Adherence to the immunomodulatory drugs for multiple sclerosis: contrasting factors affect stopping drug and missing doses.
ABSTRACT Long-term immunomodulatory drug (IMD) treatment is now common in multiple sclerosis (MS). However, predictors of adherence are not well understood; past studies lacked lifestyle factors such as alcohol use and predictors of missed doses have not been evaluated. We examined both levels of non-adherence-stopping IMD and missing doses.
This longitudinal prospective study followed a population-based cohort (n = 199) of definite MS patients in Southern Tasmania (January 2002 to April 2005, source population 226 559) every 6 months. Baseline factors (demographic, clinical, psychological and cognitive) affecting adherence were examined by logistic regression and a longitudinal analysis (generalized estimating equation (GEE)).
Of the 97 patients taking an IMD (mean follow-up = 2.4 years), 73% (71/97) missed doses, with 1 in 10 missing > 10 doses in any 6-month period. Missed doses were positively associated with alcohol amount consumed per session (p = 0.008). A history of missed doses predicted future missed doses (p < 0.0005). Over one-quarter (27/97) stopped their current IMD, which was associated with lower education levels (p = 0.032) and previous relapses (p = 0.05). No cognitive or psychological test predicted adherence.
There were few strong predictors of missed doses, although people with MS consuming more alcoholic drinks per session are at a higher risk of missing doses. Divergent factors influenced the two levels of non-adherence indicating the need for a multifaceted approach to improving IMD adherence. In addition, missed doses should be assessed and incorporated into clinical trial design and clinical practice as poor adherers could impact on clinical outcomes.
- [Show abstract] [Hide abstract]
ABSTRACT: The name multiple sclerosis (MS) refers to 2 features of the disease: multiple describes the number of central nervous system lesions and sclerosis refers to the demyelinated nature of the lesions. Today, these lesions are usually called plaques rather than scleroses. Multiple sclerosis is a complex inflammatory disease of the central nervous system that is variable in terms of symptoms and presentation. The objectives of this article are to review briefly the epidemiology and pathophysiology of MS and to focus on the major categories of therapies currently in use to treat MS. Research is progressing at a rapid pace. The article also discusses some of the most promising new compounds in clinical trials.Journal of infusion nursing: the official publication of the Infusion Nurses Society 01/2009; 32(3):137-44. DOI:10.1097/NAN.0b013e3181a1a895
- [Show abstract] [Hide abstract]
ABSTRACT: A computationally efficient method is described for calculating the scattered fields from conducting bodies of arbitrary shape. The process is non-iterative and incrementally propagates a planar field distribution through the conductor via spectral decomposition of the wave, inserting the necessary boundary conditions as required. Integration is performed numerically using Fast Fourier Transform routines. The technique is compared with two analytic methods for calculating the scattered fields from a perfectly conducting half plane and then from a perfectly conducting cylinder. A generalisation of the method to deal with scattering off bodies composed of any dielectric material is discussed.Microwave Conference, 1985. 15th European; 10/1985
Conference Paper: LASH-TOR: a generic transition-oriented routing algorithm[Show abstract] [Hide abstract]
ABSTRACT: Cluster networks are seen as the future access networks for multimedia streaming, e-commerce, network storage, etc. For these applications, performance and high availability are particularly crucial. Regular topologies are preferred when performance is the primary concern. However, due to spatial constraints or fault-related issues, the network structure may become irregular, which makes more difficult to find deadlock-free minimal paths. Over the recent years, several solutions have been proposed. One of them is the LASH routing, which enables minimal routing by assigning paths to different virtual layers. In this paper, we propose an extension of LASH in order to reduce the number of required virtual layers by allowing transitions between virtual layers. Evaluation results show that the new routing scheme (LASH-TOR) is able to obtain full minimal routing with a reduced number of virtual channels. For torus and mesh networks, with only two virtual channels, LASH throughput is increased by an average factor of improvement of 3.30 for large networks. For regular networks with some unconnected (faulty) links, equal performance improvements are achieved. Even for highly irregular networks of size up to 128 switches the new routing scheme only needs three virtual channels for guaranteeing minimal routing. Besides, LASH-TOR performs well compared to dimension order routing for mesh and torus networks.Parallel and Distributed Systems, 2004. ICPADS 2004. Proceedings. Tenth International Conference on; 08/2004