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Resource Stewardship

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https://www.readbyqxmd.com/read/28697159/outpatient-parenteral-antimicrobial-therapy-and-judicious-use-of-pediatric-emergency-resources
#1
Michael Xu, Quynh Doan
BACKGROUND: Pediatric returns to the emergency department (RTED) vary between 3% and 13% of the total ED volume of visits. However, the incidence and contribution of scheduled RTED on pediatric emergency department (PED) utilization is less clear. Antimicrobial stewardship programs on inpatient wards have been shown to improve judicious use of outpatient parenteral antimicrobial therapy (OPAT) in upon discharge. The implementation of such programs in PEDs has yet to be reported. The objectives of this study are to quantify the burden of scheduled RTED for OPAT on PED utilization and to examine how frequently OPAT use are supported by published practice standards for 3 common pediatric infections-cellulitis, pneumonia, and urinary tract infections...
July 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28689031/re-defining-the-characteristics-of-environmental-volunteering-creating-a-typology-of-community-scale-green-infrastructure
#2
Gemma Jerome, Ian Mell, Dave Shaw
One way to engage people with green infrastructure (GI) is as environmental volunteers. Previous studies explored the nature of such groups/projects in terms of the benefits they deliver such as their impact on levels of social capital within a pre-defined community. However, existing literature contributes little to our understanding of the composition, characteristics and mechanisms used to form and maintain these groups. As such, it is difficult to establish the influencing factors determining the capacity of a group to sustain its provision over time...
July 6, 2017: Environmental Research
https://www.readbyqxmd.com/read/28678309/fenticonazole-an-effective-topical-treatment-for-superficial-mycoses-as-the-first-step-of-antifungal-stewardship-program
#3
F Tumietto, L Giacomelli
The resistance of microorganisms to antimicrobial drugs is a major issue for public health, with important consequences in terms of morbidity, mortality and resource use. The phenomenon is so serious that in some areas of the world resistant strains to all available drugs have been selected. Many conditions may result in the development of resistance: they include the indiscriminate or inappropriate (e.g., for viral infection or colonization) use of antibiotics, the excessive duration of the prescribed treatment regimens, as well as inadequate dosing or administration routes...
June 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28662451/a-spatial-framework-for-targeting-urban-planning-for-pollinators-and-people-with-local-stakeholders-a-route-to-healthy-blossoming-communities
#4
Chloe C Bellamy, Alexander P N van der Jagt, Shelley Barbour, Mike Smith, Darren Moseley
Pollinators such as bees and hoverflies are essential components of an urban ecosystem, supporting and contributing to the biodiversity, functioning, resilience and visual amenity of green infrastructure. Their urban habitats also deliver health and well-being benefits to society, by providing important opportunities for accessing nature nearby to the homes of a growing majority of people living in towns and cities. However, many pollinator species are in decline, and the loss, degradation and fragmentation of natural habitats are some of the key drivers of this change...
June 26, 2017: Environmental Research
https://www.readbyqxmd.com/read/28655372/antibiotic-stewardship-new-frontier-familiar-journey
#5
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...
May 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28654801/hybrid-governance-of-aquaculture-opportunities-and-challenges
#6
Joanna Vince, Marcus Haward
The development of third party assessment and certification of fisheries and aquaculture has provided new forms of governance in sectors that were traditionally dominated by state based regulation. Emerging market based approaches are driven by shareholder expectations as well as commitment to corporate social responsibility, whereas community engagement is increasingly centered on the questions of social license to operate. Third party assessment and certification links state, market and community into an interesting and challenging hybrid form of governance...
June 24, 2017: Journal of Environmental Management
https://www.readbyqxmd.com/read/28642146/is-antimicrobial-stewardship-cost-effective-a-narrative-review-of-the-evidence
#7
REVIEW
Nichola R Naylor, Nina Zhu, Marlies Hulscher, Alison Holmes, Raheelah Ahmad, Julie V Robotham
AIMS: 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?", whilst 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...
June 19, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28595316/developing-a-local-antimicrobial-resistance-action-plan-the-cornwall-one-health-antimicrobial-resistance-group
#8
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
#9
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
#10
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...
July 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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
REVIEW
O J Dyar, G Tebano, C 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...
July 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
#17
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
#18
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
#19
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
#20
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
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