scholarly journals La granulomatosi eosinofilica con poliangioite: dalla pelle al cuore

2020 ◽  
Vol 39 (9) ◽  
pp. 575-580
Author(s):  
Aldo Ravaglia ◽  
Andrea Guala ◽  
Roberto Gnavi ◽  
Alberto Borraccino ◽  
Keyword(s):  
Working Group ◽  
Internal Variability ◽  
Entire Period ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Regional Variability ◽  
Pharmaceutical Service ◽  
Treatment Prevalence ◽  
Pharmaceutical Prescription ◽  
Piedmont Region

Background - he variability in the prescription of antibiotics in the infant population registers changes that cannot always be explained by the associated morbidity alone. Italy, despite its decreasing trend, is still among those countries with the highest prescriptions and shows an important inter-regional variability. The Pharmaceutical Service of the Piedmont Region gave the start to a working group with the task of describing the prescriptive activities, evaluating any internal variability and proposing strategies for improvement. Aim - The aim of the work is to describe the results achieved in Piedmont in 2012-2018 with regard to the paediatric treatment. Materials and methods - Data on prescriptions in paediatrics, grouped for ATC, were obtained from the regional pharmaceutical prescription system. Prescriptive rates and treatment prevalence - children with at least one prescription during the year - were calculated for the total number of residents. Results - The overall rate was reduced from 931 to 689 prescriptions per thousand children. In the same period, the prevalence of prescriptions was also reduced from 45.5% to 34.8%. Non-associated amoxicillin accounted for less than 15% of prescriptions, while clavulanate amoxicillin was the most widely used antibiotic with the 45% of the prescriptions. The ratio of amoxicillin to clavulanate amoxicillin remained strongly negative over the entire period, although it slightly improved from 0.27 to 0.42. Conclusion - The proportion of treatments, though decreasing, is still far from those of other virtuous European nations. Amoxicillin, unlike what suggested by inter-national and national guidelines, is the least prescribed antibiotics with an excess in clavulanate amoxicillin prescriptions that is difficult to explain. According to recent AIFA reports, the observed differences seem to depend partly on the patient's family but mainly on the prescriptive behaviours. Therefore, the professionals involved should compare prescribing practices to further improve prescriptive appropriateness.

REVIEW OF INDEPENDENT NURSE PRESCRIBING IN A PAEDIATRIC CYSTIC FIBROSIS (CF) AND RESPIRATORY POPULATION

2016 ◽  
Vol 101 (9) ◽  
pp. e2.6-e2
Author(s):  
Gabis Chana ◽  
Michelle Tabberner ◽  
Wendy Nixon ◽  
Sue Frost ◽  
Leslie Barrett ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Medical Condition ◽  
Junior Doctors ◽  
Positive Contribution ◽  
Oral Antibiotics ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Exclusion Criteria ◽  
Patient Journey ◽  
Telephone Advice

AimWith pressures on junior doctors' availability in the NHS, non-medical prescribing is topical. Independent Nurse Prescribers (INPs) can prescribe any licensed medicine for any medical condition within their level of competence.1 An audit was undertaken of the four INPs employed by the Respiratory Department evaluating current prescribing practices.MethodThe requirement for this audit was identified by the multidisciplinary team (MDT) and Trust approval was obtained. A data collection form was designed capturing patient demographics and full details of prescribed items.Over a 3 month period (August to October 2014) outpatient cystic fibrosis (CF) and respiratory prescriptions were studied using cluster sampling. Over a 6 week period prescription requests by CF INPs faxed to General Practitioners (GPs) were reviewed. INPs also prescribe via telephone, documenting advice on trust forms; these were preliminarily audited. All data was analysed using Microsoft Excel. Legality of prescriptions and adherence to national and local guidelines were evaluated. Reference keys were used to designate non-adherence post-application of exclusion criteria.ResultsA total of 77 outpatient prescriptions (45 CF and 32 respiratory) were completed by the 4 INPs, containing 122 items (72 CF and 50 respiratory). Of the CF prescribed items 21 were oral antibiotics (29%). Respiratory INPs mainly prescribed 14 inhaler devices (28%) and 12 inhaled bronchodilators (24%).All INP prescriptions met legal requirements. Basic details of medicinal products (drug name and dose) were documented for all items. A key finding was that duration/quantity was not indicated for 27 (54%) respiratory items.After applying exclusion criteria, of the CF prescribed items, 56/59 (95%) adhered to national guidelines and 47/66 (71%) followed local guidelines. The leading reason for not following local guidelines was not documenting allergy status. Of the respiratory prescribed items, 34 (100%) adhered to national guidelines and 31/32 (97%) followed local guidelines.A total of 33 faxes (with 38 items) were completed and 35 items (92%) were oral antibiotics. Drug name, dose and frequency were stated for all items. From the faxed items, 38 (100%) adhered to national guidelines and 32/33 (97%) followed local guidelines.Over 5 days, CF INPs provided telephone advice for 12 patients. Of these, 6 patients had respiratory exacerbation. Telephone advice led to faxes being sent to GPs for 9 patients. This was preliminary data with a re-audit planned after amendment of trust form.ConclusionOverall INP prescribing was found to be safe and effective. This review enabled education of the respiratory team of prescribing practices via a local audit meeting. The positive contribution that INPs provide to patient care was highlighted as they improve the patient journey and support the MDT. The demand for INP prescribing in particular with CF has provided opportunity for a pharmacist prescriber to join the CF MDT. It is recommended medical and pharmacist prescribing to be reviewed.

scholarly journals Envisioning AI for K-12: What Should Every Child Know about AI?

2019 ◽  
Vol 33 ◽  
pp. 9795-9799 ◽  
Author(s):  
David Touretzky ◽  
Christina Gardner-McCune ◽  
Fred Martin ◽  
Deborah Seehorn
Keyword(s):  
Artificial Intelligence ◽  
Science Teachers ◽  
Working Group ◽  
National Standards ◽  
National Guidelines ◽  
Call To Action ◽  
The Public ◽  
Online Resource ◽  
Teachers And Students ◽  
K 12

The ubiquity of AI in society means the time is ripe to consider what educated 21st century digital citizens should know about this subject. In May 2018, the Association for the Advancement of Artificial Intelligence (AAAI) and the Computer Science Teachers Association (CSTA) formed a joint working group to develop national guidelines for teaching AI to K-12 students. Inspired by CSTA's national standards for K-12 computing education, the AI for K-12 guidelines will define what students in each grade band should know about artificial intelligence, machine learning, and robotics. The AI for K-12 working group is also creating an online resource directory where teachers can find AI- related videos, demos, software, and activity descriptions they can incorporate into their lesson plans. This blue sky talk invites the AI research community to reflect on the big ideas in AI that every K-12 student should know, and how we should communicate with the public about advances in AI and their future impact on society. It is a call to action for more AI researchers to become AI educators, creating resources that help teachers and students understand our work.

scholarly journals 2076. Comparison of Diagnosis and Prescribing Practices between Virtual Visits and Office Visits for Sinusitis within a Primary Care Network

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S700-S700
Author(s):  
Kristen Johnson ◽  
Kayla Burns ◽  
Lisa Dumkow ◽  
Megan Yee ◽  
Nnaemeka Egwuatu
Keyword(s):  
Primary Objective ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Office Visits ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Duration Of Treatment ◽  
Online Questionnaire ◽  
Virtual Visits ◽  
Tract Infections

Abstract Background The majority of antibiotics prescribed in the outpatient setting result from upper respiratory tract infections; however, these infections are often viral. Virtual visits (VV) have emerged as a popular alternative to office visits (OV) for sinusitis complaints and are an important area for stewardship programs to target for intervention. Methods A retrospective cohort study was conducted utilizing the outpatient electronic medical record for Mercy Health Physician Partners (MHPP) and Zipnosis database for VV to compare diagnosis and prescribing between OV and VV for sinusitis. VV consisted of an online questionnaire for patients to complete, which was then sent to a provider to evaluate electronically without face-to-face interaction. Adult patients were included with a diagnosis code for sinusitis during the 6-month study period from January to June 2018. The primary objective was to compare rates of appropriate diagnosis of viral vs. bacterial sinusitis between OV and VV, based on national guideline recommendations. Secondary objectives were to compare the appropriateness of antibiotic prescribing and supportive therapy prescribing between OV and VV, as well as 24-hour, 7-day and 30-day re-visits. Results A total of 350 patients were included in the study (OV n = 175, VV n = 175). Appropriate diagnosis per national guidelines was 45.7% in OV compared with 69.1% in the VV group (P < 0.001). Additionally, patients that completed VV were less likely to receive antibiotic prescriptions (OV 94.3%, VV 68.6%, P < 0.001). Guideline-concordant antibiotic prescribing was similar between groups (OV 60.6%, VV 58.3%, P = 0.70) and both visit types had a median duration of treatment of 10 days (P = 0.88). Patients that completed VV were more likely to re-visit for sinusitis within 24 hours (OV 1.7%, VV 8%, P = 0.006) and within 30-days (OV 7.4%, VV 14.9%, P = 0.027). In multivariate logistic regression the only factor independently associated with 24-hour re-visit was patient self-request for antibiotics (OR 0.20, 95% CI 0.06–0.68). Conclusion Appropriate diagnosis of sinusitis was more likely in the VV group, which shows that VV provides a good platform to target outpatient antimicrobial prescribing. These findings support opportunities for antimicrobial stewardship intervention in both OV and VV. Disclosures All authors: No reported disclosures.

The role of the microbiology laboratory in antimicrobial stewardship

2016 ◽  
Author(s):  
Peter Riley
Keyword(s):  
Antimicrobial Stewardship ◽  
Empiric Therapy ◽  
Laser Desorption Ionization ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Chain Reaction ◽  
Ionization Time ◽  
Polymerase Chain ◽  
Susceptibility Tests

Microbiology laboratories play an important role in antimicrobial stewardship at the level of individual patients and the population as a whole. When empiric therapy has been started, rapid results can lead to earlier targeted treatment. Accumulated results of susceptibility tests can be analysed and used to generate local or national guidelines on empiric treatment and prophylaxis. Several methods can be used to determine microbial identity and antimicrobial susceptibility, including traditional culture-based methods and newer molecular methods such as matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry, polymerase chain reaction (PCR), and whole-genome sequencing. These methods and potential advantages are reviewed. Before results are reported, expert rules are applied and results edited. At this point the laboratory can influence prescribing practices.

scholarly journals Ethical aspects in the management of antibacterial agents utilization

2013 ◽  
pp. 137-144
Author(s):  
Renato Malta ◽  
Salvatore Di Rosa ◽  
Natale D’Alessandro
Keyword(s):  
Health Care ◽  
Antibacterial Agents ◽  
Wide Spectrum ◽  
University Hospital ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Beneficial Effects ◽  
Defined Daily Doses ◽  
Bed Days

Introduction: Antibacterial prescribing practices between 2004 and 2008 were investigated in the P. Giaccone University Hospital in Palermo, Italy to provide a foundation for critical analysis of the appropriateness of health-care resource usage. Materials and methods: Antibiotic prescribing practices between 2004 and 2008 were analyzed in the hospital as a whole and in different specialty areas. Results were expressed as defined daily doses (DDD) as a function of bed-days, number of admissions, and Diagnosis Related Group (DRG) points. Results: During the study period, increases were observed in the overall DDD per 100 bed-days (68.7 vs. 91.3) and the DDD per admission (4.53 vs. 5.54), but less variation was observed in the DDD/DRG score (3.55 vs. 3.63). Use of metronidazole, carbapenems, and glycopeptides increased, while use of third-generation cephalosporins, quinolones, and oral penicillins remained fairly stable. The drugs most commonly used in 2008 were (% of total DDD): levofloxacin (18.08%), amoxicillin + clavulanic acid (13.32%), ceftriaxone (9.01%), ciprofloxacin (8.21%), clarithromycin (5.74%), metronidazole (5.36%), ceftazidime (5.16%), amoxicillin (4.92%), gentamicin (1.88%), and meropenem (1.80%). An overall trend toward the prescription of newer wide-spectrum antibacterial agents was noted. National guidelines on chemoprophylaxis in surgery were observed in only 3/17 (17.7%) units. The prevalence of nosocomial infections was lower than those reported in the literature. Discussion: Although the cases treated in the hospital have become more complex over the years, the DDD documented in our study are far too high with respect to the actual clinical needs. These findings point to a trend toward the practice of excessively defensive medicine. Greater responsibility among physicians and the promotion of primary and secondary measures of preventive hygiene are fundamental to reduce the prescriptive pressure, a goal that should also have beneficial effects on health-care costs.

scholarly journals Comparison of Pegfilgrastim Prescribing Practice to National Guidelines at a University Hospital Outpatient Oncology Clinic

2013 ◽  
Vol 9 (4) ◽  
pp. 203-206 ◽  
Author(s):  
Geralyn E. Waters ◽  
Patricia Corrigan ◽  
Mandy Gatesman ◽  
Thomas J. Smith
Keyword(s):  
Primary Prophylaxis ◽  
University Hospital ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Hospital Outpatient ◽  
Prescribing Practice

At one institution, approximately one half of primary prophylaxis pegfilgrastim was not indicated per published guidelines, highlighting a need to change prescribing practices, to reduce costs without harming patients.

scholarly journals Reducing Unnecessary Antibiotic Treatment for Acute Bronchitis Using Virtual Primary Care

2021 ◽  
Author(s):  
David McCune ◽  
James Pellegrin ◽  
Anshul Sachdeva ◽  
Roxana Cham ◽  
Jessica Sollaccio ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Bronchitis ◽  
High Rate ◽  
Urgent Care ◽  
National Committee ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Antibiotic Overuse ◽  
Patients Âgés ◽  
Systemic Antibiotics

Objective: Reducing antibiotic overuse is a point of emphasis of the Centers for Disease Control and Prevention (CDC). Despite this, both telemedicine and traditional in-person medical care struggle to meet national guidelines. This study evaluates antibiotic prescribing practices at 98point6, a Seattle-based provider of virtual primary care. This paper reviews a novel combination of machine learning with a physician-led virtual platform and smartphone interface to exceed published benchmarks for the avoidance of antibiotics in the treatment of bronchitis.   Design: This retrospective cohort study looks at patients ages 18–64 who presented to 98point6 with “acute bronchitis/bronchiolitis” diagnosed between December 1, 2019 and November 30, 2020. Visits were categorized by whether systemic antibiotics were or were not given. Cases in which systemic antibiotics were given were categorized as “broad spectrum” or “narrow spectrum”. The results are presented as descriptive statistics with demographic information and compared to published reports of antibiotic use for the treatment of bronchitis.   Results: Of the 1,238 visits with a bronchitis/bronchiolitis diagnosis, 99 (8.0%) were treated with prescribed systemic antibiotics. The rate of antibiotic avoidance of 92.0% compares favorably with published benchmarks from the National Committee for Quality Assurance and is significantly lower than rates in previously published samples for telemedicine, primary care and urgent care.   Conclusion: Virtual primary care administered by 98point6 resulted in a high rate of adherence to the established standard for the treatment of bronchitis, greatly exceeding benchmarks and published results from both telemedicine and in-person medical practice.

scholarly journals Relevance of the health insurance databases to study potentially inappropriate prescriptions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Jardin ◽  
M C Banide ◽  
G Saba ◽  
E Burlot ◽  
F Jozancy ◽  
...  
Keyword(s):  
Health Insurance ◽  
Oral Anticoagulants ◽  
The Elderly ◽  
Administrative Databases ◽  
Insurance Fund ◽  
Health Insurance Fund ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Long Term Treatment ◽  
Inappropriate Prescriptions

Abstract Issue/problem Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events. Description of the problem In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area. Results Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017. Lessons These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices. Key messages A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.

Exploring the social ecology for appropriate antibiotic prescribing and stewardship in primary care: presenting the VALUE driven model of practice derived from qualitative analysis of public and private care settings in Singapore

2021 ◽  
Author(s):  
Huiling Guo ◽  
Zoe Jane-Lara Hildon ◽  
Victor Weng Keong Loh ◽  
Meena Sundram ◽  
Muhamad Alif Bin Ibrahim ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Care Delivery ◽  
Antibiotic Prescribing ◽  
Publicly Funded ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Optimal Care ◽  
Public And Private ◽  
Primary Care Settings

Abstract Background: Singapore’s healthcare system allows both antibiotic prescribing and dispensing across public and private primary care settings, presenting an ideal context to learn from systems where dispensing is closely tied to diverse operational models and funding mechanisms. Aim: To explore processes underpinning decision-making for antibiotic prescribing by primary care doctors in Singapore, by examining doctors’ experiences in different primary care settings. Methods: Thirty semi-structured interviews were conducted with 17 doctors working in publicly funded primary care clinics (polyclinics) and 13 doctors working in private general practitioner (GP) clinics (solo, small group and large group practices). Interviews were audio-recorded and transcribed verbatim. Data were analysed using applied thematic analysis. Results: Given the lack of National Guidelines for antibiotic prescribing in the Singapore context, this practice is currently non-standardised in both private and publicly funded primary care settings. Themes contributing to best practice narratives relate to having independent funding sources and control over drug formulary orders, and valuing reduction in antimicrobial resistance (AMR). The existence of trusting patient-doctor relationships, and reasonable patient loads were observed to allow joint participatory and informed decision-making that further enabled appropriate prescribing. The importance of monitoring and application of data/evaluations to inform practice was a minority theme, nevertheless underpinning all levels of optimal care delivery.Conclusions: A model for appropriate antibiotic prescribing-related interventions needs to prioritise addressing and shaping organisational and personal Valuing of AMR reduction. These values have to also Align with wider systemic constraints experienced in publicly funded institutions, operational management of private clinics and interactions with patients at the interpersonal level. The overcoming of such constraints and allowing time for patient Liaison and trust building will crystalise these earlier initiatives. Use of data to monitor and Evaluate antibiotic prescribing, informing optimal delivery systems should be routinely shared for transparency and to improve prescribing practices. These dimensions are summarised in the VALUE model for appropriate antibiotic prescribing and stewardship in primary care, which is recommended as transferable to diverse contexts.

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