Impact of gastrointestinal polymerase chain reaction panels on antibiotic utilization in hospitalized adult patients.

Multiplex stool polymerase chain reaction (PCR) panels offer rapid comprehensive testing for patients with infectious diarrhea. We compared antibiotic utilization among hospitalized patients with suspected infectious diarrhea who underwent diagnostic testing with either a stool culture or stool PCR panel. No significant differences in antibiotic utilization were identified.

Failing better: The stochastic art of evaluating community-led environmental action programs.

This article provides insights into the evaluation of a government-funded action for climate change program. The UK-based program aimed to reduce CO2 emissions and encourage behavioral change through community-led environmental projects. It, thus, employed six community development facilitators, with expertise in environmental issues. These facilitators supported and learnt from 18 community groups over an 18-month period. The paper explores the narratives of the six professional facilitators. These facilitators discuss their experiences of supporting community groups. They also explain their contribution to the wider evaluation of the community-led projects. This paper reflects on the facilitator experience of the program's outcome-led evaluation process. In turn, it also explores how the groups they supported experienced the process. The facilitator's narratives reveal that often community-group objectives did not align with predefined outcomes established through theory of change or logic model methodologies, which had been devised in attempt to align to program funder aims. Assisting community action emerges in this inquiry as a stochastic art that requires funder and facilitator willingness to experiment and openness to the possibilities of learning from failure. Drawing on in-depth accounts, the article illustrates that a reflexive, interpretive evaluation approach can enhance learning opportunities and provides funders with more trustworthy representations of community-led initiatives. Yet, it also addresses why such an approach remains marginal within policy circles.

Multidisciplinary management of metastatic renal cell carcinoma in the era of targeted therapies.

The use of targeted agents to treat metastatic renal cell carcinoma (mRCC) has significantly extended progression-free and overall survival but raises issues relating to the long-term delivery of care and the sustained monitoring of efficacy and toxicities, certain of which have not previously been experienced. In this paper, an expert group of medical oncologists, urologists and oncology nurses and pharmacists review and make informal recommendations on the multidisciplinary management of mRCC in the light of progress made and problems that have arisen. Decentralisation of care, with a shift in emphasis from large to small hospitals and possibly to the community, may offer advantages of cost and convenience. However, the major responsibility for care should continue to lie with clinicians (either medical oncologists or urologists) with extensive experience in mRCC, assisted by specialist nurses, and working in centres with facilities adequate to monitor efficacy and manage toxicities. That said, the extended survival of patients emphasises the importance of compliance and the long-term prevention, detection and management of side effects. Much of this will take place in the community. There is therefore a need for multidisciplinary working to extend beyond specialist centres to include general practitioners, community nurses and pharmacists. Although this paper focuses on mRCC, many of the considerations discussed are also relevant to the management of more common solid tumours in the era of targeted therapy.