Predictors of short-term success of antiretroviral therapy in HIV infection

OBJECTIVES: The success of highly active antiretroviral therapy (HAART) in HIV infection may be influenced by numerous host factors. There is a lack of data presenting a combined assessment of a variety of these parameters for treatment efficacy in clinical routine practice. METHODS: Different indices of therapeutic drug monitoring (TDM) were evaluated prospectively in the context of self-reported adherence, health-related quality of life and social determinants, as measured by a questionnaire. RESULTS: A total of 210 individuals were studied between 2002 and 2004, 77% were males, mean age was 44 years, mean CD4 count was 336 cells/mm3 and 63% had a viral load < 50 copies/mL. In univariate analysis, baseline viral load, unscheduled drug levels, a 4 h pharmacokinetic profile (PK-P) at a scheduled visit and self-reported complete adherence within the previous 2 weeks were significantly associated with virological success of HAART at 12 weeks. At 24 weeks, only baseline viral load, the 4 h PK-P and adherence were significantly associated with HAART efficacy. In multivariate analysis, baseline viral load, adherence, unscheduled drug levels, trough levels at a visit with appointment as well as the 4 h PK-P were significantly associated with virological success at 12 weeks. At 24 weeks, only adherence was significantly linked to outcome. The other parameters were not found to have an impact on treatment efficacy. CONCLUSIONS: TDM and self-reported adherence were independently predictive of short-term HAART success in this prospective study. Unscheduled drug measurements provided similar diagnostic information as a 4 h PK-P. Thus, we propose the use of unscheduled drug level monitoring and self-reported adherence to help identify patients with elevated risk of virological failure.     

A self-directed adherence management program for patients with heart failure completing combined aerobic and resistance exercise training

This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.     

Predictors of NCLEX-RN success in a baccalaureate nursing program as a foundation for remediation

This study evaluated students' demographic and nursing program variables and standardized test scores to determine whether significant differences existed between students who successfully completed the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and those who were unsuccessful. In addition, the predictive accuracy of two standardized examinations, the Mosby AssessTest and the Health Education Systems, Incorporated (HESI) Exit Examination were compared. Two cohorts of graduating senior nursing students were studied (1999 cohort N = 121; 2000 cohort N = 103). Demographic and nursing program variables were obtained from student records. The Undergraduate Studies Committee provided standardized test scores (Mosby AssessTest in 1999; HESI Exit Examination in 2000). Only two program variables were consistently associated with success on the NCLEX-RN--final course grade for a didactic, senior-level medical-surgical nursing course and cumulative program grade point average. Scores on both standardized tests were significantly different in students who were successful on the NCLEX-RN and those who were not. The HESI Exit Examination demonstrated greater sensitivity, specificity, positive and negative predictive value, and test efficiency, compared with the Mosby AssessTest. Use of program variables and students' standardized test scores may allow faculty to identify students at risk for failing the NCLEX-RN and to provide structured remediation so these students may be successful on the licensing examination and begin their nursing careers.     

Predictors of NCLEX-RN success across 3 prelicensure program types

Nursing faculty are concerned about the ability of recent graduates to successfully pass NCLEX-RN on their first-attempt. To facilitate student first-time success on the examination, nurse educators need to understand what student characteristics are predictive of success. The purpose of this study was to explore student characteristics across 3 different programs types (university-based BSN, master's entry, and satellite BSN) and in each of the 3 program types to identify predicators of first-time NCLEX-RN success.     

Results of a pilot intervention trial to improve antiretroviral adherence among HIV-positive patients.

A small pilot trial of a multicomponent (behavioral strategies, simplified patient information, and social support) and multidisciplinary (cognitive-behavioral therapy and nursing) medication adherence intervention was conducted for HIV-infected adults prescribed antiretrovirals. Patients (N = 33) were randomly assigned to the intervention condition or standard care. Compared to the control group, patients in the intervention condition had significantly higher self-efficacy to communicate with clinic staff (p = .04) and to continue treatment (p = .04), were significantly more likely to be using behavioral and cognitive strategies (p = .01 and p = .04), reported significantly higher life satisfaction (p = .03), reported significantly increased feelings of social support (p = .04), and showed a trend toward an increase in taking their medications on schedule (p = .06). The intervention, however, did not appear to affect health-related anxiety or to significantly improve adherence to dose. Implications for future intervention planning are discussed.     

Predictors of success in nursing education.

This correlational study was designed to determine if successful completion of the associate degree nursing program and success on the NCLEX-RN were correlated to scores on the Educational Resources, Inc. NET and Pre-RN Examinations. Data were collected from the educational records of the sixty-eight successful graduates from the fall 2001 class. This study found composite scores on the NET and Pre-RN were statistically significant, and were useful in predicting success on the NCLEX-RN. Consistent with the literature, this study found standardized measures and educational records may be useful screening tools for admission to nursing school, to predict success in the nursing program, and the NCLEX-RN. Faculty may utilize these findings in advising students, for developing support services and to assist students in developing an action plan to prepare for the NCLEX-RN. As suggested by sample size and correlations, a replication study was designed.     

短信干预对艾滋病患者抗病毒治疗依从性影响的Meta分析

目的采用Meta分析方法评价短信干预对艾滋病患者抗病毒治疗依从性效果。方法计算机检索PubMed、EMbase、CINAHL、Web of Science、ScienceDirect、The Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,搜集短信干预对艾滋病患者抗病毒治疗依从性影响的随机对照试验(RCT),检索时限均从2000年1月至2018年12月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入10个研究,包括2 411例患者。Meta分析结果显示:与常规护理相比,短信干预能够提高艾滋病患者治疗依从性[RR=1.11,95%CI(1.03,1.20),P<0.01]。亚组分析显示,每周发送短信能够提高治疗依从性[RR=1.15,95%CI(1.00,1.33),P<0.05];但个性化发送[RR=1.17,95%CI(0.99,1.38),P=0.06]、每日发送短信[RR=1.02,95%CI(0.83,1.26),P=0.84]对治疗依从性影响无差异;干预期限为6个月能够提高治疗依从性[RR=1.11,95%CI(1.00,1.23),P=0.05],干预12个月对治疗依从性影响无差异[RR=1.07,95%CI(0.98,1.17),P=0.13];治疗前后检测的CD4^+细胞计数无差异[WMD=4.18,95%CI(-39.33,47.69),P=0.85]。结论短信干预与常规护理比较,持续半年每周发送短信提醒艾滋病患者服药能提高治疗依从性。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。     

艾滋病患者抗病毒治疗依从现状的调查分析

目的 调查我国某农村地区艾滋病患者抗病毒治疗的服药依从性现状,并分析影响服药依从性的相关因素.方法 采用问卷对安徽省阜阳市70例艾滋病患者进行匿名调查,内容包括患者服药情况及其社会人口学资料、治疗情况、副反应、服药知识.采用SPSS 13.0统计软件对数据进行整理分析.结果 70例患者过去4 d内服药依从率为50%～100%,平均85.51%,服药依从(服药依从率≥95%)的患者占42.9%.患者漏服药物的主要原因包括外出或干农活而不在家、忘记、怕被注意到服药和应服药时睡着了.经分析发现,患者的年龄、子女个数和服药知识是影响其服药依从性的相关因素.结论 所调查艾滋病患者抗病毒治疗的服药依从性为中等水平,有待于进一步提高.针对患者漏服药物的常见原因和主要相关因素,可通过对患者提醒、督导,提高和改善患者的服药知识,从而提高艾滋病患者的服药依从性,保证其治疗效果并促进艾滋病治疗和预防工作.     

Delays in completing medical school: Predictors and outcomes

This article addresses whether delayed graduation due to academic difficulties in the early years of medical school can be predicted early and whether such difficulties are likely to be manifested in later clinical clerkships and residency. A group of 103 graduates who entered Jefferson Medical College between 1970 and 1984 and who required more than 4 years to complete their studies due to academic difficulties were compared to a random sample of 120 on‐time graduates. Statistically significant differences were observed between delayed and on‐time graduates on measures of performance before, during, and after medical school in favor of on‐time graduates. Scores of 8 on the Medical College Admission Test and an undergraduate science grade‐point average of 3.25 were found to be pivotal points below which the likelihood of delayed graduation was higher than the likelihood of on‐time graduation. Discriminant analyses indicated that 76% of delayed and on‐time graduates could correctly be classified into their respective groups by using admissions variables. These findings suggest that predictors of delayed graduation can be detected early in medical school and that the same academic difficulties that resulted in delayed graduation are likely to continue through postgraduate training. Recognition of the chronic nature of these differences should alert medical schools to monitor carefully the performance of students who are delayed because of academic difficulties and to provide appropriate support on a continuing basis to enhance performance.     

Predictors of success in nursing school and on State Board Examinations in a predominantly black baccalaureate nursing program

High school grade point averages, Scholastic Aptitude Test verbal and quantitative scores, and National League for Nursing Pre-Nursing Examination scores were obtained for 456 black students enrolled in a private baccalaureate school of nursing. Discriminant analysis showed that these measures significantly differentiated between dropouts and graduates. For 181 graduates, these same predictors plus college grade point average also significantly differentiated between passers and failers on the State Board Examination.     

Three key components to successfully completing a nursing doctoral program

Using their personal experience, the authors identify three key components to successfully completing a nursing doctoral program. The first component is asking the right questions to determine the doctoral degree best suited for the potential student. The second component is having a strategic plan that includes aspects such as financial considerations (research costs and potential financial support) and the development of a strong support system (specifically study pairs). The third component is the development of a systematic approach to completing the research, writing the dissertation, and completing the oral requirements. Addressing these areas will help students balance the many demands of doctoral study.     

Improved quality of life among patients completing a pulmonary rehabilitation program: one center's early experience

INTRODUCTION: The conclusion of previous investigations that pulmonary rehabilitation (PR) is an effective intervention for the management of chronic lung disease may not be generalizable to PR programs with limited experience delivering this complex, interdisciplinary service. OBJECTIVE: Determine whether PR is effective for the first group of patients treated in a newly formed interdisciplinary PR program. METHODS: We conducted a longitudinal analysis of changes in health-related quality of life and 6-minute walk test for the first group of patients completing our newly formed 8-week outpatient PR program. We studied 6 men, age 65-77 years, with stable severe chronic obstructive pulmonary disease. Patients completed the Chronic Respiratory Disease Questionnaire immediately before and 1 year after participation in our PR program. RESULTS: Four patients completed the PR 6-minute walk test both before and after the program. We found improvement in all Chronic Respiratory Disease Questionnaire domains at follow-up (mean +/- SD before and after): dyspnea 1.67 +/- 0.82 vs 4.92 +/- 0.49; emotional function 2.33 +/- 0.82 vs 5.50 +/- 0.55; fatigue 2.00 +/- 0.63 vs 5.00 +/- 0.63; feeling of mastery over disease 1.83 +/- 0.41 vs 5.83 +/- 1.17. The interval improvements in all health-related quality of life domains were statistically significant (p < 0.02 for all comparisons). There was a trend toward improvement in exercise tolerance: 231 +/- 213 ft before PR vs 353 +/- 66 ft at the 1-year follow-up (p = 0.2). CONCLUSIONS: PR can result in sustained improvement in the quality of life of patients with severe chronic obstructive pulmonary disease, even when this complex, interdisciplinary service is delivered by a newly formed and inexperienced PR program.     

Facilitating program and NCLEX-RN success in a generic BSN program

This article focuses on a study of predictors of program and NCLEX-RN success and withdrawal in a generic BSN program at the University of Hawaii at Manoa School of Nursing. Data were collected over a 5-year period after a new curriculum was implemented. High program (95.09%) and NCLEX-RN (97.25%) success were achieved. Of the 11 who did not meet the definition of program success, 100% completed the program by another two to three semesters and 90.91% passed the NCLEX-RN as first-time takers. The program withdrawal rate was 20%. It is very important to use measures to promote program completion and NCLEX passing for both the normally progressing and at-risk student to meet the demands of the nursing shortage.     

Predictors of academic success in a Bachelor of Nursing course

A longitudinal study of one Bachelor of Nursing course (n=181) was carried out to determine the relationship between academic outcomes and pre-entry qualifications and to discuss the progress and success of students with conventional and non-conventional qualifications. A multi-linear regression analysis was used to determine which pre-entry qualification best explained the variation in the course marks. Results identified that the number of GCSE A grades obtained significantly predicted success on the BN course. On the basis of this finding it has been suggested that the new AS levels, introduced as part of the reformed 16-19 curriculum, may have greater predictive value than current A levels since they allow a broader range of study. Students entering the course with non-conventional qualifications were found to achieve slightly lower marks throughout the course and had a high rate of attrition. Further research is needed to replicate these findings and to determine whether high grades in any specific subject, for example Biology, improve the predictive value of pre-entry qualifications.     

Comprehensive clinical adherence interventions to enable antiretroviral therapy: a case report.

Adherence to antiretroviral therapy is key for successful treatment of HIV-infected persons. To enhance adherence, multilevel interventions are necessary. This is often a challenge, as this case of an HIV-infected man with a history of poor adherence and multiple virological failures shows. With a multidisciplinary approach, comprehensive intervention strategies were used to facilitate the patient's adherence to an enfuvirtide-based regimen. The interventions are described in detail and include adherence support with modified daily observed therapy, support regarding symptom management, and social relationships. The patient's clinical progress was monitored using indicators such as clinical surrogate markers, adherence to antiretroviral therapy, and HIV-related symptom and depression scores. The case illustrates how interventions that were individualized, culturally sensitive, and provided by a team of health care providers enabled a patient to optimize his adherence, which led to significant improvement in his clinical surrogate markers and subjective quality of life.