Hospital antimicrobial stewardship program implementation in the Gulf Cooperation Council States: a systematic review of evidence of implementation.

Background and Purpose: Antimicrobial resistance (AMR) has led to the development of initiatives aimed at optimizing antimicrobial use. Co-ordinated interventions for promoting and monitoring safe and effective use of antimicrobials are termed antimicrobial stewardship programs (ASP). While there are several systematic reviews on aspects of ASP, none have focused on the processes and outcomes of implementation in the Gulf Cooperation Council (GCC) States. The aim was to critically appraise, synthesize and present the available evidence on ASP implementation in the GCC States in relation to the interventions, reported outcomes and facilitators and barriers to implementation. Methodology: A systematic review protocol was developed based on PRISMA-P guidelines and registered with PROSPERO (International Prospective Register of Systematic Reviews). Electronic databases (MEDLINE, CINAHL, International Pharmaceutical Abstracts, Cochrane database and Web of Science) were searched using pre-specified terms for peer-reviewed publications in English from 2010 onward. Quality assessment, data extraction and synthesis were independently performed by two reviewers. ASP interventions were compared to the Centre of Disease Control and Prevention (CDC) checklist, a systematic assessment of key ASP interventions. Results and Discussions: ASP interventions implementation in line with CDC checklist were weak, with the majority of studies reporting only one third of the expected CDC criteria. The most commonly reported outcomes were antibiotic consumption, with very little reporting of any microbiological, clinical and economic outcomes. Key facilitators were physician and organisation support. Barriers reported included the lack of dedicated staff and lack of sufficient funding for implementation. Conclusions: There is a lack of robust studies of ASP implementation in the GCC States. Such studies should focus on CDC criteria in developing the ASP intervention and report valid and reliable outcomes including microbiological, clinical and economic outcomes. There is also a need for qualitative research to focus on facilitators, barriers and solutions to implementation

Government Antipoverty Programmes and Small and Medium Enterprises Performance in Nigeria

Over the years the Nigerian government has come up with a number of antipoverty programmes aimed at fighting poverty by financing her growth induced sector- SMEs, yet, the country is still witnessing rising levels of poverty, corruption, unemployment, low human capital development, inadequate commercial bank credit, high lending rate and low standard of education, thus, affecting the performance of small scale enterprises. In other to address the conundrum, this study examines the effect of government antipoverty programmes on small and medium enterprises’ performance in Nigeria using econometric regression model of the Ordinary Least Square (OLS). From the regression analysis, the result showed that government antipoverty programmes, corruption, unemployment, human capital development, capital, lending rate and education conformed to the a priori expectations of the study and were statistically significant in explaining the SMEs’ performance in Nigeria. The study recommends that: In order to enhance the success of government antipoverty programmes in Nigeria, the programme should be implemented through the local government on the platform of cooperative societies so that the target population will benefit from it. A blueprint for handling corrupt officials should be embedded in the policy framework of the programme before implementation. The programme should be targeted at unemployed youths with real identity rather than sinking back the funds into the pockets of corrupt officials. Every intending beneficiary should be subjected to training/skill acquisition programme and occasional workshop in the line of trade he/she wants to venture into. Adequate funding at a good lending rate should be provided for any beneficiary of the programme in order to enhance the performance of the business in Nigeria

Use of normalization process theory to explore key stakeholders’ perceptions of the facilitators and barriers to implementing electronic systems for medicines management in hospital settings.

Background: Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. Objective: To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing systems, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings using Normalization Process Theory as a theoretical framework. Methods: Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two Information Technology managers. Results: Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multi-disciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Conclusions: Many themes that are potentially transferable to other national settings have been identified and extend the evidence base. This will assist organisations around the world to better plan for implementation of medication-related eHealth systems

A qualitative study of determinants of patient behaviour leading to an infection related hospital admission.

Objective: To describe and understand the determinants of patients' behaviours surrounding admission to hospital for an acute infective episode. Method: Patients admitted to the infection or acute medicine admission units of a major Scottish teaching hospital and commenced on antibiotic therapy after admission were included. Semi-structured face-to-face interviews were conducted using a pre-piloted interview schedule guide that focused on gathering information about patient behaviours and experiences prior to admission to hospital with an acute infection. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Approach. Emerging themes were matched to the Theoretical Domains Framework of behavioural determinants. Results: Twenty-one patients consented to participate and 18 transcripts were suitable for analysis. The most common infections were those of the skin, soft tissue and respiratory tract. From the patients' perspectives, behavioural determinants that appeared to impact their admission to hospital were principally their knowledge, beliefs of consequences, the environmental context and resources (mainly out-of-hours services), social influences and their own emotions. Determinants such as knowledge of the signs and symptoms, beliefs of consequences and environmental context were facilitators of health seeking behaviours. The main barriers were a lack of awareness of consequences of infection potentially leading to delayed admission impacting infection severity, stay in secondary care and resource utilisation. Conclusions: This study has shown that any initial patient-centred intervention that is proposed to change patient behaviour needs to be based on behavioural determinants emerging in this research. The intervention may include aspects such as patient education on resources available out-of-hours and ways to access the healthcare system, education on recognising signs of infection leading to prompter treatment and positive reinforcement for patients who present with recurrences of infection

An initial exploration of the perceptions of preparedness to practise among Saudi Arabian trained hospital pharmacists

Background: There is a dearth of literature on perceptions of preparedness to practise, which explores the extent to which educational institutions prepare their students to fulfil their professional role. Objective: The aim of this study was to explore perceptions of preparedness to practise among Saudi Arabian pharmacy graduates working in hospital. Method: Face-to-face, semi-structured interviews were conducted with ten hospital pharmacists based in four hospitals in the Eastern Province of Saudi Arabia who had qualified within the last five years from a Saudi Arabian School of Pharmacy. Interviews focused on expectations of hospital practise, perceptions of preparedness and challenges encountered, and reflections on how to better prepare students. Interviews were audio-recorded, transcribed and analysed thematically by two independent researchers using the Framework Approach. Results: Five key themes were identified: expectations versus reality of practise; issues relating to university course; practice related training; adapting to the work environment; and proposed improvements to undergraduate education. Participants were generally disappointed to find practise was not as expected. University training was largely didactic, with skills such as critical thinking not being sufficiently developed. Where practice related training was provided, it was variable in length and content. Cultural issues, most notably working in a mixed sex environment, were also considered to impact preparedness. Suggested improvements included greater focus on skills development and structured training placements. Conclusions: Participants experiences in university, and experiential placements varied greatly and were perceived to impact greatly on preparedness to practise. Further multiple perspective exploration of perceptions of preparedness to practise is warranted

Shared multisensory experience affects Others' boundary: The enfacement illusion in schizophrenia

Schizophrenia has been described as a psychiatric condition characterized by deficits in one's own and others' face recognition, as well as by a disturbed sense of body-ownership. To date, no study has integrated these two lines of research with the aim of investigating Enfacement Illusion (EI) proneness in schizophrenia. To accomplish this goal, the classic EI protocol was adapted to test the potential plasticity of both Self-Other and Other-Other boundaries. Results showed that EI induced the expected malleability of Self-Other boundary among both controls and patients. Interestingly, for the first time, the present study demonstrates that also the Other-Other boundary was influenced by EI. Furthermore, comparing the two groups, the malleability of the Other-Other boundary showed an opposite modulation. These results suggest that, instead of greater Self-Other boundary plasticity, a qualitative difference can be detected between schizophrenia patients and controls in the malleability of the Other-Other boundary. The present study points out a totally new aspect about body-illusions and schizophrenia disorder, demonstrating that EI is not only confined to self-sphere but it also affects the way we discriminate others, representing a potential crucial aspect in the social domain

Outpatient parenteral antibiotic therapy (OPAT): a qualitative study of patient perspectives in those choosing not to self-administer.

OPAT is a well established treatment for administration of intravenous (IV) antibiotics, and models of administration include home self-administration. Despite this offering advantages, statistics indicate that less patients in the research centre home self-administer compared with other national centres

The Expression of GHS-R in Primary Neurons Is Dependent upon Maturation Stage and Regional Localization

Ghrelin is a hormone with a crucial role in the regulation of appetite, regulation of inflammation, glucose metabolism and cell proliferation. In the brain ghrelin neurons are located in the cortex (sensorimotor area, cingular gyrus), and the fibres of ghrelin neurons in hypothalamus project directly to the dorsal vagal complex (DVC). Ghrelin binds the growth hormone secretagogue receptor (GHS-R) a G-protein-coupled receptor with a widespread tissue distribution, indeed these receptors are localized both in nonnervous, organs/tissues (i.e. adipose tissue, myocardium, adrenals, gonads, lung, liver, arteries, stomach, pancreas, thyroid, and kidney) as well as in central nervous system (CNS) and higher levels of expression in the pituitary gland and the hypothalamus and lower levels of expression in other organs, including brain. A GHS-R specific monoclonal antibody has been developed and characterized and through it we demonstrate that GHS-R is expressed in primary neurons and that its expression is dependent upon their developmental stage and shows differences according to the brain region involved, with a more pronounced expression in hippocampal rather than cortical neurons. A characterization of GHS-R within the central nervous system is of extreme importance in order to gain insights on its role in the modulation of neurodegenerative events such as Alzheimer's disease

Blockade of IGF2R improves muscle regeneration and ameliorates Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a debilitating fatal X-linked muscle disorder. Recent findings indicate that IGFs play a central role in skeletal muscle regeneration and development. Among IGFs, insulinlike growth factor 2 (IGF2) is a key regulator of cell growth, survival, migration and differentiation. The type 2 IGF receptor (IGF2R) modulates circulating and tissue levels of IGF2 by targeting it to lysosomes for degradation. We found that IGF2R and the store-operated Ca2+ channel CD20 share a common hydrophobic binding motif that stabilizes their association. Silencing CD20 decreased myoblast differentiation, whereas blockade of IGF2R increased proliferation and differentiation in myoblasts via the calmodulin/calcineurin/NFAT pathway. Remarkably, anti-IGF2R induced CD20 phosphorylation, leading to the activation of sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA) and removal of intracellular Ca2+. Interestingly, we found that IGF2R expression was increased in dystrophic skeletal muscle of human DMD patients and mdx mice. Blockade of IGF2R by neutralizing antibodies stimulated muscle regeneration, induced force recovery and normalized capillary architecture in dystrophic mdx mice representing an encouraging starting point for the development of new biological therapies for DMD

Optimized "in vitro" culture conditions for human rheumatoid arthritis synovial fibroblasts

The composition of synovial fluid in rheumatoid arthritis (RA) is complex and strongly influences the microenvironment of joints and it is an inseparable element of the disease. Currently, \u201cin vitro\u201d studies are performed on RA cells cultured in the presence of either recombinant proinflammatory cytokines-conditioned medium or medium alone. In this study, we evaluated the use of synovial fluid, derived from RA patients, as optimal culture condition to perform \u201cin vitro\u201d studies on RA synovial fibroblasts. We observed that synovial fluid is more effective in inducing cell proliferation with respect to TNF-alpha or culture medium alone. Spontaneous apoptosis in fibroblasts was also decreased in response to synovial fluid. The expression of proinflammatory cytokines in the presence of synovial fluid was significantly elevated with respect to cells cultured with TNF-alpha or medium, and the overall morphology of cells was also modified. In addition, modulation of intracellular calcium dynamics elicited in response to synovial fluid or TNF-alpha exposure is different and suggests a role for the purinergic signalling in the modulation of the effects. These results emphasize the importance of using RA synovial fluid in \u201cin vitro\u201d studies involving RA cells, in order to reproduce faithfully the physiopathological environmental characteristic of RA joints