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Practice Pointers by AARON SAGUIL, MD, MPH, Uniformed Services University of the Health Sciences, Bethesda, Maryland Am Fam Physician. This clinical content conforms to AAFP criteria for continuing medical education (CME). Procalcitonin point-of-care testing reduces antibiotic prescribing in adults (Strength of recommendation [SOR]: A, based on consistent, good-quality patient-oriented evidence), but increases antibiotic prescribing and adverse consequences in children. Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records. Inappropriate prescription of antibiotics in pediatric practice: analysis of the prescriptions in primary care [published ahead of print April 18, 2016]. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America [published correction appears in The Management of Chronic Obstructive Pulmonary Disease Working Group. This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for Copyright © 2016 by the American Academy of Family Physicians. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.(SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Rapid streptococcal antigen point-of-care testing, viral polymerase chain reaction testing (adults only), and C-reactive protein testing reduced antibiotic prescribing, but studies of adverse consequences were lacking. VA/Do D clinical practice guideline for the management of chronic obstructive pulmonary disease. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.Antibiotic-resistant bacterial infections lead to approximately 23,000 deaths in the United States each year.1 Inappropriate antibiotic prescribing is the leading cause of resistance and accounts for one-third of all antibiotic prescriptions each year.2 Clinical, system-level, or educational interventions that reduce inappropriate prescribing Point-of-care tests to rapidly determine the likelihood that a patient has a specific infection (e.g., rapid streptococcal antigen test of a throat swab sample, multiviral polymerase chain reaction, or an influenza-specific test of throat or nasopharyngeal secretions) or has a bacterial infection instead of a viral one (e.g., blood procalcitonin, blood C-reactive protein); tympanometry to aid in diagnosing acute otitis media; delayed antibiotic prescribing (e.g., giving prescriptions to patients with instructions to delay filling, leaving prescriptions for patient collection, postdating prescriptions, requesting recontact with physician); clinical scoring tools based on combinations of signs and symptoms Electronic decision support (computer-aided, evidence-based prescribing recommendations); paper-based physician reminders about prescribing; physician audit plus feedback; financial or regulatory incentives for physicians or patients; antimicrobial stewardship programs Clinic-based patient or parent education about when antibiotics may be appropriate (e.g., videos, pamphlets, verbal education, waiting room posters); public education campaigns (e.g., billboards, bus advertisements, radio and television advertisements); clinician education about current treatment guidelines; communication skills training programs for physicians Adapted from the Agency for Healthcare Research and Quality, Effective Health Care Program. Improving antibiotic prescribing for uncomplicated acute respiratory tract infections. Rockville, Md.: Agency for Healthcare Research and Quality; January 2016. Accessed June 27, 2016Point-of-care tests to rapidly determine the likelihood that a patient has a specific infection (e.g., rapid streptococcal antigen test of a throat swab sample, multiviral polymerase chain reaction, or an influenza-specific test of throat or nasopharyngeal secretions) or has a bacterial infection instead of a viral one (e.g., blood procalcitonin, blood C-reactive protein); tympanometry to aid in diagnosing acute otitis media; delayed antibiotic prescribing (e.g., giving prescriptions to patients with instructions to delay filling, leaving prescriptions for patient collection, postdating prescriptions, requesting recontact with physician); clinical scoring tools based on combinations of signs and symptoms Electronic decision support (computer-aided, evidence-based prescribing recommendations); paper-based physician reminders about prescribing; physician audit plus feedback; financial or regulatory incentives for physicians or patients; antimicrobial stewardship programs Clinic-based patient or parent education about when antibiotics may be appropriate (e.g., videos, pamphlets, verbal education, waiting room posters); public education campaigns (e.g., billboards, bus advertisements, radio and television advertisements); clinician Agency for Healthcare Research and Quality, Effective Healthcare Program.

Before retraining as a barrister Andrew spent nine years in the corporate world.

Andrew is also often instructed for Employment Appeal Tribunal matters.

His experience at tribunal covers a wide range of employment law areas including whistle-blowing, discrimination (including sex, race, disability, pregnancy and age), harassment, victimisation, equal pay, unfair dismissal, TUPE, unlawful deductions and breach of contract.

Delayed prescribing practices reduced antibiotic prescribing, but reduced patient satisfaction and increased symptom length. Contact [email protected] copyright questions and/or permission requests.

(SOR: A, based on consistent, good-quality patient-oriented evidence.) Electronic decision supports reduced antibiotic prescribing without affecting the risk of complications. Diagnosis and treatment of respiratory illness in children and adults.