SummaryBackgroundStaphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.MethodsIn this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.FindingsBetween Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18–45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference −1·4%, 95% CI −7·0 to 4·3; hazard ratio 0·96, 0·68–1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3–4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).InterpretationAdjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.FundingUK National Institute for Health Research Health Technology Assessment.

Objective-To compare general practitioners' reported management of acute back pain with "evidence based" guidelines for its management.Design-Confidential postal questionnaire. A minority performed manipulation (201/6) or acupuncture (6%). One third rated their satisfaction with management ofback pain as 4 out of 10 or less. Conclusions-The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting ofevidence. IntroductionBack pain is one of the commonest conditions managed in primary care, responsible each year for about 12 million general practitioner consultations, over 50 million work days lost, and almost £500m costs to the NHS.' Few management strategies for back pain have been proved in primary care, partly because most cases settle within a few weeks.2Given that most episodes of back pain settle with

Professional organisations and regulatory bodies are making critical reflection a mandatory component of professional practice. Reflection is a vital part of learning from experience and is central to developing and maintaining competency across a practitioner's lifetime. This paper will discuss key educational theories to illustrate why reflection is important. Kolb's and Gibbs' reflective cycles are used to structure the process of critical reflection. Elements of the educational tradition of Bildung are discussed and integrated to enrich the understanding of self and to facilitate the reader's ability to enhance their professional practice.

PurposeThis article sets out to revisit Janis' groupthink theory that holds that, when anxiety is present for a decision‐making group, premature concurrence seeking emerges unless other mitigating factors are present. Research from selected segments of the decision making literature are introduced to explain the underlying causes of concurrence seeking. The result is an elaboration of the theory based on a synthesis of older and newer ideas, supporting Janis' core thesis that anxiety triggers this phenomenon.Design/methodology/approachThe paper is conceptual and draws on literature addressing the impact of emotions on decision‐making behaviour; human responses to anxiety, including psychological defence modes and mechanisms; and groupthink research and writing.FindingsThe theoretical elaboration of the groupthink model centres on the idea that anxiety associated with a decision task triggers implicit motivations of anxiety reduction in groups, which are enacted through the activation of common defence mechanisms, thus resulting in the symptoms of defective decision making. A table that recasts the symptoms of groupthink as common defence mechanisms is provided.Research limitations/implicationsSuggestions are made for broadening the conceptual base of the groupthink model, including consideration of the research on negative and positive emotions.Practical implicationsThe article distinguishes between poor decision making due to groupthink and other causes. Remedies for the emergence of groupthink include better approaches to recognising and surfacing anxiety and other negative emotions, so they can be managed constructively. Such remedies complement more conventional methods of improving group decision making.Originality/valueThe article focuses on the underlying causes of premature concurrence seeking, an aspect of the groupthink model that is not well understood. It builds on Janis' explanation of anxiety as the main cause, by elaborating the linkages between the presence of anxiety, the symptoms of groupthink and the signs of defective decision making. In this, the article draws on research into the effects of negative emotions on decision‐making behaviour and related theories. It synthesises several research streams to provide a more comprehensive explanation of concurrence seeking.

The results revealed that students found a wide range of assessments motivating. There was some satisfaction with the mix and range of assessments. Three assessments emerged as the most motivating for student learning: Clinical/fieldwork II and III and Methods of inquiry III. In addition, four factors associated with assessment appeared to influence student motivation: perceived relevance and content of the assessment, enthusiastic lecturers and group influences. These factors need to be explored in more detail but in order to do so, educators need to be prepared to engage in an open dialogue with students about the learning climate that is created within higher education.