Search results for: HR department
1381 Variations in Heat and Cold Waves over Southern India
Authors: Amit G. Dhorde
Abstract:
It is now well established that the global surface air temperatures have increased significantly during the period that followed the industrial revolution. One of the main predictions of climate change is that the occurrences of extreme weather events will increase in future. In many regions of the world, high-temperature extremes have already started occurring with rising frequency. The main objective of the present study is to understand spatial and temporal changes in days with heat and cold wave conditions over southern India. The study area includes the region of India that lies to the south of Tropic of Cancer. To fulfill the objective, daily maximum and minimum temperature data for 80 stations were collected for the period 1969-2006 from National Data Center of India Meteorological Department. After assessing the homogeneity of data, 62 stations were finally selected for the study. Heat and cold waves were classified as slight, moderate and severe based on the criteria given by Indias' meteorological department. For every year, numbers of days experiencing heat and cold wave conditions were computed. This data was analyzed with linear regression to find any existing trend. Further, the time period was divided into four decades to investigate the decadal frequency of the occurrence of heat and cold waves. The results revealed that the average annual temperature over southern India shows an increasing trend, which signifies warming over this area. Further, slight cold waves during winter season have been decreasing at the majority of the stations. The moderate cold waves also show a similar pattern at the majority of the stations. This is an indication of warming winters over the region. Besides this analysis, other extreme indices were also analyzed such as extremely hot days, hot days, very cold nights, cold nights, etc. This analysis revealed that nights are becoming warmer and days are getting warmer over some regions too.Keywords: heat wave, cold wave, southern India, decadal frequency
Procedia PDF Downloads 1281380 Clinical Advice Services: Using Lean Chassis to Optimize Nurse-Driven Telephonic Triage of After-Hour Calls from Patients
Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar
Abstract:
It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care
Procedia PDF Downloads 1741379 Risk Factors Associated with Increased Emergency Department Visits and Hospital Admissions Among Child and Adolescent Patients
Authors: Lalanthica Yogendran, Manassa Hany, Saira Pasha, Benjamin Chaucer, Simarpreet Kaur, Christopher Janusz
Abstract:
Children and adolescent patients visit the Psychiatric Emergency Department (ED) for multiple reasons. Visiting the Psychiatric ED itself can be a traumatic experience that can affect an adolescents mental well-being, regardless of a history of mental illness. Despite this, limited research exists in this domain. Prospective studies have correlated adverse psychosocial determinants among adolescents to risk factors for poor well-being and unfavorable behavior outcomes. Studies have also shown that physiological stress is a contributor in the development of health problems and an increase in substance abuse in adolescents. This study aimed to retrospectively determine which psychosocial factors are associated with an increase in psychiatric ED visits. 600 charts of patients who had a psychiatric ED and inpatient admission visit from January 2014 through December 2014 were reviewed. Sociodemographics, diagnoses, ED visits and inpatient admissions were collected. Descriptive statistics, chi-square tests and independent t-test analyses were utilized to examine differences in the sample to determine which factors affected ED visits and admissions. The sample was 50% female, 35.2% self-identified black, and had a mean age of 13 years. The majority, 85%, went to public school and 17% were in special education. Attention Deficit Hyperactivity Disorder was the most common admitting diagnosis, found in 132(23%) responders. Most patients came from single parent household 305 (53%). The mean ages of patients that were sexually active, with legal issues, and reporting marijuana substance abuse were 15, 14.35, and 15 years respectively. Patients from two biological parent households had significantly fewer ED visits (1.2 vs. 1.7, p < 0.01) and admissions (0.09 vs. 0.26, p < 0.01). Among social factors, those who reported sexual, physical or emotional abuse had a significantly greater number of ED visits (2.1 vs. 1.5, p < 0.01) and admissions (0.61 vs. 0.14, p < 0.01) than those who did not. Patients that were sexually active or had legal issues or substance abuse with marijuana had a significantly greater number of admissions (0.43 vs. 0.17, p < 0.01), (0.54 vs. .18, p < 0.01) and (0.46 vs. 0.18, p < 0.01) respectively. This data supports the theory of the stability of a two parent home. Dual parenting plays a role in creating a safe space where a child can develop; this is shown by subsequent decreases in psychiatric ED visits and admissions. This may highlight the psychological protective role of a two parent household. Abuse can exacerbate existing psychiatric illness or initiate the onset of new disease. Substance abuse and legal issues result in early induction to the criminal system. Results show that this causes an increase in frequency of visits and severity of symptoms. Only marijuana, but not other illicit substances, correlated with higher incidence of psychiatric ED visits. This may speak to the psychotropic nature of tetrahydrocannabinols and their role in mental illness. This study demonstrates the array of psychosocial factors that lead to increased ED visits and admissions in children and adolescents.Keywords: adolescent, child psychiatry, emergency department, substance abuse
Procedia PDF Downloads 3321378 The Efficacy of Pre-Hospital Packed Red Blood Cells in the Treatment of Severe Trauma: A Retrospective, Matched, Cohort Study
Authors: Ryan Adams
Abstract:
Introduction: Major trauma is the leading cause of death in 15-45 year olds and a significant human, social and economic costs. Resuscitation is a stalwart of trauma management, especially in the pre-hospital environment and packed red blood cells (pRBC) are being increasingly used with the advent of permissive hypotension. The evidence in this area is lacking and further research is required to determine its efficacy. Aim: The aim of this retrospective, matched cohort study was to determine if major trauma patients, who received pre-hospital pRBC, have a difference in their initial emergency department cardiovascular status; when compared with injury-profile matched controls. Methods: The trauma databases of the Royal Brisbane and Women's Hospital, Royal Children's Hospital (Herston) and Queensland Ambulance Service were accessed and major trauma patient (ISS>12) data, who received pre-hospital pRBC, from January 2011 to August 2014 was collected. Patients were then matched against control patients that had not received pRBC, by their injury profile. The primary outcomes was cardiovascular status; defined as shock index and Revised Trauma Score. Results: Data for 25 patients who received pre-hospital pRBC was accessed and the injury profiles matched against suitable controls. On admittance to the emergency department, a statistically significant difference was seen in the blood group (Blood = 1.42 and Control = 0.97, p-value = 0.0449). However, the same was not seen with the RTS (Blood = 4.15 and Control 5.56, p-value = 0.291). Discussion: A worsening shock index and revised trauma score was associated with pre-hospital administration of pRBC. However, due to the small sample size, limited matching protocol and associated confounding factors it is difficult to draw any solid conclusions. Further studies, with larger patient numbers, are required to enable adequate conclusions to be drawn on the efficacy of pre-hospital packed red blood cell transfusion.Keywords: pre-hospital, packed red blood cells, severe trauma, emergency medicine
Procedia PDF Downloads 3931377 GIS Data Governance: GIS Data Submission Process for Build-in Project, Replacement Project at Oman electricity Transmission Company
Authors: Rahma Saleh Hussein Al Balushi
Abstract:
Oman Electricity Transmission Company's (OETC) vision is to be a renowned world-class transmission grid by 2025, and one of the indications of achieving the vision is obtaining Asset Management ISO55001 certification, which required setting out a documented Standard Operating Procedures (SOP). Hence, documented SOP for the Geographical information system data process has been established. Also, to effectively manage and improve OETC power transmission, asset data and information need to be governed as such by Asset Information & GIS department. This paper will describe in detail the current GIS data submission process and the journey for developing it. The methodology used to develop the process is based on three main pillars, which are system and end-user requirements, Risk evaluation, data availability, and accuracy. The output of this paper shows the dramatic change in the used process, which results subsequently in more efficient, accurate, and updated data. Furthermore, due to this process, GIS has been and is ready to be integrated with other systems as well as the source of data for all OETC users. Some decisions related to issuing No objection certificates (NOC) for excavation permits and scheduling asset maintenance plans in Computerized Maintenance Management System (CMMS) have been made consequently upon GIS data availability. On the Other hand, defining agreed and documented procedures for data collection, data systems update, data release/reporting and data alterations has also contributed to reducing the missing attributes and enhance data quality index of GIS transmission data. A considerable difference in Geodatabase (GDB) completeness percentage was observed between the years 2017 and year 2022. Overall, concluding that by governance, asset information & GIS department can control the GIS data process; collect, properly record, and manage asset data and information within the OETC network. This control extends to other applications and systems integrated with/related to GIS systems.Keywords: asset management ISO55001, standard procedures process, governance, CMMS
Procedia PDF Downloads 1251376 Issues and Problems of Leadership Competencies among Head of Science Panels in Sarawak
Authors: Adawati Suhaili, Kamisah Osman, Mohd Effendi, Ewan Mohd Matore
Abstract:
The global education reform has prompted Malaysia to transform the education system in Malaysia through the Malaysian Education Blueprint (MEB) 2013-2025. This transformation is aimed to achieve the top one-third rank in international assessment. The low achievement of student scientific literacy in TIMMS (Trends in International Mathematics and Science Study ) and PISA (Programme for International Student Assessment) has caused concern to the Ministry Of Education (MOE) despite various reform efforts. Therefore, an alternative action by enhancing the role of the Head of Science Panels (HoSPs) as a key change agent in catalyzing the improvement of student performance should be considered. Highlights of previous studies have shown that subject leadership is able to enhance teacher teaching quality in order to increase student learning. To lead the Science department and guide Science teachers more effectively, HoSPs need to strengthen their leadership skills. However, the issue of weaknesses in the leadership competencies of HoSPs in Malaysia has caused them to lack confidence and ability in leading the Science Department. The main objective of this study is to explore the factors that contribute to the problems faced by HoSPs at Sarawak in their leadership roles. This study used a qualitative design framework and using a semi-structured interview method for data collection. There were six informants involved in the interview consisting of lecturers, Senior Administrative Assistant Teacher and HoSPs. The findings of the study had been identified four main factors that contribute to problems in the leadership competencies of HoSPs in Sarawak, namely leadership practices, leadership structure, academic subjects and school change. The results are significant to the MOE in strengthening the leadership competencies of HoSPs in a more focus for improving the achievement of scientific literacy of students in Malaysia. This study can help improve the Hosps' leadership competencies in Malaysia.Keywords: issues, problems, Malaysia education blueprint, leadership competencies, head of science panels
Procedia PDF Downloads 1981375 Investigation of the Prevalence, Phenotypes, and Risk Factors Associated with Demodex Infestation and Its Relationship with Acne
Authors: Sina Alimohammadi, Mahnaz Banihashemi, Maryam Poursharif
Abstract:
Demodex is a mandatory parasite of pilosebaceous. D. folliculorum lives as a single parasite or as a number of parasites in hair follicles, and D. brevis as a single parasite living in sebaceous glands. Transmission of Demodex from one person to another requires direct skin contact; it also has a greater density in the forehead, cheeks, nose, and nasolabial folds. Demodex can cause some clinical symptoms such as follicular pityriasis, rosacea-like demodicosis, postural folliculitis, papules, seborrheic dermatitis, blepharitis, dermatitis around the lips, and hyperpigmented spots. In this study, the prevalence of Demodex species in patients referred to the dermatology department of Sayad Shirazi Hospital Gorgan, Iran, in the years 2019-2020 was investigated. Material and Methods: The study population consisted of 242 samples taken from the people referred to the dermatology department of Sayad Shirazi Hospital during the years 2019-2020, which were sampled by adhesive tape. All of the participants completed the questionnaires. The samples were examined microscopically for the presence of Demodex. Results: Out of 242 participants, 67 (27.68%) were infected with Demodex. Most cases of infection were observed in the group of 21 to 30 years (28 people; 11.57%) and then in the group of 31 to 40 years (21 people; 8.67%). Also, in the group of people under 10 years and over 60 years, no positive cases (0%) of Demodex were observed in microscopic examinations. Out of 11 variables, there was a statistically significant difference in relation to the three variables of age (P = 0.000003), use of cleansing solutions (P = 0.002), and the presence of acne (P = 0.0013). Conclusion: According to the results of this study, it was found that the incidence of Demodex in one group of acne patients is higher than in others, which emphasizes the possible role of Demodex in the pathogenesis of acne. In this study, there was an inverse relationship between the incidence of Demodex and the use of skin cleansing solutions. Also, the prevalence of Demodex is higher in the group of 20-30 years, and its prevalence does not increase with age. Due to the possibility of drug resistance in the future, regular studies on genotyping and drug resistance are recommended.Keywords: acne, demodex, mite, prevalence
Procedia PDF Downloads 891374 ‘Call Before, Save Lives’: Reducing Emergency Department Visits through Effective Communication
Authors: Sandra Cardoso, Gaspar Pais, Judite Neves, Sandra Cavaca, Fernando Araújo
Abstract:
In 2021, Portugal has 63 emergency department (ED) visits per 100 people annually, the highest numbers in Europe. While EDs provide a critical service, high use is indicative of inappropriate and inefficient healthcare. In Portugal, all ED have the Manchester Triage System (MTS), a clinical risk management tool to enable that patients are seen in order of clinical priority. In 2023, more than 40% of the ED visits were of non-urgent conditions (blue and green), that could be better managed in primary health care (PHC), meaning wrong use of resources and lack of health literacy. From 2017, the country has a phone line, SNS24 (Contact Centre of the National Health Service), for triage, counseling, and referral service, 24 hours/7 days a week. The pilot project ‘Call before, save lives’ was implemented in the municipalities of Póvoa de Varzim and Vila do Conde (around 150.000 residents), in May 2023, by the executive board of the Portuguese Health Service, with the support of the Shared Services of the Ministry of Health, and local authorities. This geographical area has short travel times, 99% of the population a family doctor and the region is organized in a health local unit (HLU), integrating PHC and the local hospital. The purposes of this project included to increase awareness to contact SNS 24, before going to an ED, and non-urgent conditions oriented to a family doctor, reducing ED visits. The implementation of the project involved two phases, beginning with: i) development of campaigns using local influencers (fishmonger, model, fireman) through local institutions and media; ii) provision of telephone installed on site to contact SNS24; iii) establishment of open consultation in PHC; iv) promotion of the use of SNS24; v) creation of acute consultations at the hospital for complex chronic patients; and vi) direct referral for home hospitalization by PHC. The results of this project showed an excellent level of access to SNS24, an increase in the number of users referred to ED, with great satisfaction of users and professionals. The second phase, initiated in January 2024, for access to the ED, the need for prior referral was established as an admission rule, except for certain situations, as trauma patients. If the patient refuses, their registration in the ED and subsequent screening in accordance with the MTS must be ensured. When the patient is non-urgent, shall not be observed in the ED, provided that, according to his clinical condition, is guaranteed to be referred to PHC or to consultation/day hospital, through effective scheduling of an appointment for the same or the following day. In terms of results, 8 weeks after beginning of phase 2, we assist of a decrease in self-reported patients to ED from 59% to 15%, and a reduction of around 7% of ED visits. The key for this success was an effective public campaign that increases the knowledge of the right use of the health system, and capable of changing behaviors.Keywords: contact centre of the national health service, emergency department visits, public campaign, health literacy, SNS24
Procedia PDF Downloads 671373 Health Economics in the Cost-Benefit Analysis of Transport Schemes
Authors: Henry Kelly, Helena Shaw
Abstract:
This paper will seek how innovative methods from Health Economics and, to a lesser extent, wellbeing analysis can be applied in the Cost-Benefit Analysis (CBA) of transport infrastructure and policy interventions. The context for this will focus on the framework articulated by the UK Treasury (finance department) and the English Department for Transport. Both have well-established methods for undertaking CBA, but there is increased policy interest, particularly at a regional level of exploring broader strategic goals beyond those traditionally associated with transport user benefits, productivity gains, and labour market access. Links to different CBA approaches internationally, such as New Zealand, France, and Wales will be referenced. By exploring a complementary method of accessing the impacts of policies through the quantification of health impacts is a fruitful line to explore. In a previous piece of work, 14 impact pathways were identified, mapping the relationship between transport and health. These are wide-ranging, from improved employment prospects, the stress of unreliable journey times, and air quality to isolation and loneliness. Importantly, we will consider these different measures of health from an intersectional point of view to ensure that the basis that remains in the health industry does not get translated across to this work. The objective is to explore how a CBA based on these pathways may, through quantifying forecast impacts in terms of Quality-Adjusted Life Years may, produce different findings than a standard approach. Of particular interest is how a health-based approach may have different distributional impacts on socio-economic groups and may favour distinct types of interventions. Consideration will be given to the degree this approach may double-count impacts or if it is possible to identify additional benefits to the established CBA approach. The investigation will explore a range of schemes, from a high-speed rail link, highway improvements, rural mobility hubs, and coach services to cycle lanes. The conclusions should aid the progression of methods concerning the assessment of publicly funded infrastructure projects.Keywords: cost-benefit analysis, health, QALYs transport
Procedia PDF Downloads 801372 Alternative Ways of Knowing and the Construction of a Department Around a Common Critical Lens
Authors: Natalie Delia
Abstract:
This academic paper investigates the transformative potential of incorporating alternative ways of knowing within the framework of Critical Studies departments. Traditional academic paradigms often prioritize empirical evidence and established methodologies, potentially limiting the scope of critical inquiry. In response to this, our research seeks to illuminate the benefits and challenges associated with integrating alternative epistemologies, such as indigenous knowledge systems, artistic expressions, and experiential narratives. Drawing upon a comprehensive review of literature and case studies, we examine how alternative ways of knowing can enrich and diversify the intellectual landscape of Critical Studies departments. By embracing perspectives that extend beyond conventional boundaries, departments may foster a more inclusive and holistic understanding of critical issues. Additionally, we explore the potential impact on pedagogical approaches, suggesting that alternative ways of knowing can stimulate alternative way of teaching methods and enhance student engagement. Our investigation also delves into the institutional and cultural shifts necessary to support the integration of alternative epistemologies within academic settings. We address concerns related to validation, legitimacy, and the potential clash with established norms, offering insights into fostering an environment that encourages intellectual pluralism. Furthermore, the paper considers the implications for interdisciplinary collaboration and the potential for cultivating a more responsive and socially engaged scholarship. By encouraging a synthesis of diverse perspectives, Critical Studies departments may be better equipped to address the complexities of contemporary issues, encouraging a dynamic and evolving field of study. In conclusion, this paper advocates for a paradigm shift within Critical Studies departments towards a more inclusive and expansive approach to knowledge production. By embracing alternative ways of knowing, departments have the opportunity to not only diversify their intellectual landscape but also to contribute meaningfully to broader societal dialogues, addressing pressing issues with renewed depth and insight.Keywords: critical studies, alternative ways of knowing, academic department, Wallerstein
Procedia PDF Downloads 721371 Ways for University to Conduct Research Evaluation: Based on National Research University Higher School of Economics Example
Authors: Svetlana Petrikova, Alexander Yu Kostinskiy
Abstract:
Management of research evaluation in the Higher School of Economics (HSE) originates from the HSE Academic Fund created in 2004 to facilitate and support academic research and presents its results to international academic community. As the means to inspire the applicants, science projects went through competitive selection process evaluated by the group of experts. Drastic development of HSE, quantity of applied projects for each Academic Fund competition and the need to coordinate the conduct of expert evaluation resulted in founding of the Office for Research Evaluation in 2013. The Office’s primary objective is management of research evaluation of science projects. The standards to conduct the evaluation are defined as follows: - The exercise of the process approach, the unification of the functioning of department. - The uniformity of regulatory, organizational and methodological framework. - The development of proper on-line evaluation system. - The broad involvement of external Russian and international experts, the renouncement of the usage of own employees. - The development of an algorithm to make a correspondence between experts and science projects. - The methodical usage of opened/closed international and Russian databases to extend the expert database. - The transparency of evaluation results – free access to assessment while keeping experts confidentiality. The management of research evaluation of projects is based on the sole standard, organization and financing. The standard way of conducting research evaluation at HSE is based upon Regulations on basic principles for research evaluation at HSE. These Regulations have been developed from the moment of establishment of the Office for Research Evaluation and are based on conventional corporate standards for regulatory document management. The management system of research evaluation is implemented on the process approach basis. Process approach means deployment of work as a process, which is the aggregation of interrelated and interacting activities processing inputs into outputs. Inputs are firstly client asking for the assessment to be conducted, defining the conditions for organizing and carrying of the assessment and secondly the applicant with proper for the competition application; output is assessment given to the client. While exercising process approach to clarify interrelation and interacting main parties or subjects of the assessment are determined and the way for interaction between them forms up. Parties to expert assessment are: - Ordering Party – The department of the university taking the decision to subject a project to expert assessment; - Providing Party – The department of the university authorized to provide such assessment by the Ordering Party; - Performing Party – The legal and natural entities that have expertise in the area of research evaluation. Experts assess projects in accordance with criteria and states of expert opinions approved by the Ordering Party. Objects of assessment generally are applications or HSE competition project reports. Mainly assessments are deployed for internal needs, i.e. the most ordering parties are HSE branches and departments, but assessment can also be conducted for external clients. The financing of research evaluation at HSE is based on the established corporate culture and traditions of HSE.Keywords: expert assessment, management of research evaluation, process approach, research evaluation
Procedia PDF Downloads 2531370 Human Resources Development and Management: A Guide to School Owners
Authors: Charita B. Lasala, Lakambini G. Reluya
Abstract:
The human factor composing the organization is an asset that needs to be managed conscientiously and to be in tuned with the organization’s need. Thus, the human resources add value to the organization by using their talents, skills and knowledge in transforming the other resources of the organization to either produce or to deliver products and services that generate profits or other valued forms for return. Keeping these kinds of employees has always been the main goal of each Human Resources Department in every company worldwide; regardless of the work being done. They are the most important resource a company can have and treating them well will make them priceless assets that can help make a business a success. Larmen de Guia Memorial College (LGMC) and Royal Oaks International School (ROIS) is one of the many organizations that seek ways to keep the human factor and are in the process of formalization and that people management is on the top of the list thus, this study was made since there was a need for the creation of the Human Resources Department due to its absence in the organization and to help the organization in keeping these valued employees. The study was anchored on the concept that human resources consist of people who perform its activities and that all decisions that affect the workforce concern the organization’s human resources functions. In conducting this study, it made use of the mixed method using both the qualitative and quantitative approaches with focus group discussions. The design has three stages namely: problem conceptualization, case analysis, and output. The output from the survey and interviews tells the abstracted ideas on the proposed HR program for the said institution. Based on the findings of the study, it can be concluded that the personnel in the institution is not in the correct perspective, much more that the personnel has no specific job descriptions. The hiring procedure is not extensive, nor the personnel was given the chance to be exposed to training that would aid them in job development and enhancement of their skills and talents. The compensation package offered by the institution does not commensurate to their services rendered. Lastly, it is concluded that in the opinion/decision rendered by the grievance committee is not fair and that the institution failed to give good motivation/initiative for the employees to be more productive.Keywords: employee benefits, employee relations, human resources and management, people management, recruitment, trainings
Procedia PDF Downloads 3171369 Spontaneous Eruption of Impacted Teeth While Awaiting Surgical Intervention
Authors: Alison Ryan, Himani Chhabra, Mohammed Dungarwalla, Judith Jones
Abstract:
Background: Impacted and ectopic teeth present in 1-2% of orthodontic patients and often require joint surgical and orthodontic management. The authors present two patients undergoing orthodontic treatment, where the impacted teeth, in a hopeless position, spontaneously erupted during the period of cessation of general anaesthetic lists during the COVID-19 pandemic. Patient information: A healthy 11-year-old boy was referred to the Department of Oral and Maxillofacial Surgery for the management of a mesioangular impacted LR7. The patient was seen by the joint oral surgery/orthodontic team, who planned for the removal of the LR7 under general anaesthetic. A healthy 13-year-old boy was referred to the same Department and team for surgical extraction of unerupted and buccally impacted UL3 and UR3 under general anaesthetic. Management and outcome: The majority of elective dental-alveolar work ceased as a result of the global pandemic. On resumption of activity, the first patient was reviewed in July 2021. The LR7 had spontaneously erupted in a favourable position, and following MDT review, a decision was made to forgo any further surgical intervention. The second patient was reviewed in July 2021. The UL3 had clinically erupted, and there was radiographic evidence of favourable movement of UR3. Due to the nature of the patient’s malocclusion, the decision was made to proceed with the extractions as previously planned. Key Learning Points: Severely impacted teeth do have a prospect of spontaneous eruption or alignment without clinical intervention, and current literature states the initial location, axial inclination, degree of root formation, and relation of the impacted tooth to adjacent teeth roots may influence spontaneous eruption. There is potential to introduce a period of observation to account for this possibility in the developing dentition, with the aim of reducing the unnecessary need for surgical intervention. This could help prevent episodes of general anaesthetic and allocate theatre space more appropriately.Keywords: spontaneous eruption, impaction, observation, hopeless position, surgical, orthodontic, change in treatment plan
Procedia PDF Downloads 811368 A Case-Series Analysis of Tuberculosis in Patients at Internal Medicine Department
Authors: Cherif Y., Ghariani R., Derbal S., Farhati S., Ben Dahmen F., Abdallah M.
Abstract:
Introduction: Tuberculosis (TBC) is a frequent infection and is still a major public health problem in Tunisia. The aim of this work is to focus on diagnostic and therapeutic characteristics of TBC in patients referred to our internal medicine department. Patients and Methods: The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2016 to December 2019, collecting patients with latent or patent TBC. Twenty-eight medical records of adults diagnosed with TBC were reviewed. Results: Twenty-eight patients, including 18 women and 10 men, were diagnosed with TBC. Their mean age is 48 years (range: 22-78 years). Five patients have a medical history of diabetes mellitus, 1 patient was followed for systemic lupus erythematosus treated with corticosteroids and immunosuppressant drugs, and another was treated with corticosteroids for Mac Duffy syndrome. The TBC is latent in 12 cases and patent in 16 cases. The most common symptoms were fever and weight loss and were found in 10 cases, a cough in 2 cases, sputum in 3 cases, lymph nodes in 4 cases, erythema nodosum in 2 cases, and neurological signs in 3 cases. Lymphopenia is noticed in 3 cases and a biological inflammatory syndrome in 18 of the cases. The purified protein derivate reaction was positive in 17 cases, anergic in 3 cases, negative in 5 cases, and not done in 3 cases. The acid-fast bacilli stain culture was strongly positive in one patient. The histopathological study was conclusive in 11 patients and showed granulomatosis with caseous necrosis. TBC was pulmonary in 7 patients, lymph node in 7 cases, peritoneal in 7 cases, digestive in 1 case, neuromeningeal in 3 cases, and thyroïd in 1 case. Seven patients had multifocal TBC. All the patients received anti-tuberculosis treatment with a mean duration of 8 months with no failure or relapse with an average follow-up time of 10.58 months. Conclusion: Diagnosis and management of TBC remain essential to avoid serious complications. The survey is necessary to ensure timely detection and treatment of infected adults to decrease its incidence. The best treatment remains preventive through vaccination and improving social and economic conditions.Keywords: tuberculosis, infection, autoimmune disease, granulomatosis
Procedia PDF Downloads 1851367 Comparative Study of Radiation Protection in a Hospital Environment
Authors: Lahoucine Zaama, Sanae Douama
Abstract:
In this work, we present the results of a dosimetry study in a Moroccan radiology department . The results are compared with those of a similar study in France. Furthermore, it determines the coefficient of transmission of the lead sheets of different thicknesses depending on the voltage (KV) in a direct exposure. The objective of this study is to choose the thickness of the radiation means to determine the leaf sample sealed with the smallest percentage value radiation transmission, and that in the context of optimization. Thus the comparison among the studies is essential to consider conduct studies and research in this framework to achieve the goal of optimization.Keywords: radiology, dosimetry, radiation, dose, transmission
Procedia PDF Downloads 4941366 Scourge of Sexual Offence: A Socio-Demographic Profile of Survivors of Sexual Offences
Authors: A. Priyanka, Sunil Kumar Kainoor, Parinitha Nayaka
Abstract:
Introduction: Ever since the ancient times, rape and other sexual offences are considered to be heinous crimes. Rape is not just another word in the dictionary, but it is the most barbaric act of violence committed with sex being the weapon. Rape is among the highest forms of crime experienced by women and children in all sectors of the society. In recent years, there has been an alarming rise in ratio of rape in India. The burden of such crimes on the society is very huge. The venereal diseases are the worst consequence along with unwanted pregnancies. Aims and Objectives: To determine the socio-demographic profile of the survivors of sexual offences reported to Dept. of Forensic Medicine of a South Indian medical college. Material methods: This retrospective study was conducted in the Department of Forensic Medicine of Raichur Institute of Medical Sciences, Raichur, Karnataka, India. Only survivors of sexual offences cases were included in the study group. Examination of all survivors was carried out by doctors of the said Department. Study period is one year six months, January 2015 to June 2016. Results/ case history: In total 140 cases of sexual offences were examined during study period of which the total survivors accounted to 62.85% i.e. 88 cases. Of the 88 survivors, 61 (69.31%) were registered under POCSO Act. The most affected age group of victims was 10-18 years in 59 (67%) cases. 61% were in acquaintance with the assailants, 18% were classmates/ friends, 13% of accused were Family members/ Relatives, 8% were strangers. 85% of the survivors were hailing from rural setup, while 15% were from urban. 60.65% of the survivors were students, 37.7% were doing Coolie/ Agricultural works. Conclusion: Delay in reporting of cases resulted in loss of vital physical evidences as no concrete report could be generated from the forensic lab after examination of specimens thus there should be coordination among doctors, forensic experts and investigating agency. It is worth mentioning that though a large number of cases of sexual offences are reported as rape many among them are consented acts and hence definite evidence of forceful sexual intercourse is lagging.Keywords: consensual sex, India, POCSO Act- 2012, India, pregnancy, rape, sexual offence
Procedia PDF Downloads 3101365 Economic Evaluation of Cataract Eye Surgery by Health Attendant of Doctor and Nurse through the Social Insurance Board Cadr at General Hospital Anutapura Palu Central Sulawesi Indonesia
Authors: Sitti Rahmawati
Abstract:
Payment system of cataract surgery implemented by professional attendant of doctor and nurse has been increasing, through health insurance program and this has become one of the factors that affects a lot of government in the budget establishment. This system has been implemented in purpose of quality and expenditure control, i.e., controlling health overpayment to obtain benefit (moral hazard) by the user of insurance or health service provider. The increasing health cost becomes the main issue that hampers the society to receive required health service in cash payment-system. One of the efforts that should be taken by the government in health payment is by securing health insurance through society's health insurance. The objective of the study is to learn the capability of a patient to pay cataract eye operation for the elders. Method of study sample population in this study was patients who obtain health insurance board card for the society that was started in the first of tri-semester (January-March) 2015 and claimed in Indonesian software-Case Based Group as a purposive sampling of 40 patients. Results of the study show that total unit cost analysis of surgery service unit was obtained $75 for unit cost without AFC and salary of nurse and doctor. The operation tariff that has been implemented today at Anutapura hospitals in eye department is tariff without AFC and the salary of the employee is $80. The operation tariff of the unit cost calculation with double distribution model at $65. Conclusion, the calculation result of actual unit cost that is much greater causes incentive distribution system provided to an ophthalmologist at $37 and nurse at $20 for one operation. The surgery service tariff is still low; consequently, the hospital receives low revenue and the quality of health insurance in eye operation department is relatively low. In purpose of increasing the service quality, it requires adequately high cost to equip medical equipment and increase the number of professional health attendant in serving patients in cataract eye operation at hospital.Keywords: economic evaluation, cataract operation, health attendant, health insurance system
Procedia PDF Downloads 1701364 How to Use E-Learning to Increase Job Satisfaction in Large Commercial Bank in Bangkok
Authors: Teerada Apibunyopas, Nithinant Thammakoranonta
Abstract:
Many organizations bring e-Learning to use as a tool in their training and human development department. It is getting more popular because it is easy to access to get knowledge all the time and also it provides a rich content, which can develop the employees skill efficiently. This study focused on the factors that affect using e-Learning efficiently, so it will make job satisfaction increased. The questionnaires were sent to employees in large commercial banks, which use e-Learning located in Bangkok, the results from multiple linear regression analysis showed that employee’s characteristics, characteristics of e-Learning, learning and growth have influence on job satisfaction.Keywords: e-Learning, job satisfaction, learning and growth, Bangkok
Procedia PDF Downloads 4911363 Prescription of Lubricating Eye Drops in the Emergency Eye Department: A Quality Improvement Project
Authors: Noorulain Khalid, Unsaar Hayat, Muhammad Chaudhary, Christos Iosifidis, Felipe Dhawahir-Scala, Fiona Carley
Abstract:
Dry eye disease (DED) is a common condition seen in the emergency eye department (EED) at Manchester Royal Eye Hospital (MREH). However, there is variability in the prescription of lubricating eye drops among different healthcare providers. The aim of this study was to develop an up-to-date, standardized algorithm for the prescription of lubricating eye drops in the EED at MREH based on international and national guidelines. The study also aimed to assess the impact of implementing the guideline on the rate of inappropriate lubricant prescriptions. Primarily, the impact was to be assessed in the form of the appropriateness of prescriptions for patients’ DED. The impact was secondary to be assessed through analysis of the cost to the hospital. Data from 845 patients who attended the EED over a 3-month period were analyzed, and 157 patients met the inclusion and exclusion criteria. After conducting a review of the literature and collaborating with the corneal team, an algorithm for the prescription of lubricants in the EED was developed. Three plan-do-study-act (PDSA) cycles were conducted, with interventions such as emails, posters, in-person reminders, and education for incoming trainees. The appropriateness of prescriptions was evaluated against the guidelines. Data were collected from patient records and analyzed using statistical methods. The appropriateness of prescriptions was assessed by comparing them to the guidelines and by clinical correlation with a specialized registrar. The study found a substantial improvement in the number of appropriate prescriptions, with an increase from 55% to 93% over the three PDSA cycles. There was additionally a 51% reduction in expenditure on lubricant prescriptions, resulting in cost savings for the hospital (approximate saving of £50/week). Theoretical importance: Appropriate prescription of lubricating eye drops improves disease management for patients and reduces costs for the hospital. The development and implementation of a standardized guideline facilitate the achievement of these goals. Conclusion: This study highlights the inconsistent management of DED in the EED and the potential lack of training in this area for healthcare providers. The implementation of a standardized, easy-to-follow guideline for lubricating eye drops can help to improve disease management while also resulting in cost savings for the hospital.Keywords: lubrication, dry eye disease, guideline, prescription
Procedia PDF Downloads 711362 Innovation Management in State-Owned-Enterprises in the Digital Transformation: An Empirical Case Study of Swiss Post
Authors: Jiayun Shen, Lorenz Wyss, Thierry Golliard, Matthias Finger
Abstract:
Innovation is widely recognized as the key for private enterprises to win the market competition. The state-owned-enterprises need to be innovative to compete in the market after the privatization as well. However, it is a lack of research to study how state-owned-enterprises manage innovation to create new products and services. Swiss Post, a Swiss state-owned-enterprises, has established a department to transform the corporate culture and foster innovation to achieve digital transformation. This paper describes the innovation management process at the Swiss Post and analyzes the impacts of the instruments, the organizational structure, and explores the barriers of innovation. This study used qualitative methods based on a review of the literature on innovation management and semi-structured interviews. Being established for over five years, the Swiss Post’s innovation management department has established a software-assisted modularized platform with systematic instruments to help the internal employees with the different innovation processes. It guides the innovators from idea creation to piloting in markets and supports with a separate financing source, with knowledge inputs and coaching, as well as with connections to external partners through the open innovation and venturing team. The platform also adapts to different business units within the corporate with a customized tailor for the various operational business units. The separate financing instruments enabled the creation and further development of new ideas; the coaching services contribute greatly to the transformation of teams’ innovation culture by providing new knowledge, thinking methods, and use cases for inspiration. It also facilitates organizational learning to help the whole corporate with the digital transformation. However, it is also confronted with a big challenge in twofold. Internally, the disruptive projects often hardly overcome the obstacles of long-established operational processes in the traditional business units; externally, the expectations of the public and restrictions from the federal government have become high hurdles for the company to stay and compete in the innovation track.Keywords: empirical case study, innovation management, state-owned-enterprise, Swiss Post
Procedia PDF Downloads 1221361 Osteochondroma of Clivus: An Unusual Cause of Headache
Authors: Muhammad Faisal Khilji, Rana Shoaib Hamid, Asim Qureshi
Abstract:
A fifty years old female presented in the emergency department of a tertiary care hospital with complaints of migraine type headache for the last few months. Her last episode of headache was severe, increasing in intensity, associated with nausea but no fever, lasting more than 24 hours and not resolving with analgesics. On examination there was no neurological deficit. CT scan of brain showed a large Pedunculated, non-expansible, non-aggressive bony lesion in the clivus with its sharp fragment impinging into the pons. Findings were further confirmed with MRI brain. Trans-sphenoidal excision biopsy was done and histopathology proved the lesion to be osteochondroma of clivus.Keywords: osteochondroma, clivus, headache, CT scan
Procedia PDF Downloads 4291360 Predicting Wearable Technology Readiness in a South African Government Department: Exploring the Influence of Wearable Technology Acceptance and Positive Attitude
Authors: Henda J Thomas, Cornelia PJ Harmse, Cecile Schultz
Abstract:
Wearables are one of the technologies that will flourish within the fourth industrial revolution and digital transformation arenas, allowing employers to integrate collected data into organisational information systems. The study aimed to investigate whether wearable technology readiness can predict employees’ acceptance to wear wearables in the workplace. The factors of technology readiness predisposition that predict acceptance and positive attitudes towards wearable use in the workplace were examined. A quantitative research approach was used. The population consisted of 8 081 South African Department of Employment and Labour employees (DEL). Census sampling was used, and questionnaires to collect data were sent electronically to all 8 081 employees, 351 questionnaires were received back. The measuring instrument called the Technology Readiness and Acceptance Model (TRAM) was used in this study. Four hypotheses were formulated to investigate the relationship between readiness and acceptance of wearables in the workplace. The results found consistent predictions of technology acceptance (TA) by eagerness, optimism, and discomfort in the technology readiness (TR) scales. The TR scales of optimism and eagerness were consistent positive predictors of the TA scales, while discomfort proved to be a negative predictor for two of the three TA scales. Insecurity was found not to be a predictor of TA. It was recommended that the digital transformation policy of the DEL should be revised. Wearables in the workplace should be embraced from the viewpoint of convenience, automation, and seamless integration with the DEL information systems. The empirical contribution of this study can be seen in the fact that positive attitude emerged as a factor that extends the TRAM. In this study, positive attitude is identified as a new dimension to the TRAM not found in the original TA model and subsequent studies of the TRAM. Furthermore, this study found that Perceived Usefulness (PU) and Behavioural Intention to Use and (BIU) could not be separated but formed one factor. The methodological contribution of this study can lead to the development of a Wearable Readiness and Acceptance Model (WRAM). To the best of our knowledge, no author has yet introduced the WRAM into the body of knowledge.Keywords: technology acceptance model, technology readiness index, technology readiness and acceptance model, wearable devices, wearable technology, fourth industrial revolution
Procedia PDF Downloads 891359 Evaluation of Antimicrobial Susceptibility Profile of Urinary Tract Infections in Massoud Medical Laboratory: 2018-2021
Authors: Ali Ghorbanipour
Abstract:
The aim of this study is to investigate the drug resistance pattern and the value of the MIC (minimum inhibitory concentration)method to reduce the impact of infectious diseases and the slow development of resistance. Method: The study was conducted on clinical specimens collected between 2018 to 2021. identification of isolates and antibiotic susceptibility testing were performed using conventional biochemical tests. Antibiotic resistance was determined using kibry-Bauer disk diffusion and MIC by E-test methods comparative with microdilution plate elisa method. Results were interpreted according to CLSI. Results: Out of 249600 different clinical specimens, 18720 different pathogenic bacteria by overall detection ratio 7.7% were detected. Among pathogen bacterial were Gram negative bacteria (70%,n=13000) and Gram positive bacteria(30%,n=5720).Medically relevant gram-negative bacteria include a multitude of species such as E.coli , Klebsiella .spp , Pseudomonas .aeroginosa , Acinetobacter .spp , Enterobacterspp ,and gram positive bacteria Staphylococcus.spp , Enterococcus .spp , Streptococcus .spp was isolated . Conclusion: Our results highlighted that the resistance ratio among Gram Negative bacteria and Gram positive bacteria with different infection is high it suggest constant screening and follow-up programs for the detection of antibiotic resistance and the value of MIC drug susceptibility reporting that provide a new way to the usage of resistant antibiotic in combination with other antibiotics or accurate weight of antibiotics that inhibit or kill bacteria. Evaluation of wrong medication in the expansion of resistance and side effects of over usage antibiotics are goals. Ali ghorbanipour presently working as a supervision at the microbiology department of Massoud medical laboratory. Iran. Earlier, he worked as head department of pulmonary infection in firoozgarhospital, Iran. He received master degree in 2012 from Fergusson College. His research prime objective is a biologic wound dressing .to his credit, he has Published10 articles in various international congresses by presenting posters.Keywords: antimicrobial profile, MIC & MBC Method, microplate antimicrobial assay, E-test
Procedia PDF Downloads 1331358 Innovation of e-Learning for Architectural Design Courses at the University of Jordan
Authors: Samer Abu Ghazaleh, Jawdat Gousous
Abstract:
E-learning in general started in Jordan around ten years ago in universities and at different departments and colleges. This paper will investigate the possibility to apply e-learning in architecture department at University of Jordan. As known architecture departments in general depend greatly in its syllabus upon design courses and studios, which consists nearly one third of its total credit hours. A survey has been conducted for architectural students at the University of Jordan and several conclusions have been reached irrespective of age, gender and nationality of the students, where the main problem was the way of the communication between the tutor and the student.Keywords: cellular telephone, design courses, e-learning, internet
Procedia PDF Downloads 4701357 Effectiveness of Self-Learning Module on the Academic Performance of Students in Statistics and Probability
Authors: Aneia Rajiel Busmente, Renato Gunio Jr., Jazin Mautante, Denise Joy Mendoza, Raymond Benedict Tagorio, Gabriel Uy, Natalie Quinn Valenzuela, Ma. Elayza Villa, Francine Yezha Vizcarra, Sofia Madelle Yapan, Eugene Kurt Yboa
Abstract:
COVID-19’s rapid spread caused a dramatic change in the nation, especially the educational system. The Department of Education was forced to adopt a practical learning platform without neglecting health, a printed modular distance learning. The Philippines' K–12 curriculum includes Statistics and Probability as one of the key courses as it offers students the knowledge to evaluate and comprehend data. Due to student’s difficulty and lack of understanding of the concepts of Statistics and Probability in Normal Distribution. The Self-Learning Module in Statistics and Probability about the Normal Distribution created by the Department of Education has several problems, including many activities, unclear illustrations, and insufficient examples of concepts which enables learners to have a difficulty accomplishing the module. The purpose of this study is to determine the effectiveness of self-learning module on the academic performance of students in the subject Statistics and Probability, it will also explore students’ perception towards the quality of created Self-Learning Module in Statistics and Probability. Despite the availability of Self-Learning Modules in Statistics and Probability in the Philippines, there are still few literatures that discuss its effectiveness in improving the performance of Senior High School students in Statistics and Probability. In this study, a Self-Learning Module on Normal Distribution is evaluated using a quasi-experimental design. STEM students in Grade 11 from National University's Nazareth School will be the study's participants, chosen by purposive sampling. Google Forms will be utilized to find at least 100 STEM students in Grade 11. The research instrument consists of 20-item pre- and post-test to assess participants' knowledge and performance regarding Normal Distribution, and a Likert scale survey to evaluate how the students perceived the self-learning module. Pre-test, post-test, and Likert scale surveys will be utilized to gather data, with Jeffreys' Amazing Statistics Program (JASP) software being used for analysis.Keywords: self-learning module, academic performance, statistics and probability, normal distribution
Procedia PDF Downloads 1141356 Left Cornual Ectopic Pregnancy with Uterine Rupture - a Case Report
Authors: Vinodhini Elangovan, Jen Heng Pek
Abstract:
Background: An ectopic pregnancy is defined as any pregnancy implanted outside of the endometrial cavity. Cornual pregnancy, a rare variety of ectopic pregnancies, is seen in about 2-4% of ectopic pregnancies. It develops in the interstitial portion of the fallopian tube and invades through the uterine wall. This case describes a third-trimester cornual pregnancy that resulted in a uterine rupture. Case: A 38-year old Chinese lady was brought to the Emergency Department (ED) as a standby case for hypotension. She was 30+6 weeks pregnant (Gravida 3, Parous 1). Her past obstetric history included a live birth delivered via lower segment Caesarean section due to non-reassuring fetal status in 2002 and a miscarriage in 2012. She developed generalized abdominal pain. There was no per vaginal bleeding or leaking liquor. There was also no fever, nausea, vomiting, constipation, diarrhea, or urinary symptoms. On arrival in the ED, she was pale, diaphoretic, and lethargic. She had generalized tenderness with guarding and rebound over her abdomen. Point of care ultrasound was performed and showed a large amount of intra-abdominal free fluid, and the fetal heart rate was 170 beats per minute. The point of care hemoglobin was 7.1 g/dL, and lactate was 6.8 mmol/L. The patient’s blood pressure dropped precipitously to 50/36 mmHg, and her heart rate went up to 141 beats per minute. The clinical impression was profound shock secondary to uterine rupture. Intra-operatively, there was extensive haemoperitoneum, and the fetus was seen in the abdominal cavity. The fetus was delivered immediately and handed to the neonatal team. On exploration of the uterus, the point of rupture was at the left cornual region where the placenta was attached to. Discussion: Cornual pregnancies are difficult to diagnose pre-operatively with low ultrasonographic sensitivity and hence are commonly confused with normal intrauterine pregnancies. They pose a higher risk of rupture and hemorrhage compared to other types of ectopic pregnancies. In very rare circumstances, interstitial pregnancies can result in a viable fetus. Uterine rupture resulting in hemorrhagic shock is a true obstetric emergency that can result in significant morbidity and mortality for the patient and the fetus, and early diagnosis in the emergency department is crucial. The patient in this case presented with known risk factors of multiparity, advanced maternal age, and previous lower segment cesarean section, which increased the suspicion of uterine rupture. Ultrasound assessment may be beneficial to any patient who presents with symptoms and a history of uterine surgery to assess the possibility of uterine dehiscence or rupture. Management of a patient suspected of uterine rupture should be systematic in the emergency department and follow an ABC approach. Conclusion: This case demonstrates the importance for an emergency physician to maintain the suspicion for ectopic pregnancy even at advanced gestational ages. It also highlights how even though all emergency physicians may not be qualified to do a detailed pelvic ultrasound, it is essential for them to be competent with a point of care ultrasound to make a prompt diagnosis of conditions such as uterine rupture.Keywords: cornual ectopic , ectopic pregnancy, emergency medicine, obstetric emergencies
Procedia PDF Downloads 1291355 Evaluation of Existence of Antithyroid Antibodies, Anti-Thyroid Peroxidase and Anti-Thyroglobulin in Patients with Hepatitis C Viral Infections
Authors: Junaid Mahmood Alam, Sana Anwar, Sarah Sughra Asghar
Abstract:
Chronic hepatitis or Hepatitis C viral (HCV) infection has been identified as one of the factors that could elicit autoimmune disease resulting in the development of auto-antibodies. Furthermore, HCV is implicated in contravening of forbearance to antigens, therefore, inciting auto-reactivity. In this regard, several near and past studies noted the prevalence of thyroid dysfunction and production of anti-thyroid antibodies (ATAb) such as anti-thyroid peroxidase (AntiTPO) and anti-thyroglobulin (AntiTG) in patients with HCV. Likewise, one of the etiologies of augmentation of thyroid disease is basically interferon therapy for HCV infections, for which a number of autoimmune diseases have been noted including Grave’s disease, Hishimoto thyroiditis. A prospectively case-control study was therefore carried out at department of clinical biochemistry lab services and chemical pathology in collaboration with department of clinical microbiology, at Liaquat National Hospital and Medical College, Karachi Pakistan for the period January 2015 to December 2017. Two control groups were inducted for comparison purpose, control group 1 = without HCV infection and with thyroid disorders (n = 20), control group 2 = with HCV infection and without thyroid disorders (n = 20), whereas HCV infected were n = 40 where more than half were noted to be positive for either of HCV IgG and Ag. In HCV group, patients with existing sub-clinical hypothyroidism and clinical hyperthyroidism were less than 5%. Analysis showed the presence of AntiTG in 12 HCV patients (30%), AntiTPO in 15 (37.5%) and both AntiTG and antiTPO in 10 patients (25%). Only 3 patients were found with the history of anti-thyroid auto-antibodies (7.5%) and one with parents and relatives with auto-immune disorders (2.5%). Patients that remained untreated were 12 (30%), under treatment 18 (45%) and with complete-course of treatment 10 (25%). As per review of the literature, meta-analysis of evident data and cross-sectional studies of selective cohorts (as studied in presented research), thyroid connection is designated as one of the most recurrent endocrine ailment associated with chronic HCV infection. Moreover, it also represents an extrahepatic disease in the continuum of HCV syndrome. In conclusion, HCV patients were more likely to encompass thyroid disorders especially related to development of either of ATAb or both antiTG and AntiTPO.Keywords: Hepatitis C viral (HCV) infection, anti-thyroid antibodies, anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies
Procedia PDF Downloads 1571354 Comparison of the Efficacy of Ketamine-Propofol versus Thiopental Sodium-Fentanyl in Procedural Sedation in the Emergency Department: A Randomized Double-Blind Clinical Trial
Authors: Maryam Bahreini, Mostafa Talebi Garekani, Fatemeh Rasooli, Atefeh Abdollahi
Abstract:
Introduction: Procedural sedation and analgesia have been desirable to handle painful procedures. The trend to find the agent with more efficacy and less complications is still controversial; thus, many sedative regimens have been studied. This study tried to assess the effectiveness and adverse effects of thiopental sodium-fentanyl with the known medication, ketamine-propofol for procedural sedation in the emergency department. Methods: Consenting patients were enrolled in this randomized double-blind trial to receive either 1:1 ketamine-propofol (KP) or thiopental-fentanyl (TF) 1:1 mg: Mg proportion on a weight-based dosing basis to reach the sedation level of American Society of Anesthesiologist class III/IV. The respiratory and hemodynamic complications, nausea and vomiting, recovery agitation, patient recall and satisfaction, provider satisfaction and recovery time were compared. The study was registered in Iranian randomized Control Trial Registry (Code: IRCT2015111325025N1). Results: 96 adult patients were included and randomized, 47 in the KP group and 49 in the TF group. 2.1% in the KP group and 8.1 % in the TF group experienced transient hypoxia leading to performing 4.2 % versus 8.1 % airway maneuvers for 2 groups, respectively; however, no statistically significant difference was observed between 2 combinations, and there was no report of endotracheal placement or further admission. Patient and physician satisfaction were significantly higher in the KP group. There was no difference in respiratory, gastrointestinal, cardiovascular and psychiatric adverse events, recovery time and patient recall of the procedure between groups. The efficacy and complications were not related to the type of procedure or patients’ smoking or addiction trends. Conclusion: Ketamine-propofol and thiopental-fentanyl combinations were effectively comparable although KP resulted in higher patient and provider satisfaction. It is estimated that thiopental fentanyl combination can be as potent and efficacious as ketofol with relatively similar incidence of adverse events in procedural sedation.Keywords: adverse effects, conscious sedation, fentanyl, propofol, ketamine, safety, thiopental
Procedia PDF Downloads 2181353 Partnering With Key Stakeholders for Successful Implementation of Inhaled Analgesia for Specific Emergency Department Presentations
Authors: Sarah Hazelwood, Janice Hay
Abstract:
Methoxyflurane is an inhaled analgesic administered via a disposable inhaler, which has been used in Australia for 40 years for the management of pain in children & adults. However, there is a lack of data for methoxyflurane as a frontline analgesic medication within the emergency department (ED). This study will investigate the usefulness of methoxyflurane in a private inner-city ED. The study concluded that the inclusion of all key stakeholders in the prescribing, administering & use of this new process led to comprehensive uptake & vastly positive outcomes for consumer & health professionals. Method: A 12-week prospective pilot study was completed utilizing patients presenting to the ED in pain (numeric pain rating score > 4) that fit the requirement of methoxyflurane use (as outlined in the Australian Prescriber information package). Nurses completed a formatted spreadsheet for each interaction where methoxyflurane was used. Patient demographics, day, time, initial numeric pain score, analgesic response time, the reason for use, staff concern (free text), & patient feedback (free text), & discharge time was documented. When clinical concern was raised, the researcher retrieved & reviewed patient notes. Results: 140 methoxyflurane inhalers were used. 60% of patients were 31 years of age & over (n=82) with 16% aged 70+. The gender split; 51% male: 49% female. Trauma-related pain (57%) saw the highest use of administration, with the evening hours (1500-2259) seeing the greatest numbers used (39%). Tuesday, Thursday & Sunday shared the highest daily use throughout the study. A minimum numerical pain score of 4/10 (n=13, 9%), with the ranges of 5 - 7/10 (moderate pain) being given by almost 50% of patients. Only 3 instances of pain scores increased post use of methoxyflurane (all other entries showed pain score < initial rating). Patients & staff noted obvious analgesic response within 3 minutes (n= 96, 81%, of administration). Nurses documented a change in patient vital signs for 4 of the 15 patient-related concerns; the remaining concerns were due to “gagging” on the taste, or “having a coughing episode”; one patient tried to leave the department before the procedure was attended (very euphoric state). Upon review of the staff concerns – no adverse events occurred & return to therapeutic vitals occurred within 10 minutes. Length of stay for patients was compared with similar presentations (such as dislocated shoulder or ankle fracture) & saw an average 40-minute decrease in time to discharge. Methoxyflurane treatment was rated “positively” by > 80% of patients – with remaining feedback related to mild & transient concerns. Staff similarly noted a positive response to methoxyflurane as an analgesic & as an added tool for frontline analgesic purposes. Conclusion: Methoxyflurane should be used on suitable patient presentations requiring immediate, short term pain relief. As a highly portable, non-narcotic avenue to treat pain this study showed obvious therapeutic benefit, positive feedback, & a shorter length of stay in the ED. By partnering with key stake holders, this study determined methoxyflurane use decreased work load, decreased wait time to analgesia, and increased patient satisfaction.Keywords: analgesia, benefits, emergency, methoxyflurane
Procedia PDF Downloads 1231352 Emergency Department Utilisation of Older People Presenting to Four Emergency Departments
Authors: M. Fry, L. Fitzpatrick, Julie Considine, R. Z. Shaban, Kate Curtis
Abstract:
Introduction: The vast majority of older Australians lives independently and are self-managing at home, despite a growing number living with a chronic illness that requires health intervention. Evidence shows that between 50% and 80% of people presenting to the emergency department (ED) are in pain. Australian EDs manage 7.2 million attendances every year and 1.4 million of these are people aged 65 years or more. Research shows that 28% of ED patients aged 65 years or more have Cognitive impairment (CI) associated with dementia, delirium and neurological conditions. Background: Traditional ED service delivery may not be suitable for older people who present with multiple, complex and ongoing illnesses. Likewise, ED clinical staff often perceive that their role should be focused more on immediate and potential lifethreatening illness and conditions which are episodic in nature. Therefore, the needs of older people and their family/carers may not be adequately addressed in the context of an ED presentation. Aim: We aimed to explore the utilisation and characteristics of older people presenting to four metropolitan EDs. Method: The findings being presented are part of a program of research exploring pain management practices for older persons with long bone fractures. The study was conducted across four metropolitan emergency departments of older patients (65years and over) and involved a 12-month randomised medical record audit (n=255). Results: ED presentations across four ED sites in 2012 numbered 168021, with 44778 (26.6%) patients aged 65 and over. Of the 44778 patients, the average age was 79.1 years (SD 8.54). There were more females 23932 (53.5%). The majority (26925: 85.0%) of older persons self-referred to the ED and lived independently. The majority arrived by ambulance (n=18553: 41.4%) and were allocated triage category was 3 (n=19,507:43.65%) or Triage category 4 at (n=15,389: 34.43%). The top five triage symptom presentations involved pain (n=8088; 18.25%), dyspnoea (n=4735; 10.7%), falls (n=4032; 9.1%), other (n=3984; 9.0%), cardiac (n=2987; 6.7%). The top five system based diagnostic presentations involved musculoskeletal (n=8902; 20.1%), cardiac (n=6704:15.0%), respiratory (n=4933; 11.0%), neurological (n=4909; 11.0%), gastroenterology (n=4321; 9.7%). On review of one tertiary hospital database the vital signs on average at time triage: Systolic Blood Pressure 143.6mmHg. Heart Rate 83.4 beats/minute; Respiratory Rate 18.5 breaths/ minute; Oxygen saturation 97.0% and Tympanic temperature 36.7 and Blood Glucose Level 7.4mmols/litre. The majority presented with a Glasgow Coma Score of 14 or higher. On average the older person stayed in the ED 4:56 (SD 3:28minutes).The average time to be seen was 39 minutes (SD 48 minutes). The majority of older persons were admitted (n=27562: 61.5%), did not wait for treatment (n= 8879: 0.02%) discharged home (n=16256: 36.0%). Conclusion: The vast majority of older persons are living independently, although many require admission on arrival to the ED. Many arrived in pain and with musculoskeletal injuries and or conditions. New models of care need to be considered, which may better support self-management and independent living of the older person and the National Emergency Access Targets.Keywords: chronic, older person, aged care, emergency department
Procedia PDF Downloads 235