Renal transplant patient compliance with free immunosuppressive medications.

BACKGROUND: Noncompliance with immunosuppressive medications after renal transplantation is believed to be a major cause of allograft rejection and graft loss, with the impressive costs of these agents considered a significant reason for noncompliance. Our purpose was to determine the compliance rates of renal transplant patients who received their immunosuppressant therapy free of charge and evaluate their patterns of compliance. METHODS: All patients who received a renal transplant and received their immunosuppressant medications at our institution for their first year posttransplant were included in the study. Compliance rate was calculated and serum immunosuppressant concentrations were obtained to validate compliance assessments. RESULTS: Eighteen patients were included in the study. Approximately 48% of noncompliant patients were found to have subtarget drug concentrations, although only 14% of compliant patients had subtarget levels (chi2=12.9, P<0.001). At 5 months posttransplant, 95% of the patients remained compliant; however, by 12 months posttransplant, only 48% of the patients remained compliant. The mean time to the first noncompliant month was 9.8 months (95% confidence intervals=8.60-11.0). CONCLUSIONS: Patients who received their immunosuppressants free of charge were generally compliant within their first year of transplantation, however, compliance tended to decrease over time. This suggests that drug cost alone does not explain noncompliant behavior. Intensive efforts to increase medication compliance before month 8 posttransplantation should be implemented.

Cognitive and emotional changes during a simulated 686-m deep dive.

Three experienced divers were subjected simultaneously to world record hyperbaric pressures using an oxygen-helium-10% nitrogen breathing mixture. The simulated depth reached by these divers was 686 m (2250 ft). Cognitive and emotional state measures were obtained predive, during compression, decompression, and postdive. Although the divers showed no overt signs of nitrogen narcosis or HPNS, declines in memory, adaptive, and spatial functions were seen at 670 m. These performance deficits were reversed when the divers returned to surface pressures. The observed declines in performance are discussed in light of their implications for future dives.

Behavioral assessment technique as a clinical intervention.

Behavioral assessment procedures have been used to predict the onset of addictive behaviors. However, no controlled studies have been conducted to demonstrate the usefulness of such procedures in the treatment of drug abuse. A group using the Behavioral Assessment Technique (BAT) as an indicator for clinical intervention was compared to a group in which the BAT was not used clinically. The results indicated that the BAT was not particularly effective for clinical purposes. This failure was independent of the BAT's accuracy in predicting drug usage. Alternative hypotheses were discussed.

Two methods of predicting drug-taking.

A behavioral analysis technique was compared to detoxified heroin addicts in their ability to predict drug behavior. It was found that the behavioral analysis technique was more successful than the heroin addicts in predicting drug-taking. Moreover, this difference was more pronounced when only transition drug usage (a drug-use week preceded by one or more drug-free weeks) was considered. The use of the behavioral analysis technique, as part of an intervention system, was discussed.