Our findings indicate that favorable levels of adherence, much of which was assessed via patient self-report, can be achieved in sub-Saharan African settings and that adherence remains a concern in North America.

BackgroundAdherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy.Methods and FindingsWe examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity.ConclusionsWe found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations.

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aware of Internet video-sharing sites and should be prepared to respond to patients who obtain their health information from these sources. 5 The potential use of these sites for effective communication by health professionals should also be considered.

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Background: Smoking remains the leading preventable cause of premature deaths. Several pharmacological interventions now exist to aid smokers in cessation. These include Nicotine Replacement Therapy [NRT], bupropion, and varenicline. We aimed to assess their relative efficacy in smoking cessation by conducting a systematic review and meta-analysis.

Objective: To determine the effect of smoking cessation on mortality after myocardial infarction.Data Sources: English-and non-English-language articles published from 1966 through 1996 retrieved using keyword searches of MEDLINE and EMBASE supplemented by letters to authors and searching bibliographies of reviews.Study Selection: Selection of relevant abstracts and articles was performed by 2 independent reviewers. Articles were chosen that reported the results of cohort studies examining mortality in patients who quit vs continued smoking after myocardial infarction.Data Extraction: Mortality data were extracted from the selected articles by 2 independent reviewers. Data Synthesis: Twelve studies were included containing data on 5878 patients. The studies took place in 6 countries between 1949 and 1988. Duration of follow-up ranged from 2 to 10 years. All studies showed a mortality benefit associated with smoking cessation. The combined odds ratio based on a random effects model for death after myocardial infarction in those who quit smoking was 0.54 (95% confidence interval, 0.46-0.62). Relative risk reductions across studies ranged from 15% to 61%. The number needed to quit smoking to save 1 life is 13 assuming a mortality rate of 20% in continuing smokers. The mortality benefit was consistent regardless of sex, duration of followup, study site, and time period. Conclusion:Results of several cohort studies suggest that smoking cessation after myocardial infarction is associated with a significant decrease in mortality.

ed blood cell (RBC) transfusion is the most common medical procedure in contemporary medicine. 1 In the United States, 7.6% of all hospitalized patients will receive at least 1 blood transfusion during their hospitalization, and its use has increased between 1997 and 2011 by 134%. 1 With the main objective to improve oxygen delivery to tissues, 2 RBC transfusion is used in a variety of medical situations, ranging from correction of chronic low-grade anemia to resuscitation of the massively bleeding patient. 2-5 When a decision to transfuse has been made, usual practice is to order 1 or more compatible RBC units from the blood bank. Limited characteristics of the RBC unit can be requested, such as cytomegalovirus (CMV) status, leukoreduction, or irradiation; however, evidence of clinical benefit with these specific characteristics is limited. 6 There is growing preclinical and clinical evidence that blood donor characteristics may affect recipient outcomes. Erythropoiesis is altered by aging, 7 as are other characteristics related to blood, including immune tolerance, inflammation, oncogenicity, and premature cellular turnover. 8,9 Humans who live longer may also have different genetic factors affecting RBC characteristics. 10 Immunological phenomena related to donors, such as the antileukocyte antibodies (anti-HLA or antineutrophil antibodies) that occur after pregnancies (eg, sex effect on transfusion-related acute lung injury [TRALI]), have been shown to affect clinical outcomes. 11,12 Transfusion of a blood component is analogous to solid organ transplantation because it involves the retrieval of an organ (blood) from a donor, postdonation processing and IMPORTANCE While red blood cells (RBCs) are administered to improve oxygen delivery and patient outcomes, they also have been associated with potential harm. Unlike solid organ transplantation, the clinical consequences of donor characteristics on recipients have not been evaluated in transfusion medicine. OBJECTIVE To analyze the association of RBC donor age and sex with the survival of transfusion recipients. DESIGN, SETTING, AND PARTICIPANTS We established a longitudinal cohort by linking data from a blood collection agency with clinical and administrative data at 4 academic hospitals. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were fitted to evaluate the risk of donor age and sex on transfusion recipient survival.