Publications
178 results found
Blanco-Mavillard I, Bennasar-Veny M, De Pedro-Gómez J, et al., 2018, Implementation of a knowledge mobilization model to prevent peripheral venous catheter-related adverse events. PREBACP study: A multicenter cluster randomized trial protocol, Implementation Science, Vol: 13, ISSN: 1748-5908
BackgroundPeripheral venous catheters are the most commonly used invasive devices in hospitals worldwide. Patients can experience multiple adverse events during the insertion, maintenance, and management of these devices. Health professionals aim to resolve the challenges of care variability in the use of peripheral venous catheter through adherence to clinical practice guidelines. The aim of this cluster-randomized controlled trial is to determine the efficacy of a multimodal intervention on incidence of adverse events associated with the use of peripheral venous catheters in adult hospital patients. Additional aims are to analyze the fidelity of nurses and the relationship between contextual factors on the use of best available and the outcomes of the intervention.MethodsFive public hospitals in the Spanish National Health System, with diverse profiles, including one university hospital and four second-level hospitals, will be included. In total, 20 hospitalization wards will be randomized for this study by ward to one of two groups. Those in the first group receive an intervention that lasts 12 months implementing evidence-based practice in healthcare related to peripheral catheters through a multimodal strategy, which will contain updated and poster protocols insertion, maintenance and removal of peripheral venous catheters, technologies applied to e-learning, feedback on the results, user and family information related to peripheral catheter, and facilitation of the best evidence by face-to-face training session. Primary outcome measures: Incidence of adverse events associated with the use of peripheral venous catheters is measured by assessing hospital records. Secondary outcome measures: Nurses’ adherence to clinical practice guidelines, clinical outcomes, and the cost of implementing the multimodal intervention.DiscussionClinical implementation is a complex, multifaceted phenomenon which requires a deep understanding of decision-making, knowledge mobil
Castro Sanchez EM, Vila-Candel R, Soriano-Vidal F, et al., 2018, Influence of health literacy on acceptance of influenza and pertussis vaccinations: a cross-sectional study among Spanish pregnant women, BMJ Open, Vol: 8, ISSN: 2044-6055
Objectives Immunisations against influenza and Bordetella pertussis infection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations.Setting University hospital in Valencia (Spain).Participants 119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment.Primary and secondary outcome measures HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination.Results 119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R2=0.22, p=0.014) and Newest Vital Sign (adjusted R2=0.258, p=0.001) scores. Depending on the scale, 56%–85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information.Conclusions Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination.
Castro Sanchez EM, Iwami M, Ahmad R, et al., 2018, Articulating citizen participation in national antimicrobial resistance plans: a comparison of European countries, European Journal of Public Health, ISSN: 1101-1262
BackgroundNational action plans determine country responses to anti-microbial resistance (AMR). These plans include interventions aimed at citizens. As the language used in documents could persuade certain behaviours, we sought to assess the positioning and implied responsibilities of citizens in current European AMR plans. This understanding could lead to improved policies and interventions.MethodsReview and comparison of national action plans for AMR (NAP-AMR) obtained from the European Centre for Disease Prevention and Control (plans from 28 European Union and four European Economic Area/European Free Trade Association countries), supplemented by European experts (June–September 2016). To capture geographical diversity, 11 countries were purposively sampled for content and discourse analyses using frameworks of lay participation in healthcare organization, delivery and decision-making.ResultsCountries were at different stages of NAP-AMR development (60% completed, 25% in-process, 9% no plan). The volume allocated to citizen roles in the plans ranged from 0.3 to 18%. The term ‘citizen’ was used by three countries, trailing behind ‘patients’ and ‘public’ (9/11), ‘general population’ (6/11) and ‘consumers’ (6/11). Increased citizen awareness about AMR was pursued by ∼2/3 plans. Supporting interventions included awareness campaigns (11/11), training/education (7/11) or materials during clinical encounters (4/11). Prevention of infection transmission or self-care behaviours were much less emphasized. Personal/individual and social/collective role perspectives seemed more frequently stimulated in Nordic countries.ConclusionCitizen roles in AMR plans are not fully articulated. Documents could employ direct language to emphasise social or collective responsibilities in optimal antibiotic use.
WHO, Castro Sanchez E, Holmes A, 2018, WHO competency framework for health workers’ education and training on antimicrobial resistance, Geneva, Switzerland, Publisher: World Health Organization, WHO/HIS/HWF/AMR/2018.1
In support of WHO and Member States efforts to implement the Global Action plan on Antimicrobial Resistance (GAP AMR), WHO has published a competency framework for health workers’ education and training on antimicrobial resistance (AMR). The competency framework is one of several products being developed by WHO in collaboration with partners and leading research institutions to address the first objective of the GAP AMR, which is to improve awareness and understanding of AMR through effective communication, education and training.The framework is a matrix menu of core and additional knowledge, skills and attitudes for health workers in the field of human health. It is designed to be used as a reference guide and applied according to local priorities and needs. The ultimate aim is to ensure that all health workers are equipped with the requisite competencies at pre-service education and in-service training levels to address AMR in policy and practice settings.
Nellums LB, Thompson H, Holmes A, et al., 2018, Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis, Lancet Infectious Diseases, Vol: 18, Pages: 796-811, ISSN: 1473-3099
BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus
Soriano-Vidal FJ, Vila-Candel R, Soriano-Martín PJ, et al., 2018, The effect of prenatal education classes on the birth expectations of Spanish women, Midwifery, Vol: 60, Pages: 41-47, ISSN: 0266-6138
Background: Maternity care has focused on lowering maternal and neonatal morbidity, though women's beliefs and expectations of care have been set aside. Women face childbirth with preconceived expectations, some of which could be expressed on their birth plan. The latter could beinfluenced by health professionals through prenatal education classes, though this has not been measured before. Antenatal classes have been argued against,since no resulting improvement in childbirth experience has been demonstrated, though some advantages may be seen: they favour communication and give time for expressing maternal expectations and beliefs. The present study evaluates the influence of prenatal educational classes led by midwives upon women birth preferences. Methods: A multicentre, observational, prospective study was carried out, measuring variables in pregnant women attending prenatal educational classes in different health centres within the health districts in Valencia (Spain) over the period January-October 2012. Birth plan preferences were compared prior to and upon completion of the classes. Results: A total of 212 eligible pregnant women (78.3% nulliparous) with an average age of 31.39±4.0 years consented to participate in the study. There were significant differences in birth plan preferences prior to and upon completion of the prenatal classes. Three items showed an increase between the initial session and the end of the intervention: the ability to push spontaneously, episiotomy avoidance, and early breastfeeding. An adjusted general linear model was used to compare pre-post results in relation to sociodemographic and obstetric variables. Discussion: The changes in birth plans could suggest that prenatal educational classes exert an influence upon maternal birth preferences.
Macduff C, Rafferty AM, Prendiville A, et al., 2018, Antimicrobial resistance: Join us for a fresh approach, British Journal of Nursing, Vol: 27, Pages: 356-356, ISSN: 0966-0461
Cabellos Garcia A, Castro Sanchez EM, Martinez- Sabater A, et al., 2018, Influence of health literacy on oral anticoagulation therapy: a factor yet to be known, Atencion Primaria, Vol: 50, Pages: 256-257, ISSN: 0212-6567
Castro Sanchez EM, 2018, The role of the nurse in stewardship, Antimicrobial stewardship: from principles to practice
Rawson T, Moore L, Castro Sanchez E, et al., 2018, Development of a patient-centred intervention to improve knowledge and understanding of antibiotic therapy in secondary care, Antimicrobial Resistance and Infection Control, Vol: 7, ISSN: 2047-2994
Introduction: We developed a personalised antimicrobial information module co-designed with patients. This study aimed to evaluate the potential impact of this patient-centred intervention on short-term knowledge and understanding of antimicrobial therapy in secondary care. Methods:Thirty previous patients who had received antibiotics in hospital within 12 months were recruited to co-design an intervention to promote patient engagement with infection management. Two workshops, containing five focus-groups were held. These were audio-recorded. Data were analysed using a thematic framework developed deductively based on previous work. Line-by-line coding was performed with new themes added to the framework by two researchers. This was used to inform the development of a patient information module, embedded within an electronic decision support tool (CDSS). The intervention was piloted over a four-week period at Imperial College Healthcare NHS Trust on 30 in-patients. Pre- and post-intervention questionnaires were developed and implemented to assess short term changes in patient knowledge and understanding and provide feedback on the intervention. Data were analysed using SPSS and NVIVO software. Results: Within the workshops, there was consistency in identified themes. The participants agreed upon and co-designed a personalised PDF document that could be integrated into an electronic CDSS to be used by healthcare professionals at the point-of-care. Their aim for the tool was to provide individualised practical information, signpost to reputable information sources, and enhance communication between patients and healthcare professionals.Eighteen out of thirty in-patients consented to participant in the pilot evaluation with 15/18(83%) completing the study. Median (range) age was 66(22-85) years. The majority were male (10/15;66%). Pre-intervention, patients reported desiring further information regarding their infections and antibiotic therapy, including side effects
Bermúdez-Tamayo C, Hernández MN, Alguacil J, et al., 2018, [Gaceta Sanitaria in 2017. Improving the quality of our journal]., Gac Sanit, Vol: 32, Pages: 117-120
Birgand G, Castro-Sánchez E, Hansen S, et al., 2018, Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries, Antimicrobial Resistance and Infection Control, Vol: 7, ISSN: 2047-2994
Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones - antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.
Budhathoki SS, Bhattachan M, Castro Sanchez EM, et al., 2018, Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal: A descriptive study, BMC Women's Health, Vol: 18, ISSN: 1472-6874
Background: Menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girlsbetween menarche and menopause. Despite being an important issue concerning women and girls in the menstruatingage group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygienemanagement in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescentgirls on menstrual hygiene management in post-earthquake Nepal.Methods: A mixed methods study was carried out among the earthquake affected women and adolescent girls inthree villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire thatcaptured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of theNepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent’s personalexperiences of menstrual hygiene management.Results: Menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8%of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusablesanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method(76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in thefirst month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceivedto be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice.Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) weremore likely to use the reusable sanitary cloth.Conclusions: In t
Gea-Caballero V, Castro Sanchez EM, 2018, Los entornos profesionales enfermeros en Atención Primaria: un elemento clave para la salud pública, Revista Panamericana de Salud Pública, Vol: 42, ISSN: 1020-4989
Un entorno de práctica profesional en enfermería (EPPE) es el que promueve, facilita u obstaculiza al personal de enfermería para prestar cuidados de calidad, además de incrementar la seguridad y bienestar de los pacientes y de sus profesionales. Construir entornos positivos fomenta la excelencia de la organización, optimiza los resultados y mejora la percepción y satisfacción del usuario. En numerosos países se ha podido constatar que determinados ámbitos asistenciales de enfermería considerados excelentes influyen de forma objetiva en los resultados en salud, con disminución de la morbimortalidad, aumento de la calidad y mejora del cuidado (1), además de la contención de costes (2) y otros múltiples beneficios para la sociedad, el ciudadano, el usuario y el profesional.
Roope L, Tonkin-Crine S, Herd N, et al., 2018, Reducing expectations for antibiotics in primary care: testing the provision of different types of information, PHE Public Health Research and Science Conference 2018
Lishman H, Aylin P, Alividza V, et al., 2017, Investigating the burden of antibiotic resistance in ethnic minority groups in high-income countries: protocol for a systematic review and meta-analysis., Systematic Reviews, Vol: 6, ISSN: 2046-4053
Background: Antibiotic resistance (ABR) is an urgent problem globally, with overuse and misuse of antibioticsbeing one of the main drivers of antibiotic-resistant infections. There is increasing evidence that the burden ofcommunity-acquired infections such as urinary tract infections and bloodstream infections (both susceptible andresistant) may differ by ethnicity, although the reasons behind this relationship are not well defined. It has beendemonstrated that socioeconomic status and ethnicity are often highly correlated with each other; however, it isnot yet known whether accounting for deprivation completely explains any discrepancy seen in infection risk. Therehave currently been no systematic reviews summarising the evidence for the relationship between ethnicity andantibiotic resistance or prescribing.Methods: This protocol will outline how we will conduct this systematic literature review and meta-analysisinvestigating whether there is an association between patient ethnicity and (1) risk of antibiotic-resistant infectionsor (2) levels of antibiotic prescribing in high-income countries. We will search PubMed/MEDLINE, EMBASE, GlobalHealth, Scopus and CINAHL using MESH terms where applicable. Two reviewers will conduct title/abstract screening,data extraction and quality assessment independently. The Critical Appraisal Skills Programme (CASP) checklist will beused for cohort and case-control studies, and the Cochrane collaboration’s risk of bias tool will be used for randomisedcontrol trials, if they are included. Meta-analyses will be performed by calculating the minority ethnic group to majorityethnic group odds ratios or risk ratios for each study and presenting an overall pooled odds ratio for the two outcomes.The Grading of Recommendations, Assessments, Development and Evaluation (GRADE) approach will be used to assessthe overall quality of the body of evidence.Discussion: In this systematic review and meta-analysis, we will aim to collate the avail
Mariano V, Castro Sanchez EM, 2017, Partnering with patients in hemodialysis to prevent catheter-associated bloodstream infections, JAVA - Journal of the Association for Vascular Access, Vol: 22, Pages: 210-213, ISSN: 1552-8855
The threat of catheter-associated bloodstream infections (CABSIs) among hemodialysis patients is present beyond the healthcare setting. With the rise of antimicrobial resistant infections, the benefits of partnering with patients in preventing CABSIs cannot be overemphasized. Patient education is the cornerstone of patient engagement, and a pre-requisite for other involvement strategies. The responsibility for educating patients is multidisciplinary and must be accentuated at all stages of hemodialysis care. Enhancing patient self-efficacy in preventing CABSIs requires them to have an adequate level of knowledge on infection prevention and the skills and confidence to self-care in the community. Providing patient education is the first step to empowerpatients, facilitating their ownership of their journey in care and safeguarding them from infections.
Gea Caballero V, Castro Sanchez EM, Juarez-Vela R, et al., 2017, Elementos esenciales de los entornos profesionales enfermeros en Atencion Primaria y su influencia en la calidad del cuidado, Enfermeria Clinica, Vol: 28, Pages: 27-35, ISSN: 1579-2013
ObjectivesNursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality.MethodWe conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%).ResultsOne hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021).ConclusionsNursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions.
Rawson T, Castro Sanchez E, Charani E, et al., 2017, Involving citizens in priority setting for public health research: implementation in infection research, Health Expectations, Vol: 21, Pages: 222-229, ISSN: 1369-7625
BackgroundPublic sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research.MethodA scenario including six infection themes for funding was developed to assess citizen priorities for research funding. This was tested over two days at a university public festival. Votes were cast anonymously along with rationale for selection. The scenario was then implemented during a three-hour focus group exploring views on engagement in strategic decisions and in-depth evaluation of the tool.Results188/491(38%) prioritized funding research into drug-resistant infections followed by emerging infections(18%). Results were similar between both days. Focus groups contained a total of 20 citizens with an equal gender split, range of ethnicities and ages ranging from 18 to >70 years. The tool was perceived as clear with participants able to make informed comparisons. Rationale for funding choices provided by voters and focus group participants are grouped into three major themes: (i) Information processing; (ii) Knowledge of the problem; (iii) Responsibility; and a unique theme within the focus groups (iv) The potential role of citizens in decision making. Divergent perceptions of relevance and confidence of “non-experts” as decision makers were expressed.ConclusionVoting scenarios can be used to collect, en-masse, citizens' choices and rationale for research priorities. Ensuring adequate levels of citizen information and confidence is important to allow deployment in other formats.
Castro Sanchez EM, Gilchrist M, McEwen J, et al., 2017, Antimicrobial stewardship: widening the collaborative approach, Journal of Antimicrobial Stewardship
Anti microbial stewardship programs (ASPs) would benefit from the participation of nurses to strengthen the increasingly complex mix of clinical, educational, research, organizational and political interventions included within ASPs.
CastroSánchez E, Holmes A, Pittet D, 2017, Institutional Safety Climate, Publisher: Wiley, Pages: 193-200, ISBN: 9781118846865
Troughton R, Castro Sanchez EM, Birgand GJC, et al., 2017, Post-discharge surveillance of surgical site infections: is anyone getting it right?
Castro Sanchez EM, Iwami M, Ahmad R, et al., 2017, Articulating citizen participation in national policies for addressing antimicrobial resistance in European countries - an updated analysis, ECCMID 2017, Publisher: European Society of Clinical Microbiology and Infectious Diseases
Pereira N, Castro Sanchez EM, Nathwani D, 2017, How can multi-professional education support better stewardship?, Infectious Disease Reports, Vol: 9, ISSN: 2036-7449
Antimicrobial stewardship is widely accepted as an efficient strategy to combat the growing threat of antimicrobial resistance. Education is one of the cornerstones of successful antimicrobial stewardship programs. There is also general agreement that antimicrobial stewardship is a team effort that must involve the whole continuum of healthcare workers. Providing adequate education for all different professionals although challenging is deemed crucial to achieve good results. This paper reviews the different strategies available to educate the multiple healthcare workers, discusses how education can improve antimicrobial stewardship programs and outlines some of the challenges faced and research gaps that need to be addressed in order to improve education in this field.
Bermudez Tamayo C, Negrín Hernández M, Bolívar J, et al., 2017, Gaceta Sanitaria in 2016. A new stage; the strengthening of e-Gaceta and its internationalisation, Gaceta Sanitaria, Vol: 31, Pages: 77-81, ISSN: 1578-1283
Rawson T, moore L, Hernandez B, et al., 2017, A systematic review of clinical decision support systems for antimicrobial management: Are we failing to investigate these interventions appropriately?, Clinical Microbiology and Infection, Vol: 23, Pages: 524-532, ISSN: 1469-0691
ObjectivesClinical 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. MethodPRISMA 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.ResultsFifty-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.ConclusionGreater 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.
Charani E, Gharbi M, Moore LSP, et al., 2017, The effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals – an interrupted time series study, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 1825-1831, ISSN: 1460-2091
Objectives To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). Methods In August 2011, the antimicrobial prescribing policy was converted into a mobile application (app). A segmented regression analysis of interrupted time series was used to assess the impact of the app on prescribing indicators using data (2008-2014) from a biannual point prevalence study (PPS) in medicine and surgery wards. There were six data points pre and six data points post-implementation. Results There was an increase in compliance with policy (e.g. compliance with empirical therapy or expert advice) in medicine (6.48%, CI -1.25—14.20) and surgery (6.63%, CI 0.15—13.10) in the implementation period, with a significant sudden change in level in surgery (p<0.05). There was an increase, though not significant, in medicine (15.20%, CI 17.81—48.22) and surgery (35.97%, -3.72—75.66) in the percentage of prescriptions that had a stop/review date documented. The documentation of indication decreased in both medicine (-16.25%, CI -42.52—10.01) and surgery (-14.62%, CI -42.88—13.63).Conclusion Introducing the ‘app’ to an existing ASP had a significant impact on the compliance to policy in surgery, and a positive but not significant effect on documentation of stop/review date in both specialties. The negative effect on the third indicator may have been due to existing ASP efforts. The broader value of providing an antimicrobial policy on a digital platform e.g. the reach and access to the policy, should be measured using indicators more sensitive to mHealth interventions.
Holmes AH, Boyd SE, Moore LSP, et al., 2017, Obtaining antibiotics online from within the UK: a cross-sectional study, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091
Charani E, Castro Sanchez E, Nathwany D, et al., 2017, What are the key elements of an antimicrobial stewardship programme on a global scale – results of a global survey, European Congress of Clinical Microbiology and Infectious Diseases
Alividza V, Mariano V, Steel S, et al., 2017, Investigating the impact of poverty on colonization/infection with drug-resistant organisms in humans: a scoping review, ECCMID 2017
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.