Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries:results of an internet-based global point prevalence survey

Summary: Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux

Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study

Background. It is well-known that the use of care services is most intensive in the last phase of life. However, so far only a few determinants of end-of-life care utilization are known. The aims of this study were to describe the utilization of acute and long-term care among older adults in their last year of life as compared to those not in their last year of life, and to examine which of a broad range of determinants can account for observed differences in care utilization. Methods. Data were used from the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified population-based cohort of 3107 persons aged 55 ? 85 years at baseline and representative of the Netherlands, follow-up cycles took place at 3, 6 and 9 years. Those who died within one year directly after a cycle were defined as the "end-of-life group" (n = 262), and those who survived at least three years after a cycle were defined as the "survivors". Utilization of acute and long-term care services, including professional and informal care, were recorded at each cycle, as well as a broad range of health-related and psychosocial variables. Results. The end-of-life group used more care than the survivors. In the younger-old this difference was most pronounced for acute care, and in the older-old, for long-term care. Use of both acute and long-term home care in the last year of life was fully accounted for by health problems. Use of institutional care at the end of life was partly accounted for by health problems, but was not fully explained by the determinants included. Conclusion. This study shows that severity of health problems are decisive in the explanation of the increase in use of care services towards the end-of-life. This information is essential for an appropriate allocation of professional health care to the benefit of older persons themselves and their informal caregivers. © 2009 Pot et al; licensee BioMed Central Ltd

The Business Value of Health

For organizational development that is future-oriented, enterprises increasingly need qualified, motivated and efficient workers who are able and willing to contribute actively to technical and organizational innovations. Furthermore, customers and consumers are increasingly interested in healthy products and services. Therefore, health has become a (potential) business value of strategic importance. In interaction with all relevant stakeholders, an approach was developed for companies that want to manage their health impact in a proactive and preventive manner. The approach was termed Integral Health Management (IHM). IHM forms a strategic approach for reducing the costs of sickness absence and working disability, while the productivity and resilience of the company and its employees are increased. This brings the company direct economic benefits. Finally, it is of prime interest for employees to remain physically and mentally healthy and employable. The IHM approach distinguishes seven lines of development: (1) health as a strategic company interest; (2) the realization of a healthy primary process; (3) a safe and sound physical (work) environment; (4) an inspiring social (work) environment; (5) vital people; (6) a sound relationship with the immediate organizational environment and local community, and (7) healthy products and/or services. The inter-relationships between the seven development lines are essential for combining an improvement of the business impact on health with a strategic interest of companies and organizations. The seven lines of IHM development can easily be linked to the European Foundation for Quality Management's European Excellence Model

Social Innovation of Work and Employment

© 2012 Springer-Verlag Berlin Heidelberg. All rights reserved. Social innovation of work and employment are prerequisites to achieve the EU2020 objectives of smart, sustainable and inclusive growth. It covers labour market innovation on societal level and workplace innovation on organisational level. This paper focuses on the latter. Workplace innovations are social both in their ends (quality of working life, well-being and development of talents together with organisational performance) and in their means (employee participation and empowerment). Complementary to technological innovations they regard innovations in social aspects of organisations such as work organisation, HRM and work relations. Workplace innovation - or innovative workplaces as it is sometimes called - deserves to be better incorporated in EU policies, as also has been recommended by the European Economic and Social Committee and the OECD. Some countries have experienced the benefits of national campaigns already.edition: 1status: publishe

Workplace innovation and its relations to performance and effects for employees

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Allgemeinverbindlichkeitserklärung von Wettbewerbsregeln

Allgemeinverbindlichkeitserklärung von Wettbewerbsregeln : Möglichkeiten u. Grenzen e. Reformierung d. Vorschriften über Wettbewerbsregeln nach d. §§ 28 ff. GWB. - München : Florentz, 1983. - LIX, 280 S. - Zugl.: Augsburg, Univ., Diss. - (Rechtswissenschaftliche Forschung und Entwicklung ; 39

Implementing Workplace Innovation Across Europe: Why, How and What?

This article discusses the implementation of workplace innovation (WPI) in European companies. Based on a 51-case study research in 10 EU Member States this article addresses four questions: 1] Why do companies apply workplace innovation; 2] What are different motives for management, employees and employee representatives to implement WPI; 3] What are important leverage factors for the implementation of WPI; and 4] What is known about the (expected) effects according to management, employees and employee representatives? Results show that successful WPI is an interplay of management-driven business goals and employee-driven quality of work goals. Companies differ in their implementing strategies but constructive cooperation between management and employees is a key success factor for successful WPI