Search results for: clinical outcome

Authors: Guilherme Giacomini, Ana Luiza Menegatti Pavan, Allan Felipe Fattori Alves, Marcela de Oliveira, Fernando Antonio Bacchim Neto, José Ricardo de Arruda Miranda, Seizo Yamashita, Diana Rodrigues de Pina

Abstract:

The maxillary sinus (MS), part of the paranasal sinus complex, is one of the most enigmatic structures in modern humans. The literature has suggested that MSs function as olfaction accessories, to heat or humidify inspired air, for thermoregulation, to impart resonance to the voice and others. Thus, the real function of the MS is still uncertain. Furthermore, the MS anatomy is complex and varies from person to person. Many diseases may affect the development process of sinuses. The incidence of rhinosinusitis and other pathoses in the MS is comparatively high, so, volume analysis has clinical value. Providing volume values for MS could be helpful in evaluating the presence of any abnormality and could be used for treatment planning and evaluation of the outcome. The computed tomography (CT) has allowed a more exact assessment of this structure, which enables a quantitative analysis. However, this is not always possible in the clinical routine, and if possible, it involves much effort and/or time. Therefore, it is necessary to have a convenient, robust, and practical tool correlated with the MS volume, allowing clinical applicability. Nowadays, the available methods for MS segmentation are manual or semi-automatic. Additionally, manual methods present inter and intraindividual variability. Thus, the aim of this study was to develop an automatic tool to quantity the MS volume in CT scans of paranasal sinuses. This study was developed with ethical approval from the authors’ institutions and national review panels. The research involved 30 retrospective exams of University Hospital, Botucatu Medical School, São Paulo State University, Brazil. The tool for automatic MS quantification, developed in Matlab®, uses a hybrid method, combining different image processing techniques. For MS detection, the algorithm uses a Support Vector Machine (SVM), by features such as pixel value, spatial distribution, shape and others. The detected pixels are used as seed point for a region growing (RG) segmentation. Then, morphological operators are applied to reduce false-positive pixels, improving the segmentation accuracy. These steps are applied in all slices of CT exam, obtaining the MS volume. To evaluate the accuracy of the developed tool, the automatic method was compared with manual segmentation realized by an experienced radiologist. For comparison, we used Bland-Altman statistics, linear regression, and Jaccard similarity coefficient. From the statistical analyses for the comparison between both methods, the linear regression showed a strong association and low dispersion between variables. The Bland–Altman analyses showed no significant differences between the analyzed methods. The Jaccard similarity coefficient was > 0.90 in all exams. In conclusion, the developed tool to quantify MS volume proved to be robust, fast, and efficient, when compared with manual segmentation. Furthermore, it avoids the intra and inter-observer variations caused by manual and semi-automatic methods. As future work, the tool will be applied in clinical practice. Thus, it may be useful in the diagnosis and treatment determination of MS diseases. Providing volume values for MS could be helpful in evaluating the presence of any abnormality and could be used for treatment planning and evaluation of the outcome. The computed tomography (CT) has allowed a more exact assessment of this structure which enables a quantitative analysis. However, this is not always possible in the clinical routine, and if possible, it involves much effort and/or time. Therefore, it is necessary to have a convenient, robust and practical tool correlated with the MS volume, allowing clinical applicability. Nowadays, the available methods for MS segmentation are manual or semi-automatic. Additionally, manual methods present inter and intraindividual variability. Thus, the aim of this study was to develop an automatic tool to quantity the MS volume in CT scans of paranasal sinuses. This study was developed with ethical approval from the authors’ institutions and national review panels. The research involved 30 retrospective exams of University Hospital, Botucatu Medical School, São Paulo State University, Brazil. The tool for automatic MS quantification, developed in Matlab®, uses a hybrid method, combining different image processing techniques. For MS detection, the algorithm uses a Support Vector Machine (SVM), by features such as pixel value, spatial distribution, shape and others. The detected pixels are used as seed point for a region growing (RG) segmentation. Then, morphological operators are applied to reduce false-positive pixels, improving the segmentation accuracy. These steps are applied in all slices of CT exam, obtaining the MS volume. To evaluate the accuracy of the developed tool, the automatic method was compared with manual segmentation realized by an experienced radiologist. For comparison, we used Bland-Altman statistics, linear regression and Jaccard similarity coefficient. From the statistical analyses for the comparison between both methods, the linear regression showed a strong association and low dispersion between variables. The Bland–Altman analyses showed no significant differences between the analyzed methods. The Jaccard similarity coefficient was > 0.90 in all exams. In conclusion, the developed tool to automatically quantify MS volume proved to be robust, fast and efficient, when compared with manual segmentation. Furthermore, it avoids the intra and inter-observer variations caused by manual and semi-automatic methods. As future work, the tool will be applied in clinical practice. Thus, it may be useful in the diagnosis and treatment determination of MS diseases.

Keywords: maxillary sinus, support vector machine, region growing, volume quantification

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Authors: N. N. Pilau, M. S. Abubakar, A. Danmaigoro, P. C. Mshelia, Y. Sani

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A severely debilitated 4months old Caucasian male dog presented dehydration, emaciation, vomiting, icteric ocular and oral mucous membranes, generalized lymphadenopathy, hematuria, anorexia and prolonged recumbency. Clinical workup was done in established protocols for diagnosis based on history, clinical signs and selected laboratory tests. Treatment course were administered over 48hours during which the patient died of overwhelming hepatopathy, nephropathy and pneumonia. Postmortem findings supported by ante mortem laboratory test results tentatively diagnosed leptospirosis, a disease endemic and presenting potentially fatal epidemics and zoonoses in some countries amongst the developing regions of the world. This disease is reviewed and a call for attention on the public health significance of the disease is hereby presented through this case report.

Keywords: canine, endemic, leptospirosis, prevalence

Procedia PDF Downloads 488

Authors: Isabel Cristina Ortiz Trujillo, Lina Maria Martinez Sanchez, Felipe Hernández Restrepo, Daniel Gallego Gonzalez, Natalia Vargas Grisales, Camilo Andrés Agudelo Vélez

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Chorioamnionitis, is a pregnancy infection, causes different fetal and maternal symptoms. Streptococcus agalactiae present in the normal vaginal microflora of some women, favouring its abnormal multiplication during pregnancy, causing perinatal morbidity and mortality. Objective. Describe the clinical and epidemiological profile of the patients with diagnosis of clinical chorioanmionitis. Methodology. Descriptive, cross-sectional study. The population was patients with diagnosis of clinical chorioanmionitis. The information was taken from the medical records. The research was approved by the Ethics Committee. We used the program SPSS ® version 17.0 (SPSS Inc; Chicago, Illinois, USA) for the information analysis, descriptive statistics were used. Results. 78 patients in total with clinical chorioamnionitis, with a mean age of 26.3 ±5, 8 years old, the 69.2% primigravid women. 2.6% of women had positive culture for Streptococcus agalactiae in urine sample during current pregnancy and 30.7% had received some kind of antibiotics during current pregnancy. The 57.7% had 37 to 40 weeks of gestation in the current pregnancy it was calculated more frequently by ultrasound (66.7% in first quarter, 11.5% in the second and 1.9% in the third). In a 60.3% way of termination of pregnancy was vaginal and a 35.9 percent were caesarean section. Among the women in the study, a 30.8% had premature rupture of membranes. Conclusion. The chorioamnionitis continues to be an important cause of antibiotic use during pregnancy or labour and the decision to do a caesarean, with highest percentage in pregnancies-preterm and preterm premature rupture of membranes.

Keywords: chorioamnionitis, Streptococcus agalactiae, pregnancy complications, infectious

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Authors: Fatemeh Keshavarz

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Background: Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, often leading to joint damage and physical disability. This study aimed to investigate the relationship of serum levels of interleukin 17 and anti-CCP factor with disease severity in RA patients. Materials and Methods: Fifty-four patients with RA confirmed by clinical and laboratory criteria were recruited. A 5 ml venous blood sample was taken from every patient, its serum was separated. Based on clinical data and severity of symptoms, patients were classified into three groups of those with mild, moderate, and severe symptoms. Serum levels of IL-17 and anti-CCP in all samples were measured using ELISA. Results: Analysis of IL-17 serum levels in different groups showed that its amount was higher in the group with mild clinical symptoms than in other groups. Comparison of IL-17 serum levels between mild and moderate disease severity groups showed a statistically significant relationship. There was also a positive linear relationship between anti-CCP and serum IL-17 levels in different groups of the disease, and serum IL-17 levels were inversely related to the duration of exposure to the disease. Conclusion: Higher IL-17 serum levels in patients with mild symptom severity confirm that this highly specific marker is involved in the pathogenesis of RA and may be effective in initiating patients’ clinical symptoms.

Keywords: IL-17, anti-CCP, rheumatoid arthritis, autoimmune

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Authors: Amina Bouzitouna, Kheireddine Ouali, Sandra Amri, Houria Rahmoun, Mourad Bensouilah

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Aim of this study: To evaluate the effect of Cisthanche tinctoria treatment on maternal-fetal outcome and antioxidant systems of streptozotocin-induced diabetic rats. Materials and methods: Virgin female Wistar rats were injected with 50 mg/kg streptozotocin before mating. Oral administration of an methanolic extract of Cistanche tinctoria was given to non-diabetic and diabetic pregnant rats at doses of 200 mg/kg from 0 to 19th day of pregnancy. At day 20 of pregnancy the rats were killed and a maternal blood sample was collected for the determination Vitamin C (Vit C) and malonaldehyde (MDA). The gravid uterus was weighed with its contents and fetuses were analyzed. Results and conclusion: The data showed that the diabetic dams presented an increased glycemic level, resorption, placental weight, placental index, and fetal anomalies, and reduced VIT C and MDA determinations, live fetuses, maternal weight gain, gravid uterine weight, and fetal weight. It was also verified that Cisthanche tictoria treatment had no hypoglycemic effect, did not improve maternal outcomes in diabetic rats, but it contributed to maintain GSH concentration similarly to non-diabetic groups, suggesting relation with the decreased incidence of visceral anomalies.

Keywords: cistanche tinctoria, diabetes, pregnancy, reproductive outcome, anomaly, orobanchacées

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Authors: Venencia Albert, Arulselvi Subramanian, Hara Prasad Pati, Asok K. Mukhophadhyay

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Acute traumatic coagulopathy in an endogenous dysregulation of the intrinsic coagulation system in response to the injury, associated with three-fold risk of poor outcome, and is more amenable to corrective interventions, subsequent to early identification and management. Multiple definitions for stratification of the patients' risk for early acute coagulopathy have been proposed, with considerable variations in the defining criteria, including several trauma-scoring systems based on prehospital data. We aimed to develop a clinically relevant definition for acute coagulopathy of trauma based on conventional coagulation assays and to assess its efficacy in comparison to recently established prehospital prediction models. Methodology: Retrospective data of all trauma patients (n = 490) presented to our level I trauma center, in 2014, was extracted. Receiver operating characteristic curve analysis was done to establish cut-offs for conventional coagulation assays for identification of patients with acute traumatic coagulopathy was done. Prospectively data of (n = 100) adult trauma patients was collected and cohort was stratified by the established definition and classified as "coagulopathic" or "non-coagulopathic" and correlated with the Prediction of acute coagulopathy of trauma score and Trauma-Induced Coagulopathy Clinical Score for identifying trauma coagulopathy and subsequent risk for mortality. Results: Data of 490 trauma patients (average age 31.85±9.04; 86.7% males) was extracted. 53.3% had head injury, 26.6% had fractures, 7.5% had chest and abdominal injury. Acute traumatic coagulopathy was defined as international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s. Of the 100 adult trauma patients (average age 36.5±14.2; 94% males), 63% had early coagulopathy based on our conventional coagulation assay definition. Overall prediction of acute coagulopathy of trauma score was 118.7±58.5 and trauma-induced coagulopathy clinical score was 3(0-8). Both the scores were higher in coagulopathic than non-coagulopathic patients (prediction of acute coagulopathy of trauma score 123.2±8.3 vs. 110.9±6.8, p-value = 0.31; trauma-induced coagulopathy clinical score 4(3-8) vs. 3(0-8), p-value = 0.89), but not statistically significant. Overall mortality was 41%. Mortality rate was significantly higher in coagulopathic than non-coagulopathic patients (75.5% vs. 54.2%, p-value = 0.04). High prediction of acute coagulopathy of trauma score also significantly associated with mortality (134.2±9.95 vs. 107.8±6.82, p-value = 0.02), whereas trauma-induced coagulopathy clinical score did not vary be survivors and non-survivors. Conclusion: Early coagulopathy was seen in 63% of trauma patients, which was significantly associated with mortality. Acute traumatic coagulopathy defined by conventional coagulation assays (international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s) demonstrated good ability to identify coagulopathy and subsequent mortality, in comparison to the prehospital parameter-based scoring systems. Prediction of acute coagulopathy of trauma score may be more suited for predicting mortality rather than early coagulopathy. In emergency trauma situations, where immediate corrective measures need to be taken, complex multivariable scoring algorithms may cause delay, whereas coagulation parameters and conventional coagulation tests will give highly specific results.

Keywords: trauma, coagulopathy, prediction, model

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Authors: Atena Sadat Hosseini, Mohammadhossein Habibi

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Acute myeloid leukemia (AML) is the most typically diagnosed leukemia. In older adults, AML imposes a dismal outcome. AML originates with a dominant mutation, then adds collaborative, transformative mutations leading to myeloid transformation and clinical/biological heterogeneity. Several chemotherapeutic drugs are used for this cancer. These drugs are naturally associated with several side effects, and finding a more accurate molecular mechanism of these drugs can have a significant impact on the selection and better candidate of drugs for treatment. In this study, we evaluated bortezomibin myeloma cells using bioinformatics analysis and evaluation of RNA-Seq data. Then investigated the molecular pathways proteins- proteins interactions associated with this chemotherapy drug. A total of 658upregulated genes and 548 downregulated genes were sorted.AUF1 (hnRNP D0) binds and destabilizes mRNA, degradation of GLI2 by the proteasome, the role of GTSE1 in G2/M progression after G2 checkpoint, TCF dependent signaling in response to WNT demonstrated in upregulated genes. Besides insulin resistance, AKT phosphorylates targets in the nucleus, cytosine methylation, Longevity regulating pathway, and Signal Transduction of S1P Receptor were related to low expression genes. With respect to this results, HIST2H2AA3, RP11-96O20.4, ZED9, PRDX1, and DOK2, according to node degrees and betweenness elements candidates from upregulated genes. in the opposite side, PYURF, NRSN1, FGF23, UPK3BL, and STAG3 were a prominent role in downregulated genes. Sum up, Using in silico analysis in the present study, we conducted a precise study ofbortezomib molecular mechanisms in myeloma cells. so that we could take further evaluation to discovermolecular cancer therapy. Naturally, more additional experimental and clinical procedures are needed in this survey.

Keywords: myeloma cells, acute myeloid leukemia, bioinformatics analysis, bortezomib

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Authors: Hamna Hamid, Kashmala Zaman

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The aim of this study was to evaluate the relationship between self-efficacy, resilience, and social support among clinical psychologists, counselors, and teachers of special schools. The study also assesses the gender differences in self-efficacy, resilience, social support, and vicarious trauma and also vicarious trauma differences among three professions, i.e., clinical psychologists, counselors, and teachers of special schools. A sample of 150 women and 97 men were handed out a set questionnaire to complete: a General Self-Efficacy Scale, Brief Resilience Scale, Multidimensional Scale of Perceived Social Support, and Vicarious Trauma Scale. Results showed that there is a significant negative correlation between self-efficacy, resilience, and vicarious trauma. Women experience higher levels of vicarious trauma as compared to men. At the same time, clinical psychologists and counselors experience higher levels of vicarious trauma as compared to teachers of special schools. The moderation effect of social support is not significant towards resilience and vicarious trauma.

Keywords: self-efficacy, resilience, vicarious-trauma social-support, social support

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Authors: K. S. Poutanen, P. Dussort, A. Erkner, S. Fiszman, K. Karnik, M. Kristensen, C. F. M. Marsaux, S. Miquel-Kergoat, S. Pentikäinen, P. Putz, R. E. Steinert, J. Slavin, D. J. Mela

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Dietary fiber (DF) intake has been associated with lower body weight or less weight gain. These effects are generally attributed to putative effects of DF on appetite. Many intervention studies have tested the effect of DFs on appetite-related measures, with inconsistent results. However, DF includes a wide category of different compounds with diverse chemical and physical characteristics, and correspondingly diverse effects in human digestion. Thus, inconsistent results between DF consumption and appetite are not surprising. The specific contribution of different compounds with varying physico-chemical properties to appetite control and the mediating mechanisms are not well characterized. This systematic review aimed to assess the influence of specific DF characteristics, including viscosity, gel forming capacity, fermentability, and molecular weight, on appetite-related outcomes in healthy humans. Medline and FSTA databases were searched for controlled human intervention trials, testing the effects of well-characterized DFs on subjective satiety/appetite or energy intake outcomes. Studies were included only if they reported: 1) fiber name and origin, and 2) data on viscosity, gelling properties, fermentability, or molecular weight of the DF materials tested. The search generated 3001 unique records, 322 of which were selected for further consideration from title and abstract screening. Of these, 149 were excluded due to insufficient fiber characterization and 124 for other reasons (not original article, not randomized controlled trial, or no appetite related outcome), leaving 49 papers meeting all the inclusion criteria, most of which reported results from acute testing (<1 day). The eligible 49 papers described 90 comparisons of DFs in foods, beverages or supplements. DF-containing material of interest was efficacious for at least one appetite-related outcome in 51/90 comparisons. Gel-forming DF sources were most consistently efficacious but there were no clear associations between viscosity, MW or fermentability and appetite-related outcomes. A considerable number of papers had to be excluded from the review due to shortcomings in fiber characterization. To build understanding about the impact of DF on satiety/appetite specifically there should be clear hypotheses about the mechanisms behind the proposed beneficial effect of DF material on appetite, and sufficient data about the DF properties relevant for the hypothesized mechanisms to justify clinical testing. The hypothesized mechanisms should also guide the decision about relevant duration of exposure in studies, i.e. are the effects expected to occur during acute time frame (related to stomach emptying, digestion rate, etc.) or develop from sustained exposure (gut fermentation mediated mechanisms). More consistent measurement methods and reporting of fiber specifications and characterization are needed to establish reliable structure-function relationships for DF and health outcomes.

Keywords: appetite, dietary fiber, physico-chemical properties, satiety

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Authors: Prataksitorn Chonlakan, Tiparat Wongsilarat

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The traditional clinical practice guideline used at the emergency room at Songkhla Hospital in caring for patients who come in contact with jellyfish venom took a long time for the pain to reduce to the level that patients can cope with. To investigate the effectiveness of clinical practice guidelines by comparing the effectiveness of a newly developed clinical practice guideline with the traditional clinical practice guideline in the following aspects: 1) pain reduction, 2) length of pain, 3) the rate of patient’s re-visit, 4) the rate of severe complications such as anaphylactic shock, and cardiac arrest, and death, and 5) patient satisfaction. This study employed a quasi-experimental research design. Thirty subjects were selected with purposive sampling from jellyfish-sting patients who came for treatment at the Emergency Room of Songkhla Hospital. The subjects were divided using random assignment into two groups of 15 each: an experimental group, and the control group. The control group was treated using the traditional clinical practice guideline consisting of rinsing the affected area with 0.9% normal saline, using a cloth soaked with vinegar to press against the affected area, and controlling pain using tramadol or diclofenac intramuscular injection. The data were analyzed using descriptive statistics and paired t-test at the significance level p < 0.05. The results of the study revealed the following. The pain level in the experimental group was significantly lower than that of the control group (the average pain score of the experimental group was 3.46 while that of the control group was 6.33) (p < 0.05).The length of pain in the experimental group was significantly lower than that of the control group (the average length of pain in the experimental group was 48.67 minutes while that of the control group was 105.35 minutes) (p < 0.05). The rate of re-visit within 12 hours in the experimental group was significantly lower than that of the control group (the rate of re-visit within 12 hours of the experimental group was 0.07 while that of the control group was 0.00) (p < 0.05).No severe complications such as anaphylactic shock, and cardiac arrest were found in the two groups of subjects.The rate of satisfaction among the subjects in the experimental group was significantly higher than that of the control group (the rate of satisfaction among the subjects of the experimental group was 90.00 percent while that among the control group was 66.33 percent) (p < 0.05). The newly develop clinical practice guideline could reduce pain and increase satisfaction among jellyfish-sting patients better than the traditional clinical practice guideline.

Keywords: effectiveness, clinical practice guideline, jellyfish-sting patients, cardiac arrest

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Authors: Omneya Messallam

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Technology has been developed dramatically in most of the educational disciplines. For instance, digital rendering subject, which is being taught in both Interior and Architecture fields, is witnessing almost annually updated software versions. A lot of students and educators argued that there will be no need for manual rendering techniques to be learned. Therefore, the Interior Design Visual Presentation 1 course (ID133) has been chosen from the first level of the Interior Design (ID) undergraduate program, as it has been taught for six years continually. This time frame will facilitate sound observation and critical analysis of the use of appropriate teaching methodologies. Furthermore, the researcher believes in the high value of the manual rendering techniques. The course objectives are: to define the basic visual rendering principles, to recall theories and uses of various types of colours and hatches, to raise the learners’ awareness of the value of studying manual render techniques, and to prepare them to present their work professionally. The students are female Arab learners aged between 17 and 20. At the outset of the course, the majority of them demonstrated negative attitude, lacking both motivation and confidence in manual rendering skills. This paper is a reflective appraisal of deploying two student-centred teaching pedagogies which are: Project-based learning (PBL) and Outcome-based education (OBE) on ID133 students. This research aims of developing some teaching strategies to enhance the quality of teaching in this given course over an academic semester. The outcome of this research emphasized the positive influence of applying such educational methods on improving the quality of students’ manual rendering skills in terms of: materials, textiles, textures, lighting, and shade and shadow. Furthermore, it greatly motivated the students and raised the awareness of the importance of learning the manual rendering techniques.

Keywords: project-based learning, outcome-based education, visual presentation, manual render, personal competences

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Authors: Harpa Ragnarsdóttir, Magnús Kjartan Gíslason, Kristín Briem, Guðný Lilja Oddsdóttir

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Introduction: Whiplash-Associated Disorder (WAD) is a health problem characterized by motor, neurological and psychosocial symptoms, stressing the need for a multimodal treatment approach. To achieve individualized multimodal approach, prognostic factors need to be identified early using validated patient-reported and objective outcome measures. The aim of this study is to demonstrate the degree of association between patient-reported and clinical outcome measures of WAD patients in the subacute phase. Methods: Individuals (n=41) with subacute (≥1, ≤3 months) WAD (I-II), medium to high-risk symptoms, or neck pain rating ≥ 4/10 on the Visual Analog Scale (VAS) were examined. Outcome measures included measurements for movement control (Butterfly test) and cervical active range of motion (cAROM) using the NeckSmart system, a computer system using an inertial measurement unit (IMU) that connects to a computer. The IMU sensor is placed on the participant’s head, who receives visual feedback about the movement of the head. Patient-reported neck disability, pain intensity, general health, self-perceived handicap, central sensitization, and difficulties due to dizziness were measured using questionnaires. Excel and R statistical software were used for statistical analyses. Results: Forty-one participants, 15 males (37%), 26 females (63%), mean (SD) age 36.8 (±12.7), underwent data collection. Mean amplitude accuracy (AA) (SD) in the Butterfly test for easy, medium, and difficult paths were 2.4mm (0.9), 4.4mm (1.8), and 6.8mm (2.7), respectively. Mean cAROM (SD) for flexion, extension, left-, and right rotation were 46.3° (18.5), 48.8° (17.8), 58.2° (14.3), and 58.9° (15.0), respectively. Mean scores on the Neck Disability Index (NDI), VAS, Dizziness Handicap Inventory (DHI), Central Sensitization Inventory (CSI), and 36-Item Short Form Survey RAND version (RAND) were 43% (17.4), 7 (1.7), 37 (25.4), 51 (17.5), and 39.2 (17.7) respectively. Females showed significantly greater deviation for AA compared to males for easy and medium Butterfly paths (p<0.05). Statistically significant moderate to strong positive correlation was found between the DHI and easy (r=0.6, p=0.05), medium (r=0.5, p=0.05)) and difficult (r=0.5, p<0.05) Butterfly paths, between the total RAND score and all cAROMs (r between 0.4-0.7, p≤0.05) except flexion (r=0.4, p=0.7), and between the NDI score and CSI (r=0.7, p<0.01), VAS (r=0.5, p<0.01), and DHI (r=0.7, p<0.01) scores respectively. Discussion: All patient-reported and objective measures were found to be outside the reference range. Results suggest females have worse movement control in the neck in the subacute WAD phase. However, no statistical difference based on gender was found in patient-reported measures. Suggesting females might have worse movement control than males in general in this phase. The correlation found between DHI and the Butterfly test can be explained because the DHI measures proprioceptive symptoms like dizziness and eye movement disorders that can affect the outcome of movement control tests. A correlation was found between the total RAND score and cAROM, suggesting that a reduced range of motion affects the quality of life. Significance: The NeckSmart system can detect abnormalities in cAROM, fine movement control, and kinesthesia of the neck. Results suggest females have worse movement control than males. Results show a moderate to a high correlation between several patient-reported and objective measurements.

Keywords: whiplash associated disorders, car-collision, neck, trauma, subacute

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Authors: Watin Alkhelaiwi, Iseult Wilson, Marian Traynor, Katherine Rogers

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Clinical nursing education allows nursing students to gain essential knowledge from practice experience and develop nursing skills in a variety of clinical environments. Integrating theoretical knowledge and practical skills is made easier for nursing students by providing opportunities for practice in a clinical environment. Nursing competency is an essential capability required to fulfill nursing responsibilities. Effective mentoring in clinical settings helps nursing students develop the necessary competence and promotes the integration of theory and practice. Preceptors play a considerable role in clinical nursing education, including the supervision of nursing students undergoing a rigorous clinical practicum. Preceptors are also involved in the clinical assessment of nursing students’ competency. The assessment of nursing students’ competence by professional practitioners is essential to investigate whether nurses have developed an adequate level of competence to deliver safe nursing care. Competency assessment remains challenging among nursing educators and preceptors, particularly owing to the complexity of the process. Consistency in terms of assessment methods and tools and valid and reliable assessment tools for measuring competence in clinical practice are lacking. Nurse preceptors must assess students’ competencies to prepare them for future professional responsibilities. Preceptors encounter difficulties in the assessment of competency owing to the nature of the assessment process, lack of standardised assessment tools, and a demanding clinical environment. The purpose of the study is to examine nursing preceptors’ experiences of assessing nursing interns’ competency in Saudi Arabia. There are three objectives in this study; the first objective is to examine the preceptors’ view of the Saudi assessment tool in relation to preceptorship, assessment, the assessment tool, the nursing curriculum, and the grading system. The second and third objectives are to examine preceptors’ view of "competency'' in nursing and their interpretations of the concept of competency and to assess the implications of the research in relation to the Saudi 2030 vision. The study uses an exploratory sequential mixed-methods design that involves a two-phase project: a qualitative focus group study is conducted in phase 1, and a quantitative study- a descriptive cross-sectional design (online survey) is conducted in phase 2. The results will inform the preceptors’ view of the Saudi assessment tool in relation to specific areas, including preceptorship and how the preceptors are prepared to be assessors, and assessment and assessment tools through identifying the appropriateness of the instrument for clinical practice. The results will also inform the challenges and difficulties that face the preceptors. These results will be analysed thematically for the focus group interview data, and SPSS software will be used for the analysis of the online survey data.

Keywords: clinical assessment tools, clinical competence, competency assessment, mentor, nursing, nurses, preceptor

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Authors: M. Hirani, M. Devine, O. Obisesan, C. Bryant

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Introduction: The use of four or more implants to support a fixed prosthesis in the edentulous mandible is well documented, with high levels of clinical outcomes recorded. Despite this, the use of three implant-supported fixed prostheses offers the potential to deliver a more cost-effective method of oral rehabilitation in the lower arch, an important consideration given that edentulism is most prevalent in low-income subpopulations. The purpose of this study aimed to evaluate the implant and prosthetic survival rate, changes in marginal bone level, and patient satisfaction associated with a three-implant-supported fixed prosthesis for rehabilitation of the edentulous mandible over a follow-up period of at least one year. Methods: A comprehensive literature search was performed to evaluate studies that met the selection criteria. The information extracted included the study design and population, participant demographics, observation period, loading protocol, and the number of implants placed together with the required outcome measures. Mean values and standard deviations (SD) were calculated using SPSS® (IBM Corporation, New York, USA), and the level of statistical significance across all comparative studies described was set at P < 0.05. Results: The eligible studies included a total of 1968 implants that were placed in 652 patients. The subjects ranged in age from 33-89 years, with a mean of 63.2 years. The mean cumulative implant and prosthetic survival rates were 95.5% and 96.2%, respectively, over a mean follow-up period of 3.25 years. The mean marginal bone loss recorded was 1.04 mm, and high patient satisfaction rates were reported across the studies. Conclusion: Current evidence suggests that a three implant-supported fixed prosthesis for the edentulous mandible is a successful treatment strategy presenting high implant and prosthetic survival rates over the short-to-medium term. Further well-designed controlled clinical trials are required to evaluate longer-term outcomes, with supplemental data correlating implant dimensions and prosthetic design.

Keywords: implants, mandible, fixed, prosthesis

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Authors: Mohammadreza Mohebbi, Masoumeh Sanagou

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The ability to predict clinical outcomes is of great importance to physicians and clinicians. A number of different methods have been used in an effort to accurately predict these outcomes. These methods include the development of scoring systems based on multivariate statistical modelling, and models involving the use of classification and regression trees. The process usually consists of two consecutive phases, namely model development and external validation. The model development phase consists of building a multivariate model and evaluating its predictive performance by examining calibration and discrimination, and internal validation. External validation tests the predictive performance of a model by assessing its calibration and discrimination in different but plausibly related patients. A motivate example focuses on prediction modeling using a sample of patients undergone coronary artery bypass graft (CABG) has been used for illustrative purpose and a set of primary considerations for evaluating prediction model studies using specific quality indicators as criteria to help stakeholders evaluate the quality of a prediction model study has been proposed.

Keywords: clinical prediction models, clinical decision rule, prognosis, external validation, model calibration, biostatistics

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Authors: Matej Stritesky

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The research deals with the connection between the Schwartz Theory of Basic Values and the ethical principles in psychology, on which the meta-code of ethics the European Federation of Psychological Associations is based. The research focuses on ethically problematic situations in clinical psychology in the Czech Republic. Based on the analysis of papers that identified ethically problematic situations faced by clinical psychologists, a questionnaire of ethically problematic situations in clinical psychology (EPSCP) was created for the purposes of the research. The questionnaire was created to represent situations that correspond to the 4 principles on which the meta-code of ethics the European Federation of Psychological Associations is based. The questionnaire EPSCP consists of descriptions of 32 situations that respondents evaluate on a scale from 1 (psychologist's behaviour is ethically perfectly fine) to 10 (psychologist's behaviour is ethically completely unacceptable). The EPSCP questionnaire, together with Schwartz's PVQ questionnaire, will be presented to 60 psychology students. The relationship between principles in clinical psychology and the values on Schwartz´s value continuum will be described using multidimensional scaling. A positive correlation is assumed between the higher-order value of openness to change and problematic ethical situations related to the principle of integrity; a positive correlation between the value of the higher order of self-transcendence and the principle of respect and responsibility; a positive correlation between the value of the higher order of conservation and the principle of competence; and negative correlation between the value of the higher order of ego strengthening and sensitivity to ethically problematic situations. The research also includes an experimental part. The first half of the students are presented with the code of ethics of the Czech Association of Clinical Psychologists before completing the questionnaires, and to the second half of the students is the code of ethics presented after completing the questionnaires. In addition to reading the code of ethics, students describe the three rules of the code of ethics that they consider most important and state why they chose these rules. The output of the experimental part will be to determine whether the presentation of the code of ethics leads to greater sensitivity to ethically problematic situations.

Keywords: clinical psychology, ethically problematic situations in clinical psychology, ethical principles in psychology, Schwartz theory of basic values

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Authors: Shanti Faridah Salleh, Azzahrah Anuar, Hamimah Ujir, Rohana Sapawi, Wan Hashim Wan Ibrahim, Noraziah Abdul Wahab, Majina Sulaiman, Raudhah Ahmadi, Al-Khalid Othman, Johari Abdullah

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Integrated Cumulative Grade Point Average or iCGPA is an evaluation and reporting system that represents a comprehensive development of students’ achievement in their academic programs. Universiti Malaysia Sarawak, UNIMAS has started its implementation of iCGPA in 2016. iCGPA is driven by the Outcome-Based Education (OBE) system that has been long integrated into the higher education in Malaysia. iCGPA is not only a tool to enhance the OBE concept through constructive alignment but it is also an integrated mechanism to assist various stakeholders in making decisions or planning for program improvement. The outcome of this integrated system is the reporting of students’ academic performance in terms of cognitive (knowledge), psychomotor (skills), and affective (attitude) of which the students acquire throughout the duration of their study. The iCGPA reporting illustrates the attainment of student’s attribute in the eight domains of learning outcomes listed in the Malaysian Qualifications Framework (MQF). This paper discusses on the implementation of iCGPA in UNIMAS on the policy and strategy to direct the whole university to implement the iCGPA. The steps and challenges in integrating the exsting Outcome-Based Education and utilising iCGPA as a tool to quantify the students’ achievement are also highlighted in this paper. Finally, the ACADEMIA system, which is a dedicated centralised program ensure the implementation of iCGPA is a success has been developed. This paper discusses the structure and the analysis of ACADEMIA program and concludes the analysis made on the improvement made on the implementation of constructive alignment in all 40 programs involves in iCGPA implementation.

Keywords: constructive alignment, holistic graduates, mapping of assessment, programme outcome

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Authors: Stéfani T. A. Dantas, Laura T. S. Takume, Bruna F. Rossi, Érika R. Bonsaglia, Ivana G. Castilho, José C. F. Pantoja, Ary Fernandes Júnior, Juliano L. Gonçalves, Marcos V. Santos, Rinaldo A. Mota, Vera L. M. Rall

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Staphylococcus aureus is one of the main pathogens causing contagious bovine mastitis, being more frequently isolated from subclinical form, although the clinical form also occurs. Clinical mastitis cause visual signs, such as swelling, fever, hardening of the mammary gland, or any change in the characteristics of the milk. Considering the subclinical type, there are no visible signs in the animal nor changes in the milk. S. aureus has many important virulence factors for the establishment of its pathogenicity in animals, such as enterotoxins, which are also responsible for foodborne poisoning. Our objective is to perform a comparative analysis between 103 isolates of S. aureus, obtained from the milk of cows with clinical mastitis and 103 more, from subclinical type, in relation to the presence of these enterotoxins and verify if their presence plays an important role in the signs of illness. We will investigate all enterotoxins described till now, such as sea-see, seg-sez, sel26, sel 27, se01, and se02 (This study was approved by the Sao Paulo State University Animal Use Ethics Committee, No. 0136/2017). For the PCR assay, we used Illustra Bacteria Mini Spin Kit for bacterial DNA. At this moment, we have already tested sea-see, seg-ser, sew, and sex, and the results have already been submitted to Fisher Exact Probability Test or Chi-square Test. Considering the isolates obtained from clinical mastitis, the most frequent enterotoxins were selw (99%), selx (78%) and selh (50.5%), and sec, see, sej, sell, selp,and ser were absent. Among the subclinics, selw (82.5%) selm (15.5%) and selx (14.6%) were the most frequent, and sea-see, seg, sei-sel, sem-ser were absent. We have already observed statistically significant differences for seb, seg, seh, sei, selo, selu, selw and selx. Other interesting results were the low number of genes in each isolate from subclinical mastitis [0 genes: 14 (13.6%); 1 gene: 55 (53.4%); 2 genes: 33 (32%) or 3: 1 (0.97%)] compared to clinical isolates [1 gene: 5 (4.9%); 2 genes: 29 (28.1%); 3 genes: 38 (36.9%); 4 genes: 14 (13.6%); 5 genes: 5 (4.9%); 6 genes: 4 (3.9%); 7 genes: 5 (4.9%); 8 genes: 2 (1.9%) and 9 genes: 1 (1%)]. Based on these results, we can conclude that enterotoxins indeed play an important role in clinical signs in cattle with mastitis.

Keywords: mastitis, S. aureus, PCR, staphylococcal enterotoxin

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Authors: Aamna Tufail, Kajal Kotecha, Iordanis Toursounidis, Ravinder Pabla

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Introduction/Aims: Acute Myeloid Leukaemia (AML) is a part of leukaemic group of hematopoietic disorders with a varying range of presentations, including oro-facial manifestations. Early recognition and management are essential for favourable outcomes. Materials and Methods: We present our experience, clinical presentation, and clinical photographs of a patient with previously undiagnosed AML who presented with oral symptoms to the emergency department of our hospital. An analysis of clinical characteristics, diagnostic investigations, and management modalities was performed. Results/Statistics: A 58-year-old man presented to A&E reporting an 11-day history of right sided facial swelling, acute TMJ symptoms, and oral discomfort. A dentist ruled out acute dental causes one day post onset of symptoms. Initial assessment was anatomically inconsistent and did not reveal a routine oral or maxillofacial etiology. Detailed clinical examination demonstrated fever, generalised pallor, swelling and erythema of right nasolabial region, bilateral masseteric tenderness, intraoral palatal ecchymosis, palatal ulceration, buccal and labial petechiae, cervical lymphadenopathy, and haematoma on dorsum of right hand overlying right 2nd metacarpal joint. Suspecting a systemic medical cause, we requested haematological investigations, which revealed neutropenia, thrombocytopenia, and anaemia. Flow cytometry confirmed CD34 + AML. Oral discomfort was managed symptomatically. The patient was referred to a tertiary care centre for acute haematologic care, where he was treated with IV antibiotics and continuing cycles of chemotherapy. Conclusions/Clinical Relevance: Oro-facial manifestations may be the first clinical sign of AML. Awareness of its features is vital in early diagnosis. In this context, dentists and oral medicine specialists can play an important role in detecting clinical signs of haematological disorders such as AML.

Keywords: acute myeloid leukaemia, oral symptoms, ulceration, diagnosis, management

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Authors: Tayaba Dastgeer, Farhan Rasheed, Muhammad Saeed, Maqsood Ahmad, Zia Ashraf, Abdul Waheed, Muhammad Kamran, Mohsin Khurshid

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Objectives: The study aimed to determine the efficacy of linezolid against clinical isolates of methicillin-resistant staphylococcus aureus (MRSA). Methodology: This cross-sectional study was conducted in the microbiology department of Allama Iqbal Medical College Lahore from August 2017 to September 2019. Isolates were confirmed as MRSA via the presence of the mec-A gene. Confirmed MRSA isolates were processed for susceptibility testing against different antimicrobials, especially linezolid, via the disc diffusion method. Zone sizes were interpreted according to CLSI guidelines. Results: Various types of clinical samples were included in the study; however, the highest frequency of MRSA isolates was found in pus samples, followed by other clinical samples. Among hospitalized patients, most MRSA isolates were obtained from patients in the surgical ward. Of 243 mec-A gene detected isolates, Vancomycin and linezolid showed 100% susceptibility, chloramphenicol showed declining resistance 78 (32.09%), and emerging sensitivity 165 (67.90%) against MRSA. Conclusion: Linezolid is a very efficient drug against MRSA, but the use of this novel drug must be conserved for vancomycin-resistant Staphylococcus aureus or when more resistant pathogens are suspected.

Keywords: MRSA, chloramphenicol, linezolid, nosocomial infections

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Authors: J. Milton, C. Uzoigwe, O. Ayeko, B. Offorha, K. Anderson, R. G. Middleton

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Background: We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 units in order to determine if the unit volume was associated with performance for each particular outcome. Method: We analysed 175 institutions treating a total of 67,673 patients over the course of a year. Results: The number of hip fractures seen per unit ranged between 86 and 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. Patients treated at large institutions had shorter lengths of stay. With regard to most other outcomes, there was no association between unit case volume and performance, notably compliance with the Best Practice Tariff, time to surgery, proportion of eligible patients undergoing total hip arthroplasty, length of stay, delirium risk, and pressure sore risk assessments. Conclusion: There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.

Keywords: institution volume, mortality, neck of femur fractures, osteoporosis

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Authors: Nagaletchumi Balasubramaniam, A. Mohd Isa

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Engineers have a leading role in planning, designing, building and ensuring a sustainable future. Universiti Tenaga Nasional (UNITEN) acknowledges this role by assigning sustainable development as one of the expected traits that a UNITEN student should have upon graduation, formalized as the Programme Outcomes 7 (PO7): Students graduating from the Bachelor of Electrical and Electronics (BEEE) program will have the ability to demonstrate knowledge of the impact of professional engineering solutions in environmental contexts and the need for sustainable development. This paper explores how PO7 is integrated within the BEEE (Hons) program in UNITEN under the framework of Outcome Base Education (OBE). Five technical core courses were specifically assigned by UNITEN to reflect attainment of PO7. Under UNITEN’s definition, the attainment criterion of a PO is set as 70/40. This means that 70% of the students taking the course achieve at least 40% of the full marks. The paper first gives an overview of the overall OBE system as applied in UNITEN, particularly describing the key and supporting courses approach adopted for each PO. Then, the paper reviews the mechanism in which PO7 is taught and assessed in the five assigned courses. Data on PO7 attainment from four of the five courses are collected and analyzed for two student cohorts to investigate the interrelationship between the courses assigned to PO7. It was found that the five courses have different mechanisms for assessing PO7, and that generally PO7 is attained for the assigned courses. This reflects positively on the UNITEN method for integrating sustainable development within the engineering undergraduate programme.

Keywords: direct assessment, engineering education, outcome base education, programme outcome, sustainable development

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Authors: Aakriti Lohiya

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Sigmund Freud’s clinical theories were deeply influenced by his childhood and his environment before his exile in England. In this article, the author illuminates his different works and the metaphors in them. The clinical relevance of Freud’s theories is much disputed and chatted but rarely has any psychoanalytic writing touched upon the way in which his theories are linked with life experiences. Exploring the metaphors in Freud’s theories will take us into the uncharted paths of how the experience of life events meets experience in the clinic. A sincere and critical reflection of the ideas proposed by Freud would certainly help us to locate its unfamiliar stages. Many of his theories and ideas attempted to create contact with his early childhood experiences. Freud was Jewish by birth but atheist by nature, which was reflected in many of his theories. The ways in which Freud theorizes the psychosexual development of a being and many of his mammoth theories are elucidated in this study. On the other hand, some of his ideas remain a challenge, which requires remembering, restating, and functioning through the clinical and mystical elements in his writing.

Keywords: sigmund freud, exile, psychoanalytic theory, metaphor, psychosexual theory

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Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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Authors: Omar Mayyas

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Clinical decision-making (CDM) is essential to community health nursing (CHN) education. For this reason, nursing educators are responsible for developing these skills among nursing students because nursing students are exposed to highly critical conditions after graduation. However, due to limited exposure to real-world situations, many nursing students need help developing clinical decision-making skills in this area. Therefore, the impact of Virtual Simulation (VS) on community health nursing students' clinical decision-making in nursing education has to be investigated. This study aims to examine the difference in CDM ability among CHN students who received traditional education compared to those who received VS classes, to identify the factors that may influence CDM ability differences between CHN students who received a traditional education and VS classes, and to provide recommendations for educational programs that can enhance the CDM ability of CHN students and improve the quality of care provided in community settings. A mixed-method study will conduct. A randomized controlled trial will compare the CDM ability of CHN students who received 1hr traditional class with another group who received 1hr VS scenario about diabetic patient nursing care. Sixty-four students in each group will randomly select to be exposed to the intervention from undergraduate nursing students who completed the CHN course at York University. The participants will receive the same Clinical Decision Making in Nursing Scale (CDMNS) questionnaire. The study intervention will follow the Medical Research Council (MRC) approach. SPSS and content analysis will use for data analysis.

Keywords: clinical decision-making, virtual simulation, community health nursing students, community health nursing education

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Authors: Deepak Nathiya1, Ramesh Roop Rai, Pratima Singh1, Preeti Raj1, Supriya Suman, Balvir Singh Tomar

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Background: Sarcopenia is a catabolic state in liver cirrhosis (LC), accelerated with a breakdown of skeletal muscle to release amino acids which adversely affects survival, health-related quality of life, and response to any underlying disease. The primary objective of the study was to investigate the long-term effect of branched-chain amino acids (BCAA) supplementations on parameters associated with improved prognosis in sarcopenic patients with LC, as well as to evaluate its impact on cirrhotic-related events. Methods: We carried out a 24 week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention trial comparing the efficacy of BCAA against lactoalbumin (L-ALB) on 106 sarcopenic liver cirrhotics. The BCAA (intervention) group was treated with 7.2 g BCAA per whereas, the lactoalbumin group was also given 6.3 g of L-Albumin. The primary outcome was to assess the impact of BCAA on parameters of sarcopenia: muscle mass, muscle strength, and physical performance. The secondary outcomes were to study combined survival and maintenance of liver function changes in laboratory and clinical markers in the duration of six months. Results: Treatment with BCAA leads to significant improvement in sarcopenic parameters: muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. Prognostic markers also improved significantly in the study. Conclusion: The current clinical trial demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced liver cirrhosis.

Keywords: sarcopenia, liver cirrhosis, BCAA, quality of life

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Authors: Lily Parm, Irma Nool, Liina Männiksaar, Mare Tupits, Ivi Prits, Merilin Kuhi, Valentina Raudsepp

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Background: The results of previous clinical satisfaction surveys show that nursing students swhounderw entinternships in the pediatricwardhadthelowestsatisfactioncomparedtootherwards, but the quality of students' practicaltrainingexperienceisanimportant determinant in nursing education. The aim of theresearchwastodescribenursingstudents` assessment to the clinical learning environment and supervision in pediatric wards Method: Theresearchisquantitative. All studentswhohadpracticaltraining in the pediatric ward participated in the study (N = 39). FordatacollectionClinicalLearningEnvironment, Supervision, and NurseTeacher (CLES + T) evaluationscalewasused, wherethescalewasanswered on a 5-point Likert scale. In addition, 10 backgroundvariableswereused in the questionnaire. IBM SPSS Statistics 28.0 wasusedfordataanalysis. Descriptive statistics and Spearmanncorrelationanalysiswasusedtofindcorrelatinsbetweenbackgroundvariables and satisfaction with supervision.Permissiontoconductthestudy (No 695) hasbeenobtainedbytheEthicsCommittee of theInstituteforHealthDevelopment. Results: Of therespondents, 28 (71.8%) werefirst-year, 9 (23.1%) second-year and 2 (5.1%) fourth-yearstudents. Thelargestshare of the last practicaltrainigwas in nursing, with 27 (69.2%) respondents. Mainlythementorswerenursesfor 32 (82,1%) of students.Satisfactionwiththementoring (4.4 ± 0.83) and wardnursemanager`sleaderhiostyle (4.4 ± 0.7), ratedthehighest and therole of thenurseteacherwasratedthelowest (3,7 ± 0.83.In Spearmann'scorrelationanalysis, therewas a statisticallystrongcorrelationbetween a positiveattitudetowardsthesupervisor'ssupervision and receivingfeedbackfromthesupervisor (r =0.755; p <0.001), studentsatisfactionwithsupervision (r = 0.742; p <0.001), supervisionbased on cooperation (r = 0.77) and instructionbased on theprinciple of equalitythatpromotedlearning (r = 0.755; p <0.001). Conclusions: Theresults of theresearchshowedhighsatisfactionwiththesupervisionand therole of wardmanager. Stillbettercooperationisneededbetweenpracticalplacement and nursingschooltoenhancethestudents`satisfactionwithsupervision.

Keywords: CLES+T, clinical environment, nurse teacher, statisfaction, pediatric ward, mentorship

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Authors: Majid Khan

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Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

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Authors: K. Grigoryan, T. Jurcik

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Interpersonal and school-related factors, along with individual characteristics, can predict non-suicidal self-injures (NSSI). The objective of this review is to describe psychosocial variables associated with NSSI among adolescents. A better understanding of this phenomenon may facilitate the identification of potentially effective interventions for adolescents. Relevant empirical studies and reviews from clinical, cross-cultural, and social psychology, as well as cognitive psychology literature, were synthesized into two broad topics: social/interpersonal and individual factors. Variables related to the occurrence of NSSI are discussed, including social support, peer modeling, abuse, personality traits, sense of belongingness, self-compassion, and others. Based on these findings, specific clinical recommendations were identified that need to be further evaluated empirically. The systemic interventions recommended in this review may further promote research in circumventing this social and clinical problem.

Keywords: non-suicidal self-injury, psychosocial factors, mental health, adolescence

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Authors: Yang Wei, Xueyan Wang, Hui Zou

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Objective: Investigation the prevalence of menopausal symptoms in patients with allergic symptoms, evaluation of the effect of sex hormones combined with anti-allergic therapy in these patients. Method: Age of 45-65 years old women with allergic symptoms at the same time in gynecological-endocrinology clinic in our hospital were selected from Feb 1 to May 31, 2010, randomly. The patients were given oral estradiol valerate plus progestin pills combined with anti-allergy treatment and then evaluated twice a week and one month later. Evaluation criterion: Menopause Rating Scale (MRS) and the degree of clinical symptoms were used to evaluate menopause and allergy separately. Results: 1) There were 195 cases of patients with menopausal symptoms at the age. Their MRS were all over 15. 2) Among them 45 patients were with allergic symptom accounted for 23% which were diagnosed by allergic department. 3) Evaluated after one week: the menopausal symptoms were improved and MRS were less than or equal to 5 in all these patients; the skin symptom of allergic symptoms vanished completely. 4) Evaluated after one month: Menopause symptoms were improved steadily; other clinical symptoms of allergy were also improved or without recurrence. Conclusion: The incidence rate of menopausal women with clinical symptoms of allergic diseases is high and it needs attention. The effect of sex hormones combined with anti-allergic therapy is obvious.

Keywords: menopausal, allergy, sex hormone, anti-allergy treatment

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