Development and Implementation of a Pharmacist-managed Outpatient Parenteral Antimicrobial Therapy Program

Purpose The development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy (OPAT) program in a county teaching hospital are described. Summary A pharmacist-managed OPAT program was developed and implemented at a county teaching hospital to provide consistent evaluation, approval, and monitoring of patients requiring OPAT for the treatment of infection. The developmental and implementation stages of the OPAT program included (1) a needs assessment, (2) the identification of resources necessary for program operation, (3) delineation of general OPAT program operations and activities of individual OPAT clinicians, (4) the development of patient selection criteria, including a plan of care algorithm, and (5) acquisition of administrative support to approve the program. In this program, the OPAT pharmacist plays an integral role in the management and oversight of OPAT patients, working under a collaborative agreement with infectious diseases physicians. The OPAT pharmacist assists with appropriate patient and regimen selection, confirmation of orders on discharge, assuring that laboratory tests for safety surveillance are performed and evaluated, performing routine monitoring for adverse events and line complications, and assuring the removal of the vascular access device upon the completion of OPAT. Conclusion: The OPAT program provides structured monitoring, patient follow-up, and led to improvements in patient outcome with minimization of treatment and line-related adverse events

Correlation of Adherence to the 2012 Infectious Diseases Society of America Practice Guidelines with Patient Outcomes in the Treatment of Diabetic Foot Infections in an Outpatient Parenteral Antimicrobial Programme

Aim To evaluate adherence to the 2012 Infectious Diseases Society of America practice guidelines for the management of patients with diabetic foot infections and to determine an association between adherence and clinical outcome. Methods A retrospective chart review was performed to evaluate the management and clinical outcomes of patients with diabetic foot infections treated with outpatient parenteral antimicrobial therapy between 1 January 2011 and 30 June 2012 at Wishard Health Services/Eskenazi Health. Adherence to individual Infectious Diseases Society of America diabetic foot infection treatment guideline recommendations was measured, and then assessed in relation to clinical outcome. Results A total of 57 patients (61% male, mean age 54 years) with moderate to severe diabetic foot infection met the inclusion criteria. None of the treatment courses of these patients adhered to all the Infectious Diseases Society of America guideline recommendations. The recommendations most frequently adhered to were consultation of appropriate multidisciplinary teams (n=54, 94.7%) and performance of diagnostic imaging (n=52, 89.5%). The recommendations least frequently adhered to were diabetic foot wound classification scoring on admission (n=0, 0%), appropriate culture acquisition (n=12, 21.2%), surgical intervention when indicated (n=32, 46.2%) and appropriate empiric antibiotic selection (n=34, 59.7%). Of 56 patients, 52 (92.9%) experienced clinical cure at the end of outpatient parenteral antimicrobial therapy compared with 34 of 53 patients (64%) at 6 months after the completion of therapy. Adherence to individual guidelines was not associated with clinical outcome. Patients who experienced treatment failure were more likely to have severe diabetic foot infection or peripheral neuropathy. Conclusions Adherence to the Infectious Diseases Society of America diabetic foot infection guideline recommendations was found to be suboptimal in the present study. The effect of adhering to individual Infectious Diseases Society of America diabetic foot infection recommendations on clinical outcome needs to be investigated

Molecular characterisation of protist parasites in human-habituated mountain gorillas (Gorilla beringei beringei), humans and livestock, from Bwindi impenetrable National Park, Uganda

Over 60 % of human emerging infectious diseases are zoonotic, and there is growing evidence of the zooanthroponotic transmission of diseases from humans to livestock and wildlife species, with major implications for public health, economics, and conservation. Zooanthroponoses are of relevance to critically endangered species; amongst these is the mountain gorilla (Gorilla beringei beringei) of Uganda. Here, we assess the occurrence of Cryptosporidium, Cyclospora, Giardia, and Entamoeba infecting mountain gorillas in the Bwindi Impenetrable National Park (BINP), Uganda, using molecular methods. We also assess the occurrence of these parasites in humans and livestock species living in overlapping/adjacent geographical regions

Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma

Multiple myeloma is a malignant B-cell neoplasm that involves the skeleton in approximately 80% of the patients. With an average age of 60 years and a 5-years survival of nearly 45% Brenner et al. (Blood 111:2516–2520, 35) the onset is to be classified as occurring still early in life while the disease can be very aggressive and debilitating. In the last decades, several new imaging techniques were introduced. The aim of this review is to compare the different techniques such as radiographic survey, multidetector computed tomography (MDCT), whole-body magnetic resonance imaging (WB-MRI), fluorodeoxyglucose positron emission tomography- (FDG-PET) with or without computed tomography (CT), and 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy. We conclude that both FDG-PET in combination with low-dose CT and whole-body MRI are more sensitive than skeleton X-ray in screening and diagnosing multiple myeloma. WB-MRI allows assessment of bone marrow involvement but cannot detect bone destruction, which might result in overstaging. Moreover, WB-MRI is less suitable in assessing response to therapy than FDG-PET. The combination of PET with low-dose CT can replace the golden standard, conventional skeletal survey. In the clinical practise, this will result in upstaging, due to the higher sensitivity

Damaged hardmen: organised crime and the half-life of deindustrialisation

Despite frequent associations, deindustrialization features rarely in studies of organized crime, and organized crime is at best a spectral presence in studies of deindustrialization. By developing an original application of Linkon's concept of the “half‐life,” we present an empirical case for the symbiotic relationship between former sites of industry and the emergence of criminal markets. Based on a detailed case‐study in the west of Scotland, an area long associated with both industry and crime, the paper interrogates the environmental, social, and cultural after‐effects of deindustrialization at a community level. Drawing on 55 interviews with residents and service‐providers in Tunbrooke, an urban community where an enduring criminal market grew in the ruins of industry, the paper elaborates the complex landscapes of identity, vulnerability, and harm that are embedded in the symbiosis of crime and deindustrialization. Building on recent scholarship, the paper argues that organized crime in Tunbrooke is best understood as an instance of “residual culture” grafted onto a fragmented, volatile criminal marketplace where the stable props of territorial identity are unsettled. The analysis allows for an extension of both the study of deindustrialization and organized crime, appreciating the “enduring legacies” of closure on young people, communal identity, and social relations in the twenty‐first century

Tenants' campaigns for tenure neutrality and a general needs model of social housing: making universal claims

The policy of tenure neutrality championed by the International Union of Tenants as essential to a right to adequate housing advances a model of general needs or, in other words, universal social rented housing provision unrestricted by income limits or needs-based rationing. Support for this model has been severely undermined by recent European Commission rulings that have restricted access to social housing to those least capable of coping in a competitive market place. As general needs demand for affordable housing continues to swell, the challenge for adherents of tenure neutrality is to demonstrate that universal social housing can meet both the needs of the most vulnerable and the demands of those excluded from homeownership by price inflation and credit limits. This paper examines the promotion of universal social housing by tenants’ organisations and challenges the extent to which this model is intended ‘for all’. In a case study of the defence of municipal housing by English tenants’ movements, it identifies the exclusionary narratives that render the particular housing needs of advantaged social groups as universal. The paper concludes by reviewing strategies to resolve the tensions between the universal and the particular to reinvigorate support for tenure neutrality in arguments for widening access and supply of social housing