Limited end-user knowledge of methotrexate despite patient education: an assessment of rheumatologic preventive practice and effectiveness.

BACKGROUND: Methotrexate (MTX) is a first-line disease-modifying agent and anchor drug for biologic therapy used in rheumatoid arthritis and other inflammatory rheumatic disorders. Adverse effects are a common cause of drug discontinuation and include preventable serious incidents that may result in patient harm or death. OBJECTIVES: The objective of this study was to audit adherence by health professionals to national and international guidelines for patient education and risk reduction in patients prescribed MTX for inflammatory rheumatic diseases. METHODS: A combination of interviews, case record reviews, and self-administered patient knowledge questionnaires with individual patient feedback was used. The setting was the rheumatology outpatient department of a district general hospital. RESULTS: Fifty-one patients participated in the audit. The mean age was 58.6 (SD, 13.1) years and median duration of disease was 3.7 years (interquartile range, 1.7-7.6 years). Nurse-led patient education was documented at baseline for 94.1% of participants. Despite this, only 11.8% of participants recognized the potentially lethal drug-drug interaction with trimethoprim/Septrin (co-trimoxazole), and less than 60.8% recognized possible major adverse effects related to MTX. Although lifestyle implications relating to alcohol consumption and pregnancy/breast-feeding were recognized by the majority, only 52.9% of males were aware of recommendations in relation to conception. Univariable and multivariable analyses identified male sex, not speaking English as a first language, and a longer duration of therapy as predictors of lower levels of patient knowledge. CONCLUSIONS: Despite consistent baseline patient education, end-user knowledge and awareness pertinent to MTX safety are limited. Good-quality written information in the most appropriate language, patient feedback on educational programs, follow-up testing of patient knowledge, and targeted reeducation are recommended to address individual deficiencies in core knowledge.

Assessment of glacier status and its controlling parameters from 1990 to 2018 of Hunza Basin, Western Karakorum.

Ice masses and snow of Hunza River Basin (HRB) are an important primary source of fresh water and lifeline for downstream inhabitants. Changing climatic conditions seriously put an impact on these available ice and snow masses. These glaciers may affect downstream population by glacial lake outburst floods (GLOF) and surge events due to climatic variation. So, monitoring of these glaciers and available ice masses is important. This research delivers an approach for dynamics of major glaciers of the Hunza River Basin. We delineated 27 major glaciers of HRB and examined their status by using Landsat (OLI, ETM+, ETM, TM), digital elevation model (DEM) over the period of 1990-2018. In 1990, the total area covered by these glaciers is about 2589.75 ± 86 km2 and about 2565.12 ± 68km2 in 2018. Our results revealed that from 2009 to 2015, glacier coverage of HRB advanced with a mean annual advance rate of 2.22 ± 0.1 km2 a-1. Conversely, from 1994 to 1999, the strongest reduction in glacier area with a mean rate of - 3.126 ± 0.3 km2 a-1 is recorded. The glaciers of HRB are relatively stable compared to Hindukush, Himalayan, and Tibetan Plateau region of the world. The steep slope glacier's retreat rate is more than that of gentle slope glaciers, and the glaciers below an elevation of 5000 m above sea level change significantly. Based on climate data from 1995 to 2018, HRB shows a decreasing trend in temperature and increasing precipitation. The glacier area's overall retreat is due to an increase in summer temperature while the glacier advancement is induced possibly by winter and autumn precipitation.