The actual and preferred methods of continuing medical education (CME) on diabetes were determined from a telephone survey of a stratified random sample of over 600 primary care physicians in Pennsylvania. A response rate of 73% was obtained. Journal articles were identified as the leading source of information that affected practice behavior related to diabetes. However, no single journal was read by a majority of physicians, and information provided in diabetes journals reached fewer than 10% of primary care physicians. Local educational programs and programs offered by hospitals were the preferred choices for continuing medical education. When reported patterns of care for diabetic patients were compared with published standards of care, no statistical differences were found between physicians who had and physicians who had not attended a CME course. To be most effective, CME courses should be intensive and may need to be presented locally to reach the widest possible audience.
RATIONALE: We previously demonstrated associations between antibiotic allergy and prevalence of microbes such as methicillin resistant staphylococcus aureus and vancomycin resistant enterococcus in the general population. We hypothesized that the high prevalence of antibiotic allergy in Cystic Fibrosis (CF) could affect their sputum microbiome. METHODS: An IRB approved, retrospective analysis was performed on 271 cystic fibrosis patients seen at our medical center from 2001-2012. Sputum culture results (obtained in 2012) were analyzed in 201 of these subjects. RESULTS: Chart-reported antibiotic allergy was present in 35% of CF patients compared to 11% of the general population. The most common reactions were penicillin (48.4%), cephalosporins (36.8%), vancomycin (24.2%), and fluoroquinolones (11.6%).We identified numerous organisms that were cultured at different frequencies in antibiotic-allergic vs. non-allergic CF patients. Six pathogens were present at >two fold higher rates in patients with antibiotic allergy: Alcaligenes xylosoxidans, methicillin-resistant Staphylococcus aureus, Stenotrophomonas (Xanthomonas) maltophilia, methicillin-sensitive Staphylococcus aureus, mucoid Pseudomonas aeruginosa, and non-mucoid Pseudomonas aeruginosa. There were seven bacteria that cultured at >two fold less rates in antibiotic allergic patients: Enterobacter asburiae, Pantoea (Enterobacter) agglomerans, Streptococcus pneumoniae, Klebsiella oxytoca (extended-Spectrum Beta-lactamase), Klebsiella pneumoniae, Moraxella catarrhalis, and Pseudomonas fluorescens putida group. CONCLUSIONS: Differences in sputum microbes in antibiotic allergic and non-allergic subjects may have important implications for disease course and antibiotic treatment. Future work is needed to understand the nature of the relationship between microbiome and antibiotic allergy.
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