GSK1070916 Education is part of the foundation for a

Education is part of the foundation for a successful ASP. A well-designed educational program provides prescribers with updated knowledge on antimicrobial use, drug resistance, and infectious disease management. Educational interventions have been shown to improve prescribing competency, change prescribing habits, and help prescribers adhere to guidelines. In an ASP, institution-based education programs can also integrate local data with national guidelines and encourage antimicrobial therapies that are appropriate or preferred for the institution. When appropriate regimens are not usually selected by the primary prescribers, such programs may influence clinicians\' prescription during their evaluation of the patient and help to preserve other stewardship strategies such as formula restriction or reviewing. In YMUH, the concept of the judicious use of carbapenems was conveyed to the main prescribing clinicians through monthly academic meeting by the ID physician. Cases of both appropriate and inappropriate antibiotic use were discussed in the session. The logic of the thinking process for clinicians in the empirical use of antimicrobials was not exclusively targeted toward broad-spectrum GSK1070916 and an effective de-escalation strategy based on a patient\'s unique culture result. Educational models that encourage reflection on practice, and small-group learning and discussions, are more likely to change behaviors. Another noteworthy finding is that, concordant with the reduced consumption of carbapenems, there was a swift decrease in the rate of CRAB almost immediately after the initiation of multidisciplinary ASP. Although multiple measures such as hand hygiene and environmental cleaning were promoted in the ASP, the most dramatic changes in this early phase was the decreased use of carbapenems. CRAB has emerged as an important pathogen in the hospitals of Taiwan. The increase in infections caused by CRAB has been directly linked to the use of antipseudomonal carbapenems. Our finding suggests that restriction in the use of antipseudomonal carbapenems would be an effective measure to control the increase of CRAB. Interestingly, such effect was not found in other drug-resistant bacteria including carbapenem-resistant Pseudomonas aeruginosa and Enterobateriaceae. Whether the carbapenem-control strategy is pathogen-specific should be further studied.
Acknowledgments This work was supported by a grant from the 2014 Taiwan Antimicrobial Stewardship Program of the Centers for Disease Control, Taiwan, R.O.C. Part of the study was presented by poster at the 7th International Congress of the Asia Pacific Society of Infection Control, Taipei, Taiwan, March 26–29, 2015. We thank all hospital physicians for their collaboration in the presented ASP.
Introduction Stroke is a leading cause of death and the main cause of serious disability worldwide. In Taiwan, stroke is the third leading cause of death. Stroke can be divided into three subtypes, namely, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Although each subtype presents distinct pathogenic factors, several conventional common risk factors, including obesity, hypertension, diabetes, dyslipidemia, and smoking, are responsible for stroke development. Dyslipidemia, characterized by high triglyceride, high total cholesterol, high low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C) levels, is associated with an increased risk of major cardiovascular disease (CAD) and stroke. HDL-C mediates the transport of cholesterol from peripheral tissues to the liver; as a result, plasma cholesterol levels decrease. HDL-C also elicits protective effects against CAD and stroke because HDL-C exhibits antiatherogenic, antioxidant, and anti-inflammatory properties. Hence, high HDL-C levels may prevent the occurrence of CAD and stroke. Apolipoprotein A1 (ApoA1) is a major component of HDL-C and may be correlated with dyslipidemia, insulin resistance, and metabolic syndromes. Several ApoA1 polymorphisms correlated with serum HDL-C level are also associated with human diseases. A high A allele frequency of ApoA1-75G/A polymorphism is related to lower HDL-C and ApoA1 levels in northern Indians. CAD prevalence is significantly higher in carriers with the A allele than in carriers with the G allele. Morcillo et al demonstrated that the AA genotype of ApoA1-75G/A polymorphism is a risk factor for type 2 diabetes. HDL-C level is high in healthy Chinese people with the AA genotype. The HDL-C level is also high in healthy male carriers with the CT heterogenotype of ApoA1+83 C/T. HDL-C and glycosylated hemoglobin levels are similarly high in carriers with the C allele of APoA1 rs12721026 in Brazil. Chen et al demonstrated that the G allele of ApoA1-75G/A polymorphism is associated with hypertension; furthermore, the C allele of +83 C/T polymorphism is correlated with hypertension in CAD carriers. ApoA1 gene polymorphism also predicts the cardiometabolic risk of South Asian immigrants in the USA. However, studies have yet to determine the relationship between ApoA1 gene polymorphism and stroke in Taiwanese patients. Thus, this study aimed to investigate the association of ApoA1 rs5070 polymorphism and different stroke subtypes in Taiwanese people.