Search

Executive summaryThe coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of stewardship of viral diagnostic tests to aid infection prevention efforts in healthcare facilities. We highlight diagnostic stewardship lessons learned during the COVID-19 pandemic and discuss how diagnostic stewardship principles can inform management and mitigation of future emerging pathogens in acute-care settings. Diagnostic stewardship during the COVID-19 pandemic evolved as information regarding transmission (eg, routes, timing, and efficiency of transmission) became available. Diagnostic testing approaches varied depending on the availability of tests and when supplies and resources became available. Diagnostic stewardship lessons learned from the COVID-19 pandemic include the importance of prioritizing robust infection prevention mitigation controls above universal admission testing and considering preprocedure testing, contact tracing, and surveillance in the healthcare facility in certain scenarios. In the future, optimal diagnostic stewardship approaches should be tailored to specific pathogen virulence, transmissibility, and transmission routes, as well as disease severity, availability of effective treatments and vaccines, and timing of infectiousness relative to symptoms. This document is part of a series of papers developed by the Society of Healthcare Epidemiology of America on diagnostic stewardship in infection prevention and antibiotic stewardship.1

Abstract:Disney’s Beauty and the Beast, both Trousdale and Wise’s animated (1991) and Condon’s live-action (2017) productions, are often criticized for their perpetuation of traditional gender roles. While the ballroom scene(s) in both films are often a focal point of this criticism, a close reading of the choreography holds a subtext not often seen by the common viewer—one that illustrates a complex partnership with shifting roles rather than a static understanding of domineering male leads and dainty female follows. This article contextualizes the significance of dance in these adaptations as an expansion of the themes within the “Beauty and the Beast” hypotext and the performative aspects of gender within DanceSport subculture. Particularly prominent in Condon’s live-action remake, postmodern elements are incorporated into Belle and Beast’s waltz, where they disrupt traditional gender roles and take turns both leading and following in the dance. The themes of leading and following and the conformity/non-conformity of gender roles continue throughout the micro-narrative of the film’s multiple ballroom scenes, illustrating a shift from traditional gender roles to an equal partnership between both dancers on and off the dance floor.

AbstractBackground:Nudging in microbiology is an antimicrobial stewardship strategy to influence decision making through the strategic reporting of microbiology results while preserving prescriber autonomy. The purpose of this scoping review was to identify the evidence that demonstrates the effectiveness of nudging strategies in susceptibility result reporting to improve antimicrobial use.Methods:A search for studies in Ovid MEDLINE, Embase, PsycINFO, and All EBM Reviews was conducted. All simulated and vignette studies were excluded. Two independent reviewers were used throughout screening and data extraction.Results:Of a total of 1,346 citations screened, 15 relevant studies were identified. Study types included pre- and postintervention (n = 10), retrospective cohort (n = 4), and a randomized controlled trial (n = 1). Most studies were performed in acute-care settings (n = 13), and the remainder were in primary care (n = 2). Most studies used a strategy to alter the default antibiotic choices on the antibiotic report. All studies reported at least 1 outcome of antimicrobial use: utilization (n = 9), appropriateness (n = 7), de-escalation (n = 2), and cost (n = 1). Moreover, 12 studies reported an overall benefit in antimicrobial use outcomes associated with nudging, and 4 studies evaluated the association of nudging strategy with subsequent antimicrobial resistance, with 2 studies noting overall improvement.Conclusions:The number of heterogeneous studies evaluating the impact of applying nudging strategies to susceptibility result reports is small; however, most strategies do show promise in altering prescriber’s antibiotic selection. Selective and cascade reporting of targeted agents in a hospital setting represent the majority of current research. Gaps and opportunities for future research identified from our scoping review include performing prospective randomized controlled trials and evaluating other approaches aside from selective reporting.

ABSTRACTCumulative susceptibility test data (CSTD) are used to guide empirical antimicrobial therapy and to track trends in antibiotic resistance. The Clinical and Laboratory Standards Institute recommends reporting CSTD at least annually and sets the minimum number of isolates per reported organism at 30. To comply, many hospitals combine data from multiple intensive care units (ICUs); however, this may not be appropriate to guide empirical therapy because of variations in patient populations. In this study, susceptibility data for two different ICUs at a tertiary care hospital in Toronto, Canada, were used to create a traditional CSTD report, which combined data from different ICUs, and a rolling-average CSTD report, which pooled 2 years of data for each ICU separately. For simplicity, data for only the most common Gram-negative organisms (Escherichia coli, Pseudomonas aeruginosa) and the most relevant antibiotics (ciprofloxacin, piperacillin-tazobactam) were examined. With the rolling-average method, significant differences in susceptibility were seen between the ICUs in 50% of the organism-antimicrobial combinations. Furthermore, the 3% median year-over-year difference in susceptibilities seen for the 16 organism-antibiotic combinations by using the traditional method was lower than the 14% median difference seen for the 20 between-ICU within-year comparisons obtained using the rolling-average method. Changes in our selection of empirical antibiotics resulted from this revised approach, and our results suggest that pooling data from ICUs with different patient populations may not be appropriate. A rolling-average method may be an appropriate strategy for the creation of individual-unit CSTD reports.

With the joining of two families in Misfit in Love, Ali explores intracommunity prejudice and racism, weaving these taboo topics in with the book's romantic threads. Back in April 2020, when the book was in its second draft, Ali had a discussion with Levin about whether they should reference the pandemic given the wedding features a crowd of characters. "Ali writes from her own experience a lot and wants to include a diverse cast of characters that reflect her own family and social circle", Kendra Levin, Ali's editor at Salaam Reads, says. [Extracted from the article]