An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial

Background Fever is the most common reason for a child to be taken to a general practitioner (GP), especially during out-of-hours care. It is mostly caused by self-limiting infections. However, antibiotic prescription rates remain high, especially during out-of-hours care. Anxiety and lack of knowledge among parents, and perceived pressure to prescribe antibiotics amongst GPs, are important determinants of excessive antibiotic prescriptions. An illness-focused interactive booklet has the potential to improve this by providing parents with information about fever self-management strategies. The aim of this study is to develop and determine the effectiveness of an interactive booklet on management of children presenting with fever at Dutch GP out-of-hours cooperatives. Methods/design We are conducting a cluster randomised controlled trial (RCT) with 20 GP out-of-hours cooperatives randomised to 1 of 2 arms: GP access to the illness-focused interactive booklet or care as usual. GPs working at intervention sites will have access to the booklet, which was developed in a multistage process. It consists of a traffic light system for parents on how to respond to fever-related symptoms, as well as information on natural course of infections, benefits and harms of (antibiotic) medications, self-management strategies and ‘safety net’ instructions. Children < 12 years of age with parent-reported or physician-measured fever are eligible for inclusion. The primary outcome is antibiotic prescribing during the initial consultation. Secondary outcomes are (intention to) (re)consult, antibiotic prescriptions during re-consultations, referrals, parental satisfaction and reassurance. In 6 months, 20,000 children will be recruited to find a difference in antibiotic prescribing rates of 25% in the control group and 19% in the intervention group. Statistical analysis will be performed using descriptive statistics and by fitting two-level (GP out-of-hours cooperative and patient) random intercept logistic regression models. Discussion This will be the first and largest cluster RCT evaluating the effectiveness of an illness-focused interactive booklet during GP out-of-hours consultations with febrile children receiving antibiotic prescriptions. It is hypothesised that use of the booklet will result in a reduced number of antibiotic prescriptions, improved parental satisfaction and reduced intention to re-consult

Erythematous nodes, urticarial rash and arthralgias in a large pedigree with NLRC4-related autoinflammatory disease, expansion of the phenotype

Autoinflammatory disorders (AID) are a heterogeneous group of diseases, characterized by an unprovoked innate immune response, resulting in recurrent or ongoing systemic inflammation and fever1-3. Inflammasomes are protein complexes with an essential role in pyroptosis and the caspase-1-mediated activation of the proinflammatory cytokines IL-1β, IL-17 and IL-18

Steviamine, a new class of indolizidine alkaloid [(1R,2S,3R,5R,8aR)-3-hydroxy­meth­yl-5-methyl­octa­hydro­indolizine-1,2-diol hydro­bromide]

X-ray crystallographic analysis of the title hydro­bromide salt, C10H20N+·Br−, of (1R,2S,3R,5R,8aR)-3-hydroxy­meth­yl-5-methyl­octa­hydro­indolizine-1,2-diol defines the absolute and relative stereochemistry at the five chiral centres in steviamine, a new class of polyhydroxy­lated indolizidine alkaloid isolated from Stevia rebaudiana (Asteraceae) leaves. In the crystal structure, mol­ecules are linked by inter­molecular O—H⋯Br and N—H⋯Br hydrogen bonds, forming double chains around the twofold screw axes along the b-axis direction. Intra­molecular O—H⋯O inter­actions occur

Towards Better Territorial Governance in Europe. A guide for practitioners, policy and decision makers based on contributions from the ESPON TANGO Project

Guides help you do things. You turn to them when you need to find out how to solve a problem. They are a form of knowledge transfer, written by experts but in a way that is accessible and helpful to a wide group of users. This Guide was written by the researchers on the ESPON applied research study of Territorial Approaches to New Governance (TANGO). It aims to help those persons and institutions that are delivering territorial governance across Europ

Towards Better Territorial Governance in Europe. A guide for practitioners, policy and decision makers based on contributions from the ESPON TANGO Project

Guides help you do things. You turn to them when you need to find out how to solve a problem. They are a form of knowledge transfer, written by experts but in a way that is accessible and helpful to a wide group of users. This Guide was written by the researchers on the ESPON applied research study of Territorial Approaches to New Governance (TANGO). It aims to help those persons and institutions that are delivering territorial governance across Europe