The Impact of Prescribed Dosage Assumptions on the Evaluation of Adherence and Persistence to Medication in Patients After Acute Myocardial Infarction

Medication adherence is a significant problem in public health. Prescription-level pharmacy databases have great potential for monitoring actual drug adherence patterns at the healthcare system level. Many research papers have reported adherence estimates in different settings and populations. However, comparison between studies is not always straightforward due to different approaches taken when computing adherence. A crucial component to accurately estimate adherence is the availability of days’ supply information for each dispensing event. Reasonable assumptions regarding medication dosage have to be made, when this information is not available. In this study, we evaluate adherence and persistence to medication in patients after myocardial infarction and show that corresponding estimates differ significantly, when using different dosage assumptions, namely, when using defined daily dose or tablet per day dosage regimens. Moreover, we demonstrate that observed differences between medications might be a result of inaccurate dosage assumptions. We propose a comparison of distribution of days between dispensing events to that of days’ supplied as a relatively simple visual inspection to validate dosage assumptions.

Visual and quantitative control for the performance of spirometry

Most spirometry errors reduce test results. The aim of the study was comparison results of spirometry performed with the ATS/ERS quantitative criteria and simple visual inspection criteria. 75 patients performed spirometry twice on the same day: according to criteria of the ATS/ERS quality for spirometry and on visual control. Statistical analysis was performed with Bland-Altman method. Forced expiratory volume (FVC) and forced expiratory volume in one second (FEV1) were greater for the cases with quantitative control. The mean difference between FVCs was 0.37 ± 0.29 L. The mean difference between FEV1s was 0.06 ± 0.2 L. Using ATS/ERS spirometry guide-lines may help improve results and avoids spirometry errors.

Baxter elastomeric pumps: Feasibility of weight estimates

Purpose Elastomeric pumps are used to infuse a 46-h fluorouracil protocol and patients are asked to visually inspect the pump daily. The pump has a variability of ±10% and there are additional patient variables that can increase this. The feasibility of weighing the pump rather than a visual inspection along with the secondary objective to confirm the pump’s variability in real world conditions was undertaken. Methods Empty pumps were weighed using both pharmacy and kitchen scales. Pumps upon completion of the 46-h infusion were also weighed using both pharmacy and kitchen scales. Results The kitchen scale was as accurate as the pharmacy grade scale. Disconnected pumps showed the expected variability from using these infusor pumps along with a few showing greater variability likely due to patient variables. Conclusion Weighing pumps appears to be feasible both at the pharmacy and home level. Next steps would be to weigh pumps during the infusion to validate an alternate method to simple visual inspection for patients to confirm proper infusing of the pump at their home.

Gingival Biotype Assessement: Visual Inspection Relevance And Maxillary Versus Mandibular Comparison

Objective: This clinical study was aimed at evaluating the accuracy of gingival visual inspection procedures during clinical examination and determining whether differences existed between the maxillary and mandibular gingival biotypes. Materials and Methods: The study included 53 patients and 124 clinicians. The clinicians were asked to assign to each subject, using photographic documents, one of three biotypes: thin-scalloped, thick-scalloped, or thick-flat gingival biotype. A total of 19716 responses were collected for statistical analysis. Results: Identification accuracy of the gingival biotype and the intra-examiner repeatability presented poor highlighting of the limited relevance of visual inspection. In addition, the percent of agreement between classifications based on the global view of both the maxilla and mandible and the classification based on the individual mandibular or maxillary anterior teeth was not statistically significant. Conclusion: Based on the above results, it can be concluded that a simple visual inspection is not effective for the identification of gingival biotype. Furthermore, evidence suggests that a difference of biotype between the maxilla and the mandible in the same patient is conceivable. Therefore, orthodontic clinical examination should incorporate a reproducible method of determining the individualized gingival biotype for each group of teeth that will be moved.