General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms intervention (campaign, mass media) and outcomes (antibiotic, antimicrobial resistance). 7References were screened for inclusion by one author with a random subset of 10% screened 8 by a second author. No date restrictions were applied and only articles of English language 9 were considered. Studies had to have a control group or be an interrupted time-series. 10Outcomes had to measure change in antibiotic-related prescribing/consumption and/or the 11 publics' knowledge, attitudes or behaviour. Two reviewers assessed the quality of studies. 12Narrative synthesis was performed.

In many developing countries consumption of animal source foods (ASF) among the poor is still at a level where increasing its share in total caloric intake may have many positive nutritional benefits. This paper explores whether ownership of different livestock species increases consumption of ASF and helps improving child nutritional status, finding some evidence that both food consumption patterns and nutritional outcomes may be affected by livestock ownership in rural Uganda. Our results are suggestive that promoting (small) livestock ownership has the potential for affecting human nutrition in rural Uganda, but further research is needed to more precisely estimate the direction and size of these effects.

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BackgroundHospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors.ObjectivesTo develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics.MethodsA theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development.ResultsA key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions.ConclusionsThe key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.

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Background Antimicrobial resistance poses a major threat to global health. Excessive use of antibiotics accelerates the process of resistance. Interventions to prevent the inappropriate use of antibiotics can be targeted at doctors, patients, and the public. The aim of this systematic review was to identify the components of successful communication interventions targeted at the general public to improve antibiotic use. Methods The databases Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched in July, 2015. The main search terms were related to the population (public, community, population, neighbourhood), intervention (communication, campaign, mass media), and outcomes (antibiotic, antimicrobial resistance). For each search term, synonyms and controlled vocabulary for respective databases were used. Titles, abstracts, and full-text references were screened for inclusion by one author with a random subset of 10% screened by a second author. No date restrictions were applied, and only articles in English were considered. Studies had to have a control group or be an interrupted time-series with interventions targeted at the general public. Outcomes had to measure change in antibiotic-related prescribing or consumption, knowledge, attitudes, or behaviour. Two reviewers assessed the quality of studies. Narrative synthesis was performed. Findings 14 studies were included with an estimated 74-75 million participants. Most studies were conducted in the USA or Europe, used mass media, targeted both the general public and clinicians, and measured changes in antibiotic prescribing. There was quite strong (p<0•05 to ≥0•01) to very strong (p<0•001) evidence that interventions conducted on a national, community, and household level that targeted antibiotic prescribing for respiratory tract infections could achieve substantial reductions in antibiotic prescribing. The largest change in antibiotic prescribing was a 30% reduction. Insuffi cient studies were available to distinguish the separate components of interventions. No studies of high quality were identifi ed.

In many developing countries consumption of animal source foods (ASF) among the poor is still at a level where increasing its share in total caloric intake may have many positive nutritional benefits. This paper explores whether ownership of different livestock species increases consumption of ASF and helps improving child nutritional status, finding some evidence that both food consumption patterns and nutritional outcomes may be affected by livestock ownership in rural Uganda. Our results are suggestive that promoting (small) livestock ownership has the potential for affecting human nutrition in rural Uganda, but further research is needed to more precisely estimate the direction and size of these effects.

Background: Deciding whether to discontinue antibiotics at early review is a cornerstone of hospital antimicrobial stewardship practice worldwide. In England, this approach is described in government guidance ('Start Smart then Focus'). However, < 10% of hospital antibiotic prescriptions are discontinued at review, despite evidence that 20-30% could be discontinued safely. We aimed to quantify the relative importance of factors influencing prescriber decision-making at review. Methods: We conducted an online choice experiment, a survey method to elicit preferences. Acute/general hospital prescribers in England were asked if they would continue or discontinue antibiotic treatment in 15 hypothetical scenarios. Scenarios were described according to six attributes, including patients' presenting symptoms and whether discontinuation would conflict with local prescribing guidelines. Respondents' choices were analysed using conditional logistic regression. Results: One hundred respondents completed the survey. Respondents were more likely to continue antibiotics when discontinuation would 'strongly conflict' with local guidelines (average marginal effect (AME) on the probability of continuing + 0.194 (p < 0.001)), when presenting symptoms more clearly indicated antibiotics (AME of urinary tract infection symptoms + 0.173 (p < 0.001) versus unclear symptoms) and when patients had severe frailty/ comorbidities (AME = + 0.101 (p < 0.001)). Respondents were less likely to continue antibiotics when under no external pressure to continue (AME = − 0.101 (p < 0.001)). Decisions were also influenced by the risks to patient health of continuing/discontinuing antibiotic treatment. Conclusions: Guidelines that conflict with antibiotic discontinuation (e.g. pre-specify fixed durations) may discourage safe discontinuation at review. In contrast, guidelines conditional on patient factors/treatment response could help hospital prescribers discontinue antibiotics if diagnostic information suggesting they are no longer needed is available.