scholarly journals Diagnosis and Management of UTI in Primary Care Settings—A Qualitative Study to Inform a Diagnostic Quick Reference Tool for Women Under 65 Years

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 581
Author(s):  
Emily Cooper ◽  
Leah Jones ◽  
Annie Joseph ◽  
Rosie Allison ◽  
Natalie Gold ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Nurse Practitioners ◽  
Respiratory Infections ◽  
Theoretical Domains Framework ◽  
Signs And Symptoms ◽  
Diagnosis And Management ◽  
Skill Gaps ◽  
Management Guidance ◽  
Tract Infections

Background: To inform interventions to improve antimicrobial use in urinary tract infections (UTIs) and contribute to a reduction in Escherichia coli bloodstream infection, we explored factors influencing the diagnosis and management of UTIs in primary care. Design: Semi-structured focus groups informed by the Theoretical Domains Framework. Setting: General practice (GP) surgeries in two English clinical commissioning groups (CCGs), June 2017 to March 2018. Participants: A total of 57 GP staff within 8 focus groups. Results: Staff were very aware of common UTI symptoms and nitrofurantoin as first-line treatment, but some were less aware about when to send a urine culture, second-line and non-antibiotic management, and did not probe for signs and symptoms to specifically exclude vaginal causes or pyelonephritis before prescribing. Many consultations were undertaken over the phone, many by nurse practitioners, and followed established protocols that often included urine dipsticks and receptionists. Patient expectations increased use of urine dipsticks, and immediate and 5 days courses of antibiotics. Management decisions were also influenced by patient co-morbidities. No participants had undertaken recent UTI audits. Patient discussions around antibiotic resistance and back-up antibiotics were uncommon compared to consultations for respiratory infections. Conclusions: Knowledge and skill gaps could be addressed with education and clear, accessible, UTI diagnostic and management guidance and protocols that are also appropriate for phone consultations. Public antibiotic campaigns and patient-facing information should cover UTIs, non-pharmaceutical recommendations for “self-care”, prevention and rationale for 3 days antibiotic courses. Practices should be encouraged to audit UTI management.

scholarly journals Incidence of tuberculosis and opportunistic respiratory infections in cases of human immunodeficiency virus: a one-year study at a tertiary care hospital

2020 ◽  
Vol 7 (7) ◽  
pp. 1068
Author(s):  
Chintha Venkata Subrahmanyam ◽  
Mahesh Vidavaluru
Keyword(s):  
Respiratory Infections ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Pulmonary Complications ◽  
Care Hospital ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Management Protocol ◽  
One Year ◽  
Tract Infections

Background: Evaluation of respiratory signs and symptoms among HIV patients is a challenging task for a number of reasons. A definitive diagnosis is highly recommended before starting management protocol. Objectives of this study was to primarily evaluate the incidence of pulmonary tuberculosis and opportunistic respiratory infections among the cases of HIV and to estimate the CD4 counts of all the patients and correlate with the respiratory infections among the cases.Methods: The present study was a one-year study conducted at Narayana Medical College and all the cases of HIV presented with signs and symptoms of lower respiratory tract infections were included after obtaining consent. Relevant biochemical, microbiological investigations and CD4 counts of all the cases were done and noted. The data was entered in Microsoft excel spread sheet and analysed for any corrections. Mean, median and SD was calculated for all the continuous variables.Results: A total of 127 cases with 87 males and females 40 females with a ratio of 2.2:1 were included. Mean age of the total cases in the study was 46.12±8.3 years and 29.92% were above 60 years. Hetero sexual exposure was the commonest cause and 59.84% of cases were diagnosed with bacterial pneumonia. Prevalence of tuberculosis among the cases of this study was 22.05%. The mean CD4 cell count with SD among the study was 168.57±142.21.Conclusions: Knowledge of the pattern of pulmonary complications in patients with HIV infection in relation to CD4 count will help clinicians develop faster diagnostic and therapeutic approach to patient management.

scholarly journals Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care

2020 ◽  
Author(s):  
Volker Heinz Hackert ◽  
Nicole H.T.M. Dukers-Muijrers ◽  
Christian J.P.A. Hoebe
Keyword(s):  
Primary Care ◽  
Influenza A ◽  
Q Fever ◽  
Signs And Symptoms ◽  
Predictive Values ◽  
Influenza A H1n1 ◽  
Primary Care Patients ◽  
Acute Q Fever ◽  
Tract Infections ◽  
Respiratory Conditions

Abstract Background From early 2009, South Limburg, Netherlands, experienced a massive outbreak of Q fever, overlapping with the influenza A(H1N1)pdm09 pandemic during the second half of the year and affecting approximately 2.9% of the regional population. Acute Q fever shares clinical features with other respiratory conditions. Most symptomatic acute infections are characterized by mild symptoms, or an isolated febrile syndrome. Pneumonia was present in a majority of hospitalized patients during the Dutch 2007-2010 Q fever epidemic. Early empiric doxycycline, guided by signs and symptoms and patient history, should not be delayed awaiting laboratory confirmation, as it may shorten disease and prevent progression to focalized persistent Q fever. We assessed signs’ and symptoms’ association with acute Q fever to guide early empiric treatment in primary care patients. Methods In response to the outbreak, regional primary care and hospital-based specialty physicians tested a total of 1228 subjects for Q fever. Testing activity was bimodal, a first “wave” lasting from March to December 2009, followed by a second “wave” which lasted into 2010 and coincided with peak pandemic influenza activity. We approached all 253 notified acute Q fever cases and a random sample of 457 Q fever negative individuals for signs and symptoms of disease. Using data from 140/229(61.1%) Q fever positive and 194/391(49.6%) Q fever negative respondents from wave 1, we built symptom-based models predictive of Q-fever outcome, validated against each other and against our wave 2 data. Results Our models had moderate AUC scores (0.68% to 0.72%), with low positive (4.6-8.3%), but high negative predictive values (91.7-99.5%). Male sex, fever, and pneumonia were strong positive predictors, while cough was a strong negative predictor of acute Q fever in these models. Conclusion Whereas signs and symptoms of disease do not appear to predict acute Q fever, they may help rule it out in favour of other respiratory conditions, prompting a delayed or non-prescribing approach instead of early empiric doxycycline in primary care patients with non-severe presentations. Signs and symptoms thus may help reduce the overuse of antibiotics in primary care during and following outbreaks of Q fever.

A Patient With Abnormal Menses: Case Study of a Nurse Practitioner’s Approach to Diagnosis and Management of von Willebrand Disease

2016 ◽  
Vol 22 (2) ◽  
pp. 101-105
Author(s):  
Mirella Vasquez Brooks ◽  
D. Michael Brooks ◽  
Shirley Alvaro
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Blood Clotting ◽  
Von Willebrand Disease ◽  
Diagnostic Workup ◽  
Diagnosis And Management ◽  
Ongoing Care ◽  
Von Willebrand

Von Willebrand disease (vWD) is an inherited disorder that slows and hinders the blood clotting process. The literature on evaluation, diagnosis, and referral of vWD for nurse practitioners working in primary care is scant. This article presents the history and pathophysiology of vWD and a case study of an individual with vWD, including diagnostic workup, appropriate referral to a hematologist, and ongoing care.

scholarly journals What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e042626 ◽  
Author(s):  
Trisha Greenhalgh ◽  
Paul Thompson ◽  
Sietse Weiringa ◽  
Ana Luisa Neves ◽  
Laiba Husain ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Early Warning ◽  
Delphi Study ◽  
Signs And Symptoms ◽  
Early Warning Score ◽  
Rapid Review ◽  
Delphi Panel ◽  
Duration Of Symptoms ◽  
Published Evidence

BackgroundTo develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care.MethodsThe study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel, interviews, focus groups and software development. Participants were 112 primary care clinicians and 50 patients recovered from COVID-19, recruited through social media, patient groups and snowballing. Using rapid literature review, we identified signs and symptoms which are commoner in severe COVID-19. Building a preliminary set of items from these, we ran four rounds of an online Delphi panel with 72 clinicians, the last incorporating fictional vignettes, collating data on R software. We refined the items iteratively in response to quantitative and qualitative feedback. Items in the penultimate round were checked against narrative interviews with 50 COVID-19 patients. We required, for each item, at least 80% clinician agreement on relevance, wording and cut-off values, and that the item addressed issues and concerns raised by patients. In focus groups, 40 clinicians suggested further refinements and discussed workability of the instrument in relation to local resources and care pathways. This informed design of an electronic template for primary care systems.ResultsThe prevalidation RECAP-V0 comprises a red flag alert box and 10 assessment items: pulse, shortness of breath or respiratory rate, trajectory of breathlessness, pulse oximeter reading (with brief exercise test if appropriate) or symptoms suggestive of hypoxia, temperature or fever symptoms, duration of symptoms, muscle aches, new confusion, shielded list and known risk factors for poor outcome. It is not yet known how sensitive or specific it is.ConclusionsItems on RECAP-V0 align strongly with published evidence, clinical judgement and patient experience. The validation phase of this study is ongoing.Trial registration numberNCT04435041.

scholarly journals 2079. Outpatient Antimicrobial Stewardship Initiative to Reduce Unnecessary Use of Antibiotics in Patients with Upper Respiratory Infections: Findings Shared by a Metropolitan Community Hospital in NYC

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S701-S701
Author(s):  
Jilan Shah ◽  
Dora Izaguirre-Anariba ◽  
Hariprasad Rao ◽  
Yash Patel ◽  
Kyaw Zin Win ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Antimicrobial Stewardship ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
The United States ◽  
Primary Care Settings ◽  
Tract Infections ◽  
Dedicated Team

Abstract Background Antibiotic-resistant infections are one of the greatest public health issues with more than 2 million infections and 23,000 deaths per year in the United States. Reducing inappropriate antibiotic use is essential to reduce both antibiotic resistance and adverse events. The most important modifiable risk factor for antibiotic resistance is inappropriate prescribing of antibiotics. At least 30% of outpatient antibiotic prescriptions in the United States are unnecessary. We aimed to pilot our outpatient antimicrobial stewardship initiative to track and reduce antibiotic prescriptions among adult patients presenting with common acute respiratory infections in our hospital’s outpatient primary care settings. Methods A retrospective and prospective cohort study from October, 2017 to March, 2019. Implemented a robust outpatient antimicrobial stewardship initiative with a dedicated team and data analyst based on CDC core elements for outpatient antimicrobial stewardship and a prior UHF initiative. Data of common respiratory tract infections and the respective rates of antibiotic prescriptions from 3 adult primary care sites were collected from the EHR. Serials of educational interventions were performed between June, 2018 to September, 2018. We disseminated resources from the CDC and DOH like brochures, posters, viral prescription pads, pocket guidelines, grand rounds and electronic lectures for providers and periodic provider feedback reports. Results Our findings revealed that the physician compliance rate of antibiotics not prescribed for common respiratory tract infections remarkably improved from 72% to 85% after implementing our interventions (Figure 1). The chi-square test showed 40, and P value is 0.000034 which is less than 0.05. Thus, we are 95% confident that there is a significant association between our interventions and reduction of inappropriate antibiotic use (Figure 2). Conclusion Introduction of a robust and multifaceted Outpatient Antimicrobial Stewardship initiative with a dedicated team can substantially decrease outpatient antibiotic prescription rates for respiratory tract infections in metropolitan community hospital-based primary care settings. Disclosures All authors: No reported disclosures.

scholarly journals Understanding constraints on integrated care for people with HIV and multimorbid cardiovascular conditions: an application of the Theoretical Domains Framework

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Julie Schexnayder ◽  
Chris T. Longenecker ◽  
Charles Muiruri ◽  
Hayden B. Bosworth ◽  
Daniel Gebhardt ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Preventive Care ◽  
Healthcare Providers ◽  
Theoretical Domains Framework ◽  
Hiv Care ◽  
Care Providers ◽  
Cvd Risk ◽  
Link Type ◽  
Cvd Prevention

Abstract Background People with HIV (PWH) experience increased cardiovascular disease (CVD) risk. Many PWH in the USA receive their primary medical care from infectious disease specialists in HIV clinics. HIV care teams may not be fully prepared to provide evidence-based CVD care. We sought to describe local context for HIV clinics participating in an NIH-funded implementation trial and to identify facilitators and barriers to integrated CVD preventive care for PWH. Methods Data were collected in semi-structured interviews and focus groups with PWH and multidisciplinary healthcare providers at three academic medical centers. We used template analysis to identify barriers and facilitators of CVD preventive care in three HIV specialty clinics using the Theoretical Domains Framework (TDF). Results Six focus groups were conducted with 37 PWH. Individual interviews were conducted with 34 healthcare providers and 14 PWH. Major themes were captured in seven TDF domains. Within those themes, we identified nine facilitators and 11 barriers to CVD preventive care. Knowledge gaps contributed to inaccurate CVD risk perceptions and ineffective self-management practices in PWH. Exclusive prioritization of HIV over CVD-related conditions was common in PWH and their providers. HIV care providers assumed inconsistent roles in CVD prevention, including for PWH with primary care providers. HIV providers were knowledgeable of HIV-related CVD risks and co-located health resources were consistently available to support PWH with limited resources in health behavior change. However, infrequent medical visits, perceptions of CVD prevention as a primary care service, and multiple co-location of support programs introduced local challenges to engaging in CVD preventive care. Conclusions Barriers to screening and treatment of cardiovascular conditions are common in HIV care settings and highlight a need for greater primary care integration. Improving long-term cardiovascular outcomes of PWH will likely require multi-level interventions supporting HIV providers to expand their scope of practice, addressing patient preferences for co-located CVD preventive care, changing clinic cultures that focus only on HIV to the exclusion of non-AIDS multimorbidity, and managing constraints associated with multiple services co-location. Trial registration ClinicalTrials.gov, NCT03643705

scholarly journals Highlights for Management of a Child with a Urinary Tract Infection

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Sabeen Habib
Keyword(s):  
Urinary Tract ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Signs And Symptoms ◽  
Young Person ◽  
High Grade Fever ◽  
Need For Treatment ◽  
Gram Negative Organisms ◽  
Tract Infections

Urinary tract infections remain the most common bacterial infection in childhood.Escherichia coliis responsible for over 80% of Pediatric UTIs. Other common gram negative organisms include Kleibsiella, Proteus, Enterobacter and occasionally Pseudomonas. Signs and symptoms vary greatly by age of the patient becoming more specific as the child grows older. Even in the absence of specific signs a UTI should be included in the differential diagnosis of high grade fever. In younger children, presence of upper respiratory infections, otitis media or gastroenteritis does not eliminate the possibility of a UTI. Culture of the urine remains the gold standard for diagnosing UTIs. All males and females with well documented UTIs should be imaged for the presence of urological anomalies associated with UTI. Depending on patient's clinical symptoms and tolerance, therapy can be oral or parenteral as they have both been found equally efficacious. Healthcare professionals should ensure that when a child or young person has been identified as having a suspected UTI, they and their parents are given information about the need for treatment, the importance of completing any course of treatment and advice about prevention and possible long-term management.

Trends in primary-care consultations, comorbidities, and antibiotic prescriptions for respiratory infections in The Netherlands before implementation of pneumococcal vaccines for infants

2011 ◽  
Vol 140 (5) ◽  
pp. 823-834 ◽  
Author(s):  
A. M. M. VAN DEURSEN ◽  
T. J. M. VERHEIJ ◽  
M. M. ROVERS ◽  
R. H. VEENHOVEN ◽  
R. H. H. GROENWOLD ◽  
...  
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Respiratory Infections ◽  
Antibiotic Prescription ◽  
Primary Care Patient ◽  
Care Patient ◽  
Care Utilization ◽  
Preventive Strategies ◽  
Prescription Rates ◽  
Tract Infections

SUMMARYThe burden of respiratory infections is mainly seen in primary healthcare. To evaluate the potential impact of new preventive strategies against respiratory infections, such as the implementation of pneumococcal conjugate vaccines for infants in 2006 in The Netherlands, we conducted a baseline retrospective cohort study of electronic primary-care patient records to assess consultation rates, comorbidities and antibiotic prescription rates for respiratory infections in primary care. We found that between 1995 and 2005, overall registered consultation rates for lower respiratory tract infections had increased by 42·4%, upper respiratory infections declined by 4·9%, and otitis media remained unchanged. Concomitantly, there was a steady rise in overall comorbidity (75·7%) and antibiotic prescription rates (67·7%). Since Dutch primary-care rates for respiratory infections changed considerably between 1995 and 2005, these changes must be taken into account to properly evaluate the effect of population-based preventive strategies on primary-care utilization.

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