Prevalence of Universal Medication Schedule prescribing and links to adherence

2020 ◽  
Vol 77 (3) ◽  
pp. 196-205
Author(s):  
Michael S Wolf ◽  
Michael S Taitel ◽  
Jenny Z Jiang ◽  
Laura M Curtis ◽  
Guisselle A Wismer ◽  
...  
Keyword(s):  
Tier 2 ◽  
Patient Centered ◽  
Once Daily ◽  
Medication Schedule ◽  
Tier 1 ◽  
Proportion Of Days Covered ◽  
Actual Use ◽  
Multivariable Analyses ◽  
Tier 3

Abstract Purpose A Universal Medication Schedule (UMS) that uses explicit language to describe when to take medicine has been proposed as a patient-centered prescribing and dispensing standard. Despite widespread support, evidence of its actual use and efficacy is limited. We investigated the prevalence of UMS instructions and whether their use was associated with higher rates of medication adherence. Methods National pharmacy records were analyzed for a cohort of type 2 diabetic adults ≥18 years old (N = 676,739) new to ≥1 oral diabetes medications between January and June 2014. Prescription instructions (N = 796,909) dispensed with medications were classified as UMS or non-UMS. Instructions coded as UMS were further categorized as either providing precise UMS language (tier 1: “take 1 pill at morning, noon, evening, or bedtime”) or offering some explicit guidance (tier 2: “take 1 tablet by mouth before breakfast”; tier 3: “take 1 tablet twice daily with a meal”). Adherence over 12 months was measured by proportion of days covered. Results One-third of instructions (32.4%, n = 258,508) were classified as UMS (tier 1: 12.6%, n = 100,589; tier 2: 6.0%, n = 47,914; tier 3: 13.8%, n = 110,005). In multivariable analyses, UMS instructions (all tiers) exhibited better adherence compared to non-UMS instructions (relative risk [RR], 1.01; 95% confidence interval [CI], 1.00-1.02; P = 0.01). Patients older than 65 years who were less educated and taking medication more than once daily received greater benefit from tier 1 UMS instructions (RR, 1.14; 95% CI, 1.07-1.21; P < 0.001). Conclusion While infrequently used, the UMS could help older, less-educated patients adhere to more complex regimens with minimal investment.

Optimal Timing for Launching Installation of Tier 2 and 3 Systems of School-Wide Positive Behavioral Interventions and Supports

2021 ◽  
pp. 109830072199608
Author(s):  
Angus Kittelman ◽  
Sterett H. Mercer ◽  
Kent McIntosh ◽  
Robert Hoselton
Keyword(s):  
Longitudinal Study ◽  
Behavioral Interventions ◽  
Structural Equation ◽  
Equation Modeling ◽  
Optimal Timing ◽  
First Year ◽  
Tier 2 ◽  
Positive Behavioral Interventions ◽  
Tier 1 ◽  
Tier 3

The purpose of this longitudinal study was to examine patterns in implementation of Tier 2 and 3 school-wide positive behavioral interventions and supports (SWPBIS) systems to identify timings of installation that led to higher implementation of advanced tiers. Extant data from 776 schools in 27 states reporting on the first 3 years of Tier 2 implementation and 359 schools in 23 states reporting on the first year of Tier 3 implementation were analyzed. Using structural equation modeling, we found that higher Tier 1 implementation predicted subsequent Tier 2 and Tier 3 implementation. In addition, waiting 2 or 3 years after initial Tier 1 implementation to launch Tier 2 systems predicted higher initial Tier 2 implementation (compared with implementing the next year). Finally, we found that launching Tier 3 systems after Tier 2 systems, compared with launching both tiers simultaneously, predicted higher Tier 2 implementation in the second and third year, so long as Tier 3 systems were launched within 3 years of Tier 2 systems. These findings provide empirical guidance for when to launch Tier 2 and 3 systems; however, we emphasize that delays in launching advanced systems should not equate to delays in more intensive supports for students.

scholarly journals Global Inland Capture and Culture Finfisheries Follow Different Trends When Evaluated by the Human Development Index

2021 ◽  
Vol 13 (15) ◽  
pp. 8420
Author(s):  
Peter W. Sorensen ◽  
Maria Lourdes D. Palomares
Keyword(s):  
Socioeconomic Factors ◽  
Human Development ◽  
Human Development Index ◽  
Developed Countries ◽  
Global Scale ◽  
Tier 2 ◽  
Development Index ◽  
Tier 1 ◽  
Catch Reconstruction ◽  
Tier 3

To assess whether and how socioeconomic factors might be influencing global freshwater finfisheries, inland fishery data reported to the FAO between 1950 and 2015 were grouped by capture and culture, country human development index, plotted, and compared. We found that while capture inland finfishes have greatly increased on a global scale, this trend is being driven almost entirely by poorly developed (Tier-3) countries which also identify only 17% of their catch. In contrast, capture finfisheries have recently plateaued in moderately-developed (Tier-2) countries which are also identifying 16% of their catch but are dominated by a single country, China. In contrast, reported capture finfisheries are declining in well-developed (Tier-1) countries which identify nearly all (78%) of their fishes. Simultaneously, aquacultural activity has been increasing rapidly in both Tier-2 and Tier-3 countries, but only slowly in Tier-1 countries; remarkably, nearly all cultured species are being identified by all tier groups. These distinctly different trends suggest that socioeconomic factors influence how countries report and conduct capture finfisheries. Reported rapid increases in capture fisheries are worrisome in poorly developed countries because they cannot be explained and thus these fisheries cannot be managed meaningfully even though they depend on them for food. Our descriptive, proof-of-concept study suggests that socioeconomic factors should be considered in future, more sophisticated efforts to understand global freshwater fisheries which might include catch reconstruction.

Incorporation of plasma-based next-generation sequencing to improve guideline-concordant molecular testing in patients with newly diagnosed metastatic nonsquamous non-small cell lung cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 14-14
Author(s):  
Charu Aggarwal ◽  
Melina Elpi Marmarelis ◽  
Wei-Ting Hwang ◽  
Dylan G. Scholes ◽  
Aditi Puri Singh ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Change ◽  
Molecular Testing ◽  
Tier 2 ◽  
Newly Diagnosed ◽  
Next Generation ◽  
First Line ◽  
Tier 1 ◽  
Tier 3 ◽  
The Impact

14 Background: Current NCCN guidelines recommend comprehensive molecular profiling for all newly diagnosed patients with metastatic non-squamous NSCLC to enable the delivery of personalized medicine. We have previously demonstrated that incorporation of plasma based next-generation gene sequencing (NGS) improves detection of clinically actionable mutations in patients with advanced NSCLC (Aggarwal et al, JAMA Oncology, 2018). To increase rates of comprehensive molecular testing at our institution, we adapted our clinical practice to include concurrent use of plasma (P) and tissue (T) based NGS upon initial diagnosis. P NGS testing was performed using a commercial 74 gene assay. We analyzed the impact of this practice change on guideline concordant molecular testing at our institution. Methods: A retrospective cohort study of patients with newly diagnosed metastatic non-squamous NSCLC following the implementation of this practice change in 12/2018 was performed. Tiers of NCCN guideline concordant testing were defined, Tier 1: complete EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, Tier 2: included above, but with incomplete NTRK testing, Tier 3: > 2 genes tested, Tier 4: single gene testing, Tier 5: no testing. Proportion of patients with comprehensive molecular testing by modality (T NGS vs. T+P NGS) were compared using one-sided Fisher’s exact test. Results: Between 01/2019, and 12/2019, 170 patients with newly diagnosed metastatic non-Sq NSCLC were treated at our institution. Overall, 98.2% (167/170) patients underwent molecular testing, Tier 1: n = 100 (59%), Tier 2: n = 39 (23%), Tier 3/4: n = 28 (16.5%), Tier 5: n = 3 (2%). Amongst these patients, 43.1% (72/167) were tested with T NGS alone, 8% (15/167) with P NGS alone, and 47.9% (80/167) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS: 95.7% (79/80) compared to T alone: 62.5% (45/72), p < 0.0005. Prior to the initiation of first line treatment, 72.4% (123/170) patients underwent molecular testing, Tier 1: n = 73 (59%), Tier 2: n = 27 (22%) and Tier 3/4: n = 23 (18%). Amongst these, 39% (48/123) were tested with T NGS alone, 7% (9/123) with P NGS alone and 53.6% (66/123) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS, 100% (66/66) compared to 52% (25/48) with T NGS alone (p < 0.0005). Conclusions: Incorporation of concurrent T+P NGS testing in treatment naïve metastatic non-Sq NSCLC significantly increased the proportion of patients undergoing guideline concordant molecular testing, including prior to initiation of first-line therapy at our institution. Concurrent T+P NGS should be adopted into institutional pathways and routine clinical practice.

scholarly journals Initial Experience in Predicting the Risk of Hospitalization of 496 Outpatients with COVID-19 Using a Telemedicine Risk Assessment Tool

2020 ◽  
Author(s):  
James B O'Keefe ◽  
Elizabeth J Tong ◽  
Thomas H Taylor ◽  
Ghazala D Datoo O'Keefe ◽  
David C Tong
Keyword(s):  
Risk Assessment ◽  
Assessment Tool ◽  
Cox Regression ◽  
Risk Assessment Tool ◽  
Individual Risk ◽  
Tier 2 ◽  
Tier 1 ◽  
Risk Patients ◽  
Tier 3

Objective: To determine whether a risk prediction tool developed and implemented in March 2020 accurately predicts subsequent hospitalizations. Design: Retrospective cohort study, enrollment from March 24 to May 26, 2020 with follow-up calls until hospitalization or clinical improvement (final calls until June 19, 2020) Setting: Single center telemedicine program managing outpatients from a large medical system in Atlanta, Georgia Participants: 496 patients with laboratory-confirmed COVID-19 in isolation at home. Exclusion criteria included: (1) hospitalization prior to telemedicine program enrollment, (2) immediate discharge with no follow-up calls due to resolution. Exposure: Acute COVID-19 illness Main Outcome and Measures: Hospitalization was the outcome. Days to hospitalization was the metric. Survival analysis using Cox regression was used to determine factors associated with hospitalization. Results: The risk-assessment rubric assigned 496 outpatients to risk tiers as follows: Tier 1, 237 (47.8%); Tier 2, 185 (37.3%); Tier 3, 74 (14.9%). Subsequent hospitalizations numbered 3 (1%), 15 (7%), and 17 (23%) and for Tiers 1-3, respectively. From a Cox regression model with age ≥ 60, gender, and self-reported obesity as covariates, the adjusted hazard ratios using Tier 1 as reference were: Tier 2 HR=3.74 (95% CI, 1.06-13.27; P=0.041); Tier 3 HR=10.87 (95% CI, 3.09-38.27; P<0.001). Tier was the strongest predictor of time to hospitalization. Conclusions and Relevance: A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified both low-risk and high-risk patients with better performance than individual risk factors alone. This approach may be appropriate for optimum allocation of resources.

SFBT Within the Tier 2 Framework

2017 ◽  
Author(s):  
Michael S. Kelly ◽  
Johnny S. Kim ◽  
Cynthia Franklin
Keyword(s):  
Classroom Climate ◽  
Tier 2 ◽  
Social Emotional ◽  
Prevention Services ◽  
Coaching Intervention ◽  
Tier 1 ◽  
American Schools ◽  
Tier 2 Intervention ◽  
Tier 3 ◽  
Teacher Coaching

The educational policy changes of the past 20 years have increased the focus on the provision of prevention services within schools, both for individual students and for social-emotional programming delivered in their classroom. Whether characterized as Response to Intervention (RTI), Positive Behavior Intervention and Supports (PBIS), or Multi-Tiered Systems of Supports (MTSS), the focus on a 3-tier framework of universal (Tier 1), selective (Tier 2) and indicated (Tier 3) has become one of the largest evidence-based framework ever scaled up within American schools, with over 19,000 schools across all 50 states having implemented PBIS by this writing. This chapter focuses on an example of a SFBT Tier 2 intervention, the Working on What Works (WOWW) teacher coaching intervention, that strives to create a better classroom climate for teachers and their students.

TIER-2 IN EAST ASIA1: CHALLENGES AND ANSWERS

2008 ◽  
Vol 2008 (1) ◽  
pp. 49-55
Author(s):  
Alexander Nicolau
Keyword(s):  
Media Coverage ◽  
Oil Spills ◽  
Oil Industry ◽  
Government Agencies ◽  
Tier 2 ◽  
International Media ◽  
The Past ◽  
Tier 1 ◽  
Tier 3 ◽  
And Training

ABSTRACT On numerous occasions, East Asia has been affected by marine oil spills incidents, originating from tankers and other types of ships. Important spills incidents that involved the IOPC Funds in the last decade (e.g. Nakhodka, Evoikos, Natuna Sea and Solar 1 …) indicate an average occurrence of one spill per year. This figure remains significantly high when considering that some States in the region are still not parties to international compensation regimes. In addition, numerous incidents do not benefit of international media coverage, thus making them often unnoticed. Lower scale incidents (within the range of hundreds of tonnes) occur on a more frequent basis and may appear trivial to respond to. Nevertheless, they represent the same range of difficulties experienced during larger scale incidents (logistics, suitable means to apply dispersants promptly and effectively, availability of temporary storage, lack of plan and training …) In terms of response, the ultimate authority in the coordination of spill response activities is in the hands of Government Agencies. However, the equipment and manpower available belong in various proportions to both Government Agencies and the Oil Industry. The latter operates numerous oil terminals and offshore facilities and is responsible to respond to minor spills defined as Tier 1. In the case of a large spill that exceeds the on-site capability, Tier 3 Cooperatives funded by the vast majority of major companies were created to assist and complement the local response, by offering access to a large range of special supplementary resources and services, such as the Airborne Dispersant Delivery System. Whilst Tiers 1 and 3 are well defined and are respectively synonyms of small and huge oil spill incidents, there is a lack of clarity and consistency in-between, thus making the Tier 2 response difficult to define. This gap that is often underestimated and may result in a preparedness weakness leading to unfortunate consequences. The aim of this paper is to analyse the Tier-2 response requirements and to discuss on the challenges of implementing effective measures in a region where the only imports of crude oil of China have more than doubled in the past five years.

The Cancer Molecular Screening and Therapeutics Program (MoST): Actionable mutation frequencies in a population with rare and less common cancers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3136-3136
Author(s):  
Subotheni Thavaneswaran ◽  
Mandy L. Ballinger ◽  
John Grady ◽  
Mark Cowley ◽  
Anthony Joshua ◽  
...  
Keyword(s):  
Performance Status ◽  
Unmet Need ◽  
Tumor Board ◽  
Molecular Characteristics ◽  
Cancer Type ◽  
Tier 2 ◽  
Molecular Screening ◽  
Pathogenic Variants ◽  
Tier 1 ◽  
Tier 3

3136 Background: Personalizing therapy will arguably have no greater impact than on patients (pts) with rare (< 6 per 100,000 population) or less common cancers (6-12/100,000). MoST combines a molecular screening platform and biomarker-driven treatments for pts with advanced cancer, with a particular focus on rare and less common cancers (RLC). Methods: Molecular screening was performed using in-house and commercial panels on archival tumor tissue. A Molecular Tumor Board by consensus reported on pathogenic variants with potential therapeutic actionability. Tiers of actionability were defined as: Tier 1–eligible for a MoST substudy; Tier 2–clinical evidence of efficacy in any cancer type, Tier 3—preclinical evidence. The clinical and molecular characteristics of the first 1,000 pts are presented here. Results: Pts were recruited from Sept 2016 to Dec 2018. A report was issued in 94% of cases in a median of 7.7 weeks from consent. In 6%, there was insufficient tissue. The median age at cancer diagnosis was 35 years (range 4-85 years), and 49% were male. Pts had a median of 2 lines of prior systemic therapy (0-11), and a median baseline ECOG performance status of 0 (range 0-3). 82% of pts had RLCs. A total of 2642 pathogenic variants were reported, of which 1144 (43%) were deemed therapeutically actionable. 651(57%) of actionable variants (AVs) occurred in RLC (Table). Most commonly, AVs were found in the cell cycle, homologous recombination repair (HR) and fibroblast growth factor (FGF) pathways. 559(66%) of pts had at least one AV identified, 30% tier 1, 63% tier 2 and 6% tier 3, including 66% of RLC. In 30% of cases, a tumor mutational burden >11 mutations/ megabase was reported. Conclusions: Here we report a high frequency of AVs in RLC, providing a rational basis for assessing the potential of personalized therapy in a population with a historically unmet need for effective treatment. Clinical trial information: ACTRN12616000908437. [Table: see text]

scholarly journals Detection of Broadly Neutralizing Activity within the First Months of HIV-1 Infection

2016 ◽  
Vol 90 (11) ◽  
pp. 5231-5245 ◽  
Author(s):  
V. Sanchez-Merino ◽  
A. Fabra-Garcia ◽  
N. Gonzalez ◽  
D. Nicolas ◽  
A. Merino-Mansilla ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Geometric Mean ◽  
First Year ◽  
Tier 2 ◽  
Chronic Infections ◽  
Neutralizing Activity ◽  
Recombinant Viruses ◽  
Tier 1 ◽  
Tier 3 ◽  
Hiv 1

ABSTRACTA fraction of HIV-1 patients are able to generate broadly neutralizing antibodies (bNAbs) after 2 to 4 years of infection. In rare occasions such antibodies are observed close to the first year of HIV-1 infection but never within the first 6 months. In this study, we analyzed the neutralization breadth of sera from 157 antiretroviral-naive individuals who were infected for less than 1 year. A range of neutralizing activities was observed with a previously described panel of six recombinant viruses from five different subtypes (M. Medina-Ramirez et al., J Virol85:5804–5813, 2011,http://dx.doi.org/10.1128/JVI.02482-10). Some sera were broadly reactive, predominantly targeting envelope epitopes within the V2 glycan-dependent region. The neutralization breadth was positively associated with time postinfection (P= 0.0001), but contrary to what has been reported for chronic infections, no association with the viral load was observed. Notably, five individuals within the first 6 months of infection (two as early as 77 and 96 days postinfection) showed substantial cross-neutralization. This was confirmed with an extended panel of 20 Env pseudoviruses from four different subtypes (two in tier 3, 14 in tier 2, and four in tier 1). Sera from these individuals were capable of neutralizing viruses from four different subtypes with a geometric mean 50% infective dose (ID50) between 100 and 800. These results indicate that induction of cross-neutralizing responses, albeit rare, is achievable even within 6 months of HIV-1 infection. These observations encourage the search for immunogens able to elicit this kind of response in preventive HIV-1 vaccine approaches.IMPORTANCEThere are very few individuals able to mount broadly neutralizing activity (bNA) close to the first year postinfection. It is not known how early in the infection cross-neutralizing responses can be induced. In the present study, we show that bNAbs, despite being rare, can be induced much earlier than previously thought. The identification of HIV-1-infected patients with these activities within the first months of infection and characterization of these responses will help in defining new immunogen designs and neutralization targets for vaccine-mediated induction of bNAbs.

scholarly journals COVID-19 Pandemic Impacts Decision-Making and Psychosocial Behavior in Women Seeking Fertility Treatment in APAC—an ASPIRE Patient Experience Report

2021 ◽  
Vol 03 (03) ◽  
pp. 58-77
Author(s):  
Budi Wiweko ◽  
Tuong M. Ho ◽  
Atsushi Tanaka ◽  
Vanessa Raggio ◽  
Jung-Ryeol Lee ◽  
...  
Keyword(s):  
Patient Experience ◽  
Experience Report ◽  
Asia Pacific ◽  
Fertility Treatment ◽  
Tier 2 ◽  
Patient Centered ◽  
Tier 1 ◽  
Group A ◽  
Psychosocial Behavior ◽  
Patient Concerns

Background: ASPIRE (Asia-Pacific Initiative on Reproduction) aims to develop a “patient-centered” guide to provide fertility treatment based on patient preferences, needs, and concerns during and beyond the SARS-Cov-2 pandemic. Methods: Women, aged 20–45 years old, trying to conceive for more than 6 months and contemplating for pregnancy including IVF treatment. A country wise analysis of patient behavior, attitudes and concerns, reasons for disruption of treatment and availability of assistance from fertility clinics during SARS-Cov-2 pandemic was performed. Six problem statements addressing patient concerns were identified and corresponding solutions to improve patient experience were formulated. A two-tier recommendation was developed. Tier 1 comprises recommendations in which the rate of “absolutely agree” responses were [Formula: see text]60%, whereas tier 2 refers to recommendations in which the rate of “absolutely agree” plus “agree” together was >60%. Results: Women in countries that have better infection control and are living a new normal were less worried about the pandemic influencing their lifestyle and finances. The proportion of women choosing not to continue IVF/IUI treatment during COVID-19 was similar across countries. Sixty-five percent of women in Group A intend to continue treatment during COVID-19 pandemic. Nine out of 10 patients are expected to resume or start treatment once fertility clinics are accessible. A patient-centered guide focusing on management of patient safety concerns, reduction in difficulty of access to hospitals, prioritization of patients, provision of emotional support, and improvement in patient education and acceptance of remote health services was developed. Conclusion: This ASPIRE patient experience report highlights a patient-centered guide on provision of safe fertility treatment across the Asia-Pacific region, which can be adapted to suit country-specific requirements depending on the stage of the pandemic, local restrictions, and availability of resources.

scholarly journals Helping Children with Emotional Difficulties

2018 ◽  
Vol 30 (2) ◽  
Author(s):  
Lee R. Pearce
Keyword(s):  
Behavioral Interventions ◽  
Skills Training ◽  
Fifth Grade ◽  
Future Research ◽  
Tier 2 ◽  
Prosocial Skills ◽  
Tier 1 ◽  
Rti Model ◽  
Tier 3 ◽  
Rural Elementary School

This article describes a Response to Intervention (RTI) model of service delivery implemented within a rural elementary school for students in kindergarten through fifth grade experiencing significant emotional and behavioral difficulties. A multi-tiered model is presented that includes school wide interventions in Tier 1, as well as a six separate interventions applied within Tier 2 and Tier 3. These included applied behavioral analysis, social skills training, counseling,  differentiated instruction, cognitive behavioral interventions and parent involvement designed to assist identified students with improving prosocial skills. Nine children were treated within this program model over a two year period, resulting in two students being placed in special education under the category of emotional disturbance by the project’s termination. Positive and negative aspects of the project’s implementation are reviewed, along with directions for future research.  

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