Challenges to nurse prescribers of a no‐antibiotic prescribing strategy for managing self‐limiting respiratory tract infections

Aims. To report a qualitative study of the experiences of nurse prescribers in managing patients with self‐limiting respiratory tract infections. Background. Patients frequently attend primary care with respiratory tract infections. Although a no‐prescribing strategy is recommended for these consultations, general practitioners frequently prescribe antibiotics, citing non‐clinical reasons such as patient pressure. Nurses increasingly manage people with respiratory tract infections, but research has not yet explored their experiences within such consultations. Design. Semi‐structured interviews and focus groups. Methods. Fifteen semi‐structured interviews and three focus groups (n = 5, n = 4, and n = 12) with a purposive sample of nurse prescribers (n = 34) and other non‐medical prescribers (n = 2) were conducted between November 2009–November 2010. A qualitative approach was used to develop conceptual categories from the dataset, and emerging themes were explored in subsequent interviews/focus groups. Findings. Although participants reported experiencing numerous challenges within these consultations, they believed that they possessed some of the communication skills to deal effectively with patients without prescribing antibiotics. Participants reported that protocols supported their decision‐making and welcomed the benefits of peer support in dealing with ‘demanding’ patients. However, the newness of nurses and other non‐medical prescribers to the prescribing role meant that some were cautious in dealing with patients with respiratory tract infections. Conclusion. Training for nurses and other non‐medical prescribers should focus on building their confidence and skills to manage people with respiratory tract infections without recourse to antibiotics. Further work should seek to explore which strategies are most effective in managing respiratory tract infections while maintaining patient satisfaction with care.     

Picking the low‐hanging fruit: Why not choose oral antibiotics for skin and soft‐tissue infections in the emergency department

Skin and soft‐tissue infections are a common presentation to EDs in Australasia. In the absence of sepsis or decreased oral absorption, substantial supportive data exists that shows oral antibiotics are non‐inferior to intravenous antibiotics for uncomplicated skin and soft‐tissue infections. However, despite a fair evidence base, clinicians are not consistently putting this into practice. This perspective reviews the relevant literature, discusses barriers to the implementation of this more parsimonious approach and also proposes several potential solutions. It is important that ED clinicians are encouraged to use oral antibiotics for uncomplicated infections, as this would lead to similar clinical outcomes but with fewer resources for staff and patient, as well as increased patient satisfaction.     

2010～2013年鲍曼不动杆菌感染分布及耐药性监测

目的了解鲍曼不动杆菌的感染分布特征及耐药性,为临床抗感染治疗提供有效的实验室依据。方法回顾性分析2010~2013年临床分离的鲍曼不动杆菌的分布和耐药情况,采用Whonet 5.6软件进行数据分析。结果共检出1 038株鲍曼不动杆菌,痰液标本占81.5%;主要分布在重症加强护理病房(ICU);该菌对多粘菌素B的耐药率最低,为0.6%,对头孢哌酮/舒巴坦、亚胺培南和美洛培南的耐药率分别为26.4%、35.5%和35.9%。对亚胺培南敏感的菌株对多粘菌素B、美洛培南、头孢哌酮/舒巴坦和氨苄西林/舒巴坦耐药率分别为0.5%、2.1%、3.2%和9.9%,对头孢曲松和头孢噻肟的敏感度低于30%,对其他药物的敏感度大于70%。对亚胺培南耐药的菌株,对多粘菌素B和头孢哌酮/舒巴坦耐药率分别为0.8%和65.5%,对其他药物的耐药率均在86%以上;耐药株主要分布于ICU和神经外科。结论碳青霉烯类和头孢哌酮/舒巴坦是治疗鲍曼不动杆菌的首选药物,对碳青霉烯类耐药鲍曼不动杆菌的治疗应联合用药,加强ICU和神经外科的消毒隔离措施和耐药性监测。     

2010～2012年某院临床常见病原菌耐药性分析

目的了解南宁市第一人民医院2010年1月至2012年12月临床常见病原菌对常用抗菌药物的耐药情况,为临床抗菌药物的合理使用提供依据。方法对2010年1月至2012年12月临床标本分离出的病原菌药敏试验结果进行回顾性分析。结果 3年共分离出病原菌10 153株,其中革兰阴性杆菌占61.2%,革兰阳性球菌占26.6%,真菌占12.2%。分离数排列前6位的病原菌为：绿脓假单胞菌（16.6%）、大肠埃希菌（14.5%）、肺炎克雷伯菌（11.6%）、白色念珠菌（9.8%）、鲍曼不动杆菌（5.4%）、金黄色葡萄球菌（4.1%）。革兰阴性杆菌对亚胺培南、阿米卡星、派拉西林/他唑巴坦敏感,对氨苄西林、复方磺胺甲噁唑耐药率高;革兰阳性球菌对万古霉素、哌拉西林/他唑巴坦敏感,对红霉素、氨苄西林、青霉素耐药;白色念珠菌对两性霉素B、制霉菌素、5-氟胞嘧啶敏感。结论医院分离的常见病原菌为革兰阴性杆菌,临床应重视病原菌的耐药性监测,在治疗过程中合理使用抗菌药物。     

Sonographic appearance of proliferative fasciitis‐‐‐A case report

Proliferative fasciitis is a benign entity involving the subcutaneous tissues and fascias, characterized by the proliferation of fibroblast‐like spindle cells and ganglion‐like cells. However, proliferative fasciitis may be easily confused with sarcoma clinically and pathologically, because it appears as a rapidly growing painful mass and has histologic features such as high cellularity, bizarre morphologic patterns, mitotic figures, and diffuse infiltrative proliferation. Imaging findings of proliferative fasciitis have been very rarely reported. We report the sonographic findings in a case of proliferative fasciitis in a 43‐year‐old woman with histopathological correlation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :445–449, 2017     

A Novel Three‐Dimensional‐Printed Ultrasound‐Guided Hip Arthrocentesis Model

When evaluating patients with hip pain, clinicians may be trained to both evaluate for a hip effusion and perform ultrasound‐guided arthrocentesis to evaluate the etiology of the effusion. We present a novel 3‐dimensional‐printed hip arthrocentesis model, which can be used to train clinicians to perform both tasks under ultrasound guidance. Our model uses a combination of a 3‐dimensional‐printed hip joint, as well as readily available materials such as an infant Ambu (Ballerup, Denmark) bag, syringe, intravenous line kit, and silicone. We present our experience so that others may use and adapt our model for their training purposes.     

A GPIb‐IX‐V complex signaling environment

See also David T, Strassel C, Eckly A, Cazenave J‐P, Gachet C, Lanza F. The platelet glycoprotein GPIbβ intracellular domain participates in von Willebrand factor induced‐filopodia formation independently of the Ser 166 phosphorylation site. This issue, pp 1077–87.