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Concepts and Issues in Adherence
Published in Lynn B. Myers, Kenny Midence, Adherence to Treatment in Medical Conditions, 2020
When patient reports have been compared to some objective measure of medicine taking, studies have tended to show that patients are accurate when they say that they have not taken their medication (e.g. Fletcher, 1989). However, for those who state that they have taken their medication as prescribed, often these verbal reports are not confirmed by objective records. For example, in a clinical trial involving nebulized medication for asthma (Spector et al., 1986), adherence was measured by a patient diary and an electronic method which records each inhalation (Nebulizer Chronolog; Advanced Technology Products, Lakewood, Colorado). Results indicated that patients over-reported using their medication over 50% of the time. Similarly, Gordis, Markowitz and Lilienfield (1969) estimated childrens’ adherence to penicillin by urine analysis and mothers’ reports of adherence. They found that the former figure was significantly lower than the latter figure (42% vs 73%).
Conduct of an inquiry into alleged misconduct
Published in Frank Wells, Michael Farthing, Fraud and Misconduct in Biomedical Research, 2019
The second major pitfall is that if the handling of the allegation does not follow due process, maintaining absolute confidentiality, then those specifically involved with the perpetration of the fraud or misconduct may come to hear of the suspicions. This would allow them the time and opportunity to destroy evidence such as forged signatures on consent forms, to create previously missing data such as patient diary cards, or to modify patient records to make it seem that an ineligible (or even fictitious) patient actually did have the condition under investigation in the study. If the fraud were very serious, knowledge that it was soon to be unearthed would give the perpetrator a chance to move away or even leave the country. There have actually been cases of suicide or sudden unexplained death when researchers suspected of serious misconduct believed they were about to be caught out.
Practice information and records
Published in Ray Stanbridge, The Business of Private Medical Practice, 2018
Computerisation is an absolute must for all forward-looking private medical practices. Tailor-made products have been on the market for some time. These include not only the basic accounting records described above, but also facilities for controlling the patient diary, patient records and the general practice management.
Metagenomics study on taxonomic and functional change of gut microbiota in patients with obesity with PCOS treated with exenatide combination with metformin or metformin alone
Published in Gynecological Endocrinology, 2023
Jingwen Gan, Jie Chen, Rui-Lin Ma, Yan Deng, Xue-Song Ding, Shi-Yang Zhu, Ai-Jun Sun
Both groups of patients were measured waist circumference and body weight before and after 12 weeks of treatment, and calculated body mass index (BMI). A standard 75 g oral glucose tolerance test (OGTT) was performed in the morning after overnight fasting for 12 h, and blood glucose and insulin levels were measured at 0, 30, 60, 120 min, respectively. Fasting blood samples were collected from the patients at baseline and 3 months after treatment. The levels of sex hormones were collected during the 2nd and 3rd days of the menstrual cycle from women who showed regular menstruation or on any day for amenorrheic patients. Fasting blood samples were also used to measure the level of glycated hemoglobin (HbA1c), and blood lipids during the menstrual period. Patients can record adverse reaction events in the patient diary.
Asthma control and quality of life in a real-life setting: a cross-sectional study of adult asthma patients in Japan (ACQUIRE-2)
Published in Journal of Asthma, 2019
Mitsuru Adachi, Soichiro Hozawa, Masanori Nishikawa, Atsushi Yoshida, Tatsunori Jinnai, Gen Tamura
There are several possible explanations for the large number of patients with poorly controlled asthma by JGL-based criteria. First, patients may have poor adherence to treatment because they underestimate the severity of their disease [6]. Second, healthcare professionals may not provide adequate instruction regarding correct administration of medication (i.e. proper inhalation technique). It is important to note that in addition to providing in-depth instruction at initial treatment, continuous education is crucial for patients to effectively manage this chronic disease [8]. Moreover, to improve asthma control levels, the selection of appropriate pharmacological and non-pharmacological treatment should be based on regular assessments of control levels, and the application of the GINA control-based management cycle [12]. This cycle involves three main steps: (1) assessment of symptom control and risk factors (including lung function), inhaler technique and adherence, and patient preferences; (2) pharmacological and non-pharmacological treatment adjustment; and (3) review of response based on symptoms, exacerbations, side effects, patient satisfaction, and lung function. Finally, it should be noted that asthma symptoms reported in a daily patient diary differ from those reported in a daily clinical setting.
China STudy of valsartan/amlodipine fixed-dose combination-bAsed long-Term blood pressUre management in HypertenSive patients: a one-year registry (China STATUS III)
Published in Current Medical Research and Opinion, 2019
Yong Huo, Ye Gu, Genshan Ma, Jincheng Guo, Longgen Xiong, Zhurong Luo, Jianhong Xie, Weimin Li, Jianrong Zhao, Xiaowei Yan, Wei Liu, Yawei Xu, Xiaomei Bao, Luosha Zhao, Ming Yang, Bei Wang, The China STATUS III Study Group
Home blood pressure monitoring (HBPM), also called self-measured BP or home self-measured BP, was performed by all patients during the study period. A patient diary was distributed at each visit, to record the HBPM results and drug compliance. The HBPM value was defined as upper-arm BP measured in the morning before taking medicines (6:00 to 9:00), morning BP (10:00 to 11:00), afternoon BP (16:00 to 17:00) and average home evening BP (evening BP [18:00 to 21:00]). BP was measured three times at each time point and, subsequently, the last two measurements were used to calculate the average BP. Patients had to measure BP once every morning and night for 7 days and the average of the later 6 days was considered for assessment. In case BP could not be measured for 7 days, patients could measure BP for at least 3 days and the average of the later 2 days was considered for assessment. BP control based on home BP was defined as average SBP <135 mmHg and average DBP <85 mmHg for each visit. All patients were equipped with verified upper arm full automatic electronic sphygmomanometer (type: HEM-7112). The investigators instructed the patients on how to use the sphygmomanometer at home for BP monitoring. Electronic sphygmomanometers were calibrated before they were provided to the patients.