Reducing Antimicrobial Use by Implementing Evidence-Based, Management-Related Prevention Strategies in Dairy Cows in Switzerland

The aim of this study was to reduce antimicrobial use (AMU) on dairy farms that implemented evidence-based management strategies. The study not only examined whether these strategies led to a reduction in AMU in practice, but also examined the influence of the level of their implementation on AMU. For data analysis, practice software recordings of the farm veterinarians were used. The AMU data of 50 farms with prevention strategies applied (intervention group, IG) over 3 years (2017–2019) and of 74 farms without prevention strategies (control group, CG) over 2 years (2018–2019) were analyzed. Project participation was supported with 500 Swiss francs (~545 USD) per farmer per year. The AMU was compared between the IG and CG using the treatment incidence. In December 2017/January 2018, the farmers of the IG had chosen at least one of the proposed 17 prevention strategies from one of three sectors, i.e., udder health, uterine health and/or replacement calf health. The prevention strategies, were developed in a standard operating procedure protocol and were discussed in detail with the farmers before the implementation. Forty-eight farms chose at least one udder strategy, 10 farms at least one uterine strategy and 37 farms at least one calf strategy. By choosing an udder health strategy or a uterine health strategy, the corresponding systemically administered AMU could be significantly reduced (p < 0.04) in the IG compared with the CG. In addition, udder strategies that were well-implemented led to a significant reduction (p = 0.05) of intramammary “highest priority critically important antimicrobials (HPCIA)” (quinolones, cephalosporins 3rd and higher generation, macrolides and ketolides, glycopeptides, and polymyxins). The level of implementation was significantly lower in 2019 compared to 2018 (p < 0.05, Fisher's exact test). No significant reduction in AMU could be achieved for the calf sector. A reduction of AMU in dairy farms is possible by implementing evidence-based management-related prevention strategies. The level of implementation has only an influence on the consumption of HPCIA. The reduction of AMU in practice by means of evidence-based measures requires supportive human resources instead of financial support, because financial support for farmers seems not to motivate them sufficiently.

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A RANDOMIZED TRIAL TO MEASURE THE OPTIMAL ROLE OF THE PHARMACIST IN PROMOTING EVIDENCE-BASED ANTIBIOTIC USE IN ACUTE CARE HOSPITALS

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300105033 ◽

2001 ◽

Vol 17 (2) ◽

pp. 171-180 ◽

Cited By ~ 26

Author(s):

George Dranitsaris ◽

Diana Spizzirri ◽

Monique Pitre ◽

Allison McGeer

Keyword(s):

Acute Care ◽

Broad Spectrum ◽

Randomized Clinical Trials ◽

Intervention Group ◽

Hospital Setting ◽

Control Group ◽

Evidence Based ◽

Care Hospital ◽

Broad Spectrum Antibiotics ◽

The Impact

Background: There is a considerable gap between randomized clinical trials and implementing the results into practice. This is particularly relevant in the use of broad-spectrum antibiotics in hospitals. Hospital pharmacists can be effective vehicles for bridging this gap and promoting evidence-based medicine. To determine the most effective way of using the pharmacist in this role, a prospective cefotaxime intervention study was conducted with randomization incorporated into the design as well as patient-related therapeutic outcomes.Methods: A total of 323 patients who were prescribed cefotaxime were randomized into an intervention or nonintervention group where only the former was challenged by pharmacists for inappropriate cefotaxime usage relative to hospital guidelines. The primary outcome was the appropriateness of cefotaxime prescribing between groups. Logistic regression analysis was then used to identify factors that were associated with successful clinical response.Results: Overall, 94% of orders in the intervention group met cefotaxime dosage criteria compared with 86% in the control group (p = .018). However, there was no impact with respect to promoting cefotaxime use for an appropriate indication (81% vs. 80%; p = .67). There was a trend for improved clinical outcomes in patients who received cefotaxime within hospital guidelines (OR = 1.73; p = .31).Conclusions: The pharmacist as a vehicle for promoting the appropriate use of broad-spectrum antibiotics in the acute care hospital setting can improve the dosing of such agents. However, several barriers to optimizing the impact of the pharmacist were implied by the data. Removing these barriers could increase the pharmacists' utility as an agent for improved patient care.

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Impact of Ready to Learn and Play Framework on Occupational Performance for Children With Autism

American Journal of Occupational Therapy ◽

10.5014/ajot.2021.75s2-rp366 ◽

2021 ◽

Vol 75 (Supplement_2) ◽

pp. 7512515366p1-7512515366p1

Author(s):

Janis Leinfuss ◽

Erin Ohara

Keyword(s):

Sensory Processing ◽

Standard Care ◽

Intervention Group ◽

Children With Autism ◽

Autism Spectrum ◽

Control Group ◽

Evidence Based ◽

Occupational Performance ◽

Ready To Learn ◽

Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Individuals with autism spectrum disorder (ASD) often have sensory processing difficulties that impact their occupations. Data were analyzed comparing SCOPE scores at pre- and posttest for children receiving standard-care OT or Ready to Learn and Play (RtLP) framework plus standard care. The intervention group showed statistically significant improvement in SCOPE scores over the control group. The RtLP framework shows promise as an evidence-based tool to positively impact the occupational performance of students with ASD. Primary Author and Speaker: Janis Leinfuss Additional Authors and Speakers: Erin Ohara

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Impact of an Antimicrobial Utilization Program on Antimicrobial Use at a Large Teaching Hospital A Randomized Controlled Trial

Infection Control and Hospital Epidemiology ◽

10.1086/605924 ◽

2009 ◽

Vol 30 (10) ◽

pp. 931-938 ◽

Cited By ~ 81

Author(s):

Bernard C. Camins ◽

Mark D. King ◽

Jane B. Wells ◽

Heidi L. Googe ◽

Manish Patel ◽

...

Keyword(s):

Internal Medicine ◽

Teaching Hospital ◽

Antimicrobial Agents ◽

Intervention Group ◽

Control Group ◽

Antimicrobial Use ◽

Randomized Controlled ◽

Antimicrobial Usage ◽

Antimicrobial Utilization ◽

The Impact

Background.Multidisciplinary antimicrobial utilization teams (AUTs) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited.Objective.To determine the impact of an AUT on antimicrobial use at a teaching hospital.Design.Randomized controlled intervention trial.Setting.A 953-bed, public, university-affiliated, urban teaching hospital.Patients.Patients who were given selected antimicrobial agents (piperacillin-tazobactam, levofloxacin, or vancomycin) by internal medicine ward teams.Intervention.Twelve internal medicine teams were randomly assigned monthly: 6 teams to an intervention group (academic detailing by the AUT) and 6 teams to a control group that was given indication-based guidelines for prescription of broad-spectrum antimicrobials (standard of care), during a 10-month study period.Measurements.Proportion of appropriate empirical, definitive (therapeutic), and end (overall) antimicrobial usage.Results.A total of 784 new prescriptions of piperacillin-tazobactam, levofloxacin, and vancomycin were reviewed. The proportion of antimicrobial prescriptions written by the intervention teams that was considered to be appropriate was significantly higher than the proportion of antimicrobial prescriptions written by the control teams that was considered to be appropriate: 82% versus 73% for empirical (risk ratio [RR], 1.14; 95% confidence interval [CI], 1.04-1.24), 82% versus 43% for definitive (RR, 1.89; 95% CI, 1.53-2.33), and 94% versus 70% for end antimicrobial usage (RR, 1.34; 95% CI, 1.25-1.43). In multivariate analysis, teams that received feedback from the AUT alone (adjusted RR, 1.37; 95% CI, 1.27-1.48) or from both the AUT and the infectious diseases consultation service (adjusted RR, 2.28; 95% CI, 1.64-3.19) were significantiy more likely to prescribe end antimicrobial usage appropriately, compared with control teams.Conclusions.A multidisciplinary AUT that provides feedback to prescribing physicians was an effective method in improving antimicrobial use.Trial Registration.ClinicalTrials.gov identifier: NCT00552838.

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Implementation and Effects of an Information Technology-Based Intervention to Support Speech and Language Therapy Among Stroke Patients with Aphasia: Protocol for a Virtual Randomized Controlled Trial (Preprint)

10.2196/preprints.30621 ◽

2021 ◽

Author(s):

Esther Kim ◽

Laura Laird ◽

Carlee Wilson ◽

Till Bieg ◽

Phillip Mildner ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Lexical Retrieval ◽

Evidence Based ◽

Waitlist Control ◽

Treatment Assessment ◽

Randomized Controlled ◽

Waitlist Control Group

BACKGROUND Mobile application-based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia (PwA) as an adjunct or in lieu of traditional in-person therapy approaches. These apps can increase the intensity of treatment, and have been shown to result in meaningful outcomes across several domains OBJECTIVE VoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to engage PwA to improve their naming abilities through interaction with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. METHODS A multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. Intervention group participants will engage in five weeks of training with the app, followed by post-treatment assessment and follow-up assessment after an additional five weeks. Those in the waitlist control group will have five weeks of no training, followed by a pre-treatment assessment, training for five weeks and post-treatment assessment. All aspects of the trial are being conducted remotely given the COVID-19 pandemic. RESULTS Recruitment of participants started in September 2020 and the study is expected to be completed by March 2022. Publication of results is expected within six months of study completion. CONCLUSIONS Results of the RCT will provide data to inform evidence-based practice on the use of technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in PwA within an easily accessible, cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can inform the profession on telerehabilitation practices and monitoring app-based home therapy programs. CLINICALTRIAL ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364

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Lack of effects of evidence-based, individualised counselling on medication use in insured patients with mild hypertension in China: a randomised controlled trial

BMJ evidence-based medicine ◽

10.1136/bmjebm-2019-111197 ◽

2019 ◽

Vol 25 (3) ◽

pp. 102-108

Author(s):

Mengyang Di ◽

Chen Mao ◽

Zuyao Yang ◽

Hong Ding ◽

Qu Liu ◽

...

Keyword(s):

Mild Hypertension ◽

Antihypertensive Drugs ◽

Controlled Trial ◽

Intervention Group ◽

Medication Use ◽

Control Group ◽

Evidence Based ◽

Randomised Controlled ◽

Insured Patients

ObjectiveTo evaluate whether evidence-based, individualised (EBI) counselling regarding hypertension and the treatment would affect medication use in insured patients with mild hypertension in China.MethodsWe conducted a parallel-group, randomised controlled trial in two primary care centres in Shenzhen, a metropolitan city in China. Patients with mild primary hypertension, 10-year risk of cardiovascular diseases (CVDs) lower than 20% and no history of CVDs were recruited and randomly allocated to two groups. EBI plus general counselling was provided to the intervention group and general counselling alone to the control group. EBI counselling included information on the 10-year CVD risk and treatment benefit in terms of absolute risk reduction estimated for each individual and information on average side effects and costs of antihypertensive drugs. The outcomes included use of antihypertensive drugs and adherence to the treatment at 6-month follow-up, with the former being primary outcome.ResultsTwo hundred and ten patients were recruited, with 103 and 107 allocated to the intervention and control groups, respectively. At baseline, 62.4% of the patients were taking antihypertensive drugs that were all covered by health insurance. At the end of 6-month follow-up, there was no statistically significant difference in the rate of medication use between the intervention group and the control group (65.0% vs 57.9%; OR=1.35, 95% CI: 0.77 to 2.36). The difference in adherence rate between the two groups was not statistically significant either (43.7% vs 40.2%; OR=1.15, 95% CI 0.67 to 2.00]). The results were robust in sensitivity analyses that used different cutoffs to define the two outcomes.ConclusionsThe EBI counselling by health educators other than the caring physicians had little impact on treatment choices and drug-taking behaviours in insured patients with mild primary hypertension in this study. It remains unclear whether EBI counselling would make a difference in uninsured patients, especially when conducted by the caring physicians.Trial registration numberChiCTR-TRC-14004169.

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Abstract 18944: Efficacy of Clinical Notifications to Health Care Providers in Management of Heart Failure Patients

Circulation ◽

10.1161/circ.132.suppl_3.18944 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Reyhaneh M Akhavein ◽

Jiri Sklenar ◽

Jessica Minnier ◽

Stephen Heitner

Keyword(s):

Heart Failure ◽

Health Care Providers ◽

Anticoagulation Therapy ◽

Intervention Group ◽

Direct Result ◽

Control Group ◽

Evidence Based ◽

Written Communication ◽

Care Providers ◽

Provider Behavior

Introduction: Adherence to guideline recommendations for patients with heart failure improves short and long-term outcomes, and can potentially reduce healthcare costs. Hypothesis: Written communication to care providers of individuals with heart failure with reduced systolic function (HFrEF) will result in better adherence to guidelines. Methods: We prospectively enrolled providers of all outpatients with HFrEF at Oregon Health and Science University in 2012. We reviewed adherence to six evidence-based HF therapies in each patient [ACE-I/ARB, beta blocker, aldosterone antagonist, anticoagulation therapy for atrial fibrillation or flutter, CRT, and ICD]. We excluded patients with destination therapy, resolution of HFrEF, lost to follow-up or death. After implementation of exclusion criteria, of 320 patients evaluated, 114 patients were ultimately included. These patients’ providers were randomized to either receiving a standardized written communication (intervention) or none (control). The letter highlighted 2013 ACCF/AHA heart failure management guidelines, and was sent by US mail to providers in intervention group. Six months later, we re-evaluated all patients according to the same criteria at the outset. Results: Optimal medical therapy (OMT) in intervention group improved in only 9% of patients who were previously sub-optimally treated (p 0.83), but 31% of patients who had already been on OMT experienced deescalated therapies despite no clear documentation (p 0.65). In control group, 11% of patients had increased treatment according to guidelines, and 9% of patients who had already been receiving OMT had deescalated treatment. There were no new ICDs implanted as a result of intervention, while 6.5% of patients in control group did receive ICD (p 0.46). Conclusions: Identification of patients with HFrEF and assessment of adherence to guideline-based therapies is now feasible via electronic medical record enquiry. Written notifications do not result in improved adherence to evidence-based guidelines, nor do these letters seem to alter provider behavior at all. We speculated that the lack of response is a direct result of “notification-fatigue”, and that alternative provider behavior modification techniques need to be evaluated.

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A web-based dietary intervention in early pregnancy and neonatal outcomes: a randomized controlled trial

Journal of Public Health ◽

10.1093/pubmed/fdy117 ◽

2018 ◽

Vol 41 (2) ◽

pp. 371-378 ◽

Cited By ~ 2

Author(s):

R A K Kennedy ◽

C M E Reynolds ◽

S Cawley ◽

E O’Malley ◽

D M McCartney ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Standard Care ◽

Dietary Intervention ◽

Controlled Trial ◽

Intervention Group ◽

Neonatal Outcomes ◽

Dietary Behaviour ◽

Control Group ◽

Evidence Based ◽

Randomized Controlled

Abstract Background Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes. Methods Women <18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women. Results Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P > 0.05). Conclusions We found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women’s engagement and modifies dietary behaviour.

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Training General Practitioners in Evidence-Based Tobacco Treatment: An Evaluation of the Tobacco Treatment Training Network in Crete (TiTAN-Crete) Intervention

Health Education & Behavior ◽

10.1177/1090198118775481 ◽

2018 ◽

Vol 45 (6) ◽

pp. 888-897 ◽

Cited By ~ 7

Author(s):

Charis Girvalaki ◽

Sophia Papadakis ◽

Constantine Vardavas ◽

Andrew L. Pipe ◽

Eleni Petridou ◽

...

Keyword(s):

Self Efficacy ◽

Intervention Group ◽

Future Research ◽

Control Group ◽

Evidence Based ◽

Cross Sectional ◽

Training Interventions ◽

Tobacco Treatment ◽

Patient Reported ◽

Quasi Experimental

Background. Rates of tobacco treatment delivery in primary care are suboptimal. Aims. We report on the effectiveness of the TiTAN Crete intervention on rates of patient-reported 4As (ask, advise, assist, arrange) tobacco treatment and general practitioner’s (GP) knowledge, attitudes, self-efficacy, and intentions. Methods. A quasi-experimental pilot study with pre-post evaluation was conducted in Crete, Greece (2015-2016). GPs ( n = 24) intervention and control group and a cross-sectional sample of their patients ( n = 841) were surveyed before the implementation of the intervention. GPs in the intervention group received training, practice, and patient tools to support the integration of the 4As treatment into clinical routines. Intervention group GPs ( n = 14) and a second cross-sectional sample of patients ( n = 460) were surveyed 4 months following the intervention to assess changes in outcomes of interest. Multilevel modeling was used to analyze data. Results. Among GPs exposed to the intervention, significant increases in knowledge, self-efficacy, and rates of 4As delivery were documented between the pre- and postassessment and compared with those of the control group. Specifically, the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for 4As delivery between the pre-and postassessment among GPs exposed to the TiTAN intervention were as follows: Ask AOR 3.66 (95% CI [2.61, 5.14]); Advise AOR 4.21 (95% CI [3.02, 5.87]); Assist AOR 13.10 (95% CI [8.83, 19.42]) and Arrange AOR 4.75 (95% CI [2.67, 8.45]). Conclusion. We found significant increases in rates at which GPs delivered evidence-based tobacco treatment following exposure to the TiTAN intervention. Future research should examine methods for supporting broader dissemination of well-designed training interventions in general practice.

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Assessing the Effect of Virtual Education on Information Literacy Competency for Evidence-based Practice of the Undergraduate Nursing Students

10.21203/rs.3.rs-75619/v1 ◽

2020 ◽

Author(s):

Maryam Shamsaee ◽

Parvin Magholian ◽

Leila Ahmadian ◽

Jamileh Farokhzadian ◽

Farhad Fatehi

Keyword(s):

Nursing Students ◽

Information Literacy ◽

Information Seeking ◽

Search Strategy ◽

Evidence Based Practice ◽

Intervention Group ◽

Virtual Education ◽

Control Group ◽

Evidence Based ◽

Significant Difference

Abstract Background: Information literacy is one of the important prerequisites for an effective evidence-based practice (EBP). Therefore, it is necessary to pay attention to curricular development and use new educational methods such as virtual education to strengthen information literacy competency in nursing students. This study investigated the effect of virtual education on nursing students’ information literacy competency for EBP.Methods: This interventional study was performed with two groups of intervention and control and a pretest and posttest design. Seventy-nine nursing students were selected and assigned into the intervention or control groups by random sampling. Virtual education of the information literacy was uploaded on a website in the form of seven modules delivered in four weeks. Questionnaires of demographic information and information literacy for EBP were used to collect data before and one month after the virtual education.Results: The results showed no significant difference between the control and intervention groups in all dimensions of information literacy competency in the pre-test stage. In the post-test, the virtual education improved some dimensions of information literacy competency for EBP including information seeking skills (t= 3.144, p= 0.002) and knowledge about search operators (t= 39.84, p= 0.001) in the intervention groups compared with the control group. Virtual education of the information literacy did not have any significant effect on nursing students in terms of use of different information resources and development of search strategy and frequency of the correct answer to the question of formulating a search strategy in intervention group (p>0.05). Conclusion: Virtual education had a significant effect some demotions of the information literacy competency for EBP in nursing students. Nursing professors and educators are recommended to train information literacy by integrating virtual and face-to-face education. Researchers should also examine the effectiveness of these interventions, their barriers and facilitators.

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Expert-based medication reviews to reduce polypharmacy in older patients in primary care: a northern-Italian cluster-randomised controlled trial

BMC Geriatrics ◽

10.1186/s12877-021-02612-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Angelika Mahlknecht ◽

Christian J. Wiedermann ◽

Marco Sandri ◽

Adolf Engl ◽

Martina Valentini ◽

...

Keyword(s):

Older Patients ◽

Primary Outcome ◽

Hospital Admissions ◽

Controlled Trial ◽

Intervention Group ◽

Cluster Randomised Controlled Trial ◽

Control Group ◽

Evidence Based ◽

Cluster Randomised ◽

Randomised Controlled

Abstract Background Evidence regarding clinically relevant effects of interventions aiming at reducing polypharmacy is weak, especially for the primary care setting. This study was initiated with the objective to achieve clinical benefits for older patients (aged 75+) by means of evidence-based reduction of polypharmacy (defined as ≥8 prescribed drugs) and inappropriate prescribing in general practice. Methods The cluster-randomised controlled trial involved general practitioners and patients in a northern-Italian region. The intervention consisted of a review of patient’s medication regimens by three experts who gave specific recommendations for drug discontinuation. Main outcome measures were non-elective hospital admissions or death within 24 months (composite primary endpoint). Secondary outcomes were drug numbers, hospital admissions, mortality, falls, fractures, quality of life, affective status, cognitive function. Results Twenty-two GPs/307 patients participated in the intervention group, 21 GPs/272 patients in the control group. One hundred twenty-five patients (40.7%) experienced the primary outcome in the intervention group, 87 patients (32.0%) in the control group. The adjusted rates of occurrence of the primary outcome did not differ significantly between the study groups (intention-to-treat analysis: adjusted odds ratio 1.46, 95%CI 0.99–2.18, p = 0.06; per-protocol analysis: adjusted OR 1.33, 95%CI 0.87–2.04, p = 0.2). Hospitalisations as single endpoint occurred more frequently in the intervention group according to the unadjusted analysis (OR 1.61, 95%CI 1.03–2.51, p = 0.04) but not in the adjusted analysis (OR 1.39, 95%CI 0.95–2.03, p = 0.09). Falls occurred less frequently in the intervention group (adjusted OR 0.55, 95%CI 0.31–0.98; p = 0.04). No significant differences were found regarding the other outcomes. Definitive discontinuation was obtained for 67 (16.0%) of 419 drugs rated as inappropriate. About 6% of the prescribed drugs were PIMs. Conclusions No conclusive effects were found regarding mortality and non-elective hospitalisations as composite respectively single endpoints. Falls were significantly reduced in the intervention group, although definitive discontinuation was achieved for only one out of six inappropriate drugs. These results indicate that (1) even a modest reduction of inappropriate medications may entail positive clinical effects, and that (2) focusing on evidence-based new drug prescriptions and prevention of polypharmacy may be more effective than deprescribing. Trial registration Current Controlled Trials (ID ISRCTN: 38449870), date: 11/09/2013.

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