Monitoring Medication Adherence by Unannounced Pill Counts Conducted by Telephone: Reliability and Criterion-Related Validity

Abstract

Background: Although demonstrated valid for monitoring medication adherence, unannounced pill counts conducted in patients’ homes are costly and logistically challenging. Telephone-based unannounced pill counts offer a promising adaptation that resolves most of the limitations of home-based pill counting. Purpose: We tested the reliability and criterion-related validity of a telephone-based unannounced pill count assessment of antiretroviral adherence. Method: HIV-positive men and women (N = 89) in Atlanta, Georgia, completed a telephone-based unannounced pill count and provided contemporaneous blood specimens to obtain viral loads; 68 participants also received an immediate second pill count conducted during an unannounced home visit. Results: A high degree of concordance was observed between the number of pills counted on the telephone and in the home (intraclass correlation [ICC] = .981, p < .001) and percent of pills taken (ICC = .987, p < .001). Adherence obtained by the telephone count and home count reached 92% agreement (Kappa coefficient = .94). Adherence determined by telephone-based pill counts also corresponded with patient viral load, providing evidence for criterion-related validity. Conclusion: Unannounced telephone-based pill counts offer a feasible objective method for monitoring medication adherence.     

舒脑欣滴丸治疗血虚血瘀型慢性脑供血不足的临床观察

[目的] 研究舒脑欣滴丸对血虚血瘀型慢性脑供血不足的临床疗效。[方法] 将100例符合纳入标准的慢性脑供血不足患者随机分为两组,治疗组(舒脑欣滴丸)50例、对照组(尼莫地平)50例。治疗4周后观察证候评分、经颅多普勒(TCD)、血流变的变化。[结果] 1)中医症状评分及疗效上,两组脑供血不足中医症状评分均明显低于治疗前(均P<0.05),治疗组总有效率显着高于对照组(P<0.05).两组失眠症状评分均明显低于治疗前(P<0.05),治疗组总有效率显着高于对照组(P<0.05).2)脑血流改善方面,经颅多普勒结果检测治疗组双侧大脑中动脉(MCA)及双侧基底动脉(BA)治疗后搏动指数(PI)降低,与治疗前比较有统计学差异(P<0.05),且治疗组左侧大脑中动脉(LMCA)及双侧基底动脉(BA)的搏动指数(PI)与对照组比较亦有统计学差异(P<0.05).血流速度增快两组间比较,对照组有效率高于治疗组,有统计学差异(P<0.05);血流速度减慢两组间比较无统计学意义(P>0.05).[结论] 舒脑欣滴丸可明显改善血虚血瘀型慢性脑供血不足患者临床症状,能够双向调节脑血流速度,提高血管顺应性,提高脑灌注。     

HPLC测定六味丁香丸中的土木香内酯

目的采用RP-HPLC法测定六味丁香丸中的土木香内酯。方法采用EClipse XDB-C18色谱柱,乙腈-0.05%磷酸溶液(50∶50)为流动相,柱温40℃,流速1.0 m L·min-1,检测波长194 nm。结果土木香内酯0.293~3.51μg与峰面积的线性关系良好(r=0.9999),平均加样回收率为98.74%,RSD=0.57%(n=6)。结论所用方法准确、简便、灵敏、可靠,可用于六味丁香丸的质量控制。     

复方川芎滴丸制备工艺再探讨

目的优选复方川芎滴丸的最佳制备工艺。方法以药物与基质的配比、滴制温度、冷却液的温度为考察因素,采用正交试验设计,以滴丸的圆整度、丸重差异、溶散时限、外观质量的综合评分为评价指标,优选滴丸的成型工艺;以滴距、滴速为考察因素,优选最佳滴制工艺。结果滴丸制备的最佳条件为药物中间体与基质配比12,滴制温度80℃,冷却剂温度15~20℃,滴距5cm,滴速40gtt/min。结论该制备工艺合理,简便,易于控制,适用于本制剂的制备。     

Efficacy and safety of Xihuang pill for gastric cancer: A protocol for systematic review and meta-analysis

Background:Xihuang pill has been widely applied as a promising adjunctive drug for gastric cance. However, the exact effects and safety of Xihuang pill have yet to be systematically investigated. We aimed to summarize the effificacy and safety of Xihuang pill for the treatment of advanced GC through the meta-analysis, in order to provide scientific reference for the design of future clinical trials.Methods:The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant randomized controlled trials were searched from PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and echnology Periodical Database, and Chinese Biomedical Literature Database. Papers in English or Chinese published from their inception to October 2020 will be included without any restrictions. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. The RevMan 5.4 and Stata 16.0 software will be applied for statistical analyses. Statistical heterogeneity will be computed by I² tests. Sensitivity analysis will be conducted to evaluate the stability of the results. The publication bias will be evaluated by funnel plots and Egger test. The quality of evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluate system.Results:The results of our research will be published in a peer-reviewed journal.Conclusion:The conclusion of this study will provide helpful evidence of the effect and safety of Xihuang pill for the treatment of GC in clinical practice.OSF registration number:10.17605/OSF.IO/VFJAK.     

糖肾康丸薄层色谱鉴别

目的建立糖肾康丸的质量标准。方法采用TLC对糖肾康丸中的黄芪、山茱萸、五味子、黄柏进行定性鉴别。结果定性鉴别方法准确、专属性强。结论该方法简便可行、准确、专属性强,可有效控制糖肾康丸的质量。     

HPLC法同时测定养心宁神丸中丹参酮ⅡA和丹酚酸B的含量

目的建立高效液相色谱法测定养心宁神丸中丹参酮ⅡA和丹酚酸B的质量分数。方法采用Agilent ZORBAX XDB-C18(250 mm×4.6 mm,5μm)色谱柱,以乙腈为流动相A,0.1%(体积分数)H3PO4溶液为流动相B,梯度洗脱,流速:1.0 m L/min,柱温:30℃。结果丹参酮ⅡA和丹酚酸B分别在1.444~14.44μg/m L(R=0.999 9)、38.84~388.4μg/m L范围内(R=0.999 5)呈良好的线性关系,平均回收率分别为101.42%(RSD=3.06%)、101.97%(RSD=2.23%)。结论本方法简便、快捷、重复性好,可以用于养心宁神丸的质量控制。     

冠状动脉慢血流与血管内皮的相关性研究及药物干预

目的探讨冠状动脉慢血流与血管内皮的相关性及应用麝香通心滴丸进行药物干预的作用。方法选取2016年12月至2017年12月于沈阳医学院附属中心医院循环内科因胸痛、胸闷就诊的患者共59例,分为试验组(28例,慢血流患者)及对照组(31例,血流正常的患者),检测两组低密度脂蛋白胆固醇(LDL-C)、尿酸、同型半胱氨酸、NO、ET-1指标水平。试验组术中测量应用药物前后校正的TIMI及应用麝香通心滴丸1个月后低密度脂蛋白、尿酸、同型半胱氨酸、NO、ET-1水平,并进行相关性分析。结果试验组同型半胱氨酸、低密度脂蛋白、尿酸、ET-1水平高于对照组(P<0.05,P<0.01),而NOS低于对照组(P<0.05)。试验组患者用药后CTFC(校正的TIMI)显著降低(P<0.05),用药前与用药后1个月的LDL-C、尿酸、ET-1水平比较差异有统计学意义(P<0.05,P<0.01)结论冠状动脉慢血流的患者内皮功能存在受损,麝香通心滴丸可以改善血流速度及改善内皮功能。     

Understanding HIV-Related Pill Aversion as a Distinct Barrier to Medication Adherence

Abstract

Pill aversion, defined as difficulty swallowing pills without identifiable medical cause, is a poorly characterized barrier to sustained viral suppression for many HIV-infected persons. We aimed to quantify the frequency of self-reported pill aversion, characterize its symptoms, and measure the association between self-reported pill aversion and missing antiretroviral doses. This is a prospective, observational, exploratory survey study of English-speaking persons living with HIV (PLHIV) at a single urban tertiary outpatient clinic. Participants completed anonymous questionnaires about their experiences of swallowing antiretroviral pills. The primary outcome was skipping pills due to pill aversion symptoms. Of 384 participants, a quarter (25.5%) skipped pills due to pill aversion symptoms. Younger age, being Non-Hispanic Black or Hispanic, not being married or partnered, having public insurance, not being employed, having less than a college education, and having a mental health diagnosis were associated with skipping pills due to pill aversion. On multivariable regression analyses, PLHIV who skipped pills were more likely to report symptoms of gagging, nausea at the time of swallowing, and heavy feeling in the stomach, as well as being bothered by the taste, smell, and size of the pills. PLHIV who skipped pills were also more likely to report negative and fear-based emotions about pill-taking than PLHIV who did not skip pills due to pill aversion. HIV-related pill aversion may represent a significant and frequent barrier to adherence in an adult HIV population.