Diagnostic value of real-time polymerase chain reaction to detect viruses in young children admitted to the paediatric intensive care unit with lower respiratory tract infection

INTRODUCTION: The aetiology of lower respiratory tract infections in young children admitted to the paediatric intensive care unit (PICU) is often difficult to establish. However, most infections are believed to be caused by respiratory viruses. A diagnostic study was performed to compare conventional viral tests with the recently developed real-time PCR technique. METHOD: Samples from children aged under 5 years presenting to a tertiary PICU suspected of having a lower respiratory tract infection were tested using conventional methods (viral culture and immunofluorescence) and real-time PCR during the winter season from December 2004 to May 2005. Conventional methods were used to check for respiratory syncytial virus, influenzavirus, parainfluenzavirus 1–3, rhinoviruses and adenoviruses. Real-time PCR was used to test for respiratory syncytial virus, influenzavirus, parainfluenzavirus 1–4, rhinoviruses, adenoviruses, human coronaviruses OC43, NL63 and 229E, human metapneumovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae. RESULTS: A total of 23 patients were included, of whom 11 (48%) were positive for a respiratory virus by conventional methods. Real-time PCR confirmed all of these positive results. In addition, real-time PCR identified 22 more viruses in 11 patients, yielding a total of 22 (96%) patients with a positive sample. More than one virus was detected in eight (35%) children. CONCLUSION: Real-time PCR for respiratory viruses was found to be a sensitive and reliable method in PICU patients with lower respiratory tract infection, increasing the diagnostic yield twofold compared to conventional methods

Human Bocavirus and KI/WU Polyomaviruses in Pediatric Intensive Care Patients

We evaluated the prevalence of human bocavirus and KI and WU polyomaviruses in pediatric intensive care patients with and without lower respiratory tract infection (LRTI). The prevalence of these viruses was 5.1%, 0%, and 2.6%, respectively, in children with LRTI and 4.8%, 4.8%, and 2.4%, respectively, in those without LRTI

Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: study protocol for a cluster randomised controlled trial.

Whilst current guidelines highlight the importance of pain management for children with acute otitis media (AOM), there is evidence to suggest that this is not implemented in everyday practice. We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness

External validation of prediction models for pneumonia in primary care patients with lower respiratory tract infection: an individual patient data meta-analysis

Pneumonia remains difficult to diagnose in primary care. Prediction models based on signs and symptoms (S&S) serve to minimize the diagnostic uncertainty. External validation of these models is essential before implementation into routine practice. In this study all published S&S models for prediction of pneumonia in primary care were externally validated in the individual patient data (IPD) of previously performed diagnostic studies

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications

C-reactive protein point-of-care testing and associated antibiotic prescribing

Background. In clinical trials, the potential of point-of-care (POC) C-reactive protein (CRP) tests was demonstrated in decreasing antibiotic prescribing in adults with acute cough in general practice, but effects of implementation are unknown. Objective. To determine the overall effect of POC CRP testing on antibiotic prescribing rate in general practice. Methods. In an observational study, GPs were instructed to use POC CRP in adults with acute cough following current guidelines. After routine history taking and physical examination, they reported whether they intended to prescribe antibiotics (‘pre-test decision’). They reported their revised decision after receiving the POC CRP test result (‘post-test decision’). Primary outcome was the percentage of patients in whom the GP changed his or her decision to prescribe antibiotics. Secondary outcome was the difference between ‘pre-test’ and ‘post-test’ antibiotic prescribing % at group level. Results. A total of 40 GPs enrolled 939 patients, 78% of whom were tested for CRP. GPs changed their decision after POC CRP testing in 200 patients (27%). Antibiotic prescribing before and after CRP testing did not differ (‘pre-test’ 31%, ‘post-test’ 28%; 95% confidence interval of difference −7 to 1). In 41% of the tested patients, the indication for testing was in accordance with the guidelines. Conclusion. POC CRP influenced GPs to change their decision about antibiotic prescribing in patients with acute cough. POC CRP testing does not reduce overall antibiotic prescribing by GPs who already have a low antibiotic prescribing rate

A case study of nurse practitioner care compared with general practitioner care for children with respiratory tract infections

Aim: To compare quality of care provided by nurse practitioners (NP) with care provided by general practitioners (GP) for children with respiratory tract infections (RTI) in the Netherlands. Background: Nurse practitioners increasingly manage acute conditions in general practice, with opportunities for more protocolled care. Studies on quality of NPs’ care for children with RTIs are limited to the US healthcare system and do not take into account baseline differences in illness severity. Design: Retrospective observational cohort study. Methods: Data were extracted from electronic healthcare records of children 0–6 years presenting with RTI between January–December 2013. Primary outcomes were antibiotic prescriptions and early return visits. Generalized estimating equations were used to correct for potential confounders. Results: A total of 899 RTI consultations were assessed (168 seen by NP; 731 by GP). Baseline characteristics differed between these groups. Overall antibiotic prescription and early return visit rates were 21% and 24%, respectively. Adjusted odds ratio for antibiotic prescription after NP vs. GP delivered care was 1.40 (95% confidence interval 0.89–2.22) and for early return visits 1.53 (95% confidence interval 1.01–2.31). Important confounder for antibiotic prescription was illness severity. Presence of wheezing was a confounder for return visits. Complication and referral rates did not differ. Conclusion: Antibiotic prescription, complication and referral rates for paediatric RTI consultations did not differ significantly between NP and GP consultations, after correction for potential confounders. General practitioners, however, see more severely ill children and have a lower return visit rate. A randomised controlled study is needed to determine whether NP care quality is truly noninferior

Nitrofurantoin failure in males with an uncomplicated urinary tract infection: a primary care observational cohort study.

BackgroundNitrofurantoin is the first-choice antibiotic treatment for uncomplicated urinary tract infections (UTIs) in males according to the Dutch primary care UTI guideline. However, prostate involvement may be undetected and renders this treatment less suitable.AimTo compare the nitrofurantoin failure fraction with that found with use of other antibiotics in adult males diagnosed by their GP with an uncomplicated UTI, as well as GP adherence to the Dutch primary care UTI guideline.Design and settingRetrospective observational cohort study using routine healthcare data for males seeking care at GP practices participating in the Julius GP Network from 2014 to 2020.MethodMedical records were screened for signs and symptoms of complicated UTIs, antibiotic prescriptions, and referrals. Treatment failure was defined as prescription of a different antibiotic within 30 days after initiation of antibiotic therapy and/or acute hospital referral. The effects of age and comorbidities on failure were assessed using multivariable logistic regression.ResultsMost UTI episodes in males were uncomplicated (n = 6805/10 055 episodes, 68%). Nitrofurantoin  was prescribed in 3788 (56%) of uncomplicated UTIs, followed by ciprofloxacin (n = 1887,  28%), amoxicillin/clavulanic acid (n = 470,  7%), and trimethoprim/sulfamethoxazole (n = 285, 4%). Antibiotic failure occurred in  25% (95% confidence interval [CI] = 23 to 26), 10% (95% CI = 9 to 12), 20% (95% CI = 16 to 24), and 14% (95% CI = 10 to 19) of episodes, respectively. The nitrofurantoin failure fraction increased with age. Comorbidities, adjusted for age, were not associated with nitrofurantoin failure.ConclusionNitrofurantoin failure was common in males with uncomplicated UTI and increased with age

On folding of coated papers

The mechanical behaviour of coated papers during folding has been investigated. This problem has been studied with experimental techniques and numerical analyses in order to give a better understanding of the folding properties of coated papers pertinent to the mechanical behaviour in general, and particularly cracking along the fold. A microscopy investigation has been performed. The surface of the folded paper has been carefully examined to study the event of fracture and related issues. The influence of the grammage on the cracking event has been studied and it was shown that the coating material would not fail if the paper sample was sufficiently thin. It was found that a stress or strain based criterion is sufficient to describe the cracking of the coating layers and that the anisotropy of paper should be taken into account when studying the folding process. The finite element method has been used for the numerical analyses remembering that the geometry of the problem is rather complicated, excluding a solution in analytical form. Using different constitutive models for the base stock, it has been shown that the deformation of the coated paper during folding is much governed by the paper substrate. The numerical results also suggested that particular forms of plastic anisotropy can substantially reduce the maximum strain levels in the coating. Furthermore, it has also been shown that delamination buckling, in the present circumstances, has a very small influence on the strain levels in the coating layer subjected to high tensile loading. Dynamic effects have also been studied and it has been shown that a quasi-static analysis of the problem is sufficient in order to describe many of the important features related to cracking. An attempt to model strong anisotropy of paper has been presented and the results indicate that the large anisotropy in the thickness direction of coated papers needs to be taken into account in order to fully understand the mechanics of folding. Finally, an experimental investigation has been presented in order to study if important mechanical properties of the coating material could be determined by microindentation techniques. The results presented indicate that microindentation can be a powerful tool for characterization of these materials, but only if careful efforts are made in order to account for the influence from plasticity as well as from boundary effects. KEYWORDS: folding, coated papers, finite element method, cracking, indentation, anisotropy, plasticity