Factors influencing palliative care in advanced dementia : A systematic review

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Background: Dementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs. Aim: To investigate the factors influencing provision of PC services for people with advanced dementia. Methods: A systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed, CINAHL and Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data. Key findings: In total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning. Conclusions: Even though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.Peer reviewe

A study of oral counselling and audit processes for dispensed medications in community pharmacy.

The concept of professional audit was introduced to the pharmacy profession by the Royal Pharmaceutical Society in 1992. Since then audit has been promoted as a tool for raising the standard of practice and improving the quality of patient care. The aim of this study was to develop and implement an audit cycle as a tool to explore a community pharmacy service whilst assessing the impact of audit on the service provision and examining its acceptability and feasibility in community settings. The study was based on six stages of an audit cycle. The first stage comprised of semi- structured interviews with community pharmacists, in which provision of oral counselling for dispensed medications was prioritised. This was a service without an universally accepted definition, an issue which was addressed in stage two of the study using a Nominal Group technique. In stage three, the level and content of oral advice given for dispensed medications in community pharmacies were established. It was found that 33% of all the dispensed medications received oral advice in community pharmacies. Standards for the extent of advice for repeat medications as well as items dispensed for the first time were set in stage four which were implemented in the next stage. Feasibility and acceptability of the audit processes and tools devised during the study were examined in a group of self selected pharmacists in stage six of this study. Analysing the findings indicated that the provision of oral advice for dispensed medications was influenced by multitude of variables including the ownership or employment status of pharmacist, number of years of post registration as well as medication status as a repeat or new. The only variable remaining significant in predicting community pharmacists counselling behaviour for different patient groups as well as various therapeutic groups was medication status as repeat or new. Implementation of the audit cycle resulted in pharmacists meeting the agreed standards for provision of counselling demonstrating that audit can be a flexible tool which can accommodate different levels of practice and still achieve an improvement of standards. Implementation of audit continually raises standards of pharmacists' counselling services helping them to meet the public expectations as well as preparing pharmacists to face the challenges involved in embarking on the new roles such as provision of medicine management and the repeat dispensing services as proposed by the Government

WHO AWaRe Classification for Antibiotic Stewardship: Tackling Antimicrobial Resistance - A Descriptive Study from an English NHS Foundation Trust Prior to and During the COVID-19 Pandemic

© 2023 Abdelsalam Elshenawy, Umaru and Aslanpour. This is an open-access accepted manuscript version of an article which has been published in final form at https://doi.org/10.3389/fmicb.2023.1298858Antimicrobial resistance (AMR) is a silent and rapidly escalating pandemic, presenting a critical challenge to global health security. During the pandemic, this study was undertaken at a NHS Foundation Trust in the United Kingdom to explore antibiotic prescribing trends for respiratory tract infections (RTIs), including pneumonia, and the COVID-19 pandemic across the years 2019 and 2020. This study, guided by the WHO’s AWaRe classification, sought to understand the impact of the pandemic on antibiotic prescribing and antimicrobial stewardship (AMS). The research methodology involved a retrospective review of medical records from adults aged 25 and older admitted with RTIs, including pneumonia, in 2019 and 2020. The application of the AWaRe classification enabled a structured description of antibiotic use. The study evaluated antibiotic use in 640 patients with RTIs. Notably, it observed a slight increase in the use of amoxicillin/clavulanic acid and a substantial rise in azithromycin prescriptions, highlighting shifts in prescribing trends. Despite these changes, some antibiotics displayed steady consumption rates. These findings highlight the importance of understanding antibiotic use patterns during the AMR threat. The increase in the usage of “Watch” category antibiotics during the pandemic emphasises the urgency of robust AMS measures. The research confirms that incorporating the AWaRe classification in prescribing decisions is crucial for patient safety and combating antibiotic misuse. This study provides essential insights into the changing landscape of antibiotic prescribing during a global health crisis, reinforcing the necessity for ongoing AMS vigilance to effectively address AMR challenges.Peer reviewe

Performance Evaluation Metrics for Cloud, Fog and Edge Computing: A Review, Taxonomy, Benchmarks and Standards for Future Research

Optimization is an inseparable part of Cloud computing, particularly with the emergence of Fog and Edge paradigms. Not only these emerging paradigms demand reevaluating cloud-native optimizations and exploring Fog and Edge-based solutions, but also the objectives require significant shift from considering only latency to energy, security, reliability and cost. Hence, it is apparent that optimization objectives have become diverse and lately Internet of Things (IoT)-specific born objectives must come into play. This is critical as incorrect selection of metrics can mislead the developer about the real performance. For instance, a latency-aware auto-scaler must be evaluated through latency-related metrics as response time or tail latency; otherwise the resource manager is not carefully evaluated even if it can reduce the cost. Given such challenges, researchers and developers are struggling to explore and utilize the right metrics to evaluate the performance of optimization techniques such as task scheduling, resource provisioning, resource allocation, resource scheduling and resource execution. This is challenging due to (1) novel and multi-layered computing paradigm, e.g., Cloud, Fog and Edge, (2) IoT applications with different requirements, e.g., latency or privacy, and (3) not having a benchmark and standard for the evaluation metrics. In this paper, by exploring the literature, (1) we present a taxonomy of the various real-world metrics to evaluate the performance of cloud, fog, and edge computing; (2) we survey the literature to recognize common metrics and their applications; and (3) outline open issues for future research. This comprehensive benchmark study can significantly assist developers and researchers to evaluate performance under realistic metrics and standards to ensure their objectives will be achieved in the production environments

Shorter and Longer Antibiotic Durations for Respiratory Infections: To Fight Antimicrobial Resistance—A Retrospective Cross-Sectional Study in a Secondary Care Setting in the UK

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/As antimicrobial resistance (AMR) escalates globally, examining antibiotic treatment durations for respiratory infections becomes increasingly pertinent, especially in the context of the COVID-19 pandemic. In a UK secondary care setting, this retrospective study was carried out to assess the appropriateness of antibiotic treatment durations—shorter (≤5 days) versus longer (6–7 days and >8 days)—for respiratory tract infections (RTIs) in 640 adults across 2019 and 2020, in accordance with local antimicrobial guidelines. The analysis employed these guidelines and clinical evidence to examine the effectiveness and suitability of antibiotic prescribing practices. This study considered the ‘Shorter Is Better’ approach, noting an increased rate of patient discharges associated with shorter antibiotic regimens (≤5 days). It further demonstrates that shorter treatments are as effective as longer ones for conditions such as COPD exacerbation, COVID-19 pneumonia, and hospital-acquired pneumonia (HAP), except in cases of community-acquired pneumonia (CAP) and unspecified diagnoses. Nevertheless, this study raises concerns over an observed increase in mortality risk with shorter treatment durations. Although these mortality differences were not statistically significant and might have been influenced by the COVID-19 pandemic, the need for extended research with a larger sample size is highlighted to confirm these findings. This study also emphasises the critical need for accurate and specific diagnoses and considering risk assessments at admission, advocating for tailored, evidence-based antibiotic prescribing to ensure patient safety. It contributes to antimicrobial stewardship efforts by reinforcing the importance of adapting antibiotic use to current healthcare challenges and promoting a global commitment to fight antimicrobial resistance. This approach is crucial for enhancing patient outcomes and saving lives on a global scale.Peer reviewe

Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: Antimicrobial resistance (AMR), a major global public health threat that has caused 1.2 million deaths, calls for immediate action. Antimicrobial stewardship (AMS) promotes judicious antibiotic use, but the COVID-19 pandemic increased AMR by 15%. Although there are paramount data on the impact of COVID-19 on AMS, empirical data on AMS implementation during the pandemic are lacking. This study aimed to investigate antibiotic prescribing and AMS implementation prior to the pandemic (PP) in 2019 and during the pandemic (DP) in 2020 at one NHS Foundation Trust in England. Method: This cross-sectional study involved adult patients admitted to one NHS Foundation Trust in England, focusing on those prescribed antibiotics for respiratory tract infections (RTIs). This included cases of pneumonia in both years under study and COVID-19 cases in 2020. Data were retrospectively extracted from medical records using a validated data extraction tool, which was developed based on the ‘Start Smart, Then Focus’ (SSTF) approach of the AMS Toolkit. Results: This study included 640 patients. The largest age group in the study was 66–85 years, comprising 156 individuals (48.8%) PP in 2019 and 148 (46.3%) DP in 2020. CAP was the predominant diagnosis, affecting approximately 126 (39.4%) PP and 136 (42.5%) DP patients. Regarding the timing of antibiotic review post-admission, reviews were typically conducted within 48–72 h, with no significant difference between 2019 and 2020, with an odds ratio of 1.02 (95% CI 0.97 to 1.08, p-Value = 0.461). During the pandemic, there was a significant difference in both AMS interventions, ‘Continue Antibiotics’ and ‘De-escalation’, with odds ratios of 3.36 (95% CI 1.30–9.25, p = 0.015) and 2.77 (95% CI 1.37–5.70, p = 0.005), respectively. Conclusion: This study emphasises the need for robust AMS to ensure adherence to guidelines. It acknowledges the impact of comorbidities and advocates for sustained stewardship efforts to combat resistance both during and after the pandemic era.Peer reviewe

Novel survey distribution methods: impact on antimicrobial resistance research outcomes

© 2024 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Peer reviewe

Medicines Related Problems (MRPs) originating in Primary care settings in Older Adults - A Systematic Review

© The Author(s) 2021. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/)Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.Peer reviewe

A systematic review of counterfeit and substandard medicines in field quality surveys

This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpCounterfeit and substandard medicines pose a great threat to public health and the economy worldwide. Reports suggest their prevalence is increasing and can no longer be ignored. A detailed account on the current nature of the problem and identification of knowledge limitations in terms of geographical location, medicine classes, and type of medicine analysis performed is not available. Our objective was to systematically review articles that have reported investigations of counterfeit and substandard medicinesPeer reviewe

Status and trends of e-Health tools in Kuwait: A narrative review

Background: Kuwait is witnessing an alarming increase in diabetes and high prevalence of multi-drug resistant strains. E-Health solutions have the potential to deliver timely, quality and cost-effective solutions to these public health challenges. However, little is known about the existing e-health solutions in Kuwait. Aims: This study aims to explore the current e-health tools and applications in Kuwait, and the factors that affect their adoption and implementation. Methods: A literature search was carried out for articles on e-health in Kuwait using the following electronic databases: PubMed, Google Scholar, Scopus, Web of Science, CINAHL, Medline and Proquest. Reference lists of all included items were additionally searched. A manual search was also conducted using WHO EMRO Virtual Health Sciences Library and MOH policies and standards. Results: 1121 papers were retrieved from databases and 29 papers were added from manual searching of reference lists. 495 papers were considered for review after the removal of duplicates. Thirty studies met the inclusion/exclusion criteria. Implementing electronic health records and establishing a childhood-onset diabetes registry are the main e-Health achievements to date. Implementing e-Health tools has been hindered by various socio-political, financial, infrastructural, organizational, technical and individual barriers. Conclusion: The modest e-Health achievements warrant bigger and faster implementation steps focusing on developing an e-Health policy framework and drawing an implementation road-map that is evidence based and research informed