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https://www.readbyqxmd.com/read/28595316/developing-a-local-antimicrobial-resistance-action-plan-the-cornwall-one-health-antimicrobial-resistance-group
#1
Neil Powell, Iain Davidson, Phillip Yelling, Andrew Collinson, Adam Pollard, Lisa Johnson, Nick Gibson, Jennifer Taylor, Kathryn Wisner, William Gaze, Janice South, Diane Ashiru-Oredope
Objectives: The UK Five Year Antimicrobial Resistance (AMR) Strategy was published in September 2013 and recommended a One Health approach emphasizing the importance of collaboration to tackle AMR. We describe the inauguration of what we believe to be the first regional One Health group established in the UK. The purpose of the group was to ensure the implementation of a coordinated Cornwall-wide response to the UK AMR Strategy and we describe the outputs of the group to date. Methods: The Cornwall Antimicrobial Resistance Group was set up as a sub-group of the Health & Wellbeing Board's Health Protection Committee...
June 7, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28588766/how-externalities-impact-an-evaluation-of-strategies-to-prevent-antimicrobial-resistance-in-health-care-organizations
#2
REVIEW
Jenine R Leal, John Conly, Elizabeth Ann Henderson, Braden J Manns
BACKGROUND: The rates of antimicrobial-resistant organisms (ARO) continue to increase for both hospitalized and community patients. Few resources have been allocated to reduce the spread of resistance on global, national and local levels, in part because the broader economic impact of antimicrobial resistance (i.e. the externality) is not fully considered when determining how much to invest to prevent AROs, including strategies to contain antimicrobial resistance, such as antimicrobial stewardship programs...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28573434/the-whole-price-of-vancomycin-toxicities-troughs-and-time
#3
Meghan N Jeffres
Vancomycin is a glycopeptide antibiotic that is active against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus. Nephrotoxicity, which is usually reversible, is the most serious common adverse effect of vancomycin. Vancomycin-associated nephrotoxicity prolongs hospital stays, imposes a need for additional antibiotics and, in rare circumstances, dialysis treatment, and increases medical costs and mortality. Risk factors for nephrotoxicity include the dose and duration of vancomycin treatment, serum trough concentration, patient characteristics, and concomitant receipt of nephrotoxins...
June 1, 2017: Drugs
https://www.readbyqxmd.com/read/28532194/cost-effectiveness-of-ceftolozane-tazobactam-plus-metronidazole-compared-with-piperacillin-tazobactam-as-empiric-therapy-for-the-treatment-of-complicated-intra-abdominal-infections-based-on-the-in-vitro-surveillance-of-bacterial-isolates-in-the-uk
#4
Vimalanand Prabhu, Jason Foo, Harblas Ahir, Eric Sarpong, Sanjay Merchant
AIMS: An increase in the prevalence of antimicrobial resistance among gram-negative pathogens has been noted recently. A challenge in empiric treatment of complicated intra-abdominal infection (cIAI) is identifying initial appropriate antibiotic therapy, which is associated with reduced length of stay and mortality compared with inappropriate therapy. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam + metronidazole compared with piperacillin/tazobactam (commonly used in this indication) in the treatment of patients with cIAI in UK hospitals...
June 8, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28526311/dramatic-effects-of-a-new-antimicrobial-stewardship-program-in-a-rural-community-hospital
#5
Claudia R Libertin, Stephanie H Watson, William L Tillett, Joy H Peterson
BACKGROUND: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28479995/genetic-structure-among-greater-white-fronted-goose-populations-of-the-pacific-flyway
#6
Craig R Ely, Robert E Wilson, Sandra L Talbot
An understanding of the genetic structure of populations in the wild is essential for long-term conservation and stewardship in the face of environmental change. Knowledge of the present-day distribution of genetic lineages (phylogeography) of a species is especially important for organisms that are exploited or utilize habitats that may be jeopardized by human intervention, including climate change. Here, we describe mitochondrial (mtDNA) and nuclear genetic (microsatellite) diversity among three populations of a migratory bird, the greater white-fronted goose (Anser albifrons), which breeds discontinuously in western and southwestern Alaska and winters in the Pacific Flyway of North America...
May 2017: Ecology and Evolution
https://www.readbyqxmd.com/read/28472291/antibiotic-stewardship-in-small-hospitals-barriers-and-potential-solutions
#7
Edward Stenehjem, David Y Hyun, Ed Septimus, Kalvin C Yu, Marc Meyer, Deepa Raj, Arjun Srinivasan
Antibiotic stewardship programs (ASPs) improve antibiotic prescribing. 73% of United States (US) hospitals have < 200 beds. Small hospitals (< 200 beds) have similar rates of antibiotic prescribing compared to large hospitals but the majority of small hospitals lack ASPs that satisfy the Centers for Disease Control and Prevention's (CDC) core elements. All hospitals, regardless of size, are now required to have ASPs by The Joint Commission and the Centers for Medicare and Medicaid Services has proposed a similar requirement...
May 2, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28459897/association-of-inpatient-antimicrobial-utilization-measures-with-antimicrobial-stewardship-activities-and-facility-characteristics-of-veterans-affairs-medical-centers
#8
Christopher J Graber, Makoto M Jones, Ann F Chou, Yue Zhang, Matthew Bidwell Goetz, Karl Madaras-Kelly, Matthew H Samore, Peter A Glassman
BACKGROUND: Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. Antimicrobial stewardship programs (ASPs) have been advocated to improve antimicrobial utilization, but program implementation is variable. OBJECTIVE: To determine associations between ASPs and facility characteristics, and inpatient antimicrobial utilization measures in the Veterans Affairs (VA) system in 2012. DESIGN: In 2012, VA administered a survey on antimicrobial stewardship practices to designated ASP contacts at VA acute care hospitals...
May 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28433726/managing-responsible-antimicrobial-use-perspectives-across-the-healthcare-system
#9
REVIEW
Oliver J Dyar, Gianpiero Tebano, Céline Pulcini
BACKGROUND: Healthcare systems consist of building blocks. Shaping how these building blocks function and interact can promote responsible antimicrobial use, and this represents an important opportunity for managers at different points within healthcare systems to act upon. AIMS: To review real-world examples of how healthcare systems can promote responsible antimicrobial use, focusing on the role of governance and managers. SOURCES: We searched and reviewed existing literature and official documents, which mostly focused on antibiotics...
April 19, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28424768/model-based-policymaking-a-framework-to-promote-ethical-good-practice-in-mathematical-modeling-for-public-health-policymaking
#10
Lisa A Boden, Iain J McKendrick
Mathematical models are increasingly relied upon as decision support tools, which estimate risks and generate recommendations to underpin public health policies. However, there are no formal agreements about what constitutes professional competencies or duties in mathematical modeling for public health. In this article, we propose a framework to evaluate whether mathematical models that assess human and animal disease risks and control strategies meet standards consistent with ethical "good practice" and are thus "fit for purpose" as evidence in support of policy...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28371928/does-electronic-stewardship-work
#11
Barbara B Lambl, Nathan Kaufman, Janice Kurowski, W O'Neill, Frederick Buckley, Maureen Duram, Barbara Swartz, Duncan Phillips, Mitchell Rein, Marc Rubin
Faced with national requirements to promote antimicrobial stewardship and reduce drug-resistant infections, community hospitals are challenged to make the best use of existing resources. Eighteen months after building antibiotic decision support into our electronic order platform, high-risk antibiotic use decreased by 83% (P < .001) at our community hospital. Hospital-acquired Clostridium difficile infections declined 24% (P = .07).
March 21, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28298480/antimicrobial-stewardship-programmes-bedside-rationing-by-another-name
#12
Simon Oczkowski
Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general...
March 15, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28295871/promoting-resource-stewardship-reducing-inappropriate-free-thyroid-hormone-testing
#13
Julie A Gilmour, Alanna Weisman, Steven Orlov, Robert J Goldberg, Alyse Goldberg, Hayley Baranek, Geetha Mukerji
RATIONALE: Free thyroxine (fT4) and free triiodothyronine (fT3) tests are often ordered when not clinically warranted. Preventing laboratory overuse by reducing inappropriate fT4 and fT3 testing is one strategy to promote resource stewardship. OBJECTIVES: (1) To characterize the frequency of inappropriate fT4 and fT3 testing and (2) to implement a quality improvement strategy aimed at reducing the number of these tests performed. METHODS: Quality improvement tools were used to create sequential change ideas: (1) education of physicians regarding appropriate indications for ordering fT4/fT3 and (2) implementation of a hospital-wide laboratory and forced-function system with a reflex fT4...
March 14, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28270268/antibiotic-stewardship-new-frontier-familiar-journey
#14
Caren McHenry Martin
Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts...
March 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28261580/a-blueprint-to-evaluate-one-health
#15
Simon R Rüegg, Barry J McMahon, Barbara Häsler, Roberto Esposito, Liza Rosenbaum Nielsen, Chinwe Ifejika Speranza, Timothy Ehlinger, Marisa Peyre, Maurizio Aragrande, Jakob Zinsstag, Philip Davies, Andrei Daniel Mihalca, Sandra C Buttigieg, Jonathan Rushton, Luís P Carmo, Daniele De Meneghi, Massimo Canali, Maria E Filippitzi, Flavie Luce Goutard, Vlatko Ilieski, Dragan Milićević, Helen O'Shea, Miroslav Radeski, Richard Kock, Anthony Staines, Ann Lindberg
One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28225697/who-should-ration
#16
Philip M Rosoff
A principal component of physician decision making is judging what interventions are clinically appropriate. Due to the inexorable and steady increase of health care costs in the US, physicians are constantly being urged to exercise judicious financial stewardship with due regard for the financial implications of what they prescribe. When applied on a case-by-case basis, this otherwise reasonable approach can lead to either inadvertent or overt and arbitrary restriction of interventions for some patients rather than others on the basis of clinically irrelevant characteristics such as ethnicity, gender, age, or skin color...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28173888/current-state-of-antimicrobial-stewardship-in-children-s-hospital-emergency-departments
#17
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
#18
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
#19
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
#20
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
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