scholarly journals Nurse roles in antimicrobial stewardship: lessons from public sectors models of acute care service delivery in the United Kingdom

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Enrique Castro-Sánchez ◽  
Mark Gilchrist ◽  
Raheelah Ahmad ◽  
Molly Courtenay ◽  
Jo Bosanquet ◽  
...  
Keyword(s):  
Public Sector ◽  
Antimicrobial Stewardship ◽  
Health Care Services ◽  
Economies Of Scale ◽  
Care Service ◽  
Careful Consideration ◽  
Context Sensitive ◽  
Inappropriate Use ◽  
Global Threat ◽  
The Uk

Abstract Background Health care services must engage all relevant healthcare workers, including nurses, in optimal antimicrobial use to address the global threat of drug-resistant infections. Reflecting upon the variety of antimicrobial stewardship (AMS) nursing models already implemented in the UK could facilitate policymaking and decisions in other settings about context-sensitive, pragmatic nurse roles. Methods We describe purposefully selected cases drawn from the UK network of public sector nurses in AMS exploring their characteristics, influence, relations with clinical and financial structures, and role content. Results AMS nursing has been deployed in the UK within ‘vertical’, ‘horizontal’ or ‘hybrid’ models. The ‘vertical’ model refers to a novel, often unique consultant-type role ideally suited to transform organisational practice by legitimising nurse participation in antimicrobial decisions. Such organisational improvements may not be straightforward, though, due to scalability issues. The ‘horizontal’ model can foster coordinated efforts to increase optimal AMS behaviours in all nurses around a narrative of patient safety and quality. Such model may be unable to address tensions between the required institutional response to sepsis and the inappropriate use of antibiotics. Finally, the ‘hybrid’ model would increase AMS responsibilities for all nurses whilst allocating some expanded AMS skills to existing teams of specialists such as sepsis or vascular access nurses. This model can generate economies of scale, yet it may be threatened by a lack of clarity about a nurse-relevant vision. Conclusions A variety of models articulating the participation of nurses in antimicrobial stewardship efforts have already been implemented in public sector organisations in the UK. The strengths and weaknesses of each model need considering before implementation in other settings and healthcare systems, including precise metrics of success and careful consideration of context-sensitive, resource dependent and pragmatic solutions.

Faculty and Resident Physicians' Attitudes, Perceptions, and Knowledge about Antimicrobial Use and Resistance

2011 ◽  
Vol 32 (7) ◽  
pp. 714-718 ◽  
Author(s):  
Lilian Abbo ◽  
Ronda Sinkowitz-Cochran ◽  
Laura Smith ◽  
Ella Ariza-Heredia ◽  
Orlando Gómez-Marín ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Inappropriate Use ◽  
Resident Physicians

We surveyed faculty and residents to assess attitudes, perceptions, and knowledge about antimicrobial use and resistance. Most respondents were concerned about resistance when prescribing antibiotics and agreed that antibiotics are overused, that inappropriate use is professionally unethical, and that others, but not themselves, overprescribe antibiotics. Antimicrobial stewardship programs should capitalize on these perceptions.

scholarly journals Antimicrobial Stewardship: Development and Pilot of an Organisational Peer-to-Peer Review Tool to Improve Service Provision in Line with National Guidance

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 44
Author(s):  
Olaolu Oloyede ◽  
Emma Cramp ◽  
Diane Ashiru-Oredope
Keyword(s):  
Public Health ◽  
Peer Review ◽  
Antimicrobial Stewardship ◽  
Service Provision ◽  
Good Practice ◽  
Survey Method ◽  
Global Public Health ◽  
Inappropriate Use ◽  
National Guidance ◽  
New Antibiotics

Antimicrobial resistance continues to be a considerable threat to global public health due to the persistent inappropriate use of antibiotics. Antimicrobial stewardship (AMS) programs are essential in reducing the growth and spread of antibiotic resistance, in an environment which lacks incentives for the development of new antibiotics. Over the years, a variety of resources have been developed to strengthen antimicrobial stewardship. However, the differences in resources available present a challenge for organisations/teams to establish the best resources to utilise for service provision. A peer review tool was formulated using four national documents on AMS and tested through three phases with feedback. A survey method was used to collect feedback on the validity, feasibility, and impact of the AMS peer review tool. Feedback received was positive from the earlier pilots. The tool was found to be useful at identifying areas of good practice and gaps in antimicrobial stewardship across various pilot sites. Feedback suggests the tool is useful for promoting improvements to AMS programs and highlights that the content and features of the tool are appropriate for evaluating stewardship.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

Economies of scale in European life insurance

2018 ◽  
Vol 19 (2) ◽  
pp. 190-207 ◽  
Author(s):  
Udo Klotzki ◽  
Alexander Bohnert ◽  
Nadine Gatzert ◽  
Ulrike Vogelgesang
Keyword(s):  
Life Insurance ◽  
Fixed Effects ◽  
Economies Of Scale ◽  
Insurance Markets ◽  
Fixed Effects Model ◽  
Content Type ◽  
Administrative Costs ◽  
Life Insurers ◽  
Acquisition Costs ◽  
The Uk

Purpose Due to the continuing low interest rate environment as well as the increase in acquisition costs, price transparency, cost transparency and competition with banks, the cost of life insurance becomes increasingly important for customers, insurers and shareholders. Against this background, the purpose of this paper is to study the development of insurers’ economies of scale in regard to administrative costs for four of the largest European life insurance markets. Design/methodology/approach The analysis on economies of scale is based on a comprehensive set of 477 life insurers in Germany, Italy, Spain and the UK, yearly data between 2000 and 2014, and regression calculations that are based on 4,855 observations. Findings The results show that economies of scale exist for all considered markets and for most of the considered years. However, the extent of economies of scale varies considerably across countries. Originality/value Overall, the existing academic literature on costs and corresponding economies of scale in life insurance primarily deals with analyses of total costs instead of administrative costs, a single year or a single market. This paper contributes to the existing literature by conducting an analysis of recent market dynamics and economies of scale in regard to administrative costs for the period from 2000 and 2014 for four of the largest European life insurance markets for which the respective data were available (Germany, Italy, Spain and the UK) and 477 life insurers in total. This is done by means of a log-log transformation of premiums and costs and a fixed effects model based on these transformed figures for 4,855 observations. In addition, for each market, the authors analyze the development of administrative costs for a total of 477 insurers.

MOTIVES FOR CORPORATE HEDGING: EVIDENCE FROM THE UK

2005 ◽  
Vol 01 (01) ◽  
pp. 0550003 ◽  
Author(s):  
EPHRAIM CLARK ◽  
AMRIT JUDGE
Keyword(s):  
Risk Management ◽  
Financial Distress ◽  
Economies Of Scale ◽  
Foreign Currency ◽  
Annual Reports ◽  
Data Sets ◽  
Growth Options ◽  
Corporate Hedging ◽  
Currency Exposure ◽  
The Uk

In this paper, we use survey data and data from annual reports to identify the determinants of hedging activity of United Kingdom (UK) firms in the context of an overall program of risk management. Comparing the two sets of data makes it possible to identify misclassified firms, that is, firms whose hedging claims are not consistent across the two data sets. Our results on the consistent data show that the likelihood of hedging is related to growth options, foreign currency exposure, liquidity and economies of scale in hedging costs. Contrary to many previous US studies, we also find strong evidence linking the decision to hedge and the expected costs of financial distress. Results for the misclassified firms suggest that they are actually hedgers that hedge less extensively than the correctly classified (CC) hedgers.

Trust, efficacy and ethicacy when testing prisoners for COVID-19

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Steve Lambert ◽  
Dean Wilkinson
Keyword(s):  
Large Scale ◽  
Current System ◽  
Epidemiological Studies ◽  
Careful Consideration ◽  
Power Relationships ◽  
England And Wales ◽  
Content Type ◽  
Large Scale Testing ◽  
The Uk ◽  
The Impact

Purpose The outbreak of the severe acute respiratory syndrome coronavirus 2 virus and subsequent COVID-19 illness has had a major impact on all levels of society internationally. The extent of the impact of COVID-19 on prison staff and prisoners in England and Wales is unknown. Testing for COVID-19 both asymptomatic and symptomatic, as well as for antibodies, to date, has been minimal. The purpose of this paper is to explore the widespread testing of COVID-19 in prisons poses philosophical and ethical questions around trust, efficacy and ethicacy. Design/methodology/approach This paper is both descriptive, providing an overview of the widespread testing of COVID-19 in prisoners in England and Wales, and conceptual in that it discusses and argues the issues associated with large-scale testing. This paper provides a discussion, using comparative studies, of the issues associated with large-scale testing of prisoners across the prison estate in England and Wales (120 prisons). The issues identified in this paper are contextualised through the lens of COVID-19, but they are equally transferrable to epidemiological studies of any pandemic. Given the prevalence of COVID-19 globally and the lack of information about its spread in prisons, at the time of writing this paper, there is a programme of asymptomatic testing of prisoners. However, there remains a paucity of data on the spread of COVID-19 in prisons because of the progress with the ongoing testing programme. Findings The authors argue that the widespread testing of prisoners requires careful consideration of the details regarding who is included in testing, how consent is gained and how tests are administered. This paper outlines and argues the importance of considering the complex nuance of power relationships within the prison system, among prisoner officers, medical staff and prisoners and the detrimental consequences. Practical implications The widespread testing of COVID-19 presents ethical and practical challenges. Careful planning is required when considering the ethics of who should be included in COVID-19 testing, how consent will be gained, who and how tests will be administered and very practical challenges around the recording and assigning of COVID-19 test kits inside the prison. The current system for the general population requires scanning of barcodes and registration using a mobile number; these facilities are not permitted inside a prison. Originality/value This paper looks at the issues associated with mass testing of prisoners for COVID-19. According to the authors’ knowledge, there has not been any research that looks at the issues of testing either in the UK or internationally. The literature available details countries’ responses to the pandemic rather and scientific papers on the development of vaccines. Therefore, this paper is an original review of some of the practicalities that need to be addressed to ensure that testing can be as successful as possible.

scholarly journals Economic cost of congenital CMV in the UK

2018 ◽  
Vol 104 (6) ◽  
pp. 559-563 ◽  
Author(s):  
Jenny Retzler ◽  
Nick Hex ◽  
Chris Bartlett ◽  
Anne Webb ◽  
Sharon Wood ◽  
...  
Keyword(s):  
Public Sector ◽  
Vaccine Development ◽  
Cost Model ◽  
Financial Burden ◽  
Secondary Data ◽  
Economic Cost ◽  
Future Research ◽  
The Public ◽  
The Uk

ObjectiveCongenital cytomegalovirus (cCMV) is the most common infectious cause of congenital disability. It can disrupt neurodevelopment, causing lifelong impairments including sensorineural hearing loss and developmental delay. This study aimed, for the first time, to estimate the annual economic burden of managing cCMV and its sequelae in the UK.DesignThe study collated available secondary data to develop a static cost model.SettingThe model aimed to estimate costs of cCMV in the UK for the year 2016.PatientsIndividuals of all ages with cCMV.Main outcome measuresDirect (incurred by the public sector) and indirect (incurred personally or by society) costs associated with management of cCMV and its sequelae.ResultsThe model estimated that the total cost of cCMV to the UK in 2016 was £732 million (lower and upper estimates were between £495 and £942 million). Approximately 40% of the costs were directly incurred by the public sector, with the remaining 60% being indirect costs, including lost productivity. Long-term impairments caused by the virus had a higher financial burden than the acute management of cCMV.ConclusionsThe cost of cCMV is substantial, predominantly stemming from long-term impairments. Costs should be compared against investment in educational strategies and vaccine development programmes that aim to prevent virus transmission, as well as the value of introducing universal screening for cCMV to both increase detection of children who would benefit from treatment, and to build a more robust evidence base for future research.

In search of better opportunities: transnational social workers in the UK navigating the maze of global and social mobility

2018 ◽  
Author(s):  
Shereen Hussein
Keyword(s):  
Social Work ◽  
Social Workers ◽  
Essential Element ◽  
Work Practice ◽  
Western World ◽  
International Mobility ◽  
Context Sensitive ◽  
Level Of Training ◽  
International Identity ◽  
The Uk

Social workers are increasingly becoming global professionals, both in utilising their professional qualifications as a means to achieve international mobility, and in the expectation of gaining an internationally transferable set of skills. However, there is a continued dilemma in defining such professional international identity due to contradictory processes of ‘indigenisation’, or the extent to which social work practice fits local contexts; ‘universalism’, finding commonalities across divergent contexts; and ‘imperialism’ where western world-views are privileged over local and Indigenous cultural perspectives (Gray, 2005). Many regard social work to be especially context-sensitive in that a good understanding of language and cultural clues is an essential element in the ability of workers to perform their work effectively. In that sense, while global professional mobility facilitates transnational social work (Hanna and Lyons, 2014), social work is not yet a global ‘common project’ and clear differences remain at the level of training, qualifications and practice (Weiss-Gal and Welbourne, 2008; Hussein, 2011, 2014).

scholarly journals The Living Wage: An Economic Geography Based Explanation for a Policy for Equality

2015 ◽  
Vol 15 (4) ◽  
pp. 589-605 ◽  
Author(s):  
Carlo J. Morelli ◽  
Paul T. Seaman
Keyword(s):  
Public Sector ◽  
Labour Force ◽  
Living Wage ◽  
Labour Force Survey ◽  
The Public ◽  
Household Inequality ◽  
The Uk ◽  
Wage Demand ◽  
The Impact ◽  
Low Pay

This article examines the theoretical underpinning of living wage campaigns. The article uses evidence, derived from the UK Quarterly Labour Force Survey from 2005 to 2008, to examine the extent to which a living wage will address low pay within the labour force. We highlight the greater incidence of low pay within the private sector and then focus upon the public sector where the living wage demand has had most impact. The article builds upon the results from the Quarterly Labour Force Survey with analysis of the British Household Panel Survey in 2007 in order to examine the impact that the introduction of a living wage, within the public sector, would have in reducing household inequality.

scholarly journals The evolution of public–private partnership in Ireland: a sustainable pathway?

2016 ◽  
Vol 84 (3) ◽  
pp. 579-595 ◽  
Author(s):  
Gail Sheppard ◽  
Matthias Beck
Keyword(s):  
Public Sector ◽  
Public Private Partnership ◽  
Institutional Isomorphism ◽  
Public Private Partnerships ◽  
Credit Crisis ◽  
Private Partnership ◽  
Institutional Legitimacy ◽  
The Uk ◽  
Voluntary Adoption ◽  
Institutional Capacity Building

Ireland is a latecomer to public–private partnerships, having only adopted them in 1998. Prior to the credit crisis, Ireland followed the UK model, with public–private partnerships being implemented in transport, education, housing/urban regeneration and water/wastewater. Having stalled during the credit crisis, public–private partnerships have recently been reactivated with the domestic infrastructure stimulus programme. The focus of this article is on Ireland as a younger participant in public–private partnerships and the nexus between adoption patterns and the sustainability characteristics of Irish public–private partnerships. Using document analysis and exploratory interviews, the article examines the reasons for Ireland's interest in public–private partnerships, which cannot be attributed to economic rationales alone. We consider three explanations: voluntary adoption – where the UK model was closely followed as part of a domestic modernisation agenda; coercive adoption – where public–private partnership policy was forced upon public sector organisations; and institutional isomorphism – where institutional creation and change around public–private partnerships were promoted to help public sector organisations gain institutional legitimacy. We find evidence of all three patterns, with coercive adoption becoming more relevant in recent years, which is likely to adversely affect sustainability unless incentives for voluntary adoption are strengthened and institutional capacity building is boosted. Points for practitioners There are many reasons why public sector organisations procure via public–private partnerships, and motivations can change over time. In Ireland, public–private partnership adoption changed from being largely voluntary to increasingly coercive. Irrespective of motives, public–private partnership procurement must be underpinned by incentives and institutional enabling mechanisms, which should be strengthened to make Ireland's public–private partnership strategy sustainable.

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