitating condition and reinforcement determinants are influential factors in the use of telemedicine services for remote-patient clinical diagnosis and management by the Nigerian clinicians. Copyright © 2017. Published by Elsevier B.V.

Adherence to treatment guidelines for acute diarrhoea in children up to 12 years in Ujjain, India - a cross-sectional prescription analysis

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Marrone Gaetano

2011-01-01

Full Text Available Abstract Background Diarrhoea accounts for 20% of all paediatric deaths in India. Despite WHO recommendations and IAP (Indian Academy of Paediatrics and Government of India treatment guidelines, few children suffering from acute diarrhoea in India receive low osmolarity oral rehydration solution (ORS and zinc from health care providers. The aim of this study was to analyse practitioners' prescriptions for acute diarrhoea for adherence to treatment guidelines and further to determine the factors affecting prescribing for diarrhoea in Ujjain, India. Methods This cross-sectional study was conducted in pharmacies and major hospitals of Ujjain, India. We included prescriptions from all practitioners, including those from modern medicine, Ayurveda, Homeopathy as well as informal health-care providers (IHPs. The data collection instrument was designed to include all the possible medications that are given for an episode of acute diarrhoea to children up to 12 years of age. Pharmacy assistants and resident medical officers transferred the information regarding the current diarrhoeal episode and the treatment given from the prescriptions and inpatient case sheets, respectively, to the data collection instrument. Results Information was collected from 843 diarrhoea prescriptions. We found only 6 prescriptions having the recommended treatment that is ORS along with Zinc, with no additional probiotics, antibiotics, racecadotril or antiemetics (except Domperidone for vomiting. ORS alone was prescribed in 58% of the prescriptions; while ORS with zinc was prescribed in 22% of prescriptions, however these also contained other drugs not included in the guidelines. Antibiotics were prescribed in 71% of prescriptions. Broad-spectrum antibiotics were prescribed and often in illogical fixed-dose combinations. One such illogical combination, ofloxacin with ornidazole, was the most frequent oral antibiotic prescribed (22% of antibiotics prescribed. Practitioners from

[Transcultural adaptation of scales for treatment adherence in hemodialysis: Renal Adherence Behaviour Questionnaire(RABQ) and Renal Adherence Attitudes Questionnaire(RAAQ)].

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