Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey

Bloodstream infections (BSIs) are common, however international guidelines are available only for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and candidaemia. This international ESCMID cross-sectional survey, open from December 2016 to February 2017, explored the management of BSIs by infection specialists. All infection specialists (senior or trainees) giving at least weekly advice on positive blood cultures could participate. Their practices were evaluated using six clinical vignettes presenting uncomplicated BSI cases. A total of 616 professionals from 56 countries participated [333/616 (54%) infectious diseases specialists, 188/616 (31%) clinical microbiologists], of whom 76% (468/616) were members of an antimicrobial stewardship team. Large variations in practice were noted, in particular for the Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa vignettes. Echocardiography was considered standard of care by 81% (373/459) of participants for MRSA, 78% (400/510) for methicillin-susceptible S. aureus and 60% (236/395) for Candida albicans. Antimicrobial combination therapy was recommended by 2% (8/360) of respondents for C. albicans, 11% (43/378) for E. coli, 27% (114/420) for MRSA and 39% (155/393) for E. faecalis. Intravenous-to-oral switch was considered in 68% (285/418) for MRSA, 79% (306/388) for E. faecalis, 72% (264/366) for P. aeruginosa and 75% (270/362) for C. albicans. In multivariable analysis, IDSA guideline-compliant practice was more frequent among participants belonging to an antimicrobial stewardship team (aOR?=?1.7, P?=?0.018 for the MRSA vignette; and aOR?=?2.0, P?=?0.008 for the candidaemia vignette). This survey showed large variations in practice among infection specialists. International guidelines on management of BSI are urgently needed.     

国内部分医院β-内酰胺类抗生素皮肤试验现状调查分析

摘 要 目的：采用问卷调查了解并分析我国医院β-内酰胺类抗生素皮肤试验的实际操作情况。方法：通过电子邮件或传真方式对国内100家医院的临床药师进行问卷调查。问卷内容涵盖医院的名称、级别;β-内酰胺类药物皮肤试验方法,包括皮试液的来源和浓度、操作方法、观察时间、阳性结果的判定标准;涉及过敏史时,β-内酰胺类药物的皮肤试验以及针对口服青霉素制剂是否需要皮肤试验等14个方面的相关问题。结果：共收到信息完整的反馈问卷80份（反馈比80%）。调查显示各医院β-内酰胺类药物皮肤试验流程各有不同。不同医院在抗生素皮试品种、皮试方法、涉及过敏史时药物的选择以及口服青霉素制剂是否进行皮试等方面均存在明显差异。结论：本研究反映了现阶段我国医疗机构在β-内酰胺类抗生素皮肤试验方面缺乏统一标准,亟需尽快出台相关临床指南或共识,以保证临床使用该类药物的安全性与规范性。     

Development of masticatory function in extremely low and very low birthweight infants —A follow-up study using questionnaires—

We first conducted a questionnaire study about the development of mastication of EVLBW (extremely low and very low birthweight) infants aged 2 to 4 years in 1998, and results showed that they tended to “dislike of firm foods”, to be “picky eaters” and to have “trouble swallowing foods with a mouth full of food/drink”, when compared with the normal birthweight (NBW) infants. The purpose of the present study is so designed to investigate moreover the development of masticatory function, the oral and facial shape, dental problems, and the relationship between systemic growth and these issues in EVLBW infants. We carried out a follow-up questionnaire study 5 years later in 2003 and compared current masticatory function among EVLBW infants, the low birthweight (LBW) and NBW infants. A significantly higher number of EVLBW infants were considered to be “small eaters”, but no differences were found in the items: “picky eating”, “dislike of firm foods” and “trouble swallowing foods with a mouth full of food/drink”. This differed from a study conducted 5 years earlier. The guardians of the EVLBW infants were worried about language delay significantly and still worried about the shape of the child's head and face significantly more often. No significant differences were found in the results of dental screening in school. In conclusion, the guardians of the EVLBW infants felt that masticatory problems decreased as their children grew. The EVLBW infants were suggested to catch up with normal infants in masticatory function by early school age.     

Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial

BACKGROUND: Dental anxiety is a significant cause of poor dental health. Because patients often prefer nonpharmacological interventions, the clinical effectiveness of clearly structured approaches is of particular interest. METHODS: This prospective randomized controlled study compares a brief relaxation method (BR) with music distraction (MD) and with a control group (C). The authors randomly assigned 90 patients with dental anxiety to BR, MD or C groups. They assessed the outcomes by means of the state anxiety subscale of the State-Trait Anxiety Inventory. RESULTS: Both BR and MD reduced dental anxiety significantly. In contrast, patients in the C group did not exhibit a significant change in their anxiety level. BR was significantly superior to MD. Stratification according to the patient's general level of dental anxiety revealed that BR also was particularly effective in highly anxious subjects, whereas MD did not have a clinically relevant effect on these subjects. CONCLUSIONS: BR appears to be a safe, economically sound and effective nonpharmacological approach to the short-term reduction of dental anxiety. Additional investigations are needed to validate these findings in a larger clinical trial and to determine the long-term effects of this intervention. CLINICAL IMPLICATIONS: Relaxation techniques are a pragmatic, effective and cost-saving method of facilitating dental treatment in anxious patients.     

Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid

BackgroundPatients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective.MethodsThe authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition.ResultsMedicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies.ConclusionsPolicymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness.Clinical ImplicationsDentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.     

以医学院校学生需求为导向的大学英语课程体系设置研究

目的了解医学院校学生对大学英语课程设置、教学方式的看法以及对后续英语课程的需求,为大学英语课程体系设置提供参考。方法2018年1月,以西安医学院2013至2017级2000名非英语专业本科生为调查对象,通过问卷星网络平台发布《西安医学院大学英语课程设置调查问卷》,对问卷数据进行实时统计与分析。结果回收有效问卷1815份,有效回收率90.75%。结果显示,排在前三位的英语学习目的为"通过四六级考试或其他英语考试,获取证书(1366人,75.26%)""为以后工作考虑(1093人,60.22%)""为考研做准备(1060人,58.4%)"。学生期待"阅读、写作、翻译等技能训练"以及"口语操练和跨文化知识学习"的比例较高,分别占78.51%(1425人)和65.84%(1195人)。68.76%(1248人)的学生认为有必要"开设人文英语或医学通用学术英语"课程。结论目前单一的大学英语课程设置和教学方式不能满足医学生学习需求,应以《大学英语教学指南》为指导,探讨构建突出医学院校特色、满足不同专业学生需求的多类别与多层次大学英语课程体系。     

Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the Detection of Malingered Pain-Related Disability in Chronic Pain

The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.     

职业院校教师心理素质量表的编制和信效度检验

目的 编制职业院校教师心理素质量表,并检验其信效度。方法 通过对630例职业院校教师的调研和访谈,编制了职业院校教师心理素质量表,间隔两周后对其中的87例教师重新施测,考察问卷的重测信度、同质性信度;选用大学优秀教师心理素质量表（DTPA）、中学教师心理素质量表（MTCA）作为效标问卷,对其中64例进行效标效度检验。结果 探索性因子分析形成6个因子,分别为表达与交流性、创新性、操作演示性、稳定性、聪慧性、职业认同感。量表重测信度为0.654,6个因子的Cronbach＇sα系数均大于0.7;总的分半信度系数为0.871,90.6%的条目的 CVR在0.6以上。效标效度检验除操作演示性与两个量表的相关没有达到显著性水平外,其他均具有统计学意义（P〈0.05）。结论该量表具有较好的信度效度,可以作为职业院校教师心理素质的测量工具。