Support for fungal infection treatment mediated by pharmacist-led antifungal stewardship activities.

OBJECTIVE: At the Yokohama General Hospital, pharmacist-led antimicrobial stewardship programs (ASP) including antifungal stewardship programs (AFP) were started in 2012. To investigate the efficacy of the programs, we compared several parameters that are recommended for the measurement of ASP in Japan based on pre- and post-AFP activities. PATIENTS AND METHODS: The subjects were inpatients who developed candidemia between April 2008 and March 2016. They were divided into two groups: pre-AFP (April 2008 until March 2012) and post-AFP (April 2012 until March 2016). The results were compared between the two groups. RESULTS: The cumulative optimal antifungal drug usage rate, as a process parameter, significantly increased in the post-AFP group (p = 0.025). Furthermore, the days of therapy of antifungal drugs in the pre- and post-AFP groups was median 6.0 (interquartile range [IQR] 0.3-15.7) and median 3.4 (IQR 1.9-3.4) per 1,000 patient-days, respectively; there was a significant decrease in the post-AFP group (p < 0.001). Expenditure on antifungal drugs, as an outcome parameter, in the pre- and post-AFP groups was 9390.5 ± 5687.1 and 5930.8 ± 4687.0 US dollars, respectively; there was a significant decrease in the post-AFP group (p = 0.002). CONCLUSIONS: These results suggest that pharmacist-led antifungal stewardship activities improve both outcome and process parameters.

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship.

Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs.

Reaching consensus on factors impacting optimal use of an orthopaedic emergency theatre in a public hospital.

Background: The operating theatre (OT) complex of hospitals represents areas of considerable expenditure with regard to costs and requires maximum use to ensure optimum cost benefit for both patients and the hospital. Inefficient use of an operating theatre room (OTR) may result in hospital wasteful expenditure and frustrations for patients owing to surgery delays, cancellations and prolonged hospitalisation while waiting. Aim: The aim of the study was to explore and describe using a consensus method, factors impacting the use of an emergency orthopaedic theatre that can be optimised in a selected public hospital in Gauteng province. Setting: The study was conducted by a professional nurse and orthopaedic surgeon working in the theatre of a selected public hospital in Gauteng province. Method: A qualitative, explorative and descriptive design was adopted. Data were collected using a nominal group technique (NGT) among professional nurses and orthopaedic surgeons. Data analysis was done through cross-analysis where participants reached a consensus on the voted ideas from the group. Results: Consensus was reached and three main themes emerged: (1) inadequate resources; (2) poor organisation and (3) communication. Conclusion: The optimal use of an emergency orthopaedic theatre is influenced by the availability of resources being human and material, good organisation and clear communication. Contribution: The study has demonstrated that a variety of factors needs to be considered to optimise the use of an orthopaedic emergency theatre. The management of an OT requires a concerted effort from the nurses and doctors.

Technostress and time spent online. A cross-cultural comparison for teachers and students.

Introduction: Research shows that ICT is beneficial for academics and students, aiding in overcoming distance barriers, streamlining administration, and improving teaching and learning processes. However, the negative impact of technology, particularly technostress, are garnering attention. In the context of the concerns about technostress among higher education institutions (HEI), the aim of the study is to analyze the technostress creators and inhibitors for university teachers and students in different European countries. The topical concept of digital well-being is seen as "a subjective individual experience of optimal balance between the benefits and drawbacks obtained from mobile connectivity, focusing on the personal perception of what amount of time spent using technology is optimal so that well-being is preserved". Method: To explore specific aspects related to use of technology, two - parallel online surveys for academics (N = 446) and students (N = 660) from four European countries (Romania, Germany, Norway, and Finland) were conducted between November 2022 - January 2023. The surveys included the Technostress scale and the Technostress Inhibitors Scale, the Technology self-efficacy Scale, and a questionnaire focusing on socio-demographic aspects, work experience, academic field, dimensions related to the actual use of technology and participants perception on the optimal use of technology for work, learning or personal tasks, in terms of the period of day/week and amount of time spent. We also inquired about the social support given and received when using technology and the formal and informal rules, expectations, policies, punishments, and rewards regarding the use of technology. Results: The findings suggest that the perceived optimal use of technology is significantly lower than the actual use for all the contexts. Overuse of technology was associated with technostress. Our results also showed that technology self-efficacy and social support from colleagues and teachers are negatively associated with technostress. Country differences regarding technostress and time spent online were also observed. Discussions: Despite the needed caution in interpreting the results because of the unbalanced sample size across countries, the results could be used to develop research and support interventions within European countries to promote digital well-being, a better work-life balance with further positive effects on academic satisfaction and work/learning productivity.

[Déterminants du succès d'une démarche provinciale d'usage optimal des antipsychotiques chez les résidents en soins de longue durée selon les acteurs clés impliqués dans l'implantation].

Le Québec présente le taux de prescriptions d'antipsychotiques le plus élevé chez les personnes âgées de 65 ans et plus au Canada. La démarche « Optimiser les pratiques, les usages, les soins et les services - antipsychotiques ¼ (OPUS-AP) vise à pallier cet enjeu. Étant donné ses premiers résultats prometteurs, notre étude visait à identifier les déterminants de son succès. Elle repose sur un devis d'étude de cas regroupant une analyse documentaire et 21 entrevues auprès d'acteurs clés impliqués dans l'implantation. Les résultats mettent en lumière cinq déterminants centraux : 1) une démarche intégrée, collaborative et probante; 2) des communications et des réseaux au service de la démarche; 3) un climat d'implantation favorable aux changements; 4) un engagement et une implication des parties prenantes; et 5) une stratégie d'application des connaissances intégrée et appuyée. Des défis et recommandations pour assurer la pérennisation et la mise à l'échelle d'OPUS-AP et inspirer des démarches similaires sont identifiés.

Practical checklist for implementation of antifungal stewardship programmes.

Introduction. Antifungal stewardship programmes are needed in healthcare facilities to limit the overuse or misuse of antifungals, which are responsible for an increase in antifungal resistance.Hypothesis/Gap Statement. Core recommendations for antifungal stewardship were published by the Mycoses Study Group Education and Research Consortium, while the Centers for Disease Control and Prevention (CDC) provided a Core Elements of Hospital Antibiotic Stewardship Programs checklist. The recommendations offer global core elements for best practices in antifungal stewardship, but do not provide a framework for the implementation of antifungal stewardship programmes in healthcare facilities.Aim. In line with the recommendations, it is of the utmost importance to establish a practical checklist that may be used to implement antifungal stewardship programmes.Methodology. The practical checklist was established by a national consensus panel of experts involved in antifungal stewardship activities. A preliminary checklist was sent to all experts. The final document was approved by the panel after discussion and the resolution of any disagreements by consensus.Results. The final checklist includes the following items: leadership support; actions to support optimal antifungal use; actions to monitor antifungal prescribing, use and resistance; and an education programme.Conclusion. This antifungal stewardship checklist offers opportunities for antifungal resistance containment, given that antifungal stewardship activities promote the optimal use of antifungals.

Achieving optimal technology use: A proposed model for health technology reassessment.

BACKGROUND: Healthcare providers, managers and policy-makers in many jurisdictions are focused on a common goal: optimizing value and quality of care provided to their citizens within a resource envelope. Health technology reassessment is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology currently used in the healthcare system to inform optimal use of that technology in comparison with its alternatives. There are, however, few practical experiences with health technology reassessment and, as such, a nascent theoretical and methodological base. Health technology reassessment is a key strategy to achieve optimal healthcare resource utilization, and establishing a model for health technology reassessment is a required methodological step. METHODS AND RESULTS: The purpose of this article is to answer three formative questions: (1) What is health technology reassessment? (2) When should a health technology reassessment be implemented? (3) What is the role of health technology reassessment in evidence-informed health policy? Finally, we propose a conceptual framework for health technology reassessment, which others can modify, adapt, or adopt in their own context. The model consists of three broad phases and six iterative stages: (1) identification, (2) prioritization, (3) evidence synthesis, (4) determine policy/practice recommendation, (5) policy/practice implementation and (6) monitoring and evaluation. Two foundational components (meaningful stakeholder engagement and ongoing knowledge exchange and utilization) are represented across all stages. CONCLUSION: This description of health technology reassessment and the proposed model can be used by healthcare policy-makers and researchers to advance the field of technology management, with the goal of achieving optimal use throughout a technology's lifecycle.

Systemic Therapy for Soft Tissue Sarcoma: Proposals for the Optimal Use of Pazopanib, Trabectedin, and Eribulin.

Soft tissue sarcoma (STS) is a rare tumor with more than 50 histologic subtypes. Although treatment outcomes for patients with STS have improved greatly over the past few decades owing to the adoption of a multidisciplinary approach, patients with advanced disease have a poor prognosis. The development of anticancer drugs has been directed toward improving overall survival (OS). Doxorubicin monotherapy is currently the only standard option for the first-line treatment of STS. However, there is no standard therapy for second-line and later treatment at present. Since 2012, three anticancer drugs-pazopanib, trabectedin, and eribulin-have been approved in Japan for the second-line or later treatment of patients with advanced STS of any histologic subtype. However, the chemosensitivity of STS to each of these drugs varies by histologic subtype and their safety profiles differ; thus, histologic subtype and patient characteristics must be considered when determining optimal treatment. In this article, we review data from clinical studies related to the efficacy of all three drugs, including their effect on OS, and propose optimal treatment strategies for advanced STS by histologic subtype. In addition, with regard to the safety profiles, we highlight the key issues to be considered when selecting patients for treatment with pazopanib, trabectedin, or eribulin and ensuring their appropriate use, based on our combined clinical experience as specialists in the treatment of patients with STS. The proposed treatment strategies as well as treatment precautions based on clinical experience would benefit patients by maximizing the therapeutic effects and enhancing the proper use of these drugs. FUNDING: Eisai Co., Ltd.