Antibiotic prescription practices and opinions regarding antimicrobial resistance among veterinarians in Kentucky, USA

Background Inappropriate antimicrobial use (AMU) is a global concern. Opinions of veterinarians regarding AMU and its role in the development of antimicrobial resistance (AMR) may influence their prescription practices. It is important to understand these opinions, prescription practices and their potential impact on the development of AMR in order to guide efforts to curb the problem. Therefore, the objective of this study was to investigate the antimicrobial prescription practices and opinions of veterinarians in Kentucky regarding AMU and AMR. Methods This cross-sectional study used a 30-question survey questionnaire administered to veterinarians who were members of the Kentucky Veterinary Medical Association. Survey responses from 101 participants were included in the study. Descriptive statistics were computed and associations between categorical variables assessed using Chi-square or Fisher’s exact tests. Firth logistic models were used to investigate predictors of “Compliance with prescription policies” and “Cost of antimicrobial affects prescription decisions”. Results Almost all (93%) respondents indicated that improper AMU contributed to selection for AMR. A total of 52% of the respondents believed that antimicrobials were appropriately prescribed, while the remaining 48% believed that antimicrobials were inappropriately prescribed. Significant predictors of compliance with prescription policies were availability of prescription policy at the veterinary facility (Odds Ratio (OR) = 4.2; p<0.001) and over-prescription (OR = 0.35; p = 0.025). Similarly, significant predictors of cost of antimicrobials affecting prescription decisions were lack of post-graduate training (OR = 8.3; p = 0.008) and practice type, with large animal practices having significantly lower odds of the outcome (OR = 0.09; p = 0.004) than small animal practices. Conclusion Most veterinarians indicated that improper AMU contributed to selection for AMR. Since the odds of compliance with prescription policies were 4-times higher among veterinarians working at facilities that had prescription policies compared to those at facilities that didn’t, more veterinary facilities should be encouraged to adopt prescription policies to help improve compliance and reduce AMR. Veterinarians would also benefit from continued professional education to help improve prescription practices, antimicrobial stewardship and curb AMR.

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Common Barriers, Attitudes, and Practices of Veterinary Practitioners Regarding Antimicrobial Resistance and Stewardship in Chattogram, Bangladesh

Open Veterinary Science ◽

10.1515/ovs-2020-0109 ◽

2021 ◽

Vol 2 (1) ◽

pp. 72-80

Author(s):

Md. Sahidur Rahman ◽

Nazifa Rafa

Keyword(s):

Antimicrobial Resistance ◽

Perceived Risk ◽

Categorical Variables ◽

Local Market ◽

Large Animal ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices ◽

Severity Of The Disease ◽

Antimicrobial Treatments

Abstract The perceived risk of antimicrobial-resistant pathogens creates the necessity for understanding the role of the prescriber groups. Hence, we conducted a cross-sectional survey among veterinary practitioners to assess their understanding regarding antimicrobial prescribing and the issue of antimicrobial resistance (AMR) in livestock. We collected responses from 100 veterinarians engaged in the large animal, poultry, and pet animal care practices. Proportions were calculated for categorical variables and the results were visualized. We revealed two key barriers: a lack of enough information and of training on the proper prescription of antimicrobials. Prescribing a wide variety of antimicrobials and doing incomplete courses of antimicrobial treatments were two very important causes pointed out by the respondents for the development of antimicrobial resistance. A number of highest-priority critically important antimicrobials (HP-CIAs) of human health were found to be used by veterinary practitioners. In addition to clinical features like types of organisms and severity of the disease, the availability of drugs in the local market and the economic conditions of farmers have the potential to influence the decisions of veterinarians in prescribing antimicrobials. The professional development of veterinarians and the maintenance of strong coordination are crucial to ensure the proper engagement of veterinarians as the front-line fighters for tackling the AMR issue.

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Common Barriers, Attitudes and Practices of Veterinary Practitioners Regarding Antimicrobial Resistance and Stewardship in Bangladesh

10.20944/preprints202009.0567.v1 ◽

2020 ◽

Author(s):

Md. Sahidur Rahman ◽

Nazifa Rafa

Keyword(s):

Antimicrobial Resistance ◽

Perceived Risk ◽

Categorical Variables ◽

Local Market ◽

Large Animal ◽

Visual Aids ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices

Usage of antimicrobials in veterinary practices has always been under scrutiny due to the perceived risk of resulting in antimicrobial-resistant pathogens. This creates the necessity for understanding the role of the prescriber group. Hence, we conducted a cross-sectional survey among veterinary practitioners from August to November 2019 in the Chattogram district of Bangladesh, aiming to assess the practitioner’s perceptions regarding antimicrobial prescribing and antimicrobial resistance (AMR) issue. We collected responses from 100 veterinarians engaged in the treatment of the large animal, poultry, and pet animal through a self-administrated questionnaire. Proportions were calculated for categorical variables and the results are presented using visual aids. Our study revealed two key barriers - scarcity of enough information on antimicrobial used, and the lack of training in the proper prescription of antimicrobials. Participants recognized that prescribing too many varieties of antimicrobials and the use of an incomplete course of drugs as two very important causes for the development of antimicrobial resistance. In addition, prescription of inappropriate doses and incentives from pharmaceutical companies were dubbed as important causes. We also found that along with clinical features and types of organisms, the availability of drugs in the local market and the economic conditions of farmers have potential impacts on the antimicrobials prescribing decision of the veterinarians. However, all participants recognized the emerging threats of AMR. Results suggested that capacity building of veterinarians and the maintenance of strong coordination are crucial in ensuring the proper engagement of veterinarians as the front-line fighters for tackling the AMR issue.

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Antibiotic prescription practices and attitudes towards the use of antimicrobials among veterinarians in the City of Tshwane, South Africa

PeerJ ◽

10.7717/peerj.10144 ◽

2021 ◽

Vol 9 ◽

pp. e10144

Author(s):

Ronita Samuels ◽

Daniel Nenene Qekwana ◽

James W. Oguttu ◽

Agricola Odoi

Keyword(s):

South Africa ◽

Adverse Reactions ◽

Clinical Signs ◽

Route Of Administration ◽

Categorical Variables ◽

Relative Risk Ratio ◽

Prescription Practices ◽

Improper Use ◽

Selection For ◽

The City

Background Understanding the prescription practices and attitudes of veterinarians towards antimicrobial resistance (AMR) is crucial in guiding efforts to curb AMR. This study investigated prescription practices and attitudes towards AMR among veterinarians in the City of Tshwane, South Africa. Methods Out of the 83 veterinarians invited to participate in the study, 54 signed the consent form and completed the questionnaire. Percentages and 95% confidence intervals of all categorical variables were computed. A multinomial logistic model was used to identify predictors of the veterinarians’ view towards antimicrobial use. Results The majority (88%) of respondents indicated that improper use of antimicrobials contributed to selection for AMR. Veterinarians relied on clinical signs and symptoms (88%, 48/54) to decide whether to prescribe antimicrobials or not. However, the choice of antimicrobials depended on the cost of antibiotics (77.2%), route of administration (81.5%), and risk of potential adverse reactions (79.6%; 43/54). Many (61.5%) veterinarians were of the view that often antimicrobials are appropriately prescribed and 88.7% agreed that improper use of antimicrobials contributed to selection for antimicrobial resistant organisms. Compared to females, males were significantly more likely (Relative Risk Ratio (RRR) = 9.0; P = 0.0069) to agree rather than to “neither agree nor disagree” that their colleagues over-prescribed antimicrobials. Conclusions The decisions to prescribe antimicrobials by the veterinarians depended on clinical presentation of the patient, while the choice of antimicrobial depended on cost, route of administration, and risk of potential adverse reactions. Most veterinarians were of the view that antimicrobials were prescribed judiciously.

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STUDENTS INTEREST IN CONTINUING PROFESSIONAL EDUCATION NURSES IN HEALTH EDUCATION INSTITUTIONS IN BANYUMAS

INDONESIAN NURSING JOURNAL OF EDUCATION AND CLINIC (INJEC) ◽

10.24990/injec.v2i1.3 ◽

2018 ◽

Vol 2 (1) ◽

pp. 14

Author(s):

Rahmaya Nova Handayani ◽

Adiratna Sekarsiwi

Keyword(s):

Nursing Education ◽

Health Education ◽

Support System ◽

Professional Education ◽

Continuing Professional Education ◽

Health Science ◽

Dominant Factor ◽

Student Interest ◽

Cross Sectional ◽

System Method

Introduction. Types of nursing education in Indonesia are vocational, academic and professional. Professional education is higher education after an undergraduate program that prepares students to have jobs with specific skill requirements. The purpose of this study was to identify factors that affect student interest in continuing professional education nurses based on perception, motivation and support system. Method. The study design was a descriptive analytic cross-sectional approach. Unstratified sampling using random sampling with a sample of 111 respondents in health education institutions in karisidenan Banyumas, there are Harapan Bangsa Purwokerto Institute of Health Science, Purwokerto Muhammadiyah University, Jenderal Sudirman University.Data was analysed by using multivariate logistic regression. Results. The results of the study showed that no correlation perception, motivation, and support system of nurses Profession election interest in health education institutions in-karisidenan Banyumas (p=0,999; 0,956; 0,135).Discussion. The most dominant factor affecting the interest of the nurse profession was support system.Keywords: interest, perception, motivation, support system, professional nurses

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Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041882 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1882

Author(s):

Kate Emond ◽

Melanie Bish ◽

Michael Savic ◽

Dan I. Lubman ◽

Terence McCann ◽

...

Keyword(s):

Mental Health ◽

Rural Areas ◽

Cross Sectional Study ◽

Categorical Variables ◽

Considerable Proportion ◽

Sectional Study ◽

Cross Sectional ◽

Health Related ◽

Manage Mental ◽

Manage Mental Health

Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.

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Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications

Antibiotics ◽

10.3390/antibiotics10070866 ◽

2021 ◽

Vol 10 (7) ◽

pp. 866

Author(s):

Iltaf Hussain ◽

Nisa Yousaf ◽

Sana Haider ◽

Pervisha Jalil ◽

Muhammad Usman Saleem ◽

...

Keyword(s):

Antimicrobial Resistance ◽

University Students ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Dosing Regimen ◽

Student Knowledge ◽

Chi Square ◽

Cross Sectional ◽

Self Administered Questionnaire

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

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Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal

Veterinary Sciences ◽

10.3390/vetsci8050070 ◽

2021 ◽

Vol 8 (5) ◽

pp. 70

Author(s):

Rita Baptista ◽

Ryane Englar ◽

Berta São Braz ◽

Rodolfo Oliveira Leal

Keyword(s):

General Practitioners ◽

Healthcare Providers ◽

Small Animal ◽

Cross Sectional Study ◽

Online Forums ◽

Educational Strategies ◽

Cross Sectional ◽

Current Trends ◽

Therapeutic Value

In both human and veterinary healthcare, gastrointestinal protectants (GIPs) are considered a staple of clinical practice in that they are prescribed by general practitioners (GPs) and specialists alike. Concerning GIP use, overprescription of proton pump inhibitors (PPIs) has become a growing concern among human healthcare providers. This trend has also been documented within veterinary practice, prompting the American College of Veterinary Internal Medicine (ACVIM) to publish a consensus statement in 2018 concerning evidence-based indications for GIP use. This observational cross-sectional study evaluated self-reported prescribing protocols among Portuguese GPs to determine whether there is adherence to the consensus guidelines. Respondents were Portuguese GPs recruited by social media posts in veterinarian online forums. Data were collected from 124 respondents concerning their GIPs of choice and their rationales for prescribing them. Data were mined for prescription patterns and protocols. Among GIPs, PPIs were prescribed more often. Rationales for use included gastrointestinal ulceration and erosion (GUE), prophylactic management of nonerosive gastritis, pancreatitis, reflux esophagitis, and steroid-induced ulceration. Once-daily administration of PPIs was the most frequent dosing regime among respondents. Ninety-six percent of PPI prescribers advocated that the drug be administered either shortly before or at mealtime. Forty-nine percent of respondents supported long-term use of PPIs. Fifty-nine percent of respondents acknowledged discontinuing PPIs abruptly. This study supports that Portuguese GPs commonly prescribe GIPs in accordance with ACVIM recommendations to medically manage GUE. However, misuse of GIPs does occur, and they have been prescribed where their therapeutic value is debatable. Educational strategies should target GPs in an effort to reduce GIP misuse.

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Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020060 ◽

2021 ◽

Vol 6 (2) ◽

pp. 60

Author(s):

Jyoti Acharya ◽

Maria Zolfo ◽

Wendemagegn Enbiale ◽

Khine Wut Yee Kyaw ◽

Meika Bhattachan ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Surveillance System ◽

Surveillance Data ◽

World Health ◽

Cross Sectional ◽

Antimicrobial Resistance Surveillance ◽

Data Collection Process ◽

Data Compilation ◽

Site Variation ◽

Health Organization

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019–2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing.

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Epilepsy as a Comorbidity in Polymyositis and Dermatomyositis—A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083983 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3983

Author(s):

Ella Nissan ◽

Abdulla Watad ◽

Arnon D. Cohen ◽

Kassem Sharif ◽

Johnatan Nissan ◽

...

Keyword(s):

Proportional Hazards ◽

Cross Sectional Study ◽

Cox Proportional Hazards ◽

Categorical Variables ◽

Rank Test ◽

Control Group ◽

Multivariable Logistic Regression Analysis ◽

Positive Trend ◽

Continuous Variables ◽

Cross Sectional

Polymyositis (PM) and dermatomyositis (DM) are autoimmune-mediated multisystemic myopathies, characterized mainly by proximal muscle weakness. A connection between epilepsy and PM/DM has not been reported previously. Our study aim is to evaluate this association. A case–control study was conducted, enrolling a total of 12,278 patients with 2085 cases (17.0%) and 10,193 subjects in the control group (83.0%). Student’s t-test was used to evaluate continuous variables, while the chi-square test was applied for the distribution of categorical variables. Log-rank test, Kaplan–Meier curves and multivariate Cox proportional hazards method were performed for the analysis regarding survival. Of the studied 2085 cases, 1475 subjects (70.7%) were diagnosed with DM, and 610 patients (29.3%) with PM. Participants enrolled as cases had a significantly higher rate of epilepsy (n = 48 [2.3%]) as compared to controls (n = 141 [1.4%], p < 0.0005). Using multivariable logistic regression analysis, PM was found only to be significantly associated with epilepsy (OR 2.2 [95%CI 1.36 to 3.55], p = 0.0014), whereas a non-significant positive trend was noted in DM (OR 1.51 [95%CI 0.99 to 2.30], p = 0.0547). Our data suggest that PM is associated with a higher rate of epilepsy compared to controls. Physicians should be aware of this comorbidity in patients with immune-mediated myopathies.

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Association between Short Hours of Sleep and Overweight/Obesity in Mexican Adolescent Population: A School-Based Cross-Sectional Study

Healthcare ◽

10.3390/healthcare9080939 ◽

2021 ◽

Vol 9 (8) ◽

pp. 939

Author(s):

Ana Fresan ◽

Alma Delia Genis-Mendoza ◽

María Lilia López-Narváez ◽

Tania Guadalupe Gómez-Peralta ◽

Daniela Georgina Aguilar-Velázquez ◽

...

Keyword(s):

Cross Sectional Study ◽

The Body ◽

Categorical Variables ◽

Continuous Variables ◽

Sectional Study ◽

Cross Sectional ◽

Obese Adolescent ◽

School Based ◽

Prevalence Of Obesity ◽

Mexican Adolescents

Background/Aim: Obesity in adolescents is increasing; as such, the aim of this study was to determine the prevalence of obesity in Mexican adolescents and examine its possible association with hours of sleep. Methods: A school-based cross-sectional study was carried out. This study included 863 adolescents aged between 11 and 16 years. The prevalence of obesity was estimated using the body mass index (BMI). The duration of sleep (and other information) was assessed by a self-reported questionnaire. The Cochran–Mantel–Hansel test for categorical variables and a general linear model for continuous variables were used to evaluate the interaction effect of BMI and sex with respect to sleeping and assessed activity conditions. Results: It was found that 47.6% of the adolescents were overweight/obese. Men were more frequently overweight/obese than women (52.6% vs. 41.8%, p = 0.002). Moreover, overweight/obese adolescents were younger and spent fewer daily hours watching television (p < 0.05). Men practiced sports more hours per week than women (p = 0.04). However, women spent more daily time on the internet (p = 0.05), and overweight/obese adolescent women slept fewer hours than overweight/obese men and adolescents with normal weight (p = 0.008). Conclusions: The development of strategies for the prevention of overweight/obesity and the improvement of sleep duration should include a gender perspective to improve health habits in Mexican adolescents.

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