scholarly journals Associations with antibiotic prescribing for acute exacerbation of COPD in primary care

2021 ◽  
pp. BJGP.2020.0823
Author(s):  
David Gillespie ◽  
Christopher Butler ◽  
Janine Bates ◽  
Kerry Hood ◽  
Hasse Melbye ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Exacerbation ◽  
Point Of Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Bacterial Aetiology ◽  
Clinical Signs And Symptoms ◽  
Demographic Features

Background: C-reactive protein point-of-care testing (CRP-POCT) has been shown to reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care by 26%, without compromising patient care. Fewer than half of AECOPD patients present with bacterial aetiology and further safe reductions may be possible. Aim: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in UK primary care. Design and Setting: This was a secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care. Method: Clinicians collected participant’s demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made following participants being randomised to receive a point-of-care CRP measurement. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20mg/L, CRP ≥20mg/L). Results: We included 649 participants from 86 general practices across England and Wales. The odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio (AOR)=5.22,95%CI:3.24-8.41), wheeze (AOR=1.64,95% CI:1.07-2.52), diminished vesicular breathing (AOR=2.95,95%CI:1.70-5.10), or evidence of consolidation (AOR=34.40,95% CI:2.84-417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per-year increase =0.98,95% CI:0.95-1.00), as was the presence of heart failure (AOR=0.32,95% CI:0.12-0.85). Conclusion: Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. The diagnostic and prognostic value of these features may help identify further safe reductions.

scholarly journals Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review

2021 ◽  
pp. BJGP.2021.0319
Author(s):  
Hannah Harrison ◽  
Juliet A Usher-Smith ◽  
Lanxin Li ◽  
Lydia Eleanor Roberts ◽  
Zhiyuan Lin ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Cancer ◽  
Prediction Models ◽  
Assessment Tool ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Risk Patients ◽  
Clinical Signs And Symptoms ◽  
General Practise

Background: Timely diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at risk patients. Aim: This review identifies and compares published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent kidney or bladder cancer. Method: A search identified primary research reporting or validating models predicting the risk of bladder or kidney cancer in Medline and EMBASE. After screening identified studies for inclusion, we extracted data onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool. Results: The search identified 20,661 articles. Twenty studies (29 models) were identified through screening. All the models included haematuria (visible, non-visible or unspecified), and seven included additional signs and symptoms (such as abdominal pain). The models combined clinical features with other factors (including demographic factors and urinary biomarkers) to predict the risk of undiagnosed prevalent cancer. Most models (n=24) had acceptable-to-good discrimination (AUROC>0.7), however, only six have been externally validated. All of the studies had either high or unclear risk of bias (RoB). Conclusion: Models were identified that could be used in primary care to guide referrals, with potential to identify lower risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria. However, before application in general practise external validations in appropriate populations are required.

Infection surveillance in nursing homes in Stockholm County, Sweden, 2005 - 2014

2016 ◽  
Vol 12 (3) ◽  
Author(s):  
Ann Tammelin
Keyword(s):  
Nursing Homes ◽  
Infection Control ◽  
Urinary Catheter ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
County Council ◽  
Antibiotic Prescribing ◽  
Viral Gastroenteritis ◽  
Stockholm County ◽  
Infection Surveillance

Swedish nursing homes are obliged to have a management system for systematic quality work including self-monitoring of which surveillance of infections is one part. The Department of Infection Control in Stockholm County Council has provided a simple system for infection surveillance to the nursing homes in Stockholm County since 2002. A form is filled in by registered nurses in the nursing homes at each episode of infection among the residents. A bacterial infection is defined by antibiotic prescribing and a viral infection by clinical signs and symptoms. Yearly reports of numbers of infections in each nursing home and calculated normalized figures for incidence, i.e. infections per 100 residents per year, as well as proportion of residents with urinary catheter are delivered to the medically responsible nurses in each municipality by the Department of Infection Control. Number of included residents has varied from 4,531 in 2005 to 8,157 in 2014 with a peak of 10,051 in 2009. The yearly incidences during 2005 - 2014 (cases per 100 residents) were: Urinary tract infection (UTI) 7.9-16.0, Pneumonia 3.7-5.3, Infection of chronic ulcer 3.4–6.8, Other infection in skin or soft tissue 1.4–2.9, Clostridium difficile-infection 0.2–0.7, Influenza 0–0.4 and Viral gastroenteritis 1.2–3.7. About 1 % of the residents have a suprapubic urinary catheter, 6–7 % have an indwelling urinary catheter. Knowledge about the incidence of UTI has contributed to the decrease of this infection both in residents with and without urinary catheter.

scholarly journals Dementia and Major Neurocognitive Disorders: Some Lessons Learned One Century after the first Alois Alzheimer’s Clinical Notes

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 5
Author(s):  
Donatella Rita Petretto ◽  
Gian Pietro Carrogu ◽  
Luca Gaviano ◽  
Lorenzo Pili ◽  
Roberto Pili
Keyword(s):  
Young Woman ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Neurocognitive Disorders ◽  
Lessons Learned ◽  
Alzheimer Dementia ◽  
Clinical Notes ◽  
Alois Alzheimer ◽  
Clinical Signs And Symptoms

Over 100 years ago, Alois Alzheimer presented the clinical signs and symptoms of what has been later called “Alzheimer Dementia” in a young woman whose name was Augustine Deter [...]

scholarly journals Correction to: Levoketoconazole improves clinical signs and symptoms and patient-reported outcomes in patients with Cushing’s syndrome

Pituitary ◽  
2020 ◽  
Author(s):  
Eliza B. Geer ◽  
Roberto Salvatori ◽  
Atanaska Elenkova ◽  
Maria Fleseriu ◽  
Rosario Pivonello ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Patient Reported Outcomes ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Cushing's Syndrome ◽  
Original Version ◽  
Patient Reported ◽  
Author Group ◽  
Clinical Signs And Symptoms

The original version of the article unfortunately contained an error in the first name and the surname of one of the authors in the author group. The last author name was incorrectly published as ‘F. Pecori Giraldi’ and the corrected name is ‘Francesca Pecori Giraldi’ (First name: Francesca; Surname: Pecori Giraldi).

scholarly journals A 38-year demographic study of central and peripheral giant cell granulomas of the jaws

2016 ◽  
Vol 15 (2) ◽  
pp. 220-223 ◽  
Author(s):  
Shadi Saghafi ◽  
Reza Zare-Mahmoodabadi ◽  
Narges Ghazi ◽  
Mohammad Zargari
Keyword(s):  
Giant Cell ◽  
Medical Science ◽  
Age Distribution ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Posterior Maxilla ◽  
Frequent Site ◽  
Male Patients ◽  
Clinical Signs And Symptoms ◽  
Anterior Mandible

Objective: The purpose of this study was to retrospectively analyze the demographic characteristics of patients with central giant cell granulomas (CGCGs) and peripheral giant cell granulomas (PGCGs) in Iranian population.Methods: The data were obtained from records of 1019 patients with CGCG and PGCG of the jaws referred to our department between 1972 and 2010. This 38-year retrospective study was based on existing data. Information regarding age distribution, gender, location of the lesion and clinical signs and symptoms was documented. Results: A total of 1019 patients were affected GCGLs including 435 CGCGs and 584 PGCGs during the study. The mean age was 28.91 ± 18.16. PGCGs and CGCGs had a peak of occurrence in the first and second decade of life respectively. A female predominance was shown in CGCG cases (57.70%), whereas PGCGs were more frequent in males (50.85%). Five hundred and ninety-eight cases of all giant cell lesions (58.7 %) occurred in the mandible. Posterior mandible was the most frequent site for both CGCG and PGCG cases. The second most common site for PGCG was posterior maxilla (21%), whereas anterior mandible was involved in CGCG (19.45%). The majority of patients were asymptomatic. Conclusions: In contrast to most of previous studies PGCGs occur more common in the first decade and also more frequently in male patients. Although the CGCGs share some histopathologic similarities with PGCGs, differences in demographic features may be observed in different populations which may help in the diagnosis and management of these lesions.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.220-223

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