Failure of a Best Practice Alert to Reduce Antibiotic Prescribing Rates for Acute Sinusitis Across an Integrated Health System in the Midwest.

BACKGROUND: Antimicrobial resistance is a growing concern, and in recent years, there has been increased interest in ambulatory antimicrobial stewardship. Acute rhinosinusitis (ARS) is one of the most common outpatient diagnoses that results in an antibiotic prescription. OBJECTIVE: To determine if a best practice alert (BPA) will affect the percentage of oral antibiotic prescriptions for adults with ARS. METHODS: A prospective, pre/post study was initiated to evaluate the percentage of oral antibiotic prescriptions for ARS in 117 primary care clinics in the Midwest. Included in the study results were 16,570 adults who had an office visit for ARS: 8,106 patients from December 1, 2015, to February 28, 2016, were in the pre-intervention group without an active BPA, and 8,464 patients from December 1, 2016, to February 28, 2017, were in the post-intervention group when the BPA was active. The primary outcome was the number of oral antibiotic prescriptions for ARS compared with the number of office visits for ARS in the pre- and postintervention groups. RESULTS: The percentage of oral antibiotics prescribed for the pre- and postintervention groups were 94.8% and 94.3%, respectively (P = 0.152). The BPA displayed for 7,780 visits, prompting discontinuation of an antibiotic for 10 (0.1%) visits in the postintervention group. CONCLUSIONS: This study suggests that, although an electronic alert may be attractive to facilitate antimicrobial stewardship, it may be ineffective. These results warrant alternative measures to facilitate ambulatory antimicrobial stewardship. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to declare. Study concept and design were contributed by Hansen, D. Leedahl, and N. Leedahl. Hansen and N. Leedahl took the lead in data collection, with assistance from Carson and D. Leedahl. Data interpretation was performed by all the authors. The manuscript was written by Hansen, along with the other authors, and revised by all the authors.

Lepra. Impacto psicosocial / Leprosy. Psychosocial impact

Las enfermedades infecciosas se han convertido en un importante problema de salud, y reto para científicos, médicos e investigadores. En la actualidad son cientos de miles de personas que padecen de Lepra. El estigma y las discapacidades producidas los convierten en inhabilitados sociales. La aparición de la Bioética como nuevo paradigma del pensamiento médico, con sus principios de beneficencia, no maleficencia, autonomía y justicia, ha conmocionado al mundo de las ciencias médicas. Se realiza un análisis filosófico de un dilema bioético importante en nuestro medio: la ética médica y la Enfermedad de Hansen (Lepra), el humanismo como base de la relación médico paciente y la reflexión acerca del impacto psicosocial y económico de la Lepra. Se realizan algunas reflexiones que debe tener en cuenta el médico y enfermera de familia, así como el resto del Equipo Básico de Salud y los trabajadores de la Atención Primaria, con el paciente de Lepra. Se concluye que la relación médico-paciente en enfermos de Lepra requiere un humanismo vivo y desde el punto de vista (AU)

Infectious illnesses are an important health problem and a challenge for scientists, doctors and investigators. At the present time there are hundreds of thousands of people suffering from leprosy. The stigma and the inabilities produced makes them socially disabled. The appearance of Bioethics as a new paradigm of medical thought, with its charity principles, non balefulness, autonomy and justice, has revolutionised the world of the medical sciences. A philosophical analysis of an important dilemma ofbioethics in our environment is performed: the medical ethics and Hansen’s illness (leprosy), humanism as the base of the patient- doctor relationship and the reflection in the impact psychosocial and economic impact of leprosy. Some reflections that doctors and nurses, as well as the rest of the Basic Health Team and Primary Attention workers should bear in mind when dealing with leprosy patients are offered. The conclusion is that the doctor-patient relationship when dealing with leprosy requires active humanism and, psychosocially, it is necessary to conquer the taboo and the discrimination that leprosy sparks off in the community (AU)

Integración de los servicios sanitarios para la lepra / Integration of leprosy services

No disponible

Status of health in India and its future prospects.

PIP: This overview of health programs and conditions in India reveals that health is related to economic development antipoverty measures, food production and distribution, drinking water supply, sanitation, housing, environmental protection, and education. There are urgent requirements for effective intersectorial coordination. Unprecedented growth of 1 million a year has resulted in slums and shanties--a place of epidemics; urbanization has contributed to environmental pollution impacting on health, and water pollution to water-born diseases. Health services are still insufficient to meet the needs. Sanitation practices contribute to cholera, dysentery, diarrhea, enteric fevers, and malaria. Indian Systems of Medicine and Homeopathy must be active in preventive and health care. Accomplishments include in 1987/8 a decline in leprosy cases attributed to the existence of leprosy control units. 40 AIDS Surveillance Units are actively treating and screening. The Naval Goitre Control Programme's goal is replacement of iodized salt for edible salt by 1992, thereby reducing mental retardation and low birth weight babies. The Family Welfare Programme, targets a New Production Rate of Unity before 2000. A National Technology Mission on immunization and the Universal Immunization Programme plans to be operational in all districts by 1990. Oral rehydration therapy programs dispense free packets to fill the needs of 1 million children under 5 who suffer from diarrhea 3 times a year with 3 million facing death. The Primary Health Care Programme provides iron and folic acid to women with nutritional anemia and Vitamin A to children. Health service developments have been increased.^ieng