Quality indicators for responsible antibiotic use in the inpatient setting: a systematic review followed by an international multidisciplinary consensus procedure

Background This study was conducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project and aimed to develop generic quality indicators (QIs) for responsible antibiotic use in the inpatient setting. Methods A RAND-modified Delphi method was applied. First, QIs were identified by a systematic review. A complementary search was performed on web sites of relevant organizations. Duplicates were removed and disease and patient-specific QIs were combined into generic indicators. The relevance of these QIs was appraised by a multidisciplinary international stakeholder panel through two questionnaires and an in-between consensus meeting. Results The systematic review retrieved 70 potential generic QIs. The QIs were appraised by 25 international stakeholders with diverse backgrounds (medical community, public health, patients, antibiotic research and development, regulators, governments). Ultimately, 51 QIs were selected in consensus. QIs with the highest relevance score included: (i) an antibiotic plan should be documented in the medical record at the start of the antibiotic treatment; (ii) the results of bacteriological susceptibility testing should be documented in the medical record; (iii) the local guidelines should correspond to the national guidelines but should be adapted based on local resistance patterns; (iv) an antibiotic stewardship programme should be in place at the healthcare facility; and (v) allergy status should be taken into account when antibiotics are prescribed. Conclusions This systematic and stepwise method combining evidence from literature and stakeholder opinion led to multidisciplinary international consensus on generic inpatient QIs that can be used globally to assess the quality of antibiotic use

A never ending story: interaction patterns and economic development

Industrial marketing and purchasing is an interesting phenomenon. On the surface it appears as very mundane, a simple day-to-day activity performed by purchasers, sales personnel, and technical specialists; i.e. most often by professions representing ‘middle management’. As such, it is not surrounded with any of the greater prestige ascribed to more hyped business activities, such as financing and strategy. Furthermore, industrial marketing and purchasing is seldom recognised as being of any greater importance for society at large. In policy circles, for example the UN, OECD and EU, where they stress the importance of innovation, productivity and growth, industrial marketing and purchasing is rarely mentioned as a related phenomenon . Behind the scenes, however, an empirical, much more challenging view is outlined. When the content and the effects of industrial marketing and purchasing processes are scrutinised empirically, these activities appear as perhaps the most important source for business development, industrial renewal, efficiency and innovation. From this perspective, industrial marketing and purchasing seems to be a critical phenomenon for creating prosperity for both companies and communities and for general economic growth. It is this role of industrial marketing and purchasing that we highlight and discuss in this article. Based on extensive empirical research results, we argue that interaction is the main ingredient in these processes. This implies that the supplier-customer interaction has a central development function for efficiency and innovativeness, for companies as well as for the economy at large. Thus, there is a strong need to include and consider this key engine for dynamics (and its role in developing materialised structures as well as ideas) in any theoretical study of economic development

A competing or co-operating cluster or seven decades of combinatory resources? What's behind a prospering biotech valley?

The Stockholm-Uppsala region is claimed to be one of the worlds' most expansive biomedical regions, both when it concerns scientific and business activities. Or, as it was formulated in a special section in Nature, October 2001: p. 6. "A world class scientific & business environment". A common explanation to the growing commercial activities in the Uppsala region has been a critical event within the cluster; the restructuring the pharmaceutical company Pharmacia. However, research focus on how resources are combined results in an almost opposite picture. It is in interaction with stable and healthy industrial and academic units that new projects/companies develop. Furthermore, this interacting seems not to be restricted to a biomedical cluster, but stretches over several different places and industrial areas.Interaction Knowledge development Value creation Cluster borders Networks