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Journal of Bodywork and Movement... Apr 2024Exercise adherence is necessary for achieving long-term benefits. Along with other elements, stories and narratives can play a role in understanding and promoting...
INTRODUCTION
Exercise adherence is necessary for achieving long-term benefits. Along with other elements, stories and narratives can play a role in understanding and promoting adherence. The aim of the present study was to explore how stories and narratives may affect adherence to Pilates.
METHOD
8 Pilates practitioners who had been participating in a Pilates program for 6 or more years were interviewed. Data obtained were analysed using thematic narrative analysis, (focusing on the whats of stories) and holistic narrative analysis (examining how narratives acted on adherence).
RESULTS AND DISCUSSION
Results highlight pain, Pilates as a health-related method, and the social relations as characters, plots and scenarios of stories enhancing long-term participation in Pilates. Exercise is medicine and eudaimonic well-being are presented as narratives articulating the coherence to practitioners' adherence. They act for participants subjectivizing their Pilates practice into a serious commitment to health.
CONCLUSION
Stories and narratives are relevant to give meaning and sense to the adherence to Pilates. A focus on stories can be added as a strategy to promote adherence to Pilates.
Topics: Humans; Exercise Movement Techniques; Female; Male; Adult; Narration; Patient Compliance; Middle Aged; Qualitative Research
PubMed: 38763604
DOI: 10.1016/j.jbmt.2024.03.046 -
Molecular Genetics & Genomic Medicine May 2024Ellis-van Creveld syndrome (EvCS) is a chondroectodermal dysplasia caused by germline pathogenic variants in ciliary complex subunit 1 and 2 genes (EVC, EVC2) on...
BACKGROUND
Ellis-van Creveld syndrome (EvCS) is a chondroectodermal dysplasia caused by germline pathogenic variants in ciliary complex subunit 1 and 2 genes (EVC, EVC2) on chromosome 4p16.2. This disease has a broad phenotype, and there are few described phenotype-genotype correlations.
METHODS
Ethical Compliance: Written informed consent was obtained from the parents. Here, we report a genetically confirmed Mexican patient with EvCS having two inherited pathogenic variants in trans in EVC2: c.[1195C>T];[2161delC].
RESULTS
This patient allowed a genotypic-phenotypic comparison with another Mexican subject who presented a more attenuated phenotype; furthermore, our patient also presented cleft palate, a rarely reported feature.
CONCLUSION
Our case shows the importance of comparing functional hemizygosity between patient's phenotypes when they share a variant, and our case also supports the association of alterations in the palate as part of the EvCS phenotype.
Topics: Humans; Cleft Palate; Ellis-Van Creveld Syndrome; Phenotype; Mexico; Male; Female; Intercellular Signaling Peptides and Proteins
PubMed: 38760995
DOI: 10.1002/mgg3.2451 -
Trials May 2024The SARS CoV-2 pandemic has resulted in more than 1.1 million deaths in the USA alone. Therapeutic options for critically ill patients with COVID-19 are limited. Prior...
SCARLET (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial): study protocol for a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 trial of i.v. citicoline (CDP-choline) in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory...
BACKGROUND
The SARS CoV-2 pandemic has resulted in more than 1.1 million deaths in the USA alone. Therapeutic options for critically ill patients with COVID-19 are limited. Prior studies showed that post-infection treatment of influenza A virus-infected mice with the liponucleotide CDP-choline, which is an essential precursor for de novo phosphatidylcholine synthesis, improved gas exchange and reduced pulmonary inflammation without altering viral replication. In unpublished studies, we found that treatment of SARS CoV-2-infected K18-hACE2-transgenic mice with CDP-choline prevented development of hypoxemia. We hypothesize that administration of citicoline (the pharmaceutical form of CDP-choline) will be safe in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure (HARF) and that we will obtain preliminary evidence of clinical benefit to support a larger Phase 3 trial using one or more citicoline doses.
METHODS
We will conduct a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 dose-ranging and safety study of Somazina® citicoline solution for injection in consented adults of any sex, gender, age, or ethnicity hospitalized for SARS CoV-2-associated HARF. The trial is named "SCARLET" (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial). We hypothesize that SCARLET will show that i.v. citicoline is safe at one or more of three doses (0.5, 2.5, or 5 mg/kg, every 12 h for 5 days) in hospitalized SARS CoV-2-infected patients with HARF (20 per dose) and provide preliminary evidence that i.v. citicoline improves pulmonary outcomes in this population. The primary efficacy outcome will be the SO:FO ratio on study day 3. Exploratory outcomes include Sequential Organ Failure Assessment (SOFA) scores, dead space ventilation index, and lung compliance. Citicoline effects on a panel of COVID-relevant lung and blood biomarkers will also be determined.
DISCUSSION
Citicoline has many characteristics that would be advantageous to any candidate COVID-19 therapeutic, including safety, low-cost, favorable chemical characteristics, and potentially pathogen-agnostic efficacy. Successful demonstration that citicoline is beneficial in severely ill patients with SARS CoV-2-induced HARF could transform management of severely ill COVID patients.
TRIAL REGISTRATION
The trial was registered at www.
CLINICALTRIALS
gov on 5/31/2023 (NCT05881135).
TRIAL STATUS
Currently enrolling.
Topics: Humans; Cytidine Diphosphate Choline; Double-Blind Method; SARS-CoV-2; COVID-19; Randomized Controlled Trials as Topic; COVID-19 Drug Treatment; Clinical Trials, Phase II as Topic; Pneumonia, Viral; Treatment Outcome; Hypoxia; Male; Pandemics; Coronavirus Infections; Hospitalization; Female; Betacoronavirus; Clinical Trials, Phase I as Topic; Respiratory Insufficiency; Administration, Intravenous; Adult
PubMed: 38760804
DOI: 10.1186/s13063-024-08155-0 -
BMJ Open May 2024Family caregivers of children living with HIV/AIDS in most cases are found to be overwhelmed and under-resourced, yet they are believed to be the primary source of...
BACKGROUND
Family caregivers of children living with HIV/AIDS in most cases are found to be overwhelmed and under-resourced, yet they are believed to be the primary source of support for children living with HIV/AIDS. Family caregivers experience different challenges that affect their children's antiretroviral therapy (ART) adherence.
AIM
This study explored the lived experiences of family caregivers of children living with HIV/AIDS who sought ART services for these children at the St Joseph's Hospital of Jirapa, Ghana.
METHOD
Using a qualitative phenomenology design and a semistructured in-depth interview guide and using purposive sampling, data were gathered from 13 family caregivers of children living with HIV/AIDS receiving ART treatment at St Joseph's Hospital, Jirapa following ethical approval. All interviews were audio-taped and transcribed verbatim. Reflexive thematic analysis was used to analyse the transcribed data.
FINDINGS
Six themes were generated: five challenges and one support. Family caregivers of children living with HIV/AIDS experienced: (1) Financial challenges, (2) Human-related challenges, (3) Challenges at HIV testing and counselling (HTC) centres, (4) Challenges with transportation, (5) Challenges in disclosing children's HIV status to them and (6) Support received from HTC and their family members.
CONCLUSION AND RECOMMENDATION
Family caregivers of children living with HIV/AIDS experience daunting challenges in their quest to care for their children. Governmental and non-governmental HIV/AIDS programme support should include small business skills training and acquisition including capital to help set up small-scale businesses for such caregivers to reduce their financial challenges. Access to ART at clinics closer to caregivers is also key to promoting adherence. Family and community support has been recognised as key to enhancing ART adherence. Education of caregivers on policy regarding disclosure of the HIV/AIDS status of children, the need to work to reduce the time spent by caregivers at HTC, and ensuring privacy by limiting access to HTCs to only caregivers and their children, are important to enhancing adherence.
Topics: Humans; Ghana; Caregivers; Male; Female; Child; HIV Infections; Adult; Qualitative Research; Medication Adherence; Social Support; Adolescent; Middle Aged; Child, Preschool; Anti-Retroviral Agents; Interviews as Topic; Anti-HIV Agents
PubMed: 38760044
DOI: 10.1136/bmjopen-2023-081036 -
International Journal of Medical... May 2024Psychiatric medication can have adverse effects such as weight gain, which is a metabolic risk factor for the development of cardiovascular disease and diabetes. This...
BACKGROUND
Psychiatric medication can have adverse effects such as weight gain, which is a metabolic risk factor for the development of cardiovascular disease and diabetes. This study aimed to assess whether an IT-supported task shift from physicians to pharmacists could improve clinical guideline compliance in assessing metabolic risk factors for psychiatric patients.
METHOD
An IT tool was designed and implemented in the electronic health record to enable pharmacists to efficiently screen patients for metabolic risk factors. The tool provided a risk score for each patient based on criteria from the cross-regional guideline. All admitted patients with a score were assessed by the pharmacists, who referred and discussed the patients with a physician when deemed relevant. We measured guideline compliance during baseline (manual screening) and intervention (automated screening) after implementing the IT tool and pharmacist assessment. After the intervention period, we conducted follow-up interviews with all participating pharmacists.
RESULTS
Guideline compliance increased significantly from 26 % (baseline) to 63 % (intervention) (Fisher's exact test p < .001, N = 98). The task shift from physicians to pharmacists was also significant (Fisher's exact test, p < .001, N = 40). Interviews revealed that the pharmacists found the task shift meaningful and received positive feedback from the physicians. The facilitators of the task shift included interprofessional collaboration, physician shortage, provider empowerment, and the manageable nature of the task. The barriers included a need for further competence development and lack of pharmacist authorization. The IT tool was considered useful and suggestions for improvements emerged.
CONCLUSION
The IT-supported task shift from physician to pharmacist significantly improved guideline compliance in the assessment of metabolic risk factors in psychiatric patients. The findings support increasing the pharmacist's role in psychiatric care to improve patient outcomes.
PubMed: 38759477
DOI: 10.1016/j.ijmedinf.2024.105483 -
Medicine May 2024The aim of this study is to assess the impact of intensive risk awareness management along with cardiac rehabilitation nursing in elderly patients with acute myocardial... (Observational Study)
Observational Study
The aim of this study is to assess the impact of intensive risk awareness management along with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure. We selected 101 elderly patients with acute myocardial infarction and heart aging treated from January 2022 to March 2023. They were divided into control and observation groups based on hospitalization numbers. The control group (n = 50) received routine nursing, while the observation group (n = 51) received intensive risk awareness management and cardiac rehabilitation nursing. We compared medication possession ratio (MPR), cardiac function, self-care ability scale scores, quality-of-life, incidents, and satisfaction between the 2 groups. Before intervention, there was no significant difference in MPR values between the 2 groups (P > .05). After intervention, MPR values increased in both groups, with a greater increase in the observation group (P < .05). Cardiac function showed no significant difference before intervention (P > .05), but after intervention, the observation group had lower left ventricular end-systolic and diastolic diameters and higher left ventricular ejection fraction compared to the control group (P < .05). Self-care skills, health knowledge, self-responsibility, and self-concept scores improved in both groups after intervention, with higher scores in the observation group (P < .05). The observation group had higher scores in various quality-of-life domains (P < .05). The total incidence of adverse events was lower in the observation group (5.88%) compared to the control group (20.00%) (P < .05). Patient satisfaction was significantly higher in the observation group (96.08%) than in the control group (84.00%) (P < .05). Intensive risk awareness management combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart aging can enhance medication compliance, improve quality-of-life, enhance self-care abilities, boost cardiac function, reduce incidents, and increase patient satisfaction.
Topics: Humans; Male; Female; Aged; Heart Failure; Myocardial Infarction; Quality of Life; Cardiac Rehabilitation; Aged, 80 and over; Self Care; Patient Satisfaction; Medication Adherence; Health Knowledge, Attitudes, Practice
PubMed: 38758887
DOI: 10.1097/MD.0000000000037381 -
Medicine May 2024This study aims to investigate the impact of continuous 4C nursing on patients with diabetes retinopathy (DR) and its influence on self-care ability. A total of 100 DR... (Observational Study)
Observational Study
This study aims to investigate the impact of continuous 4C nursing on patients with diabetes retinopathy (DR) and its influence on self-care ability. A total of 100 DR patients admitted to our hospital from October 2020 to October 2022 were randomly divided into a control group and an observation group, with 50 cases in each group. The control group received routine care, while the observation group received continuous 4C care. The nursing effects of both groups were compared. After nursing, the observation group showed a lower self-rating anxiety scale score and a higher self-care ability scale score compared to the control group (P < .05). The SQQL-VI scores for all social activities were also higher in the observation group (P < .05). Additionally, the observation group had lower levels of fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin than the control group (P < .05). Moreover, the observation group had higher visual acuity and lower intraocular pressure than the control group (P < .05). The visual impairment rate was lower and the overall compliance rate was higher in the observation group compared to the control group (P < .05). After nursing, both groups showed improvements in symptoms, visual function, physical function, psychological and social activity scores, visual acuity, and patient satisfaction scores. The observation group showed greater improvements compared to the control group (P < .05). The application of continuous 4C nursing in DR patients has shown positive effects, including improved patient compliance and satisfaction, enhanced patient quality of life and visual acuity. These findings suggest that continuous 4C nursing should be widely promoted and applied in clinical practice.
Topics: Humans; Quality of Life; Diabetic Retinopathy; Male; Female; Self Care; Middle Aged; Aged; Visual Acuity; Blood Glucose; Glycated Hemoglobin
PubMed: 38758866
DOI: 10.1097/MD.0000000000037920 -
JMIR Formative Research May 2024Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard,...
BACKGROUND
Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity.
OBJECTIVE
This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older.
METHODS
In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed.
RESULTS
The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%).
CONCLUSIONS
The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.2196/29675.
PubMed: 38758585
DOI: 10.2196/46151 -
JAMA Health Forum May 2024Controlled substances have regulatory requirements under the US Federal Controlled Substance Act that must be met before pharmacies can stock and dispense them. However,...
IMPORTANCE
Controlled substances have regulatory requirements under the US Federal Controlled Substance Act that must be met before pharmacies can stock and dispense them. However, emerging evidence suggests there are pharmacy-level barriers in access to buprenorphine for treatment for opioid use disorder even among pharmacies that dispense other opioids.
OBJECTIVE
To estimate the proportion of Medicaid-participating community retail pharmacies that dispense buprenorphine, out of Medicaid-participating community retail pharmacies that dispense other opioids and assess if the proportion dispensing buprenorphine varies by Medicaid patient volume or rural-urban location.
DESIGN, SETTING, AND PARTICIPANTS
This serial cross-sectional study included Medicaid pharmacy claims (2016-2019) data from 6 states (Kentucky, Maine, North Carolina, Pennsylvania, Virginia, West Virginia) participating in the Medicaid Outcomes Distributed Research Network (MODRN). Community retail pharmacies serving Medicaid-enrolled patients were included, mail-order pharmacies were excluded. Analyses were conducted from September 2022 to August 2023.
MAIN OUTCOMES AND MEASURES
The proportion of pharmacies dispensing buprenorphine approved for opioid use disorder among pharmacies dispensing an opioid analgesic or buprenorphine prescription to at least 1 Medicaid enrollee in each state. Pharmacies were categorized by median Medicaid patient volume (by state and year) and rurality (urban vs rural location according to zip code).
RESULTS
In 2016, 72.0% (95% CI, 70.9%-73.0%) of the 7038 pharmacies that dispensed opioids also dispensed buprenorphine to Medicaid enrollees, increasing to 80.4% (95% CI, 79.5%-81.3%) of 7437 pharmacies in 2019. States varied in the percent of pharmacies dispensing buprenorphine in Medicaid (range, 73.8%-96.4%), with significant differences between several states found in 2019 (χ2 P < .05), when states were most similar in the percent of pharmacies dispensing buprenorphine. A lower percent of pharmacies with Medicaid patient volume below the median dispensed buprenorphine (69.1% vs 91.7% in 2019), compared with pharmacies with above-median patient volume (χ2 P < .001).
CONCLUSIONS AND RELEVANCE
In this serial cross-sectional study of Medicaid-participating pharmacies, buprenorphine was not accessible in up to 20% of community retail pharmacies, presenting pharmacy-level barriers to patients with Medicaid seeking buprenorphine treatment. That some pharmacies dispensed opioid analgesics but not buprenorphine suggests that factors other than compliance with the Controlled Substance Act influence pharmacy dispensing decisions.
Topics: Humans; Medicaid; Buprenorphine; United States; Cross-Sectional Studies; Health Services Accessibility; Opioid-Related Disorders; Pharmacies; Community Pharmacy Services; Opiate Substitution Treatment; Narcotic Antagonists
PubMed: 38758569
DOI: 10.1001/jamahealthforum.2024.1077 -
JAMA Network Open May 2024Oral endocrine treatments have been shown to be effective when carefully adhered to. However, in patients with early breast cancer, adherence challenges are notable,...
IMPORTANCE
Oral endocrine treatments have been shown to be effective when carefully adhered to. However, in patients with early breast cancer, adherence challenges are notable, with 17% experiencing nonpersistence and 41% nonadherence at least once.
OBJECTIVE
To model the persistence of and adherence to oral anticancer treatment of a patient with localized breast cancer.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was conducted using anonymous reimbursement data belonging to French female patients with breast cancer, extracted from the French Health Insurance database from January 2013 to December 2018. Data analysis was conducted from January 2021 to May 2022.
MAIN OUTCOMES AND MEASURES
The main outcome was the detection of episodes of nonpersistence and nonadherence 6 months before they happened. Adherence was defined as the ratio between the time covered by a drug purchase and the time between 2 purchases; patients were considered nonadherent if the ratio of their next 3 purchases was less than 80%. Disparities in persistence and adherence based on criteria such as age, treatment type, and income were identified.
RESULTS
A total of 229 695 female patients (median [IQR] age, 63 [52-72] years) with localized breast cancer were included. A deep learning model based on a gated-recurrent unit architecture was used to detect episodes of nonpersistence or nonadherence. This model demonstrated an area under the receiving operating curve of 0.71 for persistence and 0.73 for adherence. Analyzing the Shapley Additive Explanations values also gave insights into the contribution of the different features over the model's decision. Patients older than 70 years, with past nonadherence, taking more than 1 treatment in the previous 3 months, and with low income had greater risk of episodes of nonpersistence. Age and past nonadherence, including regularity of past adherence, were also important features in the nonadherence model.
CONCLUSIONS AND RELEVANCE
This cohort study found associations of patient age and past adherence with nonpersistence or nonadherence. It also suggested that regular intervals in treatment purchases enhanced adherence, in contrast to irregular purchasing patterns. This research offers valuable tools for improving persistence of and adherence to oral anticancer treatment among patients with early breast cancer.
Topics: Humans; Breast Neoplasms; Female; Medication Adherence; Middle Aged; Aged; Cohort Studies; France; Antineoplastic Agents
PubMed: 38758553
DOI: 10.1001/jamanetworkopen.2024.11909