Optimizing design of research to evaluate antibiotic stewardship interventions: consensus recommendations of a multinational working group.

BACKGROUND: Antimicrobial stewardship interventions and programmes aim to ensure effective treatment while minimizing antimicrobial-associated harms including resistance. Practice in this vital area is undermined by the poor quality of research addressing both what specific antimicrobial use interventions are effective and how antimicrobial use improvement strategies can be implemented into practice. In 2016 we established a working party to identify the key design features that limit translation of existing research into practice and then to make recommendations for how future studies in this field should be optimally designed. The first part of this work has been published as a systematic review. Here we present the working group's final recommendations. METHODS: An international working group for design of antimicrobial stewardship intervention evaluations was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). The group comprised clinical and academic specialists in antimicrobial stewardship and clinical trial design from six European countries. Group members completed a structured questionnaire to establish the scope of work and key issues to develop ahead of a first face-to-face meeting that (a) identified the need for a comprehensive systematic review of study designs in the literature and (b) prioritized key areas where research design considerations restrict translation of findings into practice. The working group's initial outputs were reviewed by independent advisors and additional expertise was sought in specific clinical areas. At a second face-to-face meeting the working group developed a theoretical framework and specific recommendations to support optimal study design. These were finalized by the working group co-ordinators and agreed by all working group members. RESULTS: We propose a theoretical framework in which consideration of the intervention rationale the intervention setting, intervention features and the intervention aims inform selection and prioritization of outcome measures, whether the research sets out to determine superiority or non-inferiority of the intervention measured by its primary outcome(s), the most appropriate study design (e.g. experimental or quasi- experimental) and the detailed design features. We make 18 specific recommendation in three domains: outcomes, objectives and study design. CONCLUSIONS: Researchers, funders and practitioners will be able to draw on our recommendations to most efficiently evaluate antimicrobial stewardship interventions

Family characteristics of Indian parasuicide patients : a controlled study

In this article a controlled study of the family structure of a South African Indian parasuicide population is described. Twenty subjects from a local general hospital were scored on the Suicidal Intent Scale (SIS) and the Family Assessment Device (FAD). Twenty matched medical patients without a history of parasuicide were selected from the same hospital as a control group. They were matched for age, sex, educational standard, ethnic group and socio-economic status. All subjects were scored on the Family Assessment Device (FAD). Subjects from both groups were re-tested between six to eight weeks after the initial assessment. Analyses of variance indicated significant differences between the two groups on indicators of family interactional pathology. This seems to be compounded by family stresses emanating from socio-cultural transition. The results of the study support the view that family therapy should be implemented in the treatment of parasuicide. The unique population under study provides cross-cultural data relevant to parasuicide research and invites possibilities for further investigationPeer reviewe