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Introduction: This study in Argentina evaluated the impact of the growzen™ buddy smartphone app on adherence to recombinant human growth hormone (r-hGH) treatment. Methods: The adherence data, invitation dates with a link to the app, app activation dates, and height measurements entered were extracted from the growzen™ digital health ecosystem. Patients with 12 months of adherence data, aged ≥2 years at treatment start, and aged <19 years were selected both before and after app implementation. Mean adherence was classified as optimal (≥85%) versus suboptimal (<85%). Adherence before and after implementation and the pre-post effect on adherence were assessed. Results: Data for 830 patients were available. Prior to app implementation, the proportion of patients with optimal adherence was 68% (n = 348/515). Following the app implementation, out of 315 patients, 302 (96%) received an invitation with a link to the app, 225 (71%) activated their account, and 127 (40%) entered height data in the first year. There was a significant early increase in the proportion of patients with optimal adherence following implementation: 82% (n = 258/315), p < 0.001. After implementation, the proportion of patients with optimal adherence included 80% (n = 78/98) of those with an active account who did not enter height measurements and 89% (n = 113/127) of those who did. There was a significant and positive pre-post app effect on adherence (p < 0.01) in patients with an active account. Discussion: Our results show that using the growzen™ buddy app has a rapid and positive impact on adherence to r-hGH treatment, and patients who were more engaged with the app demonstrated better adherence.

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Introduction: The appropriate use of recombinant human growth hormone (r-hGH) treatment provides an opportunity to improve growth outcomes among pediatric patients with growth hormone deficiency (GHD). However, a major challenge in clinical practice is to adequately recognize and address factors that negatively affect treatment adherence. TUITEK® patient support program (PSP) was designed to help caregivers of children diagnosed with GHD to personalize the care pathway, improve adherence, and achieve better outcomes. Effectiveness of TUITEK® PSP has been demonstrated previously in a smaller sample (n = 31) in Taiwanese population. Here, we present the results from Argentina. Methods: TUITEK® PSP was piloted among 76 caregivers of children with GHD administering r-hGH using easypod™ (Merck KGaA, Darmstadt, Germany) auto-injector device in Argentina. Based on TUITEK® personalization questionnaire, caregivers were assigned to high- and low-risk groups across four categories that may influence adherence, including disease and treatment coherence (DTC), self-administration (SA), treatment-related anxiety (TRA), and emotional burden (EB). The caregivers who were included in atleast one high-risk group had the provision of telephone calls with a nurse practitioner every 2 weeks for 3 months. The Wilcoxon signed-rank test was employed to assess changes in questionnaire-based scoring patterns between baseline and follow-up evaluations. Results: Statistically significant changes (p < 0.05) in questionnaire scores between baseline and follow-up evaluations were observed across the four categories. The mean/median DTC (n = 11) and SA (n = 23) scores changed from 2.45/3 and 2.17/2, respectively, to 4/4, with all the caregivers moving to low-risk group following program completion (100%) for both categories. The mean/median TRA score (n = 40) changed from 3.58/3 to 2.5/2 and 67.5% of patients (27/40) moved to low-risk group. The mean/median EB score (n = 32) changed from 3.69/3 to 3.13/3 however, none of the caregivers moved to low-risk group (0%). Conclusion: TUITEK® PSP is a simple, practical, and time-efficient interventional tool that can be used to address key adherence-related issues among caregivers of children with GHD and provide personalized adherence support. Our findings demonstrate that TUITEK® PSP has the potential to improve treatment adherence and self-management, thereby improving growth outcomes in Argentina.

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BACKGROUND: Early initiation with high efficacy therapies seems to be better than an escalation approach in terms of disability prevention in patients with relapsing-remitting MS (RRMS). Although efficacy and safety of cladribine tablets have been shown in clinical trials, real-world evidence (RWE) studies from Latin America are scarce. OBJECTIVE: To describe the baseline characteristics of patients enrolled in the Argentina Patient Support Program (PSP) for cladribine tablets (Adveva®), with at least 1 treatment course, evaluate treatment persistence, adverse event reports from PSP patients and reported relapses characterization. METHODS: Anonymized data routinely collected by Adveva® team of patients that received the first dose of cladribine from April 16th 2018 to March 31st 2021 were analyzed. Treatment persistence was defined as the percentage of patients that initiated year 2 (Y2) from the population of patients with elapsed time since year 1 (Y1) cladribine tablet initiation of at least 18 months. In addition, using the pharmacovigilance data, reported adverse events and the time elapsed from treatment initiation to relapse were analyzed. RESULTS: The present analysis included 269 patients (mean age: 41.7 ± 16 years) that had initiated Y1 of cladribine tablets treatment between April 16th 2018 and March 31st 2021. Although only 29.4% (79/269) of our population was treatment naïve, the ratio of naïve/switch patients that initiated cladribine tablets increased from April 2018-March 2019 to April 2020-March 2021. From the 110 patients with elapsed time since treatment initiation ≥18 months, 101 patients initiated Y2 indicating a persistence level of 91.8%. During follow-up, 425 adverse events were reported, mainly MS relapse (8.9%, 38/425), fatigue (3.8%, 16/425) and headache (3.5%, 15/425). Lymphopenia and infections were rarely reported by RRMS patients treated with cladribine tablets. MS relapse was more frequently reported in patients switching from a previous treatment (87.5%, 27/32) than in the naïve cohort (12.5%, 5/32). CONCLUSIONS: The first real life experience in RRMS patients from Latin America demonstrated that the Adveva® enrolled support program patients have a high persistence level to oral treatment with cladribine tablets. Our results also confirmed the known safety profile of cladribine tablets, with a low incidence of lymphopenia and infections.

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Cancer incidence has been rising in the Caribbean and is expected to have significant adverse implications for the health of people in the region and health systems in this decade. While developed countries, for the most part, enjoy the benefits of advanced technologies and adaptive systems in cancer control and management, a different experience confronts a large segment of the Caribbean population. The region has experienced some success in enhancing cancer services, however, there is a need to address gaps in several areas through nationally and regionally tailored initiatives. This Review complements previous publications on the challenges, actions, and progress towards cancer prevention and care in Caribbean countries but also further outlines potential positive impacts that can be derived from addressing gaps pertaining to cancer education, data management, screening and risk assessment, navigation services, gender factors, and resource development. The proposed approaches encapsulate concepts of health theories that are applicable across the ecological domains. When implemented in combination, the proposals may effectively contribute to reducing the cancer burden in the region.

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RESUMO Objetivo identificar a percepção de fonoaudiólogos sobre a própria atuação em cuidados paliativos em um hospital público de Santa Catarina. Método trata-se de um estudo qualitativo, descritivo, realizado com cinco fonoaudiólogos atuantes em um hospital público de Santa Catarina. Os dados foram coletados mediante entrevista semiestruturada e submetidos à análise de conteúdo. Resultados após análise do conteúdo do discurso dos fonoaudiólogos participantes, surgiram as seguintes categorias: conceito e entendimento sobre cuidados paliativos e atuação do fonoaudiólogo; reconhecimento da Fonoaudiologia na atuação multiprofissional; relação interpessoal com o paciente e a família e dificuldades na prática de cuidados paliativos. Conclusão a percepção dos fonoaudiólogos revela o conceito de que os cuidados paliativos são prestados a pacientes que não possuem mais possibilidade de cura, mas para os quais há necessidade de tratar comorbidades e proporcionar melhor qualidade de vida. Evidenciaram-se durante as entrevistas: a percepção da atuação fonoaudiológica na área da disfagia, o reconhecimento dos demais profissionais de que a atuação fonoaudiológica tem se ampliado e de que o cuidado deve se estender a toda a família.

ABSTRACT Purpose To identify speech-language pathologists' perception on their performance in palliative care at a public hospital in Santa Catarina State, Brazil. Methods It is a descriptive, qualitative study, conducted by 5 speech-language pathologists at a public hospital in Santa Catarina State. Data were collected by means of a semi-structured interview and submitted to content analysis. Results After the content analysis of the participating speech-language pathologists, the following post-defined categories emerged: concept and understanding of palliative care and speech-language pathologists' performance; the importance of the speech-language pathologists in multidisciplinary teams; interpersonal relationship with patients and their families, and constraints in the practice of palliative care. Conclusion According to speech-language pathologists' perception, palliative care is delivered to patients without any possibility of cure, but it is necessary to treat their comorbidities, and provide them with better quality of life; the perception of the speech-language pathology performance in the field of dysphagia stood out; report of other professionals acknowledging speech-language pathologists' performance in the area of dysphagia has been expanded; and such care should be extended to the whole family.

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BACKGROUND:: People with diabetes have a high risk of developing micro and macrovascular complications that increase treatment costs and shorten life expectancy. Telecoaching programmes can improve short-term control of diabetes and reduce disease burden. AIMS:: To analyse the effect of a health telecoaching programme in the control of type 2 diabetes. METHODS:: A pragmatic clinical trial was carried out. Thirty-one patients with type 2 diabetes were divided into control and intervention groups. The control group received usual nursing care, and those in the intervention group received usual care and telecoaching for 24 weeks. FINDINGS:: The intervention group improved: measurements of abdominal circumference, systolic and diastolic blood pressure and body mass index; variables related to glycaemic control (fasting venous glucose and glycated haemoglobin/HbA1c); and high-density lipoprotein levels. CONCLUSION:: The data indicate that telecoaching is an effective tool for diabetes management. It is recommended that the study should be developed to include more people and run over the long term.

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