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Sample records for adherence drug concentrations

  1. Performance of Cpred/Cobs concentration ratios as a metric reflecting adherence to antidepressant drug therapy

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    Yan Feng

    2011-03-01

    Full Text Available Yan Feng1, Marc R Gastonguay2, Bruce G Pollock3,5, Ellen Frank3, Gail H Kepple4, Robert R Bies5,6,71Discovery Medicine and Clinical Pharmacology, Bristol-Myers Squibb, Lawrenceville, NJ, USA; 2Metrum Institute, Tariffville, CT, USA; 3Department of Psychiatry, School of Medicine, 4Department of Depression Prevention, University of Pittsburgh, PA, USA; 5Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada; 6Division of Clinical Pharmacology, School of Medicine and Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, IN, USA; 7Indiana Clinical Translational Research Institute, Indiana University School of Medicine, IN, USABackground: Nonadherence is very common among subjects undergoing pharmacotherapy for schizophrenia and depression. This study aimed to evaluate the performance of the ratio of the nonlinear mixed effects pharmacokinetic model predicted concentration to observed drug concentration (ratio of population predicted to observed concentration (Cpred/Cobs and ratio of individual predicted to observed concentration (Cipred/Cobs as a measure of erratic drug exposure, driven primarily by variable execution of the dosage regimen and unknown true dosage history.Methods: Modeling and simulation approaches in conjunction with dosage history information from the Medication Event Monitoring System (MEMS, provided by the “Depression: The search for treatment relevant phenotypes” study, was applied to evaluate the consistency of exposure via simulation studies with scenarios representing a long half-life drug (escitalopram. Adherence rates were calculated based on the percentage of the prescribed doses actually taken correctly during the treatment window of interest. The association between Cpred/Cobs, Cipred/Cobs ratio, and adherence rate was evaluated under various assumptions of known dosing history.Results: Simulations for those scenarios representing a known

  2. DRUG COMPLIANCE AND ADHERENCE TO TREATMENT

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    Manmohan

    2012-09-01

    Full Text Available ABSTRACT: BACKGROUND: In spite of any number of medicines will not be of use unless patient takes’ them. After diagnosing the disease, the next most i mportant step is to follow the instructions of physician in terms of treatment. The doctor’s respons ibility does not end with writing prescription, assuming patient will adhere to it. He/ she should cross check the behavior of patient for drug compliance and see that patient follo ws it and get the benefit. Non compliance is the main barrier for the effective delivery of the medical care. This will have greater implications on the economic burde n on the country in terms of frequent hospitalization, use of expensive medicines in case o f relapse due to non adherence.Though the terms compliance and adherence are used synonymously , they differ in the delivery of quality of the medicare as the former implicates the passive fol lowing of the physician instruction, while in the later, patient actively participates in the dev elopment of the treatment plan, which will improves outcome of the treatment. Adherence is the preferred term over compliance by WHO.

  3. 从血药浓度监测角度分析癫痫病患儿用药依从性%Analysis of Epilepsy Children Medication Adherence From the Blood Drug Concentration Monitoring

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    王锦秋; 张恩施; 雷建林; 丰艳梅

    2015-01-01

    Through the blood drug concentration monitoring,understand the medication adherence in children with epilepsy, find out the cause of the epilepsy treatment failure. According to different age groups,the possible causes of epilepsy medication adherence in children with lower for statistical analysis. Older you get,the higher the rate of noadherence taking medicine. Themselves to reduce dose,missing drugs,dose not accurate is a common cause of noadherence taking medicine. To improve epilepsy medication adherence,epileptic cure rate.%通过血药浓度监测,了解癫痫患儿用药依从性情况,找出癫痫患儿治疗失败的原因。按不同年龄段,对可能造成癫痫患儿用药依从性降低的原因进行统计分析。年龄越大,用药不依从率越高。自行减量、断续漏服药、服药剂量不准确等是常见的不依从原因。提高癫痫患儿用药依从性,可提升癫痫病治愈率。

  4. Quantification of the Forgiveness of Drugs to Imperfect Adherence.

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    Assawasuwannakit, P; Braund, R; Duffull, S B

    2015-03-01

    The circumstance of how sensitive therapeutic success is under imperfect adherence is driven by the property known as forgiveness. To date, no studies have considered variability in the pharmacokinetic-pharmacodynamic process in conjunction with imperfect adherence patterns in order to develop a comparative criterion to determine the forgiveness of a drug. In this study, we have proposed a criterion to quantify forgiveness; illustrated the criterion for a theoretical example and evaluated the forgiveness of a motivating example, namely warfarin. A forgiveness criterion, relative forgiveness, is defined as the number of times more likely that a target is successfully attained under perfect adherence compared to imperfect adherence; or when comparing two drugs under a standard setting of imperfect adherence. The relative forgiveness criterion may have important implications for both drug development and clinical practice since the choice of drug can account for the likely influence of its forgiveness.

  5. Ensuring medication adherence with direct oral anticoagulant drugs: lessons from adherence with vitamin K antagonists (VKAs).

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    Di Minno, Alessandro; Spadarella, Gaia; Tufano, Antonella; Prisco, Domenico; Di Minno, Giovanni

    2014-05-01

    Medication adherence (taking drugs properly) is uncommon among patients on warfarin. Poor adherence to warfarin leads to an increase in adverse medical events, including stroke in atrial fibrillation (AF). Factors related to patients, physicians and the health system account for poor adherence. Direct oral anticoagulants (DOACs) are easier to use than warfarin, with fewer drug and food interactions and no need for routine blood monitoring. A proper use of DOACs may reduce the risk of stroke in AF. However, in clinical settings where no laboratory monitoring is needed, a poor medication adherence is common and may impact clinical outcomes. In the management of chronic disorders, careful knowledge of the individual patient's attitudes and behaviors is a pre-requisite for a successful doctor-patient communication. To increase patient's awareness of the risks and benefits of DOACs and, in turn, increase medication adherence, at each follow-up visit physicians should screen for priorities and motivational problems; check for the lack of understanding and/or knowledge; assess any health system or personal barriers to medication adherence; identify appropriate interventions and provide tailored support to patient needs. Dissemination of guidelines to the health care chain (prescribing physician, general practitioners, caregivers, nurses, pharmacists) further encourages medication adherence. However, the long-term effect of some of these strategies is unknown; one tool may not fit all patients, and the prescribing physician should consider individualization of these aids to ensure medication adherence and persistence (continuing to take drugs properly in long-term treatments) for DOACs in every day practice.

  6. Adherence of paclitaxel drug in magnetite chitosan nanoparticles

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    Escobar Zapata, Edna V.; Martinez Perez, Carlos A.; Rodriguez Gonzalez, Claudia A.; Castro Carmona, Javier S. [Instituto de Ingenieria y Tecnologia, Universidad Autonoma de Ciudad Juarez, Ave. Del Charro 610 norte, Col. Partido Romero, C.P. 32320, Cd. Juarez Chihuahua (Mexico); Quevedo Lopez, Manuel A. [Departamento de Polimeros y Materiales, Universidad de Sonora, Blvd. Luis Encinas y Rosales, Hermosillo, Sonora (Mexico); Garcia-Casillas, Perla E., E-mail: pegarcia@uacj.mx [Instituto de Ingenieria y Tecnologia, Universidad Autonoma de Ciudad Juarez, Ave. Del Charro 610 norte, Col. Partido Romero, C.P. 32320, Cd. Juarez Chihuahua (Mexico)

    2012-09-25

    Highlights: Black-Right-Pointing-Pointer Chitosan silica magnetite adsorbs antineoplastic drug. Black-Right-Pointing-Pointer Silica coating improve the drug adherence. - Abstract: Cancer treatment is a big challenge in medicine where chemotherapies and radiotherapies are aggressive and poorly effective having side effects as delirium, fatigue, insomnia, nausea and vomiting which are common problems for cancer patients. For this reason, during the last two decades, many researchers have developed several techniques to improve the current therapies; one of them is the functionalization of magnetic nanoparticles for drug delivery. In this work, magnetic nanoparticles with an average crystallite size 21.8 nm were covered in a core/shell type; magnetite/silica, magnetite/chitosan, and a double shell magnetite/silica/chitosan were developed for attaching an antineoplastic drug. The mechanism for the functionalization of the nanoparticles with a single and double shell was studied with Fourier transformed infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS). The adherence of an antineoplastic drug, paclitaxel, onto functionalized nanoparticles was analyzed with a UV-Visible spectroscopy at a wavelength of 253 nm. It was found that the adherence of the drug is improved up to 18% when magnetite nanoparticles are coated with a single chitosan shell, and when the nanoparticles are coated with a silica/chitosan shell the adherence increases up to 29%.

  7. Generic substitution of antihypertensive drugs : does it affect adherence?

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    Van Wijk, Boris L G; Klungel, Olaf H; Heerdink, Eibert R; de Boer, Anthonius

    2006-01-01

    BACKGROUND: Generic substitution is an important opportunity to reduce the costs of pharmaceutical care. However, pharmacists and physicians often find that patients and brand-name manufacturers have doubt about the equivalence of the substituted drug. This may be reflected by decreased adherence to

  8. Adherence to hospital drug formularies and cost of drugs in hospitals in Denmark

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    Plet, H. T.; Hallas, J.; Kjeldsen, L. J.

    2013-01-01

    PURPOSE: To investigate adherence rates to hospital drug formularies (HDFs) and cost of drugs in hospitals. METHODS: Data on drugs used during 2010 were analyzed for ten hospitals (two hospitals from each of the five regions), constituting 30 % of hospitals and 45 % of hospital beds in Denmark. D...

  9. Drug effects on platelet adherence to collagen and damaged vessel walls.

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    Packham, M A; Cazenave, J P; Kinlough-Rathbone, R L; Mustard, J F

    1978-01-01

    The interaction of platelets with damaged vessel walls leads to the formation of platelet-fibrin thrombi and may also contribute to the development of atherosclerotic lesions because platelets adherent to exposed collagen release a mitogen that stimulates smooth muscle cell proliferation. The first step in thrombus formation, platelet adherence to an injured vessel wall, can be studied quantitatively by the use of platelets labeled with 51chromium. In these investigations, rabbit aortas were damaged by passage of a balloon catheter and segments of the aortas were everted on probes that were rotated in platelet suspensions. Collagen-coated glass cylinders were also used. Adherence was measured in a medium containing approximately physiologic concentrations of calcium, magnesium, protein and red blood cells. Conditions of testing influence the effect of non-steroidal anti-inflammatory drugs, sulfinpyrazone, and dipyridamole on platelet adherence. Aspirin and sulfinpyrazone were not inhibitory when tested in a medium with a 40% hematocrit; this indicates that products formed by platelets from arachidonate probably do not play a major part in the adherence of the first layer of platelets to the surface, although they may be involved in thrombus formation. Indomethacin, dipyridamole, prostaglandin E1, methylprednisolone and penicillin G and related antibiotics did inhibit platelet adherence although the concentrations required were higher than would likely be achieved in vivo upon administration to human patients. None of the non-steroidal anti-inflammatory drugs inhibited the release of granule contents from adherent platelets. Pretreatment of the damaged vessel wall with aspirin increased platelet adherence, presumably because it prevented the formation of PGI2 by the vessel wall. Platelet adherence to undamaged or damaged vessel walls was enhanced by prior exposure of the wall to thrombin. Platelet reactions with aggregating agents and platelet survival can be

  10. Did the diabetes check improve drug adherence of Dutch patients with diabetes?: an intervention study.

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    Hendriks, M.; Vervloet, M.; Dijk, L. van

    2005-01-01

    Background: Poor adherence to treatment of chronic diseases is a worldwide problem. Medicines are often part of therapy and appropriate drug use is important in optimizing health care outcomes. Pharmacies can improve drug adherence by providing information and assistance to their patients. Several i

  11. Correlation between lamivudine plasma concentrations and patient self-reported adherence to antiretroviral treatment in experienced HIV patients

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    Minzi OM

    2011-11-01

    Full Text Available OM Minzi1, V Mugoyela2, LL Gustafsson31Unit of Pharmacology and Therapeutics, 2Department of Medicinal Chemistry, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; 3Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, SwedenBackground: Adherence to antiretroviral treatment (ART is important to achieve treatment success in human immunodeficiency virus (HIV-infected patients. Most HIV clinics apply the patient self-report (PSR method. However, the reliability of this method in experienced HIV patients remains questionable.Purpose: To validate the PSR method for measuring adherence to ART using lamivudine (3TC plasma concentrations in experienced HIV patients.Methods: The study was conducted in Dar Es Salaam and involved 220 patients who were receiving ART services at HIV clinics for more than 12 months. Self-reported adherence information to ART was obtained on the day of HIV clinic visit. The patients were asked to mention the number of doses missed within the past 7 days. In addition, blood samples (2 mL were collected from each patient on the same day. The blood samples were determined for 3TC plasma concentrations. The target 3TC plasma concentration as indicator concentration for adherent patients was determined in 20 patients who took their evening dose of antiretrovirals under supervision. The blood from these patients was drawn 3 hours after drug administration.Results: Complete drug levels of 3TC and self-reported adherence data was obtained in 200 treatment-experienced HIV patients. Lamivudine plasma concentrations obtained in these patients ranged between 0.02–17.36 µg/mL. The mean time from dose administration to blood drawing was 3.1 ± 1.2 hours with coefficient of variation >39%. The mean 3TC plasma concentration obtained in 20 patients who took their antiretroviral dose under supervision was

  12. On the possibility of low cost, adherent therapeutic drug monitoring in oncology

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    Dalla Marta, Silvia; Fornasaro, Stefano; Jaworska, Aleksandra; Toffoli, Giuseppe; Bonifacio, Alois; Sergo, Valter

    2016-05-01

    A frequent quantification of drugs concentrations in plasma of patients subject to chemotherapy is seldom performed, mostly because the standard methods (Gas or Liquid Chromatography coupled with Mass Spectroscopy) are expensive and time consuming. In this paper we report the approach pursued in one of the research units of the EU project RAMAN4CLINICS to tackle the problem of a low cost, time adherent quantification of drugs used for oncological patients using a Surface Enhanced Raman Scattering (SERS) spectroscopy. More specifically, the issues concerning the repeatability of the nanostructured substrates will be presented and some promising results to increase the selectivity of the measures toward specific drugs will be discussed, with examples concerning one cytotoxic agent, Irinotecan and one kinase inhibitor, Sunitinib.

  13. Pattern and Determinants of Antiretroviral Drug Adherence among Nigerian Pregnant Women

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    S. O. Ekama

    2012-01-01

    Full Text Available Background. The need for a high level of adherence to antiretroviral drugs has remained a major hurdle to achieving maximal benefit from its use in pregnancy. This study was designed to determine the level of adherence and identify factors that influence adherence during pregnancy. Method. This is a cross-sectional study utilizing a semistructured questionnaire. Bivariate and multiple logistic regression models were used to determine factors independently associated with good drug adherence during pregnancy. Result. 137 (80.6% of the interviewed 170 women achieved adherence level of ≥95% using 3 day recall. The desire to protect the unborn child was the greatest motivation (51.8% for good adherence. Fear of being identified as HIV positive (63.6% was the most common reason for nonadherence. Marital status, disclosure of HIV status, good knowledge of ART, and having a treatment supporter were found to be significantly associated with good adherence at bivariate analysis. However, after controlling for confounders, only HIV status disclosure and having a treatment partner retained their association with good adherence. Conclusion. Disclosure of HIV status and having treatment support are associated with good adherence. Maternal desire to protect the child was the greatest motivator for adherence.

  14. A Patient Education Program to Improve Adherence Rates with Antituberculosis Drug Regimens.

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    Morisky, Donald E.; And Others

    1990-01-01

    An incentive scheme to reward positive health behaviors (adherence to antituberculosis drug regimens) was tested with 88 active and 117 preventive patients randomly assigned to intervention and control groups. Preventive patients who received incentives were significantly more likely to continue care and had higher adherence levels. Actives showed…

  15. Drug-adherence questionnaires not valid for patients taking blood-pressure-lowering drugs in a primary health care setting.

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    Steeg, N. van de; Sielk, M.; Pentzek, M.; Bakx, C.; Altiner, A.

    2009-01-01

    PURPOSE: To validate two established questionnaires [Morisky and Medication Adherence Report Scale (MARS-5)] for the measurement of medical adherence of patients treated with antihypertensive drugs in primary care in Germany. SETTING: General practitioners (GPs) and their patients in North Rhine-Wes

  16. Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital

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    Bruce SP

    2015-03-01

    Full Text Available Background: The burden of diabetes mellitus, especially Type-2, continues to increase across the world. Medication adherence is considered an integral component in its management. Poor glycemic controls due to medication nonadherence accelerates the development of long-term complications which consequently leads to increased hospitalization and mortality. Objective: This study examined the level of adherence to oral antidiabetic drugs among patients who visited the teaching hospital and explored the probable contributory factors to non-adherence. Methods: A cross-sectional descriptive study using systematic sampling to collect quantitative data was undertaken. Questionnaires were administered to out-patients of the medical department of a teaching hospital in Ghana. Logistic regression was performed with statistical significance determined at p<0.05. Results: A total of 200 diabetic patients participated in the study. Using the Morisky Medication Adherence scale, the level of adherence determined was 38.5%. There were significant correlations between level of adherence and educational level [(OR=1.508; (CI 0.805- 2.825, P=0.019, and mode of payment [(OR=1.631; (CI 0.997- 2.669, P=0.05. Conclusion: Adherence in diabetic patients was low among respondents and this can be improved through education, counseling and reinforcement of self-care. There were several possible factors that contributed to the low adherence rate which could benefit from further studies.

  17. Employment-Based Reinforcement of Adherence to Oral Naltrexone Treatment in Unemployed Injection Drug Users

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    Dunn, Kelly; DeFulio, Anthony; Everly, Jeffrey J.; Donlin, Wendy D.; Aklin, Will M.; Nuzzo, Paul A.; Leoutsakos, Jeannie-Marie S.; Umbricht, Annie; Fingerhood, Michael; Bigelow, George E.; Silverman, Kenneth

    2012-01-01

    Naltrexone has high potential for use as a relapse prevention pharmacotherapy for opiate dependence; however suffers from notoriously poor adherence when prescribed for oral self-administration. This study evaluated whether entry to a therapeutic workplace could be used to reinforce adherence with oral naltrexone. Opiate-dependent and cocaine-using injection drug users were detoxified, inducted onto oral naltrexone, and randomly assigned to a Contingency (n=35) or Prescription (n=32) group fo...

  18. Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study

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    Meigs James B

    2009-02-01

    Full Text Available Abstract Background Adherence to oral antidiabetic medications is often suboptimal. Adherence differences may contribute to health disparities for black diabetes patients, including higher microvascular event rates, greater complication-related disability, and earlier mortality. Methods In this longitudinal retrospective cohort study, we used 10 years of patient-level claims and electronic medical record data (1/1/1992–12/31/2001 to assess differences in short- and long-term adherence to oral antidiabetic medication among 1906 newly diagnosed adults with diabetes (26% black, 74% white in a managed care setting in which all members have prescription drug coverage. Four main outcome measures included: (1 time from diabetes diagnosis until first prescription of oral antidiabetic medication; (2 primary adherence (time from first prescription to prescription fill; (3 time until discontinuation of oral antidiabetic medication from first prescription; and (4 long-term adherence (amount dispensed versus amount prescribed over a 24-month follow-up from first oral antidiabetic medication prescription. Results Black patients were as likely as whites to initiate oral therapy and fill their first prescription, but experienced higher rates of medication discontinuation (HR: 1.8, 95% CI: 1.2, 2.7 and were less adherent over time. These black-white differences increased over the first six months of therapy but stabilized thereafter for patients who initiated on sulfonylureas. Significant black-white differences in adherence levels were constant throughout follow-up for patients initiated on metformin therapy. Conclusion Racial differences in adherence to oral antidiabetic drug therapy persist even with equal access to medication. Early and continued emphasis on adherence from initiation of therapy may reduce persistent racial differences in medication use and clinical outcomes.

  19. [Adherence and difficulties related to drug treatment in patients with depression].

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    Ibanez, Grazielle; Mercedes, Bruna Paiva do Carmo; Vedana, Kelly Graziani Giacchero; Miasso, Adriana Inocenti

    2014-01-01

    This research verified adherence and knowledge of people with depression regarding prescribed pharmacotherapy, satisfaction with the health team and difficulties related to drug treatment. This is descriptive and cross-sectional study, with quail-quantitative approach. The study included 27 people assisted in an outpatient clinic in the interior of the state of São Paulo - Brazil. Data were collected through semi-structured interviews and review of medical records and analyzed using descriptive statistics and content analysis. It was found that 29.6% of patients were no adherent to medication and 51.9% were unaware of the dose of prescribed drugs. Impact of drug therapy in depressive symptoms on self-care, dissatisfaction with effects of psychoactive drugs, lack of support, use of multiple medications and lack of knowledge about the disorder and treatment were reported as difficulties in following drug therapy. This study shows critical factors to the promotion of patient safety in following drug therapy.

  20. Impact of post myocardial infarction depression on drug adherence of cardiological medicines

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    Hemanta Dutta

    2015-07-01

    Full Text Available Background: Depressive symptoms are very usual in patients experiencing a history of myocardial infarction (MI. An individual who has developed depression after an episode of MI becomes non compliant with the treatment of cardiology. Aim: To test the impact of post MI depression on drug adherence of cardiological medicines. Settings and design: The study was conducted on patients of acute MI (n=50 attending cardiology outpatient department (OPD of Assam Medical College and Hospital, Dibrugarh at eight weeks after the index event. Methods: Screening was performed by the Primary Care Evaluation of Mental Disorders (PRIME-MD and diagnoses of major depressive disorder were established according to the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR criteria. The eight-item Morisky Medication Adherence Questionnaire was applied to the patients to assess drug adherence after eight weeks from the MI episode. Results: Statistically significant strong association and correlation were found between post MI depression and drug adherence of cardiological medicines (Wald 9.84, Odd’s ratio 2.054, p=0.002, rho=0.714. Conclusion: The result of analysis has revealed that post MI depression has an unfavourable impact on drug adherence, ultimately contributing to increased risk of cardiological morbidity and death rate. Therefore, routine screening of depressive symptoms should be mandatory in cardiology.

  1. Drug adherence behavior among hypertensive out-patients at a tertiary health institution in Manicaland province, Zimbabwe, 2011

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    Mukora-Mutseyekwa FN

    2013-01-01

    Full Text Available Fadzai NN Mukora-Mutseyekwa, Elizabeth M ChadambukaFaculty of Health Sciences, Africa University, Mutare, ZimbabweObjectives: This study investigated the level of drug adherence among hypertensive outpatients at a tertiary hospital in Zimbabwe. Specific objectives included measurement of blood pressure (BP control achievement, estimating prevalence of drug adherence behavior, and establishing the association between drug adherence behavior and achievement of BP control.Methods and materials: An analytic cross sectional design was applied on a convenience sample of 102 participants using an interviewer administered questionnaire. Self-reported adherence was assessed using the Morisky Medication Adherence Scale.Findings: The median age of participants was 68.5 years (Q1 61; Q3 76. The majority were female (n = 71; 69.6%. BP control (<140/90 mmHg was achieved in 52% (n = 53. Self-reported drug adherence was 40.2% (n = 42. After multivariate logistic regression analysis, participants with normal BP measurements were more than three times as likely to report maximal adherence to prescribed drug schedules (odds ratio 3.37; 95% confidence interval: 1.38–8.24.Conclusion: Poor drug adherence behavior prevails among hypertensive outpatients. This contributes to poor achievement of BP control. The hospital is recommended to set up a specialized hypertension clinic in the Out-patients' Department where an intensified health education package can be introduced as well as community awareness programs on the importance of medication adherence.Keywords: drug adherence, behavior, hypertension

  2. A pilot randomized controlled clinical trial to improve antiepileptic drug adherence in young children with epilepsy.

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    Modi, Avani C; Guilfoyle, Shanna M; Mann, Krista A; Rausch, Joseph R

    2016-03-01

    The primary aim was to examine the preliminary efficacy of a family tailored problem-solving intervention to improve antiepileptic drug (AED) adherence in families of children with new-onset epilepsy. Secondary aims were to assess changes in targeted mechanisms and treatment feasibility and acceptability. Fifty families (M(age) = 7.6 ± 3.0; 80% Caucasian; 42% idiopathic localization related) completed baseline questionnaires and were given an electronic monitor to observe daily AED adherence. If adherence was ≤ 95% in the first 7 months of the study, families were randomized (Supporting Treatment Adherence Regimens (STAR): n = 11; Treatment as Usual (TAU): n = 12). Twenty-one families were not randomized due to adherence being ≥95%. The STAR intervention included four face-to-face and two telephone problem-solving sessions over 8 weeks. Significant group differences in adherence were found during active intervention (weeks 4-6; TAU = -12.0 vs. STAR = 18.1, p < 0.01; and weeks session 6-8: TAU = -9.7 vs. STAR = 15.3, p < 0.05). Children who received the STAR intervention exhibited improved adherence compared to children in the TAU group during active treatment. Significant changes in epilepsy knowledge and management were noted for the STAR group. Families expressed benefitting from the STAR intervention. Future studies should include a larger sample size and booster intervention sessions to maintain treatment effects over time.

  3. A systematic review of antiretroviral adherence interventions for HIV-infected people who use drugs.

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    Binford, Meredith Camp; Kahana, Shoshana Y; Altice, Frederick L

    2012-12-01

    HIV-infected persons who use drugs (PWUDs) are particularly vulnerable for suboptimal combination antiretroviral therapy (cART) adherence. A systematic review of interventions to improve cART adherence and virologic outcomes among HIV-infected PWUDs was conducted. Among the 45 eligible studies, randomized controlled trials suggested directly administered antiretroviral therapy, medication-assisted therapy (MAT), contingency management, and multi-component, nurse-delivered interventions provided significant improved short-term adherence and virologic outcomes, but these effects were not sustained after intervention cessation. Cohort and prospective studies suggested short-term increased cART adherence with MAT. More conclusive data regarding the efficacy on cART adherence and HIV treatment outcomes using cognitive behavioral therapy, motivational interviewing, peer-driven interventions and the integration of MAT into HIV clinical care are warranted. Of great concern was the virtual lack of interventions with sustained post-intervention adherence and virologic benefits. Future research directions, including the development of interventions that promote long-term improvements in adherence and virologic outcomes, are discussed.

  4. Influence of subinhibitory concentrations of antimicrobials on hydrophobicity, adherence and ultra-structure of Fusobacterium nucleatum

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    Okamoto Ana C.

    2002-01-01

    Full Text Available Fusobacterium nucleatum is considered a bridge organism between earlier and later colonizers in dental biofilms and a putative periodontopathogen. In Dentistry, antimicrobial agents are used for treatment and control of infectious diseases associated with dental plaque. Antiseptics have been used in association with antibiotics to reduce infections after oral surgeries. In this study, the influence of subinhibitory concentrations (SC of chlorhexidine, triclosan, penicillin G and metronidazole, on hydrophobicity, adherence to oral epithelial cells, and ultra-structure of F. nucleatum was examined. All isolates were susceptible to chlorhexidine, triclosan, and metronidazole; however, most of the isolates were susceptible to penicillin G, and all of them were hydrophilic when grown with or without antimicrobials. Adherence was decreased by all antimicrobials. Results suggest that adherence of F. nucleatum was influenced by adhesins because structures such as fimbries or capsule were not observed by transmission electronic microscope.

  5. Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

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    Moura LMVR

    2016-10-01

    Full Text Available Lidia M V R Moura,1 Thiago S Carneiro,1 Andrew J Cole,1 John Hsu,2,3 Barbara G Vickrey,4 Daniel B Hoch1 1Department of Neurology, 2Mongan Institute for Health Policy, Department of Medicine, Massachusetts General Hospital, 3Department of Health Care Policy, Harvard Medical School, Boston, MA, 4Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Background and aim: Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED side effects at every visit is associated with increased patient-reported medication adherence.Patients and methods: This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1 phone interview (patient-reported and 2 medical records abstraction (physician-documented. Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions.Results: Sixty-two (25% patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04. Among the participants, evidence that AED side effects were addressed was present in 48 (77% medical records and reported by 51 (82% patients. Twenty-eight (45% patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%. There was no association between addressing AED side effects (neither physician-documented nor patient-reported and complete medication adherence (P=0.22 and 0.20.Discussion and

  6. Plasma nevirapine concentrations predict virological and adherence failure in Kenyan HIV-1 infected patients with extensive antiretroviral treatment exposure

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    Kimulwo, Maureen J.; Okendo, Javan; Aman, Rashid A.; Ogutu, Bernhards R.; Kokwaro, Gilbert O.; Ochieng, Dorothy J.; Muigai, Anne W. T.; Oloo, Florence A.

    2017-01-01

    Treatment failure is a key challenge in the management of HIV-1 infection. We conducted a mixed-model survey of plasma nevirapine (NVP) concentrations (cNVP) and viral load in order to examine associations with treatment and adherence outcomes among Kenyan patients on prolonged antiretroviral therapy (ART). Blood plasma was collected at 1, 4 and 24 hours post-ART dosing from 58 subjects receiving NVP-containing ART and used to determine cNVP and viral load (VL). Median duration of treatment was 42 (range, 12–156) months, and 25 (43.1%) of the patients had virologic failure (VF). cNVP was significantly lower for VF than non- VF at 1hr (mean, 2,111ng/ml vs. 3,432ng/ml, p = 0.003) and at 4hr (mean 1,625ng/ml vs. 3,999ng/ml, p = 0.001) but not at 24hr post-ART dosing. Up to 53.4%, 24.1% and 22.4% of the subjects had good, fair and poor adherence respectively. cNVP levels peaked and were > = 3μg.ml at 4 hours in a majority of patients with good adherence and those without VF. Using a threshold of 3μg/ml for optimal therapeutic nevirapine level, 74% (43/58), 65.5% (38/58) and 86% (50/58) of all patients had sub-therapeutic cNVP at 1, 4 and 24 hours respectively. cNVP at 4 hours was associated with adherence (p = 0.05) and virologic VF (p = 0.002) in a chi-square test. These mean cNVP levels differed significantly in non-parametric tests between adherence categories at 1hr (p = 0.005) and 4hrs (p = 0.01) and between ART regimen categories at 1hr (p = 0.004) and 4hrs (p<0.0001). Moreover, cNVP levels correlated inversely with VL (p< = 0.006) and positively with adherence behavior. In multivariate tests, increased early peak NVP (cNVP4) was independently predictive of lower VL (p = 0.002), while delayed high NVP peak (cNVP24) was consistent with increased VL (p = 0.033). These data strongly assert the need to integrate plasma concentrations of NVP and that of other ART drugs into routine ART management of HIV-1 patients. PMID:28235021

  7. Physician adherence to hypertension treatment guidelines and drug acquisition costs of antihypertensive drugs at the cardiac clinic: a pilot study

    Directory of Open Access Journals (Sweden)

    Abdulameer SA

    2012-01-01

    Full Text Available Shaymaa Abdalwahed Abdulameer1, Mohanad Naji Sahib1, Noorizan Abd Aziz1,2, Yahaya Hassan1,2, Hadeer Akram Abdul AlRazzaq1, Omar Ismail31School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia; 2Faculty of Pharmacy, Universiti Teknologi MARA (UiTM, 42300 Puncak Alam, Selangor, Malaysia; 3Hospital Pulau Pinang, 10900, Penang, MalaysiaAbstract: Prescribing pattern surveys are one of the pharmacoepidemiological techniques that provide an unbiased picture of prescribing habits. Prescription surveys permit the identification of suboptimal prescribing patterns for further evaluation. The aims of this study were to determine the prescribing trend, adherence of the prescribers to the guideline, and the impact of drug expenditure on drug utilization at the cardiac clinic of Penang Hospital, Malaysia. This was a cross-sectional study. Demographic data of the patients, diagnoses and the drugs prescribed were recorded. The average drug acquisition costs (ADAC were calculated for each antihypertensive drug class on a daily and annual basis. Adherence to the guideline was calculated as a percentage of the total number of patients. A total of 313 individuals fulfilled the inclusion criteria. The average age of the study population was 59.30 ± 10.35 years. The mean number of drugs per prescription in the study was 2.09 ± 0.78. There were no significant differences in the demographic data. Antihypertensive drugs were used in monotherapy and polytherapy in 20.8% and 79.2% of the patients, respectively. Adherence to the guideline regarding prescription occurred in 85.30% of the patients. The lowest priced drug class was diuretics and the highest was angiotensin-receptor blockers. In conclusion, the total adherence to the guideline was good; the adherence percentage only slightly decreased with a co-existing comorbidity (such as diabetes mellitus. The use of thiazide diuretics was encouraged because they are well tolerated and

  8. Correlates of non-adherence to antiretroviral therapy in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam.

    Science.gov (United States)

    Jordan, M R; Obeng-Aduasare, Y; Sheehan, H; Hong, S Y; Terrin, N; Duong, D V; Trung, N V; Wanke, C; Kinh, N V; Tang, A M

    2014-08-01

    The HIV epidemic in Vietnam is concentrated, with high prevalence estimates among injection drug users and commercial sex workers. Socio-demographics, substance use and clinical correlates of antiretroviral therapy non-adherence were studied in 100 HIV-1 infected drug users receiving antiretroviral therapy for at least 6 months in Hanoi, Vietnam. All study participants were men with a mean age of 29.9 ± 4.9 years. The median duration on antiretroviral therapy was 16.2 ± 12.7 months; 83% reported 'very good' or 'perfect' adherence in the past 30 days on a subjective one-item Likert scale at time of study enrollment; 48% of participants reported drug use within the previous 6 months, with 22% reporting current drug use. Injection drug use with or without non-injection drug use in the past 6 months (95% C.I. 2.19, 1.30-3.69) and years on antiretroviral therapy (95% C.I. 1.43, 1.14-1.78) were correlated with suboptimal adherence. These findings support Vietnam's ongoing scale-up of harm reduction programmes for injection drug users and their integration with antiretroviral therapy delivery. Moreover, results highlight the need to identify and implement new ways to support high levels of antiretroviral therapy adherence as duration on antiretroviral therapy increases.

  9. Drug resistance and adherence to human intestines of enteroaggregative Escherichia coli.

    Science.gov (United States)

    Yamamoto, T; Echeverria, P; Yokota, T

    1992-04-01

    Clinical isolates of enteroaggregative Escherichia coli (EAggEC) were tested for their in vitro susceptibilities to 27 antimicrobial agents. Marked drug resistance was observed with sulfamethoxazole, ampicillin, and chloramphenicol in contrast to such antimicrobial agents as cefixime, sparfloxacin, and ciprofloxacin. One of the EAggEC strains carried a plasmid that conferred on its host resistance to ampicillin, tetracycline, sulfamethoxazole, streptomycin, and spectinomycin and an ability to adhere to child ileal villi or HeLa cells in the characteristic aggregative pattern. This plasmid also mediated D-mannose-resistant hemagglutinin production and bacterial clump formation (autoagglutination). The data demonstrate appearance of marked drug resistance and an intestine-adherence and drug-resistance plasmid in the newest category of diarrheagenic E. coli.

  10. Treatment adherence to disease-modifying antirheumatic drugs in Chinese patients with rheumatoid arthritis

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    Xia Y

    2016-05-01

    Full Text Available Yunfei Xia,1,* Rulan Yin,1,2,* Ting Fu,1,2 Lijuan Zhang,1,2 Qiuxiang Zhang,1,2 Genkai Guo,1 Liren Li,2 Zhifeng Gu11Department of Rheumatology, Affiliated Hospital of Nantong University, 2School of Nursing, Nantong University, Nantong, People’s Republic of China *These authors contributed equally to this work Objective: Nonadherence in rheumatoid arthritis (RA patients using disease-modifying antirheumatic drugs (DMARDs may lead to joint damage and function loss. The aim of this cross-sectional study was to explore Chinese RA patients’ adherence rates and investigate potential risk factors for nonadherence.Methods: A total of 122 RA patients were recruited from the Affiliated Hospital of Nantong University from January 2014 to April 2015. Patients were asked to complete a set of standardized self-report questionnaires (Compliance Questionnaire on Rheumatology, Health Assessment Questionnaire, Short Form-36 questionnaire, 28-joint Disease Activity Score, Hospital Anxiety and Depression Scale, and Visual Analog Scale. Independent samples t-tests, chi-square analyses, and logistic regression modeling were used to analyze these data.Results: Based on Compliance Questionnaire on Rheumatology, 38% of the patients adhered to DMARDs. Adherence was associated with education, income, depression, and the total number of DMARDs. Other demographic and clinical characteristics were not associated with adherence. Logistic regression models identified income, depression, and the total number of DMARDs as predictors of medication nonadherence.Conclusion: In this study, 62% of patients with RA were not adherent to their DMARD prescription. Education, income, depression, and the total number of DMARDs were associated with medication adherence, and income, depression, and the total number of DMARDs were independent predictors of medication adherence in patients with RA. These findings could help medical personnel develop helpful interventions to improve

  11. Non-adherence to telemedicine interventions for drug users: systematic review

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    Taís de Campos Moreira

    2014-06-01

    Full Text Available OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug addiction. METHODS A systematic review was conducted of randomized controlled trials investigating different telemedicine treatment methods for drug addiction. The following databases were consulted between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library, Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated were: appropriate sequence of data generation, allocation concealment, blinding, description of losses and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions evaluated were of at least three months duration and, although they all used telemedicine as support, treatment methods differed. Regarding the quality of the studies, the values also varied from very poor to high quality. High quality studies showed better adherence rates, as did those using more than one technique of intervention and a limited treatment time. Mono-user studies showed better adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving telemedicine on the part of users of psycho-active substances differed considerably, depending on the country, the intervention method, follow-up time and substances used. Using more than one technique of intervention, short duration of treatment and the type of substance used by patients appear to facilitate adherence.

  12. Prescription factors associated with medication non-adherence in Japan assessed from leftover drugs in the SETSUYAKU-BAG campaign: Focus on oral antidiabetic drugs

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    Kaori Koyanagi

    2016-07-01

    Full Text Available Background: Medication adherence has an important influence on health outcomes in patients with chronic diseases. However, few studies have been performed in Japan to determine factors related to medication non-adherence. Objective: The aim of this study was to identify prescription factors related to medication non-adherence by investigating patient characteristics, all prescriptions, and prescriptions for oral antidiabetic drugs (OADs.Methods: A retrospective cross-sectional survey of prescription data about implementation of dosing regimen was performed at community pharmacies engaged in appropriate use of leftover drugs. We evaluated the amount of drugs originally prescribed and the reduced amount after use of leftover drugs, and then calculated prescription reduction ratio (PRR. We analyzed prescription factors contributing to non-adherence based on the PRR.Results: Prescription information for 1,207 patients was reviewed, revealing that patients were non-adherent to 58% of prescriptions. Lack of a drug copayment, fewer concurrent drugs, and drugs not in single-dose packaging were associated with non-adherence. Among the 1,207 patients, 234 prescriptions for diabetes and 452 OAD formulations were included. Forty-seven percent of prescriptions and 29% of the formulations were non-adherent. A higher dosing frequency and preprandial administration were associated with non-adherence. Among the OADs, adherence was lower for α-glucosidase inhibitors and biguanides than for sulfonylureas. Conclusions: Several factors related to patient characteristics, general drug prescriptions, and OAD prescriptions were associated with non-adherence. Further consideration will be needed to improve adherence to medication in Japan. Health care providers should perform more careful monitoring of adherence in patients with the factors identified by this study.

  13. Subinhibitory concentrations of triclosan promote Streptococcus mutans biofilm formation and adherence to oral epithelial cells.

    Science.gov (United States)

    Bedran, Telma Blanca Lombardo; Grignon, Louis; Spolidorio, Denise Palomari; Grenier, Daniel

    2014-01-01

    Triclosan is a general membrane-active agent with a broad-spectrum antimicrobial activity that is commonly used in oral care products. In this study, we investigated the effect of sub-minimum inhibitory concentrations (MICs) of triclosan on the capacity of the cariogenic bacterium Streptococcus mutans to form biofilm and adhere to oral epithelial cells. As quantified by crystal violet staining, biofilm formation by two reference strains of S. mutans was dose-dependently promoted, in the range of 2.2- to 6.2-fold, by 1/2 and 1/4 MIC of triclosan. Observations by scanning electron microscopy revealed the presence of a dense biofilm attached to the polystyrene surface. Growth of S. mutans in the presence of triclosan at sub-MICs also increased its capacity to adhere to a monolayer of gingival epithelial cells. The expression of several genes involved in adherence and biofilm formation in S. mutans was investigated by quantitative RT-PCR. It was found that sub-MICs of triclosan significantly increased the expression of comD, gtfC, and luxS, and to a lesser extent of gtfB and atlA genes. These findings stress the importance of maintaining effective bactericidal concentrations of therapeutic triclosan since sub-MICs may promote colonization of the oral cavity by S. mutans.

  14. Subinhibitory concentrations of triclosan promote Streptococcus mutans biofilm formation and adherence to oral epithelial cells.

    Directory of Open Access Journals (Sweden)

    Telma Blanca Lombardo Bedran

    Full Text Available Triclosan is a general membrane-active agent with a broad-spectrum antimicrobial activity that is commonly used in oral care products. In this study, we investigated the effect of sub-minimum inhibitory concentrations (MICs of triclosan on the capacity of the cariogenic bacterium Streptococcus mutans to form biofilm and adhere to oral epithelial cells. As quantified by crystal violet staining, biofilm formation by two reference strains of S. mutans was dose-dependently promoted, in the range of 2.2- to 6.2-fold, by 1/2 and 1/4 MIC of triclosan. Observations by scanning electron microscopy revealed the presence of a dense biofilm attached to the polystyrene surface. Growth of S. mutans in the presence of triclosan at sub-MICs also increased its capacity to adhere to a monolayer of gingival epithelial cells. The expression of several genes involved in adherence and biofilm formation in S. mutans was investigated by quantitative RT-PCR. It was found that sub-MICs of triclosan significantly increased the expression of comD, gtfC, and luxS, and to a lesser extent of gtfB and atlA genes. These findings stress the importance of maintaining effective bactericidal concentrations of therapeutic triclosan since sub-MICs may promote colonization of the oral cavity by S. mutans.

  15. 'Null method' determination of drug biophase concentration.

    Science.gov (United States)

    Tallarida, Ronald J; Lamarre, Neil; Raffa, Robert B

    2012-03-01

    PK/PD modeling is enhanced by improvements in the accuracy of its metrics. For PK/PD modeling of drugs and biologics that interact with enzymes or receptors, the equilibrium constant of the interaction can provide critical insight. Methodologies such as radioliogand binding and isolated tissue preparations can provide estimates of the equilibrium constants (as the dissociation constant, K value) for drugs and endogenous ligands that interact with specific enzymes and receptors. However, an impediment to further precision for PK/PD modeling is that it remains a problem to convert the concentration of drug in bulk solution (A) into an estimate of receptor occupation, since A is not necessarily the concentration (C) of drug in the biophase that yields fractional binding from the law of mass action, viz., C/(C + K). In most experimental studies A is much larger than K, so the use of administered instead of biophase concentration gives fractional occupancies very close to unity. We here provide a simple way to obtain an estimate of the factor that converts the total drug concentration into the biophase concentration in isolated tissue preparation. Our approach is an extension of the now classic 'null method' introduced and applied by Furchgott to determination of drug-receptor dissociation constants.

  16. Impact of post myocardial infarction depression on drug adherence of cardiological medicines

    OpenAIRE

    Hemanta Dutta; Soumitra Ghosh; DJ Dutta

    2015-01-01

    Background: Depressive symptoms are very usual in patients experiencing a history of myocardial infarction (MI). An individual who has developed depression after an episode of MI becomes non compliant with the treatment of cardiology. Aim: To test the impact of post MI depression on drug adherence of cardiological medicines. Settings and design: The study was conducted on patients of acute MI (n=50) attending cardiology outpatient department (OPD) of Assam Medical College and Hospital...

  17. Effectiveness and drug adherence of biologic monotherapy in routine care of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Kristensen, Lars Erik; Christensen, Robin;

    2015-01-01

    DMARD) treatment as monotherapy without concomitant conventional synthetic DMARDs (csDMARDs) during the study period 1 May, 2011 through 30 April 2013 were eligible for inclusion. All patient files were checked to ensure that they were in accordance with the treatment registration in DANBIO. Descriptive statistics......DMARDs, with the exception of infliximab, which had significantly poorer drug adherence (P treatments for RA was prescribed in Denmark as monotherapy, of which 70% were...

  18. Predictors of adherence to safe handling practices for antineoplastic drugs: A survey of hospital nurses.

    Science.gov (United States)

    Silver, Sharon R; Steege, Andrea L; Boiano, James M

    2016-01-01

    Despite growing awareness of the hazards of exposure to antineoplastic drugs (ADs), surveys continue to find incomplete adherence to recommended safe handling guidelines. A 2011 survey of healthcare workers presents an opportunity to examine factors associated with adherence among 1094 hospital nurses who administered ADs. Data for these hypothesis-generating analyses were taken from an anonymous, web-based survey of healthcare workers. Regression modeling was used to examine associations between a number of predictors (engineering controls, work practices, nurse perceptions, and nurse and hospital characteristics) and three outcomes reported by nurses: use of personal protective equipment (PPE); activities performed with gloves previously worn to administer ADs; and spills of ADs. Adherence to safe handling guidelines was not universal, and AD spills were reported by 9.5% of nurses during the week prior to the survey. Familiarity with safe handling guidelines and training in safe handling were associated with more reported PPE use. Nurse-perceived availability of PPE was associated with more reported PPE use and lower odds of reported spills. Use of closed system drug-transfer devices and luer-lock fittings also decreased the odds of self-reported AD spills, while more frequent AD administration increased the risk. AD administration frequency was also associated with performing more activities with gloves previously worn to administer ADs, and nurse perception of having adequate time for taking safety precautions with fewer such activities. The results suggest that training and familiarity with guidelines for safe handling of ADs, adequate time to adhere to guidelines, and availability of PPE and certain engineering controls are key to ensuring adherence to safe handling practices. Further assessment of training components and engineering controls would be useful for tailoring interventions targeting these areas.

  19. Medicine possession ratio as proxy for adherence to antiepileptic drugs: prevalence, associations, and cost implications

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    Jacobs K

    2016-04-01

    Full Text Available Karen Jacobs,1 Marlene Julyan,2 Martie S Lubbe,1 Johanita R Burger,1 Marike Cockeran1 1Medicine Usage in South Africa, Faculty of Health Sciences, 2Clinical Pharmacy, School of Pharmacy, North-West University (Potchefstroom Campus, Potchefstroom, South Africa Objective: To determine the adherence status to antiepileptic drugs (AEDs among epilepsy patients; to observe the association between adherence status and age, sex, active ingredient prescribed, treatment period, and number of comorbidities; and to determine the effect of nonadherence on direct medicine treatment cost of AEDs. Methods: A retrospective study analyzing medicine claims data obtained from a South African pharmaceutical benefit management company was performed. Patients of all ages (N=19,168, who received more than one prescription for an AED, were observed from 2008 to 2013. The modified medicine possession ratio (MPRm was used as proxy to determine the adherence status to AED treatment. The MPRm was considered acceptable (adherent if the calculated value was ≥80%, but ≤110%, whereas an MPRm of <80% (unacceptably low or >110% (unacceptably high was considered nonadherent. Direct medicine treatment cost was calculated by summing the medical scheme contribution and patient co-payment associated with each AED prescription. Results: Only 55% of AEDs prescribed to 19,168 patients during the study period had an acceptable MPRm. MPRm categories depended on the treatment period (P>0.0001; Cramer’s V=0.208 but were independent of sex (P<0.182; Cramer’s V=0.009. Age group (P<0.0001; Cramer’s V=0.067, active ingredient (P<0.0001; Cramer’s V=0.071, and number of comorbidities (P<0.0001; Cramer’s V=0.050 were statistically but not practically significantly associated with MPRm categories. AEDs with an unacceptably high MPRm contributed to 3.74% (US$736,376.23 of the total direct cost of all AEDs included in the study, whereas those with an unacceptably low MPRm amounted to US

  20. An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study

    Science.gov (United States)

    Gurumurthy, Ranjana; Chanda, Kulkarni; Sarma, GRK

    2017-01-01

    INTRODUCTION Adherence to antiepileptic drug (AED) therapy is important for controlling seizures in patients with epilepsy (PWE). It is vital to identify the factors influencing adherence to AED therapy using validated tools. This study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence. METHODS This was a cross-sectional study involving PWE who had a confirmed diagnosis. Treatment adherence was assessed using the four-item Morisky Medication Adherence Scale. Univariate analysis with chi-square test was used to observe the association between different variables and AED adherence. Binary logistic regression analysis was used to identify the predictors of adherence. RESULTS 451 PWE (mean age 27.3 ± 8.1 years) were enrolled in the study; 251 (55.7%) were male and 198 (43.9%) were from the lower socioeconomic class. 326 (72.3%) patients had high adherence to AED therapy, while 125 (27.7%) had low adherence. AED adherence was significantly associated with socioeconomic status (p = 0.043) and type of epilepsy (p = 0.033). However, no significant difference was observed between adherence and age, gender, marital status, epilepsy duration, number and type of AEDs, and occurrence of adverse drug reactions. Patients with focal epilepsy and those from the middle/lower-middle socioeconomic classes were less likely to be nonadherent. The primary reason for nonadherence was forgetfulness. CONCLUSION This study found that a majority of PWE have optimal rates of AED adherence and that forgetfulness is the primary reason for nonadherence among PWE. PMID:26805666

  1. Optical measurement of drug concentrations in tissue

    Energy Technology Data Exchange (ETDEWEB)

    Mourant, J.R.; Bigio, I.J.; Jack, D.A.; Johnson, T.M.; Miller, H.D. [Los Alamos National Lab., NM (United States). Chemical Sciences and Technology Div.

    1997-10-01

    This is the final report of a one-year, Laboratory Directed Research and Development (LDRD) project at Los Alamos National Laboratory (LANL). The aim of this project was to develop noninvasive fiber-optic methods for measuring drug concentrations in tissue. Such a system would make possible the study of chemotherapy drug kinetics at specific, targeted locations in the body after the drug is administered. The major result of this project is the development of techniques for measuring changes in absorption of a medium with unknown scattering properties. The developed method was verified by testing on several media with scattering properties in the range typically found for tissue.

  2. Can drugs work in patients who do not take them? The problem of non-adherence in resistant hypertension.

    Science.gov (United States)

    Ruzicka, Marcel; Hiremath, Swapnil

    2015-09-01

    Patients with uncontrolled hypertension on adequate combination and doses of blood pressure-lowering drugs present a diagnostic and therapeutic dilemma. Currently, hypertension guidelines point out uncommon causes of hypertension (either organic such as secondary hypertension or drugs/substances interfering with blood pressure-lowering drugs or causing hypertension) as a cause of hypertension resistance. Non-adherence to drugs, however, is equally, if not more, a cause of hypertension resistance. True resistance to pharmacotherapy is relatively uncommon, as in the majority of patients with non-adherence and/or secondary hypertension, the diagnosis of the problem may potentially lead to better control. Conventionally applied indirect methods to detect non-adherence are inadequate to uncover all cases of non-adherence, especially intentional non-adherence. Rigorous methods to detect non-adherence including direct observed therapy and measuring drug/metabolite levels in body fluids should be considered simultaneously if not before costly and invasive investigations for patients with difficult to control hypertension. However, data on the effectiveness of whether diagnosing non-adherence ultimately controls hypertension is still awaited.

  3. Adherence and resource use among patients treated with biologic drugs: findings from BEETLE study

    Directory of Open Access Journals (Sweden)

    Degli Esposti L

    2014-09-01

    Full Text Available Luca Degli Esposti,1 Diego Sangiorgi,1 Valentina Perrone,2 Sonia Radice,2 Emilio Clementi,3,4 Francesco Perone,4,5 Stefano Buda1 1CliCon Srl Health, Economics and Outcomes Research, Ravenna, Italy; 2Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L Sacco University Hospital, Università di Milano, Milan, Italy; 3Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, CNR Institute of Neuroscience, L Sacco University Hospital, Università di Milano, Milan, Italy; 4Scientific Institute, IRCCS E Medea, Lecco, Italy; 5Local Health Unit, Caserta, Italy Objectives: Systemic administration of anti-tumor necrosis factor alpha (anti-TNF alpha leads to an anti-inflammatory and joint protective effect in pathologies such as rheumatoid arthritis, psoriasis, and Crohn's disease. The aim of this study was to assess adherence to therapy, persistence in treatment (no switches or interruptions, and consumption of care resources (drugs, outpatient services, hospitalizations. Methods: We conducted an observational retrospective cohort analysis using the administrative databases of five local health units. Patients filling at least one prescription for anti-TNF alpha between January 1, 2009 and December 31, 2011 were included and followed up for 1 year. Patients were defined as adherent if >80% of the follow-up period was covered by drugs dispensation. Results: A total of 1,219 patients were analyzed (mean age 49.6±14.6, male 47%. Among enrolled patients, 36% were affected by rheumatoid arthritis, and 31% and 10% were affected by psoriasis and Crohn's disease, respectively; other indications remained below these percentages. Thirty-four percent of patients (420 were treated with adalimumab, 51% (615 with etanercept, and 15% (184 with infliximab. Among the 94% of patients who did not switch, those treated with infliximab had a higher rate of adherence across all indications (51% overall when compared to that

  4. Determinants of Adherence with Malaria Chemoprophylactic Drugs Used in a Traveler’s Health Clinic

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    Ibrahim Shady

    2015-01-01

    Full Text Available Background. The WHO recommends mefloquine, atovaquone/proguanil, and doxycycline for malaria chemoprophylaxis. Adherence to a drug is determined by many factors. Objective. To detect the determinants of travelers’ adherence to malaria chemoprophylaxis. Methods. A prospective comparative study was conducted from January 2012 to July 2013 that included travelers (928 travelers to malaria endemic countries who visited the THC. They were classified into 3 groups: the 1st is the mefloquine group (396 travelers, the 2nd is the doxycycline group (370 travelers, and finally those who did not receive any drugs (162 travelers. The participants from the 1st and 2nd groups enrolled in the study. Results. Univariate and multivariate analyses were performed. The predictors for adherence in the mefloquine group were travel to an African destination [OR = 51 (6.8–2385], higher than a secondary school education [OR = 21 (4.1–144.2], organized travel [OR = 4 (2.1–6.5], traveling for leisure [OR = 2.1 (1.1–0.4], and nationality [OR = 2 (1.11–4.00]. In the doxycycline group, the predictors included higher than a secondary education [OR = 20.1 (4.5–125.1], organized travel [OR = 11.4 (5.5–20.9], travel for leisure [OR = 7 (2.3–22.9], travel to an African destination [OR = 6.1 (0.41–417], and nationality [OR = 4.5 (2.3–9.5]. Conclusion. Adherence with malaria chemoprophylaxis could be affected by many factors such as nationality, education, and organized travel.

  5. Employment-based reinforcement of adherence to oral naltrexone treatment in unemployed injection drug users.

    Science.gov (United States)

    Dunn, Kelly E; Defulio, Anthony; Everly, Jeffrey J; Donlin, Wendy D; Aklin, Will M; Nuzzo, Paul A; Leoutsakos, Jeannie-Marie S; Umbricht, Annie; Fingerhood, Michael; Bigelow, George E; Silverman, Kenneth

    2013-02-01

    Oral naltrexone has high potential for use as a relapse prevention pharmacotherapy for opiate dependence yet suffers from notoriously poor adherence. This study evaluated whether entry to a therapeutic workplace could reinforce adherence with oral naltrexone. Opiate-dependent and cocaine-using injection drug users were detoxified, inducted onto oral naltrexone, and randomly assigned to a contingency (n = 35) or prescription (n = 32) group for a 26-week period. Contingency participants were required to ingest naltrexone under staff observation to gain access to the therapeutic workplace. Prescription participants received a take-home supply of naltrexone and could access the workplace independent of naltrexone ingestion. Primary outcome measures were percent of urine samples positive for naltrexone at 30-day assessments and negative for opiates and cocaine at 30-day assessments. Contingency participants provided significantly more urine samples that were positive for naltrexone compared with prescription participants (72% vs. 21%, p negative (71% vs. 60%, p = .19.) or cocaine-negative (56% vs. 53%, p = .82) samples in the contingency and prescription groups, respectively. Opiate-positive samples were significantly more likely to occur in conjunction with cocaine (p workplace significantly promoted adherence to oral naltrexone, and that the majority of opiate use occurred in conjunction with cocaine use, suggesting that untreated cocaine use may limit the effectiveness of oral naltrexone in promoting opiate abstinence.

  6. Adherence to Disease Modifying Drugs among Patients with Multiple Sclerosis in Germany: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Kerstin Hansen

    Full Text Available Long-term therapies such as disease modifying therapy for Multiple Sclerosis (MS demand high levels of medication adherence in order to reach acceptable outcomes. The objective of this study was to describe adherence to four disease modifying drugs (DMDs among statutorily insured patients within two years following treatment initiation. These drugs were interferon beta-1a i.m. (Avonex, interferon beta-1a s.c. (Rebif, interferon beta-1b s.c. (Betaferon and glatiramer acetate s.c. (Copaxone.This retrospective cohort study used pharmacy claims data from the data warehouse of the German Institute for Drug Use Evaluation (DAPI from 2001 through 2009. New or renewed DMD prescriptions in the years 2002 to 2006 were identified and adherence was estimated during 730 days of follow-up by analyzing the medication possession ratio (MPR as proxy for compliance and persistence defined as number of days from initiation of DMD therapy until discontinuation or interruption.A total of 52,516 medication profiles or therapy cycles (11,891 Avonex, 14,060 Betaferon, 12,353 Copaxone and 14,212 Rebif from 50,057 patients were included into the analysis. Among the 4 cohorts, no clinically relevant differences were found in available covariates. The Medication Possession Ratio (MPR measured overall compliance, which was 39.9% with a threshold MPR≥0.8. There were small differences in the proportion of therapy cycles during which a patient was compliant for the following medications: Avonex (42.8%, Betaferon (40.6%, Rebif (39.2%, and Copaxone (37%. Overall persistence was 32.3% at the end of the 24 months observation period, i.e. during only one third of all included therapy cycles patients did not discontinue or interrupt DMD therapy. There were also small differences in the proportion of therapy cycles during which a patient was persistent as follows: Avonex (34.2%, Betaferon (33.4%, Rebif (31.7% and Copaxone (29.8%.Two years after initiating MS-modifying therapy, only

  7. Measuring and modelling the effects of systematic non-adherence to mass drug administration.

    Science.gov (United States)

    Dyson, Louise; Stolk, Wilma A; Farrell, Sam H; Hollingsworth, T Déirdre

    2017-03-01

    It is well understood that the success or failure of a mass drug administration campaign critically depends on the level of coverage achieved. To that end coverage levels are often closely scrutinised during campaigns and the response to underperforming campaigns is to attempt to improve coverage. Modelling work has indicated, however, that the quality of the coverage achieved may also have a significant impact on the outcome. If the coverage achieved is likely to miss similar people every round then this can have a serious detrimental effect on the campaign outcome. We begin by reviewing the current modelling descriptions of this effect and introduce a new modelling framework that can be used to simulate a given level of systematic non-adherence. We formalise the likelihood that people may miss several rounds of treatment using the correlation in the attendance of different rounds. Using two very simplified models of the infection of helminths and non-helminths, respectively, we demonstrate that the modelling description used and the correlation included between treatment rounds can have a profound effect on the time to elimination of disease in a population. It is therefore clear that more detailed coverage data is required to accurately predict the time to disease elimination. We review published coverage data in which individuals are asked how many previous rounds they have attended, and show how this information may be used to assess the level of systematic non-adherence. We note that while the coverages in the data found range from 40.5% to 95.5%, still the correlations found lie in a fairly narrow range (between 0.2806 and 0.5351). This indicates that the level of systematic non-adherence may be similar even in data from different years, countries, diseases and administered drugs.

  8. Minimum inhibitory concentration of adherence of Punica granatum Linn (pomegranate) gel against S. mutans, S. mitis and C. albicans.

    Science.gov (United States)

    Vasconcelos, Laurylene César de Souza; Sampaio, Fábio Correia; Sampaio, Maria Carmélia Correia; Pereira, Maria do Socorro Vieira; Higino, Jane Sheila; Peixoto, Maria Helena Pereira

    2006-01-01

    The purpose of this study was to investigate the antimicrobial effect of a Punica granatum Linn (pomegranate) phytotherapeutic gel and miconazole (Daktarin oral gel) against three standard streptococci strains (mutans ATCC 25175, sanguis ATCC 10577 and mitis ATCC 9811), S. mutans clinically isolated and Candida albicans either alone or in association. The effect of minimum inhibitory concentrations of the gels on the adherence of these microorganisms to glass was assessed in the presence of 5% sucrose, using increasing and doubled concentrations of the diluted solution of the gels ranging from 1:1 to 1:1024. The minimum inhibitory concentrations of adherence of Punica granatum L. gel against the test organisms were: 1:16 for S. mutans (ATCC), S. mutans (CI) and S. sanguis; 1:128 for S. mitis and 1:64 for C. albicans. The minimum inhibitory concentrations of adherence of miconazole against the same organisms were: 1:512, 1:64, 1:4, 1:128 and 1:16, respectively. In experiments with three and four associated microorganisms, the Punica granatum L. gel had greater efficiency in inhibiting microbial adherence than the miconazole. The results of this study suggest that this phytotherapeutic agent might be used in the control of adherence of different microorganisms in the oral cavity.

  9. Adherence to Precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners.

    Science.gov (United States)

    Boiano, James M; Steege, Andrea L; Sweeney, Marie H

    2015-01-01

    Precautionary guidelines detailing standards of practice and equipment to eliminate or minimize exposure to antineoplastic drugs during handling activities have been available for nearly three decades. To evaluate practices for compounding antineoplastic drugs, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing primarily oncology nurses, pharmacists, and pharmacy technicians. This national survey is the first in over 20 years to examine self-reported use of engineering, administrative, and work practice controls and PPE by pharmacy practitioners for minimizing exposure to antineoplastic drugs. The survey was completed by 241 nurses and 183 pharmacy practitioners who compounded antineoplastic drugs in the seven days prior to the survey. They reported: not always wearing two pairs of chemotherapy gloves (85%, 47%, respectively) or even a single pair (8%, 10%); not always using closed system drug-transfer devices (75%, 53%); not always wearing recommended gown (38%, 20%); I.V. lines sometimes/always primed with antineoplastic drug (19%, 30%); and not always using either a biological safety cabinet or isolator (9%, 15%). They also reported lack of: hazard awareness training (9%, 13%); safe handling procedures (20%, 11%); and medical surveillance programs (61%, 45%). Both employers and healthcare workers share responsibility for adhering to precautionary guidelines and other best practices. Employers can ensure that: workers are trained regularly; facility safe-handling procedures reflecting national guidelines are in place and support for their implementation is understood; engineering controls and PPE are available and workers know how to use them; and medical surveillance, exposure monitoring, and other administrative controls are in place. Workers can seek out training, understand and follow facility procedures, be role models for junior staff, ask questions, and report

  10. Paradoxes in antiretroviral treatment for injecting drug users: access, adherence and structural barriers in Asia and the former Soviet Union.

    Science.gov (United States)

    Wolfe, Daniel

    2007-08-01

    Offered proper support, injection drug users (IDUs) can achieve the same levels of adherence to and clinical benefit from antiretroviral treatment (ARV) as other patients with HIV. Nonetheless, in countries of Asia and the former Soviet Union where IDUs represent the largest share of HIV cases, IDUs have been disproportionately less likely to receive ARV. While analysis of adherence amongst IDUs has focused on individual patient ability to adhere to medical regimens, HIV treatment systems themselves are in need of examination. Structural impediments to provision of ARV for IDUs include competing, vertical systems of care; compulsory drug treatment and rehabilitation services that often offer neither ARV nor effective treatment for chemical dependence; lack of opiate substitution treatments demonstrated to increase adherence to ARV; and policies that explicitly or implicitly discourage ARV delivery to active IDUs. Labeling active drug users as socially untrustworthy or unproductive, health systems can create a series of paradoxes that ensure confirmation of these stereotypes. Needed reforms include professional education and public campaigns that emphasize IDU capacity for health protection and responsible choice; recognition that the chronic nature of injecting drug use and its links to HIV infection require development of ARV treatment delivery that includes active drug users; and integrated treatment that strengthens links between health providers and builds on, rather than seeks to bypass, IDU social networks and organizations.

  11. High-intensity cannabis use and adherence to antiretroviral therapy among people who use illicit drugs in a Canadian setting.

    Science.gov (United States)

    Slawson, Gregory; Milloy, M-J; Balneaves, Lynda; Simo, Annick; Guillemi, Silvia; Hogg, Robert; Montaner, Julio; Wood, Evan; Kerr, Thomas

    2015-01-01

    Cannabis is increasingly prescribed clinically and utilized by people living with HIV/AIDS (PLWHA) to address symptoms of HIV disease and to manage side effects of antiretroviral therapy (ART). In light of concerns about the possibly deleterious effect of psychoactive drug use on adherence to ART, we sought to determine the relationship between high-intensity cannabis use and adherence to ART among a community-recruited cohort of HIV-positive illicit drug users. We used data from the ACCESS study, an ongoing prospective cohort study of HIV-seropositive illicit drug users linked to comprehensive ART dispensation records in a setting of universal no-cost HIV care. We estimated the relationship between at least daily cannabis use in the last 6 months, measured longitudinally, and the likelihood of optimal adherence to ART during the same period, using a multivariate linear mixed-effects model accounting for relevant socio-demographic, behavioral, clinical and structural factors. From May 2005 to May 2012, 523 HIV-positive illicit drug users were recruited and contributed 2,430 interviews. At baseline, 121 (23.1 %) participants reported at least daily cannabis use. In bivariate and multivariate analyses we did not observe an association between using cannabis at least daily and optimal adherence to prescribed HAART (Adjusted Odds Ratio = 1.12, 95 % Confidence Interval [95 % CI]: 0.76-1.64, p value = 0.555.) High-intensity cannabis use was not associated with adherence to ART. These findings suggest cannabis may be utilized by PLWHA for medicinal and recreational purposes without compromising effective adherence to ART.

  12. Access to highly active antiretroviral therapy for injection drug users: adherence, resistance, and death

    Directory of Open Access Journals (Sweden)

    David Vlahov

    Full Text Available Injection drug users (IDUs continue to comprise a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs.

  13. Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review

    Directory of Open Access Journals (Sweden)

    Mravčík V

    2013-10-01

    Full Text Available Viktor Mravčík,1,2 Lisa Strada,3 Josef Štolfa,4,5 Vladimir Bencko,6 Teodora Groshkova,7 Jens Reimer,3 Bernd Schulte3 1National Monitoring Centre for Drugs and Drug Addiction, 2Department of Addictology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; 3Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany; 4Department of General Practice, Institute for Postgraduate Medical Education in Prague, 5Department of General Practice, Second Faculty of Medicine, 6Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; 7European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal Introduction and methods: Hepatitis C virus (HCV infections are highly prevalent amongst people who inject drugs (PWID. Despite well documented evidence of its effectiveness, suggested cost-effectiveness, and potential to reduce HCV prevalence rates, the uptake of antiviral HCV treatment by PWID is low. This nonsystematic literature review describes factors associated with the uptake, adherence, and efficacy of HCV treatment among PWID and discusses strategies to increase their uptake of treatment. Results: Low HCV treatment uptake among PWID is associated with a number of patient-related and provider-related barriers. Beliefs and fears about low efficacy and adverse effects on the patient’s part are common. A substantial number of factors are associated with the chaotic lifestyle and altered social functioning of PWID, which are often associated with decompensation or relapsing into drug addiction. This may lead to perceived low adherence with treatment and low efficacy on the provider’s part too, where lack of support, inadequate management of addiction, and other drug-related problems and poor treatment of side effects have been described. Practical issues such as the accessibility of treatment and finances also play a role

  14. Characteristics, interactions and coating adherence of heterogeneous polymer/drug coatings for biomedical devices.

    Science.gov (United States)

    McManamon, Colm; de Silva, Johann P; Delaney, Paul; Morris, Michael A; Cross, Graham L W

    2016-02-01

    With this rise in surgical procedures it is important to focus on the mobility and safety of the patient and reduce the infections that are associated with hip replacements. We examine the mechanical properties of gentamicin sulphate as a model antimicrobial layer for titanium-alloy based prosthetic hips to help prevent methicillin-resistant Staphylococcus aureus infection after surgery. A top layer of poly(lactic-co-glycolic acid) is added to maintain the properties of the gentamicin sulphate as well as providing a drug delivery system. Through the use of nanoindentation and micro-scratch techniques it is possible to determine the mechanical and adhesive properties of this system. Nanoindentation determined the modulus values for the poly(lactic-co-glycolic acid) and gentamicin sulphate materials to be 8.9 and 5.2GPa, respectively. Micro-scratch established that the gentamicin sulphate layer is strongly adhered to the Ti alloy and forces of 30N show no cohesive or adhesive failure. It was determined that the poly(lactic-co-glycolic acid) is ductile in nature and delaminates from the gentamicin sulphate layer of at 0.5N.

  15. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Katy A. van Galen

    2014-01-01

    Full Text Available Administering drugs as fixed-dose combinations (FDCs versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03–1.71. Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00–2.13. We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

  16. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    van Galen, Katy A; Nellen, Jeannine F; Nieuwkerk, Pythia T

    2014-01-01

    Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03-1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00-2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

  17. Medication adherence in patients with diabetes mellitus: does physician drug dispensing enhance quality of care? Evidence from a large health claims database in Switzerland

    Science.gov (United States)

    Huber, Carola A; Reich, Oliver

    2016-01-01

    Background The drug-dispensing channel is a scarcely explored determinant of medication adherence, which is considered as a key indicator for the quality of care among patients with diabetes mellitus. In this study, we investigated the difference in adherence between diabetes patients who obtained their medication directly from a prescribing physician (physician dispensing [PD]) or via a pharmacy. Methods A retrospective cohort study was conducted using a large health care claims database from 2011 to 2014. Patients with diabetes of all ages and receiving at least one oral antidiabetic drug (OAD) prescription were included. We calculated patients’ individual adherence to OADs defined as the proportion of days covered (PDC), which was measured over 1 year after patient identification. Good adherence was defined as PDC ≥80%. Multivariate logistic regression analysis was performed to assess the relationship between the PDC and the dispensing channel (PD, pharmacy). Results We identified a total of 10,430 patients prescribed drugs by a dispensing physician and 16,292 patients receiving drugs from a pharmacy. Medication adherence was poor in both patient groups: ~40% of the study population attained good adherence to OADs. We found no significant impact of PD on the adherence level in diabetes patients. Covariates associated significantly with good adherence were older age groups, male sex, occurrence of comorbidity and combined diabetes drug therapy. Conclusion In conclusion, adherence to antihyperglycemic medication is suboptimal among patients with diabetes. The results of this study provide evidence that the dispensing channel does not have an impact on adherence in Switzerland. Certainly, medication adherence needs to be improved in both supply settings. Physicians as well as pharmacists are encouraged to develop and implement useful tools to increase patients’ adherence behavior. PMID:27695299

  18. Therapist Adherence in Brief Strategic Family Therapy for Adolescent Drug Abusers

    Science.gov (United States)

    Robbins, Michael S.; Feaster, Daniel J.; Horigian, Viviana E.; Puccinelli, Marc J.; Henderson, Craig; Szapocznik, Jose

    2011-01-01

    Objective: Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or…

  19. Therapeutic drug monitoring of indinavir and nelfinavir to assess adherence to therapy in human immunodeficiency virus-infected children

    NARCIS (Netherlands)

    Van Rossum, AMC; Bergshoeff, AS; Fraaij, PLA; Hugen, PWH; Hartwig, NG; Geelen, SPM; Wolfs, TFW; Weemaes, CMR; De Groot, R; Burger, DM

    2002-01-01

    Introduction. Adherence to highly active anti-retroviral therapy is required to obtain an optimal long term virologic response rate of HIV-1-infected children. Plasma concentrations of protease inhibitors (PIs) outside the limits of the reference values indicate nonadherence to anti-retroviral thera

  20. Therapeutic drug monitoring of indinavir and nelfinavir to assess adherence to therapy in human immunodeficiency virus-infected children.

    NARCIS (Netherlands)

    Rossum, A.M. van; Bergshoeff, A.S.; Fraaij, P.L.; Hugen, P.W.H.; Hartwig, N.G.; Geelen, S.P.M.; Wolfs, T.F.; Weemaes, C.M.R.; Groot, R. de; Burger, D.M.

    2002-01-01

    INTRODUCTION: Adherence to highly active antiretroviral therapy is required to obtain an optimal long term virologic response rate of HIV-1-infected children. Plasma concentrations of protease inhibitors (PIs) outside the limits of the reference values indicate nonadherence to antiretroviral therapy

  1. Non-adherence to disease-modifying antirheumatic drugs is associated with higher disease activity in early arthritis patients in the first year of the disease

    OpenAIRE

    2015-01-01

    INTRODUCTION: Non-adherence to disease-modifying antirheumatic drugs (DMARDs) hampers the targets of rheumatoid arthritis (RA) treatment, obtaining low disease activity and decreasing radiological progression. This study investigates if, and to what extent, non-adherence to treatment would lead to a higher 28-joint count disease activity score (DAS28) in the first year after diagnosis. METHODS: Adult patients from an ongoing cohort study on treatment adherence were selected if they fulfilled ...

  2. Analysis of Antiretrovirals in Single Hair Strands for Evaluation of Drug Adherence with Infrared-Matrix-Assisted Laser Desorption Electrospray Ionization Mass Spectrometry Imaging

    OpenAIRE

    Rosen, Elias P.; Thompson, Corbin G.; Bokhart, Mark T.; Prince, Heather M.A.; Sykes, Craig; Muddiman, David C.; Kashuba, Angela D.M.

    2015-01-01

    Adherence to a drug regimen can be a strong predictor of health outcomes, and validated measures of adherence are necessary at all stages of therapy from drug development to prescription. Many of the existing metrics of drug adherence (e.g., self-report, pill counts, blood monitoring) have limitations, and analysis of hair strands has recently emerged as an objective alternative. Traditional methods of hair analysis based on LC–MS/MS (segmenting strands at ≥1 cm length) are not capable of pre...

  3. Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Injection Drug Users: A Randomized Controlled Trial

    Science.gov (United States)

    Safren, Steven A.; O'Cleirigh, Conall M.; Bullis, Jacqueline R.; Otto, Michael W.; Stein, Michael D.; Pollack, Mark H.

    2012-01-01

    Objective: Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment adherence. Injection drug users comprise a substantial portion of individuals with HIV in the United States and globally. The present study tested cognitive behavioral therapy for adherence and depression (CBT-AD) in patients…

  4. Detection of drug-dependent platelet antibodies by use of solid-phase red cell adherence techniques.

    Science.gov (United States)

    Leach, M F; Cooper, L K; Aubuchon, J P

    1995-01-01

    Many drugs have been reported to cause drug-dependent thrombocytopenia, either by the immune complex or by hapten mechanisms. Testing for the presence of these platelet antibodies has not been considered feasible for transfusion services because their presence was thought to be rare, and their detection involved complex and costly methods. We have developed a new technique for detection of these antibodies that can be performed without the need for specialized and expensive instrumentation. A solid-phase red cell adherence assay was used to detect drug-dependent platelet antibodies active by either the immune complex or the hapten mechanism. Three cases were evaluated for the presence of drug-dependent platelet antibodies. Two patients presented with thrombocytopenia that could not be attributed to other causes. The third case was evaluated for the presence of drug-dependent antibodies after poor responses to platelet transfusions. In these three cases, discontinuation of the implicated drugs, i.e., porcine heparin, quinine sulfate, amoxicillin, Bactrim, and albuterol, was followed by a correction of thrombocytopenia or improved platelet transfusion response within 72 hours. This test methodology and protocol has proven very useful in avoiding transfusions with little likelihood of benefit, and in identifying drugs interfering with platelet recovery or survival. Further investigations with this technique may expand our knowledge of the capability of this technique and of the observed frequency of drug-related immunologic platelet destruction.

  5. Predicting Noninsulin Antidiabetic Drug Adherence Using a Theoretical Framework Based on the Theory of Planned Behavior in Adults With Type 2 Diabetes: A Prospective Study.

    Science.gov (United States)

    Zomahoun, Hervé Tchala Vignon; Moisan, Jocelyne; Lauzier, Sophie; Guillaumie, Laurence; Grégoire, Jean-Pierre; Guénette, Line

    2016-04-01

    Understanding the process behind noninsulin antidiabetic drug (NIAD) nonadherence is necessary for designing effective interventions to resolve this problem. This study aimed to explore the ability of the theory of planned behavior (TPB), which is known as a good predictor of behaviors, to predict the future NIAD adherence in adults with type 2 diabetes. We conducted a prospective study of adults with type 2 diabetes. They completed a questionnaire on TPB variables and external variables. Linear regression was used to explore the TPB's ability to predict future NIAD adherence, which was prospectively measured as the proportion of days covered by at least 1 NIAD using pharmacy claims data. The interaction between past NIAD adherence and intention was tested. The sample included 340 people. There was an interaction between past NIAD adherence and intention to adhere to the NIAD (P = 0.032). Intention did not predict future NIAD adherence in the past adherers and nonadherers groups, but its association measure was high among past nonadherers (β = 5.686, 95% confidence interval [CI] -10.174, 21.546). In contrast, intention was mainly predicted by perceived behavioral control both in the past adherers (β = 0.900, 95% CI 0.796, 1.004) and nonadherers groups (β = 0.760, 95% CI 0.555, 0.966). The present study suggests that TPB is a good tool to predict intention to adhere and future NIAD adherence. However, there was a gap between intention to adhere and actual adherence to the NIAD, which is partly explained by the past adherence level in adults with type 2 diabetes.

  6. Fibrinogen and thrombin concentrations are critical for fibrin glue adherence in rat high-risk colon anastomoses

    Directory of Open Access Journals (Sweden)

    Eliseo Portilla-de Buen

    2014-04-01

    Full Text Available OBJECTIVE: Fibrin glues have not been consistently successful in preventing the dehiscence of high-risk colonic anastomoses. Fibrinogen and thrombin concentrations in glues determine their ability to function as sealants, healers, and/or adhesives. The objective of the current study was to compare the effects of different concentrations of fibrinogen and thrombin on bursting pressure, leaks, dehiscence, and morphology of high-risk ischemic colonic anastomoses using fibrin glue in rats. METHODS: Colonic anastomoses in adult female Sprague-Dawley rats (weight, 250-350 g treated with fibrin glue containing different concentrations of fibrinogen and thrombin were evaluated at post-operative day 5. The interventions were low-risk (normal or high-risk (ischemic end-to-end colonic anastomoses using polypropylene sutures and topical application of fibrinogen at high (120 mg/mL or low (40 mg/mL concentrations and thrombin at high (1000 IU/mL or low (500 IU/mL concentrations. RESULTS: Ischemia alone, anastomosis alone, or both together reduced the bursting pressure. Glues containing a low fibrinogen concentration improved this parameter in all cases. High thrombin in combination with low fibrinogen also improved adherence exclusively in low-risk anastomoses. No differences were detected with respect to macroscopic parameters, histopathology, or hydroxyproline content at 5 days post-anastomosis. CONCLUSIONS: Fibrin glue with a low fibrinogen content normalizes the bursting pressure of high-risk ischemic left-colon anastomoses in rats at day 5 after surgery.

  7. Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.

    Science.gov (United States)

    Dunn, Kelly; DeFulio, Anthony; Everly, Jeffrey J; Donlin, Wendy D; Aklin, Will M; Nuzzo, Paul A; Leoutsakos, Jeannie-Marie S; Umbricht, Annie; Fingerhood, Michael; Bigelow, George E; Silverman, Kenneth

    2015-06-01

    Oral naltrexone could be a promising relapse-prevention pharmacotherapy for recently detoxified opioid-dependent patients; however, interventions are often needed to promote adherence with this treatment approach. We recently conducted a study to evaluate a 26-week employment-based reinforcement intervention of oral naltrexone in unemployed injection drug users (Dunn et al., 2013). Participants were randomly assigned into a contingency (n = 35) group required to ingest naltrexone under staff observation to gain entry into a therapeutic workplace or a prescription (n = 32) group given a take-home supply of oral naltrexone and access to the workplace without observed ingestion. Monthly urine samples were collected and analyzed for evidence for naltrexone adherence, opioid use, and cocaine use. As previously reported, contingency participants provided significantly more naltrexone-positive urine samples than prescription participants during the 26-week intervention period. The goal of this current study is to report the 12-month outcomes, which occurred 6 months after the intervention ended. Results at the 12-month visit showed no between-groups differences in naltrexone-positive, opioid-negative, or cocaine-negative urine samples and no participant self-reported using naltrexone at the follow-up visit. These results show that even after a period of successfully reinforced oral naltrexone adherence, longer-term naltrexone use is unlikely to be maintained after reinforcement contingencies are discontinued. (PsycINFO Database Record

  8. 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

    Directory of Open Access Journals (Sweden)

    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.

  9. Low concentration of ethylenediaminetetraacetic acid (EDTA) affects biofilm formation of Listeria monocytogenes by inhibiting its initial adherence.

    Science.gov (United States)

    Chang, Yuhua; Gu, Weimin; McLandsborough, Lynne

    2012-02-01

    The distribution and survival of the food-borne pathogen Listeria monocytogenes is associated with its biofilm formation ability, which is affected by various environmental factors. Here we present the first evidence that EDTA at low concentration levels inhibits the biofilm formation of L. monocytogenes. This effect of EDTA is not caused by a general growth inhibition, as 0.1 mM EDTA efficiently reduced the biofilm formation of L. monocytogenes without affecting the planktonic growth. Adding 0.1 mM of EDTA at the starting time of biofilm formation had the strongest biofilm inhibitory effect, while the addition of EDTA after 8 h had no biofilm inhibitory effects. EDTA was shown to inhibit cell-to-surface interactions and cell-to-cell interactions, which at least partially contributed to the repressed initial adherence. The addition of sufficient amounts of cations to saturate EDTA did not restore the biofilm formation, indicating the biofilm inhibition was not due to the chelating properties of EDTA. The study suggests that EDTA functions in the early stage of biofilm process by affecting the initial adherence of L. monocytogenes cells onto abiotic surfaces.

  10. ‘Null Method’ Determination of Drug Biophase Concentration

    Science.gov (United States)

    Tallarida, Ronald J.; Lamarre, Neil

    2014-01-01

    PK/PD modeling is enhanced by improvements in the accuracy of its metrics. For PK/PD modeling of drugs and biologics that interact with enzymes or receptors, the equilibrium constant of the interaction can provide critical insight. Methodologies such as radioliogand binding and isolated tissue preparations can provide estimates of the equilibrium constants (as the dissociation constant, K value) for drugs and endogenous ligands that interact with specific enzymes and receptors. However, an impediment to further precision for PK/PD modeling is that it remains a problem to convert the concentration of drug in bulk solution (A) into an estimate of receptor occupation, since A is not necessarily the concentration (C) of drug in the biophase that yields fractional binding from the law of mass action, viz., C/(C + K). In most experimental studies A is much larger than K, so the use of administered instead of biophase concentration gives fractional occupancies very close to unity. We here provide a simple way to obtain an estimate of the factor that converts the total drug concentration into the biophase concentration in isolated tissue preparation. Our approach is an extension of the now classic ‘null method’ introduced and applied by Furchgott to determination of drug-receptor dissociation constants. PMID:22037914

  11. User profiles of a smartphone application to support drug adherence--experiences from the iNephro project.

    Directory of Open Access Journals (Sweden)

    Stefan Becker

    Full Text Available PURPOSE: One of the key problems in the drug therapy of patients with chronic conditions is drug adherence. In 2010 the initiative iNephro was launched (www.inephro.de. A software to support regular and correct drug intake was developed for a smartphone platform (iOS. The study investigated whether and how smartphone users deployed such an application. METHODS: Together with cooperating partners the mobile application "Medikamentenplan" ("Medication Plan" was developed. Users are able to keep and alter a list of their regular medication. A memory function supports regular intake. The application can be downloaded free of charge from the App Store™ by Apple™. After individual consent of users from December 2010 to April 2012 2042338 actions were recorded and analysed from the downloaded applications. Demographic data were collected from 2279 users with a questionnaire. RESULTS: Overall the application was used by 11688 smartphone users. 29% (3406/11688 used it at least once a week for at least four weeks. 27% (3209/11688 used the application for at least 84 days. 68% (1554/2279 of users surveyed were male, the stated age of all users was between 6-87 years (mean 44. 74% of individuals (1697 declared to be suffering from cardiovascular disease, 13% (292 had a previous history of transplantation, 9% (205 were suffering from cancer, 7% (168 reported an impaired renal function and 7% (161 suffered from diabetes mellitus. 69% (1568 of users were on <6 different medications, 9% (201 on 6 - 10 and 1% (26 on more than 10. CONCLUSION: A new smartphone application, which supports drug adherence, was used regularly by chronically ill users with a wide range of diseases over a longer period of time. The majority of users so far were middle-aged and male.

  12. Detection of drug-dependent, platelet-reactive antibodies by solid-phase red cell adherence assays.

    Science.gov (United States)

    Leach, M F; Cooper, L K; AuBuchon, J P

    1997-06-01

    We developed a simple modification of the solid-phase red cell adherence (SPRCA) assay system that can be used to identify drug-dependent platelet antibodies (DDPAs) reactive by either the hapten or immune complex reaction mechanisms. Between January 1994 and August 1996 we tested sera from 173 patients [123 (71%) with unexplained thrombocytopenia and 50 (29%) because of poor responses to platelet transfusions not explicable by alloimmunization or the clinical situation] for DDPAs possibly associated with the receipt of 61 different drugs. We correlated positive results with patients' clinical courses. DDPAs were identified in samples from 138 (80%) of the patients tested. Antibodies reactive only by the hapten mechanism were identified in 51 (37%) of those sera exhibiting positive reactions. The clinical courses of 108 (78%) patients were evaluable. Discontinuation of the implicated drug(s) resulted in prompt (<5 d) resolution of the thrombocytopenia or improvement in response to transfusion in all of these patients. In four cases thrombocytopenia returned upon re-exposure to the implicated drug. This adaptation of SPRCA provides a simple means of investigating the possibility of DDPAs and documents a higher frequency of these antibodies than has previously been suspected.

  13. An evaluation of adherence in patients with multiple sclerosis newly initiating treatment with a self-injectable or an oral disease-modifying drug

    Directory of Open Access Journals (Sweden)

    Munsell M

    2016-12-01

    Full Text Available Michael Munsell,1 Molly Frean,1 Joseph Menzin,1 Amy L Phillips2 1Boston Health Economics, Inc., Waltham, MA, USA; 2Health Economics & Outcomes Research, EMD Serono Inc., Rockland, MA, USA Objective: As the multiple sclerosis (MS disease-modifying drug (DMD treatment options have expanded to include oral therapies, it is important to understand whether route of administration is associated with DMD adherence. The objective of this study was to compare adherence to DMDs in patients with MS newly initiating treatment with a self-injectable versus an oral DMD. Methods: This retrospective database study used IMS Health Real World Data Adjudicated Claims – US data between July 1, 2010 and June 30, 2014. Adherence was measured by medication possession ratio (MPR, calculated as the total number of treated days divided by the total number of days from the first treated day until the end of 12-month follow-up. A binary measure representing adherence (MPR ≥0.8 versus nonadherence (MPR <0.8 to therapy was used. Logistic regression evaluated the likelihood of adherence to index DMD type (self-injectable vs oral. Covariates included patient baseline characteristics (ie, age, sex, comorbidities and index DMD type. Results: The analysis included 7,207 self-injectable and 1,175 oral DMD-treated patients with MS. In unadjusted analyses, the proportion of patients adherent to therapy (MPR ≥0.8 did not differ significantly between the self-injectable (54.1% and the oral DMD cohorts (53.0%; P=0.5075. After controlling for covariates, index DMD type was not a significant predictor of adherence (odds ratio [OR] 1.062; 95% confidence interval [CI]: 0.937–1.202; P=0.3473. Higher likelihood of adherence was associated with male sex (OR 1.20; 95% CI: 1.085–1.335; P=0.0005 and age groups older than 18–34 years (ORs 1.220–1.331; P<0.01. Depression was associated with a lower likelihood of adherence (OR 0.618; 95% CI: 0.511–0.747; P<0.0001. Conclusion: Male

  14. Review: Drug concentrations in hair and their relevance in drug facilitated crimes.

    Science.gov (United States)

    Xiang, Ping; Shen, Min; Drummer, Olaf H

    2015-11-01

    Segmental hair analysis can provide valuable retrospective information on the history of drug exposure in victims of drug facilitated crimes (DFC). This is now possible with availability of sensitive tandem MS techniques such as GC-MS/MS and LC-MS/MS allowing drugs to be detected at pg/mg concentrations after a single dose. In this review hair concentrations of 35 psychoactive drugs given in 20 controlled dose studies are reviewed and compared to the 25 different drugs detected in reported case work. The most common drugs were the benzodiazepines and related hypnotics, gamma-hydroxybutyrate (GHB), ketamine and methamphetamine. Those concentrations reported in DFC were mostly similar or higher than that seen in controlled dose studies. The factors that affecting interpretation of segmental hair results including hair color, growth rates, sample preparation and surface contamination are discussed.

  15. Adherence to drug-refill is a useful early warning indicator of virologic and immunologic failure among HIV patients on first-line ART in South Africa.

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    Ziad El-Khatib

    Full Text Available BACKGROUND: Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy (ART in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor (NNRTI recipients in South Africa. METHODS: In 2008, 456 patients on NNRTI-based ART for a median of 44 months (range 12-99 months; 1,510 person-years were enrolled in a retrospective cohort study in Soweto. Charts were reviewed for clinical characteristics before and during ART. Multivariable logistic regression and Kaplan-Meier survival analysis assessed associations with virologic (two repeated VL>50 copies/ml and immunologic failure (as defined by WHO. RESULTS: After a median of 15 months on ART, 19% (n = 88 and 19% (n = 87 had failed virologically and immunologically respectively. A cumulative adherence of <95% to drug-refill visits was significantly associated with both virologic and immunologic failure (p<0.01. In the final multivariable model, risk factors for virologic failure were incomplete adherence (OR 2.8, 95%CI 1.2-6.7, and previous exposure to single-dose nevirapine or any other antiretrovirals (adj. OR 2.1, 95%CI 1.2-3.9, adjusted for age and sex. In Kaplan-Meier analysis, the virologic failure rate by month 48 was 19% vs. 37% among adherent and non-adherent patients respectively (logrank p value = 0.02. CONCLUSION: One in five failed virologically after a median of 15 months on ART. Adherence to drug-refill visits works as an early warning indicator for both virologic and immunologic failure.

  16. Adherence to Safe Handling Guidelines by Health Care Workers Who Administer Antineoplastic Drugs

    OpenAIRE

    Boiano, James M.; Steege, Andrea L.; Sweeney, Marie H.

    2014-01-01

    The toxicity of antineoplastic drugs is well documented. Many are known or suspected human carcinogens where no safe exposure level exists. Authoritative guidelines developed by professional practice organizations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. As a means of evaluating the extent of use of primary prevention practices such as engineering, administrative and work practice controls, personal protective equipment ...

  17. Adherence to guidelines for avoiding drug interactions associated with warfarin--a Nationwide Swedish Register Study.

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    Jonatan D Lindh

    Full Text Available PURPOSE: To investigate the extent to which clinicians avoid well-established drug-drug interactions associated with warfarin. We hypothesised that clinicians would avoid combining non-steroidal anti-inflammatory drugs (NSAIDs, tramadol and sulfamethoxazole with warfarin. METHODS: A cross-sectional analysis of nationwide dispensing data was performed in Swedish individuals 18 years or older (n =  7,563,649. Odds ratios of interacting NSAIDs, tramadol and sulfamethoxazole versus respective prevalence of comparator drugs codeine, and ciprofloxacin in patients co-dispensed interacting warfarin versus patients unexposed was calculated. RESULTS: The odds of receiving an interacting NSAID versus the comparator codeine was markedly lower in patients with warfarin than in the remaining population (adjusted OR 0.21; 95% CI 0.20 - 0.22. Also, the interacting drugs tramadol and sulfamethoxazole were less common among patients dispensed warfarin as compared to the remaining population, although the decrease was much more modest (adjusted OR 0.83; CI 0.80-0.87 and 0.81; CI 0.73 - 0.90. CONCLUSIONS: In conclusion, Swedish doctors in the vast majority of cases refrain from prescribing NSAIDs to patients already on warfarin. Tramadol and sulfamethoxazole are however rarely avoided.

  18. Adherence to safe handling guidelines by health care workers who administer antineoplastic drugs.

    Science.gov (United States)

    Boiano, James M; Steege, Andrea L; Sweeney, Marie H

    2014-01-01

    The toxicity of antineoplastic drugs is well documented. Many are known or suspected human carcinogens where no safe exposure level exists. Authoritative guidelines developed by professional practice organizations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. As a means of evaluating the extent of use of primary prevention practices such as engineering, administrative and work practice controls, personal protective equipment (PPE), and barriers to using PPE, the National Institute for Safety and Health (NIOSH) conducted a web survey of health care workers in 2011. The study population primarily included members of professional practice organizations representing health care occupations which routinely use or come in contact with selected chemical agents. All respondents who indicated that they administered antineoplastic drugs in the past week were eligible to complete a hazard module addressing self-reported health and safety practices on this topic. Most (98%) of the 2069 respondents of this module were nurses. Working primarily in hospitals, outpatient care centers, and physician offices, respondents reported that they had collectively administered over 90 specific antineoplastic drugs in the past week, with carboplatin, cyclophosphamide, and paclitaxel the most common. Examples of activities which increase exposure risk, expressed as percent of respondents, included: failure to wear nonabsorbent gown with closed front and tight cuffs (42%); intravenous (I.V.) tubing primed with antineoplastic drug by respondent (6%) or by pharmacy (12%); potentially contaminated clothing taken home (12%); spill or leak of antineoplastic drug during administration (12%); failure to wear chemotherapy gloves (12%); and lack of hazard awareness training (4%). The most common reason for not wearing gloves or gowns was "skin exposure was minimal"; 4% of respondents, however, reported skin contact during handling and

  19. Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2 diabetes

    NARCIS (Netherlands)

    de Vries, Sieta T.; Keers, Joost C.; Visser, Rosalie; de Zeeuw, Dick; Haaijer-Ruskamp, Flora M.; Voorham, Jaco; Denig, Petra

    2014-01-01

    Objective: To assess the relationship of patients' medication beliefs and treatment complexity with unintentional and intentional non-adherence for three therapeutic groups commonly used by patients with type 2 diabetes. Methods: Survey data about adherence (Medication Adherence Report Scale) and be

  20. Prediction of drug release from HPMC matrices: effect of physicochemical properties of drug and polymer concentration.

    Science.gov (United States)

    Fu, X C; Wang, G P; Liang, W Q; Chow, M S S

    2004-03-05

    A working equation to predict drug release from hydroxypropyl methylcellulose (HPMC) matrices was derived using a training set of HPMC matrices having different HPMC concentration (w/w, 16.5-55%) and different drugs (solubilities of 1.126-125.5 g/100 ml in water and molecular volumes of 0.1569-0.4996 nm(3)). The equation was log(M(t)/M( infinity ))=-0.6747+1.027 log t -0.1759 (log C(s)) log t +0.4027 (log V) log t -1.041C(H) +0.3213 (log C(s)) C(H) -0.4101 (log V) C(H) -0.3521 (log V) log C(s) (n=263, r=0.9831), where M(t) is the amount of drug released at time t, M( infinity ) the amount of drug released over a very long time, which corresponds in principle to the initial loading, t the release time (h), C(s) the drug solubility in water (g/100 ml), V the volume of drug molecule (nm(3)), and C(H) is HPMC concentration (w/w). The benefit of the novel model is to predict M(t)/M( infinity ) values of a drug from formulation and its physicochemical properties, so applicable to the HPMC matrices of different polymer levels and different drugs including soluble drugs and slightly soluble drugs.

  1. Influence of drug concentration on the diffusion parameters of caffeine

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    R Ben Mustapha

    2011-01-01

    Full Text Available Background and Objectives : In the fields of the pharmaceutical and cosmetic industries and in toxicology, the study of the skin penetration of molecules is very interesting. Various studies have considered the impact of different physicochemical drug characteristics, skin thickness, and formulations, on the transition from the surface of the skin to the underlying tissues or to the systemic circulation; however, the influence of drug concentration on the permeation flux of molecules has rarely been raised. Our study aims to discover the influence of caffeine concentration in a formulation on the percutaneous penetration from gels, as a result of different dose applications to polysulfate membrane and human skin. Materials and Methods : For this purpose, three identical base gels were used at 1, 3, and 5% of caffeine, to evaluate the effect of the concentration of caffeine on in vitro release through the synthetic membrane and ex vivo permeation through the human skin, using diffusion Franz TM cells. Results : The diffusion through the epidermal tissue was significantly slower than through the synthetic membrane, which recorded an increase of flux with an increase in the concentration of caffeine. The skin permeation study showed that diffusion depended not only on the concentration, but also on the deposited amount of gel. Nevertheless, for the same amount of caffeine applied, the flux was more significant from the less concentrated gel. Conclusion : Among all the different concentrations of caffeine examined, 1% gel of caffeine applied at 5 mg / cm 2 showed the highest absorption characteristics across human skin.

  2. Assessment of adherence to drug and non-drug treatments and its changes under the influence of an education program in patients with rheumatoid arthritis

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    E V Orlova

    2012-01-01

    Full Text Available Objective: to assess awareness of drug and non-drug treatments for rheumatoid arthritis (RA and compliance in patients before and after their participation in an education program, as well as the survival of the knowledge and the need for retraining. Subjects and methods. The study included 43 patients with RA: 23 study group patients were trained according to an education program (Rheumatoid Arthritis Health School, 20 patients formed a control group. The education program consisted of 4 daily 90-min studies. Adherence to drug and non-drug treatments was assessed at baseline and at 3 and 6 months. Results. In the study group, the basic therapy remained stably high (about 100% within 6 months. At 3 months after studies, nonsteroidal anti-inflammatory drugs could be discontinued in 23.8% (p < 0.05. After 6 months, the proportion of patients using laser therapy increased by 57.1% (p < 0.01 and accounted for 47.8%; the use of electric and ultrasound treatments showed a 55.6% increase (p < 0.01 and was 60.9%. The number of patients who were compliant to the procedures for shaping a correct functional stereotype increased by 14 and 10 times following 3 and 6 months (60.9% and 43.5%, respectively; p < 0.01. After 3 months, there was a rise in the number of patients using hand ortheses by 75.0% (30.4%; p < 0.01; knee ortheses by 50.0% (39.1%; p < 0.01; individual inner soles by 71.4% (52.2%; p < 0.01; and walking sticks and crutches by 60.0% (34.8%; p < 0.01. Following 6 months, the positive changes remained only after the relative use of inner soles (60.9% and support means (34.8%; p < 0.05. The number of patients who regularly did physical activity increased by 5.3 (69.6%; р < 0.01 and 3.7 (47.8%; p < 0.01 times at 3 and 6 months, respectively. The trend in the control group was less pronounced, determining statistically significant differences between the groups in most indicators (р < 0.05. Conclusion. The education program retains high

  3. The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm.

    Science.gov (United States)

    Gustafsson, Lars L; Wettermark, Björn; Godman, Brian; Andersén-Karlsson, Eva; Bergman, Ulf; Hasselström, Jan; Hensjö, Lars-Olof; Hjemdahl, Paul; Jägre, Ingrid; Julander, Margaretha; Ringertz, Bo; Schmidt, Daniel; Sjöberg, Susan; Sjöqvist, Folke; Stiller, Carl-Olav; Törnqvist, Elisabeth; Tryselius, Rolf; Vitols, Sigurd; von Bahr, Christer

    2011-04-01

    The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.

  4. An evaluation of adherence in patients with multiple sclerosis newly initiating treatment with a self-injectable or an oral disease-modifying drug

    Science.gov (United States)

    Munsell, Michael; Frean, Molly; Menzin, Joseph; Phillips, Amy L

    2017-01-01

    Objective As the multiple sclerosis (MS) disease-modifying drug (DMD) treatment options have expanded to include oral therapies, it is important to understand whether route of administration is associated with DMD adherence. The objective of this study was to compare adherence to DMDs in patients with MS newly initiating treatment with a self-injectable versus an oral DMD. Methods This retrospective database study used IMS Health Real World Data Adjudicated Claims – US data between July 1, 2010 and June 30, 2014. Adherence was measured by medication possession ratio (MPR), calculated as the total number of treated days divided by the total number of days from the first treated day until the end of 12-month follow-up. A binary measure representing adherence (MPR ≥0.8) versus nonadherence (MPR <0.8) to therapy was used. Logistic regression evaluated the likelihood of adherence to index DMD type (self-injectable vs oral). Covariates included patient baseline characteristics (ie, age, sex, comorbidities) and index DMD type. Results The analysis included 7,207 self-injectable and 1,175 oral DMD-treated patients with MS. In unadjusted analyses, the proportion of patients adherent to therapy (MPR ≥0.8) did not differ significantly between the self-injectable (54.1%) and the oral DMD cohorts (53.0%; P=0.5075). After controlling for covariates, index DMD type was not a significant predictor of adherence (odds ratio [OR] 1.062; 95% confidence interval [CI]: 0.937–1.202; P=0.3473). Higher likelihood of adherence was associated with male sex (OR 1.20; 95% CI: 1.085–1.335; P=0.0005) and age groups older than 18–34 years (ORs 1.220–1.331; P<0.01). Depression was associated with a lower likelihood of adherence (OR 0.618; 95% CI: 0.511–0.747; P<0.0001). Conclusion Male sex and age older than 18–34 years were significantly associated with a higher likelihood of adherence, while depression was associated with a lower likelihood of adherence. Index DMD type

  5. Bidirectional adherence changes and associated factors in patients switched from free combinations to equivalent single-pill combinations of antihypertensive drugs.

    Science.gov (United States)

    Wang, Tzung-Dau; Chen, Ying-Hsien; Huang, Chien-Hua; Chen, Wen-Jone; Chen, Ming-Fong

    2014-05-01

    There are no reported studies assessing the effects of fixed-dose single-pill combinations (SPCs) of antihypertensive drugs on adherence in real-world patients with hypertension switched from free combinations to the corresponding SPCs. In this retrospective cohort study with a 1-year mirror-image design, a total of 896 patients who had been prescribed with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and a thiazide-type diuretic within the preceding 12 months of the index (switching) date and the corresponding SPC within 12 months after the index date were included by using the Taiwan National Health Insurance database from January 2001 to December 2007. Adherence was measured by medication possession ratio (MPR). For patients switched to SPCs, the MPR increased significantly from 42% in the preindex period to 69% in the postindex period (relative difference, 75%; 95% confidence interval, 58%-100%; Pdrugs, and congestive heart failure. In summary, despite of the dramatic effect of SPCs on improving adherence, this strategy is not effective or even worse in patients adequately adhering to their free-combined antihypertensive regimens. The inverse association between adherence improvement and number of concurrent antihypertensive drugs suggests early use of SPCs to curtail the nonadherence gap.

  6. Depression longitudinally mediates the association of appearance concerns to ART non-adherence in HIV-infected individuals with a history of injection drug use.

    Science.gov (United States)

    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.

  7. Patterns of prescription antihypertensive drug utilization and adherence to treatment guidelines in the city of Novi Sad

    Directory of Open Access Journals (Sweden)

    Tomas Ana

    2016-01-01

    Full Text Available Background/Aim. Hypertension is one of the leading causes of cardiovascular morbidity and mortality and more than a half of all health insurance expenditures for reimbursed medicines are allocated to antihypertensive drugs in Serbia. The aim of this study was to identify the antihypertensive drug utilization patterns among hypertensive outpatients in the city of Novi Sad, Serbia, determine the adherence to clinical guidelines and address the economic aspects of current prescribing practices. Methods. This retrospective observational study was conducted in Novi Sad over a period of six months. The data on the number of packages, size of packages, and retail price of antihypertensives issued on prescription in outpatients with the diagnosis of essential arterial hypertension was collected from all state-owned pharmacies in Novi Sad. Drug consumption was analyzed using the Anatomical Therapeutic Chemical (ATC/defined daily dose (DDD methodology. Results. Total consumption of antihypertensives issued on prescription over 6 month period in the city of Novi sad, Serbia was 283,48 DDD per 1,000 inhabitans per day (DID. Angiotensin converting enzyme inhibitors (ACEi were most commonly prescribed drugs, and were used 3 times more often than calcium channel blockers and 5 times more than betablockers. The consumption of diuretics and angiotensin receptor antagonists was low within all groups of outpatients. Both national and international guidelines state superiority and effectiveness of diuretics in treatment of hypertension in the elderly, but their consumption was unreasonable low despite the fact that over 70% of all antihypertensive drugs in the city of Novi Sad were dispensed in people aged > 60. The use of more expensive ACEi was observed, despite the guidelines deeming all the drugs of these class equally effective in treatment of hypertension. Conclusion. Large differences in utilization of different groups of antihypertensive agents were noted

  8. Strong Correlation Between Concentrations of Tenofovir (TFV) Emtricitabine (FTC) in Hair and TFV Diphosphate and FTC Triphosphate in Dried Blood Spots in the iPrEx Open Label Extension: Implications for Pre-exposure Prophylaxis Adherence Monitoring.

    Science.gov (United States)

    Gandhi, Monica; Glidden, David V; Liu, Albert; Anderson, Peter L; Horng, Howard; Defechereux, Patricia; Guanira, Juan V; Grinsztejn, Beatriz; Chariyalertsak, Suwat; Bekker, Linda-Gail; Grant, Robert M

    2015-11-01

    Self-reported adherence to pre-exposure prophylaxis (PrEP) has limitations, raising interest in pharmacologic monitoring. Drug concentrations in hair and dried blood spots (DBS) are used to assess long-term-exposure; hair shipment/storage occurs at room temperature. The iPrEx Open Label Extension collected DBS routinely, with opt-in hair collection; concentrations were measured with liquid chromatography/tandem mass spectrometry. In 806 hair-DBS pairs, tenofovir (TFV) hair levels and TFV diphosphate (DP) in DBS were strongly correlated (Spearman coefficient r = 0.734; P hair TFV/DBS emtricitabine (FTC) triphosphate (TP) (r = 0.781; P hair FTC/DBS TFV-DP (r = 0.74; P hair FTC/DBS FTC-TP (r = 0.587; P Hair TFV/FTC concentrations correlate strongly with DBS levels, which are predictive of PrEP outcomes.

  9. Serum magnesium concentration in drug-addicted patients.

    Science.gov (United States)

    Karakiewicz, Beata; Kozielec, Tadeusz; Brodowski, Jacek; Chlubek, Dariusz; Noceń, Iwona; Starczewski, Andrzej; Brodowska, Agnieszka; Laszczyńska, Maria

    2007-03-01

    Drug addiction is a complex problem which leads to many somatic, psychic and social diseases. It is accompanied by the disturbed metabolism of various macro and micronutrients. The aim of this study was to assess serum magnesium concentration in drug-addicted patients and analyze whether Human Immunodeficiency Virus (HIV) infection and methadone treatment affect the level of serum magnesium in these patients. The examination was conducted in a group of 83 people - patients of Szczecin-Zdroje Psychiatric Hospital (Poland). They were 21 to 49 years old, and the mean age was 32 +/- 7 years. The control group consisted of 81 healthy individuals. Flame atomic-absorption spectrometry method was used to determine the magnesium concentration. The total serum magnesium concentration was calculated for the whole patient group, subgroups of women and men, a subgroup of people infected with HIV, and a subgroup receiving methadone substitution treatment. How magnesium behaves depending on age and addiction period, was checked. The mean concentration of magnesium in blood serum of the patients examined was 0.57 mmol/L, which was significantly lower than in the control group. In the subgroup of men it was 0.57 mmol/L, and in the subgroup of women - 0.55 mmol/L; the differences were not statistically significant. In the patient group nobody had the appropriate magnesium concentration in blood serum. No significant correlation was found between the magnesium concentration, age of the patients and addiction period. In the subgroup of seropositive people the mean concentration of magnesium was 0.55 mmol/L, and in the subgroup of non-infected patients - 0.58 mmol/L; the difference was not statistically significant. The mean concentration of magnesium in the subgroup treated with methadone was 0.59 mmol/L, and in the subgroup not involved in this type of therapy - 0.55 mmol/L; it was not a statistically significant difference.

  10. Analysis of Antiretrovirals in Single Hair Strands for Evaluation of Drug Adherence with Infrared-Matrix-Assisted Laser Desorption Electrospray Ionization Mass Spectrometry Imaging.

    Science.gov (United States)

    Rosen, Elias P; Thompson, Corbin G; Bokhart, Mark T; Prince, Heather M A; Sykes, Craig; Muddiman, David C; Kashuba, Angela D M

    2016-01-19

    Adherence to a drug regimen can be a strong predictor of health outcomes, and validated measures of adherence are necessary at all stages of therapy from drug development to prescription. Many of the existing metrics of drug adherence (e.g., self-report, pill counts, blood monitoring) have limitations, and analysis of hair strands has recently emerged as an objective alternative. Traditional methods of hair analysis based on LC-MS/MS (segmenting strands at ≥1 cm length) are not capable of preserving a temporal record of drug intake at higher resolution than approximately 1 month. Here, we evaluated the detectability of HIV antiretrovirals (ARVs) in hair from a range of drug classes using infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI) mass spectrometry imaging (MSI) with 100 μm resolution. Infrared laser desorption of hair strands was shown to penetrate into the strand cortex, allowing direct measurement by MSI without analyte extraction. Using optimized desorption conditions, a linear correlation between IR-MALDESI ion abundance and LC-MS/MS response was observed for six common ARVs with estimated limits of detection less than or equal to 1.6 ng/mg hair. The distribution of efavirenz (EFV) was then monitored in a series of hair strands collected from HIV infected, virologically suppressed patients. Because of the role hair melanin plays in accumulation of basic drugs (like most ARVs), an MSI method to quantify the melanin biomarker pyrrole-2,3,5-tricarboxylic acid (PTCA) was evaluated as a means of normalizing drug response between patients to develop broadly applicable adherence criteria.

  11. Interpretation of pharmaceutical drug concentrations in young children's head hair.

    Science.gov (United States)

    Chatterton, Craig; Turner, Kirsten; Klinger, Nadine; Etter, Matthieu; Duez, Mathieu; Cirimele, Vincent

    2014-01-01

    Three separate cases of child administration of prescription drugs are described. Following liquid-liquid extraction, high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to identify and quantify methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenyl-1-pyrrolidine (EDDP), tramadol, amitriptyline, and nortriptyline in children's hair. The children's age ranged from 14 months to 7 years; in all three cases, the drug in question was detected in more than one section of hair. Methadone was detected in the concentration range of 0.65-0.99 and 0.04-0.4 ng/mg; tramadol was detected in the concentration range of 1.5-2.2 ng/mg; amitriptyline and nortriptyline were detected in the concentration range of 0.18-1.06 and 0.38-2.0 ng/mg, respectively. In each case, the children's parents admitted to or were found guilty of drug administration to the child. These cases demonstrate the added value of hair testing and emphasize the importance of using hair samples to complement conventional analyses.

  12. Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.

    Directory of Open Access Journals (Sweden)

    Jennifer Settergren

    Full Text Available PURPOSE: To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the dispensed doses of atorvastatin/simvastatin would be decreased. METHODS: Cross-sectional analysis of nationwide dispensing data. Odds ratios of interacting erythromycin, verapamil/diltiazem versus respective prevalence of comparator drugs doxycycline, amlodipine/felodipine in patients co-dispensed interacting statins simvastatin/atorvastatin versus patients unexposed (pravastatin/fluvastatin/rosuvastatin was calculated. For fibrates, OR of gemfibrozil versus fenofibrate/bezafibrate in patients co-dispensed any statin was assessed. RESULTS: OR of interacting erythromycin versus comparator doxycycline did not differ between patients on interacting and comparator statins either in patients dispensed high or low statin doses (adjusted OR 0.87; 95% CI 0.60-1.25 and 0.92; 95% CI 0.69-1.23. Interacting statins were less common among patients dispensed verapamil/diltiazem as compared to patients on amlodipine/felodipine (OR high dose 0.62; CI 0.56-0.68 and low dose 0.63; CI 0.58-0.68. Patients on any statin were to a lesser extent dispensed gemfibrozil compared to patients not dispensed a statin (OR high dose 0.65; CI 0.55-0.76 and low dose 0.70; CI 0.63-0.78. Mean DDD (SD for any statin was substantially higher in patients co-dispensed gemfibrozil 178 (149 compared to patients on statin monotherapy 127 (93, (p<0.001. CONCLUSIONS: Prescribers may to some extent avoid co-prescription of statins with calcium blockers and fibrates with an increased risk of myopathy

  13. 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.

  14. Barriers to drug adherence in the treatment of urea cycle disorders: Assessment of patient, caregiver and provider perspectives

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    Oleg A. Shchelochkov

    2016-09-01

    Conclusions: Despite positive views of their effectiveness, respondents found medications, medical foods and dietary supplements difficult to take and viewed adherence as inadequate, thus contributing to hyperammonemic episodes.

  15. Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia.

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    Susan Dierickx

    Full Text Available The potential benefits of Mass Drug Administration (MDA for malaria elimination are being considered in several malaria endemic countries where a decline in malaria transmission has been reported. For this strategy to work, it is important that a large proportion of the target population participates, requiring an in-depth understanding of factors that may affect participation and adherence to MDA programs.This social science study was ancillary to a one-round directly observed MDA campaign with dihydroartemisinin-piperaquine, carried out in 12 villages in rural Gambia between June and August 2014. The social science study employed a mixed-methods approach combining qualitative methods (participant observation and in-depth interviewing and quantitative methods (structured follow-up interviews among non-participating and non-adhering community members.Of 3942 people registered in the study villages, 67.9% adhered to the three consecutive daily doses. For the remaining villagers, 12.6% did not attend the screening, 3.5% was not eligible and 16% did not adhere to the treatment schedule. The main barriers for non-participation and adherence were long and short-term mobility of individuals and specific subgroups, perceived adverse drug reactions and rumors, inconveniences related to the logistics of MDA (e.g. waiting times and the perceived lack of information about MDA.While, there was no fundamental resistance from the target communities, adherence was 67.9%. This shows the necessity of understanding local perceptions and barriers to increase its effectiveness. Moreover, certain of the constraining factors were socio-spatially clustered which might prove problematic since focal areas of residual malaria transmission may remain allowing malaria to spread to adjacent areas where transmission had been temporarily interrupted.

  16. Assessing antiretroviral adherence via electronic drug monitoring and self-report: an examination of key methodological issues.

    Science.gov (United States)

    Pearson, Cynthia R; Simoni, Jane M; Hoff, Peter; Kurth, Ann E; Martin, Diane P

    2007-03-01

    We explored methodological issues related to antiretroviral adherence assessment, using 6 months of data collected in a completed intervention trial involving 136 low-income HIV-positive outpatients in the Bronx, NY. Findings suggest that operationalizing adherence as a continuous (versus dichotomous) variable and averaging adherence estimates over multiple assessment points (versus using only one) explains greater variance in HIV-1 RNA viral load (VL). Self-reported estimates provided during a phone interview accounted for similar variance in VL as EDM estimates (R (2) = .17 phone versus .18 EDM). Self-reported adherence was not associated with a standard social desirability measure, and no difference in the accuracy of self-report adherence was observed for assessment periods of 1-3 days. Self-reported poor adherence was more closely associated with EDM adherence estimates than self-reported moderate and high adherence. On average across assessment points, fewer than 4% of participants who reported taking a dose of an incorrect amount of medication.

  17. Utility of cerebrospinal fluid drug concentration as a surrogate for unbound brain concentration in nonhuman primates.

    Science.gov (United States)

    Nagaya, Yoko; Nozaki, Yoshitane; Kobayashi, Kazumasa; Takenaka, Osamu; Nakatani, Yosuke; Kusano, Kazutomi; Yoshimura, Tsutomu; Kusuhara, Hiroyuki

    2014-01-01

    In central nervous system drug discovery, cerebrospinal fluid (CSF) drug concentration (C(CSF)) has been widely used as a surrogate for unbound brain concentrations (C(u,brain)). However, previous rodent studies demonstrated that when drugs undergo active efflux by transporters, such as P-glycoprotein (P-gp), at the blood-brain barrier, the C(CSF) overestimates the corresponding C(u,brain). To investigate the utility of C(CSF) as a surrogate for interstitial fluid (ISF) concentration (C(ISF)) in nonhuman primates, this study simultaneously determined the C(CSF) and C(ISF) of 12 compounds, including P-gp substrates, under steady-state conditions in cynomolgus monkeys using intracerebral microdialysis coupled with cisternal CSF sampling. Unbound plasma concentrations of non- or weak P-gp substrates were within 2.2-fold of the C(ISF) or C(CSF), whereas typical P-gp substrates (risperidone, verapamil, desloratadine, and quinidine) showed ISF-to-plasma unbound (K(p,uu,ISF)) and CSF-to-plasma unbound concentration ratios (K(p,uu,CSF)) that were appreciably lower than unity. Although the K(p,uu,CSF) of quinidine, verapamil, and desloratadine showed a trend of overestimating the K(p,uu,ISF), K(p,uu,CSF) showed a good agreement with K(p,uu,ISF) within 3-fold variations for all compounds examined. C(u,brain) of some basic compounds, as determined using brain homogenates, overestimated the C(ISF) and C(CSF). Therefore, C(CSF) could be used as a surrogate for C(ISF) in nonhuman primates.

  18. An assessment of antihypertensive drug prescription patterns and adherence to joint national committee-8 hypertension treatment guidelines among hypertensive patients attending a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Rakesh Romday

    2016-12-01

    Results: Out of 500 patients, 299 (59.8% were male and 201 (40.2% were female. Mean age of male and female patients were found to be 57.68+/-15.32 and 61.29+/-12.65 years respectively. As per present study, most of the physicians prescribed single drug (monotherapy, 34.6% to control BP followed by two-drug combination (18.4%, three-drug combination (11.8% and four-drug combination (3%. Two drugs regimen was prescribed in 18.4% of the hypertensive patients. Angiotensin receptor blocker + diuretic combination (4.4% was mostly used in two drug combination therapy followed by Angiotensin receptor blockers + Diuretics (3.6% and Calcium channel blocker + ACEIs combination (2.6%. No combination of ACEIs + ARBs was prescribed in any prescription. The overall rate of adherence was 16.5 % (Pre-hypertension; 87.90% (Stage 1 hypertension; and 68.20% (Stage 2 hypertension. Conclusions: In conclusion, present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with comorbid conditions. [Int J Res Med Sci 2016; 4(12.000: 5125-5133

  19. Murine intracochlear drug delivery: reducing concentration gradients within the cochlea.

    Science.gov (United States)

    Borkholder, David A; Zhu, Xiaoxia; Hyatt, Brad T; Archilla, Alfredo S; Livingston, William J; Frisina, Robert D

    2010-09-01

    Direct delivery of compounds to the mammalian inner ear is most commonly achieved by absorption or direct injection through the round window membrane (RWM), or infusion through a basal turn cochleostomy. These methods provide direct access to cochlear structures, but with a strong basal-to-apical concentration gradient consistent with a diffusion-driven distribution. This gradient limits the efficacy of therapeutic approaches for apical structures, and puts constraints on practical therapeutic dose ranges. A surgical approach involving both a basal turn cochleostomy and a posterior semicircular canal canalostomy provides opportunities for facilitated perfusion of cochlear structures to reduce concentration gradients. Infusion of fixed volumes of artificial perilymph (AP) and sodium salicylate were used to evaluate two surgical approaches in the mouse: cochleostomy-only (CO), or cochleostomy-plus-canalostomy (C+C). Cochlear function was evaluated via closed-system distortion product otoacoustic emissions (DPOAE) threshold level measurements from 8 to 49 kHz. AP infusion confirmed no surgical impact to auditory function, while shifts in DPOAE thresholds were measured during infusion of salicylate and AP (washout). Frequency dependent shifts were compared for the CO and C+C approaches. Computer simulations modeling diffusion, volume flow, interscala transport, and clearance mechanisms provided estimates of drug concentration as a function of cochlear position. Simulated concentration profiles were compared to frequency-dependent shifts in measured auditory responses using a cochlear tonotopic map. The impact of flow rate on frequency dependent DPOAE threshold shifts was also evaluated for both surgical approaches. Both the C+C approach and a flow rate increase were found to provide enhanced response for lower frequencies, with evidence suggesting the C+C approach reduces concentration gradients within the cochlea.

  20. "We fear the police, and the police fear us": structural and individual barriers and facilitators to HIV medication adherence among injection drug users in Kiev, Ukraine.

    Science.gov (United States)

    Mimiaga, Matthew J; Safren, Steven A; Dvoryak, Sergiy; Reisner, Sari L; Needle, Richard; Woody, George

    2010-11-01

    Ukraine has one of the most severe HIV/AIDS epidemics in Europe, with an estimated 1.63% of the population living with HIV/AIDS in 2007. Injection drug use (IDU) remains the predominant mode of transmission in Kiev - the capital and largest city. Prior reports suggest that the HIV infection rate among IDUs in Kiev reaches 33%, and many have poor and inequitable access to highly active antiretroviral therapy (HAART). Among those with access to HAART, little is understood about barriers and facilitators to HAART medication adherence. In May 2009, two semi-structured focus groups were conducted with HIV-infected IDUs seeking treatment at the City AIDS Center, Kiev. The goal was to use this information to adapt and tailor, to Ukrainian culture, an evidence-based intervention for improving adherence to HAART. All 16 participants attributed HIV infection to IDU. Their average age was 31.6 (SD=7.0), average time with HIV 5.7 years (SD=4.0), average time on HAART 2.5 years (SD=1.7), average time as IDU 14.6 years (SD=6.8), and 88% were on opioid substitution therapy. The most salient themes related to adherence barriers included: (1) harassment and discrimination by police; (2) opioid dependence; (3) complexity of drug regimen; (4) side effects; (5) forgetting; (6) co-occurring mental health problems; and (7) HIV stigma. Facilitators of adherence included: (1) cues for pill taking; (2) support and reminders from family, significant other, and friends; (3) opioid substitution therapy; and (4) wanting improved health. Additional factors explored included: (1) knowledge about HAART; (2) storage of medications; and (3) IDU and sexual risk behaviors. Findings highlighted structural and individual barriers to adherence. At the structural level, police discrimination and harassment was reported to be a major barrier to adherence to opioid substitution therapy and HAART. Privacy and stigma were barriers at the individual level. Recommendations for adherence interventions included

  1. Strong Correlation Between Concentrations of Tenofovir (TFV) Emtricitabine (FTC) in Hair and TFV Diphosphate and FTC Triphosphate in Dried Blood Spots in the iPrEx Open Label Extension: Implications for Pre-exposure Prophylaxis Adherence Monitoring

    Science.gov (United States)

    Gandhi, Monica; Glidden, David V.; Liu, Albert; Anderson, Peter L.; Horng, Howard; Defechereux, Patricia; Guanira, Juan V.; Grinsztejn, Beatriz; Chariyalertsak, Suwat; Bekker, Linda-Gail; Grant, Robert M.

    2015-01-01

    Self-reported adherence to pre-exposure prophylaxis (PrEP) has limitations, raising interest in pharmacologic monitoring. Drug concentrations in hair and dried blood spots (DBS) are used to assess long-term-exposure; hair shipment/storage occurs at room temperature. The iPrEx Open Label Extension collected DBS routinely, with opt-in hair collection; concentrations were measured with liquid chromatography/tandem mass spectrometry. In 806 hair-DBS pairs, tenofovir (TFV) hair levels and TFV diphosphate (DP) in DBS were strongly correlated (Spearman coefficient r = 0.734; P < .001), as were hair TFV/DBS emtricitabine (FTC) triphosphate (TP) (r = 0.781; P < .001); hair FTC/DBS TFV-DP (r = 0.74; P < .001); hair FTC/DBS FTC-TP (r = 0.587; P < .001). Drug detectability was generally concordant by matrix. Hair TFV/FTC concentrations correlate strongly with DBS levels, which are predictive of PrEP outcomes. PMID:25895984

  2. Development and Evaluation of an Improved Methodology for Assessing Adherence to Evidence-Based Drug Therapy Guidelines Using Claims Data

    Science.gov (United States)

    Kawamoto, Kensaku; Allen LaPointe, Nancy M.; Silvey, Garry M.; Anstrom, Kevin J.; Eisenstein, Eric L.; Lobach, David F.

    2007-01-01

    Non-adherence to evidence-based pharmacotherapy is associated with increased morbidity and mortality. Claims data can be used to detect and intervene on such non-adherence, but existing claims-based approaches for measuring adherence to pharmacotherapy guidelines have significant limitations. In this manuscript, we describe a methodology for assessing adherence to pharmacotherapy guidelines that overcomes many of these limitations. To develop this methodology, we first reviewed the literature to identify prior work on potential strategies for overcoming these limitations. We then assembled a team of relevant domain experts to iteratively develop an improved methodology. This development process was informed by the use of the proposed methodology to assess adherence levels for 14 pharmacotherapy guidelines related to seven common diseases among approximately 36,000 Medicaid beneficiaries. Finally, we evaluated the ability of the methodology to overcome the targeted limitations. Based on this evaluation, we conclude that the proposed methodology overcomes many of the limitations associated with existing approaches. PMID:18693865

  3. Significant interaction between activated charcoal and antiretroviral therapy leading to subtherapeutic drug concentrations, virological breakthrough and development of resistance.

    Science.gov (United States)

    Tseng, Alice L; la Porte, Charles; Salit, Irving E

    2013-01-01

    A 42-year-old, treatment-experienced woman, virologically suppressed on tenofovir/emtricitabine and boosted atazanavir, experienced virological breakthrough, drop in CD4(+) T-cell count and undetectable drug concentrations. Adherence to treatment was confirmed, but repeat testing yielded similar results. After 2 months, the patient stated that she had been taking activated charcoal to manage gastrointestinal symptoms associated with her combination antiretroviral therapy, but she had recently discontinued the charcoal. Atazanavir concentrations were therapeutic but the patient's viral load rebounded and genotype testing revealed new reverse transcriptase mutations. The patient was changed to zidovudine, lamivudine, and boosted darunavir and achieved viral suppression. At 1 year follow-up, her viral load remained activated charcoal and atazanavir/ritonavir leading to virological breakthrough and development of resistance.

  4. Assessment of the degree of adherence to health facility indicators related to rational drug use in Selected Health Facilities of Amhara Region, Northwest Ethiopia

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    Wubante Demilew Nigussie

    2014-04-01

    Full Text Available Purpose: The purpose of this study was to assess the degree of adherence of health care facility to World Health Organization health facility indicators in selected health care facilities of Amhara Region, Northwest Ethiopia. Methods: A cross sectional study was conducted among randomly selected health care facilities of Amhara region from March 01 to 15, 2014. Data was collected by interview and observation using structured questionnaire and check list respectively. Ethical clearance was obtained from the ethics review committee of Amhara regional state health bureau. The data was checked for completeness and consistency, cleared, coded, and entry and analysis was done by using SPSS (version 16. Results: The percentage availability of key essential drugs was found to be 73.05%, availability of Essential Drug List (EDL, Standard Treatment Guidelines (STG, drug formulary and average stock out duration were 75%, 87.5% 75% and 34 days respectively. Conclusion: The study revealed that evaluation of the patterns of drug use based on World Health Organization (WHO facility indicators was not satisfactory. So there is a need for managerial and educational intervention to improve rational drug use and thereby need to improve’ availability of essential drug list, standard treatment guidelines, drug formulary in order to access unbiased information for health care providers and also to prevent stock out of key essential drugs.

  5. Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomized controlled trial

    DEFF Research Database (Denmark)

    Plet, Hanne T.; Kjeldsen, Lene J.; Christensen, René Depont;

    2014-01-01

    The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals.......The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals....

  6. Physical energy for drug delivery; poration, concentration and activation.

    Science.gov (United States)

    Lakshmanan, Shanmugamurthy; Gupta, Gaurav K; Avci, Pinar; Chandran, Rakkiyappan; Sadasivam, Magesh; Jorge, Ana Elisa Serafim; Hamblin, Michael R

    2014-05-01

    Techniques for controlling the rate and duration of drug delivery, while targeting specific locations of the body for treatment, to deliver the cargo (drugs or DNA) to particular parts of the body by what are becoming called "smart drug carriers" have gained increased attention during recent years. Using such smart carriers, researchers have also been investigating a number of physical energy forces including: magnetic fields, ultrasound, electric fields, temperature gradients, photoactivation or photorelease mechanisms, and mechanical forces to enhance drug delivery within the targeted cells or tissues and also to activate the drugs using a similar or a different type of external trigger. This review aims to cover a number of such physical energy modalities. Various advanced techniques such as magnetoporation, electroporation, iontophoresis, sonoporation/mechnoporation, phonophoresis, optoporation and thermoporation will be covered in the review. Special emphasis will be placed on photodynamic therapy owing to the experience of the authors' laboratory in this area, but other types of drug cargo and DNA vectors will also be covered. Photothermal therapy and theranostics will also be discussed.

  7. Antimicrobial drug concentrations and sampling techniques in the equine lung.

    Science.gov (United States)

    Winther, Lotte

    2012-08-01

    The distribution of antimicrobial drugs in the equine lung is important in designing optimal dosage regimens for the treatment of lower airway infections. Several studies in horses and other species have shown that the pharmacokinetics of a drug in the lung cannot necessarily be predicted by its behaviour in plasma, and influencing factors include the class of drug, the animal species and the chosen sampling technique. This review provides a description of the target site for bacterial lower airway infections and describes the penetration of antibiotics into lung matrices. It also offers an overview of published equine pulmonary pharmacokinetic studies and considers the different sampling methods used and the influence existing methodological problems can have on the interpretation of data. An awareness of these factors is important in establishing optimal dosage regimes to treat lower airway infections in horses.

  8. Adherence to On-Time ART Drug Pick-Up and Its Association with CD4 Changes and Clinical Outcomes Amongst HIV Infected Adults on First-Line Antiretroviral Therapy in Nigerian Hospitals.

    Science.gov (United States)

    Anoje, Chukwuemeka; Agu, Kenneth Anene; Oladele, Edward A; Badru, Titilope; Adedokun, Oluwasanmi; Oqua, Dorothy; Khamofu, Hadiza; Adebayo, Olufunso; Torpey, Kwasi; Chabikuli, Otto Nzapfurundi

    2017-02-01

    Medication adherence is a major determinant of antiretroviral treatment (ART) success. Promptness in medication refill pick-ups may give an indication of medication adherence. This study determined medication refill adherence among HIV positive patients on ART and its association with treatment outcomes in HIV treatment centers in Nigeria. This retrospective multi-center cohort study involved a review of ART refill records for 3534 HIV-positive patients aged 18-60 years who initiated first-line ART between January 2008 and December 2009 and were on therapy for ≥18 months after ART initiation. Drug refill records of these patients for 10 consecutive refill visits after ART initiation were analyzed. The first ten consecutive refill appointment-keeping rates after ART initiation ranged from 64.3 % to 76.1 % which decreased with successive visits. Altogether, 743 (21.1 %) patients were deemed adherent, meaning they picked up their drugs within 7 days of the drug refill appointment date on at least nine out of ten refill visits. The adherent group of patients had a mean CD4 cells increase of 206 ± 6.1 cells/dl after 12 months of ART compared to 186 ± 7.1 cells/dl reported among the nonadherent group (p = 0.0145). The proportion of patients in the adherent category who showed no OIs after 12 months on ART (81 %) was significantly higher when compared to the proportion in the non-adherent category (23.5 %), (p = 0.008). The multivariate analysis showed that the odds of being adherent was 2-3 times more in patients who had a baseline CD4 count of less than 200 cells/dl compared to those with a baseline CD4 of >350 cells/dl. (AOR 2.43, 95 % CI 1.62-3.66). In addition, for patients with baseline CD4 cell count of 201-350 cells/dl, the odds of being adherent was found to be 1.9 compared to those with baseline CD4 of greater than 350 cells/dl (AOR 1.93, 95 % CI 1.27-2.94). Pharmacy refill data can serve as an adherence measure. Adherence to on-time drug

  9. Elevated glucose concentrations promote receptor-independent activation of adherent human neutrophils: an experimental and computational approach

    DEFF Research Database (Denmark)

    Kummer, Ursula; Zobeley, Jürgen; Brasen, Jens Christian;

    2007-01-01

    these dynamic metabolic changes, mathematical simulations were performed. A model for glycolysis in neutrophils was created. The results indicated that the frequency change in NAD(P)H oscillations can result from the activation of the hexose monophosphate shunt, which competes with glycolysis for glucose-6......-phosphate. Experimental confirmation of these simulations was performed by measuring the effect of glucose concentrations on flavoprotein autofluorescence, an indicator of the rate of mitochondrial electron transport. Moreover, after prolonged exposure to elevated glucose levels, neutrophils return......Neutrophil activation plays integral roles in host tissue damage and resistance to infectious diseases. As glucose uptake and NADPH availability are required for reactive oxygen metabolite production by neutrophils, we tested the hypothesis that pathological glucose levels (>or=12 m...

  10. Adherence to the Treatment in Psychiatric Patients

    Directory of Open Access Journals (Sweden)

    Mehmet Emin Demirkol

    2015-09-01

    Conclusion: Although medical treatments and drug industry develop day by day, there have been no changes in the treatment adherence ratios in the past years. To generate possible solutions, treatment adherence should be assessed in all clinical interviews and if patient is non-adherent this issue should be handled seriously. [Cukurova Med J 2015; 40(3.000: 555-568

  11. A New Approach for Estimating Background Rates of Erosion Using Concentration of Meteoric 10-Be Adhered to River Sediment: Application to the Rapidly Eroding Waipaoa Basin, New Zealand

    Science.gov (United States)

    Reusser, L. J.; Bierman, P. R.; Pavich, M.; Finkel, R.

    2007-12-01

    New and existing data suggest that the concentration of atmospherically- produced, meteoric 10-Be adhered to river sediment provides a proxy for basin-scale erosion rates. Although the widely applied method of analyzing in situ produced 10-Be in river sediments has proven useful for estimating pre-anthropogenic rates of erosion in a variety of environments, there are lithologic limitation. In contrast, measuring the concentration of meteoric 10-Be adhered to river sediment allows erosion rate analysis in landscapes underlain by quartz-deficient or fine-grained lithologies, as well as in basins where the concentration of quartz varies spatially. By assuming that basins are in an overall isotopic steady-state, that erosion is rapid enough that decay is negligible, and that the integrated delivery rate of 10-Be from the atmosphere (D10-Be) can be estimated, basin-scale mass loss rates (Ms) can be solved by equating the 10-Be flux in from the atmosphere with the flux of 10-Be out of the basin on sediment (C10-Be) and expressed as sediment yield per unit area (Ys). Fin = Fout D10-Be * A = Ms * C10-Be Ms = (D10-Be * A)/ C10-Be Ys = D10-Be / C10-Be To validate this new approach, we examined the limited data that do exist and found reasonable correspondence between erosion rates estimated from meteoric 10-Be concentrations and estimated by other means. As a first application, we use meteoric 10-Be in river sediment to estimate basin-scale erosion rates from catchments within and near the mud-stone dominated Waipaoa River Basin draining the tectonically active east coast of New Zealand's North Island. Near total conversion of indigenous forest to pasture over the past century in the Waipaoa Basin has resulted in some of the most dramatic and widespread erosional features on the planet, and contemporary sediment yields that rank among the highest in the world (~7 million kg/(km2 * yr)). The amount of meteoric 10-Be adhered to eight river sediment samples suggests that modern

  12. [Adherence to psychopharmacological treatment: Psychotherapeutic strategies to enhance adherence].

    Science.gov (United States)

    Lencer, R; Korn, D

    2015-05-01

    Effective psychopharmacological medication with good tolerability represents the cornerstone of treatment for severe mental illness; however, the 1-year adherence rates are only approximately 50%. The term adherence emphasizes the collaborative responsibility of the clinician and the patient for a positive treatment outcome. Reasons for non-adherence are manifold and include patient-specific factors, such as self-stigmatization, lack of social and familial support, cognitive impairment and substance use besides insufficient effectiveness and the occurrence of side effects of the psychotropic drugs. To enhance adherence, both clinician and patient have to fully understand all the reasons for and against adherence to medication before a collaborative decision is made on future long-term treatment. A positive attitude towards medication critically depends on whether patients feel that the medication supports the attainment of the individual goals.

  13. Trends in antithrombotic drug use and adherence to non-vitamin K oral anticoagulants in the Netherlands

    NARCIS (Netherlands)

    Hanemaaijer, Susan; Sodihardjo, Fong; Horikx, Annemieke; Wensing, Michel; de Smet, Peter A G M; Bouvy, Marcel L.; Teichert, Martina

    2015-01-01

    Background Non-vitamin K oral anticoagulants (NOACs) became available in the Netherlands in 2008, providing another antithrombotic treatment besides vitamin K antagonists (VKAs) and antiplatelet agents (APAs). Objective To describe the patterns of antithrombotic drug use between 2008 and 2013 by exa

  14. Impact of the nature and concentration of plasticizers on the ability of PVC to sorb drug.

    Science.gov (United States)

    Al Salloum, H; Saunier, J; Aymes-Chodur, C; Barakat, H; Yagoubi, N

    2015-12-30

    The sorption of a drug by an infusion set may dramatically reduce the drug delivery efficiency. In this paper, we investigated how the drug sorption, in static conditions, is affected by the plasticizer's nature and ratio in the case of plasticized PVC, one of the most common material for infusion set tubing. Within the study, the drug concentration in diazepam solutions was studied after contact with PVC films containing different amounts of DEHP, DEHT, TOTM and DINCH® plasticizers. Moreover the partition coefficients between material and water were calculated. The drug sorption levels were equivalent for the different plasticizers and there was a plasticizer ratio for which the drug uptake was enhanced. As a consequence, the amount of sorbed drug might not be only linked to the amount of plasticizer in the film and to the solubility of the drug in the plasticizer alone: it must probably depend on specific interactions between plasticizer and PVC.

  15. Getting the shots: methods to gain adherence to a multi-dose vaccination program for inner city, drug-involved prostitution communities.

    Science.gov (United States)

    Daughtridge, Giffin W; Ross, Timothy W; Ceballos, Paola A; Stellar, Carmen E

    2014-04-01

    Street-based sex-work and poly-substance drug use, coupled with low vaccination rates and limited utilization of the mainstream health care system, put the sex worker communities of Bogotá's city center at extreme risk of infection with the hepatitis B virus (HBV). Vaccination is critical to maintaining low prevalence of the disease and low incidence of new cases, yet the floating and inconsistent nature of Bogotá's drug-involved female and transsexual prostitution communities make it difficult to complete a 3-dose vaccination program. Between December 2011 and March of 2012, the Fénix Foundation collaborated with the Bogotá Health Department to deliver free HBV vaccines to this vulnerable population. This paper outlines methods used in the vaccination program to generate a 37.7% adherence rate, significantly higher than that previously reported for HBV vaccination programs also targeting marginalized populations. This program's practices are based on the Fénix peer leader method, and are offered as a model that can be applied to other health interventions operating in analogous contexts, with similarly high-risk populations.

  16. The frequency of drugs among Danish drivers before and after the introduction of fixed concentration limits

    DEFF Research Database (Denmark)

    Steentoft, Anni; Simonsen, Kirsten Wiese; Linnet, Kristian

    2010-01-01

    Until July 2007, the driving under the influence of drugs (DUID) legislation in Denmark was based on impairment, evaluated on the basis of a clinical investigation and toxicological analyses, but in 2007 fixed concentration limits were introduced into the Danish traffic legislation. The objective...... for this study was to investigate the prevalence of medication and illicit drugs among Danish drivers before and after 2007....

  17. Anti-epileptic drug intake adherence: the value of the blood drug level measurement and the clinical approach Aderência à ingestão de medicamentos antiepilépticos: o valor da avaliação dos níveis sanguíneos e a abordagem clínica

    Directory of Open Access Journals (Sweden)

    MARLEIDE DA MOTA GOMES

    1998-12-01

    Full Text Available It was evaluated the patient antiepileptic drug (AED intake adherence in a pilot cross-sectional study carried out at a neurologic out-patient clinic of a university hospital. Ninety-three AED blood concentration (phenobarbital, phenytoin, carbamazepine were analyzed from 24 patients. The variability of the AED blood level was measured (in the steady state period by means of the variation coefficient and compared with the self-reported antiepileptic medication non-adherence, AED blood level according to the range (therapeutic or not, and the seizure control. It was not observed any strong correlation between the higher value of variability and the other three parameters of no adherence. The highest correlation was with the blood drug level (therapeutic or not. The evaluation of blood drug measurement alone, except in cases of extreme low adherence and variability of drug intake, is not enough for the recognition of incorrect drug intake, but the clinical markers and the self-reported adherence have to be also considered for this sort of evaluation.Avaliou-se a aderência à ingesta de drogas antiepilépticas (DAE em estudo piloto transversal conduzido em ambulatório de hospital neurológico universitário. Noventa e três amostras sanguíneas com concentraç��o de DAE (fenobarbital, fenitoína, carbamazepina foram analisadas de 24 pacientes. A variabilidade dos níveis sanguíneos das DAE (em estado estável - steady state period, analizada por meio do coeficiente de variação foi comparada com a auto-referida não aderência à ingesta da DAE, níveis sanguíneos das DAE de acordo com a faixa (terapêutica ou não e o controle das crises epilépticas. Não foi observada correlação forte entre o maior valor da variabilidade e os outros três parâmetros de aderência, apesar da maior correlação com o nível sanguíneo (terapêutico ou não. A avaliação do nível sérico isolado, exceto em caso de extrema baixa aderência e

  18. Measuring adherence to antiretroviral therapy in children and adolescents in western Kenya

    Directory of Open Access Journals (Sweden)

    Rachel C Vreeman

    2014-11-01

    Full Text Available Introduction: High levels of adherence to antiretroviral therapy (ART are central to HIV management. The objective of this study was to compare multiple measures of adherence and investigate factors associated with adherence among HIV-infected children in western Kenya. Methods: We evaluated ART adherence prospectively for six months among HIV-infected children aged ≤14 years attending a large outpatient HIV clinic in Kenya. Adherence was reported using caregiver report, plasma drug concentrations and Medication Event Monitoring Systems (MEMS®. Kappa statistics were used to compare adherence estimates with MEMS®. Logistic regression analyses were performed to assess the association between child, caregiver and household characteristics with dichotomized adherence (MEMS® adherence ≥90% vs. <90% and MEMS® treatment interruptions of ≥48 hours. Odds ratios (ORs and 95% confidence intervals (95% CIs were calculated. Results: Among 191 children, mean age at baseline was 8.2 years and 55% were female. Median adherence by MEMS® was 96.3% and improved over the course of follow-up (p<0.01, although 49.5% of children had at least one MEMS® treatment interruption of ≥48 hours. Adherence estimates were highest by caregiver report, and there was poor agreement between MEMS® and other adherence measures (Kappa statistics 0.04–0.37. In multivariable logistic regression, only caregiver-reported missed doses in the past 30 days (OR 1.25, 95% CI 1.14–1.39, late doses in the past seven days (OR 1.14, 95% CI 1.05–1.22 and caregiver-reported problems with getting the child to take ART (OR 1.10, 95% CI 1.01–1.20 were significantly associated with dichotomized MEMS® adherence. The caregivers reporting that ART made the child sick (OR 1.12, 95% CI 1.01–1.25 and reporting difficulties in the community that made giving ART more difficult (e.g. stigma (OR 1.14, 95% CI 1.02–1.27 were significantly associated with MEMS® treatment interruptions in

  19. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper

    DEFF Research Database (Denmark)

    Brockow, K; Garvey, L H; Aberer, W

    2013-01-01

    search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group...

  20. Clinical significance of 2 h plasma concentrations of first-line anti-tuberculosis drugs

    DEFF Research Database (Denmark)

    Prahl, Julie B; Johansen, Isik S; Cohen, Arieh S;

    2014-01-01

    OBJECTIVES: To study 2 h plasma concentrations of the first-line tuberculosis drugs isoniazid, rifampicin, ethambutol and pyrazinamide in a cohort of patients with tuberculosis in Denmark and to determine the relationship between the concentrations and the clinical outcome. METHODS: After 6......-207 days of treatment (median 34 days) 2 h blood samples were collected from 32 patients with active tuberculosis and from three patients receiving prophylactic treatment. Plasma concentrations were determined using LC-MS/MS. Normal ranges were obtained from the literature. Clinical charts were reviewed...... failure occurred more frequently when the concentrations of isoniazid and rifampicin were both below the normal ranges (P = 0.013) and even more frequently when they were below the median 2 h drug concentrations obtained in the study (P = 0.005). CONCLUSIONS: At 2 h, plasma concentrations of isoniazid...

  1. Mathematical Model to Predict Skin Concentration after Topical Application of Drugs

    Directory of Open Access Journals (Sweden)

    Hiroaki Todo

    2013-12-01

    Full Text Available Skin permeation experiments have been broadly done since 1970s to 1980s as an evaluation method for transdermal drug delivery systems. In topically applied drug and cosmetic formulations, skin concentration of chemical compounds is more important than their skin permeations, because primary target site of the chemical compounds is skin surface or skin tissues. Furthermore, the direct pharmacological reaction of a metabolically stable drug that binds with specific receptors of known expression levels in an organ can be determined by Hill’s equation. Nevertheless, little investigation was carried out on the test method of skin concentration after topically application of chemical compounds. Recently we investigated an estimating method of skin concentration of the chemical compounds from their skin permeation profiles. In the study, we took care of “3Rs” issues for animal experiments. We have proposed an equation which was capable to estimate animal skin concentration from permeation profile through the artificial membrane (silicone membrane and animal skin. This new approach may allow the skin concentration of a drug to be predicted using Fick’s second law of diffusion. The silicone membrane was found to be useful as an alternative membrane to animal skin for predicting skin concentration of chemical compounds, because an extremely excellent extrapolation to animal skin concentration was attained by calculation using the silicone membrane permeation data. In this chapter, we aimed to establish an accurate and convenient method for predicting the concentration profiles of drugs in the skin based on the skin permeation parameters of topically active drugs derived from steady-state skin permeation experiments.

  2. Drug delivery options to increase patient adherence and satisfaction in the management of rheumatoid arthritis – focus on subcutaneous tocilizumab

    Directory of Open Access Journals (Sweden)

    Nakashima Y

    2014-07-01

    Full Text Available Yasuharu Nakashima,1 Masakazu Kondo,2 Hisaaki Miyahara,3 Yukihide Iwamoto11Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan; 2Kondo Clinic of Rheumatology and Orthopaedic Surgery, Fukuoka, Japan; 3Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, JapanAbstract: Rheumatoid arthritis (RA is a chronic, progressive, inflammatory disease associated with joint destruction. Tocilizumab (TCZ is a humanized monoclonal anti-interleukin-6 receptor antibody that was initially developed for use as an intravenous (IV infusion. Previous studies have shown that TCZ-IV is an important treatment option in patients with moderate-to-severe RA. A subcutaneous (SC formulation of 162 mg TCZ that was recently developed and approved provides an additional treatment option for RA patients. In the present review, we provide an update on the efficacy and safety of TCZ-SC, compared with TCZ-IV. The TCZ-SC doses of 162 mg every 2 weeks (q2w or weekly (qw were selected based on pharmacokinetic and pharmacodynamic studies. Both TCZ-SC q2w and qw regimens showed equivalent effects to TCZ-IV in most patients; however, the TCZ-SC qw regimen consistently showed a more rapid effect in terms of C-reactive protein normalization. Randomized controlled studies showed that TCZ-SC monotherapy or combined with disease-modifying antirheumatic drugs demonstrated comparable efficacy to TCZ-IV in patients who were both biologic-naïve and refractory to tumor necrosis factor inhibitors. TCZ-SC at both qw and q2w were generally well-tolerated for up to 24 weeks. There was a low rate of withdrawal due to adverse events, and their incidence was comparable with that seen with TCZ-IV. An injection site reaction was seen in approximately 10% of patients who received the subcutaneous formulation. In conclusion, although clinical results are still limited, the currently available evidence

  3. Hypnosis control based on the minimum concentration of anesthetic drug for maintaining appropriate hypnosis.

    Science.gov (United States)

    Furutani, Eiko; Nishigaki, Yuki; Kanda, Chiaki; Takeda, Toshihiro; Shirakami, Gotaro

    2013-01-01

    This paper proposes a novel hypnosis control method using Auditory Evoked Potential Index (aepEX) as a hypnosis index. In order to avoid side effects of an anesthetic drug, it is desirable to reduce the amount of an anesthetic drug during surgery. For this purpose many studies of hypnosis control systems have been done. Most of them use Bispectral Index (BIS), another hypnosis index, but it has problems of dependence on anesthetic drugs and nonsmooth change near some particular values. On the other hand, aepEX has an ability of clear distinction between patient consciousness and unconsciousness and independence of anesthetic drugs. The control method proposed in this paper consists of two elements: estimating the minimum effect-site concentration for maintaining appropriate hypnosis and adjusting infusion rate of an anesthetic drug, propofol, using model predictive control. The minimum effect-site concentration is estimated utilizing the property of aepEX pharmacodynamics. The infusion rate of propofol is adjusted so that effect-site concentration of propofol may be kept near and always above the minimum effect-site concentration. Simulation results of hypnosis control using the proposed method show that the minimum concentration can be estimated appropriately and that the proposed control method can maintain hypnosis adequately and reduce the total infusion amount of propofol.

  4. Drug adherence and multidisciplinary care in patients with multiple sclerosis: Protocol of a prospective, web-based, patient-centred, nation-wide, Dutch cohort study in glatiramer acetate treated patients (CAIR study

    Directory of Open Access Journals (Sweden)

    Siepman Theodora

    2011-03-01

    Full Text Available Abstract Background Multiple sclerosis (MS is a chronic inflammatory demyelinating disease of the central nervous system, for which no definitive treatment is available. Most patients start with a relapsing-remitting course (RRMS. Disease-modifying drugs (DMDs reduce relapses and disability progression. First line DMDs include glatiramer acetate (GA, interferon-beta (INFb-1a and INFb-1b, which are all administered via injections. Effectiveness of DMD treatment depends on adequate adherence, meaning year-long continuation of injections with a minimum of missed doses. In real-life practice DMD-treated patients miss 30% of doses. The 6-month discontinuation rate is up to 27% and most patients who discontinue do so in the first 12 months. Treatment adherence is influenced by the socio-economic situation, health care and caregivers, disease, treatment and patient characteristics. Only a few studies have dealt with adherence-related factors in DMD-treated patients. Self-efficacy expectations were found to be related to GA adherence. Patient education and optimal support improve adherence in general. Knowledge of the aspects of care that significantly relate to adherence could lead to adherence-improving measures. Moreover, identification of patients at risk of inadequate adherence could lead to more efficient care. In the near future new drugs will become available for RRMS. Detailed knowledge on factors prognostic of adherence and on care aspects that are associated with adequate adherence will improve the chances of these drugs becoming effective treatments. We investigate in RRMS patients the relationship between drug adherence and multidisciplinary care, as well as factors associated with adherence. Given the differences in the frequency of administration and in the side effects between the DMDs we decided to study patients treated with the same DMD, GA. Methods/design The Correlative analyses of Adherence In Relapsing remitting MS (CAIR study is

  5. [Influence of Perftoran nanoemulsion on blood plasma concentrations of lipophilic drugs].

    Science.gov (United States)

    Pshenkina, N N

    2012-01-01

    The influence of perfluorocarbon blood substitute Perfloran on the plasma concentrations of bendazole, drotaverine, ketorolac and verapamil upon intravenous introduction after Perfloran infusion (5 ml/kg) has been investigated on rabbits. It has been found that the plasma concentrations of verapamil, drotaverine and bendazole (highly lipophilic drugs with log(P) = 4.5, 4.9 and 3.5, respectively) increased in the presence of Perfloran. The influence of Perfloran on the concentration of weakly lipophilic ketorolac was less significant. Perfloran effectively bound drotaverine, ketorolac and verapamil in vitro, whereas the binding of ketorolac by the emulsion particles was weak. Evidently, the infusion of hydrophobic nanoemulsion Perftoran elevates the sorption capacity of plasma and creates prerequisites for the redistribution drugs and favors increase in their concentrations.

  6. Multicenter study of posaconazole therapeutic drug monitoring: exposure-response relationship and factors affecting concentration.

    Science.gov (United States)

    Dolton, Michael J; Ray, John E; Chen, Sharon C-A; Ng, Kingsley; Pont, Lisa; McLachlan, Andrew J

    2012-11-01

    Posaconazole has an important role in the prophylaxis and salvage treatment of invasive fungal infections (IFIs), although poor and variable bioavailability remains an important clinical concern. Therapeutic drug monitoring of posaconazole concentrations has remained contentious, with the use of relatively small patient cohorts in previous studies hindering the assessment of exposure-response relationships. This multicenter retrospective study aimed to investigate relationships between posaconazole concentration and clinical outcomes and adverse events and to assess clinical factors and drug interactions that may affect posaconazole concentrations. Medical records were reviewed for patients who received posaconazole and had ≥1 concentration measured at six hospitals in Australia. Data from 86 patients with 541 posaconazole concentrations were included in the study. Among 72 patients taking posaconazole for prophylaxis against IFIs, 12 patients (17%) developed a breakthrough fungal infection; median posaconazole concentrations were significantly lower than in those who did not develop fungal infection (median [range], 289 [50 to 471] ng/ml versus 485 [0 to 2,035] ng/ml; P posaconazole concentration was a significant predictor of breakthrough fungal infection via binary logistic regression (P posaconazole exposure, including coadministration with proton pump inhibitors, metoclopramide, phenytoin or rifampin, and the H(2) antagonist ranitidine (P posaconazole exposure (P posaconazole concentrations are common and are associated with breakthrough fungal infection, supporting the utility of monitoring posaconazole concentrations to ensure optimal systemic exposure.

  7. Assessing the risk of drug-induced cholestasis using unbound intrahepatic concentrations.

    Science.gov (United States)

    Riede, Julia; Poller, Birk; Huwyler, Jorg; Camenisch, Gian

    2017-03-02

    Inhibition of the bile salt export pump (BSEP) has been recognized as a key factor in the development of drug-induced cholestasis (DIC). The risk of DIC in human has previously been assessed using in vitro BSEP inhibition data (IC50) and unbound systemic drug exposure under assumption of the "free drug hypothesis". This concept, however, is unlikely valid as unbound intrahepatic drug concentrations are affected by active transport and metabolism. To investigate this hypothesis we experimentally determined the in vitro liver-to-blood partition coefficients (Kp,uu) for 18 drug compounds using the hepatic Extended Clearance Model (ECM). In vitro-in vivo translatability of Kp,uu values was verified for a subset of compounds in rat. Consequently, unbound intrahepatic concentrations were calculated from clinical exposure (systemic and hepatic inlet) and measured Kp,uu data. Using these values, corresponding safety margins against BSEP IC50 values were determined and compared to the clinical incidence of DIC. Depending on the ECM class of a drug, in vitro Kp,uu values deviated up to 14-fold from unity and unbound intrahepatic concentrations were affected accordingly. The use of in vitro Kp,uu-based safety margins allowed to separate clinical cholestasis frequency into three classes (no cholestasis, cholestasis in ≤ 2%, and in > 2% of subjects) for 17 out of 18 compounds. This assessment was significantly superior compared to using unbound extracellular concentrations as a surrogate for intrahepatic concentrations. Furthermore, the assessment of Kpuu according to ECM provides useful guidance for the quantitative evaluation of genetic and physiological risk factors for the development of cholestasis.

  8. Iontophoretic Permeation of Lisinopril at Different Current Densities and Drug Concentrations

    Directory of Open Access Journals (Sweden)

    Ashish Jain

    2012-08-01

    Full Text Available Purpose: The purpose of the present work was to assess iontophoretic permeation of Lisinopril at different current densities and concentrations for development of patient-controlled active transdermal system. Methods: In vitro iontophoretic transdermal delivery of Lisinopril across the pigskin was investigated at three different drug concentrations and three different current densities (0.25- 0.75 mA/cm2 in the donor cell of the diffusion apparatus, using cathodal iontophoresis along with the passive controls. Results: For passive permeation, the steady state flux significantly increased with the increasing of donor drug concentration. At all concentration levels, iontophoresis considerably increased the permeation rate compared to passive controls. Iontophoretic transport of Lisinopril was to be found increase with current densities. Flux enhancement was highest at the lowest drug load and lowest at the highest drug load. Conclusion: The obtained results indicate that permeation rate of Lisinopril across the pigskin can be considerably enhanced, controlled or optimized by the use of Iontophoresis technique.

  9. Multicenter Study of Posaconazole Therapeutic Drug Monitoring: Exposure-Response Relationship and Factors Affecting Concentration

    OpenAIRE

    Dolton, Michael J; Ray, John E.; Chen, Sharon C.-A.; Ng, Kingsley; Pont, Lisa; McLachlan, Andrew J

    2012-01-01

    Posaconazole has an important role in the prophylaxis and salvage treatment of invasive fungal infections (IFIs), although poor and variable bioavailability remains an important clinical concern. Therapeutic drug monitoring of posaconazole concentrations has remained contentious, with the use of relatively small patient cohorts in previous studies hindering the assessment of exposure-response relationships. This multicenter retrospective study aimed to investigate relationships between posaco...

  10. HIV Medication Adherence

    Science.gov (United States)

    HIV Treatment HIV Medication Adherence (Last updated 3/2/2017; last reviewed 3/2/2017) Key Points Medication adherence means sticking firmly to ... Before and After Starting HIV Medicines . What is medication adherence? Adherence means “to stick firmly.” So for ...

  11. Flexing the PECs: Predicting environmental concentrations of veterinary drugs in Canadian agricultural soils.

    Science.gov (United States)

    Kullik, Sigrun A; Belknap, Andrew M

    2017-03-01

    Veterinary drugs administered to food animals primarily enter ecosystems through the application of livestock waste to agricultural land. Although veterinary drugs are essential for protecting animal health, their entry into the environment may pose a risk for nontarget organisms. A means to predict environmental concentrations of new veterinary drug ingredients in soil is required to assess their environmental fate, distribution, and potential effects. The Canadian predicted environmental concentrations in soil (PECsoil) for new veterinary drug ingredients for use in intensively reared animals is based on the approach currently used by the European Medicines Agency for VICH Phase I environmental assessments. The calculation for the European Medicines Agency PECsoil can be adapted to account for regional animal husbandry and land use practices. Canadian agricultural practices for intensively reared cattle, pigs, and poultry differ substantially from those in the European Union. The development of PECsoil default values and livestock categories representative of typical Canadian animal production methods and nutrient management practices culminates several years of research and an extensive survey and analysis of the scientific literature, Canadian agricultural statistics, national and provincial management recommendations, veterinary product databases, and producers. A PECsoil can be used to rapidly identify new veterinary drugs intended for intensive livestock production that should undergo targeted ecotoxicity and fate testing. The Canadian PECsoil model is readily available, transparent, and requires minimal inputs to generate a screening level environmental assessment for veterinary drugs that can be refined if additional data are available. PECsoil values for a hypothetical veterinary drug dosage regimen are presented and discussed in an international context. Integr Environ Assess Manag 2017;13:331-341. © 2016 Her Majesty the Queen in Right of Canada

  12. Positron emission tomography and target-controlled infusion for precise modulation of brain drug concentration

    Energy Technology Data Exchange (ETDEWEB)

    Eriksson, Olof [Uppsala Imanet AB, 751 85 Uppsala (Sweden); Department of Radiology, Oncology and Clinical Immunology, Division of Radiology, Uppsala University, 751 85 Uppsala (Sweden)], E-mail: olof.eriksson@uppsala.imanet.se; Josephsson, Ray [Clinical Imaging Unit, Novartis Pharma AG, CH 9057 Basel (Switzerland); Langstrom, Bengt [Uppsala Imanet AB, 751 85 Uppsala (Sweden); Bergstroem, Mats [Department of Pharmaceutical Biosciences, Faculty of Pharmacy, Uppsala University, 751 24 Uppsala (Sweden)

    2008-04-15

    Introduction: There are several instances when it is desirable to control brain concentration of pharmaceuticals, e.g., to modulate the concentration of anesthetic agents to different desired levels fitting to different needs during the course of surgery. This has so far only been possible using indirect estimates of drug concentration such as assuming constant relation between tissue and blood including extrapolations from animals. Methods: A system for controlling target tissue concentration (UIPump) was used to regulate whole-brain concentrations of a central benzodiazepine receptor antagonist at therapeutic levels with input from brain kinetics as determined with PET. The system was tested by using pharmacological doses of flumazenil mixed with tracer amounts of [{sup 11}C]flumazenil. Flumazenil was used as a model compound for anesthesia. An infusion scheme to produce three different steady-state levels in sequence was designed based on kinetic curves obtained after bolus injection. The subjects (Sprague-Dawley rats, n=6) were monitored in a microPET scanner during the whole experiment to verify resulting brain kinetic curves. Results: A steady-state brain concentration was rapidly achieved corresponding to a whole-brain concentration of 118{+-}6 ng/ml. As the infusion rate decreased to lower the exposure by a factor of 2, the brain concentration decreased to 56{+-}4 ng/ml. A third increased steady-state level of anesthesia corresponding to a whole-brain concentration of 107{+-}7 ng/ml was rapidly achieved. Conclusion: The experimental setup with computerized pump infusion and PET supervision enables accurate setting of target tissue drug concentration.

  13. Time-course measurements of drug concentrations in hair and toenails after single administrations of pharmaceutical products.

    Science.gov (United States)

    Kuwayama, Kenji; Miyaguchi, Hajime; Iwata, Yuko T; Kanamori, Tatsuyuki; Tsujikawa, Kenji; Yamamuro, Tadashi; Segawa, Hiroki; Inoue, Hiroyuki

    2016-06-24

    Hair and nails are often used to prove long-term intake of drugs in forensic drug testing. The aim of this study was to evaluate the effectiveness of drug testing using hair and nails and the feasibility of determining when drugs were ingested by measuring the time-courses of drug concentrations in hair and toenails after single administrations of various drugs. Healthy subjects ingested four pharmaceutical products containing eight active ingredients in single doses. Hair and toenails were collected at predetermined intervals, and drug concentrations in hair and nails were measured for 12 months. The administered drugs and their main metabolites were extracted using micropulverized extraction with a stainless steel bullet and were analyzed using liquid chromatography/tandem mass spectrometry. Acidic compounds such as ibuprofen and its metabolites were not detected in both specimens. Acetaminophen, a weakly acidic compound, was detected in nails more frequently than in hair. The maximum concentration of allyl isopropyl acetylurea, a neutral compound, in nails was significantly higher than in hair. Nails are an effective specimen to detect neutral and weakly acidic compounds. For fexofenadine, a zwitterionic compound, and for most basic compounds, the maximum concentrations in hair segments tended to be higher than those in nails. The hair segments showing the maximum concentrations varied between drugs, samples, and subjects. Drug concentrations in hair segments greatly depended on the selection of the hair. Careful interpretation of analytical results is required to predict the time of drug intake. Copyright © 2016 John Wiley & Sons, Ltd.

  14. Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8.

    Science.gov (United States)

    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.

  15. Adherence to Artesunate-Amodiaquine Therapy for Uncomplicated Malaria in Rural Ghana: A Randomised Trial of Supervised versus Unsupervised Drug Administration

    Directory of Open Access Journals (Sweden)

    Kwaku Poku Asante

    2009-01-01

    Full Text Available Introduction. To enhance effective treatment, african nations including Ghana changed its malaria treatment policy from monotherapy to combination treatment with artesunate-amodiaquine (AS+AQ. The major challenge to its use in loose form is adherence. Objective. The objectives of this study were to investigate adherence and treatment outcome among patients treated with AS+AQ combination therapy for acute uncomplicated malaria. Methodology. The study was conducted in two rural districts located in the middle belt of Ghana using quantitative methods. Patients diagnosed with acute uncomplicated malaria as per the Ghana Ministry of Health malaria case definitions were randomly allocated to one of two groups. All patients in both groups were educated about the dose regimen of AS+AQ therapy and the need for adherence. Treatment with AS+AQ was supervised in one group while the other group was not supervised. Adherence was assessed by direct observation of the blister package of AS+AQ left on day 2. Results. 401 participants were randomized into the supervised (211 and unsupervised (190 groups. Compliance in both supervised (95.7% and unsupervised (92.6% groups were similar (P=.18. The commonest side-effects reported on day 2 among both groups were headaches, and body weakness. Parasite clearance by day 28 was >95% in both groups. Discussion/Conclusions. Administration of AS-AQ in both groups resulted in high levels of adherence to treatment regimen among adolescent and adult population in central Ghana. It appears that high level of adherence to AS-AQ is achievable through a rigorous education programme during routine clinic visits.

  16. Barriers and facilitators of adherence to antiretroviral drug therapy and retention in care among adult HIV-positive patients: a qualitative study from Ethiopia.

    Directory of Open Access Journals (Sweden)

    Woldesellassie M Bezabhe

    Full Text Available BACKGROUND: Antiretroviral therapy (ART has been life saving for hundreds of thousands of Ethiopians. With increased availability of ART in recent years, achievement of optimal adherence and patient retention are becoming the greatest challenges in the management of HIV/AIDS in Ethiopia. However, few studies have explored factors influencing medication adherence to ART and retention in follow-up care among adult Ethiopian HIV-positive patients, especially in the Amhara region of the country, where almost one-third of the country's ART is prescribed. The aim of this qualitative study was to collect such data from patients and healthcare providers in the Amhara region of Ethiopia. METHODS: Semi-structured interviews were conducted with 24 patients, of whom 11 had been lost to follow-up and were non-persistent with ART. In addition, focus group discussions were performed with 15 ART nurses and 19 case managers. All interviews and focus groups were audio-recorded, transcribed, and coded for themes and patterns in Amharic using a grounded theory approach. The emergent concepts and categories were translated into English. RESULTS: Economic constraints, perceived stigma and discrimination, fasting, holy water, medication side effects, and dissatisfaction with healthcare services were major reasons for patients being non-adherent and lost to follow-up. Disclosure of HIV status, social support, use of reminder aids, responsibility for raising children, improved health on ART, and receiving education and counseling emerged as facilitators of adherence to ART. CONCLUSIONS: Improving adherence and retention requires integration of enhanced treatment access with improved job and food security. Healthcare providers need to be supported to better equip patients to cope with the issues associated with ART. Development of social policies and cooperation between various agencies are required to facilitate optimal adherence to ART, patient retention, and improved

  17. 78 FR 34109 - ``Script Your Future'' Medication Adherence Campaign

    Science.gov (United States)

    2013-06-06

    ... HUMAN SERVICES Food and Drug Administration ``Script Your Future'' Medication Adherence Campaign AGENCY... importance of medication adherence to enhance the health of Americans. Medication adherence is taking... each patient. Nearly three out of four Americans report that they do not take their medication...

  18. Relationship between RFC gene expression and intracellular drug concentration in methotrexate-resistant osteosarcoma cells.

    Science.gov (United States)

    Wang, J J; Li, G J

    2014-07-24

    Osteosarcoma is a primary malignant tumor in adolescents, associated with high mortality and morbidity. The high-dose methotrexate (MTX) chemotherapy used to treat this disease may induce primary or secondary drug resistance, resulting in a reduced effect of comprehensive treatment. In this study, the relationship between reduced folate carrier (RFC) gene expression and intracellular drug concentration in MTX-resistant osteosarcoma cells (Saos-2) was investigated. MTX-resistant human osteosarcoma cells (Saos-2/MTX2.2, Saos-2/MTX4.4) were prepared. The sensitivities of Saos-2 (primary cells), Saos-2/MTX2.2, and Saos-2/MTX4.4 cells to MTX, diamminedichloroplatinum (DDP), ifosfamide (IFO), epirubicine (EPI), adriamycin (ADM), theprubicin (THP), and paclitaxel (PTX) were detected by MTT. The median inhibitory concentration (IC50) and resistance index were measured. Semi-quantitative RT-PCR was used to evaluate the expression of RFC gene in cells. The intracellular (3)H-MTX concentration was determined. Results showed that IC50 of Saos-2/MTX2.2 and Saos-2/MTX4.4 was 4.87 and 12.73 times that of Saos-2, respectively. Both Saos-2/MTX2.2 and Saos-2/MTX4.4 had resistance to IFO, ADM, EPI, THP, and PTX, but not DDP. Compared to Saos-2/MTX2.2 and Saos-2/MTX4.4, the expression of RFC mRNA in Saos-2 was significantly higher. The intracellular (3)H-MTX concentration reached a peak at 50 min. After 70 min, the concentration was maintained at a plateau. During this phase, the (3)H-MTX concentration in Saos-2 cells was 2.15 times higher than the concentration in Saos-2/MTX4.4 cells. The reduced RFC mRNA expression in PTX-resistant osteosarcoma cells may be related to the decrease in intracellular (3)H-MTX concentration.

  19. A method for direct in vivo measurement of drug concentrations from a single 2H NMR spectrum.

    Science.gov (United States)

    Evelhoch, J L; McCoy, C L; Giri, B P

    1989-03-01

    The use of 2H-labeled drugs provides a measure of drug concentration in situ directly from a single 2H NMR spectrum obtained with any antenna by correcting only for differential saturation effects. The limit of detection for a drug labeled with three equivalent deuterons is roughly 0.5 mM.

  20. Adherence to Pre-Exposure Prophylaxis for HIV Prevention in a Clinical Setting.

    Directory of Open Access Journals (Sweden)

    Madeline C Montgomery

    Full Text Available The HIV epidemic in the United States (US disproportionately affects gay, bisexual, and other men who have sex with men (MSM. Pre-exposure prophylaxis (PrEP using co-formulated tenofovir disoproxil fumarate (TDF and emtricitabine (FTC has demonstrated high efficacy in reducing HIV incidence among MSM. However, low adherence was reported in major efficacy trials and may present a substantial barrier to successful PrEP implementation. Rates of adherence to PrEP in "real-world" clinical settings in the US remain largely unknown.We reviewed demographic and clinical data for the first 50 patients to enroll in a clinical PrEP program in Providence, Rhode Island. We analyzed self-reported drug adherence as well as drug concentrations in dried blood spots (DBS from patients who attended either a three- or six-month follow-up appointment. We further assessed drug concentrations and the resistance profile of a single patient who seroconverted while taking PrEP.Of the first 50 patients to be prescribed PrEP, 62% attended a follow-up appointment at three months and 38% at six months. Of those who attended an appointment at either time point (70%, n = 35, 92% and 95% reported taking ±4 doses/week at three and six months, respectively. Drug concentrations were performed on a random sample of 20 of the 35 patients who attended a follow-up appointment. TDF levels consistent with ±4 doses/week were found in 90% of these patients. There was a significant correlation between self-reported adherence and drug concentrations (r = 0.49, p = 0.02. One patient who had been prescribed PrEP seroconverted at his three-month follow-up visit. The patient's drug concentrations were consistent with daily dosing. Population sequencing and ultrasensitive allele-specific PCR detected the M184V mutation, but no other TDF- or FTC-associated mutations, including those present as minor variants.In this clinical PrEP program, adherence was high, and self-reported drug adherence

  1. Efficacy, adherence and tolerability of once daily tenofovir DF-containing antiretroviral therapy in former injecting drug users with HIV-1 receiving opiate treatment: results of a 48-week open-label study

    Directory of Open Access Journals (Sweden)

    Esser S

    2011-10-01

    Full Text Available Abstract Objective To assess efficacy, adherence and tolerability of once daily antiretroviral therapy containing tenofovir disoproxil fumarate (DF 300 mg in HIV-1-infected former injecting drug users receiving opiate treatment (IVDU. Methods European, 48-week, open-label, single-arm, multicenter study. Patients were either antiretroviral therapy-naïve, restarting therapy after treatment discontinuation without prior virological failure or switching from existing stable treatment. Results Sixty-seven patients were enrolled in the study and 41 patients completed treatment. In the primary analysis (intent-to-treat missing = failure at week 48, 34% of patients (23/67; 95% CI: 23%-47% had plasma HIV-1 RNA 3. Although self-reported adherence appeared high, there were high levels of missing data and adherence results should be treated with caution. No new safety issues were identified. Conclusions Levels of missing data were high in this difficult-to-treat population, but potent antiretroviral suppression was achieved in a substantial proportion of HIV-infected IVDU-patients.

  2. Dosage prediction via estimation of shell thickness and concentration of drug carrier with microbubbles.

    Science.gov (United States)

    Lu, S J; Chuang, C Y; Tsao, Jenho

    2007-01-01

    For drug delivery applications, dosage prediction before release and estimation after release are required functions. In this study, we attempted to establish a method to evaluate liposome concentrations and liposome shell thickness for dosage prediction. We use the Trilling model with parameter of phospholipids bilayers to simulate the frequency responses under the different acoustic pressure and establish an experimental protocol to evaluate the liposome concentrations and the liposome shell thickness. Our results illustrate the changes on the signal strength for different concentrations and show that it is relatively stable to estimate the concentrations when the cycles are lower (15 cycles). Besides, it is verified that the second harmonic signal is more sensitive in analyzing different concentrations. On the other hand, it is proved that the liposome shell thickness affect signal strength and thinner thickness will increase the second harmonic response. Therefore, in accordance with the theoretical and experimental results, we would be able to estimate the concentration and the shell thickness of the liposomes. By numerical analysis methods, dosage prediction would be built.

  3. Adherence to Treatment of Phenylketonuria

    Directory of Open Access Journals (Sweden)

    Tatiane Alves Vieira

    2015-05-01

    Full Text Available Introduction: Phenylketonuria (PKU is caused by the deficient activity of phenylalanine hydroxylase. Aim: To identify the factors associated with treatment adherence among patients with PKU seen at a southern Brazil reference center. Methodology: A cross-sectional, outpatient-based study including 56 patients with PKU (median age, 12 years for whom a Phe-restrict diet plus specific metabolic formula have been prescribed. Patients were considered adherent or nonadherent depending on the median phenylalanine concentration for the 12 months prior to study and target levels of phenylalanine for each age range (<13 years = ≤360 µmol/L; ≥13 years = ≤900 µmol/L. Data were collected through a review of patient’s medical records and a set of interviews with patients and their relatives. Results: Eighteen patients (32.1%; ≥13 years, 11 were classified as treatment adherent. Among all factors analyzed, only mental retardation, living with parents, and level of maternal education were associated with adherence to treatment. Conclusion: Our findings reinforce the importance of the family as promoting factor for treatment adherence.

  4. High Variability of Plasma Drug Concentrations in Dual Protease Inhibitor Regimens

    Science.gov (United States)

    Guiard-Schmid, Jean-Baptiste; Poirier, Jean-Marie; Meynard, Jean-Luc; Bonnard, Philippe; Gbadoe, Ayi Hola; Amiel, Corinne; Calligaris, Frédérique; Abraham, Bruno; Pialoux, Gilles; Girard, Pierre-Marie; Jaillon, Patrice; Rozenbaum, Willy

    2003-01-01

    Ritonavir (RTV) strongly increases the concentrations of protease inhibitors (PIs) in plasma in patients given a combination of RTV and another PI. This pharmacological interaction is complex and poorly characterized and shows marked inter- and intraindividual variations. In addition, RTV interacts differently with saquinavir (SQV), indinavir (IDV), amprenavir (APV), and lopinavir (LPV). In this retrospective study on 542 human immunodeficiency virus-infected patients, we compared inter- and intraindividual variability of plasma PI concentrations and correlations between the Cmin (minimum concentration of drug in plasma) values for RTV and the coadministered PI Cmin values. Mean RTV Cmins are significantly lower in patients receiving combinations containing APV or LPV than in combinations with SQV or IDV. With the most common PI dose regimens (600 mg of IDV twice a day [BID], 800 mg of SQV BID, and 400 mg of LPV BID), the interindividual Cmin variability of patients treated with a PI and RTV seemed to be lower with APV and LPV than with IDV and SQV. As regards intraindividual variability, APV also differed from the other PIs, exhibiting lower Cmin variability than with the other combinations. Significant positive correlations between RTV Cmin and boosted PI Cmin were observed with IDV, SQV, and LPV, but not with APV. Individual dose adjustments must take into account the specificity the pharmacological interaction of each RTV/PI combination and the large inter- and intraindividual variability of plasma PI levels to avoid suboptimal plasma drug concentrations which may lead to treatment failure and too high concentrations which may induce toxicity and therefore reduce patient compliance. PMID:12604531

  5. Nevirapine concentrations in saliva measured by thin layer chromatography and self-reported adherence in patients on antiretroviral therapy at kilimanjaro christian medical centre, Tanzania

    NARCIS (Netherlands)

    George, L.; Muro, E.P.; Ndaro, A.; Dolmans, W.M.; Burger, D.M.; Kisanga, E.R.

    2014-01-01

    BACKGROUND: Thin layer chromatography (TLC) can be used to perform therapeutic drug monitoring in resource-limited settings, where more expensive analytical methods, such as high-performance liquid chromatography or liquid chromatography-mass spectrometry, are not feasible. OBJECTIVES: The aim of th

  6. Patient Adherence to Biologic Agents in Psoriasis

    DEFF Research Database (Denmark)

    Hsu, Der Yi; Gniadecki, Robert

    2016-01-01

    BACKGROUND: Low adherence to therapies in psoriasis decreases treatment outcomes and increases the total health care costs. In spite of the wide use of biologic agents, patients' adherence to these drugs has not been extensively investigated. OBJECTIVE: The aim of this study is to measure adherence...... adverse effects, and positive attitudes to the treatment. CONCLUSION: Adherence to biologic therapies is very high in patients with psoriasis, which is consistent with a positive attitude to the treatment....... to the biologic drugs in a population of patients treated for psoriasis vulgaris using the medication possession ratio (MPR) index and to survey patients' attitudes to the treatment. METHODS: This is a single-center study on 247 patients with psoriasis vulgaris treated with adalimumab (n = 113), etanercept (n...

  7. Low concentration of quercetin antagonizes the cytotoxic effects of anti-neoplastic drugs in ovarian cancer.

    Directory of Open Access Journals (Sweden)

    Na Li

    Full Text Available OBJECTIVE: The role of Quercetin in ovarian cancer treatment remains controversial, and the mechanism is unknown. The aim of this study was to investigate the therapeutic effects of Quercetin in combination with Cisplatin and other anti-neoplastic drugs in ovarian cancer cells both in vitro and in vivo, along with the molecular mechanism of action. METHODS: Quercetin treatment at various concentrations was examined in combination with Cisplatin, taxol, Pirarubicin and 5-Fu in human epithelial ovarian cancer C13* and SKOV3 cells. CCK8 assay and Annexin V assay were for cell viability and apoptosis analysis, immunofluorescence assay, DCFDA staining and realtime PCR were used for reactive oxygen species (ROS-induced injury detection and endogenous antioxidant enzymes expression. Athymic BALB/c-nu nude mice were injected with C13*cells to obtain a xenograft model for in vivo studies. Immunohistochemical analysis was carried out to evaluate the ROS-induced injury and SOD1 activity of xenograft tumors. RESULTS: Contrary to the pro-apoptotic effect of high concentration (40 µM-100 µM of Quercetin, low concentrations (5 µM-30 µM of Quercetin resulted in varying degrees of attenuation of cytotoxicity of Cisplatin treatment when combined with Cisplatin. Similar anti-apoptotic effects were observed when Quercetin was combined with other anti-neoplastic agents: Taxol, Pirarubicin and 5-Fluorouracil (5-Fu. Low concentrations of Quercetin were observed to suppress ROS-induced injury, reduce intracellular ROS level and increase the expression of endogenous antioxidant enzymes, suggesting a ROS-mediated mechanism of attenuating anti-neoplastic drugs. In xenogeneic model, Quercetin led to a substantial reduction of therapeutic efficacy of Cisplatin along with enhancing the endogenous antioxidant enzyme expression and reducing ROS-induced damage in xenograft tumor tissue. CONCLUSION: Taken together, these data suggest that Quercetin at low concentrations

  8. 76 FR 12969 - Campaign To Improve Poor Medication Adherence (U18)

    Science.gov (United States)

    2011-03-09

    ... HUMAN SERVICES Food and Drug Administration Campaign To Improve Poor Medication Adherence (U18) AGENCY... ] importance of good medication adherence, a vital first step toward improved adherence behavior and better...' awareness of the importance of good medication adherence and provide tools to prescribers to help...

  9. Electrophoretic concentration and sweeping-micellar electrokinetic chromatography analysis of cationic drugs in water samples.

    Science.gov (United States)

    Wuethrich, Alain; Haddad, Paul R; Quirino, Joselito P

    2015-07-03

    Sample preparation by electrophoretic concentration, followed by analysis using sweeping-micellar electrokinetic chromatography, was studied as a green and simple analytical strategy for the trace analysis of cationic drugs in water samples. Electrophoretic concentration was conducted using 50 mmol/L ammonium acetate at pH 5 as acceptor electrolyte. Electrophoretic concentration was performed at 1.0 kV for 50 min and 0.5 kV and 15 min for purified and 10-fold diluted waste water samples, respectively. Sweeping-micellar electrokinetic chromatography was with 100 mmol/L sodium phosphate at pH 2, 100 mmol/L sodium dodecyl sulfate and 27.5%-v/v acetonitrile as separation electrolyte. The separation voltage was -20 kV, UV-detection was at 200 nm, and the acidified concentrate was injected for 36 s at 1 bar (or 72% of the total capillary length, 60 cm). Both purified water and 10-fold diluted waste water exhibited a linear range of two orders of concentration magnitude. The coefficient of determination, and intra- and interday repeatability were 0.991-0.997, 2.5-6.2, and 4.4-9.7%RSD (n=6), respectively, for purified water. The values were 0.991-0.997, 3.4-7.1, and 8.7-9.8%RSD (n=6), correspondingly, for 10-fold diluted waste water. The method detection limit was in the range from 0.04-0.09 to 1.20-6.97 ng/mL for purified and undiluted waste water, respectively.

  10. Changes in first-line injectable disease-modifying therapy for multiple sclerosis: predictors of non-adherence, switching, discontinuation, and interruption of drugs.

    Science.gov (United States)

    Degli Esposti, Luca; Piccinni, Carlo; Sangiorgi, Diego; Perrone, Valentina; Aledda, Lucia; Marrosu, Maria Giovanna; Lombardo, Fabio

    2017-01-11

    This study was aimed to describe changes of Disease-Modifying Treatments (DMT) in an Italian cohort of patients with multiple sclerosis (MS) and to identify predictors of therapeutic modifications. Patients with MS and treated with the first-line injectable DMT (interferons-IFNs or glatiramer) between 1/7/2009 and 31/10/2012 were selected from administrative databases of the MS Center of Cagliari (Sardinia, Italy). Socio-demographic, therapeutic, and clinical information was collected in the 6 months preceding the index date. All patients were followed for 36 months to evaluate therapeutic changes in terms of non-adherence, switch, temporary discontinuation, and permanent interruption. Predictors of changes were estimated by multivariable regression models. Data on 1698 patients were collected: glatiramer was prescribed in 27% of cases, IFNβ-1b in 22%, IFNβ-1a-im in 20%, IFNβ-1a-sc-44mcg in 19%, and IFNβ-1a-sc-22mcg in 12%. Non-adherence was observed in 25% of cases, therapeutic switch in 30%, discontinuation in 37%, and permanent interruption in 28%. The risk of non-adherence was higher for IFNβ-1b, compared with IFNβ-1a-im (adjOR = 1.73). Therapeutic switch occurred especially in patients recently diagnosed (each year from diagnosis causes a decrease of this risk adjHR = 0.97); the risk of discontinuation was higher with EDSS = 4-6 and 7-9 (adjHR = 1.52 and 4.42, respectively). The risk of permanent interruption increased with the augmentation of disability (adjHR = 1.67 and 5.43 for EDSS 4-6 and 7-9). This study mirrored a detailed framework of DMT prescription and identified factors related to changes in the MS therapy. These findings could support healthcare providers in the evaluation and maximization of benefits associated with a long-term DMT.

  11. Plasma Drug Concentrations of Orally Administered Rosuvastatin in Hispaniolan Amazon Parrots (Amazona ventralis).

    Science.gov (United States)

    Beaufrère, Hugues; Papich, Mark G; Brandão, João; Nevarez, Javier; Tully, Thomas N

    2015-03-01

    Atherosclerotic diseases are common in pet psittacine birds, in particular Amazon parrots. While hypercholesterolemia and dyslipidemia have not definitely been associated with increased susceptibility to atherosclerosis in parrots, these are important and well-known risk factors in humans. Therefore statin drugs such as rosuvastatin constitute the mainstay of human treatment of dyslipidemia and the prevention of atherosclerosis. No pharmacologic studies have been performed in psittacine birds despite the high prevalence of atherosclerosis in captivity. Thirteen Hispaniolan Amazon parrots were used to test a single oral dose of 10 mg/kg of rosuvastatin with blood sampling performed according to a balanced incomplete block design over 36 hours. Because low plasma concentrations were produced in the first study, a subsequent pilot study using a dose of 25 mg/kg in 2 Amazon parrots was performed. Most plasma samples for the 10 mg/kg dose and all samples for the 25 mg/kg dose had rosuvastatin concentration below the limits of quantitation. For the 10 mg/kg study, the median peak plasma concentration and time to peak plasma concentration were 0.032 μg/mL and 2 hours, respectively. Our results indicate that rosuvastatin does not appear suitable in Amazon parrots as compounded and used at the dose in this study. Pharmacodynamic studies investigating lipid-lowering effects of statins rather than pharmacokinetic studies may be more practical and cost effective in future studies to screen for a statin with more ideal properties for potential use in psittacine dyslipidemia and atherosclerotic diseases.

  12. Novel in vivo imaging analysis of an inner ear drug delivery system in mice: comparison of inner ear drug concentrations over time after transtympanic and systemic injections.

    Directory of Open Access Journals (Sweden)

    Sho Kanzaki

    Full Text Available OBJECTIVE: Systemic steroid injections are used to treat idiopathic sudden-onset sensorineural hearing loss (ISSHL and some inner ear disorders. Recent studies show that transtympanic (TT steroid injections are effective for treating ISSHL. As in vivo monitoring of drug delivery dynamics for inner ear is lacking, its time course and dispersion of drugs is unknown. Here, we used a new in vivo imaging system to monitor drug delivery in live mice and to compare drug concentrations over time after TT and systemic injections. METHODS: Luciferin delivered into the inner ears of GFAP-Luc transgenic mice reacted with luciferase in GFAP-expressing cells in the cochlear spiral ganglion, resulting in photon bioluminescence. We used the Xenogen IVIS® imaging system to measure how long photons continued to be emitted in the inner ear after TT or systemic injections of luciferin, and then compared the associated drug dynamics. RESULTS: The response to TT and IP injections differed significantly. Photons were detected five minutes after TT injection, peaking at ~20 minutes. By contrast, photons were first detected 30 minutes after i.p. injection. TT and i.p. drug delivery time differed considerably. With TT injections, photons were detected earlier than with IP injections. Photon bioluminescence also disappeared sooner. Delivery time varied with TT injections. CONCLUSIONS: We speculate that the drug might enter the Eustachian tube from the middle ear. We conclude that inner-ear drug concentration can be maintained longer if the two injection routes are combined. As the size of luciferin differs from that of therapeutics like dexamethasone, combining drugs with luciferin may advance our understanding of in vivo drug delivery dynamics in the inner ear.

  13. Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective

    OpenAIRE

    Lukshmy Menik Hettihewa; Amarasinghe Isuru; Jayarathna Kalana

    2011-01-01

    The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT), percentage of drugs actually dispensed (PDAD), percentage of drugs adequately labeled (PDAL) and patient′s knowledge on correct dosage (PKCD) were compared in these selected teaching hospitals (TH), general hospitals (GHs) and district hosp...

  14. Chronic alcohol use affects therapeutic steady state plasma drug concentrations of stavudine, lamivudine and nevirapine in HIV-infected patients during 9 months follow up period: WHO AUDIT tool application

    Directory of Open Access Journals (Sweden)

    Godfrey S. Bbosa

    2013-10-01

    Full Text Available Chronic alcohol consumption is a common problem among the HIV-infected patients on HAART. The study determined the effect of chronic alcohol use on steady state plasma drug concentrations of stavudine (d4T, lamivudine (3TC and nevirapine (NVP in HIV-infected patients during the 9 months follow up period. It also determined whether there were some patients with undetectable plasma drug concentrations in their plasma during the follow up. A case control using repeated measures design with serial measurements model, where plasma drug concentrations were measured at 3 month intervals was used. Chronic alcohol-use using WHO AUDIT tool was used to screen patients. A total of 41 patients (21 alcohol group and 20 control group were followed up for 9 months with blood sampling done at 3 month intervals. The Shimadzu Class-VPTM HPLC Chromatography data system version 6.1 equipment with UV detector was used to measure the plasma drug concentrations. Data was analyzed using SAS 2003 version 9.1 statistical package with repeated measures fixed the model and means were compared using the student t-test. The mean steady state plasma concentration of both d4T and 3TC in chronic alcohol use group were lower than in the control group all throughout the 9 months period of follow-up. The mean steady state plasma drug concentrations of NVP were higher in the alcohol group at 0 and 3 months and lower in the 6 and 9 months as compared to the control group. The mean total plasma NVP concentration was higher in the chronic alcohol group as compared to the control group and the difference was statistically significant (p≤0.05. However some patients had undetectable plasma drug concentrations despite of having ≥ 95 % adherence rate. Chronic alcohol use by the HIV-infected patients lowers the steady state plasma drug concentrations of d4T, 3TC and NVP in patients. [Int J Basic Clin Pharmacol 2013; 2(5.000: 507-516

  15. An Adherence Semigroup

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    By a dynamical system we mean a pair of (X,T), where X is compact Hausdorff space. In this paper we define an adherence semigroup A(X,T)∈XX, which is the set of all pointwise limit of subnets of (Tn)n∈N. We will prove some commonness between adherence semigroup and Ellis semigroup.

  16. Utility of measuring serum concentrations of anti-TNF agents and anti-drug antibodies in inflammatory bowel disease.

    Science.gov (United States)

    Guerra, Iván; Chaparro, María; Bermejo, Fernando; Gisbert, Javier P

    2011-07-01

    Tumor necrosis factor alpha (TNFα) is a cytokine with a critical role in the pathogenesis of some chronic inflammatory diseases, such as inflammatory bowel diseases. Anti-TNF agents, which neutralize the biological activity of TNFα, are widely used among the different therapeutic options for the treatment of patients with inflammatory bowel diseases. These drugs are very useful in clinical practice, but some patients experience lack and loss of response during the treatment. Drug serum concentration, antibodies against anti-TNF agents, clearance of the drug, formation of immune complexes, a more severe disease and probably other unknown factors can influence the treatment's efficacy. Nowadays, the management of patients with lack or loss of response is empirical. The measurement of drug concentrations and antibodies against anti-TNF agents might be useful for improving the selection of patients that will benefit from the maintenance treatment. In clinical practice, these methods may help us decide which strategy will be used in cases of loss of response: treatment intensification, shortening the infusion interval, increasing the dose, switching to another anti-TNF agent or to a drug with another mechanism of action. The optimal strategy in the future may be comprised of an early detection of loss of response to the treatment by assessing clinical symptoms and finding evidence of activity of the disease on endoscopic or radiological examinations when necessary, as well as a better management of anti-TNF treatment aided by measuring the serum concentration of the drug and antibodies against the drug.

  17. Metabolite to parent drug concentration ratios in hair for the differentiation of tramadol intake from external contamination and passive exposure.

    Science.gov (United States)

    Madry, Milena M; Rust, Kristina Y; Guglielmello, Rosetta; Baumgartner, Markus R; Kraemer, Thomas

    2012-11-30

    Tramadol was found in a man's hair sample during an abstinence test necessary to regain his driving license. The suspect denied having taken tramadol claiming external contamination as the reason for the positive result, as he was working in a tramadol production company. Nevertheless, low concentrations of both major metabolites, N-desmethyltramadol (NDMT) and O-desmethyltramadol (ODMT), were found in hair (180 and 6 pg/mg hair, respectively). To assess this case, tramadol concentrations and metabolite to parent drug concentration ratios were determined in hair samples of 75 patients taking tramadol and of eight employees working in the production and laboratory site of the same company. Additionally, wash water used for decontaminating hair was analyzed for both groups, patients and employees. Analysis of hair sample extracts was performed by LC-MS/MS using multiple reaction monitoring (MRM), information dependent acquisition (IDA) and enhanced product ion scan (EPI). High variations of metabolite to parent drug concentration ratios in hair samples of patients were observed. Differences in NDMT and ODMT to tramadol concentration ratios were found when comparing the cohort of patients to employees. The suspect could be included in the cohort of employees considering the ODMT to tramadol concentration ratio in hair and tramadol concentration ratio in wash water versus hair. Metabolite to parent drug concentration ratios of hair samples may represent a helpful tool for the differentiation of tramadol intake versus external contamination. Ratios of tramadol concentrations in wash water versus the subjects' hair may provide additional information for case assessments.

  18. Cryopreservation of adherent neuronal networks.

    Science.gov (United States)

    Ma, Wu; O'Shaughnessy, Thomas; Chang, Eddie

    2006-07-31

    Neuronal networks have been widely used for neurophysiology, drug discovery and toxicity testing. An essential prerequisite for future widespread application of neuronal networks is the development of efficient cryopreservation protocols to facilitate their storage and transportation. Here is the first report on cryopreservation of mammalian adherent neuronal networks. Dissociated spinal cord cells were attached to a poly-d-lysine/laminin surface and allowed to form neuronal networks. Adherent neuronal networks were embedded in a thin film of collagen gel and loaded with trehalose prior to transfer to a freezing medium containing DMSO, FBS and culture medium. This was followed by a slow rate of cooling to -80 degrees C for 24 h and then storage for up to 2 months in liquid nitrogen at -196 degrees C. The three components: DMSO, collagen gel entrapment and trehalose loading combined provided the highest post-thaw viability, relative to individual or two component protocols. The post-thaw cells with this protocol demonstrated similar neuronal and astrocytic markers and morphological structure as those detected in unfrozen cells. Fluorescent dye FM1-43 staining revealed active recycling of synaptic vesicles upon depolarizing stimulation in the post-thaw neuronal networks. These results suggest that a combination of DMSO, collagen gel entrapment and trehalose loading can significantly improve conventional slow-cooling methods in cryopreservation of adherent neuronal networks.

  19. Adherence in patients with chronic treatment: data of “adherence day 2013”

    Directory of Open Access Journals (Sweden)

    Olatz Ibarra Barrueta

    2015-01-01

    Full Text Available Objetive: The primary objective of this study was to evaluate the adherence level in chronic conditions patients during “The Adherence Day” celebrated on November 15, 2013. Methods: We performed a transversal, observational and multicenter study at 43 Spanish hospitals, in order to estimate adherence in chronic treatments. We used the validated questionnaires Haynes- Sackett and Morisky- Green to measure medication adherence; but also a visual analogue scale and questions related with treatment complexity and selective adherence were applied. We performed a descriptive analysis and the closeness of agreement between questionnaires results. Results: A total of 723 surveys were collected especially among outpatients. 43% of the participants were women, with a median age of 51 and taking 3 drugs per day. 10.8% of the patients reported to have difficulty taking their pills according to Haynes- Sackett test. However, depending on Morisky- Green questionnaire, 56.4% of the participants were totally compliant; but considering only the question about forgetfulness, more were adherents (77%. 71% of the patients considered their compliance level as good (more than 8 according to visual analogue scale. And 11% presented a selective adherence, no taking equally well all the medications. The closeness of agreement between questionnaires and Morisky- Green test, as gold standard, was poor for Haynes- Sackett and weak for visual analogue scale. Conclusions: In our study only 56% of the patients with chronic treatment had a perfect adherence

  20. Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective.

    Science.gov (United States)

    Hettihewa, Lukshmy Menik; Isuru, Amarasinghe; Kalana, Jayarathna

    2011-04-01

    The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT), percentage of drugs actually dispensed (PDAD), percentage of drugs adequately labeled (PDAL) and patient's knowledge on correct dosage (PKCD) were compared in these selected teaching hospitals (TH), general hospitals (GHs) and district hospitals (DHs) in Galle. ADT in DH (1.16 min) and GH (1.07 min) were high when compared with ADT in TH (0.81 min). PDAD was 100% in DH, 97.79% in GH and lowest in TH (94.64%). PDAL was highest (22.66%) in TH, 17.57% in GH and lowest in DH (1.57%). PKCD was 100% in GH and lowest in DH (0%) and only 50% in TH in Galle district. We noted that there was a significant difference in ADT in all three categories (P PKCD was 0% due to negligence in dispensing practices. We also noted a 100% PKCD only in GH due to the practice of a well-prepared correct labeling system in GH. We noticed that these patients were provided drugs with inadequate labeling and that patients had only a poor knowledge about the drug administration schedule. We conclude that there was a low dispenser-patient ratio in all three hospitals and that there was a need for an implementation plan for proper dispensing techniques by introducing a well-prepared drug labeling system in a printed format.

  1. Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective

    Directory of Open Access Journals (Sweden)

    Lukshmy Menik Hettihewa

    2011-01-01

    Full Text Available The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT, percentage of drugs actually dispensed (PDAD, percentage of drugs adequately labeled (PDAL and patient′s knowledge on correct dosage (PKCD were compared in these selected teaching hospitals (TH, general hospitals (GHs and district hospitals (DHs in Galle. ADT in DH (1.16 min and GH (1.07 min were high when compared with ADT in TH (0.81 min. PDAD was 100% in DH, 97.79% in GH and lowest in TH (94.64%. PDAL was highest (22.66% in TH, 17.57% in GH and lowest in DH (1.57%. PKCD was 100% in GH and lowest in DH (0% and only 50% in TH in Galle district. We noted that there was a significant difference in ADT in all three categories (P < 0.05. We noted that dispensers spend only a short dispensing time and showed a tendency for dispensing errors. We found that PDAL was very low in all hospitals but PDAD was significantly high. Even though the ADT was high in DH, PKCD was 0% due to negligence in dispensing practices. We also noted a 100% PKCD only in GH due to the practice of a well-prepared correct labeling system in GH. We noticed that these patients were provided drugs with inadequate labeling and that patients had only a poor knowledge about the drug administration schedule. We conclude that there was a low dispenser-patient ratio in all three hospitals and that there was a need for an implementation plan for proper dispensing techniques by introducing a well-prepared drug labeling system in a printed format.

  2. Drug Concentration Thresholds Predictive of Therapy Failure and Death in Children With Tuberculosis: Bread Crumb Trails in Random Forests

    Science.gov (United States)

    Swaminathan, Soumya; Pasipanodya, Jotam G.; Ramachandran, Geetha; Hemanth Kumar, A. K.; Srivastava, Shashikant; Deshpande, Devyani; Nuermberger, Eric; Gumbo, Tawanda

    2016-01-01

    Background. The role of drug concentrations in clinical outcomes in children with tuberculosis is unclear. Target concentrations for dose optimization are unknown. Methods. Plasma drug concentrations measured in Indian children with tuberculosis were modeled using compartmental pharmacokinetic analyses. The children were followed until end of therapy to ascertain therapy failure or death. An ensemble of artificial intelligence algorithms, including random forests, was used to identify predictors of clinical outcome from among 30 clinical, laboratory, and pharmacokinetic variables. Results. Among the 143 children with known outcomes, there was high between-child variability of isoniazid, rifampin, and pyrazinamide concentrations: 110 (77%) completed therapy, 24 (17%) failed therapy, and 9 (6%) died. The main predictors of therapy failure or death were a pyrazinamide peak concentration <38.10 mg/L and rifampin peak concentration <3.01 mg/L. The relative risk of these poor outcomes below these peak concentration thresholds was 3.64 (95% confidence interval [CI], 2.28–5.83). Isoniazid had concentration-dependent antagonism with rifampin and pyrazinamide, with an adjusted odds ratio for therapy failure of 3.00 (95% CI, 2.08–4.33) in antagonism concentration range. In regard to death alone as an outcome, the same drug concentrations, plus z scores (indicators of malnutrition), and age <3 years, were highly ranked predictors. In children <3 years old, isoniazid 0- to 24-hour area under the concentration-time curve <11.95 mg/L × hour and/or rifampin peak <3.10 mg/L were the best predictors of therapy failure, with relative risk of 3.43 (95% CI, .99–11.82). Conclusions. We have identified new antibiotic target concentrations, which are potential biomarkers associated with treatment failure and death in children with tuberculosis. PMID:27742636

  3. Linezolid plasma concentrations and occurrence of drug-related haematological toxicity in patients with gram-positive infections.

    Science.gov (United States)

    Cattaneo, Dario; Orlando, Giovanna; Cozzi, Valeria; Cordier, Laura; Baldelli, Sara; Merli, Stefania; Fucile, Serena; Gulisano, Cecilia; Rizzardini, Giuliano; Clementi, Emilio

    2013-06-01

    Retrospective studies have documented a significant association between linezolid (LNZ) plasma concentrations and drug-related haematological toxicity. However, the safe upper threshold level for LNZ plasma trough concentrations (Cmin values) has not been defined with certainty. A prospective observational study was performed aimed at comparing LNZ Cmin values in patients developing drug-related side effects with those measured in patients not experiencing LNZ toxicity. LNZ Cmin values were measured from the first week after starting therapy and were repeated periodically up to the end of treatment. Fifty patients, for a total of 210 LNZ Cmin evaluations, were considered. All patients (n=9) who developed drug-related haematological toxicity also had significantly higher plasma LNZ Cmin values during the first week of therapy (9.0±6.4 mg/L vs. 4.9±3.7 mg/L; P<0.01) and thereafter (9.3±5.4 mg/L vs. 4.4±3.4 mg/L; P<0.01). The significant association between LNZ plasma concentrations and haematological toxicity was also confirmed by multivariate logistic regression analysis including age, serum creatinine and concomitant medications as independent variables. A causal relationship between LNZ concentrations and the risk of developing drug-related haematological toxicity was observed. Accordingly, application of therapeutic drug monitoring may improve the safety outcome of patients receiving LNZ therapy.

  4. Correlation between the use of 'over-the-counter' medicines and adherence in elderly patients on multiple medications

    DEFF Research Database (Denmark)

    Olesen, Charlotte; Harbig, Philipp; Barat, Ishay

    2014-01-01

    (herbal medicines, dietary supplements, or non-prescribed drugs) was elicited during home visit interviews. Prescription drug adherence was determined by pill counts. A patient was categorised as non-adherent if the mean adherence rate for all drugs consumed was ... to be adherent than were non-users (odds ratio 0.41; 95 % confidence interval 0.18–0.91). Sensitivity analyses where adherence was defined different show no relationship between adherence and use of OTC medicine. Furthermore, separate analyses of herbal medicines, dietary supplements, or non-prescribed drugs did...... not correlate with adherence to prescriptions. Conclusion Amongst elderly patients on multiple medications a positive relationship was found between the overall use of OTC medicines and adherence to prescription drugs, in contrast to none when adherence were defined different or herbal medicines, dietary...

  5. Comparison of continuous infusion with intermittent bolus administration of cefotaxime on blood and cavity fluid drug concentrations in neonatal foals.

    Science.gov (United States)

    Hewson, J; Johnson, R; Arroyo, L G; Diaz-Mendez, A; Ruiz-López, J A; Gu, Y; del Castillo, J R E

    2013-02-01

    Healthy neonatal foals were treated with cefotaxime by bolus (40 mg/kg i.v. q6h for 12 doses; n=10) or by infusion (loading dose of 40 mg/kg i.v. followed by continuous infusion of a total daily dose of 160 mg/kg per 24 h for 3 days; n=5). Population pharmacokinetics was determined, and concentrations in cavity fluids were measured at steady state (72 h). Highest measured serum drug concentration in the bolus group was 88.09 μg/mL and minimum drug concentration (C(min)) was 0.78 μg/mL at 6-h postadministration (immediately before each next dose), whereas infusion resulted in a steady-state concentration of 16.10 μg/mL in the infusion group. Mean cefotaxime concentration in joint fluid at 72 h was higher (P=0.051) in the infusion group (5.02 μg/mL) compared to the bolus group (0.78 μg/mL). Drug concentration in CSF at 72 h was not different between groups (P=0.243) and was substantially lower than serum concentrations in either group. Insufficient data on pulmonary epithelial lining fluid were available to compare the methods of administration for cefotaxime in this cavity fluid. Results support continuous drug infusion over bolus dosing in the treatment for neonatal foal septicemia to optimize time that cefotaxime concentration exceeds the minimum inhibitory concentration of common equine pathogens.

  6. Stability of adherence to highly active antiretroviral therapy over time among clients enrolled in the treatment adherence demonstration project.

    Science.gov (United States)

    Tesoriero, James; French, Tyler; Weiss, Linda; Waters, Mark; Finkelstein, Ruth; Agins, Bruce

    2003-08-01

    Adherence to antiretroviral medications is essential to therapeutic success. Many published studies have investigated the degree of adherence or nonadherence, but sample sizes have generally been small, and adherence has seldom been viewed as a longitudinal process. This paper investigates the stability of adherence over time among HIV-infected individuals attending adherence support programs in New York State. The study cohort consists of 435 clients who were on HAART at baseline and who completed at least 2 follow-up interviews. Although cross-sectional nonadherence did not exceed 35%, nonadherence reached 54% when considered across all 3 interviews. Analysis of transition matricies revealed moderate stability in adherence over time (e.g., first follow-up adherence was 81.0% for clients adherent at baseline, compared with 58.3% for clients nonadherent at baseline). Second-order transition matricies offered additional predictive utility. Multivariate results indicated that, for some, it was the transition from a desirable to an undesirable state (e.g., from no illicit drug use to illicit drug use) that increased the likelihood of nonadherence, rather than the presence of these characteristics over time. Findings illustrate the importance of multiple, periodic assessments of adherence and the need to consider strategies to increase stability in the factors affecting adherence to HAART.

  7. A concentration gradient generator on a paper-based microfluidic chip coupled with cell culture microarray for high-throughput drug screening.

    Science.gov (United States)

    Hong, Bo; Xue, Peng; Wu, Yafeng; Bao, Jingnan; Chuah, Yon Jin; Kang, Yuejun

    2016-02-01

    Inspired by the paper platforms for 3-D cell culture, a paper-based microfluidic device containing drug concentration gradient was designed and constructed for investigating cell response to drugs based on high throughput analysis. This drug gradient generator was applied to generate concentration gradients of doxorubicin (DOX) as the model drug. HeLa cells encapsulated in collagen hydrogel were incubated in the device reservoirs to evaluate the cell viability based on the controlled release of DOX spatially. It was demonstrated that drug diffusion through the paper fibers created a gradient of drug concentration, which influenced cell viability. This drug screening platform has a great opportunity to be applied for drug discovery and diagnostic studies with simultaneous and parallel tests of drugs under various gradient concentrations.

  8. Gamma-hydroxybutyrate concentrations in the blood of impaired drivers, users of illicit drugs, and medical examiner cases.

    Science.gov (United States)

    Jones, A Wayne; Holmgren, Anita; Kugelberg, Fredrik C

    2007-01-01

    Gamma-hydroxybutyrate (GHB) was determined in blood samples from impaired drivers, people arrested for petty drug offenses (non-traffic cases), and GHB-related deaths. The method of analysis involved conversion of GHB into gamma-butyrolactone and determination of the latter by gas chromatography with a flame ionization detector, and with gamma-valerolactone as the internal standard. The mean and median concentrations of GHB in blood from impaired drivers (N=473) were 90 and 84 mg/L, respectively, and offenders were predominantly men (96%) with an average age of 26 year (range 15-50 year). In 185 cases, GHB was the only drug present in blood at mean and median concentrations of 92 and 86 mg/L, respectively. People arrested for petty drug offenses (N=1061) had slightly higher GHB concentrations in their blood: median 118 mg/L for men and 111 mg/L for women. In GHB-related deaths (N=33), the mean and median concentrations were considerably higher: 307 mg/L and 190 mg/L, respectively, and the highest was 2200 mg/L. The typical signs of drug influence noted by the arresting police officers included sedation, agitation, slurred speech, irrational behaviour, jerky movements, and spitting. The short elimination half-life of GHB means that the concentrations in blood decrease rapidly and are probably a lot lower than at the time of driving, which was 30-90 min earlier.

  9. Combining PET biodistribution and equilibrium dialysis assays to assess the free brain concentration and BBB transport of CNS drugs

    Science.gov (United States)

    Gunn, Roger N; Summerfield, Scott G; Salinas, Cristian A; Read, Kevin D; Guo, Qi; Searle, Graham E; Parker, Christine A; Jeffrey, Phil; Laruelle, Marc

    2012-01-01

    The passage of drugs in and out of the brain is controlled by the blood–brain barrier (BBB), typically, using either passive diffusion across a concentration gradient or active transport via a protein carrier. In-vitro and preclinical measurements of BBB penetration do not always accurately predict the in-vivo situation in humans. Thus, the ability to assay the concentration of novel drug candidates in the human brain in vivo provides valuable information for derisking of candidate molecules early in drug development. Here, positron emission tomography (PET) measurements are combined with in-vitro equilibrium dialysis assays to enable assessment of transport and estimation of the free brain concentration in vivo. The PET and equilibrium dialysis data were obtained for 36 compounds in the pig. Predicted P-glycoprotein (P-gp) status of the compounds was consistent with the PET/equilibrium dialysis results. In particular, Loperamide, a well-known P-gp substrate, exhibited a significant concentration gradient consistent with active efflux and after inhibition of the P-gp process the gradient was removed. The ability to measure the free brain concentration and assess transport of novel compounds in the human brain with combined PET and equilibrium dialysis assays can be a useful tool in central nervous system (CNS) drug development. PMID:22274741

  10. HIV Treatment Adherence

    Science.gov (United States)

    ... Viral Suppression Doctor, Clinical & Dental Visits Treatment Adherence Mental Health Substance Abuse Issues Sexual Health Nutrition & Food Safety Exercise Immunizations Aging with HIV/AIDS Women’s Health Housing ...

  11. Assessment of surface concentrations in resorbable ocular implants: controlled drug delivery devices for 5-fluorouracil (5-FU)

    Science.gov (United States)

    Milne, Peter J.; Gautier, Sandrine; Parel, Jean-Marie A.; Jallet, Valerie

    1997-05-01

    The antineoplastic drug 5-fluorouracil (5-fluoro- 2,4,(1H,3H)-pyrimidinedione; 5-FU) has been used to control proliferation of penetrating fibroblasts and to prevent channel closure following glaucoma filtration surgery (trabeculectomy) or laser sclerectomy. Because of the toxicity of the drug, administration of low dosages slowly over time, at the site of the desired treatment, is indicated for optimum efficacy. Repeated injections of low dosages of the drug represent an undesirable intervention and may also result in unwanted toxicity to the corneal epithelium. A suitable biocompatible and resorbable polymer matrix composed of a poly (D,L-lactic-co-glycolic acid: PLGA) has been admixed with varying amounts of 5-FU and cast as shapes suitable for intracorneal implantation. Slow biodegradation of this polymer over a one to two week period has been shown to result in an acceptably slow drug release mechanism. An issue arising during the clinical evaluation of the efficacy of this drug delivery system was how best to quantify the concentration of 5-FU and its distribution spatially in the solid implant. FT-IR and FT-Raman spectroscopies distinguishes between the drug and the polymer matrix and were used to differentiate and quantitate the 5-FU concentration of the implants.

  12. Demographic and health related data of users of a mobile application to support drug adherence is associated with usage duration and intensity.

    Directory of Open Access Journals (Sweden)

    Stefan Becker

    Full Text Available A wealth of mobile applications are designed to support users in their drug intake. When developing software for patients, it is important to understand the differences between individuals who have, who will or who might never adopt mobile interventions. This study analyzes demographic and health-related factors associated with real-life "longer usage" and the "usage-intensity per day" of the mobile application "Medication Plan".Between 2010-2012, the mobile application "Medication Plan" could be downloaded free of charge from the Apple-App-Store. It was aimed at supporting the regular and correct intake of medication. Demographic and health-related data were collected via an online questionnaire. This study analyzed captured data.App-related activities of 1799 users (1708 complete data sets were recorded. 69% (1183/1708 applied "Medication Plan" for more than a day. 74% were male (872/1183, the median age 45 years. Variance analysis showed a significant effect of the users' age with respect to duration of usage (p = 0.025. While the mean duration of use was only 23.3 days for users younger than 21 years, for older users, there was a substantial increase over all age cohorts up to users of 60 years and above (103.9 days. Sex and educational status had no effect. "Daily usage intensity" was directly associated with an increasing number of prescribed medications and increased from an average of 1.87 uses per day and 1 drug per day to on average 3.71 uses per day for users stating to be taking more than 7 different drugs a day (p<0.001. Demographic predictors (sex, age and educational attainment did not affect usage intensity.Users aged 60+ as well as those with complicated therapeutic drug regimens relied on the service we provided for more than three months on average. Mobile applications may be a promising approach to support the treatment of patients with chronic conditions.

  13. BR 04-2 CONCENTRATION-RESPONSE MODELING OF ANTIHYPERTENSIVE DRUGS - IMPLICATION IN CLINICAL DEVELOPMENT.

    Science.gov (United States)

    Yim, Dong-Seok

    2016-09-01

    In the early phase of clinical development of antihypertensive drugs, quantitative modeling to predict their dose-concentration-response relationship is important to plan future clinical development and finding optimal dosage regimen at marketing approval. Two cases of concentration-response models of antihypertensive are presented here.Case 1: Carvedilol is a α1- and nonselective β- adrenergic receptor antagonist currently used for the management of mild-to-moderate essential hypertension and congestive heart failure. The aim of this study was to perform a population pharmacokinetic-pharmacodynamic (PK-PD) model that describes PK and PD (systolic blood pressure (SBP) and diastolic blood pressure (DBP)) of both IR and SR formulations of carvedilol. For population PD modeling, the sequential PK-PD modeling approach (i.e., IPP approach) was used and the turnover model incorporating cosine functions for circadian rhythm was best described the SBP and DBP changes. In conclusion, the population PK-PD model adequately explained the observed data from two different formulations.Case 2: Fimasartan is a non-peptide angiotensin II receptor antagonist which selectively blocks the AT1 receptor. Population pharmacokinetic-pharmacodynamic (PK-PD) analysis of fimasartan was performed to evaluate the food effect on mechanistic PK-PD relationship, using data from a food interaction study in 24 healthy subjects. A two-compartment linear PK model with zero-order (fasted) or Weibull (fed with high fat diet) absorption best described the PK of fimasartan. Relative bioavailability decreased by 37% when the subjects were given high fat diet. The turnover PK-PD model combined with pre-defined cosine function for circadian rhythm described the BP changes measured within 24 hours after dosing better than the effect compartment or transduction models. To predict the influence of high fat diet on the blood pressure lowering effect of fimasartan in healthy subjects, we simulated the BP

  14. Antiretroviral drugs saquinavir and ritonavir reduce inhibitory concentration values of itraconazole against Histoplasma capsulatum strains in vitro

    Directory of Open Access Journals (Sweden)

    Raimunda Sâmia Nogueira Brilhante

    2016-04-01

    Full Text Available Abstract Recent studies have shown that some drugs that are not routinely used to treat fungal infections have antifungal activity, such as protease inhibitor antiretroviral drugs. This study investigated the in vitro susceptibility of Histoplasma capsulatum var. capsulatum to saquinavir and ritonavir, and its combination with the antifungal itraconazole. The susceptibility assay was performed according to Clinical and Laboratory Standards Institute guidelines. All strains were inhibited by the protease inhibitor antiretroviral drugs. Saquinavir showed minimum inhibitory concentrations ranging from 0.125 to 1 μg mL−1 for both phases, and ritonavir presented minimum inhibitory concentrations ranging from 0.0312 to 4 μg mL−1and from 0.0625 to 1 μg mL−1 for filamentous and yeast phase, respectively. Concerning the antifungal itraconazole, the minimum inhibitory concentration values ranged from 0.0019 to 0.125 μg mL−1 and from 0.0039 to 0.0312 μg mL−1 for the filamentous and yeast phase, respectively. The combination of saquinavir or ritonavir with itraconazole was synergistic against H. capsulatum, with a significant reduction in the minimum inhibitory concentrations of both drugs against the strains (p < 0.05. These data show an important in vitro synergy between protease inhibitors and itraconazole against the fungus H. capsulatum.

  15. Concordance of adherence measurement using self-reported adherence questionnaires and medication monitoring devices.

    Science.gov (United States)

    Shi, Lizheng; Liu, Jinan; Koleva, Yordanka; Fonseca, Vivian; Kalsekar, Anupama; Pawaskar, Manjiri

    2010-01-01

    The primary objective of this review was to identify and examine the literature on the association between medication adherence self-reported questionnaires (SRQs) and medication monitoring devices. The primary literature search was performed for 1980-2009 using PubMed, PubMed In Process and Non-Indexed, Ovid MEDLINE, Ovid MEDLINE In-Process, PsycINFO (EBSCO), CINAHL (EBSCO), Ovid HealthStar, EMBASE (Elsevier) and Cochrane Databases and using the following search terms: 'patient compliance', 'medication adherence', 'treatment compliance', 'drug monitoring', 'drug therapy', 'electronic', 'digital', 'computer', 'monitor', 'monitoring', 'drug', 'drugs', 'pharmaceutical preparations', 'compliance' and 'medications'. We identified studies that included SRQs and electronic monitoring devices to measure adherence and focused on the SRQs that were found to be moderately to highly correlated with the monitoring devices. Of the 1679 citations found via the primary search, 41 full-text articles were reviewed for correlation between monitoring devices and SRQs. A majority (68%) of articles reported high (27%), moderate (29%) or significant (12%) correlation between monitoring devices (37 using Medication Event Monitoring System [MEMS®] and four using other devices) and SRQs (11 identified and numerous other unnamed SRQs). The most commonly used SRQs were the Adult/Pediatric AIDS Clinical Trial Group (AACTG/PACTG; 24.4%, 10/41) followed by the 4-item Morisky (9.8%, 4/41), Brief Medication Questionnaire (9.8%, 4/41) and visual analogue scale (VAS; 7.3%, 3/41). Although study designs differed across the articles, SRQs appeared to report a higher rate of medication adherence (+14.9%) than monitoring devices. In conclusion, several medication adherence SRQs were validated using electronic monitoring devices. A majority of them showed high or moderate correlation with medication adherence measured using monitoring devices, and could be considered for measuring patient

  16. Impact of prescription size on statin adherence and cholesterol levels

    Directory of Open Access Journals (Sweden)

    Mehler Phillip S

    2007-10-01

    Full Text Available Abstract Background Therapy with 3-Hydroxy-3-methylglutaryl Co-enzyme A reductase inhibitors (statins improve outcomes in a broad spectrum of patients with hyperlipidemia. However, effective therapy requires ongoing medication adherence; restrictive pharmacy policies may represent a barrier to successful adherence, particularly among vulnerable patients. In this study we sought to assess the relationship between the quantity of statin dispensed by the pharmacy with patient adherence and total cholesterol. Methods We analyzed a cohort of 3,386 patients receiving more than one fill of statin medications through an integrated, inner-city health care system between January 1, 2000 and December 31, 2002. Our measure of adherence was days of drug acquisition divided by days in the study for each patient, with adequate adherence defined as ≥ 80%. Log-binomial regression was used to determine the relative risk of various factors, including prescription size, on adherence. We also assessed the relationship between adherence and total cholesterol using multiple linear regression. Results After controlling for age, gender, race, co-payment, comorbidities, and insurance status, patients who obtained a majority of fills as 60-day supply compared with 30-day supply were more likely to be adherent to their statin medications (RR 1.41, 95% CI 1.28–1.55, P Conclusion In a healthcare system serving predominantly indigent patients, the provision of a greater quantity of statin medication at each prescription fill contributes to improved adherence and greater drug effectiveness.

  17. Iontophoretic transdermal delivery of glycyrrhizin: effects of pH, drug concentration, co-ions, current intensity, and chemical enhancers.

    Science.gov (United States)

    Yamamoto, Rie; Takasuga, Shinri; Kominami, Katsuya; Sutoh, Chiyo; Kinoshita, Mine; Kanamura, Kiyoshi; Takayama, Kozo

    2013-01-01

    The aim of the present study was to evaluate the feasibility of transdermal delivery of glycyrrhizin, an agent used in the treatment of chronic hepatitis C, by cathodal iontophoresis using Ag/AgCl electrodes in vitro. The effects of donor pH (pH 4-7), concentration of drug (0.025-0.2% (w/v)), concentration of external chloride ions (Cl(-)) (0-133 mM), current strength (0-0.5 mA/cm(2)), and permeation enhancers (urea and Tween 80) on the skin permeability of glycyrrhizin were examined in in vitro skin permeation studies using porcine ear skin as the membrane. The cumulative amount of permeated glycyrrhizin and the steady-state skin permeation flux of glycyrrhizin across porcine skin increased in a pH-dependent manner. The skin permeability of glycyrrhizin was independent of the concentration of drug and competed only with a high external Cl(-) concentration. The skin permeation flux of glycyrrhizin increased with the current (R(2)=0.8955). The combination of iontophoresis and enhancers provided an additive or synergistic effect, and a skin permeation flux of about 60 µg/h/cm(2) was achieved. The plasma concentration of glycyrrhizin in humans, extrapolated from the in vitro steady-state permeation flux across porcine skin, was within the therapeutic level. These results suggest that cathodal iontophoresis can be used as a transdermal drug delivery system for glycyrrhizin using reasonable patch sizes and acceptable levels of current intensity.

  18. Measuring and prediction mediction adherence using dispensing data and patient beliefs

    NARCIS (Netherlands)

    Geers, H.C.J.

    2012-01-01

    Introduction Medication adherence can be subdivided into drug initiation, drug taking compliance and (non)persistence. Objective of this thesis was to (1) investigate whether measurement methods and reporting of adherence influenced outcomes, (2) predict poor drug taking compliance and nonpersistenc

  19. Spectrophotometric Method for the Determination of Two Coformulated Drugs with Highly Different Concentrations. Application on Vildagliptin and Metformin Hydrochloride

    Science.gov (United States)

    Zaazaa, H. E.; Elzanfaly, E. S.; Soudi, A. T.; Salem, M. Y.

    2016-03-01

    A new smart simple validated spectrophotometric method was developed for the determination of two drugs one of which is in a very low concentration compared to the other. The method is based on spiking and dilution then simple mathematical manipulation of the absorbance spectra. This method was applied for the determination of a binary mixture of vildagliptin and metformin hydrochloride in the ratio 50:850 in laboratory prepared mixtures containing both drugs in this ratio and in pharmaceutical dosage form with good recoveries. The developed method was validated according to ICH guidelines and can be used for routine quality control testing.

  20. The breast cancer resistance protein BCRP (ABCG2) concentrates drugs and carcinogenic xenotoxins into milk.

    Science.gov (United States)

    Jonker, Johan W; Merino, Gracia; Musters, Sandra; van Herwaarden, Antonius E; Bolscher, Ellen; Wagenaar, Els; Mesman, Elly; Dale, Trevor C; Schinkel, Alfred H

    2005-02-01

    Contamination of milk with drugs, pesticides and other xenotoxins can pose a major health risk to breast-fed infants and dairy consumers. Here we show that the multidrug transporter BCRP (encoded by ABCG2) is strongly induced in the mammary gland of mice, cows and humans during lactation and that it is responsible for the active secretion of clinically and toxicologically important substrates such as the dietary carcinogen PhIP, the anticancer drug topotecan and the antiulcerative cimetidine into mouse milk.

  1. Therapeutic drug monitoring of cerebrospinal fluid vancomycin concentration during intraventricular administration.

    Science.gov (United States)

    Popa, D; Loewenstein, L; Lam, S W; Neuner, E A; Ahrens, C L; Bhimraj, A

    2016-02-01

    Limited data are available on intraventricular vancomycin dosing for meningitis. This study explored clinical characteristics that correlated with cerebrospinal fluid (CSF) concentrations. Over a nine-year period, 13 patients with 34 CSF vancomycin concentrations were evaluated. CSF output and time from dose correlated with CSF vancomycin concentration. No relationship was seen with regards to CSF protein, white blood cell count or glucose.

  2. Strategic use of dual regimens of boosted protease inhibitors plus maraviroc in poorly adherent subjects in view of long-acting drugs

    Science.gov (United States)

    Capetti, Amedeo Ferdinando; Micale, Mariangela; Carenzi, Laura; Niero, Fosca; Landonio, Simona; Vimercati, Stefania; Dedivitiis, Gianfranco; Rizzardini, Giuliano

    2017-01-01

    Abstract In view of the forthcoming long-acting antiretrovirals, measures should be taken to prevent the selection of HIV drug resistance mutations. All subjects who had been switched to boosted protease inhibitors plus maraviroc (bPIs/MVC) with baseline HIV-1 RNA >50 copies/mL between June, 2014, and April, 2015, were retrospectively evaluated. HIV-1 RNA, CD4+ T-cells, serum glucose, creatinine, ALT, and adverse events were controlled every 3 to 4 months. We retrospectively analyzed 44 patients: 18 were taking darunavir/ritonavir (DRV/r) and 26 atazanavir/ritonavir (ATV/r) once daily, plus MVC 300 mg once daily. Seven subjects were in CDC stage C. All had a follow-up of at least 24 weeks, 28 exceeded 48 weeks, and 21 exceeded 72 weeks. All had experienced at least 1 viral failure and had selected at least 1 resistance-associated mutation (RAM). At baseline, 38 had plasma HIV-1 RNA 50-499 copies/mL and 6 had ≥500. At week 24, none had viremia >500 and 30 (68.2%) had suppressed HIV-1 RNA below 50 copies/mL. Of the subgroup with 48 weeks’ follow-up, 23 had HIV-1 RNA 50-499 copies/mL, 5 had ≥500, and 20/28 suppressed to <50 copies/mL. Of the longest observed subgroup (72 weeks), 17 had HIV-1 RNA 50-499 copies/mL, and 4 had ≥500 copies/mL and 15/21 (71.4%) suppressed to <50 copies/mL. This combination allowed fair suppression of viral replication, with minor genotypic evolution in 6 subjects, and seems to be a feasible strategy to prevent damaging future options. PMID:28207500

  3. Treatment non-adherence in pseudo-refractory epilepsy.

    Science.gov (United States)

    Brodtkorb, Eylert; Samsonsen, Christian; Sund, Janne Kutschera; Bråthen, Geir; Helde, Grethe; Reimers, Arne

    2016-05-01

    Non-adherence to antiepileptic drug treatment strongly affects the outcome of epilepsy and is frequently clinically unrecognized. This review addresses current knowledge on medication-taking behavior in people with epilepsy, as well as the importance of tailoring interventions to the individual patterns of non-adherence. Non-adherence can be categorized as non-initiation, poor execution (accidental or intentional) or non-persistence and are related to clinical characteristics and health care barriers. All available methods to assess adherence are hampered by shortcomings. Self-reports are indirect and subjective. Pill-counts, electronic bottle-tops and pharmacy records are objective, but indirect measures of drug ingestion. Therapeutic drug monitoring is both direct and objective, but pharmacokinetic and diurnal variability must be taken into account. Young adults with generalized epilepsy may be particularly vulnerable to non-adherence. The drug burden in the form of polytherapy, multiple dosing and side effects are obvious obstacles. Poor understanding of the principles of prophylactic treatment as well as drug costs may be important in people with low socioeconomic status. Depression is also associated with low adherence. In people with multihandicaps, failed oral intake may be due to behavioral or physical problems, as well as insufficient education of the caregivers. Non-adherence often results in seizure breakthrough and hospital admissions, but the consequences may be more dramatic. It is the leading cause of status epilepticus in people with epilepsy, and the association with sudden death (SUDEP) is clear. The management of poor drug-taking behavior should be based on the identification of the specific causes in each individual and corresponding multiprofessional interventions. Non-adherence to antiepileptic drugs needs more clinical and scientific attention.

  4. A hybrid Markov chain-von Mises density model for the drug-dosing interval and drug holiday distributions.

    Science.gov (United States)

    Fellows, Kelly; Rodriguez-Cruz, Vivian; Covelli, Jenna; Droopad, Alyssa; Alexander, Sheril; Ramanathan, Murali

    2015-03-01

    Lack of adherence is a frequent cause of hospitalizations, but its effects on dosing patterns have not been extensively investigated. The purpose of this work was to critically evaluate a novel pharmacometric model for deriving the relationships of adherence to dosing patterns and the dosing interval distribution. The hybrid, stochastic model combines a Markov chain process with the von Mises distribution. The model was challenged with electronic medication monitoring data from 207 hypertension patients and against 5-year persistence data. The model estimates distributions of dosing runs, drug holidays, and dosing intervals. Drug holidays, which can vary between individuals with the same adherence, were characterized by the patient cooperativity index parameter. The drug holiday and dosing run distributions deviate markedly from normality. The dosing interval distribution exhibits complex patterns of multimodality and can be long-tailed. Dosing patterns are an important but under recognized covariate for explaining within-individual variance in drug concentrations.

  5. In silico prediction of brain exposure: drug free fraction, unbound brain to plasma concentration ratio and equilibrium half-life

    Science.gov (United States)

    Spreafico, Morena; Jacobson, Matthew P.

    2014-01-01

    The focus of CNS drug pharmacokinetics programs has recently shifted from determining the total concentrations in brain and blood to considering also unbound fractions and concentrations. Unfortunately, assessing unbound brain exposure experimentally requires demanding in vivo and in vitro studies. We propose a physical model, based on lipid binding and pH partitioning, to predict in silico the unbound volume of distribution in the brain. The model takes into account the partition of a drug into lipids, interstitial fluid and intracellular compartments of the brain. The results are in good agreement with the experimental data, suggesting that the contributions of lipid binding and pH partitioning are important in determining drug exposure in brain. The predicted values are used, together with predictions for plasma protein binding, as corrective terms in a second model to derive the unbound brain to plasma concentration ratio starting from experimental values of total concentration ratio. The calculated values of brain free fraction and passive permeability are also used to qualitatively determine the brain to plasma equilibration time in a model that shows promising results but is limited to a very small set of compounds. The models we propose are a step forward in understanding and predicting pharmacologically relevant exposure in brain starting from compounds’ chemical structure and neuropharmacokinetics, by using experimental total brain to plasma ratios, in silico calculated properties and simple physics-based approaches. The models can be used in central nervous system drug discovery programs for a fast and cheap assessment of unbound brain exposure. For existing compounds, the unbound ratios can be derived from experimental values of total brain to plasma ratios. For both existing and hypothetical compounds, the unbound volume of distribution due to lipid binding and pH partitioning can be calculated starting only from the chemical structure. PMID:23578025

  6. Adherence to Pharmacological Treatment for Juvenile Bipolar Disorder

    Science.gov (United States)

    Drotar, Dennis; Greenley, Rachel Neff; Demeter, Christine A.; McNamara, Nora K.; Stansbrey, Robert J.; Calabrese, Joseph R.; Stange, Jonathan; Vijay, Priya; Findling, Robert L.

    2007-01-01

    Objective: The objective of this study was to describe the prevalence and correlates of adherence to divalproex sodium (DVPX) and lithium carbonate (Li) combination treatment during the initial stabilization treatment phase. Method: Adherence to Li/DVPX combination therapy was measured by the presence or absence of minimum serum concentrations of…

  7. Multidrug resistance-associated protein 1 decreases the concentrations of antiepileptic drugs in cortical extracellular fluid in amygdale kindling rats

    Institute of Scientific and Technical Information of China (English)

    Ying-hui CHEN; Cui-cui WANG; Xia XIAO; Li WEI; Guoxiong XU

    2013-01-01

    Aim:To investigate whether multidrug resistance-associated protein 1 (MRP1) was responsible for drug resistence in refractory epilepsy in amygdale kindling rats.Methods:Rat amygdale kindling was used as a model of refractory epilepsy.The expression of MRP1 mRNA and protein in the brains was examined using RT-PCR and Western blot.MRP1-positive cells in the cortex and hippocampus were studied with immunohistochemical staining.The rats were intraperitoneally injected with phenytoin (50 mg/kg) or carbamazepine (20 mg/kg),and their concentrations in the cortical extracellular fluid were measured using microdialysis and HPLC.Probenecid,a MRP1 inhibitor (40 mmol/L,50 μL) was administered through an inflow tube into the cortex 30 min before injection of the antiepileptic drugs.Results:The expression of MRP1 mRNA and protein was significantly up-regulated in the cortex and hippocampus in amygdale kindling rats compared with the control group.Furthermore,the number of MRP1-positive cells in the cortex and hippocampus was also significantly increased in amygdale kindling rats.Microdialysis studies showed that the concentrations of phenytoin and carbamazepine in the cortical extracellular fluid were significantly decreased in amygdale kindling rats.Pre-administration of probenecid could restore the concentrations back to their control levels.Conclusion:Up-regulation of MRP1 is responsible for the resistance of brain cells to antiepileptic drugs in the amygdale kindling rats.

  8. Assessment of drug hypersensitivity with non-irritating concentrations of antibacterial agents for allergic skin tests: a review

    Directory of Open Access Journals (Sweden)

    Pritam Biswas

    2014-08-01

    Full Text Available Hypersensitivity reactions to antibiotics are common with a prevalence of 6-10% of all adverse reactions. There is a lack of guidelines and standardization of skin tests for the screening of hypersensitivity to all antibiotics, in terms of the methodology, dose and time of evaluation of the tests. Literature from Europe and America suggests the use of non-irritating concentration (NIC of antibiotics for skin testing such as intra dermal test (IDT, skin prick test (SPT. These are concentrations at which the drug is unlikely to produce irritation by virtue of its chemical nature resulting in false positive reactions. These concentrations have been validated by trials in their populations. Due to the increase of antibiotic resistance in our country, declaring a patient allergic to a specific class of antibiotics based on positive skin tests can further narrow the therapeutic armory. These individuals have an increased incidence of infections with resistant organisms as well as increased cost of hospitalization. This is due to the use of alternative broad spectrum antibiotics. Therefore, there is a need for a standardized protocol for the use of skin tests in screening of hypersensitivity, with validated NIC of all antibacterial agents. The aim of this article is to review literature of protocols for assessment of drug hypersensitivity with NIC of antibacterial drugs for SPT, IDT and also establish the need for research in this area in our country. [Int J Basic Clin Pharmacol 2014; 3(4.000: 586-590

  9. Parent and Metabolite Opioid Drug Concentrations in Unintentional Deaths Involving Opioid and Benzodiazepine Combinations.

    Science.gov (United States)

    Fields, Marcia D; Abate, Marie A; Hu, Lan; Long, D Leann; Blommel, Matthew L; Haikal, Nabila A; Kraner, James C

    2015-07-01

    Effects of benzodiazepines on postmortem opioid parent and parent/metabolite blood concentration ratios were determined for fentanyl-, hydrocodone-, methadone-, or oxycodone-related accidental deaths. These opioids are partially metabolized by the CYP3A4 enzyme system, which is also affected by diazepam and alprazolam. Opioid/metabolite combinations examined were as follows: fentanyl/norfentanyl, hydrocodone/dihydrocodeine, methadone/EDDP, and oxycodone/oxymorphone. Parent opioid concentrations were analyzed for 877 deaths. Parent/metabolite concentration ratios were analyzed for 349 deaths, excluding cases with co-intoxicants present known to interfere with opioid elimination. Alprazolam in combination with diazepam significantly decreased median hydrocodone concentrations by 48% (p = 0.01) compared to hydrocodone alone. The methadone parent/metabolite concentration ratio was reduced by 35% in the presence of diazepam compared to methadone alone (p = 0.03). Benzodiazepines did not statistically significantly affect fentanyl or oxycodone concentrations. Possible factors affecting opioid concentrations and possible toxicity development, including any differential effects on specific opioids, should continue to be explored.

  10. [Effects of two trypanosomicide drugs, gention violet and WR6026, on platelet concentrates preservation].

    Science.gov (United States)

    Soares, Sheila; Moraes-Souza, Hélio; Tostes, Maria Aparecida Vieira; Lourenço, Dayse Maria

    2004-01-01

    In order to verify the viability of platelet concentrate during its preservation period when added with two trypanosomicidal chemical substances, gentian violet and quinoline WR6026, we tested these concentrates and verified the following parameters: number of platelets, pH and platelet aggregation test with a pair of agonists. Significant alterations were observed in the platelet concentrate treated with gentian violet suggesting important damage to the platelet viability. With WR6026 similar values to the controls were observed, opening new perspectives for the utilization of this salt for the chemoprophylaxis of transfusional Chagas' disease in highly endemic regions.

  11. Modelling imperfect adherence to HIV induction therapy

    Directory of Open Access Journals (Sweden)

    Smith? Robert J

    2010-01-01

    Full Text Available Abstract Background Induction-maintenance therapy is a treatment regime where patients are prescribed an intense course of treatment for a short period of time (the induction phase, followed by a simplified long-term regimen (maintenance. Since induction therapy has a significantly higher chance of pill fatigue than maintenance therapy, patients might take drug holidays during this period. Without guidance, patients who choose to stop therapy will each be making individual decisions, with no scientific basis. Methods We use mathematical modelling to investigate the effect of imperfect adherence during the inductive phase. We address the following research questions: 1. Can we theoretically determine the maximal length of a possible drug holiday and the minimal number of doses that must subsequently be taken while still avoiding resistance? 2. How many drug holidays can be taken during the induction phase? Results For a 180 day therapeutic program, a patient can take several drug holidays, but then has to follow each drug holiday with a strict, but fairly straightforward, drug-taking regimen. Since the results are dependent upon the drug regimen, we calculated the length and number of drug holidays for all fifteen protease-sparing triple-drug cocktails that have been approved by the US Food and Drug Administration. Conclusions Induction therapy with partial adherence is tolerable, but the outcome depends on the drug cocktail. Our theoretical predictions are in line with recent results from pilot studies of short-cycle treatment interruption strategies and may be useful in guiding the design of future clinical trials.

  12. Cost-effectiveness of routine measuring of serum drug concentrations and anti-drug antibodies in treatment of rheumatoid arthritis patients with TNF-α blockers

    Directory of Open Access Journals (Sweden)

    Laine J

    2016-04-01

    Full Text Available Juha Laine,1 T Sakari Jokiranta,2,3 Kari K Eklund,4,5 Merja Väkeväinen,1 Kari Puolakka6 1Pfizer Oy, Helsinki, 2United Medix Laboratories Ltd, Espoo, 3Research Programs Unit, Immunobiology, 4Department of Rheumatology, University of Helsinki, 5Helsinki University Central Hospital, Helsinki, 6Department of Medicine, South Karelia, Finland Abstract: Monitoring of anti-drug antibodies (ADAbs or serum concentrations of biologicals in treatment of rheumatoid arthritis could provide an explanation for a loss of efficacy and help in the choice of subsequent medication. Current clinical practices do not generally include such monitoring of tumor necrosis factor (TNF-α blockers on a routine basis. The main aims of this study were to estimate the probabilities of optimal and nonoptimal treatment decisions if infliximab or adalimumab drug trough level (DL and ADAbs are tested or not in rheumatoid arthritis, and to model cost-effectiveness of performing such monitoring on a routine basis. Data on DLs and ADAbs concentrations were obtained in Finland from clinically requested monitoring analyses of 486 and 1,137 samples from patients on adalimumab and infliximab, respectively. DL was within the target range in 42% of samples from adalimumab- and 50.4% of infliximab-treated patients. ADAbs were detected in approximately 20% and 13.5% of samples from adalimumab- and infliximab-treated patients, respectively. ADAbs were found in 52.3% and 41.3% of those with low adalimumab or infliximab DLs, respectively. The monitoring data were incorporated into probabilities for making the optimal treatment decision. Economic impact of clinical decision-making was modeled in a short-term (3–6 months scenario with 100 hypothetical patients. In the model, the combined measurement of DLs and ADAbs was cost-saving compared to the nontesting scenario when the monitoring results affected the treatment decision in at least 2–5 of 100 patients, a proportion which is easily

  13. Factors related to adherence to treatment for systemic hypertension

    Directory of Open Access Journals (Sweden)

    Silvana Maria Coelho Leite Fava

    2014-06-01

    Full Text Available This study aimed to seek the evidence available in the literature regarding the factors related to adherence to treatment for systemic hypertension. It used the method of integrative review in the databases MEDLINE, CINAHL, and LILACS, using the keywords: hypertension, compliance, non-compliance, adherence, non-adherence, patient compliance, in the period 2004 – 2008, and articles in Portuguese, English and Spanish, with the use of a validated instrument and content analysis. 28 studies were selected, 64.3% of which had level of evidence VI. The following were identified as factors related to adherence to treatment: treatment costs, educational activities, sex, physician-patient relationship, physiological and behavioral aspects, drug therapy, attending checkups and lifestyle. The use of combined strategies is suggested in order to increase the individuals’ adherence to the treatment. Gaps point to the valorization of dialogic relationships for integrated and more efficacious health practices.

  14. Cost-effectiveness of routine measuring of serum drug concentrations and anti-drug antibodies in treatment of rheumatoid arthritis patients with TNF-α blockers.

    Science.gov (United States)

    Laine, Juha; Jokiranta, T Sakari; Eklund, Kari K; Väkeväinen, Merja; Puolakka, Kari

    2016-01-01

    Monitoring of anti-drug antibodies (ADAbs) or serum concentrations of biologicals in treatment of rheumatoid arthritis could provide an explanation for a loss of efficacy and help in the choice of subsequent medication. Current clinical practices do not generally include such monitoring of tumor necrosis factor (TNF)-α blockers on a routine basis. The main aims of this study were to estimate the probabilities of optimal and nonoptimal treatment decisions if infliximab or adalimumab drug trough level (DL) and ADAbs are tested or not in rheumatoid arthritis, and to model cost-effectiveness of performing such monitoring on a routine basis. Data on DLs and ADAbs concentrations were obtained in Finland from clinically requested monitoring analyses of 486 and 1,137 samples from patients on adalimumab and infliximab, respectively. DL was within the target range in 42% of samples from adalimumab- and 50.4% of infliximab-treated patients. ADAbs were detected in approximately 20% and 13.5% of samples from adalimumab- and infliximab-treated patients, respectively. ADAbs were found in 52.3% and 41.3% of those with low adalimumab or infliximab DLs, respectively. The monitoring data were incorporated into probabilities for making the optimal treatment decision. Economic impact of clinical decision-making was modeled in a short-term (3-6 months) scenario with 100 hypothetical patients. In the model, the combined measurement of DLs and ADAbs was cost-saving compared to the nontesting scenario when the monitoring results affected the treatment decision in at least 2-5 of 100 patients, a proportion which is easily exceeded in real-life clinical practice. This study indicates that routine monitoring of drug level and ADAbs is cost-beneficial in clinical practice, thereby improving the decision-making process in using TNF-α blockers.

  15. An in situ method to quantitatively determine dissolved free drug concentrations in vitro in the presence of polymer excipients using pulsatile microdialysis (PMD).

    Science.gov (United States)

    Vejani, Charchil; Bellantone, Robert A

    2015-12-30

    In drug formulations containing polymer excipients, the effects of the polymer on the dissolved free drug concentration and resulting dissolution or release can be important, especially for poorly soluble drugs. In this study, an in vitro method based on pulsatile microdialysis (PMD) was developed to quantitatively determine dissolved free concentrations of drugs in the presence of polymers in aqueous media in situ (e.g., in place within the system being characterized). Formulations were made by dissolving various ratios of the drug griseofulvin and polymer PVP K30 in water and allowing the mix to equilibrate. A PMD probe was immersed in each mixture and the dissolved free drug concentrations were determined in the PMD samples. The experimental procedure and the equations used for data analysis are presented. To assess the consistency of data, a binding model was fit to the data obtained using PMD by calculating the dissolved free drug fraction fD for each drug-polymer ratio in solution, and obtaining the product of the binding stoichiometry and binding constant (νK per mole of polymer) from the slope of a plot of (1-fD)/fD vs. the molar polymer concentration. For comparison, equilibrium binding experiments were also performed at 23C, and the determined value of νK was similar to the value found using PMD. Experiments were performed at three temperatures, and a plot of ln (νK) vs. 1/T was linear and a binding enthalpy of -110.9±4.4J/mol of monomer was calculated from its slope. It was concluded that PMD can be used to determine the dissolved free drug concentrations in situ, which allows characterization of the drug-polymer interaction, even for low drug concentrations. This information may be important in modeling the dissolution or release of drugs from formulations containing polymers.

  16. Polymorphisms in drug-metabolizing enzymes and steady-state exemestane concentration in post-menopausal patients with breast cancer

    Science.gov (United States)

    Hertz, Daniel L.; Kidwell, Kelley M.; Seewald, Nicholas J.; Gersch, Christina L.; Desta, Zeruesenay; Flockhart, David A; Storniolo, Ana-Maria; Stearns, Vered; Skaar, Todd C; Hayes, Daniel F; Henry, N. Lynn; Rae, James M.

    2016-01-01

    Discovery of clinical and genetic predictors of exemestane pharmacokinetics was attempted in 246 post-menopausal patients with breast cancer enrolled on a prospective clinical study. A sample was collected two hours after exemestane dosing at a 1 or 3 month study visit to measure drug concentration. The primary hypothesis was that patients carrying the low-activity CYP3A4*22 (rs35599367) SNP would have greater exemestane concentration. Additional SNPs in genes relevant to exemestane metabolism (CYP1A1/2, CYP1B1, CYP3A4, CYP4A11, AKR1C3/4, AKR7A2) were screened in secondary analyses and adjusted for clinical covariates. CYP3A4*22 was associated with a 54% increase in exemestane concentration (p<0.01). Concentration was greater in patients who reported White race, had elevated aminotransferases, renal insufficiency, lower body mass index, and had not received chemotherapy (all p<0.05), and CYP3A4*22 maintained significance after adjustment for covariates (p<0.01). These genetic and clinical predictors of exemestane concentration may be useful for treatment individualization in patients with breast cancer. PMID:27549341

  17. Primary non-adherence to prescribed medication in general practice

    DEFF Research Database (Denmark)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún

    2013-01-01

    prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200&emsp14......;000; patients: 21 571; prescriptions: 22 991). Eight drug classes were selected to reflect symptom relief and degree of copayment. Two-tailed chi-square test and odds ratios for non-adherence by patient copayment groups were calculated. RESULTS: The rate of primary non-adherence was 6...

  18. Psychosocial factors and treatment adherence in paediatric HIV/AIDS.

    Science.gov (United States)

    Naar-King, S; Arfken, C; Frey, M; Harris, M; Secord, E; Ellis, D

    2006-08-01

    A social ecological model provides a promising framework for understanding the individual, family, and societal factors contributing to non-adherence to treatment of paediatric HIV. This study explored which factors relevant to this model are associated with caregivers' adherence and child health outcomes. A cross-sectional design was utilized to assess relationships among current individual, familial, extra-familial factors, caregiver adherence, and viral load. Data were collected from 43 caregivers, and viral load data were obtained from the medical records of their HIV+ children. Caregiver drug and alcohol use and HIV+ status were associated with non-adherence and elevated viral load. Negative outcome expectancy was associated with lower adherence but was not significant in the multivariate analyses. Family factors were not significant, but these measures had low reliability in this sample. Extra-familial factors such as dissatisfaction with medical specialty care and more stressful life events were not directly associated with adherence but were related to increased caregiver substance use. Results of this first study to explore multiple predictors of adherence and health outcomes in paediatric HIV require replication with larger samples, but findings suggest caregiver characteristics that place children at risk for disease progression due to poor adherence to treatment.

  19. High Variability of Plasma Drug Concentrations in Dual Protease Inhibitor Regimens

    OpenAIRE

    Guiard-Schmid, Jean-Baptiste; Poirier, Jean-Marie; Meynard, Jean-Luc; Bonnard, Philippe; Gbadoe, Ayi Hola; Amiel, Corinne; Calligaris, Frédérique; Abraham, Bruno; Pialoux, Gilles; Girard, Pierre-Marie; Jaillon, Patrice; Rozenbaum, Willy

    2003-01-01

    Ritonavir (RTV) strongly increases the concentrations of protease inhibitors (PIs) in plasma in patients given a combination of RTV and another PI. This pharmacological interaction is complex and poorly characterized and shows marked inter- and intraindividual variations. In addition, RTV interacts differently with saquinavir (SQV), indinavir (IDV), amprenavir (APV), and lopinavir (LPV). In this retrospective study on 542 human immunodeficiency virus-infected patients, we compared inter- and ...

  20. The effect of surfactant and solid phase concentration on drug aggregates in model aerosol propellent suspensions.

    Science.gov (United States)

    Bower, C; Washington, C; Purewal, T S

    1996-04-01

    The effect of increasing solid phase concentration on the morphology and flocculation rate of model aerosol suspensions has been investigated. Suspensions of micronized salbutamol sulphate and lactose in trichlorotrifluoroethane (P113) were studied under conditions of increasing shear stress. By use of image analysis techniques, measurement of aggregate size, fractal dimension and rate of aggregation was performed. The effect of the surfactant sorbitan monooleate on morphology and flocculation rate was also studied. Increased solid phase concentration caused an increase in the rate of aggregation and average aggregate size at a given value of shear stress. Surfactant addition retarded the aggregation rate, and caused a shift from a diffusion-limited cluster aggregation to a reaction-limited cluster aggregation mechanism. The aggregate profiles showed a corresponding change from rugged and crenellated without surfactant, to increasingly smooth and Euclidian with increasing surfactant concentration. The morphological changes were characterized by a decrease in the average boundary fractal dimension which also correlated well with the corresponding reduction in aggregation rate.

  1. The multi-concentration and two-dimensional capillary electrophoresis method for the analysis of drugs in urine samples

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    A novel method has been developed by integration of multi-concentration and two-dimensional(2D) capillary electrophoresis(CE) for simultaneous enhancement of detection sensitivity and separation power in complex samples.Capillary zone electrophoresis(CZE) was used as the first dimension separation according to mobilities,from which the effluent fractions were further analyzed by micellar electrokinetic capillary chromatography(MEKC) acting as the second dimension.Cation-selective exhaustive injection(CSEI) preconcentration method was used to introduce more analytes into the capillary.Furthermore,pH junction and sweeping dual concentration strategies were employed to avoid sample zone diffusion at the interface.The resulting electrophoregram was quite different from that of either CZE or MEKC separation.Up to(0.5-1.2) ×104 fold improvements in sensitivity were obtained relative to the conventional electrokinetic injection method.The proposed method was successfully applied to the determination of drugs in human urine.

  2. Interdependence of initial cell density, drug concentration and exposure time revealed by real-time impedance spectroscopic cytotoxicity assay

    DEFF Research Database (Denmark)

    Caviglia, Claudia; Zor, Kinga; Canepa, Silvia

    2015-01-01

    We investigated the combined effect of the initial cell density (12 500, 35 000, 75 000, and 100 000 cells cm−2) and concentration of the anti-cancer drug doxorubicin on HeLa cells by performing timedependent cytotoxicity assays using real-time electrochemical impedance spectroscopy. A correlation...... between the rate of cell death and the initial cell seeding density was found at 2.5 μM doxorubicin concentration, whereas this was not observed at 5 or 100 μM. By sensing the changes in the cell–substrate interaction using impedance spectroscopy under static conditions, the onset of cytotoxicity...... was observed 5 h earlier than when using a standard colorimetric end-point assay (MTS) which measures changes in the mitochondrial metabolism. Furthermore, with the MTS assay no cytotoxicity was observed after 15 h of incubation with 2.5 μM doxorubicin, whereas the impedance showed at this time point cell...

  3. Lack of prophylactic efficacy of oral maraviroc in macaques despite high drug concentrations in rectal tissues.

    Science.gov (United States)

    Massud, Ivana; Aung, Wutyi; Martin, Amy; Bachman, Shanon; Mitchell, James; Aubert, Rachael; Solomon Tsegaye, Theodros; Kersh, Ellen; Pau, Chou-Pong; Heneine, Walid; García-Lerma, J Gerardo

    2013-08-01

    Maraviroc (MVC) is a potent CCR5 coreceptor antagonist that is in clinical testing for daily oral pre-exposure prophylaxis (PrEP) for HIV prevention. We used a macaque model consisting of weekly SHIV162p3 exposures to evaluate the efficacy of oral MVC in preventing rectal SHIV transmission. MVC dosing was informed by the pharmacokinetic profile seen in blood and rectal tissues and consisted of a human-equivalent dose given 24 h before virus exposure, followed by a booster postexposure dose. In rectal secretions, MVC peaked at 24 h (10,242 ng/ml) with concentrations at 48 h that were about 40 times those required to block SHIV infection of peripheral blood mononuclear cells (PBMCs) in vitro. Median MVC concentrations in rectal tissues at 24 h (1,404 ng/g) were 30 and 10 times those achieved in vaginal or lymphoid tissues, respectively. MVC significantly reduced macrophage inflammatory protein 1β-induced CCR5 internalization in rectal mononuclear cells, an indication of efficient binding to CCR5 in rectal lymphocytes. The half-life of CCR5-bound MVC in PBMCs was 2.6 days. Despite this favorable profile, 5/6 treated macaques were infected during five rectal SHIV exposures as were 3/4 controls. MVC treatment was associated with a significant increase in the percentage of CD3(+)/CCR5(+) cells in blood. We show that high and durable MVC concentrations in rectal tissues are not sufficient to prevent SHIV infection in macaques. The increases in CD3(+)/CCR5(+) cells seen during MVC treatment point to unique immunological effects of CCR5 inhibition by MVC. The implications of these immunological effects on PrEP with MVC require further evaluation.

  4. Evaluation of crystal violet decolorization assay for minimal inhibitory concentration detection of primary antituberculosis drugs against Mycobacterium tuberculosis isolates

    Directory of Open Access Journals (Sweden)

    Ahmet Yilmaz Coban

    2016-01-01

    Full Text Available In this study we evaluated the crystal violet decolorization assay (CVDA for detection of minimum inhibitory concentration (MIC of antituberculosis drugs. 53 isolates were tested in this study and 13 of them were multidrug resistant (MDR isolates. The antibiotics concentrations were 2-0.06 mg/L for isoniazid (INH and rifampicin (RIF and were 16-0.25 mg/L for streptomycin (STM and ethambutol (EMB. Crystal violet (CV-25 mg/L was added into the microwells on the seventh day of incubation and incubation was continued until decolorization. Decolorization of CV was the predictor of bacterial growth. Overall agreements for four drugs were detected as 98.1%, and the average time was detected as 9.5 ± 0.89 day after inoculation. One isolate for INH and two isolates for STM were determined resistant in the reference method, but susceptible by the CVDA. One isolate was susceptible to EMB by the reference method, but resistant by the CVDA. All results were concordant for RIF. This study shows that CVDA is a rapid, reliable and suitable for determination of MIC values of Mycobacterium tuberculosis. And it can be used easily especially in countries with limited-sources.

  5. A novel doxorubicin-loaded in situ forming gel based high concentration of phospholipid for intratumoral drug delivery.

    Science.gov (United States)

    Wu, Wenqi; Chen, Hui; Shan, Fengying; Zhou, Jing; Sun, Xun; Zhang, Ling; Gong, Tao

    2014-10-06

    The purpose of this study was to develop a safe and effective drug delivery system for local chemotherapy. A novel injectable in-situ-forming gel system was prepared using small molecule materials, including phospholipids, medium chain triglycerides (MCTs), and ethanol. Thus, this new sustained release system was named PME (first letter of phospholipids, MCT, and ethanol). PME has a well-defined molecule structure, a high degree of safety, and better biocompatible characteristics. It was in sol state with low viscosity in vitro and turned into a solid or semisolid gel in situ after injection. When loaded with doxorubicin (Dox), PME-D (doxorubicin-loaded PME) exhibited notably antitumor efficiency in S180 sarcoma tumors bearing mice after a single intratumoral injection. In vitro, PME-D had remarkable antiproliferative efficacies against MCF-7 breast cancer cells for over 5 days. Moreover, the initial burst effect can hardly be observed from PME system, which was different from many other in-situ-forming gels. The in vivo biodistribution study showed the high Dox concentration in tumors compared with other major organs after PME-D intratumoral administration. The strong signal in tumors was retained for more than 14 days after one single injection. The high concentration of Dox in tumor and long-term retention may explain the superior therapeutic efficacy and reduced side effects. The PME-D in-situ-forming gel system is a promising drug delivery system for local chemotherapy.

  6. Cocaine analytes in human hair: evaluation of concentration ratios in different cocaine sources, drug-user populations and surface-contaminated specimens.

    Science.gov (United States)

    Ropero-Miller, Jeri D; Huestis, Marilyn A; Stout, Peter R

    2012-07-01

    Hair specimens were analyzed for cocaine (COC), benzoylecgonine (BE), cocaethylene (CE) and norcocaine (NCOC) by liquid chromatography-tandem mass spectrometry. Drug-free hair was contaminated in vitro with COC from different sources with varied COC analyte concentrations. Results were compared to COC analyte concentrations in drug users' hair following self-reported COC use (Street) and in hair from participants in controlled COC administration studies (Clinical) on a closed clinical research unit. Mean ± standard error analyte concentrations in Street drug users' hair were COC 27,889 ± 7,846 (n = 38); BE 8,132 ± 2,523 (n = 38); CE 901 ± 320 (n = 20); NCOC 345 ± 72 pg/mg (n = 32). Mean percentages to COC concentration were BE 29%, CE 3% and NCOC 1%. Concentrations in hair were lower for Clinical participants. COC contamination with higher CE, BE or NCOC content produced significantly higher concentrations (P = 0.0001) of all analytes. CE/COC and NCOC/COC ratios did not improve differentiation of COC use from COC contamination. COC concentrations in illicit and pharmaceutical COC affect concentrations in contaminated hair. Criteria for distinguishing COC use from contamination under realistic concentrations were not significantly improved by adding CE and NCOC criteria to COC cutoff concentration and BE/COC ratio criteria. Current criteria for COC hair testing in many forensic drug-testing laboratories may not effectively discriminate between COC use and environmental COC exposure.

  7. Adherence as a language game.

    Science.gov (United States)

    Kolberg, Espen Skarstein

    2017-03-02

    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.

  8. Aggressive crime, alcohol and drug use, and concentrated poverty in 24 U.S. urban areas.

    Science.gov (United States)

    Valdez, Avelardo; Kaplan, Charles D; Curtis, Russell L

    2007-01-01

    The nexus between substance use and aggressive crime involves a complex interrelationship among mediating individual and community-level variables. Using multilevel logistic regression models, we investigate how community-level concentration of poverty variables mediate the predictive relationships among individual level social attachment variables and substance use on aggressive crime in a large national sample of male arrestees (N = 20,602) drawn from 24 U.S. urban areas. The findings support our hypothesis that individual social attachments to marriage and the labor force (education and employment) are the principal individual-level pathway mediating the substance abuse/aggression nexus. In the random intercept model, 3.17% of the variation not explained by the individual-level predictor variables is attributable to community-level variation in urban area female-headed households and households receiving welfare. This confirms our hypothesis that social structural conditions of an urban environment differentially expose persons to conditions that predict being arrested for an aggressive crime. Our findings tend to counter the cultural theorists who argue for an indigenous culture of violence in inner-city ghettos and barrios.

  9. Determination of bile salt critical micellization concentration on the road to drug discovery.

    Science.gov (United States)

    Natalini, Benedetto; Sardella, Roccaldo; Gioiello, Antimo; Ianni, Federica; Di Michele, Alessandro; Marinozzi, Maura

    2014-01-01

    With the discovery of the bile acid (BA)-activated nuclear and membrane receptors, the role of BAs as signalling molecules in important paracrine and endocrine networks has been fully documented in the last decade. Besides regulating their own synthesis and transport, BAs have been demonstrated being involved in triggering the adaptive response to cholestasis and other insults to liver. More to the point, their recognized ability to control the general energy-related metabolism and inflammation processes has contributed to justify the renewed interest towards this class of amphiphilic steroidal compounds. All these evidences feed a continuing interest in the BA research aimed at designing and synthesizing new side chain- and body-modified derivatives endowed with improved biological and physico-chemical profiles, as well as with proper ADMET behaviour. In this context, the micellar aggregation of BAs, and the respective critical micellization concentration (CMC) value (determined on the BA sodium salt, BS), is considered a key parameter that needs to be determined in the preliminary phase of compound characterization, being implicated in cytotoxicity issues. An extraordinary variety of different analytical techniques and methods have been proposed along the years with the aim of better identifying the start of the self-aggregation process of BS monomers. The unicity of the physico-chemical nature of such class of compounds can be invoked to explain this unusual interest. Accordingly, a number of both invasive and non-invasive approaches have been developed along with a limited number of indirect chromatographic-based estimation strategies. Worth to be mentioned among the non-invasive determination methods are those based on potentiometry, freezing point depression, surface tension, nuclear magnetic resonance, viscosimetry, turbidimetry, microcalorimetry, refractometry, conductimetry, spectrophotometry, cholesterol solubilization, and monoglucuronide solubilization

  10. Accelerator mass spectrometry measurement of intracellular concentrations of active drug metabolites in human target cells in vivo.

    Science.gov (United States)

    Chen, J; Garner, R C; Lee, L S; Seymour, M; Fuchs, E J; Hubbard, W C; Parsons, T L; Pakes, G E; Fletcher, C V; Flexner, C

    2010-12-01

    Accelerator mass spectrometry (AMS) is an ultrasensitive technique to detect radiolabeled compounds. We administered a microdose (100 µg) of (14)C-labeled zidovudine (ZDV) with or without a standard unlabeled dose (300 mg) to healthy volunteers. Intracellular ZDV-triphosphate (ZDV-TP) concentration was measured using AMS and liquid chromatography-tandem mass spectrometry (LC/MS/MS). AMS analysis yielded excellent concordance with LC/MS/MS and was 30,000-fold more sensitive. The kinetics of intracellular ZDV-TP formation changed several-fold over the dose range studied (100 µg-300 mg). AMS holds promise as a tool for quantifying intracellular drug metabolites and other biomediators in vivo.

  11. Concentration of Non-Steroidal Anti-Inflammatory Drugs in the Pelvic Floor Muscles: An Experimental Comparative Rat Model

    Science.gov (United States)

    Chin, Hung-Yen; Changchien, Eileen; Lin, Mei-Fung; Chiang, Chi-Hsin

    2014-01-01

    Purpose The aim of this study is to explore non-steroid anti-inflammation drugs (NSAIDs) potency for pelvic floor muscle pain by measuring local concentration in a rat model. Materials and Methods We used nine NSAIDs, including nabumetone, naproxen, ibuprofen, meloxicam, piroxicam, diclofenac potassium, etodolac, indomethacin, and sulindac, and 9 groups of female Wister rats. Each group of rats was fed with one kind of NSAID (2 mg/mL) for three consecutive days. Thereafter, one mL of blood and one gram of pelvic floor muscle were taken to measure drug pharmacokinetics, including partition coefficient, lipophilicity, elimination of half-life (T1/2) and muscle/plasma converting ratio (Css, muscle/Css, plasma). Results Diclofenac potassium had the lowest T1/2 and the highest mean Css, muscle/Css, plasma (1.9 hours and 0.85±0.53, respectively). The mean Css, muscle/Css, plasma of sulindac, naproxen and ibuprofen were lower than other experimental NSAIDs. Conclusion Diclofenac potassium had the highest disposition in pelvic floor muscle in a rat model. The finding implies that diclofenac potassium might be the choice for pain relief in pelvic muscle. PMID:24954342

  12. Biologic Influences on Exercise Adherence.

    Science.gov (United States)

    Dishman, Rod K.

    1981-01-01

    Diagnostic profiles of 362 male participants in an exercise program were analyzed to determine the biological variables between exercise adherence and symptoms of coronary disease. Findings indicated that individuals with lower metabolic capacity tended to adhere longer, to be less fit, were leaner, and began with more symptoms related to coronary…

  13. Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients

    DEFF Research Database (Denmark)

    Olesen, Charlotte; Harbig, Philipp; Buus, Kirsten Marie;

    2014-01-01

    Background Elderly polypharmacy patients may be more at risk of not adhering to medication. If so, the underlying reasons may be more readily disclosed during private discussions with patients. Hence pharmaceutical care discussions at home might improve treatment adherence. Objective The aim...... of this study was to investigate the impact of pharmaceutical care on medication adherence, hospitalisation and mortality in elderly patients prescribed polypharmacy. Setting Pharmaceutical care discussed at home. Methods A randomised controlled trial with two arms; pharmaceutical care (n = 315) and controls (n...... by a pill-count. Patients were categorised as non-adherent if their mean adherence rate for all drugs consumed was pharmaceutical care on non-adherence and hospitalisation was analysed by 2 × 2 tables, and mortality by Cox regression. Main outcome measure Medication adherence...

  14. Medication adherence: the critical step towards better patient outcome

    Directory of Open Access Journals (Sweden)

    Anish Desai

    2014-10-01

    Full Text Available Medication adherence is defined as patient's adherence to take their medications as prescribed and continue to take the prescribed medication for stipulated time frame. Medication non-adherence is a growing concern to physicians, healthcare systems, and other stakeholders (e.g., payers and there is an increasing evidence of its prevalence and is associated with adverse clinical outcomes eventually resulting into higher costs of care. The cost of non-adherence has been estimated at $100 billion to $300 billion annually, including costs from avoidable hospitalizations, nursing home admissions, and premature deaths. Improving adherence to medication is critical to improve the quality of health care, to encourage better chronic care management, and promote better health outcomes. Reasons for non-adherence are multiple and complex. Studies have reported that poor adherence to drug dosage is due to patient perception that the disease is non-significant, adverse drug effects, lack of treatment effectiveness, and the patient's poor or incomplete knowledge of the disease and (cost. A multifactorial approach is required to tackle this complex problem as a single approach will be ineffective for all patients. The most effective intervention is to use a combination of approaches and address literacy, behavior, and organizational issues. There are challenges as well as opportunities in addressing the public health issue of medication adherence. Changing healthcare reforms, advances in digital health media, social media and modern technologies can now provide alternatives to tackle this issue. [Int J Basic Clin Pharmacol 2014; 3(5.000: 748-754

  15. Development of a method for the quantification of the molar gold concentration in tumour cells exposed to gold-containing drugs.

    Science.gov (United States)

    Ott, Ingo; Scheffler, Heike; Gust, Ronald

    2007-05-01

    The knowledge of the cellular molar concentration of a drug is an extremely important parameter for the discussion and interpretation of its efficacy and bioavailability. Concerning metal complexes, electrothermal atomic absorption spectroscopy (ETAAS) offers a valuable analytical tool. However, matrix effects often hamper proper quantification of the metal concentration in biological tissues. This paper describes the development of an ETAAS method for the quantification of the molar gold concentration in HT-29 colon carcinoma cells. ETAAS analytical conditions were optimised and a factor was developed which allows the calculation of the molar cellular gold concentration from the measured gold per cellular biomass value. The method was used to quantify the gold content in HT-29 cells after exposure to the gold drug auranofin. Results indicated a strong cellular uptake of auranofin (compared to other metal anticancer drugs), which significantly correlated with the antiproliferative effects triggered by this agent.

  16. Spillover adherence effects of fixed-dose combination HIV therapy

    Directory of Open Access Journals (Sweden)

    Kauf TL

    2012-02-01

    Full Text Available Teresa L Kauf1, Keith L Davis2, Stephanie R Earnshaw2, E Anne Davis31Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, 2RTI Health Solutions, Research Triangle Park, NC, 3Independent consultant, Pittsboro, NC, USAAbstract: The impact of fixed-dose combination (FDC products on adherence to other, non-fixed regimen components has not been examined. We compared adherence to a third antiretroviral (ART component among patients receiving a nucleoside reverse transcriptase inhibitor (NRTI backbone consisting of the FDC Epzicom®, GlaxoSmithKline Inc, Research Triangle Park, NC (abacavir sulfate 600 mg + lamivudine 300 mg; FDC group versus NRTI combinations taken as two separate pills (NRTI Combo group using data from a national sample of 30 health plans covering approximately 38 million lives from 1997 to 2005. Adherence was measured as the medication possession ratio (MPR. Multivariate logistic regression compared treatment groups based on the likelihood of achieving ≥95% adherence, with sensitivity analyses using alternative thresholds. MPR was assessed as a continuous variable using multivariate linear regression. Covariates included age, gender, insurance payer type, year of study drug initiation, presence of mental health and substance abuse disorders, and third agent class. The study sample consisted of 650 FDC and 1947 NRTI Combo patients. Unadjusted mean adherence to the third agent was higher in the FDC group than the NRTI Combo group (0.92 vs 0.85; P < 0.0001. In regression analyses, FDC patients were 48% and 39% more likely to achieve 95% and 90% third agent adherence, respectively (P ≤ 0.03. None of the other MPR specifications achieved comparable results. Among managed care patients, use of an FDC appears to substantially improve adherence to a third regimen component and thus the likelihood of achieving the accepted standard for adherence to HIV therapy of 95%.Keywords

  17. The Relationship between Cognitive Appraisal and Adherence to Medical Regimens in Type 2 Diabetic Patients

    OpenAIRE

    Shahnaz Ahrari; Ali Mohammadpour; Zahra Amouzeshi; Alireza Agha-Yousefi

    2014-01-01

    Introduction: Non-adherence to medical regimen has remained a challenge to the medical profession as well as to social sciences. To achieve positive results, the factors negatively impacting patient adherence to medical regimens (i.e., diet, drug and exercise regimen) must be scrutinized in detail. The objective of this research was to explore the relationship between cognitive appraisal and adherence to medical regimens in type 2 diabetic patients. Methods: In this correla...

  18. Alcohol use, antiretroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus

    Directory of Open Access Journals (Sweden)

    Kekwaletswe CT

    2014-03-01

    Full Text Available Connie T Kekwaletswe,1 Neo K Morojele1,21Alcohol and Drug Abuse Research Unit, Medical Research Council, Pretoria, 2School of Public Health, University of the Witwatersrand, Johannesburg, South AfricaBackground: The primary objectives of this study were to determine the association between alcohol and antiretroviral therapy (ART adherence and the perceived appropriateness and acceptability of elements of an adherence counseling program with a focus on alcohol-related ART nonadherence among a sample of ART recipients in human immunodeficiency virus (HIV clinics in Tshwane, South Africa.Methods: We conducted a cross-sectional study with purposive sampling. The sample comprised 304 male and female ART recipients at two President's Emergency Plan For AIDS Relief-supported HIV clinics. Using an interview schedule, we assessed patients' alcohol use (Alcohol Use Disorders Identification Test, other drug use, level of adherence to ART, and reasons for missing ART doses (AIDS Clinical Trials Group adherence instrument. Additionally, patients’ views were solicited on: the likely effectiveness of potential facilitators; the preferred quantity, duration, format, and setting of the sessions; the usefulness of having family members/friends attend sessions along with the patient; and potential skill sets to be imparted.Results: About half of the male drinkers’ and three quarters of the female drinkers’ Alcohol Use Disorders Identification Test scores were suggestive of hazardous or harmful drinking. Average self-reported ART adherence was 89.7%. There was a significant association between level of alcohol use and degree of ART adherence. Overall, participants perceived two clinic-based sessions, each of one hour’s duration, in a group format, and facilitated by a peer or adherence counselor, as most appropriate and acceptable. Participants also had a favorable attitude towards family and friends accompanying them to the sessions. They also favored an

  19. Patterns and obstacles to oral antidiabetic medications adherence among type 2 diabetics in Ismailia, Egypt: a cross section study

    OpenAIRE

    Heissam, Khaled; Abuamer, Zeinab; El-Dahshan, Nahed

    2015-01-01

    Introduction Diabetes is a costly and increasingly common chronic disease. Effective management of diabetes to achieve glycemic control improves patient quality of life. Adherence rates to drug regimens in patients with type 2 diabetes are relatively low and vary widely between populations. There are many factors that could affect patient adherence to drug therapy. The aim of the present study was assessing patterns and obstacles to adherence of type 2 diabetic patients to their oral hypoglyc...

  20. Group-based trajectory modeling to assess adherence to biologics among patients with psoriasis

    Directory of Open Access Journals (Sweden)

    Li Y

    2014-04-01

    continuously high adherence, respectively. Additional analyses suggested GBTM-based categorization was best predicted by patient age, sex, certain comorbidities, and particular drug use.Conclusion: GBTM is a more appropriate way to model dynamic behaviors and offers researchers an alternative to more traditional drug adherence measurements.Keywords: classification, proportion days of covered (PDC, patterns, dynamic, behavior, grouping

  1. Psychotropic Medication Adherence among Community-Based Individuals with Developmental Disabilities and Mental Illness

    Science.gov (United States)

    Tan, Xi; Marshall, Vincent D.; Balkrishnan, Rajesh; Patel, Isha; Chang, Jongwha; Erickson, Steven R.

    2015-01-01

    Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan®…

  2. Effects of penicillin and erythromycin on adherence of invasive and noninvasive isolates of Streptococcus pyogenes to laminin

    Science.gov (United States)

    Šmitran, Aleksandra; Vuković, Dragana; Gajić, Ina; Marinković, Jelena; Ranin, Lazar

    2015-01-01

    This study investigated the possible relationship between the invasiveness of group A Streptococcus (GAS) strains and their abilities to adhere to laminin and assessed the effects of subinhibitory concentrations of penicillin and erythromycin on the ability of GAS to adhere to laminin. The adherence of noninvasive and highly invasive isolates of GAS to laminin was significantly higher than the adherence displayed by isolates of low invasiveness. Antibiotic treatment caused significant reductions in adherence to laminin in all three groups of strains. Penicillin was more successful in reducing the adherence abilities of the tested GAS strains than erythromycin. PMID:26270594

  3. The influence of cognition, anxiety and psychiatric disorders over treatment adherence in uncontrolled hypertensive patients.

    Directory of Open Access Journals (Sweden)

    Úrsula Jacobs

    Full Text Available BACKGROUND: Poor adherence is estimated to cause 125 thousand deaths per year and is linked to 10% of all hospital stays in the U.S. Up to one third of elderly hypertensive patients don't have adherence, which is responsible for high proportion of hospitalizations. Hypertension is also related to poor performance in tests that assess cognitive functions. On the other hand, poor cognitive performance is associated with low adherence to treatment. OBJECTIVE: To assess the association between cognitive function, anxiety and psychiatric disorders with adherence to drug treatment in patients with hypertension. METHODOLOGY AND PRINCIPAL FINDINGS: This a cohort studies with 56 adult patients with uncontrolled hypertension who participated of all meetings of a pharmaceutical intervention in a randomized clinical trial of pharmaceutical care. Cognitive function was measured by the Mini Mental State Examination (Mini-mental. The memory was measured by digit and word spans, tower and church shadow test, short story test and metamemory. Anxiety and psychiatric disorders were evaluated by the State Trace Anxiety Inventory and the Self-Report Questionnaire, respectively. The participants were classified as adherent or non-adherent to the drug treatment, according to the identification of plasma levels of hydrochlorothiazide. All non-adherent patients (n = 12 and 35 out 44 (79.5% patients with adherence to treatment had at least one memory test with an altered score (P = 0.180. Participants with an unsatisfactory score in the Mini-mental had six-fold higher risk of non-adherence to treatment when compared to those with a normal score (RR = 5.8; CI 95%: 1.6-20.8; P = 0.007. The scores of anxiety and psychiatric disorders were not associated with adherence to the pharmacological treatment. CONCLUSION: Cognitive deficit impairs adherence to drug therapy and should be screened as part of a program of pharmaceutical care to improve adherence to

  4. Postmortem Blood Concentrations of R- and S-Enantiomers of Methadone and EDDP in Drug Users: Influence of Co-Medication and P-glycoprotein Genotype

    DEFF Research Database (Denmark)

    Buchard, Anders; Linnet, Kristian; Johansen, Sys Stybe;

    2010-01-01

    We investigated toxicological and pharmacogenetic factors that could influence methadone toxicity using postmortem samples. R- and S-methadone were measured in femoral blood from 90 postmortem cases, mainly drug users. The R-enantiomer concentrations significantly exceeded that of the S-enantiome......We investigated toxicological and pharmacogenetic factors that could influence methadone toxicity using postmortem samples. R- and S-methadone were measured in femoral blood from 90 postmortem cases, mainly drug users. The R-enantiomer concentrations significantly exceeded that of the S......-enantiomers (Wilcoxon's test, p

  5. Relationship of race-, sexual orientation-, and HIV-related discrimination with adherence to HIV treatment: a pilot study.

    Science.gov (United States)

    Boarts, Jessica M; Bogart, Laura M; Tabak, Melanie A; Armelie, Aaron P; Delahanty, Douglas L

    2008-10-01

    Adherence to highly active antiretroviral therapy (HAART) must be close to perfect in order to maintain suppression of HIV viral load, and to prevent the development of drug resistant strains of HIV. People living with HIV (PLWH) often report low levels of adherence. One variable that has been linked to poor adherence is perceived discrimination; however, research has generally not considered the possible unique effects of different types of discrimination on adherence. The present pilot study aimed to examine the association of three types of discrimination (due to HIV+ status, race, or sexual orientation) with adherence among 57 PLWH. Logistic regression analyses were conducted to demonstrate the relationships between each type of discrimination and self-reported adherence. Racial discrimination significantly predicted lower adherence levels, whereas sexual orientation- and HIV-related discrimination did not. Results underscore the importance of addressing discrimination issues, specifically racial, when designing interventions to improve adherence to HAART.

  6. Methods for measuring, enhancing, and accounting for medication adherence in clinical trials.

    Science.gov (United States)

    Vrijens, B; Urquhart, J

    2014-06-01

    Adherence to rationally prescribed medications is essential for effective pharmacotherapy. However, widely variable adherence to protocol-specified dosing regimens is prevalent among participants in ambulatory drug trials, mostly manifested in the form of underdosing. Drug actions are inherently dose and time dependent, and as a result, variable underdosing diminishes the actions of trial medications by various degrees. The ensuing combination of increased variability and decreased magnitude of trial drug actions reduces statistical power to discern between-group differences in drug actions. Variable underdosing has many adverse consequences, some of which can be mitigated by the combination of reliable measurements of ambulatory patients' adherence to trial and nontrial medications, measurement-guided management of adherence, statistically and pharmacometrically sound analyses, and modifications in trial design. Although nonadherence is prevalent across all therapeutic areas in which the patients are responsible for treatment administration, the significance of the adverse consequences depends on the characteristics of both the disease and the medications.

  7. Adherence, knowledge, and difficulties related to pharmacological treatment for people with schizophrenia

    Directory of Open Access Journals (Sweden)

    Adriana Inocenti Miasso

    2015-06-01

    Full Text Available This study aimed to verify the adherence and knowledge of people with schizophrenia as regards their prescribed pharmacotherapy, and to identify the difficulties related to the monitoring of drug therapy. It was a retrospective, cross-sectional, and descriptive study conducted in an outpatient psychiatry clinic, with 21 patients with schizophrenia, through chart review and a semi-structured interview. The data were analyzed using descriptive statistics and content analysis showing that, although 76.2% of patients adhere to treatment, most were unaware of the treatment regimen. Limitations in the administration of drugs, troublesome due to side effects and conflicts regarding the need for the drugs, were the difficulties pointed out by the study participants. The contradiction between high adherence and lack of knowledge about prescriptions reveal that promoting treatment adherence and patient safety requires interventions that address the skills and knowledge of the individual, as well as the support available for the administration of prescription drugs.

  8. Grado de adherencia terapéutica a los fármacos del metabolismo óseo-mineral: ¿toman nuestros pacientes la medicación prescrita? Degree of therapeutic adherence to bone mineral metabolism drugs: Do our patients take the prescribed medication?

    Directory of Open Access Journals (Sweden)

    María Nieves Cazorla Santana

    2013-03-01

    Full Text Available Los fármacos del metabolismo óseo-mineral tienen gran importancia el tratamiento de los pacientes de hemodiálisis, pero desconocemos las preferencias, y el grado de conocimiento de estos fármacos. Los objetivos del estudio fueron conocer el grado de adherencia terapéutica a los fármacos del metabolismo oseo-mineral, e identificar los factores más relevantes que influyen en la adherencia a este tipo de tratamiento. Pacientes y métodos: Se realizó un estudio transversal en un Centro de hemodiálisis, incluyendo 106 pacientes. Utilizamos el cuestionario simplificado de adherencia a la medicación (SMAQ¹ y un cuestionario específico sobre cumplimiento y preferencias, para conocer el grado de adherencia. Resultados: El 37,7% de los pacientes fue incumplidor según el cuestionario SMAQ. De ellos, el 34% no tomaba la medicación a la misma hora (PBone mineral metabolism drugs are of great importance in treating haemodialysis patients, but we are unaware of their preferences and degree of knowledge of these drugs. The aims of the study were to find out the degree of therapeutic adherence to bone mineral metabolism drugs and to identify the most relevant factors that influence adherence to this type of treatment. Patients and methods: A transversal study was carried out at a haemodialysis centre, including 106 patients. We used the simplified medication adherence questionnaire (SMAQ¹ and a specific questionnaire on compliance and preferences, in order to find out the degree of adherence. Results: 37.7% of the patients were non-compliant, according to the SMAQ. Of these, 34% did not take the medication at the same time (P<0.000, 5.7% did not comply with the treatment at weekends (P<0.010, 13.2% stop taking the medication when they feel unwell (P<0.010; and in the last week, 18% acknowledged that they forgot the treatment 1 day (P= 0.001 and between 2-3 days (12,5%. 52% did not have preferences for any phosphorus chelant and 60.4% knew about

  9. The Relationship between Cognitive Appraisal and Adherence to Medical Regimens in Type 2 Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Shahnaz Ahrari

    2014-12-01

    Full Text Available Introduction: Non-adherence to medical regimen has remained a challenge to the medical profession as well as to social sciences. To achieve positive results, the factors negatively impacting patient adherence to medical regimens (i.e., diet, drug and exercise regimen must be scrutinized in detail. The objective of this research was to explore the relationship between cognitive appraisal and adherence to medical regimens in type 2 diabetic patients. Methods: In this correlational study, 218 type 2 diabetes patients receiving treatment at the Diabetes Clinic affiliated with Gonabad University of Medical Sciences were selected through non-probability (convenience sampling from April 2012 to May 2013. Two valid and reliable questionnaires of cognitive appraisal and adherence to medical regimens were completed by each patient. The data were analyzed using SPSS ver 13. Results: A relationship was observed between perceived cognitive and adherence to some aspects of medical regimen. Also direct relationship was observedbetween perceived cognitive in form challenge and adherence of diet in patients with diabetes. There was no statistically significant relationship between aspects of cognitive appraisal and adherence to the drug regimen. Conclusion: The results suggest that interventions undertaken to improve adherence to medical regimen, particularly to drug regimen in patients with type 2 diabetes, should be focused on enriching cognitive appraisal. Nurses need to help patients perceive diabetes as less of a threat and in fact should empower them, so as to look upon it as more of a challenge.

  10. Assessment of Antiretroviral Treatment Adherence among Children Attending Care at a Tertiary Hospital in Southeastern Nigeria

    Directory of Open Access Journals (Sweden)

    Cletus Akahara

    2017-01-01

    Full Text Available Background. Adherence is the strongest predictor of successful treatment outcome among children infected with HIV. Our aim was to assess the antiretroviral drugs adherence status of HIV-infected children attending care at a tertiary hospital in Southeastern Nigeria. Method. The study involved a cross-sectional survey of 210 HIV-infected children attending care at a tertiary hospital in Southeastern Nigeria using self-report method of assessment. Optimal ART adherence is defined as patient taking not missing more than 1 dose of combined antiretroviral therapy medication in the preceding 2 weeks prior to the study. Result. A majority of the subjects 191 (91% had good adherence. There was a significant relationship between adherence and patient educational level (p=0.004, duration of treatment (p=0.001, drug administrator (p=0.005, and orphan status (p=0.001. The motivating factor for adherence was “not falling sick as before” while stigma was the most discouraging factor. Conclusion. The adherence level in this study was good. Stigma was an important reason given by patient/caregivers for nonadherence. There is need for concerted effort in addressing this barrier to improve adherence and prevent the emergence of drug resistance and treatment failure.

  11. Self-perception of knowledge and adherence reflecting the effectiveness of antiretroviral therapy

    Science.gov (United States)

    Dagli-Hernandez, Carolina; Lucchetta, Rosa Camila; de Nadai, Tales Rubens; Galduróz, José Carlos Fernandez; Mastroianni, Patricia de Carvalho

    2016-01-01

    Objectives To evaluate which indirect method for assessing adherence best reflects highly active antiretroviral therapy (HAART) effectiveness and the factors related to adherence. Method This descriptive, cross-sectional study was performed in 2012 at a reference center of the state of São Paulo. Self-report (simplified medication adherence questionnaire [SMAQ]) and drug refill parameters were compared to the viral load (clinical parameter of the effectiveness of pharmacotherapy [EP]) to evaluate the EP. The “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH) was used to evaluate factors related to adherence and the EP and, complementarily, patient self-perception of adherence was compared to the clinical parameter of the EP. Results Seventy-five patients were interviewed, 60 of whom were considered as adherent from the clinical parameter of the EP and ten were considered as adherent from all parameters. Patient self-perception about adherence was the instrument that best reflected the EP when compared to the standardized self-report questionnaire (SMAQ) and drug refill parameter. The level of education and the level of knowledge on HAART were positively correlated to the EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were the factors most frequently reported as a cause of nonadherence. Conclusion A new parameter of patient self-perception of adherence, which is a noninvasive, inexpensive instrument, could be applied and assessed as easily as self-report (SMAQ) during monthly drug refill, since it allows monitoring adherence through pharmaceutical assistance. Therefore, patient adherence to HAART could be evaluated using self-perception (CEAT-VIH) and the viral load test. PMID:27695297

  12. Assuring the Proper Analytical Performance of Measurement Procedures for Immunosuppressive Drug Concentrations in Clinical Practice: Recommendations of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology Immunosuppressive Drug Scientific Committee.

    Science.gov (United States)

    Seger, Christoph; Shipkova, Maria; Christians, Uwe; Billaud, Elaine M; Wang, Ping; Holt, David W; Brunet, Mercè; Kunicki, Paweł K; Pawiński, Thomasz; Langman, Loralie J; Marquet, Pierre; Oellerich, Michael; Wieland, Eberhard; Wallemacq, Pierre

    2016-04-01

    Monitoring immunosuppressive drugs (ISDs) in blood or plasma is still a key therapeutic drug monitoring (TDM) application in clinical settings. Narrow target ranges and severe side effects at drug underexposure or overexposure make accurate and precise measurements a must. This overview prepared by the Immunosuppressive Drugs Scientific Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology is intended to serve as a summary and guidance document describing the current state-of-the-art in the TDM of ISDs.

  13. Factors related to patient adherence to antidiabetic drug therapy Factores relacionados a la adhesión del paciente diabético a la terapéutica medicamentosa Fatores relacionados à adesão do paciente diabético à terapêutica medicamentosa

    Directory of Open Access Journals (Sweden)

    Heloisa Turcatto Gimenes

    2009-02-01

    Full Text Available The objective of the present study was to assess patient adherence to antidiabetic drug therapy and its association with factors related to the patient, patient-provider relationship, therapeutic regimen and the disease itself. The study comprised 46 diabetic patients enrolled in a research and extension education center in the State of Sao Paulo, southeastern Brazil, in 2007. Data was collected through interviews using a questionnaire and the Treatment Adherence Measure (TAM. The patient adherence level to antidiabetic drug therapy was 78.3%. In conclusion, since prevalence of adherence is below that recommended in the literature, and in the light of poor blood glucose control and alleged failure of therapeutic regimen, health providers are urged to measure diabetic patient treatment adherence, because it is key to adequate diabetes management with drugs.Este estudio tuvo el objetivo de determinar la adhesión del paciente diabético a la terapéutica medicamentosa y verificar la asociación de la adhesión con factores relacionados al paciente, a la relación profesional-paciente, al esquema terapéutico y a la enfermedad. Participaron 46 diabéticos registrados en un centro de investigación y extensión universitaria en el interior del Estado de San Pablo, en 2007. Los datos fueron obtenidos mediante entrevista, utilizándose un cuestionario y la prueba de Medida de Adhesión al Tratamiento - MAT. Los resultados mostraron que la adhesión del paciente diabético al tratamiento medicamentoso para tratamiento de la diabetes fue de 78,3%. Se concluye que, al considerar que la prevalencia de la adhesión obtenida en el presente estudio estuvo por debajo de la recomendada en la literatura y frente a la vigencia del mal control de la glucemia y de la supuesta falencia en el esquema terapéutico, se urgente que los profesionales de la salud reconozcan la importancia de evaluar la adhesión de los pacientes diabéticos, al tratamiento medicamentoso

  14. Study of Adherent Oxide Scales

    Science.gov (United States)

    1987-09-14

    The bond between alumina and NiCrAl substrate is intrinsically strong. The segregation of sulfur to the interface reduces bond strength, sulfur is...which laser-processing and minor element additions improve oxide scale adherence of a NiCrAl turbine coating composition. However, it was shown at the...adherence. However, significant observations were made with respect to the morphology of the oxide scale that forms on NiCrAl and NiCrAlY and these are

  15. Rapid Method To Determine Intracellular Drug Concentrations in Cellular Uptake Assays: Application to Metformin in Organic Cation Transporter 1-Transfected Human Embryonic Kidney 293 Cells.

    Science.gov (United States)

    Chien, Huan-Chieh; Zur, Arik A; Maurer, Tristan S; Yee, Sook Wah; Tolsma, John; Jasper, Paul; Scott, Dennis O; Giacomini, Kathleen M

    2016-03-01

    Because of the importance of intracellular unbound drug concentrations in the prediction of in vivo concentrations that are determinants of drug efficacy and toxicity, a number of assays have been developed to assess in vitro unbound concentrations of drugs. Here we present a rapid method to determine the intracellular unbound drug concentrations in cultured cells, and we apply the method along with a mechanistic model to predict concentrations of metformin in subcellular compartments of stably transfected human embryonic kidney 293 (HEK293) cells. Intracellular space (ICS) was calculated by subtracting the [(3)H]-inulin distribution volume (extracellular space, ECS) from the [(14)C]-urea distribution volume (total water space, TWS). Values obtained for intracellular space (mean ± S.E.M.; μl/10(6) cells) of monolayers of HEK cells (HEK-empty vector [EV]) and cells overexpressing human organic cation transporter 1 (HEK-OCT1), 1.21± 0.07 and 1.25±0.06, respectively, were used to determine the intracellular metformin concentrations. After incubation of the cells with 5 µM metformin, the intracellular concentrations were 26.4 ± 7.8 μM and 268 ± 11.0 μM, respectively, in HEK-EV and HEK-OCT1. In addition, intracellular metformin concentrations were lower in high K(+) buffer (140 mM KCl) compared with normal K(+) buffer (5.4 mM KCl) in HEK-OCT1 cells (54.8 ± 3.8 μM and 198.1 ± 11.2 μM, respectively; P < 0.05). Our mechanistic model suggests that, depending on the credible range of assumed physiologic values, the positively charged metformin accumulates to particularly high levels in endoplasmic reticulum and/or mitochondria. This method together with the computational model can be used to determine intracellular unbound concentrations and to predict subcellular accumulation of drugs in other complex systems such as primary cells.

  16. Automated microinjection system for adherent cells

    Science.gov (United States)

    Youoku, Sachihiro; Suto, Yoshinori; Ando, Moritoshi; Ito, Akio

    2007-07-01

    We have developed an automated microinjection system that can handle more than 500 cells an hour. Microinjection injects foreign agents directly into cells using a micro-capillary. It can randomly introduce agents such as DNA, proteins and drugs into various types of cells. However, conventional methods require a skilled operator and suffer from low throughput. The new automated microinjection techniques we have developed consist of a Petri dish height measuring method and a capillary apex position measuring method. The dish surface height is measured by analyzing the images of cells that adhere to the dish surface. The contrast between the cell images is minimized when the focus plane of an object lens coincides with the dish surface. We have developed an optimized focus searching method with a height accuracy of +/-0.2 um. The capillary apex position detection method consists of three steps: rough, middle, and precise. These steps are employed sequentially to cover capillary displacements of up to +/-2 mm, and to ultimately accomplish an alignment accuracy of less than one micron. Experimental results using this system we developed show that it can introduce fluorescent material (Alexa488) into adherent cells, HEK293, with a success rate of 88.5%.

  17. Toxicology findings in suicides: concentrations of ethanol and other drugs in femoral blood in victims of hanging and poisoning in relation to age and gender of the deceased.

    Science.gov (United States)

    Jones, Alan Wayne; Holmgren, Anita; Ahlner, Johan

    2013-10-01

    Over-consumption of alcohol and/or abuse of other drugs are closely linked to attempted or completed suicides. In this retrospective 10-year study (2001-2010), we compared the toxicology findings in hanging suicides (n = 4551) with drug poisoning (intoxication) suicides (n = 2468). The mean age of hanging deaths was 49 ± 19 y (±SD) and 80% were male, compared with a mean age of 52 ± 17 y and 47% males for the intoxication deaths. Poly-drug use was more common in poisoning suicides with an average of 3.6 drugs/case compared with 1.8 drugs/case in hangings. Moreover, 31% of hangings were negative for alcohol and/or drugs. Alcohol was detected (>0.20 g/L) in femoral blood in 30% of hanging suicides (mean 1.39 g/L) and 36% of drug poisonings (mean 1.39 g/L). The median BACs did not depend on the person's age or gender (p > 0.05). Ethanol, paracetamol, citalopram, diazepam, propiomazine, alimemazine and zopiclone were amongst the top-ten drugs detected in both methods of suicide. With the exception of ethanol, the concentrations of drugs in blood were considerably higher in the poisoning deaths, as might be expected. Regardless of the method of suicide, antidepressants and/or antipsychotics were common findings, which could implicate mental health as a significant suicide risk factor.

  18. Adherence with Preventive Medication in Childhood Asthma

    Directory of Open Access Journals (Sweden)

    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.

  19. Biodegradable drug-eluting nanofiber-enveloped implants for sustained release of high bactericidal concentrations of vancomycin and ceftazidime: in vitro and in vivo studies.

    Science.gov (United States)

    Hsu, Yung-Heng; Chen, Dave Wei-Chih; Tai, Chun-Der; Chou, Ying-Chao; Liu, Shih-Jung; Ueng, Steve Wen-Neng; Chan, Err-Cheng

    2014-01-01

    We developed biodegradable drug-eluting nanofiber-enveloped implants that provided sustained release of vancomycin and ceftazidime. To prepare the biodegradable nanofibrous membranes, poly(D,L)-lactide-co-glycolide and the antibiotics were first dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. They were electrospun into biodegradable drug-eluting membranes, which were then enveloped on the surface of stainless plates. An elution method and a high-performance liquid chromatography assay were employed to characterize the in vivo and in vitro release rates of the antibiotics from the nanofiber-enveloped plates. The results showed that the biodegradable nanofiber-enveloped plates released high concentrations of vancomycin and ceftazidime (well above the minimum inhibitory concentration) for more than 3 and 8 weeks in vitro and in vivo, respectively. A bacterial inhibition test was carried out to determine the relative activity of the released antibiotics. The bioactivity ranged from 25% to 100%. In addition, the serum creatinine level remained within the normal range, suggesting that the high vancomycin concentration did not affect renal function. By adopting the electrospinning technique, we will be able to manufacture biodegradable drug-eluting implants for the long-term drug delivery of different antibiotics.

  20. Adherence with tobramycin inhaled solution and health care utilization

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    Sacco Patricia

    2011-01-01

    Full Text Available Abstract Background Adherence with tobramycin inhalation solution (TIS during routine cystic fibrosis (CF care may differ from recommended guidelines and affect health care utilization. Methods We analyzed 2001-2006 healthcare claims data from 45 large employers. Study subjects had diagnoses of CF and at least 1 prescription for TIS. We measured adherence as the number of TIS therapy cycles completed during the year and categorized overall adherence as: low ≤ 2 cycles, medium >2 to Results Among 804 individuals identified with CF and a prescription for TIS, only 7% (n = 54 received ≥ 4 cycles of TIS per year. High adherence with TIS was associated with a decreased risk of hospitalization when compared to individuals receiving ≤ 2 cycles (adjusted odds ratio 0.40; 95% confidence interval 0.19-0.84. High adherence with TIS was also associated with lower outpatient service costs (IQR: $2,159-$8444 vs. $2,410-$14,423 and higher outpatient prescription drug costs (IQR: $35,125-$60,969 vs. $10,353-$46,768. Conclusions Use of TIS did not reflect recommended guidelines and may impact other health care utilization.

  1. Improving patient outcomes in psoriasis: strategies to ensure treatment adherence

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    Yélamos O

    2015-07-01

    Full Text Available Oriol Yélamos, Sandra Ros, Lluís Puig Department of Dermatology, Hospital de la Santa Creu i Sant Pau – Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain Abstract: Psoriasis is a frequent inflammatory disease with a chronic and relapsing course. Therefore, patients with psoriasis are likely to undergo different treatments for long periods of time. Traditionally, therapies used in psoriasis have been associated with poor levels of adherence due to the complexity of the regimens and the poor results obtained with the topical therapies. These poor outcomes are associated with high levels of frustration and anxiety, which decrease adherence and worsen the disease. With the recent introduction of highly efficacious biologic therapies, patients can achieve very good and prolonged responses. However, most patients with psoriasis have mild disease and may be treated with skin-directed therapies. Therefore, it is important to develop strategies to improve adherence in order to achieve better outcomes, and to improve the overall quality of life. Hence, acknowledging the causes of nonadherence is crucial for implementing these strategies. In this summary, we review the causes of nonadherence, and we provide behavioral strategies in order to improve adherence and, ultimately, the outcome of patients with psoriasis. Keywords: psoriasis, adherence, outcome, drug therapy, psychotherapy

  2. Adherence to treatment for diabetes mellitus: validation of instruments for oral antidiabetics and insulin

    Directory of Open Access Journals (Sweden)

    Lilian Cristiane Gomes-Villas Boas

    2014-01-01

    Full Text Available OBJECTIVES: to verify the face validity, criterion-related validity and the reliability of two distinct forms of presentation of the instrument Measurement of Adherence to Treatment, one being for ascertaining the adherence to the use of oral antidiabetics and the other for adherence to the use of insulin, as well as to assess differences in adherence between these two modes of drug therapy. METHOD: a methodological study undertaken with 90 adults with Type 2 Diabetes Mellitus. The criterion-related validity was verified using the Receiver Operating Characteristic curves; and for the reliability, the researchers calculated the Cronbach alpha coefficient, the item-total correlation, and the Pearson correlation coefficient. RESULTS: the oral antidiabetics and the other showed sensitivity of 0.84, specificity of 0.35 and a Cronbach correlation coefficient of 0.84. For the adherence to the use of insulin, the values found were, respectively, 0.60, 0.21 and 0.68. A statistically significant difference was found between the final scores of the two forms of the instrument, indicating greater adherence to the use of insulin than to oral antidiabetics. CONCLUSION: it is concluded that the two forms of the Measurement of Adherence to Treatment instrument are reliable and should be used to evaluate adherence to drug treatment among people with diabetes mellitus.

  3. Diagnosing medication non-adherence in a patient with myocardial infarction

    Directory of Open Access Journals (Sweden)

    Siqin eYe

    2012-08-01

    Full Text Available BackgroundMedication non-adherence continues to be a major challenge facing the healthcare system. A case is presented of a 48 year-old man with myocardial infarction who was found to be non-adherent to multiple medications. Conceptual models are reviewed along with current approaches for assessment and treatment of medication non-adherence.DesignCase report and literature review.DiscussionA theoretical model for medication non-adherence built on the Theory of Planned Behavior is presented. Empirical evidence is reviewed for determinants of non-adherent behavior such as health beliefs and self-efficacy. Current methods to assess medication non-adherence, including self-report, pill count, biological drug levels, pharmacy refill, and electronic bottles are summarized along with their limitations. Finally, an individualized approach for assessment is described using the case presented and the conceptual framework outlined above. Follow-up for the patient and potential interventions to improve medication adherence are discussed. ConclusionDespite the challenges, a conceptual framework for medication non-adherence can guide assessment and treatment. Further research for innovative and effective methods to detect and treat medication non-adherence is urgently needed to aid clinicians in treating this pervasive behavioral problem.

  4. Antihypertension medication adherence and associated factors at Dessie Hospital, North East Ethiopia, Ethiopia

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    Legese Chelkeba

    2013-06-01

    Full Text Available Hypertension is an overwhelming global challenge. Despite the development of many effective anti hypertensive drugs, target to reduce morbidity and mortality due to high blood pressures are reached in only a minor of patients in clinical practice. Poor adherence is one of the biggest obstacles in therapeutic control of blood pressures. There are complaints from patients and physicians that the poor result of actual antihypertensive drug therapies. Many people with age indifference are attacked by this “silent killer” or which results in target organ damage as a complication. The aim of this study was to assess the magnitude of adherence and the factors associated with non-adherence to anti-hypertensive medication. Cross sectional exclusively convenient study was conducted by using structured questionnaires consisting of open and closed-ended questions on patients diagnosed for hypertension and have already been on anti hypertensive medications at least for three months at Dessie Referral hospital from 20/01/2012 to 29/01/2012. A total of hundred hypertensive patients were screened from hundred six cases by the exclusive criteria and the overall incidence of anti-hypertensive medication non adherence was 26%. The study identifies reasons why patients don’t adherent with the drug regiments. Among Factors associated with non adherence were health system and health care provider poor interaction with patient and therapy factors like frustration and unwanted effect of the medication in the long run. There was indication of non adherence from the study area. Great emphasis should be placed on intervention strategies such as patient counseling and increasing awareness of the physicians, all other prescribers and health care providers at large about the non adherence of anti hypertensive drugs as well as the complication what comes due to this medication non adherence. [Int J Res Med Sci 2013; 1(3.000: 191-197

  5. Factors associated with suboptimal adherence to antiretroviral therapy in Asia

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    Awachana Jiamsakul

    2014-05-01

    Full Text Available Introduction: Adherence to antiretroviral therapy (ART plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh in the first 24 months of ART in an Asian HIV cohort. Methods: As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i 14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results: Out of 1316 patients, 32% ever reported 2 assessments per patient per year had an odds ratio (OR=0.7 (95% confidence interval (CI (0.55 to 0.90, p=0.006, compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs (OR=1.92, 95% CI (1.23 to 3.00, p=0.004 and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71, p<0.001. Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67, p=0.001 compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI combination. SubAdh decreased with increasing time on ART (all p<0.001. Similar associations were found with adherence <95% as the outcome. Conclusions: We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social

  6. Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

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    Shuler KM

    2014-05-01

    Full Text Available Kimberly M Shuler Shuler Counseling and Consulting, Fayetteville, AR, USA Purpose: In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams. Materials and methods: A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia. Results: Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an

  7. Dimethadione embryotoxicity in the rat is neither correlated with maternal systemic drug concentrations nor embryonic tissue levels.

    Science.gov (United States)

    Ozolinš, Terence R S; Weston, Andrea D; Perretta, Anthony; Thomson, Jason J; Brown, Nigel A

    2015-11-15

    Pregnant rats treated with dimethadione (DMO), the N-demethylated metabolite of the anticonvulsant trimethadione, produce offspring having a 74% incidence of congenital heart defects (CHD); however, the incidence of CHD has high inter-litter variability (40-100%) that presents a challenge when studying the initiating events prior to the presentation of an abnormal phenotype. We hypothesized that the variability in CHD incidence was the result of differences in maternal systemic concentrations or embryonic tissue concentrations of DMO. To test this hypothesis, dams were administered 300 mg/kg DMO every 12h from the evening of gestational day (GD) 8 until the morning of GD 11 (six total doses). Maternal serum levels of DMO were assessed on GD 11, 12, 13, 14, 15, 18 and 21. Embryonic tissue concentrations of DMO were assessed on GD 11, 12, 13 and 14. In a separate cohort of GD 12 embryos, DMO concentrations and parameters of growth and development were assessed to determine if tissue levels of DMO were correlated with these endpoints. Embryos were exposed directly to different concentrations of DMO with whole embryo culture (WEC) and their growth and development assessed. Key findings were that neither maternal systemic concentrations nor tissue concentrations of DMO identified embryos that were sensitive or resistant to DMO in vivo. Direct exposure of embryos to DMO via WEC also failed to show correlations between embryonic concentrations of DMO with developmental outcomes in vitro. We conclude that neither maternal serum nor embryonic tissue concentrations of DMO predict embryonic outcome.

  8. Concentrations of alprazolam in blood from impaired drivers and forensic autopsies were not much different but showed a high prevalence of co-ingested illicit drugs.

    Science.gov (United States)

    Jones, Alan Wayne; Holmgren, Anita

    2013-03-01

    Alprazolam is a benzodiazepine anxiolytic widely prescribed for treatment of panic-disorder and social phobias, although this medication is also subject to abuse. In this paper, the concentrations of alprazolam in venous blood samples from impaired drivers were compared with femoral blood samples from forensic autopsies classified as intoxication or other causes of death (e.g. natural, trauma). After liquid-liquid extraction (n-butyl acetate) alprazolam was determined in blood by capillary gas chromatography with a nitrogen-phosphorous detector. The mean (median) and range of alprazolam concentrations in blood from impaired drivers (n = 773) were 0.08 mg/L (0.05 mg/L) and 0.02-3.9 mg/L, respectively. Many traffic offenders had co-ingested ethanol (13%), amphetamine (46%), cannabis (32%), or heroin (14%), as well as other drugs. In deaths attributed to drug intoxication, the mean (median) and range of alprazolam concentrations in blood (n = 438) were 0.10 mg/L (0.06 mg/L) and 0.02-1.6 mg/L, respectively, which were not much different from other causes of death (n = 278); 0.08 mg/L (0.05 mg/L) and 0.02-0.9 mg/L. Median concentrations of alprazolam in blood from living and deceased persons did not seem to depend on the number of co-ingested substances. The result of this pharmacoepidemiological study suggests that alprazolam is a fairly innocent drug when used as monotherapy, but toxicity problems arise when co-ingested with illicit drugs and/or psychoactive medication.

  9. Effect of a non-steroidal, anti-inflammatory drug (Indocin) on selected parameters of muscular function following concentric and eccentric work

    OpenAIRE

    Vejarano, Maria Eugenia

    1985-01-01

    Evidence from various studies indicates that eccentric contractions produce more post-exercise changes in muscular function than do concentric contractions. Delayed muscular soreness, the pain and tenderness present 1 or 2 days after exercise, is negatively correlated with muscular performance and occurs particularly after eccentric work. The action of an analgesic, anti-inflammatory drug (Indocin) on muscular soreness indicates it may be effective in accelerating recover...

  10. Determination of the inhibitory concentration 50% (IC50) of four selected drugs (chlortetracycline, doxycycline, enrofloxacin and difloxacin) that reduce in vitro the multiplication of Chlamydophila psittaci.

    Science.gov (United States)

    Failing, K; Theis, P; Kaleta, E F

    2006-11-01

    A total of 18 chlamydial isolates from various psittacine birds, one isolate from a domestic pigeon and one isolate from a Pekin duck were isolated in continuous Buffalo Green Monkey (BGM) kidney cell cultures. All 20 isolates were identified by nested multiplex polymerase chain reaction as Chlamydophila psittaci. These isolates were multiplied to high titres and subsequently tested for in vitro sensitivity against two tetracyclines (chlortetracycline and doxycycline) and two quinolones (enrofloxacin and difloxacin) at concentrations of 0.0, 0.25, 0.50, 1.00, and 10.00 microg/ml. Replication of chlamydia in BGM cell cultures is assayed on the basis of formation of intracytoplasmic inclusions that are visualized by Giménez staining. All isolates, although to variable degrees, are sensitive to all four drugs. The number of chlamydial inclusions decreases gradually over a broad range of increasing concentrations of the drugs. The variation in the number of inclusions between isolates is remarkably high for chlortetracycline less for doxycycline and minimal for both fluoroquinolones, the enrofloxacin and difloxacin. The decline in numbers of inclusions is highly dose-dependend and the observed reduction stretches over a wide range of drug dilutions. Therefore, it is proposed to calculate drug sensitivity values in terms of inhibitory concentration 50%, (IC5). Its calculation includes all tested drug dilutions instead of the hitherto more common minimal inhibitory concentration, MIC, which is based on results of serial dilution tests for cell-free growing bacteria. Using a logistic regression model for the calculation of the inhibitory concentration 50% of all 20 chlamydial isolates, the IC50 is 0.807 microg/ml for tetracycline, 0.497 microg/ml for doxycycline, 0.180 microg/ml for enrofloxacin and 0.168 microg/ml for difloxacin. Complete prevention of inclusion formation was already seen for enrofloxacin at a concentration of 1.0 microg/ml in 12 out of 20 and for

  11. Electrically-responsive anti-adherent hydrogels for photodynamic antimicrobial chemotherapy.

    Science.gov (United States)

    Fallows, Steven J; Garland, Martin J; Cassidy, Corona M; Tunney, Michael M; Singh, Thakur Raghu Raj; Donnelly, Ryan F

    2012-09-01

    The loading of the photosensitisers meso-Tetra (N-methyl-4-pyridyl) porphine tetra tosylate (TMP), methylene blue (MB) and TMP with sodium dodecyl sulphate (SDS) into and release from hydrogels composed of the polyelectrolyte poly(methyl vinyl ether-co-maleic acid) crosslinked in a 2:1 ratio with PEG 10,000 were investigated as a potential rapid photodynamic antimicrobial chemotherapy (PACT) treatment for infected wounds using iontophoresis as a novel delivery method. Photosensitiser uptake was very high; (% TMP uptake; 95.53-96.72%) (% MB uptake; 90.58-93.26%) and was PMVE/MA concentration independent, whilst SDS severely limited TMP uptake (5.93-8.75%). Hydrogel hardness, compressibility and adhesiveness on the dermal surface of neonate porcine skin increased with PMVE/MA concentration and were significantly increased with SDS. The ionic conductivities of the hydrogels increased with PMVE/MA concentration. Drug release was PMVE/MA concentration independent, except for drug release under iontophoteric conditions for MB and TMP (without SDS). In just 15 min, the mean% drug concentrations released of TMP, TMP (with SDS) and MB using an electric current ranged from 22.30 to 64.72 μg ml(-1), 6.37-4.59 μg ml(-1) and 11.73-36.57 μg ml(-1) respectively. These concentrations were in excess of those required to induce complete kill of clinical strains of meticillin-resistant Staphylococcus aureus and Burkholderia cepacia. Thus these results support our contention that the iontophoteric delivery of TMP and MB using anti-adherent, electrically-responsive, PEG-crosslinked PMVE/MA hydrogels are a potential option in the rapid PACT treatment of infected wounds.

  12. Absolute quantification of the total and anti-drug antibody-bound concentrations of recombinant human α-glucosidase in human plasma using protein-G extraction and LC-MS/MS

    NARCIS (Netherlands)

    Bronsema, Kees J; Bischoff, Rainer; Pijnappel, W W M Pim; Ploeg, Ans T van der; van de Merbel, Nico C

    2015-01-01

    The administration of protein-based pharmaceuticals can cause the in vivo formation of anti-drug antibodies (ADAs) which may reduce the efficacy of the therapy by binding to the protein drug. An accurate determination of the total and ADA-bound concentrations of the drug gives information on the ext

  13. Benzodiazepine whole blood concentrations in cases with positive oral fluid on-site screening test results using the DrugWipe(®) single for benzodiazepines.

    Science.gov (United States)

    Blencowe, Tom; Vimpari, Kari; Lillsunde, Pirjo

    2011-07-01

    Reliable on-site oral fluid screening devices are a useful and convenient means of policing traffic. In Finland, benzodiazepines represent a particular challenge to traffic safety. This study presents a retrospective examination of toxicological analysis results from whole blood in cases which gave a positive screening result for benzodiazepines in oral fluid using the DrugWipe Single device (Securetec). Use of oral fluid on-site screening tests and blood confirmation analyses reflects the real situation in many countries. The data were compiled from the databases of Alcohol and Drug Analytics Unit at the National Institute for Health and Welfare. Confirmation analysis results in whole blood were obtained using gas chromatography-mass spectrometry. Data were from 224 real cases in which the Finnish police had conducted a DrugWipe Single benzodiazepines test on drivers suspected of driving under the influence of drugs (DUID). The benzodiazepine concentrations encountered in positive oral fluid screening cases in this study indicate that the device is able to detect these substances even at relatively low levels. However, the DrugWipe device does not enable any distinction between therapeutic use and harmful use of benzodiazepines at higher doses.

  14. Drug adherence and multidisciplinary care in patients with multiple sclerosis: Protocol of a prospective, web-based, patient-centred, nation-wide, Dutch cohort study in glatiramer acetate treated patients (CAIR study)

    NARCIS (Netherlands)

    P.J. Jongen (Peter); G. Hengstman (Gerald); R. Hupperts (Raymond); H. Schrijver (Hans); J. Gilhuis (Job); J.H. Vliegen (Joseph); E. Hoogervorst (Erwin); M. van Huizen (Marc); E. van Munster (Eric); J. Samijn (Johnny); E.L.L.M. de Schryver (Els); T.A.M. Siepman (Theodora); M. Tonk (Martijn); E. Zandbergen (Eveline); J. ten Holter (Jacques); R. van der Kruijk (Ruud); G.F. Borm (George Florimond)

    2011-01-01

    textabstractBackground: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, for which no definitive treatment is available. Most patients start with a relapsing-remitting course (RRMS). Disease-modifying drugs (DMDs) reduce relapses and disability p

  15. Drug adherence and multidisciplinary care in patients with multiple sclerosis: protocol of a prospective, web-based, patient-centred, nation-wide, Dutch cohort study in glatiramer acetate treated patients (CAIR study).

    NARCIS (Netherlands)

    Jongen, P.J.H.; Hengstman, G.J.D.; Hupperts, R.; Schrijver, H.; Gilhuis, J.; Vliegen, J.H.; Hoogervorst, E.; Huizen, M. van; Munster, E. van; Samijn, J.; Schryver, E. de; Siepman, T.; Tonk, M.; Zandbergen, E.; Holter, J. ten; Kruijk, R. van der; Borm, G.F.

    2011-01-01

    BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, for which no definitive treatment is available. Most patients start with a relapsing-remitting course (RRMS). Disease-modifying drugs (DMDs) reduce relapses and disability progression.

  16. Coupled gel spreading and diffusive transport models describing microbicidal drug delivery

    Science.gov (United States)

    Funke, Claire; MacMillan, Kelsey; Ham, Anthony S.; Szeri, Andrew J.; Katz, David F.

    2016-11-01

    Gels are a drug delivery platform being evaluated for application of active pharmaceutical ingredients, termed microbicides, that act topically against infection by sexually transmitted HIV. Despite success in one Phase IIb trial of a vaginal gel delivering tenofovir, problems of user adherence to designed gel application regimen compromised results in two other trials. The microbicide field is responding to this issue by simultaneously analyzing behavioral determinants of adherence and pharmacological determinants of drug delivery. Central to both user adherence and mucosal drug delivery are gel properties (e.g. rheology) and applied volume. The specific problem to be solved here is to develop a model for how gel rheology and volume, interacting with loaded drug concentration, govern the transport of the microbicide drug tenofovir into the vaginal mucosa to its stromal layer. The analysis here builds upon our current understanding of vaginal gel deployment and drug delivery, incorporating key features of the gel's environment, fluid production and subsequent gel dilution, and vaginal wall elasticity. We consider the microbicide drug tenofovir as it is the most completely studied drug, in both in vitroand in vivostudies, for use in vaginal gel application. Our goal is to contribute to improved pharmacological understanding of gel functionality, providing a computational tool that can be used in future vaginal microbicide gel design.

  17. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  18. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil.

    Science.gov (United States)

    Campos, Lorenza Nogueira; Guimarães, Mark Drew Crosland; Remien, Robert H

    2010-04-01

    Depression and anxiety are common among HIV-infected people and rank among the strongest predictors of non-adherence to antiretroviral therapy (ART). This longitudinal study aimed to assess whether symptoms of anxiety and depression are predictors of non-adherence among patients initiating ART at two public referral centers (n = 293) in Belo Horizonte, Brazil. Prevalence of severe anxiety and depression symptoms before starting ART was 12.6% and 5.8%, respectively. Severe anxiety was a predictor of non-adherence to ART during follow-up period (RH = 1.87; 95% CI = 1.14-3.06) adjusted for low education, unemployment, alcohol use in the last month and symptoms of AIDS; while a history of injection drug use had borderline statistical significance with non-adherence. These findings suggest that using a brief screening procedure to assess anxiety and depression symptoms before initiating ART help identify individuals for interventions to improve adherence and quality of life.

  19. Response of Plasmodium falciparum to cotrimoxazole therapy: relationship with plasma drug concentrations and dihydrofolate reductase and dihydropteroate synthase genotypes

    DEFF Research Database (Denmark)

    Khalil, Insaf F; Rønn, Anita M; Alifrangis, Michael;

    2005-01-01

    , MSP-1, MSP-2, and glutamate-rich protein before treatment and upon recrudescence showed that all recurring parasites were recrudescences. The plasma levels of TRM, AcSMX, and SMX indicated adequate drug absorption in all patients. This suggests parasite resistance as a cause of treatment failure...... treatment and at days 3, 7, and 14 or upon recrudescence to ascertain drug absorption. Forty patients (89%) had an adequate clinical response, one patient (2%) had an early treatment failure response, while four patients (8%) showed late treatment failure responses. Genotyping of merozoite surface protein 1....... The presence of dhfr Ile 51 and Asn 108 alone or coupled with dhps Ala-436 among parasites that were cleared after treatment indicates that these alleles alone are insufficient to cause in vivo resistance. However, the presence of the triple mutant dhfr (Ile-51/Arg-59/Asn-108) with the dhps Gly-437 genotype...

  20. Primary medication non-adherence after discharge from a general internal medicine service.

    Directory of Open Access Journals (Sweden)

    Brooks A Fallis

    Full Text Available BACKGROUND: Medication non-adherence frequently leads to suboptimal patient outcomes. Primary non-adherence, which occurs when a patient does not fill an initial prescription, is particularly important at the time of hospital discharge because new medications are often being prescribed to treat an illness rather than for prevention. METHODS: We studied older adults consecutively discharged from a general internal medicine service at a large urban teaching hospital to determine the prevalence of primary non-adherence and identify characteristics associated with primary non-adherence. We reviewed electronic prescriptions, electronic discharge summaries and pharmacy dispensing data from April to August 2010 for drugs listed on the public formulary. Primary non-adherence was defined as failure to fill one or more new prescriptions after hospital discharge. In addition to descriptive analyses, we developed a logistical regression model to identify patient characteristics associated with primary non-adherence. RESULTS: There were 493 patients eligible for inclusion in our study, 232 of whom were prescribed new medications. In total, 66 (28% exhibited primary non-adherence at 7 days after discharge and 55 (24% at 30 days after discharge. Examples of medications to which patients were non-adherent included antibiotics, drugs for the management of coronary artery disease (e.g. beta-blockers, statins, heart failure (e.g. beta-blockers, angiotensin converting enzyme inhibitors, furosemide, stroke (e.g. statins, clopidogrel, diabetes (e.g. insulin, and chronic obstructive pulmonary disease (e.g. long-acting bronchodilators, prednisone. Discharge to a nursing home was associated with an increased risk of primary non-adherence (OR 2.25, 95% CI 1.01-4.95. CONCLUSIONS: Primary non-adherence after medications are newly prescribed during a hospitalization is common, and was more likely to occur in patients discharged to a nursing home.

  1. How payment scheme affects patients’ adherence to medications? A systematic review

    Science.gov (United States)

    Aziz, Hamiza; Hatah, Ernieda; Makmor Bakry, Mohd; Islahudin, Farida

    2016-01-01

    Background A previous systematic review reported that increase in patients’ medication cost-sharing reduced patients’ adherence to medication. However, a study among patients with medication subsidies who received medication at no cost found that medication nonadherence was also high. To our knowledge, no study has evaluated the influence of different medication payment schemes on patients’ medication adherence. Objective This study aims to review research reporting the influence of payment schemes and their association with patients’ medication adherence behavior. Methods This study was conducted using systematic review of published articles. Relevant published articles were located through three electronic databases Medline, ProQuest Medical Library, and ScienceDirect since inception to February 2015. Included articles were then reviewed and summarized narratively. Results Of the total of 2,683 articles located, 21 were included in the final analysis. There were four types of medication payment schemes reported in the included studies: 1) out-of-pocket expenditure or copayments; 2) drug coverage or insurance benefit; 3) prescription cap; and 4) medication subsidies. Our review found that patients with “lower self-paying constraint” were more likely to adhere to their medication (adherence rate ranged between 28.5% and 94.3%). Surprisingly, the adherence rate among patients who received medication as fully subsidized was similar (rate between 34% and 84.6%) as that of other payment schemes. The studies that evaluated patients with fully subsidized payment scheme found that the medication adherence was poor among patients with nonsevere illness. Conclusion Although medication adherence was improved with the reduction of cost-sharing such as lower copayment, higher drug coverage, and prescription cap, patients with full-medication subsidies payment scheme (received medication at no cost) were also found to have poor adherence to their medication. Future

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

    Science.gov (United States)

    Diez-Perez, A; Naylor, K E; Abrahamsen, B; Agnusdei, D; Brandi, M L; Cooper, C; Dennison, E; Eriksen, E F; Gold, D T; Guañabens, N; Hadji, P; Hiligsmann, M; Horne, R; Josse, R; Kanis, J A; Obermayer-Pietsch, B; Prieto-Alhambra, D; Reginster, J-Y; Rizzoli, R; Silverman, S; Zillikens, M C; Eastell, R

    2017-03-01

    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.

  3. Evaluation of a pilot study to influence medication adherence of patients with diabetes mellitus type-2 by the pharmacy.

    NARCIS (Netherlands)

    Adhien, P.; Dijk, L. van; Vegter, M. de; Westein, M.; Nijpels, G.; Hugtenburg, J.G.

    2013-01-01

    Background: Interventions aimed to increase adherence to drug treatment usually are not tailored to the needs of individual patients. A modular pharmacy intervention, named ‘Support for Diabetes’, was developed to improve adherence to type 2 diabetes treatment. Objective: To evaluate the implementat

  4. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review

    NARCIS (Netherlands)

    Heestermans, Tessa; Browne, Joyce L; Aitken, Susan C; Vervoort, Sigrid C; Klipstein-Grobusch, Kerstin

    2016-01-01

    Objective The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of pa

  5. Differentiation of cellular processes involved in the induction and maintenance of stimulated neutrophil adherence.

    Science.gov (United States)

    English, D; Gabig, T G

    1986-05-01

    Neutrophil adherence stimulated by phorbol myristate acetate (PMA) was investigated by quantitating the attachment of 51Cr-labeled neutrophils to plastic surfaces and to the endothelium of umbilical veins mounted in compartmentalized Lucite chambers. PMA-induced adherence could be functionally separated into an induction phase requiring cellular metabolism and a Mg++ dependent maintenance phase that was independent of cellular metabolism. Thus, metabolic inhibitors (N-ethylmaleimide, 2-deoxyglucose) blocked adherence when added to neutrophils prior to PMA, but did not cause detachment of cells adhering as a consequence of prior exposure to PMA. PMA failed to induce adherence of neutrophils incubated at low (0.4 degree C) temperature, but temperature reduction, even for prolonged periods, did not cause detachment of adherent cells. Thus, the attractive forces that mediate stimulated adherence persist independently of any sustained metabolic response to the inducing stimulus. However, removal of Mg++ from the media above adherent cells resulted in immediate detachment, indicating that the cation was required for the persistent expression or maintenance of the attractive forces involved. The extent of stimulated adherence correlated well with the extent of degranulation when rates were varied by limiting the incubation time or stimulus concentration. This correlation was not absolute; in the absence of Mg++, PMA induced degranulation normally but failed to enhance adherence. To explain these findings, we investigated the possibility that PMA-stimulated adherence was maintained by Mg++-dependent cellular adherence molecules released during exocytosis. Supernatants of stimulated neutrophils were devoid of adherence-promoting activity, and only weak activity was recovered in supernatants of mechanically disrupted neutrophils. PMA effectively stimulated the tight adherence of degranulated neutrophil cytoplasts to plastic surfaces and did so in the absence of stimulated

  6. Pharmacokinetics of fluconazole in cerebrospinal fluid and serum of rabbits: validation of an animal model used to measure drug concentrations in cerebrospinal fluid.

    Science.gov (United States)

    Madu, A; Cioffe, C; Mian, U; Burroughs, M; Tuomanen, E; Mayers, M; Schwartz, E; Miller, M

    1994-09-01

    Complete concentration-time data describing the pharmacokinetics of fluconazole in the cerebrospinal fluid (CSF) following a single dose are not available for humans or animals. We studied the pharmacokinetics of fluconazole with an indwelling intracisternal needle as described by R.G. Dacey and M.A. Sande (Antimicrob. Agents Chemother. 6:437-441, 1974). To determine whether the presence of an intracisternal needle alters pharmacokinetics in the CSF, we validated this model with uninfected rabbits by measuring pharmacokinetic constants following direct intracisternal and intravenous administration of fluconazole. Following direct injection, there was no alteration of elimination rates in the CSF with increasing sample number or time. Following intravenous administration, the penetration and kinetic constants were the same in individual animals from which multiple CSF samples were obtained as in a composite subject constructed by pooling virgin samples from different animals. The presence of the intracisternal needle did not alter CSF chemistry or leukocyte counts, and erythrocyte contamination was < 0.001%. While drug concentrations were measured by a microbiological assay, we also compared the sensitivity and reproducibility of a high-performance liquid chromatography (HPLC) assay with those of the microbiological assay. Following a single intravenous dose, the maximum concentration of the drug in serum, the time to maximum concentration of the drug in serum, the terminal elimination half-life in the CSF, and the percent penetration by fluconazole were 6.12 micrograms/ml, 1 h, 9.0 h, and 84.3%, respectively. We conclude that the sampling of CSF via an indwelling needle does not alter fluconazole pharmacokinetics, cause inflammation, or alter chemical parameters; that the microbiological assay is at least equivalent in sensitivity and reproducibility to the HPLC assay; and that robust parameters describing the pharmacokinetics of fluconazole are possible with this

  7. Do patients initiate therapy? Primary non-adherence to statins and antidepressants in Iceland

    DEFF Research Database (Denmark)

    Thengilsdõttir, G.; Pottegård, A.; Halldõrsson, M.;

    2015-01-01

    Background Primary non-adherence occurs when a drug has been prescribed but the patient fails to have it dispensed at the pharmacy. Aims To assess primary non-adherence to statins and antidepressants in Iceland, the association of demographic factors with primary non-adherence, and the time from...... when a prescription is issued until it is dispensed. Methods Data on patients receiving a new prescription for a statin or an antidepressant from the Primary Health Care database were linked with dispensing histories from The Icelandic Prescription Database. The proportion of patients who did not have.......0% for statins and antidepressants, respectively. The majority of patients had their prescription dispensed within 7 days (85% for statins, 87% for antidepressants). Being disabled and receiving a prescription for an expensive drug was associated with higher rates of primary non-adherence. Conclusion The rate...

  8. Importance of doctor-patient relationship for patient adherence with medication regimes

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Vedsted, Peter

    Aim: It has been supposed that the relation between the doctor and the patient has implications for the adherence to medication. This study explores the effect of patient reported doctor-patient relationship on patient adherence with medication regiments. Methods: Design: Prospective cohort study...... of patients' evaluation of the doctor-patient-relation and adherence with new medication regimens. Setting: Primary care in Ringkjoebing County, Denmark in 2004. Participants: 10,972 patients aged 18 and over who had been consulting within a 3-month period evaluated 115 primary care physicians (PCPs) in 48...... not have any drug prescriptions one year prior to the evaluation and had at least one new drug prescription for chronic conditions (statins, antihypertensives, SSRI/SNRI, oral antidiabetics) in the year after the evaluation were included as incident, new users of this medication.   The adherence...

  9. Tuberculosis treatment adherence and fatality in Spain

    Directory of Open Access Journals (Sweden)

    Vidal Rafael

    2009-12-01

    Full Text Available Abstract Background The adherence to long tuberculosis (TB treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment. Methods Prospective study of a large cohort of TB cases diagnosed during 2006-2007 by 61 members of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR. Predictive factors of completion outcome (cured plus completed treatment vs. defaulters plus lost to follow-up and fatality (died vs. the rest of patients were based on logistic regression, calculating odds ratios (OR and 95% confidence intervals (CI. Results Of the 1490 patients included, 29.7% were foreign-born. The treatment outcomes were: cured 792 (53.2%, completed treatment 540 (36.2%, failure 2 (0.1%, transfer-out 33 (2.2%, default 27 (1.8%, death 27 (1.8%, lost to follow-up 65 (4.4%, other 4 (0.3%. Completion outcome reached 93.5% and poor adherence was associated with: being an immigrant (OR = 2.03; CI:1.06-3.88, living alone (OR = 2.35; CI:1.05-5.26, residents of confined institutions (OR = 4.79; CI:1.74-13.14, previous treatment (OR = 2.93; CI:1.44-5.98, being an injecting drug user (IDU (OR = 9.51; CI:2.70-33.47 and treatment comprehension difficulties (OR = 2.93; CI:1.44-5.98. Case fatality was 1.8% and it was associated with the following variables: age 50 or over (OR = 10.88; CI:1.12-105.01, retired (OR = 12.26;CI:1.74-86.04, HIV-infected (OR = 9.93; CI:1.48-66.34, comprehension difficulties (OR = 4.07; CI:1.24-13.29, IDU (OR = 23.59; CI:2.46-225.99 and Directly Observed Therapy (DOT (OR = 3.54; CI:1.07-11.77. Conclusion Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required

  10. Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study.

    Directory of Open Access Journals (Sweden)

    Sharada P Wasti

    Full Text Available BACKGROUND: Antiretroviral therapy (ART is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV and Acquired Immune Deficiency Syndrome (AIDS. Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. METHODS: A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. RESULTS: A total of 282 (85.5% respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014; alcohol use (OR = 12.89, p = 1 hour (OR = 2.84, p = 0.035. Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription, followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. CONCLUSION: Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop

  11. Adherence and neurocognitive screening in Romanian HIV patients

    Directory of Open Access Journals (Sweden)

    M Arbune

    2012-11-01

    Full Text Available Background: Adherence is critical for the effectiveness of antiretroviral HIV therapy (ART, accordingly decreasing the opportunistic diseases and increasing the quality of life. Neurocognitive disorders (NCD are still frequent in ART era and could impair the adherence, but how ethical is to refer ART in patients with NCD? Objective: To assess the relation between NCD and adherence in HIV Romanian patients. Material and methods: Cross-sectional screening study on 151 patients under ART, no drug users, from HIV Clinic - Galati, assessed by HIV-Associated Dementia Scale (HDS, Hospital Anxiety and Depression Scale (HADS [1], ART CNS-effectiveness Letendre scores [2] and adherence assessment questionnaire CNLAS- Romania. Normal values: HDS >10; anxiety/ depression <8. Statistical analysis performed: Chi-square test and Mann-Whitney test, with 5% significance level. Results: Characteristics of the patients: median age 22 [20; 56] years old; sex ratio F/M 1.17; median educational level 8 [0; >12] years; HBV co-infection 27.8%; AIDS stage 85.3%; current median CD4 526/mm3 [8; 1605] and 65% undetectable HIV-RNA levels. 49.6% (75/151 patients attain HDS scores <10 and imply probable NCD. Scores below 8 for anxiety are more frequent than for depression: 24% vs 13%. The median ART CNS penetration score is 8 [5; 12]. Adherence is considered for 66% patients and is correlating with CD4 number (p=0.001, educational level >4 years (p=0.001; OR=4.2, HDS >10 (p=0.01; OR=2.4 and ART-CNS penetration score >7 (p=0.023; OR=2.4. Low HDS are influenced by old age (p=0.003, depression (p=0.02 and ART-CNS penetration scores <7 (p=0.01. Anxiety is related neither with adherence nor with NCD by HDS, but females are obvious anxious than males (p<0.001. Conclusions: Basic educational level is sufficient for developing ART adherence. High scores of HDS screening should be predictors for ART adherence. Referring ART as well to patients with low HDS scores is rational and

  12. Determinants of Antiretroviral Therapy Adherence among Women in Southern Malawi: Healthcare Providers' Perspectives.

    Science.gov (United States)

    McKinney, Ogbochi; Modeste, Naomi N; Lee, Jerry W; Gleason, Peter C; Maynard-Tucker, Gisele

    2014-01-01

    Background. The purpose of this study was to explore healthcare providers' perspectives on antiretroviral (ART) adherence in two ART clinics in southern Malawi. Nonadherence to ART is a significant hindrance to the success of HIV/AIDS treatment. Methods. A one-on-one semistructured interview was conducted with eight healthcare providers in two ART clinics in rural and urban southern Malawi. The interviews were focused on factors facilitating or hindering ART adherence and strategies to improve adherence. Interviews were audio-recorded, transcribed, and content-analyzed with the use of the constant comparison approach. Results. Of the eight participants, 63% were between the ages of 20 and 30 years and 37% were HIV counselors. Factors facilitating adherence include patients' belief and knowledge, HIV/AIDS education, and a supportive network. Barriers to adherence include discrimination, nondisclosure of HIV status, food insecurity, medication side effects, religion, misinformation, and staff and drug shortages. Strategies to improve adherence were identified by participants to include nutritional/food supplementation for malnourished or undernourished patients and patient counseling. Conclusions. There is a need for collaborative efforts between healthcare providers, patients, and faith-based organizations to identify and address hindrances and facilitators to patients' adherence. Further research is needed to develop strategies addressing religion, staff, and drug shortages.

  13. Determinants of Antiretroviral Therapy Adherence among Women in Southern Malawi: Healthcare Providers’ Perspectives

    Directory of Open Access Journals (Sweden)

    Ogbochi McKinney

    2014-01-01

    Full Text Available Background. The purpose of this study was to explore healthcare providers’ perspectives on antiretroviral (ART adherence in two ART clinics in southern Malawi. Nonadherence to ART is a significant hindrance to the success of HIV/AIDS treatment. Methods. A one-on-one semistructured interview was conducted with eight healthcare providers in two ART clinics in rural and urban southern Malawi. The interviews were focused on factors facilitating or hindering ART adherence and strategies to improve adherence. Interviews were audio-recorded, transcribed, and content-analyzed with the use of the constant comparison approach. Results. Of the eight participants, 63% were between the ages of 20 and 30 years and 37% were HIV counselors. Factors facilitating adherence include patients’ belief and knowledge, HIV/AIDS education, and a supportive network. Barriers to adherence include discrimination, nondisclosure of HIV status, food insecurity, medication side effects, religion, misinformation, and staff and drug shortages. Strategies to improve adherence were identified by participants to include nutritional/food supplementation for malnourished or undernourished patients and patient counseling. Conclusions. There is a need for collaborative efforts between healthcare providers, patients, and faith-based organizations to identify and address hindrances and facilitators to patients’ adherence. Further research is needed to develop strategies addressing religion, staff, and drug shortages.

  14. Noninfectious uveitis: strategies to optimize treatment compliance and adherence

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    Dolz-Marco R

    2015-08-01

    Full Text Available Rosa Dolz-Marco,1 Roberto Gallego-Pinazo,1 Manuel Díaz-Llopis,2 Emmett T Cunningham Jr,3–6 J Fernando Arévalo7,8 1Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, 2Faculty of Medicine, University of Valencia, Spain; 3Department of Ophthalmology, California Pacific Medical Center, San Francisco, 4Department of Ophthalmology, Stanford University School of Medicine, Stanford, 5The Francis I Proctor Foundation, University of California San Francisco Medical Center, 6West Coast Retina Medical Group, San Francisco, CA, USA; 7Vitreoretina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 8Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Noninfectious uveitis includes a heterogenous group of sight-threatening ocular and systemic disorders. Significant progress has been made in the treatment of noninfectious uveitis in recent years, particularly with regard to the effective use of corticosteroids and non-corticosteroid immunosuppressive drugs, including biologic agents. All of these therapeutic approaches are limited, however, by any given patient’s ability to comply with and adhere to their prescribed treatment. In fact, compliance and adherence are among the most important patient-related determinants of treatment success. We discuss strategies to optimize compliance and adherence. Keywords: noninfectious uveitis, intraocular inflammation, immunosuppressive treatment, adherence, compliance, therapeutic failure

  15. Adherence to Medication among Older Israeli Arabs: a Cross-Sectional Study

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    Merav Ben-Natan

    2013-01-01

    Full Text Available Objective.  To identify the factors that affect adherence to medication among older persons aged 65 and older in the Arab sector using an extended Theory of Reasoned Action. Design, Sample: A Cross-sectional questionnaire survey was conducted among convenience sample of 200 older persons in Israel aged 65 and older from the Israeli Arab sector who use prescription drugs. Measurments: The questionnaire was prepared by the researchers based on the literature review and the extended research model. Results. Research findings indicate that 80.5% of respondents fully adhere to medication. Respondents believe that medication is important and must be adhered to and they attribute much significance to the effect of significant others (physician, children on medication adherence. Moreover, adherence was found to decline with the rise in number of medications. Adherence also rises with lower functioning of respondents, who consequently receive more assistance with daily activities.  Conclusion.  The present study supports the use of an extended psychosocial theory for identifying factors affecting the medication adherence of older Arabs. It is very important to assess older persons' adherence to medication. Reevaluation of the number of medications prescribed, sources of assistance, and guidance for proper administration of medications, should be considered.

  16. A 36 months, Danish multicenter, open-label, study to investigate adherence, treatment satisfaction, motivation and quality of life in RRMS patients treated with fingolimod

    DEFF Research Database (Denmark)

    Schreiber, Karen; Kant, Matthias; Pfleger, Claudia

    . Differences in treatment adherence to various disease modifying drugs in the treatment of MS are not well understood and the impact of treatment satisfaction, motivation and quality of life on treatment adherence is infrequently investigated. Lack of adherence or even treatment discontinuation may be a result...... in treatment adherence to various disease modifying drugs in the treatment of MS are not well understood and the impact of treatment satisfaction, motivation and quality of life on treatment adherence is infrequently investigated. Lack of adherence or even treatment discontinuation may be a result of patient...... extend treatment satisfaction, motivation and Quality of Life influence adherence in Danish patients with RRMS. Methods The study was conducted in Denmark from May 2013 to May 2016 at 8 out of 10 possible MS clinics. A total of 195 MS patients treated with fingolimod were included in the study over...

  17. Revisiting the internal consistency and factorial validity of the 8-item Morisky Medication Adherence Scale

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    Arsène Zongo

    2016-10-01

    Full Text Available Objective: To assess the internal consistency and factorial validity of the adapted French 8-item Morisky Medication Adherence Scale in assessing adherence to noninsulin antidiabetic drug treatment. Study Design and Setting: In a cross-sectional web survey of individuals with type 2 diabetes of the Canadian province of Quebec, self-reported adherence to the antidiabetes drug treatment was measured using the Morisky Medication Adherence Scale-8. We assessed the internal consistency of the Morisky Medication Adherence Scale-8 with Cronbach’s alpha, and factorial validity was assessed by identifying the underlying factors using exploratory factor analyses. Results: A total of 901 individuals completed the survey. Cronbach’s alpha was 0.60. Two factors were identified. One factor comprised five items: stopping medication when diabetes is under control, stopping when feeling worse, feeling hassled about sticking to the prescription, reasons other than forgetting and a cross-loading item (i.e. taking drugs the day before. The second factor comprised three other items that were all related to forgetfulness in addition to the cross-loading item. Conclusion: Cronbach’s alpha of the adapted French Morisky Medication Adherence Scale-8 was below the acceptable value of 0.70. This observed low internal consistency of the scale is probably related to the causal nature of the items of the scale but not necessarily a lack of reliability. The results suggest that the adapted French Morisky Medication Adherence Scale-8 is a two-factor scale assessing intentional (first factor and unintentional (second factor non-adherence to the noninsulin antidiabetes drug treatment. The scale could be used to separately identify these outcomes using scores obtained on each of the sub-scales.

  18. Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Christensen, Ib Jarle; Tarp, Ulrik;

    2010-01-01

    OBJECTIVE: To compare tumor necrosis factor alpha inhibitors directly regarding the rates of treatment response, remission, and the drug survival rate in patients with rheumatoid arthritis (RA), and to identify clinical prognostic factors for response. METHODS: The nationwide DANBIO registry...... collects data on rheumatology patients receiving routine care. For the present study, we included patients from DANBIO who had RA (n = 2,326) in whom the first biologic treatment was initiated (29% received adalimumab, 22% received etanercept, and 49% received infliximab). Baseline predictors of treatment...

  19. Factors associated with low adherence to medicine treatment for chronic diseases in Brazil

    Science.gov (United States)

    Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal

    2016-01-01

    ABSTRACT OBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. PMID:27982378

  20. Drugs use by adolescents and their perceptions about specialized treatment adherence and dropout Uso de drogas por adolescentes: sus percepciones sobre adhesión y el abandono del tratamiento especializado O uso de drogas por adolescentes e suas percepções sobre adesão e abandono de tratamento especializado

    Directory of Open Access Journals (Sweden)

    Gabriela Pereira Vasters

    2011-04-01

    Full Text Available Drugs use in adolescence is an important issue to be discussed, due to the early damage it causes. This study investigated adolescent drugs use, ranging from the first trial to perceptions about treatment adherence. Based on qualitative research, the researchers aimed to understand the problem from the subjects’ viewpoint. Data were analyzed through thematic categorization. Fourteen teenagers were interviewed: mostly males, 14 to 19 years old and low education. Marijuana was the most used drug upon the first trial. Friends, free time and "parties" favored drugs use. Teenagers also used drugs to escape from conflicts and feelings. Different intrinsic and extrinsic factors were reported as favorable to treatment adherence and dropout. The findings can contribute to establish therapeutic intervention proposals for adolescent drug users.El uso de drogas en la adolescencia es una cuestión importante a ser debatida por los perjuicios ocasionados precozmente. El estudio objetivó conocer el uso de drogas entre adolescentes, partiendo del inicio del uso hasta las percepciones sobre la adhesión al tratamiento. Basándose en la investigación cualitativa, se buscó comprender los aspectos citados desde el punto de vista de los sujetos. Los datos fueron analizados por categorización temática. Catorce adolescentes fueron entrevistados, la mayoría era del sexo masculino, con edad entre 14 a 19 años y baja escolaridad. La marihuana fue la droga más utilizada en la primera experiencia. Amigos, tiempo libre y "fiestas" favorecieron la aproximación con las drogas; estas también fueron utilizadas por los adolescentes como fuga de los conflictos y sentimientos. Diferentes aspectos intrínsecos y extrínsecos fueron referidos como favorables a la adhesión o al abandono del tratamiento. Los hallazgos pueden contribuir en la elaboración de propuestas de intervenciones terapéuticas direccionadas a adolescentes usuarios de drogas.O uso de drogas na

  1. Monitoring the concentrations of nonsteroidal anti-inflammatory drugs and cyclooxygenase-inhibiting activities in the surface waters of the Tone Canal and Edo River Basin.

    Science.gov (United States)

    Nishi, Iwaki; Kawakami, Tsuyoshi; Onodera, Sukeo

    2015-01-01

    Environmental pollution by pharmaceuticals has become a major problem in many countries worldwide. However, little is known about the concentrations of pharmaceuticals in water sources in Japan. The objective of this study was to clarify variations in the concentrations of seven nonsteroidal anti-inflammatory drugs (NSAIDs) and in cyclooxygenase(COX)-inhibiting activities in river water and domestic wastewater collected from the Tone Canal and the Edo River Basin in Japan. Total NSAID concentrations were higher in the Tone Canal than in the Edo River, and the highest concentration was observed at the domestic wastewater inflow point located in the Tone Canal (concentration averages of salicylic acid, ibuprofen, felbinac, naproxen, mefenamic acid, diclofenac, and ketoprofen in wastewater samples were 55.3, 162.9, 39.7, 11.8, 30.8, 259.7, and 48.3 ng L(-1), respectively). Gas chromatography-tandem mass spectrometry showed that wastewater samples collected during cooler seasons contained higher levels of COX-inhibiting activity. COX-inhibiting activities were highly correlated with NSAID concentrations (particularly for ketoprofen and diclofenac); however, other COX inhibitors, such as NSAIDs that were not examined in this study and/or other chemicals with COX-inhibiting activity, could exist in the water samples because the concentrations of NSAIDs obtained from the water samples did not account for the total COX-inhibiting activities observed. Therefore, COX inhibition assays may be helpful for evaluating the aquatic toxicity of COX inhibitors. In this study, we demonstrated that COX inhibitors in surface water may influence aquatic organisms more than was expected based on NSAID concentrations. Thus, further studies examining other COX inhibitors in the aquatic environment are necessary.

  2. Adherence to hypertension medication: Quantitative and qualitative investigations in a rural Northern Vietnamese community

    Science.gov (United States)

    Nguyen, Thi-Phuong-Lan; Schuiling-Veninga, Catharina C. M.; Nguyen, Thi Bach Yen; Vu, Thu-Hang; Wright, E. Pamela; Postma, Maarten J.

    2017-01-01

    Objectives The purposes of this study were to assess the adherence to medication of hypertensive patients visiting community health stations in a rural area in Vietnam, to examine the relationship between levels of adherence and cardiovascular risk among hypertensive patients and to further understand factors influencing adherence. Methods This study is part of a prospective one-year study conducted on hypertension management in a population aged 35 to 64 years. Data on age, sex, blood pressure and blood test results were collected at baseline. Cardiovascular risk was based on the Cardiovascular Risk Prediction Model for populations in Asia. To calculate medication adherence, the number of days the drug was taken was divided by the number of days since the first day of the prescription. A threshold of 80% was applied to differentiate between adherence and non-adherence. In-depth interviews were conducted among 18 subjects, including subjects classified as adherent and as non-adherent. Results Among 315 patients analyzed, 49.8% of the patients were adherent. Qualitative investigation revealed discrepancies in classification of adherence and non-adherence based on quantitative analysis and interviews. No significant difference in medication compliance between two cardiovascular disease risk groups (10% risk) was found, also not after controlling for age, sex, and ethnicity (adjusted odds ratio at 1.068; 95% CI: 0.614 to 1.857). The odds of medication adherence in females was 1.531 times higher than in males but the difference was not statistically significant (95% CI: 0.957 to 2.448). Each one-year increase in age resulted in patients being 1.036 times more likely to be compliant (95% CI: 1.002 to 1.072). Awareness of complications related to hypertension was given as the main reason for adherence to therapy. Conclusions Medication adherence rate was relatively low among hypertensive subjects. The data suggest that rather than risk profile, the factor of age should

  3. Strong relationship between oral dose and tenofovir hair levels in a randomized trial: hair as a potential adherence measure for pre-exposure prophylaxis (PrEP.

    Directory of Open Access Journals (Sweden)

    Albert Y Liu

    Full Text Available Pre-exposure prophylaxis (PrEP trials using tenofovir-based regimens have demonstrated that high levels of adherence are required to evaluate efficacy; the incorporation of objective biomarkers of adherence in trial design has been essential to interpretation, given the inaccuracy of self-report. Antiretroviral measurements in scalp hair have been useful as a marker of long-term exposure in the HIV treatment setting, and hair samples are relatively easy and inexpensive to collect, transport, and store for analysis. To evaluate the relationship between dose and tenofovir concentrations in hair, we examined the dose proportionality of tenofovir in hair in healthy, HIV-uninfected adults.A phase I, crossover pharmacokinetic study was performed in 24 HIV-negative adults receiving directly-observed oral tenofovir tablets administered 2, 4, and 7 doses/week for 6 weeks, with a ≥3-week break between periods. Small samples of hair were collected after each six-week period and analyzed for tenofovir concentrations. Geometric-mean-ratios compared levels between each pair of dosing conditions. Intensive plasma pharmacokinetic studies were performed during the daily-dosing period to calculate areas-under-the-time-concentration curves (AUCs.Over 90% of doses were observed per protocol. Median tenofovir concentrations in hair increased monotonically with dose. A log-linear relationship was seen between dose and hair levels, with an estimated 76% (95% CI 60-93% increase in hair level per 2-fold dose increase. Tenofovir plasma AUCs modestly predicted drug concentrations in hair.This study found a strong linear relationship between frequency of dosing and tenofovir levels in scalp hair. The analysis of quantitative drug levels in hair has the potential to improve adherence measurement in the PrEP field and may be helpful in determining exposure thresholds for protection and explaining failures in PrEP trials. Hair measures for adherence monitoring may also

  4. Effects of SULT1A1 Copy Number Variation on Estrogen Concentration and Tamoxifen-Associated Adverse Drug Reactions in Premenopausal Thai Breast Cancer Patients: A Preliminary Study.

    Science.gov (United States)

    Charoenchokthavee, Wanaporn; Ayudhya, Duangchit Panomvana Na; Sriuranpong, Virote; Areepium, Nutthada

    2016-01-01

    Tamoxifen is a pharmacological estrogen inhibitor that binds to the estrogen receptor (ER) in breast cells. However, it shows an estrogenic effect in other organs, which causes adverse drug reactions (ADRs). The sulfotransferase 1A1 (SULT1A1) enzyme encoded by the SULT1A1 gene is involved in estrogen metabolism. Previous research has suggested that the SULT1A1 copy number is linked with the plasma estradiol (E2) concentration. Here, a total of 34 premenopausal breast cancer patients, selected from the Thai Tamoxifen (TTAM) Project, were screened for their SULT1A1 copy number, plasma E2 concentration and ADRs. The mean age was 44.3±11.1 years, and they were subtyped as ER+/ progesterone receptor (PR) + (28 patients), ER+/ PR- (5 patients) and ER-/PR- (1 patient). Three patients reported ADRs, which were irregular menstruation (2 patients) and vaginal discharge (1 patient). Most (33) patients had two SULT1A1 copies, with one patient having three copies. The median plasma E2 concentration was 1,575.6 (IQR 865.4) pg/ml. Patients with ADRs had significantly higher plasma E2 concentrations than those patients without ADRs (p = 0.014). The plasma E2 concentration was numerically higher in the patient with three SULT1A1 copies, but this lacked statistical significance.

  5. Viability of primary osteoblasts after treatment with tenofovir alafenamide: Lack of cytotoxicity at clinically relevant drug concentrations

    Science.gov (United States)

    Callebaut, Christian; Liu, Yang; Babusis, Darius; Ray, Adrian; Miller, Michael; Kitrinos, Kathryn

    2017-01-01

    Tenofovir alafenamide (TAF) is a phosphonoamidate prodrug of the nucleotide HIV reverse transcriptase inhibitor tenofovir (TFV). TAF is approved for the treatment of HIV-1 infection as part of the single-tablet regimen containing elvitegravir, cobicistat, emtricitabine, and TAF. When dosed once-daily, TAF results in approximately 90% lower levels of plasma TFV and a 4-fold increase in intracellular TFV-diphosphate (TFV-DP) in PBMCs compared with the TFV prodrug tenofovir disoproxil fumarate (TDF). Several antiretrovirals, including TDF, have been associated with bone mineral density decreases in patients; the effect of clinically relevant TAF concentrations on primary osteoblast viability was therefore assessed in vitro. Studies in PBMCs determined that a 2-hour TAF exposure at concentrations similar to human plasma Cmax achieved intracellular TFV-DP levels comparable to those observed after the maximum recommended human dose of 25 mg TAF. Comparable intracellular TFV-DP levels were achieved in primary osteoblasts with 2-hour TAF exposure daily for 3 days at concentrations similar to those used for PBMCs (100–400 nM). No change in cell viability was observed in either primary osteoblasts or PBMCs. The mean TAF CC50 in primary osteoblasts after 3 days of daily 2-hour pulses was >500 μM, which is >1033 times higher than the TAF maximum recommended human dose plasma Cmax. In summary, primary osteoblasts were not preferentially loaded by TAF compared with PBMCs, with comparable TFV-DP levels achieved in both cell types. Furthermore, there was no impact on osteoblast cell viability at clinically relevant TAF concentrations. PMID:28182625

  6. LOW ADHERENCE TO TREATMENT AFTER MYOCARDIAL INFARCTION: CAUSES AND WAYS OF ADJUSTMENT CONSIDERING PSYCHO-EMOTIONAL STATE OF PATIENTS

    Directory of Open Access Journals (Sweden)

    E. A. Kuzheleva

    2016-01-01

    Full Text Available Aim. To study the reasons of low adherence to treatment in patients after myocardial infarction as well as methods of its correction considering the mental and emotional state of patients. Material and methods. Patients (n=115 after myocardial infarction registered in "Acute Myocardial Infarction Register» were enrolled into the study. The Moriscos-Green scale was used to determine the degree of adherence to treatment, and psycho-emotional state of patients was assessed by the Hospital Anxiety and Depression Scale (HADS. The special questionnaire was used to study the causes of poor adherence. Results. Only 45% of patients after myocardial infarction have a high commitment to the doctor's recommendations. The main reason for low adherence was forgetfulness (42%. Among other reasons were: fear of side effects (16%; lack of therapeutic effect according to patients' opinion (12%; doubts about the doctor's prescriptions (14%; a large number of prescribed drugs (12%; high cost of drugs (4%. The structure of the causes of poor adherence to treatment varied greatly depending on the psycho-emotional status. Adherence to treatment can be improved by specific physician’s actions (48.5% of patients. At the same time 14% of patients did not want to take drugs for a long time under any circumstances. Conclusion. Adherence to treatment of patients after myocardial infarction deserves attention from doctors. The personalized approach considering patient’s opinion, as well as their specific features, is essential for the development of ways to improve adherence.

  7. 两类药物洗脱支架药物释放曲线对血管壁内药物浓度影响的数值研究%Numerical Study on the Effects of Drug Release Profile of Two Drug -eluting Stents on the Drug Concentration within the Vessel Wall

    Institute of Scientific and Technical Information of China (English)

    吴昊; 蒋文涛; 晏菲; 陈宇; 樊瑜波

    2013-01-01

    研究两类药物释放曲线对血管壁中药物浓度分布的影响,为药物洗脱支架(DES)的优化设计提供依据;建立三维支架-血管模型,采用数值方法分析了雷帕霉素和紫杉醇两种药物释放曲线下血管壁中药物的浓度分布;初始药物释放率的增大会导致初始血管壁内药物浓度的增大,但随着时间的增加,血管壁中的药物浓度均趋于平稳。两种药物释放曲线下血管壁中的药物浓度均是随着时间的变化先增加后减少的,相比来说,雷帕霉素血管壁中的药物浓度随着时间变化的趋势要比紫杉醇血管壁中的药物浓度随着时间变化的趋势平稳,并且雷帕霉素血管壁中的药物浓度分布要比紫杉醇中血管壁中的药物浓度分布均匀。血管壁中药物浓度变化趋势的平稳性以及药物浓度分布的均匀性表明,雷帕霉素药物释放曲线要优于紫杉醇药物释放曲线。%To study the effects of two drug release profiles on the drug concentration for better design of drug -eluting stents (DES).A 3D virtual drug -eluting -vessel stent was modeled,and numerical simulation was used to investigate the drug concentration within the vessel wall at the drug release profile of rapamycin and paclitaxel,The initial drug concentration was increased with initial drug release rate increasing,but over time the drug concentration in the vessel wall would be stabilized.The drug concentrations pro-duced by both drug release profiles were first increased and then decreased with time,and compared with the concentration variation trend of paclitaxel,the concentration variation trend of rapamycin was steadier.In addition,the rapamycin concentration distribution in the vessel wall was more uniform than the paclitaxel concentration distribution.The stability of the drug concentration variation trend and the uniformity of drug concentration within the vessel wall show that rapamycin release profile is

  8. Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Hallas, Jesper; Ravn-Nielsen, Lene Vestergaard

    2016-01-01

    : an adherence questionnaire used in the intervention and a prescription-based measure. METHODS: The development of the intervention was based on adherence and behavioral theories and evidence of effective interventions. This included a focused medication review, a patient interview, and follow-up telephone...... calls. Two tools were used to identify adherence problems: The Drug Adherence Work-up (DRAW) tool and an adherence questionnaire. Process data included drug-related problems (DRPs) with recommendations to the physicians, medication- and lifestyle problems identified at the patient interview, actions......-related and 40% lifestyle-related. In connection with the interview, 528 actions were taken within 8 different categories. MI was a central technique applicable for most problems and was employed in nearly all patients (94%). About half of the patients reported increased focus on lifestyle change, and 21...

  9. Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal

    Directory of Open Access Journals (Sweden)

    Shigdel R

    2014-06-01

    Full Text Available Rajesh Shigdel,1 Elise Klouman,2 Anita Bhandari,2 Luai A Ahmed11Department of Health and Care Sciences, 2Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, NorwayPurpose: There are a high number of HIV-infected patients receiving antiretroviral therapy (ART in the Kathmandu District of Nepal, but information on adherence and factors influencing it are scarce in this population. The present study aimed to estimate ART adherence among HIV-infected patients in the Kathmandu District of Nepal, and to determine the factors associated with ART adherence.Patients and methods: This study included 316 HIV-infected patients attending three ART centers in the Kathmandu District. Information on sociodemographic characteristics, socioeconomic status, and ART use for the previous 7 days was collected via interview. Participants were considered adherent if they reported taking ≥95% of their ART as prescribed. The association between explanatory variables and ART adherence was measured using logistic regression and reported as odds ratios (OR with 95% confidence intervals (CI.Results: Male participants accounted for 64.6% (n=204. Overall ART adherence was 86.7%. ART adherence in men and women were 84.3% and 91.1%, respectively. Age (OR 1.04; 95% CI 1.00–1.09, travel time to ART centers (OR 1.38; 95% CI 1.12–1.71, history of illegal drug use (OR 3.98; 95% CI 1.71–9.24, and adverse effects (OR 4.88; 95% CI 1.09–21.8, were all independently and negatively associated with ART adherence. Use of reminder tools (OR 3.45; 95% CI 1.33–8.91 was independently and positively associated with ART adherence.Conclusion: The observed ART adherence in this study is encouraging. Travel time to ART centers, self-reported adverse effects, illegal drug use, and not using reminder tools were the major determinants of ART adherence. Interventions that take these factors into account could further improve ART

  10. Association between patients' beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

    Directory of Open Access Journals (Sweden)

    Wu P

    2016-06-01

    Full Text Available Ping Wu,1 Naifeng Liu2 1Department of Clinical Pharmacy, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, 2Institute of Cardiovascular Disease, Southeast University Medical School, Nanjing, People’s Republic of China Purpose: The objective of this study was to identify, using the theory of planned behavior (TPB, patients’ beliefs about taking oral antidiabetic drugs (OADs as prescribed, and to measure the correlations between beliefs and medication adherence.Patients and methods: We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8. Spearman’s rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.Results: From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037 was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000, not accepting the disease (P=0.000, ignorance of life-long drug adherence (P=0.038, being busy (P=0.001, or poor memory (P=0.008 were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011.Conclusion: The results indicate that the TPB model could be used to examine adherence to OADs. One

  11. Drug-efflux and target-site gene expression patterns in Haemonchus contortus larvae able to survive increasing concentrations of levamisole in vitro

    Science.gov (United States)

    Sarai, Ranbir S.; Kopp, Steven R.; Coleman, Glen T.; Kotze, Andrew C.

    2014-01-01

    While there is some evidence that changes in nicotinic acetylcholine receptor (nAChR) subunits confer resistance to levamisole in gastrointestinal helminth parasites, the exact nature of the resistance mechanism(s) is unclear. We utilised the presence of a resistant fraction within the Wallangra 2003 isolate of Haemonchus contortus larvae in order to subdivide the population into three subpopulations of larvae able to survive increasing concentrations of the drug. We then measured gene expression levels in the subpopulations and the larval population as a whole, focusing on genes encoding the subunit components of levamisole-sensitive receptors, genes encoding ancillary proteins involved in receptor assembly, and P-glycoprotein (P-gp) genes. The subpopulation surviving the lowest levamisole concentration showed increases of 1.5- to 3-fold in a number of P-gp genes (Hco-pgp-3, -4, -10, and -14) alongside unchanged receptor genes, compared to the whole Wallangra larval population. On the other hand, the subpopulation surviving the intermediate levamisole concentration showed an increase in only a single P-gp (Hco-pgp-14), alongside decreases in some receptor subunit (Hco-unc-63a) and ancillary protein genes (Hco-unc-50, Hco-ric-3.1 and 3.1). The subpopulation surviving the highest levamisole concentration showed further decreases in receptor subunit genes (Hco-unc-63a and Hco-unc-29 paralogs) as well as genes involved in receptor assembly (Hco-unc-74, Hco-unc-50, Hco-ric-3.1 and 3.1), alongside no increased P-gp gene levels. This suggests a biphasic pattern of drug resistance in the larvae of this worm isolate, in which a non-specific P-gp-mediated mechanism confers low levels of resistance, while higher level resistance is due to altered receptor subunit composition as a result of changes in both subunit composition and in the levels of proteins involved in receptor assembly. PMID:25057457

  12. 3D modeling of effects of increased oxygenation and activity concentration in tumors treated with radionuclides and antiangiogenic drugs

    Energy Technology Data Exchange (ETDEWEB)

    Lagerloef, Jakob H.; Kindblom, Jon; Bernhardt, Peter [Department of Radiation Physics, Goeteborg University, Goeteborg 41345 (Sweden); Department of Oncology, Sahlgrenska University Hospital, Goeteborg 41345 (Sweden); Department of Radiation Physics, Goeteborg University, Goeteborg, Sweden and Department of Nuclear Medicine, Sahlgrenska University Hospital, Goeteborg 41345 (Sweden)

    2011-08-15

    Purpose: Formation of new blood vessels (angiogenesis) in response to hypoxia is a fundamental event in the process of tumor growth and metastatic dissemination. However, abnormalities in tumor neovasculature often induce increased interstitial pressure (IP) and further reduce oxygenation (pO{sub 2}) of tumor cells. In radiotherapy, well-oxygenated tumors favor treatment. Antiangiogenic drugs may lower IP in the tumor, improving perfusion, pO{sub 2} and drug uptake, by reducing the number of malfunctioning vessels in the tissue. This study aims to create a model for quantifying the effects of altered pO{sub 2}-distribution due to antiangiogenic treatment in combination with radionuclide therapy. Methods: Based on experimental data, describing the effects of antiangiogenic agents on oxygenation of GlioblastomaMultiforme (GBM), a single cell based 3D model, including 10{sup 10} tumor cells, was developed, showing how radionuclide therapy response improves as tumor oxygenation approaches normal tissue levels. The nuclides studied were {sup 90}Y, {sup 131}I, {sup 177}Lu, and {sup 211}At. The absorbed dose levels required for a tumor control probability (TCP) of 0.990 are compared for three different log-normal pO{sub 2}-distributions: {mu}{sub 1} = 2.483, {sigma}{sub 1} = 0.711; {mu}{sub 2} = 2.946, {sigma}{sub 2} = 0.689; {mu}{sub 3} = 3.689, and {sigma}{sub 3} = 0.330. The normal tissue absorbed doses will, in turn, depend on this. These distributions were chosen to represent the expected oxygen levels in an untreated hypoxic tumor, a hypoxic tumor treated with an anti-VEGF agent, and in normal, fully-oxygenated tissue, respectively. The former two are fitted to experimental data. The geometric oxygen distributions are simulated using two different patterns: one Monte Carlo based and one radially increasing, while keeping the log-normal volumetric distributions intact. Oxygen and activity are distributed, according to the same pattern. Results: As tumor pO{sub 2

  13. Identifying solutions to medication adherence in the visually impaired elderly.

    Science.gov (United States)

    Smith, Miranda; Bailey, Trista

    2014-02-01

    Adults older than 65 years of age with vision impairment are more likely to have difficulty managing medications compared with people having normal vision. This patient population has difficulty reading medication information and may take the wrong medication or incorrect doses of medication, resulting in serious consequences, including overdose or inadequate treatment of health problems. Visually impaired patients report increased anxiety related to medication management and must rely on others to obtain necessary drug information. Pharmacists have a unique opportunity to pursue accurate medication adherence in this special population. This article reviews literature illustrating how severe medication mismanagement can occur in the visually impaired elderly and presents resources and solutions for pharmacists to take a larger role in adherence management in this population.

  14. Clinical pharmacist interventions to support adherence to thrombopreventive therapy

    DEFF Research Database (Denmark)

    Hedegaard, Ulla

    individualised interventions and team-based care, e.g. integrating a clinical pharmacist with particular focus on patients’ drug-related problems. One approach with growing evidence of improving medication adherence is motivational interviewing (MI). So far, no clinical pharmacist intervention using MI has...... to the different results in the two trials is that the stroke patients - compared to the hypertension patients - may have been more motivated for taking their medication as they just experienced a serious event. Another factor is that a secondary prevention clinic was established during the stroke study, which may...... by the clinical pharmacists and the patients.  Sensitivity and specificity for the two scales of the adherence questionnaire demonstrating the best agreement with prescription-based measures were about 90% and 30%, and the agreement with refill data was fairly low with kappa values below 0.3, suggesting...

  15. Self-perception of knowledge and adherence reflecting the effectiveness of antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Dagli-Hernandez C

    2016-09-01

    Full Text Available Carolina Dagli-Hernandez,1 Rosa Camila Lucchetta,1 Tales Rubens de Nadai,2 José Carlos Fernandez Galduróz,3 Patricia de Carvalho Mastroianni1 1Department of Drugs and Medications, School of Pharmaceutical Sciences of the UNESP – Univ Estadual Paulista, Araraquara, 2Department of Surgery and Anatomy, Americo Brasiliense State Hospital, 3Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP, São Paulo, Brazil Objectives: To evaluate which indirect method for assessing adherence best reflects highly active antiretroviral therapy (HAART effectiveness and the factors related to adherence. Method: This descriptive, cross-sectional study was performed in 2012 at a reference center of the state of São Paulo. Self-report (simplified medication adherence questionnaire [SMAQ] and drug refill parameters were compared to the viral load (clinical parameter of the effectiveness of pharmacotherapy [EP] to evaluate the EP. The “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH was used to evaluate factors related to adherence and the EP and, complementarily, patient self-perception of adherence was compared to the clinical parameter of the EP. Results: Seventy-five patients were interviewed, 60 of whom were considered as adherent from the clinical parameter of the EP and ten were considered as adherent from all parameters. Patient self-perception about adherence was the instrument that best reflected the EP when compared to the standardized self-report questionnaire (SMAQ and drug refill parameter. The level of education and the level of knowledge on HAART were positively correlated to the EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were the factors most frequently reported as a cause of nonadherence. Conclusion: A new parameter of patient self-perception of adherence, which is a noninvasive, inexpensive instrument, could be applied and assessed as easily as self

  16. Evaluation of multiple measures of antiretroviral adherence in the Eastern European country of Georgia

    Directory of Open Access Journals (Sweden)

    Nikoloz Chkhartishvili

    2014-04-01

    Full Text Available Introduction: There is little information on adherence to antiretroviral therapy (ART in the Eastern European region. This prospective study evaluated multiple measures of adherence and their association with viral suppression among HIV patients in Georgia. Methods: A prospective cohort study enrolled 100 consecutive antiretroviral-naïve adult (age ≥18 years patients, who were followed for three months. Adherence was assessed by medication refill and three self-report measures (an AIDS Clinical Trial Group [ACTG] tool for four-day adherence, a visual analogue scale [VAS] and a rating task for 30-day adherence. The VAS represented a line anchored by 0 and 100% corresponding to the percentage of prescribed doses taken. The rating task asked patients to rate their ability to take all medications as prescribed, with responses categorized into six levels of adherence: very poor (0%, poor (20%, fair (40%, good (60%, very good (80% and excellent (100%. Patients with adherence of ≥95% by medication refill, ACTG and VAS, and ≥80% by rating task, were defined as adherent. Results: Of 100 patients enrolled, eight had missing data and were excluded from analysis. Among the remaining 92 patients, the median age was 39 years, and 70% were men. Major modes of HIV acquisition were injection drug use (IDU; 47.3% and heterosexual contact (44.1%. The proportions of adherent patients were as follows: 68% by medication refill, 90% by ACTG questionnaire, 38% by VAS and 42% by rating task. On average, four months after commencing ART, 52 (56.5% patients had a viral load <400 copies/ml and 26 (28.3% patients had a viral load <50 copies/ml. Of 43 persons with a history of IDU, 22 (51.2% reached a viral load of <400 copies/ml. In multivariate analysis, only refill adherence was a statistically significant predictor of viral suppression of <400 copies/ml: the risk ratio was 1.7 (95% CI: 1.1–2.8. Refill adherence, VAS and rating task were associated with viral

  17. Acoustical Studies of Molecular Interactions in the Solution of Methyl Cobalamine Drug at Different Temperatures and Concentrations

    Directory of Open Access Journals (Sweden)

    Ritesh R. Naik

    2014-07-01

    Full Text Available In the present study, ultrasonic velocity (U, density (ρ, and viscosity (η have been measured at frequency 1 MHz in the binary mixtures of methyl cobalamine with water in the concentration range (0.1 to 0.0125% at 303 K, 308 K, and 313 K using a multi-frequency ultrasonic interferometer. The measured  values of density, ultrasonic velocity, and viscosity have been used to estimate the acoustical parameters, namely adiabatic compressibility (βa, relaxation time (τ, acoustic impedance (z, free length (Lf, free volume (Vf, internal pressure (Πi, and Wada’s constant (W. The obtained results support the complex formation, molecular association by intermolecular hydrogen bonding in the binary liquid mixtures.

  18. Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects

    Science.gov (United States)

    Fonsah, Julius Y.; Njamnshi, Alfred K.; Kouanfack, Charles; Qiu, Fang; Njamnshi, Dora M.; Tagny, Claude T.; Nchindap, Emilienne; Kenmogne, Léopoldine; Mbanya, Dora; Heaton, Robert; Kanmogne, Georgette D.

    2017-01-01

    Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (p40 years) were less likely to be non-adherent (p<0.01) and had shorter non-adherent periods (p<0.0001). The presence of depression symptoms correlated with non-adherence to ART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p = 0.04) and longer non-adherent periods (p = 0.04). Change in ART regimen was significantly associated with increased likelihood of non-adherence and increased duration of the non-adherence period. Addressing these underlying risk factors could improve ART adherence, retention in care and treatment outcomes for HIV/AIDS patients in Cameroon. PMID:28141867

  19. Adherence to antiretroviral therapy and associated factors among patients living with HIV/AIDS in Dessie Referral Hospital, Northern Ethiopia

    Directory of Open Access Journals (Sweden)

    Birhanu Demeke

    2014-09-01

    Full Text Available Background: Antiretroviral therapy has transformed the HIV infection into a chronic manageably disease. Optimal adherence (≥ 95% has required to achieve treatment success; however, still non-adherence remains major problem among patients receiving antiretroviral therapy (ART. The aim of this study was to determine adherences rate and evaluate factors affecting adherence among patients on ART in Dessie Referral Hospital (DRH. Materials and Methods: A cross sectional study employing both qualitative and quantitative methods was used. A total of 130 people living with HIV/AIDS on ART were included. All patients who came to the hospital during study period were considered based on convenient sampling technique. Chi-Square test is used to examine the association of adherence with associated factors. Both data entry and analysis was done using SPSS version 16. Results: Of 130 respondents, 58(44.6% were males and 72(55.4% were females and 107 (82.3% had 100% adherences, 10(7.7% had 95 -100% and the rest, 13(10% had <95% adherences with overall adherence rate of 90% for last month prior to the study period. The main reasons for non-adherence were 12(37.5% forgetfulness, 7(21.8% being away from home and 4 (12.5% being extremely ill. Use of other medications in addition to antiretroviral drugs (p=0.01, treatment fit into daily routines (p=0.01, family disclosure (p=0.01, active substance use (p=0.04 and living condition (p=0.00 were significantly associated with adherence to ART. Conclusion: The self reported adherence rate to ART (90% was found to be relatively higher which needs inclusion of other methods to ensure consistency of this value. Forgetfulness, being away from home and being extremely ill were the foremost reasons for non-adherence. The patients should be encouraged to maintain this high level of adherence.

  20. Intent-to-adhere and adherence to malaria prevention recommendations in two travel clinics.

    Science.gov (United States)

    Goldstein, Irit; Grefat, Rami; Ephros, Moshe; Rishpon, Shmuel

    2015-01-01

    Malaria infects 30,000 travelers annually worldwide. At greatest risk are those who travel for long duration. Prevention of malaria includes chemoprophylaxis. This prospective study on 121 travelers who visited two travel clinics shows that adherence to prophylactic treatment was low, especially in long duration trips, and that adherence rate could be predicted by the much more available intent-to-adhere rate.

  1. Factors affecting adherence to antihypertensive medication in Greece: results from a qualitative study

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    Vassiliki Tsiantou

    2010-08-01

    Full Text Available Vassiliki Tsiantou1, Polina Pantzou2, Elpida Pavi1, George Koulierakis2, John Kyriopoulos11Department of Health Economics, National School of Public Health, Athens, Greece; 2Department of Sociology, National School of Public Health, Athens, GreeceIntroduction: Although hypertension constitutes a major risk factor for cardiovascular morbidity and mortality, research on adherence to antihypertensive treatment has shown that at least 75% of patients are not adherent because of the combined demographic, organizational, psychological, and disease- and medication-related factors. This study aimed to elicit hypertensive patients’ beliefs on hypertension and antihypertensive treatment, and their role to adherence.Methods: Transcripts from semistructured interviews and focus groups were content analyzed to extract participants’ beliefs about hypertension and antihypertensive treatment, and attitudes toward patient–physician and patient–pharmacist relationships.Results: Hypertension was considered a very serious disease, responsible for stroke and myocardial infarction. Participants expressed concerns regarding the use of medicines and the adverse drug reactions. Previous experience with hypertension, fear of complications, systematic disease management, acceptance of hypertension as a chronic disease, incorporation of the role of the patient and a more personal relationship with the doctor facilitated adherence to the treatment. On the other hand, some patients discontinued treatment when they believed that they had controlled their blood pressure.Conclusion: Cognitive and communication factors affect medication adherence. Results could be used to develop intervention techniques to improve medication adherence.Keywords: hypertension, medication adherence, patient compliance, doctor–patient communication, antihypertensive medicine

  2. Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach

    Science.gov (United States)

    De las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

    2017-01-01

    Purpose To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients’ adherence to psychopharmacological medications. Method A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Results Structural equation modeling demonstrated that psychiatric patients’ treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients’ trust in their psychiatrists (doctors’ subscale), 3) negatively with patients’ belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. Conclusion This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients’ adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients’ psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

  3. Efficacy of a brief multifactorial adherence-based intervention on reducing the blood pressure of patients with poor adherence: protocol for a randomized clinical trial

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    Llobera Joan

    2010-09-01

    Full Text Available Abstract Background Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug. Methods/Design The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen. Measurement The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost. Discussion The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI. Trial registration Current controlled trials ISRCTN21229328

  4. Significance of higher drug concentration in erythrocytes of mice infected with Schistosoma japonicum and treated orally with mefloquine at single doses.

    Science.gov (United States)

    Tao, Yi; Xue, Jian; Jiang, Bin; Zhang, Hao-Bing; Xiao, Shu-Hua

    2015-12-01

    The purpose of the present study is to understand the pharmacokinetic feature of mefloquine measured by erythrocytes and plasma in Schistosoma japonicum (S. j.)-infected mice and non-infected mice after oral administration of the drug at single doses. A high-performance liquid chromatography (HPLC) method was used to measure the plasma and erythrocyte concentrations of mefloquine at varying intervals posttreatment. Our results demonstrated that in non-infected mice treated orally with mefloquine at an ineffective dose of 50 mg/kg or effective dose of 200 mg/kg for 2-72 h, the erythrocyte-to-plasma ratios of mefloquine were 5.8-11.2 or 2-14.2. On the other hand, in S. j.-infected mice treated with the same single doses of the drug, the erythrocyte and plasma drug concentration ratios were 3.1-4.6 or 2.9-8.5, manifesting that either in infected mice or in non-infected mice that received oral mefloquine resulted in higher concentration of mefloquine in erythrocytes than that in plasma. Unexpectedly, under oral administration of mefloquine at a higher single dose of 200 mg/kg, the pharmacokinetic parameter C max values for plasma from S. j.-infected and non-infected mice were 1.6 ± 0.3 and 2.0 ± 0.4 μg/mL, respectively, which were below the determined in vitro LC50 (50 % lethal concentration) value of 4.93 μg/mL. Therefore, the plasma concentration of mefloquine may display a little effect against schistosomes during the treatment. Although the values of T 1/2 and AUC0-∞ for erythrocytes were significantly longer and higher in infected mice than those of corresponding non-infect mice that received the same single mefloqine dose of 50 mg/kg, the C max value was only 2.6 ± 0.4 μg/mL lower than the determined in vitro LC50, which may explain why this low single dose is ineffective against schistosomes in vivo. After administration of higher mefloquine dose of 200 mg/kg, the C max value for erythrocytes in infected mice was 30 % (7.4 ± 0

  5. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe N; Chong, Alice; Alter, David A

    2007-01-01

    covered, compared with long-term mortality (median of 2.4 years of follow-up) using multivariable survival models (and propensity analyses) adjusted for sociodemographic factors, illness severity, comorbidities, and concomitant use of evidence-based therapies. RESULTS: Among statin users...... drug considered a control given the absence of clinical trial-proven survival benefits. MAIN OUTCOME MEASURES: Patient adherence was subdivided a priori into 3 categories--high (proportion of days covered, > or =80%), intermediate (proportion of days covered, 40%-79%), and low (proportion of days...... no relationships between drug adherence and cancer-related admissions, outcomes for which biological plausibility do not exist. CONCLUSION: The long-term survival advantages associated with improved drug adherence after AMI appear to be class-specific, suggesting that adherence outcome benefits are mediated...

  6. Measurement of oxide adherence to PFM alloys.

    Science.gov (United States)

    Mackert, J R; Parry, E E; Hashinger, D T; Fairhurst, C W

    1984-11-01

    A method has been reported for evaluating adherence of an oxide to its substrate metal to a maximum value of about 40 MPa. Oxidized alloy plates were cemented between two aluminum cylinders with a high-strength cyanoacrylate cement and loaded in tension until failure occurred either at the oxide/metal interface, within the oxide layer, or in the cement itself. Significant differences were found among the oxide adherence values obtained from different PFM alloys. The oxides formed on five of the alloys exhibited adherence strengths in excess of the published value for cohesive strength of dental opaque porcelain, indicating that they possess sufficient adherence to act as the transition zone between the porcelain and the alloy. In addition, a correspondence was found between the quality of porcelain bond for a given alloy and its oxide adherence strength. These results remove the principal objection to the oxide-layer theory of porcelain bonding in dental alloy systems and emphasize the importance of oxide adherence in the establishment of a bond. It is therefore suggested that future work devoted to porcelain-metal bonding should seek to elucidate the mechanism of oxide adherence to PFM alloys and explore the development of new alloys which form adherent oxides.

  7. Feasibility of mHealth and Near Field Communication technology based medication adherence monitoring.

    Science.gov (United States)

    Morak, Juergen; Schwarz, Mark; Hayn, Dieter; Schreier, Guenter

    2012-01-01

    Poor patients' adherence to intake of prescribed medication has been identified as a serious problem in the treatment of chronically ill patients. Technical solutions are needed to measure and - if necessary - to increase the patients' adherence. A telemonitoring solution was developed to record a patient's medication intake based on smart blisters and mobile phones with NFC functionality. The components allowed recording of drug type, timestamp, and dosage of pills taken. The system's usability and technical feasibility was evaluated in the course of an application study. Over a period of 13 months 59 patients suffering from diabetes were monitored. 1,760 blisters were handed out to these patients and 14,843 takeout events were recorded and transmitted via mobile phone. Results indicate the feasibility of this concept to monitor adherence. Although the system still needs to be optimized for routine use it shows the potential for targeting the problem of poor patient adherence by NFC enabled devices.

  8. Preparation and characterisation of controlled release co-spray dried drug-polymer microparticles for inhalation 1: influence of polymer concentration on physical and in vitro characteristics.

    Science.gov (United States)

    Salama, Rania; Hoe, Susan; Chan, Hak-Kim; Traini, Daniela; Young, Paul M

    2008-06-01

    A series of co-spray dried microparticles containing di-sodium cromoglycate (DSCG) and polyvinyl alcohol (PVA - 0%, 30%, 50%, 70% and 90% w/w, respectively), were prepared as potential controlled release (CR) viscous/gelling vehicles for drug delivery to the respiratory tract. The microparticles were characterised in terms of particle size, crystal structure, density, surface morphology, moisture sorption, surface energy and in vitro aerosolisation efficiency. The co-spray dried particles were amorphous in nature and had spherical geometry. High-resolution atomic force microscopy analysis of the surfaces of the DSCG/PVA suggested no significant differences in roughness between microparticles containing 30-90% w/w PVA (ANOVA, p<0.05), while no specific trend in either size or density was observed with respect to PVA concentration. In comparison, a linear decrease in the relative moisture sorption (R2=0.997) and concurrent increase in total surface free energy (R2=0.870) were observed as PVA concentration was increased. Furthermore a linear increase in the aerosolisation efficiency, measured by inertial impaction, was observed as PVA concentration was increased (R2=0.993). In addition, the increase in aerosolisation efficiency showed good correlation with equilibrium moisture content (R2=0.974) and surface energy measurement (R2=0.905). These relationships can be attributed to the complex interplay of particle forces at the contiguous interfaces in this particulate system.

  9. 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...

  10. Curing the disobedient patient: medication adherence programs as pharmaceutical marketing tools.

    Science.gov (United States)

    Lamkin, Matt; Elliott, Carl

    2014-01-01

    Pharmaceutical companies have long focused their marketing strategies on getting doctors to write more prescriptions. But they lose billions in potential sales when patients do not take their prescribed drugs. Getting patients to "adhere" to drug therapies that have unpleasant side effects and questionable efficacy requires more than mere ad campaigns urging patients to talk to their doctors. It requires changing patients' beliefs and attitudes about their medications through repeated contact from people patients trust. Since patients do not trust drug companies, these companies are delivering their marketing messages through nurses, pharmacists, and even other patients--leveraging patients' trust in these intermediaries to persuade them to consume more brand name drugs. Armed with the premise that better adherence improves patients' health, drug companies justify manipulating patients by reframing reasonable decisions to decline therapy as pathological, and promote brand loyalty in the guise of offering medical care.

  11. Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea.

    Directory of Open Access Journals (Sweden)

    Janet Gare

    Full Text Available Adherence to antiretroviral therapy (ART is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12 of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91, pill count measurements indicated only 40% (34/84 with >95% adherence in the last month. Taking other medications while on ART (p = 0.01 and taking ART for ≥1 year (p = 0.037 were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033. Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.

  12. Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea.

    Science.gov (United States)

    Gare, Janet; Kelly-Hanku, Angela; Ryan, Claire E; David, Matthew; Kaima, Petronia; Imara, Ulato; Lote, Namarola; Crowe, Suzanne M; Hearps, Anna C

    2015-01-01

    Adherence to antiretroviral therapy (ART) is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG) in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12) of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91), pill count measurements indicated only 40% (34/84) with >95% adherence in the last month. Taking other medications while on ART (p = 0.01) and taking ART for ≥1 year (p = 0.037) were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033). Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.

  13. Adherence to a new oral anticoagulant treatment prescription: dabigatran etexilate

    Directory of Open Access Journals (Sweden)

    L Bellamy

    2009-07-01

    Full Text Available L Bellamy1, N Rosencher1, BI Eriksson21Anaesthesiology Department, Hôpital Cochin (AP-HP, René Descartes University, Paris 75014 France; 2Orthopaedic Department, University Hospital Sahlgrenska/Ostra, Gothenburg, SwedenAbstract: The recent development of new oral anticoagulants, of which dabigatran etexilate is currently at the most advanced stage of development, is the greatest advance in the provision of convenient anticoagulation therapy for many years. A new oral anticoagulation treatment, dabigatran etexilate, is already on the market in Europe. The main interest probably will be to improve the prescription and the adherence to an effective thromboprophylaxis in medical conditions such as atrial fibrillation without bleeding side effects, without the need for monitoring coagulation, and without drug and food interactions such as vitamin K anticoagulant (VKA treatment. Dabigatran is particularly interesting for extended thromboprophylaxis after major orthopedic surgery in order to avoid daily injection for a month. However, oral long-term treatments such as VKA are not systematically associated with a higher compliance level than injected treatments such as low-molecular-weight heparins. Indeed, adherence to an oral treatment, instead of the usual daily injection in major orthopedic surgery, is complex, and based not only on the frequency of dosing but also on patient motivation, understanding, and socio-economic status. New oral anticoagulants may be useful in this way but education and detection of risk factors of nonadherence to treatment are still essential.Keywords: oral anticoagulant, adherence, compliance, education, dabigatran

  14. Baseline Substance Use Interferes with Maintenance of HIV Medication Adherence Skills.

    Science.gov (United States)

    Dale, Sannisha K; Traeger, Lara; O'Cleirigh, Conall; Bedoya, C Andres; Pinkston, Megan; Wilner, Julianne G; Stein, Michael; Safren, Steven A

    2016-05-01

    Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV improves both adherence and depression outcomes relative to enhanced treatment as usual (ETAU). However, in persons with injection drug use (PWIDU) histories, adherence gains seen during treatment have not been maintained postintervention. Therefore, we examined whether heroin or cocaine use at study entry moderated acquisition or maintenance of adherence gains after CBT-AD. HIV-positive adults in treatment for opioid dependence (n = 89) were randomly assigned to CBT-AD or ETAU and completed 3-, 6-, and 12-month assessments. Participants were majority male (61%), white (48%), and heterosexual (79%). Hierarchical linear modeling was used to evaluate whether heroin or cocaine use at baseline interacted with intervention assignment to predict change in adherence during active treatment and follow-up. CBT-AD-related improvement in adherence during the active intervention period did not vary by baseline substance use. However, cocaine use (but not heroin use) at baseline interacted with intervention assignment to predict a significant decline in follow-up adherence (cocaine use × group condition coefficient = -0.77, t = -2.44, p = 0.02) such that by 12 months, adherence among CBT participants was significantly lower among those who used cocaine (45.0%) compared to those who did not (72.3%; t = 2.50, p = 0.018). HIV-positive PWIDU who use heroin or cocaine at baseline can benefit from the CBT-AD intervention to improve adherence to antiretroviral therapy; therefore, providers should not withhold an active psychosocial treatment for HIV-positive PWIDU who are using. Cocaine use at baseline may limit the degree to which gains are maintained postintervention, and therefore, booster sessions may be needed.

  15. Single oral doses of (±) 3,4-methylenedioxymethamphetamine ('Ecstasy') produce lasting serotonergic deficits in non-human primates: relationship to plasma drug and metabolite concentrations.

    Science.gov (United States)

    Mueller, Melanie; Yuan, Jie; McCann, Una D; Hatzidimitriou, George; Ricaurte, George A

    2013-05-01

    Repeated doses of the popular recreational drug methylenedioxymethamphetamine (MDMA, 'Ecstasy') are known to produce neurotoxic effects on brain serotonin (5-HT) neurons but it is widely believed that typical single oral doses of MDMA are free of neurotoxic risk. Experimental and therapeutic trials with MDMA in humans are underway. The mechanisms by which MDMA produces neurotoxic effects are not understood but drug metabolites have been implicated. The aim of the present study was to assess the neurotoxic potential of a range of clinically relevant single oral doses of MDMA in a non-human primate species that metabolizes MDMA in a manner similar to humans, the squirrel monkey. A secondary objective was to explore the relationship between plasma MDMA and metabolite concentrations and lasting serotonergic deficits. Single oral doses of MDMA produced lasting dose-related serotonergic neurochemical deficits in the brains of squirrel monkeys. Notably, even the lowest dose of MDMA tested (5.7 mg/kg, estimated to be equivalent to 1.6 mg/kg in humans) produced significant effects in some brain regions. Plasma levels of MDMA engendered by neurotoxic doses of MDMA were on the order of those found in humans. Serotonergic neurochemical markers were inversely correlated with plasma concentrations of MDMA, but not with those of its major metabolites, 3,4-dihydroxymethamphetamine and 4-hydroxy-3-methoxymethamphetamine. These results suggest that single oral doses of MDMA in the range of those used by humans pose a neurotoxic risk and implicate the parent compound (MDMA), rather than one of its metabolites, in MDMA-induced 5-HT neural injury.

  16. Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects.

    Science.gov (United States)

    Fonsah, Julius Y; Njamnshi, Alfred K; Kouanfack, Charles; Qiu, Fang; Njamnshi, Dora M; Tagny, Claude T; Nchindap, Emilienne; Kenmogne, Léopoldine; Mbanya, Dora; Heaton, Robert; Kanmogne, Georgette D

    2017-01-01

    Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (pART regimen, age, gender, and education showed that subjects with opportunistic infections had 3.1-times higher odds of having been non-adherent (p40 years) were less likely to be non-adherent (pART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p = 0.04) and longer non-adherent periods (p = 0.04). Change in ART regimen was significantly associated with increased likelihood of non-adherence and increased duration of the non-adherence period. Addressing these underlying risk factors could improve ART adherence, retention in care and treatment outcomes for HIV/AIDS patients in Cameroon.

  17. Improving adherence with inhaler therapy in COPD

    Directory of Open Access Journals (Sweden)

    Suzanne C Lareau

    2010-11-01

    Full Text Available Suzanne C Lareau1, Barbara P Yawn21College of Nursing, University of Colorado Denver, Aurora, Colorado; 2Department of Research, Olmsted Medical Center, Rochester, Minnesota, USAAbstract: Chronic obstructive pulmonary disease (COPD is a major public health problem, associated with considerable morbidity and health care costs. The global burden of COPD morbidity is predicted to rise substantially in the coming decade, but could be moderated by better use of existing management strategies. Smoking cessation, medication therapy, and pulmonary rehabilitation have all been shown to diminish morbidity and improve patient outcomes. But each of these strategies requires adherence. Adherence is crucial for optimizing clinical outcomes in COPD, with nonadherence resulting in a significant health and economic burden. Suboptimal medication adherence is common among COPD patients, due to a number of factors that involve the medication, the delivery device, the patient, and the health professionals caring for the patient. Lack of medication adherence needs to be identified and addressed by using simplified treatment regimens, increasing patient knowledge about self-management, and enhancing provider skills in patient education, communication, and adherence counseling. This article reports some of the challenges of medication nonadherence faced by the clinician in the management of COPD, and suggests ways to evaluate and improve adherence effectively in primary care.Keywords: chronic obstructive pulmonary disease, adherence, clinician

  18. Adherence to Antihypertensive Medications in Iranian Patients

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    Azin Behnood-Rod

    2016-01-01

    Full Text Available Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8 was administered to measure adherence. Results. Mean (±SD overall MMAS-8 score was 5.75 (±1.88. About half of the sample (139 cases, 49.6% showed low adherence (MMAS-8 score < 6. There was a negative linear association between the MMAS-8 score and systolic BP (r=-0.231, P<0.001 as well as diastolic BP (r=-0.280, P<0.001. In linear regression model, overweight/obesity (B=-0.52, P=0.02, previous history of admission to emergency services due to hypertensive crisis (B=-0.79, P=0.001, and getting medication directly from drugstore without refill prescription in hand (B=-0.51, P=0.04 were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence.

  19. Among once-daily regimens, single tablet regimens (STRs are associated with better adherence

    Directory of Open Access Journals (Sweden)

    R Murri

    2012-11-01

    Full Text Available Previous published evidences showed that taking HAART once-daily (OD is associated to better adherence when compared to BID or TID regimens. However, no further studies investigated whether, among OD regimens, adherence levels can be differently influenced. Aim of the study was to evaluate levels of self-reported adherence in HIV+ people according to type of HAART dosing (STR, OD with more than one pill or BID. To limit reporting biases, the study was performed in five different non-clinic settings covering North and Central Italy. A total of 230 patients on stable HAART were asked to complete a semi-structured, anonymous questionnaire reporting their attitude toward HAART, their adherence and the acceptability of their regimen. Self-perception of adherence was also investigated with a single item for comparison with real adherence behavior. Most of the subjects were males (66% with a mean age of 46 years, with higher education level (72% and a long history of HIV infection (mean 13.6 years. 17% of patients were on a first-line regimen. 21% reported to miss at least one dose during the past week (STR: 6%; OD >1 pill 23% and BID 21%; p<0.05. People taking STR and BID tend to report less discontinuations (all the drug of the day for at least 3 times in a month compared to OD>1 pill (6 and 4% vs 11%. People taking therapies other than HAART reported similar adherence levels of people taking only HAART, even when stratified for dosing groups. Even people judging their adherence as ‘optimal’ or ‘very good’, 10 and 17% respectively, reported having missed a dose during the last week. At stepwise regression model, optimal adherence was correlated to being male (OR: 2.38; 95% CI: 1.19–4.74, younger (OR: 3.04; 95% CI: 1.01–9.13 and with a shorter HIV infection (OR: 3.58; 95% CI: 1.04–12.38. People taking simpler once-daily STR tend to report better adherence than people taking OD>1 pill or BID. Perception of optimal adherence is largely

  20. Who takes the medicine? Adherence to antiretroviral therapy in Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Teshome W

    2015-10-01

    Full Text Available Wondu Teshome,1 Mihretu Belayneh,1 Mathewos Moges,1 Misganu Endriyas,2 Emebet Mekonnen,2 Sinafiksh Ayele,2 Tebeje Misganaw,2 Mekonnen Shiferaw,2 Palanivel Chinnakali,3 Sven Gudmund Hinderaker,4 Ajay MV Kumar5 1School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia; 3Department of Preventive and Social Medicine, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India; 4Centre for International Health, University of Bergen, Bergen, Norway; 5The International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India Background: Treatment adherence is critical for the success of antiretroviral therapy (ART for people living with HIV. There is limited representative information on ART drug adherence and its associated factors from Southern Ethiopia. We aimed at estimating the level of adherence to ART among people living with HIV and factors associated with it in 20 randomly selected ART clinics of Southern Ethiopia.Methods: In this cross-sectional study, we interviewed consecutive HIV patients on first-line antiretroviral regimen attending the clinics in June 2014 using a pretested and structured questionnaire. For measuring adherence, we used 4-day recall method based on “The AIDS Clinical Trial Group adherence assessment tool”. Patients were classified as “Incomplete adherence” if they missed any of the doses in the last 4 days. Data were singly entered using EpiData and descriptive analysis, and unadjusted odds ratios were calculated using EpiDataStat software. Multivariate logistic regression analysis was performed using Stata v12.0.Results: Of 974 patients interviewed, 539 (56% were females, and mean age was 35 years. The proportion of patients with incomplete adherence was 13% (95% confidence interval: 11%–15

  1. Comparison of various measures for assessing medication refill adherence using prescription data

    NARCIS (Netherlands)

    Vink, N. M.; Klungel, O. H.; Stolk, R. P.; Denig, P.

    2009-01-01

    Background Several measures using prescription data have been developed for estimating medication refill adherence. Few Studies have made direct comparisons, and little is known about the accuracy of these measures in patients oil a multiple-drug regimen. Purpose To compare different calculation met

  2. A new application of micellar liquid chromatography in the determination of free ampicillin concentration in the drug-human serum albumin standard solution in comparison with the adsorption method.

    Science.gov (United States)

    Stępnik, Katarzyna E; Malinowska, Irena; Maciejewska, Małgorzata

    2016-06-01

    The determination of free drug concentration is a very important issue in the field of pharmacology because only the unbound drug fraction can achieve a pharmacological effect. Due to the ability to solubilize many different compounds in micellar aggregates, micellar liquid chromatography (MLC) can be used for direct determination of free drug concentration. Proteins are not retained on the stationary phase probably due to the formation of protein - surfactant complexes which are excluded from the pores of stationary phase. The micellar method is simple and fast. It does not require any pre-preparation of the tested samples for analysis. The main aim of this paper is to demonstrate a completely new applicability of the analytical use of MLC concerning the determination of free drug concentration in the standard solution of human serum albumin. The well-known adsorption method using RP-HPLC and the spectrophotometric technique was applied as the reference method. The results show that the free drug concentration value obtained in the MLC system (based on the RP-8 stationary phase and CTAB) is similar to that obtained by the adsorption method: both RP-HPLC (95.83μgmL(-1), 79.86% of free form) and spectrophotometry (95.71μgmL(-1), 79.76%). In the MLC the free drug concentration was 93.98μgmL(-1) (78.3%). This indicates that the obtained results are within the analytical range of % of free ampicillin fraction and the MLC with direct sample injection can be treated like a promising method for the determination of free drug concentration.

  3. Adherence to anti-depressant medication

    DEFF Research Database (Denmark)

    Buus, Niels

    2014-01-01

    The study of medicine taking is controversial as it often reveals a discrepancy between healthcare professionals' advice and patients' actual behaviour. Qualitative researchers have examined depressed people's adherence to prescriptions of antidepressants by exploring the meaning they impute to t...

  4. HAART Adherence Strategies for Methadone Clients Who Are HIV-Positive: A Treatment Manual for Implementing Contingency Management and Medication Coaching

    Science.gov (United States)

    Haug, Nancy A.; Sorensen, James L.; Gruber, Valerie A.; Lollo, Nicole; Roth, Gregory

    2006-01-01

    Research demonstrates that injection drug users with HIV and/or AIDS have difficulty adhering to complex regimens of HIV medications. Because of the risk of increased viral resistance associated with irregular medication adherence, there is considerable clinical need to assist clients who abuse substances in taking their antiretroviral medications…

  5. Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial.

    NARCIS (Netherlands)

    Zwikker, H.E.; Ende, C.H. van den; Lankveld, W.G. van; Broeder, A.A. den; Hoogen, F.H. van den; Mosselaar, B. van de; Dulmen, S. van; Bemt, B.J. van den

    2014-01-01

    Objective: To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). Methods: Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMAR

  6. Medication Adherence and its Related Factors in Patients with Type II Diabetes

    Directory of Open Access Journals (Sweden)

    Behzad Gholamaliei

    2016-03-01

    Full Text Available Background and Objectives: Low levels of medication adherence in patients with type 2 diabetes is one of the greatest challenges in the treatment and control of diabetes. This study was designed to determine medication adherence and its related factors in patients with type II diabetes. Materials and Methods: In this cross-sectional study, a total of 300patients with type 2diabetes records in the health centers of Tuyserkan city were randomly selected in 2015. Data collection instrument was a self-made questionnaire, which consisted of factors related to the medication adherence. Questionnaires were completed after confirmation of validity and reliability, by interviews. To analyze the data, descriptive and inferential statistics (T-test, AnOVA, Simple and multiple linear regression were applied, using SPSS software, version 19. Results: Overall, %26.3 of patients were male and %73.7 were female. Also, %65 of patients were illiterate, %24 had some degree of symptoms, and %59.4 had poor medication adherence. There was a significant relationship between age, education, patient care and treatment expenditure, health care team and health system, therapy-related factors and condition-related factors, beliefs about illness, efficacy, and concerns about drugs and medication adherence (P < 0.05. Conclusions: This study showed that medication adherence in patients with diabetes was not suitable and individual, economical and social factors were influential.Therefore, the role of these factors must be considered when designing intervention programs.

  7. Patient medication adherence and physician prescribing among congestive heart failure patients of Yemen

    Directory of Open Access Journals (Sweden)

    K M Alakhali

    2013-01-01

    Full Text Available Congestive heart failure has been associated with high morbidity and mortality requiring hospitalisation and is further complicated by noncompliance and under prescriptions. We aim to determine medication adherence and percentage deviation among Asians population in general and Yemenis in particular. A cross-sectional, prospective observational study with purposive sampling was conducted at two cardiac outpatient centers in 70 congestive heart failure patients for a period of 3 months. An Arabic translated Morisky 4 item scale assessed the adherence of patients. Deviation in prescribing was determined by chart review. All 70 patients had mean age of 56.6΁16 years. Morisky 4 item scale predicted low adherence (n=33; 47.1% and overall nonadherencerate (n=38; 54.2% was slightly higher than adherence. Percentage nonadherence versus adherence was high with diuretics (53 vs. 46% and, digoxin (40 vs. 29%. The adherence percentage of angiotensin receptor blockers (9% and beta blockers (8% was low. Diuretics were the most prescribed drugs (n=69; 99%, followed by angiotensin converting enzyme inhibitors (n=51; 73%, cardiac glycoside (n=48; 69%, few patients were on angiotensin receptor blockers (n=8; 11% and (n=9; 13% beta blockers. The maximum prescribing rate deviation was seen with angiotensin receptor blockers (−89% and beta blockers (−87% followed by nitrates (−77%. Digoxin (−31% and angiotensin converting enzymes (−27% deviated comparatively less. Prescribing as well as utilisation rates generally were low resulting in nonachievement of therapeutic goals which could be resolved using multimodel approach.

  8. Patient Medication Adherence and Physician Prescribing among Congestive Heart Failure Patients of Yemen

    Science.gov (United States)

    Alakhali, K. M.; Daniel, P. S; Noohu, A. M.; Sirajudeen, S. A.

    2013-01-01

    Congestive heart failure has been associated with high morbidity and mortality requiring hospitalisation and is further complicated by noncompliance and under prescriptions. We aim to determine medication adherence and percentage deviation among Asians population in general and Yemenis in particular. A cross-sectional, prospective observational study with purposive sampling was conducted at two cardiac outpatient centers in 70 congestive heart failure patients for a period of 3 months. An Arabic translated Morisky 4 item scale assessed the adherence of patients. Deviation in prescribing was determined by chart review. All 70 patients had mean age of 56.6±16 years. Morisky 4 item scale predicted low adherence (n=33; 47.1%) and overall nonadherencerate (n=38; 54.2%) was slightly higher than adherence. Percentage nonadherence versus adherence was high with diuretics (53 vs. 46%) and, digoxin (40 vs. 29%). The adherence percentage of angiotensin receptor blockers (9%) and beta blockers (8%) was low. Diuretics were the most prescribed drugs (n=69; 99%), followed by angiotensin converting enzyme inhibitors (n=51; 73%), cardiac glycoside (n=48; 69%), few patients were on angiotensin receptor blockers (n=8; 11%) and (n=9; 13%) beta blockers. The maximum prescribing rate deviation was seen with angiotensin receptor blockers (−89%) and beta blockers (−87%) followed by nitrates (−77%). Digoxin (−31%) and angiotensin converting enzymes (−27%) deviated comparatively less. Prescribing as well as utilisation rates generally were low resulting in nonachievement of therapeutic goals which could be resolved using multimodel approach. PMID:24403656

  9. Mobile Applications to Improve Medication Adherence.

    Science.gov (United States)

    Haase, Jamie; Farris, Karen B; Dorsch, Michael P

    2017-02-01

    Background and Introduction: Mobile applications are useful tools to improve medication adherence. As developers continue to improve the features of existing mobile applications, pharmacists should be aware of the current features that are available to patients. There are limited studies available that discuss which applications have the most desirable features. The aim of this study was to compare available mobile applications and identify ideal application features used to improve medication adherence.

  10. 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...... Tissue Society have convened a working group to propose a screening strategy to detect a lack of adherence to these drugs. The question to answer was whether the bone turnover markers (BTMs) PINP and CTX can be used to identify low adherence in patients with postmenopausal osteoporosis initiating oral...... bisphosphonates for osteoporosis. The findings of the TRIO study specifically address this question and were used as the basis for testing the hypothesis. RESULTS: Based on the findings of the TRIO study, specifically addressing this question, the working group recommends measuring PINP and CTX at baseline and 3...

  11. Microbicide clinical trial adherence: insights for introduction

    Directory of Open Access Journals (Sweden)

    Cynthia Woodsong

    2013-04-01

    Full Text Available After two decades of microbicide clinical trials it remains uncertain if vaginally- delivered products will be clearly shown to reduce the risk of HIV infection in women and girls. Furthermore, a microbicide product with demonstrated clinical efficacy must be used correctly and consistently if it is to prevent infection. Information on adherence that can be gleaned from microbicide trials is relevant for future microbicide safety and efficacy trials, pre-licensure implementation trials, Phase IV post-marketing research, and microbicide introduction and delivery. Drawing primarily from data and experience that has emerged from the large-scale microbicide efficacy trials completed to-date, the paper identifies six broad areas of adherence lessons learned: (1 Adherence measurement in clinical trials, (2 Comprehension of use instructions/Instructions for use, (3 Unknown efficacy and its effect on adherence/Messages regarding effectiveness, (4 Partner influence on use, (5 Retention and continuation and (6 Generalizability of trial participants' adherence behavior. Each is discussed, with examples provided from microbicide trials. For each of these adherence topics, recommendations are provided for using trial findings to prepare for future microbicide safety and efficacy trials, Phase IV post-marketing research, and microbicide introduction and delivery programs.

  12. [Solcoseryl--dental adherent paste in the treatment of acute radiation-induced inflammation of oral mucosa, gingivae and tongue].

    Science.gov (United States)

    Kryst, L; Kowalik, S; Bartkowski, S; Henning, G

    1990-07-01

    On the basis of a study carried out in three teaching departments of maxillofacial surgery the effect was analysed of Solcoseryl dental adherent paste and Linomag in the treatment of acute radiation-induced stomatitis. Both drugs were effective but Solcoseryl was superior to the other drug since it accelerated healing by about 50% and formed a protecting dressing on the inflamed mucosa.

  13. Adherence and Risk Behaviour in Patients with HIV Infection Receiving Antiretroviral Therapy in Bangkok.

    Science.gov (United States)

    Clarke, Amanda; Kerr, Stephen; Honeybrook, Adam; Cooper, David A; Avihingsanon, Anchalee; Duncombe, Chris; Phanuphak, Praphan; Ruxrungtham, Kiat; Ananworanich, Jintanat; Kaldor, John

    2012-01-01

    It could be postulated that due to lifestyle factors, patients with poor antiretroviral therapy (ART) adherence may also have risky sexual behaviour potentially leading to HIV transmission. There are limited data regarding unprotected sex risk and ART adherence in resource limited settings and our study set out to investigate these in an HIV clinic in Bangkok. Patients completed an anonymous questionnaire regarding their relationship details, ART adherence, sexual behaviour, alcohol and drug use and HIV transmission beliefs. Laboratory findings and medical history were also collected. Unprotected sex risk (USR) was defined as inconsistent condom use with a partner of negative or unknown HIV status. Five hundred and twelve patients completed the questionnaire. Fifty seven per cent of patients reported having taken ARV >95% of the time in the last month and 58% had been sexually active in the previous 30 days. Only 27 patients (5%) were classified as having USR in our cohort. Multivariate analysis showed USR was associated with female gender (OR 2.9, 95% CI 1.2-7.0, p0.02) but not with adherence, age, type or number of partners, recreational drug or alcohol use nor beliefs about HIV transmission whilst taking ART. Levels of USR in this resource limited setting were reassuringly low and not associated with poor ART adherence; as all USR patients had undetectable viral loads onward HIV transmission risk is likely to be low but not negligible. Nonetheless condom negotiation techniques, particularly in women, may be useful in this group.

  14. The Role of Adherence and Retreatment in De Novo Emergence of MDR-TB.

    Science.gov (United States)

    Cadosch, Dominique; Abel Zur Wiesch, Pia; Kouyos, Roger; Bonhoeffer, Sebastian

    2016-03-01

    Treatment failure after therapy of pulmonary tuberculosis (TB) infections is an important challenge, especially when it coincides with de novo emergence of multi-drug-resistant TB (MDR-TB). We seek to explore possible causes why MDR-TB has been found to occur much more often in patients with a history of previous treatment. We develop a mathematical model of the replication of Mycobacterium tuberculosis within a patient reflecting the compartments of macrophages, granulomas, and open cavities as well as parameterizing the effects of drugs on the pathogen dynamics in these compartments. We use this model to study the influence of patient adherence to therapy and of common retreatment regimens on treatment outcome. As expected, the simulations show that treatment success increases with increasing adherence. However, treatment occasionally fails even under perfect adherence due to interpatient variability in pharmacological parameters. The risk of generating MDR de novo is highest between 40% and 80% adherence. Importantly, our simulations highlight the double-edged effect of retreatment: On the one hand, the recommended retreatment regimen increases the overall success rate compared to re-treating with the initial regimen. On the other hand, it increases the probability to accumulate more resistant genotypes. We conclude that treatment adherence is a key factor for a positive outcome, and that screening for resistant strains is advisable after treatment failure or relapse.

  15. One-year adherence to oral antihyperglycemic medication and risk prediction of patient outcomes for adults with diabetes mellitus

    Science.gov (United States)

    Huber, Carola A.; Rapold, Roland; Brüngger, Beat; Reich, Oliver; Rosemann, Thomas

    2016-01-01

    Abstract Medication adherence is essential in preventing adverse intermediate outcomes, but little is known on hard outcomes. The aims of this study were to determine the 1-year adherence to oral antihyperglycemic drugs (OADs) and to predict the risk of subsequent health outcomes among (non)adherent patients with diabetes. Using a large Swiss healthcare claims database from 2011 to 2014, we identified all patients aged ≥18 years with diabetes and treated with at least 1 OAD prescription. Adherence to OADs was measured as the proportion of days covered (PDC) over 1 year and subdivided into 2 categories: adherent (PDC ≥ 80%), nonadherent (PDC < 80%). We estimated the relative risk of hospitalization and mortality at follow-up using multivariate Cox proportional hazard models. Based on a sample of 26,713 patients, adherence to OADs was quite low: 42% of the patients achieved a PDC of ≥80% during the 1-year observation period. A 7% reduction in the hospitalization risk and a 10% reduction in the risk of mortality could be observed in adherent patients compared to nonadherent patients (hazard ratio [HR], 0.93 [95% CI, 0.89–0.97]; HR, 0.90 [95% CI, 0.82–0.99]). Subgroup analysis showed that an intensified diabetes therapy had no significant influence on the risk of both outcomes in adherent patients. Poor medication adherence increases the risk of subsequent hospitalizations and premature mortality in patient with diabetes, regardless of disease severity and comorbidities. This emphasizes the need for an earlier identification of patients with poor medication adherence. The awareness of physicians and patients regarding the importance of adherence in diabetes treatment should be increased. PMID:27368004

  16. Treatment Adherence of Tuberculosis Patients Attending Two Reference Units in Equatorial Guinea.

    Science.gov (United States)

    Fagundez, Gabriela; Perez-Freixo, Hugo; Eyene, Juan; Momo, Juan Carlos; Biyé, Lucia; Esono, Teodoro; Ondó Mba Ayecab, Marcial; Benito, Agustín; Aparicio, Pilar; Herrador, Zaida

    2016-01-01

    Equatorial Guinea has one of the highest burden of tuberculosis (TB) in Africa. Incomplete adherence to TB treatment has been identified as one of the most serious remaining problem in tuberculosis control. The following study is aimed at determining the adherence to anti-tuberculosis treatment in Equatorial Guinea and its determinants, as well as at assessing the knowledge of the people about the disease. In this cross-sectional study, participants were recruited by non-probabilistic consecutive sampling amongst patients who attended the reference units for TB in Bata and Malabo between March and July 2015. Socio-demographic and clinical data were collected. Adherence to treatment and knowledge about TB were assessed by Morisky-Green-Levine and Batalla tests and a questionnaire on adherence related factors specifically prepared for this research. Descriptive statistics were computed to summarize the data and bivariate analyses by adherence profile were performed with χ2 test for categorical data. A total of 98 patients with TB were interviewed. 63.27% of interviewees had good knowledge about TB (Batalla test) while 78.57% of respondents were adherent according to the Morisky-Green-Levine test. A low educational level, lack of family support and lack of medical advice about the disease were significantly associated to lower adherence level. Patients with re-infection (due to relapse or treatment failure) and those who have suffered from drug shortages were also less adherents. The National Programme for TB Control should consider improving the early diagnosis and follow-up of TB cases, as well as the implementation of all components of DOTS (Directly observed Treatment, short-course) strategy all over the country.

  17. Treatment Adherence of Tuberculosis Patients Attending Two Reference Units in Equatorial Guinea

    Science.gov (United States)

    Eyene, Juan; Momo, Juan Carlos; Biyé, Lucia; Esono, Teodoro; Ondó Mba Ayecab, Marcial; Benito, Agustín; Aparicio, Pilar

    2016-01-01

    Equatorial Guinea has one of the highest burden of tuberculosis (TB) in Africa. Incomplete adherence to TB treatment has been identified as one of the most serious remaining problem in tuberculosis control. The following study is aimed at determining the adherence to anti-tuberculosis treatment in Equatorial Guinea and its determinants, as well as at assessing the knowledge of the people about the disease. In this cross-sectional study, participants were recruited by non-probabilistic consecutive sampling amongst patients who attended the reference units for TB in Bata and Malabo between March and July 2015. Socio-demographic and clinical data were collected. Adherence to treatment and knowledge about TB were assessed by Morisky-Green-Levine and Batalla tests and a questionnaire on adherence related factors specifically prepared for this research. Descriptive statistics were computed to summarize the data and bivariate analyses by adherence profile were performed with χ2 test for categorical data. A total of 98 patients with TB were interviewed. 63.27% of interviewees had good knowledge about TB (Batalla test) while 78.57% of respondents were adherent according to the Morisky-Green-Levine test. A low educational level, lack of family support and lack of medical advice about the disease were significantly associated to lower adherence level. Patients with re-infection (due to relapse or treatment failure) and those who have suffered from drug shortages were also less adherents. The National Programme for TB Control should consider improving the early diagnosis and follow-up of TB cases, as well as the implementation of all components of DOTS (Directly observed Treatment, short-course) strategy all over the country. PMID:27622461

  18. Utility of therapeutic drug monitoring in the management of HIV-infected pregnant women in receipt of lopinavir.

    LENUS (Irish Health Repository)

    Caswell, R J

    2011-01-01

    The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and\\/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.

  19. Evaluation of a pilot study to influence medication adherence of patients with diabetes mellitus type-2 by the pharmacy.

    OpenAIRE

    Adhien, P.; Dijk, L. van; Vegter, M.; Westein, M.; Nijpels, G.; Hugtenburg, J.G.

    2013-01-01

    Background: Interventions aimed to increase adherence to drug treatment usually are not tailored to the needs of individual patients. A modular pharmacy intervention, named ‘Support for Diabetes’, was developed to improve adherence to type 2 diabetes treatment. Objective: To evaluate the implementation of a new care intervention by using focus groups including pharmacy teams, and assess patient satisfaction. Setting: Community pharmacies in The Netherlands Method: The intervention comprises a...

  20. Adherence of pharmaceutical advertisements in medical journals to FDA guidelines and content for safe prescribing.

    Directory of Open Access Journals (Sweden)

    Deborah Korenstein

    Full Text Available BACKGROUND: Physician-directed pharmaceutical advertising is regulated in the United States by the Food and Drug Administration (FDA; adherence to current FDA guidelines is unknown. Our objective was to determine adherence rates of physician-directed print advertisements in biomedical journals to FDA guidelines and describe content important for safe prescribing. METHODS AND FINDINGS: Cross-sectional analysis of November 2008 pharmaceutical advertisements within top U.S.-based biomedical journals publishing original research. We excluded advertisements for devices, over the counter medications, and disease awareness. We utilized FDA guideline items identifying unique forms of advertisement bias to categorize advertisements as adherent to FDA guidelines, possibly non-adherent to at least 1 item, or non-adherent to at least 1 item. We also evaluated advertisement content important for safe prescribing, including benefit quantification, risk information and verifiable references. All advertisements were evaluated by 2 or more investigators, with differences resolved by discussion. Twelve journals met inclusion criteria. Nine contained pharmaceutical advertisements, including 192 advertisements for 82 unique products; median 2 per product (range 1-14. Six "teaser" advertisements presented only drug names, leaving 83 full unique advertisements. Fifteen advertisements (18.1% adhered to all FDA guidelines, 41 (49.4% were non-adherent with at least one form of FDA-described bias, and 27 (32.5% were possibly non-adherent due to incomplete information. Content important for safe prescribing was often incomplete; 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification. Study limitations included its focus on advertisements from a single month, the subjectivity of FDA guidelines themselves, and the necessary subjectivity of determinations of adherence

  1. ON THE SELECTION OF DRUGS DOSAGE REGIMEN

    Directory of Open Access Journals (Sweden)

    E. N. Bochanova

    2015-09-01

    Full Text Available A complex system of hemostasis regulation, insufficient data on drugs pharmacokinetics, multiple factors effecting treatment, including patient’s adherence to therapy, that can lead to the need for the dosage regimen specification are presented.

  2. Adesão de pacientes com AIDS ao tratamento com antiretrovirais: dificuldades relatadas e proposição de medidas atenuantes em um hospital escola Adhesión del paciente con SIDA al tratamiento con antiretrovirales: dificultades relatadas y propuesta de medidas atenuantes en un hospital escuela Adherence of AIDS patients to treatment with antiretroviral drugs in a university hospital: difficulties observed and suggestions of interventions

    Directory of Open Access Journals (Sweden)

    Rosely Moralez de Figueiredo

    2001-01-01

    Full Text Available Com finalidade de propor medidas que facilitem a adesão do paciente com AIDS ao tratamento, este trabalho teve como objetivo caracterizar os erros e as principais dificuldades relatadas por 61 pacientes com AIDS atendidos junto ao Hospital de Clínicas da UNICAMP. Os erros mais freqüentes foram referentes às combinações entre as drogas e falta de jejum; as dificuldades relatadas foram: quantidade de medicamentos e reações adversas. As autoras propuseram, a partir destes dados, a utilização de um roteiro ilustrado para realização de orientações relativas aos medicamentos. Espera-se assim que a orientação individualizada possa contribuir para minimizar as falhas da adesão à terapêutica.Con la finalidad de proponer medidas que faciliten la adhesión del paciente con SIDA al tratamiento, este trabajo tuvo como objetivo caracterizar los errores y las principales dificultades relatadas por 61 pacientes con SIDA atendidos en el Hospital Clínicas de la UNICAMP. Los errores más frecuentes estuvieron relacionados con las combinaciones entre las drogas y la falta de ayuno; las dificultades relatadas fueron: Cantidad de medicamentos y reacciones adversas. Las autoras propusieron, a partir de estos datos, la utilización de una guía ilustrada para dar orientaciones relacionadas con los medicamentos. Se espera que la orientación individualizada pueda contribuir para disminuir las fallas en la adhesión al tratamiento.This study aimed at identifying the incidence of drug intake errors and the main therapy-related difficulties among AIDS patients as well as at proposing measures to increase patients' adherence to treatment. Sixty-one patients with AIDS assisted by the University Hospital of São Paulo State University at Campinas were interviewed. The most frequent errors concerned the combinations of drugs and the length of fasting. The difficulties reported were adverse effects and the variety of drugs. Based on these data, the authors

  3. Bacterial adherence on UHMWPE doped with Vitamin E: an in vitro study

    Energy Technology Data Exchange (ETDEWEB)

    Molina-Manso D; Gomez-Barrena E; Esteban J; Adames H; Martinez M J; Cordero J; Fernandez-Roblas R; Puertolas J A, E-mail: dmolina@fjd.es

    2010-11-01

    Biomaterials may improve its capacity to resist bacterial adherence, and subsequent infection through material changes. Our aim was to test the bacterial adherence to vitamin E (VE) doped UHMWPE with S. aureus and S. epidermidis (collection and clinical strains), compared to virgin material. Experimental UHMWPE with 3%, 0.4%, and commercial 0.1% VE concentration (1000 ppm) were tested. The biofilm-developing ability was used as a covariable. The collection strain of S. aureus showed significantly less adherence to the commercial VE UHMWPE (p=0.036) but the clinical strains did not significantly modified its adhesion to UHMWPE in presence of VE. The collection strain of S. epidermidis showed significantly less adherence to experimental UHMWPE with VE, independently of the concentration used (p=0.008). However, only 1 of the 4 clinical strains under study clearly confirmed these results in commercial VE polyethylene. Vitamin E doped UHMWPE affects the adherence of some S. aureus and S. epidermidis strains, independently of the concentration in use, but the results showed important intraspecies differences.

  4. Assessing adherence factors in patients under topical treatment: development of the Topical Therapy Adherence Questionnaire (TTAQ).

    Science.gov (United States)

    Zschocke, Ina; Mrowietz, Ulrich; Lotzin, Annett; Karakasili, Eleni; Reich, Kristian

    2014-04-01

    Medication adherence rates strongly depend on favorable disease outcomes. It is known that medication adherence rates are lower for topical treatment than for systemic treatment. However, to date no validated instrument for the assessment of adherence factors in topical treatment is available. The aim of this study was to develop a new questionnaire to assess adherence risk factors in topical treatment. The development of the Topical Therapy Adherence Questionnaire (TTAQ) and Patient Preference Questionnaire (PPQ) was based on a systematic literature review, and qualitative patient focus interviews and expert focus groups' input. The psychometric properties and comprehensibility of the TTAQ and PPQ were assessed in a feasibility study with 59 psoriasis patients. Our first preliminary results indicate that the TTAQ and PPQ are psychometrically sound and reliable measures for the assessment of factors influencing topical treatment adherence. The questionnaires are currently being further developed and various parameters (e.g., time point of assessment) are currently being tested in an exploratory pilot study with ca. 2,000 psoriasis patients receiving topical treatment in a European clinical trial. The use of the final versions of TTAQ and PPQ in clinical practice may facilitate the early identification of specific non-adherence factors in patients under topical treatment, which could enable designing and applying adherence-enhancing interventions according to the patient's individual needs.

  5. Patient education improves adherence to peg-interferon and ribavirin in chronic genotype 2 or 3 hepatitis C virus infection: A prospective, real-life, observational study

    Institute of Scientific and Technical Information of China (English)

    Patrice Cacoub; Denis Ouzan; Pascal Melin; Jean-Philippe Lang; Michel Rotily; Thierry Fontanges; Marina Varastet; Michel Chousterman; Patrick Marcellin

    2008-01-01

    AIM: To evaluate the impact of therapeutic education on adherence to antiviral treatment and sustained virological response (SVR) in a real-life setting in genotype 2/3 hepatitis C, as there are few adherence data in genotype 2/3 infection, even from randomized trials. METHODS: This prospective survey included genotype 2/3 patients who received peg-interferon alfa-2b and ribavirin. There was no intervention. Adherence was self-reported over the past 4 wk (peg-interferon) or 7 d (ribavirin). Adherence to bitherapy was defined as adherence to the two drugs for≥20 wk. SVR was defined as undetectable RNA≥12 wk after the end of treatment. RESULTS: 370/674 patients received education during the first 3 mo of treatment. After 6 mo, adherence to bitherapy was higher in educated patients (61% vs 47%, P=0.01). Adherence to peg-interferon was 78% vs 69% (P=0.06). Adherence to ribavirin was 70% vs 56% (P=0.006). The SVR (77% vs 70%, P = 0.05) and relapse (10% w 16%, P = 0.09) rates tended to be improved. After adjustment for baseline differences, education improved adherence [Odds ratio (OR) 1.58, P=0.04] but not the SVR (OR 1.54, P=0.06). CONCLUSION: In genotype 2/3 patients, therapeutic education helped maintain real-life adherence to bitherapy.

  6. Predictors and impact of non-adherence in adults with attention-deficit/hyperactivity disorder receiving OROS methylphenidate: results from a randomized, placebo-controlled trial

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    Kooij J J Sandra

    2013-01-01

    Full Text Available Abstract Background Medication non-adherence has an important impact on treatment efficacy and healthcare burden across a range of conditions and therapeutic areas. The aim of this analysis was to determine predictors of non-adherence and impact of non-adherence on treatment response in adults with attention-deficit/hyperactivity disorder (ADHD. Methods Post-hoc analysis of a 13-week randomized, double-blind placebo-controlled study of OROS methylphenidate (MPH 54 and 72 mg/day. Primary efficacy variable was the Conners’ Adult ADHD Rating Scale – Screening Version (CAARS:O-SV. Daily adherence was calculated as average daily adherence (100 × capsules taken/2, with overall adherence calculated as the average daily adherence. Predictors of adherence were assessed using mixed-effects logistic regression. Descriptive statistics were generated for change in CAARS:O-SV score for adherent (> 95% adherence and non-adherent subjects. Predictors of change were analyzed using a mixed model. Results Subjects were allocated to OROS MPH (54 mg, n = 87; 72 mg, n = 92 or placebo (n = 97. Mean adherence was 92.6% and 93.3% (OROS MPH 54 and 72 mg/day, respectively, versus 97.5% (placebo. Adherence was higher and less variable in completers. Factors significantly associated with non-adherence included female sex, shorter time since ADHD diagnosis, higher education level (completion of university and score on the Drug Use Screening Inventory psychiatric disorders subscale. Improvements from baseline in CAARS:O-SV score were numerically greater in subjects defined as adherent than in those who were non-adherent. Significant predictors of CAARS:O-SV change in patients who completed the study included percentage adherence up to the point of assessment (p p p = 0.0003. Conclusion The results of this analysis suggest that newly diagnosed patients, those with a high score on the DUSI-R psychiatric disorder scale, women, and subjects with high educational degrees may

  7. Adherence in paediatric renal failure and dialysis: an ethical analysis of nurses' attitudes and reported practice.

    Science.gov (United States)

    Mellor, Joe Scott; Hulton, Sally-Anne; Draper, Heather

    2015-02-01

    Minors have difficulty adhering to the strict management regimen required whilst on renal dialysis for chronic renal failure. This leads to ethical tensions as healthcare professionals (HCPs) and parents try, in the minor's best interests, to ensure s/he adheres. All 11 dialysis nurses working in a large, regional paediatric dialysis unit were interviewed about their perceptions and management of non-adherence and the ethical issues this raised for them. Participants reported negative attitudes to non-adherence alongside sympathy and feelings of frustration. They discussed the competing responsibilities between nurses, parents and minors, and how responsibility ought to be transferred to the minor as s/he matures; the need for minors to take responsibility ahead of transferring to adult services; and, the process of transferring this responsibility. Our discussion concentrates on the ethical issues raised by the participants' reports of how they respond to non-adherence using persuasion and coercion. We consider how understandings of capacity, traditional individual autonomy, and willpower can be used to comprehend the issue of non-adherence. We consider the relational context in which the minor receives, and participates in, healthcare. This exposes the interdependent triad of relationships between HCP, parent and minor and aids understanding of how to provide care in an ethical way. Relational ethics is a useful alternative understanding for professionals reflecting upon how they define their obligations in this context.

  8. High affinity capture and concentration of quinacrine in polymorphonuclear neutrophils via vacuolar ATPase-mediated ion trapping: Comparison with other peripheral blood leukocytes and implications for the distribution of cationic drugs

    Energy Technology Data Exchange (ETDEWEB)

    Roy, Caroline; Gagné, Valérie; Fernandes, Maria J.G.; Marceau, François, E-mail: francois.marceau@crchul.ulaval.ca

    2013-07-15

    Many cationic drugs are concentrated in acidic cell compartments due to low retro-diffusion of the protonated molecule (ion trapping), with an ensuing vacuolar and autophagic cytopathology. In solid tissues, there is evidence that phagocytic cells, e.g., histiocytes, preferentially concentrate cationic drugs. We hypothesized that peripheral blood leukocytes could differentially take up a fluorescent model cation, quinacrine, depending on their phagocytic competence. Quinacrine transport parameters were determined in purified or total leukocyte suspensions at 37 °C. Purified polymorphonuclear leukocytes (PMNLs, essentially neutrophils) exhibited a quinacrine uptake velocity inferior to that of lymphocytes, but a consistently higher affinity (apparent K{sub M} 1.1 vs. 6.3 μM, respectively). However, the vacuolar (V)-ATPase inhibitor bafilomycin A1 prevented quinacrine transport or initiated its release in either cell type. PMNLs capture most of the quinacrine added at low concentrations to fresh peripheral blood leukocytes compared with lymphocytes and monocytes (cytofluorometry). Accumulation of the autophagy marker LC3-II occurred rapidly and at low drug concentrations in quinacrine-treated PMNLs (significant at ≥ 2.5 μM, ≥ 2 h). Lymphocytes contained more LAMP1 than PMNLs, suggesting that the mass of lysosomes and late endosomes is a determinant of quinacrine uptake V{sub max}. PMNLs, however, exhibited the highest capacity for pinocytosis (uptake of fluorescent dextran into endosomes). The selectivity of quinacrine distribution in peripheral blood leukocytes may be determined by the collaboration of a non-concentrating plasma membrane transport mechanism, tentatively identified as pinocytosis in PMNLs, with V-ATPase-mediated concentration. Intracellular reservoirs of cationic drugs are a potential source of toxicity (e.g., loss of lysosomal function in phagocytes). - Highlights: • Quinacrine is concentrated in acidic organelles via V-ATPase-mediated ion

  9. Analysis of reasons for low adherence to antiepileptic therapy in patients with symptomatic epilepsy

    Directory of Open Access Journals (Sweden)

    M. A. Vagina

    2014-01-01

    Full Text Available Objective: to study the major factors that influence treatment adherence.Patients and methods. One hundred patients aged 20 to 68 years (mean age 42.9±3.0 years for women and 43.3±5.0 years for men diagnosed with a ≥3-year history of symptomatic epilepsy were screened. The minimal and maximal durations of the disease were 5 and 59 years, respectively (mean 20.8±3.9 years.Results and discussion. There was a female preponderance in the treatment adherence group. The patients who had secondary special education were unemployed, disabled, and single were in both comparison groups. These data are indicative of social stigmatization in epileptic patients. Patients with severe epilepsy on multiple drug therapy were prevalent. Neuropsychological testing revealed higher levels of anxiety and depression among those who were non-adherent to therapy.Conclusion. The sex, age, and social characteristics (education level, disability of patients with epilepsy and its clinical picture, neurological symptoms and changes were ascertained by magnetic resonance imaging had no significant impact on therapy adherence.The factors influencing treatment adherence should include multiple drug therapy (co-administration of two or three drugs and the high frequency of drug use, which is more frequently observed in patients with severe treatment-resistant epilepsy. Anxiety and depressive disorders in epileptic patients resulted in impaired compliance with anticonvulsant therapy.

  10. GOLD guidelines adherence impact on the NHS budget

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    Alessandro Guasconi

    2014-03-01

    Full Text Available OBJECTIVE: Aim of this study was the evaluation of the adherence level to GOLD guidelines for the COPD patients’ treatment in the Italian GPs setting, observing the time trend on ICS therapies’ pharmacoutilization, specifically in mild and moderate COPD patients, which is considered inappropriate by GOLD guidelines. Moreover, a pharmacoeconomic analysis has been implemented in order to evaluate the economical burden of the improper management of COPD.METHODS: The retrospective GPs database study has analyzed patients with at least one diagnosis of COPD during the periods January 2005 – December 2008 (Cohort 1 and January 2009 – December 2011 (Cohort 2, who had a reported value of VEMS, at least one prescription of a drug from ATC R03 class within two months from the date of spirometric exam and aged 40 or more. Disease severity has been defined according to 2008 GOLD guidelines. Comparison between the cohorts has been implemented to verify possible variations in guideline adherence. Furthermore, an economical analysis has been developed in order to highlight saves obtained by following GOLD guidelines and the total inappropriate therapies’ costs.RESULTS: The first cohort involved 2,103 COPD patients, while the second cohort included 1,647 subjects. Reduction of ICS therapies has been shown between the two cohorts, with a decrease of 8.4% for mild patient and 1.6% for moderate patients; considering all the disease severities, the reduction was about 4%. Pharmacoeconomic analysis on mild and moderate patients has pointed out that about 50% of the total ICS treatments (814,692 € on 1,658,164 € is related to the ICS element, and so considered inappropriate costs.CONCLUSION: Economic differences between the two periods have highlighted a minor mean costs for Cohort 2, underlining an improvement in the adherence to the GOLD guidelines in the last period.http://dx.doi.org/10.7175/fe.v15i1.887

  11. Improving medication adherence in patients with hypertension

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Kjeldsen, Lene Juel; Pottegård, Anton

    2015-01-01

    BACKGROUND: and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve...... medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS: Patients (N=532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review......, tailored adherence counselling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at one-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months...

  12. Adherence to diabetes medication in individuals with schizophrenia:a systematic review of rates and determinants of adherence

    OpenAIRE

    Gorczynski, Paul; Patel, Hiren; Ganguli, Rohan

    2014-01-01

    Introduction: Despite the importance of medication adherence for the effective treatment of type II diabetes mellitus (T2DM), little research has examined adherence with diabetes medication treatment in schizophrenia. The purpose of this systematic review was to 1) evaluate rates of adherence and determinants of adherence with medication for T2DM in individuals with schizophrenia, and, where possible, 2) examine the relationship between medication adherence and glycemic control. Methods: Stud...

  13. Cargo delivery to adhering myoblast cells from liposome-containing poly(dopamine) composite coatings

    DEFF Research Database (Denmark)

    Madsen, Martin Elias Lynge; Mian Teo, Boon; Laursen, Marie Bækgaard;

    2013-01-01

    Designing surfaces to deliver therapeutic compounds to adhering cells is of paramount importance for both implantable devices and tissue engineering. We report the assembly of composite films consisting of liposomes as drug deposits in a poly(dopamine) matrix. We monitor the film assembly using...... a quartz crystal microbalance with dissipation. We assess the response of adhering myoblast cells to these films containing fluorescent lipids in terms of uptake efficiency and cell mean fluorescence using flow cytometry. The viability of adhering myoblast cells, when the hydrophobic cytotoxic compound...... thiocoraline is entrapped in the lipid membrane, is assessed for different films. Coatings with one or two liposome deposition steps are considered. Further, the effect of the polymer separation layers between the liposome layers is determined. We found that it is possible to use the different nano...

  14. Biomarkers and biometric measures of adherence to use of ARV-based vaginal rings

    Directory of Open Access Journals (Sweden)

    Randy M Stalter

    2016-05-01

    for further development based on the following measurements: intracellular drug levels, drug levels in hair, the accumulation of a vaginal analyte that diffuses into the ring, and the depletion of an intrinsic ring constituent. Conclusions: While some approaches show significant promise over others, it is recommended that a strategy of using complementary biometric and behavioural approaches be adopted to best understand participants’ adherence to ARV-based ring products in clinical trials.

  15. Adherence to Plasmodium vivax malaria treatment in the Brazilian Amazon Region

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    Pereira Elza A

    2011-12-01

    Full Text Available Abstract Background Patients' adherence to malaria treatment is an important factor in determining the therapeutic response to anti-malarial drugs. It contributes to the patient's complete recovery and prevents the emergence of parasite resistance to anti-malarial drugs. In Brazil, the low compliance with malaria treatment probably explains the large number of Plasmodium vivax malaria relapses observed in the past years. The goal of this study was to estimate the proportion of patients adhering to the P. vivax malaria treatment with chloroquine + primaquine in the dosages recommended by the Brazilian Ministry of Health. Methods Patients who were being treated for P. vivax malaria with chloroquine plus primaquine were eligible for the study. On the seventh day of taking primaquine, they were visited at their home and were interviewed. The patients were classified as probably adherent, if they reported having taken all the medication as prescribed, in the correct period of time and dosage, and had no medication tablets remaining; probably non-adherent, if they reported not having taken the medication, in the correct period of time and dosage, and did not show any remaining tablets; and certainly non-adherent, if they showed any remaining medication tablets. Results 242 of the 280 patients reported having correctly followed the prescribed instructions and represented a treatment adherence frequency (CI95% of 86.4% (81.7%-90.1%. Of the 38 patients who did not follow the recommendations, 27 (9.6% were still taking the medication on the day of the interview and, therefore, still had primaquine tablets left in the blister pack. These patients were then classified as certainly non-adherent to treatment. Although 11 patients did not show any tablets left, they reported incorrect use of the prescribed therapy regimen and were considered as probably non-adherent to treatment. Conclusions Compliance with the P. vivax malaria treatment is a characteristic of

  16. Effect of therapeutic plasma concentrations of non-steroidal anti-inflammatory drugs on the production of reactive oxygen species by activated rat neutrophils

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    Paino I.M.M.

    2005-01-01

    Full Text Available The release of reactive oxygen specie (ROS by activated neutrophil is involved in both the antimicrobial and deleterious effects in chronic inflammation. The objective of the present investigation was to determine the effect of therapeutic plasma concentrations of non-steroidal anti-inflammatory drugs (NSAIDs on the production of ROS by stimulated rat neutrophils. Diclofenac (3.6 µM, indomethacin (12 µM, naproxen (160 µM, piroxicam (13 µM, and tenoxicam (30 µM were incubated at 37ºC in PBS (10 mM, pH 7.4, for 30 min with rat neutrophils (1 x 10(6 cells/ml stimulated by phorbol-12-myristate-13-acetate (100 nM. The ROS production was measured by luminol and lucigenin-dependent chemiluminescence. Except for naproxen, NSAIDs reduced ROS production: 58 ± 2% diclofenac, 90 ± 2% indomethacin, 33 ± 3% piroxicam, and 45 ± 6% tenoxicam (N = 6. For the lucigenin assay, naproxen, piroxicam and tenoxicam were ineffective. For indomethacin the inhibition was 52 ± 5% and diclofenac showed amplification in the light emission of 181 ± 60% (N = 6. Using the myeloperoxidase (MPO/H2O2/luminol system, the effects of NSAIDs on MPO activity were also screened. We found that NSAIDs inhibited both the peroxidation and chlorinating activity of MPO as follows: diclofenac (36 ± 10, 45 ± 3%, indomethacin (97 ± 2, 100 ± 1%, naproxen (56 ± 8, 76 ± 3%, piroxicam (77 ± 5, 99 ± 1%, and tenoxicam (90 ± 2, 100 ± 1%, respectively (N = 3. These results show that therapeutic levels of NSAIDs are able to suppress the oxygen-dependent antimicrobial or oxidative functions of neutrophils by inhibiting the generation of hypochlorous acid.

  17. Quality of life associated with treatment adherence in patients with type 2 diabetes: a cross-sectional study

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    Valdivia-Martínez José J

    2008-07-01

    Full Text Available Abstract Background Despite certain contradictions, an association has been identified between adherence to drug treatment and the quality of life in patients with type 2 diabetes. The contradictions observed emphasize the importance of using different methods to measure treatment adherence, or the association of psychological precursors of adherence with quality of life. For this reason, we have used an indirect method to measure adherence (pill count, as well as two adherence behaviour precursors (attitude and knowledge, to assess the association between adherence and the quality of life in type 2 diabetes patients. Methods A cross-sectional comparative study on a random sample of 238 type 2 diabetic patients was carried out over one year in four family medicine units of the Mexican Institute of Social Security (IMSS in Aguascalientes, Mexico. Treatment adherence was measured using the indirect method of pill count to assess adherence behaviour, obtaining information at two home visits. In the first we recorded the medicine prescribed and in the second, we counted the medicine remaining to determine the proportion of the medicine taken. We also assessed two adherence behaviour precursors: the patients' knowledge regarding their medical prescription measured through a structured questionnaire; and attitudes to treatment adherence using a Likert scale. Quality of life was measured through the WHOQOL-100 (the WHO Quality of Life questionnaire. Information concerning both knowledge and attitude was obtained through interviews with the patients. A multiple linear regression model was constructed to establish the relationship between each quality of life domain and the variables related to adherence, controlling for covariates. Results There was no association between quality of life and treatment adherence behaviour. However, the combination of strong knowledge and a positive attitude was associated with five of the six quality of life domains

  18. Impact of a pharmaceutical care program on clinical evolution and antiretroviral treatment adherence: a 5-year study

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    Hernández Arroyo MJ

    2013-08-01

    Full Text Available María Jesús Hernández Arroyo,1 Salvador Enrique Cabrera Figueroa,2 Rosa Sepúlveda Correa,3 María de la Paz Valverde Merino,1 Alicia Iglesias Gómez,4 Alfonso Domínguez-Gil Hurlé5 On behalf of the Tormes Team 1Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain; 2Pharmacy Institute, University Austral of Chile, Valdivia, Chile; 3Department of Statistics, University of Salamanca, Salamanca, Spain; 4Infectious Disease Service, University Hospital of Salamanca, Salamanca, Spain; 5Department of Pharmacy and Pharmaceutical Technology, University of Salamanca, Salamanca, Spain Background: Antiretroviral treatments (ART form the basis of adequate clinical control in human immunodeficiency virus-infected patients, and adherence plays a primary role in the grade and duration of the antiviral response. The objectives of this study are: (1 to determine the impact of the implementation of a pharmaceutical care program on improvement of ART adherence and on the immunovirological response of the patients; and (2 to detect possible correlations between different adherence evaluation measurements. Methods: A 60-month long retrospective study was conducted. Adherence measures used were: therapeutic drug monitoring, a simplified medication adherence questionnaire, and antiretroviral dispensation records (DR. The number of interviews and interventions related to adherence made for each patient in yearly periods was related to the changes in the adherence variable (measured with DR in these same yearly periods. The dates when the laboratory tests were drawn were grouped according to proximity with the study assessment periods (February–May, 2005–2010. Results: A total of 528 patients were included in the study. A significant relationship was observed between the simplified medication adherence questionnaire and DR over the 60-month study period (P < 0.01. Improvement was observed in the mean adherence level (P < 0.001, and there was a

  19. Factors affecting medication adherence in elderly people

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    Jin HK

    2016-10-01

    Full Text Available Hyekyung Jin,1 Yeonhee Kim,2 Sandy Jeong Rhie1,3 1College of Pharmacy, 2Center for Excellence in Teaching & Learning, 3Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea Background: Little is known about the functional health literacy (FHL associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods: This was a cross-sectional survey. Participants (n=160 aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results: The mean score of the total FHL was 7.72±3.51 (range 0–15. The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=-0.215, P=0.022, sufficient explanation of medication counseling (β=-0.335, P=0.000, education level (β=-0.153, P=0.045, health-related problems (β=-0.239, P=0.004, and dosing frequency (β=0.189, P=0.018. Conclusion: In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists

  20. Adherence to methotrexate in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Bliddal, Henning; Eriksen, Stine A; Christensen, Robin;

    2015-01-01

    Objectives. To study adherence to methotrexate (MTX) and factors of importance thereof in patients with rheumatoid arthritis (RA). Methods. Patients with a hospital diagnosis of RA (ICD10 codes M05.X or M06.X) after January 1, 1997, and aged ≥18 years at the date of first diagnosis/contact, with ......Objectives. To study adherence to methotrexate (MTX) and factors of importance thereof in patients with rheumatoid arthritis (RA). Methods. Patients with a hospital diagnosis of RA (ICD10 codes M05.X or M06.X) after January 1, 1997, and aged ≥18 years at the date of first diagnosis...

  1. A mobile application improves therapy-adherence rates in elderly patients undergoing rehabilitation

    Science.gov (United States)

    Mertens, Alexander; Brandl, Christopher; Miron-Shatz, Talya; Schlick, Christopher; Neumann, Till; Kribben, Andreas; Meister, Sven; Diamantidis, Clarissa Jonas; Albrecht, Urs-Vito; Horn, Peter; Becker, Stefan

    2016-01-01

    Abstract Medication adherence is crucial for success in the management of patients with chronic conditions. This study analyzes whether a mobile application on a tablet aimed at supporting drug intake and vital sign parameter documentation affects adherence in elderly patients. Patients with coronary heart disease and no prior knowledge of tablet computers were recruited. They received a personal introduction to the mobile application Medication Plan, installed on an Apple iPad. The study was conducted using a crossover design with 3 sequences: initial phase, interventional phase (28 days of using the app system), and comparative phase (28 days of using a paper diary). Users experienced the interventional and comparative phases alternately. A total of 24 patients (12 males; mean age 73.8 years) were enrolled in the study. The mean for subjectively assessed adherence (A14-scale; 5-point Likert scale, from “never” to “very often” which results in a score from 0 to 56) before the study was 50.0 (SD = 3.44). After both interventions there was a significant increase, which was more pronounced after the interventional phase (54.0; SD = 2.01) than after the comparative phase (52.6; SD = 2.49) (for all pairs after both interventions, P <0.001). Neither medical conditions nor the number of drug intake (amount and frequency of drug taking) per day affected subjective adherence. Logging data showed a significantly stronger adherence for the medication app than the paper system for both blood pressure recordings (P <0.001) and medication intake (P = 0.033). The majority of participants (n = 22) stated that they would like to use the medication app in their daily lives and would not need further assistance with the app. A mobile app for medication adherence increased objectively and subjectively measured adherence in elderly users undergoing rehabilitation. The findings have promising clinical implications: digital tools can assist chronic disease patients achieve

  2. Adherence to statin therapy in patients with type 2 diabetes: An important dilemma

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    Shadi Farsaei

    2015-01-01

    Full Text Available Background: Despite the importance of patients′ adherence to their drug treatments for achieving desired therapeutic goals and the proven role 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins for the health status of patients with cardiovascular diseases, there is not enough information regarding diabetic patients′ adherence to statin therapy in developing countries. In this clinical study we aimed to assess the adherence of diabetes type 2 patients to statin therapy in a research based community clinic in Iran. Materials and Methods: In this prospective clinical study which was done at Isfahan Endocrinology and Metabolism Research Center, 204 diabetic type 2 patients under treatment with statin were interviewed twice and their demographic data (age, gender, body mass index, education, statin information (type, dose and their serum lipid profile were recorded. Three months after the initial visits, patients were assessed using pill counting method and according to patients′ self-reporting and also assessed low-density lipoprotein (LDL cholesterol goal attainment <100 mg/dl. Results: Adherence rate was 79.7% and 69% according to pill counting and self-reporting among study population. Moreover, 68.4% of patients achieved their LDL cholesterol goal of <100 mg/dl and adherent patients reached therapeutic goal significantly more than those who were considered non-adherence to statin therapy (P < 0.01. Conclusion: Adherence to statin therapy, as reflected by pill count method, is significantly related to LDL cholesterol goal achievement in patients with diabetes and dyslipidemia. Pill count method can be used to identify patients who are nonadherent to statin therapy and at high risk for failure to attain LDL cholesterol goals.

  3. A cohort study of possible risk factors for over-reporting of antihypertensive adherence

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    Lee Mei-Ling Ting

    2001-12-01

    Full Text Available Abstract Background The identification of poor medicinal adherence is difficult because direct observation of medication use is usually impractical. Up to 50% of individuals on chronic therapies may not be taking their medication as prescribed. This study is one of the first to explore possible risk factors for over-reporting of antihypertensive adherence using electronic medication monitoring. Methods The adherence of 286 individuals on single-drug antihypertensive therapy in a large managed care organization was electronically monitored for approximately three months. Questionnaires on socioeconomic background, adherence to therapy, health beliefs, and social support before and after adherence monitoring were completed. Over-reporting of antihypertensive adherence was assessed by comparing the self-reported frequency of noncompliance with that determined from electronic dosing records. Risk factors for over-reporting were identified by contingency table analysis and step-wise logistic regression. Results Although only 21% of participants acknowledged missing doses on one or more days per week, electronic monitoring documented nonadherence at this or a higher level in 42% of participants. The following variables were associated with over-reporting: >1 versus 1 daily dose (OR = 2.58; 95% CI = 1.50–4.41; p = .0006, lower perceived health risk from nonadherence (OR = 1.35; 95% CI = 1.10–1.64; p = .0035, and annual household income of $30,000 (OR = 2.64; 95% CI = 1.13–6.18; p = .025. Conclusions Over-reporting of adherence may be affected by factors related to dosing frequency, health beliefs and socioeconomic status. This topic deserves further investigation in other patient populations to elucidate possible underlying behavioral explanations.

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

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    Jessica E Haberer

    Full Text Available 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 <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. 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

  5. Treatment Adherence and Quality of Life in Diabetes Mellitus Patients in Indonesia

    Directory of Open Access Journals (Sweden)

    D. A. Perwitasari

    2016-04-01

    Full Text Available Adherence to treatment of diabetes mellitus (DM can support successful therapy due to drug consumption over longtime periods. The objectives of this study are to evaluate the treatment adherence in DM as related to the quality of life and to evaluate factors associated with adherence and quality of life. This study used the Brief Medication Questionnaire (BMQ to measure patients’ adherence. The Diabetes Quality of Life Clinical Trial Questionnaire (DQLCTQ was used to measure patients’ quality of life. Subjects of this cross-sectional study were DM patients attending two private hospitals in Yogyakarta and who had been taking DM medications for more than 6 months. Statistical analyses used in this study were student’s t test and regression linear test. We recruited 65 DM patients who met the inclusion criteria. There were no significant differences of BMQ screens and DQLCTQ functions between monotherapy and combination therapy groups (p> .05. The BMQ screens’ score of combination therapy were higher than monotherapy groups. The physical function, health distress, and mental health of combination therapy groups were higher than monotherapy group. The male patients had significantly higher score of regimen domain of BMQ than female patients (0.35 and 0.17, respectively. The older age has the lower score of treatment effect of DQLCTQ (p< .05. The belief, recall, and belief about adverse drug reaction of BMQ have positive correlation with physical function (r = .542, .424, and .640, respectively. Our study concluded that the quality of care, sex, and age may predict patients’ adherence and quality of life. There were positive correlation between patients’ adherence and quality of life.

  6. Access to highly active antiretroviral therapy for injection drug users: adherence, resistance, and death Acesso de usuários de drogas injetáveis ao tratamento anti-retroviral altamente potente: aderência, resistência e mortalidade

    Directory of Open Access Journals (Sweden)

    David Vlahov

    2006-04-01

    Full Text Available Injection drug users (IDUs continue to comprise a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs.Os usuários de drogas injetáveis (UDI ainda representam um importante grupo de risco para a infecção pelo HIV no mundo em geral, além de constituir o grupo central das epidemias de HIV na Ásia e no Leste Europeu e Rússia. Os programas de prevenção do HIV variam, desde a testagem sorológica e aconselhamento, educação, intervenções comportamentais e em redes, tratamento da dependência química, desinfecção de agulhas com água sanitária, troca de agulhas e ampliação do acesso a seringas, além da redução da transição ao uso injetável e a prevenção primária da dependência química. Com o advento da terapia anti-retroviral altamente potente (HAART, em 1996, houve uma melhora clínica dramática. Além disso, o impacto do tratamento

  7. Adherence to oral antineoplastic agents by cancer patients: definition and literature review.

    Science.gov (United States)

    Bassan, F; Peter, F; Houbre, B; Brennstuhl, M J; Costantini, M; Speyer, E; Tarquinio, C

    2014-01-01

    Since the 1990s, oral chemotherapy has been gaining ground as cancer treatment. This therapy seems to have few toxic effects and offers patients good quality of life. However, in addition to the fears the therapy might generate in patients, oral treatment raises a new issue, which, until now, has been marginal in this field: therapeutic observance or adherence. We investigated the research into adherence to oral chemotherapy among cancer patients published between 1990 and July 2013. Studies showed considerable diversity in terms of both the definition and measurement of adherence. As well, adherence to antineoplastic therapy is affected by the patient's understanding of the treatment and ability to remember information provided by the physician, treatment length and psychological distress. Our review of the few studies on adherence to anticancer drug treatment raises some questions that could be pursued in future research. In light of our findings, patients should receive 'therapy education' to help them and their support groups better understand the disease and its treatment and to achieve optimal health management and improved treatment effectiveness.

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

    Science.gov (United States)

    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.

  9. Verifying quantitative stigma and medication adherence scales using qualitative methods among Thai youth living with HIV/AIDS.

    Science.gov (United States)

    Fongkaew, Warunee; Viseskul, Nongkran; Suksatit, Benjamas; Settheekul, Saowaluck; Chontawan, Ratanawadee; Grimes, Richard M; Grimes, Deanna E

    2014-01-01

    HIV/AIDS-related stigma has been linked to poor adherence resulting in drug resistance and the failure to control HIV. This study used both quantitative and qualitative methods to examine stigma and its relationship to adherence in 30 HIV-infected Thai youth aged 14 to 21 years. Stigma was measured using the HIV stigma scale and its 4 subscales, and adherence was measured using a visual analog scale. Stigma and adherence were also examined by in-depth interviews. The interviews were to determine whether verbal responses would match the scale's results. The mean score of stigma perception from the overall scale and its 4 subscales ranged from 2.14 to 2.45 on a scale of 1 to 4, indicating moderate levels of stigma. The mean adherence score was .74. The stigma scale and its subscales did not correlate with the adherence. Totally, 17 of the respondents were interviewed. Contrary to the quantitative results, the interviewees reported that the stigma led to poor adherence because the fear of disclosure often caused them to miss medication doses. The differences between the quantitative and the qualitative results highlight the importance of validating psychometric scales when they are translated and used in other cultures.

  10. A randomized controlled trial examining the efficacy of motivational counseling with observed therapy for antiretroviral therapy adherence.

    Science.gov (United States)

    Goggin, Kathy; Gerkovich, Mary M; Williams, Karen B; Banderas, Julie W; Catley, Delwyn; Berkley-Patton, Jannette; Wagner, Glenn J; Stanford, James; Neville, Sally; Kumar, Vinutha K; Bamberger, David M; Clough, Lisa A

    2013-07-01

    This study determined whether motivational interviewing-based cognitive behavioral therapy (MI-CBT) adherence counseling combined with modified directly observed therapy (MI-CBT/mDOT) is more effective than MI-CBT counseling alone or standard care (SC) in increasing adherence over time. A three-armed randomized controlled 48-week trial with continuous electronic drug monitored adherence was conducted by randomly assigning 204 HIV-positive participants to either 10 sessions of MI-CBT counseling with mDOT for 24 weeks, 10 sessions of MI-CBT counseling alone, or SC. Poisson mixed effects regression models revealed significant interaction effects of intervention over time on non-adherence defined as percent of doses not-taken (IRR = 1.011, CI = 1.000-1.018) and percent of doses not-taken on time (IRR = 1.006, CI = 1.001-1.011) in the 30 days preceding each assessment. There were no significant differences between groups, but trends were observed for the MI-CBT/mDOT group to have greater 12 week on-time and worse 48 week adherence than the SC group. Findings of modest to null impact on adherence despite intensive interventions highlights the need for more effective interventions to maintain high adherence over time.

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

    Science.gov (United States)

    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. PMID:25355176

  12. Guideline Adherence of Antithrombotic Treatment Initiated by General Practitioners in Patients With Nonvalvular Atrial Fibrillation: A Danish Survey

    DEFF Research Database (Denmark)

    Brandes, Axel; Overgaard, Mikkel; Plauborg, Liane

    2013-01-01

    .001) of the patients. Of all patients, 66.3% were treated with oral anticoagulants, 18.7% with antiplatelet drugs only, and 15% received no antithrombotic therapy. Based on the CHADS(2) score, 75.7% of the patients were treated in adherence with the guidelines, 16% were undertreated, and 8.4% overtreated......) score. Applying the CHA(2)DS(2)-VASc score, this proportion was only 53.4%. Antiplatelet drug treatment was in adherence to the guidelines (CHADS(2) and CHA(2)DS(2)-VASc score of 1) in only 31% and 12% of the patients, respectively. ConclusionsAntithrombotic treatment of AF patients is in general well...

  13. Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients.

    Directory of Open Access Journals (Sweden)

    Anne Pauly

    Full Text Available In psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common non-adherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy.269 patients from a German university hospital were included in a prospective, open, clinical trial with consecutive control and intervention groups. Control patients (09/2012-03/2013 received usual care, whereas intervention patients (05/2013-12/2013 underwent a program to enhance adherence during their stay and up to three months after discharge. The program consisted of therapy simplification and individualized patient education (multi-dimensional component during the stay and at discharge, as well as subsequent phone calls after discharge (inter-sectoral component. Adherence was measured by the "Medication Adherence Report Scale" (MARS and the "Drug Attitude Inventory" (DAI.The improvement in the MARS score between admission and three months after discharge was 1.33 points (95% CI: 0.73-1.93 higher in the intervention group compared to controls. In addition, the DAI score improved 1.93 points (95% CI: 1.15-2.72 more for intervention patients.These two findings indicate significantly higher medication adherence following the investigated multi-dimensional and inter-sectoral program.German Clinical Trials Register DRKS00006358.

  14. Introducing the Adherence Strategy Engineering Framework (ASEF)

    DEFF Research Database (Denmark)

    Wagner, Stefan Rahr; Toftegaard, Thomas Skjødeberg; Bertelsen, Olav W.

    2013-01-01

    Background: Patients performing self-care in the unsupervised setting do not always adhere to the instructions they were initially provided with. As a consequence, a patient’s ability to successfully comply with the treatment plan cannot be verified by the treating healthcare professional, possib...

  15. Community health workers adherence to referral guidelines

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

    2016-01-01

    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) and trea......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......) and treatment guidelines, there is limited evidence whether CHWs adhere to the referral guidelines and refer severely ill children for further management. In southwest Uganda, this study examined whether CHWs referred children according to training guidelines and described factors associated with adherence...... to the referral guideline. Methods A secondary analysis was undertaken of data collected during two cluster-randomized trials conducted between January 2010 and July 2011, one in a moderate-to-high malaria transmission setting and the other in a low malaria transmission setting. All CHWs were trained to prescribe...

  16. Barriers to adherence in cystic fibrosis

    DEFF Research Database (Denmark)

    Bregnballe, Vibeke; Schiøtz, Peter Oluf

    2012-01-01

    Danish patients with cystic fibrosis aged 14 to 25 years and their parents. Conclusions: The present study showed that the majority of adolescents with CF and their parents experienced barriers to treatment adherence. Patients and parents agreed that the three most common barriers encountered lack...

  17. Psoriasis: improving adherence to topical therapy.

    NARCIS (Netherlands)

    Feldman, S.R.; Horn, E.J.; Balkrishnan, R.; Basra, M.K.; Finlay, A.Y.; McCoy, D.; Menter, A.; Kerkhof, P.C.M. van de

    2008-01-01

    Topical therapy has an important role in psoriasis treatment. It is efficacious and has a favorable safety profile as demonstrated in clinical trials. However, poor treatment outcomes from topical therapy regimens likely result from poor adherence and ineffective use of the medication. The Internati

  18. Adherence to Exercise and Physical Activity: Preface.

    Science.gov (United States)

    Morgan, William P.; Dishman, Rod K.

    2001-01-01

    Introduces a collection of papers on adherence to exercise programs and physical activity from the 2000 American Academy of Kinesiology and Physical Education conference, which included research on middle school boys and girls, college men and women, and men and women in the later years, as well as on the more traditional subject of middle aged…

  19. Non-adherence in difficult asthma and advances in detection.

    Science.gov (United States)

    Lindsay, John T; Heaney, Liam G

    2013-12-01

    Non-adherence to anti-inflammatory therapies is common in patients referred for specialist assessment at difficult-to-treat asthma services. In the difficult asthma setting, non-adherence to treatment is associated with poor baseline asthma control, increased frequency of exacerbations and asthma-related hospitalizations, as well as increased risk of death. Here, we present a review of the current literature surrounding the prevalence and risks of non-adherence in difficult asthma and we report on current methods of measuring treatment adherence and advances in the detection of non-adherence. We will also explore methods by which non-adherence in difficult asthma can be addressed.

  20. Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare

    Directory of Open Access Journals (Sweden)

    Hogg Robert S

    2011-04-01

    Full Text Available Abstract Background Barriers to HIV treatment among injection drug users (IDU are a major public health concern. However, there remain few long-term studies investigating key demographic and behavioral factors - and gender differences in particular - that may pose barriers to antiretroviral therapy (ART, especially in settings with universal healthcare. We evaluated access and adherence to ART in a long-term cohort of HIV-positive IDU in a setting where medical care and antiretroviral therapy are provided free of charge through a universal healthcare system. Methods We evaluated baseline antiretroviral use and subsequent adherence to ART among a Canadian cohort of HIV-positive IDU. We used generalized estimating equation logistic regression to evaluate factors associated with 95% adherence to antiretroviral therapy estimated based on prescription refill compliance. Results Between May 1996 and April 2008, 545 IDU participants were followed for a median of 23.8 months (Inter-quartile range: 8.5 - 91.6, among whom 341 (63% were male and 204 (37% were female. Within the six-month period prior to the baseline interview, 133 (39% men and 62 (30% women were on ART (p = 0.042. After adjusting for clinical characteristics as well as drug use patterns measured longitudinally throughout follow-up, female gender was independently associated with a lower likelihood of being 95% adherent to ART (Odds Ratio [OR] = 0.70; 95% Confidence Interval: 0.53-0.93. Conclusions Despite universal access to free HIV treatment and medical care, female IDU were less likely to access and adhere to antiretroviral therapy, a finding that was independent of drug use and clinical characteristics. These data suggest that interventions to improve access to HIV treatment among IDU must be tailored to address unique barriers to antiretroviral therapy faced by female IDU.

  1. Relevance of dosage in adherence to treatment with long-acting anticholinergics in patients with COPD

    Directory of Open Access Journals (Sweden)

    Izquierdo JL

    2016-02-01

    Full Text Available José Luis Izquierdo,1 José Manuel Paredero,2 Raul Piedra3 1Department of Pneumology, Hospital Universitario de Guadalajara, 2Department of Pharmacy, 3Department of Primary Care, Guadalajara Integrated Care Management, Guadalajara, Spain Introduction: The aim of this study was to assess the degree of adherence for two standard regimens for administrating anticholinergic drugs (12 and 24 hours in patients with chronic obstruction of the airflow and to establish whether the use of a once-daily dose improves the level of treatment adherence.Methods: We used long-acting anticholinergics (LAMAs as a study variable, and included the entire health area of Castile-La Mancha, numbering 2,100,998 inhabitants, as the study population. We analyzed a total of 16,446 patients who had been prescribed a LAMA between January 1, 2013 and December 31, 2013. The follow-up period, based on a centralized system of electronic prescription management, was extended until December 2014.Results: During 2013, the medication collected was 7.4%–10.7% higher than indicated by labeling. This was very similar for all LAMAs, irrespective of the patient’s sex, the molecule, the device, and the drug dosage. We did not observe seasonal variations in the consumption of LAMAs, nor did we detect differences between prescription drugs for once-daily (every 24 hours versus twice-daily (every 12 hours administration, between the different molecules, or between different types of inhalers for the same molecule. The results were similar in 2014.Conclusion: The principal conclusion of this study is that, in an area with a centralized management system of pharmacological prescriptions, adherence to treatment with LAMAs is very high, irrespective of the molecules or inhalation device. We did not find that patients who used twice-daily medication had a lower adherence. Keywords: COPD, treatment, adherence, LABAs, LAMAs, PDC, asthma

  2. Clinical Benefits of an Adherence Monitoring Program in the Management of Secondary Hyperparathyroidism with Cinacalcet: Results of a Prospective Randomized Controlled Study

    Science.gov (United States)

    Forni Ogna, Valentina; Pruijm, Menno; Zweiacker, Carole; Wuerzner, Grégoire; Tousset, Eric; Burnier, Michel

    2013-01-01

    Background/Aims. One of the causes of uncontrolled secondary hyperparathyroidism (sHPT) is patient's poor drug adherence. We evaluated the clinical benefits of an integrated care approach on the control of sHPT by cinacalcet. Methods. Prospective, randomized, controlled, multicenter, open-label study. Fifty hemodialysis patients on a stable dose of cinacalcet were randomized to an integrated care approach (IC) or usual care approach (UC). In the IC group, cinacalcet adherence was monitored using an electronic system. Results were discussed with the patients in motivational interviews, and drug prescription adapted accordingly. In the UC group, drug adherence was monitored, but results were not available. Results. At six months, 84% of patients in the IC group achieved recommended iPTH targets versus 55% in the UC group (P = 0.04). The mean cinacalcet taking adherence improved by 10.8% in the IC group and declined by 5.3% in the UC group (P = 0.02). Concomitantly, the mean dose of cinacalcet was reduced by 7.2 mg/day in the IC group and increased by 6.4 mg/day in the UC group (P = 0.03). Conclusions. The use of a drug adherence monitoring program in the management of sHPT in hemodialysis patients receiving cinacalcet improves drug adherence and iPTH control and allows a reduction in the dose of cinacalcet. PMID:23971019

  3. Clinical Benefits of an Adherence Monitoring Program in the Management of Secondary Hyperparathyroidism with Cinacalcet: Results of a Prospective Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Valentina Forni Ogna

    2013-01-01

    Full Text Available Background/Aims. One of the causes of uncontrolled secondary hyperparathyroidism (sHPT is patient’s poor drug adherence. We evaluated the clinical benefits of an integrated care approach on the control of sHPT by cinacalcet. Methods. Prospective, randomized, controlled, multicenter, open-label study. Fifty hemodialysis patients on a stable dose of cinacalcet were randomized to an integrated care approach (IC or usual care approach (UC. In the IC group, cinacalcet adherence was monitored using an electronic system. Results were discussed with the patients in motivational interviews, and drug prescription adapted accordingly. In the UC group, drug adherence was monitored, but results were not available. Results. At six months, 84% of patients in the IC group achieved recommended iPTH targets versus 55% in the UC group (. The mean cinacalcet taking adherence improved by 10.8% in the IC group and declined by 5.3% in the UC group (. Concomitantly, the mean dose of cinacalcet was reduced by 7.2 mg/day in the IC group and increased by 6.4 mg/day in the UC group (. Conclusions. The use of a drug adherence monitoring program in the management of sHPT in hemodialysis patients receiving cinacalcet improves drug adherence and iPTH control and allows a reduction in the dose of cinacalcet.

  4. Bacterial adherence to anodized titanium alloy

    Energy Technology Data Exchange (ETDEWEB)

    Peremarch, C Perez-Jorge; Tanoira, R Perez; Arenas, M A; Matykina, E; Conde, A; De Damborenea, J J; Gomez Barrena, E; Esteban, J, E-mail: cperemarch@fjd.es

    2010-11-01

    The aim of this study was to evaluate Staphylococcus sp adhesion to modified surfaces of anodized titanium alloy (Ti-6Al-4V). Surface modification involved generation of fluoride-containing titanium oxide nanotube films. Specimens of Ti-6Al-4V alloy 6-4 ELI-grade 23- meets the requirements of ASTM F136 2002A (AMS 2631B class A1) were anodized in a mixture of sulphuric/hydrofluoric acid at 20 V for 5 and 60 min to form a 100 nm-thick porous film of 20 nm pore diameter and 230 nm-thick nanotube films of 100 nm in diameter. The amount of fluorine in the oxide films was of 6% and of 4%, respectively. Collection strains and six clinical strains each of Staphylococcus aureus and Staphylococcus epidermidis were studied. The adherence study was performed using a previously published protocol by Kinnari et al. The experiments were performed in triplicates. As a result, lower adherence was detected for collection strains in modified materials than in unmodified controls. Differences between clinical strains were detected for both species (p<0.0001, Kruskal-Wallis test), although global data showed similar results to that of collection strains (p<0.0001, Kruskal-Wallis test). Adherence of bacteria to modified surfaces was decreased for both species. The results also reflect a difference in the adherence between S. aureus and S. epidermidis to the modified material. As a conclusion, not only we were able to confirm the decrease of adherence in the modified surface, but also the need to test multiple clinical strains to obtain more realistic microbiological results due to intraspecies differences.

  5. Susceptibility breakpoints for amphotericin B and Aspergillus species in an in vitro pharmacokinetic-pharmacodynamic model simulating free-drug concentrations in human serum

    NARCIS (Netherlands)

    Elefanti, A.; Mouton, J.W.; Verweij, P.E.; Zerva, L.; Meletiadis, J.

    2014-01-01

    Although conventional amphotericin B was for many years the drug of choice and remains an important agent against invasive aspergillosis, reliable susceptibility breakpoints are lacking. Three clinical Aspergillus isolates (Aspergillus fumigatus, Aspergillus flavus, and Aspergillus terreus) were tes

  6. Experiencing antiretroviral adherence: helping healthcare staff better understand adherence to paediatric antiretrovirals

    Directory of Open Access Journals (Sweden)

    Phelps Benjamin R

    2010-12-01

    Full Text Available Abstract Background Lack of adherence to antiretroviral medications is one of the key challenges for paediatric HIV care and treatment programmes. There are few hands-on opportunities for healthcare workers to gain awareness of the psychosocial and logistic challenges that caregivers face when administering daily antiretroviral therapy to children. This article describes an educational activity that allows healthcare workers to simulate this caregiver role. Methods Paediatric formulations of several antiretroviral medications were dispensed to a convenience sample of staff at the Baylor College of Medicine-Bristol-Myers Squibb Children's Clinical Center of Excellence in Mbabane, Swaziland. The amounts of the medications remaining were collected and measured one week later. Adherence rates were calculated. Following the exercise, a brief questionnaire was administered to all staff participants. Results The 27 clinic staff involved in the exercise had varying and low adherence rates over the week during which the exercise was conducted. Leading perceived barriers to adherence included: "family friends don't help me remember/tell me I shouldn't take it" and "forgot". Participants reported that the exercise was useful as it allowed them to better address the challenges faced by paediatric patients and caregivers. Conclusions Promoting good adherence practices among caregivers of children on antiretrovirals is challenging but essential in the treatment of paediatric HIV. Participants in this exercise achieved poor adherence rates, but identified with many of the barriers commonly reported by caregivers. Simulations such as this have the potential to promote awareness of paediatric ARV adherence issues among healthcare staff and ultimately improve adherence support and patient outcomes.

  7. A review on the relation between the brain-serum concentration ratio of drugs and the influence of P-glycoprotein

    DEFF Research Database (Denmark)

    Ejsing, Thomas Broeng; Morling, Niels; Linnet, Kristian

    2007-01-01

    This overview on the brain-serum relationship for drugs illustrates the importance of the drug transporter P-glycoprotein at the blood-brain barrier. Generally, an inverse relationship exists between the magnitude of the brain-serum ratio and the influence of P-glycoprotein. Concerning...... the pharmacogenomics of P-glycoprotein, no clear effect of single nucleotide polymorphisms (SNPs) has been demonstrated in humans....

  8. Medication adherence and the use of new pharmaceutical formulations: the case of levothyroxine.

    Science.gov (United States)

    Scavone, Cristina; Sportiello, Liberata; Cimmaruta, Daniela; Sullo, Maria G; Vitelli, Bonaventura; Rafaniello, Concetta; Fossati, Tiziano; Rossi, Francesco

    2016-06-01

    According to World Health Organization, medication adherence refers not only to pharmacological treatment, but also extends to all behaviors which guarantee patient's health. Poor medication adherence is the main cause of low efficacy of pharmacological therapy and it is more common in chronic diseases. For example, among hypothyroid patients, it was estimated that after 5 years of levothyroxine therapy 21.5% of patients still have a TSH level >5.0 mU/L due to poor medication adherence. Moreover, it was found that almost 40% of pediatric patients had at least one episode of non-compliance following thyroidectomia. Several strategies can be adopted in order to improve medication adherence. These include self-monitoring drug therapy and self-management programs, simplified dosing regimens, directly involving pharmacists in drug therapy management, use of pharmaceutical formulations more attractive to the patient and through the therapeutic drug monitoring. The effects mediated by the thyroid gland, the clinical symptoms of hypothyroidism and the main characteristics of levothyroxine therapy have been discussed. In order to give an overview of interactions with food and drinks, pharmacokinetic characteristics, efficacy/safety profile, as well as the impact on medication adherence of levothyroxine in oral solution and soft gel capsule formulations, a literature search was performed. The results of 21 clinical studies were reviewed. Levothyroxine oral solution and soft gel capsule formulations showed irrelevant interactions with food and drinks, with a dissolution profile minimally influenced by pH variations. According to pharmacokinetic study results, bioequivalence between these formulations and levothyroxine tablets was confirmed. Regarding the efficacy/safety profile, while some studies did not detect any difference between levothyroxine formulations, other studies suggested that oral solution and soft gel capsule were associated to a higher efficacy compared to

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

    Directory of Open Access Journals (Sweden)

    Aline Santarem Ernesto

    2012-08-01

    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.

  10. Adherence of Moraxella bovis to cell cultures of bovine origin.

    Science.gov (United States)

    Annuar, B O; Wilcox, G E

    1985-09-01

    The adherence of five strains of Moraxella bovis to cell cultures was investigated. M bovis adhered to cultures of bovine corneal epithelial and Madin-Darby bovine kidney cells but not to cell types of non-bovine origin. Both piliated and unpiliated strains adhered but piliated strains adhered to a greater extent than unpiliated strains. Antiserum against pili of one strain inhibited adherence of piliated strains but caused only slight inhibition of adherence to the unpiliated strains. Treatment of bacteria with magnesium chloride caused detachment of pili from the bacterial cell and markedly inhibited adherence of piliated strains but caused only slight inhibition of adherence by the unpiliated strains. The results suggested that adhesion of piliated strains to cell cultures was mediated via pili but that adhesins other than pili may be involved in the attachment of unpiliated strains of M bovis to cells.

  11. Adherence and uptake of artemisinin-based combination treatments for uncomplicated malaria: a qualitative study in northern Ghana.

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    Samuel Chatio

    Full Text Available Based on the recommendations of the World Health Organization in 2004, Ghana changed her antimalarial drug policy from mono-therapy to Artemisinin-based Combination Therapy (ACTs. The country is currently using three first line drugs artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria. Despite this policy, little or no qualitative studies have been conducted to establish the factors influencing adherence to the new treatment for malaria. This study explored factors influencing adherence to the use of ACTs in northern Ghana.This was a qualitative study comprising forty (40 in-depth interviews with patients with malaria who visited selected public and private health facilities and received ACTs. Systematic sampling technique was used to select participants who were given ACTs for the interviews. Nvivo 9 software was used to code the data into themes for further analysis.The study revealed very important differences in knowledge about ACTs. As expected, the less or illiterates could not mention the type of ACT they would prefer to use for treating their malaria. The educated ones had a good knowledge on ACTs and preferred artemether-lumefantrinee in treating their malaria. The reason was that the drug was good and it had minimal or no side effects. Individual attitudes toward the use of medications and the side effects associated with the use of these ACTs were found to be the main factors affecting adherence to the use of ACTs. Perceived cure of illness after the initial dose greatly affected adherence. Other factors such as forgetfulness and lack of information also influenced patient adherence to ACTs use.Individual knowledge, attitudes and behaviors greatly influence patients' adherence to ACTs use. Since ACTs take a number of days to complete, continuous education by health professionals could improve on adherence to ACTs use by patients with malaria.

  12. Glucose significantly enhances enterotoxigenic Escherichia coli adherence to intestinal epithelial cells through its effects on heat-labile enterotoxin production.

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    Prageeth Wijemanne

    Full Text Available The present study tested whether exposure of enterotoxigenic Escherichia coli (ETEC to glucose at different concentrations in the media results in increased bacterial adherence to host cells through increased heat-labile enterotoxin (LT production, thereby suggesting the effects are physiological. Porcine-origin ETEC strains grown in Casamino acid yeast extract medium containing different concentrations of glucose were washed and inoculated onto IPEC-J2 porcine intestinal epithelial cells to test for effects on adherence and host cell cAMP concentrations. Consistent with previous studies, all LT+ strains had higher ETEC adherence to IPEC-J2 cells than did LT- strains. Adherence of the LT- but not the LT+ strains was increased by pre-incubating the IPEC-J2 cells with LT and decreased by co-incubation with GM1 ganglioside in a dose-dependent manner (P<0.05. To determine whether the glucose concentration of the cell culture media has an effect on adherence, IPEC-J2 cells were inoculated with LT+ or LT- strains in cell culture media containing a final glucose concentration of 0, 0.25, 0.5, 1.0 or 2.0%, and incubated for 4 h. Only media containing 0.25% glucose resulted in increased adherence and cAMP levels, and this was limited to IPEC-J2 cells inoculated with LT+ strains. This study supports the hypothesis that glucose, at a concentration optimal for LT expression, enhances bacterial adherence through the promotion of LT production. Hence, these results establish the physiological relevance of the effects of glucose on LT production and provide a basis for how glucose intake may influence the severity of ETEC infection.

  13. Type 2 diabetes: cost-effectiveness of medication adherence and lifestyle interventions

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    Nerat T

    2016-10-01

    Full Text Available Tomaž Nerat, Igor Locatelli, Mitja Kos Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia Introduction: Type 2 diabetes is a major burden for the payer, however, with proper medication adherence, diet and exercise regime, complication occurrence rates, and consequently costs can be altered.Aims: The aim of this study was to conduct a cost-effectiveness analysis on real patient data and evaluate which medication adherence or lifestyle intervention is less cost demanding for the payer.Methods: Medline was searched systematically for published type 2 diabetes interventions regarding medication adherence and lifestyle in order to determine their efficacies, that were then used in the cost-effectiveness analysis. For cost-effectiveness analysis-required disease progression simulation, United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used. The intervention duration was set to 1, 2, 5, and 10 years. Complications and drug costs in euro (EUR were based on previously published type 2 diabetes costs from the Health Care payer perspective in Slovenia.Results: Literature search proved the following interventions to be effective in type 2 diabetes patients: medication adherence, the Mediterranean diet, aerobic, resistance, and combined exercise. The long-term simulation resulted in no payer net savings. The model predicted following quality-adjusted life-years (QALY gained and incremental costs for QALY gained (EUR/QALYg after 10 years of intervention: high-efficacy medication adherence (0.245 QALY; 9,984 EUR/QALYg, combined exercise (0.119 QALY; 46,411 EUR/QALYg, low-efficacy medication adherence (0.075 QALY; 30,967 EUR/QALYg, aerobic exercise (0.069 QALY; 80,798 EUR/QALYg, the Mediterranean diet (0.057 QALY; 27,246 EUR/QALYg, and resistance exercise (0.050 QALY; 111,847 EUR/QALYg.Conclusion: The results suggest that medication adherence intervention is, regarding cost

  14. The use of capecitabine in daily practice: a study on adherence and patients' experiences

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    Timmers L

    2012-10-01

    Full Text Available Lonneke Timmers,1 Eleonora L Swart,1 Christel CLM Boons,1 Dirk Mangnus,1 Peter M van de Ven,2 Godefridus J Peters,3 Epie Boven,3 Jacqueline G Hugtenburg11Department of Clinical Pharmacology and Pharmacy, 2Department of Epidemiology and Biostatistics, 3Department of Medical Oncology, VU University Medical Center, Amsterdam, The NetherlandsBackground: Adherence to pharmacological therapy is a complex and multifactorial issue that can substantially alter the outcome of treatment. Especially when using long-term medication, cancer patients have adherence rates similar to those of patients with other diseases. The consequences of poor adherence are poor health outcomes and increased health care costs. Only few studies have focused on the use of oral anticancer agents in daily practice. Information about the reasons for nonadherence is essential for the development of interventions that may improve adherence. This report presents the CAPER-capecitabine protocol, which is designed to study the adherence to capecitabine and the influence of patient attitudes towards medication and self-reported side effects. Furthermore, the relationships between patient characteristics, disease characteristics, side effects, quality of life, patient beliefs and attitudes towards disease and medication, dose adjustments, reasons for discontinuation, and plasma concentration of three of the main metabolites, including the active compound 5-fluorouracil, will be explored.Methods: In this multicenter, prospective, observational cohort study, 90 patients aged 18 years or older starting treatment with capecitabine will be included and followed for a period up to five cycles. The main study parameters are adherence, patient attitudes towards medication, and the number and grade of patient-reported side effects. At baseline and during week 2 of cycles 1, 3 and 5, patients will be asked to donate blood and fill out a questionnaire. Blood samples will be analyzed for plasma

  15. Improving adherence to medical regimens for juvenile rheumatoid arthritis

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    Lindsley Carol B

    2007-05-01

    Full Text Available Abstract Poor adherence to medical regimens can compromise the efficacy of treatments for children and adolescents with juvenile rheumatoid arthritis (JRA. The purpose of this review is to describe medical regimens for the treatment of JRA and the rates of adherence to these regimens. We also summarize and critically the few research studies aimed at improving adherence to regimens for JRA. Finally, we summarize strategies for enhancing adherence in clinical practice.

  16. Iron Chelation Adherence to Deferoxamine and Deferasirox in Thalassemia

    OpenAIRE

    Trachtenberg, Felicia; Vichinsky, Elliott; Haines, Dru; Pakbaz, Zahra; Mednick, Lauren; Sobota, Amy; Kwiatkowski, Janet; Thompson, Alexis A.; Porter, John; Coates, Thomas; Giardina, Patricia J.; Olivieri, Nancy; Yamashita, Robert; Neufeld, Ellis J.

    2011-01-01

    The Thalassemia Clinical Research Network collected adherence information from 79 patients on deferoxamine and 186 on deferasirox from 2007 to 2009. Chelation adherence was defined as percent of doses administered in the last 4 weeks (patient report) out of those prescribed (chart review). Chelation history since 2002 was available for 97 patients currently on deferoxamine and 217 on deferasirox, with crude estimates of adherence from chart review. Self-reported adherence to both deferoxamine...

  17. Medication adherence among transgender women living with HIV

    OpenAIRE

    2016-01-01

    Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the U.S. report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transg...

  18. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

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    Jones Gareth

    2012-08-01

    Full Text Available Abstract Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95% of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80% of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures and medication adherence (verified by non-invasive hair analysis. Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i the way people think about the underlying goal of their treatments explains medication and exercise

  19. Effect of Aqueous Extract of Aegle marmelos Fruit on Adherence and β-Lactam Resistance of Enteropathogenic Escherichia coli by Down Regulating Outer Membrane Protein C

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    Subramaniya Bharathi Raja

    2009-01-01

    Full Text Available Problem statement: Enteropathogenic Escherichia Coli (EPEC continue to be a major health problem, leading to death due to diarrhea, predominantly in children below the age of five. Due to evolution of multi drug resistance in EPEC and side effects caused to host by antibiotics necessitated a search for alternative medicines from medicinal plants. One such medicinal plant used since ancient times to cure diarrhea is Aegle marmelos. This study was done to investigate the effect of aqueous extract of Aegle marmelos fruit (AEAM on outer membrane protein C (OmpC of EPEC, which plays a key role in adherence and antibiotic resistance. Approach: Fixation of minimum inhibitory concentration. In presence and absence of AEAM antibiotic susceptibility test was performed. Expression analysis of OmpC and OmpF was carried out by RT-PCR of EPEC in presence and absence of AEAM. Morphological changes of EPEC in presence and absence of AEAM were analyzed by TEM. In infant mouse ileal loop model, histological analysis, adherence of bacteria to ileal loops and Western blotting for caspase-3 and Hsp70 were done. Results: OmpC (~42kDa a porin, played an important role in selective transport of nutrients and also acted as an adhesin, whereas OmpF (~38kDa is also a porin which is non selective. Susceptibility of EPEC to β-lactam antibiotics in presence of AEAM can be attributed to down regulation of OmpC and upregulation of OmpF. The changes in Omp expression also triggered morphological changes in EPEC. Histology and western blot of Hsp70 and Caspase-3 in rat ileal loop confirmed the effect of AEAM on attenuating the virulence of EPEC by preventing its infection due to loss of adherence. Loss of adherence was due to morphological changes and down regulation of OmpC in EPEC. Conclusion: From this study, we concluded that the protection offered by AEAM against EPEC was due to down regulation of OmpC, leading to loss of adherence and up regulation of OmpF, which

  20. Medication Adherence in Psychopharmacologically Treated Adults with ADHD

    Science.gov (United States)

    Safren, Steven A.; Duran, Petra; Yovel, Iftah; Perlman, Carol A.; Sprich, Susan

    2007-01-01

    Objective: One of the potential causes of residual symptoms of ADHD in adults can be difficulties with consistent adherence to medications. Method: This formative study examined self-reported medication adherence in adults with ADHD with clinically significant symptoms despite medication treatment. Results: Mean adherence for the two-week period…

  1. Adhesion Forces and Composition of Planktonic and Adhering Oral Microbiomes

    NARCIS (Netherlands)

    Wessel, S. W.; Chen, Y.; Maitra, A.; van den Heuvel, E. R.; Slomp, A. M.; Busscher, H. J.; van der Mei, H. C.

    2014-01-01

    The oral microbiome consists of a planktonic microbiome residing in saliva and an adhering microbiome (the biofilm adhering to oral hard and soft tissues). Here we hypothesized that possible differences in microbial composition of the planktonic and adhering oral microbiome on teeth can be related t

  2. Measuring adherence to treatment of paediatric HIV/AIDS.

    Science.gov (United States)

    Naar-King, S; Frey, M; Harris, M; Arfken, C

    2005-04-01

    Parent, child, physician report and pill counts were used to measure adherence in paediatric HIV. Relationships to viral load were assessed. Pill counts were considered invalid. Adherence measures did not correlate with one another. Physicians reported lower adherence than parents, but parent and physician report correlated with viral load. The clinical and research utility of the various measures are discussed.

  3. A Matter of Trust: Patient Barriers to Primary Medication Adherence

    Science.gov (United States)

    Polinski, J. M.; Kesselheim, A. S.; Frolkis, J. P.; Wescott, P.; Allen-Coleman, C.; Fischer, M. A.

    2014-01-01

    Primary medication adherence occurs when a patient properly fills the first prescription for a new medication. Primary adherence only occurs about three-quarters of the time for antihypertensive medications. We assessed patients' barriers to primary adherence and attributes of patient-provider discussions that might improve primary adherence…

  4. Optimization and inhibition of the adherent ability of Plasmodium falciparum-infected erythrocytes

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    Heidi Smith

    1992-01-01

    Full Text Available The vast majority of the 1-2 million malaria associated deaths that occur each year are due to anemia and cerebral malaria (the attachment of erythrocytes containing mature forms of Plasmodium falciparum to the endothelial cells that line the vascular beds of the brain. A "model" system"for the study of cerebral malaria employs amelanotic melanoma cells as the "target"cells in an vitro cytoadherence assay. Using this model system we determined that the optimum pH for adherence is 6.6 to 6.8, that high concentrations of Ca²* (50mM result in increased levels of binding, and that the type of buffer used influences adherence (Bis Tris > MOPS > HEPES > PIPES. We also observed that the ability of infected erythrocytes to cytoadhere varied from (erythrocyte donor to donor. We have produced murine monoclonal antibodies against P. falciparum-infected red cells which recognized modified forms of human band 3; these inhibit the adherence of infected erythrocytes to melanoma cells in a doso responsive fashion. Antimalarials (chloroquine, quinacrine, mefloquine, artemisinin, on the other hand, affected adherence in an indirect fashion i.e. since cytoadherence is due, in part to the presence of knobs on the surface of the infected erythrocyte, and knob formation is dependent on intracellular parasite growth, when plasmodial development is inhibited so is knob production, and consequently adherence is ablated.

  5. Effect of citrus lemon oil on growth and adherence of Streptococcus mutans.

    Science.gov (United States)

    Liu, Ying; Zhang, Xiangyu; Wang, Yuzhi; Chen, Feifei; Yu, Zhifen; Wang, Li; Chen, Shuanglu; Guo, Maoding

    2013-07-01

    In order to exploit novel anticaries agents, we investigated the effects of citrus lemon oil (CLO), a type of natural product, on growth and adherence of the primary oral cariogenic bacteria Streptococcus mutans (S. mutans). The growth inhibitory effect was explored with a micro-dilution assay. Adherence was analyzed by colony counts on the respective surfaces and the adherence inhibition rate (AIR). Real time-PCR was used to investigate the effects of CLO on transcription of glucosyltransferase (Gtf) encoding genes, gtfB, C and D. Neson-Somogyi method was used to measure the effects of CLO on Gtf activity. The minimum inhibitory concentration of CLO against S. mutans was 4.5 mg/ml. The CLO effectively reduced the adherence of S. mutans on glass surface (the AIR were from 98.3 to 100 %, P > 0.05) and saliva-coated enamel surface (the AIR were from 54.8 to 79.2 %, P < 0.05). CLO effectively reduced the activity of Gtf and the transcription of gtfs in a dose dependent manner (P < 0.05). In conclusion, CLO can effectively inhibit the growth and the adherence to glass and saliva-coated enamel surfaces of S. mutans. It can also inhibit the transcription of gtfs, as well as the Gtf enzyme activity.

  6. Medication adherence among older adults with schizophrenia.

    Science.gov (United States)

    Leutwyler, Heather C; Fox, Patrick J; Wallhagen, Margaret

    2013-02-01

    Older adults with schizophrenia are a growing segment of the population, yet their physical and mental health status is extremely poor. This article presents findings from a qualitative study that explored the understanding older adults with schizophrenia have of their physical health status. The study was conducted among 28 older adults with schizophrenia from a variety of settings using semi-structured interviews and participant observation. Self-management of psychiatric and non-psychiatric medications and its effect on participants' health status was one of the central themes that emerged from the study. Different styles of medication adherence were identified and factors associated with each style are presented. The findings provide insights into the design of clinical interventions aimed at promoting medication adherence among older adults with schizophrenia.

  7. Self-reported adherence supports patient preference for the single tablet regimen (STR in the current cART era

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    G Sterrantino

    2012-11-01

    Full Text Available Objective: To analyze self-reported adherence to antiretroviral regimens containing ritonavir-boosted protease inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTI, raltegravir, and maraviroc. Methods: Overall, 372 consecutive subjects attending a reference center for HIV treatment in Florence, Italy, were enrolled in the study, from December 2010 to January 2012 (mean age 48 years. A self-report questionnaire was filled in. Patients were defined as “non-adherent” if reporting one of the following criteria:<90% of pills taken in the last month, ≥1 missed dose in the last week, spontaneous treatment interruptions reported, or refill problems in the last 3 months. Gender, age, CD4, HIV-RNA, years of therapy, and type of antiretroviral regimen were analyzed with respect to adherence. Results: At the time of the questionnaire, 89.8% of patients had <50 copies/mL HIV-RNA and 14.2% were on their first combined antiretroviral therapy. 57% of patients were prescribed a regimen containing ritonavir boosted protease inhibitors (boosted PI, 41.7% NNRTI, 17.2% raltegravir, and 4.8% maraviroc; 49.5% of the subjects were on bis-in-die regimens, while 50.5% were on once-daily regimens, with 23.1% of these on the single tablet regimen (STR: tenofovir/emtricitabine/efavirenz. The non-adherence proportion was lower in NNRTI than in boosted-PI treatments (19.4% vs 30.2%, and even lower in STR patients (17.4%. In multivariable logistic regression, patients with the NNRTI regimen (OR: 0.56, 95% CI: 0.34–0.94 and the STR (OR: 0.45, 95% CI: 0.22–0.92 reported lower non-adherence. Efavirenz regimens were also associated with lower non-adherence (OR: 0.42, 95% CI: 0.21–0.83, while atazanavir/ritonavir regimens were associated with higher non-adherence. No other relation to specific antiretroviral drugs was found. A higher CD4 count, lower HIV-RNA, and older age were also found to be associated with lower non-adherence, while a longer time on

  8. 奥美拉唑对利培酮和9-羟利培酮血药浓度影响的研究%Influence study of omeprazole on blood drug concentration of risperidone and 9-hydroxy risperidone

    Institute of Scientific and Technical Information of China (English)

    巫艳芬; 王玉梅; 陈宝燕

    2014-01-01

    目的:观察奥美拉唑对利培酮和9-羟利培酮血药浓度的影响。方法20例精神分裂症合并胃溃疡患者,给予利培酮联合奥美拉唑治疗1周。检测奥美拉唑治疗后利培酮以及9-羟利培酮血药浓度。结果未使用奥美拉唑前,利培酮与9-羟利培酮血药浓度为(29.25±7.82)μg/L;使用奥美拉唑后,利培酮与9-羟利培酮血药浓度为(37.15±11.68)μg/L,差异有统计学意义(P<0.05)。结论奥美拉唑能够提高利培酮与9-羟利培酮血药浓度,因此,临床上治疗精神分裂症合并胃溃疡患者,给予奥美拉唑联合利培酮治疗时,应该监测患者利培酮与9-羟利培酮血药浓度,及时对药物剂量进行调整。%Objective To observe the influence of omeprazole on blood drug concentration of risperidone and 9-hydroxy risperidone. Methods A total of 20 schizophrenia with gastric ulcer cases were treated by risperidone combined with omeprazole for 1 week. Detections of blood drug concentration of risperidone and 9-hydroxy risperidone were made after the omeprazole treatment. Results Before application of omeprazole, blood drug concentration of risperidone and 9-hydroxy risperidone was (29.25±7.82)μg/L. After using omeprazole, blood drug concentration of risperidone and 9-hydroxy risperidone was (37.15±11.68) μg/L. The difference had statistical significance (P<0.05). Conclusion Omeprazole can increase the blood drug concentration of risperidone and 9-hydroxy risperidone, which should be monitored in the risperidone combined with omeprazole treatment of schizophrenia with gastric ulcer, and timely adjustment of drug dose is necessary.

  9. Adherence with isoniazid for prevention of tuberculosis among HIV-infected adults in South Africa

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    Muller F James

    2006-06-01

    Full Text Available Abstract Background Tuberculosis (TB is the most common opportunistic infection in HIV-infected adults in developing countries. Isoniazid (INH is recommended for treatment of latent TB infection, however non-adherence is common. The purpose of this study was to apply in-house prepared isoniazid (INH urine test strips in a clinical setting, and identify predictors of positive test results in an adherence questionnaire in HIV-infected adults taking INH for prevention of TB. Methods Cross-sectional study of adherence using a questionnaire and urine test strips for detection of INH metabolites at two hospitals in Pietermaritzburg, South Africa. Participants were aged at least 18 years, HIV positive, and receiving INH for prevention of tuberculosis disease. Univariate and multivariate analyses are used to identify factors relevant to adherence. Results 301 consecutive patients were recruited. 28% of participants had negative urine tests. 32 (37.2%, 95% CI25.4, 45.0 of the 86 patients who received INH from peripheral pharmacies said the pharmacy had run out of INH at some time, compared with central hospital pharmacies (p = 0.0001. In univariate analysis, a negative test was associated with self-reported missed INH doses (p = 0.043. Each 12-hour increment since last reported dose increased the likelihood of a negative test by 34% (p = 0.0007. Belief in INH safety was associated with a positive test (p = 0.021. In multivariate analysis, patients who believed INH is important for prevention of TB disease were more likely to be negative (p = 0.0086. Conclusion Adequate drug availability at peripheral pharmacies remains an important intervention for TB prevention. Key questions may identify potentially non-adherent patients. In-house prepared urine tests strips are an effective and cheap method of objectively assessing INH adherence, and could be used an important tool in TB control programs.

  10. Improving diabetes medication adherence: successful, scalable interventions

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-01-01

    Full Text Available Leah L Zullig,1,2 Walid F Gellad,3,4 Jivan Moaddeb,2,5 Matthew J Crowley,1,2 William Shrank,6 Bradi B Granger,7 Christopher B Granger,8 Troy Trygstad,9 Larry Z Liu,10 Hayden B Bosworth1,2,7,11 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University, Durham, NC, USA; 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA; 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA; 6CVS Caremark Corporation; 7School of Nursing, Duke University, Durham, NC, USA; 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; 9North Carolina Community Care Networks, Raleigh, NC, USA; 10Pfizer, Inc., and Weill Medical College of Cornell University, New York, NY, USA; 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Abstract: Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US healthcare system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population. We identify key characteristics that make these interventions effective and scalable. This information is intended to inform healthcare systems seeking proven, low resource, cost-effective solutions to improve medication adherence. Keywords: medication adherence, diabetes mellitus, chronic disease, dissemination research

  11. A Study of Adherent Oxide Formation

    Science.gov (United States)

    1983-10-01

    improve oxide scale adherence to NiCrAl were investigated. Laser-processed materials were isothermally and cyclically oxidized and oxide scale...modified NiCrAl altered the morphology of the alumina scale and promoted the formation of a thinner, dense protective layer. • Thin aluminum oxide films...6 A. Materials. ........................... 6 B. Oxidation Studies. ....................... 7 1. NiCrAl .. .......................... 7a2

  12. Pharmacy Adherence Measures to Assess Adherence to Antiretroviral Therapy: Review of the Literature and Implications for Treatment Monitoring

    OpenAIRE

    Mayer, Kenneth H.; McMahon, James H.; Jordan, Michael R.; Kelley, Karen; Bertagnolio, Silvia; Hong, Steven Y.; Wanke, Christine A.; Sharon R Lewin; Elliott, Julian H.

    2011-01-01

    Prescription or pill-based methods for estimating adherence to antiretroviral therapy (ART), pharmacy adherence measures (PAMs), are objective estimates calculated from routinely collected pharmacy data. We conducted a literature review to evaluate PAMs, including their association with virological and other clinical outcomes, their efficacy compared with other adherence measures, and factors to consider when selecting a PAM to monitor adherence. PAMs were classified into 3 categories: medica...

  13. Can adherence to antihypertensive therapy be used to promote adherence to statin therapy?

    Directory of Open Access Journals (Sweden)

    Richard H Chapman

    2009-08-01

    Full Text Available Richard H Chapman1, Elise M Pelletier1, Paula J Smith1, Craig S Roberts21US Health Economics and Outcomes Research, IMS Health, Falls Church, VA, USA; 2Global Outcomes Research, Pfizer Inc, New York, NY, USAObjective: To compare adherence with statin therapy in patients switching to single-pill amlodipine besylate/atorvastatin calcium with patients adding a separate statin to their amlodipine regimen.Methods: We identified hypertensive patients prescribed amlodipine who switched to amlodipine/atorvastatin (switch or added a statin to their amlodipine regimen (add-on from July 2004 to June 2007. Propensity score matching (1 switch:3 add-on was applied based on ‘nearest neighbor’ approach. The primary adherence measure was patients with proportion of days covered (PDC ≥0.80 at 180 days; secondary measures included mean PDC and persistence. A sensitivity analysis was performed, accounting for total statin/amlodipine exposure.Results: Among 4556 matched patients (n = 1139 switch; n = 3417 add-on, mean age was 53.9 years and 52.1% were male. After 180 days, adherence with statin therapy was higher for the switch vs add-on cohort (50.8% vs 44.3%; P < 0.001. After adjusting for pre-index amlodipine adherence, the switch cohort was more likely to be adherent than the add-on cohort (odds ratio: 1.64 [95% confidence interval: 1.42 to 1.89]. Persistence was higher in the switch than the add-on cohort (127.6 vs 117 days; P < 0.001.Conclusion: Hypertensive patients taking amlodipine who initiated statin therapy via single-pill amlodipine/atorvastatin were more likely to remain adherent to their statin than patients adding a separate statin to their antihypertensive regimen.Keywords: adherence, amlodipine, atorvastatin, cardiovascular disease, persistence, single-pill

  14. Action and coping plans related to the behavior of adherence to drug therapy among coronary heart disease outpatients Planes de acción y de enfrentamiento de obstáculos relacionados al comportamiento de adhesión a la terapia medicamentosa en pacientes con coronariopatía Planos de ação e de enfrentamento de obstáculos relacionados ao comportamento de adesão à terapia medicamentosa em coronariopatas

    Directory of Open Access Journals (Sweden)

    Laura Bacelar de Araujo Lourenço

    2012-10-01

    Full Text Available OBJECTIVE: to analyze the action and coping plans related to the behavior of adhering to drug therapy, developed by coronary heart disease (CHD outpatients, and to identify the barriers perceived to adopting this behavior. METHODS: the participants (n=59 were invited to formulate action plans and coping plans for the behavior of adhering to the cardio-protective medications and the symptom-relief medications. RESULTS: specific action plans for taking the medications associated with temporal markers and the sleep-wake cycle were shown. The most frequently reported obstacles were forgetfulness and absence of routine in daily living activities. The coping plans for overcoming forgetfulness were the most specific. CONCLUSION: this study's findings support the application of implementation intentions aimed at optimizing adherence to drug therapy among patients with CHD.OBJETIVO: analizar los planes de acción y de enfrentamiento de obstáculos relacionados al comportamiento de adhesión a la terapia medicamentosa, elaborados por pacientes con coronariopatía en seguimiento de ambulatorio e identificar las barreras percibidas para adopción de este comportamiento. MÉTODO: los participantes (n=59 fueron invitados a elaborar planes de acción (action planning y de enfrentamiento de obstáculos (coping planning para el comportamiento de adhesión a los medicamentos cardio-protectores y de alivio de los síntomas. RESULTADOS: fueron evidenciados planes de acción específicos para la tomada de los medicamentos que asociaron el comportamiento a marcadores temporales y al ciclo vigilia sueño. Los obstáculos más frecuentemente relatados fueron el olvido y la ausencia de rutina en las actividades de vida diaria. Los planes de enfrentamiento elaborados para superar el olvido fueron los más específicos. CONCLUSIÓN: los hallazgos de este estudio subvencionan la aplicación de la implementación de la intención para optimizar la adhesión de pacientes con

  15. Adherence to asthma guidelines in general practices.

    Science.gov (United States)

    Roghmann, M C; Sexton, M

    1999-06-01

    Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

  16. Crack cocaine use and adherence to antiretroviral treatment among HIV-infected black women.

    Science.gov (United States)

    Sharpe, Tanya Telfair; Lee, Lisa M; Nakashima, Allyn K; Elam-Evans, Laurie D; Fleming, Patricia L

    2004-04-01

    Since the appearance of crack cocaine in the 1980s, unprecedented numbers of women have become addicted. A disproportionate number of female crack users are Black and poor. We analyzed interview data of HIV-infected women > or = 18 years of age reported to 12 health departments between July 1997 and December 2000 to ascertain if Black women reported crack use more than other HIV-infected women and to examine the relationship between crack use and antiretroviral treatment (ART) adherence among Black women. Of 1655 HIV-infected women, 585 (35%) were nonusers of drugs, 694 (42%) were users of other drugs and 376 (23%) were crack users. Of the 1196 (72%) Black women, 306 (26%) were crack users. We used logistic regression to examine the effect of crack use on adherence to ART, controlling for age and education among Black women. In multivariate analysis, crack users and users of other drugs were less likely than non-users to take their ART medicines exactly as prescribed (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.24-0.56), OR = 0.47; 95% CI = 0.36-0.68), respectively. HIV-infected Black women substance users, especially crack cocaine users, may require sustained treatment and counseling to help them reduce substance use and adhere to ART.

  17. Exfoliation in ecstasy: liquid crystal formation and concentration-dependent debundling observed for single-wall nanotubes dispersed in the liquid drug γ-butyrolactone

    Science.gov (United States)

    Bergin, Shane D.; Nicolosi, Valeria; Giordani, Silvia; de Gromard, Antoine; Carpenter, Leslie; Blau, Werner J.; Coleman, Jonathan N.

    2007-11-01

    Large-scale debundling of single-walled nanotubes has been demonstrated by dilution of nanotube dispersions in the solvent γ-butyrolactone. This liquid, sometimes referred to as 'liquid ecstasy', is well known for its narcotic properties. At high concentrations the dispersions form an anisotropic, liquid crystalline phase which can be removed by mild centrifugation. At lower concentrations an isotropic phase is observed with a biphasic region at intermediate concentrations. By measuring the absorbance before and after centrifugation, as a function of concentration, the relative anisotropic and isotropic nanotube concentrations can be monitored. The upper limit of the pure isotropic phase was CNT~0.004 mg ml-1, suggesting that this can be considered the nanotube dispersion limit in γ-butyrolactone. After centrifugation, the dispersions are stable against sedimentation and further aggregation for a period of 8 weeks at least. Atomic-force-microscopy studies on films deposited from the isotropic phase reveal that the bundle diameter distribution decreases dramatically as concentration is decreased. Detailed data analysis suggests the presence of an equilibrium bundle number density. A population of individual nanotubes is always observed which increases with decreasing concentration until almost 40% of all dispersed objects are individual nanotubes at a concentration of 6 × 10-4 mg ml-1. The number density of individual nanotubes peaks at a concentration of ~6 × 10-3 mg ml-1 where almost 10% of the nanotubes by mass are individualized.

  18. Once-weekly prophylactic dosing of recombinant factor IX improves adherence in hemophilia B

    Science.gov (United States)

    Djambas Khayat, Claudia

    2016-01-01

    Regular prophylactic treatment in severe hemophilia should be considered an optimal treatment. There is no general agreement on the optimal prophylaxis regimen, and adherence to prophylaxis is a main challenge due to medical, psychosocial, and cost controversies. Improved approaches in prophylaxis regimen of hemophilia B are needed to make patients’ lives easier. There is some evidence to support the efficacy of once-weekly prophylaxis. Longer sampling schedules are required for the determination of pharmacokinetic (PK) properties of factor IX (FIX). The half-life of FIX seems to be longer than previously described and is expected to be 34 hours. The clinical significance of maintaining a 1% trough level is widely debated in hemophilia B. The overall relationship between factor concentrate levels and incidence of joint bleeding was found to be very weak. Data also indicate that the distribution of FIX into an extravascular FIX compartment may contribute to hemostasis independently of circulating plasma FIX levels. Clinical assessment of the frequency and severity of bleeds remain an important measure of the efficacy of treatment. Role of PK-guided therapy remains to be established. Two prospective randomized studies had evaluated the efficacy and safety of 100 IU/kg once-weekly prophylaxis with nonacog alfa, and this prophylaxis regimen was found to be associated with lower annual bleeding rate compared with on-demand treatment in adolescents and adults with moderately severe-to-severe hemophilia B. Secondary prophylaxis therapy with 100 IU/kg nonacog alfa once weekly reduced annual bleeding rate by 89.4% relative to on-demand treatment. Residual FIX may be supportive of effectiveness. Once-weekly prophylaxis was well tolerated in the two studies, with a safety profile similar to that reported during the on-demand treatment period. To individually tailor treatment to clinical response and to minimize costs of factor concentrate, it would be of interest to

  19. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Girma Belaineh

    2008-07-01

    Full Text Available Abstract Background The devastating impact of AIDS in the world especially in sub-Saharan Africa has led to an unprecedented global effort to ensure access to antiretroviral (ARV drugs. Given that medication-taking behavior can immensely affect an individual's response; ART adherence is now widely recognized as an 'Achilles heel' for the successful outcome. The present study was undertaken to investigate the rate and predictors of adherence to antiretroviral therapy among HIV-infected persons in southwest Ethiopia. Methods The study was conducted in the antiretroviral therapy unit of Jimma University Specialized Hospital. A prospective study was undertaken on a total of 400 HIV infected person. Data were collected using a pre-tested interviewer-administered structured questionnaire at first month (M0 and third month (M3 follow up visits. Results A total of 400 and 383 patients at baseline (M0 and at follow up visit (M3 respectively were interviewed. Self-reported dose adherence in the study area was 94.3%. The rate considering the combined indicator (dose, time and food was 75.7%. Within a three month follow up period, dose adherence decreased by 2% and overall adherence rate decreased by more than 3%. Adherence was common in those patients who have a social support (OR, 1.82, 95%CI, 1.04, 3.21. Patients who were not depressed were two times more likely to be adherent than those who were depressed (OR, 2.13, 95%CI, 1.18, 3.81. However, at the follow up visit, social support (OR, 2.42, 95%CI, 1.29, 4.55 and the use of memory aids (OR, 3.29, 95%CI, 1.44, 7.51 were found to be independent predictors of adherence. The principal reasons reported for skipping doses in this study were simply forgetting, feeling sick or ill, being busy and running out of medication in more than 75% of the cases. Conclusion The self reported adherence rate was high in the study area. The study showed that adherence is a dynamic process which changes overtime and cannot

  20. Adherence to physical and mental activity interventions: Coping plans as a mediator and prior adherence as a moderator.

    NARCIS (Netherlands)

    Evers, A.W.M.; Klusmann, V.; Schwarzer, R.; Heuser, I.

    2012-01-01

    Objective. Adherence to behavioural intervention programmes is a necessary condition for beneficial outcomes to be achieved. This study tested whether social cognitive variables and coping plans predict adherence. Design and methods. Adherence was examined in a randomized controlled trial with healt

  1. 蒺藜总黄酮对大鼠血小板黏附和聚集功能的影响%Effects of total flavonoid glycosides of Tribulus terrestris L.on platelet adherence and aggregation function in rats

    Institute of Scientific and Technical Information of China (English)

    王云; 韩继举; 赵晓民; 吴亚平; 冯蕾

    2011-01-01

    目的:探讨蒺藜总黄酮对血小板黏附和聚集功能的影响.方法:选用不同药物浓度,采用体外血液灌流的方法,在低切变率下观察血小板在胶原蛋白表面上的黏附形态,计算黏附面积;利用血小板聚集仪,以二磷酸腺苷诱导大鼠血小板聚集,测定血小板最大聚集率.结果:不同浓度的蒺藜总黄酮均能明显降低血小板在胶原蛋白表面上的黏附面积(P<0.01),对照组血小板的黏附聚集成团,实验组则疏松散在或单个黏附;血小板最大聚集率在蒺藜总黄酮高、中剂量组也显著下降(P<0.01).结论:蒺藜总黄酮具有显著抑制血小板黏附和聚集的作用.%OBJECTIVE To observe the effects of Tribulus terrestris L. On platelet adherence and aggregation function. METHODS Under different concentration of the drug, the adherence appearance of platelet on collagen protein were observed and calculated the area by hemoperfusion in vitro at low shear rate; adenosine diphosphate was used to induce platelet aggregation and the maximum ratio of platelet aggregation was detected. RESULTS Total flavonoid glycosides of Tribulus terrestris L. Reduced platelet adherence area on collagen surface significantly (P<0. 01). In control group, platelet agglutinated into pieces and single platelet was rare. In experimental group, the platelet adhered loosely and there were many single spreading triangle or polygon platelets. The maximum ratio of platelet aggregation decreased significantly at higher concentration of the drug (P<0. 01). CONCLUSION The results suggest that total flavonoid glycosides of Tribulus terrestris L. Can inhibit experimental platelet adherence and aggregation.

  2. Adherence of Helicobacter pylori to the Gastric Mucosa

    Directory of Open Access Journals (Sweden)

    Marguerite Clyne

    1997-01-01

    Full Text Available Bacterial adhesion to the intestinal epithelium is a critical initial step in the pathogenesis of many enteric diseases. Helicobacter pylori is a duodenal pathogen that adheres to the gastric epithelium and causes gastritis and peptic ulceration. The mechanism by which H pylori causes disease has not yet been elucidated but adherence to the gastric mucosa is thought to be an important virulence determinant of the organism. What is known about adherence of H pylori to the gastric mucosa is summarized. Topics discussed are the mechanism of H pylori adherence; in vitro and in vivo models of H pylori infection; and adherence and potential adhesins and receptors for H pylori.

  3. Adherence Characteristics of Cement Clinker on Basic Bricks

    Institute of Scientific and Technical Information of China (English)

    GUO Zongqi; Michel Rigaud

    2002-01-01

    Based on the sandwich test, adherence mechanisms of cement clinker on various basic bricks were tackled by microstructural observations with help of cathodoluminescence technique. Doloma based bricks offer sufficient lime to react with clinker, forming C3 S rich layer and initializing superior adherence. However, clinker with low silica ratio leads to MgO agglomeration at the interface of doloma bricks, which reduces adherence strength. On magnesia spinel bricks, fine, crystalline spinel easily reacts with lime containing phases from clinker to form lowmelting phases and belite zone, which shows high adherence performance. Lack of fine spinel in magnesia spinel bricks results in poor adherence.

  4. CBT for Medication Adherence and Depression (CBT-AD) in HIV-Infected Patients Receiving Methadone Maintenance Therapy

    Science.gov (United States)

    Soroudi, Nafisseh; Perez, Giselle K.; Gonzalez, Jeffrey S.; Greer, Joseph A.; Pollack, Mark H.; Otto, Michael W.; Safren, Steven A.

    2008-01-01

    For individuals with HIV who are current or former injection drug users, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes the feasibility and outcome, in a case series approach, of cognitive behavioral therapy to improve adherence…

  5. Survival of adhering staphylococci during exposure to a quaternary ammonium compound evaluated by using atomic force microscopy imaging

    NARCIS (Netherlands)

    Crismaru, Mihaela; Asri, Lia ATW; Loontjens, Jacobus; Krom, Bastiaan P; de Vries, Jacob; van der Mei, Henderina; Busscher, Hendrik

    2011-01-01

    Effects of a quaternary ammonium compound (QAC) on the survival of adhering staphylococci on a surface were investigated using atomic force microscopy (AFM). Four strains with different minimal inhibitory concentrations (MIC) and minimal bactericidal concentrations (MBC) for the QAC were exposed to

  6. Sharia Adherence Mosque Survey: Correlations between Sharia Adherence and Violent Dogma in U.S. Mosques

    Directory of Open Access Journals (Sweden)

    Mordechai Kedar

    2011-12-01

    Full Text Available A random survey of 100 representative mosques in the U.S. was conducted to measure the correlation between Sharia adherence and dogma calling for violence against non-believers.  Of the 100 mosques surveyed, 51% had texts on site rated as severely advocating violence; 30% had texts rated as moderately advocating violence; and 19% had no violent texts at all.  Mosques that presented as Sharia adherent were more likely to feature violence-positive texts on site than were their non-Sharia-adherent counterparts.  In 84.5% of the mosques, the imam recommended studying violence-positive texts.  The leadership at Sharia-adherent mosques was more likely to recommend that a worshipper study violence-positive texts than leadership at non-Sharia-adherent mosques.  Fifty-eight percent of the mosques invited guest imams known to promote violent jihad.  The leadership of mosques that featured violence-positive literature was more likely to invite guest imams who were known to promote violent jihad than was the leadership of mosques that did not feature violence-positive literature on mosque premises.  

  7. Psychosocial factors affecting medication adherence among HIV-1 infected adults receiving combination antiretroviral therapy (cART) in Botswana.

    Science.gov (United States)

    Do, Natalie T; Phiri, Kelesitse; Bussmann, Hermann; Gaolathe, Tendani; Marlink, Richard G; Wester, C William

    2010-06-01

    As increasing numbers of persons are placed on potentially life-saving combination antiretroviral therapy (cART) in sub-Saharan Africa, it is imperative to identify the psychosocial and social factors that may influence antiretroviral (ARV) medication adherence. Using an 87 question survey, the following data were collected from patients on cART in Botswana: demographics, performance (Karnofsky) score, perceived stigma and level of HIV disclosure, attitudes and beliefs concerning HIV/AIDS, substance and/or drug use, depression, and pharmacy and healthcare provider-related factors. Overall adherence rates were determined by patient self-report, institutional adherence, and a culturally modified Morisky scale. Three hundred adult patients were recruited between April and May 2005. The overall cART adherence rate was 81.3% based on 4 day and 1 month patient recall and on clinic attendance for ARV medication refills during the previous 3 months. Adults receiving cART for 1-6 months were the least adherent (77%) followed by those receiving cART for greater than 12 months (79%). Alcohol use, depression, and nondisclosure of positive HIV status to their partner were predictive of poor adherence rates (p value HIV disclosure to "at-risk" partners and provide ongoing counseling and education to help patients recognize and overcome HIV-associated stigma, alcohol abuse, and depression.

  8. Iron Chelation Adherence to Deferoxamine and Deferasirox in Thalassemia

    Science.gov (United States)

    Trachtenberg, Felicia; Vichinsky, Elliott; Haines, Dru; Pakbaz, Zahra; Mednick, Lauren; Sobota, Amy; Kwiatkowski, Janet; Thompson, Alexis A.; Porter, John; Coates, Thomas; Giardina, Patricia J.; Olivieri, Nancy; Yamashita, Robert; Neufeld, Ellis J.

    2015-01-01

    The Thalassemia Clinical Research Network collected adherence information from 79 patients on deferoxamine and 186 on deferasirox from 2007 to 2009. Chelation adherence was defined as percent of doses administered in the last 4 weeks (patient report) out of those prescribed (chart review). Chelation history since 2002 was available for 97 patients currently on deferoxamine and 217 on deferasirox, with crude estimates of adherence from chart review. Self-reported adherence to both deferoxamine and deferasirox were quite high, with slightly higher adherence to the oral chelator (97 vs. 92%). Ninety percent of patients on deferasirox reported at least 90% adherence, compared with 75% of patients on deferoxamine. Adherence to both chelators was highest in children, followed by adolescents and older adults. Predictors of lower deferoxamine adherence were smoking in the past year, problems sticking themselves (adults only), problems wearing their pump, and fewer transfusions in the past year. Predictors of lower deferasirox adherence were bodily pain and depression. Switching chelators resulted in increased adherence, regardless of the direction of the switch, although switching from deferoxamine to deferasirox was far more common. As adherence to deferoxamine is higher than previously reported, it appears beneficial for patients to have a choice in chelators. PMID:21523808

  9. Iron chelation adherence to deferoxamine and deferasirox in thalassemia.

    Science.gov (United States)

    Trachtenberg, Felicia; Vichinsky, Elliott; Haines, Dru; Pakbaz, Zahra; Mednick, Lauren; Sobota, Amy; Kwiatkowski, Janet; Thompson, Alexis A; Porter, John; Coates, Thomas; Giardina, Patricia J; Olivieri, Nancy; Yamashita, Robert; Neufeld, Ellis J

    2011-05-01

    The Thalassemia Clinical Research Network collected adherence information from 79 patients on deferoxamine and 186 on deferasirox from 2007 to 2009. Chelation adherence was defined as percent of doses administered in the last 4 weeks (patient report) out of those prescribed(chart review). Chelation history since 2002 was available for 97 patients currently on deferoxamine and 217 on deferasirox, with crude estimates of adherence from chart review. Self-reported adherence to both deferoxamine and deferasirox were quite high, with slightly higher adherence to the oral chelator (97 vs. 92%). Ninety percent of patients on deferasirox reported at least 90% adherence, compared with 75% of patients on deferoxamine. Adherence to both chelators was highest in children, followed by adolescents and older adults.Predictors of lower deferoxamine adherence were smoking in the past year, problems sticking themselves (adults only), problems wearing their pump, and fewer transfusions in the past year. Predictors of lower deferasirox adherence were bodily pain and depression. Switching chelators resulted in increased adherence, regardless of the direction of the switch, although switching from deferoxamine to deferasirox was far more common. As adherence to deferoxamine is higher than previously reported, it appears beneficial for patients to have a choice in chelators.

  10. Therapeutic drug monitoring of levetiracetam by high-performance liquid chromatography with photodiode array ultraviolet detection: preliminary observations on correlation between plasma concentration and clinical response in patients with refractory epilepsy.

    Science.gov (United States)

    Lancelin, Frédérique; Franchon, Emilie; Kraoul, Linda; Garciau, Isabelle; Brovedani, Sophie; Tabaouti, Khalid; Landré, Elisabeth; Chassoux, Francine; Paubel, Pascal; Piketty, Marie-Liesse

    2007-10-01

    Levetiracetam is a new antiepileptic drug prescribed for the treatment of patients with refractory partial seizures with or without secondary generalization as well as for the treatment of juvenile myoclonic epilepsy. A rapid and specific method by high-performance liquid chromatography diode array detection was developed to measure the concentration of levetiracetam in human plasma. The trough plasma concentrations measured in 69 epileptic patients treated with 500 to 3000 mg/d of levetiracetam ranged from 1.1 to 33.5 microg/mL. The mean (range) levetiracetam plasma concentrations in responders and nonresponders were 12.9 microg/mL (4.6-21 microg/mL) and 9.5 microg/mL (1.1-20.9 microg/mL), respectively. A wide variability in concentration-response relationships was observed in patients. Using a receiver operating characteristic curve, the threshold levetiracetam concentration for a therapeutic response was 11 microg/mL. The sensitivity and specificity for this threshold levetiracetam concentration were 73% and 71%, respectively. According to chi analysis, this finding was not significant probably because of the small number of patients and because of their refractory seizure type. Nevertheless, the levetiracetam plasma concentration could be used to help clinicians detect severe intoxication or to verify compliance by repeating the measurement in patients.

  11. Determination of the total concentration of highly protein-bound drugs in plasma by on-line dialysis and column liquid chromatography : application to non-steroidal anti-inflammatory drugs

    NARCIS (Netherlands)

    Herráez-Hernández, R; van de Merbel, N C; Brinkman, U A

    1995-01-01

    The potential of on-line dialysis as a sample preparation procedure for compounds highly bound to plasma proteins is evaluated, using non-steroidal anti-inflammatory drugs as model compounds and column liquid chromatography as the separation technique. Different strategies to reduce the degree of dr

  12. Optimization of a model of red blood cells for the study of anti-oxidant drugs, in terms of concentration of oxidant and phosphate buffer.

    Science.gov (United States)

    Bureau, A; Lahet, J-J; Lenfant, F; Bouyer, F; Petitjean, M; Chaillot, B; Freysz, M

    2005-08-01

    The aggression of erythrocytes by an oxidative stress induces hemolysis. This paper aims to valid a model of erythrocytes in terms of composition of the phosphate buffer solution and of concentration of a well-known oxidant, AAPH. Three compositions of phosphate buffer solution are mixed with three concentrations of oxidant. The influence of these two parameters on hemolysis is independently studied by a variance analysis and a Kruskal-Wallis test when ANOVA is not available. The hemolysis rate increases with time at fixed oxidant concentration, but is not influenced by the composition of the buffer solution. The highest hemolysis rate, 90%, was only measured within 2 h with the highest oxidant concentration. If we retain this concentration of oxidant, the lower concentration of the buffer can by eliminated by a significant less hemolysis and the highest concentration of the buffer can by chosen in regard of the better precision for a similar hemolysis compared to the mean buffer. We hope to study the effect of anti-oxidant agent with such a model of erythrocytes.

  13. Traditional complementary and alternative medicine and antiretroviral treatment adherence among HIV patients in Kwazulu-Natal, South Africa.

    Science.gov (United States)

    Peltzer, Karl; Friend-du Preez, Natalie; Ramlagan, Shandir; Fomundam, Henry; Anderson, Jane

    2009-12-30

    Adherence to antiretroviral medication in the treatment of HIV is critical, both to maximize efficacy and to minimize the emergence of drug resistance. The aim of this prospective study in three public hospitals in KwaZulu-Natal, South Africa, is to assess the use of Traditional Complementary and Alternative Medicine (TCAM) by HIV patients and its effect on antiretroviral (ARV) adherence 6 months after initiating ARVs. 735 (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation and 519 after six months on antiretroviral therapy (ART) Results indicate that the use of herbal therapies for HIV declined significantly from 36.6% prior to antiretroviral treatment (ART) initiation to 7.9% after being on ARVs for 6 months. Faith healing methods, including spiritual practices and prayer for HIV declined from 35.8% to 22.1% and physical/body-mind therapy (exercise and massage) declined from 5.0% to 1.9%. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 87.4%. In multivariate regression analyses, ARV non-adherence (dose, schedule and food) was associated with the use of herbal treatment, not taking micronutrients and the use of over-the-counter drugs. The use of TCAM declined after initiating ARVs. As herbal treatment for HIV was associated with reduced ARV adherence, patients' use of TCAM should be considered in ARV adherence management.

  14. Exfoliation in ecstasy: liquid crystal formation and concentration-dependent debundling observed for single-wall nanotubes dispersed in the liquid drug {gamma}-butyrolactone

    Energy Technology Data Exchange (ETDEWEB)

    Bergin, Shane D [School of Physics, Trinity College Dublin, University of Dublin, Dublin 2 (Ireland); Nicolosi, Valeria [School of Physics, Trinity College Dublin, University of Dublin, Dublin 2 (Ireland); Giordani, Silvia [School of Physics, Trinity College Dublin, University of Dublin, Dublin 2 (Ireland); Gromard, Antoine de [School of Physics, Trinity College Dublin, University of Dublin, Dublin 2 (Ireland); Carpenter, Leslie [School of Physics, Trinity College Dublin, University of Dublin, Dublin 2 (Ireland); Blau, Werner J [School of Physics, Trinity College Dublin, University of Dublin, Dublin 2 (Ireland); Coleman, Jonathan N [School of Physics, Trinity College Dublin, University of Dublin, Dublin 2 (Ireland)

    2007-11-14

    Large-scale debundling of single-walled nanotubes has been demonstrated by dilution of nanotube dispersions in the solvent {gamma}-butyrolactone. This liquid, sometimes referred to as 'liquid ecstasy', is well known for its narcotic properties. At high concentrations the dispersions form an anisotropic, liquid crystalline phase which can be removed by mild centrifugation. At lower concentrations an isotropic phase is observed with a biphasic region at intermediate concentrations. By measuring the absorbance before and after centrifugation, as a function of concentration, the relative anisotropic and isotropic nanotube concentrations can be monitored. The upper limit of the pure isotropic phase was C{sub NT}{approx}0.004 mg ml{sup -1}, suggesting that this can be considered the nanotube dispersion limit in {gamma}-butyrolactone. After centrifugation, the dispersions are stable against sedimentation and further aggregation for a period of 8 weeks at least. Atomic-force-microscopy studies on films deposited from the isotropic phase reveal that the bundle diameter distribution decreases dramatically as concentration is decreased. Detailed data analysis suggests the presence of an equilibrium bundle number density. A population of individual nanotubes is always observed which increases with decreasing concentration until almost 40% of all dispersed objects are individual nanotubes at a concentration of 6 x 10{sup -4} mg ml{sup -1}. The number density of individual nanotubes peaks at a concentration of {approx}6 x 10{sup -3} mg ml{sup -1} where almost 10% of the nanotubes by mass are individualized.

  15. Long-Term Antiretroviral Treatment Adherence in HIV-Infected Adolescents and Adults in Uganda: A Qualitative Study

    Science.gov (United States)

    Inzaule, Seth C.; Hamers, Raph L.; Kityo, Cissy; Rinke de Wit, Tobias F.; Roura, Maria

    2016-01-01

    Background Long-term success of HIV antiretroviral therapy requires near-perfect adherence, maintained throughout one’s lifetime. However, perceptions towards ART and patterns of adherence may change during the life course. We assessed challenges to long-term adherence in adolescents and adults in three regional HIV treatment centers in Uganda. Methods We conducted 24 in-depth interviews and 2 focus group discussions with a total of 33 health-care providers and expert clients (HIV patients on long-term ART who assist with adherence support of fellow patients). Interview topics included experiences with patients on long-term treatment with either declining adherence or persistent poor adherence. Transcribed texts were coded and analyzed based on the social-ecological framework highlighting differences and commonalities between adolescents and adults. Results The overarching themes in adolescents were unstructured treatment holidays, delays in disclosure of HIV status by caretakers, stigma, which was mainly experienced in boarding schools, and diminishing or lack of clinical support. In particular, there was minimal support for early and gradual disclosure for caretakers to the infected children, diminishing clinical support for young adults during transition to adult-based care and declining peer-to-peer support group activities. The predominating theme in adults was challenges with treatment access among temporary economic migrants. Common themes to adults and adolescents were challenges with disclosure in intimate relationships, treatment related factors including side effects, supply of single tablets in place of fixed-dose combined drugs, supply of drug brands with unfavorable taste and missed opportunities for counseling due to shortage of staff. Conclusion Adherence counseling and support should be adapted differently for adolescents and adults and to the emerging life course challenges in long-term treated patients. Programs should also address constraints

  16. Efficacy and safety of a multifactor intervention to improve therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD: protocol for the ICEPOC study

    Directory of Open Access Journals (Sweden)

    Prados-Torres Daniel

    2011-02-01

    evaluate the effectiveness of this multifactor intervention on patient adherence to inhaled drugs considering that it will be right and feasible to the clinical practice context. Trial registration Current Controlled Trials ISCTN18841601

  17. Type 2 diabetes: cost-effectiveness of medication adherence and lifestyle interventions

    Science.gov (United States)

    Nerat, Tomaž; Locatelli, Igor; Kos, Mitja

    2016-01-01

    Introduction Type 2 diabetes is a major burden for the payer, however, with proper medication adherence, diet and exercise regime, complication occurrence rates, and consequently costs can be altered. Aims The aim of this study was to conduct a cost-effectiveness analysis on real patient data and evaluate which medication adherence or lifestyle intervention is less cost demanding for the payer. Methods Medline was searched systematically for published type 2 diabetes interventions regarding medication adherence and lifestyle in order to determine their efficacies, that were then used in the cost-effectiveness analysis. For cost-effectiveness analysis-required disease progression simulation, United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used. The intervention duration was set to 1, 2, 5, and 10 years. Complications and drug costs in euro (EUR) were based on previously published type 2 diabetes costs from the Health Care payer perspective in Slovenia. Results Literature search proved the following interventions to be effective in type 2 diabetes patients: medication adherence, the Mediterranean diet, aerobic, resistance, and combined exercise. The long-term simulation resulted in no payer net savings. The model predicted following quality-adjusted life-years (QALY) gained and incremental costs for QALY gained (EUR/QALYg) after 10 years of intervention: high-efficacy medication adherence (0.245 QALY; 9,984 EUR/QALYg), combined exercise (0.119 QALY; 46,411 EUR/QALYg), low-efficacy medication adherence (0.075 QALY; 30,967 EUR/QALYg), aerobic exercise (0.069 QALY; 80,798 EUR/QALYg), the Mediterranean diet (0.057 QALY; 27,246 EUR/QALYg), and resistance exercise (0.050 QALY; 111,847 EUR/QALYg). Conclusion The results suggest that medication adherence intervention is, regarding cost-effectiveness, superior to diet and exercise interventions from the payer perspective. However, the latter could also be utilized

  18. Associations Between Personality Traits and Adherence to Antidepressants Assessed Through Self-Report, Electronic Monitoring, and Pharmacy Dispensing Data: A Pilot Study.

    Science.gov (United States)

    Wouters, Hans; Amin, Darya F H; Taxis, Katja; Heerdink, Eibert R; Egberts, Antoine C G; Gardarsdottir, Helga

    2016-10-01

    Treatment with antidepressants is often compromised by substantial nonadherence. To understand nonadherence, specific medication-related behaviors and beliefs have been studied, but less is known about broader and temporally stable personality "traits." Furthermore, adherence has often been assessed by a single method. Hence, we investigated associations between the Big Five personality traits and adherence assessed by self-report, electronic drug use monitoring, and dispensing data. Using the Big Five Inventory, we assessed the personality traits "openness," "conscientiousness," "extraversion," "agreeableness," and "neuroticism" of patients treated with antidepressants who were invited through community pharmacies. Self-reported adherence was assessed with the Medication Adherence Rating Scale (score >24), electronic monitoring with medication event monitoring system (MEMS) devices (therapy days missed ≤ 10% and personality traits, the third and fourth quartiles of "conscientiousness" were associated with better self-reported adherence (odds ratio, 3.63; 95% confidence interval, 1.34-9.86 and odds ratio, 2.97; 95% confidence interval, 1.09-8.08; P ≤ 0.05). No relationships were found between personality traits and adherence assessed through electronic drug use monitoring or dispensing data. We therefore conclude that adherence to antidepressant therapy seems to be largely unrelated to personality traits.

  19. Behavioral Economics Matters for HIV Research: The Impact of Behavioral Biases on Adherence to Antiretrovirals (ARVs).

    Science.gov (United States)

    Linnemayr, Sebastian; Stecher, Chad

    2015-11-01

    Behavioral economics (BE) has been used to study a number of health behaviors such as smoking and drug use, but there is little knowledge of how these insights relate to HIV prevention and care. We present novel evidence on the prevalence of the common behavioral decision-making errors of present-bias, overoptimism, and information salience among 155 Ugandan HIV patients, and analyze their association with subsequent medication adherence. 36 % of study participants are classified as present-biased, 21 % as overoptimistic, and 34 % as having salient HIV information. Patients displaying present-bias were 13 % points (p = 0.006) less likely to have adherence rates above 90 %, overoptimistic clients were 9 % points (p = 0.04) less likely, and those not having salient HIV information were 17 % points (p < 0.001) less likely. These findings indicate that BE may be used to screen for future adherence problems and to better design and target interventions addressing these behavioral biases and the associated suboptimal adherence.

  20. Paying for antiretroviral adherence: is it unethical when the patient is an adolescent?

    Science.gov (United States)

    Healy, Justin; Hope, Rebecca; Bhabha, Jacqueline; Eyal, Nir

    2017-03-01

    With the expansion of antiretroviral treatment programmes, many children and adolescents with HIV in sub-Saharan Africa could expect to live healthy lives. Yet adolescents have the highest levels of poor antiretroviral adherence and of loss to follow-up compared with other age groups. This can lead to increased morbidity and mortality, to the development of drug-resistant strains, and to high societal costs. While financial incentives have been extensively used to promote medication adherence among adults, their use among adolescents remains rare. And while there is a large body of ethical literature exploring financial incentives among adults, little philosophical thought has gone into their use among adolescents. This paper explores three oft-mentioned ethical worries about financial incentives for health behaviours and it asks whether these concerns are more serious in the context of incentives for improving adolescent adherence. The three worries are that such incentives would unduly coerce adolescents' decision-making, would compromise distributive justice and would crowd out intrinsic motivations and non-monetary values. Our tentative conclusion is that more empirical investigation of these concerns is necessary, and that at this point they are not compelling enough to rule out trials in which adolescents are incentivised for antiretroviral adherence.

  1. Silver colloidal nanoparticles: antifungal effect against adhered cells and biofilms of Candida albicans and Candida glabrata.

    Science.gov (United States)

    Monteiro, D R; Gorup, L F; Silva, S; Negri, M; de Camargo, E R; Oliveira, R; Barbosa, D B; Henriques, M

    2011-08-01

    The aim of this study was to evaluate the effect of silver nanoparticles (SN) against Candida albicans and Candida glabrata adhered cells and biofilms. SN (average diameter 5 nm) were synthesized by silver nitrate reduction with sodium citrate and stabilized with ammonia. Minimal inhibitory concentration (MIC) tests were performed for C. albicans (n = 2) and C. glabrata (n = 2) grown in suspension following the Clinical Laboratory Standards Institute microbroth dilution method. SN were applied to adhered cells (2 h) or biofilms (48 h) and after 24 h of contact their effect was assessed by enumeration of colony forming units (CFUs) and quantification of total biomass (by crystal violet staining). The MIC results showed that SN were fungicidal against all strains tested at very low concentrations (0.4-3.3 μg ml(-1)). Furthermore, SN were more effective in reducing biofilm biomass when applied to adhered cells (2 h) than to pre-formed biofilms (48 h), with the exception of C. glabrata ATCC, which in both cases showed a reduction ∼90%. Regarding cell viability, SN were highly effective on adhered C. glabrata and respective biofilms. On C. albicans the effect was not so evident but there was also a reduction in the number of viable biofilm cells. In summary, SN may have the potential to be an effective alternative to conventional antifungal agents for future therapies in Candida-associated denture stomatitis.

  2. Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: a systematic review

    Science.gov (United States)

    Banerjee, Amitava; Khandelwal, Shweta; Nambiar, Lavanya; Saxena, Malvika; Peck, Victoria; Moniruzzaman, Mohammed; Faria Neto, Jose Rocha; Quinto, Katherine Curi; Smyth, Andrew; Leong, Darryl; Werba, José Pablo

    2016-01-01

    Background Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy. Objectives To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level. Methods Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin–renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers. Results Of 2246 screened articles, 25 studies were included (12 trials, 11 cohort studies, 1 cross-sectional study and 1 case–control study) with 132 140 individuals overall (smallest n=30, largest n=63 301). 3 studies included upper middle-income countries, 1 included a low middle-income country and 21 (84%) included high-income countries (9 in the USA). Studies concerned established CVD (n=4), cerebrovascular disease (n=7) and coronary heart disease (n=14). Three studies considered persistence and adherence. Quantity and quality of evidence was limited for adherence, persistence and across drug classes. Studies were concerned with governance and delivery (n=19, including 4 trials of fixed-dose combination therapy, FDC), intellectual resources (n=1), human resources (n=1) and health system financing (n=4). Full prescription coverage, reduced copayments, FDC and counselling were facilitators associated with higher adherence. Conclusions High-quality evidence on health system barriers and facilitators to adherence to secondary prevention medications for CVD is lacking, especially for low-income settings. Full prescription coverage

  3. Effect of Drug Loading Method on Drug Content and Drug Release from Calcium Pectinate Gel Beads

    OpenAIRE

    2010-01-01

    Drug-loaded calcium pectinate gel (CaPG) beads were prepared by either mixing, absorption, or swelling method. The effects of drug loading method as well as the drug loading factors (i.e., drug concentration, soaking time in drug solution, type of solvent) on drug content and drug release were investigated. The amount of drug uptake (i.e., drug content) into CaPG beads increased as the initial drug concentration increased and varied depending on the loading method. The in vitro release studie...

  4. Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review

    Directory of Open Access Journals (Sweden)

    Zhang Tuohong

    2011-05-01

    Full Text Available Abstract Background Charging for tuberculosis (TB treatment could reduce completion rates, particularly in the poor. We identified and synthesised studies that measure costs of TB treatment, estimates of adherence and the potential impact of charging on treatment completion in China. Methods Inclusion criteria were primary research studies, including surveys and studies using qualitative methods, conducted in mainland China. We searched MEDLINE, PUBMED, EMBASE, Science Direct, HEED, CNKI to June 2010; and web pages of relevant Chinese and international organisations. Cost estimates were extracted, transformed, and expressed in absolute values and as a percentage of household income. Results Low income patients, defined at household or district level, pay a total of US$ 149 to 724 (RMB 1241 to 5228 for medical costs for a treatment course; as a percentage of annual household income, estimates range from 42% to 119%. One national survey showed 73% of TB patients at the time of the survey had interrupted or suspended treatment, and estimates from 9 smaller more recent studies showed that the proportion of patients at the time of the survey who had run out of drugs or were not taking them ranged from 3 to 25%. Synthesis of surveys and qualitative research indicate that cost is the most cited reason for default. Conclusions Despite a policy of free drug treatment for TB in China, health services charge all income groups, and costs are high. Adherence measured in cross sectional surveys is often low, and the cumulative failure to adhere is likely to be much higher. These findings may be relevant to those concerned with the development and spread of multi-drug resistant TB. New strategies need to take this into account and ensure patient adherence.

  5. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia

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    Nasir T Wabe

    2011-01-01

    Full Text Available Background : Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia. Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved. Aims : The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia. Patients and Method : The study consists of two phases. A cross-sectional review of randomly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview, with pre tested adherence and self management and monitoring tool questioner of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic. Result: Oral hypoglycemic agent were prescribed for 351(91.4 of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6%. About 312 (88.9% patients on oral hypoglycemic agent were on mono therapy, the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3% and metformine 80(25.7%. Only 41.8% of the patient had adequate glycemic control. The main external factors for non adherence were lack of finance (37.1% followed by perceived side effect of drug 29.2%. Only 6.5% patient who missed their medications disclosed to physician during consultation. The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied. Conclusion: Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine. While the current prescribing strategy do not achieve glycemic control on majority of the patient. This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management.

  6. Pharmacy adherence measures to assess adherence to antiretroviral therapy: review of the literature and implications for treatment monitoring.

    Science.gov (United States)

    McMahon, James H; Jordan, Michael R; Kelley, Karen; Bertagnolio, Silvia; Hong, Steven Y; Wanke, Christine A; Lewin, Sharon R; Elliott, Julian H

    2011-02-15

    Prescription or pill-based methods for estimating adherence to antiretroviral therapy (ART), pharmacy adherence measures (PAMs), are objective estimates calculated from routinely collected pharmacy data. We conducted a literature review to evaluate PAMs, including their association with virological and other clinical outcomes, their efficacy compared with other adherence measures, and factors to consider when selecting a PAM to monitor adherence. PAMs were classified into 3 categories: medication possession ratio (MPR), pill count (PC), and pill pick-up (PPU). Data exist to recommend PAMs over self-reported adherence. PAMs consistently predicted patient outcomes, but additional studies are needed to determine the most predictive PAM parameters. Current evidence suggests that shorter duration of adherence assessment (≤ 6 months) and use of PAMs to predict future outcomes may be less accurate. PAMs which incorporate the number of days for which ART was prescribed without the counting of remnant pills, are reasonable minimum-resource methods to assess adherence to ART.

  7. Subtoxic Concentrations of Hepatotoxic Drugs Lead to Kupffer Cell Activation in a Human In Vitro Liver Model: An Approach to Study DILI

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    Victoria Kegel

    2015-01-01

    Full Text Available Drug induced liver injury (DILI is an idiosyncratic adverse drug reaction leading to severe liver damage. Kupffer cells (KC sense hepatic tissue stress/damage and therefore could be a tool for the estimation of consequent effects associated with DILI. Aim of the present study was to establish a human in vitro liver model for the investigation of immune-mediated signaling in the pathogenesis of DILI. Hepatocytes and KC were isolated from human liver specimens. The isolated KC yield was 1.2±0.9×106 cells/g liver tissue with a purity of >80%. KC activation was investigated by the measurement of reactive oxygen intermediates (ROI, DCF assay and cell activity (XTT assay. The initial KC activation levels showed broad donor variability. Additional activation of KC using supernatants of hepatocytes treated with hepatotoxic drugs increased KC activity and led to donor-dependent changes in the formation of ROI compared to KC incubated with supernatants from untreated hepatocytes. Additionally, a compound- and donor-dependent increase in proinflammatory cytokines or in anti-inflammatory cytokines was detected. In conclusion, KC related immune signaling in hepatotoxicity was successfully determined in a newly established in vitro liver model. KC were able to detect hepatocyte stress/damage and to transmit a donor- and compound-dependent immune response via cytokine production.