Rationale and development of a business case for antimicrobial stewardship programs in acute care hospital settings.

Background: Antimicrobial stewardship programs (ASPs) have been shown to reduce inappropriate antimicrobial use and its consequences. However, these programs lack legislative requirements in many places and it can be difficult to determine what human resources are required for these programs and how to create a business case to present to hospital administrators for program funding. The objectives of the current paper were to review legislative requirements and outline human resource requirements for ASPs, and to create a base business case for ASPs. Methods: A working group of antimicrobial stewardship experts from across Canada met to discuss the necessary components for creation of a business case for antimicrobial stewardship. A narrative review of the literature of the regulatory requirements and human resource recommendations for ASPs was conducted. Informed by the review and using a consensus decision-making process, the expert working group developed human resource recommendations based on a 1000 bed acute care health care facility in Canada. A spreadsheet based business case model for ASPs was also created. Results: Legislative and /or regulatory requirements for ASPs were found in 2 countries and one state jurisdiction. The literature review and consensus development process recommended the following minimum human resources complement: 1 physician, 3 pharmacists, 0.5 program administrative and coordination support, and 0.4 data analyst support as full time equivalents (FTEs) per 1000 acute care beds. Necessary components for the business case model, including the human resource requirements, were determined to create a spreadsheet based model. Conclusions: There is evidence to support the negative outcomes of inappropriate antimicrobial use as well as the benefits of ASPs. Legislative and /or regulatory requirements for ASPs are not common. The available evidence for human resource recommendations for ASPs using a narrative review process was examined and a base business case modelling scenario was created. As regulatory requirements for ASPs increase, it will be necessary to create accurate business cases for ASPs in order to obtain the necessary funding to render these programs successful.

Observation of the wrapping mechanism in amine carbon dioxide molecular interactions on heterogeneous sorbents.

Liquid, solvated amine based carbon capture is the core of all commercial or planned CO2 capture operations. Despite the intense research, few have looked systematically into the nature of amine molecules and their CO2 interaction. Here, we report a systematic introduction of linear ethylene amines on the walls of highly porous Davankov type network structures through simple bromination intermediates. Surprisingly, isosteric heats of CO2 adsorption show a clear linear trend with the increase in the length of the tethered amine pendant groups, leading to a concerted cooperative binding with additional H-bonding contributions from the unassociated secondary amines. CO2 uptake capacities multiply with the nitrogen content, up to an unprecedented four to eight times of the starting porous network under flue gas conditions. The reported procedure can be generalized to all porous media with the robust hydrocarbon framework in order to convert them into effective CO2 capture adsorbents.

Potentiation of warfarin's hypoprothrombinemic effect with miconazole vaginal suppositories.

A 53-year-old woman being treated for a vaginal yeast infection experienced ecchymosis. Laboratory evaluation revealed a prolonged prothrombin time. It is possible that the bleeding was due to an interaction between warfarin and miconazole. Health care professionals should be aware of the potential for drug interactions with vaginally administered miconazole, especially in women receiving anticoagulation therapy.