We observed that this specialists who treat patients with different rheumatic conditions are well informed of these factors, which may explain the high rates of preventative prescriptions observed in our study population

We observed that this specialists who treat patients with different rheumatic conditions are well informed of these factors, which may explain the high rates of preventative prescriptions observed in our study population. rates of GI-prevention therapy. Our educational program did not alter these rates. < 0.05. RESULTS Physician survey sub-study Of a total of 456 invited physicians, 441 (96.7%) returned valid questionnaires. Those that responded experienced a imply 14 8.6 years of professional activity. Three hundred and seventy-four (84.8%) were members of one or more scientific societies, and 189 (42.9%) were aware that their respective societies experienced published guidelines or recommendations for the management of NSAIDs. Two hundred and eighty (63.4%) were orthopedic surgeons, 116 (24.7%) Rabbit polyclonal to LOXL1 were rheumatologists, and 45 were other types of specialists (10.2%). Only 24 (5.7%) doctors responded that NSAID use was not associated with GI toxicity; 368 (88.2%), a substantial majority, stated that NSAID use was associated with GI, renal, CV, or liver damage. A total of 207 (50.2%) overestimated the overall rate of upper GI complications in NSAID users, and 261 (63.0%) stated that NSAID use could lead to complications of the lower GI tract. The two symptoms that doctors considered to be the most frequently reported by patients in relation to NSAID therapy were epigastric pain (67.1%) and heartburn (54.8%). The frequency of dyspepsia as an adverse effect of NSAIDs was underestimated by 45.2% of respondents. As summarized in Table ?Table2,2, most recognized the risk factors for GI complications in NSAID users; there were no differences between the responses of rheumatologists and orthopedists, which were the two main specialties represented by the participants. Indomethacin (61.9%), piroxicam (34.0%), diclofenac (18.5%) and ketorolac (11.0%) were considered to be the most gastrotoxic brokers, while coxibs, paracetamol and metamizol were considered to be the safest for the GI tract. Table 2 Responses to the question, Which of the following factors do you believe is usually/are risk factors for GI complications in patients who take NSAIDs (%) contamination103 (88.8)257 (91.8)19 (90.4)379 (90.9)Smoking87 (75.00)223 (79.6)13 (61.7)323 (77.5)Dyspepsia history73 (62.9)250 (89.3)19 (90.4)342 (82.0)Alcohol105 (90.5)257 (91.8)20 (95.3)382 (91.6)High dose of NSAIDs113 (97.4)275 (98.2)21 (100.0)409 (98.1) Open in a separate windows When questioned about coxibs, 93 (22.5%) of the specialists believed them to be less effective than NSAIDs, but 84.6% said they were safer for the GI than NSAIDs were. However, 43.9% of the specialists stated that coxibs were more toxic for the GI tract than a combination of NSAID + PPI. Furthermore, 211 (52.2%) reported that concomitant low-dose aspirin reduced the GI benefit of coxibs, and 394 (94.7%) considered coxibs to be toxic to the CV system; a proportion that fell to 72.7% (= 0.140) when the same question was asked about NSAIDs. Over half of the physicians (56.1%) reported that histamine H2 receptor antagonists (H2-RAs) were effective in preventing ulcers and ulcer complications in NSAID users; almost all (98.5%) reported the same effect with PPIs. Responding about GI prevention therapy habits with NSAIDs, 217 (52.4%) took this precaution on a program basis, 45.9% only when risk factors were present, and 5.3% only when patients were receiving long-term NSAID therapy. H2-RAs (44.6%), misoprostol (41.2%) and PPIs (94%) were considered to be effective for the prevention and treatment of NSAID-induced dyspepsia. Effects of the educational program on patient management Demographics and characteristics of patients: Of 456 invited participants, 382 (83.7%) submitted information regarding 3728 patients over the two phases (1732 in phase?I?- before the evidence-based seminar, and 1722 in phase II – after the seminar). Two hundred and seventy-four patients were excluded for the following reasons: 43 were under the age of 18 years, and 231 lacked an NSAID prescription. Table ?Table33 summarizes the main characteristics of the patients included in the study. No statistical differences were found between patients referred to in the two phases. Table 3 Characteristics of patients included in the educational program of the study1 (%) = 1732)Phase II (= 1722)< 0.0001) increase in prescription rates of aceclofenac, celecoxib, ibuprofen, meloxicam and etoricoxib after the visit with the specialist, but this increase was similar in both phases (Table ?(Table4).4). The main reasons for prescribing NSAIDs was the diagnosis of osteoarthritis [1015 (63.24%) in phase?Iand 987 (61.96%) in phase II] or rheumatoid arthritis [148 (9.22%) and 186 (11.68%) in phases?I?and II, respectively]. In phase?I, NSAID therapy was terminated in 15.98% of patients following the visit to the specialist, a similar percentage to that reported in phase.Responding about GI prevention therapy habits with NSAIDs, 217 (52.4%) took this precaution on a routine basis, 45.9% only when risk factors were present, and 5.3% only when patients were receiving long-term NSAID therapy. responded had a mean 14 8.6 years of professional activity. Three hundred and seventy-four (84.8%) were members of one or more scientific societies, and 189 (42.9%) were aware that their respective societies had published guidelines or recommendations for the management of NSAIDs. Two hundred and eighty (63.4%) were orthopedic surgeons, 116 (24.7%) were rheumatologists, and 45 were other types of specialists (10.2%). Only 24 (5.7%) doctors responded that NSAID use was not associated Uridine diphosphate glucose with GI toxicity; 368 (88.2%), a substantial majority, stated that NSAID use was associated with GI, renal, CV, or liver damage. A total of 207 (50.2%) overestimated the overall rate of upper GI complications in NSAID users, and 261 (63.0%) stated that NSAID use could lead to complications of the lower GI tract. The two symptoms that doctors considered to be the most frequently reported by patients in relation to NSAID therapy were epigastric pain (67.1%) and heartburn (54.8%). The frequency of dyspepsia as an adverse effect of NSAIDs was underestimated by 45.2% of respondents. As summarized in Table ?Table2,2, most identified the risk factors for GI complications in NSAID users; there were no differences between the responses of rheumatologists and orthopedists, which were the two main specialties represented by the participants. Indomethacin (61.9%), piroxicam (34.0%), diclofenac (18.5%) and ketorolac (11.0%) were considered to be the most gastrotoxic agents, while coxibs, paracetamol and metamizol were considered to be the safest for the GI tract. Table 2 Responses to the question, Which of the following factors do you believe is/are risk factors for GI complications in patients who take NSAIDs (%) infection103 (88.8)257 (91.8)19 (90.4)379 (90.9)Smoking87 (75.00)223 (79.6)13 (61.7)323 (77.5)Dyspepsia history73 (62.9)250 (89.3)19 (90.4)342 (82.0)Alcohol105 (90.5)257 (91.8)20 (95.3)382 (91.6)High dose of NSAIDs113 (97.4)275 Uridine diphosphate glucose (98.2)21 (100.0)409 (98.1) Open in a separate window When questioned about coxibs, 93 (22.5%) of the specialists believed them to be less effective than NSAIDs, but 84.6% said they were safer for the GI than NSAIDs were. However, 43.9% of the specialists stated that coxibs were more toxic for the GI tract than a combination of NSAID + PPI. Furthermore, 211 (52.2%) reported that concomitant low-dose aspirin reduced the GI benefit of coxibs, and 394 (94.7%) considered coxibs to be toxic to the CV system; a proportion that fell to 72.7% (= 0.140) when the same question was asked about NSAIDs. Over half of the physicians (56.1%) reported that histamine H2 receptor antagonists (H2-RAs) were effective in preventing ulcers and ulcer complications in NSAID users; almost all (98.5%) reported the same effect with PPIs. Responding about GI prevention therapy habits with NSAIDs, 217 (52.4%) took this precaution on a routine basis, 45.9% only when risk factors were present, and 5.3% only when patients were receiving long-term NSAID therapy. H2-RAs (44.6%), misoprostol (41.2%) and PPIs (94%) were considered to be effective for the prevention and treatment of NSAID-induced dyspepsia. Effects of the educational program on patient management Demographics and characteristics of patients: Of 456 invited participants, 382 (83.7%) submitted information regarding 3728 patients over the two phases (1732 in phase?I?- before the evidence-based seminar, and 1722 in phase II - after the seminar). Two hundred and seventy-four patients were excluded for the following reasons: 43 were under the age of 18 years, and 231.Finally one potential limitation of the study is the validity of our conclusions outside Spain. educational program had little impact on prescribing habits. CONCLUSION: Specialists are informed Uridine diphosphate glucose of advances in NSAID-associated adverse effects and have high rates of GI-prevention therapy. Our educational program did not alter these rates. < 0.05. RESULTS Physician survey sub-study Of a total of 456 invited physicians, 441 (96.7%) returned valid questionnaires. Those that responded had a mean 14 8.6 years of professional activity. Three hundred and seventy-four (84.8%) were members of one or more scientific societies, and 189 (42.9%) were aware that their respective societies had published guidelines or recommendations for the management of NSAIDs. Two hundred and eighty (63.4%) were orthopedic cosmetic surgeons, 116 (24.7%) were rheumatologists, and 45 were other types of professionals (10.2%). Only 24 (5.7%) doctors responded that NSAID use was not associated with GI toxicity; 368 (88.2%), a substantial majority, stated that NSAID use was associated with GI, renal, CV, or liver damage. A total of 207 (50.2%) overestimated the overall rate of top GI complications in NSAID users, and 261 (63.0%) stated that NSAID use could lead to complications of the lower GI tract. The two symptoms that doctors considered to be the most frequently reported by individuals in relation to NSAID therapy were epigastric pain (67.1%) and heartburn (54.8%). The rate of recurrence of dyspepsia as an adverse effect of NSAIDs was underestimated by 45.2% of respondents. As summarized in Table ?Table2,2, most recognized the risk factors for GI complications in NSAID users; there were no differences between the reactions of rheumatologists and orthopedists, which were the two main specialties represented from the participants. Indomethacin (61.9%), piroxicam (34.0%), diclofenac (18.5%) and ketorolac (11.0%) were considered to be probably the most gastrotoxic providers, while coxibs, paracetamol and metamizol were considered to be the safest for the GI tract. Table 2 Responses to the query, Which of the following factors do you believe is definitely/are risk factors for GI complications in individuals who take NSAIDs (%) illness103 (88.8)257 (91.8)19 (90.4)379 (90.9)Smoking87 (75.00)223 (79.6)13 (61.7)323 (77.5)Dyspepsia history73 (62.9)250 (89.3)19 (90.4)342 (82.0)Alcohol105 (90.5)257 (91.8)20 (95.3)382 (91.6)High dose of NSAIDs113 (97.4)275 (98.2)21 (100.0)409 (98.1) Open in a separate windowpane When questioned about coxibs, 93 (22.5%) of the professionals believed them to be less effective than NSAIDs, but 84.6% said they were safer for the GI than NSAIDs were. However, 43.9% of the specialists stated that coxibs were more toxic for the GI tract than a combination of NSAID + PPI. Furthermore, 211 (52.2%) reported that concomitant low-dose aspirin reduced the GI good thing about coxibs, and 394 (94.7%) considered coxibs to be toxic to the CV system; a proportion that fell to 72.7% (= 0.140) when the same query was asked about NSAIDs. Over half of the physicians (56.1%) reported that histamine H2 receptor antagonists (H2-RAs) were effective in preventing ulcers and ulcer complications in NSAID users; almost all (98.5%) reported the same effect with PPIs. Responding about GI prevention therapy practices with NSAIDs, 217 (52.4%) took this precaution on a program basis, 45.9% only when risk factors were present, and 5.3% only when individuals were receiving long-term NSAID therapy. H2-RAs (44.6%), misoprostol (41.2%) and PPIs (94%) were considered to be effective for the prevention and treatment of NSAID-induced dyspepsia. Effects of the educational system on patient management Demographics and characteristics of individuals: Of 456 invited participants, 382 (83.7%) submitted info regarding 3728 individuals over the two phases (1732 in phase?I?- before the evidence-based seminar, and 1722 in phase II - after the seminar). Two hundred and seventy-four individuals were excluded for the following reasons: 43 were under the age of 18 years, and 231 lacked an NSAID prescription. Table ?Table33 summarizes the main characteristics of the individuals included in the study. No statistical variations were found between individuals referred to in the two phases. Table 3 Characteristics of individuals included in the educational system of the study1 (%) = 1732)Phase II (= 1722)< 0.0001) increase in prescription rates of aceclofenac, celecoxib, ibuprofen, meloxicam and etoricoxib after the visit with the professional, but this increase was similar in both phases (Table ?(Table4).4). The main reasons for prescribing NSAIDs was the analysis of osteoarthritis [1015 (63.24%) in phase?Iand 987 (61.96%) in phase II] or rheumatoid arthritis [148 (9.22%) and 186 (11.68%) in phases?We?and II, respectively]. In phase?We, NSAID therapy was Uridine diphosphate glucose terminated in 15.98% of.As summarized in Table ?Table2,2, most recognized the risk factors for GI complications in NSAID users; there were no differences between your replies of rheumatologists and orthopedists, that have been the two primary specialties represented with the individuals. > 80% of sufferers with and without risk elements. The educational plan acquired little effect on prescribing behaviors. CONCLUSION: Experts are up to date of developments in NSAID-associated undesireable effects and also have high prices of GI-prevention therapy. Our educational plan didn’t alter these prices. < 0.05. Outcomes Physician study sub-study Of a complete of 456 asked doctors, 441 (96.7%) returned valid questionnaires. The ones that responded acquired a indicate 14 8.6 years of professional activity. 3 hundred and seventy-four (84.8%) had been members of 1 or even more scientific societies, and 189 (42.9%) were conscious that their respective societies acquired published suggestions or tips for the administration of NSAIDs. 2 hundred and eighty (63.4%) were orthopedic doctors, 116 (24.7%) were rheumatologists, and 45 were other styles of experts (10.2%). Just 24 (5.7%) doctors responded that NSAID make use of was not connected with GI toxicity; 368 (88.2%), a considerable bulk, stated that NSAID make use of was connected with GI, renal, CV, or liver organ damage. A complete of 207 (50.2%) overestimated the entire rate of higher GI problems in NSAID users, and 261 (63.0%) stated that NSAID make use of may lead to problems of the low GI tract. Both symptoms that doctors regarded as the most regularly reported by sufferers with regards to NSAID therapy had been epigastric discomfort (67.1%) and acid reflux (54.8%). The regularity of dyspepsia as a detrimental aftereffect of NSAIDs was underestimated by 45.2% of respondents. As summarized in Desk ?Desk2,2, most discovered the risk elements for GI problems in NSAID users; there have been no differences between your replies of rheumatologists and orthopedists, that have been the two primary specialties represented with the individuals. Indomethacin (61.9%), piroxicam (34.0%), diclofenac (18.5%) and ketorolac (11.0%) were regarded as one of the most gastrotoxic realtors, while coxibs, paracetamol and metamizol were regarded as the safest for the GI tract. Desk 2 Responses towards the issue, Which of the next factors do you think is normally/are risk elements for GI problems in sufferers who consider NSAIDs (%) an infection103 (88.8)257 (91.8)19 (90.4)379 (90.9)Smoking87 (75.00)223 (79.6)13 (61.7)323 (77.5)Dyspepsia background73 (62.9)250 (89.3)19 (90.4)342 (82.0)Alcohol105 (90.5)257 (91.8)20 (95.3)382 (91.6)High dose of NSAIDs113 (97.4)275 (98.2)21 (100.0)409 (98.1) Open up in another screen When questioned about coxibs, 93 (22.5%) from the experts believed these to be much less effective than NSAIDs, but 84.6% said these were safer for the GI than NSAIDs were. Nevertheless, 43.9% from the specialists stated that coxibs were more toxic for the GI tract when compared to a mix of NSAID + PPI. Furthermore, 211 (52.2%) reported that concomitant low-dose aspirin reduced the GI advantage of coxibs, and 394 (94.7%) considered coxibs to become toxic towards the CV program; a percentage that dropped to 72.7% (= 0.140) when the same issue was asked about NSAIDs. More than half from the doctors (56.1%) reported that histamine H2 receptor antagonists (H2-RAs) had been effective in preventing ulcers and ulcer problems in NSAID users; virtually all (98.5%) reported the same impact with PPIs. Responding about GI avoidance therapy behaviors with NSAIDs, 217 (52.4%) took this precaution on the regimen basis, 45.9% only once risk factors had been present, and 5.3% only once sufferers had been getting long-term NSAID therapy. H2-RAs (44.6%), misoprostol (41.2%) and PPIs (94%) were regarded as effective for the avoidance and treatment of NSAID-induced dyspepsia. Ramifications of the educational plan on patient administration Demographics and features of sufferers: Of 456 asked individuals, 382 (83.7%) submitted details regarding 3728 sufferers over both stages (1732 in stage?I?- prior to the evidence-based workshop, and 1722.The provided information was not attained from a data source but from the records of the participating physicians. had been co-prescribed with NSAIDs in > 80% of sufferers with and without risk elements. The educational plan acquired little effect on prescribing behaviors. CONCLUSION: Experts are up to date of developments in NSAID-associated undesireable effects and also have high prices of GI-prevention therapy. Our educational plan didn’t alter these prices. < 0.05. Outcomes Physician study sub-study Of a complete of 456 asked doctors, 441 (96.7%) returned valid questionnaires. The ones that responded acquired a indicate 14 8.6 years of professional activity. 3 hundred and seventy-four (84.8%) had been members of 1 or even more scientific societies, and 189 (42.9%) were conscious that their respective societies acquired published suggestions or tips for the administration of NSAIDs. 2 hundred and eighty (63.4%) were orthopedic doctors, 116 (24.7%) were rheumatologists, and 45 were other styles of experts (10.2%). Just 24 (5.7%) doctors responded that NSAID make use of was not connected with GI toxicity; 368 (88.2%), a considerable bulk, stated that NSAID make use of was connected with GI, renal, CV, or liver organ damage. A complete of 207 (50.2%) overestimated the entire rate of higher GI problems in NSAID users, and 261 (63.0%) stated that NSAID make use of may lead to problems of the low GI tract. Both symptoms that doctors regarded as the most regularly reported by sufferers with regards to NSAID therapy had been epigastric discomfort (67.1%) and acid reflux (54.8%). The regularity of dyspepsia as a detrimental aftereffect of NSAIDs was underestimated by 45.2% of respondents. As summarized in Desk ?Desk2,2, most determined the risk elements for GI problems in NSAID users; there have been no differences between your replies of rheumatologists and orthopedists, that have been the two primary specialties represented with the individuals. Indomethacin (61.9%), piroxicam (34.0%), diclofenac (18.5%) and ketorolac (11.0%) were regarded as one of the most gastrotoxic agencies, while coxibs, paracetamol and metamizol were regarded as the safest for the GI tract. Desk 2 Responses towards the issue, Which of the next factors do you think is certainly/are risk elements for GI problems in sufferers who consider NSAIDs (%) infections103 (88.8)257 (91.8)19 (90.4)379 (90.9)Smoking87 (75.00)223 (79.6)13 (61.7)323 (77.5)Dyspepsia background73 (62.9)250 (89.3)19 (90.4)342 (82.0)Alcohol105 (90.5)257 (91.8)20 (95.3)382 (91.6)High dose of NSAIDs113 (97.4)275 (98.2)21 (100.0)409 (98.1) Open up in another home window When questioned about coxibs, 93 (22.5%) from the experts believed these to be much less effective than NSAIDs, but 84.6% said these were safer for the GI than NSAIDs were. Nevertheless, 43.9% from the specialists stated that coxibs were more toxic for the GI tract when compared to a mix of NSAID + PPI. Furthermore, 211 (52.2%) reported that concomitant low-dose aspirin reduced the GI advantage of coxibs, and 394 (94.7%) considered coxibs to become toxic towards the CV program; a percentage that dropped to 72.7% (= 0.140) when the same issue was asked about NSAIDs. More than half from the doctors (56.1%) reported that histamine H2 receptor antagonists (H2-RAs) had been effective in preventing ulcers and ulcer problems in NSAID users; virtually all (98.5%) reported the same impact with PPIs. Responding about GI avoidance therapy behaviors with NSAIDs, 217 (52.4%) took this precaution on the schedule basis, 45.9% only once risk factors had been present, and 5.3% only once sufferers had been getting long-term NSAID therapy. H2-RAs (44.6%), misoprostol (41.2%) and PPIs (94%) were regarded as effective for the avoidance and treatment of NSAID-induced dyspepsia. Ramifications of the educational plan on patient administration Demographics and features of sufferers: Of 456 asked individuals, 382 (83.7%) submitted details regarding 3728 sufferers over both stages (1732 in stage?I?- prior to the evidence-based workshop, and 1722 in stage II - following the workshop). 2 hundred and seventy-four sufferers had been excluded for the next factors: 43 had been under the age group of 18 years, and 231 lacked an NSAID prescription. Desk ?Desk33 summarizes the primary characteristics from the sufferers contained in the research. No statistical distinctions.

We observed that this specialists who treat patients with different rheumatic conditions are well informed of these factors, which may explain the high rates of preventative prescriptions observed in our study population
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