Implementing antimicrobial stewardship in the Australian private hospital system: a qualitative study.

Objective: To explore organisational factors and barriers contributing to limited uptake of antimicrobial stewardship (AMS) in Australian private hospitals and to determine solutions for AMS implementation.

Methods: A qualitative study using a series of focus group discussions was conducted in a large private hospital making use of a semistructured interview guide to facilitate discussion among clinical and non-clinical stakeholders. A thematic analysis using five sequential components that mapped and interpreted emergent themes surrounding AMS implementation was undertaken by a multidisciplinary team of researchers.

Venous thromboembolism prophylaxis in the critically ill: a point prevalence survey of current practice in Australian and New Zealand intensive care units.

Background: Critically ill patients are at high risk of morbidity and mortality caused by venous thromboembolism (VTE). In addition to premorbid predisposing conditions, critically ill patients may be exposed to prolonged immobility, invasive intravascular catheters and frequent operative procedures, and further may have contraindications to pharmaceutical prophylactic measures designed to attenuate VTE risk. There are limited data describing current VTE prophylaxis regimens in Australia and New Zealand.

Antibiotic prophylaxis for cardiac surgery in Australia.

Objective: To evaluate national practice for antibiotic prophylaxis in cardiac surgery with respect to the use of protocols, agent selection and duration of administration.

Design, Setting And Participants: Two point-prevalence surveys of intensive care units in 24 public and 27 private hospitals performing cardiac surgery in Australia, conducted in 2004 and 2008, using a structured telephone questionnaire of the attending senior intensive care clinician in each unit.

Main Outcome Measures: Existence of a protocol in the unit for antibiotic prophylaxis, specific antibiotic agents used and their duration of administration.

Documentation of clinical review and vital signs after major surgery.

Objective: To describe the quality of postoperative documentation of vital signs and of medical and nursing review and to identify the patient and hospital factors associated with incomplete documentation.

Design, Setting And Participants: Retrospective audit of medical records of 211 adult patients following major surgery in five Australian hospitals, August 2003--July 2005.

Main Outcome Measures: Proportion of patients with complete documentation of medical review (each day) and nursing review and vital signs (heart rate, blood pressure, respiratory rate, temperature and oxygen saturation) (each nursing shift), and the proportion of available opportunities for medical and nursing review where documentation was incomplete.

Critically ill obstetric patients in Australia: a retrospective audit of 8 years' experience in a tertiary intensive care unit.

Objective: To review the indications for admission, demographics, clinically relevant aspects of medical care and outcomes of critically ill obstetric patients admitted to a tertiary hospital intensive care unit.

Design: Retrospective review.

Setting And Participants: General medical and surgical ICU of a tertiary university-affiliated hospital in central Melbourne, Victoria, Australia.

Acute stress ulceration prophylaxis: point prevalence surveys in intensive care units in Victoria, 1997 and 2005.

Objective: To assess current practice in acute stress ulceration (ASU) prophylaxis in adult intensive care units in Victoria, Australia, in 1997 and 2005.

Methods: Point prevalence surveys using a structured telephone questionnaire of ASU prophylaxis practices were performed in adult ICUs in Victoria on 11 November 1997 and 13 April 2005.

Results: All Victorian ICUs identified on each study day participated, comprising 30 ICUs in 1997 and 35 ICUs in 2005.

Heparin: the cheap alternative for immunomodulation in sepsis?

Severe sepsis, involving a systemic inflammatory response caused by infection and acute organ dysfunction, is one of the most common non-cardiac causes of death in intensive care unit patients worldwide. The mainstay of treatment for severe sepsis is aggressive antibiotic therapy combined with supportive care for associated organ dysfunction. In 2001, recombinant human activated protein C was shown to improve survival in patients with severe sepsis, but two further studies of the immunomodulatory effects of endogenous anticoagulant agents did not show any survival benefit.

Helicobacter pylori in intensive care: why we should be interested.

Helicobacter pylori is estimated to infect over 50% of the world's population, the majority of whom are asymptomatic. Although most research to date has focused on local gastroduodenal disease manifestations, the potential impact of H. pylori infection and the associated chronic active inflammation on systemic disease processes is now being explored.