Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice

<p>Abstract</p> <p>Background</p> <p>Next to other GP characteristics, diagnostic labelling (the proportion of acute respiratory tract (RT) episodes to be labelled as infections) probably contributes to a higher volume of antibiotic prescriptions for acute RT episodes. However, it is unknown whether there is an independent association between diagnostic labelling and the volume of prescribed antibiotics, or whether diagnostic labelling is associated with the number of presented acute RT episodes and consequently with the number of antibiotics prescribed per patient per year.</p> <p>Methods</p> <p>Data were used from the Second Dutch National Survey of General Practice (DNSGP-2) with 163 GPs from 85 Dutch practices, serving a population of 359,625 patients. Data over a 12 month period were analysed by means of multiple linear regression analysis. Main outcome measure was the volume of antibiotic prescriptions for acute RT episodes per 1,000 patients.</p> <p>Results</p> <p>The incidence was 236.9 acute RT episodes/1,000 patients. GPs labelled about 70% of acute RT episodes as infections, and antibiotics were prescribed in 41% of all acute RT episodes. A higher incidence of acute RT episodes (beta 0.67), a stronger inclination to label episodes as infections (beta 0.24), a stronger endorsement of the need of antibiotics in case of white spots in the throat (beta 0.11) and being male (beta 0.11) were independent determinants of the prescribed volume of antibiotics for acute RT episodes, whereas diagnostic labelling was not correlated with the incidence of acute RT episodes.</p> <p>Conclusion</p> <p>Diagnostic labelling is a relevant factor in GPs' antibiotic prescribing independent from the incidence of acute RT episodes. Therefore, quality assurance programs and postgraduate courses should emphasise to use evidence based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics in stead of single inflammation signs or diagnostic labels.</p

Knowledge in process? Exploring barriers between epidemiological research and local health policy development

The Redes de Trueque (RT) thrived during the economic crisis of 2001 – 2002 in Argentina and still stand out as one of the largest Complementary Currency System in the world. These local exchange networks reach a large scale during times of severe economic distress, but as large non-state initiatives, they pose a governance problem. Four types of governance systems were structured within the Argentine RT, of varying degrees of sustainability: a) loosely regulated market systems, b) hierarchies, c) associational regional networks, and d) local communities. Based on a four dimensional analytical framework, this paper discusses the rules of governance and sustainability of the governance systems in the RT. It found that some became more sustainable than others in terms of achieving combinations of scale and organisational modes

A Review on the Mechanical Modeling of Composite Manufacturing Processes

© 2016, The Author(s). The increased usage of fiber reinforced polymer composites in load bearing applications requires a detailed understanding of the process induced residual stresses and their effect on the shape distortions. This is utmost necessary in order to have more reliable composite manufacturing since the residual stresses alter the internal stress level of the composite part during the service life and the residual shape distortions may lead to not meeting the desired geometrical tolerances. The occurrence of residual stresses during the manufacturing process inherently contains diverse interactions between the involved physical phenomena mainly related to material flow, heat transfer and polymerization or crystallization. Development of numerical process models is required for virtual design and optimization of the composite manufacturing process which avoids the expensive trial-and-error based approaches. The process models as well as applications focusing on the prediction of residual stresses and shape distortions taking place in composite manufacturing are discussed in this study. The applications on both thermoset and thermoplastic based composites are reviewed in detail

Unravelling the role of the interface for spin injection into organic semiconductors

Whereas spintronics brings the spin degree of freedom to electronic devices, molecular/organic electronics adds the opportunity to play with the chemical versatility. Here we show how, as a contender to commonly used inorganic materials, organic/molecular based spintronics devices can exhibit very large magnetoresistance and lead to tailored spin polarizations. We report on giant tunnel magnetoresistance of up to 300% in a (La,Sr)MnO3/Alq3/Co nanometer size magnetic tunnel junction. Moreover, we propose a spin dependent transport model giving a new understanding of spin injection into organic materials/molecules. Our findings bring a new insight on how one could tune spin injection by molecular engineering and paves the way to chemical tailoring of the properties of spintronics devices.Comment: Original version. Revised version to appear in Nature Physics

Perceived difficulty and appropriateness of decision making by General Practitioners: a systematic review of scenario studies

Background: Health-care quality in primary care depends largely on the appropriateness of General Practitioners’ (GPs; Primary Care or Family Physicians) decisions, which may be influenced by how difficult they perceive decisions to be. Patient scenarios (clinical or case vignettes) are widely used to investigate GPs’ decision making. This review aimed to identify the extent to which perceived decision difficulty, decision appropriateness, and their relationship have been assessed in scenario studies of GPs’ decision making; identify possible determinants of difficulty and appropriateness; and investigate the relationship between difficulty and appropriateness. Methods: MEDLINE, EMBASE, PsycINFO, the Cochrane Library and Web of Science were searched for scenario studies of GPs’ decision making. One author completed article screening. Ten percent of titles and abstracts were checked by an independent volunteer, resulting in 91% agreement. Data on decision difficulty and appropriateness were extracted by one author and descriptively synthesised. Chi-squared tests were used to explore associations between decision appropriateness, decision type and decision appropriateness assessment method. Results: Of 152 included studies, 66 assessed decision appropriateness and five assessed perceived difficulty. While no studies assessed the relationship between perceived difficulty and appropriateness, one study objectively varied the difficulty of the scenarios and assessed the relationship between a measure of objective difficulty and appropriateness. Across 38 studies where calculations were possible, 62% of the decisions were appropriate as defined by the appropriateness standard used. Chi-squared tests identified statistically significant associations between decision appropriateness, decision type and decision appropriateness assessment method. Findings suggested a negative relationship between decision difficulty and appropriateness, while interventions may have the potential to reduce perceived difficulty. Conclusions: Scenario-based research into GPs’ decisions rarely considers the relationship between perceived decision difficulty and decision appropriateness. The links between these decisional components require further investigation

Clinical standards for the assessment, management, and rehabilitation of post-TB lung disease

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR). METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement). RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR. CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD

Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January-April 2020

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic

Supporting Key Aspects of Practice in Making Mathematics Explicit in Science Lessons

STEM integration has often been recommended as a way to support students to develop 21st Century skills needed to function in the complex modern world. In order for students to experience integration, however, their teachers need support in designing, developing and implementing integrated curricular instruction, which is often at odds with a very subject-focused educational system. This paper reports on the second year of a research study conducted with five secondary science and mathematics teachers, concerned with supporting them to teach explicitly the mathematics components within science lessons, mediated via technology. It outlines how the teachers collaborated with the support of science and mathematics education researchers within a community of practice, named a Teaching and Learning Network (TLN). The network was intended to promote and enhance teacher capacity for the interdisciplinary teaching of mathematics in science in the face of various contextual and other obstacles observed in the first year of the study. This study found that the opportunity to work in a Teaching and Learning Network supported the teachers’ ownership of the design of the integrated learning unit, enhanced their content knowledge of the mathematics, their use of the data logging technology and their understanding of an inquiry based pedagogical approach. Participation in the TLN provided teachers with the mechanism to cross the boundaries of the subject disciplines, and thereby promoted change in their attitudes, professional knowledge and to some extent, practice

Training in crisis communication and volcanic eruption forecasting:Design and evaluation of an authentic role-play simulation

We present an interactive, immersive, authentic role-play simulation designed to teach tertiary geoscience students in New Zealand to forecast and mitigate a volcanic crisis. Half of the participating group (i.e., the Geoscience Team) focuses on interpreting real volcano monitoring data (e.g., seismographs, gas output etc.) while the other half of the group (i.e., the Emergency Management Team) forecasts and manages likely impacts, and communicates emergency response decisions and advice to local communities. These authentic learning experiences were aimed at enhancing upper-year undergraduate students’ transferable and geologic reasoning skills. An important goal of the simulation was specifically to improve students’ science communication through interdisciplinary team discussions, jointly prepared, and delivered media releases, and real-time, high-pressure, press conferences. By playing roles, students experienced the specific responsibilities of a professional within authentic organisational structures. A qualitative, design-based educational research study was carried out to assess the overall student experience and self-reported learning of skills. A pilot and four subsequent iterations were investigated. Results from this study indicate that students found these role-plays to be a highly challenging and engaging learning experience and reported improved skills. Data from classroom observations and interviews indicate that the students valued the authenticity and challenging nature of the role-play although personal experiences and team dynamics (within, and between the teams) varied depending on the students’ background, preparedness, and personality. During early iterations, observation and interviews from students and instructors indicate that some of the goals of the simulation were not fully achieved due to: A) lack of preparedness, B) insufficient time to respond appropriately, C) appropriateness of roles and team structure, and D) poor communication skills. Small modifications to the design of Iterations 3 and 4 showed an overall improvement in the students’ skills and goals being reached. A communication skills instrument (SPCC) was used to measure self-reported pre- and post- communication competence in the last two iterations. Results showed that this instrument recorded positive shifts in all categories of self-perceived abilities, the largest shifts seen in students who participated in press conferences. Future research will be aimed at adapting this curricula to new volcanic and earthquake scenarios