Search results for: military hospital

Authors: Neslihan Cetin

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In this study, we will aim to analyze how the period of the state of emergency in Turkey lead to gaps in law and the formation of areas in which there was a complete lack of supervision. The state of emergency that was proclaimed following the coup attempt of July 15, 2016, continued until July 18, 2018, that is to say, 2 years, without taking into account whether the initial circumstances persisted. As part of this work, we claim that the state of emergency provided the executive power with important tools for governing, which it took constant use. We can highlight how the concern for security at the center of the basic considerations of the people in a city was exploited as a foundation by the military power in Turkey to interfere in the political, legal, and social spheres. The constitutions of 1924, 1961, and 1982 entrusted the army with the role of protector of the integrity of the state. This became an instrument at the hands of the military to legitimize their interventions in the name of public security. Its interventions in the political field are indeed politically motivated. The constitution, the legislative, and regulatory systems are modified and monopolized by the military power that dominates the legislative, regulatory, and judicial power, leading to a state of exception. With the political convulsions over a decade, the government was able to usurp the instrument called the state of exception. In particular, the decree-laws of the state of emergency, which the executive makes frequent and generally abusive use, became instruments in the hands of the government to take measures that it wishes to escape from the rules and the pre-established control mechanisms. Thus the struggle against the political opposition becomes more unbalanced and destructive. To this must also be added the ineffectiveness of ex-post controls and domestic remedies. This research allows us to stress how a legal concept, such as ‘the state of emergency’ can be politically exploited to make it a legal weapon that continues to produce victims.

Keywords: constitutional law, state of emergency, rule of law, instrumentalization of law

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Authors: María Victoria Alvarez Magañini, Lautaro Nahuel Rubbi

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According to different theories, the hegemonic war between the United States and the People's Republic of China seems to be imminent. However, nowadays, it is clear that China's conventional military capacity is inferior to that of the United States. Nevertheless, the conditions that in the past were considered to be an indicator of validity in asymmetrical warfare, at present, in a possible asymmetric war scenario, are no longer considered to be taken as such. The military capacity is not the only concept that represents the main indicator of victory. The organisation and the use of forces are also an essential part of it. The present paper aims to analyze the Chinese Defense Strategy in relation to the concept of asymmetric warfare in the face of a possible war with the United States. The starting point will be developed on the basis of application of the theory which corresponds to the concept aforementioned making focus on recent developments of the People’s Republic of China in the field of non-conventional defense. A comparative analysis of the conventional forces of both powers/countries will also be carried out.

Keywords: asymmetric warfare, China, United States, hegemonic warfare

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Authors: Zoaib Mirza

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Pakistan is an Islamic country that got its partition from India in 1947 so that the people could practice the religion of Islam. The ideology of Pakistan was based on the notion that sovereignty only belonged to God Almighty (in Arabic, God means “Allah”), and Muslims will live in accordance with Islam principles. The Quran (Holy Book) and Sunnah (authentic practices of Prophet Mohammad, Peace Be Upon Him, that explains the application of the Quran) are foundations of the Islamic principles. It has been over 75 years, but unfortunately, Pakistan, due to its own political, social, and economic mistakes, is responsible for not being able to become a true Islamic nation to justify its partition from India. The rationale for writing this paper is to analyze the factors that led to changes in the democratic movements impacting the country's political, social, and economic growth. The methodology to examine the historical and political context of Pakistan’s history is by referencing the scholarly work of Israr Ahmed, a Pakistani Islamic theologian, philosopher, and Islamic scholar. While from a Western perspective, Karl Marx, Mar Weber, Hannah Arendt, Sheldon Wolin, Paulo Freire, and Jacques Ranciere's philosophies specific to totalitarianism, politics, military rule, religion, capitalism, and superpower are used as the framework to analyze Pakistan’s democracy. The study's findings conclude that Pakistan's democracy is unstable and has been impacted by military and civilian governance, which led to political, social, and economic downfall. To improve the current situation, the citizens of Pakistan have to realize that the success of a nation is only dependent on the level of consciousness of the leader and not the political system. Therefore, it is the responsibility of every citizen to be conscious of how they select their leader and take responsibility for the current situation in Pakistan.

Keywords: Pakistan, Islam, democracy, totalitarianism, military, religion, capitalism

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Authors: Victor Au, Khin Maung Than, Zaw Win Aung, Linawati Jumat

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Background & Objectives: Cardiac arrests can occur anywhere or anytime, and most of the cases will be brought to the emergency department except the cases that happened in at in-patient setting. Raja IsteriPangiran Anak Saleha (RIPAS) Hospital is the only tertiary government hospital which located in Brunei Muara district and received all referral from other Brunei districts. Data of cardiac arrests in Brunei Darussalam scattered between Emergency Medical Ambulance Services (EMAS), Emergency Department (ED), general inpatient wards, and Intensive Care Unit (ICU). In this audit, we only focused on cardiac arrest cases which had happened or presented to the emergency department RIPAS Hospital. Theobjectives of this audit were to look at demographic of cardiac arrest cases and the survival to discharge rate of In-Hospital Cardiac Arrest (IHCA) and Out-Hospital Cardiac Arrest (OHCA). Methodology: This audit retrospective study was conducted on all cardiac arrest cases that underwent Cardiopulmonary Resuscitation (CPR) in ED RIPAS Hospital, Brunei Muara, in the year 2019-2020. All cardiac arrest cases that happened or were brought in to emergency department were included. All the relevant data were retrieved from ED visit registry book and electronic medical record “Bru-HIMS” with keyword diagnosis of “cardiac arrest”. Data were analyzed and tabulated using Excel software. Result: 313 cardiac arrests were recorded in the emergency department in year 2019-2020. 92% cases were categorized as OHCA, and the remaining 8% as IHCA. Majority of the cases were male with age between 50-60 years old. In OHCA subgroup, only 12.4% received bystander CPR, and 0.4% received Automatic External Defibrillator (AED) before emergency medical personnel arrived. Initial shockable rhythm in IHCA group accounted for 12% compare to 4.9% in OHCA group. Outcome of ED resuscitation, 32% of IHCA group achieved return of spontaneous circulation (ROSC) with a survival to discharge rate was 16%. For OHCA group, 12.35% achieved ROSC, but unfortunately, none of them survive till discharge. Conclusion: Standardized registry for cardiac arrest in the emergency department is required to provide valid baseline data to measure the quality and outcome of cardiac arrest. Zero survival rate for out hospital cardiac arrest is very concerning, and it might represent the significant breach in cardiac arrest chains of survival. Systematic prospective data collection is needed to identify contributing factors and to improve resuscitation outcome.

Keywords: cardiac arrest, OHCA, IHCA, resuscitation, emergency department

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Authors: S. Kurt, B. C. Demirbag

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Meeting employees’ expectations from an organization physically and mentally is a result of one’s assessing his or her work and its environment as well as his feeling about them. It was to determine the job satisfaction levels of the nurses in public hospitals. This descriptive study was carried out with 404 nurses (60%) accepting to take part in the study voluntarily and working in the same hospital for at least three months from 673 nurses working in hospitals depending on The Secretaryship of Public Hospital Association in Rize. The study aimed to reach the whole population by not taking samples. The data were collected by the personal information form (16 questions) prepared by the researcher, and the job satisfaction scale (36 articles) between June 1st and August 30th, 2014. According to scale, mean scores of nurses’ job satisfaction were 3.23±0.51. In addition, it was determined that the factors such as nurses’s age, marital status, childbearing, place of duty, position in workplace, being liked of job, education status, work experience, weekly working hours, maturing in professional practice, unit worked, hospital worked and colleagues affected the job satisfaction levels of nurses (p <0.05). In conclusion; the nurses’ general job satisfaction levels were moderate level.

Keywords: hospitals, job satisfaction level, nurses, public hospitals

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Authors: Mera Ababneh, Sayer Al-Azzam, Karem Alzoubi, Abeer Rababa'h

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Background: Medication errors are among the most common medical errors. Their occurrences result in patient’s mortality, morbidity, and additional healthcare costs. Continuous monitoring and detection is required. Objectives: The aim of this study was to compare medication errors in outpatient’s prescriptions in two different hospitals (paper system vs. electronic system). Methods: This was a cross sectional observational study conducted in two major hospitals; King Abdullah University Hospital (KAUH) and Princess Bassma Teaching Hospital (PBTH) over three months period. Data collection was conducted by two trained pharmacists at each site. During the study period, medication prescriptions and dispensing procedures were screened for medication errors in both participating centers by two trained pharmacist. Results: In the electronic prescription hospital, 2500 prescriptions were screened in which 631 medication errors were detected. Prescription errors were 231 (36.6%), and dispensing errors were 400 (63.4%) of all errors. On the other side, analysis of 2500 prescriptions in paper-based hospital revealed 3714 medication errors, of which 288 (7.8%) were prescription errors, and 3426 (92.2%) were dispensing errors. A significant number of 2496 (67.2%) were inadequately and/or inappropriately labeled. Conclusion: This study provides insight for healthcare policy makers, professionals, and administrators to invest in advanced technology systems, education, and epidemiological surveillance programs to minimize medication errors.

Keywords: medication errors, prescription errors, dispensing errors, electronic prescription, handwritten prescription

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Authors: Maxim Kravchenko

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The paper looks into the structure and contents of the concept of empire in the social consciousness of modern Americans. To construct the model of this socially and politically relevant concept we have conducted an experiment with respondents born and living in the USA. Empire is seen as a historic notion describing such entities as the British empire, the Russian empire, the Ottoman empire and others. It seems that the democratic regime adopted by most countries worldwide is incompatible with imperial status of a country. Yet there are countries which tend to dominate in the contemporary world and though they are not routinely referred to as empires, in many respects they are reminiscent of historical empires. Thus, the central hypothesis of the study is that the concept of empire is cultivated in some states through the intermediary of the mass media though it undergoes a certain transformation to meet the expectations of a democratic society. The transformation implies that certain components which were historically embedded in its structure are drawn to the margins of the hierarchical structure of the concept whereas other components tend to become central to the concept. This process can be referred to as restructuration of the concept of empire. To verify this hypothesis we have conducted a study which falls into two stages. First we looked into the definition of empire featured in dictionaries, the dominant conceptual components of empire are: importance, territory/lands, recognition, independence, authority/power, supreme/absolute. However, the analysis of 100 articles from American newspapers chosen at random revealed that authors rarely use the word «empire» in its basic meaning (7%). More often «empire» is used when speaking about countries, which no longer exist or when speaking about some corporations (like Apple or Google). At the second stage of the study we conducted an associative experiment with the citizens of the USA aged 19 to 45. The purpose of the experiment was to find out the dominant components of the concept of empire and to construct the model of the transformed concept. The experiment stipulated that respondents should give the first association, which crosses their mind, on reading such stimulus phrases as “strong military”, “strong economy” and others. The list of stimuli features various words and phrases associated with empire including the words representing the dominant components of the concept of empire. Then the associations provided by the respondents were classified into thematic clusters. For instance, the associations to the stimulus “strong military” were compartmentalized into three groups: 1) a country with strong military forces (North Korea, the USA, Russia, China); 2) negative impression of strong military (war, anarchy, conflict); 3) positive impression of strong military (peace, safety, responsibility). The experiment findings suggest that the concept of empire is currently undergoing a transformation which brings about a number of changes. Among them predominance of positively assessed components of the concept; emergence of two poles in the structure of the concept, that is “hero” vs. “enemy”; marginalization of any negatively assessed components.

Keywords: associative experiment, conceptual components, empire, restructurasation of the concept

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Authors: Jonida Hasanaj

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Abstract: Four years after the pandemic, numerous studies discuss the long-term effects of COVID-19 on patients, with chronic fatigue syndrome being a prominent concern. Understanding the mechanisms behind this syndrome is crucial for developing prevention, treatment, and rehabilitation strategies. The appropriateness of physiotherapeutic treatment in covid 19 and post-COVID-19 patients has remained uncertain due to inconsistent diagnostic criteria, highlighting the need for further research. This paper intends to offer guidelines and specific suggestions for hospital-based physical therapists managing COVID-19 hospitalized patients at ‘’Expert Physiotherapy’ and ’American Hospital’ in Albania using a national approach in accordance with worldwide initiatives. Several studies indicate that chronic tiredness syndrome and high intracranial pressure could result from failure of the post-Covid-19 lymphatic system. Enabling the patient to intensify their physical activity and enhance their ability to move, exercise, and even resume a regular life cycle is the aim of physiotherapy treatment.

Keywords: mobility, physiotherapy, post-covid 19, rehabilitation, results

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Authors: Sanele E. Nene L., Lia M. Hewitt

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Background: Artificial intelligence (AI) has a high value in healthcare, various applications have been developed for the efficiency of clinical operations, such as appointment/surgery scheduling, diagnostic image analysis, prognosis, prediction and management of specific ailments. Purpose: The purpose of this study was to explore, describe, contrast, evaluate, and develop the various leadership strategies as a conceptual framework, applied by public health Operational Managers (OMs) to embrace AI benefits, with the aim to improve the healthcare system in a public hospital. Design and Method: A qualitative, exploratory, descriptive and contextual research design was followed and a descriptive phenomenological approach. Five phases were followed to conduct this study. Phenomenological individual interviews and focus groups were used to collect data and a phenomenological thematic data analysis method was used. Findings and conclusion: Three themes surfaced as the experiences of AI by the OMs; Positive experiences related to AI, Management and leadership processes in AI facilitation, and Challenges related to AI.

Keywords: ambivalence, embracing, Artificial intelligence, public hospital

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Authors: Nicole Marella G. Tan, Al Joseph R. Molina, Raisa Celine R. Rosete, Soraya Elisse E. Escandor, Blythe N. Ke, Veronica Marie E. Ramos, Apolinario Ericson B. Berberabe, Jose Jonas D. del Rosario, Regina Pascua-Berba, Eileen Liesl A. Cubillan, Winlove P. Mojica

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Emergency risk and health communications play a vital role in any pandemic response. However, the Philippine General Hospital (PGH) lacked a system of information delivery that could effectively fulfill the hospital’s communication needs as a COVID-19 referral hospital. This study aimed to describe the establishment of a communication framework for information dissemination within a tertiary government hospital during the COVID-19 pandemic and evaluated the perceived usefulness of its outputs. This is a mixed quantitative-qualitative study with two phases. Phase 1 documented the formation and responsibilities of the Information Education Communication (IEC) Committee. Phase 2 evaluated its output and outcomes through a hospital-wide survey of 528 healthcare workers (HCWs) using a pre-tested questionnaire. In-depth explanations were obtained from five focused group discussions (FGD) amongst various HCW subgroups. Descriptive analysis was done using STATA 16 while qualitative data were synthesized thematically. Communication practices in PGH were loosely structured at the beginning of the pandemic until the establishment of the IEC Committee. The IEC Committee was well-represented by concerned stakeholders. Nine types of infographics tackled different aspects of the hospital’s health operations after thorough inputs from concerned offices. Internal and external feedback mechanisms ensured accurate infographics. Majority of the survey respondents (98.67%) perceived these as useful in their work or daily lives. FGD participants cited the relevance of infographics to their occupations, suggested improvements, and hoped that these efforts would be continued in the future. Sustainability and comprehensive reach were the main concerns in this undertaking. The PGH COVID-19 IEC framework was developed through trial and testing as there were no existing formal structures to communicate health risks and to properly direct the HCWs in the chaotic time of a pandemic. It is a continuously evolving framework which is perceived as useful by HCWs and is hoped to be sustained in the future.

Keywords: COVID-19, pandemic, health communication, infographics, social media

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Authors: Tedman Cheuk-Yiu Chau, Xavier Harvey, Hung Nguyen

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Defunctioning ileostomies are frequently used as an adjunct to low anterior resection in the surgical treatment of rectal cancer. Despite reducing the rate of clinically relevant anastomotic leak, the burden of defunctioning ileostomy is significant, with up to two-thirds of patients reporting stoma-related morbidity. International data have demonstrated an increased risk of bowel dysfunction and lower quality of life in patients with delayed closure (greater than six months post-surgery). While timely reversal is safe and cost-effective, the time to the reversal in Australian and New Zealand public hospitals is not described in the published literature. Thus, it is important to assess the current timeliness of ileostomy closure in the Australian regional context and examine the reasons for the delay. A retrospective analysis of ileostomy closure in Launceston General Hospital (LGH) patients treated with low/ultra low anterior resection for rectal cancer between 2012 and 2019 was undertaken. 94 cases of rectal adenocarcinoma undergoing ultralow anterior resection were examined over the years between 2012-2019. Amongst these, 21 cases (22.3%) were not reversed due to disease progress, death prior to reversal, or surgical complication. Demographics, disease status, surgical technique, and hospital inpatient events of these cases were examined. An average waiting time of 213.2 days was noted. Reasons for the delay include non-specified/prolonged hospital waiting time (54%), delayed or complicated chemotherapy course (13%), surgical complication (11%), advanced age, and frailty(5%). Complication of a delayed ileostomy reversal includes post-operation ileus and the development of an incisional hernia. We conclude that a delayed reversal of ileostomy can contribute to a higher incidence of stoma-related co-morbidities and contribute to a longer hospital stay and therefore use of public hospital resources.

Keywords: anterior resection, colorectal surgery, ileostomy reversal, rectal cancer

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Authors: Thoetchai Peeraphatdit, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham, Niyada Naksuk

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Background: Serum electrolyte abnormalities are a common cause of an acquired prolonged QT syndrome, especially, in the coronary care unit (CCU) setting. Optimal electrolyte ranges among the CCU patients have not been sufficiently investigated. Methods: We identified 8,498 consecutive CCU patients who were admitted to the CCU at Mayo Clinic, Rochester, the USA, from 2004 through 2013. Association between first serum electrolytes and baseline corrected QT intervals (QTc), as well as in-hospital mortality, was tested using multivariate linear regression and logistic regression, respectively. Serum potassium 4.0- < 4.5 mEq/L, ionized calcium (iCa) 4.6-4.8 mg/dL, and magnesium 2.0- < 2.2 mg/dL were used as the reference levels. Results: There was a modest level-dependent relationship between hypokalemia ( < 4.0 mEq/L), hypocalcemia ( < 4.4 mg/dL), and a prolonged QTc interval; serum magnesium did not affect the QTc interval. Association between the serum electrolytes and in-hospital mortality included a U-shaped relationship for serum potassium (adjusted odds ratio (OR) 1.53 and OR 1.91for serum potassium 4.5- < 5.0 and ≥ 5.0 mEq/L, respectively) and an inverted J-shaped relationship for iCa (adjusted OR 2.79 and OR 2.03 for calcium < 4.4 and 4.4- < 4.6 mg/dL, respectively). For serum magnesium, the mortality was greater only among patients with levels ≥ 2.4 mg/dL (adjusted OR 1.40), compared to the reference level. Findings were similar in sensitivity analyses examining the association between mean serum electrolytes and mean QTc intervals, as well as in-hospital mortality. Conclusions: Serum potassium 4.0- < 4.5 mEq/L, iCa ≥ 4.6 mg/dL, and magnesium < 2.4 mg/dL had a neutral effect on QTc intervals and were associated with the lowest in-hospital mortality among the CCU patients.

Keywords: calcium, electrocardiography, long-QT syndrome, magnesium, mortality, potassium

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Authors: Silvia Maria Moya

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After the Great Depression, the number of admissions to psychiatric facilities saw a significant increase. This increase, coupled with the arrival of new antipsychotic drugs, prepared the ground to the psychiatric deinstitutionalization movement in North America. Community services became an essential part of care where the role of the nurse also became crucial in the management of patients. Looking through the archives of the Department of Psychiatry at the Ottawa Montfort Hospital, this project aims to assess the role of the nurse in a multidisciplinary team in a period of psychiatric deinstitutionalization. This research focuses on the different roles of the mental health nurse during the second half of the twentieth century. The case study, used as a methodological approach allows in-depth analysis of the journey of a female patient with long hospital course. The analysis of the document ‘psychiatric evaluation’ on the medical records of outpatient Montfort Hospital – where, on a regular basis, different health professionals of the multidisciplinary team write their notes – allow us to better understand the difficulties of the patient, their problems, their family and work relationships and the evolution of their self-esteem, but most importantly, it allows us to identify the importance of the different nurse`s roles in the team and in the mental health setting. This project therefore reveals that the nurse occupies a larger professional space than the other professionals in the multidisciplinary team and highlights the role of mental health nurses with patients and their families and their leadership role within a multidisciplinary team.

Keywords: mental health, nursing, deinstitutionalization, professional space

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Authors: Awais Ahmad

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People of Khyber Pakhtunkhwa (KP) and Federally Administered Tribal Areas (FATA) remains underrepresented in Pakistan’s mainstream media and their miseries and concerns are unheard and unnoticed. Rising the incidents of human rights violation in KP province of Pakistan, and its absence in the mainstream media has raised many questions on the clause of press freedom known as 19/A in the constitution of Pakistan, that has claimed freedom of speech to all Pakistani citizens. Using a ‘think a loud’ research technique, senior most journalists of KP have been interviewed to get to know reasons of why and how Pashtun’s voices have been silenced in a democratic country where individual’s opinion is considered more powerful, and they can exercise freedom to protest and speak-up for their rights. The information collected from the journalists has been used to evaluate press freedom in KP and FATA by applying the institutional theory. The paper evaluates different recent cases where Pashtun journalists, media outlets and social activists were being punished for criticizing authorities and military establishment. This study also explores that the perception of local journalists regarding press freedom and what are the factors they consider it restrictions while they perform their duties.

Keywords: press freedom, federally administered tribal areas (fata), khyber pakhtunkhwa (kp), military establishment

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Authors: Ana L. Martins, Luis Orfão

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Healthcare systems have been subject to various research efforts aiming at process improvement under a lean approach. Another perspective, agility, has also been used, though in a lower scale, in order to analyse the ability of different hospital services to adapt to demand uncertainties. Both perspectives have a common denominator, the improvement of effectiveness and efficiency of the services in a healthcare setting context. Mixing the two approached allows, on one hand, to streamline the processes, and on the other hand the required flexibility to deal with demand uncertainty in terms of both volume and variety. The present research aims to analyse the impacts of the combination of both perspectives in the effectiveness and efficiency of an hospital service. The adopted methodology is based on a case study approach applied to the process of the ambulatory surgery service of Hospital de Lamego. Data was collected from direct observations, formal interviews and informal conversations. The analyzed process was selected according to three criteria: relevance of the process to the hospital, presence of human resources, and presence of waste. The customer of the process was identified as well as his perception of value. The process was mapped using flow chart, on a process modeling perspective, as well as through the use of Value Stream Mapping (VSM) and Process Activity Mapping. The Spaghetti Diagram was also used to assess flow intensity. The use of the lean tools enabled the identification of three main types of waste: movement, resource inefficiencies and process inefficiencies. From the use of the lean tools improvement suggestions were produced. The results point out that leagility cannot be applied to the process, but the application of lean and agility in specific areas of the process would bring benefits in both efficiency and effectiveness, and contribute to value creation if improvements are introduced in hospital’s human resources and facilities management.

Keywords: case study, healthcare systems, leagility, lean management

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Authors: D. Tedesco, G. Feletti, P. Trucco

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The present study aims to develop a Decision Support System (DSS) to support the operational decision of the Emergency Medical Service (EMS) regarding the assignment of medical emergency requests to Emergency Departments (ED). In the literature, this problem is also known as “hospital selection” and concerns the definition of policies for the selection of the ED to which patients who require further treatment are transported by ambulance. The employed research methodology consists of the first phase of revision of the technical-scientific literature concerning DSSs to support the EMS management and, in particular, the hospital selection decision. From the literature analysis, it emerged that current studies are mainly focused on the EMS phases related to the ambulance service and consider a process that ends when the ambulance is available after completing a request. Therefore, all the ED-related issues are excluded and considered as part of a separate process. Indeed, the most studied hospital selection policy turned out to be proximity, thus allowing to minimize the transport time and release the ambulance in the shortest possible time. The purpose of the present study consists in developing an optimization model for assigning medical emergency requests to the EDs, considering information relating to the subsequent phases of the process, such as the case-mix, the expected service throughput times, and the operational capacity of different EDs in hospitals. To this end, a Discrete Event Simulation (DES) model was created to evaluate different hospital selection policies. Therefore, the next steps of the research consisted of the development of a general simulation architecture, its implementation in the AnyLogic software and its validation on a realistic dataset. The hospital selection policy that produced the best results was the minimization of the Time To Provider (TTP), considered as the time from the beginning of the ambulance journey to the ED at the beginning of the clinical evaluation by the doctor. Finally, two approaches were further compared: a static approach, which is based on a retrospective estimate of the TTP, and a dynamic approach, which is based on a predictive estimate of the TTP determined with a constantly updated Winters model. Findings reveal that considering the minimization of TTP as a hospital selection policy raises several benefits. It allows to significantly reduce service throughput times in the ED with a minimum increase in travel time. Furthermore, an immediate view of the saturation state of the ED is produced and the case-mix present in the ED structures (i.e., the different triage codes) is considered, as different severity codes correspond to different service throughput times. Besides, the use of a predictive approach is certainly more reliable in terms of TTP estimation than a retrospective approach but entails a more difficult application. These considerations can support decision-makers in introducing different hospital selection policies to enhance EMSs performance.

Keywords: discrete event simulation, emergency medical services, forecast model, hospital selection

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Authors: Wiktor Stypczyński

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During the Cold War, both sides of the conflict developed advanced operational plans in case of a Third World War outbreak. In the Warsaw Pact, Soviet generals in Moscow chose targets for each army, but each country's General Staff had to create specific plans for their nation. This led to the creation of a Strategic Culture within the Warsaw Pact that was reflected in the plans of each army. This paper aims to showcase the Strategic Culture of the Warsaw Pact by using the plans of the People's Polish Army as an example. Examining one army at a time will allow for a more detailed and unique perspective on the matter. Understanding the past Strategic Culture is crucial in comprehending the current post-Soviet strategic situation in Eastern Europe, especially with the current situation in Ukraine. This paper is based on Benon Miśkiewicz's classic methodology of military history. While this methodology is the foundation, the research findings will also draw on the Strategic Studies methodology and the accomplishments of war and military science. Additionally, the Security and Political Studies methodology will be a crucial element in constructing the narrative.

Keywords: cold war, operetional plans, strategic culture, polish people's army

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Authors: Yongde Dai

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The recent Chinese military action blockbusters, notably known as, Wolf Warrior/Zhan Lang (2015), Operation Mekong/Mei gong he xing dong (2016), Warrior 2/Zhan Lang 2 (2017) and Operation Red Sea/Hong hai xing dong (2018), have achieved phenomenal box-office successes and in particular, Wolf Warrior 2 became China’s highest-grossing film of all time. However, their yearly presence tends to show a paradigmic shift from China’s primacy of wen manliness (soft) to wu masculinity (hard). With the increasing cinematic exposure of a more muscular image manifesting in both the Chinese heroic soldiers and China itself as a rising global power, the backlash of the Chinese public against the proliferation of the feminized masculinity influenced by the ‘pretty-boy’ pop-culture and China’s harder approach to the current Sino-US tensions have correspondingly emerged and continued to brew. Chinese masculinity imagined in these films is one of the key factors that enable a gendered interpretation of the correlation between the Chinese on-screen fantasy and off-screen reality, that is, China’s public and official discourse about the hegemonic masculinity and non-hegemonic masculinity as well as China’s international profile on cinematic appearance and in today’s Sino-US relation. By reading closely at the four megahits as visual-audio texts with Chinese masculinity studies by Kam Louie and Geng Song, this paper attempts to examine the Chinese construction of manliness with historical accounts and argue why and how the recurrent emphasis of hard/military masculinity (wu) on screen are viewed as China’s contemporary rewriting of the ‘sick-man’ history in the film form. Through this investigation, the paper finds that the rewriting of the ‘sick-man’ history in the cinematic world through heroic brawny soldiers comes to resonate a collective anxiety of China in countering the real-life increasing feminized masculinity on the public appearance, particularly on the male celebrities. In addition, the superpower fantasy about China illuminates a hypermasculine imaginary of China as a global rising power and this coincidently echoes China’s current tougher diplomatic strategy tackling the Sino-US trade war, South China sea dispute and Huawei-US lawsuits.

Keywords: Chinese masculinity, Chinese military action film, feminized masculinity, manhood and nationhood, sick man of Asia

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Authors: Edwin Onwuka, Segun Omidiora, Eugenia Abiodun-Eniaiyekan

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The Nigerian military is often the subject of active critical inquiries having played significant roles in Nigeria’s national development. However, the soldier is one of the most vilified characters in Nigeria’s imaginative literature, be it in poetry, drama or prose fiction. In the main, the characterization of soldiers is predictable because of their entrenched stereotype as oppressors, tyrants, bullies, rapists, despots, killers or at best law-breakers subject to no authority outside the military institution. In most novels, the soldier’s personality is associated with force and violence; still, few have defied the norm to portray soldiers that go against the grain of notoriety. Such novels have characterized the Nigerian soldier positively as a civil, thinking and human personality in relating to civil society. To a great extent, two major impetuses that influence literary representation of characters and institutions in African literature are ideology and commitment, and one necessarily impacts on the other in shaping the artistic vision of the writer. Using two war novels therefore as templates, this paper argues that the ideology that drives the Nigerian writer’s socio-cultural commitment to national development shapes their portrayal of the Nigerian soldier in imaginative literature. A major objective of this study, therefore, is to show through close textual analysis that the writers’ ideologies influence their perception and characterization of the Nigerian soldier in Isidore Okpewho’s The Last Duty and Festus Iyayi’s Heroes, two representative novels of both persuasions described above. New Historicism is the critical framework applied in this study and its conclusion is that the Nigerian writer’s characterization of the soldier is influenced by his ideological perception of the military in the policy against the backdrop of their past socio-political activities.

Keywords: commitment, ideology, national development, new historicism, Nigerian soldier

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Authors: Boularas El-Alia, Arbi Raja, Bachir Bouiadjra Sara, Rezk-Kallah Haciba, Rezkkallah Baghdad

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Objectives : To determine the handling practices of cytotoxic drugs and to describe clinical manifestations expressed by hospital personnel of Sidi Bel Abbes during the year 2014. Methods: Sectional descriptive study conducted in 3 center university hospital units (Hematology, Oncology and Urology) and Gynecology of EHS Sidi Bel Abbes. A questionnaire was administered to hospital workers regulary exposed to cytotoxic drugs. A work-place visit was performed to have an overview about working conditions. The Cytotoxic Contact Index (CCI) was calculated for each nurse on a period of 15 working days. Treatment of the results was done using SPSS software. Results: The survey reveals that 22 men and 58 women are exposed to cytotoxic drugs for an average of 7 years. Many symptoms such as ocular irritation (38,75%), throat irritation (56,25%), headache (68,75%), dizziness (43,75%), nausea (37,5%), metallic taste (30%), were reported with high frequency. Are noted in the offspring, 3 congenital anomalies,2 diaphragmatic hernia and a cleft palate. The Cytotoxic Contact Index (CCI) was higher than 3 among Oncology nurses and higher than 1 for most of the nurses of Hematology and Gynecology service. The wearing of personal protective clothing was not respected by all workers: (22/23) wear gloves and (20/23) wear a mask,(5/23) wear a cap, (2/23) wear glasses. Only 3 nurses have benefited from continuous training on handling cytotoxic drugs. Conclusion: This study shows a high occupational exposure risk to cytotoxic drugs among persons handling these drugs and the necessity to apply rigorously all measures related to personal protection awareness and training of personnel to minimize these exposure.

Keywords: cytotoxic drugs, handling, clinical manifestations, hospital staff

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Authors: J. Byimana, I. A. Muhire, J. E. Nzabahimana, A. Nyombayire

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Introduction: A successful cardiopulmonary resuscitation during a sudden cardiac arrest can be delayed by different components including new hospital setting, lack of adequate training, lack of pre-established resuscitation team and ineffective communication and lead to an unexpected outcome which is death. The main objective of the study was to assess the readiness of resuscitation teams during cardiac arrest and the organizational approaches that would best support their functioning in a new hospital facility, and to detect any factor that may have contributed to responses. This study analyses the readiness of Resuscitation Team (RT) during cardiac arrest. —Material and methods: A prospective Analytic design was carried out at a newly established United Nations level 2 hospital facility, on four RTM (resuscitation team member). A semi structured questionnaire was used to collect data. —Results: This study highlights indicate that the response time during cardiac arrest simulation meet both American heart association (AHA) and European resuscitation council guidelines. The study offers useful evidence about the impact of a new facility on RTM performance and provides an exposure of staff to emergency events within the Work setting.

Keywords: cardiac arrest, code blue, simulation, resuscitation team member

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Authors: Vitalijus Leibenka

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After 2014 the world of Russia’s actions in annexing Crimea has seen a hybrid war that has helped Russia achieve its goals. The world and NATO nations have pointed out that hybrid action can help achieve not only military but also economic and political goals. One of the weapons of action in hybrid warfare is information warfare tools, the use of which helps to carry out actions in the context of hybrid warfare as a whole. In addition, information war tools can be used alone, over time and for long-term purposes. Although forms of information war, such as propaganda and disinformation, have been used in the past, in old conflicts and wars, new forms of information war have emerged as a result of technological development, making the dissemination of information faster and more efficient. The world understands that information is becoming a weapon, but not everyone understands that both information war and information warfare differ in their essence and full content. In addition, the damage and impact of the use of information war, which may have worse consequences than a brief military conflict, is underestimated. Lithuania is also facing various interpretations of the information war. Some believe that the information attack is an information war and the understanding of the information war is limited to a false message in the press. Others, however, deepen and explain the essence of the information war. Society has formed in such a way that not all people are able to assess the threats of information war, to separate information war from information attack. Recently, the Lithuanian government has been taking measures in the context of the information war, making decisions that allow the development of the activities of the state and state institutions in order to create defense mechanisms in the information war. However, this is happening rather slowly and incompletely. Every military conflict, related to Lithuania in one way or another, forces Lithuanian politicians to take up the theme of information warfare again. As a result, a national cyber security center is being set up, and Russian channels spreading lies are banned. However, there is no consistent development and continuous improvement of action against information threats. Although a sufficiently influential part of society (not a political part) helps to stop the spread of obscure information by creating social projects such as “Demaskuok” and “Laikykis ten su Andriumi tapinu”, it goes without saying that it will not become a key tool in the fight against information threats. Therefore, in order to achieve clean dissemination of information in Lithuania, full-fledged and substantial political decisions are necessary, the adoption of which would change the public perception of the information war, its damage, impact and actions that would allow to combat the spread. Political decisions should cover the educational, military, economic and political areas, which are one of the main and most important in the state, which would allow to fundamentally change the situation against the background of information war.

Keywords: information war, information warfare, hybrid war, hybrid warfare, NATO, Lithuania, Russia

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Authors: I. Mentziou, C. Delezos, A. Nestoridou, G. Boskou

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Introduction: The system of production and distribution of meals can have a significant impact on the food intake of hospital patients who are likely to develop malnutrition. In hospitals, the consequences of food borne infections can range from annoying to life-threatening for a patient, since they can lead up to death in vulnerable groups. Aim: The aim of the present study was to evaluate the satisfaction of the patients from the food services in Greek hospitals. Methods: Eleven hospitals of the Attica region were chosen. The sample derived from 637 adult patients who were hospitalized in those hospitals, during the period September 2009 - April 2010. Tailor made questionnaires were used to interview patients upon their satisfaction from the current food service system as well as from the total quality management system of the hospital. The number of completed questionnaires was proportional to the hospital capacity. Results: The majority of the patients seem to be pleased from the quality and the variety of the meals; they judged positively the behaviour of the food service personnel and the hygiene of serving conditions. Patients made suggestions for more frequent meals, larger variety of choices and better presented meals served under proper hygiene conditions by the personnel. Conclusions: The results indicate that the patients are satisfied in regards to the meal choices and the serving methods. However, factors like temperature and hygiene conditions are not always perceived to be in a way that fulfills the necessary prerequisite requirements. A total quality management system as a driver for better patient satisfaction is Indispensable.

Keywords: evaluation, food service, HACCP, hospital, patients

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Authors: S. Kurian, S. Satpathy, S. K. Gupta, S. Arya, D. K. Sharma

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Advances in the use of health care technology have resulted in increased adverse events (AEs) related to the use of medical devices. The study focused on the existing reporting systems. This study was conducted in a tertiary care public sector hospital. Devices included Syringe infusion pumps, Cardiac monitors, Pulse oximeters, Ventilators and Defibrillators. A total of 211 respondents were recruited. Interviews were held with 30 key informants. Medical records were scrutinized. Relevant statistical tests were used. Resident doctors reported maximum frequency of AEs, followed by nurses; and least by consultants. A significant association was found between the cadre of health care personnel and awareness that the patients and bystanders have a risk of sustaining AE. Awareness regarding reporting of AEs was low, and it was generally done verbally. Other critical findings are discussed in the light of the barriers to reporting, reasons for non-compliance, recording system, and so on.

Keywords: adverse events, health care technology, medical devices, public sector hospital, reporting systems

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Authors: Chanpen Meenakorn

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This research aimed to examine the relationships between customer expectations and service quality management of Banpaew Hospital Samutsakorn in Thailand. The study sample consisted of 360 customers in patient unit. Data were collected using self-administered questionnaire. Descriptive statistics used were percentage, mean, and standard deviation. The analytical statistics comprised Pearson’s product moment correlation coefficient analysis. The result showed that service quality of nurses was very good with sustainable development trend. Physical evidence was at a high level, and the process and personal were rated at a high level. Additional, the study suggested that head nurse should be encouraged to improve service quality management, management training. Nurse administrators should create an appropriate nursing department climate, and provide necessary resources in the department. In addition, the nurse administrators should continuously follow up the results of customer expectations and focus on patients/customers, process management, information and knowledge management, and evaluation of service quality also.

Keywords: Banpaew Hospital, Customer Expectations, Service Provided, Samutsakorn

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Authors: D. S. Chakraborty, S. Ghosh, A. Hazra

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Objective: Medication errors are a reality in all settings where medicines are prescribed, dispensed and used. High Alert Medications (HAM) are those that bear a heightened risk of causing significant patient harm when used in error. We conducted a knowledge-attitude-practice survey, among residents working in a teaching hospital, to assess the ground situation with regard to the handling of HAM. Methods: We plan to approach 242 residents among the approximately 600 currently working in the hospital through purposive sampling. Residents in all disciplines (clinical, paraclinical and preclinical) are being targeted. A structured questionnaire that has been pretested on 5 volunteer residents is being used for data collection. The questionnaire is being administered to residents individually through face-to-face interview, by two raters, while they are on duty but not during rush hours. Results: Of the 156 residents approached so far, data from 140 have been analyzed, the rest having refused participation. Although background knowledge exists for the majority of respondents, awareness levels regarding HAM are moderate, and attitude is non-uniform. The number of respondents correctly able to identify most ( > 80%) HAM in three common settings– accident and emergency, obstetrics and intensive care unit are less than 70%. Several potential errors in practice have been identified. The study is ongoing. Conclusions: Situation requires corrective action. There is an urgent need for improving awareness regarding HAM for the sake of patient safety. The pharmacology department can take the lead in designing awareness campaign with support from the hospital administration.

Keywords: high alert medication, medication error, questionnaire, resident

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Authors: J. Silva, P. Arezes, R. Schierl, N. Costa

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In order to study environmental contamination by cytostatic drugs in Portugal hospitals, sampling campaigns were conducted in three hospitals in 2015 (112 samples). Platinum containing drugs and fluorouracil were chosen because both were administered in high amounts. The detection limit was 0.01 pg/cm² for platinum and 0.1 pg/cm² for fluorouracil. The results show that spills occur mainly on the patient`s chair, while the most referenced occurrence is due to an inadequately closed wrapper. Day hospitals facilities were detected as having the largest number of contaminated samples and with higher levels of contamination.

Keywords: cytostatic, contamination, hospital, procedures, handling

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Authors: Sofia Sutera

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Despite the introduction of the Women, Peace, and Security (WPS) Agenda in 2000, thanks to the UNSCR 1325 and subsequent resolutions, and the clear stance of the UN towards the support of increased participation of women in peace and security processes, women’s leadership in this context remains very low. Considering specifically the framework of peacekeeping operations, the aim of this paper is to analyze the way women’s leadership is constructed in the Swedish Armed Forces (SAF). In the context of the WPS Agenda, Sweden has been chosen as a case study because of the relevance of its singular feminist policies (the statement in 2014 from Wallström, previous and current Minister for Foreign Affairs and Deputy Prime Minister, that Sweden is pursuing a feminist foreign policy is a clear example). Moreover, the SAF adopted in 2016 the Handbok Gender. This policy addresses explicitly the gender perspective embraced by the Swedish military institution, a sui-generis organization even in the Scandinavian reality. Indeed, the SAF has assumed a clear commitment to represent its institution as gender aware and gender equal. The theoretical perspective utilized in this research, which focuses specifically on women, is feminism and particularly a feminist constructivist approach, with an institutional focus on the military institution, has been chosen. Taking into account the specificity of the feminist research, the above-mentioned gender policy has been examined by means of a critical discourse analysis (CDA) whose main aim is to investigate the social structures of discourse and the power relationships inherent to it. Thus, CDA appears to be quite relevant in order to understand the construction of women’s leadership in the Handbok Gender. Nevertheless, even in a country which officially identifies as feminist and which is characterized by a peculiar military institution, the conclusions of this analysis revealed that women’s leadership in peacekeeping operations remains very low.

Keywords: feminism, peacekeeping operations, swedish armed forces, UNSCR 1325, women's leadership, WPS agenda

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Authors: Hana A. Jameel Alsaeed, Rayyan Ibrahim Khaleel, Hanaa Hussein Mukhlif

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Background: Contamination in Iraq's hospitals is a localized problem with high rates of disease And deaths that mainly affect poor areas. Thus, this study aims to evaluate hospital infections in the city of Mosul and to identify the etiology. So to assess environmental infection prevention in pediatric wards and newborn critical care units in Mosul city. Methods: The present study is a cross-sectional hospital based in Mosul-Iraq between (10th February to 1st April 2022). Purposive sample of 60 nurses from neonatal intensive care units and pediatric wards in three pediatric teaching hospitals in Mosul city; Data was gathered using a questionnaire created by the researchers after reviewing previous studies. Results: The study showed that the majority of the study infection prevention and control policy isn't available in 46.7% of departments, and 45% of hospital workers in Iraq don't know if there is an Iraqi version of it. 70% of the study group had participated in an infection control training program. Conclusions: In the majority of samples 55% of respondents to the study claimed not to be aware of these rules. 60% of the study's participants had never attended a course on infection prevention and control, according to the study's findings on education and training programs. In the neonatal and critical care unit, nurses' skill levels, years of experience, and actual duties varied by wide statistically significant differences.

Keywords: pediatric, infection control, assessment, mosul city

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Authors: Osagbai Joshua Eriki, Ngozi Agunwamba, Alice Hill, Lorna Almond, Maniya Duffy, Devashini Naidoo, David Ho, Raman Deo

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Aims: To evaluate the baseline eating pattern in a psychiatric hospital through quantifying purchases of food and drink items at the hospital shop and to implement a traffic light healthy eating labeling system. Method: A electronic till with reporting capabilities was purchased. A two-week period of baseline data collection was conducted. Thereafter, a system for labeling items based on the nutritional value of the food items at the hospital shop was implemented. Green labeling represented the items with the lowest calories and red the most. Further data was collated on the number and types of items purchased by patients according to the category, and the initial effectiveness of the system was evaluated. Result: Despite the implementation of the traffic light system, the red category had the highest number of items purchased by patients, highlighting the importance of promoting healthy eating choices. However, the study also showed that the system was effective in promoting healthy options, as the number of items purchased from the green category increased during the study period. Conclusion: The implementation of a traffic light labeling system for items sold at the hospital shop offers a promising approach to promoting healthy eating habits and choices. This is likely to contribute to a toolkit of measures when considering the multifactorial challenges that obesity and weight issues pose for long-stay psychiatric inpatients

Keywords: mental health, nutrition, food, healthy

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