Overviews of reviews on patient compliance with medication protocols used in highly active antiretroviral therapy

Purpose:To provide evidence support for the development of clinical practice guidelines regarding patient adherence to medication protocols used in highly active antiretroviral therapy(HAART)in China.Methods:We analyzed information contained in recent systematic reviews and metaanalyses regarding patient compliance with medication protocols used in HAART.Results:Nine systematic reviews and one meta-analysis were included in our study which involved three different aspects of patient compliance:influencing factors,assessment methods,and interventions.Conclusions:The high quality data obtained from our study was suitable for use in developing clinically useful guidelines for patent compliance with HAART medication protocols.

Self-monitoring of blood glucose in gestational diabetes mellitus patients during the COVID-19 pandemic in low- and middle-income countries

Self-monitoring of blood glucose(SMBG)is critical for gestational diabetes mellitus(GDM)care.However,there are several hurdles to its practice during the coronavirus disease 2019(COVID-19)pandemic in GDM patients in low-and middle-income countries when GDM care recommendations emphasize telemedicine-based care.Based on available knowledge,this letter proposes the following barriers to SMBG in these GDM patients during the ongoing COVID-19 pandemic:Poor internet connectivity,affordability of SMBG and digital applications to connect with healthcare providers,government-imposed social mobility restriction,psychological stress,and mental health conditions.Nevertheless,definitive evidence will only be acquired from rigorous research.

The effect of post-discharge telephone intervention on rehabilitation following total hip replacement surgery

Purpose:To determine the effect of post-discharge telephone intervention with both patients and family caregivers on patient compliance with doctors’advice and rehabilitation progress in total hip replacement patients.Methods:In total,249 participants were assigned to either the control or telephone intervention group according to the discharge date.The patients in the intervention group were contacted by phone three to seven days after discharge,at one month,and at three months post-discharge.Their family caregivers received were contacted by phone twice a month.Content of the telephone intervention included discussion of exercise,cautions in daily life,and regular examination.The patients in the control group received routine health education and follow-up.All participants were evaluated by the questionnaire of compliance with doctors’advice when they were discharged at one,three,and six months after discharge.The Harris Hip Score of patients was assessed on discharge day and six months after discharge.Results:There was no significant difference between the patients’compliance scores in the two groups on discharge day or one month after discharge.Three and six months after discharge,the scores in the intervention group were significantly higher than the control group(p<0.05).There was no significant difference between the groups in the Harris Hip Score on discharge day.Six months after discharge,the Harris Hip Score in the intervention group was significantly higher than the control group(p<0.05).Conclusion:Telephone intervention with patients and family caregivers improved patient compliance with doctors’advice and promoted functional hip joint rehabilitation.

Evaluation of an educational telephone intervention strategy to improve non-screening colonoscopy attendance:A randomized controlled trial

BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement,and because of its huge clinical and economic impact,they have been widely implemented.However,outside of this population programmes,educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018.The intervention group(IG)received a telephone intervention,while the control group(CG)did not.Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment.The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy.The impact on patient compliance with preparedness protocols related to bowel cleansing,antithrombotic management,and sedation scheduling was also evaluated.A second call was conducted to assess patient satisfaction.Intention-to-treat(ITT)and perprotocol(PP)analyses were performed.RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively.Six hundred thirteen(83%)patients were contacted in the IG.The non-attendance rate was lower in the IG,both in the ITT analysis(IG 8.4%vs CG 14.3%,P<0.001)and in the PP analysis(4.4%vs 14.3%,P<0.001).In a multivariable analysis,belonging to the control group increased the risk of nonattendance in both,the ITT analysis(OR 1.81,95%CI:1.27 to 2.58,P=0.001)and the PP analysis(OR 3.56,95%CI:2.25 to 5.64,P<0.001).There was also a significant difference in compliance with preparedness protocols[bowel cleansing:IG 61.7%vs CG 52.6%(P=0.001),antithrombotic management:IG 92.5%vs CG 62.8%(P=0.001),and sedation scheduling:IG 78.8%vs CG 0%(P≤0.001)].We observed a net benefit of €55600/year after the intervention.The information given before the procedure was rated as excellent by 26%(CG)and 51%(IG)of patients,P≤0.001.CONCLUSION Educational telephone nurse intervention improves attendance,protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact,which supports its imple-mentation and maintenance over time.

Recent advancements on novel approaches of insulin delivery

A large number of populations are living with diabetes, which is the most common endocrine disorder which isclassified into Type-I and Type-II diabetes. Diabetes is one of the listed diseases specified in Section 3 of the Drugand Magic Remedies Act, 1954, where advertisement of drugs for certain diseases has been prohibited. It can bemanaged or controlled with proper diagnosis and treatment and by changing food habits. In addition to therapywith oral hypoglycemic agents, patients are also given subcutaneous insulin injections which is traditionally usedin diabetes therapy. This multi-dose injectable therapy has relatively low patient compliance. To avoid theassociated drawbacks with this therapy, several other delivery techniques, including oral, buccal, rectal, transdermal and pulmonary routes were investigated for effective insulin delivery. Several novel techniques along withnovel devices are discussed in this review. The recent development in insulin delivery and products going throughvarious phases of clinical trials are focused here. This review enumerates how the investigation, recent technology, and developments in research played a pivotal role in the treatment of diabetes in near future withalternative, safe, and efficient insulin delivery.

The effect of folic acid on the development of stomach and other gastrointestinal cancers

OBJECTIVE: To evaluate the roles of folic acid and beta-carotene in the chemoprevention of gastric and other gastrointestinal (GI) cancers. METHODS: In a randomized, double-blind, placebo-controlled trial, a total of 216 patients with atrophic gastritis were randomly assigned to one of the four groups: (1) folate (FA, 20 mg per day plus vitamin B(12) 1 mg, intramuscularly, per month for one year, then 20 mg two times a week plus 1 mg per three months for the next year); (2) natural beta-carotene (N-betaC, 30 mg per day for first year, then 30 mg two times a week for the next); (3) synthetic beta-carotene (S-betaC, administered as in N-betaC); and (4) placebo. Follow-ups continued from 1994 to 2001. RESULTS: A total of 7 new cases of gastrointestinal cancers were diagnosed with 3 stomach, 1 colon and 1 esophageal cancers occurring in the placebo group; 1 stomach cancer in both of the N-betaC and S-betaC groups, and no cancer occurring in FA group. In terms of GI cancers, there was a significant reduction in the FA group, compared with the placebo group (P = 0.04). A similar trend was observed in both N-betaC and S-betaC groups (P = 0.07 - 0.08). Taken together, the three intervention groups displayed a highly significant decrease in occurrence (P = 0.004, vs placebo), and a lower risk for GI cancers (OR = 0.12; 95% confidence interval, 0.03 - 0.51). For development of gastric cancer, any one of the three active-treated groups did not reach statistically significant reduction. The FA group showed obvious improvement of the gastric mucosal lesions with more patients displaying lesions reversed or stable atrophy and inflammation (P = 0.04), reversed intestinal metaplasia (P = 0.06) at the end of follow-up, and reversed displasia (P = 0.017) at 12 months. Two cases of false jaundice were found in beta-carotene groups with no influence on administration, and no side-effects were reported in FA group. CONCLUSIONS: This trial revealed the interventional effect of folic acid on the development of GI cancers, a similar effect of beta-carotene was also detected. Also, folic acid may be of use to treat atrophic gastritis by preventing or reversing the precancerous lesions.