Background: High systolic blood pressure is the leading risk factor for global mortality. Applying effective strategies to control hypertension is a rising concern. Guidelines are approved to be effective in the management of patients with cost‑ effective interventions. The aim of this study is to evaluate the adherence of family physicians working in Isfahan health centers to the national hypertension Guideline, in 2019. Methods: Using a cross‑ sectional study, the practice of 43 physicians selected by a multistage sampling method from the perspective of hypertension management was observed in 377 visits. The data gathering form was designed according to the national hypertension Guideline. adherence to the Guideline was evaluated by dividing the earned score by the most score one can earn. Data were analyzed using Independent T‑ test, Pearson correlation and linear regression model. Results: The mean score of adherence to the national hypertension Guideline was 33. 6 ± 16. 42%. There was a significant association between physician’ s sex, years passed from graduation, type of occupation contract, type of university of education, and attending empowerment class and adherence to the national hypertension Guideline. Conclusions: The results of our study show that family physicians just follow one‑ third of the recommendations in the national hypertension Guideline.

Antibiotic Guidelines have proven to be a simple and effective intervention to guide the choice of appropriate empiric antibiotic regimens. The goals of this study were to evaluate adherence to Guidelines and streamlining of antibiotics. Hospital records of hospitalized patients in infectious diseases ward Imam Khomeini Hospital, Tehran, Iran, from May 2008 to September 2009 were reviewed.adherence to Guideline was defined as the use of empiric antibiotic in accordance with the clinical diagnosis and local Guideline recommendations.In this study, 528 patients with a confirmed infectious disease diagnosis were considered for analysis.The four most frequent diagnoses were skin and soft tissue infections, tuberculosis, respiratory tract infections, and HIV associated opportunistic infections. The most frequent prescribed antibiotic was ceftriaxone.Overall adherence to Guideline was 70.8% and the adherence for the most frequent diagnosis was 68%. Frequency of compatibility with the Guidelines for were administrated regimes on the basis of drug selection, dosage form and drug dosing were 86.2%, 97% and 84.7%, respectively. The mean lag time between patients’ hospital admission and starting empiric therapy was 1.69±4.9 days. In general, physicians’ adherence with Guidelines for empiric antibiotic therapy was high in infectious disease ward with a justified delay. Larger studies are required to establish these conclusions.

Objective: Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism is a preventable complication in hospitalized trauma patients. Currently, the VTE Guideline is the standard of care. However, underutilization of the Guideline was reported. This study aimed to report the adherence to the VTE Guideline in a Level 1 trauma center in Thailand. Methods: A retrospective review was performed on adult trauma patients admitted between January and December 2013. The inclusion criteria were Injury Severity Score ≥ 9 and admission in the hospital ≥ 7 days. The patients were classified into “ very high risk of DVT, ” “ high risk of DVT, ” and “ high risk of bleeding” groups according to the hospital Guideline. adherence to the Guideline, utility of the prophylaxis, and VTE occurrence were recorded. Results: During a 12-month period, 352 cases met the inclusion criteria. The overall adherence to the Guideline was 28. 9%, 5. 2% in the “ very high risk of DVT” group, 18. 4% in the “ high risk of DVT” group, and 57. 9% in the “ high risk of bleeding” group. VTE occurrence was 11 incidences in 10 patients (2. 8%). The “ high risk of bleeding” group had the highest in VTE occurrence (10 of 11 incidences). Conclusions: The adherence to the VTE prophylaxis Guideline in Thailand was higher than previous studies. The pharmacological prophylaxis should be initiated as soon as possible.

Background: Prophylactic antibiotics can reduce post-surgical infection rates, but their improper use in surgery remains a significant concern. This misuse leads to adverse drug reactions, increased bacterial resistance, and unnecessary hospital costs. Objectives: This study aimed to examine and compare prophylactic antibiotic prescribing practices in general surgery departments at two Tehran university hospitals, in relation to established Guidelines. Methods: A cross-sectional study was conducted on 194 surgical patients. Data collection included demographic details, surgery type, and antibiotic prophylaxis protocols, covering medication type, dosage, pre-surgical timing, and prophylaxis duration. Results: The study included 27.8% clean surgeries and 72.2% clean-contaminated surgeries. Cefazolin was the primary antibiotic prescribed. According to the American Society of Health-System Pharmacists (ASHP) treatment Guidelines, 10% of patients received antibiotics without proper indication. Among the 90 cases requiring antibiotic prophylaxis, appropriate antibiotic selection occurred in 39.0% of cases at Rasul Akram Hospital and 41.5% at Firouzgar Hospital. In these cases, errors were noted in dosing (79.8%), pre-operative timing (97.4%), and administration protocol (100%). Only 33% of cases followed the optimal prophylaxis duration. Conclusions: These hospitals require an evidence-based antibiotic prescription program that adheres to clinical Guidelines and includes close monitoring of implementation. Regular training and review of clinical Guidelines are essential for all healthcare professionals.

2Background: The purpose of this study was to evaluate the adherence to the ESC 2020 Guideline for the management of NSTE-ACS patients admitted to Shahid Chamran Cardiology Hospital affiliated to Isfahan University of Medical Sciences in 2021. Methods: In this retrospective study which was done during April 2021 to September 2021 we reviewed the hospital documents of 239 NSTE-ACS patients, in regard to prescribed medication during the admission period in Shahid Chamran Heart Center. Guideline-adherence was evaluated according to ESC2020 Guideline. Totally 18 items were evaluated including Antiplatelet (Clopidogrel, Ticagrelor, and Prasugrel) Anticoagulant (Heparin or Enoxaparin), PPI, Statin, Beta blocker, and RAAS blockers (including ACEI/ARB or MRA). In each section the selected drug and the administered dose were compared with the Guideline and the Guideline adherence for each part was expressed as percent. Results: Almost complete Guideline adherence was described for 12 out of 18 reviewed items (77%). However, Guideline adherence in relation to the type of medicine chosen as an antiplatelet was reported to be very low, and only 1. 2% of the cases received ticagrelor or prasugrel which are the Guideline recommended antiplatelet agent. Additionally, most of the administered GP2b3a antagonist agents such as eptifibatide were not in accordance with the Guideline (Guideline adherence 39. 74%). Also, the choice of the anticoagulant agent was among the items with low Guideline adherence (29. 76%) and the cross-over between anticoagulants (changing heparin to enoxaparin or vice versa) which has been inhibited by the Guideline was seen with high incidence in this center (78 cases). Conclusion: The present study showed relatively high Guideline adherence in the most aspects of medical management. However, compliance was reported to be low in relation to the antiplatelet selection, the choice of the anticoagulant agent, and the indication for GP2b3a antagonist use, which maybe due to the higher cost of recommended agents, and shortage of some medications and dosage forms in Iran

Background: Venous thromboembolism (VTE) exerts a considerable burden on the health care systems. Although many practice Guidelines have been developed regarding prophylaxis and treatment of venous thromboembolism, there is a large gap between the recommendations and the medical practice in health care centers. In this study, we tried to assess adherence of the medical team to Guidelines for venous thromboprophylaxis in medical and surgical wards of teaching hospitals affiliated to Shiraz University of Medical Sciences.Materials and Methods: In this cross-sectional descriptive study, a total number of 500 patients were recruited among hospitalized patients in neurosurgery, orthopedics, general surgery, internal medicine, and obstetrics & gynecology departments and surgical and medical intensive care units.Afterwards, adherence to thromboprophylaxis Guidelines was assessed by comparing the medical records of patients with proper indications extracted from the American College of Chest Physicians Guidelines for VTE prophylaxis (ACCP, 9th edition). In other words, for each patient a comparison between proper indications of receiving thromboprophylaxis and the regimen used in practice was made.Results: Out of 472 patients assessed with respect to the appropriateness of the administered prophylaxis, 212 (45.1%) had received proper type of thromboprophylaxis with regard to ACCP Guidelines. Orthopedic surgical wards showed the highest rate of appropriateness while neurosurgical wards showed the lowest rate of adherence (76% vs.1.8%). The overall rate of inappropriateness was 54.9% (260 patients). Inappropriateness was divided into 3 categories: 1) patients had absolute indications to receive thromboprophylaxis but were not provided with any type of prophylaxis in practice (171 patients, 36.2% of total), 2) in presence of absolute indications, incorrect type of prophylaxis was administered (52 patients, 11% of total), 3) in absence of indications for thromboprophylaxis, patients received some forms of prophylaxis (35 patients, 7.4% of total).Conclusion: The findings of the present study showed that prophylaxis are not properly utilized and physicians’ practices vary considerably among different specialties.