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1
Phillips, Robin H. Carleton University Dissertation Geography. "Landowner attitudes toward private stewardship programs; an examination of the Island Nature Trust's private stewardship landowner contact program." Ottawa, 1995.
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Borhart, Glen W. "Stewardship educational program based on the Lukan pericopes (Pentecost season--Series C) /." Online full text .pdf document, available to Fuller patrons only, 1999. http://www.tren.com.
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Holmes, Glen. "The Manitoba Product Stewardship Program, a comparative review and assessment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0018/MQ45060.pdf.
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Breiner, Amber Leigh. "Stewardship planning on conservation easements in the Forest Legacy Program /." Connect to title online (Scholars' Bank), 2008. http://hdl.handle.net/1794/7999.
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Ng, Chun-kong. "Cost effectiveness study of the antibiotics stewardship program in a regional hospital." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36886336.
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Ng, Chun-kong, and 吳振江. "Cost effectiveness study of the antibiotics stewardship program in a regional hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B39724906.
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Hudson, Teresa Michelle. "Assessing and evaluating the Forest Stewardship Program : promoting and conducting sound wildlife management /." Thesis, This resource online, 1995. http://scholar.lib.vt.edu/theses/available/etd-01102009-063302/.
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Jennings, Brian M. "Implementation of recommended Forest Stewardship Program practices in West Virginia ten-year assessment /." Morgantown, W. Va. : [West Virginia University Libraries], 2003. http://etd.wvu.edu/templates/showETD.cfm?recnum=2981.
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Thesis (M.S.)--West Virginia University, 2003.<br>Title from document title page. Document formatted into pages; contains viii, 60 p. : ill. Includes abstract. Includes bibliographical references (p. 58-60).
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Carl, Phillip A. "Identifying and using motives for charitable giving in the development program of a church-related social ministry institution." Theological Research Exchange Network (TREN), 1989. http://www.tren.com.
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Martinek, Michael Anthony. "Evaluation of the US Forest Service - Forest Stewardship Program and Spatial Analysis Project in Illinois." OpenSIUC, 2010. https://opensiuc.lib.siu.edu/theses/344.
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In 1978, the Federal government passed the Forestry Assistance Act which provides guidelines for states to support management on non-industrial private lands through the Forest Stewardship Program (FSP). In 1983, Illinois passed the Illinois Forestry Development Act which outlines the specific requirements for non-industrial private landowners residing in Illinois to take advantage of the FSP. Since the inception of the program, there has been little analysis to determine the quality of land enrolled in the FSP. Launched in 2004, the Spatial Analysis Project is a program sponsored by the US Forest Service to determine the type of land enrolled within FSP. Within each state, the SAP used an aggregate analysis based upon multiple criteria to divide all land available for the FSP into three categories - low, medium, and high stewardship potential. The objective of this project was twofold, first to determine if Illinois is effectively enrolling lands in the high stewardship potential category. Secondly, because timber production must be the primary goal of a FSP plan in Illinois, this study analyzed whether lands classified as high stewardship potential were also high in forest productivity. Results indicate that while Illinois is effectively enrolling high stewardship potential lands, these lands are not necessarily highly productive. This information could be used to give preference for cost-share assistance to those lands that are classified as highly productive, particularly in times when funding is limited, rather than on a first come, first served basis.
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Yontz, Brian David. "Teacher Candidates’ Perceptions of the Emphasis on Stewardship in Their Initial Teacher Licensure Program." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1275054415.
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Heerspink, Robert. "A program to cultivate the practice of financial stewardship in a local Christian Reformed congregation." Theological Research Exchange Network (TREN), 1993. http://www.tren.com.
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McCann, David Page. "Using GIS and landowner survey to determine if the Forest Stewardship Program is effective at generating involvement in forest health issues in West Virginia." Morgantown, W. Va. : [West Virginia University Libraries], 2005. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=4420.
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Thesis (M.S.)--West Virginia University, 2005.<br>Title from document title page. Document formatted into pages; contains vii, 209 p. : ill., col. maps. Includes abstract. Includes bibliographical references (p. 49-52).
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Steibel, Eduardo. "How to increase church financial support a program for implementing the Biblical principles of stewardship in a local Brazilian Baptist church /." Theological Research Exchange Network (TREN), 1988. http://www.tren.com.
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Hordowick, Julie. "Involving landowners in wetland conservation, barriers and motivations for action and implications for stewardship program planning." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ61908.pdf.
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Reich, Denis Andrew. "Evaluating the Conservation Security Program utilizing the perceptions and economics of producer participation implications for land stewardship in Iowa agriculture /." [Ames, Iowa : Iowa State University], 2007.
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Barrameda, Pricillo G. Sansanee Choowaew. "Certificate of stewardship contract and watershed management : a comparative study between participants and non-participants of integrated social forestry program /." Abstract, 2008. http://mulinet3.li.mahidol.ac.th/thesis/2551/cd412/4937421.pdf.
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Chandler, Ben. "Equipping select local church leaders to increase missions giving by valuing and promoting the Cooperative Program." Theological Research Exchange Network (TREN), access this title online, 2006. http://dx.doi.org/10.2986/tren.054-0254.
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Rosa, Regis Goulart. "Impacto da aderência ao programa de controle de antimicrobianos na mortalidade de pacientes com neutropenia febril." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/53148.
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Terapia empírica com antimicrobiano de amplo espectro faz parte do manejo inicial padrão de pacientes com neutropenia febril (NF). Evidências suficientes de quais esquemas antibióticos devem ser inicialmente prescritos já existem; embora, nenhum estudo randomizado tenha avaliado se a aderência a programas de controle de antimicrobianos (PCAs) resulta em diminuição das taxas de mortalidade por esta síndrome. No presente estudo de coorte prospectivo, realizado em um hospital terciário no período de outubro de 2009 a agosto de 2011, avaliou-se o impacto da aderência ao PCA, aferida através da prescrição antimicrobiana inicial, na mortalidade em 295 episódios de NF (em 145 indivíduos adultos) que necessitaram de tratamento endovenoso hospitalar. Após análise multivariada através de regressão de Cox, incluindo outros preditores de mortalidade, a aderência ao PCA mostrou-se fator de proteção independente para morte 28 dias após início do episódio de NF (razão de hazard ajustada[HR], 0.29; intervalo de confiança de 95% [IC 95%], 0.11 a 0.72). Os fatores de risco encontrados para a não-aderência ao PCA foram presença de hipotensão (risco relativo ajustado[RR], 1.90; IC 95%, 1.37 a 2.63), diarreia (RR, 2.13; IC 95%, 1.66 a 2.73), dor perianal (RR, 2.08; IC 95%, 1.54 a 2.82), suspeita de foco infeccioso em cavidade oral (RR, 2.45; IC 95%, 1.75 a 3.43) e manifestações cutâneas de infecção (RR, 2.34; IC 95%, 1.81 a 3.04). A escolha antimicrobiana inicial é particularmente importante no manejo inicial do paciente com febre em vigência de neutropenia; a aderência ao PCA, que preconiza o uso racional de antibióticos, mostrou ser efetiva na redução de mortalidade durante o curso da doença. A presença de fatores modificadores da terapia inicial representa risco para não-adesão ao programa de controle de antimicrobianos.<br>Empirical therapy with broad-spectrum antimicrobial is part of the initial management of patients with febrile neutropenia (FN). Enough evidence on which antibiotics schemes should be initially prescribed already exists; however, no randomized study has evaluated whether adherence to antimicrobial stewardship programs (ASPs) results in lower rates of mortality from this syndrome. In the present prospective cohort study performed in a tertiary hospital, from October 2009 to August 2011, we evaluated the impact of adherence to ASP, measured by initial antimicrobial prescribing, in mortality of 295 episodes of FN (in 145 adults) that required intravenous inpatient treatment. After multivariate analysis through Cox regression, including other predictors of mortality, adherence to ASP proved to be an independent protective factor for death 28 days after the beginning of the episode of FN (adjusted hazard ratio [HR], 0.29; 95% confidence interval [95% CI], 0.11 to 0.72). The risk factors found to noncompliance to ASP were presence of hypotension (adjusted relative risk [RR], 1.90; 95% CI, 1.37 to 2.63), diarrhea (RR, 2.13; 95% CI, 1.66 to 2.73), perianal pain (RR, 2.08; 95% CI, 1.54 to 2.82), suspected source of infection in oral cavity (RR, 2.45; 95% CI 1.75 to 3.43) and cutaneous manifestations of infection (RR, 2.34; 95% CI, 1.81 to 3.04). The choice of antimicrobial is particularly important in the initial management of patients with fever in the presence of neutropenia; the adherence to ASP, which calls for rational use of antibiotics, was effective in reducing mortality during the course of the disease. The presence of signs or symptoms that demand changes in the initial therapy poses risks to nonadherence to the antimicrobial management program.
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Esteve, Palau Erika. "Impacte clínic i econòmic de les infeccions urinàries per E.Coli Blee i de l’aplicació d’un programa d’optimització d’antimicrobians (PROA) en el seu abordatge terapèutic." Doctoral thesis, Universitat Autònoma de Barcelona, 2019. http://hdl.handle.net/10803/666930.
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Les betalactamases d'espectre estès (BLEE) són enzims produïts per bacils gramnegatius capaços d'hidrolitzar l'anell betalactàmic inactivant certs antibiòtics com les oximino-cefalosporines i monobactams, i són inhibides per inhibidors de betalactamases com l'àcid clavulànic, el sulbactam, el tazobactam o l'avibactam. A més, els microorganismes productors d'aquestes betalactamases, sovint presenten co-resistència a altres antibiòtics. Aquesta peculiaritat redueix les opcions terapèutiques en les infeccions produïdes per bacteris productors de BLEE, la qual cosa es correlaciona amb uns pitjors resultats clínics. La prevalença d'enterobacteris productors de BLEE ha anat en augment en els darrers anys, tant a Espanya com a la resta d'Europa, objectivant-se igualment un increment en les soques d'adquisició comunitària. Aquesta situació dificulta el tractament de les infeccions urinàries produïdes per enterobacteris productors de BLEE i resulta en un major consum de recursos sanitaris. Resulta imprescindible un abordatge multidisciplinar per aquest tipus d'infeccions, de cara a optimitzar-ne el maneig per assegurar l'èxit terapèutic, tenint en compte l'impacte ecològic que poden tenir els tractaments antibiòtic, així com assegurar l'ús de tractaments cost-efectius. Per a tal efecte, en els darrers anys s'han anat implementat arreu de l'Estat els Programes d'Optimtizació d'Antimicrobians (PROA).
El present treball ha focalitzat en l'impacte clínic i econòmic que han tingut les infeccions urinàries per E.coli productor de BLEE a l'Hospital del Mar de Barcelona en els darrers anys, així com l'impacte que la implementació d'un Programa d'Optimització d'Antimicrobians ha tingut en les mateixes, tant en termes clínics com econòmics.
Es van analitzar les infeccions urinàries per E.coli productor de BLEE que van requerir hospitalització entre agost de 2010 i juliol de 2013 mitjançant un estudi de cohorts retrospectiu, observant-se una pitjor evolució clínica comparat amb les produïdes per E.coli no BLEE (major fracàs clínic al 7è dia; p = 0.002), a més de suposar un increment en els costos atribuïts a les mateixes (4980€ vs 2612€ per episodi).
Amb aquestes dades, es va decidir avaluar l'impacte que la progressiva implementació d'un PROA estava tenint en aquestes infeccions. Per aquest propòsit, es van revisar tots els pacients amb diagnòstic d'infecció urinària per E.coli BLEE que havien consultat a l'Hospital del Mar entre gener de 2014 i desembre de 2015, i es va avaluar l'impacte clínic i econòmic que havien tingut els casos en els quals s'havia realitzat algun tipus d'intervenció comparat amb els que no l'havien rebut. Les intervencions per part de l'equip de PROA van tenir un impacte positiu quant a curació clínica (p = 0.008). No es va poder demostrar que aquestes intervencions tinguessin un impacte econòmic en les infeccions urinàries per E.coli BLEE.<br>Extended-spectrum betalactamases (ESBL) are enzymes produced by gram-negative bacilli capable of hydrolyzing the betalactamic ring by inactivating certain antibiotics such as oximinum-cephalosporins and monobactams, and are inhibited by betalactamase inhibitors such as clavulanic acid, sulbactam, tazobactam or avibactam. In addition, the microorganisms producing these betalactamases often present co-resistance to other antibiotics. This peculiarity reduces the therapeutic options in infections produced by ESBL-producing bacteria, which correlates with worse clinical outcomes. The prevalence of ESBL-producing enterobacteria has been increasing in recent years, both in Spain and in the rest of Europe, with an increase in community strains. This situation hinders the treatment of urinary infections produced by ESBL-producing enterobacteria and results in a greater consumption of health resources. A multidisciplinary approach for these infections is essential, in order to optimize its management to ensure therapeutic success, taking into account the ecological impact that antibiotic treatments can have on them, as well as ensuring the use of cost effective treatments. For this purpose, in recent years, Antimicrobial Stewardship Programs (ASP) have been implemented throughout the Country.
The present work has focused on the clinical and economic impact that ESBL-producing E.coli urinary tract infections had at the Hospital del Mar in Barcelona in recent years, as well as the impact of the implementation of an ASP in these infections, both clinical and economic.
We analysed the episodes of urinary tract infections caused by ESBL-producing E.coli that required hospitalization between August 2010 and July 2013 by a retrospective cohort study, showing a poorer clinical outcome compared to non-ESBL-producing E.coli infections (higher clinical failure at day 7; p = 0.002), as well as an increase in the attributable costs (€ 4980 versus 2612 € per episode).
With these results, we decided to analyse the impact that the progressive implementation of an ASP was having on these infections. For this purpose, all patients diagnosed with urinary tract infection by ESBL E.coli who had consulted at Hospital del Mar between January 2014 and December 2015 were reviewed, and assessed the clinical and economic impact that ASP interventions had on them. The interventions by
the ASP team had a positive impact on clinical cure (p = 0.008). It was not possible to demonstrate an economic impact of these interventions on ESLB E.coli urinary tract infections.
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Muller, Allison. "Bon usage des antibiotiques : résultats d'actions dans différents types d'établissements de santé." Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCE021/document.
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La résistance bactérienne aux antibiotiques est un problème de santé publique mondial principalement lié à un mésusage des antibiotiques (surconsommation et prescription inadéquate).Pour lutter contre cette menace, des recommandations diffusées par les sociétés savantes et des plans d’action ont été mis en place. Même si ils sont nécessaires, ils ne sont pas suffisants pour assurer une amélioration significative de l’usage des antibiotiques. Un fort taux de non-conformité de la prescription antibiotique au regard des recommandations est observé dans les établissements de santé (ES). La mise en place de programmes volontaristes de bon usage antibiotique au sein de chaque ES s’avère essentiel pour améliorer l’usage des antibiotiques : une action sur les comportements des prescripteurs est indispensable, par le biais de différentes stratégies. Qu’elles soient persuasives ou restrictives, celles-ci ont toutes montré leur efficacité, sans entraîner d’effets cliniques néfastes pour les patients (pas d’augmentation de la mortalité ni de la durée de séjour), tout en permettant une réduction des coûts liés aux anti-infectieux.Par le biais de nos travaux, nous avons cherché à étudier le bon usage antibiotique en milieu hospitalier, à l’échelle de différents types d’ES (hôpital local, centre hospitalier régional universitaire, cohorte de 259 ES), et en évaluant l’impact de recommandations nationales ou de programmes et de guides locaux. Ces travaux nous ont permis de constater que la diffusion de recommandations nationales pouvait permettre de réduire les consommations de carbapénèmes, et qu’un programme mené dans un hôpital local pouvait être très efficace pour réduire les consommations de fluoroquinolones, mais également la résistance bactérienne à plus long terme. Des audits ciblés sur la prescription des aminosides et l’antibioprophylaxie chirurgicale ont permis de mettre en évidence des non-conformités récurrentes orientant sur des actions d’amélioration ciblées à mener.En conclusion, ce travail souligne l’importance des programmes de bon usage antibiotique au sein de chaque ES, quel que soit le type et le nombre de lits. En effet, ces programmes venant en appui aux recommandations ont démontré leur efficacité pour réduire les consommations et améliorer la qualité des prescriptions antibiotiques, grâce à leur impact positif sur les comportements des prescripteurs<br>Bacterial resistance to antibiotics is a worldwide public health issue which is mainly linked to antibiotic misuse (overconsumption and inappropriate prescription).To fight this threat, recommendations from learned societies and national action plans have been set up. Even if they are necessary, they are not sufficient to provide a significant improvement in the antibiotic use. A high rate of non-compliance with the recommendations is observed among healthcare facilities (HCFs). The setting up of proactive antimicrobial stewardship programs (ASP) among every HCF is essential to improve antibiotic use: an action on prescribers’ behavior is necessary, by using various strategies. These strategies, however persuasive or restrictive, have been shown to be effective, with no clinical negative effects for the patients (no increase in mortality and in length of stay), while reducing anti-infective costs.With this work, we aimed to study the appropriateness of antibiotic use in hospitals, at different HCFs levels (local hospital, university hospital, 259 French HCFs cohort), by assessing the impact of national recommendations or local ASP and guidelines. These studies showed that national recommendations could lead to a reduction in carbapenem consumptions, and that an ASP conducted in a local hospital could be very effective to reduce fluoroquinolones consumptions, and bacterial resistance at a longer term. Targeted audits on aminoglycosides prescription and on surgical antibioprophylaxis have permitted to highlight recurrent non-compliances, guiding improvement measures to set up.In conclusion, this work supports the weight of ASPs among each HCF, whatever type and size. Indeed, these ASPs, set up in support of the national recommendations, have demonstrated their effectiveness in reducing antibiotic consumptions and improving prescription appropriateness, by their positive impact on prescribers’ behaviors
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Gautier, Estelle. "A Theory and Process Evaluation of the Umhlathuze Water Stewardship Programme of the International Water Stewardship Programme." Master's thesis, Faculty of Commerce, 2019. https://hdl.handle.net/11427/31772.
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Water is a scarce resource without which human survival is at risk and major economies would collapse if not carefully managed. Water stewardship involves collaboration between role players from the public- and private sector as well as civil society to effectively mitigate some of the water related risks and improve water security. Good practice examples of water stewardship have been captured in only a limited number of international studies through the work of a few organisations driving adoption of stewardship practices. Most of these are internal documents and remain unpublished. There are a few local, unpublished studies that are specific to water stewardship as an approach to water resources management in South-Africa. A comprehensive literature review on water resource management institutions in South published between 1997 and 2011, shows that research is predominantly focused on catchment management agencies (CMA) than on other entities such as international water management bodies, water user associations or water irrigation boards (Meissner, 2013) The uMhlathuze Water Stewardship Programme (UWaSP) is a South African programme selected to evaluate if the programme has been established against globally recognised good practices of water stewardship and to what extent it has been implemented accordingly. The programme is part of an international water stewardship programme which provided an ideal opportunity to evaluate a local programme against a global good practice model. The international literature on water stewardship as well as literature on adaptive co-management approaches to water resources management enabled the development of a consolidated global good practice evaluation model of water stewardship. The research included consideration of contextual influences that may have enabled or hindered the implementation of the establishment of the water stewardship programme. The South African literature shows that a specific type of integrated water resources management ( IWRM) , catchment management associations (CMA’) share certain adaptive co-management elements with a water stewardship approach to water management. These include three concepts extracted from the literature namely collaborative stakeholder engagement, adaptation through learning (experimentation) as well as a bioregional approach to water resources management which means implementation of management structures at the river basin level (Meisner, 2016). The local contextual factors influencing implementation of the UWaSP and commonalities with CMA’s are considered during the discussion, against the background of the findings of local studies.
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Gres, Emelyne. "Usage et mésusage des antibiotiques chez les enfants de moins de 5 ans au niveau des centres de santé primaire en Afrique de l’Ouest et du Centre." Electronic Thesis or Diss., Bordeaux, 2024. http://www.theses.fr/2024BORD0223.
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Dans les pays à revenus faibles et intermédiaires (PRFI), les maladies infectieuses sont la principale cause de mortalité infantile, faisant des antibiotiques un pilier essentiel des soins médicaux. Cependant, l'utilisation croissante de ces médicaments s'accompagne souvent de prescriptions inappropriées, principalement en raison du manque de personnel formé et de moyens diagnostics. L'Organisation Mondiale de la Santé (OMS) met en garde contre l'usage irrationnel des antibiotiques. Une exposition inutile à ces médicaments augmente le risque d'effets indésirables graves, alourdit les coûts des soins de santé et contribue à l’émergence de l’antibiorésistance. Malgré ces enjeux, l'absence de systèmes de surveillance des pratiques de prescriptions entraîne un manque de données, notamment pour la population pédiatrique, limitant la mise en place d’interventions adaptées. Mon travail de doctorat a consisté à décrire et quantifier l'usage et le mésusage des antibiotiques chez les enfants malades de moins de 5 ans dans les centres de santé primaire (CSP) en Afrique de l'Ouest et du Centre. Dans le cadre du projet AIRE qui a mis en œuvre l’utilisation de l’oxymétrie de pouls (OP) dans les consultations de Prise en Charge Intégrée des Maladies de l’Enfant (PCIME), nous avons analysé les pratiques de prescriptions d’antibiotiques de 15 854 enfants malades de moins de 5 ans consultant des CSP publics du Burkina Faso, de la Guinée, du Mali et du Niger (06/2021 – 07/2022). Les résultats montrent des taux élevés de prescription d’antibiotiques chez les enfants (2 - 59 mois), s’élevant à 71 % au Burkina Faso, 66 % en Guinée, 63 % au Mali et 36 % au Niger. Chez les nouveau-nés (0 à 59 jours), les proportions étaient aussi élevées, atteignant 83 % au Burkina Faso. La grande majorité des antibiotiques prescrits appartenaient au groupe Access de la classification AWaRe, associé à un faible risque de développement de résistances bactériennes. Ces résultats sont positifs et conformes au seuil fixé par les recommandations de l'OMS qui accompagnent la classification AWaRe. L’analyse de l’adéquation des prescriptions par rapport aux recommandations PCIME des différents pays révèle des pratiques de mésusage des antibiotiques. D'une part, on observe des taux alarmants de surprescription, définie par la prescription d'antibiotiques à des enfants inéligibles d’après leur classification PCIME. Parmi les enfants inclus dans le projet AIRE, 49 % des nouveau-nés et 25 % des enfants ont reçu une surprescription d'antibiotiques. Le jeune âge, les symptômes respiratoires et un test paludisme négatif ou non réalisé sont des facteurs associés à cette surprescription, reflétant des pratiques de prescription présomptives. D'autre part, nos analyses révèlent des opportunités manquées de traitement par antibiotique chez les enfants qui en nécessiteraient selon les recommandations PCIME. Parmi les nouveau-nés ayant consulté, 7,5 % n’ont pas reçu d’antibiotiques alors qu’ils étaient éligibles. Chez les enfants âgés de 2 à 59 mois, ce taux atteint près d’un enfant sur 10. Enfin, dans un contexte différent, l'essai clinique randomisé mené en République Démocratique du Congo (07/2019 – 01/2020) sur la prise en charge simplifiée de la malnutrition aiguë (OptiMA) nous a permis d’étudier la prévalence de la consommation d'antibiotiques. Pendant le suivi, 17,8 % des 482 enfants atteints de malnutrition aiguë sévère ont reçu au moins un antibiotique, sans différence significative entre le protocole standard et le protocole OptiMA. Ces études démontrent clairement la fréquence élevée des prescriptions d'antibiotiques chez les enfants consultant les CSP dépourvus de moyens diagnostiques, dont une grande partie est injustifiée, soulignant un besoin d’interventions. Nous avons donc mené une revue systématique de la littérature pour recenser les programmes de gestion des antibiotiques disponibles en contexte pédiatrique dans les PRFI (…)<br>In low- and middle-income countries (LMICs), infectious diseases are the leading cause of child mortality, making antibiotics a critical component of medical care. However, the increasing use of these drugs is often accompanied by inappropriate prescriptions, mainly due to a lack of trained personnel and reliable diagnostic tools. The World Health Organization (WHO) warns against the irrational use of antibiotics. Unnecessary exposure to these drugs increases the risk of severe adverse effects, raises healthcare costs, and contributes to the emergence of antibiotic resistance. Despite these challenges, the absence of surveillance systems for antibiotic prescribing practices leads to a lack of data, particularly for the paediatric population, which limits the implementation of appropriate interventions. My doctoral work aimed to describe and quantify the use and misuse of antibiotics among sick children under 5 years old in primary health care centres (PHC) in West and Central Africa. As part of the AIRE project, which implemented the use of pulse oximetry (PO) in Integrated Management of Childhood Illness (IMCI) consultations, we analysed antibiotic prescribing practices for 15,854 sick children under 5 years old attending public PHC in Burkina Faso, Guinea, Mali, and Niger (06/2021 – 07/2022). The results have shown high rates of antibiotic prescriptions among children (2-59 months), reaching 71% in Burkina Faso, 66% in Guinea, 63% in Mali, and 36% in Niger. Among neonates (0-59 days), the proportions were high, with 83% in Burkina Faso. According to the WHO's AWaRe classification, the vast majority of prescribed antibiotics belonged to the Access group, which is associated with a low risk of developing bacterial resistance. These results were consistent with the threshold set by the WHO recommendations accompanying the AWaRe classification. Analysis of prescribing practices with IMCI recommendations in different countries reveals situations of antibiotic misuse. On the one hand, there are alarming rates of overprescription, defined as the prescription of antibiotics to children who are ineligible according to their IMCI classification. Among the children included in the AIRE project, 49% of neonates and 25% of children were overprescribed antibiotics. Factors associated with this overprescription include young age, respiratory symptoms, and a negative or missed malaria test, reflecting presumptive prescribing practices. On the other hand, our analyses reveal missed opportunities for antibiotic treatment in children who would need it according to the IMCI guidelines. Among consulted neonates, 7.5% did not receive antibiotics despite being eligible. This rate rises to 9.6% for children aged 2-59 months, almost one in ten. Finally, in a different context, the randomised clinical trial on simplified management of acute malnutrition (OptiMA) in the Democratic Republic of Congo (July 2019 - January 2020) allowed us to study the prevalence of antibiotic use. During follow-up, 17.8% of the 482 children with severe acute malnutrition received at least one antibiotic, with no significant difference between the standard protocol and the OptiMA protocol. These studies document the frequency of antibiotic prescriptions among sick children in primary care centres lacking diagnostic tools, with a significant proportion being unjustified, highlighting the need for intervention. We, therefore, conducted a systematic review of the literature to identify available Antibiotic Stewardship Programs (ASP) in paediatric settings in LMICs. This research highlights different interventions depending on the level of child care and available resources. Hospitals prioritize protocols and audits, while PHCs focus on clinician training and the implementation of prescription support tools. My work provides new insights into antibiotic prescribing practices among children in West and Central Africa, revealing numerous inappropriate practices (…)
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Coulter, Sonali A. "An economic evaluation of antimicrobial stewardship programs in metropolitan Australian hospitals." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/116505/9/Sonali_Coulter_Thesis.pdf.
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This thesis provides the first economic evaluation of Antimicrobial Stewardship (AMS) interventions in two Metropolitan Australian Hospitals. AMS interventions are cost-saving from a hospital perspective and are cost-effective particularly if teamed with rapid diagnostics in the microbiology laboratory. The uncertainty in the mortality estimates does not allow for a high level of confidence in the cost-effectiveness decision for policy makers. While mortality is a useful metric, morbidity associated with bloodstream infections due to inappropriate prescribing needs to be collected over a longer period of time to capture the true benefits of AMS interventions.
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Metz, Jakob Friedrich [Verfasser]. "Ein Antibiotic Stewardship Programm an der Kinderklinik München-Harlaching / Jakob Friedrich Metz." Tübingen : Universitätsbibliothek Tübingen, 2020. http://d-nb.info/1221597604/34.
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Schädel, Jana [Verfasser]. "Effekt eines multimodalen Antimicrobial Stewardship-Programms bei Fieber in Neutropenie / Jana Schädel." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1113011955/34.
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Chambers, Kristy LeAnn. "Stewardship of creation: A guidebook for the Episcopal Church." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3206.
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Lo, Chiu-sing. "Territory-wide Antibiotic Stewardship Programme and its effectiveness in public hospitals in Hong Kong." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38478626.
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Lo, Chiu-sing, and 勞超成. "Territory-wide Antibiotic Stewardship Programme and its effectiveness in public hospitals in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724505.
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Mas, Morey Pedro. "Intervención del farmacéutico clínico para optimizar el uso de antimicrobianos en hospitales de pequeño-mediano tamaño y su impacto económico." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665854.
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El aumento de las resistencias a los antimicrobianos actualmente disponibles unido a la falta de comercialización de nuevos fármacos supone que las instituciones sanitarias recurran a desarrollar programas para hacer frente a las infecciones causadas por dichos microorganismos. Estos programas, conocidos como Programas de Optimización de Antimicrobianos (PROA) son ampliamente implantados en hospitales de gran tamaño pero su implantación en hospitales de pequeño-mediano tamaño (< 500 camas) es poco frecuente y sus resultados desconocidos. El objetivo de la presente Tesis Doctoral es evaluar las intervenciones propuestas por un PROA en el que participa un farmacéutico clínico o bien de protocolos de actuación similares, en hospitales de pequeño-mediano tamaño, para optimizar el uso de los antimicrobianos y su impacto económico. Para ello se realizó una revisión sistemática de la bibliografía existente y un estudio experimental. La revisión sistemática incluyó artículos publicados en PubMed y Cochrane Library referentes a hospitales con menos de 500 camas que describieran los resultados microbiológicos, clínicos y/o económicos asociados a la implantación de un PROA con participación activa de un farmacéutico clínico. Para realizar el estudio experimental se partió de las intervenciones farmacéuticas propuestas durante un periodo de dos años (octubre 2012 – octubre 2014) en un hospital de pequeño tamaño sin PROA. Los pacientes externos y aquellos ingresados en UCI o urgencias fueron excluidos del estudio. Las intervenciones del estudio experimental se centraron en: asegurar la selección, indicación y dosis apropiada de antimicrobiano; evitar eventos adversos, alergias, intolerancias o interacciones farmacológicas; promocionar la terapia secuencial y el desecalaje terapéutico; y evitar la duración excesiva de tratamiento antimicrobiano. Durante el periodo experimental los carbapenems y linezolid se considerados antibióticos de “especial vigilancia” para garantizar un uso racional de éstos y utilizarlos como último recurso terapéutico, mientras que amoxicilina-clavulánico, piperacilina-tazobactam y vancomicina se consideraron fármacos de elección. El uso de los antimicrobianos y los costes asociados se comparó con los dos años previos al periodo de intervención del farmacéutico clínico.
La revisión sistemática incluyó 28 estudios procedentes de 26 hospitales, la mayoría de Estados Unidos o Canadá. Igual que en el estudio experimental, la mayor parte de estos estudios comparó los resultados obtenidos tras la implantación del PROA con aquellos que se obtuvieron previamente a la implantación del programa. De forma general, estos estudios no determinaron grandes cambios en los parámetros microbiológicos o clínicos pero si hallaron importantes ahorros económicos asociados a un menor uso de antimicrobianos o a la utilización de otros más baratos tras la implantación del PROA. En cuanto al estudio experimental, se realizaron un total de 386 intervenciones farmacéuticas en 303 pacientes con una aceptación por parte del personal médico del 83,4%. Prácticamente el 60% de las intervenciones farmacéuticas estaban destinadas al ajuste de dosis de antimicrobiano siendo las más frecuentes aquellas centradas en los pacientes con insuficiencia renal. En relación al uso de antimicrobianos, respecto a los dos años previos a la intervención se detectó un descenso significativo en el uso de los antibióticos de “especial vigilancia” (de 39,9 a 28 DDD/1000 pacientes-día) y un aumento en el consumo de piperacilina-tazobactam (de 13,2 a 17,2 DDD/1000 pacientes-día) y de las cefalosporinas (de 123,5 a 149,1 DDD/1000 pacientes-día). El ahorro total obtenido durante los dos años de intervención fue de 32003 €.
De la presente Tesis Doctoral se concluye que en hospitales de pequeño-mediano tamaño, tanto la implantación de PROA en el que participa un farmacéutico clínico como la realización de intervenciones farmacéuticas similares, contribuyen a optimizar el tratamiento antimicrobiano y a disminuir el coste asociado al uso de antimicrobianos. Si bien, con la evidencia actualmente disponible no se puede afirmar que dichas intervenciones tengan un claro beneficio en las variables clínicas o microbiológicas.<br>Antimicrobial resistance to currently available antimicrobials and the lack of commercialization of new drugs have lead health institutions to implement specific programs to fight against these microorganisms. These programs, known as Antimicrobial Stewardship Programs (ASP), have been widely implemented in large hospitals but little is known regarding small-to-medium-sized hospitals (<500 beds). The main objective of this Doctoral Thesis is to evaluate interventions described for ASP participated in by clinical pharmacists or similar interventions proposed by a clinical pharmacist, in small-to-medium-sized hospitals in order to optimize the use of antimicrobials and its economic impact. A literature systematic review and an experimental study were carried out.
The systematic review included articles from Pubmed and Cochrane Library databases describing microbiological, clinical and/or antimicrobial use/cost outcomes for ASP participated in by clinical pharmacists in small-to-medium-sized hospitals. The experimental study analyzed the impact of clinical pharmacist interventions (PI) over a 2-year period (October 2012 to October 2014) in a 164-bed hospital without a formal ASP. Excluded from the experimental study were outpatients and patients admitted to the intensive care unit or the emergency department. The PI focused on appropriate indication and appropriate dosage; drug adverse events, allergies, intolerance and interactions; sequential therapy; therapeutic de-escalation; excessive duration of treatment and therapeutic drug monitoring. Furthermore, carbapenems and linezolid were classified as special-vigilance drugs intended only to be used as last-resort antibiotics, while amoxicillin-clavulanic, piperacillin-tazobactam and vancomycin were included in the group of preferred drugs. Antimicrobial use and expenditure were compared with that of the previous 2-year period.
The systematic review included 28 studies from 26 hospitals, mostly American or Canadian. Most cases (23 studies) consisted of time-series comparisons of pre-and-post intervention periods. Interventions from these studies were not generally associated with significant changes in microbiological or clinical parameters as mortality or readmission rates but were associated with substantial cost savings, mainly due to reduced use of antibiotics or the use of cheaper antibiotics.
On the other hand, during the experimental study 386 PI were implemented in 303 patients. The overall acceptance rate was 83.4%. Dose adjustments or interval modifications accounted for nearly two-thirds of all PI and dose adjustment or interval modification due to kidney impairment was the most frequently performed PI. In the intervention period significant reductions in the use of special-vigilance drugs (from 39.9 to 28 defined daily doses (DDD)/1000 patient-days) were seen and increases in the use of piperacillin-tazobactam (from 13.2 to 17.2 DDD/1000 patient-days) and of cephalosporins (from 123.5 to 149.1 DDD/1000 patient-days). Total cost savings were €32003, representing a 5.1% decrease in overall expenditure.
We conclude that in small hospitals whether they have ASP in which a clinical pharmacist participates or if similar interventions proposed by a clinical pharmacist are carried out, both contribute to optimize the antimicrobial treatment and to reduce the cost associated with the use of antimicrobials. What remains unclear, however, is the association of these interventions with better clinical and microbiological outcomes.
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Alghamdi, Saleh. "The adoption of antimicrobial stewardship programmes in Ministry of Health hospitals in Saudi Arabia." Thesis, University of Hertfordshire, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.768496.
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Aim: This thesis aims to explore and investigate the level and process of adoption of Antimicrobial Stewardship Programmes (ASPs) and factors influencing their implementation in Saudi Ministry of Health (MOH) hospitals. The findings of this study will provide hospitals and policy makers with evidence-based recommendations on how barriers to ASPs adoption can be overcome, which will ultimately improve antimicrobial use and reduce antimicrobial resistance (AMR). Method: A mixed method approach was carried out using both qualitative and quantitative research methods. Semi-structured interviews were conducted with healthcare professionals in three Saudi hospitals to explore the enablers and barriers to their adoption of ASPs. A survey was then developed based on these findings to investigate the level of hospitals’ adoption of ASPs and factors influencing their implementation at a national level. Further, a case study using in-depth interviews was utilised to understand the process of ASP adoption in a Saudi hospital, and how adoption challenges were addressed. Finally, a self-administered questionnaire was used to examine patients’ knowledge and perceptions of antimicrobial use and resistance, and to evaluate the institutional role of patient education on antimicrobial use in two Saudi hospitals. The overall methodology of the research is summarised in Figure I. Results: Despite the introduction of a national ASP strategy, adoption of ASPs in Saudi MOH hospitals remains low. Organisational barriers such as the lack of senior management support, lack of supportive IT infrastructure and the shortage of ASP team members hinder hospitals’ efforts to adopt ASPs. Further barriers relate to the lack of formal enforcement by MOH and the physicians fears of patients' complications and clinical liability. Patients admitted to Saudi hospitals lack knowledge and perceptions of AMR, and the adoption of ASPs may improve hospitals’ role in patients' education. Conclusions: Despite the established benefits of ASPs, their adoption in Saudi MOH hospitals remains low. Urgent action is needed to address the strategies priorities associated with AMR, including access to antimicrobials, antimicrobial stewardship and education and research. Policy makers are urged to consider making ASPs adoption in hospitals a regulatory requirement supported by national guidelines and surveillance programmes. It is essential to increase the provision of ID and infection control residency and training programmes to meet the extreme shortage of ID physicians, pharmacists, microbiologists and infection control practitioners. Higher education institutions and teaching hospitals are required to introduce antimicrobial prescribing and stewardship competencies into undergraduate Medical, Pharmacy, Dental, Nursing and Veterinary curriculum, as well as introduction of AMR topics in order to increase knowledge and awareness of ASPs and AMR. Collaboration between ASPs adopting and non-adopting hospitals is essential to share implementation experience, strategies and solutions to overcome barriers. Healthcare specialised associations are needed to be part of AMR conversation and guide healthcare professionals’ training and accreditation. Multiple stakeholders should be actively part of the conversations around tacking AMR. Primary care, secondary care, community pharmacies and policy makers should strive to create a shared culture of responsibility among all healthcare partners to improve antimicrobial therapy and reduce risks of AMR
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Coetzee, Johannes Christiaan. "Understanding the extension capacity needs of the CapeNature Stewardship Programme in the Western Cape Province of South Africa." Thesis, Rhodes University, 2018. http://hdl.handle.net/10962/63220.
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There is an increasing call for conservation programmes to provide sound evidence of effectiveness, and employing empirical evaluations can assist in the transition to evidence-based conservation practices. The objectives of this research were to develop a logic model for the CapeNature Stewardship Programme which would articulate the programme's theory of operation with respect to its Stewardship Programme landholders. The second major objective was to develop psychometric instruments for assessing the motivations and satisfactions of the programme's stewardship landholders. Both objectives included the aim to provide robust and repeatable instruments for exploring landholder's psychology, and developing a programme's theory of operation to understand the programme and improve with understanding the needs of the landowners. In this regard the processes and methodologies employed represent a major component of this research. A mixed methods approach was utilized, including stakeholder and volunteer surveys, conducted via mailing hardcopies and the internet, together with three focus groups held with the programme's management, extension staff and the stewardship landholders. Analysis of the data thus collected included both qualitative and quantitative approaches, specifically coding and content analysis, together with statistical tests of internal consistency, factor analysis and doubling correspondence analysis. Robust indices for example validity and internal consistency were developed for assessing landholder’s satisfaction with extension and level of satisfaction with the stewardship programme (Babbie 2007). These indices revealed that landholders in the Stewardship Programme are not satisfied with the programme, and exhibit behaviours suggesting they act as advocates for the programme. Demographic data and additional information provided further insights into the programme. The development of a method for articulating the programme's theory of operation is represented, together with four logic models which graphically illustrate this theory. This process and theory allowed for recommendations to be provided for the programme's improvement. A platform for adaptive management and further evaluations of this, and similar programmes, represents a major outcome of this research, understanding the extension capacity needs for the conservation of biodiversity in the CapeNature Stewardship Programme to function as a model for improving the implementation of the programme across the Western Cape, South Africa. This research feeds into an evaluation of CapeNature’s Biodiveristy Stewardship programme and demonstrates the importance of incorporating psychology into conservation interventions.
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Walker, Clara Isabella. "Stewardship as an educational process of social learning and change: two case studies conducted in the Western Cape." Thesis, Rhodes University, 2011. http://hdl.handle.net/10962/d1003657.
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Stewardship in South Africa, as it is being implemented within the framework of the Biodiversity Stewardship Programme (BSP), is an attempt by conservation agencies to engage landowners in the voluntary securing of parcels of biodiverse land, through signing a contract for a certain time period, not to develop the landscape in ways that will impact negatively on the biodiversity of the area in question. The focus of this study is the relationship between biodiversity stewardship and social learning, as I hope to ascertain how stewardship practices are helping to resolve the current problems of biodiversity loss in the Western Cape. The overall aim of this research is to gain an understanding of how, in its capacity as a conservation education process, the Cape Nature Stewardship Programme can foster social learning amongst the landowners involved in its implementation, by leading them to a better understanding of their environmental responsibilities. Data was generated through the use of interviews and informal discussions with participants together with document analysis, such as brochures, pamphlets and presentations. My approach to the analysis of my data was two-phased. In the first phase, I analysed the data generated from the interview process and from reviewing the documents the stewardship officials supplied me with. The second phase involved looking into the results of the two case studies, and formulating analytical statements which were then used to review the case evidence within a social learning perspective, derived from Wals (2007). In constructing an analytical framework for the interpretation of my data, I drew heavily on Wals' (2007) notion of social learning occurring in sequential activities. I used this insight as a lens through which to trace the educational effects of the implementation of the CNSP in the two case study areas.The research highlighted evidence that Stewardship initiatives should be based on the foundation of social learning and invest time and effort in building an environmental knowledge capital amongst the landowners involved. By equipping them with these necessary conservation skills, one creates a 'community of practice' where those individuals adopt a sustainability habitus contributing towards a change and environmental understanding and practises in field.
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Luginbuhl, Mather April Marie. "The Final Nail in the Coffin of Small-Scale Farming in the United States: Stewardship and Greenhouse Gas Markets in the United States." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1275393945.
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Jurow, Kate. "Making Meaning Together: The role of interpretation during a short-term nature excursion." Antioch University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1468589329.
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Winkler, Julia Theresa [Verfasser], and André [Akademischer Betreuer] Gessner. "Strukturierte Fragebogenerhebung unter klinisch tätigen Ärzten zur Optimierung der mikrobiologischen Befundmitteilung im Rahmen des Antibiotic Stewardship-Programms am Universitätsklinikum Regensburg / Julia Theresa Winkler ; Betreuer: André Gessner." Regensburg : Universitätsbibliothek Regensburg, 2017. http://d-nb.info/1149366591/34.
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Baur, David [Verfasser], and Evelina [Akademischer Betreuer] Tacconelli. "Antibiotic Stewardship-Programme reduzieren die Inzidenz von Infektionen und Kolonisation durch Antibiotika- resistente Bakterien und Clostridium difficile : Eine systematische Review und Meta-Analyse / David Baur ; Betreuer: Evelina Tacconelli." Tübingen : Universitätsbibliothek Tübingen, 2019. http://d-nb.info/1199929565/34.
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Goodale, Kathleen. "Biodiversity and Farming: An Evaluation of a Voluntary Stewardship Program and Exploration of Farmer Values." 2013. http://hdl.handle.net/10222/35456.
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Farming relies on the ecosystem services provided by biodiversity for production. Farming has been, however, responsible for habitat degradation and destruction, and consequently, biodiversity loss. At present, efforts to increase habitat on farmland are largely confined to voluntary programs. The effectiveness of the provincially delivered Agricultural Biodiversity Conservation (ABC) program was measured using a quantitative survey. Follow-up interviews during farm tours further explored qualitatively how farmers value biodiversity and biodiversity conservation on their land. Results from the survey quantitatively link ABC program participation to increased engagement in riparian management and modified harvesting activities. Qualitative results suggest that the motivation for engagement in biodiversity conservation stems from the farmers’ interest in preserving the balance between production and 'nature', thereby preserving what they perceive to be the health of their land. These results have implications for the improvement of the ABC program and of future stewardship program design.
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Miller, Alexandra. "Manitoba Piping Plover Stewardship Program: a provincial strategy for the management of the endangered piping plover (Charadrius melodus circumcinctus)." Thesis, 2006. http://hdl.handle.net/1993/271.
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The Manitoba Piping Plover Stewardship Project was initiated in 2002 to determine the status of Piping Plovers (Charadrius melodus) in Manitoba and to develop a provincial management strategy that outlined provincial management goals and necessary stewardship actions. In 2002 and 2003, intensive surveys of historical and potential sites across Manitoba were conducted and measures taken to protect eggs and chicks from predation and human disturbance. With the use of fencing, signs, predator exclosures and guardian volunteers, predation and recreational disturbance were minimized sufficiently at most sites to allow for increased nest success and fledging rates. An overall apparent nest success rate of 62% and an apparent fledge rate of 1.16 fledglings/pair was achieved during this study. The study concluded that Piping Plover nest success and productivity at the majority of historical nesting sites in Manitoba is being limited by habitat availability, medium to high predation rates and recreational pressures.<br>October 2006
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WU, YA-FENG, and 吳雅鳳. "Impact of Antimicrobial Stewardship Program Interventions on the distribution of drug-resistant bacteria in a Hospital in Southern Taiwan." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/w7zgqt.
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碩士<br>嘉南藥理大學<br>醫務管理系<br>105<br>Since the discovery of penicillin in 1928, the era of antibiotic therapy has been opened. As the antibiotics are widely used, humans face a new crisis - the multidrug-resistant organisms (MDROs) appear to threaten the human health, the problems of drug resistance have caused human health shocks. According to the National Health Research Institutes "Taiwan Surveillance of Antimicrobial Resistance (TSAR)" I-VII (1998 ~ 2010) survey, the domestic multi-drug resistant organisms (MDROs ) Has risen gradually and is one of the most serious in the world. U.S. Food and Drug Administration(FDA) approved the listing of antibiotics from 1983 to 2011 the number of declining , the past 20 years has not introduced a new class of antibiotics, according to statistics estimated that 5 to 10 years will not have a new role in the machine Antibiotics can be used clinically .The Ministry of Health and Welfare has implemented an National Action Plan. Antimicrobial Stewardship Program since 2013. It is hoped that through the implementation of the program, we will allow you to face up to the problem of drug resistance and promote the rational use of antibiotics. Because the participation in antibiotic management program, to understand the abuse of antibiotics caused serious problems, would like to collect the hospital nearly six years of drug-resistant strains of bacteria, to understand our hospital strains of drug resistance trends and plans before and after the implementation of multiple anti- Whether there is improvement in the production of the situation, and further explore the patient population which patients are more likely to cause antibiotic abuse caused by multiple drug-resistant strains of infection, and increase the cost of medical expenses, but also the need for prudent use of antibiotics . According to the data collected, the common pathogenic bacteria in our hospital are: Escherichia coli、Klebsiella pneumoniae 、Pseudomonas aeruginosa、Acinetobacter baumannii、 Staphylococcus aureus and Enterococcus spp. We monitor the proportion of these strains is also increasing the trend of rising year by year, and in the patient population is the intensive care unit and blood cancer patients and elderly .A higher proportion of drug-resistant bacteria
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Chen, Yu-Jen, and 陳育仁. "Assess The Outcomes of A Hospital-Wide Computerized Antimicrobial Stewardship Program in A Regional Teaching Hospital in Northern Taiwan." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/7z4hht.
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碩士<br>臺北醫學大學<br>藥學系(碩博士班)<br>102<br>Concerns related to increasing antimicrobial resistance have been elevated recently by numerous reports pertaining to outbreaks of infection caused by multidrug-resistant (MDR) organisms worldwide.Two complementary strategies help prevention and control antimicrobial resistance: infection control measures to reduce the spread of MDR organisms; and optimization of antibiotic usage for therapy and prophylaxis. The latter strategy is commonly mentioned under the term ‘antibiotic stewardship.When antibiotic stewardship is implemented, there are several interventions required. Single interventions such as healthcare provider education or formulary restriction are not sufficient alone . Prior literature on the effectiveness and safety of antibiotic optimization were conducted in small or specific patient populations, including patients in diagnosis-related group assignment.Only few research available regarding the impacts of a comprehensive hospital-based antimicrobial control program on healthcare quality in a large hospital setting.
The purpose of this study is to evaluate the outcomes of a hospital-wide computerized antimicrobial stewardship program in aregional teaching hospital in Northern Taiwan.
A hospital-wide computerized antimicrobial approval system (HCAAS) was developed to guide the use of 30 parenteral antimicrobial agents, in a hospital with 1078-beds [60beds in Intensive Care Units (ICUs)] in northern Taiwan in December 2005. The HCAAS is an intranet-based application, which was built under the Health Information System (HIS) and linked to the comprehensive electronic medical records.This study used the retrospective analysis of hospitalized patients who used restricted antimicrobial agents between January 1, 2003 to December 31, 2013. The objective of the study was to evaluate and report the impacts of HCAAS before and after the implementation on the hospital. The program outcomes examined here include antibiotic consumption and expenditures, changes in antimicrobial resistance of major healthcare-associated bacterial pathogens, length of hospital stay, hospital acquired infection, and patients outcomes before and after implementation of the program were examined.
The results indicate that the antibiotic comsumption rate was above 1.2 % before the implementation of HCAAS. After implementing the HCAAS in 2006, there was a statistically significant decrease in antibiotic consumption (P<0.001). The antibiotic expendicture was also significantly decreased after the HCAAS (P=0.024). The length of hospital stay before the HCAAS implementation was about 10 days. There was a significant change on hospital stay before and after the implementation of HCAAS (P<0.001). Finally, the hospital acquired infection related ORSA rate was significantly decreased by comparing before and after the HCAAS (P=0.015). This research has demonstrated that the HCAAS along with the strict infection control measure would help decrease the spread of resistant organism in the hospital.
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Mackenzie, Bruce. "Supporting Environmental Stewardship and Livelihood Benefits in Ontario's Greenbelt: Assessing the Potential Contribution of the Alternative Land Use Services Program." Thesis, 2008. http://hdl.handle.net/10012/4117.
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Ontario’s Greenbelt is key to the region’s sustainability and plays an important role in stopping urban sprawl, preserving agricultural land and maintaining ecological goods and services. However, there have been concerns expressed in the literature and by non-government organizations that the Greenbelt legislation, on its own, will not ensure the viability of the farming economy in this region, or ensure adequate ecological stewardship. These concerns point to the need for other programs and policies to complement the Greenbelt legislation, and to help ensure that the goals of the Greenbelt are met. This research study assesses the potential of the Alternative Land Use Services Program (ALUS) as a tool for promoting agricultural viability and associated land stewardship in Ontario’s Greenbelt. An Alternative Land Use Services program would pay farmers for the provision of environmental services in the public interest. Using a qualitative methodological approach based on a literature review, a review of government and non-government organization documents and interviews with key stakeholders, this study compares the potential contribution of the ALUS program with that of other reasonable alternatives currently available to promote farmland protection and farm stewardship. The research also provides an analytical framework and a comprehensive set of criteria for selection and design of programs in support of sustainable agriculture in the Greenbelt. The primary research findings indicate that an ALUS program in the Greenbelt, established as a stand-alone regional project or as part of a provincial or national program, could help to strengthen the Greenbelt’s roles in stopping urban sprawl, preserving agricultural land and maintaining ecological goods and services. The ALUS concept and means of applying it could also play an important role in discussions regarding how to support the farm economy and rural communities in the Greenbelt. ALUS may be particularly appropriate as a means of enhancing the economic and ecological aspects of peri-urban agriculture. One of the thesis conclusions is that while ALUS could play a positive role in the Greenbelt, the program would be insufficient if it were applied on its own. ALUS will need to be packaged with a suite of existing programs that would be able to complement ALUS and address some of its weakness in order to make a stronger contribution. This research has identified new opportunities to promote land stewardship and enhance livelihoods in the agricultural sector as well as a new agenda for sustainable agriculture in the Greenbelt. More generally, the framework for analysis that was applied in this research has a broader applicability and usefulness in sustainability-based decision making processes. The approach outlines how sustainability assessments might specify sustainability considerations and integrate them together in particular applications.
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Nkosi, Bongani Eustance. "Evaluation of impact of antimicrobial stewardship in limiting the spread of antimicrobial resistance in Gauteng Province." Thesis, 2018. http://hdl.handle.net/10500/25701.
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The threat of antimicrobial resistance particularly in the intensive care unit has become a global issue. This study aimed to evaluate the effectiveness of antimicrobial stewardship in limiting the spread of antimicrobial resistance in the hospital’s ICU. The study further determined the deficiencies of the ASP and recommended strategies to remedy the identified deficiencies.
A quasi-experimental descriptive quantitative design was used in this study. The study was conducted at the intensive care unit of an academic hospital. A structured questionnaire was used to extract information from patients’ medical records. This evaluation showed that the antimicrobial stewardship program had a sufficient impact on the appropriate use of antimicrobials in the hospital’s ICU. While there were a small (19.05 %) number of patients inappropriately prescribed antimicrobials, a moderate (35.59%) number of patients developed hospital acquired infections during the study period. In addition, the results revealed a lack of the facility’s leadership commitment to antimicrobial stewardship, which is crucial for ensuring the availability of human, financial and information technology resources
Through the evaluation of the program the deficiency in the program’s performance can be identified and optimised. For the studied facility, the performance of the program could be improved by gaining the support of the facility leadership. The present study endorses the evaluation of health promotion initiatives to improve patients’ safety and outcome in healthcare institutions.
Keywords<br>Health Studies<br>D. Litt. et Phil. (Health Studies)
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Okwumabua, Dieluwa Nat. "Impact of the Manitoba Product Stewardship Program on residential solid waste recycling in four municipalities of the South-Central Recycling Region of Manitoba (1992-2000)." 2009. http://hdl.handle.net/1993/3768.
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Under the Manitoba Round Table's Strategy for Solid Waste Minimization and Management, a central obligation of the provincial government is to effectively reinforce waste minimization activities, such as recycling, and to ensure equitable opportunities and access to programs for program participants. Recycling is a system that includes a circuit of collection, processing, manufacture and consumption that diverts raw materials from the residential waste stream to industries for the manufacturing of new raw materials and products. Such activities provide benefits to both urban centres and rural municipalities in Manitoba and conserve resources. The Province of Manitoba, in proclaiming its Waste Reduction and Prevention (WRAP) Act in August 1990, enabled the Province to assign responsibilities for the stewardship of products and materials that have the potential to become waste. Under this Act, the government of Manitoba established the Manitoba Product Stewardship Corporation (MPSC) in January 1995 to provide financial support for household recycling services in all communities of the province. The establishment of this program was intended to encourage efficient collection, processing, and marketing of recyclable commodities generated in the province. The purpose of this study is to evaluate the impact of Manitoba Product Stewardship Program (MPSP) on Residential Solid Waste Recycling in four Municipalities of the South-central Recycling Region of Manitoba since the inception of MPSP in 1995. The study results show that some recycling programs existed and were well established before the inception of MPSP, and that MPSP has the highest positive impact on a program such as that of Portage la Prairie that was established after the inception of MPSP. The Town of Winkler, the R.M. of Grey and the R.M. of Roland, where programs were already well established before MPSP, saw moderate positive net changes. Some noticeable improvements were observed in recycling promotion and education, as well as in the infrastructure of the four communities. Even though MPSP did not directly pay for the infrastructure, its support payment motivated more collection and hence the need for and support of the infrastructure. MPSP support payments are the major positive net change in all sampled communities. The support payment is a steady source of revenue that helps communities with existing programs keep their programs in place and remove recycling costs from their municipal budgets. The most significant net change and benefit occurred in the City of Portage la Prairie where a recycling program did not exist before the inception of MPSP.
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Valente, Márcia Sofia Oliveira. "Impactos da implementação de programas de apoio à prescrição de antimicrobianos: uma revisão sistemática de literatura." Master's thesis, 2019. http://hdl.handle.net/10400.1/13660.
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Esta dissertação elabora uma revisão de literatura sobre os impactos da implementação de um Programa de Apoio à Prescrição de Antimicrobianos em meio hospitalar, com o objetivo de verificar o estado da arte e identificar as lacunas na literatura que possam ser exploradas quer em estudos futuros, quer ao nível de um trabalho de doutoramento. A metodologia utilizada na realização deste trabalho foi a revisão sistemática de literatura que permite reunir e discutir um conjunto significativo de publicações e resultados relevantes sobre o tema.
Os resultados obtidos foram publicados na última década e demonstram que o programa em questão está associado à redução de custos diretos com antimicrobianos, otimizando a sua utilização e, consequentemente, contribuindo para uma melhoria ou manutenção de indicadores clínicos associados à hospitalização. No entanto, os artigos selecionados reforçam a necessidade do estudo dos custos e benefícios indiretos e sociais resultante da implementação do programa, como sendo o custo do absentismo relacionado com o tempo de hospitalização, por exemplo.<br>This academic work is a systematic review of the literature on the implementation of Antimicrobial Stewardship Programs and aims to map the state of the art and identify potential gaps in the literature that may be addressed in future studies. Results show that such program usually leads to a decrease of the direct antimicrobial costs, helps process optimization and, thus, enhances the hospital’s clinical indicators. However, this systematic review of the literature suggests that additional investigation is needed on the indirect and social costs and benefits of this type of program, namely on the cost of the absenteeism as it relates to the hospitalization time.
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van, de Merwe Sarah. "Managing Information Technology Waste in the Regional Municipality of Waterloo." Thesis, 2009. http://hdl.handle.net/10012/4557.
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Information technology (IT) is one of the fastest growing product groups on the market today (Babu et al., 2006). This technology has become inexpensive to produce and continues to improve in the areas of memory, speed, operating systems, weight, and audio/visual capabilities (Envirosris, 2000). All of these factors have led to a decrease in product lifespan and an increase in the amount of IT-waste produced. IT-waste contains a number of hazardous materials. If this waste is not managed appropriately it can create serious environmental and human health problems. In Canada, there are no federal policies in place to manage IT-waste. Management of IT-waste has largely been the responsibility of local governments. Consequently, there is no uniformity. A wide spectrum of management approaches ranges from ‘do nothing’ to enacting bans to prohibit this waste from entering landfills. Recently (April 1, 2009), a program (Ontario Electronic Stewardship Waste Electronic and Electrical Equipment- OES WEEE) has been created at the provincial level to help with IT management. Residential participation in this program remains voluntary.
This research is exploratory and aims at examining the potential for a sustainable integrated waste management (IWM) plan for residential IT-waste, using the Regional Municipality of Waterloo (RMoW) as a case study. A multiple methods approach was employed to gain an understanding of IT-waste issues and to develop a set of sustainable IWM criteria for evaluation of the OES program and RMoW. Methods used to collect data included: a literature review, surveys, plan analysis, direct observation, key informant interviews, and archival research. A number of recommendations apply specifically to Waterloo Region. Others more broadly address local governments across Ontario for better management of residential IT-waste and other e-waste products.
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Castro, Luís Nuno Cruz Santos. "Antimicrobial stewardship programs : do conceito à prática clínica." Master's thesis, 2015. http://hdl.handle.net/10451/25793.
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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015<br>Antimicrobial Stewardship Programs representam a normalização de esforços e da gestão de recursos humanos, técnicos e farmacológicos no sentido de prestar melhores cuidados de saúde pela promoção da ótimização do uso de antibióticos com vista à redução da taxa de infeções por microrganismos multiresistentes e prevenção do surgimento de resistência antibiótica.
No seu âmbito, pretende-se implementar estratégias que permitam minimização do consumo de antibióticos e documentação precisa de resultados de modo a evidenciar o sucesso das intervenções e o cumprimento efectivo dos objectivos propostos. Ambos estratégias e resultados a medir são definidos tendo necessariamente em vista o contexto singular de cada instituição.
A sustentabilidade dos programas passa pela sua avaliação precisa que deverá concluir acerca do benefício clínico individual e colectivo e custo-efectividade. Apesar do racional lógico que sustenta a implementação dos programas, é notoriamente pobre a base de evidência que deveria servir-lhe de base e o esforço no sentido de a aprofundar deve ser intensificado.
Em Portugal, é exemplo de Antimicrobial Stewardship o Programa de Prevenção e Controlo de Infeção e de Resistência aos Antibióticos que enquadra a constituição de Grupos Locais de Coordenação e apresenta objectivos gerais e específicos em busca dos quais estes devem operar.<br>Antimicrobial Stewardship Programs represent the normalization of efforts and management of human, technical and pharmacological resources in an attempt of providing better healthcare services through the promotion of optimal antimicrobial use aiming to reduce infections by multi-resistant microorganisms and preventing the development of antibiotic resistance.
They postulate the implementation of strategies allowing minimization of antimicrobial consumption and precise documentation of results in order to provide evidence of success and objective atainement. Both strategies and results are defined necessarily keeping in mind the institution’s singular context.
Program sustainability is dependent on its precise evaluation which should observe individual and collective clinical benefit as well as cost-effectiveness. Despite the rationale that underlies program implementation, the evidence base that should be providing foundation to it is notoriously poor and efforts should be intensified in its deepening.
In Portugal, the Programa de Prevenção e Controlo de Infeção e de Resistência aos Antibióticos is an example of Antimicrobial Stewardship and provides the framework for local coordination groups constituition as well as their general and specific goals, on the pursuit of which they should operate.
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Buck, Bronwen Suzanne. "Partnership principles and the stewardship potential of employer supported volunteer programs." Thesis, 2008. http://hdl.handle.net/10012/3775.
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An emphasis on citizen engagement, which has direct bearing on conservation and community organizations, is emerging within the corporate realm. Businesses are beginning to view local involvement as a strategic component of their corporate social responsibility mandates, suggesting that it provides win-win benefits in branding them as leaders in the field while advancing noteworthy causes. Concurrently, conservation groups are seeking to partner with corporations in an effort to diversify funding sources, accomplish much needed work and find creative methods for outreach to a “non- traditional” support base. This research explores employer supported volunteer initiatives, an emerging facet of corporate community engagement where businesses form alliances with community organizations to facilitate donation of staff time to carry out hands-on conservation activities. Using a literature review, a series of global case examples and data collected from key local (Ontario-based) conservation and corporate-based informants, this study assesses the challenges and opportunities associated with cross-sectoral collaboration while investigating the potential of employer supported volunteer programs to foster conservation stewardship. Respondents from both sectors face such challenges as finding or maintaining suitable contacts, organizing team volunteer opportunities with mutually beneficial outcomes and understanding each other’s frames of reference. Despite these hurdles, they also realize that employer supported volunteerism can raise awareness about stewardship and the importance of volunteerism in general, provide opportunities for enhanced collaboration and demonstrate leadership in the arena of corporate social responsibility. Collective experience from both sectors provides the basis to determine thirteen principles for effective partnerships. Accompanied by a set of best practices to forward conservation programs, these principles supply an essential “how to” guide for cross-sectoral partners to work together effectively. The implementation of these principles will assist in providing a stepping stone to tap more fully into the potential for joint partnership and even garner greater capacity for stewardship than could be achieved by civil society or corporate players alone.
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Rossouw, Andre Steyn. "Towards developing an understanding of biodiversity stewardship in the city of Cape Town." Thesis, 2012. http://hdl.handle.net/10413/8580.
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Together with the prospect of global environmental change, biodiversity loss is arguably the most pressing environmental issue of our time. Conserving biodiversity is a complex issue and effectively engaging people in conserving biodiversity, although challenging, is crucial. Various conservation initiatives exist that incentivise landowners to participate in restrictive conservation agreements such as the stewardship programme. From an environmental perspective, stewardship is simply people taking care of the earth and the stewardship programme is an innovative conservation initiative that aims to assist private or communal landowners by making biodiversity conservation more attractive through incentives and providing them with the necessary skills and know-how. In South Africa, landowners can enter into biodiversity stewardship agreements in the following options: A Biodiversity Management Agreement (under National Environmental Management Biodiversity Act No. 10 of 2004), a Protected Environment (under Protected Areas Act No. 57 of 2003) or a Nature Reserve or National Park (under PAA) with the latter two agreements requiring formal declaration and restrictions on the land. The time frames and management requirements are aligned with the degree of conservation protection. Understanding landowner perceptions and motivations is critical for the successful implementation of the Biodiversity Stewardship Programme. The aim of this study was to determine how new participatory conservation systems, such as the Biodiversity Stewardship Programme, can assist in biodiversity conservation on private land within the City of Cape Town. This research made use of a case study methodology with the main research tool being semi-structured face-to-face interviews conducted with landowners and managers. This was supplemented with documentation and participant and direct observations. It was evident that predicting pro-environmental behaviour based on characteristics and perceptions is complex and varies from individual to individual. It emerged that certain characteristics can possibly indicate pro-environmental behaviour however pro-environmental behaviour does not necessarily indicate a willingness to participate in restrictive conservation measures such as the Stewardship Programme. Despite a lack of resources and capacity amongst conservation institutions, the research discovered a well-coordinated well-structured conservation system built around constructive partnerships in particular amongst the official conservation organisations. Biodiversity stewardship forms a crucial component of a set of tools to consolidate the protected area network in the City of Cape Town and is playing an increasingly important role in conserving the unique biodiversity within the City.<br>Thesis (M.Env.Dev.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.
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Chen, Yao-Shen, and 陳垚生. "Impact of an Antimicrobial Stewardship Programby Linking Early Intervention of Infectious Disease Specialists and Microbiologic Reports on Management of Bacteremic Patients." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/57793164920574303478.
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碩士<br>高雄醫學大學<br>醫務管理學研究所碩士在職專班<br>100<br>Background & Purposes. Inappropriate and over use of antimicrobial agents and its’ related emergence of antimicrobial resistance are major public issues concerned currently. Bacteremia is a severe infection and leads into considerable morbidity, mortality, and medical costs. The emergence of antimicrobial resistance embarrasses the selection in treatment of infectious diseases and injures patient safety. The study was targeted to retrospectively review the impact of an antimicrobial stewardship program by linking early intervention of infectious disease specialists and microbiologic reports on management of bacteremic patients.
Materials & Methods. A 1,400-bed medical center in southern Taiwan and 377 targeted bacteremic patients with important or drug-resistant pathogens. To collect administrative data of hospitalized patients, pharmacy prescription and expenditure, and clinical relevant information, by chart review, in targeted bacteremic patients caused by important or multidrug-resistant pathogens respectively.
Results. Between the pre- and post-intervention phases (January 1, 2011 – June 30,2011 vs. July 1, 2011 – December 31, 2011), there was no difference in administrative indicators. In the post-phase, the amounts in usage of intravenous and oral antimicrobial agents decreased by 217.8 DDD/1,000 inpatients-day (PD) (11.7%); the reduction occurred most in penicillins, cephalosporins, and quinolones (>10%). The expenditure of all antimicrobials, antimicrobials for inpatients, and average daily cost of inpatient-day decreased in post-phase: NT$ 7,070,288(9.0%), NT$5,991,896 (12.2%), and NT$ 40.5/PD (14.0%), respectively. The carbapenem-resistant rate in Acinetobacter baumannii and Pseudomonas aeruginosa decreased from 50% to 43% and 8.9% to 6.0%, respectively (p < 0.05). The percentage of extended-spectrum β-lactamase producing Escherichia coli and vancomycin-resistant Enterococcus faecium increased from 16.6% to 19.2% and from 14.0% to 30.7%, respectively, (p < 0.05). In an analysis of 377 bacteremic patients caused by important pathogens, patients in pre-phase were with older age (72.3 ± 15. vs. 68.8 ± 16.2, p = 0.031), more cases with chronic heart failure (10.6% vs. 4.1%, p = 0.018) and in bed-ridden (25.1% vs. 13.5%, p = 0.005).However, cases in post-phase with higher severity of infection by McCabe-Jackson category (p = 0003), and more cases presenting acute hematologic failure and acute liver failure. In comparison between two phases, there was no difference in delay time between bacteremia onset and use of appropriate antimicrobials, timing of appropriate antimicrobials used, and mortality rate.
Conclusion. This study underlines the importance of antimicrobial stewardship program. By linking early intervention of infectious disease specialists and microbiologic reports on management of bacteremic patients can effectively reduce the expenditure of antimicrobial expenditure in hospital.