Evaluating the associations between compliance with CKD guideline component metrics and renal outcomes

Understanding the association between compliance to the Chronic Kidney Disease (CKD) guidelines in real-world clinical settings and renal outcomes remains a critical gap in knowledge. A comprehensive analysis was conducted using data from a national, multicenter CKD registry. This study included 4,455 patients with an estimated glomerular filtration rate (eGFR) measurement on the index date and eight additional metrics recorded within six months. These metrics comprised serum electrolyte levels, low-density lipoprotein cholesterol, hemoglobin, and the use of renin-angiotensin system inhibitors. The primary outcome was a composite of renal events, defined by a decline in eGFR to < 15 mL/min/1.73 m2 or a reduction of ≥ 30% in eGFR, confirmed by follow-up tests. Over a median follow-up of 513 days, 838 renal events were observed. High serum potassium levels (> 5.4 mmol/L) were associated with increased event rates compared to lower levels. Similarly, low serum sodium-chloride levels (< 33) correlated with higher event rates. Usage of renin-angiotensin system inhibitors, low serum calcium (< 8.4 mg/dL), and high uric acid levels (> 7.0 mg/dL) were also linked to increased events. Conversely, higher hemoglobin levels (≥ 13 g/dL) were associated with lower event rates. Compliance to guidelines, categorized into quartiles based on the number of met metrics, revealed a significantly reduced risk of events in the highest compliance group (meeting 8 metrics) compared to the lowest (0-5 metrics). Compliance to CKD guidelines in clinical practice is significantly associated with improved renal outcomes, emphasizing the need for guideline-concordant care in the management of CKD.

Executive summary: Japanese pediatric guideline for the treatment and management of asthma (JPGL) 2020

This article covers the salient and updated themes of the Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGL) 2020 published by the Japanese Society of Pediatric Allergy and Clinical Immunology. In the 2020 guidelines, five new clinical questions (CQs) have been added to address the 12 CQs regarding the treatment of childhood asthma. "Infant and preschool asthma" is diagnosed when young children (<6 years of age) have three or more episodes of clear expiratory wheezing, which continue for more than 24 h, and symptom improvement can be observed after beta-2 agonist inhalation. In children without clear improvement, diagnostic therapeutic trial for the duration of 1 month with controller treatment can be used. Since long-term management is initiated, the treatment level is adjusted based on the current control status and the management of risk factors, with the provision for holistic care. This underscores the smooth transition of pediatric patients into adult services. There are several differences between the JPGL and the guidelines of other countries. Further evidence is obtained as the utility of the newly proposed management plans should be evaluated in the Japanese population.

Executive summary: Japanese guidelines for atopic dermatitis (ADGL) 2021

This is an abridged edition of English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. In Japan, from the perspective of evidence-based medicine, the current strategies for the treatment of AD consist of three primary measures: (i) use of topical corticosteroids, tacrolimus ointment, and delgocitinib ointment as the main treatment of the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling, and advice about daily life. In the present revised guidelines, the description about three new drugs, namely, dupilumab, delgocitinib, and baricitinib, has been added. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.

The Daily Dose: Utilizing WhatsApp to engage pharmacy students in clinical discussion

BACKGROUND AND PURPOSE

There are many challenges associated with longitudinally applying therapeutic knowledge in the pharmacy curriculum. This study investigated student participation using the messaging platform, WhatsApp (Meta Platforms, Inc.), as a discussion-based platform for pharmacy students.

EDUCATIONAL ACTIVITY AND SETTING

The created WhatsApp group chat discussion, "The Daily Dose," was a longitudinal learning experience occurring during pharmacy students' last year of clinical rotations or third year of didactic learning. Students were asked daily clinical questions in the application and participation was primarily assessed. This study included a pre-survey, discussion participation assessment, and a post-survey. The surveys assessed student self-evaluations of their learning, clinical confidence levels, board preparedness, and program learning experience feedback.

FINDINGS

A total of 115 questions were asked and 37 students voluntarily joined. Students participated by responding to 97% of questions. Of the 37 students who joined, 81% were experiential education students and 19% were didactic education students. A moderator needed to prompt for participation for 34% of the questions. The majority of students (95%) learned something new. Experiential education students were more likely to participate than didactic education students. A moderator may be beneficial to keep the discussion active. Students' self-evaluations of clinical confidence and board preparedness increased after participating in The Daily Dose.

SUMMARY

The Daily Dose is an innovative way to engage student discussion and reinforce pharmacy therapeutic knowledge. This tool could be expanded to use with multiple pharmacy learners.

[Pitfalls in dermatohistology : Stumbling blocks and problems in routine dermatopathology]

Excisions and biopsies are firmly anchored in everyday dermatology. The biopsy, excision or diagnostic-therapeutic confirmation of the clinical diagnosis of neoplasms or inflammatory diseases is decisive for the dermatopathological diagnosis of tissue samples. Dermatopathology, however, is not a magic box into which a tissue sample can be placed without comment or information and receive-within 24 h at the latest-a complete, high-quality diagnosis. The present article describes problems, hurdles, and challenges in everyday dermatopathology that occur on the way to the microscope, even before the actual dermatopathological diagnosis takes place.

Role of professional networks on social media in addressing clinical questions at general practice: a cross-sectional study of general practitioners in Australia and New Zealand

Background

Clinicians frequently have questions about patient care. However, for more than half of the generated questions, answers are never pursued, and if they are, often not answered satisfactorily. We aimed to characterise the clinical questions asked and answers provided by general practitioners (GP) through posts to a popular professional social media network.

Methods

In this cross-sectional study, we analysed clinical questions and answers posted between January 20th and February 10th 2018 on a popular GP-restricted (Australia, New Zealand) Facebook group. Each clinical question was categorised according to ‘background’ or ‘foreground’ question; type (e.g. treatment, diagnosis); and the clinical topic (e.g. cardiovascular). Each answer provided in response to included questions was categorised into: (i) short answer (e.g. agree/disagree); (ii) provided an explanation to justify the answer; and (iii) referred to a published relevant evidence resource.

Results

Of 1060 new posts during the study period, 204 (19%) included a clinical question. GPs most commonly asked about treatment (n = 87; 43%) and diagnosis (n = 59; 29%). Five major topics (23% skin, 10% psychology, 9% cardiovascular, 8% female genital, and 7% musculoskeletal) accounted for 118 (58%) questions. Each question received on average 10 (SD = 9) answers: 42% were short; 51% provided an explanation; and only 6% referred to relevant research evidence. Only 3 answers referred to systematic reviews.

Conclusions

In this sample of Australian and New Zealand GPs, who were members of a GP social media group, GPs asked clinical questions that can be organised into a limited number of question types and topics. This might help guide the development of GP learning programs.

The TRIP database showed most acute respiratory infections questions were already addressed by Cochrane reviews

OBJECTIVES

Cochrane systematic reviews require more methodological support from Cochrane Review Groups (CRGs) than is customarily received by authors from journals; CRGs must therefore prioritize reviews to conserve resources. The TRIP database provided a data set of questions to guide prioritization for the acute respiratory infections (ARIs) CRG.

STUDY DESIGN AND SETTING

We extracted the ARI searches from the TRIP database (2010 to 2017) that contained at least one disease and one clinical management term, (defined as a "search"), and tabulated these by frequency.

RESULTS

There were 314,346 ARI searches from which we inferred 45,497 clinical questions, covering 365 topics. Two-thirds (30,541) of these addressed 20 clinical questions, of which treatment were the most frequent, followed by diagnosis, mortality, and prognosis. The five most frequent clinical questions were "Influenza + Vaccination" 4,989 (12.1%), "acute otitis media + antibiotics" 3,578 (8.7%), "common cold + vitamin C" 3,528 (8.6%), "meningitis + corticosteroids" 1,910 (4.6%), and "pneumonia + general treatment" 1,765 (4.3%). The 20 most frequent clinical questions were addressed by Cochrane reviews or protocols.

CONCLUSION

ARI questions are common and repeated often. Most may have been addressed by Cochrane reviews. The remainder form the basis of a priority list to assign resources for future Cochrane topics.

[Revision of JSH Guideline for Tumors of Hematopoietic and Lymphoid Tissues 2018: lymphoma]

The Japanese Society of Hematology has revised its clinical practice guidelines for Tumors of Hematopoietic and Lymphoid Tissues, and this version will be published in 2018. In the lymphoma section, the revised 4^th edition (2017) of the WHO classification was adopted and reflected in all issues. The descriptions of all clinical questions (CQs) were thoroughly updated according to the latest published studies. The CQs were modified to reflect recent progress in the treatment of follicular, diffuse large B-cell, and Hodgkin lymphomas. Some of the treatment algorithms were amended aiming to become more useful tools in clinical practices. Because of rapid advances in lymphoma treatment, continuous revision of these clinical practice guidelines is critical.