Antibiotic prescribing before and after the diagnosis of comorbidity: a cohort study using primary care electronic health records

BACKGROUND: Comorbidities like diabetes or COPD increase patients' susceptibility to infections, but it is unclear how the onset of comorbidity impacts antibiotic use. We aimed to estimate rates of antibiotic use before and after diagnosis of comorbidity in primary care to identify opportunities for antibiotic stewardship. // METHODS: We analysed UK primary care records from the Clinical Practice Research Datalink (CPRD) database. Adults registered between 2008-2015 without prior comorbidity diagnoses were eligible for inclusion. Monthly adjusted rates of antibiotic prescribing were estimated for patients with new-onset stroke, coronary heart disease, heart failure, peripheral arterial disease, asthma, chronic kidney disease, diabetes or COPD in the 12 months before and after diagnosis, and for controls without comorbidity. // RESULTS: 106,540 / 1,071,94 (9.9%) eligible patients were diagnosed with comorbidity. Antibiotic prescribing rates increased 1.9-2.3 fold in the 4-9 months preceding diagnosis of asthma, heart failure and COPD, before declining to stable levels within 2 months after diagnosis. A less marked trend was seen for diabetes (Rate ratio 1.55, 95%-CI: 1.48-1.61). Prescribing rates for patients with vascular conditions increased immediately before diagnosis and remained 30-39% higher than baseline afterwards. Rates of prescribing to controls increased by 17-28% in the months just before and after consultation. // CONCLUSIONS: Antibiotic prescribing increased rapidly before diagnosis of conditions presenting with respiratory symptoms (COPD, heart failure, asthma), and declined afterwards. This suggests onset of respiratory symptoms may be misdiagnosed as infection. Earlier diagnosis of these comorbidities could reduce avoidable antibiotic prescribing

Magnetic phase diagrams from non-collinear canonical band theory

A canonical band theory of non-collinear magnetism is developed and applied to the close packed fcc and bcc crystal structures. This is a parameter-free theory where the crystal and magnetic symmetry and exchange splitting uniquely determine the electronic bands. In this way, we are able to construct phase diagrams of magnetic order for the fcc and bcc lattices. Several examples of non-collinear magnetism are seen to be canonical in origin, in particular, that of γ-Fe. In this approach, the determination of magnetic stability results solely from changes in kinetic energy due to spin hybridization, and on this basis we are able to analyze the microscopic reasons behind the occurrence of non-collinear magnetism in the elemental itinerant magnets

On the impact of the Bristol ChemLabS’ outreach programme on admissions to the School of Chemistry

Analysis of the average number of applicants received from schools that engaged in the Bristol ChemLabS Outreach program prior to a student‟s application with those that did not engage, shows a significant increase in applicants from engaged schools. The significance is weaker when just Post 16 students are considered but this is almost certainly due to a smaller sample size. When this analysis was inspected in terms of the distance of the school from the University of Bristol, there was an increase in the number of applicants from engaged schools irrespective of distance. However, a statistically significant increase was observed for schools within 50 miles of the University from an analysis of just Post 16 students. Students who applied to the department from an engaged school were more likely to accept an offer and also to make the department their firm acceptance. A slightly higher number of applications that were rejected came from engaged schools too. There are two possible reasons; first, the engagement may have encouraged more students who did not have the required entry qualifications. Second, during the period of analysis, the overall entry grades went up by one grade each year. Such a dramatic rise was probably the reason for the slightly elevated numbers

A qualitative study of physician perspectives of cost-related communication and patients’ financial burden with managing chronic disease

Abstract Background Patient financial burden with chronic disease poses significant health risks, yet it remains outside the scope of clinical visits. Little is known about how physicians perceive their patients’ health-related financial burden in the context of primary care. The purpose of this study was to describe physician experiences with patients’ financial burden while managing chronic disease and the communication of these issues. Methods In November 2013, four focus groups were conducted in an academic medical center. A convenience sample of 29 internal and family medicine resident physicians was used in this study. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding physicians’ experiences with identifying, managing, and communicating financial burden with their patients in the context of primary care. Results Major themes identified were 1) patient financial burden with chronic care is visible to physicians, 2) patient’s financial burden with chronic care and discussing these issues is important to physicians, 3) ability to identify patients who perceive financial burden is imperfect, 4) communication of financial burden with patients is complex and difficult to navigate, 5) strategies utilized to address concerns are not always generalizable, and 6) physicians have ideas for widespread change to make these conversations easier for them. Conclusion Awareness of physician perspectives in identifying and addressing their patients’ disease-related financial burden may better equip researchers and medical educators to develop interventions that aid care teams in better understanding these patient concerns to promote compliance with treatment recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/116043/1/12913_2015_Article_1189.pd

Antibiotic prescribing frequency amongst patients in primary care: a cohort study using electronic health records

BACKGROUND: Reducing inappropriate antibiotic prescribing in primary care is a public health priority. Objectives: We hypothesized that a subset of patients account for the majority of antibiotic prescriptions in primary care. We investigated the relationship between the total amount of antibiotics prescribed, individual-level antibiotic use and comorbidity. METHODS: This was a cohort study using electronic health records from 1 948 390 adults registered with 385 primary care practices in the UK in 2011-13. We estimated the average number of antibiotic prescriptions per patient and the association between prescribing and comorbidity. We modelled the impact on total prescribing of reducing antibiotic use in those prescribed antibiotics most frequently. RESULTS: On average 30.1% (586 194/1 948 390) of patients were prescribed at least one antibiotic per year. Nine percent (174 602/1 948 390) of patients were prescribed 53% (2 091 496/3 922 732) of the total amount of antibiotics, each of whom received at least five antibiotic prescriptions over 3 years. The presence of any comorbidity increased the prescribing rate by 44% [adjusted incidence rate ratio (IRR) 1.44, 95% CI 1.43-1.45]; rates of prescribing to women exceeded those in men by 62% (adjusted IRR 1.62, 95% CI 1.62-1.63). CONCLUSIONS: Half of antibiotics prescribed to adults in primary care were for <10% of patients. Efforts to tackle antimicrobial resistance should consider the impact of this on total prescribing

A rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections in community settings [version 1; peer review: awaiting peer review]

Background: Cross-sectional studies indicate that up to 80% of active SARS-CoV-2 infections may be asymptomatic. However, accurate estimates of the asymptomatic proportion require systematic detection and follow-up to differentiate between truly asymptomatic and pre-symptomatic cases. We conducted a rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections based on methodologically appropriate studies in community settings. / Methods: We searched Medline and EMBASE for peer-reviewed articles, and BioRxiv and MedRxiv for pre-prints published before 25/08/2020. We included studies based in community settings that involved systematic PCR testing on participants and follow-up symptom monitoring regardless of symptom status. We extracted data on study characteristics, frequencies of PCR-confirmed infections by symptom status, and (if available) cycle threshold/genome copy number values and/or duration of viral shedding by symptom status, and age of asymptomatic versus (pre)symptomatic cases. We computed estimates of the asymptomatic proportion and 95% confidence intervals for each study and overall using random effect meta-analysis. / Results: We screened 1138 studies and included 21. The pooled asymptomatic proportion of SARS-CoV-2 infections was 23% (95% CI 16%-30%). When stratified by testing context, the asymptomatic proportion ranged from 6% (95% CI 0-17%) for household contacts to 47% (95% CI 21-75%) for non-outbreak point prevalence surveys with follow-up symptom monitoring. Estimates of viral load and duration of viral shedding appeared to be similar for asymptomatic and symptomatic cases based on available data, though detailed reporting of viral load and natural history of viral shedding by symptom status were limited. Evidence into the relationship between age and symptom status was inconclusive. / Conclusion: Asymptomatic viral shedding comprises a substantial minority of SARS-CoV-2 infections when estimated using methodologically appropriate studies. Further investigation into variation in the asymptomatic proportion by testing context, the degree and duration of infectiousness for asymptomatic infections, and demographic predictors of symptom status are warranted