Experiences from the Missouri Antimicrobial Stewardship Collaborative: A mixed methods study

We performed a mixed-methods study to evaluate antimicrobial stewardship program (ASP) uptake and to assess variability of program implementation in Missouri hospitals. Despite increasing uptake of ASPs in Missouri, there is wide variability in both the scope and sophistication of these programs

Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: A systematic review

Background The role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people. Methods A systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies. Results Of 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none. Conclusions More research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence

Conjunctival complications related to Ahmed glaucoma valve insertion

PURPOSE: Conjunctival complications may occur after glaucoma drainage device surgery. We analyzed the frequency, risk factors, management and outcomes of Ahmed glaucoma valve (AGV)-related conjunctival complications. METHODS: Retrospective review of postoperative conjunctival complications in patients undergoing AGV insertion. Only subjects with >/=1-year follow-up were included. RESULTS: The charts of 158 subjects with a median age of 64+/-16.2 years were reviewed. Median follow-up was 43.5 months (range, 12 to 103 mo). Fifty-three (33.5%) wound dehiscences and 14 (8.9%) device exposures were diagnosed 31.6+/-35.7 and 996+/-735 days after procedure, respectively (P<0.001). Ninety-one subjects (57.6%) had no conjunctival complications. This uncomplicated group used 3.3 (+/-1.1) [95% confidence interval (CI): 3.07, 3.51] hypotensive medications before surgery as compared with 3.8 (+/-1.1) (95% CI: 3.48, 4.10) and 3.9 (+/-0.9) (95% CI: 3.36, 4.36) for dehiscence and exposure groups, respectively (P=0.01). The inferonasal quadrant was associated with the highest rate of dehiscences (4/7, 57.1%) (95% CI: 18.4, 90.1), followed by the inferotemporal quadrant (30/65, 46.2%) (95% CI: 33.1, 58.2), the superotemporal (15/61, 24.6%) (95% CI: 12.9, 33.8), and the superonasal (4/25, 16%) (95% CI: 10.9-52.0; P<0.0073). There were no differences in dehiscence and exposure rates between limbal versus fornix-based approaches (P=0.54; 95% CI: 24.8-44.9, 24.4-45.7, 5.9-19.6, 3-45.1, respectively). Forty-eight (90.6%) dehiscent wounds resolved with conservative management and 5 were resutured, whereas all exposed devices were managed surgically. CONCLUSIONS: Conjunctival dehiscence is usually a benign, common complication after AGV insertion. It does not need repair as long as the tube is well covered. AGV tube or plate exposures are less common, occur later and were promptly repaired as per current practice. Important factors predisposing to these problems include a greater number of preoperative hypotensive medications and the implantation quadrant