The effectiveness of a pharmacy-based eHealth intervention promoting correct use of medication in patients with asthma and COPD: Results from a non-randomized pre-post study (Preprint)

2021 ◽  
Author(s):  
Kyma Schnoor ◽  
Anke Versluis ◽  
Robbert Bakema ◽  
Sanne van Luenen ◽  
Marcel J. Kooij ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Inhaled Corticosteroids ◽  
Study Groups ◽  
Chronic Obstructive ◽  
Maintenance Medication ◽  
Significant Difference ◽  
One Year ◽  
Ehealth Intervention ◽  
Antimycotic Treatment ◽  
Over Time

BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. Whilst medication can control and improve disease symptoms, incorrect use of medication is a common problem. eHealth intervention ‘SARA’ aims to improve participants’ correct use of inhalation medication by providing information, as well as as-needed tailored follow-up support by a pharmacist. OBJECTIVE The primary aim of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. Secondary aims were to investigate its effects in terms of adherence to maintenance medication and antimycotic treatment. METHODS In this non-randomized pre-post study, medication dispensing data of 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed oral corticosteroids short courses. Medication adherence was assessed by calculating the proportion of days covered (PDC) from dispensed inhalation maintenance medication, wherefore a distinction was made between new and chronic users. Antimycotic treatment was investigated from dispensed oral antimycotics in participants who were also dispensed inhaled corticosteroids (ICS). Outcomes were assessed one year before and one year after implementation of SARA and compared between SARA participants and control participants. More specifically, for exacerbation rates and medication adherence, a difference score was calculated (year after SARA minus year before SARA), and subsequently compared between the study groups with independent samples t-tests. For antimycotics, the relative number of participants who were dispensed antimycotics was calculated and subsequently analyzed with a mixed-effects logistic regression RESULTS The study population comprised 9,452 participants, of whom 2,400 were SARA participants. The mean age of the population was about 61, and approximately two-third was female. The results showed an increase in mean exacerbation rates over time for both study groups; 0.05 increase in SARA and 0.15 in controls. However this increase in exacerbations was significantly lower in the SARA condition (t9450= 3.10, 95% CI= 0.04 – 0.16, P= .002, Cohen d = 0.06). Chronic users of inhalation medication showed an increase in medication adherence over time in both study groups (6.73 in SARA and 4.48 control participants respectively); yet, this increase was significantly higher for SARA participants (t5886= -2.74, 95% CI= -3.86 – -0.84, P=.01, Cohen d = -0.07). In new users of inhalation medication, results showed no significant difference in medication adherence between SARA and controls in the year after implementation of SARA (t1434= -1.85, 95% CI= -5.60 – 0.16, P=.06, Cohen d = -0.10). In ICS-users, no significant differences between the study groups were found over time in terms of the proportion of participants who were dispensed antimycotics (t5654= 0.29, 95% CI= -0.40 - 0.54, P=.76, Cohen d = 0.00). CONCLUSIONS This study provides preliminary evidence that eHealth intervention SARA might have the potential to decrease exacerbation rates and improve medication adherence.

scholarly journals Time-to-first exacerbation, adherence, and medical costs among US patients receiving umeclidinium/vilanterol or tiotropium as initial maintenance therapy for chronic obstructive pulmonary disease: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David Slade ◽  
Riju Ray ◽  
Chad Moretz ◽  
Guillaume Germain ◽  
François Laliberté ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Medication Adherence ◽  
Index Date ◽  
Medical Costs ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Maintenance Medication ◽  
Kaplan Meier ◽  
Long Acting

Abstract Background Adherence to chronic obstructive pulmonary disease (COPD) maintenance medication is important for managing symptoms and exacerbation risk, and is associated with reduced mortality, hospitalizations, and costs. This study compared on-treatment exacerbations, medical costs, and medication adherence in patients with COPD initiating treatment with umeclidinium/vilanterol (UMEC/VI) or tiotropium (TIO). Methods This retrospective matched cohort study selected patients from Optum’s de-identified Clinformatics Data Mart database who initiated maintenance treatment with UMEC/VI or TIO between 01/01/2014 and 12/31/2017 (index date defined as the first dispensing). Eligible patients were ≥ 40 years of age and had ≥ 12 months continuous health plan coverage pre- and post-index; ≥ 1 medical claim for COPD pre-index or on the index date; no moderate/severe COPD-related exacerbations on the index date; no asthma diagnosis pre- or post-index; no maintenance medication fills containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists pre-index or on the index date; and no fills for both UMEC/VI and TIO on the index date. Outcomes included time-to-first (Kaplan–Meier analysis) and rates of on-treatment COPD-related moderate/severe exacerbations, medication adherence (proportion of days covered [PDC] and proportion of adherent patients [PDC ≥ 0.8]), and COPD-related medical costs per patient per month (PPPM). Propensity score matching was used to adjust for potential confounders. Results Each cohort included 3929 matched patients. Kaplan–Meier rates of on-treatment COPD-related exacerbations were similar between cohorts (hazard ratio at 12 months; overall: 0.93, moderate: 0.92, severe: 1.07; all p > 0.05). UMEC/VI versus TIO initiators had significantly higher adherence (mean PDC: 0.44 vs 0.37; p < 0.001; proportion with PDC ≥ 0.8: 22.0% vs 16.4%; p< 0.001) and significantly lower mean on-treatment COPD-related total medical costs ($867 vs $1095 PPPM; p = 0.028), driven by lower outpatient visit costs. Conclusions These findings provide valuable information for physicians considering UMEC/VI or TIO as initial maintenance therapy options for patients with COPD.

scholarly journals Incidence, Characteristics, and Prognosis of Incidentally Discovered Hepatocellular Carcinoma after Liver Transplantation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Walid El Moghazy ◽  
Samy Kashkoush ◽  
Glenda Meeberg ◽  
Norman Kneteman
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Tumor Recurrence ◽  
Patient Survival ◽  
Steady Increase ◽  
Liver Transplants ◽  
Significant Difference ◽  
One Year ◽  
Over Time

Background. We aimed to assess incidentally discovered hepatocellular carcinoma (iHCC) over time and to compare outcome to preoperatively diagnosed hepatocellular carcinoma (pdHCC) and nontumor liver transplants.Methods.We studied adults transplanted with a follow-up of at least one year. Patients were divided into 3 groups according to diagnosis of hepatocellular carcinoma.Results.Between 1990 and 2010, 887 adults were transplanted. Among them, 121 patients (13.6%) had pdHCC and 32 patients (3.6%) had iHCC; frequency of iHCC decreased markedly over years, in parallel with significant increase in pdHCC. Between 1990 and 1995, 120 patients had liver transplants, 4 (3.3%) of them had iHCC, and only 3 (2.5%) had pdHCC, while in the last 5 years, 263 patients were transplanted, 7 (0.03%) of them had iHCC, and 66 (25.1%) had pdHCC (P<0.001). There was no significant difference between groups regarding patient survival; 5-year survival was 74%, 75.5%, and 77.3% in iHCC, pdHCC, and non-HCC groups, respectively (P=0.702). Patients with iHCC had no recurrences after transplant, while pdHCC patients experienced 17 recurrences (15.3%) (P=0.016).Conclusions.iHCC has significantly decreased despite steady increase in number of transplants for hepatocellular carcinoma. Patients with iHCC had excellent outcomes with no tumor recurrence and survival comparable to pdHCC.

Changes in Voice- and Swallowing-Related Symptoms After Thyroidectomy: One-Year Follow-Up Study

2018 ◽  
Vol 127 (3) ◽  
pp. 171-177 ◽  
Author(s):  
Young Min Park ◽  
Kyung Ho Oh ◽  
Jae-Gu Cho ◽  
Seung-Kuk Baek ◽  
Soon-Young Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Symptom Relief ◽  
Temporal Changes ◽  
Rehabilitation Programs ◽  
Significant Difference ◽  
One Year ◽  
Associated Risk Factors ◽  
Changes Over Time ◽  
Over Time

Objective: We analyzed the changes in voice- and swallowing-related symptoms that occurred over time in patients who underwent thyroidectomy and identified any associated risk factors. Methods: One hundred and three patients who underwent thyroidectomy were enrolled. Results: The mean thyroidectomy voice-related questionnaire (TVQ) score before surgery was 12.41 ± 12.19; it significantly increased to 28.24 ± 18.01 ( P < .001) 1 month postoperatively, decreased to 24.02 ± 17.30 ( P = .014) and 20.66 ± 15.29 ( P = .023) 3 and 6 months postoperatively, respectively. It was continuously decreased to 18.83 ± 14.63 twelve months postoperatively. The temporal changes in TVQ scores between patients who underwent total thyroidectomy or lobectomy were significantly different. There was a statistically significant difference in the temporal changes in TVQ according to whether neck dissection was performed. The temporal changes in TVQ in patients with and without extrathyroidal extension were significantly different. Conclusions: Voice- and swallowing-related discomfort in patients who received thyroidectomy showed dynamic changes over time. There was a significant difference in the degree of change according to clinicopathological factors. Patients with these risk factors may benefit from appropriate patient education and various rehabilitation programs for symptom relief.

scholarly journals 2505. Incidence of Transmitted Drug Resistance and Its Clinical Implications Between 1999 and 2018 in a Regional HIV Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S868-S869
Author(s):  
Raynell Lang ◽  
Hartmut B Krentz ◽  
Quang Vu ◽  
M John Gill
Keyword(s):  
Study Groups ◽  
Resistance Testing ◽  
Transmitted Drug Resistance ◽  
Pill Burden ◽  
Art Initiation ◽  
Drug Tolerability ◽  
Significant Difference ◽  
One Year ◽  
And Control ◽  
Effective Drugs

Abstract Background Baseline genotype antiretroviral resistance testing (GART) were introduced to allow better selection of antiretroviral therapy (ART), minimizing the use of less effective drugs and risk for ongoing transmission of drug-resistant virus. However, the value of baseline GART has recently been questioned due to declining incidence of TDR in the setting of improved drug tolerability profiles and effectiveness. We aimed to evaluate the long-term clinical and economic impact of TDR using a well characterized, geographically defined cohort between 1999–2018. Methods In the Southern Alberta Cohort (SAC) database we identified all (ART naïve) HIV patients, ≥16 years of age, with a baseline GART. They were classified by presence or absence of TDR. Clinical and sociodemographic data were obtained from database and chart review. All statistical analysis was performed with Stata. Results During the study 745 GART tests were done on ART naïve patients. Baseline ART resistance was documented in 78 /745 patients. TDR was to the NNRTI class in 59 (75.6%), to NRTI in 12 (15.4%) and to the PI class in 7 (8.9%) patients. Two patients had two class resistance and none had INSTI resistance. There was a significant difference in cost per year of therapy comparing the TDR and control ($17,152/year vs. $15,362/year, P ≤ 0.001). Patients with TDR had greater pill burden with 20% being on BID/TID ART regimens compared with the controls of 13% (P = 0.003). No differences in incident ART adverse events (12.8% TDR vs. 13.3% no TDR), drug interactions (1.6% vs. 1.0%) or reasons to stop or change ARVs were seen between study groups. The duration of ART on any given drug class was similar between the two populations (P = 0.6694) as was status of viral suppression at one year 73% vs. 65%. Conclusion Presence of TDR at baseline had little immediate impact on ART initiation or tolerance, but by limiting choices negatively impacted pill burden and dosing as well as drug costs. Disclosures All authors: No reported disclosures.

scholarly journals Clinical value of IL-13 and ECP in the serum and sputum of eosinophilic AECOPD patients

2020 ◽  
Vol 245 (14) ◽  
pp. 1290-1298
Author(s):  
Ting Li ◽  
Li Gao ◽  
Hong-Xia Ma ◽  
Yang-Yang Wei ◽  
Yue-Hua Liu ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Peripheral Blood ◽  
Eosinophil Cationic Protein ◽  
Chronic Obstructive ◽  
Clinical Value ◽  
Cationic Protein ◽  
Obstructive Pulmonary Disease ◽  
Interleukin 13 ◽  
Significant Difference ◽  
One Year

Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory disease and eosinophils (EOS) participate in inflammation process. Acute exacerbation of COPD (AECOPD) is an inevitable trend in the development of the disease and has attracted widespread attention. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of interleukin-13 and eosinophil cationic protein in the serum and sputum were measured to explore their clinical value in eosinophilic AECOPD patients. The patients were divided into an eosinophilic group (52 cases, 48.15%) and a noneosinophilic group (56 cases, 51.85%). The eosinophilic group had fewer acute exacerbations in the past year, shorter average hospitalization days, lower respiratory failure rate, mechanical ventilation utilization rate, and lower CAT and mMRC scores ( P <  0.05). The levels of interleukin-13 and eosinophil cationic protein in sputum in the eosinophilic group were higher than those in the noneosinophilic group ( P <  0.05), and there was no significant difference in the serum between the two groups ( P >  0.05). The receiver operating characteristic (ROC) curves of sputum interleukin-13 and eosinophil cationic protein predicting peripheral blood EOS% ≥2% of AECOPD patients were statistically significant ( P <  0.05). The noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up, and there was no significant difference in mortality between the two groups. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. Interleukin-13 and eosinophil cationic protein are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies in the future. Impact statement Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an inevitable trend in the development of the disease and eosinophils (EOS) participate in inflammation process. It is important to explore some relatively simple biomarkers in AECOPD which are useful to recognize the disease. In the present study, 108 hospitalized patients with AECOPD were collected and the levels of IL-13 and ECP in the serum and sputum were measured. The levels of IL-13 and ECP in sputum in the eosinophilic group were higher than those in the noneosinophilic group. Moreover, the noneosinophilic group had a higher rate of rehospitalization due to acute exacerbation during the one-year follow-up. The results show that eosinophils in peripheral blood are a simple, convenient, and inexpensive index for assessing the condition and prognosis of AECOPD patients. IL-13 and ECP are involved in the pathogenesis of eosinophilic AECOPD and may be the new targeted anti-inflammatory therapies.

Effectiveness and Safety Comparison for Systemic Corticosteroid Therapy With and Without Inhaled Corticosteroids for COPD Exacerbation Management

2018 ◽  
Vol 52 (11) ◽  
pp. 1070-1077 ◽  
Author(s):  
Jordan A. Pearce ◽  
Dane L. Shiltz ◽  
Qian Ding
Keyword(s):  
Corticosteroid Therapy ◽  
Systemic Corticosteroid ◽  
Inhaled Corticosteroids ◽  
Prospective Trial ◽  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Inpatient Setting ◽  
Copd Exacerbation ◽  
Significant Difference ◽  
Systemic Corticosteroid Therapy

Background: Only 1 small, single-center study has evaluated the combination of systemic plus inhaled corticosteroid (ICS) routes for chronic obstructive pulmonary disease (COPD) exacerbation management. This study aims to further improve the existing quantity and quality of evidence regarding the utility for combination therapy in the management of COPD exacerbation. Objectives: To evaluate length of hospital stay, readmission rate, incidence of infection, and mortality in hospitalized patients who experience a COPD exacerbation and receive systemic corticosteroid therapy with or without concurrent ICS. Methods: Design: retrospective cohort study. Participants and setting: patients at least 18 years old admitted between May 31, 2015, and May 31, 2016, for an acute COPD exacerbation at any of 7 Indiana University Health system hospitals. Interventions: patients who received an oral or intravenous systemic corticosteroid either with or without concurrent ICS therapy. Results: This study included 241 patients. No significant difference was found between rates of 30-day readmission or inpatient mortality. Patients receiving concurrent therapy had longer lengths of stay versus those who only received systemic corticosteroid therapy (6.35 ± 3.98 vs 4.99 ± 2.89 days, P = 0.0039). Differences in the rates of antifungal use and mechanical ventilation did not statistically differ. Conclusion and Relevance: There was no significant benefit demonstrated when adding ICS to systemic corticosteroid therapy for COPD exacerbation management. These preliminary findings build on the limited evidence on how best to manage corticosteroid therapy in the inpatient setting, but a large, prospective trial remains warranted to confirm these findings given the design, size, and concern for selection bias limitations in the present study.

AL Amyloidosis and Patient Reported Quality of Life

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3317-3317
Author(s):  
Rahma Warsame ◽  
Shaji Kumar ◽  
Carrie A. Thompson ◽  
Morie A. Gertz ◽  
Martha Q. Lacy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Research Funding ◽  
Early Death ◽  
Cell Transplant ◽  
Significant Difference ◽  
Patient Reported ◽  
One Year ◽  
Over Time

Abstract Background: Patients with light chain amyloidosis (AL) often have delayed diagnosis and present with significant symptomatology; this may result in decreased quality of life (QOL). With improving treatment options providing longer survival, it is increasingly important to assess QOL. However there is paucity of data in the literature addressing QOL in AL patients. We prospectively employ a "Hematology Patient Reported Symptom Screen" (HPRSS) which consists of three questions about fatigue, pain and overall QOL. The aim of this study is to understand if HPRSS parameters predict various clinical outcomes. Methods: Eligibility for this retrospective study was as follows: 1) New diagnosis of AL between 2009-2014; 2) baseline HPRSS documented in the medical record; and 3) at least a year of follow-up, which included either death within or follow-up through 12 months after diagnosis. The HPRSS questions were rated on a 1-10 scale, with 10 being the worst for fatigue and pain, and 10 being the best for overall QOL. Scores were abstracted from visits at time of diagnosis, and at 12 months +/- 1 month post-diagnosis. We considered a 2-point difference in serial scores a "change" over time. Results: For the 302 patients in this study, the baseline median scores [interquartile range] for fatigue, pain, and QOL were 6 [3,7], 2 [0,5] and 5 [3,8], respectively. Median overall survival (OS) was 39.1 months, with 102 deaths in the first year. There were significant differences in baseline HPRSS between those who lived longer than one year and the early death patients in the domains of fatigue (5 [IQR 3, 7] vs. 7 [IQR 5, 8], p<0.0001) and QOL (6 [IQR 4, 8] vs. 5 [IQR 3, 7], p=0.006), but not in pain (2 [IQR 0, 5] vs. 2 [IQR 0, 5]). There were significant baseline differences in the early death group for alkaline phosphatase, bilirubin, creatinine, and Mayo stage. Patients who received ASCT had the best baseline fatigue 4 [2.5,6] and QOL 7 [5,8] scores and were significantly different from those who did not receive ASCT [fatigue p<0.0001) and QOL (p<0.0001)] On univariate analysis fatigue and QOL were prognostic for OS. On multivariate analysis Mayo 2012 staging, autologous stem cell transplant and baseline fatigue remained independently prognostic. When analyses were restricted to the 125 patients with HPRSS measurements at 12 months, we found that over time QOL scores improved significantly 6 [IQR 3.5, 8] to 7 [IQR 5, 8] (two sided Wilcoxon signed rank p=0.01), but fatigue (5 [IQR 2, 5] to 4.5 [IQR 3, 6]) and pain scores (2 [IQR 0 ,4] to 1.5 [IQR 0, 4]) did not. Patients with worse baseline parameters tended to have improvement in QOL by 12 months while those with the best baseline parameters tended to decline in QOL although not statistically significant. When we included the 102 patients who died within 12 months to the comparison, the early death patients had the worst baseline parameters and there were significant differences across all 4 groups for most characteristics (Table 1). There was no association between achieving hematologic or organ response with change in QOL. Conclusion: Asking patients with AL to rate their fatigue and QOL using a 10-point scale has predictive value. Patient reported fatigue at diagnosis is an independent prognostic factor for survival. Survival at one year was associated with significant improvement in QOL. Table 1. Baseline parameters between patients with early death and/or survive 12 months. Grouped by Patient Reported QOL at 12 months Relative to Baseline Dead by 12 months, n=102 Improved, n=44 Stable, n=55 Worsened, n=26 pa HPRSS scores [IQR] Baseline QOL Baseline fatigue Baseline pain 12 month QOL 12 month fatigue 12 month pain 5 [3,7] 7 [5,8] 2 [0,5] NA NA NA 4 [3-5] b,c,d6 [4-8] b,c2 [0-4] 7 [6-9] b,d4 [1.25-6] 1 [0-3] 7 [4-8] 4 [2-7] 2 [1-5] 7 [4-8] 5 [3-6] 2 [0-4] 8 [7-10] 2.5 [0-5.25] 2 [0-6.25] 5 [3-7] 5 [3-6] 2.5 [1-4] <0.0001 <0.0001 NS NS 0.001 NS dFLC, mg/dL 48 (2.89-726) 30 (1.1-494) 19 (36-455) 22 (0.2-2097) 0.008 Troponin, ng/mL 0.065 (<0.01-0.84) 0.02 (<0.01-1.6) 0.01 (<0.01-0.19) 0.01 (<0.01-0.14) <0.0001 NT-proBNP pg/mL 5222 (159-70,000) 1766 (26-16868) 1381 (24-19180) 496 (56-2973) <0.0001 Received Transplant (%) 4 (4) 13 (33) 36 (50) 13 (50) 0.0002 a Significant by Wilcoxon across all 4 categories; b Significant difference between Improved and Worsened; c Significant difference between Improved and Stable; d Significant difference between Worsened and Stable Disclosures Kumar: Millenium: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Abbvie: Research Funding; Janssen: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Novartis: Research Funding; Onyx: Consultancy, Research Funding. Thompson:Kite Pharma: Research Funding.

scholarly journals Feasibility of Implementing a Web-based Tool Built from Pharmacy Claims Data (e-MEDRESP) to Monitor Adherence to Respiratory Medications in Primary Care

2021 ◽  
Author(s):  
Alia Yousif ◽  
Catherine Lemière ◽  
Amélie Forget ◽  
Marie-France Beauchesne ◽  
Lucie Blais
Keyword(s):  
Primary Care ◽  
Medication Adherence ◽  
Claims Data ◽  
Inhaled Corticosteroids ◽  
Physician Satisfaction ◽  
Chronic Obstructive ◽  
Web Based ◽  
Telephone Interviews ◽  
Pharmacy Claims

Objectives: e-MEDRESP is a novel web-based tool that provides easily interpretable information on patient adherence to asthma/chronic obstructive pulmonary disease medications, using pharmacy claims data. This study investigated the feasibility of implementing e-MEDRESP in primary care. Materials and Methods: In this 16-month prospective cohort study, e-MEDRESP was integrated into electronic medical records. Nineteen family physicians and 346 of their patients were enrolled. Counters embedded in the tool tracked physician use during the follow-up. Patient/physician satisfaction with e-MEDRESP was evaluated though telephone interviews and online questionnaires. The capacity of e-MEDRESP to improve adherence was explored using a pre–post analysis. Results: Overall, 252 patients had at least one medical visit during follow-up. e-MEDRESP was consulted by 15 (79%) physicians for 85 (34%) patients during clinic visits. Seventy-three patients participated in telephone interviews; 84% reported discussing their medication use with their physician; 33% viewed their e-MEDRESP report and indicated that it was easy to interpret. The physicians reported that the tool facilitated their evaluation of their patients’ medication adherence (mean ± standard deviation rating: 4.8 ± 0.7, on a 5-point Likert scale). Although the pre–post analysis did not reveal improved adherence in the overall cohort, adherence improved significantly in patients whose adherence level was <80% and patients prescribed inhaled corticosteroids (26.9% [95% CI 14.3%–39.3%]) or long-acting muscarinic agents (26.4% [95% CI 12.4%–40.2%]). Conclusions: e-MEDRESP was successfully integrated in clinical practice. It could serve as a powerful tool to help physicians monitor their patients’ medication adherence.

scholarly journals Treatment of advanced-stage ovarian cancer including combination of intra-abdominal chemotherapy

2021 ◽  
Vol 20 (2) ◽  
pp. 28-35
Author(s):  
V. V. Saevets ◽  
A. V. Privalov ◽  
A. V. Vazhenin ◽  
Y. A. Semenov ◽  
A. V. Shmidt
Keyword(s):  
Ovarian Cancer ◽  
Survival Rate ◽  
Abdominal Cavity ◽  
Relative Survival ◽  
Study Groups ◽  
Stage Iiia ◽  
Results Of Treatment ◽  
Significant Difference ◽  
One Year ◽  
The One

Introduction. Ovarian cancer is the leading cause of death from gynecological malignancies: the one-year relative survival rate with stages 3 and 4 of the disease is 20%. The results of treatment remain unsatisfactory, which dictates the need to find new methods of treatment. The aim of the study was to evaluate the effectiveness of the use of HIIH (hyperthermic intraperitoneal intraoperative chemoperfusion, HIPEC) in patients with the diagnosis of: ovarian cancer IIIA-From the stage of the disease.Materials and methods. 117 cases of stage IIIA-C ovarian cancer treated at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine from January 2014 to March 2021 were retrospectively studied. All patients underwent 3 cycles of neoadjuvant chemotherapy (NAPHT) according to the paclitaxel+carboplatin (PCb) scheme, followed by surgical treatment to the extent of maximum cytoreductive surgery. Two study groups were formed: 1 — cases with GIIH (N=57), 2-without GIIH (N=60). On the 14-16 day after the operation, all patients underwent 3 cycles of adjuvant chemotherapy according to the PCb scheme.Results. A significant increase in overall survival was found in the first group of patients with HIPEC. This technique allows to increase the survival rate of patients for 14 months at stage IIIA-B (p<0.05). At stage IIIC, there was no statistically significant difference in the survival rate of patients. There was a tendency to increase the survival rate by 5 months (p>0.05), which is associated with the pronounced prevalence of the tumor process and the technical impossibility of removing the tumor. Discussion. The concentration of drugs in the abdominal cavity and in the blood plasma significantly differs due to the functioning of the peritoneal-plasma barrier, which leads to a lower toxicity in comparison with systemic chemotherapy, and therefore allows you to give a large dose of the drug with fewer adverse events, and the fact of hyperthermia (42°C) has a positive effect on the effectiveness of intraperitoneal chemotherapy. To date, this method has not been included in the clinical recommendations on the territory of the Russian Federation, but data from foreign literature, including randomized trials, have shown the high effectiveness of this method.Conclusion. The results obtained in the course of our study demonstrate the effectiveness of this technique, in the form of an increase in overall and relapse-free survival with acceptable toxicity.

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