Evaluation of antimicrobial purchasing by companion animal veterinary facilities in Canada, the United Kingdom, and the United States of America (2019-2021)

BACKGROUND

Measuring antimicrobial use is a core component of antimicrobial stewardship. Purchasing data may be easier to obtain than prescription data in some situations, but differences in clinic size, caseload and collection timeframes must be considered.

OBJECTIVE

Our objective was to evaluate purchases of systemic antibacterial agents by small animal veterinary facilities in 5 networks across 3 countries, using a mg/veterinarian full time equivalent (FTE)/week as the metric.

METHODS

Data were obtained from purchasing records of 2194 veterinary facilities from networks from the United States (US, n = 3: US-A, 1036 facilities; US-B, 101 facilities; US-C, 886 facilities), Canada (n = 1: 117 facilities) and the United Kingdom (UK, n = 1: 54 facilities) during 2019-2021.

RESULTS

In total, 20 020 269 767 mg (20.02 t) of antimicrobials were purchased. Overall differences between the UK and North America were driven by significantly higher purchases of amoxicillin-clavulanic acid in the UK (P < .001), with substantially less purchasing of third generation cephalosporins in the UK (P < .0001). A significant association was found between FTE and purchasing, with decreased purchasing (mg/FTE/week) as facility FTE increased. Significant differences also were found among US regions. Facilities in the top 10% of total purchasing accounted for 23%-30% of purchases, compared to only 1.6%-3.8% for the bottom 10%.

CONCLUSIONS AND CLINICAL IMPORTANCE

These data provide useful information about general purchasing trends, inter- and intraregional differences and differences among facility types and identify high purchasing outliers for further investigation.

Comparative life cycle assessment of disposable and reusable laryngeal mask airways

BACKGROUND

Growing awareness of the negative impacts from the practice of health care on the environment and public health calls for the routine inclusion of life cycle criteria into the decision-making process of device selection. Here we present a life cycle assessment of 2 laryngeal mask airways (LMAs), a one-time-use disposable Unique™ LMA and a 40-time-use reusable Classic™ LMA.

METHODS

In life cycle assessment, the basis of comparison is called the "functional unit." For this report, the functional unit of the disposable and reusable LMAs was taken to be maintenance of airway patency by 40 disposable LMAs or 40 uses of 1 reusable LMA. This was a cradle-to-grave study that included inputs and outputs for the manufacture, transport, use, and waste phases of the LMAs. The environmental impacts of the 2 LMAs were estimated using SimaPro life cycle assessment software and the Building for Environmental and Economic Sustainability impact assessment method. Sensitivity and simple life cycle cost analyses were conducted to aid in interpretation of the results.

RESULTS

The reusable LMA was found to have a more favorable environmental profile than the disposable LMA as used at Yale New Haven Hospital. The most important sources of impacts for the disposable LMA were the production of polymers, packaging, and waste management, whereas for the reusable LMA, washing and sterilization dominated for most impact categories.

DISCUSSION

The differences in environmental impacts between these devices strongly favor reusable devices. These benefits must be weighed against concerns regarding transmission of infection. Health care facilities can decrease their environmental impacts by using reusable LMAs, to a lesser extent by selecting disposable LMA models that are not made of certain plastics, and by ordering in bulk from local distributors. Certain practices would further reduce the environmental impacts of reusable LMAs, such as increasing the number of devices autoclaved in a single cycle to 10 (-25% GHG emissions) and improving the energy efficiency of the autoclaving machines by 10% (-8% GHG emissions). For both environmental and cost considerations, management and operating procedures should be put in place to ensure that reusable LMAs are not discarded prematurely.

Relational and overt aggression in preschool

This research was designed as an initial attempt to assess relational aggression in preschool-age children. Our goal was to develop reliable measures of relational aggression for young children and to use these instruments to address several important issues (e.g., the relation between this form of aggression and social-psychological adjustment). Results provide evidence that relationally aggressive behaviors appear in children's behavioral repertoires at relatively young ages, and that these behaviors can be reliably distinguished from overtly aggressive behaviors in preschool-age children. Further, findings indicate that preschool girls are significantly more relationally aggressive and less overtly aggressive than preschool boys. Finally, results show that relational aggression is significantly related to social-psychological maladjustment (e.g., peer rejection) for both boys and girls.

Relational and overt aggression in preschool

This research was designed as an initial attempt to assess relational aggression in preschool-age children. Our goal was to develop reliable measures of relational aggression for young children and to use these instruments to address several important issues (e.g., the relation between this form of aggression and social-psychological adjustment). Results provide evidence that relationally aggressive behaviors appear in children's behavioral repertoires at relatively young ages, and that these behaviors can be reliably distinguished from overtly aggressive behaviors in preschool-age children. Further, findings indicate that preschool girls are significantly more relationally aggressive and less overtly aggressive than preschool boys. Finally, results show that relational aggression is significantly related to social-psychological maladjustment (e.g., peer rejection) for both boys and girls.

Lazaroids--not nitric oxide synthetase inhibitors--improve hemodynamics after thermal injury in anesthetized guinea pigs

Our objective was to study the effects of a lipid peroxidation inhibitor (U74389G) and nitric oxide synthetase inhibitor (NG-methyl-L-arginine) on hemodynamic stability in burn shock. The design was a prospective, placebo control, randomized, and masked multigroup study in a research laboratory of a university hospital. We used 24 guinea pigs (N = 24), and induced burn shock by a scalding thermal injury (75 degrees C) to 35% of their body surface area. Hemodynamics and gas exchange were observed for 90 minutes after the burn injury in the four groups: no burn, burn-control, burn-U74 (10 mg/kg U74389G), and burn-LNMA (20 mg/Kg NG-methyl-L-arginine). The percentage of mean arterial pressure, normalized for the initial value at 30 minutes after the burn injury, decreased in all groups over time but was not significantly different in any group. The normalized percentage of flow also decreased over time in all groups with the slope of the linear regression significantly less in the burn-U74 group (-0.32 95% CI, -0.05, -0.15) and the no burn group (-0.37 95% CI, -0.48, -0.26), compared with the burn-control group (-0.66 95% CI, -0.77, -0.56) and the burn-LNMA group (-0.66 95% CI, -0.77, -0.56). The slope of the linear regression for the normalized percentage of systemic vascular resistance was significantly more marked in the burn-control group (2.45 95% CI, 1.35, 3.54) and the burn-LNMA group (1.22 95% CI, 0.89, 1.55) compared with the no burn group (0.16 95% CI, 0.11, 0.44) or the burn-U74 group (0.34 95% CI, 0.06, 0.74). The burn shock resulted in hemodynamic instability as measured with increased systemic vascular resistance, decreased cardiac output, and mean arterial pressure. Use of a lazaroid (U74389G), not a nitric oxide synthetase inhibitor (NG-methyl-L-arginine), altered the clinical course after thermal injury. These data suggest the importance of lipid peroxidation and free radicals as secondary mediators in the evolution of burn shock.

Patient readiness for scheduled therapies: nursing's positive contribution

In this era of cost accountability and containment, scheduling issues have increasing importance. The authors monitored the readiness of patients in one institution for morning therapy appointments. The purpose of the study, which lasted for a period of 5 days, was to obtain an accurate picture of patient readiness for therapy and to determine whether nurses were able to have patients ready for therapy on time.

Culture confirmation of cytomegalovirus and herpes simplex virus by direct enzyme-labeled DNA probes and in situ hybridization

Using probes consisting of horseradish peroxidase (HRP) directly attached to DNA, scrapings or trypsinized cells from 217 adequate clinical samples were cultured and analyzed in 3 blind studies by in situ hybridization for the presence of cytomegalovirus (CMV) and herpes simplex virus (HSV). Sixty samples were judged inadequate due to insufficient cell numbers; however, this problem was significantly decreased during the course of the study. One hundred and eighteen samples were found positive and 70 samples were found negative for CMV. Scrapings of cultured cells from 29 clinical samples revealed 9 samples which were positive and 20 samples which were negative for HSV. Forty-two additional samples, containing either uninfected cells or cells infected with various strains of CMV, were analyzed for the ability of the HRP-DNA CMV probe to detect such isolates. Twenty samples were positive and 22 negative for CMV. No false-negatives or false-positives were observed for either CMV or HSV. In addition to the specificity noted above neither the CMV nor the HSV DNA probe hybridized to potential contaminants found in clinical specimens.

The coordination of bimanual aiming movements: evidence for progressive desynchronization

It is known that when simultaneous bimanual aiming movements are made to targets with different IDs (Index of Difficulty), Fitts' Law is violated. There is massive slowing of the easy target hand, but a debate has arisen over the degree of synchronization between the hands and whether this effect represents a coordinative structure or interference due to neural cross-talk. This issue was investigated in an experiment with 12 subjects who moved styli forward in the sagittal plane to pairs of targets that differed in difficulty (0.77/3.73 ID and 0.77/5.17 ID). Reaction time, movement time, and kinematic measures of resultant velocity and acceleration were analysed. The results showed clear-cut timing differences between the hands that depended on both the ID difference between target pairs and elapsed time of the movement. The violation of Fitts' Law was confined to the easy target hand. Pronounced individual differences in both timing differences and left-right asymmetry were also noted. Neither the coordinative structure nor the neural cross-talk models can fully account for these data, and it is possible that the initial constraints on movement are moderated by visually driven corrective movements.

Comparison of in situ hybridization and monoclonal antibodies for early detection of cytomegalovirus in cell culture

The abilities of each of four diagnostic tests--direct fluorescent monoclonal antibody (direct FA) staining, indirect fluorescent monoclonal antibody (indirect FA) staining, in situ hybridization with biotinylated DNA probes, and in situ hybridization with DNA probes directly linked to enzymatically active horseradish peroxidase-to detect cytomegalovirus soon after culture were compared. Only the indirect FA test and the in situ hybridization method with directly linked HRP-DNA probes provided consistent and reliable cytomegalovirus detection as early as 15 h postinfection.

The role of the pyriform cortex in the generation of interictal spikes in the kindled preparation

The development of interictal spikes (IIS) was monitored during amygdala or pyriform cortex kindling in a series of 4 experiments. It was found that (1) spike-like transients were often present in the pyriform cortex EEG before kindling had begun; (2) these transients developed progressively into large amplitude and complex IIS as kindling proceeded; (3) the pyriform cortex IIS continued to show the greatest proportion of earliest onset spikes in most animals after kindling was completed; (4) other sites (including the ventral, but not the dorsal hippocampus) gradually developed the capacity to generate IIS as kindling progressed; (5) although specific sites within the pyriform cortex may serve as a generator, their location along the longitudinal axis of the pyriform lobe varied from animal to animal (and did not appear to depend upon the location of the kindling electrode); (6) although there often appeared to be 2 spike types, based on the polarity of the first component, there were also transitional waveforms, raising the possibility that they were variations on a single spike type, and (7) the IIS were often preceded, usually in the pyriform cortex, by reliable pre-spike events (smaller spikes or a 'ripple' on the EEG).

Multiplicity of hepatic excretory mechanisms for organic anions

Previous studies based upon competition between different organic anions for biliary excretion in vivo have suggested that all organic anions share a common hepatic secretory mechanism. Corriedale sheep with an inherited defect in organic anion excretion by the liver were used to study this problem directly without the need for competition studies, the results of which are difficult to analyze. Maximal biliary excretion of sulfobromphthalein (BSP) in mutant Corriedale sheep was less than 7% of that observed in normal sheep whereas maximal biliary excretion of taurocholate, the major organic anion in sheep bile, was not different in mutant and normal sheep. Taurocholate infusion enhanced maximal hepatic excretion of BSP in normal but not in mutant sheep. These studies of an inheritable disorder which appears to be identical to the Dubin-Johnson syndrome in man, demonstrate that taurocholate excretion requires at least one step in biliary excretion which is not required by other organic anions such as bile pigment, porphyrins, drugs, and dyes.