With the success of antiretroviral therapy (ART), non-human immunodeficiency virus (HIV)-related comorbidities like cardiovascular diseases (CVDs) are of increasing concern. We describe important recent research developments on the epidemiology of CVD in HIV infection, ART-related metabolic changes, and cardioprotective anti-inflammatory mechanisms, and summarize management strategies for CVD risk reduction. We systematically identified and analysed systematic reviews and most cited literature published in the last 3 years and supplemented findings with selected evidence based on clinical expertise. Among HIV-infected individuals, the prevalence of CVD risk factors and the risk for CVD is higher compared with HIV negatives. Antiretroviral drugs may induce dyslipidaemia, reduce insulin sensitivity, and promote body fat redistribution that additionally contributes to CVD risk. Some antiretroviral drugs may increase risk for CVD events, but the absolute risk increase is moderate and has to be put into perspective with the massive HIV-related benefits. Sustained HIV suppression reduces systemic inflammatory markers and is associated with a moderate reduction in CVD events. Regular CVD risk assessment and counselling to stop smoking must be regularly done in all HIV-infected individuals. Statins are effective for the treatment of dyslipidaemia in HIV infection, but drug interactions with ART need to be considered. Human immunodeficiency virus-infected individuals are at increased risk for CVD. Timely initiation of ART with consequent viral suppression is likely to reduce CVD events and to offset potential side effects from ART-induced metabolic changes. Reduction in smoking in HIV-infected individuals is a public health priority.

Antibiotic resistance is closely correlated with antibiotic use in primary care and is a major threat to public health.¹ Various antibiotic stewardship approaches involving communication training, specific education interventions, point-of-care testing, electronic decision support systems, and delayed prescribing have the strongest evidence base for beneficial effects on antibiotic prescribing.^2,3 However, their system-wide implementation would often require time, major resources, and substantial structural efforts. Prescription feedback interventions are less resource intensive, timely implementable and beneficial effects have been found across various medical fields.⁴ For antibiotic prescribing, however, current evidence is inconsistent and scarce,^2,3 in particular for a large-scale system-wide implementation with no direct patient or physician contact.^5-13 Existing large-scale trials evaluating prescription feedback did not continuously or specifically target high prescribers, were of short duration, and were implemented in settings not sharing the complexity of the Swiss or US health care system.^5,6

Background: Negative pressure wound therapy (NPWT) is a widely used method of wound treatment. We performed a systematic review of randomised controlled trials (RCTs) comparing the patient-relevant benefits and harms of NPWT with standard wound therapy (SWT) in patients with wounds healing by secondary intention. Methods: We searched for RCTs in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: July 2018) and screened reference lists of relevant systematic reviews and health technology assessments. Manufacturers and investigators were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome (e.g. wound closure). We assessed publication bias and, if feasible, performed meta-analyses, grading the results into different categories (hint, indication or proof of a greater benefit or harm). Results: We identified 48 eligible studies of generally low quality with evaluable data for 4315 patients and 30 eligible studies with missing data for at least 1386 patients. Due to potential publication bias (proportion of inaccessible data, 24%), we downgraded our conclusions. A meta-analysis of all wound healing data showed a significant effect in favour of NPWT (OR 1.56, 95% CI 1.15 to 2.13, p = 0.008). As further analyses of different definitions of wound closure did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. A meta-analysis of hospital stay (in days) showed a significant difference in favour of NPWT (MD − 4.78, 95% CI − 7.79 to − 1.76, p = 0.005). As further analyses of different definitions of hospital stay/readmission did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. There was neither proof (nor indication nor hint) of greater benefit or harm of NPWT for other patient-relevant outcomes such as mortality and adverse events. Conclusions: In summary, low-quality data indicate a greater benefit of NPWT versus SWT for wound closure in patients with wounds healing by secondary intention. The length of hospital stay is also shortened. The data show no advantages or disadvantages of NPWT for other patient-relevant outcomes. Publication bias is an important problem in studies on NPWT, underlining that all clinical studies need to be fully reported.

Most antibiotics in human medicine are prescribed in primary care for respiratory tract and urinary tract infections,^1-4 contributing to increased population-level antibiotic resistance.^5-7 Effective strategies to reduce antibiotic prescribing in primary care, like face-to-face education or communication training for primary care physicians, are resource intense, costly, challenging to apply on a large scale, and may not reach clinicians with high prescription rates who are not motivated to participate in such interventions.^8,9 Therefore, system-wide strategies to improve antibiotic use in primary care are needed. Peer comparison audit and feedback can be an effective tool to modify physician behavior and be applied on a health system level as a low-cost intervention for reducing antibiotic prescribing in primary care.^10-12 Only a few randomized clinical trials have evaluated audit and feedback interventions for antibiotic prescribing in primary care at the health system level. These trials have produced inconsistent results,^10,12-14 which may be owing to the intensity and type of feedback interventions, different settings, and baseline level of prescribing.