[Adherence of physicians to colorectal cancer screening: which is their compliance to this strategy?]. / Adherencia de la población médica a los programas de rastreo de cáncer colorrectal: ¿Cuál es el cumplimiento de esta medida preventiva entre los profesionales?

BACKGROUND: Colorectal cancer (CRC) screening is strongly recommended as early diagnosis improves survival and reduces mortality. However, the adherence in general population is about 50% and even lower among physicians. OBJECTIVE: 1) To estimate the percentage of physicians that had done a screening test. 2) To estimate the frequency of tests used by these professionals. METHODS: We conducted an anonymous survey among 269 physicians, 50-year-old or more, from four hospitals and four scientific conventions in 2008. This validated survey included specialty, family history, compliance to screening, clinical features at screening, age, tests used reasons for having or not done the tests and results. RESULTS: Twenty-four hundred and two data surveys were included (response rate 90%). Average age was 58+6 years. Specialties were Internal Medicine (72%), Surgery (18%) and others (9%). One hundred physicians had a test done [41% (IC95% 35-47)]. The most used test was colonoscopy [70% (IC 95% 60-78)], followed by barium enema [10% (IC 95% 5-18)]. From screened physicians, 36% had family history of CRC, 63% did not and 1% was unaware of this antecedent. Physicians referred the following reasons for not being compliant: personal decision, fear of the procedure, insufficient knowledge of guidelines and lack of time. CONCLUSIONS: The compliance of physicians to CRC screening is suboptimal. New strategies should be implemented to achieve changes in health habits of physicians and compliance to preventive strategies.

Replacement of broad-spectrum cephalosporins by piperacillin-tazobactam: impact on sustained high rates of bacterial resistance.

We have previously observed a significant reduction of ceftriaxone resistance in Proteus mirabilis associated with an increase in the use of cefepime, along with a decrease in the consumption of broad-spectrum cephalosporins (CEP). However, we did not observe such a reduction with Klebsiella pneumoniae. Therefore, we sought to determine whether replacement of CEP by piperacillin-tazobactam might be useful in reducing sustained high rates of CEP resistance by this organism. We used a 6-month "before and after model"; during the second (intervention) period, most prescriptions of CEP were changed to piperacillin-tazobactam at the pharmacy. No additional barrier precautions were undertaken. During intervention, consumption of ceftazidime decreased from 17.73 to 1.14 defined daily doses (DDD) per 1,000 patient-days (P < 0.0001), whereas that of piperacillin-tazobactam increased from 0 to 30.57 DDD per 1,000 patient-days (P < 0.0001). The levels of resistance to CEP by K. pneumoniae and P. mirabilis decreased from 68.4 and 57.9% to 37.5 and 29.4%, respectively (P < 0.05). We conclude that replacement of ceftazidime by piperacillin-tazobactam might be a suitable strategy to decrease endemic CEP resistance by K. pneumoniae and P. mirabilis, even where there are high bacterial resistance rates and irrespective of any additional precautions for controlling nosocomial infection.