Antibiotic prophylaxis of infective endocarditis

Links between infective endocarditis (IE) and den-tal and other invasive procedures were first identified in the1920s, and the use of antibiotic prophylaxis (AP) to prevent IEwas first recommended by the American Heart Association in1955. Recognising the weak evidence to support this practiceand the wider risks of anaphylaxis and antibiotic resistance,guidelines in the USA and Europe have been rationalised inthe last decade with restriction of AP to those patients per-ceived to be at the highest risk. In the UK, the NationalInstitute for Health and Care Excellence controversially rec-ommended the complete cessation of AP for all invasive pro-cedures in 2008 and subsequent epidemiological studies havesuggested a significant increase in cases above the baselinetrend. AP appears to be safe and is likely to be cost-effective.Until further data are available, we recommend continued ad-herence to US and European guidelines

World Workshop on Oral Medicine VII : What participants perceive as important

Our objective was to identify which aspects of World Workshop on Oral Medicine (WWOM) participation were perceived as significant for participants\u2019 professional development. Online survey was sent to previous WWOM participants. Qualitative analysis of participants\u2019 responses to an open-ended question was performed. Fifty-two WWOM participants responded. Nearly three quarters of respondents (72.3%) felt that participation in the WWOM helped their career. A high percentage of respondents (67.3%) provided answers that fell under the domains of international collaboration, followed by personal academic benefits (48%). Overall, the results indicate that WWOM participation played an important role in individual's professional development. We identified aspects of WWOM involvement that the participants perceived as important. This information will be used for the development of an objective instrument for measuring impact of WWOM on participant's professional path

Oral antibiotic prescribing by NHS dentists in England 2010-2017

Introduction Dentists prescribe a significant proportion of all antibiotics, while antimicrobial stewardship aims to minimise antibiotic-prescribing to reduce the risk of developing antibiotic-resistance and adverse drug reactions. Aims To evaluate NHS antibiotic-prescribing practices of dentists in England between 2010-2017. Methods NHS Digital 2010-2017 data for England were analysed to quantify dental and general primary-care oral antibiotic prescribing. Results Dental prescribing accounted for 10.8% of all oral antibiotic prescribing, 18.4% of amoxicillin and 57.0% of metronidazole prescribing in primary care. Amoxicillin accounted for 64.8% of all oral antibiotic prescribing by dentists, followed by metronidazole (28.0%), erythromycin (4.4%), phenoxymethylpenicillin (0.9%), clindamycin (0.6%), co-amoxiclav (0.5%), cephalosporins (0.4%) and tetracyclines (0.3%). Prescriptions by dentists declined during the study period for all antibiotics except for co-amoxiclav. This increase is of concern given the need to restrict co-amoxiclav use to infections where there is no alternative. Dental prescribing of clindamycin, which accounted for 43.9% of primary care prescribing in 2010, accounted for only 14.6% in 2017. Overall oral antibiotic prescribing by dentists fell 24.4% as compared to 14.8% in all of primary care. Conclusions These data suggest dentists have reduced antibiotic prescribing, possibly more than in other areas of primary-care. Nonetheless, opportunities remain for further reduction

Quantifying infective endocarditis risk in patients with predisposing cardiac conditions

Aims: There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions. Methods and results: English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered 'moderate risk') had similar levels of risk (OR 66 and 57) and risks in other 'moderate-risk' conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered 'high risk' for 6 months following surgery) had lower risk than all 'moderate-risk' conditions-even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices. Conclusion: These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some 'moderate-risk' patients was similar to that of several 'high-risk' conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation

The cost-effectiveness of antibiotic prophylaxis for patients at risk of infective endocarditis

Background: In March 2008, the National Institute for Health and Care Excellence (NICE) recommended stopping antibiotic prophylaxis (AP) for those at risk of infective endocarditis (IE) undergoing dental procedures in the UK, citing a lack of evidence of efficacy and cost-effectiveness. We have performed a new economic-evaluation of AP based on contemporary estimates of efficacy, adverse events and resource implications. Methods: A decision analytic cost-effectiveness model was used. Health service costs and benefits (measured as Quality Adjusted Life Years, QALYs) were estimated. Rates of IE before and after the NICE guidance were available to estimate prophylactic efficacy. AP adverse event rates were derived from recent UK data and resource implications were based on English Hospital Episode Statistics. Results: AP was less costly and more effective than no AP for all patients at risk of IE. The results are sensitive to AP efficacy, but efficacy would have to be substantially lower for AP not to be costeffective. AP was even more cost-effective in patients at high-risk of IE. Only a marginal reduction in annual IE rates (1.44 cases in high-risk and 33 cases in all at-risk patients) would be required for AP to be considered cost-effective at £20,000 ($26,600) per QALY. Annual cost savings of £5.5-8.2m ($7.3-10.9m) and health gains >2,600 QALYs could be achieved from reinstating AP in England. Conclusions: AP is cost-effective for preventing IE, particularly in those at high-risk. These findings support the cost-effectiveness of guidelines recommending AP use in high-risk individuals

Familial cortical dysplasia type IIA caused by a germline mutation in DEPDC5

Whole-exome sequencing of two brothers with drug-resistant, early-onset, focal epilepsy secondary to extensive type IIA focal cortical dysplasia identified a paternally inherited, nonsense variant of DEPDC5 (c.C1663T, p.Arg555*). This variant has previously been reported to cause familial focal epilepsy with variable foci in patients with normal brain imaging. Immunostaining of resected brain tissue from both brothers demonstrated mammalian target of rapamycin (mTOR) activation. This report shows the histopathological features of cortical dysplasia associated with a DEPDC5 mutation, confirms mTOR dysregulation in the malformed tissue and expands the spectrum of neurological manifestations of DEPDC5 mutations to include severe phenotypes with large areas of cortical malformation.Thomas Scerri, Jessica R. Riseley, Greta Gillies, Kate Pope, Rosemary Burgess, Simone A. Mandelstam ... et al

A faithful compass: rethinking the term restorative justice to find clarity

In the field of restorative justice (rj) there is regular debate regarding the terms restorative and justice. In spite of efforts to come to a common vision, this ongoing discussion illustrates how theoretical and practical disagreements have resulted in rj being characterized as ambiguous and inconsistent within the judicial context and beyond (Gavrielides, 2008; Sullivan & Tifft, 2005; Johnstone & Van Ness, 2007). Arising out of research conducted in an education context (Vaandering, 2009), this paper identifies the impact of this ambiguity on educators. More importantly, however, it examines the term justice and discovers that an overemphasis on justice as fairness and individual rights has pulled the field off-course. The paper identifies that what is needed is a broader understanding of justice than that given in the judicial context and makes the case for justice as honouring the inherent worth of all and enacted through relationship. If understood as such, I argue that the terms restorative and justice must remain paired and in place in order to serve as a muchneeded compass needle that guides proponents of rj in the field to their desired destinations