"It happens to everyone" vs. "You're not a real man": The relationship between intimate communication and men's sexual difficulties.

Sexual difficulties can have negative intrapersonal and interpersonal consequences on both members of a couple, but little is known about how communication in a relationship relates to men's experience of sexual difficulties. We explored the associations among components of intimate communication, men's sexual difficulties, relationship satisfaction, and sexual satisfaction in a sample of men in mixed-gender and same-gender relationships (n = 341). Among all components of intimate communication, sexual communication was most consistently related to indicators of sexual difficulties, relationship satisfaction, and sexual satisfaction. Results generally remained consistent across mixed-gender and same-gender couples, with some exceptions relevant to sexual difficulties.

Impact of cascade reporting of antimicrobial susceptibility on fluoroquinolone and meropenem consumption at a Veterans' Affairs medical center.

OBJECTIVE: To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption. DESIGN: A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumption before and after the implementation of cascade reporting. SETTING: A 399-bed, tertiary-care, Veterans' Affairs medical center. PARTICIPANTS: Antimicrobial consumption data across 8 inpatient units were extracted from the Center for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) antimicrobial use (AU) module from April 2017 through March 2019, reported as antimicrobial days of therapy (DOT) per 1,000 days present (DP). INTERVENTION: Cascade reporting is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow-spectrum agents. A multidisciplinary team developed cascade reporting algorithms for gram-negative bacteria based on local antibiogram and infectious diseases practice guidelines, aimed at restricting the use of fluoroquinolones and carbapenems. The algorithms were implemented in March 2018. RESULTS: Following the implementation of cascade reporting, mean monthly meropenem (P =.005) and piperacillin/tazobactam (P = .002) consumption decreased and cefepime consumption increased (P < .001). Ciprofloxacin consumption decreased by 2.16 DOT per 1,000 DP per month (SE, 0.25; P < .001). Clostridioides difficile rates did not significantly change. CONCLUSION: Ciprofloxacin consumption significantly decreased after the implementation of cascade reporting. Mean meropenem consumption decreased after cascade reporting was implemented, but we observed no significant change in the slope of consumption. cascade reporting may be a useful strategy to optimize antimicrobial prescribing.

Time may heal wounds: Aging and life regrets.

Psychological research on regret has focused mostly on the negative emotions associated with troubling past decisions. Because aging is associated with a preference for positive information in attention and memory, investigation into positive emotions elicited by regrets may provide insights into adult developmental changes in subjective experience. The present study investigated age differences in regret-related affect in a survey of adults (n = 629) aged 18-92 years. Positive and negative affect emerged as discrete dimensions of regret-related affect with age trajectories that benefit well-being. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Current State of Antimicrobial Stewardship: Challenges, Successes, and Future Directions.

PURPOSE OF REVIEW: The aim of this study is to examine the current state of the field of antimicrobial stewardship (AS) by highlighting key challenges and successes, as well as exciting future directions. RECENT FINDINGS: AS mandates from the Centers for Medicare and Medicaid (CMS) and the Joint Commission (TJC) will stimulate increased compliance with current AS standards, but overall compliance is currently poor. Key challenges to progress in the field of AS include insufficient workforce and monetary resources, poorly defined AS metrics, and much needed expansion beyond the inpatient hospital setting. Despite these challenges, massive progress has been made in the last two and a half decades since the field of AS emerged. AS metrics are rapidly evolving and transforming the way antimicrobial stewardship programs (ASPs) measure success. Rapid diagnostics and diagnostic test stewardship are proving to be extremely effective when coupled with an ASP. Telehealth may improve access to ASP expertise in resource poor settings, and the role of bedside nurses as ASP team members has the potential to greatly augment ASP efforts. Allergy testing as an ASP strategy remains largely underutilized. ASPs have made significant gains in the battle against antimicrobial resistance (AR), but considerable advancement is still needed. Awareness of current challenges is critical to ensure progress in the field. The field of AS is expanding and transforming rapidly through integration, technology, and improved processes.

Use of Lactobacillus probiotics for bacterial genitourinary infections in women: a review.

BACKGROUND: Lactobacilli are the dominant bacteria of the vaginal flora and possess antimicrobial properties that regulate other urogenital microbiota. Incomplete cure and recurrence of genitourinary infections lead to a shift in the local flora from a predominance of lactobacilli to coliform uropathogens. Use of Lactobacillus-containing probiotics to restore commensal vaginal flora has been proposed for the treatment and prophylaxis of bacterial urogenital infections. OBJECTIVE: This review summarizes randomized controlled trials that have assessed the therapeutic efficacy and tolerability of lactobacilli in bacterial vaginosis (BV) and urinary tract infection (UTI). METHODS: Relevant randomized controlled trials published in English were identified through a search of MEDLINE (through November 2007), ClinicalTrials.gov, and the Cochrane Database (second quarter 2007). The search terms included probiotics, Lactobacillus, lactobacilli, urinary, urogenic, bacterial vaginosis, vaginal, colonization, bacteremia, sepsis, pathogenic, taxonomy, diagnosis, and infections. RESULTS: Eleven randomized controlled trials were identified that investigated the effects of lactobacilli in the treatment and prophylaxis of bacterial urogenital infections. In the 2 studies that reported a beneficial effect for probiotics in the treatment of BV, cure rates for lactobacilli at 30 days were 60% (P=0.004) and 88% (P<0.005), more than double the effect of controls. One trial reported a 35% reduction in recurrent episodes of BV compared with placebo (P=0.004). Among the 4 trials involving treatment of UTI, 1 reported a 73% reduction in episodes of recurrent UTI compared with the previous year (P=0.001). Seven studies found no therapeutic effect of lactobacilli in the treatment or prophylaxis of BV or UTI. Only 2 of the identified trials attempted to validate the probiotic dosing strategy by obtaining quantitative evidence of local colonization with lactobacilli and had sufficient power to detect treatment effects, and only 1 trial addressed the stability of the probiotic product at the end of the study. CONCLUSIONS: Despite enhanced cure rates in some studies, concerns about product stability and limited documentation of strain-specific effects prevent recommendations for the use of Lactobacillus-containing probiotics in the treatment of BV. The results of studies of lactobacilli for the prophylaxis of UTI remain inconclusive as a result of small sample sizes and use of unvalidated dosing strategies.