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Aims and ObjectivesPaediatric GAS pharyngitis is common1 and associated with chronic health complications. Antibiotic treatment decreases risk of complications.2 Many cases of pharyngitis are viral, and most milder GAS cases self-resolve without complication; injudicious antibiotic use is associated with bacterial resistance.3 4 A spike in GAS infections in Winter 2022 increased investigation and antibiotic prescribing.5 Guidelines were produced to manage potential GAS pharyngitis in our ED, incorporating revised FeverPAIN score treatment thresholds.6 We audited adherence to determine impact on appropriate clinical management.Method and DesignWe audited microbiology results, medical notes and antibiotic prescribing rates of patients presenting with symptoms of pharyngitis who received bacterial throat swab (BTS) testing - calculating FeverPAIN scores. We excluded <3 year-olds or provisional scarlet fever diagnoses. GAS-positive BTS were compared with associated FeverPAIN scores to calculate Positive Predictive Values (PPV), and corresponding antibiotic prescribing rates.Results and Conclusion21 BTS were sent in the 2 months pre-guideline (October – December 2022), and 137 BTS were sent in the 6 months post-guideline (December 2022 – June 2023). GAS positivity was 38.1% versus 33.6% respectively. Rates of GAS-positive patients receiving antibiotics on discharge decreased from 100.0% to 69.6% (p=0.077); all GAS-positive patients not given antibiotics on discharge were prescribed antibiotics after swab result. GAS-negative patients receiving antibiotics fell from 69.2% to 57.1% (p=0.543). FeverPAIN ≥4 had a PPV of 50% pre-guideline, whilst the post-guideline revised treatment threshold FeverPAIN ≥3 had PPV of 41.1%.Whilst demonstrating good guideline adherence and targeted antibiotic prescribing post guideline introduction, this didn’t improve the correct identification and treatment of GAS. The FeverPAIN score PPV was low, meaning there were children who could have come to harm had BTS not been sent and results acted upon. This suggests reduced reliability of FeverPAIN scoring. With future spikes in GAS cases likely, further research needs to be done to correctly target antibiotic prescribing for GAS pharyngitis.References Martin JM, Green M. Group A streptococcus. Semin Pediatr Infect Dis. 2006;17(3):140-8. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021;12(12):CD000023. Dooling KL, Shapiro DJ, Van Beneden C, Hersh AL, Hicks LA. Overprescribing and inappropriate antibiotic selection for children with pharyngitis in the United States, 1997-2010. JAMA Pediatr. 2014;168(11):1073-4. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229-41. Public Health Scotland. Group A Streptococcal Infections. 2023 [Accessed 22nd June 2023] https://www.hps.scot.nhs.uk/a-to-z-of-topics/streptococcal-infections/group-astreptococcal-infections/ NHS England. Group A streptococcus in children interim clinical guidance summary. 2022. [Accessed 22nd June 2023]

Get to the heart of Central Asia with relevant, up-to-date advice on what to see and skip, and what hidden discoveries await you in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Includes special features on visa and border information; the Silk Road, community-based tourism; and other activities.

Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades (1). The science is unequivocal; a global increase of 1.5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse (2, 3). Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality (5, 6). Global heating is also contributing to the decline in global yield potential for major crops, falling by 1.8–5.6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition (4).

WHY doesn't the council get people on community...

YOU make the entirely reasonable point (\"Beyond the Bombs\", December 4, 1992) that there are parallels to be drawn between \"uncontrolled sectarianism\" in Northern Ireland and \"the uncontrolled racism\" found in America three decades ago. You then go on to suggest that solutions to the race question in the US - such as bussing and forced integration - might also work to overcome division and distrust in Northern Ireland. Integrated schools have succeeded in Northern Ireland over the past 11 years not because of British government policy (although recent legislative support for integrated education can only be welcome), but because of grassroot support from thousands of dedicated parents determined to create something different for their children. As a result of their determination, the number of integrated schools in Northern Ireland has risen from one in 1981 to 18 in 1992, with more planned over the next few years.

Statistics Canada counts an admission every time an offender begins any period of custody; an individual will be counted as many times as his/her legal status changes) and that the average length of stay in these facilities is only a few weeks.

A COLOMBIAN woman seeks the street magician Maset Naseeb Shah in New Delhi. Bollywood beats fill the gaps between magic acts of dubious quality . Co2 (venue 202) Cafe Royal Fringe Theatre (venue 47)