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  • 1
    Online Resource
    Online Resource
    Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe
    BMJ ; 2021
    In:  BMJ Global Health Vol. 6, No. 11 ( 2021-11), p. e006920-
    Details
    In: BMJ Global Health, BMJ, Vol. 6, No. 11 ( 2021-11), p. e006920-
    Abstract: As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns. Design This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics. Results The most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels. Conclusions Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.
    Type of Medium: Online Resource
    ISSN: 2059-7908
    URL: Article
    DOI: 10.1136/bmjgh-2021-006920
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2851843-3
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  • 2
    Online Resource
    Online Resource
    Gastrointestinal histoplasmosis presenting as a small bowel obstruction in an immunocompetent patient
    BMJ ; 2023
    In:  BMJ Case Reports Vol. 16, No. 8 ( 2023-08), p. e255349-
    Details
    In: BMJ Case Reports, BMJ, Vol. 16, No. 8 ( 2023-08), p. e255349-
    Abstract: The clinical presentation of gastrointestinal histoplasmosis (GIH) is often non-specific, mimicking several other gastrointestinal diseases, making diagnosis difficult. We present a case of GIH, causing bowel obstruction in an immunocompetent patient. A woman in her 80s presented with anorexia and a distended abdomen. A CT scan of the abdomen and pelvis (CTAP) showed ileal thickening. Endoscopy was performed and ileal biopsies were taken. A diagnosis of histoplasmosis was made by histopathology, and she began treatment with liposomal amphotericin and itraconazole. Despite presenting well at her routine follow-up appointments, she presented 4 months after diagnosis with worsening symptoms of anorexia and abdominal distention. CTAP showed the ileal stricture causing bowel obstruction. She underwent itraconazole and steroid treatment while having nasogastric tube decompression. Subsequent gastrografin follow through showing partial obstruction and surgical resection was planned. Unfortunately, her condition deteriorated, her kidney function worsened and she suffered from aspiration pneumonia with eventual demise.
    Type of Medium: Online Resource
    ISSN: 1757-790X
    URL: Article
    DOI: 10.1136/bcr-2023-255349
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2467301-8
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  • 3
    Online Resource
    Online Resource
    EMQs for Surgery
    BMJ ; 2005
    In:  BMJ Vol. 331, No. 7521 ( 2005-10-15), p. s174.2-s174
    Details
    In: BMJ, BMJ, Vol. 331, No. 7521 ( 2005-10-15), p. s174.2-s174
    Type of Medium: Online Resource
    ISSN: 0959-8138 , 1756-1833
    URL: Article
    DOI: 10.1136/bmj.331.7521.s174-a
    Language: English
    Publisher: BMJ
    Publication Date: 2005
    detail.hit.zdb_id: 1479799-9
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  • 4
    Online Resource
    Online Resource
    N utritional Outcomes of patients Undergoing Resection for upper gastroIntestinal cancer in AuStralian Hospitals (NOURISH): protocol for a multicentre point prevalence study
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 5 ( 2020-05), p. e035824-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 5 ( 2020-05), p. e035824-
    Abstract: Nutritional intervention and prevention of malnutrition is significantly important for patients with upper gastrointestinal oesophageal, pancreatic and gastric cancer. However, there is limited information regarding nutritional status, and perioperative nutritional interventions that patients receive when undergoing curative surgery. Methods and analysis Patients diagnosed with upper gastrointestinal cancer, planned for curative intent resection across 27 Australian hospitals will be eligible to participate in this point prevalence study. The primary aim is to determine the prevalence of malnutrition in patients with upper gastrointestinal cancer at the time of surgery using subjective global assessment. Secondary aims are to determine the type and frequency of perioperative nutritional intervention received, the prevalence of clinically important weight loss and low muscle strength, and to investigate associations between the use of an evidence-based nutrition care pathway or protocol for the nutritional management of upper gastrointestinal surgical oncology patients and malnutrition prevalence. Data collection will be completed using a purpose-built data collection tool. Ethics and dissemination Ethical approval was granted in May 2019 (LNR/51107/PMCC-2019). The design and reporting of this study comply with the Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting of observational cohort studies. Findings will be published in peer-reviewed scholarly journals and presented at relevant conferences. Results will assist in defining priority areas for research to improve patient outcomes.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2019-035824
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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  • 5
    Online Resource
    Online Resource
    Surviving a weekend on call in general surgery
    BMJ ; 2006
    In:  BMJ Vol. 333, No. 7580 ( 2006-12-09), p. s221-s221
    Details
    In: BMJ, BMJ, Vol. 333, No. 7580 ( 2006-12-09), p. s221-s221
    Type of Medium: Online Resource
    ISSN: 0959-8138 , 1756-1833
    URL: Article
    DOI: 10.1136/bmj.333.7580.s221
    Language: English
    Publisher: BMJ
    Publication Date: 2006
    detail.hit.zdb_id: 1479799-9
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  • 6
    Online Resource
    Online Resource
    Writing an operative note
    BMJ ; 2005
    In:  BMJ Vol. 330, No. 7492 ( 2005-03-19), p. s116.2-s116
    Details
    In: BMJ, BMJ, Vol. 330, No. 7492 ( 2005-03-19), p. s116.2-s116
    Type of Medium: Online Resource
    ISSN: 0959-8138 , 1756-1833
    URL: Article
    DOI: 10.1136/bmj.330.7492.s116-a
    Language: English
    Publisher: BMJ
    Publication Date: 2005
    detail.hit.zdb_id: 1479799-9
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  • 7
    Online Resource
    Online Resource
    Can simulation training improve foundation doctors’ assessment and management of acutely unwell surgical patients?
    BMJ ; 2013
    In:  BMJ
    Details
    In: BMJ, BMJ
    Type of Medium: Online Resource
    ISSN: 0959-8138 , 1756-1833
    URL: Article
    DOI: 10.1136/bmj.f3298
    Language: English
    Publisher: BMJ
    Publication Date: 2013
    detail.hit.zdb_id: 1479799-9
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  • 8
    Online Resource
    Online Resource
    Effectiveness and cost-effectiveness of TeleStroke consultations to support the care of patients who had a stroke presenting to regional emergency departments in Western Australia: an economic evaluation case study protocol
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 1 ( 2021-01), p. e043836-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 1 ( 2021-01), p. e043836-
    Abstract: The Western Australia (WA) Acute TeleStroke Programme commenced incrementally across regional WA during 2016–2017. Since the introduction of the TeleStroke Programme, there has been monitoring of service outputs, including regional patient access to tertiary stroke specialist advice and reperfusion treatment; however, the impact of consultation with a stroke specialist via telehealth (videoconferencing or telephone) on the effectiveness and cost-effectiveness of stroke care and the drivers of cost-effectiveness has not been systematically evaluated. Methods and analysis The aim of the case study was to examine the impact of consultation with a stroke specialist via telehealth on the effectiveness and cost-effectiveness of stroke and transient ischaemic attack care using a mixed methods approach. A categorical decision tree model will be constructed in collaboration with clinicians and programme managers. A before and after comparison using state-wide administrative datasets will be used to run the base model. If sample size and statistical power permits, the cases and comparators will be matched by stroke type and presence of CT scan at the initial site of presentation, age category and presenting hospital. The drivers of cost-effectiveness will be explored through stakeholder interviews. Data from the qualitative analysis will be cross-referenced with trends emerging from the quantitative dataset and used to guide the factors to be involved in subgroup and sensitivity analysis. Ethics and dissemination Ethics approval for this case study has been granted from the Western Australian Country Health Service Human Research and Ethics Committee (RGS3076). Reciprocal approval has been granted from Curtin University Human Research Ethics Office (HRE2019-0740). Findings will be disseminated publicly through conference presentation and peer-review publications. Interim findings will be released as internal reports to inform the service development.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-043836
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 9
    Online Resource
    Online Resource
    Implementation of an organ space infection prevention bundle reduces the rate of organ space infection after elective colorectal surgery
    BMJ ; 2021
    In:  BMJ Open Quality Vol. 10, No. 2 ( 2021-05), p. e001278-
    Details
    In: BMJ Open Quality, BMJ, Vol. 10, No. 2 ( 2021-05), p. e001278-
    Abstract: Surgical site infections (SSIs) are morbid and costly complications after elective colorectal surgery. SSI prevention bundles have been shown to reduce SSI in colorectal surgery, but their impact on organ space infections (OSI) is variable. Adoption of an evidence-based practice without an implementation strategy is often unsuccessful. Our aim was to successfully implement an OSI prevention bundle and to achieve a cost-effective reduction in OSI following elective left-sided colorectal operations. Methods The Translating Research into Practice model was used to implement an OSI prevention bundle in all patients undergoing elective left-sided colorectal resections by a single unit from November 2018 to September 2019. The new components included oral antibiotics with mechanical bowel preparation, when required, and use of impermeable surgical gowns. Other standardised components included alcoholic chlorhexidine skin preparation, glove change after bowel handling prior to wound closure with clean instruments. The primary outcome was OSI. Secondary outcomes included bundle compliance, unintended consequences and total patient costs. Outcomes were compared with all patients undergoing elective left-sided colorectal resections at the same institution in 2017. Results Elective colorectal resections were performed in 173 patients across two cohorts. The compliance rate with bundle items was 63% for all items and 93% for one omitted item. There was a reduction in OSI from 12.9% (11 of 85) to 3.4% (3 of 88, p 〈 0.05) after implementation of the OSI prevention bundle. The average cost of an OSI was $A36 900. The estimated savings for preventing eight OSIs by using the OSI bundle in the second cohort was $A295 198. Conclusion Successful implementation of an OSI prevention bundle was associated with a reduced rate of OSI after elective colorectal surgery. The OSI bundle and its implementation were cost-effective. Further study is required to investigate the sustainability of the OSI prevention bundle.
    Type of Medium: Online Resource
    ISSN: 2399-6641
    URL: Article
    DOI: 10.1136/bmjoq-2020-001278
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2952859-8
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