Understanding antimicrobial use in pet dogs: An anthropologically informed mixed-methods study

Background: Antimicrobial use in companion animals could be an overlooked contributor to antimicrobial resistance relevant to human health. The aim of this study was to describe the material, biotic, and infrastructural interdependencies involved in antimicrobial use in the veterinary care of UK companion animals, particularly dogs. Methods: Veterinary clinics, the main site of decision-making regarding companion animal antimicrobial use, are the focus of this mixed-methods thesis. Highest priority critically important antimicrobial (HPCIA) dispensing data were analysed using a mixed-effect, hierarchical modelling approach (dogs nested in clinics nested in veterinary groups). Ethnographic fieldwork in three veterinary clinics lasting nine months explored the animal–human–microbe interactions at play and situated these within wider political and economic contexts of the companion animal veterinary sector. Observations, interviews, and documentary analysis were undertaken and synthesised using a comparative approach. Findings: Records of 468,665 antimicrobial dispensing events were analysed. Differences in the odd ratios of an event comprising of a HPCIA were apparent between veterinary groups (ranging from 1.00 to 7.31, 95% confidence interval 5.14–10.49). Fieldwork identified the infrastructural arrangements that support current patterns of antimicrobial use including the ‘business model of busyness’ and the role of the veterinary-industrial complex. Interspecies care involved the entanglement of mammalian and microbial bodies and was delivered within temporal and logistical constraints, at times in tension with infection control procedures. Antimicrobials formed part of the veterinary care for socially desirable—yet inherently unhealthy—breeds of dog. Conclusions: Antimicrobial use is a bio-social practice that is produced by social, material, semiotic, and technical networks extending beyond the actors at the interface of their deployment. By rendering visible these networks—and decentring human behaviour as the focus for efforts to address antimicrobial use—this thesis proposes alternative approaches to reduce the pressures to prescribe antimicrobials in companion animals

Understanding antibiotic use: practices, structures and networks.

In this article, we consider how social sciences can help us to understand the rising use of antibiotics globally. Drawing on ethnography as a way to research how we are in the world, we explore scholarship that situates antibiotic use in relation to interactions of pathogens, humans, animals and the environment in the context of globalization, changes in agriculture and urbanization. We group this research into three areas: practices, structures and networks. Much of the public health and related social research concerning antimicrobial resistance has focused on antibiotic use as a practice, with research characterizing how antibiotics are used by patients, farmers, fishermen, drug sellers, clinicians and others. Researchers have also positioned antibiotic use as emergent of political-economic structures, shedding light on how working and living conditions, quality of care, hygiene and sanitation foster reliance on antibiotics. A growing body of research sees antibiotics as embedded in networks that, in addition to social and institutional networks, comprise physical, technical and historical connections such as guidelines, supply chains and reporting systems. Taken together, this research emphasizes the multiple ways that antibiotics have become built into daily life. Wider issues, which may be invisible without explication through ethnographic approaches, need to be considered when addressing antibiotic use. Adopting the complementary vantage points of practices, networks and structures can support the diversification of our responses to AMR

Current and potential providers of blood pressure self-screening: a mixed methods study in Oxfordshire.

OBJECTIVES: To (1) establish the extent of opportunities for members of the public to check their own blood pressure (BP) outside of healthcare consultations (BP self-screening), (2) investigate the reasons for and against hosting such a service and (3) ascertain how BP self-screening data are used in primary care. DESIGN: A mixed methods, cross-sectional study. SETTING: Primary care and community locations in Oxfordshire, UK. PARTICIPANTS: 325 sites were surveyed to identify where and in what form BP self-screening services were available. 23 semistructured interviews were then completed with current and potential hosts of BP self-screening services. RESULTS: 18/82 (22%) general practices offered BP self-screening and 68/110 (62%) pharmacies offered professional-led BP screening. There was no evidence of permanent BP self-screening activities in other community settings.Healthcare professionals, managers, community workers and leaders were interviewed. Those in primary care generally felt that practice-based BP self-screening was a beneficial activity that increased the attainment of performance targets although there was variation in its perceived usefulness for patient care. The pharmacists interviewed provided BP checking as a service to the community but were unable to develop self-screening services without a clear business plan. Among potential hosts, barriers to providing a BP self-screening service included a perceived lack of healthcare commissioner and public demand, and a weak-if any-link to their core objectives as an organisation. CONCLUSIONS: BP self-screening currently occurs in a minority of general practices. Any future development of community BP self-screening programmes will require (1) public promotion and (2) careful consideration of how best to support-and reward-the community hosts who currently perceive little if any benefit

Getting our house in order: an audit of the registration and publication of clinical trials supported by the National Institute for Health Research Oxford Biomedical Research Centre and the Musculoskeletal Biomedical Research Unit.

To audit the proportion of clinical trials that had been publically registered and, of the completed trials, the proportion published.2 major research institutions supported by the National Institute of Health Research (NIHR).The proportion of trials reporting results within 12 months, 24 months and 'ever'. Factors associated with non-publication were analysed using logistic regression.Phases 2-4 clinical trials identified from internal documents and publication lists.In total, 286 trials were identified. We could not find registration for 4 (1.4%) of these, all of which were completed and published. Of the trials with a registered completion date pre-January 2015, just over half (56%) were published, and half of these were published within 12 months (36/147, 25%). For some trials, information on the public registers was found to be out-of-date and/or inaccurate. No clinical trial characteristics were found to be significantly associated with non-publication. We have produced resources to facilitate similar audits elsewhere.It was feasible to conduct an internal audit of registration and publication in 2 major research institutions. Performance was similar to, or better than, comparable cohorts of trials sampled from registries. The major resource input required was manually seeking information: if all registry entries were maintained, then almost the entire process of audit could be automated-and routinely updated-for all research centres and funders

Acceptability and psychological impact of out-of-office monitoring to diagnose hypertension: an evaluation of survey data from primary care patients.

BACKGROUND: Out-of-office blood pressure (BP) is recommended for diagnosing hypertension in primary care due to its increased accuracy compared to office BP. Moreover, being diagnosed as hypertensive has previously been linked to lower wellbeing. There is limited evidence regarding the acceptability of out-of-office BP and its impact on wellbeing. AIM: To assess the acceptability and psychological impact of out-of-office monitoring in people with suspected hypertension. DESIGN AND SETTING: A pre- and post-evaluation of participants with elevated (and#8805;130 mmHg) systolic BP, assessing the psychological impact of 28 days of self-monitoring followed by ambulatory BP monitoring for 24 hours. METHOD: Participants completed standardised psychological measures pre- and post-monitoring, and a validated acceptability scale post-monitoring. Descriptive data were compared using and#967;2 tests and binary logistic regression. Pre- and post-monitoring comparisons were made using the paired t-test and Wilcoxon signed rank test. RESULTS: Out-of-office BP monitoring had no impact on depression and anxiety status in 93% and 85% of participants, respectively. Self-monitoring was more acceptable than ambulatory monitoring (n = 183, median 2.4, interquartile range [IQR] 1.9-3.1 versus median 3.2, IQR 2.7-3.7, Pandlt;0.01). When asked directly, 48/183 participants (26%, 95% confidence interval [CI] = 20 to 33%) reported that self-monitoring made them anxious, and 55/183 (30%, 95% CI = 24 to 37%) reported that ambulatory monitoring made them anxious. CONCLUSION: Out-of-office monitoring for hypertension diagnosis does not appear to be harmful. However, health professionals should be aware that in some patients it induces feelings of anxiety, and self-monitoring may be preferable to ambulatory monitoring.</p

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

Background Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay. Aim To establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations. Design and setting Systematic review assessing the effectiveness of GP DA testing in adults. Method MEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively. Results The authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high. Conclusion GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.</p

P.p1 {margin: 0.0px 0.0px 0.0px 0.0px; Font: 24.0px Helvetica} Physical Activity For The Prevention And Treatment Of Major Chronic Disease: An Overview Of Systematic Reviews

Evidence of physical activity (PA) as beneficial for health stems mainly from observational studies. Findings from randomised controlled trials (RCTs) often differ and systematic reviews of RCTs demonstrate mixed results making translation into clinical practice difficult. An overview of existing review evidence is needed to identify PA interventions that are effective in preventing or treating major chronic disease

P.p1 {margin: 0.0px 0.0px 0.0px 0.0px; Font: 24.0px Helvetica} Physical Activity For The Prevention And Treatment Of Major Chronic Disease: An Overview Of Systematic Reviews

Evidence of physical activity (PA) as beneficial for health stems mainly from observational studies. Findings from randomised controlled trials (RCTs) often differ and systematic reviews of RCTs demonstrate mixed results making translation into clinical practice difficult. An overview of existing review evidence is needed to identify PA interventions that are effective in preventing or treating major chronic disease