Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria Are Underused in Clinical Practice.

BACKGROUND: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. They are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice. OBJECCTIVE: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks. METHODS: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU. RESULTS: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only rarely or sometimes. Use of AD and CU PROM is associated with being female, younger, and a dermatologist. The Patient-Oriented Scoring Atopic Dermatitis Index and Urticaria Activity Score were the most common PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. Users of AD and CU PROM would like training in selecting the proper PROM. CONCLUSIONS: Although PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.

Mitigation of ruminal methane production with enhancing the fermentation by supplementation of different tropical forage legumes.

The aim of this research was to evaluate the influence of forage species adapted to the tropical region of Ecuador on gas production, enteric methane, digestion, and ruminal fermentation. The tree forage evaluated were C. arborea, E. fusca, B. forficata, E. poeppigiana, C. argentea, G. sepium, C. tora, and F. macrophylla. Ruminal fluid of four adult sheep fistulated with permanent cannulas in the rumen was used in the in vitro gas production technique. The in vitro gas production parameters were lower (P < 0.05) in the C. arborea (A = 41.68 mL gas/g DM, c = 0.044%/h and Lag = 1.654 h) and the average gas production rate for B. forficata was 1.017 mL/h (P < 0.05). C. arborea presented higher (P = 0.0001) effective degradation and real DM digestibility (40.461 g/kg and 82.51 mg/g, respectively). With respect to VFA, the highest (P < 0.05) proportion of acetic, propionic, and butyric was observed in C. arborea, G. sepium, and E. poeppigiana (72.52, 23.09, and 7.44 mol/100 mol, respectively) and the lowest (P = 0.0001) ratio: acetic/propionic was observed in G. sepium (2.92 mol/100 mol). The content of NH3-N (mg/L) showed no difference. The lowest (P = 0.0001) methane production was observed in C. arborea (1.23 mL CH4/g DM). The use of forage species of tropical climate rich in secondary metabolites in ruminant diets has the capacity to reduce the gas production and enteric methane; however, this is at the expense of the reduction of the fermentation of organic matter in the rumen.