Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study

<p>Abstract</p> <p>Background</p> <p>Antihypertensive drug choices and treatment levels are not in accordance with the existing guidelines. We aimed to assess the impact of a guideline implementation intervention on antihypertensive drug prescribing.</p> <p>Methods</p> <p>In this controlled before and after study, the effects of a multifaceted (education, audit and feedback, local care pathway) quality programme was evaluated. The intervention was carried out in a health centre between 2002 and 2003. From each health care unit (n = 31), a doctor-nurse pair was trained to act as peer facilitators in the intervention.</p> <p>All antihypertensive drugs prescribed by 25 facilitator general practitioners (intervention GPs) and 53 control GPs were retrieved from the nationwide Prescription Register for three-month periods in 2001 and 2003. The proportions of patients receiving specific antihypertensive drugs and multiple antihypertensive drugs were measured before and after the intervention for three subgroups of hypertension patients: hypertension only, with coronary heart disease, and with diabetes.</p> <p>Results</p> <p>In all subgroups, the use of multiple concurrent medications increased. For intervention patients with hypertension only, the odds ratio (OR) was 1.12 (95% CI 0.99, 1.25; p = 0.06) and for controls 1.13 (1.05, 1.21; p = 0.002). We observed no statistically significant differences in the change in the prescribing of specific antihypertensive agents between the intervention and control groups. The use of agents acting on the renin-angiotensin-aldosterone system increased in all subgroups (hypertension only intervention patients OR 1.19 (1.06, 1.34; p = 0.004) and controls OR 1.24 (1.15, 1.34; p < 0.0001).</p> <p>Conclusions</p> <p>A multifaceted guideline implementation intervention does not necessarily lead to significant changes in prescribing performance. Rigorous planning of the interventions and quality projects and their evaluation are essential.</p

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9–24·7), corresponding to 1·92 billion (1·89–1·95) prevalent cases, compared with a prevalence of 28·2% (27·8–28·5) and 1·50 billion (1·48–1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1–75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1–612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2–123·7]), and other neglected tropical diseases (36·3 [24·4–52·8]), collectively accounting for 84·7% (84·1–85·2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation

Response to &ldquo;Medical Education Electives Can Promote Teaching and Research Interests Among Medical Students&rdquo; [Response to Letter]

Sateesh B Arja, Sireesha Bala Arja, Praveen Kottath Veetil, Simi Paramban Medical Education Unit Avalon University School of Medicine, Willemstad, CuracaoCorrespondence: Sateesh B Arja, Medical Education Unit, Avalon University School of Medicine, Willemstad, Curacao, Tel +599-96965682, Email [email protected]

Medical Education Electives Can Promote Teaching and Research Interests Among Medical Students

Sateesh B Arja, Sireesha Bala Arja, Kumar Ponnusamy, Praveen Kottath Veetil, Simi Paramban, Yoshita Chandru Laungani Medical Education Unit Avalon University School of Medicine, Willemstad, Curacao, Netherlands AntillesCorrespondence: Sateesh B Arja, Medical Education Unit Avalon University School of Medicine, Willemstad, Curacao, Netherlands Antilles, Tel +599-96965682, Email [email protected]: Although all residents routinely teach medical students, not all residents are involved in teaching or trained in teaching during undergraduate medical school, as accreditation bodies do not mandate the promotion of teaching skills to undergraduate medical students. With relatively inadequate formal training and residents’ intrinsic time constraints, tactically incorporating formal medical education elective experiences in medical school curricula is understandable. This study explores if medical education electives at Avalon University School of Medicine (AUSOM) can enhance medical students’ interest in teaching and research.Methods: The medical education elective at AUSOM was developed to give interested medical students an elective experience. The course modules include accreditation/regulation, curriculum development, learning theories, assessments, and research methodology. Students can choose any one of the modules. We offered the medical education elective to twenty-five students in the year 2021. All of them gave feedback at the end of the elective. The data was analyzed qualitatively through framework analysis, which includes familiarization, generating initial codes, searching for themes, reviewing, and defining and naming themes.Results: Different themes emerged, enhancing the interest in academic medicine, understanding research methodologies, supporting learners, and awareness of learning theories.Conclusion: Doing medical education electives at AUSOM enhanced students’ interest in teaching, and students reported that they could understand research methodologies, especially those related to medical education. Medical students should have opportunities for electives in medical education, and more research is required to evaluate the effectiveness of medical education electives across medical schools.Keywords: medical education, electives, medical educational research, medical educators, health science student

Are calcifying microvesicles another analogous substructure of calcifying nanoparticles?

Trueman C Atughonu, Sateesh B Arja, Farooq A ShiekhAvalon University School of Medicine, Willemstad, CuracaoWe correspond in response to the article entitled, "Contrast-enhanced MR imaging of atherosclerosis using citrate-coated superparamagnetic iron oxide nanoparticles: calcifying microvesicles as imaging target for plaque characterization" by Wagner et al.1 In this article, the authors have used a new term "calcifying microvesicles" for the first time in the literature. We think our commentary will highlight these calcifying microvesicles with the similar analogous structures already existing in nature. We hope our discussion will clear up many of those questions.View original paper by Wagner and colleagues

Cross-Border Accreditation in the Caribbean: A Potential Threat to the Integrity of the Accreditation Process?

Kati Reddy, Mashal Unar, Hira Unar, Sateesh B Arja Medical Education Unit, Avalon University School of Medicine, Willemstad, Netherlands AntillesCorrespondence: Kati Reddy, Email [email protected]: According to the World Directory of Medical Schools, the Caribbean region hosts around 100 medical schools, leading to variations in education programs and student performance. Accreditation is crucial for maintaining educational standards. The proliferation of accrediting agencies recognized by the World Federation of Medical Education (WFME) has led to cross-border accreditation practices and market-driven competition. Concerns about the integrity of accreditation processes in the Caribbean region have raised questions about educational quality and global implications. Establishing a framework and scrutiny of the WFME regarding cross-border accreditation is essential to preserve educational standards and prevent global implications. ECFMG’s intervention is urgently needed to investigate and restore the integrity of medical school accreditation in the Caribbean, setting a precedent for global accreditation standards.Keywords: medical education, accreditation standards, educational quality, cross-border accreditation, accreditation challenge

Research highlights from the International Journal&nbsp;of Nanomedicine 2014

Sarah H Mian, Neel A Patel, Farina Shah, Sateesh B Arja, Farooq A ShiekhDepartment of Basic Medical Sciences, Avalon University School of Medicine, Cura&ccedil;ao, Netherlands AntillesCan nanocarriers conquer gene therapy?Evaluation of: Magalh&atilde;es M, Farinha D, Pedroso de Lima MC, Faneca H. Increased gene delivery efficiency and specificity of a lipid-based nanosystem incorporating a glycolipid. Int J Nanomedicine. 2014;9:4979&ndash;4989. Hepatocellular carcinoma (HCC) is a devastating disease that makes up 70%&ndash;85% of all cases of liver cancer, affecting millions of people worldwide.1 Unfortunately, HCC is aggressive and deadly; patients typically live for only 6 to 20 months after diagnosis, highlighting the dire need for new effective therapies. Although gene therapy has the potential to offer new biologically based medicines, the efficient, selective, and safe delivery of DNA- or RNA-based drugs to target cells including hepatocytes is still a major limiting factor to the broad applications of gene therapy in cancer diseases.2&ndash;