Expected Practice as a Novel Antibiotic Stewardship Intervention.

"Expected practice" is a recently described method to alter clinical behavior. We implemented an expected practice around short-course antibiotic therapy, which was associated with decreased antibiotic utilization for multiple bacterial infections. Thus, we describe this expected practice as a novel, simple, and inexpensive tool to enhance antibiotic stewardship

Extraterritorial Discovery: Extension of Jurisdiction by the Eleventh Circuit

A problem which frequently arises in connection with international litigation concerns the assertion of jurisdiction by a court over a person, or res located in a foreign state. Extension of jurisdiction by United States courts to foreign enterprises has typically been manifested by discovery orders compelling document production. Foreign states have attempted to block this extension of jurisdiction by enacting nondisclosure statutes which subject violators to criminal liability for compliance with United States discovery orders. This Note examines the analysis developed by United States courts to determine the propriety of enforcing discovery orders that may subject a party to liability under a foreign nondisclosure statute. This Note will compare the approaches taken by the Seventh and Eleventh Circuits. Finally, the ramifications and potential problems of the extension of jurisdiction by the Eleventh Circuit will be addressed

Could a Muslim – or a Catholic or a Jew – Be President? A 1788 Constitutional Debate

Histor

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review & revise’ experience

Background: We aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review & revise’ which is a key strategy to minimise antibiotic overuse in hospitals. Methods: In this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study. Results: Participants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions. Conclusions: This study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review & revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received

Pathogenic Fungi Regulate Immunity by Inducing Neutrophilic Myeloid-Derived Suppressor Cells

Peer reviewedPublisher PD

Subvalvular left ventricular pseudoaneurysm after mitral valve replacement: Two-dimensional echocardiographic findings

Disruption of the posterior mitral anulus is a rare complication of mitral valve replacement that may result in subvalvular left ventricular pseudoaneurysm formation. Such pseudoaneurysm formation was easily recognized by two-dimensional echocardiography in a 54 year old man 3 years after his second mitral valve replacement.The finding was confirmed by cineangiography and direct surgical inspection. Recognition of this rare complication of mitral valve replacement has therapeutic importance because surgical correction is necessary