Threatened efficiency not autonomy: Prescriber perceptions of an established pediatric antimicrobial stewardship program

2019 ◽  
Vol 40 (05) ◽  
pp. 522-527 ◽  
Author(s):  
Julia E. Szymczak ◽  
Eimear Kitt ◽  
Molly Hayes ◽  
Kathleen Chiotos ◽  
Susan E. Coffin ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Social And Emotional ◽  
Phone Calls ◽  
Stewardship Program ◽  
Favorable Impression ◽  
Pediatric Inpatient ◽  
Communication Breakdowns

AbstractBackground:Implementing antimicrobial stewardship programs (ASPs) can be challenging due to prescriber resistance. Although barriers to implementing new ASPs have been identified, little is known about how prescribers perceive established programs. This information is critical to promoting the sustainability of ASPs.Objective:To identify how prescribers perceive an established pediatric inpatient ASP that primarily utilizes prior authorization.Methods:We conducted a cross-sectional survey administered from February through June 2017 in a large children’s hospital. The survey contained closed- and open-ended questions. Descriptive statistics and thematic content analysis approaches were used to analyze responses.Results:Of 394 prescribers invited, 160 (41%) responded. Prescribers had an overall favorable impression of the ASP, believing that it improves the quality of care (92.4% agree) and takes their judgment seriously (73.8%). The most common criticism of the ASP was that it threatened efficiency (26.0% agreed). In addition, 68.7% of respondents reported occasionally engaging in workarounds. Analysis of 133 free-text responses revealed that prescribers perceived that interacting with the ASP involved too many phone calls, caused communication breakdowns with the dispensing pharmacy, and led to gaps between approval and dispensing of antibiotics. Reasons given for workarounds included not wanting to change therapy that appears to be working, consultant disagreement with ASP recommendations, and the desire to do everything possible for patients.Conclusions:Prescribers had a generally favorable opinion of an established ASP but found aspects to be inefficient. They reported engaging in workarounds occasionally for social and emotional reasons. Established ASPs should elicit feedback from frontline prescribers to optimize program impact.

scholarly journals Physicians’ attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals

2021 ◽  
Vol 19 (1) ◽  
pp. 2192
Author(s):  
Nathalie Sayegh ◽  
Souheil Hallit ◽  
Rabih Hallit ◽  
Nadine Saleh ◽  
Rouba K. Zeidan
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Antimicrobial Stewardship Program ◽  
National Guidelines ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Positive Attitudes ◽  
Stewardship Program ◽  
Prospective Audit And Feedback

Background: Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program. Objectives: To examine physicians’ attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals. Methods: A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians’ attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements. Results: 158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians’ autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents. Conclusions: Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians.

Breast-feeding promotion in hospitals and prospective breast-feeding rates during the first year of life in two national surveys 1997–1998 and 2017–2019 in Germany

2021 ◽  
pp. 1-13
Author(s):  
Nele Hockamp ◽  
Constanze Burak ◽  
Erika Sievers ◽  
Silvia Rudloff ◽  
Anja Burmann ◽  
...  
Keyword(s):  
Breast Feeding ◽  
Infant Nutrition ◽  
Feeding Habits ◽  
First Year ◽  
Feeding Rates ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Web Based ◽  
Phone Calls ◽  
First Year Of Life

Abstract Objectives: The present study aimed to assess the current state of breast-feeding promotion in hospitals and the prevalence of breast-feeding during the first year of life in Germany and to compare the results with a study 20 years earlier. Design: In the studies on ‘breast-feeding and infant nutrition in Germany’ named ‘SuSe’, a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breast-feeding and infant nutrition during the first year of life (0·5, 2, 4, 6 and 12 months after birth) in mother–infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breast-feeding promotion and prevalence were evaluated using recommendations from the WHO and the UNICEF. Setting: Two nationwide surveys SuSe I (1997–1998) and SuSe II (2017–2019). Participants: In SuSe I, 177 hospitals and 1717 mother–infant pairs and in SuSe II 109 hospitals and 962 mother–infant pairs were included. Results: In SuSe II, hospitals implemented seven of the WHO ‘Ten Steps to Successful Breastfeeding’ to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57 % v. 33 %) and continued breast-feeding until 6 (78 % v. 48 %) and 12 months (41 % v. 13 %). In both studies, exclusive breast-feeding decreased between 4 and 6 months of age due to the introduction of complementary feeding. Conclusions: In Germany, breast-feeding habits have come closer to the recommendations over the last 20 years.

scholarly journals Cross-sectional survey of the undergraduate rheumatology curriculum in European medical schools: a EULAR School of Rheumatology initiative

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000743 ◽  
Author(s):  
Abhishek Abhishek ◽  
Annamaria Iagnocco ◽  
J W J Bijlsma ◽  
Michael Doherty ◽  
Frédéric Lioté
Keyword(s):  
Musculoskeletal Diseases ◽  
Site Response ◽  
Joint Infection ◽  
Medical Schools ◽  
Calcium Pyrophosphate ◽  
Free Text ◽  
Curriculum Content ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Additional Information

ObjectivesTo survey the undergraduate rheumatic and musculoskeletal diseases (RMDs) curriculum content in a sample of medical schools across Europe.MethodsThe undergraduate musculoskeletal diseases and disability curriculum of University of Nottingham, UK, was used as a template to develop a questionnaire on curriculum content. The questionnaire elicited binary (yes/no) responses and included the option to provide additional information as free text. The survey was mailed to members of the European League Against Rheumatism (EULAR) School of Rheumatology (Undergraduate Classroom) and to EULAR Standing Committee on Education and Training members in January 2017, with a reminder in February 2017.ResultsResponses were received from 21 schools belonging to 11 countries. Assessment of gait, hyperalgesic tender site response and hypermobility were not included in many curricula. Similarly, interpretation of investigations undertaken on synovial fluid was taught in only 16 schools. While disease-modifying anti-rheumatic drugs and biological agents, and urate-lowering treatment were included in the curricula of 20 and 21 institutions, respectively, only curricula from 18 schools included core non-pharmacological interventions. Osteoarthritis, gout, rheumatoid arthritis, spondyloarthropathy, polymyalgia rheumatica and lupus were included in the curriculum of all institutions. However, common RMDs such as calcium pyrophosphate deposition, fibromyalgia, giant cell arteritis and bone and joint infection were included in 19 curricula.ConclusionThis survey highlights areas of similarities and differences in undergraduate curricula across Europe. It is hoped that the results of this survey will catalyse the development and agreement of a minimum core European Curriculum for undergraduate education in RMDs.

scholarly journals Antimicrobial stewardship program in China’s tertiary hospitals in 2018: a nationwide cross-sectional online survey

2020 ◽  
Author(s):  
Yue Zhou ◽  
Haishaerjiang Wushouer ◽  
Xi Zhang ◽  
Jiajia Feng ◽  
Likai Lin ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Evaluation System ◽  
Clinical Pathways ◽  
Popular Science ◽  
Outcome Evaluation ◽  
Antimicrobial Use ◽  
Cross Sectional ◽  
Prescription Audit ◽  
Stewardship Program ◽  
Tertiary Hospitals

Abstract Background The study aimed to assess the development of antimicrobial stewardship (AMS) program in China’s tertiary hospitals to identify the potential challenges for AMS program and provide references and benchmarks for strategic policymaking. Methods A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System (CARSS) between November 1, 2018 and December 10, 2018. The questionnaire included 5 sections regarding structure, technical support, antimicrobial use management, antimicrobial use surveillance and education. Descriptive statistics were used for data analysis. Results Of 1044 tertiary hospitals under CARSS, 13.4% (140) hospitals participated in the study. Among them, 99.3% (139/140) set up AMS program. Hospital president (82.1%, 115/140) and medical service department (59.3%, 83/140) were responsible for AMS outcomes in most hospitals. Structured antimicrobial formulary restriction management was adopted by 99.3% (139/140) hospitals. Infection disease department, infection control department and microbiological laboratories were established in 87.1% (122/140), 99.3% (139/140), and 100% (140/140) hospitals, respectively. Up to 85.6% (124/140) hospitals applied clinical pathways and 33.6% (47/140) hospitals implemented hospital-specific guidelines for infectious diseases. Outpatient prescription audit, inpatient prescription audit and prophylactic antimicrobial prescription audit of aseptic operation were performed in 99.3% (139/140), 98.6% (138/140) and 95.7% (134/140) hospitals, respectively. Up to 97.1% (136/140) hospitals participated in antimicrobial use surveillance network and 99.3% (139/140) hospitals established the specialized management of carbapenem and tigecycline. Staff education and AMS-related popular science education were provided with different ways and frequency in 100% (140/140) and 88.6% (124/140) hospitals, respectively. Conclusions AMS in China’s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments. More efforts should be put into further promoting and strengthening the development of hospital-specific guidelines and the establishment of progress and outcome evaluation system.

scholarly journals Application of smartphones in dermatology practice: a cross-sectional survey

2021 ◽  
Vol 7 (2) ◽  
pp. 171
Author(s):  
Priya Prabhakaran Nair ◽  
Leela Manju
Keyword(s):  
Point Of Care ◽  
Cross Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Survey Tool ◽  
Clinical Photography ◽  
Inappropriate Use ◽  
Phone Calls ◽  
Smartphone Use ◽  
Level Of Training

<p><strong>Background:</strong> Smartphones have revolutionised medical practice including dermatology because of its multiple functions assisting practitioners at the point of care and beyond. We aimed to analyse the pattern of smartphone use by dermatologists and to explore their opinions and difficulties faced while using smartphone</p><p><strong>Methods:</strong> This cross-sectional study included a population of dermatology consultants and residents in Kerala, India. A validated self-reported questionnaire was emailed to them using a survey tool to collect the data</p><p><strong>Results:</strong> Overall 100 practitioners responded to the questionnaire with a response rate 10.6%. Consultants and residents accounted for 81% and 19% of the participants respectively. Females (78%) outnumbered males. Most (58.6%) belonged to age group 31-40 years. Everyone owned a smartphone with the most prevalent operating system (OS) being android (85.9%). Medical communication was done mostly using phone calls (92%). Drug reference (94%) was the most popular noncommunicative application. Most participants (85%) used smartphone camera for clinical photography. OS freezing was the biggest technical issue whereas inappropriate use and distraction were the biggest nontechnical challenges of smartphone use. Clinical photography was taken by 95% for disease monitoring with significantly higher usage in females. Those upto 40 years of age significantly took and shared clinical photographs for second opinion more than older ones. Only 17.2% with significantly higher males than females took written consent for photography.</p><p><strong>Conclusions:</strong> Dermatologists use smartphone extensively for communication, information and photography with preferences varying with age, gender and level of training.</p>

Life satisfaction and adolescent music making: A comparison of youth choirs and bands in Spain

2021 ◽  
pp. 102986492110214
Author(s):  
Salvador Oriola-Requena ◽  
Diego Calderón-Garrido ◽  
Josep Gustems
Keyword(s):  
Life Satisfaction ◽  
Academic Motivation ◽  
Musical Instrument ◽  
Positive Influence ◽  
Leadership Capacity ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Social And Emotional ◽  
Music Making ◽  
Youth Music

Adolescents who are members of youth music groups learn music and develop other skills such as group work and conflict resolution. These skills and feelings may represent socioemotional factors underlying increased life satisfaction, leadership capacity, and academic motivation, together with the acquisition of emotional skills. The aim of the research was to determine the degree of life satisfaction reported by a sample of 660 Spanish adolescents who were members of a youth band or choir. It also aimed to examine correlations between life satisfaction, leadership capacity, academic motivation, and emotional development. Potential differences between these variables attributable to participants’ age, gender, type of youth music group, and musical instrument played were explored using a cross-sectional survey comprising four standardized questionnaires. The results show that the participants were highly satisfied with their lives. There were strong positive correlations between the variables studied but also some significant differences between the two groups (choirs and bands), and between players of different instrument families. These results are in line with those other studies, confirming the positive influence of group music making on adolescents’ social and emotional growth.

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

2021 ◽  
Author(s):  
Edmond Li ◽  
Rosy Tsopra ◽  
Geronimo Jimenez ◽  
Alice Serafini ◽  
Gustavo Gusso ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Lessons Learned ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Face To Face ◽  
Remote Care

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099

scholarly journals Patient-Reported Use of the After Visit Summary in a Primary Care Internal Medicine Practice

2019 ◽  
Vol 7 (5) ◽  
pp. 703-707
Author(s):  
Sarita Pathak ◽  
Gregory Summerville ◽  
Celia P Kaplan ◽  
Sarah S Nouri ◽  
Leah S Karliner
Keyword(s):  
Primary Care ◽  
Multivariable Analysis ◽  
Free Text ◽  
Primary Care Visit ◽  
Communication Tool ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Visit ◽  
Patient Reported ◽  
Communication Errors

Participants completed a cross-sectional survey about their use of the after visit summary (AVS) at a previous primary care visit. Of 355 participants, 294 (82.8%) recalled receiving it, 67.4% consulted it, 45.9% consulted it more than once, and 31.6% shared the AVS. In multivariable analysis, higher education and older age were associated with AVS consultation. Among the subset of 133 patients recalling personalized free-text instructions, 96% found them easy to understand and 94.4% found them useful. Our findings suggest that the AVS is a useful communication tool and improvement efforts should emphasize clarity for those most vulnerable to communication errors.

576 Firefighter Post-injury Return to Work: A Balance of Dedication and Obligation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S130-S130
Author(s):  
Lauren B Nosanov ◽  
Kathleen S Romanowski
Keyword(s):  
Return To Work ◽  
Burn Injury ◽  
Organizational Level ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Post Injury ◽  
Cross Sectional ◽  
Burn Center ◽  
Medical Evaluation ◽  
The Individual

Abstract Introduction Over the duration of firefighters’ careers there exists a high probability of sustaining burn injuries necessitating medical evaluation and treatment. While many are minor and do not significantly affect the ability to work in full capacity, there exists risk for both short and long-term incapacitation. It is not uncommon for firefighters to push for earlier return to work than is medically advisable. However, there are additional external factors which drive premature return to duty. Methods An online cross-sectional survey was sent to firefighters who were members of a statewide Professional Firefighters’ Union. A multiple-choice format was used to assess demographics, injury details, medical care received and return to work. Free text format allowed for elaboration regarding factors influencing decisions to return to work. Results The survey was sent to 30,000 firefighters, with 413 (1.4%) responses received. Excluding those with incomplete data, 354 remained for analysis. Of these, 132 (37.3%) reported a burn injury which required medical evaluation. The majority were sustained during active duty, with 90.7% using protective gear at the time. Most burns were small and affected the head (50.8%) and upper extremities (48.3%). The majority were not treated at a Burn Center. While 12 (16.2%) reported returning to work prematurely themselves, nearly half indicated that they knew a colleague whom they felt had returned to work too soon. Factors cited include firefighter culture, finances, limitations of workman’s compensation, pressure from peers and employers, dislike of light duty and a driving desire to get back to work. Conclusions While many cite love of the job and a culture of pride and camaraderie that is “in our DNA”, firefighters’ decisions to return to work after burn injury are equally driven external pressures and obligations. Additional education is needed at both the individual and organizational level, which may best be facilitated by evaluation and treatment at a Burn Center. Applicability of Research to Practice Improved understanding of factors driving firefighters’ views on returning to duty after injury may help establish support systems and improve education regarding risks of premature return to work, particularly with regard to reinjury.

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