P1 Large scale three-dimensional cartilage tissue engineering using adult bone marrow stem cells from OA patients

Fitxes dels barri

Current state of antimicrobial stewardship in children’s hospital emergency departments

BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation. RESULTS A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR. CONCLUSIONS Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children's hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support. Infect Control Hosp Epidemiol 2017;38:469-475

Evaluation of prescription pattern of antifungal drugs in the dermatology department of a tertiary care teaching hospital

Background: In general, fungal infections are one of the contributors of disease burden in the community, but irrational use of antifungal drugs can result in unwanted adverse events or antifungal drugs resistance. The present study was designed to analyze the prescription pattern of antifungal drugs prescribed in the dermatology department of a tertiary care teaching hospital. Methods: After getting permission from the ethics committee, this prospective observational cross-sectional study was conducted by analysis of prescriptions of 900 voluntary participant patients over a period of seven months in the dermatology outpatient department of a tertiary care teaching hospital in western India. Prescribed medicines’ parameters were analyzed as per WHO/INRUD prescription indicators. Results: Overall 900 prescriptions were analyzed, and among them around 50% patients were having tinea corporis and tinea cruris, making it the most common fungal infection. The most commonly prescribed antifungals were Clotrimazole (34.59%), followed by Fluconazole (31.61%) and Luliconazole (23.52%). Percentage of drugs prescribed from the WHO model list of essential medicines was 71.22%. Average number of antifungal drugs per prescription was 2.83 ± 0.57%. Conclusions: This study indicates prescribing practices of anti-fungal drugs and supportive medicines at tertiary care hospital that can be further improved by promoting prescribing by generic names. Overall final list of essential medicines at district level, state level and national level may vary as compared to the WHO list for anti-fungal drugs and doctors can consider alternative drugs as per domestic resistant pattern

A study of cutaneous adverse drug reactions in the dermatology department of a tertiary care teaching hospital in Gujarat

Background: Various drugs are responsible for different cutaneous adverse drug reactions (CADRs). Considering variation in drug responses and the day-to-day increasing burden of ADRs, this study was done with emphasis on the need for effective evaluation and the reporting of the ADR reporting programme. Methods: This was an observational cross-sectional study conducted for the duration of six months in the dermatology department to evaluate various clinical patterns of CADRs. Results: A total of 60 CADRs were reported. Among them, 51.67% were present in males and 48.33% were present in females. The most common CADR was FDE (35%), followed by macula-papular rash (25%). Antimicrobials were most commonly responsible for CADRs, followed by NSAIDs, antiepileptic, anti-gout, and anti-hypertensive medications. Conclusions: For better patient care, drug safety, and rational use of medicines, knowledge of various drugs responsible for CADRs can be useful for health care professionals to reduce mortality and morbidity by monitoring, reporting, and assessment of CADRs whenever detected

Chronic Headache Education and Self-management Study (CHESS) : Health Economics Analysis Plan [v2.0]

Objective The Chronic Headache Education and Self-management Study (CHESS) is a multicomponent programme of interlocking studies funded by an NIHR programme grant to develop an education and self-management support intervention for people living with chronic headache (here in referred to as the CHESS intervention) and assess its clinical and cost- effectiveness in a randomised controlled trial. This analysis plan relates to the economic evaluation of the CHESS intervention using data from the two-arm multi-centre randomised controlled trial component of the CHESS programme. The within-trial economic evaluation will aim to estimate the cost-effectiveness of the CHESS intervention compared with best supportive care over the 12-month trial period of follow-up. The purpose of the health economics analysis plan is to outline an explicit framework of methods that will be used to analyse the health economic data in a robust manner. The document has been written based on information contained in the trial protocol version 3.7 dated on 19.Sep.2019. Background rationale Chronic headaches present a major problem both for the individual and society. Previous studies on supportive self-management interventions in this population have largely been small studies with short term follow-up, they often did not report clinically relevant outcomes, or were conducted in different healthcare systems therefore difficult to translate into an NHS setting. These studies also did not necessarily focus on chronic headache but rather looked at headache with no frequency specified. Based on the results of our systematic review there may be potential for large gain through a combination of self-management education and appropriate use of prophylaxis and management of medication overuse headache in a chronic headache population. In order to develop the evidence base needed for self-management intervention for chronic headache there needs to be a carefully developed, piloted and evaluated intervention package which has been supported by good qualitative work on understanding outcomes of interest. There is therefore the need for a robust clinical and cost-effectiveness trial within an NHS setting. Objectives The objective is to answer the question: Amongst adults with chronic headache arising from migraine, chronic tension type headache or medication overuse headache, is the provision of a self-management support programme in addition to best usual NHS care clinically and cost effective

Documentation technique : équipement et réparation des livres

For robots of increasing complexity such as humanoid robots, conventional identification of rigid body dynamics models based on CAD data and actuator models becomes difficult and inaccurate due to the large number of additional nonlinear effects in these systems, e.g., stemming from stiff wires, hydraulic hoses, protective shells, skin, etc. Data driven parameter estimation offers an alternative model identification method, but it is often burdened by various other problems, such as significant noise in all measured or inferred variables of the robot. The danger of physically inconsistent results also exists due to unmodeled nonlinearities or insufficiently rich data. In this paper, we address all these problems by developing a Bayesian parameter identification method that can automatically detect noise in both input and output data for the regression algorithm that performs system identification. A post-processing step ensures physically consistent rigid body parameters by nonlinearly projecting the result of the Bayesian estimation onto constraints given by positive definite inertia matrices and the parallel axis theorem. We demonstrate on synthetic and actual robot data that our technique performs parameter identification with 10 to 30% higher accuracy than traditional methods. Due to the resulting physically consistent parameters, our algorithm enables us to apply advanced control methods that algebraically require physical consistency on robotic platforms

Jyotismati Taila and Ashtamangal Ghrita Nasya in the management of Mental Retardation - A Comparative Study

Mental retardation is still elusive to researchers due to multidimensionality of psychological, medical, educational and social aspects, which alters mental functions and capability. Mental sub capability divided in 4 categories, Mild, Moderate, Severe and Profound. Chief aim of management of mental retardation is to make child more capable of performing common activities of everyday life by positive improvement in mental sub-capability. Mental retardation required multidimensional management approach. Present study focused on medicinal intervention, particularly analysis of comparative effectiveness of selected drug formulations (Astamangalghrita and Jyotismatitaila) from classical text of Ayurveda. Study design with the aims to compare the effectiveness of Jyotismatitaila and Astamangal Ghrita Nasya on Mental retardation. Assessment were based on Mental Status Score and IQ score taken before starting of treatment and after completion of treatment in both group. Obtained data was analyzed statistically. In this study, from result we conclude that both drugs are effective to improve Mental Status parameter and in IQ, but higher percentage and significance wise Jyotismati Taila had better result than Astamangal Ghrita Nasya

A quantum probability account of individual differences in causal reasoning

We use quantum probability (QP) theory to investigate individual differences in causal reasoning. By analyzing data sets from Rehder (2014) on comparative judgments, and from Rehder & Waldmann (2016) on absolute judgments, we show that a QP model can both account for individual differences in causal judgments, and why these judgments sometimes violate the properties of causal Bayes nets. We implement this and previously proposed models of causal reasoning (including classical probability models) within the same hierarchical Bayesian inferential framework to provide a detailed comparison between these models, including computing Bayes factors. Analysis of the inferred parameters of the QP model illustrates how these can be interpreted in terms of putative cognitive mechanisms of causal reasoning. Additionally, we implement a latent classification mechanism that identifies subcategories of reasoners based on properties of the inferred cognitive process, rather than post hoc clustering. The QP model also provides a parsimonious explanation for aggregate behavior, which alternatively can only be explained by a mixture of multiple existing models. Investigating individual differences through the lens of a QP model reveals simple but strong alternatives to existing explanations for the dichotomies often observed in how people make causal inferences. These alternative explanations arise from the cognitive interpretation of the parameters and structure of the quantum probability model

Chronic Headache Education and Self-management Study (CHESS) : Statistical Analysis Plan [v1.1]

Background and rationale Chronic headaches present a major problem both for the individual and society. Previous studies on supportive self-management interventions in this population have largely been small studies with short term follow-up, they often did not report clinically relevant outcomes, or were conducted in different healthcare systems therefore difficult to translate into an NHS setting. These studies also did not necessarily focus on chronic headache but rather looked at headache with no frequency specified. Based on the results of our systematic review there may be potential for large gain through a combination of self-management education and appropriate use of prophylaxis and management of medication overuse headache in a chronic headache population. In order to develop the evidence base needed for self-management intervention for chronic headache there needs to be a carefully developed, piloted and evaluated intervention package which has been supported by good qualitative work on understanding outcomes of interest. There is therefore the need for a robust clinical and cost-effectiveness trial within an NHS setting. Objectives The objective is to answer the question: Amongst adults with chronic headache arising from migraine, chronic tension type headache or medication overuse headache, is the provision of a self-management support programme in addition to best usual NHS care clinically and cost effective? ISRCTN number: 7970810

Effect of microneedling by dermaroller on acne scars: an observational study at tertiary care hospital

Background: Post acne facial scar is very distressing phenomenon. There are many treatment options like laser resurfacing, dermabrasion, microdermabrasion and non-ablative laser resurfacing but it may cause adverse effects and interference with the daily activities of the patient. Microneedling or dermaroller therapy is newer modality in management of acne scars with satisfactory improvement and no significant side effect. Objective of our study was to evaluate efficacy and safety of microneedling in the treatment of atrophic facial acne scars. Methods: Twenty-eight patients of Fitzpatrick skin type IV to V having atrophic facial acne scars and fulfilling inclusion criteria were treated with multiple sittings of microneedling (dermaroller) treatment at monthly interval. Goodman and Baron’s qualitative and quantitative acne scar grading system was used for assessment. Patients were evaluated clinically and by serial photography. Presence of any active infection, active acne, wounds, blisters, keloids, taking some medications like Accutane, antihypertensives, anticoagulants, systemic retinoids, topical retinoids, those undergoing cosmetic procedures, treatment with injecting fillers or ablative or non-ablative laser resurfacing, diabetes, collagen diseases and those who do not agree to participate in study were excluded. Results: Any change in the grading of scars after the end of treatment and follow-up period was noted. Efficacy and improvement of dermaroller treatment was assessed by Goodman and Baron’s global acne scarring system. Out of 18 patients (of total 28) with Goodman and Baron’s qualitative grade-4, 16 (88.90%) patients reduced to grade-1. 21 out of 28 patients achieved ‘excellent’ response. Adverse effects were limited to transient erythema and post inflammatory hyperpigmentation. Conclusions: Microneedling therapy seems to be simple, safe and efficacious for the management of atrophic facial acne scars