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David N Schwartz

Publications and source records attributed to David N Schwartz.

9 recordsLinked to original sources
PubMed2006

Pharmacists' perceptions of the effectiveness of antimicrobial control programs.

PURPOSE: The perceptions of the effectiveness of antimicrobial control programs (ACPs) among infectious diseases (ID) pharmacists were studied. METHODS: A survey asking pharmacists to characterize the ACP in their hospitals and rate the program's effectiveness was distributed electronically in 1999 and by regular mail in 2000 to all 365 members of the Society of Infectious Diseases Pharmacists residing in North America. RESULTS: Of the 365 surveys distributed, 323 (88.5%) were completed, 233 of which were eligible for analysis. Most respondents (99%) indicated the use of one or more ACP components (mean +/- S.D., 4.3 +/- 1.9) in their hospitals. The ACP components used most frequently included prescriber education, review of patient medical records, formularies, prior authorization, infectious diseases consultation, and clinical practice guidelines. A similar percentage of respondents indicated that ID pharmacists and ID physicians directly participated in implementing and monitoring the effectiveness of ACPs (57% and 58%, respectively). Of the 231 respondents whose hospitals had an ACP, 73% perceived that their ACP effectively addressed antimicrobial resistance, patient outcomes, or costs, with cost reduction viewed as being accomplished more often than the improvement of patient outcomes or containment of antimicrobial resistance (62%, 35%, and 38%, respectively; p < 0.001). Many indicated uncertainty regarding the effectiveness of their ACP, with a substantial percentage of respondents believing that the level of support for these programs was inadequate. CONCLUSION: ID pharmacists in 231 North American hospitals perceived that their ACP was not sufficiently effective at improving patient outcomes, containing antimicrobial resistance, and decreasing medication costs, possibly due to inadequate institutional support for the program.

Anti-Infective Agents↗
PubMed2006

Learning by doing: developing fellows' academic skills through collaborative research.

Physicians in postgraduate training are expected to learn research methods but how best to achieve that curricular goal is unclear. This article describes a novel educational approach to develop research skills among infectious disease fellows. Five infectious disease fellows and two faculty members participated in a collaborative research project as a vehicle for active, problem-based learning. During the learning experience several tasks with specific learning objectives were achieved. The authors evaluated the weaknesses and strengths of the collaborative research project as an educational program. This problem-based approach for learning research methods seems more effective than traditional methods and may be applicable to a broad range of training programs.

Cohort Studies↗
PubMed2005

Effects of type and level of training on variation in physician knowledge in the use and acquisition of blood cultures: a cross sectional survey.

BACKGROUND: Blood culture (BCX) use is often sub-optimal, and is a user-dependent diagnostic test. Little is known about physician training and BCX-related knowledge. We sought to assess variations in caregiver BCX-related knowledge, and their relation to medical training. METHODS: We developed and piloted a self-administered BCX-related knowledge survey instrument. Expert opinion, literature review, focus groups, and mini-pilots reduced > 100 questions in multiple formats to a final questionnaire with 15 scored content items and 4 covariate identifiers. This questionnaire was used in a cross-sectional survey of physicians, fellows, residents and medical students at a large urban public teaching hospital. The responses were stratified by years/level of training, type of specialty training, self-reported practical and theoretical BCX-related instruction. Summary scores were derived from participant responses compared to a 95% consensus opinion of infectious diseases specialists that matched an evidence based reference standard. RESULTS: There were 291 respondents (Attendings = 72, Post-Graduate Year (PGY) = 3 = 84, PGY2 = 42, PGY1 = 41, medical students = 52). Mean scores differed by training level (Attending = 85.0, PGY3 = 81.1, PGY2 = 78.4, PGY1 = 75.4, students = 67.7) [p < or = 0.001], and training type (Infectious Diseases = 96.1, Medicine = 81.7, Emergency Medicine = 79.6, Surgery = 78.5, Family Practice = 76.5, Obstetrics-Gynecology = 74.4, Pediatrics = 74.0) [p < or = 0.001]. Higher summary scores were associated with self-reported theoretical [p < or = 0.001] and practical [p = 0.001] BCX-related training. Linear regression showed level and type of training accounted for most of the score variation. CONCLUSION: Higher mean scores were associated with advancing level of training and greater subject-related training. Notably, house staff and medical students, who are most likely to order and/or obtain BCXs, lack key BCX-related knowledge. Targeted education may improve utilization of this important diagnostic tool.

Blood↗
PubMed2005

Antimicrobial consumption data from pharmacy and nursing records: how good are they?

OBJECTIVE: To determine whether randomly selected intravenous (IV) antimicrobial doses dispensed from an inpatient pharmacy were administered. DESIGN: This was a prospective, cross-sectional study in which dose administration was confirmed by direct observation and by assessment of the medication administration record (MAR). A retrospective analysis of the return rate of unused IV antimicrobial doses was performed subsequently. SETTING: Medical and surgical intensive care units (ICUs) and non-ICUs of a 550-bed urban public teaching hospital. PARTICIPANTS: Hospitalized patients with an order in the pharmacy database for an IV antimicrobial during 9 non-consecutive weekdays in June 1999. RESULTS: Of 397 doses, 221 (55.7%) assessed by bedside observation and 238 (59.9%) assessed by MAR review were classified as administered; 139 doses (35.0%) were dispensed but changes in the drug order or the patient's status prevented their administration. In the subsequent assessment, of 745 IV antimicrobial doses dispensed during 24 hours, 322 (43.2%) were returned to the pharmacy unused; 423 (56.8%) of the doses-consistent with our prior observations-were presumably administered. CONCLUSIONS: Because computerized pharmacy data may overestimate actual antimicrobial consumption, such data should be validated when used in studies of hospital antimicrobial use. Dispense-return analysis offers a simple validation method.

Anti-Bacterial Agents↗
PubMed2004

Why don't they listen? Adherence to recommendations of infectious disease consultations.

The effectiveness of an infectious diseases (ID) consultation is dependent on adherence to the recommendations. To delineate the factors that affect adherence, we conducted a prospective cohort study of 465 consultations at 2 academic institutions in which we evaluated the consultation process, patient and consultant characteristics, types of recommendations, and compliance with recommendations. The overall compliance rate was 80%, with 85% adherence to crucial recommendations. Multivariate analysis revealed that adherence to ID recommendations was higher when the recommendations were therapeutic instead of diagnostic, when they related to a specific clinical question, when recommendations were deemed crucial by the ID service, if the primary service was medicine, and if the consultation note was legible and organized. Whether modification of consultant practice will lead to improved recommendation compliance and patient outcomes warrants further study.

Adolescent↗
PubMed2003

Antibiotic combinations with redundant antimicrobial spectra: clinical epidemiology and pilot intervention of computer-assisted surveillance.

Redundant antibiotic combinations are a potentially remediable source of antibiotic overuse. At a public teaching hospital, we determined the incidence, cost, and indications for such combinations and measured the effects of a pharmacist-based intervention. Of 1189 inpatients receiving >or=2 antibiotics, computer-assisted screening identified 192 patients (16.1%) receiving potentially redundant combinations. Chart reviews showed that 137 episodes (71%) were inappropriate. Physician overprescribing errors were found in 77 episodes (56%); most involved redundant coverage for gram-positive or anaerobic organisms. In 76 episodes (55%), lapses in the medication ordering and distribution system led to the persistence in the pharmacy records of regimens no longer active according to the patient charts. The incidence of redundant antibiotic combinations was significantly higher in the intensive care unit and surgery services, compared with medical services. Interventions to discontinue redundant agents were successful in 134 (98%) of the 137 episodes. Potential drug cost savings and reduction in redundant antibiotic combination days were 10,800 dollars and 584 days, respectively; pharmacist time for patient review and intervention cost 2880 dollars. Use of redundant antibiotic combinations was common, and a pharmacist-based intervention was feasible, with a potential annualized cost savings of 48,000 dollars.

Anti-Bacterial Agents↗
PubMed2002

Antibiotic resistance: a survey of physician perceptions.

BACKGROUND: Antibiotic resistance is caused partly by excessive antibiotic prescribing, yet little is known about prescribers' views on this problem. METHODS: We surveyed 490 internal medicine physicians at 4 Chicago-area hospitals to assess their attitudes about the importance of antibiotic resistance, knowledge of its prevalence, self-reported experience with antibiotic resistance, beliefs about its causes, and attitudes about interventions designed to address the problem. RESULTS: The response rate was 87% (424 of 490 physicians). Antibiotic resistance was perceived as a very important national problem by 87% of the respondents, but only 55% rated the problem as very important at their own hospitals. Nearly all physicians (97%) believed that widespread and inappropriate antibiotic use were important causes of resistance. Yet, only 60% favored restricting use of broad-spectrum antibiotics, although this percentage varied by hospital and physician group. CONCLUSIONS: Although most physicians view antibiotic resistance as a serious national problem, perceptions about its local importance, its causes, and possible solutions vary more widely. Disparities in physician knowledge, beliefs, and attitudes may compromise efforts to improve antibiotic prescribing and infection control practices.

Anti-Bacterial Agents↗