Who listens and who doesn’t? Factors associated with adherence to antibiotic stewardship intervention in a Singaporean tertiary hospital

Abstract Background The emerging threat of antibiotic resistance is growing exponentially and antibiotic stewardship programs are cornerstone to fight against this global threat. The study aimed to explore the knowledge, perspectives and practices of physicians regarding various aspects of antibiotic stewardship program including antibiotic stewardship activities, rational use of antibiotics, antibiotic resistance, prescribing practices and factors associated with these practices. Methods In this qualitative study, a total of 17 semi-structured, in-depth interviews with doctors of three tertiary care public sector hospitals in Bahawalpur and Rahim Yar Khan were conducted. The convenient sampling method was adopted to collect the data and the saturation point criterion was applied to determine the sample size. Thematic analysis approach was used to draw conclusions from the data. Results The analysis of data yielded five themes, 12 subthemes and 26 categories. The themes included, (i) perception about antibiotic use and antibiotic stewardship, (ii) antibiotic prescription practices, (iii) antibiotic resistance, (iv) limited strategies adopted by hospital administration to ensure quality and safe distribution of antibiotics, (v) implementation of antibiotic stewardship program: barriers, suggestion and future benefits. Doctors had misconceptions about the rational use of antibiotics. The perception regarding antibiotic stewardship programs was poor. Moreover, very few activities related to ASP existed. The participants gave many suggestions for successful implementation of ASP in order to reduce the burden of antibiotic resistance, including development of guidelines for the use of antibiotics, strict legislation regarding use of antibiotics, active participation of healthcare professionals and awareness program among general public about the use of antibiotics. Conclusion This study concluded that poor knowledge of doctors regarding ASP, non-existence of antibiogram of hospital and lack of rules for the safe use of antibiotics were the main driving factors associated with irrational antibiotic prescription practices and development of AR.

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Association of Ventilator Type with Hospital Mortality in Critically Ill Patients with SARS-CoV2 Infection: A Retrospective Study.

10.21203/rs.3.rs-565958/v1 ◽

2021 ◽

Author(s):

Alexis FERRE ◽

Fabien Marquion ◽

Marc Delord ◽

Jean-Pierre Bédos ◽

Hugo Bellut ◽

...

Keyword(s):

Hospital Mortality ◽

Multivariate Regression ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Patient Characteristics ◽

Tertiary Hospital ◽

Prospective Data ◽

Factors Associated ◽

Kaplan Meier ◽

Patient Groups

Abstract Background: To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection) during the first wave of the disease in France.Methods: We retrospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March and May 2020. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a transport ventilator was used. Kaplan-Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality.Results: We included 82 patients (61 [74.4%] men) with a median age of 64 years [55–74], of whom 23 (28.1%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were older age (HR, 1.06/year; 95%CI, 1.00–1.11; P=0.05) and diabetes mellitus (HR, 3.32; 95%CI, 1.13–9.76; P=0.03) but not ventilator type. Using non-ICU ventilator was associated neither with a longer duration of invasive mechanical ventilation (20 [12-36] vs. 25 [15-31] days; P=0.87) nor with a longer ICU stay (24 [14-40] vs. 27 [15-37] days; P=0.64).Conclusions: In patients with ARDS due to COVID-19, the use of non-ICU ventilators, such as transport ventilators, was not associated with worse outcomes. Although prospective data are needed to confirm our findings, this study suggests that transport ventilators may be valuable during COVID-19 surges that overwhelm ICU resources.

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Factors Associated with the Survival Outcome of Hepatocellular Carcinoma Patients on Supportive Care in a Tertiary Hospital in South-West Nigeria

European Scientific Journal ESJ ◽

10.19044/esj.2019.v15n24p59 ◽

2019 ◽

Vol 15 (24) ◽

Author(s):

Olusegun Adekanle ◽

Oluwasegun Ijarotimi ◽

Akinwumu Oluwole Komolafe ◽

Samuel Anu Olowookere ◽

Comfort Olusola Famurewa ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Supportive Care ◽

Tertiary Hospital ◽

Survival Outcome ◽

Factors Associated ◽

South West

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Health research capacity of professional and technical personnel in a first-class tertiary hospital in northwest China: multilevel repeated measurement, 2013–2017, a pilot study

Health Research Policy and Systems ◽

10.1186/s12961-020-00616-7 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Peijing Yan ◽

Yongfeng Lao ◽

Zhenxing Lu ◽

Xu Hui ◽

Biao Zhou ◽

...

Keyword(s):

Research Group ◽

Multilevel Model ◽

Comparison Group ◽

Research Capacity ◽

Northwest China ◽

Tertiary Hospital ◽

Research Fund ◽

Factors Associated ◽

Technical Personnel ◽

Administrative Position

Abstract Objectives To explore the health research capacity (HRC) and factors associated with professional and technical personnel (PTP) in a first-class tertiary hospital in northwest China. Methods We collected the repeated measurement data from a first-class tertiary hospital in northwest China between 2013 and 2017. HRC of PTP was assessed by a comprehensive evaluation system and measured by research capacity score (RCS). The participants were divided into research group (RCS >0) and comparison group (RCS = 0); participants of the comparison group were selected by two-stage stratified random sampling. Multilevel model for repeated measures was used to investigate the potential factors associated with HRC. Results A total of 924 PTP were included (308 in the research group and 616 in the comparison group). This study found consistent growth in RCS and associated 95% CIs for the hospital during 2013 and 2017. The linear multilevel model showed PTP with a doctorate degree had higher RCS than those with a master’s degree (β, 1.74; P <0.001), bachelor’s degree (β, 2.02; P <0.001) and others without a degree (β, 2.32; P <0.001). Furthermore, the PTP with intermediate (β, 0.13; P = 0.015), vice-high (β, 0.27; P = 0.001) and senior (β, 0.63; P <0.001) professional titles had higher RCS than those with junior positions. Compared with PTP in the administration, those in paediatrics had higher RCS (β, 0.28; P = 0.047) though similar to PTP in other departments. PTP with an administrative position had a higher RCS than those in non-administrative positions (β, 0.26; P <0.001). The RCS increased with the research fund (β, 0.15; P <0.001). However, no associations were found between RCS and sex, age, ethnic, graduate school or technical type. Conclusions HRC with associated variation of PTP for the hospital in northwest China increasingly improved and degree, professional title, administrative position, and research fund were related to HRC of PTP. Multi-central prospective studies are needed to clarify the potential relationship of related factors and HRC of PTP.

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Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon

Toxins ◽

10.3390/toxins11010022 ◽

2019 ◽

Vol 11 (1) ◽

pp. 22 ◽

Cited By ~ 10

Author(s):

Sâmella S. Oliveira ◽

Eliane C. Alves ◽

Alessandra S. Santos ◽

João Pedro T. Pereira ◽

Lybia Kássia S. Sarraff ◽

...

Keyword(s):

Rural Areas ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Control Group ◽

Cross Sectional ◽

Factors Associated ◽

Amazonas State ◽

Hemostatic Disorders ◽

To Receive ◽

De Medicina

Bothrops snakebites usually present systemic bleeding, and the clinical–epidemiological and laboratorial factors associated with the development of this manifestation are not well established. In this study, we assessed the prevalence of Bothrops snakebites with systemic bleeding reported at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, in Manaus, Amazonas State, Brazil, and the clinical–epidemiological and laboratorial factors associated with systemic bleeding. This is an observational, cross-sectional study carried out between August, 2013 and July, 2016. Patients who developed systemic bleeding on admission or during hospitalization were considered cases, and those with non-systemic bleeding were included in the control group. Systemic bleeding was observed in 63 (15.3%) of the 442 Bothrops snakebites evaluated. Bothrops snakebites mostly occurred in males (78.2%), in rural areas (89.0%) and in the age group of 11 to 30 years old (40.4%). It took most of the patients (59.8%) less than 3 h to receive medical assistance. Unclottable blood (AOR = 3.11 (95% CI = 1.53 to 6.31; p = 0.002)) and thrombocytopenia (AOR = 4.52 (95% CI = 2.03 to 10.09; p < 0.001)) on admission were independently associated with systemic bleeding during hospitalization. These hemostatic disorders on admission increase the chances of systemic bleeding during hospitalization. Prospective studies are needed to clarify the pathophysiology of systemic bleeding in Bothrops snakebites in the Amazon region.

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