Compliance of daily iron supplementation during pregnancy affecting the hemoglobin level in second trimester and at term

Objectives: To determine the compliance rate of iron supplementation during pregnancy and the hemoglobin concentration in second trimester and at term.Methods: The study conducted among term pregnant women admission to the hospital for delivery who had non-anemic status at the initial visit for antenatal care, received daily iron supplementation before 20 weeks of gestation. They were interviewed to obtain the personal data, daily taking the supplemented tablet and side-effects. The compliance rate categorized as >80%, >50-80%, 25-50%, and < 25% according to the women’s response that they took daily tablet of 6-7, 3-5, 2, and 0-1 days/week, respectively. The type of supplementation and laboratory results of hemoglobin level were retrieved from their medical records.Results: Almost 90% of 350 participants had the compliance rate of >80%. The common side-effects were nausea and constipation. The side-effect rates were 10.5%, 12.1%, 66.7% in >80%, >50-80%, <25% compliance groups, respectively. In second trimester and term pregnancy revealed some anemic women. While hemoglobin concentrations above 13 gm/dl, which defined as high concentrated hemoglobin, revealed 12% during second trimester, and up to 30% at term in high compliance group.Conclusions: There was high compliance rate of iron supplementation with the high hemoglobin level markedly found in high compliance group.

NCOG-44. NEUROLOGIC ASSESSMENT IN NEURO-ONCOLOGY (NANO) SCALE IN A PHASE II STUDY OF PEMBROLIZUMAB OR PEMBROLIZUMAB PLUS BEVACIZUMAB IN PATIENTS WITH RECURRENT GLIOBLASTOMA

PURPOSE The neurologic assessment in neuro-oncology (NANO) scale was developed as a standardized metric to objectively measure neurologic function in brain tumor patients to complement radiographic assessment in defining overall outcome. A multicenter, phase 2 study of pembrolizumab with or without bevacizumab in patients with recurrent glioblastoma incorporated the NANO scale as an exploratory endpoint. METHODS Neurologic examination was evaluated at baseline and MRI assessments using the NANO scale until patients came off study. Statistical descriptive data analysis was performed using R (version 3.4.3). Correlation analysis utilized Fisher’s exact test. RESULTS NANO compliance rate was 94% in 80 patients accrued on the study. Of the 80 patients, 7 were missing NANO at baseline visit and were excluded from analysis for NANO response criteria. Fifteen patients did not have end of treatment NANO evaluation. Of 73 patients, 35 (48%) had a normal neurologic examination at baseline by NANO. Strength and language accounted for the majority of changes in neurologic function over the course of study treatment. Eighteen patients (25%) had neurologic progression by NANO, of whom 2 did not have concurrent radiographic progression. Three patients (pembrolizumab plus bevacizumab cohort) had a neurologic response associated with stable disease on MRI. NANO assessment prior to initiation of cycle 3 correlated with RANO response (p=0.011), change in KPS (p=0.002) and dexamethasone requirement (p=0.007) while those with NANO progression at this assessment had worse overall survival (291 vs 324 days), but this trend did not achieve statistical significance (p=0.2). CONCLUSIONS Evaluation of neurologic function by NANO scale was feasible in a multicenter prospective study in patients with GBM with a high compliance rate. The NANO scale objectively tracked stable neurologic function in most patients throughout the trial period and was associated with a trend for survival.

Barriers to effective outpatient hypertension treatment: a view of physicians and patients

Aim. To study the opinion of primary care physicians and hypertensive (HTN) outpatients with different compliance rate on factors preventing effective antihypertensive therapy (AHT).Material and methods. Primary care physicians and HTN outpatients were questioned. Questionnaires for physicians and patients included informative and survey parts, with a list of possible factors aggravated adherence to treatment. The assessment was carried out using visual analogue scale. The patient questionnaire also included questions about AHT and the eight-item Morisky Medication Adherence Scale (MMAS-8). The calculation was carried out with a 95% confidence interval (CI).Results. The survey involved 298 physicians and 517 patients. Among patients, about 1% had a high compliance rate, 34% — moderate, 65% — low. In all groups, AHT did not significantly differ and was characterized by a low frequency of prescribing fixeddose combinations (27,1%). According to physicians, the most significant and equivalent are the economic aspects of treatment — 7,9±2,1 (95% CI: 7,51-8,38), the need for lifestyle change — 7,9±2,4 (95% CI: 7,37-8,38) and, to a slightly lesser extent, psychological aspects 6,8±2,2 (95% CI: 5,43-6,43). The economic aspects of treatment and need for lifestyle change were also most significant factors according to patients with high (8,8±1,8 (95% CI: 7,23-10,37) and 8,4±1,7 (95% CI: 6,93-9,87), respectively) and low (95% CI: 6,4±3,0 (5,65-7,07) and 6,2±2,8 (95% CI: 5,5-6,82) respectively) compliance rates. For patients with moderate compliance rate, the most significant and almost equivalent factors were the need for lifestyle change — 5,6±3,3 (95% CI: 4,53- 6,71), the need for regular visits — 5,6±3,1 (95% CI: 4,53-6,58) and the need for selfmanagement — 5,6±2,8 (95% CI: 4,63-6,48).Conclusion. The results obtained make it possible to forecast the compliance rate of patients with HTN, and, therefore, direct more efforts to those with a low rate, thereby increasing the effectiveness of AHT.

Evaluation of personal protection afforded by repellent-treated sandals against mosquito bites in south-eastern Tanzania.

Background: The Indonesian government has put malaria as a priority disease that needs to be addressed. Lampung is one of the provinces with a high malaria incidence with Annual Paracite Incidence at 4.44 per 1000 population. The most cases occurred in Pesawaran Regency. There were 1.915 malaria cases in 2016. The highest positive case of malaria occurred in the Hanura Health Center with 1.738 cases, with the most cases being vivax malaria. The high case of malaria in the region is due to the favorable natural conditions as mosquito breeding places such as forests, lagoons and abandoned ponds. One of the biggest challenges in the treatment of malaria is the decline in the efficacy of even anti-malaria drug resistance due to low adherence in taking the drug. So this research is important to know the level of adherence to take medication in patients with vivax malaria in the work area of ​​the Hanura Health Center.Methods: This research was a descriptive analytic study with survey methods. Morisky Medication Adherence Scale (MMAS-8) questionnaire was used as the instrument. Eligible patients’who had undergone treatment with Artemisinin-based Combination Therapy and primaquine for 14 days were The subject of study. They were numbered 68 people in the working area of ​​Hanura Health Center.Results: The level of adherence to take medication in patients with vivax malaria in the working area of ​​Hanura Health Center is classified as low, namely a high compliance rate of 44.1% and a low compliance rate of 55.9%. The highest proportion of respondents with low levels of adherence were aged 25-45 years (55.3%), low education level (81.6%), working (57.9%), and having a history of malaria more than once (94, 7%).Conclusions: The level of adherence to take treatment in patients with vivax malaria in the working area of ​​Hanura Health Center is relatively low, with the highest proportion of adults, low education, work and have a history of malaria more than once.

Adherence to Plasmodium vivax malaria treatment in Hanura Public Health Center, Pesawaran District of Indonesia

Background: The Indonesian government has put malaria as a priority disease that needs to be addressed. Lampung is one of the provinces with a high malaria incidence with Annual Paracite Incidence at 4.44 per 1000 population. The most cases occurred in Pesawaran Regency. There were 1.915 malaria cases in 2016. The highest positive case of malaria occurred in the Hanura Health Center with 1.738 cases, with the most cases being vivax malaria. The high case of malaria in the region is due to the favorable natural conditions as mosquito breeding places such as forests, lagoons and abandoned ponds. One of the biggest challenges in the treatment of malaria is the decline in the efficacy of even anti-malaria drug resistance due to low adherence in taking the drug. So this research is important to know the level of adherence to take medication in patients with vivax malaria in the work area of ​​the Hanura Health Center.Methods: This research was a descriptive analytic study with survey methods. Morisky Medication Adherence Scale (MMAS-8) questionnaire was used as the instrument. Eligible patients’who had undergone treatment with Artemisinin-based Combination Therapy and primaquine for 14 days were The subject of study. They were numbered 68 people in the working area of ​​Hanura Health Center.Results: The level of adherence to take medication in patients with vivax malaria in the working area of ​​Hanura Health Center is classified as low, namely a high compliance rate of 44.1% and a low compliance rate of 55.9%. The highest proportion of respondents with low levels of adherence were aged 25-45 years (55.3%), low education level (81.6%), working (57.9%), and having a history of malaria more than once (94, 7%).Conclusions: The level of adherence to take treatment in patients with vivax malaria in the working area of ​​Hanura Health Center is relatively low, with the highest proportion of adults, low education, work and have a history of malaria more than once.

Palivizumab Prophylaxis among Infants at Increased Risk of Hospitalization due to Respiratory Syncytial Virus Infection in UAE: A Hospital-Based Study

Background. Respiratory syncytial virus (RSV) represents a significant public health burden and the leading cause of lower respiratory tract infections globally, and it is the major cause of hospitalization during the winter. We aimed to evaluate the effectiveness of palivizumab prophylaxis to reduce the hospitalization in children at high risk of RSV infection. Methods. We performed a retrospective observational single-arm hospital-based study including five RSV seasons (September to March) from 2012 to 2017. We retrospectively included premature infants born at less than 35 weeks of gestation with chronic lungs disease or hemodynamic significant congenital heart disease for palivizumab prophylaxis against RSV infection according to the criteria presented. Results. A total of 925 children were enrolled in the study over the five RSV seasons. Of them, 410 (44.3%) infants born at <32 weeks of gestation and 515 (55.6%) infants born at 32–35 weeks of gestation with mean (±SD) birth weight of 1104.8 ± 402.85 and 1842.5 ± 377.5, respectively. The compliance with the course of palivizumab was reported in 841 (90.9%) children. Of them, about 75 (8.9%) hospitalized children were reported, and 17 (2.02%) RSV positive children were detected. Hospitalization due to RSV infection was decreased from 9.23% in the 2012-2013 season to 0.67% in the 2016-2017 season. Conclusion. This study demonstrated that palivizumab prophylaxis in children at high risk of developing RSV infection was effective in reducing the risk of hospitalization with a high compliance rate over the five RSV seasons.

MAIN REASONS AND CURRENT METHODS OF CORRECTION OF POOR ADHERENCE TO ANTIRETROVIRAL TREATMENT IN DIFFICULT PATIENTS

The review of literature on strategies of improvement and maintaining of the treatment compliance aimed at increasing the treatment efficacy for patients with chronic diseases is presented. Emphasis is placed on the need for increasing compliance rate in people living with HIV. Practical recommendations for achievement of high compliance rate in antiviral treatment for «difficult» patients were discussed. Publications mainly for the last 10 years in peer-reviewed medical journals and on current Internet resources including elibrary and Pub-Med were used.

Using a pedigree-based questionnaire to improve efficiency in a general oncology genetics clinic.

66 Background: Genetic counseling has two major components – education and medical history. Our Lyndon B Johnson (LBJ) General Oncology Genetics Clinic includes a diverse patient (pt) group. The majority of pts do not speak English, requiring medical translation, which lengthens encounters. To improve efficiency, a pre-visit genetics questionnaire (GQ) was created to gather pt and family history. Methods: The GQ includes: breast-obstetric history, urologic history, colon history, dermatology, maternal and paternal family history. Between November 2, 2017 and May 10, 2018 pts were contacted before their encounter. The GQ was given to pts, who were encouraged to complete it in advance, return electronically, or bring to the visit. Encounter duration for pts was calculated based on their check in and check out time documented in Epic. A partially completed GQ is defined as leaving a major section blank, like paternal or maternal history. Results: 92 pts were seen in the LBJ Oncology Genetics Clinic. The overall compliance rate for a completed GQ was 37% (Table 1). 51% of the pts were non-English speaking. For pts who completed the GQ, the mean overall cycle time is 55 minutes, which is reduced on average 33.0% compared to those who did not complete the GQ. Encounter duration in minutes, and compliance rate. Conclusions: We demonstrate that using a pedigree-based GQ in an Oncology Genetics Clinic is feasible with non-English speaking pts and can reduce clinic cycle times up to 33%. The greatest reduction in cycle time occurred when a completed GQ was emailed to the clinic. Interestingly, non-English speaking patients had a shorter cycle time compared to English speaking patients, which could be explained by an approximately twice as high compliance rate in the non-English speaking patients, further supporting the association between GQ completion and cycle time reduction. To improve cycle time further, increasing overall compliance rate from 37% provides a future direction.[Table: see text]

Prevalence and characteristics of caesarean section (CS) among pregnant women who delivered at the Colonial War Memorial Hospital (CWMH) Suva, Fiji, 2016

IntroductionIn recent decades we have noted a marked increase in caesarean section (CS) rates in both developed anddeveloping countries. Institutional data indicate a rise in CS rates in Fiji however published data in thisregard is lacking. This study aims to estimate the prevalence and identify the characteristics of CS atColonial War Memorial Hospital (CWMH) in 2016.MethodologyThis is a retrospective audit of 1625 women who underwent CS at CWMH from 1st January 2016 to 31stDecember 2016. A data collection form was developed to collect data from the birth register book. Thedata collected included patients’ demographic characteristics, indication for CS, surgeon hierarchy, andwound check review. Data was analyzed using SPS and the results were presented in tables and graphs.ResultsOf the1625 CS patients who met the study criteria, the majority were I-Taukei (77%; n=1148) and 20-34years old (60%; n=887) and Primigravida (45.5%, n=739). Caesarean delivery was mostly performed bysenior registrar (n=1002; 62%). Of 1625 CS 87.7% (n=1409) were emergency CS and 13.3% (n=216) wereelective CS. Fetal distress was found in 56% (n=911) of all CS cases. , followed by obstructed labour(15.6%) and foetus mal-presentation (13%). More than half of patients (n=537; 59.0%) were considered asnon-reassuring for fetal distress. In obstructed labour group 81.1% (n=223) were first stage obstruction.Breech was most common mal-presentation (n=192; 86%). The results of the study revealed that there wasa high compliance rate (n=1435; 97%) of non-private CS mothers (n 1478) followed at CWMH for awound check following caesarean.ConclusionIn 2016 CWMH recorded it highest rate of CS births and while it just at the newly defineoptimum CS rate, it is part of a rising trend in CS rates in CWMH. In this respect there is aconcern that the majority of CS was done on first time mothers with at least secondary leveleducation, this trend as this would suggest an ongoing trend to increasing CS rates. There is aneed to define fetal distress and arrested labour amongst these women to reduce unnecessary CS.Further studies are needed to explore the impact of this CS rate on hospital budget and resourcesand therefore the implications of a rising trend.

HUBUNGAN PENGETAHUAN TERHADAP TINGKAT KEPATUHAN PASIEN TUBERCULOSIS DI BALAI KESEHATAN PARU MASYARAKAT PROVINSI JAWA BARAT

Penyakit tuberkulosis merupakan infeksi menular yang sampai saat ini masih menjadi masalah kesehatan masyarakat dunia. Kepatuhan pasien TB Paru merupakan parameter utama dalam menilai berhasil tidaknya pengobatan TB Paru.Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan terhadap tingkat kepatuhan pasien TB paru di BKPM Provinsi Jawa Barat. penelitian ini merupakan penelitian observational dengan desain cross sectional, pengukuran data dengan menggunakan kuesioner yang sudah divalidasi oleh Armelia Hayati tahun 2011 kemudian dianalisa univariat dan bivariat dengan menggunakan uji Chi-Square. Hasil penelitian ini diperoleh dari 27 responden mempunyai tingkat pengetahuan sangat baik sebesar 59,3% dan tingkat kepatuhan kelompok terbesar dengan tingkat kepatuhan tinggi sebesar 66,7%. hasil uji Chi-Square didapatkan nilai p value = 0,462 kurang dari 0,05 artinya tidak ada hubungan yang signifikan antara pengetahuan pasien TB paru dengan kepatuhan berobat pasien TB paru. Abstract Tuberculosis is a contagious infection that is still a world public health problem. Compliance of tuberculosis patients is a major parameter in assessing the success or failure of tuberculosis treatment.This study aims to determine the relationship of knowledge to the level of compliance of tuberculosis patients in BKPM West Java Province. This research is an observational research with cross sectional design, data measurement using questionnaires already validated by Armelia Hayati in 2011 and then analyzed univariat and bivariate by using Chi-Square test. The results of this study were obtained from 27 respondents have a very good knowledge level of 59.3% and the level of compliance of the largest group with high compliance rate of 66.7%. Chi-Square test results obtained p value = 0.462 less than 0.05 means there is no significant relationship between the knowledge of patients with tuberculosis compliance treatment.