Evaluation of a pharmacist-led antibiotic stewardship program and implementation of prescribing order sets.

BACKGROUND: It is established that pharmacists can play a role in antibiotic stewardship in inpatient settings; however, there remains a paucity of data regarding pharmacist impact on antibiotic stewardship in outpatient care. OBJECTIVES: The purpose of this study was to assess the impact of an outpatient pharmacist antimicrobial stewardship program involving the implementation of prescribing order sets on the rate of compliance with guideline-recommended antibiotic use. METHODS: This was a single-center, retrospective study conducted at a resident-run, adult medicine clinic evaluating the implementation of a pharmacist-led antimicrobial stewardship education program and prescribing order sets. Adult patients were included if they were treated for a diagnosis of urinary tract infection or Helicobacter pylori infection. The primary outcome was a composite of the proportion of antibiotic prescribing that was compliant with guideline-recommended treatment, including indication, antibiotic selection, dose, and duration. The secondary outcomes included an analysis of the individual components of the primary outcome and a subgroup analysis according to infection type. RESULTS: A total of 115 and 43 patients were included in the preintervention and intervention groups, respectively. No statistically significant difference was observed in the proportion of complete guideline-recommended antibiotic regimens after the implementation of the stewardship intervention (P = 0.703) or in any individual component of the composite outcome. However, a subgroup analysis of each infection type demonstrated statistically significant improvements in both complete H pylori regimens and antibiotic selection. CONCLUSIONS: Although the implementation of a pharmacist-led antimicrobial stewardship program at an adult medicine clinic did not lead to an improvement in complete guideline-recommended antibiotic prescribing, notable improvements were observed after subgroup analyses.

Citizen science sampling programs as a technique for monitoring microplastic pollution: results, lessons learned and recommendations for working with volunteers for monitoring plastic pollution in freshwater ecosystems.

A citizen science microplastic monitoring method was developed to engage the public and quantify microplastic contamination at various sites along an approximately 550 km length of the Ottawa River from Lake Temiskaming to Hawkesbury, Ontario, Canada. The volunteers filtered 100 L of river water through a 100-µm mesh at their desired location along the Ottawa River. All but one of the river samples (n = 43) contained microplastics, with the vast majority of microplastics identified as microfibers. Microplastic concentrations ranged from 0.02 to 0.41 microplastic pieces per litre. We noted numerous advantages in working with citizen scientists including actively engaging citizens in the research, ease of recruiting volunteers within the established Ottawa Riverkeeper network, and expanded spatial coverage at minimal additional costs. Despite these important advantages, there are some important considerations with citizen scientist sampling including the rare events where volunteers mislabelled sample sheets (e.g. labelling as control instead of river sample) and the relatively low volume of water (100 L) that the volunteers could easily sample using our methodology. Recommendations for future citizen science projects for freshwater microplastic research include utilising an established and engaged network, running both field and lab control samples (blanks) to obtain estimates of contamination with microplastic fibres, and increasing the amount of water filtered to obtain more reliable estimates of microplastic pollution in our freshwater ecosystems.

Nutrient resorption of two evergreen shrubs in response to long­term fertilization in a bog.

Plant resorption of multiple nutrients during leaf senescence has been established but stoichiometric changes among N, P and K during resorption and after fertilization are poorly understood. We anticipated that increased N supply would lead to further P limitation or co-limitation with N or K [i.e. P-(co)limitation], decrease N resorption and increase P and K resorption, while P and K addition would decrease P and K resorption and increase N resorption. Furthermore, Ca would accumulate while Mg would be resorbed during leaf senescence, irrespective of fertilization. We investigated the effect of N, P and K addition on resorption in two evergreen shrubs (Chamaedaphne calyculata and Rhododendron groenlandicum) in a long-term fertilization experiment at Mer Bleue bog, Ontario, Canada. In general, N addition caused further P-(co)limitation, increased P and K resorption efficiency but did not affect N resorption. P and K addition did not shift the system to N limitation and affect K resorption, but reduced P resorption proficiency. C. calyculata resorbed both Ca and Mg while R. groenlandicum resorbed neither. C. calyculata showed a higher resorption than R. groenlandicum, suggesting it is better adapted to nutrient deficiency than R. groenlandicum. Resorption during leaf senescence decreased N:P, N:K and K:P ratios. The limited response of N and K and the response of P resorption to fertilization reflect the stoichiometric coupling of nutrient cycling, which varies among the two shrub species; changes in species composition may affect nutrient cycling in bogs.