Controversial Recommendations Research Articles

Ethical considerations for large language models in ophthalmology.

This review aims to summarize and discuss the ethical considerations regarding large language model (LLM) use in the field of ophthalmology. This review of 47 articles on LLM applications in ophthalmology highlights their diverse potential uses, including education, research, clinical decision support, and surgical assistance (as an aid in operative notes). We also review ethical considerations such as the inability of LLMs to interpret data accurately, the risk of promoting controversial or harmful recommendations, and breaches of data privacy. These concerns imply the need for cautious integration of artificial intelligence in healthcare, emphasizing human oversight, transparency, and accountability to mitigate risks and uphold ethical standards. The integration of LLMs in ophthalmology offers potential advantages such as aiding in clinical decision support and facilitating medical education through their ability to process queries and analyze ophthalmic imaging and clinical cases. However, their utilization also raises ethical concerns regarding data privacy, potential misinformation, and biases inherent in the datasets used. Awareness of these concerns should be addressed in order to optimize its utility in the healthcare setting. More importantly, promoting responsible and careful use by consumers should be practiced.

Just give the contrast? Appraisal of guidelines on intravenous iodinated contrast media use in patients with kidney disease

ObjectiveTo appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them.MethodsWe searched four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool.ResultsTen guidelines were included, with a median STAR score of 46.0 (range 28.5–61.5). The guidelines performed well in “Recommendations” domain (31/40, 78%), while poor in “Registry” (0/20, 0%) and “Protocol” domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m2 and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means.ConclusionGuidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols.Critical relevance statementThe heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow.Key points• Guidelines concerning iodinated contrast media use in kidney disease patients vary.• Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols.• Investigations are encouraged to establish a safer iodinated contrast media use workflow.Graphical

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project.

Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.

Spinal Orthoses in the Treatment of Osteoporotic Thoracolumbar Vertebral Fractures in the Elderly: A Systematic Review With Quantitative Quality Assessment

Systematic review. Spinal orthoses are frequently used to non-operatively treat osteoporotic vertebral fractures (OVF), despite the available evidence is rare. Previously systematic reviews were carried out, presenting controversial recommendations. The present study aimed to systematic review the recent and current literature on available evidence for the use of orthoses in OVF. A systematic review was conducted using PubMed, Medline, EMBASE and CENTRAL databases. Identified articles including previous systematic reviews were screened and selected by three authors. The results of retrieved articles were presented in a narrative form, quality assessment was performed by two authors using scores according to the study type. Thirteen studies (n = 5 randomized controlled trials, n = 3 non- randomized controlled trials and n = 5 prospective studies without control group) and eight systematic reviews were analyzed. Studies without comparison group reported improvements in pain, function and quality of life during the follow-up. Studies comparing different types of orthoses favor non-rigid orthoses. In comparison to patients not wearing an orthosis three studies were unable to detect beneficial effects and two studies reported about a significant improvement using an orthosis. In the obtained quality assessment, three studies yielded good to excellent results. Previous reviews detected the low evidence for spinal orthoses but recommended them. Based on the study quality and the affection of included studies in previous systematic reviews a general recommendation for the use of a spinal orthosis when treating OVF is not possible. Currently, no superiority for spinal orthoses in OVF treatment was found.

“I WANT to exercise”: the controversial recommendations for physical activity on the Ministry of Health website

The scope of this article is to analyze the contents regarding physical activity posted on the Brazil Health website of the Ministry of Health, between 2017-2020, describing them and discussing the (non-)existent interactions between the contents published and the Physical Education and Public Health area. Through net ethnographic tools, 98 publications that deal with physical activity/physical exercise/corporal practices were located, which were posted on the website over four years. It was observed that the behavioral aspect of health promotion is predominant in all the content, and three perspectives on physical activity recommendations were identified: "sportivized," daily and generalized physical activity. These approaches are analyzed and considered along with the lack of the predominance of leisure in the recommendations, the absence of coordination with SUS programs and policies, and the lack of clippings that assess the social and economic inequalities in the country that affect the health/disease process and, consequently, the practice of physical activities. In addition to these points, it is essential that communication campaigns to encourage the movement treat the recognition of physical activity as a human right and foster the commitment to a fairer and more equitable society.

Improved Agreement With American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on Carpal Tunnel Syndrome.

The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines on the diagnosis and management of carpal tunnel syndrome (CTS). Previous versions made controversial recommendations, which failed to yield universal endorsement. Updated guidelines were published in 2016, and we aimed to evaluate agreement with their highest-strength recommendations among members of the American Society for Surgery of the Hand. An online questionnaire was sent to American Society for Surgery of the Hand members. There were 22 questions that inquired about respondents' specialty, experience level, and practice patterns. We sought to determine their level of agreement with 6 of the highest-strength recommendations in the guidelines. We also investigated their awareness of the guidelines and perceived barriers to their use in clinical practice. The response rate was 17%. The typical respondent was a private practice orthopedic surgeon with at least 10 years of practice. The majority of respondents were aware of the AAOS guidelines. Approximately half (55%) felt that there were no significant barriers to their implementation into clinical practice. Overall, our study demonstrated that nearly half of the respondents agreed with the highest-strength recommendations. There is an improved agreement with the current AAOS guidelines on CTS, perhaps because they reflect a more accurate role in assisting physicians with their independent medical judgment, rather than as fixed protocols. We believe that all surgeons managing CTS should be familiar with the AAOS guidelines. [Orthopedics. 2023;46(2):114-120.].

Effectiveness of prehabilitation in Low Anterior Rectal Resection Surgery (LARS) with previous neoadjuvant therapy

Objectives: There is a limited amount of evidence regarding prehabilitation in elective abdominal surgeries, leading to controversial recommendations within the main enhanced-recovery guidelines to date. Thus, our goal was to compare the effectiveness of prehabilitation in reducing post-operative complications and hospital stay in low anterior rectal resection surgery (LARS).

Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study

BackgroundIn 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak.MethodsFrom August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study.ResultsA total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM.ConclusionManagement of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide.

Take It with a Grain (or More) of Salt: Why Industry-Backed Dietary Guidelines Fail Americans and How To Fix Them.

The U.S. Dietary Guidelines lack oversight and accountability. The result: Guidelines that reflect food industry interests instead of modern science. This deleterious guidance goes on to govern federally-subsidized food assistance programs and to influence dietary choices throughout the private sector and private life. Ultimately, the Guidelines significantly contribute to the endemic chronic disease they seek to address. The Guidelines Advisory Committee is notoriously rife with conflicts of interest, and thus most Guidelines scholarship has focused on reforming the Committee. But the 2015 and 2020 Guidelines show that these reforms are insufficient and agency-level change is necessary. In 2015, the Committee made several controversial recommendations related to red meat, ultraprocessed foods, sodium, and sustainability. Due to industry backlash, only the sodium recommendation survived in the final Guidelines published by the Secretaries of the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS). In 2020, the Secretaries, for the first time, predetermined a list of eighty topics that the Committee may consider. Absent from this list are the most contentious topics from previous years. There is little recourse because the Guidelines are not considered an agency action subject to the Administrative Procedure Act (APA), despite their vast impact on food assistance programs, healthcare practices, tort law, and more. This Note proposes two ways to bring the Guidelines within the APA’s coverage. The first is a litigation strategy, arguing that the D.C. District Court relied on erroneous reasoning when it held that the Guidelines are not an agency action subject to the APA. Second, this Note describes some ways that Congress could amend the Nutrition Act, the statute governing the Guidelines. Applying the APA to the Guidelines would allow for public participation and public challenge, greater transparency, and greater efficiency across agencies. Evidence-based Guidelines would improve overall health, reduce healthcare costs, and ensure that food assistance beneficiaries can access healthy foods. A robust set of Guidelines would improve public confidence in the recommendations and enable further food law reforms, such as amending the Farm Bill, that would make it easier for people to make healthy choices.

Guidelines: the same evidence but different conclusions - relaxation of indications for irradiation of cellular blood components?

Guidelines: the same evidence but different conclusions - relaxation of indications for irradiation of cellular blood components?

High-Flow Nasal Cannula and COVID-19: A Clinical Review.

During the coronavirus disease 2019 (COVID-19) pandemic, noninvasive respiratory support has played a central role in managing patients affected by moderate-to-severe acute hypoxemic respiratory failure, despite inadequate scientific evidence to support its usage. High-flow nasal cannula (HFNC) treatment has gained popularity because of its effectiveness in delivering a high fraction of humidified oxygen, which improves ventilatory efficiency and the respiratory pattern, as well as its reported high tolerability, ease of use, and application outside of ICUs. Nevertheless, the risk of infection transmission to health-care workers has raised some concerns about its use in the first wave of the pandemic outbreak, with controversial recommendations provided by different scientific societies. This narrative review provides an overview of the recent evidence on the physiologic rationale, risks, and benefits of using HFNC instead of conventional oxygen therapy and other types of noninvasive respiratory support devices, such as continuous positive airway pressure and noninvasive ventilation in patients affected by COVID-19 pneumonia with associated acute hypoxemic respiratory failure. It also summarizes the available evidence with regard to the clinical use of HFNC during the current pandemic and its reported outcomes, and highlights the risks of bioaerosol dispersion associated with HFNC use.

Advancing the Evidence Base in the Care of Term and Late Preterm Infants.

Advancing the Evidence Base in the Care of Term and Late Preterm Infants.

The Role of Novel Agents in Treating CLL-Associated Autoimmune Hemolytic Anemia.

Autoimmune cytopenias (AICs) have been reported as a common complication in chronic lymphocytic leukemia (CLL) with autoimmune hemolytic anemia (AIHA), accounting for most cases. According to iwCLL guidelines, AICs poorly responsive to corticosteroids are considered indication for CLL-directed treatment. Chemo-immunotherapy has classically been employed, with variable results, and little data are available on novel agents, the current backbone of CLL therapy. The use of idelalisib in the setting of AICs is controversial and recent recommendations suggest avoiding idelalisib in this setting. Ibrutinib, through ITK-driven Th1 polarization of cell-mediated immune response, is known to produce an immunological rebalancing in CLL, which stands as a fascinating rationale for its use to treat autoimmunity. Although treatment-emergent AIHA has rarely been reported, ibrutinib has shown rapid and durable responses when used to treat AIHA arising in CLL. There is poor evidence regarding the role of BCL-2 inhibitors in CLL-associated AICs and the use of venetoclax in such cases is debated. Furthermore, their frequent use in combination with anti-CD20 agents might represent a confounding factor in evaluating their efficacy. In conclusions, because of their ability to mitigate an immunological dysregulation that is (at least partly) responsible for autoimmunity in CLL, to date BTK-inhibitors stand out as the most suitable choice when treatment of autoimmune cytopenias is required.

Dental Care in Times of the COVID-19 Pandemic: A Review.

Given the dynamic relationship between oral and general health, dental care must not be neglected even during a public health emergency. Nevertheless, the fear of contracting the infection appears to have caused instances of dental treatment avoidance. In these times of uncertainty, regulatory and public health organizations have made numerous and sometimes controversial recommendations to practitioners and to the public about how to secure their oral health care needs. Dentists, as advocates of oral health, should actively maintain their practices while considering local epidemiological reports and recommendations regarding prevention of SARS-CoV-2 infection. Providing appropriate safety measures, accurate triage and prioritization of patients, notice to susceptible communities, remote health care delivery when appropriate, and epidemiological reports of COVID-19 (whenever possible) are all critical considerations for dental practitioners.

Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Cardiovascular societies have developed recommendations regarding the management of thoracic aortic diseases. While improvements in treatment have been observed during the past decade in regard to patient selection, thoracic endovascular aortic repair (TEVAR) and associated techniques, and high-volume centralization, the broad expansion of TEVAR has raised considerations about its indications, appropriateness, limitations, and application. The aim of this systematic review was to assess the similarities and differences among current cardiovascular societies’ guidelines for the management of thoracic aortic diseases. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from January 2009 to May 2020. The initial search identified 990 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from cardiovascular societies published between 2010 and 2020. Selected controversial topics were analyzed, including diagnosis, imaging, spinal cord ischemia prevention, and management of the most important thoracic aortic pathologies. The analysis included data concerning the therapeutic approach in acute and chronic type B aortic dissection, penetrating aortic ulcer, intramural hematoma, thoracic aortic aneurysm, and traumatic aortic injury, as well a discussion of inflammatory aneurysms, aortitis, and genetic syndromes. The review presents consistent and controversial recommendations, as well as “gray zone” issues that need further investigation. There was significant overlap and agreement among the 5 societies regarding the management of thoracic aortic diseases. Especially in dissection and aneurysm management, TEVAR has established its role as the treatment of choice. However, robust evidence is still needed in many aspects of the management of thoracic aortic pathologies.

Epidemiology and treatment of acute elbow dislocations: current concept based on primary surgical ligament repair of unstable simple elbow dislocations

PurposeAcute elbow dislocations are complex injuries that predispose to chronic instability and pain. The ideal treatment strategy is part of controversial discussion and evidence-based recommendations for the treatment could not be concluded from the literature. The purpose of the present study was to assess current epidemiological data, injury pattern, and the changing trend for treatment.MethodsThis study presents a retrospective review of 72 patients ≥ 18 years of age who were treated in our level I trauma centre with acute elbow dislocations from 2014 to 2018. The data were acquired by analysis of the institution’s database, and radiological examinations.ResultsThe average age of the patients was 48.5 years (range 18–86). The ratio of male to female patients was 1.9:1. A fall onto the outstretched arm (42%) was the most common injury mechanism. By classification, 42% of the elbow dislocations were simple, and 58% complex. A total of 85% of patients underwent surgery including 73% of the simple elbow dislocations due to remaining instability or non-congruency of the reduced elbow. The indication for surgical treatment correlated merely with the grade of instability and displacement, but not with age.ConclusionAcute elbow dislocations need identification of the precise injury pattern and instability after reduction of the elbow joint. To achieve a congruent and stable joint, we recommend primary surgical repair as first-line treatment for patients with unstable simple and complex elbow dislocation independent of age.

Managing and Measuring Emergency Department Care: Results of the Fourth Emergency Department Benchmarking Definitions Summit.

A shared language and vocabulary are essential for managing emergency department (ED) operations. This Fourth Emergency Department Benchmarking Alliance (EDBA) Summit brought together experts in the field to review, update, and add to key definitions and metrics of ED operations. Summit objectives were to review and revise existing definitions, define and characterize new practices related to ED operations, and introduce financial and regulatory definitions affecting ED reimbursement. Forty-six ED operations, data management, and benchmarking experts were invited to participate in the EDBA summit. Before arrival, experts were provided with documents from the three prior summits and assigned to update the terminology. Materials and publications related to standards of ED operations were considered and discussed. Each group submitted a revised set of definitions prior to the summit. Significantly revised, topical, or controversial recommendations were discussed among all summit participants. The goal of the in-person discussion was to reach consensus on definitions. Work group leaders made changes to reflect the discussion, which was revised with public and stakeholder feedback. The entire EDBA dictionary was updated and expanded. This article focuses on an update and discussion of definitions related to specific topics that changed since the last summit, specifically ED intake, boarding, diversion, and observation care. In addition, an extensive new glossary of financial and regulatory terminology germane to the practice of emergency medicine is included. A complete and precise set of operational definitions, time intervals, and utilization measures is necessary for timely and effective ED care. A common language of financial and regulatory definitions that affect ED operations is included for the first time. This article and its companion dictionary should serve as a resource to ED leadership, researchers, informatics and health policy leaders, and regulatory bodies.

Strengthening prehospital clinical practice guideline implementation in South Africa: a qualitative case study

BackgroundMethods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, research into alternative methods of CPG development using existing CPG documents (CPG adaptation) — a specific issue for guideline development groups in low- and middle-income countries — is sparse. There are only a few examples showcasing the pragmatic application of such alternative approaches in settings with time and budget constraints, especially in the prehospital setting. This paper aims to describe and strengthen the methods of developing prehospital CPGs using alternative guideline development methods through a case study design.MethodsWe qualitatively explored a CPG development project conducted in 2016 for prehospital providers in South Africa as a case study. Key stakeholders, involved in various processes of the guideline project, were purposefully sampled. Data were collected from one focus group and six in-depth interviews and analysed using thematic analysis. Overarching themes and sub-themes were inductively developed and categorised as challenges and recommendations and further transformed into action points.ResultsKey challenges revolved around guideline implementation as opposed to development. These included the unavoidable effect of interest and beliefs on implementing recommendations, the local evidence void, a shifting implementation context, and opposing end-user needs. Guideline development and implementation strengthening priority actions included: i) developing a national end-user document; ii) aligning recommendations with local practice; iii) communicating a clear and consistent message; iv) addressing controversial recommendations; v) managing the impact of interests, beliefs and intellectual conflicts; and vi) transparently reporting implementation decisions.ConclusionThe cornerstone of a successful guideline development process is the translation and implementation of CPG recommendations into clinical practice. We highlight key priority actions for prehospital guideline development teams with limited resources to strengthen guideline development, dissemination, and implementation by drawing from lessons learnt from a prehospital guideline project conducted in South Africa.

The Controversy Surrounding Rev. Włodzimierz Kirchner’s Brochure [Challenging Poverty in Bałuty

Włodzimierz Kirchner (1875-1970) – former priest, activist in the Łódź and Warsaw districts of the Christian Charity Association, he supported the efforts of the organisation by publishing articles on philanthropy. He was a proponent of the so-called ‘enlightened philanthropy’, i.e. he argued that social support cannot be of a spontaneous and chaotic character, but, rather, it should be controlled and monitored so that unemployment can be prevented. To justify his theses, the main of which was a conviction that giving alms was a waste of money and a tool spreading demoralisation, he conducted an analysis of dysfunctional communities, e.g. Bałuty (near Łódź back then). He depicted the inhabitants of the area (serving as a synecdoche of the dysfunctional communities throughout Poland) as a group of pretenders and impostors hustling potential benefactors by using a theatricalisation of behaviours which evoked empathy. He collected and published his conclusions in the brochure titled Walka z nędzą na Bałutach, which – due to its controversial recommendations of emotional restraint and the application of the method of control and monitoring – stirred aversion among various groups of intellectuals. Kirchner was accused of blind support of doctrines and extreme aestheticism, while the leftist press accused him of hypocrisy typical of the clergy.

1460. The Effectiveness of Short vs. Long Antibiotic Therapy in Hospitalized Adult Patients with Urinary Tract Infections: A Systematic Review and Meta-Analysis

BackgroundUrinary tract infections (UTIs) are a frequent cause of morbidity and mortality in hospitalized patients, if not adequately and promptly treated. The optimal treatment duration is controversial and most recommendations are based on clinical experience. Current guidelines recommend 5–14 days of treatment depending on the type and severity of infection and the antibiotic used. With the emergence of multi-drug resistance, shorter durations are increasingly favored. This systematic review of randomized controlled trials (RCTs) aims at providing updated evidence on the effectiveness of short (≤7 days) vs. long (>7 days) antibiotic regimens in hospitalized adult patients.MethodsMEDLINE, EMBASE, and CENTRAL were searched to identify relevant RCTs. Trial quality was evaluated using Cochrane’s Risk of Bias Tool. The primary outcome was clinical success. Secondary outcomes included microbiological success, withdrawal due to adverse events (AE), relapse, and reinfection rates. A random-effect meta-analysis was performed using R.Results8 RCTs conducted between 1995 and 2018 were identified. Trial quality was considered poor in 5, fair in 1 and good in 2 RCTs. Clinical and microbiological success was reported in all studies. Withdrawal due to AE was reported in 5, relapse and reinfection in 3 studies. Overall, there was no difference in clinical success between short and long courses (OR = 0.92, 95% CI 0.66–1.29; 2111 patients) (figure). Similarly, microbiological success was comparable in the two arms (OR = 1.0, 95% CI 0.70–1.43; 2111 patients). There was a higher, but nonsignificant, number of withdrawals due to AE in the long duration arm (OR = 0.78, 95% CI 0.29–2.11; 1890 patients). Patients receiving short courses had a nonsignificant higher rate of relapse (OR = 2.65, 95% CI 0.31–22.39, 175 patients). However, there was no difference in reinfection rates (OR = 1.12, 95% CI 0.26–4.90; 175 patients). A subgroup analysis limited to complicated UTIs showed similar results.ConclusionBased on the limited available evidence, short antibiotic courses appear to be equally effective as longer courses in the management of inpatient UTIs. Further research is needed to determine appropriate antibiotic treatment durations and assess treatment-related development of drug resistance. Disclosures All authors: No reported disclosures.