The impact of a PCR assay for candidemia on antifungal drug prescribing in critical care: an interrupted time series pilot study.

Objective To evaluate the feasibility of conducting a definitive study to assess the impact of introducing a rapid PCR-based test for candidemia on antifungal drug prescribing. Method Prospective, single centre, interrupted time series study consisting of three periods of six months' duration. The assay was available during the second period, during which the PCR assay was available for routine use by physicians Monday–Friday with guaranteed 24-h turnaround time. For each period total antifungal drug use, expressed as treatment-days, was recorded and an adjustment was made to exclude estimated use for proven candidemia. Also, during the intervention period, antifungal prescribing decisions for up to 72 h after each PCR result became available were recorded as either concordant or discordant with that result. Results While overall antifungal use remained relatively stable throughout, after adjustment for candidemia, there was a 38% reduction in use following introduction of the PCR test; however, this was nonsignificant at the 95% level. During the intervention period overall concordance between the PCR result and prescribing decisions was 84%. Conclusions The PCR assay for candidemia was requested, prescribing decisions were generally concordant with the results produced and there was an apparent decrease in antifungal prescription, although this was sustained even after withdrawal of the intervention; these findings should be more thoroughly evaluated in a larger trial.

Critical Success Factors for Transfer-Operate-Transfer Urban Water Supply Projects in China

Over the years, build-operate-transfer (BOT) has continuously attracted research interests. Many studies on BOT have been carried out. Variations of BOT such as build-own-operate-transfer and build-own-operate have also been reported in some relevant publications. However, few investigations thus far have been conducted for transfer-operate-transfer (TOT). Therefore, there is a knowledge gap in this particular field. TOT is a new model that is suitable for existing infrastructure and public utility projects formerly funded by the governments and currently operated by state-owned enterprises. It refers to the transfer of a running public project to a foreign business or domestic private entity. Based on four case studies carried out in the Chinese water supply industry, this paper examines why there is an increasing need for TOT projects and identifies the distinctive features of TOT practice in China. This is followed by an introduction of a framework of critical success factors (CSFs) for TOT projects. The most important factors include project profitability, asset quality, fair risk allocation, competitive tendering, internal coordination within government, employment of professional advisors, corporate governance, and government supervision. The identification of CSFs provides a useful guidance to project parties planning to participate in TOT practice.