Non-adherence to guideline recommendations for insulins: a qualitative study amongst primary care practitioners - BMC Primary Care

According to Cabana et al., barriers in the domain of knowledge refer to the lack of familiarity with or awareness of the guideline [Perspectives concerning attitude were most frequent, with lack of agreement as the most prominent category.

Yes, and that's why I think it's somewhat remarkable that practice nurse X just said “I prefer to start with this [insulin degludec], because then I might be able to continue it for a long time”. Meanwhile I'm thinking, you don't know what will be sufficient for the patient.

But I doubt if it [choosing glargine 100 U/ml instead of NPH insulin because of the risk of hypoglycemia] is because of the fear rather than the actual risk of nocturnal hypoglycemiaOne perspective concerning the lack of outcome expectancy was identified. Some healthcare professionals preferred non-recommended insulins for poorly controlled T2DM patients, because they believed guideline-recommended insulins had a lower glucose-lowering potential than other insulins.

Ahh, I prefer NPH insulin. But I checked my actual prescriptions, and then I saw something else. Ahh… the practice nurse, she’d choose Lantus [insulin glargine 100 U/ml] every timeIn some situations, patients’ abilities restricted the use of guideline-recommended insulins. For example, patients using NPH insulin need to resuspend the insulin before administration. According to the healthcare professionals, not all patients are capable to do this, thus requiring another insulin.

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Adiposity and grip strength: a Mendelian randomisation study in UK Biobank - BMC MedicineBackground Muscle weakness, which increases in prevalence with age, is a major public health concern. Grip strength is commonly used to identify weakness and an improved understanding of its determinants is required. We aimed to investigate if total and central adiposity are causally associated with grip strength. Methods Up to 470,786 UK Biobank participants, aged 38–73 years, with baseline data on four adiposity indicators (body mass index (BMI), body fat percentage (BF%), waist circumference (WC) and waist-hip-ratio (WHR)) and maximum grip strength were included. We examined sex-specific associations between each adiposity indicator and grip strength. We explored whether associations varied by age, by examining age-stratified associations (| 50 years, 50–59 years, 60–64 years,65 years +). Using Mendelian randomisation (MR), we estimated the strength of the adiposity–grip strength associations using genetic instruments for each adiposity trait as our exposure. Results In males, observed and MR associations were generally consistent: higher BMI and WC were associated with stronger grip; higher BF% and WHR were associated with weaker grip: 1-SD higher BMI was associated with 0.49 kg (95% CI: 0.45 kg, 0.53 kg) stronger grip; 1-SD higher WHR was associated with 0.45 kg (95% CI:0.41 kg, 0.48 kg) weaker grip (covariate adjusted observational analyses). Associations of BMI and WC with grip strength were weaker at older ages: in males aged | 50 years and 65 years + , 1-SD higher BMI was associated with 0.93 kg (95% CI: 0.84 kg, 1.01 kg) and 0.13 kg (95% CI: 0.05 kg, 0.21 kg) stronger grip, respectively. In females, higher BF% was associated with weaker grip and higher WC was associated with stronger grip; other associations were inconsistent. Conclusions Using different methods to triangulate evidence, our findings suggest causal links between adiposity and grip strength. Specifically, higher BF% (in both sexes) and WHR (males only) were associated with weaker grip streng
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Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study - BMC CancerBackground Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. Methods We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009–2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan–Meier estimator and Cox regression with shared frailty. Results The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85–0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. Conclusion This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. Trial reg
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Less meat in the shopping basket. The effect on meat purchases of higher prices, an information nudge and the combination: a randomised controlled trial - BMC Public HealthBackground Reduced meat consumption benefits human and planetary health. Modelling studies have demonstrated the significant health and environmental gains that could be achieved through fiscal measures targeting meat. Adding other interventions may enhance the effect of a fiscal measure. The current study aimed to examine the effect of higher meat prices, an information nudge and a combination of both measures on meat purchases in a three-dimensional virtual supermarket. Methods A parallel designed randomised controlled trial with four conditions was performed. Participants (≥ 18 years) were randomly assigned to the control condition or one of the experimental conditions: a 30% price increase for meat (‘Price condition’), an information nudge about the environmental impact of meat production and consumers’ role in that regard (‘Information nudge condition’) or a combination of both (‘Combination condition’). Participants were asked to shop for their household for one week. The primary outcome was the difference in the total amount of meat purchased in grams per household per week. Results Between 22 June 2020 and 28 August 2020, participants were recruited and randomly assigned to the control and experimental conditions. The final sample included 533 participants. In the ‘Combination condition’, − 386 g (95% CI: − 579, − 193) meat was purchased compared with the ‘Control condition’. Compared to the ‘Control condition’ less meat was purchased in the ‘Price condition’ (− 144 g (95%CI: − 331, 43)), although not statistically significant, whereas a similar amount of meat was purchased in the ‘Information nudge condition’ (1 g (95%CI: − 188, 189)). Conclusion Achieving the most pronounced effects on reduced meat purchases will require a policy mixture of pricing and an information nudge. Less meat is purchased in a virtual supermarket after raising the meat price by 30% combined with an information nudge. The results could be used to design evidence-based policy measure
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