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he end of the study period, with a 12·03% reduction in resistance rate compared with the counterfactual situation, the overall trend remained on an upward trajectory. On examination of the long-term effect following implementation of the Quality Premium, there was an increase in the number of isolates resistant to at least one of the five broad-spectrum antibiotics tested (IRR 1·002 [1·000-1·003]; p=0·047).

Although interventions targeting antibiotic use can result in changes in resistance over a short period, they might be insufficient alone to curtail antimicrobial resistance.

National Institute for Health Research, Economic and Social Research Council, Rosetrees Trust, and The Stoneygate Trust.

National Institute for Health Research, Economic and Social Research Council, Rosetrees Trust, and The Stoneygate Trust.

Latent tuberculosis infection (LTBI) is one of the most prevalent infections globally and can lead to the development of active tuberculosis disease. In many low-burden countries, LTBI is concentrated within migrant populations often because of a higher disease burden in the migrant's country of origin. National programmes consequently focus on screening and treating LTBI in migrants to prevent future tuberculosis cases; however, how effective these programmes are is unclear. We aimed to assess LTBI treatment initiation and outcomes among migrants, and the factors that influence both.

For this systematic review and meta-analysis, we searched Embase, MEDLINE, and Global Health, and manually searched grey literature from Jan 1, 2000, to April 21, 2020. We included primary research articles reporting on LTBI treatment initiation or completion, or both, in migrants and excluded articles in which data were not stratified by migrant status, or in which the data were related to outcomes before 2000. There were no be met, with greater focus needed on engaging migrants more effectively in the clinic and understanding the diverse and unique barriers and facilitators to migrants initiating and completing treatment.

European Society of Clinical Microbiology and Infectious Diseases, the Rosetrees Trust, the National Institute for Health Research, and the Academy of Medical Sciences.

European Society of Clinical Microbiology and Infectious Diseases, the Rosetrees Trust, the National Institute for Health Research, and the Academy of Medical Sciences.

Current guidelines recommend a risk-adjusted treatment strategy for the management of acute pulmonary embolism. This is a particular patient category for whom optimal treatment (anticoagulant treatment, reperfusion strategies, and duration of hospitalisation) is currently unknown. We investigated whether treatment of acute intermediate-risk pulmonary embolism with parenteral anticoagulation for a short period of 72 h, followed by a switch to a direct oral anticoagulant (dabigatran), is effective and safe.

We did a multinational, multicentre, single-arm, phase 4 trial at 42 hospitals in Austria, Belgium, France, Germany, Italy, Netherlands, Romania, Slovenia, and Spain. Adult patients (aged ≥18 years) with symptomatic intermediate-risk pulmonary embolism, with or without deep-vein thrombosis, were enrolled. Patients received parenteral low-molecular-weight or unfractionated heparin for 72 h after diagnosis of pulmonary embolism before switching to oral dabigatran 150 mg twice per day following a standard cl events occurring in those with intermediate-high-risk pulmonary embolism (seven [3%; upper bound of right-sided 95% CI 5] of 283). MEK inhibitor At 6 months, 11 (3% [95% CI 1-5]) of 402 patients had at least one major bleeding event and 16 (4% [2-6]) had at least one clinically relevant non-major bleeding event; the only fatal haemorrhage occurred in one (<1%) patient before the switch to dabigatran.

A strategy of early switch from heparin to dabigatran following standard clinical assessment was effective and safe in patients with intermediate-risk pulmonary embolism. Our results can help to refine guideline recommendations for the initial treatment of acute intermediate-risk pulmonary embolism, optimising the use of resources and avoiding extended hospitalisation.

German Federal Ministry of Education and Research, University Medical Center Mainz, and Boehringer Ingelheim.

German Federal Ministry of Education and Research, University Medical Center Mainz, and Boehringer Ingelheim.

Quality of care is consistently shown to be inadequate in health-care settings in many low-income and middle-income countries, including in private facilities, which are rapidly growing in number but often do not have effective quality stewardship mechanisms. The SafeCare programme aims to address this gap in quality of care, using a standards-based approach adapted to low-resource settings, involving assessments, mentoring, training, and access to loans, to improve clinical quality and facility business performance. We assessed the effect of the SafeCare programme on quality of patient care in faith-based and private for-profit facilities in Tanzania.

In this cluster-randomised controlled trial, health facilities were eligible if they were dispensaries, health centres, or hospitals in the faith-based or private for-profit sectors in Tanzania. We randomly assigned facilities (11) using computer-generated stratified randomisation to receive the full SafeCare package (intervention) or an assessment only (col quality and care processes, scarcity of resources for quality improvement, and inadequate financial and regulatory incentives for improvement.

UK Health Systems Research Initiative (Medical Research Council, Economic and Social Research Council, UK Department for International Development, Global Challenges Research Fund, and Wellcome Trust).

UK Health Systems Research Initiative (Medical Research Council, Economic and Social Research Council, UK Department for International Development, Global Challenges Research Fund, and Wellcome Trust).

Elimination of dental sources of infection prior to cardiovascular surgery (CVS) is performed to reduce perioperative infection and complications. This study aims to evaluate if preoperative dental intervention is associated with increased risk of adverse events.

A retrospective medical record review of inpatient consultations (n=1513) completed by the Hospital Dentistry Service at University of California Los Angeles Medical Center from January 2011 to December 2020 was performed. Seven hundred thirty-eight consults met the inclusion criteria and were divided into 4 groups Group A were patients that were dentally unhealthy and received surgical dental intervention (n=265), Group B were patients that were dentally unhealthy and underwent non-surgical dental treatment (n=14), Group C were patients that were dentally unhealthy and did not receive the recommended dental treatment (n=29), and Group D were patients that were dentally healthy requiring no intervention (n= 430). They were evaluated for major adverse events in 3 categories dental complications, medical adverse events and death.

Dental complications were only experienced in Group A, all of which were bleeding. Only 2 patients were found to have major bleeding, which was more likely due to anticoagulation and CVS rather than dental extractions. There was no significant difference in the number of medical adverse events or number of deaths during the postoperative period between groups.

The results of this study suggest that elimination of oral infection prior to CVS does not increase the risk of morbidity or mortality.

The results of this study suggest that elimination of oral infection prior to CVS does not increase the risk of morbidity or mortality.

The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction.

A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride+1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride+1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7.

The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus.

Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.

Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.

Computer-aided detection (CADe) techniques based on artificial intelligence algorithms can assist endoscopists in detecting colorectal neoplasia. CADe has been associated with an increased adenoma detection rate, a key quality indicator, but the utility of CADe compared with existing advanced imaging techniques and distal attachment devices is unclear.

For this systematic review and network meta-analysis, we did a comprehensive search of PubMed/Medline, Embase, and Scopus databases from inception to Nov 30, 2020, for randomised controlled trials investigating the effectiveness of the following endoscopic techniques in detecting colorectal neoplasia CADe, high definition (HD) white-light endoscopy, chromoendoscopy, or add-on devices (ie, systems that increase mucosal visualisation, such as full spectrum endoscopy [FUSE] or G-EYE balloon endoscopy). We collected data on adenoma detection rates, sessile serrated lesion detection rates, the proportion of large adenomas detected per colonoscopy, and withdrawallesion detection rate was shown (OR 1·37 [95% CI 0·65-2·88]). No significant difference in withdrawal time was reported for CADe compared with the other techniques.

Based on the published literature, detection rates of colorectal neoplasia are higher with CADe than with other techniques such as chromoendoscopy or tools that increase mucosal visualisation, supporting wider incorporation of CADe strategies into community endoscopy services.

None.

None.

Although most patients with epithelial ovarian cancer respond to frontline platinum-based chemotherapy, around 70% will relapse within 3 years. The phase 3 JAVELIN Ovarian 100 trial compared avelumab (anti-PD-L1 monoclonal antibody) in combination with chemotherapy followed by avelumab maintenance, or chemotherapy followed by avelumab maintenance, versus chemotherapy alone in patients with treatment-naive epithelial ovarian cancer.

JAVELIN Ovarian 100 was a global, open-label, three-arm, parallel, randomised, phase 3 trial run at 159 hospitals and cancer treatment centres in 25 countries. Eligible women were aged 18 years and older with stage III-IV epithelial ovarian, fallopian tube, or peritoneal cancer (following debulking surgery, or candidates for neoadjuvant chemotherapy), and had an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients were randomly assigned (111) via interactive response technology to receive chemotherapy (six cycles; carboplatin dosed at an area under the serum-concentration-time curve of 5 or 6 intravenously every 3 weeks plus paclitaxel 175 mg/m

every 3 weeks or 80 mg/m

once a week [investigators' choice]) followed by avelumab maintenance (10 mg/kg intravenously every 2 weeks; avelumab maintenance group); chemotherapy plus avelumab (10 mg/kg intravenously every 3 weeks) followed by avelumab maintenance (avelumab combination group); or chemotherapy followed by observation (control group).