21 research outputs found
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 scientiïŹc 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
Recommended from our members
Preferred orientation relationship between Cu6Sn5 scallop-type grains and Cu substrate in reactions between molten Sn-based solders and Cu
A strong crystallographic orientation relationship between the Cu6Sn5 scallop-type grains and their Cu substrate has been found by synchrotron micro-X-ray diffraction study. Even though the crystal structures of Cu6Sn5 (monoclinic) and Cu (face-centered-cubic) are very different, angular distributions of crystallographic directions between Cu6Sn5 and Cu revealed a strong orientation relationship. Both SnPb solder and pure Sn showed the same result, indicating that this is general behavior between Sn-based solders and Cu. The strong orientation relation suggests that Cu6Sn5 forms prior to Cu3Sn in the wetting reactions. A total of six different orientation relationships were found. In all the cases, the [1 01] direction of Cu6Sn5 preferred to be parallel to the [110] direction of Cu with a misfit of 0.24percent. Due to pseudohexagonal structure of the Cu6Sn5 , the six relationships can be categorized into two groups. From the orientation distribution, one group was found to be less rigid then the other group. (18 References)
Recommended from our members
Preferred orientation relationship between Cu6Sn5 scallop-type grains and Cu substrate in reactions between molten Sn-based solders and Cu
A strong crystallographic orientation relationship between the Cu6Sn5 scallop-type grains and their Cu substrate has been found by synchrotron micro-X-ray diffraction study. Even though the crystal structures of Cu6Sn5 (monoclinic) and Cu (face-centered-cubic) are very different, angular distributions of crystallographic directions between Cu6Sn5 and Cu revealed a strong orientation relationship. Both SnPb solder and pure Sn showed the same result, indicating that this is general behavior between Sn-based solders and Cu. The strong orientation relation suggests that Cu6Sn5 forms prior to Cu3Sn in the wetting reactions. A total of six different orientation relationships were found. In all the cases, the [1 01] direction of Cu6Sn5 preferred to be parallel to the [110] direction of Cu with a misfit of 0.24percent. Due to pseudohexagonal structure of the Cu6Sn5 , the six relationships can be categorized into two groups. From the orientation distribution, one group was found to be less rigid then the other group. (18 References)