Reasons For Poor Compliance Research Articles

Monitoring and compliance mechanisms as a diagnostic and prognostic tool of international anti-corruption cooperation: A data-driven study

Abstract This article focuses on text-as-data analysis to identify and compare the main patterns in the implementation of international anti-corruption rules, as well as compliance with them. It is based on the observation that a comprehensive study of the operation and outcomes of international anti-corruption treaties’ monitoring and compliance mechanisms (MMs) has not yet been attempted. The primary objectives are twofold: first, to obtain structured information in the form of data on compliance with the main anti-corruption treaties by processing the text of the reports these MMs have published since their creation; and, second, to examine the impact of these treaties on state behaviour by elaborating on this newly structured information (i.e., text-as-data). This article offers the first comprehensive review of country performance, combined with a structured legal analysis of outcomes from the perspective of the interaction between international and domestic law. The findings reveal that results in implementation and compliance have been decidedly mixed. Several countries have introduced reforms to implement anti-corruption treaties, facilitate law enforcement, and ease international cooperation to investigate and prosecute corruption offences. However, numerous problems identified with prevention, particularly in European and American countries, suggest that states too often over-rely on the repressive aspects of fighting corruption and undervalue preventive mechanisms, which frequently do not exist or are inadequate. Moreover, the article identifies enduring challenges and signs of regression across different areas of prevention, criminal repression, and international cooperation, which have far-reaching implications for the effectiveness of anti-corruption policies in many jurisdictions. Finally, the data obtained from the Organisation for Economic Co-operation and Development demonstrates considerable disparities in enforcement among the reviewed countries; a few jurisdictions have yet to see a single foreign bribery case prosecuted. Additionallly, they offer new evidence that reasons for poor compliance are highly contextual, with different implications for domestic reforms.

Effect of Mobile Phone Call Reminders With Standard Therapy Versus Standard Therapy Alone on Compliance With Iron Supplementation in Antenatal Women With Iron Deficiency Anemia: A Randomized Controlled Trial.

IntroductionIn spite of the implementation of the National nutritional anemia prophylaxis program in India, the prevalence of anemia during pregnancy is 50 in 100 women. One main cause for the high frequency of anemia among antenatal women in India is a lack of iron consumption. Few studies are available in the literature where efforts have been made to improve compliance with iron therapy. In the same line of thinking, it was decided in the present study to use mobile phone calls as a reminder for iron tablets.MethodThe present study is a randomized controlled open-label trial. Antenatal women with gestational age between 13-28 weeks of pregnancy diagnosed with iron deficiency anemia (Hb - 8 to 11 gm/dl) having mobile phones were included in the study. Recruited women were randomized into two groups of study groups receiving standard therapy with the addition of fortnightly mobile phone call reminders and a control group receiving standard therapy alone.ResultsCompliance with iron supplementation was observed higher in the study group as compared to the control group (range of 48% to 93%). There was a mean hemoglobin rise in both the groups at the time of delivery compared with the hemoglobin at the time of recruitment (Study group- 9.74 to 10.69, Control group- 9.48 to 10.06). There was a statistically higher (0.00001) increase in the mean hemoglobin concentration in the study group (0.96 gm/dl) as compared to the control group (0.59 gm/dl). The reasons for poor compliance were boredom with taking daily oral iron therapy (66.66%), constipation (3.7%), forgetfulness (14.81%), and heartburn (14.81%). There was no statistical difference in the reason for poor compliance with iron supplementation in both groups.ConclusionThe present study concludes that mobile phone call reminders along with standard therapy with iron supplementation improve compliance with iron supplementation and lead to a greater rise in hemoglobin in antenatal women with iron deficiency anemia.

182 Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do

BackgroundThe Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors’ experiences of and attitudes toward mental capacity assessment (MCAx).MethodsThis is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.ResultsParticipants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001).ConclusionsThis study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.dexter.penn.14@ucl.ac.uk

Non-compliance Among the Patients Taking Anti- Tubercular Drugs in a Teaching Hospital

Background: Tuberculosis (TB) remains a major, worldwide, public-health problem in the 21st century. Patient non-compliance is a major barrier to the control of TB, treatment of individual patients and in the development of drug resistance. The reasons for poor compliance are complex, ranging from characteristics of individual patients to qualities of social economic environment of the patient and the health service. Methods: An observational, cross sectional study was carried out in the Department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka during the six months period. Results: The average age group of compliance patients is between 46-55 years and between 26-45 among the defaulter group. The gender, marital and employment status were not significantly associated with compliance. Furthermore the study also show that the majority (35%) of compliance group reside at distances less than 5 km. from the TB centre while the majority from the defaulters (92%) resided over 15 km. Multiple logistic regression analysis showed the barriers to TB treatment include: disbelief in the fact that TB can result in death if not treated, belief in traditional medicine for curing TB, bad healthcare worker attitudes, long distance to the clinic for treatment, belief that TB treatment takes very long and the pill burden. Conclusion: Knowledge, patient-provider communications, social support and accessibility might have played significant roles in the low completion rate of TB treatment. Planned interventions targeted at these factors should be implemented with their effects carefully monitored to improve current TB control in Bangladesh. Bangladesh J Medicine 2022; 33: 168-175

Short-term effect of foot-and-mouth disease (FMD) vaccination on the milk yield in the Deoni and crossbred cows.

Biannual vaccination of the cattle with inactivated foot-and-mouth disease (FMD) vaccine is the control strategy in endemic countries. Reduction in the milk yield is one of the main reasons for poor compliance of the cattle owners to FMD vaccination. As it can adversely affect the herd immunity, the present study aimed to quantify the losses in the milk yield post-FMD vaccination. Retrospective data on the milk yield (kg) recordings, days in milk, parity, and age at vaccination of the Deoni and crossbred cows were collected from 10 days before (-10) to 10 days after (+10) FMD vaccination (dpv). Days in milk were categorized into three stages of lactation for Deoni and crossbred cows. Age (month) was categorized into four classes. Least squares means of the milk yield were generated after adjusting for year, age, parity, and stage of lactation. Based on exploratory data analysis, the corrected milk yield records from -2 to +2 dpv for 5 years comprising 614 data points on Deoni cows (n=54) and 488 data points on crossbred cows (n=55) were used for the final analysis. Because of the correlated errors on the corrected milk yield, linear mixed model ANOVA was done by fitting dpv as fixed effect and cow as random effect, and the results revealed the effect of dpv was non-significant (P>0.05) in either breed. With respect to dpv 0, a marginal reduction of 90 g in the corrected milk yield in the Deoni cow was recorded on dpv 1, while the reduction was about 360 g on dpv 0 as compared dpv -1 in the crossbred cow. It was concluded that FMD vaccination caused a transient non-significant reduction in the milk yield in the Deoni and crossbred cows.

Efficacy of a 28-compartment pillbox for improving iron supplement compliance in healthy pregnant women: a randomised controlled trial

A randomised controlled trial was conducted. The primary objective was to evaluate the efficacy of a pillbox for increasing iron supplement compliance by comparing the proportion of pregnant women who had no remaining iron tablets between pregnant women attending ANC who were given a pillbox to use and women with no pillbox in four-week period between ANC visits. The secondary objective was to evaluate the reasons for poor compliance and possible factors associated with the non-compliance. One hundred and ninety pregnant women were enrolled, 95 participants were randomised into each of the groups. The proportion of pregnant women who had no remaining iron tablets at the end was statistically significantly lower in the pillbox group than in the control group [53.3% and 23.1%, respectively, p < .001, RR2.308 (95% CI 1.515 − 3.517)]. The most common reason given for having of iron tablets remaining was forgetfulness. The visual analog scale (VAS) scores indicated that patient’s responsibility feeling, duration of sleep each day and presence of a handicapped or small child in care significantly influenced the proportion of pregnant women who had remaining iron tablets at the end in both groups. We concluded that a pillbox was found to be an effective tool for improving pregnant women’s compliance with taking their iron supplements. IMPACT STATEMENT What is already known about this subject? Antenatal care (ANC) influences maternal and neonatal outcomes. The incidence of anaemia in pregnant women is reported to be around 42% and approximately 50% result from iron deficiency. Maternal anaemia increases the risk of foetal low birth weight, preterm birth, perinatal mortality, stillbirth and maternal mortality. What do the results of this study add? The 28–compartment pillbox is effective for improving iron supplement compliance in healthy pregnant women. Forgetfulness is the most common reason given for having remaining iron tablets. The lower score on the visual analog scale of patient’s feeling of responsibility, long duration of sleep a day and the presence of a handicapped or small child in their care were significantly associated with having remaining iron tablets. What are the implications are of these finding for clinical practice and/or further research? The 28–compartment pillbox can be implied to routine antenatal care for improving iron supplement compliance in healthy pregnant women. Health care providers should be reminded to encourage compliance with iron supplement prescription in pregnant women who are at risk of poor compliance as indicated by low VAS of the patient’s feeling of responsibility, long duration of sleep in a day and pregnant women who have responsibility to take care of handicapped or small children.

Knowledge, practice and correlates of compliance to safety precautions: Across-sectional study

Background: Universal safety precaution (USP), a concept aimed at protecting health care workers (HCW) from acquiring infection following accidental exposures to infected blood and body products (BBP). Knowledge and practice have been a huge challenge to HCW despite the grave consequences of exposure.Objective: The study aims to ascertain level of knowledge and practice and to determine correlates of compliance among Primary Health Care Workers in Rivers State.Material and method: The study was a cross sectional observational study which involves HCW in selected primary Health care centers (PHCC) in Rivers State. It involves the use of semi structured self-administered pre tested questionnaire and an observational check list. A multistage sampling technique was used.Data was analyzed using statistical package for social sciences (SPSS) version 17 statistical software. Categorical data was analyzed using chi square test while students T- test was used for quantitative data. Level of statistical significance was set at 0.05.Result: A total of 366 respondents participated in the study with 108(29.5%) males and 258(70.5%) females, while 125(34.2%) of respondents were aged 30-39 years and 50(13.7%) respondents were ≥50 years. More doctors 38(76%) complied with safety practice than nurses 19(31.7%). Compliance was higher in female HCW than males 111(43.0%) and 34(31.5%) respectively.Conclusion: knowledge and practice of USP among HCW was abysmal, several factors were highlighted as reasons for poor compliance. Measures therefore must be taken by responsible authority to address these shortfall.

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

BackgroundUrothelial bladder carcinoma accounts for around 3.9% cases of all the male cancers in India. Non-muscle-invasive bladder carcinoma (NMIBC) is predominant group which constitute approximately three fourth of the urothelial bladder cancer. Intravesical BCG immunotherapy is the corner stone of today’s NMIBC management. However, as with any other therapy it has its own complications and its interruption due to these adverse effects is a major cause of suboptimal efficacy. The aim of this study was to assess the complications of intravesical BCG therapy and their management in NMIBC patients.MethodsThis was a retrospective descriptive study conducted between October 2016 and November 2019; a backward review of 149 patients with diagnosis of NMIBC that undergone intravesicle BCG therapy was performed. Patient’s demographical, clinical, diagnostic and procedural data regarding bladder tumour, BCG therapy, its complications and management were collected and analysed.ResultsTotal 149 patients were analysed, comprising 116 males and 33 females. The mean age was of 57.2 ± 6.7 years. Total 85.23% were primary and 14.76% were recurrent tumours. Total 96 patients (64.42%) completed the planned course, while 53 (35.57%) interrupted. The reasons for BCG interruption includes adverse effects (15.4%), progression of disease (6.7%), disease refractory to BCG (4.6%) and disease recurrence during BCG (3.3%). Most of the adverse events occurred in first 6 months and most interruptions occurred after the induction period. Cystitis was the most common observed adverse effect seen in 39.6% patients. Frequency, urgency, haematuria were common presentation. Radical cystectomy was the most common (16.10%) further treatment with patients whose treatment was interrupted.ConclusionBCG is an indispensable therapy available for NMIBC, but it is associated with array of adverse effects and complications, which are the main reasons for poor compliance to BCG therapy. Although BCG-related complications can affect any organ in the body, potentially life-threatening systemic BCG-related infections are encountered in only < 5% of patients. There are some difficulties in diagnosis of the BCG complications because acid-fast staining, culture and PCR test are not always positive; tissue biopsies should be indicated sometimes to evaluate histopathology and presence of M. bovis. A persistently monitored multidisciplinary approach with high index of suspicion and prompt anti-TB therapy can help to derive the maximum benefits while keeping the complications at check.

Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do

BackgroundThe Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with...

Risk factors for non-compliance in post vasectomy follow up

Vasectomy is regarded as the most effective method of birth control, with over half a million performed annually in the United States. Poor compliance with providing a post vasectomy semen analysis (PVSA) has previously been reported in both the Family Medicine and Urologic literature, with rates ranging from 34-46%. Reasons for poor compliance with PVSA are not well described. Only one prior study was identified that examined socioeconomic factors predictive of non-compliance. We sought to further characterize this population by examining the pre operative characteristics of patients of a large volume vasectomy surgeon that were predictive of failure to provide a PVSA. A retrospective, single institution chart review Records were reviewed from April 2015 to April 2018, which identified 1137 patients who underwent vasectomy by a single surgeon. Patients who underwent vasectomy for non-fertility related reasons were excluded. Other exclusion criteria included requiring in vitro fertilization to conceive prior to the procedure. Patient characteristics analyzed include age, race, marital status, insurance type, and number of children. Univariate and multivariate logistic regression were performed to compare our two cohorts and to assess for factors predictive of post vasectomy compliance. 1,137 patients underwent vasectomy. The average age was 37.5 years. 89.5% and 88.7% of the patients were White/Caucasian and married, respectively. 27.5% of patients did not follow up for PVSA at any interval. Age was similar between patients who did and did not submit a PVSA (37.8 vs 37.3 years). However race, martial status, and insurance did differ, as patients in the no PVSA cohort were more likely to be African American (8.3% vs 3.7%), single (15.3% vs 9.7%) and have Title 19/Medicaid (2.9% vs 1.2%) insurance coverage (all p values <0.05). On multivariate analysis, single relationship status was independently predictive of failing to present for post vasectomy semen analysis (RR 1.86, p = 0.02). Age (RR 1.02, p = 0.08) and increasing number of children (RR 1.11, p =0.09) approached significance. A significant percentage of patients do not provide a PVSA confirming sterility, with single relationship status being most predictive of noncompliance when controlling for all other preoperative variables. As with all vasectomy patients, counseling these patients that they are not sterile until proven with a PVSA is paramount.

Drug Compliance in Children with Juvenile Idiopathic Arthritis and Reasons for Poor Compliance

Children with chronic disorders are at risk for a higher medication non-adherence. Juvenile idiopathic arthritis (JIA) is a chronic childhood disorder where often medication non-adherence is an issue. The purpose of this study was to assess drug compliance of JIA patients,to find out the proportion of patients having poor drug compliance and to find out possible reasons of poor drug compliance. This was a retrospective study conducted in the Pediatric Rheumatology follow up clinic, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. All JIA patients attending pediatric rheumatology follow up clinic during the study period was included. Data were collected using a structured questionnaire. Among the total 900 registered JIA cases, 116(12.9%) patients had poor compliance. Among 116 poor compliant patients, systemic onset JIA cases were the highest (34.5%), followed by enthesitis related arthritis (30.2%). Among the poor compliant patients, 6.9% patients had regular follow up and 93.1% had irregular follow up. Major reasons of poor compliance were financial crisis, lack of awareness and difficulty in transportation. Poor compliance to treatment of JIA in our setting was common. The most important reason for poor compliance was financial crisis.

A Mixed-Methods Study of Patient Views on Reflux Symptoms and Medication Routines

Gastroesophageal reflux disease is a chronic disorder often accompanied by laryngopharyngeal reflux. Speech-language pathologists are tasked with treating these patients with voice, dysphagia, and/or reflux therapy. This study investigated patient-reported reasons for reduced compliance with recommended reflux treatment and the top symptoms in patients with reflux, dysphagia, and voice symptoms. This study used a cross-sectional qualitative and quantitative mixed-methods design to identify and describe patients' reflux symptoms and reflux medication routines. Fifty-one patients completed a face-to-face, semistructured interview, a questionnaire, and the Reflux Symptom Index (RSI). Interview transcripts were coded by authors for concepts in two cycles. During the 51 interviews, the top four reported symptoms were heartburn (n = 17), mucous (n = 11), dysphagia, and globus (n = 10). Further, 62.7% (n = 32/51) described an incorrect routine in taking their proton pump inhibitor (PPI): taking it with other pills, taking it with food/drink, and uncertainty about which pill is for reflux. RSI scores were moderately correlated with patient-reported reflux severity (r = 0.62, P < 0.0001, r2 = 0.34). Correct compliance with PPI timing was not enough to significantly lower RSI scores more than those who did not comply (an average RSI of 20.0 vs. 25.9, P = 0.1252). Literature has not described the most relevant reflux-related symptoms and why PPI compliance is notoriously poor, from the patients' perspective. The results of this study confirm that PPI compliance is poor, and the reasons for poor compliance could have been prevented with patient education. Even when PPI compliance was adequate, symptoms like globus, mucous, voice dysfunction, and dysphagia persisted. Other interventions such as evidence-based diet and behavioral changes should be a part of voice/dysphagia/reflux therapy.

Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study.

BackgroundDiabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania.MethodsAll diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up.ResultsAmong the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis.ConclusionsFinancial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-016-0288-z) contains supplementary material, which is available to authorized users.

A feasible method to improve adherence of Hawley retainer in adolescent orthodontic patients: a randomized controlled trial.

BackgroundRetention is an important component of orthodontic treatment; however, poor compliance with retainer use is often encountered, especially in adolescents. The purpose of this study was to prove the hypothesis that verbal instructions combined with images showing the severe consequences of poor compliance can increase retainer use.MethodsThis study was a randomized controlled trial. The sample was recruited from Wenzhou, People’s Republic of China, between February 2013 and May 2014, and 326 participants were randomized into three groups. Patients and parents in Group A (n=106) were given routine retainer wear instructions only; in Group B (n=111), images illustrating the severe consequences of poor compliance with Hawley retainer use were shown to patients, combined with routine instructions; and in Group C (n=109), images illustrating the severe consequences of poor compliance with Hawley retainer use were shown to patients and parents, combined with routine instructions. Three months after debonding, questionnaires were used to investigate daily wear time and the reasons for poor compliance. Differences in means between the groups were tested by one-way analysis of variance.ResultsThe mean daily wear time in Group C (15.09±4.13 hours) was significantly greater than in Group A (12.37±4.58 hours, P<0.01) or Group B (13.50±4.22 hours, P<0.05); the mean daily wear time in Group B was greater than in Group A, but was not significant (P=0.67). Reasons for nonusage were forgetting to wear the retainer (51%) and finding the retainer bothersome to frequently insert and remove (42%).ConclusionVerbal instructions combined with images showing the severe consequences of poor compliance can increase retainer use. Parents play an important role in compliance with retainer use in adolescent patients.

Automating patient safety incident reporting to improve healthcare quality in the defence medical services

There are many reasons for poor compliance with patient safety incident reporting in the UK. The Defence Medical Services has made a significant investment to address the culture and process...

The use of personal hearing protection in hostile territory and the effect of health promotion activity: advice falling upon deaf ears

IntroductionNoise-induced hearing loss is a significant cause of morbidity among serving soldiers despite provision of a range of personal hearing protection (PHP) and education and training. It appears that soldiers...

Attitudes and perceptions among the pediatric health care providers toward influenza vaccination in Qatar: A cross-sectional study

BackgroundInfluenza is a communicable but preventable viral illness. Despite safe and effective vaccine availability, compliance rates are globally low. Neither local data on percentage of vaccination nor reasons for poor compliance among pediatric health providers are available in Qatar. AimTo estimate the percentage of vaccinated health care providers at pediatrics department and know their perception and attitudes toward influenza vaccinations. MethodsCross-sectional survey, conducted on 300 pediatrics healthcare professionals from January through April 2013 at the main tertiary teaching hospital in Qatar, included details of demographics, frequency, perceptions and suggestive ways to improve the compliance. FindingFrom among 230 respondents, 90 physicians and 133 allied health care professionals participated in this survey. Our study showed that percentages of participants who received flu vaccination were 67.7% and those who did not receive vaccination were 32.3%. Allied HCPs (69%) are more likely to get the vaccine compared to the physicians (66%). flu vaccination was approximately 5 times likely to be higher in the age group more than 40 years (P=0.002) compared to age less than or equals 40 years. Overall 70% healthcare providers were willing to recommend immunization to colleagues and patients compared to 30%, who were not willing. The reasons for noncompliance included fear of side effects, contracting the flu, vaccine safety and lack of awareness about the effectiveness. In order to promote immunization, participants believe that use of evidence-based statement, participating in an educational campaign, provides no cost/on site campaigns and leadership support is the most practical interventions. ConclusionsIn the present study, the vaccine coverage among pediatrics HCPs seems higher than previously reported rates. Despite their positive attitude toward influenza vaccination, low acceptance and misconceptions of seasonal influenza vaccination by pediatric HCPs may have a negative effect on the successful immunization delivery and children immunization rate. Our findings would be useful for designing and implementing educational programs targeted to improve vaccination coverage rates.

PO-0174 Attitudes Of Paediatric Health Care Workers Towards Influenza Vaccination In Qatar

<h3>Background</h3> Influenza is a communicable but preventable viral illness; despite safe, effective vaccine availability compliance rates are globally low, there is no Local data on percentage and reasons for poor compliance among paediatric health workers in Qatar. <h3>Aims</h3> To estimate the percentage of vaccinated health care providers at paediatrics department and their attitudes towards influenza vaccination. <h3>Methods</h3> Cross-sectional Survey was conducted from November 2012 till April 2013 among 90 physicians and 133 allied health at main tertiary teaching hospital, included details of demographics, frequency, perceptions and suggestive ways to improve the compliance. <h3>Results</h3> Our study showed that percentage of flu vaccination (68.3%) with (31.7%) were not vaccinated, nurses were significantly more likely to be vaccinated than doctors (45.7% vs 40.6%), overall (71.7%) of responders will recommend it to colleagues and patients compared to (28.3%) will not, main reasons for noncompliance included: fear of side effects, contracting the flu, vaccine safety and lack of proper information about the effectiveness. to promote uptake participants believe that offer an evidence based statement ensuring safety, effectiveness is a practical intervention to be used along with providing no cost on site campaigns. <h3>Conclusions</h3> Poor compliance and low acceptance of influenza vaccination by paediatric health care workers had negative impact on our children immunisation rate perception that medical provider had not recommended it, they appear to have many of the same misconceptions about influenza vaccine, findings will be useful to used for urgent action to design and implement education programs to improve vaccination rate.

Lithium-Induced Fixed Drug Eruption in a Case of Bipolar Mania

To the Editor: Lithium is one of the commonly used drugs for the treatment of bipolar affective disorders. Its use is associated with various side effects, dermatologic side effects being one of them. Dermatologic side effects can be one of the reasons for poor compliance and are reported in 3%–45% of the population receiving lithium. Mohandas and Rajmohan1 found acneiform eruptions, psoriasis, maculopapular eruptions, and follicular eruptions to be most commonly reported. However, fixed drug eruption due to the use of lithium carbonate has not been reported. We report one such case in a patient with bipolar mania. Case report. Mr A, a 16-year-old male diagnosed with bipolar affective disorder as the second episode of mania with psychotic symptoms according to ICD-10 criteria, reported for follow-up. A maintenance dose of tablet lithium carbonate 900 mg/d was effective until the past year. At this visit, he reported blisters over the dorsal aspects of the hands and foot, with lesions extending to the mouth and genitalia. After 2–3 days, the blisters had subsided and were now seen to have been replaced by a hypopigmented patch surrounded by hyperpigmented border over the same areas (Figure 1). The lesions were associated with itching and disappeared after a few days of treatment with povidone-iodine (Betadine) application and multivitamin capsules. Figure 1. Fixed Drug Eruption Over the Wrist Mr A attributed the lesions to the antidiarrheal medication taken during one of those instances and continued taking lithium carbonate in the same dose. His serum lithium level was within the therapeutic range at this visit. However, the lesions recurred in a similar manner a month later on 2 successive occasions. On consultation, lithium carbonate therapy was stopped because lithium carbonate was considered the possible precipitant. A rechallenge was done in a low dose, after which the lesions appeared again, thereby confirming lithium to be the likely cause. The Naranjo Adverse Drug Reaction Probability Scale2 was applied with a score of 6, suggesting that lithium carbonate was the probable cause of the side effect. Mr A was subsequently started on tablet sodium valproate (1,000 mg/d) and olanzapine (10 mg/d). He was maintaining well for 4 months after the change in medications but was lost to follow-up. The exact cause for the cutaneous side effects associated with lithium is not known, but the role of stress and psychological factors has been proposed. Kansal et al3 state that the decrease in cyclic adenosine monophosphate and inositol that results from lithium treatment has also been considered as a possible cause. The low intracellular levels of calcium, the lack of differentiation of keratinocytes, and enhanced phagocytic activity of leukocytes have been suggested as the possible mechanisms of action. Reduction in the dosage apart from specific intervention for the lesions has been suggested as a possible treatment strategy.

G218(P) The Paediatric Sepsis 6 Initiative

Introduction and rationaleSevere sepsis is common in children and the incidence is rising. (estimated prevalence of 0.89/1000 children/year in US population) It is associated with significant morbidity and mortality. Improved...