4,659 research outputs found
Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial
Background:
‘When should I worry?’ is an interactive booklet for parents of children presenting with respiratory tract infections (RTIs) in primary care and associated training for clinicians. A randomised controlled trial (the EQUIP study) demonstrated that this intervention reduced antibiotic prescribing and future consulting intentions. The aims of this qualitative process evaluation were to understand how acceptable the intervention was to clinicians and parents, how it was implemented, the mechanisms for any observed effects, and contextual factors that could have influenced its effects.<p></p>
Methods:
Semi-structured interviews were conducted with 20 parents and 13 clinicians who participated in the trial. Interviews were audio-recorded and transcribed verbatim. Data were analysed using a framework approach, which involved five stages; familiarisation, development of a thematic framework, indexing, charting, and interpretation.<p></p>
Results:
Most parents and clinicians reported that the ‘When should I worry’ interactive booklet (and online training for clinicians) was easy to use and valuable. Information on recognising signs of serious illness and the usual duration of illness were most valued. The interactive use of the booklet during consultations was considered to be important, but this did not always happen. Clinicians reported lack of time, lack of familiarity with using the booklet, and difficulty in modifying their treatment plan/style of consultation as barriers to use. Increased knowledge and confidence amongst clinicians and patients were seen as key components that contributed to the reductions in antibiotic prescribing and intention to consult seen in the trial. This was particularly pertinent in a context where decisions about the safe and appropriate management of childhood RTIs were viewed as complex and parents reported frequently receiving inconsistent messages.
Conclusions:
The ‘When should I worry’ booklet, which is effective in reducing antibiotic prescribing, has high acceptability for clinicians and parents, helps address gaps in knowledge, increases confidence, and provides a consistent message. However, it is not always implemented as intended. Plans for wider implementation of the intervention in health care settings would need to address clinician-related barriers to implementation
'Experience talks': physician prioritisation of contrasting interventions to optimise management of acute cough in general practice
Background
Uptake of interventions to improve quality of care by clinicians is variable and is influenced by clinicians' attitudes. The influence of clinicians' experience with an intervention on their preference for adopting interventions is largely unknown.
Methods
Thematic analysis of semi-structured interviews exploring views and attitudes towards an illness-focused intervention (specific communication skills training) and a disease-focused intervention (C-reactive protein, or CRP, point-of-care testing) to optimize management of lower respiratory tract infections (LRTI) among general practitioners (GPs) who had used both interventions for two years in a randomised trial (exposed GPs), and GPs without experience of either intervention (non-exposed GPs).
Results
All but two of the ten non-exposed GPs indicated that they would prioritise implementation of the disease-focused intervention of CRP testing over communication skills training, while all but one GP in the exposed group said that they would prioritise the illness-focused approach of communication skills training as it was more widely applicable, whereas CRP testing was confirmatory and useful in a subgroups of patients.
Conclusion
There are differences in attitudes to prioritising contrasting interventions for optimising LRTI management among GPs with and without experience of using the interventions, although GPs in both groups recognised the importance of both approaches to optimise management of acute cough. GPs' experiences with and attitudes towards interventions need to be taken into account when planning rollout of interventions aimed at changing clinical practice
Comment on Rishu et al. Time required to initiate outbreak and pandemic observational research
We applaud the work of Rishu and colleagues in tracking the timelines to initiation of outbreak and pandemic observational research. Through this work they highlight the challenges in being prepared with a clinical research response in the next pandemic. Pandemics are unpredictable but also recurrent. Recent experience of Ebola and Zika outbreaks highlight the devastating impact these outbreaks have on the health, economy and security of communities for generations to come
Severe Lumbar Disability Is Associated With Decreased Psoas Cross-Sectional Area in Degenerative Spondylolisthesis
Study Design: Retrospective cohort. Objectives: Alterations in lumbar paraspinal muscle cross-sectional area (CSA) may correlate with lumbar pathology. The purpose of this study was to compare paraspinal CSA in patients with degenerative spondylolisthesis and severe lumbar disability to those with mild or moderate lumbar disability, as determined by the Oswestry Disability Index (ODI). Methods: We retrospectively reviewed the medical records of 101 patients undergoing lumbar fusion for degenerative spondylolisthesis. Patients were divided into ODI score ≤40 (mild/moderate disability, MMD) and ODI score \u3e40 (severe disability, SD) groups. The total CSA of the psoas and paraspinal muscles were measured on preoperative magnetic resonance imaging (MRI). Results: There were 37 patients in the SD group and 64 in the MMD group. Average age and body mass index were similar between groups. For the paraspinal muscles, we were unable to demonstrate any significant differences in total CSA between the groups. Psoas muscle CSA was significantly decreased in the SD group compared with the MMD group (1010.08 vs 1178.6 mm2, P =.041). Multivariate analysis found that psoas CSA in the upper quartile was significantly protective against severe disability (P =.013). Conclusions: We found that patients with severe lumbar disability had no significant differences in posterior lumbar paraspinal CSA when compared with those with mild/moderate disability. However, severely disabled patients had significantly decreased psoas CSA, and larger psoas CSA was strongly protective against severe disability, suggestive of a potential association with psoas atrophy and worsening severity of lumbar pathology. © The Author(s) 2018
Conditional versus non-conditional incentives to maximise return of participant completed questionnaires in clinical trials: a cluster randomised study within a trial
Background High participant retention enhances the validity of clinical trials. A monetary incentive can increase retention, but it is not known if when it is provided and if it is conditional matters. We aimed to determine whether there was a difference in the number of follow-up trial questionnaires returned when a monetary (gift voucher) incentive was given to participants at recruitment (non-conditional), compared to informing participants at recruitment that the incentive would be given only once their 14-day daily diary (questionnaire) had been returned (conditional).
Method A cluster randomised study within a trial embedded within the Antivirals for influenza-Like Illness, An rCt of Clinical and Cost effectiveness in primary CarE (ALIC4E) Trial. Matched site pairs (GP practices) were randomised using computer-generated random numbers, to either a non-conditional or conditional monetary voucher incentive (only once their 14-day daily diary (questionnaire) had been returned. Sites were matched on previous recruitment levels and practice list size. Analyses were conducted according to randomised groups irrespective of compliance with a two-sided 5% level statistical significance level. The main analysis of the primary outcome (site proportion of diaries returned) was linear regression accounting for site pair (using cluster-robust variance). Additional weighted, paired and non-parametric sensitivity analyses were conducted. Secondary outcomes were the site average number of completed pages, time to return diary, and cost related to the incentive (administration and postage).
Results Of the 42 randomised sites (21 for each intervention), only 28 recruited at least one participant with only 10 practice pairs recruiting participants at both constituent sites. Raw diaries return proportions were 0.58 (127/220) and 0.73 (91/125) for non-conditional and conditional incentive groups. Regression analysis adjusted for site pair showed no significant difference in returns, − 0.09, (95% CI, − 0.29, 0.10, p = 0.34); when weighted, there was still no clear difference: 0.15 (95% CI, − 0.02, 0.31, p = 0.07). There was no clear statistical evidence of a difference in time taken to return questionnaires, nor the proportion of pages completed, by the intervention group in the main analyses (all p > 0.05). The conditional incentive was approximately £23 cheaper per diary returned based upon observed data.
Conclusion There was no clear evidence of a statistically significant difference in the proportion of participant-completed diaries returned between conditional or non-conditional incentive groups. The time to questionnaire return and completeness of the returned questionnaires were similar in both groups. There was substantial statistical uncertainty in the findings. Some of the sensitivity analyses suggested that a meaningful benefit of a conditional incentive of a magnitude that would be meaningful was plausible. The conditional approach costs less in cash terms
MR447: Seasonal Water Table and Temperature Relationships in Calcareous Till and Residual Soils of Central Maine
Water table depths and soil temperatures were monitored for four growing seasons in six calcareous till pedons developed on gently rolling to level till plains in Corinth and Exeter, Maine. These soils are part of a new catena that supports potato production in southeastern Penobscot County. Three of these coarse-loamy to fine-loamy pedons are moderately well drained Oxyaquic Eutrudepts taxadjuncts in potato fields, and three are somewhat poorly drained Aquic Dystric Eutrudepts in predominantly deciduous forest. Soil morphology, hydrologic data, and a,a dipyridyl applications support the described subgroup classification of each pedon, along with the udic moisture regime. Despite a smooth, glaciated landscape that would suggest the presence of extensive lodgment till, five observation sites lacked a densic contact and one contained residuum (saprolite) in the substratum. Apparent water tables in the SPD very deep soils, as well as oxyaquic hydrology in the deep soils on 0 to 3 percent slopes, suggest the more permeable subglacial melt-out till predominating, rather than lodgment till in all of these pedons. Growing season concepts were compared based on frost-free season at 0 and -2.2° C thresholds, soil temperatures in the plow layer, soil temperature at 50 cms and well-water temperature. The commencement of the growing season in the spring did not differ much across all five concepts. However, in the fall there was a 4- to 8-week lag between the air or shallower soil-temperature growing-season concepts and the deeper soil or well-water-temperature growing-season concepts. Daytime air temperature during the first 2 years of monitoring differed significantly between spring and fall seasons, but not between field and forest sites within each season.https://digitalcommons.library.umaine.edu/aes_miscreports/1027/thumbnail.jp
Risk of adverse outcomes following urinary tract infection in older people with renal impairment : Retrospective cohort study using linked health record data
Funding: This report is independent research arising from a National Institute of Health Research (NIHR) Doctoral Research Fellowship awarded to HA, and supported by Health and Care Research Wales (HCRW) (grant number DRF-2014-07-010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Data Availability: Data analysed for this study were obtained under institutional license from the Clinical Practice Research Datalink, https://www.cprd.com/intro.asp. Data are not available for sharing but can be applied for through the CPRD. Relevant information to allow acquisition of a replicable data set is available in the paper and its Supporting Information files.Peer reviewedPublisher PD
Impact of antibiotic treatment duration on outcomes in older men with suspected urinary tract infection: retrospective cohort study
Purpose Clinical guidelines recommend at least 7 days of antibiotic treatment for older men with urinary tract infection (UTI). There may be potential benefits for patients, health services, and antimicrobial stewardship if shorter antibiotic treatment resulted in similar outcomes. We aimed to determine if treatment duration could be reduced by estimating risk of adverse outcomes according to different prescription durations. Methods This retrospective cohort study included men aged greater than or equal to 65 years old with a suspected UTI. We compared outcomes in men prescribed 3, 5, 7, and 8 to 14 days of antibiotic treatment in a multivariable logistic regression analysis and 3 versus 7 days in a propensity‐score matched analysis. Our outcomes were reconsultation and represcription (proxy for treatment failure), hospitalisation for UTI, sepsis, or acute kidney injury (AKI), and death. Results Of 360 640 men aged greater than or equal to 65 years, 33 745 (9.4%) had a UTI. Compared with 7 days, men prescribed 3‐day treatment had greater odds of reconsultation and represcription (adjusted OR 1.48; 95% CI, 1.25‐1.74) but lower odds of AKI hospitalisation (adjusted OR 0.66; 95% CI, 0.45‐0.97). We estimated that treating 150 older men with 3 days instead of 7 days of antibiotics could result in four extra reconsultation and represcriptions and one less AKI hospitalisation. We estimated annual prescription cost savings at around £2.2 million. Conclusions Antibiotic treatment for older men with suspected UTI could be reduced to 3 days, albeit with a small increase in risk of treatment failure. A definitive randomised trial is urgently needed
Clinician-targeted interventions to reduce antibiotic prescribing for acute respiratory infections in primary care:An overview of systematic reviews
This is the protocol for a review and there is no abstract. The objectives are as follows: To systematically review the literature and appraise the existing evidence from systematic reviews regarding the effects of interventions, aimed at changing clinician behaviour, to reduce antibiotic prescribing for ARIs in primary care
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