Association between guidelines and medical practitioners' perception of best management for patients attending with an apparently uncomplicated acute sire throat: a cross-sectional survey in five countries

Objective To investigate the relationship between guidelines and the medical practitioners' perception of optimal care for patients attending with an apparently uncomplicated acute sore throat in five countries (Australia, Germany, Sweden, UK and USA). Design International cross-sectional survey. Setting Primary healthcare (PHC). Participants Medical practitioners working in PHC. Main outcome measures ORs for: (A) perception of throat swabs as important, (B) perception of blood tests (C reactive protein, B-ESR and B-leucocytes) as important and (C) antibiotic prescriptions if no pathogenic bacteria isolated on throat swab. Results Guidelines differed significantly; those recommending throat swabs (Sweden and USA) were associated with practitioners perceiving them as important. The UK guideline was the only one actively discouraging the use of throat swabs. Hence, compared with the USA (reference), a throat swab showing no pathogenic bacteria increased the probability of antibiotic prescribing in the UK with OR 3.2 (95% CI 1.7 to 6.1) for adults, whereas it reduced the probability in Sweden for adults OR 0.35 (95% CI 0.13 to 0.96) and children 0.19 (95% CI 0.069 to 0.50). Conclusions The differences between practitioners' perceptions of best management were associated with their guidelines. It remains unclear if guidelines influenced medical practitioners' perception or if guidelines merely reflect the consensus of current practice. A larger effort should be made to reach an international consensus in high-income countries about the best management of patients attending for an uncomplicated acute sore throat

A prospective cohort study on anemia and blood transfusion in critically ill patients

Background: The management of anemia and blood transfusion practices in the ICU have been a subject of controversy. Aims: The aims of this study were 1) To assess the prevalence of anemia and study the association of blood transfusion and mortality in critically ill patients. 2) To compare restrictive transfusion policy (Hb < 7 g/dl) and liberal transfusion policy. (Hb < 10 g/dl). Settings and Design: A matched cohort study was performed in a tertiary care teaching hospital. Materials and Methods: To study the association between blood transfusions and mortality, control patients were those who never received blood during ICU stay. They were selected according to the following matching criteria: Age (± 5 years), sex, APACHE II score (± 5 points), history of cardiac or renal disease and clinical diagnosis. Statistical Analysis Used: The Chi-square test. Results: The incidence of anemia is high in critically ill patients. Anemic patients had a longer duration of stay in the ICU. There is an association between blood transfusion and higher mortality in critically ill patients. A restrictive transfusion policy was associated with lesser mortality. Conclusions: Anemia is associated with increased morbidity reflected by the increased duration of stay in the ICU. Blood transfusion is associated with increased mortality and a restrictive transfusion policy is associated with increased survival

A systematic review on the health outcomes associated with non-endocarditis manifestations of chronic Q fever

The aim of this study was to systematically review the non-endocarditis manifestations of chronic Q fever and understand the significance of non-specific symptoms like pain and fatigue in chronic endovascular, osteomyelitis and abscess due to chronic Q fever. We performed a systematic review using Pub Med (the National Library of Medicine (NLM)) and Scopus databases. All studies in English on chronic Q fever that listed clinical manifestations other than infective endocarditis (IE) and chronic fatigue syndrome (CFS). Meta-analysis was carried out to investigate the effects of patient’s health outcomes (pain, fatigue, the need for surgery and mortality) on vascular infections, osteomyelitis and abscess. Among cases not presenting as IE or CFS, vascular infections and osteomyelitis were the most common chronic Q fever disease manifestations. There were distinct regional patterns of disease. Compared with infective endocarditis, these are significantly associated with increased risk of pain: osteomyelitis (relative risk (RR) = 4.13, 95% confidence interval (CI) 3.36–5.07), abscess (RR = 3.59, 95% CI 3.28–3.93) and vascular infection (RR = 2.46, 95% CI 1.99–3.03). The strongest significant association was observed between osteomyelitis and pain. There was no significant association between fatigue and these manifestations. Clinicians have to be aware of uncommon manifestations of chronic Q fever as they present with non-specific symptoms and are significantly associated with increased risk of morbidity and mortality. The findings emphasise the need to investigate patients with positive chronic Q fever serology presenting with acute or chronic pain for possible underlying complications

Assessment of the Clinical Pulmonary Infection Scores for prediction of ventilator associated pneumonia in patients with out of hospital cardiac arrest

Background: Patients suffering out-of-hospital cardiac arrest (OHCA) are at an increased risk of aspiration pneumonitis and development of subsequent aspiration pneumonia. The diagnostic uncertainty in this context can lead to a large proportion receiving broad spectrum antibiotics. Methods: This was a three-year, retrospective cohort study of consecutive patients admitted with OHCA. Data were collected in an Australian tertiary centre intensive care unit (ICU) between December 2016–December 2019. We assessed the incidence of Ventilator associated pneumonia (VAP), admission Clinical Pulmonary Infection Scores (CPIS) in patients with OHCA and its’ association with VAP at day 3 [1]. We also assessed antibiotics prescribing (timing of initiation and drug choice) and intensive care mortality relative to the day 1 CPIS. Results: Over the three years, 100 patients were admitted with OHCA. The incidence of VAP was 6%. The CPIS on admission was not associated with development of VAP at day 3 (p = 0.75) and no significant association was found between choice of antibiotic regimens and VAP incidence. Timing of initiation of antibiotics was associated with VAP (12hrs vs 48hrs, p = 0.035) but not the choice of antibiotic (penicillin and cephalosporins vs antipseudomonal antibiotics). CPIS score at day 1 was not associated with ICU mortality in a multivariate analysis. Conclusion: We demonstrated a very low incidence of VAP in OHCA patients in comparison to published studies. In this context, there was no evidence for an association between CPIS score and VAP at day 3. The CPIS may have utility as a decision support tool for targeted antibiotic prescribing in this cohort