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Biomedical subjects

N J Ostrop

Publications and source records attributed to N J Ostrop.

8 recordsLinked to original sources
PubMed2000

Antiretroviral medication adherence and persistence with respect to adherence tool usage.

Adherence to complex drug regimens over an extended period is a key factor in reaping the health benefits of highly active antiretroviral therapy (HAART). Forgetting a dose is the most commonly stated reason for suboptimal adherence, indicating a potential benefit of reminder devices. We examined antiretroviral drug adherence and duration of therapy with respect to adherence tool usage. Adherence was monitored for 12 months in a cohort of patients, using pharmacy refill data. Seventy-eight subjects were administered a questionnaire with regard to tool use at least once at 6 and/or 12 months; patients who replied to the questionnaire were eligible for this study. Persistence of remaining on therapy was obtained from the subjects, charts. The tools included individualized schedules, dosettes and electronic reminder devices, which were offered free of charge to all patients. Of the 64 subjects who entered this study, 60.9% (n = 39) used at least one adherence tool. The median adherence in those using tools was 95%; three quarters showed greater than 91% adherence. Adherence rates with respect to individual tools did not differ significantly for schedules and dosettes, with medians of 95% (n = 31) and 94% (n = 13), respectively. Median adherence with electronic reminders was 76% (n = 5). Seventy-four percent of patients remained on therapy after 12 months of study. Taking into consideration previous antiretroviral treatment, actual persistence at 12 months was 87%. Employing and individualizing strategies, including adherence tools, to enhance patient adherence to complex regimens in addition to counseling and follow-up, has resulted in good adherence rates and persistence.

Adult↗
PubMed2000

Long-term patient adherence to antiretroviral therapy.

OBJECTIVE: To measure patient adherence to antiretroviral therapy over a two-year period and to identify factors impacting adherence. METHODS: In a regional HIV treatment center, 100 consecutive patients starting any new antiretroviral agent were enrolled in this study, which consisted of a one-year retrospective data review and a one-year prospective component. The tools used for evaluating adherence were the monthly prescription refill data and a patient questionnaire. Data analyzed included overall adherence, adherence to individual antiretrovirals, and change in adherence over time, as well as factors reported as influencing adherence. RESULTS: Greater than 80% adherence in taking prescribed doses was seen in 75% of patients during the retrospective phase of the study; adherence increased to 84% in the prospective phase. Throughout the prospective phase of the study, monthly median adherence rates were 98-100%. Suboptimal adherence secondary to pill fatigue or number of daily pills did not occur. Reported nonadherence to dietary restrictions varied among drugs. The primary cause given for poor adherence was difficulty remembering followed by inconvenient dosing schedule and difficulty scheduling administration times around meals. At least one adherence tool was used by 61% of patients. A diagnosis of AIDS was associated with lower adherence in our patient population (p = 0.039); substance abuse and psychiatric history had no influence. CONCLUSIONS: Adherence to antiretroviral treatment regimens did not diminish over the two years studied. Several patients with poor adherence were identified, emphasizing the importance of addressing this issue both prior to and throughout treatment. A personalized approach by healthcare providers can optimize patient adherence to antiretroviral therapy by providing careful drug selection in addition to routine follow-up and the provision of information, feedback, and reminder systems.

Acquired Immunodeficiency Syndrome↗
PubMed1999

The use of antiretroviral agents in patients with renal insufficiency.

Current guidelines for the dosing of antiretroviral agents in HIV-positive patients with renal insufficiency including those requiring dialysis are limited, as revealed by a literature search performed using Health Knowledge Network MEDLINE and HealthSTAR. Pharmacokinetic and chemical aspects were taken into consideration to develop further recommendations. Results showed reverse transcriptase inhibitor dosage adjustment guidelines are available, but for patients receiving dialysis, guidelines are limited to zidovudine and didanosine. There are limited clinical data on dosage adjustments required for the use of protease inhibitors or non-nucleoside reverse transcriptase inhibitors (NNRTIs). Indinavir appears to require no dose modification. For nelfinavir, ritonavir and saquinavir, the chemical and pharmacokinetic characteristics along with the pathophysiology of renal dysfunction and dialysis suggest that these agents can likely be given at usual doses with close monitoring for toxicities. More data is required to make recommendations for use of NNRTIs in renal insufficiency. Combining the information from previous dosing guidelines and the pharmacokinetic data of antiretroviral agents allows for preliminary recommendations to be made until confirmed by definitive clinical data.

Anti-HIV Agents↗
PubMed1997

Efficacy and safety of intravenous phosphate replacement in critically ill patients.

OBJECTIVE: To evaluate the efficacy and safety of intravenous potassium phosphate administered in a fixed-dose regimen in critically ill patients. DESIGN: Prospective, unblind study. SETTING: Surgical-medical intensive care unit (ICU). PARTICIPANTS: Patients who developed hypophosphatemia during their ICU admission. INTERVENTIONS: Patients with a serum phosphate concentration between 1.27 and 2.48 mg/dL (group 1) and those with a concentration of 1.24 mg/dL or less (group 2) received 15 and 30 mmol, respectively, of phosphate as a potassium salt via a central line over 3 hours. MAIN OUTCOME MEASURES: Normalization of serum phosphate within 6 hours of infusion, the development of arrhythmias during the infusion, and the development of hypocalcemia and hyperkalemia after the infusion were evaluated. Redevelopment of hypophosphatemia and the need for further therapy were also assessed. RESULTS: Thirty-seven episodes of hypophosphatemia were entered in this study: 27 in group 1 (17 patients) and 10 in group 2 (10 patients). The mean serum phosphate concentration increased significantly from 2.02 to 2.82 mg/dL in group 1 and from 0.83 to 2.17 mg/dL in group 2, with no change in calcium or potassium. Normalization of serum phosphate with this initial dose occurred in 81.5% of the episodes in group 1 and 30% in group 2. However, over the following 2 days, 45% of the patients in group 1 and 60% in group 2 required further phosphate supplementation. No arrhythmias occurred during the 3-hour infusion that were related to the potassium phosphate. A significant drop in total serum calcium concentrations occurred in 2 patients who were slightly hypercalcemic prior to the infusion. Serum calcium concentrations remained above normal, but this was not associated with any adverse effects. CONCLUSIONS: The administration of potassium phosphate 15 mmol to critically ill patients with mild-to-moderate hypophosphatemia over 3 hours is both effective and safe. The administration of potassium phosphate 30 mmol to severely hypophosphatemic patients was safe but achieved normalization of serum phosphate in a minority of patients. Either a higher dose or the subsequent administration of more potassium phosphate may be required to normalize serum phosphate concentrations. Once normalization has occurred, there is a high likelihood of redevelopment of hypophosphatemia over the following 2 days and supplementation should be given accordingly.

Adult↗
PubMedDate not supplied

Intravaginal morphine: an alternative route of administration.

The availability of various dosage forms allows morphine to be administered in a number of ways. However, if the oral and rectal routes are not feasible, the parenteral one may appear to be the only viable option. Morphine was administered by the intravaginal route in a 44-year-old woman as an alternative to intravenous patient-controlled analgesia. The dosage forms included sustained- and immediate-release tablets as well as regular suppositories. The initial dosage was calculated according to guidelines for switching to oral administration and titrated to response. Adequate pain control was achieved, but due to unpredictable bioavailability, close monitoring was essential.

Administration, Intravaginal↗