Guidelines for management of rheumatic diseases in developing countries from basics to real-world situation: relevance, need, and processes for development.

Guidelines or recommendations help to provide uniform standards in medical practice. The development of guidelines requires adherence to pre-defined norms prescribed by different international organizations such as the European League against Rheumatism (EULAR). We searched Pubmed and LILACS to identify published papers in five major rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies, osteoarthritis, and scleroderma) from different countries based on their economic prosperity and could find a lack of published literature from most economically weaker regions. Similarly, published guidelines in these rheumatic diseases were sparse from Asia and Africa, which are economically developed to a lesser extent than other regions of the world. Considering differing economic realities driving patient care in different regions of the world, unique challenges in certain geographic areas such as musculoskeletal manifestations of infectious diseases like leprosy and tuberculosis, as well as distinct risk of malignancies and other comorbid conditions, National Rheumatology societies should work towards developing more guidelines for rheumatic diseases from regions such as Asia and Africa, while following strictly the prescribed norms for the same. With a paucity of guidelines for such regions currently, an alternative (although less preferable) suggestion would be that major international societies, whose guidelines are widely read and followed the world over, should consider inputs from experts from diverse regions of the world while developing these guidelines.

Failure of a Best Practice Alert to Reduce Antibiotic Prescribing Rates for Acute Sinusitis Across an Integrated Health System in the Midwest.

BACKGROUND: Antimicrobial resistance is a growing concern, and in recent years, there has been increased interest in ambulatory antimicrobial stewardship. Acute rhinosinusitis (ARS) is one of the most common outpatient diagnoses that results in an antibiotic prescription. OBJECTIVE: To determine if a best practice alert (BPA) will affect the percentage of oral antibiotic prescriptions for adults with ARS. METHODS: A prospective, pre/post study was initiated to evaluate the percentage of oral antibiotic prescriptions for ARS in 117 primary care clinics in the Midwest. Included in the study results were 16,570 adults who had an office visit for ARS: 8,106 patients from December 1, 2015, to February 28, 2016, were in the pre-intervention group without an active BPA, and 8,464 patients from December 1, 2016, to February 28, 2017, were in the post-intervention group when the BPA was active. The primary outcome was the number of oral antibiotic prescriptions for ARS compared with the number of office visits for ARS in the pre- and postintervention groups. RESULTS: The percentage of oral antibiotics prescribed for the pre- and postintervention groups were 94.8% and 94.3%, respectively (P = 0.152). The BPA displayed for 7,780 visits, prompting discontinuation of an antibiotic for 10 (0.1%) visits in the postintervention group. CONCLUSIONS: This study suggests that, although an electronic alert may be attractive to facilitate antimicrobial stewardship, it may be ineffective. These results warrant alternative measures to facilitate ambulatory antimicrobial stewardship. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to declare. Study concept and design were contributed by Hansen, D. Leedahl, and N. Leedahl. Hansen and N. Leedahl took the lead in data collection, with assistance from Carson and D. Leedahl. Data interpretation was performed by all the authors. The manuscript was written by Hansen, along with the other authors, and revised by all the authors.

Paucibacilar ou multibacilar? Uma contribuiçäo para os serviços de saúde / Paucibacillary or multibacillary? A contribution to health services

A principal conseqüência de uma incorreta classificação operacional refere-se aos pacientes MB quando classificados como PB. Esse trabalho tem como proposta estudar a aplicabilidade das recomentações da Coordenação Nacional de Dermatologia Sanit ria/Ministério da Saúde (CNDS/MS) quanto aos procedimentos para a classificação operacional comparando primeiro os procedimentos para a classificação operacional efetuados pelo Instituto Estadual de Dermatologia Sanit ria - IEDS (Centro de referência) com o recomendado pela CNDS/MS. A seguir compara-se a classificação executada pelo IEDS, padrão ouro, com dois diferentes cen rios de serviços de saúde do país e finalmente compara-se os procedimentos da CNDS/MS com os realizados pelos técnicos de saúde do Estado de São Paulo. Esta última comparação foi realizada para demonstrar o grau de aderência dos serviços de saúde do Estado de São Paulo com os procedimentos recomendados pela CNDS/MS. A discordância observada entre a classificação do IEDS e a preconizada pela CNDS/MS é de 3,5 por cento por conta dos casos dimorfos e indeterminados. Se o resultado da baciloscopia fosse o único critério de alocação, 20 por cento dos MB seriam classificados e tratados como PB, e dos PB 5 por cento seriam tratados como MB. Se o teste com Mitsudina fosse usado como critério isolado dos MB 19 por cento seriam classificados e tratados como PB. Nos PB, 10 por cento seriam tratados como MB. A comparação da classificação do Estado de São Paulo contra a CNDS mostrou uma concordância de 95,8 por cento. Os resultados apontam no sentido de que as recomendações da CNDS/MS contituem-se num método de classificação de casos que prescinde de grande variedade de material de consumo, de equipamentos ou técnicas mais elaboradas permitindo que o profissional no nível local decida com segurança se os pacientes são MB e ou PB além de serem plenamente aplic veis numa grande rede de serviços públicos.