A simple dose of antibiotics: qualitative analysis of sepsis reporting in UK newspapers

BACKGROUND: A recent drive to improve sepsis awareness has been accompanied by prolific media reporting about its management in children. Media reporting is known to influence public understanding of health issues and subsequent health-seeking behaviour. AIM: To examine UK newspaper representations of sepsis in children to better understand how the messages they convey may impact on parents' consulting behaviour and expectations about antimicrobial prescribing. DESIGN & SETTING: Qualitative analysis of articles published in 12 UK newspapers from January 1988 to June 2018. METHOD: Thematic analysis of 140 articles about sepsis in children identified through a search on the Nexis database. RESULTS: Reporting about sepsis in UK newspapers was characterised by emotive personal narratives about affected children who have suffered death or disability. These events were frequently presented as resulting from failings within the healthcare system that could have been avoided by early treatment. Health professionals were portrayed as inadequately prepared to recognise and manage sepsis, and as reluctant to prescribe antibiotics, even when necessary. Parents were positioned as advocates for their children, and as being ultimately responsible for ensuring that they receive appropriate treatment. CONCLUSION: This research identified messages about sepsis in the UK news media that could influence public attitudes about antibiotic prescribing in acute childhood illness. Public health communications about sepsis awareness must acknowledge the wider implications of unnecessary antibiotic use as a driver of antimicrobial resistance to reduce the risk of damaging efforts to promote rational prescribing

Are antimicrobial stewardship and sepsis awareness competing goals?

Antimicrobial resistance (AMR) has emerged as one of the most significant threats to population health of recent times. It is estimated that its associated mortality could reach 10 million by 2050. Availability of effective antimicrobial prophylaxis is essential to allow many routine surgical and obstetric procedures to be performed safely. Reducing unnecessary antimicrobial use is integral to controlling the spread of AMR. As awareness of the need for judicious antimicrobial prescribing has grown, so has recognition of the importance of early diagnosis and management of sepsis, with high profile media reporting of selected cases, often involving children. Early administration of antibiotics to improve outcomes from sepsis conflicts, in part, with a drive to reduce antimicrobial prescribing. Previous research has suggested that AMR is often perceived as a distant and theoretical threat that has little personal impact, which may in part be related to how it is framed in news media. There is no evidence about how reporting of sepsis in children impacts on public understandings about antibiotic use. This PhD aims to better understand how the risks of antimicrobial resistance and sepsis are constructed in the popular news and how these impact on the attitudes and behaviour of the public, as parents and carers. Content analysis of 616 articles from 6 national newspapers published between 1988 and 2018 demonstrated key differences in the way AMR and sepsis are framed. AMR is framed predominantly according to its potential impact on future global health. Its causes and solutions are presented as complex and dependent on co-ordinated actions between policymakers and the healthcare, farming and pharmaceutical industries. In contrast, sepsis is framed as an issue whose drivers lie predominantly within the healthcare sector and whose main solution is better awareness. The use of personalised narratives about individuals affected by sepsis increases its relevance and accessibility for the public. Thematic analysis of a subset of articles demonstrated that failings in the health service were portrayed as the cause of avoidable deaths in children, often through failure to prescribe timely antibiotics, with parents positioned as advocates for their children. Exploration of these themes in 20 focus groups with 84 parents, carers and individuals with lived experience of sepsis demonstrated that decisions about when to seek health advice had to be balanced against a perceived moral duty to avoid placing excessive demands on healthcare resources. Health professionals were frequently perceived to be ambivalent about the need for antibiotics, with parent preference often influencing decisions. Few participants had direct experience of AMR, which was widely perceived to be a risk confined to individuals who use antibiotics inappropriately. There is a need to align messages about the complex interplay between AMR, sepsis and antimicrobial use. Personal narratives about individuals affected by AMR, similar to those used in sepsis awareness campaigns, may increase accessibility of public health messaging about preserving the efficacy of antibiotics

Vitamin D and subsequent all-age and premature mortality: a systematic review

<br>Background: All-cause mortality in the population < 65 years is 30% higher in Glasgow than in equally deprived Liverpool and Manchester. We investigated a hypothesis that low vitamin D in this population may be associated with premature mortality via a systematic review and meta-analysis.</br> <br>Methods: Medline, EMBASE, Web of Science, the Cochrane Library and grey literature sources were searched until February 2012 for relevant studies. Summary statistics were combined in an age-stratified meta-analysis.</br> <br>Results: Nine studies were included in the meta-analysis, representing 24,297 participants, 5,324 of whom died during follow-up. The pooled hazard ratio for low compared to high vitamin D demonstrated a significant inverse association (HR 1.19, 95% CI 1.12-1.27) between vitamin D levels and all-cause mortality after adjustment for available confounders. In an age-stratified meta-analysis, the hazard ratio for older participants was 1.25 (95% CI 1.14-1.36) and for younger participants 1.12 (95% CI 1.01-1.24).</br> <br>Conclusions: Low vitamin D status is inversely associated with all-cause mortality but the risk is higher amongst older individuals and the relationship is prone to residual confounding. Further studies investigating the association between vitamin D deficiency and all-cause mortality in younger adults with adjustment for all important confounders (or using randomised trials of supplementation) are required to clarify this relationship.</br&gt

Temporal changes in clinical and radiographic variables in dogs with preclinical myxomatous mitral valve disease: The EPIC study

The Evaluation of pimobendan in dogs with cardiomegaly caused by preclinical myxomatous mitral valve disease (EPIC) study monitored dogs with myxomatous mitral valve disease (MMVD) as they developed congestive heart failure (CHF)

A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy

Original article can be found at: http://www.sciencedirect.com Copyright Chartered Society of Physiotherapy [Full text of article is not available in the UHRA]Objective: To investigate the difference in outcome between patients treated with group exercise, physiotherapy or osteopathy. Design: Prospective study of patients referred at random to one of three treatments, with follow-up 6 weeks after discharge and after 12 months. Setting: National Health Service physiotherapy department at St Albans City Hospital, part of the West Hertfordshire Musculoskeletal Therapy Service. Participants: Two hundred and thirty-nine patients aged 18–65 years recruited from referrals to the physiotherapy department with chronic low back pain. Interventions: Eligible patients were randomised to group exercises led by a physiotherapist, one-to-one predominantly manipulative physiotherapy, or osteopathy. Main outcomes: Oswestry Disability Index (ODI), EuroQol-5D, shuttle walking test and patients’ subjective responses to pain and treatment. Results: All three treatments indicated comparable reductions in mean (95% confidence intervals) ODI at 6-week follow-up: group exercise, −4.5 (−0.9 to −8.0); physiotherapy, −4.1 (−1.4 to −6.9); and osteopathy, −5.0 (−1.6 to −8.4). Attendance rates were significantly lower among the group exercise patients. One-to-one therapies provided evidence of greater patient satisfaction. Conclusion: The study supports the use of a variety of approaches for the treatment of chronic low back pain. Particular attention needs to be given to the problems of attracting enough participants for group sessions, as these can be difficult to schedule in ways that are convenient for different participants.Peer reviewe

Efficacy of a Brief Tele-Cognitive Behavioral Treatment vs Attention Control for Head and Neck Cancer Survivors With Body Image Distress: A Pilot Randomized Clinical Trial

IMPORTANCE: Although 1 in 4 head and neck cancer (HNC) survivors experience clinically significant body image distress (BID), a psychosocial morbidity that adversely affects quality of life, effective interventions for these patients are lacking. OBJECTIVE: To evaluate the acceptability and preliminary efficacy of BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment), a brief tele-cognitive behavioral therapy, at reducing BID among HNC survivors. DESIGN, SETTING, AND PARTICIPANTS: This parallel-group pilot randomized clinical trial recruited adult HNC survivors with BID between August 13, 2020, and December 9, 2021, from the Medical University of South Carolina HNC clinic during a routine survivorship encounter. Data were analyzed from May 3 to June 16, 2022. INTERVENTIONS: BRIGHT consisted of 5 weekly psychologist-led video tele-cognitive behavioral therapy sessions. Attention control (AC) consisted of dose- and delivery-matched survivorship education. MAIN OUTCOMES AND MEASURES: Change in HNC-related BID was assessed using IMAGE-HN (Inventory to Measure and Assess imaGe disturbancE-Head and Neck), a validated patient-reported outcome (score range, 0-84, with higher scores indicating greater HNC-related BID). Clinical response rate was measured as the proportion of patients with a clinically meaningful change in IMAGE-HN scores. RESULTS: Of the 44 HNC survivors with BID allocated to BRIGHT (n = 20) or AC (n = 24), the median (range) age was 63 (41-80) years, and 27 patients (61%) were female. Patients rated BRIGHT\u27s acceptability highly (all metrics had a mean rating of ≥4.5/5), and 19 of 20 patients (95%) receiving BRIGHT were likely or highly likely to recommend it to other HNC survivors with BID. BRIGHT decreased HNC-related BID from baseline to 1 month postintervention relative to AC (mean model-based difference in change in IMAGE-HN score, -7.9 points; 90% CI, -15.9 to 0.0 points) and from baseline to 3 months postintervention relative to AC (mean model-based difference in change in IMAGE-HN score, -17.1 points; 90% CI, -25.6 to -8.6 points). At 3 months postintervention, the clinical response rate of BRIGHT was 6.6-fold higher than AC (model-based odds ratio, 6.6; 90% CI, 2.0-21.8). The improvement in HNC-related BID for BRIGHT vs AC at 3 months was clinically significant, and the effect size was large (Cohen d, -0.9; 90% CI, -1.4 to -0.4). CONCLUSIONS AND RELEVANCE: In this pilot randomized clinical trial, BRIGHT was acceptable, may result in a clinically meaningful improvement in HNC-related BID, and showed a high clinical response rate. These promising preliminary data support conducting a large efficacy trial to establish BRIGHT as the first evidence-based treatment for HNC survivors with BID. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03831100