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Combating Antibiotic Resistance

Combating Antibiotic Resistance

Several factors contri­bute to the urgency of the antibiotic resistance crisis in the United States. “Discovering the next generation of antibiotics is exceedingly challenging,” says Brad Spellberg, MD. Pharmaceutical companies are hesitant to develop antibiotics because they tend to be a poor financial investment. The London School of Economics recently estimated that a new antibiotic would have an average net value of -$50 million at discovery. Further complicating the issue is the overtly hostile regulatory environment, particularly for antibiotics. Fighting Back According to Dr. Spellberg, who co-authored a paper on how to combat antibiotic resistance that was published in Medscape Infectious Diseases, the U.S. needs a national prospective surveillance system to track where antibiotic resistance to specific pathogens is occurring geographically and the frequency of these cases. “The lack of this data is a significant detriment to policy efforts aimed at fighting resistance,” Dr. Spellberg adds. “We also need a publicly available, national data collection system to monitor variation in antibiotic use across healthcare systems and geography.” Antibiotic stewardship has been recommended to combat antibiotic resistance, but Dr. Spellberg says the cornerstone of this strategy lies in stressing the importance to physicians and patients to not overuse these drugs. “Simply telling people to not overuse antibiotics is ineffective,” he says. “We need technologies that support stewardship and economic policies that promote appropriate use of these drugs.” Practical Solutions Rapid diagnostic testing has emerged as a technology to inform providers about what antibiotic to use, if any, for patients. “It’s difficult to determine which patients have bacterial or viral infections,” says Dr. Spellberg. “Rapid diagnostics have the potential to eliminate...
Smoking Cessation in People With HIV/AIDS

Smoking Cessation in People With HIV/AIDS

Published research shows that cigarette smoking rates among people living with HIV/AIDS are substantially higher than those of the general public. “The prevalence of smoking adults in the United States is about 18%, but that figure increases to approximately 50% for people with HIV/AIDS,” says Damon J. Vidrine, DrPH, MS. “Furthermore, people with HIV/AIDS are at higher risk from the adverse health consequences of smoking, including heart disease, cancer, pulmonary disease, and overall mortality.” A recent study found that more than 60% of deaths among people living with HIV/AIDS can be attributed to smoking. “Smoking can also interfere with the efficacy of medications used to keep HIV/AIDS under control,” adds Ellen R. Gritz, PhD. Despite compelling evidence suggesting that people with HIV/AIDS could benefit considerably from smoking cessation treatment, large-scale trials conducted exclusively in these patients are scarce. “Few studies have looked at interventions that have been effective for long-term smoking abstinence in these patients,” says Dr. Gritz. “We need more studies that focus on the unique needs of people with HIV/AIDS in the context of this patient group being economically disadvantaged.” A Unique Smoking Cessation Intervention Dr. Gritz, Dr. Vidrine, and colleagues had a study published in Clinical Infectious Diseases that compared a usual care (UC) approach with an innovative cell phone counseling-based smoking cessation intervention in low-income, multiethnic people with HIV/AIDS who smoked. “We wanted to develop and implement a smoking cessation intervention that addressed the complex medical and social needs encountered by these patients,” says Dr. Vidrine. “This is one of the largest studies to look at a smoking cessation intervention that exclusively targets people living...

The Ongoing Decline of Resident Education

A paper from Johns Hopkins looked at traditional, every fourth night calls compared to reduced-hours interns working staggered shifts of an every fifth night call or “night float.” “Night float” means working a shift that begins in the evening and ends in the morning, typically 8:00 PM to 8:00 AM. The study found that although interns working on the “night float” or every fifth night shifts got significantly more sleep than the control group of interns working longer shifts every fourth night, “both the every fifth night and night float models increased hand-offs, decreased availability for teaching conferences, and reduced intern presence during daytime work hours. Residents and nurses in both experimental models perceived reduced quality of care, so much so with night float that it was terminated early.” [Emphasis added] A JAMA Surgery paper received far less attention but had a similar theme. It surveyed 213 surgical interns from 11 university hospitals in July 2011 and May 2012 (the first academic year that the new 16-hour limit was in force). Although 82% of the interns reported a neutral or good quality of life, more than one-quarter had symptoms of emotional exhaustion and depersonalization, and 32% said their work-life balance was poor. Two-thirds said they thought about their satisfaction with being a surgeon daily or weekly, and 14% said they considered dropping out of surgery training at least weekly. More than half of the residents said that the work-hour changes had decreased their time spent in the operating room. At the end of their intern year, 44% said they did not believe that the work-hour limits led to reduced...
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