Comparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery: Randomized Clinical Trial

Background Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. Objective This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. Methods This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient’s smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. Results One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. Conclusions Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. Trial Registration Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507

Alterações no índice de massa corporal: Coorte em indivíduos em uso de dolutegravir

Goal: To assess body mass index (BMI) changes in people living with HIV (PLHIV) and using antiretroviral therapy (ART) with dolutegravir (DTG) and its associated factors. Methods: Retrospective and prospective cohorts of PLHIV who started ART with DTG or used DTG after changing the therapeutic regimen, from Belo Horizonte, between February/2017 and March/2020. Data were gathered from clinical records of the Drug Logistics and Laboratory Test Control Systems. BMI changes were analyzed in the following week intervals 1-24(t24), 25-48(t48), 49-72(t73), and 73-96(t96) using the Wilcoxon test and generalized estimation equation (GEE) model, at 5% significance level. Results: A total of 614 individuals were included and average was 38.4 years old. Most were men (85.5%) and 52.3% had started ART with DTG. These individuals, and the immunosuppressed ones, showed significant increases in BMI when compared to those who used DTG after switching therapeutics or the non-immunosuppressed ones (p-value <0.05). After 96 weeks, individuals starting ART with DTG had a mean increase in BMI of 1.02 Kg/m2, whereas those who used DTG after the therapeutic change had an increase of 0.56 Kg/m2 (p<0.05). DTG use length, ART type, immune status, baseline BMI, and age were associated (p<0.05) with BMI increases. Conclusions: We observed an increase in BMI both in individuals starting ART with DTG use and those using it after changing the therapeutic regimen.

PNPLA3, TM6SF2, and MBOAT7 Influence on Nutraceutical Therapy Response for Non-alcoholic Fatty Liver Disease: A Randomized Controlled Trial

Introduction: PNPLA3, TM6SF2, and MBOAT7 genes play a crucial role in non-alcoholic fatty liver disease (NAFLD) development and worsening. However, few data are available on their treatment response influence. The aim of this trial is to explore the effect derived from silybin-phospholipids complex (303 mg of silybin-phospholipids complex, 10 μg of vitamin D, and 15 mg of vitamin E twice a day for 6 months) oral administration in NAFLD patients carrying PNPLA3-rs738409, TM6SF2-rs58542926, or MBOAT7-rs641738 genetic variants.Materials and Methods: In all, 92 biopsy-proven NAFLD patients were grouped in 30 NAFLD wild type controls, 30 wild type treated patients, and 32 mutated treated ones. We assessed glycemia (FPG), insulinemia, HOMA-IR, aspartate and alanine aminotransferases (AST, ALT), C-reactive protein (CRP), thiobarbituric acid reactive substance (TBARS), stiffness, controlled attenuation parameter (CAP), dietary daily intake, and physical activity at baseline and end of treatment.Results: The wild-type treated group showed a significant improvement of FPG, insulinemia, HOMA-IR, ALT, CRP, and TBARS (p &lt; 0.05), whereas no improvements were recorded in the other two study groups. NAFLD wild type treated patients showed higher possibilities of useful therapeutic outcome (p &lt; 0.01), obtained from the prescribed therapeutic regimen, independently from age, sex, comorbidities, medications, CAP, and stiffness in comparison to the mutated group.Discussion: The assessed mutations are independently associated with no response to a silybin-based therapeutic regimen and could be considered as useful predictive markers in this context.Clinical Trial Registry Number:www.ClinicalTrials.gov, identifier: NCT04640324.

Efficacy of oclacitinib for the control of feline atopic skin syndrome: correlating plasma concentrations with clinical response

Objectives The aim of this study was to assess the efficacy of a new therapeutic regimen of oclacitinib for the control of feline atopic skin syndrome (FASS) and to correlate plasma levels of this drug with clinical effects. Methods Twenty-eight client-owned cats with a clinical diagnosis of FASS were recruited. Oclacitinib was administered at 1 mg/kg q12h for 2 weeks and then at 1 mg/kg q24h for a further 2 weeks. At the study outset (D0), and 7 (D7) and 28 (D28) days after starting treatment, clinical lesions were assessed using a validated scoring system (SCORing Feline Allergic Dermatitis [SCORFAD]) and pruritus was graded via an adapted visual analogue scale (PVAS). At the same time points, plasma oclacitinib levels and haematological variables were measured. Results Among 18 cats completing the study, PVAS and SCORFAD improved by ⩾50% in 61% and 88% of animals, respectively. Mean PVAS decreased significantly between D0 and D7 and between D0 and D28 (both P <0.001) but not between D7 and D28. Likewise, mean SCORFAD values decreased significantly between D0 and D7 and between D0 and D28 (both P <0.001) but not between D7 and D28. On D7 and D28, plasma oclacitinib concentrations varied widely from 0 to 1443.2 ng/ml and from from 0 to 1177.7 ng/ml, respectively. Oclacitinib concentrations showed no correlation with clinical effects (SCORFAD and PVAS). Conclusions and relevance Oclacitinib emerged as being safe and effective to control clinical signs of FASS. A mean dose of 1 mg/kg, even without extending twice-daily treatment beyond the first 2 weeks, could be a suitable therapeutic regimen. Plasma drug levels did not seem useful to predict clinical response during treatment.

Can we think of a TAT, that is a “tailored antiplatelet therapy”?

What can be seen from the case report by Verzelloni et al. has a double value, beyond the case itself. First of all, the use of platelet aggregation assessment tests, such as TEG-PM, allows clinicians to verify the exact timing between the suspension of thienopyridines and the possibility of surgery without further temporal delays and is also able to favor the evolution of ischemic problems or hemodynamic instability not easily treatable. It therefore allows clinicians to optimize the bleeding / thrombosis matching. Secondly, the use of point of care methodologies for the evaluation of platelet aggregation allows us to evaluate the adequacy of the anti-aggregation, facilitating, where resistance or percentages of anti-aggregation are lower than expected, modification of the therapeutic regimen.

STEROID SPARING DRUGS IN IMMUNE MEDIATED MUCOCUTANEOUS DISEASES-A REVIEW ON THERAPEUTIC REGIMEN

Corticosteroid remains mainstay of treatment for immune mediated mucocutaneous disorders. The very usefulness of the drug, which has become a double-edged sword, when used for long time. The administration of immunomodulators decrease the dose of steroids, reduces the steroid side effects and improves rejuvenation time. In addition to immunomodulatory drugs there are some drugs that are used to spare corticosteroids in the treatment of immune mediated mucocutaneous diseases. This review attempts to elicit the use of steroid sparing drugs in immune mediated diseases.