Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits

Antibiotic Prescribing Variability in a Large Urgent Care Network: A New Target for Outpatient Stewardship

Improving antibiotic prescribing in outpatient settings is a public health priority. In the United States, urgent care (UC) encounters are increasing and have high rates of inappropriate antibiotic prescribing. Our objective was to characterize antibiotic prescribing practices during UC encounters, with a focus on respiratory tract conditions. This was a retrospective cohort study of UC encounters in the Intermountain Healthcare network. Among 1.16 million UC encounters, antibiotics were prescribed during 34% of UC encounters and respiratory conditions accounted for 61% of all antibiotics prescribed. Of respiratory encounters, 50% resulted in antibiotic prescriptions, yet the variability at the level of the provider ranged from 3% to 94%. Similar variability between providers was observed for respiratory conditions where antibiotics were not indicated and in first-line antibiotic selection for sinusitis, otitis media, and pharyngitis. These findings support the importance of developing antibiotic stewardship interventions specifically targeting UC settings.

Comparison of Reliability and Validity of the Chinese Four-Level and Three-District Triage Standard and the Australasian Triage Scale

Emergency triage is an important tool for prioritizing urgent or critical patients, and its effect needs to be investigated and evaluated. This observational study aimed to compare the reliability and validity of the Chinese four-level and three-district triage standard (CHT) and the Australasian Triage Scale (ATS) in an adult emergency department of a general hospital in China. From 2016-01 to 2017-01, twelve nurses independently performed on-site triage of 254 patients and 1552 patients to assess the scales' reliability and validity, respectively. The interrater reliability, as assessed by the weighted k scores, was 0.686 (95% CI 0.608–0.757) for the CHT and 0.731 (95% CI 0.663–0.790) for the ATS, and the k scores between the CHT and the ATS were 0.630 (95% CI 0.594–0.669). Temperature, respiration, pulse, blood oxygen saturation, waiting time, treatment time, emergency disposition, hospitalization rate, and mortality were significantly associated with the triage levels of the CHT and ATS (p < 0.001). The area under the receiver operating characteristic (AUROC) curve values of the CHT and ATS for predicting intensive care treatment were 0.845 (95% CI: 0.825–0.866) and 0.740 (95% CI: 0.715–0.765), respectively. The reliability and validity of the CHT and ATS were moderate, and both of them can be used to identify critical patients in emergency departments. It is necessary to further improve the triage system in terms of structure and content.

A defined human aging phenome

Aging is among the most complex phenotypes that occur in humans. Identifying the interplay between different age-associated features is undoubtedly critical to our understanding of aging and thus age-associated diseases. Nevertheless, what constitutes human aging is not well characterized. Towards this end, we mined millions of PubMed abstracts for age-associated terms, enabling us to generate a detailed description of the human aging phenotype. We discovered age-associated features in clusters that can be broadly associated with previously defined hallmarks of aging, consequently identifying areas where interventions could be pursued. Importantly, we validated the newly discovered features by manually verifying the prevalence of these features in combined cohorts describing 76 million individuals, allowing us to stratify features in aging that appear to be the most prominent. In conclusion, we propose a comprehensive landscape of human aging: the human aging phenome.