ObjectivesOur hospital replaced the format for delivering portable antimicrobial prescribing guidance from a paper-based pocket guide to a smartphone application (app). We used this opportunity to assess the relationship between its use and the attitudes and behaviours of antimicrobial prescribers.MethodsWe used 2 structured cross-sectional questionnaires issued just prior to and 3 months following the launch of the smartphone app. Ordinal Likert scale responses to both frequencies of use and agreement statements permitted quantitative assessment of the relationship between variables.ResultsThe smartphone app was used more frequently than the pocket guide it replaced (p < 0.01), and its increased use was associated with sentiments that the app was useful, easy to navigate and its content relevant. Users who used the app more frequently were more likely to agree that the app encouraged them to challenge inappropriate prescribing by their colleagues (p = 0.001) and were more aware of the importance of antimicrobial stewardship (p = 0.005). Reduced use of the app was associated with agreement that senior physicians’ preferences for antimicrobial prescribing would irrespectively overrule guideline recommendations (p = 0.0002).ConclusionsSmartphone apps are an effective and acceptable format to deliver guidance on antimicrobial prescribing. Our findings suggest that they may empower users to challenge incorrect prescribing, breaking well-established behaviours, and thus supporting vital stewardship efforts in an era of increased antimicrobial resistance. Future work will need to focus on the direct impact on drug prescriptions as well as identifying barriers to implementing smartphone apps in other clinical settings.

These data illustrate the cost of palliative management of recurrent and refractory ovarian cancer, which must be considered in the context of quality and duration of survival. They indicate the potential to improve cost efficiency by improving resource management, for example, by shifting from inpatient to outpatient chemotherapy, everything else being equal.

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Peer reviewed articleim: To establish the cost-effectiveness of screening and treating meticillin-sensitive Staphylococcus aureus (MSSA) carriers, potentially reducing both fi nancial and clinical burdens of managing healthcareacquired infections.Methods: A decision health economic model analysed the impact of a 'screen and treat' strategy for Hospital inpatients from the perspective of the UK National Health Service.Results: Cost savings in excess of £600k and around 840 potential infections could be avoided in a 70,000 patient cohort, at a nasal carriage prevalence of 30 % . For 2000 high infection risk cardiothoracic surgery patients, cost savings could reach £8,636 per annum. The dominance of the 'screen and treat' strategy holds for plausible variations in the model parameter values and simple modelling of secondary transmission.Conclusion: Adopting rapid screening and treating MSSA nasal carriers should be clinically and fi nancially advantageous, compared to current strategies of not screening, even under conservative assumptions for costs and probabilities of managing infections. Abstract A