scholarly journals TP9.2.6An update of the surgical management of truncal cutaneous abscesses: A systematic scoping review of current practice in 2021

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Melissa-rose Bennet ◽  
Olivia Hartrick ◽  
Russell Eason ◽  
Niroshini Rajaretnam
Keyword(s):  
Scoping Review ◽  
Patient Flow ◽  
Perianal Abscess ◽  
Antibiotic Use ◽  
Operative Management ◽  
Cochrane Library ◽  
Publication Date ◽  
National Guidelines ◽  
Incision And Drainage ◽  
Quality Evidence

Abstract Introduction NHS England has shown efficiency in patient flow and reduction of length of stay resulting in cost savings. There’s considerable variability in local and national guidelines for Incision and drainage (I&D) of cutaneous truncal abscesses which can financially impact NHS expenditure. This Systematic Scoping Review (SSR) aims to explore current management recommendations for I&D of cutaneous truncal abscesses in both adult and paediatric populations; and assess the quality of this research. Method SSR search strategy employed the PICO framework. Cochrane Library, NICE Evidence, Pubmed, OVID medicine, CINAHL and EBSCO databases were searched using search syntax ((“abscess*”OR“perianal abscess*”) AND (“incision and drainage”OR“I&D”) AND (“Equipment*”OR”instrument*”OR“Kit*”OR“theatre staff*”OR“team*”)). Full texts were systematically assessed. Final review performed in accordance with Joanna-Briggs-Institute protocol. Results 131 articles were identified. No limit was placed on publication date. After removal of duplicates and abstract screening, 10 full text articles were assessed. Research suggests day-case emergency surgery pathways to manage I&D of abscesses are efficient and sustainable. Antibiotic use after I&D is weakly recommended and there is low quality evidence for using internal packing for healing perianal abscess cavities, and yet, this is established, common practice. Conclusion There’s variable quality evidence reviewing the surgical pathways for I&D and the post-operative management of cutaneous truncal abscesses. Overall, the findings are limited and further work is required to establish national guidelines.

scholarly journals Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy

2020 ◽  
Author(s):  
E Blix ◽  
Robyn Maude ◽  
E Hals ◽  
S Kisa ◽  
E Karlsen ◽  
...  
Keyword(s):  
Scoping Review ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Fetal Monitoring ◽  
Low Risk ◽  
Cochrane Library ◽  
National Guidelines ◽  
Creative Commons ◽  
Active Labour ◽  
Randomised Controlled

© 2019 Blix et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, there is no scientific evidence for the ideal device, timing, frequency and duration for IA. We aimed to give an overview of the field, identify and describe methods and practices for performing IA, map the evidence and accuracy for different methods of IA, and identify research gaps. Methods We conducted a systematic scoping review following the Joanna Briggs methodology. Med-line, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach. Results The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29–2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult. Conclusion Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.

Antimicrobial use at the end of life: a scoping review

2020 ◽  
pp. bmjspcare-2020-002558
Author(s):  
Jack Fairweather ◽  
Lesley Cooper ◽  
Jacqueline Sneddon ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Resistance ◽  
Adverse Effects ◽  
End Of Life ◽  
Scoping Review ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Cochrane Library ◽  
Antibiotic Prescribing ◽  
Ovid Medline ◽  
Tract Infections

ObjectiveTo examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial resistance.DesignScoping reviewData sourcesAn information scientist searched Ovid MEDLINE, Ovid EMBASE, The Cochrane library, PubMed Clinical Queries, NHS Evidence, Epistemonikos, SIGN, NICE, Google Scholar from inception to February 2019 for any study design including, but not limited to, randomised clinical trials, prospective interventional or observational studies, retrospective studies and qualitative studies. The search of Ovid MEDLINE was updated on the 10 June 2020.Study selectionStudies reporting antibiotic use in patients approaching end of life in any setting and clinicians’ attitudes and behaviour in relation to antibiotic prescribing in this populationData extractionTwo reviewers screened studies for eligibility; two reviewers extracted data from included studies. Data were analysed to describe antibiotic prescribing patterns across different patient populations, the benefits and adverse effects (for individual patients and wider society), the rationale for decision making and clinicians behaviours and attitudes to treatment with antibiotics in this patient group.ResultsEighty-eight studies were included. Definition of the end of life is highly variable as is use of antibiotics in patients approaching end of life. Prescribing decisions are influenced by patient age, primary diagnosis, care setting and therapy goals, although patients’ preferences are not always documented or adhered to. Urinary and lower respiratory tract infections are the most commonly reported indications with outcomes in terms of symptom control and survival variably reported. Small numbers of studies reported on adverse events and antimicrobial resistance. Clinicians sometimes feel uncomfortable discussing antibiotic treatment at end of life and would benefit from guidelines to direct care.ConclusionsUse of antibiotics in patients approaching the end of life is common although there is significant variation in practice. There are a myriad of intertwined biological, ethical, social, medicolegal and clinical issues associated with the topic.

scholarly journals A scoping review of the Clinical Frailty Scale

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sophie Church ◽  
Emily Rogers ◽  
Kenneth Rockwood ◽  
Olga Theou
Keyword(s):  
Scoping Review ◽  
Literature Search ◽  
Research Evidence ◽  
Web Of Science ◽  
Cochrane Library ◽  
Publication Date ◽  
Clinical Frailty Scale ◽  
And Function ◽  
Comprehensive Literature Search ◽  
Frailty Score

Abstract Background Frailty is increasingly recognized as an important construct which has health implications for older adults. The Clinical Frailty Scale (CFS) is a judgement-based frailty tool that evaluates specific domains including comorbidity, function, and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill). The aim of this scoping review is to identify and document the nature and extent of research evidence related to the CFS. Methods We performed a comprehensive literature search to identify original studies that used the Clinical Frailty Scale. Medline OVID, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane Library and Embase were searched from January 2005 to March 2017. Articles were screened by two independent reviewers. Data extracted included publication date, setting, demographics, purpose of CFS assessment, and outcomes associated with CFS score. Results Our search yielded 1688 articles of which 183 studies were included. Overall, 62% of studies were conducted after 2015 and 63% of the studies measured the CFS in hospitalized patients. The association of the CFS with an outcome was examined 526 times; CFS was predictive in 74% of the cases. Mortality was the most common outcome examined with CFS being predictive 87% of the time. CFS was associated with comorbidity 73% of the time, complications 100%, length of stay 75%, falls 71%, cognition 94%, and function 91%. The CFS was associated with other frailty scores 94% of the time. Conclusions This scoping review revealed that the CFS has been widely used in multiple settings. The association of CFS score with clinical outcomes highlights its utility in the care of the aging population.

scholarly journals Transition of Adolescents with Chronic Kidney Disease to Adult Health Service: Scoping Review

2020 ◽  
pp. 24-36
Author(s):  
Elena N. Kulakova ◽  
Tatjana L. Nastausheva ◽  
Inna V. Kondratjeva ◽  
Tatjana G. Zvyagina ◽  
Maria P. Koltakova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Service ◽  
Scoping Review ◽  
Scientific Knowledge ◽  
Russian Language ◽  
Cochrane Library ◽  
Publication Date ◽  
Adult Health ◽  
Inclusion Criteria

Background. The transition of adolescents with chronic diseases from pediatric to adult health service is often accompanied by a decrease in adherence to the recommendations, non-regular scheduled medical consultations, disease course monitoring violation. All together it can lead to exacerbation and progression of the chronic disease and a decrease in quality of life. Programs for patients with nephrological diseases that optimize the process of their transition to adult service can improve the course of chronic kidney disease (according to international experts).Objective. The aim of the study was to systematize data from the published literature on the transition of adolescents with chronic kidney disease to adult health service; identify gaps in scientific knowledge; and determine areas for future research.Methods. Scoping review was performed by searching for articles in the databases: PubMed, eLIBRARY.RU, The Cochrane Library, via Google Scholar and in reference lists of selected articles. We have selected articles published in Russian or English with no publication date limitation and corresponding to inclusion criteria.Results. 185 (8.5%) out of 2,184 identified literature sources were included in the study. The results of 25 works were included in the analysis of transition programs efficacy. There were no Russian-language articles matching the inclusion criteria. The majority of publications types were original scientific studies (retrospective observational studies, questionnaire surveys, qualitative and mixed methods studies with interviewing) and narrative reviews. It was shown that both complex programs and narrow-focus interventions have been implemented to improve the transition process. It has been noted that the efficacy of such initiatives still remains insufficiently studied, including among experimental studies.Conclusion. Formation of the scientific knowledge system on the transition of patients with chronic kidney disease to adult health service requires high-level evidence. Further researches are needed in this field in the Russian health system as well.

scholarly journals Good practices for dialysis education, treatment, and eHealth: A scoping review

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255734
Author(s):  
Anita van Eck van der Sluijs ◽  
Sanne Vonk ◽  
Brigit C. van Jaarsveld ◽  
Anna A. Bonenkamp ◽  
Alferso C. Abrahams
Keyword(s):  
Scoping Review ◽  
Health Care Professionals ◽  
Good Practice ◽  
Cochrane Library ◽  
Local Health ◽  
Dialysis Access ◽  
National Guidelines ◽  
Dialysis Treatment ◽  
Good Practices

Background Recommendations regarding dialysis education and treatment are provided in various (inter)national guidelines, which should ensure that these are applied uniformly in nephrology and dialysis centers. However, there is much practice variation which could be explained by good practices: practices developed by local health care professionals, which are not evidence-based. Because an overview of good practices is lacking, we performed a scoping review to identify and summarize the available good practices for dialysis education, treatment, and eHealth. Methods Embase, Pubmed, the Cochrane Library, CINAHL databases and Web of Science were searched for relevant articles using all synonyms for the words ‘kidney failure’, ‘dialysis’, and ‘good practice’. Relevant articles were structured according to the categories dialysis education, dialysis treatment or eHealth, and assessed for content and results. Results Nineteen articles (12 for dialysis education, 3 for dialysis treatment, 4 for eHealth) are identified. The good practices for education endorse the importance of providing complete and objective predialysis education, assisting peritoneal dialysis (PD) patients in adequately performing PD, educating hemodialysis (HD) patients on self-management, and talking with dialysis patients about their prognosis. The good practices for dialysis treatment focus mainly on dialysis access devices and general quality improvement of dialysis care. Finally, eHealth is useful for HD and PD and affects both quality of care and health-related quality of life. Conclusion Our scoping review identifies 19 articles describing good practices and their results for dialysis education, dialysis treatment, and eHealth. These good practices could be valuable in addition to guidelines for increasing shared-decision making in predialysis education, using patients’ contribution in the implementation of their dialysis treatment, and advanced care planning.

scholarly journals Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e048613
Author(s):  
Maya M Jeyaraman ◽  
Leslie Copstein ◽  
Nameer Al-Yousif ◽  
Rachel N Alder ◽  
Scott W Kirkland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nurse Practitioners ◽  
Scoping Review ◽  
Primary Healthcare ◽  
Healthcare Professionals ◽  
Patient Flow ◽  
Grey Literature ◽  
Cochrane Library ◽  
Future Research ◽  
Ed Overcrowding

ObjectivesTo conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.DesignA scoping review.Data sourcesA comprehensive database search of Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) databases was conducted (inception until January 2020) using peer-reviewed search strategies, complemented by a search of grey literature sources.Eligibility criteriaInterventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.MethodsWe engaged and collaborated, with 13 patient partners during the design and conduct stages of this review. We conducted this review using the JBI guidelines. Two reviewers independently selected studies and extracted data. We conducted descriptive analysis of the included studies (frequencies and percentages).ResultsFrom 23 947 records identified, we included 268 studies published between 1981 and 2020. The majority (58%) of studies were conducted in North America and were predominantly cohort studies (42%). The reported interventions were either ‘within ED’ (48%) interventions (eg, PHCP-led ED triage or fast track) or ‘outside ED’ interventions (52%) (eg, after-hours GP clinic and GP cooperatives). PHCPs involved in the interventions were: GP (32%), NP (26%), nurses with expanded role (16%) and combinations of the PHCPs (42%). The ‘within ED’ and ‘outside ED’ interventions reported outcomes on patient flow and ED utilisation, respectively.ConclusionsWe identified many interventions involving PHCPs that predominantly reported a positive impact on ED utilisation/patient flow metrics. Future research needs to focus on conducting well-designed randomized controlled trials (RCTs) and systematic reviews to evaluate the effectiveness of specific interventions involving PHCPs to critically appraise and summarise evidence on this topic.

scholarly journals Mapping the Knowledge on Coping Processes in Patients with Pancreatic Cancer

2020 ◽  
Vol 3 ◽  
pp. 1-15
Author(s):  
Patrick Ristau ◽  
Claudia Oetting-Roß ◽  
Andreas Büscher
Keyword(s):  
Pancreatic Cancer ◽  
Scoping Review ◽  
Current Knowledge ◽  
Cochrane Library ◽  
Publication Date ◽  
Coping With Cancer ◽  
Complex Process ◽  
Scoping Reviews ◽  
Coping Processes ◽  
Cancer Specific Mortality

Background: Pancreatic cancer is one of the malignant diseases with the highest cancer-specific mortality. At the time of diagnosis, life expectancy is often already very limited, as it is usually discovered late and in an advanced stage. Coping with cancer is a complex process. Coping strategies of patients with pancreatic cancer probably differ from those of other malignancies. Yet to date, there exists no pancreatic cancer-specific coping model. Objective: The objective of this scoping review is to explore and characterize the academic literature related to coping processes in patients with pancreatic cancer. Methods/Design: The JBI's three-step search strategy, combined with the Arksey and O'Malley framework, will be used to identify articles via PubMed/MEDLINE, CINAHL, Cochrane Library, Google Scholar, CAMbase, CareLit, CC Med, Scopus, and PsycARTICLES (Arksey & O'Malley, 2005; Peters et al., 2017). It follows the PRISMA guidelines for scoping reviews (Tricco et al., 2018). Primary and secondary studies and reviews which report on coping with pancreatic cancer (adenocarcinoma) in adults in English or German language will be included in this scoping review, regardless of publication date or study design. Discussion: This scoping review will add new insights on coping with pancreatic cancer by summarizing current knowledge, and identifying research 

scholarly journals Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy

2020 ◽  
Author(s):  
E Blix ◽  
Robyn Maude ◽  
E Hals ◽  
S Kisa ◽  
E Karlsen ◽  
...  
Keyword(s):  
Scoping Review ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Fetal Monitoring ◽  
Low Risk ◽  
Cochrane Library ◽  
National Guidelines ◽  
Creative Commons ◽  
Active Labour ◽  
Randomised Controlled

© 2019 Blix et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, there is no scientific evidence for the ideal device, timing, frequency and duration for IA. We aimed to give an overview of the field, identify and describe methods and practices for performing IA, map the evidence and accuracy for different methods of IA, and identify research gaps. Methods We conducted a systematic scoping review following the Joanna Briggs methodology. Med-line, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach. Results The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29–2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult. Conclusion Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.

scholarly journals Post-Neoadjuvant Surveillance and Surgery as Needed Compared with Post-Neoadjuvant Surgery on Principle in Multimodal Treatment for Esophageal Cancer: A Scoping Review

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 429
Author(s):  
Julian Hipp ◽  
Blin Nagavci ◽  
Claudia Schmoor ◽  
Joerg Meerpohl ◽  
Jens Hoeppner ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Local Recurrence ◽  
Scoping Review ◽  
Multimodal Treatment ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Randomized Controlled

Background: A substantial fraction of patients with esophageal cancer show post-neoadjuvant pathological complete response (pCR). Principal esophagectomy after neoadjuvant treatment is the standard of care for all patients, although surveillance and surgery as needed in case of local recurrence may be a treatment alternative for patients with complete response (CR). Methods: We performed a scoping review to describe key characteristics of relevant clinical studies including adults with non-metastatic esophageal cancer receiving multimodal treatment. Until September 2020, relevant studies were identified through systematic searches in the bibliographic databases Medline, Web of Science, Cochrane Library, Science Direct, ClinicalTrials, the German study register, and the WHO registry platform. Results: In total, three completed randomized controlled trials (RCTs, with 468 participants), three planned/ongoing RCTs (with a planned sample size of 752 participants), one non-randomized controlled study (NRS, with 53 participants), ten retrospective cohort studies (with 2228 participants), and one survey on patients’ preferences (with 100 participants) were identified. All studies applied neoadjuvant chemoradiation protocols. None of the studies examined neoadjuvant chemotherapeutic protocols. Studies investigated patient populations with esophageal squamous cell carcinoma, adenocarcinoma, and mixed cohorts. Important outcomes reported were overall, disease-free and local recurrence-free survival. Limitations of the currently available study pool include heterogeneous chemoradiation protocols, a lack of modern neoadjuvant treatment protocols in RCTs, short follow-up times, the use of heterogeneous diagnostic methods, and different definitions of clinical CR. Conclusion: Although post-neoadjuvant surveillance and surgery as needed compared with post-neoadjuvant surgery on principle has been investigated within different study designs, the currently available results are based on a wide variation of diagnostic tools to identify patients with pCR, short follow-up times, small sample sizes, and variations in therapeutic procedures. A thoroughly planned RCT considering the limitations in the currently available literature will be of great importance to provide patients with CR with the best and less harmful treatment.

scholarly journals Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Bongyoung Kim ◽  
◽  
Myung Jin Lee ◽  
Se Yoon Park ◽  
Song Mi Moon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Quality Indicators ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Republic Of Korea ◽  
Cochrane Library ◽  
Surgical Prophylaxis ◽  
Modified Delphi ◽  
Stewardship Program ◽  
The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

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