23 results on '"Natsch, Stephanie"'
Search Results
2. A practice guide on antimicrobial stewardship in nursing homes.
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Eikelenboom-Boskamp, Andrea, van Loosbroek, Mariëlle, Lutke-Schipholt, Evelien, Nelissen-Vrancken, Marjorie, Verkaaik, Mike, Geels, Paul, Natsch, Stephanie, and Voss, Andreas
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NURSING care facilities ,ANTIMICROBIAL stewardship ,ELDER care ,INFECTION control ,CAREGIVERS - Abstract
A practice guide to help nursing homes set up an antimicrobial stewardship (AMS) program was developed based on experiences gained during a project at one of the largest providers of elderly care in the South-east of the Netherlands. The guideline for the implementation of AMS in Dutch hospitals served as a starting point and were tailored to the unique characteristics of a nursing home setting. This practice guide offers recommendations and practical tools while emphasizing the importance of establishing a multidisciplinary approach to oversee AMS efforts. The recommendations and practical tools address various elements of AMS, including the basic conditions to initiate an AMS program and a comprehensive approach to embed an AMS program. This approach involves educating nurses and caregivers, informing volunteers and residents/their representatives, and the activities of an antibiotic team (A-team). The practice guide also highlights a feasible work process for the A-team. This process aims to achieve a culture of continuous learning and improvement that can enhance the overall quality of antibiotic prescribing rather than making individual adjustments to client prescriptions. Overall, this practice guide aims to help nursing homes establish an AMS program through collaborative efforts between involved physicians, pharmacists, clinical microbiologists, and infection control practitioners. The involved physician plays a crucial role in instilling a sense of urgency and developing a stepwise strategy. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Meropenem to Treat Valproic Acid Intoxication.
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Smolders, Elise J., Ter Heine, Rob, Natsch, Stephanie, and Kramers, Kees
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- 2022
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4. Information needs and patient perceptions of the quality of medication information available in hospitals: a mixed method study.
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Bekker, Charlotte L., Mohsenian Naghani, Shaghayegh, Natsch, Stephanie, Wartenberg, Naomi S., and van den Bemt, Bart J. F.
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INFORMATION needs ,MEDICAL personnel ,INDIVIDUAL needs ,SENSORY perception - Abstract
Background Providing appropriate medication information to patients is of utmost importance for optimal pharmacotherapy. (Un)intentional miscommunication and information gaps resulting in unmet needs could negatively affect patient's ability to use their medication properly. Objective To identify the information needs and patient perceptions of the quality of medication information available in hospitals in the Netherlands. Setting Cardiology, oncology, or rheumatology department of five hospitals. Methods Adult cardiology, oncology, and rheumatology patients participated in this mixed-method study. Focus groups and individual interviews were held to identify patients' views on the medication information and their information needs. Outcomes were used to construct a questionnaire that was used in a survey among patients to compare existing medication information with patients' needs, and to judge the quality of the provided information. Main outcome measure Patients needs with medication information. Results Four themes derived from interviews with 44 patients: (1) Content; almost all patients acknowledged to receive insufficient information not meeting their personal needs. (2) Moment of delivery; patients were dissatisfied with the timing. (3) Method of delivery; patients highly preferred verbal and written information. (4) Contextual quality prerequisites that should be met according to patients; medication information should be accessible, comprehensive, reliable and understandable. A total of 352 patients completed the questionnaire. Almost all patients reported all items as important, whereas up to 74.6% patients were not informed. Up to half of the patients perceived verbal information from healthcare providers, written information of leaflets and folders of insufficient quality. Conclusion Patients attending Dutch hospitals have needs for extensive medication information, which should be tailored to their individual needs. According to patients the quality of medication information available in hospitals can be improved. [ABSTRACT FROM AUTHOR]
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- 2020
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5. Trends, seasonality and the association between outpatient antibiotic use and antimicrobial resistance among urinary bacteria in the Netherlands.
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Martínez, Evelyn Pamela, Rosmalen, Joost van, Bustillos, Roberto, Natsch, Stephanie, Mouton, Johan W, Verbon, Annelies, van Rosmalen, Joost, and ISIS-AR study group
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DRUG resistance in microorganisms ,DRUG resistance in bacteria ,ANTIBIOTICS ,KLEBSIELLA ,BACTERIA ,URINARY organs ,KLEBSIELLA pneumoniae - Abstract
Objectives: To determine trends, seasonality and the association between community antibiotic use and antimicrobial resistance (AMR) in Escherichia coli and Klebsiella pneumoniae in urinary tract infections.Methods: We analysed Dutch national databases from January 2008 to December 2016 regarding antibiotic use and AMR for nitrofurantoin, trimethoprim, fosfomycin and ciprofloxacin. Antibiotic use was expressed as DDD/1000 inhabitant-days (DID) and AMR was expressed as the percentage of resistance from total tested isolates. Temporal trends and seasonality were analysed with autoregressive integrated moving average (ARIMA) models. Each antibiotic use-resistance combination was cross-correlated with a linear regression of the ARIMA residuals.Results: The trends of DID increased for ciprofloxacin, fosfomycin and nitrofurantoin, but decreased for trimethoprim. Similar trends were found in E. coli and K. pneumoniae resistance to the same antibiotics, except for K. pneumoniae resistance to ciprofloxacin, which decreased. Resistance levels peaked in winter/spring, whereas antibiotic use peaked in summer/autumn. In univariate analysis, the strongest and most significant cross-correlations were approximately 0.20, and had a time delay of 3-6 months between changes in antibiotic use and changes in resistance. In multivariate analysis, significant effects of nitrofurantoin use and ciprofloxacin use on resistance to these antibiotics were found in E. coli and K. pneumoniae, respectively. There was a significant association of nitrofurantoin use with trimethoprim resistance in K. pneumoniae after adjusting for trimethoprim use.Conclusions: We found a relatively low use of antibiotics and resistance levels over a 9 year period. Although the correlations were weak, variations in antibiotic use for these four antibiotics were associated with subsequent variations in AMR in urinary pathogens. [ABSTRACT FROM AUTHOR]- Published
- 2020
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6. Consecutive antibiotic use in the outpatient setting: an extensive, longitudinal descriptive analysis of antibiotic dispensing data in the Netherlands.
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de Jong, Loek A. W., van der Linden, Paul D., Roukens, Monique M. B., van de Garde, Ewoudt M. W., van der Velden, Alike W., Natsch, Stephanie, and SWAB’s Working Group on Surveillance of Antimicrobial Use
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ANTIBIOTICS ,OUTPATIENT medical care ,FOSFOMYCIN ,CIPROFLOXACIN ,THERAPEUTICS ,TRIMETHOPRIM - Abstract
Introduction: Taking consecutive antibiotic use into account is of importance to obtain insight in treatment within disease episodes, use of 2nd- and 3rd-choice antibiotics, therapy failure and/or side effects. Nevertheless, studies dealing with consecutive antibiotic use are scarce. We aimed at evaluating switch patterns in antibiotic use in the outpatient setting in the Netherlands.Methods: Outpatient antibiotic dispensing data was processed to antibiotic treatment episodes consisting of single prescriptions or consecutive prescriptions (2006 to 2014). Consecutive prescriptions were categorised into prolongations and switches. Switches were further analysed to obtain antibiotic switch percentages and trends over time. Outcomes were compared with recommendations of Dutch guidelines.Results: A total of 43,179,867 antibiotic prescriptions were included in the analysis, consisting of single prescriptions (95%), prolongations (2%) and switches (3%). The highest switch percentages were found for trimethoprim (7.6%) and nitrofurantoin (5.4%). For fosfomycin, ciprofloxacin, flucloxacillin and trimethoprim we found the highest yearly increase in switching. Amoxicillin/clavulanic acid was most often used as second antibiotic in a switch. A surprisingly high number of 2nd- and 3rd-choice antibiotics are prescribed as first antibiotic in a treatment.Conclusions: Although the actual reason for a switch is unknown, switch patterns can reveal problems concerning treatment failure and guideline adherence. In general, switch percentages of antibiotics in the Netherlands are low. The data contributes to the knowledge regarding antibiotic switch patterns in the outpatient setting. [ABSTRACT FROM AUTHOR]- Published
- 2019
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7. A multifaceted intervention to reduce guideline non-adherence among prescribing physicians in Dutch hospitals.
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Bos, Jacqueline, Natsch, Stephanie, Bemt, Patricia, Pot, Johan, Nagtegaal, J., Wieringa, Andre, Wilt, Gert, Smet, Peter, Kramers, Cornelis, Bos, Jacqueline M, van den Bemt, Patricia M L A, Pot, Johan L W, Nagtegaal, J Elsbeth, van der Wilt, Gert Jan, and De Smet, Peter A G M
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HOSPITAL administration ,UROLOGICAL nursing ,LOGISTIC regression analysis ,DRUG therapy ,CONFIDENCE intervals ,HOSPITAL pharmacies ,LONGITUDINAL method ,MEDICAL protocols ,PHYSICIANS ,RESEARCH funding ,CONTINUING medical education - Abstract
Background Despite the potential of clinical practice guidelines to improve patient outcomes, adherence to guidelines by prescribers is inconsistent. Objective The aim of the study was to determine whether an approach of introducing an educational programme for prescribers in the hospital combined with audit and feedback by the hospital pharmacist reduces non-adherence of prescribing physicians to key pharmacotherapeutic guidelines. Setting This prospective intervention study with a before-after design evaluated patients at surgical, urological and orthopaedic wards. Method An educational program covering pain management, antithrombotics, fluid and electrolyte management, prescribing in case of renal insufficiency, application of radiographic contrast agents and surgical antibiotic prophylaxis was presented to prescribers on the participating wards. Hospital pharmacists performed medication safety consultations, combining medication review of patients who are at risk for drug related problems with visits to ward physicians. Main outcome measure The outcome measure was the proportion of the admissions of patients in which the physician did not adhere to one or more of the included guidelines. Difference was expressed in odds ratios (OR) with 95% confidence intervals (CI). Multivariable logistic regression analysis was performed. Results 1435 Admissions of 1378 patients during the usual care period and 1195 admissions of 1090 patients during the intervention period were included. Non-adherence was observed significantly less often during the intervention period [21.8% (193/886)] as compared to the usual care period [30.5% (332/1089)]. The adjusted OR was 0.61 (95% CI 0.49-0.76). Conclusion This study shows that education and support of the prescribing physician can reduce guideline non-adherence at surgical wards. [ABSTRACT FROM AUTHOR]
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- 2017
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8. Surveillance of antimicrobial use in Dutch long-term care facilities.
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Roukens, Monique, Verhoef, Linda, Stobberingh, Ellen, and Natsch, Stephanie
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ANTI-infective agents ,ANTIBIOTICS ,NOROVIRUS diseases ,NITROFURANTOIN ,FLUOROQUINOLONES ,DRUG resistance in microorganisms ,DRUG administration ,DRUGSTORES ,ENZYME inhibitors ,EPIDEMIOLOGY ,ESCHERICHIA coli ,LONG-term health care ,NURSING care facilities ,QUINOLONE antibacterial agents ,STAPHYLOCOCCUS aureus ,THERAPEUTICS - Abstract
Objectives: : Residents living in a long-term care facility (LTCF) are more susceptible to infections. Treatment with antimicrobials is sometimes necessary; however, antibiotic use is considered one of the most important drivers of the development of antibiotic resistance. Surveillance data on antibiotic use in these LTCFs are necessary to get more insight into these patterns. The objective of this study was to describe antibiotic use in LTCFs in the Netherlands.Methods: : One hundred and seventy-seven LTCFs in the Netherlands were contacted and asked to participate in a study concerning antibiotic resistance and antibiotic use. Associated pharmacies were asked to provide data about systemic antibiotic use for each participating LTCF location over 1 year. Results on antibiotic use are reported here.Results: : Antibiotic use data from 96 LTCFs were collected from the pharmacies, and 68 of these LTCFs completed additional questionnaires on general characteristics of their location. Mean total use of systemic antimicrobials was 73 DDDs/1000 residents per day (range 2-197 DDDs/1000 residents per day). Co-amoxiclav (23 DDDs/1000 residents/day, range 0-70) was used the most, followed by nitrofurantoin derivatives (12 DDDs/1000 residents/day, range 0-38) and fluoroquinolones (12 DDDs/1000 residents/day, range 0-52). Statistical analysis revealed no significant correlations between the LTCF characteristics and the level of antibiotic use.Conclusions: There was a high use of broad-spectrum antimicrobials, with a large variation in total antibiotic use between individual locations. Further analysis of more in-depth data and possible influencing factors is needed. [ABSTRACT FROM AUTHOR]- Published
- 2017
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9. Usefulness of quality indicators for antibiotic use: case study for the Netherlands.
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VAN DER VELDEN, ALIKE W., ROUKENS, MONIQUE, VAN DE GARDE, EWOUDT, LOURENS, MARCO, NATSCH, STEPHANIE, and SWAB's working group on surveillance of antimicrobial use
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HEALTH status indicators ,MEDICAL quality control ,ANTIBIOTICS ,MEDICAL care ,HEALTH policy ,BENCHMARKING (Management) ,CLINICAL medicine ,DRUG utilization ,MEDICAL protocols ,PRIMARY health care ,KEY performance indicators (Management) - Abstract
Copyright of International Journal for Quality in Health Care is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2016
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10. Carriage of antimicrobial-resistant commensal bacteria in Dutch long-term-care facilities.
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Verhoef, Linda, Roukens, Monique, de Greeff, Sabine, Meessen, Nico, Natsch, Stephanie, and Stobberingh, Ellen
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DRUG resistance in microorganisms ,ANTI-infective agents ,COMMENSALISM ,MICROORGANISMS ,ESCHERICHIA coli ,LOGISTIC regression analysis ,FECES ,MICROBIOLOGY ,URINE microbiology ,BACTERIAL diseases ,CARRIER state (Communicable diseases) ,HEALTH facilities ,LONG-term health care ,MICROBIAL sensitivity tests ,NASAL cavity ,STAPHYLOCOCCUS aureus ,DISEASE prevalence - Abstract
Objectives: The objective of this study was to assess carriage of antimicrobial-resistant commensal microorganisms, i.e. Escherichia coli and Staphylococcus aureus, and its predictors in long-term-care facilities (LTCFs).Methods: Nasal swabs and/or urine or incontinence samples were collected from participating residents in 111 LTCFs and tested for the presence of S. aureus and/or E. coli, respectively. Antimicrobial resistance to eight antimicrobials was linked to antimicrobial usage in the year preceding sampling and to LTCF characteristics. Using multilevel logistic regression, predictors of carriage of ESBL-producing E. coli in LTCFs were identified.Results: S. aureus was identified in 1269/4763 (26.6%) nasal swabs, including 13/4763 (0.3%) MRSA carriers in 9/107 (8%) LTCFs. Of the 5359 urine/incontinence samples, 2934 (55%) yielded E. coli, including 123 (4.2%) producing ESBL, which were found in 53/107 locations (range 1%-33%). For all but one antimicrobial (i.e. nitrofurantoin) >20% of isolated E. coli were resistant. Multilevel multivariable logistic regression identified two predictors of carriage of ESBL-producing E. coli: (i) antimicrobial usage (OR 1.8, 95% CI 1.1-3.0 for each extra 50 DDD/1000 residents/day); and (ii) presence of MRSA carriers in the LTCFs (OR 2.4, 95% CI 1.0-5.6).Conclusions: The low proportion of 4.2% ESBL-producing E. coli and the low prevalence of 0.3% MRSA carriage found in LTCF residents suggest that Dutch LTCFs are not yet an important reservoir of MDR potential pathogens. Nevertheless, the large variation between LTCFs warrants close monitoring of antimicrobial resistance in LTCFs. Integrated surveillance, i.e. linking data sources on antimicrobial usage, microbiological testing, clinical background data and epidemiological data, is needed. [ABSTRACT FROM AUTHOR]- Published
- 2016
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11. Adoption of a national antimicrobial guide (SWAB-ID) in the Netherlands.
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Schuts, Emelie, Bosch, Caroline, Gyssens, Inge, Kullberg, Bart-Jan, Hall, Maurine, Natsch, Stephanie, Sebens, Fre, Adams, Martha, Drew, Richard, and Prins, Jan
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ANTI-infective agents ,HOSPITALS ,COMMUNICABLE diseases ,DRUG resistance in microorganisms ,MEDICAL protocols - Abstract
The article presents a comparison of national antimicrobial guide, SWAB-ID based and non-SWAB-ID based. It was in 2006 when the Dutch Working Party on Antibiotic Policy (SWAB) developed an online national antimicrobial guide for treatment of infectious diseases. The Netherland's adoption of this guide is discussed.
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- 2016
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12. Effect of tailored antibiotic stewardship programmes on the appropriateness of antibiotic prescribing in nursing homes.
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van Buul, Laura W., van der Steen, Jenny T., Achterberg, Wilco P., Schellevis, François G., Essink, Rob T. G. M., de Greeff, Sabine C., Natsch, Stephanie, Sloane, Philip D., Zimmerman, Sheryl, Twisk, Jos W. R., Veenhuizen, Ruth B., and Hertogh, Cees M. P. M.
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DRUG prescribing ,ANTIBIOTICS ,NURSING care facilities ,COMMUNITY-based participatory research ,LOGISTIC regression analysis ,PHYSICIANS - Abstract
Objectives: To evaluate the effect of tailored interventions on the appropriateness of decisions to prescribe or withhold antibiotics, antibiotic use and guideline-adherent antibiotic selection in nursing homes (NHs). Methods:We conducted a quasi-experimental study in 10 NHs in the Netherlands. A participatory action research (PAR) approach was applied, with local stakeholders in charge of selecting tailored interventions based on opportunities for improved antibiotic prescribing that they derived from provided baseline data. An algorithm was used to evaluate the appropriateness of prescribing decisions, based on infections recorded by physicians. Effects of the interventions on the appropriateness of prescribing decisions were analysed with a multilevel logistic regression model. Pharmacy datawere used to calculate differences in antibiotic use and recorded infectionswere used to calculate differences in guideline-adherent antibiotic selection. Results: The appropriateness of 1059 prescribing decisions was assessed. Adjusting for pre-test differences in the proportion of appropriate prescribing decisions (intervention, 82%; control, 70%), post-test appropriateness did not differ between groups (crude: P=0.26; adjusted for covariates: P=0.35).We observed more appropriate prescribing decisions at the start of data collection and before receiving feedback on prescribing behaviour. No changes in antibiotic use or guideline-adherent antibiotic selection were observed in intervention NHs. Conclusions: The PAR approach, or the way PAR was applied in the study, was not effective in improving antibiotic prescribing behaviour. The study findings suggest that drawing prescribers' attention to prescribing behaviour and monitoring activities, and increasing use of diagnostic resources may be promising interventions to improve antibiotic prescribing in NHs. [ABSTRACT FROM AUTHOR]
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- 2015
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13. Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia.
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Farida, Helmia, Rondags, Angelique, Gasem, M. Hussein, Leong, Katharina, Adityana, A., Broek, Peterhans J., Keuter, Monique, and Natsch, Stephanie
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ANTIBIOTICS ,COMMUNITY-acquired infections treatment ,COMMUNITY-acquired pneumonia ,DRUG resistance ,DELPHI method ,MIDDLE-income countries ,DEVELOPING countries ,PATIENTS - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2015
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14. Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment: a cohort study on clinical outcome.
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van de Garde, Ewoudt M. W., Natsch, Stephanie, Prins, Jan M., and van der Linden, Paul D.
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Objective: Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the outpatient to inpatient transition and the subsequent clinical course. Design: Retrospective cohort study. Setting: Dutch PHARMO Record Linkage System. Participants: 7323 patients aged >18 years and hospitalised with pneumonia in the Netherlands between 2004 and 2010. Main study parameter: We identified all prescribed antibiotics prior to, during and after hospitalisation. In case of prior outpatient treatment, the continuation of antibiotic treatment on admission was categorised as: no atypical coverage > no atypical coverage; atypical coverage > atypical coverage; no atypical coverage > atypical coverage; and atypical coverage > no atypical coverage. Main outcome measures: Length of hospital stay, in-hospital mortality and readmission within 30 days. Results: Twenty-two per cent of the patients had received prior outpatient treatment, of which 408 (25%) patients were switched on admission to antibiotics with atypical coverage. There were no differences in length of hospital stay, in-hospital mortality or readmission rate between the four categories of patients with prior outpatient treatment. The adjusted HR for adding atypical coverage versus no atypical coverage was 0.91 (95% CI 0.55 to 1.51) for time to discharge. For in-hospital mortality and readmission within 30 days, the adjusted ORs were 1.09 (95% CI 0.85 to 1.34) and 0.59 (95% CI 0.30 to 1.18), respectively. Conclusions: This study found no association between mode of continuing antibiotic treatment at the outpatient to inpatient transition and relevant clinical outcomes. In particular, adding atypical coverage in patients without prior atypical coverage did not influence the outcome. [ABSTRACT FROM AUTHOR]
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- 2015
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15. Quality Indicators to Measure Appropriate Antibiotic Use in Hospitalized Adults.
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van den Bosch, Caroline M. A., Geerlings, Suzanne E., Natsch, Stephanie, Prins, Jan M., and Hulscher, Marlies E. J. L.
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MEDICAL quality control ,ANTIBIOTICS ,HOSPITAL patients ,DISEASES in adults ,DRUG monitoring ,HEALTH status indicators - Abstract
This article describes the systematic development of a set of generic quality indicators to meet an important requirement for an effective stewardship program: the ability to measure appropriateness of hospital antibiotic use, at the patient level along the entire antibiotic pathway.Background. An important requirement for an effective antibiotic stewardship program is the ability to measure appropriateness of antibiotic use. The aim of this study was to develop quality indicators (QIs) that can be used to measure appropriateness of antibiotic use in the treatment of all bacterial infections in hospitalized adult patients.Methods. A RAND-modified Delphi procedure was used to develop a set of QIs. Potential QIs were retrieved from the literature. In 2 questionnaire mailings with an in-between face-to-face consensus meeting, an international multidisciplinary expert panel of 17 experts appraised and prioritized these potential QIs.Results. The literature search resulted in a list of 24 potential QIs. Nine QIs describing recommended care at patient level were selected: (1) take 2 blood cultures, (2) take cultures from suspected sites of infection, (3) prescribe empirical antibiotic therapy according to local guideline, (4) change empirical to pathogen-directed therapy, (5) adapt antibiotic dosage to renal function, (6) switch from intravenous to oral, (7) document antibiotic plan, (8) perform therapeutic drug monitoring, and (9) discontinue antibiotic therapy if infection is not confirmed. Two QIs describing recommended care at the hospital level were also selected: (1) a local antibiotic guideline should be present, and (2) these local guidelines should correspond to the national antibiotic guidelines.Conclusions. The selected QIs can be used in antibiotic stewardship programs to determine for which aspects of antibiotic use there is room for improvement. At this moment we are testing the clinimetric properties of these QIs in 1800 hospitalized patients, in 22 Dutch hospitals. [ABSTRACT FROM PUBLISHER]
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- 2015
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16. Development of quality indicators for antimicrobial treatment in adults with sepsis.
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van den Bosch, Caroline M. A., Hulscher, Marlies E. J. L., Natsch, Stephanie, Gyssens, Inge C., Prins, Jan M., and Geerlings, Suzanne E.
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SEPSIS ,SEPTIC shock treatment ,ANTI-infective agents ,TREATMENT effectiveness ,HEALTH outcome assessment ,PATIENTS - Abstract
Background Outcomes in patients with sepsis are better if initial empirical antimicrobial use is appropriate. Several studies have shown that adherence to guidelines dictating appropriate antimicrobial use positively influences clinical outcome, shortens length of hospital stay and contributes to the containment of antibiotic resistance. Quality indicators (QIs) can be systematically developed from these guidelines to define and measure appropriate antimicrobial use. We describe the development of a concise set of QIs to assess the appropriateness of antimicrobial use in adult patients with sepsis on a general medical ward or Intensive Care Unit (ICU). Methods A RAND-modified, five step Delphi procedure was used. A multidisciplinary panel of 14 experts appraised and prioritized 40 key recommendations from within the Dutch national guideline on antimicrobial use for adult hospitalized patients with sepsis (www.swab.nl/guidelines). A procedure to select QIs relevant to clinical outcome, antimicrobial resistance and costs was performed using two rounds of questionnaires with a face-to-face consensus meeting between the rounds over a period of three months. Results The procedure resulted in the selection of a final set of five QIs, namely: obtain cultures; prescribe empirical antimicrobial therapy according to the national guideline; start intravenous drug therapy; start antimicrobial treatment within one hour; and streamline antimicrobial therapy. Conclusion This systematic, stepwise method, which combined evidence and expert opinion, led to a concise and therefore feasible set of QIs for optimal antimicrobial use in hospitalized adult patients with sepsis. The next step will entail subjecting these quality indicators to an applicability test for their clinimetric properties and ultimately, using these QIs in quality-improvement projects. This information is crucial for antimicrobial stewardship teams to help set priorities and to focus improvement. [ABSTRACT FROM AUTHOR]
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- 2014
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17. Medication reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety.
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van Sluisveld, Nelleke, Zegers, Marieke, Natsch, Stephanie, and Wollersheim, Hub
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DRUGS ,THEORY of knowledge ,MEDICATION errors ,HOSPITAL admission & discharge - Abstract
Background: Medication errors are a leading cause of patient harm. Many of these errors result from an incomplete overview of medication either at a patient's referral to or at discharge from the hospital. One solution is medication reconciliation, a formal process in which health care professionals partner with patients to ensure an accurate and complete transfer of medication information at interfaces of care. In 2007, the Dutch government compelled hospitals to implement a bundle concerning medication reconciliation at hospital admission and discharge. But to date many hospitals have failed to implement this bundle fully. The aim of this study was to gain insight into the barriers and drivers of the implementation process. Methods: We performed face to face, semi-structured interviews with twenty health care professionals and managers from several departments at a 953 bed university hospital in the Netherlands and also from the surrounding community health services. The interviews were analysed using a combined theoretical framework of Grol and Cabana to classify the drivers and barriers identified. Results: There is lack of awareness and insufficient knowledge of health care professionals about the health care problem and the bundle medication reconciliation. These result in a lack of support for implementing the bundle. In addition clinicians are reluctant to reallocate tasks to nurses or pharmacy technicians. Another major barrier is a lack of communication, understanding and collaboration between hospital and community caregivers. The introduction of more competitive market forces has made matters worse. Major drivers are a good implementation plan, patient awareness, and obligation by the government. Conclusions: We identified a wide range of barriers and drivers which health care professionals believe influence the implementation of medication reconciliation. This reflects the complexity of implementation. Implementation can be improved if these factors are adequately addressed. The feasibility and effectiveness of these strategies should be tested in controlled trails. [ABSTRACT FROM AUTHOR]
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- 2012
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18. Improving the Process of Antibiotic Therapy in Daily Practice: Interventions to Optimize Timing, Dosage Adjustment to Renal Function, and Switch Therapy.
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Vogtländer, Nils P.J., van Kasteren, Marjo E.E., Natsch, Stephanie, Kullberg, Bart-Jan, Hekster, Yechiel A., and van der Meer, Jos W.M.
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ANTIBIOTICS ,MEDICINE ,QUALITY control ,ANTI-infective agents ,THERAPEUTICS ,EMERGENCY medical services - Abstract
Background Timely administration of the first dose, dosage adjustment to renal function, switch from intravenous to oral administration, and streamlining are important aspects of rational antibiotic prescription. The goals of this study were to investigate all of these variables, compare them with predefined quality standards, and implement improvement with specific interventions. Methods At the departments of internal medicine, surgery, and neurology and the emergency department of a tertiary referral university medical center, all consecutive patients receiving therapeutic antibiotics were enrolled. Dosages, timing of first doses, dosing intervals, administration routes, and adjustment of the chosen drug to clinical data were investigated. After the preintervention period, barriers to change were identified, followed by specific interventions and a postintervention measurement. Results In the preintervention and postintervention periods, 247 and 250 patients were enrolled, receiving 563 and 598 antibiotic prescriptions, respectively. The mean time from the order to first dose at the wards improved from 2.7 to 1.7 hours in potentially severe cases (P = .003). Dosage adjustment to renal function remained unchanged at 45% vs 52% (P = .09) of cases where necessary. Switching of therapy from intravenous to oral improved from 46% to 62% (P = .03) and was performed a mean of 1.6 days earlier (P = .002). Streamlining was performed correctly in most cases, and thus no interventions were necessary. Conclusions Timing of antibiotic therapy and switch therapy may be improved with a combination of interventions. To improve poor adjustment of dosing to renal function, other strategies are needed. In our setting, streamlining was already correct in most cases. [ABSTRACT FROM AUTHOR]
- Published
- 2004
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19. Earlier Initiation of Antibiotic Treatment for Severe Infections After Interventions to Improve...
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Natsch, Stephanie and Kullberg, Bart J.
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ANTIBIOTICS ,COMMUNICABLE disease treatment - Abstract
Examines whether combined interventions improve the timely administration of antibiotic therapy and acquisition of material for culture from patients admitted to the emergency department with a serious infectious disease. Median time from admission to the initial administration of antibiotics; Factors that improve the timing of antibiotic administration.
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- 2000
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20. Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA): study protocol for a cluster randomized controlled trial.
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Rutten, Jeanine J. S., van Buul, Laura W., Smalbrugge, Martin, Geerlings, Suzanne E., Gerritsen, Debby L., Natsch, Stephanie, Sloane, Philip D., Veenhuizen, Ruth B., van der Wouden, Johannes C., and Hertogh, Cees M. P. M.
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CLUSTER randomized controlled trials ,URINARY tract infections ,NURSING home patients ,SYMPTOMS ,LONG-term health care ,ELECTRONIC health records - Abstract
Background: Antibiotic overprescribing for suspected urinary tract infection (UTI) in nursing homes (NHs) is common. Typical clinical scenarios in which antibiotics are inappropriately prescribed include response to nonspecific signs and symptoms and/or a positive urine test in the absence of symptoms referable to the urinary tract. These and other scenarios for inappropriate antibiotic prescribing were addressed in a recent international Delphi study which resulted in the development of a decision tool for the empiric treatment of UTI in frail older adults. The aim of the current study is to implement this decision tool, by integrating it into the electronic health record (EHR) and providing education on its content and use, and to evaluate its effect on appropriate antibiotic prescribing. An additional aim is to evaluate the quality of the intervention and the implementation process.Methods: A cluster Randomized Controlled Trial (cRCT) is conducted in sixteen NHs and aims to include 897 residents diagnosed with suspected UTI. NHs in the intervention group use the EHR-integrated decision tool, and receive education for physicians and nursing staff; in the control group care as usual is provided. Data is collected through case report forms within the EHR at the day of diagnosis and at 3, 7, and 21 days thereafter. The primary outcome is appropriate antibiotic prescribing for suspected UTI at the day of diagnosis. Secondary outcomes include the course of symptoms, alternative diagnoses, treatment changes, complications, hospitalization, and mortality. Data on total antibiotic prescribing are additionally collected in the participating NHs 12 months before and during the study. Finally, the process evaluation combines cRCT data with questionnaires and qualitative interviews with NH professionals.Discussion: This is the first cRCT to evaluate the recently developed, international decision tool for empiric treatment of suspected UTI in NH residents. Study findings will elucidate the effect of the intervention on appropriate antibiotic prescribing for suspected UTI, and provide insight into the applicability of the decision tool in NHs in general and in specific subgroups of NH residents. With this study we aim to contribute to antibiotic stewardship efforts in long-term care.Trial Registration: The ANNA study was registered at the Netherlands Trial Register on 26 February 2019, with identification number NTR NL7555 . [ABSTRACT FROM AUTHOR]- Published
- 2020
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21. Guidelines for the Prevention of Antimicrobial Resistance in Hospitals.
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Natsch, Stephanie, van Kasteren, Marjo E. E., Kullberg, Bart-Jan, and van der Meer, Jos W. M.
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- 1998
22. Development of quality indicators for antimicrobial treatment in adults with sepsis.
- Author
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van den Bosch, Caroline Ma, Hulscher, Marlies Ejl, Natsch, Stephanie, Gyssens, Inge C, Prins, Jan M, Geerlings, Suzanne E, Dutch Sepsis QI expert panel, van den Bosch, Caroline M A, and Hulscher, Marlies E J L
- Abstract
Background: Outcomes in patients with sepsis are better if initial empirical antimicrobial use is appropriate. Several studies have shown that adherence to guidelines dictating appropriate antimicrobial use positively influences clinical outcome, shortens length of hospital stay and contributes to the containment of antibiotic resistance.Quality indicators (QIs) can be systematically developed from these guidelines to define and measure appropriate antimicrobial use. We describe the development of a concise set of QIs to assess the appropriateness of antimicrobial use in adult patients with sepsis on a general medical ward or Intensive Care Unit (ICU).Methods: A RAND-modified, five step Delphi procedure was used. A multidisciplinary panel of 14 experts appraised and prioritized 40 key recommendations from within the Dutch national guideline on antimicrobial use for adult hospitalized patients with sepsis (http://www.swab.nl/guidelines). A procedure to select QIs relevant to clinical outcome, antimicrobial resistance and costs was performed using two rounds of questionnaires with a face-to-face consensus meeting between the rounds over a period of three months.Results: The procedure resulted in the selection of a final set of five QIs, namely: obtain cultures; prescribe empirical antimicrobial therapy according to the national guideline; start intravenous drug therapy; start antimicrobial treatment within one hour; and streamline antimicrobial therapy.Conclusion: This systematic, stepwise method, which combined evidence and expert opinion, led to a concise and therefore feasible set of QIs for optimal antimicrobial use in hospitalized adult patients with sepsis. The next step will entail subjecting these quality indicators to an applicability test for their clinimetric properties and ultimately, using these QIs in quality-improvement projects. This information is crucial for antimicrobial stewardship teams to help set priorities and to focus improvement. [ABSTRACT FROM AUTHOR]- Published
- 2014
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23. Dosing of Amoxicillin/Clavulanate for Treatment of Lower Respiratory Tract Infection.
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Natsch, Stephanie and Meer, Jos W. M. van der
- Published
- 1998
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