Prophylaxis increases the risk of multidrug resistance among recurrent infections. This has important implications in the risk-benefit assessment of prophylaxis as a management strategy and in the selection of empirical treatment of breakthrough infections in prophylaxis patients.
OBJECTIVE
To evaluate the correlation between the International Prostate Symptom Score (IPSS) and the Visual Prostate Symptom Score (VPSS), a visual assessment of urinary stream, frequency, nocturia, and quality of life using pictograms, in a health safety net population.
METHODS
Men presenting to San Francisco General Hospital with lower urinary tract symptoms completed the IPSS and the VPSS without and then with assistance. Statistical analysis was performed using the chi-square test, the Wilcoxon signed rank test, and the Spearman rank correlation.
RESULTS
One hundred twenty-one patients were enrolled between December 2013 and May 2014 with a mean age of 54 years. There were statistically significant correlations between total VPSS and total IPSS (ρ = 0.71; P <.001) and for frequency (ρ = 0.47; P <.001), nocturia (ρ = 0.69; P <.001), force of stream (ρ = 0.65; P <.001), and quality of life (ρ = 0.69; P <.001). In addition, there were statistically significant correlations between total VPSS and both VPSS quality of life (ρ = 0.69; P <.001) and Qmax (ρ = −0.473; P = .006). The mean absolute disagreement for participants who took the IPSS independently vs with assistance was greater than for those who took the VPSS independently vs assistance for all symptoms: frequency (0.64 vs 0.3, respectively; P <.001), weak stream (0.82 vs 0.14, respectively; P <.001), nocturia (0.38 vs 0.23, respectively; P = .023), and quality of life (0.63 vs 0.32, respectively; P = .005).
CONCLUSION
Many men altered their IPSS responses when they received assistance. There was significantly less alteration in responses using the VPSS, suggesting that the VPSS is useful in determining lower urinary tract symptoms, particularly in patients with limited education and literacy.
The 2019 novel coronavirus disease (COVID-19) pandemic produced an abrupt and near shutdown of nonemergent patient care. Children's National Hospital (CNH) mounted a multidisciplinary, coordinated ambulatory response that included supply chain management, human resources, risk management, infection control, and information technology. To ensure patient access, CNH expanded telemedicine and instituted operational innovations for outpatient procedures. While monthly in-person ambulatory subspecialty visits decreased from 25 889 pre-COVID-19 to 4484 at nadir of the COVID-19 pandemic, telemedicine visits increased from 70 to
Delivery of mental health treatment in the home can close gaps in care. Telehealth also provides access to healthcare that has been disrupted due to the COVID-19 pandemic. In 2016, a home direct-to-consumer telehealth program was initiated. Mental health encounters made up a significant portion of all telehealth encounters and COVID-19 had a significant impact on accelerating the utilization of telehealth. Telemental health has been more successful at meeting targeted volumes than the overall health system. Of all the mental health diagnoses before and during COVID-19, attention deficit hyperactivity disorder, Autism Spectrum Disorder, and Anxiety Disorder were most common. The direct-to-consumer telehealth program saved patients a significant amount of travel miles and associated time, based on data from the period before COVID-19. Payment reimbursement for direct-to-consumer telehealth professional services was similar to reimbursement for in-person visits. This program demonstrates direct-to-consumer telehealth is a feasible and acceptable care modality for a variety of youth mental health disorders.
Summary
Introduction
Urinary tract infection (UTI) affects 10% of girls and 3% of boys by age 16. Both the American Academy of Pediatrics and National Institute for Health and Clinical Excellence Guidelines recommend urine testing prior to initiation of antibiotic treatment, and the use of local antibiograms to guide empiric antibiotic therapy. Urine culture results not only provide the opportunity to halt empiric therapy if there is no bacterial growth, but also allow for tailoring of broad-spectrum therapy. Additionally, the use of antiobiograms is recommended to improve empiric antibiotic selection based on local resistance patterns. However, execution of guideline recommendations has proven challenging. In order to develop targeted interventions aimed at improving adherence to these guidelines, understanding the barriers that may exist in implementing them is critical.
Objectives
The present study sought to investigate practice patterns and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of UTI in children, with the aim of ultimately improvinguo A adherence to UTI management guidelines.
Study design
A random, national sample of physicians caring for children was surveyed from the American Medical Association Masterfile. Participants were queried regarding practice type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms.
Results
Of respondents who acknowledged contact by surveyors, 47% completed the survey (n=366). Most respondents (84%) obtained urinalysis and culture prior to treatment for UTI. Physicians reported that they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%). Urine collection by bag was more common in circumcised boys (>30%) compared with girls (20%) and uncircumcised boys (20%) (P=0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization. Of the 70% of respondents reporting antibiogram access (n=256), 50% reported its use the majority of the time with empiric prescription (n=128).
Discussion
While most practitioners reported following guidelines to obtain urine testing prior to antibiotic prescription for UTI, urine collection by bag was common. Additionally, <50% of practitioners adhered to guideline recommendations for empiric antibiotic selection based on local antibiograms. Interventions to improve adherence to UTI management guidelines should focus on: (1) improving catheterization practices; (2) educating parents regarding the value of catheterization; and (3) incorporating local antibiograms into electronic medical records.
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