Blister packaging to support warfarin adherence in paediatric patients: A pilot retrospective study
Bibliographic record
Abstract
Abstract Introduction Warfarin continues to be used in children for specific indications. Children must test their blood regularly and adherence to the medication routine can be highly challenging. Warfarin nonadherence has the potential for significant complications. Blister packaging (BP) is not commonly applied to warfarin therapy due to frequent dose titrations however BP may be useful in improving adherence. Objective To evaluate the efficacy of BP warfarin to determine its impact on outpatient management. Methods Retrospective chart review of children aged from 18 months to 18 years with suboptimal adherence transitioned to BP between 2021 and 2023. Data collected included international normalized ratio (INR) reminders, missed doses, bleeding or thrombotic events, and INRs for 6 months pre-/post-BP. Time in therapeutic range (TTR) analysis as a measure of safety and efficacy was used. Results Eleven charts were reviewed. Mean and median age were 11 and 9 years, respectively (4 to 17 range), nine female and two male. International normalized ratio reminders required decreased 30% pre-/post-BP initiation 84 (mean 7.6, range 0 to 18/child) and 59 (mean 5.4; range 1 to 15/child), respectively. Missed doses decreased by 20% pre-/post-BP 35 (mean 3.2; range 0 to 10) and 29 (mean 2.6; range 0 to 10), respectively. The TTR increased by a median of 11.61% from pre to post. This difference was not statistically significant (P-value from Wilcoxon signed rank test: 0.1602). Conclusion This study demonstrates that BP is a viable option that supports warfarin management. Caregivers described BP as beneficial with a trend to increased TTR and a decrease in healthcare provider workload.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".