Current Utilization of Antifungal Agents for Intra-abdominal Infections Categorized by Patient Risk Factors During Surgical Procedures: A Literature Review.

The high morbidity and mortality rates associated with invasive fungal infections have led to the overutilization of empiric antifungal therapies. With increasing antibiotic resistance, the careful consideration of prophylactic or empiric antifungal use is critical. The purpose of this review is to evaluate the available literature regarding the current practice of utilizing antifungal agents for intra-abdominal infections based on specific surgical procedures and patient risk factors. Relevant articles were identified through a comprehensive literature search of several databases using the keywords antifungal agents, postoperative period, preoperative care, surgical procedures, and intra-abdominal infections. Only articles that evaluated the use of empiric antifungals for suspected or confirmed intra-abdominal infections and surgical procedures were included in this review. Based on the available literature, antifungal prophylaxis is appropriate in patients who meet the criteria for high-risk invasive candidiasis, kidney or liver transplant recipients, severely-immunocompromised patients with perforated peptic ulcer, peritonitis, and patients on peritoneal dialysis who are failing on a therapeutic antibiotic regimen. We acknowledge that the evidence for using antifungal therapy empirically for all surgical procedures is lacking, and the following review is based on available literature and current guidelines.

Effects of compaction pressure, speed and punch head profile on the ultrasonically-extracted physical properties of pharmaceutical compacts.

Despite a well-established manufacturing-process understanding, tablet quality issues are frequently encountered during various stages of drug-product development. Compact breaking force (tensile strength), capping and friability are among the commonly observed characteristics that determine the integrity, quality and manufacturability of tablets. In current study, a design space of the compaction pressure, compaction speed and head flat types is introduced for solid dosage compacts prepared from pure silicified microcrystalline cellulose, a popular tableting excipient. In the reported experiments, five types of head flat types at six compaction pressure levels and two compaction speeds were employed and their effects on compact mechanical properties evaluated. The mechanical properties of the tablets were obtained non-destructively. It is demonstrated these properties correlate well with compact porosity and tensile strength, thus their availability is of practical value. The reported mechanical properties are observed to be linearly sensitive to the tableting speed and compaction pressure, and their dependency on the head-flat profile, while clearly visible in the presented waveforms, was found to be nonlinear in the range of the parameter space. In this study, we detail a non-destructive, easy-to-use approach for characterizing the porosity and tensile strength of pharmaceutical tablets.

A new paradigm for mental-health quality and safety: are we ready?

OBJECTIVE:: Development of a Mental Health Quality and Safety Framework with co-designed priority areas for improvement. METHOD:: A qualitative and inductive approach was utilised, including a literature search, consultations with staff and focus groups with consumers and carers. RESULTS:: Thematic analysis resulted in 32 categories, grouped into seven key themes. Combined with the evidence base, these were distilled into component parts of the Framework. CONCLUSIONS:: A change in strategy and culture is required, balancing a traditionally centralised top-down approach to health care governance and improvement, with a complementary localised bottom-up model that embeds improvement science principles involving frontline staff, consumers and carers. This Framework, that centres on patient safety and quality improvement, in combination with a corresponding cultural change, can enhance clinical outcomes, service efficiency, staff morale and staff retention rates.

Blame and accountability 1: understanding blame and blame pathologies.

OBJECTIVE: In this first paper the role and dynamics of blame in the context of medical critical incidents is examined. Blame pathologies are described and the complex nature of medical adverse events and the environment are explored. METHODS: The literature is examined and a case scenario explored. RESULTS: Evidence regarding effects of a 'blame culture' on clinicians and organizations is presented. In an accompanying second paper the place of accountability in relation to clinicians and health organizations is elucidated. CONCLUSIONS: The necessary conditions for an accountable, responsive, fair and transparent health culture are proposed.

Blame and accountability 2: on being accountable.

OBJECTIVE: This second paper follows an exploration of the nature of blame and addresses the balance between a 'blame-free' health culture and appropriate accountability. This paper aims to define and describe accountability as a key component of clinical governance and a responsive, fair and transparent health culture. METHODS: The literature is examined and the concept of a fair and transparent health culture is explored. The case vignette in Part 1 is used to illustrate a particular issue of accountability. RESULTS: The place of accountability in relation to clinicians and health organisations is elucidated. CONCLUSIONS: The necessary conditions for an accountable, responsive, fair and transparent health culture are proposed.