Search results for: medical units

Authors: Catherine Bernard

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The maldistribution of clinicians within countries is well documented. It is a common theme throughout the world that rural areas often struggle to recruit and retain health workers resulting in inadequate healthcare for many. This paper will concentrate on the responsibilities that medical schools may have in addressing this shortage of rural health workers. Recommendations are made with regards to targeted rural student admissions, rurally-based medical schools, rural clinical rotations and a curriculum orientated towards rural health issues. The evidence gathered suggests that individual factors are positive in encouraging health workers to practice in rural locations. However, there is strength in numbers, and combining all the recommendations will likely result in a synergistic effect, thereby increasing numbers of rural health workers and achieving accessible healthcare for those living in rural populations.

Keywords: medical education, medical education design, public health, rural health

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Authors: Fatemeh Noughani, Seyd Mehdi Sadat

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Medical tourism or travel therapy is travelling from one country to another to be under medical treatment, utilizing the health factors of natural sector like mineral water springs and so on. From 1990s medical tourism around the world developed and grew because of different factors like globalization and free trade in the fields of health services, changes in exchange rates in the world economy (which caused the desirability of Asian countries as a medical tourist attraction) in a way that currently there is a close competition in this field among famous countries in medical services to make them find a desirable place in medical tourism market of the world as a complicated and growing industry in a short time. Perhaps tourism is an attractive industry and a good support for the economy of Iran, if we try to merge oil earnings and tourism industry it would be better and more constructive than putting them in front of each other. Moving from oil toward tourism economy especially medical tourism, must be one of the prospects of Iran's government for the oil industry to provide a few percent of the yearly earnings of the country. Among the achievements in medical tourism we can name the prevention of brain drain to other countries and an increase in employment rate for healthcare staff, increase in foreign exchange earnings of the country because of the tourists' staying and followed by increasing the quality of life and cultural transmission as well as empowering the medical human resources.

Keywords: developing countries, health tourism, quality of life, cultural transmission

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Authors: Betsy Hannam

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Background: Staff nurses felt overwhelmed to learn new skills or complete competencies during their shift. Med/Surg units need to provide dedicated, uninterrupted time to complete training and mandatory competencies and practice skills. Purpose: To improve nurse satisfaction and competence by creating a Skills Day with uninterrupted time to complete competencies, brush up on skills, and evaluate skills learned through pre- and post-tests. Methods: The USL and CNL interviewed nurses to obtain input regarding skills needing reinforcement and included mandatory competencies relevant to Med/Surg to create the Skills Day agenda. Content experts from multiple disciplines were invited to educate staff to help address knowledge gaps. To increase attendance, multiple class days were offered. Results: 2018 Skills Day was held for an inpatient unit with 95% participation (n=35 out of 37RNs). The average pretest score, comprised of content questions from topics discussed, was 57%, and post test scoresaveraged 80%. 94% of test scores improved or remained the same. RNs were given an evaluation at the end of the day, where100% of staff noted Skills Day as beneficial, and 97% requested to repeat next year. Another Med/Surg unit asked to join Skills Day in 2019. In 2019, with 89% participation (n=57 out 64 RNs), the average pretest score was 68%, and the average post test score was 85%. 97% of scores improved or remained the same. 98% reported the class as beneficial, and 96% requested to repeat next year. Skills Day 2020-2022 on hold due to COVID. Looking forward to Skills Day 2023. Conclusion: Skills Day allows nurses to maintain competencies and improve knowledge in areas of interest without the stress of a patient assignment. Having unit leaders organize Skills Day, with the involvement of content experts from multiple disciplines, showed to be a successful and innovative team approach to support professional development.

Keywords: education, competency, skills day, medical/surgical

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Authors: Adam Y. Sulaiman, Gerard I.Obasi, Roma Chang, Hussein Sayed Moghaieb, Ming J. Huang, Neil J. Hewitt

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Residential air-conditioning units are essential for quality indoor comfort in hot climate countries. Nevertheless, because of their non-renewable energy sources and the contribution of ecologically unfriendly working fluids, these units are a major source of CO2 emissions in these countries. The utilisation of sustainable technologies nowadays is essential to reduce the adverse effects of CO2 emissions by replacing conventional technologies. This paper investigates the feasibility of running an off-grid solar-powered air-conditioning bed unit using three low GWP refrigerants (R32, R290, and R600a) to supersede conventional refrigerants.A prototype air conditioning unit was built to supply cold air to a canopy that was connected to it. The assembled unit was designed to distribute cold air to a canopy connected to it. This system is powered by two 400 W photovoltaic panels, with battery storage supplying power to the unit at night-time. Engineering Equation Solver (EES) software is used to mathematically model the vapor compression cycle (VCC) and predict the unit's energetic and exergetic performance. The TRNSYS software was used to simulate the electricity storage performance of the batteries, whereas the IES-VE was used to determine the amount of solar energy required to power the unit. The article provides an analytical design guideline, as well as a comprehensible process system. Combining a renewable energy source to power an AC based-VCC provides an excellent solution to the real problems of high-energy consumption in warm-climate countries.

Keywords: air-conditioning, refrigerants, PV panel, energy storages, VCC, exergy

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Authors: Emmanuel Temitope Adaranijo

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Medical error is on the increase in many nations and like many developing nations, Nigeria is not excluded and more importantly, Lafia, Nasarawa state, where the study was carried. The study was undertaken to explore Patients' knowledge and their reactions to medical errors in hospitals in Lafia Local Government Area; therefore, five objectives were formulated to guide the study. The survey research design was employed and triangulation of quantitative and qualitative instruments was used to collect data. The total population for the study was 330,712 and the sample size was 400; however, only 343 patients and three doctors responded to the quantitative and qualitative study, respectively. Frequency distribution, simple percentage, and r test were used to analyze the data obtained from respondents. The findings revealed that medical errors are prevalent in hospitals in Lafia and the patients are neither aware nor willing to report such occurrence. The study recommends that social workers, hospital management, and governments should take up their roles in reducing the occurrence of medical errors.

Keywords: health, hospital, medical errors, social work

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Authors: Sanjeev Sharma, Suman Lata

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With the availability of diverse printed, electronic literature and web sites on medical and health related information, it is impossible for the medical professional to get the information he seeks in the shortest possible time. For all these problems information literacy is the only solution. Thus, information literacy is recognized as an important aspect of medical education. In the present study, an attempt has been made to know the information literacy skills of the faculty and students at medical colleges of Haryana, Punjab and Chandigarh. The scope of the study was confined to the 12 selected medical colleges of three States (Haryana, Punjab, and Chandigarh). The findings of the study were based on the data collected through 1018 questionnaires filled by the respondents of the medical colleges. It was found that Online Medical Websites (such as WebMD, eMedicine and Mayo Clinic etc.) were frequently used by 63.43% of the respondents of Chandigarh which is slightly more than Haryana (61%) and Punjab (55.65%). As well, 30.86% of the respondents of Chandigarh, 27.41% of Haryana and 27.05% of Punjab were familiar with the controlled vocabulary tool; 25.14% respondents of Chandigarh, 23.80% of Punjab, 23.17% of Haryana were familiar with the Boolean operators; 33.05% of the respondents of Punjab, 28.19% of Haryana and 25.14% of Chandigarh were familiar with the use and importance of the keywords while searching an electronic database; and 51.43% of the respondents of Chandigarh, 44.52% of Punjab and 36.29% of Haryana were able to make effective use of the retrieved information. For accessing information in electronic format, 47.74% of the respondents rated their skills high, while the majority of respondents (76.13%) were unfamiliar with the basic search technique i.e. Boolean operator used for searching information in an online database. On the basis of the findings, it was suggested that a comprehensive training program based on medical professionals information needs should be organized frequently. Furthermore, it was also suggested that information literacy may be included as a subject in the health science curriculum so as to make the medical professionals information literate and independent lifelong learners.

Keywords: information, information literacy, medical professionals, medical colleges

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Authors: Steven D. P Moore

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A novel method referred to asKýklos(Ky) dimensional geometry is proposed as an entity specific core geometric dimensional measurement system. Ky geometric measures can constructscaled multi-dimensionalmodels using regular and irregular sets in IRn. This entity specific-derived geometric measurement system shares similar fractal methods in which a ‘fractal transformation operator’ is applied to a set S to produce a union of N copies. The Kýklos’ inputs use 1D geometry as a core measure. One-dimensional inputs include the radius interval of a circle/sphere or the semiminor/semimajor axes intervals of an ellipse or spheroid. These geometric inputs have finite values that can be measured by SI distance units. The outputs for each interval are divided and subdivided 1D subcomponents with a union equal to the interval geometry/length. Setting a limit of subdivision iterations creates a finite value for each 1Dsubcomponent. The uniqueness of this method is captured by allowing the simplest 1D inputs to define entity specific subclass geometric core measurements that can also be used to derive length measures. Current methodologies for celestial based measurement of time, as defined within SI units, fits within this methodology, thus combining spatial and temporal features into geometric core measures. The novel Ky method discussed here offers geometric measures to construct scaled multi-dimensional structures, even models. Ky classes proposed for consideration include celestial even subatomic. The application of this offers incredible possibilities, for example, geometric architecture that can represent scaled celestial models that incorporates planets (spheroids) and celestial motion (elliptical orbits).

Keywords: Kyklos, geometry, measurement, celestial, dimension

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Authors: Ramūnas Antanaitis, Lina Anskienė, Robertas Stoškus

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This study was conducted during 2021.05.01 – 2021.08.31 at the Lithuanian University of health sciences and one Lithuanian dairy farm with 500 dairy cows (55.911381565736, 21.881321760608195). Average calving – 50 cows per month. Cows (n=20) in the treatment group (TG) were fed with feed supplement Optipartum C+ 200 (Enzymes: Alfa- Amylase 57 Units; Beta-Glucanase 107 Units) from 21 days before calving till 30 days after calving with feeding rate 200g/cow/day. Cows in the control group (CG) were fed a feed ration without feed supplement. Measurements started from 6 days before calving and continued till 21 days after calving. The following indicators were registered: with the RumiWatch System: Rumination time; Eating time; Drinking time; Rumination chews; Eating chews; Drinking gulps; Bolus; Chews per minute; Chews per bolus. With SmaXtec system - the temperature, pH of the contents of cows' reticulorumens and cows' activity. According to our results, we found that feeding of cows, from 21 days before calving to 30 days after calving, with a feed supplement with alfa- amylase and beta-glucanase (Optipartum C+ 200) (with dose 200g/cow/day) can produce an increase in: 9% rumination time and eating time, 19% drinking time, 11% rumination chews, 16% eating chews,13% number of boluses per rumination, 5% chews per minute and 16% chews per bolus. We found 1.28 % lower reiticulorumen pH and 0.64% lower reticulorumen temperature in cows fed with the supplement compared with control group cows. Also, cows feeding with enzymes were 8.80% more active.

Keywords: Alfa-Amylase, Beta-Glucanase, cows, in-line, sensors

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Authors: Anny Retnowati, Elisabeth Sundari

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This research aims to elaborate the meaning of personal data protection principles on patient access to health data in medical records in Indonesia and its implications. The method uses normative legal research by examining health law in Indonesia regarding the patient's right to access their health data in medical records. The data will be analysed qualitatively using the interpretation method to elaborate on the limitation of the meaning of personal data protection principles on patients' access to their data in medical records. The results show that patients only have the right to obtain copies of their health data in medical records. There is no right to inspect directly at any time. Indonesian health law limits the principle of patients' right to broad access to their health data in medical records. This restriction has implications for the reduction of personal data protection as part of human rights. This research contribute to show that a limitaion of personal data protection may abuse the human rights.

Keywords: access, health data, medical records, personal data, protection

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Authors: Kingsley Oturu, Winifred Ijomah, Wale Coker, Chibueze Achi

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With the impact of BREXIT and the need for cross-border collaboration, this international research investigated the use of a conceptual model for remanufacturing medical equipment (with a focus on anesthetic machines and baby incubators). Early findings of the research suggest that contextual factors need to be taken into consideration, as well as an emphasis on cleaning (e.g., sterilization) during the process of remanufacturing medical equipment. For example, copper tubings may be more important in the remanufacturing of anesthetic equipment in tropical climates than in cold climates.

Keywords: medical equipment remanufacture, sustainability, circular business models, remanufacture process model

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Authors: Shraddha Jain Sharma, Ratnalata Gupta

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Predicting stock movements in the financial market is both difficult and rewarding. Analysts and academics are increasingly using advanced approaches such as machine learning techniques to anticipate stock price patterns, thanks to the expanding capacity of computing and the recent advent of graphics processing units and tensor processing units. Stock market prediction is a type of time series prediction that is incredibly difficult to do since stock prices are influenced by a variety of financial, socioeconomic, and political factors. Furthermore, even minor mistakes in stock market price forecasts can result in significant losses for companies that employ the findings of stock market price prediction for financial analysis and investment. Soft computing techniques are increasingly being employed for stock market prediction due to their better accuracy than traditional statistical methodologies. The proposed research looks at the need for soft computing techniques in stock market prediction, the numerous soft computing approaches that are important to the field, past work in the area with their prominent features, and the significant problems or issue domain that the area involves. For constructing a predictive model, the major focus is on neural networks and fuzzy logic. The stock market is extremely unpredictable, and it is unquestionably tough to correctly predict based on certain characteristics. This study provides a complete overview of the numerous strategies investigated for high accuracy prediction, with a focus on the most important characteristics.

Keywords: stock market prediction, artificial intelligence, artificial neural networks, fuzzy logic, accuracy, deep learning, machine learning, stock price, trading volume

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Authors: Muhammad Afzal, Shahbaz Mushtaq, Duc-Anh-An-Vo, Kathryn Reardon Smith, Thanh Ma

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Climate change has become one of the most challenging environmental issues in the 21st century. Climate change-induced natural disasters, especially floods, are the major factors of livelihood vulnerability, impacting millions of individuals worldwide. Evaluating and mitigating the effects of floods requires an in-depth understanding of the relationship between vulnerability and livelihood capital assets. Using an integrated approach, sustainable livelihood framework, and system thinking approach, the study developed a conceptual model of a generalized livelihood system in District Rajanpur, Pakistan. The model visualizes the livelihood vulnerability system as a whole and identifies the key feedback loops likely to influence the livelihood vulnerability. The study suggests that such conceptual models provide effective communication and understanding tools to stakeholders and decision-makers to anticipate the problem and design appropriate policies. It can also serve as an evaluation technique for rural livelihood policy and identify key systematic interventions. The key finding of the study reveals that household income, health, and education are the major factors behind the livelihood vulnerability of the rural poor of District Rajanpur. The Pakistani government tried to reduce the livelihood vulnerability of the region through different income, health, and education programs, but still, many changes are required to make these programs more effective especially during the flood times. The government provided only cash to vulnerable and marginalized families through income support programs, but this study suggests that along with the cash, the government must provide seed storage facilities and access to crop insurance to the farmers. Similarly, the government should establish basic health units in villages and frequent visits of medical mobile vans should be arranged with advanced medical lab facilities during and after the flood.

Keywords: livelihood vulnerability, rural communities, flood, sustainable livelihood framework, system dynamics, Pakistan

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Authors: Jakob Renko, Deja Praprotnik, Kristina Martinovič, Igor Karnjuš

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Introduction: Catheter-related bloodstream infections are a major burden for healthcare and patients. Although infections of this type cannot be completely avoided, they can be reduced by taking preventive measures. The aim of this study is to review and analyze the existing literature on preventive interventions to prevent central venous catheters (CVC) infections. Methods: A systematic literature review was carried out. The international databases CINAHL, Medline, PubMed, and Web of Science were searched using the search strategy: "catheter-related infections" AND "intensive care units" AND "prevention" AND "central venous catheter." Articles that met the inclusion and exclusion criteria were included in the study. The literature search flow is illustrated by the PRISMA diagram. The descriptive research method was used to analyze the data. Results: Out of 554 search results, 22 surveys were included in the final analysis. We identified seven relevant preventive measures to prevent CVC infections: washing the whole body with chlorhexidine gluconate (CHG) solution, disinfecting the CVC entry site with CHG solution, use of CHG or silver dressings, alcohol protective caps, CVC care education, selecting appropriate catheter and multicomponent care bundles. Discussion and conclusions: Both single interventions and multicomponent care bundles have been shown to be currently effective measures to prevent CVC infections in adult patients in the ICU. None of the measures identified stood out in terms of their effectiveness. Prevention work to reduce CVC infections in the ICU is a complex process that requires the simultaneous consideration of several factors.

Keywords: central venous access, critically ill patients, hospital-acquired complications, prevention

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Authors: Wanda Luen-Wun Siu, Xiaowen Zhang

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The outbreak of the COVID-19 epidemic has caused great difficulties for South-South cooperation, but there are also opportunities. China’s health diplomacy has changed from dispatching medical teams, assisting in the construction of hospitals, and encouraging medical investment in the Africa health sector. This paper adopted a retrospective review of China’s health diplomacy in Africa from 1963 to 2020. Findings suggested that China has a preference for aiding Africa health infrastructure and sending medical teams to African countries. China’s health diplomacy in Africa is a success and has established secure diplomatic relations with African countries, thanks to the medical and health assistance to Africa over 60 years. This research contributes to the literature of health diplomacy and foreign relations and indicates that China’s health aid has fostered cooperation at the medical and diplomatic levels.

Keywords: Africa, china’s health diplomacy, COVID-19, bilateral relations

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Authors: Ludovic Fabre, Paola Melani, Patrick Lemaire

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The goal of this study was to test whether and how emotions influence drone operators in estimation skills. The empirical study was run in the context of numerical estimation. Participants saw a two-digit number together with a collection of cars. They had to indicate whether the stimuli collection was larger or smaller than the number. The two-digit numbers ranged from 12 to 27, and collections included 3-36 cars. The presentation of the collections was dynamic (each car moved 30 deg. per second on the right). Half the collections were smaller collections (including fewer than 20 cars), and the other collections were larger collections (i.e., more than 20 cars). Splits between the number of cars in a collection and the two-digit number were either small (± 1 or 2 units; e.g., the collection included 17 cars and the two-digit number was 19) or larger (± 8 or 9 units; e.g., 17 cars and '9'). Half the collections included more items (and half fewer items) than the number indicated by the two-digit number. Before and after each trial, participants saw an image inducing negative emotions (e.g., mutilations) or neutral emotions (e.g., candle) selected from International Affective Picture System (IAPS). At the end of each trial, participants had to say if the second picture was the same as or different from the first. Results showed different effects of emotions on RTs and percent errors. Participants’ performance was modulated by emotions. They were slower on negative trials compared to the neutral trials, especially on the most difficult items. They errored more on small-split than on large-split problems. Moreover, participants highly overestimated the number of cars when in a negative emotional state. These findings suggest that emotions influence numerical estimation, that effects of emotion in estimation interact with stimuli characteristics. They have important implications for understanding the role of emotions on estimation skills, and more generally, on how emotions influence cognition.

Keywords: drone operators, emotion, numerical estimation, arithmetic

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Authors: Atour Taghipour

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In the real world each manufacturing company is an independent business unit. These business units are linked to each other through upstream and downstream linkages. The management of these linkages is called coordination which, could be considered as a difficult engineering task. The degree of difficulty of coordination depends on the type and the nature of information exchanged between partners as well as the structure of relationship from mutual to the network structure. The literature of manufacturing systems comprises a wide range of varieties of methods and approaches of coordination. In fact, two main streams of research can be distinguished: central coordination versus decentralized coordination. In the centralized systems a high degree of information exchanges is required. The high degree of information exchanges sometimes leads to difficulties when independent members do not want to share information. In order to address these difficulties, decentralized approaches of coordination of operations planning decisions based on some minimal information sharing have been proposed in many academic disciplines. This paper first proposes a framework of analysis in order to analyze the proposed approaches in the literature, based on this framework which includes the similarities between approaches we categorize the existing approaches. This classification can be used as a research map for future researches. The result of our paper highlights several opportunities for future research. First, it is proposed to develop more dynamic and stochastic mechanisms of planning coordination of manufacturing units. Second, in order to exploit the complementarities of approaches proposed by diverse science discipline, we propose to integrate the techniques of coordination. Finally, based on our approach we proposed to develop coordination standards to guaranty both the complementarity of these approaches as well as the freedom of companies to adopt any planning tools.

Keywords: network coordination, manufacturing, operations planning, supply chain

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Authors: Y. Y. Babanyara, D. B. Ibrahim, T. Garba

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Proper management of medical waste is a crucial issue for maintaining human health and the environment. The waste generated in the hospitals has the potential for spreading infections and causing diseases. The study is aimed at assessing the medical waste management practices in Nigeria. Three instruments, questionnaire administration, in-depth interview and observation method for data collection were adopted in the study. The results revealed that the hospital does not quantify medical waste. Segregation of medical wastes is not conducted according to definite rules and standards. Wheeled trolleys are used for on-site transportation of waste from the points of production to the temporary storage area. Offsite transportation of the hospital waste is undertaken by a private waste management company. Small pickups are mainly used to transport waste daily to an off-site area for treatment and disposal. The main treatment method used in the final disposal of infectious waste is incineration. Non-infectious waste is disposed off using land disposal method. The study showed that the hospital does not have a policy and plan in place for managing medical waste. The study revealed number of problems the hospital faces in terms of medical waste management, including; lack of necessary rules, regulations and instructions on the different aspects of collections and disposal of waste, failure to quantify the waste generated in reliable records, lack of use of coloured bags by limiting the bags to only one colour for all waste, the absence of a dedicated waste manager, and no committee responsible for monitoring the management of medical waste. Recommendations are given with the aim of improving medical waste management in the hospital.

Keywords: medical waste, treatment, disposal, public health

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Authors: Zahra Asgharpour, Eric Renteria, Sebastian De Boodt

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There is a growing trend towards personalization of medical care, as evidenced by the emphasis on outcomes based medicine, the latest developments in CT and MR imaging and personalized treatment in a variety of surgical disciplines. 3D Printing has been introduced and applied in the medical field since 2000. The first applications were in the field of dental implants and custom prosthetics. According to recent publications, 3D printing in the medical field has been used in a wide range of applications which can be organized into several categories including implants, prosthetics, anatomical models and tissue bioprinting. Some of these categories are still in their infancy stage of the concept of proof while others are in application phase such as the design and manufacturing of customized implants and prosthesis. The approach of 3D printing in this category has been successfully used in the health care sector to make both standard and complex implants within a reasonable amount of time. In this study, some of the clinical applications of 3D printing in design and manufacturing of a patient-specific hip implant would be explained. In cases where patients have complex bone geometries or are undergoing a complex revision on hip replacement, the traditional surgical methods are not efficient, and hence these patients require patient-specific approaches. There are major advantages in using this new technology for medical applications, however, in order to get this technology widely accepted in medical device industry, there is a need for gaining more acceptance from the medical device regulatory offices. This is a challenge that is moving onward and will help the technology find its way at the end as an accepted manufacturing method for medical device industry in an international scale. The discussion will conclude with some examples describing the future directions of 3D Medical Printing.

Keywords: CT/MRI, image processing, 3D printing, medical devices, patient specific implants

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Authors: Nabin Prasad Joshi

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A new variant of the coronavirus family found in the Wuhan city market of China is causing serious harm to human beings. After the WHO decided COVID-19 was a pandemic situation, everyone started to measure the prevention of infectious diseases according to WHO guidelines. It includes social distancing, isolation, quarantine, lockdown, sanitation, and masking, respectively. During this time, the researcher has observed the difficulties of cultivating the new normal in people in Nepal. People have perceived the single coronavirus differently; common populations and frontline workers have different perceptions of coronavirus. The researcher started to measure the psychosocial impact of the COVID-19 pandemic on frontline workers and general populations in Kathmandu valley. The total number of sample units for this research is 82; it includes 52 general populations and 30 frontline workers. These sample units are selected through convenient sampling and purposive sampling, respectively. This research is based on descriptive and exploratory design. DASS-21 of the Nepali version is a comprehensive data collection tool for depression, anxiety, and stress measurement in this research, and simultaneously the psychosocial checklist, key-informant interview, and case study have been done. Quantitative data are analyzed with the help of excel, and qualitative data are through thematic analysis. The study has shown that the occurrence of psychosocial issues among frontline workers is greater than in general populations. It is found that the informants with higher education status have greater psychosocial issues in comparison to low education status. In the context of a pandemic, family/friends’ support can function as a protective factor when at adequate levels.

Keywords: anxiety, depression, isolation, lockdown

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Authors: Zeynep Sener, Mehtap Dursun

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Supplier evaluation and selection is one of the most important components of an effective supply chain management system. Due to the expanding competition in healthcare, selecting the right medical device suppliers offers great potential for increasing quality while decreasing costs. This paper proposes a fuzzy decision making approach for medical supplier selection. A real-world medical device supplier selection problem is presented to illustrate the application of the proposed decision methodology.

Keywords: fuzzy decision making, fuzzy multiple objective programming, medical supply chain, supplier selection

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Authors: Victor Kang, Sirene Bellahnid, Amy Al-Simaani

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Efficient documentation and completion of clerical tasks are pillars of efficient patient-centered care in acute settings such as the emergency department (ED). Medical scribes aid physicians with documentation, navigation of electronic health records, results gathering, and communication coordination with other healthcare teams. However, the use of medical scribes is not widespread, with some hospitals even continuing to discontinue their programs. One reason for this could be the lack of studies that have outlined concrete improvements in efficiency and patient and provider satisfaction in emergency departments before and after incorporating scribes. Methods: We conducted a review of the literature concerning the implementation of a medical scribe program and emergency department performance. For this review, a narrative synthesis accompanied by textual commentaries was chosen to present the selected papers. PubMed was searched exclusively. Initially, no date limits were set, but seeing as the electronic medical record was officially implemented in Canada in 2013, studies published after this date were preferred as they provided insight into the interplay between its implementation and scribes on quality improvement. Results: Throughput, efficiency, and cost-effectiveness were the most commonly used parameters in evaluating scribes in the Emergency Department. Important throughput metrics, specifically door-to-doctor and disposition time, were significantly decreased in emergency departments that utilized scribes. Of note, this was shown to be the case in community hospitals, where the burden of documentation and clerical tasks would fall directly upon the attending physician. Academic centers differ in that they rely heavily on residents and students; so the implementation of scribes has been shown to have limited effect on these metrics. However, unique to academic centers was the provider’s perception of incrased time for teaching was unique to academic centers. Consequently, providers express increased work satisfaction in relation to time spent with patients and in teaching. Patients, on the other hand, did not demonstrate a decrease in satisfaction in regards to the care that was provided, but there was no significant increase observed either. Of the studies we reviewed, one of the biggest limitations was the lack of significance in the data. While many individual studies reported that medical scribes in emergency rooms improved relative value units, patient satisfaction, provider satisfaction, and increased number of patients seen, there was no statistically significant improvement in the above criteria when compiled in a systematic review. There is also a clear publication bias; very few studies with negative results were published. To prove significance, data from more emergency rooms with scribe programs would need to be compiled which also includes emergency rooms who did not report noticeable benefits. Furthermore, most data sets focused only on scribes in academic centers. Conclusion: Ultimately, the literature suggests that while emergency room physicians who have access to medical scribes report higher satisfaction due to lower clerical burdens and can see more patients per shift, there is still variability in terms of patient and provider satisfaction. Whether or not this variability exists due to differences in training (in-house trainees versus contractors), population profile (adult versus pediatric), setting (academic versus community), or which shifts scribe work cannot be determined based on the studies that exist. Ultimately, more scribe programs need to be evaluated to determine whether these variables affect outcomes and prove whether scribes significantly improve emergency room efficiency.

Keywords: emergency medicine, medical scribe, scribe, documentation

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Authors: Sima Majnooni

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This paper discusses the Green Climate Fund's environmental and social management framework (GCF). The environmental and social management framework ensures the accredited entity considers the GCF's accreditation standards and effectively implements each of the GCF-funded projects. The GCF requires all accredited entities to meet basic transparency and accountability standards as well as environmental and social safeguards (ESMS). In doing so, the accredited entity sets up different independent units. One of these units is called the Grievance Mechanism. When allegations of environmental and social harms are raised in association with GCF-funded activities, affected parties can contact the entity’s grievance unit. One of the most challenging things about the accredited entity's grievance unit is the lack of available information and resources on the entities' websites. Many AEs have anti-corruption or anti-money laundering unit, but they do not have the environmental and social unit for affected people. This paper will argue the effectiveness of environmental and social grievance mechanisms of AEs by using a qualitative approach to indicate how many of AEs have a poor or an effective GRM. Some ESMSs seem highly effective. On the other hand, other mechanisms lack basic requirements such as a clear, transparent, uniform procedure and a definitive timetable. We have looked at each AE mechanism not only in light of how the website goes into detail regarding the process of grievance mechanism but also in light of their risk category. Many mechanisms appear inadequate for the lower level risk category entities (C) and, even surprisingly, for many higher-risk categories (A). We found; in most cases, the grievance mechanism of AEs seems vague.

Keywords: grievance mechanism, vague environmental and social policies, green climate fund, international climate finance, lower and higher risk category

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Authors: Tahmidul Islam

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Propensity Score Matching (PSM) technique has been widely used for estimating causal effect of treatment in observational studies. One major step of implementing PSM is estimating the propensity score (PS). Logistic regression model with additive linear terms of covariates is most used technique in many studies. Logistics regression model is also used with cubic splines for retaining flexibility in the model. However, choosing the functional form of the logistic regression model has been a question since the effectiveness of PSM depends on how accurately the PS been estimated. In many situations, the linearity assumption of linear logistic regression may not hold and non-linear relation between the logit and the covariates may be appropriate. One can estimate PS using machine learning techniques such as random forest, neural network etc for more accuracy in non-linear situation. In this study, an attempt has been made to compare the efficacy of Generalized Additive Model (GAM) in various linear and non-linear settings and compare its performance with usual logistic regression. GAM is a non-parametric technique where functional form of the covariates can be unspecified and a flexible regression model can be fitted. In this study various simple and complex models have been considered for treatment under several situations (small/large sample, low/high number of treatment units) and examined which method leads to more covariate balance in the matched dataset. It is found that logistic regression model is impressively robust against inclusion quadratic and interaction terms and reduces mean difference in treatment and control set equally efficiently as GAM does. GAM provided no significantly better covariate balance than logistic regression in both simple and complex models. The analysis also suggests that larger proportion of controls than treatment units leads to better balance for both of the methods.

Keywords: accuracy, covariate balances, generalized additive model, logistic regression, non-linearity, propensity score matching

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Authors: Mai Ali

Abstract:

Background: Preparing Hypo-screen-bags in advance streamlines the time-consuming process of administering glucose systemic correction. Additionally, Hypo-Screen Grab Bags are widely adopted in UK hospitals. Aim: The aim of the study is to improve hypoglycemia screening efficiency and equipment accessibility by streamlining item access to grab bag restocking staff. Methodology: The study centered on neonatal wards at LGI & St. James Neonatal Unit and related units. A web-based survey was conducted to evaluate local practices, gathering 21 responses from relevant general staff. The survey outcomes: (1) The demand for accessible grab bags is evident for smoother processes. (2) The potential to enhance efficiency through improved preparation of hypo-screen grab bags. Intervention: A Hypo-Screen Grab Bag was designed, including checklists for stocked items and required samples. Medical staff oversee restocking after use. Conclusion: The study successfully improved hypoglycemia screening efficiency and aided junior staff with accessible supplies and a user-friendly checklist.

Keywords: neonatal hypoglycemia, grab bag, hypo-screening, junior staff

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Authors: Alaa Alateeqi, Sara Aldhulaiee, Sara Alibraheem, Noura Alsaleh

Abstract:

For the past few decades or so, Kuwait's local food industry has grown remarkably due to increase in demand for processed or semi processed food products in the market. It is important that the ever increasing food manufacturing/processing units maintain the required quality standards as per regional and to some extent international quality requirements. It has been realized that all Kuwait food manufacturing units should understand and follow the international standard practices, and moreover a set of guidelines must be set for quality assurance such that any new business in this area is aware of the minimum requirements. The current study has been undertaken to identify the gaps in Kuwait food industries in following the Good Manufacturing Practices (GMP) in terms of quality planning, control and quality assurance. GMP refers to Good Manufacturing Practices, which are a set of rules, laws or regulations that certify producing products within quality standards and ensuring that it is safe, pure and effective. The present study therefore reports about a ‘case study’ in a reputed food manufacturing unit in Kuwait; starting from assessment of the current practices followed by diagnosis, report of the diagnosis and road map and corrective measures for GMP implementation in the unit. The case study has also been able to identify the best practices and establish a benchmarking data for other companies to follow, through measuring the selected company's quality, policies, products and strategies and compare it with the established benchmarking data. A set of questionnaires and assessment mechanism has been established for companies to identify their ‘benchmarking score’ in relation to the number of non-conformities and conformities with the GMP standard requirements.

Keywords: good manufacturing practices, GMP, benchmarking, Kuwait Food Industries, food quality

Procedia PDF Downloads 443

Authors: Mayssa Bensalah, Atef Boujelben, Mouna Baklouti, Mohamed Abid

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Image segmentation has a fundamental role in analysis and interpretation for many applications. The automated segmentation of organs and tissues throughout the body using computed imaging has been rapidly increasing. Indeed, it represents one of the most important parts of clinical diagnostic tools. In this paper, we discuss a thorough literature review of recent methods of tumour segmentation from medical images which are briefly explained with the recent contribution of various researchers. This study was followed by comparing these methods in order to define new directions to develop and improve the performance of the segmentation of the tumour area from medical images.

Keywords: features extraction, image segmentation, medical images, tumor detection

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Authors: John Hardy

Abstract:

The expansion of special operations forces (SOF) in the twenty-first century is often discussed in terms of the size and disposition of SOF units. Research regarding the number SOF personnel, the equipment SOF units procure, and the variety of roles and mission that SOF fulfill in contemporary conflicts paints a fascinating picture of changing expectations for the use of force. A strong indicator of the changing nature of SOF in contemporary conflicts is the fusion of strike and intelligence functions in the SOF in many countries. What were once more distinct roles on the kind of battlefield generally associated with the concept of conventional warfare have become intermingled in the era of persistent conflict which SOF face. This study presents a historical analysis of the co-evolution of the intelligence and direct action functions carried out by SOF in counterterrorism, counterinsurgency, and training and mentoring missions between 2004 and 2016. The study focuses primarily on innovation in the US military and the diffusion of key concepts to US allies first, and then more broadly afterward. The findings show that there were three key phases of evolution throughout the period of study, each coinciding with a process of innovation and doctrinal adaptation. The first phase was characterized by the fusion of intelligence at the tactical and operational levels. The second phase was characterized by the industrial counterterrorism campaigns used by US SOF against irregular enemies in Iraq and Afghanistan. The third phase was characterized by increasing forward collection of actionable intelligence by SOF force elements in the course of direct action raids. The evolution of strike and intelligence functions in SOF operations between 2004 and 2016 was significantly influenced by reciprocity. Intelligence fusion led to more effective targeting, which then increased intelligence collection. Strike and intelligence functions were then enhanced by greater emphasis on intelligence exploitation during operations, which further increased the effectiveness of both strike and intelligence operations.

Keywords: counterinsurgency, counterterrorism, intelligence, irregular warfare, military operations, special operations forces

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Authors: Behnoush Moghiminia, Jesus Anaya Diaz

Abstract:

The current study attempts to present the relationship between the structure development and Patkaneh as one of the Iranian geometric patterns and parametric algorithms by introducing two practical methods. While having a structural function, Patkaneh is also used as an ornamental element. It can be helpful in the scientific and practical review of Patkaneh. The current study aims to use Patkaneh as a parametric form generator based on the algorithm. The current paper attempts to express how can a more complete algorithm of this covering be obtained based on the parametric study and analysis of a sample of a Patkaneh and also investigate the relationship between the development of the geometrical pattern of Patkaneh as a structural-decorative element of Iranian architecture and digital design. In this regard, to achieve the research purposes, researchers investigated the oldest type of Patkaneh in the architecture history of Iran, such as the Northern Entrance Patkaneh of Oshtorjan Jame’ Mosque. An accurate investigation was done on the history of the background to answer the questions. Then, by investigating the structural behavior of Patkaneh, the decorative or structural-decorative role of Patkaneh was investigated to eliminate the ambiguity. Then, the geometrical structure of Patkaneh was analyzed by introducing two practical methods. The first method is based on the constituent units of Patkaneh (Square and diamond) and investigating the interactive relationships between them in 2D and 3D. This method is appropriate for cases where there are rational and regular geometrical relationships. The second method is based on the separation of the floors and the investigation of their interrelation. It is practical when the constituent units are not geometrically regular and have numerous diversity. Finally, the parametric form algorithm of these methods was codified.

Keywords: geometric properties, parametric design, Patkaneh, structural analysis

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Authors: Rhay-Hung Weng, Ching-Yuan Huang, Wan-Ping Chen

Abstract:

Recently, many hospitals have put much emphasis upon the development of nurse innovation. The present study aimed to clarify how nurse innovation is related to medical service quality and medical service experience. This study adopted questionnaire-survey method with nurses and customers of the inpatient wards from three Taiwanese hospitals as the research subjects. After pairing, there were 294 valid questionnaires. Hierarchical regression analysis was utilized to test the possible impact of nurse innovation on medical service quality and experience. In terms of the dimensions of nurse innovation, “innovation behavior” ranked the highest (3.24), followed by knowledge creation and innovation diffusion; in terms of the degree of the medical service quality, 'reliability' ranked the highest (4.35). As for the degree of the medical service experience, 'feel experience' ranked the highest (4.44). All dimensions of nurse innovation have no significant effects on medical service quality and medical service experience. Of these three dimensions of nurse innovation, the level of innovation behavior was perceived by the nurses as the highest. The study found that nurse innovation has no significant effects on medical service quality and medical service experience. Managers shall provide sufficient resources and budget for fostering innovation development and encourage their nurses to develop nursing innovation for patents. The education and training courses on “patient-centered ” shall be enhanced among hospital nurses. Health care managers shall also explore the difficulties about innovation diffusion and find the solutions for nurses.

Keywords: innovation, employee innovative behavior, service quality, service experience

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Authors: Nisar Ahmed Memon

Abstract:

A new medical image watermarking scheme delivering high embedding capacity is presented in this paper. Integer Wavelet Transform (IWT), Companding technique and adaptive thresholding are used in this scheme. The proposed scheme implants, recovers the hidden information and restores the input image to its pristine state at the receiving end. Magnetic Resonance Imaging (MRI) images are used for experimental purposes. The scheme first segment the MRI medical image into non-overlapping blocks and then inserts watermark into wavelet coefficients having a high frequency of each block. The scheme uses block-based watermarking adopting iterative optimization of threshold for companding in order to avoid the histogram pre and post processing. Results show that proposed scheme performs better than other reversible medical image watermarking schemes available in literature for MRI medical images.

Keywords: adaptive thresholding, companding technique, data authentication, reversible watermarking

Procedia PDF Downloads 273