mHealth products. Therefore, this study aimed to characterise real-world experiences of mHealth products for patients with diabetes, one of the largest populations of mHealth users. Publicly available posts from patients with diabetes (both types) and/or caregivers about continuous blood glucose monitoring were extracted from the Diabetes.co.uk forum, from 2016 to 2019, and subset to those containing names of select diabetes mHealth products. From these, a random sample of 80 users (153 posts) were qualitatively analysed using thematic analysis. Of 80 users, 73 had posts relevant to the study objectives, and 7 users were excluded as they did not provide an experience or perception of mHealth. Most common themes were satisfaction (32 users, 44% of users), accuracy (25 users, 34%) and cost (22 users, 30%). Of users mentioning satisfaction, 84% were happy with the product. However, where users discussed accuracy, 56% did not believe products to be accurate, and 32% discussed inconsistencies between outputs of different devices. Some users however, said accuracy did not matter as the value of mHealth is in tracking trends (32%). Cost was important for continued use of mHealth devices, and discussions regarding cost often related to NHS and insurance provision of mHealth products (11 users, 50%). mHealth is changing diabetes management, and whilst many users express positive attitudes there are key challenges for mHealth to overcome if its growth is to continue. This study can help researchers understand use-behaviours of mHealth products, in addition to areas for improvement to maximise benefit to patients with diabetes.

Objectives: To evaluate the effect of guideline adherence in treatment of hypertension in a tertiary care hospital in Calicut. Materials and Methods: A prospective observational study was conducted for a period of 6 months with a follow up of 81 hypertensive prescriptions among 100 patients, who were admitted in PVS Hospital, Calicut. BP was the parameter assessed on the baseline and follow up after one month. The effects of empirical treatment were compared with treatment based on JNC 8 guideline. Results: In a total of 81 prescriptions, 32 (39.5%) prescriptions were found in the age group of ≤60 years, in which 12 (37.5%) were males and 20 (62.5%) were females and 49 (60.5%) prescriptions were comes under the age group of >60 years, in which 34 (69.39%) were males and 15 (30.61%) were females. Among monotherapy, 14 (35%) prescriptions had ARBs as antihypertensive drug followed by diuretics 12 (30%), beta blockers 6 (15%), ACE Inhibitors 4 (10%) and Calcium Channel Blockers 4 (10%). About 59.26% of the medical records showed good level of JNC-8 guideline adherence. This adherence has significant negative association only with diabetes mellitus comorbidity (p=0.0152, Ø= -0.241) not with other co morbidities. Among 81, 69 (85.18%) patients were on goal BP on second visit. However BP control have a positive association with guideline adherence (p= 4.6E-05, Ø=0.275) and negative association with mono therapy (p<0.01, Ø= -0.108). Conclusion: Prescribing practices were fairly compliant with guidelines. Doctors poorly adhered to guidelines in hypertensive patients with Diabetes. Significantly better hypertension control was seen in patients who were on guideline adherent therapy.

Objectives: This study aims in the identification of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) associated with vemurafenib using disproportionality analysis of the FDA database of Adverse Event Reporting System (FAERS). Methods: Data were obtained from the public release of data in FAERS. Case/ non-case method was adopted for the analysis of association between vemurafenib use and DRESS. The data mining algorithm used for the analysis was Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR). A value of ROR-1.96SE.1, PRR$2 were considered as positive signal. Results: A total of 7,869 reports for DRESS have been reported in the FDA database. Amongst which 101 reports were associated with vemurafenib. DRESS ranked 49 th among 900 vemurafenib associated adverse drug events. The mean age was 55.87 (95% CI, 52.21-59.52) and female to male ratio was 1.466:1. A positive signal was obtained with ROR: 13.10 and PRR: 13.12. Four deaths were reported and the non-death serious reports included hospitalization, lifethreatening, disability, and other serious events with 61, 11, 2 and 39 reports respectively. Linear regression analysis indicated there was a significant correlation between the PRR and time (R=0.810; p=0.027) and ROR and time (R=0.807; p=0.028). The Log Likelihood ratio for DRESS with vemurafenib was found to be 151.14 and the reporting ratio was 11.11 (Critical value-5.59). Conclusions: A positive signal was observed for vemurafenib associated DRESS, although a causal relation cannot be definitively proved. Health care professionals should be cautious about the possibility of encountering serious adverse events associated with vemurafenib and should be reported to the regulatory authorities.

Objectives: Extrapulmonary impacts of chronic obstructive pulmonary disease (COPD) often include sleep disturbance, poor sleep quality, and daytime sleepiness resulting in detrimental impact on patients' overall health-related quality of life (HRQoL). This study evaluated the impact of sleep disturbance on HRQoL in patients with COPD. Methods: Literature searches were performed in biomedical databases until March 2019. Specific search terms identified observational studies assessing HRQoL in COPD that included sleep as a patient-reported outcome (PRO) endpoint. Only full text articles published in English were included. Results: Out of total 1247 abstracts identified for initial screening, 177 were selected for full text review. Based on the inclusion criteria, PRO-related information from 36 studies are analyzed. Sleep disturbances and poor sleep quality was on average prevalent in more than onethird, ranging from 27%-100% of COPD patients.

A systematic search was conducted using PubMed, Embase, and Cochrane for real-world studies (January 2014 to February 2019) following PRISMA guidelines. Cross-references were checked to identify studies post 2009, with ongoing status. Results: Of 2,838 screened articles, 42 met the inclusion criteria. Observed adherence ranged between 69%-98% in the US, 57%-96% in European, 62%-93% in African, 79%-80% in Latin and 66%-98% in Asian population. Most of the studies indicated a positive correlation between adherence and VS, consistent across all geographies, irrespective of adherence-thresholds (90-95%) and treatment class. Across all ARTs, the odds of detectable viral load (.400 copies/ml) for different adherence levels range as follows: 95-99%: 1.5 (1.2-1.9); 90-94%: 2.0 (1.5-2.8); ,90%: 4.1 (3.1-5.4). The impact of adherence also varies as per the treatment class. For unboosted-PIs, patients with adherence $95% were 1.6 times and 7.7 times more likely to achieve viral-suppression than those with adherence between 75%-95% and ,75% respectively. For INSTIs, patients with adherence $95% were 1.1 times and 4 times more likely to achieve viral-suppression than those with adherence between 75%-95% and ,75% respectively. Main determinants of non-adherence were alcohol/ substance use (p,0.005) apart from gender, age, comorbidities and polypharmacy. Naïve patients seemed to be more adherent than the experienced patients. Conclusions: Adherence levels of 90-95% seem to maximise the possibility of achieving sustained viral suppression with clinically significant improvements. Interventions to improve adherence in HIV patients with alcohol/substance use are deemed desirable.