scholarly journals Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

2017 ◽  
Vol 38 (4) ◽  
pp. 476-482 ◽  
Author(s):  
Irene K. Louh ◽  
William G. Greendyke ◽  
Emilia A. Hermann ◽  
Karina W. Davidson ◽  
Louise Falzon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hand Hygiene ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Grey Literature ◽  
Quality Criteria ◽  
Acute Care Hospitals ◽  
Cochrane Library ◽  
Chlorhexidine Bathing ◽  
The Impact

OBJECTIVEPrevention ofClostridium difficileinfection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.DESIGNWe searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.SETTINGWe included studies performed in acute-care hospitals.PATIENTS OR PARTICIPANTSWe included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.INTERVENTIONSWe used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.RESULTSOf 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.CONCLUSIONSDaily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.Infect Control Hosp Epidemiol2017;38:476–482

scholarly journals The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

2013 ◽  
Vol 34 (4) ◽  
pp. 437-439 ◽  
Author(s):  
Adam Weston ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Alfred DeMaria ◽  
Shira Doron
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Educational Program ◽  
Business Models ◽  
National Level ◽  
State Level ◽  
Acute Care Hospitals ◽  
The State ◽  
Team Approach ◽  
The Impact

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

2018 ◽  
Vol 39 (8) ◽  
pp. 941-946 ◽  
Author(s):  
Bradley J. Langford ◽  
Julie Hui-Chih Wu ◽  
Kevin A. Brown ◽  
Xuesong Wang ◽  
Valerie Leung ◽  
...  
Keyword(s):  
Observational Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Defined Daily Doses ◽  
Prospective Audit And Feedback ◽  
The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

Interventions to Decrease Use in Prehospital and Emergency Care Settings Among Super-Utilizers in the United States: A Systematic Review

2019 ◽  
Vol 77 (2) ◽  
pp. 99-111 ◽  
Author(s):  
Samantha Iovan ◽  
Paula M. Lantz ◽  
Katie Allan ◽  
Mahshid Abir
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Acute Care ◽  
Emergency Care ◽  
Grey Literature ◽  
The United States ◽  
Care Utilization ◽  
Regression To The Mean ◽  
High Quality ◽  
The Impact

Interest in high users of acute care continues to grow as health care organizations look to deliver cost-effective and high-quality care to patients. Since “super-utilizers” of acute care are responsible for disproportionately high health care spending, many programs and interventions have been implemented to reduce medical care use and costs in this population. This article presents a systematic review of the peer-reviewed and grey literature on evaluations of interventions to decrease prehospital and emergency care use among U.S. super-utilizers. Forty-six distinct evaluations were included in the review. The most commonly evaluated intervention was case management. Although a number of interventions reported reductions in prehospital and emergency care utilization and costs, methodological and study design weaknesses—especially regression to the mean—were widespread and call into question reported positive findings. More high-quality research is needed to accurately assess the impact of interventions to reduce prehospital and emergency care use in the super-utilizer population.

scholarly journals A systematic review of pharmacists’ interventions to support medicines optimisation in patients with visual impairment

2019 ◽  
Vol 41 (6) ◽  
pp. 1400-1407 ◽  
Author(s):  
Basma Y. Kentab ◽  
Heather E. Barry ◽  
Sinaa A. Al-Aqeel ◽  
Carmel M. Hughes
Keyword(s):  
Systematic Review ◽  
Visual Impairment ◽  
Randomised Controlled Trials ◽  
Grey Literature ◽  
Cochrane Library ◽  
Future Research ◽  
Controlled Trials ◽  
Medicines Optimisation ◽  
Randomised Controlled ◽  
The Impact

Abstract Background People with visual impairment often report poorer health and encounter many challenges when using medicines. Pharmacists can play a significant role in optimising medicines use for these patients. However, little is known about pharmacists’ current practices when providing services to this population nor the impact of such services, if any, on medicines optimisation-related outcomes. Aim of the review This systematic review aims to identify the types, and assess the effectiveness of, interventions provided by pharmacists on medicines optimisation-related outcomes. Method Systematic searches of the following electronic databases were carried out from date of inception to March 2018: Cochrane Library; MEDLINE; EMBASE; International Pharmaceutical Abstracts; Scopus; and Cumulative Index to Nursing and Allied Health Literature. Several trial registries and grey literature resources were also searched. Any randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies, or interrupted time series analyses reporting on interventions provided by pharmacists to adult visually impaired patients and/or their caregivers in order to improve medicines optimisation-related outcomes of medicine safety, adherence, patient satisfaction, shared decision making, or quality of life were included. Results A total of 1877 titles/abstracts were screened, and 27 full text articles were assessed for eligibility. On examination of full texts, no studies met the inclusion criteria for this review. Conclusion This review highlights the need for future research that would be vital for promoting the safe and effective use of medicines and the delivery of pharmaceutical care services to people with visual impairment.

scholarly journals Effectiveness of health technology electronic prescribing: A protocol for systematic review and meta-analysis Study

2017 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
Saeed Eslami ◽  
Hamidreza Dehghan ◽  
Mahdieh Namayandeh ◽  
Arezo Dehghani ◽  
Saeed Hajian Dashtaki ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Quality Criteria ◽  
Analysis Data ◽  
Healthcare Services ◽  
Electronic Prescribing ◽  
Cochrane Library ◽  
Policy Makers

INTRODUCTION: There is increasing evidence that electronic prescribing (ePrescribing) can improve the quality and safety of healthcare services. However, it has also become clear that this implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, the systematic review can provide us with a general overview of the results of the studies and can help us find the truth. This review will aim to identify, appraise and synthesise clinical trial studies on ePrescribing in hospital settings.METHODS AND ANALYSIS:  Data sources will include the following  databases: pubmed, scopus and cochrane library. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature. Studies will be independently screened for eligibility by 2 reviewers and data extraction is done by 2 people. Articles are evaluated on the basis of the quality criteria of JADAD. The data is analyzed by the STATA software.DISSEMINATION: The results of the study will be published in a peer-reviewed journal and presented at relevant conferences. Policy makers and healthcare decision-makers can use these results.

scholarly journals Factors influencing sexual behaviour between tourists and tourism employees: A systematic review

2016 ◽  
Vol 6 (1) ◽  
pp. 530 ◽  
Author(s):  
Padam P Simkhada ◽  
Aditi Sharma ◽  
Edwin R Van Teijlingen ◽  
Rachel L Beanland
Keyword(s):  
Systematic Review ◽  
Sexual Behaviour ◽  
Grey Literature ◽  
Travel Medicine ◽  
Tourism Industry ◽  
Cochrane Library ◽  
Middle Income ◽  
Sexual Activities ◽  
Factors Influencing ◽  
The Impact

<p><strong><em>Background:</em></strong> Increased travel abroad has a significant impact on the incidence and prevalence of Sexually Transmitted Infections (STIs). Previous reviews have focused on the knowledge, attitudes and behaviour of tourists and acquisition of STIs. Less is known about the impact on tourism operators in countries visited by tourists.  The aim of this review is to ascertain factors influencing sexual behaviour between workers in the tourism industry and tourists; exploring the prevalence of sexual behaviour between the two populations, their perceptions of sexual risk while engaging in sexual activities and the knowledge of tourism operators regarding STIs.</p><p><strong><em>Methods:</em></strong> A systematic review was conducted. Database searches were performed in Medline/Ovid, EMBASE, Cochrane library and CINAHL for studies published between 2000 and March 2016. Grey literature searches were completed in the NHS database and Google Scholar between 2000 and December 2013. Papers were independently selected by two researchers. Data were extracted and critically appraised using a pre-designed extraction form and adapted CASP checklist.</p><p><strong><em>Results: </em></strong>The search identified 1,602 studies and 16 were included after review of the full text. Studies were conducted in nine countries. Findings suggest that STI knowledge, attitude and practice were fairly good among tourists and tourism workers, but there is a need for pre-travel advice for travellers, especially those travelling to low and middle-income countries. Greater importance was given to tourists than to tourism operators and locals interacting with tourists. Studies suggest that as a group both tourist and tourist workers were likely to engage in sexual activities. Overall, both condom use and STI screening were low, among tourists as well as tourism operators. Furthermore, studies reported links between drug and alcohol use and sexual behaviour and risk taking.</p><p><strong><em>Conclusion:</em></strong><strong> </strong>Although less research appeared to have been conducted among tourism workers than tourists, it does demonstrate the need for education, training and promotion of travel medicine. STI screening, pre-travel advice, travel history in terms of contracting STIs and safe-sex awareness-raising are needed. More and better sexual health education and relevant tourism policies are needed globally. </p>

scholarly journals Promoting men’s awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions

2018 ◽  
Vol 1 ◽  
pp. 16 ◽  
Author(s):  
Mohamad M. Saab ◽  
Martin Davoren ◽  
Aileen Murphy ◽  
David Murphy ◽  
Eoghan Cooke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Help Seeking ◽  
Grey Literature ◽  
World Health ◽  
Cochrane Library ◽  
Medical Attention ◽  
Younger Men ◽  
Self Examination ◽  
The Impact

Background: Testicular cancer (TC) is commonly diagnosed among men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders such as testicular torsion and epididymitis can lead to testicular ischemia, sepsis, and infertility if left untreated. This systematic review aims to evaluate the effectiveness of studies promoting men’s knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsychINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, Clinicaltrials.gov, Grey Literature Report, and Open Grey were searched for studies published between November 2014 and April 2018. The methodological quality and level of evidence per outcome were assessed.  Results: There were five papers included: two were experimental studies, two were systematic reviews, and one was an integrative review. The majority of the reviewed interventions were successful in increasing men’s awareness of TC and self-examination. Examples include a television show featuring a celebrity with TC, a university campaign, and interactive educational sessions. The impact of the reviewed interventions on health beliefs (i.e. perceived susceptibility, severity, benefits, barriers, and self-efficacy) varied across the reviewed literature. Studies promoting help-seeking for testicular symptoms and awareness of benign testicular disorders were lacking. Conclusions: This review highlights the importance of evaluating educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.

Impact of California’s mandate for antimicrobial stewardship programs on rates of methicillin-resistant Staphylococcus aureus and Clostridioides difficile infection in acute-care hospitals

2020 ◽  
pp. 1-7
Author(s):  
Alessandra B. Garcia Reeves ◽  
Sally C. Stearns ◽  
Justin G. Trogdon ◽  
James W. Lewis ◽  
David J. Weber ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Fixed Effects ◽  
Acute Care Hospitals ◽  
The United States ◽  
Methicillin Resistant ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Impact

Abstract Objective: To estimate the impact of California’s antimicrobial stewardship program (ASP) mandate on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infection (CDI) rates in acute-care hospitals. Population: Centers for Medicare and Medicaid Services (CMS)–certified acute-care hospitals in the United States. Data Sources: 2013–2017 data from the CMS Hospital Compare, Provider of Service File and Medicare Cost Reports. Methods: Difference-in-difference model with hospital fixed effects to compare California with all other states before and after the ASP mandate. We considered were standardized infection ratios (SIRs) for MRSA and CDI as the outcomes. We analyzed the following time-variant covariates: medical school affiliation, bed count, quality accreditation, number of changes in ownership, compliance with CMS requirements, % intensive care unit beds, average length of stay, patient safety index, and 30-day readmission rate. Results: In 2013, California hospitals had an average MRSA SIR of 0.79 versus 0.94 in other states, and an average CDI SIR of 1.01 versus 0.77 in other states. California hospitals had increases (P < .05) of 23%, 30%, and 20% in their MRSA SIRs in 2015, 2016, and 2017, respectively. California hospitals were associated with a 20% (P < .001) decrease in the CDI SIR only in 2017. Conclusions: The mandate was associated with a decrease in CDI SIR and an increase in MRSA SIR.

scholarly journals Promoting men’s awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions

2018 ◽  
Vol 1 ◽  
pp. 16
Author(s):  
Mohamad M. Saab ◽  
Martin Davoren ◽  
Aileen Murphy ◽  
David Murphy ◽  
Eoghan Cooke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Help Seeking ◽  
Grey Literature ◽  
World Health ◽  
Cochrane Library ◽  
Medical Attention ◽  
Younger Men ◽  
Self Examination ◽  
The Impact

Background: Testicular cancer (TC) is commonly diagnosed among men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders such as testicular torsion and epididymitis can lead to testicular ischemia, sepsis, and infertility if left untreated. This systematic review aims to evaluate the effectiveness of studies promoting men’s knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsychINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, Clinicaltrials.gov, Grey Literature Report, and Open Grey were searched for studies published between November 2014 and April 2018. The methodological quality and level of evidence per outcome were assessed.  Results: There were five papers included: two were experimental studies, two were systematic reviews, and one was an integrative review. The majority of the reviewed interventions were successful in increasing men’s awareness of TC and self-examination. Examples include a television show featuring a celebrity with TC, a university campaign, and interactive educational sessions. The impact of the reviewed interventions on health beliefs (i.e. perceived susceptibility, severity, benefits, barriers, and self-efficacy) varied across the reviewed literature. Studies promoting help-seeking for testicular symptoms and awareness of benign testicular disorders were lacking. Conclusions: This review highlights the importance of evaluating educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.

scholarly journals Adherence to Lifestyle Interventions for Treatment of Adults with Depression: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (24) ◽  
pp. 13268
Author(s):  
Adoración Castro ◽  
Miquel Roca ◽  
Ignacio Ricci-Cabello ◽  
Mauro García-Toro ◽  
Pau Riera-Serra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptomatology ◽  
Meta Analysis ◽  
Grey Literature ◽  
Intervention Group ◽  
Dropout Rate ◽  
Cochrane Library ◽  
Future Research ◽  
Lifestyle Interventions ◽  
The Impact

The aim of this systematic review was to determine the adherence to lifestyle interventions for adults with depression and to estimate the dropout rates in trials examining the impact of these interventions. A bibliographic search was conducted in PubMed, Embase, PsycINFO, the Cochrane library, and several sources of grey literature. We included randomised controlled trials examining the impact of multiple lifestyle interventions on depressive symptomatology in adults when compared to control or other active treatments. Two reviewers independently screened citations, extracted the relevant data, and assessed the risk of bias using Cochrane tools. A random effects meta-analysis of proportions was used to summarise the proportion of participants who completed the intervention and to determine the proportion of dropouts at post-treatment assessment. Multiple subgroup analyses were also carried out. We identified six trials. The meta-analysis of proportions showed that 53% (95%CI 49% to 58%) of the participants assigned to the intervention group fully adhered to the intervention program. The weighted mean proportion of completed intervention sessions was 66%. The pooled trial dropout rate was 22% (95%CI 20% to 24%). Around half of adults with depression adhere to lifestyle interventions. Future research is needed to develop interventions to support adherence to lifestyle interventions in depressive patients.

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