Publications
122 results found
Rawson T, Moore L, Hernandez B, et al., 2016, Patient engagement with infection management in secondary care: a qualitative investigation of current experiences, BMJ Open, Vol: 6, ISSN: 2044-6055
Objective To understand patient engagement with decision-making for infection management in secondary care and the consequences associated with current practices.Design A qualitative investigation using in-depth focus groups.Participants Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months in the UK were identified for recruitment. Ten agreed to participate. All participants had experience of infection management in secondary care pathways across a variety of South-East England healthcare institutes. Study findings were subsequently tested through follow-up focus groups with 20 newly recruited citizens.Results Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is 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 engaging with decision-making. This poor communication drives individuals to seek information from alternative sources, including online, which is associated with concerns over reliability and individualisation. Failures in communication and information provision by clinicians in secondary care influence individuals’ future ideas about infections and their management. This alters their future actions towards antimicrobials and can drive prescription non-adherence and loss to follow-up.Conclusions Current infection management and antimicrobial prescribing practices in secondary care fail to engage patients with the decision-making process. Secondary care physicians must not view infection management episodes as discrete events, but as cumulative experiences which have the potential to shape future patient behaviour and understanding of antimicrobial use.
Castro Sanchez EM, Kyratsis Y, Iwami M, et al., 2016, Serious electronic games as behavioural change interventions in healthcare- associated infections and infection prevention and control: scoping review of the literature and future directions., Antimicrobial Resistance and Infection Control, Vol: 5, ISSN: 2047-2994
Background: The uptake of improvement initiatives in infection prevention and control (IPC) has often provenchallenging. Innovative interventions such as ‘serious games’ have been proposed in other areas to educate andhelp clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of seriousgames in IPC. The purposes of the study were: a) to synthesise research evidence on the use of serious games inIPC to support healthcare workers’ behaviour change and best practice learning; and b) to identify gaps across theformulation and evaluation of serious games in IPC.Methods: A scoping study was conducted using the methodological framework developed by Arksey andO’Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus,Cochrane, Google Scholar) in December 2015. Evidence from these studies was assessed against an analyticframework of intervention formulation and evaluation.Results: Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and fourfinally selected. Studies focused on intervention inception and development rather than implementation. Expertinvolvement in game design was reported in 2/4 studies. Potential game users were not included in needsassessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported.Conclusions: The growing interest in serious games for health has not been coupled with adequate evaluation ofprocesses, outcomes and contexts involved. Explanations about the mechanisms by which game components mayfacilitate behaviour change are lacking, further hindering adoption.
Rawson T, Abbara A, Kranzer K, et al., 2016, Factors which influence treatment initiation for pulmonary non-tuberculous mycobacterium infection in HIV negative patients; a multicentre observational study, Respiratory Medicine, Vol: 120, Pages: 101-108, ISSN: 1532-3064
BackgroundClinical, radiological and microbiological criteria inform diagnosis of pulmonary Non-Tuberculous Mycobacteria (NTM) disease and treatment decisions. This multicentre, review aims to characterise NTM disease meeting ATS/IDSA criteria and define factors associated with initiation of treatment.MethodsSputum samples growing NTM from 5 London hospitals between 2010 and 2014 were identified. Data for HIV-negative individuals meeting ATS/IDSA guidelines for pulmonary NTM disease were extracted. Associations between clinical variables and treatment decision were investigated using Chi-squared, Fishers-exact or Mann Whitney tests. Factors associated with treatment in univariate analysis (p < 0.150) were included in a multivariate logistic regression model.ResultsNTM were identified from 817 individuals' sputum samples. 108 met ATS/IDSA criteria. 42/108 (39%) were initiated on treatment. Median age was 68 (56–78) in the cohort.On multivariate analysis, factors significantly associated with treatment of pulmonary NTM infection were: Cavitation on HRCT (OR: 6.49; 95% CI: 2.36–17.81), presenting with night sweats (OR 4.18; 95% CI: 1.08–16.13), and presenting with weight loss (OR 3.02; 95% CI: 1.15–7.93).Of those treated, 18(43%) have completed treatment, 9(21%) remain on treatment, 10(24%) stopped due to side effects, 5(12%) died during treatment. Mortality was 31% (n = 13) in treated versus 21% (n = 14) in the non-treated cohort. Subgroup analysis of individual NTM species did not observe any differences in treatment initiation or outcomes between groups.DiscussionDecision to treat pulmonary NTM infection requires clinical judgement when interpreting clinical guidelines. Factors independently associated with decision to treat in this HIV-negative cohort include cavitation on HRCT and presenting with night sweats or weight loss.
Rawson T, Moore L, Gill D, et al., 2016, Promoting medical student engagement with antimicrobial stewardship through involvement in undergraduate research, Journal of Infection, Vol: 74, Pages: 200-202, ISSN: 1532-2742
The National Health Service recognises the importance of research, teaching, and training tothe future success of the organisation and medical students are expected to qualify with thenecessary clinical, professional, and academic skills to support this. There is a wide variationin the level of cross-specialty engagement with Antimicrobial Stewardship (AMS) &Antimicrobial resistance (AMR) research at UK and international state-of-the-artconferences, with a heterogeneous level of importance also attributed amongst undergraduateand postgraduate training pathways across clinical medicine. It therefore seems apparent thatthe AMS-AMR agenda needs to be promoted from within specialties, rather than being‘pushed’ on them as an external agenda, to promote broad ownership and capacity within allclinical specialties that use antimicrobials. This must start early during undergraduate medicaltraining. We investigated whether the use of an online platform designed to facilitate medicalstudent research projects could be utilised to promote undergraduate engagement with AMSAMRat Imperial College School of Medicine between July 2015 and 2016. During thisperiod 12 applicants were appointed to 11 of the 13 advertised projects. So far, studentsundertaking these projects have achieved: 1 peer-reviewed publication, 3 national oralpresentations, 1 national prize, 1 international poster presentation, 3 national posterpresentations, and 2 further manuscripts are currently under peer-review. Furthermore,despite the students’ broad career interests there has been a high retention rate with studentsrequesting involvement in further AMS-AMR related activities. Further longitudinalassessment of this tool for promoting undergraduate engagement with AMS-AMR research isnow being explored.
Boyd 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
Rawson 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: 1460-2091
OBJECTIVES: 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.
Sartelli M, Weber DG, Ruppé E, et al., 2016, Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA), World Journal of Emergency Surgery, Vol: 11, ISSN: 1749-7922
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
Rawson 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
Troughton R, Birgand G, Moore L, et al., 2016, Blogging in infectious diseases and clinical microbiology: assessment of the ‘blogosphere' content, SHEA Spring Conference 2016
Blogs are becoming increasingly widespread, and can be useful for quickly and interactively communicating new information. To explore this resource we analysed the content and characteristics of influential infectious disease (ID) and infection control (IC) blogs and bloggers to describe the ID blogosphere.
Rawson TM, Moore LSP, Hernandez B, et al., 2016, Missed opportunities for shared decision making in antimicrobial stewardship: The potential consequences of a lack of patient engagement in secondary care, International Journal of Infectious Diseases, Vol: 45, Pages: 122-123, ISSN: 1878-3511
Background: 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 second
Rawson TM, Moore LSP, Hatcher JC, et al., 2016, Plasmid-mediated colistin resistance mechanisms: is it time to revise our approach to selective digestive decontamination?, LANCET INFECTIOUS DISEASES, Vol: 16, Pages: 149-150, ISSN: 1473-3099
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- Citations: 9
Rawson TM, Gill D, Buckley J, et al., 2015, The role of the multidisciplinary team in decision making for vascular graft infection, JOURNAL OF VASCULAR SURGERY, Vol: 62, Pages: 1686-1686, ISSN: 0741-5214
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- Citations: 8
Rawson TM, Abbara A, Kranzer K, et al., 2015, A MULTI-CENTRE REVIEW OF THE MANAGEMENT OF PULMONARY NON-TUBERCULOUS MYCOBACTERIAL (NTM) INFECTION IN HIV-NEGATIVE SUBJECTS, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A210-A211, ISSN: 0040-6376
Rawson TM, Moore LSP, Gilchrist MJ, et al., 2015, Antimicrobial stewardship: are we failing in cross-specialty clinical engagement?, Journal of Antimicrobial Chemotherapy, Vol: 71, Pages: 554-559, ISSN: 1460-2091
Background Antimicrobial resistance (AMR) is a public health priority and leading patient safety issue. Globally, antimicrobial stewardship (AMS) has been integral in promoting therapeutic optimization whilst minimizing harmful antimicrobial use. A cross-sectional, observational study was undertaken to investigate the coverage of AMS and antibacterial resistance across clinical scientific conferences in 2014, as a surrogate marker for current awareness and attributed importance.Methods Clinical specialties were identified, and the largest corresponding clinical scientific/research conferences in 2014 determined (i) within the UK and (ii) internationally. Conference characteristics and abstracts were interrogated and analysed to determine those related to AMS and AMR. Inter-specialty variation was assessed using χ2 or Fisher's exact statistical analysis.Results In total, 45 conferences from 23 specialties were analysed representing 59 682 accepted abstracts. The UK had a significantly greater proportion of AMS-AMR-related abstracts compared with international conferences [2.8% (n = 221/7843) compared with 1.8% (n = 942/51 839); P < 0.001]. Infection conferences contained the greatest proportion of AMS-AMR abstracts, representing 20% (732/3669) of all abstracts [UK 66% (80/121) and international 18% (652/3548); P < 0.0001]. AMS-AMR coverage across all general specialties was poor [intensive care 9% (116/1287), surgical 1% (8/757) and medical specialties 0.64% (332/51 497)] despite high usage of antimicrobials across all.Conclusions Despite current AMS-AMR strategies being advocated by infection specialists and discussed by national and international policy makers, AMS-AMR coverage remained limited across clinical specialty scientific conferences in 2014. We call for further intervention to ensure specialty engagement with AMS programmes and promote the AMR agenda across clinical practice.
Rawson T, Shah A, Hodgson J, 2015, An Introduction to Hospital Medicine for Pre-Clinical Medical Students, Publisher: The Codex Project, ISBN: 978-1-910046-09-8
Rawson TM, Bouri S, Allen C, et al., 2015, Improving the management of spontaneous bacterial peritonitis in cirrhotic patients: assessment of an intervention in trainee doctors., Clin Med (Lond), Vol: 15, Pages: 426-430
Spontaneous bacterial peritonitis (SBP) in cirrhotic patients is a serious complication associated with a high mortality rate. A baseline audit of the acute medical take (AMT) at Northwick Park suggested a lack of awareness regarding management. A questionnaire based on contemporary SBP guidelines was circulated to all trainee doctors (FY1 to SpR). Ascitic fluid testing requests were analysed over a six-month period. The electronic requesting system was updated to include prompts and direct links to Trust SBP guidelines, and a one-hour lecture to all members of the AMT, supported by an educational booklet on SBP, was performed. Re-audit was carried out six months post-intervention, the AMT completed a second questionnaire and ascitic fluid testing requests were re-audited. In comparable pre- and post-intervention AMT cohorts, a clinical and educational intervention led to a significant improvement in understanding of when to investigate (p≤0.001), samples (p = 0.002) and containers (p≤0.001) required, urgency of obtaining results (p≤0.001), and initiation of treatment for suspected SBP (p = 0.007). Significantly more ascitic samples were sent, with specific suspicion of SBP more readily documented, crucial to expediting laboratory processing. Targeted education and production of a clinical algorithm has significantly improved the management of patients with SBP.
Rawson TM, Lee MJ, Khanna P, et al., 2015, Microbiological characterisation of prosthetic vascular graft infection, JOURNAL OF INFECTION, Vol: 71, Pages: 400-402, ISSN: 0163-4453
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- Citations: 5
Rawson TM, Brima N, Almajid F, et al., 2015, Outcomes From Treating Tuberculosis With Rifampicin or Rifabutin in HIV-Infected Persons Also Receiving Antiretroviral Therapy, JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol: 68, Pages: E84-E87, ISSN: 1525-4135
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- Citations: 7
Rawson TM, Moore LSP, Gilchrist MJ, et al., 2015, Antimicrobial stewardship: are we failing in cross-specialty clinical engagement?, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091
Rawson TM, Lee MJ, Khanna P, et al., 2015, Standardising the Management of Aortic and Peripheral Vascular Graft Infection (VGI): The Northwest London Hospitals VGI Management Algorithm, Publisher: WILEY-BLACKWELL, Pages: 15-15, ISSN: 0007-1323
Rawson TM, Dubb S, Pozniak A, et al., 2015, Assessing the role of peripheral CD8 T cells in neurocognitive impairment in HIV-infected men who have sex with men: data from the MSM Neurocog Study, INTERNATIONAL JOURNAL OF STD & AIDS, Vol: 26, Pages: 128-132, ISSN: 0956-4624
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- Citations: 5
Rawson T, Anjum V, Hodgson J, et al., 2014, Leprosy and tuberculosis concomitant infection: a poorly understood, age-old relationship, Leprosy Review, Vol: 85, Pages: 288-295, ISSN: 0305-7518
Historically, archaeological evidence, post-mortem findings and retro-spective analysis of leprosy institutions’ data demonstrates a high observed incidenceof concomitant infection with leprosy and tuberculosis (TB). However, reports ofconcomitant infection in the modern literature remain scarce, with estimates ofannual new case detection rates of concomitant infection at approximately 0·02cases per 100,000 population. Whilst the mechanism for this apparent decline inconcomitant infections remains unclear, further research on this topic has remainedrelatively neglected. Modelling of the interaction of the two organisms has suggestedthat the apparent decline in observations of concomitant infection may be due to theprotective effects of cross immunity, whilst more recently others have questionedwhether it is a more harmful relationship, predisposing towards increased hostmortality. We review recent evidence, comparing it to previously held understandingon the epidemiological relationship and our own experience of concomitant infection.From this discussion, we highlight several under-investigated areas, which maylead to improvements in the future delivery of leprosy management and services, aswell as enhance understanding in other fields of infection management. Theseinclude, a) highlighting the need for greater understanding of host immunogeneticsinvolved in concomitant infection, b) whether prolonged courses of high dose steroidspre-dispose to TB infection? and, c) whether there is a risk of rifampicin resistancedeveloping in leprosy patients treated in the face of undiagnosed TB and otherinfections? Longitudinal work is still required to characterise these temporalrelationships further and add to the current paucity of literature on this subject matter.
Rawson TM, Anjum V, Hodgson J, et al., 2014, Leprosy and tuberculosis concomitant infection: A poorly understood, age-old relationship, LEPROSY REVIEW, Vol: 85, Pages: 288-295, ISSN: 0305-7518
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- Citations: 19
Rawson TM, Lee MJ, Renton S, et al., 2014, The need for a validated pathway for the diagnosis and management of prosthetic vascular graft infection, JOURNAL OF VASCULAR SURGERY, Vol: 60, Pages: 551-551, ISSN: 0741-5214
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- Citations: 1
Rawson T, AlMajiid F, Janmohamed A, et al., 2014, Outcomes from rifabutin-based tuberculosis treatment in HIV-infected individuals: A two-centre case-control study, Publisher: WILEY-BLACKWELL, Pages: 138-138, ISSN: 1464-2662
Dubb S, Rawson T, Mandalia S, et al., 2014, MSM Neurocog: Role of peripheral CD8 T cells in neurocognitive screening test outcome, HIV MEDICINE, Vol: 15, Pages: 76-76, ISSN: 1464-2662
Rawson TM, Rao PVR, 2014, Leprosy and lymphatic filariasis comorbidity: the case for an integrated functional limitation grading system, LEPROSY REVIEW, Vol: 85, Pages: 63-67, ISSN: 0305-7518
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- Citations: 6
Rawson T, Anjum V, 2013, Leprosy Interpreted as Diabetes RelatedComplications, Indian Journal of Leprosy, ISSN: 0254-9395
Rawson T, Muir D, Mackie NE, et al., 2012, Factors associated with cerebrospinal fluid HIV RNA in HIV infected subjects undergoing lumbar puncture examination in a clinical setting, JOURNAL OF INFECTION, Vol: 65, Pages: 239-245, ISSN: 0163-4453
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- Citations: 48
Rawson T, Basnayake S, Pozniak A, 2012, Use of rifabutin in the treatment of tuberculosis in HIV positive individuals, Publisher: WILEY-BLACKWELL, Pages: 43-44, ISSN: 1464-2662
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