Editorial

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Open AccessEditorial

Introduction to the ESPAUR Webinar and Report 2021–2022: Key Findings and Stakeholder Engagement

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Med. Sci. Forum 2022, 15(1), 18; https://doi.org/10.3390/msf2022015018 - 08 May 2023

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Abstract

During the coronavirus (COVID-19) pandemic, we saw significant decreases in the incidence of bloodstream infections (BSIs), antibiotic-resistant infections, and the burden of resistant infections. The reasons for this are complex and multifactorial, but likely, at least in part, due to changes in healthcare [...] Read more.

During the coronavirus (COVID-19) pandemic, we saw significant decreases in the incidence of bloodstream infections (BSIs), antibiotic-resistant infections, and the burden of resistant infections. The reasons for this are complex and multifactorial, but likely, at least in part, due to changes in healthcare delivery and healthcare seeking behavior. As healthcare systems return to pre-pandemic ways of working, now is a pivotal moment to ensure focus remains on what is often referred to as the ‘silent pandemic’: antimicrobial resistance (AMR). The ninth English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR) report provides an overview of the national data on antibiotic prescribing and resistance, antimicrobial stewardship implementation, and awareness activities. The active contribution from and collaboration with the ESPAUR oversight group and the engagement of stakeholder organizations, including the devolved administrations, are also reported. Findings from the ESPAUR report were presented at a webinar on 23 November 2022. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Research

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Open AccessAbstract

Antimicrobial Consumption in England, 2017 to 2021

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Med. Sci. Forum 2022, 15(1), 1; https://doi.org/10.3390/msf2022015001 - 18 Jan 2023

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Abstract

The UK’s 5-year National Action Plan for Antimicrobial Resistance has an ambition to reduce total antimicrobial consumption, a key driver of antimicrobial resistance, in humans by 15% by 2024, highlighting the need for active surveillance to inform on progression. The English Surveillance Programme [...] Read more.

The UK’s 5-year National Action Plan for Antimicrobial Resistance has an ambition to reduce total antimicrobial consumption, a key driver of antimicrobial resistance, in humans by 15% by 2024, highlighting the need for active surveillance to inform on progression. The English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report, Chapter 3, commentates on key national antimicrobial consumption trends, across primary and secondary care in England, between 2017 to 2021. These findings were presented at the ESPAUR Report webinar on 23 November 2022. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Open AccessAbstract

Research on Antimicrobial Utilization and Resistance in England 2021–22 (ESPAUR Report)

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Emily Agnew

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Julie V. Robotham

Med. Sci. Forum 2022, 15(1), 17; https://doi.org/10.3390/msf2022015017 - 28 Mar 2023

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Abstract

The Research Chapter (Chapter 8) of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2021–2022 showcases the research that has been undertaken and that is ongoing at the UK Health Security Agency (UKHSA) in the field of healthcare-associated infections (HCAIs) [...] Read more.

The Research Chapter (Chapter 8) of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2021–2022 showcases the research that has been undertaken and that is ongoing at the UK Health Security Agency (UKHSA) in the field of healthcare-associated infections (HCAIs) and antimicrobial resistance (AMR) from April 2021 to March 2022 [...] Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Other

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Open AccessProceeding Paper

Surveillance and Stewardship Approaches for COVID-19 Novel Therapeutics in England from 2021 to 2022 (ESPAUR Report)

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Med. Sci. Forum 2022, 15(1), 2; https://doi.org/10.3390/msf2022015002 - 01 Mar 2023

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Abstract

The UK Health Security Agency’s (UKHSA) COVID-19 therapeutics programme was commissioned by the Department of Health and Social Care with the remit to evaluate the use and role of COVID-19 treatments. COVID-19 therapeutics data were assessed from two main data sources: novel therapy [...] Read more.

The UK Health Security Agency’s (UKHSA) COVID-19 therapeutics programme was commissioned by the Department of Health and Social Care with the remit to evaluate the use and role of COVID-19 treatments. COVID-19 therapeutics data were assessed from two main data sources: novel therapy requests via Blueteq and medicines supply data via Rx-info. The five COVID-19 therapies in use in England between 1 October 2021 and 31 March 2022 included nirmatrelvir plus ritonavir, remdesivir, molnupiravir, sotrovimab, and casirivimab with imdevimab. During this time period, treatment requests for novel therapies against COVID-19 were submitted for nearly 52,000 patients in England. The UKHSAs COVID-19 therapeutics programme has been key to supporting the deployment of novel COVID-19 therapies in England by undertaking genomic, virological, and epidemiologic surveillance, through both national surveillance systems and academic collaboration. Effective therapies are particularly important for protecting the health of patients at greater risk of developing severe COVID-19. This national surveillance and stewardship programme was successfully rolled out at pace at the start of the pandemic and leads on work nationally to reduce the development of resistance. These findings were presented at the ESPAUR Report webinar on 23 November 2022. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Open AccessProceeding Paper

Antimicrobial Resistance in England 2017 to 2021 (ESPAUR Report 2021–22)

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Mariyam Mirfenderesky

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Katherine L. Henderson

Med. Sci. Forum 2022, 15(1), 3; https://doi.org/10.3390/msf2022015003 - 24 Mar 2023

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Abstract

The English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) antimicrobial resistance (AMR) chapter reports on bacterial, viral, and fungal AMR trends between 2017 and 2021 in England. A 10.8% increase in patient episodes of bacteraemia or fungaemia was observed, and the estimated [...] Read more.

The English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) antimicrobial resistance (AMR) chapter reports on bacterial, viral, and fungal AMR trends between 2017 and 2021 in England. A 10.8% increase in patient episodes of bacteraemia or fungaemia was observed, and the estimated burden of resistance decreased by 4.2%. Individuals with an antimicrobial-resistant strain (resistant to ≥1 key AMR burden-defined antibiotics) had a higher crude case fatality rate (18.1%) compared to those with a susceptible strain (16.3%). The effect of deprivation on carbapenemase-producing organisms (CPO) incidence, and the impact of the AMR burden across ethnic groups, have been described for the first time. Understanding the impact of ethnicity, deprivation, regional divergence, and potential confounders remains a crucial avenue of enquiry to target appropriate AMR interventions. These findings were presented at the ESPAUR Report webinar on 23 November 2022. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Open AccessProceeding Paper

Farm Vet Champion Delivery of Training and SMART Goal Setting to Improve Antimicrobial Stewardship in Farm Veterinary Practice

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Med. Sci. Forum 2022, 15(1), 4; https://doi.org/10.3390/msf2022015004 - 24 Mar 2023

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Farm Vet Champions (FVC) is a collaborative project to unite and empower UK farm vets to establish, embed, and champion responsible antimicrobial stewardship. FVCs support the veterinary profession to improve animal health and welfare standards and provide positive inspiration and leadership towards One [...] Read more.

Farm Vet Champions (FVC) is a collaborative project to unite and empower UK farm vets to establish, embed, and champion responsible antimicrobial stewardship. FVCs support the veterinary profession to improve animal health and welfare standards and provide positive inspiration and leadership towards One Health efforts. The initiative provides farm vets and their teams with free online learning, and an online tool that encourages users to set goals that are specific, measurable, achievable, and realistic, within a set time limit. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Supporting Correct Antimicrobial Choices in Sepsis

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Balwinder Bolla

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Alex Rond-Alliston

Med. Sci. Forum 2022, 15(1), 5; https://doi.org/10.3390/msf2022015005 - 24 Mar 2023

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Abstract

Antimicrobial audits on A&E and acute admissions wards have highlighted deficiencies in prescribing practices, particularly the inappropriate use of broad-spectrum agents. A clinical decision-making tool was created to expedite and facilitate the process of selecting correct antimicrobial treatments based on the site and [...] Read more.

Antimicrobial audits on A&E and acute admissions wards have highlighted deficiencies in prescribing practices, particularly the inappropriate use of broad-spectrum agents. A clinical decision-making tool was created to expedite and facilitate the process of selecting correct antimicrobial treatments based on the site and severity of an infection, and also included the consideration of penicillin allergy. Simple, efficient, and effective, this tool has already been shared with many NHS Trusts nationally. Further audits, after this tool was introduced, show improvements in some aspects of antimicrobial prescribing, despite limited opportunities to deliver an awareness campaign of this resource. Such action will be needed to drive further improvements in antimicrobial prescribing choices in sepsis. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Supporting Timely IV to Oral Antibiotic Switch through Development of Accessible Clinical Decision Tools

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Med. Sci. Forum 2022, 15(1), 6; https://doi.org/10.3390/msf2022015006 - 24 Mar 2023

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The timely and appropriate IV to Oral Switch (IVOS) of antibiotics is beneficial to patient care and AMR strategies. However, a lack of prescriber confidence in deciding to switch often prolongs IV antibiotic use. The creation of a bite-size educational video and a [...] Read more.

The timely and appropriate IV to Oral Switch (IVOS) of antibiotics is beneficial to patient care and AMR strategies. However, a lack of prescriber confidence in deciding to switch often prolongs IV antibiotic use. The creation of a bite-size educational video and a smartphone application clinical decision tool, has brought the learning process closer to everyday practice, in an easy to access and understandable manner. Both have been very well received and shared with many acute NHS Trusts. The implementation was correlated with an improvement in audit findings. The multidisciplinary and collaborative approach in developing these tools has been the key to success. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Scaling-Up Interventions for Strengthening Antimicrobial Stewardship Using a One Health Approach in Wakiso District, Uganda

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Grace Biyinzika Lubega

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Med. Sci. Forum 2022, 15(1), 7; https://doi.org/10.3390/msf2022015007 - 24 Mar 2023

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We implemented a multidisciplinary project between Uganda and the UK aimed at strengthening antimicrobial stewardship (AMS) in Wakiso district, with a focus on capacity building, stakeholder engagement, and knowledge exchange using a One Health approach. Project activities included: trainings and workshops on antimicrobial [...] Read more.

We implemented a multidisciplinary project between Uganda and the UK aimed at strengthening antimicrobial stewardship (AMS) in Wakiso district, with a focus on capacity building, stakeholder engagement, and knowledge exchange using a One Health approach. Project activities included: trainings and workshops on antimicrobial resistance (AMR), AMS, infection prevention and control (IPC); Global Point Prevalence Survey (GPPS) data collection and analysis; and the mentorship of lower level health facilities. Our project demonstrated that AMS interventions using a One Health approach can enhance understanding of the prudent use of antimicrobials and improve practices at health facilities and within communities. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Managing Penicillin Allergy in Primary Care: An Important but Neglected Aspect of Antibiotic Stewardship

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Jonathan A. T. Sandoe

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Sarah Tonkin-Crine

Med. Sci. Forum 2022, 15(1), 8; https://doi.org/10.3390/msf2022015008 - 24 Mar 2023

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Abstract

An estimated 2.7 million people in the UK are potentially prevented from accessing highly effective and inexpensive penicillins as a result of incorrect penicillin allergy records. Removing incorrect penicillin allergy records may lead to improved patient outcomes and contribute to the tackling of [...] Read more.

An estimated 2.7 million people in the UK are potentially prevented from accessing highly effective and inexpensive penicillins as a result of incorrect penicillin allergy records. Removing incorrect penicillin allergy records may lead to improved patient outcomes and contribute to the tackling of antibiotic resistance. We aim to develop and evaluate whether the ‘Penicillin Allergy Assessment Pathway’ (PAAP) is effective in improving patient outcomes. At the first stage of this work, we have focused on understanding patients’ and primary care clinicians’ views of attending and referring to penicillin allergy testing, and then prescribing and consuming penicillin following a negative test result. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Informing Antibiotic Guardianship to Combat Antimicrobial Resistance: The Liverpool Citizens’ Jury on AMR

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Med. Sci. Forum 2022, 15(1), 9; https://doi.org/10.3390/msf2022015009 - 24 Mar 2022

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Abstract

The Liverpool Citizens’ Jury was a public consultation on the use of health data to tackle the significant problem of Antimicrobial Resistance (AMR) and is the first step in creating a local AMR network with national and international relevance. The 18 jurors were [...] Read more.

The Liverpool Citizens’ Jury was a public consultation on the use of health data to tackle the significant problem of Antimicrobial Resistance (AMR) and is the first step in creating a local AMR network with national and international relevance. The 18 jurors were tasked with learning about AMR as it relates to research and considered how organisations might collect, share and utilise pseudo-anonymised patient data. The overarching aim is to produce a new model supporting societal change focused on Antibiotic Guardianship and to combat the public health challenge of AMR. The model will be implemented in the UK and provided to an international network enabling global knowledge transfer. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Antibiotic Amnesty: Engaging with the Public across the Midlands Region of England

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Med. Sci. Forum 2022, 15(1), 10; https://doi.org/10.3390/msf2022015010 - 24 Mar 2023

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Antimicrobial resistance (AMR) is a major public health threat. The hoarding, sharing and unsafe disposal of unused or expired antibiotics in domestic waste streams or sewage systems by patients may contribute to the risk of acquiring or spreading antibiotic-resistant bacteria. Community pharmacies in [...] Read more.

Antimicrobial resistance (AMR) is a major public health threat. The hoarding, sharing and unsafe disposal of unused or expired antibiotics in domestic waste streams or sewage systems by patients may contribute to the risk of acquiring or spreading antibiotic-resistant bacteria. Community pharmacies in the UK accept returned medicines for safe disposal, including antibiotics, but awareness of this is low. We organised an antibiotic amnesty campaign in the Midlands region of England; the aim of the campaign was to raise awareness of the risks of AMR and highlight the safe disposal of antibiotics via community pharmacy, timed to coincide with World Antimicrobial Awareness Week in November 2021. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Dental Antimicrobial Prescribing in the Midlands: A Regional Action Plan

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Med. Sci. Forum 2022, 15(1), 11; https://doi.org/10.3390/msf2022015011 - 24 Mar 2023

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The aim of our project was to create a resource to support an improvement in dental antibiotic prescribing. The initial phase considered antimicrobial prescribing activity, through NHSBSA data collection, which demonstrated that prescribing in the Midlands was higher than the England average. The [...] Read more.

The aim of our project was to create a resource to support an improvement in dental antibiotic prescribing. The initial phase considered antimicrobial prescribing activity, through NHSBSA data collection, which demonstrated that prescribing in the Midlands was higher than the England average. The second phase involved a targeted action plan through the creation of a bespoke regional website. It is a single resource combining the latest evidence-based guidance to tackle inappropriate prescribing and antimicrobial resistance. The national toolkit on Dental Antimicrobial Stewardship was updated for the Midlands, including adapted audit tools. Communication tools were developed, involving patient discussion tools and a multi-professional awareness campaign. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Open AccessProceeding Paper

Developing a Board and Online Game to Educate People on Antimicrobial Resistance and Stewardship: The AMS Game

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Med. Sci. Forum 2022, 15(1), 12; https://doi.org/10.3390/msf2022015012 - 24 Mar 2023

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To support efforts towards addressing the increasingly growing global burden of antimicrobial resistance (AMR), a diverse and multicountry team of stakeholders developed a board and online game on antimicrobial stewardship (AMS). The game aims to create awareness and develop knoweledge of healthcare teams [...] Read more.

To support efforts towards addressing the increasingly growing global burden of antimicrobial resistance (AMR), a diverse and multicountry team of stakeholders developed a board and online game on antimicrobial stewardship (AMS). The game aims to create awareness and develop knoweledge of healthcare teams at all levels. Reports from initial players reflect that the game is an innovative, engaging and inclusive education resource on AMR and AMS. The game continues to be promoted for continued and wider usage across the globe. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Engaging the Global Dental Profession to Help Tackle Antibiotic Resistance

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Paula Anabalon-Cordova

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Med. Sci. Forum 2022, 15(1), 13; https://doi.org/10.3390/msf2022015013 - 24 Mar 2023

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In the pre-antibiotic era, deaths from dental infections were common. Dentists are responsible for prescribing around 10% of antibiotics across healthcare globally. During 2020, dental antibiotic prescribing increased dramatically due to COVID-19 pandemic restrictions on dental procedures, which are vital for preventing and [...] Read more.

In the pre-antibiotic era, deaths from dental infections were common. Dentists are responsible for prescribing around 10% of antibiotics across healthcare globally. During 2020, dental antibiotic prescribing increased dramatically due to COVID-19 pandemic restrictions on dental procedures, which are vital for preventing and managing dental infections. FDI World Dental Federation responded with a framework about the essential role of dental teams in tackling antibiotic resistance, setting out a program to engage the global dental profession. Three exemplars include an open online course (with >2300 learners enrolled from >100 countries), a pledge for national dental organizations, and an early career researcher network. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

National Antimicrobial Stewardship Activities in Primary and Secondary Care in England 2021–22 (ESPAUR Report)

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Med. Sci. Forum 2022, 15(1), 14; https://doi.org/10.3390/msf2022015014 - 28 Mar 2023

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A summary of key national primary and secondary care antimicrobial stewardship interventions led by the UK Health Security Agency (UKHSA) are highlighted. This includes development and implementation of TARGET Antibiotics Toolkit resources in community pharmacy and General Practice and the development of a [...] Read more.

A summary of key national primary and secondary care antimicrobial stewardship interventions led by the UK Health Security Agency (UKHSA) are highlighted. This includes development and implementation of TARGET Antibiotics Toolkit resources in community pharmacy and General Practice and the development of a national intravenous-to-oral switch (IVOS) criteria for use in secondary care. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Open AccessProceeding Paper

Development and User Feedback on Antimicrobial Stewardship Explainer Videos: A Collaborative Approach between the UK and Eight African Countries

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Jessica Fraser

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Diane Ashiru-Oredope

Med. Sci. Forum 2022, 15(1), 15; https://doi.org/10.3390/msf2022015015 - 28 Mar 2023

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Antimicrobial resistance is a growing, complex, and global threat. Health partnerships are working to address antimicrobial resistance through antimicrobial stewardship activities. To support this work, the Commonwealth Partnerships for Antimicrobial Stewardship programme developed four antimicrobial stewardship explainer animation videos in eight different accents, [...] Read more.

Antimicrobial resistance is a growing, complex, and global threat. Health partnerships are working to address antimicrobial resistance through antimicrobial stewardship activities. To support this work, the Commonwealth Partnerships for Antimicrobial Stewardship programme developed four antimicrobial stewardship explainer animation videos in eight different accents, with input from over 50 stakeholders across eight African countries and the UK. The videos highlight different scenarios and explain AMS in easy-to-understand ways for both health practitioners and the public. Health partnerships piloted the videos in several ways, including in clinical waiting rooms, trainings, and AMS meetings, and provided feedback in a survey. In total, 94% of survey respondents gave the videos either a ‘5’ or ‘4’ for usefulness, with ‘5’ indicating ‘very useful’. Moving forward, through collaboration with the health partnerships, the videos will continue to be disseminated and adapted. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Open AccessProceeding Paper

ESPAUR Report 2021 to 2022 Chapter 5: NHS England Improvement and Assurance Schemes

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Med. Sci. Forum 2022, 15(1), 16; https://doi.org/10.3390/msf2022015016 - 28 Mar 2023

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Abstract

NHS England designs and administers improvement and assurance schemes that include elements to incentivize prudent use of antimicrobials, optimise patient outcomes, minimise avoidable exposure to antimicrobials, and reduce selection pressure for antimicrobial resistance (AMR). These schemes include the NHS System Oversight Framework, the [...] Read more.

NHS England designs and administers improvement and assurance schemes that include elements to incentivize prudent use of antimicrobials, optimise patient outcomes, minimise avoidable exposure to antimicrobials, and reduce selection pressure for antimicrobial resistance (AMR). These schemes include the NHS System Oversight Framework, the Pharmacy Quality Scheme for community pharmacies, the NHS Standard Contract, and the Commissioning for Quality and Innovation (CQUIN) framework. This report describes the schemes implemented from 2021 to 2022, and it reports the scheme performance of NHS commissioners and healthcare provider organisations. A summary of improvement and assurance schemes from 2022 to 2023 is also provided. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

Open AccessProceeding Paper

Antimicrobial Resistance: Professional and Public Education, Engagement, and Training Activities 2021–2022 (ESPAUR Report)

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Med. Sci. Forum 2022, 15(1), 19; https://doi.org/10.3390/msf2022015019 - 05 Jul 2023

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This is a summary of initiatives to engage and educate the general public and healthcare professionals about antimicrobial use, stewardship and resistance, as covered in the 2021–2022 English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report. Activities led by the UK Health [...] Read more.

This is a summary of initiatives to engage and educate the general public and healthcare professionals about antimicrobial use, stewardship and resistance, as covered in the 2021–2022 English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report. Activities led by the UK Health Security Agency (UKHSA) and collaborating organisations are highlighted. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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Open AccessProceeding Paper

Schoolchildren as Agents of Change towards Antimicrobial Resistance

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Med. Sci. Forum 2022, 15(1), 20; https://doi.org/10.3390/msf2022015020 - 25 Aug 2023

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Schoolchildren are in their formative years, and therefore at an ideal stage in their lives to take in knowledge and best practices that will guide their future behavior. Through the Roll Back Antimicrobial Resistance (RBA) Initiative in Tanzania, antimicrobial resistance (AMR) School Clubs [...] Read more.

Schoolchildren are in their formative years, and therefore at an ideal stage in their lives to take in knowledge and best practices that will guide their future behavior. Through the Roll Back Antimicrobial Resistance (RBA) Initiative in Tanzania, antimicrobial resistance (AMR) School Clubs have successfully educated and empowered schoolchildren to become antibiotic guardians and AMR champions. Using appropriate language and consideration of the local context, the project has employed a variety of innovative activities, including AMR arts and crafts, competitions, storytelling and interactive learning that would teach children in an engaging and enjoyable manner. The School Club project has demonstrated how a mix of fun-based knowledge and skills transfer methods and rewarding competitions can change antimicrobial use knowledge and practice in schoolchildren. Full article

(This article belongs to the Proceedings of ESPAUR Report Webinar and Antibiotic Guardian Shared Learning Awards)

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