Antimicrobial stewardship in Australia: the role of qualitative research in programme development.

Antimicrobial stewardship (AMS) in Australia is supported by a number of factors, including enabling national policies, sectoral clinical governance frameworks and surveillance programmes, clinician-led educational initiatives and health services research. A One Health research programme undertaken by the National Centre for Antimicrobial Stewardship (NCAS) in Australia has combined antimicrobial prescribing surveillance with qualitative research focused on developing antimicrobial use-related situational analyses and scoping AMS implementation options across healthcare settings, including metropolitan hospitals, regional and rural hospitals, aged care homes, general practice clinics and companion animal and agricultural veterinary practices. Qualitative research involving clinicians across these diverse settings in Australia has contributed to improved understanding of contextual factors that influence antimicrobial prescribing, and barriers and facilitators of AMS implementation.

Feasibility and Validity of a Framework for Antimicrobial Stewardship in General Practice: Key Stakeholder Interviews.

There is little guidance about developing systems for antimicrobial stewardship (AMS) for general practice. A literature review identified six key components: governance, monitoring of antibiotic prescribing and resistance with feedback to prescribers, consultation support, education of the public and general practitioners, pharmacist and nurse involvement, and research, which were incorporated into a potential framework for the general practice context. Objectives: to determine the feasibility and validity of the proposed AMS framework.

Antimicrobial Stewardship in General Practice: A Scoping Review of the Component Parts.

There is no published health-system-wide framework to guide antimicrobial stewardship (AMS) in general practice. The aim of this scoping review was to identify the component parts necessary to inform a framework to guide AMS in general practice. Six databases and nine websites were searched.

Use of electronic medical records to describe general practitioner antibiotic prescribing patterns.

Background And Objectives: The computerised medical records of general practice patients can inform our understanding of antibiotic prescribing and assist in antimicrobial stewardship (AMS). The aim of this study was to describe Australian general practitioner (GP) antibiotic prescribing patterns using data extracted from electronic medical records (EMR).

Method: A descriptive analysis of patient records from 44 general practices, between 2010 and 2014, in the eastern region of metropolitan Melbourne was undertaken.

Effectiveness of interventions involving pharmacists on antibiotic prescribing by general practitioners: a systematic review and meta-analysis.

Background: The use of community antibiotic stewardship programmes (ASPs) is rising; however, their effectiveness when pharmacists are involved is uncertain.

Objectives: To assess the effectiveness of ASPs involving pharmacists at improving antibiotic prescribing by general practitioners (GPs).

Methods: Medline, Embase, Emcare, PubMed, PsycINFO, Cochrane CENTRAL, CINAHL Plus and Web of Science databases were searched to February 2018.

Antimicrobial prescribing for children in primary care.

Aim: To describe the patterns of antimicrobial prescribing in general practice for children aged ≤18 years.

Methods: This is a review of routinely collected patient data extracted from computerised medical records from 39 general practices in eastern metropolitan Melbourne over a 5-year period, 2010-2014.

Main Outcome Measures: Proportion of paediatric consultations resulting in antibiotic prescription, type and frequency of antibiotics prescribed, antibiotic prescribing stratified by age, reason for indication and inter-practice variation.

Improving antibiotic prescribing by general practitioners: a protocol for a systematic review of interventions involving pharmacists.

Introduction: Effective antibiotic options in general practice for patients with infections are declining significantly due to antibiotic over-prescribing and emerging antibiotic resistance. To better improve antibiotic prescribing by general practitioner (GP), pharmacist-GP collaborations have been promoted under antibiotic stewardship programmes. However, there is insufficient information about whether and how pharmacists help GPs to more appropriately prescribe antibiotics.

Riding into the golden years: injury patterns and outcomes of advanced-age motorcycle trauma.

Background: Our objectives were to characterize injury, complications, and outcomes for older riders after motorcycle accidents due to the rising trend in advanced-age motorcyclists.

Methods: From 2008 to 2013, injured motorcyclists were compared by age group: younger (0 to 54 years) vs older (≥55 years) in a retrospective review of the trauma databank at North Memorial Medical Center, a Level-1 trauma center.

Results: Of 432 patients, the older group (n = 100) had more fractures (60% vs 42%), injuries per patient (2 vs 1), intensive care unit admissions (48% vs 32%), ventilator days (8 vs 5), in-hospital complications (16% vs 8%), and hospital days (5.

Ectopic ureter presenting as anterior wall vaginal prolapse.

The differential diagnoses for anterior wall vaginal prolapse (AWVP) include cystocele, enterocele, urethral diverticulum, and Gartner duct cyst. We present a case of a patient with a known solitary right kidney (congenital absence of a left kidney) presenting with lower urinary tract symptoms, absence of urinary incontinence, and feeling of bulge in the vagina. Physical examination revealed grade II AWVP.

Laparoscopic repair of an incarcerated right indirect sliding inguinal hernia involving a retroperitoneal ileum.

Introduction: Laparoscopic techniques for the repair of inguinal hernias have become an increasingly popular alternative to open techniques. No clear consensus has emerged as to the best laparoscopic technique, but the body of evidence increasingly favors a total extraperitoneal (TEP) approach.

Results And Discussion: We report the case of an adult man with an incarcerated right indirect inguinal sliding hernia involving the first known instance of a retroperitoneal ileum, and the novel use of a laparoscopic combined TEP approach and transabdominal preperitoneal (TAPP) approach to repair his hernia without complications.

Cardiac surgery in patients with major lower extremity amputation: a single institution experience.

Background: Cardiac surgery patients with lower-extremity amputations pose a challenge in terms of medical comorbidities and functional recovery.

Methods: A retrospective review of all patients (n=10) with preexisting below-knee amputation (BKA) or more proximal amputation level who underwent cardiac surgery between April 1998 and April 2008. Data were analyzed to evaluate outcomes.

Accuracy and precision of a robotic sample processor.

The accuracy and precision of the Packard Probe 1000, a computer-driven robotic sample processor, were determined using NCCLS Guideline 18-P, employing a rigorous gravimetric procedure. For volumes of 25, 100, and 200 muL, inaccuracy ranged from -0.5 to +0.

Legionella fairfieldensis sp. nov. isolated from cooling tower waters in Australia.

Three Legionella-like organisms were isolated from water from the cooling towers of two Australian institutions. The strains grew on buffered charcoal-yeast extract (BCYE) agar but not on BCYE agar in the absence of L-cysteine. Gas-liquid chromatography profiles of the isolates were consistent with those for Legionella spp.

Characterization of a Legionella anisa strain isolated from a patient with pneumonia.

Legionella anisa, previously found only in environmental specimens, was isolated from a bronchial lavage specimen of an immunocompromised patient with pneumonia. Growth, physiologic, gas-liquid chromatographic, serologic, and DNA characteristics were consistent with those of the type strain of L. anisa, WA-316-C3 (ATCC 35292).

Assay of follitropin and lutropin by fluorescence enzyme immunoassay.

Recently developed fluorescent enzyme immunoassays (FEIs) for follitropin (FSH) and lutropin (LH) designed for the Stratus analyzer were compared with a typical dual FSH-LH radioimmunoassay (RIA) procedure. The FEIs use monoclonal antibodies in a sandwich reaction scheme similar to that of immunoradiometric procedures but with filter paper tabs rather than polystyrene beads and alkaline phosphatase as a tag instead of a radioisotope. Precision of the FEI was comparable with that of the RIA tests with CVs typically under 10%.

Seroepidemiology of Chlamydia trachomatis infection in infertile women in Melbourne.

A serological study was undertaken to determine the prevalence of antibody to Chlamydia trachomatis in women and to investigate any possible role of the organism in infertility and pelvic inflammatory disease. Thirty-seven per cent of pregnant women were found to have antibodies to Chl. trachomatis, as were 69% of women with pelvic inflammatory disease.

The antibody response to Brucella: immunoglobulin response measured by enzyme-linked immunosorbent assay and conventional tests.

An enzyme-linked immunosorbent assay was adapted to measure total and individual classes of brucella antibody. The results were compared with those of conventional tests for brucella antibody on the sera of a number of healthy seropositive abattoir workers and several patients with either acute or suspected chronic brucellosis. IgG was the class of brucella specific immunoglobulin most commonly detected in all groups.

Pseudohypoparathyroidism presenting as renal osteodystrophy.

Pseudohypoparathyroidism (pseudo HPT) is the prototype of a group of diseases with end organ unresponsiveness to parathyroid hormone (PTH). Patients with the classic form of this disease have both renal and osseous resistance to PTH. We describe a rare variant of pseudo HPT with classic renal unresponsiveness to PTH but normal skeletal responsiveness to this hormone.

The diagnosis of a choledochal cyst by ultrasound.

A case of a choledochal cyst is described in which the correct diagnosis was obtained preoperatively by ultrasound. The cyst contained calculi. A specific preoperative diagnosis will lead to lower operative morbidity and mortality.

A radiographic and histologic study of fracture healing in osteopetrotic rats.

Repair of tibial fractures in osteopetrotic rats was delayed in comparison to that of normal littermates, due to reduced remodeling. Reduced bone resorption, known to be the cause of the disease in this mutation, is expressed in both skeletal development and fracture repair. The possible implications for human juvenile osteopetrosis are discussed.