BackgroundAntimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs. ObjectiveThis study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for common cold (upper respiratory tract infection [URTI]), bronchitis, sore throat, acute otitis media, and sinusitis. MethodsA cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, a multicenter inception cohort study of registrars’ in-consultation clinical and educational experiences. Analysis used univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was “antibiotic prescribed” for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media. The study factor was consultation type (telehealth or F2F). ResultsA total of 2392 registrars participated (response rate=93.4%). The proportions of diagnoses that were managed via telehealth were 25% (5283/21384) overall, 19% (641/3327) for acute sore throat, 29% (3733/12773) for URTI, 21% (364/1772), for acute bronchitis, 4.1% (72/1758) for acute otitis media, and 27% (473/1754) for acute sinusitis. Antibiotics were prescribed for 51% (1685/3327) of sore throat diagnoses, 6.9% (880/12773) of URTI diagnoses, 64% (1140/1772) of bronchitis diagnoses, 61% (1067/1754) of sinusitis diagnoses, and 73% (1278/1758) of otitis media diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (adjusted odds ratio [OR] 0.69, 95% CI 0.55-0.86; P=.001), URTI (adjusted OR 0.64, 95% CI 0.51-0.81; P<.001), and otitis media (adjusted OR 0.47, 95% CI 0.26-0.84; P=.01). There were no significant differences for acute bronchitis (adjusted OR 1.07, 95% CI 0.79-1.45; P=.66) or acute sinusitis (adjusted OR 1, 95% CI 0.76-1.32; P=.99). ConclusionsGP registrars are less likely to prescribe antibiotics for sore throat, URTI, and otitis media when seeing patients by telehealth versus F2F. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs. Therefore, there is no deleterious effect on antibiotic stewardship.
Assessment of patients with acute poisoning includes history-taking, assessment of airway, breathing, circulation and consciousness level, physical examination to elicit relevant clinical signs and appropriate investigations. Diagnosis is usually based on the history, recognition of toxidromes (when present) and results of investigations.
Among plasma metabolites linked with a health-conscious food pattern (HCFP) identified in the Malmo & BULL; Diet and Cancer epidemiological study, circulating ergothioneine (ERT) concentrations exhibited the strongest independent association with reduced risk of cardiometabolic disease and all-cause mortality and were also related to alcohol consumption. Thus, we first assessed whether alcohol intake and ERT were similarly associated in participants of the Hunter Community Study (HCS) that did not follow an HCFP-based diet. Then, we sought to identify the presence of associations with some biomarkers associated with cardiovascular disease. In a multivariable adjusted, robust regression analysis, compared to non-drinkers, safe drinkers had, on average, a serum ERT concentration 0.112 (95% CI: 0.0-0.225; P = 0.051) units higher and moderate-hazardous drinkers had a serum ERT concentration 0.240 (95% CI: 0.093-0.387; P = 0.001) units higher. Moreover, stepwise multiple linear regression shows that age (P = 0.025), and asymmetric dimethyl-L-arginine (ADMA) (P = 0.001) were independently associated with serum ERT concentrations, independently of age, sex, education, household income, marital status, and health status of participants, or possible alcohol-induced organ damage. The relationship between ERT and ADMA offers a potential explanation for the interplay between ERT, and decreased risk of cardiometabolic disease and all-cause mortality. Also, it provides new mechanistic insights into the association between alcohol consumption and cardiovascular diseases, possibly mediated by ADMA metabolic pathways.
Objectives This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: We aim to describe the overall prognosis (focusing on the pain course) and the negative impact(s) of acute and chronic musculoskeletal, widespread, and neuropathic pain in children (aged six to 12 years) and adolescents (aged 13 to 18 years) by evaluating: incidence of pain recovery at three and 12 months after reporting acute or chronic pain; change in pain severity at three and 12 months after reporting acute or chronic pain; and negative impact(s) of pain at three and 12 months after reporting chronic pain.
Herein, we compare the different experimental regimes used to induce testicular heat stress and summarise their impact on sperm production and male fertility. Irrespective of the protocol used, scrotal heat stress causes loss of sperm production. This is first seen 1-2 weeks post heat stress, peaking 4-5 weeks thereafter. The higher the temperature, or the longer the duration of heat, the more pronounced germ cell loss becomes, within extreme cases this leads to azoospermia. The second, and often underappreciated impact of testicular hyperthermia is the production of poor-quality spermatozoa. Typically, those cells that survive hyperthermia develop into morphologically abnormal and poorly motile spermatozoa. While both apoptotic and non-apoptotic pathways are known to contribute to hyperthermic germ cell loss, the mechanisms leading to formation of poor-quality sperm remain unclear. Mechanistically, it is unlikely that testicular hyperthermia affects messenger RNA (mRNA) abundance, as a comparison of four different mammalian studies shows no consistent single gene changes. Using available evidence, we propose two novel models to explain how testicular hyperthermia impairs sperm formation. Our first model suggests aberrant alternative splicing, while the second model proposes a loss of RNA repression. Importantly, neither model requires consistent changes in RNA species.
