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1.
J Antimicrob Chemother ; 74(12): 3418-3422, 2019 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-31504574

RESUMEN

Antimicrobial stewardship (AMS) has developed over the past decade as a critical tool to promote the appropriate use of antimicrobials in order to contain antimicrobial resistance (AMR) and conserve antimicrobial medicines. Current literature supports the role of the nurse in AMR, with a strong focus on the responsibilities of the nurse in infection prevention and control (IPC), both in the formal role of the IPC nurse specialist, and the more general IPC role of the bedside nurse. There is also growing support for the collaborative role of the nurse in the multidisciplinary AMS team. There is, however, very little literature examining the clinical practice role of the nurse in AMS. In this discussion, we contend that nursing practice may unknowingly contribute to AMR owing to varying methods of administration of intermittent intravenous infusions, resulting in under-dosing of antimicrobial medicines.


Asunto(s)
Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/métodos , Infusiones Intravenosas/métodos , Rol de la Enfermera , Enfermería/métodos , Actitud del Personal de Salud , Relación Dosis-Respuesta a Droga , Humanos , Control de Infecciones/métodos , Enfermeras y Enfermeros , Encuestas y Cuestionarios
2.
Artículo en Inglés | MEDLINE | ID: mdl-35493977

RESUMEN

Background: Antimicrobial stewardship aims to optimise the use of antimicrobial medicines to preserve the efficacy of these medicines and to contain antimicrobial resistance where possible. Nurses constitute the largest group of healthcare workers; however, the role played by nurses within current antimicrobial stewardship strategies is largely unacknowledged despite nurses being at point-of-care at the hospital bedside. Objectives: To identify recommendations for the antimicrobial stewardship role of the bedside nurse in key global antimicrobial stewardship guidelines. Methods: Scoping review methodology was used to systematically search published and 'grey' literature in PubMed, EBSCOhost, Google Scholar, government websites, and websites of professional societies and organisations. Search dates were 1990 to 2020. Inclusion criteria were English language antimicrobial stewardship guidelines for hospitals. Screening was conducted in two stages for title and abstract and then full text relevancy and documented according to the PRISMA Extension for Scoping Reviews. Results: Of the 1 824 articles that were retrieved, only 43 met the inclusion criteria. Inclusion of the bedside nurse on the antimicrobial stewardship team occurred in 13.9% (n=6) of the papers. A role for the bedside nurse was recommended in antibiotic stewardship (32.5%; n=14), infection prevention and control (23.2%; n=10), and administration of antimicrobial medicines (20.9%; n=9) of reviewed documents. Other recommendations included the use of evidence-based antimicrobial stewardship (20.9%; n=9), collaboration with other healthcare staff (11.6%; n=5), facilitation of transition of care (18.6%; n=8), and nurse prescription of antibiotics (4.6%; n=2). Conclusion: This scoping review highlights a slow but incremental increase in recognition of the role of the bedside nurse within the operational hub of antimicrobial stewardship strategies. Contributions of the study: The present study was undertaken to fill the gap in the literature on clinical nurses' contribution in antimicrobial stewardship. The findings of the review largely demonstrate that multidisciplinary antimicrobial stewardship guidelines fail to view the bedside nurse as a contributor within antimicrobial stewardship strategies.

3.
Artículo en Inglés | MEDLINE | ID: mdl-35517853

RESUMEN

Background: Antimicrobial stewardship (AMS) is a proactive healthcare intervention to improve patient outcomes by optimising antimicrobial use. Although nursing involvement is a recognised necessity, bedside nurses may not yet possess competencies to fulfil this role. Objectives: To identify recommendations for AMS education for the bedside nurse in key global AMS guidelines. Methods: Scoping review methodology was used to systematically search published and 'grey' literature in PubMed, EBSCOhost, Google Scholar, government websites and websites of professional societies and organisations. Search dates were from 1990 to 2020. Inclusion criteria were English language AMS guidelines for hospitals. Results: Literature searches retrieved 1 824 articles, with 43 meeting the review inclusion criteria. Reference was made to AMS nursing education in 23 (53.4%) of the articles. Educational opportunities for nurses were recommended: inclusion of AMS concepts/content into undergraduate and postgraduate nursing curricula (n=12; 27.9%), in-hospital training (n=14; 32.5%) and continuing professional development (n=6; 13.9%). Recommendations for nursing education were as follows: role of AMS in preventing antimicrobial resistance (n=7; 16.2%), infection prevention and control (n=3; 6.9%), diagnostics in AMS (n=5; 11.6%), pharmacology (n=11; 25.5%) and collaboration (n=2; 4.6%). Identified nursing educational gaps were: nurses not recognising their role within AMS (n=5; 11.6%), inadequate nursing resources and expertise for dosing, pharmacokinetic/pharmacodynamic strategies and managing possible drug incompatibilities with extended/prolonged infusions (n=3; 6.9%), and inappropriate nurse disposal of antibiotic waste (n=1; 2.3%). Conclusion: Although recommendations for nursing education were found in many key AMS guidelines, few guidelines provided detailed descriptions of the nursing competencies that were required for this role. Contributions of the study: This study serves to compile and highlight previously little-known recommendations within key international antimicrobial stewardship (AMS) guidelines for the education of clinical nurses in their AMS role. It provides a summary of expected clinical nurse competencies. It adds to current discussion within the literature on how to improve and support this critical nursing role.

4.
Trop Med Int Health ; 15(2): 224-31, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20002615

RESUMEN

OBJECTIVES: To assess the performance of an educational campaign to increase adherence to a mass-administered DEC regimen against lymphatic filariasis (LF) in Orissa, and to identify factors that could enhance future campaigns. METHOD: Randomized cluster survey, comparing areas that did and did not receive the educational campaign, using a household coverage survey and knowledge, attitudes and practices (KAP) survey. RESULTS: LF MDA coverage for the entire population (n = 3449) was 56% (95% CI: 50.0-61.9). There was no statistical difference between the areas that did and did not receive the educational campaign. The most common barriers to adherence were fear of medication side effects (47.4%) and lack of recognition of one's risk for LF (15.8%). Modifiable, statistically significant, multivariable predictors of adherence were knowing that DEC prevents LF (aOR = 2.6, 95% CI: 1.4-5.1), knowing that mosquitoes transmit LF (aOR = 1.9, 95% CI: 1.1-3.2), and knowing both about the mass drug administration (MDA) in advance and that mosquitoes transmit LF (aOR = 5.4, 95% CI: 2.8-10.4). CONCLUSIONS: India needs to increase compliance with MDA programmes to reach its goal of interrupting LF transmission. Promoting a simple public health message before MDA distribution, which takes into account barriers to and predictors of adherence, could raise compliance with the LF MDA programme.


Asunto(s)
Filariasis Linfática/prevención & control , Filaricidas/uso terapéutico , Cumplimiento de la Medicación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Filariasis Linfática/transmisión , Femenino , Filaricidas/efectos adversos , Programas de Gobierno/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Humanos , India , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/organización & administración , Evaluación de Programas y Proyectos de Salud , Adulto Joven
5.
Int Endod J ; 43(1): 84-90, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20002805

RESUMEN

AIM: To report a case of oral non-Hodgkin's lymphoma with a delayed diagnosis. SUMMARY: Non-Hodgkin's lymphoma of the oral cavity is an uncommon but important condition. Early diagnosis is complicated when the presenting signs and symptoms are similar to those of odontogenic infections. This report describes the case of a 38-year-old female patient who presented to her dentist complaining of pain in her upper jaw. Subsequent dental treatment, including extraction, root canal treatment and apicectomy including biopsy were carried out by the patient's dentist and local dental hospital. Nine months elapsed before a more extensive surgical exploration established a diagnosis of lymphoma.


Asunto(s)
Errores Diagnósticos , Linfoma no Hodgkin/diagnóstico , Neoplasias Maxilares/diagnóstico , Periodontitis Periapical/diagnóstico , Adulto , Diagnóstico Tardío , Femenino , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Neoplasias Maxilares/tratamiento farmacológico , Neoplasias Maxilares/radioterapia , Procedimientos Quirúrgicos Orales/efectos adversos , Fístula Oroantral/etiología , Tratamiento del Conducto Radicular , Extracción Dental
6.
Artículo en Inglés | MEDLINE | ID: mdl-37333058

RESUMEN

Background: Antimicrobial stewardship has become an important initiative within intensive care units in the global fight against antimicrobial resistance. Support for nurses to participate in and actively direct antimicrobial stewardship interventions is growing however, there may be barriers that impede the development of this nursing role. Objectives: To explore the views of healthcare professionals regarding barriers to the antimicrobial stewardship role of the nurse in intensive care in a private hospital in KwaZulu-Natal, South Africa. Methods: Using a qualitative research approach, purposive sampling was used to identify fifteen participants from the disciplines of nursing, surgery, anaesthetics, internal medicine, microbiology, and pharmacy in a general intensive care unit. Content analysis was used to code data obtained from each individual interview. Results: The following categories and subcategories were derived: regarding barriers to the role of the nurse in antimicrobial stewardship: (i) lack of collaboration (subcategories: not participating in the antimicrobial stewardship programme, no feedback about antimicrobial resistance in the unit, and not part of decision-making); (ii) inadequate knowledge (subcategories: not understanding infection prevention and control, missing the link between laboratory results and start of treatment, and poor knowledge of antibiotics and their administration); and (iii) inexperienced nurses (subcategories: shortage of intensive care nurses, lack of experienced nurses, and inadequate nursing staff to provide in-service training). Conclusion: The nursing role within antimicrobial stewardship was negatively affected by both staffing and collaborative difficulties, which impacted on the implementation of antimicrobial stewardship within the unit. Contributions of the study: Nurses are not well-integrated into antimicrobial stewardship. Insufficient training and education on aspects of antimicrobial stewardship are available to nurses.

7.
J Hosp Infect ; 103(3): 244-250, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31421195

RESUMEN

BACKGROUND: There is growing recognition by national and international policymakers of the contribution nurses make towards antimicrobial stewardship. Although undergraduate education provides an ideal opportunity to prepare nurses for antimicrobial stewardship roles and activities, only two-thirds of undergraduate nursing programmes incorporate any antimicrobial stewardship teaching and only 12% cover all the recommended antimicrobial stewardship principles. Nurses also report that they do not have a good knowledge of antibiotics, and many have not heard of the term antimicrobial stewardship. AIM: To provide international consensus on the antimicrobial stewardship competency descriptors appropriate for undergraduate nurse education. METHODS: A modified Delphi approach comprising two online surveys delivered to an international panel of 15 individuals reflecting expertise in prescribing and medicines management in the education and practice of nurses; and antimicrobial stewardship. Data collection took place between February and March 2019. FINDINGS: A total of 15 participants agreed to become members of the expert panel, of whom 13 (86%) completed round 1 questionnaire, and 13 (100%) completed round 2. Consensus was achieved, with consistently high levels of agreement across panel members, on six overarching competency domains and 63 descriptors, essential for antimicrobial stewardship practice. CONCLUSION: The competency descriptors should be used to direct undergraduate nurse education and the antimicrobial stewardship practices of qualified nurses (including those working in new roles such as Nursing Associates) due to the high levels of agreement reached on competency descriptors.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos/métodos , Consenso , Educación de Pregrado en Medicina/métodos , Educación en Enfermería/métodos , Humanos , Encuestas y Cuestionarios
8.
Br J Gen Pract ; 48(428): 1064-6, 1998 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9624748

RESUMEN

BACKGROUND: Postnatal depression affects 15% of all women derived. Good practice in antenatal and postnatal care suggests that regular contact should take place with members of the primary health care team (PHCT) but, despite this, many cases of postnatal depression are probably not detected. It is also widely perceived that depressed women consult more frequently about themselves and their babies, but it is not clear whether the number of contacts with the primary health care team as a whole reflects this. AIM: To determine whether the use of the Edinburgh Postnatal Depression Scale (EPNDS) at postnatal examination would detect women not recognized as depressed by the PHCT. To determine whether the number of contacts with the PHCT could be used as a screening tool for postnatal depression. METHOD: The EPNDS was administered at postnatal examination to 176 women delivering their babies between 1 April 1995 and 31 October 1995. Contacts with PHCT members were recorded up to the 42nd day after delivery, together with their assessment of the subjects' mental health. RESULTS: Of 30 women scoring > or = 12 on the EPNDS, only 13 were perceived to be depressed by the PHCT. The team as a whole identified more depressed women than any individual professional group. There was no significant difference in the number of contacts made with professionals by women who were or were not depressed. Asian women were more likely to be depressed than women from other ethnic groups. CONCLUSION: Despite the PHCT as a whole identifying more depressed women than any individual group, more than half were not identified by professionals. Tools such as the EPNDS should be used routinely in primary care; there is an urgent need to validate the EPNDS for non-Caucasian women.


Asunto(s)
Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología , Femenino , Humanos , Atención Posnatal , Escalas de Valoración Psiquiátrica
9.
N Z Med J ; 100(821): 209-11, 1987 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-3455481

RESUMEN

Surveys of intravenous drug users were undertaken in July 1985 and one year later to assess behaviours which could result in risk of HIV infection and transmission. Ready availability of sterile syringes was reported by 48% in 1986 and 63% in 1985. Sharing of syringes amongst intravenous drug users is a common practice. In 1986, 22% of subjects reported no sharing of syringes, 16% sharing with one and 62% with between 2 and 20 others. There was a significant trend towards less sharing, and improved sterilisation of syringes in 1986. Nearly all subjects were aware of the risks of HIV transmission via shared syringes. In 1985, 19% of subjects reported adopting safer-sex practices compared with 28% in 1986. A history of prostitution was reported by 50% of women. All subjects were aware intravenous drug users had been asked not to donate blood, and none reported having done so within five years. All the subjects tested for HIV antibody were negative.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/transmisión , Narcóticos/administración & dosificación , Trastornos Relacionados con Opioides/complicaciones , Femenino , Seropositividad para VIH/epidemiología , Humanos , Inyecciones Intravenosas , Masculino , Factores de Riesgo , Conducta Sexual , Esterilización/métodos
10.
Psychol Rep ; 78(2): 516-8, 1996 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-9148309

RESUMEN

This paper describes a preliminary study of diagnosis and treatment of depression by general practitioners in England. They regarded primary care depression as a reactive mood disorder with both physical and psychological symptoms and associated with those groups who are most vulnerable to life stressors. Four groups were seen as at risk from depression: elderly persons, menopausal women, young mothers, and those in early adulthood. The practitioners relied primarily on their experience to diagnose depression rather than following any official diagnostic criteria. Although they were in favour of nondrug therapy in treating depression, they mainly practised drug therapy due to time pressure and limited availability of resources.


Asunto(s)
Comparación Transcultural , Trastorno Depresivo/diagnóstico , Grupo de Atención al Paciente , Adulto , Anciano , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Diagnóstico Diferencial , Inglaterra , Medicina Familiar y Comunitaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicología , Trastornos Somatomorfos/terapia
11.
Fam Pract ; 11(3): 300-6, 1994 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-7843522

RESUMEN

In order to compare measures of job satisfaction, mental health and job stress among general practitioners (GPs), the results of a 1993 survey were compared with that obtained in the previous study in 1987. Eight-hundred and fifty GPs were selected at random by seven Family Health Service Authorities in England, 380 of whom returned questionnaires suitable for statistical analysis. There were significant differences between the 1987 and 1993 surveys. GPs experienced less job satisfaction, poorer mental health and more stress in 1993 than in 1987. These changes may have occurred as a result of the introduction of the new contract.


Asunto(s)
Servicios Contratados , Medicina Familiar y Comunitaria , Satisfacción en el Trabajo , Salud Mental , Estrés Psicológico/complicaciones , Adulto , Anciano , Inglaterra , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Personalidad Tipo A
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