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Management of acute diarrhea in adults in China: a cross-sectional survey

BACKGROUND: The aim of this study was to evaluate the management of acute adult diarrhea in China and assess adherence of clinical practice to national guidelines and 2012 World Gastroenterology Organization guidelines. METHODS: A cross-sectional survey was carried out among physicians in 20 hospita...

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Autores principales: Hou, Feng-Qin, Wang, Yan, LI, Jun, Wang, Gui-Qiang, Liu, Ying
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556318/
https://www.ncbi.nlm.nih.gov/pubmed/23324386
http://dx.doi.org/10.1186/1471-2458-13-41
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author Hou, Feng-Qin
Wang, Yan
LI, Jun
Wang, Gui-Qiang
Liu, Ying
author_facet Hou, Feng-Qin
Wang, Yan
LI, Jun
Wang, Gui-Qiang
Liu, Ying
author_sort Hou, Feng-Qin
collection PubMed
description BACKGROUND: The aim of this study was to evaluate the management of acute adult diarrhea in China and assess adherence of clinical practice to national guidelines and 2012 World Gastroenterology Organization guidelines. METHODS: A cross-sectional survey was carried out among physicians in 20 hospitals in two different areas of China (Beijing, 10; Shaanxi province, 10). Summary statistics were calculated for the overall study group and for each region. Between-region differences were assessed with χ(2) or t-tests. RESULTS: Data were collected for 800 patients (≥18 years; mean ± SD age 37.0 ± 16.3 years; 56.4% female). The mean ± SD time between diarrhea onset and visiting a diarrhea clinic was 2.4 ± 1.6 days; this interval was significantly shorter in Beijing than Shaanxi (2.0 ± 1.4 vs 2.8 ± 1.8 days, respectively; p < 0.001). Overall, 31.4% of patients self-medicated before visiting the clinic, most commonly with antibiotics. Routine stool examinations were ordered for 70.6% of patients, vibrio cholera stool culture for 57.5%, but non-vibrio bacteria stool culture for only 11.4%. Only 61.6% of patients received fluid and electrolyte therapy: 28.3% oral rehydration solution (ORS) and 33.4% intravenous fluids (even though only 13.8% needed). Antibiotics were the most common drugs (60.8%) and the most common antibiotics were fluoroquinolones, followed by aminoglycosides. Totally 51.3% of patients received irrational antibiotic treatment (unnecessary for 47.9%; indicated but not prescribed for 3.4%). After antibiotics, the most commonly prescribed drugs were dioctahedral smectite (59.3%); For Shaanxi compared with Beijing, less individuals received ORS (7.8% vs 48.5%,respectively; p < 0.001) and more received intravenous fluids (46.3% vs 20.5%, respectively; p < 0.001). Significantly more of the patients in Shaanxi province were administered antibiotics (64.5% vs 57%, respectively; p = 0.03), and more received intravenous antibiotics than Beijing (49.0% vs 27.0%, respectively; p < 0.001). CONCLUSIONS: Adherence to both national guidelines and 2012 World Gastroenterology Organization guidelines for the management of acute diarrhea in adult was limited among tertiary hospital physicians. The findings suggest nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.
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spelling pubmed-35563182013-01-30 Management of acute diarrhea in adults in China: a cross-sectional survey Hou, Feng-Qin Wang, Yan LI, Jun Wang, Gui-Qiang Liu, Ying BMC Public Health Research Article BACKGROUND: The aim of this study was to evaluate the management of acute adult diarrhea in China and assess adherence of clinical practice to national guidelines and 2012 World Gastroenterology Organization guidelines. METHODS: A cross-sectional survey was carried out among physicians in 20 hospitals in two different areas of China (Beijing, 10; Shaanxi province, 10). Summary statistics were calculated for the overall study group and for each region. Between-region differences were assessed with χ(2) or t-tests. RESULTS: Data were collected for 800 patients (≥18 years; mean ± SD age 37.0 ± 16.3 years; 56.4% female). The mean ± SD time between diarrhea onset and visiting a diarrhea clinic was 2.4 ± 1.6 days; this interval was significantly shorter in Beijing than Shaanxi (2.0 ± 1.4 vs 2.8 ± 1.8 days, respectively; p < 0.001). Overall, 31.4% of patients self-medicated before visiting the clinic, most commonly with antibiotics. Routine stool examinations were ordered for 70.6% of patients, vibrio cholera stool culture for 57.5%, but non-vibrio bacteria stool culture for only 11.4%. Only 61.6% of patients received fluid and electrolyte therapy: 28.3% oral rehydration solution (ORS) and 33.4% intravenous fluids (even though only 13.8% needed). Antibiotics were the most common drugs (60.8%) and the most common antibiotics were fluoroquinolones, followed by aminoglycosides. Totally 51.3% of patients received irrational antibiotic treatment (unnecessary for 47.9%; indicated but not prescribed for 3.4%). After antibiotics, the most commonly prescribed drugs were dioctahedral smectite (59.3%); For Shaanxi compared with Beijing, less individuals received ORS (7.8% vs 48.5%,respectively; p < 0.001) and more received intravenous fluids (46.3% vs 20.5%, respectively; p < 0.001). Significantly more of the patients in Shaanxi province were administered antibiotics (64.5% vs 57%, respectively; p = 0.03), and more received intravenous antibiotics than Beijing (49.0% vs 27.0%, respectively; p < 0.001). CONCLUSIONS: Adherence to both national guidelines and 2012 World Gastroenterology Organization guidelines for the management of acute diarrhea in adult was limited among tertiary hospital physicians. The findings suggest nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system. BioMed Central 2013-01-16 /pmc/articles/PMC3556318/ /pubmed/23324386 http://dx.doi.org/10.1186/1471-2458-13-41 Text en Copyright ©2013 HOU et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Hou, Feng-Qin
Wang, Yan
LI, Jun
Wang, Gui-Qiang
Liu, Ying
Management of acute diarrhea in adults in China: a cross-sectional survey
title Management of acute diarrhea in adults in China: a cross-sectional survey
title_full Management of acute diarrhea in adults in China: a cross-sectional survey
title_fullStr Management of acute diarrhea in adults in China: a cross-sectional survey
title_full_unstemmed Management of acute diarrhea in adults in China: a cross-sectional survey
title_short Management of acute diarrhea in adults in China: a cross-sectional survey
title_sort management of acute diarrhea in adults in china: a cross-sectional survey
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556318/
https://www.ncbi.nlm.nih.gov/pubmed/23324386
http://dx.doi.org/10.1186/1471-2458-13-41
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