Patients’ Preferences for Connected Insulin Pens: A Discrete Choice Experiment Among Patients with Type 1 and Type 2 Diabetes

Background

This study quantified how people with diabetes value the unique features of connected insulin pens and related mobile apps, and the underlying reasons for preferring connected versus non-connected insulin pens.

Methods

A discrete choice experiment (DCE) was conducted in the USA and UK to elicit preferences of adults (≥ 18 years) with type 1 or 2 diabetes for attributes of insulin pens. Attributes included device type, dosing support, glucose monitoring, additional app features, and data sharing. Relative attribute importance (RAI) scores were calculated to capture the relative importance of an attribute. Predicted choice probabilities were obtained to compare different profiles for connected and non-connected insulin pens.

Results

The DCE was completed by 540 participants (58.9% male; 90.7% Caucasian; mean age, 58.3 years; 69.4% type 2 diabetes). Participants most valued the possibility of using a connected insulin pen with dosing support and automated dose logging (RAI = 39.9%), followed by automatic transfer of glucose levels (RAI = 29.0%), additional features of tracking diet and physical activity (RAI = 14.6%), data sharing (RAI = 13.6%), and device type (RAI = 2.9%). All profiles of connected insulin pens were preferred over a non-connected pen (p < 0.001), and pen profiles with advanced features were preferred over those without (p < 0.001). Preferences differed by age but not diabetes type, country of residence, or insulin regimen.

Conclusion

People with diabetes in the USA and UK prefer connected over non-connected insulin pens due largely to the availability of automated logging of dose and glucose levels.

     

Pharmacokinetics and Exposure–Response Analyses of Daratumumab in Combination Therapy Regimens for Patients with Multiple Myeloma

Introduction

Daratumumab, a human IgG monoclonal antibody targeting CD38, has demonstrated activity as monotherapy and in combination with standard-of-care regimens in multiple myeloma. Population pharmacokinetic analyses were conducted to determine the pharmacokinetics of intravenous daratumumab in combination therapy versus monotherapy, evaluate the effect of patient- and disease-related covariates on drug disposition, and examine the relationships between daratumumab exposure and efficacy/safety outcomes.

Methods

Four clinical studies of daratumumab in combination with lenalidomide/dexamethasone (POLLUX and GEN503); bortezomib/dexamethasone (CASTOR); pomalidomide/dexamethasone, bortezomib/thalidomide/dexamethasone, and bortezomib/melphalan/prednisone (EQUULEUS) were included in the analysis. Using various dosing schedules, the majority of patients (684/694) received daratumumab at a dose of 16 mg/kg. In GEN503, daratumumab was administered at a dose of 2 mg/kg (n?=?3), 4 mg/kg (n?=?3), 8 mg/kg (n?=?4), and 16 mg/kg (n?=?34). A total of 650 patients in EQUULEUS (n?=?128), POLLUX (n?=?282), and CASTOR (n?=?240) received daratumumab 16 mg/kg. The exposure–efficacy and exposure–safety relationships examined progression-free survival (PFS) and selected adverse events (infusion-related reactions; thrombocytopenia, anemia, neutropenia, lymphopenia, and infections), respectively.

Results

Pharmacokinetic profiles of daratumumab were similar between monotherapy and combination therapy. Covariate analysis identified no clinically important effects on daratumumab exposure, and no dose adjustments were recommended on the basis of these factors. Maximal clinical benefit on PFS was achieved for the majority of patients (approximately 75%) at the 16 mg/kg dose. No apparent relationship was observed between daratumumab exposure and selected adverse events.

Conclusion

These data support the recommended 16 mg/kg dose of daratumumab and the respective dosing schedules in the POLLUX and CASTOR pivotal studies.

Funding

Janssen Research & Development.

     

Oral or Topical Pain Therapy—How Would Patients Decide? A Discrete Choice Experiment in Patients with Peripheral Neuropathic Pain

To ensure an adequate pain therapy with high patient adherence, it is necessary to know and consider patient preferences. A discrete choice experiment was used to obtain patients’ preferences regarding treatment with systemic or topical pain medication. Patients with peripheral neuropathic pain (pNP) were recruited in two pain-focused practices in Germany. To identify relevant attributes of topical or systemic pain medication, a literature review and face-to-face interviews with experts for pain treatment were conducted. The attributes used in the choice scenarios were noticeable onset of effect, time spent in medical office, risk of systemic and local side effects, and impairment of daily life with regard to sleep quality and sexuality. The model was estimated with a mixed multinomial logit regression model. The study included 153 participants suffering from moderate to severe pNP. Most important attributes from patient’s perspective was noticeable onset of effect (odds ratio 2.141 [95% confidence interval 1.837 to 2.494]), followed by risk of systemic side effects (2.038 [1.731 to 2.400]) and risk of sexual dysfunction (1.839 [1.580 to 2.140]), while risk of local side effects regarding skin ranked fourth (1.612 [1.321 to 1.966]). The impairment of sleep quality was also significant but less important (1.556 [1.346 to 1.798]). Local side effects were more likely to be accepted than systemic side effects. The risk of sexual dysfunction as a side effect of treatment is very important for patients, although it has received little attention in the literature.     

Preferences and Reinforcers for Students With Profound Multiple Disabilities: Can We Identify Them?

Previous research has documented that there are limits to our current knowledge about procedures for identifying preferences and reinforcers for individuals with profound multiple disabilities as compared with other individuals with less significant disabilities. In this paper, we review the procedures used by other researchers to assess preferences and identify reinforcers for these individuals. Two experiments were completed that adapted the preference assessment and reinforcer testing procedures described by these researchers. These included changes in the trial and session format and the type of stimuli presented during the preference assessment, types of student behavior studies, and the research design used during reinforcement testing. Results show that while more preferences were identified with the adapted procedures, this increase did not lead to the identification of more effective reinforcers. The reinforcing effects of the preferred stimuli were idiosyncratic among the students and the data were variable both within and across participants. Implications for practice are discussed.     

Multidisciplinary Professional Roles Addressing Needs in Multiple Myeloma: An Innovative ‘Virtual’ Pharmacist Surveillance Clinic

ObjectivesAdvances in pharmacologic options has rendered multiple myeloma a chronic disease for most patients. This article explores the role of the pharmacist in new therapy start counseling, supportive care, and patient navigation in people affected by multiple myeloma. The role of the pharmacist in the pharmacist-led ‘Virtual Multiple Myeloma Clinic’ and the foundations guiding pharmacist prescribing are described in detail. Directions for future patient-centered research and opportunities in multiple myeloma are explored, specific to this jurisdiction.Data SourcesThese include academic databases (PubMed, MedLine), professional guideline documents, and first-person experience.ConclusionAlthough the treatment landscape for multiple myeloma therapy is rapidly evolving, the survival of patients with multiple myeloma has greatly increased, rendering this largely a chronic disease. Accordingly, the role of the clinical pharmacist in multiple myeloma clinics is extensive. Counseling on first-time therapies, supportive care (adverse events management, bone health, and vaccinations), and seamless patient care across local pharmacies and health care facilities are explored. The hematology pharmacist-led Virtual Multiple Myeloma Clinic, providing individualized efficacy monitoring and counseling to patients with stable multiple myeloma on oral immunomodulatory therapy, has been pivotal in optimizing clinic workload management.Implications for Nursing PracticePossessing additional prescribing authority is paramount to the efficiency of pharmacists in clinic. Outside of pharmacy, prescribers in community treatment centers require education on the management of novel multiple myeloma therapies. Family physicians and nurses may also benefit from an overview of common issues that patients may experience because of their multiple myeloma treatments, which may enable them to better manage side effects or complications resulting from treatment.     

The Bachelor’s thesis in nursing: Characteristics and students’ approach and satisfaction

AimThe aim of the study was to describe the characteristics of the Bachelor’s thesis of fourth-year nursing students at a Spanish public university, the criteria that students used to choose a topic and students’ degree of satisfaction after completing the Bachelor’s thesis.DesignQuantitative study.MethodsWe examined 420 Bachelor’s theses carried out from 2013 to 2018 and conducted an online survey among fourth-year students in the 2017–18 and 2018–19 academic years (81 completed questionnaires).ResultsThe Bachelor’s thesis took the form of a research proposal. The most frequent proposal type was a qualitative hospital-based study whose objective was to understand the experiences of adult or adolescent patients, close family members, or nurses. Students chose topics for personal reasons. Most participants reported feeling satisfied with the knowledge and skills acquired.ConclusionsStudents completing a Bachelor’s thesis in the form of a research proposal have the potential to transfer their research skills to their nursing practice.     

Correlations Between Individuals’ Characteristics and Spinal Stiffness in Individuals With and Without Back Pain: A Combined Analysis of Multiple Data Sets

Objective

The purpose of this study was to describe the correlations between individual characteristics and spinal stiffness as measured with different spinal stiffness measurement devices in individuals with and without back pain.

Merging Yoga and Occupational Therapy for Parkinson’s Disease: Program Adaptation and Development

Abstract

Purpose: To adapt the Merging Yoga and Occupational Therapy program and develop the Merging Yoga and Occupational Therapy for Parkinson’s disease (MY-OT for PD) program, designed to target fall risk management. Creating a new program involved the targeted development of Stage 1 manuals.

Methods: Researchers employed a pragmatic qualitative design to focus on meeting the purpose of the study. Stage 1 manuals were created following a literature review, a focus group of participants with PD, and individual interviews with experts in practice or research. Visual familiarization with data, generation of conclusions, and results verification were used to translate participant feedback into manual revisions.

Results: Themes included revisions to model, content, and delivery. Revisions were incorporated into Stage 1 manuals to create a PD-specific program to improve fall risk management.

Conclusion: A structured process is necessary to create Stage 1 manuals in a novel population prior to feasibility and pilot testing.     

Are Contents of Physical Therapy in Nine Japanese Hospitals for Inpatients with Stroke Related to Inpatients’ and Physical Therapists’ Characteristics?

[Purpose] This study investigated the factors that influence activities provided during physical therapy for stroke. [Subjects] Data were collected from 85 physical therapists and 216 inpatients with stroke. [Methods] Time spent on specific functional activities provided to inpatients with stroke was recorded at nine rehabilitation facilities. These were used as dependent variables. Physical therapists’ characteristics, including years since acquiring a license, gender, and treatment concepts influencing physical therapy for stroke, were recorded. Inpatients’ characteristics, including age, gender, affected side, days post stroke, score on the Modified Rankin Scale (mRS), and gait ability measured by the Functional Independence Measure (FIM gait), were also recorded. Physical therapists’ and inpatients’ characteristics were used as independent variables. The t-test, correlation coefficients, and analysis of covariance were used to investigate which independent variables correlated with which dependent variables. [Results] Pre-gait, advanced gait, and community mobility were significantly correlated with mRS and FIM gait (|r_s| = 0.32–0.62). Time spent on other functional activities had a weak correlation with inpatients’ characteristics. Time spent on functional activities had no or few correlations with physical therapists’ characteristics. [Conclusion] Relationships between time spent on specific functional activities and physical therapists’ characteristics were weaker than those for inpatients’ characteristics. Physical therapy for stroke includes many factors.Key words: Physical therapy, Rehabilitation, Stroke     

Expected roles and utilization of specialist nurses in Japan: the nurse administrators’ perspective

onishi m. & kanda k. (2010) Journal of Nursing Management 18, 311–318
Expected roles and utilization of specialist nurses in Japan: the nurse administrators’ perspective Aim This study explored (1) expected roles for specialist nurses in Japan and (2) nurse administrators’ experience-based management strategies for effective implementation of these roles. Background In Japan, specialist nurses have begun to be recognized as valuable human resources. However, managerial issues in utilizing specialist nurses, including unclear roles and lack of reports on effective management strategies, remain. Method Three focus-group discussions were conducted. Nine nurse administrators participated. Data were analysed using qualitative content analysis techniques. Results The expected roles for specialist nurses were: (1) facilitating general nurses’ learning; (2) monitoring and improving the patient care standard; and (3) developing new roles for nursing. Two management strategies were: (1) enhancing specialist nurses’ influence, and (2) enhancing specialist nurses’ motivation. Conclusions Specialist nurses are important human resources able to assume responsibility for process improvement in nursing care. Effective ways to enhance specialist nurses’ influence and motivation include developing their management and communication skills, and coordinating their workload and relationships with other health care professionals. Implications for Nursing Management Process improvement indicators may be useful for evaluating specialist nurses’ work. Nurse administrators can contribute to effective implementation of specialist nurses’ roles not only by clarifying their roles but also by empowering them to keep up with changing organizational needs.     

Targeting Schlemm’s Canal in the Medical Therapy of Glaucoma: Current and Future Considerations

Schlemm’s canal (SC) is a unique, complex vascular structure responsible for maintaining fluid homeostasis within the anterior segment of the eye by draining the excess of aqueous humour. In glaucoma, a heterogeneous group of eye disorders afflicting approximately 60 million individuals worldwide, the normal outflow of aqueous humour into SC is progressively hindered, leading to a gradual increase in outflow resistance, which gradually results in elevated intraocular pressure (IOP). By and large available antiglaucoma therapies do not target the site of the pathology (SC), but rather aim to decrease IOP by other mechanisms, either reducing aqueous production or by diverting aqueous flow through the unconventional outflow system. The present review first outlines our current understanding on the functional anatomy of SC. It then summarizes existing research on SC cell properties; first in the context of their role in glaucoma development/progression and then as a target of novel and emerging antiglaucoma therapies. Evidence from ongoing research efforts to develop effective antiglaucoma therapies targeting SC suggests that this could become a promising site of future therapeutic interventions.     

Selective α-Synuclein Knockdown in Monoamine Neurons by Intranasal Oligonucleotide Delivery: Potential Therapy for Parkinson’s Disease

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Pharmacotherapy for Obesity and Changes in Eating Behavior: a Patient and Physician’s Perspective

This article, co-authored by a patient with obesity, diabetes, and hypertension, and an obesity medicine specialist, discusses the patient’s experience with the onset of diabetes complicating obesity and with her frustration living with these diagnoses until finding an obesity medicine specialist physician who helped her lose weight and reverse her diabetes. The patient continues to maintain a significant weight loss and is diabetes free for 5.5 years after treatment initiation. The physician discusses the application of combination treatment that can be effective in diabetes reversal in such cases. He also discusses salient clinical lessons exemplified by this case.     

A Five-step Systematic Therapy for Treating Plugged Ducts and Mastitis in Breastfeeding Women: A Case–Control Study

PurposeThis study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct.MethodsThis retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST.ResultsAfter a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ² = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ² = 25.65, p < .001).ConclusionFSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.     

Communication Dilemmas in the Context of Cancer: Survivors’ and Partners’ Strategies for Communicating Throughout Survivorship

More people are now living longer beyond cancer treatment and are facing the complexities associated with survivorship. Communicating amid a cancer experience, for example, can be difficult for couples, and survivors must face these challenges for extended periods of time. The current study employed a communication perspective to explore couples’ conversations throughout cancer survivorship. In-depth interviews with 35 cancer survivors and 25 partners yielded insight into the specific communicative challenges couples face after completing cancer treatment. The data highlight cancer's lingering uncertainties and are discussed in terms of the dyadic challenges inherent in couples’ communicative efforts.