Do musculoskeletal physiotherapists believe the NICE guidelines for the management of non-specific LBP are practical and relevant to their practice? : a cross sectional survey

Background: Evidence-based practice has become fundamentally important in the field of musculoskeletal physiotherapy, which include clinical practice guidelines, such as those developed by National Institute for Health and Clinical Excellence (NICE) for low back pain. Objectives: To gauge whether musculoskeletal physiotherapist working in the UK are compliant with the NICE guidelines for back pain, and if they believe them to be practical and relevant to their current practice. Design: Descriptive cross-sectional voluntary electronic survey. Methods: A survey of musculoskeletal physiotherapists currently working in the UK was conducted through an anonymous online data collection website over a two month data collection period. Data was collected about demographic details of participants, and their views about the NICE guidelines through a specially designed questionnaire, and are presented descriptively. Results: Two hundred and twenty-three therapists participated. Following a thematic content analysis seven key themes were identified about the guidelines: they facilitated evidence-based practice; they were unrealistic and idealistic; they did not facilitate a multimodal approach; they promoted largely a passive approach; they challenged therapist autonomy; they were outdated; they lacked relevance and specificity. Conclusion: Musculoskeletal physiotherapists strongly believe in the principles of EBP, and thought the NICE back pain guidelines were relevant to their practice. However the recommendations made within the guidelines were not realistic in day to day practice and they impacted negatively on the practice in a number of ways.</p

When should you suspect community-acquired MRSA? How should you treat it?

There are no clinical or epidemiologic features that will help you to clearly distinguish community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) from methicillin-sensitive (CA-MSSA) infections (strength of recommendation [SOR]: B, prospective cohort studies). Incision and drainage is the primary therapy for purulent skin and soft tissue infections (SOR: B, randomized, controlled clinical trials [RCTs]). There are inadequate data evaluating the role of oral antibiotics for MRSA (SOR: B, single RCT)

MENINGKATKAN SIKAP PERCAYA DIRI DAN HASIL BELAJAR SISWA MELALUI MODEL PROBLEM BASED LEARNING TIPE STAD DALAM PEMBELAJARAN IPS(Penelitian Tindakan Kelas Materi Peninggalan-Peninggalan Sejarah Dari Masa Hindu Budha Dan Islam Di Indonesia Pada Siswa Kelas V SDN Gumuruh 8 Bandung)

Penelitian ini bertujuan untuk meningkatkan kemampuan sikap percaya diri dan hasil belajar siswa melalui model Problem Based Learning tipe STAD dalam pembelajaran IPS pada Materi Peninggalan-Peninggalan Sejarah Dari Masa Hindu Budha Dan Islam Di Indonesia. Penelitian tindakan kelas dilaksanakan di kelas V SDN Gumuruh 8 Bandung. Penelitian ini dilatar belakangi dengan keadaan siswa di kelas V SDN Gumuruh 8 yang kurang memiliki sikap percaya diri saat proses pembelajaran berlangsung dan hasil belajar yang belum mencapai KKM dikarenakan guru sering menggunakan ceramah konvensional. Penelitian ini menggunakan metode Penelitian Tindakan Kelas dengan menggunakan sistem siklus yang terdiri dari perencanaan, pelaksanaan, observasi, analisis dan refleksi. Penelitian ini dilaksanakan dalam 2 siklus. Dalam tiap siklusnya dilaksanakan kegiatan pembelajaran dengan menerapkan model pembelajaran inquiry yang terdiri dari 5 tahap yaitu 1. Merumuskan Masalah, 2. Membangun struktur kerja 3.Merumuskan jawaban sementara (hipotesis), 4.Menguji jawaban tentative, 5. Menarik kesimpulan. Teknik evaluasi yang digunakan pada penelitian ini adalah teknik tes dan non tes. Teknik tes untuk mengetahui hasil belajar siswa, dan teknik non tes untuk mengetahui sikap percaya diri siswa. Hasil penelitian menunjukkan bahwa penggunaan model Problem Based Learning tipe STAD dapat meningkatkan kemampuan sikap percaya diri dan hasil belajar siswa. Hal tersebut dapat dilihat dari nilai rata-rata peningkatan kemampuan sikap percaya diri dan hasil belajar siswa dari data awal sebelum pelaksanaan siklus sampai siklus II, yaitu data awal sebelum pelaksanaan siklus muncul sikap percaya diri 2,23 dengan kategori cukup, siklus I 2,93 dengan kategori baik dan siklus II 3,36 dengan kategori sangat baik dan data awal sebelum pelaksanaan siklus hasil belajar adalah 59,7, siklus I 70,66 dan siklus II 86,6. Kesimpulan yang diperolah dari penelitian ini adalah, bahwa penggunaan model pembelajaran Problem Based Learning tipe STAD sangat menunjang terhadap peningkatan kemampuan sikap percaya diri dan hasil belajar siswa pada Materi Peninggalan-Peninggalan Sejarah Dari Masa Hindu Budha Dan Islam Di Indonesia di kelas V SDN Gumuruh 8 Bandung. Dengan demikian, penggunaan model Problem Based Learning tipe STAD dapat dijadikan salah satu model pembelajaran untuk diterapkan pada pembelajaran IPS. Kata kunci: Problem Based Learning, STAD, Percya Diri, Hasil Belajar

What is the most effective treatment for acne rosacea?

Topical metronidazole and azelaic acid are equally effective for the papulopustular lesions of acne rosacea, although metronidazole is better tolerated. Oral doxycycline, tetracycline, and metronidazole are also effective, but not enough evidence exists to determine whether one is more effective than another or more effective than topical therapy (strength of recommendation [SOR]: A, systematic review and individual randomized controlled trials [RCTs]). Some evidence supports a benefit for topical sodium sulfacetamide with sulfur, and benzoyl peroxide (SOR: B, small single RCTs). Pulsed-light and laser therapy may improve the erythema and telangiectasias associated with acne rosacea (SOR: C, case series). All patients with acne rosacea should use sunscreen and emollients, and avoid skin irritants (SOR: C, expert opinion)

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

Some Like It Hot: Linking Diffuse X-ray Luminosity, Baryonic Mass, and Star Formation Rate in Compact Groups of Galaxies

We present an analysis of the diffuse X-ray emission in 19 compact groups of galaxies (CGs) observed with Chandra. The hottest, most X-ray luminous CGs agree well with the galaxy cluster X-ray scaling relations in $L_X-T$ and $L_X-\sigma$, even in CGs where the hot gas is associated with only the brightest galaxy. Using Spitzer photometry, we compute stellar masses and classify HCGs 19, 22, 40, and 42 and RSCGs 32, 44, and 86 as fossil groups using a new definition for fossil systems that includes a broader range of masses. We find that CGs with total stellar and HI masses $\gtrsim10^{11.3}$ M$_\odot$ are often X-ray luminous, while lower-mass CGs only sometimes exhibit faint, localized X-ray emission. Additionally, we compare the diffuse X-ray luminosity against both the total UV and 24 $\mu$m star formation rates of each CG and optical colors of the most massive galaxy in each of the CGs. The most X-ray luminous CGs have the lowest star formation rates, likely because there is no cold gas available for star formation, either because the majority of the baryons in these CGs are in stars or the X-ray halo, or due to gas stripping from the galaxies in CGs with hot halos. Finally, the optical colors that trace recent star formation histories of the most massive group galaxies do not correlate with the X-ray luminosities of the CGs, indicating that perhaps the current state of the X-ray halos is independent of the recent history of stellar mass assembly in the most massive galaxies.Comment: 20 pages, 7 figures, accepted for publication in Ap