When once is not enough – further evidence of procalcitonin-guided antibiotic stewardship

Every day, critical care physicians around the world face the same challenge of the optimal timing of antimicrobial administration: when to start and when to stop antibiotics. Duration of antibiotic therapy for sepsis is mostly based on expert opinion, but its reduction is arguably the most promising approach to decrease emergence and selection of antibiotic resistance. The study by Hochreiter and colleagues presents another piece of evidence suggesting that procalcitonin may indeed be a valuable diagnostic parameter to guide antibiotic treatment duration, despite the ongoing controversy about the diagnostic accuracy of pro-calcitonin

Once is not Enough: Thoughts on Replication in Functional Analysis Research in Aphasia

TB

Once Is Not Enough: Withholding Postoperative Prophylactic Antibiotics in Prosthetic Breast Reconstruction Is Associated with an Increased Risk of Infection

There has been a trend toward limiting perioperative prophylactic antibiotics, based on research not conducted in plastic surgery patients. The authors’ university hospital instituted antibiotic prescribing guidelines based on the Surgical Care Improvement Project. An increased rate of surgical-site infections was noted in breast reconstruction patients. The authors sought to determine whether the change in antibiotic prophylaxis regimen affected rates of surgical-site infections

Extended Prophylactic Antibiotics for Mastectomy with Immediate Breast Reconstruction: A Meta-analysis

Background: The risk of surgical site infection (SSI) for breast surgery in patients without additional risk factors is low, below 5%. Evidence shows the risk of SSI is significantly elevated in patients undergoing immediate breast reconstruction (IBR). However, there is no consensus regarding the use of extended antibiotic prophylaxis. We aim to determine the effect of extended antibiotic prophylaxis on the incidence of SSI after IBR. Methods: PubMed and Scopus were searched by 2 independent reviewers. Data abstracted included types of study, basic characteristics, detailed antibiotic prophylaxis information, SSI event, and other secondary outcomes. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study and used a random-effects model to estimate the results. Study quality, bias, and heterogeneity were also analyzed. Results: A total of 11 studies (15,966 mastectomy procedures) were included. We found an overall 5.99% SSI rate in our population. Three studies comparing topical antibiotics with no topical antibiotics demonstrated statistical significance (RR = 0.26, 95% CI: 0.12–0.60, P = 0.001), whereas 8 studies comparing extended systemic antibiotics with standard of care found no statistical significance (RR = 0.80, 95% CI: 0.60–1.08, P = 0.13). Conclusions: In the setting of IBR following mastectomy, there is insufficient evidence for the use of extended prophylactic antibiotics to reduce SSI rates. Welldesigned randomized controlled trials in patients undergoing IBR should be conducted to determine the appropriate regimen and/or duration of prophylactic antibiotics on SSI outcomes

Identity and affect in design cognition

Much Design Research effort has been afforded to investigating how designers think and what they do; often in the form of protocol analysis. These investigations have mainly focused on how designers influence material culture however, little attention has been paid to another line of enquiry; that is how the act of designing affects the individual undertaking the work and the role of social psychological phenomena e.g. attitudes, evaluations, emotions, impressions, motivations and social behaviour - on design activity. This interplay of affect between design activity and a designer’s social psychological behaviour is a complex two way process that warrants further investigation. Our research agenda focuses on the individual undertaking design activity and asks how does designing affect the designer and their behaviour? In this paper two issues are addressed: 1. The immediate effects of design activity on the designer 2. The role of self-concept in design cognition These two issues are investigated through a series of experiments carried out under semi-controlled conditions using several forms of observation and novel self-concept inventories. This paper draws attention to the need to consider self-concept and affect in design cognition and introduces the idea of design identity, which is uniquely different to the concept of design experience often quoted in the literature. This is an area of the ongoing research agenda within the Department of Design and Technology, Loughborough University, UK. Keywords: Design Activity; Design Behaviour; Psychology of Design; Self-Concept; Immediate Effects</p