scholarly journals Why Patients Do Not Comply With Headache Diaries?

2021 ◽  
Author(s):  
Cláudia Borbinha ◽  
Isabel Pavão Martins
Keyword(s):  
Clinical Practice ◽  
Medication Overuse ◽  
Good Clinical Practice ◽  
Poor Compliance ◽  
Clinical Variables ◽  
Factors Associated ◽  
Headache Center

Abstract Background: Headache calendars are part of good clinical practice in headache clinics. However, patients’ compliance is rather variable. We aim to identify factors associated with poor compliance. Methods: Consecutive patients observed in follow-up visits of a tertiary headache center were divided into two groups; with a fullfilled calendar (Calendar compliers, CC) and without calendar (Calendar noncompliers, CNC). Incomplete / forgotten records were excluded. Demographic and clinical variables were compared, and CNC were asked the reasons for not filling the calendar. Results: From 93 patients (45.6±13.3 years, on average; 83 females), the majority with migraine (96.8%), 61.3% were CC. CNC were more likely to have medication overuse (34.5% vs. 12.3%, p=0.01) and had a tendency to be paid workers (79.3% vs. 52.6%, p=0.05) compared to CC. Most CC considered calendars useful to improve doctors and patients knowledge about headaches.Conclusions: Although these results need to be evaluated in other contexts, they suggest that patients with medication overuse have a more denial attitute towards headache records and may need additional reinforcement.

scholarly journals Why Patients Do Not Comply With Headache Diaries?

2021 ◽  
Author(s):  
Cláudia Borbinha ◽  
Isabel Pavão Martins
Keyword(s):  
Clinical Practice ◽  
Medication Overuse ◽  
Good Clinical Practice ◽  
Clinical Variables ◽  
Factors Associated ◽  
Headache Center

Abstract Background/ObjectiveHeadache calendars are part of good clinical practice in headache clinics. However, patients’ compliance is rather variable. We aim to identify factors associated with poor compliance.MethodsConsecutive patients observed in follow-up visits of a tertiary headache center were divided into two groups; with a fullfilled calendar (Calendar compliers, CC) and without calendar (Calendar noncompliers, CNC). Incomplete /forgotten records were excluded. Demographic and clinical variables were compared, and CNC were asked the reasons for not filling the calendar. ResultsFrom 93 patients (45.6±13.3 years, on average; 83 females), the majority with migraine (96.8%), 61.3% were CC. CNC were more likely to have medication overuse (34.5% vs. 12.3%, p=0.01) and had a tendency to be paid workers (79.3% vs. 52.6%, p=0.05) compared to CC.Most CC considered calendars useful to improve doctors and patients knowledge about headaches.ConclusionsAlthough these results need to be evaluated in other contexts, they suggest that patients with medication overuse have a more denial attitute towards headache records and may need additional reinforcement.

Factors associated with a negative outcome of medication-overuse headache: A 3-year follow-up (the ‘CARE’ protocol)

Cephalalgia ◽  
2013 ◽  
Vol 33 (7) ◽  
pp. 431-443 ◽  
Author(s):  
Grazia Sances ◽  
Federica Galli ◽  
Natascia Ghiotto ◽  
Marta Allena ◽  
Elena Guaschino ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Minnesota Multiphasic Personality Inventory ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Chi Square ◽  
Factors Associated ◽  
Care Protocol ◽  
Socio Economic Variables ◽  
Negative Outcome

Aim To evaluate factors associated with a negative outcome in a 3-year follow-up of subjects diagnosed with medication-overuse headache (MOH) (revised-ICHD-II criteria). Methods All consecutive patients entering the center’s inpatient detoxification program were analyzed in a prospective, non-randomized fashion. All participants were assessed by a neurologist using an ad hoc patient record form. Personality was assessed using the Minnesota Multiphasic Personality Inventory (MMPI)-2, Chi-square test, one-way analysis of variance (ANOVA), and odds ratios (OR) were calculated as appropriate. Results One-hundred and fifty patients completed the follow-up (79.3% females, age 46.40 ± 11.31 years): 13 never stopped their drug overuse (A), 38 stopped their overuse, but relapsed at least once (B), and 99 stopped and never relapsed (C). The Group A patients differed from those in B + C as they were more frequently single (OR 0.134; p = 0.007) and unemployed (OR 3.273; p = 0.04), took a higher number of drug doses ( p < 0.001), and less frequently drank coffee (OR 3.273; p = 0.044). Personality profile: subjects in A scored higher than those in C on the following scales: Hypochondriasis ( p = 0.007), Depression ( p = 0.003), Paranoia ( p = 0.025), Fears ( p = 0.003), Obsessiveness ( p = 0.026), Bizarre Mentation ( p = 0.046), Social Discomfort ( p = 0.004), Negative Treatment Indicators ( p = 0.040), Repression ( p = 0.007), Overcontrolled Hostility ( p = 0.040), Addiction Admission ( p = 0.021), Social Responsibility ( p = 0.039), and Marital Distress ( p = 0.028). Conclusion Disease outcome in MOH patients is influenced negatively by overuse severity and by specific psychological and socio-economic variables. Other possible modifier factors were voluptuary habits.

scholarly journals Factors Associated With Inadequate Response to Bisphosphonate Therapy in Patients With Osteoporosis in Real-Life Clinical Practice: a Single-Center Retrospective Analysis of 300 Patients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A245-A246
Author(s):  
Luciana Pinto Valadares ◽  
Bruno Silva de Araujo Ferreira ◽  
Bernardo Matos Cunha ◽  
Larissa Aniceto Moreira ◽  
Frederico Gideoni Albinati Batista ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Real Life ◽  
Bisphosphonate Therapy ◽  
Categorical Variables ◽  
Inadequate Response ◽  
Oral Bisphosphonates ◽  
Single Center ◽  
Mineral Density ◽  
Factors Associated

Abstract Introduction: Bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA) is a useful tool to monitor response to osteoporosis treatment in clinical practice. Despite bisphosphonates therapy, some patients may exhibit bone loss during treatment for different reasons. These patients may have greater fracture risk than responders and may have unrecognized secondary causes that require further attention and treatment. Objectives: To identify factors associated with inadequate response (IR) to bisphosphonates therapy in patients with osteoporosis in real-life clinical practice. Methods: This is a single-center case-control study of patients with osteoporosis treated with bisphosphonates as recommended. Baseline and follow-up (12–24 months/apart) DXA scans were performed on same device (GE-Lunar Prodigy). IR was defined as loss of BMD greater than the least significant change (LSC) on the follow-up DXA. Clinical, biochemical and densitometric parameters of patients with IR were compared to responders using t-test or Mann-Whitney test (continuous), or chi-square test (categorical variables), as appropriated. We used logistic regression to assess the association magnitude between exposures and IR. Results: From 300 patients included from 2014 to 2018 (13% males, mean age 68 ±10 years), 198(66%) were treated with oral bisphosphonates and 102(34%) with zoledronic acid (ZA). IR was observed in 44(15%) patients. All parameters were similar at baseline, except for greater prevalence of oral bisphosphonates (82% vs 63%, p=0.016) and anticonvulsants use (18% vs 7%, p=0.015) in patients with IR compared to responders. Additionally, patients with IR exhibited a lower % change in CTX following therapy in comparison to responders (median -37% [IQR -68; -16%] vs -57% [-74; -32], p=0.029, respectively), and higher serum CTX levels after treatment (median 236pg/mL [IQR 162; 344] vs 165pg/mL [119; 254], p=0.004). The likelihood of IR was greater with oral bisphosphonates then with ZA (OR 2.61, IC95% 1.16–5.81, p=0.002), and with anticonvulsants use (OR 2.94. IC95% 1.19–7.25, p=0.019). The association with IR persisted for both variables (p≤0.01), when accounted simultaneously in the same model, along with age and gender. Conclusion: Inadequate bisphosphonate response was present in 15% of individuals, which was independently associated with anticonvulsant use and particularly among those on oral bisphosphonate therapy rather than ZA. This knowledge may help to clinically identify potential modifiable factors related to unresponsiveness and to optimize treatment accordingly.

scholarly journals An FDA Analysis of Inspected Entities After Receiving Official Action Indicated Letters for Good Clinical Practice Violations

2021 ◽  
Author(s):  
Miah Jung ◽  
Rachelle M. Swann ◽  
Michelle S. Anantha ◽  
Faranak Jamali
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Drug Evaluation ◽  
Good Clinical Practice ◽  
Cross Sectional Study ◽  
Voluntary Action ◽  
Cross Sectional ◽  
Depth Analysis ◽  
The Status

Abstract Background Limited research has been conducted to examine whether clinical investigators (CIs), sponsors (SPs), contract research organizations (CROs), and sponsor-investigators (SIs) continue conducting clinical trials following issuance of FDA Official Action Indicated (OAI) letters. FDA issues OAI letters for significant regulatory violations. The objective of this study was to evaluate the status of inspected entities who received OAI letters in the conduct of Center for Drug Evaluation and Research (CDER)-regulated clinical trials (CRCTs). Methods This cross-sectional study included an analysis of inspectional data from CDER’s Good Clinical Practice (GCP) inspections for OAI letters issued from October 1, 2010, to September 30, 2015, with an in-depth analysis of post-OAI status of inspected entities, including OAI follow-up inspections. Results Of the 2248 GCP letters issued during this period, 104 (4.6%) OAI letters were sent: 95 (4.2%) to CIs (91% of OAIs), 7 (0.3%) to SPs (7% of OAIs), and 2 (0.08%) to SIs (2% of OAIs). Majority of OAI letters were issued as a result of a for-cause inspection. Five CIs were excluded from analysis. No OAI letters were sent to CROs. Only 30% of CIs (27 out of 90) continued to conduct CRCTs. OAI follow-up inspections were completed for these CIs resulting in 16 No Action Indicated (NAI), 11 Voluntary Action Indicated (VAI), and no OAI letters. Majority (64%) of the VAI letters noted repeated but not significant violations. Conclusions Majority (70%) of CIs who received an OAI letter were no longer conducting CRCTs at the time of follow-up. Of the 27 CIs continuing CRCTs, 16 (59%) OAI follow-up inspections resulted in NAI classifications and 11 (41%) in VAI.

Psychological factors associated with failure of detoxification treatment in chronic headache associated with medication overuse

Cephalalgia ◽  
2016 ◽  
Vol 36 (14) ◽  
pp. 1356-1365 ◽  
Author(s):  
S Bottiroli ◽  
M Viana ◽  
G Sances ◽  
N Ghiotto ◽  
E Guaschino ◽  
...  
Keyword(s):  
Psychological Factors ◽  
Minnesota Multiphasic Personality Inventory ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Headache Frequency ◽  
Factors Associated ◽  
Frequency Group ◽  
Group B

Aim The aim of this study was to evaluate the psychological factors associated with a negative outcome following detoxification in a 2-month follow-up in medication-overuse headache. Methods All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion. Psychiatric conditions and personality characteristics were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the Minnesota Multiphasic Personality Inventory (MMPI)-2. χ2 tests, one-way analyses of variance, and odds ratios (ORs) were used. Results A total of 248 patients completed the follow-up: 156 stopped overuse and their headaches reverted to an episodic pattern (Group A); 23 kept overusing without any benefit on headache frequency (Group B); and 51 stopped overuse without any benefit on headache frequency (Group C). The prognostic factors for the outcome of Group B were higher scores on the correction (OR 1.128; p = 0.036), depression (OR 1.071; p = 0.05), hysteria (OR 1.106; p = 0.023), and overcontrolled hostility (OR 1.182; p = 0.04) MMPI-2 scales, whereas those for Group C were psychiatric comorbidities (OR 1.502; p = 0.021) and higher scores on the hysteria scale (OR 1.125; p = 0.004). Conclusions The outcome of detoxification is influenced by psychological factors that should be considered when considering treatment strategies.

Counselling improves follow-up HIV testing at Week 6 for HIV postexposure prophylaxis recipients

Sexual Health ◽  
2013 ◽  
Vol 10 (3) ◽  
pp. 288 ◽  
Author(s):  
Bianca Farrugia Parsons ◽  
Kate Fisher ◽  
Damien Cordery ◽  
Deborah Couldwell
Keyword(s):  
Sexual Health ◽  
Hiv Testing ◽  
Social Worker ◽  
Health Centre ◽  
Postexposure Prophylaxis ◽  
National Guidelines ◽  
Clinical Variables ◽  
Factors Associated

Demographic and clinical variables of clients attending a sexual health centre in western Sydney from 1 July 2009 to 30 June 2011 were examined to determine if nonoccupational HIV postexposure prophylaxis (NPEP) was being dispensed according to national guidelines,1 and to identify factors associated with completion of follow-up. The results showed that 95.8% of antiretroviral prescriptions were consistent with national guidelines.1 Consultation with a social worker significantly improved attendance for six week follow up serology (P = 0.027).

Kernicterus in a Full-Term Infant: The Need for Increased Vigilance

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 798-798
Author(s):  
William Moneit
Keyword(s):  
Clinical Practice ◽  
Good Clinical Practice ◽  
Term Infant ◽  
Full Term ◽  
Full Term Infant ◽  
Follow Up Care ◽  
First Time Mothers ◽  
First Time

I read the article, "Kernicterus in a Full-Term Infant," in the June 1994 issue of Pediatrics, and wish to comment on the conclusions drawn by Penn et al. On the point of follow-up care after infants are discharged at 24 hours of life or sooner: I have found it to be good clinical practice to bring these infants into the office for their first examination at 3 days of life. The number of times that I have seen problems with newborns and especially those born to first time mothers are countless.

scholarly journals Factors associated with adherence to guidelines of good clinical practice during hospital treatment of patients with the first episode of schizophrenia spectrum disorders

2019 ◽  
Vol 76 (10) ◽  
pp. 998-1006 ◽  
Author(s):  
Milena Stasevic ◽  
Ivana Stasevic-Karlicic ◽  
Nevena Divac ◽  
Anita Grgurevic ◽  
Igor Grbic
Keyword(s):  
Clinical Practice ◽  
Good Clinical Practice ◽  
Prescribing Patterns ◽  
Diagnosis And Treatment ◽  
National Guideline ◽  
Psychotic Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Factors Associated ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders

Background/Aim. Adherence to the guidelines of Good Clinical Practice (GCP) during the treatment of specific disorders is considered a guarantee of the implementation of a uniform, evidence-based clinical practice in psychiatry. The aim of this study was to analyze the concordance of prescribing patterns of antipsychotic drugs with the recommendations of good clinical practice in Serbia and an insight into the effects that introduction of the National Guideline for the Diagnosis and Treatment of Schizophrenia had on the prescribing practice in this area. Methods. Noninterventional, observational study was conducted at the Clinic for Mental Disorders ?Dr Laza Lazarevic? in Belgrade. It included a consecutive sample of 675 previously untreated patients, hospitalized from January 1st, 2012 to December 31st, 2015, dismissed with a discharge diagnosis of any of schizophrenia spectrum disorders. The data about demographic and clinical characteristics of patients, characteristics of prescribers and prescribed antipsychotics were obtained retrospectively, from the patients? medical records. For the analysis of primary data, the descriptive statistical methods and methods for testing statistical hypotheses were used. A method of logistic regression was used to identify the factors associated with adherence to the GCP recommendations. Results. Totaly, 446 (66.1%) of subjects were treated with antipsychotic monotherapy. After the introduction of National Guideline for the Diagnosis and Treatment of Schizophrenia prescribing of second generation antipsychotic monotherapy (78.41% vs. 63.5%, respectively; p < 0.001) increased significantly compared to the previous period. The factors independently associated with adherence to the recommendations of the GCP were the year of hospitalization, the age of the prescriber, and the age and education of the patient. Conclusion. After the introduction of the National Guide to Good Clinical Practice for the Diagnosis and Treatment of Schizophrenia there have been significant, but insufficient changes in the prescribing patterns of antipsychotics during the treatment of the first psychotic episode in Serbia.

scholarly journals Professional Attitudes Toward the Use of Denture Adhesives: A Survey among Nepalese Prosthodontists

2020 ◽  
Vol 22 (4) ◽  
pp. 211-216
Author(s):  
Amar Bhochhibhoya ◽  
SB Rana ◽  
R Sharma
Keyword(s):  
Clinical Practice ◽  
Clinical Skills ◽  
Good Clinical Practice ◽  
Early Stages ◽  
Anonymous Questionnaire ◽  
Tissue Changes ◽  
Denture Adhesives ◽  
Dental Profession ◽  
And Function

The dental profession has been slow to accept denture adhesive (DA) as a means to enhance denture retention and function which has produced conflicting views both in clinical practice and dental education. Many practitioners view adhesive usage as a reflection of lack of prosthetic expertise and poor clinical skills. A survey was conducted among Nepalese Prosthodontists to explore their attitudes towards DAs. A pre-tested, self-administered anonymous questionnaire consisting of 12 close-ended questions was mailed to the participants. Among all the respondents, 91.7% used DA as a beneficial adjunct to stabilize trial bases in the early stages of denture fabrication. However, only 41.3% of prosthodontists prescribed DA for routine denture patients. Majority of respondents prescribed powder form of adhesives (96.7%). Respondents believed that denture adhesives were helpful in stabilizing trial bases in the early stages of denture fabrication (80%), enhanced the fit of the prosthesis (81.7%) and provided psychologic comfort to the patient (91.7%). They agreed that denture adhesives have the potential to mask pathological tissue changes under ill-fitting dentures (65 %), to permit avoidance of good clinical practice (45%), and to contribute to patients not seeing a dentist for regular follow up visits (61.7%). It was concluded that DAs are a beneficial adjunct to the dentist in the fabrication of dentures. However, enough cautions are required for preventing potential misuses of DAs, by both dentists and patients. The efficient way to optimize the beneficial aspects of DA depends on its rational, selective, and supervised usage.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

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