Differences in adherence to acute and long- term, guideline based medical therapies, in addition to numerous other patient care factors not evaluated in this study, could account for these findings.
To the best of our knowledge, this is the first study to show improved long-term guideline adherence following the implementation of a CDSS.
The French long-term guideline value was based on a study of Holmström et al. (1989), which investigated nasal histopathology in two groups of workers: one group was from a chemical plant and the other group comprised wood workers.
The value is also to be considered a long-term guideline value as sensory irritation was not considered to increase at repeated exposures as found in a recent mouse study.
The effects of dose levels, route, timing (life stages), and duration of BPA exposures on reported early and late effects, and whether there is a linkage between the low-dose early end points from short-term, small, basic exploratory studies and the outcomes from long-term guideline studies, need to be evaluated.
The WHO defined 10 µg/m as the long-term guideline value for PM2.5 together with three ITs of 35 µg/m (IT-1), 25 µg/m (IT-2) and 15 µg/m (IT-3); long-term exposure to IT-1, IT-2 and IT-3 levels increased the mortality risk by approximately 15%, 9% and 3%, respectively.
29 As mentioned above, an annual average PM2.5 concentration of 10 µg/m was regarded by WHO as the long-term guideline value for PM2.5; long-term exposure to an annual average concentration of more than 10 µg/m could increase mortality from lung cancer.
However, in the long term some guideline recommendations and some barriers are more important to address than others, with practice and policy implications.
Graziano asserts that the Bangladeshi standard reflects a somewhat arbitrary threshold, and that, over the long term, the WHO guideline should be followed whenever possible.
Reaching and maintaining the standard proposed by the guidelines for long term anaemia treatment in unselected populations of dialysis patients continues to be a very difficult goal to achieve in clinical practice.
1 Guidelines recommend long term use of low dose aspirin (75-150 mg/das) an an effective antiplatelet regimen for patients with cardiovascular disease, unless contraindicated. 2 3 Despite the strong evidence supporting the protective effects of low dose aspirin, discontinuation rates of around 50% have been reported in patients who have been taking this medication for several years.
