Validation and implementation of a national survey to assess antimicrobial stewardship awareness, practices and perceptions amongst community pharmacists in Australia

Objectives Antimicrobial stewardship (AMS) programmes are well established in hospitals, yet such programmes have not been widely implemented in the community. Understanding current practices and perceptions of community pharmacists about AMS may provide insights into the implementation of AMS in community pharmacies. The aims of this study were to validate a questionnaire to measure community pharmacists’ perceptions of AMS and to explore barriers and facilitators to their involvement in community-based AMS initiatives. Methods A 44-item survey questionnaire comprising sections on demographics, AMS practices and perceptions of community pharmacists, and barriers and facilitators to AMS was hosted online. Community pharmacists were recruited through social media pages of community pharmacist groups across Australia. Cronbach’s alpha and exploratory factor analysis were used to measure the reliability and validity of the survey tool, respectively. Results A total of 330 community pharmacists started the survey, with 255 of them completing at least one question. Pharmacists were more likely to intervene with general practitioners (GPs) (≥80% of the time) for allergies, dosing and drug interactions and were less likely to intervene if they felt the choice of antibiotic was inappropriate (45%). Major barriers limiting pharmacists’ participation in AMS were lack of access both to patient data (82.6%) and to a standard guideline to implement AMS programmes (72.1%). Almost all pharmacists (98%) reported that better collaboration with GPs would improve their participation in AMS initiatives. Conclusion Future studies utilising the knowledge gained from this study may provide a framework for AMS in community pharmacy settings

Structure of sufficient quantum coarse-grainings

Let H and K be Hilbert spaces and T be a coarse-graining from B(H) to B(K). Assume that density matrices D_1 and D_2 acting on H are given. In the paper the consequences of the existence of a coarse-graining S from B(K) to B(H) satisfying ST(D_1)=D_1 and ST(D_2)=D_2 are given. (This condition means the sufficiency of T for D_1 and D_2.) Sufficiency implies a particular decomposition of the density matrices. This decomposition allows to deduce the exact condition for equality in the strong subadditivity of the von Neumann entropy.Comment: 13 pages, LATE

Medication Adherence, Burden and Health-Related Quality of Life in Adults with Predialysis Chronic Kidney Disease: A Prospective Cohort Study

This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 ) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) mL/min/1.73 m2 . Overall, 43% and 60% of participants reported medication nonadherence based on MGLS and TABS, respectively. Higher perceived medication burden and desire for decision-making were associated with nonadherent behaviour. Poorer HRQOL was associated with higher regimen complexity, whereas nonadherence was associated with a decline in physical HRQOL over time. Medication nonadherence, driven by perceived medication burden, was prevalent in this cohort, and was associated with a decline in physical HRQOL over time

Lamellae-controlled electrical properties of polyethylene-morphology, oxidation and effects of antioxidant on the DC conductivity

Destruction of the spherulite structure in low-density polyethylene (LDPE) is shown to result in a more insulating material at low temperatures, while the reverse effect is observed at high temperatures. On average, the change in morphology reduced the conductivity by a factor of 4, but this morphology-related decrease in conductivity was relatively small compared with the conductivity drop of more than 2 decades that was observed after slight oxidation of the LDPE (at 25 \ub0C and 30 kV mm-1). The conductivity of LDPE was measured at different temperatures (25-60 \ub0C) and at different electrical field strengths (3.3-30 kV mm-1) for multiple samples with a total crystalline content of 51 wt%. The transformation from a 5 μm coherent structure of spherulites in the LDPE to an evenly dispersed random lamellar phase (with retained crystallinity) was achieved by extrusion melt processing. The addition of 50 ppm commercial phenolic antioxidant to the LDPE matrix (e.g. for the long-term use of polyethylene in high voltage direct current (HVDC) cables) gave a conductivity ca. 3 times higher than that of the same material without antioxidants at 60 \ub0C (the operating temperature for the cables). For larger amounts of antioxidant up to 1000 ppm, the DC conductivity remained stable at ca. 1 7 10-14 S m-1. Finite element modeling (FEM) simulations were carried out to model the phenomena observed, and the results suggested that the higher conductivity of the spherulite-containing LDPE stems from the displacement and increased presence of polymeric irregularities (formed during crystallization) in the border regions of the spherulite structures

Unravelling CO oxidation reaction kinetics on single Pd nanoparticles in nanoconfinement using a nanofluidic reactor and DSMC simulations

Steady state catalytic oxidation of CO in nanofluidic channels decorated with Pd nano particles was studied using the Direct Simulation Monte Carlo (DSMC) method. Diffusion, collision, adsorption, desorption and reaction processes are simulated simultaneously. The influence of various adsorption (sticking coefficient, saturation coverage), desorption (activation energy, pre-exponential factor) and reaction (activation barrier) parameters on the final CO2 turnover are determined. These effects are considered to tune DSMC surface reaction model with respect to the experimental results. With DSMC, it was possible to get insights on reactivity of the individual Pd particles and the resulting varying reaction conditions along the channel due to local conversion effects. From the local coverages, the limit of CO:O2 inlet ratio to get maximum CO2 turnover without poisoning the catalyst with CO were determined. The approach paves the way to accurately represent micro- and nanoscale flows at the same system size as that of experiments

Roll-to-Roll Dyed Conducting Silk Yarns: A Versatile Material for E-Textile Devices

KGaA, Weinheim Textiles are a promising base material for flexible and wearable electronic applications such as sensors, actuators, and energy harvesters. An essential component in such electronic textiles (e-textiles) is electrically conducting yarns. Here, a continuous dyeing process is presented to convert an off-the-shelf silk sewing thread into a wash and wear resistant functional thread with a conductivity of about 70 S cm−1; a record high value for coated yarns. An aqueous ink based on the conducting polymer:polyelectrolyte complex poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT:PSS) is modified, to produce more than 100 m of dyed conducting threads, which are subsequently converted into e-textiles by both hand weaving and machine embroidery. The yarns are resistant to abrasion and wear, and can be machine washed at least 15 times with retained electronic properties. The woven fabric is used to design a capacitive touch sensor which functions as an e-textile keyboard

Perceptions and current practices of community pharmacists regarding antimicrobial stewardship in Tasmania

Background Despite increasing interest in antimicrobial stewardship (AMS), little is known about the related practices and perceptions of community pharmacists. Objective To develop and validate a questionnaire to measure the current practices of, and barriers to community pharmacists’ participation in AMS. Setting Community pharmacists in Tasmania, Australia. Method A questionnaire to explore AMS knowledge, current practices and perceptions of community pharmacists was developed. It was designed after rigorous literature review, expert opinion, and feedback from a group of community pharmacists. A convenience sample of 140 Tasmanian community pharmacists was used for this study. Cronbach’s alpha and exploratory factor analysis (EFA) were used for reliability and validity. The questionnaire was hosted online, a link to which was sent by invitation e-mails, fax and post to community pharmacists in Tasmania, Australia. Main outcome measure Current AMS practices, perceived importance, barriers and facilitators of AMS. Results Eighty-five pharmacists responded to the survey yielding a response rate of 61%. EFA identified one factor solution for each of three perceptions scales and showed acceptable reliability. The Cronbach’s alpha of perceived importance-understanding was 0.699, perceived importance-motivating was 0.734, perceived support from GPs was 0.890, operational barriers was 0.585, general facilitators was 0.615. Most pharmacists reported that they counselled patients on adverse effects (86%), drug interactions (94%), and allergies (96%). In contrast, less than half (43%) intervened with prescribers regarding antibiotic selection. Lack of training, lack of access to patients’ records, limited interactions with general practitioners and absence of a reimbursement model were major barriers limiting community pharmacists’ participation in AMS. Conclusion The questionnaire was of acceptable reliability and validity; a larger study will further contribute in its reliability and validity. Future studies utilising the questionnaire at national and international level may provide further insights into the determinants of community pharmacist’s involvement in AMS