Physician Adherence Research Articles

Hypertension in the Middle East: current state, human factors, and barriers to control.

Hypertension is the leading source of morbidity and death. In the 21st century, there still is a major gap between high and low to middle-income countries in awareness, management, and control; countries in the Middle East represent an example of such disparities. In this review of the literature, light is shed on the prevalence and modifiable risk factors of hypertension specific to the region, as well as regional disparities in diagnosis and management. The crude prevalence rate is estimated to be around 29.5% with wide variability between countries. Various modifiable factors affect the prevalence of hypertension in this region such as excessively high rates of smoking, obesity, a sedentary lifestyle, some gender gap, and a suboptimal healthcare system; socio-economic factors and disparities in education, literacy, and urbanization play a significant role. Patient adherence to treatment is a determining factor of blood pressure control and nonadherence adversely affect outcomes. In addition, physician adherence to international guidelines is poor. Recognizing these barriers to hypertension management, this review serves as a call for increased national and regional efforts to implement favorable healthcare policies and improve clinical outcomes.

A survey study of knowledge, attitude, and practice regarding oncofertility among health professionals in Uruguay.

e24041 Background: Oncofertility is a field dedicated to preserve fertility of children, adolescents, and young cancer patients'. For young cancer patients, fertility preservation (FP) has become an important concern that needs to be addressed before cancer treatment. This study aimed to evaluate the general knowledge, attitudes, and practice towards FP and pregnancy-related issues of health care professionals in Uruguay. Methods: We conducted an online survey distributed to physicians from multidisciplinary areas (Oncology, Radiotherapy, Hematology, Pediatric hematology-oncology, Gynecology, Urology) involved in daily medical care to young cancer patients. Results: 208 physicians from 16 geographical regions completed the survey. 53 % of the subjects were less than 40 years old, and 77.7% identified themselves as women. Most of the responders (99 %) agreed that FP counseling should be part of cancer treatment; however, only 49 % discusses FP and refers their patients in their daily clinical practice. Regarding referral of patients to an Oncofertility specialist, 36% do it occasionally, and 15% have never referred. Half of the responders (50%) stated that they know the available FP options for young cancer patients, 49% have an idea, and 1% are not aware. 37 % of participants consider that FP treatments would delay cancer treatment initiation, impacting their attitude towards FP recommendation and referral. Regarding FP coverage, 51.7 % were not aware of financial coverage for fertility preservation treatments availableness. 57% of physicians directly involved in breast cancer (BC) care agreed with the statement that oocyte cryopreservation is safe in BC patients with positive hormonal receptors, 35% are not sure, and 8% believe it is not safe, 46% believe pregnancy is safe after BC, 34% is not sure, while 20% consider it is unsafe. Conclusions: This study demonstrates the need to increase FP awareness in Uruguayan health care professionals. Moreover, several misconceptions on FP and pregnancy-related issues in BC patients have been identified. Focused research and education to improve physicians' knowledge and adherence to available international guidelines are urgently required to improve the care of young cancer patients who desire future fertility. Key Words: Oncofertility, fertility preservation, oocyte cryopreservation, breast cancer, pregnancy.

Personalised, Rational, Efficacy-Driven Cancer Drug Dosing via an Artificial Intelligence SystEm (PRECISE): A Protocol for the PRECISE CURATE.AI Pilot Clinical Trial.

Introduction: Oncologists have traditionally administered the maximum tolerated doses of drugs in chemotherapy. However, these toxicity-guided doses may lead to suboptimal efficacy. CURATE.AI is an indication-agnostic, mechanism-independent and efficacy-driven personalised dosing platform that may offer a more optimal solution. While CURATE.AI has already been applied in a variety of clinical settings, there are no prior randomised controlled trials (RCTs) on CURATE.AI-guided chemotherapy dosing for solid tumours. Therefore, we aim to assess the technical and logistical feasibility of a future RCT for CURATE.AI-guided solid tumour chemotherapy dosing. We will also collect exploratory data on efficacy and toxicity, which will inform RCT power calculations.Methods and analysis: This is an open-label, single-arm, two-centre, prospective pilot clinical trial, recruiting adults with metastatic solid tumours and raised baseline tumour marker levels who are planned for palliative-intent, capecitabine-based chemotherapy. As CURATE.AI is a small data platform, it will guide drug dosing for each participant based only on their own tumour marker levels and drug doses as input data. The primary outcome is the proportion of participants in whom CURATE.AI is successfully applied to provide efficacy-driven personalised dosing, as judged based on predefined considerations. Secondary outcomes include the timeliness of dose recommendations, participant and physician adherence to CURATE.AI-recommended doses, and the proportion of clinically significant dose changes. We aim to initially enrol 10 participants from two hospitals in Singapore, perform an interim analysis, and consider either cohort expansion or an RCT. Recruitment began in August 2020. This pilot clinical trial will provide key data for a future RCT of CURATE.AI-guided personalised dosing for precision oncology.Ethics and dissemination: The National Healthcare Group (NHG) Domain Specific Review Board has granted ethical approval for this study (DSRB 2020/00334). We will distribute our findings at scientific conferences and publish them in peer-reviewed journals.Trial registration number: NCT04522284

Assessing the appropriateness of antimicrobial therapy in patients with sepsis at a Vietnamese national hospital

ObjectivesTo assess the appropriateness of empirical antimicrobial therapy for sepsis and septic shock and determine factors associated with patient treatment outcomes at a Vietnamese national hospital.MethodsA cross-sectional study was conducted on 134 patients diagnosed with sepsis and/or septic shock at Thong-Nhat Hospital, Ho Chi Minh City, Vietnam, from January 2018 to June 2018. Appropriateness of antimicrobial therapy was defined as physician adherence to antimicrobial guidelines using the Sanford Guide to Antimicrobial Therapy and the Vietnam national guidelines. Bayesian model averaging technique was used to identify the related factors associated with patient treatment outcomes.ResultsThe median age of patients was 70 years. Organisms were identified in 54.5% of cases and predominated by Escherichia coli and staphylococci. Appropriate empirical antimicrobial agents were initiated in 56.6% (n = 73) of all cases. Of these patients, 31 cases (42.5%) and 61 cases (83.6%) received the antimicrobials in accordance with recommendations related to dosage and route of administration, respectively, bringing the overall rate of appropriate empirical antimicrobial therapy down to 23.3%. Patients who progressed to septic shock, received inappropriate antimicrobial therapy and required ICU admission were more likely to suffer treatment failure.ConclusionsThe study findings suggest that clinicians should appropriately adhere to antimicrobial guidelines, especially in patients with septic shock and those who require ICU care, to improve treatment outcomes.

BPI21-007: Physician Adherence to Treatment Guidelines Based on Priority Groups for Breast Cancer Patients During the COVID-19 Pandemic

"BPI21-007: Physician Adherence to Treatment Guidelines Based on Priority Groups for Breast Cancer Patients During the COVID-19 Pandemic" published on 17 Mar 2021 by National Comprehensive Cancer Network.

Multivariable Analysis of Primary Care Physician Adherence to Guideline-recommended Pharmacotherapy of Stable Coronary Artery Disease

Aim. To study predictors of primary care physician adherence to guideline-recommended pharmacotherapy of stable coronary artery disease.Material and methods. This pharmacoepidemiologic cross-sectional study was conducted in primary care setting of Moscow. 805 patients (mean age 68.9±9.9 years, males 51.4%) with established stable coronary artery disease (SCAD) were included. Demography, medical history, prescribed pharmacological treatment data were obtained. Physician adherence to guideline-recommended pharmacotherapy (GRP) of SCAD was evaluated based on the Class I guideline recommendations. Pharmacotherapeutic guideline adherence index (PGAI) was introduced as composite quality indicator, calculated in line with “all-or-none” rule and in regard with documented contraindications. To search for predictors of adherence the patient population was divided in two groups by level of physician adherence measured by PGAI. Statistical analysis was performed by IBM SPSS Statistics 16.0, the level of statistical significance was set at p<0.05.Results. The prescription rates of essential drug therapies of SCAD (regarding contraindications) were quite adequate: beta-blockers/calcium channel blockers – 90,1%, acetylsalicylic acid/clopidogrel/oral anticoagulants – 95,7%, statins/ezetimibe – 86,3%, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers – 87,6%. 82,9% (n=667) of patients were prescribed treatment for SCAD in compliance with the guidelines. Suboptimal pharmacotherapy was identified in 17,1% (n=138) of patients. These groups were similar in sex distribution (males 50,4 vs. 56,5%; p=0,188). Mean age tended to be lower in GRP adherent group (68,5±9,9 vs. 70,6±10,0 years; p=0,052). Bivariable analysis showed that good adherence to guideline-recommended pharmacotherapy was associated with higher prevalence of stable angina (66,4 vs. 53,6%; p=0,004), arterial hypertension (93,3 vs. 79,7%; p<0,001) and dyslipidemia (21,4 vs. 9,4%; p<0,001) and with lower prevalence of myocardial infarction (48,1 vs. 67,4%; p<0,001). Logistic multivariable regression model (gender, age, 6 medical history variables) identified 6 patient-related factors that were significantly associated with physician adherence to guideline-recommended pharmacotherapy: age (odds ratio [OR] 0,97; 95% confidence interval [CI] 0,95-0,99; p=0,009), arterial hypertension (OR 3,89; 95%CI 2,19-6,90; p<0,001), dyslipidemia (OR 2,31; 95%CI 1,23-4,34; p=0,009), chronic heart failure (OR 1,95; 95%CI 1,06-3,61; p=0,032), revascularization (OR 2,14; 95%CI 1,33-3,45; p=0,002), myocardial infarction (OR 0,28; 95%CI 0,16-0,48; p<0,001).Conclusion. Primary care cardiologist adherence to guideline-recommended pharmacotherapy of SCAD was satisfactory evaluated as 82,9% by composite indicator PGAI. Arterial hypertension, heart failure, dyslipidemia и revascularization were predictors of better physician adherence. History of myocardial infarction and older age were risk factors of non-adherence. Identification of patient-related factors associated with underperformance may facilitate tailoring quality improvement interventions in primary care of coronary patients.

Implementing Continuous Quality Improvement in an Integrated Community Urology Practice: Lessons Learned

To determine the effectiveness of 2 different continuous quality improvement interventions in an integrated community urology practice. We specifically assessed the impact of audited physician feedback on improving physicians' adoption of active surveillance for low-risk prostate cancer (CaP) and adherence to a prostate biopsy time-out intervention. The electronic medical records of Genesis Healthcare Partners were analyzed between August 24, 2011 and September 30, 2020 to evaluate the performance of 2 quality interventions: audited physician feedback to improve active surveillance adoption in low-risk CaP patients, and audited physician feedback to promote adherence to an electronic medical records embedded prostate biopsy time-out template. Physician and Genesis Healthcare Partners group adherence to each quality initiative was compared before and after each intervention type using ANOVA testing. For active surveillance, we consistently saw an increase in active surveillance adoption for low risk CaP patients in association with continuous audited feedback (P < .001). Adherence to the prostate biopsy time-out template improved when audited feedback was provided (P < .001). The implementation of clinical guidelines into routine clinical practice remains challenging and poses an obstacle to the improvement of United States healthcare quality. Continuous quality improvement should be a dynamic process, and in our experience, audited feedback coupled with education is most effective.

Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018.

Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer, recommending a shift to less aggressive diagnostic, surgical, and postoperative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL), or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease both before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of TLs were performed in the outpatient setting versus 70% of TTs. Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared with TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.

Clinical audit on diagnosis of ascites in infants and children in Assiut University Children Hospital

BackgroundAscites is pathologic fluid accumulation within the peritoneal cavity. The peritoneum generates a fluid that acts as a lubricant. It allows the abdominal organs to glide smoothly over one another. Ascites is that excess of this fluid that can build up between visceral and parietal layers.ObjectiveA clinical audit was done to assess the degree of adherence of medical physicians at Assiut University Children Hospital to protocols for diagnosis of ascites according to Tomar 2016 guidelines.Patients and methodsThe study included 60 infants and children admitted to Assiut University Children Hospital with ascites.ResultsThe study included 60 infants and children admitted to Assiut University Children Hospital with ascites during a period of 1 year. Overall, 33 cases were males and 27 cases were females. All studied cases presented with ascites at the time of diagnosis.ConclusionRegarding this initial audit about diagnosis of ascites in infants and children in Assiut University Children Hospital, there is no complete adherence to Tomar 2016 guidelines.

Clinical Protocol of the Brazilian Ministry of Health on Parkinson's Disease: adherence and perception of the prescribing physician

This study evaluated the adherence of physicians to the Clinical Protocol and Therapeutic Guidelines on Parkinson's Disease (CPTG-PD) within the scope of the Unified Health System (SUS). A descriptive analysis of 375 drug application documents sent to the Pharmaceutical Services of the Rio Grande do Sul State Public Health Department (AF/SES/RS) between March and September 2016, and a structured survey to evaluate the physician's perception about the protocol and barriers to its use was conducted. Only 5.33% of the requests analyzed presented all the necessary data, considering the criteria of the protocol. The requests from specialists had a higher percentage of adherence to the diagnostic and dose criteria (p<0.05). The main barriers to protocol use were the lack of awareness or familiarity with the protocol (48%) and the lack of time to complete the mandatory documents (52%). More recently qualified physicians tended to perceive fewer barriers to protocol use (p<0.05). The results indicate that actions are still necessary to implement the PCDT-DP in medical practice, focusing on care and management teams. Greater integration between pharmaceutical assistance and the healthcare network is needed.

Adherence to Clinical Quidelines on Preoperative Assessment and Correction of Cardiovascular Risk in Non-cardiac Surgery

Surgical care is associated with a high risk of complications. In 2014 the updated joint ESC/ESA guidelines on preoperative assessment and perioperative management of patients were published to improve patient safety in non-cardiac surgery. The increase in the adherence to clinical guidelines promotes the improving of the healthcare quality and safety improvement.Aim. To study physicians' level of adherence to ESC/ESA clinical guidelines for preoperative assessment and perioperative management of patients.Material and methods. A retrospective observational study included 102 patients admitted to Moscow general hospital from 01.03.2019 to 30.06.2018 for elective surgery. All of them underwent preoperative examination in outpatient department of the hospital and had at least one concomitant disease requiring drug therapy. The medical records data on the preoperative examination and perioperative treatment with beta-blockers, HMG CoA reductase inhibitors and angiotensin-converting-enzyme (ACE) inhibitors/ angiotensin receptor blockers (ARBs) were analyzed for compliance with the ESC/ESA guidelines.Results. A standardized cardiac risks assessment was not documented in the results of preoperative examination. Electrocardiography (ECG), echocardiography and non-invasive stress tests were performed according to clinical guidelines in 100%, 77.8% and 25% of cases, respectively. Unnecessary ECG and echocardiography were prescribed in 50.5% and 72% of cases, respectively. Appropriate correction of ACE inhibitors/ARBs therapy was performed in 66.7% patients with congestive heart failure and only in 2.7% with arterial hypertension. In 19 patients with ischemic cardiac disease, 13 (84.2%) patients received HMG CoA reductase inhibitors and 16 (68.4%) ones received beta-blockers during hospitalization. Inappropriate omission of statins, beta-blockers and ACE inhibitors (ARBs) during hospitalization was registered in 22.2%, 11% and 4.9% patients, respectively.Conclusion. The number of inappropriate ECGs and echocardiographies, as well as incorrect treatment with beta-blockers, HMG CoA reductase inhibitors and ACE inhibitors (ARBs) in perioperative period evidence that the adherence of physicians to the clinical guidelines on preoperative assessment and perioperative management of patients remains low.It is reasonably to develop risk-based interdisciplinary protocols for preoperative examination, algorithms for interdisciplinary communication and interaction between specialists and the healthcare levels, as well as physicians' education for better adherence to clinical guidelines.

Adherence of primary care physicians to recommended guidelines for blood pressure measurement

Purpose: Accurate blood pressure measurement (BPM) is the main point for the proper diagnosis and management of hypertension. In this paper, we aim to assess the approaches taken by family physicians (FPs) about BPM and blood pressure measurement devices’ (BPMDs) standards. Materials and Methods: A survey was prepared in accordance with the current hypertension guidelines to assess the knowledge and awareness of FPs about BPM methods and BPMDs’ standards. Questionnaires were filled out face-to-face with family physicians. Results: In total, 300 of 412 local FPs were included in this study. Office BPMs were preferred by 41.7% of physicians, whereas 42.7% expressed their preference for HBPMs for hypertension diagnosis and treatment. Aneroid devices were chosen by 61.3% of FPs who believed that their knowledge and skills about BPM were excellent. The rate of FPs who preferred devices not compatible with one of the recommended devices in the guidelines was 79.7%. A total of 53% of FPs recommended upper arm automatic BPMDs to their patients and only 25% of FPs recommended BPMDs proved by clinical studies. Conclusion: We concluded that the awareness, knowledge, and routine daily practice of FPs in Mersin regarding BPM and BPMDs are poor and need to be improved. The results of this study may help us to question the approaches of FPs to hypertensive patients and may improve HT management.

PATIENT AND PHYSICIAN ASSOCIATED FACTORS OF ADHERENCE TO EVIDENCE-BASED GUIDELINES IN DIABETES MELLITUS TYPE 2

Introduction: Diabetes mellitus type 2 (T2DM) is a chronic disease that needs a high standard of health care. Clinical practice guidelines are diabetes care that ensures regular monitoring of diabetic patients, including annual diagnostic tests.&#x0D; Objective: This study aims to review the Patient and physician-associated factors of adherence to evidence-based guidelines in Diabetes mellitus type 2&#x0D; Methods: studies in this review article were obtained by online research through scientific websites, including the PubMed database and Google scholar. The search process included using several keywords; the keywords used were "physicians, patients, adherence, factors, diabetes, guidelines." We have reviewed the studies that were published between 2015 and 2020. We excluded all the articles before 2015.&#x0D; Conclusion: adherence of physicians with evidence-based guidelines of DM2 was associated with lack of knowledge, patients' compliance, advanced co-morbidities, and geriatric patients. While the patients' adherence was related to patient education, knowledge, ability and behavior, patient preferences, and the relationship between the physician and the diabetic patient.&#x0D; Keywords: diabetes mellitus, physicians, patients, adherence, factors, Diabetes, guidelines.

Vaccination during the First Diagnosis of Multiple Myeloma: A Cohort Study of the French National Health Insurance Database.

Purpose: Infections are frequent and often result in serious complications in patients with multiple myeloma (MM). Prophylactic vaccination is recommended for influenza virus, Streptococcus pneumoniae (SP), and Hemophilus influenzae b (Hib). The aims of this study were to measure the vaccination rates within 24 months after the diagnosis of multiple myeloma and to identify factors associated with vaccine use. Methods: MM patients were selected through the French national health insurance database from 1 January 2010 to 31 December 2015. Patients with a previous history of MM were excluded. Results: Vaccination rates against influenza, SP, and Hib among 22,831 newly diagnosed MM patients were, respectively, 28.5%, 10.3%, and 1.4%. Only 0.7% received all three vaccines. Factors associated with vaccination were young age, male gender, an absence of comorbidity, a history of higher medication and vaccine consumption, Herpes simplex virus (HSV), Varicella zoster virus (VZV), and the use of pneumocystis prophylaxis. Conclusion: The low rates of vaccination indicate the need to improve physician and MM patient adherence and education regarding vaccination.

Evaluation of Knowledge and Adherence of Primary Healthcare Physicians Regarding Hypertension Prevention Guidelines in the Jazan Region, Saudi Arabia.

Introduction:Adherence to hypertension prevention guidelines can aid in better control of blood pressure.Aim:This study aims to evaluate knowledge and adherence of Primary Healthcare Centers (PHCs) physicians in the Jazan region, Saudi Arabia about guidelines pertaining to prevention of hypertension.Methods:This cross-sectional study targeted PHCs physicians in the Jazan region. A questionnaire was developed based on preventive components of the Saudi Hypertension Management Guidelines (SHMGs) and was completed via interviews to measure demographics, knowledge of PHCs’ physicians about prevention of hypertension, and their adherence to guidelines concerning screening for hypertension and provision of lifestyle counselling.Results:A total of 234 PHC physicians participated in this investigation. The median age of the physicians was 38 and percentages of male and female physicians were similar. The findings suggest a low level of knowledge and practice adherence concerning prevention of hypertension among PHCs physicians in Jazan region where only 24 physicians (10%) knew the recommended amount of daily sodium intake to reduce blood pressure among pre-hypertensive patients. Similarly, only 30 physicians (13%) reported adherence to the SHMGs concerning annual screening for the disease. None of the associations concerning influence of physicians demographics on level of knowledge or practice adherence were statistically significant (P value >0.05).Conclusion:The majority of the recruited physicians were misinformed about several components related to screening for hypertension and dietary needs for lowering blood pressure levels. The low knowledge may explain the low adherence to recommended SHMGs for prevention of the disease.

Adoption of the ADA/EASD guidelines in 10 Eastern and Southern European countries: Physician survey and good clinical practice recommendations from an international expert panel

AimsEvidence from cardiovascular outcomes trials (CVOTs) of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors was reflected in the most recent guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). The aim of the present study was to assess the adoption of the ADA/EASD guidelines in a convenience sample of physicians from Eastern and Southern Europe, the barriers to the implementation of these guidelines and the measures needed to facilitate their implementation. MethodsAttendees at two international diabetes conferences could volunteer to respond to a fully anonymous survey. Responses were analysed descriptively and a panel of experts from around the region was consulted to interpret the survey results. ResultsResponses (n = 96) from 10 countries were analysed. Most participants (63.4%) considered the ADA/EASD guidelines fundamental to their practice. All respondents saw the value of the CVOT-based ADA/EASD recommendations and 77–80% generally implemented them. Measures suggested to improve adherence to the ADA/EASD guidelines included aligning reimbursement policy with the guidelines (54.4%), publishing guidelines in a simple and concise form (42.4%) and translating guidelines into local languages (33.3%). ConclusionsAligning reimbursement with recent evidence and providing short summaries of the ADA/EASD guidelines in local languages could facilitate physician adherence.

Using Persuasion science to improve COVID-19 contact tracing

Using Persuasion science to improve COVID-19 contact tracing

Snakebite Envenomation in Rwanda: Patient Demographics, Medical Care, and Antivenom Availability in the Formal Healthcare Sector.

Snakebite envenomation (SBE) is a neglected One Health issue that overwhelmingly affects people living in rural and impoverished regions of Africa and Asia. Information on SBE is scarce in Rwanda; thus, our objectives were to 1) describe the demographics of SBE patients seeking hospital care, 2) evaluate physician adherence to national treatment guidelines, and 3) assess availability of snake antivenom at hospitals in Rwanda. To achieve these goals, we obtained national data on animal bites/stings and visited every district and provincial hospital in Rwanda to obtain physical records of SBE patients treated in 2017 and 2018. Hospital pharmacies were assessed for antivenom availability. We identified snakes as the second leading cause of animal bites, after dogs, among patients who sought hospital care in 2017 and 2018. Of 363 SBE patients, the highest number of cases occurred among children (< 18 years; 32%) and young adults (18-30 years; 33%), females (61%), farmers (82%), and those living in Eastern Province (37%). Overall, physician adherence to treatment guidelines was 63%. Prescriptions of vitamin K and antivenom were low (4% and 13%, respectively), and only 8% of hospital pharmacies had antivenom in stock throughout the study period. The antivenom stocked was an Indian generic suited for Asian snakes. This minimum estimate of hospitalization cases does not include individuals who died in communities or sought care outside the formal sector. Our study highlights the need to map incidence, risk factors, and patient experiences to mitigate human-snake conflicts and improve patient outcomes.

Revisiting the safety of topical calcineurin inhibitors in patients with atopic dermatitis

Topical calcineurin inhibitors (TCI) have emerged from the shadow of topical corticosteroids as another first-line remedies for treating acute flares of atopic dermatitis (AD). The effectiveness of TCI in maintenance therapy is also undeniable. The wider use of TCI increases the relevance of the issue of their safety. The adherence of physicians and their patients to the treatment with TCI is constrained by a controversial FDA black box warning against these drugs based on the theoretical risk of skin tumors, especially lymphoma. This warning, formulated in 2005, has been repeatedly refuted. However, there have been studies that at least partially supported cautious use of TCI. In recent years, the results of large cohort prospective studies clarifying the issue of oncological safety of TCI have been published. The review highlights the results of various studies with optimistic, pessimistic and balanced conclusions regarding the safety of TCI, primarily their effect on tumorigenesis, in order to better inform physicians about the benefit/risk balance when using these drugs in AD patients. The data presented in this review indicate that there is no increased risk of melanoma and other forms of skin cancer in TCI users, but these data do not completely rule out the risk of skin lymphoma. However, the very low level of potential risk to an individual patient gives physicians the right to neglect this risk when choosing TCI as a treatment option for AD.

Adherence to the National Guidelines for Follow-Up Protocol in Subjects with Type 2 Diabetes Mellitus in Greece: The GLANCE Study.

Introduction Physician adherence, or lack therefore, to diabetes care and follow-up guidelines may be linked to the rates of achieving suboptimal glycaemic, blood pressure and lipid targets in people with type 2 diabetes mellitus (T2DM). In this cross-sectional study we evaluated physician adherence to the patient follow-up protocol (PFP) of the 2017 Hellenic Diabetes Association (HDA) guidelines and also assessed glycated haemoglobin (HbA1c), blood pressure and lipid control achievement rates in the routine care setting in Greece.MethodsEligible subjects were adults with T2DM receiving oral hypoglycaemic agents (OHAs) for ≥ 1 year who had ≥ 2 HbA1c measurements in the previous year and an HbA1c target < 7%. Overall adherence at the subject level was defined as the percentage of the 62 HDA PFP items that had been met during the past year.ResultsBetween June and December 2018, 601 eligible subjects (54.6% men; mean age 65.2 years; median T2DM duration 5.9 years, of whom 96.5% had ≥ 1 medical condition/comorbidity), were enrolled into the study by 53 hospital- and office-based endocrinologists, internists and general practitioners. The main OHAs prescribed at enrolment were metformin (91.0%), dipeptidyl peptidase-4 inhibitors (60.7%), sodium-glucose co-transporter-2 inhibitors (23.5%) and sulphonylureas (16.3%). Mean overall physician adherence to the PFP was 43.6%. Predictors of greater higher physicans’ adherence were female sex (p = 0.026), > 3 medical conditions/comorbidities (p = 0.043) and diabetic complications (p < 0.001). HbA1c, low-density lipoprotein-cholesterol, systolic/diastolic blood pressure and composite metabolic targets were achieved by 82.1, 57.0, 42.6 and 21.6% of subjects, respectively.ConclusionsIn Greek routine care, physician adherence to the PFP of the 2017 HDA guidelines is suboptimal. Future efforts should focus on identifying the barriers to an adequate adherence by physicians to the full PFP, with the aim to provide optimal patient care.Electronic supplementary materialThe online version of this article (10.1007/s13300-020-00935-6) contains supplementary material, which is available to authorized users.