Implementing criteria-based early switch/early discharge programmes:a European perspective

AbstractEarly switch (ES) from intravenous (IV) to oral antibiotic therapy programmes is increasingly included as a component of hospital antimicrobial stewardship initiatives that aim to optimize antimicrobial therapy while limiting toxicity and resistance. In terms of prioritizing the most cost-effective stewardship interventions, ES has been seen as a ‘low-hanging fruit’, which refers to selecting the most obtainable targets rather than confronting more complicated issues. Administration of highly bioavailable oral antibiotics should be considered for nearly all non-critically ill patients and has been recommended as an effective and safe strategy for over two decades. However, to accrue the most benefit from ES, it should be combined with an early discharge (ED) plan, protocol, or care pathway. Benefits of this combined approach include improved patient comfort and mobility, reduced incidence of IV-line-related adverse effects, reduced IV antimicrobial preparation time, decreased hospital stays, reduced antimicrobial purchasing and administration costs, decreased patient deconditioning, and shortened recovery times. Results from published studies document decreases in healthcare resource use and costs following implementation of ES programmes, which in most studies facilitate the opportunity for ED and ED programmes. Barriers to the implementation of these programmes include clinician misconceptions, practical considerations, organizational factors, and a striking lack of awareness of IV to oral switch guidance. These and other barriers will need to be addressed to maximize the effectiveness of ES and ED programmes. As national antimicrobial stewardship programmes dictate the inclusion of ES and ED programmes within healthcare facilities, programmes must be developed and success must be documented

"Doing Good Things for Men": Ma’Ddaimba-Balas Indigenous Men’s Group Evaluation Report: 2004–2005

Current mortality and morbidity data suggest that the health of the Aboriginal and Torres Strait Islander male population is the worst of any population in Australia (Wenitong 2002). Across Australia, Indigenous males’ life expectancy is 59 years (18 years less than the Australian average)(SCRGSP 2005), and the death rate of young and middle aged Indigenous males is of particular concern, with devastating consequences for their culture, families and the community.\ud \ud Despite poor health, many Indigenous males do not access care and treatment services when they need them. Barriers to access include distance to and availability of services, lack of transport, lack of private health insurance, lack of confidence and embarrassment, and a belief that women both dominate health services and principally provide services to women. The lack of employment of male health workers or their subordination to female non-Indigenous nurses or doctors is also a barrier (Adams 2001). \ud \ud Improving access to health services could prolong the survival of those Indigenous men who suffer a range of serious diseases. But medical care alone is not sufficient to correct the alarming Indigenous health statistics at a population level. Social and economic factors such as education, employment, drug dependency and stress are more important for health gains in the population as a whole (World Health Organisation 1998). Hence any systematic and community-driven approach to addressing health will necessarily need to involve broad strategies that address not only the improvement of access to health services, but also the social determinants of health at individual, organisational and community levels.\ud \ud This report describes the activities of Ma’Ddaimba-Balas (which translates as brother, brother) Indigenous Men’s Group in Innisfail, a small rural town in North Queensland. The Group has been part of a 3-way empowerment research partnership with a team of university researchers and another Indigenous Men’s Group since February 2004 to determine the medium - long term usefulness of men’s groups as a vehicle for health promotion strategies especially in rural Indigenous settings. The Ma’Ddaimba-Balas Men’s Group joined an earlier partnership of researchers from the University of Queensland and James Cook University (based in Cairns) with the Yaba Bimbie Men’s Group in the nearby Indigenous community of Yarrabah. The partners had been working since 2001 through a process of participatory action research (PAR) designed to support the men to take greater control and responsibility for the issues affecting their health and wellbeing. The Yarrabah study had provided initial evidence that men’s groups in Indigenous settings can lead to social and behavioural change and that PAR is potentially a useful tool in supporting social change (Tsey, Wenitong, et al 2004). \ud \ud Based on the preliminary findings from the Yarrabah research, the research team successfully obtained a three-year grant from the National Health and Medical Research Council (NHMRC) from 2004 to consolidate the participatory action research work in Yarrabah and extend the process to another Indigenous Men’s Group. This report describes the strategies, challenges and outcomes resulting from the first two years of the three-year research-funded work of the Ma’Ddaimba-Balas Men’s Group, between January 2004 and December 2005

In-drain denitrifying woodchip bioreactors for reducing nitrogen runoff from sugarcane

Denitrifying woodchip bioreactors offer an opportunity to intercept and reduce nitrogen loads between agricultural fields and downstream aquatic ecosystems. Here we assessed the performance of three in-drain bioreactor beds installed in open drains receiving runoff and shallow ground water from rain-fed sugarcane production in the Wet Tropics of Australia. Drain nitrate-N concentrations were generally low, with a mean of 0.2 mg L−1 and maximum of 3.3 mg L−1, which may have been partially due to denitrification in the contributing soils. Bioreactors reduced the concentration of nitrate-N in intercepted waters (average 41% reduction). However, removal rates were often limited by nitrate-N availability. Load reduction over the 2018/19 season was just 0.11 kg N ha−1 yr−1. This limited performance was in large part due to the dynamic nature of nitrogen loads in this system. Specifically, a high proportion of the annual nitrogen load occurring during ‘first-flush’ events immediately after fertilization (i.e. 72% during a 10-day period in 2018/19) resulting in considerable bypass flow (i.e. low interception). Our study is the first in the Australian Wet Tropics to assess the annualized performance and total load reductions of in-drain denitrifying bioreactor beds. Although showing their potential, our results highlight the fact that denitrifying bioreactor performance is determined by the hydraulic context of the catchment, and the proportion of the annual nitrate load that can be successfully intercepted