Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

In this current environment, where fiscal uncertainty seems to be a constant and budget and personnel cuts are a frequent concern, librarians are exploring new and exciting ways to help their patrons and institutions. Although traditional services-the swift and timely delivery of up-to-date and accurate information-should continue to be performed with the uniform excellence on which library patrons depend, librarians can add value to these core services by seeking out additional functions applicable to their patrons' needs, and embracing these new and emerging roles.

Background and Purpose: Carotid artery plaque progression has been associated with significant cerebrovascular morbidity and mortality. Even though, lifestyle modifications are the cornerstone of the management of atherosclerotic disease, the long term effects of a healthy diet and regular exercise on the atherosclerotic burden of carotid arteries is not clear. This meta-analysis was undertaken to assess this possibility. Methods: Randomized controlled trials comparing the efficacy of intensive lifestyle measures (diet and/or exercise) and usual care were identified by a systematic search. Three independent researchers searched MEDLINE, OVid, PUBMED, EMBASE and CINAHL for eligible studies. We included studies which provided baseline and quantitative carotid intimal medial thickness (IMT) data measured after at least 3 years. Comprehensive Meta-Analysis Version 2.0 was used for statistical analysis. Results: We identified 4 eligible studies of which 2 studies looked at the effect of diet alone while 1 looked at the effect of diet and exercise. One study was excluded from the analysis because of lack of sufficient data. There was no significant heterogeneity between the 3 studies analyzed (p: 0.699). A total of 980 patients were analyzed; 492 patients in the intervention group and 488 patients in the control group. After at least 3 years of follow up, lifestyle changes were negatively correlated with carotid IMT with a difference of mean of -0.023; SE: 0.007 (95% CI: -0.036 to -0.010, p: 0.001 ) when compared with the control group, reflecting the pooled effect size (Figure). Conclusion: Sustained long terms lifestyle changes i.e. diet and exercise, not only prevent the progression but also regress carotid artery atherosclerosis after at least three years of follow up.