Objectives: We followed the effects of changes to a new antibiotic policy favouring a ureidopenicillin as opposed to a third-generation cephalosporin on the long-term incidence of Clostridium ...difficile diarrhoea (CDD) and antibiotic utilization in a large Elderly Medicine Unit. Patients and methods: In 1999, piperacillin–tazobactam was added to the formulary in Elderly Medicine and its use promoted in preference to cefotaxime. Following review and feedback to clinicians of surveillance data, cefotaxime prescribing was actively restricted during 2000–2001. An audit of prescriber adherence to antibiotic policy was carried out by reviewing the records of 159 patients during February–April 2001. In December 2001, due to manufacturer production problems, supply of piperacillin–tazobactam was stopped. We performed standardized period prevalence surveillance (February–April) allowing comparisons of antibiotic utilization and CDD incidence during the 5 year study period (1998–2002). Results: CDD incidence did not change significantly (P>0.1) during 1998–1999 despite a marked increase in piperacillin–tazobactam prescribing. However, when cefotaxime prescribing was curtailed in 2001, CDD rates decreased (in four of five wards) and overall by 52% (P=0.008). When piperacillin–tazobactam became unavailable in 2002, despite advice to the contrary cefotaxime prescribing rose five-fold, and CDD rates increased in four of five wards and by 232% (P<0.01) overall. Adherence to antibiotic policy introduced in 2000 was good (81% accordance); 94%, 88% and 73% of patients with cellulitis, urinary tract and respiratory tract infection, respectively, received appropriate antibiotics. Conclusions: Long-term prescribing of piperacillin–tazobactam in Elderly Medicine in preference to cefotaxime is associated with reduced rates of CDD. However, unless cephalosporin prescribing is curtailed, the beneficial effects on CDD rates may be missed. This is one of few studies to document adverse effects due to loss of antibiotic supply.
A survey of 586 trainee doctors in Yorkshire was undertaken to ascertain current junior doctors’ knowledge and understanding of alcohol units. Approximately 18% of trainees had no knowledge of ...alcohol units despite the fact that 82% believed they had a good knowledge. Once again, those who did not drink alcohol knew less about alcohol units than those who did. Little progress seems to have been made on this important subject since our previous survey 7 years ago. Further steps must be taken to ensure that junior doctors are taught about alcohol units during the course of their training so that they are able to counsel patients appropriately.
Atrial fibrillation/flutter (AF) predisposes to ischaemic stroke and is associated with greater disability and mortality than those without AF. The prevalence of AF rises with age and increases ...sharply in older people. In one study, AF accounted for 10-15% of ischaemic strokes in younger people and nearly 25% in people aged over 80 years 3. Therapeutic oral anticoagulation with international normalized ratio (INR) of 2-3 is well established both for primary and secondary stroke prevention. Here, Das et al assess the quality of life of elderly people on warfarin for atrial fibrillation.
Reforms to postgraduate training in the UK may affect recruitment to geriatric medicine. In 2005, a questionnaire survey was undertaken to determine the factors favouring geriatric medicine as a ...career choice and whether these might be used to influence recruitment.
In all, 1,036 responses to the questionnaire were received (response rate 56.4%); 4% of the respondents decided to specialise in geriatric medicine as students, 3.8% of consultants and 8.6% of registrars decided as pre-registration house officers while 39% of consultants and 7% of registrars chose geriatric medicine while a middle grade in another specialty. The strongest influences on choice were clinical aspects of the specialty (34.1%) and inspirational seniors (26.2%). However, 9.2% of consultants and 10.1% of registrars subsequently regretted their career decision.
Geriatric medicine seems to be a career choice for doctors of increasing maturity and including more posts in foundation programmes may not improve recruitment as anticipated. Although a small number of doctors regretted choosing geriatric medicine as a career, this was rarely to do with core aspects of the specialty.
Estimates suggest that approximately 1 in 10 patients admitted to hospital experience an adverse event resulting in harm. Methods to improve patient safety have concentrated on developing safer ...systems of care and promoting changes in professional behaviour. There is a growing international interest in the development of interventions that promote the role of patients preventing error, but limited evidence of effectiveness of such interventions. The present study aims to undertake a randomised controlled trial of patient-led teaching of junior doctors about patient safety.
A randomised cluster controlled trial will be conducted. The intervention will be incorporated into the mandatory training of junior doctors training programme on patient safety. The study will be conducted in the Yorkshire and Humber region in the North of England. Patients who have experienced a safety incident in the NHS will be recruited. Patients will be identified through National Patient Safety Champions and local Trust contacts. Patients will receive training and be supported to talk to small groups of trainees about their experiences. The primary aim of the patient-led teaching module is to increase the awareness of patient safety issues amongst doctors, allow reflection on their own attitudes towards safety and promote an optimal culture among the doctors to improve safety in practice. A mixture of qualitative and quantitative methods will be used to evaluate the impact of the intervention, using the Attitudes to Patient Safety Questionnaire (APSQ) as our primary quantitative outcome, as well as focus groups and semi-structured interviews.
The research team face a number of challenges in developing the intervention, including integrating a new method of teaching into an existing curriculum, facilitating effective patient involvement and identifying suitable outcome measures.
Current controlled Trials: ISRCTN94241579.
A survey of 445 doctors in Yorkshire was conducted to ascertain their knowledge and awareness of alcohol units. Only 58% had some knowledge, and general practitioners scored better (69%) than ...hospital doctors (45%). However, 14% of doctors had no knowledge at all about alcohol units. Those who did not drink alcohol knew less than those who did and trainee doctors had significantly less knowledge than more senior physicians. Junior doctors who often deal with alcohol-related problems in their day-to-day hospital work had a poor knowledge. There needs to be a greater emphasis on alcohol and alcohol-related problems (including how to calculate alcohol units) in undergraduate and postgraduate curricula to improve doctors' knowledge and awareness of this important subject.
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