Lab Wisely in Canada: Enhancing and highlighting the role of all clinical laboratory professionals in reducing harm and waste

Introduction/Objective Stewardship initiatives are a key strategy for addressing inappropriate utilization of clinical laboratory resources. These approaches require engagement of multiple types of stakeholders. Some professional groups are historically underrepresented, such as those who perform specimen collection, testing, and quality processes. A specific campaign is needed to engage these groups and highlight their expertise. Methods/Case Report We surveyed Medical Laboratory Technologists and Medical Laboratory Assistants to understand the barriers they face to participating in laboratory stewardship initiatives. These survey findings helped shape tools and resources that we created for new campaign called Lab Wisely. We also identified that one-third of existing Choosing Wisely Canada recommendations relate to laboratory testing. We categorized and tagged each recommendation to create a publicly-available searchable database which was placed on the campaign website (LabWisely.ca). Results (if a Case Study enter NA) NA Conclusion Laboratory testing is featured in a significant proportion of all Choosing Wisely Canada recommendations, supporting the idea that the clinical laboratory should be heavily involved in reducing medical overuse in healthcare. In our survey, we found that laboratory professionals face time and workload constraints, but feel a professional responsibility for ensuring appropriate resource use by all users. There was also a lack of ‘know- how’ around tangible ways to become involved. The Lab Wisely website has become a one-stop-shop for highlighting the role of technical and scientific professionals in laboratory stewardship and providing concrete tools that can be used to develop capacity in these groups. Every level of staff can and should be involved in improving the utilization of clinical laboratory services.

Resuscitative Endovascular Balloon Occlusion of the Aorta is a Risk Factor for Intestinal Necrosis: A Case Report

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is effective for temporary hemorrhage control and resuscitative effort, as it enhances cerebral and coronary circulation in trauma patients. However, an inappropriate utilization of REBOA leads to critical complications. Placement of the balloon in Zone 2 of the aorta should be avoided as the occlusion restricts the intestinal blood supply leading to fatal complications. There is a scarcity of case reports on complications associated with endovascular balloon occlusion in the literature. Here, we have presented a rare case in which Zone 2 REBOA contributed to an ischemic complication in a trauma patient.Case presentationA 50-year-old man with severe trauma, who accidentally got buried under a fallen cement wall, was carried to the nearest hospital. Contrast-enhanced computed tomography showed an unstable pelvic fracture that required hemostatic intervention. Prior to being transferred to another hospital, the patient was treated with endovascular balloon placement. A Zone 2 endovascular balloon placement with resuscitative effort accidentally led to insufficient abdominal blood flow and he developed extensive intestinal necrosis. Following surgical intervention, the patient was resuscitated; however, he developed partial intestinal necrosis and was subsequently managed with surgical intestinal resection.ConclusionsBlood supply to the abdominal organs should be considered when deploying the balloon. Further, balloon positioning, aortic occlusion time, and inflation volume should be carefully considered to avoid ischemic complications.

A study on a general cyber machine tools monitoring system in smart factories

The massive data produced in real manufacturing processes provides a micro observation mechanism for managers and producers, which helps to analyze and grasp the manufacturing details, to form a macro decision-making mechanism, and finally to improve the manufacturing quality and production efficiency. This paper deeply investigates the real-time acquisition method of machine tool processing data and presents a general method of data analysis in different actual application scenarios to solve the general problem of insufficient and inappropriate utilization of machine tools. A framework of general machine tool monitoring system with four layers is proposed and several key stumbling blocks are researched, such as heterogeneous machine data acquisition, data analysis, and related application. These achievements are applied in a general cyber machine tools monitoring system based on MTConnect, which has greatly improved the utilization of machine tools and become a valuable unit in the framework of intelligent manufacturing and smart factory.

Numerical Evaluation on Analysis Methods of Trapping Site Density in Steels Based on Hydrogen Permeation Curve

Hydrogen permeation techniques have been widely utilized to extract hydrogen effective diffusivity, as well as hydrogen trapping site characteristics in steels. Several methods have been proposed to examine reversible and irreversible trapping site characteristics. However, the inappropriate utilization of these simplified models, as well as incorrect value assignment to the key parameters, can result in several orders of magnitude difference in hydrogen trapping site density. Therefore, in order to evaluate these models and verify their application prerequisites, a serial of hydrogen permeation tests were numerically simulated and examined, separately considering reversible and irreversible hydrogen trapping sites. In the meantime, suggestions were given to conduct hydrogen permeation test more effectively, and evaluate hydrogen trapping site characteristics more precisely.

Implementation of a chemotherapy stewardship process

Purpose To design and implement a chemotherapy stewardship process to optimize the location of chemotherapy administration in an effort to decrease the number of inappropriate inpatient anticancer regimen administrations and decrease institutional costs associated with inpatient administration. Summary As the costs of anticancer agents continue to rise, it is crucial that multidisciplinary efforts are aimed at managing anticancer medication utilization; this is especially important for high-cost medications, medications whose use requires increased monitoring due to safety concerns, and medications that do not exert effects quickly and, as such, can be more appropriately administered in the outpatient setting. It is imperative that pharmacists play a role in managing chemotherapy medication utilization, as pharmacists provide expertise in formulary management, a vast knowledge of financial impact and reimbursement processes, and clinical knowledge that can help predict the expected effectiveness and adverse effects of each anticancer regimen. Our institution sought to develop and implement a multidisciplinary chemotherapy stewardship program targeting the optimization of site of anticancer agent administration with a goal of decreasing both cost and inappropriate utilization of high-cost, high-risk anticancer agents. Conclusion Implementation of a chemotherapy stewardship service may decrease the number of inappropriate inpatient anticancer regimen administrations and decrease inpatient resource use, thereby decreasing costs to institutions. The concept of a chemotherapy stewardship process was well received by multidisciplinary healthcare colleagues, and a collaborative approach should be used to design and implement such processes.

Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: A retrospective cohort study

Background Two-thirds of antibiotic prescriptions administered in pediatric inpatient care are inappropriate. This inappropriate utilization is associated with the emergence of antimicrobial resistance (AMR) and a decline in antibiotic susceptibility in many pathogenic organisms isolated in intensive care units. Antibiotic stewardship programs (ASPs) have been recommended as a strategy to reduce and delay the impact of AMR. A crucial step in ASPs is understanding antibiotic utilization practices and quantifying the problem of inappropriate antibiotic use to support a targeted solution. We aim to characterize antibiotic utilization and determine the appropriateness of antibiotic prescription in a tertiary care pediatric intensive care unit in Saudi Arabia.Methods A retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital (KASCH), Riyadh, Saudi Arabia, over a 6-month period. Days of therapy (DOT) and DOT per 1000 patient-days were used as measures of antibiotic consumption. The appropriateness of antibiotic use was assessed by two independent pediatric infectious disease physicians based on the guidelines of the Centers for Disease Control (CDC) 12-step campaign to prevent antimicrobial resistance among hospitalized children.Results During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient-days. A total of 274 antibiotic courses were administered over 2553 antibiotic days. Ceftriaxone, vancomycin, ceftazidime, and cefazolin were responsible for the highest rates of consumption (164.8, 150.5, 91.7, and 83.1 DOTs per 1000 patient-days, respectively). Forty-eight percent of antibiotic courses were found to be nonadherent to at least 1 CDC step. The top reasons were inappropriate antibiotic choice (empirically or definitive) (31.3%) and inappropriate prophylaxis (30.2%). Infectious disease service consultation decreased the likelihood of inappropriate consumption of antibiotics.Conclusions Antibiotic consumption was high in our setting, with significant inappropriate utilization mainly due to empiric choices and the duration of prophylaxis. These data could inform decision-making in antimicrobial stewardship programs and strategies. The CDC steps provide a more objective tool and limit biases when assessing antibiotic appropriateness.

The characteristics and level of musculoskeletal imaging training in physiotherapy educational programme in Nigeria

Background: Previous studies have shown that deficiency in training has led to inappropriate utilization of diagnostic imaging among healthcare professionals. Thus, raising concerns about patient safety and economic cost. This study aimed to assess the characteristics and level of musculoskeletal imaging (MI) training received by physiotherapists who graduated from Nigerian universities and completed the one-year mandatory internship. Methods: An online version of the Physiotherapist Musculoskeletal Imaging Profiling Questionnaire (PMIPQ), that was previously validated, was administered to all eligible physiotherapists identified through the Medical Rehabilitation Therapist Board’s (MRTBN) database. Parts A to C of the PMIPQ was used to obtain data on demographics, characteristics and level of training on various MI modalities. Data were analyzed using descriptive statistics, Friedman’s ANOVA, and Kruskal-Wallis, at P ≤ 0.05. Results: The results showed that only 10.0% of the respondents had a standalone undergraduate course in MI, 92.8% did not have MI clinical posting exposure during the internship and 67.3% had never attended any MI workshop. There was a significant difference in the level of training received across various MI modalities [χ2 (15) = 1285.899; P = 0.001]. However, there was no significant difference in the level of MI training across the institutions (P = 0.36). The study participants with Doctor of Physiotherapy (DPT) education were better trained in MI than their counterparts with bachelor’s degree (P = 0.047). Conclusions: The overall level of MI training among the respondents was deficient, but the knowledge of X-ray was significantly higher than other MI modalities. Based on the overall findings in this study, we recommend that diagnostic imaging contents be introduced early in the entry-level DPT curriculum that is recently approved by the National University Commission.

Patterns of self-medication with antibiotics in Maputo City: a qualitative study

Background Mozambique classifies but does not yet enforce antibiotics as prescription-only-medicine (POM) allowing the public access to a variety of antibiotics that otherwise are provided on prescription. This contributes to the growing practice of self-medication with antibiotics (SMA) which systematically exposes individuals to the risk of developing antibiotic resistance, antibiotic side effects and increases the health service costs and morbidity. This study aimed at describing the patterns of SMA among Maputo city pharmacy customers. Methods A qualitative study conducted between October 2018 and March 2019 was developed with thirty-two pharmacy customers and seventeen pharmacists. Using convenience sampling, customers were recruited after buying antibiotics without prescription from nine private pharmacies. Of the thirty-two participants, twenty participated in in-depth interviews and twelve in two focus groups discussions (FGD) with six participants each. Purposive sampling and a snowball technique were used to recruit pharmacists. The transcripts were coded and analyzed using latent content analysis. Nvivo 11 was used to store and retrieve the data. The COREQ (Tong, 2007) checklist for interviews and FGD was performed. Results Customers admitted practices of SMA, pharmacists admitted dispensing a variety of antibiotics without prescription. Non-prescribed antibiotics (NPA) were obtained through five different patterns including; using the generic name, describing the physical appearance and using empty package, describing symptoms or health problem to pharmacists, using old prescriptions and sharing antibiotics with family, friends, and neighbors. Conclusion Different patterns of SMA are contributing to the indiscriminate use of antibiotics among customers. The NPA utilization is perceived as an expression of self-care where participants experience self-perceived symptoms and indulge in self-treatment as a method of caring for themselves. Moreover, antibiotics are mostly used to treat diseases that do not necessarily need antibiotics. Strong and effective public health education and promotion initiatives should be implemented to discourage inappropriate utilization of antibiotics and SMA practices.