Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners

BACKGROUND: Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff. METHODS: Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information. RESULTS: Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis. CONCLUSIONS: Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk

Libraries and open access: the implications of open-access publishing and dissemination for libraries in higher education institutions

This chapter discusses the consequences of open-access (OA) publishing and dissemination for libraries in higher education institutions (HEIs). Key questions (which are addressed in this chapter) include: 1. How might OA help information provision? 2. What changes to library services will arise from OA developments (particularly if OA becomes widespread)? 3. How do these changes fit in with wider changes affecting the future role of libraries? 4. How can libraries and librarians help to address key practical issues associated with the implementation of OA (particularly transition issues)? This chapter will look at OA from the perspective of HE libraries and will make four key points: 1. Open access has the potential to bring benefits to the research community in particular and society in general by improving information provision. 2. If there is widespread open access to research content, there will be less need for library-based activity at the institution level, and more need for information management activity at the supra-institutional or national level. 3. Institutional libraries will, however, continue to have an important role to play in areas such as managing purchased or licensed content, curating institutional digital assets, and providing support in the use of content for teaching and research. 4. Libraries are well-placed to work with stakeholders within their institutions and beyond to help resolve current challenges associated with the implementation of OA policies and practices.