Stewardship Concepts Research Articles

Knowledge, attitude, and practice about antimicrobial stewardship concepts among practitioners

Knowledge, attitude, and practice about antimicrobial stewardship concepts among practitioners

Knowledge and Perceptions of Antimicrobial Stewardship Concepts Among Final Year Veterinary Students in South Africa.

Antimicrobial resistance (AMR) has become a major global public health crisis due to inappropriate use in humans, animals, and crops. Studies to assess the knowledge and perceptions of antimicrobial stewardship (AMS) practices among medical and health care professionals have been conducted, yet this is the first among veterinary students in South Africa. A descriptive study surveyed 147 final year veterinary students at the Faculty of Veterinary Science, University of Pretoria. Of these, 102 completed the questionnaire (69% response rate). Most stated they knew what AMS was, while a minority heard of it for the first time. A small number understood poor hand washing could contribute to AMR. Almost a quarter of students stated their AMS knowledge was poor, and most noted a need for more training. The BVSc curriculum should include more material on AMS and AMR to bridge training gaps.

Antibiotics Knowledge, Usage, and Prescription Patterns Among Dental Practitioners in Hyderabad, South India.

Antimicrobial resistance is a pertinent issue in the healthcare sector, accounting for 1.27 million patient deaths worldwide. Dental practitioners account for 3% to 11% of total antibiotic prescriptions. Therefore, this study aimed to specifically assess their knowledge of antibiotic prescriptions, guidelines, and clinical practices. Before conducting this knowledge, attitude, and practice (KAP) survey, study approval was obtained from the Scientific Review Board of Saveetha Dental College and Hospitals, Chennai, India. A total of 200 participants were randomly selected from the list of Indian Dental Association (Hyderabad chapter), and dental colleges, dental conferences, and peer suggestions. We received a total of 130 responses by the end of the survey. The survey revealed gaps in practitioners' KAP. Of those surveyed, 83 (63.85%) of the practitioners kept themselves updated about antibiotic guidelines and news, but many (94, 72.31%) were unaware of the WHO's access, watch, reserve (AWaRe) and antimicrobial stewardship concepts (103, 79.23%). A total of 111 (85.38%) practitioners considered cross-reactions with other medications, yet only 28 (21.5%) practitioners tested patients for antibiotic sensitivity. While 64 (49.23%) practitioners encountered patients who did not respond to antibiotics, 84 (64.62%) practitioners encountered patients who demanded antibiotics. This study highlights the lack of awareness about the WHO's AWaRe classification and antimicrobial stewardship among the majority of dental practitioners across Hyderabad. Misuse or overuse of antibiotics was indicated in this survey by both patients and dental practitioners. Prioritizing updates on antibiotic knowledge and guidelines and awareness of their use is important. It is essential to educate patients about the ill effects of self-prescribing antibiotics. Dental practitioners need to consider cross-reactions and antibiotic-sensitivity testing before prescribing antibiotics. Labeling the sensitivity of a particular antibiotic for specific microbes on packaging can help reduce misuse and the use of antibiotics for the wrong indications.

1302. Interactive Case-based Antimicrobial Stewardship Education Program to Pharmacists at a Large Community Health System

Abstract Background Education on antimicrobial stewardship (AMS) is one of the several elements outlined by the Center for Disease Control for hospital antibiotic stewardship programs. However, the Infectious Diseases Society of America guideline on implementing antimicrobial stewardship notes that passive education should not be a sole method for training as the effects are often short lived. AMS education strategies beyond didactic lectures and written material distribution are needed. We sought to describe the implementation of an interactive, case-based AMS educational program targeting pharmacists across a multi-hospital community health system licensed for over 1,500 beds. Methods Each month, a custom patient case was drafted by an infectious diseases trained pharmacist to highlight a common AMS principle encountered in practice. These topics were broadly categorized into appropriate empiric antibiotic selection, treatment plan modification, and identification of non-infectious clinical syndromes. A specific question with multiple choice answers was drafted. The case was disseminated to all hospital pharmacists via email using Microsoft Outlook. Pharmacists were prompted to use the voting buttons to select the correct answer (Figure 1). After a week, results of the survey was shared with the entire pharmacist staff along with information on the primary teaching point and detailed explanations for why each answer was correct or incorrect. Example Voting Buttons for Case-Based Education Results A total of eleven AMS cases were disseminated to 88 hospital pharmacists involved with direct patient care. Average number of responses per case was 27 (31%), range 17-41 (19%-47%). Average number of correct responses for each case was 74%, range 26%-100%. The highest rates of correct responses came from cases focusing on empiric antibiotic selection (87%), followed by identification of non-infectious clinical syndromes (73%). The lowest rate of correct responses were found with treatment plan modification cases (65%). Conclusion This case-based AMS education program leveraged existing technology to provide engagement across a large and geographically diverse pharmacist staff, provide opportunity to apply stewardship concepts, and assess staff pharmacist knowledge on general AMS principles. Disclosures Matthew Song, PharmD, BCIDP, Merck: Stocks/Bonds|ObsEva: Stocks/Bonds.

Investigating Knowledge of Antibiotics, Antimicrobial Resistance and Antimicrobial Stewardship Concepts Among Final Year Undergraduate Pharmacy Students in Northern Nigeria.

Well trained, knowledgeable and competent pharmacists are indispensable in the fight against antimicrobial resistance (AMR), which is a current global public health problem. The aim of this work was to assess knowledge of antibiotics, antimicrobial resistance and antimicrobial stewardship of fifth year pharmacy students at three universities in Northern Nigeria. A descriptive cross-sectional study that used a paper-based questionnaire to collect data from July to September 2021 was conducted. The questionnaire was self-administered and divided into four sections. The first section collected information about the demographic data of respondents, while section B explored their knowledge of antibiotics and AMR. Section C contained six questions assessing knowledge of various aspects of antimicrobial stewardship (AMS), while the final part assessed respondents' preparedness to work with antibiotics and perceptions of their current knowledge of these concepts. Descriptive statistics were used to report the results obtained. A total of 164 questionnaires were retrieved. Majority of respondents were male (58.3%) and aged between 21 and 25 years (53.4%). Most of them had some knowledge of antibiotics and AMR, however several misconceptions with respect to these concepts were identified. Only 80 (48.8%) of respondents indicated that they knew what AMS was, although most of these students were correctly knowledgeable about the goals and scope of AMS and composition of the AMS team. Generally, less than half of respondents agreed that their current knowledge of antibiotics, AMR or AMS was adequate for their future careers, and over 90% of them agreed that they would like more education about these topics. Many of the study's' respondents were somewhat knowledgeable about these concepts, although several knowledge gaps were also observed. Improving undergraduate pharmacy education with respect to these concepts is recommended.

Implementation of antibiotic stewardship programmes in paediatric patients in regional referral hospitals in Tanzania: experience from prescribers and dispensers

In 2017, Tanzania launched the National Action Plan for Antimicrobial Resistance (NAPAR), 2017-2022 and implementation of antibiotic stewardship programmes (ASPs) was one of the agendas. Since the launch of the National Action Plan, no study has been done to assess its implementation. To explore the experiences of prescribers and dispensers on implementing ASPs among paediatric patients attending Regional Referral Hospitals (RRHs) in Tanzania. An exploratory qualitative study was conducted among key informants, in 14 RRHs in Tanzania between July and August 2020. A total of 28 key informants, 14 dispensers in charge of pharmacies and 14 medical doctors in charge of paediatric departments (prescribers), were interviewed. A hybrid thematic analysis was conducted on the gathered information. Most of the study participants were not conversant with the term 'antibiotic stewardship'. Some had heard about the programmes but were not aware of the activities involved in the programme. Those who were knowledgeable on ASPs mentioned the lack of existence of such programmes in their settings. They further added that absence or limited knowledge of the stewardship concepts may have influenced the current poor practices. Barriers to the implementation of ASPs mentioned were lack of laboratory facilities to support culture and susceptibility tests, lack of materials and reagents, management pressure to prevent loss or to generate income, patients' influence and limited training opportunities. Despite launching the NAPAR in 2017, we found limited implementation of ASPs in the management of paediatric patients. This study highlighted some barriers and identified possible intervention points.

The valued coexistence of protection motivation and stewardship in information security behaviors

Organizations need to consider different managerial approaches to motivate security compliance behavior as more employees work outside of the office. This study examines two approaches for motivating security compliance behaviors in a changing work environment. We examine protection motivation and stewardship-based strategic approaches to determine their effectiveness towards influencing information security behaviors. Independently, each approach has received demonstrable evidence of contributing to organizational behaviors. However, as the nature of work changes (e.g., hoteling, traveling, working from home), it also changes the security risk landscape for organizations, rendering the effectiveness of previous security controls debatable. This study contends there is value to management in integrating both protection motivation and stewardship approaches in this context. A research model is developed that integrates both approaches; protection motivation and stewardship concepts. We find that constructs consistent with protection motivation theory are more likely to explain decreases in security policy violations than stewardship theory. Further, by combining protection motivation and stewardship perspectives, this study's results supplement our understanding of security policy violations in a changing work environment. We show that the two together account for 51 percent of the variance, and thus both have value. Our findings suggest that a PMT-based strategy is a stronger approach for influencing compliance behavior. Therefore, it is important for organizations to continue focusing their efforts on threat communications as well as enhancing employees’ abilities to respond. However, we also show that organizations should build a sense of belonging with their employees such that their employees become stewards of the organization's resources.

Aligning Patient Safety and Stewardship: A Harm Reduction Strategy for Children.

Purpose of reviewReview important patient safety and stewardship concepts and use clinical examples to describe how they align to improve patient outcomes and reduce harm for children.Recent findingsCurrent evidence indicates that healthcare overuse is substantial. Unnecessary care leads to avoidable adverse events, anxiety and distress, and financial toxicity. Increases in antimicrobial resistance, venous thromboembolism, radiation exposure, and healthcare costs are examples of patient harm associated with a lack of stewardship. Studies indicate that many tools can increase standardization of care, improve resource utilization, and enhance safety culture to better align safety and stewardship.SummaryThe principles of stewardship and parsimonious care can improve patient safety for children.

Resident Physician Prescribing Variability Demonstrates Need for Antimicrobial Stewardship in Continuity Clinic: A Pilot Study.

Inappropriate antimicrobial use is common in the outpatient setting but often goes unaddressed by stewardship education. Residents might benefit from directed stewardship education. We conducted a needs assessment of resident knowledge, attitudes, and behaviors regarding antibiotic use and stewardship in outpatient continuity clinics. Internal medicine (IM) residents with continuity clinic at Minneapolis Veterans Affairs Health Care System were eligible. Antimicrobial prescriptions and number of visits were extracted from the Computerized Patient Record System (July 1, 2017-March 31, 2018). Antimicrobial rate (prescriptions per 1000 visits) was calculated for each resident. Results from a resident survey that included demographics, attitudes, and case-based multiple-choice knowledge questions were linked by unique identifier to antimicrobial rate. Prescription and visit data were available for 37 residents. Mean monthly antimicrobial rate was 51 prescriptions per 1000 visits (range 8-239). Surveys were completed by 19 residents (51%). Respondents were 32% female, 32% interns, and 11% international medical graduates. An online resource was most commonly used for prescribing guidance, whereas lectures and small group sessions for residents were rated as the most helpful educational modalities. Many respondents reported being unprepared to perform basic tasks related to antimicrobial stewardship. Median percentage correct was 57% of case-based knowledge questions (interquartile range 50%-71%). Antimicrobial rates among IM residents at a VA outpatient continuity clinic are low and vary by provider. Residents agree with key antimicrobial stewardship concepts but lack preparation in tasks related to antimicrobial stewardship. Knowledge regarding antimicrobial prescribing was low.

Greening the office: Saving resources, saving money, and educating our patients.

ObjectiveDermatologists can benefit from adopting environmental sustainability in the management of their practices. We can also use opportunities to share best practices in environmental stewardship concepts with our colleagues, patients, and communities. Herein, we review easy steps for any health care professional, and dermatologists in particular, to adopt environmental sustainability and become more active in the fight against climate change.MethodsThis study included a select literature review, an identification of resources, and an overview of MyGreenDoctor.org.ResultsMany simple, cost effective, energy saving resources were identified. A reference list of climate change resources for health are organizations to help with lower their carbon footprints, educating their staff and patients, and advocacy for better environmental stewardship is presented.ConclusionGoing green is an easy process that can save money, boost morale, and help educate patients while reducing the carbon footprint of any size medical practice.

A cross-sectional survey of knowledge, perceptions and practice of antimicrobial stewardship concepts among university non-health professional undergraduate students in southwest Nigeria

Background: Non-health professional students (NHPS) can be a veritable tool in the advocacy for antimicrobial stewardship in a community if imbued with adequate knowledge and correct perceptions. However, little is known about the knowledge, perceptions, and practice (KPP) of antimicrobial stewardship among NHPS.Objective: This study aimed to evaluate the KPP of antimicrobial stewardship among NHPS.Methods: A cross-sectional survey of KPP of antimicrobial stewardship was carried out among 600 consecutively selected NHPS at Olabisi Onabanjo University, Nigeria, using a pretested 30-item self-administered questionnaire with varying options and a 5-point Likert scale. Each correct answer in the knowledge domain was scored “1” and incorrect “0” and a total of eleven points were available. The modified Bloom’s cut-off points were used to grade the knowledge into good (≥9 points), moderate (7-8 points) and poor (≤6 points). The Kruskal-Wallis test was used to assess the differences in perceptions among the groups.Results: Many of the respondents (319;53.2%) were male, 274 (45.7%) had used antimicrobials without advice from physicians or pharmacists. The respondents (387; 64.5%) scored ≤ 6.0 of the total 11.0 on the knowledge scale and 430 (71.7%) with a significant difference between faculties (p<0.001) strongly agreed or agreed that “everyone needs to take responsibility for using antimicrobials responsibly”.Conclusions: Many of the non-health professional students had poor knowledge of antimicrobial stewardship and had practices that are antithetical to the concept. However, the majority perceived correctly, that appropriate use of antimicrobials was a collective responsibility.Keywords: Antimicrobial; stewardship; non-health professional; knowledge; Nigeria

Teaching Laboratory Stewardship in the Medical Student Core Clerkships Pathology-Teaches.

Current health care spending is unsustainable, and there is a need to teach high-value care principles to future physicians. Pathology-Teaches is an educational intervention designed to teach laboratory stewardship early in clinical training, at the level of the medical student in their core clinical clerkships. To assess the pilot implementation of case-based educational modules in 5 required core clerkships at our institution. The online cases were developed by using a multidisciplinary approach. In the Pathology-Teaches educational module, students make decisions regarding the ordering or interpretation of laboratory testing within the context of a clinical scenario and receive immediate feedback during the case. The intervention was assessed by using pretest and posttest. Student feedback was also collected from end-of-rotation evaluations. A total of 203 students completed the Pathology-Teaches pilot, including 72 in Family Medicine, 72 in Emergency Medicine, 24 in Internal Medicine, 24 in Neurology, and 11 in Obstetrics-Gynecology (OB-GYN). Pathology-Teaches utility was demonstrated by significantly increased improvement between pretest and posttest scores (mean, 63.1% versus 83.5%; P < .001; Hedge g effect size = 0.93). Of the 494 students who completed the Pathology-Teaches questions on the end-of-rotation evaluation, 251 provided specific feedback, with 38.6% (97 of 251) rating the activity as "extremely valuable" or "very valuable," and 41.4% (104 of 251) as "some/moderate value." Qualitative feedback included 17 positive comments with 6 requests to scale up or include more cases, 16 constructive comments for improvement mainly regarding the technical aspects, and 5 negative comments. Pathology-Teaches effectively teaches stewardship concepts, and most students perceived value in this educational intervention.

Diversity of Shareholder Stewardship in Asia: Faux Convergence

Since the UK adopted the world’s first stewardship code in 2010, stewardship codes have proliferated across Asia. Given the UK Code’s prominence, it is tempting to assume that every other stewardship code preforms the same function as the UK Code. This assumption belies the truth: all these codes – regardless of whether they have in fact drawn inspiration from the UK Code – have taken different trajectories due to each adopting jurisdiction’s distinctive institutional and legal context. Using empirical evidence and in-depth case studies of stewardship in Japan and Singapore, this article reveals how any reception of UK-style stewardship concepts is only skin-deep. Even where the text of stewardship codes in Asia resemble the UK Code in form, their functional impact on corporate governance significantly depart from, or even run counter to, the intended functions of the UK Code. The article illustrates how stewardship codes in Asia have been used as a convenient vehicle for local governments and/or market players to achieve their own particular interests through an inexpensive, non-binding, and malleable vehicle, the formal adoption of which sends a signal of “good corporate governance” to the rest of the world. While such practices explain and contextualize the widespread adoption of stewardship codes in Asia, they also compound the challenge of drawing positive or normative conclusions from this development. The observation advanced in this article is important as leading corporate governance scholars, prominent international organizations, and market participants, have appeared content to draw such conclusions unaware that stewardship codes generally do not fulfill a similar function to the UK Code in Asia. The article concludes by explaining how adopting globally recognized mechanisms of “good corporate governance” at a superficial formal level, and then altering their function to serve local purposes, appears to be a rising trend in corporate governance in Asia (and elsewhere). This phenomenon, which we coin “faux convergence”, calls for the re-examination of important and impactful theories about corporate governance convergence. As an initial foray, this article develops an expanded taxonomy of corporate governance convergence and lays the foundation for future research on “faux convergence”.

P046: A quality improvement initiative for improving integration of resource stewardship concepts into undergraduate medical education

Introduction: It is estimated that up to 30% of medical services in Canada are potentially unnecessary, not supported by current evidence or may cause patient harm. This type of practice negatively impacts patients and the healthcare system. Evidence suggests that medical education strongly impacts resource utilization in future practice. Our objective was to integrate Choosing Wisely (CW) recommendations into the undergraduate medical education curriculum to improve students understanding of resource stewardship in their pre-clerkship training. Methods: Post-course survey data and written feedback were collected from the Cumming School of Medicines 2019 class. Qualitative analysis of written feedback was used to identify perceived strengths and areas of improvement to inform additional changes for the 2020 class through a Plan-Do-Study-Act (PDSA) cycle. Results: The post-course survey was completed by 143 students. 60% reported the inclusion of CW improved their ability to develop a clinical management plan. Using the information gathered from the qualitative analysis, we made the following changes for the 2020 class: create an introductory lecture on resource stewardship, incorporate relevant CW recommendations into case study learning objectives, and create standardized slides on CW recommendations for lecturers. Feedback from the 2020 class revealed that the changes were well received and students reported feeling more comfortable with resource stewardship concepts. Conclusion: This data reveals that our efforts have increased students confidence in creating a management plan that integrates resource stewardship and patient safety, and elicited strong faculty support. We will continue to integrate these changes and to obtain student and faculty feedback to help inform additional iterative changes for the subsequent cohort. Our findings are valuable for other medical schools across Canada seeking to incorporate CW material.

Knowledge and perceptions of antimicrobial stewardship concepts among final year pharmacy students in pharmacy schools across South Africa

Background: Antimicrobial stewardship is currently not mandatory as part of the undergraduate training of pharmacists. Identifying gaps in knowledge and a better understanding of pharmacy students’ perceptions about antimicrobial stewardship could assist in recommendations for appropriate changes to the pharmacy degree curricula that may lead to more appropriate use of antimicrobials, within the multi-disciplinary team.Methods: A descriptive quantitative study with a survey design was conducted at the eight universities offering the pharmacy degree in South Africa. An electronic questionnaire with four main categories on antimicrobial stewardship was administered to final (fourth) year pharmacy students (June–August 2015).Results: An overall response rate of 26.6% (n = 260) was obtained from 978 students, despite a weekly reminder. Most of the respondents were familiar with antimicrobial stewardship programmes in South Africa (71.9%), and claimed to know what antimicrobial stewardship is (83.5%) with significant differences between the universities (p 0.001). Only 37.7% of the respondents recalled having had formal training on antimicrobial stewardship, with responses from the eight universities differing significantly (p 0.001). However, almost all respondents (98.5%) felt that a strong knowledge of antimicrobials was important for their future career, with 90.0% indicating that they would like more training on antimicrobial stewardship at undergraduate level.Conclusion: There were significant differences between the eight universities with regards to undergraduate education on antimicrobial stewardship. In order to help prevent antimicrobial resistance, efforts should be made to introduce concepts of antimicrobial stewardship into the undergraduate pharmacy curricula to promote better use of antimicrobials and prevent antimicrobial resistance.

Knowledge and perceptions of antimicrobial stewardship concepts among final year pharmacy students in pharmacy schools across South Africa

Background: Antimicrobial stewardship is currently not mandatory as part of the undergraduate training of pharmacists. Identifying gaps in knowledge and a better understanding of pharmacy students’ perceptions about antimicrobial stewardship could assist in recommendations for appropriate changes to the pharmacy degree curricula that may lead to more appropriate use of antimicrobials, within the multi-disciplinary team.Methods: A descriptive quantitative study with a survey design was conducted at the eight universities offering the pharmacy degree in South Africa. An electronic questionnaire with four main categories on antimicrobial stewardship was administered to final (fourth) year pharmacy students (June–August 2015).Results: An overall response rate of 26.6% (n = 260) was obtained from 978 students, despite a weekly reminder. Most of the respondents were familiar with antimicrobial stewardship programmes in South Africa (71.9%), and claimed to know what antimicrobial stewardship is (83.5%) with sign...

Current strategies against multi-drug resistant organisms

The global spread of multi-drug resistant organisms (MDRO) is a major threat to public health. Fighting MDRO spread requires a multi-faceted approach as summarized in the German Antibiotic Resistance Strategy (DART). In the hospital, this includes antibiotic stewardship concepts and strict infection control measures. Treatment of MDRO is sophisticated. Within the last years, several antibiotics with activity against MRSA were launched and facilitate an individual therapy according to site of infection and co-morbidities. In contrast, novel antibiotics against carbapenemase producing Gram-negatives are still lacking. Current studies have shown, that a colistin-based combination treatment can improve the prognosis in these patients. The following article reviews MDRO definitions, burden of disease, treatment options and general strategies against MDRO.

Is Fluconazole or an Echinocandin the Agent of Choice for Candidemia

Candidemia is among the most common nosocomial bloodstream infections and is associated with high mortality, increased length of hospital stay, and significant economic burden. The introduction of the echinocandins in the 2000s has expanded the armamentarium against Candida spp and provides therapeutic options that are effective, safe, and tolerable. Although the Infectious Diseases Society of America favors echinocandins as treatment for candidemia in selected settings (at least as initial therapy), there remain divergent opinions about whether an echinocandin or fluconazole is the preferred agent for candidemia, and clinical practice guidelines are in flux. In this review, the currently available laboratory and clinical data are summarized and critically evaluated. A MEDLINE search of the English language literature was performed using the search terms echinocandin, fluconazole, and candidemia. References of review articles and guidelines were also screened for inclusion. Studies whose primary goal was to compare echinocandins with fluconazole were evaluated as well as studies that differentiated pharmacological and pharmacokinetic properties between agents. It is clear that echinocandins and fluconazole each have roles in the management of candidemia. Specific recommendations are provided that will hopefully optimize outcomes in candidemia while incorporating stewardship concepts of cost-effectiveness and limiting the emergence of resistance. Despite the advantages brought by the echinocandins and fluconazole, outcomes among patients with candidemia remain suboptimal. Improved treatment of candidemia may ultimately be achieved by optimizing the use of antifungal agents rather than the development of new drugs.

Comparative impact of an antibiotic stewardship program among different departments at the Tel Aviv Medical Center, Israel

Background: Escalating antimicrobial resistance has created the need for multidisciplinary antibiotic stewardship programs (ABS). South Africa lacks infectious diseases trained clinical pharmacists. Netcare LinksfieldHospital ABS participated in a global mentoring programwith infectious diseases (ID) pharmacists from TheOhio StateUniversityWexnerMedical Center stewardship programme in the United States. One of the goals was to develop educational tools to teach general stewardship concepts to non-ID trainedpharmacists atNetcare LinksfieldHospital.Historically, severalattempts have been tried using traditionalmethods of teaching with limited success and engagement by the pharmacists. The purpose of this project was to develop a non-traditional educational ABS tool thatwouldengage thepharmacist and improve their infectious diseases knowledge. Methods M A Guide to Antibiotic Stewardship”. The document teaches why ABS is necessary, describes the most common gram positive, gram negative, anaerobic and atypical organisms, which antibiotics are used to treat these organisms, and clinical pearls specific to the hospital. The final pages provide all antibiotics and antifungals available in South Africa, their route of administration and spectrumof activity. Learning outcome was measured by a pre/post quiz. The pharmacists were instructed to take the quiz without any preparation. A week later the comic book was given to each pharmacist and the concepts were taught by the clinical pharmacist who completed the OSUWMC mentoring program. A post-test was then administered in addition to a satisfaction survey. Statistical analysis was done using the t-test Results: PharmacistsID knowledge of ABS significantly improved after using the comic book to learn ABS. (the mean of the pre-tests 66% vs. the mean of the post-test 96% p=0.0001). The satisfaction survey showed 100% of pharmacist responded favorably to this method of learning. Conclusion: The Comic Life app provides a novel method of teaching ABS to pharmacists. Further topics on antibiotic stewardship will be developed and taught using this method. Due to the success of this teaching method the comic book will be usedin all 54 Netcare hospitals to improve the ID knowledge of pharmacist.

Fluorescent lamp recycling initiatives in the United States and a recycling proposal based on extended producer responsibility and product stewardship concepts

This paper presents an overview of mercury-containing lamp (MCL) recycling initiatives currently available in the world, especially in the United States. The majority of MCLs contain mercury which is a neurotoxin, a persistent pollutant in the environment, and can bioaccumulate in the food chain. Although there are some recycling options in the United States, collection rates are still at 23% of all potential used MCLs. This shows that citizens are either indifferent to or unaware of the recycling alternatives. On the other hand, MCL recycling seems not to be a cost-effective process and, for this reason, in the United States, take-back programmes are still sponsored only by consumers or municipalities. A few retailers have recently initiated limited take-back alternatives and manufacturers have not yet supported financially any consistent recycling alternative in the country. Considering successful experiences, this paper makes a suggestion for an MCL recycling system based on the concepts of extended producer responsibility and product stewardship. A manufacturer-importer advance recycling fee is proposed to finance the collection and recycling system while a MCL-energy recycling fee supported by the energy sector creates a lamp refund process. 'PRO Lamp', a producer responsibility organization, will manage the entire system through a widespread public-private agreement.