The results of a multisite, randomized controlled trial show that C-reactive protein (CRP) point-of-care testing resulted in decreased antibiotic prescribing for patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD), with no evidence of harm.The authors of the study say the findings, published today in the New England Journal of Medicine, suggest that CRP testing, which measures the level of a protein produced by the liver in response to inflammation, can help clinicians avoid unnecessary antibiotic prescribing for a condition that is frequently treated with antibiotics, despite evidence that they aren’t always needed.”The evidence from our trial suggests that CRP-guided antibiotic prescribing for COPD exacerbations in primary care clinics may reduce patient-reported use of antibiotics and the prescribing of antibiotics by clinicians,” the authors write.Clinical criteria not enough to rule out antibioticsFor the trial, a team led by investigators from the University of Oxford and Cardiff University recruited patients over the age of 40 from 86 general medical practices in England and Wales who consulted a clinician for sudden worsening of symptoms of COPD—a group of lung conditions that cause breathing difficulties.Acute exacerbations of COPD are marked primarily by three symptoms: extreme shortness of breath, a large increase in sputum production, and a change in sputum appearance. The condition can be triggered by viral or bacterial infections, but also by environmental pollutants or other irritants.Antibiotic prescribing for acute exacerbations of COPD is generally based on patients having at least two of the three main clinical symptoms, but these symptoms can be subjective and aren’t considered accurate enough to determine which patients can be treated safely without antibiotics. The investigators wanted to see whether CRP point-of-care testing could help clinicians with that decision.The patients were randomly assigned 1:1 to receive either usual care or usual care guided by CRP point-of-care testing. Guidelines for interpretation of CRP test results suggest that antibiotics are unlikely to be beneficial for patients with a CRP level of lower than 20 milligrams per liter (mg/L), may be beneficial for those with a CRP level of 20 to 40 mg/L, and are likely to be beneficial for those with a CRP level higher than 40 mg/L.The two primary outcomes in the study were patient-reported antibiotic use within 4 weeks after randomization and COPD-related health status at 2 weeks after randomization, as measured by patient responses to the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD status) to 6 (very poor COPD status). The investigators also reviewed data from electronic medical records to determine antibiotic prescribing during the initial consultation and over the first 4 weeks of follow-up.A total of 649 patients underwent randomization, with 325 in the CRP-guided group and 324 in the usual-care group. Data obtained from 537 patients showed that fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57% vs 77.4%; adjusted odds ratio [aOR], 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference on the Clinical COPD Questionnaire at 2 weeks was – 0.19 points (two-sided 90% CI, – 0.33 to – 0.55) in favor of the CRP-guided group. That finding, the authors explain, indicates that reduced antibiotic use in the CRP-guided group did not compromise disease-specific quality of life.Review of the antibiotic prescribing decisions made by clinicians showed that a lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs 69.7%; aOR, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of consultation (59.1% vs 79.7%; aOR, 0.30; 95% CI, 0.20 to 0.46). A total of 158 antibiotic prescriptions were issued to patients in the CRP-guided group, and 234 were issued to those in the usual-care group.Analysis of secondary outcomes—including the prevalence of potentially pathogenic organisms in sputum, healthcare use, COPD-related health status, and general health status at 6 months—found no significant differences between the two groups. Two patients in the usual-care group died within 4 weeks of randomization, but the causes were considered to be unrelated to the trial.’Compelling’ evidenceIn an editorial that accompanies the study, Allan Brett, MD, and Majdi Al-Hasan, MBBS, of the University of South Carolina School of Medicine, say the results of the trial are “compelling enough to support CRP testing as an adjunctive measure to guide antibiotic use in patients with acute exacerbations of COPD.”They note, however, that the findings only suggest a way to reduce antibiotic prescribing without compromising clinical outcomes, but they don’t establish which patients truly benefit from antibiotics, or which antibiotics are most appropriate for treating acute exacerbations of COPD.”Additional clinical trials will be necessary to address these uncertainties,” they write.See also:Jul 11 N Engl J Med abstractJul 11 N Engl J Med editorial
101 delegates attended the four-day event at the Cinnamon Lakeside Hotel in Colombo, Sri Lanka, which included the AGM, IT workshops, network development and marketing, and two days of one-to-one meetings.During the AGM a number of board changes were implemented, and the chairman of the FPS Group Advisory Board, Gihan Nanayakkara, was re-elected for a further two years. www.fps-group.net
KAZAKHSTAN: The Zhuzhou Electric Locomotive subsidiary of China South announced a US$100m order to supply locomotives to Kazak state railway KTZ on October 23. The Chinese firm was selected from three international bidders. The 4·8 MW locos will have AC drives and a top speed of 200 km/h. CSR has been co-operating with KTZ since 2000, and supplied KZ4A locomotives to the country for the first time in 2002.
World Health Organization Director General, Tedros Adhanom Ghebreyesus,(NPR) The COVID-19 viral disease that has swept into at least 114 countries and killed more than 4,000 people is now officially a pandemic, the World Health Organization announced Wednesday.“This is the first pandemic caused by coronavirus,” said WHO Director-General Tedros Adhanom Ghebreyesus.Eight countries — including the U.S. — are now each reporting more than 1,000 cases of COVID-19, caused by the virus that has infected more than 120,000 people worldwide.“In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled,” Tedros said.Noting the rising death toll from the respiratory virus, the WHO head said, “In the days and weeks ahead, we expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher.”The WHO is “deeply concerned,” Tedros said, “both by the alarming levels of spread and severity, and by the alarming levels of inaction” by the world’s leaders in response to the outbreak.“We have therefore made the assessment that COVID-19 can be characterized as a pandemic,” he added.As he acknowledged the viral disease’s reach, Tedros also urged people not to be fearful because of its status as a pandemic. He also said the term should not be taken to mean that the fight against the virus is over.“Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by the virus,” Tedros said. “It doesn’t change what WHO is doing. And it doesn’t change what countries should do.”A severe outbreak in Italy has now caused more than 630 deaths there, and the country’s case total continues to rise sharply. It’s now at 10,000 cases, second only to China. There are 9,000 cases in Iran, and more than 7,700 in South Korea.Those countries are all imposing drastic measures in an attempt to slow the spread of the COVID-19 illness, which has a higher fatality rate for elderly people and those with underlying health conditions.“In the Americas, Honduras, Jamaica and Panama are all confirming coronavirus infections for the first time,” NPR’s Jason Beaubien reports. “Elsewhere Mongolia and Cyprus are also now reporting cases.”The WHO declared the coronavirus outbreak a global health emergency in January, as cases surged in China, the epicenter of the outbreak.As the outbreak has ballooned, so has speculation that the organization would raise its warnings about the virus to the highest level. But Tedros said WHO experts had determined that the scale of the coronavirus’s impact didn’t warrant the description. And he noted that declaring the outbreak a pandemic would raise the risk of a public panic. Share Tweet Share Tedros and others had hoped the virus would be contained, citing data from China showing that the number of new cases there peaked in late January and early February. 108 Views no discussions CoronavirusInternationalLifestyleLocalNews WHO Declares COVID-19 Global Pandemic by: – March 11, 2020 Coronavirus symptoms and preventionTo prevent the coronavirus from spreading, the CDC recommends washing hands with soap and water for at least 20 seconds or using a hand sanitizer if a sink isn’t available. The World Health Organization says people should wear face masks only if they’re sick or caring for someone who is.“For most people, COVID-19 infection will cause mild illness; however, it can make some people very ill and, in some people, it can be fatal,” the WHO says. “Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for severe disease.”The most common symptoms of COVID-19, according to a recent WHO report that draws on more than 70,000 cases in China: fever (in 88% of cases); dry cough (68%); fatigue (38%); sputum/phlegm production (33%).Shortness of breath occurred in nearly 20% of cases, and about 13% had a sore throat or headache, the WHO said. Share Sharing is caring!
WACO, Texas (AP) — Northwestern State coach Brooke Stoehr knows most people will only see the lopsided final margin.Stoehr saw much more in her Lady Demons in a 77-36 loss to Big 12 champion Baylor in the first round of the NCAA Tournament.“You have to look at terms in how they competed in each possession. They didn’t put their head down,” Stoehr said. “I’m very proud of that.”A day after the No. 3 seed Baylor men were upset by Georgia State, the Lady Bears (31-3) never provided any opportunity for an upset by Southland Conference tournament champion and No. 15 seed Northwestern State.The Big 12 champion Lady Bears (31-3), the No. 2 seed in the Oklahoma City Regional, went ahead to stay with an early 14-2 run in which Nina Davis and Khadijah Cave each had six points to break a 7-7 tie.“There’s so many upsets all over, men and women, that have already happened, and we just don’t want that to be us,” said Davis, the Big 12 player of the year who had 17 points in 23 minutes.Alexis Prince had 14 points for Baylor, including a 3-pointer to cap a 15-3 run after halftime with seven of eight shots made to go up 60-29.Janelle Perez, the 5-foot-2 guard, had 10 points for Northwestern State (19-15), whose coach like Baylor coach Kim Mulkey was an NCAA Final Four point guard at Louisiana Tech.“I’m used to everybody being bigger. Obviously, they’re a lot bigger than what we’re used to,” said Perez, who finished 4-of-15 shooting, 2-of-11 on 3-pointers. “Their length was a factor. I try to get my teammates open shots and continue to play the way I’ve played since I was little.”Cave finished with 12 points and Kristy Wallace had 11 rebounds while playing a team-high 27 minutes. All 11 Baylor players got in for at least 11 minutes — and all scored.“Obviously a very difficult opponent for us today to match up size-wise. I’m extremely proud of our group and our team and the way they competed. They weren’t afraid,” Stoehr said. “It says a lot about the character they have and who they are. Baylor’s size and athleticism obviously affected some of our shots today. It’s just something you can’t simulate.”After playing for Leon Barmore at Louisiana Tech, Mulkey was an associate head coach for the legendary women’s coach and recruited Stoehr to play there. Mulkey was there for the younger guard’s first two seasons before leaving in 2000 for Baylor.“This game is kind of difficult for me because Brooke’s on that other sideline, and I knew that what she had, and I knew that maybe they were outmatched a little bit, height, size, talent,” Mulkey said. “But her team never stopped playing hard. She’s got her team playing hard.”Northwestern State, which opened the game with a shot-clock violation on its first possession and then an air ball on a 3-point try the next one, tied the game at 7 on Tia Youngblood’s jumper with 15:22 left in the first half.Davis made two free throws only 20 seconds later to start the 14-2 run. All of Cave’s points in that came on three layups, the last with 11:50 left in the half to make it 21-9.HOME COURT ADVANTAGEBaylor has won 20 home games in a row overall, including the first two rounds in last year’s NCAA Tournament. The Lady Bears opened at home for the fourth time in five years, and are now 7-0 in those NCAA games. They have won 151 consecutive home games against unranked opponents. The last such loss was to Auburn in the 2003 WNIT finals.TIP-INSNorthwestern St.: The Lady Demons shot only 24 percent (14 of 59) overall. They had only six field goals after halftime.Baylor: The Lady Bears finished with a 53-26 rebounding advantage. … Their 39 defensive rebounds were their most ever in an NCAA Tournament game.UP NEXTNorthwestern St.: Season over.Baylor: Play Arkansas in second-round game Sunday.FIVE FOULSBaylor finished the game with only five personal fouls — one each by five different players. And that’s what Mulkey mentioned when asked about having 23 assists and only five turnovers. “How about those five fouls. I don’t know if I’ve ever coached a game where we had as few as fouls, particularly since we played man to man,” she said. “I thought it was a misprint.