Why is it important to integrate coordinated treatments for comorbid/co-occurring disorders? Provide at least two examples of the potential financial challenges associated with managing the implementation of treatment. (Minimum 150 words & references)
The included studies were
of variable quality following the application of the CASP
appraisal tool. No study explicitly addressed researcher
reflexivity, but we overlooked this. In the case of this re-
view, the emergence of similar themes across all of the
studies overcame this limitation. Through inclusion only of
studies that related to LTCFs, the importance of the context
and health care organization was protected. The synthesis
of the findings in terms of discussing factors influencing
AMS in LTCFs attempted to increase the clinical relevance
of the review results. The findings were credible, and
sufficient supportive data existed for synthesis of the
findings for the purposes of this review.
5 Conclusion
This meta-synthesis review highlighted some key influ-
ences on antibiotic prescribing in LTCFs. The specific
LTCF context factors, such as the relationship between the
GP or nurse and the patient, restricted access to resources
302 A. Fleming et al.
and social factors (for example, the central role of the
nurse) have an important impact on antibiotic prescribing
in LTCFs. The need for multidisciplinary collaborative
AMS strategies to address the variability in practice and
knowledge, and to increase the awareness of AMR, is
evident. This synthesis of existing studies may contribute
important information to the development of future high-
quality studies addressing antibiotic prescribing in LTCFs.
Acknowledgments This research was supported by the Health Research Board in Ireland under Grant Number PHD/2007/16.
Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and the source are credited.
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3. Kuehn BM. ‘‘Nightmare’’ bacteria on the rise in US hospitals,
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5. Zimmerman S, Sloane PD, Bertrand R, Olsho LE, Beeber A,
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6. Tonkin-Crine S, Yardley L, Little P. Antibiotic prescribing for
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