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Improving Medication Compliance

doi: 10.1097/01.EEM.0000361685.13951.ec
In Brief

There is no proven way to ensure patients follow medication directions for extended periods of time, according to a new report in the Cochrane Database of Systematic Reviews.

Researchers led by R. Brian Haynes, MD, PhD, of McMaster University, updated a 2005 review summarizing randomized control trials of interventions to help patients follow prescriptions.

They found that four of 10 interventions reported in nine trials showed an effect on adherence and at least one clinical outcome for short-term treatments, which lasted one to three weeks. In those short-term trials, the researchers found one intervention that significantly improved patient adherence but did not enhance clinical outcome. Some effective approaches included counseling and providing written instructions.

For long-term treatments, 36 of 81 interventions reported in 69 trials were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Some approaches with limited success included sending reminders to patients and following up with phone calls.

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First TB Cases May Predict Outbreak

The first two cases of tuberculosis in a region may provide clues on the potential for an outbreak, according to the July 1 American Journal of Respiratory and Critical Care Medicine.

Researchers from the KNCV Tuberculosis Foundation in the Hague, Netherlands, led by Sandra Kik, MSc, analyzed data from the Netherlands Tuberculosis Register and the National Institute of Public Health from more than 18,200 patients with reported TB between 1993 and 2004. They discounted cases that were not culture-confirmed, could not be exactly matched between the two databases, or were duplicates. Remaining cases were divided into 622 cluster episodes, with 1,756 individual cases, 54 of which were large clusters (five or more cases).

They found that if the first two patients were diagnosed within three months of each other, lived in urban areas, and if one or both were of sub-Saharan African nationality, there was a 56 percent chance that the two cases will lead to a large outbreak of TB. If the patients exhibit none of those characteristics, the odds are just one percent.

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Rapid Response Teams Ineffective

Rapid response teams in hospitals do not result in a reduced rate of cardiopulmonary arrests or deaths, according to the December 3 issue of JAMA.

Researchers led by Paul S. Chan, MD, of the University of Missouri, Kansas City, examined the association between a rapid response team intervention and long-term challenges in hospital-wide cardiopulmonary arrests and mortality rates. The study included adult inpatients admitted between January 2004 and August 2007 at a 404-bed tertiary care academic hospital. Rapid response team education and program rollout occurred from Sept. 1 to Dec. 31, 2005. A total of 24,193 patient admissions were evaluated prior to the intervention and 24,978 after.

The researchers found there were 376 rapid response team activations after intervention implementation. The most common reasons for activation were altered neurological status, tachycardia exceeding 130 beats per minute, tachypnea exceeding 30 breaths per minute, and hypotension assessed as blood pressure lower than 90 mmHg.

Case fatality rates after cardiopulmonary arrest were similar prior to and after the rapid response team intervention (77.9% vs. 76.1%). Hospital-wide mortality rates did not meaningfully change after the intervention: 3.22 prior to intervention vs. 3.09 after intervention, per 100 admissions. Secondary analyses revealed few instances of rapid response team undertreatment or underuse that may have affected the mortality findings.

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EPs: Resuscitation Practices Lacking

An overwhelming majority of emergency physicians say resuscitation practices in the United States are not very effective, according to a recent ACEP survey.

The college conducted the State of Resuscitation survey in September, releasing the results in November. A total of 1056 online questionnaires were completed by ACEP members in selected sections. The survey was administered by Saperstein Associates, an independent opinion research company, and was sponsored by ZOLL Medical Corporation.

The survey found almost all EPs (94%) believe a patient in sudden cardiac arrest is more likely to survive if a CPR-trained bystander administers CPR before professional rescuers arrive. More than half said the length of time between patient collapse and first responder arrival is an important factor in determining the success of resuscitation efforts. Other factors viewed as having a positive impact included faster patient-to-doctor times (77%), data collection and sharing (73%), automated technologies (66%), and real-time feedback on compressions (65%).

More than half the respondents said poor survival rates from sudden cardiac arrest is related to the aging population, while one-quarter said obesity has contributed most to poor survival rates. Though EPs said bystander CPR would improve survival, efforts to teach laypersons are scattered and often nonexistent, and respondents want civic leaders to be more engaged in the issue.

© 2009 Lippincott Williams & Wilkins, Inc.