Pharmacist-led implementation of a vancomycin guideline across medical and surgical units: impact on clinical behavior and therapeutic drug monitoring outcomes

This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpBackground: Vancomycin is the antibiotic of choice for the treatment of serious infections such as methicillin-resistant Staphylococcus aureus (MRSA). Inappropriate prescribing of vancomycin can lead to therapeutic failure, antibiotic resistance, and drug toxicity. Objective: To examine the effectiveness of pharmacist-led implementation of a clinical practice guideline for vancomycin dosing and monitoring in a teaching hospital. Methods: An observational pre–post study design was undertaken to evaluate the implementation of the vancomycin guideline. The implementation strategy principally involved education, clinical vignettes, and provision of pocket guidelines to accompany release of the guideline to the hospital Intranet. The target cohort for clinical behavioral change was junior medical officers, as they perform the majority of prescribing and monitoring of vancomycin in hospitals. Assessment measures were recorded for vancomycin prescribing, therapeutic drug monitoring, and patient outcomes. Results: Ninety-nine patients, 53 pre- and 46 post-implementation, were included in the study. Prescribing of a loading dose increased from 9% to 28% (P=0.02), and guideline adherence to starting maintenance dosing increased from 53% to 63% (P=0.32). Dose adjustment by doctors when blood concentrations were outside target increased from 53% to 71% (P=0.12), and correct timing of initial concentration measurement increased from 43% to 57% (P=0.23). Appropriately timed trough concentrations improved from 73% to 81% (P=0.08). Pre-dose (trough) concentrations in target range rose from 33% to 44% (P=0.10), while potentially toxic concentrations decreased from 32% to 21% (P=0.05) post-implementation. Infection cure rates for patients increased from 85% to 96% (P=0.11) after the guideline was implemented. Conclusion: The implementation strategy employed in this study demonstrated potential effectiveness, and should prompt additional larger studies to optimize strategies that will translate into improved clinical practice using vancomycin

Book reviews

Teaching/Communication/Extension/Profession,

Effective information and the influence of an extension event on perceptions and adoption

Perceptions are known to play an important role in the innovation adoption decision. Once influential perceptions have been identified, there is the potential for information to influence adoption by changing these perceptions. In this paper, the influence of an extension workshop targeting grain growers’ perceptions known to be associated with the adoption of integrated weed management and herbicide resistance management has been measured using regression analysis. Consistent with a Bayesian learning framework, the greatest influence on grower perceptions and intended adoption behaviour was observed where information could be delivered with a high degree of certainty and validity.Crop Production/Industries, Farm Management,

The 4W Model of Drowning

The aim of the study was to develop a conceptual model of drowning incidents. The authors conducted qualitative content analysis of drowning-incident videos (n = 41), and semi-structured interviews of those involved in drowning incidents (n = 34), followed by the measurement of frequencies and Boolean search with matrix intersection. Results confirmed that when there is human activity in, above, or around an aquatic environment, a drowning incident may occur to whomever, wherever, and under whatever circumstance. Factors that determined drowning outcome were, in order of importance, rescuer characteristics (Who1), casualty characteristics (Who2), location (Wherever), and general circumstances (Whatever). The interaction of the rescuer with the casualty largely determines the outcome of drowning. The 4W model is a promising tool in lifesaving and lifeguarding

Towards an emotional energy geography: Attending to emotions and affects in a former coal mining community in South Wales, UK

In this paper, we make a case for bringing energy geography into closer dialogue with emotional geography, and argue that doing so has the potential to greatly improve our understanding of energy systems and their intersection with everyday life, bringing essential but often overlooked aspects into view. We draw on research carried out as part of an arts and humanities-based project in South Wales (UK), a region once dominated by coal extraction. We present and discuss material from sixteen oral histories recorded with long-standing members of the village of Ynysybwl. Reading their accounts through the lens of emotional-affective constructs reveals not only participants’ emotions about aspects of energy production and consumption, but also the atmospheres and affects arising within and out of the energy system. This brings to light the affectual agency of the energy system as an infrastructure assemblage and its role in everyday production of space. Related to this, it surfaces essential aspects of experiences of energy system change. We argue that recognising and exploring affect and emotion is crucial for energy geography as it continues to explore the functionings of energy systems, and energy transitions

ADOPT: a tool for predicting adoption of agricultural innovations

A wealth of evidence exists about the adoption of new practices and technologies in agriculture but there does not appear to have been any attempt to simplify this vast body of research knowledge into a model to make quantitative predictions across a broad range of contexts. This is despite increasing demand from research, development and extension agencies for estimates of likely extent of adoption and the likely timeframes for project impacts. This paper reports on the reasoning underpinning the development of ADOPT (Adoption and Diffusion Outcome Prediction Tool). The tool has been designed to: 1) predict an innovation‘s likely peak extent of adoption and likely time for reaching that peak; 2) encourage users to consider the influence of a structured set of factors affecting adoption; and 3) engage R, D & E managers and practitioners by making adoptability knowledge and considerations more transparent and understandable. The tool is structured around four aspects of adoption: 1) characteristics of the innovation, 2) characteristics of the population, 3) actual advantage of using the innovation, and 4) learning of the actual advantage of the innovation. The conceptual framework used for developing ADOPT is described.Adoption, Diffusion, Prediction, Research and Development/Tech Change/Emerging Technologies,

Framingham Stroke Risk Profile and poor cognitive function: a population-based study.

BACKGROUND: The relationship between stroke risk and cognitive function has not previously been examined in a large community living sample other than the Framingham cohort. The objective of this study was to examine the relationship between 10-year risk for incident stroke and cognitive function in a large population-based sample. METHODS: Participants were 7377 adults aged 50 years and over of the 2002 wave of the English Longitudinal Study of Ageing, a prospective cohort study. A modified version of the Framingham Stroke Risk Profile (incorporating age, sex, systolic blood pressure, antihypertensive medication, diabetes, smoking status, cardiovascular disease, and atrial fibrillation) was used to assess 10-year risk of stroke. Linear regression models were used to determine the cross-sectional relationship of stroke risk to global cognitive function and performance in multiple cognitive domains. RESULTS: In unadjusted models 10 percentage point increments of 10-year stroke risk were associated with poor global cognitive function (-0.40 SD units, 95% CI -0.43 - -0.38), and lowered performance in all cognitive domains. After statistical adjustment for age, sex, testing interval and other correlates of cognitive function the association with stroke risk was attenuated though remained significant for global cognitive function (-0.06 SD units, 95% CI -0.09 - -0.03), immediate and delayed verbal memory, semantic verbal fluency and processing speed. CONCLUSION: In individuals free from a history of stroke or dementia, high subclinical cerebrovascular disease burden was associated with worse cognitive function in multiple domains.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Amorphization of embedded Cu nanocrystals by ion irradiation

While bulk crystalline elemental metals cannot be amorphized by ion irradiation in the absence of chemical impurities, the authors demonstrate that finite-size effects enable the amorphization of embedded Cu nanocrystals. The authors form and compare the atomic-scale structure of the polycrystalline, nanocrystalline, and amorphous phases, present an explanation for the extreme sensitivity to irradiation exhibited by nanocrystals, and show that low-temperature annealing is sufficient to return amorphized material to the crystalline form

Neighborhood Deprivation, Individual Socioeconomic Status, and Cognitive Function in Older People: Analyses from the English Longitudinal Study of Ageing

To assess the relationship between cognitive function, socioeconomic status, and neighborhood deprivation (lack of local resources of all types, financial and otherwise). DESIGN : Nationally representative cross-section. SETTING : The English Longitudinal Study of Ageing (ELSA). PARTICIPANTS : Seven thousand one hundred twenty-six community-dwelling individuals aged 52 and older and resident in urban areas. MEASUREMENTS : Individual cognitive function score and index of multiple deprivation (IMD) at the Super Output Area level, adjusting for health, lifestyle, and sociodemographic confounders. Analyses were conducted separately according to sex and age group (52–69 and ≥70). RESULTS : IMD affected cognitive function independent of the effects of education and socioeconomic status. For example, in fully adjusted models, women aged 70 and older had a standardized cognitive function score ( z -score) that was 0.20 points (95% confidence interval (CI)=0.01–0.39) lower in the bottom 20% of wealth than the top 20%, 0.44 points (95% CI=0.20–0.69) lower in the least-educated group than in the most educated, and 0.31 points (95% CI 0.15–0.48) lower if resident lived in an area in the bottom 20% of IMD than in the top 20%. CONCLUSION : In community-based older people in urban neighborhoods, neighborhood deprivation—living in a neighborhood with high levels of deprivation, compared with national levels—is associated with cognitive function independent of individual socioeconomic circumstances. The mechanisms underlying this relationship are unclear and warrant further investigation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66217/1/j.1532-5415.2007.01557.x.pd

Exposure to secondhand smoke and cognitive impairment in non-smokers: national cross sectional study with cotinine measurement

Objective To examine the association between a biomarker of exposure to secondhand smoke (salivary cotinine concentration) and cognitive impairment