Identification of pathogens from the upper respiratory tract of adult emergency department patients at high risk for influenza complications in a pre-Sars-CoV-2 environment

Objective To evaluate how evidence-based our daily practice was. Design Retrospective study. Setting Emergency department of a public district hospital. Patients and Methods Between 1st August 2000 to 7th August 2000, 91 patients' records were chosen at random. A chief diagnosis was assigned for each patient. Corresponding treatments were reviewed by searching relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses. Each patient had only one chief diagnosis but could have multiple interventions for that diagnosis. Results Out of 91 records, 14 were discarded. All of them had not been given any intervention and 11 required admission. For the remaining 77 records, there were 38 subjects in medical, paediatric, or gynaecological specialties and 39 in surgical or orthopaedic specialties. Intervention(s) given for each subject were then searched electronically through our hospital Knowledge Gateway and the results were expressed as either EBM-positive or EBM-negative. “EBM-positive” interventions denoted a support by RCTs. “EBM-negative” interventions denoted an absence of any supportive RCTs. Each patient might have EBM-positive and/or EBM-negative interventions together if that patient received more than one treatment. There were 52 patients (52/77 = 68%) who had one of their interventions being RCT-supported. The majority were patients with (1) antipyretic use of paracetamol in upper respiratory tract infection, or (2) control of pain by nonsteroidal anti-inflammatory drug, dologesic and paracetamol. There were 25 patients (25/77 = 32%) who did not receive any RCT-supported interventions. Concurrently 53 patients out of 77 (69%) received EBM-negative interventions. The majority were patients with (1) the use of antibiotics, antitussives and antihistamines in upper respiratory tract infection, (2) antispasmodics in gastroenteritis or patients with nonspecific abdominal pain, and (3) the use of analgesic balm in minor orthopaedic complaints. Conclusion Sixty-eight percent of patients had EBM-positive interventions. Thirty-two percent of patients did not receive any EBM-positive intervention. It was quite encouraging as compared to studies in other specialties with similar design. Concurrently 69% of patients had also been given EBM-negative interventions. There were areas for improvement if we were to implement EBM practice in the emergency department.

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Secretory IgA in Mucosa of Pharynx and Larynx Plays an Important Role against Influenza A Virus Infection in Kidney Yang Deficiency Syndrome Model

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/9316763 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Shaozhe Zhao ◽

Lei Yuan ◽

Yi Li ◽

Longchan Liu ◽

Zixin Luo ◽

...

Keyword(s):

High Risk ◽

Virus Infection ◽

Respiratory Tract ◽

Influenza A Virus ◽

Influenza A ◽

Morbidity And Mortality ◽

Secretory Iga ◽

Upper Respiratory Tract ◽

Gene Expressions ◽

Upper Respiratory

Objective. Influenza virus poses a major threat to human health and has serious morbidity and mortality which commonly occurs in high-risk populations. Pharynx and larynx of the upper respiratory tract mucosa is the first defense line against influenza virus infection. However, the ability of the pharynx and larynx organ to eliminate the influenza pathogen is still not clear under different host conditions. Methods. In this study, a mouse model of kidney yang deficiency syndrome (KYDS) was used to mimic high-risk peoples. Two different methods of influenza A (H1N1) virus infection by nasal dropping or tracheal intubation were applied to these mice, which were divided into four groups: normal intubation (NI) group, normal nasal dropping (ND) group, model intubation (MI) group, and model nasal dropping (MD) group. The normal control (NC) group was used as a negative control. Body weight, rectal temperature, and survival rate were observed every day. Histopathologic changes, visceral index, gene expressions of H1N1, cytokine expressions, secretory IgA (SIgA) antibodies of tracheal lavage fluids in the upper respiratory tract, and bronchoalveolar lavage fluids were analyzed by ELISA. Results. The MD group had an earlier serious morbidity and mortality than the others. MI and NI groups became severe only in the 6th to 7th day after infection. The index of the lung increased significantly in NI, MI, and MD groups. Conversely, indices of the thymus and spleen increased significantly in NC and ND groups. H&E staining showed severe tissue lesions in MD, MI, and NI groups. H1N1 gene expressions were higher in the MD group compared with the MI group on the 3rd day; however, the MD group decreased significantly on the 7th day. IL-6 levels increased remarkably, and SIgA expressions decreased significantly in the MD group compared with the NC group. Conclusions. SIgA secretions are influenced directly by different conditions of the host in the pharynx and larynx in the upper respiratory tract mucosa. In the KYDS virus disease mode, SIgA expressions could be inhibited severely, which leads to serious morbidity and mortality after influenza A virus infection. The SIgA expressions of the pharynx and larynx would be an important target in high-risk populations against the influenza A virus for vaccine or antiviral drugs research.

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An Analysis of Unscheduled Return Visits to the Accident and Emergency Department of a General Public Hospital

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790301000304 ◽

2003 ◽

Vol 10 (3) ◽

pp. 153-161 ◽

Cited By ~ 12

Author(s):

CP Ng ◽

CH Chung

Keyword(s):

Emergency Department ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Upper Respiratory Tract Infection ◽

Upper Respiratory Tract ◽

Related Factors ◽

Public Emergency ◽

Upper Respiratory ◽

Return Visits

Objectives To identify the reasons for unscheduled return visits to a public emergency department and possible strategies to reduce unscheduled return visits. Design Cross-sectional survey. Setting A public emergency department in Hong Kong. Patients Unscheduled return visits within 48 hours in a three-month period from 14 January 2000 to 15 April 2000. Main outcome measures Patients' epidemiological characteristics, reasons, complaints and outcome of the unscheduled return visits. Results During the study period, 3.3% (1,060) of the attendance was unscheduled return visits within 48 hours as recorded in the computerized A&E Information System of the hospital. However, only 738 patients (70%) responded to the questionnaire. These 738 patients formed the study population for further analysis. Illness-related factors accounted for 87% of the total unscheduled return visits. Patient-related factors were responsible for about 10% of unscheduled return visits. Doctor-related factors accounted for about 3% of unscheduled return visits. There was only one system-related unscheduled return visit. For the outcome of return visits, about 76% (559) was discharged after the second consultation. About 5% (40) was referred to specialist clinics. Around 24% (179) of patients was admitted. Of those admitted, 78% (140) was illness-related, 13% (23) was patient-related and 9% (16) was doctor-related. Upper respiratory tract infection was the most frequent complaint (34%), followed by painful conditions (23%) and injuries (10%). For children at or below 10 years of age, upper respiratory tract infection (60%) and febrile illness (15%) were the most frequent complaints. Conclusions The study found that the reasons for return visits were multiple. These “unscheduled return visits” should not be automatically regarded as poor indicator of service. Better patient education, organized family practice system, upgrading of professional training and targeted audit are possible means to reduce unscheduled return visits.

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1466. Antibiotic utilization reports may reduce prescribing practices for Upper Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1647 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S735-S735

Author(s):

David Augusto Terrero Salcedo ◽

Allison Kelly ◽

Victoria Tate

Keyword(s):

Emergency Department ◽

Respiratory Tract ◽

Antibiotic Prescription ◽

Upper Respiratory Tract ◽

Care Providers ◽

Post Intervention ◽

Face To Face ◽

Antibiotic Utilization ◽

Upper Respiratory ◽

Tract Infections

Abstract Background More than 90% of Upper respiratory tract infections (URI) have a viral etiology; nonetheless, these represent the most common reason for ambulatory antibiotic prescription. This translates in higher risk of antibiotic-related adverse events and promotion of antimicrobial resistance. Methods A prospective single-center intervention surveying and providing individual, face-to-face comparative reports of antibiotic utilization, for any of the 4 diagnostic entities that constitute upper respiratory tract infection (common cold, pharyngitis, acute rhinosinusitis and acute bronchitis), was performed in our Emergency Department. Example of monthly provider reports used which included general and individualized goals. Results A total of 12 health care providers were followed for 12 months. Education, prescribing reports and individual goals were provided. The pre-intervention prescription rate from September to December 2018 averaged 74.75% (SD 20.59, 95% CI 61.6-87.8), with a post-intervention rate of 55.5% from September to December of 2019 (SD 19.20, 95% CI 43.3-67.7) that was statistically significant (p=0.0036). A higher use of antibiotic was observed in physicians when compared to non-physician providers in both pre and post intervention stages (reduction of 16.6% vs 23% after intervention respectively), with no statistical difference between the two groups (CI 95% of -38.82 to 2.395, p=0.0773). A proposed target of 50% or less was observed in 5 of 12 providers (41.6%), and 2 out of 12 (16.7%) had increase in their antibiotic utilization rate. Comparative use of antimicrobials in the pre (September-December 2018) and post (September-December 2019) - intervention periods. Average individual antimicrobial use rate before and after intervention. Conclusion Routine face-to-face utilization reports may constitute an effective approach in reducing antibiotic prescription practices in the Emergency Department, and potentially, in other outpatient healthcare settings. Disclosures All Authors: No reported disclosures

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