Sikkens, J.J.; Agtmael, M.A. van; Peters, E.J.G.; Lettinga, K.D.; Kuip, M. van der; Vandenbroucke-Grauls, C.M.J.E.; Wagner, C.; Kramer, M.H.H.
Importance: Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. Objective: To examine whether an
This was followed by quinolones and cephalosporin. Ciprofloxacin and cephalexin were the most commonly prescribed quinolones and cephalosporins respectively. Gentamycin was ... Conclusion: Broad spectrum and older generation antibacterials were the predominantly utilized antimicrobials in this survey. Agents like ...
Speksnijder, D.C.; Jaarsma, A.D.C.; Gugten, van der, A.C.; Verheij, T.J.M.; Wagenaar, J.A.
Antimicrobial use in farm animals might contribute to the development of antimicrobial resistance in humans and animals, and there is an urgent need to reduce antimicrobial use in farm animals. Veterinarians are typically responsible for prescribing and overseeing antimicrobial use in animals. A thorough understanding of veterinarians' current prescribing practices and their reasons to prescribe antimicrobials might offer leads for interventions to reduce antimicrobial use in farm animals. Th...
Speksnijder, D. C.; Jaarsma, A. D C; van der Gugten, A. C.; Verheij, T. J M; Wagenaar, J. A.
Antimicrobial use in farm animals might contribute to the development of antimicrobial resistance in humans and animals, and there is an urgent need to reduce antimicrobial use in farm animals. Veterinarians are typically responsible for prescribing and overseeing antimicrobial use in animals. A
Speksnijder, D.C.; Jaarsma, A.D.C.; Gugten, van der A.C.; Verheij, T.J.M.; Wagenaar, J.A.
Antimicrobial use in farm animals might contribute to the development of antimicrobial resistance in humans and animals, and there is an urgent need to reduce antimicrobial use in farm animals. Veterinarians are typically responsible for prescribing and overseeing antimicrobial use in animals. A
Speksnijder, D. C.; Jaarsma, A. D. C.; van der Gugten, A. C.; Verheij, T. J. M.; Wagenaar, J. A.
Antimicrobial use in farm animals might contribute to the development of antimicrobial resistance in humans and animals, and there is an urgent need to reduce antimicrobial use in farm animals. Veterinarians are typically responsible for prescribing and overseeing antimicrobial use in animals. A
Full Text Available The introduction of an antimicrobial stewardship (AMS program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the prescribing etiquette described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs.
Sikkens, Jonne J; van Agtmael, Michiel A; Peters, Edgar J G; Lettinga, Kamilla D; van der Kuip, Martijn; Vandenbroucke-Grauls, Christina M J E; Wagner, Cordula; Kramer, Mark H H
Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. The Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. We offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing. Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time. A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531
Full Text Available Objectives: Antimicrobial stewardship programs have been designed to measure and improve the use of antimicrobials to achieve optimal clinical outcomes and reduce bacterial resistance. The aim of this study was to review patterns of antimicrobial prescribing for hospitalized patients in the acute care setting and assess the appropriateness of antimicrobial use among prescribers in a tertiary care hospital in Oman. Methods: We conducted a retrospective audit of the appropriateness of antimicrobial prescribing in patients admitted to acute care settings in a tertiary care hospital in Oman over a four-week period (1 November to 28 November 2012. The data of all discharged patients were retrieved from the department databases. Patient records and prescriptions were reviewed by an infectious disease consultant. The rationality of antimicrobial use was evaluated, analyzed, and judged based on local standard guidelines and the experience of the evaluating consultant. Results: There were 178 patients discharged from acute medical teams over the study period. Sixty-four percent of the patients received a total of 287 antimicrobial agents during admission. The average number of antimicrobials prescribed per patient in those prescribed antimicrobials was 2.5±1.1. The most commonly prescribed antimicrobial agent was piperacillin/tazobactam. Most patients had infections from gram-negative organisms, and high rates of extended spectrum beta-lactamase producing organisms were observed. Cultures were obtained before antimicrobial initiation in 25% of patients. Variability in antimicrobial selection for common infections was observed. Conclusions: National guidelines for the management of common infections are needed to minimize the overuse and misuse of antimicrobial agents in tertiary care hospitals. A large surveillance study on antimicrobial prescribing appropriateness in different hospital settings is warranted.
Livorsi, Daniel J; Linn, Carrie M; Alexander, Bruce; Heintz, Brett H; Tubbs, Traviss A; Perencevich, Eli N
OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits. DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared. SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center. RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider's volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; P<.01) and the primary care setting (r=0.82; P=0.03). CONCLUSIONS In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider's rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers. Infect Control Hosp Epidemiol 2018;39:64-70.
Speksnijder, D C; Jaarsma, A D C; van der Gugten, A C; Verheij, T J M; Wagenaar, J A
Antimicrobial use in farm animals might contribute to the development of antimicrobial resistance in humans and animals, and there is an urgent need to reduce antimicrobial use in farm animals. Veterinarians are typically responsible for prescribing and overseeing antimicrobial use in animals. A thorough understanding of veterinarians' current prescribing practices and their reasons to prescribe antimicrobials might offer leads for interventions to reduce antimicrobial use in farm animals. This paper presents the results of a qualitative study of factors that influence prescribing behaviour of farm animal veterinarians. Semi-structured interviews with eleven farm animal veterinarians were conducted, which were taped, transcribed and iteratively analysed. This preliminary analysis was further discussed and refined in an expert meeting. A final conceptual model was derived from the analysis and sent to all the respondents for validation. Many conflicting interests are identifiable when it comes to antimicrobial prescribing by farm animal veterinarians. Belief in the professional obligation to alleviate animal suffering, financial dependency on clients, risk avoidance, shortcomings in advisory skills, financial barriers for structural veterinary herd health advisory services, lack of farmers' compliance to veterinary recommendations, public health interests, personal beliefs regarding the veterinary contribution to antimicrobial resistance and major economic powers are all influential determinants in antimicrobial prescribing behaviour of farm animal veterinarians. Interventions to change prescribing behaviour of farm animal veterinarians could address attitudes and advisory skills of veterinarians, as well as provide tools to deal with (perceived) pressure from farmers and advisors to prescribe antimicrobials. Additional (policy) measures could probably support farm animal veterinarians in acting as a more independent animal health consultant. © 2014 Blackwell
Smith, Sue; Hawker, Jeremy I; Smith, Gillian E; Morbey, Roger; Johnson, Alan P; Fleming, Douglas M; Shallcross, Laura; Hayward, Andrew C
A key component of strategies to reduce antimicrobial resistance is better antimicrobial prescribing. The majority of antibiotics are prescribed in primary care. While many existing surveillance systems can monitor trends in the quantities of antibiotics prescribed in this setting, it can be difficult to monitor the quality of prescribing as data on the condition for which prescriptions are issued are often not available. We devised a standardized methodology to facilitate the monitoring of condition-specific antibiotic prescribing in primary care. We used a large computerized general practitioner database to develop a standardized methodology for routine monitoring of antimicrobial prescribing linked to clinical indications in primary care in the UK. Outputs included prescribing rate by syndrome and percentages of consultations with antibiotic prescription, for recommended antibiotic, and of recommended treatment length. The standardized methodology can monitor trends in proportions of common infections for which antibiotics were prescribed, the specific drugs prescribed and duration of treatment. These data can be used to help assess the appropriateness of antibiotic prescribing and to assess the impact of prescribing guidelines. We present a standardized methodology that could be applied to any suitable national or local database and adapted for use in other countries. © Crown copyright 2017.
Charani, Esmita; Edwards, Rachel; Sevdalis, Nick; Alexandrou, Banos; Sibley, Eleanor; Mullett, David; Franklin, Bryony Dean; Holmes, Alison
Antimicrobial use in acute care is widely reported to be suboptimal. Inappropriate use of antimicrobials is a major contributing factor to the emergence of multidrug resistance and health care-associated infection. Addressing prescribing behavior is a key component of antimicrobial stewardship. We performed a novel systematic review of both qualitative and quantitative literature on antimicrobial prescribing behavior in acute care. We assessed the extent to which behavioral sciences and social marketing were used and whether this could be related to the effectiveness of reported outcomes. MEDLINE, Excerpta Medica Database (EMBASE), Applied Social Sciences Index and Abstracts (ASSIA), Business Source Complete, The Cochrane Library, PsychInfo, Database of Abstracts of Reviews of Effectiveness (DARE) and Health Management Information Consortium (HMIC) were searched for studies undertaken during the period January 1999-April 2011 and published in English. Five qualitative and 5 quantitative studies met the quality criteria. Qualitative studies highlight the predominant influence of social norms, attitudes, and beliefs on antimicrobial prescribing behavior. Quantitative studies reporting interventions to optimize antimicrobial prescribing behavior do not use theoretical science or primary research to inform the design and choice of the interventions deployed. Despite qualitative evidence demonstrating the impact of behavioral determinants and social norms on prescribing, these influences are not given due consideration in the design and evaluation of interventions. To ensure a better understanding of prescribing behaviors and to improve the quality of interventions and research in this area, the incorporation and application of behavioral sciences supported by appropriate multidisciplinary collaboration is recommended.
Ahluwalia, Sanjiv; Sadak, Mohamed; Ashworth, Mark
Introduction Seventy-five percent of all antimicrobials are prescribed in primary care. There is a growing concern about inappropriate oral antimicrobial prescribing. Interventions to enhance antimicrobial stewardship are actively promoted through educational and other means. GP training practice status has been shown to influence patient care. This study seeks to study the influence of GP training practice status on antimicrobial prescribing. Methods A cross-sectional analysis of practice antimicrobial prescribing data was conducted for the year 2015-2016 comparing training and non-training practices across England. Data for all practices and prescribing was obtained from NHS Digital. Univariate analyses were conducted on the two measures of antibiotic prescribing included in the study. Multivariable regression models were constructed to identify the predictors of antibiotic prescribing volumes and of broad spectrum antibiotic prescribing. Results GP training practice status was a significant predictor of overall antibiotic prescribing volume, B = -0.009 (95% confidence intervals, -0.012, -0.005), p < 0.001. GP training practices prescribed fewer antibiotics, representing a reduction of 6.2 centiles from the median. GP training practice status was also a significant predictor of broad spectrum antibiotic prescribing, B = -0.3 (95% confidence intervals, -0.04, -0.01), p = 0.001. GP training practices prescribed fewer broad spectrum antibiotics, representing a reduction from the median of 6.0 centiles. Discussion Training practices prescribe fewer antimicrobials overall and specifically fewer broad spectrum oral antimicrobials (quinolones and cephalosporins). There is a need for further research to understand the interplay between postgraduate GP training and reductions in antimicrobial prescribing.
Lambert, M F; Masters, G A; Brent, S L
Antimicrobial drug resistance is a significant cause of avoidable morbidity and mortality. Inappropriate prescribing of antimicrobials is acknowledged as a key determinant of this phenomenon. Many approaches are advocated for reducing this inappropriate prescribing, including regulatory, professional and educational interventions. Mass media campaigns are often suggested as a useful tool in managing public expectations, but the evidence to support this is weak, as no controlled studies of such campaigns exist. Evaluating such campaigns is problematic, and uncontrolled observations are misleading. We report here the first controlled study of such an intervention in the use of antimicrobials. Two sequential mass media campaigns, providing information on the appropriate use of antimicrobials, were conducted during early 2004 and 2005 in the North East of England. These messages were articulated in the campaign by the cartoon character 'Moxy Malone'. The campaigns were supported by printed materials, and in parts of this area, with professional education and prescribing support. A retrospective controlled before-after study was conducted, examining the effects on observed prescribing of antimicrobials for the populations covered by these two cycles of mass media campaigns. These populations were controlled with matched populations in the North of England. The primary outcome examined was prescribing rates (items) for all microbial agents for these populations, corrected for population structure (STAR-PU). A repeated measures analysis of variance (ANOVA) was used to analyse factors that had a possible effect on the prescribing of antibacterial drugs. This was supported by a survey of primary care organizations (PCOs) of all interventions undertaken around antimicrobial use in the intervention and comparison populations. In this retrospective study, there was incomplete reporting of adjuvant interventions undertaken by the PCOs intervention and comparison areas, so
van Buul, L.W.; Sikkens, J.J.; van Agtmael, M.A.; Kramer, M.H.H.; van der Steen, J.T.; Hertogh, C.M.P.M.
It is challenging to change physicians' antimicrobial prescribing behaviour. Although antimicrobial prescribing is determined by contextual (e.g. a lack of guidelines), cultural (e.g. peer practice) and behavioural (e.g. perceived decision making autonomy) factors, most antimicrobial stewardship
Papoutsi, Chrysanthi; Mattick, Karen; Pearson, Mark; Brennan, Nicola; Briscoe, Simon; Wong, Geoff
Antimicrobial resistance has led to widespread implementation of interventions for appropriate prescribing. However, such interventions are often adopted without an adequate understanding of the challenges facing doctors-in-training as key prescribers. The review followed a realist, theory-driven approach to synthesizing qualitative, quantitative and mixed-methods literature. Consistent with realist review quality standards, articles retrieved from electronic databases were systematically screened and analysed to elicit explanations of antimicrobial prescribing behaviours. These explanations were consolidated into a programme theory drawing on social science and learning theory, and shaped though input from patients and practitioners. By synthesizing data from 131 articles, the review highlights the complex social and professional dynamics underlying antimicrobial prescribing decisions of doctors-in-training. The analysis shows how doctors-in-training often operate within challenging contexts (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels, uncertainty about application of knowledge in practice) where they prioritize particular responses (fear of criticism and individual responsibility, managing one's reputation and position in the team, appearing competent). These complex dynamics explain how and why doctors-in-training decide to: (i) follow senior clinicians' prescribing habits; (ii) take (or not) into account prescribing aids, advice from other health professionals or patient expectations; and (iii) ask questions or challenge decisions. This increased understanding allows for targeted tailoring, design and implementation of antimicrobial prescribing interventions. This review contributes to a better understanding of how antimicrobial prescribing interventions for doctors-in-training can be embedded more successfully in the hierarchical and inter-professional dynamics of
Boesten, J.; Harings, L.; Winkens, B.; Knottnerus, A.; Weijden, G.D.E.M. van der
: Since guidelines on antibiotic drug treatment often focus on appropriate first choice drugs, assessment of guideline adherence should only concentrate on the first drug prescribed, and not on subsequent antibiotics prescribed after failure of the first one. PURPOSE: To determine a valid cut-off
Oliver, Stefanie Jane; Cush, James; Ward, Jeanette E
To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee. Prescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee. As AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.
Adams, Samantha; de Bont, Antoinette
Recent medical informatics and sociological literature has painted the image of a new type of patient--one that is reflexive and informed, with highly specified information needs and perceptions, as well as highly developed skills and tactics for acquiring information. Patients have been re-named "reflexive consumers." At the same time, literature about the questionable reliability of web-based information has suggested the need to create both user tools that have pre-selected information and special guidelines for individuals to use to check the individual characteristics of the information they encounter. In this article, we examine suggestions that individuals must be assisted in developing skills for "reflexive consumerism" and what these particular skills should be. Using two types of data (discursive data from websites and promotional items, and supplementary data from interviews and ethnographic observations carried out with those working to sustain these initiatives), we examine how users are directly addressed and discussed. We argue that these initiatives prescribe skills and practices that extend beyond finding and assessing information on the internet and demonstrate that they include ideals of consumerism and citizenship.
Fertner, Mette Ely; Sanchez, Javier; Boklund, Anette
The emergence of pathogens resistant to antimicrobials has prompted political initiatives targeting a reduction in the use of veterinary antimicrobials in Denmark, especially for pigs. This study elucidates the tendency of pig farms with a significantly higher antimicrobial use to remain...... in clusters in certain geographical regions of Denmark. Animal Daily Doses/100 pigs/day were calculated for all three age groups of pigs (weaners, finishers and sows) for each quarter during 2012-13 in 6,143 commercial indoor pig producing farms. The data were split into four time periods of six months....... Repeated spatial cluster analyses were performed to identify persistent clusters, i.e. areas included in a significant cluster throughout all four time periods. Antimicrobials prescribed for weaners did not result in any persistent clusters. In contrast, antimicrobial use in finishers clustered...
Panesar, Preet; Jones, Alisdair; Aldous, Alicia; Kranzer, Katharina; Halpin, Eamus; Fifer, Helen; Macrae, Bruce; Curtis, Carmel
Objectives Our hospital replaced the format for delivering portable antimicrobial prescribing guidance from a paper-based pocket guide to a smartphone application (app). We used this opportunity to assess the relationship between its use and the attitudes and behaviours of antimicrobial prescribers. Methods We used 2 structured cross-sectional questionnaires issued just prior to and 3 months following the launch of the smartphone app. Ordinal Likert scale responses to both frequencies of use and agreement statements permitted quantitative assessment of the relationship between variables. Results The smartphone app was used more frequently than the pocket guide it replaced (p Smartphone apps are an effective and acceptable format to deliver guidance on antimicrobial prescribing. Our findings suggest that they may empower users to challenge incorrect prescribing, breaking well-established behaviours, and thus supporting vital stewardship efforts in an era of increased antimicrobial resistance. Future work will need to focus on the direct impact on drug prescriptions as well as identifying barriers to implementing smartphone apps in other clinical settings. PMID:27111775
Stefanie Jane Oliver
Full Text Available BackgroundTo support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing.What we didFinding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee.What we learnedPrescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60% about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee.Strengthening AMS in remote settingsAs AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.
Fertner, Mette; Sanchez, Javier; Boklund, Anette; Stryhn, Henrik; Dupont, Nana; Toft, Nils
The emergence of pathogens resistant to antimicrobials has prompted political initiatives targeting a reduction in the use of veterinary antimicrobials in Denmark, especially for pigs. This study elucidates the tendency of pig farms with a significantly higher antimicrobial use to remain in clusters in certain geographical regions of Denmark. Animal Daily Doses/100 pigs/day were calculated for all three age groups of pigs (weaners, finishers and sows) for each quarter during 2012–13 in 6,143 commercial indoor pig producing farms. The data were split into four time periods of six months. Repeated spatial cluster analyses were performed to identify persistent clusters, i.e. areas included in a significant cluster throughout all four time periods. Antimicrobials prescribed for weaners did not result in any persistent clusters. In contrast, antimicrobial use in finishers clustered persistently in two areas (157 farms), while those issued for sows clustered in one area (51 farms). A multivariate analysis including data on antimicrobial use for weaners, finishers and sows as three separate outcomes resulted in three persistent clusters (551 farms). Compared to farms outside the clusters during this period, weaners, finishers and sows on farms within these clusters had 19%, 104% and 4% higher use of antimicrobials, respectively. Production type, farm type and farm size seemed to have some bearing on the clustering effect. Adding these factors as categorical covariates one at a time in the multivariate analysis reduced the persistent clusters by 24.3%, 30.5% and 34.1%, respectively. PMID:26317206
Roberts, Elaine; Dawoud, Dalia M; Hughes, Dyfrig A; Cefai, Christopher
This study aims to evaluate the effectiveness and acceptability of a pharmacist-led antimicrobial stewardship intervention, consisting of consultant performance audit and feedback, on antimicrobial prescribing quality. From October 2010 to September 2012, the prescribing performance of medical consultant teams rotating on the acute medical admissions unit was measured against four quality indicators. Measurements were taken at baseline then at quarterly intervals during which time consultants received feedback. Proportion of prescriptions adhering to each indicator was compared with baseline using paired sample z-test (significance level P < 0.01, Bonferroni corrected). Consultants' views were explored using anonymous questionnaires. Overall, 2609 antimicrobial prescriptions were reviewed. Improvement from baseline was statistically significant in all follow-up periods for two indicators: 'antimicrobials should have a documented indication in the medical notes' and 'antimicrobials should adhere to guideline choice or have a justification for deviation', reaching 6.0% (95% CI 2.5, 9.6) and 8.7% (95% CI 3.7, 13.7), respectively. Adherence to the indicator 'antimicrobials should have a documented stop/review prompt' improved significantly in all but the first follow-up period. For the indicator: 'antimicrobial assessed by antimicrobial specialists as unnecessary', improvement was statistically significant in the first (-4.7%, 95% CI -8.0, -1.4) and fourth (-4.2%, 95% CI -7.7%, -0.8%) periods. Service evaluation showed support for the pharmacist-led stewardship activities. There were significant and sustained improvements in prescribing quality as a result of the intervention. Consultants' engagement and acceptance of stewardship activities were demonstrated. © 2015 Royal Pharmaceutical Society.
Full Text Available Antanas Norkus, Rytas Ostrauskas, Rimantas Žalinkevičius, Lina Radzevičienė, Rita Šulcaitė Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania Background: Patients with diabetes mellitus in Lithuania have access to almost all the latest blood glucose-lowering drugs available in the rest of the world. This study evaluated the effects of prescribing of treatment (oral medications, insulin, or both in Lithuanian patients with type 1 or 2 diabetes and poor blood glucose control. Methods: The relevant information was obtained from specialized questionnaires completed by 26 consulting endocrinologists in Lithuania between October 1, 2008 and December 31, 2008. The study cohort comprised 865 randomly selected patients with diabetes mellitus and a glycosylated (HbA1c level ≥7%. In total, there were 95 patients with type 1 diabetes and 770 with type 2 diabetes. Results: Linear regression for patients with type 1 diabetes revealed a weak trend towards higher doses of insulin reflecting lower HbA1c values. The mean dose of insulin in patients with type 1 diabetes before an endocrinology consultation was 57.1 ± 15.7 U/day (0.8 ± 0.2 U/kg, which increased significantly to 63.3 ± 16.5 U/day (0.9 ± 0.2 U/kg after an endocrinology consultation (P < 0.05. Treatment prescribed for patients with type 2 diabetes depended on the duration of disease. Earlier treatment recommended for 68% of patients with type 2 diabetes was subsequently changed by the endocrinologist. Linear regression showed that the insulin dose prescribed before a specialist consultation as well as that recommended by an endocrinologist was significantly correlated with body mass index. Conclusion: Appropriate prescribing of blood glucose-lowering drugs does not always translate into good metabolic control of diabetes mellitus. The mean HbA1c was 8.5% ± 1.3% in patients with type 2 diabetes treated with oral drugs alone versus 9.0% ± 1.3% in those
Hardefeldt, L Y; Holloway, S; Trott, D J; Shipstone, M; Barrs, V R; Malik, R; Burrows, M; Armstrong, S; Browning, G F; Stevenson, M
Investigations of antimicrobial use in companion animals are limited. With the growing recognition of the need for improved antimicrobial stewardship, there is urgent need for more detailed understanding of the patterns of antimicrobial use in this sector. To investigate antimicrobial use for medical and surgical conditions in dogs and cats by Australian veterinarians. A cross-sectional study was performed over 4 months in 2011. Respondents were asked about their choices of antimicrobials for empirical therapy of diseases in dogs and cats, duration of therapy, and selection based on culture and susceptibility testing, for common conditions framed as case scenarios: 11 medical, 2 surgical, and 8 dermatological. A total of 892 of the 1,029 members of the Australian veterinary profession that completed the survey satisfied the selection criteria. Empirical antimicrobial therapy was more common for acute conditions (76%) than chronic conditions (24%). Overall, the most common antimicrobial classes were potentiated aminopenicillins (36%), fluoroquinolones (15%), first- and second-generation cephalosporins (14%), and tetracyclines (11%). Third-generation cephalosporins were more frequently used in cats (16%) compared to dogs (2%). Agreement with Australasian Infectious Disease Advisory Panel (AIDAP) guidelines (generated subsequently) was variable ranging from 0 to 69% between conditions. Choice of antimicrobials by Australian veterinary practitioners was generally appropriate, with relatively low use of drugs of high importance, except for the empirical use of fluoroquinolones in dogs, particularly for otitis externa and 3rd-generation cephalosporins in cats. Future surveys will determine whether introduction of the 2013 AIDAP therapeutic guidelines has influenced prescribing habits. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Malo, Sara; Bjerrum, Lars; Feja, Cristina
Institute for Health Data and Disease Control in Denmark, and from the Aragon Information System of Drug Consumption. The number of Defined Daily Doses (DDD) of the different substances were calculated, and the quality of the antimicrobial prescription was analysed using the 'Drug Utilization 90 %' method...... and the European Surveillance of Antimicrobial Consumption (ESAC) quality indicators for outpatient antimicrobial use. RESULTS: The majority of the prescriptions (90 % of total DDD) were comprised of 14 (of 39) different antimicrobials in Denmark, based mainly on narrow spectrum penicillin, and 11 (of 59......) antimicrobials in Aragon, principally broad spectrum penicillins. The quality indicators described an elevated consumption of antimicrobials and an important seasonal variation in Aragon. In Denmark, the values obtained reflected a more moderate use with minor seasonal variation. CONCLUSIONS: The results showed...
Gebrekirstos, Negash Hadera; Workneh, Birhanu Demeke; Gebregiorgis, Yosef Sibhatu; Misgina, Kebede Haile; Weldehaweria, Negassie Berhe; Weldu, Meresa Gebremedhin; Belay, Hailay Siyum
Non-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia. A drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated. From 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%), 121 (33%), and 94 (25.6%) of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5). The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO) [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1-3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2.66, 95% CI; 1.24, 5.68] respectively). The magnitude of
Paterson, David L
Managing serious infections is a balance between providing timely and appropriate broad-spectrum empirical therapy for individual patients, which has been consistently shown to improve outcomes, and reducing unnecessary use of antimicrobial agents, which may contribute to the development of antimicrobial resistance. To control the spread of antimicrobial resistance, hospitals commonly implement programs designed to optimize antimicrobial use, supported by infection-control measures. Hospital-based antimicrobial management programs--also called "antimicrobial stewardship programs"--are primarily based on education coupled with a "front-end" approach (i.e., restricting the availability of selected antimicrobial agents) or a "back-end" approach (i.e., reviewing broad-spectrum empirical therapy and then streamlining or discontinuing therapy, as indicated, on the basis of culture and susceptibility testing results and clinical response). Institutional efforts to optimize antimicrobial use should concentrate on patient outcomes, should have multidisciplinary support, and should use a combination of interventions customized to the needs, resources, and information technology infrastructure of the health care institution.
Negash Hadera Gebrekirstos
Full Text Available Abstract Background Non-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia. Methods A drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated. Results From 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%, 121 (33%, and 94 (25.6% of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5. The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1–3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2
Pedersen, Inge Kryger; Jepsen, Kim Sune
the knowledge base in the healthcare field is shifting. Drawing on in-depth interviews about diagnosing and prescribing, the article demonstrates how the problem of antimicrobial resistance is understood and engaged with by Danish general practitioners. When general practitioners speak of managing “non...
Rawson, T M; Moore, L S P; Tivey, A M; Tsao, A; Gilchrist, M; Charani, E; Holmes, A H
To improve the quality of antimicrobial stewardship (AMS) interventions the application of behavioural sciences supported by multidisciplinary collaboration has been recommended. We analysed major UK scientific research conferences to investigate AMS behaviour change intervention reporting. Leading UK 2015 scientific conference abstracts for 30 clinical specialties were identified and interrogated. All AMS and/or antimicrobial resistance(AMR) abstracts were identified using validated search criteria. Abstracts were independently reviewed by four researchers with reported behavioural interventions classified using a behaviour change taxonomy. Conferences ran for 110 days with >57,000 delegates. 311/12,313(2.5%) AMS-AMR abstracts (oral and poster) were identified. 118/311(40%) were presented at the UK's infectious diseases/microbiology conference. 56/311(18%) AMS-AMR abstracts described behaviour change interventions. These were identified across 12/30(40%) conferences. The commonest abstract reporting behaviour change interventions were quality improvement projects [44/56 (79%)]. In total 71 unique behaviour change functions were identified. Policy categories; "guidelines" (16/71) and "service provision" (11/71) were the most frequently reported. Intervention functions; "education" (6/71), "persuasion" (7/71), and "enablement" (9/71) were also common. Only infection and primary care conferences reported studies that contained multiple behaviour change interventions. The remaining 10 specialties tended to report a narrow range of interventions focusing on "guidelines" and "enablement". Despite the benefits of behaviour change interventions on antimicrobial prescribing, very few AMS-AMR studies reported implementing them in 2015. AMS interventions must focus on promoting behaviour change towards antimicrobial prescribing. Greater focus must be placed on non-infection specialties to engage with the issue of behaviour change towards antimicrobial use.
T. M. Rawson
Full Text Available Abstract Background To improve the quality of antimicrobial stewardship (AMS interventions the application of behavioural sciences supported by multidisciplinary collaboration has been recommended. We analysed major UK scientific research conferences to investigate AMS behaviour change intervention reporting. Methods Leading UK 2015 scientific conference abstracts for 30 clinical specialties were identified and interrogated. All AMS and/or antimicrobial resistance(AMR abstracts were identified using validated search criteria. Abstracts were independently reviewed by four researchers with reported behavioural interventions classified using a behaviour change taxonomy. Results Conferences ran for 110 days with >57,000 delegates. 311/12,313(2.5% AMS-AMR abstracts (oral and poster were identified. 118/311(40% were presented at the UK’s infectious diseases/microbiology conference. 56/311(18% AMS-AMR abstracts described behaviour change interventions. These were identified across 12/30(40% conferences. The commonest abstract reporting behaviour change interventions were quality improvement projects [44/56 (79%]. In total 71 unique behaviour change functions were identified. Policy categories; “guidelines” (16/71 and “service provision” (11/71 were the most frequently reported. Intervention functions; “education” (6/71, “persuasion” (7/71, and “enablement” (9/71 were also common. Only infection and primary care conferences reported studies that contained multiple behaviour change interventions. The remaining 10 specialties tended to report a narrow range of interventions focusing on “guidelines” and “enablement”. Conclusion Despite the benefits of behaviour change interventions on antimicrobial prescribing, very few AMS-AMR studies reported implementing them in 2015. AMS interventions must focus on promoting behaviour change towards antimicrobial prescribing. Greater focus must be placed on non-infection specialties to
Pedersen, Inge Kryger; Jepsen, Kim Sune
The medical professions will lose an indispensable tool in clinical practice if even simple infections cannot be cured because antibiotics have lost effectiveness. This article presents results from an exploratory enquiry into “good doctoring” in the case of antibiotic prescribing at a time when...
Is there any difference in quality of prescribing between antibacterials and antifungals? Results from the first global point prevalence study (Global PPS) of antimicrobial consumption and resistance from 53 countries.
Yusuf, Erlangga; Versporten, Ann; Goossens, Herman
To compare the quality of antibacterial with antifungal prescribing in the world. Data from the global point prevalence study (Global PPS) were used. The Global PPS took place on any one day between February and June 2015 in 335 participating hospitals from 53 countries. It collected demographic data on patients treated with antimicrobials and data on prescription characteristics of the antimicrobials. For the present study, the quality of antibiotic prescription was compared with antifungal prescription using logistic regression analysis. The following indicators were compared: the presence of the reason for prescription and stop/review date in notes, and compliance with a local guideline. There were 48565 antimicrobial prescriptions for 34731 patients [median age 63 years (range 0-106); 52.6% male] in the Global PPS. Among these antimicrobials, 43513 (89.6%) were antibacterials and 2062 were antifungals for systematic use, and these data were used in this study. Reasons for prescriptions [77.7% versus 71.8%, OR 1.4 (95% CI 1.2-1.5)] and stop/review dates [38.3% versus 31.9%, OR 1.3 (1.2-1.5)] were found more often in notes for antibacterials than for antifungals. Antibacterials were prescribed less often according to local guidelines than antifungals [57.0% versus 71.0%, OR 0.6 (0.5-0.6)]. There are differences in the quality of antibacterial and antifungal prescribing and we identified opportunities that can be used to improve the quality of antimicrobial prescribing. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: email@example.com.
Full Text Available Background: Inappropriate use of antibiotics globally has been linked to increase in antibiotic resistance. Objectives: This interventional study assessed the impact of antibiotic prescription feedback and focus group discussions (FGD on hospital-based prescribers before and after the FGD. Study Design: The present study was performed at a tertiary care centre in New Delhi, wherein 45 units from surgical specialities were included for FGD. Thirty-five units were assessed for the antibiotic usage during 12 months pre-intervention and 3 and 6 months post-intervention period. The outcome measured was a change in antibiotic prescription rates reflected as daily defined doses per 100 bed days as defined by the World Health Organisation. Results: Reduction in the level of antibiotic consumption was observed in 15 of 35 units (42.85% during the 3 months post-intervention period, which was significant (P < 0.05 in 3/35 (8.57% surgical units. A significant reduction (P < 0.05 was observed for the units of endoscopic gynaecology, super-speciality and transplant surgery units B and C, and orthopaedic unit C during the 6 months period. Decreasing trend (P < 0.05 was observed in 2/35 (5.71% units during the entire period. Overall reduction of antibiotic consumption (1.88% was observed, with an increase in the use of low-end antibiotics and a decrease in the use of high-end antibiotics. Conclusion: The present study clearly demonstrates a weak impact of FGD in changing antibiotic prescribing behaviour. Further analysis of the sustainability of FGD and its long-term impact on antimicrobial resistance needs to be evaluated. The effect of continuous educational sessions and multifaceted interventions cannot be ignored.
treatment, posters for the waiting room, brochures to patients and implementation of point of care tests (Strep A and CRP to be used in the GPs'surgeries. To ensure public awareness of the risk of resistant bacteria, media campaigns targeting both professionals and the public will be developed and the results will be published and widely disseminated at a Working Conference hosted by the World Association of Family Doctors (WONCA-Europe at the end of the project period. Discussion HAPPY AUDIT is an EU-financed project with the aim of contributing to the battle against antibiotic resistance through quality improvement of GPs' diagnosis and treatment of RTIs through development of intervention programmes targeting GPs, parents of young children and healthy adults. It is hypothesized that the use of multifaceted strategies combining active intervention by GPs will be effective in reducing prescribing of unnecessary antibiotics for RTIs and improving the use of appropriate antibiotics in suspected bacterial infections.
McDonnell, Lucy; Armstrong, David; Ashworth, Mark; Dregan, Alexandru; Malik, Umer; White, Patrick
Antimicrobial resistance in invasive infections is driven mainly by human antimicrobial consumption. Limited cross-national comparative evidence exists about variation in antimicrobial consumption and effect on resistance. We examined the relationship between national community antimicrobial consumption rates (2013) and national hospital antimicrobial resistance rates (2014) across 29 countries in the European Economic Area (EEA). Consumption rates were obtained from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Resistance data were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net), based on 196480 invasive isolates in 2014. Data availability and consistency were good. Some countries did not report figures for each strain of resistant bacteria. National antimicrobial consumption rates (2013) varied from ≤ 13 DDD (Estonia, the Netherlands and Sweden) to ≥ 30 DDD (France, Greece and Romania) per 1000 inhabitants per day. National antimicrobial resistance rates (hospital isolates, 15 species) also varied from 37.2% (Bulgaria, Greece, Romania and Slovakia). National antimicrobial consumption rates (2013) showed strong to moderate correlation with national hospital antimicrobial resistance rates (2014) in 19 strains of bacteria (r = 0.84 to r = 0.39). Some countries defied the trend with high consumption and low resistance (France, Belgium and Luxembourg) or low consumption and high resistance (Bulgaria, Hungary and Latvia). We found associations between national community antimicrobial consumption and national hospital antimicrobial resistance across a wide range of bacteria. These associations were not uniform. Different mechanisms may drive resistance in hospital-based invasive infections. Future research on international variations in antimicrobial resistance should consider environmental factors, agricultural use, vaccination policies and prescribing quality. © The Author 2017
Drinkovic, Dragana; Morris, Arthur J; Dyet, Kristin; Bakker, Sarah; Heffernan, Helen
To estimate the prevalence and characterise plasmid-mediated AmpC beta-lactamase (PMACBL)- producing Escherichia coli in the Auckland community. All cefoxitin non-susceptible (NS) E. coli identified at the two Auckland community laboratories between 1 January and 31 August 2011 were referred to ESR for boronic acid double-disc synergy testing, to detect the production of AmpC beta-lactamase, and polymerase chain reaction (PCR) to identify the presence of PMACBL genes. PMACBL-producing isolates were typed using pulsed-field gel electrophoresis (PFGE), and PCR was used to determine their phylogenetic group and to identify multilocus sequence type (ST)131. Antimicrobial susceptibility testing and detection of extended-spectrum beta-lactamases (ESBLs) were performed according to the Clinical and Laboratory Standards Institute recommendations. 101 (51%) and 74 (37%) of 200 non-duplicate cefoxitin-NS E. coli were PMACBL producers or assumed hyper-producers of chromosomal AmpC beta-lactamase, respectively. The prevalence of PMACBL-producing E. coli was 0.4%. PMACBL-producing E. coli were significantly less susceptible to norfloxacin, trimethoprim and nitrofurantoin than E. coli that produced neither a PMACBL nor an ESBL. Very few (4%) PMACBL-producing E. coli co-produced an ESBL. Most (88%) of the PMACBL-producing isolates had a CMY-2-like PMACBL. The PMACBL-producing E. coli isolates were diverse based on their PFGE profiles, 44% belonged to phylogenetic group D, and only four were ST131. 100 of the 101 PMACBL-producing E. coli were cultured from urine, and were causing urinary tract infection (UTI) in the majority of patients. The median patient age was 56 years and most (94%) of the patients were women. A greater proportion of patients with community-acquired UTI caused by PMACBL-producing E. coli received a beta-lactam antimicrobial than patients with community-acquired UTI caused by other non-AmpC, non-ESBL-producing E. coli. Thirty-six (43%) patients with community
Thomson, George H.
In his everyday work the family physician sees many patients whose problems have been diagnosed but for whom postponement of an active treatment plan is indicated. The physician must therefore prescribe procrastination in a carefully planned way. I describe some ideas and practical methods for doing this. PMID:529244
Ab Rahman, Norazida; Teng, Cheong Lieng; Sivasampu, Sheamini
Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic. Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics. Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing
Full Text Available Abstract Background The aim of the present study was to describe the use of prescribed and non prescribed medicines in a non-institutionalised population older than 15 years of an urban area during the year 2000, in terms of age and gender, social class, employment status and type of Primary Health Care. Methods Cross-sectional study. Information came from the 2000 Barcelona Health Interview Survey. The indicators used were the prevalence of use of prescribed and non-prescribed medicines in the two weeks prior to the interview. Descriptive analyses, bivariate and multivariate logistic regression analyses were carried out. Results More women than men took medicines (75.8% vs. 60% respectively. The prevalence of use of prescribed medicines increased with age while the prevalence of non-prescribed use decreased. These age differences are smaller among those with poor perceived health. In terms of social class, a higher percentage of men with good health in the more advantaged classes took non-prescribed medicines compared with disadvantaged classes (38.7% vs 31.8%. In contrast, among the group with poor health, more people from the more advantaged classes took prescribed medicines, compared with disadvantaged classes (51.4% vs 33.3%. A higher proportion of people who were either retired, unemployed or students, with good health, used prescribed medicines. Conclusion This study shows that beside health needs, there are social determinants affecting medicine consumption in the city of Barcelona.
Llor, Carl; Bjerrum, Lars
Antimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Overprescribing of antibiotics......-the-counter sale of antibiotics, the use of antimicrobial stewardship programmes, the active participation of clinicians in audits, the utilization of valid rapid point-of-care tests, the promotion of delayed antibiotic prescribing strategies, the enhancement of communication skills with patients with the aid...... is associated with an increased risk of adverse effects, more frequent re-attendance and increased medicalization of self-limiting conditions. Antibiotic overprescribing is a particular problem in primary care, where viruses cause most infections. About 90% of all antibiotic prescriptions are issued by general...
Wadmann, Sarah; Bang, Lia Evi
with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable...... patients to use medication. Therefore, GPs do much more to obtain knowledge about medications than seek advice on 'rational pharmacotherapy'. For instance, GPs also seek opportunities to acquaint themselves with the material objects of medication and medical devices. We conceptualise the knowledge needs...... of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs....
Gagliotti, C.; Balode, A.; Baquero, F.; Degener, J.; Grundmann, H.; Gur, D.; Jarlier, V.; Kahlmeter, G.; Monen, J.; Monnet, D. L.; Rossolini, G. M.; Suetens, C.; Weist, K.; Heuer, O.
Based on data collected by the European Antimicrobial Resistance Surveillance Network (EARS-Net) and the former EARSS, the present study describes the trends in antimicrobial susceptibility patterns and occurrence of invasive infections caused by Escherichia coli and Staphylococcus aureus in the
Hoo, Grace Si Ru; Liew, Yi Xin; Kwa, Andrea Lay-Hoon
While suboptimal dosing of antimicrobials has been attributed to poorer clinical outcomes, clinical cure and mortality advantages have been demonstrated when target pharmacokinetic (PK) and pharmacodynamic (PD) indices for various classes of antimicrobials were achieved to maximise antibiotic activity. Dosing optimisation requires a good knowledge of PK/PD principles. This review serves to provide a foundation in PK/PD principles for the commonly prescribed antibiotics (β-lactams, vancomycin, fluoroquinolones and aminoglycosides), as well as dosing considerations in special populations (critically ill and obese patients). PK principles determine whether an appropriate dose of antimicrobial reaches the intended pathogen(s). It involves the fundamental processes of absorption, distribution, metabolism and elimination, and is affected by the antimicrobial's physicochemical properties. Antimicrobial pharmacodynamics define the relationship between the drug concentration and its observed effect on the pathogen. The major indicator of the effect of the antibiotics is the minimum inhibitory concentration. The quantitative relationship between a PK and microbiological parameter is known as a PK/PD index, which describes the relationship between dose administered and the rate and extent of bacterial killing. Improvements in clinical outcomes have been observed when antimicrobial agents are dosed optimally to achieve their respective PK/PD targets. With the rising rates of antimicrobial resistance and a limited drug development pipeline, PK/PD concepts can foster more rational and individualised dosing regimens, improving outcomes while simultaneously limiting the toxicity of antimicrobials.
Leekha, Surbhi; Terrell, Christine L; Edson, Randall S
Antimicrobial agents are some of the most widely, and often injudiciously, used therapeutic drugs worldwide. Important considerations when prescribing antimicrobial therapy include obtaining an accurate diagnosis of infection; understanding the difference between empiric and definitive therapy; identifying opportunities to switch to narrow-spectrum, cost-effective oral agents for the shortest duration necessary; understanding drug characteristics that are peculiar to antimicrobial agents (such as pharmacodynamics and efficacy at the site of infection); accounting for host characteristics that influence antimicrobial activity; and in turn, recognizing the adverse effects of antimicrobial agents on the host. It is also important to understand the importance of antimicrobial stewardship, to know when to consult infectious disease specialists for guidance, and to be able to identify situations when antimicrobial therapy is not needed. By following these general principles, all practicing physicians should be able to use antimicrobial agents in a responsible manner that benefits both the individual patient and the community.
BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug
tabulation and goodness of fit. Results showed that there is significant statistical differences in the number of drugs prescribed per patient encounter, percentage of encounter with an injection prescribed, in adherence to WHO prescribing ...
The importance of learning from medical error has recently received increasing emphasis. This paper focuses on prescribing errors and argues that, while learning from prescribing errors is a laudable goal, there are currently barriers that can prevent this occurring. Learning from errors can take place on an individual level, at a team level, and across an organisation. Barriers to learning from prescribing errors include the non-discovery of many prescribing errors, lack of feedback to th...
Tafa, Belay; Endale, Adugna; Bekele, Desalegn
The continuing emergence, development and spread of pathogenic organisms that are resistant to antimicrobials are a cause of increasing concern. The control of antimicrobial resistance requires knowledge of factors causing antimicrobial resistance, good attitudes towards the intervention strategies as well as changes in antibiotic prescribing behavior of health workers. Hence, this study was aimed to assess paramedical staffs' knowledge and attitudes towards antimicrobial resistance and their antibiotics prescription practices in Dire Dawa, Ethiopia. A cross-sectional survey was conducted among paramedical staffs working in hospitals and health centers. A total of 218 paramedical staffs were participated and a self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 20. Chi square/Fisher's exact tests were used for comparison of data and a p value of less than 0.05 was considered statistically significant. Out of the total, 137 (62.8%) of paramedical staffs had good knowledge on the factors causing antimicrobial resistance. The most common causes of antimicrobial resistance reported were patients' poor adherence (96.5%), self prescription (95%), and empiric choice of antibiotics (94.5%). In general, more than 80% of the respondents had positive attitudes towards the antimicrobials resistance intervention strategies. Relatively less proportion of participants recognized that antimicrobial resistance as a problem in their local institutions. The most perceived driving forces for unnecessary antibiotics prescriptions were treatment failure (67.7%) and patient push (53.3%). The majority, 76.9% of the prescribers mentioned that standard treatment guidelines were available in their institutions though only 15.7% of them reported referring the guidelines on the daily basis. Among the prescribers, 85.8% never attended formal trainings on antibiotics prescriptions. As this study generated important information on knowledge and attitudes
Hay, Alison; Bradley, Eleanor; Nolan, Peter
To explore the attitudes of multidisciplinary team members to nurse prescribing and to establish its perceived advantages and disadvantages. Five focus groups were conducted with a range of healthcare professionals in one trust. A total of 46 participants took part in the study A structured schedule was used during each discussion to elicit group members' views on supplementary nurse prescribing. The data were analysed thematically and key themes and concepts were identified. These are summarised under five main headings: what is supplementary prescribing?; why introduce supplementary prescribing?; perceived benefits of supplementary prescribing; concerns about supplementary prescribing; and skills necessary for supplementary prescribing. Analysis of the data suggests that although teams were generally supportive of nurse prescribing they are largely confused about what is being recommended and why. There was concern about how nurse prescribing will be implemented and its potential to disrupt team functioning. A considerable amount of preparation will be required to ensure that nurse prescribers have the organisational and team support to adapt to their new roles.
Toska, Aikaterini; Geitona, Mary
Greece is among the countries with the highest rates of antimicrobial resistance (AMR) and simultaneous antibiotic consumption. The aim of this study was to assess the perceptions and knowledge of AMR and irrational antibiotic prescribing of nurses working in paediatric hospitals in Greece. A self-administered questionnaire was distributed to nurses in paediatric hospitals and paediatric clinics in Greece. Descriptive and multivariate statistical analyses were performed. Levels of significance were two-tailed and statistical significance was p=0.05. A total of 87% of participants reported irrational prescribing to be an important cause of AMR. Diagnostic uncertainty was stated by 55.5% as the main cause of irrational antibiotic prescribing and 94% suggested the use of protocols and guidelines as the main measure to control overprescribing. Parental demand for antibiotics in hospitals has increased according to 51.8% of respondents. Strong correlation was observed between social-demographic characteristics and antibiotic resistance, as well as irrational prescribing. Assessing nurses' knowledge and perceptions of antimicrobial resistance and irrational prescribing is vital as nurses actively participate in the antibiotics administration process and antimicrobial management in Greece. Their involvement could contribute to educate patients and parents on the public-health implications of overprescribing and antimicrobial resistance.
The overuse of antimicrobials is recognized as the main selective pressure driving the emergence and spread of antimicrobial resistance in human bacterial pathogens. Urinary tract infections (UTIs) are among the most common infections presented in primary care and empirical antimicrobial treatment is currently recommended. Previous research has identified that a substantial proportion of Irish general practitioners (GPs) prescribe antimicrobials for UTIs that are not in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The aim of this trial is to design, implement and evaluate the effectiveness of a complex intervention on GP antimicrobial prescribing and adult (18 years of age and over) patients\\' antimicrobial consumption when presenting with a suspected UTI.
Ness, Valerie; Malcolm, William; McGivern, Guy; Reilly, Jacqui
The objective of this study was to retrospectively analyse patterns of primary care antibiotic prescribing by nurse prescribers in Scotland. Data on dispensed antibiotic prescriptions written by nurse prescribers in 2007-13 were obtained from the Prescribing Information System, a database of all NHS prescriptions dispensed in Scotland. Since 2007, there has been a steady increase in the volume of antibiotic prescribing in primary care undertaken by nurse prescribers. There was considerable variability in the frequency of antibiotic prescribing among nurses and across NHS regions. Since 2007, an increasing proportion of antibiotics prescribed by nurses are those recommended for first-line empirical treatment of infection, with a reduction in the proportion of broader-spectrum agents. Other measures of prescribing quality (duration of treatment of adult females with urinary tract infection and use of recommended doses) have improved since 2007. This paper is the first, to our knowledge, to present an analysis of data on antibiotic prescribing in primary care by nurse prescribers. Inappropriate prescribing is a problem and, given the impact that antibiotic prescribing has on antimicrobial resistance, it is important that the prescribing behaviour of nurses is explored. This is especially significant as this is a growing body of prescribers who predominately work in the community, where the majority of antibiotics are prescribed. This analysis showed that practice varies across NHS regions and between prescribers and although more information is needed to establish whether nurse prescribers are prescribing appropriately, some quality indicators may suggest that they are following best practice. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
Full Text Available Lucélio B Couto, Gustavo S Romão, Reinaldo B Bestetti Department of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil We have read with great interest the paper by Kassab et al, who have essentially shown that good teachers will be good tutors in a problem-based learning (PBL environment. We have been facing great difficulties to select tutors because there has been no tradition in PBL in our region in the preuniversity teaching. Furthermore, the majority of our teachers have been formed in a discipline-based medical curriculum. Therefore, it is reassuring to learn from the work by Kassab et al that subject-matter mastery is the powerful independent predictor of tutoring skills. View the original paper by Kassab and colleagues.
Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.
The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...... (approximately) showed no significant change compared to control or no overall positive findings. We identified 79 eligible studies which described 96 separate interventions to change prescribing behaviour. Of these interventions, 49 (51%, 41%-61%) showed a positive significant change compared to the control...
Jacob, Megan E; Hoppin, Jane A; Steers, Nicola; Davis, Jennifer L; Davidson, Gigi; Hansen, Bernie; Lunn, Katharine F; Murphy, K Marcia; Papich, Mark G
To determine opinions of faculty members with clinical appointments, clinical veterinarians, residents, and interns at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections. Cross-sectional survey. 71 veterinarians. An online questionnaire was sent to all veterinarians with clinical service responsibilities at the North Carolina State University veterinary teaching hospital (n = 167). The survey included 23 questions regarding demographic information, educational experiences, current prescribing practices, and personal opinions related to antimicrobial selection, antimicrobial use, restrictions on antimicrobial use, and antimicrobial resistance. Of the 167 veterinarians eligible to participate, 71 (43%) responded. When respondents were asked to rate their level of concern (very concerned = 1; not concerned = 5) about antimicrobial-resistant infections, most (41/70 [59%]) assigned a score of 1, with mean score for all respondents being 1.5. Most survey participants rated their immediate colleagues (mean score, 1.9) as more concerned than other veterinary medical professionals (mean score, 2.3) and their clients (mean score, 3.4). Fifty-nine of 67 (88%) respondents felt that antimicrobials were overprescribed at the hospital, and 32 of 69 (46%) respondents felt uncomfortable prescribing at least one class of antimicrobials (eg, carbapenems or glycopeptides) because of public health concerns. Findings indicated that veterinarians at this teaching hospital were concerned about antimicrobial resistance, thought antimicrobials were overprescribed, and supported restricting use of certain antimicrobial classes in companion animals. Findings may be useful in educating future veterinarians and altering prescribing habits and antimicrobial distribution systems in veterinary hospitals.
Skingsley, David; Bradley, Eleanor J; Nolan, Peter
To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they
Kirkham, Deborah; Darbyshire, Daniel; Gordon, Morris; Agius, Steven; Baker, Paul
Prescribing is an error-prone process for all doctors, from those who are newly qualified through to those at consultant level. Newly qualified doctors write the majority of in-patient prescriptions and therefore represent an opportunity for safety improvement. Attention to prescribing as a patient-safety issue and potential educational interventions to help improve the situation have been published, but offer little to inform educators why and how any interventions may succeed. In order to identify areas of good practice, and to provide evidence of areas requiring further investigation and innovation, we aimed to ascertain the full range of prescribing practices for final-year medical students and newly qualified doctors across a large geopolitical region of the UK. A questionnaire methodology was used. One questionnaire was sent to those responsible for final-year education, and a further, different questionnaire was sent to those responsible for the training of newly qualified doctors, asking about prescribing education in their locality. Questionnaires were sent to 15 hospitals in total. Prescribing is an error-prone process for all doctors Twelve hospitals contributed to final-year medical student data: a response rate of 80 per cent. A variety of methods, including student assistantship, pharmacist-led skills sessions and practical assessment, were offered to varying degrees. Free-text responses identified opportunities for different prescribing education and support. All 15 hospitals provided data on doctors' education, with interventions including e-learning, assessment and support from ward-based pharmacists. Current education focuses on the technical and knowledge-based paradigm of prescribing. Human factors and the impact of electronic prescribing should play a part in future developments in prescribing education. © 2015 John Wiley & Sons Ltd.
... least 10 countries (Australia, Austria, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom ... plan Global report on surveillance Country situation analysis Policy to combat antimicrobial resistance More on antimicrobial resistance ...
Shawahna, Ramzi; Rahman, Nisar-Ur; Ahmad, Mahmood; Debray, Marcel; Yliperttula, Marjo; Declèves, Xavier
To examine the incidence of prescribing errors in a main public hospital in Pakistan and to assess the impact of introducing electronic prescribing system on the reduction of their incidence. Medication errors are persistent in today's healthcare system. The impact of electronic prescribing on reducing errors has not been tested in developing world. Prospective review of medication and discharge medication charts before and after the introduction of an electronic inpatient record and prescribing system. Inpatient records (n = 3300) and 1100 discharge medication sheets were reviewed for prescribing errors before and after the installation of electronic prescribing system in 11 wards. Medications (13,328 and 14,064) were prescribed for inpatients, among which 3008 and 1147 prescribing errors were identified, giving an overall error rate of 22·6% and 8·2% throughout paper-based and electronic prescribing, respectively. Medications (2480 and 2790) were prescribed for discharge patients, among which 418 and 123 errors were detected, giving an overall error rate of 16·9% and 4·4% during paper-based and electronic prescribing, respectively. Electronic prescribing has a significant effect on the reduction of prescribing errors. Prescribing errors are commonplace in Pakistan public hospitals. The study evaluated the impact of introducing electronic inpatient records and electronic prescribing in the reduction of prescribing errors in a public hospital in Pakistan. © 2011 Blackwell Publishing Ltd.
Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.
The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...... (approximately) showed no significant change compared to control or no overall positive findings. We identified 79 eligible studies which described 96 separate interventions to change prescribing behaviour. Of these interventions, 49 (51%, 41%-61%) showed a positive significant change compared to the control...... or inconclusive. Positive studies (+) were those that demonstrated a statistically significant change in the majority of outcomes measured at level of p change in the opposite direction and inconclusive studies...
Sharma, Kopal; Jain, Pushpawati; Sharma, Amit
This study aimed to identify the current knowledge, attitude, and perception (KAP) of the future prescribers about antimicrobial (AM) education so that the identified lacunae in the training curriculum can be effectively addressed. A questionnaire-based survey was carried out in the 2(nd) year students of medical and the dental undergraduate (UG) courses at a tertiary care teaching center in Jaipur. Each respondent completed the given questionnaire independently in the allocated time. A scoring system was used to rate the KAP of the respondents as poor, average, or good. Statistically significant differences were found in the KAP of the medical and dental future prescribers (P = 0.0086, 0.0002, and <0.0001 for the KAP, respectively). The attitude of the UG students towards AM education is good, but the deficiencies in the knowledge and perception need to be improved further. Suitable interventions to address these lacunae must be planned.
Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and
This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem. Created: 7/6/2017 by Centers for Disease Control and Prevention (CDC). Date Released: 7/6/2017.
It is a routine matter for undergraduates to find eigenvalues and eigenvectors of a given matrix. But the converse problem of finding a matrix with prescribed eigenvalues and eigenvectors is rarely discussed in elementary texts on linear algebra. This problem is related to the "spectral" decomposition of a matrix and has important technical…
Nov 2, 2012 ... symptoms may occur in the context of fluctuating attention, sleep/wake disturbance and poor orientation. Anti-psychotics. Importantly, with regard to prescribing antipsychotics, HIV-positive patients may be more susceptible to extra-pyramidal side-effects (EPSEs), neuroleptic malignant syndrome and tardive.
S.A. Adams (Samantha); A.A. de Bont (Antoinette)
textabstractRecent medical informatics and sociological literature has painted the image of a new type of patient-one that is reflexive and informed, with highly specified information needs and perceptions, as well as highly developed skills and tactics for acquiring information. Patients have been
Full Text Available Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU. Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02, and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01. There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04. Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit.
Lilian M. Abbo
Full Text Available Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections.
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Gulliford, Martin C; Dregan, Alex; Moore, Michael V; Ashworth, Mark; Staa, Tjeerd van|info:eu-repo/dai/nl/304827762; McCann, Gerard; Charlton, Judith; Yardley, Lucy; Little, Paul; McDermott, Lisa
OBJECTIVES: Overutilisation of antibiotics may contribute to the emergence of antimicrobial drug resistance, a growing international concern. This study aimed to analyse the performance of UK general practices with respect to antibiotic prescribing for respiratory tract infections (RTIs) among young
Background. There is a global emergence of resistance against commonly prescribed antibiotics. Empirical antibiotic prescribing should be guided by local antimicrobial susceptibility patterns. Aim. To identify organisms and determine antibiotic susceptibility in urinary tract infections (UTIs) at 3 Military Hospital, Bloemfontein ...
E. V. Dovgan’
Full Text Available The data on different antimicrobial agents (fluoroquinolones, minoglycosides, macrolides, fusidic acid, chloramphenicol and their activity against various microorganisms are reviewed. The findings from different researchers are analyzed. Considerable attention is devoted to the problem of antimicrobial resistance in ophthalmology. Pharmacokinetics of topical antimicrobial agents applied in ophthalmology, their safety and tolerability are described. The indications for topical antimicrobial agents use in ophthalmology approved in Russian Federation are presented. With regard for pharmacokinetics and pharmacodynamics, safety profile and good tolerability, it is concluded that fluoroquinolones are medication of choice for empirical antimicrobial treatment in ophthalmology.
Beerlage-de Jong, Nienke; van Gemert-Pijnen, Julia E.W.C.; Wentzel, M.J.; Hendrix, Ron; Tjin-Kam-Jet-Siemons, Liseth
The rise of antimicrobial resistance (AMR) is a severe global health problem. Tackling this problem requires the prudent prescribing of antimicrobials. This is promoted through Antimicrobial Stewardship Programs (ASPs). In this position paper we describe i) how a socio-technical multidisciplinary
Nielsen, Peter Vilhelm
The- velocity level in a room ventilated by jet ventilation is strongly influenced by the supply conditions. The momentum flow in the supply jets controls the air movement in the room and, therefore, it is very important that the inlet conditions and the numerical method can generate a satisfactory...... description of this momentum flow. The Prescribed Velocity Method is a practical method for the description of an Air Terminal Device which will save grid points close to the opening and ensure the right level of the momentum flow....
Mason, Jay W
Solithromycin, a ketolide/macrolide antibiotic, has recently been reported to be free of the expected QT-prolonging effect of macrolides. It appears that its keto substitution provides a structural basis for this observation, as the other two tested ketolides also have minimal QT effect.Among non-cardiovascular therapies, antimicrobials probably carry the greatest potential to cause cardiac arrhythmias. This is a result of their propensity to bind to the delayed rectifier potassium channel, IKr, inducing QT prolongation and risk of torsades de pointes ventricular tachycardia, their frequent interference with the metabolism of other QT prolongers and their susceptibility to metabolic inhibition by numerous commonly used drugs.Unfortunately, there is evidence that medical practitioners do not take account of the QT/arrhythmia risk of antimicrobials in their prescribing practices. Education on this topic is sorely needed. When a macrolide is indicated, a ketolide should be considered in patients with a QT risk. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: email@example.com.
Liu, Ronghua; Lin, Lin; Wang, Dujuan
Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics. Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients. The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years. The highest proportion of patients were primigravida 72%. Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days. In total, 27% of patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes. Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes. Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.
The human gut contains 1013 - 1014 bacteria that are exposed to selection pressure whenever antibiotics are administered.1 The same selection pressure applies to respiratory flora, which is one of the reasons why antimicrobial therapy prescribed for the treatment of respiratory tract infection should aim to eradicate ...
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McArthur, J Vaun; Tuckfield, R C; Baker-Austin, C
Bacteria have evolved unique mechanisms that allow them survive in the presence of strong selection pressures. Included in these mechanisms is the ability to share genetic determinants among and between species of bacteria thus spreading metal or antibiotic resistance traits quickly. The textile industry in response to demand has developed antimicrobial fabrics by the addition of bactericidal compounds during production. Some of these antimicrobials include metal nanoparticles, quaternary ammonia compounds, and broad spectrum compounds like triclosan. Bacteria have already expressed resistance to each of these bactericides. Here we discuss the evolutionary and ecological consequences of antimicrobial textiles in terms of co-selection. We predict that continued use of such materials could result in increased and widespread resistance to specific antimicrobials, especially metals, with an increased resistance to antibiotics. Such increases have the potential to find their way into other bacterial populations of human pathogens leading to serious and unintended public health consequences.
... may be harboring disease organisms. Determining human and ecological risks from exposure to antimicrobial pesticides requires different ... Open Government Regulations.gov Subscribe USA.gov White House Ask. Contact Us Hotlines FOIA Requests Frequent Questions ...
requirements for the registration, assessment, marketing, authorization, and quality control of .... The mobile phase was consisted of a mixture of methanol, dichloromethane, ammonia and acetonitrile. (40:40:20:10) as stated in BP 2004. A test solution of 0.05% w/v was prepared by mixing 750 ml of water with powdered ...
ABSTRACT. An attempt was made to assess the quality and compare the physicochemical equivalence of six brands of ciprofloxacin tablets marketed in Tigray, Ethiopia. Six brands of ciprofloxacin tablets were used in the study. Identity, weight uniformity test, disintegration test, dissolution test and assay for the content of ...
have an effective means of monitoring the quality of generic drug products in the market. This results in widespread ... countries. Marketing of such drugs has been widely reported in Africa, Asia, and Latin America. © CNCS .... three-fourth of the plate. The plate was dried in air for 15 minutes and examined under UV-light,.
An attempt was made to assess the quality and compare the physicochemical equivalence of six brands of ciprofloxacin tablets marketed in Tigray, Ethiopia. Six brands of ciprofloxacin tablets were used in the study. Identity, weight uniformity test, disintegration test, dissolution test and assay for the content of active ...
Ankita Bist; Gajanan P. Kulkarni; Kashinath M. Gumma
Background: Evidence indicates high prevalence of inappropriate prescribing of medicines especially in the elderly. This can cause increased incidence of adverse drug reactions, morbidity, mortality and cost of treatment. Also inappropriate use of antibiotics promotes emergence of antimicrobial resistance. This study aims to study the prescribing patterns of antibiotics administered in geriatric patients, disease conditions for which the antibiotics were prescribed and adherence of these anti...
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Dean, Bryony; Schachter, Mike; Vincent, Charles; Barber, Nick
To prevent errors made during the prescription of drugs, we need to know why they arise. Theories of human error used to understand the causes of mistakes made in high-risk industries are being used in health-care. They have not, however, been applied to prescribing errors, which are a great cause of patient harm. Our aim was to use this approach to investigate the causes of such errors. Pharmacists at a UK teaching hospital prospectively identified 88 potentially serious prescribing errors. We interviewed the prescribers who made 44 of these, and analysed our findings with human error theory. Our results suggest that most mistakes were made because of slips in attention, or because prescribers did not apply relevant rules. Doctors identified many risk factors-work environment, workload, whether or not they were prescribing for their own patient, communication within their team, physical and mental well-being, and lack of knowledge. Organisational factors were also identified, and included inadequate training, low perceived importance of prescribing, a hierarchical medical team, and an absence of self-awareness of errors. To reduce prescribing errors, hospitals should train junior doctors in the principles of drug dosing before they start prescribing, and enforce good practice in documentation. They should also create a culture in which prescription writing is seen as important, and formally review interventions made by pharmacists, locum arrangements, and the workload of junior doctors, and make doctors aware of situations in which they are likely to commit errors.
Rún Sigurðardóttir, Nanna; Nielsen, Anni Brit Sternhagen; Munck, Anders; Bjerrum, Lars
To compare the appropriateness of antibiotic prescribing for upper respiratory tract infections (URTIs) in two countries with different prevalence of antimicrobial resistance: Denmark and Iceland. A cross-sectional study. General practitioners (GPs) in Denmark (n = 78) and Iceland (n = 21) registered all patients with URTI according to the Audit Project Odense (APO) method during a three-week period in the winter months of 2008 and 2009. Appropriateness of antibiotic prescribing in patients with URTI in Denmark and Iceland. A total of 1428 patients were registered (Denmark: n = 1208; Iceland: n = 220). A majority of patients in both countries were prescribed antibiotics, and only a minority of the prescriptions could be classified as appropriate prescribing. In general, Icelandic GPs more often prescribed antibiotics (Iceland = 75.8% vs. Denmark = 59.3%), but Danish GPs had a higher percentage of inappropriate antibiotic prescribing for sinusitis, and Icelandic GPs for pharyngotonsillitis. No differences were found for acute otitis media (AOM). The different antibiotic prescribing patterns between Denmark and Iceland could not fully be explained by different symptoms and signs among patients. Icelandic GPs have a higher antibiotic prescribing rate compared with Danish GPs, but the percentage of inappropriate antibiotic prescribing is highest in Denmark for sinusitis, and in Iceland for pharyngotonsillitis. Key points Within the Nordic countries there are marked differences in antimicrobial resistance and antibiotic use. Iceland differs from Denmark by a higher antibiotic prescribing rate and a higher prevalence of antimicrobial resistance. The majority of antibiotics are prescribed in primary care and most often for upper respiratory infections (URTIs). Only a minor amount of antibiotic prescriptions for URTIs can be classified as appropriate; inappropriate antibiotic prescribing is higher in Denmark than in Iceland for sinusitis and the opposite for
This article outlines the current state of law in Canada in respect to good faith in contratial relations. The topic is highly relevant due to expected growth in the numbers of contracts concluded between European and Canadian enterprises in the wake of adoption of the Comprehensive Economic...
Sears, M R; Rea, H H; Fenwick, J; Gillies, A J; Holst, P E; O'Donnell, T V; Rothwell, R P
The circumstances surrounding the deaths of 75 asthmatic patients who had been prescribed a domiciliary nebuliser driven by an air compressor pump for administration of high dose beta sympathomimetic drugs were investigated as part of the New Zealand national asthma mortality study. Death was judged unavoidable in 19 patients who seemed to have precipitous attacks despite apparently good long term management. Delays in seeking medical help because of overreliance on beta agonist delivered by nebuliser were evident in 12 cases and possible in a further 11, but these represented only 8% of the 271 verified deaths from asthma in New Zealanders aged under 70 during the period. Evidence for direct toxicity of high dose beta agonist was not found. Nevertheless, the absence of serum potassium and theophylline concentrations and of electrocardiographic monitoring in the period immediately preceding death precluded firm conclusions whether arrhythmias might have occurred due to these factors rather than to hypoxia alone. In most patients prescribed domiciliary nebulisers death was associated with deficiencies in long term and short term care similar to those seen in patients without nebulisers. Discretion in prescribing home nebulisers, greater use of other appropriate drugs, including adequate corticosteroids, and careful supervision and instruction of patients taking beta agonist by nebuliser should help to reduce the mortality from asthma.
Iyigundogdu, Zeynep Ustaoglu; Demir, Okan; Asutay, Ayla Burcin; Sahin, Fikrettin
In conjunction with an increasing public awareness of infectious diseases, the textile industry and scientists are developing hygienic fabrics by the addition of various antimicrobial and antiviral compounds. In the current study, sodium pentaborate pentahydrate and triclosan are applied to cotton fabrics in order to gain antimicrobial and antiviral properties for the first time. The antimicrobial activity of textiles treated with 3 % sodium pentaborate pentahydrate, 0.03 % triclosan, and 7 % Glucapon has been investigated against a broad range of microorganisms including bacteria, yeast, and fungi. Moreover, modified cotton fabrics were tested against adenovirus type 5 and poliovirus type 1. According to the test results, the modified textile goods attained very good antimicrobial and antiviral properties. Thus, the results of the present study clearly suggest that sodium pentaborate pentahydrate and triclosan solution-treated textiles can be considered in the development of antimicrobial and antiviral textile finishes.
Rodney W. Sando
Describes the weather patterns in northern Minnesota as related to prescribed burning. The prevailing wind direction, average wind speed, most persistent wind direction, and average Buildup Index are considered in making recommendations.
Lipsky, Benjamin A; Dryden, Matthew; Gottrup, Finn
of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document....... RESULTS: All open wounds will be colonized with bacteria, but antibiotic therapy is only required for those that are clinically infected. Therapy is usually empirical to start, but definitive therapy should be based on results of appropriately collected specimens for culture. When prescribed, it should...
Hopkins, Heidi; Bruxvoort, Katia J; Cairns, Matthew E
Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia.Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster...... measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed...... in different settings.Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those...
Full Text Available The prevalence of antimicrobial resistance in India is among the highest in the world. Antimicrobial use in inpatient settings is an important driver of resistance, but is poorly characterized, particularly in hospitalized children. In this study, conducted as part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC project, we examined the prevalence of and indications of antimicrobial use, as well as antimicrobial agents used among hospitalized children by conducting four point prevalence surveys in six hospitals between February 2016 and February 2017. A total of 681 children were hospitalized in six hospitals across all survey days, and 419 (61.5% were prescribed one or more antimicrobials (antibacterials, antivirals, antifungals. Antibacterial agents accounted for 90.8% (547/602 of the total antimicrobial prescriptions, of which third-generation cephalosporins (3GCs accounted for 38.9% (213/547 and penicillin plus enzyme inhibitor combinations accounted for 14.4% (79/547. Lower respiratory tract infection (LRTI was the most common indication for prescribing antimicrobials (149 prescriptions; 24.8%. Although national guidelines recommend the use of penicillin and combinations as first-line agents for LRTI, 3GCs were the most commonly prescribed antibacterial agents (55/149 LRTI prescriptions; 36.9%. In conclusion, 61.5% of hospitalized children were on at least one antimicrobial agent, with excessive use of 3GCs. Hence there is an opportunity to limit their inappropriate use.
Ali Adem Bahar
Full Text Available The rapid increase in drug-resistant infections has presented a serious challenge to antimicrobial therapies. The failure of the most potent antibiotics to kill “superbugs” emphasizes the urgent need to develop other control agents. Here we review the history and new development of antimicrobial peptides (AMPs, a growing class of natural and synthetic peptides with a wide spectrum of targets including viruses, bacteria, fungi, and parasites. We summarize the major types of AMPs, their modes of action, and the common mechanisms of AMP resistance. In addition, we discuss the principles for designing effective AMPs and the potential of using AMPs to control biofilms (multicellular structures of bacteria embedded in extracellular matrixes and persister cells (dormant phenotypic variants of bacterial cells that are highly tolerant to antibiotics.
Gibbons, J F; Boland, F; Egan, J; Fanning, S; Markey, B K; Leonard, F C
Antimicrobial use and resistance in animal and food production are of concern to public health. The primary aims of this study were to determine the frequency of resistance to 12 antimicrobials in Escherichia coli isolates from 39 pig farms and to identify patterns of antimicrobial use on these farms. Further aims were to determine whether a categorization of farms based on the duration of in-feed antimicrobial use (long-term versus short-term) could predict the occurrence of resistance on these farms and to identify the usage of specific antimicrobial drugs associated with the occurrence of resistance. Escherichia coli were isolated from all production stages on these farms; susceptibility testing was carried out against a panel of antimicrobials. Antimicrobial prescribing data were collected, and farms were categorized as long term or short term based on these. Resistance frequencies and antimicrobial use were tabulated. Logistic regression models of resistance to each antimicrobial were constructed with stage of production, duration of antimicrobial use and the use of 5 antimicrobial classes included as explanatory variables in each model. The greatest frequencies of resistance were observed to tetracycline, trimethoprim/sulphamethoxazole and streptomycin with the highest levels of resistance observed in isolates from first-stage weaned pigs. Differences in the types of antimicrobial drugs used were noted between long-term and short-term use farms. Categorization of farms as long- or short-term use was sufficient to predict the likely occurrence of resistance to 3 antimicrobial classes and could provide an aid in the control of resistance in the food chain. Stage of production was a significant predictor variable in all models of resistance constructed and did not solely reflect antimicrobial use at each stage. Cross-selection and co-selection for resistance was evident in the models constructed, and the use of trimethoprim/sulphonamide drugs in particular was
Pallavi Dnyaneshwar Admane
Full Text Available Objective: Antimicrobial agents are the greatest contribution to 20th century, which are used for cure and prevention of infections. Widespread use of antimicrobials has facilitated the development of resistance.Aim: the study was to assess the use of antimicrobials in tertiary care hospital in Maharashtra.Method: Prescription audit was done to assess the use of antimicrobials. Total 1942 prescriptions were analyzed for average number of drugs prescribed, antimicrobials prescribed by generic name or brand name, percentage of antibiotics among the prescribed drugs, use of fixed drug combinations, if any.Statistical analysis used: Data was analyzed by percentage.Result: Demographic analysis showed that out of 1942 patients in OPD, most were male (56.38 and in the age group between 35 to 50 years. In 1942 prescription, 30.25% drugs were antimicrobials. Three drugs were prescribed in 52.15% of the prescription, followed by 4 drugs in 19.78% prescriptions. 79.18% prescriptions were prescribed by generic name while 20.82% were prescribed by brand name. 29.18% of drugs were fixed dose combinations of all the antibiotics were prescribed empirically on the basis of provisional diagnosis. Of the total of antibiotics prescribed, amoxicillin was prescribed in 50.66% of patients, followed by cotrimoxazole in 26.05 % patients, cephalexin (8.50% were used commonly. Conclusion: The rational use of antimicrobial agents is one of the main contributors to control worldwide emergence of antibacterial resistance, side effects and reduced cost of the treatment.
Wang, Nan; Neuner, Elizabeth; Pallotta, Andrea; Athans, Vasilios; Wesolowski, Jill; Willner, Marc; Rivard, Kaitlyn; Srinivas, Pavithra; Fraser, Thomas G; Gordon, Steven
Abstract Background Documenting indication for antimicrobial use is a best practice and stewardship initiative recommended by the CDC. On September 20, 2016, a mandatory selection of antimicrobial indication as empiric, pathogen-directed, or prophylaxis was implemented for all prescribers within Cleveland Clinic Health System (CCHS), which comprises of an academic medical center and 8 community hospitals in Ohio, and 1 community hospital in Florida. This study sought to validate and describe ...
Full Text Available ... Veterinary Safety & Health Antimicrobial Resistance Animation of Antimicrobial Resistance Share Tweet Linkedin Pin it More sharing options ... produced a nine-minute animation explaining how antimicrobial resistance both emerges and proliferates among bacteria. Over time, ...
Full Text Available ... how antimicrobial resistance both emerges and proliferates among bacteria. Over time, the use of antimicrobial drugs will result in the development of resistant strains of bacteria, complicating clinician's efforts to select the appropriate antimicrobial ...
Full Text Available ... Animal & Veterinary Safety & Health Antimicrobial Resistance Animation of Antimicrobial Resistance Share Tweet Linkedin Pin it More sharing options ... CVM) produced a nine-minute animation explaining how antimicrobial resistance both emerges and proliferates among bacteria. Over time, ...
Francis, Nick A; Hood, Kerenza; Lyons, Ronan; Butler, Christopher C
The volume of prescribed antibiotics is associated with antimicrobial resistance and, unlike most other antibiotic classes, flucloxacillin prescribing has increased. We aimed to describe UK primary care flucloxacillin prescribing and factors associated with subsequent antibiotic prescribing as a proxy for non-response. Clinical Practice Research Datalink patients with acute prescriptions for oral flucloxacillin between January 2004 and December 2013, prescription details, associated Read codes and patient demographics were identified. Monthly prescribing rates were plotted and logistic regression identified factors associated with having a subsequent antibiotic prescription within 28 days. 3 031 179 acute prescriptions for 1 667 431 patients were included. Average monthly prescription rates increased from 4.74 prescriptions per 1000 patient-months in 2004 to 5.74 (increase of 21.1%) in 2013. The highest prescribing rates and the largest increases in rates were seen in older adults (70+ years), but the overall increase in prescribing was not accounted for by an ageing population. Prescribing 500 mg tablets/capsules rather than 250 mg became more common. Children were frequently prescribed low doses and small volumes (5 day course) and prescribing declined for children, including for impetigo. Only 4.2% of new prescriptions involved co-prescription of another antibiotic. Age (antibiotic prescription, which occurred after 17.6% of first prescriptions. There is a need to understand better the reasons for increased prescribing of flucloxacillin in primary care, optimal dosing (and the need to co-prescribe other antibiotics) and the reasons why one in five patients are prescribed a further antibiotic within 4 weeks. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
van Buul, Laura W; van der Steen, Jenny T; Achterberg, Wilco P; Schellevis, François G; Essink, Rob T G M; de Greeff, Sabine C; Natsch, Stephanie; Sloane, Philip D; Zimmerman, Sheryl; Twisk, Jos W R; Veenhuizen, Ruth B; Hertogh, Cees M P M
To evaluate the effect of tailored interventions on the appropriateness of decisions to prescribe or withhold antibiotics, antibiotic use and guideline-adherent antibiotic selection in nursing homes (NHs). We conducted a quasi-experimental study in 10 NHs in the Netherlands. A participatory action research (PAR) approach was applied, with local stakeholders in charge of selecting tailored interventions based on opportunities for improved antibiotic prescribing that they derived from provided baseline data. An algorithm was used to evaluate the appropriateness of prescribing decisions, based on infections recorded by physicians. Effects of the interventions on the appropriateness of prescribing decisions were analysed with a multilevel logistic regression model. Pharmacy data were used to calculate differences in antibiotic use and recorded infections were used to calculate differences in guideline-adherent antibiotic selection. The appropriateness of 1059 prescribing decisions was assessed. Adjusting for pre-test differences in the proportion of appropriate prescribing decisions (intervention, 82%; control, 70%), post-test appropriateness did not differ between groups (crude: P = 0.26; adjusted for covariates: P = 0.35). We observed more appropriate prescribing decisions at the start of data collection and before receiving feedback on prescribing behaviour. No changes in antibiotic use or guideline-adherent antibiotic selection were observed in intervention NHs. The PAR approach, or the way PAR was applied in the study, was not effective in improving antibiotic prescribing behaviour. The study findings suggest that drawing prescribers' attention to prescribing behaviour and monitoring activities, and increasing use of diagnostic resources may be promising interventions to improve antibiotic prescribing in NHs. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For
Full Text Available The decision to vote and choosing among the candidates is an extremely important one with repercussions on everyday life by determining, in global mode, its quality for the whole society. Therefore the whole process by which the voter decides becomes a central concern. Prescribers, supposed to have a big influence on the electoral market, are a component of the microenvironment political organizations. These are people who occupy important positions that can influence the behavior of others. In the political environment, prescribers are known under the name of "opinion formers", "opinion leaders", "mediators" (Beciu, 2009 or "influencers" (Keller and Berry, 2003 Weimann, 1994. This paper aims to review the central opinions on what is the influence prescribers, opinion makers on voting behavior, voting and decisions on whether and how they act?
Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene
Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how......) and the Danish Microbiology Database (performed microbiological testing). We will assess and quantify the use of microbiological testing prior to antibiotic prescription. Furthermore we will investigate associations between GP characteristics, use of microbiological investigations and description patterns...
Full Text Available ... More in Antimicrobial Resistance National Antimicrobial Resistance Monitoring System About NARMS 2015 NARMS Integrated Report Data Meetings and Publications Resources Judicious Use of ...
Full Text Available ... More in Antimicrobial Resistance National Antimicrobial Resistance Monitoring System ... If you need help accessing information in different file formats, see Instructions for Downloading ...
... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Good moral character. 316.10 Section 316.10... NATURALIZATION § 316.10 Good moral character. (a) Requirement of good moral character during the statutory period... prescribed period, he or she has been and continues to be a person of good moral character. This includes the...
Tzialla, C.; Borghesi, A.; Serra, G.; Stronati, M.; Corsello, G.
Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units (NICUs) and in industrialized countries about 1% of neonates are exposed to antibiotic therapy. Sepsis has often nonspecific signs and symptoms and empiric antimicrobial therapy is promptly initiated in high risk of sepsis or symptomatic infants. However continued us...
Current changes in legislation regarding prescription rights increase the possibility of non-medical practitioners being authorised to presctibe medication. There has been ongoing debate about granting psychologists in South Africa a limited right to prescribe (RTP) psychotropic medication. The main reasons advanced for ...
Beerlage-de Jong, Nienke; Wentzel, Jobke; Hendrix, Ron; van Gemert-Pijnen, Lisette
Background: Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily
Beerlage-de Jong, Nienke; Wentzel, M.J.; Hendrix, Ron; van Gemert-Pijnen, Julia E.W.C.
Background Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily
Shiona K Glass-Kaastra
Full Text Available BACKGROUND: The volume and patterns of antimicrobial drug use are key variables to consider when developing guidelines for prescribing, and programs to address stewardship and combat the increasing prevalence of antimicrobial resistant pathogens. Because drug programs are regulated at the provincial level, there is an expectation that antibiotic use may vary among provinces.
Murphy, Colleen P.; Reid-Smith, Richard J.; Boerlin, Patrick; Weese, J. Scott; Prescott, John F.; Janecko, Nicol; McEwen, Scott A.
This study investigated oral and parenteral antimicrobial use in dogs and cats, and evaluated antimicrobial use in feline upper respiratory tract disease (FURTD), feline lower urinary tract disease (FLUTD), and canine infectious tracheobronchitis. Study journals (n = 1807) were submitted by 84 veterinarians. Sixty-five percent of the antimicrobials prescribed in dogs and 67% in cats were β-lactams. Most frequently prescribed in dogs were cephalexin (33%) and amoxicillin-clavulanic acid (16%),...
Full Text Available Background. Antibiotic overprescribing is the major driving force for the emergence of antibiotics resistance. The aim of this study was to assess antibiotics prescribing at primary healthcare facilities in Addis Ababa, Ethiopia. Methods. The study was conducted in six public health centers found in Addis Ababa City. Data was collected retrospectively from a total of 900 prescriptions and selected medical charts of patients in the health centers in 2016. Data was entered and analyzed using EPI Info 7 and SPSS 20, respectively. Descriptive statistics and logistic regression analysis were used to analyze the data. Results. One or more antibiotics were prescribed in 56.0% of the prescriptions. Antibiotics accounted for 46.0% of the total cost of medicines prescribed. Amoxicillin was the most frequently (44.8% prescribed antibiotic and upper respiratory tract infection was the most common (24.5% diagnosis for prescribing antibiotics. Laboratory investigation was done for only about 27% of the cases for which antibiotics were prescribed. Conclusion. There was a high rate of antibiotics prescribing in the health centers often empirically which might exacerbate the antimicrobial resistance situation in the country. Large-scale study should be conducted to fully understand the prescribing pattern and identify the associated factors thereby design and implement appropriate interventions.
Dawoud, Dalia; Griffiths, Peter; Maben, Jill; Goodyer, Larry; Greene, Russell
Supplementary prescribing (SP) is a drug therapy management model implemented in the United Kingdom since 2003. It is a voluntary partnership between an independent prescriber; a supplementary prescriber, for example, nurse or pharmacist; and the patient, to implement an agreed patient-specific clinical management plan (CMP). To investigate pharmacist prescribers' views and experiences of the early stages of SP implementation. A qualitative, longitudinal study design was used. A purposive, maximum variability sample of 16 pharmacist supplementary prescribers, trained in Southern England, participated. Eleven were hospital pharmacists, owing to the overrepresentation of hospital pharmacists in the first cohort. Two semistructured interviews were conducted with each participant, at 3 and 6 months after their registration as prescribers. The Framework approach was used for data collection, management, and analysis. Three typologies of pharmacists' experiences were identified: "a blind alley", "a stepping stone" and "a good fit". Despite some delays in its implementation, SP was seen as a step forward. Some participants also believed that it improved patient care and pharmacists' integration in the health care team and increased their job satisfaction. However, there was a concern that SP, as first implemented, was bureaucratic and limited pharmacists' freedom in their decision making. Hence, pharmacists were more supportive of the then imminent introduction of a pharmacist independent prescribing (IP) role. Despite challenges, the SP role represented a step forward for pharmacists in the United Kingdom. It is possible that pharmacist SP can coexist with IP in the areas suitable for CMP use. Elsewhere, SP is likely to become more of a "stepping stone" to an IP role than the preferred model for pharmacist prescribing. Future research needs to objectively assess the outcomes of pharmacist SP, preferably in comparison with IP, to inform decision making among pharmacists
Essential oils from Rhanterium epapposum Oliv. (Asteraceae) was investigated for its repellent, antimicrobial and acetyl- and butyrylcholine esterase inhibitory activities. The oil showed good repellent activity while oils demonstrated weak in antimicrobial and cholinesterase inhibitions. Terpenoids...
Griffith, Milena M; Patel, Jean A; Sutton, Sarah H; Bolon, Maureen K; Esterly, John S; Gross, Alan E; Postelnick, Michael J; Zembower, Teresa R; Scheetz, Marc H
Antimicrobial drug shortages continue to increase, with few new therapeutic options available. Nationally, proposals have been offered to alleviate drug shortages; however, these recommendations are unlikely to effect change in the near future. Thus, antimicrobial stewardship leaders in acute care hospitals must develop a prospective management strategy to lessen the impact of these shortages on patient care. Herein, we describe several resources available to aid professionals in antimicrobial stewardship and healthcare epidemiology to manage drug shortages. An effective approach should include prospectively tracking shortages and maximizing inventory by appropriately managing usage. Several tenets should underpin this management. Alternative agents should be rationally chosen before the inventory of the primary agent has reached zero, ethical considerations should be taken into account, and timely notification and communication with key stakeholders should occur throughout the prescribing and dispensing process.
Lyell, David; Magrabi, Farah; Raban, Magdalena Z; Pont, L G; Baysari, Melissa T; Day, Richard O; Coiera, Enrico
Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB. One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured. Compared to scenarios with no CDS, correct CDS reduced omission errors by 38.3% (p < .0001, n = 120), 46.6% (p < .0001, n = 70), and 39.2% (p < .0001, n = 120) for low, low + interrupt and high complexity scenarios respectively. Incorrect CDS increased omission errors by 33.3% (p < .0001, n = 120), 24.5% (p < .009, n = 82), and 26.7% (p < .0001, n = 120). Participants made commission errors, 65.8% (p < .0001, n = 120), 53.5% (p < .0001, n = 82), and 51.7% (p < .0001, n = 120). Task complexity and interruptions had no impact on AB. This study found evidence of AB omission and commission errors in e-prescribing. Verification of CDS alerts is key to avoiding AB errors. However, interventions focused on this have had limited success to date. Clinicians should remain vigilant to the risks of CDS failures and verify CDS.
Brinkman, David J; Tichelaar, Jelle; Graaf, Sanne; Otten, René H J; Richir, Milan C; van Agtmael, Michiel A
Prescribing errors are an important cause of patient safety incidents and are frequently caused by junior doctors. This might be because the prescribing competence of final-year medical students is poor as a result of inadequate clinical pharmacology and therapeutic (CPT) education. We reviewed the literature to investigate which prescribing competencies medical students should have acquired in order to prescribe safely and effectively, and whether these have been attained by the time they graduate. PubMed, EMBASE and ERIC databases were searched from the earliest dates up to and including January 2017, using the terms 'prescribing', 'competence' and 'medical students' in combination. Articles describing or evaluating essential prescribing competencies of final-year medical students were included. Twenty-five articles describing, and 47 articles evaluating, the prescribing competencies of final-year students were included. Although there seems to be some agreement, we found no clear consensus among CPT teachers on which prescribing competencies medical students should have when they graduate. Studies showed that students had a general lack of preparedness, self-confidence, knowledge and skills, specifically regarding general and antimicrobial prescribing and pharmacovigilance. However, the results should be interpreted with caution, given the heterogeneity and methodological weaknesses of the included studies. There is considerable evidence that final-year students have insufficient competencies to prescribe safely and effectively, although there is a need for a greater consensus among CPT teachers on the required competencies. Changes in undergraduate CPT education are urgently required in order to improve the prescribing of future doctors. © 2018 VU University Medical Centre. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
Berland-Benhaïm, C; Bartoli, C; Karsenty, G; Piercecchi-Marti, M-D
To describe the legal framework of medicine prescription in France in 2013. With the assistance of lawyer and forensic pathologist, consultation (legifrance.gouv.fr), analysis, summary of French laws and rules surrounding drugs prescriptions to humans for medical purpose. Free medicine prescription is an essential feature of a doctor's action. To prescribe involve his responsibility at 3 levels: deontological, civilian and penal. Aim of the rules of medicine prescription is to preserve patient's safety and health. Doctors are encouraged to refer to recommendations and peer-reviewed publication every time the prescriptions go out of the case planned by law. Knowledge and respect of medicine prescription legal rules is essential for a good quality practice. Medical societies have a major role to improve medicine use among practitioners. Copyright © 2013. Published by Elsevier Masson SAS.
Purpose: To evaluate self-medication practices and prescribing patterns of antimicrobial agents. Methods: The study was carried out in Port Harcourt, Nigeria in 6 hospitals/clinics, 4 community pharmacies and the campus of University of Port Harcourt. 1,200 case files or charts of outpatients treated at the selected ...
Higgins, H M; Golding, S E; Mouncey, J; Nanjiani, I; Cook, A J C
In the United Kingdom, blanket antibiotic dry cow therapy (BDCT) is commonly prescribed. An alternate strategy is selective dry cow therapy (SDCT) whereby a teat sealant is given instead of an antibiotic to cows with a low probability of infection. Switching from BDCT to SDCT can significantly reduce antibiotic use. The aims of this study were to explore how veterinarians (vets) rationalized their prescribing decisions for mammary treatments at drying off, and the barriers and motivators they perceived to implementing SDCT. Face-to-face interviews were conducted with 20 purposively recruited vets from 6 practices in England, United Kingdom. The data were analyzed qualitatively using an inductive thematic analysis. The majority of participants stated a personal preference for SDCT because it constitutes more responsible antibiotic use. On the majority of farms, the prescribing decision was taken by a senior veterinarian and BDCT was prescribed. Less experienced vets expressed a desire to be more involved in the decision-making process. The first theme, prioritizing responsible antimicrobial prescribing, encapsulated the difficulties vets expressed engaging with farmers, conflicts of interest, and vets' determination to take action. The second theme, the effect of a vet's experience on their ability to influence farmers, focused on the specific challenges faced by less experienced vets and the importance of vets being both trusted by farmers and being knowledgeable. The third theme, vets' perceptions about the risk and complexity of implementing SDCT, revealed markedly different levels of concern and fears about adverse outcomes with teat sealants versus antibiotics. The results also showed differences in perceptions about how difficult SDCT is to implement in practice. The last theme, vets' suggestions for facilitating the introduction of SDCT, was wide ranging and provided useful insight from a veterinary perspective into ways to facilitate SDCT. Initiatives that
Wang, Hsiu-Yin; Chiu, Cheng-Hsun; Huang, Ching-Tai; Cheng, Chun-Wen; Lin, Yu-Jr; Hsu, Ying-Jen; Chen, Chi-Hua; Deng, Shin-Tarng; Leu, Hsieh-Shong
A blood culture-guided review strategy was applied to a hospital-wide computerised antimicrobial approval system (HCAAS) at a medical centre in Taiwan. The study aimed to evaluate the impact of this deployment on prescribers' behaviours, antimicrobial consumption, antimicrobial expenditure and healthcare quality in adult intensive care units (ICUs). The HCAAS automatically identifies patients with positive blood cultures and notifies the pre-assigned infectious diseases (ID) physicians for an online second review of the current antimicrobial regimen. Patients from 16 adult ICUs were selected as a focus group. Descriptive analysis, McNemar's test, interrupted time-series analysis and univariate regression analysis were applied. The number of prescriptions assigned for second review increased from 304 in 2010 to 682 in 2012. The approval rate for the antimicrobial regimen in the second review exceeded 70%. In disapproved cases, prescribers accepted the recommendation from ID physicians in 66.1% of cases in the first year; the acceptance rate increased to 80.6% in 2012. Among the restricted antimicrobial agents, consumption gradients decreased for all eight drug classes. The overall antimicrobial expenditure gradient declined significantly following deployment of the second review strategy. The healthcare-associated infection rate continued to decrease over time, and the mortality and ICU re-admission rates remained stable after deployment. A blood culture-guided review of antimicrobial use based on clinical and microbiological evidence improves accuracy in choosing appropriate antimicrobial agents and encourages de-escalation. Consumption and expenditure gradients of antimicrobial agents decreased after the intervention, and healthcare quality was not compromised. Copyright © 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
Jones Paul W
Full Text Available Abstract Background Over 300 therapies have been proposed for premenstrual syndrome. To date there has been only one survey conducted in the UK of PMS treatments prescribed by GPs, a questionnaire-based study by the National Association of Premenstrual Syndrome in 1989. Since then, selective serotonin re-uptake inhibitors have been licensed for severe PMS/PMDD, and governmental recommendations to reduce the dosage of vitamin B6 (the first choice over-the-counter treatment for many women with PMS have been made. This study investigates the annual rates of diagnoses and prescribing patterns for premenstrual syndrome (1993–1998 within a computerised general practitioner database. Methods Retrospective survey of prescribing data for premenstrual syndrome between 1993–1998 using the General Practice Research Database for the West Midlands Region which contains information on 282,600 female patients Results Overall the proportion of women with a prescription-linked diagnosis of premenstrual syndrome has halved over the five years. Progestogens including progesterone were the most commonly recorded treatment for premenstrual syndrome during the whole study period accounting for over 40% of all prescriptions. Selective serotonin-reuptake inhibitors accounted for only 2% of the prescriptions in 1993 but rose to over 16% by 1998, becoming the second most commonly recorded treatment. Vitamin B6 accounted for 22% of the prescriptions in 1993 but dropped markedly between 1997 and 1998 to 11%. Conclusions This study shows a yearly decrease in the number of prescriptions linked to diagnoses for premenstrual syndrome. Progestogens including progesterone, is the most widely prescribed treatment for premenstrual syndrome despite the lack of evidence demonstrating their efficacy.
De Asha, AR; Barnett, CT; Struchkov, V; Buckley, JG
Introduction: \\ud Clinicians typically use findings from cohort studies to objectively inform judgements regarding the potential (dis)advantages of prescribing a new prosthetic device. However, before finalising prescription a clinician will typically ask a patient to 'try out' a change of prosthetic device while the patient is at the clinic. Observed differences in gait when using the new device should be the result of the device’s mechanical function, but could also conceivably be due to pa...
Full Text Available A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H, Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items and patient care indicators (5 items. Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791. The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65 to 0.74 (95% CI: 0.69-0.78. The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48 to 0.82 (95% CI: 0.78-0.85. The instrument also showed high discriminant validity (prescribing indicators P<0.0001 and patient care indicators P<0.0001. Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.
Tichelaar, Jelle; Graaf, Sanne; Otten, René H. J.; Richir, Milan C.; van Agtmael, Michiel A.
Aims Prescribing errors are an important cause of patient safety incidents and are frequently caused by junior doctors. This might be because the prescribing competence of final‐year medical students is poor as a result of inadequate clinical pharmacology and therapeutic (CPT) education. We reviewed the literature to investigate which prescribing competencies medical students should have acquired in order to prescribe safely and effectively, and whether these have been attained by the time they graduate. Methods PubMed, EMBASE and ERIC databases were searched from the earliest dates up to and including January 2017, using the terms ‘prescribing’, ‘competence’ and ‘medical students’ in combination. Articles describing or evaluating essential prescribing competencies of final‐year medical students were included. Results Twenty‐five articles describing, and 47 articles evaluating, the prescribing competencies of final‐year students were included. Although there seems to be some agreement, we found no clear consensus among CPT teachers on which prescribing competencies medical students should have when they graduate. Studies showed that students had a general lack of preparedness, self‐confidence, knowledge and skills, specifically regarding general and antimicrobial prescribing and pharmacovigilance. However, the results should be interpreted with caution, given the heterogeneity and methodological weaknesses of the included studies. Conclusions There is considerable evidence that final‐year students have insufficient competencies to prescribe safely and effectively, although there is a need for a greater consensus among CPT teachers on the required competencies. Changes in undergraduate CPT education are urgently required in order to improve the prescribing of future doctors. PMID:29315721
Høgli, June Utnes; Garcia, Beate Hennie; Skjold, Frode; Skogen, Vegard; Småbrekke, Lars
Appropriate antibiotic prescribing is associated with favourable levels of antimicrobial resistance (AMR) and clinical outcomes. Most intervention studies on antibiotic prescribing originate from settings with high level of AMR. In a Norwegian hospital setting with low level of AMR, the literature on interventions for promoting guideline-recommended antibiotic prescribing in hospital is scarce and requested. Preliminary studies have shown improvement potentials regarding antibiotic prescribing according to guidelines. We aimed to promote appropriate antibiotic prescribing in patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at a respiratory medicine department in a Norwegian University hospital. Our specific objectives were to increase prescribing of appropriate empirical antibiotics, reduce high-dose benzylpenicillin and reduce total treatment duration. We performed an audit and feedback intervention study, combined with distribution of a recently published pocket version of the national clinical practice guideline. We included patients discharged with CAP or AECOPD and prescribed antibiotics during hospital stay, and excluded those presenting with aspiration, nosocomial infection and co-infections. The pre- and post-intervention period was 9 and 6 months, respectively. Feedback was provided orally to the department physicians at an internal-educational meeting. To explore the effect of the intervention on appropriate empirical antibiotics and mean total treatment duration we applied before-after analysis (Student's t-test) and interrupted time series (ITS). We used Pearson's χ2 to compare dose changes. In the pre-and post-intervention period we included 253 and 155 patients, respectively. Following the intervention, overall mean prescribing of appropriate empirical antibiotics increased from 61.7 to 83.8 % (P antibiotic prescribing had increased and sustained, while the effect on treatment
U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...
Sneddon, Jacqueline; Gilchrist, Mark; Wickens, Hayley
The role of antimicrobial pharmacists has changed considerably over the past 15 years. We describe here the development and ratification of a new expert professional curriculum to guide the training and development of antimicrobial specialist pharmacists. The curriculum has been developed by the UK Clinical Pharmacy Association Pharmacy Infection Network and endorsed by the Royal Pharmaceutical Society as a tool to support pharmacists in meeting the requirements for joining the Royal Pharmaceutical Society Faculty. This new resource has also been endorsed by PHE, the Scottish Antimicrobial Prescribing Group and the BSAC, and will support antimicrobial pharmacists in delivery of antimicrobial stewardship, which will in turn help the fight against antimicrobial resistance. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
O'Connor, Marie N
Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.
Results: The average number of drugs prescribed per encounter was 2.9. Encounters with injections were 0.5%. The percentage of drugs prescribed by generic name was 31.6%. All the drugs prescribed were from the National Essential Drugs List. Calcium antagonists were the most frequently used group of drugs (41.3%), ...
Sharma, Suparna; Bowman, Clive; Alladin-Karan, Bibi; Singh, Narendra
The increase in antimicrobial-resistant infections has led to significant morbidity, mortality, and healthcare costs. The impact of antimicrobial resistance is greatest on low-income countries, which face the double burden of fewer antibiotic choices and higher rates of infectious diseases. Currently, Guyana has no national policy on rational prescribing. This study aims to characterize antibiotic prescribing patterns in children discharged from the emergency department at Georgetown Public Hospital Corporation (GPHC), as per the World Health Organization (WHO) prescribing indicators. A retrospective chart review of pediatric patients (aged 1 month-13 years) seen in the GPHC emergency department between January and December 2012 was conducted. Outpatient prescriptions for eligible patients were reviewed. Patient demographics, diagnosis, and drugs prescribed were recorded. The following WHO Prescribing Indicators were calculated: i) average number of drugs prescribed per patient encounter, ii) percentage of encounters with an antibiotic prescribed, iii) percentage of antibiotics prescribed by generic name, and iv) percentage of antibiotics prescribed from essential drugs list or formulary. Eight hundred eleven patient encounters were included in the study. The mean patient age was 5.55 years (s = 3.98 years). 59.6 % (n = 483) patients were male. An average of 2.5 drugs were prescribed per encounter (WHO standard is 2.0). One or more antibiotic was prescribed during 36.9 % (n = 299) of all encounters (WHO standard is 30 %). 90.83 % of antibiotics were prescribed from the essential drugs formulary list and 30 % of the prescriptions included the drug's generic name. The average duration of antibiotic therapy was 5.73 days (s = 3.53 days). Of the 360 antibiotics prescribed, 74.7 % (n = 269) were broad-spectrum. B-lactam penicillins were prescribed most frequently (51.4 %), with amoxicillin being the most popular choice (33.9 %). The
Zhong, Wenjun; Maradit-Kremers, Hilal; St. Sauver, Jennifer L.; Yawn, Barbara P.; Ebbert, Jon O.; Roger, Véronique L.; Jacobson, Debra J.; McGree, Michaela E.; Brue, Scott M.; Rocca, Walter A.
Objective To describe age and sex patterns of drug prescribing in Olmsted County, MN. Prescription drugs are an important component of health care delivery, yet little is known about the prescribing patterns in the general population. Patients and Methods Population-based drug prescription records for the Olmsted County population in the year 2009 were obtained using the Rochester Epidemiology Project medical records-linkage system (n = 142,377). Drug prescriptions were classified using RxNorm codes and grouped using the National Drug File – Reference Terminology (NDF-RT). Results Overall, 68% of the population received a prescription from at least one drug group, 52% received prescriptions from 2 or more groups, and 21% received prescriptions from 5 or more groups. The most commonly prescribed drug groups in the entire population were penicillins and beta-lactam antimicrobials (17%), antidepressants (13%), opioid analgesics (12%), antilipemic agents (11%), and vaccines/toxoids (11%). However, prescribing patterns differed by age and sex. Vaccines/toxoids, penicillins and beta-lactam antimicrobials, and anti-asthmatic drugs were most commonly prescribed in persons younger than 19 years. Antidepressants and opioid analgesics were most commonly prescribed in young and middle-aged adults. Cardiovascular drugs were most commonly prescribed in older adults. Women received more prescriptions than men for several groups of drugs, in particular for antidepressants. For several groups of drugs, the use increased with advancing age. Conclusion This study provides valuable baseline information for future studies of drug utilization and drug-related outcomes in this population. PMID:23790544
Qian, Jingjing; Hansen, Richard A; Surry, Daniel; Howard, Jennifer; Kiptanui, Zippora; Harris, Ilene
Pharmaceutical companies paid at least $3.91bn to prescribers in 2013, yet evidence indicating whether industry payments shift prescribing away from generics is limited. This study examined the association between amount of industry payments to prescribers and generic drug prescribing rates among Medicare Part D prescribers. A cross-sectional analysis was conducted among 770 095 Medicare Part D prescribers after linking the 2013 national Open Payments data with 2013 Medicare Provider Utilization and Payment data. The exposure variable was the categorized amount of total industry payments to prescribers (i.e., meals, travel, research, and ownership). The outcome was prescriber's annual generic drug prescribing rate. Multivariable generalized linear regression models were used to examine the association between the amount of industry payments and prescriber's annual generic drug prescribing rates, controlling for prescriber's demographic and practice characteristics. In this sample, over one-third (38.0%) of Medicare Part D prescribers received industry payments in 2013. The mean annual generic drug prescribing rate was highest among prescribers receiving no payments and lowest among those receiving more than $500 of industry payments (77.5% vs. 71.3%, respectively; p industry payments was independently associated with prescribers' generic drug prescribing rate; higher payments corresponded with lower generic drug prescribing rates. Other prescriber characteristics associated with higher annual generic drug prescribing rate included male sex, non-northeast region, specialty, and patient volume. Receipt of industry payments was associated with a decreased rate of generic drug prescribing. How this affects patient care and total medical costs warrants further study. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Full Text Available ... version) Arabic Translation of Animation of Antimicrobial Resistance Chinese Translation of Animation of Antimicrobial Resistance French Translation ... FEAR Act Site Map Nondiscrimination Website Policies U.S. Food and Drug Administration 10903 New Hampshire Avenue Silver ...
Full Text Available ... Medicine (CVM) produced a nine-minute animation explaining how antimicrobial resistance both emerges and proliferates among bacteria. ... concept more understandable to non-scientists by showing how bacterial antimicrobial resistance can develop and spread. All ...
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Avent, Minyon L; Hall, Lisa; Davis, Louise; Allen, Michelle; Roberts, Jason A; Unwin, Sean; McIntosh, Kylie A; Thursky, Karin; Buising, Kirsty; Paterson, David L
In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results. The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use. Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. WHAT IS KNOWN ABOUT THE TOPIC?: The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare
Conclusions: Community interventions for appropriate use of antibiotics should be designed with a special focus on women. This should be done through public awareness campaigns and improving access to reliable medical services. Drug prescribers are key not only to appropriate antimicrobial prescription, but also to adequate dispensing, and are strong advocates for the possible misconceptions on antimicrobial usage by lay people.
An anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes (microbiocidal) or prevent the growth of microbes (microbiostatic). Sulphonamide drugs were the first antimicrobial drugs, and paved the way for the antibiotic revolution in medicine. The first sulfonamide, trade named Prontosil, was actually a prodrug. However, with the development of antimicrobials, microorganisms have adapted ...
Courtenay, Molly; Carey, Nicola; Gage, Heather; Stenner, Karen; Williams, Peter
The aim of this study were to compare nurse prescribers and non-prescribers managing people with diabetes in general practice regarding: (a) patient characteristics; (b) activities and processes of care; (c) patient outcomes (self-management, clinical indicators, satisfaction) and (d) resource implications and costs. Over 28,000 nurses in the UK can prescribe the same medicines as doctors provided that it is in their level of experience and competence. Over 30%, mostly in general practice, prescribe medicines for patients with diabetes. A comparative case study. Nurses managing care of people with Type 2 diabetes were recruited in twelve general practices in England; six could prescribe, six could not. Patients, recruited by nurses, were followed up for 6 months (2011-2012). The patient sample comprised 131 in prescriber sites, 83 in non-prescriber sites. Patients of prescribers had been diagnosed and cared for by the nurse longer than those of non-prescribers. There were no differences in reported self-care activities or HbA1c test results between the patients of prescribers and non-prescribers. Mean HbA1c decreased significantly in both groups over 6 months. Patients of prescribers were more satisfied. Consultation duration was longer for prescribers (by average of 7·7 minutes). Non-prescribing nurses sought support from other healthcare professionals more frequently. Most prescribing nurses were on a higher salary band than non-prescribers. Clinical outcomes of patients managed by prescribing and non-prescribing diabetes nurses are similar. Prescribing nurses had longer relationships with their patients and longer consultations, possibly contributing to higher satisfaction with care. Employment costs of prescribing nurses are potentially higher. © 2015 John Wiley & Sons Ltd.
Hamilton, Hilary J
Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.
Gallagher Paul F
Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.
Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L
Ana Paula Cezar Machado
Full Text Available Abstract Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU, are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.
Machado, Ana Paula Cezar; Tomich, Catharina Somerlate Franco; Osme, Simone Franco; Ferreira, Daniela Marques de Lima Mota; Mendonça, Maria Angélica Oliveira; Pinto, Rogério Melo Costa; Penha-Silva, Nilson; Abdallah, Vânia Olivetti Steffen
Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU), are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.
Honey, Brooke Lynn; Bray, Whitney M; Gomez, Michael R; Condren, Michelle
Medication errors are hazardous and costly. Children are at increased risk for medication errors because of weight-based dosing, limited FDA indications, and human calculation errors. The aim of this study is to determine the frequency and type of resident prescribing errors in a pediatric clinic and further compare error rates of residents in different training programs. Resident prescription error data from a pediatric clinic was collected for 5 months. Upon detection of an error, residents were notified/given feedback regarding the type of error, ways to remedy errors, and future prevention methods. Data were categorized based on medication involved, error type, and resident training program. The review included 2941 prescriptions, with the overall resident prescribing error rate being 5.88%. The pediatric resident error rate was 4%. Family medicine, internal medicine, and medicine/pediatrics had error rates of 11%, 8%, and 7%, respectively. The prescribing error rate showed a statistically significant difference with pediatrics compared with family medicine, internal medicine, and medicine/pediatrics (P medication error type was overdose, followed by unclear quantity. Among the medication classes, topical agents and antimicrobials were among the top prescribed. Numerous types of medication errors occur in a pediatric clinic. Prescribing errors take place among all medical trainees; however, medication error rates in the pediatric population may vary among resident specialty. Identifying the cause of prescribing errors will allow institutions to create educational programs tailored for safe medication use in children as well as systemwide changes for error reduction.
H NMR, 13C NMR, mass spectra, and elemental analyses data. The reaction was performed by using ordinary condensation type, which enabled to easy work-up and good yield. Synthesized compounds were screened for antimicrobial ...
Barry, Patrick J
Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.
Olufemi Ernest Ojo
Full Text Available Antimicrobial usage in animals contributes to the emergence of antimicrobial resistant bacterial strains. Investigations were carried out on how the characteristics, knowledge, attitude and practices of antimicrobial marketers influenced antimicrobials usage in animal production in Oyo and Kaduna States, Nigeria. Focus group discussions, in-depth interviews and structured questionnaires were used to gather information about the characteristics and activities of antimicrobial marketers. Overall, 70 (56.9 % of 123 marketers had post-secondary education while 76 (61.8 % were trained on the use of antimicrobials. Eighteen (14.6 % of the marketers were licensed veterinarians. Only 51 (41.5 % marketers displayed adequate knowledge about antimicrobials and antimicrobial usage. Sixty-seven (54.6 % marketers requested a prescription before selling antimicrobials while 113 (91.9 % marketer recommended antimicrobials for use in animals. Two-third of the marketers (66.7 % prescribed antimicrobials without physically examining sick animals but based their prescriptions on verbal reports of clinical signs by farmers and on their personal experience. Marketers with higher educational qualification displayed more adequate knowledge of antimicrobials and antimicrobial usage than those with basic education background only. More years of experience in antimicrobial marketing did not translate to better knowledge on antimicrobial usage. Only 45 (36.6 % respondents were aware of the existence of regulatory agencies monitoring the use of antimicrobials in animals. Farmers ignored the services of veterinarians in the diagnosis and control of animal diseases but resorted to drug marketers for help. Effective communication of existing legislations on antimicrobial usage, improved access to veterinary services and strict enforcement of regulatory policies are recommended for checking non-judicious use of antimicrobial agents in animal production. Sales of
Tong, Shuangmei; Pan, Jiaqian; Lu, Shan; Tang, Jing
Antimicrobial therapy is among the mainstream treatment modalities employed in clinical settings. Antimicrobial sensitivity of the pathogen and patient compliance are key determinants of the efficacy of antimicrobial therapy. In this study, we sought to investigate the factors that affect patient compliance to antimicrobial therapy in a Chinese teaching hospital to enhance patient compliance and to prevent abuse and misuse of antibiotics by patients. A questionnaire survey was conducted among patients willing to answer all the questions who were prescribed antimicrobial drugs orally, and for whom at least half of the duration of therapy was not under the supervision of a doctor or nurse. Data analyses were performed using Kruskal-Wallis test and multivariate logistic regression. A total of 720 patients participated in the survey; of these, 714 patients provided complete data and were included in the analysis. Up to 86.97% of patients showed noncompliance to antimicrobial therapy (total compliance score compliance (total compliance score = 8). On multivariate analyses, understanding of the treatment was an important factor associated with compliance. A range of factors were associated with compliance to antimicrobial therapy, including understanding of the treatment, gender, age, home address, education level, and family income. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.
Gulliford, Martin C; Dregan, Alex; Moore, Michael V; Ashworth, Mark; Staa, Tjeerd van; McCann, Gerard; Charlton, Judith; Yardley, Lucy; Little, Paul; McDermott, Lisa
Overutilisation of antibiotics may contribute to the emergence of antimicrobial drug resistance, a growing international concern. This study aimed to analyse the performance of UK general practices with respect to antibiotic prescribing for respiratory tract infections (RTIs) among young and middle-aged adults. Data are reported for 568 UK general practices contributing to the Clinical Practice Research Datalink. Participants were adults aged 18-59 years. Consultations were identified for acute upper RTIs including colds, cough, otitis-media, rhino-sinusitis and sore throat. For each consultation, we identified whether an antibiotic was prescribed. The proportion of RTI consultations with antibiotics prescribed was estimated. There were 568 general practices analysed. The median general practice prescribed antibiotics at 54% of RTI consultations. At the highest prescribing 10% of practices, antibiotics were prescribed at 69% of RTI consultations. At the lowest prescribing 10% of practices, antibiotics were prescribed at 39% RTI consultations. The median practice prescribed antibiotics at 38% of consultations for 'colds and upper RTIs', 48% for 'cough and bronchitis', 60% for 'sore throat', 60% for 'otitis-media' and 91% for 'rhino-sinusitis'. The highest prescribing 10% of practices issued antibiotic prescriptions at 72% of consultations for 'colds', 67% for 'cough', 78% for 'sore throat', 90% for 'otitis-media' and 100% for 'rhino-sinusitis'. Most UK general practices prescribe antibiotics to young and middle-aged adults with respiratory infections at rates that are considerably in excess of what is clinically justified. This will fuel antibiotic resistance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Williams, D; Bennett, K; Heery, A; Feely, J
To study the effect of safety concerns and the introduction of freely available nicotine replacement therapy (NRT) on the prescribing of Buproprion within the General Medical Services (GMS) scheme in Ireland. Using the state-supported GMS prescription database in Ireland, we identified 8166 patients who were prescribed Buproprion and 18,450 patients who were prescribed NRT over a 12-month-period. A decline in the prescribing of Buproprion was noted which coincided with concerns regarding the safety of the drug but which preceded the introduction of NRT to the GMS. Furthermore, patients who were prescribed Buproprion were less likely to be co-prescribed potentially interacting drugs (odds ratio (OR): 0.48, 95% confidence intervals (CI): 0.42, 0.54) or drugs known to reduce seizure threshold (OR: 0.63, 95% CI: 0.6, 0.67) indicating good prescribing practice. Patients aged 65 years or more were less likely to be prescribed any form of smoking cessation therapy compared with those aged Buproprion and were likely to have been influenced both by the safety concerns and the introduction of freely available NRT to the GMS population. Copyright 2003 John Wiley & Sons, Ltd.
Full Text Available Fire is a dominant ecological factor in Mediterranean-type ecosystems. Management strategies include prescribed (controlled burning, which has been used in the management of several species, such as Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. The effects of prescribed burning on Pinus laricio have been little studied. The first aim of this study was to characterize total and simple phenolic compounds in Pinus laricio. The second aim was to understand: i the short term (one to three months and medium term (three years effects of prescribed burning, and ii the effects of periodic prescribed burning on the production of phenolic compounds in Pinus laricio. The first result of this study is the presence of total and simple phenolic compounds in the needles of Pinus laricio. 3-Vanillyl propanol is the major compound. After a prescribed burning, the synthesis of total phenolic compounds increases in Pinus laricio for a period of three months. Total phenolic compounds could be used as bioindicators for the short-term response of Pinus laricio needles to prescribed burning. Simple phenolic compounds do not seem to be good indicators of the impact of prescribed burning because prescribed burnings are low in intensity.
Som, Abhigyan; Vemparala, Satyavani; Ivanov, Ivaylo; Tew, Gregory N
Infectious diseases and antibiotic resistance are now considered the most imperative global healthcare problem. In the search for new treatments, host defense, or antimicrobial, peptides have attracted considerable attention due to their various unique properties; however, attempts to develop in vivo therapies have been severely limited. Efforts to develop synthetic mimics of antimicrobial peptides (SMAMPs) have increased significantly in the last decade, and this review will focus primarily on the structural evolution of SMAMPs and their membrane activity. This review will attempt to make a bridge between the design of SMAMPs and the fundamentals of SMAMP-membrane interactions. In discussions regarding the membrane interaction of SMAMPs, close attention will be paid to the lipid composition of the bilayer. Despite many years of study, the exact conformational aspects responsible for the high selectivity of these AMPs and SMAMPs toward bacterial cells over mammalian cells are still not fully understood. The ability to design SMAMPs that are potently antimicrobial, yet nontoxic to mammalian cells has been demonstrated with a variety of molecular scaffolds. Initial animal studies show very good tissue distribution along with more than a 4-log reduction in bacterial counts. The results on SMAMPs are not only extremely promising for novel antibiotics, but also provide an optimistic picture for the greater challenge of general proteomimetics.
Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...
Countries have come to place heavy reliance on antibiotics, a phenomena that has contributed to widespread resistant bacteria. Unless antibiotic prescribing patterns are kept in check, the spread of resistant bacteria will lead to a proliferation of dreadful diseases. In this study, antibiotic prescribing patterns at Van Velden ...
Velo, Giampaolo P; Minuz, Pietro
1. Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients. 2. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. 3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. 4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. 5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.
Courtenay, Molly; Castro-Sánchez, Enrique; Deslandes, Rhian; Hodson, Karen; Lim, Rosemary; Morris, Gary; Reeves, Scott; Weiss, Marjorie
Multi-drug resistant infections have been identified as one of the greatest threats to human health. Healthcare professionals are involved in an array of patient care activities for which an understanding of antimicrobial stewardship is important. Although antimicrobial prescribing and stewardship competencies have been developed for healthcare professionals who adopt the role of a prescriber, competencies do not exist for other medicine-related stewardship activities. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities. This report presents a protocol for a study designed to provide national consensus on antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education. A modified Delphi process will be used in which a panel of Experts, comprising members from across the United Kingdom, with expertise in prescribing and medicines management with regard to the education and practice of healthcare professionals, and antimicrobial prescribing and stewardship, will be invited to take part in two survey rounds. The competencies developed will be applicable to all undergraduate healthcare professional education programmes. They will help to standardise curricula content and enhance the impact of antimicrobial stewardship education.
Effective control of plaque and gingivitis are among our most important treatment goals. Several antimicrobial products have demonstrated safety and various degrees of effectiveness as adjuncts to mechanical plaque control. Our clinical decisions relating to antimicrobial products should be based on the expanding body of research that documents product safety and effectiveness in reducing both plaque and gingivitis. Antimicrobials present exciting prospects for in-office and home use, but they do not replace thorough root debridement and traditional plaque control. However, when selected based on individual patient needs and used in recommended regimens, antimicrobials can be important additions to both professional treatment and oral hygiene practices.
Johnson, Alan P.; Ashiru-Oredope, Diane; Beech, Elizabeth
Antibiotic use is a major driver for the emergence and spread of antibiotic resistance. Antimicrobial stewardship programmes aim to improve antibiotic prescribing with the objectives of optimizing clinical outcomes while at the same time minimizing unintended consequences such as adverse effects and the selection of antibiotic resistance. In 2013, a five-year national strategy for tackling antimicrobial resistance was published in the UK. The overarching goal of the strategy is to slow the de...
Rafalskiy, V V; Dovgan, E V
Urinary tract infection (UTI) is one of the most common reasons for prescribing antibiotics in outpatient and inpatient settings. One of the main criteria for selecting antimicrobial drugs for treating UTI is data on the antibiotic resistance of uropathogens. The article discusses the difficulties in interpreting the results of antimicrobial sensitivity testing of uropathogens and the impact of antibiotic resistance of uropathogens on the clinical effectiveness of managing UTI.
Martinez-Becerra, Francisco; Silva, Daniel-Adriano; Dominguez-Ramirez, Lenin; Mendoza-Hernandez, Guillermo; Lopez-Vidal, Yolanda; Soldevila, Gloria; Garcia-Zepeda, Eduardo A.
Chemokines are key molecules involved in the control of leukocyte trafficking. Recently, a novel function as antimicrobial proteins has been described. CCL13 is the only member of the MCP chemokine subfamily displaying antimicrobial activity. To determine Key residues involved in its antimicrobial activity, CCL13 derived peptides were synthesized and tested against several bacterial strains, including Pseudomonas aeruginosa. One of these peptides, corresponding to the C-terminal region of CCL13 (CDAP-4) displayed good antimicrobial activity. Electron microscopy studies revealed remarkable morphological changes after CDAP-4 treatment. By computer modeling, CDAP-4 in α helical configuration generated a positive electrostatic potential that extended beyond the surface of the molecule. This feature is similar to other antimicrobial peptides. Altogether, these findings indicate that the antimicrobial activity was displayed by CCL13 resides to some extent at the C-terminal region. Furthermore, CDAP-4 could be considered a good antimicrobial candidate with a potential use against pathogens including P. aeruginosa
Ticehurst, Rob; Thomast, Mark
resulted in a generally prudent level of consumption in recent years. Opportunities exist to improve the pattern of antimicrobial prescribing in the expectation that this will help to slow the spread of antimicrobial resistance in our community.
Furuya, E. Yoko; Kuperman, Gilad J.; Cimino, James J.; Bakken, Suzanne
Objectives To develop and apply formal ontology creation methods to the domain of antimicrobial prescribing and to formally evaluate the resulting ontology through intrinsic and extrinsic evaluation studies. Methods We extended existing ontology development methods to create the ontology and implemented the ontology using Protégé-OWL. Correctness of the ontology was assessed using a set of ontology design principles and domain expert review via the laddering technique. We created three artifacts to support the extrinsic evaluation (set of prescribing rules, alerts and an ontology-driven alert module, and a patient database) and evaluated the usefulness of the ontology for performing knowledge management tasks to maintain the ontology and for generating alerts to guide antibiotic prescribing. Results The ontology includes 199 classes, 10 properties, and 1,636 description logic restrictions. Twenty-three Semantic Web Rule Language rules were written to generate three prescribing alerts: 1) antibiotic-microorganism mismatch alert; 2) medication-allergy alert; and 3) non-recommended empiric antibiotic therapy alert. The evaluation studies confirmed the correctness of the ontology, usefulness of the ontology for representing and maintaining antimicrobial treatment knowledge rules, and usefulness of the ontology for generating alerts to provide feedback to clinicians during antibiotic prescribing. Conclusions This study contributes to the understanding of ontology development and evaluation methods and addresses one knowledge gap related to using ontologies as a clinical decision support system component—a need for formal ontology evaluation methods to measure their quality from the perspective of their intrinsic characteristics and their usefulness for specific tasks. PMID:22019377
Jeffs, Lianne; Thampi, Nisha; Maione, Maria; Steinberg, Marilyn; Morris, Andrew M; Bell, Chaim M
Inappropriate use of antimicrobials is linked to the development and spread of drug-resistant pathogens and is associated with increased morbidity, mortality, lengths of hospital stay, and health care costs. "Antimicrobial stewardship" is the umbrella term for an evidence-based knowledge translation strategy involving comprehensive quality improvement activities to optimize the use of antimicrobials, improve patient outcomes, reduce the development of antimicrobial resistance and hospital-acquired infections such as Clostridium difficile, and decrease health care costs. To assess the perceptions and experiences of antimicrobial stewardship program leaders in terms of clinicians' attitudes toward and behaviours related to antimicrobial prescribing. In this qualitative study, semistructured interviews were conducted with 6 antimicrobial stewards (2 physicians and 4 pharmacists) at 3 academic hospitals between June and August 2013. The following 3 key themes emerged from the interviews: getting the right people on board, building collegial relationships, and rapidly establishing a track record. The study results elucidated the role and mechanisms that the program leader and other antimicrobial stewards used to influence other clinicians to engage in effective utilization of antimicrobials. The results also highlighted the methods employed by members of the antimicrobial stewardship team to tailor their strategies to the local context and to stakeholders of participating units; to gain credibility by demonstrating the impact of the antimicrobial stewardship program on clinical outcomes and cost; and to engage senior leaders to endorse and invest in the antimicrobial stewardship program, thereby adding to the antimicrobial stewards' credibility and their ability to influence the uptake of effective antimicrobial use. Collectively, these results offer insight into processes and mechanisms of influence employed by antimicrobial stewards to enhance antimicrobial use among
Sadigh-Rad, Laya; Majdi, Leila; Javaezi, Mehrnush; Delirrad, Mohammad
As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran. In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations. Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients' encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant. Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences.
Lesar, Timothy S
CONTEXT Prescribing errors involving medication dose formulations have been reported to occur frequently in hospitals. No systematic evaluations of the characteristics of errors related to medication dosage formulation have been performed. OBJECTIVE To quantify the characteristics, frequency, and potential adverse patient effects of prescribing errors involving medication dosage forms . DESIGN Evaluation of all detected medication prescribing errors involving or related to medication dosage forms in a 631-bed tertiary care teaching hospital. MAIN OUTCOME MEASURES Type, frequency, and potential for adverse effects of prescribing errors involving or related to medication dosage forms. RESULTS A total of 1,115 clinically significant prescribing errors involving medication dosage forms were detected during the 60-month study period. The annual number of detected errors increased throughout the study period. Detailed analysis of the 402 errors detected during the last 16 months of the study demonstrated the most common errors to be: failure to specify controlled release formulation (total of 280 cases; 69.7%) both when prescribing using the brand name (148 cases; 36.8%) and when prescribing using the generic name (132 cases; 32.8%); and prescribing controlled delivery formulations to be administered per tube (48 cases; 11.9%). The potential for adverse patient outcome was rated as potentially “fatal or severe” in 3 cases (0.7%), and “serious” in 49 cases (12.2%). Errors most commonly involved cardiovascular agents (208 cases; 51.7%). CONCLUSIONS Hospitalized patients are at risk for adverse outcomes due to prescribing errors related to inappropriate use of medication dosage forms. This information should be considered in the development of strategies to prevent adverse patient outcomes resulting from such errors. PMID:12213138
Full Text Available ... use of antimicrobial drugs will result in the development of resistant strains of bacteria, complicating clinician's efforts to select the appropriate antimicrobial for treatment. Accordingly, efforts are underway in both veterinary and human medicine to preserve the effectiveness of these drugs. ...
Full Text Available This article highlights new members, novel mechanisms of action, new functions, and interesting applications of antimicrobial peptides reported in 2014. As of December 2014, over 100 new peptides were registered into the Antimicrobial Peptide Database, increasing the total number of entries to 2493. Unique antimicrobial peptides have been identified from marine bacteria, fungi, and plants. Environmental conditions clearly influence peptide activity or function. Human α-defensin HD-6 is only antimicrobial under reduced conditions. The pH-dependent oligomerization of human cathelicidin LL-37 is linked to double-stranded RNA delivery to endosomes, where the acidic pH triggers the dissociation of the peptide aggregate to release its cargo. Proline-rich peptides, previously known to bind to heat shock proteins, are shown to inhibit protein synthesis. A model antimicrobial peptide is demonstrated to have multiple hits on bacteria, including surface protein delocalization. While cell surface modification to decrease cationic peptide binding is a recognized resistance mechanism for pathogenic bacteria, it is also used as a survival strategy for commensal bacteria. The year 2014 also witnessed continued efforts in exploiting potential applications of antimicrobial peptides. We highlight 3D structure-based design of peptide antimicrobials and vaccines, surface coating, delivery systems, and microbial detection devices involving antimicrobial peptides. The 2014 results also support that combination therapy is preferred over monotherapy in treating biofilms.
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Full Text Available Despite numerous existing potent antibiotics and other antimicrobial means, bacterial infections are still a major cause of morbidity and mortality. Moreover, the need to develop additional bactericidal means has significantly increased due to the growing concern regarding multidrug-resistant bacterial strains and biofilm associated infections. Consequently, attention has been especially devoted to new and emerging nanoparticle-based materials in the field of antimicrobial chemotherapy. The present review discusses the activities of nanoparticles as an antimicrobial means, their mode of action, nanoparticle effect on drug-resistant bacteria, and the risks attendant on their use as antibacterial agents. Factors contributing to nanoparticle performance in the clinical setting, their unique properties, and mechanism of action as antibacterial agents are discussed in detail.
Morley, Paul S; Apley, Michael D; Besser, Thomas E; Burney, Derek P; Fedorka-Cray, Paula J; Papich, Mark G; Traub-Dargatz, Josie L; Weese, J Scott
Recognizing the importance of antimicrobial resistance and the need for veterinarians to aid in efforts for maintaining the usefulness of antimicrobial drugs in animals and humans, the Board of Regents of the American College of Veterinary Internal Medicine charged a special committee with responsibility for drafting this position statement regarding antimicrobial drug use in veterinary medicine. The Committee believes that veterinarians are obligated to balance the well-being of animals under their care with the protection of other animals and public health. Therefore, if an animal's medical condition can be reasonably expected to improve as a result of treatment with antimicrobial drugs, and the animal is under a veterinarian's care with an appropriate veterinarian-client-patient relationship, veterinarians have an obligation to offer antimicrobial treatment as a therapeutic option. Veterinarians also have an obligation to actively promote disease prevention efforts, to treat as conservatively as possible, and to explain the potential consequences associated with antimicrobial treatment to animal owners and managers, including the possibility of promoting selection of resistant bacteria. However, the consequences of losing usefulness of an antimicrobial drug that is used as a last resort in humans or animals with resistant bacterial infections might be unacceptable from a public or population health perspective. Veterinarians could therefore face the difficult choice of treating animals with a drug that is less likely to be successful, possibly resulting in prolonged or exacerbated morbidity, to protect the good of society. The Committee recommends that voluntary actions be taken by the veterinary profession to promote conservative use of antimicrobial drugs to minimize the potential adverse effects on animal or human health. The veterinary profession must work to educate all veterinarians about issues related to conservative antimicrobial drug use and
Gómez-Moreno, Gerardo; Guardia, Javier; Cutando, Antonio; Calvo-Guirado, José-Luis
In this third article we describe the pharmacological interactions resulting from the use of anti-microbial agents. Although the antimicrobials prescribed in odontology are generally safe they can produce interactions with other medicaments which can give rise to serious adverse reactions which are well documented in clinical studies. Antibiotics with grave and dangerous life threatening consequences are erythromycin, clarithromycin and metronidazol and the anti-fungal agents are ketoconazol and itraconazol. Regarding the capacity of the anti-microbials to reduce the efficacy of oral anti-contraceptives the clinical studies to date are inconclusive, however, it would be prudent for the oral cavity specialist to point out the risk of a possible interaction. Therefore the specialist should be aware of possible interactions as a consequence of administering an antibiotic together with other medicaments the patient may be taking.
U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data - Part D Prescriber Public...
Wang, Fengwen; Sigmund, Ole; Jensen, Jakob Søndergaard
We systematically design materials using topology optimization to achieve prescribed nonlinear properties under finite deformation. Instead of a formal homogenization procedure, a numerical experiment is proposed to evaluate the material performance in longitudinal and transverse tensile tests...
J.E.C.M. Aarts (Jos)
markdownabstract__Abstract__ Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of
This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers.
Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt
The Quality of Prescribing for Psychiatric Patients Soerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3...... need to improve the quality in prescribing for psychiatric patients....
Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt
The Quality of Prescribing for Psychiatric PatientsSoerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3...... need to improve the quality in prescribing for psychiatric patients....
Le Couteur, David G; Kendig, Hal
Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted.
Hazra, Nisha C; Dregan, Alex; Jackson, Stephen; Gulliford, Martin C
To use primary care electronic health records (EHRs) to evaluate prescriptions and inappropriate prescribing in men and women at age 100. Population-based cohort study. Primary care database in the United Kingdom, 1990 to 2013. Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084; n = 8,982 women, n = 2,102 men). Main drug classes prescribed and potentially inappropriate prescribing according to the 2012 American Geriatrics Society Beers Criteria. At the age of 100, 73% of individuals (79% of women, 54% of men) had received one or more prescription drugs, with a median of 7 (interquartile range 0-12) prescription items. The most frequently prescribed drug classes were cardiovascular (53%), central nervous system (CNS) (53%), and gastrointestinal (47%). Overall, 32% of participants (28% of men, 32% of women) who received drug prescriptions may have received one or more potentially inappropriate prescriptions, with temazepam and amitriptyline being the most frequent. CNS prescriptions were potentially inappropriate in 23% of individuals, and anticholinergic prescriptions were potentially inappropriate in 18% of individuals. The majority of centenarians are prescribed one or more drug therapies, and the prescription may be inappropriate for up to one-third of these individuals. Research using EHRs offers opportunities to understand prescribing trends and improve pharmacological care of the oldest adults. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.
Conaty, Oisín; Gaughan, Leah; Downey, Colum; Carolan, Noreen; Brophy, Megan Joanne; Kavanagh, Ruth; McNamara, Deborah A A; Smyth, Edmond; Burns, Karen; Fitzpatrick, Fidelma
Purpose The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework. Design/methodology/approach Orthopaedic patients receiving joint replacements, hip fracture repairs or open-reduction internal-fixation procedures were included. Antimicrobial(s); dose, time of administration and duration of SAP were evaluated for appropriateness based on the local SAP guidelines. After baseline data collection, a driver diagram was constructed with interventions devised for plan-do-study-act cycles. Data were fed back weekly using a point prevalence design (PPD). Interventions included SAP guideline changes, reminders and tools to support key messages. Findings SAP in 168 orthopaedic surgeries from 15 June 2016 to 31 January 2017 was studied. Prescribing appropriateness improved from 20 to 78 per cent. Junior doctor changeover necessitated additional education and reminders. Practical implications Due to constant staff changeover; continuous data collection, communication, education and reminders are essential to ensure continuous compliance with clinical guidance. Patients with hip fractures are difficult to weigh, requiring weight estimation for weight-based antimicrobial dosing. Unintended consequences of interventions included the necessity to change pre-operative workflow to accommodate reconstitution time of additional antimicrobials and inadvertent continuation of new antimicrobials post-operatively. Originality/value Rather than perform the traditional retrospective focused audit, we established a prospective, continuous, interventional quality improvement (QI) project focusing on internal processes within the control of the project team with rapid cyclical changes and interventions. The weekly PPD was pragmatic and enabled the QI project to be sustained with no additional resources.
Hardefeldt, L Y; Browning, G F; Thursky, K; Gilkerson, J R; Billman-Jacobe, H; Stevenson, M A; Bailey, K E
Antimicrobials are widely used in Australian veterinary practices, but no investigation into the classes of antimicrobials used, or the appropriateness of use in horses, has been conducted. The aim of the study was to describe antimicrobial use for surgical prophylaxis in equine practice in Australia. Cross-sectional questionnaire survey. An online questionnaire was used to document antimicrobial usage patterns. Information solicited in the questionnaire included demographic details of the respondents, the frequency with which antimicrobials were used for specific surgical conditions (including the dose, timing and duration of therapy) and practice antimicrobial use policies and sources of information about antimicrobials and their uses. A total of 337 members of the Australian veterinary profession completed the survey. Generally, the choice of antimicrobial was appropriate for the specified equine surgical condition, but the dose and duration of therapy varied greatly. While there was poor optimal compliance with British Equine Veterinary Association guidelines in all scenarios (range 1-15%), except removal of a nonulcerated dermal mass (42%), suboptimal compliance (compliant antimicrobial drug selection but inappropriate timing, dose or duration of therapy) was moderate for all scenarios (range 48-68%), except for an uninfected contaminated wound over the thorax, where both optimal and suboptimal compliance was very poor (1%). Veterinarians practicing at a university hospital had higher odds of compliance than general practice veterinarians (Odds ratio 3.2, 95% CI, 1.1-8.9, P = 0.03). Many survey responses were collected at conferences which may introduce selection bias, as veterinarians attending conferences may be more likely to have been exposed to contemporary antimicrobial prescribing recommendations. Antimicrobial use guidelines need to be developed and promoted to improve the responsible use of antimicrobials in equine practice in Australia. An emphasis
van Hoek, Monique L.
Reptiles are among the oldest known amniotes and are highly diverse in their morphology and ecological niches. These animals have an evolutionarily ancient innate-immune system that is of great interest to scientists trying to identify new and useful antimicrobial peptides. Significant work in the last decade in the fields of biochemistry, proteomics and genomics has begun to reveal the complexity of reptilian antimicrobial peptides. Here, the current knowledge about antimicrobial peptides in reptiles is reviewed, with specific examples in each of the four orders: Testudines (turtles and tortosises), Sphenodontia (tuataras), Squamata (snakes and lizards), and Crocodilia (crocodilans). Examples are presented of the major classes of antimicrobial peptides expressed by reptiles including defensins, cathelicidins, liver-expressed peptides (hepcidin and LEAP-2), lysozyme, crotamine, and others. Some of these peptides have been identified and tested for their antibacterial or antiviral activity; others are only predicted as possible genes from genomic sequencing. Bioinformatic analysis of the reptile genomes is presented, revealing many predicted candidate antimicrobial peptides genes across this diverse class. The study of how these ancient creatures use antimicrobial peptides within their innate immune systems may reveal new understandings of our mammalian innate immune system and may also provide new and powerful antimicrobial peptides as scaffolds for potential therapeutic development. PMID:24918867
McCreary, J.G.; Woodyard, A.
The basis for a good contract is that it is beneficial to both parties. A good foundation will cement the responsibilities and obligations of the parties after areas of agreement have been negotiated. Unfortunately, software licenses do not always reflect what is best for all. Some clauses are definitely for the benefit of the vendor, while others are required by a prudent client. The resulting contract is then a matter of reasonable compromise to achieve a good business relationship. Major issues of warranty, liability, training, support, and payment may be in conflict. Such topics as maintenance, testing, patents, extent of use, and return of software are often overlooked or addressed unevenly. This paper addresses these subjects and provides guidelines for software licenses. An understanding of legal phrases is of value. A better understanding of the viewpoints of both the vendor and the client results in a better working relationship
Pawar, S P; Pal, S C
The effect against bacteria of petroleum ether (60-80 degrees C), chloroform and methanolic extract of dried root of Terminalia catappa Linn. (combrataceae) was employed by cup plate agar diffusion method. The chloroform extract showed prominent antimicrobial activity against S. aureus and E. coli as compared to other tested microorganisms, while petroleum ether extract was devoid of antimicrobial activity. The methanolic: extract exhibited MIC of 0.065 mg/ml against E. coli. and chloroform extract exhibited MIC of 0.4 mg/ml against S. aureus The chloroform has well as methanolic extracts showed good antimicrobial activity against Gram positive and Gram negative microorganisms.
Kan, C. W.; Lam, Y. L.; Yuen, C. W. M.; Luximon, A.; Lau, K. W.; Chen, K. S.
This paper explores the use of plasma treatment as a pretreatment process to assist the application of antimicrobial process on cotton fabric with good functional effect. In this paper, antimicrobial finishing agent, Microfresh Liquid Formulation 9200-200 (MF), and a binder (polyurethane dispersion, Microban Liquid Formulation R10800-0, MB) will be used for treating the cotton fabric for improving the antimicrobial property and pre-treatment of cotton fabric by plasma under atmospheric pressure will be employed to improve loading of chemical agents. The chemical analysis of the treated cotton fabric will be conducted by Fourier transform Infrared Spectroscopy.
K. N. Shivakumara
Full Text Available A series of amino acid conjugated diphenylmethylpiperazine derivatives were synthesized by coupling diphenylmethylpiperazine with different Boc-amino acids using EDCI/HOBt as coupling agent and NMM as base. The synthesized compounds were characterized by 1H-NMR and elemental analysis. The Boc-deblocked derivatives were tested for their antimicrobial activity. We are here reporting that Phe and Trp conjugated diphenylmethylpiperazine showed equally good antibacterial activities as that of conventional antimicrobial drugs.
Reybroeck, Wim; Daeseleire, Els; De Brabander, Hubert F; Herman, Lieve
The bee diseases American and European foulbrood and nosemosis can be treated with anti-infectious agents. However, in the EU and the USA the use of these agents in beekeeping is strictly regulated due to the lack of tolerance (e.g. Maximum Residue Limit) for residues of antibiotics and chemotherapeutics in honey. This article reviews the literature dealing with antimicrobials of interest in apiculture, stability of these antimicrobials in honey, and disposition of the antimicrobials in honeybee hives. Copyright © 2012 Elsevier B.V. All rights reserved.
Introduction: A frightening increase in the number of isolated multidrug resistant bacterial strains linked to the decline in novel antimicrobial drugs entering the market is a great cause for concern. Cationic antimicrobial peptides (AMPs) have lately been introduced as a potential new class...... of antimicrobial drugs, and computational methods utilizing molecular descriptors can significantly accelerate the development of new peptide drug candidates. Areas covered: This paper gives a broad overview of peptide and amino-acid scale descriptors available for AMP modeling and highlights which...
Rosas-Burgos, Ema C; Burgos-Hernández, Armando; Noguera-Artiaga, Luis; Kačániová, Miroslava; Hernández-García, Francisca; Cárdenas-López, José L; Carbonell-Barrachina, Ángel A
Some studies have reported that different parts of the pomegranate fruit, especially the peel, may act as potential antimicrobial agents and thus might be proposed as a safe natural alternative to synthetic antimicrobial agents. The high tannin content, especially punicalagin, found in pomegranate extracts, has been reported as the main compound responsible for such antimicrobial activity. Because the pomegranate peel chemical composition may vary with the type of cultivar (sweet, sour-sweet and sour), pomegranates may also differ with respect to their antimicrobial capacity. The extract from PTO8 pomegranate cultivar peel had the highest antimicrobial activity, as well as the highest punicalagins (α and β) and ellagic acid concentrations. In the results obtained from both antibacterial and antifungal activity studies, the sour-sweet pomegranate cultivar PTO8 showed the best antimicrobial activity, and the highest ellagic acid concentrations. The results of the present study suggest that ellagic acid content has a significant influence on the antimicrobial activity of the pomegranate extracts investigated. The pomegranate peel of the PTO8 cultivar is a good source of antifungal and antibacterial compounds, and may represent an alternative to antimicrobial agents of synthetic origin. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.
Antimicrobial resistance (AMR) is now a global threat. Its emergence rests on antimicrobial overuse in humans and food-producing animals; globalization and suboptimal infection control facilitate its spread. While aggressive measures in some countries have led to the containment of some resistant gram-positive organisms, extensively resistant gram-negative organisms such as carbapenem-resistant enterobacteriaceae and pan-resistant Acinetobacter spp. continue their rapid spread. Antimicrobial conservation/stewardship programs have seen some measure of success in reducing antimicrobial overuse in humans, but their reach is limited to acute-care settings in high-income countries. Outside the European Union, there is scant or no oversight of antimicrobial administration to food-producing animals, while evidence mounts that this administration leads directly to resistant human infections. Both horizontal and vertical infection control measures can interrupt transmission among humans, but many of these are costly and essentially limited to high-income countries as well. Novel antimicrobials are urgently needed; in recent decades pharmaceutical companies have largely abandoned antimicrobial discovery and development given their high costs and low yield. Against this backdrop, international and cross-disciplinary collaboration appears to be taking root in earnest, although specific strategies still need defining. Educational programs targeting both antimicrobial prescribers and consumers must be further developed and supported. The general public must continue to be made aware of the current scale of AMR’s threat, and must perceive antimicrobials as they are: a non-renewable and endangered resource. PMID:24237856
Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.
Prajapati, Anchal; Prajapati, Aalap; Sathaye, Swati
The aim of the study is to reinstate the fact that antibiotics are not required as prophylaxis for third molar surgery. So the standard of care after extraction of mandibular third molar surgery for all healthy patients should be a good anti-inflammatory regimen rather than a antibiotic prophylaxis. Surgical removal of impacted mandibular third molar is the most common procedure and many complications are usually encountered in this procedure like-pain, trismus, infection, swelling, inflammation and nerve damage. Now, the question that arises is does the age old practice of prescribing postoperative antibiotics solve these problems or adds on some new. The data collected and analysed in our observational study, however, reinstates that instead, it is the proper aseptic precautions and good anti-inflammatory regimen that are more important than the prophylactic antibiotics (Pasupathy and Alexander in J Craniofac Surg, 2011). Moreover, giving antibiotics means opening up the loopholes to bacterial resistance. A retrospective analysis of the data collected from 40 patients coming to the department of Dental and Implant Surgery, Karamsad, Anand between October 2014 and December 2014, operated for third molar surgery was carried out. Data from 40 patients requiring disimpaction of mandibular third molar was analysed. Postoperatively, only anti-inflammatory medication was prescribed to all the patients. None of the patients showed any of the signs or symptoms of infection.
Sørensen, Karsten Engsig
An analysis of the rules governing trade in goods under the GATT agreement and the Agreement on Safeguards......An analysis of the rules governing trade in goods under the GATT agreement and the Agreement on Safeguards...
... There are two main types of cholesterol: HDL (good) cholesterol and LDL (bad) cholesterol: HDL stands for high-density lipoproteins. It is called the "good" cholesterol because it carries cholesterol from other parts ...
... Mental Health This information in Spanish ( en español ) Good mental health Nutrition and mental health Exercise and ... a friend. Return to top More information on Good mental health Read more from womenshealth.gov Action ...
Cowan, Raquel U; Kishan, Divya; Walton, Aaron L; Sneath, Emmy; Cheah, Thomas; Butwilowsky, Judith; Friedman, N Deborah
Residents of residential aged care facilities (RACFs) are at risk of colonization and infection with multidrug-resistant bacteria, and antibiotic prescribing is often inappropriate and not based on culture-proven infection. We describe low levels of resident colonization and environmental contamination with resistant gram-negative bacteria in RACFs, but high levels of empirical antibiotic use not guided by microbiologic culture. This research highlights the importance of antimicrobial stewardship and environmental cleaning in aged care facilities. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Early years mathematics classrooms can be colourful, exciting, and challenging places of learning. Andrea McDonough and fellow teachers have noticed that some students make good decisions about using materials to assist their problem solving, but this is not always the case. These experiences lead her to ask the following questions: (1) Are…
Antibiotics are among the most frequently prescribed medications in current medicine, however there is an increasing resistance emerging against our current arsenal of antibiotics. Therefore, it is important that we do research into antimicrobial substances that uniquely work on essential pathways
Fleming, Aoife; Bradley, Colin; Cullinan, Shane; Byrne, Stephen
To explore healthcare professionals' views of antibiotic prescribing in long-term care facilities (LTCFs). To use the findings to recommend intervention strategies for antimicrobial stewardship in LTCFs. Qualitative semistructured interviews were conducted. The data were analysed by thematic content analysis. After the interviews, the emerging findings were mapped to the theoretical domains framework (TDF), and the behaviour change wheel and behaviour change technique (BCT) taxonomy were used to recommend future intervention strategies. Interviews were conducted with 37 healthcare professionals who work in LTCFs (10 general practitioners, 4 consultants, 14 nurses, 9 pharmacists) between December 2012 and March 2013. Interviews were conducted in the greater Cork region. The main domains from the TDF which emerged were: 'Knowledge', 'Environmental context and resources', 'Social influences', 'Beliefs about consequences', 'Memory, attention and decision making', with the findings identifying a need for 'Behavioural regulation'. Many participants believed that antibiotic prescribing was satisfactory at their LTCF, despite the lack of surveillance activities. This study, using the TDF and BCT taxonomy, has found that antibiotic prescribing in LTCFs is influenced by many social and contextual factors. The challenges of the setting and patient population, the belief about consequences to the patient, and the lack of implementation of guidelines and knowledge regarding antibiotic prescribing patterns are significant challenges to address. On the basis of the study findings and the application of the TDF and BCT taxonomy, we suggest some practical intervention functions for antimicrobial stewardship in LTCFs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Full Text Available ... Center for Veterinary Medicine is cited as the corporate author. Animation Animation of Antimicrobial Resistance (video) Animation ... Information Safety Emergency Preparedness International Programs News & Events Training & Continuing Education Inspections & Compliance Federal, State & Local Officials ...
Full Text Available ... resistance both emerges and proliferates among bacteria. Over time, the use of antimicrobial drugs will result in ... Emergency Preparedness International Programs News & Events Training & Continuing Education Inspections & Compliance Federal, State & Local Officials Consumers Health ...
Full Text Available ... to make the concept of antimicrobial resistance more real and understandable to veterinarians, livestock producers, lawmakers, consumer ... FEAR Act Site Map Nondiscrimination Website Policies U.S. Food and Drug Administration 10903 New Hampshire Avenue Silver ...
Full Text Available ... Monitoring System About NARMS 2015 NARMS Integrated Report Data Meetings and Publications Resources Judicious Use of Antimicrobials ... Federal, State & Local Officials Consumers Health Professionals Science & Research Industry Scroll back to top Popular Content Home ...
Antimicrobial pesticides are substances or mixtures of substances used to destroy or suppress the growth of harmful microorganisms such as bacteria, viruses, or fungi on inanimate objects and surfaces.
Full Text Available ... complex. This video was designed to make the concept of antimicrobial resistance more real and understandable to ... audiences. We hope this animation will make the concept more understandable to non-scientists by showing how ...
Full Text Available ... use of antimicrobial drugs will result in the development of resistant strains of bacteria, complicating clinician's efforts ... Emergency Preparedness International Programs News & Events Training & Continuing Education Inspections & Compliance Federal, State & Local Officials Consumers Health ...
Full Text Available ... More sharing options Linkedin Pin it Email Print The Food and Drug Administration's (FDA's) Center for Veterinary ... both emerges and proliferates among bacteria. Over time, the use of antimicrobial drugs will result in the ...
Full Text Available ... issue of antimicrobial resistance is that the subject material appears abstract and is complex. This video was ... can develop and spread. All FDA CVM produced material may be copied, reproduced, and distributed as long ...
KEY WORDS: 4-Phenylsemicarbazone, Metal complexes, Stereochemistry, Antimicrobial activity. INTRODUCTION ... stereochemistry of semicarbazone metal complexes [8-13], this group of ligands deserve further investigations. ..... The cytotoxicity of tested compounds generally increased with increase concentration and ...
Many microorganisms can survive, and perhaps proliferate on textiles, generating adverse effects such as: disease transmission, odor generation, pH changes, staining, discoloration and loss of performance. These adverse effects may threaten users' health, deteriorate textile properties and degrade service quality. It may, therefore, be desirable to incorporate antimicrobials on textiles for controlling the growth of microorganisms. This dissertation focuses on the development of antimicrobial fibers and fabrics by integration of antimicrobials with these textiles. The applications of hydantoin-based halamines were mainly investigated in the research. The typical process is that hydantoin containing compounds are grafted onto textiles and transformed to halamine by chlorination. Hydantoin-based halamines are usually chloramines that release chlorine (Cl+) via cleavage of the -NCl functional group which attacks and kills microbes. The antimicrobial behavior is rechargeable many times by rinsing the fiber or fabric with chlorine-containing solution. Some quaternary ammonium type antimicrobials were also investigated in this research. The choice of integrating techniques is dependant on both the textile and antimicrobial compounds. In this dissertation, the nine approaches were studied for incorporating antimicrobial with various textiles: (1) co-extrusion of fibers with halamine precursor additive; (2) grafting of the quaternary ammonium compounds onto ethylene-co-acrylic acid fiber for creating quaternary ammonium type antimicrobial fiber; (3) entrapment of the additives in thermally bonded bicomponent nonwoven fabrics; (4) attaching antimicrobial additives to surfaces with latex adhesive coating; (5) grafting of antimicrobial compounds onto rubber latex via UV exposure; (6) reaction of halamine with needle-punched melamine formaldehyde nonwoven fabric and laminates; (7) coating melamine resin onto tent fabrics and laminates; (8) synthesis of super absorbent polymer
DiTomaso, Joseph M.; Brooks, Matthew L.; Allen, Edith B.; Minnich, Ralph; Rice, Peter M.; Kyser, Guy B.
Prescribed burning has primarily been used as a tool for the control of invasive late-season annual broadleaf and grass species, particularly yellow starthistle, medusahead, barb goatgrass, and several bromes. However, timely burning of a few invasive biennial broadleaves (e.g., sweetclover and garlic mustard), perennial grasses (e.g., bluegrasses and smooth brome), and woody species (e.g., brooms and Chinese tallow tree) also has been successful. In many cases, the effectiveness of prescribed burning can be enhanced when incorporated into an integrated vegetation management program. Although there are some excellent examples of successful use of prescribed burning for the control of invasive species, a limited number of species have been evaluated. In addition, few studies have measured the impact of prescribed burning on the long-term changes in plant communities, impacts to endangered plant species, effects on wildlife and insect populations, and alterations in soil biology, including nutrition, mycorrhizae, and hydrology. In this review, we evaluate the current state of knowledge on prescribed burning as a tool for invasive weed management.
Kammersgaard, Tobias; Heinskou, Marie Bruvik; Demant, Jakob Johan
This study investigates the buying of stolen goods in Denmark. The study consists of a self-report survey based on a representative sample of the general Danish population (n = 2311) and six focus group interviews consisting of both informants experienced with buying stolen goods and of those wit...... the buyers of stolen goods did not buy stolen goods because they could not afford legitimate products. We recommend targeting consumers not interested in buying stolen goods with information about how to avoid such activity....
Turnidge, John D; Meleady, Kathy T
will inform policy development and clinical decision making and improve consumer awareness of antimicrobial use and resistance. The system will continue to develop as a comprehensive system, with additional data over time, and appropriate clinical and epidemiological review. What is known about this topic? Surveillance of antimicrobial use and resistance is critical to inform effective policy development and public health responses to the growing problem of antimicrobial resistance. Until now, surveillance of antimicrobial use and resistance in Australia has been fragmented, with state and territory and professional group differences in data collection, analysis and reporting. What does this paper add? This paper profiles the development of the AURA surveillance system, the first nationally coordinated surveillance system for antimicrobial use and resistance, and its use of a partnership approach with contributing programs in order to promote participation and to obtain data to inform strategies to prevent and contain antimicrobial resistance. This paper highlights the establishment phase, noting that the system continues to be improved with growing participation from all sectors. What are the implications for practitioners? National surveillance data from the AURA surveillance system provides evidence for action to guide improvements in infection control, antimicrobial prescribing and the prevention and control of antimicrobial resistance across all healthcare sectors. It will also enable trends to be identified and reported on, and have the capability of determining the effect of interventions to improve and rationalise antimicrobial prescribing.
Danishuddin, Mohd; Kaushal, Lalima; Hassan Baig, Mohd; Khan, Asad U.
Drug resistance is one of the major concerns for antimicrobial chemotherapy against any particular target. Knowledge of the primary structure of antimicrobial agents and their activities is essential for rational drug design. Thus, we developed a comprehensive database, anti microbial drug database (AMDD), of known synthetic antibacterial and antifungal compounds that were extracted from the available literature and other chemical databases, e.g., PubChem, PubChem BioAssay and ZINC, etc. The ...
Antimicrobial peptides serve as a first line of defence against invading microorganisms and are an essential part of our fast innate immune system. They are ancient molecules found in all classes of life. Antimicrobial peptides rapidly kill a broad spectrum of microbes and are immunomodulatory, i.e. having additional actions influencing inflammation and other innate immune responses. Results presented in this thesis demonstrate that proteases of common human pathogens degrade and inactivate t...
Kotenkova, E. A.; Lukinova, E. A.; Fedulova, L. V.
The aim of the study was to investigate porcine oral cavity mucosa (OCM), nasal cavity mucosa (NCM), rectal mucosa (RM) and tongue mucosa (TM) as sources of antimicrobial compounds. Ultrafiltrates with MW >30 kDa, MW 5-30 kDa and MW control: for the fraction with MW >30 kDa, the zone of microbial growth inhibition was 7.5 mm, for the MW<5 kDa fraction, it was 7 mm, and for MW 5-30 kDa fraction, it was 4.5 mm. No significant differences were found in high molecular weight proteomic profile, while qualitative and quantitative differences were observed in the medium and low molecular weight areas, especially in OCM and NCM. HPLC showed 221 tissue-specific peptides in OCM, 156 in NCM, 225 in RM, but only 5 in TM. The results observed confirmed porcine mucous tissues as a good source of antimicrobial compounds, which could be an actual alternative for reduction of microbial spoilage of foods.
Gibbons, James F; Boland, Fiona; Buckley, James F; Butler, Francis; Egan, John; Fanning, Séamus; Markey, Bryan K; Leonard, Finola C
Neonatal enteritis is a common condition of young calves and can be caused by pathogenic strains of Escherichia coli. We hypothesised that on-farm antimicrobial use would result in an increased frequency of resistance in these strains during the calving season. We also sought to determine if the frequency of resistance reflected on-farm antimicrobial use. Faecal samples were collected from cases of calf enteritis on 14 spring-calving dairy farms during two 3 week periods: Period 1 - February 11th through March 2nd 2008 and Period 2 - April 14th through May 5th 2008. E. coli were cultured from these samples, pathogenic strains were identified and antimicrobial susceptibility testing was carried out on these pathogenic isolates. Antimicrobial prescribing data were collected from each farm for the previous 12 months as an indicator of antimicrobial use. The correlation between antimicrobial use and resistance was assessed using Spearman's correlation coefficient. Logistic regression analysis was used to investigate the relationship between resistance, sampling period and pathotype. Penicillins and aminopenicillins, streptomycin, and tetracyclines were the most frequently prescribed antimicrobials and the greatest frequencies of resistance were detected to these 3 antimicrobial classes. A strong correlation (ρ=0.879) was observed between overall antimicrobial use and frequencies of antimicrobial resistance on farms. Sampling period was significant in the regression model for ampicillin resistance while pathotype was significant in the models for streptomycin, tetracycline and trimethoprim/sulphamethoxazole resistance. The frequencies of resistance observed have implications for veterinary therapeutics and prudent antimicrobial use. Resistance did not increase during the calving season and factors other than antimicrobial use, such as calf age and bacterial pathotype, may influence the occurrence of resistance in pathogenic E. coli. Copyright © 2014 Elsevier B.V. All
de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W
Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs.
Dijk, L. van; Lindert, H. van
Background: Most research on the use of medication focuses on adults. Children, however, use medication too, most of which is prescribed by GP's. Children also use non-prescribed medication (f.e. bought in the drugstore), but the extent to which is not known. Moreover, it is not known to what extent
Greene, Jeremy A
Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.
Full Text Available Anti-microbial resistance is a growing problem that has impacted the world and brought about the beginning of the end for the old generation of antibiotics. Increasingly, more antibiotics are being prescribed unnecessarily and this reckless practice has resulted in increased resistance towards these drugs, rendering them useless against infection. Nanotechnology presents a potential answer to anti-microbial resistance, which could stimulate innovation and create a new generation of antibiotic treatments for future medicines. Preserving existing antibiotic activity through novel formulation into or onto nanotechnologies can increase clinical longevity of action against infection. Additionally, the unique physiochemical properties of nanoparticles can provide new anti-bacterial modes of action which can also be explored. Simply concentrating on antibiotic prescribing habits will not resolve the issue but rather mitigate it. Thus, new scientific approaches through the development of novel antibiotics and formulations is required in order to employ a new generation of therapies to combat anti-microbial resistance.
Kumar, Mayur; Curtis, Anthony; Hoskins, Clare
Anti-microbial resistance is a growing problem that has impacted the world and brought about the beginning of the end for the old generation of antibiotics. Increasingly, more antibiotics are being prescribed unnecessarily and this reckless practice has resulted in increased resistance towards these drugs, rendering them useless against infection. Nanotechnology presents a potential answer to anti-microbial resistance, which could stimulate innovation and create a new generation of antibiotic treatments for future medicines. Preserving existing antibiotic activity through novel formulation into or onto nanotechnologies can increase clinical longevity of action against infection. Additionally, the unique physiochemical properties of nanoparticles can provide new anti-bacterial modes of action which can also be explored. Simply concentrating on antibiotic prescribing habits will not resolve the issue but rather mitigate it. Thus, new scientific approaches through the development of novel antibiotics and formulations is required in order to employ a new generation of therapies to combat anti-microbial resistance.
Maxwell, Simon; Mucklow, John
Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885
Murphy, Sinéad; Bennett, Kathleen; Doherty, Colin P
This study was undertaken to describe prescribing practice for the anti-convulsant drug (AED) Sodium Valproate (VPA) in an Irish population of woman of childbearing age during the period of the emergence of new data showing a high rate of developmental abnormalities in offspring of women who took VPA during pregnancy. All prescriptions dispensed from community pharmacies in Ireland between 2008 and 2013 inclusive were examined for women aged 16-44 years from all three drug reimbursement schemes in Ireland. Numbers of prescriptions and women on AEDs were identified, as was the rural/urban distribution of the drug along with co-prescribing of folic acid and the oral contraceptive pill. All data analysis was conducted using SAS v9.3. The rate of prescribing of VPA in Ireland declined slightly from 3.5/1000 per eligible population in 2008 to 3.14/1000 in 2013. While rates of prescribing fell for epilepsy, there appeared to be a rise in prescription for other indications of VPA. In 2013, co-prescription of folic acid or oral contraceptives was relatively low across all community schemes. Finally, an address distant from academic specialist centers predicted a higher exposure to VPA. Recently the European Medicine's Agency suggested that alternatives to VPA be considered before prescribing to women of childbearing age. Despite this, the rate of VPA prescribing in Ireland appears to be increasing for indications other than epilepsy. It may be necessary to improve the dissemination of information about the potential negative effects of VPA in this population. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Bernard W. Andrews
Full Text Available Individually Prescribed Instruction (IPI is an approach to teaching that emphasizes the diagnosis of learning problems and the provision of prescriptive assignments to assist individual students overcome their difficulties. When this strategy is employed effectively, the teaching environment is highly adaptive. The teacher matches the students' abilities to alternate ways of learning, and also provides remedial assistance and positive reinforcement. Individually Prescribed Instruction has been shown to be effective across the school curriculum. This writer reviews the success of this strategy for assisting students overcome learning problems, and proposes a model for its implementation in music instruction.
slowdown of progression to resistance could be achieved by improving prescribing practice, drug quality, and patient compliance. Objective: To determine the antimalarial prescribing pattern and to assess rational prescribing of chloroquine by prescribers in government hospitals and parastatals in Lagos State. Methods: ...
Bruehl, Stephen; Apkarian, A. Vania; Ballantyne, Jane C.; Berger, Ann; Borsook, David; Chen, Wen G.; Farrar, John T.; Haythornthwaite, Jennifer A.; Horn, Susan D.; Iadarola, Michael J.; Inturrisi, Charles E.; Lao, Lixing; Mackey, Sean; Mao, Jianren; Sawczuk, Andrea; Uhl, George R.; Witter, James; Woolf, Clifford J.; Zubieta, Jon-Kar; Lin, Yu
Use of opioid analgesics for pain management has increased dramatically over the past decade, with corresponding increases in negative sequelae including overdose and death. There is currently no well-validated objective means of accurately identifying patients likely to experience good analgesia with low side effects and abuse risk prior to initiating opioid therapy. This paper discusses the concept of data-based personalized prescribing of opioid analgesics as a means to achieve this goal. Strengths, weaknesses, and potential synergism of traditional randomized placebo-controlled trial (RCT) and practice-based evidence (PBE) methodologies as means to acquire the clinical data necessary to develop validated personalized analgesic prescribing algorithms are overviewed. Several predictive factors that might be incorporated into such algorithms are briefly discussed, including genetic factors, differences in brain structure and function, differences in neurotransmitter pathways, and patient phenotypic variables such as negative affect, sex, and pain sensitivity. Currently available research is insufficient to inform development of quantitative analgesic prescribing algorithms. However, responder subtype analyses made practical by the large numbers of chronic pain patients in proposed collaborative PBE pain registries, in conjunction with follow-up validation RCTs, may eventually permit development of clinically useful analgesic prescribing algorithms. Perspective Current research is insufficient to base opioid analgesic prescribing on patient characteristics. Collaborative PBE studies in large, diverse pain patient samples in conjunction with follow-up RCTs may permit development of quantitative analgesic prescribing algorithms which could optimize opioid analgesic effectiveness, and mitigate risks of opioid-related abuse and mortality. PMID:23374939
Murphy, Colleen P; Reid-Smith, Richard J; Boerlin, Patrick; Weese, J Scott; Prescott, John F; Janecko, Nicol; McEwen, Scott A
This study investigated oral and parenteral antimicrobial use in dogs and cats, and evaluated antimicrobial use in feline upper respiratory tract disease (FURTD), feline lower urinary tract disease (FLUTD), and canine infectious tracheobronchitis. Study journals (n = 1807) were submitted by 84 veterinarians. Sixty-five percent of the antimicrobials prescribed in dogs and 67% in cats were β-lactams. Most frequently prescribed in dogs were cephalexin (33%) and amoxicillin-clavulanic acid (16%), and in cats, amoxicillin-clavulanic acid (40%) and cefovecin (17%); 7% of the prescriptions in dogs and 12% in cats were for fluoroquinolones. Sixty-seven percent of the disease events associated with canine infectious tracheobronchitis, and 70% and 74% associated with FURTD and FLUTD, respectively, were treated with antimicrobials. These results suggest that cefovecin and fluoroquinolones may be over-used and antimicrobial use for the treatment of FURTD, FLUTD, and canine infectious tracheobronchitis could probably be reduced to lessen resistance selection pressure without compromising patient health.
Maturana, P; Martinez, M; Noguera, M E; Santos, N C; Disalvo, E A; Semorile, L; Maffia, P C; Hollmann, A
Antimicrobial peptides (AMPs) are small cationic molecules that display antimicrobial activity against a wide range of bacteria, fungi and viruses. For an AMP to be considered as a therapeutic option, it must have not only potent antibacterial properties but also low hemolytic and cytotoxic activities . Even though many studies have been conducted in order to correlate the antimicrobial activity with affinity toward model lipid membranes, the use of these membranes to explain cytotoxic effects (especially hemolysis) has been less explored. In this context, we studied lipid selectivity in two related novel AMPs, peptide 6 (P6) and peptide 6.2 (P6.2). Each peptide was designed from a previously reported AMP, and specific amino acid replacements were performed in an attempt to shift their hydrophobic moment or net charge. P6 showed no antimicrobial activity and high hemolytic activity, and P6.2 exhibited good antibacterial and low hemolytic activity. Using both peptides as a model we correlated the affinity toward membranes of different lipid composition and the antimicrobial and hemolytic activities. Our results from surface pressure and zeta potential assays showed that P6.2 exhibited a higher affinity and faster binding kinetic toward PG-containing membranes, while P6 showed this behavior for pure PC membranes. The final position and structure of P6.2 into the membrane showed an alpha-helix conversion, resulting in a parallel alignment with the Trps inserted into the membrane. On the other hand, the inability of P6 to adopt an amphipathic structure, plus its lower affinity toward PG-containing membranes seem to explain its poor antimicrobial activity. Regarding erythrocyte interactions, P6 showed the highest affinity toward erythrocyte membranes, resulting in an increased hemolytic activity. Overall, our data led us to conclude that affinity toward negatively charged lipids instead of zwitterionic ones seems to be a key factor that drives from hemolytic to
Grau, Santiago; Bou, Germán; Fondevilla, Esther; Nicolás, Jordi; Rodríguez-Maresca, Manuel; Martínez-Martínez, Luis
Collateral damage caused by antibiotic use includes resistance, which could be reduced if the global inappropriate use of antibiotics, especially in low-income countries, could be prevented. Surveillance of antimicrobial consumption can identify and target practice areas for quality improvement, both in the community and in healthcare institutions. The defined daily dose, the usual adult dose of an antimicrobial for treating one patient for one day, has been considered useful for measuring antimicrobial prescribing trends within a hospital. Various denominators from hospital activity including beds, admissions and discharges have been used to obtain some standard ratios for comparing antibiotic consumption between hospitals and countries. Laboratory information systems in Clinical Microbiology Services are the primary resource for preparing cumulative reports on susceptibility testing results. This information is useful for planning empirical treatment and for adopting infection control measures. Among the supranational initiatives on resistance surveillance, the EARS-Net provides information about trends on antimicrobial resistance in Europe. Resistance is the consequence of the selective pressure of antibiotics, although in some cases these agents also promote resistance by favouring the emergence of mutations that are subsequently selected. Multiple studies have shown a relationship between antimicrobial use and emergence or resistance. While in some cases a decrease in antibiotic use was associated with a reduction in resistance rates, in many other situations this has not been the case, due to co-resistance and/or the low biological cost of the resistance mechanisms involved. New antimicrobial agents are urgently needed, which coupled with infection control measures will help to control the current problem of antimicrobial resistance. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U
Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World
This paper continues the study of ETOL forms and good EOL forms done by Maurer, Salomaa and Wood. It is proven that binary very complete ETOL forms exist, good synchronized ETOL forms exist and that no propagating or synchronized ETOL form can be very complete.......This paper continues the study of ETOL forms and good EOL forms done by Maurer, Salomaa and Wood. It is proven that binary very complete ETOL forms exist, good synchronized ETOL forms exist and that no propagating or synchronized ETOL form can be very complete....
The course 'Transport of hazardous goods' was held in Berlin in November 1988 in cooperation with the Bundesanstalt fuer Materialforschung und -pruefung. From all lecturs, two are recorded separately: 'Safety of tank trucks - requirements on the tank, development possibiities of active and passive safety' and 'Requirements on the transport of radioactive materials - possible derivations for other hazardous goods'. The other lectures deal with hazardous goods law, requirements on packinging, risk assessment, railroad transport, hazardous goods road network, insurance matters, EC regulations, and waste tourism. (HSCH) [de
Sviestina, Inese; Mozgis, Dzintars
The point prevalence survey was conducted as part of the Antibiotic Resistance and Prescribing in European Children (ARPEC) Project. The study aimed at analyzing pediatric and neonatal antimicrobial prescribing patterns in Latvian hospitals, to identify targets for quality improvement. A one day cross-sectional point prevalence survey on antibiotic use in hospitalized children was conducted in November 2012 in 10 Latvian hospitals, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. Overall 549 patients were included in the study; 167 (39%) patients admitted to pediatric wards and 25 (21%) patients admitted to neonatal wards received at least one antimicrobial. Pediatric top three antibiotic groups were third-generation cephalosporins (55 prescriptions, 28%), extended spectrum penicillins (n=32, 16%) and first-generation cephalosporins (n=26, 13%). Eleven pediatric patients (85%) received surgical prophylaxis more than 1 day; 143 pediatric patients (86%) received antibiotics intravenously. Lower respiratory tract infections were the most common indications for antibiotic use both in pediatric (n=60, 35.9%) and neonatal patients (n=9, 36%). The most used antibiotics for neonatal patients were benzylpenicillin (n=12, 32%), and gentamicin (n=9, 24%). We identified a few problematic areas, which need improvement: the high use of third-generation cephalosporins for pediatric patients, prolonged surgical prophylaxis, predominant use of parenteral antibiotics and an urgent need for local antibiotic guidelines. Copyright © 2014 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
Improving pediatric patient safety by preventing medication errors that may result in adverse drug events and consequent healthcare expenditure,is a worldwide challenge to healthcare. In pediatrics, reported medication error rates in general, and prescribing error rates in particular, vary between
%), Alpha methyl dopa (10%), Beta Blockers (8.5%), combination of ... It was concluded that the prescribing of the new generation drugs i.e. Calcium channel blockers, ACE inhibitors with supposedly little or no metabolic side effects is a new ...
Purpose: To assess dispensing and prescribing practices with regard to antimalarial drugs for pediatrics in private pharmacies and public hospitals in Dar es Salaam, Tanzania. Methods: This was a cross-sectional, descriptive study that assessed the knowledge and practice of 200 drug dispensers in the private community ...
Mar 1, 2015 ... scribed NSAID (62.2%) followed by Diclofenac potassi- um (13.7%) and Tenoxicam and Piroxicam were least prescribed (0.1%). Salicylates were the highest pre- scribed class of NSAIDs (62.2%), followed by Acetic acid derivatives (23.1%), Propionic acid derivatives. (14.1%), Cox-2-selective inhibitors ...
urban SA ART sites to describe clinician compliance with tenofovir prescribing and monitoring guidelines in HIVinfected adults on firstline ART. Methods. We included treatmentnaive patients aged ≥16 years who started firstline tenofovirbased ART between 2010 and 2012 at Khayelitsha and Themba Lethu clinics in Cape ...
prescribing among elderly patients in a Malaysian community. Muhammad Eid Akkawi, Mohamad Haniki Nik Mohamed. Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia. *For correspondence: Email: email@example.com; Tel: 0060-186675232. Sent for review: 25 September 2017.
Linda R. Donoghue; Von J. Johnson
Describes 5 years of prescribed burning in the North Central States from 1968 through 1972. Provides information concerning participating agencies, burned-acreage, purpose-of-burn, fuels, and weather. Also examines other aspects such as ignition and burning techniques, hours-to-complete, time of fire start, and cost-per-acre.
Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt
OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...
Purpose: To determine the prescribing pattern of methylphenidate and atomoxetine to patients with. Attention-Deficit/Hyperactivity Disorder (ADHD) in South Africa. Methods: A retrospective, cross-sectional pharmacoepidemiological study was conducted based on the data from a medical aid administrator in South Africa for ...
Purpose: To determine the prescribing pattern of methylphenidate and atomoxetine to patients with Attention-Deficit/Hyperactivity Disorder (ADHD) in South Africa. Methods: A retrospective, cross-sectional pharmacoepidemiological study was conducted based on the data from a medical aid administrator in South Africa for ...
Anne Black; Dave Thomas; James Saveland
Over the past decade, the wildland fire community has developed a number of innovative methods for conducting a review following escape of a prescribed fire. The stated purpose been to identify methods that not only meet policy requirements, but to reduce future escapes. Implicit is the assumption that a review leads to learning. Yet, as organizational learning expert...
Anne E. Black; Dave Thomas; James Saveland; Jennifer D. Ziegler
The U.S. wildland fire community has developed a number of innovative methods for conducting a review following escape of a prescribed fire (expanding on the typical regional or local reviews, to include more of a learning focus - expanded After Action Reviews, reviews that incorporate High Reliability Organizing, Facilitated Learning Analyses, etc). The stated purpose...
Debout, Christophe; Lescot, Thomas; Loyer, Frédérique; Ambrosino, Florence
While, in France, various health professionals are authorised to prescribe, they approach this activity in a different way, depending on the professional category to which they belong. The areas and products concerned are specific to each profession, and inevitably evolve. This article presents the different perspectives of a doctor, a midwife and a nurse. Copyright © 2016. Published by Elsevier Masson SAS.
Bager, Flemming; Aarestrup, Frank Møller; Wegener, Henrik Caspar
as possible and ultimately abolished. During the first half of the 1990s the consumption of tetracyclines, mainly in pig production, increased markedly. This was countered by severely reducing through legal means the financial enticement for veterinarians to prescribe medicines and by restricting...... (DANMAP), which monitors resistance among bacteria from food animals, food and humans. A programme to monitor all use of prescription medicine in food animals at the herd level is presently being implemented. Another initiative was the elaboration of a series of practical recommendations to veterinarians...... of avoparcin in May 1995. The ban was later extended by the European Commission to include all EU member states. In May 1999, the EU Scientific Steering Committee recommended that use for growth promotion of antimicrobials, which are or may be used in human or veterinary medicine should be phased out as soon...
Full Text Available Cationic antimicrobial peptides are ancient and ubiquitous immune effectors that multicellular organisms use to kill and police microbes whereas antibiotics are mostly employed by microorganisms. As antimicrobial peptides (AMPs mostly target the cell wall, a microbial 'Achilles heel', it has been proposed that bacterial resistance evolution is very unlikely and hence AMPs are ancient 'weapons' of multicellular organisms. Here we provide a new hypothesis to explain the widespread distribution of AMPs amongst multicellular organism. Studying five antimicrobial peptides from vertebrates and insects, we show, using a classic Luria-Delbrück fluctuation assay, that cationic antimicrobial peptides (AMPs do not increase bacterial mutation rates. Moreover, using rtPCR and disc diffusion assays we find that AMPs do not elicit SOS or rpoS bacterial stress pathways. This is in contrast to the main classes of antibiotics that elevate mutagenesis via eliciting the SOS and rpoS pathways. The notion of the 'Achilles heel' has been challenged by experimental selection for AMP-resistance, but our findings offer a new perspective on the evolutionary success of AMPs. Employing AMPs seems advantageous for multicellular organisms, as it does not fuel the adaptation of bacteria to their immune defenses. This has important consequences for our understanding of host-microbe interactions, the evolution of innate immune defenses, and also sheds new light on antimicrobial resistance evolution and the use of AMPs as drugs.
Yoshinari, T.; Uchida, M. (Shinagawa Fuel Co. Ltd., Nagoya (Japan))
In recent years, the occurrence of infection by methicillin resistant staphylococcus aureus (MRSA), for which almost all antibiotics do not affect, in facilities such as hospitals is causing trouble. The antimicrobial property of silver has been known empirically since the ancient times. However, since 1985, so called silver zeolite in which zeolite carries silver ions has become utilized as an inorganic antimicrobial agent with silver as its constituent. In this article, the effect of inhibiting MRSA propagation of antimicrobial fibers containing silver zeolite is explained centering around the physical properties of silver zeolite. MRSA has resistance against antibiotics, methicillin which is mainly used at present. When the antimicrobial power of silver zeolite is compared with those of copper zeolite and zinc zeolite, the antimicrobial power of silver zeolite is the strongest and further increases as the silver ion concentration in the zeolite increases. Silver zeolite is safe to use and used for tools and clothes to be used in the fields of food and medical care. 12 refs., 3 figs., 8 tabs.
Holm, Henrik Ole
Analyse af Jeannette Ehlers' værk "Whip it Good" med betragtninger over et paradigmeskft fra et Vestlig til et ikke-vestligt.......Analyse af Jeannette Ehlers' værk "Whip it Good" med betragtninger over et paradigmeskft fra et Vestlig til et ikke-vestligt....
This paper considers how we can arrive at a concept of the good university. It begins with ideas expressed by Australian Vice-Chancellors and in the "league tables" for universities, which essentially reproduce existing privilege. It then considers definitions of the good university via wish lists, classic texts, horror lists, structural…
Examines the working lives of geneticists and journalists to place into perspective what lies behind personal ethics and success. Defines "good work" as productive activity that is valued socially and loved by people engaged in it. Asserts that certain cultural values, social controls, and personal standards are necessary to maintain good work and…
Zicht, Barbara, Ed.; And Others
Providing teacher background on the concepts of productivity and capital goods, this document presents 3 teaching units about these ideas for different grade levels. The grade K-2 unit, "How Do They Do It?," is designed to provide students with an understanding of how physical capital goods add to productivity. Activities include a field trip to…
Suggestions are presented from parents on how to help children with disabilities (with particular focus on Downs Syndrome) learn good grooming habits in such areas as good health, exercise, cleanliness, teeth and hair care, skin care, glasses and other devices, and social behavior. (CB)
Goldman, Roberta E; Dubé, Catherine; Lapane, Kate L
E-prescribing is part of a new generation of electronic solutions for the medical industry that may have great potential for improving work flow and communication between medical practices and pharmacies. In the US, it has been introduced with minimal monitoring of errors and general usability. This paper examines refill functionality in e-prescribing software. A mixed method study including focus groups and surveys was conducted. Qualitative data were collected in on-site focus groups or individual interviews with clinicians and medical office staff at 64 physician office practices. Focus group participants described their experiences with the refill functionality of e-prescribing software, provided suggestions for improving it, and suggested improvements in office procedures and software functionality. Overall, approximately 50% reduction in time spent each day on refills was reported. Overall reports of refill functionality were positive; but clinicians and staff identified numerous difficulties and glitches associated managing prescription refills. These glitches diminished over time. Benefits included time saved as well as patient convenience. Potential for refilling without thought because of the ease of use was noted. Clinicians and staff appreciated the ability to track whether patients are filling and refilling prescriptions. E-prescribing software for managing medication refills has not yet reached its full potential. To reduce work flow barriers and medication errors, software companies need to develop error reporting systems and response teams to deal effectively with problems experienced by users. Examining usability issues on both the medical office and pharmacy ends is required to identify the behavioral and cultural changes that accompany technological innovation and ease the transition to full use of e-prescribing software. 2010 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Purpose: Antimicrobial stewardship (AS is a consensus multidisciplinary activity aimed at better care for patients and containment of Antimicrobial resistance (AR. The purpose of this article is to characterize AS process in Bulgaria at hospital and national level. Material/Methods: Analysis of national AS activities was performed. AS program of the Medical Institute – Ministry of the Interior (MI – is presented as a model of hospital implementation. Results: In Bulgaria, the first National program for a rational antibiotic policy was developed in 2001, and National AR Surveillance system BulSTAR works since more than 15 years. Ministry of healthcare is the main regulator: hospital AS is mandatory and required for the process of hospital accreditations. At MI antibiotic policy program includes Guidelines for: - Empiric antibiotic therapy, - therapy by specialities, - Antibiotic prophylaxis in Surgery. According to the results of point prevalence survey Global PPS-2015, antibiotic use in MI was 24 %, quality indicators showed 100 % written reason for the use of antibiotics and tailoring to the microbiology result. Approaches in antimicrobials prescribing were similar to those of the other EU countries. However, the spectrum of the prescribed antibiotics was more limited and with higher usage of generic ceftriaxone. To improve the usage of antibiotics in Ambulatory care Guidelines were issued in 2016. It remains: to introduce National action plan for AS, with appropriate funding, staffing and control. Conclusions: AS activities in Bulgaria should be broaden, better controlled and supported as official Governmental policy.
Antibiotic stewardship programme (ASP) is a multifaceted approach to improve patients' clinical outcomes, prevent the emergence of antimicrobial resistance, and reduce hospital costs by prudent and focused antimicrobial use. Development of local treatment guidelines according to local ecology, rapid
Ahmad, Saba; Farrukh, Muhammad Akhyar
Sulfonamides, being the member of the oldest anti-microbial group of compounds possess wide anti-microbial activities and are effective against pathogenic strains of gram-positive and gram-negative bacteria. They are widely used in the treatment of various infectious diseases e.g. malaria, urinary tract infections, respiratory tract infections etc. Based on their effectiveness against most of the bacteria, two novel sulfonamides (N-(2-methoxy phenyl)-4-methylbenzenesulfonamide and N-ethyl-4-methyl-N-(3-methyl phenyl)benzenesulfonamide) were synthesized. The compounds were characterized by FT-IR and elemental analyzer. Their anti-microbial activity was assessed and observed against gram-positive and gram-negative bacteria using disc diffusion method. They showed good anti-microbial activities.
Full Text Available Antimicrobial peptides (AMPs are extensive group of molecules that produced by variety tissues of invertebrate, plants, and animal species which play an important role in their immunity response. AMPs have different classifications such as; biosynthetic machines, biological sources, biological functions, molecular properties, covalent bonding patterns, three dimensional structures, and molecular targets.These molecules have multidimensional properties including antimicrobial activity, antiviral activity, antifungal activity, anti-parasite activity, biofilm control, antitumor activity, mitogens activity and linking innate to adaptive immunity that making them promising agents for therapeutic drugs. In spite of this advantage of AMPs, their clinical developments have some limitation for commercial development. But some of AMPs are under clinical trials for the therapeutic purpose such as diabetic foot ulcers, different bacterial infections and tissue damage. In this review, we emphasized on the source, structure, multidimensional properties, limitation and therapeutic applications of various antimicrobial peptides.
Diane M. Parente
Full Text Available Abstract A recent study led by the Centers for Disease Control and Prevention (CDC revealed at least 30% of antibiotic prescriptions in the outpatient setting were inappropriate. In this study of all ages, among adult patients, results were similar to the overall population, with the majority of inappropriate prescribing relating to respiratory infections. We applied the same methodology to investigate rates of antibiotic prescribing for respiratory tract infections in outpatient primary care clinics at the Providence Veterans Affairs Medical Center. The results of our evaluation reflected comparable rates of inappropriate prescribing, but when stratified by teaching versus non-teaching primary care clinics, inappropriate prescribing was significantly higher in non-teaching clinics (17.6% vs 44.0%, p < .0001. Respiratory infection visits in non-teaching outpatient clinics may be a pragmatic target for antimicrobial stewardship programs.
Patrick J. Lewis
Full Text Available The work is in a documentary film format utilizing digital video through computer software that presents the interviewees' responses to two questions juxtaposed with images and statements of "a good teacher" from popular culture. The two questions are: 1. Can you recall a primary or elementary teacher whom you had that you thought was a good teacher? 2. What was it about her/him that made you think she/he was a good teacher? However, in some of the interviews the interviewer utilizes other questions and/or prompts in order to encourage the participant to expand or elaborate within her/his story. Like TRINH T. Minh-ha (1992 "storytelling is an ongoing field of exploration in all of my works" (p.144. Through the interviews interpretive themes emerge around the notion of who is/what makes a good teacher. Some of the themes suggest personal characteristics such as "kindness," "patient," "passionate," "calm," "respect," "firm," "understanding" and "encouraging" that entwine with an idea of "personal connection" with the teacher. Other themes suggest shared experience and teaching attributes. These themes are presented with the images of good teachers from popular films. The notion of "good" and "good teacher" are purposefully not demarcated or defined by the interviewer or asked of the participants. This term is implicitly defined in the stories shared by each of the participants and the stories of the teacher films. URN: urn:nbn:de:0114-fqs0802415
For decades humanitarianism has captured and shaped the dreams of the populations of the global North, dreams of a better world, of a common humanity, of goodness, of solidarity, and of global healing. In this article I argue that when taking art and cultural objects into account humanitarian......, Danmarks Indsamling [Denmark Collects], and the second is from Norwegian playwright Arne Lygre’s 2011 play, I Disappear. What is at stake in both of these scenes is the status of humanitarianism as a good-enough fantasy and promise of doing good....
Full Text Available The paper is focused on a current problem of transport of counterfeit goods in the European Union. Counterfeiting has a strong influence on the distribution organizations worldwide because most of counterfeit goods threaten the health and safety of consumers. Counterfeiting is a serious problem in the world economy today. The purpose of this paper is to point out the danger of counterfeiting in connection with the transport of Intellectual Property (IP rights - infringing goods. Background of the paper’s content is based on secondary data research of publicly available sources - international statistics and world reports.
Full Text Available Customs control, is regulated by law in different countries. Different countries define through the law, the control of goods.. Main purpose of this paper is to analyze two types of customs controls, and their effect in reducing avoidance of duty or tax evasion which may be caused by the import of goods of certain companies. For this reason we researched which model is implemented in developing countries and what results were reached through questionnaires. In this sense the next research question, consists in defining the moment of customs control pre or post-clearance control of goods.
A general reminder: any transportation of hazardous goods by road is subject to the European ADR rules. The goods concerned are essentially the following: Explosive substances and objects; Gases (including aerosols and non-flammable gases such as helium and nitrogen); Flammable substances and liquids (inks, paints, resins, petroleum products, alcohols, acetone, thinners); Toxic substances (acids, thinners); Radioactive substances; Corrosive substances (paints, acids, caustic products, disinfectants, electrical batteries). Any requests for the transport of hazardous goods must be executed in compliance with the instructions given at this URL: http://ts-dep.web.cern.ch/ts-dep/groups/he/HH/adr.pdf Heavy Handling Section TS-HE-HH 73793 - 160364
Liu, Zhiyuan; Zhong, Mou; Sun, Yuhua; Chen, Junhong; Feng, Bo
Titanium with hybrid microporous/nanotubes (TMNT) structure on its surface was fabricated by acid etching and subsequently anodization at different voltages. Bovine lactoferricin, a kind of antimicrobial peptide, and sodium alginate (NaAlg) were loaded onto titanium surface through layer by layer assembly. The drug release, cytocompatibility and antimicrobial property against S.aureus and E.coil were studied by release experiment, osteoblast and bacterial cultures. Results indicated that samples with nanotubes of bigger diameter carried more drugs and had better biocompatibility, and drug-loaded samples acquired better biocompatibility compared with drug-free samples. Furthermore, the drug-loaded samples exhibited good initial antimicrobial property, but weak long-term antimicrobial property. Therefore, drug-loaded titanium with micro/nano structure, especially, of big diameter nanotubes, could be a promise material for medical implants, such as internal/external fixation devices.
Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank
OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts....... DESIGN: A comparative case study approach, analysing variation in outcomes across different settings. SETTING: Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers...... characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for m...
Fink, Patrick B; Deyo, Richard A; Hallvik, Sara E; Hildebran, Christi
Prescription drug monitoring programs (PDMPs) were created to facilitate responsible use of controlled substances. In Oregon, physicians, physician's assistants (MDs/DOs/PAs), dentists, nurse practitioners (NPs), and naturopathic physicians (NDs) may prescribe opioids, but differences in prescribing practices, patient mix, and patient outcomes among prescriber types have not been characterized. De-identified Oregon PDMP data from October 2011 through October 2014 were linked with vital records and a statewide hospital discharge registry. The disciplines of registered prescribers were identified by board affiliations. Prescription profiles associated with opioid overdose risk were tabulated for patients with at least one registered prescriber. Opioid-related hospitalizations and deaths were identified using ICD-9 and ICD-10 codes. There were 5,935 prescribers registered during the study period. Patients of NPs or NDs received more high-risk opioid prescriptions than patients of MDs/DOs/PAs. For example, they received greater proportions of high-dose prescriptions (NP 12.9%, ND 15%, MD/DO/PA 11.1%), and had greater opioid-related hospitalization (NP 1.7%, ND 3.1%, MD/DO/PA 1.2%; P prescriptions came from prescribers in other disciplines. Our analysis suggests significant differences in opioid prescription profiles and opioid-related hospitalization and mortality among patients receiving opioid prescriptions from nurse practitioners, naturopathic physicians, or medical clinicians in Oregon. However, these differences appear largely due to differences in patient mix between provider types rather than discipline-specific prescribing practices. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
Jensen, Vibeke Frøkjær; Emborg, Hanne-Dorthe; Aarestrup, Frank Møller
This study describes trends in the use and indications for prescriptions of antimicrobial agents in the Danish pig production in the period between 2002 and 2008 and is the first description of a complete prescription pattern for one animal species in an entire country. Data on all prescription...... for pigs in Denmark were retrieved from the VetStat database. Antimicrobial use was measured in defined animal daily doses (ADD) for the specific age-group and in ADDkg as a measure of amounts used. According to the results of the ADDkg data, 26% of all antimicrobials were prescribed for sows, 38...
Abd-El-Aziz, Alaa S; Agatemor, Christian; Etkin, Nola
Antimicrobial resistance threatens the achievements of science and medicine, as it deactivates conventional antimicrobial therapeutics. Scientists respond to the threat by developing new antimicrobial platforms to prevent and treat infections from these resistant strains. Metal-based antimicrobial macromolecules are emerging as an alternative to conventional platforms because they combine multiple mechanisms of action into one platform due to the distinctive properties of metals. For example, metals interact with intracellular proteins and enzymes, and catalyse various intracellular processes. The macromolecular architecture offers a means to enhance antimicrobial activity since several antimicrobial moieties can be conjugated to the scaffold. Further, these macromolecules can be fabricated into antimicrobial materials for contact-killing medical implants, fabrics, and devices. As volatilization or leaching out of the antimicrobial moieties from the macromolecular scaffold is reduced, these medical implants, fabrics, and devices can retain their antimicrobial activity over an extended period. Recent advances demonstrate the potential of metal-based antimicrobial macromolecules as effective platforms that prevent and treat infections from resistant strains. In this review these advances are thoroughly discussed within the context of examples of metal-based antimicrobial macromolecules, their mechanisms of action and biocompatibility. Copyright © 2016 Elsevier Ltd. All rights reserved.
Kailaku, SI; Syakir, M.; Mulyawanti, I.; Syah, ANA
Coconut shell liquid smoke is produced from the pyrolysis and condensation of smoke from the burning process of coconut shell. It is known to have considerably high content of polyphenol. Beside acting as antioxidant, polyphenol is also a good antimicrobial. This research was conducted in order to study the antimicrobial activity of coconut shell liquid smoke. Coconut shell liquid smoke used in this study was produced from three different processing stages, which obtained three different grades of liquid smoke (grade 1, 2 and 3). Each sample of coconut shell liquid smoke was extracted using ethyl alcohol and petroleum ether. The extract was then analyzed for its antimicrobial activity against S. aereus, E. coli and C. albicans using well diffusion method. Total phenol and microbial microscopic structure of the liquid smoke were also examined. The results showed that there was influence of coconut shell liquid smoke on the inhibition of S. aureus, E. coli and C. albican growth. This fact was marked by the forming of clear area surrounding the well on the dish agar media. The highest percentage of inhibition showed by the extract of grade 3 coconut shell liquid smoke. This may be explained by the highest total phenol content in grade 3 liquid smoke. Microscopic examination showed that there was a breakage of microbial cell walls caused by the antimicrobial property of the liquid smoke. It was concluded that coconut shell liquid smoke was beneficial as antimicrobial agent, and while all grades of liquid smoke contains polyphenol, the content was influenced by the processing stage and thus influenced its level of microbial growth inhibition.
Good posture is about more than standing up straight so you can look your best. It is an important ... pain, injuries, and other health problems. What is posture? Posture is how you hold your body. There ...
Mahoney, Diane Feeney; Ladd, Elissa
The purpose of this study was to gain understanding about nurse practitioners' (NPs') prescriptive decision making for geriatric patients with attention to pharmaceutical marketing influences. Prior research has focused on physician prescribers and identified suboptimal practices. Because the majority of medications are prescribed to older adults, NPs in geriatric practice were targeted as an information-rich group to interview about prescribing issues. Given the exploratory nature of this research, qualitative focus group methods were employed using content analysis. Fifteen NPs were recruited at an annual national geriatric NP conference. They worked in all regions of the United States, had an average of 9 years prescribing experience, and participated in 1 of the 2 focus groups. The key theme that emerged was that they were more than a prescriber. Findings revealed overwhelming consistency among the NP participants that their nursing background instilled a holistic approach that encompassed both nondrug and therapeutic drug options and skepticism about drug marketing, as well as offered a positive difference by tailoring to their patients' biophysical, psychological, and economic needs with an involvement in the interplay of geriatric care issues not typically addressed by physicians. The participants' reported approaches were in alignment with geriatric prescribing recommendations. Copyright 2010 Mosby, Inc. All rights reserved.
Dabur, Rajesh; Gupta, Amita; Mandal, T K; Singh, Desh Deepak; Bajpai, Vivek; Gurav, A M; Lavekar, G S
The antimicrobial potential of seventy-seven extracts from twenty-four plants was screened against eight bacteria and four pathogenic fungi, using microbroth dilution assay. Lowest concentration of the extract, which inhibits any visual microbial growth after treatment with p-iodonitrotetrazolium violet, was considered to be minimum inhibitory concentration (MIC). Water extracts of Acacia nilotica, Justicia zelanica, Lantana camara and Saraca asoca exhibited good activity against all the bacteria tested and the MIC was recorded in range of 9.375-37.5 microg/ml and 75.0-300.0 microg/ml against the bacterial and fungal pathogens, respectively. The other extracts of Phyllanthus urinaria, Thevetia nerifolia, Jatropha gossypifolia Saraca asoca, Tamarindus indica, Aegle marmelos, Acacia nilotica, Chlorophytum borivilianum, Mangifera indica, Woodfordia fruticosa and Phyllanthus emblica showed antimicrobial activity in a range of 75-1200 microg/ml.
Wilson, Eleanor; Seymour, Jane
In the UK there has been a widespread introduction of 'anticipatory prescribing' in community based palliative care. This involves general practitioners (GPs) writing prescriptions in anticipation of them being needed and has been encouraged to try to minimise the risk of patients suffering uncontrolled symptoms and distress; a key reason why terminally ill patients are admitted to hospital in contradiction of most people's preferences. This paper presents the findings from an ethnographic study of healthcare professionals across four care homes and four community sites in two regions (East Midlands and Lancashire/South Cumbria) of the UK. Data were collected from a range of community health professionals, resulting in 83 episodes of observation and 72 interviews. Findings highlight how essential good interdisciplinary communication is to the process of anticipatory prescribing and end-of-life care. This study found that when interdisciplinary communication worked well the anticipatory prescribing process could be carried out smoothly, optimising patient care.
Al-Mohamadi, Ameen; Al-Harbi, Atika Mohammed; Manshi, Areej Mansour; Rakkah, Mona Majdi
The rising costs of health care continue to make health insurance important for many countries. Health insurance may cover different aspects of health care in Saudi Arabia including the prescribed drugs. Physicians usually have different personal attitudes toward insured and uninsured patients. This study is to investigate the prescribing behavior of physicians to those groups of patients in the private setting. A prospective study was conducted during the period between October 2011 and January 2012, in three Saudi private hospitals. Prescriptions for insured and uninsured patients were randomly selected and analyzed. Data regarding diagnosis, age, gender, co-morbidity, number of items and the total cost of the medication in Saudi Riyals (SR) were collected through a chart review form. Three thousand sixty six patients' prescriptions were included in this study, 34.7% of them were females. 273 patients (75.2%) were insured while 90 were not. 24.8% were patients who paid cash. Majority (57.6%) of the patients were with diabetes plus hypertension and other co-morbidity. 20.7% of patients were taking three medications or less, while 67.8% were taking 4-10 and 11.6% were taking more than 10 medications. Analysis of differences showed that, patients who were insured have a higher number of prescribed medications (p ⩽ 0.001), and a higher total price of prescription than those who were paying cash only (p ⩽ 0.001). In a more confirmatory step, all uninsured patients (n = 90) were closely matched in the age, gender, diagnosis and hospital with similar 90 insured patients. Results of this matching process confirmed the above findings. Physicians in private setting are more likely to prescribe more drugs and/or brand drugs to insured patients than for uninsured patients. Further studies to view the reasons behind this behavior and strategies to prevent such actions are needed.
Cope, Anwen L; Chestnutt, Ivor G; Wood, Fiona; Francis, Nick A
Background The frequency of consulting for dental problems in general medical practice, and antibiotic prescribing associated with these consultations, is poorly described. Aim To describe consultation rates and antibiotic use for dental problems in UK general medical practice, and explore factors associated with antibiotic prescribing for dental conditions. Design and setting A retrospective cohort study using Clinical Practice Research Datalink, a database of general practice patient records in the UK. Method All dental consultations between 2004 and 2013 were identified. The main outcome was the prescription of an antibiotic during a dental consultation. Multilevel logistic regression was conducted to examine factors associated with antibiotic prescription. Results In all, 288 169 dental consultations were included in the cohort. The average rate of dental consultations was 6.06 consultations per 1000 patient-years. Rates of dental consultation decreased from 6.84 consultations per 1000 patient-years in 2008, to 4.23 consultations per 1000 patient-years in 2013. Consultation rates were higher among females than males and highest in patients aged 20–29 years. An antibiotic was prescribed in 57.1% of consultations. Significant predictors (Pdental problems in UK general practice are relatively low but more than half result in the prescription of an antibiotic. This raises concerns about patient morbidity and contributions to antimicrobial resistance. PMID:27025554
Full Text Available ... Integrated Report Data Meetings and Publications Resources Judicious Use of Antimicrobials Page Last Updated: 02/23/2018 Note: If you need help accessing information in different file formats, see Instructions for Downloading Viewers and Players . Language Assistance Available: EspaÃ±ol | ç¹é«ä¸æ | ...
Enzler, Mark J.; Berbari, Elie; Osmon, Douglas R.
Antimicrobial prophylaxis is commonly used by clinicians for the prevention of numerous infectious diseases, including herpes simplex infection, rheumatic fever, recurrent cellulitis, meningococcal disease, recurrent uncomplicated urinary tract infections in women, spontaneous bacterial peritonitis in patients with cirrhosis, influenza, infective endocarditis, pertussis, and acute necrotizing pancreatitis, as well as infections associated with open fractures, recent prosthetic joint placement...
Wolfson, J S; Hooper, D C
The fluoroquinolones, a new class of potent orally absorbed antimicrobial agents, are reviewed, considering structure, mechanisms of action and resistance, spectrum, variables affecting activity in vitro, pharmacokinetic properties, clinical efficacy, emergence of resistance, and tolerability. The primary bacterial target is the enzyme deoxyribonucleic acid gyrase. Bacterial resistance occurs by chromosomal mutations altering deoxyribonucleic acid gyrase and decreasing drug permeation. The dr...
Full Text Available ... U.S. Food and Drug Administration A to Z Index Follow FDA En EspaÃ±ol Search FDA Submit ... non-scientists by showing how bacterial antimicrobial resistance can develop and spread. All FDA CVM produced material ...
Full Text Available ... EspaÃ±ol Search FDA Submit search Popular Content Home Food Drugs Medical Devices Radiation-Emitting Products Vaccines, ... Biologics Animal & Veterinary Cosmetics Tobacco Products Animal & Veterinary Home Animal & Veterinary Safety & Health Antimicrobial Resistance Animation of ...
Full Text Available ... use of antimicrobial drugs will result in the development of resistant strains of bacteria, complicating clinician's efforts ... èª | ÙØ§Ø±Ø³Û | English FDA Accessibility Careers FDA Basics FOIA No FEAR Act Site Map ...
Robert D. Coleman; Carol A. Clausen
It is unlikely that a single antimicrobial compound, whether synthetic or natural, will provide the âmagic bulletâ for eliminating multiple biological agents affecting wood products. Development of synergistic combinations of selected compounds, especially those derived from natural sources, is recognized as a promising approach to improved wood protection. Recent...
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Full Text Available ... emerges and proliferates among bacteria. Over time, the use of antimicrobial drugs will result in the development of resistant strains ... human medicine to preserve the effectiveness of these drugs. One of the major obstacles to understanding the ... Page Last Updated: 02/23/2018 ...
Sittig Dean F
Full Text Available Abstract Background The United States (US Health Information Technology for Economic and Clinical Health Act of 2009 has spurred adoption of electronic health records. The corresponding meaningful use criteria proposed by the Centers for Medicare and Medicaid Services mandates use of computerized provider order entry (CPOE systems. Yet, adoption in the US and other Western countries is low and descriptions of successful implementations are primarily from the inpatient setting; less frequently the ambulatory setting. We describe prescriber and staff perceptions of implementation of a CPOE system for medications (electronic- or e-prescribing system in the ambulatory setting. Methods Using a cross-sectional study design, we conducted eight focus groups at three primary care sites in an independent medical group. Each site represented a unique stage of e-prescribing implementation - pre/transition/post. We used a theoretically based, semi-structured questionnaire to elicit physician (n = 17 and staff (n = 53 perceptions of implementation of the e-prescribing system. We conducted a thematic analysis of focus group discussions using formal qualitative analytic techniques (i.e. deductive framework and grounded theory. Two coders independently coded to theoretical saturation and resolved discrepancies through discussions. Results Ten themes emerged that describe perceptions of e-prescribing implementation: 1 improved availability of clinical information resulted in prescribing efficiencies and more coordinated care; 2 improved documentation resulted in safer care; 3 efficiencies were gained by using fewer paper charts; 4 organizational support facilitated adoption; 5 transition required time; resulted in workload shift to staff; 6 hardware configurations and network stability were important in facilitating workflow; 7 e-prescribing was time-neutral or time-saving; 8 changes in patient interactions enhanced patient care but required education; 9 pharmacy
Sturm, H.; Austvoll-Dahlgren, A.; Aaserud, M.; Oxman, A. D.; Ramsay, C.; Vernby, A.; Koesters, J. P.
Background Pharmaceuticals, while central to medical therapy, pose a significant burden to health care budgets. Therefore regulations to control prescribing costs and improve quality of care are implemented increasingly. These include the use of financial incentives for prescribers, namely increased
Full Text Available The present study aims to understand how Machiavellians switch from one kind of response to another in different circumstances to maximize their profit. We set up a specific experimental paradigm that involved both a cooperative and competitive version of a public goods game. We found that Machiavellianism accounts for the total amount of money paid by the players (N = 144 across five rounds in the cooperative but not in the competitive game. Compared with the others, individuals with higher scores on Mach scale contributed less to the public goods in the cooperative condition, but no difference was found in the competitive condition. Finally, this relationship was influenced by the sequence of the games. These results indicate that Machiavellians skillfully evaluate social environments and strive to exploit those with abundant contributions to public goods.
Beck Jørgensen, Torben; Sørensen, Ditte-Lene
Good governance is a broad concept used by many international organizations to spell out how states or countries should be governed. Definitions vary, but there is a clear core of common public values, such as transparency, accountability, effectiveness, and the rule of law. It is quite likely......, however, that national views of good governance reflect different political cultures and institutional heritages. Fourteen national codes of conduct are analyzed. The findings suggest that public values converge and that they match model codes from the United Nations and the European Council as well...... as conceptions of good governance from other international organizations. While values converge, they are balanced and communicated differently, and seem to some extent to be translated into the national cultures. The set of global public values derived from this analysis include public interest, regime dignity...
According to the antimicrobial activity classification, eucalypt and Cootamundra and silver wattles extracts (both water and ethanol) presented good efficacy against B. cereus, a food poisoning agent, and moderate efficacy against the remaining microorganisms. E. coli, a Gram negative, exhibited low sensibility to all foliar ...
Background: Adequate treatment and control of Urinary Tract Infection (UTI) depends on a good knowledge of the agents causing the infection. The study was designed to assess the aetiology of childhood UTI and the susceptibility of these pathogens to the commonly available antimicrobial agents. Methodology: Children ...
This edited collection shows that good parenthood is neither fixed nor stable. The contributors show how parenthood is equally done by men, women and children, in and through practices involving different normative guidelines. The book explores how normative layers of parenthood are constituted...... by notions such as good childhood, family ideals, national public health and educational strategies. The authors illustrate how different versions of parenthood coexist and how complex sets of actions are demanded to fulfil today’s expectations of parenthood in Western societies. This interdisciplinary book...
Campbell, Catherine; Scott, Kerry; Skovdal, Morten
Background: While patient-provider interactions are commonly understood as mutually constructed relationships,the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notionsof ‘good’ and ‘bad’ patients, are under-examined. This article......, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly andcoming to the clinic when told). As healthcare workers may decide to punish patients who do not live up the‘good patient persona’, many patients seek to perform within the confines of the ‘good patient persona...
Chakkol, Mehmet; Johnson, Mark; Raja, Jawwad
Purpose – This paper aims to adopt service-dominant logic (SDL) to empirically explore network configurations resulting from the provision of goods, goods and services, and solutions. Design/methodology/approach – This paper uses a single, in-depth, exploratory case study in a truck manufacturer......: dyadic, triadic and tetradic. The extent to which different network actors contribute to value co-creation varies across the offerings. Research limitations/implications – This paper is based on a single, in-depth case study developed in one industrial context. Whilst this represents an appropriate...
Marr, Ian; Sarmento, Nevio; O'Brien, Matt; Lee, Karl; Gusmao, Celia; de Castro, Gloria; Janson, Sonja; Tong, Steven Y C; Baird, Rob W; Francis, Joshua R
High rates of antimicrobial resistance are seen throughout Southeast Asia. Limited antimicrobial resistance data exists for Timor-Leste, which is situated on the south-eastern portion of the Malay Archipelago. The purpose of this study was to identify antimicrobial resistance in bacteria isolated from urine and skin swabs from patients in Dili, Timor-Leste. Urine and skin swabs were collected from symptomatic patients and processed for bacterial culture in Timor-Leste. Isolates were processed in Australia using VITEK ® 2 (bioMerieux, France) for bacterial identification and to determine antimicrobial susceptibility according to CLSI standards. A total of 154 urine isolates and 57 skin isolates were analysed. Of the Enterobacteriaceae, 35% were resistant to ceftriaxone with an extended spectrum beta-lactamase producing phenotype. Carbapenem resistance was not found in any of the Gram-negative isolates. Of the Staphylococcus aureus isolates, 11% were of the community-acquired methicillin resistant S. aureus phenotype. A moderately high proportion of Gram negative urine isolates in Timor-Leste demonstrate phenotypic extended spectrum beta-lactamase production; and a relatively low proportion of S. aureus isolates are methicillin-resistant. Improved understanding of antimicrobial resistance rates in Timor-Leste can help guide antimicrobial prescribing and inform antimicrobial stewardship strategies. Copyright © 2017. Published by Elsevier Ltd.
... overuse of antibiotics and low rate generic prescribing still occur in the health facilities studied. Drug availability, clinician\\'s level of training, cost of drugs, feedback from patients and socio-economic status of patients are major factors influencing prescribing in the facilities. Keywords: Drug prescribing, Indicators, Practices, ...
The study of prescribing pattern seeks to monitor, evaluate and suggest a modification in prescriber's prescribing habits so as to make medical care rational and cost effective. Information about antibiotic use pattern is necessary for a constructive approach to problems that arise from multiple antibiotics available. To identify ...
John R. Weir
Spotfires have and always will be a problem that burn bosses and fire crews will have to contend with on prescribed burns. Weather factors (temperature, wind speed and relative humidity) are the main variables burn bosses can use to predict and monitor prescribed fire behavior. At the Oklahoma State University Research Range, prescribed burns are conducted during...
of high dose prescriptions. We also noted a change in the patterns of antipsyhotics prescribed at this center. In a previous study on psychotropic drug prescribing at this hospital in 2007, it was found that haloperidol was the most commonly prescribed antipsychotic drug, followed by chlorpromazine and trifluoperazine.
Siew Hoon Lim; J.M. Bowker; Cassandra Y. Johnson; H. Ken Cordell
Using a household survey and regression methods, we assessed preferences for prescribed fire in the southern United States. We found that the majority of the respondents favored the use of prescribed fire. However, we observed pronounced racial variation in opinions on prescribed fire and its side effects. African Americans and Hispanics were less supportive and were...
William C. Fischer
Provides a standard format and checklist to guide the land manager through the important steps for prescribed burning. Describes the kind of information needed to prepare fire prescriptions and burning plans. Identifies the elements of a fire prescription, a burning plan, and a prescribed fire evaluation. A plan written for an actual prescribed burning is included as...
Gielen, S.C.; Dekker, J.; Francke, A.L.; Mistiaen, P.; Kroezen, M.
Background: In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently,
... prescribing commuted traveltime. 97.2 Section 97.2 Animals and Animal Products ANIMAL AND PLANT HEALTH... ANIMAL PRODUCTS OVERTIME SERVICES RELATING TO IMPORTS AND EXPORTS § 97.2 Administrative instructions prescribing commuted traveltime. Each period of overtime and holiday duty as prescribed in § 97.1 shall in...
Cordoba Currea, Gloria Cristina; Siersma, Volkert Dirk; Lopez-Valcarcel, Beatriz Gonzalez
in “prescribing style” – understood as a subjective tendency to prescribe – has an important effect on variation in prescription of antibiotics by using the concept of prescribing style as a latent variable in a multivariable model. We report variation as a Median Odds Ratio (MOR) which is the transformation...
Gielen, S.C.; Dekker, J.; Francke, A.L.; Mistiaen, P.; Kroezen, M.
Background: In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently,
Suleman, T; van Vuuren, S; Sandasi, M; Viljoen, A M
This study reports on the inhibitory and bactericidal properties of 39 South African (SA) propolis samples and three propolis samples from Brazil. Ethanolic extracts of propolis (EEP) were prepared and their antimicrobial activities tested using the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays. Some samples displayed substantial antimicrobial activity with MIC and MBC values as low as 6 μg ml(-1) against Staphylococcus aureus. The correlation between liquid chromatography-mass spectrometry (LC-MS) chemical data and the antimicrobial activity of propolis extracts was investigated using multivariate data analysis tools. Orthogonal projections to latent structures (OPLS) models were created for the two Gram-positive bacteria (Enterococcus faecalis and S. aureus) and Candida albicans. Using the S-plot function, it was possible to identify the bioactive constituents in propolis as chrysin, pinocembrin, galangin and pinobanksin-3-O-acetate. The SA propolis samples tested displayed noteworthy antimicrobial activity, favourably comparable to that of the Brazilian comparator and 'gold standard'. The observed antimicrobial activity of SA propolis can possibly be attributed to its flavonoid content. Based on the good antimicrobial activity observed for SA propolis, this natural resource shows promise and should be considered for development which may contribute to growing the bio-economy in the region. © 2015 The Society for Applied Microbiology.
Blumenthal, Kimberly G; Shenoy, Erica S; Hurwitz, Shelley; Varughese, Christy A; Hooper, David C; Banerji, Aleena
Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P allergy over time (54% vs 80%; P allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Home; Journals; Resonance – Journal of Science Education; Volume 11; Issue 8. Good Times in Tübingen. Wolfgang Engelmann. Book Review Volume 11 Issue 8 August 2006 pp 101-102. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/011/08/0101-0102. Author Affiliations.
Full Text Available Transformation of a totalitarian, basically administratively coordinated system into a democratic one that is coordinated predominantly by markets and competition has been triggered by, among others, the perception of a serious deficit in welfare and happiness. Public policy has a special task transforming the economic order by liberalisation, privatisation, stabilisation and the installation of institutions that are supportive for competition. After 15 years since transformation began, there are sufficiently differentiated success stories to test the hypothesis: it was good governance that is responsible for success and bad governance for failure. The empirical results support the “Lorenzetti hypothesis”: where freedom, security and trust prevail, the economy flourishes, where they are lacking, the costs of long-term investment are too high. The initial conditions of transition countries seem to be quite similar, nevertheless, even there one can discern good and bad governance. The extent of socialist lawfulness, planning security, cronyism and corruption differed widely between East Berlin and Tashkent. And a good deal of such variations can be found in the pre-socialist history of these countries. However, the main conclusion is that the co-evolution hypothesis states that both, welfare and good governance, go together.
Offersen, Sara Marie Hebsgaard; Vedsted, Peter; Andersen, Rikke Sand
the Danish welfare state and the middle-class popula- tion is embodied in a responsibility for individual health. Overall, we identify a striving to be a ‘good citizen’; this entails confl icting moral possibilities in relation to experiencing, interpreting and acting on bodily sensations. We examine how...
For decades humanitarianism has captured and shaped the dreams of the populations of the global North, dreams of a better world, of a common humanity, of goodness, of solidarity, and of global healing. In this article I argue that when taking art and cultural objects into account humanitarian rea...
to mediate a complaint, if a patient is unable to resolve their concerns directly with a healthcare professional. Mediation can be a successful way to bring two parties together, and there are numerous professional organisations in South Africa that offer an impartial mediation service. GUEST EDITORIAL. A good complaints ...
Amato, Paul R.; Kane, Jennifer B.; James, Spencer
This study attempted to assess the notion that a "good divorce" protects children from the potential negative consequences of marital dissolution. A cluster analysis of data on postdivorce parenting from 944 families resulted in three groups: cooperative coparenting, parallel parenting, and single parenting. Children in the cooperative coparenting…
Poulsen, Rolf; Rasmussen, Kourosh Marjani
In the basic Markowitz and Merton models, a stock’s weight in efficient portfolios goes up if its expected rate of return goes up. Put differently, there are no financial Giffen goods. By an example from mortgage choice we illustrate that for more complicated portfolio problems Giffen effects do...
Maintains that the standardized teacher/course evaluation form has become a ritual at virtually every major U.S. university. Argues that many good teachers are unrewarded, ineffective ones win prizes, and the evaluation process is a means of monitoring political orthodoxy. (CFR)
Roberts, Jason A; Norris, Ross; Paterson, David L; Martin, Jennifer H
Optimizing the prescription of antimicrobials is required to improve clinical outcome from infections and to reduce the development of antimicrobial resistance. One such method to improve antimicrobial dosing in individual patients is through application of therapeutic drug monitoring (TDM). The aim of this manuscript is to review the place of TDM in the dosing of antimicrobial agents, specifically the importance of pharmacokinetics (PK) and pharmacodynamics (PD) to define the antimicrobial exposures necessary for maximizing killing or inhibition of bacterial growth. In this context, there are robust data for some antimicrobials, including the ratio of a PK parameter (e.g. peak concentration) to the minimal inhibitory concentration of the bacteria associated with maximal antimicrobial effect. Blood sampling of an individual patient can then further define the relevant PK parameter value in that patient and, if necessary, antimicrobial dosing can be adjusted to enable achievement of the target PK/PD ratio. To date, the clinical outcome benefits of a systematic TDM programme for antimicrobials have only been demonstrated for aminoglycosides, although the decreasing susceptibility of bacteria to available antimicrobials and the increasing costs of pharmaceuticals, as well as emerging data on pharmacokinetic variability, suggest that benefits are likely. PMID:21831196
Full Text Available Background: Fixed Dose Combinations (FDCs improve patient compliance and decrease pill burden. However, irrational prescribing of FDCs is a major health concern. As resident doctors are primarily involved in patient management at tertiary care hospitals, knowledge about prescribing FDCs is of paramount importance. Objective: To evaluate knowledge, attitude and practice, regarding use of FDCs by resident doctors at a tertiary care teaching hospital. Materials and Methods: The study was carried out among resident doctors working at Civil Hospital, Ahmedabad, a tertiary care teaching hospital. One hundred resident doctors from the departments of medicine, obstetrics and gynaecology, surgery, paediatrics, skin and psychiatry, who gave their informed consent, were enrolled. A prevalidated questionnaire regarding knowledge, attitude and prescribing practice of fixed dose combinations was filled up. Data was analyzed with suitable statistical tests. Results: Out of the 100 residents recruited for the study, 34, 33 and 33 residents were selected from the 1 st , 2 nd and 3 rd year respectively. The resident doctors were not aware about all of the advantages and disadvantages of FDCs. On an average, only 31% of the residents (lowest 16% among 1 st year residents had knowledge about the Essential Medicine List (EML. Knowledge about rationality of given FDCs was lacking in 81% of the residents. Only 47% could name a single banned FDC in India. Common sources of information about FDCs were medical representatives, colleagues/peers, the Monthly Index of Medical Specialities (MIMS and Continuous Medical Education (CMEs. A majority of residents (96% agreed that FDCs should be allowed to be marketed. The residents opined that most commonly prescribed FDCs were of antimicrobial drugs, amongst which amoxicillin + clavulanic acid was the most frequent. Conclusion: There is need to improve knowledge about rationality, EML, usage and banned FDCs in post graduate
Prescribed burning is highly uncommon in the Netherlands, where wildfire awareness is increasing but its risk management does not yet include fuel management strategies. A major exception is on two military bases, that need to burn their fields in winter and spring to prevent wildfires during summer shooting practice. Research on these very frequent burns has so far been limited to effects on biodiversity, yet site managers and policy makers have questions regarding the soil temperatures reached during these burns because of potential impact on soil properties and soil dwelling fauna. In March 2015, I therefore measured soil and litter temperatures under heath and grass vegetation during a prescribed burn on military terrain in the Netherlands. Soil and litter moisture were sampled pre- and post-fire, ash was collected, and fireline intensity was estimated from flame length. While standing vegetation was dry (0.13 g water/g biomass for grass and 0.6 g/g for heather), soil and litter were moist (0.21 cm3/cm3 and 1.6 g/g, respectively). Soil heating was therefore very limited, with maximum soil temperature at the soil-litter interface remaining being as low as 6.5 to 11.5°C, and litter temperatures reaching a maximum of 77.5°C at the top of the litter layer. As a result, any changes in physical properties like soil organic matter content and bulk density were not significant. These results are a first step towards a database of soil heating in relation to fuel load and fire intensity in this temperate country, which is not only valuable to increase understanding of the relationships between fire intensity and severity, but also instrumental in the policy debate regarding the sustainability of prescribed burns.
Lahm, P.W.; Haddow, D.V.; Lamb, D.V.
The potential conflict between the public's desire for clean air and good visibility versus the ecological need for using prescribed fire as a land management tool presents a continuing challenge for land management agencies. In many western states, prescribed fire is a large, intermittent source of particulates that can have a significant short-term impact on fine particulate concentrations and visibility. In general, the ecological need for the use of prescribed fire in the West is increasing as fuel loadings increase, unnatural successional changes continue, and research clarifies the role of fire in natural ecosystems. This paper discusses the future use of prescribed fire as a land management tool given the development of new air quality standards designed to control PM 10 and air toxics and new programs designed to protect and enhance visibility
Jayathissa, Sisira; Dixon, Paul; Bruce, Raymond; Reith, David
Metformin is the mainstay of treatment of type 2 diabetes. However, there has been significant concern on prescribing metformin in patients with renal impairment as a result of metformin-associated lactic acidosis (MALA). Recent studies have cast doubt on the existence of MALA purely related to metformin use. Medsafe recently initiated changes to datasheet so lower doses of metformin could be used in patients with GFR down to 15ml/min. In this paper we outline the context and implications of this change.
The first chapter of the following article discusses measures in terms of substitution treatment of a program of the Austrian Minister of the Interior. The relevance of psychosocial measures and aims of substitution treatment for opioid-dependent patients is illuminated. The abstinence as the only goal definition is modified and by the results of the study PREMOS a target differentiation at addiction work is illustrated. The second chapter addresses the misuse of prescribed drugs. Thereby police report data will be analyzed and the market situation of opioids will be outlined.
S. Maddali Bongi
Full Text Available Physical exercise, aiming to improve range of movement, muscle strength and physical well being, lately substituted the immobilization previously prescribed in rheumatic diseases. International guidelines, recommendations of Scientific Societies, and structured reviews regard physical exercise as of pivotal importance in treating rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, fibromyalgia syndrome, osteoporosis, and to be considered in connective tissue diseases. Therapeutic exercise should: aim to improve firstly local symptoms and then general health; respect the pain threshold; be a part of a treatment including pharmacological therapies and other rehabilitation techniques, be administered by skilled physiotherapist under the guide of a rheumatologist, be different according to different diseases, disease phases and patient expectations.
Full Text Available Rupali D Shah, Thomas I LemonSchool of Medicine, Cardiff University, University Hospital of Wales, Cardiff, WalesGordon, Catchpole and Baker1 have discussed and investigated a very interesting, currently relevant, subject in medical education; particularly with the introduction of the prescribing test for undergraduates trialled in the UK this year and set to become a fully-fledged part of the curriculum and assessment criteria for 2014 graduates.2 It would of course be of great interest to compare the themes discussed in this paper and see they how would compare to recent graduates in late 2014.View original paper by Gordon and colleagues.
Stock, Sarah J.E.
Natural antimicrobials are peptides that are essential components of the innate immune system, providing broad-spectrum protection against bacteria, yeasts and some viruses. In addition to their innate immune activity, they exhibit properties suggesting they interact with the adaptive immune system. These functions imply they may be of particular importance in pregnancy. Intrauterine infection is responsible for approximately one third of cases of preterm labour, and normal ...
This chapter is focused on antimicrobial modifications of polymer materials intended for medical devices production. Firstly, a brief introduction into the field of medical application of polymers is presented. Considering the fact that polymer medical devices are often connected with occurrence of nosocomial infections, the next part refers to this phenomenon and its causes. One of the possibilities of reducing of the infection occurrence is aimed at polymer modification. It is a key topic o...
Stewart, Philip S.
The tolerance of microorganisms in biofilms to antimicrobial agents is examined through a meta-analysis of literature data. A numerical tolerance factor comparing the rates of killing in the planktonic and biofilm states is defined to provide a quantitative basis for the analysis. Tolerance factors for biocides and antibiotics range over three orders of magnitude. This variation is not explained by taking into account the molecular weight of the agent, the chemistry of the agent, the substrat...
Shearer, David S
The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.
Kelesidis, Theodoros; Falagas, Matthew E
Substandard/counterfeit antimicrobial drugs are a growing global problem. The most common substandard/counterfeit antimicrobials include beta-lactams (among antibiotics) and chloroquine and artemisin derivatives (among antimalarials). The most common type of substandard/counterfeit antimicrobial drugs have a reduced amount of the active drug, and the majority of them are manufactured in Southeast Asia and Africa. Counterfeit antimicrobial drugs may cause increased mortality and morbidity and pose a danger to patients. Here we review the literature with regard to the issue of substandard/counterfeit antimicrobials and describe the prevalence of this problem, the different types of substandard/counterfeit antimicrobial drugs, and the consequences for the individuals and global public health. Local, national, and international initiatives are required to combat this very important public health issue. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
Gram, Malene; Grønhøj, Alice
to be appropriate child and parental behavior. The study takes a practice theoretical perspective, building on previous research on family consumption, and draws empirically on 35 interviews with 5–6 year-olds and 13 family interviews. Findings show that the children recognize the position of ‘the good child......This article explores ‘childing’ pratices in relation to family supermarket shopping in Denmark. ‘Parenting’ practices have been explored for long but little attention has been given to how children strive to be ‘good’ children, who live up to certain standards and recognize what they perceive......’ and most often prefer to take on this position, which is confirmed by their parents. The children can describe how ‘the good child’—in their eyes—should behave. They prefer consensus and not being embarrassing or embarrassed. The study concludes that the children are strongly immersed in social norms...
Nde, Francis; Fah, Aimé Bernard Djitafo; Simo, Francis Ampère; Wouessidjewe, Denis
The present study conducted in Cameroon from June 2013 to February 2014 aimed to estimating the level of pharmacovigilance knowledge and practice of health professionals in Cameroon. We conducted a descriptive cross-sectional survey on 149 health professionals in Cameroon from June to September 2013. Data were analyzed using software IBM SPSS 20.0. We calculated proportions and odd ratio, and confident interval of their values, keeping a threshold of p of 0.05 to determine the level of significance. Ninety percent (90%) of declaration of side effects were made to the medical representatives and 4% to the National Pharmacovigilance Centre. Fifty four percent (54%) of physicians were not aware of the existence of a National Pharmacovigilance system. Ten (10%) of prescribers had never heard of pharmacovigilance, however respondents answered unanimously that they need training on pharmacovigilance. A wrong definition was given by most of the nurses and dentists (61,1% and 58,3% respectively) as compared to physicians and pharmacists (respectively 15.2% and 26,5%). Given the results of this study, the establishment of a National Pharmacovigilance system based on a solid legal foundation is necessary in Cameroon. This implementation must go through the involvement of all stakeholders and their awareness raising on the importance of this activity and its positive impact on the health of populations. Pharmacovigilance is a public health problem in Cameroon, with due to lack of good knowledge and practice of prescribers, precisely physicians, pharmacists, nurses, and dentists who are not always aware of an existing pharmacovigilance system in Cameroon.
E.G. McPherson; F. Ferrini
We know that âtrees are good,â and most people believe this to be true. But if this is so, why are so many trees neglected, and so many tree wells empty? An individualâs attitude toward trees may result from their firsthand encounters with specific trees. Understanding how attitudes about trees are shaped, particularly aversion to trees, is critical to the business of...
Poot, Betty; Zonneveld, Rebecca; Nelson, Katherine; Weatherall, Mark
Nurse practitioners (NPs) in New Zealand have been able to prescribe medicines since 2001; however, little is known about their prescribing practice. This study describes the NPs who prescribe community-dispensed medicines, the patients, and identifies the most frequently prescribed medications. A retrospective search of the Ministry of Health pharmaceutical collection was completed from 2013 to 2015. NP registration number, patient age, gender, deprivation index, and the name and date of dispensed medication, including the New Zealand pharmaceutical schedule therapeutic group, were identified. NPs prescribe a broad range of medications across all therapeutic groups with antibacterial and analgesics being the most commonly prescribed medicines. This is comparable to all prescribers in New Zealand and NPs in Australia. The majority of patients lived in the more deprived areas of New Zealand indicating that NPs are working in areas of greater health need. The majority of NPs registered in New Zealand prescribe medicines. Those in primary care prescribe the most medications. NPs prescribe a broad range of medicines across all drug therapeutic groups. The patients seen by NPs often live in the most deprived areas of New Zealand. Understanding prescribing patterns will help to inform curricular development and continuing education programs for NPs. ©2017 American Association of Nurse Practitioners.
Survey participants in the United Kingdom admitted keeping leftover antimicrobial drugs for future use and taking them without medical advice. Dr. J. Todd Weber, director of CDC's Office of Antimicrobial Resistance, advises against the practice, which can be dangerous and can promote antimicrobial drug resistance. Created: 10/19/2006 by Emerging Infectious Diseases. Date Released: 10/26/2006.
This article presents the challenges regarding the development of a collaborative practice agreement in order to undertake nurse prescribing in an emergency department in a large teaching hospital. Nurse prescribing has been introduced quite recently in Ireland. Although there is a plethora of knowledge regarding the topic, there are many personal and professional challenges in relation to this emerging role. The nurse prescribing initiative in Ireland is continually developing and many nurses now have the authority to prescribe from almost the same range of medicines as doctors. Prescribing has the potential to improve job satisfaction, autonomy and ultimately improves patient outcomes. However, nurses need to be cognisant of the impact it can have on the dynamics of the healthcare team. An analysis of some complexities of nurse prescribing is given, in conjunction with reflective thoughts on a clinical incident in the area of morphine prescribing.
Pomerleau, Adam C; Nelson, Lewis S; Hoppe, Jason A; Salzman, Matthew; Weiss, Paul S; Perrone, Jeanmarie
Emergency department (ED) providers are high volume but low quantity prescribers of opioid analgesics (OA). Few studies have examined differences in opioid prescribing decisions specifically among ED providers. The aim of this study was to describe OA prescribing decisions of ED providers at geographically diverse centers, including utilization of prescribing guidelines and prescription drug monitoring programs (PDMP). This was a multi-center cross-sectional Web-based survey of ED providers who prescribe OA. Respondents were asked about their OA prescribing decisions, their use of PDMPs, and their use of prescribing guidelines. Data was analyzed using descriptive statistics and chi-square tests of association were used to assess the relationship between providers' opioid prescribing decisions and independent covariates. The total survey population was 957 individuals and 515 responded to the survey for an overall response rate of 54%. The frequency respondents prescribed different types of pain medication was variable between centers. of respondents were registered to access a PDMP, and were not aware whether their state had a PDMP. Forty percent (172/426) of respondents used OA prescribing guidelines, while 24% (103/426) did not, and 35% (151/426) were unaware of prescribing guidelines. No significant differences in OA prescribing decisions were found between groups either by use of PDMP or by guideline adherence. In this multi-center survey study of ED clinicians, OA prescribing varied between centers The utilization of prescribing guidelines and PDMPs was not associated with differences in OA prescribing decisions. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: email@example.com
... or Office Furniture. 52.247-11 Section 52.247-11 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.247-11 Net Weight—Household Goods or Office Furniture. As prescribed in 47.207-4(b... Weight—Household Goods or Office Furniture (APR 1984) (a) Net weight—full loads. The net weight of the...
Keen, Patricia L; Montforts, M. H. M. M
.... Recognizing the connectivity between overlapping complex systems, the book discusses the subject from the perspective of an ecosystem approach"-- "This book explores the role that antimicrobial...
Uchil, Rajesh R; Kohli, Gurdeep Singh; Katekhaye, Vijay M; Swami, Onkar C
The global burden of antimicrobial resistance is rising and is associated with increased morbidity and mortality in clinical and community setting. Spread of antibiotic resistance to different environmental niches and development of superbugs have further complicated the effective control strategies. International, national and local approaches have been advised for control and prevention of antimicrobial resistance. Rational use of antimicrobials, regulation on over-the-counter availability of antibiotics, improving hand hygiene and improving infection prevention and control are the major recommended approaches. Thorough understanding of resistance mechanism and innovation in new drugs and vaccines is the need. A multidisciplinary, collaborative, regulatory approach is demanded for combating antimicrobial resistance.
Nordström, Randi; Malmsten, Martin
on the identification such peptides, as well as on their optimization to reach potent antimicrobial and anti-inflammatory effects at simultaneously low toxicity against human cells. In comparison, delivery systems for antimicrobial peptides have attracted considerably less interest. However, such delivery systems......, or through achieving co-localization with intracellular pathogens. Here, an overview is provided of the current understanding of delivery systems for antimicrobial peptides, with special focus on AMP-carrier interactions, as well as consequences of these interactions for antimicrobial and related biological...
Kosanić, Marijana; Ranković, Branislav; Dašić, Marko
The aim of the study is to examine in-vitro antioxidant and antimicrobial activity of the acetonic and methanolic extracts of the mushrooms Boletus aestivalis, Boletus edulis and Leccinum carpini. Antioxidant activity was evaluated by using free radical scavenging activity and reducing power. In addition, total content of phenol and flavonoid in extracts were determined as pyrocatechol equivalent, and as rutin equivalent, respectively. As a result of the study acetonic extracts from Boletus edulis was more powerful antioxidant activity with IC50 value of 4.72 μg/mL which was similar or greater than the standard antioxidants, ascorbic acid (IC50 = 4.22 μg/mL), BHA (IC50 = 6.42 μg/mL) and α-tocopherol (IC50 = 62.43 μg/mL). Moreover, the tested extracts had effective reducing power. A significant relationship between total phenolic and flavonoid contents and their antioxidative activities was significantly observed. The antimicrobial activity of each extract was estimated by determination of the minimum inhibitory concentration by using microdilution plate method against five species of bacteria and five species of fungi. Generally, the tested mushroom extracts had relatively strong antimicrobial activity against the tested microorganisms. The minimum inhibitory concentration for both extracts related to the tested bacteria and fungi were 1.25 - 10 mg/ mL. The present study shows that tested mushroom species demonstrated a strong antioxidant and antimicrobial activity. It suggests that mushroom may be used as good sources of natural antioxidants and for pharmaceutical purposes in treating of various deseases. PMID:24250542
Metwally, A. M.; Omar, A. A.; Harraz, F. M.; El Sohafy, S. M.
Psidium guajava L. leaves were subjected to extraction, fractionation and isolation of the flavonoidal compounds. Five flavonoidal compounds were isolated which are quercetin, quercetin-3-O-α-L-arabinofuranoside, quercetin-3-O-β-D-arabinopyranoside, quercetin-3-O-β-D-glucoside and quercetin-3-O-β-D-galactoside. Quercetin-3-O-β-D-arabinopyranoside was isolated for the first time from the leaves. Fractions together with the isolates were tested for their antimicrobial activity. The antimicrobial studies showed good activities for the extracts and the isolated compounds. PMID:20931082
Isolates of coagulase positive S. aureus resistance to 10 antimicrobials was determined by disc diffusion method. Staphylococcus .... Table 1: Antimicrobial resistance of coagulase positive Staphylococcus. aureus isolates from chickens in Maiduguri,. Nigeria. Antimicrobials .... on Danish poultry and pig farms. Preventive.
Full Text Available Regarding increasing rate of drug resistance among microbial pathogens, a global search to find new antimicrobial agents from natural compounds with fewer side effects has been considered by many researchers worldwide. Bioactive compounds with good antimicrobial activity have been isolated from different algae and cyanobacteria. The current study was performed to determine antimicrobial potential and to characterize the effect of algal growth modes (autotrophic, heterotrophic and mixotrophic and extraction solvents on antimicrobial activity of the microalgae Chlorella vulgaris against four bacterial and one fungal pathogens. C. vulgaris was grown under different growth conditions and the biomass was harvested. Different extracts were prepared using acetone, chloroform and ethyl acetate as extraction solvents and antimicrobial activity of the extracts was investigated against two Gram positive bacteria (Bacillus subtilis and Staphylococcus aureus, two Gram negative bacteria (Escherichia coli and Pseudomonas aeruginosa and a fungal strain (Candida albicans using agar well diffusion assay. In addition, Minimal Inhibitory Concentration (MIC of the extracts were determined. Moreover, the total oil content and lipid productivity of C. vulgaris grown under different modes were determined. The heterotrophic growth resulted in stronger antimicrobial activity compared to the other growth conditions. In addition, the highest antimicrobial activity was observed for chloroform mediated extract and extraction using acetone resulted in minimum antimicrobial activity. Moreover, heterotrophic and mixotrophic growth significantly increased the total lipid content and lipid productivity compared to the autotrophic growth. C. vulgaris exhibited good antimicrobial potential and the antimicrobial efficacy could be influenced by extraction solvents and growth conditions.
Alam, K; Mishra, P; Prabhu, M; Shankar, P R; Palaian, S; Bhandari, R B; Bista, D
To analyze the prescriptions of out-patients for rational prescribing and dispensing and to evaluate the patient's knowledge regarding use of drugs, using INRUD indicators. A cross-sectional, descriptive study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal during the time period from June 10th to August 19th 2004. Totally 247 prescriptions were randomly selected for analysis, wherein 720 drugs were prescribed. Only 15% of drugs were prescribed by generic name, 21.67% of the total drugs consisted of fixed-dose combinations, only 40% of drugs were from the Essential drug list of Nepal and 29.44% (n=212) were from the WHO Essential drug list. It was found that more than half (54.17%) of the drugs were from Nepalese National Formulary and 35.69% were from WHO model formulary. Dermatological products were most commonly prescribed followed by drugs acting on central nervous system, antimicrobials and drugs acting on cardiovascular system. Among the drugs dispensed, 79.16% were oral followed by topical (18.19%) and parenteral forms (2.98%). Diagnosis was mentioned only in 3.23% (n=8) of the prescriptions and the average cost per prescription was found to be 241.11 Nepalese rupees (US$ 3.26). It was found out that pharmacist labelled only 0.4% of the medication envelopes with the name of the patient. However, 82.6% of the medication envelopes were labelled with name of the drug and 87.0% with drug strength. Only 53.8% (n=133) of the patient knew both the duration of the therapy and administration time of drugs. There is a need for educational intervention for prescribers and both managerial and educational intervention for the hospital pharmacists to improve prescribing and dispensing.
van der Velden, Alike W; Kuyvenhoven, Marijke M; Verheij, Theo J M
Antibiotic overprescribing is a significant problem. Multifaceted interventions improved antibiotic prescribing quality; their implementation and sustainability, however, have proved difficult. We analysed the effectiveness of an intervention embedded in the quality cycle of primary care practice accreditation on quantity and quality of antibiotic prescribing for respiratory tract and ear infections (RTIs). This was a pragmatic, cluster-randomized intervention trial in 88 Dutch primary care practices. The intervention (physician education and audit/feedback on antibiotic prescribing quantity and quality) was integrated in practice accreditation by defining an improvement plan with respect to antibiotic prescribing for RTIs. Numbers and types of dispensed antibiotics were analysed from 1 year prior to the intervention to 2 years after the intervention (pharmacy data). Overprescribing, underprescribing and non-first-choice prescribing for RTIs were analysed at baseline and 1 year later (self-registration). There were significant differences between intervention and control practices in the changes in dispensed antibiotics/1000 registered patients (first year: -7.6% versus -0.4%, P = 0.002; second year: -4.3% versus +2%, P = 0.015), which was more pronounced for macrolides and amoxicillin/clavulanate (first year: -12.7% versus +2.9%, P = 0.001; second year: -7.8% versus +6.7%, P = 0.005). Overprescribing for RTIs decreased from 44% of prescriptions to 28% (P < 0.001). Most general practitioners (GPs) envisaged practice accreditation as a tool for guideline implementation. GP education and an audited improvement plan around antibiotics for RTIs as part of primary care practice accreditation sustainably improved antibiotic prescribing. Tools should be sought to further integrate and facilitate education and audit/feedback in practice accreditation. © The Author 2015. Published by Oxford University Press on behalf of the British Society for
Johnson, Chris F; Williams, Brian; MacGillivray, Stephen A; Dougall, Nadine J; Maxwell, Margaret
Antidepressant prescribing continues to increase, with 5-16% of adults receiving antidepressants annually. Total prescribing growth is due in part to increased long-term use, greater selective serotonin re-uptake inhibitor (SSRI) use and the use of higher SSRI doses. Evidence does not support routine use of higher SSRI doses for depression treatment, and factors influencing the use of such doses are not well known. The aim of this study was to explore factors influencing GPs' use of antidepressants and their doses to treat depression. Semi-structured interviews with a purposive sample of 28 practising GPs; sampled by antidepressant prescribing volume, practice size and deprivation level. A topic guide drawing on past literature was used with enough flexibility to allow additional themes to emerge. Interviews were audio-recorded and transcribed verbatim. Framework analysis was employed. Constant comparison and disconfirmation were carried out across transcripts, with data collection being interspersed with analysis by three researchers. The thematic framework was then systematically applied to the data and conceptualised into an overarching explanatory model. Depression treatment involved ethical and professional imperatives of 'doing the right thing' for individuals by striving to achieve the 'right care fit'. This involved medicalised and non-medicalised patient-centred approaches. Factors influencing antidepressant prescribing and doses varied over time from first presentation, to antidepressant initiation and longer-term treatment. When faced with distressed patients showing symptoms of moderate to severe depression GPs were confident prescribing SSRIs which they considered as safe and effective medicines, and ethically and professionally appropriate. Many GPs were unaware that higher doses lacked greater efficacy and onset of action occurred within 1-2 weeks, preferring to wait 8-12 weeks before increasing or switching. Ongoing pressures to maintain
Al-Niemat, Sahar I.; Bloukh, Diana T.; Al-Harasis, Manal D.; Al-Fanek, Alen F.; Salah, Rehab K.
Objective was to evaluate the use of antibiotics prescribed in hospital outpatient and emergency clinics in King Hussein Medical Centre (KHMC) using WHO prescribing indicators in an attempt to rationalize the use of antibiotics in the Royal Medical Services. We retrospectively surveyed a sample of 187,822 antibiotic prescriptions obtained from 5 outpatient pharmacies in KHMC written over the period of 3 consecutive months May 2007 to July 2007. The percentage of encounters of an antibiotic prescribed was calculated using the methodology recommended by the WHO. An additional indicator, the percentage share of different antibiotics was also included to identify the frequency prescribed from those antibiotics. The average percentage of prescriptions involving antibiotics was 35.6% out of 187,822 prescriptions surveyed. From these, 65,500 antibiotic prescriptions were observed. Penicillins most frequently amoxcillins and Quinolones most frequently ciprofloxacinllin and norfloxacillin were the most commonly prescribed antibiotics with an average percentage of 31.8% and 27.5%. The average prescribing rate for the other antibiotic categories was as follows: macrolides 5.2%, cephalosporins 16% and amoxcillins/clavulanate 5.4%. The high percentage of prescriptions involving antibiotics observed in KHMC pharmacies requires rational use of antibiotics and judicious prescribing by Military prescribers. An insight into factors influencing antibiotic prescribing patterns and adherence to antibiotic prescribing guidelines by the Military prescribers is warranted. (author)
Ghosh, Probir Kumar; Bhattacharjee, Paramita; Das, Satadal
Antimicrobial potency of herbal extracts is well known. The review of patents and research articles revealed that several herbal extracts have been employed in the formulation of topical products such as creams, exclusive of the cream reported in the present study. 0ur previous study has established antimicrobial potency of supercritical carbon dioxide extracts of tuberose flowers, better known for its sweet fragrance. The present work focuses on formulating a topical antimicrobial herbal cream with methyl eugenol (principal antimicrobial compound) rich - supercritical carbon dioxide extract of tuberose flowers, having good combination of phytochemical and antimicrobial potencies. Supercritical carbon dioxide parameters such as temperature, pressure and time were optimized using full factorial experimental design to obtain methyl eugenol-rich extracts. A cream was formulated using the extract having the best combination of phytochemical and antimicrobial potencies and was assayed further for in vitro antimicrobial potency; physiochemical and sensory properties. Two commercial antimicrobial cream samples were used as reference samples in the study. The extract obtained at 40°C, 10 MPa, 135 min at 1 L min-1 flow rate of gaseous C02 showed the best combination of phytochemical and antimicrobial potencies and was used for formulation of herbal creams. The cream formulated with 5% w/w of extract arrested growth of the common human skin pathogen Staphylococcus aureus and showed stable physiochemical properties and high sensory appeal for a year. The cream could be considered as a 'finished herbal product&' in compliance with the World Health 0rganization guidelines.
Sara I V C Lima
Full Text Available Although there is a conflict between the treatment benefits for a single individual and society, restrictions on antibiotic use are needed to reduce the prevalence of resistance to these drugs, which is the main result of irrational use. Brazil, cataloged as a pharmemerging market, has implemented restrictive measures for the consumption of antibiotics. The objective of this study was to investigate the quality of antimicrobial prescriptions and user knowledge of their treatment with these drugs.A two-stage cross-sectional, combined and stratified survey of pharmacy users holding an antimicrobial prescription was conducted in the community between May and November 2014. A pharmacist analyzed each prescription for legibility and completeness, and applied a structured questionnaire to the users or their caregivers on their knowledge regarding treatment and user sociodemographic data. An estimated 29.3% of prescriptions had one or more illegible items, 91.3% had one or more missing items, and 29.0% had both illegible and missing items. Dosing schedule and patient identification were the most commonly unreadable items in prescriptions, 18.81% and 12.14%, respectively. The lack of complete patient identification occurred in 90.53% of the prescriptions. It is estimated that 40.3% of users have used antimicrobials without prescription and that 46.49% did not receive any guidance on the administration of the drug.Despite the measures taken by health authorities to restrict the misuse of antimicrobials, it was observed that prescribers still do not follow the criteria of current legislation, particularly relating to items needed for completion of the prescription. Moreover, users receive little information about their antimicrobial treatment.
Lima, Sara I V C; Diniz, Rodrigo S; Egito, Eryvaldo S T; Azevedo, Paulo R M; Oliveira, Antonio G; Araujo, Ivonete B
Although there is a conflict between the treatment benefits for a single individual and society, restrictions on antibiotic use are needed to reduce the prevalence of resistance to these drugs, which is the main result of irrational use. Brazil, cataloged as a pharmemerging market, has implemented restrictive measures for the consumption of antibiotics. The objective of this study was to investigate the quality of antimicrobial prescriptions and user knowledge of their treatment with these drugs. A two-stage cross-sectional, combined and stratified survey of pharmacy users holding an antimicrobial prescription was conducted in the community between May and November 2014. A pharmacist analyzed each prescription for legibility and completeness, and applied a structured questionnaire to the users or their caregivers on their knowledge regarding treatment and user sociodemographic data. An estimated 29.3% of prescriptions had one or more illegible items, 91.3% had one or more missing items, and 29.0% had both illegible and missing items. Dosing schedule and patient identification were the most commonly unreadable items in prescriptions, 18.81% and 12.14%, respectively. The lack of complete patient identification occurred in 90.53% of the prescriptions. It is estimated that 40.3% of users have used antimicrobials without prescription and that 46.49% did not receive any guidance on the administration of the drug. Despite the measures taken by health authorities to restrict the misuse of antimicrobials, it was observed that prescribers still do not follow the criteria of current legislation, particularly relating to items needed for completion of the prescription. Moreover, users receive little information about their antimicrobial treatment.
Full Text Available Ethical behavior encompasses actions that benefit both self and society. This means that tackling antimicrobial resistance (AMR becomes an ethical obligation, because the prospect of declining anti-infectives affects everyone. Without preventive action, loss of drugs that have saved lives over the past century, will condemn ourselves, people we know, and people we don’t know, to unacceptable risk of untreatable infection. Policies aimed at extending antimicrobial life should be considered within an ethical framework, in order to balance the choice, range, and quality of drugs against stewardship activities. Conserving availability and effectiveness for future use should not compromise today’s patients. Practices such as antimicrobial prophylaxis for healthy people ‘at risk’ should receive full debate. There are additional ethical considerations for AMR involving veterinary care, agriculture, and relevant bio-industries. Restrictions for farmers potentially threaten the quality and quantity of food production with economic consequences. Antibiotics for companion animals do not necessarily spare those used for humans. While low-income countries cannot afford much-needed drugs, pharmaceutical companies are reluctant to develop novel agents for short-term return only. Public demand encourages over-the-counter, internet, black market, and counterfeit drugs, all of which compromise international control. Prescribers themselves require educational support to balance therapeutic choice against collateral damage to both body and environment. Predicted mortality due to AMR provides justification for international co-operation, commitment and investment to support surveillance and stewardship along with development of novel antimicrobial drugs. Ethical arguments for, and against, control of antimicrobial resistance strategies are presented and discussed in this review.
Nikolaisen, Nanett Kvist; Lassen, Desireé Corvera Kløve; Chriél, Mariann; Larsen, Gitte; Jensen, Vibeke Frøkjær; Pedersen, Karl
For proper treatment of bacterial infections in mink, knowledge of the causative agents and their antimicrobial susceptibility patterns is crucial. The used antimicrobials are in general not registered for mink, i.e. most usage is "off-label". In this study, we report the patterns of antimicrobial resistance among pathogenic bacteria isolated from Danish mink during the period 2014-2016. The aim of this investigation was to provide data on antimicrobial resistance and consumption, to serve as background knowledge for new veterinary guidelines for prudent and optimal antimicrobial usage in mink. A total number of 308 Escherichia coli isolates, 41 Pseudomonas aeruginosa, 36 Streptococcus canis, 30 Streptococcus dysgalactiae, 55 Staphylococcus delphini, 9 Staphylococcus aureus, and 20 Staphylococcus schleiferi were included in this study. Among E. coli, resistance was observed more frequently among the hemolytic isolates than among the non-hemolytic ones. The highest frequency of resistance was found to ampicillin, 82.3% and 48.0% of the hemolytic of the non-hemolytic isolates, respectively. The majority of the P. aeruginosa isolates were only sensitive to ciprofloxacin and gentamicin. Among the Staphylococcus spp., the highest occurrence of resistance was found for tetracycline. Regarding the nine S. aureus, one isolate was resistant to cefoxitin indicating it was a methicillin-resistant Staphylococcus aureus. Both β-hemolytic Streptococcus species showed high levels of resistance to tetracycline and erythromycin. The antimicrobial consumption increased significantly during 2007-2012, and fluctuated at a high level during 2012-2016, except for a temporary drop in 2013-2014. The majority of the prescribed antimicrobials were aminopenicillins followed by tetracyclines and macrolides. The study showed that antimicrobial resistance was common in most pathogenic bacteria from mink, in particular hemolytic E. coli. There is a need of guidelines for prudent use of
Get past all the hype about PHP and dig into the real power of this language. This book explores the most useful features of PHP and how they can speed up the web development process, and explains why the most commonly used PHP elements are often misused or misapplied. You'll learn which parts add strength to object-oriented programming, and how to use certain features to integrate your application with databases. Written by a longtime member of the PHP community, PHP: The Good Parts is ideal for new PHP programmers, as well as web developers switching from other languages. Become familiar w
The author states that the problem of nuclear wastes is solved. He states that 90 per cent of radioactive wastes are now permanently managed and that technical solutions for deep geological storage and for transmutation will soon solve the problem for the remaining 10 pc. He states that geological storage will be funded (it is included in electricity price). He denounces why these facts which he consider as good news, do not prevail. He proposes several documents in appendix: a text explaining the nuclear fuel cycle in France, and an extract of a report made by the national inventory of radioactive materials and wastes
In this presentation author deals with the Implementation of good manufacturing practice for radiopharmaceuticals. The presentation is divided into next parts: Batch size; Expiration date; QC Testing; Environmental concerns; Personnel aspects; Radiation concerns; Theoretical yields; Sterilizing filters; Control and reconciliation of materials and components; Product strength; In process sampling and testing; Holding and distribution; Drug product inspection; Buildings and facilities; Renovations at BNL for GMP; Aseptic processing and sterility assurance; Process validation and control; Quality control and drug product stability; Documentation and other GMP topics; Building design considerations; Equipment; and Summary
Full Text Available Resistance of microorganisms to antibiotics has increased. The use of natural components with antimicrobial properties can be of great significance to reduce this problem. The presented work is focused on the study of the effect of encapsulation of selected plant and animal antimicrobial substances (herbs, spices, lysozyme and nisin on their activity and stability. Antimicrobial components were packaged into liposomes and polysaccharide particles (alginate, chitosan and starch. Antimicrobial activity was tested against two Gram-positive (Bacillus subtilis and Micrococcus luteus and two Gram-negative (Escherichia coli and Serratia marcescens bacteria. Encapsulation was successful in all types of polysaccharide particles and liposomes. The prepared particles exhibited very good long-term stability, especially in aqueous conditions. Antimicrobial activity was retained in all types of particles. Liposomes with encapsulated herb and spice extracts exhibited very good inhibitory effect against all tested bacterial strains. Most of herbal extracts had very good antimicrobial effect against the tested Gram-negative bacterial strains, while Gram-positive bacteria were more sensitive to lysozyme particles. Thus, particles with co-encapsulated herbs and lysozyme are more active against different types of bacteria, and more stable and more effective during long-term storage. Particles with encapsulated mixture of selected plant extracts and lysozyme could be used as complex antimicrobial preparation with controlled release in the production of food and food supplements, pharmaceutical and cosmetic industries.
Matouskova, Petra; Marova, Ivana; Bokrova, Jitka; Benesova, Pavla
Resistance of microorganisms to antibiotics has increased. The use of natural components with antimicrobial properties can be of great significance to reduce this problem. The presented work is focused on the study of the effect of encapsulation of selected plant and animal antimicrobial substances (herbs, spices, lysozyme and nisin) on their activity and stability. Antimicrobial components were packaged into liposomes and polysaccharide particles (alginate, chitosan and starch). Antimicrobial activity was tested against two Gram-positive ( Bacillus subtilis and Micrococcus luteus ) and two Gram-negative ( Escherichia coli and Serratia marcescens ) bacteria. Encapsulation was successful in all types of polysaccharide particles and liposomes. The prepared particles exhibited very good long-term stability, especially in aqueous conditions. Antimicrobial activity was retained in all types of particles. Liposomes with encapsulated herb and spice extracts exhibited very good inhibitory effect against all tested bacterial strains. Most of herbal extracts had very good antimicrobial effect against the tested Gram-negative bacterial strains, while Gram-positive bacteria were more sensitive to lysozyme particles. Thus, particles with co-encapsulated herbs and lysozyme are more active against different types of bacteria, and more stable and more effective during long-term storage. Particles with encapsulated mixture of selected plant extracts and lysozyme could be used as complex antimicrobial preparation with controlled release in the production of food and food supplements, pharmaceutical and cosmetic industries.
Full Text Available Introduction: the antibiotic usage in Italy is above the European average. From several years the Campania was the first Italian region in terms of antimicrobial consumption. Aim: to evaluate antibiotic utilisation in primary health care in Campania, a region of approximately 5.7 million inhabitants in the south of Italy. Method: we collected, from an electronic database, all prescription drugs reimbursed in 2005. The cohort was defined as the population of subjects receiving at least one prescription of any antimicrobial agent for systemic use, classified according to their therapeutic role using Anatomic Therapeutic Chemical (ATC classification. Drugs cost and consumption were quantified using National Health Service (NHS prospective and Defined Daily Dose system (DDD respectively. All costs were expressed in Euro 2005. Results: antiinfectives agents (ATC J was the second class of drugs in terms of cost, representing 16.1% of the regional drug expenditure. Their consumption were 33 DDD/1000 inhabitants/day. Stratifying by age antibiotic use was highest in children and elderly subjects. Penicillins, macrolides and cephalosporins were the most prescribed antibiotic classes in all age groups. Discussion: despite guidelines introduced to limit the prescription of parenteral antibiotics to the patients who are most likely to benefit from it, they were mostly prescribed. This represented a serious problem for the development of drug-resistant bacteria.
Prescott, John E; Fresne, Julie A; Youngclaus, James A
The authors reflect on the article in this issue entitled "Borrow or Serve? An Economic Analysis of Options for Financing a Medical School Education" by Marcu and colleagues, which makes a compelling case that a medical school education is a good investment, no matter what financing option students use, from federal service programs to federal loans. The lead author of this Commentary shares lessons learned from his own medical school education, which was funded by an Armed Forces Health Professions Scholarship, and from his current position interacting with medical students across the United States.Regardless of the financing path they choose, all students should understand basic financial concepts and the details of the various pathways that are available to pay for their medical school education, as well as how each could potentially impact their own future and that of their families. One underappreciated aspect of financing a medical school education is that federal repayment scenarios can link loan payments to income, rather than debt levels, which means that all physicians are able to afford their loan payments no matter what specialty they practice, what they are paid, or where they live.Medical education, while expensive, remains the good investment. An MD degree can lead to a lifetime of personal fulfillment and societal contributions. Everyone, with rare exceptions, accepted to a U.S. medical school will be able to finance their medical education via a path that aligns with their personal values and priorities.
Ricci, Judith R; Coulen, Charmaine; Berger, Jan E; Moore, Marsha C; McQueen, Angela; Jan, Saira A
Patients prescribed medications with US Food and Drug Administration-issued black box warnings (BBWs) warrant additional vigilance by prescribers because these drugs can cause serious adverse drug events. Seniors are at greater risk for adverse drug events due to increased medication burden and greater health vulnerability. To improve our understanding of the prescribing and patient-monitoring practices of physicians prescribing medications with a BBW to patients age >or=65 years in an ambulatory care setting. A retrospective cohort study of administrative pharmacy and medical claims identified 58,190 patients age >or=65 years in the Horizon Blue Cross Blue Shield of New Jersey beneficiary population with >or=1 claim for >or=1 of the 8 targeted medications between January 1, 2005, and December 31, 2005. Medications included carbamazepine, amiodarone, ketoconazole, loop diuretics, methotrexate, cyclosporine, metformin and combinations, and cilostazol. Patients were followed 12 months from the index prescription date to evaluate prescriber compliance with BBWs using operationalized definitions of compliance. Patients prescribed drugs with a drug-laboratory warning had lower rates of prescriber BBW compliance (0.7%-24.9%) than patients prescribed drugs with a drug-disease warning (84.7%-90.2%). Administrative claims analysis identified low rates of prescriber compliance with BBWs in managing patients age >or=65 years. Claims analysis may be a cost-effective strategy to monitor prescriber compliance with BBWs in older patients at higher risk.
Dunn, J R
White teeth have been an indicator of physical attractiveness throughout history. Only recently have we been able to whiten teeth with few side effects, making tooth bleaching a popular and effective dental treatment. The American Dental Association (ADA) has established guidelines on safety and effectiveness for tooth bleaching. External stains from aging or inherent dark color are more responsive to bleaching than internal stains. Dentist-prescribed home bleaching--including a careful dental exam, custom-fabricated trays, tacky high-viscosity gels, adequate instructions, and recall exams--has been shown to be an effective method for bleaching teeth. Trays can be worn overnight or during the day with similar effectiveness. The bleaching effect can last up to 3 years with more than 50% success.
Soerensen, A L; Nielsen, L P; Poulsen, B K
The Quality of Prescribing for Psychiatric PatientsSoerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3......Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark; 4Institute of Biomedicine, Aarhus University, Aarhus, 5Centre of Emergency Medicine Research, Aarhus University Hospital & Aarhus University, Aarhus, Denmark; 6Aalborg University Hospital, Psychiatry and 7Aalborg University...... the severity of potential clinical consequences and identify possible predictive factors of PIP.METHODS: The study was designed as a prospective study of PIP using medication reviews. Patients who were admitted during a 4 month period (August 2013 - November 2013) to a psychiatric university hospital were...
Ke, Yonggang; Ong, Luvena L.; Sun, Wei; Song, Jie; Dong, Mingdong; Shih, William M.; Yin, Peng
We describe a general framework for constructing two-dimensional crystals with prescribed depth and sophisticated three-dimensional features. These crystals may serve as scaffolds for the precise spatial arrangements of functional materials for diverse applications. The crystals are self-assembled from single-stranded DNA components called DNA bricks. We demonstrate the experimental construction of DNA brick crystals that can grow to micron-size in the lateral dimensions with precisely controlled depth up to 80 nanometers. They can be designed to display user-specified sophisticated three-dimensional nanoscale features, such as continuous or discontinuous cavities and channels, and to pack DNA helices at parallel and perpendicular angles relative to the plane of the crystals. PMID:25343605
Moriarty, Camilla; Carroll, Will
Ibuprofen, a propionic acid derivative, is a non-steroidal anti-inflammatory drug. The oral formulation is widely used in paediatric practice and after paracetamol it is one of the most common drugs prescribed for children in hospital. The treatment of fever with antipyretics such as ibuprofen is controversial as fever is the normal response of the body to infection and unless the child becomes distressed or symptomatic, fever alone should not be routinely treated. Combined treatment with paracetamol and ibuprofen is commonly undertaken but almost certainly is not helpful. This article aims to describe the indications and mode of action of the drug, outline its pharmacokinetics and highlight the important key messages regarding its use in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Full Text Available Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. The Food and Drug Administration (FDA describes that generic drugs are essential possibilities that allow better access to healthcare for all Americans. They are replicas of brand-name drugs and are the identical as those of brand-name drugs in dosage form, safety, strength, route of administration, quality, performance features, and anticipated to use. Healthcare authorities and users can be guaranteed that FDA-approved generic drug products have met the same stiff principles as the innovator drug. The company that made Bayer aspirin fought in court enthusiastically to keep generic versions off the shelves, in the 1920s. The company lost in court, and consumers suddenly had an array of choices in generic aspirin. The Supreme Court of India uttering ‘the Supreme Court's ruling will prevent companies from further seeking unwarranted patents on HIV and other essential medicines.’ Generic medicine cannot be sold at a price higher than the branded medicine, so it is regularly a low-priced option. Thereafter, both the end user and the government who pay for part of the price of the medicine under the Pharmaceutical Benefits Scheme in Australia are benefitted. The treatment of diseases using essential drugs, prescribed by their generic names, has been emphasised by the WHO and many national health policies. Although there are some improvements in generic medicine prescribing, it has been advised by the WHO that ‘countries should intensify efforts to measure and regularly monitor medicine prices and availability, and adopt policy measures to address the issues identified.’
Khan, K.M.; Salar, U.; Yousuf, S.; Naz, F.
5-Nitroimidazole derivatives 2-8 were synthesized from secnidazole. The syntheses were accomplished in two steps which start from the oxidation of secnidazole to the secnidazolone 1. Secnidazolone 1 was converted into its hydrazone derivative 2-8 by treating with different substituted acid hydrazide. Compounds 2-8 were evaluated for their antimicrobial activity against Gram-positive and Gram-negative bacteria, compounds 3 and 4 showed the significant activity against Staphylococcus epidermidis, however, compound 2 showed good inhibitions against Corynebacterium diphtheria when compared with the standard. Compound 3 showed good inhibitory potential against tested Gram-negative bacterial strains i.e. Enterobacter aerogene, Escherichia coli, Salmonella typhi, Salmonella paratyphi A, Shigella flexeneri and Vibrio choleriae. All synthetic derivatives were also tested against eight fungal stains, however, they were weekly active against Aspergillus flavus and Candida albican. The synthesized compounds were characterized by different spectroscopy techniques. (author)
Full Text Available A series of Schiff bases (1–17 and esters (18–24 of propionic acid was synthesized in appreciable yield and characterized by physicochemical as well as spectral means. The synthesized compounds were evaluated in vitro for their antimicrobial activity against Gram-positive bacteria Staphylococcus aureus, Bacillus subtilis, Gram negative bacterium Escherichia coli and fungal strains Candida albicans and Aspergillus niger by tube dilution method. Results of antimicrobial screening indicated that besides having good antibacterial activity, the synthesized compounds also displayed appreciable antifungal activity and compound 10 emerged as the most active antifungal agent (pMICca and pMICan = 1.93. The results of QSAR studies demonstrated that antibacterial, antifungal and overall antimicrobial activities of synthesized propionic acid derivatives were governed by the topological parameters, Kier’s alpha first order shape index (κα1 and valence first order molecular connectivity index (1χv.
Full Text Available Nowadays food preservation, quality maintenance, and safety are major growing concerns of the food industry. It is evident that over time consumers’ demand for natural and safe food products with stringent regulations to prevent food-borne infectious diseases. Antimicrobial packaging which is thought to be a subset of active packaging and controlled release packaging is one such promising technology which effectively impregnates the antimicrobial into the food packaging film material and subsequently delivers it over the stipulated period of time to kill the pathogenic microorganisms affecting food products thereby increasing the shelf life to severe folds. This paper presents a picture of the recent research on antimicrobial agents that are aimed at enhancing and improving food quality and safety by reduction of pathogen growth and extension of shelf life, in a form of a comprehensive review. Examination of the available antimicrobial packaging technologies is also presented along with their significant impact on food safety. This article entails various antimicrobial agents for commercial applications, as well as the difference between the use of antimicrobials under laboratory scale and real time applications. Development of resistance amongst microorganisms is considered as a future implication of antimicrobials with an aim to come up with actual efficacies in extension of shelf life as well as reduction in bacterial growth through the upcoming and promising use of antimicrobials in food packaging for the forthcoming research down the line.
Jan 31, 2012 ... An acetone extract of Loxostylis alata was separated into six fractions based on polarity by a solvent- solvent fractionation procedure and the different fractions were screened for antimicrobial and antioxidant activities. The number of antimicrobial compounds in the carbon tetrachloride (CCl4), chloroform ...
In recent years, silver in form of silver ions, has been gaining importance in the wound management as an effective broad-spectrum antimicrobial agent. Silver has a long history as an antimicrobial agent, especially in the treatment of wounds. Alginates and carboxymethyl (CM) cotton contain carboxyl...
Nov 16, 2009 ... This study was carried out to evaluate the antimicrobial activity of extracts of the leaves and leaf waste discarded in the process of obtaining the hard fibers of Agave sisalana. The antimicrobial activity was determined by the paper disk diffusion method using Gram-positive and Gram-negative bacteria (non-.
Balakrishnan, Indran; Shorten, Robert J
As pathology services become more centralized and automated, the measurement of therapeutic antimicrobial drugs concentrations is increasingly performed in clinical biochemistry or 'blood science' laboratories. This review outlines key groups of antimicrobial agents: aminoglycosides, glycopeptides, antifungal agents and antituberculosis agents, their role in managing infectious diseases, and the reasons why serum concentration measurement is important. © The Author(s) 2016.
Mayaki, Z; Kabo, R; Moutschen, M; Albert, A; Dardenne, N; Sondag, D; Gérard, C
The lack of traceability and monitoring of blood donors and transfused patients constitute a barrier to the most basic rules of haemovigilance and overall good transfusion practices. This study draws up an inventory of knowledge, attitudes and clinical practice of blood prescribers in Niamey. A questionnaire was administered to 180 prescribers of blood products in Niamey in 2011. Questions were related to basic informations on blood transfusion and clinical use of blood. Analyses were performed using SAS 9.3 version. The sample consisted of 180 respondents from several professional categories: 51 physicians (28.33%), 10 medical students (5.56%), 84 nurses (46.67%), 15 anaesthesiologist assistant (8.33%) and 20 midwives (11.11%). Among these, 22.2% received training in blood transfusion safety. Half of the respondents (50.8%) got between 50 and 75% of correct answers, 45.8% got less than 50% correct while 3.35% scored more than 75% correct answers. The overall quality of responses was higher among physicians compared to other prescribers (Ptransfusion safety (Ptransfusion practices is necessary for prescribers of blood products. Accompanying measures to improve transfusion practice must be considered or strengthened through assessments, knowledge update/upgrade (regular, ongoing training) and establishment of active and motivated hospital transfusion committees. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Fröhlich, Samanta E; Zaccolo, Anamaria V; da Silva, Sabrina L C; Mengue, Sotero S
To evaluate quality of life among patients of Family Health Strategy Units and how it relates to the prescribing complexity and to the number of psychotropic medications prescribed, including adjustments for sociodemographic characteristics. Family Health Strategy Units in a municipality in the Brazilian state of Rio Grande do Sul. Cross-sectional study using face-to-face interviews and prescribing analysis among users of Family Health Strategy Units. Patients were recruited by consecutive sampling. Multiple linear regression models were fitted to the different domains of quality of life in the WHOQOL-Bref questionnaire. The response rate for the patients who completed the interview was 97%. The prescribed medication data and sociodemographic characteristics of the sample were included as covariates. Prescribing complexity was analyzed by means of the Medication Regimen Complexity Index. The assumptions in the estimated models were tested and the models were validated. Quality of life among patients of Family Health Strategy Units. At total, 336 patients answered the questionnaire. Through multiple linear regression, it was observed that higher prescribing complexity was associated with significantly low scores in the physical (-2.01, 95% CI = -2.89 to -1.35) and overall (-1.93, 95% CI = -2.81 to -0.99) quality of life domains. Greater amounts of psychotropic medications prescribed were associated with significantly low scores in the physical (-1.02, 95% CI = -1.29 to -0.56), psychological (-2.52, 95% CI = -3.15 to -1.65) and overall (-0.97, 95% CI = -2.06 to -0.33) domains of the interviewees' quality of life. The estimated models were adjusted for the sociodemographic characteristics of the sample and presented good predictive capacity. The evaluated aspects of the prescribed medication (complexity and presence of psychotropic medications) were associated with low scores in the physical, psychological and overall quality of life domains. This may be an intrinsic
Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary
Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use
Denver, Louise; Jensen, Christian; Mees, Inger
a correlation between the students’ perceptions of the lecturers’ general lecturing competence (defined as knowledge of subject and teaching skills) and their perceptions of their English language proficiency (Jensen et al. 2013). In return for their assistance, each lecturer received a feedback sheet on how...... to improve their communicative effectiveness. The feedback was given by experienced tutors of English who had extensive experience of teaching and assessing English in an everyday ELF context. This paper sets out to investigate what sort of recommendations were provided, concentrating on the 24 lecturers...... whose L1 was Danish. An examination of the tutors’ comments showed that they could be divided into two main categories: formal language skills and pragmatic or metadiscursive features. The observations on language features are presented using a slightly adapted version of Lavelle’s (2008) “good...
Jessy Pavón Pérez
the case of children, the elderly and pregnant women. There is a great variety of medications and many of them do not have a definitive view of their safety, so the available information for prescription of drugs in pregnant women is poor. Objective: to assess quality in the rational use of antimicrobials in pregnant women admitted to "Doña Leonor Perez Cabrera" home for pregnant women during the 2007 to 2009 period. Methods: retrospective and descriptive, indication-prescription type study of drug use. The review of medical records allowed the study of social variables such as maternal age, gestational age on admission, occupation, diagnosis requiring the use of antimicrobials, most commonly used form of diagnosis and the most prescribed antimicrobials. Results: through the analysis of the variables and of treatment regimens, it was possible to evaluate the quality of prescribing antimicrobials. The results led to evidence that pregnant women aged 21 to 30, with gestational ages on admission between 21 and 30 weeks and working women predominated. The pathology that primarily motivated the use of antimicrobials was clinically diagnosed vaginal sepsis in almost all the cases and the most prescribed antimicrobials were azithromycin, metronidazole, clotrimazole and nystatin. Conclusions: the prescribing quality was generally adequate, the effectiveness of treatment was good and the rational use of antimicrobials was rated as high and acceptable.
Foucault, Cédric; Brouqui, Philippe
Antimicrobial misuse results in the development of resistance and superbugs. Over recent decades, resistance has been increasing despite continuing efforts to control it, resulting in increased mortality and cost. Many authorities have proposed local, regional and national guidelines to fight against this phenomenon, and the usefulness of these programmes has been evaluated. Multifaceted intervention seems to be the most efficient method to control antimicrobial resistance. Monitoring of bacterial resistance and antibiotic use is essential, and the methodology has now been homogenized. The implementation of guidelines and infection control measures does not control antimicrobial resistance and needs to be reinforced by associated measures. Educational programmes and rotation policies have not been evaluated sufficiently in the literature. Combination antimicrobial therapy is inefficient in controlling antimicrobial resistance.
Charlton, Rachel; Garne, Ester; Wang, Hao
pregnancy were co-prescribed with high-dose folic acid: ranging from 1.0% (CI95 0.3-1.8%) in Emilia Romagna to 33.5% (CI95 28.7-38.4%) in Wales. CONCLUSION: The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co...... and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated. RESULTS: In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy......-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd....
The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated.
Fischer, Melissa A; Keough, Mary Ellen; Baril, Joann L; Saccoccio, Laura; Mazor, Kathleen M; Ladd, Elissa; Von Worley, Ann; Gurwitz, Jerry H
Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs). To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions. Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings. Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings. Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring
Wilkinson, Jill; Carryer, Jenny; Adams, Jeffery
To evaluate the diabetes nurse specialist prescribing project with the aim of determining whether diabetes nurse specialist prescribing is safe and effective and to inform the implementation and extension of registered nurse prescribing. Registered nurses in many countries are able to prescribe medicines, but in New Zealand, prior to the diabetes nurse specialist project, nurse practitioners were the only nurses who could prescribe medicines. New regulations allowed the nurses to prescribe a limited number of prescription medicines. The study was a process and outcome clinical programme evaluation. The project took place between April-September 2011 and involved 12 diabetes nurse specialist in four localities. Quantitative data were collected from clinical records maintained by the diabetes nurse specialist for the project (1274 patients and 3402 prescribing events), from surveys with stakeholders (general practitioners, n = 30; team members, n = 19; and patients, n = 89) and audits from patient notes (n = 117) and prescriptions (n = 227), and qualitative data from interviews with project participants (n = 18) and patients (n = 19). All data were analysed descriptively. Diabetes nurse specialist prescribing was determined to be safe, of high quality and appropriate. It brought important benefits to the effectiveness of specialist diabetes services, was acceptable to patients and was supported by the wider healthcare team. These findings are consistent with the findings reported in the international literature about nurse prescribing in a range of different practice areas. Clarification of the education and competence requirements and resourcing for the ongoing supervision of nurses is recommended if the prescribing model is to be extended. Diabetes nurse specialist prescribing improved access to medicines by providing a more timely service. Nurses felt more satisfied with their work because they could independently provide a complete episode of care
Glenn, Matthew C.; Sohler, Nancy L.; Starrels, Joanna L.; Maradiaga, Jeronimo; Jost, John J.; Arnsten, Julia H.; Cunningham, Chinazo O.
Background Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them to MMT patients not prescribed opioid analgesics. Methods We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012–2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included: patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients’ report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-squared tests, t-tests, and Mann-Whitney U tests. Results Of 611 MMT patients, most reported chronic pain (62.0%), HCV infection (52.1%), and currently using illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report HIV infection (aOR=1.6, 95% CI: 1.1–2.3) and chronic pain (aOR=7.6, 95% CI: 4.6–12.6). Conclusion Among MMT patients primarily in three Bronx clinics, nearly one-third reported taking prescribed opioid analgesics. Compared to patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients. PMID:26731299
Glenn, Matthew C; Sohler, Nancy L; Starrels, Joanna L; Maradiaga, Jeronimo; Jost, John J; Arnsten, Julia H; Cunningham, Chinazo O
Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them with MMT patients not prescribed opioid analgesics. We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012 to 2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients' report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-square tests, t tests, and Mann-Whitney U tests. Of 611 MMT patients, most reported chronic pain (62.0%), hepatitis C virus (HCV) infection (52.1%), and current use of illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report human immunodeficiency virus (HIV) infection (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1-2.3) and chronic pain (aOR = 7.6, 95% CI: 4.6-12.6). Among MMT patients primarily in 3 Bronx clinics, nearly one third reported taking prescribed opioid analgesics. Compared with patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients.
Hyldgaard, Morten; Sutherland, Duncan S; Sundh, Maria; Mygind, Tina; Meyer, Rikke Louise
Monoglyceride esters of fatty acids occur naturally and encompass a broad spectrum of antimicrobial activity. Monocaprylate is generally regarded as safe (GRAS) and can function both as an emulsifier and as a preservative in food. However, knowledge about its mode of action is lacking. The aim of this study was therefore to elucidate the mechanism behind monocaprylate's antimicrobial effect. The cause of cell death in Escherichia coli, Staphylococcus xylosus, and Zygosaccharomyces bailii was investigated by examining monocaprylate's effect on cell structure, membrane integrity, and its interaction with model membranes. Changes in cell structure were visible by atomic force microscopy (AFM), and propidium iodide staining showed membrane disruption, indicating the membrane as a site of action. This indication was confirmed by measuring calcein leakage from membrane vesicles exposed to monocaprylate. AFM imaging of supported lipid bilayers visualized the integration of monocaprylate into the liquid disordered, and not the solid ordered, phase of the membrane. The integration of monocaprylate was confirmed by quartz crystal microbalance measurements, showing an abrupt increase in mass and hydration of the membrane after exposure to monocaprylate above a threshold concentration. We hypothesize that monocaprylate destabilizes membranes by increasing membrane fluidity and the number of phase boundary defects. The sensitivity of cells to monocaprylate will therefore depend on the lipid composition, fluidity, and curvature of the membrane.
Ioannis L. Liakos
Full Text Available Polylactic acid was combined with lemongrass essential oil (EO to produce functional nanocapsules (NCs. The obtained polylactic acid nanoparticles showed antimicrobial activity both with and without the presence of lemongrass oil; however, the presence of EO improved the activity of the NCs. The presence of lemongrass assisted the formation of well-separated NCs and also provided enhanced antimicrobial properties, since lemongrass is known for its antimicrobial character. Fluorescence microscopy was used to optically observe the nanoparticles and NCs and revealed the attachment of lemongrass oil with the polylactic acid NCs. Dynamic light scattering was used to determine their size. UV absorption was used to determine the exact amount of lemongrass oil found in the polylactic acid—lemongrass oil NCs, which was important for understanding the minimum inhibitory concentration for the antimicrobial experiments. A series of clinically important microbial species were used in the study and the obtained NCs proved to have very good antimicrobial properties against all tested strains. Such NCs can be used for the design of ecological strategies, based on natural alternatives, which may be efficient against severe infections, including those that involve resistant pathogens and biofilms or those with difficult to reach localization.
Khangembam Victoria Chanu
Full Text Available Antimicrobial peptides (AMPs are highly conserved components of the innate immune system found among all classes of life. Buffalo (Bubalus bubalis, an important livestock for milk and meat production, is known to have a better resistance to many diseases as compared to cattle. They are found to express many AMPs such as defensins, cathelicidins, and hepcidin which play an important role in neutralizing the invading pathogens. Buffalo AMPs exhibit broad-spectrum antimicrobial activity against both Gram-positive and Gram-negative bacteria. Similar to its natural form, synthetic analogs of buffalo AMPs are also antimicrobial against bacteria and even fungus making them a good target for the development of therapeutic antimicrobials. In addition to its antimicrobial effect, AMPs have been demonstrated to have a number of immunomodulatory functions, and their genes are responsive to infections. Further, induction of their gene expression by external factors may help in preventing infectious diseases. This review briefly discusses the AMPs of buffalo identified to date and their possible role in innate immunity.
Chanu, Khangembam Victoria; Thakuria, Dimpal; Kumar, Satish
Antimicrobial peptides (AMPs) are highly conserved components of the innate immune system found among all classes of life. Buffalo ( Bubalus bubalis ), an important livestock for milk and meat production, is known to have a better resistance to many diseases as compared to cattle. They are found to express many AMPs such as defensins, cathelicidins, and hepcidin which play an important role in neutralizing the invading pathogens. Buffalo AMPs exhibit broad-spectrum antimicrobial activity against both Gram-positive and Gram-negative bacteria. Similar to its natural form, synthetic analogs of buffalo AMPs are also antimicrobial against bacteria and even fungus making them a good target for the development of therapeutic antimicrobials. In addition to its antimicrobial effect, AMPs have been demonstrated to have a number of immunomodulatory functions, and their genes are responsive to infections. Further, induction of their gene expression by external factors may help in preventing infectious diseases. This review briefly discusses the AMPs of buffalo identified to date and their possible role in innate immunity.
Alan P. Johnson
Full Text Available Antibiotic use is a major driver for the emergence and spread of antibiotic resistance. Antimicrobial stewardship programmes aim to improve antibiotic prescribing with the objectives of optimizing clinical outcomes while at the same time minimizing unintended consequences such as adverse effects and the selection of antibiotic resistance. In 2013, a five-year national strategy for tackling antimicrobial resistance was published in the UK. The overarching goal of the strategy is to slow the development and spread of resistance and to this end it has three strategic aims, namely to improve knowledge and understanding of resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. This article reviews the antimicrobial stewardship activities included in the strategy and describes their implementation and evaluation.
Melton, Brittany L; Zillich, Alan J; Russell, Scott A; Weiner, Michael; McManus, M Sue; Spina, Jeffrey R; Russ, Alissa L
Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts. Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors. There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P = .001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P = .012 and P = .008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently. Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment. Copyright © 2015 Elsevier Inc. All rights reserved.
Terry, David; Sinclair, Anthony
Prescribing for children at the primary-secondary/tertiary care interface is more complex than that for adults. Children often need unlicensed medicines and there may be issues over who will prescribe such items. There may also be issues in obtaining unlicensed medicines (specials) from community pharmacists. This article reviews the current arrangements in England relating to prescribing for children at the interfaces of care and describes the following: prescribing responsibility, shared-care arrangements, medication continuity on admission and discharge from hospital, unlicensed medicines, continuing-care medication arrangements and highlights potential service changes to maintain access to medicines for children.
Theresa L. Charrois
Full Text Available Several jurisdictions throughout the world, such as the UK and Canada, now have independent prescribing by pharmacists. In some areas of Canada, initial access prescribing can be done by pharmacists. In contrast, Australian pharmacists have no ability to prescribe either in a supplementary or independent model. Considerable research has been completed regarding attitudes towards pharmacist prescribing from the perspective of health care professionals, however currently no literature exists regarding pharmacy student views on prescribing. The primary objective of this study is to examine pharmacy student’s opinions and attitudes towards pharmacist prescribing in two different settings. Focus groups were conducted with selected students from two universities (one in Canada and one in Australia. Content analysis was conducted. Four main themes were identified: benefits, fears, needs and pharmacist roles. Students from the Australian University were more accepting of the role of supplementary prescribing. In contrast, the Canadian students felt that independent prescribing was moving the profession in the right direction. There were a number of similarities with the two groups with regards to benefits and fears. Although the two cohorts differed in terms of their beliefs on many aspects of prescribing, there were similarities in terms of fears of physician backlash and blurring of professional roles.
Patil, Vishakha; Mali, Rohini; Mali, Amita
Periodontitis is an infectious disease with marked inflammatory response, leading to destruction of underlying tissues. The aim of periodontal therapy is to eradicate the pathogens associated with the disease and attain periodontal health. This is achieved by non-surgical and surgical therapy; however, mechanical debridement and topical application of antiseptics may not be helpful in all cases. In such cases, adjunctive systemic antibiotic therapy remains the treatment of choice. It can reach micro-organisms at the base of the deep periodontal pockets and furcation areas via serum, and also affect organisms residing within gingival epithelium and connective tissue. Before advising any anti-microbial agent, it is necessary to have knowledge of that agent. The aim of this review article is to provide basic details of each systemic anti-microbial agent used in periodontal therapy. The points discussed are its mode of action, susceptible periodontal pathogens, dosage, its use in treatment of periodontal disease, and mechanism of bacterial resistance to each anti-microbial agent. It might be of some help while prescribing these drugs.
Full Text Available Introduction In India, antimicrobial resistance (AMR is a serious public health problem. While some official policies have been formulated, they are not comprehensive and their enforcement is not monitored or regulated. This paper discusses the success achieved by the Scottish Antimicrobial Prescribing Group (SAPG and derives lessons relevant for AMR policies in India. Methods This study involved secondary data review and discussions with SAPG representatives. Results India is the largest consumer of antibiotics for human health (10.7 units/person and this consumption is steadily increasing. Irrational use, fixed‐dose combinations and growing antibiotic use in livestock have resulted in newer drug‐resistant pathogens. In 2008, the Scottish government initiated the SAPG that has achieved nationwide success in AMR control. The enormous success achieved by SAPG has demonstrated that this delivery model is effective in addressing AMR and can also be used in India, with country‐specific modifications. Conclusions In India, strong political and stakeholder support is required for a pragmatic one‐health approach to antimicrobial governance that would involve the interplay between agriculture, livestock and pharmaceutical industries. Project management, quality improvement, information management and performance assessment through accountability measures are essential. These can be coordinated nationally and implemented locally through existing structures and institutes. This needs to be supported by a powerful clinical network and underpinned by robust educational support that is dynamic to meet the needs of local healthcare professionals and general population.
Jørgensen, Lars Christian; Friis Christensen, Sarah; Cordoba Currea, Gloria; Llor, Carl; Bjerrum, Lars
To assess the potential overprescribing in patients with acute rhinosinusitis across six countries with different antibiotic prescribing rates and different prevalence of antibiotic resistance. A cross-sectional study including GPs from two Nordic countries, two Baltic countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) during three weeks in January 2008 as part of the EU-funded project "Health Alliance for Prudent Prescribing, Yield And Use of antimicrobial Drugs In the Treatment of respiratory tract infections" (HAPPY AUDIT). Use of antibiotics for acute rhinosinusitis based on the recommendations in the European Position Paper on Rhinosinusitis and Nasal Polyps 2007 (EP3OS). In total, 618 participating GPs registered 33 273 patients with RTI of whom 1150 (3.46%) were considered to have acute rhinosinusitis. Over 50% of the patients with acute rhinosinusitis had symptoms for overprescribing) and 23% had symptoms overprescribing). A considerable number of patients with symptoms of acute rhinosinusitis were not managed according to European recommendations (EP3OS guidelines). To prevent overprescribing, efforts should be made to implement the recommendations in daily practice.
Forster, Rose; Ng, Diana; Upton, Arlo; Franklin, Rick; Thomas, Mark
The relentless emergence and spread of strains of Neisseria gonorrhoeae that are resistant to many antimicrobial agents has led to frequent changes in treatment guidelines, with a consequent risk that prescribers may not be aware of current guidelines. To determine the proportion of patients with gonorrhoea who were treated with a regimen consistent with the New Zealand Sexual Health Society (NZSHS) guidelines. We audited the treatment given to adult patients with laboratory-proven gonorrhoea in Auckland, New Zealand, during the first 6 months of 2015. Treatment compliant with the current NZSHS guidelines was administered in only 65% (458/706) episodes overall. Guideline-compliant treatment was much more likely to be prescribed for patients who presented to a sexual health clinic (89%) than for patients who presented to either a general practice or other community clinic (52%) or to a hospital (56%) (P Auckland region. Improved compliance with treatment guidelines, particularly in patients who present either to general practice or to hospitals, is necessary to maintain the efficacy of current treatment regimens. © 2017 Royal Australasian College of Physicians.
Ginzburg, Regina; Barr, Wendy B; Harris, Marissa; Munshi, Shibani
The effect of a weight-based prescribing method within the electronic health record (EHR) on the rate of prescribing errors was studied. A report was generated listing all patients who received a prescription by a clinic provider for either infants' or children's acetaminophen or ibuprofen from January 1 to July 28, 2005 (preintervention group) and from July 29 to December 30, 2005 (postintervention group). Patients were included if they were 12 years old or younger, had a prescription ordered for infants' or children's acetaminophen or ibuprofen within the EHR, and had a weight documented in the chart on the visit day. The dosing range for acetaminophen was 10-15 mg/kg every four to six hours as needed, and the regimen for ibuprofen was 5-10 mg/kg every six to eight hours as needed. Dosing errors were defined as overdosage of strength, overdosage of regimen, underdosage of strength, under-dosage of regimen, and incomprehensible dosing directions. Totals of 316 and 224 patient visits were analyzed from the preintervention and postintervention groups, respectively. Significantly more medication errors were found in the preintervention group than in the postintervention group (103 versus 46, p = 0.002). Significantly fewer strength overdosing errors occurred in the postintervention group (8.9% versus 4.0%, p = 0.028). An automated weight-based dosing calculator integrated into an EHR system in the outpatient setting significantly reduced medication prescribing errors for antipyretics prescribed to pediatric patients. This effect appeared to be strongest for reducing overdose errors.
Anđelković Petar M.
Full Text Available Nowadays, in Serbia, it's fashionable to talk about the fight against corruption. 'The spook of fighting corruption circulates through Serbia'. Is there a chance the fight will win the way it's lead? We are convinced there isn't. Since corruption is a process caused by 'rotten' characters, the anti-corruption fight must also be a process of rehabilitation and creation of the right character - the good householder's character. In this process each aspect is important (legal, economic… but for permanent eradication of the evil or the sin of corruption the most important segment is educational because it creates the genuine moral and spiritual value in a hardworking and long-term manner. In 'the period rich in disasters' (Tacitus, in the hard circumstances lasting too long, which would not be endured by any other nation, many values, material and moral have inevitably failed. A Serb has endured but also has worn out and lost many virtues, particularly the spirit of a good householder. Mutual hatred seems to be stronger than love, distrust greater than confidence, doubt stronger than faith, and robbery and spoils stronger than charity and solidarity. We need to restore the balance and despite the hardships, and because of them, we must foster mutual love, harmony, unwavering patriotism and value of domesticity. In other words, we must ensure victory of virtue over vice that threatens us from everywhere, both from inside and outside. At the time of 'nuclear techniques and jungle ethics' (Justin Popović the dispersed home of the Serbs can be turned again into a proper home only if we 'have the spirit of domesticity reigning' (Nikolaj Velimirović. To be a successful householder is to be responsible in relation to the state, institution, household that he was entrusted with: add, not to waste, create not to destroy, enlarge rather than reduce, preserve not to destroy a household. 'Do not steal from a country, it was overpaid. Your brothers
Lipsky, Benjamin A; Dryden, Matthew; Gottrup, Finn; Nathwani, Dilip; Seaton, Ronald Andrew; Stryja, Jan
With the growing global problem of antibiotic resistance it is crucial that clinicians use antibiotics wisely, which largely means following the principles of antimicrobial stewardship (AMS). Treatment of various types of wounds is one of the more common reasons for prescribing antibiotics. This guidance document is aimed at providing clinicians an understanding of: the basic principles of why AMS is important in caring for patients with infected wounds; who should be involved in AMS; and how to conduct AMS for patients with infected wounds. We assembled a group of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document. All open wounds will be colonized with bacteria, but antibiotic therapy is only required for those that are clinically infected. Therapy is usually empirical to start, but definitive therapy should be based on results of appropriately collected specimens for culture. When prescribed, it should be as narrowly focused, and administered for the shortest duration, as possible. AMS teams should be interdisciplinary, especially including specialists in infection and pharmacy, with input from administrative personnel, the treating clinicians and their patients. Available evidence is limited, but suggests that applying principles of AMS to the care of patients with wounds should help to reduce the unnecessary use of systemic or topical antibiotic therapy and ensure the safest and most clinically effective therapy for infected wounds. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
Taha, H.M.; Rasheedy, D.; Mahmoud, A.H.
Background: Elderly patients are prone to respiratory tract infections (RTIs) both; acute bronchitis and pneumonia. A large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients. There is an increased need to decrease excess antibiotic use in elderly to minimize antibiotic resistance. Objective: To describe patterns of antimicrobial use for respiratory tract infections (RTIs) among elderly Patients and methods: A cross sectional study was conducted on one hundred elderly patients, aged > 60 years, both males and females to describe patterns of antimicrobial use for respiratory tract infections (RTIs) among elderly patients. RTIs, categorized as acute bronchitis, and pneumonia, were studied for appropriateness of antimicrobial use, type of antibiotics used, and factors associated with their use. We rated antibiotic use as appropriate (when an effective drug was used), inappropriate (when a more effective drug was indicated), or unjustified (when use of any antimicrobial was not indicated). Results: Of 100 patients with RTI, overall treatment was appropriate in 79% of episodes, inappropriate in 9%, and unjustified in 12%. For acute bronchitis, treatment was appropriate in 85% and unjustified in 15% of cases. For pneumonia, treatment was appropriate in 55% of episodes. Among the most commonly used antimicrobials, B.Lactam + macrolides their use were unjustified in 41% of cases. There were statistical significant differences in the patterns of antibiotic use when stratified by age, gender, and co- morbid conditions including chronic obstructive pulmonary disease. Conclusion: Antimicrobials are unjustifiably used for 12% of RTIs and 15% of cases of acute bronchitis, thus suggesting a need for programs to improve antibiotic prescribing at hospitals.
Full Text Available Background: To prevent medication errors in prescribing, one needs to know their types and relative occurrence. Such errors are a great cause of concern as they have the potential to cause patient harm. The aim of this study was to determine the nature and types of medication prescribing errors in an Indian setting.Methods: The medication errors were analyzed in a prospective observational study conducted in 3 medical wards of a public teaching hospital in India. The medication errors were analyzed by means of Micromedex Drug-Reax database.Results: Out of 312 patients, only 304 were included in the study. Of the 304 cases, 103 (34% cases had at least one error. The total number of errors found was 157. The drug-drug interactions were the most frequently (68.2% occurring type of error, which was followed by incorrect dosing interval (12% and dosing errors (9.5%. The medication classes involved most were antimicrobial agents (29.4%, cardiovascular agents (15.4%, GI agents (8.6% and CNS agents (8.2%. The moderate errors contributed maximum (61.8% to the total errors when compared to the major (25.5% and minor (12.7% errors. The results showed that the number of errors increases with age and number of medicines prescribed.Conclusion: The results point to the establishment of medication error reporting at each hospital and to share the data with other hospitals. The role of clinical pharmacist in this situation appears to be a strong intervention; and the clinical pharmacist, initially, could confine to identification of the medication errors.
Moro, Maria Luisa; Marchi, Massimiliano; Gagliotti, Carlo; Di Mario, Simona; Resi, Davide
knowledge can also induce inappropriate prescription. The value of this study is that it simultaneously explored determinants of antimicrobial prescribing in an entire region involving both professionals and parents. PMID:19895678
Zhu, Yimin; Wang, Ying; Sha, Lin; Zhao, Jiao
The magnesium-based antimicrobial polyethylene terephthalate (PET) masterbatch (MAPM) was extruded from twin screw extruder by melting-and-mixing method, using magnesium-based antimicrobial agent (MAA) as the functional material for the first time. The magnesium-based antimicrobial fabric (MAPF) was prepared using MAPM and pure PET resin by high-speed melt-spinning technology and weaving technology for the first time. The materials used in this work were healthy to human body and friendly to environment. The characteristics of MAA, MAPM and MAPF were studied by X-ray diffraction (XRD), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). When the MAPM (MAA) content reached to 25 wt.% (5 wt.%) in MAPF, the MAA had excellent dispersion and compatibility in MAPF, and the MAPF had good physico-mechanical properties. Then the MAPF presented excellent spinnability and antimicrobial property against Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Candida albicans (C. albicans) and Aspergillus niger (A. niger), with pretty good laundering durability.
Pardon, Bart; Catry, Boudewijn; Dewulf, Jeroen; Persoons, Davy; Hostens, Miel; De Bleecker, Koen; Deprez, Piet
To document and quantify drug use in white veal calves, an intensive livestock production system where multidrug resistance is abundantly present. Drug consumption data were prospectively collected on 15 white veal production cohorts (n = 5853 calves) in Belgium (2007-09). Treatment incidences (TIs) based on animal defined daily dose (ADD), prescribed daily dose (PDD) and used daily dose (UDD) were calculated. Risk factors were identified by linear regression. The average TI(ADD) of antimicrobial treatments was 416.8 ADD per 1000 animals at risk. Predominantly, oral group antimicrobial treatments were used (95.8%). Of the oral group antimicrobial treatments, 12% and 88% were used for prophylactic or metaphylactic indications, respectively. The main indication for group and individual drug use was respiratory disease. The most frequently used antimicrobials (group treatments) were oxytetracycline (23.7%), amoxicillin (18.5%), tylosin (17.2%) and colistin (15.2%). Deviations from the leaflet dosage recommendations were frequently encountered, with 43.7% of the group treatments underdosed (often oxytetracycline and tylosin to treat dysbacteriosis). In 33.3% of the oral antimicrobial group treatments a combination of two antimicrobial preparations was used. Smaller integrations used more antimicrobials in group treatments than larger ones (P combines all steps of the production chain by having its own feed plant and slaughterhouse and by placing its calves in veal herds owned by producers that fatten these calves for this integration on contract. Producers used higher dosages than prescribed by the veterinarian in cohorts with a single caretaker (P < 0.01). The present study provided detailed information on the intensive antimicrobial use in the white veal industry. Reduction can only be achieved by reducing the number of oral group treatments.
Resistance of human and food spoilage pathogens to antimicrobial agents and the side effects of chemical agents or preservative for human is caused for finding natural new antimicrobial agents, especially among the medicinal plants. This review introduces the methods that are used for antimicrobial evaluations and synergistic activities and the antimicrobial potential of some Iranian medicinal plants.
Jensen, V F; Sommer, H M; Struve, T; Clausen, J; Chriél, M
The American mink (Neovison vison) is used for commercial fur production in Denmark. In recent years, antimicrobial prescription for Danish mink has been increasing. In this study, the patterns and trends in antimicrobial use in mink were described and a multi-variable variance analysis was carried out with the objective of identifying risk factors for antimicrobial use on herd level. The study was based on register data for 2007-2012. Information on antimicrobial use was obtained from the national database VetStat, monitoring all medicinal products used for animals on prescription level. Data on microbiological feed quality was obtained from the Voluntary Feed Control under the Mink producers Organization, and data on herd size and the relation between farm and feed producer was obtained from the registers at Kopenhagen Fur, based on yearly reporting from the mink producers. Descriptive analysis showed a clear significant effect of season on antimicrobial use, with a peak in "treatment proportions", TP (defined daily doses per kg biomass-days) in May, around the time of whelping, and a high level in the following months. In autumn, a minor peak in antimicrobial use occurred throughout the study period. From 2007 to 2011, a 102% increase in annual antimicrobial TP was noted; on herd level, the increase was associated with an increasing frequency of prescription, and a decrease in the amounts prescribed in months with prescription. A binomial model showed that on herd level, the annual number of months with antimicrobial prescription was significantly (p<0.01) affected by feed producer, veterinarian, disease (specific laboratory diagnosis) infection, herd size and year, with an interaction between feed producer and year. A log-normal model showed that in months with antimicrobial use, the TP on herd level was significantly (p<0.001) affected by year, month (season), feed producer, feed quality score, veterinarian, herd size and laboratory confirmed diagnosis of
Diploma thesis topic deals with air transport of dangerous goods. In the beginning part it describes air cargo transportation itself as well as the main characteristics. Thesis introduces organizations involved in international transport of dangerous goods. Next part of diploma thesis reveals project analysis of air transportation of dangerous goods in respect of IATA Dangerous Goods regulations and procedures. Thesis also covers introduction to air transportation of dangerous goods in specif...
It is common to distinguish between attributive and predicative goodness. There are good reasons to think that artistic value is a kind of attributive goodness. Surprisingly, however, much debate in philosophical aesthetics has proceeded as though artistic value is a kind of predicative goodness. As I shall argue, recognising that artistic value is attributive goodness has important consequences for a number of debates in aesthetics.
Carpenter, Leah R; Smith, Teresa M; Stern, Katherine; Boyd, Lisa Weissenburger-Moser; Rasmussen, Cristy Geno; Schaffer, Kelly; Shuell, Julie; Broussard, Karen; Yaroch, Amy L
Innovative approaches to childhood obesity prevention are warranted in early care and education (ECE) settings, since intervening early among youth is recommended to promote and maintain healthy behaviors. The objective of the Meals for Good pilot was to explore feasibility of implementing a food bank-based catering model to ECE programs to provide more nutritious meals, compared to meals brought from home (a parent-prepared model). In 2014-2015, a 12-month project was implemented by a food bank in central Florida in four privately-owned ECE programs. An explanatory sequential design of a mixed-methods evaluation approach was utilized, including a pre-post menu analysis comparing parent-prepared meals to the catered meals, and stakeholder interviews to determine benefits and barriers. The menu analysis of lunches showed daily reductions in calories, fat, and saturated fat, but an increase in sodium in catered meals when compared to parent-prepared meals. Interviews with ECE directors, teachers, parents, and food bank project staff, identified several benefits of the catered meals, including healthfulness of meals, convenience to parents, and the ECE program's ability to market this meal service. Barriers of the catered meals included the increased cost to parents, transportation and delivery logistics, and change from a 5 to a 2-week menu cycle during summer food service. This pilot demonstrated potential feasibility of a food bank-ECE program partnership, by capitalizing on the food bank's existing facilities and culinary programming, and interest in implementing strategies focused on younger children. The food bank has since leveraged lessons learned and expanded to additional ECE programs.
Whitmire, Alexandra; Johnston, Smith; Lockley, Steven
The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.
Jasmina M. Glamočlija
Full Text Available The present study was undertaken to investigate the chemical composition and effectiveness of the essential oil isolated from Echinophora spinosa on different bacterial and fungal species. Chemical analysis (GC/MS showed that δ³-carene (60,86 %, α-phellandrene (7,12%, p-cymene (6,22 %, myrcene (4,82 % and β-phellandrene (2,73 % were dominant components in this oil. Essential oil tested showed good antimicrobial activity. Antimicrobial potential of this oil was higher than potential of commercial antimicrobial drugs tested, streptomycin, bifonozole and ketoconazole.
Sridhara, Ajjanna M.; Gopinath, Vadiraj S.; Bose, Prosenjit; Goud, Sanath Kumar [Advinus Therapeutics Pvt. Ltd., Bangalore (India); Reddy, Kallam R. Venugopala, E-mail: email@example.com [Advinus Therapeutics Pvt. Ltd., Bangalore (India). Dept. of Studies in Industrial Chemistry; Keshavayya, Jathi [Advinus Therapeutics Pvt. Ltd., Bangalore (India). Dept. of Studies in Chemistry; Ambika, Dasannana Malige S. [Kuvempu University, Jnana Sahyadri, Karnataka (India). Dept. of Biochemistry; Peethambar, Sanenahalli K. [Kuvempu University, Jnana Sahyadri, Karnataka (India). Dept. of Plant Pathology
A series of some new 3-isoxazoline substituted methyl-3-methoxy-2-(4-oxo-3,4- dihydrophthalazine-1-yl)prop-2-enoate derivatives were designed and synthesized from methyl- (4-oxo-3,4-dihydrophthalazine-1-yl)acetate, which in turn was prepared from phthalic anhydride. The structures of synthesized new compounds were characterized by spectral data and studied for their antimicrobial activities and cytotoxicity. Several of these compounds showed good antimicrobial activity (author)
Why the need for antimicrobials in dental care? Mechanical control of dental plaque is not sufficient for all individuals, since diseases like caries and gingivitis which should be preventable by good mechanical oral hygiene measures are nevertheless all too prevalent in our society. If we accept that dental plaque microbes give rise to halitosis, caries, gingivitis and periodontal disease, it seems obvious to try antimicrobial agents in an attempt to combat them. However, it is difficult to ...
Cifuentes-D, Marcela; Silva, Francisco; García, Patricia; Bello, Helia; Briceño, Isabel; Calvo-A, Mario; Labarca, Jaime
Bacteria antimicrobial resistance is an uncontrolled public health problem that progressively increases its magnitude and complexity. The Grupo Colaborativo de Resistencia, formed by a join of experts that represent 39 Chilean health institutions has been concerned with bacteria antimicrobial susceptibility in our country since 2008. In this document we present in vitro bacterial susceptibility accumulated during year 2012 belonging to 28 national health institutions that represent about 36% of hospital discharges in Chile. We consider of major importance to report periodically bacteria susceptibility so to keep the medical community updated to achieve target the empirical antimicrobial therapies and the control measures and prevention of the dissemination of multiresistant strains.
Ana Maria Carmona-Ribeiro
Full Text Available Peptides in general hold much promise as a major ingredient in novel supramolecular assemblies. They may become essential in vaccine design, antimicrobial chemotherapy, cancer immunotherapy, food preservation, organs transplants, design of novel materials for dentistry, formulations against diabetes and other important strategical applications. This review discusses how novel formulations may improve the therapeutic index of antimicrobial peptides by protecting their activity and improving their bioavailability. The diversity of novel formulations using lipids, liposomes, nanoparticles, polymers, micelles, etc., within the limits of nanotechnology may also provide novel applications going beyond antimicrobial chemotherapy.
Hopkins, Heidi; Bruxvoort, Katia J; Cairns, Matthew E; Chandler, Clare I R; Leurent, Baptiste; Ansah, Evelyn K; Baiden, Frank; Baltzell, Kimberly A; Björkman, Anders; Burchett, Helen E D; Clarke, Siân E; DiLiberto, Deborah D; Elfving, Kristina; Goodman, Catherine; Hansen, Kristian S; Kachur, S Patrick; Lal, Sham; Lalloo, David G; Leslie, Toby; Magnussen, Pascal; Jefferies, Lindsay Mangham; Mårtensson, Andreas; Mayan, Ismail; Mbonye, Anthony K; Msellem, Mwinyi I; Onwujekwe, Obinna E; Owusu-Agyei, Seth; Reyburn, Hugh; Rowland, Mark W; Shakely, Delér; Vestergaard, Lasse S; Webster, Jayne; Wiseman, Virginia L; Yeung, Shunmay; Schellenberg, David; Staedke, Sarah G; Whitty, Christopher J M
Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. Participants 522 480 children and adults with acute febrile illness. Interventions Rapid diagnostic tests for malaria. Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive
Keller, Sara C; Dzintars, Kathryn; Gorski, Lisa A; Williams, Deborah; Cosgrove, Sara E
Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home-based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home-based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. We performed a prospective cohort study of patients requiring home-based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [aIRR]: 1.63, 95% confidence interval [CI]: 0.89-2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin (aIRR: 2.32 [95% CI: 1.20-4.46] and 4.45 [95% CI: 1.02-19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications (aIRR: 2.13, 95% CI: 1.09-4.19), as were midline catheters (aIRR: 9.44, 95% CI: 2.12-41.97). Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants. © 2018 Pharmacotherapy Publications, Inc.
There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing.
We provide a brief guide to the diagnosis and treatment of common mental disorders in people living with HIV/AIDS, including: prescribing psychotropics in HIV; neuropsychiatric side-effects of ARVs and other medications commonly prescribed in HIV; and the diagnosis and treatment of depression, anxiety, psychosis, ...
Prescriptions were considered to conform to the new antimalarial policy if artemether-lumefantrine was prescribed for uncomplicated malaria or quinine for treatment failure or complicated malaria. Results: The most frequently prescribed antimalarials for uncomplicated and complicated malaria were artemetherlumefantrine ...
Virginia L. McDaniel; James M. Guldin; Roger W. Perry
While prescribed fire is essential to maintaining numerous plant communities, fine particles produced in smoke can impair human health and reduce visibility in scenic areas. The Arkansas Smoke Management Program was established to mitigate the impacts of smoke from prescribed fires. This program uses fuel loading and consumption estimates from standard fire-behavior...
Thomas M. Schuler; Melissa Thomas Van-Gundy; Mary B. Adams; W. Mark. Ford
Pre- and post-treatment seed-bank characteristics of woody species were compared after two prescribed fires in a mesic mixed-oak forest in the central Appalachians. Nineteen woody species were identified from soil samples. Mean species richness declined but evenness did not after prescribed burning. The...
Migraine affects between 5.15% of males and 13,5-31% of females in South Africa. Little is known about the prescribing patterns of anti-migraine drugs in South Africa. The aim of the study was to investigate the prescribing of drugs for the treatment of migraine (ATC Group NOZC), with specific emphasis on sumatriptan, in a ...
Erik Berg; Barry Clinton; Jim Vose; Wayne. Swank
Prescribed fire has proven effective in controlling vegetative competition of oak regeneration across many sites in the southeastern US most fire investigations have been performed in the Piedmont and Coastal Plain. Land managers lake definitive knowledge on how to use prescribed fire to improve long-term oak regeneration success in the southern Appalachians. Several...
Foreignising as translation strategy in prescribed books for second-language learners. ... This is a prescribed book for Afrikaans second-language learners in Grade 11 in the Limpopo Province. The story ... The translation is placed even more firmly within this mould because yet another language and culture come into play.
Results:A total of 1486 drugs encounters were prescribed from both adult and paediatric outpatient wings in 2015. The average number of drugs per prescription was. 2.5(SD±1.58), with a range of 1 to 7 drugs per prescription. The antibiotic and injection-prescribing rate was 53.7% and 11.8%respectively. Generic ...
Denig, P; Witteman, CLM
Background: This study describes cognitive processes of doctors who are deciding on the treatment for a patient. This helps to uncover how prescribing decisions could benefit from (computerised) support. Methods: While thinking aloud, 61 general practitioners made prescribing decisions for five
and soluble insulin aspartame and protamine) together accounted for 63% of all the insulin prescribed, and 67% of the total cost of prescribed insulin. Almost 39% (n = 62 717) of the “combination therapy” prescriptions were for a sulfonylurea in combination with a biguanide plus at least one other antidiabetic product.
... 32 mg caffeine and 150 mg meprobamate. The originator product constituted 3.72% of prescribing frequency (average cost: R30.42) compared with 70.63% for the most popular generic (average cost: R11.65). Conclusions: Prescribers should be conscious of the benefits and risks of the active ingredient combinations.
Background: Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing ...
Prescribing Patterns and Inappropriate Use of Medications in Elderly Outpatients in a Tertiary Hospital in Nigeria. ... Tropical Journal of Pharmaceutical Research ... Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary ...
Background: High dose antipsychotic prescribing is common in psychiatric care, despite a lack of its benefit from research evidence. While several studies have explored the prevalence and factors associated with high dose antipsychotic prescribing, no such report has emanated from a developing country like Nigeria.
Meloodilist drum ǹ̀bassi viljelevatest välismaa plaadifirmadest Good Looking Recordsist ja Looking Good Recordsist, mida juhib LTJ Bukem ja temaga koostööd tegevatest muusikutest Blame, Seba, Tayla, MC Conrad, Artemis
Bijnen, E.M.E. van; Paget, W.J.; Heijer, C.D.J. den; Stobberingh, E.E.; Bruggeman, C.A.; Schellevis, F.G.
Background: Over 90% of antibiotics for human use in Europe are prescribed in primary care. We assessed the congruence between primary care treatment guidelines for skin infections and commensal Staphylococcus aureus (S. aureus) antimicrobial resistance levels in community-dwelling persons. Methods:
van Bijnen, E.M.E.; Paget, W.J.; den Heijer, C.D.J.; Stobberingh, E.E.; Bruggeman, C.A.; Schellevis, F.G.
Background: Over 90% of antibiotics for human use in Europe are prescribed in primary care. We assessed the congruence between primary care treatment guidelines for skin infections and commensal Staphylococcus aureus (S. aureus) antimicrobial resistance levels in community-dwelling persons. Methods:
Sibley, Andrew; Latter, Sue; Richard, Claude
Aim. This paper is a report of a study to identify the content of, and participation in, medicine discussion between nurse prescribers and people with diabetes in England. Background. Diabetes affects 246 million people worldwide and effective management of medicines is an essential component...... of successful disease control. There are now over 20,000 nurse independent prescribers in the UK, many of whom frequently prescribe for people with diabetes. With this responsibility comes a challenge to effectively communicate with patients about medicines. National guidelines on medicines communication have...... recently been issued, but the extent to which nurse prescribers are facilitating effective medicine-taking in diabetes remains unknown. Methods. A purposive sample of 20 nurse prescribers working with diabetes patients audio-recorded 59 of their routine consultations and a descriptive analysis...
Ylirisku, Salu; Arvola, Mattias
This chapter explores the philosopher and logician Georg Henrik von Wright’s metaethical treatise of the varieties of goodness in the context of design. von Wright investigated the use of notion of ‘good’ in language, and he identified six kinds of goodness: namely utilitarian goodness, instrumen......This chapter explores the philosopher and logician Georg Henrik von Wright’s metaethical treatise of the varieties of goodness in the context of design. von Wright investigated the use of notion of ‘good’ in language, and he identified six kinds of goodness: namely utilitarian goodness...
Keen, Patricia L; Montforts, M. H. M. M
... or antibiotic resistance genes as environmental contaminants. It also considers alternate uses and functions for antimicrobial compounds other than those intended for medicinal purposes in humans, animals, and fish...
benzodiazepine also supports boat conformation in the solid state. The antimicrobial activity for -acetyltetrahydro-1,5-benzodiazepines have been carried out. -morpholinoacetyl-2,2,4-trimethyl-1H-1,5-benzodiazepine demonstrated better antibacterial and ...
Skip Navigation Bar Home Current Issue Past Issues Good Health For the Holidays! Past Issues / Fall 2007 ... medical and health question. Healthy families know that good medical information should be a part of everyone's ...
Full Text Available Background: Packaging problems are an integral part of logistics and the implementation of packaging significantly affects the effectiveness of logistics processes, as a factor which increases the safety and the quality of products being transported. Active packaging is an area of technology needed to meet the requirements of the contemporary consumer. Active packaging creates additional opportunities in systems for packing goods, as well as offering a solution in which the packaging, the product and surroundings interact. Furthermore, active packaging allows packaging to interact with food and the environment and play a dynamic role in food preservation. The main role of antimicrobial packaging is to inhibit the growth of microorganisms that reduce the quality of the packaged product. Methods: The application of natural antimicrobial agents appears to be safe for food products. Also, these compounds have potential applications as a natural preservative in the food packaging industry. This study presents some antibacterial agents, namely chitosan, nisin and pectins. Results and conclusion: Natural substances used in active packaging can eliminate the danger of chemical substances migrating to food.
Full Text Available Amanda H Lavan, Paul F Gallagher, Denis O’Mahony Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland Abstract: The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers’ lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people’s prescriptions/screening tool to alert to right treatment criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another
Capital goods play a major role in international trade. World production of capital goods and R&D activity are highly concentrated in some developed countries. Most of the countries, especially developing countries import the most of their capital equipment from some leading capital goods exporter countries. Therefore technological advances can be transmitted across borders through trade in capital goods. In international trade countries face trade costs. Trade costs can be in the for...
Kirill Borissov; Joseph Hanna; Stephane Lambrecht
We study a parametric politico-economic model of economic growth with productive public goods and public consumption goods. The provision of public goods is funded by a proportional tax on consumers' income. Agents are heterogeneous in their initial capital endowments, discount factors and the relative weights of public consumption in overall private utility. They vote on the shares of public goods in GDP. We propose a definition of voting equilibrium, prove the existence and provide a charac...
Erdman, Susan E
We all want to live a long life with ‘good health’. But what does that really mean? Clinicians often define ‘good health’ as the absence of disease. Indeed, modern biomedical research focuses on finding remedies for specific ailments, that, when absent, will yield ‘good health’.
R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22
they are full, (2) loops correspond one-to-one to extreme points of a convex set. Some other properties of good sets are discussed. Keywords. Good set; full set; related component; loop; relatively full set. Introduction and preliminaries. In this note we make some remarks on good sets in n-fold Cartesian product as defined in.
This article shows how game theory can be applied to model good faith mathematically using an example of a classic legal dispute related to rei vindicato. The issue is whether an owner has a legal right to his good if a person has bought it in good faith by using updated probabilities. The article...
Ylirisku, Salu; Arvola, Mattias
This chapter explores the philosopher and logician Georg Henrik von Wright’s metaethical treatise of the varieties of goodness in the context of design. von Wright investigated the use of notion of ‘good’ in language, and he identified six kinds of goodness: namely utilitarian goodness, instrumen...
Full Text Available Background: The World Health Organization (WHO recommends surveillance of antibiotic use as part of the strategy to fight against antimicrobial resistance. However, there is little information about the antibiotic consumption in developing countries, especially in rural areas. Objective: The objective of this study was to describe the antimicrobial consumption in a rural hospital in India Methods: The study was performed in a district hospital situated in Anantapur, Andhra Pradesh. In accordance with WHO recommendations, we used the defined daily dose (DDD methodology to measure the antibiotic use during one year (from 1st August 2011 to 1st August 2012. The antibiotic use was measured using DDDs/100 admissions and DDDs/100 patient-days for inpatients, and DDDs/100 visits for outpatients. Results: During the study period, there were 15,735 admissions and 250,611 outpatient visits. Antibiotics were prescribed for 86% of inpatients and 12.5% of outpatients. Outpatient prescriptions accounted for 2/3 of the overall antibiotic consumption. For inpatients, the total antibiotic use was 222 DDDs/ 100 patient-days, 693 DDDs/ 100 admissions and the mean number of antibiotics prescribed was 1.8. For outpatients, the total antibiotic use was 86 DDDs/ 100 outpatient visits and the mean number of antibiotics prescribed was 1.2. The most common antibiotics prescribed were aminopenicillins and 3rd generation cephalosporins for inpatients, and tetracyclines and quinolones for outpatients. In a sample of patients with diarrhoea or upper respiratory tract infections (URTI, the proportion of patients who received antibiotics was 84% (95% confidence interval [CI], 67-93 and 52% (95% CI, 43-62, respectively. Conclusion: In this rural setting, the use of antimicrobials was extremely high, even in conditions with a predominantly viral aetiology such as diarrhoea or URTI.
Lau, Jillian S Y; Kiss, Christopher; Roberts, Erika; Horne, Kylie; Korman, Tony M; Woolley, Ian
The rise of antimicrobial use in the twentieth century has significantly reduced morbidity due to infection, however it has also brought with it the rise of increasing resistance. Some patients are on prolonged, if not "life-long" course of antibiotics. The reasons for this are varied, and include non-infectious indications. We aimed to study the characteristics of this potential source of antibiotic resistance, by exploring the antibiotic dispensing practices and describing the population of patients on long-term antibiotic therapy. A retrospective cross-sectional study of antibiotic dispensing records was performed at a large university hospital-based healthcare network in Melbourne, Australia. Outpatient prescriptions were extracted from the hospital pharmacy database over a 6 month period in 2014. Medical records of these patients were reviewed to determine the indication for prescription, including microbiology, the intended duration, and the prescribing unit. A descriptive analysis was performed on this data. 66,127 dispensing episodes were reviewed. 202 patients were found to have been prescribed 1 or more antibiotics with an intended duration of 1 year or longer. 69/202 (34%) of these patients were prescribed prolonged antibiotics for primary prophylaxis in the setting of immunosuppression. 43/202 (21%) patients were prescribed long-term suppressive antibiotics for infections of thought incurable (e.g. vascular graft infections), and 34/43 (79%) were prescribed by Infectious Diseases doctors. 66/202 (33%) patients with cystic fibrosis were prescribed prolonged courses of macrolides or fluoroquinolones, by respiratory physicians. There was great heterogeneity noted in indications for prolonged antibiotic courses, as well as antibiotic agents utilised. Our study found that that continuous antibiotic therapy represented only a small proportion of overall antibiotic prescribing at our health network. Prolonged courses of antibiotics were used mainly to
Whitney P Caron
Full Text Available Whitney P Caron1, Shaker A Mousa1,21The Pharmaceutical Research Institute, Center of Excellence of Infection Prevention (CEIP, Albany College of Pharmacy and Health Sciences, Albany, NY, USA; 2King Saud University, Riyadh, Saudi ArabiaAbstract: Antibiotics offer great benefits by reducing the duration and severity of illnesses and aiding in infection transmission control. With this being said, the inexorable process of antimicrobial drug resistance is to some degree unavoidable. Although drug resistance will likely persist and is to be expected, the overall level can be dramatically decreased with increased attention to antibiotic overuse and the pharmacokinetic and pharmacodynamic properties of different drug formulations, and the use of proper hygiene and protective barriers. Implementation of such practices as microbial surveillance and prophylaxis has been shown to result in decreased hospital length of stay, health care costs and mortality due to drug-resistant infections. This review will summarize current progress in preventative techniques aimed at reducing the incidence of infection by antimicrobial-resistant bacteria and the emergence and spread of antimicrobial-resistant strains. By employing a variety of prevention strategies, including proper personal hygiene, prescreening for carrier status before hospital admission, disinfection of hospital rooms, and careful monitoring of antimicrobial prescribing, marked progress can be achieved in the control of drug-resistant pathogens, which can translate into more effective antimicrobial therapy.Keywords: infection prevention, antibiotic, personal hygiene, disinfection, microbial surveillance, drug-resistant pathogen
Karki, A J; Holyfield, G; Thomas, D
Dental prescribing data in Wales have not been studied in detail previously. The analysis of national data available from Health Solutions Wales showed that dental prescribing in Wales accounted for 9% of total antibacterial prescribing in primary care in 2008. Penicillin and metronidazole constituted the bulk of antibiotics prescribed by dentists. Since the publication of National Institute for Health and Clinical Excellence (NICE) guidance (March 2008) on prophylaxis against infective endocarditis, dental prescriptions for amoxicillin 3g sachets and clindamycin capsules have decreased. Dental prescriptions for fluoride preparations increased in number from 2007 to 2008. Dental prescribing of controlled drugs raises no concern. The figure for antibiotic prescribing in Wales is similar to that of England. Nevertheless, the figure seems a little high, indicating potential inappropriate prescribing behaviour among dentists. Antibiotic resistance is a major public health issue and many patients each year die from infections from bacterial strains that are resistant to one or more antibiotics. Inappropriate use of antibiotics is a major cause of antibiotic resistance and every effort should be made to reduce the number of inappropriate antibiotic prescriptions in dental practice.
Kahan, Meldon; Srivastava, Anita; Spithoff, Sheryl; Bromley, Lisa
Objective To offer preliminary guidance on prescribing smoked cannabis for chronic pain before the release of formal guidelines. Quality of evidence We reviewed the literature on the analgesic effectiveness of smoked cannabis and the harms of medical and recreational cannabis use. We developed recommendations on indications, contraindications, precautions, and dosing of smoked cannabis, and categorized the recommendations based on levels of evidence. Evidence is mostly level II (well conducted observational studies) and III (expert opinion). Main message Smoked cannabis might be indicated for patients with severe neuropathic pain conditions who have not responded to adequate trials of pharmaceutical cannabinoids and standard analgesics (level II evidence). Smoked cannabis is contraindicated in patients who are 25 years of age or younger (level II evidence); who have a current, past, or strong family history of psychosis (level II evidence); who have a current or past cannabis use disorder (level III evidence); who have a current substance use disorder (level III evidence); who have cardiovascular or respiratory disease (level III evidence); or who are pregnant or planning to become pregnant (level II evidence). It should be used with caution in patients who smoke tobacco (level II evidence), who are at increased risk of cardiovascular disease (level III evidence), who have anxiety or mood disorders (level II evidence), or who are taking higher doses of opioids or benzodiazepines (level III evidence). Cannabis users should be advised not to drive for at least 3 to 4 hours after smoking, for at least 6 hours after oral ingestion, and for at least 8 hours if they experience a subjective “high” (level II evidence). The maximum recommended dose is 1 inhalation 4 times per day (approximately 400 mg per day) of dried cannabis containing 9% delta-9-tetrahydrocannabinol (level III evidence). Physicians should avoid referring patients to “cannabinoid” clinics (level
Feehan, Michael; Durante, Richard; Ruble, Jim; Munger, Mark A
The perceived demand for and barriers to pharmacist prescribing in the community pharmacy setting were studied. Qualitative interviews were conducted with 19 consumers, 20 community pharmacists, and 8 reimbursement decision-makers from payer organizations between April and June 2015. Respondents were invited to participate in a daylong interview process online. Interviews with consumers and pharmacists were conducted using online bulletin board technology. Telephone interviews were conducted with reimbursement decision-makers. As with all qualitative research, the sample sizes used were restrictive and sufficient to gauge the perceptions of those respondents only. Interview responses were not intended to be generalizable to the groups or populations from which the respondents came. There was a continuum of interest in pharmacist prescribing across the three constituencies. Consumers were predominantly resistant to the notion; however, one third were more positive about the idea. Community pharmacists were more open, particularly when prescribing was restricted to a limited set of conditions or medications. Reimbursement decision-makers were most receptive to the notion. Key barriers to pharmacist prescribing included low awareness of current pharmacist prescribing authority among consumers, concerns about the adequacy of pharmacist training, potential conflicts of interest when the prescriber was also a dispenser, and potential liability issues. Consumer respondents were generally resistant to the notion of pharmacist prescribing, with most viewing pharmacists as dispensers and not prescribers. Community pharmacists were more open to the idea, while reimbursement decision-makers were the most receptive to the notion of pharmacist prescribing. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Kermack, Andrea; Flannery, Mara; Tofighi, Babak; McNeely, Jennifer; Lee, Joshua D
Buprenorphine office-based opioid maintenance is an increasingly common form of treatment for opioid use disorders. However, total prescribing has not kept pace with the current opioid and overdose epidemic and access remains scarce among the underserved. This study sought to assess current provider attitudes and clinical practices among a targeted sample of primarily New York City public sector buprenorphine prescribers. A cross-sectional online survey purposefully sampled buprenorphine prescribers in NYC with a focus on those serving Medicaid and uninsured patient populations. Expert review of local provider networks, snowball referrals, and in-person networking generated an email list, which received a survey link. A brief 25-question instrument queried provider and practice demographics, prescribing practices including induction approaches and attitudes regarding common hot topics (e.g., buprenorphine diversion, prescriber patient limits, insurance issues, ancillary treatments). Of 132 email invitations, N=72 respondents completed (n=64) or partially completed (n=8) the survey between January and April 2016. Most (79%) were Medicaid providers in non-psychiatric specialties (72%), working in a hospital-based or community general practice (51%), and board-certified in addiction medicine or psychiatry (58%). Practice sizes were generally 100 patients or fewer (71%); many providers (64%) individually prescribed buprenorphine Buprenorphine diversion was not rated as an important practice barrier. In conclusion, this targeted survey of buprenorphine prescribers in NYC treating primarily underserved populations showed a consistent pattern of part-time prescribing to modest volumes of patients, routine use of unobserved buprenorphine induction, and primarily elective referrals to psychosocial counseling. Barriers to prescribing included prior authorization requirements, lack of clinical resources (space, staff) and psychiatric services. Federal and local efforts to
Wu, Vincent; Chan, Oscar; Maxwell, Simon R; Levine, Mitchell A; Perri, Dan; Sebalt, Rolf J; Baw, Bandar; Holbrook, Anne
Prescribing is an essential skill for all physicians, built on knowledge of clinical pharmacology, therapeutics and toxicology across the life cycle. The decline in organized clinical pharmacology training in medical schools, combined with an expanding pharmacopeia and increasing complexity of patient care, makes prescribing competency difficult for medical students to master. To develop and validate the McMaster Prescribing Competency Assessment (MacPCA), an online tool suitable for evaluating clinical pharmacology knowledge and prescribing skills of medical trainees in Canada. The MacPCA was developed using an online examination platform scalable to multiple sites across Canada. Questions represented 8 domains of safe and effective prescribing with level of difficulty aimed at a final year medical student. Validation assessment concentrated on face and construct validity. 58 participants (7, 12 and 21 medical students in Years 1, 2, and 3, respectively and 8 undergraduate controls) were recruited. Mean scores were 31% (SD 13.6), 46% (SD 14.9), 75% (SD 8.3) and 81% (SD 10.5) for the controls, Year 1, Year 2, and Year 3 (final year) students, respectively. Combined Year 2/Year 3 scores were significantly better than control/Year 1 scores (pstudent feedback indicated the test was fair, clear and unambiguous, aimed at the right level, with sufficient time for completion. The MacPCA demonstrated good face validity and successfully discriminated between upper year medical students and their junior colleagues. Further expansion of testing and validation is warranted.
Al-Somai, Niaz; Al-Muhur, Mohammed; Quteimat, Osama; Hamzah, Nashaat
There is little research on the impact of implementing and monitoring antimicrobial policy in Saudi hospitals. The purpose of this study is to measure the impact of the clinical pharmacist (CP) and infectious disease consultant (ID) interventions on the use of three antimicrobials (caspofungin, imipenem, meropenem) in hospitalized patients in the King Abdullah Medical City hospital. The study was carried out in the King Abdullah Medical City, in Mekkah, Saudi Arabia. The hospital is a tertiary center that provides CCU, CSICU, Cardiac, Hematology, ICU, Medical, Neuroscience, Oncology, and specialized surgery services. The use of three antimicrobials (caspofungin, imipenem, meropenem) was reviewed by the clinical pharmacist for four periods, pre and post implementation of policy. Relevant data were collected in four periods. In the first period, before policy implementation, data were collected retrospectively to be used as baseline status reference, and in the three remaining periods that followed data were collected prospectively, and compared to baseline data, to evaluate the role of clinical pharmacist and ID interventions in optimizing antimicrobial therapy. Caspofungin duration of therapy was not affected significantly by the intervention. Statistically significant reduction in antimicrobial therapy duration was observed in imipenem (37%) and meropenem (37%) from baseline, which indicate a better control on antimicrobial use and reduction in antimicrobial resistance. The impact of the clinical pharmacist and ID interventions, in reducing antimicrobial therapy duration using imipenem and meropenem, is clear from the result presented above. However, lack of restriction and follow up in the antimicrobial policy in case of negative culture makes antimicrobial use uncontrollable in these cases. Establishing good and accepted policy may help reduce consumption and total cost of therapy.
Schneberk, Todd; Raffetto, Brian; Kim, David; Schriger, David L
We determine episodic and high-quantity prescribers' contribution to opioid prescriptions and total morphine milligram equivalents in California, especially among individuals prescribed large amounts of opioids. This was a cross-sectional descriptive analysis of opioid prescribing patterns during an 8-year period using the de-identified Controlled Substance Utilization Review and Evaluation System (CURES) database, the California subsection of the prescription drug monitoring program. We took a 10% random sample of all patients and stratified them by the amount of prescription opioids obtained during their maximal 90-day period. We identified "episodic prescribers" as those whose prescribing pattern included short-acting opioids on greater than 95% of all prescriptions, fewer than or equal to 31 pills on 95% of all prescriptions, only 1 prescription in the database for greater than 90% of all patients to whom they gave opioids, fewer than 6 prescriptions in the database to greater than 99% of patients given opioids, and fewer than 540 prescriptions per year. We identified top 5% prescribers by their morphine milligram equivalents per day in the database. We examined the relationship between patient opioid prescriptions and provider type, with the primary analysis performed on the patient cohort who received only short-acting opioids in an attempt to avoid guideline-concordant palliative, oncologic, and addiction care, and a secondary analysis performed on all patients. Among patients with short-acting opioid only, episodic prescribers (14.6% of 173,000 prescribers) wrote at least one prescription to 25% of 2.7 million individuals but were responsible for less than 9% of the 10.5 million opioid prescriptions and less than 3% of the 3.9 billion morphine milligram equivalents in our sample. Among individuals with high morphine milligram equivalents use, episodic prescribers were responsible for 2.8% of prescriptions and 0.6% of total morphine milligram equivalents
Full Text Available The special issue “Antimicrobial Polymers” includes research and review papers concerning the recent advances on preparation of antimicrobial polymers and their relevance to industrial settings and biomedical field. Antimicrobial polymers have recently emerged as promising candidates to fight microbial contamination onto surfaces thanks to their interesting properties. In this special issue, the main strategies pursued for developing antimicrobial polymers, including polymer impregnation with antimicrobial agents or synthesis of polymers bearing antimicrobial moieties, were discussed. The future application of these polymers either in industrial or healthcare settings could result in an extremely positive impact not only at the economic level but also for the improvement of quality of life.
Gulliford, Martin; Ashworth, Mark
It must be — as an essential component of the response to the antimicrobial drug resistance problemThe growing threat of antimicrobial drug resistance (AMR) is attracting the attention of national governments and international organisations. In the words of Margaret Chan, Director-General of the World Health Organization, “We are hearing one alarm bell after another.”1 This is apparent in primary care, where the frequency of antibiotic-resistant infections is increasing. The emergence of AMR ...
Puaar, Seetal Jheeta; Franklin, Bryony Dean
Few studies have applied a systems approach to understanding the causes of specific prescribing errors in the context of hospital electronic prescribing (EP). A comprehensive understanding of underlying causes is essential for developing effective interventions to improve prescribing safety. Our objectives were to explore prescribers' perspectives of the causes of errors occurring with EP and to make recommendations to maximise benefits and minimise risks. We studied a large hospital using inpatient EP. From April to June 2016, semistructured interviews were conducted with purposively sampled prescribers involved with a prescribing error. Interviews explored prescribers' perceived causes of the error and views about EP; they were audio-recorded and transcribed verbatim. Data were thematically analysed against a framework based on Reason's accident causation model, with a focus on identifying latent conditions. Twenty-five interviews explored causes of 32 errors. Slips and rule-based mistakes were the most common active failures. Error causation was multifactorial; environmental, individual, team, task and technology error-producing conditions were all influenced by EP. There were three broad groups of latent conditions: the EP system's functionality and design; the organisation's decisions around EP implementation and use; and prescribing behaviours in the context of EP. Errors were associated with the design of EP itself and its integration within the healthcare environment. Findings suggest that EP vendors should focus on revolutionising interface design and usability issues, bearing in mind the wider healthcare context in which such software is used. Healthcare organisations should draw upon human factors principles when implementing EP. Consideration of work environment, infrastructure, training, prescribing responsibilities and behaviours should be considered to address local issues identified. © Article author(s) (or their employer(s) unless otherwise stated
Rowbotham, Samantha; Chisholm, Anna; Moschogianis, Susie; Chew-Graham, Carolyn; Cordingley, Lis; Wearden, Alison; Peters, Sarah
To report a qualitative study of the experiences of nurse prescribers in managing patients with self-limiting respiratory tract infections. Patients frequently attend primary care with respiratory tract infections. Although a no-prescribing strategy is recommended for these consultations, general practitioners frequently prescribe antibiotics, citing non-clinical reasons such as patient pressure. Nurses increasingly manage people with respiratory tract infections, but research has not yet explored their experiences within such consultations. Semi-structured interviews and focus groups. Fifteen semi-structured interviews and three focus groups (n=5, n=4, and n=12) with a purposive sample of nurse prescribers (n=34) and other non-medical prescribers (n=2) were conducted between November 2009-November 2010. A qualitative approach was used to develop conceptual categories from the dataset, and emerging themes were explored in subsequent interviews/focus groups. Although participants reported experiencing numerous challenges within these consultations, they believed that they possessed some of the communication skills to deal effectively with patients without prescribing antibiotics. Participants reported that protocols supported their decision-making and welcomed the benefits of peer support in dealing with 'demanding' patients. However, the newness of nurses and other non-medical prescribers to the prescribing role meant that some were cautious in dealing with patients with respiratory tract infections. Training for nurses and other non-medical prescribers should focus on building their confidence and skills to manage people with respiratory tract infections without recourse to antibiotics. Further work should seek to explore which strategies are most effective in managing respiratory tract infections while maintaining patient satisfaction with care. © 2012 Blackwell Publishing Ltd.
Dordević, Natasa D; Janković, Slobodan M
with the Good Clinical Practice. Our study pointed out the need for the obligatory continuation of medical education of general practitioners in decision-making process during prescribing.
Full Text Available Mainul Haque, Nor Iza A Rahman, Zainal Zulkifli, Salwani Ismail Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia Abstract: The innovation of penicillin by Dr Alexander Fleming in 1928 and its use in clinical practice saved many lives, especially during the Second World War. Tuberculosis still carries a significant public health threat and has re-emerged over the past two decades, even in modern countries where tuberculosis was thought to be eliminated. The World Health Organization defines antimicrobial resistance as the resistance of a microorganism to an antimicrobial drug that was initially effective for treatment of infections caused by the microbe. Therefore, the findings of the current study will provide data to enable the design of a new educational program to better equip our students in confronting antimicrobial resistance. This study was a cross-sectional, questionnaire-based survey, which was undertaken in the Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia. The study participants were students of the Bachelor of Medicine and Bachelor of Surgery program (MBBS of Year III, IV, and V. A total of 142 out of 164 (86% medical students returned the questionnaire. Specifically, the year-wise breakdown of responses was 29% (41, 39% (55, and 32% (45 for Year III, IV, and V, respectively. Among the study respondents, 28% (40 were male, and the remaining 72% (102 were female. In all, 67% of the participants felt more confident in “making an accurate diagnosis of infection/sepsis.” The majority (88% of the study participants stated that they would like more training on antibiotic selection. This research has found that there is a gap between theoretical input and clinical practice; the students are demanding more educational intervention to face the threat of antimicrobial resistance. Keywords: antibiotic, prescribing, resistance, medical students, knowledge
Clift, Charles; Salisbury, David M
Interest in addressing antimicrobial resistance (AMR) has grown recently but little effort has been made to consider how existing and new vaccines could impact on AMR. A 2017 Chatham House meeting considered the role of vaccines and how to demonstrate their value through their impact on AMR. Ways existing vaccines have reduced antibiotic prescribing and the prevalence of some resistant organisms were reviewed. Other new vaccines could have a similar impact. In gonorrhoea, where complete resistance has developed, vaccine may be the best option. Valuing the impact of vaccines on AMR was challenging: there were difficult methodological issues and a lack of data for modelling. A participant poll suggested priorities for accelerated vaccine development were tuberculosis, typhoid, influenza, RSV and gonorrhoea. More evidence is needed to convince policymakers but that vaccine development projects should be considered by funders on the same basis as those for new antibiotics or diagnostics. Copyright © 2017. Published by Elsevier Ltd.
blockers (28.5 %), calcium channel blockers (19.8 %), hydralazine/losartan (18.5 %) and angiotensin converting enzyme inhibitors (11.5 %). Antihypertensives prescribed as monotherapy included atenolol (23.2 %), bendrofluazide (22 %), frusemide ...
Trollor, Julian N; Salomon, Carmela; Franklin, Catherine
SUMMARY Mental illness is common in people with intellectual disability. They may also have physical health problems which can affect their mental state. Difficulties in communication can contribute to mental health problems being overlooked. These may present with changes in behaviour. Psychological management is usually preferable to prescribing psychotropic drugs. Behavioural approaches are the most appropriate way to manage challenging behaviour. If a drug is considered, prescribers should complete a thorough diagnostic assessment, exclude physical and environmental contributions to symptoms, and consider medical comorbidities before prescribing. Where possible avoid psychotropics with the highest cardiometabolic burden. Prescribe the minimum effective dose and treatment length, and regularly monitor drug efficacy and adverse effects. There is insufficient evidence to support the use of psychotropics for challenging behaviour. They should be avoided unless the behaviour is severe and non-responsive to other treatments. PMID:27756975
M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)
textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this
U.S. Department of Health & Human Services — This look-up tool is a searchable database that allows you to look up a Medicare Part D prescriber by National Provider Identifier (NPI), or by name and location....
Rasmussen, Hanne Marie Skyggedal; Søndergaard, Jens; Sokolowski, Ineta
OBJECTIVE: To test a method for improving the selection of indicators of general practitioners' prescribing. METHODS: We conducted a prescription database study including all 180 general practices in the County of Funen, Denmark, approximately 472,000 inhabitants. Principal factor analysis was used...... to model correlation between 19 register-based indicators for the quality of non-steroidal anti-inflammatory drug (NSAID) prescribing. RESULTS: The correlation between indicators ranged widely from 0 to 0.93. Factor analysis revealed three dimensions of quality: (1) "Coxib preference", comprising...... appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns....
Li, Fangfei; Collins, J Grant; Keene, F Richard
One of the major advances in medical science has been the development of antimicrobials; however, a consequence of their widespread use has been the emergence of drug-resistant populations of microorganisms. There is clearly a need for the development of new antimicrobials--but more importantly, there is the need for the development of new classes of antimicrobials, rather than drugs based upon analogues of known scaffolds. Due to the success of the platinum anticancer agents, there has been considerable interest in the development of therapeutic agents based upon other transition metals--and in particular ruthenium(II/III) complexes, due to their well known interaction with DNA. There have been many studies of the anticancer properties and cellular localisation of a range of ruthenium complexes in eukaryotic cells over the last decade. However, only very recently has there been significant interest in their antimicrobial properties. This review highlights the types of ruthenium complexes that have exhibited significant antimicrobial activity and discusses the relationship between chemical structure and biological processing--including site(s) of intracellular accumulation--of the ruthenium complexes in both bacterial and eukaryotic cells.
Wieczorek, Kinga; Osek, Jacek
Campylobacter jejuni and Campylobacter coli are recognized as the most common causative agents of bacterial gastroenteritis in the world. Humans most often become infected by ingesting contaminated food, especially undercooked chicken, but also other sources of bacteria have been described. Campylobacteriosis is normally a self-limiting disease. Antimicrobial treatment is needed only in patients with more severe disease and in those who are immunologically compromised. The most common antimicrobial agents used in the treatment of Campylobacter infections are macrolides, such as erythromycin, and fluoroquinolones, such as ciprofloxacin. Tetracyclines have been suggested as an alternative choice in the treatment of clinical campylobacteriosis but in practice are not often used. However, during the past few decades an increasing number of resistant Campylobacter isolates have developed resistance to fluoroquinolones and other antimicrobials such as macrolides, aminoglycosides, and beta-lactams. Trends in antimicrobial resistance have shown a clear correlation between use of antibiotics in the veterinary medicine and animal production and resistant isolates of Campylobacter in humans. In this review, the patterns of emerging resistance to the antimicrobial agents useful in treatment of the disease are presented and the mechanisms of resistance to these drugs in Campylobacter are discussed.
Campylobacter jejuni and Campylobacter coli are recognized as the most common causative agents of bacterial gastroenteritis in the world. Humans most often become infected by ingesting contaminated food, especially undercooked chicken, but also other sources of bacteria have been described. Campylobacteriosis is normally a self-limiting disease. Antimicrobial treatment is needed only in patients with more severe disease and in those who are immunologically compromised. The most common antimicrobial agents used in the treatment of Campylobacter infections are macrolides, such as erythromycin, and fluoroquinolones, such as ciprofloxacin. Tetracyclines have been suggested as an alternative choice in the treatment of clinical campylobacteriosis but in practice are not often used. However, during the past few decades an increasing number of resistant Campylobacter isolates have developed resistance to fluoroquinolones and other antimicrobials such as macrolides, aminoglycosides, and beta-lactams. Trends in antimicrobial resistance have shown a clear correlation between use of antibiotics in the veterinary medicine and animal production and resistant isolates of Campylobacter in humans. In this review, the patterns of emerging resistance to the antimicrobial agents useful in treatment of the disease are presented and the mechanisms of resistance to these drugs in Campylobacter are discussed. PMID:23865047
Su, Bu-Li; Zeng, Rong; Chen, Jin-Yin; Chen, Chu-Ying; Guo, Juan-Hua; Huang, Chang-Gan
The antioxidant and antimicrobial activities as well as the quantity of phenolic substances of Impatiens balsamina L. stem extracts obtained with various solvent were determined in this study. All of the extracts possessed moderate antioxidant potential in the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging and reducing power assays. Antimicrobial activity was estimated using the cylinder-plate and agar dilution methods against four bacterial and six fungal strains. The extracts showed good antimicrobial activity especially antifungal activity against all of the tested microorganisms. The total phenolic and flavonoid contents ranged from 2.88 to 13.63 mg gallic acid equivalents/g dried extract and 0.98 to 7.87 mg quercetin equivalents/g dried extract, respectively. The results presented here indicate that the I. balsamina stem extracts have antioxidant and antimicrobial properties and are therefore a potential source of antioxidant and antimicrobial agents for the food and pharmaceutical industries. Our work indicates that the I. balsamina stem may be a good candidate as natural antioxidant and antimicrobial agents. It can be applied in food industry for preservation. © 2012 Institute of Food Technologists®
Daniel-Jambun, D; Dwiyanto, J; Lim, Y Y; Tan, J B L; Muhamad, A; Yap, S W; Lee, S M
To investigate the antimicrobial properties of Etlingera coccinea and Etlingera sessilanthera and to isolate and identify the antimicrobial compounds. Extracts were obtained via sequential solvent extraction method using hexane, dichloromethane, ethyl acetate, methanol and water. Antimicrobial activity testing was done using broth microdilution assay against 17 strains of bacteria. The leaf hexane extract of E. coccinea and rhizome hexane extract of E. sessilanthera showed best antimicrobial activities, with minimum inhibitory concentration (MIC) values ranging from 0·016 to 1 mg ml -1 against Gram-positive bacteria. From these active extracts, two antimicrobials were isolated and identified as trans-2-dodecenal and 8(17),12-labdadiene-15,16-dial with MIC values ranging from 4 to 8 μg ml -1 against Bacillus cereus, Bacillus subtilis and Staphylococcus aureus. Etlingera coccinea and E. sessilanthera demonstrated good antimicrobial activities against clinically relevant bacteria strains. The antimicrobial compounds isolated showed low MIC values, hence suggesting their potential use as antimicrobial agents. This study is the first to identify the potent antimicrobials from these gingers. The antimicrobials isolated could potentially be developed further for use in treatment of bacterial infections. Also, this study warrants further research into other Etlingera species in search for more antimicrobial compounds. © 2017 The Society for Applied Microbiology.
Okmen, G; Turkcan, O; Ceylan, O; Gork, G
Medicinal plants are an important source of substances which are claimed to induce antimicrobial, antimutagenic and antioxidant effects. Many plants have been used due to their antimicrobial treatments. Antimicrobial and antioxidant activities of L. orientalis have not been reported to the present day. The aim of this work was to investigate of the antimicrobial and antioxidant potentials of different extracts from L. orientalis. The extracts were screened for antimicrobial activity against different food pathogens. These bacteria include 4 Gram positive and 3 Gram negative bacteria and one fungi. The leaf extracts of plant were tested by disc diffusion assay. The MIC was evaluated on plant extracts as antimicrobial activity. In addition to, the plant extracts were tested against the stable DPPH (2,2-diphenyl-1-picryl-hydrazylhydrate) free-radical. The acetone, ethanol and methanol extracts of L. orientalis showed maximum inhibition zone of 12 mm against Yersinia enterocolitica, Listeria monocytogenes and Staphylococcus aureus. In addition to, the methanol extract displayed a strong antioxidant activity (trolox equivalent = 2.23 mM). L. orientalis extracts have antimicrobial, and antioxidant potential. Our results support the use of this plant in traditional medicine and suggest that some of the plant extracts possess compounds with good antibacterial properties that can be used as antibacterial agents in the search for new drugs.
Full Text Available Abstract Background Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs. Methods GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period – (7 days one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. Results Two hundred forty eight forms out of the 600 (41% were returned by post. Antibiotics were prescribed in 6.4% (1711/26803 of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7% patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed, amoxicillin/clavulanate (18,7% and clarithromycin (7.6%. The most commonly treated indications were pharyngitis (29.8%, acute bronchitis (25.3% and rhinosinusitis (10.2%. Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%, amoxicillin (15.7% and clarithromycin (19.3%. Conclusions Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.
Duintjer Tebbens, Jurjen; Meurant, G.
Roč. 65, č. 1 (2014), s. 69-90 ISSN 1017-1398 R&D Projects: GA AV ČR IAA100300802 Grant - others:GA AV ČR(CZ) M100301201 Institutional research plan: CEZ:AV0Z10300504 Keywords : Arnoldi process * early termination * GMRES method * prescribed GMRES convergence * Arnoldi method * prescribed Ritz values Subject RIV: BA - General Mathematics Impact factor: 1.417, year: 2014
This article addresses the challenges that arise when record keeping systems are advocated as a necessary under-pinning for good government and good governance. The relationship between record keeping and accountability is analysed and contextualised in relation to transparency and Freedom of Information ...
Japan is the leading supplier of sophisticated capital goods to East Asian countries. These goods embody advanced technologies and facilitate learning and productivity growth. Capital goods also represent 30%-40% of Japan's exports. This paper investigates the determinants of these exports. Results from dynamic ordinary least squares estimation indicate that exports depend on exchange rates, income in the importing countries, and downstream countries' exports to the rest of the world. Results...
This paper consists of the text of two articles prepared for the second edition of the New Palgrave Dictionary of Economics. The first article provides a mathematical and diagrammatic exposition of the theory of public goods as originally formulated by Samuelson. It describes the extension of the model to take account of the costs of distortionary taxation, and discusses the concept of the marginal cost of public funds. Different types of public goods (such as mixed goods and l...