Objective To examine the impact of our new rapid refeeding protocol on patients with anorexia nervosa (AN) in our Eating Disorders Program. We hypothesize that the new protocol would lead to a more rapid weight gain and a shorter length of stay, with no effect on medical complications or program completion. Method This cohort design included consecutive inpatients and day hospital patients admitted to the program with a BMI <18 kg/m2 and a diagnosis of AN between 2007 and 2020; N = 326 patients. Main outcomes measured were rate of weight gain and length of stay. Safety indicators included electrolyte disturbances and supplementation required, complications including refeeding syndrome and completion of the program. A p value <.05 was considered statistically significant. Results Total length of stay was 21 days shorter for patients on the rapid refeeding protocol compared to the traditional refeeding protocol. Patients on the new protocol gained 0.21 more kg/week compared to patients on the old protocol. There was no difference in completion rates between programs. Electrolyte imbalances were mild to moderate and easily treated with oral electrolyte supplementation. There were no deaths or cases of refeeding syndrome with either protocol. Discussion This is the first Canadian study to assess the effectiveness and safety of rapid refeeding in an adult population. Rapid refeeding protocols can be safely administered and are cost effective. Shorter hospital admissions are desirable to minimize possible regression and dependency on inpatient services and positively impacts patients' quality of life. Public Significance This study advances the idea that rapid refeeding in patients with anorexia nervosa can be administered safely and effectively with close medical monitoring. In addition, rapid refeeding leads to shorter hospital stays, with a cost‐savings to the health system. Shorter admissions are desirable to minimize possible regression and dependency on inpatient services and also positively impacts patients' quality of life.
Very high levels of patient adherence (greater than 95 percent) are required for antiretroviral therapy (ART) to be effective and to prevent the emergence of resistant viral strains (Paterson et al. 2000; Ickovics et al. 2002). Since 1997, antiretroviral (ARV) medications have been available in India through the private sector and some employer-supported health insurance programs. It is estimated that India has 5.1 million HIV-infected persons (NACO 2004), some of whom have been on ART for several years. However, very little information is available on the levels of adherence to ART among people living with HIV/AIDS in India. With increased availability of ART, HIV-positive individuals are living healthier lives and continuing or resuming sexual activity. But, optimism related to ART's success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices and a possible increase in transmission of infections. Determining the sexual behavior of HIV-positive persons on ART is therefore an area of special interest and concern. To meet these knowledge gaps, the Horizons Program, in collaboration with research partners in Delhi and Pune, conducted a study to assess current levels of adherence to ART among a sample of people living with HIV/AIDS, identify the factors that influence their adherence to treatment, and determine their sexual risk behaviors. The study also examined the economic burden of ART on the household. Findings from the study provide important insights that are immediately relevant to the scale-up of the national ART program, which was launched in April 2004. Methods Three hundred and ten HIV-positive patients currently on ART and attending one private and three public sector health facilities in Pune and Delhi were interviewed between May and August 2004. The sample of clients from the private clinic was mostly paying out-of-pocket for their treatment (n = 252/263). The remaining private clinic clients (n = 11) and those using the public sector facilities (n = 47) were receiving free ARVs through employer-provided, government-supported health insurance programs. A semi-structured questionnaire adapted from adherence instruments developed by the Adult AIDS Clinical Trials Group (AACTG) was used for data collection. Adherence was measured using a 4-day patient self-report. Mean 4-day adherence was calculated by dividing the number of pills actually taken by the number of pills prescribed for 4 days x 100. Higher adherence was defined as a mean 4-day adherence of ≥ 90 percent and lower adherence as a mean 4-day adherence of < 90 percent. Other measures of adherence included (a) the number of missed doses over the last week, (b) the last time a full day of medication was missed, (c) the number of times treatment was stopped for more than one week, and (d) the frequency of following the medication dosage schedule. The key themes of analysis for sexual risk behavior were type of partners, knowledge of partner's status, disclosure of one's own HIV s...
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