Pancreatic replacement technology -
There was no statistically significant difference in MA between patients with different marital status, residence, course of disease, type of pain after taking medication, diabetes, and steatorrhea. Table 3 presented the results of the multivariable logistic regression analysis based on the eight variables that were statistically significant in univariate analysis.
Patients with senior high school adj. Patients with monthly household income less than 5, adj. Table 4 showed the characteristics of the 24 interviewed participants.
Supplement Table 1 showed the detailed information of each interviewed participate. Among them, 14 Seven themes regarding barriers to MA emerged from interviews: 1 Lack of knowledge, 2 Self-adjustment of PERT, 3 Lifetime of medication, 4 Side effects of PERT, 5 Forgetfulness, 6 Financial burdens, and 7 Accessibility issues Table 5.
Some patients reported that they were unaware of their disease condition, treatment options, and the nature of drugs they are taking. They believed they did not need to take medication or need to adhere to it for a long period of time.
I stopped taking it, after eating up the medicine prescribed by the doctor every time. I was worried that the long-term use of it would cause damage to my liver and kidneys, and then I stopped taking it later.
Some patients will exert their subjective initiative in taking the medication and changed the dosage according to the severity of their symptoms and type of diet. I took it for a while, but it didn't seem to have much effect, so I stopped taking it. I wanted to wait until I get older.
A few patients reported some side effects after taking the medication, which in severe cases affected their daily life, so they chose not to take the medication. However, once I took this medicine, I would become constipated, I may not have a bowel movement for several days, and my stomach felt bloated, so I just stopped taking it.
Some patients said that they would forget to bring their medicines or forget to take drugs because they were busy at work or needed to go out. In addition, a small number of patients said that they relied on reminders from others to improve MA.
Sometimes I forgot to take my medicine when I go out. Sometimes I would forget to take medicine when I was busy or had irregular meals. Sometimes I remembered it after meal. Some patients reported that taking medicine would cause a certain financial burden, so they chose not to take medicine or switch to other drugs.
My wife and I were both part-time workers. We can't afford to eat so much, so we switched to domestic pancreatic enzyme tablets later.
Considering that CP is a rare disease, not all hospitals can provide the medications patients need. Some patients reported that they lacked access to medication.
Also, I cannot buy a lot at once. I can only buy 2 weeks of drugs at a time with my medical insurance reimbursement. In addition, it was inconvenient to travel due to the COVID epidemic. It was too troublesome to buy medicine. Although PERT has been recommended as the first choice for the treatment of PEI caused by CP , there are significant center related variances in the management of PERT in clinical practice, and many patients have not been treated in a standardized way In available studies, data on adherence to PERT among CP patients is limited.
This may be very important as identifying the levels of and factors influencing MA may help to better implement PERT management and improve the prognosis of PEI. To our knowledge, this study was the first to explore the adherence to PERT among patients with CP in China.
The mixed study design was also a strength of this paper, allowing for a more comprehensive perspective on the factors influencing MA. Overall, MA to PERT was currently poor in Chinese CP patients.
During the qualitative interviews, we found that factors affecting MA included lack of knowledge, self-adjustment of PERT, lifetime of medication, side effects of PERT, forgetfulness, financial burdens, and accessibility issues.
In this study, the rate of non-adherence to PERT reached This result was close to the adherence to PERT after 1 year follow-up in the study by Khandelwal et al.
We believed that this result was true and consistent with the current status of long-term adherence to PERT in patients with CP. However, this figure was significantly lower than that in the studies by Barkin et al.
and Crosby et al. One possible explanation for such high MA in their studies was that patients included in our study all chose to receive interventional treatment for pancreatic duct stones, and the serious condition of pancreatic cancer and painful and traumatic surgical treatment experiences of the patients in their studies may contribute to their higher medication consciousness and adherence to PERT.
Adherence to PERT in patients with CP in our study was also lower than in some common chronic diseases. In a meta-analysis by Khunti et al. involving over , patients with type 2 diabetes, the mean rate of poor MA was Another meta-analysis by Durand et al.
on MA in patients with refractory hypertension reported that the pooled rates of non-adherence was Cancer, cardiovascular diseases, diabetes and chronic respiratory diseases have been listed by the World Health Organization WHO as the top four non-infectious diseases worldwide Compared with these common chronic diseases widely publicized and well-known by the individuals, given the rarity of CP, there is a clear lack of knowledge of CP among patients, as evidenced by the interviews in this study, where patients reported that they were not well informed about their conditions and the medication they were taking N15, N Therefore, we believed that a lack of disease knowledge may be one of the potential reasons for the poor adherence to PERT among CP patients.
In addition, inadequate and inconsistent medication guidance from health care providers may be another reason for poor MA. Existing studies have concluded that there is a lack of uniform consensus among gastroenterologists on the diagnosis and treatment of PEI and that only a small number of pancreatic specialists can surveil and treat PEI adequately compared to primary care providers 17 , Therefore, we recommend, first, standardized guidelines and additional education are necessary for healthcare providers.
National advanced pancreatic disease institutions should develop and promote PEI treatment guidelines applicable to CP patients in their country and conduct educational courses and guideline interpretations for non-pancreatologist on PEI and PERT to help them prescribe uniform and standardized plan of PERT.
Second, it is positive for patients to be informed about the disease and the medication they are taking. In addition, given that MA usually decreases over time, and given the long-term nature of PERT and the lack of short-term effects N5 , the follow-up monitoring and management of medication behavior is also integral to improving MA In this study, the results of multivariate analysis showed that lower levels of education and income were contributing factors for non-adherence to PERT.
These findings fall within the WHO framework for MA and were consistent with previous research findings 44 , 45 , Excessive medical costs and financial burden may be the cause of poor MA. Therefore, for patients who may have financial difficulties, health care providers should offer them an alternative cheaper drug choice at the time of prescribing.
In addition, during the interviews we also found that even patients with stable jobs similarly reported difficulties with MA N The type of work, work environment and working hours of patients may influence their willingness and behavior of taking medication, however, these factors have not been explored in depth in previous articles.
This is easy to understand, as patients who have received better education usually have better comprehension and acceptance of knowledge related to diseases and medications and have a richer knowledge reserve, resulting in their better MA.
However, we also found an interesting phenomenon. Generally, younger patients usually have a higher level of education compared to older patients, so their adherence to PERT should have been better.
However, in fact, we found that MA appeared to be worse in younger patients. The possible explanations were, first, younger patients had a relatively new diagnosis and a shorter course of disease, and that their relapses and disease experiences were less frequent.
Second, young patients tended to have a better level of education. On the one hand, good education made it easier for them to understand and accept disease knowledge, but on the other hand, these patients were also relatively more rebellious, more likely to exert their subjective initiative in the process of taking drugs, and did not comply with drug prescriptions 48 , Considering the youthfulness and good acceptance of medication non-adherent patients, with the rapid development of new media technology and instant music video platforms, based on the existing e-reminders, smartphone applications and social platforms, video pushing of medication instructions on instant music video platforms such as TikTok and bilibili may be a new way to improve the MA of patients.
This study also had some limitations. First, this was a small sample study based on a single center. Although Changhai Hospital is the largest CP diagnosis and treatment center in China and even Asia, patients at our center are more representative only for East China.
Small sample may also lead to some bias in the results of this study. In addition, patients who visited our center tended to be more severely ill and had better adherence than those in primary medical institutions.
Therefore, the findings of our study may not be fully representative of the MA to PERT of other CP patients in other institutions. to further explore various subjective, objective, and disease-related factors of adherence to PERT in Chinese CP patients and validate the results of our study, providing a reference for the management of PERT.
This study revealed the status of adherence to PERT among patients with CP in East China through a mixed study design. Overall, the MA of East Chinese CP patients was poor, and the low education and income level were the contributing factors of poor MA.
The qualitative analysis results showed that, seven themes associated with non-adherence included lack of knowledge, self-adjustment of PERT, lifetime of medication, side effects of PERT, forgetfulness, financial burdens, and accessibility issues.
Healthcare providers should personalize medication strategies to improve the MA of patients. Zhang, G. et al. Flavonoids prevent NLRP3 inflammasome activation and alleviate the pancreatic fibrosis in a chronic pancreatitis mouse model. Article PubMed CAS Google Scholar.
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Heart Assoc. Capsules comprised of a higher or lower number of active units will determine the number of capsules taken per meal or snack. Even though your doctor or dietician should always discuss and recommend what unit strength of dosage and how many capsules are taken and how often…….
the patient will be the best judge of what dosages and number of capsules are best for the symptoms. However, the doctor must always know the dosage and capsule quantity because there are risks for over dosing. The most common side effect will likely be constipation, diarrhea , nausea, and abdominal discomfort and pain.
Let your doctor know of any severe diarrhea. Sometime switching brands may help. Keep your doctor aware of any experienced side effects. Although there are alternative digestive enzyme treatments, the most often prescribed replacement therapy is CREON.
Visit the CREON Website for more information. Pancreatic enzyme replacement capsules are made from purified pig pancreas glands. And there is currently no other alternative to using pig pancreas glands. If you have a religious objection to ingestion of pork, it is possible there is special dispensation to allow pork ingestion granted by religious organizations since they are medical needs.
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Pancreatic replacement technology enzyme rwplacement therapy PERT technooogy the enzymes that your pancreas would normally make. The enzymes come in capsules that Healthy snacks for sugar cravings take Pancreatic replacement technology food. Pancretic help you to Pancreagic your food by Pancretaic down carbohydrates, Pancreatic replacement technology and proteins in your food. Most people with pancreatic cancer will need to take PERT. All pancreatic enzymes are made from pork products, and there is no alternative. You may see vegetarian enzymes in shops or online, but these are not used for pancreatic cancer as there is no evidence that they work. Organisations representing Jewish and Muslim communities have said that pork based treatments are acceptable to use. This booklet contains Citrus bioflavonoids and hormone balance about how pancreatic cancer can affect your replacemejt and nutrition. Pancreattic information on managing Pancreatic replacement technology symptoms Pancreatic replacement technology as malabsorption, enzyme replacement, poor appetite, weight loss and tcehnology diarrhoea. Contains a section about Pancreatic replacement technology supplements and information about diabetes and diet. This recipe book provides advice on how best to combat cancer-induced weight loss and other eating related problems whilst undergoing pancreatic cancer treatment. It features over 80 quick, easy and energy dense recipes for nourishing meals and snacks that have been created specifically for people who find it hard to maintain a healthy weight. Pancreatic enzyme replacement therapy involves taking the digestive enzymes you need in the form of a tablet.
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