Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis

OBJECTIVE: To identify general practitioner (GP) views and understanding on the use of delayed prescribing in primary care.DESIGN: Qualitative semistructured telephone interview study.SETTING: Primary care general practices in England.PARTICIPANTS: 32 GPs from identified high-prescribing and low-prescribing general practices in England.METHOD: Semistructured telephone interviews were conducted with GPs identified from practices within clinical commissioning groups with the highest and lowest prescribing rates in England. A thematic analysis of the data was conducted to generate themes.RESULTS: All GPs had a good understanding of respiratory tract infection (RTI) management and how the delayed prescribing approach could be used in primary care. However, GPs highlighted factors that were influential as to whether delayed prescribing was successfully carried out during the consultation. These included the increase in evidence of antimicrobial resistance, and GPs' prior experiences of using delayed prescribing during the consultation. The patient-practitioner relationship could also influence treatment outcomes for RTI, and a lack of an agreed prescribing strategy within and between practices was considered to be of significance to GPs. Participants expressed that a lack of feedback on prescribing data at an individual and practice level made it difficult to know if delayed prescribing strategies were successful in reducing unnecessary consumption. GPs agreed that coherent and uniform training and guidelines would be of some benefit to ensure consistent prescribing throughout the UK.CONCLUSIONS: Delayed prescribing is encouraged in primary care, but is not always implemented successfully. Greater uniformity within and between practices in the UK is needed to operationalise delayed prescribing, as well as providing feedback on the uptake of antibiotics. Finally, GPs may need further guidance on how to answer the concerns of patients without interpreting these questions as a demand for antibiotics, as well as educating the patient about antimicrobial resistance and supporting a good patient-practitioner relationship

Using psychological theory and qualitative methods to develop a new evidence-based website about acupuncture for back pain.

INTRODUCTION: Potential acupuncture patients seek out information about acupuncture from various sources including websites, many of which are unreliable. We aimed to create an informative, scientifically accurate and engaging website to educate patients about acupuncture for back pain and modify their beliefs in a way that might enhance its clinical effects. METHODS: We used psychological theory and techniques to design an evidence-based website, incorporating multimedia elements. We conducted qualitative "think aloud" audio-recorded interviews to elicit user views of the website. A convenience sample of ten participants (4 male; aged 21-64 years from the local community) looked at the website in the presence of a researcher and spoke their thoughts out loud. Comments were categorised by topic. RESULTS: The website comprises 11 main pages and addresses key topics of interest to potential acupuncture patients, including beneficial and adverse effects, mechanisms of action, safety, practicalities, and patients' experiences of acupuncture. It provides information through text, evidence summaries and audio-clips of four patients' stories and two acupuncturists' descriptions of their practice, and three short films. Evidence from the think aloud study was used to identify opportunities to make the website more informative, engaging, and user-friendly. CONCLUSIONS: Using a combination of psychological theory and qualitative interviews enabled us to produce a user-friendly, evidence-based website that is likely to change patients' beliefs about acupuncture for back pain. Before using the website in clinical settings it is necessary to test its effects on key outcomes including patients' beliefs and capacity for making informed choices about acupuncture

Viral load drives disease in humans experimentally infected with respiratory syncytial virus

Rationale: Respiratory syncytial virus (RSV) is the leading cause ofchildhood lower respiratory infection, yet viable therapies arelacking. Two major challenges have stalled antiviral development:ethical difficulties in performing pediatric proof-of-concept studiesand the prevailing concept that the disease is immune-mediatedrather than being driven by viral load.Objectives: The development of ahumanexperimental wild-type RSVinfection model to address these challenges.Methods: Healthy volunteers (n 5 35), in five cohorts, receivedincreasing quantities (3.0–5.4 log plaque-forming units/person) ofwild-type RSV-A intranasally.Measurements andMain Results: Overall, 77%of volunteers consistentlyshed virus. Infection rate, viral loads, disease severity, and safety weresimilar between cohorts and were unrelated to quantity of RSV received.Symptomsbegan near the time of initial viral detection, peakedin severity near when viral load peaked, and subsided as viral loads(measured by real-time polymerase chain reaction) slowly declined.Viral loads correlated significantly with intranasal proinflammatorycytokine concentrations (IL-6 and IL-8). Increased viral load correlatedconsistently with increases inmultiple different diseasemeasurements(symptoms, physical examination, and amount of nasal mucus).Conclusions:Viralloadappears todrive diseasemanifestations inhumanswith RSV infection. The observed parallel viral and disease kineticssupport a potential clinical benefit of RSV antivirals. This reproduciblemodel facilitates the development of future RSV therapeutics