Improvement of antibiotic prescription in outpatient care: a cluster-randomized intervention study using a sentinel surveillance network of physicians

Objectives To assess the effectiveness of implementing guidelines, coupled with individual feedback, on antibiotic prescribing behaviour of primary care physicians in Switzerland. Methods One hundred and forty general practices from a representative Swiss sentinel network of primary care physicians participated in this cluster-randomized prospective intervention study. The intervention consisted of providing guidelines on treatment of respiratory tract infections (RTIs) and uncomplicated lower urinary tract infections (UTIs), coupled with sustained, regular feedback on individual antibiotic prescription behaviour during 2 years. The main aims were: (i) to increase the percentage of prescriptions of penicillins for all RTIs treated with antibiotics; (ii) to increase the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics; (iii) to decrease the percentage of quinolone prescriptions for all cases of exacerbated COPD (eCOPD) treated with antibiotics; and (iv) to decrease the proportion of sinusitis and other upper RTIs treated with antibiotics. The study was registered at ClinicalTrials.gov (NCT01358916). Results While the percentage of antibiotics prescribed for sinusitis or other upper RTIs and the percentage of quinolones prescribed for eCOPD did not differ between the intervention group and the control group, there was a significant increase in the percentage of prescriptions of penicillins for all RTIs treated with antibiotics [57% versus 49%, OR = 1.42 (95% CI 1.08-1.89), P = 0.01] and in the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics [35% versus 19%, OR = 2.16 (95% CI 1.19-3.91), P = 0.01] in the intervention group. Conclusions In our setting, implementing guidelines, coupled with sustained individual feedback, was not able to reduce the proportion of sinusitis and other upper RTIs treated with antibiotics, but increased the use of recommended antibiotics for RTIs and UTIs, as defined by the guideline

Causes of increased flood frequency in central Europe in the 19th century

Historians and historical climatologists have long pointed to an increased flood frequency in central Europe in the mid- and late 19th century. However, the causes have remained unclear. Here, we investigate the changes in flood frequency in Switzerland based on long time series of discharge and lake levels, precipitation, and weather types and based on climate model simulations, focusing on the warm season. Annual series of peak discharge or maximum lake level, in agreement with previous studies, display increased frequency of floods in the mid-19th century and decreased frequency after the Second World War. Annual series of warm-season mean precipitation and high percentiles of 3 d precipitation totals (partly) reflect these changes. A daily weather type classification since 1763 is used to construct flood probability indices for the catchments of the Rhine in Basel and the outflow of Lake Lugano, Ponte Tresa. The indices indicate an increased frequency of flood-prone weather types in the mid-19th century and a decreased frequency in the post-war period, consistent with a climate reconstruction that shows increased (decreased) cyclonic flow over western Europe in the former (latter) period. To assess the driving factors of the detected circulation changes, we analyze weather types and precipitation in a large ensemble of atmospheric model simulations driven with observed sea-surface temperatures. In the simulations, we do not find an increase in flood-prone weather types in the Rhine catchment in the 19th century but a decrease in the post-war period that could have been related to sea-surface temperature anomalies

Abwasserbehandlung und Lösungsmittel-Rückgewinnung im Rahmen der Chemieingenieur-Ausbildung

It should be a goal of chemical education to make students meet aspects of environmental protection in the lab courses. Students at the Fachhochschule Darmstadt learn to treat waste water by methods of precipitation, ion exchange, charcoal adsorption, etc. and recycle organic solvents. The amount of waste can be reduced significantly. Traditional goals of education remain intact. Furthermore, students become aware of the urgent necessity of and the important role of chemistry in environmental protection

Management of injuries in Swiss primary care practices: a cross-sectional study within the Sentinella surveillance system

Introduction: Injuries are amongst the most frequent causes of morbidity and mortality worldwide. Our aim was to describe the frequency, type of injury and care provided in primary care in Switzerland. Methods: We used anonymous data from 14,307 injury-related consultations of all ages, with a representative sample of 160 primary care physicians from the Sentinella network throughout the year 2017. Descriptive information about patients presenting with one or multiple injuries and the type of care provided were collected in a weekly questionnaire. Data about the primary care physicians including their experience, postgraduate training, equipment and skills were obtained using a single anonymous questionnaire. Negative binomial regression models with mixed effects were used to examine the association between primary care physicians' characteristics, the proportion represented by injured patients in their total activity and independent management in primary care (without referral). With these models, the associations are expressed as a ratio of prevalence (PR). Results: The median proportion (prevalence) of injury-related consultations was 2.0% (range 0.0-19.8%), with a significant difference between paediatricians and general practitioners (median 1.2% vs 2.1%). Nearly 60% of consultations for injuries involved men, 21.0% were for patients &lt;18 years and 15.3% for those above 65. Sprains and dislocations (31.2%) were the most frequent diagnoses followed by cutaneous injuries (23.0%), contusions (20.1%) and fractures (18.8%). Of the injuries presenting directly to primary care, 87.0% were managed by the primary care physician without referral to external services. Fractures were the main diagnosis motivating referral, yet 67.9% of them were entirely managed within primary care. Multivariable analyses showed that training as a paediatrician and a longer experience in primary care were associated with having a lower prevalence of injury-related consultations (adjusted PR [adjPR] 0.49, 95% confidence interval [CI] 0.31-0.78 and adjPR 0.41, 95% CI 0.23-0.75, respectively), whereas the ability to offer wound care including sutures and both splints and casts were associated with a much higher prevalence of injury-related consultations (adjPR 9.36, 95% CI 3.42-25.61 and adjPR 2.38, 95% CI 1.43-3.97, respectively). Conclusion: The proportion represented by injured patients in a primary care physician's total activity is heterogeneous. Most patients with mild to moderate injuries could be managed in primary care without referral to secondary care. Further studies could explore factors associated with patients' decision to consult their primary care physician or emergency services for injuries. Exploring outcomes of primary care and patients' satisfaction is another future research priority.</p

Analyzing Intracellular Binding and Diffusion with Continuous Fluorescence Photobleaching

Transport and binding of molecules to specific sites are necessary for the assembly and function of ordered supramolecular structures in cells. For analyzing these processes in vivo, we have developed a confocal fluorescence fluctuation microscope that allows both imaging of the spatial distribution of fluorescent molecules with confocal laser scanning microscopy and probing their mobility at specific positions in the cell with fluorescence correlation spectroscopy and continuous fluorescence photobleaching (CP). Because fluorescence correlation spectroscopy is restricted to rapidly diffusing particles and CP to slower processes, these two methods complement each other. For the analysis of binding-related contributions to mobility we have derived analytical expressions for the temporal behavior of CP curves from which the bound fraction and/or the dissociation rate or residence time at binding sites, respectively, can be obtained. In experiments, we investigated HeLa cells expressing different fluorescent proteins: Although enhanced green fluorescent protein (EGFP) shows high mobility, fusions of histone H2B with the yellow fluorescent protein are incorporated into chromatin, and these nuclei exhibit the presence of a stably bound and a freely diffusing species. Nonpermanent binding was found for mTTF-I, a transcription termination factor for RNA polymerase I, fused with EGFP. The cells show fluorescent nucleoli, and binding is transient. CP yields residence times for mTTF-I-EGFP of ∼13 s