International sore throat guidelines and international medical graduates: a mixed methods systematic review

Abstract

AIM: To examine national and international guidelines on sore throat management and subsequently, to explore the phenomenon of international medical graduates working in general and rural practice in New Zealand. METHOD:Two separate systematic reviews were conducted that resulted in a contingent methodology. Contingent methodologies involve syntheses of data that are derived sequentially. The initial review for this study examined international sore throat guidelines and their key points. The results of this initial review resulted in the theory that international medical graduates may be unaware of the New Zealand specific sore throat guidelines and the problem of acute rheumatic fever in this country. The subsequent review examined the phenomenon of international medical graduates working in general or rural practice in New Zealand. Data sources were Medline, Google Scholar, Trip Database, and NHS Evidence, Embase and Scopus. Electronic databases were searched for relevant data published January 2000-December 2013. Additional hand searches found key references from articles and websites. RESULTS:International guidelines for the management of sore throats differ from New Zealand guidelines. Of resource rich countries, New Zealand has the second highest number of international medical graduates: they may not use New Zealand specific sore throat guidelines.DISCUSSION: Acute rheumatic fever is virtually eradicated in most resource rich countries. Rheumatic fever rates of among indigenous Māori and Pacifika people in New Zealand have failed to reduce over the last three decades. Knowledge and actions of international medical graduates in relation to sore throat management needs investigating.

Association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries

“…Hence, the main divider between Open access different sore throat guidelines is whether to rely solely on clinical scoring of symptoms and signs or to also rely on additional information obtained from a throat swab processed using culture or a POCT to detect the presence of GAS. 31 However, it seems the impact guidelines have on medical practitioners' perception of the best management strategy for these patients is limited. 32 33 The primary aim of this study was to investigate difference between countries in the OR for (a) perception of throat swabs as important, (b) perception of blood tests (C reactive protein (CRP), B-ESR and B-leucocytes) as important and (C) antibiotic prescriptions if no pathogenic bacteria isolated on throat swab in patients with an apparently uncomplicated acute sore throat.…”

“…Hence, the main divider between different sore throat guidelines is whether to rely solely on clinical scoring of symptoms and signs or to also rely on additional information obtained from a throat swab processed using culture or a POCT to detect the presence of GAS. 31 However, it seems the impact guidelines have on medical practitioners’ perception of the best management strategy for these patients is limited. 32 33 …”

Worldwide comparison of treatment guidelines for sore throat

“…[65][66][67][68] These reviews include guidelines published up to 2006, 65 2010, 66 2012 68 and 2015 (date of latest reference), 67 respectively. The major limitations of these reviews are the restrictions to North American and European guidelines, [65][66][67] to English language 67,68 and to published literature. 66,67 To our knowledge, the present work is the first review of sore throat guidelines that has no geographic or linguistic restrictions, and includes guidelines not The review of the guidelines reveals important divergences regarding diagnostic and antibiotic treatment criteria in different countries.…”

From the Editor: Biology and culture

“…Regarding biology, in this issue there is one research report about depression, 3 one about sore throats, 4 and two papers about stopping Bryson's 'perpetuating the sequence of hereditary combinations' resulting in another person, otherwise known as contraception. 5,6 Lawton and colleagues 5 draw attention to the difficulties Māori teenagers experience in accessing post partum contraception -largely a consequence of fragmented health services and cost barriersand Roke et al 6 report on New Zealand women's experiences and satisfaction with the Jadelle® contraceptive implant.…”

“…This report shows how a thoughtful GP asked and answered this question from his clinical practice. In an interesting two-stage literature review Hoare et al 4 argue that New Zealand's many international medical graduates coming from cultures that expect rheumatic fever not to be present in developed countries may be unprepared for providing appropriate sore throat treatment in some parts of this country.…”