Adherence to the 2007 ATS/IDSA guidelines for treating PNTM disease is poor. Across all physician specialties evaluated, suboptimal or potentially harmful antibiotic regimens were commonly prescribed.

Poor adherence to management guidelines in nontuberculous mycobacterial pulmonary diseases Nontuberculous mycobacterial pulmonary diseases (NTM-PD) are increasingly recognised as opportunistic infections of humans. Nodular/bronchiectatic disease and fibrocavitary disease are the most frequent manifestations [1]. Although guidelines have been published [1], there are few data on diagnostic and treatment practices outside of reference clinics. A recent survey in the USA suggested limited adherence to guidelines for diagnosis and treatment of NTM-PD [2]. We performed a survey on diagnostic and treatment practices for NTM-PD in five European countries (EU5) (France, Germany, Italy, Spain and the UK) and Japan, using previously published methods [2]. We randomly selected and contacted 3590 physicians (EU5: 2970; Japan: 620) from databases of each country [3, 4]; of these, 3154 (EU5: 2585; Japan: 569) participated. A total of 997 (EU5: 757; Japan: 240) physicians proved eligible for inclusion in round two, i.e. they managed at least one patient who 1) was diagnosed with NTM-PD, as defined by the participating physician; 2) was currently under the physician's care; 3) had active NTM-PD at some point during the past 12 months, regardless of whether treatment was provided; and 4) had complete information available. Of these eligible physicians, 619 (62%; EU5: 446;

Wide variation in the use of intravesical postoperative chemotherapy exists among urologists in the United States. The reason for the great diversity in the use of intravesical postoperative chemotherapy is speculative. However, physician awareness, physician bias, recurrence risk, and local pharmacy and hospital practice factors are all likely contributing factors.

Background Adult midgut malrotation is a rare cause of an acute abdomen requiring urgent intervention. It may also present in the non-acute setting with chronic, non-specific symptoms. The objective of this study is to identify the clinical features, appropriate investigations and current surgical management associated with adult malrotation. Methods A systematic review was conducted according to PRISMA guidelines, identifying confirmed cases of adult malrotation. Patient demographics, clinical features, investigation findings and operative details were analysed. Results Forty-five reports met the inclusion criteria, totalling 194 cases. Mean age was 38.9 years (n = 92), and 52.3% were male (n = 130). The commonest presenting complaints were abdominal pain (76.8%), vomiting (35.1%) and food intolerance (21.6%). At least one chronic symptom was reported in 87.6% and included intermittent abdominal pain (41.2%), vomiting (12.4%) and obstipation (11.9%). Computerised tomography scanning was the most frequent imaging modality (81.4%), with a sensitivity of 97.5%. The whirlpool sign was observed in 30.9%; abnormalities of the superior mesenteric axis were the commonest finding (58.0%). Ladd's procedure was the most common surgical intervention (74.5%). There was no significant difference in resolution rates between emergency and elective procedures (p = 0.46), but length of stay was significantly shorter for elective cases. (p = 0.009). There was no significant difference in risk of mortality, or symptom resolution, between operative and conservative management (p = 0.14 and p = 0.44, respectively). Conclusion Malrotation in the adult manifests with chronic symptoms and should be considered as a differential diagnosis in patients with abdominal pain, vomiting and food intolerance. Abbreviations CTComputerised tomography MRI Magnetic resonance imaging SMA Superior mesenteric axis