18 research outputs found
Taking antimicrobial stewardship initiatives to the next level: Development of a serious prescribing game for acute care
No full textSurveillance of antimicrobial consumption data: Development of an early warning system for carbapenem resistance derived from a retrospective analysis of an OXA-48 producing K. pneumoniae outbreak
No full textEfeito da temperatura em diferentes aspectos da fotossíntese de Lithothamnion superpositum (Corallinales, Rhodophyta
No full textTCC(graduação) - Universidade Federal de Santa Catarina. Centro de Ciências Biológicas. Biologia.As mudanças climáticas globais provocarão conseqüências físicas e químicas no ambiente marinho. Dentre elas, possíveis variações na temperatura promovem alterações fisiológicas alterando o comportamento respiratório e fotossintético e, assim as taxas de crescimento de organismos fitobênticos, especialmente. Dentre estes organismos, algas calcárias têm grande importância ecológica, com fornecimento de nicho e substrato para outras algas e invertebrados. Nesse grupo os efeitos de alterações da temperatura da água do mar são potencialmente ainda mais preocupantes, pois além de serem organismos chaves para o ambiente marinho, estão intimamente relacionadas ao ciclo do carbono. O presente trabalho verificou mudanças na resposta fotossintética de Lithothamnion superpositum (Corallinales, Rhodophyta) relacionadas à variação de temperatura. Assim, espécimes trazidos da Rebio do Arvoredo (22º C) foram incubados por 24h, a 15°C, 20°C, 25°C e 30°C. Por sete dias consecutivos as taxas de transferência de elétrons (ETR) e a fluorescência da Clorofila a do Fotossistema II foram aferidos com o fluorímetro DIVING-PAM. Também foram observados o balanço de oxigênio dissolvido e pH mantendo as plantas e controles no claro e escuro. Após esse tempo, foram extraídos os pigmentos (Aloficocianina, Ficocianina, Ficoeritrina e Clorofila). Os resultados evidenciam que as plantas mantidas a 20, 25 e 35°C, tiveram pouca diferença em relação à Pmáx, Ik e à β. Em relação à α não houve diferença significativa entre elas. Maiores concentrações de pigmentos foram encontradas nas plantas mantidas a 25°C. Pode-se sugerir, portanto, que as melhores temperaturas para as algas dessa espécie são as mais altas, encontradas nas regiões tropicais
The impact of the newer knowledge of nutrition: nutrition science and nutrition policy, 1900-1939.
No full textIdeas concerning relationships between diet and health in the UK are
traced from the 1904 Comittee on Physical Deterioration to the outbreak
of World War II. Archive material is used to describe the often
conflicting views of the Medical Research Council and the Ministry of
Health and Board of Education concerning the public health applications
of nutrition science. In particular, the work of the Ministry of
Health's first Advisory Comittee on Nutrition, which was appointed in
1931, is reviewed and evaluated. The debate among public healh
practitioners over the nature, cause and extent of the 'nutrition
problem' is documented and the role in this debate of official dietary
guidelines which appeared during the 1930s, is assessed.
The Impact of the Newer Knowledge of Nutrition on welfare feeding policy
Is evaluated in the context of the official promotion of milk feeding in
schools. In particular, Corry Mann's experimental evidence which was
used to endorse this policy, is reconsidered, and it is shown that the
NRC view that the trial was proof of the presence in milk of a "growth
factor" which produced preferential growth efficiency in adequately fed
children , was in error. From a re-evaluation of the evidence it is
suggested that the experiment merely recorded catch-up growth in a group
of poorly nourished children. The view that there existed an extensive
nutritional problem due to poor quality diets is examined and
challenged.
Both dietary survey data and anthropometric evidence are used to present
the case that there was throughout the period studied a widespread
problem of underfeeding among the poor and that intervention strategies
based on the Newer Knowledge were not an appropriate method of dealing
with this problem. This casts doubts on the widely held view that there
was a need for nutrition education and suggests that the problem was one of poverty rather than Ignorance. Disaggregated anthropometric data
located by the author are analysed according to NCHS standards to assess
the prevalence of underfeeding. Significantly higher prevalences of
stunting than low weight-for-age exist in all data sets; this phenomenon
is considered in detail and low weight-for-age is proposed as the
preferred index of malnutrition in 20th Century historical studies.
Attention is drawn to the relevance of these studies for the current
nutrition and public health debate
Real time antimicrobial resistance surveillance in critical care: Identifying outbreaks of carbapenem resistant gram negative bacteria from routinely collected data
No full textBackground: Statistically significant variation in antimicrobial resistance (AMR) occurs between hospitals, within hospitals, and over time. Whilst case mix and antimicrobial use contribute, the impact of cross-transmission on these fluctuations is not well understood. We investigated the utility of applying a statistical algorithm to identify outbreaks of carbapenem-resistant infections across three critical care units in a multi-centre teaching hospital network serving a population of 2 million in London, UK.
Methods & Materials: We applied a negative binomial regression model which accounts for seasonality and linear trends, as described by Noufaily et al., to routinely collected microbiology data (fiscal years 2009-2015 for two units, 2012-2015 for the third) for carbapenem-resistant Pseudomonas spp. and Enterobacteriaceae (CRE). The first two years of data for each unit was used to train the algorithm. Exceedances (i.e. weeks with possible outbreaks) were validated by antibiogram comparison (as a proxy-indicator of strain similarity), against hospital infection control reports, and where available through genotypic typing.
Results: Across the three units, 154 CRE (from 3640 Enterobacteriaceae) were identified. The algorithm identified 17 exceedance weeks, in 11 multi-week clusters. In four of these clusters (three K. pneumoniae, one E. coli) organisms shared identical antibiograms; typing was available for one K. pneumoniae cluster, indicating clonal NDM cross-transmission, and this was the only outbreak (of the 11 clusters) identified in hospital infection control reports. Among 786 carbapenem-resistant Pseudomonas spp. (from 2378 isolated), 27 exceedance weeks were detected, in 15 multi-week clusters. Organisms in eight clusters shared identical antibiograms. No typing was available and none of the clusters had been identified in hospital infection control reports. No additional outbreaks of CRE or carbapenem-resistant Pseudomonas spp. were identified through routine surveillance or in hospital infection control reports.
Conclusion: The rise of carbapenem resistant organisms necessitates low-cost, easy-to-use surveillance mechanisms to aid early identification of outbreaks, particularly in critical care. Our data suggests such outbreaks may be more common than previously thought, and may be going undetected by current surveillance systems. Application of the Noufaily algorithm to routinely collected microbiology data provides a valid mechanism to better target limited hospital epidemiology, infection control, and diagnostics resources
Forecasting carbapenem resistance from antimicrobial consumption surveillance: Lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit
No full textThis study aimed to forecast the incidence rate of carbapenem resistance and to assess the impact of an antimicrobial stewardship intervention using routine antimicrobial consumption surveillance data. Following an outbreak of OXA-48-producing Klebsiella pneumoniae (January 2008–April 2010) in a renal cohort in London, a forecasting ARIMA model was derived using meropenem consumption data [defined daily dose per 100 occupied bed-days (DDD/100 OBD)] from 2005–2014 as a predictor of the incidence rate of OXA-48-producing organisms (number of new cases/year/100,000 OBD). Interrupted times series assessed the impact of meropenem consumption restriction as part of the outbreak control. Meropenem consumption at lag −1 year (the preceding year), highly correlated with the incidence of OXA-48-producing organisms (r = 0.71; P = 0.005), was included as a predictor within the forecasting model. The number of cases/100,000 OBD for 2014–2015 was estimated to be 4.96 (95% CI 2.53–7.39). Analysis of meropenem consumption pre- and post-intervention demonstrated an increase of 7.12 DDD/100 OBD/year (95% CI 2.97–11.27; P < 0.001) in the 4 years preceding the intervention, but a decrease thereafter. The change in slope was −9.11 DDD/100 OBD/year (95% CI −13.82 to −4.39). Analysis of alternative antimicrobials showed a significant increase in amikacin consumption post-intervention from 0.54 to 3.41 DDD/100 OBD/year (slope +0.72, 95% CI 0.29–1.15; P = 0.01). Total antimicrobials significantly decreased from 176.21 to 126.24 DDD/100 OBD/year (P = 0.05). Surveillance of routinely collected antimicrobial consumption data may provide a key warning indicator to anticipate increased incidence of carbapenem-resistant organisms. Further validation using real-time data is needed
Missed opportunities for shared decision making in antimicrobial stewardship: The potential consequences of a lack of patient engagement in secondary care
No full textBackground: Within infectious diseases in secondary care, understanding of the potential for behavioural changes arising from patient involvement in antimicrobial decision making is lacking. Shared decision making is becoming part of international policy. The United States have passed it into legislation and the United Kingdom has implemented a number of national interventions across healthcare pathways. This study aims to understand the level of patient involvement in decision making around antimicrobial use in secondary care and the potential consequences associated with it.
Methods & Materials: Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months were recruited to participate in group interviews. Group interactions were audio-recorded, transcribed verbatim, and thematically analysed.
Results: Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is currently communicated in a unilateral manner with individuals ‘told’ that they have an infection and will receive an antimicrobial (often unnamed), leading to loss of ownership, frustration, anxiety and ultimately distancing them from participation in decision making. This poor communication drives individuals to seek information from alternative sources, including on-line resources, which are associated with concerns over reliability and individualisation. This failure of communication and information provision from clinicians in secondary care influences individual's future ideas about infections and their management. This alters their future actions towards infections and antimicrobials and can drive non-adherence to prescribed antimicrobial regimes and loss-to-follow-up after discharge from secondary care.
Conclusion: Current infection management and antimicrobial prescribing practices in secondary care may be failing to engage patients in the decision making process. It is vital that secondary care physicians do not view infection management episodes as discrete events, but as cumulative experiences which have the potential to drive future non-adherence to prescribed antimicrobial regimes and thus poor individual outcomes and antimicrobial resistance. This lesson is transferable to all settings of healthcare, where poor communication and information provision having the potential to influence future health seeking behaviours. We call for the development of clear, pragmatic mechanism to support healthcare professionals and patients engage in infection related decision making during consultations
A systematic review of clinical decision support systems for antimicrobial management: Are we failing to investigate these interventions appropriately?
No full textObjectives
Clinical decision support systems (CDSS) for antimicrobial management can support clinicians to optimise antimicrobial therapy. We reviewed all original literature (qualitative and quantitative) to understand the current scope of CDSS for antimicrobial management and analyse existing methods used to evaluate and report such systems.
Method
PRISMA guidelines were followed. Medline, EMBASE, HMIC Health and Management, and Global Health databases were searched from 1st January 1980 to 31st October 2015. All primary research studies describing CDSS for antimicrobial management in adults in primary or secondary care were included. For qualitative studies, thematic synthesis was performed. Quality was assessed using Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) criteria. CDSS reporting was assessed against a reporting framework for behaviour change intervention implementation.
Results
Fifty-eight original articles were included describing 38 independent CDSS. The majority of systems target antimicrobial prescribing (29/38;76%), are platforms integrated with electronic medical records (28/38;74%), and have rules based infrastructure providing decision support (29/38;76%). On evaluation against the intervention reporting framework, CDSS studies fail to report consideration of the non-expert, end-user workflow. They have narrow focus, such as antimicrobial selection, and use proxy outcome measures. Engagement with CDSS by clinicians was poor.
Conclusion
Greater consideration of the factors that drive non-expert decision making must be considered when designing CDSS interventions. Future work must aim to expand CDSS beyond simply selecting appropriate antimicrobials with clear and systematic reporting frameworks for CDSS interventions developed to address current gaps identified in the reporting of evidence
Activation of seed-specific genes in leaves and roots of the desiccation tolerant plant, Xerophyta humilis
No full textIncludes abstract.Includes bibliographical references (leaves 131-169).The ability of tissues to survive almost complete loss of cellular water is a trait found throughout the plant kingdom. While this desiccation tolerance is common in seeds of most angiosperms it is rare in their vegetative tissues. Xerophyta humilis (Bak.) Dur and Schintz belongs to a small group of resurrection angiosperms and it possesses the ability to withstand extreme desiccation of greater than 90% in both its seeds and vegetative tissues and return to active metabolism upon rehydration. We have tested the hypothesis that vegetative desiccation tolerance in angiosperms has evolved as an adaptation of seed desiccation tolerance
