BackgroundDyspepsia guidelines recommend that patients treated with proton pump inhibitors (PPIs) should step down to the lowest effective dose or return to self-care, but rebound hyperacidity can make this difficult. Many patients continue on PPIs in the long term, which may lead to safety and financial implications.AimTo determine if a nurse-led educational support programme and rescue therapy for rebound symptoms can help patients achieve a sustained reduction in PPI use.Design & settingA prospective interventional study was conducted at 26 surgeries across the UK.MethodAdult patients, treated with PPIs for ≥2 consecutive months with an active repeat prescription, were invited to a 20-minute dyspepsia clinic appointment with a trained nurse adviser. An action plan to reduce and/or stop their PPI usage was agreed and alginate supplied for the self-management of rebound symptoms. After 12 months, PPI status was reviewed and prescribing cost savings calculated.ResultsAfter 12 months, 75.1% of 6249 eligible patients stepped down or off PPIs (35.3% stepped off; 5.0% stepped down then off; 34.8% stepped down only), while 8.7% of patients had reverted to their original PPI dose. PPI prescriptions fell from 89 915 to 45 880 and alginate prescriptions increased from 2405 to 6670. An average of 1.7 bottles (500 ml each) of alginate were used per patient who stepped down or off. Estimated annual cost-saving on prescriptions was £31 716.30.ConclusionA programme of education and short-term rebound symptom management helped the majority of patients to successfully step down or off PPIs, significantly reducing the potential risks associated with chronic therapy.

For the translation, transcultural adaptation and a pilot test of the instrument were done. Also, the compliance of the breast cancer patients to the treatment was measured. The questionnaire "Cancer Patient Self-Report Questionnaire Non-Adherence" was translated and adapted; and a pilot test with 30 patients was performed. For this study, the questionnaire, Morisky-Green test, was also used. A hundred and thirteen patients diagnosed with breast cancer and who used oral chemotherapy were evaluated. The evaluated patients' average age was 57 years. 82.5% of them had invasive lobular carcinoma cancer, and almost 50% had a family history of breast cancer. The evaluation of the compliance shows that only 31.85% of the patients completed the medical treatment. Patients who presented adverse reactions were more susceptible to stopping the treatment. The low compliance on the medicated treatment is worrying and shows the need to improve it and further research to identify which factors contribute to the non-compliance to such treatment.