Healthcare Professionals' Perceptions, Barriers, and Facilitators towards Adopting Computerised Clinical Decision Support Systems in Antimicrobial Stewardship in Jordanian Hospitals.

Understanding healthcare professionals' perceptions towards a computerised decision support system (CDSS) may provide a platform for the determinants of the successful adoption and implementation of CDSS. This cross-sectional study examined healthcare professionals' perceptions, barriers, and facilitators to adopting a CDSS for antibiotic prescribing in Jordanian hospitals. This study was conducted among healthcare professionals in Jordan's two tertiary and teaching hospitals over four weeks (June-July 2021). Data were collected in a paper-based format from senior and junior prescribers and non-prescribers (n = 254) who agreed to complete a questionnaire. The majority (n = 184, 72.4%) were aware that electronic prescribing and electronic health record systems could be used specifically to facilitate antibiotic use and prescribing. The essential facilitator made CDSS available in a portable format (n = 224, 88.2%). While insufficient training to use CDSS was the most significant barrier (n = 175, 68.9%). The female providers showed significantly lower awareness (p = 0.006), and the nurses showed significantly higher awareness (p = 0.041) about using electronic prescribing and electronic health record systems. This study examined healthcare professionals' perceptions of adopting CDSS in antimicrobial stewardship (AMS) and shed light on the perceived barriers and facilitators to adopting CDSS in AMS, reducing antibiotic resistance, and improving patient safety. Furthermore, results would provide a framework for other hospital settings concerned with implementing CDSS in AMS and inform policy decision-makers to react by implementing the CDSS system in Jordan and globally. Future studies should concentrate on establishing policies and guidelines and a framework to examine the adoption of the CDSS for AMS.

Real-world study of the impact of recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) on quality of life and productivity in Europe.

BACKGROUND: Although current therapy for patients with early-stage squamous cell carcinoma of the head and neck (SCCHN) is potentially curative, the recurrence rate is high. Patients with recurrent or metastatic (R/M) SCCHN have a poor prognosis and substantial disease burden, including impaired health-related quality of life (HRQoL), productivity loss and indirect costs, such as need for caregiver support. The aim of this study was to characterize the impact of R/M SCCHN and its first-line treatment on patient and caregiver quality of life, daily activities and work productivity using real-world evidence from Europe. METHODS: This was a multicentre retrospective study of patients with R/M SCCHN in France, Germany, Italy, Spain and the United Kingdom incorporating patient and caregiver surveys, and a physician-reported medical chart review, conducted between January and May 2019. Patients aged 18 or over with a physician confirmed diagnosis R/M SCCHN completed four validated measures of disease activity and its impact on quality of life and work productivity, while caregivers also completed questionnaire to assess the burden of providing care. Physicians provided data for clinical characteristics, patient management, testing history and treatment patterns. RESULTS: A total of 195 medical/clinical oncologists provided data for 937, predominantly male (72%) patients, with almost half of patients aged over 65 years. The most frequently reported symptoms were fatigue (43%), weight loss (40%), pain (35%) and difficulty swallowing (32%). The EXTREME regimen was the most common first line therapy in over half of patients, who reported moderate or extreme pain/discomfort, and anxiety/depression, and problems with self-care resulting in a diminished health status compared with the general population. Only 14% were employed with high absenteeism or presenteeism, and over half of patients had a caregiver for whom the burden of care was substantial. CONCLUSION: Our results provide real-world insight into the multi-faceted burden associated with R/M SCCHN. The combination of poor HRQoL and the impairment in daily activities, social life and employment illustrates the wider impact of R/M SCCHN on patients and their caregivers, and highlights a need for novel 1 L treatment regimens to improve the humanistic and productivity burdens of this cancer.

European white paper: oropharyngeal dysphagia in head and neck cancer.

PURPOSE: To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS: Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS: Twenty-four sections on HNC-specific OD topics. CONCLUSION: This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

Screening Tools Used by Clinical Pharmacists to Identify Elderly Patients at Risk of Drug-Related Problems on Hospital Admission: A Systematic Review.

None of the models met the four key stages required to create a quality risk prediction model. Further research is needed to either refine the tools developed to date or develop new ones that have good performance and have been externally validated before considering the potential impact and implementation of such tools.

Young People and the Management of Chronic Illness by Primary Care Pharmacists: A Systematic Review.

Recent evidence has shown that the incidence of long-term illnesses in young people aged 10-24 years is increasing. It is essential to highlight the importance of long-term health conditions in this age group and understand young people's health needs to be able to improve current support for young people. Pharmacists, as medicine experts, are in a unique position to promote young people's health. The role of primary care pharmacists in the management of chronic illnesses in young people has not been widely researched. The aim of this review was to explore the current role of primary care pharmacists in the management of chronic illnesses in young people aged 10-24 years. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using Medical Subject Headings (MeSH) and Embase subject headings (Emtree) terms, covering three main themes: Pharmacists, young people and chronic illnesses. Articles were critically appraised using Critical Appraisal Skills Programme (CASP) tools. Eight articles were included in this review. Seven articles included original research studies (one observational study, two surveys, two qualitative interview studies and two interventions). The remaining article was a literature review. All of the articles made reference to community pharmacists, while there was no information about GP pharmacists. Roles that community pharmacists identified as high-priority in their practice when dealing with young people included supporting young people to develop generic healthcare skills, counselling and building trusted relationships directly with young people, helping young people to find credible health information and the provision of specialist services. Community pharmacists feel that they have a role to play in supporting young people with chronic illness and have identified many areas where they can provide services and support.

Estimates of Energy Intake and Expenditure in Elite Female Touch Players During an International Tournament.

This study assessed energy intake and expenditure of international female touch players during an international tournament. Energy intake (food diary) and expenditure (accelerometer, global positioning system) were recorded for 16 female touch players during a four-day tournament, competing in 8.0 ± 1.0 matches; two on Days 1, 2, and 4, and three on Day 3. Total daily energy expenditure (43.6 ± 3.1 Kcal·kg-1 body mass (BM)) was not different (p > .05) from energy intake (39.9 ± 9.4 Kcal·kg-1 BM). Carbohydrate intakes were below current recommendations (6-10 g·kg-1 BM) on Days 1 (4.4 ± 0.6 g·kg-1 BM) and 3 (4.7 ± 1.0 g·kg-1 BM) and significantly below (p < .05) on Day 2 (4.1 ± 1.0 g·kg-1 BM). Protein and fat intakes were consistent with recommendations (protein, 1.2-2.0 g·kg-1 BM: fat, 20-35% total Kcal) across Days 1-3 (protein, 1.9 ± 0.8, 2.2 ± 0.8, and 2.0 ± 0.7 g·kg-1 BM; fat, 35.6 ± 6.8, 38.5 ± 6.4, and 35.9 ± 5.4% total Kcal). Saturated fat intakes were greater (p < .05) than recommendations (10% total Kcal) on Days 1-3 (12.4 ± 2.9, 14.2 ± 5.1, and 12.7 ± 3.5% total Kcal). On average, female touch players maintained energy balance. Carbohydrate intakes appeared insufficient and might have contributed to the reduction (p < .05) in high-intensity running on Day 3. Further research might investigate the applicability of current nutrition recommendations and the role of carbohydrate in multimatch, multiday tournaments.

Spatiotemporal patterns of mercury accumulation in lake sediments of western North America.

For the Western North America Mercury Synthesis, we compiled mercury records from 165 dated sediment cores from 138 natural lakes across western North America. Lake sediments are accepted as faithful recorders of historical mercury accumulation rates, and regional and sub-regional temporal and spatial trends were analyzed with descriptive and inferential statistics. Mercury accumulation rates in sediments have increased, on average, four times (4×) from 1850 to 2000 and continue to increase by approximately 0.2µg/m(2) per year. Lakes with the greatest increases were influenced by the Flin Flon smelter, followed by lakes directly affected by mining and wastewater discharges. Of lakes not directly affected by point sources, there is a clear separation in mercury accumulation rates between lakes with no/little watershed development and lakes with extensive watershed development for agricultural and/or residential purposes. Lakes in the latter group exhibited a sharp increase in mercury accumulation rates with human settlement, stabilizing after 1950 at five times (5×) 1850 rates. Mercury accumulation rates in lakes with no/little watershed development were controlled primarily by relative watershed size prior to 1850, and since have exhibited modest increases (in absolute terms and compared to that described above) associated with (regional and global) industrialization. A sub-regional analysis highlighted that in the ecoregion Northwestern Forest Mountains, <1% of mercury deposited to watersheds is delivered to lakes. Research is warranted to understand whether mountainous watersheds act as permanent sinks for mercury or if export of "legacy" mercury (deposited in years past) will delay recovery when/if emissions reductions are achieved.

Loss of household protection from use of insecticide-treated nets against pyrethroid-resistant mosquitoes, benin.

Pyrethroid resistance is becoming widespread in Anopheles gambiae mosquitoes, coinciding with expanded use of insecticide-treated nets (ITNs) throughout Africa. To investigate whether nets in use are still protective, we conducted household trials in northern and southern Benin, where An. gambiae mosquitoes are susceptible and resistant, respectively, to pyrethroids. Rooms were fitted with window traps and monitored for mosquito biting and survival rates before and after the nets were treated with pyrethroid. Sleeping under an ITN in the location with resistant mosquitoes was no more protective than sleeping under an untreated net, regardless of its physical condition. By contrast, sleeping under an ITN in the location with susceptible mosquitoes decreased the odds of biting by 66%. ITNs provide little or no protection once the mosquitoes become resistant and the netting acquires holes. Resistance seriously threatens malaria control strategies based on ITN.

Inverted duplications on acentric markers: mechanism of formation.

Acentric inverted duplication (inv dup) markers, the largest group of chromosomal abnormalities with neocentromere formation, are found in patients both with idiopathic mental retardation and with cancer. The mechanism of their formation has been investigated by analyzing the breakpoints and the genotypes of 12 inv dup marker cases (three trisomic, six tetrasomic, two polysomic and one X chromosome derived marker) using a combination of fluorescence in situ hybridization, quantitative SNP array and microsatellite analysis. Inv dup markers were found to form either symmetrically with one breakpoint or asymmetrically with two distinct breakpoints. Genotype analyses revealed that all inv dup markers formed from one single chromatid end. This observation is incompatible with the previously suggested model by which the acentric inv dup markers form through inter-chromosomal U-type exchange. On the basis of the identification of DNA sequence motifs with inverted homologies within all observed breakpoint regions, a new general mechanism is proposed for the acentric inv dup marker formation: following a double-strand break an acentric fragment forms, during either meiosis or mitosis. The open DNA end of the acentric fragment is stabilized by the formation of an intra-chromosomal loop promoted by the presence of sequences with inverted homologies. Likely coinciding with the neocentromere formation, this stabilized fragment is duplicated during an early mitotic event, insuring the marker's survival during cell division and its presence in all cells.

Rapid immobilisation and leaching of wet-deposited nitrate in upland organic soils.

Nitrate (NO3-) is often observed in surface waters draining terrestrial ecosystems that remain strongly nitrogen (N) limited. It has been suggested that this occurs due to hydrological bypassing of soil or vegetation N retention, particularly during high flows. To test this hypothesis, artificial rain events were applied to 12 replicate soil blocks on a Welsh podzolic acid grassland hillslope, labelled with 15N-enriched NO3- and a conservative bromide (Br-) tracer. On average, 31% of tracer-labelled water was recovered within 4 h, mostly as mineral horizon lateral flow, indicating rapid vertical water transfer through the organic horizon via preferential flowpaths. However, on average only 6% of 15N-labelled NO3- was recovered. Around 80% of added NO3- was thus rapidly immobilised, probably by microbial communities present on the surfaces of preferential flowpaths. Transitory exceedance of microbial N-uptake capacity during periods of high water and N flux may therefore provide a mechanism for NO3- leaching.

Insecticide-treated nets against malaria vectors and polystyrene beads against Culex larvae.

In Parasitology Today in 1985, Curtis and Lines, and Curtis and Minjas presented the ideas of insecticide-treated nets and polystyrene beads for mosquito control. The former idea has grown to be a major component of the strategy for malaria prevention, especially in Africa. However, although polystyrene beads have been demonstrated to work extremely well, they have yet to be taken up on a major scale.

Transmission of malaria in the Tesseney area of Eritrea: parasite prevalence in children, and vector density, host preferences, and sporozoite rate.

Malaria transmission was studied from July to September, 2002 in three villages of the Tesseney sub-zone, in the western lowlands of Eritrea. The three methods used for mosquito collection were light traps, pyrethrum spray catches, and pit shelter collections. All anopheline mosquitoes that were collected belonged to the Anopheles gambiae complex and they were identified by PCR as the sibling species Anopheles arabiensis (Patton). Apart from An. arabiensis, the only other mosquitoes caught were culicines. The vector population increased greatly for about a month after the start of the rains. The anthropophilic indices obtained from the blood-fed An. arabiensis resting indoors and outdoors were only 20% and 25%, respectively, with most of the other meals on goats. ELISA for P. falciparum circumsporozoite protein revealed only one positive out of 1,026 tested. The malaria prevalence among children <10 years was only 3.3% (all P.falciparum) from 300 slides examined. These low rates seem to reflect recent success in malaria control in Eritrea.

[Evaluation of the enzyme-linked immunosorbant assay in detecting circumsporozoite protein of anopheline vectors in Yunnan].

OBJECTIVE: To detect circumsporozoite protein (CSP) in anopheline vectors from south Yunnan and to evaluate ELISA in the detection. METHODS: Salivary glands of the anopheline mosquitoes were taken for finding sporozoites by microscopy and part of the glands was used for detecting CSP by ELISA. An. minimus was experimentally infected by blood from vivax malaria patient (with Plasmodium vivax) and examined for sporozoites and CSP. Eight species of anopheline mosquitoes were caught in the field and examined. Monoclonal antibodies to P. falciparum (Pf2A10) and P. vivax (Pv210, Pv247) were used in ELISA for detecting CSP. RESULTS: Sporozoites were found in the salivary glands of 27 out of 36 An. minimus experimentally infected (75.0%), 29 were ELISA CSP positives (80.6%), and 26 of the 27 mosquitoes showed Pv210 CSP positive. Among 1010 parous anopheline mosquitoes from the field, 7 were found sporozoite positive (0.69%), 8 were ELISA CSP positive (0.79%), and 6 of the 7 mosquitoes showed CSP positive. Of 4675 wild mosquitoes in 8 anopheline species with different ages, 11 were found CSP positive (0.24%) including An. minimus, An. sinensis and An. maculatus with a positive rate of 0.20%, 0.24% and 0.39% respectively. Among the 11 mosquitoes, 9 were Pv210 positive and 2 were Pf2A10 positive. CONCLUSION: CSP detection by ELISA is a useful method to monitor the malaria transmission capacity of anopheline vectors.

Ethnobotanical survey and testing of plants traditionally used against hematophagous insects in Eritrea.

An ethnobotanical study was conducted to find plants traditionally used against nuisance insects in three regions of Eritrea: highland, eastern escarpment and wet lowland. Six plants were collected, two of them were reported to be used against mosquitoes (Ocimum forskolei, Lamiaceae and Nicotiana glauca, Solanaceae), two others against fleas (Salvia shimperi, Lamiaceae and Otostegia integrifolia, Lamiaceae) and Neorautanenia mitis (Fabaceae) and Calpurnea aurea (Fabaceae) against animal lice. The effect of fresh leaves and shoots of O. forskolei hanging on walls at the head and foot of beds was tested in Eritrea against Anopheles arabiensis and 53% reduction in mean number of mosquitoes per house was achieved. Blood meals of mosquitoes collected from houses and pit shelters were analysed to determine whether biting diversion occurred due to the use of plants in the houses. No diversion of biting was observed to goats, which are abundant in the test area. Hot water distillates of N. glauca, S. schimperi and O. integrifolia were tested against An. gambiae s.s. in the laboratory using a Hemotek membrane blood feeder with pig skin replacing the parafilm membrane. The approximate doses in microl/cm(2) for 50% repellency with the extracts of S. schimperi, N. glauca and O. integrifolia were 0.97, 1.72 and 2.44, respectively. Even though the plants only achieved partial protection, they have a potential for widespread use as a complement to other control methods.

Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care.

OBJECTIVES: To compare the recognized defined daily dose per 100 bed-days (DDD/100 bed-days) measure with the defined daily dose per finished consultant episode (DDD/FCE) in a group of hospitals with a variety of medicines management strategies. To compare antibiotic usage using the above indicators in hospitals with and without electronic prescribing systems. METHODS: Twelve hospitals were used in the study. Nine hospitals were selected and split into three cohorts (three high-scoring, three medium-scoring and three low-scoring) by their 2001 medicines management self-assessment scores (MMAS). An additional cohort of three electronic prescribing hospitals was included for comparison. MMAS were compared to antibiotic management scores (AMS) developed from a questionnaire relating specifically to control of antibiotics. FCEs and occupied bed-days were obtained from published statistics and statistical analyses of the DDD/100 bed-days and DDD/FCE were carried out using SPSS. RESULTS: The DDD/100 bed-days varied from 81.33 to 189.37 whilst the DDD/FCE varied from 2.88 to 7.43. The two indicators showed a high degree of correlation with r=0.74. MMAS were from 9 to 22 (possible range 0-23) and the AMS from 2 to 13 (possible range 0-22). The two scores showed a high degree of correlation with r=0.74. No correlation was established between either indicator and either score. CONCLUSIONS: The WHO indicator for medicines utilization, DDD/100 bed-days, exhibited the same level of conformity as that exhibited from the use of the DDD/FCE indicating that the DDD/FCE is a useful additional indicator for identifying hospitals which require further study. The MMAS can be assumed to be an accurate guide to antibiotic medicines management controls. No relationship has been found between a high degree of medicines management control and the quantity of antibiotic prescribed.

DEET mosquito repellent provides personal protection against malaria: a household randomized trial in an Afghan refugee camp in Pakistan.

Synthetic repellents based on di-ethyl 3-methyl benzamide (DEET) are a popular method of obtaining protection from mosquitoes and yet clear evidence for a protective effect against malaria has hitherto never been convincingly demonstrated. A household randomized trial was undertaken among a study population of 127 families (25%) in an Afghan refugee village in Pakistan to compare the efficacy of repellent soap (Mosbar containing 20% DEET and 0.5% permethrin) vs. a placebo lotion. Cases of falciparum and vivax malaria were detected by passive case detection at the camp's clinic. At the end of the 6 month trial 3.7% (23 of 618) of individuals in the Mosbar group had presented with one or more episodes of falciparum malaria compared with 8.9% (47 of 530) of the placebo group (odds ratio 0.44, 95% CI 0.25-0.76). 16.7% of the Mosbar group (103 of 618) presented with vivax malaria compared with 11.7% (62 of 530) of the placebo group, and thus no effect was shown against vivax malaria (odds ratio 1.29, 95% CI 0.86-1.94). A considerable proportion of individuals (22%) had presented with vivax malaria during the 7 months leading up to the trial and thus any intervention effect would be partially masked by relapsed infections. The distribution of mosquitoes among households was broadly similar between Mosbar and placebo groups. The repellent was popularly received and very few side-effects were reported. There is a case for giving repellents more prominence in public health as a preventive measure in regions where vectors bite in the early evening or in emergency situations such as epidemics or newly established refugee camps.