Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over four million people worldwide. There are multiple reports of prolonged viral shedding in people ...infected with SARS-CoV-2 but the presence of viral RNA on a test does not necessarily correlate with infectivity. The duration of quarantine required after clinical recovery to definitively prevent transmission is therefore uncertain. In addition, asymptomatic and presymptomatic transmission may occur, and infectivity may be highest early after onset of symptoms, meaning that contact tracing, isolation of exposed individuals and social distancing are essential public health measures to prevent further spread. This review aimed to summarise the evidence around viral shedding vs infectivity of SARS-CoV-2.
In the current study, the author explores the complex effects and contradictory roles of the Internet as a source of empowerment and control, and as a site of “risk management.” Drawing on a study of ...the Internet usage of Australian men with prostate cancer, the author investigates how access to information and online support affects men’s experiences of disease and, in particular, the possible implications of Internet-informed patients for the doctor-patient relationship. The data reveal that accessing information and/or support online can have a profound effect on men’s experiences of prostate cancer, providing a method of taking some control over their disease and limiting inhibitions experienced in face-to-face encounters. However, it is also clear that some medical specialists view Internet-informed patients as a challenge to their power within medical encounters and, as a result, employ disciplinary strategies that reinforce traditional patient roles and alienate patients who use the Internet.
Highlights • Barriers to antibiotic optimization in pulmonary medicine include clinical and social barriers. • Pulmonary physicians describe mistrust in clinical guidelines for pulmonary infections. ...• Diagnostic gray areas limit antibiotic optimization in pulmonary medicine. • Immediate patient care is described as prioritized over long-term resistance risks.
Ebola has previously been predominantly isolated to African nations, with limited impact in OECD countries. In 2014 Ebola gained international visibility, based largely on the threat of it 'moving ...west'. Here we examine a group of Australian health professionals' accounts of the Ebola threat including their fears around exposure; the 'moralities' underpinning their responses; the role of 'othering' in framing the threat; and the significance of relations of mistrust. We posit that the threat of Ebola unsettled professional expectations (duty, sacrifice and exposure to risk), rights (choice and safety) and certainty (evidence or knowledge to guide practice). In making sense of the 2014 Ebola threat, the participants articulate dilemmas around human value, the contingency of professional duty and care, and transnational responsibility.
Qualitative research is practiced across diverse disciplines and contexts, and this produces a wide range of perspectives on the role of conceptualization and theory development. It also results in a ...hugely varied mix of submissions to qualitative research journals in terms of their level of conceptual elevation. This editorial explores why we conceptualize qualitative data, and some common challenges evident in current qualitative practice.
Misuse of antibiotics in hospitals in Australia and internationally is common. The combination of multi-resistant organisms and continued misuse of antibiotics is contributing to a predicted ...'antimicrobial perfect storm' in the coming decades. Attempts to influence doctors' use of antibiotics have seen limited success internationally, yet few studies have explored the potential social factors driving current practices within hospitals and the interpersonal processes that underpin persistent 'suboptimal' antibiotic use. In this qualitative study of hospital-based Australian doctors we explore some of these dynamics including: the role of clinical uncertainty and ambivalence; experiences of immediate risk; interpersonal and intra-professional pressure; and the role of localised norms and 'craft groups' in driving antibiotic practices. We argue that the development of a sociological understanding of antibiotic misuse in the hospital sector (and beyond) is vital for progress to be made in protecting antibiotics for future generations.
Surgical antibiotic prophylaxis (SAP) is a critical area to optimize to reduce the escalation of antimicrobial resistance. This article explores the ways by which interpersonal relationships ...influence SAP decision making.
Twenty surgeons and anesthetists participated in in-depth semistructured interviews on SAP prescribing. Results were analyzed using the framework approach.
Analysis revealed 3 ways by which interpersonal relationships influence SAP: relationship dynamics between the surgeon and the anesthetist determine appropriateness of SAP, particularly operative risk ownership; perceived hierarchies within, and between, surgical and anesthetist specialties influence antibiotic prescribing decisions; and surgical distance from the antimicrobial stewardship team, which influences use of antimicrobial stewardship principles.
Interventions to optimize SAP are more likely to be effective in enacting sustained change if they consider the interpersonal and social contexts, including issues of familiarity and cohesiveness, hierarchical patterns, and sense of place within a team. Significant relational dynamics in SAP decision making are centered around risk; that is, personal/reputational risk to different professional groups and ownership of risk for individual patient outcomes. Risk must therefore be considered for sustainable SAP optimization interventions.
ObjectivesDespite escalating antimicrobial resistance (AMR), implementing effective antimicrobial optimisation within healthcare settings has been hampered by institutional impediments. This study ...sought to examine, from a hospital management and governance perspective, why healthcare providers may find it challenging to enact changes needed to address rising AMR.DesignSemistructured qualitative interviews around their experiences of antimicrobial stewardship (AMS) and responsiveness to the requirement for optimisation. Data were analysed using the framework approach.SettingTwo metropolitan tertiary-referral hospitals in Australia.ParticipantsTwenty hospital managers and executives from the organisational level of department head and above, spanning a range of professional backgrounds and in both clinical and non-clinical roles, and different professional streams were represented.ResultsThematic analysis demonstrated three key domains which managers and executives describe, and which might function to delimit institutional responsiveness to present and future AMR solutions. First, the primacy of ‘political’ priorities. AMR was perceived as a secondary priority, overshadowed by political priorities determined beyond the hospital by state health departments/ministries and election cycles. Second, the limits of accreditation as a mechanism for change. Hospital accreditation processes and regulatory structures were not sufficient to induce efficacious AMS. Third, a culture of acute problem ‘solving’ rather than future proofing. A culture of reactivity was described across government and healthcare institutions, precluding longer term objectives, like addressing the AMR crisis.ConclusionThere are dynamics between political and health service institutions, as well as enduring governance norms, that may significantly shape capacity to enact AMS and respond to AMR. Until these issues are addressed, and the field moves beyond individual behaviour modification models, antimicrobial misuse will likely continue, and stewardship is likely to have a limited impact.
At first glance there may seem to be no clear connections between two of humanity’s most pressing problems: environmental waste and antimicrobial resistance (AMR). In fact, as we posit in this paper, ...there is an inevitable convergence across these medical and environmental domains that hinge on social and economic inequalities. Such intersections have not been given nearly enough emphasis. Here we offer a series of considerations regarding the potential nexus of environmental pollution, waste-work, poverty and the decreasing viability of antimicrobials. We suggest that AMR and environmental pollution will fundamentally shape one another over the course of the coming decades, with differential impacts across socio-economic divides. More perniciously, the coalescing of waste, environmental pollution and reduced potency of pharmaceutical infection management will in turn likely escalate cultural prejudices around hygiene, ‘untouchability’, exclusion and privilege. That is, this nexus of waste and bacterial risk will polarise and divide communities, disproportionately affecting poorer communities. This paper is intended to chart an agenda for the study of this increasingly critical site of bacterial-human-environmental relations. It does so by examining the cycle of infection, risk and vulnerability amongst the most disadvantaged sections of the population in India.
Community pharmacists, as primary care providers, are an underutilised resource in antimicrobial stewardship (AMS). Primary care plays an important role in tackling antimicrobial resistance (AMR) as ...the principle of balancing access to antimicrobials while ensuring optimal use is agnostic to health setting. Understanding the sector's perceptions and practices towards AMS involvement is a continuing focus area of research. However, there is an opportunity to understand the sociological factors which influence the profession's contribution to stewardship practice, particularly across a broader spectrum of sector stakeholders at the individual, practice, system, and policy levels.
To explore stakeholders' perceptions of the Australian community pharmacy sector's AMS involvement.
Semi-structured interviews were conducted with fifteen key informants from the Australian community pharmacy sector. Participants' insights were invited across three broad areas: (1) understanding of AMR and AMS; and the (2) current and (3) future state of community pharmacy's AMS involvement. Interviews were audio-recorded, transcribed verbatim and analyzed using a combined method of inductive (informed by the Theoretical Domains Framework) and deductive thematic analysis.
Perceptions on promoting community pharmacists' AMS involvement within their existing role in promoting the quality use of medicines were heard. Adopting an antimicrobial guardian or gatekeeper role was perceived as influenced by the timing of their interaction with a patient either prior to, or post-consultation with a general practitioner (GP). Suggestions that the profession's potential and actual role in AMS could be challenged or even delimited due to lack of access to completeness of clinical information, and perceived consequences from a clinical and professional engagement perspective were also heard.
Collaborative partnerships between GPs and community pharmacists, framing stewardship within a quality use of medicines agenda, and highlighting connections between pharmacists' professional services such as minor ailments are key elements enabling community pharmacist's antimicrobial gatekeeper and guardian role.
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