Tendon-sheath actuation mechanism is widely used in surgical robot, especially in endoscopic surgery, due to its capable of providing remote force and action transmission through long and flexible ...channel. However, hysteresis, backlash, nonlinear friction are the drawbacks of this mechanism. Our surgical robot use continuum manipulator which is useful in endoscopic surgery, due to its flexible and simple structure. Unlike other literatures that focus on tendon-sheath compensation only, the continuum manipulator is also taken into application level analysis. A model based feedforward motion compensation for tendon-sheath driven continuum manipulator is presented. The model is validated by using optical tracking system to trace the distal end position. Experiment result shows that the proposed model reduces the position error less than 5%.
Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel is used for stroke prevention in patients with atrial fibrillation (AF) who refuse to take use oral anticoagulants (OACs). However, ...clinical data comparing these treatments are limited.
The purpose of this study was to compare the clinical outcomes between DAPT and OAC in patients with AF.
A cohort study using a population-wide database of the Hong Kong Hospital Authority was performed. New patients with AF from 2010-2014 who were prescribed DAPT or OAC (warfarin or dabigatran) were followed until July 31, 2016. Outcomes were thromboembolism, bleeding, and death. Propensity score (PS) matching at a ratio of 1:2 was used to select DAPT users with characteristics similar to those of OAC users, analyzed using Poisson regression.
Among 51,946 new patients with AF, 8520 users of OAC and DAPT were identified. The likelihood of receiving DAPT over OAC increased with older age and previous intracranial hemorrhage. Among DAPT users, the incidences of thromboembolism, death, and bleeding per 100 patient-years were 15.8, 17.6, and 5.1, respectively. Compared to DAPT users, PS-matched analysis indicated a lower incidence of thromboembolism and/or death among OAC users (dabigatran: incidence rate ratio IRR 0.32; 95% confidence interval CI 0.19-0.55; warfarin: IRR 0.58; 95% CI 0.36-0.95), with no significant differences in bleeding events.
DAPT users were at markedly increased risk for thromboembolism and death compared to OAC users. These findings indicate the need for improved stroke risk reduction strategies among patients taking DAPT and the opportunities for using OAC in high-risk groups to prevent additional events.
Logit models are popular tools for analyzing discrete choice and ranking data. The models assume that judges rate each item with a measurable utility, and the ordering of a judge’s utilities ...determines the outcome. Logit models have been proven to be powerful tools, but they become difficult to interpret if the models contain nonlinear and interaction terms. We extended the logit models by adding a decision tree structure to overcome this difficulty. We introduced a new method of tree splitting variable selection that distinguishes the nonlinear and linear effects, and the variable with the strongest nonlinear effect will be selected in the view that linear effect is best modeled using the logit model. Decision trees built in this fashion were shown to have smaller sizes than those using loglikelihood-based splitting criteria. In addition, the proposed splitting methods could save computational time and avoid bias in choosing the optimal splitting variable. Issues on variable selection in logit models are also investigated, and forward selection criterion was shown to work well with logit tree models. Focused on ranking data, simulations are carried out and the results showed that our proposed splitting methods are unbiased. Finally, to demonstrate the feasibility of the logit tree models, they were applied to analyze two datasets, one with binary outcome and the other with ranking outcome.
Background and purpose
The aim was to determine trends and patterns of symptomatic medication used against dementia in 66 countries and regions.
Methods
This was a cross‐sectional study that used the ...wholesale data from the IQVIA Multinational Integrated Data Analysis System database. Sale data for symptomatic medication against dementia from 66 countries and regions from 2008 to 2018 were analysed and stratified by income level (low/middle‐income countries LMICs, n = 27; high‐income countries HICs, n = 37; regions, n = 2). The medication use volume was estimated by defined daily dose (DDD) per 1000 inhabitants per day (World Health Organization DDD harmonized the size, strength and form of each pack and reflects average dosing). Changes in medication use over time were quantified as percentage changes in compound annual growth rates (CAGRs).
Results
Total symptomatic medication against dementia sales increased from 0.85 to 1.33 DDD per 1000 inhabitants per day between 2008 and 2018 (LMICs 0.094–0.396; HICs 3.88–5.04), which is an increase of CAGR of 4.53% per year. The increase was mainly driven by the LMICs (CAGR = 15.42%) in comparison to the HICs (CAGR = 2.65%). The overall medication use from 2008 to 2018 increased for all four agents: memantine (CAGR = 8.51%), rivastigmine (CAGR = 6.91%), donepezil (CAGR = 2.72%) and galantamine (CAGR = 0.695%). In 2018, the most commonly used medication globally was donepezil, contributing to 49.8% of total use volume, followed by memantine (32.7%), rivastigmine (11.24%) and galantamine (6.36%).
Conclusion
There was an increasing trend in the use of symptomatic medications against dementia globally, but the use remained low in LMICs. Interventions may be needed to support the medication use in some countries.
A cross‐sectional study was conducted that investigated the global trend in symptomatic medication use against dementia in 66 countries and regions. There was an increasing trend in the use of medications against dementia globally. The increase was mainly driven by the low‐ to middle‐income countries (LMICs), but the overall usage remained low in LMICs compared to high‐income countries.
Abstract
Objective
To explore the extent of use and perceived effectiveness of using a medication lubricant that is specifically designed to help people who struggle to swallow their solid ...medications whole.
Method
Health care workers of varying professional levels in aged care facilities (ACFs) across Australia who are involved in medication administration were invited to participate in a structured online survey.
Results
Of the 355 health care workers who completed the survey, 48% had used the medication lubricant to aid administration of whole and/or crushed solid oral dosage forms, and of these 89% agreed with the statement that “it is effective method to facilitate medication swallowing in residents.” The main benefits of using the medication lubricant were considered to be easier medication administration to residents (49%), reduction in need for crushing of medications (34%), and better adherence with medications (33%).
Conclusions
This study showed that using a medication lubricant for aged care residents may facilitate the process of medication administration for health care workers, which they perceive to improve residents' adherence with medications. Serious complications associated with solid dosage form modification may also be decreased by using a medication lubricant, as the need for modifying medications is reduced. Therapeutic Goods Administration (TGA)‐approved medication lubricants could therefore be a valuable tool to aid the medication administration for patients who have difficulties swallowing medications. Future research may consider the clinical efficacy and acceptability of medication lubricants specifically for people with swallowing difficulties.
Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of ...mental health diagnoses during the COVID-19 pandemic.
By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database up to November 2021) the introduction of COVID-related restrictions.
A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021.
Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.
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