-
BMJ Paediatrics Open Jun 2024Neonatal sepsis (NS) is a global health issue, particularly in Sub-Saharan Africa, where it accounts for a substantial portion of neonatal morbimortality. This...
BACKGROUND
Neonatal sepsis (NS) is a global health issue, particularly in Sub-Saharan Africa, where it accounts for a substantial portion of neonatal morbimortality. This multicountry survey aimed to elucidate current practices, challenges and case definitions in managing NS among clinicians in Sub-Saharan Africa.
METHODS
The survey targeted physicians and medical practitioners working in neonatal care who participated in a Self-Administered Web Questionnaire. The main objective was to understand NS and infection case definitions and management from the clinician's point of view and to identify challenges and opportunities in sepsis management. Participants were queried on demographics, definitions and diagnostic criteria, treatment approaches, and infection prevention and control (IPC) measures. A total of 136 participants from 93 healthcare structures responded, providing valuable insights into NS management practices.
RESULTS
From May to July 2022 across 21 Sub-Saharan African countries, 136 neonatal clinicians with an average from 93 structures with on average 10-year experience took the survey. NS ranked highest among prevalent neonatal conditions. Diagnostic case definitions between sepsis and infection were attributed to clinical signs, anamnesis, C reactive protein, white blood cll count and blood cultures with no statistically significant differences. Early-onset sepsis was defined within 72 hours by 48%, while late-onset varied. Antibiotics were likely on admission (86.4%) and during the stay (82.2%). Treatment abandonment was reported unlikely. The preferred antibiotic regimen for early-onset sepsis was intravenous amoxicillin (or ampicillin), gentamycin and cefotaxime. Blood culture availability and IPC protocols were reported as limited, particularly concerning patient environment, pharmacy protocols and clean-dirty circuits.
CONCLUSIONS
This NS survey emphasises clinicians' challenges due to limited access to diagnostic tools and raises concerns about antimicrobial overexposure. IPC also seem limited, according to participants. Addressing these challenges can enhance diagnostic practices, antibiotic stewardship and infection control in the region.
Topics: Humans; Neonatal Sepsis; Infant, Newborn; Africa South of the Sahara; Surveys and Questionnaires; Practice Patterns, Physicians'; Male; Female; Anti-Bacterial Agents
PubMed: 38886111
DOI: 10.1136/bmjpo-2023-002398 -
Canadian Family Physician Medecin de... Jun 2024
Topics: Humans; Diabetes Mellitus, Type 2; Aged; Hypoglycemic Agents; Aged, 80 and over; Female; Male
PubMed: 38886093
DOI: 10.46747/cfp.7006e81 -
Canadian Family Physician Medecin de... Jun 2024To provide family physicians with prescribing and diagnostic strategies that can reduce carbon emissions associated with inhalers. (Review)
Review
OBJECTIVE
To provide family physicians with prescribing and diagnostic strategies that can reduce carbon emissions associated with inhalers.
SOURCES OF INFORMATION
This review is based on the authors' experience developing the climate-conscious inhaler prescribing playbooks and courses for CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis). The approach was refined through patient and provider feedback since the first playbook was published in 2021. PubMed was also searched for relevant publications on inhaler use, asthma management, and chronic obstructive pulmonary disease (COPD) management. Current asthma and COPD guidelines were also reviewed.
MAIN MESSAGE
There is growing acknowledgment of the substantial impact that inhalers have on climate emissions generated by the health sector. Recent surveys indicate that most Canadian patients care about climate change and would be willing to opt for less carbon-intensive treatment and care delivery options where available. Beyond inhaler choice, there are many opportunities to address the climate impacts of respiratory care and enhance quality of care. Working with patients to ensure they are using the right medications in the right ways will produce both carbon savings and better health outcomes. The climate crisis can therefore serve as a catalyst for improving treatment of patients with respiratory conditions. Family physicians may reduce carbon emissions associated with inhalers by reducing unnecessary inhaler prescribing; ensuring patients' control of asthma and COPD is optimized; considering whether a more sustainable inhaler may be appropriate; optimizing dosing technique to reduce emissions and waste; and disposing of inhalers appropriately if possible.
CONCLUSION
Family physicians may reduce carbon emissions associated with inhalers through the following strategies: confirming diagnosis, controlling disease, considering inhaler type, optimizing dosing technique, and encouraging appropriate disposal.
Topics: Humans; Asthma; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Canada; Physicians, Family; Practice Patterns, Physicians'; Climate Change; Family Practice
PubMed: 38886092
DOI: 10.46747/cfp.7006381 -
Canadian Family Physician Medecin de... Jun 2024
PubMed: 38886091
DOI: 10.46747/cfp.7006e73 -
Canadian Family Physician Medecin de... Jun 2024
PubMed: 38886090
DOI: 10.46747/cfp.7006370 -
Canadian Family Physician Medecin de... Jun 2024
Topics: Family Practice; Humans; Canada; Biomedical Research; Societies, Medical
PubMed: 38886089
DOI: 10.46747/cfp.7006429 -
Canadian Family Physician Medecin de... Jun 2024
Topics: Humans; Family Practice
PubMed: 38886088
DOI: 10.46747/cfp.7006371_2 -
Canadian Family Physician Medecin de... Jun 2024
Topics: Humans; Apathy; Dementia; Antipsychotic Agents
PubMed: 38886087
DOI: 10.46747/cfp.7006395 -
Canadian Family Physician Medecin de... Jun 2024
Topics: Family Practice; Humans; Canada
PubMed: 38886086
DOI: 10.46747/cfp.7006405 -
Canadian Family Physician Medecin de... Jun 2024
Topics: Humans; Lipids
PubMed: 38886085
DOI: 10.46747/cfp.7006371