Self-reported vs. objectively assessed adherence to inhaled corticosteroids in asthma

Abstract Background Adherence to inhaled corticosteroids (ICS) in asthma is vital for disease control. However, obtaining reliable and clinically useful measures of adherence remains a major challenge. We investigated the association between patient-reported adherence and objectively measured adherence based on filled prescriptions with inhaled corticosteroids in adults with asthma. Methods In total, 178 patients with asthma were asked to self-assess adherence during routine visits at a respiratory outpatient clinic. Self-assessment was performed using Foster score (“How many days in a 7-day week do you take your medication as prescribed?”, with the answer divided by 7). Objective adherence was calculated as medication possession ratio (MPR). Bivariate and multivariable linear regression, adjusted for age, sex, FEV1, GINA treatment step, excessive use of SABA, and history of exacerbations were used for analyses. Results Of the included patients, 87.6% reported a Foster score of 100%, while the mean ICS MPR was 54.0% (SD 25%). Complex regimens such as twice-daily dosing or dual inhaler-use were associated with lower adherence (p = 0.015 and p < 0.001, respectively). Foster score was predictive of ICS MPR, with an absolute 32% increase in MPR between patients reporting Foster scores of 0 and 100% (95% CI 13–50%, p < 0.001). Female sex predicted higher ICS MPR (p = 0.019). Previous asthma-related hospitalization(s) predicted lower ICS MPR (p = 0.039). Conclusion Although a weak association was found between Foster score and ICS MPR, findings do not support the use of Foster score, and by that self-reported adherence, as a reliable marker of controller adherence in asthma due to significant mismatch between patient-reported adherence and MPR. Future studies should address the complex interplay between patient-reported and objectively assessed adherence to controller medication in asthma.

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Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.1.3.8 ◽

2017 ◽

Vol 1 (3) ◽

pp. 156-160

Author(s):

Jacqueline Watchmaker ◽

Sean Legler ◽

Dianne De Leon ◽

Vanessa Pascoe ◽

Robert Stavert

Keyword(s):

United States ◽

Case Series ◽

The United States ◽

Screening Tools ◽

Dermatology Department ◽

Cutaneous Manifestations ◽

Serologic Testing ◽

Patient Reported ◽

History Of ◽

Endemic Areas

Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas. Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools. Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included. Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review. Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment. Conclusion: Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.Key Points:Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variableEosinophilia was not a reliable indicator of chronic infection in this case series Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus

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Patients With a History of Oronasal Fistula Repair Exhibit Lower Oral Health Measured With Patient-Centric Outcomes Measures

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620981331 ◽

2020 ◽

pp. 105566562098133

Author(s):

Alyssa Fritz ◽

Diana S. Jodeh ◽

Fatima Qamar ◽

James J. Cray ◽

S. Alex Rottgers

Keyword(s):

Quality Of Life ◽

Oral Health ◽

Cleft Palate ◽

Fistula Repair ◽

Old Patients ◽

Oronasal Fistula ◽

Patient Reported ◽

History Of ◽

The Impact

Introduction: Oronasal fistulae following palatoplasty may affect patients’ quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients’ quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health ( P = .05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction.

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Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab112 ◽

2021 ◽

Author(s):

Mauricio Mandel ◽

Layton Lamsam ◽

Pue Farooque ◽

Dennis Spencer ◽

Eyiyemisi Damisah

Keyword(s):

Right Hemisphere ◽

Preoperative Evaluation ◽

Epileptiform Activity ◽

Neurological Deficits ◽

Depth Electrodes ◽

Depth Electrode ◽

Patient Reported ◽

Frontal Operculum ◽

History Of ◽

Electroencephalogram Eeg

Abstract The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy. We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images. A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free. We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

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Health outcomes of sexual and gender minorities after cancer: a systematic review

Systematic Reviews ◽

10.1186/s13643-021-01707-4 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Mandi L. Pratt-Chapman ◽

Ash B. Alpert ◽

Daniel A. Castillo

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Cancer Survivors ◽

Cochrane Central Register ◽

Transgender Persons ◽

Patient Reported ◽

History Of ◽

Reported Health ◽

And Gender ◽

After Cancer

Abstract Purpose Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations. Methods In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced. Results Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons. Conclusions A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care. Implications for cancer survivors Sexual orientation and gender identity are relevant to cancer survivors’ health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.

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Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

Ear Nose & Throat Journal ◽

10.1177/0145561319841207 ◽

2019 ◽

Vol 98 (5) ◽

pp. 291-294 ◽

Cited By ~ 4

Author(s):

Saudamini J. Lele ◽

Mickie Hamiter ◽

Torrey Louise Fourrier ◽

Cherie-Ann Nathan

Keyword(s):

Treatment Option ◽

Case Series ◽

Complete Response ◽

Definitive Treatment ◽

Invasive Technique ◽

Effective Treatment Option ◽

Patient Reported ◽

History Of ◽

The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

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818 A Ghost from the Past: Unmasked Insomnia Affecting Hypoglossal Nerve Stimulation Therapy Adherence

SLEEP ◽

10.1093/sleep/zsab072.815 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A319-A320

Author(s):

Elena Stuewe ◽

Aarti Grover ◽

Peter Ostrow ◽

Greg Schumaker ◽

Joel Oster ◽

...

Keyword(s):

Nerve Stimulation ◽

Hypoglossal Nerve ◽

Sleep Onset ◽

Chronic Insomnia ◽

Apnea Hypopnea Index ◽

Therapy Adherence ◽

Hypoglossal Nerve Stimulation ◽

Obstructive Sleep ◽

Patient Reported ◽

History Of

Abstract Introduction Hypoglossal nerve stimulation (HNS) is an efficacious option for treating moderate to severe obstructive sleep apnea (OSA). However, there is sparse evidence regarding tolerance and adherence to HNS therapy in patients with a diagnosis of insomnia. Report of case(s) A 57-year-old man with well-controlled depression presented for evaluation for HNS therapy. He had been diagnosed with moderate OSA with an apnea-hypopnea index of 22/hour, intolerant of continuous positive airway pressure and mandibular advancement device. He underwent uvulopalatopharyngoplasty without significant improvement. At the time of initial evaluation, he denied history of insomnia and prior sleep aid use. He subsequently underwent successful HNS device implantation and activation. One week after HNS initiation, the patient reported new symptoms of significant difficulty with sleep onset and inability to fall back asleep, which was worse than his untreated OSA symptoms. Device interrogation did not reveal any hardware problems. Adjustments to start delay, pause time and device configuration with awake endoscopy did not improve tolerance. Subsequently, the patient disclosed a remote history of insomnia, which was treated with multiple hypnotics in addition to cognitive-behavioral therapy for insomnia (CBTi) and had resolved. He was diagnosed with recurrent chronic insomnia, for which eszopiclone was initiated without significant improvement. He eventually agreed to CBTi, with partial improvement in device tolerance and improvement in insomnia symptoms. Conclusion This case highlights that HNS therapy adherence can be affected by prior history of, or a current diagnosis of insomnia. Our patient had a predisposition for insomnia that was well controlled prior to HNS therapy initiation. The onset of recurrent insomnia with HNS activation suggests that HNS was a precipitating factor for his now chronic insomnia. Although there is insufficient evidence to suggest whether history of insomnia should affect the decision to initiate HNS therapy, this case illustrates the importance of screening for insomnia at pre-implant evaluation. Our center is now routinely screening for a history of insomnia to identify patients who may benefit from treatment prior to HNS implantation. Larger studies are needed to explore a possible relationship between insomnia and HNS adherence. Support (if any):

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OSTEORADIONEKROSIS PASCA EKSTRAKSI GIGI PASIEN DENGAN RIWAYAT KANKER NASOFARING

ODONTO Dental Journal ◽

10.30659/odj.6.1.19-22 ◽

2019 ◽

Vol 6 (1) ◽

pp. 19

Author(s):

Yayun Siti Rochmah

Keyword(s):

Neck Region ◽

The Body ◽

Dental Extraction ◽

Head And Neck Region ◽

Radio Therapy ◽

Patient Reported ◽

Immunity Factor ◽

History Of ◽

Post Radiation ◽

One Year

Background: Osteoradionecrosis (ORN) post dental extraction is post dentalextraction complication with post radiation cancer theraphy. Objective : to present rare case, ORN post dental extraction with post radiation Ca nasopharing therapy 3 years ago.Case Management: A 54 years old patient reported to the dental out-patient department with a chief complaint of pus discharge from right buccal since post dental extraction 6 months ago. He gave a history of a nasopharing Carcinoma with histopatology as squamous cell carcinoms 3 years ago and radio therapy but no surgery. Intraoral examination, exposed necrotic bone found from right lower retromolar area 46 with pus discharge. Radiographic view was likely squester. Local surgical debridement and the sequestrectomy was undertaken with general anaesthesia. Antibiotic injection treatment was ceftriaxon 2x 1gram, infus metronidazol 3x500 mg and ketorolac 3x1 ampul, the patient was treated for 3 days and educated to maintain his oral hygiene with povidone iodine gargle.Discussion: Osteoradionecrosis (ORN) is late effect of radiation therapy thatresults in irreversible tissue death, which is clinically observed as bony exposure for more than 3 months duration. The mandible is affected more often than the maxilla or any other bones of head and neck region. The incidence of ORN in the mandible is reported to be between 2% and 22% and most often affects the body of the mandible. Ideal time is one year minimal post radiotherapy to get maximal vascularization for optimal healing. But immunity factor and radiation doses can trigger emergense ORN.Conclusion: Need time consideration, clinic analysis and pathologys before doing dental extraction for post radiotherapy cancer cases to prevent ORN.

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Fibrous Epulis Misdiagnosed for Combined Periodontic-Endodontic Lesion

International Journal of Medical and Dental Sciences ◽

10.18311/ijmds/2017/18849 ◽

2017 ◽

Vol 6 (2) ◽

pp. 1546

Author(s):

Nabil Khzam ◽

Reza Shah Mansouri ◽

Alexander Poli ◽

Mahmoud M. Bakr

Keyword(s):

Periodontal Disease ◽

Excisional Biopsy ◽

Osseous Metaplasia ◽

Ossifying Fibroma ◽

Peripheral Ossifying Fibroma ◽

Periodontal Debridement ◽

Patient Reported ◽

History Of ◽

Chronic Irritation

Fibrous epulis or peripheral ossifying fibroma is a reactive non-neoplastic condition that affects the gingiva as a result of chronic irritation. A case of a 44 year old female is presented in this study with a gingival swelling related to the maxillary central incisors. The Patient reported a history of trauma ten years ago and a recent root canal treatment of tooth 21, followed by referral to a specialist with a misdiagnosis for a combined periodontic-endodontic lesion affecting the maxillary central incisors. Excisional biopsy of the lesion revealed a diagnosis of ulcerated fibrous epulis with osseous metaplasia also known as peripheral ossifying fibroma. Periodontal debridement was performed to eliminate supra and subgingival plaque and calculus as well as gingival inflammation that could have been the source of irritation. The clinical and histopathological pictures and the surgical procedures associated with management of the periodontal disease are described. The etiological factor behind the development of the gingival reactive lesion remains unknown and could be the history of trauma, the chronic irritation induced by the plaque and calculus associated with the periodontal disease or a combination of both. We endeavour to follow up the case in order to report any recurrence.

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“This Is Not the Original Timeline”: A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State

Case Reports in Psychiatry ◽

10.1155/2021/6619579 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Godwin Tong ◽

Kieran Groom ◽

Louisa Ward ◽

Muhammad Naeem

Keyword(s):

Case Report ◽

Mental State ◽

Young Male ◽

Obsessive Compulsive ◽

Psychiatric Admission ◽

Compulsive Disorder ◽

Psychiatric Setting ◽

Patient Reported ◽

History Of ◽

Core Symptoms

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

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Historical explanation, emotives, and emotional suffering

Theoria Beograd ◽

10.2298/theo1902141r ◽

2019 ◽

Vol 62 (2) ◽

pp. 141-152

Author(s):

Ljiljana Radenovic

Keyword(s):

French Revolution ◽

Emotional Regulation ◽

18Th Century ◽

Political Regimes ◽

French Society ◽

Emotional Suffering ◽

History Of ◽

The Times ◽

Objectively Measured ◽

The Revolution

One of the main goals of the book ?The Navigation of Feeling: A Framework for the History of Emotions ? by William Reddy (Reddy, 2001) is to provide an explanation of the events that led to the French Revolution and the political regimes that followed the First Republic. What makes Reddy?s approach unique is that, unlike standard political, social, economic and similar approaches, it emphasizes the role that emotions and emotional suffering have in the change of political regimes. For this purpose Reddy introduces the concept of emotives. According to him, we use emotives to express and change the emotions we feel. By expressing and changing emotions, we reconsider the values we endorse, and in the times of crisis, we sometimes embrace new ones. In this way, emotives play important role not only in the emotional regulation but also in the formation of our identity. Reddy argues that in the strict emotional regimes in which the use of emotives is restricted individuals experience emotional suffering. Such suffering is not relative to culture and can be objectively measured. Thus, for Reddy some political regimes are better than others. Within this theoretical framework Reddy describes the emotional regime of the French society that preceded the revolution as strict. According to him, emotional suffering that was caused by such regime played substantial role in bringing about the revolution. In this paper I will argue that the emotional regime of the 18th century France was not as strict as Reddy argues. What was strict were the rules for how to behave not for the emotional expressions, i.e. for the use of emotives. Thus, his analysis of the emotional pre-revolutionary regime is not without weakness. I will conclude with some problems that Reddy?s analysis of the acute emotional suffering characteristic of the revolutionary period faces.

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