bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic Prescribing in 4 Assisted-Living Communities: Incidence and Potential for Improvement
Authors: Sloane Philip D. , Zimmerman Sheryl , Reed David , Beeber Anna Song , Chisholm Latarsha , Kistler Christine , Khandelwal Christine , Weber David J. , Mitchell C. Madeline 
Published: October 2014

Objective.To describe the prevalence, characteristics, and appropriateness of systemic antibiotic use in assisted living (AL) and to conduct a preliminary quality improvement intervention trial to reduce inappropriate prescribing.Design.Pre-post study, with a 13-month intervention period.Setting.Four AL communities.Participants.All prescribers, all AL staff who communicate with prescribers, and all patients who had an infection during the baseline and intervention periods.Intervention.A standardized form for AL staff, an online education course and 5 practice briefs for prescribers, and monthly quality improvement meetings with AL staff.Measurements.Monthly inventory of all systemic antibiotic prescriptions; interviews with the prescriber, AL staff member, closest family member, and patient (when capable) regarding 85 antibiotic prescribing episodes (30 baseline, 55 intervention), with data review by an expert panel to determine prescribing appropriateness.Results.The mean number of systemic antibiotic prescriptions was 3.44 per 1,000 resident-days at baseline and 3.37 during the intervention, a nonsignificant change (P = .30). Few prescribers participated in online training. AL staff use of the standardized form gradually increased during the program. The proportion of prescriptions rated as probably inappropriate was 26% at baseline and 15% during the intervention, a nonsignificant trend (P = .25). Drug selection was largely appropriate during both time periods.Conclusions.AL antibiotic prescribing rates appear to be approximately one-half those seen in nursing homes, with up to a quarter being potentially inappropriate. Interventions to improve prescribing must reach all physicians and staff and most likely will require long time periods to have the optimal effect.
Pediatrician Perceptions of an Outpatient Antimicrobial Stewardship Intervention
Authors: Szymczak Julia E. , Feemster Kristen A. , Zaoutis Theoklis E. , Gerber Jeffrey S. 
Published: October 2014

Objective.Inappropriate antibiotic prescribing commonly occurs in pediatric outpatients with acute respiratory tract infections. Antimicrobial stewardship programs are recommended for use in the hospital, but less is known about whether and how they will work in the ambulatory setting. Following a successful cluster-randomized trial to improve prescribing for common acute respiratory tract infections using education plus audit and feedback in a large, pediatric primary care network, we sought to explore the perceptions of the intervention and antibiotic overuse among participating clinicians.Methods.We conducted a qualitative study using semistructured interviews with 24 pediatricians from 6 primary care practices who participated in an outpatient antimicrobial stewardship intervention. All interviews were transcribed and analyzed using a modified grounded theory approach.Results.Deep skepticism of the audit and feedback reports emerged. Respondents ignored reports or expressed distrust about them. One respondent admitted to gaming behavior. When asked about antibiotic overuse, respondents recognized it as a problem, but they believed it was driven by the behaviors of nonpediatric physicians. Parent pressure for antibiotics was identified by all respondents as a major barrier to the more judicious use of antibiotics. Respondents reported that they sometimes “caved” to parent pressure for social reasons.Conclusions.To improve the effectiveness and sustainability of outpatient antimicrobial stewardship, it is critical to boost the credibility of audit data, engage primary care pediatricians in recognizing that their behavior contributes to antibiotic overuse, and address parent pressure to prescribe antibiotics.
Can Additional Information Be Obtained from Claims Data to Support Surgical Site Infection Diagnosis Codes?
Authors: Warren David K. , Nickel Katelin B. , Wallace Anna E. , Mines Daniel , Fraser Victoria J. , Olsen Margaret A. 
Published: October 2014

Objective.International Classification of Diseases, Ninth Revision, Clinical Modification(ICD-9-CM) diagnosis codes are increasingly used to identify healthcare-associated infections, often with insufficient evidence demonstrating validity of the codes used. Absent medical record verification, we sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment.Methods.We performed a retrospective cohort study, using private insurer claims data from persons less than 65 years old withICD-9-CMprocedure or Current Procedure Terminology (CPT-4) codes for anterior cruciate ligament (ACL) reconstruction from January 2004 through December 2010. SSIs occurring within 90 days after ACL reconstruction were identified byICD-9-CMdiagnosis codes. Antibiotic utilization, surgical treatment, and microbiology culture claims within 14 days of SSI codes were used as evidence to support the SSI diagnosis.Results.Of 40,702 procedures, 401 (1.0%) were complicated by SSI, 172 (0.4%) of which were specifically identified as septic arthritis. Most SSIs were associated with an inpatient admission (232/401 [58%]), and/or surgical procedure(s) for treatment (250/401 [62%]). Temporally associated antibiotics, surgical treatment procedures, and cultures were present for 84% (338/401), 61% (246/401), and 59% (238/401), respectively. Only 5.7% (23/401) of procedures coded for SSI after the procedure had no antibiotics, surgical treatments, or cultures within 14 days of the SSI claims.Conclusions.More than 94% of patients identified by our claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. This method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.
Measurement of Implementation Components and Contextual Factors in a Two-State Healthcare Quality Initiative to Reduce Ventilator-Associated Pneumonia
Authors: Ali Kisha Jezel , Farley Donna O. , Speck Kathleen , Catanzaro Mary , Wicker Karol G. , Berenholtz Sean M. 
Published: October 2014

Objective.To develop and field test an implementation assessment tool for assessing progress of hospital units in implementing improvements for the prevention of ventilator-associated pneumonia (VAP) in a two-state collaborative, including data on actions implemented by participating teams and contextual factors that may influence their efforts. Using the data collected, learn how implementation actions can be improved and analyze effects of implementation progress on outcome measures.Design.We developed the tool as an interview protocol that included quantitative and qualitative items addressing actions on the Comprehensive Unit-based Safety Program (CUSP) and clinical interventions for use in guiding data collection via telephone interviews.Setting.We conducted interviews with leaders of improvement teams from units participating in the two-state VAP prevention initiative.Methods.We collected data from 43 hospital units as they implemented actions for the VAP initiative and performed descriptive analyzes of the data with comparisons across the 2 states.Results.Early in the VAP prevention initiative, most units had made only moderate progress overall in using many of the CUSP actions known to support their improvement processes. For contextual factors, a relatively small number of barriers were found to have important negative effects on implementation progress (in particular, barriers related to workload and time issues). We modified coaching provided to the unit teams to reinforce training in weak spots that the interviews identified.Conclusion.These assessments provided important new knowledge regarding the implementation science of quality improvement projects, including feedback during implementation, and give a better understanding of which factors most affect implementation.
Nascent Regional System for Alerting Infection Preventionists about Patients with Multidrug-Resistant Gram-Negative Bacteria: Implementation and Initial Results
Authors: Rosenman Marc B. , Szucs Kinga A. , Finnell S. Maria E. , Khokhar Shahid , Egg James , Lemmon Larry , Shepherd David C. , Friedlin Jeff , Li Xiaochun , Kho Abel N. 
Published: October 2014

Objective.To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting.Design.Observational, retrospective study.Setting.Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE).Patients.During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO.Methods/Intervention.A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014).Results.The 573 patients (median age, 66 years; 68% women) had extended-spectrum β-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn).Conclusions.It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.
Multidrug-Resistant Organism Infections in US Nursing Homes: A National Study of Prevalence, Onset, and Transmission across Care Settings, October 1, 2010-December 31, 2011
Authors: Kahvecioglu Daver , Ramiah Kalpana , McMaughan Darcy , Garfinkel Steven , McSorley Veronica E. , Nguyen Quy Nhi , Yang Manshu , Pugliese Christopher , Mehr David , Phillips Charles D. 
Published: October 2014

Objective.To understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs).Methods.Descriptive analyses of MDRO infections among NH residents using all NH residents in the Long-Term Care Minimum Data Set (MDS) 3.0 between October 1, 2010 and December 31, 2011.Results.Analysis of MDS data revealed a very high volume of bidirectional patient flow between NHs and ACHs, indicating the need to study MDRO infections in NHs as well as in hospitals. A total of 4.24% of NH residents had an active MDRO diagnosis on at least 1 MDS assessment during the study period. This rate significantly varied by sex, age, urban/rural status, and state. Approximately 2% of NH discharges to ACHs involved a resident with an active diagnosis of infection due to MDROs. Conversely, 1.8% of NH admissions from an ACH involved a patient with an active diagnosis of infection due to MDROs. Among residents who acquired an MDRO infection during the study period, 57% became positive in the NH, 41% in the ACH, and 2% in other settings (eg, at a private home or apartment).Conclusion.Even though NHs are the most likely setting where residents would acquire MDROs after admission to an NH (accounting for 57% of cases), a significant fraction of NH residents acquire MDRO infection at ACHs (41%). Thus, effective MDRO infection control for NH residents requires simultaneous, cooperative interventions among NHs and ACHs in the same community.
How do social skills enable nascent entrepreneurs to enact perseverance strategies in the face of challenges? A comparative case study of success and failure
Authors: Lamine Wadid , Mian Sarfraz , Fayolle Alain 
Published: October 2014

Purpose
– This paper seeks to advance ongoing research in entrepreneurial perseverance. While the concept of perseverance is not new, few researchers paid attention to behavioural persistence in the entrepreneurial context. The purpose of this paper is to explore the emergence of new technology based firms (NTBF) by focusing on the role of nascent entrepreneurs’ social skills in the meeting the changes of entrepreneurial perseverance.

Design/methodology/approach
– In this paper the authors study the start-up phase of entrepreneurial process. The authors opted for a longitudinal case study approach in order to enhance the knowledge on entrepreneurs’ social skills and perseverance. For triangulation purpose the data were gathered using four different information sources. The use of Nvivo8 as the data analysis tool helped to impose a discipline and structure which facilitated the extraction of core insights.

Findings
– This paper contributes to the understanding of the entrepreneurial perseverance in the context of new venture creation. Particularly, reading the entrepreneurial process through the lens of the perseverance strategies model (Van Gelderen, 2012) provided a way to identify and then to assess the impact of the social skills on the overall entrepreneurial perseverance and their combined impact on the performance of NTBF creation process. In doing so, the authors identify the impact of entrepreneurs’ social skills to deal with a series of entrepreneurial problems such as scarcity of resources, uncertainty and ambiguity and consequently their impact on the likelihood of survival for new ventures. The issues that arose mostly reflected the inherent complexity of technology transfer processes, the university and entrepreneurs’ diverging cultures, and the very characteristics of the start-up phase of NTBFs. The findings reveal how social skills impact the entrepreneurial paths and probable outcomes.

Research limitations/implications
– This paper contributes to the understanding of the entrepreneurial perseverance in the context of NTBF creation. The findings reveal how social skills and perseverance impact the entrepreneurial paths and probable outcomes.

Practical implications
– The paper has implications for entrepreneurial support mechanisms such as technology business incubators in helping them to improve the efficacy and efficiency of their assistance to entrepreneurs through the development of their skill-sets and perseverance and providing enabling networking. In addition, the research has implications for entrepreneurship education and training. Indeed, there is an urgent need to design and implement courses and programs aiming at developing soft skills in entrepreneurship.

Originality/value
– In exploring networking and issues of perseverance for nascent entrepreneurs operating in new technology-based sectors, which the authors consider as an under searched area in entrepreneurial literature.
Investigating the motivation for enterprise education: a CaRBS based exposition
Authors: J. Beynon Malcolm , Jones Paul , Packham Gary , Pickernell David 
Published: October 2014

Purpose– The purpose of this paper is to investigate student motivation for undertaking an entrepreneurship education programme and their ultimate employment aspirations through a novel data mining technique. The study considered what relationship certain motivation characteristics have to students’ aspirations, specifically in terms of their intention to be self-employed or employed.Design/methodology/approach– The study examined enrolment data of 720 students on an entrepreneurial education programme, with work statuses of full-time, part-time or unemployed and have known aspirations to either employment or self-employment. The Classification and Ranking Belief Simplex (CaRBS) technique is employed in the classification analyses undertaken, which offers an uncertain reasoning based visual approach to the exposition of findings.Findings– The classification findings demonstrate the level of contribution of the different motivations to the discernment of students with self-employed and employed aspirations. The most contributing aspirations were Start-Up, Interests and Qualifications. For these aspirations, further understanding is provided with respect to gender and student age (in terms of the association with aspirations towards self-employed or employed). For example, with respect to Start-Up, the older the unemployed student, the increasing association with employment rather than self-employment career aspirations.Research limitations/implications– The study identifies candidate motivation and the demographic profile for student's undertaking an entrepreneurial education programme. Knowing applicant aspirations should inform course design, pedagogy and its inherent flexibility and recognise the specific needs of certain student groups.Originality/value– The study contributes to the literature examining motivations for undertaking entrepreneurship education and categorising motivating factors. These findings will be of value to both education providers and researchers.
Entrepreneurial configurations of small firms
Authors: de Villiers Scheepers M.J. , Verreynne Martie-Louise , Meyer Denny 
Published: October 2014

Purpose– The purpose of this paper is to develop contemporary entrepreneurial configurations of small firms and relates them to performance. Adding a process dimension, the authors extend the more commonly used resource and growth taxonomies in this field of research.Design/methodology/approach– A review of current literature on small firm configurations is followed by a discussion of its dimensions, namely, context (external and internal environment), content (entrepreneurial orientation (EO)) and process (strategy making). These are related to perceived performance, using cluster analysis and ANOVA for a sample of 320 small New Zealand firms.Findings– The results isolate young corporates, young simple and mature consolidator clusters. Young corporates outperform their counterparts in dynamic environments in how they use formal structures, and their high EO and generative strategy-making (GSM).Research limitations/implications– This study uses self-reporting measures and a cross-sectional design.Practical implications– The findings show how young, small firms can enhance their performance practically by aligning the key dimensions of an entrepreneurial configuration. These firms could benefit from early formalization of systems and structures, a high EO, and by using a GSM approach.Originality/value– The contribution is threefold. First, the authors empirically verify the existence of three clusters of small firms and then link these to perceived performance. Second, by basing the small-firm configurations on a content, context, process framework, the authors highlight the importance of aligning these dimensions to performance. Third, the authors find evidence of the role of early formalization to accompany GSM and EO if small firms want to improve performance outcomes.
Loop‐mediated isothermal amplification assay targeting the blaCTX‐M9 gene for detection of extended spectrum β‐lactamase‐producing Escherichia coli and Klebsiella pneumoniae
Authors: Thirapanmethee Krit , Pothisamutyothin Kanokporn , Nathisuwan Surakit , Chomnawang Mullika T. , Wiwat Chanpen 
Published: October 2014

AbstractExtended‐spectrum β‐lactamases (ESBLs) produced by Enterobacteriaceae are one of the resistance mechanisms to most β‐lactam antibiotics. ESBLs are currently a major problem in both hospitals and community settings worldwide. Rapid and reliable means of detecting ESBL‐producing bacteria is necessary for identification, prevention and treatment. Loop‐mediated isothermal amplification (LAMP) is a technique that rapidly amplifies DNA with high specificity and sensitivity under isothermal conditions. This study was aimed to develop a convenient, accurate and inexpensive method for detecting ESBL‐producing bacteria by a LAMP technique. ESBLs‐producing Escherichia coli and Klebsiella pneumoniae were isolated from a tertiary hospital in Bangkok, Thailand and reconfirmed by double‐disk synergy test. A set of four specific oligonucleotide primers of LAMP for detection of blaCTX‐M9 gene was designed based on blaCTX‐M9 from E. coli (GenBank Accession No. AJ416345). The LAMP reaction was amplified under isothermal temperature at 63°C for 60 min. Ladder‐like patterns of band sizes from 226 bp of the blaCTX‐M9 DNA target was observed. The LAMP product was further analyzed by restriction digestion with MboI and TaqI endonucleases. The fragments generated were approximately 168, 177 and 250 bp in size for MboI digestion and 165, 193, 229, 281 and 314 bp for TaqI digestion, which is in agreement with the predicted sizes. The sensitivity of the LAMP technique to blaCTX‐M9 was greater than that of the PCR method by at least 10,000‐fold. These results showed that the LAMP primers specifically amplified only the blaCTX‐M9 gene. Moreover, the presence of LAMP amplicon was simply determined by adding SYBR Green I in the reaction. In conclusion, this technique for detection of ESBLs is convenient, reliable and easy to perform routinely in hospitals or laboratory units in developing countries.
The soil resistome: a critical review on antibiotic resistance origins, ecology and dissemination potential in telluric bacteria
Authors: Nesme Joseph , Simonet Pascal 
Published: October 2014

SummarySoil is a large reservoir of microbial diversity and the majority of antimicrobial compounds used today in human and veterinary health care have been isolated from soil microorganisms. The Darwinian hypothesis of an ‘arms‐shields race’ between antibiotic producers and resistant strains is often cited to explain antibiotic resistance gene determinants (ARGD) origins and diversity. ARGD abundance and antibiotic molecule exposure are, however, not systematically linked, and many other factors can contribute to resistance gene emergence, selection and dissemination in the environment. Soil is a heterogeneous habitat and represents a broad spectrum of different ecological niches. Soil harbours a large genetic diversity at small spatial scale, favouring exchange of genetic materials by means of horizontal gene transfer (HGT) that will contribute to ARGD dissemination between bacteria and eventually acquisition by pathogen genomes, therefore threatening antibiotic therapies. Our current knowledge on the extent of the soil resistome abundance and diversity has been greatly enhanced since the metagenomic revolution and help of high‐throughput sequencing technologies. Different ecological hypotheses explaining their high prevalence in soil and questioning their transfer rate to pathogens, in respect to these recent experimental results, will be discussed in the present review.