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Evaluating the Prevalence of Leading Practices in Antimicrobial Stewardship
- Barbara Braun, Salome Chitavi, Eddie Stenehjem, Mushira Khan, David Baker, David Hyun
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s41
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- Article
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- Open access
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Background: Most hospitals have a basic infrastructure in place for antimicrobial stewardship programs (ASPs). Although this is a critical first step, we need to ensure that ASPs are working to implement effective evidence-based approaches nationally. In 2018, a group of leading antibiotic stewardship organizations met and identified specific, effective, and recommended ASP activities based on current scientific evidence and their experience (Baker et al, Joint Comm J Qual Pat Saf 2019;45:517–523). To determine the extent to which hospitals are currently implementing the recommended practices, we conducted an electronic questionnaire–based assessment. Methods: A 50-item questionnaire-based assessment was sent via QualtricsTM to the hospital’s designated ASP leader. The sample comprised 992 Joint Commission accredited hospitals. The practices of interest related to (1) development of facility-specific treatment guidelines, (2) measuring appropriate use and concordance of care with these guidelines, (3) engaging clinicians while the patient is on the unit, (4) diagnostic stewardship, (5) measurement of antimicrobial utilization data, and (6) measuring hospital-acquired Clostridioides difficile infection (CDI) rates. Sampling weights were used to adjust the results for nonresponse using R software. Results: In total, 288 hospitals completed the questionnaire. Small and nonteaching hospitals were significantly less likely to respond (p < 0.005, p=0.01 respectively), however there were no differences by healthcare system membership or urban/rural location. 49% of respondents had the specialist term ASP or infectious disease (ID) in their title. Most hospitals (93.1%) had developed facility-specific treatment guidelines for specific inpatient conditions, often community-acquired pneumonia (85%), sepsis (81%), UTI (75%), and SSTI (69%). However, only 37% had formally assessed compliance with 1 or more of these guidelines. Also, 83% reported having a process for prospective audit and feedback, of which 43% do this 4–5 days per week. Similarly, 49% reported that they review all antimicrobials ordered. Recommendations are commonly given by the ASP pharmacist (69%) via some combination of telephone (78%), face-to-face (69%), text message (54%), and/or EHR alert (36%). Overall, 66% of hospitals had procedures in place to prevent inappropriate diagnostic testing for C. difficile, and 39% of hospitals had similar policies for urine specimens. Furthermore, >80% were routinely measuring days of therapy and CDI rates. Conclusions: Most hospitals have facility-specific treatment guidelines and measure CDI and days of therapy. Practices for active engagement with frontline staff in prospective audit and feedback vary widely. Greater understanding of barriers to assessing adherence to hospitals’ treatment guidelines is critical to improving this practice.
Funding: The Pew Charitable Trusts
Disclosures: None
6 - Precarity, Migration and Ageing
- Edited by Amanda Grenier, McMaster University, Ontario, Chris Phillipson, University of Manchester, Richard A. Settersten Jr, Oregon State University
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- Book:
- Precarity and Ageing
- Published by:
- Bristol University Press
- Published online:
- 02 March 2021
- Print publication:
- 15 January 2020, pp 115-146
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Summary
Introduction
The profile of older adults in the Global North is rapidly diversifying, with increasing proportions of foreign-born ageing populations in large immigrant-receiving countries like Canada and the United Kingdom. In Canada, for example, 30 per cent of those aged 65 years and over are foreign-born (Ng et al, 2012). Yet, despite this demographic significance of the foreign-born older adult population, very little research has been conducted on the complex and varied experiences of risk and insecurity vis-a-vis ageing and life course events such as international migration. It is, therefore, timely to critically examine the markers of immigration, race and ethnicity, and cultural beliefs and practices, as they intersect with poverty and socioeconomic inequality among immigrant older adults. This is particularly the case given that these intersections are likely to manifest in experiences of invisibility, marginalization and social exclusion.
This chapter presents a nuanced analysis of precarity, risk and vulnerability as it relates to ageing and migration. It begins with a story of migration that sets the context for the chapter. It then provides an outline of precarity in relation to migration, and a brief overview of the key economic and psychosocial/cultural markers of precarity in older immigrants. Next, it highlights the ‘politics of precarity’ that are inherent in the larger political economy of immigration and the relative invisibility of racialized immigrant older adults in health and social care policies, and, drawing on these, returns to a discussion of precarity among older immigrant adults. Examples of media stories about, and interviews with, older immigrants are provided throughout the chapter as a means to ground our analysis in everyday examples. The chapter concludes with a discussion of the challenges to understanding precarity in the context of migration, and provides suggestions for future research.
A story of migration: setting the context
Keith Bi is a forty-seven-year-old Chinese immigrant and the owner of Coffee Corner, a café located in the windowless basement below the office of Citizenship and Immigration Canada. Bi immigrated from the city of Xi’an, China, on a working visa after being told by one of his relatives who lives in Halifax that Canada is a good place to live.