Despite prior-approval requirements of hospitals for certain antimicrobials, doctors still manage to "stealth dose"

2007 ◽  
Keyword(s):  
Prior Approval

scholarly journals Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

2021 ◽  
pp. 1-8
Author(s):  
Katie J. Suda ◽  
Gosia S. Clore ◽  
Charlesnika T. Evans ◽  
Heather Schacht Reisinger ◽  
Ibuola Kale ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Pathways ◽  
Statistical Significance ◽  
Implementation Strategies ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prior Approval ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
Advanced Generation

Abstract Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were “completely” accepted had lower fluoroquinolone rates than sites where it was “moderately” accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) “would” or “may” be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

scholarly journals ASSESSMENT OF IMMUNOMODULATORY POTENTIAL OF AN AYURVEDIC FORMULATION, NIROCIL SYRUP IN WISTAR RATS

2020 ◽  
pp. 154-158
Author(s):  
DINESH DILIP GHADIGAONKAR ◽  
MUKESH B CHAWDA ◽  
KAPIL S THAKUR
Keyword(s):  
Wistar Rats ◽  
Animal Ethics ◽  
Complete Blood Count ◽  
Treated Group ◽  
Control Group ◽  
Differential Leukocyte Count ◽  
Experimental Animals ◽  
Prior Approval ◽  
Hemagglutination Titer ◽  
Immunomodulatory Potential

Objective: This study aims to assess the immunomodulatory potential of an Ayurvedic formulation, Nirocil syrup, in Wistar rats. Methods: The experiments were conducted on Wistar rats with prior approval from the Institutional Animal Ethics Committee. Nirocil syrup was administered for 6 weeks to experimental animals. Parameters such as hemagglutination titer, histopathology of immunological organs, complete blood count, differential leukocyte count, and immunological paw edema were recorded and compared with controlled (untreated) and becozinc treated groups. Results: Nirocil treated group significantly enhanced the antibody titer in comparison to the control group. The results are supported by the increase in blood lymphocyte count and antigenic stimulation in immunological organs (spleen). Nirocil syrup enhanced antibody formation and suppressed the immunological edema in experimental animals. Conclusions: The study concludes that the Ayurvedic formulation Nirocil syrup has immunopotentiating activity.

Sino-Vatican Diplomatic Relations: Problems and Prospects

1989 ◽  
Vol 120 ◽  
pp. 814-836 ◽  
Author(s):  
Gerald Chan
Keyword(s):  
Catholic Church ◽  
The Self ◽  
The Other ◽  
Diplomatic Relations ◽  
Republic Of China ◽  
Holy See ◽  
Political Implications ◽  
Prior Approval ◽  
The Status ◽  
Major Factors

The China Quarterly Two major factors have continued to impair diplomatic relations between the People’s Republic of China and the Vatican, namely, the so-called “two-China” problem and the independence issue. China regards the Vatican’s diplomatic relations with Taiwan as an infringement of her sovereignty, and insists they are terminated prior to her consideration of a resumption of relations (broken off in 1958) with the Holy See. The Vatican is now the only state in Europe to maintain diplomatic links with Taiwan. Moreover, the Chinese Catholic Church wishes to remain independent of the Pope in Rome. This issue is manifested in the “self-consecration” of bishops in China without seeking the Pope’s prior approval. The “two-China” problem is basically a political and diplomatic one whereas the independence issue has religious as well as political implications. Both China and the Vatican recognize the existence of these two areas of dispute but they differ in their approach towards achieving a possible resolution. China demands that the Vatican should take steps to solve the “two-China” problem before China is ready to discuss the independence question, whereas the Vatican expects China to concede on the latter point first by acknowledging the Pope as the head of the universal Church, before proceeding to discuss other matters, including the status of the Vatican’s diplomatic ties with Taiwan. These different approaches lead to the present stalemate. Each side is expecting the other to take the initiative to overcome the apparent deadlock.

Adoption Legislation and Practice in Australia

1979 ◽  
Vol 4 (2) ◽  
pp. 12-15 ◽  
Author(s):  
Peter Fopp
Keyword(s):  
Social Welfare ◽  
Government Department ◽  
Prior Approval ◽  
Adoption Agency ◽  
Welfare Department

Under the Constitution of the Commonwealth of Australia, adoption is not a matter on which the Commonwealth has power to legislate. Accordingly, each State and Territory has its own legislation which is administered by its social welfare department.The States have co-operated to draft “uniform” legislation, and during the period 1964-1970, new legislation was enacted in all States and Territories. A major aim of the uniform Acts was to curtail the practice of private, or independent, adoptions, where the child was placed in the care of a person with a view to his adoption, without any prior approval of the placement by a government department or an approved private adoption agency.

scholarly journals Inaccurate Communications in Telephone Calls to an Antimicrobial Stewardship Program

2006 ◽  
Vol 27 (7) ◽  
pp. 688-694 ◽  
Author(s):  
Darren R. Linkin ◽  
Sarah Paris ◽  
Neil O. Fishman ◽  
Joshua P. Metlay ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Antimicrobial Stewardship ◽  
Odds Ratio ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Patient Data ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Prior Approval ◽  
Telephone Calls

Background.Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system—that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used—depends on the accuracy of the patient data communicated from the primary service.Objectives.To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication.Design.We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard.Setting.A tertiary care medical center that has a prior approval system for restricted antimicrobials.Patients.Inpatients discussed in telephone ASP interactions.Intervention.Observational study.Results.Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]).Conclusions.A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.

scholarly journals ANALYSIS OF PERSPECTIVE AND COMMUNITY BEHAVIOR IN MANAGEMENT OF FOREST AREAS WITH SPECIAL PURPOSE (KHdTK) UMM

2020 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Ahmad Ardiansyah ◽  
Tatag Muttaqin ◽  
Galit Gatut Prakosa
Keyword(s):  
Human Life ◽  
Community Activities ◽  
Farming Community ◽  
Protected Forests ◽  
Community Behavior ◽  
Prior Approval ◽  
The Future ◽  
The Status ◽  
Economic Foundation ◽  
The Government

Forests are natural resources that have enormous benefits for the continuity of human life for now and in the future. The community around the forest has a big role in determining the sustainability of the forest because all community activities related to meeting the needs of daily life are very dependent on the existence of the forest. The people's behavior and actions are closely related to the community's perception of the forest. Communities in treating forests are also influenced by their experience and knowledge. Educational Forests or Special Purpose Forest Areas (KHdTK) are areas designated by the government for forestry research and development. University of Muhammadiyah Malang was appointed as the manager of Special Purpose Forest Areas (KHdTK) printed 43A, 44I, 44K-1, 44K-2, and 44L of Kedung Rejo RPH BKPH Pujon KPH Malang where the area is included in the status of production forest area and protected forest. This study aims to determine the perceptions of the surrounding community towards the plan to manage forest areas with specific objectives of UMM in plots 43A, 44I, 44K-1, 44K-2, and 44L, to determine the behavior of surrounding communities towards the plan to manage forest areas with UMM specific objectives in 43A plots, 44I, 44K-1, 44K-2, and 44L. The results of this study indicate that public perceptions of the KHdTK strategic plan by UMM were very well received. There is an inappropriate behavior of the community, namely the farming community in protected forest in 43A, but with prior approval from Perhutani, the behavior in managing the forest always considers the sustainability of the forest and the community always respects the applicable regulations, even though there is behavior that does not comply with the law but the community do that with the approval of Perhutani. The forest is the economic foundation of the surrounding community. In the future, UMM as the manager must be able to work together with the community and restore 43A plots according to their function, namely protected forests and rearranging farmers in KHdTK. 

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