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.

5-ASA in ulcerative colitis:Improving treatment compliance

5-aminosalicylic acid(5-ASA)compounds are a highly effective treatment for ulcerative colitis(UC).While UC patient compliance in clinical studies is over 90%, only 40%of patients in every day life take their prescribed therapy.Adherence to medication has been emphasized recently by a Cochrane meta-analysis that has suggested that future trials of 5-ASA in UC should look at patient compliance rather than drug efficacy. Better compliance can be obtained by reducing the number of tablets and times of administration.Given that the 5-ASA formulations have different delivery systems that split the active moiety in various regions of the intestine,it is particularly important that an adequate dose of the drug arrives at the inflamed part of the colon.5-ASA Multi matrix(MMx)is a novel,high strength(1.2 g),oral formulation designed for oncedaily dosing.It releases the active moiety throughout the colon.Different studies with this compound have shown that it is as effective as 5-ASA enema in the treatment of mild-to-moderate,left-sided UC,and is comparable to a pH-dependent,delayed release 5-ASA (Asacol ),even if given once daily.Recently,the effectiveness in the acute phase of UC has been confirmed also in maintenance.In conclusion,at present,5-ASA MMx seems theoretically the best agent for maintaining patient compliance,and consequently,treatment effectiveness.

A Comparison between the Chinese and European Patients in Acupuncture Treatment

Based on my teaching and working experience in Europe, I have made a comparison between the Chinese and European patients in acupuncture treatment, and hope it is of some significance in acupuncture clinical practice.

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.

Problems in screening colorectal cancer in the elderly

AIM:To explore the problems in the screening of colorecta carcinoma in the elderly. METHODS:Three models of colorectal cancer prevention were examined:standard screening,active check-up of suspected cases and summons to have endoscopic check- up for previously diagnosed colorectal polyps.The study was performed among three groups of elderly individuals: Group 1 (167 cases),hospitalized asymptomatic individuals without symptoms in large intestines.Group 2 (612 cases): old individuals at home for the aged,out of which 32 showed symptoms of colon disorders;Group 3 (44 cases):elderly people with diagnosed polyps.As a result of 1788 rectosigmoidoscopies,we identified 61 individuals with polyps,out of which 44 patients were over 65 years old. However,only 9 of these 44 individuals agreed to have the endoscopy performed again. RESULTS:One cancer and 13 polyps were detected in Group 1,and two polyps in Group 2.However,it should be noted that only eleven individuals from Group 2 agreed to have the endoscopy.In Group 3,there were no relapses of the polyps among the nine individuals who came back for the endoscopy. CONCLUSION:Poor understanding of the screening procedures is one of the greatest problems in early detection of the cancer in the aged.Paradoxically,the cooperation is better with hospitalized patients,than with 'successfully old' persons.

Upper gastrointestinal endoscopy:Are preparatory interventions or conscious sedation effective? A randomized trial

AIM: The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. Conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD. METHODS: Two hundred and twenty-six outpatients (pts), scheduled for a first-time non-emergency EGD were randomly assigned to 4 groups: Co-group (62 pts): throat anaesthesia only; Mi-group (52 pts): CS with i.v. midazolam; Re-group (58 pts): presence of a relative throughout the procedure; Vi-group (54 pts): additional information with a videotape. Anxiety was measured using the “Spielberger State and Trait Anxiety Scales” The patients assessed the overall discomfort during the procedure on an 100-mm visual analogue scale, and their tolerance to EGD answering a questionnaire. The endoscopist evaluated the technical difficulty of the examination and the tolerance of the patients on an 100-mm visual analogue scale and answering a questionnaire. RESULTS: Pre-endoscopy anxiety levels were higher in the Mi-group than in the other groups (P<0.001). On the basis of the patients' evaluation, EGD was well tolerated by 80.7% of patients in Mi-group, 43.5% in Co-group, 58.6% in Regroup, and 50% in Vi-group (P<0.01). The discomfort caused by EGD, evaluated by either the endoscopist or the patients, was lower in Mi-group than in the other groups. The discomfort was correlated with “age” (P<0.001) and “groups of patients” (P<0.05) in the patients' evaluation, and with “gender” (females tolerated better than males, P<0.001) and “groups of patients” (P<0.05) in the endoscopist's evaluation. CONCLUSION: Conscious sedation can improve the tolerance to EGD. Male gender and young age are predictive factors of bad tolerance to the procedure.

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.

Inflammatory bowel disease in adolescents:What problems does it pose?

Adolescents with inflammatory bowel disease face daily and long-term challenges that may be difficult for teenagers to manage. The developmental and psychosocial changes unique to this age group include becoming more autonomous and being more vulnerable to peer influence. These changes may lead to problems in medical management such as poor medication adherence and risky behavior. Being aware of these issues will help the medical team provide anticipatory guidance to address these concerns.

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.