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Hand KS, Clancy B, Allen M, Mayes A, Patel Y, Latter SM. 'It makes life so much easier'-experiences of users of the MicroGuide™ smartphone app for improving antibiotic prescribing behaviour in UK hospitals: an interview study. JAC Antimicrob Resist 2021; 3:dlab111. [PMID: 34632385 PMCID: PMC8496772 DOI: 10.1093/jacamr/dlab111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives To understand the impact on prescribing behaviour of an antimicrobial therapy
guidelines smartphone app, in widespread use in hospitals in the UK. Methods Twenty-eight doctors and five nurse prescribers from four purposively
selected hospitals in the UK participated in behavioural theory-informed
semi-structured interviews about their experiences of using the
MicroGuide™ smartphone app. Data were analysed using a thematic
content analysis. Results Five themes emerged from the interview data: convenience and accessibility;
validation of prescribing decisions; trust in app content; promotion of
antimicrobial stewardship; and limitations and concerns. Participants
appreciated the perceived convenience, accessibility and timesaving
attributes of the app, potentially contributing to more prompt treatment of
patients with time-critical illness. The interviewees also reported finding
it reassuring to use the app to support decision-making and to validate
existing knowledge. They trusted the app content authored by local experts
and considered it to be evidence-based and up-to-date. This was believed to
result in fewer telephone calls to the microbiology department for advice.
Participants recognized the value of the app for supporting the goals of
antimicrobial stewardship by promoting the responsible and proportionate use
of antimicrobials. Finally, a number of limitations of the app were
reported, including the risk of de-skilling trainees, cultural problems with
using smartphones in clinical environments and software technical
problems. Conclusions The MicroGuide app was valued as a means of addressing an unmet need for
updated, concise, trustworthy specialist information in an accessible format
at the bedside to support safe and effective antimicrobial prescribing.
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Affiliation(s)
- Kieran S Hand
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Bridget Clancy
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Mike Allen
- Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, UK
| | - Amazigom Mayes
- Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, UK
| | - Yash Patel
- Merck Sharp & Dohme Limited, Hertford Road, Hoddesdon, UK
| | - Susan M Latter
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Hood G, Hand KS, Cramp E, Howard P, Hopkins S, Ashiru-Oredope D. Measuring Appropriate Antibiotic Prescribing in Acute Hospitals: Development of a National Audit Tool Through a Delphi Consensus. Antibiotics (Basel) 2019; 8:antibiotics8020049. [PMID: 31035663 PMCID: PMC6627925 DOI: 10.3390/antibiotics8020049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022] Open
Abstract
This study developed a patient-level audit tool to assess the appropriateness of antibiotic prescribing in acute National Health Service (NHS) hospitals in the UK. A modified Delphi process was used to evaluate variables identified from published literature that could be used to support an assessment of appropriateness of antibiotic use. At a national workshop, 22 infection experts reached a consensus to define appropriate prescribing and agree upon an initial draft audit tool. Following this, a national multidisciplinary panel of 19 infection experts, of whom only one was part of the workshop, was convened to evaluate and validate variables using questionnaires to confirm the relevance of each variable in assessing appropriate prescribing. The initial evidence synthesis of published literature identified 25 variables that could be used to support an assessment of appropriateness of antibiotic use. All the panel members reviewed the variables for the first round of the Delphi; the panel accepted 23 out of 25 variables. Following review by the project team, one of the two rejected variables was rephrased, and the second neutral variable was re-scored. The panel accepted both these variables in round two with a 68% response rate. Accepted variables were used to develop an audit tool to determine the extent of appropriateness of antibiotic prescribing at the individual patient level in acute NHS hospitals through infection expert consensus based on the results of a Delphi process.
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Affiliation(s)
| | - Kieran S Hand
- University Hospital Southampton NHS Foundation Trust and School of Health Sciences, University of Southampton, Southampton SO16 6YD, UK.
| | - Emma Cramp
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
| | - Philip Howard
- Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds LS1 3EX, UK.
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Sandoe JAT, Saeed K, Guleri A, Hand KS, Dillon R, Allen M, Mayes A, Glen F, Gonzalez-Ruiz A. Opportunities for antimicrobial stewardship in patients with acute bacterial skin and skin structure infections who are unsuitable for beta-lactam antibiotics: a multicenter prospective observational study. Ther Adv Infect Dis 2019; 6:2049936118823655. [PMID: 30783523 PMCID: PMC6365991 DOI: 10.1177/2049936118823655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose: The objective of this prospective, observational study was to describe the treatment, severity assessment and healthcare resources required for management of patients with acute bacterial skin and skin structure infections who were unsuitable for beta-lactam antibiotic treatments. Methods: Patients were enrolled across five secondary care National Health Service hospitals. Eligible patients had a diagnosis of acute bacterial skin and skin structure infection and were considered unsuitable for beta-lactam antibiotics (e.g. confirmed/suspected methicillin-resistant Staphylococcus aureus, beta-lactam allergy). Data regarding diagnosis, severity of the infection, antibiotic treatment and patient management were collected. Results: 145 patients with acute bacterial skin and skin structure infection were included; 79% (n = 115) patients received greater than two antibiotic regimens; median length of the first antibiotic regimen was 2 days (interquartile range of 1–5); median time to switch from intravenous to oral antibiotics was 4 days (interquartile range of 3–8, n = 72/107); 25% (n = 10/40) patients with Eron class 1 infection had systemic inflammatory response syndrome, suggesting they were misclassified. A higher proportion of patients with systemic inflammatory response syndrome received treatment in an inpatient setting, and their length of stay was prolonged in comparison with patients without systemic inflammatory response syndrome. Conclusion: There exists an urgent need for more focused antimicrobial stewardship strategies and tools for standardised clinical assessment of acute bacterial skin and skin structure infection severity in patients who are unsuitable for beta-lactam antibiotics. This will lead to optimised antimicrobial treatment strategies and ensure effective healthcare resource utilisation.
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Affiliation(s)
| | - Kordo Saeed
- Hampshire Hospitals NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Kieran S Hand
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ryan Dillon
- Merck Sharp & Dohme UK Ltd. (MSD), Hoddesdon, UK
| | - Mike Allen
- Merck Sharp & Dohme UK Ltd. (MSD), Hoddesdon, UK
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Hand KS, Cumming D, Hopkins S, Ewings S, Fox A, Theminimulle S, Porter RJ, Parker N, Munns J, Sheikh A, Keyser T, Puleston R. Electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 UK infection specialists. J Antimicrob Chemother 2017; 72:1206-1216. [PMID: 27999065 DOI: 10.1093/jac/dkw524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/07/2016] [Indexed: 01/27/2023] Open
Abstract
Background The implementation of electronic prescribing and medication administration (EPMA) systems is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). Objectives To identify software features within EPMA systems that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. Methods A questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann-Whitney U -test. Results Responses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). Of the pharmacists, 59% had experience of EPMA in their hospitals compared with 35% of microbiologists. Pharmacists assigned higher priority to indication prompt ( P < 0.001), allergy checker ( P = 0.003), treatment protocols ( P = 0.003), drug-indication mismatch alerts ( P = 0.031) and prolonged course alerts ( P = 0.041) and lower priority to a dose checker for adults ( P = 0.02) and an interaction checker ( P < 0.05) than microbiologists. A 'soft stop' functionality was rated essential or high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection, antimicrobial resistance and drug expenditure. Conclusions The survey demonstrates key differences in health professionals' opinions of potential healthcare benefits of EPMA, but a consensus of anticipated positive impact on patient safety and AMS.
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Affiliation(s)
- Kieran S Hand
- Southampton Pharmacy Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.,Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Debbie Cumming
- Pharmacy Department, St Mary's Hospital, Parkhurst Road, Newport, Isle of Wight PO31 7QJ, UK
| | - Susan Hopkins
- Department of Infectious Diseases & Microbiology, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Andy Fox
- Southampton Pharmacy Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.,Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Sandya Theminimulle
- Microbiology Department, St Mary's Hospital, Parkhurst Road, Newport, Isle of Wight PO31 7QJ, UK
| | - Robert J Porter
- Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Church Lane, Heavitree, Exeter EX2 5AD, UK
| | - Natalie Parker
- Pharmacy Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Romsey Road, Winchester SO22 5DG, UK
| | - Joanne Munns
- Pharmacy Department, Western Sussex Hospitals NHS Foundation Trust, St Richards Hospital, Chichester PO19 6SE, UK
| | - Adel Sheikh
- Pharmacy Department, Queen Alexandra Hospital, Southwick Hill Road, Portsmouth Hospitals' NHS Trust, Portsmouth PO6 3LY, UK
| | - Taryn Keyser
- Pharmacy Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK
| | - Richard Puleston
- City Hospital, Institute of Public Health, Nottingham NG5 1PB, UK
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Austin PD, Hand KS, Elia M. Impact of definition and procedures used for absent blood culture data on the rate of intravascular catheter infection during parenteral nutrition. J Hosp Infect 2016; 93:197-205. [PMID: 27117760 DOI: 10.1016/j.jhin.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/06/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diagnosis of intravascular catheter infection may be affected by the definition and procedures applied in the absence of blood culture data. AIM To examine the extent to which different definitions of catheter infection and procedures for handling absent blood culture data can affect reported catheter infection rates. METHODS Catheter infection rates were established in a cohort of hospitalized patients administered parenteral nutrition according to three clinical and four published definitions. Paired and unpaired comparisons were made using available case analyses, sensitivity analyses and intention-to-categorize analyses. FINDINGS Complete data were available for each clinical definition (N = 193), and there were missing data (4.1-26.9%) for the published definitions. In an available case analysis, the catheter infection rate was 13.0-36.8% for the clinical definitions and 2.1-12.4% for the published definitions. For the published definitions, the rate was 1.6-32.1% in a sensitivity analysis and 11.4-16.9% in an intention-to-categorize analysis, with suggestion of bias towards a higher catheter infection rate in those with missing data, in keeping with the analyses of the clinical definitions. For paired comparisons, the strength of agreement between definitions varied from 'poor' (Cohen's kappa <0.21) to 'very good' (Cohen's kappa ≥0.81). CONCLUSION The use of different definitions of catheter infection and procedures applied in the absence of blood culture data produced widely different catheter infection rates, which could compromise measurements or comparisons of service quality or study outcome. As such, there is a need to establish and use a valid, consistent and practical definition.
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Affiliation(s)
- P D Austin
- Faculty of Medicine, University of Southampton, Southampton, UK; Southampton Pharmacy Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Pharmacy Department, Oxford University Hospitals NHS Trust, Oxford, UK.
| | - K S Hand
- Southampton Pharmacy Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - M Elia
- Faculty of Medicine, University of Southampton, Southampton, UK; Institute of Human Nutrition, University of Southampton, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Austin PD, Hand KS, Elia M. Factors influencing Candida albicans growth in parenteral nutrition with and without lipid emulsion: Using an established framework to inform maximum duration of infusion policy decisions. Clin Nutr 2014; 33:489-94. [DOI: 10.1016/j.clnu.2013.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 11/16/2022]
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Hand KS, Harris NC, Spruce AE. An antisense investigation of the role of the gamma-aminobutyric acidB1 receptor subunit in Ca2+ channel modulation in rat sensory neurones. Neurosci Lett 2000; 290:49-52. [PMID: 10925172 DOI: 10.1016/s0304-3940(00)01317-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Activation of gamma-aminobutyric acid(B) (GABA(B)) receptors in dorsal root ganglion (DRG) neurones leads to inhibition of calcium (Ca(2+)) channels. The role of the GABA(B1) receptor subunit was assessed by its depletion achieved by microinjection of DRG neurones with an antisense (A/S) oligodeoxynucleotide (ODN). Control neurones were injected with a scrambled version of the A/S ODN (missense) or were not injected. Patch clamp recordings of Ca(2+) channel current were made two to four days after injection. GABA(B1) A/S substantially reduced the current inhibition induced by baclofen, a GABA(B) agonist. Therefore, most, if not all, native GABA(B) receptors which couple to Ca(2+) channels contain GABA(B1). Moreover, if native receptors are heterodimers of GABA(B1) and GABA(B2), then GABA(B2), in isolation, is unable to sustain coupling to Ca(2+) channels.
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Affiliation(s)
- K S Hand
- Department of Pharmacology, Division of Neuroscience, The Medical School, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
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Koepp MJ, Hand KS, Labbé C, Richardson MP, Van Paesschen W, Baird VH, Cunningham VJ, Bowery NG, Brooks DJ, Duncan JS. In vivo [11C]flumazenil-PET correlates with ex vivo [3H]flumazenil autoradiography in hippocampal sclerosis. Ann Neurol 1998; 43:618-26. [PMID: 9585356 DOI: 10.1002/ana.410430510] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
By using [11C]flumazenil-positron emission tomography ([11C]FMZ-PET), we have previously shown that reductions of central benzodiazepine receptors (cBZRs) are restricted to the hippocampus in mesial temporal lobe epilepsy (mTLE) caused by unilateral hippocampal sclerosis (HS). Receptor autoradiographic studies on resected hippocampal specimens from the same patients demonstrated loss of cBZRs that was over and above loss of neurons in the CA1 subregion. Here, we report the first direct comparison of in vivo cBZR binding with [11C]FMZ-PET and ex vivo binding using [3H]FMZ autoradiography. We applied a magnetic resonance imaging-based method for partial volume effect correction to the PET images of [11C]FMZ volume of distribution ([11C]FMZ Vd) obtained in 10 patients with refractory mTLE due to unilateral, histologically verified HS. Saturation autoradiography was performed on the hippocampal specimens obtained from the same patients, allowing calculation of receptor availability ([3H]FMZ Bmax). After correction for partial volume effect, [11C]FMZ Vd in the body of the epileptogenic hippocampus was reduced by a mean of 42.1% compared with normal controls. [3H]FMZ Bmax, determined autoradiographically from the same hippocampal tissue, was reduced by a mean of 42.7% compared with control hippocampi. Absolute in vivo and ex vivo measurements of cBZR binding for the body of the hippocampus were significantly correlated in each individual. Our study demonstrates that reduction of available cBZR on remaining neurons in HS can be reliably detected in vivo by using [11C]FMZ-PET after correction for partial volume effect.
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Affiliation(s)
- M J Koepp
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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Hand KS, Baird VH, Van Paesschen W, Koepp MJ, Revesz T, Thom M, Harkness WF, Duncan JS, Bowery NG. Central benzodiazepine receptor autoradiography in hippocampal sclerosis. Br J Pharmacol 1997; 122:358-64. [PMID: 9313947 PMCID: PMC1564922 DOI: 10.1038/sj.bjp.0701365] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
1. The gamma-aminobutyric acid (GABA)A/central benzodiazepine receptor (cBZR) complex is a major inhibitory receptor in the vertebrate CNS. Binding of [11C]-flumazenil to this complex in vivo is reduced in hippocampal sclerosis (HS). It has been uncertain whether reduced cBZR binding is entirely due to neuronal loss in HS. 2. The objective of this study was to characterize abnormalities of the cBZR in HS with a correlative autoradiographic and quantitative neuropathological study. 3. Saturation autoradiographic studies were performed with [3H]-flumazenil to investigate relationships between neuronal density and receptor availability (Bmax) and affinity (Kd) in HS. Hippocampal tissue was obtained at surgery from 8 patients with intractable temporal lobe epilepsy (TLE) due to HS and autopsies of 6 neurologically normal controls. Neuronal densities were obtained by means of a 3-D counting method. 4. Bmax values for [3H]-flumazenil binding in the subiculum, CA1, CA2, CA3, hilus and dentate gyrus were all found to be significantly reduced in HS compared with controls and significant increases in affinity were observed in the subiculum, hilus and dentate gyrus. In HS, cBZR density in the CA1 region was significantly reduced (P < 0.05) to a greater extent than could be attributable to neurone loss. In other regions, Bmax was reduced in parallel with neuronal density. 5. In HS, there is a loss of cBZR in CA1 over and above loss of neurones. This finding and increases in affinity for flumazenil in subiculum, hilus and dentate gyrus imply a functional abnormality of the GABAA/cBZR complex that may have a role in the pathophysiology of epileptogenicity in HS.
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Affiliation(s)
- K S Hand
- Department of Pharmacology, School of Pharmacy, London
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