Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review & revise’ experience

Background: We aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review & revise’ which is a key strategy to minimise antibiotic overuse in hospitals. Methods: In this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study. Results: Participants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions. Conclusions: This study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review & revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received

Separation between coherent and turbulent fluctuations. What can we learn from the Empirical Mode Decomposition?

The performances of a new data processing technique, namely the Empirical Mode Decomposition, are evaluated on a fully developed turbulent velocity signal perturbed by a numerical forcing which mimics a long-period flapping. First, we introduce a "resemblance" criterion to discriminate between the polluted and the unpolluted modes extracted from the perturbed velocity signal by means of the Empirical Mode Decomposition algorithm. A rejection procedure, playing, somehow, the role of a high-pass filter, is then designed in order to infer the original velocity signal from the perturbed one. The quality of this recovering procedure is extensively evaluated in the case of a "mono-component" perturbation (sine wave) by varying both the amplitude and the frequency of the perturbation. An excellent agreement between the recovered and the reference velocity signals is found, even though some discrepancies are observed when the perturbation frequency overlaps the frequency range corresponding to the energy-containing eddies as emphasized by both the energy spectrum and the structure functions. Finally, our recovering procedure is successfully performed on a time-dependent perturbation (linear chirp) covering a broad range of frequencies.Comment: 23 pages, 13 figures, submitted to Experiments in Fluid

Interleukin-2 therapy in patients with HIV infection

BACKGROUND Used in combination with antiretroviral therapy, subcutaneous recombinant interleukin-2 raises CD4+ cell counts more than does antiretroviral therapy alone. The clinical implication of these increases is not known. METHODS We conducted two trials: the Subcutaneous Recombinant, Human Interleukin-2 in HIV-Infected Patients with Low CD4+ Counts under Active Antiretroviral Therapy (SILCAAT) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT). In each, patients infected with the human immunodeficiency virus (HIV) who had CD4+ cell counts of either 50 to 299 per cubic millimeter (SILCAAT) or 300 or more per cubic millimeter (ESPRIT) were randomly assigned to receive interleukin-2 plus antiretroviral therapy or antiretroviral therapy alone. The interleukin-2 regimen consisted of cycles of 5 consecutive days each, administered at 8-week intervals. The SILCAAT study involved six cycles and a dose of 4.5 million IU of interleukin-2 twice daily; ESPRIT involved three cycles and a dose of 7.5 million IU twice daily. Additional cycles were recommended to maintain the CD4+ cell count above predefined target levels. The primary end point of both studies was opportunistic disease or death from any cause. RESULTS In the SILCAAT study, 1695 patients (849 receiving interleukin-2 plus antiretroviral therapy and 846 receiving antiretroviral therapy alone) who had a median CD4+ cell count of 202 cells per cubic millimeter were enrolled; in ESPRIT, 4111 patients (2071 receiving interleukin-2 plus antiretroviral therapy and 2040 receiving antiretroviral therapy alone) who had a median CD4+ cell count of 457 cells per cubic millimeter were enrolled. Over a median follow-up period of 7 to 8 years, the CD4+ cell count was higher in the interleukin-2 group than in the group receiving antiretroviral therapy alone--by 53 and 159 cells per cubic millimeter, on average, in the SILCAAT study and ESPRIT, respectively. Hazard ratios for opportunistic disease or death from any cause with interleukin-2 plus antiretroviral therapy (vs. antiretroviral therapy alone) were 0.91 (95% confidence interval [CI], 0.70 to 1.18; P=0.47) in the SILCAAT study and 0.94 (95% CI, 0.75 to 1.16; P=0.55) in ESPRIT. The hazard ratios for death from any cause and for grade 4 clinical events were 1.06 (P=0.73) and 1.10 (P=0.35), respectively, in the SILCAAT study and 0.90 (P=0.42) and 1.23 (P=0.003), respectively, in ESPRIT. CONCLUSIONS Despite a substantial and sustained increase in the CD4+ cell count, as compared with antiretroviral therapy alone, interleukin-2 plus antiretroviral therapy yielded no clinical benefit in either study. (ClinicalTrials.gov numbers, NCT00004978 [ESPRIT] and NCT00013611 [SILCAAT study].

Renormalization group in the infinite-dimensional turbulence: third-order results

The field theoretic renormalization group is applied to the stochastic Navier-Stokes equation with the stirring force correlator of the form k^(4-d-2\epsilon) in the d-dimensional space, in connection with the problem of construction of the 1/d expansion for the fully developed fluid turbulence beyond the scope of the standard epsilon expansion. It is shown that in the large-d limit the number of the Feynman diagrams for the Green function (linear response function) decreases drastically, and the technique of their analytical calculation is developed. The main ingredients of the renormalization group approach -- the renormalization constant, beta function and the ultraviolet correction exponent omega, are calculated to order epsilon^3 (three-loop approximation). The two-point velocity-velocity correlation function, the Kolmogorov constant C_K in the spectrum of turbulent energy and the inertial-range skewness factor S are calculated in the large-d limit to third order of the epsilon expansion. Surprisingly enough, our results for C_K are in a reasonable agreement with the existing experimental estimates.Comment: 30 pages with EPS figure

Amplitude equations and pattern selection in Faraday waves

We present a systematic nonlinear theory of pattern selection for parametric surface waves (Faraday waves), not restricted to fluids of low viscosity. A standing wave amplitude equation is derived from the Navier-Stokes equations that is of gradient form. The associated Lyapunov function is calculated for different regular patterns to determine the selected pattern near threshold. For fluids of large viscosity, the selected wave pattern consists of parallel stripes. At lower viscosity, patterns of square symmetry are obtained in the capillary regime (large frequencies). At lower frequencies (the mixed gravity-capillary regime), a sequence of six-fold (hexagonal), eight-fold, ... patterns are predicted. The regions of stability of the various patterns are in quantitative agreement with recent experiments conducted in large aspect ratio systems.Comment: 12 pages, 1 figure, Revte

Molecular Dynamics Simulation Study of Interaction between Model Rough Hydrophobic Surfaces

We study some aspects of hydrophobic interaction between molecular rough and flexible model surfaces. The model we use in this work is based on a model we used previously (Eun, C.; Berkowitz, M. L. J. Phys. Chem. B 2009, 113, 13222-13228), when we studied the interaction between model patches of lipid membranes. Our original model consisted of two graphene plates with attached polar headgroups; the plates were immersed in a water bath. The interaction between such plates can be considered as an example of a hydrophilic interaction. In the present work we modify our previous model by removing the charge from the zwitterionic headgroups. As a result of this procedure, the plate character changes; it becomes hydrophobic. By separating the total interaction (or potential of mean force, PMF) between plates into the direct and the water-mediated interactions we observe that the latter changes from repulsive to attractive, clearly emphasizing the important role of water as a medium. We also investigate the effect of roughness and flexibility of the headgroups on the interaction between plates and observe that roughness enhances the character of the hydrophobic interaction. The presence of a dewetting transition in a confined space between charge-removed plates confirms that the interaction between plates is strongly hydrophobic. In addition, we notice that there is a shallow local minimum in the PMF in case of charge-removed plates. We find that this minimum is associated with the configurational changes that flexible headgroups undergo, as the two plates are brought together.Comment: 27 pages, 9 figure

When assessment defines the content—understanding goals in between teachers and policy

© 2020 The Authors. The Curriculum Journal published by John Wiley & Sons Ltd on behalf of British Educational Research Association.Education policy development internationally reflect a widespread expansion of learning outcome orientation in policy, curricula and assessment. In this paper, teachers’ perceptions about their work are explored, as goals and assessment play a more prominent role driven by the introduction of a learning outcomes‐oriented system. This is investigated through interviews of Norwegian teachers and extensive policy analysis of Norwegian policy documents. The findings indicate that the teachers are finding ways to negotiate and adjust to the language in the policies investigated in this study. Furthermore, the findings show that the teachers have developed their professional language according to the policies. The teachers referred to their self‐made criteria and goal sheets as central tools in explicating what is to be learned. In many ways, the tools for assessment, thus determine the content of education as well as what is valued in the educational system.publishedVersio

Women's experience of intrapartum transfer from a Western Australian birth centre co-located to a tertiary maternity hospital

© 2016 Kuliukas et al. Background: The aim of this Western Australian study was to describe the overall labour and birth experience of women who were transferred during the first and second stages of labour from a low risk woman-centred, midwifery-led birth centre to a co-located tertiary maternity referral hospital. Methods: Using a descriptive phenomenological design, fifteen women were interviewed up to 8weeks post birth (July to October, 2013) to explore their experience of the intrapartum transfer. Giorgi's method of analysis was used. Results: The following themes and subthemes emerged: 1) The midwife's voice with subthemes, a) The calming effect and b) Speaking up on my behalf; 2) In the zone with subthemes, a) Hanging in there and b) Post birth rationalizing; 3) Best of both worlds with subthemes a) The feeling of relief on transfer to tertiary birth suite and b) Returning back to the comfort and familiarity of the birth centre; 4) Lost sense of self; and 5) Lost birth dream with subthemes a) Narrowing of options and b) Feeling of panic. Women found the midwife's voice guided them through the transfer experience and were appreciative of continuity of care. There was a sense of disruption to expectations and disappointment in not achieving the labour and birth they had anticipated. There was however appreciation that the referral facility was nearby and experts were close at hand. The focus of care altered from woman to fetus, making women feel diminished. Women were glad to return to the familiar birth centre after the birth with the opportunity to talk through and fully understand their labour journey which helped them contextualise the transfer as one part of the whole experience. Conclusions: Findings can inform midwives of the value of a continuity of care model within a birth centre, allowing women both familiarity and peace of mind. Maternity care providers should ensure that the woman remains the focus of care after transfer and understand the significance of effective communication to ensure women are included in all care discussions