BACKGROUND: Antimicrobial stewardship programs are a critical tool for addressing the rising threat of antimicrobial resistance.
OBJECTIVE: To determine changes in patterns of antimicrobial use in Queensland public hospitals following introduction of the National Safety and Quality Health Service antimicrobial stewardship standard.
METHODS: A retrospective pre/post intervention study was conducted across Queensland public hospitals at the ecological level using Queensland Health\'s MedTRx database. An interrupted time series analysis was performed using linear regression models to determine rates of antimicrobial use by quarterly aggregated defined daily dose per 1000 patient days, for groups of hospitals stratified by peer group classification. Pre-defined time periods for antimicrobial stewardship program implementation in response to the introduction of the standard were analysed.
RESULTS: In the post intervention period, there was a decrease in overall use of systemic antimicrobials, glycopeptides, carbapenems and fluoroquinolones in principal referral and public acute group A hospitals. A decrease in overall use was also observed for smaller regional and remote public acute group C and D hospitals, however, increases in glycopeptide and fluoroquinolone use were observed. Third generation cephalosporin use was unchanged for all hospital peer groups. The proportion of overall use that was accounted for by narrow spectrum penicillin was low for all facilities, with modest improvements in the post intervention period observed in principal referral facilities only.
CONCLUSIONS: These findings add to current knowledge on the effectiveness of legislative quality standards on antimicrobial stewardship at the macro level and highlight gaps to target for future programs.

The enthalpy of combustion of cholesterol was measured in an adiabatic, rotating-bomb calorimeter capable of high precision with relatively small samples. The random error for the experimental measurements was 0.006 percent which may be compared with approximately 0.3 percent for prior investigations on this substance. The results obtained for the enthalpy of combustion and the derived enthalpy of formation together with the estimated overall uncertainties are: Δ H c ° ( 25 ° C ) = - 16524.0 ± 3.9 kJ/mol Δ H f ° ( 25 ° C ) = - 674.8 ± 4.1 kJ/mol The results of prior investigations are discussed briefly.

Decreasing MRI scan time is a key factor to increase patient comfort and compliance as well as the productivity of MRI scanners.
Compressed sensing (CS) should significantly accelerate 3D scans. This study evaluated the clinical application and cost effectiveness of accelerated 3D T2 sequences of the lumbar spine.
Prospective, cross-sectional, observational.
Twenty healthy volunteers and 10 patients.
A 3D T2 TSE sequence, identical 3D sequences with three different parallel imaging and CS accelerating factors, and 2D TSE sequences as a clinical reference were obtained on a 3T scanner.
Three readers evaluated the sequences for delineation of anatomical structures and image quality. A quantitative analysis consisting of root mean square error, structural similarity index, signal-to-noise ratio, and contrast-to-noise ratio were performed. The scan times were used to calculate cost differences for each sequence.
An analysis of variance with repeated measurements and the Friedman test were used to test for potential differences between the sequences. Post-hoc analysis was made with the chi-squared and Tukey-Kramer test.
CS with factor 4.5 results in unchanged image quality compared to the T2 TSE for volunteers and patients (overall image impression: 4.75 vs. 4.20 [P = 0.73] and 4.90 vs. 4.47 [P = 0.44]). The CS 4.5 scan is 167 seconds (-39%) faster than the 3D and 216.5 seconds (-45%) faster than the 2D sequences. No significant differences was found for the diagnostic certainty in the volunteers and patients between 2D TSE and 3D CS 4.5 (P = 0.89 and P = 0.43). A reduction of scan time to 148 seconds (CS 8) was still rated acceptable for most diagnosis.
CS accelerates the 3D T2 without compromising image quality. The 3D sequences offer comparable diagnostic quality to the clinical 2D standard with less scan time (-45%), potentially increasing the productivity of MRI scanners.
1 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e164-e175.

OBJECTIVE: The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care.
BACKGROUND: Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board.
METHODS: A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care.
METHODS: Five phases were used to explore the evidence, and design and test a measurement and improvement framework.
RESULTS: Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result.
CONCLUSIONS: The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care.
CONCLUSIONS: Delivering fundamentals of care is described by nurses as getting ?back to basics\'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements.