Availability Of Clinical Guidelines Research Articles

Current practices in diagnosing acute pulmonary embolism: a comprehensive analysis of adherence to contemporary practice guidelines.

Acute pulmonary embolism (APE) poses significant diagnostic challenges, with potentially fatal outcomes if not promptly identified and treated. Despite the availability of clinical guidelines, adherence to diagnostic strategies varies globally, impacting patient outcomes. Our aim was to investigate current practices for PE diagnosis among Polish physicians and their adherence to the contemporary 2019 European Society of Cardiology (ESC) guidelines. This cross‑sectional study, utilizing a web‑based survey developed with the Delphi methodology, included hospital‑based physicians of various specialties from Poland. The survey focused on diagnostic practices, risk stratification, and adherence to the ESC 2019 guidelines for PE. The study showed a limited use of guideline‑recommended clinical prediction rules, with predominant reliance on D‑dimer assessment and computed tomography pulmonary angiography. Risk stratification practices varied, and were often based on individual experience rather than evidence‑based strategies. The vast majority of physicians (80.5%) had never contacted a PE response team, but 88% stated that they would if it were available. Cardiologists were more likely to employ guideline‑recommended methods than other specialists. There is a need for increased adherence to guideline‑recommended diagnostic and risk stratification strategies in APE among physicians in Poland. Enhancing the availability of PE response teams and promoting guideline‑directed practices could improve diagnostic accuracy and patient outcomes.

Efficacy of tablet glucocorticoids depending on their starting dose in patients with type 2 amiodarone-induced thyrotoxicosis: a prospective randomized study

Background: Glucocorticoids are the first-line pharmacotherapy for amiodarone-induced destructive thyroiditis. Despite the availability of clinical guidelines, there is no unified approach to patient management (indications for prescription, starting dose, duration of therapy and withdrawal algorithm). The issues of dose-dependent effect of glucocorticoids, verification of factor of delayed treatment response, prediction of severity and duration of thyrotoxicosis remain unresolved. Aim: To evaluate the efficacy of various regimens of tablet glucocorticoids in patients with type 2 amiodarone-induced thyrotoxicosis. Methods: This was a prospective randomized open-label comparative controlled trial of the efficacy of two starting doses of prednisolone 30 mg (n = 22) and 60 (n = 22) mg daily. The study groups were comparable for gender (men to women ratio 2:1), age, anthropometric and main clinical and laboratory characteristics. After euthyroidism has been achieved, thyroid function was assessed twice at 1 and 2 months during the dose reduction and at 1, 3, 6, 9, and 12 months after prednisolone withdrawal. The follow up was 15 to 24 months. The efficacy of therapy was evaluated by the time to euthyroidism, thyrotoxicosis duration, rate of recurrent waves of destruction and relapses. We looked for predictors of delayed treatment response and severe and prolonged thyrotoxicosis. Results: There were no significant differences in the time to euthyroidism (Mantel-Cox log rank test 0.859), duration of thyrotoxicosis (Mantel-Cox log rank test 0.813), rate of recurrent waves of destruction (0.721) and relapses (0.464). Within 30 days of therapy, remission was obtained in 11/22 (50.0%) patients in active control group (prednisolone 30 mg) and in 12/22 (54.5%) patients in the 60 mg group. Delayed response ( 60 days) was defined by recurrent waves of destruction (RR = 34.7, 95% CI: 3.7–321.8; R² = 0.430; p = 0.002). High risk of severe thyrotoxicosis was predicted by the age ≤ 54 years (AUC 0.749 ± 0.095, 95% CI: 0.562–0.936; p = 0.038; sensitivity 71.4%, specificity 62.2%). The duration of thyrotoxicosis was associated with body mass index (B = -7.4, R = 0.481, R² = 0.0231; p = 0.024) and cumulative amiodarone dose (B = 0.4, R = 0.472, R² = 0.223; p = 0.026). A combination of adverse events (hyperglycemia, infection, proximal myopathy, change in appearance, hematomas) and their severity were more frequent in the patients who had received the 60 mg prednisolone starting dose (p = 0.014). Conclusion: Compared to lower doses, the use of high doses of glucocorticoids is associated with a greater severity of side effects and does not ensure any significant acceleration of thyrotoxicosis remission. The potential factors of unfavorable clinical course of type 2 amiodarone-induced thyrotoxicosis are age, body mass index, and cumulative dose of amiodarone.

Commonly Practiced Physical Therapy Interventions for the Treatment of Knee Ostoearthritis; A Descriptive Study

Background: Knee Osteoarthritis (OA) is a leading cause of disability, with treatment approaches varying widely based on clinical judgment and patient-specific factors. Despite the availability of clinical guidelines, there is inconsistency in treatment preferences among physical therapists, which may influence patient outcomes. Objective: The study aimed to identify the commonly used treatment modalities for Knee OA by physical therapists in Punjab and to evaluate the adherence to clinical guidelines in practice. Methods: A cross-sectional survey was conducted involving 100 physical therapists from various cities in Punjab, who were selected using convenience sampling. Participants were provided with a standardized questionnaire to capture demographic data, clinical experience, and preferred treatment approaches for Knee OA. Data was collected in a one-time setting across government and private clinical environments over a four-month period. Therapists with a minimum of three years of clinical experience were included if they consented to participate. The data was analyzed using SPSS version 25.0. Results: Of the physical therapists surveyed, 54% were male and 46% were female. The majority (56%) worked in private/primary health centers, with lesser representation in general/specialist hospitals (19%), tertiary/teaching hospitals (17%), and secondary/federal medical centers (8%). Diagnostic preferences showed a reliance on Range of Motion assessments, with other methods such as muscle strength and radiographic findings also utilized. Treatment preferences indicated a predominant use of TENS (87 therapists), followed by ultrasound (61 therapists), and education regarding weight control (47 therapists). Less frequently used treatments included acupuncture (2 therapists) and aerobic exercises (4 therapists). Conclusion: The treatment preferences for Knee OA among physical therapists in Punjab do not consistently align with established clinical guidelines, indicating a need for enhanced guideline education and integration. The predominance of private practice settings may influence these preferences, suggesting a potential area for targeted guideline dissemination.

Evidence-Do Gap in Quality of Direct-To-Consumer Telemedicine: Cross-Sectional Standardized Patient Study in China.

Background: The evidence-do gap between the availability of clinical guidelines and provider practice is well documented, resulting in low health care quality. With the rapid development of telemedicine worldwide, this study aimed to investigate the evidence-do gap and explore the factors for the evidence versus practice deficits as well as low quality in direct-to-consumer telemedicine. Methods: We adopted the standardized patient approach to evaluate the health worker performance and calculate the evidence-do gap in quality of the consultation process, diagnosis, and treatment in telemedicine based on China's national clinical guidelines. Moreover, we further explored the factors associated with the gap through multiple linear regression and logistic regressions. Results: Validated physician-patient interactions (N = 321) were included. On the one hand, the consultation process and treatment quality are less commendable with the huge evidence-do gap. More than three-quarters of the physicians provided low-quality care, as against standard clinical guidelines. On the other hand, the level I, specialized hospitals, doctor, associate chief physicians, and attending physicians, sponsored by Internet enterprises, more times of provider's responses and words were associated with high-quality processes; More total times of provider's responses, urticaria, and nonoffice hours of the visit were associated with high-quality diagnosis; Sponsored by Internet enterprises, more total words of provider's all responses, and urticaria were associated with high-quality treatment. Conclusions: Our findings have important implications in an era in which to better comprehend the evidence-do gap. Efforts to bridge the evidence-do gap should be focused on the important role of institutions and physicians.

Antimicrobial resistance and rational prescription practices: knowledge, perceptions and confidence of health profession interns in Uganda.

Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision. This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices. This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and multivariable logistic regression were performed. P < 0.05 was considered statistically significant. We recruited 281 participants with a mean age of 27 ± 3.8 years, of which few (n = 53; 19%) had good knowledge about AMR and rational prescription. The use of professional organization guidelines as a source of information was significantly associated with good knowledge (adjusted OR = 1.9; 95% CI: 1.0-3.5; P = 0.046). Nurses had the least knowledge compared with doctors and pharmacists. Continuous medical education (99%) and availability of clinical guidelines (98%) were identified as the most helpful intervention to improve knowledge. Most participants were confident about accurately diagnosing infections and sepsis and selecting appropriate antimicrobials. Continuous medical education and availability of clinical and professional organization guidelines should be leveraged to improve the knowledge of AMR and rational prescription among health profession interns. Their high confidence in rational prescription practices should be pivotal to the fight against AMR.

#4640 PREDICTION OF CHRONIC KIDNEY DISEASE PROGRESSSION WITH ARTIFICIAL INTELLIGENCE: A CHALLENGE WITHIN OUR REACH

Abstract Background and Aims Chronic Kidney Disease (CKD) is a common and debilitating condition that affects over 850 million people worldwide. The disease is associated with high mortality rates that can reach up to 10-15% per year, multiple complications, among which cardiovascular ones stand out. These complications can contribute to the progression of CKD, and this in turn to the appearance of complications, feeding each other. Despite the availability of clinical guidelines and predictive models, accurately predicting disease progression and identifying risk factors for progression in CKD patients remains a challenge. The limitations of current methodologies, including simplifying complex relationships and relying on linear assumptions, have hindered progress in this area. The advancement of Artificial Intelligence and Machine Learning has provided a new opportunity to address these challenges. The goal of this study was to evaluate the performance of gradient boosting algorithms in predicting the progression of renal disease in a large dataset of 1327 patients with a follow up of 10 years. Method Design: Retrospective analysis of a historical cohort from the Register of Renal Patients of Catalonia (RMRC) and the Data analytics program for health research and innovation (PADRIS) from Health Quality and Assessment Agency of Catalonia (AQuAS). Inclusion Criteria: &amp;gt; 18 y.o. CKD stages from 2 to Renal Replacement Therapy (RRT) and adequate data after pre-processing the sample. N = 1.327 patients with 27.572 records. Follow up of 10 years (January 2010 - December 2020). Variables: Age, gender, BMI, Diagnoses (ICD-10) = 95, Transplant waiting list status; RRT status; Laboratory variables = 77; f) Pharmacological treatment = 100. Method By using Light Gradient-Boosting Machine (LGBM) testing CKD progression prediction horizon in quarterly windows for multiple periods. Methodology: 1. Pre-processing of the sample and data. 2. Training and testing for variables exploration. 3. Dataset structuring in quarterly windows. 4. Samples randomization and data separation for a 5-fold cross-validation (20% test - 80% training). 5. Training and tuning of LGBM model for different prediction horizons. Results Age: 62 ± 13 years; Gender: 34% female, 66% male. Best prediction horizon was for 8 quarters (2 years), with a ROC curve of 0.967 and accuracy of 0.860. The 10 variables with major relevance in the model in order were estimated Glomerular Filtration Rate, Age, Microalbuminuria, BMI, HDL, Glucose, Urea, Platelets, Triglycerides and Sodium. Conclusion 1. The prediction of CKD progression can benefit from the use of Machine Learning with results that outperform methods based on classical statistics. 2. It can allow the individualization of the prognosis and thus be able to carry out early interventions to improve the prognosis.

Objective and subjective barriers to the effective pediatric iron deficiency anemia control: results of questionnaire assessment of pediatricians and parents

Background. Iron deficiency anemia (IDA) remains a pressing pediatric issue to date. Despite the availability of clinical guidelines and other publications that highlight the objective causes for the lack of effectiveness of treatment and prevention of IDA in children, the subjective reasons are unrenowned.Objective. The aim of the study is to evaluate health beliefs of pediatricians and parents on the problem of anemia in children to investigation into the objective and subjective causes for inadequate control of iron deficiency conditions in childhood.Materials and methods. In September 2022, single-step parallel survey of pediatricians and parents on the problem of IDA in children was conducted by random sampling technique using original questionnaires. The questions were formulated on five topics and related to a common understanding of the term “anemia”; priority reference sources; availability of diagnosis of IDA in medical institutions (MI); the position of pediatricians and parents on the treatment and prevention of IDA in children. Based on the results, the main subjective and objective barriers to the control of IDA in children are identified. The χ2 method was used for the comparative evaluation of the responses. The differences were considered significant at statistical significance of p &lt; 0.05.Results. Pediatricians (n = 81) and parents (n = 363) from 23 members of the Russian Federation took the survey. Among the objective barriers to the IDA control in children, the low availability of serum ferritin in MI, difficulties of venous access in children, a shortage of a range of iron preparations for children on Russian market were revealed. The subjective barriers were the skepticism of pediatricians and parents about the necessity for conservative prevention of IDA; poor knowledge of the criteria for diagnosis IDA and completion of IDA therapy by pediatricians; insufficient independence and selectivity of pediatricians when prescribing iron preparations; orientation of the majority of parents (93.7%) to the opinion of doctors, along with the actual rarity of full-fledged conversations with a pediatrician (16.3%).Conclusion. The main limitation of this study was the random sample method inclusion of respondents due to the impossibility of conducting a full-fledged population study. Elimination of the revealed subjective and objective factors can contribute to improving the detection of IDA in children, early appointment and higher effectiveness of treatment, reducing the frequency of disease recurrences, as well as increasing the confidence of parents in pediatricians.

New insights into fever phobia: a pilot qualitative study with caregivers and their healthcare providers

Despite the availability of clinical guidelines on the correct symptomatic management of fever in children, several studies have reported inaccurate knowledge about this symptom and inappropriate management behaviours among caregivers. There is evidence that caregivers’ management of fever is largely influenced by unrealistic and unwarranted concerns about the potential harm that elevated body temperature can cause, a phenomenon commonly referred to as fever phobia. Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the influence of the relationship between caregivers and the healthcare team. The aim of this pilot study was to explore and describe fever-related knowledge, experience and behaviour among a sample of caregivers, paediatricians and their medical assistants in the Canton of Ticino, Switzerland. We used a qualitative study design with semi-structured, one-to-one interviews with paediatricians employed in private healthcare facilities, their medical assistants and caregivers with at least one child between the ages of 0 and 3 years. We conducted individual interviews either in person or by phone, according to participants’ preferences, between October 2020 and February 2021. We performed an inductive–deductive analysis of the transcripts to identify the most meaningful themes from participants’ reports. The analysis of the transcripts yielded three main themes. The first theme refers to participants’ awareness of the emotional component in managing the child’s fever and the challenges this component presents. The second theme refers to the risk of overtreating when the child’s right to be sick is not recognized and respected. The third theme refers to the importance of the relational component, showing how a solid therapeutic alliance with the healthcare team helps caregivers develop self-confidence in managing the child’s fever. This study contributes to advance our understanding of fever phobia and to a better conceptualization and operationalization of this phenomenon.Conclusion: Our results point out to the importance of going beyond a knowledge gap paradigm and recognizing both the emotional and the relational component of fever phobia, the former being entrenched in latter, that is, the unique relationship caregivers establish with their child’s paediatrician and the medical assistant.What is Known:• Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the relational component of this phenomenon.What is New:• Our results point out to the importance of recognizing the emotional component of fever phobia, beyond its declarative and procedural knowledge dimensions. They also suggest that overtreating is not necessarily and not only the result of a phobia but also of a particular conception of health and the relational component of this phenomenon, which is entrenched in the unique relationship caregivers establish with their child’s paediatrician and the medical assistant.

АНАЛИЗ РЕЗУЛЬТАТОВ АНКЕТИРОВАНИЯ СТУДЕНТОВ СТАРШИХ КУРСОВ МЕДИЦИНСКОГО УНИВЕРСИТЕТА ПО ВОПРОСАМ РАЦИОНАЛЬНОЙ АНТИБИОТИКОТЕРАПИИ ИНФЕКЦИЙ ВЕРХНИХ ДЫХАТЕЛЬНЫХ ПУТЕЙ И ЛОР-ОРГАНОВ У ДЕТЕЙ

Despite the availability of clinical guidelines, the issues of choosing the optimal first-line antibiotic therapy in the treatment of infections of the upper respiratory tract and ENT organs in children still remain relevant. Knowledge of the etiology of infections and the rational apply of systemic antibiotics are formed in senior medical students. Therefore, the purpose of this study is to analyze the knowledge of 6th year students of a medical university on the etiology and antibiotic therapy of upper respiratory tract infections and ENT organs in children, as well as comparing the results with knowledge on these issues of pediatricians. The article presents the results of a survey among the 350 volunteer students of the 6th year of the pediatric faculty on the etiology and antibacterial treatment of upper respiratory tract infections and ENT organs in children. These data have been compaired with the results of the large-scale multicenter study «PATRIOT» (2011-2013) among the pediatricians from 18 cities of Russia. It was revealed that most students overestimate the role of Staphylococcus aureus as the main pathogen in acute otitis media and acute tonsillopharyngitis (tonsillitis) in children. The main group of empirical antibiotic therapy were called aminopenicillins, often inhibitor-protected, whereas the role of natural penicillins in streptococcal tonsillopharyngitis and amoxicillin in acute otitis media and acute sinusitis was underestimated. Among district pediatricians, the frequency of correct answers to questions regarding the etiology and antibiotic therapy of these diseases was significantly higher than among students. It was found that only 9.4% of students and 6.1% of doctors would prescribe antibiotics for uncomplicated acute respiratory infection (ARI), but in real clinical practice they were prescribed in 59.6% of cases. These data indicate a different level of knowledge between students and doctors, as well as the difference in approaches to rational antibiotic therapy in theory and in real practice.

The Characteristics of Syncope-Related Emergency Department Visits: Resource Utilization and Admission Rate Patterns in Emergency Departments.

Background and objectiveDecision-making about syncope patients presenting to the emergency department (ED) is challenging since physicians must balance the minimal risks of life-threatening conditions with the unessential use of expensive imaging or unnecessary hospitalizations. This study aimed to determine the characteristics of ED visits, resource utilization, and admission rate patterns related to syncope in the United States (US) during the period 2005-2015.MethodsData from the National Hospital Ambulatory Medical Care Survey (NHAMCS) on ED visits during the 11-year period from 2005 to 2015 were retrieved. ED visits for syncope were identified and compared against non-syncope ED visits. The demographic and clinical characteristics of patients, as well data on resource allocation and admission trends were captured and described for the syncope and the non-syncope groups.ResultsSyncope accounted for 1.11% of the total ED visits during the study period from 2005 to 2015. The incidence of syncope-related ED visits was higher among elderly females, whites, and non-Hispanics. The trend of admission rates showed a decline from about 30% in 2005-2010 to less than 20% in 2014 and 2015. Advanced imaging (CT or MRI) was ordered for 34% of syncope patients.ConclusionThe percentage of syncope-related ED visits remained stable during the study period, but the admission rates declined while the use of advanced imaging in syncope-related ED visits remained substantially high despite the advances in research and availability of clinical guidelines. Future research is needed to rationalize healthcare utilization in syncope-related ED visits and precisely identify the high-risk population.

Awareness, attitude, and practice of evidence-based medicine among primary healthcare physicians in Buraidah, Saudi Arabia.

Evidence-based medicine (EBM) is essential for safe and cost-effective care provision to the population. To assess the awareness, attitude and practices and barriers among primary care physicians about EBM in Buraidah, Qassim. Cross-sectional study in Primary Health Care centers (PHCCs) of Buraidah, Qassim. The study was conducted among physicians working in PHCCs of Buraidah. Data were collected online through Google forms. Descriptive analysis was carried out to measure the frequencies and proportions. Chi-square test was used to compare barriers based on gender, academic degree, and experience categories. A total of 96 out of 144 physicians (66.7%) responded to the invitation. About 82.3% of the participants welcomed the promotion of EBM and 92% of the physicians knew about concept of EBM. About 94.8% of the physicians agreed that EBM will improve patient outcomes. The reported barriers were; patient load (87.5%), time availability (70.8%), computer availability (33.3%), internet availability (45.8%), and 56.3% stated updated clinical letters, journals, or guidelines are not available. This study found that there was high self-reported knowledge about the EBM concept; however, the knowledge about tools was poor. A number of barriers were found such as patient load, time, availability of clinical guidelines and journals and other resources such as internet and computers. Primary care physicians should be trained and facilitated for EBM.

Клинические рекомендации МЗ РФ: готовы ли врачи их выполнять? Результаты интернет-опроса врачей

Introduction. Clinical guidelines are a collection of documents developed by professional communities and containing structured clinical information on etiology, pathogenesis, symptoms, methods of diagnosis, treatment and rehabilitation of patients. Medical spe- cialists of the Russian Federation are informed about the need to comply with the recommendations from January 1, 2022, and have completely different reactions to this fact. The purpose of the article is to analyze the results of an Internet survey of Russian doctors in their attitude to the necessity and possibility of following clinical guidelines. Materials and methods. In total, 2487 Russian doctors took part in the survey, which lasted from July 21, 21 to October 30, 21, who, after identification on the resources listed above, were asked questions with multiple answers: 1. Region of the doctor's work, 2. Medical specialty, 3. Do you think Russian doctors need clinical guidelines? 4. Should clinical guidelines be publicly available? 5. To what extent are you ready to apply the clinical guidelines? 6. Do you consider it permissible to include phytopreparations, dietary supplements in the national clinical guidelines? 7. Do you consider it permissible to mention the trade names of drugs in the clinical guidelines? 8. How often should clinical guidelines be updated? Results. The attitude of Russian doctors to clinical guidelines is heterogeneous - out of 2,487 respondents, 52.96% are ready to apply clinical guidelines in some typical cases, 33.78% are absolutely ready to follow clinical guidelines, 10.74% consider it rather unnecessary, and 3.18% categorically against clinical guidelines. 1237 (49.74%) survey participants believe that clinical guidelines must be in the public domain exclusively for doctors and / or medical professionals. 1250 (50.26%) specialists opposed open access, in particular, due to the inadmissibility of familiarization with the clinical guidelines of patients. Most of the survey participants of 1916 people (77.04%) consider it permissible to include phytopreparations and dietary supplements in clinical guidelines in the form of separate chapters, with a mention and references to clinical studies. Conclusions. The main barriers hindering the implementation of clinical guidelines into clinical practice are the level of equipment of medical facilities, lack of time due to staff shortages, availability of clinical guidelines, lack of awareness and disagreement of doctors with the content of clinical guidelines, and their low motivation. Clinical guidelines should be the "starting point" in decision-making, but unconditional implementation of clinical guidelines cannot be required in the current health care system and the lack of legal protection of doctors. The format for the application of clinical guidelines in the work of doctors requires legal elaboration, strict compliance with the International Classification of Diseases (ICD).

Audit on the monitoring of metabolic side effects of antipsychotics in acute inpatient psychiatric units at Fieldhead Hospital

AimsThe current audit aims to assess the compliance with Prescribing Observatory for Mental Health (POMH-UK) guidance on monitoring of metabolic side effects of patients prescribed antipsychotics. Compliance was monitored to ensure that all patients prescribed continuing antipsychotics have their body mass index (BMI), blood pressure, blood glucose and lipids checked within the expected time limits of minimum once per year.BackgroundPatients diagnosed with Schizophrenia rank amongst the worst of chronic medical illnesses in terms of quality of life. This may in part be due to the use of long term antipsychotic medications, in particular the use of atypical antipsychotics which have been increasingly associated with metabolic side effects including hypertension, weight gain, glucose intolerance and dyslipidaemia. These side effects are related to the development of both diabetes mellitus and cardiovascular disease and can lead to increased mortality and morbidity, affecting compliance and engagement to healthcare services. Despite the availability of clinical guidelines, monitoring and screening of metabolic side effects in patients prescribed antipsychotics continues to be suboptimal.MethodThe audit involved a review of electronic records relating to physical health monitoring of patients at two acute inpatient units from January-March 2019. Demographic and clinical variables were collected which included ethnicity, diagnostic grouping as well as current medications. Data were collected on evidence of screening for hypertension, BMI, blood glucose and lipids. Descriptive statistics were applied to study the clinical features of the sample and examine whether performance met clinical practice standard.ResultThe audit overall demonstrated partial compliance with POMH-UK guidelines with a total of 31 patients admitted on long term antipsychotics. Of these patients, 86% were prescribed atypical antipsychotics with 14% prescribed typical antipsychotics. Screening only occurred in 68% of patients for lipid profile with only 71% for BMI and 74% for blood glucose. Blood pressure had the highest compliance rate of 87% of patients being screened.ConclusionEarly identification and monitoring of complications from metabolic syndrome may decrease the risk of more serious health outcomes and improve patients’ quality of life. However in clinical practice, standards are not always met in accordance with best practice recommendations. Requirement of a tailored guideline for physical health monitoring with weekly planned interventions as well as adequate training and awareness of healthcare staff is imperative to drive improvement and increase adherence rates.

ВАКЦИНАЦИЯ ДЕТЕЙ СО ЗЛОКАЧЕСТВЕННЫМИ ЗАБОЛЕВАНИЯМИ: АКТУАЛЬНОСТЬ ПРОБЛЕМЫ

Currently, the number of cases of malignant diseases in children is increasing, but the number of children who have recovered is also increasing. In the past few years, the number of deaths has decreased thanks to the latest technologies for treating cancer patients, but there are still a number of problems in the lives of small patients after treatment. One of the important problems is the lack of continuation of the mandatory vaccination of children who have undergone a malignant disease, according to age and in accordance with the national calendar, despite the availability of clinical guidelines in domestic and foreign publications on preventive vaccination of this cohort. Many physicians make unjustified medical exclusions from vaccination based only on their own biases, which can be justified by the limited number of publications on this topic. In turn, vaccination can reduce the number of deaths from infectious complications and provide hope for further full life. Children with malignant diseases should be vaccinated against infectious diseases that can be prevented with vaccines after completion and sometimes during treatment. For such patients, there should be a vaccination schedule that takes into account the available therapy that may lead to the suppression of immunity. This article is devoted to the vaccination of children with malignant diseases.

Survey study of barriers to evidence-based decision-making in oncology care using next-generation sequencing.

e18757 Background: Next-generation sequencing (NGS) has the potential to accelerate precision medicine in oncology by informing efficient and improved clinical treatment decision-making. However, discussions on the utility of NGS in clinical practice are ongoing. This survey study examined clinical utility barriers to adoption of NGS into oncologic care. Methods: A cross-sectional online survey was sent to a nationally representative sample of oncologists/hematologists, surgeons, and pathologists (N=201). The survey gathered information on physician demographics, practice characteristics, perceived barriers to NGS testing, and potential strategies for increasing adoption. Results: Almost all physicians in the sample (99.5%) reported using NGS. Physicians reported the following aspects of NGS as the most valuable: ability to guide decision-making (73.1%), more accurate identification of corresponding treatment (56.7%), comprehensive genomic coverage (54.2%), efficient technology with faster turnaround time (49.8%), and more accurate diagnosis or prognosis (41.3%). Physicians reported that NGS results guided treatment decisions for 63% of patients (Range: 2% - 100%). Over 85% of physicians reported that confidence in interpreting results and availability of clinical guidelines were important in undertaking NGS. Correspondingly, limited evidence of clinical utility was a top barrier to testing (80.1%), with pathologists and surgeons more likely than oncologists/hematologists to consider this. Overall, 76% of physicians shared that strategies to alleviate these clinical utility barriers included increased evidence, standardized guidelines, and interpretation support. Conclusions: Given the high uptake of NGS testing in this physician sample, but the lower rates of application of test results to guide treatment, the clinical impact of NGS may not be fully optimized. This discrepancy highlights the ongoing need for real-world evidence to better understand and further optimize the evolving role of NGS in the context of the overall management of the cancer patient. [Table: see text]

Etiopathogenesis, diagnosis, and approaches to the treatment of arterial hypertension: an assessment of the physicians’ basic knowledge. Final results of the PHYSTARH project

Introduction. Arterial hypertension (AH) is a syndrome accompanied by an increase in systolic blood pressure (BP)140 mmHg and/or diastolic BP90 mmHg. It is a progressive pathology that affects the adult employable population and leads to the development of deadly complications.&#x0D; Aim. To compare the level of physicians knowledge in AHs definition, diagnosis and treatment in different centers of Russia.&#x0D; Materials and methods. In the framework of the multicenter study PHYSTARH (the full name of the project Physicians and undergraduates knowledge in arterial hypertension treatment), which was launched in 2017, an anonymous survey was conducted among 425 doctors from 9 cities/regions of Russia (Belgorod Region, Moscow, Krasnodar Territory, the Republic of Adygea, Voronezh, Primorye Territory, Tatarstan, Lipetsk, Chelyabinsk).&#x0D; Results. The study revealed an insufficient level of doctors knowledge in diagnosis and treatment of AH. Less than half of the respondents correctly answered the following questions: determining hypertension by the level of home monitoring of BP (36% of physicians), determining the degree of hypertension for the proposed numerical values (37% of physicians), definition and prevalence of the refractory hypertension (33% of physicians), definition of the masked hypertension (45% of physicians), the need for drug correction of high normal BP (9% of physicians), selection of the main classes of antihypertensive drugs without clinical situations (26% of physicians).&#x0D; Conclusion. The physicians knowledge on AH is unsatisfactory, despite the prevalence of pathology and the availability of clinical guidelines, which, in our view, justifies the need for additional public education programs for doctors in different regions.

National Clinical Guidelines on Diagnosis and Treatment of Ph-Negative Myeloproliferative Neoplasms (Polycythemia Vera, Essential Thrombocythemia, and Primary Myelofibrosis) (Edition 2020)

The development of National clinical guidelines on diagnosis and treatment of Ph-negative myeloproliferative neoplasms comes in response to the need to standardize the approach to diagnosis and treatment. The availability of clinical guidelines can facilitate the choice of adequate treatment strategy, provides practicing physicians with exhaustive and up-to-date information on advantages and shortcomings of different treatment methods as well as lets health professionals better assess expected extents of treatment required by patients. In 2013 a working group was formed to develop and formulate clinical guidelines on the treatment of myeloproliferative neoplasms. These guidelines were first published in 2014, afterwards they were revised and republished. The dynamic development of current hematology presupposes constant updating of knowledge and implementation of new diagnosis and treatment methods in clinical practice. In this context clinical guidelines present a dynamic document to be continuously amended, expanded, and updated in accordance with scientific findings and new requirements of specialists who deal directly with this category of patients. The present edition is an upgraded version of clinical guidelines with updated information on the unification of constitutional symptoms assessment using MPN-SAF TSS questionnaire (MPN10), on applying prognostic scales in primary myelofibrosis, assessing therapy efficacy in myeloproliferative neoplasms, revising indications for prescription, on dose correction, and discontinuation of targeted drugs (ruxolitinib). The guidelines are intended for oncologists, hematologists, healthcare executives, and medical students.

Physicians\u2019 prescribing behaviour and clinical practice patterns for allergic rhinitis management in Italy

BackgroundDespite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR.MethodsOne-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients’ clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.ResultsAllergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p < 0.001), while GPs’ caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67.5%) suffered from moderate/severe AR (discomfort score: 7.7 ± 1.3) and 917 (32.4%) from mild AR (5.7 ± 1.9). About one-third of mild patients had a discomfort score ≥ 7. Main prescription drivers were “effective on all symptoms” (54.3% patients) and “quick symptom relief” (47.8%), whereas minor drivers were “affordable price” (13.4%) and “refundable” (8.7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59.6%). HCPs’ believe that the majority of the patients was adherent to treatment (88% with score > 7).ConclusionsThis survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients’ adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.

Adherence to Current Lipid Guidelines by Physicians in Kuwait

Background: Alarmingly high rates of dyslipidemia have been found in the Gulf region in patients presenting with acute coronary syndrome, with the highest being found in Kuwait (37%). Therefore, it is of utmost importance to treat dyslipidemia promptly and effectively. In an effort to understand the practices of local physicians, the use of evidence-based medicine, and adherence to lipid treatment guidelines, the objective of this study was to survey and assess the current standards of care. Methods: A survey questionnaire, designed to assess physicians’ attitudes and practice towards lipid guidelines, was completed by 279 participants and returned between October 2015 and June 2016. Statistical analysis was done using SPSS. Results: Over 90% of physicians claimed to use lipid guidelines, with the majority rating themselves as knowledgeable. Younger physicians were found to be less knowledgeable and consequently used guidelines less frequently. The most important factor influencing clinical decision-making was the availability of clinical guidelines. The majority (72.4%) of physicians identified time limitation as a key barrier. The most commonly selected lipid guideline in daily practice was a guideline on the treatment of blood cholesterol published by the American College of Cardiology/American Heart Association in 2013. The most common risk assessment tool used was the Framingham risk score. Conclusions: Multiple interventions to improve guideline adherence are proposed in this study. We have taken into account the barriers to adherence, i.e., attitude, behavior, and (most importantly) knowledge, all 3 of which were reaffirmed in our investigation in Kuwait.

Recommended care received by geriatric hip fracture patients: where are we now and where are we heading?

Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance-performance analysis for prioritizing interventions to improve the in-hospital management of these patients. A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracture patients in 34 hospitals in Belgium, Italy, and Portugal. First, we assessed the level of expert consensus on the process indicators composing international guidelines on hip fracture treatment. Second, guideline adherence on in-hospital care was evaluated within and across hospitals. Third, an importance-performance analysis was conducted, linking expert consensus to guideline adherence. Level of expert consensus was high (above 75%) for 12 of 22 process indicators identified from the literature. There is large between and within hospital variation in guideline adherence for these indicators and for none of the 540 patients were all 22 process indicators adhered to. Importance-performance analysis demonstrated that three indicators that had a high level of expert consensus also had a high level of adherence (above 80%). Nine indicators, most of which have been previously linked to patient outcomes, had a high level of expert consensus but a consistently low level of adherence across hospitals and are identified as priority areas for improvement. Guideline adherence for the treatment of geriatric hip fracture patients is remarkably suboptimal. Importance-performance analysis is a useful strategic approach to assist practitioners and healthcare managers to improve the quality of care.