Inappropriate Prescribing of Proton Pump Inhibitors in Outpatient Clinics

Proton pump inhibitors are the commonly prescribed drugs for acid-related disorders. However, many of those prescriptions are inappropriate in inpatient and outpatient settings according to the recommended guidelines. Many studies have been conducted in inpatient clinics, but data about the appropriateness of proton pump inhibitor prescribing in outpatient clinics are scarce. Therefore, the aim of this study was to determine inappropriate proton pump inhibitor prescribing rates among patients admitted to a tertiary hospital family medicine outpatient clinic. A total of 259 patients (median age = 59 years; 72.6% women) were enrolled into the study and 35.9% of them had no proper indications to utilize proton pump inhibitors. Inappropriate proton pump inhibitor usage rate was significantly higher in patients older than 60 years compared with their younger counterparts (62.4% vs. 37.6%; p = .001). The most frequent reason to use a proton pump inhibitor with nonapproved indications was polypharmacy (41.9%). Despite endoscopic evaluation, 41.9% of the patients received a proton pump inhibitor without an approved indication. A significant proportion of nonindicated prescriptions were a consequence of continued prescribing without re-evaluating patients in outpatient clinics. Consideration of proton pump inhibitor indications according to the guidelines in every admission may prevent inappropriate prescriptions.

Importance of Measurement and Assessment in Postgraduate Education

Aim: Whether a specialization training program achieves its objectives or not is decided by showing that the graduates of the program have gained the expected knowledge, skills and behaviors. The measurement tools used in this decision require some specific knowledge and skills. The aim of this study was to analyze the questions asked in an examination and to investigate the suitability of the assistants and the education program in terms of educational sciences. Methods: Responses of Family Medicine residents to a multiple-choice test that consists of 50 items, conducted throughout the country. The questions were analyzed in terms of the connection with the educational objectives, the degree of difficulty, separation and distraction power. Results: Of the 150 questions asked, 20 were not found in the learning objectives. In the analysis of difficulties, 105 of the questions were easy and very easy questions; on the other hand, in the analysis of distraction, 27 out of 150 questions are sufficient for discriminating; in terms of distractors, all the distractors of the 19 problems were found to be functional. Conclusion: The examination is not suitable for the evaluation of both the residents and the program, because it is based on knowledge measurement by multiple choice quiz method, not being competency based, the questions are not included in the learning objectives, the disaggregation of the questions are weak, and the distractors are not working in a large majority. In order to avoid these situations, it would be appropriate for the family medicine trainers to undergo a training including the role and importance of measurement and assessment in education before taking the authority of assistant and program evaluation.

The relationship between BMI and blood pressure in children aged 7-12 years in Ankara, Turkey

OBJECTIVE

Recent studies have reported an increasing prevalence of childhood hypertension. Obesity is probably the most important risk factor. The relationship between hypertension and BMI in children has not been studied in Ankara, which is the second largest city in Turkey.

DESIGN

Cross-sectional study analysing direct data on height, weight and blood pressure of students.

SETTING

Population-based study in Ankara, the capital city of Turkey.

SUBJECTS

In three schools, 2826 students aged 7-12 years.

RESULTS

The overall prevalence of hypertension was 7·9 %. Among the 222 hypertensive children, 124 (56 %) were boys and ninety-eight (44 %) were girls (P=0·40). In the whole group, 3·6 % had only systolic hypertension, 0·7 % had only diastolic hypertension and 3·5 % had both systolic and diastolic hypertension. The prevalences of overweight and obesity were both 13·9 %. BMI was significantly correlated with blood pressure (P<0·001). Overweight and obesity were more common in boys (P<0·001).

CONCLUSIONS

Hypertension was more common than has been reported in other studies. Blood pressure measurement should be routine and frequent in children, especially obese children.

Depression, anxiety and quality of life in caregivers of long-term home care patients

Family caregivers of patient in long-term care facilities often have high rates of stress, burden and psychological illness. A descriptive study was carried out with 63 caregivers. Caregivers were asked to complete a demographic questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Short form 36 (SF-36), which measures health related quality of life (QoL). The majority of caregivers were female (79.4%), and most often the daughter of the patient in long-term care (47.6%). The mean BDI score of the sample was 18.8, and the mean BAI score was 20.0. Almost all the mean scores referring to the QoL were decreased (lower than 50), with the exception of mental health. On the SF-36 questionnaire, the lowest scores were observed on the role-emotional, role-physical, social functioning and vitality scales of the SF-36.

A rare adverse effect of montelukast treatment: ecchymosis

Montelukast is a leukotriene receptor antagonist that is effective in the treatment of allergic rhinitis and asthma. We report a rare case of a 31-year-old woman with a history of allergic rhinitis and moderate persistent asthma, who experienced severe bruising on her lower extremities after starting montelukast treatment. Clinicians should be aware of the possibility of unusual bruising during montelukast therapy, and in those patients montelukast should be discontinued.

Thyroid-stimulating hormone (TSH) level in nutritionally obese children and metabolic co-morbidity

OBJECTIVE

In recent years, there has been increasing focus on thyroid function in pediatric obese patients. Our aims were to investigate whether there is an association between serum thyroid-stimulating hormone (TSH) within the normal range and body mass index (BMI), and to determine if TSH levels correlate with metabolic risk factors in children.

METHODS

A retrospective cross-sectional analysis was carried out on 528 euthyroid, age- and sex-matched lean, overweight, or obese children. Anthropometric indices, blood pressure, fasting blood glucose, hepatic enzymes, lipid profiles, TSH, free triiodothyronine (fT3), and free thyroxine (fT4) were assessed from medical records and compared among groups. Subjects with known presence of diabetes, using medications altering blood pressure and glucose or lipid metabolism, with TSH levels >97.5 or <2.5 percentile, or with autoimmune thyroid disease were excluded.

RESULTS

Hypertension, dyslipidemia, and elevated levels of hepatic enzymes were found to be more common in overweight and obese children (p<0.001), and those metabolic changes were significantly correlated with the increase in BMI (p<0.05). Serum concentrations of TSH and fT3 within the normal range were higher in overweight and obese children (p<0.01), and TSH was positively correlated with total cholesterol, triglycerides, and systolic blood pressure (p<0.05).

CONCLUSION

Our findings suggest that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure. It remains to be seen whether TSH might serve as a potential marker of metabolic risk factors in obese pediatric patients.

Persistence of protection of hepatitis B vaccine and response to booster immunization in 2- to 12-year-old children

Neonatal vaccination against hepatitis B virus (HBV) infection was launched in 1998 in Turkey. The aim was to evaluate the persistence of seroprotection after HBV vaccination in order to determine the necessity of a single booster dose in 2- to 12-year-old children. This study was conducted retrospectively using hospital records of the children aged 2-12 years old who attended the pediatric outpatient clinics of Diskapi Training and Research Hospital, Ankara, Turkey between January 2010 and June 2011. Children who had received three doses of HBV vaccination in their infancy were included. A total of 530 children enrolled into the study, and 352 (66.4 %) of them had protective antibody to hepatitis surface antigens (anti-HBs) titer greater than 10 mIU/ml. The proportions of children with low, intermediate, and high anti-HB titers are different for those under 3 years of age. The majority were in the intermediate category. Those aged 4-10 years and 11 or older represented two-thirds of the children with high titers (p = 0.000). None of the children had chronic HBV infection. Unprotected children responded well after receiving the booster dose. The mean anti-HB concentration after the booster dose was more than 200 times higher than the mean antibody concentration before (p < 0.001).

CONCLUSION

Our data suggest that HBV vaccination may confer long-term immunity. Use of routine booster doses of vaccine at these ages does not appear necessary to maintain long-term protection in successfully vaccinated immunocompetent children in the region.

Counselling and knowledge about contraceptive mode of action among married women; a cross-sectional study

Background

Family planning counselling which covers knowledge transfer about contraceptive mode of action, by enabling informed choice, improves compliance to and efficiency of contraceptive methods.

The objective of this study was to investigate associations between family planning counselling, counsellor and correct knowledge about mode of action of modern contraceptive methods among married women.

Methods

For this cross-sectional study, stratified (according to current modern contraceptive method in use) random sampling was performed from the registries of two primary health care centres. Main outcomes were; prevalence of family planning counselling, professional background of the counsellor and correct knowledge about mode of action. A semi-structured questionnaire developed by the researchers was applied via face-to-face interview. The answers about mode of action were categorized as correct vs. incorrect by consensus rating.

Results

Prevalence of counselling and correct knowledge about mode of action was 49.0% and 39.3%, respectively. Higher educated women were significantly more likely to know the mode of action (p < 0.001). Being counselled by a physician (54.1%, n = 120) was not associated with correct knowledge about mode of action (p = 0.79). Non-barrier method users were less educated (p = 0.001), more often counselled (60.8% vs. 8.0%) and less knowledgeable (p < 0.001) about mode of action of their contraceptive method, compared to condom users. Nevertheless, counselled non-barrier method users were significantly more likely to know the correct mode of action of their chosen method (p = 0.021) than counselled condom users.

Conclusion

The beneficial effect of counselling on knowledge about mode of action of the more complicated, medical (non-barrier) contraceptive methods suggests that the use of family planning counselling services in primary health care should be promoted; furthermore, counselling strategies and content should be re-structured for better efficacy.