Current antimicrobial use in farm animals in the Republic of Ireland.

Antimicrobial resistance has been recognised as one of the most difficult challenges facing human and animal health in recent decades. The surveillance of antimicrobial use in animal health plays a major role in dealing with the growing issue of resistance. This paper reviews current data available on antimicrobial use in farmed animals in the Republic of Ireland, including each of the major livestock production sectors; pigs, poultry, dairy, beef and sheep. A systematic literature search was conducted to identify relevant published literature, and ongoing research was identified through the network of authors and searches of each of the research databases of the main agriculture funding bodies in Ireland. The varying quantities and quality of data available across each livestock sector underlines the need for harmonisation of data collection methods. This review highlights the progress that has been made regarding data collection in the intensive production sectors such as pigs and poultry, however, it is clear there are significant knowledge gaps in less intensive industries such as dairy, beef and sheep. To comply with European regulations an antimicrobial data collection system is due to be developed for all food-producing animals in the future, however in the short-term surveillance studies have allowed us to build a picture of current use within the Republic of Ireland. Further studies will allow us to fill current knowledge gaps and build a more comprehensive overview of antimicrobial use in farm animals in Ireland.

An evaluation of an infection prevention link nurse programme in community hospitals and development of an implementation model.

BACKGROUND: Little evidence exists to show the exact impact of the link nurse role in promoting best practice in infection prevention. This paper is a report of the implementation and evaluation of a link nurse programme for community hospitals across one NHS organisation. AIM/OBJECTIVES: The main aim of the study was to implement and evaluate an infection prevention link programme. The study objectives were: 1) to develop materials for a bespoke infection prevention programme which incorporated education, behaviour change, reward and recognition and 2) to evaluate the implementation of the programme, and to learn about barriers and enablers to implementation. METHOD: Data were collected using semi-structured telephone interviews, contact logs and online course evaluation. Data were analysed using thematic analysis. FINDINGS: We identified four overarching themes that, collectively, construct a model for the implementation of the link nurse role in infection prevention. The themes are labelled as: selection process, support networks, essential roots, and turning points for success. DISCUSSION: This study contributes to understanding the contribution of link nurses in infection prevention. We suggest our findings are transferable to different settings, and the model provides guidance to support future link nurse programmes and promote best practice in infection prevention practice.

Meaningful use and the patient portal: patient enrollment, use, and satisfaction with patient portals at a later-adopting center.

Many physicians are adopting patient portals in response to governmental incentives for meaningful use (MU), but the stage 2 requirements for portal use may be particularly challenging for newer electronic health record (EHR) users. This study examined enrollment, use based on MU requirements, and satisfaction in a recently adopting fee-for-service multispecialty system. Between 2010 and 2012, overall portal enrollment increased from 13.2% to 23.1% but varied substantially by physician specialty. In 2013, more than 97% of physicians would have met requirements for a stage 2 MU utilization measure requiring that patients download personal health information, but only 38% of all physicians (87% of primary care physicians [PCPs] and 37% of other specialists) would have met e-mail requirements. Satisfaction with the portal overall and with portal-based e-mails was high. These results suggest that later-adopting PCPs can succeed in providing satisfactory record and e-mail access but specialists may find reaching e-mail thresholds more difficult.

Use of social support during communication about sickle cell carrier status.

OBJECTIVE: To examine the use of social support behaviors by primary care providers during delivery of positive newborn screening results for Sickle Cell Anemia carrier status. METHODS: Transcripts from 125 primary care providers who conveyed Sickle Cell Anemia carrier status to standardized parents were content analyzed using categories derived from Cutrona and Suhr's social support taxonomy. Frequencies and cross-tabulation matrices were calculated to study providers' social support utilization. RESULTS: Results showed most primary care providers (80%) incorporate social support behaviors into delivery of Sickle Cell Anemia carrier results and most frequently employed social network (61.6%) and informational support (38.4%) behaviors. Providers used tangible aid (8%), esteem (1.6%), and emotional support (9.6%) behaviors less frequently. CONCLUSION: Cutrona and Suhr's taxonomy may be a useful tool for assessing supportive communication during the delivery of Sickle Cell Anemia carrier status and could be incorporated into population scale assessments of communication quality assurance. PRACTICE IMPLICATIONS: Primary care providers may need training in how to adapt supportive behaviors to parents' needs during communication of Sickle Cell Anemia carrier status. They also may benefit from specific training about how to use esteem and emotional support.

Probabilistic classification and gambling in patients with schizophrenia receiving medication: comparison of risperidone, olanzapine, clozapine and typical antipsychotics.

RATIONALE: We have previously shown that patients with schizophrenia treated with typical antipsychotics were impaired on the weather prediction probabilistic classification learning (PCL) task that relies on striatal function, and that similar patients treated with atypical antipsychotics were impaired on the Iowa gambling task (IGT) that depends on medial prefrontocortical function. OBJECTIVES: We tested the hypothesis that test performance of patients treated with risperidone will be more similar to those treated with typical rather than atypical antipsychotics. RESULTS: Groups of schizophrenia patients treated with risperidone, olanzapine, clozapine or typical antipsychotics did not differ on the Positive and Negative Syndrome Scale or the Mini Mental State Exam (MMSE) but scored lower than controls on the MMSE. For the PCL task, patients treated with clozapine improved over trials while those treated with typical antipsychotics, olanzapine, or risperidone did not. For the IGT, patients treated with typical antipsychotics or risperidone improved over trials while those treated with clozapine or olanzapine did not. CONCLUSIONS: Results generally supported the hypothesis that patients treated with risperidone perform more like those treated with typical antipsychotics than those treated with other atypical antipsychotics.

A method to assess the organizing behaviors used in physicians' counseling of standardized parents after newborn genetic screening.

Well-organized conversation can improve people's ability to comprehend and retain information. As part of a long-term effort to adapt Quality Improvement techniques for communication, we developed an explicit-criteria method to assess usage of three organizing behaviors (OBs): 'opening behaviors' to establish goals; 'structuring behaviors' to guide patients through conversation; and 'emphasizing behaviors' that signal a need for attention. Pairs of abstractors independently reviewed transcripts in a demonstration sample of conversations between physicians and standardized parents after newborn screening identifies carrier status for sickle cell disease. Criteria for at least one OB were identified in 50/84 transcripts (60%), including 27 with at least one opening behavior (32%), 5 with at least one structuring behavior (6%), and 38 with at least one emphasizing behavior (45%). The limited number of OBs raises concern about communication after newborn screening. Assessment and improvement of OB usage may improve understanding and allow parents to more actively participate in health care.

The Kingston Standardized Behavioural Assessment.

The Kingston Standardized Behavioural Assessment (KSBA), a behavioral screening tool that assesses the behavioral changes associated with dementia, particularly Alzheimer's disease (AD), is introduced. Designed to be user friendly for clinicians not trained in specialized behavioral assessment techniques, it addresses some of the problems of existing scales. A group of patients diagnosed with probable AD, vascular dementia, or mixed (AD and vascular) was assessed using the KSBA. A subgroup was also given the Neuropsychiatric Inventory (NPI). Behavioral profiles and scores were obtained for all subjects. Factor analysis revealed 2 factors described as neuropsychiatric and neuropsychological. The KSBA efficiently collects neuropsychological and neuropsychiatric behavioral symptoms of dementia, is easy to score and interpret, and yields a behavioral profile that helps identify target behaviors for intervention. It can be used to facilitate clinical decision making around level of care and can be easily incorporated into clinically based research.

Event-related potentials in young and elderly adults during a visual spatial working memory task.

The P300 event-related brain potential (ERP) was examined in 14 young (20-29 years of age) and 16 elderly (60-82 years of age) subjects during the performance of a visuospatial memory task requiring recognition of locations. Elderly and young adults exhibited similar recognition accuracy, but recognition reaction times were significantly slower in the elderly. Midline P300 amplitudes recorded in response to visuospatial probe stimuli were significantly attenuated in the elderly, and, depending on the nature of the probe, P300 latency-derived indices indicated that both cognitive and motoric slowness characterized visuospatial recognition in the aged. The results, discussed in relation to neural mechanisms supporting working memory function, suggest that alterations in attention and processing speed may play a role in visual-spatial working memory deficits associated with normal and pathological aging.

Effects of stimulus modality and response mode on the P300 event-related potential differentiation of young and elderly adults.

The P300 event-related brain potential (ERP) was examined in 14 young (20 - 29 years of age) and 16 elderly (60 - 82 years of age) adult subjects during the performance of auditory and visual discrimination tasks requiring silent counting or key pressing in response to target stimuli. P300 latencies were longer in elderly (vs young) adults and in visual (vs auditory) tasks, and visual tasks elicited larger P300 amplitudes than auditory tasks in both age groups. Neither stimulus modality nor response mode affected P300 differentiation of young and elderly subjects. Steeper P300 anterior-posterior scalp amplitude gradients were seen in the young (vs elderly) adults, regardless of stimulus or response type. Examination of inter-subject variability with the coefficient of variation (CV) statistic found the lowest (i.e., best) CV values to be exhibited in the visual task requiring the counting of target stimuli. Implications of the findings are discussed in relation to P300 applications in the clinical assessment of dementia and aging-associated cognitive alterations.