Stewardship Practices Research Articles

Expanding access to veterinary clinical decision support in resource-limited settings: a scoping review of clinical decision support tools in medicine and antimicrobial stewardship.

Digital clinical decision support (CDS) tools are of growing importance in supporting healthcare professionals in understanding complex clinical problems and arriving at decisions that improve patient outcomes. CDS tools are also increasingly used to improve antimicrobial stewardship (AMS) practices in healthcare settings. However, far fewer CDS tools are available in lowerand middle-income countries (LMICs) and in animal health settings, where their use in improving diagnostic and treatment decision-making is likely to have the greatest impact. The aim of this study was to evaluate digital CDS tools designed as a direct aid to support diagnosis and/or treatment decisionmaking, by reviewing their scope, functions, methodologies, and quality. Recommendations for the development of veterinary CDS tools in LMICs are then provided. The review considered studies and reports published between January 2017 and October 2023 in the English language in peer-reviewed and gray literature. A total of 41 studies and reports detailing CDS tools were included in the final review, with 35 CDS tools designed for human healthcare settings and six tools for animal healthcare settings. Of the tools reviewed, the majority were deployed in high-income countries (80.5%). Support for AMS programs was a feature in 12 (29.3%) of the tools, with 10 tools in human healthcare settings. The capabilities of the CDS tools varied when reviewed against the GUIDES checklist. We recommend a methodological approach for the development of veterinary CDS tools in LMICs predicated on securing sufficient and sustainable funding. Employing a multidisciplinary development team is an important first step. Developing standalone CDS tools using Bayesian algorithms based on local expert knowledge will provide users with rapid and reliable access to quality guidance on diagnoses and treatments. Such tools are likely to contribute to improved disease management on farms and reduce inappropriate antimicrobial use, thus supporting AMS practices in areas of high need.

Oregon's Approach To Demonstrating The Value Of A Modern Public Health System Through Accountability Metrics.

Oregon's public health system uses accountability metrics to improve health, eliminate inequities, and practice stewardship. First enacted into law during the 2015 legislative session, with additions and clarifications made in the 2017 session, these metrics promote collective action across sectors, bring attention to the root causes of health inequities, and hold public health authorities accountable for performance improvement as they carry out core public health functions. This article describes the development of Oregon's accountability metrics and implications for future practice. In 2023, Oregon's public health leaders adopted a new set of health outcome indicators and process measures for communicable disease control and environmental health, with performance tied to financial incentives. Oregon's process is a model for other states developing an accountability framework in their pursuit of public health transformation. Oregon's work contributes to legislative and other policy decisions for measuring the success of approaches to eliminating health inequities and for applying performance-based incentives within the public health system.

Colistin utilization at a tertiary hospital in South Africa: an opportunity for antimicrobial stewardship practices.

Introduction. Colistin (polymyxin E) has emerged as a last-resort treatment option for multidrug-resistant infections.Hypothesis/Gap Statement. Studies on the use, safety and efficacy of colistin in South Africa are limited.Aim. This study aims to describe the use of colistin and its clinical outcomes at a tertiary public hospital in South Africa.Methodology. We conducted a retrospective review of adult and paediatric patients who received parenteral colistin between 2015 and 2019.Results. A total of 69 patients (26 adults, 13 children and 30 neonates) were reviewed. Acinetobacter baumannii was the most common causative pathogen isolated (70.1 %). Colistin was predominately used to treat septicaemia (75.4 %). It was primarily administered as definitive therapy (71.0 %) and as monotherapy (56.5 %). It was used in 11.5 % of adults with infections susceptible to other antibiotics. Loading doses of intravenous colistin were administered in only 15 (57.7 %) adult patients. Neurotoxicity and nephrotoxicity occurred in 5.8 % and 43.5 % of patients, respectively. Clinical cure was achieved in 37 (53.6 %) patients. On multivariate logistic regression analysis, adults [adjusted odds ratio (aOR), 25.54; 95 % CI, 2.73-238.65; P < 0.01] and children (aOR, 8.56; 95 % CI, 1.06-69.10; P < 0.05) had higher odds of death than neonates.Conclusion. The study identified significant stewardship opportunities to improve colistin prescription and administration. Achieving optimal patient outcomes necessitates a multidisciplinary approach and vigilant monitoring of colistin use.

Results of an Italian multi-Long-Term Care Facilities survey on diagnostic, therapeutic, and infection control topics: state of the art and future perspective

Background and Aims: current trends in the world’s demographic structure indicate increasing requirements for chronic and Long-Term Care Facilities (LTCFs). As the above settings may act as reservoirs for Multidrug-Resistant Organisms (MDROs), it is essential to acquire information about diagnostic, therapeutic, and infection control practices, aiming to optimize strategies for the near future. Materials and Methods: the annual survey form for assessment of the MDRO management in LTCFs and Residential Homes (RHs) for non-self-sufficient elderly people, promoted by the Centers for Disease Control (CDC), and adapted by the version of the American National Healthcare Safety Network, was sent to LTCFs healthcare operators by the AMCLI GLISTer Working Group. Topics considered were interactions with clinical microbiology laboratories, infection prevention/control and antibiotic stewardship practices, and electronic medical records data availability. Results and Conclusions: sixteen structures, mostly from 120 to 280 beds, took part in the survey. We registered that i) MDRO colonization screening is usually not adopted in Italian LTCFs for new admissions (14; 87,5%) at present, and ii) microbiological results are usually provided by an external laboratory service. Furthermore, infection control interventions are regularly adopted, and antibiotic prescriptions are registered only in 62,5% and 75% of structures, respectively. About 70% of facilities do not have a strategy for antibiotic use optimization. Planning of 1st/2nd/3rd level MDRO surveillance programs, enhanced training activities, and improved antibiotic consumption control, whether for prophylaxis, empirical, and targeted therapy, appears of paramount importance in the complex reality of LTCFs.

Scales of plant stewardship in the precontact Pacific Northwest, USA

Numerous oral histories and substantial ethnographic evidence illustrate how plant species, communities, and even landscapes were extensively managed and cared for by ancestral communities in the Pacific Northwest. Camas ( Camassia spp.) is one such cultural keystone plant, common from the Pacific Ocean to the Rocky Mountains, with numerous records describing its role as a staple food for many Northwest peoples. Supporting deep time archeological evidence for such management or stewardship practices, however, has remained elusive. In this paper we analyze archived collections of archeological camas bulbs from 11 sites across the Willamette Valley, Oregon to demonstrate people began preparing camas within earth ovens by approximately 8000 calendar years before present and deliberately harvesting sexually mature camas plants circa 3500 calendar years before present. We compare these findings with climatological, palynological, and fire history reconstructions to discuss stewardship strategies for camas and associated plant communities through time at the population, community, and landscape levels. These findings confirm and expand upon Indigenous knowledges as well as offer time-tested methods for cultural keystone conservationists seeking to revitalize traditional plant stewardship practices throughout this region and beyond. This “camas case study” also offers another example of a human-plant symbiotic relationship, expanding our knowledge of plant food pathways, processes, and mutualisms.

Non-prescription sale and dispensing of antibiotics for prophylaxis in broiler chickens in Lusaka District, Zambia: findings and implications on one health.

The irrational use of antibiotics in humans and livestock has contributed to the emergence of antimicrobial resistance (AMR). This study investigated the commonly sold and dispensed antibiotics for prophylaxis in broiler chickens in pharmacy and agro-veterinary shop personnel in the Lusaka District of Zambia. This cross-sectional study was conducted from August 2023 to October 2023 among 200 veterinary medicine dispensers in the Lusaka District of Zambia using a simulated farmer or mystery shopper approach. Data analysis was performed using IBM Statistical Package for Social Sciences version 23.0. Out of the 200 medicine outlets investigated, 23 (11.5%) were agro-veterinary shops, while 177 (88.5%) were community pharmacies. A total of 165 community pharmacies and agro-veterinary shops provided veterinary services in the Lusaka District and sold medicines without prescription giving a 100% non-prescription sale. Of the 178 medicines dispensed for prophylaxis, 88.5% were antibiotics, while 13.5% were vitamins. The most dispensed antibiotic drug for prophylaxis in broiler chickens was oxytetracycline (30.34%), amoxicillin (17.98%) and gentamicin/doxycycline (10.67%). This study revealed a high sale and dispensing of antibiotics for prophylaxis in broiler chickens of which oxytetracycline, amoxicillin and gentamicin/doxycycline were commonly dispensed. There is a need for increased regulatory enforcement of selling antibiotics without a prescription as this may predispose poultry to the development of AMR and possible transmission of superbugs to humans and the environment. Educational interventions should be provided to community pharmacy and agro-veterinary personnel on adhering to antimicrobial stewardship practices when dispensing poultry antibiotics.

Current state of education, training and practices in antimicrobial stewardship among pharmacy students: A cross-sectional survey from Kerala, India

PurposePharmacists are recognised in guidelines from across the globe as key stakeholders in antimicrobial stewardship (AMS) initiatives. The current study aims to assess the current practices and level of training and education in relation to AMS among pharmacy students from Kerala, India. MethodsA cross-sectional web-based survey was developed and disseminated among doctor of pharmacy 5th year students and interns from selected pharmacy colleges across Kerala through key informants. Descriptive statistics were used to analyse the responses. ResultsThe response rate was 34.8% (157/450). Whilst the majority of respondents (89.8%, 141/157) recalled being taught about antimicrobial resistance (AMR) as part of the pharmacy curricula, 84.7% (133/157) believed they didn't have sufficient knowledge about AMR. Most of the respondents (64.9%, 102/157) had not received any AMS training. Clinical posting in AMS was the preferred mode of training suggested by most respondents. Respondents who audited antimicrobials as part of their clinical postings (77.9%, 88/113) reported their main responsibility was review of patient records for assessing the appropriateness of antimicrobials (68.2%, 60/88). Inappropriate selection of antimicrobials was the most common error identified by respondents (38.1%, 43/113) and the key method of communicating their recommendation was informing the prescriber in person (46%, 52/113). ConclusionWhilst pharmacy students are reviewing antimicrobial prescriptions as part of their clinical postings, their education and training in AMR and AMS remain low. The inclusion of practical clinical training for pharmacy students as part of their curricula can be a cost-effective way to promote AMS initiatives.

Healthcare professionals’ views on opioid stewardship interventions in postoperative, opioid-naive patients: a qualitative service evaluation

Abstract Introduction Overuse of opioids has led to an opioid crisis.[1] Opioid stewardship interventions have been developed in some countries. However, there are currently no uniform guidelines that can be used to implement opioid stewardship interventions in the United Kingdom. Prescribing opioids postoperatively is a key risk area of opioid use.[2] To the best of our knowledge, no previous study has explored healthcare professionals’ (HCPs’) views on opioid stewardship interventions in postoperative, opioid-naive patients. Aim To explore hospital HCPs’ views on opioid stewardship interventions for postoperative patients who were not taking opioids before surgery. Methods Semi-structured interviews were conducted with pharmacists, doctors, and nurses in one National Health Service hospital trust as a service evaluation. Participants were recruited through purposive sampling and asked about their opinions on opioid stewardship interventions in postoperative, opioid-naive patients. Interviews were audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Results Interviews were conducted with 3 doctors, 3 nurses and 4 pharmacists of diverse grades. All participants were involved in clinical opioid practice, with 9 responsible for elective surgery and 1 for trauma surgery. The main themes identified were HCPs’ knowledge and attitudes, decision-making processes, communication with patients, and discharge management. In terms of HCPs’ knowledge and attitudes, most participants were unaware of opioid stewardship. However, during the interviews, the pharmacists used their knowledge of antimicrobial stewardship to help them conceptualise opioid stewardship. Most participants were unaware of the risks associated with opioid-naive patients. Although many available resources about opioid stewardship were identified by participants, they suggested that these were not used in practice. Decision-making processes for opioid prescribing were reported as being heavily reliant on individual clinical judgment due to the absence of standardised guidelines. In addition, decisions were primarily made by anaesthetists rather than by the ward staff responsible for postoperative care. Shared decision-making with patients was limited, primarily occurring postoperatively. Time limitations, complex medical information, and patients’ lack of knowledge about opioids were reported to hinder effective communication and information exchange between HCPs and patients. HCPs reported giving patients information verbally, with minimal use of educational materials. In terms of discharge management, HCPs stressed the importance of providing clear and comprehensive information. After patients were discharged from the hospital, HCPs had no further contact with them or the primary healthcare system, leaving follow-up to GPs. Conclusion To the best of our knowledge, this is the first study to explore HCPs’ knowledge in postoperative opioid stewardship practice. Our findings suggest that although pharmacists have some knowledge of the concept of stewardship generally, many HCPs are unaware of opioid-naive patients’ risks, suggesting that more training may be needed. We identified the underutilisation of available resources and reliance on clinical judgment due to the lack of guidelines. Limited shared decision-making and communication challenges were also identified. This study was limited to a small number of participants in one hospital trust, which may compromise the generalisability and representativeness of our findings. Further work should include anaesthetists and other specialists, as well as patients and carers.

Implementation of an Automated Antibiotic Time-out at a Comprehensive Cancer Center.

Antimicrobial stewardship programs can optimize antimicrobial use and have been federally mandated in all hospitals. However, best stewardship practices in immunocompromised patients with cancer are not well established. An antimicrobial time out, in the form of an email, was sent to physicians caring for hospitalized patients reaching 5 days of therapy for targeted antimicrobials (daptomycin, linezolid, tigecycline, vancomycin, imipenem/cilastatin, meropenem) in a comprehensive cancer center. Physicians were to discontinue the antimicrobial if unnecessary or document a rationale for continuation. This is a quasi-experimental, interrupted time series analysis assessing antimicrobial use during the following times: period 1 (before time-out: January 2007-June 2010) and period 2 (after time-out: July 2010-March/2015). The primary antimicrobial consumption metric was mean duration of therapy. Days of therapy per 1000 patient-days were also assessed. Implementation of the time-out was associated with a significant decrease in mean duration of therapy for the following antimicrobials; daptomycin: -0.89 days (95% confidence interval [CI], -1.38 to -.41); linezolid: -0.89 days (95% CI, -1.27 to -.52); meropenem: -0.97 days (95% CI, -1.39 to -.56); tigecycline: -1.41 days (95% CI, -2.19 to -.63); P < .001 for each comparison. Days of therapy/1000 patient-days decreased significantly for meropenem (-43.49; 95% CI, -58.61 to -28.37; P < .001), tigecycline (-35.47; 95% CI, -44.94 to -26.00; P < .001), and daptomycin (-9.47; 95% CI, -15.25 to -3.68; P = .002). A passive day 5 time-out was associated with reduction in targeted antibiotic use in a cancer center and could potentially be successfully adopted to several settings and electronic health records.

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

Pneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed. To evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non-critically ill patients admitted with pneumonia. Cluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non-critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020. CPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (<10%) of MDRO pneumonia, coupled with feedback and education. The primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy and safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes compared differences between baseline and intervention periods across strategies. Among 59 hospitals with 96 451 (51 671 in the baseline period and 44 780 in the intervention period) adult patients admitted with pneumonia, the mean (SD) age of patients was 68.1 (17.0) years, 48.1% were men, and the median (IQR) Elixhauser comorbidity count was 4 (2-6). Compared with routine stewardship, the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy (rate ratio, 0.72 [95% CI, 0.66-0.78]; P < .001). Safety outcomes of mean days to ICU transfer (6.5 vs 7.1 days) and hospital length of stay (6.8 vs 7.1 days) did not differ significantly between the routine and CPOE intervention groups. Empiric extended-spectrum antibiotic use was significantly lower among adults admitted with pneumonia to non-ICU settings in hospitals using education, feedback, and CPOE prompts recommending standard-spectrum antibiotics for patients at low risk of MDRO infection, compared with routine stewardship practices. Hospital length of stay and days to ICU transfer were unchanged. ClinicalTrials.gov Identifier: NCT03697070.

A review of the mechanisms that confer antibiotic resistance in pathotypes of E. coli.

The dissemination of antibiotic resistance in Escherichia coli poses a significant threat to public health worldwide. This review provides a comprehensive update on the diverse mechanisms employed by E. coli in developing resistance to antibiotics. We primarily focus on pathotypes of E. coli (e.g., uropathogenic E. coli) and investigate the genetic determinants and molecular pathways that confer resistance, shedding light on both well-characterized and recently discovered mechanisms. The most prevalent mechanism continues to be the acquisition of resistance genes through horizontal gene transfer, facilitated by mobile genetic elements such as plasmids and transposons. We discuss the role of extended-spectrum β-lactamases (ESBLs) and carbapenemases in conferring resistance to β-lactam antibiotics, which remain vital in clinical practice. The review covers the key resistant mechanisms, including: 1) Efflux pumps and porin mutations that mediate resistance to a broad spectrum of antibiotics, including fluoroquinolones and aminoglycosides; 2) adaptive strategies employed by E. coli, including biofilm formation, persister cell formation, and the activation of stress response systems, to withstand antibiotic pressure; and 3) the role of regulatory systems in coordinating resistance mechanisms, providing insights into potential targets for therapeutic interventions. Understanding the intricate network of antibiotic resistance mechanisms in E. coli is crucial for the development of effective strategies to combat this growing public health crisis. By clarifying these mechanisms, we aim to pave the way for the design of innovative therapeutic approaches and the implementation of prudent antibiotic stewardship practices to preserve the efficacy of current antibiotics and ensure a sustainable future for healthcare.

Comprehensive Genomic Testing: Tissue Stewardship and Best Practices

Biomarker-driven targeted therapies have shaped the oncology treatment landscape for patients with advanced solid tumors over the past decade. Comprehensive genomic profiling (CGP) has played a key role in precision medicine as it enables simultaneous identification of multiple biomarkers to guide cancer diagnosis, therapy selection, and prognostication. As a result, tissue stewardship for successful CGP testing is paramount. In addition, widespread adoption of less invasive sampling techniques leaves less diagnostic tissue for additional or future testing as smaller biopsies are acquired. To help oncology care practitioners overcome these challenges, this paper provides an overview of current genomic testing methodologies and offers guidelines on best practices for tissue stewardship and preanalytic practices for successful CGP testing and efficient turnaround times for laboratory tests.

WAAW 2023- The 6th Institutional Composite CMEs on Integrated Antimicrobial Stewardship Practices at AIIMS, Rishikesh

WAAW 2023- The 6th Institutional Composite CMEs on Integrated Antimicrobial Stewardship Practices at AIIMS, Rishikesh

ASPICON 2023: 5TH National Conference on Antimicrobial Stewardship Practices in India

ASPICON 2023: 5TH National Conference on Antimicrobial Stewardship Practices in India

Rise in the Pathogenic Status of Coagulase-Negative Staphylococci Causing Bloodstream Infection.

Coagulase-negative staphylococci (CoNS) are one of the frequently isolated bacteria from blood cultures. Since they are part of the normal skin flora, they were previously considered contaminants. But now, they can be considered as established pathogens causing bloodstream infection (BSI). This study aims to estimate the prevalence of CoNS in BSI cases. This study was conducted at the Microbiology Department, All India Institute of Medical Sciences (AIIMS), Raipur, India, for eight months (January 2022 to August 2022). Data were collected retrospectively from medical and laboratory records. Paired blood cultures from 5085 clinically suspected sepsis cases were subjected to aerobic culture for five days in the BacT ALERT 3D system. Pathogenicity was established after recovery of CoNS from paired blood cultures of symptomatic patients. CoNS were isolated from 2.35% of patients, the most common species being Staphylococcus haemolyticus (51.67%). About 90% of isolates were methicillin-resistant. All the isolates were susceptible to linezolid, teicoplanin, and vancomycin, except one isolate of S. haemolyticus which was intermediate to vancomycin. Minimum inhibitory concentration (MIC) 50 and MIC 90 for vancomycin were 1 ug/ml and 2 ug/ml, respectively. Conclusion: Paired blood cultures are necessary to determine the pathogenicity of CoNS in BSI cases. A high prevalence of methicillin resistance, accompanied by high resistance rates to other non-beta lactam antibiotics, warrants the strict implementation of antimicrobial stewardship practices.

Empathetic Disposition, Stewardship as Principals’ Leadership Practices and Teachers’ Commitment in Delta State Mission Schools

This study explored the empathetic disposition, stewardship as principals' leadership practices and teachers’ commitment in Delta State mission schools. It was guided by three research questions and hypotheses respectively. The study utilized an ex-post-facto research design of the correlational method. The population consists of 906 teachers and 102 principals in Delta State mission schools, from which a sample of 204 respondents were selected through purposive sampling method. Data was collected using two researcher-designed questionnaires: The Principals’ Empathetic Disposition and Stewardship Practices Questionnaire (PEDSPQ) and the Teachers Commitment Questionnaire (TCQ). The face and content validity of the instruments was established through expert review. Pilot testing assessed the reliability using Cronbach’s alpha. In the pilot study, the PEDSPQ demonstrated a reliability coefficient of 0.79 and the TCQ had a reliability coefficient of 0.84. Data collected were analysed using coefficient of determination, Pearson’s r correlation and multiple regression to answer research questions and hypotheses testing at a 0.05 level of significance. Finding revealed that principals' empathetic disposition, stewardship practices were significantly related to teachers’ commitment. It was recommended that Mission schools leaders should prioritize the development of emotional intelligence skills among principals. Providing training and workshops focused on empathy, active listening, and understanding others' perspectives can enhance principals' ability to connect with and support their teachers effectively among other.

Empowerment of Accounting Industry Towards Sustainable Employment

This study focuses on accounting as a crucial aspect of business, providing control, stability, and accountability to a company’s finances. However, high turnover rates and career change are evident not only in the Philippines but also abroad. The country is facing a shortage of accountants due to a drop in college enrollment and those licensed working abroad. The Philippine Institute of Certified Public Accountants (PICPA) reported that local accounting firms have hit a tipping point and begun hiring non-certified public accountants to fill the widening gap. High turnover rates can lead to lost productivity, increased costs, and a decline in morale. Accounting professionals help businesses track and manage transactions, including expenses and incomes, and make sound financial decisions. Without them, the world would be less safe and stable, resulting in increased fraud, financial instability, and overall economic inefficiency. Strategic management is necessary to improve efficiency and set goals. Understanding the strengths, weaknesses, opportunities, and threats of the profession is crucial to recognizing what needs to be built or empowered and what needs to be resolved and avoided. The worldwide shortage of accountants makes it easier for Filipino accountants to find better opportunities elsewhere. Pursuing an accounting degree and passing licensure examinations is not an easy feat, and the profession is not being recognized enough. A strategic management plan could make the accounting and auditing profession more attractive to potential employees and create a more positive and supportive work environment for accountants and auditors in the country. The accounting industry’s empowerment is crucial for sustainable employment, as businesses increasingly prioritize sustainability. Accountants play a vital role in creating resilient and stable jobs by adopting sustainable practices and embedding them into their business processes. They act as catalysts for change, leading businesses to make more responsible financial decisions and promoting sustainable long-term growth. This approach goes beyond financial matters, recognizing the value of environmental stewardship, social justice, and ethical practices. Accountants can leverage their expertise to drive positive change and create a more just and sustainable future. Future research should focus on job enlargement and enrichment, addressing issues such as work-life balance, technological skills, and sustainability variables. Future studies should re-evaluate each step and emphasize the challenges in implementing empowerment and sustainability strategies for the accounting industry. Keywords: empowerment, sustainable employment, accountancy, turnover, professional development

The Practice of Antimicrobial Stewardship in Thoracic Surgery and its Effectiveness.

This study examines the effects of the bundle of antimicrobial stewardship measures for prophylactic antibiotics among thoracic surgery patients. A local protocol, based on current guidelines starting from December 2014, was developed by the Infection Control and Thoracic Surgery Teams. The effects of this protocol were assessed by monitoring a total of 1380 patients before and after its implementation from January 1, 2011, to December 31, 2022.

Data stewardship in FTLD research: Investigator and research participant views.

Federal policies and guidelines have expanded the return of individual results to participants and expectations for data sharing between investigators and through repositories. Here, we report investigators' and study participants' views and experiences with data stewardship practices within frontotemporal lobal degeneration (FTLD) research, which reveal unique ethical challenges. Semi-structured interviews with (1) investigators conducting FTLD research that includes genetic data collection and/or analysis and (2) participants enrolled in a single site longitudinal FTLD study. Analysis of the interviews identified three meta themes: perspectives on data sharing, experiences with enrollment and participation, and data management and security as mechanisms for participant protections. This study identified a set of preliminary gaps and needs regarding data stewardship within FTLD research. The results offer initial insights on ethical challenges to data stewardship aimed at informing future guidelines and policies.

Regularly Test Your Stewardship Practices

Regularly Test Your Stewardship Practices