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Journal articleKnight GM, Costelloe C, Murray KA, et al., 2017,
Addressing the unknowns of antimicrobial resistance: quantifying and mapping the drivers of burden
, Clinical Infectious Diseases, Vol: 66, Pages: 612-616, ISSN: 1058-4838The global threat of antimicrobial resistance (AMR) has arisen through a network of complex interacting factors. Many different sources and transmission pathways contribute to the ever-growing burden of AMR in our clinical settings. The lack of data on these mechanisms and the relative importance of different factors causing the emergence and spread of AMR hampers our global efforts to effectively manage the risks. Importantly, we have little quantitative knowledge on the relative contributions of these sources and are likely to be targeting our interventions suboptimally as a result. Here we propose a systems mapping approach to address the urgent need for reliable and timely data in order to strengthen the response to AMR.
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Journal articleBasetti S, Hodgson J, Rawson TM, et al., 2017,
Scarlet fever: A guide for general practitioners
, London Journal of Primary Care, Vol: 9, Pages: 77-79, ISSN: 1757-1472There has been an increase in the incidence of scarlet fever with most cases presenting in General Practice and Emergency Departments. Cases present with a distinctive macro-papular rash, usually in children. This article aims to increase awareness of scarlet fever by highlighting key symptoms and stating potential complications if untreated. In patients who have the typical symptoms, a prescription of a suitable antibiotic such as phenoxymethylpenicillin (Penicillin V) should be made immediately to reduce the risk of complications and the spread of infection.
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Journal articleJheeta S, Franklin BD, 2017,
The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study
, BMC Health Services Research, Vol: 17, ISSN: 1472-6963BackgroundThe aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices.MethodsThe study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses’ medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre- versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend.ResultsObservations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3–6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9–5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1–2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8–4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications.ConclusionsFindings suggest no change in medication error rate, alth
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Journal articleSartelli M, Weber DG, Ruppe E, et al., 2017,
Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)
, World Journal of Emergency Surgery, Vol: 12, ISSN: 1749-7922 -
Journal articlePulcini C, Morel CM, Tacconelli E, et al., 2017,
Human resources estimates and funding for antibiotic stewardship teams are urgently needed
, Clinical Microbiology and Infection, Vol: 23, Pages: 785-787, ISSN: 1469-0691Antibiotic stewardship (AS) teams are essential actors for combating antibiotic-resistant bacteria in healthcare and community settings, and are routinely mentioned in national and international guidelines, recommendations and action plans. Usually, AS teams in resource-rich settings are multidisciplinary, made up of different experts, commonly including infectious diseases (ID) specialists, clinical microbiologists and pharmacists, adequately trained in antibiotic prescribing and stewardship [1].
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Journal articleSartelli M, Labricciosa FM, Barbadoro P, et al., 2017,
The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey
, WORLD JOURNAL OF EMERGENCY SURGERY, Vol: 12, ISSN: 1749-7922BackgroundAntimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world.MethodsA cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery.ResultsThe response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%).ConclusionThe
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Journal articleRawson T, Castro Sanchez E, Charani E, et al., 2017,
Involving citizens in priority setting for public health research: implementation in infection research
, Health Expectations, Vol: 21, Pages: 222-229, ISSN: 1369-7625BackgroundPublic sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research.MethodA scenario including six infection themes for funding was developed to assess citizen priorities for research funding. This was tested over two days at a university public festival. Votes were cast anonymously along with rationale for selection. The scenario was then implemented during a three-hour focus group exploring views on engagement in strategic decisions and in-depth evaluation of the tool.Results188/491(38%) prioritized funding research into drug-resistant infections followed by emerging infections(18%). Results were similar between both days. Focus groups contained a total of 20 citizens with an equal gender split, range of ethnicities and ages ranging from 18 to >70 years. The tool was perceived as clear with participants able to make informed comparisons. Rationale for funding choices provided by voters and focus group participants are grouped into three major themes: (i) Information processing; (ii) Knowledge of the problem; (iii) Responsibility; and a unique theme within the focus groups (iv) The potential role of citizens in decision making. Divergent perceptions of relevance and confidence of “non-experts” as decision makers were expressed.ConclusionVoting scenarios can be used to collect, en-masse, citizens' choices and rationale for research priorities. Ensuring adequate levels of citizen information and confidence is important to allow deployment in other formats.
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Journal articleBirgand GJC, Troughton R, Moore L, et al., 2017,
Blogging in infectious diseases and clinical microbiology: Assessment of the 'blogosphere' content
, Infection Control and Hospital Epidemiology, Vol: 38, Pages: 832-839, ISSN: 1559-6834Objective.To analyzeinfluential infectious diseases, antimicrobial stewardship, infection control, or medical microbiology blogs and bloggers.Setting. World Wide WebDesign. We conducted a systematic search for blogs in accordance with the PRISMA guidelines in September 2015.Methods.A snowball sampling approach was applied to identify blogs using various search engines. Blogs were eligible if they: 1) focused on infectious diseases (ID), antimicrobial stewardship (AMS), infection control (IC), or medical microbiology (MM); 2) were intended for health professionals, 3) were written in English and updated regularly. We mapped blogs/bloggers characteristics and used an innovative tool to assess their architecture and content. Motivations and perceptions of bloggers and readers were assessed. Results.A total of 88 blogs were identified. 28 (32%) focused on ID, 46 (52%) on MM and 14 (16%) in IC or AMS. Bloggers were mainly male, MD and/or PhD, 32 (36%) posted at least weekly, and 51 (58%) for a research purpose. The aims were considered clear for 23 (26%) blogs, the field covered was broad for 25 (28%), presentation was good for 22 (25%), 51 were easy to read (58%) and 46 included expert interpretation (52%). Among the top 10 blogs (2 equally-ranked), 3 focused on ID, 6 on MM and 2 on IC. Bloggers questioned were motivated by sharing independent expertise/opinion. Readers appreciated the concise messages given on scientific and practical updates.Conclusions.This study describes high level blogs in ID/IC/MM suggesting how bloggers should build/orientate blogs for readers, and highlighting current gaps in topics such as AMS.
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Journal articleNaylor NR, Zhu N, Hulscher M, et al., 2017,
Is antimicrobial stewardship cost-effective? A narrative review of the evidence
, Clinical Microbiology and Infection, Vol: 23, Pages: 806-811, ISSN: 1198-743XAIMS: This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship (AMS) programmes, to address the question 'is AMS cost-effective?', while providing resources and guidance for future research in this area. SOURCES: PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles. CONTENT: Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However, overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice. IMPLICATIONS: Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. Although the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalizability and usability of cost-effectiveness results.
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Journal articleSkodvin B, Aase K, Brekken AL, et al., 2017,
Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study
, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 2666-2672, ISSN: 0305-7453BackgroundMany countries are on the brink of establishing antibiotic stewardship programmes in hospitals nationwide. In a previous study we found that communication between microbiology laboratories and clinical units is a barrier to implementing efficient antibiotic stewardship programmes in Norway. We have now addressed the key communication barriers between microbiology laboratories and clinical units from a laboratory point of view.MethodsQualitative semi-structured interviews were conducted with 18 employees (managers, doctors and technicians) from six diverse Norwegian microbiological laboratories, representing all four regional health authorities. Interviews were recorded and transcribed verbatim. Thematic analysis was applied, identifying emergent themes, subthemes and corresponding descriptions.ResultsThe main barrier to communication is disruption involving specimen logistics, information on request forms, verbal reporting of test results and information transfer between poorly integrated IT systems. Furthermore, communication is challenged by lack of insight into each other’s area of expertise and limited provision of laboratory services, leading to prolonged turnaround time, limited advisory services and restricted opening hours.ConclusionsCommunication between microbiology laboratories and clinical units can be improved by a review of testing processes, educational programmes to increase insights into the other’s area of expertise, an evaluation of work tasks and expansion of rapid and point-of-care test services. Antibiotic stewardship programmes may serve as a valuable framework to establish these measures.
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