Foundation Medical Partners

Since its original description in 1961, Corynebacterium minutissimum, the causative agent of erythrasma, has rarely been associated with extracutaneous disease. We report a case of cellulitis and bacteremia due to C. minutissimum. We discuss the treatment of C. minutissimum infection and describe the clinical settings in which isolation of Corynebacterium species from blood cultures should be considered significant.

BACKGROUND: The American Academy of Neurology (AAN) conducts periodic surveys of its members to profile and monitor changes in the characteristics of US neurologists and their practices. OBJECTIVE: To assess neurologists' characteristics, geographic distribution, practice arrangements, professional activities, practice volume, procedures performed, sources of revenue, involvement with managed care and capitation, and other selected topics. METHODS: The AAN Member Census survey was sent to US neurologists in the fall of 1996 (response rate = 89%), and the Practice Profile survey was sent to a random sample of 1,986 US neurologists in the summer of 1997 (response rate = 55%) who had completed a Member Census survey. The results of the Practice Profile survey were compared with those of two prior surveys conducted in 1991 to 1992 and 1993 to 1994. RESULTS: The mean age of US neurologists is 48 years, 18% are women, 93% are US citizens, and 24% are international medical graduates. The proportion of neurologists in solo practices, group practices, and medical schools/universities has not changed. The weekly hours worked has remained stable (58 hours), but the time spent in administrative activities has increased (p < 0.001). The average number of patient visits per week to neurologists appears to have increased (p < 0.001), as has the proportion of neurologists performing procedures (p < 0.05). The majority of neurologists have contracts with managed care organizations (82%), and a minority (32%) have capitated payment arrangements. Medicare continues to be the largest source of clinical revenue. Nearly 50% of all respondents have experience in developing clinical practice guidelines or critical pathways, and >20% of respondents employed physician extenders to assist in their practices. CONCLUSION: Neurologists are spending more time in administrative activities, are performing or interpreting more procedures, and are seeing more patients. Neurologists' involvement with capitation is comparable with that in a nationally representative sample of physicians, and they are exploring innovative ways, such as developing practice guidelines and using physician extenders, to improve the quality and efficiency of providing neurologic care.

<title>Abstract</title> <bold>Background</bold> Heroin Assisted Treatment (HAT) is an enhanced harm reduction programme designed for treatment-refractory opioid dependent individuals. The first HAT service in England was established in 2019, involving twice-daily supervised injections of medical-grade heroin (diamorphine). International research has produced promising evidence for HAT in reducing a range of intravenous drug-related harms and promoting myriad social benefits such as reduced criminal activity, increased social engagement and improved wellbeing. However, strict regulatory controls may constrain service users’ opportunities for social re-integration, inadvertently prioritising abstinence-focused treatment goals and definitions of ‘recovery’. The impact of HAT delivery from service user’s perspectives is not well documented, and this is the first qualitative research conducted within a fully operational HAT service in England. <bold>Methods</bold> We conducted semi-structured interviews with HAT service users in a North-East England drug treatment service (N=12). Data was subjected to thematic analysis, with common themes emerging inductively from the data. <bold>Results</bold> Participants overcame barriers to engagement and retention through self-motivation and commitment, supportive staff relationships and de-stigmatising treatment experiences that increased service users’ self-efficacy and sense of belonging. They reported multiple physical, emotional and social impacts, including minimised street heroin use and criminal behaviour, improved physical health, increased social engagement and emotional wellbeing. <bold>Conclusions</bold> Physical, social and psychological healing interacted throughout the course of HAT to facilitate holistic improvements in quality of life and wellbeing. However, HAT’s intensive treatment schedule was restrictive of patient’s daily activities, which could be mitigated through greater flexibility in treatment regulations. Middlesbrough HAT is an example of innovative drug treatment that offers continuing opportunities for success within a broad definition of recovery, in which abstinence sits on a spectrum alongside diverse forms of social, physical and psychological recovery from drug-related harms.

-acetylcysteine was investigated in two clinical trials and one RCT and was minimally effective in the RCT and in one clinical study. Our review did not identify available studies of local alternative otoprotective agents that could reliably replace systemic STS in terms of safety and efficacy for pediatric patients. Further research on the optimal dosage, delivery method, and timing of otoprotective agents is needed.