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Resource Stewardship

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https://www.readbyqxmd.com/read/28173888/current-state-of-antimicrobial-stewardship-in-children-s-hospital-emergency-departments
#1
Rakesh D Mistry, Jason G Newland, Jeffrey S Gerber, Adam L Hersh, Larissa May, Sarah M Perman, Nathan Kuppermann, Peter S Dayan
BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution...
February 8, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28157831/board-characteristics-governance-objectives-and-hospital-performance-an-empirical-analysis-of-german-hospitals
#2
Andrea Thiel, Vera Winter, Vera Antonia Büchner
BACKGROUND: There is a growing need for hospital supervisory boards to support hospital management in different areas, including (financial) monitoring, resource provision, stakeholder relationships, and strategic decision-making. Little is currently known about how boards' emphases on these various governance objectives contribute to performance. PURPOSE: Using a dominant logics perspective, this article aims to detect the governance logics that hospital boards emphasize, to determine whether there are distinct clusters of hospitals with the same sets of emphases, and to show how cluster membership relates to board characteristics and financial performance...
February 2, 2017: Health Care Management Review
https://www.readbyqxmd.com/read/28118861/a-report-of-the-efforts-of-the-veterans-health-administration-national-antimicrobial-stewardship-initiative
#3
Allison A Kelly, Makoto M Jones, Kelly L Echevarria, Stephen M Kralovic, Matthew H Samore, Matthew B Goetz, Karl J Madaras-Kelly, Loretta A Simbartl, Anthony P Morreale, Melinda M Neuhauser, Gary A Roselle
OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities...
January 25, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28112087/tackling-the-climate-targets-set-by-the-paris-agreement-cop-21-green-leadership-empowers-public-hospitals-to-overcome-obstacles-and-challenges-in-a-resource-constrained-environment
#4
E Weimann, B Patel
The healthcare sector itself contributes to climate change, the creation of hazardous waste, use of toxic metals such as mercury, and water and air pollution. To mitigate the effect of healthcare provision on the deteriorating environment and avoid creating further challenges for already burdened health systems, Global Green Hospitals was formed as a global network. Groote Schuur Hospital (GSH), as the leading academic hospital in Africa, joined the network in 2014. Since then, several projects have been initiated to reduce the amount of general waste, energy consumption and food waste, and create an environmentally friendlier and more sustainable hospital in a resource-constrained public healthcare setting...
December 21, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28100141/caring-to-learn-and-learning-to-care
#5
Kristin G Cloyes, Susan J Rosenkranz, Katherine P Supiano, Patricia H Berry, Meghan Routt, Sarah M Llanque, Kathleen Shannon-Dorcy
The increasing numbers of aging and chronically ill prisoners incarcerated in Western nations is well-documented, as is the growing need for prison-based palliative and end-of-life care. Less often discussed is specifically how end-of-life care can and should be provided, by whom, and with what resources. One strategy incorporates prisoner volunteers into end-of-life services within a peer-care program. This article reports on one such program based on focused ethnographic study including in-depth interviews with inmate hospice volunteers, nursing staff, and corrections officers working in the hospice program...
January 2017: Journal of Correctional Health Care
https://www.readbyqxmd.com/read/28093208/selective-reporting-of-antibiotic-susceptibility-test-results-in-european-countries-an-escmid-cross-sectional-survey
#6
Céline Pulcini, Gianpiero Tebano, Nico T Mutters, Evelina Tacconelli, Emmanuelle Cambau, Gunnar Kahlmeter, Vincent Jarlier
Selective reporting of antibiotic susceptibility test (AST) results is one possible laboratory-based antibiotic stewardship intervention. The primary aim of this study was to identify where and how selective reporting of AST results is implemented in Europe both in inpatient and in outpatient settings. An ESCMID cross-sectional, self-administered, internet-based survey was conducted among all EUCIC (European Committee on Infection Control) or EUCAST (European Committee on Antimicrobial Susceptibility Testing) national representatives in Europe and Israel...
January 10, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28056822/the-first-occurrence-of-a-ctx-m-esbl-producing-escherichia-coli-outbreak-mediated-by-mother-to-neonate-transmission-in-an-irish-neonatal-intensive-care-unit
#7
Ciara O'Connor, Roy K Philip, John Kelleher, James Powell, Alan O'Gorman, Barbara Slevin, Neil Woodford, Jane F Turton, Elaine McGrath, Cathriona Finnegan, Lorraine Power, Nuala H O'Connell, Colum P Dunne
BACKGROUND: Escherichia coli (E. coli) comprise part of the normal vaginal microflora. Transfer from mother to neonate can occur during delivery resulting, sometimes, in neonatal bacterial disease. Here, we aim to report the first outbreak of CTX-M ESBL-producing E. coli with evidence of mother-to-neonate transmission in an Irish neonatal intensive care unit (NICU) followed by patient-to-patient transmission. METHODS: Investigation including molecular typing was conducted...
January 5, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28034534/antimicrobial-stewardship-practices-in-virginia
#8
Kimberly B Lee, Jesus Aaron Ramirez, Rebeccah Collins, John Bucheit, Kakotan Sanogo, Michael P Stevens
The Society of Healthcare Epidemiology of America, the Centers for Disease Control and Prevention, and the President's Council of Advisors on Science and Technology recognize the need to combat antimicrobial resistance through the promotion of antimicrobial stewardship programs. Health care facilities in Virginia were surveyed using a 23-item survey focused on facility characteristics and antimicrobial stewardship strategies. Antimicrobial stewardship activities were highly variable and many are missing key personnel and resources...
December 26, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/28031432/implementation-of-rapid-molecular-infectious-disease-diagnostics-the-role-of-diagnostic-and-antimicrobial-stewardship
#9
Kevin Messacar, Sarah K Parker, James K Todd, Samuel R Dominguez
New rapid molecular infectious disease diagnostic technologies enable expedited accurate microbiologic diagnoses. However, diagnostic and antimicrobial stewardship are necessary to ensure these technologies conserve, rather than consume, additional health care resources and optimally impact patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and direct testing towards appropriate patients. Antimicrobial stewardship is needed to ensure prompt, appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside...
December 28, 2016: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/28027333/personalized-prescription-feedback-using-routinely-collected-data-to-reduce-antibiotic-use-in-primary-care-a-randomized-clinical-trial
#10
Lars G Hemkens, Ramon Saccilotto, Selene Leon Reyes, Dominik Glinz, Thomas Zumbrunn, Oliver Grolimund, Viktoria Gloy, Heike Raatz, Andreas Widmer, Andreas Zeller, Heiner C Bucher
Importance: Feedback interventions using routinely collected health data might reduce antibiotic use nationwide without requiring the substantial resources and structural efforts of other antibiotic stewardship programs. Objective: To determine if quarterly antibiotic prescription feedback over 2 years reduces antibiotic use when implemented in a complex health care system. Design, Setting, and Participants: Pragmatic randomized trial using routinely collected claims data on 2900 primary care physicians with the highest antibiotic prescription rates in Switzerland...
February 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28001135/a-survey-of-physicians-attitudes-toward-decision-making-authority-for-initiating-and-withdrawing-va-ecmo-results-and-ethical-implications-for-shared-decision-making
#11
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27999061/from-guidelines-to-practice-a-pharmacist-driven-prospective-audit-and-feedback-improvement-model-for-peri-operative-antibiotic-prophylaxis-in-34-south-african-hospitals
#12
Adrian J Brink, Angeliki P Messina, Charles Feldman, Guy A Richards, Dena van den Bergh
BACKGROUND: Few data exist on the implementation of process measures to facilitate adherence to peri-operative antibiotic prophylaxis (PAP) guidelines in Africa. OBJECTIVES: To implement an improvement model for PAP utilizing existing resources, in order to achieve a reduction in surgical site infections (SSIs) across a heterogeneous group of 34 urban and rural South African hospitals. METHODS: A pharmacist-driven, prospective audit and feedback strategy involving change management and improvement principles was utilized...
December 20, 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27975076/the-role-of-antimicrobial-stewardship-in-the-clinical-microbiology-laboratory-stepping-up-to-the-plate
#13
Shawn H MacVane, John M Hurst, Lisa L Steed
We report the development of a collaborative relationship between antimicrobial stewardship and clinical microbiology that incorporates stewardship practices into daily laboratory rounds. Antimicrobial stewardship involvement on rounds was a welcomed and effective initiative with substantial rates of intervention. New opportunities to positively impact use of antimicrobials and laboratory resources were realized.
October 2016: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/27934550/healthcare-resource-allocation-decisions-affecting-uninsured-services
#14
Krista Lyn Harrison, Holly A Taylor
Purpose Using the example of community access programs (CAPs), the purpose of this paper is to describe resource allocation and policy decisions related to providing health services for the uninsured in the USA and the organizational values affecting these decisions. Design/methodology/approach The study used comparative case study methodology at two geographically diverse sites. Researchers collected data from program documents, meeting observations, and interviews with program stakeholders. Findings Five resource allocation or policy decisions relevant to providing healthcare services were described at each site across three categories: designing the health plan, reacting to funding changes, and revising policies...
November 21, 2016: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/27927861/what-is-the-more-effective-antibiotic-stewardship-intervention-pre-prescription-authorization-or-post-prescription-review-with-feedback
#15
Pranita D Tamma, Edina Avdic, John F Keenan, Yuan Zhao, Gobind Anand, James Cooper, Rebecca Dezube, Steven Hsu, Sara E Cosgrove
BACKGROUND: The optimal approach to conducting antibiotic stewardship interventions has not been defined. We compared days of antibiotic therapy (DOT) using pre-prescription authorization (PPA) versus post-prescription review with feedback (PPRF) strategies. METHODS: A quasi-experimental, crossover trial comparing PPA and PPRF for adult inpatients prescribed any antibiotic was conducted. For the first four months, two medicine teams were assigned to the PPA arm and the other two teams to the PPRF arm...
December 7, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/27917966/enabling-sustainable-pastoralism-policies-and-investments-that-optimise-livestock-production-and-rangeland-stewardship
#16
R Ouedraogo, J Davies
Pastoralism is a system of dynamically managing livestock and land for economic, social and environmental benefit. To a large extent, pastoralism is an adaptation to ecological and climatic variability and is not simply a livestock production system but provides significant environmental services to humanity. Evidence from a range of national contexts shows that sustainable pastoralist development requires an understanding of the dual environmental and economic roles of pastoralism and an adaptation of policies and investments to support both...
November 2016: Revue Scientifique et Technique
https://www.readbyqxmd.com/read/27913975/clinical-impact-of-an-antibiotic-stewardship-program-at-a-children-s-hospital
#17
Brian R Lee, Jennifer L Goldman, Diana Yu, Angela L Myers, Leslie M Stach, Erin Hedican, Mary Anne Jackson, Jason G Newland
INTRODUCTION: Antibiotic stewardship programs (ASP) improve appropriate antibiotic use. Data are limited on the clinical benefit of ASPs in children's hospitals. This study's objective was to determine the impact of an ASP on length of stay (LOS) and readmission rate among patients admitted to children's hospitals. METHODS: Data from a prospective-audit-with-feedback ASP were used to examine the ASP review characteristics, including antibiotic(s) prescribed, clinical indication, recommendations made by the ASP, and agreement with recommendations...
December 2, 2016: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/27902375/improving-time-to-optimal-staphylococcus-aureus-treatment-using-a-penicillin-binding-protein-2a-assay
#18
Sonia N Rao, Sheila K Wang, Jose Gonzalez Zamora, Amy P Hanson, Radhika S Polisetty, Kamaljit Singh
The penicillin-binding protein 2a (PBP2a) assay is a quick, accurate and inexpensive test for determining methicillin susceptibility in Staphylococcus aureus. A pre-post-study design was conducted using a PBP2a assay with and without the impact of an antimicrobial stewardship intervention to improve time to optimal therapy for methicillin-susceptible and methicillin-resistant S. aureus isolates. Our results demonstrate significantly improved time to optimal therapy and support the use of a PBP2a assay as part of an programme for all healthcare facilities, especially those with limited resources...
December 2016: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/27880667/the-current-treatment-landscape-other-fungal-diseases-cryptococcosis-fusariosis-and-mucormycosis
#19
Olivier Lortholary, Mario Fernández-Ruiz, John R Perfect
Compared with major invasive mycoses such as aspergillosis and candidiasis, the antifungal stewardship management strategies of other fungal diseases have different opportunities and considerations. Cryptococcosis, fusariosis and mucormycosis are globally prevalent invasive fungal diseases (IFDs), but are not currently included in antifungal prophylaxis guidelines for immunocompromised hosts. Since the implementation of biomarkers as part of diagnostic screening strategies, the concept of pre-emptive antifungal therapy has emerged for these IFDs...
November 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27832047/core-elements-of-outpatient-antibiotic-stewardship
#20
Guillermo V Sanchez, Katherine E Fleming-Dutra, Rebecca M Roberts, Lauri A Hicks
The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients...
November 11, 2016: MMWR. Recommendations and Reports: Morbidity and Mortality Weekly Report. Recommendations and Reports
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