ABSTRACT
Introduction: Antibiotic resistance is a serious threat to global public health. It reduces the effectiveness of treatments for serious bacterial infections and thus increases the risk of fatal outcomes. Antibiotic prescriptions are often not in line with clinical evidence-based guidelines. The process of emergence of resistant bacteria can be slowed down by adherence to guidelines. Yet this adherence seems to be lacking in primary health care. Methods and Analysis: This pragmatic quasi-experimental study using a controlled before-after design was carried out in South-East-Lower Saxony in 2018-2020. The voluntary attendance of interactive trainings with condensed presentation of current guidelines for general practitioners (GP) on antibiotic management for urinary and respiratory tract infections is regarded as intervention. Those GP not attending the trainings constitute the control group. Data were collected via questionnaires; routine health records are provided by a statutory health insurance. The primary outcome is the proportion of (guideline-based) prescriptions in relation to the relevant ICD-10 codes as well as daily defined doses and the difference in proportion of certain prescriptions according to guidelines before and after the intervention as compared to the control group. Further outcomes are among others the subjectively perceived risk of antibiotic resistance and the attitude toward the guidelines. The questionnaires to assess this are based on theory of planned behavior (TPB) and health action process approach (HAPA). Variations over time and effects caused by measures other than WASA (Wirksamkeit von Antibiotika-Schulungen in der niedergelassenen Aerzteschaft-Effectiveness of antibiotic management training in the primary health care sector) training are taken into account by including the control group and applying interrupted time series analysis. Ethics and Dissemination: The study protocol and the data protection concept respectively were reviewed and approved by the Ethics Committee of the Hannover Medical School and the Federal Commissioner for Data Protection and Freedom of Information. Trial Registration: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013951, identifier DRKS00013951.
ABSTRACT
INTRODUCTION: General survey of emergency care in nursing homes in the City of Braunschweig. METHODS: Retrospective analysis of data from death registry, resuscitation registry and further routine data from the local health authorities and the emergency medical services (EMS). RESULTS: 30 nursing homes with 3,100 beds (mean: 103; range: 35-250) were included; operators of nursing homes were 18 non-profit organizations; 7 private (local); 5 private (nationwide). Among the inhabitants of these 30 nursing homes 880 deaths occurred, 406 (46 %) in hospital; 4,895 EMS deployments for emergency care; 4,493 (92 %) resulting in emergency department visits; 19 CPRs. EMS deployments without a physician order per bed 1.0 (0.4-1.6); emergency department visits per bed 1.4 (0.7-3.1); rate of EMS deployments without physicians order / emergency department visits 70 % (41-96 %); deaths per bed 0,29 (0.12-0.48); rate of deaths in hospital 46 % (0-62 %); CPRs per 1,000 beds 6.1 (0-28); CPR failure rate 22 (0-83) per 1,000 deaths per year. EMS deployment without physician order was significantly more frequent in privately (nationwide) operated nursing homes 1.2 (1.0-1.4). In the entire urban region, the incidence of EMS deployment without a physician order was 0.2 per inhabitant per year and the rate of hospital deaths was 64 %. CONCLUSION: Compared to the entire population of the City of Braunschweig, EMS deployment was more frequent in nursing homes. The chance of hospital death or failed CPR was slightly lower. There are large variations between the different nursing homes. Indicators from routine data can provide guidance for more specific surveys but do not allow benchmarking.
Subject(s)
Emergency Medical Services , Nursing Homes , Emergency Service, Hospital , Germany , Humans , Registries , Retrospective StudiesABSTRACT
There is a high prevalence of posttraumatic stress disorder (PTSD) in the refugee population. In order to identify affected individuals and offer targeted help, there is an urgent need for easily understandable, reliable, valid, and efficient screening measures. The aim of the present study was to compare the diagnostic efficiency of the Process of Recognition and Orientation of Torture Victims in European Countries to Facilitate Care and Treatment (PROTECT) questionnaire (PQ) to that of the eight-item short-form Posttraumatic Diagnostic Scale (PDS-8) and the Patient Health Questionnaire (PHQ-9). Using structured clinical interviews, the prevalence rates of PTSD and major depression episode (MDE) were assessed in a refugee sample (N = 118), and receiver operating characteristic analyses were determined and compared. Of participants in the sample, 29.7%, 95% CI [22.0%, 38.5%], were diagnosed with PTSD and 33.1%, 95% CI [24.4%, 41.9%], were diagnosed with MDE. The area under the curve (AUC) for all measures was moderate, AUCs = 0.79-0.86; hence, measures did not differ in terms of their discriminatory abilities. Using the favored cutoff points, sensitivity and specificity were 80-97% and 60-70%, respectively. In terms of their discriminatory abilities, none of the investigated measures can be favored more than the others. Thus, for detection of these two disorders, the shorter PQ could be more efficient. Because the high co-occurrence of PTSD and MDE might limit the explanatory power of results in the present study, the findings should be cross-validated in the future.
Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Tamizaje para Trastorno de Estrés Postraumático en Refugiados: Comparación de la Eficiencia Diagnóstica de 2 Medidas de auto-reporte para el Trastorno de Estrés Postraumático TAMIZAJE PARA TEPT EN REFUGIADOS Hay una alta prevalencia de Trastorno de Estrés Postraumático (TEPT) en la población de refugiados. Se requieren con urgencia medidas de tamizaje fácilmente comprensibles, confiables, válidas y eficientes, para identificar a los individuos afectados y ofrecer ayuda focalizada. El objetivo del presente estudio fue comparar la eficiencia diagnóstica del cuestionario PROTECT (PQ) con la de la forma corta de 8 ítems de la Escala de Diagnóstico Postraumático (PDS-8, por sus siglas en inglés) y del Cuestionario sobre la Salud del Paciente (PHQ-9, por sus siglas en inglés). Mediante el uso de entrevistas clínicas estructuradas, se evaluaron las tasas de prevalencia de TEPT y Episodio Depresivo Mayor (EDM) en una muestra de refugiados (n=118), además de determinar y comparar los análisis de las características operativas del receptor. De los participantes en la muestra, 29.7%, IC 95% [22.0%, 38.5%], fueron diagnosticados con TEPT y 33.1%, IC 95% [24.4%, 41.9%] fueron diagnosticados con EDM. El área bajo la curva (AUC en sus siglas en inglés) para todas las mediciones fue moderada, AUCs=.79-.86; por lo tanto, las mediciones no difirieron en términos de su capacidad discriminatoria. Usando los puntos de corte favorecidos, la sensibilidad y especificidad fueron 80-97% y 60-70% respectivamente. En términos de su capacidad discriminatoria, ninguna de las medidas investigadas puede ser favorecida más que las otras. Por lo tanto, al detectar estos dos trastornos, la PQ breve puede ser más eficiente. Dado que la co-ocurrencia de TEPT y EDM podría limitar el poder explicatorio de los resultados del presente estudio, los resultados deben ser validados de forma cruzada en el futuro.
