A done in humans, animals and the wider

A Annual Report of the Chief Medical Officer (2011)
highlighted the urgent need of the strategic management of AMR in England,
suggesting the scale of threat of antimicrobial resistance been seen from the
Healthcare Associated Infection and antimicrobial usage in England Point
Prevalence Survey (2014), and the need for action. In response to this,
Department of Health set out UK 5 Year AMR Strategy 2013 to 2018 (2013) and PHE
took in charge of the role of providing surveillance data, and has worked
closely with National Health Service on implementation of antimicrobial
stewardship programme and facilitation of professional education and public
engagement. The most recent English Surveillance Programme for Antimicrobial
Utilisation and Resistance (ESPAUR) (2017) highlighted that the development of
NHS antimicrobial stewardship initiatives, namely Quality Premium (QP) and
Commissioning for Quality and Innovation (CQUIN) showed the most significant
results. The report stated that both has quantified their achievement and made
it clear that action was needed across every Trust. Even similar action has
also been carried out in China, such as Administrative Regulations for Clinical
Use of Antibiotics (2012) and National guidelines for antimicrobial therapy (2013),
but a number of studies including the one by Li W et al. (2016) was highly
critical of the strategic management of AMR in China. Suggesting that
regulation policy and following actions was not solving the most problematic
area which is the rural area. The report criticised the lack of input and the
identified major challenges are the lack of qualified healthcare professionals
and poor access of information. More broadly, official guideline specifically
for tackling antimicrobial resistance has only recently been developed in 2016,
and thus evidence-based use has not yet been widely investigated, so the
benefits and outcomes of the initiatives are still hard to tell and

Consumption of Antibiotic without change of infection episode
have declined over this period, but limited research been done, it is hard to
show and conclude its effectiveness in China. But what I realised from chatting
with the staff in elective placement hospital is that UK and China will be
collaborated to tackle the antimicrobial resistance problem especially in rural
China region. What I do know now is that large-scale, interdisciplinary, UK-
China collaborative research would be done in humans, animals and the wider
environment in China (Research Council UK, n.d.). The first confirmed
collaboration would be done in Anhui with University of Bristol, investigating
on localised strategies to optimise AMR regulation (2016). All the project will
be started in early 2019 so it is still impossible to attribute success to any
one collaboration, nor it is possible to tell which components of the
collaboration would benefit the most. But what I do know is the multimodal,
region-adapted research and interventions can show us where the problem is. I
also know that having the backing of a national guidance and global surveillance
gains the attention of government executives, bringing focus and resource to
AMR where needed and providing strong reinforcement. But much learning about
what works in China has been limited because so little research and evaluation
was conducted to determine effectiveness or to identify mechanisms of change
and contextual influences. A key thought upon reflection is that future AMR
regulations in China or even global context would benefit from a programme of
high quality evaluation research running in parallel to help understand what
works and why.

Most importantly, as a future physiotherapist, ensuring own
responsibility to infection control to prevent infection from occurring in the
first place should be one of the best way for me to reduce the need to
prescribe antibiotics and prevent antimicrobial resistance. Therefore in the
future practice, infection prevention and control would become even more
important and I should regularly reflect my practice to ensure an optimal contribution
in infection control.




Learning Outcome: Evaluate the health care needs of the population served by the elective
placement and demonstrate cultural competence with adaptation of practice
appropriate to the placement.

patients were targeted to have their own individual treatment plans tailored
with their own needs throughout my placement, I noticed that patients tend to
take an uninvolved role in clinical decision making process and there were
disproportionate amount of passive treatment implementation comparing to my
placement experience in UK. As the placement progressed I noted that Chinese
manual therapy, acupuncture, electrotherapy and traction therapy formed a large
proportion of the treatments (See Appendix E). A number of studies including
one by Rongchong et al. (2015) have found that Chinese patients are more likely
to take an uncomplaining role on clinical decision-making process and more
likely to prefer inactive treatment like manual therapy and acupuncture.
Additionally this is not only limited to geographic location, a number of
studies also found out that multiracial Chinese in other countries are having a
higher tendency of taking uninvolved role among other ethnicity (Leung YM et
al., 2014; Kwok C & Koo FK, 2017).

At the start of the placement, having no experience of
working with this service user group I felt slightly challenging and limited
with their passive approach