Purpose This systematic review aimed to determine the rate and identify correlates of adherence and persistence over five years of treatment with adjuvant endocrine therapy in female breast cancer patients. Methods Relevant articles were identified from Medline, Embase, AMED, PsycINFO, International Pharmaceutical Abstracts, and APA PsycArticles. Studies that measured patient adherence in the implementation or persistence phase for a period of at least five years using objective or multiple measures of adherence and investigated correlates of adherence were included. The titles, abstracts and full articles were screened and reviewed by two authors and any discrepancies were discussed with a third author. Results Twenty-six studies were included. Mean rate of adherence at five-year for implementation phase was 66.2% (SD = 17.3%), and mean persistence was 66.8% (SD = 14.5%). On average, adherence decreased by 25.5% (SD = 9.3%) from the first to fifth year. Higher rate of adherence was observed through self-report in comparison to database or medical record. Older age, younger age, higher comorbidity index, depression and adverse effects were associated with lower adherence. Treatment with aromatase inhibitors, received chemotherapy, and prior medication use were associated with improved adherence. Conclusion Adherence to adjuvant endocrine therapy decreased from the first to fifth year of treatment. On average, one-third of patients were not adherent to treatment by the fifth year. Nineteen recurring factors were found to be significantly associated with long-term adherence in multiple studies. Further research using objective or multiple measures of adherence are needed to improve validity of results.

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Objectives: To develop an integrated software package to augment the teaching and learning of pharmacokinetics to undergraduate pharmacy students, covering various aspects of pharmacokinetics from basic principles, calculations and their application, including therapeutic drug monitoring (TDM) in clinical practice and bioequivalence calculations for industry, as well as several computer-aided learning modules (CAL). Materials and Methods: JAVA was utilized to allow for a modular design and the ability to build future functionality into the system. A database of patient information with multiple drugs of interest, with plasma concentration values, was constructed to allow students to appreciate the variability of pharmacokinetic parameters in different clinical conditions. Computer-assisted learning (CAL) modules were prepared to assist students in understanding selected pharmacokinetics topics. Software testing, validation, system testing and user satisfaction surveys were conducted to evaluate suitability and accuracy. Results: A comprehensive and modular pharmacokinetics computer program was successfully developed using Java and NetBeans. The program produced accurate and reproducible values for numerous pharmacokinetic parameters, based on a user satisfaction survey, the average usability score of 68.8 indicating good usability status among undergraduate students. Conclusion: The software is the first attempt to produce a comprehensive package with multiple points of calculation including compartmental and non-compartmental analysis, TDM and bioequivalence, as well as learning modules, all integrated into one environment suitable for both pharmacy students and pharmacists. End users were generally satisfied with the software and provided feedback and recommendations to further improvements with the ultimate aim of introducing the system to undergraduates for teaching purposes.

A strong foundation in pharmacokinetics is essential not only to provide effective therapeutic outcomes for patients but also crucial to the pharmaceutical industry and the regulation of generic pharmaceuticals. Bioequivalence is an important regulatory concern for a pharmaceutical company in the manufacture of generic drugs. Pharmacokinetics should be mastered by pharmacy students to prepare them for their future careers, particularly in a hospital setting where pharmacists typically play a central role in clinical pharmacokinetics services. However, basic pharmacokinetics is sometimes not well-received by students because of its basis in mathematics and the relative difficulty in connecting basic concepts with clinical relevance. This narrative literature review examines the methodologies employed to teach pharmacokinetics, the move towards computer-aided and distance learning, and the current software systems available to facilitate this. A better understanding of the limitations of current approaches is crucial to take steps to enhance the teaching and learning of such an important subject.