Little is known about implementation of antimicrobial stewardship (AMS) programs in retirement homes, a setting with an older adult population which is at increased risk of antibiotic-related harm. This study evaluated a pharmacist-led prospective audit and feedback (PAF) pilot program in retirement homes.

This quasi-experimental study evaluated antibiotic use in 9 intervention homes and 396 control homes from June 2022 to May 2023 (baseline period), compared to June 2023 to December 2024 (intervention period). PAF was conducted remotely by long-term care pharmacists; recommendations were provided to the prescriber via fax. The primary outcome was antibiotic days of therapy (DOT) per 1000 resident-days. Determinants to implementation were gathered from participating pharmacists and mapped to the Theoretical Domains Framework.

During the intervention, of 794 antibiotic assessments, 89 recommendations were made and 27 (30%) were accepted. Total antibiotic use measured in DOT per 1,000 resident days in intervention homes was similar before and after PAF (54.0 before vs. 57.9 after). Similarly, usage in the control group was relatively stable (49.0 before vs. 51.6 after) (DiD Analysis: +2.4 DOT/1,000 resident days, 95% CI −7.8, 12.3). Barriers to PAF implementation included communication challenges (communication via fax) and limited clinical information (lack of indication on prescription). Facilitators included organizational support and pharmacist motivation.

While this pilot had limited uptake and was not associated with a change in antibiotic use, it highlighted important barriers and facilitators for AMS in retirement homes. This initiative strengthened local capabilities for antibiotic use surveillance to support future AMS interventions.

Considering the significant impact of communication skills on healthcare outcomes, effective communication is essential in delivering dietetic care. However, traditional methods of feedback to students on their communications skills may not fully capture non-verbal or empathic dimensions of interaction(1). Video-based feedback has demonstrated value in healthcare training(2). It is essential to understand how different types of video feedback are received and how the integration of video recording technology is perceived as affecting consultation simulation activities. Point-of-view technology are high-quality hands-free devices that record user perspective video. This research aimed to explore student and actor perceptions and experiences of using point-of-view (POV) technology in simulations and subsequent POV video-feedback processes.

Students participated in simulated communication with a patient actor while wearing POV technology during the consultation and could then re-watch their consultation. This multi-method qualitative study used in-person focus groups with first-year MSc Dietetics students who had used POV devices in a simulated consultation and/or an assessment, and semi-structured online interviews with simulated patient actors who had worn the devices. They were conducted in March 2025. Focus groups and interviews were facilitated by trained researchers with no prior relationship with the students or patient actors, transcribed and analysed using Braun and Clarke’s six-phase inductive thematic analysis in NVivo(3). Ethical approval was received from King’s College London (LRS/DP-24/25-46586; MRA-24/25-48479).

17 students across three focus groups and 5 patient actors participated. Overlapping and distinct perspectives from students and actors were generated across five themes. 1) Appropriateness and fit for learning context: students valued the immersive perspective of POV recordings over conventional room-based recording method, enhancing relevance for dietetic practice. 2) Technical and usability issues: both groups reported challenges with device comfort, stability, and camera angle, although actors generally found the device soon “just became part of the role.” 3) Reflective learning value: recordings were viewed as enhanced reflection and were particularly beneficial for developing awareness of non-verbal behaviours such as body language, empathy, and patient-centred communication. 4) Authenticity of simulation: actors reported minimal disruption to role-play, though some noted increased student self-consciousness. 5) Implementation considerations: both groups recommended structured orientation, ergonomic refinements, and clear guidance on data use to optimise acceptability and sustainability.

This study demonstrates that POV video feedback is a feasible and pedagogically valuable approach for enhancing communication skills in dietetics education. Dual student and patient actor’s perspectives capture relational and non-verbal elements often overlooked in traditional feedback approaches, supporting students’ self-reflection and empathy development. However, technical and ergonomic refinements, alongside early integration and clear data governance, are essential for wider adoption. The findings contribute novel insights into simulation-based dietetic education and highlight POV technology as a promising approach for strengthening communication skill training prior to clinical placements.

To synthesize evidence on institutional spillover effects of antimicrobial use (AMU) on antimicrobial resistance (AMR) and Clostridioides difficile infections on individuals without direct antimicrobial exposure.

Systematic review.

Three databases were searched through August 2024 for studies evaluating spillover effects of AMU on unexposed individuals in institutional settings. Study characteristics, AMU, and outcomes were extracted. Study quality was assessed based on underlying methodology to detect spillover effect. A hybrid synthesis, including effect direction and meta-analysis of studies reporting continuous AMU and non-aggregate outcomes was utilized. Reporting followed PRISMA guidelines.

Of 5916 screened studies, five observational studies met inclusion criteria. Three were conducted across 68 hospital wards (ward-level exposure), and two across 693 nursing homes (facility-level exposure). Three studies evaluated all antimicrobial classes; two focused on penicillins, fluoroquinolones, and carbapenems. Two studies examined C. difficile, one MRSA, one carbapenem-resistant Enterobacterales, and one reported combined AMR and C. difficile outcomes. Low to moderate quality evidence indicated a positive spillover effect direction with increasing facility AMU. Meta-analysis of three studies yielded a pooled IRR of 1.54 (95% CI 0.85–2.80) per 100 days of therapy per 1,000 patient-days, with significant heterogeneity (I2 = 97.6%).

This review identified five studies suggesting a positive association between institutional AMU and collateral risks of AMR and C. difficile among unexposed individuals. Findings were limited by methodological heterogeneity and potential publication bias. Standardizing terminology, specifying spillover mechanisms, and adopting robust observational designs can enhance future research on spillover effects.

Admission to shared hospital rooms are a risk factor of healthcare-associated (HA) SARS-CoV-2. Quantifying the impact of engineering controls such as ventilation and filtration is essential to informing resource utilization and infection prevention guidelines.

Multicenter test-negative study of patients exposed to SARS-CoV-2 in shared rooms across five hospitals between January and October, 2022. Independent variables tested were measured air changes per hour (ACH), presence of any room mechanical ventilation (RMV), or portable high-efficiency particulate air (HEPA) filter. Covariates included facility (number of beds in room, outbreak status of unit), source patient (presence of symptoms, RT-PCR cycle threshold (Ct) value), and exposed patient factors (age, sex, time from last SARS-CoV-2 vaccine, previous SARS-CoV-2 infection, exposure duration). Multilevel logistic mixed models used to estimate the impact of engineering controls on transmission.

Among 468 exposed patients, secondary attack rate was 26.3% (range 7.5–33.3% across hospitals). In multivariable analysis, increased ACH was associated with decreased odds of infection (adjusted odds ratio (aOR) 0.88, 95% CI 0.78–1.00; p=.046) as were exposure duration and Ct value of source patient. Presence of RMV was also associated with decreased odds of infection (aOR 0.51, 95% CI 0.27–0.95; p=.034) while use of portable HEPA filter was not significant (aOR 0.58, 95% CI 0.26–1.31; p=.18).

Improved ventilation was independently associated with lower odds of SARS-CoV-2 infection among exposed roommates. Ensuring RMV is present and optimizing ACH may significantly mitigate the risk of HA-SARS-CoV-2. Future prospective studies should assess optimal ACH thresholds and the impact of portable HEPA filters.

Although virtually all academics who study human ‘race’ agree that it is a social construct, members of the general public still commonly regard ‘race’ as a biological property (i.e. they think that ‘races’ are genetically distinct). Even though empirical data from genetics and other fields do not support biological conceptions of race, this erroneous viewpoint is widely held, suggesting that there are impediments to effective communication of the relevant science. Here, we suggest five such impediments: (1) belief in genetic determinism, together with an over-reliance on an essentialist view of human groups, (2) overly simplistic interpretation of biological inheritance, (3) belief in the naturalistic fallacy and the associated naturalization of non-biological variation among racialized groups, (4) failure of the academic and educational communities to take responsibility for teaching the science of ‘race’ and racism, and (5) apologism towards racist founders of academic fields, including the evolutionary sciences. We address how and why each of these factors supports the spread of racism and suggest strategies for containing this spread.

Antimicrobial stewardship programs (ASPs) aim to mitigate antimicrobial resistance (AMR) by optimizing antibiotic use including reducing unnecessary broad-spectrum therapy. This study evaluates the impact of ASP funding and resources on the use of broad-spectrum antibiotics in Ontario hospitals.

We conducted a cross-sectional study of antimicrobial use (AMU) across 63 Ontario hospitals from April 2020 to March 2023. The Ontario ASP Landscape Survey provided data on ASP resourcing and antibiotic utilization. The main outcome was the proportion of all antibiotics that were broad-spectrum, defined as: fluoroquinolones; third-generation cephalosporins; beta-lactam/beta-lactamase inhibitors; carbapenems; clindamycin; and parenteral vancomycin. Secondary outcomes included the proportions of individual antibiotic classes listed above and anti-pseudomonal agents. Statistical analysis involved logistic regression to determine the odds ratio (OR) of the association between ASP funding/resourcing and broad-spectrum antibiotic use.

Among 63 hospitals, 48 reported designated ASP funding/resources. Median broad-spectrum antibiotic use was 52.5%. ASP funding/resources was not associated with overall broad-spectrum antibiotic use (0.97, 95% CI: 0.75–1.25, P = 0.79). However, funding was associated with lower use of fluoroquinolones (OR 0.67, 95% CI: 0.46–0.96, P = 0.03), clindamycin (OR 0.69, 95% CI: 0.47–1.00, P = 0.05), and anti-pseudomonal agents (OR 0.76, 95% CI: 0.59–0.98, P = 0.03).

The presence of designated funding and resources for hospital ASPs is linked to reduced use of specific broad-spectrum antibiotics but not overall broad-spectrum antibiotic use. Enhancing ASP resourcing may be an important factor in limiting targeted antibiotic use, thereby increasing the effectiveness of efforts to mitigate AMR.

There are little reported data on the perspectives of fathers caring for children with chronic conditions. Although survival of children with advanced heart disease has improved, long-term morbidity remains high. This study describes the experience and prognostic awareness of fathers of hospitalised children with advanced heart disease.

Cross-sectional survey study of parents caring for children hospitalised with advanced heart disease admitted for ≥ 7 days over a one-year period. One parent per patient completed surveys, resulting in 27 father surveys. Data were analysed using descriptive methods.

Nearly all (96%) of the fathers reported understanding their child’s prognosis “extremely well” or “well,” and 59% felt they were “very prepared” for their child’s medical problems. However, 58% of fathers wanted to know more about prognosis, and 22% thought their child’s team knew something about prognosis that they did not. Forty-one per cent of fathers did not think that their child would have lifelong limitations, and 32% anticipated normal life expectancies. All 13 fathers who had a clinical discussion of what would happen if their child got sicker found this conversation helpful. Nearly half (43%) of the fathers receiving new prognostic information or changes to treatment course found it “somewhat” or “a little” confusing.

Fathers report excellent understanding of their child’s illness and a positive experience around expressing their hopes and fears. Despite this, there remain many opportunities to improve communication, prognostic awareness, and participation in informed decision-making of fathers of children hospitalised with advanced heart disease.

To evaluate inter-physician variability and predictors of changes in antibiotic prescribing before (2019) and during (2020/2021) the coronavirus disease 2019 (COVID-19) pandemic.

We conducted a retrospective cohort analysis of physicians in Ontario, Canada prescribing oral antibiotics in the outpatient setting between January 1, 2019 and December 31, 2021 using the IQVIA Xponent data set. The primary outcome was the change in the number of antibiotic prescriptions between the prepandemic and pandemic period. Secondary outcomes were changes in the selection of broad-spectrum agents and long-duration (>7 d) antibiotic use. We used multivariable linear regression models to evaluate predictors of change.

There were 17,288 physicians included in the study with substantial inter-physician variability in changes in antibiotic prescribing (median change of −43.5 antibiotics per physician, interquartile range −136.5 to −5.0). In the multivariable model, later career stage (adjusted mean difference [aMD] −45.3, 95% confidence interval [CI] −52.9 to −37.8, p < .001), family medicine (aMD −46.0, 95% CI −62.5 to −29.4, p < .001), male patient sex (aMD −52.4, 95% CI −71.1 to −33.7, p < .001), low patient comorbidity (aMD −42.5, 95% CI −50.3 to −34.8, p < .001), and high prescribing to new patients (aMD −216.5, 95% CI −223.5 to −209.5, p < .001) were associated with decreases in antibiotic initiation. Family medicine and high prescribing to new patients were associated with a decrease in selection of broad-spectrum agents and prolonged antibiotic use.

Antibiotic prescribing changed throughout the COVID-19 pandemic with overall decreases in antibiotic initiation, broad-spectrum agents, and prolonged antibiotic courses with inter-physician variability. These findings present opportunities for community antibiotic stewardship interventions.

We sought to evaluate the impact of antibiotic selection and duration of therapy on treatment failure in older adults with catheter-associated urinary tract infection (CA-UTI).

We conducted a population-based cohort study comparing antibiotic treatment options and duration of therapy for non-hospitalized adults aged 66 and older with presumed CA-UTI (defined as an antibiotic prescription and an organism identified in urine culture in a patient with urinary catheterization documented within the prior 90 d). The primary outcome was treatment failure, a composite of repeat urinary antibiotic prescribing, positive blood culture with the same organism, all-cause hospitalization or mortality, within 60 days. We determined the risk of treatment failure accounting for age, sex, comorbidities, and healthcare exposure using log-binomial regression.

Of 4,436 CA-UTI patients, 2,709 (61.1%) experienced treatment failure. Compared to a reference of TMP-SMX (61.9% failure), of those treated with fluoroquinolones, 56.3% experienced failure (RR 0.91, 95% CI: 0.85–0.98) and 60.9% of patients treated with nitrofurantoin experienced failure (RR 1.02, 95% CI: 0.94–1.10). Compared to 5–7 days of therapy (treatment failure: 59.4%), 1–4 days was associated with 69.5% failure (RR 1.15, 95% CI: 1.05–1.27), and 8–14 days was associated with a 62.0% failure (RR 1.05, 95% CI: 0.99–1.11).

Although most treatment options for CA-UTI have a similar risk of treatment failure, fluoroquinolones, and treatment durations ≥ 5 days in duration appear to be associated with modestly improved clinical outcomes. From a duration of therapy perspective, this study provides reassurance that relatively short courses of 5–7 days may be reasonable for CA-UTI.