Use and quality of point-of-care microscopy, urine culture and susceptibility testing for urinalysis in general practice

ObjectivesTo investigate the effect of adding point-of-care (POC) susceptibility testing to POC culture on appropriate use of antibiotics as well as clinical and microbiological cure for patients with suspected uncomplicated urinary tract infection (UTI) in general practice.DesignOpen, individually randomised controlled trial.SettingGeneral practice.ParticipantsWomen with suspected uncomplicated UTI, including elderly patients above 65, patients with recurrent UTI and patients with diabetes. The sample size calculation predicted 600 patients were needed.InterventionsFlexicult SSI-Urinary Kit was used for POC culture and susceptibility testing and ID Flexicult was used for POC culture only.Main outcome measuresPrimary outcome: appropriate antibiotic prescribing on the day after consultation defined as either (1) patient with UTI: to prescribe a first-line antibiotic to which the infecting pathogen was susceptible or a second line if a first line could not be used or (2) patient without UTI: not to prescribe an antibiotic. UTI was defined by typical symptoms and significant growth in a reference urine culture performed at one of two external laboratories.Secondary outcomes: clinical cure on day five according to a 7-day symptom diary and microbiological cure on day 14. Logistic regression models taking into account clustering within practices were used for analysis.Results20 general practices recruited 191 patients for culture and susceptibility testing and 172 for culture only. 63% of the patients had UTI and 12% of these were resistant to the most commonly used antibiotic, pivmecillinam. Patients randomised to culture only received significantly more appropriate treatment (OR: 1.44 (95% CI 1.03 to 1.99), p=0.03). There was no significant difference in clinical or microbiological cure.ConclusionsAdding POC susceptibility testing to POC culture did not improve antibiotic prescribing for patients with suspected uncomplicated UTI in general practice. Susceptibility testing should be reserved for patients at high risk of resistance and complications.Trial registration numberNCT02323087; Results.

Download Full-text

Clinical accuracy of point-of-care urine culture in general practice

Scandinavian Journal of Primary Health Care ◽

10.1080/02813432.2017.1333304 ◽

2017 ◽

Vol 35 (2) ◽

pp. 170-177 ◽

Cited By ~ 6

Author(s):

Anne Holm ◽

Gloria Cordoba ◽

Tina Møller Sørensen ◽

Lisbeth Rem Jessen ◽

Niels Frimodt-Møller ◽

...

Keyword(s):

General Practice ◽

Urine Culture ◽

Point Of Care ◽

Clinical Accuracy

Download Full-text

An Observational Study of Gout Prevalence and Quality of Care in a National Australian General Practice Population

The Journal of Rheumatology ◽

10.3899/jrheum.150310 ◽

2015 ◽

Vol 42 (9) ◽

pp. 1702-1707 ◽

Cited By ~ 50

Author(s):

Philip C. Robinson ◽

William J. Taylor ◽

Nicola Dalbeth

Keyword(s):

General Practice ◽

Quality Of Care ◽

Point Of Care ◽

Serum Urate ◽

Practice Population ◽

Australian General Practice ◽

General Practices ◽

Low Levels ◽

Crude Prevalence

Objective.The central strategy for effective gout management is longterm urate-lowering therapy to maintain the serum urate at a level below 0.36 mmol/l. We sought to determine the prevalence of gout and the quality of care in a national Australian general practice population.Methods.Data were from general practice point-of-care electronic records over a 5-year period (n = 1,479,449). Information was collected on patients with gout according to a validated definition. All patients who visited the same general practices over the study period formed the denominator group. We determined the estimated prevalence of gout, the frequency of allopurinol prescription, and serum urate testing, and the percentage of patients achieving a target serum urate level.Results.The crude prevalence of gout in this general practice population was 1.54% (95% CI 1.52–1.56). Prevalence in men was 2.67% and in women 0.53%. Prevalence increased with age in both men and women (4.90%, 95% CI 4.82–4.99, in men > 65 yrs). Allopurinol was prescribed to 57% of patients with gout during the 5 years of the study. Only 55% of patients with gout had their serum urate tested at any time during the 5-year study period. A target serum urate concentration of < 0.36 mmol/l at any time during the 5-year study period was documented in 22.4% of all people with gout.Conclusion.Gout is managed poorly in Australian primary care, with low levels of allopurinol prescribing and serum urate testing. Collectively, these factors probably contribute to low achievement of serum urate targets.

Download Full-text

Quality of the Diagnostic Process, Treatment Decision, and Predictors for Antibiotic Use in General Practice for Nursing Home Residents with Suspected Urinary Tract Infection

Antibiotics ◽

10.3390/antibiotics10030316 ◽

2021 ◽

Vol 10 (3) ◽

pp. 316

Author(s):

Stine Dyhl Sommer-Larsen ◽

Sif Helene Arnold ◽

Anne Holm ◽

Julie Aamand Olesen ◽

Gloria Cordoba

Keyword(s):

General Practice ◽

Nursing Home ◽

Urinary Tract ◽

Urine Culture ◽

Treatment Decision ◽

Antibiotic Use ◽

Diagnostic Process ◽

Urinary Tract Symptoms ◽

Tract Infections

Urinary tract infections (UTIs) are common in nursing home (NH) residents and Denmark is one of the countries with the highest antibiotic use in NHs. The aim of this study was to assess the quality of the diagnostic process and treatment decision on the day of the first contact from NHs to general practice and assess predictors for prescription of antibiotics in NH residents without an indwelling urinary catheter. The study was a prospective observational study in general practice in the Capital Region of Denmark; 490 patients were included; 158 out of 394 (40.1%, 95% CI 35; 45) patients with suspected UTI had urinary tract symptoms; 270 out of 296 (91.2%, 95% CI 87; 94) patients without urinary tract symptoms had a urine culture performed. Performing urine culture in the general practice was inversely associated to prescription of antibiotics on day one (OR 0.27, 95% CI 0.13; 0.56). It is imperative to support the implementation of interventions aimed at improving the quality of the diagnostic process on day one, as less than half of the patients given the diagnosis “suspected UTI” had urinary tract symptoms, and most patients without urinary tract symptoms had a urine culture performed.

Download Full-text

Analytic laboratory performance of a point of care urine culture kit for diagnosis and antibiotic susceptibility testing

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-015-2460-4 ◽

2015 ◽

Vol 34 (10) ◽

pp. 2111-2119 ◽

Cited By ~ 8

Author(s):

E. Bongard ◽

N. Frimodt-Møller ◽

M. Gal ◽

M. Wootton ◽

R. Howe ◽

...

Keyword(s):

Antibiotic Susceptibility ◽

Susceptibility Testing ◽

Urine Culture ◽

Point Of Care ◽

Antibiotic Susceptibility Testing ◽

Laboratory Performance

Download Full-text

Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽

10.1186/s13054-020-03369-5 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Arif Hussain ◽

Gabriele Via ◽

Lawrence Melniker ◽

Alberto Goffi ◽

Guido Tavazzi ◽

...

Keyword(s):

Lung Ultrasound ◽

Expert Panel ◽

Point Of Care ◽

Expert Consensus ◽

Future Research ◽

Point Of Care Ultrasound ◽

The Past ◽

Modified Delphi ◽

Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Download Full-text

Stromal Vascular Fraction for Osteoarthritis of the Knee Regenerative Engineering

Regenerative Engineering and Translational Medicine ◽

10.1007/s40883-021-00226-x ◽

2021 ◽

Author(s):

Chinedu C. Ude ◽

Shiv Shah ◽

Kenneth S. Ogueri ◽

Lakshmi S. Nair ◽

Cato T. Laurencin

Keyword(s):

Quality Of Life ◽

Clinical Evidence ◽

Point Of Care ◽

Stromal Vascular Fraction ◽

Clinic Visit ◽

Osteoarthritis Of The Knee ◽

Clinical Patient ◽

Inflammatory Proteins ◽

Anti Inflammatory

Abstract Purpose The knee joint is prone to osteoarthritis (OA) due to its anatomical position, and several reports have implicated the imbalance between catabolic and anabolic processes within the joint as the main culprit, thus leading to investigations towards attenuation of these inflammatory signals for OA treatment. In this review, we have explored clinical evidence supporting the use of stromal vascular fraction (SVF), known for its anti-inflammatory characteristics for the treatment of OA. Methods Searches were made on PubMed, PMC, and Google Scholar with the keywords “adipose fraction knee regeneration, and stromal vascular fraction knee regeneration, and limiting searches within 2017–2020. Results Frequently found interventions include cultured adipose-derived stem cells (ADSCs), SVF, and the micronized/microfragmented adipose tissue-stromal vascular fraction (MAT-SVF). Clinical data reported that joints treated with SVF provided a better quality of life to patients. Currently, MAT-SVF obtained and administered at the point of care is approved by the Food and Drug Administration (FDA), but more studies including manufacturing validation, safety, and proof of pharmacological activity are needed for SVF. The mechanism of action of MAT-SVF is also not fully understood. However, the current hypothesis indicates a direct adherence and integration with the degenerative host tissue, and/or trophic effects resulting from the secretome of constituent cells. Conclusion Our review of the literature on stromal vascular fraction and related therapy use has found evidence of efficacy in results. More research and clinical patient follow-up are needed to determine the proper place of these therapies in the treatment of osteoarthritis of the knee. Lay Summary Reports have implicated the increased inflammatory proteins within the joints as the main cause of osteoarthritis (OA). This has attracted interest towards addressing these inflammatory proteins as a way of treatment for OA. The concentrated cell-packed portion of the adipose product stromal vascular fraction (SVF) from liposuction or other methods possesses anti-inflammatory effects and has been acclaimed to heal OA. Thus, we searched for clinical evidence supporting their use, for OA treatment through examining the literature. Data from various hospitals support that joints treated with SVF provided a better quality of life to patients. Currently, there is at least one version of these products that are obtained and given back to patients during a single clinic visit, approved by the FDA.

Download Full-text

Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

Conflict and Health ◽

10.1186/s13031-021-00342-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Keely Jordan ◽

Todd P. Lewis ◽

Bayard Roberts

Keyword(s):

Systematic Review ◽

Health System ◽

Health Systems ◽

Point Of Care ◽

System Level ◽

System Quality ◽

High Quality ◽

Humanitarian Settings ◽

Quality Health

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

Download Full-text

Improving the Quality of Children’s Mental Health Care with Progress Measures: A Mixed-Methods Study of PCIT Therapist Attitudes

Administration and Policy in Mental Health and Mental Health Services Research ◽

10.1007/s10488-021-01156-0 ◽

2021 ◽

Author(s):

Corinna C. Klein ◽

B. Erika Luis Sanchez ◽

Miya L. Barnett

Keyword(s):

Mental Health ◽

Health Care ◽

General Practice ◽

Qualitative Interviews ◽

Behavioral Observation ◽

Parent Report ◽

Therapist Attitudes ◽

Child Interaction ◽

Report Measure

AbstractProgress measures are an evidence-based technique for improving the quality of mental health care, however, clinicians rarely incorporate them into treatment. Research into how measure type impacts clinician preference has been recommended to help improve measure implementation. Parent–Child Interaction Therapy (PCIT) is an assessment-driven treatment that serves as an ideal intervention through which to investigate measure preferences given its routine use of two types of assessments, a behavioral observation (the Dyadic Parent–Child Interaction Coding System) and a parent-report measure (the Eyberg Child Behavior Inventory). This study investigated PCIT therapist attitudes towards progress measures used within PCIT and children’s mental health treatment generally. A mixed-method (QUAN + QUAL) study design examined PCIT therapist attitudes towards two types of progress measures and measures used in two contexts (PCIT and general practice). Multi-level modeling of a survey distributed to 324 PCIT therapists identified predictors of therapist attitudes towards measures, while qualitative interviews with 23 therapists expanded and clarified the rationale for differing perceptions. PCIT therapists reported more positive attitudes towards a behavioral observation measure, the DPICS, than a parent-report measure, the ECBI, and towards measures used in PCIT than in general practice. Clinician race/ethnicity was significantly related to measure-specific attitudes. Qualitative interviews highlighted how perceptions of measure reliability, type of data offered, ease of use, utility in guiding sessions and motivating clients, and embeddedness in treatment protocol impact therapist preferences. Efforts to implement progress monitoring should consider preferences for particular types of measures, as well as how therapists are trained to embed measures in treatment.

Download Full-text

The quality of prescribing in general practice in Kerman, Iran

International Journal of Health Care Quality Assurance ◽

10.1108/09526860510612207 ◽

2005 ◽

Vol 18 (5) ◽

pp. 353-360 ◽

Cited By ~ 11

Author(s):

Gholamreza‐Sepehri ◽

Manzumeh‐Shamsi Meimandi

Keyword(s):

General Practice ◽

Quality Of Prescribing

Download Full-text