Towards precision medicine in sepsis: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.

BACKGROUND: Our current understanding of the pathophysiology and management of sepsis is associated with a lack of progress in clinical trials, which partly reflects insufficient appreciation of the heterogeneity of this syndrome. Consequently, more patient-specific approaches to treatment should be explored. AIMS: To summarize the current evidence on precision medicine in sepsis, with an emphasis on translation from theory to clinical practice. A secondary objective is to develop a framework enclosing recommendations on management and priorities for further research. SOURCES: A global search strategy was performed in the MEDLINE database through the PubMed search engine (last search December 2017). No restrictions of study design, time, or language were imposed. CONTENT: The focus of this Position Paper is on the interplay between therapies, pathogens, and the host. Regarding the pathogen, microbiologic diagnostic approaches (such as blood cultures (BCs) and rapid diagnostic tests (RDTs)) are discussed, as well as targeted antibiotic treatment. Other topics include the disruption of host immune system and the use of biomarkers in sepsis management, patient stratification, and future clinical trial design. Lastly, personalized antibiotic treatment and stewardship are addressed (Fig. 1). IMPLICATIONS: A road map provides recommendations and future perspectives. RDTs and identifying drug-response phenotypes are clear challenges. The next step will be the implementation of precision medicine to sepsis management, based on theranostic methodology. This highly individualized approach will be essential for the design of novel clinical trials and improvement of care pathways.

[Supervisors being assessed]. / Supervisoren onder het vergrootglas.

OBJECTIVE: Since 2015, a permanent quality cycle is mandatory for medical residency specialist training. One aspect of this cycle is the System for Evaluation of Teaching Qualities (SETQ), which allows trainees to give feedback about their supervisor. We analysed how these quality evaluations are discussed within groups of supervisors. DESIGN: Questionnaire study amongst residency training program directors. METHOD: From September 2013 till February 2014, an online questionnaire was distributed amongst 255 program directors of medical residency specialist training in 54 teaching hospitals. The questionnaire assessed (a) if feedback was discussed, (b) the purpose of the feedback discussions, (c) their format, (d) the perceived outcomes and (e) any need for supervisor support in relation to any future feedback discussions. RESULTS: The response rate for the questionnaire was 61%. The majority of supervisor groups (86%) followed up on their individual SETQ feedback. Formats included individually between the program director and supervisor (34%), in a peer group of supervisors (69%), and in group format involving both trainees and supervisors (68%). Respondents listed the mutual learning process and devising improvement plans as aims of discussing feedback in a group format. There is considerable variation between groups of supervisors in terms of how the feedback is discussed. Over fifty percent of the group discussions resulted in concrete agreements for improvement plans. CONCLUSION: The feedback by trainees on the teaching performance of their supervisors is not wasted. The vast majority of supervisors follow up on their teaching performance feedback in peer group meetings.