Polytomous regression did not outperform dichotomous logistic regression in diagnosing serious bacterial infections in febrile children

OBJECTIVE: To compare polytomous and dichotomous logistic regression analyses in diagnosing serious bacterial infections (SBIs) in children with fever without apparent source (FWS). STUDY DESIGN AND SETTING: We analyzed data of 595 children aged 1-36 months, who attended the emergency department with fever without source. Outcome categories were SBI, subdivided in pneumonia and other-SBI (OSBI), and non-SBI. Potential predictors were selected based on previous studies and literature. Four models were developed: a polytomous model, estimating probabilities for three diagnostic categories simultaneously; two sequential dichotomous models, which differed in variable selection, discriminating SBI and non-SBI in step 1, and pneumonia and OSBI in step 2; and model 4, where each outcome category was opposed to the other two. The models were compared with respect to the area under the receiver-operating characteristic curve (AUC) for each of the three outcome categories and to the variable selection. RESULTS: Small differences were found in the variables that were selected in the polytomous and dichotomous models. The AUCs of the three outcome categories were similar for each modeling strategy. CONCLUSION: A polytomous logistic regression analysis did not outperform sequential and single application of dichotomous logistic regression analyses in diagnosing SBIs in children with FWS.     

Zoonotic infections as causes of hospitalization among febrile Bedouin patients in southern Israel

A prospective 12-month study was conducted throughout 1998 to determine the frequency of selected bacterial zoonoses as causes of fever among hospitalized Bedouins in southern Israel. One or more zoonoses were diagnosed in 30 (27%) of 110 patients admitted with fever. Brucellosis was diagnosed in 9 (8%), rickettsial infections in 20 (18%), and ehrlichiosis in 2 (2%), one of whom had also evidence of rickettsial spotted fever infection. None of the patients was diagnosed with Q fever. Compared with patients without zoonoses, patients with zoonoses were younger (P = 0.01), fewer of them had underlying conditions (P < 0.02), they had a longer febrile period prior to hospitalization (P = 0.04), a significantly higher proportion had arthralgia (P = 0.02), rash (P = 0.03), and splenomegaly (P = 0.04) and a lower proportion had pathological findings on chest auscultation (P < 0.01). Patients with zoonoses were found to have more commonly anaemia (P = 0.03) and leucopenia (P = 0.02) compared to the rest of the study population. Of the 30 patients with zoonoses 60% were misdiagnosed and only 57% received adequate antibiotic treatment. Zoonotic infections are a common cause of fever in adult Bedouins living in southern Israel. Because of the non-specific features of these diseases they are often misdiagnosed. Blood cultures and multiple serological tests should be used in the investigation of fever in such patients and tetracycline should be considered for initial empirical treatment.     

Children should be seen and heard. Chronically ill children should have a voice in treatment decisions

Traditionally, sick children have obeyed orders--the doctor's orders, their parents' orders. Father (mother, doctor, nurse) knows best. But indications are that in the future, chronically ill children will have some say in their own treatment decisions. And although few healthcare facilities today have any policies in place to ensure such participation, they may face increasing pressure to implement such policies. Both the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and the American Academy of Pediatrics recommend that children actively participate in the consent-assent-dissent process for healthcare decisions. Children's participation need not be total or complete; it may involve only selected aspects. Participation will (1) increase their ownership of the decision and encourage them to obtain the necessary follow-up care, (2) increase their ability to make such decisions in the future, and (3) perhaps make healthcare less threatening and more attractive to them as future healthcare consumers. Providers could encourage a cautious, gradual increase in participation by chronically ill children and adolescents. It should start by involving them in concrete tasks (like setting dates and times) and lead to active negotiation with parents and healthcare workers regarding treatment.     

肿瘤患儿化疗后细菌感染的临床分析

目的探讨肿瘤患儿化疗后细菌感染的危险因素,制定有针对性的感染干预措施。方法选取2010年7月-2011年7月医院诊治的恶性肿瘤患儿400例,观察肿瘤患儿化疗后细菌感染率及感染部位分布,分析患儿发生感染的危险因素,采用SPSS17.0软件进行统计分析。结果 400例患儿中105例发生感染,感染率为26.3%;其中呼吸道感染比例最高,占48.6%,其次为口腔感染,占17.1%;共检出病原菌105株,前3位病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、铜绿假单胞菌,分别占35.2%、27.6%和21.0%;经单因素分析,年龄<3岁、接受侵入性操作、白细胞计数<2×109/L、中性粒细胞<0.5×109/L、住院时间>20d患儿发生感染率显著高于其他患儿,两者差异有统计学意义(P<0.05);经logistic回归分析,住院时间>20d、白细胞计数<2×109/L、中性粒细胞≤0.5×109/L及接受侵入性操作是肿瘤患儿化疗后细菌感染的危险因素。结论医院患儿化疗后细菌感染率较高,住院时间、接受侵入性操作等是导致感染的危险因素,针对上述危险因素进行有效干预,可显著降低肿瘤患儿化疗后细菌感染率。     

我国熟肉制品生产企业应尽快建立HACCP体系

作者介绍了我国熟肉制品生产及管理现状 ,阐述了HACCP在保证熟肉制品质量方面的重要性 ,具体描述了在熟肉制品企业建立HACCP体系的要求和步骤     

Vital signs of the systemic inflammatory response syndrome in adult patients with acute infections presenting in out-of-hours primary care: A cross-sectional study

BackgroundSigns of the systemic inflammatory response syndrome (SIRS) – fever (or hypothermia), tachycardia and tachypnoea – are used in the hospital setting to identify patients with possible sepsis.ObjectivesTo determine how frequently abnormalities in the vital signs of SIRS are present in adult out-of-hours (OOH) primary care patients with suspected infections and assess the association with acute hospital referral.MethodsWe conducted a cross-sectional study at the OOH GP cooperative in Nijmegen, the Netherlands, between August and October 2015. GPs were instructed to record the body temperature, heart rate and respiratory rate of all patients with suspected acute infections. Vital signs of SIRS, other relevant signs and symptoms, and referral state were extracted from the electronic registration system of the OOH GP cooperative retrospectively. Logistic regression analysis was used to evaluate the association between clinical signs and hospital referral.ResultsA total of 558 patients with suspected infections were included. At least two SIRS vital signs were abnormal in 35/409 (8.6%) of the clinic consultations and 60/149 (40.3%) of the home visits. Referral rate increased from 13% when no SIRS vital sign was abnormal to 68% when all three SIRS vital signs were abnormal. Independent associations for referral were found for decreased oxygen saturation, hypotension and rapid illness progression, but not for individual SIRS vital signs.ConclusionAlthough patients with abnormal vital signs of SIRS were referred more often, decreased oxygen saturation, hypotension and rapid illness progression seem to be most important for GPs to guide further management.     

How video cases should be used as authentic stimuli in problem-based medical education

PURPOSE: To examine problem-based learning (PBL) students' views on the added value of video cases compared to text-based cases in the pre-clinical phase of undergraduate medical education and on the conditions for productive use of video in tutorial group discussions. METHOD: Participants were 2nd-year students who had completed a PBL programme featuring video cases. Three groups of 6-8 randomly selected students participated in focus-group interviews guided by a moderator using a 'questioning route'. The interviews were audiotaped, transcribed and analysed. The summary reports were approved by the students. RESULTS: According to the students, the video cases enabled them to create realistic mental pictures of disorders, provided integrated pictures of patients as people, which challenged them to elaborate the cases seriously and were more memorable than text-based cases. Cases that students perceived as fostering the productive use of video were neither too directive nor too complete, tailored to students' prior knowledge, short, varied in design and complementary to other materials. The cases should be viewed in a structured, purposeful manner, with cues, instructions and prompts to focus attention on essential issues. CONCLUSION: The video cases were generally perceived as a valuable stimulus for group discussions in PBL. However, productive use depended on specific conditions. Many of the advantages and conditions mentioned are supported by earlier non-empirical claims in the literature or can be explained by theory and empirical studies on symbol systems. Future observational studies should address the effects of specific attributes of video as a medium.     

多重聚合酶链反应系统用于儿童常见细菌及真菌血流感染的价值研究

目的探讨多重聚合酶链反应系统用于儿童常见细菌及真菌血流感染的价值。方法选取2014年1月-2016年1月医院住院疑诊血流感染患儿135例,采集患儿的血标本,分别采用血培养法、16SrDNA-PCR和多重聚合酶链反应系统进行检测,对比3种方法检测儿童血流感染的阳性率。结果血培养法检测阳性标本12份,阳性率为8.89%,16SrDNA-PCR检测阳性标本26份,阳性率为19.26%,多重聚合酶链反应系统检测阳性标本24份,阳性率为17.78%;16SrDNA-PCR和多重聚合酶链反应系统的阳性率均显著高于血培养法(P<0.05);16SrDNA-PCR和多重聚合酶链反应系统阳性率比较,差异无统计学意义。结论多重聚合酶链反应系统具有操作简单、检测时间短等优势,可在较短时间内鉴定儿童血流感染的常见病原菌,对临床诊疗有较好的指导意义。     

The changing epidemiology of invasive bacterial infections in Massachusetts children, 1984 through 1991.

Coincident with the licensure of Haemophilus influenzae b conjugate vaccines from 1987 to 1990, the incidence of meningitis and other invasive infections caused by H influenzae type b declined in Massachusetts children by 87% and 91%, respectively. By 1991, Neisseria meningitidis had replaced H influenzae b as the leading cause of bacterial meningitis, accounting for 57% of cases. During the period 1984 through 1991, serogroup C displaced sero-group B as the most common cause of N meningitidis disease. Streptococcus pneumoniae caused 92% of nonmeningitis invasive disease, with sero-groups 14, 6, 19, 18, 4, 23, and 9 causing 94.5% of infections. These findings have implications for the development of additional polysaccharide-protein conjugate vaccines for the prevention of childhood infections.     

The capture-mark-recapture technique can be used as a stopping rule when searching in systematic reviews

ObjectiveResearchers have no empirically based search stopping rule when looking for potentially relevant articles for inclusion in systematic reviews. We tested a stopping strategy based on capture–mark–recapture (CMR; i.e., the Horizon Estimate) statistical modeling to estimate the total number of articles in the domain of clinical decision support tools for osteoporosis disease management using four large bibliographic databases (Medline, EMBASE, CINAHL, and EBM reviews).Study Design and SettingRetrospective evaluation of the Horizon Estimate using a systematic review of randomized controlled trials (RCTs) at two levels of article screening: title and abstract (1,246 potentially relevant articles) and full text (42 potentially relevant articles).ResultsThe CMR model suggests that the total number of potential articles was 1,838 for the first level of screening, and 49 for the full-text level. The four databases provided 68% of known articles for the first level of screening and 81% for full-text screening.ConclusionsThe CMR technique can be used in systematic reviews to estimate the closeness to capturing the total body of literature on a given topic. More studies are needed to objectively determine the usefulness of Horizon Estimates as a stopping rule strategy for systematic review searching.