Value of hospital antimicrobial stewardship programs [ASPs]:a systematic review

Abstract Background Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods An update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs. Results One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range:$2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions. Conclusions Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention

Why ask questions? Contextual effects on the grammatical structure in the language production of children with SLI

In this small-scale study we investigated the influence of different aspects of context on the language production of children with specific language impairment (SLI). Each of the variables, type of partner, the partner’s interactional style and the type of material used for eliciting conversation, was related to the probability of the use of a set of grammatical constructions by the child. The results show that the interactional style of the conversational partner as well as the type of elicitation material used can have an influence on the grammatical complexity in the language production of children with SLI. Further investigation of such contextual effects from a dialogical perspective would have important implications for intervention with these children

Conversation versus narration in pre-school children with language impairment

he study focuses on two elicitation methods for language sampling in children with language impairment: conversation and narration. It has been noted in other studies on different clinical groups that language elicited in different speaking contexts varies in aspects such as MLU, fluency and syntactic complexity. The purpose of this study was to compare genre effects on different aspects of language production in a group of pre-school children with language impairment. The results show that there are differences in language production during conversation compared with narration. Intelligibility and fluency were found to be higher in conversation than in narration, whereas MLU in words was higher in narration. The narrative task elicited more phrasal expansions and grammatical morphemes per utterance than the conversation. However, the children used more complex verb forms in conversation than in narration. The results are discussed in relation to recent research

From my perspective: Perceived participation in mainstream schools in students with autism spectrum conditions

Objectives: To examine perceived participation in students with ASC and their classmates in mainstream schools and to investigate correlations between activities the students wanted to do and actually participated in. Methods: Twenty-two students with ASC and their 382 classmates responded to a 46-item questionnaire regarding perceived participation in mainstream schools. Results: On 57% of the items, students with ASC perceived lower participation than their classmates. These results emphasize the importance of knowledge about students’ perceived participation. However, positive correlations between what the students wanted to do and actually did indicate that students with ASC may be participating to the extent that they wanted. Conclusion: Students with ASC perceived lower overall participation in mainstream school than their classmates. The correlations between “I want to” and “I do” statements in students with ASC indicated that aspects of autonomy are important to incorporate when studying, and interpreting, self-rated participation in mainstream schools