Search results for: hospital capacity planning

Authors: Nuttapimon Bhirommuang, Kulapong Jayanama

Abstract:

Background: Prevalence of malnutrition in hospitalized patient is higher than general population. As a result of the unawareness of consequence and the more concerning in the other aspects of care, many patients with high risk of malnutrition are unrecognized. Even if malnutrition has been identified as affecting in many patient outcomes, the impact may differ in each population and group of patients. Objectives: The aims of this study were to examine the association between the nutritional status and the length of stay and hospital costs in hospitalized patients, to investigate the factors related these outcomes and to determine the frequency of malnutrition in hospitals. Method: This retrospective cohort study enrolled all patients aged 15 years old or older and admitted in SDMC, Ramathibodi Hospital between 1st January 2016 and 30th September 2016. The nutritional status assessment by Nutrition Alert Form (NAF) was performed by well-trained nurses in all patients at admission. Baseline characteristics were recorded. Length of stay and hospital costs were collected during their hospitalization. Univariate analysis, nonparametric rank test, Kruskal-Wallis test were used to compare means in the case of nonnormally and noncontinuously distributed data. Chi-square used to analyze categorical variables, the nutritional status and the length of stay and hospital costs and identify possible confounding factors (data were analyzed using SPSS version 18.0). Result: Of the 2,906 patients, 3.9% were severe malnutrition (NAF-C score > 10) and 11.4% were moderate malnutrition (NAF-B score 6 - 10). Both length of stay and hospital costs were found significantly higher in more severe malnutrition group (p < 0.001), NAF = A: 3.21 days, 95% CI 3.06-3.35 and 111,544.25 THB, 95% CI 106,994.41 – 116,094.1; NAF = B: 7.54 days, 95% CI 6.32 – 8.76 and 162,302.4 THB, 95% CI 129,557.88 – 195,046.92; NAF =C: 14.77 days, 95% CI 11.34 – 18.2 and 323,572.11 THB, 95% CI 226,958.1 – 420,096.13 (1 THB = 0.03019 USD). Age of each nutritional status group had also significant increase from NAF A to NAF C (p < 0.001): 55.07, 67.03 and 73.88 years old, respectively. Conclusion: The prevalence of malnutrition in Ramathibodi hospital is voluminous. Severe malnutrition screening by NAF is significantly correlated with worse clinical outcome, especially higher length of stay and hospital costs. Elderly is also a significant factor which correlates with malnutrition. The results of this study could change the awareness of health personnel and the practice protocol. Moreover, the further study concerning nutritional support in high-risk group of malnutrition is ongoing to confirm this hypothesis.

Keywords: malnutrition, NAF, length of stay, hospital costs

Procedia PDF Downloads 273

Authors: Joanne F. Hayek

Abstract:

This study explores the use of gamification to promote citizen e-participation in urban planning. The research departs from a case study: the ‘Shape Your City’ web app designed and programmed by the author and presented as part of the 2021 Dubai Design Week to engage citizens in the co-creation of the future of their city through a gamified experience. The paper documents the design and development methodology of the web app and concludes with the findings of its pilot release. The case study explores the use of mobile interactive mapping, real-time data visualization, augmented reality, and machine learning as tools to enable co-planning. The paper also details the user interface design strategies employed to integrate complex cross-sector e-planning systems and make them accessible to citizens.

Keywords: gamification, co-planning, citizen e-participation, mobile interactive mapping, real-time data visualization

Procedia PDF Downloads 141

Authors: Amal Sellami, Ahlem Ammar

Abstract:

Writing is acknowledged to be a cognitively demanding and complex task. Indeed, the writing process is composed of three iterative sub-processes, namely planning, translating (writing), and reviewing. Not only do second or foreign language learners need to write according to this process, but they also need to respect the norms and rules of language and writing in the text to-be-produced. Accordingly, researchers have suggested to approach writing as a collaborative task in order to al leviate its complexity. Consequently, collaboration has been implemented during the whole writing process or only during planning orreviewing. Researchers report that implementing collaboration during the whole process might be demanding in terms of time in comparison to individual writing tasks. Consequently, because of time constraints, teachers may avoid it. For this reason, it might be pedagogically more realistic to limit collaboration to one of the writing sub-processes(i.e., planning or reviewing). However, previous research implementing collaboration in planning or reviewing is limited and fails to explore the effects of the seconditionson the written text. Consequently, the present study examines the effects of collaboration in planning and collaboration in reviewing on the written text. To reach this objective, quantitative as well as qualitative methods are deployed to examine the written texts holistically and in terms of fluency, complexity, and accuracy. Participants of the study include 4 pairs in each group (n=8). They participated in two experimental conditions, which are: (1) collaborative planning followed by individual writing and individual reviewing and (2) individual planning followed by individual writing and collaborative reviewing. The comparative research findings indicate that while collaborative planning resulted in better overall text quality (precisely better content and organization ratings), better fluency, better complexity, and fewer lexical errors, collaborative reviewing produces better accuracy and less syntactical and mechanical errors. The discussion of the findings suggests the need to conduct more comparative research in order to further explore the effects of collaboration in planning or in reviewing. Pedagogical implications of the current study include advising teachers to choose between implementing collaboration in planning or in reviewing depending on their students’ need and what they need to improve.

Keywords: collaboration, writing, collaborative planning, collaborative reviewing

Procedia PDF Downloads 99

Authors: Pascal Rey, Anaïs Weber

Abstract:

Many mining projects are being developed in Africa the last decades. Due to the economic opportunities they offer, these projects result in a massive and rapid influx of migrants to the surrounding area. In areas where central government representation is low and local administration lack financial resources, urban development is often anarchical, beyond all public control. It leads to socio-spatial segregation, insecurity and the risk of social conflicts rising. Aware that their economic development is very correlated with local situation, mining companies get more and more involved in regional planning in setting up tools and Strategic Directions document. One of the commonly used tools in this regard is the “Influx Management Plan”. It consists in looking at the region’s absorption capacities in order to ensure its coherent development and by developing several urban centers than one macrocephalic city. It includes many other measures such as urban governance support, skills transfer, creation of strategic guidelines, financial support (local taxes, mining taxes, development funds etc.) local development projects. Through various examples of mining projects in Guinea, A country that is host to many large mining projects, we will look at the implications of regional and urban planning of which mining companies are key playor as well as public authorities. While their investment capacity offers advantages and accelerates development, their actions raise questions of the unilaterality of interests and local governance. By interfering in public affairs are mining companies not increasing the risk of central and local government shirking their responsibilities in terms of regional development, or even calling their legitimacy into question? Is such public-private collaboration really sustainable for the region as a whole and for all stakeholders?

Keywords: Africa, guinea, mine, urban planning

Procedia PDF Downloads 498

Authors: Dalia Almaghaslah

Abstract:

Design thinking approach; empathize, define, ideate prototype, test, implement, was used to assess outpatient experiences in two hospital pharmacies in the Asir region, Saudi Arabia. Semi-structured interviews were conducted with 40 patients. The data were analyzed using thematic analysis. The findings suggested that patients were generally satisfied with pharmaceutical services provided in both pharmacies. Pharmacists were found to have enough knowledge, good attitude, and efficient communication and counselling skills. Non-pharmacy-related factors such as cultural factors (gender segregation), long waiting times, uncomfortable waiting areas, lack of electronic prescribing, number waiting system were found to have a negative impact on patients' experiences and satisfaction. Prototypes will be used to test the effects of implementing the electronic system in Al -mahal hospital and to test changing the physical layout of the waiting area in Asir hospital.

Keywords: design thinking, hospital pharmacy, patient satisfaction, Saudi Arabia

Procedia PDF Downloads 137

Authors: Lichung Jen, Yi Chun Liu, Kuan-Wei Lee

Abstract:

Fruitful data has been accumulated in database nowadays and is commonly used as support for decision-making. In the healthcare industry, hospital, for instance, ordering pharmacy inventory is one of the key decision. With large drug inventory, the current cost increases and its expiration dates might lead to future issue, such as drug disposal and recycle. In contrast, underestimating demand of the pharmacy inventory, particularly standing drugs, affects the medical treatment and possibly hospital reputation. Prescription behaviour of hospital physicians is one of the critical factor influencing this decision, particularly irregular prescription behaviour. If a drug’s usage amount in the month is irregular and less than the regular usage, it may cause the trend of subsequent stockpiling. On the contrary, if a drug has been prescribed often than expected, it may result in insufficient inventory. We proposed a hierarchical Bayesian mixture model with two components to identify physicians’ regular/irregular prescription patterns with probabilities. Heterogeneity of hospital is considered in our proposed hierarchical Bayes model. The result suggested that modeling the prescription patterns of physician is beneficial for estimating the order quantity of medication and pharmacy inventory management of the hospital. Managerial implication and future research are discussed.

Keywords: hierarchical Bayesian model, poission mixture model, medicines prescription behavior, irregular behavior

Procedia PDF Downloads 127

Authors: Hooshang Mohammad Alikhani, Javad Nikoukar

Abstract:

Restructuring and deregulation of power industry have changed the objectives of transmission expansion planning and increased the uncertainties. Due to these changes, new approaches and criteria are needed for transmission planning in deregulated power systems. The objective of this research work is to present a new approach for transmission expansion planning with considering new objectives and uncertainties in deregulated power systems. The approach must take into account the desires of all stakeholders in transmission expansion planning. Market based criteria must be defined to achieve the new objectives. Combination of market based criteria, technical criteria and economical criteria must be used for measuring the goodness of expansion plans to achieve market requirements, technical requirements, and economical requirements altogether.

Keywords: deregulated power systems, transmission network, stakeholder, energy systems

Procedia PDF Downloads 653

Authors: Ibrahim A. Alkali

Abstract:

There is no reservation on the outstanding contribution of patient families in restoration of hospitalised patients, hence their consideration as essential component of hospital ward regimen. The psychological and emotional support a patient requires has been found to be solely provided by the patient’s family. However, consideration of their presence as one of the major functional requirements of an inpatient setting design have always been a source of disquiet, especially in developing countries where policies, norms and protocols of healthcare administration have no consideration for the patients’ family. This have been a major challenge to the hospital ward facilities, a concern for the hospital administration and patient management. The study therefore is aimed at obtaining a consensus opinion on the best approach for family integration in the design of an inpatient setting.  A one day visioning charrette involving Architects, Nurses, Medical Doctors, Healthcare assistants and representatives from the Patient families was conducted with the aim of arriving at a consensus opinion on practical design approach for sustainable family integration. Patient’s family are found to be decisive character of hospital ward regimen that cannot be undermined. However, several challenges that impede family integration were identified and subsequently a recommendation for an ideal approach. This will serve as a guide to both architects and hospital management in implementing much desired Patient and Family Centred Care.

Keywords: patient's family, inpatient setting, care giving, integration

Procedia PDF Downloads 208

Authors: Maryam Siyami

Abstract:

Nowadays, one of the major environmental challenges is hospital waste, which, due to the presence of hazardous, toxic, and infectious agents, is of particular concern. The expansion of cities and population growth has significantly accelerated the establishment of various healthcare institutions. In this paper, the geotechnical-environmental risks in healthcare centers have been examined. The Iranian Leopold Matrix method was used to analyze the data. According to the study results, the greatest impact was related to socio-economic, environmental factors, particularly waste and wastewater management. Additionally, the most significant geotechnical-environmental risks at hospital were hospital hazardous waste, chemicals, and waste disposal. In conclusion, the most beneficial geotechnical-environmental measures were determined to be wastewater collection, waste collection, and recycling.

Keywords: risk, geotechnics, environment, Leopold Matrix

Procedia PDF Downloads 20

Authors: Chitrangi Gupta, Arvind Bhardwaj

Abstract:

This study seeks to investigate and quantify the influence of various dimensions of supply chain management (namely, supplier relationships, compatibility, specifications and standards, delivery processes, and after-sales service) on distinct dimensions of healthcare service quality (specifically, responsiveness, trustworthiness, and security) within the operational framework of XYZ Superspeciality Hospital, situated in Delhi. The name of the Hospital is not being mentioned here because of the privacy policy of the hospital. The primary objective of this research is to elucidate the impact of supply chain management practices on the overall quality of healthcare services offered within hospital settings. Employing a quantitative research design, this study utilizes a hypothesis-testing approach to systematically discern the relationship between supply chain management dimensions and the quality of health services. The findings of this study underscore the significant influence exerted by supply chain management dimensions, specifically supplier relationships, specifications and standards, delivery processes, and after-sales service, on the enhancement of healthcare service quality. Moreover, the study's results reveal that demographic factors such as gender, qualifications, age, and experience do not yield discernible disparities in the relationship between supply chain management and healthcare service quality.

Keywords: supply chain management, healthcare, hospital operations, service delivery

Procedia PDF Downloads 67

Authors: Matloub Hussaina

Abstract:

This paper investigates the impact of information sharing and capacity constraints on backlog bullwhip effect of Automatic Pipe Line Inventory and Order Based Production Control System (APIOBPCS). System dynamic simulation using iThink Software has been applied. It has been found that smooth ordering by Tier 1 can be achieved when Tier 1 has medium capacity constraints. Simulation experiments also show that information sharing helps to reduce 50% of backlog bullwhip effect in capacitated supply chains. This knowledge is of value per se, giving supply chain operations managers and designers a practical way in to controlling the backlog bullwhip effect. Future work should investigate the total cost implications of capacity constraints and safety stocks in multi-echelon supply chain.

Keywords: supply chain dynamics, information sharing, capacity constraints, simulation, APIOBPCS

Procedia PDF Downloads 318

Authors: M. Moiz

Abstract:

Family planning has been known and accepted as a key tool to decrease fertility, provides birth spacing and plays a vital role to attain better outcomes for maternal and child health. Pakistan initiated various family planning programs to preserve maternal and child health for six decades. However, less contraceptive use leading to high fertility and low birth spacing is ultimately a risk for increasing morbidity and mortality. As an outcome of 2012 London Summit on Family Planning where 20 countries including Pakistan made its commitment to increase contraceptive prevalence rate by 55% and provide a universal access to reproductive health to protect human rights of women and ensure safe, choice informed and affordable contraceptives throughout the country. This paper will assess some of the factors of service delivery, coverage and the role of Ministry of Health and Population Welfare Department in providing Family Planning services and how it can be improved in Pakistan. In view of Pakistan Demographic Health Survey 2017-18, there are total nine million potential users of contraceptives and one third among them never used with unmet need while every fifth pregnancy ends into abortion indicates need for Family Planning services. In order to explain this concern, a comprehensive analysis has been done on role of governance in implementing family planning policy and its limitations are discussed. Moreover, this paper highlights policy options and recommendations for improving service provision through public and private sector in creating demand for Family Planning services in Pakistan.

Keywords: contraceptive prevalence rate, family planning, maternal and child health, policy options

Procedia PDF Downloads 164

Authors: J. Koiso-Kanttila, A. Soikkeli, A. Aapaoja

Abstract:

Construction in Finland is focusing increasingly on renovation instead of conventional new construction, and this trend will continue to grow in the coming years and decades. Renovation of the large number of suburban residential apartment buildings built in the 1960s and 1970s poses a particular challenge. However, renovation projects are demanding for the residents of these buildings, since they usually are uninitiated in construction issues. On the other hand, renovation projects generally apply the operating models of new construction. Nevertheless, the residents of an existing residential apartment building are some of the best experts on the site. Thus, in this research project we applied a relational model in developing and testing at case sites a planning process that employs interactive planning methods. Current residents, housing company managers, the city zoning manager, the contractor’s and prefab element supplier’s representatives, professional designers and researchers all took part in the planning. The entire interactive planning process progressed phase by phase as the participants’ and designers’ concerted discussion and ideation process, so that the end result was a renovation plan desired by the residents.

Keywords: apartment building renovation, interactive planning, project alliance, user-orientedness

Procedia PDF Downloads 385

Authors: Rihab Ben Lamine, Raoudha Ben Jemaa, Ikram Amous Ben Amor

Abstract:

This paper proposes a graph planning technique for semantic adaptable Web Services composition. First, we use an ontology based context model for extending Web Services descriptions with information about the most suitable context for its use. Then, we transform the composition problem into a semantic context aware graph planning problem to build the optimal service composition based on user's context. The construction of the planning graph is based on semantic context aware Web Service discovery that allows for each step to add most suitable Web Services in terms of semantic compatibility between the services parameters and their context similarity with the user's context. In the backward search step, semantic and contextual similarity scores are used to find best composed Web Services list. Finally, in the ranking step, a score is calculated for each best solution and a set of ranked solutions is returned to the user.

Keywords: semantic web service, web service composition, adaptation, context, graph planning

Procedia PDF Downloads 520

Authors: Neritan Shkodrani, Klearta Rrushi, Anxhela Shaha

Abstract:

Generally, the design of axial load capacity of deep foundations is based on the data provided from field tests, such as SPT (Standard Penetration Test) and CPT (Cone Penetration Test) tests. This paper reports the results of axial load capacity analysis of drilled shafts at a construction site at Semani, in Fier county, Fier prefecture in Albania. In this case, the axial load capacity analyses are based on the data of 416 SPT tests and 12 CPTU tests, which are carried out in this site construction using 12 boreholes (10 borings of a depth 30.0 m and 2 borings of a depth of 80.0m). The considered foundation widths range from 0.5m to 2.5 m and foundation embedment lengths is fixed at a value of 25m. SPT – based analytical methods from the Japanese practice of design (Building Standard Law of Japan) and CPT – based analytical Eslami and Fellenius methods are used for obtaining axial ultimate load capacity of drilled shafts. The considered drilled shaft (25m long and 0.5m - 2.5m in diameter) is analyzed for the soil conditions of each borehole. The values obtained from sets of calculations are shown in different charts. Then the reported axial load capacity values acquired from SPT and CPTU data are compared and some conclusions are found related to the mentioned methods of calculations.

Keywords: deep foundations, drilled shafts, axial load capacity, ultimate load capacity, allowable load capacity, SPT test, CPTU test

Procedia PDF Downloads 104

Authors: Yalong Jiang, Zheru Chi

Abstract:

In this paper, we study the factors which determine the capacity of a Convolutional Neural Network (CNN) model and propose the ways to evaluate and adjust the capacity of a CNN model for best matching to a specific pattern recognition task. Firstly, a scheme is proposed to adjust the number of independent functional units within a CNN model to make it be better fitted to a task. Secondly, the number of independent functional units in the capsule network is adjusted to fit it to the training dataset. Thirdly, a method based on Bayesian GAN is proposed to enrich the variances in the current dataset to increase its complexity. Experimental results on the PASCAL VOC 2010 Person Part dataset and the MNIST dataset show that, in both conventional CNN models and capsule networks, the number of independent functional units is an important factor that determines the capacity of a network model. By adjusting the number of functional units, the capacity of a model can better match the complexity of a dataset.

Keywords: CNN, convolutional neural network, capsule network, capacity optimization, character recognition, data augmentation, semantic segmentation

Procedia PDF Downloads 153

Authors: Carmela Mariano

Abstract:

The literature, the scientific and disciplinary debate related to the impacts of climate change on the territory has highlighted, in recent years, the need for climate-proof and resilient tools of urban planning that adopt an integrated and inter-scalar approach for the construction of urban regeneration strategies by the objectives of the European Strategy on adaptation to climate change, the 2030 Agenda for Sustainable Development and the Climate Conference. This article addresses the operational implications of urban climate resilience in urban planning tools as a priority objective of policymakers (government bodies, institutions, etc.) to respond to the risks of climate change-related impacts on the environment. Within the general framework of the research activities carried out by the author, this article provides a critical synthesis of the analysis and evaluation of some case studies from the Italian national context, which enabled, through an inductive method, the assessment of the process of implementing the adaptation to climate change within the regional urban planning frameworks (regional urban laws), specific regional adaptation strategies or local adaptation plans and within the territorial and urban planning tools of a metropolitan or local scale. This study aims to identify theoretical–methodological, and operational references for the innovation and integration of planning tools concerning climate change that allow local planners to test these references in specific territorial contexts to practical adaptation strategies for local action.

Keywords: urban resilience, urban regeneration, climate-proof-planning, urban planning

Procedia PDF Downloads 17

Authors: A. Shafaghat, H. Khabbaz, S. Moravej, Ah. Shafaghat

Abstract:

The bearing capacity of closely spaced shallow footings alters with their spacing and the shape of footing. In this study, the bearing capacity and settlement of two adjacent footings constructed on a sand layer are investigated. The effect of different footing shapes including square, circular, ring and strip on sandy soil is captured in the calculations. The investigations are carried out numerically using PLAXIS-3D software and analytically employing conventional settlement equations. For this purpose, foundations are modelled in the program with practical dimensions and various spacing ratios ranging from 1 to 5. The spacing ratio is defined as the centre-to-centre distance to the width of foundations (S/B). Overall, 24 models are analyzed; and the results are compared and discussed in detail. It can be concluded that the presence of adjacent foundation leads to the reduction in bearing capacity for round shape footings while it can increase the bearing capacity of rectangular footings in some specific distances.

Keywords: bearing capacity, finite element analysis, loose sand, settlement equations, shallow foundation

Procedia PDF Downloads 256

Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

Abstract:

In a disaster event, sharing patient information between the pre-hospital Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre- EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors that are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality, and the data were analyzed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system that can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analyzed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospital staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: emergency medical teams, communication, information and communication technologies, disaster

Procedia PDF Downloads 126

Authors: R. Litt, A. Kana, K. House

Abstract:

The primary aim of this patient-related experience questionnaire was to gain a better understanding of our patients' experience as inpatients when they undergo orthognathic surgery. The secondary aim of this study was to identify ways in which we can improve the orthognathic inpatient experience and to share this with other units. All patients who received orthognathic surgery at an NHS hospital - Bristol Royal Infirmary, England, over the course of 6 months were asked to complete a questionnaire regarding their care. This data was then analysed and compared to the same questionnaire given to patients treated in a private hospital where orthognathic surgery was completed. All treatment was completed by the same surgeon. The design of the questions took into account NICE (National Institute for Health and Care Excellence) guidance on improving the experience of patient care. Particularly taking into account patients' essential requirements of care, for example, assessing and managing pain, ensuring adequate and appropriate nutrition, and ensuring the patients' personal needs are regularly reviewed and addressed. Overall the patient-related experience after orthognathic surgery was comparable in both the NHS and private hospitals. However, the questionnaire highlighted aspects of inpatient care after orthognathic surgery that can easily be improved in order to provide our patients with the best possible care.

Keywords: orthognathic surgery, patient feedback, jaw surgery, inpatient experience

Procedia PDF Downloads 149

Authors: An-Yi Wang, Wei-Fong Kao, Shin-Han Tsai

Abstract:

Introduction: Information as patient characteristics, resuscitation scene, resuscitation provider perspectives and families wish affects on resuscitation decision-making for out-of-hospital cardiac arrest (OHCA). There is no consistency consensus on how families and emergency physicians approach this decision. The main purpose of our study is to evaluate the characteristics of withholding resuscitation efforts arrival at the hospital. Methods: We retrospectively analyzed patients with OHCA without pre-hospital return-of-spontaneous circulation (ROSC) who was sent to our emergency department (ED) between January 2014 and December 2015. Baseline characteristics, pre-hospital course, and causes of the cardiopulmonary arrest among patients were compared. Results: In 2 years, total 155 arrest patients without pre-hospital ROSC was included. 33(21.3%) patients withhold the resuscitation efforts in ED with mean resuscitation duration 4.45 ± 7.04 minutes after ED arrival. In withholding group, the initial rhythm of arrests was all non-shockable. 9 of them received endotracheal intubation before decision-making. None of the patients in withhold resuscitation group survived to discharge. There was no significant difference among gender, underlying cardiovascular disease, malignancy, chronic renal disease, nor witness collapse between withhold and continue resuscitation groups. Univariate analysis showed there was lower percentage of bystander resuscitation (32.3% vs. 50.4%, p=0.071), and the lower percentage of transport via emergency medical service (EMS) (78.8% vs. 91.8%, p=0.054) in withholding group. Multivariate analysis showed old age (adjusted odds ratio=1.06, 95% C.I.=[1.02-1.11], p<0.05), with underlying respiratory insufficiency (adjusted odds ratio=12.16, 95% C.I.=[3.34-44.29], p<0.05), living at home compared with nursing home (adjusted odds ratio=37.75, 95% C.I.=[1.09-1110.70], p<0.05) were more likely to withhold resuscitation. Transport via EMS was more likely to continue resuscitation (adjusted odds ratio=0.11, 95% C.I.=[0.02-0.71], p<0.05). Conclusion: The decision-making for families and emergency physicians to withhold or continue resuscitation for out-of-hospital cardiac arrest is complex and multi-factorial. Continue resuscitation efforts in nursing home residents is high, and further study among this population is warranted.

Keywords: cardiopulmonary resuscitation, out-of-hospital cardiac arrest, termination resuscitation, withhold resuscitation

Procedia PDF Downloads 253

Authors: Shankar M. Bakkannavar, Smitha Nayak, Vinod C. Nayak, Ravi Bagali

Abstract:

Attendance rate for hospital outpatient appointments plays a pivotal role in operational efficiency of a hospital. Strategic interventions like ‘reminder systems’ prior to the scheduled appointment has proved to be an effective strategy for outpatient appointment ‘show-ups’. This study is designed with an objective to assess the effectiveness of SMS reminders as an intervention to enhance the effectiveness of hospital outpatient attendance. Method: The survey was conducted at Columbia Asia Hosiptal, Bangalore. We surveyed 60 patients who had a scheduled outpatient appointment in Department of General Medicine, Department of Obstetrics and Gynecology and the Orthopedics department, as these departments had a heavy patient flow and had higher contributions to the top line of the hospital. Results: Majority (64%) of the patients preferred to be sent an SMS reminder on the outpatient appointment schedule. 37 (61%) respondents stated that the ideally, reminders could be effective only if they are sent 24-48 hours prior to the appointment schedule. 41(68%) respondents were of the opinion that a minimum of two reminders would be necessary to ensure patients show up for the appointment. 1% level of significance. It also observed that there is strong association between age and preference on mode of reminder (P=0.002).

Keywords: reminder systems, appointment show-ups, SMS reminders, health Information

Procedia PDF Downloads 354

Authors: O. I. Nkwonta, B. Dzwairo, J. Adeyemo, A. Jaiyola, N. Sawyerr, F. Otieno

Abstract:

The effective management of water resources is of great importance to ensure the supply of water resources to support changing water requirements over a selected planning horizon and in a sustainable and cost-effective way. Essentially, the purpose of the water resources planning process is to balance the available water resources in a system with the water requirements and losses to which the system is subjected. In such situations, Water resources yield and planning model can be used to solve those difficulties. It has an advantage over other models by managing model runs, developing a representative system network, modelling incremental sub-catchments, creating a variety of standard system features, special modelling features, and run result output options.

Keywords: complex, water resources, planning, cost effective and management

Procedia PDF Downloads 573

Authors: Gülnar Bayramoğlu Barman

Abstract:

Since the industrial revolution, technological developments and increased population have caused environmental damages. To protect the nature and architectural environment, firstly, green architecture, ecological architecture and then sustainability occurred. This term has been proposed not to be a new term but a response to environmental disturbances caused by human activities and it is re-conceptualization of architecture. Sustainable architecture or sustainability is lot more extensive than ecological and green architecture. It contains the imbalance between environmental problems that is natural environment and consumption that occurred all around the world. An important part of sustainability debate focused on urban planning and design for more sustainable forms and patterns. In particular, it is discussed that planning and design of urban areas have a major effect on transport and therefore can help reduce car usage, emissions, global warming and climate change. There are many planning and design approaches and movement that introduce certain criteria and strategies to prevent car dependency and encourage people to use public transportation and walking. However, when review the literature, it is seen that planning movements, such as New Urbanism and Transit Oriented Development originated and were implemented mostly in West European and North American Cities. The purpose of this study is to find out whether all those criteria, principles and strategies are also relevant planning approaches for more non-western cities like Baku, which has a very different planning background and therefore possibly different urban form and transport issues. In order to answer the above mentioned question, planning and design approaches in the literature and these recent planning movements were studied and a check list was formed which indicate planning and design approaches that can help attain a more sustainable transport outcome. The checklist was then applied to the case of Baku.

Keywords: sustainability, sustainable development, sustainable transportation, transport, urban design

Procedia PDF Downloads 438

Authors: Lucie Litvack, Malaz Elsaddig, Kevin Jones

Abstract:

There is strong evidence to support the efficacy of the World Health Organization (WHO) Surgical Safety Checklist in improving patient safety; however, its use can be associated with difficulties. This study uses qualitative data collected in Kitovu Healthcare Complex, a rural Ugandan hospital, to identify factors that may influence the use of the checklist in a low-income setting. Potential barriers to and motivators for the hospital’s use of this checklist are identified and explored through observations of current patient safety practices; semi-structured interviews with theatre staff; a focus group with doctors; and trial implementation of the checklist. Barriers identified include the institutional context; knowledge and understanding; patient safety culture; resources and checklist contents. Motivators for correct use include prior knowledge; team attitudes; and a hospital advocate. Challenges are complex and unique to this socioeconomic context. Stepwise change to improve patient safety practices, local champions, whole team training, and checklist modification may assist the implementation and sustainable use of the checklist in an effective way.

Keywords: anaesthesia, patient safety, Uganda, WHO surgical safety checklist

Procedia PDF Downloads 356

Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

Abstract:

Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

Procedia PDF Downloads 222

Authors: Bindhiya Thomas, Rehana Hafeez

Abstract:

Background: The Surgical Ambulatory Unit (SAU) also known as the Same Day Emergency Care (SDEC) is an established part of many hospitals providing same day emergency care service to surgical patients who would have otherwise required admission through the A&E. Prior to Covid, the SAU was functioning as a 12-hour service, but during the Covid crisis this service was transformed to a 24 hour functioning Surgical Ambulatory Assessment unit (SAAU). We studied the effects that this change brought about in-patient care in our hospital. Objective: The objective of the study was to assess the impact of a 24-hour Surgical Ambulatory Assessment unit on patient care during the time of Covid, in particular its role in freeing A&E capacity and delivering effective patient care. Methods: We collected two sets of data retrospectively. The first set was collected over a 6-week period when the SAU was functioning at the Princess Royal University Hospital. On March 23rd, 2020, the SAU was transformed into a 24-hour SAAU. Following this transformation, a second set of patient data was collected over a period of 6 weeks. A comparison was made between data collected from when the hospital had a 12-hour Surgical Ambulatory unit and later when it was transformed into a 24-hour facility. Its effects on the change in the number of patients breaching the four hour waiting period and the number of emergency surgical admissions. Results: The 24-hour Surgical Ambulatory Assessment unit brought significant reductions in the number of patients breaching the waiting period of 4 hours in A&E from 44% during the period of the 12-hour Surgical Ambulatory care facility to 0% from when the 24-hour Surgical Ambulatory Assessment Unit was established. A 28% reduction was also seen in the number of surgical patients' admissions from A&E. Conclusions: The 24-hour SAAU was found to have a profound positive impact on emergency care of surgical patients. Especially during the Covid crisis, it played a crucial role in providing not only effective and accessible patient care but also in reducing the A&E workload and admissions. It thus proved to be a strategic tool that helped to deal with the immense workload in emergency care during the Covid crisis and helped free much needed headspace at a time of uncertainty for the A&E to better configure their services. If sustained, the 24-hour SAAU could be relied on to augment the NHS emergency services in the future, especially in the event of another crisis.

Keywords: Princess Royal University Hospital, surgical ambulatory assessment unit, surgical ambulatory unit, same day emergency care

Procedia PDF Downloads 164

Authors: Mohammad Sadeghi, Mahdieh Saniee

Abstract:

Nowadays, development laws have become a major branch of engineering science, laws help humankind achieve his/her basic needs, and it is attracted to the attention of the nations. Therefore, lawyers have been invited to contemplate legislator's approaches respecting legislating countries' economic, social and cultural development plans and to observe the reliance of approaches on two elements of distributive justice and transitional justice in light of legal rationality. Legal rationality in development planning has encountered us with this question that whether a rational approach and existing models in the Iran development planning system approximate us to the goal of development laws respecting the rationalist approach and also regarding wisely decision-making model. The present study will investigate processes, approaches, and damages of development planning in the legislation of country development plans to answer this question.

Keywords: rationality, decision-making process, policymaking, development

Procedia PDF Downloads 115

Authors: Akinwale S. O., Koya O. A.

Abstract:

The need to provide ecologically-friendly and effective lawn mowing solution is crucial for the well-being of humans. This study involved the modification of a human-powered lawn mower designed to cut tall grasses in residential areas. This study designed and fabricated a reel-type mower blade system and a pedal-powered test rig for the blade system. It also evaluated the performance of the machine. The machine was tested on some overgrown grass plots at College of Education Staff School Ilesa. Parameters such as theoretical field capacity, field efficiency and effective field capacity were determined from the data gathered. The quality of cut achieved by the unit was also documented. Test results showed that the fabricated cutting system produced a theoretical field capacity of 0.11 ha/h and an effective field capacity of 0.08ha/h. Moreover, the unit’s cutting system showed a substantial improvement over existing reel mower designs in its ability to cut on both the forward and reverse phases of its motion. This study established that the blade system described herein has the capacity to cut tall grasses. Hence, this device can therefore eliminate the need for powered mowers entirely on small residential lawns.

Keywords: effective field capacity, field efficiency, theoretical field capacity, quality of cut

Procedia PDF Downloads 147

Authors: Punam Kumari Mandal, Namita Yangden, Bhumika Rai, Achala Niraula, Sabitra Subedi

Abstract:

introduction: Family planning not only improves women’s health but also promotes gender equality, better child health, and improved education outcomes, including poverty reduction. The objective of this study is to assess the utilization of family planning methods and associated factors in Sunsari, Nepal. methodology: A cross-sectional analytical study was conducted among women of the reproductive age group (15-49 years) in Sunsari in 2020. Nonprobability purposive sampling was used to collect information from 212 respondents through face-to-face interviews using a Semi-structured interview schedule from ward no 1 of Barju rural municipality. Data processing was done by using SPSS “statistics for windows, version 17.0(SPSS Inc., Chicago, III.USA”). Descriptive analysis and inferential analysis (binary logistic regression) were used to find the association of the utilization of family planning methods with selected demographic variables. All the variables with P-value <0.1 in bivariate analysis were included in multivariate analysis. A P-value of <0.05 was considered to indicate statistical significance at a level of significance of 5%. results: This study showed that the mean age and standard deviation of the respondents were 26±7.03, and 91.5 % of respondent’s age at marriage was less than 20 years. Likewise, 67.5% of respondents use any methods of family planning, and 55.2% of respondents use family planning services from the government health facility. Furthermore, education (AOR 1.579, CI 1.013-2.462)., husband’s occupation (AOR 1.095, CI 0.744-1.610)., type of family (AOR 2.741, CI 1.210-6.210)., and no of living son (AOR 0.259 CI 0.077-0.872)are the factors associated with the utilization of family planning methods. conclusion: This study concludes that two-thirds of reproductive-age women utilize family planning methods. Furthermore, education, the husband’s occupation, the type of family, and no of living sons are the factors associated with the utilization of family planning methods. This reflects that awareness through mass media, including behavioral communication, is needed to increase the utilization of family planning methods.

Keywords: family planning methods, utilization. factors, women, community

Procedia PDF Downloads 137