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First-Time Use of Clinical Pharmacists to Improve Appropriate Antibiotic Prescribing in a Medical ICU in Viet Nam
- Tuan Mai Van, Nhu Hiep Pham, Thi Lan Huong Hoang, Nhat Tan Dang, Thi Ngoc Anh Pham, Thanh Huy Nguyen, Quoc Tuan Cao, Vu Thuy Hang Pham, Nga Nguyen, Amber Vasquez, Lan Nguyen Thi Phong, Hien Bui, Manh Hung Bui
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s236
- Print publication:
- October 2020
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- Article
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Background: Antibiotic overuse has led to increasing rates of antibiotic resistant infections and unnecessary antibiotic costs. Clinical pharmacists can play a key role in optimizing appropriate use of antimicrobials and reducing antimicrobial resistance. However, the role of clinical pharmacists in antimicrobial stewardship is new and not well established in Viet Nam. Objective: We evaluated the use of clinical pharmacists for improved antimicrobial prescribing. Methods: We assembled an antibiotic stewardship program (ASP) team consisting of a clinical pharmacist and a specialist in infection prevention and control in a 60-bed medical intensive care unit (MICU) at Hue Central Hospital in central Viet Nam. During January–September 2018, the ASP team collected baseline antibiotic prescribing days of therapy (DOT) for all antibiotics administered in the MICU. Then, from October 2018 through June 2019, the ASP team reviewed daily positive clinical bacterial cultures and susceptibility results for all patients present in the MICU. They reviewed medical charts, including antimicrobial prescriptions, during week days and only if patient was still in the ICU at the time of ASP rounds. The team recommended changes to antibiotic therapy verbally to physicians and left the decision to change antibiotic therapy to their discretion. The ASP team documented whether their recommendations were accepted or rejected. Statistical significance was determined using the Student t test. Results: The ASP team reviewed 160 medical charts and made 169 ASP recommendations: 122 (72%) to continue current treatment; 24 (14%) to monitor drug levels or obtain diagnostic tests; 10 (6%) to discontinue therapy; 6 (4%) to de-escalate therapy; 5 (3%) to adjust doses; and 2 (1%) to broaden therapy. Only 8 of the recommended changes (5%) were declined by the clinicians. The average monthly DOT for all types of antibiotics declined significantly from 2,213 to 1,681 (24% decrease; P = .04). Reductions in DOT for the most common broad-spectrum antibiotics included colistin from 303 to 276 (P = .75); imipenem-cilastatin 434 to 248 (P = .06); doripenem 150 to 144 (P = .85). Piperacillin-tazobactam increased from 122 to 142 (P = 0.75). Conclusions: We demonstrated that daily review of cultures and antibiotic use decreased overall antibiotic prescribing. Given that few recommendations included discontinuation of therapy, ASP rounds likely raised awareness for clinicians to optimize antibiotic use.
Funding: None
Disclosures: None
7 - Services Liberalization in Vietnam: The Case of FDI in Logistics Sector
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- By Nguyen Anh Thu, Vietnam National University, Vu Thanh Huong, Vietnam National University, Nguyen Thi Minh Phuong, Vietnam National University
- Edited by Siew Yean Tham, Sanchita Basu Das
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- Book:
- Services Liberalization in ASEAN
- Published by:
- ISEAS–Yusof Ishak Institute
- Published online:
- 04 July 2018
- Print publication:
- 14 November 2017, pp 212-241
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Summary
Introduction
Since the Doi Moi in 1986, Vietnam has been progressively opening up its services sector. In recent years, it has made significant efforts to liberalize the sector by participating in various trade agreements, including bilateral, and multilateral agreements related to trade in service, namely GATS (General Agreement on Trade in Services), AFAS (ASEAN Framework Agreement on Services), different ASEAN+1 FTAs and recently the EU–Vietnam FTA (EVFTA) and Trans-Pacific Partnership (TPP) agreement. In line with its commitments, Vietnam has reviewed, revised and issued numerous legislative regulations and policies towards a freer flow of services. Consequently, the regulatory framework related to the services sector in Vietnam has become more transparent and open to foreign suppliers, enabling them to have better access to its domestic services market.
However, the ease of doing business in Vietnam remains at a relatively low ranking — the 90th among 189 countries (World Bank 2016), partly because the services-related policies are still relatively restrictive towards foreign direct investment (FDI). Therefore, there is a need for Vietnam to evaluate its challenges in services liberalization, especially in the aspect of commercial presence (i.e. mode 3), by examining the impediments to FDI inflows in services so as to enable Vietnam to benefit from ASEAN's initiatives to liberalize services.
This chapter analyses the development and contribution of the services sector to Vietnam's economy. It also discusses services trade liberalization under AFAS and GATS along with the domestic FDI policies in the services sector. The logistic sector was selected as a case study for a deeper analysis of Vietnam's services liberalization. Based on these economy-wide and sector-specific discussions, the chapter will identify key challenges facing Vietnam in attracting FDI into the services sector. The chapter concludes with policy recommendations for Vietnam as well as for ASEAN.
3 - Intra-Urban Mobility in Ho Chi Minh City and Hanoi
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- By Patrick Gubry, Institut de Recherche pour le Developpement (IRD), Le Thi Huong, Ho Chi Minh City Institute for Development Studies (HIDS), Tran Thi Thanh Thuy, Ho Chi Minh City Institute for Development Studies (HIDS), Nguyen Thi Thieng, National Economics University (NEU) Institute for Population and Social Studies (IPSS), Pham Thuy Huong, National Economics University (NEU), Vu Hoang Ngan, National Economics University (NEU)
- Edited by Patrick Gubry, Franck Castiglioni, Jean-Michel Cusset, Nguyen Thi Thieng, Pham Thuy Huong
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- Book:
- The Vietnamese City in Transition
- Published by:
- ISEAS–Yusof Ishak Institute
- Published online:
- 21 October 2015
- Print publication:
- 11 February 2010, pp 63-100
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Summary
Ho Chi Minh City and Hanoi are the two largest urban centres in Vietnam as far as population and economic potential are concerned. In recent years, population growth has been a major factor in the economic growth of these centres. However, in both Ho Chi Minh City and Hanoi, the hike in population is causing critical problems in the urban development process. As these cities grow, so does the movement of people in them.
Intra-urban Movement
There has been a tremendous increase in population movement in Vietnam since 1986, when an economic liberalization policy (Doi Moi or Renovation) began to be implemented. Although considerable research has already been done on the migration aspect, there is still not a clear understanding of mobility within the major centres, with a particular focus on the two largest ones, Ho Chi Minh City (overall population of 5 million with 3.7 million in the urban area in 1999) and Hanoi (overall population of 2.7 million with 1.5 million in the urban area). A positive migration balance from the city centres to the suburbs has been observed, based on the two most recent censuses, one conducted in 1989 and the other in 1999. There is a considerable increase in intra-urban mobility in the wake of fast-track urbanization, and this is becoming a key urban planning consideration. This evolution and the policies implemented are impacting the living space of citizens in terms of environment (suggesting improvement) and are tending to increase routine travel distances (suggesting deterioration).
Such intra-urban mobility (that taking place within the administrative limits of the two cities) includes on the one hand intra-urban migration or residential mobility (changing one's residence within the administrative limits), and on the other hand temporary mobility, including commuting movements. This is tending to accentuate the inadequacy of urban infrastructure and transit because of increasing the density of suburban zones, which are the least affluent.