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[基层医疗中与过度诊断和过度治疗相关的25个传染病误区]

[Twenty-five myths in infectious diseases in primary care associated with overdiagnosis and overtreatment].

作者信息

Llor Carles, Moragas Ana, Cordoba Gloria

机构信息

Centro de Salud Via Roma, Barcelona, España; Grupo de Trabajo de Enfermedades Infecciosas de la semFYC.

Universitat Rovira i Virgili. Centro de Salud Jaume I, Tarragona, España.

出版信息

Aten Primaria. 2018 Nov;50 Suppl 2(Suppl 2):57-64. doi: 10.1016/j.aprim.2018.09.005. Epub 2018 Sep 27.

DOI:10.1016/j.aprim.2018.09.005
PMID:30270191
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6836970/
Abstract

Overdiagnosis and overprescribing is common in current clinical practice of infectious diseases in primary care. On the basis of studies published in the medical literature we identify my means of a non-systematic review a total of 25 myths associated with the diagnosis and treatment and present the literature pertaining to each myth. These myths result in extraneous testing (overdiagnosis) and excessive antimicrobial treatment (overtreatment). Most of these myths are ingrained among general practitioners in our country. Not only should these myths be debunked from our clinical practice, but they should also be reversed, and we encourage our readers to critically appraise their practice when it comes down to the misconceptions treated in this manuscript. We attempt to give guidance to clinicians facing these frequent clinical scenarios.

摘要

在基层医疗中,传染病的当前临床实践中过度诊断和过度开药的现象很常见。基于医学文献中发表的研究,我们通过非系统综述的方式,共识别出25个与诊断和治疗相关的误区,并呈现了与每个误区相关的文献。这些误区导致了不必要的检查(过度诊断)和过度的抗菌治疗(过度治疗)。我国的全科医生中大多都根深蒂固地存在这些误区。这些误区不仅应从我们的临床实践中被揭穿,还应被扭转,并且我们鼓励读者在面对本手稿中所涉及的误解时,批判性地评估自己的实践。我们试图为面临这些常见临床情况的临床医生提供指导。

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本文引用的文献

1
Approach of clinicians to candiduria and related outcome in the elderly.临床医生对老年人尿念珠菌病及相关结果的处理方法。
J Mycol Med. 2018 Sep;28(3):428-432. doi: 10.1016/j.mycmed.2018.05.011. Epub 2018 Jun 8.
2
Global increase and geographic convergence in antibiotic consumption between 2000 and 2015.2000 年至 2015 年间,抗生素消费在全球范围内增长,并在地理上趋同。
Proc Natl Acad Sci U S A. 2018 Apr 10;115(15):E3463-E3470. doi: 10.1073/pnas.1717295115. Epub 2018 Mar 26.
3
Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections.广谱与窄谱抗生素与急性呼吸道感染儿童治疗失败、不良事件及生活质量的关联
JAMA. 2017 Dec 19;318(23):2325-2336. doi: 10.1001/jama.2017.18715.
4
[Management of odontogenic infections in Primary Care: Antibiotic?].[基层医疗中牙源性感染的管理:抗生素?]
Aten Primaria. 2017 Dec;49(10):611-618. doi: 10.1016/j.aprim.2017.05.003. Epub 2017 Jul 25.
5
Misconceptions of Spanish general practitioners' attitudes toward the management of urinary tract infections and asymptomatic bacteriuria: an internet-based questionnaire study.西班牙全科医生对尿路感染和无症状菌尿管理态度的误解:一项基于互联网的问卷调查研究
Rev Esp Quimioter. 2017 Oct;30(5):372-378. Epub 2017 Jul 24.
6
Antibiotics for acute bronchitis.用于急性支气管炎的抗生素
Cochrane Database Syst Rev. 2017 Jun 19;6(6):CD000245. doi: 10.1002/14651858.CD000245.pub4.
7
Short-course versus long-course oral antibiotic treatment for infections treated in outpatient settings: a review of systematic reviews.门诊治疗感染的短疗程与长疗程口服抗生素治疗:系统评价的综述
Fam Pract. 2017 Sep 1;34(5):511-519. doi: 10.1093/fampra/cmx037.
8
Implications of Antibiotic Resistance for Patients' Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis.抗生素耐药性对社区常见感染患者康复的影响:一项系统评价和荟萃分析。
Clin Infect Dis. 2017 Aug 1;65(3):371-382. doi: 10.1093/cid/cix233.
9
Estimated saving of antibiotics in pharyngitis and lower respiratory tract infections if general practitioners used rapid tests and followed guidelines.如果全科医生使用快速检测并遵循指南,估计在咽炎和下呼吸道感染中可节省的抗生素用量。
Aten Primaria. 2017 Jun-Jul;49(6):319-325. doi: 10.1016/j.aprim.2016.07.002. Epub 2016 Nov 22.
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