No abstract

Acute sore throat is a common presentation in primary care settings. We aimed to improve our compliance with national antibiotic guidelines for sore throat symptoms to 90% in 3 months' time period. The national guidelines are based on Centor criteria. A retrospective audit of 102 patient records with sore throat symptoms presenting between 1 January to 30 December 2015 showed that over 50% were given antibiotics. Those who were prescribed antibiotics, 27% did not meet NICE criteria and 85% of patients were given immediate antibiotic prescription. Centor criteria was documented in just 2% of cases. Compliance with correct antibiotic course length was 15%. Antibiotic choice and dose was correct in 94% and 92% of cases respectively. Antibiotic frequency was correctly prescribed in 100% of patients.We introduced interventions that included oral and poster presentations to multidisciplinary team, dissemination of guidelines through internal e-mail and systemic changes to GP electronic patient record system EMIS. This involved creating an automated sore throat template and information page. On re-auditing of 71 patients, after two PDSA cycles, compliance with NICE criteria was 87% with a significant reduction in immediate prescribing (66%). Centor criteria documentation was 42%. Correct antibiotic course length was prescribed in over 30% of cases. Other antibiotic regimen parameters (choice, dose and frequency) were correct in 100% of cases.The initial results demonstrated that significant changes were needed. In particular, reducing the amount of antibiotics prescribed by increasing compliance with NICE criteria and ensuring all parameters of antibiotic prescription were correct. We showed that significant sustainable improvement is achievable through carefully devised automated systemic changes that provides critical information in readily accessible format, and does not solely rely on prescribers' knowledge and initiative. The outcome of these interventions are a decrease in immediate antibiotic prescription, significant increase in Centor criteria documentation and an increase in compliance with the correct course length of antibiotics. All these measures would contribute to reduction in antimicrobial resistance and improvement in patient care in the community. Future work must focus on improving compliance with correct antibiotic course length.

Deforestation in remote mountainous regions is considered to be one of the fundamental elements for triggering changes in the biophysical environment driven by various socioeconomic parameters, particularly population growth and road construction in a previously inaccessible environment. A sudden increase in population exerts adverse impacts on the local natural resources, specifically forests. The present study is conducted in Tribal District Kurram, located in the northwestern mountainous belt of Pakistan. This study is aimed to analyze the temporal pattern of deforestation and to explore the impacts of population growth and accessibility on forest cover. It is based on remotely sensed data, focused group discussions, interviews and field observations. The satellite images were processed and classified using ArcGIS and ERDAS IMAGINE. The time span of this study is 1972 to 2019, which is further divided into three periods. The results revealed that almost half (48%) of the forest cover was reduced in ca. five decades. However, considerable variation has been observed in the deforestation rate during the study period. The results of this study revealed that both population change and accessibility have played a vital role in the deforestation process.

No abstract

No abstract