scholarly journals Retrospective Analysis of Tacrolimus Intrapatient Variability as a Measure of Medication Adherence

2021 ◽  
Vol 8 ◽  
pp. 205435812110217
Author(s):  
Jordana Herblum ◽  
Niki Dacouris ◽  
Michael Huang ◽  
Jeffrey Zaltzman ◽  
G. V. Ramesh Prasad ◽  
...  
Keyword(s):  
Medication Adherence ◽  
De Novo ◽  
Demographic Data ◽  
Graft Loss ◽  
Poor Response ◽  
Self Report ◽  
Medication History ◽  
Primary Analysis ◽  
Younger Age ◽  
Intrapatient Variability

Background: Increased intrapatient variability (IPV) in tacrolimus levels is associated with graft rejection, de novo donor-specific antibodies, and graft loss. Medication nonadherence may be a significant contributor to high IPV. Objective: The objective of this study is to determine the utility of tacrolimus IPV in detecting nonadherence by examining the relationship between self-reported adherence and tacrolimus coefficient of variability (COV), a measure of IPV. Design: Retrospective cohort study. Setting: St. Michael’s Hospital, Toronto, Ontario. Patients: All patients who were at least 1-year post-kidney transplant as of March 31, 2019, prescribed tacrolimus as an immunosuppressant and had a self-reported adherence status. Patients were excluded from the primary analysis of examining the correlation between COV and self-reported adherence if they lacked a calculatable COV. Measurements: Self-reported adherence, COV, demographic data, transplant, and medication history. Methods: A modified Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) administered by healthcare professionals to assess self-reported adherence was used. The COV of tacrolimus trough levels was calculated and its correlation to BAASIS response was noted. The median COV was used as a cutoff to examine the characteristics of patients deemed “high COV” and “low COV.” Results: A total of 591 patients fit the initial criteria; however, only 525 had a recent calculatable COV. Overall, 92.38% of the population were adherent by self-report. Primary analysis identified a COV of 25.2% and 29.6% in self-reported adherent and nonadherent patients, respectively, though the result was not significant ( P = .2). Secondary analyses showed a significant correlation between younger age at transplant and at the time of adherence self-reporting with nonadherence ( P = .01). In addition, there was a strong correlation between those nonadherent with routine post-transplant blood work and younger age ( P < .01). Limitations: The limitations included modified nonvalidated BAASIS questionnaire, social desirability bias, BAASIS only administered in English, and patients with graft failure not active in clinic not being captured. Conclusions: The COV should not be used as the sole method for determining medication adherence. However, COV may have some utility in capturing individuals who are not adherent to their blood work or patients who are having a poor response to tacrolimus and should be switched to another medication.

scholarly journals The prevalence of impulsive compulsive behaviors in patients treated with apomorphine infusion: a retrospective analysis

2021 ◽  
Author(s):  
Pedro Barbosa ◽  
Atbin Djamshidian ◽  
Andrew John Lees ◽  
Thomas Treharne Warner
Keyword(s):  
Continuous Infusion ◽  
Disease Duration ◽  
De Novo ◽  
Demographic Data ◽  
Disease Onset ◽  
Brain Bank ◽  
Treatment Prevalence ◽  
Younger Age ◽  
Average Maximum ◽  
Compulsive Behaviors

ABSTRACT Background: Impulsive compulsive behaviors (ICBs) can affect a significant number of Parkinson’s disease (PD) patients. Objective: We have studied brain samples from a brain bank of PD patients who received apomorphine via continuous infusion in life to assess the prevalence and outcome of ICBs. Methods: A search on the Queen Square Brain Bank (QSBB) database for cases donated from 2005 to 2016 with a pathological diagnosis of idiopathic PD was conducted. Notes of all donors who used apomorphine via continuous infusion for at least three months were reviewed. Clinical and demographic data were collected, as well as detailed information on treatment, prevalence and outcomes of ICBs. Results: 193 PD cases, 124 males and 69 females, with an average age at disease onset of 60.2 years and average disease duration of 17.2 years were reviewed. Dementia occurred in nearly half of the sample, depression in one quarter, and dyskinesias in a little over 40%. The prevalence of ICBs was 14.5%. Twenty-four individuals used apomorphine infusion for more than three months. Patients on apomorphine had younger age at disease onset, longer disease duration, and higher prevalence of dyskinesias. The prevalence of de novo ICB cases among patients on apomorphine was 8.3%. Apomorphine infusion was used for an average of 63.1 months on an average maximum dose of 79.5 mg per day. Ten patients remained on apomorphine until death. Conclusions: Apomorphine can be used as an alternative treatment for patients with previous ICBs as it has low risk of triggering recurrence of ICBs.

scholarly journals Association between medication adherence and intrapatient variability in tacrolimus concentration among stable kidney transplant recipients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyunmin Ko ◽  
Hyo Kee Kim ◽  
Chris Chung ◽  
Ahram Han ◽  
Seung-Kee Min ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Kidney Transplant ◽  
Controlled Trial ◽  
Self Report ◽  
Tacrolimus Concentration ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Hoc Analysis ◽  
Intrapatient Variability ◽  
Post Hoc

AbstractThis study analyzed the association between medication adherence and the intrapatient variability (IPV) of tacrolimus concentrations among kidney transplant recipients through a post hoc analysis of the dataset from a recently conducted randomized controlled trial. Among 138 patients enrolled in the original trial, 92 patients with ≥ 5 months of medication event monitoring system (MEMS) use and ≥ 4 tacrolimus trough values were included in this post hoc analysis. The variability of tacrolimus trough levels was calculated using coefficient variation (CV) and mean absolute deviation. Adherence was assessed using MEMS and self-report via the Basal Assessment of Adherence to Immunosuppressive Medication Scale. There were no statistically significant differences in the CV [median 16.5% [interquartile range 11.6–25.5%] and 16.0% [11.5–23.5%], respectively, P = .602] between the nonadherent (n = 59) and adherent groups (n = 33). There was also no significant correlation between the CV and adherence detected by MEMS (taking adherence, ρ = − 0.067, P = .527; dosing adherence, ρ = − 0.098, P = .352; timing adherence, ρ = − 0.113, P = .284). Similarly, adherence measured by self-report did not significantly affect the IPV (P = .452). In this post hoc analysis, nonadherent behavior, measured through electronic monitoring or self-report, did not affect the IPV.

scholarly journals Medication Adherence in Adolescents with Psychiatric Disorders

2021 ◽  
Vol 49 (4) ◽  
pp. 295-306
Author(s):  
Clara Both ◽  
Konstantin Mechler ◽  
Larissa Niemeyer ◽  
Christine Jennen-Steinmetz ◽  
Sarah Hohmann ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Socioeconomic Factors ◽  
Psychiatric Disorders ◽  
Subjective Experience ◽  
Rating Scale ◽  
Demographic Data ◽  
Careful Consideration ◽  
Self Report ◽  
Future Research ◽  
Common Phenomenon

Abstract. Objective: This study investigates whether adolescents’ adherence to psychotropic medication is associated with demographic and socioeconomic factors, and to what extent parents’ assessments of their offspring’s attitudes toward treatment correspond with the adolescents’ self-report. Methods: This study is part of the multicenter SEMA study (Subjective Experience and Medication Adherence in Adolescents with Psychiatric Disorders). Adolescents’ subjective attitudes toward medication and their adherence were assessed using the patient and parent versions of the QATT (Questionnaire on Attitudes Toward Treatment) and the MARS (Medication Adherence Rating Scale). Furthermore, we collected socioeconomic and demographic data. Results: Of the n = 75 adolescents included in the study, n = 45 (60 %) were classified as completely adherent. Patients receiving monotherapy were more often completely adherent than those receiving a combination of different medications. There was no statistically significant association between adherence and demographic or socioeconomic factors. Consensus between adolescents and their parents regarding adolescents’ attitudes toward treatment ranged from slight (κ = 0.157) to fair (κ = 0.205). Conclusion: Incomplete medication adherence in adolescents with psychiatric disorders is a common phenomenon and still poorly understood. Demographic and socioeconomic factors do not seem to be relevant in this respect. However, adolescents’ subjective attitudes towards medication, which parents are presumably unable to adequately assess, warrant more careful consideration in future research.

Su1801 One Simple Question Is Sufficient for Measuring Medication Adherence in Inflammatory Bowel Disease Patients Using Self-Report

2016 ◽  
Vol 150 (4) ◽  
pp. S556
Author(s):  
Mirjam Severs ◽  
Marie-Josée J. Mangen ◽  
Herma H. Fidder ◽  
Mirthe E. Van Der Valk ◽  
Mike Van Der Have ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Medication Adherence ◽  
Bowel Disease ◽  
Self Report ◽  
Simple Question ◽  
Inflammatory Bowel

Abstract 3016: Spirituality and Medication Adherence in Older African American Adults Diagnosed with Hypertension: A Qualitative Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lisa M Lewis
Keyword(s):  
African American ◽  
Medication Adherence ◽  
Qualitative Study ◽  
Antihypertensive Medication ◽  
Demographic Data ◽  
Patient Treatment ◽  
List Type ◽  
Medication Regimen ◽  
Antihypertensive Medications ◽  
The Mean

Background : Medication adherence (ADH) is key to decreasing hypertension (HTN)-related morbidity and mortality in older African-American (AA) adults. However, older AA adults have poorer ADH to prescribed antihypertensive medications when compared to their younger and Caucasian-American counterparts. Patient beliefs and cultural concepts about their medications influence their medication ADH. An important cultural concept in this regards is spirituality, which is a significant resource in the AA community. Thus, the purpose of this qualitative study was to explore the role of spirituality in ADH to antihypertensive medications for older AA adults. Methods: Older AA adults who were members of a Program of All Inclusive Care for the Elderly (PACE) and who were (a) diagnosed with HTN; (b) prescribed at least one antihypertensive medication; (c) self-identified as African-American or Black; and (d) self-identified as spiritual completed one in-depth individual face-to-face in this qualitative descriptive study informed by grounded theory. Demographic data were also collected. Results : Twenty-one PACE members completed the study. All of the participants were female. The mean age of participants was 73 years with most completing high school (67%). The mean HTN diagnosis was16.7 years and mean number of prescriptions for antihypertensives was 3.3. Participants indicated that their spirituality was used in a collaborative process with formal health care to manage their ADH to antihypertensive medications. This process was identified as Partnering with God to Manage My Medications. Partnering with God to Manage My Medications indicated that the PACE members acknowledged personal responsibility for adhering to their antihypertensive medication regimen but used their spirituality as a resource for making decisions to remain adherent; coping with medication side effects; and increasing their self-efficacy to deal with barriers to ADH . Conclusions : Spirituality played a positive role in medication adherence for the PACE members. Incorporating individual beliefs, such as spirituality, into patient treatment for HTN may capitalize on their inner resources for medication ADH and demonstrates culturally appropriate care.

Differentiation between Schizoid and Avoidant Personalities: An Empirical Test*

1989 ◽  
Vol 34 (8) ◽  
pp. 785-790 ◽  
Author(s):  
James C. Overholser
Keyword(s):  
Personality Disorder ◽  
Empirical Test ◽  
Psychiatric Patients ◽  
Demographic Data ◽  
Clinical Information ◽  
Self Report ◽  
Almost All ◽  
Anxiety Depression ◽  
Univariate Analyses ◽  
Number Of Authors

A number of authors have questioned the rationale for subdividing the DSM-II schizoid diagnosis into three separate personality disorders in DSM-III, the schizoid, avoidant, and schizotypal. The present study was designed to explore differences between psychiatric patients with schizoid and avoidant personalities as compared to psychiatric controls with no personality disorder. Differences were examined on demographic data, self-report measures, and clinical information. A Multivariate Analysis of Variance (MANOVA) revealed a significant overall effect for groups across MMPI subscales. However, subsequent univariate Analyses of Variance (ANOVA's) revealed that almost all differences were between the two personality disorder groups as compared to the psychiatric controls. Contrary to expectations, schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients. No meaningful distinctions were found between the avoidant and the schizoid personalities. Results are discussed in terms of problems with the assessment methods and the diagnostic criteria.

scholarly journals The Effect of the E-Patuh Application on HIV/Aids Patients’ Adherence in Consuming Antiretroviral

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Alfian Alfian ◽  
Kusman Ibrahim ◽  
Imas Rafiyah
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Health Care Providers ◽  
Antiretroviral Treatment ◽  
Intervention Group ◽  
Self Report ◽  
Care Providers ◽  
Aids Patients ◽  
Antiretroviral Adherence ◽  
Hiv Aids

Medication adherence is behavior that refers to client obeys in following a medication, and makes lifestyle changes in accordance of recommendations from health care providers. Antiretroviral adherence is paramount for HIV/AIDS patients. The effects were often a problem in antiretroviral treatment and toxicity and often be the reason for replacing or stopping antiretroviral treatment. This study aimed to determine the “E-Patuh” Applications effect on antiretroviral adherence in patients Of HIV/AIDS In West Java. The research design was a quasi-experimental with nonequivalent control group design. The location of this research was in RSUD Kota Bandung and in RSUD Kota Banjar. The respondents was selected without randomization and used purposive sampling technique. Respondents in this study were 30 respondents. Data were obtained using self-report questionnaires. The intervention group was monitored a 30-day android-based E-Patuh application and monitored on an E-Patuh website and then measured adherence value with self-report. Data were analyzed using SPSS 22 with chi-square test. The results showed a significant difference between adherence value before and after application of E-Patuh in the intervention group with (p <0.05) with obtained p value = 0,006. The results of this study prove a positive effect on the using of E-Patuh applications against ARV medication adherence in the intervention group with the support system of the E-Patuh application. The used of E-Patuh is helpful in improving ARV adherence in HIV/AIDS patients. The features contained in E-Patuh were directly reminiscent of the timing of taking medication for PWLH. E-Patuh should be consideration for PLHIV and health care providers in hospitals to improve ARV adherence to reduce mortality rates in people living with HIV.

scholarly journals Impact of Genetic Polymorphism of Myeloid Differentiation Primary Response Gene 88, Enhancer of Zeste Homolog 2, and B-cell Lymphoma 2 like 11 in Patients with Diffuse Large B Cell Lymphoma Treated with Rituximab, Cyclophosphamide, Doxorubicin, Vincristin

2021 ◽  
Vol 9 (A) ◽  
pp. 98-105
Author(s):  
Hussam Zawam ◽  
Noha E. Ibrahim ◽  
Rasha Salama ◽  
Mai Samir ◽  
Walaa Abdelfattah ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Poor Response ◽  
Cell Of Origin ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Younger Age ◽  
Extranodal Disease ◽  
Large B Cell

BACKGROUND: Despite the growing landscape of genetic drivers in Diffuse Large B-cell Lymphoma, yet their clinical implication is still unclear and R-CHOP regimen remains a “one size fits all” therapy. We aimed in this study to examine the prevalence of EZH2, BCL211 and MYD 88 genetic polymorphisms in DLBCL patients and correlate the results with various clinical and survival outcomes. METHODS: Genotyping of MYD88 (rs387907272 T/C), EZH2 (rs3757441 C/T), and BCL2L11 (rs3789068 A/G) polymorphisms were conducted using real time polymerase chain reaction analysis in a total of 75 DLBCL patients. RESULTS: Most of our cases carried the wild TT genotype of MYD88 gene (64%), the mutant TT genotype of EZH2 gene (52%) and the wild AA genotype of BCL2L11 gene (48%). Regarding cell of origin, Germinal Centre (GC) phenotype was present in 56% of cases while 44% expressed the Post-GC (PGC) phenotype. Poor response outcome to first line R-CHOP was significantly correlated with the mutated CC genotype of MYD 88 (p=0.02), while better response to R-CHOP was significantly associated with younger age <50 years (p <0.0001), good PS (p=0.046), normal LDH level (p=0.003), earlier stage (p <0.0001), good IPI score (p=0.009), absence of extranodal disease (p <0.0001) and absence of bulky disease (p=0.004). The median PFS and the 2 year OS were significantly higher in younger age, earlier stage, good IPI score, absence of extranodal disease, absence of bulky disease and in GC phenotype. CONCLUSIONS: Our results emphasized that the mutated genotype of MYD 88 gene polymorphism is significantly associated with poor response to R-CHOP therapy.

scholarly journals Brain-behaviour modes of covariation in healthy and clinically depressed young people

2018 ◽  
Author(s):  
Agoston Mihalik ◽  
Fabio S. Ferreira ◽  
Maria J. Rosa ◽  
Michael Moutoussis ◽  
Gabriel Ziegler ◽  
...  
Keyword(s):  
Brain Connectivity ◽  
Demographic Data ◽  
Strong Association ◽  
Early Adulthood ◽  
Well Being ◽  
Self Report ◽  
Multivariate Statistical ◽  
Functional Brain ◽  
Clinically Depressed ◽  
Critical Developmental Period

AbstractUnderstanding how variations in dimensions of psychometrics, IQ and demographics relate to changes in brain connectivity during the critical developmental period of adolescence and early adulthood is a major challenge. This has particular relevance for mental health disorders where a failure to understand these links might hinder the development of better diagnostic approaches and therapeutics. Here, we investigated this question in 306 adolescents and young adults (14-24y, 25 clinically depressed) using a multivariate statistical framework, based on canonical correlation analysis (CCA). By linking individual functional brain connectivity profiles to self-report questionnaires, IQ and demographic data we identified two distinct modes of covariation. The first mode mapped onto an externalization/internalization axis and showed a strong association with sex. The second mode mapped onto a well-being/distress axis independent of sex. Interestingly, both modes showed an association with age. Crucially, the changes in functional brain connectivity associated with changes in these phenotypes showed marked developmental effects. The findings point to a role for the default mode, frontoparietal and limbic networks in psychopathology and depression.

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