Factors influencing palliative care in advanced dementia : A systematic review

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Background: Dementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs. Aim: To investigate the factors influencing provision of PC services for people with advanced dementia. Methods: A systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed, CINAHL and Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data. Key findings: In total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning. Conclusions: Even though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.Peer reviewe

SWOT Analysis and Insights into the Health Research Authority Approval Process for COVID-19 Antimicrobial Stewardship Research in UK Secondary Care: Advocating Think Ethics.

© 2024 Research Square. This article is distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/This article examines the Health Research Authority's (HRA) approval process, guided by the 'Think Ethics' principal, for an antimicrobial stewardship (AMS) research project at an English NHS Foundation Trust during the COVID-19 pandemic. Employing a SWOT analysis to reflect critically on the process, the project encompassed a retrospective examination of patient records and a survey of healthcare workers, navigating the application of the Integrated Research Application System (IRAS). The HRA's streamlined procedures, involving intensive reviews by the NHS Research Ethics Committee (REC) and regulatory checks, refined the approval process, precluding the need for multiple assessments across NHS bodies. Achieving HRA consent necessitated adherence to confidentiality protocols and the submission of extensive documentation. Only upon securing all requisite regulatory approvals could the project proceed, highlighting the essentiality of proficient project management and strategic communication. The study's outcomes shed light on AMS practices, the shifts in antibiotic prescribing patterns, and the pandemic's influence on these dynamics. Crucially, the investigation emphasised the vital importance of robust AMS in managing antibiotic utilisation and in combating antimicrobial resistance. Reflecting on this journey emphasises the importance of involving the public and patients, creating effective participant information sheets (PIS), registering research projects in databases, such as ISRCTN and OCTOPUS, and constructively addressing feedback. These lessons has significantly enhanced the authors' research skills, emphasising the crucial importance of ethical consideration and transparent communication in academic research. This article offers a thorough reflection of the Health Research Authority approval process, advocating its adoption in future antimicrobial stewardship and antimicrobial resistance investigations, which are imperative to global health. Moreover, undertaking a SWOT analysis has yielded strategic insights, facilitating a more informed approach to the process of the HRA approval process, especially in relation to COVID-19 antimicrobial stewardship research within UK secondary care

WHO AWaRe Classification for Antibiotic Stewardship: Tackling Antimicrobial Resistance - A Descriptive Study from an English NHS Foundation Trust Prior to and During the COVID-19 Pandemic

© 2023 Abdelsalam Elshenawy, Umaru and Aslanpour. This is an open-access accepted manuscript version of an article which has been published in final form at https://doi.org/10.3389/fmicb.2023.1298858Antimicrobial resistance (AMR) is a silent and rapidly escalating pandemic, presenting a critical challenge to global health security. During the pandemic, this study was undertaken at a NHS Foundation Trust in the United Kingdom to explore antibiotic prescribing trends for respiratory tract infections (RTIs), including pneumonia, and the COVID-19 pandemic across the years 2019 and 2020. This study, guided by the WHO’s AWaRe classification, sought to understand the impact of the pandemic on antibiotic prescribing and antimicrobial stewardship (AMS). The research methodology involved a retrospective review of medical records from adults aged 25 and older admitted with RTIs, including pneumonia, in 2019 and 2020. The application of the AWaRe classification enabled a structured description of antibiotic use. The study evaluated antibiotic use in 640 patients with RTIs. Notably, it observed a slight increase in the use of amoxicillin/clavulanic acid and a substantial rise in azithromycin prescriptions, highlighting shifts in prescribing trends. Despite these changes, some antibiotics displayed steady consumption rates. These findings highlight the importance of understanding antibiotic use patterns during the AMR threat. The increase in the usage of “Watch” category antibiotics during the pandemic emphasises the urgency of robust AMS measures. The research confirms that incorporating the AWaRe classification in prescribing decisions is crucial for patient safety and combating antibiotic misuse. This study provides essential insights into the changing landscape of antibiotic prescribing during a global health crisis, reinforcing the necessity for ongoing AMS vigilance to effectively address AMR challenges.Peer reviewe

An investigation into factors affecting the implementation of Antimicrobial Stewardship (AMS) before and during the COVID-19 pandemic in two acute care settings

This study investigates the factors impacting the implementation of Antimicrobial Stewardship (AMS) before and during the COVID-19 pandemic across two acute care settings. Utilising storytelling to enhance the impact of the research, the study focuses on the dual challenges posed by COVID-19 and Antimicrobial Resistance (AMR). The research highlights the importance of effective AMS to address both viral and bacterial threats. It presents a "tale of two pandemics," examining how COVID-19 and AMR intersect and complicate treatment protocols. The study emphasises the crucial role of AMS in maintaining the appropriate and effective use of antibiotics, which are vital in preventing infections and preserving their efficacy. Key factors affecting antibiotic use, both before and during the pandemic, are explored through the perspectives of healthcare professionals. By leveraging storytelling, the research aims to communicate complex issues in a more engaging and relatable manner, thereby increasing the understanding and impact of AMS principles. The study provides practical recommendations to enhance patient care safety and quality, ensuring that AMS practices are upheld even in the face of unprecedented healthcare challenges. By addressing these factors, the study contributes to ongoing efforts to improve AMS implementation, ultimately safeguarding public health against the threats of AMR and future pandemics.Peer reviewe

P11 Pharmacists’ knowledge, attitudes and perceptions towards antimicrobial stewardship and resistance during the COVID-19 pandemic at secondary care settings in the UK

© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).Addressing antimicrobial resistance (AMR) became critical during the COVID-19 pandemic, as inappropriate antibiotic prescribing worsened AMR. The WHO emphasized the need for antimicrobial stewardship (AMS), and the Royal Pharmaceutical Society underscored pharmacists’ roles in optimising antimicrobial use. Understanding pharmacists’ knowledge, attitudes, and perceptions (KAP) regarding antibiotic prescribing, AMR, and AMS is vital to enhancing global AMS efforts. To explore pharmacists’ KAP during the COVID-19 pandemic, a prospective cross-sectional study was conducted in 2023 using an online survey via Qualtrics, targeting registered pharmacists in a secondary care NHS Foundation Trust in the UK. The study received ethical approval, involved patient and public input, and was registered with ISRCTN and OCTOPUS. Most respondents were aged 25–31, female, and held postgraduate degrees. They demonstrated strong awareness of AMR and AMS, with the majority recognizing AMR as a public health concern and endorsing updated antibiotic guidelines. The study underscores pharmacists’ essential role in combating AMR, highlighting their potential to co-lead AMS initiatives and improve global health outcomes.Peer reviewe

Report: Optimising Antimicrobial Use During the COVID-19 Pandemic in UK Acute Care Settings (2020-2024) – Insights from Three Sequential Studies

This report presents findings from a comprehensive research project conducted in UK acute care settings, encompassing three sequential investigations. These studies included a systematic review of key antimicrobial stewardship (AMS) strategies, an analysis of patient records to observe shifts in antibiotic prescribing patterns, and a survey of healthcare professionals. The results highlighted the critical role of multidisciplinary teams in AMS (93%), an increase in inappropriate antibiotic prescribing, and significant disruptions in AMS activities during the pandemic. These findings underscore the urgent need for resilient and strategic AMS adaptations to optimise antimicrobial use, combat antimicrobial resistance, and enhance patient care and quality of life. Additionally, this research proposed practical tools for effective AMS implementation, such as the AMS framework or roadmap for implementation at both patient and organisational levels, an AMS dynamic dashboard, AMS cards, and an AMS educational programme. These tools aim to improve antibiotic prescribing and stewardship, integrate seamlessly with various systems, and offer practical solutions to antimicrobial resistance, ultimately safeguarding public health and saving patient lives. By advancing AMS practices, this project contributes to the global effort to optimise antibiotic use and improve healthcare outcomes

Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: Antimicrobial resistance (AMR), a major global public health threat that has caused 1.2 million deaths, calls for immediate action. Antimicrobial stewardship (AMS) promotes judicious antibiotic use, but the COVID-19 pandemic increased AMR by 15%. Although there are paramount data on the impact of COVID-19 on AMS, empirical data on AMS implementation during the pandemic are lacking. This study aimed to investigate antibiotic prescribing and AMS implementation prior to the pandemic (PP) in 2019 and during the pandemic (DP) in 2020 at one NHS Foundation Trust in England. Method: This cross-sectional study involved adult patients admitted to one NHS Foundation Trust in England, focusing on those prescribed antibiotics for respiratory tract infections (RTIs). This included cases of pneumonia in both years under study and COVID-19 cases in 2020. Data were retrospectively extracted from medical records using a validated data extraction tool, which was developed based on the ‘Start Smart, Then Focus’ (SSTF) approach of the AMS Toolkit. Results: This study included 640 patients. The largest age group in the study was 66–85 years, comprising 156 individuals (48.8%) PP in 2019 and 148 (46.3%) DP in 2020. CAP was the predominant diagnosis, affecting approximately 126 (39.4%) PP and 136 (42.5%) DP patients. Regarding the timing of antibiotic review post-admission, reviews were typically conducted within 48–72 h, with no significant difference between 2019 and 2020, with an odds ratio of 1.02 (95% CI 0.97 to 1.08, p-Value = 0.461). During the pandemic, there was a significant difference in both AMS interventions, ‘Continue Antibiotics’ and ‘De-escalation’, with odds ratios of 3.36 (95% CI 1.30–9.25, p = 0.015) and 2.77 (95% CI 1.37–5.70, p = 0.005), respectively. Conclusion: This study emphasises the need for robust AMS to ensure adherence to guidelines. It acknowledges the impact of comorbidities and advocates for sustained stewardship efforts to combat resistance both during and after the pandemic era.Peer reviewe

O04 UKHSA Start Smart Then Focus antimicrobial stewardship: effective implementation during the COVID-19 pandemic at an NHS Foundation Trust in the UK

© 2024 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Antimicrobial resistance (AMR) is a critical global health threat, causing 1.2 million deaths annually. While antimicrobial stewardship (AMS) promotes responsible antibiotic use, the COVID-19 pandemic led to a 15% rise in AMR. This study investigated AMS implementation before and during the pandemic through a retrospective analysis of 640 patient records using the UK Health Security Agency’s AMS toolkit at an NHS Foundation Trust. Despite stable antibiotic prescription appropriateness, adherence to guidelines dropped from 64% to 36% during the pandemic. The findings emphasize the importance of adaptable AMS practices, such as ‘De-escalation,’ in managing AMR and ensuring effective healthcare post-pandemic.Peer reviewe

Shorter and Longer Antibiotic Durations for Respiratory Infections: To Fight Antimicrobial Resistance—A Retrospective Cross-Sectional Study in a Secondary Care Setting in the UK

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/As antimicrobial resistance (AMR) escalates globally, examining antibiotic treatment durations for respiratory infections becomes increasingly pertinent, especially in the context of the COVID-19 pandemic. In a UK secondary care setting, this retrospective study was carried out to assess the appropriateness of antibiotic treatment durations—shorter (≤5 days) versus longer (6–7 days and >8 days)—for respiratory tract infections (RTIs) in 640 adults across 2019 and 2020, in accordance with local antimicrobial guidelines. The analysis employed these guidelines and clinical evidence to examine the effectiveness and suitability of antibiotic prescribing practices. This study considered the ‘Shorter Is Better’ approach, noting an increased rate of patient discharges associated with shorter antibiotic regimens (≤5 days). It further demonstrates that shorter treatments are as effective as longer ones for conditions such as COPD exacerbation, COVID-19 pneumonia, and hospital-acquired pneumonia (HAP), except in cases of community-acquired pneumonia (CAP) and unspecified diagnoses. Nevertheless, this study raises concerns over an observed increase in mortality risk with shorter treatment durations. Although these mortality differences were not statistically significant and might have been influenced by the COVID-19 pandemic, the need for extended research with a larger sample size is highlighted to confirm these findings. This study also emphasises the critical need for accurate and specific diagnoses and considering risk assessments at admission, advocating for tailored, evidence-based antibiotic prescribing to ensure patient safety. It contributes to antimicrobial stewardship efforts by reinforcing the importance of adapting antibiotic use to current healthcare challenges and promoting a global commitment to fight antimicrobial resistance. This approach is crucial for enhancing patient outcomes and saving lives on a global scale.Peer reviewe

Novel survey distribution methods: impact on antimicrobial resistance research outcomes

© 2024 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Peer reviewe