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Prescribing antibiotics may reinforce patients’ beliefs that antibiotics are needed and increase future consultations for similar symptoms. This review determines the effect of antibiotic prescribing for respiratory infections in primary care on future reattendance.
A systematic review and meta-analysis of randomised controlled trials (RCTs) and cohort studies and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Participants were adults or children presenting with respiratory infection in primary care.
MEDLINE (Ovid), PubMed, Embase, the Cochrane Central Register of Controlled Trials, clinical trial registries and grey literature sources were searched from inception until 6 February 2024.
Eligible studies included open-label RCTs or cohort studies of antibiotics compared with no antibiotics in adults or children with respiratory infections. The outcome of interest was reattendance at least 28 days after the initial consultation.
Two reviewers independently screened, selected, assessed the quality and extracted data. Separate meta-analyses were presented for RCT and cohort studies and a combined meta-analysis of all studies.
We identified 2128 records and reviewed 48 full texts, of which five met the inclusion criteria. These reported three RCTs (1207 randomised to antibiotics, 672 controls) and three cohort studies (209 138 exposed to antibiotics, 46 469 controls). In the meta-analysis of RCTs, relative risk (RR) of reattendance with antibiotics was 1.10 (95% CI: 0.99 to 1.23), and in cohort studies, RR was 1.21 (95% CI: 0.94 to 1.49). An important limitation is that most studies were in UK primary care.
Evidence suggests prescribing antibiotics for acute respiratory tract infections in primary care probably modestly increases future reattendance for similar conditions. Reducing antibiotic prescribing may help decrease demand for primary care.
CRD42023470731.
Maternal and child malnutrition is a significant public health concern in Pakistan, with 40% of children under five being stunted. In response, the Government of Pakistan initiated the Benazir Nashonuma Programme (BNP), a nutritional supplementation programme for pregnant women, mothers of children aged 0 to 23 months and children aged 6 to 24 months. This study aims to evaluate the effectiveness of the BNP in reducing childhood stunting and improving maternal and child health outcomes.
A quasi-experimental longitudinal study comprising baseline, midline and endline surveys will be conducted across 18 districts (9 intervention and 9 control) in Pakistan. The surveys will use a two-stage cluster sampling method to enrol 13 200 children aged 0–59 months and their mothers from the Benazir Income Support Programme households. The primary outcome of interest is the prevalence of under-five stunting. We will use a difference-in-differences approach to estimate the impact by comparing the documented changes over time between the intervention and control groups.
This study will provide critical insights into the effectiveness of the BNP in addressing childhood undernutrition in Pakistan. The findings will inform policy and programmatic decisions aimed at reducing undernutrition in resource-constrained settings. Ethical approval has been obtained from the Ethics Review Committee of Aga Khan University and the Pakistan National Bioethics Committee.
by Fahad Alzahrani, Nawaf Almutairi, Abdullah Aloufi, Abdulmalik Kattan, Abdulaziz Hakeem, Mohammed Alharbi, Naif Alarawi, Haifa A. Fadil, Ehsan Habeeb
ObjectivesEvidence-based medicine (EBM) combines clinical expertise, patient values, and the best available evidence to guide healthcare decision-making. Despite its importance in pharmacy practice, EBM adoption in Saudi Arabian pharmacies remains under-researched. This study aimed to assess the knowledge, attitudes, and practices regarding EBM among hospital and community pharmacists in the Madinah Region, Saudi Arabia.
MethodsA cross-sectional study was conducted with 206 pharmacists from September to November 2023. Data were collected through a validated online self-administered questionnaire to evaluate pharmacists’ knowledge, attitude, and practice (KAP), as well as their understanding of EBM technical terms.
Ethical approvalThe study was approved by the Scientific Ethics Committee of the College of Pharmacy at Taibah University, Madinah region, Saudi Arabia (reference number COPTU-REC-77–20230827). All participants received a consent form before participating.
ResultsPharmacists demonstrated moderate knowledge (76.5%), neutral attitudes (76%), and fair practices (68%) toward EBM, with hospital pharmacists scoring higher than community pharmacists. Moreover, 83.3% believed that EBM could enhance patient health outcomes, 80.0% were willing to learn, and 35.9% believed that EBM focuses solely on research without considering clinical experience. Time constraints (34.0%) were a major barrier, and 46.1% of the participants lacked appropriate training. EBM education was correlated with higher knowledge and attitude scores; however, it had no significant impact on practice scores. Significant barriers identified were the difficulty in conveying technical terms (16%) and limited access to adequate training opportunities.
ConclusionDespite positive attitudes toward EBM, many pharmacists perceive it as a potential threat to good clinical practice. This perception underscores the need for targeted educational initiatives that promote EBM benefits, address misconceptions, and provide practical support for its integration in both hospital and community pharmacy settings.
To estimate the prevalence of dementia and mild cognitive impairment (MCI) in the older prisoner population in England and Wales and to establish risk of harm to self and others, activity of daily living needs and social networks of prisoners with likely MCI and dementia.
We screened 869 older prisoners (aged 50 years and older) using the Montreal Cognitive Assessment (MoCA). Participants testing positive on the MoCA (≤23) were interviewed using the Addenbrooke’s Cognitive Examination, Third Revision (ACE-III) and a range of standardised assessments were used to assess risks of externalised violence and of self-harm; activities of daily living needs; mental health needs; history and symptoms of brain injury (if applicable) and social networks.
The sample was drawn randomly from women’s prisons (n=10) and a representative range of adult men’s prisons (n=11) across England and Wales.
Participants were aged 50 or over and resident in one of the participating prison establishments on the study’s census day.
ACE-III.
We recruited 596 men and 273 women prisoners. Across the whole sample of older prisoners, the prevalence of dementia was 7.0% (95% CI 5.5%, 8.9%) (when weighted for sex and age), with the highest prevalence found among prisoners aged 70 years and older at 11.8% (95% CI 8.0%, 17.1%). The prevalence of dementia for men was 7.0% (95% CI 5.2%, 9.4%) and for women was 6.0% (95% CI 3.8%, 9.5%). Only two individuals (3%) who screened positively on the MoCA had a diagnosis of dementia in their prison healthcare notes, suggesting current under-recognition. The prevalence of MCI was 0.8% (95% CI 0.4% to 1.7%, weighted by age). Of those who screened positively on the MoCA, 32 (46%) participants had a high or very high risk of harm to self or others, and 70 (35%) had no friends with whom they could talk to about private matters or to call on for help (n=35, 50%).
Approximately 1020 older adults living in prison have symptoms of likely dementia, and service provision for this group is inadequate.
by Mehdi Hosseinzadeh, Amir Haider, Mazhar Hussain Malik, Mohammad Adeli, Olfa Mzoughi, Entesar Gemeay, Mokhtar Mohammadi, Hamid Alinejad-Rokny, Parisa Khoshvaght, Thantrira Porntaveetus, Amir Masoud Rahmani
This paper seeks to enhance the performance of Mel Frequency Cepstral Coefficients (MFCCs) for detecting abnormal heart sounds. Heart sounds are first pre-processed to remove noise and then segmented into S1, systole, S2, and diastole intervals, with thirteen MFCCs estimated from each segment, yielding 52 MFCCs per beat. Finally, MFCCs are used for heart sound classification. For that purpose, a single classifier and an innovative ensemble classifier strategy are presented and compared. In the single classifier strategy, the MFCCs from nine consecutive beats are averaged to classify heart sounds by a single classifier (either a support vector machine (SVM), the k nearest neighbors (kNN), or a decision tree (DT)). Conversely, the ensemble classifier strategy employs nine classifiers (either nine SVMs, nine kNN classifiers, or nine DTs) to individually assess beats as normal or abnormal, with the overall classification based on the majority vote. Both methods were tested on a publicly available phonocardiogram database. The heart sound classification accuracy was 91.95% for the SVM, 91.9% for the kNN, and 87.33% for the DT in the single classifier strategy. Also, the accuracy was 93.59% for the SVM, 91.84% for the kNN, and 92.22% for the DT in the ensemble classifier strategy. Overall, the results demonstrated that MFCCs were more effective than other features, including time, time-frequency, and statistical features, evaluated in similar studies. In addition, the ensemble classifier strategy improved the accuracies of the DT and the SVM by 4.89% and 1.64%, implying that the averaging of MFCCs across multiple phonocardiogram beats in the single classifier strategy degraded the important cues that are required for detecting the abnormal heart sounds, and therefore should be avoided.This study aims to (1) characterize healthcare professionals' (HCPs') experiences related to the prevention and management of pressure injuries (PIs) and (2) explore the educational needs of individuals with a past or current history of PIs and their caregivers from the perspective of HCPs. This is a qualitative descriptive study. HCPs (n = 18) were interviewed using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and coded using NVivo. Three overarching themes encompassing various dimensions were identified: (1) Facilitators related to PI prevention and management, (2) Challenges related to PI prevention and management and (3) Recommendations for improving patient and caregiver PI education. HCPs identified a greater number of challenges than facilitators related to PI care. This study emphasizes the importance of a patient-centred and interprofessional approach to patient education for PI prevention and management. Meaningful interventions focused on the patient may improve health literacy and empower patients and caregivers in PI care. Investing in preventive measures and raising awareness are crucial to reducing PI incidence. The findings have implications for HCPs and researchers seeking to enhance patient care and promote effective PI prevention strategies.
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