Teachers' and students' perceptions on barriers and facilitators for eHealth education in the curriculum of functional exercise and physical therapy: a focus groups study.

BACKGROUND: Despite the growing importance of eHealth it is not consistently embedded in the curricula of functional exercise and physical therapy education. Insight in barriers and facilitators for embedding eHealth in education is required for the development of tailored strategies to implement eHealth in curricula. This study aims to identify barriers/facilitators perceived by teachers and students of functional exercise/physical therapy for uptake of eHealth in education. METHODS: A qualitative study including six focus groups (two with teachers/four with students) was conducted to identify barriers/facilitators. Focus groups were audiotaped and transcribed in full. Reported barriers and facilitators were identified, grouped and classified using a generally accepted framework for implementation including the following categories: innovation, individual teacher/student, social context, organizational context and political and economic factors. RESULTS: Teachers (n = 11) and students (n = 24) of functional exercise/physical therapy faculties of two universities of applied sciences in the Netherlands participated in the focus groups. A total of 109 barriers/facilitators were identified during the focus groups. Most related to the Innovation category (n = 26), followed by the individual teacher (n = 22) and the organization (n = 20). Teachers and students identified similar barriers/facilitators for uptake of eHealth in curricula: e.g. unclear concept of eHealth, lack of quality and evidence for eHealth, (lack of) capabilities of students/teachers on how to use eHealth, negative/positive attitude of students/teachers towards eHealth. CONCLUSION: The successful uptake of eHealth in the curriculum of functional exercise/physical therapists needs a systematic multi-facetted approach considering the barriers and facilitators for uptake identified from the perspective of teachers and students. A relatively large amount of the identified barriers and facilitators were overlapping between teachers and students. Starting points for developing effective implementation strategies can potentially be found in those overlapping barriers and facilitators. REGISTRATION: The study protocol was a non-medical research and no registration was required. Participants gave written informed consent.

Quality indicators for physiotherapy care in hip and knee osteoarthritis: development and clinimetric properties.

OBJECTIVE: The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA). METHODS: Guideline recommendations were rated for their relevance by an expert panel, transformed into potential indicators and incorporated into a questionnaire, the Quality Indicators for Physiotherapy in Hip and Knee Osteoarthritis (QIP-HKOA). Adherence with each indicator was rated on a Likert scale (0 = never to 4 = always). The QIP-HKOA was administered to groups of expert (n = 51) and general (n = 134) physiotherapists (PTs) to test its discriminative power. Reliability was tested in a subgroup of 118 PTs by computing the intraclass correlation coefficient (ICC). QIP-HKOA items were included if they were considered to be related to the cornerstones of physiotherapy in hip and knee OA (exercises and education), had discriminative power and/or if they were followed by <75% of PTs in both groups. RESULTS: Nineteen indicators were derived from 41 recommendations. Twelve indicators were considered to be the cornerstones of physiotherapy care; six indicators had discriminative power and/or were followed by <75% PTs in both groups, resulting in an 18-item QIP- HKOA. The QIP-HKOA score was significantly higher with expert [60.73; standard deviation (SD) 5.67] than with general PTs (54.65; SD 6.17) (p < 0.001). The ICC of the QIP-HKOA among 46/118 PTs was 0.89. CONCLUSION: The QIP-HKOA, based on 18 process indicators derived from a physiotherapy guideline on hip and knee OA was found to be reliable and discriminated between expert and general PTs. Its ability to measure improvement in the quality of the process of physiotherapy care needs to be further examined.

Physical therapists' management of rheumatoid arthritis: results of a Dutch survey.

BACKGROUND AND AIM: For tailored implementation of evidence-based recommendations and guidelines on physical therapy in patients with rheumatoid arthritis (RA), insight into current physical therapy practice is needed. METHOD: Two hundred and fifty general physical therapists and 211 specialized physical therapists with advanced arthritis training were sent a questionnaire to assess the frequency with which they applied a set of assessments (n = 10) and interventions (n = 7) included in a Dutch physical therapy guideline for RA. Differences between general and specialist physical therapists were analysed using Student's t-tests or chi-square tests where appropriate. RESULTS: In total, 233 physical therapists (51%) responded. Of these, 96 (41%) had completed an additional arthritis course and were designated as specialist physical therapists. Among the physical therapists who returned the questionnaire, 69% (or more) reported that they 'always' assessed limitations in daily functioning, pain, morning stiffness, muscle strength, joint range of motion, joint stability, gait and limitations in leisure activities as part of their initial assessment, and 37% and 48% reported 'always' to assess aerobic capacity and limitations in work situations, respectively. Concerning interventions, exercise therapy and education were 'always' applied by 70% and 68% of the responders, respectively. Only a minority of responders reported 'always' applying ultrasound, electrical stimulation, heat therapy, massage and passive mobilizations (0%, 0%, 5%, 5% and 14%, respectively). Apart from aerobic capacity and work limitations, all other assessments were reported as 'always' applied by significantly (p < 0.05) more specialist physical therapists than general physical therapists. Regarding interventions, significantly more specialist physical therapists reported that they 'always' applied exercise therapy and education. Significantly fewer specialist physical therapists than in the general group reported 'always' using heat therapy, massage and mobilizations (p < 0.05). CONCLUSION: The majority of physical therapists reported that they 'always' applied most of the assessments and interventions recommended in a Dutch physical therapy guideline for the management of RA. Areas for improvement include the assessment of aerobic capacity and work limitations. The observed differences between specialist and general physical therapists support the added value of advanced arthritis courses.

Physiotherapy in rheumatoid arthritis: development of a practice guideline.

BACKGROUND: To improve the quality of the physiotherapy management in patients with rheumatoid arthritis (RA) a Dutch practice guideline, based on current scientific evidence and best practice, was developed. This guideline comprised all elements of a structured approach (assessment, treatment and evaluation) and was based on the Internatio-nal Classification of Functioning, disability and Health (ICF) and the ICF core sets for RA. METHODS: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 10 experts from different professional backgrounds resulting in the final guideline. RESULTS: In total 7 topics were selected. For the initial assessment, three recommendations were made. Based on the ICF core sets for RA a list of health problems relevant for the physiotherapist was made and completed with red flags and points of attention. Concerning treatment, three recommendations were formulated; both exercise therapy and education on physiotherapy were recommended, whereas passive interventions (delivery of heat or cold, mechanical, electric and electromagnetic energy, massage, passive mobilization/manipulation and balneotherapy) were neither recommended nor discouraged. For treatment evaluation at the level of activities and participation, the Health Assessment Questionnaire was recommended. For evaluating specific body structures and functions the handheld dynamometer, 6-minute walk test or Ästrand bicycle test (including Borg-scale for rating the perceived exertion), Escola Paulista de Medicina Range of Motion Scale and a Visual Analog Scale for pain and morning stiffness were recommended. CONCLUSION: This physiotherapy practice guideline for RA included seven recommendations on the initial assessment, treatment and evaluation, which were all based on the ICF and the ICF Core Set for RA. The implementation of the guideline in clinical practice needs further evaluation.

Fatigue of zirconia and dental bridge geometry: Design implications.

UNLABELLED: Zirconia is currently used as a framework material for posterior all-ceramic bridges. While the majority of research efforts have focused on the microstructure and corresponding mechanical properties of this material, clinical fractures appear to be largely associated with the appliance geometry. OBJECTIVE: The objective of this study was to estimate the maximum stress concentration posed by the connector geometry and to provide adjusted estimates of the minimum connector diameter that is required for achieving 20 years of function. METHODS: A simple quantitative description of the connector geometry in an all-ceramic 4-unit bridge design is used with published stress concentration factor charts to estimate the degree of stress concentration and the maximum stress. RESULTS: The magnitude of stress concentration estimated for clinically relevant connector geometries ranges from 2 to 3. Using previously published recommendations for connector designs, adjusted estimates for the minimum connector diameter required to achieve 20 years of clinical function are presented. SIGNIFICANCE: To prevent clinical fractures the minimum connector diameter in multi-unit bridges designs must account for the loads incurred during function and the extent of stress concentration posed by the connector geometry.

Characterization of Dutch Staphylococcus aureus from bovine mastitis using a Multiple Locus Variable Number Tandem Repeat Analysis.

Current typing methods for Staphylococcus aureus have important drawbacks. We evaluated a Multiple Locus Variable Number Tandem Repeat Analysis (MLVA) scheme with 6 loci which lacks most drawbacks on 85 bovine mastitis isolates from The Netherlands. For each locus the number of repeat units (RU) was calculated. Each combination of repeat units was assigned a MLVA-type (MT). We compared the MLVA typing result with Multi Locus Sequence Typing (MLST), spa-typing and Pulsed-Field Gel Electrophoresis (PFGE). MLVA typing resulted in 18 MTs, although 3 loci could not always be amplified. Spa-typing distinguished 10 spa-types including 3 dominant and 2 new types. PFGE showed 5 dominant profiles with 15 related profiles and 6 unique profiles. MLST showed 4 dominant STs. Some types appeared to be bovine specific. The Simpson's Indices of diversity for PFGE, MLST, spa-typing and MLVA were 0.887, 0.831, 0.69 and 0.781, respectively, indicating that discriminatory power of MLVA was between MLST and spa-typing, whereas PFGE displayed the highest discriminatory power. However, MLVA is fast and cheap when compared to the other methods. The Adjusted Rand index and Wallace's coefficient indicated that MLVA was highly predictive for spa-type, but not vice versa. Analysis of the region neighboring SIRU05 showed a difference in the genetic element bordering the repeats of SIRU05 that explained the negative SIRU05 PCRs. PFGE, MLST, and MLVA are adequate typing methods for bovine-associated S. aureus.

The echinocandin caspofungin impairs the innate immune mechanism against Candida parapsilosis.

Since caspofungin inhibits fungal cell wall beta-glucan synthesis and the fungal cell wall plays an important role in the recognition of Candida by phagocytic cells, we studied phagocytosis in the presence of caspofungin. The aim of this work was to investigate the effect of pre-treatment of Candida parapsilosis with caspofungin on phagocytic mechanisms (opsonisation, oxidative burst, phagocytosis and killing). C. parapsilosis grown in the presence of caspofungin at concentrations above the minimal inhibitory concentration (MIC) were more difficult to opsonise and to phagocytose. C. parapsilosis exposed to any concentration of caspofungin below and above the MIC was more difficult to kill. Caspofungin-treated C. parapsilosis impaired the oxidative burst. Overall, it appears that caspofungin treatment of C. parapsilosis alters the capacity of polymorphonuclear leukocytes to phagocytose and delays killing of the organism. This may allow C. parapsilosis to persist in tissues.

Surveillance study of the susceptibility of Haemophilus influenzae to various antibacterial agents in Europe and Canada.

BACKGROUND: Haemophilus influenzae is a major respiratory tract pathogen that is becoming increasingly resistant to beta-lactam antibiotics. MATERIALS AND METHODS: Using a microdilution method performed to Clinical and Laboratory Standards Institute (CLSI) guidelines, we determined the minimal inhibitory concentrations (MICs) of various antibacterial agents against 536 isolates of H. influenzae. The isolates were obtained from patients with respiratory tract infections being treated in 18 European and two Canadian centres between 2006 and 2007. RESULTS: Levofloxacin, moxifloxacin, cefixime and cefpodoxime with MIC(90) values of < or = 0.03, < or = 0.03, 0.03 and 0.06 g/mL, respectively, were the four most active agents tested. Overall, amoxicillin resistance was observed in 25.0% of the strains, but was generally reversed with the addition of clavulanic acid. In 73 strains (13.6%) resistance was due to beta-lactamase (BL) production while the remainder (n = 61; 11.4%) were BL-negative, amoxicillin-resistant (BLNAR) strains. Comparison of penicillin binding protein 3B sequences in BLNAR isolates revealed that only mutations at amino acids 502 (alanine [Ala] --> threonine [Thr]/valine [Val]) and 526 (asparagine [Asn] --> lysine [Lys]) were significantly associated with amoxicillin resistance among European H. influenzae isolates (p < 0.0001 for both). CONCLUSIONS: This surveillance study highlights an increased prevalence of amoxicillin-resistant strains of H. influenzae compared with a previous study that we performed in 2004/2005. The third-generation cephalosporins cefixime and cefpodoxime, as well as amoxicillin plus clavulanic acid, continue to be very active against both BL-positive and BLNAR strains of H. influenzae, and thus remain useful treatment options for patients with respiratory tract infections.

Validity and responsiveness of the Rehabilitation Activities Profile (RAP) in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the internal consistency, validity and responsiveness of the Rehabilitation Activities Profile (RAP; a rehabilitation tool structuring the multidisciplinary team care process) in patients with rheumatoid arthritis. METHODS: In 85 rheumatoid arthritis patients admitted to a rheumatology clinic the RAP was applied at admission, at discharge, and six weeks thereafter. Additional assessments included measures of physical and psychological functioning, disease activity and quality of life. The internal consistency of the RAP was determined with Cronbach's alpha. Associations between the RAP and other outcome measures were determined by Spearman rank correlation coefficients. Responsiveness measures included the standardized response mean (SRM), effect size (ES) and responsiveness ratio (RR). RESULTS: Cronbach's alpha of the RAP total score was 0.78. The RAP total score correlated significantly with all other outcome measures. The mean RAP total score improved from 15.2 to 13.2 at discharge (change -2.0; 95% confidence interval (CI) -3.4 to -0.7) and to 11.5 (change -3.7; 95% CI -3.9 to -1.5) six weeks thereafter. The responsiveness of the RAP total score was low (standardized response mean -0.34, effect size -0.30) to high (responsiveness ratio -0.87) at discharge and moderate (standardized response mean -0.54, effect size -0.55) to high (responsiveness ratio -1.56) six weeks thereafter. CONCLUSIONS: The RAP appeared to be an internally consistent, valid and responsive measure to reflect limitations on the level of activities and participation in patients with rheumatoid arthritis admitted for multidisciplinary team care.

In vitro activity of AR-709 against Streptococcus pneumoniae.

We investigated the in vitro activity of AR-709, a novel diaminopyrimidine antibiotic currently in development for treatment of community-acquired upper and lower respiratory tract infections, against 151 Streptococcus pneumoniae strains from various European countries. AR-709 showed excellent activity against both drug-susceptible and multidrug-resistant pneumococci.

The impact of introducing an ICF-based rehabilitation tool on staff satisfaction with multidisciplinary team care in rheumatology: an exploratory study.

OBJECTIVE: To investigate the impact of introducing a rehabilitation tool on multidisciplinary team members' satisfaction with team functioning, team conferences and written information exchange. DESIGN: Pretest posttest design. SETTING: Day patient and inpatient wards of a rheumatology rehabilitation clinic. SUBJECTS: Members of two multidisciplinary teams. INTERVENTIONS: The introduction of an electronic version of the Rehabilitation Activities Profile. MAIN MEASURES: The Group Environment Scale and questionnaires on satisfaction with team conferences and administrative procedures administered before (T1) and 12 months after (T2) the introduction of the Rehabilitation Activities Profile. RESULTS: The Group Environment Scale cohesion subscale was significantly higher at T2 than at T1 in the day patient setting (mean difference 1.9; 95% confidence interval (CI) 0.3; 3.4), whereas in the inpatient setting the Group Environment Scale cohesion and the order and organization subscales were significantly lower (mean differences -3.0; 95% CI -4.7; -1.3 and -2.7; 95% CI -4.3; -1.1, respectively). Satisfaction with team conferences was significantly higher at T2 compared with T1 in the day patient setting (mean difference total score 0.6; 95% CI 0.3; 1.0), but not in the inpatient setting (mean difference -0.3; 95% CI -0.7; 0.2). In both settings, the proportions of health professionals spending >10 minutes on administrative tasks per patient contact were significantly higher at T2 than at T1. CONCLUSIONS: In the day patient setting, the introduction of a rehabilitation tool had a positive effect on team members' satisfaction with team functioning and team conferences, whereas in the inpatient setting the effect was absent or the opposite. In both settings, the time spent on administrative tasks increased.

Can contextualization increase understanding during man-machine communication? A theory-driven study.

The Internet offers unlimited possibilities for finding health information. However, the user is often faced with the problem of understanding it. Contextualization has a role to play in enhancing the user's comprehension. We report on a study which addresses this issue, using a theoretical model of communication whose central theme is that of context. A randomized controlled experimental design was chosen, using as a test-bed the website SeniorGezond we had previously developed. The study was composed of a pre-test, the intervention with the website and a post-test. Participants (n=40) were randomly assigned to exposure or no exposure to contextualization with the website. Results show that contextualization increases understanding for non-knowledgeable users. Furthermore, the participant's cognitive style was found to be a significant factor on understanding. We also found that participants bring their own contexts such as social context and psychological context to support their understanding.

Antimicrobial activity of a multispecies probiotic (Ecologic 641) against pathogens isolated from infected pancreatic necrosis.

AIMS: Although probiotic prophylaxis has been suggested to prevent small bowel bacterial overgrowth, bacterial translocation and infection of pancreatic necrosis in severe acute pancreatitis, limited data are available on their antimicrobial activity. METHODS AND RESULTS: Using the well-diffusion method, we studied the antimicrobial properties of a multispecies probiotic product (Ecologic 641) against a collection of pathogens cultured from infected pancreatic necrosis. All individual probiotic strains included in the multispecies preparation were able to inhibit the growth of the pathogens to some extent. However, the combination of the individual strains (i.e. the multispecies preparation) was able to inhibit all pathogenic isolates. Probiotic-free supernatants adjusted to pH 7 were not able to inhibit pathogen growth. CONCLUSION: Ecologic 641 is capable of inhibiting growth of a wide variety of pathogens isolated from infected pancreatic necrosis. The antimicrobial properties are to a large extent explained by the production of organic acids. SIGNIFICANCE AND IMPACT OF THE STUDY: Ecologic 641 is currently being used in a Dutch nationwide double-blind, placebo-controlled, randomized multicentre trial in patients with predicted severe acute pancreatitis.

In vitro activity of telavancin against gram-positive clinical isolates recently obtained in Europe.

The in vitro activity of telavancin was tested against 620 gram-positive isolates. For staphylococci, MICs at which 50 and 90% of isolates were inhibited (MIC(50) and MIC(90)) were both 0.25 microg/ml, irrespective of methicillin resistance. MIC(50) and MIC(90) were 0.25 and 0.5 microg/ml for vancomycin-susceptible enterococci and 1 and 2 microg/ml for vancomycin-resistant enterococci, respectively. Streptococcus pneumoniae, group A and B beta-hemolytic streptococci, and viridans streptococci were inhibited by < or =0.12 microg/ml.

Illness stories on the internet: what do breast cancer patients want at the end of treatment?

The study aims to elicit user requirements for internet-based applications disclosing fellow patients' illness stories for the benefit of breast cancer patients. Twenty-six breast cancer patients, recruited via the Dutch Patient Organization for Breast Cancer, were interviewed about their preferences with regards to content, appearance, and search options concerning fellow patients' illness stories online. The interviews were analysed quantitatively (SPSS) and qualitatively (NVivo). Participants were mainly interested in fellow patients' experiences about how to cope with emotions, the impact of cancer in daily life, and physical discomforts. Most participants preferred a section of an illness story in text format about a specific topic; some of them wanted to be able to click on to the corresponding complete story, comprising of text alone or supported by voice or video clip. A majority of participants wanted to be able to select illness stories on the basis of several authors' features, i.e. treatment underwent, age, presence of metastases, time since diagnosis, and whether or not caring for children. Participants gave arguments for their preferences. The findings of this study will be used for designing an online trial with breast cancer patients aiming at refining the user requirements.

N-trimethyl chitosan (TMC) nanoparticles loaded with influenza subunit antigen for intranasal vaccination: biological properties and immunogenicity in a mouse model.

In this study, the potential of N-trimethyl chitosan (TMC) nanoparticles as a carrier system for the nasal delivery of a monovalent influenza subunit vaccine was investigated. The antigen-loaded nanoparticles were prepared by mixing a solution containing TMC and monovalent influenza A subunit H3N2 with a tripolyphosphate (TPP) solution, at ambient temperature and pH 7.4 while stirring. The nanoparticles had an average size of about 800 nm with a narrow size distribution and a positive surface charge. The nanoparticles showed a loading efficiency of 78% and a loading capacity of 13% (w/w). It was shown that more than 75% of the protein remained associated with the TMC nanoparticles upon incubation of the particles in PBS for 3h. The molecular weight and antigenicity of the entrapped hemagglutinin was maintained as shown by polyacrylamide gel electrophoresis and Western blotting, respectively. Single i.n. or i.m. immunization with antigen-loaded TMC nanoparticles resulted in strong hemagglutination inhibition and total IgG responses. These responses were significantly higher than those achieved after i.m. administration of the subunit antigen, whereas the IgG1/IgG2a profile did not change substantially. The i.n. administered antigen-TMC nanoparticles induced higher immune responses compared to the other i.n. antigen formulations, and these responses were enhanced by i.n. booster vaccinations. Moreover, among the tested formulations only i.n. administered antigen-containing TMC nanoparticles induced significant IgA levels in nasal washes of all mice. In conclusion, these findings demonstrate that TMC nanoparticles are a potent new delivery system for i.n. administered influenza antigens.

The impact of the implementation of a rehabilitation tool on the contents of the communication during multidisciplinary team conferences in rheumatology.

OBJECTIVE: Problems with multidisciplinary team conferences in health care include the exchange of too much (discipline-specific) information. The aim of this study was to investigate the effect of the implementation of a rehabilitation tool on the contents of communication during multidisciplinary team conferences in a rheumatology setting. METHODS: All initial and follow-up team conferences of 25 consecutive patients with rheumatoid arthritis admitted to a day patient care ward were videotaped during a period before (period I) and after (period II) the introduction of a rehabilitation tool. The aims of the rehabilitation tool were to enhance discussions on the co-ordination of care rather than merely exchange of information. This was achieved by providing a framework for the setting and evaluation of common treatment goals and management strategies as well as accompanying electronic and printed records. For every team conference, the duration of time spent on three types of communication was recorded: (1) grounding regarding the patient's health status, (2) the making of practical arrangements by no more than two health professionals, and (3) the co-ordination of common treatment goals or management strategies. Comparisons of the proportions of time spent on the different types of communication between the two periods were done by means of the Mann-Whitney U-test. RESULTS: Apart from the 25 initial team conferences in both periods, 86 and 71 follow-up team conferences were available in periods I and II, respectively. Regarding the initial team conferences, the proportion of time spent on grounding and practical arrangements was significantly smaller in period II than in period I. In addition, the proportion of time spent on common goals or management strategies was significantly greater in period II than in period I. For the follow-up team conferences, the proportion of time spent on practical arrangements was significantly smaller in period II, than in period I. Moreover, the proportions of time spent on the other types of communication did not differ significantly between the two periods. CONCLUSION: The implementation of a rehabilitation tool including a computer application increased the proportion of time spent on the discussion of common treatment goals or management strategies during initial but not during follow-up team conferences in a day patient rheumatology clinic.

Longitudinal European surveillance study of antibiotic resistance of Haemophilus influenzae.

OBJECTIVES: We assessed the current resistance rates of Haemophilus influenzae against beta-lactams and other agents in Europe and compared the results with those of our previously performed surveillance study. METHODS: MICs of the antibiotics were determined using broth microdilution. The penicillin-binding domain of PBP3 of beta-lactamase (BL)-negative, amoxicillin-resistant (BLNAR) isolates was sequenced. RESULTS: The percentage of BL-positive and BLNAR strains ranged from 0% to 17.6% and 0% to 33.9%, respectively. Compared with 1997/98 and 2002/03, the overall percentage of strains non-susceptible to amoxicillin decreased from 19.8% and 23.3%, respectively, to 16.4% in 2004/05. The percentage of BL-producing strains decreased from 11.0% and 13.7%, respectively, to 7.6%, whereas the number of BLNAR strains remained stable (8.8% and 9.6%, respectively, versus 8.8% in 2004/05). Comparison of penicillin binding protein (PBP) 3B gene sequences between BLNAR and susceptible strains revealed novel amino acid mutations. CONCLUSIONS: In spite of large inter-regional differences, the overall resistance of H. influenzae to amoxicillin in Europe seems to decline due to a decreasing number of BL-producing strains, whereas the overall percentage of BLNAR strains seems relatively constant.

Bacterial resistance: a sensitive issue complexity of the challenge and containment strategy in Europe.

The development of antimicrobial agents has been a key achievement of modern medicine. However, their overuse has led to an increasing incidence of infections due to antibiotic-resistant microorganisms. Quantitative figures on the current economic and health impact of antimicrobial resistance are scant, but it is clearly a growing challenge that requires timely action. That action should be at the educational, ethical, economic and political level. An important first step would be to increase public awareness and willingness to take the necessary measures to curb resistance. Hence, studies are needed that would provide solid, quantitative data on the societal impact of antibiotic resistance. This review discusses the complexity of resistance, identifies its main drivers and proposes measures to contain it on a European scale.