Encouraging good antimicrobial prescribing practice: A review of antibiotic prescribing policies used in the South East Region of England

BACKGROUND: Good prescribing practice has an important part to play in the fight against antimicrobial resistance. Whilst it was perceived that most hospitals and Health Authorities possessed an antibiotic policy, a review of antibiotic policies was conducted to gain an understanding of the extent, quality and usefulness of these policies. METHODS: Letters were sent to pharmacists in hospitals and health authorities in across the South East region of the National Health Service Executive (NHSE) requesting antibiotic policies. data were extracted from the policies to assess four areas; antibiotic specific, condition specific, patient specific issues and underpinning evidence. RESULTS: Of a possible 41 hospital trusts and 14 health authorities, 33 trusts and 9 health authorities (HAs) provided policies. Both trust and HA policies had a median publication date of 1998 (trust range 1993-99, HA 1994-99). Eleven policies were undated. The majority of policies had no supporting references for the statements made. All policies provided some details on specific antibiotics. Gentamicin and ciprofloxacin were the preferred aminoglycoside and quinolone respectively with cephalosporins being represented by cefuroxime or cefotaxime in trusts and cephradine or cephalexin in HAs. 26 trusts provided advice on surgical prophylaxis, 17 had meningococcal prophylaxis policies and 11 covered methicillin resistant Staphylococcus aureus (MRSA). There was little information for certain groups such as neonates or children, the pregnant or the elderly. CONCLUSION: There was considerable variation in content and quality across policies, a clear lack of an evidence base and a need to revise policies in line with current recommendations

Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

OBJECTIVES: Kawasaki disease (KD) is an increasingly common vasculitis with risk of coronary artery aneurysms (CAAs). The last UK survey was in 1990, whereas current epidemiology, treatment patterns and complication rates are unknown. The aim of this study was to address this knowledge gap. METHODS: A British Paediatric Surveillance Unit survey in the UK and Ireland from 1 January 2013 to 28 February 2015 ascertained demographics, ethnicity, seasonal incidence, treatment and complication rates. RESULTS: 553 cases were notified: 389 had complete KD, 46 had atypical KD and 116 had incomplete KD; 2 were diagnosed at postmortem with an incidence of 4.55/100 000 children under 5 years, with a male to female ratio of 1.5:1 and a median age of 2.7 years (2.5 months–15 years). Presentation was highest in January and in rural areas. Most were white (64%), and Chinese and Japanese Asians were over-represented as were black African or African mixed-race children. 94% received intravenous immunoglobulin (IVIG). The overall CAA rate was 19%, and all-cardiac complications affected 28%. Those with CAA received IVIG later than in those without (median 10 days vs 7 days). Those under 1 year had fewer symptoms, but the highest CAA rate (39%). Overall 8 of 512 cases (1.6%) had giant CAA, and 4 of 86 cases (5%) under 1 year of age developed giant CAA. Mortality from KD was 0.36%. CONCLUSIONS: The UK and Ireland incidence of KD has increased and is more frequently seen in winter and rural areas. Delayed IVIG treatment is associated with CAA, suggesting earlier and adjunctive primary treatment might reduce complications to prevent CAA, particularly in the very young

Bulk Incorporation with 4‐Methylphenethylammonium Chloride for Efficient and Stable Methylammonium‐Free Perovskite and Perovskite‐Silicon Tandem Solar Cells

Methylammonium (MA)-free perovskite solar cells have the potential for better thermal stability than their MA-containing counterparts. However, the efficiency of MA-free perovskite solar cells lags behind due to inferior bulk quality. In this work, 4-methylphenethylammonium chloride (4M-PEACl) is added into a MA-free perovskite precursor, which results in greatly enhanced bulk quality. The perovskite crystal grains are significantly enlarged, and defects are suppressed by a factor of four upon the incorporation of an optimal concentration of 4M-PEACl. Quasi-2D perovskites are formed and passivate defects at the grain boundaries of the perovskite crystals. Furthermore, the perovskite surface chemistry is modified, resulting in surface energies more favorable for hole extraction. This facile approach leads to a steady state efficiency of 23.7% (24.2% in reverse scan, 23.0% in forward scan) for MA-free perovskite solar cells. The devices also show excellent light stability, retaining more than 93% of the initial efficiency after 1000 h of constant illumination in a nitrogen environment. In addition, a four-terminal mechanically stacked perovskite-silicon tandem solar cell with champion efficiency of 30.3% is obtained using this MA-free composition. The encapsulated tandem devices show excellent operational stability, retaining more than 98% of the initial performance after 42 day/night cycles in an ambient atmosphere