RESUMEN
DESIGN/PARTICIPANTS: This was a multicentre retrospective cohort study of adult patients (≥18 years) presenting with a process associated International Classification of Diseases code (ICD-AM-10) pertaining to sepsis between January 2017 and July 2020 to rural Emergency Departments. MAIN OUTCOME MEASURES: Our primary outcome was antibiotic appropriateness as defined by the Australian Therapeutic Guidelines (for antibiotic selection relative to infecting source) and the National Antimicrobial Prescribing Survey tool. Our secondary outcome was in-hospital mortality. METHODS: Relevant clinical and non-clinical, physiological and laboratory data were collected retrospectively. Multivariate logistic regression was used to estimate the odds of both inappropriate antibiotic prescribing and in-hospital mortality based on clinical and non-clinical factors. RESULTS: A total of 378 patients were included who primarily presented with sepsis of unknown origin (36.8%), a genitourinary (22.22%) or respiratory (18.78%) source. Antibiotics were appropriately prescribed in 59% of patients. A positive Quick Sequential Organ Failure Assessment score (qSOFA) (odds ratio [OR] = 0.49; 95% confidence interval [CI], 0.29-0.83), a respiratory infection source (OR = 0.5; 95% CI, 0.29-0.86) and documented allergy (OR = 0.42; 95% CI, 0.25-0.72) were associated with a lower risk of appropriate prescribing in multivariate analysis. Forty-one percent of patients received antibiotics within 1 h of presentation. Inappropriate antibiotic prescribing was not associated with in-hospital mortality. CONCLUSION: The rates of appropriate antibiotic prescribing in rural Emergency Departments for patients presenting with sepsis is low, but comparable to other referral metropolitan centres.
Asunto(s)
Antibacterianos , Sepsis , Adulto , Humanos , Estudios Retrospectivos , Antibacterianos/uso terapéutico , Hospitales Rurales , Australia , Sepsis/tratamiento farmacológico , Servicio de Urgencia en HospitalAsunto(s)
Enfermedades del Pie/diagnóstico , Talón , Dolor/diagnóstico , Guías de Práctica Clínica como Asunto , Antiinflamatorios no Esteroideos/uso terapéutico , Diagnóstico Precoz , Medicina Familiar y Comunitaria/normas , Fascitis Plantar/diagnóstico , Fascitis Plantar/terapia , Femenino , Enfermedades del Pie/etiología , Enfermedades del Pie/terapia , Humanos , Masculino , Aparatos Ortopédicos , Dolor/etiología , Manejo del Dolor , Dimensión del Dolor , Pronóstico , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
The Rainey Hospice House, South Carolina's first stand-alone inpatient facility opened in September 1998. During the year 2000, 220 inpatients were served in the house. Patients ranged in age from 23 to 107 years old (average age 73). Cancer was the most common hospice diagnosis, followed by congestive heart failure, cardiovascular disease and cerebrovascular disease, dementia, cirrhosis, renal failure, and COPD. Thirty-three percent of patients were in the program less than ten days. Over 98 percent of deaths under hospice care were described as peaceful. During 2000, our outpatients and our inpatients were similar in age, insurance coverage, diagnoses, and time in the program. Inpatient hospice is highly valued by families and patients alike. It is especially useful for the following patients: those with uncontrolled symptoms, those with exhausted care givers, those with no caregivers, those who require total care, and those very close to death. The symptoms most likely to precipitate inpatient admission include pain, nausea, confusion, and agitation. Given the graying of South Carolina's population and the increase in outpatient hospice care, more areas of the state will need inpatient facilities in the future.
Asunto(s)
Cuidados Paliativos al Final de la Vida/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Cuidados Paliativos al Final de la Vida/organización & administración , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Humanos , Pacientes Internos , Persona de Mediana Edad , South CarolinaAsunto(s)
Mareo/diagnóstico , Alcoholismo/psicología , Mareo/psicología , Salud de la Familia , HumanosRESUMEN
Maryland data substantiate the safety of isoniazid therapy in preventing tuberculosis. To eradicate tuberculosis in the U.S., private physicians must play an active role by offering preventive therapy to patients at high risk of developing the disease.
Asunto(s)
Isoniazida/uso terapéutico , Tuberculosis/prevención & control , Adolescente , Adulto , Asia/etnología , Niño , Preescolar , Femenino , Humanos , Lactante , Isoniazida/efectos adversos , Masculino , Maryland/epidemiología , Persona de Mediana Edad , Refugiados , Factores de Riesgo , Tuberculosis/epidemiología , Tuberculosis/etnología , Tuberculosis/transmisiónRESUMEN
Family practice residents rarely detect more than one half of the alcoholic patients they see. This study examines detection rates in terms of the patient's presenting complaint, the clinical encounter, and the resident's attitudes. Over four months 218 patients of the family practice center of a large community hospital completed a survey that included the Short Michigan Alcoholism Screening Test (SMAST). Chart audits of each patient's visit assessed each resident's behavior in recording questions about the patient's use of alcohol. After the first four months, each resident completed a survey of his or her experiences and attitudes concerning alcoholism. Using the SMAST scores and chart audits, 25 of the 218 patients were identified as alcoholic. The residents detected only 12 of the 25 alcoholics. Of 51 patients who presented for physical examinations, the residents recorded asking only 28 about their drinking; of 157 patients who presented for more limited visits, the residents recorded asking only six about their drinking. Residents rated the alcoholic patient as less motivated, more dangerous, less hopeful, and much sicker than the average person. First-year residents rated alcoholics much more negatively than did upper-level residents. The SMAST again proved to be much more effective than clinical interviews in detecting alcoholism in patients.