Search

Antimicrobial stewardship programs (ASPs) are recommended by the Centers for Disease Control and Prevention and World Health Organization and mandated by the Joint Commission to curb antimicrobial resistance. However, <50% of institutions have optimal ASPs in place. Building on its experience of antimicrobial stewardship (AMS) advocacy, the Infectious Diseases Society of America (IDSA) developed the AMS Centers of Excellence (CoE) program, which will serve as a conduit to share best practices and highlight the standards for other hospitals to achieve in order to advance the field of AMS. A designation of CoE signifies that these institutions deliver high-quality care consistently, serve as the "gold" standard for executing novel AMS principles, and demonstrate commitment to their ASP. Here, we describe the process and purpose of designating institutions as AMS CoEs, provide awareness to clinicians on opportunities available through IDSA with this CoE designation, and discuss the evolution of the program., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Introduction: Graphical analysis of networking maps can be used to measure the health, connectivity, and vulnerabilities of a professional community. We aimed to capture and map the connections and relationships between individuals and organizations in the healthcare simulation community of the state of Western Australia. It was also intended that this analysis would encourage new opportunities for collaboration to advance simulation-based education., Methods: In association with a baseline list of established simulation practitioners, an online survey instrument and propriety mapping software were used to establish links and interactions between individuals, colleagues, their own, and external organizations., Results: There were 79 respondents to the survey, with 500 pairs of relationships generated for 203 nominated personnel. Two thirds of respondents were from medical, nursing, and allied health fields. The average number of collaborators for each respondent was 6.6. Collaborative patterns were presented in matrices and social network maps. These data identified leaders, important networks, and weaknesses in this community of practice., Conclusions: The study confirmed that there were a handful of simulation educators with many linkages both within and external to their own organizations. In addition, isolated groups with poor cross-organizational associations were identified. This information can be used by healthcare and educational organizations, and funding agencies, to better understand associations and collaborations across the wider simulation community and to consider appropriate improvements to strengthen the simulation network.

Antimicrobial stewardship programs (ASPs) are a key national initiative to promote appropriate use of antibiotics and to reduce the burden of resistance. The dilemma of managing the outlier physician is especially complex. We outline strategies to establish a successful ASP that reviews appropriate efforts to achieve the goal of modifying outlier physicians' behavior. One must try to differentiate deviation from ASP norms from all other issues of outliers. Essential elements include identifying and understanding the local problems, planning, and achieving hospital administration and medical staff support. A successful ASP includes effective communication and acceptance of evidence-based recommendations, so that patient clinical outcomes will be optimized., (© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.)

Background: Coronoid process hyperplasia is an uncommon finding, characterized by an enlargement of the coronoid process, causing a mechanical obstacle by its interposing in the posterior portion of the maxilla or zygomatic arch., Case Presentation: The article presents a case report of a bilateral coronoid process hyperplasia in a 3-year-old girl demonstrated with inability to open the mouth and restricted jaw movement. Panoramic x-ray and 3-dimensional computed tomographic reconstruction showed bilateral elongation of the coronoid processes associated with deformation of the mandibular condyle with no involvement of the articular space. A coronoid resection by intraoral approach was done, followed by an aggressive physiotherapy. A considerable improvement in mouth opening of 30 mm was achieved. We strongly suggest early surgical treatment of coronoid hyperplasia to recover morphology and function consequently to reduce skeletofacial deformities in young patients., Conclusions: The article presents a clinical and surgical case of bilateral coronoidectomy in a 3-year-old girl, with retrognathic mandible. The diagnosis of bilateral coronoid process hyperplasia was confirmed, and the surgical treatment was under general anesthesia, with nasotracheal intubation guided by a nasofiber endoscope, using an intraoral approach.

Twenty-one agents are approved by the US Food and Drug Administration (FDA) for the therapy of skin and soft tissue infections. Of these, the five newest agents, tedizolid, telavancin, oritavancin, dalbavancin, and ceftaroline, are active against and "non-inferior" to vancomycin against methicillin-resistant Staphylococcus aureus (MRSA). Oritavancin is indicated as a single-dose intravenous regimen, while dalbavancin is a two-dose intravenous regimen given 1 week apart. Telavancin has multiple mechanisms of action. A 6-day regimen of once-daily intravenous or oral dose of tedizolid was compared with 10 days of linezolid and found to be "non-inferior" and have fewer side effects. Ceftaroline has not only MRSA activity but also activity against Escherichia coli and Klebsiella spp. We review the spectra of activity of these new agents, their clinical trials and their therapeutic efficacy, noting differences in their dosing schedules, in vitro activities and costs as potential determinants for appropriate utilization.

Unlabelled: The aim of this study is to determine the prognostic value of available clinical and histological parameters to predict subclinical nodal metastases and survival. For that purpose we used a modification of the Jakobsson [9] grading system proposed by Richard W. Nason [12] and applied it to a series of patients with oral carcinoma. Correlation between histological parameters and cervical lymph node metastasis were made and the chi-square test showed a strong significant association between mode of invasion, depth of tumor invasion, vascular invasion and cervical metastases. Analysis of overall survival showed that overall survival strongly correlates with cervical node metastases (p=0.0004). We found that overall survival correlates with vascular invasion (p=0.005) and also overall survival correlates with tumour depth (p=0.001). There is a strong relationship between malignancy score and survival (p=0.00001) and a high malignancy score is associated with poor prognoses., Patients: a total 32 with over 14 points of malignancy score, 25 (78.1%) died and 7 (21.9%) are alive. Analysis of the risk factors for subclinical cervical metastases in patients with oral cancer is important for predicting prognosis and achieving a high survival rate.