Correlation Between Objective Habit Metrics and Objective Medication Adherence: Retrospective Study of 15,818 Participants From Clinical Studies.

Background: Medication adherence, or how patients take their medication as prescribed, is suboptimal worldwide. Improving medication-taking habit might be an effective way to improve medication adherence. However, habit is difficult to quantify, and conventional habit metrics are self-reported, with recognized limitations.

Joint quantile regression of longitudinal continuous proportions and time-to-event data: Application in medication adherence and persistence.

This study introduces a novel joint modeling framework integrating quantile regression for longitudinal continuous proportions data with Cox regression for time-to-event analysis, employing integrated nested Laplace approximation for Bayesian inference. Our approach facilitates an examination across the entire distribution of patient health metrics over time, including the occurrence of key health events and their impact on patient outcomes, particularly in the context of medication adherence and persistence. Integrated nested Laplace approximation's fast computational speed significantly enhances the efficiency of this process, making the model particularly suitable for applications requiring rapid data analysis and updates.

Intake Patterns and Experiences of Patients Using Direct Oral Anticoagulants Measured by Electronic Monitoring in Community Pharmacies.

Purpose: Several international organizations advocate for monitoring of adherence to direct oral anticoagulants (DOACs), given the prevalent issue of suboptimal adherence to DOACs. The aim was to investigate intake patterns in patients on DOAC therapy by electronic monitoring of medication adherence in community pharmacies (using a Medication Event Monitoring System (MEMS)-device), and to assess patients' experiences with this device.

Patients And Methods: Patients using apixaban, rivaroxaban or edoxaban and visiting a community pharmacy, were included.

The Importance of Assessing Drug Exposure and Medication Adherence in Evaluating Investigational Medications: Ensuring Validity and Reliability of Clinical Trial Results.

The objective of this current opinion paper is to draw global attention to medication adherence, emphasizing its crucial role in drug trials. Frequently, trialists lean on traditional approaches to assess medication adherence, which, while comfortable, may only reveal what trialists desire rather than offering the essential insights needed for informed decision making in drug development. Understanding drug exposure and medication adherence is paramount when evaluating the effectiveness and safety of investigational medications.

Evaluating Objective Metrics of habit strength for taking medications.

Habit strength for taking medication is associated with medication adherence. However, habit strength is typically measured via self-reports, which have limitations. Objective sensors may provide advantages to self-reports.

Electronically monitored medication adherence in idiopathic pulmonary fibrosis: prevalence, predictors and outcomes.

Medication adherence studies in idiopathic pulmonary fibrosis (IPF) are limited, use cross-sectional designs and report discontinuation rates. We prospectively investigated adherence to pirfenidone in IPF patients using electronic monitoring, which provides insights on whether and when the medication was taken on a day-by-day basis. We investigated the impact of nonadherence on lung function and selected predictors for nonadherence based on the COM-B behavioural model.

Machine Learning-Based Extraction of Breast Cancer Receptor Status From Bilingual Free-Text Pathology Reports.

As part of its core business of gathering population-based information on new cancer diagnoses, the Belgian Cancer Registry receives free-text pathology reports, describing results of (pre-)malignant specimens. These reports are provided by 82 laboratories and written in 2 national languages, Dutch or French. For breast cancer, the reports characterize the status of estrogen receptor, progesterone receptor, and Erb-b2 receptor tyrosine kinase 2.

Parameter estimation in a minimal model of cardio-pulmonary interactions.

Mechanical ventilation is a widely used breathing support for patients in intensive care. Its effects on the respiratory and cardiovascular systems are complex and difficult to predict. This work first presents a minimal mathematical model representing the mechanics of both systems and their interaction, in terms of flows, pressures and volumes.

Pre-ejection period, the reason why the electrocardiogram Q-wave is an unreliable indicator of pulse wave initialization.

Objective: Pulse wave velocity measurements are an indicator of arterial stiffness and possible cardiovascular dysfunction. It is usually calculated by measuring the pulse transit time (PTT) over a known distance through the arteries. In animal studies, reliable PTT measures can be obtained using two pressure catheters.

Next-generation, personalised, model-based critical care medicine: a state-of-the art review of in silico virtual patient models, methods, and cohorts, and how to validation them.

Critical care, like many healthcare areas, is under a dual assault from significantly increasing demographic and economic pressures. Intensive care unit (ICU) patients are highly variable in response to treatment, and increasingly aging populations mean ICUs are under increasing demand and their cohorts are increasingly ill. Equally, patient expectations are growing, while the economic ability to deliver care to all is declining.

Minimally invasive estimation of ventricular dead space volume through use of Frank-Starling curves.

This paper develops a means of more easily and less invasively estimating ventricular dead space volume (Vd), an important, but difficult to measure physiological parameter. Vd represents a subject and condition dependent portion of measured ventricular volume that is not actively participating in ventricular function. It is employed in models based on the time varying elastance concept, which see widespread use in haemodynamic studies, and may have direct diagnostic use.

Improved pressure contour analysis for estimating cardiac stroke volume using pulse wave velocity measurement.

Background: Pressure contour analysis is commonly used to estimate cardiac performance for patients suffering from cardiovascular dysfunction in the intensive care unit. However, the existing techniques for continuous estimation of stroke volume (SV) from pressure measurement can be unreliable during hemodynamic instability, which is inevitable for patients requiring significant treatment. For this reason, pressure contour methods must be improved to capture changes in vascular properties and thus provide accurate conversion from pressure to flow.

Minimally invasive, patient specific, beat-by-beat estimation of left ventricular time varying elastance.

Background: The aim of this paper was to establish a minimally invasive method for deriving the left ventricular time varying elastance (TVE) curve beat-by-beat, the monitoring of which's inter-beat evolution could add significant new data and insight to improve diagnosis and treatment. The method developed uses the clinically available inputs of aortic pressure, heart rate and baseline end-systolic volume (via echocardiography) to determine the outputs of left ventricular pressure, volume and dead space volume, and thus the TVE curve. This approach avoids directly assuming the shape of the TVE curve, allowing more effective capture of intra- and inter-patient variability.

Practical identifiability analysis of a minimal cardiovascular system model.

Background And Objective: Parameters of mathematical models of the cardiovascular system can be used to monitor cardiovascular state, such as total stressed blood volume status, vessel elastance and resistance. To do so, the model parameters have to be estimated from data collected at the patient's bedside. This work considers a seven-parameter model of the cardiovascular system and investigates whether these parameters can be uniquely determined using indices derived from measurements of arterial and venous pressures, and stroke volume.

Structural identifiability analysis of a cardiovascular system model.

The six-chamber cardiovascular system model of Burkhoff and Tyberg has been used in several theoretical and experimental studies. However, this cardiovascular system model (and others derived from it) are not identifiable from any output set. In this work, two such cases of structural non-identifiability are first presented.

Modelling of the nonlinear end-systolic pressure-volume relation and volume-at-zero-pressure in porcine experiments.

The End-Systolic Pressure-Volume Relation (ESPVR) is generally modelled as a linear relationship between P and V as cardiac reflexes, such as the baroreflex, are typically suppressed in experiments. However, ESPVR has been observed to behave in a curvilinear fashion when cardiac reflexes are not suppressed, suggesting the curvilinear function may be more clinically appropriate. Data was gathered from 41 vena cava occlusion manoeuvres performed experimentally at a variety of PEEPs across 6 porcine specimens, and ESPVR determined for each pig.

Model-based computation of total stressed blood volume from a preload reduction manoeuvre.

Total stressed blood volume is an important parameter for both doctors and engineers. From a medical point of view, it has been associated with the success or failure of fluid therapy, a primary treatment to manage acute circulatory failure. From an engineering point of view, it dictates the cardiovascular system's behavior in changing physiological situations.

Early detection of abnormal left ventricular relaxation in acute myocardial ischemia with a quadratic model.

Aims: The time constant of left ventricular (LV) relaxation derived from a monoexponential model is widely used as an index of LV relaxation rate, although this model does not reflect the non-uniformity of ventricular relaxation. This study investigates whether the relaxation curve can be better fitted with a "quadratic" model than with the "conventional" monoexponential model and if changes in the LV relaxation waveform due to acute myocardial ischemia could be better detected with the quadratic model.

Methods And Results: Isovolumic relaxation was assessed with quadratic and conventional models during acute myocardial ischemia performed in 6 anesthetized pigs.

Simulation of left atrial function using a multi-scale model of the cardiovascular system.

During a full cardiac cycle, the left atrium successively behaves as a reservoir, a conduit and a pump. This complex behavior makes it unrealistic to apply the time-varying elastance theory to characterize the left atrium, first, because this theory has known limitations, and second, because it is still uncertain whether the load independence hypothesis holds. In this study, we aim to bypass this uncertainty by relying on another kind of mathematical model of the cardiac chambers.

A multi-scale cardiovascular system model can account for the load-dependence of the end-systolic pressure-volume relationship.

Background: The end-systolic pressure-volume relationship is often considered as a load-independent property of the heart and, for this reason, is widely used as an index of ventricular contractility. However, many criticisms have been expressed against this index and the underlying time-varying elastance theory: first, it does not consider the phenomena underlying contraction and second, the end-systolic pressure volume relationship has been experimentally shown to be load-dependent.

Methods: In place of the time-varying elastance theory, a microscopic model of sarcomere contraction is used to infer the pressure generated by the contraction of the left ventricle, considered as a spherical assembling of sarcomere units.