Antipseudomonal antibiotics are commonly prescribed for diabetic foot infections (DFI) at our institution despite a low local prevalence of Pseudomonas aeruginosa. A multidisciplinary team implemented a DFI electronic health record (EHR)-embedded treatment algorithm and order set.

This multi-center, quasi-experimental study evaluated adults on antibiotics admitted for DFI to vascular surgery or medical units pre- and post-implementation of an EHR-embedded treatment algorithm and order set. Exclusion criteria: duplicate patients, concomitant infection, transfer from an outside hospital. Primary endpoint: antipseudomonal use among included patients (DOT/1000 DFI days present). Secondary outcomes: empiric antipseudomonal use, length of stay, 30-day readmission, mortality, amputation, and Clostridioides difficile infection. Patient demographics, diagnostics, treatments, and outcomes were evaluated.

Two hundred ten patients were included with 70 patients included in each group. The post-algorithm group had lower antipseudomonal DOT/1000 DFI days present compared to the pre-intervention group (360 vs 503, P < 0.001). The post-order set group had the lowest antipseudomonal use (347 vs 503, P < 0.001). Empiric antipseudomonal use decreased from 85.7% pre-intervention to 72% post-algorithm and 68.5% post-order set. Collectively, 30-day mortality was < 5%. Amputation during and within 30 days of hospitalization was similar in the pre-intervention (48.6%), post-algorithm (30%), and post-order set (41.4%) groups. Methicillin-susceptible Staphylococcus aureus and Streptococcus spp. were most frequently isolated. Wound cultures were not collected in 24.3%, 22.9%, and 40% of the pre-intervention, post-algorithm, and post-order set group.

EHR-embedded clinical decision-making tools reduce antipseudomonal use for DFI treatment without increasing 30-day mortality or amputation.

Physical activity interventions can confer a range of physical and mental health benefits among young people with mental disorders. In some contexts, such as Ireland, integrated physical activity is not easily available within child and adolescent mental health services. Therefore, an interagency pilot intervention was established in a child and adolescent mental health service in Ireland with the integration of a novel exercise practitioner into the multidisciplinary mental health team.

A qualitative evaluation was conducted to understand the impact of the pilot intervention and to understand issues of implementation that arose throughout.

In-depth qualitative interviews with service users’ parents/guardians (N = 3) and a single focus group with existing service providers (N = 3), framed by the RE-AIM framework were conducted to evaluate the pilot intervention. Data were analysed using thematic analysis to explore themes.

Three overarching themes were identified. These were as follows: (i) Making changes toward healthier physical activity behaviours; (ii) An intervention of therapeutic holism; and (iii) The integrated service delivery.

This research provides insight on the value of a novel integrated exercise practitioner in outpatient young persons’ mental health services in Ireland, indicating an enhanced and complimentary therapeutic service. These findings will be helpful for integrating Exercise Practitioners in this setting going forward.