European Respondents Research Articles

Psychological capital and the intent to pursue employment with developed and emerging market multinational corporations

The entrance of emerging market multinational corporations (EMNCs) into developed markets and their subsequent demand for western talent is an important new research topic in the field of human resource development (HRD). Upon entering developed markets, EMNCs will find themselves competing with a host of well-established western firms for the same limited pool of talent. Due to possible liability of origin issues, EMNCs may be perceived as less attractive employers. Human resource development professionals tasked with helping these newly arrived firms to recruit necessary talent will find the ability to identify those individuals most likely to pursue employment with an EMNC highly beneficial. In pursuit of this goal, five hypotheses were tested on 703 American and European respondents. Specifically, we examined the interaction between the level of psychological capital of western job seekers and their intent to pursue employment in order to identify possible predispositions for finding EMNCs as attractive employers.

Global Differences in the Present and Future Management of Cerebral Aneurysms

The publication of the International Subarachnoid Aneurysm Trial and the International Study of Unruptured Intracranial Aneurysms rapidly changed the management of patients with subarachnoid hemorrhage in many countries. Future trends of aneurysm management will have significant implications for patients, health systems, and how we educate future cerebrovascular specialists internationally. We describe past, present, and future trends in the management of patients with cerebral aneurysms. We recorded responses from 283 neurosurgeons and neuroradiologists in 46 countries. We explored similarities and differences in the availability and use of endovascular and open techniques of aneurysm treatment, imaging, and follow-up techniques, effectiveness and limitations of currently available techniques. More European respondents report that their hospitals perform coiling and fewer report that they perform stenting. The proportions of coiling to clipping vary greatly in all regions. Respondents predicted that flow-diversion treatment of aneurysms with the use of stenting will show large increases and that coiling will show a mild decrease in Europe and North America and an increase in the rest of the world. Respondents predicted that although clipping will remain essential, it will significantly decrease in use during the next 5 years all over the world. Significant differences exist in the management of cerebral aneurysms internationally, but the trends indicate that endovascular means of treating aneurysms will continue to increase in popularity globally. This report illustrates changes, which have significant economic and educational implications, that need to be addressed by organized neurosurgery in conjunction with industry partners.

Use of Parathyroid Hormone Assay after Thyroidectomy: A Survey of US and European Surgeons

IntroductionHypocalcemia after thyroidectomy results in prolongation of hospitalization and patient discomfort but can be predicted by PTH assays. However, there is considerable variation in their use.MethodsThis study was undertaken to document current US and European practice patterns regarding the use of this assay. Anonymous surveys were collected in 2009–2011 from members of the American Academies of Otolaryngology-Head and Neck Surgery and Endocrine Surgery and the European, Italian, French, Spanish and British Societies of Endocrine Surgery.ResultsThere were 356 American (3% response) and 61 European (10% response) respondents. 105 (29.8%) American and 25 (41%) European respondents reported routine PTH assay use. Fellowship trained surgeons reported increased use of the PTH assay (P = 0.004). Shorter reported average post-operative hospital stay was associated with American physicians (P = 0.0001), community practice location (P = 0.0002) and routine calcium supplementation (P = 0.0015).ConclusionsSurgical training was associated with routine use of the PTH assay. Average reported hospital stay was lower for American and community practice physicians and correlated with post-operative oral calcium use.

Socially Embedded Investments: Explaining Gender Differences in Job-Specific Skills

This article offers an innovative explanation for gender differences in job specialization that connects individual choices to the social structure. Decisions about jobs are modeled as a choice over different tenure-reward slopes, which are steeper for more specialized skills. The choice of job depends on expected duration. Individuals have imperfect information about their probability of success in different jobs and form expectations partly by observing the social context. Because women face greater constraints and uncertainties than men, their choices depend more on this context. Contextual influences on job specialization are tested for European respondents nested in 234 different regions. Consonant with the theory’s predictions, women are found to have more specialized jobs in regions where (1) the preceding generation’s job specialization diverged less by gender, (2) peers arrange a more equal division of housework, and (3) peers have fewer children. None of these contextual variables have significant effects on men.

A 2011 Survey of Clinical Practice Patterns in the Management of Graves' Disease

More than two decades have passed since members from the American Thyroid Association (ATA), European Thyroid Association, and Japan Thyroid Association were surveyed on management practices for patients with hyperthyroidism due to Graves' disease (GD). We sought to document current practices in the management of GD and compare these results both to those documented in earlier surveys and to practice recommendations made in the 2011 ATA/American Association of Clinical Endocrinologists (AACE) hyperthyroidism practice guidelines. Lastly, we sought to examine differences in GD management among international members of U.S.-based endocrine societies. Members of The Endocrine Society (TES), ATA, and AACE were invited to participate in a web-based survey dealing with testing, treatment preference, and modulating factors in patients with GD. A total of 730 respondents participated in the survey, 696 of whom completed all sections. Respondents included 641 TES members, 330 AACE members, and 157 ATA members. The preferred mode of therapy in uncomplicated GD was antithyroid drugs (ATDs) by 53.9% of respondents, radioactive iodine (RAI) therapy by 45.0%, and thyroid surgery in 0.7%. Compared with 1991, fewer U.S. (59.7 vs. 69%) and European (13.3% vs. 25%) respondents would use RAI therapy. Methimazole and carbimazole were the preferred ATDs, with only 2.7% of respondents selecting propylthiouracil. Patients with Graves' ophthalmopathy were treated with ATDs (62.9%) or surgery (18.5%) and less frequently with RAI plus corticosteroids (16.9%) or RAI alone (1.9%). Striking changes have occurred in the management of GD over the past two decades, with a shift away from RAI and toward ATDs in patients with uncomplicated GD. Apparent international differences persist but should be interpreted with caution. Current practices diverge in some areas from recently published guidelines; these differences should be assessed serially to determine the impact of the guidelines on future clinical practice.

Primary care clinicians' perceptions of antibiotic resistance: a multi-country qualitative interview study

To explore and compare primary care clinicians' perceptions of antibiotic resistance in relation to the management of community-acquired lower respiratory tract infection (LRTI) in contrasting European settings. Qualitative interview study with 80 primary care clinicians in nine European countries. Data were subjected to a five-stage analytical framework approach (familiarization; developing a thematic framework from the interview questions and the themes emerging from the data; indexing; charting; and mapping to search for interpretations in the data). Preliminary analysis reports were sent to all network facilitators for validation. Most clinicians stated that antibiotic resistance was not a problem in their practice. Some recommended enhanced feedback about local resistance rates. Northern European respondents generally favoured using the narrowest-spectrum agent, motivated by containing resistance, whereas southern/eastern European respondents were more motivated by maximizing the potential of a rapid treatment effect and so justified empirical use of broad-spectrum antibiotics. Antibiotic treatment failure was ascribed largely to viral aetiology rather than resistant bacteria. Clinicians generally agreed that resistance will become more serious without enhanced antibiotic stewardship or new drug discovery. If current rates of antibiotic resistance are likely to result in important treatment failures, then provision of local resistance data is likely to enhance clinicians' sense of importance of the issue. Interventions to enhance the quality of antibiotic prescribing in primary care should address perceptions, particularly in the south and east of Europe, that possible advantages to patients from antibiotic treatment in general, and from newer broad-spectrum compared with narrow-spectrum agents, outweigh disadvantages to patients and society from associated effects on antibiotic resistance.

PO-57 A worldwide survey to assess the current approach to the treatment of patients with cancer and venous thromboembolism

Introduction: Since the results of the CLOT trial were published in 2003, low-molecular-weight heparin (LWMH) has been recommended as the preferred anticoagulant treatment over vitamin K antagonists (VKAs) for venous thromboembolism (VTE) in patients with cancer. However, there is uncertainty about the duration and dose of LMWH treatment. We assessed the current practice of anticoagulant treatment of patients with cancer and VTE in various countries. Methods: An electronic survey tool was used to build a survey containing 49 questions on different aspects of the treatment of patients with cancer and VTE, and personal links were sent to both thrombosis and non-thrombosis specialists. Results: For this analysis, 123 completed surveys were available, which represented 53% of all invitations to date. Respondent's specialties varied from haematology (26%), oncology (17%), haemato-oncology (4.1%), pulmonology (14%), general internal medicine (13%), surgery (4.9%) and other (1.6%). The majority (85%) of respondents generally use LMWH for longterm anticoagulant treatment. The application of LMWH is significantly higher (p=0.031) among European respondents (69/75; 92%) compared to respondents from the United States or Canada (30/40, 75%). Of all specialists who give LMWH for long-term treatment, 55% use fully therapeutic doses, while the remainder chooses for a dose reduction after a certain period of time. When continuing anticoagulants after the long-term treatment period, 45% of respondents prefer LMWH, 9.0% VKA, while the others choose per individual patient for either LMWH or VKA. In patients on LMWH who develop recurrent VTE during treatment, 42% of the respondents continue LWMH with a higher dose, 8.2% give double therapy with LMWH and VKA and 30% would insert a vena caval filter. Discussion: In this pre-final assessment, we observed a relatively high observance rate of the guidelines, with respect to the type of anticoagulant used for the long-term treatment of VTE in cancer patients. In contrast, the dose of LMWH and the continuation of treatment after 6 months are examples of areas in which heterogeneous responses may reflect the limited available clinical evidence. Interestingly, a lower percentage of the specialists in the US routinely use LMWH in patients with cancer compared to European specialists.

Burden of Gastro-Oesophageal Reflux Disease in Patients with Persistent and Intense Symptoms Despite Proton Pump Inhibitor Therapy

Research on the negative impact of gastro-oesophageal reflux disease (GORD) on the health-related quality of life (HR-QOL) and resource utilization of patients with persistent and intense GORD symptoms despite proton pump inhibitor (PPI) therapy is lacking. The aim of this study was to describe the population of patients with GORD with persistent moderate-to-severe symptoms despite ongoing PPI therapy, and to compare their HR-QOL and healthcare resource use with patients with low GORD symptom load during ongoing PPI therapy. In this post hoc analysis of the 2007 National Health and Wellness Survey (NHWS), PPI-compliant (≥22 days with PPI use in the past month) European (France, Germany and the UK) and US respondents with physician-diagnosed GORD were stratified into those with persistent and intense GORD symptoms, those with low symptom load, or an intermediate group. 5672 PPI-compliant respondents were identified (persistent and intense symptoms, n = 1741; low symptom load, n = 1805; intermediate group, n = 2126). Respondents with persistent and intense symptoms had poorer HR-QOL than patients with a low symptom load, but none of the differences were statistically significant. Respondents with persistent and intense symptoms also reported lower work productivity (all countries; significant difference [p < 0.01] only in the US), greater activity impairment (all countries; significant difference [p < 0.01] only in the US) and more hours missed from work due to health problems (US, UK and Germany; significant difference [p < 0.01] only in the US). In the UK and US, respondents with persistent and intense symptoms reported significantly more visits to both primary-care physicians and specialists than respondents with a low symptom load (all p < 0.01). Additionally, US respondents with persistent and intense symptoms reported significantly more emergency room visits (p < 0.01). The 2007 NHWS gives support to the hypothesis that persistent and intense GORD symptoms despite PPI therapy have a significant and negative impact on both HR-QOL and healthcare resource utilization. These findings outline the need for new treatment options for symptomatic GORD patients taking PPI therapy.

Corporate social responsibility and sustainability education: A trans-Atlantic comparison

AbstractUsing a sample of 72 European and 22 North American educational institutions, we examine the extent to which business schools in North America and Europe are driving educational programs and initiatives in corporate social responsibility and sustainability (CSRS). Drawing on several theoretical perspectives, such as institutional-comparative perspectives and resource dependence theory, the study indicates the increasing prominence of CSRS education in business schools on both continents. It does so through analysis of the extent to which business schools offer (a) dedicated CSRS programs, (b) CSRS tracks and majors, (c) compulsory CSRS classes or modules, and (d) optional CSRS modules across the range of taught programs. Contrary to some previous findings, religious affiliation, public/private status, and program size had only a negligible direct association with schools' commitment to CSRS education. However, business school prestige showed a statistically significant relationship. Finally, the study highlights how European respondents' perceptions concerning the primary drivers and constraints of CSRS initiatives differed from those in North America.

Corporate social responsibility and sustainability education: A trans-Atlantic comparison

AbstractUsing a sample of 72 European and 22 North American educational institutions, we examine the extent to which business schools in North America and Europe are driving educational programs and initiatives in corporate social responsibility and sustainability (CSRS). Drawing on several theoretical perspectives, such as institutional-comparative perspectives and resource dependence theory, the study indicates the increasing prominence of CSRS education in business schools on both continents. It does so through analysis of the extent to which business schools offer (a) dedicated CSRS programs, (b) CSRS tracks and majors, (c) compulsory CSRS classes or modules, and (d) optional CSRS modules across the range of taught programs. Contrary to some previous findings, religious affiliation, public/private status, and program size had only a negligible direct association with schools' commitment to CSRS education. However, business school prestige showed a statistically significant relationship. Finally, the study highlights how European respondents' perceptions concerning the primary drivers and constraints of CSRS initiatives differed from those in North America.

Survey of Post‐thyroidectomy Parathyroid Hormone (PTH) Assay Use by American vs European Thyroid Surgeons

Objective: 1) Identify differences in PTH assay usage by European vs American physicians. 2) Analyze factors that correlate with these differences. Method: Anonymous surveys of physicians regarding their use of post-thyroidectomy PTH assay were collected in 2009 from members of the American Academies of Otolaryngology and Endocrine Surgery and compared with 2010 survey data from members of the European, Italian, French, Spanish, and British Societies of Endocrine Surgery. Results: European respondents returned 61 surveys that were compared with 356 received from American physicians (11% vs 3% response rate). A total of 40.1% of the European physicians used the PTH assay vs 29.8% of the American physicians (chi-square P = .083). A total of 63% of US respondents were otolaryngologists, compared with 7% of the Europeans, but usage among US physicians was not significantly correlated with specialty. Fewer American physicians were fellowship trained (26.6% vs 44.3% (chi-square P = .003)). Using Mann-Whitney testing, estimates of the rate of temporary hypocalcemia were similar, median 10% to 20% ( P = .708), but American respondents provided a lower estimated rate of permanent hypocalcemia ( P = .007). Conclusion: We found a trend suggesting that more European physicians obtain PTH levels than US physicians and report higher rates of permanent hypocalcemia among thyroidectomy patients, perhaps accounting for their more frequent use of PTH assays.

Paths to citizenship? Public views on the extension of rights to legal and second-generation immigrants in Europe

This study uses variations in the legal-institutional frameworks of citizenship to explore cross-nationally public views about granting equal rights to legal immigrants and citizenship status to second-generation immigrants in 20 European countries. We link the literatures on citizenship regimes and attitudes toward immigrants to construct a conceptual model that is tested using ISSP data from 2003 and a set of matching contextual measures. Results from hierarchical linear regression analyses indicate that (1) opposition to the extension of rights to legal immigrants is augmented by shorter periods of required residency for naturalization and (2) granting citizenship status to second-generation immigrants is not sensitive to whether a regime consents or not to citizenship by birth. Net of individual and contextual controls, the findings also show that resistance to the expansion of rights to legal immigrants is higher in countries consenting to dual citizenship. Furthermore, our analyses reveal that Eastern European respondents do not differ significantly from their Western counterparts with respect to extending rights to either category of immigrants. These results are discussed in reference to the diversity of citizenship regimes in Europe and in light of the existing debates on harmonizing immigration policies.

Work-Related Attitudes in Asia and Europe: Institutional Approach

The differences in attitudes and values in countries with similar cultural roots but different institutional backgrounds were found in a study conducted in three European countries (Alas and Edwards 2007). The differences in work-related attitudes in the three Finno-Ugrian countries, Estonia, Finland and Hungary, are influenced by the respective countries' historical legacy, in particular differences in levels of institutional development (ibid). In order to test this result and to advise companies doing business on different continents, the authors enlarged the sample by adding countries from Europe and Asia. Countries on both continents have been divided into two groups according to their institutional backgrounds. Europe has been divided into two parts according to recent history and developmental level: East European and West European countries. The former group has undergone a transition from planned command economy over the last 20 years, the latter has a long tradition of capitalism and the market economy. Similarly, in Asia Japan, South Korea and Hong Kong have well established market systems, while China has been developing a socialist market economy since the late 1970s (Warner et al., 2005). Managers in Eastern Europe and China have had similar challenges: to focus on organisational efficiency and to change competitive strategies (Alas et al2009b; Wang, 2007).The main research question is: are there differences in work-related attitudes between employees from countries with different institutional background on two continents and, if so, what are the reasons for these differences?The paper begins with hypotheses development. This is followed by description of the empirical study and finally data collected from empirical studies in four regions (China; Japan, South Korea and Hong Kong ['Asia']; formerly socialist Eastern Europe; and Western Europe) are analysed and the results discussed. An institutional model of differences in attitudes toward society, organisations and work has been developed.The findings indicate both similarities and differences between work-related attitudes in Asia and Europe. Even between East and West European respondents who share a similar culture, there were in certain instances substantial differences in attitudes. The same is true in Asia: &nbsp; attitudes &nbsp;of &nbsp;Chinese &nbsp;respondents &nbsp;differ &nbsp;from&nbsp;attitudes of the three other Asian countries in the survey. At the same time the findings indicate that the institutional framework influences work-related attitudes, as evidenced by the similarities in some of the responses from Chinese and East European respondents.The main conclusion from this study is that the differences in attitudes held toward society, organisations and work by people in Asia and Europe are influenced both by institutional context and cultural background. Both factors, and combinations of both factors, should be considered by owners and managers of multinational corporations. These results may help managers of multinational companies to achieve better work-related attitudes among employees working in plants on different continents.http://dx.doi.org/10.5755/j01.ee.22.1.215

The burden of high-risk surgery and the potential benefit of goal-directed strategies

The survey by Cannesson and colleagues [1] in the previous issue of Critical Care shows that only around 16% of anesthetists (5.4% of 210 US respondents and 30.4% of 158 European respondents) use a specific treatment protocol (that is, follow a goal-directed strategy) for the peri-operative hemodynamic management of patients undergoing high-risk surgery. In 2008, Weiser and colleagues [2] estimated the global volume of surgery to be 234.2 million procedures a year. According to Pearse and colleagues [3], high-risk surgical procedures represent around 12.5% of this total. A meta-analysis of the 29 randomized controlled trials investigating the value of peri-operative goal-directed strategies reported an average mortality rate of 9.4% in control groups and a significantly reduced mortality rate of 5.9% when a goal-directed strategy was adopted [4]. When putting all the pieces of this puzzle together, one can estimate that around 860,000 lives could potentially be saved every year (the equivalent of one life every 37 seconds) if such strategies became the standard of care around the world (Table ​(Table11). Table 1 Estimates of the potential worldwide benefit of peri-operative goal-directed strategies In addition, millions of post-operative complications could be avoided. Indeed, the meta-analysis by Hamilton and colleagues [4] suggests that the post-operative complication rate could be reduced from 29.8% to 18.0% with goal-directed strategies. Given the potential volume of complications after high-risk surgery (Table ​(Table1),1), the direct costs of treating these complications as well as the indirect costs related to prolonged hospital length of stay are difficult to quantify precisely but without question are astronomically high. It may be time for heath-care systems and governments to consider peri-operative goal-directed strategies as part of quality improvement programs and as national priorities.

Variation Among Pediatric Urologists and Across 2 Continents in Antibiotic Prophylaxis and Evaluation for Prenatally Detected Hydronephrosis: A Survey of American and European Pediatric Urologists

No clear practice guidelines exist to evaluate prenatally diagnosed hydronephrosis or recommend antibiotic prophylaxis. We hypothesized that among pediatric urologists there is significant variability in prenatal hydronephrosis evaluation and management. We created a survey questionnaire to answer certain questions, including 1) what prenatal parameters trigger postnatal evaluation, 2) how pediatric urologists manage prenatal hydronephrosis and 3) what are their recommendations for antibiotic prophylaxis. Survey questions included demographics and practice patterns, and influences concerning radiographic tests and prophylactic antibiotics. A Web based survey link was sent to members of the Urology Section, American Academy of Pediatrics and the European Society for Pediatric Urology. We received 156 responses. We also compared practices based in Europe in 60 respondents and in the United States in 70. There was significant response variability to all questions answered with no question achieving a consensus of more than 50%. European and American respondents were equally distributed in regard to years in practice and number of patients per month. Radiographic factors influenced the decision to perform further imaging or provide prophylactic antibiotics in around 50% of respondents. There was wide variability in parameters triggering intervention and in prophylactic antibiotics. Pediatric urologists in practice more than 15 years were less likely to prescribe antibiotic prophylaxis at birth than those in practice less than 15 years. Variation also existed by geographic region with American physicians more likely to prescribe antibiotics for any prenatal hydronephrosis compared to their European counterparts (77% vs 40%, p <0.005) and European physicians more likely to be influenced by prenatal pelvic diameter when obtaining postnatal imaging (unilateral 70% vs 47%, p = 0.009 and bilateral 55% vs 36%, p = 0.03, respectively). European pediatric urologists were also more likely to order renal scans than their American counterparts. These differences were less significant for high grade hydronephrosis. Even among pediatric urologists there is considerable variation in radiographic resource and prophylactic antibiotics use when managing prenatal hydronephrosis. Some variation may be explained by regional differences but it is most probably due to absent clear guidelines based on prospective, randomized, controlled trials.

Intensive care reimbursement practices: results from the ICUFUND survey

To assess patterns of intensive care reimbursement practices. A detailed questionnaire about basic intensive care unit (ICU) characteristics and ICU reimbursement practices was created, and then members of the European Society of Intensive Care (ESICM) were asked by e-mail to participate in the survey and complete the web-based questionnaire. There were a total of 447 responses analyzed. Of respondents, 51.5% stated that their ICU received detailed financial information; however, only 15.4% of respondents could identify each cost item for each patient. A majority of respondents (77.6%) stated that their unit's reimbursement system was included in the hospital reimbursement. ICU reimbursement systems were most commonly based on previous year's ICU expenditure (51.0%) and diagnosis-related group weights (36%). Selecting European respondents (n = 306) showed that supplying detailed financial information makes ICU doctors significantly more satisfied (p = 0.019) with their reimbursement system. Regarding ICU funding elements, the most satisfied with their ICU reimbursement system were those respondents from ICUs where nursing workload score was used (p = 0.018). Our result indicates that ICU physicians who receive detailed financial information about their units are more satisfied with their reimbursement system than those not receiving this information. Nursing workload score may have advantage over other forms of reimbursement practices. ICU physicians would like to be more involved in their unit's financial aspects and would prefer separate funding from hospital.

Attitudes toward Corporate Responsibilities in Western Europe and in Central and East Europe

This study investigated the attitudes toward social, economic, and environmental corporate responsibilities of 3064 current managers and business students in 8 European countries. Participants in Western European countries had significantly different perspectives on the importance of these corporate responsibilities (CR) than those in Central and East European countries. Within each country, environmental CR is perceived as most important in both CEE and Western European countries. Across countries, Western European respondents accord more importance to social CR and less importance to economic CR. CEE countries are not homogenous, e.g., CR attitudes in the Czech Republic are closer to that of Western Europeans, possibly triggered by the accession to EU. Work experience (managers vs. business students) influences social and environmental orientations more than the economic orientation for only some countries. Generational differences were found as well: Business students attribute more importance to environmental CR and less importance to social CR than managers.

Predictors of university students’ willingness in the USA to use clergy as sources of skilled help

This exploratory study investigated U.S. university students’ perceptions (N = 186) and the predictor variables associated with their willingness to use clergy as a source of help. In the final regression analysis using the predicted variable of willingness to use clergy as a source of help (R = 0.816, R 2= 0.665, Adjusted R 2= 0.650), there were seven significant predictor variables: (a) trust of clergy, (b) empathic ability of clergy, (c) having previously sought help from clergy, (d) respondents’ dominant/minority cultural identification, (e) attendance at religious services at least once a year, (f) believing that spiritual counselling is as effective as psychotherapy, and (g) receiving religious/spiritual education as a child. An eighth variable was retained in the final regression model because of its proximity to significance (Friendships between clergy and people, p = 0.051). Accusations against clergy and the belief that clergy are held to a higher standard did not predict willingness to use clergy as a source of help. A general linear model (F = 125.696, df = 10, p < 0.001) revealed that those who self-identified with Protestant Christianity, Catholic/Orthodox Christianity, and Judaism were more likely to consider seeking help from clergy than those who self-identified with another religious tradition (Hinduism, Islam, or Buddhism), or adherence to spiritual not religious belief. Further, those who self-identified as Jewish or Christian were also more like to perceive clergy as trustworthy and empathic. Finally, African American/Caribbean Black respondents were more likely than either Latino/Latino American respondents or European American respondents to seek help from clergy, to perceive clergy as empathic, and to believe that spiritual counselling is as effective as psychotherapy (F = 1495, df = 12, p < 0.001).

A European survey of antibiotic management of methicillin-resistant Staphylococcus aureus infection: current clinical opinion and practice

Although the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) varies across Europe, healthcare-associated MRSA infections are common in many countries. Despite several national guidelines, the approach to treatment of MRSA infections varies across the continent, and there are multiple areas of management uncertainty for which there is little clinical evidence to guide practice. A faculty, convened to explore some of these areas, devised a survey that was used to compare the perspectives of infection specialists from across Europe on the management of MRSA infections with those of the faculty specialists. The survey instrument, a web-based questionnaire, was sent to 3840 registered delegates of the 19th European Congress of Clinical Microbiology and Infectious Diseases, held in April 2009. Of the 501 (13%) respondents to the survey, 84% were infection/microbiology specialists and 80% were from Europe. This article reports the survey results from European respondents, and shows a broad range of opinion and practice on a variety of issues pertaining to the management of minor and serious MRSA infections, such as pneumonia, bacteraemia, and skin and soft tissue infections. The issues include changing epidemiology, when and when not to treat, choice of treatment, and duration and route of treatment. The survey identified areas where practice can be improved and where further research is needed, and also identified areas of pan-European consensus of opinion that could be applied to European guidelines for the management of MRSA infection.

The Burden of Disrupting Gastro-Oesophageal Reflux Disease

Recent data indicate that among patients with gastro-oesophageal reflux disease (GORD) there is a subgroup with a higher disrupting burden of illness in terms of symptom frequency and overall impact. The aim of this study was to evaluate the burden of disrupting versus non-disrupting GORD on individuals, healthcare providers and society. Data were obtained from European (France, Germany, Italy, Spain and the UK) and US respondents in the 2007 National Health and Wellness Survey (NHWS). Respondents with GORD were classified as having disrupting or non-disrupting GORD based on self-reported symptom frequency, presence of night-time symptoms and medication usage. Disrupting GORD was defined as the presence of GORD symptoms on at least 2 days/week in addition to either night-time symptoms or use of prescribed/over-the-counter medication at least twice a week during the past month. Of 116 536 respondents included in the 2007 NHWS, 23% reported GORD symptoms; 39% of these were acknowledged as having disrupting GORD. These patients had higher healthcare resource utilization than those with non-disrupting disease. Respondents with disrupting GORD also had poorer health-related quality of life, greater impairments in health-related work productivity and absenteeism (all p < 0.05 vs non-disrupting GORD), and higher associated total medical costs. Overall, patients with physician-diagnosed GORD also had significantly lower health-related quality of life than self-diagnosed respondents (p < 0.05). GORD is a common disease that places a substantial burden on affected individuals and society. A high proportion of patients have disrupting GORD, which has significant adverse potential from both a clinical and an economic perspective.