ObjectiveTo retrospectively collect data on patients with stable chronic obstructive pulmonary disease (COPD), and explore the current status of medication adherence and its main influencing factors in China.MethodsAccording to the principle of convenience, 293 patients with COPD were enrolled in 16 tertiary hospitals located in Nanjing, Hefei, Wuhu, Xuzhou, and Chuzhou. The status quo and influencing factors of medication adherence in COPD patients were identified and analyzed by using the 8-item Morisky Drug Compliance Scale, Beliefs about Medicines Questionnaire, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and modified British Medical Research Council. The analysis was based on the framework provided by the WHO’s "five-dimensional determinants" and the mathematical relationship was demonstrated through sequential logistic regression analysis. ResultsThe medication adherence of the target population is 11.95%. A higher socio-economic status [odds ratio (OR) 0.30, 95% confidential interval (CI) 0.10 - 0.91], patients’ general beliefs about the medication utility (OR 0.29, 95%CI 0.17 - 0.50) and overuse (OR 0.30, 95%CI 0.16 - 0.55) were associated with a lower chance of being adherent in patients with COPD. While disease severity (OR 2.01, 95%CI 1.11 - 3.64) and types of drug use (OR 1.91, 95%CI 1.07 - 3.41) presented opposite results. ConclusionsMedication adherence in domestic patients with COPD is not satisfactory at the present stage. Effective ways to improve patients’ medication adherence and quality of life could be proposed from the national, living environment and individual three dimensions.
Objective To investigate the compliance status of intermittent pneumatic compression device (IPCD) in patients after lumbar surgery, and to analyze the reasons and influencing factors affecting compliance. Methods The continuous enrollment method was used to select patients who underwent posterior decompression for lumbar degenerative diseases in the orthopedic department of Peking Union Medical College Hospital between December 2022 and June 2023. The general information of patients and their compliance with IPCD were collected, and the reasons that affected compliance were analyzed. ResultsA total of 46 patients were included. The overall proportion of patients with good compliance was relatively low, and their compliance was poor. On the first and second day after surgery, the daytime compliance was relatively good (the proportion range of excellent compliance was 39%-52%); the compliance at night was significantly lower than that during the daytime (the proportion range of excellent compliance was 21%-26%); after 3 days of surgery, the patients’ compliance significantly decreased. A total of 460 time periods were observed and 195 reasons for not using IPCD were collected. The main reasons were physical discomfort caused by the device, inconvenience during bedside activities, and little significance to the patient. The compliance of female patients was better than that of males (P<0.05). Patients with education level of primary school and below had the highest compliance, while patients with high school and above had the lowest compliance (P<0.05). There was no statistically significant difference in compliance among patients of different age groups (P>0.05). Conclusions The overall compliance of patients with IPCD after lumbar surgery is poor, which is an urgent clinical problem, and the adaptability and cognitive level of patients to the device are the main factors affecting compliance. In clinical nursing work, men and patients with higher education level should be strengthened.
Objective To investigate the mastery of the management knowledge of patients with atrial fibrillation after coronary artery bypass grafting by cardiac surgeons in Beijing tertiary hospitals, and the practice status and obstacles of following the guidelines for postoperative atrial fibrillation. Methods A convenient sampling method was used to select cardiac surgeons from four tertiary hospitals in Beijing, and a self-designed questionnaire on the management of postoperative atrial fibrillation patients was used. Results A total of 227 valid questionnaires were collected. Only 47.9% of doctors and 12.8% of nurses passed in knowledge, and 31.3% of doctors and 28.5% of nurses passed in behavior. Among them, risk factor assessment, preventive medication, stroke and bleeding risk assessment were the weakest. "Lack of departmental requirements" was identified as a common barrier to healthcare workers' adherence to guidelines. Job title and participation in training were common influencing factors that affected the knowledge and behavior of healthcare workers, and knowledge level was an important factor affecting healthcare worker behavior. Conclusion In order to improve the effect of CABG surgery and improve the quality of postoperative patient management, hospitals should further strengthen the knowledge and skills training of medical staff on the management guidelines of postoperative atrial fibrillation with CABG, formulate relevant systems to ensure the clinical implementation of guidelines.
ObjectiveTo systematically review the effects of adherence therapy in improving medication adherence and clinical outcomes in psychosis patients. MethodsWe searched databases including PubMed, EMbase, The Cochrane Library (Issue 10, 2015), EBSCO, CBM, CNKI, VIP, and WanFang Data from inception to Oct. 2015, to collect randomized controlled trials (RCTs) about adherence therapy for patients with psychosis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs involving 1 244 patients were included. The results of metaanalysis showed that adherence therapy could improve attitude towards medication adherence (MD=3.12, 95%CI 1.26 to 4.98, P=0.001), behavioral adherence (SMD=0.54, 95%CI 0.21 to 0.88, P=0.001), function (SMD=0.42, 95%CI 0.28 to 0.56, P=0.000 01) and insight of diseases (SMD=0.34, 95%CI 0.15 to 0.54, P=0.000 7) in patients with psychosis. But regarding psychotic symptoms, hospital stay, medical costs and adverse drug reactions, adherence therapy did not show benefit (all P values >0.05). ConclusionCurrent evidence shows that adherence therapy could improve medication adherence, function and insight towards diseases in patients with psychosis. Due to the limited quantity and quality of included studies, more large-scale, multi-center, and high quality RCTs are needed to verify the above conclusion.
Objective To investigate the medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents and its influence on the prognosis of individuals at high risk of stroke. Methods A total of 16892 residents aged 40 years or above in eight communities in Sichuan participated in a face-to-face study from May to September 2015. A database of a high-risk population of stroke in Sichuan province was established, and data were collected via using a standardized structured questionnaire by experienced investigators, including the treatment status and medication compliance of participants with hypertension, diabetes, or dyslipidemia during the follow-up period. Multiple logistic regression analyses were performed to explore the influencing factors of medication adherence and its influence on the prognosis of individuals at high risk of stroke. Results A total of 2893 participants at high risk of stroke were enrolled. The treatment rates of hypertension, diabetes, and dyslipidemia were 50.1%, 49.2%, and 5.1%, respectively, when the high-risk individuals were identified. At the end of follow-up (with a median follow-up period of 4.8 years), the treatment rates of hypertension, diabetes, and dyslipidemia were 24.8%, 25.0%, and 7.9%, respectively. Medication adherence to antihypertensives, antidiabetics, and lipid-lowering agents were 27.8%, 25.5%, and 18.1%, respectively. Multiple logistic regression analyses showed that the education level of high school or above [odds ratio (OR)=2.134, 95% confidence interval (CI) (1.098, 4.147), P=0.025], medical insurance for urban residents [OR=1.556, 95%CI (1.086, 2.230), P=0.016] and urban employees [OR=2.325, 95%CI (1.362, 3.967), P=0.002], having fewer children [OR=0.819, 95%CI (0.719, 0.933), P=0.003], and family history of stroke [OR=1.559, 95%CI (1.066, 2.282), P=0.022] were associated with greater adherence to antihypertensives; medical insurance for urban employees was associated with greater adherence to antidiabetics [OR=2.494, 95%CI (1.173, 5.300), P=0.018]. After adjusting for confounding factors, failure to regular use of antihypertensives [OR=2.617, 95%CI (1.414, 4.842), P=0.002], antidiabetics [OR=3.909, 95%CI (2.394, 6.380), P<0.001], and lipid-lowering agents [OR=4.828, 95%CI (2.581, 9.033), P<0.001] in patients with hypertension, diabetes, and dyslipidemia, respectively were associated with increased risk of ischemic stroke during the follow-up period. Regular use of lipid-lowering agents in patients with dyslipidemia was associated with an increased risk of intracerebral hemorrhage during the follow-up [OR=4.371, 95%CI (1.156, 16.530), P=0.030]. Conclusions The prevalences of hypertension, diabetes, and dyslipidemia are high in high-risk individuals of stroke in Sichuan province. However, the treatment rates are unsatisfactory, and the medication adherence is poor. The medication adherence is affected by a variety of demographic and socioeconomic factors. Regular treatments of hypertension, diabetes, and dyslipidemia reduce the risk of ischemic stroke in individuals at high risk of stroke, but regular use of lipid-lowering agents in patients with dyslipidemia is associated with an increased risk of intracerebral hemorrhage during the follow-up.
Objective To investigate the factors influencing the medication adherence among patients with diabetes signing family doctor service contract in Beijing urban areas, and provide the basis for improving the level of medication adherence. Methods A total of 320 patients with diabetes from four community health service centers in Beijing urban areas were selected to answer the questionnaires using convenient sampling from June to September 2015. Univariate analysis and binary logistic regression were used for the influencing factors analysis. Results A total of 320 questionnaires were distributed, and 317 valid questionnaires were recovered, in which the rate of high medication adherence was 54.6%. The results of logistic regression showed that the main impact factors on medication adherence were age [odds ratio (OR)=1.918, P=0.011)], degree of education (OR=2.462, P=0.008), knowledge related to diabetes (OR=1.773, P=0.027), adopting of family doctor service or not (OR=2.521, P=0.029) and social function status (P=0.003). Conclusions The family doctor service team should implement the practice of the family doctor service to ensure that the contracted residents can make full use of the family doctor services; and strengthen the follow-up and interventions for patients less aged or with low degree of education. For those with poor social function, more attention should be paid to their self-health management behavior to improve the level of patients’ compliance. As a result, the levels of blood glucose will be well controlled to reduce possibilities of complications and improve their health status and quality of life.
ObjectiveTo explore the effects of mindful eating intervention on the dietary adherence and surgical outcomes for patients after bariatric and metabolic surgery. MethodsA total of 124 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2023 to May 2024 were recruited by convenience sampling method. The patients were randomly equally divided into the observation group and the control group respectively. Mindful eating intervention and routine follow-up management were given in the two groups respectively. The dietary aderence and the effects of bariatric and metabolic surgery were compared between the two groups. ResultsA total of 124 patients were included based on sample size calculation, with 62 patients in each group. The baseline characteristics, including gender, age, body mass index (BMI), surgical approach, and comorbidities, showed no statistically significant differences between the two groups (P>0.05). The points of dietary compliance, dietary control, and fluid intake in the observation group were all better than those in the control group (P＜0.05), while there was no significant difference in the points of nutrient intake and eating habits between the two groups (P＞0.05). Over time, the differences in the points of dietary compliance, dietary control, and fluid intake between the observation group and the control group gradually increased (P＜0.05), while there were no significant differences in the points of nutrient intake and eating habits between the two groups (P＞0.05). The BMI, percentage of excess weight loss, and remission of comorbidities in the observation group were significantly better than those in the control group at 6 months after surgery (P<0.05), there was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). ConclusionThe preliminary results of this study suggest that mindful eating intervention after bariatric and metabolic surgery can effectively improve patients’ dietary adherence and promote surgical results.
Objective To summarize the best evidence for improving adherence to exercise therapy in non-surgical patients with knee osteoarthritis (KOA), so as to provide an evidence-based basis and reference for healthcare professionals, managers, patients, and caregivers. Methods Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses Association of Ontario, National Guideline Clearinghouse, American College of Rheumatology, Osteoarthritis Research Society International, Turkish League Against Rheumatism, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, System for Information on Grey Literature in Europe, Cochrane Library, PubMed, Joanna Briggs Library, www.guide.medlive.cn, China National Knowledge Infrastructure, and WanFang Data were searched by computer for literature about improving exercise therapy compliance in non-surgical patients with KOA. The retrieval time limit was from January 1, 2017 to April 20, 2022. The quality of the included literature was evaluated by 2 researchers with evidence-based training, and ultimately evidence was extracted from the literature that met the quality evaluation criteria. Results A total of 12 publications were included, including 5 guidelines, 4 systematic reviews, and 3 expert consensuses, covering 6 aspects of multidisciplinary teamwork, development of individualized exercise plans, external support, interventions, health education, and follow-up management. A total of 18 best evidences for improving exercise therapy compliance in non-surgical patients with KOA were summarized, with 8 A-level recommendations and 10 B-level recommendations. Conclusions When applying the evidence, clinical staff should fully assess and develop exercise plans with individual patients, strengthen multidisciplinary communication and writing, make full use of external support resources and do health education and full follow-up management. Through comprehensive consideration and selection of the best evidence for implementation, the compliance of KOA non-surgical patients with exercise therapy can be improved.
ObjectiveTo adapt existing clinical practice guidelines to the management of medication adherence to highly active antiretroviral therapy (HAART) in China, so as to provide evidence to support the development of practice guidelines that meet China's actual conditions. MethodsAccording to ADAPTE methodology and status of HAART in China, we searched, appraised, selected and adapted current clinical practice guidelines on the management of medication adherence to HAART. ResultsA total of 10 guidelines were included, and the final clinical practice guidelines for the management of medication adherence to HAART involved 3 aspects, including influential factors, assessment methods, and interventions. High quality evidence resources had been formed, and the quality of final clinical practice guidelines was higher. ConclusionIt is feasible to develop clinical practice guidelines according to the ADAPTE method, and reliable evidence support has been provided for the development of clinical practice guidelines based on guideline adaption.
【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.