First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study

Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.

The Scale of Quantitative Assessment Adherence to Treatment «QAA-25»: Updating of Formulations, Constructive and Factor Validity and a Measure of Consent

Aim: To update the definitions of selected questions of the "QAA-25" (quantitative adherence assessment) scale and evaluate it according to the criteria of validity and measure of agreement.Materials and Methods. In a descriptive cross-sectional study including 200 patients with coronary heart disease, adherence was determined using traditional and alternative versions of selected questions of the QAA-25 scale, followed by assessment of construct validity, factor validity, and measure of agreement.Results. Alternative question versions did not significantly affect test results, with 81% of respondents in the outpatient sample and 69% in the inpatient sample rating them as "more acceptable." The QAA-25 scale has good construct and internal validity (α – 0.818, αst – 0.832), with moderate agreement (κ – 0.562) and demonstrates high reliability of internal validity – when scale items are consistently excluded, α values remain in the 0.801-0.839 range.Conclusion. The QAA-25 scale with modified question definitions should be used instead of the previous version of the scale. Good construct validity and factor validity, sufficient measure of agreement and specificity, high sensitivity and reliability of the QAA-25 scale allow to recommend it as a tool for assessing adherence to drug therapy, medical support, lifestyle modification and integral adherence to treatment in scientific and clinical practice.

Development of pharmaceutical care tools for people living with HIV treated at a medium- and high-complexity hospital

The exposure of people living with HIV (PLHIV) to antiretrovirals (ARV) can cause significant adverse effects, contributing to their low adherence to treatment. The pharmacist can contribute to the optimization of PLHIV drug therapy through pharmacotherapeutic monitoring, favoring adherence to ARV therapy and, consequently, suppression of the viral load. The objective of the present study was to develop a pharmacotherapeutic monitoring routine for PLHIV in outpatient follow-up at a medium- and high-complexity hospital in the city of Rio de Janeiro. This is an experimental development project that consists of using knowledge from practical experience and research from the specialized literature to subsidize the structuring of a new service to support PLHIV. The work was divided into three parts: development of the necessary instruments for pharmaceutical care, elaboration of standard operating procedures (SOPs) for patient care, and testing of routines and work tools. The educational leaflets for patients and information boards were developed through a literature search, whereas the pharmaceutical documentation instruments and SOP were developed through adaptations of the Dáder Method. All work instruments were subjected to a test to evaluate the need for changes to improve the service.

Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review

Background Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. Objective This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. Methods Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. Results Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. Conclusions This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling.

Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies

Introduction Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis. Results A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: −2,74; 95% CI: −3.39 to −2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10). Discussion The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.

Evaluation of hemostasis parameters after mitral valve replacement surgery with mechanical prostheses in patients with different treatment adherence

The aim of the study. To analyze the indicators of hemostasis with adherence to treatment in patients operated on for mitral valve prosthetics with mechanical bicuspid prostheses in dynamics after 6, 12 and 60 months.Materials and methods. The study included 260 patients who underwent surgery for prosthetics with mechanical prostheses. Patients’ adherence to treatment was assessed using the Morisky – Green test. The following hemostasis parameters were analyzed: international normalized ratio (INR), activated partial thromboplastin time (APTT), D-dimer, fibrinogen and soluble fibrin-monomer complexes.Results of the study and conclusion. At all stages of the postoperative period, the hemostasis indicators of compliant patients corresponded to the reference values for people receiving anticoagulants, in non-compliant patients, these indicators did not reach the recommended values for patients on anticoagulant therapy. The presence of correlations between compliance and hemostasis indicators is evidenced by the results of correlation analysis. In most cases, the maximum strength of the relationship between compliance and hemostasis indicators was observed after 12 months of follow-up. A noticeable strength of interrelations was traced between compliance and levels of APTT, INR and fibrinogen.

Comparative Pharmacotherapy of Hypertension

The purpose of the study. This study aims to review the practice of the utilization of antihypertensive drugs of various pharmacological groups within the condition of the therapeutic hospital in Ukrainian and Egyptian patients, adherence to treatment in patients with hypertension in Ukraine and Egypt. Materials and methods. A study of 120 patients who were treated for hypertension II stage in a therapeutic hospital in Ternopil and Cairo was conducted. All subjects completed a questionnaire that included personal, socio-demographic, and medical data. The number and type of hypotensive drugs or drug combinations were analyzed. Results and discussion. Regarding the pharmacotherapy of hypertension the use of β-blockers among Ukrainian participants did not differ from Egyptian. The use of calcium channel antagonists was a little bit higher among Egyptians than Ukrainians. Diuretics were used more often by Ukrainians than by Egyptians. The use of ACEI/ARBs surpassed the use of all other classes of antihypertensives among both groups. Whereas the ACEI/ARBs use among Egyptians was lower than Ukrainians. In this study we conducted a determination of compliance which was defined as an act of adhering to the regimen of care recommended by the clinician and persisting with it over time. The majority of Ukrainian and Egyptian patients with hypertension do not always perform the doctor's prescription. The reason for the unfull implementation of medical prescriptions with the same frequency was called deficiency of funds and forgetfulness. Near 80% of Ukrainian respondents are ready to complete the prescription with understanding, however, 14% of the patients stated that they were not always ready to fulfill the prescription, and the smallest part of patients did not think it was necessary to follow the regularity of treatment and treatment regimen. We noted no significant difference in the adherence to antihypertensive therapy between Ukrainian and Egyptian participants. Early discontinuation of treatment and suboptimal daily use of the prescribed regimens are the foremost common facets of poor adherence to treatment as well as non-adherence to antihypertensive therapy correlates with a better risk of cardiovascular events. Conclusion. ACEI/ARBs are the most commonly used group of antihypertensive drugs among Ukrainian and Egyptian patients. The majority of Ukrainian and Egyptian participants with hypertension do not always perform the doctor's prescription. Only 50% had an objective reason for insufficient compliance

Influence of Clinical Anamnestic and Psychological Factors on Adherence to Treatment of Patients with Chronic Obstructive Pulmonary Disease

The purpose of the study was to determine the influence of various factors on the level of adherence to treatment in patients with chronic obstructive pulmonary disease. Materials and methods. We examined 75 people with chronic obstructive pulmonary disease aged 45 to 65 years. In the study we used clinical examination of patients, laboratory, instrumental research methods, analysis of medical records, statistical-analytical, as well as clinical-psychopathological and psychodiagnostic methods (Morisky Medication Adherence Scale, determination of the level of subjective control, anxiety with Spielberger-Khanin method, the level of depression in the Beck questionnaire). Results and discussion. According to the results of the testing, three groups of patients were identified: 24% of patients with high, 32% of medium and 44% of low adherence to the treatment. Comparing our results with the literature, we can confirm data on a relatively low level of adherence to treatment among patients with chronic diseases, in particular chronic obstructive pulmonary disease. According to anamnestic data, patients with a high level of adherence to treatment were mostly married (61.11%) and had higher education (50%). Clinically, they belonged to group C (50%) with severe III airway obstruction (50%). These patients expressed high satisfaction with the inhaler (61.11%) and regularly communicated with the doctor (72.22%) (p <0.05). Regular communication of the patient with the doctor and satisfaction with their inhaler has an extremely significant impact on the level of adherence to treatment. According to a psychological study, these patients had an external type of subjective control (66.67%), a high level of personal anxiety (50%) and a pronounced level of depression (38.89%) (p <0.05). Numerous scientific studies on the impact of patients' commitment to the treatment of psychological factors, especially the level of personal anxiety and depression, contain a wide variety of data, which may indicate the extremely complex nature of each individual. Patients with a low level of adherence to treatment had difficulty using an inhaler (60.61%) and insufficient communication with a physician (69.70%) (p <0.05). In addition, according to psychological research, they had an internal type of subjective control (57.58%), low levels of personal anxiety (42.42%), severe (45.46%) and moderate levels of depression (42.42%) (р <0.05). Conclusion. Thus, the level of adherence to treatment in the examined patients with chronic obstructive pulmonary disease is low. This is influenced by a large number of socio-demographic, clinical-anamnestic and psychological factors

Diluted benznidazole decreases side effects in animals infected by Trypanosoma cruzi and treated with benznidazole in ponderal dose

Background: The infection caused by the protozoan Trypanosoma cruzi affects millions of people around the world and the benznidazole is the only drug available for the etiological treatment, despite the fact that its adverse effect makes the adherence to treatment more difficult. Taking advantage of the antiparasitic effect of benznidazole and minimizing its side effects, without causing discomfort symptoms to the patient, would be an important progress in the health care of individuals infected with T. cruzi. Aim: The aim of this study was to evaluate the effect of different treatment regimens using diluted and ponderal benznidazole, associated or not, in murine infection with T. cruzi. Methodology: A hundred male Swiss mice 28 – year – old infected with 1400 blood trypomastigotes of the Y strain of T. cruzi, were used in the experiment, divided into groups according to the treatment: Control (CI) - infected animals treated orally with 7% hydroalcoholic solution (vehicle of product preparation highly diluted) (N = 20); BZp - infected animals treated with BZ in ponderal dose (100 mg/kg/20days) from the detection of the infection (N = 20); BZh - infected animals treated with BZ highly diluted (30x) from the detection of the infection (N = 20), BZp+h - infected animals treated with a combination of BZ highly diluted (30x) + BZ in ponderal dose (100 mg / kg), from the detection of the infection (n= 20); BZp+hT4A - infected animals treated with the association of BZ in ponderal dose (100 mg / kg ) from the detection of the infection and BZ highly diluted (30x) four days after starting the treatment with BZp (N = 20). Clinical (body weight, water and food intake, amount of feces, temperature, aspect of the fur, mortality and survival time) and parasitological (total parasitemia and area under the parasitemia curve) parameters were evaluated. Results: It was observed a reduction of side effects associated with clinical improvement of the animals treated with the combination of BZ in ponderal dose and highly diluted given 4 days after (BZp+hT4A) or concurrently (BZp+h) with the beginning of the treatment with benznidazole in ponderal dose, with results statistically better than those observed in groups BZp, BZh e CI (p0.05). In the group treated only with the BZ ultradiluted (BZh) the parasitemia remained high, resulting in the death of all animals within a period of 20 days as observed in the CI. Conclusions: The reduction of side effects, the improvement of the clinical evolution and non-compromising the parasiticide effect, show that the association of the benznidazole medication in ponderal dose and highly diluted should be further explored. Keywords: Homeopathy, Trypanosoma cruzi, Side effects, Benznidazole References MINISTÉRIO DA SAÁDE. Secretaria de Vigilância em Saúde. Brazilian Consensus on Chagas Disease. Rev. Soc. Bras. Med. Trop. 2005; 38:7-29. WHO. World Health Organization. Sixty-third World Healthy. Assembly. Chagas disease: control and elimination. 2010.