Improved medication adherence in COPD patients using tiotropium or tiotropium olodaterol with the HealthPrize digital behavior change program.

OBJECTIVE: To assess the impact of the HealthPrize RespiPoints™ program on treatment adherence and persistence in adults with chronic obstructive pulmonary disease (COPD). METHODS: In this retrospective cohort study, program participants and nonparticipants receiving tiotropium bromide (TIO) or TIO and olodaterol between 1 January 2015-31 March 2020 were propensity score matched (PSM), from the linked database of the HealthPrize patient list and IQVIA PharMetrics® Plus. Treatment adherence, persistence, healthcare resource utilization, and costs were compared. Multivariable logistic regression models assessed the odds of adherence (≥80% proportion of days covered [PDC]), adjusted risk of discontinuation, and adjusted total healthcare costs. RESULTS: Program participants (n = 262) demonstrated a 44% greater adherence during followup than nonparticipants (n = 262) (mean [standard deviation] PDC: 0.72 [0.27] vs 0.50 [0.36], p < 0.0001). Participants had higher odds of adherence vs nonparticipants (adjusted odds ratio: 2.51; 95% confidence interval: 1.72-3.66, p < 0.0001) and a lower percentage of participants discontinued their index medication (19.85% vs 33.59%, p = 0.0004). Fewer participants were hospitalized during follow-up (13.74% vs 17.56%, p = 0.23); adjusted total medical costs were 24% lower (p = 0.08). Higher pharmacy costs partially offset lower healthcare costs. CONCLUSIONS: Program participants showed improved COPD medication adherence and persistence compared to nonparticipants.

Temporal lobe tumoral epilepsy: characteristics and predictors of surgical outcome.

OBJECTIVE: To review the clinical and neurophysiologic features and surgical outcome in patients with intractable temporal lobe tumoral epilepsy. METHODS: Patients with intractable temporal lobe epilepsy who underwent resection of temporal lobe tumors, confirmed by surgical pathology, seen between 1985 and 2000 at Yale University School of Medicine Epilepsy Center, were selected. Medical records were reviewed for age at diagnosis, age at onset of seizures, delay between seizure onset and tumor diagnosis, types and frequencies of seizures, EEG results, use of anticonvulsants, extent of surgery, and pathologic diagnosis. RESULTS: Sixty-eight patients were identified, 94.1% of them with low-grade tumors. Complex partial seizure was the most common seizure type. All patients underwent at least one surgical procedure with average follow-up of 9 years after surgical intervention. Eighty-seven percent of patients had significant postoperative seizure improvement (Engel's classes I and II). Gross total tumor resection predicted postoperative seizure freedom (p = 0.002), whereas patients with early surgical intervention, auras, and simple partial seizures had a tendency toward better seizure outcome. CONCLUSIONS: Long-term follow-up of patients with intractable temporal lobe tumoral epilepsy suggests good response of seizures to surgery, which is unrelated to age at diagnosis, EEG, or pathology. Extent of tumor resection was significantly predictive of outcome, whereas early intervention and presence of simple partial seizures showed trends as predictive factors.

Surgery for focal cortical dysplasia.

Interest in surgery for focal cortical dysplasia has grown with the enhanced ability to detect these lesions preoperatively with modern imaging techniques. This article focuses on the surgical management of epilepsy associated with focal cortical dysplasia. The authors highlight the approaches practiced at Yale University, review their recent series of operative cases, and discuss a representative case example to illustrate important aspects of surgical strategy.