Brian G. Bell

A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance

BackgroundGreater use of antibiotics during the past 50 years has exerted selective pressure on susceptible bacteria and may have favoured the survival of resistant strains. Existing information on antibiotic resistance patterns from pathogens circulating among community-based patients is substantially less than from hospitalized patients on whom guidelines are often based. We therefore chose to assess the relationship between the antibiotic resistance pattern of bacteria circulating in the community and the consumption of antibiotics in the community.MethodsBoth gray literature and published scientific literature in English and other European languages was examined. Multiple regression analysis was used to analyse whether studies found a positive relationship between antibiotic consumption and resistance. A subsequent meta-analysis and meta-regression was conducted for studies for which a common effect size measure (odds ratio) could be calculated.ResultsElectronic searches identified 974 studies but only 243 studies were considered eligible for inclusion by the two independent reviewers who extracted the data. A binomial test revealed a positive relationship between antibiotic consumption and resistance (p < .001) but multiple regression modelling did not produce any significant predictors of study outcome. The meta-analysis generated a significant pooled odds ratio of 2.3 (95% confidence interval 2.2 to 2.5) with a meta-regression producing several significant predictors (F(10,77) = 5.82, p < .01). Countries in southern Europe produced a stronger link between consumption and resistance than other regions.ConclusionsUsing a large set of studies we found that antibiotic consumption is associated with the development of antibiotic resistance. A subsequent meta-analysis, with a subsample of the studies, generated several significant predictors. Countries in southern Europe produced a stronger link between consumption and resistance than other regions so efforts at reducing antibiotic consumption may need to be strengthened in this area. Increased consumption of antibiotics may not only produce greater resistance at the individual patient level but may also produce greater resistance at the community, country, and regional levels, which can harm individual patients.

Negative transfer errors in sequential cognitive skills: strong-but-wrong sequence application.

Three experiments investigated the role of processing sequence knowledge in negative transfer within multistep cognitive skills. In Experiments 1 and 2, more training resulted in higher error rates when new processing sequences that resembled familiar ones were introduced in transfer. Transfer error responses were executed with the same speed as correct responses to familiar sequence trials, and the errors appeared to be undetected by the performers. Experiment 3 tested whether the effects of sequence learning were attributable to explicit or implicit knowledge of processing sequences. Evidence favored the implicit learning interpretation. Findings are discussed in relationship to earlier demonstrations of the einstellung effect and to current taxonomic theories of human error.

Identification of an updated set of prescribing-safety indicators for GPs

BACKGROUND Medication error is an important contributor to patient morbidity and mortality and is associated with inadequate patient safety measures. However, prescribing-safety tools specifically designed for use in general practice are lacking. AIM To identify and update a set of prescribing-safety indicators for assessing the safety of prescribing in general practice, and to estimate the risk of harm to patients associated with each indicator. DESIGN AND SETTING RAND/UCLA consensus development of indicators in UK general practice. METHOD Prescribing indicators were identified from a systematic review and previous consensus exercise. The RAND Appropriateness Method was used to further identify and develop the indicators with an electronic-Delphi method used to rate the risk associated with them. Twelve GPs from all the countries of the UK participated in the RAND exercise, with 11 GPs rating risk using the electronic-Delphi approach. RESULTS Fifty-six prescribing-safety indicators were considered appropriate for inclusion (overall panel median rating of 7-9, with agreement). These indicators cover hazardous prescribing across a range of therapeutic indications, hazardous drug-drug combinations and inadequate laboratory test monitoring. Twenty-three (41%) of these indicators were considered high risk or extreme risk by 80% or more of the participants. CONCLUSION This study identified a set of 56 indicators that were considered, by a panel of GPs, to be appropriate for assessing the safety of GP prescribing. Twenty-three of these indicators were considered to be associated with high or extreme risk to patients and should be the focus of efforts to improve patient safety.

Individual differences in undetected errors in skilled cognitive performance

Abstract Skilled performers of cognitive tasks make fewer errors than novices, but they continue to make some errors. A number of these errors, which occur in near-transfer situations, go undetected by the performer. Such errors can have disastrous consequences. We investigated a number of individual differences variables that were correlated with undetected error making in a laboratory task (number reduction) requiring subjects to apply reduction rules to strings of digits to arrive at a single digit answer. In two experiments, we determined: (a.) self-report measures of the propensity to make cognitive slips and lapses were statistically unrelated to performance on our experimental task; and (b) performance-based cognitive resource measures (i.e., working memory capacity) were related to performance. Self-report measures appear to be influenced by social desirability or some correlated construct.

The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

Long-term institutional care in the United Kingdom is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses, and are subject to polypharmacy. Prevailing models of health care provision (ad hoc, reactive, and coordinated by general practitioners) result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organization of health and social care in the United Kingdom is such that it is unlikely that a single solution to the problem of providing quality health care for care homes will be identified that can be used nationwide. Realist evaluation is a methodology that uses both qualitative and quantitative data to establish an in-depth understanding of what works, for whom, and in what settings. In this article we describe a protocol for using realist evaluation to understand the context, mechanisms, and outcomes that shape effective health care delivery to care home residents in the United Kingdom. By describing this novel approach, we hope to inform international discourse about research methodologies in long-term care settings internationally.

New measures improve the accuracy of the directed-lie test when detecting deception using a mock crime.

The present study tested the accuracy of probable-lie and directed-lie polygraph tests. One hundred and twenty men and women were recruited from the general community and paid

Safety climate in English general practices: workload pressures may compromise safety

30 to participate in a mock crime experiment. Equal numbers of males and females were assigned to either the guilty or innocent condition with equal numbers in each group receiving either a probable-lie or a directed-lie polygraph test resulting in a 2 x 2 design with two experimental factors (test type and deceptive condition). Half of the participants were guilty and half were innocent of committing a mock theft of

Tools for measuring patient safety in primary care settings using the RAND/UCLA appropriateness method

20 from a purse. All participants were paid a

Functional Magnetic Resonance Imaging may promote theoretical understanding of the Polygraph Test

50 bonus if they could convince the polygraph examiner that they were innocent. There were no significant differences in decision accuracy between probable-lie and directed-lie tests, but respiration measures were more diagnostic for the probable-lie test. New physiological measures, skin potential excursion and a new respiratory measure improved the accuracy of the directed-lie test such that 86% of the innocent participants and 93% of the guilty participants were correctly classified.

Understanding the epidemiology of avoidable significant harm in primary care: protocol for a retrospective cross-sectional study

Abstract Objectives Although most health care interactions in the developed world occur in general practice, most of the literature on patient safety has focused on secondary care services. To address this issue, we have constructed a patient safety toolkit for English general practices. We report how practice and respondent characteristics affect scores on our safety climate measure, the PC‐Safequest, and address recent concerns with high levels of workload in English general practices. Methods We administered the PC‐Safequest, a 30‐item tool that was designed to measure safety climate in primary care practices, to 335 primary care staff members in 31 practices in England. Practice characteristics, such as list size and deprivation in the area the practice served, and respondent characteristics, such as whether the respondent was a manager, were also collected and used in a multilevel analysis to predict PC‐Safequest scores. Results Managers gave their practices significantly higher safety climate scores than did non‐managers. Respondents with more years of experience had a more negative perception of the level of workload in their practice. Practices with more registered patients and in areas of higher deprivation provided lower safety climate scores. Conclusions Managers rated their practices more positively on our safety climate measure, so the differences between the perceptions of managers and other staff may need to be reduced in order to build a strong safety culture. Excessive workload for more experienced staff and lower safety climate scores for larger practices may reflect ‘burnout’. Concerns that pressures in primary care could affect patient safety are discussed.