191 research outputs found
Disparities in European healthcare system approaches to maintaining continuity of medication for non-communicable diseases during the COVID-19 outbreak
A multinational cross-sectional survey of the management of patient medication adherence by European healthcare professionals
Objectives
To examine which interventions healthcare professionals use to support patients with taking medicines and their perceptions about the effectiveness of those actions.
Design
Cross-sectional multinational study.
Setting
Online survey in Austria, Belgium, England, France, Germany, Hungary, The Netherlands, Poland, Portugal and Switzerland.
Participants
A total of 3196 healthcare professionals comprising doctors (855), nurses (1047) and pharmacists (1294) currently registered and practising in primary care and community settings.
Main outcome measures
Primary outcome: Responses to the question âI ask patients if they have missed any doses of their medicationâ for each profession and in each country.
Secondary outcome: Responses to 50 items concerning healthcare professional behaviour to support patients with medication-taking for each profession and in each country.
Results
Approximately half of the healthcare professionals in the survey ask patients with long-term conditions whether they have missed any doses of their medication on a regular basis. Pharmacists persistently report that they intervene less than the other two professions to support patients with medicines. No country effects were found for the primary outcome.
Conclusions
Healthcare professionals in Europe are limited in the extent to which they intervene to assist patients having long-term conditions with medication adherence. This represents a missed opportunity to support people with prescribed treatment. These conclusions are based on the largest international survey to date of healthcare professionalsâ management of medication adherence
SAWA experiment ? properties of mineral dust aerosol as seen by synergic lidar and sun-photometer measurements
International audienceWe propose a method of retrieving basic information on mineral dust aerosol particles from synergic sun-photometer and multi-wavelength lidar measurements as well as from the observations of lidar light depolarisation. We use this method in a case study of mineral dust episode in Central Europe. Lidar signals are inversed with a modified Klett-Fernald algorithm. Aerosol optical depth measured with the sun-photometer allows to reduce uncertainties in the inversion procedure through which we estimate vertical profile of aerosol extinction. Next we assume that aerosol particles may be represented by ensemble of randomly oriented, identical spheroids. Having calculated vertical profiles of aerosol extinction coefficients for lidar wavelengths, we compute the profiles of local Angstrom exponent. We use laser beam depolarisation together with the calculated Angstrom exponents to estimate the shapes (aspect ratios) and sizes of the spheroids. Numerical calculations are performed with the transition matrix (T-matrix) algorithm by M. Mishchenko. The proposed method was first used during SAWA measurement campaign in Warsaw, spring 2005, to characterise the particles of desert dust, drifting over Poland with a southern-eastern wind (13?14 April). Observations and T-matrix calculations show that mode radii of spheroids representative for desert aerosols' particles are in the range of 0.15?0.3 ?m, while their aspect ratios are lower than 0.7 or larger than 1.7
Genetic disorders in children with obesity
ZespoĆy genetyczne, ktĂłrym towarzyszy otyĆoĆÄ w wieku dzieciÄcym,
wystÄpujÄ
rzadko. Na potrzebÄ diagnostyki genetycznej
u dziecka otyĆego, oprĂłcz wolnego tempa wzrastania, wskazuje
wystÄpowanie charakterystycznych anomalii fenotypowych, deficytĂłw
w zakresie narzÄ
dĂłw zmysĆĂłw (wzrok, sĆuch), opĂłĆșnienie rozwoju
psychoruchowego i/lub rĂłĆŒnego stopnia upoĆledzenie umysĆowe.
ZnajomoĆÄ tych zespoĆĂłw uĆatwia prowadzenie kompleksowej
terapii u chorych. Najnowsze badania molekularne pokazujÄ
, ĆŒe
schorzenia te sÄ
heterogenne pod wzglÄdem genetycznym.
Celem pracy byĆo przedstawienie klinicznych i genetycznych
aspektĂłw najlepiej poznanych i najczÄĆciej wystÄpujÄ
cych zespoĆĂłw
genetycznych przebiegajÄ
cych z otyĆoĆciÄ
, takich jak: zespĂłĆ
Bardet-Biedl, zespĂłĆ Cohen, zespĂłĆ Alström i zespĂłĆ Prader-Willi.Genetic syndromes with obesity in children are very rare. There is
a need of genetic diagnostics in obese child when its growth is
slow and it has characteristic phenotype anomalies, deficits of sight
or hearing, psychomotor retardation and/or mental retardation of
different degree. The knowledge of these syndromes enables to undertake early and complex therapy. Recent molecular studies
reveal that such syndromes are genetically heterogenic.
The aim of the paper is to present clinical and genetic aspects of
the most known and the most common genetic syndromes with
obesity like: Bardet-Biedl syndrome, Cohen syndrome, Alström
syndrome and Prader-Willi syndrome
A Cross-Sectional Survey on Medication Management Practices for Noncommunicable Diseases in Europe During the Second Wave of the COVID-19 Pandemic
Maintaining healthcare for noncommunicable diseases (NCDs) is particularly important during the COVID-19 pandemic; however, diversion of resources to acute care, and physical distancing restrictions markedly affected management of NCDs. We aimed to assess the medication management practices in place for NCDs during the second wave of the COVID-19 pandemic across European countries. In December 2020, the European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE) conducted a cross-sectional, web-based survey in 38 European and one non-European countries. Besides descriptive statistics of responses, nonparametric tests and generalized linear models were used to evaluate the impact on available NCD services of the number of COVID-19 cases and deaths per 100,000 inhabitants, and gross domestic product (GDP) per capita. Fifty-three collaborators from 39 countries completed the survey. In 35 (90%) countries face-to-face primary-care, and out-patient consultations were reduced during the COVID-19 pandemic. The mean ± SD number of available forms of teleconsultation services in the public healthcare system was 3 ± 1.3. Electronic prescriptions were available in 36 (92%) countries. Online ordering and home delivery of prescription medication (avoiding pharmacy visits) were available in 18 (46%) and 26 (67%) countries, respectively. In 20 (51%) countries our respondents were unaware of any national guidelines regarding maintaining medication availability for NCDs, nor advice for patients on how to ensure access to medication and adherence during the pandemic. Our results point to an urgent need for a paradigm shift in NCD-related healthcare services to assure the maintenance of chronic pharmacological treatments during COVID-19 outbreaks, as well as possible future disasters
âMy patients are better than yoursâ: optimistic bias about patientsâ medication adherence by European health care professionals
Objectives: The objectives of this study were to determine the perceptions of European physicians, nurses, and pharmacists about the extent of nonadherence by patients in their country relative to their perception of nonadherence by their own patients, and to investigate the occurrence of optimistic bias about medication adherence. The study explored a key cognitive bias for prevalence and likelihood estimates in the context of health care professionalsâ beliefs about patientsâ use of medicines.
Methods: A cross-sectional online survey of 3,196 physicians (855), nurses (1,294), and pharmacists (1,047) in ten European countries (Austria, Belgium, England, France, Germany, Hungary, the Netherlands, Poland, Portugal, and Switzerland) was used.
Results: Participants differed in their perceptions of the prevalence of medication adherence initiation, implementation, and persistence present in their own patients with a chronic illness in comparison to patients with a chronic illness in general. Health care professionals demonstrated optimistic bias for initiation and persistence with medicine taking, perceiving their own patients to be more likely to initiate and persist with treatment than other patients, but reported significantly lower prevalence of medication adherence levels for their own patients than for patients in general. This finding is discussed in terms of motivational and cognitive factors that may foster optimistic bias by health care professionals about their patients, including heightened knowledge of, and positive beliefs about, their own professional competence and service delivery relative to care and treatment provided elsewhere.
Conclusion: Health care professionals in Europe demonstrated significant differences in their perceptions of medication adherence prevalence by their own patients in comparison to patients in general. Some evidence of optimistic bias by health care professionals about their patientsâ behavior is observed. Further social cognitive theory-based research of health care professional beliefs about medication adherence is warranted to enable theory-based practitioner-focused interventions to be tested and implemented
Non-Compliance with Growth Hormone Treatment in Children Is Common and Impairs Linear Growth
BACKGROUND: GH therapy requires daily injections over many years and compliance can be difficult to sustain. As growth hormone (GH) is expensive, non-compliance is likely to lead to suboptimal growth, at considerable cost. Thus, we aimed to assess the compliance rate of children and adolescents with GH treatment in New Zealand. METHODS: This was a national survey of GH compliance, in which all children receiving government-funded GH for a four-month interval were included. Compliance was defined as ℠85% adherence (no more than one missed dose a week on average) to prescribed treatment. Compliance was determined based on two parameters: either the number of GH vials requested (GHreq) by the family or the number of empty GH vials returned (GHret). Data are presented as mean ± SEM. FINDINGS: 177 patients were receiving GH in the study period, aged 12.1 ± 0.6 years. The rate of returned vials, but not number of vials requested, was positively associated with HVSDS (p < 0.05), such that patients with good compliance had significantly greater linear growth over the study period (p<0.05). GHret was therefore used for subsequent analyses. 66% of patients were non-compliant, and this outcome was not affected by sex, age or clinical diagnosis. However, Maori ethnicity was associated with a lower rate of compliance. INTERPRETATION: An objective assessment of compliance such as returned vials is much more reliable than compliance based on parental or patient based information. Non-compliance with GH treatment is common, and associated with reduced linear growth. Non-compliance should be considered in all patients with apparently suboptimal response to GH treatment
GATEKEEPERâs Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases
Background: The World Health Organizationâs strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. Objective: We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. Methods: The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. Results: Seven European countries were selected, covering Europeâs geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligenceâbased digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. Conclusions: This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space
Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA2LEN consensus
Background: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. Methods: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis. Results: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p <.001). Conclusions: This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire
Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
Background: Polypharmacy, and the associated adverse drug events such as non-adherence to prescriptions, is a
common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal
from medications with supervision by a healthcare professional, is regarded as a means of reducing adverse effects
of multiple medications including non-adherence. This systematic review examines the evidence of deprescribing
as an effective strategy for improving medication adherence amongst older, community dwelling adults.
Methods: A mixed methods review was undertaken. Eight bibliographic database and two clinical trials registers
were searched between May and December 2017. Results were double screened in accordance with pre-defined
inclusion/exclusion criteria related to polypharmacy, deprescribing and adherence in older, community dwelling
populations. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal and an a priori data collection
instrument was used. For the quantitative studies, a narrative synthesis approach was taken. The qualitative data was
analysed using framework analysis. Findings were integrated using a mixed methods technique. The review was
performed in accordance with the PRISMA reporting statement.
Results: A total of 22 original studies were included, of which 12 were RCTs. Deprescribing with adherence as an
outcome measure was identified in randomised controlled trials (RCTs), observational and cohort studies from 13
countries between 1996 and 2017. There were 17 pharmacy-led interventions; others were led by General Practitioners
(GP) and nurses. Four studies demonstrated an overall reduction in medications of which all studies corresponded with
improved adherence. A total of thirteen studies reported improved adherence of which 5 were RCTs. Adherence was
reported as a secondary outcome in all but one study.
Conclusions: There is insufficient evidence to show that deprescribing improves medication adherence. Only 13
studies (of 22) reported adherence of which only 5 were randomised controlled trials. Older people are particularly
susceptible to non-adherence due to multi-morbidity associated with polypharmacy. Bio-psycho-social factors
including health literacy and multi-disciplinary team interventions influence adherence. The authors recommend
further study into the efficacy and outcomes of medicines management interventions. A consensus on priority
outcome measurements for prescribed medications is indicated
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