Assessing the appropriateness of the management of otitis media in Australia: a population-based sample survey

AIM:Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. METHODS:We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health-care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. RESULTS:We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health-care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. CONCLUSIONS:Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME.Robyn Clay‐Williams, Jacqueline H Stephens, Helena Williams, Andrew Hallahan, Chris Dalton, Peter Hibbert ... et al. on behalf of the CareTrack Kids Investigative Tea

Grassland Retention in the North America Midwest After Periods of High Commodity Prices and Climate Variability

The conversion of grassland, wetlands, and forest to croplands may contribute environmental degradation and diminished sustainability. This study determined the impact of land use change from 2006 to 2012 and from 2012 to 2014 on the cultivation suitability of grasslands that were not converted to cropland. The model system, which includes Nebraska and South Dakota, was selected because it contains climatic conditions ranging from humid continental to semiarid and a large number of farms that produced both crops and livestock. During the study, commodity prices reached historically high values, and a severe drought occurred in 2012. Land use benchmarks were obtained by visually identifying land use at 81,600 sample sites in high-resolution remote sensing images obtained from the National Agricultural Imaging Program. Sampling sites with Land Capability Class values ≤4 were identified as suitable for cultivation if appropriate practices were followed. In 2006, 2012, and 2014, grasslands accounted for 11.0, 10.76, and 10.78 million ha in Nebraska, respectively, whereas in South Dakota, grasslands accounted for 12.12, 11.65, and 11.69 million ha, respectively. In Nebraska, the percentage of grasslands relative to working lands (grassland + croplands) decreased from 60.6% in 2006 to 58.9% in 2014, whereas in South Dakota the percentage of grassland decreased from 69.1% in 2006 to 66.0% in 2014. In eastern Nebraska and South Dakota, 74.1% of the nonconverted grasslands in 2012 were suitable for crop production. Lower-than-expected conversion rates were attributed to a growing interest in land stewardship and a desire to maintain income diversification