Patient-Provider Race and Sex Concordance: New Insights into Antibiotic Prescribing for Acute Bronchitis

Objective: To examine whether patient and provider concordance by sex or race predicts antibiotic prescribing for acute bronchitis. Study setting: General Internal Medicine and Family Medicine adult clinics at a large safety-net hospital. Study design: We used a logistic model of prescribing as a function of race and sex concordance. Data extraction: Data were extracted from de-identified patient records for those with an acute bronchitis visit between 2008 and 2010. Principal findings: 71% (95% CI 68%-73%) of visits resulted in an antibiotic prescription. Patients in race-concordant visits were 17% (95% CI 8%-25%) less likely to receive a prescription. Conclusions: Race-concordant outpatient visits were associated with more appropriate antibiotic use. Examination of characteristics such as concordance can improve our understanding of the prescribing process and inform stewardship efforts

Elaboração de instrumento para conhecer o preparo e administração de medicamentos via sonda pela equipe de enfermagem / Elaboration of instrument to know practice of preparation and administration of drugs via enteral feeding tube by nursing professionals

Objetivo: Descrever o processo científico de elaboração de um instrumento para conhecer a prática de preparo e administração de medicamentos via sonda por profissionais de enfermagem, em unidades de internação clínica adulto. Métodos: Estudo metodológico, cuja elaboração do instrumento ocorreu a partir da busca sistematizada e intencional de textos na Biblioteca Virtual em Saúde (BIREME), em abril de 2014. Resultados: Utilizaram-se sete estudos provenientes da revisão de literatura, obtendo-se um instrumento com seis questões de caracterização dos participantes e 24 questões para a observação direta do trabalho da equipe de enfermagem. Conclusão: Espera-se contribuir para a produção de pesquisas a respeito de administração de medicamentos via sonda, que servirão para fomentar novos debates no campo da saúde. Além dessas contribuições, os resultados desse estudo poderão ajudar instituições hospitalares no desenvolvimento de guias e protocolos, futuramente, a partir da observação sistemática dos seus trabalhadores

Prioritising research areas for antibiotic stewardship programmes in hospitals: a behavioural perspective consensus paper

SCOPE: Antibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team, organisation and policy levels, evidence from the behavioural sciences is underutilised in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimising effective implementation of ASPs in hospital settings, using a behavioural perspective. METHODS: A workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four high-income countries with publicly-funded health care systems (that is Canada, Germany, Norway and the UK), met face-to-face to agree on broad research priority areas using a structured consensus method. QUESTION ADDRESSED AND RECOMMENDATIONS: The consensus process on the 10 identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimise effective implementation of antibiotic stewardship programmes for hospital inpatients in HICs with publicly-funded health care systems. We suggest and detail, behavioural science evidence-guided research efforts in the following areas: 1) Comprehensively identifying barriers and facilitators to implementing antibiotic stewardship programmes and clinical recommendations intended to optimise antibiotic prescribing; 2) Identifying actors ('who') and actions ('what needs to be done') of antibiotic stewardship programmes and clinical teams; 3) Synthesising available evidence to support future research and planning for antibiotic stewardship programmes; 4) Specifying the activities in current antibiotic stewardship programmes with the purpose of defining a 'control group' for comparison with new initiatives; 5) Defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; 6) Conducting robust evaluations of antibiotic stewardship programmes with built-in process evaluations and fidelity assessments; 7) Defining and designing antibiotic stewardship programmes; 8) Establishing the evidence base for impact of antibiotic stewardship programmes on resistance; 9) Investigating the role and impact of government and policy contexts on antibiotic stewardship programmes; and 10) Understanding what matters to patients in antibiotic stewardship programmes in hospitals. Assessment, revisions and updates of our priority-setting exercise should be considered, at intervals of 2 years. To propose research priority areas in low- and medium income countries (LIMCs), the methodology reported here could be applied

Elaboração de instrumento para conhecer o preparo e administração de medicamentos via sonda pela equipe de enfermagem / Elaboration of instrument to know practice of preparation and administration of drugs via enteral feeding tube by nursing professionals

Objetivo: Descrever o processo científico de elaboração de um instrumento para conhecer a prática de preparo e administração de medicamentos via sonda por profissionais de enfermagem, em unidades de internação clínica adulto. Métodos: Estudo metodológico, cuja elaboração do instrumento ocorreu a partir da busca sistematizada e intencional de textos na Biblioteca Virtual em Saúde (BIREME), em abril de 2014. Resultados: Utilizaram-se sete estudos provenientes da revisão de literatura, obtendo-se um instrumento com seis questões de caracterização dos participantes e 24 questões para a observação direta do trabalho da equipe de enfermagem. Conclusão: Espera-se contribuir para a produção de pesquisas a respeito de administração de medicamentos via sonda, que servirão para fomentar novos debates no campo da saúde. Além dessas contribuições, os resultados desse estudo poderão ajudar instituições hospitalares no desenvolvimento de guias e protocolos, futuramente, a partir da observação sistemática dos seus trabalhadores

Chapter 9 Moral Responsibility and the Justification of Policies to Preserve Antimicrobial Effectiveness

Restrictive policies that limit antimicrobial consumption, including therapeutically justified use, might be necessary to tackle the problem of antimicrobial resistance. We argue that such policies would be ethically justified when forgoing antimicrobials constitutes a form of easy rescue for an individual. These are cases of mild and self-limiting infections in otherwise healthy patients whose overall health is not significantly compromised by the infection. In such cases, restrictive policies would be ethically justified because they would coerce individuals into fulfilling a moral obligation they independently have. However, to ensure that such justification is the strongest possible, states also have the responsibility to ensure that forgoing antimicrobials is as easy as possible for patients by implementing adequate compensation measures

Framing the agricultural use of antibiotics and antimicrobial resistance in UK national newspapers and the farming press

Despite links to animal disease governance, food and biosecurity, rural studies has neglected consideration of how actors make sense of the use of antibiotics in animal agriculture and the implications for animal and human health. As antimicrobial resistance (AMR) has become a high-profile problem, the contribution of animal antibiotics is frequently mentioned in scientific and policy documents but how different agricultural actors interpret its significance is less clear. This paper offers the first social scientific investigation of contestation and consensus surrounding the use of antibiotics in agriculture and their implications for AMR as mediated through mainstream news-media and farming print media in the UK. Frame analysis of four national newspapers and one farming paper reveals three distinct frames. A ‘system failure’ frame is the most frequently occurring and positions intensive livestock production systems as a key contributor to AMR-related crises in human health. A ‘maintaining the status quo’ frame argues that there is no evidence linking antibiotics in farming to AMR in humans and stresses the necessity of (some) antibiotic use for animal health. A third frame – which is only present in the farming media – highlights a need for voluntary, industry-led action on animal antibiotic use in terms of farmer self-interest. Common to all frames is that the relationship between agricultural use of antibiotics and problems posed by AMR is mostly discussed in terms of the implications for human health as opposed to both human and animal health

Hospital adoption of antimicrobial stewardship programmes in Gulf Cooperation Council countries: A review of existing evidence

© 2018 International Society for Chemotherapy of Infection and Cancer Antimicrobial resistance is increasing at an alarming rate in the Gulf Cooperation Council (GCC) owing to the overuse and misuse of antimicrobials. Novel and rare multidrug-resistant strains can spread globally since the region is host to the largest expatriate population in the world as well as a pilgrimage destination for more than 4 million people annually. Adoption of antimicrobial stewardship programmes (ASPs) could improve the use of antimicrobials and reduce antimicrobial resistance in the region. However, despite the established benefits of these interventions, little is known about the level of their adoption in the region and the impact of these programmes on antimicrobial use and resistance. This study aimed to review existing evidence on the level of adoption of ASPs, the facilitators and barriers to their adoption, and outcomes of their adoption in GCC hospitals