Impact of adverse drug events and treatment satisfaction on patient adherence with antihypertensive medication - a study in ambulatory patients.

AIMS: The aim of the present study was to evaluate the impact of adverse drug events (ADEs) and treatment satisfaction on antihypertensive medication adherence. METHODS: A cross-sectional study was conducted in six public hospitals in Ethiopia. We included adult ambulatory patients on antihypertensive medication. Adherence was measured using the eight-point Morisky Medication Adherence Scale, which categorizes as low (0-5), medium (6-7) and high (8) adherence. Treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4, which included questions about ADEs. Data were analysed using generalized ordered logistic regression with 95% confidence intervals (CIs). RESULTS: We included 925 out of 968 patients. Overall, 42% of patients scored low, 37% medium and 21% high adherence. Satisfaction with treatment was low, with a mean (standard deviation) TSQM score for global satisfaction of 51 (14). A total of 193 (21%) patients experienced 421 ADEs - mainly dyspeptic symptoms (12%), headache (11%) and cough (11). Experiencing more ADEs reduced the odds of being adherent [low vs. medium/high: odds ratio (OR) OR1 0.77 (95% CI 0.67, 0.89), and low/medium vs. high: OR2 0.55 (05% CI 0.41, 0.73)]. Being more satisfied increased the odds of being adherent [low vs. medium/high: OR1 1.02 (95% CI 1.01, 1.03)]. Taking medication >1 year [OR1 = 2 , 0.60 (95% CI 0.43, 0.83)] and taking calcium channel blockers [OR1 = 2 0.71 (95% CI 0.54, 0.92)] decreased the odds for both low vs. medium/high and low/medium vs. high adherence. CONCLUSIONS: Only one in five patients reported perfect (high) adherence to their antihypertensive treatment regimen. Experiencing ADEs and being dissatisfied with treatment were associated with lower adherence. In addition to addressing treatment satisfaction and drug safety in first-world countries, these should also be addressed in resource-poor settings, within patient consultations, to enhance adherence.

Association of serum sodium levels with all-cause and cardiovascular mortality in chronic kidney disease: Results from a prospective observational study.

AIMS: The prevalence of hyponatraemia in the outpatient setting has not been thoroughly explored, and little is known about the prognostic implication of dysnatraemia in chronic kidney disease (CKD) patients, in particular accommodating the effect of concurrent medications. METHODS: This is a prospective observational study of non-dialysis-dependent CKD patients managed in a nephrology clinic. Patients enrolled between 2002 and 2012 in the Chronic Renal Insufficiency Standards Implementation Study were assessed. Survival analyses were performed using baseline sodium and 12-month time-averaged sodium, with adjustment for co-morbid diseases, laboratory findings and concurrent medications. RESULTS: At baseline (n = 2093), mean estimated glomerular filtration rate was 32.8 ± 15.9 ml/min per 1.73 m(2) , median age was 67 (interquartile range 56-75) years and median serum sodium concentration was 140 (138-142) mmol/l. After a follow up of 41 (18-67) months, there were 684 deaths, 174 from cardiovascular causes; 1925 time-averaged sodium values were analysed. In the Cox multivariate adjusted regression, baseline hyponatraemia, but not hypernatraemia, was independently associated with all-cause mortality (hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.02-1.78, P = 0.04, and HR 1.15, 95% CI 0.84-1.57, P = 0.39, respectively). This was similarly the case for time-averaged hyponatraemia and hypernatraemia (HR 2.15, 95% CI 1.59-2.91, P < 0.01, and HR 1.47, 95% CI 0.93-2.38, P = 0.10, respectively). However, the association of baseline and time-averaged hyponatraemia with cardiovascular mortality was not significant. CONCLUSION: Hyponatraemia in the ambulatory setting is associated with all-cause but not cardiovascular mortality in CKD, independent of concomitant medications and co-morbidities.

Antibiotic prescribing and expenditures in outpatient adults in Greece, 2010 to 2013: evidence from real-world practice.

We provide a representative analysis of antibiotic prescribing, identify factors associated with broad-spectrum antibiotic prescribing and assess the costs associated with antibiotic use in adult outpatients in Greece. Outpatient antibiotic prescriptions for patients older than 19 years between 2010 and 2013 in Greece were extracted from the IMS Health Xponent database. Prescribing rate and total cost for prescribed antibiotics were calculated. Multivariate logistic regression was used to identify factors related to broad-spectrum antibiotic prescribing. More than 20 million antibiotics were prescribed during the study period, an annual rate of 768 prescribed antibiotics per 1,000 adults. Overall, 33.5% of antibiotics were prescribed for acute respiratory tract infections (ARTIs) for which antibiotics are often not indicated. Macrolides (29.9%), cephalosporins (26.9%) and fluoroquinolones (21.0%) were the most commonly prescribed antibiotic classes. The majority (89.0%) of antibiotics were broad-spectrum. Antibiotic expenditures were approximately EUR 185 million during the study period. Factors associated with broad-spectrum prescribing included older patient age, specialty pulmonologists or otorhinolaryngologists, training in eastern Europe, diagnosis of ARTI, acute diagnosis, and first episode of disease. Broad-spectrum antibiotic prescribing for ARTIs is common in adult Greek outpatients and frequently inappropriate. These data indicate the need for initiatives aiming to control antibiotic prescribing.

A radiolucent chair for sitting-posture radiographs in non-ambulatory children: use in biplanar digital slot-scanning.

EOS imaging (EOS System; EOS imaging, Paris, France) enables fast 2-D/3-D imaging of children in standing load-bearing position. Non-ambulatory children with neuromuscular scoliosis need evaluation of their spinal balance while in a normal daily position. We designed a customized chair fitting the EOS patient-area dimensions to obtain images in natural sitting postures. The chair is a 360° rotating orthopaedic chair made of fully radiolucent polyethylene and equipped with an adjustable headrest and three-point belts. Out of 41 consecutive patients, 36 (88%, 95% confidence interval 74-96%) had successful imaging. In most patients with severe neuromuscular trunk deformities, the EOS system combined with our chair was useful for assessing preoperative trunk collapse, pelvic obliquity and postoperative corrections in all planes. This specific device changed our daily practice for the assessment of spinal deformities in non-ambulatory patients.

Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study.

BACKGROUND: For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible. OBJECTIVE: The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts. METHODS: All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF). RESULTS: A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1%) reached the HF warning level, and 28 patients (25%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45%) had taken inaccurate measurements, 3 patients (27%) had supraventricular arrhythmia, 1 patient (9%) had a pulmonary bacterial infection, and 1 patient (9%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007). CONCLUSIONS: This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients.

Spectrum of ST amplitude: athletes and an ambulatory clinical population.

BACKGROUND AND PURPOSE: To augment data guiding thresholds for myocardial ischemia and cardiac risk, we studied resting ST amplitude in ambulatory patients and collegiate athletes. METHODS: We analyzed 4041 ECGs from ambulatory visits at the Veterans Affairs in Palo Alto, California from 1997 to 1999 and 1114 screening ECGs from Stanford University athletes in 2007-2008. Using the PR interval as the isoelectric line and >95µV and<-45µV (visually equivalent to 1mm and 0.5mm) to define ST elevation and depression, ST amplitude was measured at QRS-end. RESULTS: ST elevation was most prevalent in males, African Americans, and athletes (87% of male athletes in anterior leads). ST depression was rare in athletes and, among patients, associated with time to cardiovascular death in lateral leads (age-adjusted HR of 1.9, p<0.001). CONCLUSIONS: ST amplitude differs by gender, age, race, and athletic status, which should be considered when developing guidelines for ECG interpretation.

Adverse drug reactions in the ambulatory internal patients at the emergency department: Focus on causality assessment and drug-drug interactions.

A non-interventional retrospective study in ambulatory patients was conducted at the emergency department of the Division of internal medicine. In 2 months, 266 suspected adverse drug reactions (ADRs) were identified in 224/3453 patients (6.5 %). In 158/3453 patients (4.6 %), an ADR was the reason for emergency department visit and in 49 patients (1.4 %), ADRs led to hospitalisation. A causality assessment algorithm was developed, which included Naranjo algorithm and levels of ADR recognition by the treating physician and the investigators. Using this algorithm, 63/266 ADRs (23.7 %) were classified as "certain", whereas using solely the Naranjo score calculation, only 19/266 ADRs (7.1 %) were assessed as "probable" or "certain", and the rest of ADRs (namely, 247/266 = 92.9 %) were assessed as "possible". There were 116/266 (43.6 %) ADRs related to potential drug-drug interactions (DDIs), stated in at least one of the literature sources used. Based on the causality relationship, the rate of the clinically expressed DDIs was 19.0 %, or 12/63 "certain" ADR cases. Of these, 10 cases presented serious DDI-related ADRs. In summary, ADR causality assessment based exclusively on Naranjo algorithm demonstrated low sensitivity at an ambulatory emergency setting. Additional clinical judgment, including the opinion of the treating physician, proved necessary to avoid under-rating of the causality relationship, and enabled the determination of clinically expressed DDIs.

Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy.

The number and complexity of endoscopic gastrointestinal diagnostic and therapeutic procedures is globally increasing. Procedural analgosedation during gastrointestinal endoscopic procedures has become the gold standard of gastrointestinal endoscopies. Patient satisfaction and safety are important for the quality of the technique. Currently there are no uniform sedation guidelines and protocols for specific gastrointestinal endoscopic procedures, and there are several challenges surrounding the choice of an appropriate analgosedation technique. These include categories of patients, choice of drug, appropriate monitoring, and medical staff providing the service. The ideal analgosedation technique should enable the satisfaction of the patient, their maximum safety and, at the same time, cost-effectiveness. Although propofol is the gold standard and the most used general anesthetic for endoscopies, its use is not without risks such as pain at the injection site, respiratory depression, and hypotension. New studies are looking for alternatives to propofol, and drugs like remimazolam and ciprofol are in the focus of researchers' interest. New monitoring techniques are also associated with them. The optimal technique of analgosedation should provide good analgesia and sedation, fast recovery, comfort for the endoscopist, patients' safety, and will have financial benefits. The future will show whether these new drugs have succeeded in these goals.

Dyslipidemia and associated cardiovascular risk factors in HIV-positive and HIV-negative patients visiting ambulatory clinics: A hospital-based study.

Background: Dyslipidemia is a well-known risk factor for cardiovascular disease (CVD), accounting for more than half of all instances of coronary artery disease globally (CAD). Purpose: The purpose of this study was to determine lipid-related cardiovascular risks in HIV-positive and HIV-negative individuals by evaluating lipid profiles, ratios, and other related parameters. Methods: A hospital-based study was carried out from January 2019 to February 2021 in both HIV + and HIV- ambulatory patients. Results: High TG (p = .003), high TC (p = .025), and low HDL (p < .001) were all associated with a two-fold increased risk of CVD in people aged 45 and up. Due to higher TG (p < .001) and lower HDL (p < .001), males were found to have a higher risk of atherogenic dyslipidemia. A twofold increase in the likelihood of higher TG levels has been associated with smoking (p = .032) and alcohol intake (p = .022). A twofold increase in a high TC/HDL ratio and an elevated TG/HDL ratio was observed with an increase in waist-to-height ratio (p = .030) and a high level of FBS (126 mg/dl) and/or validated diabetes (p = .017), respectively. In HIV + participants, central obesity (p < .001), diabetes (p < .001), and high blood pressure (p < .001) were all less common than in HIV- participants. Conclusions: Dyslipidemia is linked to advanced age, male gender, diabetes, smoking, alcohol consumption, and increased waist circumference, all of which could lead to an increased risk of CVD, according to the study. The study also revealed that the risks are less common in HIV + people than in HIV-negative ambulatory patients.

Burden and severity of disease of aromatic L-amino acid decarboxylase deficiency: a systematic literature review.

OBJECTIVE: The objective was to investigate the severity of aromatic L-amino acid decarboxylase deficiency (AADCd) as reported in the published literature and to collate evidence of the clinical manifestations of AADCd, and the impact of the disease on patients, caregivers, and healthcare systems. METHODS: Published articles reporting severity of disease or disease impact were eligible for inclusion in this review. Articles were searched in MEDLINE, EMBASE, Cochrane CENTRAL, TRIP medical, and CRD databases in October 2021. The quality of the included studies was investigated using a modified version of the grading system of the Centre for Evidence-Based Medicine (CEBM). Descriptive data of the literature was extracted and a narrative synthesis of the results across studies was conducted. This review is reported according to the PRISMA reporting guidelines for systematic reviews. RESULTS: The search identified 970 unique reports, of which 59 met eligibility criteria to be included in the review. Of these, 48 included reports provided details on the clinical manifestations of AADCd. Two reports explored the disease impact on patients, while four described the impact on caregivers. Five reports assessed the impact on healthcare systems. Individuals with AADCd experience very severe clinical manifestations regardless of motor milestones achieved, and present with a spectrum of other complications. Individuals with AADCd present with very limited function, which, in combination with additional complications, substantially impact the quality-of-life of individuals and their caregivers. The five studies which explore the impact on the healthcare system reported that adequate care of individuals with AADCd requires a vast array of medical services and supportive therapies. CONCLUSIONS: Irrespective of the ambulatory status of individuals, AADCd is a debilitating disease that significantly impacts quality-of-life for individuals and caregivers. It impacts the healthcare system due to the need for complex coordinated activities of a multidisciplinary specialist team.

Health Priorities of Multi-Morbid Ambulatory Patients in New York City During the COVID-19 Pandemic: A Qualitative Analysis.

During the COVID-19 pandemic, adults with chronic conditions delayed or avoided seeking preventative and general medical care, leading to adverse consequences for morbidity and mortality. In order to bring patients back into care, we, in this qualitative study, sought to understand the foremost health-related needs of our multi-morbid ambulatory patients to inform future outreach interventions. Via a telephone-based survey of our high-risk patients, defined using a validated EPIC risk model for hospitalization and ED visits, we surveyed 214 participants an open-ended question, "What is your top health concern that you would like to speak with a doctor or nurse about". We found 4 major themes: 1) primary care matters, 2) disruptions in health care, 3) COVID-19's impact on physical and mental health, and 4) amplified social vulnerabilities. Our results suggest that interventions that reduce barriers to preventative services and disruptions to healthcare delivery are needed.

Correlation of hematological parameters and cycle threshold in ambulatory patients with SARS-CoV-2 infection.

INTRODUCTION: Former studies have shown that hematologic parameters are affected by the SARS-CoV-2 infection which has caused a global health problem. Therefore, this research aims to identify the most frequent symptoms and comorbidities in SARS-CoV-2 infected outpatients; besides, to analyze hematological parameters and their correlation with cycle threshold (Ct) values. METHODS: We analyzed a total of sixty outpatients with SARS-CoV-2 infection. They were divided according to sex. Afterward, a questionnaire was carried out to find out their symptoms and comorbidities. Additionally, blood biometry data were correlated with the Ct value, respectively. RESULTS: Sixty patients were analyzed; the mean age was 43 years. All patients were from Nayarit, Mexico. The frequency index showed that the main symptoms were headache and anosmia, and the comorbidities were obesity and smoking. The analysis of blood biometry showed a clear increase in red blood cells (RBC) related parameters in women. In both sexes an increase in the number of white blood cells (WBC) was observed. Also, all the hematological alterations correlated with the grade of infection. CONCLUSION: Headache and anosmia are the most common symptoms according to the frequency index, the main comorbidities were obesity and smoking. Also, there is a Ct value correlation with hematological parameters (WBC, mean corpuscular volume, mean corpuscular hemoglobin, hemoglobin); they can be used as a prognostic marker of infection.

COVID-19 related olfactory dysfunction prevalence and natural history in ambulatory patients.

BACKGROUND: Evidence regarding prevalence of COVID-19 related Olfactory dysfunction (OD) among ambulatory patients is highly variable due to heterogeneity in study population and measurement methods. Relatively few studies have longitudinally investigated OD in ambulatory patients with objective methods. METHODS: We performed a longitudinal study to investigate OD among COVID-19 ambulatory patients compared to symptomatic controls who test negative. Out of 81 patients enrolled, 45 COVID-19 positive patients and an age- and sex-matched symptomatic control group completed the BSIT and a questionnaire about smell, taste and nasal symptoms. These were repeated at 1 month for all COVID-19 positive patients, and again at 3 months for those who exhibited persistent OD. Analysis was performed by mixed-effects linear and logistic regression. RESULTS: 46.7% of COVID-19 patients compared to 3.8% of symptomatic controls exhibited OD at 1-week post diagnosis (p<0.001). At 1 month, 16.7%, (6 of 36), of COVID-19 patients had persistent OD. Mean improvement in BSIT score in COVID-19 patients between 1-week BSIT and 1 month follow-up was 2.0 (95% CI 1.00 - 3.00, p<0.001). OD did not correlate with nasal congestion (r= -0.25, 95% CI, -0.52 to 0.06, p=0.12). CONCLUSIONS: Ambulatory COVID-19 patients exhibited OD significantly more frequently than symptomatic controls. Most patients regained normal olfaction by 1 month. The BSIT is a simple validated and objective test to investigate the prevalence of OD in ambulatory patients. OD did not correlate with nasal congestion which suggests a congestion-independent mechanism of OD.

Association of Daily Home-Based Hot Water Bathing and Glycemic Control in Ambulatory Japanese Patients with Type 2 Diabetes Mellitus During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study.

PURPOSE: To clarify the relationship between daily hot water bathing (HWB) at home and glycemic control in middle-aged and elderly ambulatory patients with type 2 diabetes mellitus (T2DM). METHODS: We defined hemoglobin A1c (HbA1c) as the main outcome. We set 7.0% based on the mean value of the dependent variable as the cut-off point for analysis. Frequency of HWB was an explanatory variable. A two-sample t-test was used to compare between groups with continuous variables. Multiple logistic regression analysis was performed for frequency, adjusted age, sex, BMI, T2DM duration (Model 1), and other confounding factors (Model 2). Odds ratio (OR) and 95% confidence interval (95% CI) were calculated. RESULTS: Among 838 patients, there was a significant difference (p<0.001) in age between males (n=528, 62.8±8.7 years) and females (n=310, 65.0±8.1 years). In Model 1, compared with participants who used HWB more than seven times a week, those with poorly controlled HbA1c were significantly associated with low frequency of HWB: four to six times a week (OR 1.32, 95% CI 0.87-1.99) and less than three times a week (OR 1.43, 95% CI 0.98-2.10); p-value for overall trend was 0.041. In Model 2, p-value for overall trend was 0.138. CONCLUSION: A higher frequency of HWB was moderately associated with a decreased risk of poor glycemic control in middle-aged and elderly ambulatory patients with T2DM.

Knowledge, awareness, perception and reporting of experienced adverse drug reactions among outpatients in Nigeria.

Background Higher incidence of adverse drug reactions (ADRs) remain a major cause of morbidity and mortality. Most targeted ADR reporting activities are mainly professional-centered with less attention to patients' knowledge, perception and selfreporting of experienced ADRs. Objectives To comprehensively evaluate patients' knowledge, awareness, perception and reporting of experienced ADRs. Setting Three public healthcare facilities in Ibadan, southwestern Nigeria. Method A questionnaire-guided cross-sectional interview of 1190 consented ambulatory adult patients consecutively recruited from various clinics of the selected hospitals between February and June 2018. The 32-item pretested questionnaire comprised open- and closed-ended questions, as well as open-ended questions with relevant prompts. Data were summarised using descriptive statistics, while Chi square was used to investigate association between relevant categorical variables at p < 0.05. Main outcome measure Knowledge, awareness, perception and reporting of experienced ADRs among patients. Results Response rate was 99.1%. Mean age was 40.6 ± 14.9 years. Forty-nine (4.1%) patients were aware of pharmacovigilance. A total of 964 (81.0%) correctly understood what can be regarded as serious adverse drug reactions (ADRs), 444 (37.3%) had previously experienced ADRs, while 77 (6.5%) experienced reactions with current medication(s). Of this, 64 (83.1%) made a report largely to physician (52; 81.3%). Summarily, reported reactions were more with antimalarials (214; 49.1%), with itching (168; 78.5%) constituting the most frequently occurring reaction. Use of text message (276; 27.2%) and filling of ADR report form (248; 24.4%) were topmost on the list of suggested methods for ADR reporting. There was a significant association between patient's age and awareness of pharmacovigilance (p = 0.015), while educational qualification (p = 0.001) significantly influenced tendency to make a report of experienced ADRs. Conclusion Approximately four percent of patients were aware of pharmacovigilance, while more than three-quarters correctly understood the concept of serious adverse drug reactions. A little above one-quarter had previously experienced one form of reaction or the other, with majority reporting such reactions to physician. Continuous education of stakeholders in pharmacovigilance activities is advocated, while patient's active involvement in spontaneous reporting of ADRs should be carefully considered.

Profiling the propagation of error from PPG to HRV features in a wearable physiological-monitoring device.

Wearable physiological monitors are becoming increasingly commonplace in the consumer domain, but in literature there exists no substantive studies of their performance when measuring the physiology of ambulatory patients. In this Letter, the authors investigate the reliability of the heart-rate (HR) sensor in an exemplar 'wearable' wrist-worn monitoring system (the Microsoft Band 2); their experiments quantify the propagation of error from (i) the photoplethysmogram (PPG) acquired by pulse oximetry, to (ii) estimation of HR, and (iii) subsequent calculation of HR variability (HRV) features. Their experiments confirm that motion artefacts account for the majority of this error, and show that the unreliable portions of HR data can be removed, using the accelerometer sensor from the wearable device. The experiments further show that acquired signals contain noise with substantial energy in the high-frequency band, and that this contributes to subsequent variability in standard HRV features often used in clinical practice. The authors finally show that the conventional use of long-duration windows of data is not needed to perform accurate estimation of time-domain HRV features.

Multiple Wearable Sensors in Parkinson and Huntington Disease Individuals: A Pilot Study in Clinic and at Home.

BACKGROUND: Clinician rating scales and patient-reported outcomes are the principal means of assessing motor symptoms in Parkinson disease and Huntington disease. However, these assessments are subjective and generally limited to episodic in-person visits. Wearable sensors can objectively and continuously measure motor features and could be valuable in clinical research and care. METHODS: We recruited participants with Parkinson disease, Huntington disease, and prodromal Huntington disease (individuals who carry the genetic marker but do not yet exhibit symptoms of the disease), and controls to wear 5 accelerometer-based sensors on their chest and limbs for standardized in-clinic assessments and for 2 days at home. The study's aims were to assess the feasibility of use of wearable sensors, to determine the activity (lying, sitting, standing, walking) of participants, and to survey participants on their experience. RESULTS: Fifty-six individuals (16 with Parkinson disease, 15 with Huntington disease, 5 with prodromal Huntington disease, and 20 controls) were enrolled in the study. Data were successfully obtained from 99.3% (278/280) of sensors dispatched. On average, individuals with Huntington disease spent over 50% of the total time lying down, substantially more than individuals with prodromal Huntington disease (33%, p = 0.003), Parkinson disease (38%, p = 0.01), and controls (34%; p < 0.001). Most (86%) participants were "willing" or "very willing" to wear the sensors again. CONCLUSIONS: Among individuals with movement disorders, the use of wearable sensors in clinic and at home was feasible and well-received. These sensors can identify statistically significant differences in activity profiles between individuals with movement disorders and those without. In addition, continuous, objective monitoring can reveal disease characteristics not observed in clinic.

Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia.

OBJECTIVES: We examined determinants of achieving blood pressure control in patients with hypertension and of treatment intensification in patients with uncontrolled blood pressure (BP). DESIGN: A retrospective cohort study in six public hospitals, Ethiopia. PARTICIPANTS: Adult ambulatory patients with hypertension and with at least one previously prescribed antihypertensive medication in the study hospital. OUTCOME: Controlled BP (<140/90 mm Hg) and treatment intensification of patients with uncontrolled BP. RESULTS: The study population comprised 897 patients. Their mean age was 57 (SD 14) years, 63% were females, and 35% had one or more cardiometabolic comorbidities mainly diabetes mellitus. BP was controlled in 37% of patients. Treatment was intensified for 23% patients with uncontrolled BP. In multivariable (logistic regression) analysis, determinants positively associated with controlled BP were treatment at general hospitals (OR 1.89, 95% CI 1.26 to 2.83) compared with specialised hospitals and longer treatment duration (OR 1.04, 95% CI 1.01 to 1.06). Negatively associated determinants were previously uncontrolled BP (OR 0.30, 95% CI 0.21 to 0.43), treatment regimens with diuretics (OR 0.68, 95% CI 0.50 to 0.94) and age (OR 0.99, 95% CI 0.98 to 1.00). The only significant-positive-determinant for treatment intensification was duration of therapy (OR 1.05, 95% CI 1.02 to 1.09). CONCLUSIONS: The level of controlled BP and treatment intensification practice in this study was low. The findings suggest the need for in-depth understanding and interventions of the identified determinants such as uncontrolled BP on consecutive visits, older age and type of hospital.

Effect of obesity and glycated hemoglobin on oxygen saturation in ambulatory type 2 diabetic individuals: A pilot study.

AIMS: Tissue hypoxia is an important contributor to diabetic complications. Glycation of hemoglobin (Hb) and obesity are major determinant of oxygen saturation (SpO2) in blood. Hence, the present study was planned to evaluate the effect of obesity on SpO2 in a wide range of glycated hemoglobin (HbA1c) levels in ambulatory type 2 diabetic patients. MATERIAL AND METHODS: A cohort of 60 subjects irrespective of diabetic status were recruited and clustered in group I (HbA1c <6.5) and group II (HbA1c ≥6.5) depending on HbA1c. Anthropometry and routine biochemical parameters were measured. HbA1c (%) were estimated by high performance liquid chromatography (HPLC) respectively. SpO2 (%) levels were measured by pulse oximetry. Pearson correlation, bivariate regression and student 't' test were used for statistical analysis. RESULTS: Blood concentration of HbA1c was <6.5 in 29 participants and ≥6.5 in 31 participants. Plasma fasting and post prandial glucose, HbA1c as well as Hb levels were significantly (p<0.50) higher in diabetics as compared to non diabetics. Waist circumference (WC) (r=-400; p=0.026) and body mass index (BMI) (r=-381; p=0.034) showed a significant negative correlation with SpO2 in diabetic patients. On adjusting HbA1c in group II, SpO2 was found to independently and inversely associated with WC (p=0.042) and BMI (p=0.049). CONCLUSIONS: Obesity was found to be a strong independent contributor to reduction in oxygen carrying capacity in ambulatory type 2 diabetic subjects. However there is no effect of glycated Hb on SpO2 in the same population.

Higher monetary incentives led to a lowered response rate in ambulatory patients: a randomized trial.

OBJECTIVES: Monetary incentives can increase response rate in patient surveys, but calibration of the optimal incentive level is required. Our aim was to assess the effect of different monetary incentives on response rates to calibrate the optimal monetary incentive for ambulatory patients. STUDY DESIGN AND SETTING: A patient-randomized trial was performed in which targeted individuals received different gift vouchers (€5.00, €7.50, €10.00, and €12.50) on completion of a survey and interview. Eligible patients (diagnosed type 2 diabetes, over 18 years) were recruited from primary care practices. RESULTS: The response rate for the €12.50 incentive was lower compared with both the €7.50 and the €10.00 incentive [odds ratio (OR) = 0.60 and OR = 0.58]. A nonlinear model yield a better fit than a linear model. Within the observed range of incentive levels, an overall decrease in response rate was found. CONCLUSION: High monetary incentives are not only inefficient but also less effective.