95 research outputs found
STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma
Background Suboptimal adherence to inhaled steroids
is common in children with asthma and is associated
with poor disease control, reduced quality of life and
even death. Previous studies using feedback of
electronically monitored adherence data have
demonstrated improved adherence, but have not
demonstrated a significant impact on clinical outcomes.
The aim of this study was to determine whether
introduction of this approach into routine practice would
result in improved clinical outcomes.
Methods Children with asthma aged 6–16 years were
randomised to the active intervention consisting of
electronic adherence monitoring with daily reminder
alarms together with feedback in the clinic regarding
their inhaled corticosteroid (ICS) use or to the usual care
arm with adherence monitoring alone. All children had
poorly controlled asthma at baseline, taking ICS and
long-acting β-agonists. Subjects were seen in routine
clinics every 3 months for 1 year. The primary outcome
was the Asthma Control Questionnaire (ACQ) score.
Secondary outcomes included adherence and markers of
asthma morbidity.
Results 77 of 90 children completed the study
(39 interventions, 38 controls). Adherence in the
intervention group was 70% vs 49% in the control
group (p≤0.001). There was no significant difference in
the change in ACQ, but children in the intervention
group required significantly fewer courses of oral
steroids (p=0.008) and fewer hospital admissions
(p≤0.001).
Conclusions The results indicate that electronic
adherence monitoring with feedback is likely to be of
significant benefit in the routine management of poorly
controlled asthmatic subjects
Supporting People With Type 2 Diabetes in the Effective Use of Their Medicine Through Mobile Health Technology Integrated With Clinical Care to Reduce Cardiovascular Risk : Protocol for an Effectiveness and Cost-effectiveness Randomized Controlled Trial
Funding Information: The Support Through Mobile Messaging and Digital Health Technology for Diabetes research team acknowledges the support of the National Institute for Health Research (NIHR) through the Clinical Research Networks. AF, LT, and RR have received support from the NIHR Oxford Biomedical Research Centre. RH received support from the NIHR Collaboration for Leadership in Applied Health Research and Care and North Thames at Bart's Health National Health Service (NHS) Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. This paper presents independent research funded by the NIHR under its Program Grants for Applied Research as part of a wider program of work (RP-PG-1214-20003). The authors thank the personnel of the University of Oxford Primary Care and Vaccines Clinical Trials Collaborative for providing support in the conduct of the trial.Peer reviewedPublisher PD
Considering the Definition of Addiction
The definition of addiction is explored. Elements of addiction derived from a literature search that uncovered 52 studies include: (a) engagement in the behavior to achieve appetitive effects, (b) preoccupation with the behavior, (c) temporary satiation, (d) loss of control, and (e) suffering negative consequences. Differences from compulsions are suggested. While there is some debate on what is intended by the elements of addictive behavior, we conclude that these five constituents provide a reasonable understanding of what is intended by the concept. Conceptual challenges for future research are mentioned
Functional Modulation of Cardiac Form through Regionally Confined Cell Shape Changes
Developing organs acquire a specific three-dimensional form that ensures their normal function. Cardiac function, for example, depends upon properly shaped chambers that emerge from a primitive heart tube. The cellular mechanisms that control chamber shape are not yet understood. Here, we demonstrate that chamber morphology develops via changes in cell morphology, and we determine key regulatory influences on this process. Focusing on the development of the ventricular chamber in zebrafish, we show that cardiomyocyte cell shape changes underlie the formation of characteristic chamber curvatures. In particular, cardiomyocyte elongation occurs within a confined area that forms the ventricular outer curvature. Because cardiac contractility and blood flow begin before chambers emerge, cardiac function has the potential to influence chamber curvature formation. Employing zebrafish mutants with functional deficiencies, we find that blood flow and contractility independently regulate cell shape changes in the emerging ventricle. Reduction of circulation limits the extent of cardiomyocyte elongation; in contrast, disruption of sarcomere formation releases limitations on cardiomyocyte dimensions. Thus, the acquisition of normal cardiomyocyte morphology requires a balance between extrinsic and intrinsic physical forces. Together, these data establish regionally confined cell shape change as a cellular mechanism for chamber emergence and as a link in the relationship between form and function during organ morphogenesis
Beyond national narratives? : centenary histories, the First World War and the Armenian Genocide
In April 2015 the centenary of the Armenian Genocide was commemorated. Just like the First World War centenary, this anniversary has provoked a flurry of academic and public interest in what remains a highly contested history. This article assesses the state of the current historiography on the fate of the Ottoman Armenians. It focuses on the possibilities for moving beyond the national narratives which continue to dominate the field, in particular through connecting the case of the Armenian Genocide to what has been termed a ‘transnational turn’ in the writing of the history of the First World War
How to screen for non-adherence to antihypertensive therapy
The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians’ perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography–tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere
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