Antimicrobial stewardship: a competency framework to support the role of nurses

Antimicrobial resistance is a global threat that has prompted a global response. One strategy used to manage antimicrobial resistance is known as antimicrobial stewardship, its main goals being to optimise antibiotic use and avoid unnecessary antibiotic prescribing. There is an increase in the number of nurse prescribers, as well as in the percentage of antibiotics dispensed in primary care by non-medical prescribers, many of whom are nurses. Nurses, both prescribers and non-prescribers, play an important role in antimicrobial stewardship, including during the COVID-19 pandemic. To be able to fulfil that role, nurses need the right knowledge, skills, resources and behaviours. This article explores the role of nurses in antimicrobial stewardship and describes a competency framework designed to underpin it

Community nursing and antibiotic stewardship: The importance of communication and training

Antimicrobial stewardship (using antimicrobials responsibly) can reduce the risk of antimicrobial resistance (AMR). Many health professionals identify themselves as ‘antibiotic guardians’, but patient expectations, time constraints, and a lack of confidence or underdeveloped communication skills can influence decisions to prescribe. Nurse prescribers have an important role to play in antibiotic stewardship, and their numbers continue to grow. While nurse prescribers welcome this extension to their traditional role, they are often faced with barriers to antibiotic stewardship activities. These barriers may relate to their Capability (knowledge/skill), Opportunity (norms of practice, influence of patients, environmental factors), and Motivation (attitudes and beliefs, concern over outcome, emotion and habit) [COM-B]. Education, training and enablement can help to overcome these barriers, and the development of knowledge, confidence and effective communication skills should be of priority. Further, communication skills can help nurse prescribers understand patient expectations, with the use of open-ended questions, active listening and creation of a patient-centred consultation that leads to a mutually agreed end goal and way forward

Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the Theoretical Domains Framework and COM-B

Objectives: Respiratory tract infections are frequently managed by nurse and pharmacist prescribers and these prescribers are responsible for 8% of all primary care antibiotic prescriptions. Few studies have explored antibiotic prescribing amongst these prescribers, and interventions to target their antibiotic prescribing behaviour do not exist. Research objectives were to (1) use the Theoretical Domains Framework to identify the factors that influence nurse and pharmacist prescriber management of respiratory tract infections, (2) identify the Behaviour Change Techniques that can be used as the basis for the development of a theoretically informed intervention to support appropriate prescribing behaviour. Design: Qualitative design comprising semi-structured interviews, using the Theoretical Domains Framework and Capability, Opportunity and Motivation for Behaviour (COM-B). Setting: Primary care Participants: Twenty one prescribers (4 pharmacists and 17 nurses) Results: A range of factors across twelve domains of the TDF were found to influence prescriber behavior, and forty BCTs were identified as supporting appropriate prescribing. For example, patient expectations (social influence) was identified as a factor influencing prescribing decisions, and a number of BCTs (problem solving, goal setting, information about health consequences) were identified as supporting prescribers in managing these expectations. Conclusion:. With increasing numbers of nurse and pharmacist prescribers managing infections in primary care, these findings will inform theoretically grounded interventions to support appropriate prescribing behaviour by these groups

''Novel Optical Detection Schemes for In-Situ Mapping of Volatile Organochlorides in the Vadose Zone''

Long-term objective is to develop a system for measuring and identifying a wide range of volatile organic hydrocarbons, including aromatics, carbon tetrachloride, TCE and other organochlorides, at ppb levels in-situ in the subsurface (''at-depth'') using a fiber-optic REMPI probe in a cone penetrometer. Specific focus of much of the proposed work is to identify and optimize those experimental parameters which effect the in-situ determination of organic molecules in the subsurface using resonance-enhanced multi-photon ionization (REMPI). Emphasis is placed on visible excitation so that the high transmission of fiber-optics at visible wavelengths can be fully utilized. A fiber-optic REMPI system is being designed and integrated into an existing cone penetrometer system at LLNL. The design will be compatible with existing Raman and fluorescence probes

Factors influencing the prescribing behaviour of independent prescriber optometrists:a qualitative study using the Theoretical Domains Framework

Purpose Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence‐based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM‐B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour‐change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM‐B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers. Methods Using a qualitative design, semi‐structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM‐B. Results Sixteen participants (9 male, 7 female; median age 45 years, range 28–65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM‐B: Capability); confidence (TDF domain: Beliefs about capabilities, COM‐B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM‐B: Opportunity; TDF domain: Social/professional role and identity, COM‐B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM‐B: Motivation; TDF domain: Social/professional role and identity, COM‐B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM‐B: Capability; TDF domain: Environmental context and resources, COM‐B Opportunity). Conclusions Having identified theory‐derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement

A theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol

Introduction: Nurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers. Method and analysis: Development of intervention: a three stage, eight step method was used to identify relevant determinants of behaviour change and intervention components based on the Behaviour Change Wheel. The intervention is an online resource comprising underpinning knowledge and an interactive animation with a variety of open and closed questions to assess understanding. Acceptability and feasibility of intervention: nurse and pharmacist prescribers (n=12-15) will use the intervention. Evaluation includes semi-structured interviews to capture information about how the user reacts to the design, delivery and content of the intervention and influences on understanding and engagement, and a pre-post survey to assess participants perceptions of the impact of the intervention on knowledge, confidence and usefulness in terms of application to practice. Taking an initial inductive approach, data from interview transcripts will be coded and then analysed to derive themes. These themes will then be deductively mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. Descriptive statistics will be used to analyse the survey data, and trends identified. Ethics and dissemination: Ethical approval for the study has been provided by the School of Healthcare Sciences Research Governance and Ethics Committee, Cardiff University. The findings will be disseminated via publication in peer reviewed journals and through conference presentations

CONFIRMATORY FACTOR ANALYSIS OF THE MULTICULTURAL PERSONALITY QUESTIONNAIRES FOR NURSING STUDENTS

The purpose  of this study was to examine  the validity, particularly the construct  validity and reliability of Multicultural Personality Questionnaire (MPQ; van der Zee, van Oudenhoven, Ponterotto, Fietzer, 2013) and further  determined the significant difference when tested across the personal characteristics of nursing students. The original MPQ scale consists of five factors: cultural empathy, flexibility, social initiative, open- mindedness, flexibility and emotional stability. The MPQ was administered to a total of 122 nursing students (national (59.8%), Filipino-American (7.21%), and international (32.99%) nursing students. The study showed that four factors were generated  using confirmatory factor analysis. The 78-item MPQ was reduced to 21 items. The four factors included cultural empathy, social initiative, open-mindedness, and emotional stability. Flexibility was one of the factors in the original version of the five-factor scale of MPQ but not evident it in this study. The analysis of the data resulted in a reasonably good fit and a satisfactory Cronbach alpha reliability coefficient for each factor. The overall Cronbach’s alpha reliability coefficient (α) of the scale is .713;  .861, .806, .717, and .663 for cultural empathy, social initiative, open-mindedness,  and emotional stability with a percent of variance accounted for of 25.12%,  11.91%, 11.79%, and 8.26%, respectively. Significant differences were found in some factors of MPQ considering the personal characteristics of nursing students. The results indicated that the MPQ could serve as a valuable tool to measure the multicultural personality of nursing students from the Philippines

Single nucleotide polymorphism discovery in albacore and Atlantic bluefin tuna provides insights into worldwide population structure.

The optimal management of the commercially important, but mostly over-exploited, pelagic tunas, albacore (Thunnus alalunga Bonn., 1788) and Atlantic bluefin tuna (BFT; Thunnus thynnus L., 1758), requires a better understanding of population structure than has been provided by previous molecular methods. Despite numerous studies of both species, their population structures remain controversial. This study reports the development of single nucleotide polymorphisms (SNPs) in albacore and BFT and the application of these SNPs to survey genetic variability across the geographic ranges of these tunas. A total of 616 SNPs were discovered in 35 albacore tuna by comparing sequences of 54 nuclear DNA fragments. A panel of 53 SNPs yielded FST values ranging from 0.0 to 0.050 between samples after genotyping 460 albacore collected throughout the distribution of this species. No significant heterogeneity was detected within oceans, but between-ocean comparisons (Atlantic, Pacific and Indian oceans along with Mediterranean Sea) were significant. Additionally, a 17-SNP panel was developed in Atlantic BFT by cross-species amplification in 107 fish. This limited number of SNPs discriminated between samples from the two major spawning areas of Atlantic BFT (FST = 0.116). The SNP markers developed in this study can be used to genotype large numbers of fish without the need for standardizing alleles among laboratories.This work was supported by ATM2010Hegaluze (351BI20090047), ATM2009Hegalabur (351BI20090034) and ATM2008Bonorte (ACM2008BONORTE) projects funded by the Basque Government, and the ACEITUNA (CTM2011-27505) project funded by the Spanish Ministerio de Economía y Competitividad

Benign Adrenocortical Tumors and the Detection of Nonadrenal Neoplasia.

CONTEXT: Patients with adrenocortical tumors have been frequently observed to have nonadrenal neoplasia. OBJECTIVE: To investigate whether patients with benign adrenocortical tumors have a higher likelihood of having nonadrenal neoplasia detected. DESIGN AND PARTICIPANTS: Case-control study of patients with benign adrenocortical tumors (cases; n = 400) and normal adrenal glands (controls; n = 400), who underwent repeated abdominal cross-sectional imaging. MAIN OUTCOMES: Primary analyses: association between case-control status and benign abdominal neoplasia detected via cross-sectional imaging. Secondary analyses: association between case-control status and tumors detected via other imaging modalities. RESULTS: The mean interval of abdominal imaging was 4.7 (SD = 3.8) years for cases and 5.9 (4.8) years for controls. Cases were more likely to have detected intraductal papillary mucinous neoplasms (IPMNs) of the pancreas (8.5% vs. 4.5%, adjusted OR = 2.22, 95% CI (1.11, 4.63)) compared with controls. In secondary analyses, cases were more likely to have detected thyroid nodules (25.5% vs. 17.0%, adjusted OR = 1.77, 95% CI (1.15, 2.74)), hyperparathyroidism or parathyroid adenomas (3.5% vs. 1.3%, adjusted OR = 3.00, 95% CI (1.00, 11.64)), benign breast masses (6.0% vs. 3.3%, adjusted OR = 3.25, 95% CI (1.28, 8.78)), and benign prostatic hyperplasia (20.5% vs. 5.3%, adjusted OR = 3.20, 95% CI (1.14, 10.60)). Using a composite outcome, cases had higher odds of detection of the composite of IPMN, thyroid nodules, parathyroid tumors, benign breast masses, and prostate hyperplasia (adjusted OR = 2.36, 95% CI: 1.60, 3.50) when compared with controls. CONCLUSIONS: Patients with benign adrenocortical tumors had higher odds of detected pancreatic IPMN, as well as thyroid nodules, parathyroid tumors, benign breast masses, and prostate hyperplasia compared with patients with normal adrenal glands. These associations may have important implications for patient care and healthcare economics, regardless of whether they reflect incidental discoveries due to imaging detection or frequency bias, or a common risk for developing multiple neoplasia

The Lateralizing Asymmetry of Adrenal Adenomas

Abstract Context It is presumed that the incidence of adrenal adenomas is symmetric between the left and right adrenal gland; however, anecdotal observations suggest a potential lateralizing asymmetry. Objective: To investigate the symmetry in detection of adrenal adenomas and relevance to patient care. Design: Cross-sectional and longitudinal studies. Population and Setting One thousand three hundred seventy-six patients with abdominal computed tomography or magnetic resonance imaging demonstrating benign-appearing adrenal adenomas. Main Outcome Location and size of adrenal adenomas. Results: Left-sided adenomas were discovered in 65% of patients, right-sided in 21%, and bilateral adenomas in 14%. Among unilateral adenomas, 75% were left-sided. Left-sided adenomas were more prevalent than right-sided adenomas in each size category except the largest: <10 mm, 87%; 10 to 19 mm, 74%; 20 to 29 mm, 72%; ≥30 mm, 56% (P < 0.0001 for each category, except P = 0.19 when ≥30 mm). Among those with bilateral adenomas, the left-sided adenoma was significantly larger than the right one in 61% of patients (P < 0.001). There were no significant differences in the baseline prevalence or incidence of cardiometabolic diseases between patients with left-sided vs right-sided adenomas during 5.10 (4.2) years of follow-up. Conclusions: Adrenal adenomas are substantially more likely to be identified on the left adrenal than the right. This observation may be due to detection bias attributed to the location of the right adrenal, which may preclude identification of right-sided adenomas until they are substantially larger. These findings suggest the potential for an underrecognition of right-sided adenomas that may also impair the accurate detection of bilateral adrenal diseases