Removal Of Risk Factors Research Articles

UTI in Primary Care: Are we Prescribing Too Much?

Objectives: The aim of this article were to review usefulness of early clinical detection of UTI without lab tests as diagnostic tool for UTI in primary care and to describe when to start antibiotic treatment for management of UTI according to international guidelines. The emphasis of this review is uncomplicated UTI. Methods: A search was conducted on PubMed and official webpages of major urological, infectious diseases and general practice organisations to identify peer reviewed original articles and reviews, using the search terms ‘UTI’. I considered only papers written in English, with emphasis on more recent articles published up to July 2023. Results: There is a variation in recommendations between guidelines can be a source of confusion and controversy for clinicians in primary care. However, early detection and treatment, education of patients and removal of risk factors may reduce the number of symptomatic episodes, antibiotics usage and antimicrobial resistance in primary care. Conclusion: The diagnosis of acute uncomplicated cystitis in healthy women can be made with reasonable certainty by evaluation of symptoms and signs without a doctor’s visit or urine tests. Individualised assessment of risk factors and previous clinical history is needed to choose the most suitable antimicrobial treatment. Immediate antimicrobial therapy with Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days), Nitrofurantoin (100 mg twice daily for 5-7 days), or Fosfomycin (3g in a single dose) is indicated for acute cystitis in adult women. However, local guidelines advice that immediate antibiotic treatment was not considered necessary for women with uncomplicated lower UTI. Antimicrobial resistance have complicated treatment of UTI worldwide.

Do adolescent risk assessment tools capture self-reported reasons for desistance? An examination of the content validity of protective factors

ABSTRACT This study used a novel approach to assess the content validity of three adolescent risk assessment tools: the Structured Assessment of Violence Risk in Youth (SAVRY; Borum et al., 2006), the Structured Assessment of Protective Factors for Violence Risk – Youth Version (SAPROF-YV; de Vries Robbé et al., 2015), and the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV; Viljoen et al., 2014). In-person interviews and online surveys were conducted with people with a history of adolescent offending (n = 103), which included open-ended questions about their desistance from offending, followed by direct questions based on the tools’ protective factors. Responses were coded using directed content analyses based on the tools’ item definitions. In open-ended questions, across participants all items were mentioned, and all items were rated as important by at least some participants. Only a few additional themes emerged that were not captured by the tools. In addition, participants primarily discussed the presence of protective factors rather than the removal of risk factors, suggesting they represent distinct constructs. Overall the findings support the content validity of the SAVRY, SAPROF-YV, and START:AV protective factors, and highlight the value of perspectives from people with lived experience in risk assessment research.

Management of Recurrent Cystitis in Women: When Prompt Identification of Risk Factors Might Make a Difference

BackgroundManagement of recurrent urinary tract infection (rUTI) is still challenging. A better understanding of the natural history of rUTI could help us reduce antibiotic use and improve antibiotic stewardship. ObjectiveTo describe the effect of risk identification, stratification, and counseling on the natural course of the disease in women with rUTI. Design, setting, and participantsA total of 373 women affected by recurrent cystitis were enrolled in this longitudinal cohort study between December 2014 and December 2019. A systematic and standardized identification of risk factors was performed. InterventionAs intervention, risk factors were treated or removed where possible. Patients with nonremovable risk factors were included in the control group. All patients were scheduled for follow-up visits every 6 mo. Outcome measurements and statistical analysisThe main outcome measures were the rate of symptomatic recurrences and improvement in questionnaire results from baseline to the end of the follow-up period. Reduction of antibiotic usage was regarded as a secondary outcome measure. Results and LimitationsFinally, 353 women were analyzed: 196 in the study group and 157 in the control group. At the end of the follow-up period, a statistically significant reduction in the symptomatic recurrence rate was found between the two groups (0.9 ± 0.2 and 2.6 ± 0.5; p < 0.001), as well as in quality of life and anxiety according to mean questionnaire results: quality of life (0.88 ± 0.06 and 0.63 ± 0.09; p < 0.001) and Spielberger State-Trait Anxiety Inventory-Form Y (32.7 ± 9.3 and 47.5 ± 14.3; p < 0.001). The use of antibiotics was significantly lower in the study group: 4410 versus 9821 (p < 0.001). A limitation to consider is the lack of a randomized design for the active approach in the high-risk group. ConclusionsIdentification, counseling, and removal of risk factors, where possible, are able to change the natural history of rUTI, by reducing the number of symptomatic episodes and antibiotic use and improving quality of life. Patient summaryIn this report, we analyzed a large cohort of women affected by recurrent urinary tract infections and followed for a long time period. We found that risk factor identification and counseling may change the natural history of recurrent urinary tract infections, concluding that this approach is able to reduce the number of symptomatic episodes, reduce antibiotic usage, and improve patients’ quality of life.

SOP: treatment of delirium

IntroductionDelirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. Most patients in intensive care units develop delirium, however, it is also frequently observed in non-intensive care unit settings. Risk factors are, among others, older age, brain pathology, severe trauma, orthopaedic or heart surgery, metabolic or electrolyte dysregulations, infections and polypharmacy. The most important measures to prevent and treat delirium are recognition and removal of risk factors and causes. Although delirium is a very common and serious complication, evidence for pharmacological treatment is poor, and guidelines remain controversial. Accordingly, non-pharmacological treatments have gained increasing attention and should be applied. Based on current literature, guidelines and personal recommendations, we developed a standard operating procedure (SOP) encompassing non-pharmacological and pharmacological treatment of delirium.CommentsIn order to prevent delirium, risk factors should be identified and taken into account when planning the hospital stay and treatment. Prevention should include multimodal non-pharmacological interventions. The treatment of delirium should encompass the elimination of potential causes and non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour.ConclusionThe SOP provides a pragmatic algorithm for the non-pharmacological and pharmacological treatment of delirium.

Perfil epidemiológico dos traumatismos crânio encefálicos em um hospital pediátrico da Serra Catarinense

Introdução: o traumatismo craniano encefálico (TCE) na infância é causa frequente de atendimento nas emergências do Brasil e do mundo. Reconhecer precocemente a gravidade dele e oferecer o manejo adequado reduz, de forma acentuada, a morbimortalidade. A Organização Mundial da Saúde (OMS) define TCE como qualquer agressão capaz de provocar lesão anatômica ou comprometimento funcional do couro cabeludo, crânio, meninges ou encéfalo. Objetivos: traçar o perfil epidemiológico dos pacientes com diagnóstico de TCE na infância. Métodos: estudo retrospectivo, quantitativo e descritivo a partir da avaliação dos prontuários dos pacientes internados em um hospital de médio porte da serra catarinense com alta complexidade em urgência e emergência no ano de 2017 com diagnóstico de traumatismo crânio encefálico. As variáveis coletadas foram: idade, sexo, mês da ocorrência, procedência (cidade), local do acidente, mecanismo do acidente, transporte pré-hospitalar, escala de coma de Glasgow (ECG), tipo de lesão, exames de imagem, internação em Unidade de terapia intensiva (UTI), necessidade de neurocirurgia, necessidade de transferência inter-hospitalar, tempo de permanência hospitalar. Resultados: dos 50 prontuários analisados houve um predomínio de TCE no sexo masculino (53%), na faixa etária entre 6 e 10 anos (33%), no mês de abril (18%), em ambiente domiciliar (52%), por queda da própria altura (24%) e procedência de Lages (62%). A maioria foi classificado como TCE leve (72%), realizaram tomografia computadorizada de crânio (80%) e receberam apenas tratamento clínico (98%). O tempo médio de internação hospitalar foi de 1 a 3 dias (80%). Destes 2% dos pacientes foram a óbito. Conclusões: o perfil desses pacientes aponta para a necessidade de implantação de medidas de prevenção como a retirada dos fatores de risco e a elaboração de um protocolo mais atualizado de atendimento aos pacientes vítimas desse agravo.

Current Management in Osteoarthritis

Osteoarthritis (OA) is a process of destruction of joint cartilage, subchondral bone and other joint structures, leading to anatomical damage to the joint, impaired movement and pain. Secondary changes may be accompanied by synovitis, caused by degradation products of cartilage and bone. There is a disturbance in balance between the synthesis of articular cartilage components and their degradation. Osteoarthritis is the most common chronic disease of the joints. It causes joint pain, stiffness, distortion and impairment of function, leading to disability. The disease occurs in the elderly, but it is not a consequence of aging. Optimal treatment requires early diagnosis and removal of risk factors. Early diagnosis may be treatment non-pharmacologically, according to NICE’s treatment in chronological order, and may still benefit from physical therapy. Late diagnosis requires more invasive treatments, including alloplasty, and prognosis is poorer. Diagnosis must be based on clinical examination and supported by imaging. Obesity is the main modifiable risk factor for OA. Other factors are hyperglycemia, diabetes, and hypercholesterolemia, injuries of knees and hips and meniscus damage. Unmodifiable risk factors are female gender, age, joint malformations, trauma. Pain and stiffness are symptoms of OA. Joint pain occurs after joint movement and disappears after rest. As the disease progresses, the pain appears already after small joint movements and finally during sleep. The main goals of treatment are patient education, pain reduction, function optimization, and the degenerative process modification. The current treatments OA are non-pharmacological methods, topically capsaicin and topically NSAIDs, paracetamol, then oral NSAIDs and, finally, arthroplasty.

THE RELEVANCE OF TRACEABILITY IN THE FOOD CHAIN

Traceability is a modern concept that allows following a product’s route from raw materials to the selling stage, taking into consideration its complete flow by means of identifying and tracking procedures and documents. Recently, food traceability has gained significant importance as it allows efficient identification, correction or removal of risk factors throughout the food chain in order to deliver only safe and quality products to consumers. The paper aims to outline the main food traceability conceptual approaches and to highlight traceability key-elements and objectives in order to emphasize the significance of a traceability system for the food chain.

Chronic pancreatitis: The case for surgery

AbstractTreatment of pain in chronic pancreatitis includes medical, endoscopic and surgical therapy. Medical treatment may involve the use of analgesics, pancreatic enzymes, antioxidants and removal of risk factors. However, a substantial number of patients do not experience pain relief with medical treatment, and those with local complications cannot be treated medically indefinitely. These require endoscopic or surgical therapy. Endoscopic therapy has involved the use of a) pancreatic sphincterotomy, b) stent placement, c) nasopancreatic drainage, d) pseudocyst drainage, e) extra corporeal shock wave lithotripsy (ESWL), and f) dilatation of strictures. The current options for surgical therapy include: a) partial pancreatic resections, b) extended pancreatic drainage procedures (which involve additional subtotal resection of the head or a deep coring out of the head, or c) pure pancreatic drainage procedures. In effect surgical procedures provide a more thorough drainage of the ductal system than pancreatic stent placement. This is especially true in the complex ductal arrangement of the head of the pancreas, where simple drainage of the duct or stent placement by endoscopy is unlikely to provide thorough drainage and relief of symptoms.

Osteonecrosis of the humeral head

A 20-year-old man with a 5-year history of acute lymphoblastic leukemia (ALL) was admitted to our hospital for severe pains in his bilateral groin and right shoulder. He had experienced these pains for 16 months. He underwent allogeneic stem cell transplantation in his second complete remission 13 months prior to hospitalization. He had received corticosteroid therapy both for ALL and for graft versus host disease for a long period (more than 13 months in total), and the total dose of corticosteroids exceeded 20 g in prednisolone equivalent at the time of the hospitalization. X-ray films of the hip joints revealed collapse of bilateral femoral heads. In addition, a subarticular radiolucent line (‘‘crescent sign’’) was also observed in an X-ray film of the right shoulder joint (Fig. 1). He was diagnosed with osteonecrosis of the femoral and humeral heads. A magnetic resonance image (MRI) showed a geographical high-intensity area spread to diaphysis, suggesting necrotic changes affecting an extensive area (Fig. 2). He was treated with narcotics for pain. Corticosteroids were reduced as rapidly as possible and maintained at a low dose to treat his adrenal insufficiency. However, his range of motion gradually decreased. Longterm corticosteroid use has been reported to be a risk factor for osteonecrosis of the humeral head, as well as the hip joint. The pathogenesis of steroid-induced osteonecrosis remains unclear, but ischemia from lipocyte hypertrophy or fat embolism has been postulated. The interval between corticosteroid administration and onset of symptom has been reported as between 6 and 18 months. Although the humeral head is the second most commonly affected site in osteonecrosis, it is often unrecognized, and its initial symptoms are often nonspecific. Removal of risk factors can reduce the risk of osteonecrosis to other joints. Thus,

Overlap Between Asthma and COPD: Where the Two Diseases Converge

Asthma and chronic obstructive pulmonary disease (COPD) are traditionally recognized as distinct diseases, with some clearly separate characteristic. Asthma originates in childhood, is associated with allergies and eosinophils, and is best treated by targeting inflammation, whereas COPD occurs in adults who smoke, involves neutrophils, and is best treated with bronchodilators and the removal of risk factors. However, the distinction between the two is not always clear. Patients with severe asthma may present with fixed airway obstruction, and patients with COPD may have hyperresponsiveness and eosinophilia. Recognizing and understanding these overlapping features may offer new insight into the mechanisms and treatment of chronic airway inflammatory diseases.

Administrative Versus Clinical Data for Coronary Artery Bypass Graft Surgery Report Cards

The objective of this study was to compare the performance of a risk model for isolated coronary artery bypass graft (CABG) surgery based on administrative data with that of a clinical risk model in predicting mortality and identifying hospital performance outliers. Clinical data records from the California CABG Mortality Reporting Program for 38,230 isolated CABG patients undergoing surgery in 2000-2001 were linked to records in the California patient discharge data (PDD) abstract. Risk factors based on administrative data that mirrored clinical risk factors were developed using the condition present at admission indicator in the PDD to separate preoperative acute conditions from complications of surgery. Using logistic regression, risk model performance across data sources was compared along with hospital risk-adjusted mortality ranks and quality ratings. The administrative data showed lower prevalence of risk factors when compared with the clinical data. The clinical risk model had somewhat better discrimination (C = 0.824) than the administrative model (C = 0.799). The clinical model yielded 17 outliers and the administrative model 16 with agreement on 12 hospitals' status. Performance of the administrative risk model was minimally affected by removal of information from prior admissions and removal of risk factors not confirmed in the clinical record. Unique properties of the California administrative data, including the ability to distinguish acute preoperative risk factors from complications of surgery, permitted construction of an administrative risk model that predicts mortality on par with most published clinical models. Despite this, the administrative model identified slightly different hospital outliers, which may indicate somewhat biased assessments of hospital patient risk.

Suicidal Terrorism: Medical–Ecological Point of View

The wave of suicidal terrorism that has shaken the world has enormous implications for medicine. This paper analyzes suicidal terrorism as a disease from the medicoecological point of view. The primary, secondary, and tertiary prevention of suicidal terrorism consist, respectively, of the removal of risk factors, or agents of suicidal terrorism (terrorist and corresponding ideologies), and the hosts of terrorism (people, buildings, transportation, etc.), and the care of the environment of terrorism (injustice, illiteracy, disease, hunger, lack of human rights and hope). Violence is a recognized public health problem. Because terrorism is the use of violence and threats on a massive scale to coerce or intimidate, especially for political purposes, terrorism demands the attention of the medical community worldwide. The physicians' duty to protect life and health whenever possible is indivisible from their duty to help prevent terrorism of all types.