Do Patients Correctly Use Steroid Nose Spray? A Patient-Reported Survey of the Nasal Spray Technique and Patient Compliance

Background:Correct nasal spray techniqueand patient compliance are the two mostimportant factors in the use of steroid nose spray. Objectives:To find out if patientsuse steroid nasal spray with a correctspray technique and if they are compliant in using the spray. Design: Patient-reported survey Participants: 100 participants (1 excluded) Main outcome measures 1) Nasal spray technique 2) Patient compliance Results: Out of 99 participants included in this study only one patient used steroid nose spray with a completely correct spray technique. 40% of patients received guidance instructions from the prescriber about the spray technique. 70% of patients reported using their spray regularly and 53% of patients were found using the correct dosage of the spray. Conclusions: Wrong spray technique and patient noncompliance is common and can be corrected. This survey emphasizes the importance of giving written and verbal instructions about the use of spray to the patients.

Targeted Transdermal Drug Delivery Systems to Manage Regular Drug Administration and Reduce Patient Noncompliance

Patient noncompliance introduces human error to medicine, and limits the extent of effective clinical care. A portable, automated patch can simplify this process by regulating and dispensing the necessary amount of medication that a patient requires systemically, directly through the skin. This device will be low-profile, noninvasive, water-resistant, easy to use, affordable, and durable, in order to reduce the hassle and any possibility of patient noncompliance. The types and doses of medication must be carefully programmed by a medical professional to ensure proper treatment. Transdermally administered medication has proven to be successful in the past in the treatment of chronic pain. To test the viability of such a versatile transdermal delivery system, we will attempt to replace traditional medication for chronic obstructive pulmonary disease (COPD) patients using prednisolone. The inconvenience of frequent dosing, multiple pills, and inhalers are major contributors to noncompliance.

Levetiracetam Therapeutic Drug Monitoring in a Large Cohort of Korean Epileptic Patients

Levetiracetam is a new antiepileptic drug (AED) used for treating and preventing partial or generalized seizures. The usefulness of levetiracetam therapeutic drug monitoring (TDM) is related to inter- or intra-individual pharmacokinetic variability, drug interactions, and patient noncompliance. We aimed to investigate the levetiracetam TDM status in Korean epilepsy patients. Serum trough levetiracetam concentrations were measured using liquid chromatography–tandem mass spectrometry in 710 samples from 550 patients. The median (range) daily and weight-adjusted levetiracetam doses were 1500 (20–5000) mg and 25.5 (3.03–133.0) mg/kg, respectively. Patients on levetiracetam monotherapy constituted only 19.5% of the population, while 30.1% were on co-medication with valproate and 56.0% with enzyme-inducing AEDs (EIAEDs). Observed levetiracetam concentrations were widely distributed, ranging 0.8–95 mg/L, with a median of 17.3 mg/L. Levetiracetam concentrations were therapeutic, supra-therapeutic, and sub-therapeutic in 58.5% (n = 393), 11.6% (n = 78), and 29.9% (n = 201) of samples, respectively. There was a strong correlation between weight-adjusted levetiracetam dosage and concentrations (ρ = 0.6896, p < 0.0001). In this large-scale clinical study, a large inter-individual difference in levetiracetam pharmacokinetics was observed, and levetiracetam concentrations were influenced by EIAEDs. For individual dose adjustments and monitoring compliance, routine levetiracetam TDM is needed in epilepsy patients.

SOLID DISPERSION OF NEBIVOLOL HYDROCHLORIDE IMPREGNATED BUCCAL PATCH: FORMULATION AND CHARACTERIZATION

Objective: The objective of the present investigation was to design and characterize a mucoadhesive buccal patch of Nebivolol hydrochloride in order to administer a small dose of a drug to treat hypertension effectively and thereby avoiding disadvantages such as patient noncompliance and low bioavailability. Methods: The buccal patches were prepared by solvent casting method. The polymers used to formulate patches were HPMC K 15 M, PVP K 30, and propylene glycol was used as plasticizer and ethanol as the solvent. The drug-polymer compatibility studied was conducted by FTIR. Results: All the developed Patches had good transparency and stability. All formulated patches showed pH in the range of 6.49 to 7.22, and drug content was more than 90%. The folding endurance value showed that the patches are flexible and non-brittle. The in vitro residence time was found to more than 30 min. Thickness, % moisture absorption, and % moisture loss values were in a normal range. The drug release study was conducted for 8 h, and it was found drug release was decreased with the increase in polymer concentration. The in vitro release profiles of the drug from all the formulations appeared to follow Korsmeyer Peppa's exponential model, and release exponent (n) was found to be more than 0.45 so that the release can be characterized by Non–Fickian (anomalous) diffusion. Conclusion: From the results, it was concluded that drug released from formulated buccal patches follows sustained release pattern, Hence can be used for the treatment of the hypertensive patient.

MO785CAUSES OF THE DELAY IN CREATING PERMANENT VASCULAR ACCESS IN HEMODIALYSIS PATIENTS

Background and Aims Many patients start HD with central venous catheter (CVC) which has multiple complications This study aims at identifying the physicians’ perspectives regarding the reasons of delayed AVF creation Method This is a cross-sectional questionnaires-based survey designed at discovering the physicians' opinions and perception about the reasons for the delay in the creation of permanent vascular access and patient’s factors, physicians factors, and hospital factors leading to this delay, Results There was a total of 212 participants, of whom 131 (61.8%) were of consultant level. The three most important factors associated with delay in AVF creation were “denial of kidney disease or the need of AVF” (76.4%), “dialysis fears and practical concern” (75.9%) and “the patient refusing to undergo AVF surgery” (73.1%). Significantly fewer consultants (42.7%) than below consultants (45.7%) pointed out that “patient noncompliance with nephrology appointments” was a significant factor (p=0.046). The most important physicians & hospital factors was “insufficient conduction of pre-dialysis care and education about AVF initiation to the patient (63.7%) The respondents were asked to choose one of four possible factors that they felt was the main factor in delaying AVF creation. Over two thirds (68.4%) chose the patient factor as the main factor There was no significant difference in this response whether the respondents were consultants or below consultants (p=0.8)) Conclusion The most agreed on factors associated with AVF creation delay are the denial of the need for dialysis, fear of dialysis and practical concern, insufficient conduction of pre-dialysis care and education about AVF initiation to the patient, and late referral to a nephrologist. a validated approach to patients' selection and referral to vascular access creation that could be applied on different types of patient in different regions is required .

HUBUNGAN DUKUNGAN KELUARGA DENGAN KEPATUHAN KUNJUNGAN KONTROL RAWAT JALAN PADA PASIEN SKIZOFRENIA

Latar Belakang. Pasien skizofrenia yang tidak patuh pada pengobatan akan memiliki risiko kekambuhan lebih tinggi dibandingkan dengan pasien patuh pada pengobatan. Ketidakpatuhan pasien dalam pengobatan diantaranya lamanya pengobatan dan dukungan keluarga yang buruk keluarga terdekat merawat dan mengantarkan pasien kontrol ulang.Tujuan. Penelitian ini bertujuan untuk mengetahui gambaran hubungan dukungan keluarga dengan kepatuhan kunjungan kontrol rawat jalan pada pasien skizofrenia.Metode. Penelitian ini menggunakan desain penelitian analitik korelasi, dengan pendekatan cross sectional. Teknik sampling yang digunakan adalah convinience sampling. Jumlah sampel pada penelitian sebanyak 51 responden. Alat pengumpulan data adalah kuesioner dukungan keluarga dan kepatuhan kunjungan kontrol.Hasil. Berdasarkan hasil analisa dengan menggunakan uji Spearman Rho didapatkan nilai p=0,000 dan nilai Correlation coefficient sebesar 0,606, yang artinya ada hubungan yang signifikan antara dukungan keluarga dengan kepatuhan kunjungan kontrol rawat jalan pada pasien skizofrenia.Kesimpulan. Hubungan antara dukungan keluarga dengan kepatuhan kunjungan kontrol rawat jalan pada pasien skizofrenia, dikategorikan kuat dengan arah korelasi positif, yaitu semakin baik dukungan keluarga, maka semakin patuh kunjungan kontrol rawat jalan pasien skizofrenia. Kata Kunci: skizofrenia, Kepatuhan, Dukungan ABSTRACTBackground. Schizophrenic patients who were not compliant with treatment had a higher risk of recurrence than patients who were compliant with treatment. Patient noncompliance with treatment included the length of treatment and poor family support from family for caring and taking the patient back to control. The purpose of this study was to determine the satisfaction level of the correlation between family support and outpatient control visits compliance on patients with schizophrenia at Mental Polyclinic in Sanjiwani Gianyar Hospital.Method. This study employed a correlation analytic study design, with a cross-sectional approach. To conduct this study, 51 respondents were recruited as the sample through the convenience sampling technique. The data were collected using family support and visit control compliance questionnaires.Results. Findings indicated that the results of the analysis using the Spearman Rho test, it was found that the value of p = 0.000 and the correlation coefficient value was 0.606, which means that there was a significant correlation between family support and outpatient control visits compliance on patients with schizophrenia.Conclusion. The correlation between family support and outpatient control visits compliance on patients with schizophrenia is categorized as strong with a positive correlation, therefore the better family support, the more compliant the outpatient control visits on patients with schizophrenia are.Keywords: Schizophrenia, Compliance, Support

Opportunities to Topically Reduce Intraocular Pressure in Glaucoma

Since glaucoma is a serious health problem, numerous therapeutics are being developed to reduce Intraocular Pressure (IOP) as the only modifiable factor of all glaucoma symptoms. IOP-lowering agents are divided into six groups, each of which has a specific mechanism of action and side effects, which are the focus of this article and are explained in detail. All the mentioned agents are formulated as eye drops. However, as conventional topical eye drops have significant disadvantages, of which poor bioavailability and patient noncompliance are the main, novel approaches to designing their drug delivery systems were used and briefly presented in this review.