Adherence to medication. N Engl J Med

Stanford University, Palo Alto, California, United States
New England Journal of Medicine (Impact Factor: 55.87). 09/2005; 353(5):487-97. DOI: 10.1056/NEJMra050100
Source: PubMed
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    • "For example, the opportunity for delivery via systemic approaches (e.g., oral formulations or parenteral injections) is largely precluded by lack of specificity, which results in undesirable side effects and systemic toxicity [3]. Topical delivery (e.g., via eye drops) allows for better targeting and, as such, is used widely for many indications [4]. However, this approach is highly inefficient (i.e., drug bioavailability <3% in many cases), and it is also subject to poor patient compliance, due in part to the required frequency of application [5]. "
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    ABSTRACT: The development of a safe, simple, and efficacious means for ocular drug delivery remains a critical unmet need. Solid microneedles (MNs) show significant promise in this regard. However, the limited drug carrying capacity of devices demonstrated to date may limit potential for clinical translation, due to the prohibitively large array sizes that may be required for delivery of therapeutically-relevant dosages. In this study, titanium deep reactive ion etching (Ti DRIE) is used to address this limitation via fabrication of MNs with complex through-thickness fenestrations (i.e., windows), which serve as reservoirs for passive delivery. Using finite element analyses, mechanical testing, and ex vivo rabbit cornea preparations, we show that these devices possess sufficient stiffness for reliable insertion. Furthermore, using spectrophotometry and fluorescence microscopy, we show that these devices can increase carrying capacity up to five-fold relative to solid MNs of comparable size, as well as enhance sub-surface deposition in ex vivo rabbit cornea. Collectively, these results begin to demonstrate the potential embodied in fenestrated Ti MNs for eventual realization of ocular drug delivery devices with more clinically-relevant form factors.
    Full-text · Article · Feb 2016 · Sensors and Actuators B Chemical
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    • "Due to the number of overall studies, purely qualitative studies were excluded, as were studies evaluating selective PCT (screening followed by treatment of infected individuals only). The set of LF publications from India was primarily based on theDefined as " the extent to which a person' s behaviour – taking medication, following a diet, and/or executing lifestyle changes—coincides with medical or health advice "[22,28]; some argue it suggests the patient has a passive role in following provider's orders "
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    ABSTRACT: Preventive chemotherapy (PCT) programmes are used to control five of the highest burden neglected tropical diseases (NTDs): soil-transmitted helminth infections (hookworm, ascariasis, and trichuriasis), lymphatic filariasis, schistosomiasis, onchocerciasis, and trachoma. Over the past decade, new resource commitments for the NTDs have enabled such programmes to intensify their control efforts, and for some diseases, to shift from goals of morbidity control to the interruption of transmission and elimination. To successfully eliminate the parasite reservoir, these programmes will undoubtedly require prolonged, high treatment coverage. However, it is important to consider that even when coverage levels reach an acceptable proportion of the target population, there may be a considerable gap between coverage (those who receive the drug) and compliance (those who actually consume the drug)—a topic of fundamental and perhaps underestimated importance. We conducted a systematic review of published literature that investigated compliance to PCT programmes for NTD control and elimination. Databases searched included PubMed/Medline, Web of Knowledge (including Web of Science), OVID, and Scopus. Data were collected on compliance rates, reasons for non-compliance, as well as the heterogeneity of compliance definitions and calculations across programmes and studies. A total of 112 studies were selected for inclusion. The findings of the review revealed substantial heterogeneity across compliance terms and definitions; an imbalance of available studies for particular disease areas and countries; and finally, a lack of longitudinal compliance studies to properly investigate the role of systematic non-compliance. The lack of consistency among reporting of compliance data can result in under- or over-estimating compliance in a population, and therefore has serious implications for setting and reaching elimination targets. Reframing of the guidelines on compliance definitions coupled with an urgent call for longitudinal research in systematic non-compliance should be essential elements in the programmatic shift from control to elimination. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1311-1) contains supplementary material, which is available to authorized users.
    Full-text · Article · Jan 2016 · Parasites & Vectors
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    • "Although they use different technologies to slow/control drug release and thereby prolong drug absorption, XR formulations are designed to minimize plasma concentration fluctuations over the course of a day despite less frequent dosing than their IR counterparts [3]. However, even with less frequent dose administration, adherence can be imperfect as patients take doses late or miss doses altogether [4]. Recognition that less frequent dosing with XR formulations can be associated with better outcomes is often tempered by expectations that QD dosing, for example , is not as " forgiving " as BID dosing, implying that a late or missed dose of an XR AED is more likely to compromise seizure control than a dose of its more frequently administered IR counterpart [5] [6] [7]. "
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    ABSTRACT: "Forgiveness" - the difference between a drug's postdose duration of action and its prescribed dosing interval - estimates the margin of therapeutic effect following a missed dose. Because this margin presumably decreases as dosing becomes less frequent, QD dosing of an antiepileptic drug (AED) is expected to be less forgiving than more frequent (e.g., BID) dosing of that same AED. However, if the AED is reformulated as an extended-release (XR) preparation, drug input may be prolonged relative to its immediate-release (IR) counterpart. It therefore stands to reason that forgiveness could be increased by an XR AED that extends the period during which therapeutic plasma concentrations are maintained if a dose is missed. Computer simulation was used to estimate forgiveness for an IR formulation of a hypothetical AED and its XR counterparts reformulated for less frequent dosing. Simulations determined forgiveness when the hypothetical IR AED was dosed TID, BID, and QD and when suitably designed XR formulations were dosed BID and QD. Simulations showed that forgiveness for an XR formulation can equal or exceed that for an IR formulation dosed more frequently.
    Full-text · Article · Jan 2016 · Epilepsy & Behavior
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