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Resource Stewardship

Michelle K Haas, Kristen Dalton, Bryan C Knepper, Sarah A Stella, Lilia Cervantes, Connie S Price, William J Burman, Philip S Mehler, Timothy C Jenkins
Background.  Syndrome-specific interventions are a recommended approach to antibiotic stewardship, but additional data are needed to understand their potential impact. We implemented an intervention to improve the management of inpatient community-acquired pneumonia (CAP) and evaluated its effects on antibiotic and resource utilization. Methods.  A stakeholder group developed and implemented a clinical practice guideline and order set for inpatient, non-intensive care unit CAP recommending a short course (5 days) of a fluoroquinolone-sparing antibiotic regimen in uncomplicated cases...
October 2016: Open Forum Infectious Diseases
A Brink, D Van den Bergh, M Mendelson, G A Richards
The optimisation of antibiotic use to maximise patient care and safety through antibiotic stewardship forms one of the cornerstones of the global response to antibiotic resistance. Stewardship efforts in low- and middle-income countries are challenged by lack of healthcare professionals trained in infection. Therefore, in resource-poor settings, the traditional model of infection specialist-led stewardship may be impractical, requiring new models to be developed. A recent South African study across 47 Netcare hospitals nationally highlighted the role of pharmacists in this regard, proving that non-specialised pharmacists can drive a prospective audit, feedback collaborative strategy and a range of improvement science principles to reduce antibiotic consumption by the same levels as that documented in high-resource, infection specialist-led stewardship programmes...
September 6, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Gabor Zilahi, Antonio Artigas, Ignacio Martin-Loeches
Over the last several decades, antibacterial drug use has become widespread with their misuse being an ever-increasing phenomenon. Consequently, antibacterial drugs have become less effective or even ineffective, resulting in a global health security emergency. The prevalence of multidrug-resistant organisms (MDROs) varies widely among regions and countries. The primary aim of antibiotic stewardship programs is to supervise the three most influential factors contributing to the development and transmission of MDROs, namely: (1) appropriate antibiotic prescribing; (2) early detection and prevention of cross-colonization of MDROs; and (3) elimination of reservoirs...
December 2016: Annals of Intensive Care
Adam Fusheini
BACKGROUND: National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004...
April 27, 2016: International Journal of Health Policy and Management
Vicki Kretsinger Grabert, Dawn Samara Kaback
No abstract text is available yet for this article.
September 26, 2016: Ground Water
Katherine Reyes, Ana Cecilia Bardossy, Marcus Zervos
Vancomycin-resistant enterococci (VRE) infections have acquired prominence as a leading cause of health care-associated infections. Understanding VRE epidemiology, transmission modes in health care settings, risk factors for colonization, and infection is essential to prevention and control of VRE infections. Infection control strategies are pivotal in management of VRE infections and should be based on patient characteristics, hospital needs, and available resources. Hand hygiene is basic to decrease acquisition of VRE...
September 19, 2016: Infectious Disease Clinics of North America
Prakash Kashwan
This article presents one of the first empirical studies of the demand for collective forest rights by forest-dependent groups locked in longstanding conflicts with government forestry agencies, which is a common feature of forested regions in the Global South. This analysis shows that (1) past engagements with community-based forest protection help foster demand for collective forest management rights despite the longstanding land use conflicts; (2) large areas of forest land affected by land use conflicts undermine the propensity of community groups to demand collective forest rights; (3) after the area affected by land use conflicts is controlled for, a larger number of land rights claimants is associated with a greater probability that a village group will claim collective forest rights; and (4) micro-institutional variables, particularly financial autonomy of village groups engaged in forest protection efforts, are likely to be among the main drivers of the local demand for collective forest management rights...
December 1, 2016: Journal of Environmental Management
K Weiss, A Simon
BACKGROUND: Antibiotic stewardship (ABS) and hospital hygiene have both been identified as key components to increase patient safety in hospital inpatients. To set the stage for a new approach in this field, a working group of German Pediatric Infectious Disease (PID) Specialists invented the Paed IC Project in 2012. METHODS: This article summarized the results of a qualitative study using telephone interviews, to which 18 German PID specialists were invited. RESULTS: All local study coordinators and additional PID specialists from the 11 paediatric tertiary care inpatient facilities consented to participate...
September 2016: Klinische Pädiatrie
F J Candel, A B García-García, M Peñuelas, A García-Alvarez, F Chiarella, L López-González, C García-Salguero, C Lejárraga, I Rodríguez-Avial
Antimicrobial resistance increases it health, social and economic impact. in all areas (state, regional and local), initiatives to try to contain the problem of resistance arise. In the update of this year 2016, we study microbiological, epidemiological and clinical aspects of multi-resistant bacteria, as well as resources for therapeutic approach, from ancient to modern drugs from therapeutic combinations to optimization Stewardship programs. In the case of fungal infection, we analyze clinical scenarios with different species in yeast or new clinical settings in filamentous fungi...
September 2016: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Adrian Y S Lee, Andrew R Hudspeth, Stephen Adelstein
The antinuclear antibody (ANA) tests are some of the more frequently requested tests for the diagnosis of autoimmunity. Although they are used primarily as diagnostic blood tests, multiple requests on the same patient continue to be encountered in the laboratory. This retrospective analysis of serial ANA testing at one pathology laboratory in Australia is the first study that examines the statistical concordance and possible implications of this on clinical practice. High-titred ANA have quite good repeatability for titre and pattern, and low-titred ANA, which can be non-specific, have poor repeatability...
October 2016: Pathology
Anand Lakhani, Elliot Lass, William K Silverstein, Karen B Born, Wendy Levinson, Brian M Wong
PROBLEM: Physician behaviors that promote overuse of health care resources develop early in training, and the medical education environment helps foster such behaviors. The authors describe the development of a Choosing Wisely list for medical students aimed at helping to curb overuse. APPROACH: The list was developed in 2015 by Choosing Wisely Canada (CWC) in partnership with the Canadian Federation of Medical Students and the Fédération médicale étudiante du Québec, which together represent all medical students in Canada...
October 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Christianne Micallef, Monsey McLeod, Enrique Castro-Sánchez, Myriam Gharbi, Esmita Charani, Luke Sp Moore, Mark Gilchrist, Fran Husson, Ceire Costelloe, Alison H Holmes
BACKGROUND: Current advances in modern technology have enabled the development and utilization of electronic medical software apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patients and the public are available, but very few target antimicrobials or infections. OBJECTIVE: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms, including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teaching hospital trusts in England...
2016: JMIR MHealth and UHealth
Onur Özgenç
The basic requirements of antibiotic prescribing are components of methodology; knowledge, logical reasoning, and analysis. Antimicrobial drugs are valuable but limited resources, different from other drugs and they are among the most commonly prescribed drugs all over the world. They are the only drugs which do not intentionally affect the patient. They affect the pathogens which invade the host. The emergence and spread of antibiotic-resistant pathogens are accelerated by heavy antibiotic usage. The effective antimicrobial stewardship and infection control program have been shown to limit the emergence of antimicrobial-resistant bacteria...
June 26, 2016: World Journal of Methodology
Adrian J Brink, Angeliki P Messina, Charles Feldman, Guy A Richards, Piet J Becker, Debra A Goff, Karri A Bauer, Dilip Nathwani, Dena van den Bergh
BACKGROUND: The available data on antimicrobial stewardship programmes in Africa are scarce. The aims of this study were to assess the implementation of an antimicrobial stewardship programme in a setting with limited infectious disease resources. METHODS: We implemented a pharmacist-driven, prospective audit and feedback strategy for antimicrobial stewardship on the basis of a range of improvement science and behavioural principles across a diverse group of urban and rural private hospitals in South Africa...
September 2016: Lancet Infectious Diseases
Atefeh Esfandiari, Arash Rashidian, Hossein Masoumi Asl, Abbas Rahimi Foroushani, Hedayat Salari, Ali Akbari Sari
BACKGROUND: Globally, the health and economic burden posed by health care-associated infections (HAIs) remains wide and severe. To curb the burden associated with HAIs, countries, including Iran, aim at HAI prevention and control. This study explores the challenges faced by the Iranian health system in addressing the issues associated with the prevention and control of HAIs. METHODS: A qualitative research method was adopted in exploring the phenomenon. We used the purposive sampling approach in reaching 24 key informants at the national and subnational levels...
June 13, 2016: American Journal of Infection Control
Chadd K Kraus, Catherine A Marco
The process of shared decision making (SDM) is an ethical imperative in the physician-patient relationship, especially in the emergency department (ED), where SDM can present unique challenges because patients and emergency physicians often have no established relationship and decisions about diagnosis, treatment, and disposition are time dependent. SDM should be guided by the ethical principles of autonomy, beneficence, nonmaleficence, and justice and the related principle of stewardship of finite resources...
August 2016: American Journal of Emergency Medicine
Phuong-Tan Nguyen-Ha, Denise Howrie, Kelli Crowley, Carol G Vetterly, William McGhee, Donald Berry, Elizabeth Ferguson, Emily Polischuk, Maria Mori Brooks, Jeffrey Goff, Terri Stillwell, Toni Darville, Ann E Thompson, James E Levin, Marian G Michaels, Michael Green
BACKGROUND: Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model. METHODS: The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines...
May 2016: Pediatrics
Ernest O Mensah, Moses K Aikins, Margaret Gyapong, Francis Anto, Moses J Bockarie, John O Gyapong
BACKGROUND: The global health system has a large arsenal of interventions, medical products and technologies to address current global health challenges. However, identifying the most effective and efficient strategies to deliver these resources to where they are most needed has been a challenge. Targeted and integrated interventions have been the main delivery strategies. However, the health system discourse increasingly favours integrated strategies in the context of functionally merging targeted interventions with multifunctional health care delivery systems with a focus on strengthening country health systems to deliver needed interventions...
May 2016: PLoS Neglected Tropical Diseases
John B Lynch
An institution that uses a value-based approach to manage and prevent problems related to the suboptimal use of antibiotics will improve its bottom line through: Efficiencies brought about by aggressive management of institutional resources. Reductions in hospital admission/readmission. Fewer complications. Better transitions in care. Increased revenues through preferential referrals.
March 2016: Healthcare Financial Management: Journal of the Healthcare Financial Management Association
Theodore Long, Mark T Silvestri, Meir Dashevsky, Andrea Halim, Robert L Fogerty
Background Cost awareness, to ensure physician stewardship of limited resources, is increasingly recognized as an important skill for physicians. The Accreditation Council for Graduate Medical Education has made cost awareness part of systems-based practice, a core competency of resident education. However, little is known about resident cost awareness. Objective We sought to assess senior resident self-perceived cost awareness and cost knowledge. Methods In March 2014, we conducted a cross-sectional survey of all emergency medicine, internal medicine, obstetrics and gynecology, orthopaedic surgery pediatrics, and medicine-pediatrics residents in their final year at Yale-New Haven Hospital...
May 2016: Journal of Graduate Medical Education
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