Infective endocarditis in intravenous drug abusers: an update

Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.This work was supported by Portuguese Foundation for Science and Technology (FCT) through the grants SFRH/BPD/47693/2008, SFRH/BPD/20987/2004 and SFRH/BPD/72632/2010 attributed to Claudia Sousa, Claudia Botelho and Diana Rodrigues, respectively

Rural-Urban Differences in Esophagectomy for Cancer

Introduction. Patients who are socioeconomically disadvantaged or in rural areas may not pursue surgery at high-volume centers, where outcomes are better for some complex procedures. The objective of this study was to determine and compare rural and urban patient differences and outcomes after undergoing esophagectomy for cancer. Methods. An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) database was performed, capturing adult patients with esophageal cancer who underwent esophagectomy. Patients were stratified into rural or urban groups by the National Center for Health Statistics Urban-Rural Classification Scheme. Demographics, hospital variables, and outcomes were compared. Results. A total of 2,877 patients undergoing esophagectomy for esophageal cancer were captured by the database, with 228 (7.92%) rural and 2,575 (89.50%) urban patients. The rural and urban groups had no difference in age, race, insurance status, and many common comorbidities. Major outcomes of mortality and length of stay were similar for both rural and urban patients (3.95% versus 4.27%, p=0.815) and (15.75±13.22 versus 15.55±14.91 days, p=0.828), respectively. There was a trend for rural patients to be more likely to discharge home (35.96% versus 29.79%, OR 0.667 [95%CI 0.479-0.929]; p=0.0167). Conclusions. This retrospective administrative database study indicates that rural and urban patients receive equivalent postoperative care after undergoing esophagectomy. The findings are reassuring as there does not appear to be a disparity in major outcomes depending on the location of residence, but further studies are necessary to assure equitable treatment for rural patients

New ways of seeing: radical theorizing

At AMJ, we encourage authors to produce novel, interesting, and theoretically bold work, and recommend that authors ask themselves how their manuscript challenges, changes, or advances what we know at a theoretical level before submitting their paper for review. The strength of a manuscript’s theoretical contribution is a key element that is considered by reviewers and associate editors alike when evaluating the merits of a study. In our endeavor to stimulate New Ways of Seeing in management research, this editorial focuses on “radical theorizing,” which is the generation of completely new theoretical insights that may lead to a substantial departure from existing paradigms. Theorization, in general, may be viewed as disciplined imagination (Mills, 1959; Weick, 1989) and allows scholars to systematically explain and predict outcomes of interest (Cook & Campbell, 1979). Radical theorizing, though, emphasizes the achievement of significant creative leaps as evidenced, for instance, by drawing on pertinent distal theories, and formulating novel relationships (cf. Colquitt & Zapata-Phelan, 2007). It can be viewed as the process by which we accomplish theoretical prescience (Corley & Gioia, 2011; Kuhn, 1962)—creating understandings that resolve existing ambiguities over future states. Interestingness is a necessary but not sufficient condition for the outcome of this process (an idea that is original and has both scientific and practical utility); it is not a process to derive ideas that are merely counterintuitive or painfully obvious. Through radical theorizing, scholars introduce new research directions that may fundamentally shape future discourse on a topic. This editorial offers ideas on how scholars might want to think about radical theorizing. We borrow from research on innovation and organizational learning as well as the philosophy of science to discuss the important role of radical theorizing in achieving scientific progress, different approaches to radical theorizing, and insights one may obtain from observing the work of radical theorizers in the past. We conclude by offering some practical tips on how one can get started with radical theorizing in their own work