BEHIND THE PROTON PUMP INHIBITOR PRESCRIPTION: AN INTERNATIONAL SURVEY ON PHYSICIAN PRACTICES AND KNOWLEDGE

ABSTRACT Background: Proton pump inhibitors (PPIs) are widely prescribed worldwide, often resulting in their overuse. Consequently, it is essential to identify the likely causes of this overuse to facilitate their appropriate prescription. Objective: This study aims to assess physician prescribing patterns, their knowledge of PPIs, and factors affecting their knowledge. Methods: An online survey was conducted among Latin American and Spanish physicians, collecting the following data: professional information, patterns of PPI usage, familiarity with published evidence, and the management approach in three hypothetical case-scenarios. Participant knowledge was categorized as sufficient or insufficient based on the results of the case scenarios. Subsequently, subgroup analysis was performed based on physician training level, years in practice, specialty, and time since the last PPI literature review. Results: A total of 371 physicians participated in the survey. Thirty-eight percent frequently prescribe PPIs, primarily for prophylactic purposes (57.9%). Eighty percent were unfamiliar with PPI deprescribing strategies, and 54.4% rarely reviewed the ongoing indication of patients taking a PPI. Sixty-four percent demonstrated sufficient knowledge in the case-scenarios. A significant association was observed between specialty type (medical vs surgical: 69.4% vs 46.8%, P5 years: 71.4% vs 58.7%, P=0.010), and sufficient knowledge. Conclusion: While most participants prescribed PPIs regularly and for prophylaxis purposes, the majority were unfamiliar with deprescribing strategies and rarely reviewed ongoing indications. Sufficient knowledge is correlated with recent literature reviews and medical specialty affiliation

Proyecto Verbum

Se desarrolla un proyecto de innovación educativa que pretende incrementar el número de lecturas efectuadas por el alumnado tomando como referencia los años anteriores, alcanzando un grado de disfrute de la propia actividad de leer. Para motivar el hábito de leer se procura vincular los contenidos de los textos a leer a los intereses y preocupaciones del alumnado, proporcionando un listado y son ellos mismos quines elige sus lecturas. Se trata de concienciar ala alumnado de que la lectura y el buen uso de la lengua son instrumentos fundamentales para su desarrollo personal y educativo. El proyecto pretende a su vez implicar a los familiares en el proceso educativo de sus hijos o hijas, abriendo nuevas vías de comunicación entre las personas y propiciando encuentros entre lectores, ya sean presenciales o a través de la red. A través de las Nuevas Tecnologías se pretende ampliar las posibilidades técnicas en las actividades lectoras. El profesorado presenta los argumentos, acciones o personajes de los libros de lectura a elegir para que elija el que prefiera. El alumnado una vez leído el libro elegido, realiza un comentario del texto e invita a sus compañeros y compañeras a leerlo si así lo cree conveniente a modo de consejo. Los alumnos y alumnas que han leído un mismo libro preparan en grupo una exposición ante el resto de la clase, del contenido del libro, de sus impresiones, valoraciones y estructura. El profesorado de las diferentes áreas advierte al alumnado los contenidos relacionados en la lectura con su materia y les proporciona información adicional que les permita sacar el máximo provecho de la lectura. En el centro se han desarrolla actividades extraescolares y complementarias como encuentros con escritores, exposiciones sobre autores y obras, recitales de poesía, lecturas dramatizadas. La valoración general del proyecto tanto por parte del profesorado como del alumnado se es positiva, a pesar de las dificultades generadas.Castilla y LeónConsejería de Educación. Dirección General de Universidades e Investigación; Monasterio de Nuestra Señora de Prado, Autovía Puente Colgante s. n.; 47071 Valladolid; +34983411881; +34983411939ES

Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations

Background & objectives: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. Methods Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. Results The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31–82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. Conclusions The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making