A nationwide survey of physician office visits found that inappropriate antibiotic prescriptions were issued for bacterial respiratory tract infections in ambulatory patients

The impact of physicians' knowledge on outpatient antibiotic use: Evidence from China's county hospitals

We designed this study to explore how factors, especially knowledge, influence the use and prescriptions of antibiotics among physicians in China's county hospitals.A questionnaire was designed to evaluate the knowledge levels of physicians. The rates of antibiotic prescriptions were collected through on-the-spot investigations. The percentage of encounters with antibiotics prescribed and the percentage of encounters with antibiotics combination prescribed were used to measure antibiotics use. Univariate analysis and the generalized linear model were applied to analyze the knowledge levels among physicians as well as their antibiotic prescriptions.A total of 334 physicians in 60 county hospitals filled out the questionnaires, and 385,529 prescriptions were collected. The mean score of the questionnaire was a pass (62.8). The physicians in the eastern region of China demonstrated higher levels of knowledge than other regions (P = .08). Physicians with a higher score prescribed less antibiotics (P < .01) and less antibiotics combination (P = .07).The knowledge gap of Chinese physicians is evident and those with a higher degree of knowledge always prescribe fewer antibiotics. Targeted training and courses to educate physicians about the risks of over-prescription of antibiotics should be conducted to improve the practice of antibiotic prescriptions.

Treatment of odontogenic pain in a correctional setting

Odontogenic pain, or toothache, is highly prevalent in correctional facilities. When there is no dental sick call because the dental clinic is closed or the facility has no dental clinic, it is critical that midlevel providers and physicians triage and manage these patients until a dentist can resolve the problem. This article explores the etiology and diagnosis of toothache, presents the authors' opinion of the standard of care for managing these patients, and makes three recommendations: (a) access to timely and definitive dental treatment should be available to all inmates experiencing dental pain, (b) antibiotic use should be limited to patients with frank infection, and (c) progress of patients awaiting a dental appointment should be monitored with frequency consistent with the differential diagnosis.

Social sciences research in neglected tropical diseases 2: A bibliographic analysis

BACKGROUND

There are strong arguments for social science and interdisciplinary research in the neglected tropical diseases. These diseases represent a rich and dynamic interplay between vector, host, and pathogen which occurs within social, physical and biological contexts. The overwhelming sense, however, is that neglected tropical diseases research is a biomedical endeavour largely excluding the social sciences. The purpose of this review is to provide a baseline for discussing the quantum and nature of the science that is being conducted, and the extent to which the social sciences are a part of that.

METHODS

A bibliographic analysis was conducted of neglected tropical diseases related research papers published over the past 10 years in biomedical and social sciences. The analysis had textual and bibliometric facets, and focussed on chikungunya, dengue, visceral leishmaniasis, and onchocerciasis.

RESULTS

There is substantial variation in the number of publications associated with each disease. The proportion of the research that is social science based appears remarkably consistent (<4%). A textual analysis, however, reveals a degree of misclassification by the abstracting service where a surprising proportion of the "social sciences" research was pure clinical research. Much of the social sciences research also tends to be "hand maiden" research focused on the implementation of biomedical solutions.

CONCLUSION

There is little evidence that scientists pay any attention to the complex social, cultural, biological, and environmental dynamic involved in human pathogenesis. There is little investigator driven social science and a poor presence of interdisciplinary science. The research needs more sophisticated funders and priority setters who are not beguiled by uncritical biomedical promises.

Global and local variations in antimicrobial susceptibilities and resistance development in the major respiratory pathogens

Acute respiratory tract infections, such as bacterial pneumonia and acute exacerbations of chronic bronchitis, have been identified by the World Health Organisation as the leading global infectious cause of death. An increasing prevalence of antibiotic resistance has been identified worldwide in the three major bacterial respiratory pathogens -Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. The selection and spread of resistance is to some degree inevitable and the importance of monitoring its progress has led to the instigation of numerous international, regional and national surveillance programmes. The results from surveillance studies show wide variations in susceptibility rates, both geographically and over time, highlighting the need for local resistance prevalence data in order to guide empirical prescribing and to identify areas in which medical need for new agents is greatest.