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Guntschnig S, Courtenay A, Abuelhana A, Scott MG. Clinical pharmacy interventions in an Austrian hospital: a report highlights the need for the implementation of clinical pharmacy services. Eur J Hosp Pharm 2023:ejhpharm-2023-003840. [PMID: 37748843 DOI: 10.1136/ejhpharm-2023-003840] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Clinical pharmacy services face challenges in Austria due to limited implementation and acceptance, outdated legislation and a lack of guidelines and training, despite the evidence from global studies of the positive impact of clinical pharmacists on patient care. OBJECTIVES First, to identify the necessary types of clinical pharmacy interventions required at a 360-bed hospital located in Austria. Second, to evaluate the extent to which physicians accept the suggestions made by clinical pharmacists. METHODS Over a period of 27 months, a clinical pharmacist made a series of interventions, which were evaluated using a six-point clinical significance scale. To determine the inter-rater reliability, a subset of 25 interventions was assessed for their clinical significance by four independent internal medicine physicians. RESULTS A total of 1064 interventions were made by the pharmacist. Clinical pharmacy input was deemed necessary for 986 out of 1364 (72.3%) patients, with an average of 1.08 interventions per patient. The prompt acceptance rate of these interventions by physicians was 83.5% (888/1064), while 12.9% (137/1064) were considered by physicians but not immediately acted upon. The average clinical significance intervention rating was 2.15. The inter-rater reliability agreement between the four MDs and between the four MDs and the pharmacist was classified as 'good' to 'moderate'. CONCLUSION This study in a secondary care Austrian hospital demonstrates the requirement for clinical pharmacy services, which are highly valued by other healthcare professionals. The clinical pharmacist is a key member of the multidisciplinary ward team, playing a vital role in reducing drug-related problems and enhancing patient safety. This work should now be scaled and tested in other Austrian hospitals.
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Affiliation(s)
- Sonja Guntschnig
- Tauernklinikum Standort Zell am See, Zell am See, Austria
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, UK
| | - Aaron Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, UK
| | - Ahmed Abuelhana
- School of Pharmacy, University of Ulster Faculty of Life and Health Sciences, Coleraine, UK
| | - Michael G Scott
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, UK
- Medicines Optimisation Innovation Centre, Antrim, UK
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Doherty AS, Adamson G, Mallett J, Darcy C, Friel A, Scott MG, Miller EFR. Minding the gap-an examination of a pharmacist case management medicines optimisation intervention for older people in intermediate care settings. Res Social Adm Pharm 2022; 18:3669-3679. [DOI: 10.1016/j.sapharm.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/14/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
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Abuelhana A, Ashfield L, Scott MG, Fleming GF, Sabry N, Farid S, Burnett K. Analysis of activities undertaken by ward-based clinical pharmacy technicians during patient hospital journey. Eur J Hosp Pharm 2021; 28:313-319. [PMID: 34697047 DOI: 10.1136/ejhpharm-2019-001972] [Citation(s) in RCA: 1] [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: 04/18/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Previous studies recognise insufficient time as an obstacle to pharmacists expanding their clinical-based activities and services. For such a reason, the role of well-trained ward-based clinical pharmacy technicians (CPTs) is to work as an integral part of the pharmacy team to achieve the best patient outcomes and medicines optimisation, releasing pharmacist time to complete more complex clinical-related activities. OBJECTIVE To demonstrate quantitatively the range and extent of daily activities undertaken by CPTs during a patient's hospital journey. METHOD A prospective-based study has been designed. All daily working services and activities undertaken by ward-based CPTs within a 450-bed Acute District General hospital were quantitatively collected and documented. Data were collected from five medical, two surgical and one cardiology wards of 30 beds in each over a period of 2 weeks for each ward representing a total of 70 working days (14 weeks, excluding weekends). RESULTS Results showed the breakdown of seven different ward-based activities throughout a typical working day with the main working load being reviews of the patients' medication charts in order to supply new medicines and refer medicines-related issues to the ward pharmacist, with an average number reviewed of (23.17±0.85) representing 77.23% of the total patients in a 30-bed ward. The CPTs' highest workload was on Mondays and Fridays, mainly during the morning working hours (09:00-12:00). Also, statistically significant differences (p<0.05; Kruskal-Wallis test) existed between the workload of the three different ward specialties (medical, surgical and cardiology) in five clinical activities out of seven undertaken by CPT per day. CONCLUSION CPTs are completing more than seven different ward pharmacy-related activities which enhance medicines optimisation, medicines management and patient care. They are a valuable resource carrying out many roles which were previously completed by junior pharmacists. Their prioritising of patients for review ensures pharmacists focus their efforts on the most vulnerable patients.
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Affiliation(s)
- Ahmed Abuelhana
- School of Pharmacy and Pharmaceutical Sciences, Faculty of Life and Health Sciences, University of Ulster, Coleraine, UK.,Misr University for Science & Technology, Giza, Egypt
| | - Linden Ashfield
- Medicine Optimisation Innovation Center, Northern Health and Social Care Trust, Antrim, UK
| | - Michael G Scott
- Medicine Optimisation Innovation Center, Northern Health and Social Care Trust, Antrim, UK
| | - Glenda F Fleming
- Medicine Optimisation Innovation Center, Northern Health and Social Care Trust, Antrim, UK
| | - Nermin Sabry
- Faculty of Pharmacy, Cairo University, Giza, Egypt
| | - Samar Farid
- Faculty of Pharmacy, Cairo University, Giza, Egypt
| | - Kathryn Burnett
- School of Pharmacy and Pharmaceutical Sciences, Faculty of Life and Health Sciences, University of Ulster, Coleraine, UK
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Syafhan NF, Al Azzam S, Williams SD, Wilson W, Brady J, Lawrence P, McCrudden M, Ahmed M, Scott MG, Fleming G, Hogg A, Scullin C, Horne R, Ahir H, McElnay JC. General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial. J Pharm Policy Pract 2021; 14:4. [PMID: 33397509 PMCID: PMC7784025 DOI: 10.1186/s40545-020-00279-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. METHODS A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. RESULTS Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4-13] to 5 [0-11] vs 8 [3-13] to 7 [3-12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0-3] to 1 [0-2] vs 1 [0-2] to 1 [0-3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of - £229.0 (95% CI - 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI - 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). CONCLUSION The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. TRIAL REGISTRATION ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498.
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Affiliation(s)
- Nadia Farhanah Syafhan
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
| | - Sayer Al Azzam
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | | | | | - Mustafa Ahmed
- Fern House Surgery, Essex, UK
- Douglas Grove Surgery, Essex, UK
| | | | - Glenda Fleming
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Anita Hogg
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Claire Scullin
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.
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Odeh M, Scullin C, Hogg A, Fleming G, Scott MG, McElnay JC. A novel approach to medicines optimisation post-discharge from hospital: pharmacist-led medicines optimisation clinic. Int J Clin Pharm 2020; 42:1036-1049. [PMID: 32524511 PMCID: PMC7476989 DOI: 10.1007/s11096-020-01059-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/11/2020] [Indexed: 11/11/2022]
Abstract
Background There is a major drive within healthcare to reduce patient readmissions, from patient care and cost perspectives. Pharmacist-led innovations have been demonstrated to enhance patient outcomes. Objective To assess the impact of a post-discharge, pharmacist-led medicines optimisation clinic on readmission parameters. Assessment of the economic, clinical and humanistic outcomes were considered. Setting Respiratory and cardiology wards in a district general hospital in Northern Ireland. Method Randomised, controlled trial. Blinded random sequence generation; a closed envelope-based system, with block randomisation. Adult patients with acute unplanned admission to medical wards subject to inclusion criteria were invited to attend clinic. Analysis was carried out for intention-to-treat and per-protocol perspectives. Main Outcome Measure 30-day readmission rate. Results Readmission rate reduction at 30 days was 9.6% (P = 0.42) and the reduction in multiple readmissions over 180-days was 29.1% (P = 0.003) for the intention-to-treat group (n = 31) compared to the control group (n = 31). Incidence rate ratio for control patients for emergency department visits was 1.65 (95% CI 1.05-2.57, P = 0.029) compared with the intention-to-treat group. For unplanned GP consultations the equivalent incident rate ratio was 2.00 (95% CI 1.18-3.58, P = 0.02). Benefit to cost ratio in the intention-to-treat and per-protocol groups was 20.72 and 21.85 respectively. Patient Health Related Quality of Life was significantly higher at 30-day (P < 0.001), 90-day (P < 0.001) and 180-day (P = 0.036) time points. A positive impact was also demonstrated in relation to patient beliefs about their medicines and medication adherence. Conclusion A pharmacist-led post-discharge medicines optimisation clinic was beneficial from a patient care and cost perspective.
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Affiliation(s)
- Mohanad Odeh
- Pharmacy Management and Pharmaceutical Care Innovation Centre, Hashemite University, 13133 Hashemite University, Zarqa, Jordan
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Claire Scullin
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - Anita Hogg
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - Glenda Fleming
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - Michael G Scott
- Medicines Optimisation Innovation Centre (MOIC), Bretten Hall, Northern Health and Social Care Trust, Antrim Site, Antrim, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Hogg A, Huey R, Scott MG, Ferguson A. Informing critical care drug requirements in response to the COVID-19 pandemic. Eur J Hosp Pharm 2020; 27:263-266. [PMID: 32661105 PMCID: PMC7371569 DOI: 10.1136/ejhpharm-2020-002368] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The main aim was to develop a process to estimate critical care drug requirements to robustly inform regional procurement planning and preparedness in response to the COVID-19 pandemic. The objectives were to identify critical care drugs required, obtain patient usage data and consider current regional practice to establish the requirement. METHOD Health and Social Care (HSC) Trusts across Northern Ireland (NI) identified critical care drugs required and an estimation of average daily usage data. The Microsoft Excel database was constructed to compile Trust data and establish regional requirement. The database was refined further according to real-world data from NI HSC Trusts, Intensive Care National Audit and Research Centre report on COVID-19 in critical care, daily regional COVID-19 figures and other available National data. Components of a tool originally developed for H1N1 and updated for COVID-19 were adapted to reflect the NI context and used in the regional database. The database was clinically reviewed to ensure that it accurately reflected current regional practice given the evolving nature of the pandemic. RESULTS The critical care drugs required in the pandemic, usage data and current regional practice were identified to establish requirement. A regional database was constructed and used to produce a model for calculating approximate critical drug requirements. The model was used to map critical drug requirements to available stock in Trusts and wholesalers/suppliers, enabling the identification of treatment capacity for these medicines regionally, both currently and for projected surges. Data have also been used in the preparation of weekly regional situation reports provided to both the HSC Board and the Department of Health. CONCLUSION The process developed is a robust approach to assist in informing regional critical care drug requirements in response to the COVID-19 pandemic. Further application has been demonstrated in regional procurement planning and preparedness.
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Affiliation(s)
- Anita Hogg
- Medicines Optimisation Innovation Centre, Northern Health and Social Care Trust, Antrim, Mid and East Antrim, UK
| | - Rachel Huey
- Medicines Optimisation Innovation Centre, Northern Health and Social Care Trust, Antrim, Mid and East Antrim, UK
| | - Michael G Scott
- Medicines Optimisation Innovation Centre, Northern Health and Social Care Trust, Antrim, Mid and East Antrim, UK
| | - Andrew Ferguson
- Intensive Care Medicine Dept, Belfast Health and Social Care Trust, Belfast, UK
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Odeh M, Scullin C, Fleming G, Scott MG, Horne R, McElnay JC. Ensuring continuity of patient care across the healthcare interface: Telephone follow-up post-hospitalization. Br J Clin Pharmacol 2019; 85:616-625. [PMID: 30675742 DOI: 10.1111/bcp.13839] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/18/2018] [Revised: 11/20/2018] [Accepted: 12/09/2018] [Indexed: 01/14/2023] Open
Abstract
AIMS To implement pharmacist-led, postdischarge telephone follow-up (TFU) intervention and to evaluate its impact on rehospitalization parameters in polypharmacy patients, via comparison with a well-matched control group. METHOD Pragmatic, prospective, quasi-experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine integrated medicines management service. RESULTS Using an intention to treat approach, reductions in 30- and 90-day readmission rates for intervention patients compared with controls were 9.9% [odds ratio = 0.57; 95% confidence interval (CI): 0.36-0.90; P < 0.001] and 15.2% (odds ratio = 0.53; 95% CI: 0.36-0.79; P = 0.021) respectively. Marginal mean time to readmission was 70.9 days (95% CI: 66.9-74.9) for intervention group compared with 60.1 days (95% CI: 55.4-64.7) for controls. Mean length of hospital stay compared with control was (8.3 days vs. 6.7 days; P < 0.001). Benefit: cost ratio for 30-day readmissions was 29.62, and 23.58 for 90-day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire, was reduced 3.2 (95% CI: -4.22 to -2.27; P < 0.001). Mean difference in Medication Adherence Report Scale was 1.4 (22.7 vs. 24.1; P < 0.001). Most patients (83.8%) reported having better control of their medicines after the intervention. CONCLUSIONS Pharmacist-led postdischarge structured TFU intervention can reduce 30- and 90-day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self-reported adherence and satisfaction.
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Affiliation(s)
- Mohanad Odeh
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.,Faculty of Pharmaceutical Sciences, Hashemite University, Jordan
| | - Claire Scullin
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Glenda Fleming
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | | | - Robert Horne
- School of Pharmacy, University College London, London, WC1N 1AX, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
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Khdour MR, Hallak HO, Aldeyab MA, Nasif MA, Khalili AM, Dallashi AA, Khofash MB, Scott MG. Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study. Br J Clin Pharmacol 2018; 84:708-715. [PMID: 29236303 DOI: 10.1111/bcp.13486] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 08/21/2017] [Revised: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022] Open
Abstract
AIMS Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of antimicrobial stewardship programme (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. METHODS A prospective audit with intervention and feedback by ASP team within 48-72 h of antibiotic administration began in September 2015. Four months of pre-ASP data were compared with 4 months of post-ASP data. Data collected included clinical and demographic data; use of antimicrobials measured by defined daily doses, duration of therapy, length of stay, readmission and all-cause mortality. RESULTS Overall, 176 interventions were made the ASP team with an average acceptance rate of 78.4%. The most accepted interventions were dose optimization (87.0%) followed by de-escalation based on culture results with an acceptance rate of 84.4%. ASP interventions significantly reduces antimicrobial use by 24.3% (87.3 defined daily doses/100 beds vs. 66.1 defined daily doses/100 beds P < 0.001). The median (interquartile range) of length of stay was significantly reduced post ASP [11 (3-21) vs. 7 (4-19) days; P < 0.01]. Also, the median (interquartile range) of duration of therapy was significantly reduced post-ASP [8 (5-12) days vs. 5 (3-9); P = 0.01]. There was no significant difference in overall 30-day mortality or readmission between the pre-ASP and post-ASP groups (26.9% vs. 23.9%; P = 0.1) and (26.1% vs. 24.6%; P = 0.54) respectively. CONCLUSIONS Our prospective audit and feedback programme was associated with positive impact on antimicrobial use, duration of therapy and length of stay.
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Affiliation(s)
- Maher R Khdour
- Faculty of Pharmacy, Al-Quds University, Abu Deis, PO Box 20002, West Bank, Palestine
| | - Hussein O Hallak
- Faculty of Pharmacy, Al-Quds University, Abu Deis, PO Box 20002, West Bank, Palestine
| | - Mamoon A Aldeyab
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, UK
| | - Mowaffaq A Nasif
- Head of Intensive Care Department at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, West Bank, Palestine
| | - Aliaa M Khalili
- Internal Medicine Resident at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, West Bank, Palestine
| | - Ahamad A Dallashi
- Internal Medicine Resident at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, West Bank, Palestine
| | - Mohammad B Khofash
- Clinical Pharmacist at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, Palestine
| | - Michael G Scott
- Pharmacy and Medicines Management Centre, Antrim Area Hospital, BT41 2RL, Northern Ireland
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Duma A, Wagner C, Titz M, Maleczek M, Hüpfl M, Weihs VB, Samaha E, Herkner H, Szekeres T, Mittlboeck M, Scott MG, Jaffe AS, Nagele P. High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery. Br J Anaesth 2017; 120:291-298. [PMID: 29406178 DOI: 10.1016/j.bja.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 07/12/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking. METHODS In this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2-6 h, and 18-30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre-1; men >15 ng litre-1). RESULTS Amongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50-84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre-1, 12 patients (13%) between 2 and 4 ng litre-1, three patients between 4 and 6 ng litre-1, and one patient (1%) between 6 and 8 ng litre-1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9-5, inter-quartile range) ng litre-1 at baseline, 4 (3.9-5) ng litre-1 at 2-6 h after surgery, and 4 (3.9-5) ng litre-1 on postoperative day 1. CONCLUSIONS One in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting. CLINICAL TRIAL REGISTRATION NCT 02394288.
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Affiliation(s)
- A Duma
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - C Wagner
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Titz
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Maleczek
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M Hüpfl
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - V B Weihs
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - E Samaha
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria; Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
| | - H Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - T Szekeres
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Mittlboeck
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - M G Scott
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA
| | - A S Jaffe
- Cardiovascular Division, Department of Internal Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA; Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - P Nagele
- Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA.
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Murray J, Muruko T, Gill CIR, Kearney MP, Farren D, Scott MG, McMullan G, Ternan NG. Evaluation of bactericidal and anti-biofilm properties of a novel surface-active organosilane biocide against healthcare associated pathogens and Pseudomonas aeruginosa biolfilm. PLoS One 2017; 12:e0182624. [PMID: 28787014 PMCID: PMC5546580 DOI: 10.1371/journal.pone.0182624] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 07/21/2017] [Indexed: 11/18/2022] Open
Abstract
Healthcare acquired infections (HAI) pose a great threat in hospital settings and environmental contamination can be attributed to the spread of these. De-contamination and, significantly, prevention of re-contamination of the environment could help in preventing/reducing this threat. Goldshield (GS5) is a novel organosilane biocide marketed as a single application product with residual biocidal activity. We tested the hypothesis that GS5 could provide longer-term residual antimicrobial activity than existing disinfectants once applied to surfaces. Thus, the residual bactericidal properties of GS5, Actichlor and Distel against repeated challenge with Staphylococcus aureus ATCC43300 were tested, and showed that GS5 alone exhibited longer-term bactericidal activity for up to 6 days on 316I stainless steel surfaces. Having established efficacy against S. aureus, we tested GS5 against common healthcare acquired pathogens, and demonstrated that, on average, a 1 log10 bactericidal effect was exhibited by GS5 treated surfaces, although biocidal activity varied depending upon the surface type and the species of bacteria. The ability of GS5 to prevent Pseudomonas aeruginosa biofilm formation was measured in standard microtitre plate assays, where it had no significant effect on either biofilm formation or development. Taken together the data suggests that GS5 treatment of surfaces may be a useful means to reducing bacterial contamination in the context of infection control practices.
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Affiliation(s)
- Jason Murray
- Nutrition Innovation Centre for food and HEalth (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, Northern Ireland, United Kingdom
| | - Tendai Muruko
- Nutrition Innovation Centre for food and HEalth (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, Northern Ireland, United Kingdom
| | - Chris I. R. Gill
- Nutrition Innovation Centre for food and HEalth (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, Northern Ireland, United Kingdom
| | - M. Patricia Kearney
- Northern Health and Social Care Trust, Antrim area Hospital, Bush House, Antrim, Co. Antrim, Northern Ireland, United Kingdom
| | - David Farren
- Northern Health and Social Care Trust, Antrim area Hospital, Bush House, Antrim, Co. Antrim, Northern Ireland, United Kingdom
| | - Michael G. Scott
- Northern Health and Social Care Trust, Antrim area Hospital, Bush House, Antrim, Co. Antrim, Northern Ireland, United Kingdom
| | - Geoff McMullan
- Institute for Global Food Security, School of Biological Sciences, Medical Biology Centre, Queens University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Nigel G. Ternan
- Nutrition Innovation Centre for food and HEalth (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, Northern Ireland, United Kingdom
- * E-mail:
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Al-Taani GM, Al-Azzam SI, Alzoubi KH, Darwish Elhajji FW, Scott MG, Alfahel H, Aldeyab MA. Prediction of drug-related problems in diabetic outpatients in a number of hospitals, using a modeling approach. Drug Healthc Patient Saf 2017; 9:65-70. [PMID: 28814901 PMCID: PMC5546779 DOI: 10.2147/dhps.s125114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective Drug-related problems (DRPs) are considered a serious, expensive, and important undesirable complication of health care. However, as current health care resources are limited, pharmacist DRP services cannot be provided to all patients. Using a modeling approach, we aimed to identify risk factors for DRPs so that patients for DRP-reduction services can be better identified. Methods Patients with diabetes from outpatient clinics from five key university-affiliated and public hospitals in Jordan were assessed for DRPs (drug without an indication, untreated indication, and drug efficacy problems). Potential risk factors for DRPs were assessed. A logistic regression model was used to identify risk factors using a randomly selected, independent, nonoverlapping development (75%) subsample from full dataset. The remaining validation subsample (25%) was reserved to assess the discriminative ability of the model. Results A total of 1,494 patients were recruited. Of them, 81.2% had at least one DRP. Using the development subsample (n=1,085), independent risk factors for DRPs identified were male gender, number of medications, prescribed gastrointestinal medication, and nonadherence to self-care and non-pharmacological recommendations. Validation results (n=403) showed an area under the receiver operating characteristic curve of 0.679 (95% confidence interval=0.629–0.720); the model sensitivity and specificity values were 65.4% and 63.0%, respectively. Conclusion Within the outpatient setting, the results of this study predicted DRPs with acceptable accuracy and validity. Such an approach will help in identifying patients needing pharmacist DRP services, which is an important first step in appropriate intervention to address DRPs.
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Affiliation(s)
- Ghaith M Al-Taani
- Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University
| | - Sayer I Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid
| | - Feras W Darwish Elhajji
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Michael G Scott
- Medicines Optimisation Innovation Centre, Pharmacy and Medicines Management Centre, Northern Health and Social Care Trust, Ballymena, Northern Ireland, UK
| | - Hamzah Alfahel
- General and Specialized Surgery Department, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mamoon A Aldeyab
- School of Pharmacy and Pharmaceutical Science, University of Ulster, Coleraine, County Londonderry, UK
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12
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Conlon-Bingham G, Aldeyab M, Kearney MP, Scott MG, Baldwin N, McElnay JC. Reduction in the incidence of hospital-acquired MRSA following the introduction of a chlorine dioxide 275 ppm based disinfecting agent in a district general hospital. Eur J Hosp Pharm 2016; 23:28-32. [PMID: 31156810 DOI: 10.1136/ejhpharm-2014-000608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/02/2014] [Revised: 06/12/2015] [Accepted: 07/22/2015] [Indexed: 11/04/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are major nosocomial pathogens whose control relies on effective antimicrobial stewardship and infection control practices. This study evaluates the impact of a chlorine dioxide-based disinfectant (275 ppm) on the incidence of hospital-acquired (HA) MRSA and HA-Clostridium difficile infection (CDI) in a district general hospital. Methods This study was carried out from November 2009 to September 2013. From November 2009 to October 2011 sodium dichloroisocyanurate was used for routine environmental disinfection. In November 2011, this was changed to a chlorine dioxide 275 ppm based disinfectant. This product was introduced into the hospital in a phased manner with intensive training on its use provided to all nursing, nursing auxiliary and hotel services staff. The effect of this change on the incidence of HA-MRSA and HA-CDI was assessed using segmented regression analysis of interrupted time series. In addition, the potential cost savings as a result of this intervention were assessed. Results The HA-MRSA trend from November 2009 to October 2011 significantly increased (p=0.006). Following the introduction of the chlorine dioxide-based disinfectant there was significant decrease in the HA-MRSA trend, with the monthly incidence being reduced by 0.003 cases/100 bed days (p=0.001), equating to an average of four cases per month after 12 months of use This resulted in an annual potential cost saving of £276 000. No significant effect on the incidence of HA-CDI was observed (coefficient -0.03; p=0.873). Conclusion This study highlights the importance of effective environmental inanimate surface decontamination in controlling the spread of MRSA and the potential cost savings that can be achieved through decreasing HA-MRSA rates.
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Affiliation(s)
- Geraldine Conlon-Bingham
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.,Pharmacy and Medicines Management Centre, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Mamoon Aldeyab
- Pharmacy and Medicines Management Centre, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Mary P Kearney
- Area Microbiology Laboratory, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Michael G Scott
- Pharmacy and Medicines Management Centre, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Naomi Baldwin
- Area Microbiology Laboratory, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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13
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Scott MG, Scullin C, Hogg A, Fleming GF, McElnay JC. Integrated medicines management to medicines optimisation in Northern Ireland (2000–2014): a review. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2014-000512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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El Hajji FWD, Scullin C, Scott MG, McElnay JC. Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms. J Eval Clin Pract 2015; 21:187-97. [PMID: 25496483 DOI: 10.1111/jep.12276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. METHODS Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. RESULTS Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). CONCLUSIONS Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized.
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Affiliation(s)
- Feras W D El Hajji
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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15
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Aldeyab MA, Elshibly SM, McElnay JC, Davies E, Scott MG, Magee FA, Leyden P, Kearney MP. An Evaluation of Compliance with an Antibiotic Policy in Surgical Wards at a General Teaching Hospital in Northern Ireland. Infect Control Hosp Epidemiol 2015; 30:921-2. [DOI: 10.1086/599308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Aldeyab MA, McElnay JC, Scott MG, Davies E, Edwards C, Elhajji FWD, Conlon G, Magee FA, Barr PJ, Kearney MP. An Evaluation of the Impact of a Single-Dose Intravenous Immunoglobulin Regimen in the Treatment of Clostridium difficile Infections. Infect Control Hosp Epidemiol 2015; 32:631-3. [DOI: 10.1086/660203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Maripuu H, Aldeyab MA, Kearney MP, McElnay JC, Conlon G, Magee FA, Scott MG. An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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18
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Aldeyab MA, McElnay JC, Scott MG, Lattyak WJ, Darwish Elhajji FW, Aldiab MA, Magee FA, Conlon G, Kearney MP. A modified method for measuring antibiotic use in healthcare settings: implications for antibiotic stewardship and benchmarking. J Antimicrob Chemother 2013; 69:1132-41. [PMID: 24222612 DOI: 10.1093/jac/dkt458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine whether adjusting the denominator of the common hospital antibiotic use measurement unit (defined daily doses/100 bed-days) by including age-adjusted comorbidity score (100 bed-days/age-adjusted comorbidity score) would result in more accurate and meaningful assessment of hospital antibiotic use. METHODS The association between the monthly sum of age-adjusted comorbidity and monthly antibiotic use was measured using time-series analysis (January 2008 to June 2012). For the purposes of conducting internal benchmarking, two antibiotic usage datasets were constructed, i.e. 2004-07 (first study period) and 2008-11 (second study period). Monthly antibiotic use was normalized per 100 bed-days and per 100 bed-days/age-adjusted comorbidity score. RESULTS Results showed that antibiotic use had significant positive relationships with the sum of age-adjusted comorbidity score (P = 0.0004). The results also showed that there was a negative relationship between antibiotic use and (i) alcohol-based hand rub use (P = 0.0370) and (ii) clinical pharmacist activity (P = 0.0031). Normalizing antibiotic use per 100 bed-days contributed to a comparative usage rate of 1.31, i.e. the average antibiotic use during the second period was 31% higher than during the first period. However, normalizing antibiotic use per 100 bed-days per age-adjusted comorbidity score resulted in a comparative usage rate of 0.98, i.e. the average antibiotic use was 2% lower in the second study period. Importantly, the latter comparative usage rate is independent of differences in patient density and case mix characteristics between the two studied populations. CONCLUSIONS The proposed modified antibiotic measure provides an innovative approach to compare variations in antibiotic prescribing while taking account of patient case mix effects.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, Northern Ireland , UK
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19
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Alahdab OG, Crealey G, Scott MG, Mairs J, McElnay JC. Product standardisation as a tool to control prescribing costs – a case study of alginate liquid preparations. International Journal of Pharmacy Practice 2013; 21:73-81. [DOI: 10.1111/j.2042-7174.2012.00230.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 05/03/2012] [Indexed: 11/29/2022]
Abstract
Abstract
Introduction
Product standardisation involves promoting the prescribing of pre-selected products within a particular category across a healthcare region and is designed to improve patient safety by promoting continuity of medicine use across the primary/secondary care interface, in addition to cost containment without compromising clinical care (i.e. maintaining safety and efficacy).
Objectives
To examine the impact of product standardisation on the prescribing of compound alginate preparations within primary care in Northern Ireland.
Methods
Data were obtained on alginate prescribing from the Northern Ireland Central Services Agency (Prescription Pricing Branch), covering a period of 43 months. Two standardisation promotion interventions were carried out at months 18 and 33. In addition to conventional statistical analyses, a simple interrupted time series analysis approach, using graphical interpretation, was used to facilitate interpretation of the data.
Results
There was a significant increase in the prescribed share of the preferred alginate product in each of the four health boards in Northern Ireland and a decrease in the cost per Defined Daily Dose for alginate liquid preparations overall. Compliance with the standardisation policy was, however, incomplete and was influenced to a marked degree by the activities of the pharmaceutical industry. The overall economic impact of the prescribing changes during the study was small (3.1%).
Conclusion
The findings suggested that product standardisation significantly influenced the prescribing pattern for compound alginate liquid preparations within primary care across Northern Ireland.
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Affiliation(s)
- Ola G Alahdab
- Clinical and Practice Research Group (CPRG), School of Pharmacy, Queen's University, Northern Ireland, UK
| | - Grainne Crealey
- Clinical Research Support Centre, Royal Group of Hospitals Trust, Belfast, Northern Ireland, UK
| | - Michael G Scott
- Pharmacy and Medicines Management, Northern Health and Social Care Trust, Antrim, Northern Ireland, UK
| | - Jill Mairs
- Pharmaceutical Procurement Centre, Whiteabbey Hospital, Newtownabbey, Northern Ireland, UK
| | - James C McElnay
- Clinical and Practice Research Group (CPRG), School of Pharmacy, Queen's University, Northern Ireland, UK
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Harrison C, Timoney M, Scott MG. GRP-006 A Policy Review of the Application of the Integrated Medicines Management Service Model in Northern Ireland. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
UNLABELLED RATIONAL, AIMS AND OBJECTIVE: The aim of the present study was to compare the ease of use and the capability of four approaches [Medication Appropriateness Index (MAI), the Beers' criteria 2003, the Improved Prescribing in the Elderly Tool (IPET) and Health Plan Employer Data and Information Set (HEDIS)] in assessing changes in medication appropriateness in elderly patients over a period of hospitalization. METHODS A retrospective observational study in two hospitals in Northern Ireland using the four measures was undertaken, involving a cohort of 192 patients (aged > 65 years). Medication appropriateness assessments were made at three stages during the patients' hospital 'journey', that is, at admission, during their inpatient stay and at discharge. The identifying rates of inappropriate prescribing in elderly patients in hospital used validated screening tools: MAI, the Beers' criteria 2003, the IPET and HEDIS. RESULTS The MAI was the most comprehensive approach but was also the most time consuming to apply. Data derived using the MAI indicated clearly that there was improved medication appropriateness over the three hospital stay stages (P < 0.001). Although this trend was also significant for the Beers' criteria 2003 (P < 0.05) and the IPET (P < 0.05) approaches, the HEDIS was unable to differentiate changes in appropriateness over time. There was a good correlation between data derived using the MAI and the Beers' criteria 2003 and the IPET approaches; this correlation was not evident for the HEDIS. CONCLUSIONS The MAI is the most convincing tool in evaluating medication appropriateness, but is very time consuming to apply. Beers' criteria 2003 and the IPET perform to an acceptable standard within the clinical setting and are more practical in their application. The HEDIS, although simplest to apply, does not have the sensitivity to measure change in appropriateness over time.
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Affiliation(s)
- Ruoyin Luo
- Clinical and Practice Research Group, School of Pharmacy, Queen's University, Belfast, Belfast, Northern Ireland, UK
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Aldeyab MA, Harbarth S, Vernaz N, Kearney MP, Scott MG, Darwish Elhajji FW, Aldiab MA, McElnay JC. The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings. Br J Clin Pharmacol 2012; 74:171-9. [PMID: 22150975 DOI: 10.1111/j.1365-2125.2011.04161.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The emergence and spread of bacteria producing extended-spectrum beta-lactamases (ESBLs) has important therapeutic and epidemiologic implications. • A key target for the establishment of hospital antibiotic stewardship is reducing the occurrence of additional antibiotic resistance. • Further research is needed to accumulate supporting evidence that reducing antibiotic use will result in a parallel reduction in antibiotic resistance. WHAT THIS STUDY ADDS • Fluoroquinolone restriction reversed ciprofloxacin resistance in primary and secondary healthcare settings. • Fluoroquinolone restriction reduced ESBL-producing bacteria incidence rates in both the primary and secondary healthcare settings. • This study highlights the value of time-series analysis in designing efficient antibiotic stewardship. AIMS The objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates. METHODS The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009). RESULTS Analysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P= 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P= 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P= 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P < 0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P= 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P < 0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates. DISCUSSION This study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, BT9 7BL Belfast, Northern Ireland, UK.
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Deetz CO, Scott MG, Ladenson JH, Seyoum M, Hassan A, Kreisel FH, Nguyen TT, Frater JL. Use of a United States-based laboratory as a hematopathology reference center for a developing country: logistics and results. Int J Lab Hematol 2012; 35:77-81. [PMID: 22938565 DOI: 10.1111/ijlh.12001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 07/16/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION With proper logistical support and sponsorship, a laboratory in an industrialized nation might be able to act as a reference laboratory for clinicians based in a developing country. METHODS We built on previous experience in the clinical laboratory to see whether a specialized histopathology service (hematopathology) could be provided to a developing country without the expertise or experience to do it in country. RESULTS Over an 13-year period, 582 cases from 579 individuals were analyzed. Principal pathologic findings included acute leukemia in 84 cases (14%), dyspoiesis in one or more of the hematopoietic lineages in 65 cases (11%, including three cases with high-grade myelodysplasia), 23 cases (4%) with findings suspicious for a chronic myeloproliferative disorder, 35 cases (6%) with findings suspicious for a lymphoproliferative disorder, and infectious organisms (presumably Leishmania in most instances) in 9 (1%) of cases. Specimens from 45 cases (8%) were unsatisfactory owing to extreme hemodilution and/or specimen degeneration. CONCLUSION With proper support, a medical laboratory in an industrialized nation may serve as a reference facility for a developing nation. The use of existing infrastructure may be remarkably effective to achieve optimal turnaround time. Although the lack of ancillary studies and follow-up biopsies limit the ability to achieve a definitive diagnosis in many cases, this must be viewed in the context of the limited ability to diagnose or manage hematopoietic neoplasia in developing nations.
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Affiliation(s)
- C O Deetz
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
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Aldeyab MA, Kearney MP, Scott MG, Aldiab MA, Alahmadi YM, Darwish Elhajji FW, Magee FA, McElnay JC. An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. J Antimicrob Chemother 2012; 67:2988-96. [PMID: 22899806 DOI: 10.1093/jac/dks330] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital Clostridium difficile infection (CDI) incidence rates. A secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool. METHODS This was an interventional, retrospective, ecological investigation in a medium-sized hospital over 6.5 years (January 2004 to June 2010). The intervention was the restriction of high-risk antibiotics (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and clindamycin). Amoxicillin/clavulanic acid and macrolides were classified as medium-risk antibiotics based on time-series analysis findings and their use was monitored. The intervention was evaluated by segmented regression analysis of interrupted time series. RESULTS The intervention was associated with a significant change in level of use of high-risk antibiotics (coefficient -17.3, P < 0.0001) and with a borderline significant trend change in their use being reduced by 0.156 defined daily doses/100 bed-days per month (P = 0.0597). The reduction in the use of high-risk antibiotics was associated with a significant change in the incidence trend of CDI (P = 0.0081), i.e. the CDI incidence rate decreased by 0.0047/100 bed-days per month. Analysis showed that variations in the incidence of CDI were affected by the age-adjusted comorbidity index with a lag of 1 month (coefficient 0.137051, P = 0.0182). Significant decreases in slope (coefficient -0.414, P = 0.0309) post-intervention were also observed for the monitored medium-risk antibiotics. CONCLUSIONS The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, BT9 7BL Belfast, Northern Ireland, UK.
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Abstract
RATIONALE, AIMS AND OBJECTIVES Previous service development work in the area of integrated medicines management (IMM) has demonstrated clear quality improvements in a targeted group of patients within a hospital in Northern Ireland. In order to determine whether this programme could be transferable to routine practice and thereby assess its generalizability, research has been carried out to quantify the health care benefits of incorporating the concept of IMM as routine clinical practice. METHOD The IMM programme of care was delivered to all eligible patients (subject to inclusion criteria) across two hospital sites in Northern Ireland during normal pharmacy opening hours. All patients were followed up for a period of 12 months from their time of hospital admission. All patient data were collected using the custom-designed Electronic Pharmacist Intervention Clinical System at each stage of their hospital journey, that is, admission, inpatient stay and discharge. RESULTS Patients who received the IMM service benefited from a reduced length of hospital stay on their reference admission (1.42 days; P = 0.020) as well as a reduced length of stay during the first rehospitalization (5.86 days; P = 0.013). There was also a trend of a reduced number of readmissions and a longer time to readmission during the 12-month follow-up period. Potential significant opportunity cost savings were demonstrated as well as a significant improvement in medication appropriateness (discharge vs. reference admission). CONCLUSIONS The IMM programme of care has proven to be transferable to routine hospital care within two hospitals in Northern Ireland. It is anticipated that this current research will further inform the development of IMM as routine clinical practice across Northern Ireland and beyond.
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Affiliation(s)
- Claire Scullin
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Hogg A, Scullin C, Luo R, Currie A, Scott MG, McElnay JC. Do patient bedside medicine lockers result in a safer and faster medicine administration round? Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Aldeyab MA, Devine MJ, Flanagan P, Mannion M, Craig A, Scott MG, Harbarth S, Vernaz N, Davies E, Brazier JS, Smyth B, McElnay JC, Gilmore BF, Conlon G, Magee FA, Elhajji FWD, Small S, Edwards C, Funston C, Kearney MP. Multihospital outbreak of Clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures. Infect Control Hosp Epidemiol 2011; 32:210-9. [PMID: 21460505 DOI: 10.1086/658333] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak. DESIGN Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland. INTERVENTIONS Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene. RESULTS A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, -0.054; lag time, 4 months; P = .003). CONCLUSION These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
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Aldeyab MA, Kearney MP, McElnay JC, Magee FA, Conlon G, Gill D, Davey P, Muller A, Goossens H, Scott MG. A point prevalence survey of antibiotic prescriptions: benchmarking and patterns of use. Br J Clin Pharmacol 2011; 71:293-6. [PMID: 21219412 DOI: 10.1111/j.1365-2125.2010.03840.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of the study was to assess current patterns of antibiotic prescribing and the impact of a hospital antibiotic policy on these practices. METHODS The study involved collecting information regarding hospitalized patients utilizing the ESAC audit tool. RESULTS In the study site hospital, the use of the restricted agents was low whilst the use of the non-restricted agents was high. Compliance with the hospital antibiotic guidelines was 70%. DISCUSSION The findings identified monitoring non-restricted antibiotics and compliance with guidelines as targets for quality improvements in our hospital. Point prevalence surveys may offer a simple method of monitoring antibiotic policies, thus, informing antibiotic stewardship.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.
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Scullin C, McElnay JC, Scott MG, Ryan M, Trouton TG, Baird S. Cost implications of the use of troponin I (cTnI) measurement to diagnose heart conditions. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2001.tb01128.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Focal points
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Affiliation(s)
- C Scullin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - J C McElnay
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - M G Scott
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
| | - M Ryan
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
| | - T G Trouton
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
| | - S Baird
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
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Schober AH, McElnay JC, Scott MG, Kearney MP. The impact of hospital antimicrobial policy on the incidence of Clostridium difficile infection. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2001.tb01123.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Focal points
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Affiliation(s)
- A H Schober
- School of Pharmacy, Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - J C McElnay
- School of Pharmacy, Queen's University of Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - M G Scott
- Antrim Area Hospital, United Hospitals Trust, 45 Bush Road, Antrim BT42 2RL
| | - M P Kearney
- Antrim Area Hospital, United Hospitals Trust, 45 Bush Road, Antrim BT42 2RL
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Alahmadi YM, Aldeyab MA, McElnay JC, Scott MG, Darwish Elhajji FW, Magee FA, Dowds M, Edwards C, Fullerton L, Tate A, Kearney MP. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 2011; 77:233-6. [PMID: 21216032 DOI: 10.1016/j.jhin.2010.09.033] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/10/2010] [Indexed: 11/26/2022]
Abstract
Blood cultures have an important role in the diagnosis of serious infections, although contamination of blood cultures (i.e. false-positive blood cultures) is a common problem within the hospital setting. The objective of the present investigation was to determine the impact of the false-positive blood culture results on the following outcomes: length of stay, hotel costs, antimicrobial costs, and costs of laboratory and radiological investigation. A retrospective case-control study design was used in which 142 false-positive blood culture cases were matched with suitable controls (patients for whom cultures were reported as true negatives). The matching criteria included age, comorbidity score and month of admission to the hospital. The research covered a 13-month period (July 2007 to July 2008). The findings indicated that differences in means, between cases and controls, for the length of hospital stay and the total costs were 5.4 days [95% CI (confidence interval): 2.8-8.1 days; P<0.001] and £5,001.5 [$7,502.2; 95% CI: £3,283.9 ($4,925.8) to £6,719.1 ($10,078.6); P<0.001], respectively. Consequently, and considering that 254 false-positive blood cultures had occurred in the study site hospital over a one-year period, patients with false-positive blood cultures added 1372 extra hospital days and incurred detrimental additional hospital costs of £1,270,381 ($1,905,572) per year. The findings therefore demonstrate that false-positive blood cultures have a significant impact on increasing hospital length of stay, laboratory and pharmacy costs. These findings highlight the need to intervene to raise the standard of blood-culture-taking technique, thus improving both the quality of patient care and resource use.
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Affiliation(s)
- Y M Alahmadi
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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32
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Conlon G, Aldeyab MA, McElnay JC, Scott MG, Magee FA, Davies E, Gill D, Darwish Elhajji FW, Elshibly SM, Kearney MP. Improving and maintaining adherence with hospital antibiotic policies: a strategy for success. J Hosp Infect 2010; 77:88-9. [PMID: 21044809 DOI: 10.1016/j.jhin.2010.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/21/2010] [Indexed: 09/30/2022]
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Aldeyab MA, Kearney MP, Scott MG, Hanley J, McElnay JC. Health-Related Quality of Life after Intensive Care Unit Discharge: A Comparison between 2 Standard Antibiotic Regimens. Infect Control Hosp Epidemiol 2009; 30:807-8. [DOI: 10.1086/599001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aldeyab MA, McElnay JC, Elshibly SM, Hughes CM, McDowell DA, McMahon MAS, Scott MG, Kearney MP. Evaluation of the efficacy of a conventional cleaning regimen in removing methicillin-resistant Staphylococcus aureus from contaminated surfaces in an intensive care unit. Infect Control Hosp Epidemiol 2009; 30:304-6. [PMID: 19215198 DOI: 10.1086/595964] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Burnett KM, Scott MG, Fleming GF, Clark CM, McElnay JC. Effects of an integrated medicines management program on medication appropriateness in hospitalized patients. Am J Health Syst Pharm 2009; 66:854-9. [DOI: 10.2146/ajhp080176] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kathryn M. Burnett
- Kathryn M. Burnett, Ph.D., is Senior Lecturer, Pharmacy Practice,. Department of Pharmacy and Pharmaceutical Sciences, School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland
| | - Michael G. Scott
- Michael G. Scott, Ph.D., is Head of Pharmacy and Medicines Management, Pharmacy Department, Antrim Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland
| | - Glenda F. Fleming
- Glenda F. Fleming, Ph.D., is Pharmacy Liaison Development Manager, Research and Development Office, Belfast, Northern Ireland
| | - Christine M. Clark
- Christine M. Clark, PhD.,. is Independent Pharmacy Consultant, Rossdale, Lancashire, England
| | - James C. McElnay
- James C. McElnay, Ph.D., is Dean, Faculty of Medicine and Health Life Science, The Queen’s University of Belfast, Belfast
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Aldeyab MA, Hughes CM, Kearney MP, Scott MG, McDowell DA, Hanley J, McMahon MAS, Elshibly SM, Bailie R, McElnay JC. Comparison of the effect of ciprofloxacin and Tazocin® on the incidence of meticillin-resistant Staphylococcus aureus (MRSA) in an Intensive Care Unit. Int J Antimicrob Agents 2008; 32:499-504. [DOI: 10.1016/j.ijantimicag.2008.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Revised: 06/07/2008] [Accepted: 06/10/2008] [Indexed: 11/28/2022]
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Aldeyab MA, Monnet DL, López-Lozano JM, Hughes CM, Scott MG, Kearney MP, Magee FA, McElnay JC. Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: a time-series analysis. J Antimicrob Chemother 2008; 62:593-600. [PMID: 18467307 DOI: 10.1093/jac/dkn198] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. A wide range of factors have been suggested to influence the spread of MRSA. The objective of this study was to evaluate the effect of antimicrobial drug use and infection control practices on nosocomial MRSA incidence in a 426-bed general teaching hospital in Northern Ireland. METHODS The present research involved the retrospective collection of monthly data on the usage of antibiotics and on infection control practices within the hospital over a 5 year period (January 2000-December 2004). A multivariate ARIMA (time-series analysis) model was built to relate MRSA incidence with antibiotic use and infection control practices. RESULTS Analysis of the 5 year data set showed that temporal variations in MRSA incidence followed temporal variations in the use of fluoroquinolones, third-generation cephalosporins, macrolides and amoxicillin/clavulanic acid (coefficients = 0.005, 0.03, 0.002 and 0.003, respectively, with various time lags). Temporal relationships were also observed between MRSA incidence and infection control practices, i.e. the number of patients actively screened for MRSA (coefficient = -0.007), the use of alcohol-impregnated wipes (coefficient = -0.0003) and the bulk orders of alcohol-based handrub (coefficients = -0.04 and -0.08), with increased infection control activity being associated with decreased MRSA incidence, and between MRSA incidence and the number of new patients admitted with MRSA (coefficient = 0.22). The model explained 78.4% of the variance in the monthly incidence of MRSA. CONCLUSIONS The results of this study confirm the value of infection control policies as well as suggest the usefulness of restricting the use of certain antimicrobial classes to control MRSA.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, BT9 7BL Belfast, Northern Ireland, UK
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Abstract
RATIONALE, AIMS AND OBJECTIVES To determine whether an increased input by clinical pharmacists at each stage of the patient's hospital journey, from admission through discharge, resulted in an enhanced level of patient care as measured by a number of clinical and economic outcomes. METHODS This project was designed to address medicines management issues in patients deemed at risk of drug-related problems. During the project, these latter patients at the time of admission were randomly assigned to an integrated medicines management (IMM) service group (n = 371) or regular hospital care group (n = 391). The IMM service involved comprehensive pharmaceutical care provided by a pharmacy team throughout each of three stages: patient admission, inpatient monitoring and counselling, and patient discharge. RESULTS Patients who received the IMM service benefited from a reduced length of hospital stay [by 2 days (P = 0.003; independent samples t-test log(e))]. IMM patients also had a decreased rate of readmission over a 12-month follow-up period (40.8% vs. 49.3%; p = 0.027; Fisher's exact test) and an increased time to readmission [20 days longer (P = 0.0356; log rank test)]. A numbers-needed-to-treat calculation indicated that for approximately every 12 patients receiving the IMM service, one readmission to hospital, within 12 months of discharge, would be prevented. The new service was welcomed by cognate health care professionals. CONCLUSION The IMM service proved very effective and can be used as a template to support the implementation of comprehensive pharmaceutical care as a routine service across Northern Ireland and beyond.
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Affiliation(s)
- Claire Scullin
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Scullin C, Scott MG, Gribbin M, McElnay JC. A HRG-based costing model for estimating pharmacy costs associated with surgical procedures. J Clin Pharm Ther 2004; 29:257-62. [PMID: 15153087 DOI: 10.1111/j.1365-2710.2004.00559.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
OBJECTIVE The present study addresses pharmacy expenditure within a surgical directorate in a UK hospital. The aim of the study was to develop a health care resource group (HRG)-based costing model that can be used to forecast pharmacy expenditure based on surgical casemix. Such a model will be of benefit as an expenditure projection tool at a time when hospitals are developing accelerated operation programmes in an attempt to decrease hospital waiting times. METHOD During the period February-April 2000, nursing staff recorded all pharmacy sourced items for each individual operation in the theatres used for general surgery, ENT surgery and gynaecological procedures; each operation was also classified according to its HRG. The associated costs of the items per HRG were identified and the average pharmaceutical cost per HRG calculated and included in the costing model. The model derived costs over the study period were compared with the actual pharmacy expenditure which was obtained from the pharmacy computer system. Finally HRG data for operations carried out in February 2002 were costed using the model for validation purposes. RESULTS The estimated pharmaceutical cost for surgery items for February-April 2000 was 121,235 UK pounds. This figure was 3.92% over the actual pharmaceutical expenditure as determined from computer records. The February 2002 casemix varied considerably from that of 2000. However, the model estimated pharmaceutical cost of surgery performed in February 2002 (38,054 UK pounds) was again very similar to the computer logged expenditure (1.09% under the actual expenditure for that period) indicating the robustness of the HRG-based costing approach.
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Affiliation(s)
- C Scullin
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, N. Ireland, UK
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Burnett KM, Scott MG, Kearney PM, Humphreys WG, McMillen RM. The identification of barriers preventing the successful implementation of a surgical prophylaxis protocol. Pharm World Sci 2002; 24:182-7. [PMID: 12426962 DOI: 10.1023/a:1020565000571] [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] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study was to introduce a protocol for the use of antimicrobials in surgical prophylaxis for the described procedures in Antrim Area Hospital. METHOD Historical data of antimicrobial use were obtained from retrospective analysis of patients' charts, for those patients identified as having one of the following 'clean/contaminated' surgical procedures over the previous six months; cholecystectomy or abdominal hysterectomy. These data were analysed, and a protocol was introduced providing guidelines for the choice of antimicrobial agent, its administration time, route, dose, duration and frequency of treatment. MAIN OUTCOME MEASURE The main outcome measure was the success of the uptake of the protocol following its implementation. RESULTS There was a total of 285 patients identified, 105 prior to and 180 post implementation. Overall, 68% of patients received some form of prophylaxis in the first cycle, and 72% in the second. CONCLUSION Although the introduction of the protocol led to slight improvements in compliance with standard prescribing procedures, with an increase in single-dose prophylaxis, and a reduction in prolonged prophylactic treatment, the improvements did not reach expectations. This paper attempts to identify the possible barriers to protocol implementation.
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Affiliation(s)
- Kathryn M Burnett
- Antrim Hospital Academic Pharmacy Practice Unit, Antrim Area Hospital, Bush Road, Antrim, BT41 2RL, UK
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Al-Eidan FA, McElnay JC, Scott MG, McConnell JB. Management of Helicobacter pylori eradication--the influence of structured counselling and follow-up. Br J Clin Pharmacol 2002; 53:163-71. [PMID: 11851640 PMCID: PMC1874294 DOI: 10.1046/j.0306-5251.2001.01531.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [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] [Received: 03/15/2001] [Accepted: 09/21/2001] [Indexed: 12/20/2022] Open
Abstract
AIMS Helicobacter pylori (H. pylori) eradication rate varies according to the treatment regimen used and other factors, e.g. antimicrobial resistance and patient compliance. The aim of the present study was to evaluate the influence of patient counselling and follow-up on H. pylori eradication rates and to document the effectiveness of a 1 week eradication regimen consisting of lansoprazole (30 mg once daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). METHODS Seventy-six dyspeptic patients, who at endoscopy were found to have gastritis, duodenitis or ulceration, and a positive H. pylori urease test, were recruited. Patients were randomly assigned to an intervention group (n = 38) or a control group (n = 38). Intervention patients received their medicines via the hospital pharmacy and were counselled (and followed up) by a hospital pharmacist. Control patients were given a standard advice sheet and referred to their GP who prescribed the same therapy. RESULTS Intervention patients exhibited a statistically significant improvement in the H. pylori eradication rate (94.7% vs 73.7%; P = 0.02) and compliance (92.1% vs 23.7; P < 0.001). Of the 64 H. pylori eradicated patients, 62 were able to eliminate their antisecretory medication compared with only 12 of the H. pylori persistent patients (P < 0.001). A pharmacoeconomic evaluation indicated that counselling and follow-up reduced the direct costs of eradication by approximately 30 UK pounds per patient. CONCLUSIONS Structured patient counselling and follow-up can have a significant effect on H. pylori eradication rates and should be a routine part of therapy.
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Affiliation(s)
- F A Al-Eidan
- School of Pharmacy, The Queen's University of Belfast, 97 Lisburn Road, Belfast BT7 1PT, Northern Ireland, UK
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Pinckard JK, Zahn J, Ashby L, Parvin CA, Scott MG. Falsely increased i-STAT chloride results for blood samples with increased urea. Clin Chem 2001; 47:2064-6. [PMID: 11673386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- J K Pinckard
- Washington University School of Medicine, Division of Laboratory Medicine, Box 8118, 660 South Euclid Ave., St. Louis, MO 63110, USA
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Uhlmann EJ, Hock KG, Issitt C, Sneeringer MR, Cervelli DR, Gorman RT, Scott MG. Reference intervals for plasma cystatin C in healthy volunteers and renal patients, as measured by the Dade Behring BN II System, and correlation with creatinine. Clin Chem 2001; 47:2031-3. [PMID: 11673373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- E J Uhlmann
- Washington University School of Medicine, Department of Pathology and Immunology, 660 S. Euclid Ave., Box 8118, St. Louis, MO 63110, USA
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Foster K, Despotis G, Scott MG. Point-of-care testing. Cost issues and impact on hospital operations. Clin Lab Med 2001; 21:269-84. [PMID: 11396083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Advancing technology has allowed for the migration of laboratory testing from the central laboratory to the near-patient setting, leading ideally to a shorter therapeutic turnaround time. This potential benefit, however, comes with a price tag. Assessing the cost-benefit ratio on a per test basis cannot effectively be done in a generalized manner, because each hospital must evaluate this with respect to its own unique circumstances. There are, however, certain outcomes, such as decreased LOS and decreased blood-product usage that, if achieved, far outweigh the cost of POCT, justifying its use. Any hospital attempting to implement POCT must also realize that hospital operations are affected by such use and that adjustments and careful laboratory oversight are required.
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Affiliation(s)
- K Foster
- Division of Laboratory Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Nowatzke WL, Parvin CA, Scott MG, Hock K, Cole TG. Correction of positive bias of the Roche Tina-quant II hemoglobin A1c (HbA1c) assay at low HbA1c percentages. Clin Chem 2001; 47:976-8. [PMID: 11325918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Johnson LR, Doherty G, Lairmore T, Moley JF, Brunt LM, Koenig J, Scott MG. Evaluation of the performance and clinical impact of a rapid intraoperative parathyroid hormone assay in conjunction with preoperative imaging and concise parathyroidectomy. Clin Chem 2001; 47:919-25. [PMID: 11325897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND (99m)Tc-sestamibi scans and rapid, intraoperative intact parathyroid hormone (PTH) assays allow preoperative identification of diseased glands and intraoperative confirmation of diseased gland removal, respectively. Use of these two new technologies may facilitate simpler, more concise surgery, shorter hospital stays, and decreased costs for frozen-section analysis. One major drawback to this new strategy has been the high cost of rapid point-of-care PTH assays. METHODS We performed rapid PTH assays with the DPC Turbo PTH assay on the DPC IMMULITE automated analyzer. The number of intraoperative frozen sections, type of anesthesia, surgical approach, length of hospital stay, and pre- and postoperative calcium values were compared between a group of 49 patients undergoing parathyroidectomy where the intraoperative PTH assay was used in conjunction with preoperative imaging, and a historical control group of 55 patients before the use of these two technologies in our institution. RESULTS Comparison of the Turbo PTH assay to the standard IMMULITE PTH assay gave the following: y = 1.08 x - 4.36 (r = 0.97; n = 48). For the 49 patients, the median turnaround time for each intraoperative PTH determination was 19 min (range, 14-40 min). The median decrease in PTH values from baseline was 88% (range, 33-99%). Thirty-seven patients required two PTH determinations, 7 required three, 4 had four, and 1 required five determinations. The average laboratory cost for the rapid intraoperative PTH assays was < $100 per patient (range, $55 to $113). Compared with the control group, the experimental group had significantly fewer frozen sections (1.4 vs 2.5; P < 0.0001), shorter hospital stays (17 discharged on the day of surgery vs none discharged on the day of surgery; P < 0.0001), greater use of local anesthesia (33% vs 0%; P < 0.001), and more unilateral, rather than bilateral neck explorations (65% vs 0%; P < 0.001). CONCLUSIONS The combination of intraoperative Turbo PTH assay and preoperative (99m)Tc-sestamibi scans can lead to significant decreases in laboratory and surgical pathology costs, hospital stays, and exposure to general anesthesia by facilitating concise parathyroidectomy surgery.
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Affiliation(s)
- L R Johnson
- Washington University School of Medicine, Department of Pathology and Immunology, Barnes-Jewish Hospital, St. Louis, MO 63110, USA
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Thorson LM, Doxsee D, Scott MG, Wheeler P, Stokes RW. Effect of mycobacterial phospholipids on interaction of Mycobacterium tuberculosis with macrophages. Infect Immun 2001; 69:2172-9. [PMID: 11254572 PMCID: PMC98144 DOI: 10.1128/iai.69.4.2172-2179.2001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2000] [Accepted: 01/16/2001] [Indexed: 11/20/2022] Open
Abstract
This study demonstrates that pretreatment of macrophages with phosphatidylinositol, of either soya bean or mycobacterial origin, results in a down-regulation of the binding and uptake of Mycobacterium tuberculosis by the phagocytes. We also describe the novel observation that cardiolipin induces an increase in the binding and uptake of M. tuberculosis by macrophages. Neither phospholipid interacts with macrophages via the 2F8 epitope of scavenger receptor A, and treatment of macrophages with either phospholipid results in a down-regulation of CR3 function and tumor necrosis factor alpha production by the phagocyte. We have also shown that the ability of macrophages to interact with mycobacteria is greatly affected by an as yet unidentified product from the interaction of chloroform and polypropylene tubes.
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Affiliation(s)
- L M Thorson
- Division of Infectious and Immunological Diseases, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Scott MG, Hancock RE. Cationic antimicrobial peptides and their multifunctional role in the immune system. Crit Rev Immunol 2001; 20:407-31. [PMID: 11145218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Many species of life contain cationic antimicrobial peptides as components of their immune systems. The antimicrobial activity of these peptides has been studied extensively, and many peptides have a broad spectrum of activity not only against gram-negative and gram-positive bacteria but also against antibiotic-resistant bacteria, fungi, viruses, and parasites. Such cationic antimicrobial peptides can also act in synergy with host molecules, such as other cationic peptides and proteins, lysozyme, and also conventional antibiotics, to kill microbes. It has been found that certain peptides are produced in large quantities at sites of infection/inflammation, and their expression can be induced by bacterial products such as endotoxic lipopolysaccharide (LPS) and proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha). These peptides often have a high affinity for bacterial products, such as LPS, allowing them to modulate the host response and reduce the inflammatory response in sepsis. More recently, they have been found to interact directly with host cells to modulate the inflammatory process and innate defenses.
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Affiliation(s)
- M G Scott
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, Canada
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Miller ER, McElnay JC, Watt NT, Scott MG, McConnell BJ. Factors Affecting the Unplanned Hospital Readmission of Elderly Patients with Cardiovascular Disease. Clin Drug Investig 2001. [DOI: 10.2165/00044011-200121100-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Zhang L, Scott MG, Yan H, Mayer LD, Hancock RE. Interaction of polyphemusin I and structural analogs with bacterial membranes, lipopolysaccharide, and lipid monolayers. Biochemistry 2000; 39:14504-14. [PMID: 11087404 DOI: 10.1021/bi0011173] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [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: 11/30/2022]
Abstract
Three structural variants (PV5, PV7, and PV8) of the horseshoe crab cationic antimicrobial peptide polyphemusin I were designed with improved amphipathic profiles. Circular dichroism spectroscopy analysis indicated that in phosphate buffer polyphemusin I, PV7, and PV8 displayed the spectrum of a type II beta-turn-rich structure, but, like polyphemusin I, all three variants adopted a typical beta-sheet structure in an anionic lipid environment. Both polyphemusin I and variants were potent broad spectrum antimicrobials that were clearly bactericidal at their minimal inhibitory concentrations. The variants were moderately less active in vitro but more effective in animal models. Moreover, these variants exhibited delayed bacterial killing, whereas polyphemusin I killed Escherichia coli UB1005 within 5 min at 2.5 microg/mL. All the peptides showed similar abilities to bind to bacterial lipopolysaccharide (LPS) and permeabilize bacterial outer membranes. Consistent with this was the observation that all peptides significantly inhibited cytokine production by LPS-stimulated macrophages and penetrated polyanionic LPS monolayers to similar extents. None of the peptides had affinity for neutral lipids as evident from both tryptophan fluorescence spectroscopy and Langmuir monolayer analysis. As compared to polyphemusin I, all variants showed reduced ability to interact with anionic lipids, and the hemolytic activity of the variants was decreased by 2-4-fold. In contrast, polyphemusin I efficiently depolarized the cytoplasmic membrane of E. coli, as assessed using a membrane potential sensitive fluorescent dye 3,3-dipropylthiacarbocyanine (diSC(3)5) assay, but the variants showed a substantially delayed and decreased depolarizing ability. The coincident assessment of cell viability indicated that depolarization of the bacterial cytoplasmic membrane potential by polyphemusin I occurred prior to lethal damage to cells. Our data suggest that increase of amphipathicity of beta-sheet polyphemusin I generally resulted in variants with decreased activity for membranes. Interestingly, all variants showed an improved ability to protect mice both against infection by Pseudomonas aeruginosa and from endotoxaemia.
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Affiliation(s)
- L Zhang
- Department of Microbiology and Immunology, University of British Columbia, #300-6174 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3
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