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At least 19 recordsLinked to original sources
PubMed1994

A cohort study of drug users' compliance with zidovudine treatment.

OBJECTIVES: Determine whether patients who have acquired the human immunodeficiency virus through injecting drug use receive less antiviral medication (zidovudine) than comparable patients of other risk groups considering access to, acceptance of, and compliance with treatment. DESIGN: Historical cohort study. SETTING: Human immunodeficiency virus outpatient clinic. PATIENTS: Human immunodeficiency virus-infected subjects eligible for zidovudine treatment between January 1, 1989, and January 1, 1992, comparing injecting drug users (IDUs) with non-IDUs ("others"). MAIN OUTCOME MEASURES: Proposal, acceptance, start of, and compliance with zidovudine treatment. RESULTS: One hundred fifty-one IDUs and 162 other human immunodeficiency virus-positive subjects became eligible for zidovudine treatment between January 1, 1989, and January 1, 1992. Both groups were proposed zidovudine as often, but zidovudine treatment was refused by 14.9% of IDUs compared with 7.1% of others (P = .029). The IDUs needed considerably more time than other subjects to accept zidovudine therapy (median delay between indication and start of zidovudine treatment, 61 days vs 30 days, P = .0001). After accepting, IDUs were as compliant with treatment as others: 81.3% vs 83.2% were good compliers, and rises of mean corpuscular volume of erythrocytes after 3 and 6 months of treatment were similar in both groups. Former drug users and IDUs receiving methadone were started on zidovudine treatment more often and complied better with treatment than active drug users. Absence of housing and presence of psychiatric diagnosis (both more prevalent in IDUs) were associated with less zidovudine treatment and worse compliance. CONCLUSION: Injecting drug users tend to delay the start of zidovudine treatment. However, once they have started, their compliance is no worse than the compliance of patients from other risk groups. These results have important implications for clinical trials, medical care, and public health.

Adult↗
PubMed2000

The importance of user compliance on the effectiveness of natural family planning programs.

Nowadays, there is an increasing interest in natural family planning methods. The biological basis for the application of natural family planning methods is the recognition of ovulation and, more extensively, of the fertile period. Several studies in the past decade have shown the efficacy of these methods and that the main cause of failure was either a conscious departure from the rules of the method or erroneous application of the method. Another problem affecting natural family planning that has been highlighted is the relatively high discontinuation rate. These features are probably due to low compliance in applying the natural family planning rules, which may be too demanding for a number of couples. In this review, there are comments on the application of natural family planning methods, the discontinuation rates and the failure of the method due to mistakes in the studies carried out in the past 15 years. Steps that can be taken to limit mistakes and discontinuity are also addressed.

Family Planning Services↗
PubMed2004

Linguistic and location effects in compliance with pesticide warning labels for amateur and professional users.

Three studies explored amateur and professional users' compliance with pesticide warning labels. Professionals were classified as people working in a profession in which the use of pesticides is a necessary part of their job. Amateurs used pesticides only in their leisure time. The first study showed that the wording used affected perception of the appropriateness of hazard statements, one of the most effective variations being the use of the personal pronoun (statements beginning "You should..."). The location of warning information was also found to affect actual compliance: Compliance increased when warning information was presented in the directions for use section. A supplemental directive increased compliance only for professional users. In a final study, "best-case" and "worst-case" linguistic variations were combined with best-case and worst-case locations for safety information. Instruction statements using the personal pronoun and presented in the directions for use section resulted in the highest levels of compliance. The differences in compliance between amateur and professional users are interpreted within the framework of Rasmussen's (1986) distinction among skill-, rule-, and knowledge-based behavior. Actual or potential applications of this research include the design of warning labels and safety information.

Adolescent↗
PubMed1998

Evaluation of compliance with a computerized protocol: weaning from mechanical ventilator support using pressure support.

STUDY OBJECTIVES: To use a computerized consultation system to evaluate the feasibility of a mechanical ventilator weaning protocol which used the rapid shallow breathing index to guide adjustments in pressure support. A program to monitor user compliance and reasons for noncompliance was built into the computerized consultation system. METHODS: A total of nine critically ill patients (ten weaning episodes) were enrolled in the protocol. The respiratory therapists performed routine computer charting in the electronic database. They accepted or declined the explicit instructions generated by the computerized protocol and displayed on the bedside terminal. The consultation program monitored whether accepted instructions were implemented by the user. RESULTS: Patient's therapy was controlled by protocol for a total of 1075 h (mean 108 h, range 4 to 339 h) and 94.8% (1321/1394) of instructions were followed by the clinical staff. Of the 42 instructions clinical staff refused to follow, 23 (55%) were extubation instructions. There were 52 (3.7%) incorrect instructions generated with 24 software errors, 21 errors in underlying logic, and seven user misunderstanding errors. CONCLUSIONS: A high level of user compliance with this protocol was achieved. The methods described herein to monitor compliance and reasons for noncompliance within a protocol are reusable in the domain of mechanical ventilation and possibly in other domains.

Evaluation Studies as Topic↗
PubMed1988

Twenty-eight-day oral contraceptives: physician and user attitudes.

A 28-day regimen of oral contraceptives that uses seven iron tablets (each containing 75 mg of ferrous fumarate) instead of seven sugar placebos was designed to encourage user compliance. To determine professional and user attitudes toward the 28-day regimen, 192 obstetrician-gynecologists and 469 women who used oral contraceptives were surveyed. Over two-thirds of the physicians stated that they approved both the 28-day regimen and the inclusion of the seven iron tablets. Over 80% of the women surveyed expressed approval of a 28-day regimen that included seven iron tablets.

Adult↗
PubMed2003

Skin patch and vaginal ring versus combined oral contraceptives for contraception.

BACKGROUND: The delivery of combination contraceptive steroids from a skin patch or vaginal ring offers potential advantages over those administered via the traditional oral route. The skin patch and vaginal ring could possibly require a lower dose due to increased bioavailability and improved user compliance. OBJECTIVES: The review's objective is to compare the contraceptive efficacy, cycle control, compliance, and safety of the contraceptive skin patch versus combination oral contraceptives and the contraceptive vaginal ring versus combination oral contraceptives. SEARCH STRATEGY: We searched the computerized databases MEDLINE, Popline, Cochrane Controlled Trials Register, EMBASE, and LILACS for trials of the contraceptive patch or the contraceptive ring. We also searched the references of the publications identified for inclusion. We contacted the manufacturers of the skin patch and the contraceptive ring in an attempt to identify published or unpublished trials that we might have missed. SELECTION CRITERIA: All randomized controlled trials in any language comparing the combination contraceptive skin patch with a combination oral contraceptive or the combination contraceptive vaginal ring with a combination oral contraceptive. DATA COLLECTION AND ANALYSIS: Titles and abstracts identified from the literature searches were assessed for potential inclusion. Data were abstracted by both the primary and second reviewers to ensure accuracy and were entered into RevMan 4.1. Peto odds ratios with 95% confidence intervals were calculated for all outcomes. Six- and 13-cycle Kaplan-Meier pregnancy rates were also entered into "Additional Tables." No sensitivity analyses were conducted since the eligible trials used different comparison oral contraceptives. The trials were critically appraised by examining the following factors: the study design; blinding; randomization method; group allocation concealment; exclusions after randomization; loss-to-follow-up; and early discontinuation. MAIN RESULTS: We found three trials of the skin patch and no eligible randomized controlled trials of the combination contraceptive vaginal ring. The six-cycle and 13-cycle Kaplan-Meier cumulative probabilities of pregnancy showed that the combination contraceptive skin patch was similar to the control combination oral contraceptive in contraceptive efficacy. One trial found that patch users discontinued early from the trial more often than oral contraceptive users (OR 1.6; 95% CI, 1.3-2.0) but a second trial found no differences in discontinuation between the groups (OR 2.6; 95% CI, 1.0-6.7). Patch users had more self-reported cycles of compliance than oral contraceptive users; the odds ratio of compliance was 2.1 (95% CI, 1.8-2.3). Patch users were more likely to report breast discomfort than oral contraceptive users with an odds ratio of 3.1 (95% CI, 2.3-4.2). The remaining commonly reported adverse events did not differ by group assignment. One trial found that women assigned to use the patch were more likely to discontinue due to adverse events than those assigned to use the oral contraceptive (OR 2.3; 95% CI, 1.6-3.3), but a second trial found no difference (OR 2.8; 95% CI, 0.7-11.3). Few serious adverse events occurred that were considered possibly or likely related to the use of the patch or oral contraceptive. REVIEWER'S CONCLUSIONS: The randomized controlled trials comparing a combination contraceptive skin patch to a combination oral contraceptive showed similar efficacy rates for the two methods. The patch group had better self-reported compliance than the oral contraceptive group. On the other hand, breast tenderness was more common among those randomized to the patch. The patch might lead to early discontinuation (overall and due to adverse events), but the trial results on this outcome were mixed. No conclusions can be drawn regarding the vaginal ring as no eligible trials were available.

Contraceptive Agents, Female↗
PubMed2003

Food prepared in iron cooking pots as an intervention for reducing iron deficiency anaemia in developing countries: a systematic review.

OBJECTIVE: To complete a systematic review of the effect of preparing food cooked in iron pots on haemoglobin concentrations and to assess compliance with pot use. DESIGN AND SEARCH STRATEGY: We searched The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, The Cochrane Controlled trials Register, The Cochrane Methodology Register, Health Technology Assessment Database and NHS Economic Evaluation Database (Cochrane Library, Issue 3, 2002). Medline (1966 to May 2002) and EMBASE (1988 to May 2002). Reference lists of published trials were examined for other potentially relevant trials and authors of selected trials were contacted to obtain information about ongoing or unpublished trials. Selection criteria included randomized trials which compared the effect of food cooked in cast iron pots with food cooked in noncast iron pots on participants of a minimum age of 4 months. One reviewer applied inclusion criteria to potentially relevant trials. Two reviewers assessed trial quality and extracted data. RESULTS: Three trials were eligible for inclusion in the review. There is some evidence from these studies that eating food prepared in iron pots increases the haemoglobin concentration of anaemic/iron deficient individuals. This effect seems to be modified by compliance, users age, and the presence of malaria and hookworm. Compliance with pot use varies considerably between countries depending on several factors, including: size of the cooking pot, targeted user group, whether the pot is used as an extra or replacement pot, and familiarity with cast iron pots. CONCLUSION: The introduction of iron pots or improving their use in communities in developing countries for the preparation of food maybe a promising innovative intervention for reducing iron deficiency and iron deficiency anaemia. Further research is required to monitor the use and effectiveness of this intervention.

Humans↗
PubMed2001

Temporary discontinuation: a compliance issue in injectable users.

This study examined compliance in injectable users and followed women post-discontinuation to document their contraceptive practices. A cohort of 189 predominantly new users of depot-medroxyprogesterone acetate and norethisterone oenanthate were recruited and followed for 2 years regardless of whether or not they continued the method. Continuation rates were 42% at 1 year and 21% at 2 years. Of the 78 women who discontinued the method, 31 reported that they were "taking a break." For 20 of these women, this break (nonuse segment) occurred within the 2-year period, and 15 of them returned to the injection before the end of study period. The other five switched methods after the nonuse segment. The mean length of the nonuse segment was 7 months (range 2-13 months). In all 20 women, no other contraceptive method was used, they remained sexually active, and started the break within 6 months of commencing use of the injectable. In addition, 11 women were in a self-reported nonuse segment at the end of the study and stated their intention to return to the method at a later date. Menstrual disturbances were cited as the main reason for the break. Strengthened counseling at method acceptance was identified as a strategy to decrease the frequency of breaks in injectable method use.

Adult↗
PubMed2000

Studying clinician-computer interaction in Web-based systems.

A growing of health-care organizations are in the process of modifying their clinical information systems (CIS) to support browser-based access. Consequently, care-providers are expected to modify their workflow to take advantage of the new technology. Intuitive interfaces, fast response and new functionality are few of the features used to promote endorsement of the change. In parallel, administrators are required to constantly assess user compliance and intervene where necessary to prevent rejection. Such monitoring translates to frequent surveys, analysis of logs and prudent utilization of user-groups. These methods tend to further burden users, suffer from "post-hoc" temporality and are difficult to maintain. In this paper we suggest an alternative approach to such data acquisition. "CareQuest" is an interactive Web-based service that can be woven into clinical applications without coding. It acquires information from the clinician at the relevant point in her workflow. It allows extensive interaction customization, data-driven response, real-time Web-based data-analysis, and full Web-based administration.

Evaluation Studies as Topic↗
PubMed2000

Implantable contraception.

This article reviews the advantages and disadvantages of progestogen-only contraceptive implants in light of the development of Implanon, a new, single-rod, etonogestrel-releasing system. Implants rapidly produce serum progestogen levels sufficient to ensure contraception for 1-5 years. The steady release ofprogestogen avoids the peaks and troughs associated with oral contraceptives, the profound ovarian suppression observed with depot injections and the need for user compliance. Implants have few serious complications. Ectopic pregnancy rates are low, and follicular hypertrophy is generally self-limiting. The principal acceptability limitation to both users and providers of Norplant is insertion and removal. Implanon is easy to insert and remove with minimal complications and pain. The main adverse event causing discontinuation of implants is a change in bleeding pattern. However, with good counselling, this is well tolerated by most women. Implants thus provide an effective, safe, economical and convenient alternative to oral, injectable or intrauterine contraceptives. Implanon is an extremely effective single-rod implant with a Pearl index of 0. It employs a new polymer and a less androgenic progestogen. These features provide easier insertion and removal for both users and clinicians, a more stable release rate and potentially fewer adverse androgenic effects compared with existing formulations.

Contraceptive Agents, Female↗
PubMed1998

Evaluation of lambdacyhalothrin-impregnated bednets in a malaria endemic area of India. Part 1. Implementation and acceptability of the trial.

In malaria endemic forested villages in Orissa State, India, a 3-year comparison of nylon nets treated with lambdacyhalothrin at 25 mg/m2, untreated nets, and no nets was carried out. Treated nets retained high insecticidal efficacy for more than 7 months. Nets washed after 3 months of use gave 98% kill in a bioassay with a 3-min exposure. Based on these bioassays during the first year, nets were later reimpregnated at 6-monthly intervals with participation of the users. Compliance with the use of nets was good. Eighty-eight percent of nets were usable even after 3 years. The main benefits perceived by treated net users were reductions in malaria, mosquito bites, head louse infestations, and other nuisance insects. The trial was well accepted by the community. Issues related to social marketing and promotion of nets are discussed.

Animals↗
PubMed2004

The design of child restraint system (CRS) labels and warnings affects overall CRS usability.

A study was conducted that assessed the effectiveness of different child restraint system (CRS) label/warning designs on users' installation performance. Forty-eight paid participants installed a convertible CRS in a vehicle, and two child test dummies in a CRS, using one of four label conditions. The label conditions were: (1) no labels, (2) the manufacturer's labels that were already affixed to the CRS ("Current"), (3) labels that were designed according to a combination of the current U.S. regulations concerning CRS labels and recently proposed changes to these regulations ("Proposed"), and (4) labels that were designed according to human factors principles and guidelines, and that were based on a hierarchical behavioral task analysis ("Optimal"). Results demonstrated that, overall, the Optimal labels resulted in higher usability ratings and better task performance. This indicates that labels designed using human factors and task analyses that identify critical task information requirements for label features will result in increased user compliance with instructions, higher usability, and improved task performance. Surprisingly, having no labels on the CRS resulted in better installation performance than when either the Current or the Proposed label conditions were used. This indicates that label design can decrease task performance; the actual physical design of a CRS may be just as critical as label content in the installation choices provided to the user. Collectively, results suggest that implementation of the proposed changes to the U.S. regulations concerning CRS labeling would likely not result in increased performance or usability compared to existing manufacturer labels that follow the current guidelines. In order to achieve significantly better ease-of-use and task performance, it would be necessary to implement features of the Optimal label condition.

Adult↗
PubMed1989

A drug information system. The patients' responses.

This article has described the practical aspects of establishing a written drug information system for the doctor and the patient. In addition, a patient questionnaire analysis has shown that patients accept the system, appreciate the material in the leaflet and are willing to receive drug information sheets. The advantages for the practitioner are that in compiling information on drugs the doctor is able to review his or her knowledge of prescriber pharmacology; the information acts as an accessible desk top reference; the information contained for both doctor and patient can be readily revised; the doctor can gain satisfaction by providing a thorough patient service. For the patient the advantages are many. These include: improved patient education; increased compliance; user safety arising from awareness of side effects and interactions; correct use of the drug by those who forget verbal messages quickly (for example, the elderly); thorough knowledge of how and when to dispose of drugs; and increased patient satisfaction with treatment. Such advantages and patient acceptance highlight this system's role as an important tool in the management of patients in general practice.

Australia↗
PubMed2003

Miniature, low-dose, intrauterine drug-delivery systems.

The safety of systemically administered sex steroids continues to be a major focus of researchers. The negative results of the Women's Health Initiative study (WHI), and follow-up reports published in JAMA, evaluating the safety of estro-progestogen in postmenopausal women, elicited an unprecedented reaction in the press by women and doctors alike. From these publications, it is clear that research should focus on new progestogens and on alternative administration routes to minimize adverse drug effects. One approach to the improvement of safety, efficacy, and acceptability of steroid hormones, including patient compliance, is to develop long-acting implantable methods that deliver the lowest possible dose to the key target tissues. This therapeutic concept of "minimal intervention" has been known for several decades, but the practical applications of the method were lacking. Intrauterine drug-delivery systems can be developed to achieve minimal intervention fertility control without influencing normal ovarian function and/or causing adverse hormonal effects. With hormone replacement therapy in postmenopausal women, research suggests that progestogens delivered directly to the uterine mucosa could reduce side effects and minimize reversal of the beneficial effect of estrogens. Various "frameless" and "framed" intrauterine systems are currently being clinically evaluated. They are less troublesome than the available intrauterine systems and could therefore be suitable for use in the majority of women for contraception and treatment purposes (e.g., menorrhagia, hormone replacement). These systems require a single short office procedure, and have a low morbidity, which is undeniably linked with more invasive methods and systemic hormonal contraceptives. Due to the technological progress miniature, low-dose, long-term intrauterine drug-delivery systems offer enhanced effectiveness, reduced side effects, and optimal user compliance. Although there is minimal absorption in the systemic circulation, they deserve the status of a locally acting method that should be regarded as fundamentally advantageous, if effective, to systemically applied medications that may have potentially inherent ill side effects.

Adult↗
PubMed1997

Electronic forms: benefits drawbacks of a World Wide Web-based approach to data entry.

It has long been realized that, compared to paper-based records, electronic record systems provide many advantages in the healthcare environment, including increased availability, improved legibility, long-term accessibility, (potentially) greater completeness, data encoding, and automated decision support and analysis. In spite of these recognized benefits, collection of patient data at the point of service generally does not occur, in large part because each such effort usually requires application-specific software and hardware, and, most significantly, provider time. Given the presence of WWW browsers now available on nearly every desktop, the support and access concerns for data entry applications can be substantially lessened. Despite these advantages, there are also downsides to the use of the WWW for data entry, including user interface issues and security. At CPMC, we are currently using web-based forms to gather patient charge data from physical and occupational therapists. Benefits of this approach have included a 98.2% user compliance rate for at least weekly data entry, and the reduction of charge posting from an average of 24.3 days to 2.3 days following the date of service. Drawbacks to WWW-based applications have included increased security exposure and persistent human tendencies to enter data in batches rather than at the time of service. A final conclusion was that, in the absence of a strong central mandate, providers must perceive a clear benefit in order to be willing to learn and use a new technology.

Attitude to Computers↗
PubMed1996

Controlled release of antibodies for long-term topical passive immunoprotection of female mice against genital herpes.

Current methods for sexually transmitted diseases (STD) prophylaxis, which can be disruptive and inconvenient, must be used before each act of sexual intercourse, so a method that provides protection over the course of many acts is desirable. We used a mouse model of vaginally-transmitted herpes simplex virus 2 (HSV-2) infection to test polymeric controlled-release devices for sustained passive immunoprotection. Vaginal disks were prepared by dispersing a monoclonal antibody to HSV-2 (III-174) within a matrix of poly(ethylene-co-vinyl acetate); these disks released 2 to 40 micrograms/day of antibody into buffered water. When disks were placed in the vagina, large amounts of III-174 (5 to 3,000 ng) were recovered from the vaginal fluid over the next 8 days. Mice were vaginally challenged with 10 ID50 of HSV-2 either 3 or 7 days after disk placement; no mice receiving III-174 disks became infected, while 65% of control mice receiving identical disks with nonspecific IgG did. Controlled-release disks with III-174 provided significant protection against HSV-2 infection (p < 0.005). This new technology for long-term STD prophylaxis should increase user compliance, a factor limiting the efficacy of current methods.

Administration, Intravaginal↗
PubMed1997

The effect of high-efficiency particulate air respirator design on occupational health: a pilot study balancing risks in the real world.

OBJECTIVES: To quantify specific factors believed to increase healthcare worker (HCW) risk for contaminated sharps injuries (eg, visibility, communication, and range of motion); to quantify the degree to which respirators of various designs impacted those same factors; and to assess HCW opinions about the suitability of selected respirators with respect to patient care and user compliance criteria. DESIGN: Sharps injury data from seven hospitals were analyzed to determine the potential contribution of visibility, communication, and range of motion to reported injuries. Healthcare workers representing various clinical specialties and physical characteristics were examined at baseline and while wearing five different respirators to quantify the impact of respirator design on visibility, communication, and range of motion. Healthcare workers were interviewed and completed a survey assessing each respirator. SETTING: Hospital and ambulatory-care settings. PARTICIPANTS: Population-based and convenience sample. RESULTS: Communication, visibility, and range of motion were found to affect contaminated sharps injuries significantly. Selected high-efficiency particulate air (HEPA) respirators were found to have a negative impact on each of these variables. Healthcare workers involved in the study also reported compliance criteria problems with selected HEPA respirators, which may effect implementation of respiratory precautions adversely. CONCLUSION: Current HEPA respirators, because of their design, potentially increase the risk of bloodborne pathogen exposure through sharps injuries. We conclude that mandating respirators without regard to the potential impact of their design to the sharps injuries may be counterproductive to HCW safety, because they may increase, rather than decrease, overall occupational risk to HCWs.

Air Pollution, Indoor↗