Mapping the evidence of the effects of environmental factors on the prevalence of antibiotic resistance in the non-built environment: Protocol for a systematic evidence map.

BACKGROUND: Human, animal, and environmental health are increasingly threatened by the emergence and spread of antibiotic resistance. Inappropriate use of antibiotic treatments commonly contributes to this threat, but it is also becoming apparent that multiple, interconnected environmental factors can play a significant role. Thus, a One Health approach is required for a comprehensive understanding of the environmental dimensions of antibiotic resistance and inform science-based decisions and actions. The broad and multidisciplinary nature of the problem poses several open questions drawing upon a wide heterogeneous range of studies. OBJECTIVE: This study seeks to collect and catalogue the evidence of the potential effects of environmental factors on the abundance or detection of antibiotic resistance determinants in the outdoor environment, i.e., antibiotic resistant bacteria and mobile genetic elements carrying antibiotic resistance genes, and the effect on those caused by local environmental conditions of either natural or anthropogenic origin. METHODS: Here, we describe the protocol for a systematic evidence map to address this, which will be performed in adherence to best practice guidelines. We will search the literature from 1990 to present, using the following electronic databases: MEDLINE, Embase, and the Web of Science Core Collection as well as the grey literature. We shall include full-text, scientific articles published in English. Reviewers will work in pairs to screen title, abstract and keywords first and then full-text documents. Data extraction will adhere to a code book purposely designed. Risk of bias assessment will not be conducted as part of this SEM. We will combine tables, graphs, and other suitable visualisation techniques to compile a database i) of studies investigating the factors associated with the prevalence of antibiotic resistance in the environment and ii) map the distribution, network, cross-disciplinarity, impact and trends in the literature.

Owner and Veterinarian Perceptions About Use of a Canine Quality of Life Survey in Primary Care Settings.

This paper describes dog owner and veterinarian perceptions around the use of a validated canine quality of life (QOL) survey to facilitate wellness conversations in two clinical settings: a veterinary teaching hospital (pilot, Phase 1) and five corporate general practice hospitals (Phase 2). Phase 1 results showed that dog owners felt the survey was valuable for understanding their dog's QOL, with 81% of owners expressing interest in learning more about canine QOL. Phase 2 reinforced owner perceptions about the survey conveyed during the pilot phase, and veterinarians reported that the survey facilitated client communication related to preventive care without increasing consultation time. These results demonstrate that beyond using QOL assessments to track patient health, the use of a QOL survey during veterinary visits could improve owner-veterinarian discussions around QOL, wellness, services and preventive care. To fully realize these benefits in clinical settings, veterinary staff preparation may be needed to communicate the purpose of QOL assessments to clients and thus facilitate deeper conversations about client needs and concerns. Key tools for achieving these could therefore include (1) sufficient veterinary team training to understand the QOL assessment and its purpose (2) training in how to communicate QOL to clients, and (3) reflexive use of QOL assessment results to engage clients in preventive care discussions. The veterinarian and client can then discuss the pros and cons of the various aspects of QOL and preventive care to arrive at a cooperative decision.