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Journal articleGharbi M, Moore LSP, Castro Sanchez E, et al., 2016,
A needs assessment study for optimising prescribing practice in secondary care junior doctors: The Antibiotic Prescribing Education among Doctors (APED)
, BMC Infectious Diseases, Vol: 16, ISSN: 1471-2334Introduction: Appropriate antimicrobial prescribing is essential for patient care, yet up tohalf of antimicrobial prescriptions written in the UK are sub-optimal. Improvingprescriber education has recently been promoted as a mechanism to optimiseantimicrobial use, but identification of key learning objectives to facilitate this is so farlacking. Using qualitative methods we investigated junior doctor knowledge, attitudes,and behaviours around antimicrobial prescribing to identify key areas to address infuture educational programmes.Methods: A cross-sectional survey of qualified doctors in training in West London wasundertaken exploring antimicrobial prescribing practices and educational needs.Results: Among 140 junior doctors from 5 London hospitals, a third (34%) reportedprescribing primarily unsupervised, and two thirds (67%) reported difficulties obtainingprescribing support outside of hours. 20% stated not feeling confident in writing anantimicrobial prescription, but confidence was increased through having confirmatorydiagnostic results (24%) and obtaining advice from a senior doctor (26%); whether thissenior was from their own specialty, or an infection-specialist, varied significantly(p<0.01) by experience. Only a small percentage (5-13%; depending on number ofyears post-qualification) of participants stated their previous antimicrobial educationwas effective. 60% of those in their first year post qualification reported wanting furthereducation in antimicrobial prescribing, rising to 74% among more experienced juniordoctors. Specific areas of educational need identified were (i) principles of antimicrobialprescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv)prescribing in the context of antimicrobial resistance, and (v) laboratory testing and testresults.Discussion: A significant proportion of junior doctors report lone prescribing ofantimicrobials in the context of low self-perceived confidence and knowledge in
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Journal articleBoyd S, Charani E, Lyons T, et al., 2016,
Information provision for antibacterial dosing in the obese patient: a sizeable absence?
, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091 -
Journal articleBoyd S, Rawson T, Moore L, et al., 2016,
Preventing bloodstream infection in children: What's the CATCH?
, The Lancet, Vol: 388, Pages: 462-463, ISSN: 0140-6736 -
Journal articleRawson TM, Butters TP, Moore LS, et al., 2016,
Exploring the coverage of antimicrobial stewardship across UK clinical postgraduate training curricula
, Journal of Antimicrobial Chemotherapy, Vol: 71, Pages: 3284-3292, ISSN: 1460-2091OBJECTIVES: Antimicrobial resistance (AMR) is a global political and patient safety issue. With ongoing strategic interventions to improve the shape of UK postgraduate clinical training, ensuring that all clinicians have appropriate knowledge and practical skills in the area of AMR is essential. To assess this, a cross-sectional analysis was undertaken of the coverage and quality of antimicrobial stewardship (AMS)/AMR within UK postgraduate clinical training curricula. METHODS: UK clinical specialty training curricula were identified. Topics and individual learning points relating to AMS or AMR were extracted for each specialty. Learning points were quality assessed against the expected level of clinical competence. Inter-specialty analysis was performed. RESULTS: Overall 37 specialties were assessed, equating to 2318 topics and 42 527 learning points. Of these, 8/2318 (0.3%) topics and 184/42 527 (0.4%) learning points were related to AMS/AMR. Infectious diseases represented all eight topics and 43/184 (23%) of the learning points. In contrast, primary care, which is responsible for the highest proportion of antimicrobial usage, had no topics and only 2/1368 (0.15%) of the AMS/AMR learning points. This paucity of representation was reflected across most of the remaining specialties. On quality assessment, the majority of learning points (111/184; 60%) required knowledge only, with no demonstration of behaviour in clinical practice required. CONCLUSIONS: Coverage of AMS/AMR is poor across the majority of UK postgraduate clinical training curricula, with little depth of learning required. Given the threat of AMR, and evolving changes in clinical training pathways, we call for cross-specialty action to address this current lack of engagement.
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Journal articleRawson T, Moore LS, Holmes AH, 2016,
Amoxicillin for Severe Acute Malnutrition in Children
, New England Journal of Medicine, Vol: 375, Pages: 190-192, ISSN: 1533-4406 -
Journal articleMicallef C, Mcleod M, Castro Sanchez EM, et al., 2016,
An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients
, Journal of Medical Internet Research, Vol: 4, ISSN: 1439-4456Background: Current advances in modern technology have enabled the development and utilization of electronic medicalsoftware apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patientsand the public are available, but very few target antimicrobials or infections.Objective: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms,including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teachinghospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garnertheir perceptions around infections/antimicrobial prescribing, and to describe patients’ experiences of their interactions withhealth care professionals in relation to this topic.Methods: A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devicesexperienced by patients at four hospitals in London and a teaching hospital in the East of England.Results: A total of 99 surveys were completed and analyzed. A total of 82% (80/98) of respondents had recently been prescribedantimicrobials; 87% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their generalpractitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65%) and prevention and/or management(32/65, 49%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skinand soft tissue infections. All patients (92/92, 100%) desired specific information on the antimicrobial prescribed. Approximatelyhalf (52/95, 55%) stated it was “fine” for doctors to use a mobile phone/tablet computer during the consultation while 13% (12/95)did not support the idea of doctors accessing health care information in this way. Although only 30% (27/89)
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Journal articleGill SK, Hui K, Farne H, et al., 2016,
Increased airway glucose increases airway bacterial load in hyperglycaemia
, Scientific Reports, Vol: 6, ISSN: 2045-2322Diabetes is associated with increased frequency of hospitalization due to bacterial lung infection.We hypothesize that increased airway glucose caused by hyperglycaemia leads to increasedbacterial loads. In critical care patients, we observed that respiratory tract bacterial colonisationis significantly more likely when blood glucose is high. We engineered mutants in genesaffecting glucose uptake and metabolism (oprB, gltK, gtrS and glk) in Pseudomonas aeruginosa,strain PAO1. These mutants displayed attenuated growth in minimal medium supplemented withglucose as the sole carbon source. The effect of glucose on growth in vivo was tested usingstreptozocin-induced, hyperglycaemic mice, which have significantly greater airway glucose.Bacterial burden in hyperglycaemic animals was greater than control animals when infected withwild type but not mutant PAO1. Metformin pre-treatment of hyperglycaemic animals reducedboth airway glucose and bacterial load. These data support airway glucose as a criticaldeterminant of increased bacterial load during diabetes.
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Journal articleAhmed Z, Garfield S, Jani Y, et al., 2016,
Impact of electronic prescribing on patient safety in hospitals: Implications for the UK
, Clinical Pharmacist, Vol: 8, ISSN: 1758-9061NHS hospitals in England are expected to be paperless by 2020 as set out in a comprehensive framework published by the National Information Board. The use of hospital electronic prescribing (EP) systems is therefore likely to increase rapidly in the near future. The aim of this review is to summarise the available evidence of the impact of inpatient EP on patient safety, with a focus on implications for the UK. MEDLINE and EMBASE were searched to identify systematic and narrative reviews published between 2000 and 2015 that examined the effects of EP on safety-related outcome measures. A total of ten reviews were identified. The evidence for the effects of EP on medication errors, adverse drug events, workflow, and healthcare professional communication are discussed, as are the potential unintended consequences and how they can be identified and mitigated. The review concludes with considerations of the evolution of EP in healthcare, especially in relation to advances in health information technology, inpatient involvement with their medication in the context of EP, and how EP may be used by policymakers and end users to further benefit patient safety.
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Journal articleAshiru-Oredope D, Budd EL, Bhattacharya A, et al., 2016,
Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focus
, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 71, Pages: 1408-1414, ISSN: 0305-7453- Cite
- Citations: 53
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Journal articleVella V, Moore LS, Robotham JV, et al., 2016,
Isolation demand from carbapenemase-producing Enterobacteriaceae screening strategies based on a West London hospital network
, Journal of Hospital Infection, Vol: 94, Pages: 118-124, ISSN: 1532-2939OBJECTIVE: To estimate the isolation demands arising from high-risk specialty-based screening for carbapenemase-producing Enterobacteriaceae (CPE), and the potential fraction of CPE burden detected. METHODS: Clinical specialty groups from three London hospitals were ranked by incidence of carbapenem resistance among Escherichia coli and Klebsiella spp. Contact precaution bed-days were estimated for three screening strategies: Strategy 1, 'circulation science and renal medicine'; Strategy 2, Strategy 1 plus 'specialist services'; and Strategy 3, Strategy 2 plus 'private patients'. Isolation bed occupancy rates and potential CPE detection rates were estimated. RESULTS: Of 99,105 admissions to the three hospitals in Financial Year 2014/15, Strategies 1, 2 and 3 would have screened 4371 (4.4%), 7482 (7.6%), and 13,542 (13.7%) patients, respectively. The specialties' isolation bed occupancy rates varied between 3% and 696% depending on strategy, number of consecutive tests, and whether or not pre-emptive isolation had been applied. Expected detection rates of the potential CPE burden in the hospital network would have varied between 17.1% and 47.5%. CONCLUSIONS: High-risk specialty-based screening has the potential to detect nearly half of the potential CPE burden, and would be more pragmatic than patient-level risk-factor-based screening. Pre-emptive isolation increases isolation requirements substantially. CPE screening strategies need to balance risk and resources.
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