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Skin and soft-tissue infections (SSTIs) account for 3% of all emergency department (ED) encounters and are frequently associated with inappropriate antibiotic prescribing. We characterized barriers and facilitators to optimal antibiotic use for SSTIs in the ED using a systems engineering framework and matched them with targeted stewardship interventions.
Design and participants:
We conducted semistructured interviews with a purposefully selected sample of emergency physicians.
An interview guide was developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Interviews were recorded, transcribed, and analyzed iteratively until conceptual saturation was achieved. Themes were identified using deductive directed content analysis guided by the SEIPS model.
We conducted 20 interviews with physicians of varying experience and from different practice settings. Identified barriers to optimal antibiotic prescribing for SSTIs included poor access to follow-up (organization), need for definitive diagnostic tools (tools and technology) and fear over adverse outcomes related to missed infections (person). Identified potential interventions included programs to enhance follow-up care; diagnostic aides (eg, rapid MRSA assays for purulent infections and surface thermal imaging for cellulitis); and shared decision-making tools.
Using a systems engineering informed qualitative approach, we successfully characterized barriers and developed targeted antibiotic stewardship interventions for SSTIs managed in the ED work system. The interventions span multiple components of the ED work system and should inform future efforts to improve antibiotic stewardship for SSTIs in this challenging care setting.
The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems and hospitals to rapidly modify standard practice, including antimicrobial stewardship services. Our study examines the impact of COVID-19 on the antimicrobial stewardship pharmacist.
A survey was distributed nationally to all healthcare improvement company members.
Pharmacist participants were mostly leaders of antimicrobial stewardship programs distributed evenly across the United States and representing urban, suburban, and rural health-system practice sites.
Participants reported relative increases in time spent completing tasks related to medication access and preauthorization (300%; P = .018) and administrative meeting time (34%; P = .067) during the COVID-19 pandemic compared to before the pandemic. Time spent rounding, making interventions, performing pharmacokinetic services, and medication reconciliation decreased.
A shift away from clinical activities may negatively affect the utilization of antimicrobials.
The purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.
Language barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.
We conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.
Physicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.
To describe: household dietary diversity across four zones in Ethiopia; the relationship between household dietary diversity and consumption of vitamin A-rich foods; and the relationship between household dietary diversity and food security status.
This was a cross-sectional survey. Data were collected using structured questionnaires in the local language. Household dietary diversity scores measured types of foods households consumed, and households were classified by food security status using a modified version of the Household Food Insecurity Access Scale. An ordinal logistics regression model was created to assess the relationship between three tiers of dietary diversity (low, medium and high) and food security while controlling for agricultural zone, educational variables and household characteristics.
Rural households in Tigray, Ethiopia.
Three hundred households in Tigray, Ethiopia, were interviewed.
Of the households, 23, 47 and 30 % had low, medium and high dietary diversity, respectively. Among households with high dietary diversity, eggs and fruit were the most common foods added to the diet. In the fully adjusted model, participants who reported being food secure had 1·8 increased odds of greater dietary diversity (95 % CI 1·0, 3·2) compared with participants who were food insecure.
Food security was positively associated with dietary diversity. In order to enhance health, interventions that improve dietary diversity and vitamin A consumption should remain important areas of focus for health leaders in the region.
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