quality and utility of information captured by surveillance systems relevant to antimicrobial CORD-Papers-2022-06-02 (Version 1)

Title: Quality and Utility of Information Captured by Surveillance Systems Relevant to Antimicrobial Resistance (AMR): A Systematic Review
Abstract: Health surveillance systems are considered vital for combatting antimicrobial resistance (AMR); however the evidence-base on the effectiveness of these systems in providing information that can be used by healthcare professionals or the acceptability of these systems by users has not been reviewed. A systematic review was conducted of a number of databases to synthesise the evidence. The review identified 43 studies that met the inclusion criteria conducted in 18 countries and used 11 attributes in their assessment of surveillance systems. The majority of systems evaluated were for monitoring the incidence of tuberculosis. The studies found that most surveillance systems were underperforming in key attributes that relate to both effectiveness and acceptability. We identified that two features of systems (ease of use and users awareness of systems) were associated with greater acceptability and completeness of systems. We recommend prioritising these for the improvement of existing systems as well as ensuring consistency in the definition of attributes studied to allow a more consistent approach in evaluations of surveillance systems and to facilitate the identification of the attributes that have the greatest impact on the utility of data produced.
Published: 2021-04-13
Journal: Antibiotics (Basel)
DOI: 10.3390/antibiotics10040431
DOI_URL: http://doi.org/10.3390/antibiotics10040431
Author Name: Al Haboubi Mustafa
Author link: https://covid19-data.nist.gov/pid/rest/local/author/al_haboubi_mustafa
Author Name: Glover Rebecca E
Author link: https://covid19-data.nist.gov/pid/rest/local/author/glover_rebecca_e
Author Name: Eastmure Elizabeth
Author link: https://covid19-data.nist.gov/pid/rest/local/author/eastmure_elizabeth
Author Name: Petticrew Mark
Author link: https://covid19-data.nist.gov/pid/rest/local/author/petticrew_mark
Author Name: Black Nick
Author link: https://covid19-data.nist.gov/pid/rest/local/author/black_nick
Author Name: Mays Nicholas
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mays_nicholas
sha: 454fae31f13b32e2c25123be00245871d6fc7197
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 33924412
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/33924412
pmcid: PMC8069834
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069834
url: https://doi.org/10.3390/antibiotics10040431 https://www.ncbi.nlm.nih.gov/pubmed/33924412/
has_full_text: TRUE
Keywords Extracted from Text Content: N. Al-Haboubi M. Petticrew E. N. Quality M.; patients Sweden [52] Escherichia coli 251,693 wound Salmonella infections 29/43 Podewils human COVID-19 AMR helicobacter pylori California [36 languages children Samaan Haemophilus influenzae patient drug-bug narrati 41/43 penicillin-resistant pneumococci Korea [21 persons clarithromycin Victoria ( pulmonary vancomycin Rifampicin cephalosporin NTP Saudi Arabia Haemophilus influenza type b conjugate vaccine fluoroquinolone US funds Klebsiella pneumoniae CRD42018085346 Helicobacter pylori v 18.0.2 Afghanistan bloodstream Olowokure UK extra-pulmonary TB carbapenem Brazil's micro-regions Haemophilus influenza Brazilian micro-regions HMIS sputum urinary tract Neisseria gonorrhoeae Staphy-lococcus aureus
Extracted Text Content in Record: First 5000 Characters:Citation: Al-Haboubi, M.; Glover, R.E.; Eastmure, E.; Petticrew, M.; Black, N.; Mays, N. Quality and The process of antimicrobial resistance (AMR), whereby microbes evolve over time to become less susceptible to medicines, has reduced the ability of healthcare providers to treat common infections. It is a naturally occurring process that takes place through genetic mutations. The main drivers for AMR include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene; poor infection and disease prevention and control; poor access to quality, affordable medicines, vaccines and diagnostics; and lack of enforcement of legislation [1] . In the context of combating AMR, the World Health Organisation (WHO) views surveillance systems as being essential for providing information on the magnitude and trends in AMR and for monitoring the effects of interventions [2] . The most widely recognised guidelines for establishing the utility of the outputs of a surveillance system are those developed by the US Centers for Disease Control and Prevention (CDC) [3] . These describe the usefulness of a system in terms of its contribution to the prevention and control of adverse health events, including an understanding of the implications of those events, based on consideration of nine attributes: Simplicity, Flexibility, Data Quality, Acceptability, Sensitivity, Positive Predictive Value (PPV), Representativeness, Timeliness, and Stability (See Appendix A for definitions). The overall usefulness of a surveillance system is considered to be influenced (to varying degrees depending on the 1. What is the effectiveness of AMR-relevant surveillance systems in providing information that can be used to inform healthcare professionals? 2. What is the acceptability of these systems to users? The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD42018085346. In order to answer the first research question (the effectiveness of systems), the following study designs were eligible for inclusion: Prospective observational studies (controlled and uncontrolled before and after studies). • Retrospective observational evaluations, including case-control studies, retrospective cohort studies, and audits. Data sources included primary data collected for research and secondary data (for example, health insurance claim data). Interventions using an experimental design. Evidence from qualitative research (such as interviews and focus groups) was considered eligible for answering the second research question on the acceptability of systems. Evaluations of surveillance systems that monitored the following organisms were eligible for inclusion: • Bacteria whose antibiotic susceptibility status was recorded by the surveillance system. • Bacteria relevant to AMR. A list was collated from the key AMR threats that have been identified by the WHO [4] , the CDC [5] , European Centre for Disease Control (ECDC) [6] , European Food Safety Authority (EFSA) [7] , and the key drug-bug combinations identified by Public Health England in the UK AMR Strategy [8] . The following types of evaluation study were excluded from the review: • Evaluations of public surveillance systems that monitor non-bacterial microorganisms (for example, viruses or fungi). Evaluations of surveillance systems that monitor bacterial microorganisms that are not on any of the priority lists described in the inclusion criteria above. • Screening systems that are limited to a single or group of hospitals, and where the information is not shared outside the hospital system. • Studies published prior to 1988, when the first CDC guidelines for evaluating Public Health Surveillance systems were published. • Articles published in languages other than English. The following databases were searched for relevant articles from 1 January 1988 until 1 June 2018: OVID Medline; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL); Global Health (OVID); Web of Science; Open Grey and Scopus. The search terms used can be found in Appendix B. They were adapted for databases in accordance with the repository's interface and search options. All search strings were run in English, and all the records were exported to Endnote reference management software v 18.0.2 and Excel 2016. In addition to searching databases, we also performed reference searches of the identified. The primary outcome for inclusion in the review, to answer the research question on effectiveness, were attributes of surveillance systems, as described by the authors. Aspects of acceptability, such as ease of use, reported in qualitative data, were the outcomes of interest for answering the second research question. The Critical Appraisal Skills Programme (CASP) checklist [9] was used for assessing the quality of reporting of the qualitative studies included in the review, and the Effective Public Health Practice Project
Keywords Extracted from PMC Text: 41/43 HMIS sputum Sweden [52] US 29/43 Saudi Arabia California [36 refugees patients Korea [21 Brazil's extra-pulmonary TB NTP human Brazilian micro-regions Samaan 22/43 Haemophilus influenza AMR patient Victoria ( Podewils professionals?What penicillin-resistant pneumococci " UK 's Afghanistan [16,55 pulmonary 251,693
Extracted PMC Text Content in Record: First 5000 Characters:The process of antimicrobial resistance (AMR), whereby microbes evolve over time to become less susceptible to medicines, has reduced the ability of healthcare providers to treat common infections. It is a naturally occurring process that takes place through genetic mutations. The main drivers for AMR include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene; poor infection and disease prevention and control; poor access to quality, affordable medicines, vaccines and diagnostics; and lack of enforcement of legislation [1]. In the context of combating AMR, the World Health Organisation (WHO) views surveillance systems as being essential for providing information on the magnitude and trends in AMR and for monitoring the effects of interventions [2]. The most widely recognised guidelines for establishing the utility of the outputs of a surveillance system are those developed by the US Centers for Disease Control and Prevention (CDC) [3]. These describe the usefulness of a system in terms of its contribution to the prevention and control of adverse health events, including an understanding of the implications of those events, based on consideration of nine attributes: Simplicity, Flexibility, Data Quality, Acceptability, Sensitivity, Positive Predictive Value (PPV), Representativeness, Timeliness, and Stability (See Appendix A for definitions). The overall usefulness of a surveillance system is considered to be influenced (to varying degrees depending on the aim of the system) by these attributes [3]. For example, a public health surveillance system that is simple, flexible, acceptable, and stable is more likely to be useful for public health action. However, the CDC acknowledges that there is no perfect system and that focusing resources to improve one attribute might have an adverse effect on another; for example, as sensitivity increases, the PPV might decrease, and efforts to increase sensitivity and PPV could result in a more complex surveillance system with reduced acceptability and timeliness [3]. There is uncertainty about what constitute the most effective characteristics of a system. A rapid review of the literature identified no systematic reviews of evaluations of the ability of surveillance systems to provide information that can be used by health care professionals to combat AMR. Such a synthesis could contribute to the evidence base when deciding whether to invest or continue investing in these systems in the future. Hence, the aim of this systematic review was to synthesise the evidence from evaluations of the quality and utility of information produced by surveillance systems that monitor organisms and conditions important in the AMR context, with a focus on human rather than animal surveillance systems. The research questions were:What is the effectiveness of AMR-relevant surveillance systems in providing information that can be used to inform healthcare professionals?What is the acceptability of these systems to users? The primary outcome for inclusion in the review, to answer the research question on effectiveness, were attributes of surveillance systems, as described by the authors. Aspects of acceptability, such as ease of use, reported in qualitative data, were the outcomes of interest for answering the second research question. The Critical Appraisal Skills Programme (CASP) checklist [9] was used for assessing the quality of reporting of the qualitative studies included in the review, and the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used for those that included a quantitative component [10]. Given the heterogeneity among study designs and contexts, a narrative review was conducted following guidelines for narrative synthesis [11]. A total of 49,000 records were identified from databases and manual searches, of which 43 studies were included in the review. Figure 1 provides the details of the records excluded at each stage of the screening process. The majority of studies were exclusively quantitative (38/43), with the other five including a qualitative component. None of the studies was purely qualitative. The majority were retrospective analyses of routinely collected data (41/43) (Table 1). Of these, five combined retrospective quantitative analysis with semi-structured interviews and another five incorporated capture/recapture methods to measure the completeness of data. In over half of the studies (29/43), the system under investigation was compared to other sources of data (laboratory reports, prescription data, medical records, or health insurance claims data) or alternative notification technologies. These comparators had been treated by researchers in two different ways:Use of another surveillance system (such as the CDC Emerging Infections Programme) as a high-quality reference standard against which to compare (for example, Nguyen et al. [12])Comparison between different methods of data collection
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