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To assess antimicrobial prescriber knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship (AS) and associated barriers to optimal prescribing.
A convenience sample of 2,900 US antimicrobial prescribers at 5 acute-care hospitals within a hospital network.
The following characteristics were assessed with an anonymous, online survey in February 2015: attitudes and practices related to antimicrobial resistance, AS programs, and institutional AS resources; antimicrobial prescribing and AS knowledge; and practices and confidence related to antimicrobial prescribing.
In total, 402 respondents completed the survey. Knowledge gaps were identified through case-based questions. Some respondents sometimes selected overly broad therapy for the susceptibilities given (29%) and some “usually” or “always” preferred using the most broad-spectrum empiric antimicrobials possible (32%). Nearly all (99%) reported reviewing antimicrobial appropriateness at 48–72 hours, but only 55% reported “always” doing so. Furthermore, 45% of respondents felt that they had not received adequate training regarding antimicrobial prescribing. Some respondents lacked confidence selecting empiric therapy using antibiograms (30%), interpreting susceptibility results (24%), de-escalating therapy (18%), and determining duration of therapy (31%). Postprescription review and feedback (PPRF) was the most commonly cited AS intervention (79%) with potential to improve patient care.
Barriers to appropriate antimicrobial selection and de-escalation of antimicrobial therapy were identified among front-line prescribers in acute-care hospitals. Prescribers desired more AS-related education and identified PPRF as the most helpful AS intervention to improve patient care. Educational interventions should be preceded by and tailored to local assessment of educational needs.
Neonatal imaging of the central nervous system has progressed rapidly in the last few years, although ultrasound (US) imaging remains the mainstay of bedside investigation. However, with the increased availability of magnetic resonance imaging (MRI), its potential utility is increasing. We highlight the relative usefulness of the imaging techniques available.
Principles of neuroimaging
Neuroinjury in the newborn
• In the preterm a range of potential effects stem from the physiologically large and vascular structure of the germinal matrix of the preterm; and may include the superadded effects of hypoxemia or ischemia. These extend from bleeds, to obstructive lesions of the ventricles, to periventricular leukomalacia. Details of the neuroanatomical effects that are usually seen clinically are discussed below under “A standard approach to assessing normal anatomy on US examinations.” Figure 6.1A–D shows diagrams that depict the anatomical location of the germinal matrix and its potential for damaging changes. These are coupled with corresponding ultrasound images and can be compared with those in Figure 6.2. Figure 6.3A–D shows the relevant comparable MRI images. Figure 6.4A–C shows relevant US anatomy in axial scans obtained via a transmastoid approach. Finally, Figure 6.5A–D shows US Doppler images obtained for the evaluation of the superior sagittal sinus with a corresponding MR venography image.
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