Impact of 5-Year Endoscopic Surveillance Intervals with Biopsy following Endoscopic Papillectomy for Ampullary Adenoma

Background: Endoscopic snare papillectomy (ESP) has been established as a safe and effective treatment for ampullary adenomas. However, little is known about the optimal post-procedure follow-up period and the role of routine endoscopic surveillance biopsy following ESP. We aimed to evaluate patient adherence to a 5-year endoscopic surveillance and routine biopsy protocol after ESP of ampullary adenoma. Methods: We reviewed our prospectively collected database (n = 98), all members of which underwent ESP for ampullary lesions from January 2011 to December 2016, for the evaluation of long-term outcomes. The primary outcome was the rate of patient adherence to 5-year endoscopic surveillance following ESP. The secondary outcomes were the diagnostic yield of routine endoscopic biopsy, recurrence rate, and adverse events after endoscopic surveillance in the 5-year follow-up (3-month, 6-month, and every 1 year). Results: A total of 19 patients (19.4%) experienced recurrence during follow-up, all of these patients experienced recurrence within 3 years of the procedure (median 217 days, range 69–1083). The adherence rate for patients with sporadic ampullary adenoma were 100%, 93.5%, and 33.6% at 1, 3, and 5 years after ESP, respectively. The diagnostic yield of routine endoscopic biopsy without macroscopic abnormality was 0.54%. Pancreatitis occurred in four patients (4%, 3 mild, 1 moderate) after surveillance endoscopic biopsy without macroscopic abnormality. Conclusions: Given the low 5-year adherence rate and diagnostic yield of routine endoscopic biopsy with risk of pancreatitis, optimal surveillance intervals according to risk stratification (low grade vs. high grade adenoma/intramucosal adenocarcinoma) may be required to improve patient adherence, and routine biopsy without macroscopic abnormality may not be recommended.

Evaluation of Antibiotic Prophylaxis Regimens in Gynecological Surgeries in a Referral Teaching Hospital: A Cross Sectional Study

Background: Drug utilization Evaluation is the main tool to assess the clinical and economic effects of drug on health-care system. The aim of the current study is to evaluate the regimens of antibiotic prophylaxis in common gynecological surgeries in a referral teaching hospital Methods: This cross-sectional study was done in Alzahra hospital, Tabriz, Iran, from July 2017 to December 2017. Patients who received antibiotics as surgical site infection prophylaxis were enrolled. Data were collected from patients’ medical records and adherence rate to the American Society of Health-System Pharmacists (ASHP) guideline was studied as the primary endpoint. Results: A total of 210 patients who undergoes common gynecological surgeries were evaluated. Cesarean section (58.6%) and total abdominal hysterectomy (28.1%) were the majority of surgeries. The type of administered antibiotic was adherent to guideline in 71.4%. Doses and duration of prescribed antibiotic (Cefazolin, the most prescribed antibiotic) were not in accordance with the guideline in 100%. Only in 58%, the time of antibiotic administration was corrected. Conclusion: In this study, the misuse of antibiotics in most cases was documented in terms of type, dose and duration of drug administration in Al-Zahra Hospital. It seems necessary to publish evidence-based guidelines and monitor their proper implementation, not only to reduce costs but also to combat antibiotic resistance.

Determinants of adherence to antiretroviral therapy among people living with HIV/AIDS in Chhattisgarh, India

Background: Achieving the WHO 2020 treatment goals will not only depend on access to HIV treatment, but also on good adherence. Chhattisgarh SACS under guidance of CST division NACO and community and family medicine department AIIMS, Raipur undertook this study to investigate the major factors that influence the adherence of PLHIV visiting ART centres of Chhattisgarh.Methods: From five ART centres, 415 participants were interviewed through simple random sampling method through a semi structured interview schedule. Results: We found that 346 of the 415 (83.3%) patients had ≤95% adherence to ART on the basis of pill count method. Major proportion (90.0%) of patients were on TLE regimen, among them (74.4%) were non-adherent. An association was found between health condition of patient, poor life style and adherence rate. Three-month drug dispensation was recommended by most of the participants to improve adherence.Conclusions: Multiple months drug dispension along with other innovative approaches should be tailored made to improve the adherence and compliance among PLHIV individuals.

Technology And Its Role In Supporting Tuberculosis Treatment Adherence

Compliance with TB treatment has now become a problem that must be handled seriously because the high non-adherence rate will give a bad contribution to the success of TB treatment, including MDR-TB and also morbidity and mortality. Many innovations have been made to improve TB treatment adherence, one of which is using mobile-based technology. This article aims to explore the effectiveness of the technology used to improve treatment adherence in TB patients: types, ways of working, advantages, and limitations of each application. This is a systematic review through searching 3 databases, namely Scopus, WoS, and Science Direct. Some of the advantages in applying technology to improve TB treatment adherence are easy to use if you understand how to operate tools/applications are cost-effective because they reduce transportation costs in reaching remote areas or in conditions of transportation difficulties such as after a disaster, the use of this technology provides patient satisfaction in treatment and facilitates the involvement of the family/support system in the treatment of patients. Several things must be considered (limitations) of the technology to be used, including experts, patient knowledge and skills, economic condition, electricity availability, and whether the technology used will not increase the burden on patients related to the stigma of TB disease. We can conclude that the use of technology is indeed very good in supporting the improvement of TB treatment adherence, but the selection of this application must pay attention to the characteristics of the population as well as the advantages and limitations of each application. Keywords: Technology, Adherence, Tuberculosis

Technology and its role in supporting Tuberculosis treatment adherence

Compliance with TB treatment has now become a problem that must be handled seriously because the high non-adherence rate will give a bad contribution to the success of TB treatment, including MDR-TB and also morbidity and mortality. Many innovations have been made to improve TB treatment adherence, one of which is using mobile-based technology. This article aims to explore the effectiveness of the technology used to improve treatment adherence in TB patients: types, ways of working, advantages, and limitations of each application. This is a systematic review through searching 3 databases, namely Scopus, WoS, and Science Direct. Some of the advantages in applying technology to improve TB treatment adherence are easy to use if you understand how to operate tools/applications are cost-effective because they reduce transportation costs in reaching remote areas or in conditions of transportation difficulties such as after a disaster, the use of this technology provides patient satisfaction in treatment and facilitates the involvement of the family/support system in the treatment of patients. Several things must be considered (limitations) of the technology to be used, including experts, patient knowledge and skills, economic condition, electricity availability, and whether the technology used will not increase the burden on patients related to the stigma of TB disease. We can conclude that the use of technology is indeed very good in supporting the improvement of TB treatment adherence, but the selection of this application must pay attention to the characteristics of the population as well as the advantages and limitations of each application.

Tele-monitoring flares using a smartphone app in patients with gout or suspected gout: a feasibility study

Objectives Gout flares are painful and disabling. We developed a smartphone app for patients to tele-monitor gout flares surveyed by clinicians. This study aimed to assess patient acceptability, technical and clinical feasibility. Methods Adult patients with either established gout or high suspicion thereof were recruited if they possessed a smartphone and reported a recent arthritis attack. A smartphone application was used to identify gout flares by asking during 90 consecutive days: 1) what is your pain score (0–10), 2) are your joints warm, 3) are your joints swollen and 4) are you currently experiencing a gout flare. The clinician was alerted via email if a flare occurred. Patient acceptability was assessed using the Technology Acceptance Model. Technical feasibility consisted of reported technical issues and clinical feasibility of actions taken by the clinician regarding gout flare alerts. Results 29 included patients completed the study. Participants mean age was 57 years and all but one were male. Adherence rate was 96% (110 out of 2,910 queries were missed). Patients had a positive attitude towards app use, found the app very easy to use (mean usability score 81 out of 100) and were neutral to positive on its usefulness. There were four minor technical issues. A total of 100 gout flare alerts were generated that led to 18 proactive contacts with patients. Conclusion A smartphone app to monitor gout flares was developed and tested, showing high adherence, good acceptability and clinical feasibility for established gout patients. Trial registration Netherlands Trial Register, https://www.trialregister.nl, NL6435

Medication Adherence for Haemophilia Patients: Outcome of Prophylaxis Treatment Intervention

There have been various Haemophilia Treatment Centres (HTCs) set up worldwide with innovative blood factor stewardship programs. Pharmacists have been an extended part of stewardship programs providing daily rounds with haematologists, treatment plan modifications, and dosage adjustment recommendations. The Haemophilia Treatment Centres in Malaysia contain the Haemophilia Medication Therapy Adherence Clinic (HMTAC), which recruits adolescent and adult populations. There have not been any adherence studies conducted on pharmacist-steered HMTAC since initiation. The current research generates baseline data to produce treatment plans and intervention measures needed for therapy optimisation in the Malaysian population. This study also explores the relationship between medication adherence, bleeding rate, and comorbidity. This cross-sectional study involved retrospective and prospective data collection using the Validated Haemophilia Regimen Treatment Adherence Scale–Prophylaxis (VERITAS-Pro) in Ampang Hospital. The retrospective data collection included reviewing patients’ medical records, bleeding diaries, and VERITAS-Pro questionnaires pre-enrolment to HMTAC. Meanwhile, the prospective data collection was the VERITAS-Pro questionnaire administration post a minimum of three months after enrolment. The inclusion criteria were patients with severe haemophilia A and B with ages ≥18 years with self-administered prophylactic regimens for a minimum period of three months. There were six (5.8%) nonadherent participants, and 97 (94.2%) adhered to the preventive treatment. The subscale dosing and remembering and the total score of the VERITAS-Pro post-HMTAC showed a significant association with ABR. There was a significant mean reduction in the post-HMTAC compared to the pre-HMTAC score for the total score and subscales timing, remembering, skipping, and communicating. There was a significant association between the post-HMTAC adherence status and ABR. It can be concluded that the HMTAC service pioneered by the pharmacists in the National Referral Centre of Haematology is efficient in significantly improving the VERITAS-Pro scoring and then translating it into a high medication adherence rate. This study also highlights a significant correlation between post-HMTAC scores on their adherence with ABR and comorbidities.

Feasibility of combining noninvasive brain stimulation and personalized counseling to increase physical activity

Few older adults meet recommended physical activity guidelines. Behavioral interventions may be more effective when combined with other modalities to promote activity. Transcranial direct current stimulation (tDCS) designed to increase the excitability of the left dorsolateral prefrontal cortex (dlPFC) — a brain region subserving motivation and executive function — has the potential to augment behavioral interventions. We designed a randomized, double-blinded trial to examine the feasibility of combining personalized behavioral counseling and tDCS targeting the left dlPFC to improve physical activity and related outcomes in sedentary older adults living within the supportive housing. Participants wore a Fit-Bit throughout the study period. Baseline step counts were determined for two weeks, then participants completed four bi-weekly personalized counseling sessions over eight weeks. They were also randomized to receive 10 sessions of tDCS or sham stimulation over the two weeks after the baseline. Physical, cognitive, and patient-reported outcomes were assessed at baseline, after ten brain stimulation sessions, and after four behavioral sessions. 33 individuals were screened and 16 enrolled (age=80±7, 13 females). 13 participants completed the study, including 100% of study assessments, 99±5% of brain stimulation sessions, and 98±7% of behavioral sessions. Fit-Bit adherence rate was 93±13%. Daily step counts were 3197±1480 at baseline and 4722±2553 over the last two weeks of the intervention. While the study is ongoing and blinded, these preliminary results indicate that it is feasible to conduct a controlled study of tDCS combined with personalized behavioral counseling to increase physical activity in sedentary older adults living within supportive housing.

Efek Samping Terapi Antiretroviral dan Kepatuhan Berobat Penderita HIV/AIDS

<p>Antiretroviral treatment side-effects and patient compliance with medical instructions continue to be a growing challenge for HIV/AIDS patients. Arv therapy has resulted in a substantial intervention that has been successful in preventing transmission and opportunistic infection. The main objective of this study was to analyze the association between side-effects of ARV therapy and medication adherence as well as another potential confounding such as opportunistic infection, family support, stress level, knowledge of ARV, marital status, and occupation. This study is a quantitative approach by using cross-sectional methods. A total of 244 respondents from 1.180 patients with confirmed HIV registered in the Care Support and Treatment (CST) service and Sriwijaya Community in the City of Palembang to respond to the survey. Non-random sampling was used to collect the samples. As the result, the majority of the respondents were male (84,43 %), ≥30 years old (57,4%), and secondary school graduates (52%). After adjusting with stress and opportunistic infection variable, a Multivariate regression analysis revealed a positive relationship between side effects and medication adherence (p-value of 0,041; 0,05), OR Adj 2,131 (1,190-4,988). PLHV who had adverse effects had a 2.131 times worse adherence rate than those who did not. In conclusion, medication adherence must be greatly improved in light of therapeutic side effects, stress levels, and opportunistic infection.</p>