Medication adherence and activity patterns underlying uncontrolled hypertension: Assessment and recommendations by practicing pharmacists using digital health care.

OBJECTIVES: This report summarizes the first use of a digital health feedback system (DHFS) by practicing pharmacists to establish evidence-based blood pressure (BP) management recommendations. SETTING: Fifteen commercial pharmacies and 39 patients in the Isle of Wight participated. PRACTICE DESCRIPTION: The pharmacists were experienced in providing New Medicine Services to patients in their communities. PRACTICE INNOVATION: The pharmacists utilized a commercially available DHFS. The DHFS utilized FDA-cleared and CE-marked class 2 medical devices passively captured and shared information about medication-taking using an ingestible sensor, and daily patterns of rest, activity, and exercise using a wearable patch that incorporates an accelerometer. INTERVENTIONS: Pharmacists provided targeted counselling for BP management as guided by the digital information. EVALUATION: Blood pressure was measured serially, and patient and provider experiences with DHFS use were assessed using satisfaction surveys. RESULTS: The mean change in SBP over the 2-week evaluation period was -7.9 ± 22.1; mean change in DBP was -2.8 ± 12.9. A root cause for persistent hypertension was determined for all of these 34 patients: 68% had pharmaceutical resistance, and 32% had inadequate medication use. Specifically, 29% were found to be capable to achieving blood pressure control on their currently prescribed medications, 68% were found to have a need for additional pharmacological treatment, and 3% needed additional adherence support. Pharmacists found that the DHFD helped in targeting specific recommendations, and to create a collaborative experience with their patients. Patients found the experience to be positive and helpful. CONCLUSION: DHFS that provides confirmation of medication taking and objective measures of lifestyle patterns can help pharmacists to identify specific factors contributing to uncontrolled hypertension, to make evidence-based prescribing and lifestyle recommendations for achieving treatment goals, and to create a collaborative experience for patients in the management of their self-care.

Body mass index continues to accurately predict percent body fat as women age despite changes in muscle mass and height.

OBJECTIVE: Body mass index (BMI) is commonly used to predict obesity in clinical practice because it is suggested to closely correlate with percent body fat (%BF). With aging, women lose both lean mass and height. Because of this, many clinicians question whether BMI is an accurate predictor of obesity in aging women. In evaluating the equation for BMI (weight/height(2)), it is clear that both variables can have a dramatic effect on BMI calculation. We evaluated the relationship between BMI and %BF, as measured by dual-energy x-ray absorptiometry, in the setting of age-related changes in height loss and body composition in women. Our objective is to determine whether BMI continues to correlate with %BF as women age. METHODS: Study participants were identified using data from five osteoporosis clinical trials, where healthy participants had full-body dual-energy x-ray absorptiometry scans. Deidentified data from 274 women aged between 35 and 95 years were evaluated. %BF, weight, age, tallest height, actual height, and appendicular lean mass were collected from all participants. BMI was calculated using the actual height and the tallest height of each study participant. %BF was compared with BMI and stratified for age. RESULTS: BMI calculated using the tallest height and BMI calculated using actual height both had strong correlations with %BF. CONCLUSIONS: Surprisingly, the effects of changes in height and lean body mass balance each other out in BMI calculation. There continues to be a strong correlation between BMI and %BF in adult women as they age.

Vaginal cancer in a patient with complicated prolapse history: a case report.

BACKGROUND: In the setting of multiple pelvic floor procedures, vaginal abnormalities are not unusual. CASE: We present the case of a 59-year-old woman with voiding dysfunction and inability to have intercourse after multiple pelvic floor procedures who presented with a vaginal mass on bimanual examination, thought to be related to prior procedures with permanent sutures. Imaging was obtained, and the lesions were thought to be suture granuloma. She was taken to the operating room for relaxing incision of her posterior repair and excision of suture granuloma. She was found to have squamous cell carcinoma of the vagina. CONCLUSIONS: In the differential of any vaginal abnormality, although rare, vaginal cancer should be included in the differential diagnosis.