Global hospital survey highlights antibiotic Rx, high guideline complianceThe first data published by the Global Point Prevalence Survey reveal that penicillins with beta-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones were the most frequently prescribed antibiotics, and guideline compliance was 77.4%. The data, from 2015, were published Apr 19 in The Lancet Global Health.The researchers used a standardized web-based surveillance method to gather data from 303 hospitals treating adults in 53 countries, including 8 lower-middle-income and 17 upper-middle-income nations. Of the 86,776 patients, 29,891 (34.4%) received at least one antimicrobial. Of the 41,213 prescriptions for antimicrobials, 36,792 (89.3%) were for systemic use. In addition to the data on the three most popular antibiotics, the authors reported that carbapenems were most frequently prescribed in Latin America and west and central Asia.Of patients who received at least one antimicrobial, 5,926 (19.8%) received a targeted antibacterial for systemic use, and 1,769 (5.9%) received a treatment for multidrug-resistant organisms. The reason for treatment was recorded for 31,694 antimicrobial prescriptions (76.9%), and a stop or review date was specified in 15,778 (38.3%). Local antibiotic guidelines were missing for 7,050 (19.2%) of the 36,792 systemic antibiotic prescriptions, and guideline compliance was 77.4%.The authors conclude, “The Global Point Prevalence Survey complements WHO’s [World Health Organization’s] Global Antimicrobial Surveillance System (which provides a standardised approach for collection, analysis, and sharing of data for antimicrobial resistance) by providing a validated method for measuring the quality of antimicrobial prescribing and the effect of interventions to improve prescribing.”They add, “These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals.”The study was funded by France-based biotechnology company bioMerieux.Apr 19 Lancet Glob Health study Study: Nitrofurantoin beats fosfomycin for uncomplicated UTIA 5-day course of nitrofurantoin resolved a higher rate of uncomplicated urinary tract infections (UTIs) than one dose of fosfomycin, according to a new study published in the Journal of the American Medical Association (JAMA). Both antibiotics are first-line therapies for UTIs.In the multicenter international study, 377 women with a confirmed UTI were randomly dosed with either a 5-day course of nitrofurantoin (100 mg three times a day) or one, 3-gram dose of fosfomycin. The primary outcome was clinical resolution at day 28. Seventy percent of patients who received nitrofurantoin were clinically cleared of their UTIs by day 28, compared with 58% of patients who received fosfomycin.Nitrofurantoin was particularly effective in treating infections caused by Escherichia coli, with 78% of patients being cured by day 28, compared with 50% in the fosfomycin group.An accompanying editorial in JAMA said the study uses a rigorous study design to reaffirm nitrofurantoin’s place as the preferred first-line choice in treating UTIs, which accounts for approximately 10 million ambulatory visits and an estimated $2 billion in total costs each year in the United States. Apr 22 JAMA study Apr 22 JAMA editorial French case study shows evolution of colistin-resistant bacteriaFrench researchers tracked the evolution of a Klebsiella pneumoniae carbapenemase (KPC) strain of bacteria for more than 4.5 years in a patient who ultimately died from sepsis. The case study, published in Clinical Infectious Diseases, shows the bacteria is capable of several genomic and phenotypic diversifications and mutations in a relatively short period, even from drug resistance to susceptibility.The patient contracted the bacterium via a contaminated endoscope at a French tertiary care hospital in 2009. The patient was seeking treatment from chronic infection in the liver’s bile ducts.Researchers collected 17 isolates until the patient died in 2014. All 17 isolates were subjected to whole-genome sequencing. During the study period, a total of 98 genetic events occurred, and the average evolutionary rate of the KPC strain was 7.5 single nucleotide polymorphisms per year per genome.Most interestingly, the researchers reported, “The contaminating strain was colistin resistant but after two years of carriage, all isolates became susceptible to colistin.” Apr 21 Clin Infect Dis study Study finds regional antibiograms may benefit community hospitalsA study of 20 community hospitals in North Carolina and Virginia determined that a regional antibiogram can provide useful information to these hospitals even for low-prevalence pathogens, according to a study today in Infection Control and Hospital Epidemiology.Antibiograms are profiles of antimicrobial susceptibility testing results of a specific pathogen to a battery of antimicrobial drugs. To determine the feasibility and value of developing a regional antibiogram for community hospitals, Duke University scientists analyzed data on 69,778 bacterial isolates across 13 gram-negative pathogen-antibiotic combinations. Combinations ranged from 174 to 27,428 results, for a median of 1,100.The team found that, across all pathogen-antibiotic combinations, 69% of local susceptibility rates fell within 1 standard deviation (SD) of the regional mean, and 97% fell within 2 SDs. But no individual hospital had more than 1 pathogen-antibiotic combination with a local susceptibility rate of more than 2 SDs of the regional mean, and all local susceptibility rates were within 2 SDs of the regional mean for low-prevalence pathogens.The authors conclude, “Small community hospitals frequently cannot develop an accurate antibiogram due to a paucity of local data. A regional antibiogram is likely to provide clinically useful information to community hospitals for low-prevalence pathogens.”Apr 23 Infect Control Hosp Epidemiol abstract
AdvertisementClick Here to Read MoreAdvertisementCommercial Vehicle Group (CVG) has elected Janice Stipp as an independent director to the board, effective February 28, 2019. Stipp will serve on the board’s audit and nominating and governance committees. She will stand for re-election at the company’s 2019 Annual Meeting of Stockholders.Stipp brings more than 35 years of financial and accounting leadership experience and has served as chief financial officer (CFO) of both public and private companies. She currently serves as a director for ArcBest Corp. and is on the Michigan State University Foundation Board. Stipp is a Certified Public Accountant as well as a Chartered Global Management Accountant, and earned her bachelor’s degree in accounting from Michigan State University, in addition to a Master of Business Administration from Wayne State University.CVG also announced the retirement of Richard Snell, effective May 16, without standing for re-election at the 2019 Annual Meeting of Stockholders. Snell has served as a director since 2004 and was chairman of the board from March 2010 through May 2018. Current Chairman Scott Arves thanked departing Director Snell and welcomed Director Stipp to the Board. “Dick has been an invaluable contributor to the Board since the company’s earliest days and provided extraordinary leadership to the board and the company during his tenure. On behalf of the entire board of directors, I want to express my appreciation for Dick’s contributions and friendship as we worked together to support the Company’s strategic goals and priorities.”Advertisement“I also want to welcome Janice to the board,” Arves added. “We are very pleased to have someone of her caliber join us. She brings relevant skills and significant experience in areas of critical importance to the company that will enhance our board’s capabilities as we guide the company through the execution of its long term growth initiatives.”Snell said, “It has been a privilege to serve the shareholders of CVG for 15 years. It has been gratifying to work with the board and management at CVG and I look forward to following their future success.”He added, “Janice will bring relevant experience and fresh perspectives to the board that will help shape the company’s future. I wish her, my fellow directors and CVG the very best.”
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The Fundy Ocean Research Center for Energy (FORCE) will hold an open house event for its underwater platform on Monday.The Fundy Advanced Sensor Technology (FAST) platform is in its final testing and sea trials after being deployed last month.The FAST platform recoverable instrument platform is designed to monitor and characterize the FORCE site. Using a variety of onboard sensing equipment, the platform will help capture data from the Minas Passage, including currents and turbulence, marine life activity, noise levels, and seabed stability.This will be the last chance to check out the platform at Parrsboro Wharf before it goes to sea.Image: Darren Pittman/ImagesEast FORCE
No win no fee agreements have been blamed for a sharp rise in the number of medical negligence claims. The Medical Defence Union says claims increased by almost 20% in 2010 after several years of stable figures. More than half of the allegations were made against GPs for delayed or wrong diagnosis, with 15% resulting from a failure to refer patients and 10% from medication errors. The MDU, which indemnifies more than half of GPs in the UK, today claimed that Conditional Fee Arrangements (CFAs) may be the cause of the rise. Head of claims Jill Harding said: ‘While we cannot know all the reasons behind an individuals patient’s decision to bring a claim after an adverse event, a factor in this increase may be the availability of ‘no win, no fee’ arrangements which enable claimants to litigate with no financial risk. ‘The current difficult economic times may also be a factor. ‘We see no evidence, however, of any deterioration in standards of care or in the professional relationships between our GP members and their patients.’ The MDU is continuing to lend its support for legal reform of the claims system, due to be debated in Parliament this summer following the recent publication of the Jackson Report.
The website – www.portoverview.com – collects status reports on Africa’s 50 most important container terminals and related logistics infrastructure, updated by local independent editors.The portal has been designed to give importers, exports, traders and forwarders the information they require in order to make the best decision on how to move cargo for their customers on the continent, said SeaIntel Maritime Analysis.According to Lars Jensen, ceo of SeaIntel: “Africa really has made some significant steps forward in opening its doors to international trade in the past decade. Africa has shown and continues to show immense potential.”We are not proclaiming to have every incident and positive development covered in every corner of Africa but what we do have is neutral, factual information provided by independent sources, some of whom are logistics operators themselves,” Jensen added.www.portoverview.comwww.seaintel.com
HLPFI reported in April 2016 that site surveys were under way for the GBP10 million (USD12.3 million) development. Some 200 m of new quayside will be added and Forth Ports states that it will be some of the strongest in Scotland, with an ultra-heavy lift pad at one end. It is being built at the east end of the port and will connect with the existing Prince Charles wharf.Forth Ports says it aims to position the Port of Dundee as a decommissioning and oil and gas hub for the North Sea. Construction is scheduled for completion by the end of 2017.Charles Hammond, chief executive of Forth Ports, said: “The Forth Ports Board is fully committed to investing in the Port of Dundee to ensure that the infrastructure is in place to capitalise on the significant opportunities presented by the North Sea oil and gas and decommissioning sectors over the coming years.” www.forthports.co.uk
Public spending watchdogs have once again raised concerns about payments to senior figures at the legal complaints body.Long-awaited annual accounts for 2014-15, published by the National Audit Office (NAO) yesterday, are qualified on the grounds that ‘novel and contentious’ payments to senior staff have not been approved by the Ministry of Justice.This is the second year in a row in which auditors have qualified the accounts of the Office for Legal Complaints. Last year’s accounts were qualified on the basis of what the NAO called irregular expenditure totalling £22,300. This related to expenses claimed by the first chief legal ombudsman, Adam Sampson, who parted company with the office in November 2014.In the latest accounts, a certifying statement by Sir Amyas Morse, comptroller and auditor general, says that in 2014-15 the office ‘made payments in respect of a remuneration scheme for senior staff… which I consider to be novel and contentious. I have concluded that this expenditure is not in conformity with the authorities which govern it and is, therefore, irregular’.The report’s governance statement says that the office is required to continue these payments under ‘contractual commitments to its employees’. Introducing the report, Steve Green (pictured), chair of the Office for Legal Complaints, admits that: ‘Disappointingly, the 2014-15 business year has been dominated by the need to resolve a range of difficult internal issues. These issues largely relate to or derive from some of the many decisions taken at the time that the Legal Ombudsman was being set up in 2010 but which only came to light in early 2014.’However he says: ‘I am confident that we are now well on the way to bringing these issues to a resolution. In spite of these internal challenges the Legal Ombudsman has continued to deliver a consistently effective service while significantly driving down its costs.’Kathryn King, interim chief ombudsman, reported that efficiency measures have cut the cost of the office’s legal jurisdiction from £16m in 2013-14 to just over £12m next year.
Uganda National Ambulance Service that is meant to provide emergency pre-hospital care to the public has failed after two years of its launch, reports the Daily Monitor.18 ambulances were flagged off in 2015 to begin a journey that will lead to better public health care after a team of researchers concluded that road traffic crashes will be the eight leading cause of death and disability by the year 2030. 90 percent of the road traffic injury deaths will occur in developing countries, of which 80 percent will happen in pre-hospital setting.The Ugandan government under an initial plan unveiled in January 2014, 100 ambulances were to be purchases at a cost of $157million over a five year period beginning with the financial year 2014/2015.“The ambulances will be fitted with modern technology where surgery can take place and an emergency telephone number known to people in case of need. The ambulance would reach the survivors in 10 to 20 minutes depending on the location,” said a government doctor during the launch.Initial batch of about 100 medical workers, ambulance drivers and crews had to be recruited and trained. The staff had their contracts cancelled during government restructuring and those that theirs expired were never renewed.Many of the ambulances are parked on grounds after due to lack maintenance service blamed on lack of funds. The Emergency number for modern ambulances for a toll free communication system, is not working.The Ugandan government is working on a National Emergency Care strategy that will see a National Ambulance System with ambulances in strategic areas coordinated by a command Centre instead of hospitals running them.As it stands less than 5% (patients) arrive by ambulance because few exist and these are mostly privately owned and prohibitively expensive. Furthermore, one in three patients arrive at Mulago (main hospital in the country) beyond the first hour after the injury, the ‘‘golden hour,’’ during which expedient treatment would greatly increase survival according to research.
The Argentine spoke of a “mutual respect” between the Barcelona and Real Madrid stars and admits his counterpart has achieved great thingsLionel Messi says Cristiano Ronaldo is a “great player”, but insists he does not strive to outperform his Real Madrid counterpart.Debate continues to rage on over who is better between the Barcelona and Madrid icons, having recently come up again after Ronaldo won the Ballon d’Or and The Best FIFA mens’ player award. The accolades were awarded to the former Real Madrid star for leading both Madrid and Portugal to European glory in 2016, as well as winning the Club World Cup.While Messi has not been able to win international honours with Argentina, having lost two Copa America finals and the World Cup final, Messi is a five-time winner of the Ballon d’Or and is widely believed to be the best player that has ever existed.There is a rivalry between the two Clasico stars, but Messi says his desire to shine comes from wanting to perform for Barca and Argentina as opposed to outshining Ronaldo.“There is a mutual respect,” he told Coach. “I view him as a great player who has achieved great things because that is exactly what he is.“My motivation, though, has always come from wanting to do well for Barcelona and Argentina, and the fans.”After losing in the Copa America final on penalties to Chile, in which Messi missed his, the attacker announced his retirement from international football, only to come back a few months later and he says he still hopes he can win silverware with his country.“After the disappointment of losing the final I had time to think and to speak with people, and I felt it was the right option to reverse my decision. I still have big ambitions to win a trophy with Argentina.”He added: “I hate to lose. It does not just affect me for a few hours after the game, but for longer. I can not stand the feeling to lose. You can use that to make sure you give everything you need to to win.”