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Background Flashcards applications are getting more and more popular among medical students. They rely on principles that have been largely proven in different studies. However, there is very limited data on their benefits in real life conditions. While infectiology is a difficult topic for medical interns, the proper use of antibiotics represents a major public health issue. Objective Evaluating the benefits of Flashcards (FC) for learning infectiology. Methods This was a prospective study conducted among residents from intensive care – anesthesiology and emergency specialties in the north-west quarter of FranceAll residents included received infectiology courses in the form of a slide show by email. They were then randomized in a 1:1 fashion into two closed online user groups unblinded. The first group received online slide shows only. The second group was invited to join a FC application for mobile phones (Brainscape®). The progression of each group was measured through an online test at 3 and 6 months. Results One hundred eighty-eight students were included in this study, 95 in the FC group and 93 in the control group. Within the FC group: 67% ( n  = 64 students) logged on to the application, mean of FC used: 50, median of FC used: 40. There was a significant attrition bias: of the 188 residents included, only 45% ( n  = 85) responded to the final test. There was no significant difference between the two groups in test results at 6 months (14.50 ± 4.18 / 28 [ n  = 44] vs 13.05 ± 5.12 / 28, [ n  = 41]; p  = 0.19, in the FC and control groups respectively; IC 95  = [-3.46; 0.56]). Conclusion Flashcards enhance elements essential to learning such as regularity and personal involvement. The lack of significance of this study may be attributable to a lack of use of the tool by the students as it was purely voluntary and there was no validating final exam, which did not allow its beneficial effects on learning to be maximized.

These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.

The effects of two interventions, Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS), were tested on 23 facility performance indicators for emergency triage assessment and treatment (ETAT), malaria, pneumonia, tuberculosis, and HIV. The trial was implemented in 36 primary care facilities in Uganda. From April 2010, two mid-level practitioners per facility participated in IMID training. Eighteen of 36 facilities were randomly assigned to Arm A, and received OSS in 2010 (nine monthly two-day sessions); 18 facilities assigned to Arm B did not receive OSS in 2010. Data were collected from Nov 2009 to Dec 2010 using a revised Ministry of Health outpatient medical form and nine registers. We analyzed the effect of IMID training alone by measuring changes before and during IMID training in Arm B, the combined effect of IMID training and OSS by measuring changes in Arm A, and the incremental effect of OSS by comparing changes across Arms A and B. IMID training was associated with statistically significant improvement in three indicators: outpatients triaged (adjusted relative risks (aRR) = 1.29, 99%CI = 1.01,1.64), emergency and priority patients admitted, detained, or referred (aRR = 1.59, 99%CI = 1.04,2.44), and pneumonia suspects assessed (aRR = 2.31, 99%CI = 1.50,3.55). IMID training and OSS combined was associated with improvements in six indicators: three ETAT indicators (outpatients triaged (aRR = 2.03, 99%CI = 1.13,3.64), emergency and priority patients admitted, detained or referred (aRR = 3.03, 99%CI = 1.40,6.56), and emergency patients receiving at least one appropriate treatment (aRR = 1.77, 99%CI = 1.10,2.84)); two malaria indicators (malaria cases receiving appropriate antimalarial (aRR = 1.50, 99%CI = 1.04,2.17), and patients with negative malaria test results prescribed antimalarial (aRR = 0.67, 99%CI = 0.46,0.97)); and enrollment in HIV care (aRR = 1.58, 99%CI = 1.32,1.89). OSS was associated with incremental improvement in emergency patients receiving at least one appropriate treatment (adjusted ratio of RR = 1.84,99%CI = 1.09,3.12). The trial showed that the OSS intervention significantly improved performance in one of 23 facility indicators.

These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.

The short-term safety and efficacy of IFN-β in patients with multiple sclerosis are well established, but less is known about this drug when taken over years and decades. Sormani and Bruzzi discuss the difficulties associated with designing studies of the long-term treatment effects of IFN-β. They then present techniques that have been employed to minimize potential sources of bias. The authors conclude that long-term use of IFN-β reduces clinical progression, but important questions relating to mortality warrant further investigation. The gold standard for measuring treatment effects is the randomized controlled trial. In patients with multiple sclerosis (MS), trial durations are typically 2–3 years, and the long-term effects of drugs for MS can only be assessed through trial extensions or observational studies that take advantage of data from registries or large single-centre databases. The main limitation of observational studies is an unavoidable selection bias that is introduced through nonrandom assignment of the intervention. Propensity score methods can mitigate this bias by balancing the groups with respect to baseline covariates, but this approach cannot correct for unmeasurable confounding factors. Extensions of clinical trials are free from selection biases because of the initial randomization, but they can only provide an assessment of early versus delayed treatment effects. Here, we discuss these methodological issues and analyse how they have been managed in studies of the long-term effects of IFN-β in patients with MS.

Background. US Public Health Service guidelines recommend early initiation of antiretroviral treatment (ART) for human immunodeficiency virus infection (HIV)–infected patients and preexposure prophylaxis (PrEP) as a prevention option for persons at risk for HIV acquisition. Before issuance of these guidelines, few clinicians reported prescribing early ART or PrEP. Methods. The Emerging Infections Network, a national network of infectious diseases physicians in the United States and Canada, was surveyed in September 2014 to assess practices of adult HIV-care providers with early ART, PrEP, and other guideline-recommended HIV prevention methods. Results. Almost half of the 1191 active members invited (48.1%) participated; 415 (72.4%) were HIV-care providers. Most providers (86.5%) indicated that they typically recommended ART initiation at diagnosis, irrespective of CD4+ cell count. However, for patients with a CD4+ cell count >500/μL, clinicians would defer ART if patients did not feel ready to initiate ART (94.7%) or had uncontrolled substance abuse (66.0%). Many providers had counseled HIV-infected patients about PrEP for partners (59.0%) or offered visits for partners to discuss PrEP (40.7%), and 31.8% had prescribed PrEP. Clinicians who deferred ART were less likely to endorse and engage in aspects of PrEP provision. Conclusions. Concordant with guidelines, most infectious diseases physicians recommend early ART, and many have experience with aspects of PrEP provision, suggesting recent evolution of clinician practices. Providers who defer ART are also cautious about PrEP. Interventions that help physicians motivate patients to initiate ART and identify missed opportunities to provide PrEP could enhance HIV prevention.

The two closely linked specialties of clinical microbiology and infectious diseases face important challenges. We report the consensus of clinical microbiologists and infectious disease physicians assembled by the European Society for Clinical Microbiology and Infectious Diseases. Both specialties have different training requirements in different European countries and are not universally recognised as professions. The specialties are rapidly evolving as they adapt to the changing demands within hospital practice, including the need to deal with emerging infections, rapidly increasing internationalisation, and immigration. Clinical microbiology needs to develop and master technological advances such as laboratory automation and an avalanche of new methods for rapid diagnostics. Simultaneously, the pressure for concentration, amalgamation, and out-sourcing of laboratory services is ever-increasing. Infectious disease physicians have to meet the professional challenge of subspecialisation and the continual need to find new niches for their skills. Despite these challenges, each of these specialties continues to thrive in Europe and will enjoy important opportunities over the next few years. The recently formed European Centre for Disease Prevention and Control in Stockholm, Sweden, will increase demands in areas of surveillance of infectious diseases and antimicrobial resistance on both specialties.

The San Antonio Uniformed Services Health Education Consortium Infectious Disease Fellowship program historically included a monthly short-answer and multiple-choice quiz. The intent was to ensure medical knowledge in relevant content areas that may not be addressed through clinical rotations, such as operationally relevant infectious disease. After completion, it was discussed in a small group with faculty. Over time, faculty noted increasing dissatisfaction with the activity. Spaced interval education is useful in retention of medical knowledge and skills by medical students and residents. Its use in infectious disease fellow education has not been described. To improve the quiz experience, we assessed the introduction of spaced education curriculum in our program. A pre-intervention survey was distributed to assess the monthly quiz with Likert scale and open-ended questions. A multiple-choice question spaced education curriculum was created using the Qstream(R) platform in 2011. Faculty development on question writing was conducted. Two questions were delivered every 2 d. Incorrectly and correctly answered questions were repeated after 7 and 13 d, respectively. Questions needed to be answered correctly twice to be retired. Fellow satisfaction was assessed at semi-annual fellowship reviews over 5 yr and by a one-time repeat survey. Pre-intervention survey of six fellows indicated dissatisfaction with the time commitment of the monthly quiz (median Likert score of 2, mean 6.5 h to complete), neutral in perceived utility, but satisfaction with knowledge retention (Likert score 4). Eighteen fellows over 5 yr participated in the spaced education curriculum. Three quizzes with 20, 39, and 48 questions were designed. Seventeen percentage of questions addressed operationally relevant topics. Fifty-nine percentage of questions were answered correctly on first attempt, improving to 93% correct answer rate at the end of the analysis. Questions were attempted 2,999 times. Fellows consistently indicated that the platform was \"highly enjoyed,\" \"beneficial,\" a \"fun format,\" and \"completely satisfied.\" Fellows additionally commented that they desired more questions and considered the platform helpful in board preparation. Formal survey data post-intervention found that the fellows were satisfied with the new approach, found it to be useful in board preparation, overall educational value, and in-line with their personal learning style (median Likert score of 4 for all queries). Fellows were satisfied with time commitment, spending a mean of 47 min on the spaced education curriculum questions per month. Introduction of a spaced education curriculum resulted in a sustained positive learner experience for >5 yr with demonstrated mastery of material. Spaced education learning is a viable addition to augment training experience, especially in areas of curricular gaps such as operational medicine. Correct answer data may also be useful to perform Accreditation Council for Graduate Medical Education-required objective assessment of knowledge.

Point-of-care access to current medical information is easily available to the practitioner through the use of smartphones, iPads, and other personal digital assistants. There are numerous mobile applications (apps) that provide easy-to-use and often well-referenced medical guidance for the infectious diseases practitioner. We reviewed 6 commonly utilized mobile apps available for handheld devices: the Emergency Medicine Residents' Association's (EMRA's) Antibiotic Guide, Epocrates Deluxe, Johns Hopkins Antibiotic Guide, Sanford Guide, the Medscape mobile app, and the Infectious Diseases Compendium. We evaluated several basic infectious diseases topics (including but not limited to endocarditis, vancomycin, and Acinetobacter infection) and attempted to objectively score them for metrics that would help the provider determine which mobile app would be most useful for his or her practice. The Johns Hopkins Antibiotic Guide and the Sanford Guide had the highest cumulative scores, whereas EMRA scored the lowest. We found that no single app will meet all of the needs of an infectious diseases physician. Each app delivers content in a unique way and would meet divergent needs for all practitioners, from the experienced clinician to the trainee. The ability to rapidly access trusted medical knowledge at the point of care can help all healthcare providers better treat their patients' infections.

OBJECTIVE To evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs) regarding carbapenem-resistant Acinetobacter baumannii (CRAB) ventilator-associated pneumonia (VAP) METHODS From June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice of each IDP. The expected and clinical success rates were divided into low (80%) categories and were then compared with standard clinical response rates archived in the existing literature. RESULTS Of 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a hospital that implemented the standard intervention combined with an intensified infection control (IC) intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17-7.73; P=.02) was associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI, 2.16-15.37; P60%). We identified a significant correlation between expected and clinical success rates (r=0.58; P<.001). CONCLUSIONS Awareness of IC among IDPs can improve physicians' expected and clinical success rates for CRAB VAP treatment, and treatment experience impacts overall treatment success. Infect. Control Hosp. Epidemiol. 2015;37(1):61-69.