ABSTRACT
Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.
ABSTRACT
Background and Objectives : To determine sex from unknown skeletal remains is vital. Various methods to do this on different bones of human skeleton have been extensively studied. In general male bones are heavier larger and muscular markings are more prominently seen as compared to female bones. The objective of this study was to find out comparative differences between the right and left clavicles from certain metrical parameters and to enable assessment of sex from unknown clavicles. Methods: The study was conducted on 213 adult clavicles, out of which 96 were of the right side and 117 were of the left. The maximum length of clavicles in mm was taken and demarking points were established by adding and subtracting 3×SD from means. Results: The mean length of right clavicle was 142.28 mm ± 11.40 mm SD and that of left clavicle was 145.14 mm ± 11.87 mm SD. It has been observed that left clavicle is longer than right clavicle by 2.82mm. Depending upon length of clavicle the sex can be decided in 3.13% male and 2.08% female in right clavicles and 1.71% male and 1.71% female in left clavicles. Conclusion: The left clavicle was longer compared to right clavicle. Demarking points give 99.75% accurate data, measured by adding & subtracting 3×SD from means. Demarking points for length of clavicles were >176.48 mm for male & <108.08 mm for female on right side and >180.75mm for male & <109.53 mm for female on left side for this study. This study is useful for medico legal and anthropological examination of bones and for academic studies in anatomy.