No abstract

SummaryBackgroundUnnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners (GPs) in England.MethodsIn this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England's Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed.FindingsBetween Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105).InterpretationSocial norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes.FundingPublic Health England.

No abstract

No abstract

No abstract

Antibiotics underpin all of modern medicine, from routine major surgery through to caesarean sections and modern cancer therapies. These drugs have revolutionized how we practice medicine, but we are in a constant evolutionary battle to evade microbial resistance and this has become a major global public health problem. We have overused and misused these essential medicines both in the human and animal health sectors and this threatens the effectiveness of antimicrobials for future generations. We can only address the threat of antimicrobial resistance (AMR) through international collaboration across human and animal health sectors integrating social, economic and behavioural factors. Our global organizations are rising to the challenge with the recent World Health Assembly resolution on AMR and development of the Global Action plan but we must act now to avoid a return to a pre-antibiotic era.

Globally, the USA has recorded the highest number of COVID-19 cases and deaths, 1 and still needs to simultaneously respond to another looming potential pandemic. The rise in multidrug-resistant bacterial infections that are undetected, undiagnosed, and increasingly untreatable threatens the health of people in the USA and globally. In 2020 and beyond, we cannot afford to ignore antimicrobial resistance (AMR). Bacterial infections unsuccessfully treated due to AMR claim at least 700 000 lives per year worldwide and are Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election These emergencies arise in the context of the larger global climate emergency. According to the Intergovernmental Panel on Climate Change, the window for reductions in greenhouse gas emissions to avoid catastrophic climate change is rapidly closing. 22 Similarly, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services warns that there is only a short time to act on threats to biodiversity. 23 Continued reliance on fossil fuels, destruction of ecosystems, dissemination of persistent toxic chemicals, and other environmental depredations-many of them permitted, if not promoted, during the Trump presidency-are incon sistent with a healthy future for humanity. The alternative is a transition to ways of living that protect both natural systems and the health of current and future generations. This path requires new approaches to generating energy, producing and consuming food, chemicals, and other manufactured goods, travelling, and designing and building cities. The vast public investments some governments are making during the COVID-19 pandemic could spur this transition, 24 and US leadership could be catalytic. The outcome of the US election will have far-reaching consequences for planetary health.

This study examined the frequency and severity of sickle related pain, its impact on quality of life, and methods of coping for 25 children with sickle cell disease, aged 6-16 years. Subjects were matched with non-affected peers and asked to complete the Central Middlesex Hospital Children's Health Diary for four weeks.Results indicated that sickle pain occurred on average one in 14 days, and total summary pain scores indicated significantly greater pain than for controls. Children with sickle cell disease could discriminate sickle pain and did not adopt sick role responses to ordinary childhood ailments. Nearly all sickle pain was dealt with at home. Sickle pain resulted in over seven times increased risk ofnot attending school and was highly disruptive of social and recreational activities.Careful assessment of sickle pain in the home environment is an essential part ofa community focused pain management service, which effectively supports children's resilience and improves their quality of life.