Clinical application evaluation and revision suggestions of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for upper respiratory tract infection in children / 中国中药杂志

Questionnaires and case investigation methods were taken in this paper, taking the clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for upper respiratory tract infection in children published by the Chinese Medicine Association as the research object. Doctors from 187 hospitals in 29 regions across the country were invited to evaluate the applicability of the Guideline and clinical application effects, so as to collect the opinions on revising the Guideline. Clinicians about 508 accepted the applicability survey of the Guideline, and considered that the structure and content of the Guideline were reasonable, with the proportions being as high as 98.23% and 98.03%, respectively. In the content of syndrome differentiation-based treatment, the factors with higher rationality included therapeutic principle and method (99.41%), diagnosis elements (98.82%), and syndrome differentiation classification (98.03%); while the factors with lower rationality included the rehabilitation and health preserving (97.05%) and complication prevention (97.24%). 98.03% of the clinicians considered theat the Guideline was to be fully applicable and basically applicable, and 1.97% of the clinicians considered it to be applicable after revision. By observing 491 cases, the Guide was applied for evaluation and analysis. The factors with higher compliance included diagnosis of Western medicine disease (100%) and the diagnosis of TCM disease (99.18%); while the factors with lower compliance included the treatment measures, with a compliance rate of 77.18% and 83.05% respectively for simple preparations and other treatment method. The safety and economy of the Guideline were good, 97.35%, 93.89%, respectively. The comprehensive evaluation was good, and 99.41% of the respondents were willing to follow the treatment schemes recommended in the Guideline, suitable for clinical application. The opinions on revision were mainly focused on dialectical treatment, complication prevention and rehabilitation. It indicates that only by actively and extensively soliciting opinions to revise the Guideline, can we improve the quality of the Guideline for clinical practice, so as to raise the level of clinical efficacy.

Viral etiology of acute upper respiratory infection in Hebei Province from 2013 to 2015 / 中华疾病控制杂志

Objective To investigate the viral etiology and the epidemilogy of acute upper respiratory tract infection in Hebei Province from 2013 to 2015,providing scientific basis for diagnosis,prevention and control of the respiratory tract infection.Methods l 551 throat swab samples of the acute upper respiratory infection patients from four hospitals in Hebei Province were collected,Multiplex real-time PCR was used to detect 15 kinds of respiratory tract viruses for all specimens after nucleic acids extraction.Results Totally 714 positive samples were obtained from 1 551 samples,with a positive rate of 46.03％.Human rhinovirus(186,11.99％)was detected as the most common viral species,followed by human parainfluenza 3(167,10.77％),respiratory syncytial virus (122,7.87％),adenovirus (108,6.96％),influenza B virus (56,3.61％),human metapneumovirus(40,2.58％),influenza A virus(39,2.51％),human boca virus (38,2.45％),human parainfluenza 1 (35,2.26％),human coronavirus-229E/NL63 (33,2.13％),human enterovirus (32,2.06％),human parainfluenza 4(31,2.00％),human coronavirus-OC43 (30,1.93％),and human parainfluenza 2(11,0.71％).176 cases (11.35％) were detected as co-infection.The infection rate(56.07％) of under 5 years old group was higher than that of other groups.Conclusions The predominant respiratory viruses,who are responsible for acute upper respiratory tract infections in Hebei Province,are HRV,PIV3,RSV,ADV and IFV.Each virus possess the specific epidemiological feature.

Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong / 世界急诊医学杂志（英文）

@#BACKGROUND: Currently there is very limited data in the literature assessing the prevalence of antihistamine prescription, and there is no local prevalence data about the prescription of antihistamine agents among primary practitioner and emergency physicians. The objectives are 1) to report the prevalence of antihistamine prescription for children less than 6 years old with acute upper respiratory infection and 2) to explore the associated factors for the prescription practice. METHODS: This is a cross-sectional study. All consecutive cases of paediatric patients aged 6 or below who presented to the emergency department during a study period of one week from April 1 to July 4, 2009 with diagnosis of acute upper respiratory infection were included. Totally 162 patients were included. RESULTS: Among the 162 cases, 141 (87%) patients were prescribed one antihistamine of any group. Sixty (37%) patients were prescribed two or more antihistamines. In multivariate logistic regression model, age was found to be significantly (P<0.001) associated with multiple antihistamine prescription (OR=1.042, 95%CI=1.02 to 1.06). Years of graduation of attending physician for more than 5 years was also a strong predictor of multiple antihistamine prescription (OR=4.654, 95%CI=2.20 to 9.84, P<0.001). CONCLUSION: In the local emergency department, patients' age and the years of graduation from medical school of the attending physician were predictors of multiple antihistamine prescription for acute upper respiratory infections for children aged less than 6.

Bocavirus en niños menores de 5 años con infección respiratoria aguda: Provincia del Chaco, 2014 / Bocavirus in infants under 5 years with acute respiratory infection. Chaco Province, Argentina, 2014

La infección respiratoria aguda (IRA) es la patología más frecuente a lo largo de la vida de una persona y es la causa más común de morbi-motalidad en menores de 5 años. El objetivo de este trabajo fue determinar la frecuencia de bocavirus (BoV) en pacientes menores de 5 años con diagnóstico presuntivo de IRA en una ciudad capital del norte argentino (Resistencia, Chaco). Se analizaron aspirados nasofaríngeos correspondientes a 488 niños durante el año 2014. Los mismos fueron testeados por PCR en tiempo real hallándose BoV en 36 casos (7.4%), de los cuales 26 (72.2%) fueron infantes de 6-18 meses de vida. La mayor concentración de positivos se registró en el período junio-septiembre con un total de 28 pacientes (77.8%). Los casos positivos para BoV se observaron como infección única en el 50% de los mismos y el resto como infecciones concomitantes con otros microorganismos. No conocemos que haya otro estudio de epidemiología molecular de BoV en el norte argentino y destacamos la importancia de investigar los nuevos virus capaces de generar infección respiratoria aguda, y difundir el conocimiento de su circulación en la comunidad.

Acute respiratory infection (ARI) is the most frequent pathology along human life, being the most common cause of morbidity and mortality in children under 5 years. The aim of this study was to determine the frequency of bocavirus (BoV) in infants under 5 years with symptoms of ARI from north Argentina (Chaco province). The study was performed on nasopharyngeal aspirates from 488 patients, in the period of January-December 2014. The samples were tested by real time PCR and 36 positive BoV cases (7.4%) were detected. The period with the highest detection rate was June-September with 28 cases (77.8%), of which 26 (72.2%) were infants between 6-18 moths of life. In half of BoV positive cases this virus was detected as single infection of the upper respiratory tract, and in the remaining 50%, as concomitant infection with other microorganisms. To our knowledge, this would be the first study on molecular epidemiology of BoV in northern Argentina. We emphasize the importance of investigating these new viruses capable of generating acute respiratory disease and also to disseminate awareness on their circulation within the community.

Quality of care for children with upper respiratory infections at Mexican family medicine clinics / Calidad de la atención en niños con infecciones respiratorias superiores en las clínicas mexicanas de medicina familiar

AbstractBackground: Upper respiratory infections are the principal cause of morbidity in children <5 years of age. The objectives of this study were (i) to develop quality-of-care indicators for evaluation of care for children with upper respiratory infections (URI) at the primary care level using data from the electronic health records and (ii) to evaluate the quality of URI care offered to children <5 years of age at family medicine clinics (FMCs).Methods: Development of indicators following the RAND-UCLA method was used. A cross-sectional analysis of quality of care provided for children with URI in four FMCs in Mexico City where 10,677 children <5 years of age with URI participated. The source of information was data from 2009 electronic health records. Quality of care was evaluated using six indicators developed in the first stage of this study.Results: The quality of care evaluation identified that only 15% of children had registries of intentional search of respiratory distress signs and 27% received information on warning signs. More than 61% of children diagnosed with uncomplicated and nonstreptococcal URI received antibiotic prescription during the first visit. In the case of children diagnosed with streptococcal pharyngitis or tonsillitis, 57.5% received the appropriate antibiotic. On average, the percentage of recommended care received was 47.2%.Conclusions: It is reasonable to promote the use of electronic health records to routinely evaluate the quality of URI care. It is necessary to consider quality flaws that were found in order to endorse strategies aimed at strengthening the technical capacity of health personnel to exercise evidence-based clinical practice.

ResumenIntroducción: Las infecciones respiratorias superiores son la principal causa de morbilidad en niños menores de cinco años. Los objetivos de este estudio fueron los siguientes: (i) desarrollar indicadores para medir la calidad de atención a niños con infecciones respiratorias superiores (IRS) en atención primaria; (ii) evaluar la calidad de la atención para IRS que los menores de cinco años reciben en clínicas de medicina familiar.Métodos: Se desarrollaron indicadores siguiendo el método RAND-UCLA. Estudio transversal de la calidad de atención en cuatro clínicas de medicina familiar en la Ciudad de México. Participaron 10,677 niños menores de cinco años con IRS. La fuente de la información fueron los registros médicos electrónicos de 2009. La calidad de la atención se determinó a través de 6 indicadores.Resultados: La evaluación de la calidad de la atención identificó que el 15% de los niños tenía registros de búsqueda intencionada de signos de dificultad respiratoria; 27% recibió información sobre las señales de alarma. Más del 61% de los niños diagnosticados con IRS no estreptocócica recibió prescripción de antibióticos durante la primera consulta. En los niños con diagnóstico de faringitis estreptocócica o amigdalitis, el 57,5% recibió el antibiótico apropiado. En promedio, el 47.2% recibió la atención recomendada.Conclusiones: Es recomendable promover el uso de los datos del expediente clínico electrónico para evaluar sistemáticamente la calidad de la atención en IRS. Es necesario considerar los problemas de calidad para diseñar las estrategias encaminadas a fortalecer la capacidad técnica del personal de salud para ejercer la práctica clínica basada en la evidencia para la atención de IRS.

Bacterial Upper Respiratory Infections

Acute bacterial upper respiratory infections include acute rhinosinusitis, acute pharyngotonsillitis, acute laryngitis, and acute epiglottitis. These are common reasons for primary care visits. Acute bacterial sinusitis usually occurs as a secondary complication of acute viral sinusitis. Acute viral sinusitis will recover over the course of 7-10 days without antibiotics. Amoxicillin is a drug of choice for acute bacterial sinusitis in the practice guidelines. Patients with acute pharyngotonsillitis should be treated with antibiotics (amoxicillin) for 10 days with the purpose of prevention of rheumatic fever. Use of rapid antigen detection should be encouraged for the appropriate use of antibiotics, especially in Korea. Etiologies of acute laryngitis in adults are mainly viruses. However, M. pneumoniae, M. catarrhalis, H. influenzae are major bacterial pathogens of laryngtitis. Acute epiglottitis, cellulitis of the epiglottis, is a life-threatening infection. Airway keeping and antibacterial therapy against H. influenzae and other bacterial pathogens are main stays of management. Evidence-based approach is greatly in need for appropriate care for patients with bacterial upper respiratory infections.

Upper Respiratory Infections in Adults

Despite major advances in medicine, acute upper respiratory infections (URI) continue to be a huge burden on society in terms of human suffering. Acute rhinopharyngitis (common cold), acute sinusitis (viral and bacterial), acute pharyngotonsillitis, acute laryngitis are categorized as this common health problem. Several viruses can cause common cold, but rhinoviruses are by far the most common. Alleviation of symptoms with drugs such as nasal decongestants and acetaminophen, remains as the main way to manage common cold. Patients with acute pharyngotonsillitis should be treated with antibiotics (amoxicillin) for 10 days, but adult patients have low risk for late complications (rheumatic fever and glomerulonephritis) of S. pyogenes infection. Patients with acute viral sinusitis will recover over the course of 7~10 days without antibiotics. Amoxicillin is drug of choice for acute bacterial sinusitis in the practice guidelines. Evidence-based approach is greatly needed for appropriate care for URI patients. Effective antiviral agents and vaccines for URI pathogens should be studied, while the related researches can be challenging. Evidence-based practice for URI and patient education are good medical practice to deal with with these very common health problems.

Understanding the Culture of Antibiotics Prescribing of Primary Physicians for Acute Upper Respiratory Infection

BACKGROUND: To understand why primary physicians prescribe antibiotics for some cases of acute upper respiratory infections and to explore the factors that influence their prescribing. METHODS: Qualitative analysis of semi-structured interviews. Participants were 12 primary physicians in the maximum variety sample. RESULTS: Interviewees were identified the problems of antibiotics abuse and misuse in Korea. Primary physicians were certain that patients will benefit from antibiotics and prescribe for the patients' expectation of fast relief. Doctors are mostly comfortable with their prescribing decisions by their clinical experiences. They are also more likely to prescribe antibiotics in pressures of time and in competitive clinical environment. CONCLUSION: Multiple factors are involved in primary physicians' decision of their prescribing for acute upper respiratory infections. Further interventions to reduces prescribing would need to improve identification of patients at risk of complications and be workable in busy clinical situations. Repeating evidence for lack of effectiveness and lack of efficiency in general might be helpful.