The transmission behaviour of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still being defined. It is likely that it is transmitted predominantly by droplets and direct contact and it is possible that there is at least opportunistic airborne transmission. In order to protect healthcare staff adequately it is necessary that we establish whether aerosol-generating procedures (AGPs) increase the risk of transmission of SARS-CoV-2. Where we do not have evidence relating to SARS-CoV-2, guidelines for safely conducting these procedures should consider the risk of transmitting related pathogens. Currently there is very little evidence detailing the transmission of SARS-CoV-2 associated with any specific procedures. Regarding AGPs and respiratory pathogens in general, there is still a large knowledge gap that will leave clinicians unsure of the risk to themselves when offering these procedures. This review aimed to summarize the evidence (and gaps in evidence) around AGPs and SARS-CoV-2.

ObjectivesTo assess an intervention for surgical antibiotic prophylaxis (SAP) improvement within surgical teams focused on addressing barriers and fostering enablers and ownership of guideline compliance.DesignThe Queensland Surgical Antibiotic Prophylaxis (QSAP) study was a multicentre, mixed methods study designed to address barriers and enablers to SAP compliance and facilitate engagement in self-directed audit/feedback and assess the efficacy of the intervention in improving compliance with SAP guidelines. The implementation was assessed using a 24-month interrupted time series design coupled with a qualitative evaluation.SettingThe study was undertaken at three hospitals (one regional, two metropolitan) in Australia.ParticipantsSAP-prescribing decisions for 1757 patients undergoing general surgical procedures from three health services were included. Six bimonthly time points, pre-implementation and post implementation of the intervention, were measured. Qualitative interviews were performed with 29 clinical team members. SAP improvements varied across site and time periods.InterventionQSAP embedded ownership of quality improvement in SAP within surgical teams and used known social influences to address barriers to and enablers of optimal SAP prescribing.ResultsThe site that reported senior surgeon engagement showed steady and consistent improvement in prescribing over 24 months (prestudy and poststudy). Multiple factors, including resource issues, influenced engagement and sites/time points where these were present had no improvement in guideline compliance.ConclusionsThe barriers-enablers-ownership model shows promise in its ability to facilitate prescribing improvements and could be expanded into other areas of antimicrobial stewardship. Senior ownership was a predictor of success (or failure) of the intervention across sites and time periods. The key role of senior leaders in change leadership indicates the critical need to engage other specialties in the stewardship agenda. The influence of contextual factors in limiting engagement clearly identifies issues of resource distributions/inequalities within health systems as limiting antimicrobial optimisation potential.

MAY I say at once that what I have ventured to call " my thoughts" upon Brahms, are not intended to be dogmatic, I do not presume to press with undue force any opinion of my own in regard to the position which Brahms does, or should, occupy among the great masters of music. With his high ideals of art and his lofty conceptions of duty in regard to it, he is assuredly the one composer who irresistibly commands our attention at the present time, and it is upon this fact that I rest the hope that I may ask you to spend a few minutes this evening in considering the question Why is there still some hesitancy to place him among the greatest composers ? Johannes Brahms, as a man and as an artist, opens up to us many interesting vistas of study. First of all, we know so little about him. I suppose no genius in musical art has ever hidden his personality and courted obscurity as he didnot that I think we lose anything valuable by this lack of knowledge-as to the secret thoughts of his mind, the exact sources of his inspiration, or the petty details of his everyday life; indeed I feel that the mystery which shrouds his personality is most attractive in this age of " interviewing," and that he is thereby set in a niche by himself among the hierarchy of musical composers. We know that he never took any pains or made any efforts to secure recognition, notoriety, or reward; and this at any rate is a gain. To the casual reader of musical history it seems remarkable that there should ever have been, and still is, so much controversy as to Brahms' artistic position. It is now pretty Downloaded by [University of Reading] at 13:31

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