Analysis of Anticoagulation Therapy Related Complications in Patients With Prosthetic Valves: Our Experience

Purpose:The aim of this study is to analyze anticoagulation?related complications in patients following mechanical valve replacement and factors influencing the outcome. Materials and Methods: A total of 250 patients were analyzed during OPD follow?up for anticoagulation?related complications and various factors influencing outcome. Patients received prosthetic valve at mitral and/or aortic or both. Results: Out of 250 patients, 48% were male and 52% were female. The mean age was 41.9 ± 14.4. A total of 139 had mitral valve replacement (MVR), 70 had aortic valve replacement (AVR), 40 had double valve replacement (DVR), and 1 patient had triple valve replacement. Valves implanted were mechanical bileaflet valve. The mean international normalization ratio (INR) in the study was 2.4 ± 0.56. A total of 49 events occurred during follow?up, of which 4.5% per patient years were anticoagulation?related hemorrhagic events and 4.8% per patient years were thromboembolic events. Among thromboembolic events, valve thrombosis occurred in 10 patients and cerebrovascular accidents occurred in 11 patients. Mean INR for thromboembolic events was 1.46 ± 0.25 and anticoagulation?related hemorrhagic events was 4.4 ± 1.03. Mortality rate was 1.6% in AVR, 4% in MVR, and 0.4% in DVR? groups; about 34% of patients needed dose modification of Acenocoumarol and reason for derangement of INR was associated with infectious process and poor compliance; 85% of cases showed good compliance for daily anticoagulation therapy. Conclusion: Anticoagulation for mechanical valve replacement can be managed with INR range of 2.0 to 2.5 in MVR and 1.5 to 2.0 in AVR with acceptable hemorrhagic and thromboembolic events. We must educate and counsel the patients during follow?up for better compliance to optimal anticoagulation.

Assessment of the contributing risk factors in adult diabetic patients attending the diabetic clinic in Bankura Sammilani Medical College, Bankura

Background: Diabetes affects all segments of the population and is one of the leading causes of premature morbidity and mortality and requires life-long healthcare services. The National Rural Health Mission launched in 2005 and the new pilot National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke offer opportunities for improving care for diabetes and other non-communicable diseases through service provision at the primary and secondary levels of care. This article describes the health services related factors and ascertains the physical status of adult diabetic patients.Methods: It is an institution based, cross-sectional, descriptive study. Complete enumeration of all patients attending diabetic clinic of Bankura Sammilani Medical College and hospital, Bankura, West Bengal was done. Eligible consenting adult patients, who were diagnosed as a case of diabetes and on treatment were interviewed with review of medical record. The study was preceded after obtaining ethical clearance. Data were entered in MS Excel spread sheet. Calculation was done with the help of software SPSS 22.0 free version.Results: Only 5.3% of study subjects had drug supply from hospital fully but rest of them had to buy from the shop. 79.3% of study subjects skipped the drug when it was finished. Diabetic complication was found to be more when distance of home from hospital was more.Conclusions: Antidiabetic drug were not regularly available in hospital so all most all had to purchase drug from the shop when not available at hospital.

Aspirin & clopidogrel non-responsiveness & its association with genetic polymorphisms in patients with myocardial infarction

Background & objectives: Cytochrome P450, P2Y 12, cyclooxygenase-1 (COX1) and glycoprotein V1 (GPVI) gene polymorphisms are known to affect patient responsiveness towards aspirin and clopidogrel dual antiplatelet therapy (DAPT). The present study was undertaken to identify aspirin and clopidogrel non-responsiveness and its association with genetic polymorphism in patients with myocardial infarction (MI). Methods: A total of 207 MI patients who were on DAPT, were included. The DAPT non-responsiveness was determined by light transmittance aggregometry using arachidonic acid and adenosine diphosphate and high platelet reactivity by collagen. Platelet activation biomarkers, thromboxane B2 (TxB2)andsoluble CD40 ligand (sCD40L) were measured in plasma. Patient compliance was checked by estimating drug and its metabolite levels (aspirin and clopidogrel) in plasma using liquid chromatography-mass spectrometry/mass spectrometry. Genomic DNA was extracted, amplified by polymerase chain reaction and subsequently sequenced to identify CYP450, P2Y 12, COX1 and GPVI gene polymorphisms. Results: Of the 207 patients, 32 were non-responders. The DAPT non-responsiveness was found in 15.5 per cent patients. The non-responsiveness showed a significant and an independent association with gender [odds ratio (OR)=0.18, 95% confidence interval (CI)=0.01-0.78, P=0.023], TxB2(OR=1.00, 95% CI=1.00-1.01, P=0.013), CYP2C19*2 G>A (OR=3.33, 95% CI=1.04-10.69, P=0.044) and GPVI T>C (OR=0.23, 95% CI=0.08-0.67, P=0.007) after adjusting the demographic, clinical and genetic confounding factors when assessed between non-responder and responder compliant patients. Interpretation & conclusions: The study showed a significant association of genetic polymorphisms (CYP2C19*2 G>A and GPVI T>C) with DAPT non-responsiveness in MI patients. The findings of this study need further validation in a large cohort of patients with clinical follow up.

Effect Evaluation of PBM Pilots in Wuhu City of Anhui Province from the Perspective of Patients / 中国药房

OBJECTIVE： To evaluate the effects of Pharmacy Benefit Management （PBM） model on drug compliance， health outcomes， economic burden and satisfaction of patients in Wuhu city of Anhui province. METHODS： In cross-sectional study， the questionnaires were designed according to the National Health Service Survey. Through cluster sampling and convenient sampling， the questionnaire survey （including subjective evaluation） was conducted among hypertensive patients who participated in or did not participate in the PBM program in pilot area of Wuhu city. Descriptive analysis was used to analyze the general characteristics of the two groups. The Propensity Score Matching （PSM） was used to approximately randomize the included data to balance the baseline characteristics. Univariate linear regression or Logistic regression analysis were used to evaluate the relationship of whether to join PBM or not with drug compliance，QALY， hospitalization probability，monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases， etc. RESULTS： A total of 755 valid questionnaires were collected， including 405 in the PBM group and 350 in the non-participating group. There was statistical significance in patient’s gender， age， education degree， nature of household registration， type of medical insurance or usual visited medical institutions （P＜0.05）. About 95％ patients （405 cases） satisfied with PBM program. 281 cases of PBM group and 193 cases of non-participating group were included through PSM. Results of regression analysis showed that lower one level at least of medication compliance in PBM group was 0.49 times as that in the non-participating group； the hospitalization probability in PBM group was 0.56 times as that in the non-participating group （P＜0.05）. There was no statistical significance of difference in control of blood pressure QALY， monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases between two groups （P＞0.05）. CONCLUSIONS： The implementation of PBM model in pilot areas can improve drug compliance and reduce hospitalization rate of patients. The most patients are highly satisfied. However， the effects of PBM on patients’ control of blood pressure， QALY and medical expense are not obvious， and its long-term effect needs more follow-up studies to verify.

Analysis on English Literature of Prescription Refills for Chronic Diseases / 中国药师

Objective:To search the English literatures on prescription refills for chronic diseases for a systemic analysis and to explore the mode and the management measures in order to develop the prescription refill and medication therapy management service for patients with chronic diseases in China .Methods:In the pubmed database , the literatures related to prescription refills published before April 2016 was retrieved.The literatures were analyzed by classification of country or region , the types of drugs and the other in-formation.Results:It was found that the United States , Britain and Sweden were the countries with the most prescription refills .The medications for hypertention , diabetes , hyperlipidemia and other chronic diseases respectively were the most types of medications men -tioned.Age, educational level, race, language, type of medication, and so on.were the factors that affected patient compliance . Pharmacists played a role in auditing , intervention and follow-up in prescription refills programs .Conclusion: The programs of pre-scription refills is well developed in America and Europe , which may be a good way to solve the demand in long-term caremedication therapy for those patients in China .

Effect of comprehensive intervention on the drug compliance in patients with hepatitis B virus-related hepatocellular carcinoma after receiving TACE / 介入放射学杂志

Objective To investigate the effect of comprehensive intervention led by nursing staffers on the drug compliance in patients with hepatitis B virus-related hepatocellular carcinoma (HCC) after receiving transcatheter arterial chemoembolization (TACE) treatment.Methods By using random sampling method,a total of 96 patients with hepatitis B virus-associated HCC,who had been treated with TACE and had taken nucleotide analogue drug for one month in the interventional department of a certain grade Ⅲ tumor hospital,were enrolled in this study.Under the premise of informed consent,comprehensive intervention,which was led by nursing staffers and was participated by both doctors and nurses,was conducted.Results After comprehensive intervention,the average score of drug compliance was (93.670±6.046) points,while the pre-intervention average score of drug compliance was (82.040±10.024) points,the difference between the two was statistically significant (P＜0.05).The ratio of patients who showed good drug compliance changed from pre-intervention 62.4％ to post-prevention 97.8％(P＜0.05).The post-prevention of patients,whose hepatitis B virus deoxyribonucleic acid (HBVDNA) level was within the normal range,was 45.16％,which was highcr than the pre-intervention ratio of 15.05％,the difference between the two was statistically significant (P＜0.05).Conclusion The comprehensive intervention led by nursing staffers can effectively improve the drug compliance in patients with hepatitis B virus-associated HCC after receiving TACE,and can reliably control serum HBVDNA level as well.

The effect of the Omaha -system -based interference on the drug compliance in chronic cardiac failure patients with clinic service / 中国基层医药

Objective To evaluate the effect about medication compliance for patients with chronic heart failure in outpatients using nursing intervention model based on Omaha system.Methods 100 patients were randomly divided into observation group(50 patients)and control group(50 patients).The two groups of patients were given routine nursing intervention,the observation group also used the Omaha system to develop care programs on this basis, and was given the implementation about continuity of care.Results On the point of the two or three months after the patients were discharged,the AHFKT -V2 questionnaire scores in the observation group[(17.690 ±1.892)points, (20.900 ±2.052)points]were significantly higher than the control group[(14.080 ±2.374)points,(18.450 ± 1.781)points],the differences were statistically significant (t =-8.488,-6.442,all P <0.05).However,the same as the points after the patients were discharged,Morisky questionnaire scores in the observation group[(1.036 ± 0.780)points,(0.487 ±0.260)points]were significantly lower than the control group[(1.54 ±1.182)points, (0.920 ±0.804)points],the differences were statistically significant(t =3.420,4.965,all P <0.05).Conclusion The use of Omaha system to develop the targeted continuity of care,can improve the patients medication compliance.

Patient based factors influencing drug compliance among hypertensive patients in a tertiary care hospital in Mysore.

Background: Hypertension is deemed as the tip of the iceberg due to the mortality and morbidity associated with it. A major factor accounting for inadequate treatment of hypertension is poor compliance. Methods: Morisky 8-Item Medication Adherence Questionnaire was used for a cross sectional study. The term compliance is defined as the extent to which the patient’s behaviour coincides with the clinical prescription, implying that the patient defaults by not following the advice of the health care provider Results: Mean age of the participants was 59.2yrs (S.D. 10.37 yrs). Compliance was found to be good 71.3% of respondents, medium in 20.4% and poor in 8.3%.52.8% had one or two other ailments (diabetes, asthma etc.). Conclusions: Patient’s medication compliance is a multifactor behaviour in which the role of patient’s attitude is very important. Patients related factors known to affect compliance were equally distributed among good, medium and poorly compliant participants

Assessment of Dietary and Drug Compliance among Diabetic Pregnant Women Attending Antenatal Clinic in Nigeria.

Aims: The negative impact of the gestational diabetes mellitus (GDM) on the maternal and fetal health is well documented. The study assessed dietary and drug compliance in 52 diabetic pregnant women attending antenatal clinic. Study Design: The survey research design was used. Primary data was collected from surveyed participants. Place and Duration of Study: Adeoyo Maternity Teaching Hospital in Ibadan, South West Nigeria, between November 2014 and March 2015. Methodology: The participants for the study were purposively selected. Out of the 60 diabetic pregnant women attending antenatal in the hospital, 52 consented to participate in the study. Data were analyzed using descriptive statistics and regression analysis. All analyses were set at p≤0.05 level of significance. Results: Results showed that the women were below 35 years old and 81% had above secondary education. Most of the respondents earn below the national minimum wage per month of N18,000 (~$ 91) and 50% of the respondents reported to have the history of parents with diabetics. Most of the respondents showed good compliance for medication and most of the dietary recommendation. However, the respondents displayed poor compliance for the consumption of high cholesterol meat (52%), nuts and legumes (44%) and sweeteners (52%). Factors which positively and significantly influence dietary compliance included age of respondents, educational level and family history of diabetics while pregnancy stage negatively influence dietary compliance. Drug compliance was positively and significantly influenced by educational level, income level and family history of diabetes. Conclusion: More attention should be placed on better monitoring of the dietary regimen for diabetic pregnant women attending antenatal by qualified diet educator or dietician.

Responses to glycemic control therapy according to age, gender, level of adiposity, and duration of diabetes in type 2 diabetic patients.

Context: It is established that glycemic control measures involving diet and oral medication reduces glycated hemoglobin concentration (HbA1c) in type 2 diabetic patients. AIMS: To determine whether glycemic levels after diabetic treatment is affected by age, gender, obesity, and diabetic duration in type 2 diabetic patients. Settings and Design: A total of 52 type 2 diabetic patients participated in a 12-week diabetic management therapy involving oral medication (metformin) and lifestyle intervention (diet). Materials and Methods: We compared the glycated hemoglobin reduction after treatment between the elderly and non-elderly; males and females; obese and non-obese; and newly diagnosed and long-standing diabetics.Results: After the diabetic treatment, participants' mean HbA1c level indicated a reduction of 1.1 ± 1.31%, weight loss of 2.46 ± 1.79 kg, and BMI reduction of 0.94 ± 0.69 kg/m 2 . A total of 23 (44.2%) patients had an acceptable HbA1c level of <</i>6.5%. Significantly greater HbA1c reduction was observed in non-elderly, non-overweight/obese, and newly diagnosed diabetic patients compared to the elderly, overweight/obese, and long-standing diabetic patients respectively (P < 0.05 or P < 0.01). HbA1c reduction did not indicate sex differences. Conclusion: The present findings suggest lower responses to glycemic control therapy in elderly, overweight/obese, and long-standing diabetic patients when compared to the non-elderly, non-overweight/obese, and newly diagnosed diabetic patients. It is recommended that treatment criteria for type 2 diabetes should account for the age, level of adiposity, and diabetic duration of the patient in order to make optimal therapeutic decisions for the treatment of diabetes mellitus in adults.

Prescription Audit and the Compliance of Medicines Prescribed in Pregnant Women.

Proper use of medicines can be ensured in the society through various ways. Scientific and rational prescription is one of them, but at the same time judicious use of medicines by the patients is also equally important. Compliance of therapy can determine fate of any medicine. This study was planned to explore some important aspects of use of medicines in pregnant women in remote villages of India. This was an observational, cross sectional study using face to face interview of the pregnant ladies and also auditing the prescriptions available from them. Present study revealed that the average age of the study population was 23.6 years and primi-gravida (51.4%) constituted slight majority over multi-gravida. Most commonly prescribed medicine during pregnancy was iron, folic acid (79%) and injection tetanus toxoid (91%). A large number of pregnant women (37.5%) were non compliant with the medicine prescribed for them. In modern therapeutics, drugs or medicines play an important role in the health of any individual. But at the same time its proper use should be ensured. This study showed the importance of use of medicines by the patient. Judicious use of scarce resources on medicines not only improves the quality of therapy but also the quality of life.

Effects of Psychoeducation Program on Insight and Treatment Attitudes in Patients with Schizophrenia, Schizophreniform Disorder, and Schizoaffective Disorder / 대한정신약물학회지

OBJECTIVE: This study aimed to confirm effectiveness of psychoeducation program on insight and treatment attitudes in patients with schizophrenia, schizophreniform disorder and schizoaffective disorder. METHODS: Seventy eight psychotic patients who were diagnosed as schizophrenia, schizophreniform disorder, and schizoaffective disorder by Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM-IV TR) were included. Subjects who decline more than 30% compared with baseline in Positive and Negative Syndrome Scale (PANSS) scores participated in psychoeducation program. Insight and Treatment Attitudes Questionnaire (ITAQ) and Drug Attitude Inventory (DAI) were assessed at pre-psychoeducation, post-psychoeducation and 2 months after discharge to estimate insight and treatment attitudes. RESULTS:There were significant improvement in ITAQ and DAI scores at post-psychoeducation and 2 months after discharge. Increase in DAI scores related with high ITAQ scores at post-psychoeducation. Small changes in PANSS scores and ITAQ scores at post-psychoeducation had positive relationship. Subjects of late onset of illness and female took better ITAQ and DAI scores after psychoeducation. CONCLUSION: This study showed that psychoeducation program would be effective for insight and treatment attitudes in patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder.

Predicting Factors Associated with Drug Compliance in Psychiatric Outpatients of a University Hospital / 대한정신약물학회지

OBJECTIVE: Drug compliance is closely related to progress and prognosis of psychiatric disease. We investigated drug compliance in psychiatric outpatients and factors that influence their compliance. METHODS: Patients who visited a university hospital were asked about drug information and drug compliance using questionnaires. Medical records of the patients were reviewed. Demographic variables, clinical characteristics and drug compliance related variables were compared between non-compliance group and compliance group. Logistic regression analysis was performed to clarify predictors of poor compliance. RESULTS: One hundred eighty one patients participate in this study. 150 patients (82.9%) were compliance group, 31 patients (17.1%) were included in non-compliance group. Patient-related, illness-related and treatment-related factors, DAI total score and knowledge of side effect did not show any difference in both groups. However, illness severity was relatively higher in non-compliance group (p = 0.070) and patient's satisfaction about explanation of side effect was lower in noncompliance group (p = 0.061). Moreover, patients who negatively answered for question about negative recognition to psychiatric medication in DAI questionnaire were more common in non-compliance group (p = 0.075). In logistic regression, answering negatively to question about negative recognition to psychiatric medication in DAI questionnaire was related to non-compliance, but did not reached statistical significance (p = 0.086). CONCLUSION: This study suggests that improving negative recognition about psychiatric medication through drug education and good doctor patient relationship could enhance drug compliance.

Study of the Compliance of Hypertensive Medication / 药物流行病学杂志

Objective:To investigate the influencing factors and medication compliance of hypertension.Method: 3 grade-Ⅲand 15 grade-Ⅱgeneral hospitals in Anhui Province were selected by random sampling.732 outpatients with a hypertension course of 6 months or above were interviewed during July and October of 2004 with the medication compliance schedule.All data were input into computers with the software Epi info 6.04,and analyzed with SPSS 11.5.Result:①The medication compliance schedule had high reliability and validity,which could be used in the surveys of medication compliance of hypertension.②The medication compliance rate of the 732 patients was only 46.4%.③Trust in medical pro- fessionals,more attention paid to the disease,more knowledge of non-compliance harm,satisfactory family income,and longer consulting time were the common advancing factors in improving the medication compliance,but a longer duration of the medication regimen,a larger number of preparations and drugs,and higher frequency of taking medicine were the bloc- king factors.Conclusion:The medication compliance of hypertensives was generally not good,and it was influenced by many factors.It is necessary that medical professionals,patients,families and society all take part in its improvement.

Analysis of Drug Compliance in Adult Patients with Bronchial Asthma / General Medicine

BACKGROUND: In Japan, there have been few reports about drug compliance, which is an important determinant of effectiveness, in the management of bronchial asthma patients. To clarify drug compliance and its relationship with various aspects of asthma management, a questionnaire survey was performed on asthmatic patients and their pharmacists.<BR>METHODS: This survey was carried out, from October to November in 2001. The subjects were limited to the regular inhaled corticosteroid (ICS) users, and were restricted to patients whose medication had not been changed for at least 6 months before the survey. The questionnaires inquired about asthma status, various factors that have been reported to be associated with drug compliance and asthma management. Patients' pharmacists were asked about prescribed medications and drug compliance based on the pharmaceutical records.<BR>RESULTS: Completed questionnaires were received from 610 patients. ICS compliance was not lower than that of anti-allergic drug but lower than that of oral sustained-released theophylline (OSRT) . Multiple regression analysis revealed a significant correlation between ICS and OSRT compliance.<BR>CONCLUSION: These results might suggest that OSRT could improve patient's compliance to drug therapy through its bronchodilatory effect, thus resulting in better compliance to ICS. If this were the case, OSRT would play an important role in asthma management.

Predicting Factors Associated with Drug Compliance in Manic Patients / 신경정신의학

OBJECTIVES: Drug compliance is the most important issue in long-term treatment outcome and prognosis of manic patients. Up to date, there has been no study about drug compliance at the point of the first manic episode and subsequent maintenance period. And also there are limited data regarding the rates of noncompliance in patients with bipolar disorder and schizoaffective disorder in Korea. So the author studied about the rate of noncompliance in manic patients and about the clinical predicting factors associated with their drug compliance. METHODS: Compliance of a patient was assessed by patient's report, family member's report, treater's estimation, investigator-administered questionnaire, record of unkept appointment and plasma concentration of mood-stabilizer. Data about patient-related, illness-related and treatment-related factors of compliance were collected by the review of medical records and interview with the patient. RESULTS: Forty patients (56.3%)were noncompliant with their pharmacologic regimen at the point of the first treatment period. Noncompliance was significantly associated with experience of childhood stressful life events(p=.035) presence of psychotic symptoms(p=.020)and treatment with combination of mood-stabilizers(p=.002) CONCLUSION: Patients who experienced serious life event in their childhood, had delusion or hallucination during the manic episode, or received the combination therapy of mood-stabilizer are prone to fail in treatment adherence.