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We calculated the human resources required for an antimicrobial stewardship program (ASP) in Korean hospitals.
Multicenter retrospective study.
Eight Korean hospitals ranging in size from 295 to 1,337 beds.
The time required for performing ASP activities for all hospitalized patients under antibiotic therapy was estimated and converted into hours per week. The actual time spent on patient reviews of each ASP activity was measured with a small number of cases, then the total time was estimated by applying the determined times to a larger number of cases. Full-time equivalents (FTEs) were measured according to labor laws in Korea (52 hours per week).
In total, 225 cases were reviewed to measure time spent on patient reviews. The median time spent per patient review for ASP activities ranged from 10 to 16 minutes. The total time spent on the review for all hospitalized patients was estimated using the observed number of ASP activities for 1,534 patients who underwent antibiotic therapy on surveillance days. The most commonly observed ASP activity was ‘review of surgical prophylactic antibiotics’ (32.7%), followed by ‘appropriate antibiotics recommendations for patients with suspected infection without a proven site of infection but without causative pathogens’ (28.6%). The personnel requirement was calculated as 1.20 FTEs (interquartile range [IQR], 1.02–1.38) per 100 beds and 2.28 FTEs (IQR, 1.93–2.62) per 100 patients who underwent antibiotic therapy, respectively.
The estimated time required for human resources performing extensive ASP activities on all hospitalized patients undergoing antibiotic therapy in Korean hospitals was ~1.20 FTEs (IQR, 1.02–1.38) per 100 beds.
This chapter provides an historical account of why the institutional setting of the BIS has been conducive to the emergence of soft law as a critical tool for managing the global financial system. Soft law developed almost naturally at the BIS as a result of the many technocratic issues it was called on to deal with throughout its long history – be it German reparation payments in the 1930s, the management of the Bretton Woods system of fixed exchange rates in the 1960s or growing financial stability concerns in the 1970s and 1980s and beyond. The Basel I Capital Accord, adopted in 1988, was a political and regulatory watershed in that respect – a non-binding code of conduct agreed by an informal committee of experts (the Basel Committee on Banking Supervision), that was subsequently implemented by national legislation in all the main constituencies. The chapter argues that the relative success of soft law in financial regulation owes a lot to the particular set-up and traditions of the BIS. However, it concludes that in order to be successful in future, soft law – much like the BIS – will have to become ever more inclusive and transparent.
It is a commonplace to state that we live in a time of continuous change. But that doesn’t make it any less true. The force and impact of change become all the more obvious when considering a horizon that spans two generations. Fifty years ago, a mere handful of advanced industrial economies dominated the global economy. Since then, a wide array of countries have emerged as new economic powerhouses. Economic development and prosperity are now more equally spread across the globe than at any other time over at least the past two centuries.
As the global organisation of central banks, the Bank for International Settlements (BIS) has played a significant role in the momentous changes the international monetary and financial system has undergone over the past half century. This book offers a key contribution to understanding these changes. It explores the rise of the emerging market economies, the resulting shifts in the governance of the international financial system, and the role of central bank cooperation in this process. In this truly multidisciplinary effort, scholars from the fields of economics, history, political science and law unravel the most poignant episodes that marked this period, including European monetary unification, the paradigm shifts in economic and financial analysis, the origins and influence of macro-financial stability frameworks, the rise of soft law in international financial governance, central bank crisis management in the wake of the Great Financial Crisis, and, finally, the institutional evolution of the BIS itself.
Standard macroeconomic models make little explicit mention of banks. While this is an acceptable simplification normally, it may neglect important details in the current economic environment, especially with respect to negative interest rates. How banks manage their balance sheets has implications for monetary policy as well as for financial stability. Recent BIS research supports the notion that soundly capitalised banks enjoy lower funding costs and lend more. But a sample of 90 euro area banks reveals that retained earnings, a key source of bank capital, would have been 75% higher had profits been ploughed back into the banks. Negative interest rates may weaken bank profitability, given that deposit rates rarely follow policy rates below zero. Thus, bank funding costs may not fall much, if at all, below zero. The usual relationship that lower interest rates engender more lending may break down when market rates turn negative. A better understanding of banks' funding methods - which vary greatly worldwide - is therefore important when assessing the likely macroeconomic outcomes of monetary policy initiatives.