Search results for: patient rehabilitation
473 Analytical Performance of Cobas C 8000 Analyzer Based on Sigma Metrics
Authors: Sairi Satari
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Introduction: Six-sigma is a metric that quantifies the performance of processes as a rate of Defects-Per-Million Opportunities. Sigma methodology can be applied in chemical pathology laboratory for evaluating process performance with evidence for process improvement in quality assurance program. In the laboratory, these methods have been used to improve the timeliness of troubleshooting, reduce the cost and frequency of quality control and minimize pre and post-analytical errors. Aim: The aim of this study is to evaluate the sigma values of the Cobas 8000 analyzer based on the minimum requirement of the specification. Methodology: Twenty-one analytes were chosen in this study. The analytes were alanine aminotransferase (ALT), albumin, alkaline phosphatase (ALP), Amylase, aspartate transaminase (AST), total bilirubin, calcium, chloride, cholesterol, HDL-cholesterol, creatinine, creatinine kinase, glucose, lactate dehydrogenase (LDH), magnesium, potassium, protein, sodium, triglyceride, uric acid and urea. Total error was obtained from Clinical Laboratory Improvement Amendments (CLIA). The Bias was calculated from end cycle report of Royal College of Pathologists of Australasia (RCPA) cycle from July to December 2016 and coefficient variation (CV) from six-month internal quality control (IQC). The sigma was calculated based on the formula :Sigma = (Total Error - Bias) / CV. The analytical performance was evaluated based on the sigma, sigma > 6 is world class, sigma > 5 is excellent, sigma > 4 is good and sigma < 4 is satisfactory and sigma < 3 is poor performance. Results: Based on the calculation, we found that, 96% are world class (ALT, albumin, ALP, amylase, AST, total bilirubin, cholesterol, HDL-cholesterol, creatinine, creatinine kinase, glucose, LDH, magnesium, potassium, triglyceride and uric acid. 14% are excellent (calcium, protein and urea), and 10% ( chloride and sodium) require more frequent IQC performed per day. Conclusion: Based on this study, we found that IQC should be performed frequently for only Chloride and Sodium to ensure accurate and reliable analysis for patient management.Keywords: sigma matrics, analytical performance, total error, bias
Procedia PDF Downloads 164472 Top-Down, Middle-Out, Bottom-Up: A Design Approach to Transforming Prison
Authors: Roland F. Karthaus, Rachel S. O'Brien
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Over the past decade, the authors have undertaken applied research aimed at enabling transformation within the prison service to improve conditions and outcomes for those living, working and visiting in prisons in the UK and the communities they serve. The research has taken place against a context of reducing resources and public discontent at increasing levels of violence, deteriorating conditions and persistently high levels of re-offending. Top-down governmental policies have mainly been ineffectual and in some cases counter-productive. The prison service is characterised by hierarchical organisation, and the research has applied design thinking at multiple levels to challenge and precipitate change: top-down, middle-out and bottom-up. The research employs three distinct but related approaches, system design (top-down): working at the national policy level to analyse the changing policy context, identifying opportunities and challenges; engaging with the Ministry of Justice commissioners and sector organisations to facilitate debate, introducing new evidence and provoking creative thinking, place-based design (middle-out): working with individual prison establishments as pilots to illustrate and test the potential for local empowerment, creative change, and improved architecture within place-specific contexts and organisational hierarchies, everyday design (bottom-up): working with individuals in the system to explore the potential for localised, significant, demonstrator changes; including collaborative design, capacity building and empowerment in skills, employment, communication, training, and other activities. The research spans a series of projects, through which the methodological approach has developed responsively. The projects include a place-based model for the re-purposing of Ministry of Justice land assets for the purposes of rehabilitation; an evidence-based guide to improve prison design for health and well-being; capacity-based employment, skills and self-build project as a template for future open prisons. The overarching research has enabled knowledge to be developed and disseminated through policy and academic networks. Whilst the research remains live and continuing; key findings are emerging as a basis for a new methodological approach to effecting change in the UK prison service. An interdisciplinary approach is necessary to overcome the barriers between distinct areas of the prison service. Sometimes referred to as total environments, prisons encompass entire social and physical environments which themselves are orchestrated by institutional arms of government, resulting in complex systems that cannot be meaningfully engaged through narrow disciplinary lenses. A scalar approach is necessary to connect strategic policies with individual experiences and potential, through the medium of individual prison establishments, operating as discrete entities within the system. A reflexive process is necessary to connect research with action in a responsive mode, learning to adapt as the system itself is changing. The role of individuals in the system, their latent knowledge and experience and their ability to engage and become agents of change are essential. Whilst the specific characteristics of the UK prison system are unique, the approach is internationally applicable.Keywords: architecture, design, policy, prison, system, transformation
Procedia PDF Downloads 130471 Electrospun Fibre Networks Loaded with Hydroxyapatite and Barium Titanate as Smart Scaffolds for Tissue Regeneration
Authors: C. Busuioc, I. Stancu, A. Nicoara, A. Zamfirescu, A. Evanghelidis
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The field of tissue engineering has expanded its potential due to the use of composite biomaterials belonging to increasingly complex systems, leading to bone substitutes with properties that are continuously improving to meet the patient's specific needs. Furthermore, the development of biomaterials based on ceramic and polymeric phases is an unlimited resource for future scientific research, with the final aim of restoring the original tissue functionality. Thus, in the first stage, composite scaffolds based on polycaprolactone (PCL) or polylactic acid (PLA) and inorganic powders were prepared by employing the electrospinning technique. The targeted powders were: commercial and laboratory synthesized hydroxyapatite (HAp), as well as barium titanate (BT). By controlling the concentration of the powder within the precursor solution, together with the processing parameters, different types of three-dimensional architectures were achieved. In the second stage, both the mineral powders and hybrid composites were investigated in terms of composition, crystalline structure, and microstructure so that to demonstrate their suitability for tissue engineering applications. Regarding the scaffolds, these were proven to be homogeneous on large areas and loaded with mineral particles in different proportions. The biological assays demonstrated that the addition of inorganic powders leads to modified responses in the presence of simulated body fluid (SBF) or cell cultures. Through SBF immersion, the biodegradability coupled with bioactivity were highlighted, with fiber fragmentation and surface degradation, as well as apatite layer formation within the testing period. Moreover, the final composites represent supports accepted by the cells, favoring implant integration. Concluding, the purposed fibrous materials based on bioresorbable polymers and mineral powders, produced by the electrospinning technique, represent candidates with considerable potential in the field of tissue engineering. Future improvements can be attained by optimizing the synthesis process or by simultaneous incorporation of multiple inorganic phases with well-defined biological action in order to fabricate multifunctional composites.Keywords: barium titanate, electrospinning, fibre networks, hydroxyapatite, smart scaffolds
Procedia PDF Downloads 103470 Review of Urbanization Pattern in Kabul City
Authors: Muhammad Hanif Amiri, Edris Sadeqy, Ahmad Freed Osman
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International Conference on Architectural Engineering and Skyscraper (ICAES 2016) on January 18 - 19, 2016 is aimed to exchange new ideas and application experiences face to face, to establish business or research relations and to find global partners for future collaboration. Therefore, we are very keen to participate and share our issues in order to get valuable feedbacks of the conference participants. Urbanization is a controversial issue all around the world. Substandard and unplanned urbanization has many implications on a social, cultural and economic situation of population life. Unplanned and illegal construction has become a critical issue in Afghanistan particularly Kabul city. In addition, lack of municipal bylaws, poor municipal governance, lack of development policies and strategies, budget limitation, low professional capacity of ainvolved private sector in development and poor coordination among stakeholders are the other factors which made the problem more complicated. The main purpose of this research paper is to review urbanization pattern of Kabul city and find out the improvement solutions and to evaluate the increasing of population density which caused vast illegal and unplanned development which finally converts the Kabul city to a slam area as the whole. The Kabul city Master Plan was reviewed in the year 1978 and revised for the planned 2million population. In 2001, the interim administration took place and the city became influx of returnees from neighbor countries and other provinces of Afghanistan mostly for the purpose of employment opportunities, security and better quality of life, therefore, Kabul faced with strange population growth. According to Central Statistics Organization of Afghanistan population of Kabul has been estimated approx. 5 million (2015), however a new Master Plan has been prepared in 2009, but the existing challenges have not been dissolved yet. On the other hand, 70% of Kabul population is living in unplanned (slam) area and facing the shortage of drinking water, inexistence of sewerage and drainage network, inexistence of proper management system for solid waste collection, lack of public transportation and traffic management, environmental degradation and the shortage of social infrastructure. Although there are many problems in Kabul city, but still the development of 22 townships are in progress which caused the great attraction of population. The research is completed with a detailed analysis on four main issues such as elimination of duplicated administrations, Development of regions, Rehabilitation and improvement of infrastructure, and prevention of new townships establishment in Kabul Central Core in order to mitigate the problems and constraints which are the foundation and principal to find the point of departure for an objective based future development of Kabul city. The closure has been defined to reflect the stage-wise development in light of prepared policy and strategies, development of a procedure for the improvement of infrastructure, conducting a preliminary EIA, defining scope of stakeholder’s contribution and preparation of project list for initial development. In conclusion this paper will help the transformation of Kabul city.Keywords: development of regions, illegal construction, population density, urbanization pattern
Procedia PDF Downloads 314469 Thermoelectric Blanket for Aiding the Treatment of Cerebral Hypoxia and Other Related Conditions
Authors: Sarayu Vanga, Jorge Galeano-Cabral, Kaya Wei
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Cerebral hypoxia refers to a condition in which there is a decrease in oxygen supply to the brain. Patients suffering from this condition experience a decrease in their body temperature. While there isn't any cure to treat cerebral hypoxia as of date, certain procedures are utilized to help aid in the treatment of the condition. Regulating the body temperature is an example of one of those procedures. Hypoxia is well known to reduce the body temperature of mammals, although the neural origins of this response remain uncertain. In order to speed recovery from this condition, it is necessary to maintain a stable body temperature. In this study, we present an approach to regulating body temperature for patients who suffer from cerebral hypoxia or other similar conditions. After a thorough literature study, we propose the use of thermoelectric blankets, which are temperature-controlled thermal blankets based on thermoelectric devices. These blankets are capable of heating up and cooling down the patient to stabilize body temperature. This feature is possible through the reversible effect that thermoelectric devices offer while behaving as a thermal sensor, and it is an effective way to stabilize temperature. Thermoelectricity is the direct conversion of thermal to electrical energy and vice versa. This effect is now known as the Seebeck effect, and it is characterized by the Seebeck coefficient. In such a configuration, the device has cooling and heating sides with temperatures that can be interchanged by simply switching the direction of the current input in the system. This design integrates various aspects, including a humidifier, ventilation machine, IV-administered medication, air conditioning, circulation device, and a body temperature regulation system. The proposed design includes thermocouples that will trigger the blanket to increase or decrease a set temperature through a medical temperature sensor. Additionally, the proposed design allows an efficient way to control fluctuations in body temperature while being cost-friendly, with an expected cost of 150 dollars. We are currently working on developing a prototype of the design to collect thermal and electrical data under different conditions and also intend to perform an optimization analysis to improve the design even further. While this proposal was developed for treating cerebral hypoxia, it can also aid in the treatment of other related conditions, as fluctuations in body temperature appear to be a common symptom that patients have for many illnesses.Keywords: body temperature regulation, cerebral hypoxia, thermoelectric, blanket design
Procedia PDF Downloads 147468 Effects of Post-sampling Conditions on Ethanol and Ethyl Glucuronide Formation in the Urine of Diabetes Patients
Authors: Hussam Ashwi, Magbool Oraiby, Ali Muyidi, Hamad Al-Oufi, Mohammed Al-Oufi, Adel Al-Juhani, Salman Al-Zemaa, Saeed Al-Shahrani, Amal Abuallah, Wedad Sherwani, Mohammed Alattas, Ibraheem Attafi
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Ethanol must be accurately identified and quantified to establish their use and contribution in criminal cases and forensic medicine. In some situations, it may be necessary to reanalyze an old specimen; therefore, it is essential to comprehend the effect of storage conditions and how long the result of a reanalyzed specimen can be reliable and reproducible. Additionally, ethanol can be produced via multiple in vivo and in vitro processes, particularly in diabetic patients, and the results can be affected by storage conditions and time. In order to distinguish between in vivo and in vitro alcohol generation in diabetes patient urine samples, various factors should be considered. This study identifies and quantifies ethanol and EtG in diabetic patients' urine samples stored in two different settings over time. Ethanol levels were determined using gas chromatography-headspace (GC-HS), and ethyl glucuronide (EtG) levels were determined using the immunoassay (RANDOX) technique. Ten urine specimens were collected and placed in a standard container. Each specimen was separated into two containers. The specimens were divided into two groups: those kept at room temperature (25 °C) and those kept cold (2-8 °C). Ethanol and EtG levels were determined serially over a two-week period. Initial results showed that none of the specimens tested positive for ethanol or EtG. At room temperature (15-25 °C), 7 and 14 days after the sample was taken, the average concentration of ethanol increased from 1.7 mg/dL to 2 mg/dL, and the average concentration of EtG increased from 108 ng/mL to 186 ng/mL. At 2–8 °C, the average ethanol concentration was 0.4 and 0.5 mg/dL, and the average EtG concentration was 138 and 124 ng/mL seven and fourteen days after the sample was collected, respectively. When ethanol and EtG levels were determined 14 days post collection, they were considerably lower than when stored at room temperature. A considerable increase in EtG concentrations (14-day range 0–186 ng/mL) is produced during room-temperature storage, although negative initial results for all specimens. Because EtG might be produced after a sampling collection, it is not a reliable indicator of recent alcohol consumption. Given the possibility of misleading EtG results due to in vitro EtG production in the urine of diabetic patients.Keywords: ethyl glucuronide, ethanol, forensic toxicology, diabetic
Procedia PDF Downloads 119467 Expression of Human Papillomavirus Type 18 L1 Virus-Like Particles in Methylotropic Yeast, Pichia Pastoris
Authors: Hossein Rassi, Marjan Moradi Fard, Samaneh Niko
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Human papillomavirus type 16 and 18 are closely associated with the development of human cervical carcinoma, which is one of the most common causes of cancer death in women worldwide. At present, HPV type 18 accounts for about 34 % of all HPV infections in Iran and the most promising vaccine against HPV infection is based on the L1 major capsid protein. The L1 protein of HPV18 has the capacity to self-assemble into capsomers or virus-like particles (VLPs) that are non-infectious, highly immunogenic and allowing their use in vaccine production. The methylotrophic yeast Pichia pastoris is an efficient and inexpensive expression system used to produce high levels of heterologous proteins. In this study we expressed HPV18 L1 VLPs in P. pastoris. The gene encoding the major capsid protein L1 of the high-risk HPV type 18 was isolated from Iranian patient by PCR and inserted into pTG19-T vector to obtain the recombinant expression vector pTG19-HPV18-L1. Then, the pTG19-HPV18-L1 was transformed into E. coli strain DH5α and the recombinant protein HPV18 L1 was expressed under IPTG induction in soluble form. The HPV18 L1 gene was excised from recombinant plasmid with XhoI and EcoRI enzymes and ligated into the yeast expression vector pPICZα linearized with the same enzymes, and transformed into P. pastoris. Induction and expression of HPV18 L1 protein was demonstrated by BMGY/BMMY and RT PCR. The parameters for induced cultivation for strain in P. pastoris KM71 with HPV16L1 were investigated in shaking flask cultures. After induced cultivation BMMY (pH 7.0) medium supplemented with methanol to a final concentration of 1.0% every 24 h at 37 degrees C for 96 h, the recombinant produced 78.6 mg/L of L1 protein. This work offers the possibility for the production of prophylactic vaccine for cervical carcinoma by P. pastoris for HPV-18 L1 gene. The VLP-based HPV vaccines can prevent persistent HPV18 infections and cervical cancer in Iran. The HPV-18 L1 gene was expressed successfully in E.coli, which provides necessary basis for preparing HPV-18 L1 vaccine in human. Also, HPV type 6 L1 proteins expressed in Pichia pastoris will facilitate the HPV vaccine development and structure-function study.Keywords: Pichia pastoris, L1 virus-like particles, human papillomavirus type 18, biotechnology
Procedia PDF Downloads 401466 A Resolution on Ideal University Teachers Perspective of Turkish Students
Authors: Metin Özkan
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In the last decade, Turkish higher education has been expanded dramatically. With this expansion, Turkey has come a long way in establishing an efficient system of higher education which is moving into a ‘mass’ system with institutions spanning the whole country. This expansion as a quantitative target leads to questioning the quality of higher education services. Especially, the qualities of higher education services depend on mainly quality of educators. Qualities of educators are most important in Turkish higher education system due to rapid rise in the number of universities and students. Therefore, it is seen important that reveals the portrait of ideal university teacher from the point of view student enrolled in Turkish higher education system. The purpose of this current study is to determine the portrait of ideal university teacher according to the views of Turkish Students. This research is carried out with descriptive scanning method and combined and mixed of qualitative and quantitative methodologies. Research data of qualitative section were collected at Gaziantep University with the participation of 45 students enrolled in 15 different faculties. Quantitative section was performed on 217 students. The data were obtained through semi-structured interview and “Ideal University Teacher Assessment” form developed by the researcher. The interview form consists of basically two parts. The first part of the interview was about personal information, the second part included questions about the characteristic of ideal university teacher. The questions which constitute the second part of the interview are; "what is a good university teacher like?” and “What human qualities and professional skills should a university teacher have? ". Assessment form which was created from the qualitative data obtained from interviews was used to attain scaling values for pairwise comparison and ranking judgment. According to study results, it has been found that ideal university teacher characteristics include the features like patient, tolerant, comprehensive and tolerant. Ideal university teacher, besides, implement the teaching methods like encouraging the students’ critical thinking, accepting the students’ recommendations on how to conduct the lesson and making use of the new technologies etc. Motivating and respecting the students, adopting a participative style, adopting a sincere way of manner also constitute the ideal university features relationships with students.Keywords: faculty, higher education, ideal university teacher, teacher behavior
Procedia PDF Downloads 207465 Foot Self-Monitoring Knowledge, Attitude, Practice, and Related Factors among Diabetic Patients: A Descriptive and Correlational Study in a Taiwan Teaching Hospital
Authors: Li-Ching Lin, Yu-Tzu Dai
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Recurrent foot ulcers or foot amputation have a major impact on patients with diabetes mellitus (DM), medical professionals, and society. A critical procedure for foot care is foot self-monitoring. Medical professionals’ understanding of patients’ foot self-monitoring knowledge, attitude, and practice is beneficial for raising patients’ disease awareness. This study investigated these and related factors among patients with DM through a descriptive study of the correlations. A scale for measuring the foot self-monitoring knowledge, attitude, and practice of patients with DM was used. Purposive sampling was adopted, and 100 samples were collected from the respondents’ self-reports or from interviews. The statistical methods employed were an independent-sample t-test, one-way analysis of variance, Pearson correlation coefficient, and multivariate regression analysis. The findings were as follows: the respondents scored an average of 12.97 on foot self-monitoring knowledge, and the correct answer rate was 68.26%. The respondents performed relatively lower in foot health screenings and recording, and awareness of neuropathy in the foot. The respondents held a positive attitude toward self-monitoring their feet and a negative attitude toward having others check the soles of their feet. The respondents scored an average of 12.64 on foot self-monitoring practice. Their scores were lower in their frequency of self-monitoring their feet, recording their self-monitoring results, checking their pedal pulse, and examining if their soles were red immediately after taking off their shoes. Significant positive correlations were observed among foot self-monitoring knowledge, attitude, and practice. The correlation coefficient between self-monitoring knowledge and self-monitoring practice was 0.20, and that between self-monitoring attitude and self-monitoring practice was 0.44. Stepwise regression analysis revealed that the main predictive factors of the foot self-monitoring practice in patients with DM were foot self-monitoring attitude, prior experience in foot care, and an educational attainment of college or higher. These factors predicted 33% of the variance. This study concludes that patients with DM lacked foot self-monitoring practice and advises that the patients’ self-monitoring abilities be evaluated first, including whether patients have poor eyesight, difficulties in bending forward due to obesity, and people who can assist them in self-monitoring. In addition, patient education should emphasize self-monitoring knowledge and practice, such as perceptions regarding the symptoms of foot neurovascular lesions, pulse monitoring methods, and new foot self-monitoring equipment. By doing so, new or recurring ulcers may be discovered in their early stages.Keywords: diabetic foot, foot self-monitoring attitude, foot self-monitoring knowledge, foot self-monitoring practice
Procedia PDF Downloads 189464 Computer-Aided Drug Repurposing for Mycobacterium Tuberculosis by Targeting Tryptophanyl-tRNA Synthetase
Authors: Neslihan Demirci, Serdar Durdağı
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Mycobacterium tuberculosis is still a worldwide disease-causing agent that, according to WHO, led to the death of 1.5 million people from tuberculosis (TB) in 2020. The bacteria reside in macrophages located specifically in the lung. There is a known quadruple drug therapy regimen for TB consisting of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Over the past 60 years, there have been great contributions to treatment options, such as recently approved delamanid (OPC67683) and bedaquiline (TMC207/R207910), targeting mycolic acid and ATP synthesis, respectively. Also, there are natural compounds that can block the tryptophanyl-tRNA synthetase (TrpRS) enzyme, chuangxinmycin, and indolmycin. Yet, already the drug resistance is reported for those agents. In this study, the newly released TrpRS enzyme structure is investigated for potential inhibitor drugs from already synthesized molecules to help the treatment of resistant cases and to propose an alternative drug for the quadruple drug therapy of tuberculosis. Maestro, Schrodinger is used for docking and molecular dynamic simulations. In-house library containing ~8000 compounds among FDA-approved indole-containing compounds, a total of 57 obtained from the ChemBL were used for both ATP and tryptophan binding pocket docking. Best of indole-containing 57 compounds were subjected to hit expansion and compared later with virtual screening workflow (VSW) results. After docking, VSW was done. Glide-XP docking algorithm was chosen. When compared, VSW alone performed better than the hit expansion module. Best scored compounds were kept for ten ns molecular dynamic simulations by Desmond. Further, 100 ns molecular dynamic simulation was performed for elected molecules according to Z-score. The top three MMGBSA-scored compounds were subjected to steered molecular dynamic (SMD) simulations by Gromacs. While SMD simulations are still being conducted, ponesimod (for multiple sclerosis), vilanterol (β₂ adrenoreceptor agonist), and silodosin (for benign prostatic hyperplasia) were found to have a significant affinity for tuberculosis TrpRS, which is the propulsive force for the urge to expand the research with in vitro studies. Interestingly, top-scored ponesimod has been reported to have a side effect that makes the patient prone to upper respiratory tract infections.Keywords: drug repurposing, molecular dynamics, tryptophanyl-tRNA synthetase, tuberculosis
Procedia PDF Downloads 112463 Clinical Value of 18F-FDG-PET Compared with CT Scan in the Detection of Nodal and Distant Metastasis in Urothelial Carcinoma or Bladder Cancer
Authors: Mohammed Al-Zubaidi, Katherine Ong, Pravin Viswambaram, Steve McCombie, Oliver Oey, Jeremy Ong, Richard Gauci, Ronny Low, Dickon Hayne
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Objective: Lymph node involvement along with distant metastasis in a patient with invasive bladder cancer determines the disease survival, therefeor, it is an essential determinant of the therapeutic management and outcome. This retrospective study aims to determine the accuracy of FDG PET scan in detecting lymphatic involvement and distant metastatic urothelial cancer compared to conventional CT staging. Method: A retrospective review of 76 patients with UC or BC who underwent surgery or confirmatory biopsy that was staged with both CT and 18F-FDG-PET (up to 8 weeks apart) between 2015 and 2020. Fifty-sevenpatients (75%) had formal pelvic LN dissection or biopsy of suspicious metastasis. 18F-FDG-PET reports for positive sites were qualitative depending on SUV Max. On the other hand, enlarged LN by RECIST criteria 1.1 (>10 mm) and other qualitative findings suggesting metastasis were considered positive in CT scan. Histopathological findings from surgical specimens or image-guided biopsies were considered the gold standard in comparison to imaging reports. 18F-FDG-avid or enlarged pelvic LNs with surgically proven nodal metastasis were considered true positives. Performance characteristics of 18F-FDG-PET and CT, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (PPV), were calculated. Results: Pelvic LN involvement was confirmed histologically in 10/57 (17.5%) patients. Sensitivity, specificity, PPV and NPV of CT for detecting pelvic LN metastases were 41.17% (95% CI:18-67%), 100% (95% CI:90-100%) 100% (95% CI:59-100%) and 78.26% (95% CI:64-89%) respectively. Sensitivity, specificity, PPV and NPV of 18F-FDG-PET for detecting pelvic LN metastases were 62.5% (95% CI:35-85%), 83.78% (95% CI:68-94%), 62.5% (95% CI:35-85%), and 83.78% (95% CI:68-94%) respectively. Pre-operative staging with 18F-FDG-PET identified the distant metastatic disease in 9/76 (11.8%) patients who were occult on CT. This retrospective study suggested that 18F-FDG-PET may be more sensitive than CT for detecting pelvic LN metastases. 7/76 (9.2%) patients avoided cystectomy due to 18F-FDG-PET diagnosed metastases that were not reported on CT. Conclusion: 18F-FDG-PET is more sensitive than CT for pelvic LN metastases, which can be used as the standard modality of bladder cancer staging, as it may change the treatment by detecting lymph node metastasis that was occult in CT. Further research involving randomised controlled trials comparing the diagnostic yield of 18F-FDG-PET and CT in detecting nodal and distant metastasis in UC or BC is warranted to confirm our findings.Keywords: FDG PET, CT scan, urothelial cancer, bladder cancer
Procedia PDF Downloads 117462 Determination of Circulating Tumor Cells in Breast Cancer Patients by Electrochemical Biosensor
Authors: Gökçe Erdemir, İlhan Yaylım, Serap Erdem-Kuruca, Musa Mutlu Can
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It has been determined that the main reason for the death of cancer disease is caused by metastases rather than the primary tumor. The cells that leave the primary tumor and enter the circulation and cause metastasis in the secondary organs are called "circulating tumor cells" (CTCs). The presence and number of circulating tumor cells has been associated with poor prognosis in many major types of cancer, including breast, prostate, and colorectal cancer. It is thought that knowledge of circulating tumor cells, which are seen as the main cause of cancer-related deaths due to metastasis, plays a key role in the diagnosis and treatment of cancer. The fact that tissue biopsies used in cancer diagnosis and follow-up are an invasive method and are insufficient in understanding the risk of metastasis and the progression of the disease have led to new searches. Liquid biopsy tests performed with a small amount of blood sample taken from the patient for the detection of CTCs are easy and reliable, as well as allowing more than one sample to be taken over time to follow the prognosis. However, since these cells are found in very small amounts in the blood, it is very difficult to capture them and specially designed analytical techniques and devices are required. Methods based on the biological and physical properties of the cells are used to capture these cells in the blood. Early diagnosis is very important in following the prognosis of tumors of epithelial origin such as breast, lung, colon and prostate. Molecules such as EpCAM, vimentin, and cytokeratins are expressed on the surface of cells that pass into the circulation from very few primary tumors and reach secondary organs from the circulation, and are used in the diagnosis of cancer in the early stage. For example, increased EpCAM expression in breast and prostate cancer has been associated with prognosis. These molecules can be determined in some blood or body fluids to be taken from patients. However, more sensitive methods are required to be able to determine when they are at a low level according to the course of the disease. The aim is to detect these molecules found in very few cancer cells with the help of sensitive, fast-sensing biosensors, first in breast cancer cells reproduced in vitro and then in blood samples taken from breast cancer patients. In this way, cancer cells can be diagnosed early and easily and effectively treated.Keywords: electrochemical biosensors, breast cancer, circulating tumor cells, EpCAM, Vimentin, Cytokeratins
Procedia PDF Downloads 253461 Time to Second Line Treatment Initiation Among Drug-Resistant Tuberculosis Patients in Nepal
Authors: Shraddha Acharya, Sharad Kumar Sharma, Ratna Bhattarai, Bhagwan Maharjan, Deepak Dahal, Serpahine Kaminsa
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Background: Drug-resistant (DR) tuberculosis (TB) continues to be a threat in Nepal, with an estimated 2800 new cases every year. The treatment of DR-TB with second line TB drugs is complex and takes longer time with comparatively lower treatment success rate than drug-susceptible TB. Delay in treatment initiation for DR-TB patients might further result in unfavorable treatment outcomes and increased transmission. This study thus aims to determine median time taken to initiate second-line treatment among Rifampicin Resistant (RR) diagnosed TB patients and to assess the proportion of treatment delays among various type of DR-TB cases. Method: A retrospective cohort study was done using national routine electronic data (DRTB and TB Laboratory Patient Tracking System-DHIS2) on drug resistant tuberculosis patients between January 2020 and December 2022. The time taken for treatment initiation was computed as– days from first diagnosis as RR TB through Xpert MTB/Rif test to enrollment on second-line treatment. The treatment delay (>7 days after diagnosis) was calculated. Results: Among total RR TB cases (N=954) diagnosed via Xpert nationwide, 61.4% were enrolled under shorter-treatment regimen (STR), 33.0% under longer treatment regimen (LTR), 5.1% for Pre-extensively drug resistant TB (Pre-XDR) and 0.4% for Extensively drug resistant TB (XDR) treatment. Among these cases, it was found that the median time from diagnosis to treatment initiation was 6 days (IQR:2-15.8). The median time was 5 days (IQR:2.0-13.3) among STR, 6 days (IQR:3.0-15.0) among LTR, 30 days (IQR:5.5-66.8) among Pre-XDR and 4 days (IQR:2.5-9.0) among XDR TB cases. The overall treatment delay (>7 days after diagnosis) was observed in 42.4% of the patients, among which, cases enrolled under Pre-XDR contributed substantially to treatment delay (72.0%), followed by LTR (43.6%), STR (39.1%) and XDR (33.3%). Conclusion: Timely diagnosis and prompt treatment initiation remain fundamental focus of the National TB program. The findings of the study, however suggest gaps in timeliness of treatment initiation for the drug-resistant TB patients, which could bring adverse treatment outcomes. Moreover, there is an alarming delay in second line treatment initiation for the Pre-XDR TB patients. Therefore, this study generates evidence to identify existing gaps in treatment initiation and highlights need for formulating specific policies and intervention in creating effective linkage between the RR TB diagnosis and enrollment on second line TB treatment with intensified efforts from health providers for follow-ups and expansion of more decentralized, adequate, and accessible diagnostic and treatment services for DR-TB, especially Pre-XDR TB cases, due to the observed long treatment delays.Keywords: drug-resistant, tuberculosis, treatment initiation, Nepal, treatment delay
Procedia PDF Downloads 75460 Orthopedic Trauma in Newborn Babies
Authors: Joanna Maj, Awais Hussain, Lyndsey Vu, Catherine Roxas
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Background: Bone injuries in babies are common conditions that arise during delivery. Fractures of the clavicle, humerus, femur, and skull are the most common neonatal bone injuries sustained from labor and delivery. During operative deliveries, zealous tractions, ineffective delivery techniques, improper uterine incision, and inadequate relaxation of the uterus can lead to bone fractures in the newborn. Neonatal anatomy is unique. Just as children are not mini-adults, newborns are not mini children. A newborn’s anatomy and physiology are significantly different from a pediatric patient's. In this paper, we describe common orthopedic trauma in newborn babies. We provide a comprehensive overview of the different types of bone injuries in newborns. We hypothesize that the rate of bone fractures sustained at birth is higher in cases of operative deliveries. Methods: Relevant literature was selected by using the PubMed database. Search terms included orthopedic conditions in newborns, neonatal anatomy, and bone fractures in neonates during operative deliveries. Inclusion criteria included age, gender, race, type of bone injury and progression of bone injury. Exclusion criteria were limited in the medical history of cases reviewed and comorbidities. Results: This review finds that a clavicle fracture is the most common type of neonatal orthopedic injury sustained at birth in both operative and non-operative deliveries. We confirm the hypothesis that infants born via operative deliveries have a significantly higher rate of bone fractures than non-cesarean section deliveries. Conclusion: Newborn babies born via operative deliveries have a higher rate of bone fractures of the clavicle, humerus, and femur. A clavicle bone fracture in newborns is most common during emergency operative deliveries in new mothers. We conclude that infants born via an operative delivery sustained more bone injuries than infants born via non-cesarean section deliveries.Keywords: clavicle fracture, humerus fracture, neonates, newborn orthopedics, orthopedic surgery, pediatrics, orthopedic trauma, orthopedic trauma during delivery, cesarean section, obstetrics, neonatal anatomy, neonatal fractures, operative deliveries, labor and delivery, bone injuries in neonates
Procedia PDF Downloads 95459 Dosimetric Comparison of Conventional Plans versus Three Dimensional Conformal Simultaneously Integrated Boost Plans
Authors: Shoukat Ali, Amjad Hussain, Latif-ur-Rehman, Sehrish Inam
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Radiotherapy plays an important role in the management of cancer patients. Approximately 50% of the cancer patients receive radiotherapy at one point or another during the course of treatment. The entire radiotherapy treatment of curative intent is divided into different phases, depending on the histology of the tumor. The established protocols are useful in deciding the total dose, fraction size, and numbers of phases. The objective of this study was to evaluate the dosimetric differences between the conventional treatment protocols and the three-dimensional conformal simultaneously integrated boost (SIB) plans for three different tumors sites (i.e. bladder, breast, and brain). A total of 30 patients with brain, breast and bladder cancers were selected in this retrospective study. All the patients were CT simulated initially. The primary physician contoured PTV1 and PTV2 in the axial slices. The conventional doses prescribed for brain and breast is 60Gy/30 fractions, and 64.8Gy/36 fractions for bladder treatment. For the SIB plans biological effective doses (BED) were calculated for 25 fractions. The two conventional (Phase I and Phase II) and a single SIB plan for each patient were generated on Eclipse™ treatment planning system. Treatment plans were compared and analyzed for coverage index, conformity index, homogeneity index, dose gradient and organs at risk doses.In both plans 95% of PTV volume received a minimum of 95% of the prescribe dose. Dose deviation in the optic chiasm was found to be less than 0.5%. There is no significant difference in lung V20 and heart V30 in the breast plans. In the rectum plans V75%, V50% and V25% were found to be less than 1.2% different. Deviation in the tumor coverage, conformity and homogeneity indices were found to be less than 1%. SIB plans with three dimensional conformal radiotherapy technique reduce the overall treatment time without compromising the target coverage and without increasing dose to the organs at risk. The higher dose per fraction may increase the late effects to some extent. Further studies are required to evaluate the late effects with the intention of standardizing the SIB technique for practical implementation.Keywords: coverage index, conformity index, dose gradient, homogeneity index, simultaneously integrated boost
Procedia PDF Downloads 470458 The Effectiveness of Warm-Water Footbath on Fatigue in Cancer Patient Undergoing Chemotherapy
Authors: Yu-Wen Lin, Li-Ni Liu
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Introduction: Fatigue is the most common symptoms experienced by cancer patients undergoing chemotherapy. Patients receiving anticancer therapies develop a higher proportion of fatigue compared with patients who do not receive anticancer therapies. Fatigue has significant impacts on quality of life, daily activities, mood status, and social behaviors. A warm-water footbath (WWF) at 41℃ promotes circulation and removes metabolites resulting in improving sleep and relieving fatigue. The aim of this study is to determine the effectiveness of WWF for relieving fatigue with cancer patients undergoing chemotherapy. Materials and Methods: This is a single-center, prospective, quasi-experimental design study in the oncology ward in Taiwan. Participants in this study were assigned to WWF group as experimental group and standard care group as a control group by purposive sampling. In the WWF group, the participants were asked to soak their feet in 42-43℃ water 15 minutes for consecutive 6 days at one day before chemotherapy. Each participant was evaluated for fatigue level by the Taiwanese version of the Brief Fatigue Inventory (BFI-T). BFI-T was completed for consecutive 8 days of the study. The primary outcome was compared the BFI-T score of WWF group to the standard care group. Results: There were 60 participants enrolled in this study. Thirty participants were assigned to WWF group and 30 participants were assigned to standard care group. Both groups have comparable characteristic. The BFI-T scores of both groups were increased associated with the days of chemotherapy. The highest BFI-T scores of both groups were on the day 4 of chemotherapy. The BFI-T scores of both groups were decreased since day 5 and significantly decreased in WWF group on day 5 compared to standard care group (4.17 vs. 5.7, P < .05). At the end of the study the fatigue at its worse were significantly decreased in WWF group (2.33 vs. 4.37, P < .001). There was no adverse event reported in this study. Conclusion: WWF is an easy, safe, non-invasive, and relatively inexpensive nursing intervention for improving fatigue of cancer patients undergoing chemotherapy. In summary, this study shows the WWF is a simple complementary care method, and it is effective for improving and relieving fatigue in a short time. Through improving fatigue is a way to enhance the quality of life which is important for cancer patients undergoing chemotherapy. Larger prospective randomized controlled trial and long-term effectiveness and outcomes of WWF should be performed to confirm this study.Keywords: chemotherapy, warm-water footbath, fatigue, Taiwanese version of the brief fatigue inventory
Procedia PDF Downloads 138457 Effects of Additional Pelvic Floor Exercise on Sexual Function, Quality of Life and Pain Intensity in Subjects with Chronic Low Back Pain
Authors: Emel Sonmezer, Hayri Baran Yosmaoglu
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The negative impact of chronic pain syndromes on sexual function has been reported in several studies; however, the influences of treatment strategies on sexual dysfunction have not been evaluated widely. The aim of this study was to determine the effects of pelvic floor exercise on sexual dysfunction in female patients with chronic low back pain. Forty-two patient with chronic low back pain were enrolled this study. Subjects were divided into two groups. Group 1 received conventional physiotherapy consist of heat therapy, ergonomic education, William flexion exercise during 6 weeks. Group 2 received pelvic floor exercises in addition to conventional physiotherapy. Female Sexual Function Index (FSFI) was used for the assessment of sexual function. Pain intensity was assessed with Visual Analogue Scale. Quality of life was assessed with World Health Organization Quality of Life Scale. All measurements were taken before and after treatment. In conventional physiotherapy group; there were significant improvement in pain intensity (p= 0,003), physical health (p=0,011), psychological health (p=0,042) subscales of quality of life scale, arousal (p=0,042), lubrication (p=0,028) and pain (p= 0,034) subscales of FSFI. In additional pelvic floor exercise group; there were significant improvement in pain intensity (p= 0,005), physical health (p=0,012) psychological health (p=0,039) subscales of quality of life scale, arousal (p=0,024), lubrication (p=0,011), orgasm (p=0,035) and pain (p= 0,015) subscales and total score (p=0,016) of FSFI. Total FSFI score (p=0,025) and orgasm (p=0,017) subscale of FSFI were significantly higher for the additional pelvic floor exercise group than the conventional physiotherapy group.The outcome of this study suggested that conventional physiotherapy may contribute to improve pain, quality of life and some parameters of the sexual function in patients with low back pain. Although additional pelvic floor exercise did not reveal more treatment effect in terms of quality of life and pain intensity, it caused significant improvement in sexual function. It is recommended that pelvic floor exercise should be added to treatment programs in order to manage sexual dysfunction more effectively in patients with chronic low back pain.Keywords: physiotherapy, chronic pain, sexual dysfunction, pelvic floor
Procedia PDF Downloads 262456 Community Engagement Strategies to Assist with the Development of an RCT Among People Living with HIV
Authors: Joyce K. Anastasi, Bernadette Capili
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Community Engagement Strategies to Assist with the Development of an RCT Among People Living with HIV Our research team focuses on developing and testing protocols to manage chronic symptoms. For many years, our team designed and implemented symptom management studies for people living with HIV (PLWH). We identify symptoms that are not curative and are not adequately controlled by conventional therapies. As an exemplar, we describe how we successfully engaged PLWH in developing and refining our research feasibility protocol for distal sensory peripheral neuropathy (DSP) associated with HIV. With input from PLWH with DSP, our research received National Institutes of Health (NIH) research funding support. Significance: DSP is one of the most common neurologic complications in HIV. It is estimated that DSP affects 21% to 50% of PLWH. The pathogenesis of DSP in HIV is complex and unclear. Proposed mechanisms include cytokine dysregulation, viral protein-produced neurotoxicity, and mitochondrial dysfunction associated with antiretroviral medications. There are no FDA-approved treatments for DSP in HIV. Purpose: Aims: 1) to explore the impact of DSP on the lives of PLWH, 2) to identify patients’ perspectives on successful treatments for DSP, 3) to identify interventions considered feasible and sensitive to the needs of PLWH with DSP, and 4) to obtain participant input for protocol/study design. Description of Process: We conducted a needs assessment with PLWH with DSP. From our needs assessment, we learned from the patients’ perspective detailed descriptions of their symptoms; physical functioning with DSP; self-care remedies tried, and desired interventions. We also asked about protocol scheduling, instrument clarity, study compensation, study-related burdens, and willingness to participate in a randomized controlled trial (RCT) with a placebo and a waitlist group. Implications: We incorporated many of the suggestions learned from the need assessment. We developed and completed a feasibility study that provided us with invaluable information that informed subsequent NIH-funded studies. In addition to our extensive clinical and research experience working with PLWH, learning from the patient perspective helped in developing our protocol and promoting a successful plan for recruitment and retention of study participants.Keywords: clinical trial development, peripheral neuropathy, traditional medicine, HIV, AIDS
Procedia PDF Downloads 79455 Imaging Features of Hepatobiliary Histiocytosis
Authors: Ayda Youssef, Tarek Rafaat, Iman zaky
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Purpose: Langerhans’ cell histiocytosis (LCH) is not uncommon pathology that implies aberrant proliferation of a specific dendritic (Langerhans) cell. These atypical but mature cells of monoclonal origin can infiltrate many sites of the body and may occur as localized lesions or as widespread systemic disease. Liver is one of the uncommon sites of affection. The twofold objective of this study is to illustrate the radiological presentation of this disease, and to compare these results with previously reported series. Methods and Materials: Between 2007 and 2012, 150 patients with biopsy-proven LCH were treated in our hospital, a paediatric cancer tertiary care center. A retrospective review of radiographic images and reports was performed. There were 33 patients with liver affection are stratified. All patients underwent imaging studies, mostly US and CT. A chart review was performed to obtain demographic, clinical and radiological data. They were analyzed and compared to other published series. Results: Retrospective assessment of 150 patients with LCH was performed, among them 33 patients were identified who had liver involvement. All these patients developed multisystemic disease; They were 12 females and 21 males with (n= 32), seven of them had marked hepatomegaly. Diffuse hypodense liver parenchyma was encountered in five cases, the periportal location has a certain predilection in cases of focal affection where three cases has a hypodense periportal soft tissue sheets, one of them associated with dilated biliary radicals, only one case has multiple focal lesions unrelated to portal tracts. On follow up of the patients, two cases show abnormal morphology of liver with bossy outline. Conclusion: LCH is a not infrequent disease. A high-index suspicion should be raised in the context of diagnosis of liver affection. A biopsy is recommended in the presence of radiological suspicion. Chemotherapy is the preferred therapeutic modality. Liver histiocytosis are not disease specific features but should be interpreted in conjunction with the clinical history and the results of biopsy. Clinical Relevance/Application: Radiologist should be aware of different patterns of hepatobiliary histiocytosis, Thus early diagnosis and proper management of patient can be conducted.Keywords: langerhans’ cell histiocytosis, liver, medical and health sciences, radiology
Procedia PDF Downloads 274454 The Quality of Life, Situations and Emerging Concerns of Parents of Children with Neurodevelopmental Disorders in Philippine Children's Medical Center during the Covid-19 Pandemic
Authors: Annelyn Fatima Lopez, Ermenilda Avendano, Aileen Marie Vargas, Lara Baylon, Rorilee Angeles
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BACKGROUND: The COVID-19 resulted in a public health emergency and quarantine measures which may negatively impact psychosocial and environmental aspects of vulnerable populations. OBJECTIVES: This study intended to determine the quality of life, situations and emerging concerns of parents of children with neurodevelopmental disorders during the ongoing coronavirus pandemic. METHODOLOGY: Parents of patients seen in the PCMC Neurodevelopmental Pediatrics OPD clinic were recruited to fill out questionnaires on parent and child characteristics, survey on situations and emerging concerns during the coronavirus pandemic and WHOQOL-BREF (Filipino version) for parental quality of life. RESULTS: Data from 115 respondents showed a lower score in the environmental domain. The child characteristics that are statistically comparable with the QoL scores include sex, severity of ID and ADHD while the parent characteristics that are statistically comparable with the QoL scores include educational attainment, monthly family income, father’s employment status and family structure (P-value <0.05). Most respondents reported physical distancing (82.61%) and curfew (80.87%) as measures implemented due to the pandemic. Inability to access essential services (43.48-74.48%) were further compounded by limited financial resources (51.30%) and public transport (60%). Government responses received include quarantine pass (90.43%), food allowance or relief package (86.09%), disinfection (60.87%), DSWD-SAP (42.61%) and cash distribution (41.74%). Concerns encountered include socio-environmental issues (i.e. no available transportation, effect on the ability to earn, inadequate food/medicine rations, disruptions in basic social services) and patient concerns (i.e. access to education, medical, developmental and behavioral services, nutrition and sleep). RECOMMENDATIONS: Programs and policies should be planned accordingly to provide improvement of quality of life for both parents and the child with a neurodevelopmental disorder.Keywords: covid-19, neurodevelopmental disorder, parental quality of life, whoqol-bref
Procedia PDF Downloads 204453 Digital Immunity System for Healthcare Data Security
Authors: Nihar Bheda
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Protecting digital assets such as networks, systems, and data from advanced cyber threats is the aim of Digital Immunity Systems (DIS), which are a subset of cybersecurity. With features like continuous monitoring, coordinated reactions, and long-term adaptation, DIS seeks to mimic biological immunity. This minimizes downtime by automatically identifying and eliminating threats. Traditional security measures, such as firewalls and antivirus software, are insufficient for enterprises, such as healthcare providers, given the rapid evolution of cyber threats. The number of medical record breaches that have occurred in recent years is proof that attackers are finding healthcare data to be an increasingly valuable target. However, obstacles to enhancing security include outdated systems, financial limitations, and a lack of knowledge. DIS is an advancement in cyber defenses designed specifically for healthcare settings. Protection akin to an "immune system" is produced by core capabilities such as anomaly detection, access controls, and policy enforcement. Coordination of responses across IT infrastructure to contain attacks is made possible by automation and orchestration. Massive amounts of data are analyzed by AI and machine learning to find new threats. After an incident, self-healing enables services to resume quickly. The implementation of DIS is consistent with the healthcare industry's urgent requirement for resilient data security in light of evolving risks and strict guidelines. With resilient systems, it can help organizations lower business risk, minimize the effects of breaches, and preserve patient care continuity. DIS will be essential for protecting a variety of environments, including cloud computing and the Internet of medical devices, as healthcare providers quickly adopt new technologies. DIS lowers traditional security overhead for IT departments and offers automated protection, even though it requires an initial investment. In the near future, DIS may prove to be essential for small clinics, blood banks, imaging centers, large hospitals, and other healthcare organizations. Cyber resilience can become attainable for the whole healthcare ecosystem with customized DIS implementations.Keywords: digital immunity system, cybersecurity, healthcare data, emerging technology
Procedia PDF Downloads 60452 Comparison Serum Vitamin D by Geographic between the Highland and Lowland Schizophrenic Patient in the Sumatera Utara
Authors: Novita Linda Akbar, Elmeida Effendy, Mustafa M. Amin
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Background: The most common of psychotic disorders is schizophrenia. Vitamin D is made from sunlight, and in the skin from UVB radiation from sunlight. If people with Vitamin D deficiency is common severe mental illness such as schizophrenia.Schizophrenia is a chronic mental illness characterised by positive symptoms and negatives symptoms, such as hallucinations and delusions, flat affect and lack of motivation we can found. In patients with Schizophrenia maybe have several environmental risk factors for schizophrenia, such as season of birth, latitude, and climate has been linked to vitamin D deficiency. There is also relationship between the risk of schizophrenia and latitude, and with an increased incidence rate of schizophrenia seen at a higher latitude. Methods: This study was an analytical study, conducted in BLUD RS Jiwa Propinsi Sumatera Utara and RSUD Deli Serdang, the period in May 2016 and ended in June 2016 with a sample of the study 60 sample (20 patients live in the Highland and Lowland, 20 healthy controls). Inclusion criteria were schizophrenic patients both men and women, aged between 18 to 60 years old, acute phase no agitation or abstinence antipsychotic drugs for two weeks, live in the Highland and Lowland, and willing to participate this study. Exclusion criteria were history of other psychotic disorders, comorbidities with other common medical condition, a history of substance abuse. Sample inspection for serum vitamin D using ELFA method. Statistical analysis using numeric comparative T-independent test. Results: The results showed that average levels of vitamin D for a group of subjects living in areas of high land was 227.6 ng / mL with a standard deviation of 86.78 ng / mL, the lowest levels of vitamin D is 138 ng / mL and the highest 482 ng / mL. In the group of subjects who settled in the low lands seem mean vitamin D levels higher than the mountainous area with an average 237.8 ng / mL with a standard deviation of 100.16 ng / mL. Vitamin D levels are lowest and the highest 138-585 ng / mL. Conclusion and Suggestion: The results of the analysis using the Mann Whitney test showed that there were no significant differences between the mean for the levels of vitamin D based on residence subject with a value of p = 0.652.Keywords: latitude, schizophrenia, Vitamin D, Sumatera Utara
Procedia PDF Downloads 250451 Reducing the Incidence Rate of Pressure Sore in a Medical Center in Taiwan
Authors: Chang Yu Chuan
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Background and Aim: Pressure sore is not only the consequence of any gradual damage of the skin leading to tissue defects but also an important indicator of clinical care. If hospitalized patients develop pressure sores without proper care, it would result in delayed healing, wound infection, increase patient physical pain, prolonged hospital stay and even death, which would have a negative impact on the quality of care and also increase nursing manpower and medical costs. This project is aimed at decreasing the incidence of pressure sore in one ward of internal medicine. Our data showed 53 cases (0.61%) of pressure sore in 2015, which exceeded the average (0.5%) of Taiwan Clinical Performance Indicator (TCPI) for medical centers. The purpose of this project is to reduce the incidence rate of pressure sore in the ward. After data collection and analysis from January to December 2016, the reasons of developing pressure sore were found: 1. Lack of knowledge to prevent pressure among nursing staffs; 2. No relevant courses about preventing pressure ulcers and pressure wound care being held in this unit; 3. Low complete rate of pressure sore care education that family members should receive from nursing staffs; 4. Decompression equipment is not enough; 5. Lack of standard procedures for body-turning and positioning care. After team members brainstorming, several strategies were proposed, including holding in-service education, pressure sore care seed training, purchasing decompression mattress and memory pillows, designing more elements of health education tools, such as health education pamphlet, posters and multimedia films of body-turning and positioning demonstration, formulation and promotion of standard operating procedures. In this way, nursing staffs can understand the body-turning and positioning guidelines for pressure sore prevention and enhance the quality of care. After the implementation of this project, the pressure sore density significantly decreased from 0.61%(53 cases) to 0.45%(28 cases) in this ward. The project shows good results and good example for nurses working at the ward and helps to enhance quality of care.Keywords: body-turning and positioning, incidence density, nursing, pressure sore
Procedia PDF Downloads 263450 AI-based Digital Healthcare Application to Assess and Reduce Fall Risks in Residents of Nursing Homes in Germany
Authors: Knol Hester, Müller Swantje, Danchenko Natalya
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Objective: Falls in older people cause an autonomy loss and result in an economic burden. LCare is an AI-based application to manage fall risks. The study's aim was to assess the effect of LCare use on patient outcomes in nursing homes in Germany. Methods: LCare identifies and monitors fall risks through a 3D-gait analysis and a digital questionnaire, resulting in tailored recommendations on fall prevention. A study was conducted with AOK Baden-Württemberg (01.09.2019- 31.05.2021) in 16 care facilities. Assessments at baseline and follow-up included: a fall risk score; falls (baseline: fall history in the past 12 months; follow-up: a fall record since the last analysis); fall-related injuries and hospitalizations; gait speed; fear of falling; psychological stress; nurses experience on app use. Results: 94 seniors were aged 65-99 years at the initial analysis (average 84±7 years); 566 mobility analyses were carried out in total. On average, the fall risk was reduced by 17.8 % as compared to the baseline (p<0.05). The risk of falling decreased across all subgroups, including a trend in dementia patients (p=0.06), constituting 43% of analyzed patients, and patients with walking aids (p<0.05), constituting 76% of analyzed patients. There was a trend (p<0.1) towards fewer falls and fall-related injuries and hospitalizations (baseline: 23 seniors who fell, 13 injury consequences, 9 hospitalizations; follow-up: 14 seniors who fell, 2 injury consequences, 0 hospitalizations). There was a 16% improvement in gait speed (p<0.05). Residents reported less fear of falling and psychological stress by 38% in both outcomes (p<0.05). 81% of nurses found LCare effective. Conclusions: In the presented study, the use of LCare app was associated with a reduction of fall risk among nursing home residents, improvement of health-related outcomes, and a trend toward reduction in injuries and hospitalizations. LCare may help to improve senior resident care and save healthcare costs.Keywords: falls, digital healthcare, falls prevention, nursing homes, seniors, AI, digital assessment
Procedia PDF Downloads 126449 Limbic Involvement in Visual Processing
Authors: Deborah Zelinsky
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The retina filters millions of incoming signals into a smaller amount of exiting optic nerve fibers that travel to different portions of the brain. Most of the signals are for eyesight (called "image-forming" signals). However, there are other faster signals that travel "elsewhere" and are not directly involved with eyesight (called "non-image-forming" signals). This article centers on the neurons of the optic nerve connecting to parts of the limbic system. Eye care providers are currently looking at parvocellular and magnocellular processing pathways without realizing that those are part of an enormous "galaxy" of all the body systems. Lenses are modifying both non-image and image-forming pathways, taking A.M. Skeffington's seminal work one step further. Almost 100 years ago, he described the Where am I (orientation), Where is It (localization), and What is It (identification) pathways. Now, among others, there is a How am I (animation) and a Who am I (inclination, motivation, imagination) pathway. Classic eye testing considers pupils and often assesses posture and motion awareness, but classical prescriptions often overlook limbic involvement in visual processing. The limbic system is composed of the hippocampus, amygdala, hypothalamus, and anterior nuclei of the thalamus. The optic nerve's limbic connections arise from the intrinsically photosensitive retinal ganglion cells (ipRGC) through the "retinohypothalamic tract" (RHT). There are two main hypothalamic nuclei with direct photic inputs. These are the suprachiasmatic nucleus and the paraventricular nucleus. Other hypothalamic nuclei connected with retinal function, including mood regulation, appetite, and glucose regulation, are the supraoptic nucleus and the arcuate nucleus. The retino-hypothalamic tract is often overlooked when we prescribe eyeglasses. Each person is different, but the lenses we choose are influencing this fast processing, which affects each patient's aiming and focusing abilities. These signals arise from the ipRGC cells that were only discovered 20+ years ago and do not address the campana retinal interneurons that were only discovered 2 years ago. As eyecare providers, we are unknowingly altering such factors as lymph flow, glucose metabolism, appetite, and sleep cycles in our patients. It is important to know what we are prescribing as the visual processing evaluations expand past the 20/20 central eyesight.Keywords: neuromodulation, retinal processing, retinohypothalamic tract, limbic system, visual processing
Procedia PDF Downloads 77448 Factors Influencing Telehealth Services for Diabetes Care in Nepal: A Mixed Method Study
Authors: Sumitra Sharma, Christina Parker, Kathleen Finlayson, Clint Douglas, Niall Higgins
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Background: Telehealth services have potential to increase accessibility, utilization, and effectiveness of healthcare services. As the telehealth services are yet to integrate within regular hospital services in Nepal, the use of the telehealth services among adults with diabetes is scarce. Prior to implementation of telehealth services for adults with diabetes, it is necessary to examine influencing factors of telehealth services. Objective: This study aimed to investigate factors influencing telehealth services for diabetes care in Nepal. Methods: This study used a mixed-method study design which included a cross-sectional survey among adults with diabetes and semi-structured interviews among key healthcare professionals of Nepal. The study was conducted in a medical out-patient department of a tertiary hospital of Nepal. The survey adapted a previously validated questionnaire, while semi-structured questions for interviews were developed from literature review and experts consultation. All interviews were audio-recorded, and inductive content analysis was used to code transcripts and develop themes. For a survey, a descriptive analysis, chi-square test, and Mann Whitney U test were used to analyze the data. Results: One hundred adults with diabetes were participated in a survey, and seven healthcare professionals were recruited for interviews. In a survey, just over half of the participants (53%) were male, and others were female. Almost all participants (98%) owned a mobile phone, and 67% of them had a computer with internet access at home. Majority of participants had experience in using Facebook messenger (95%), followed by Viber (60%) and Zoom (26%). Almost all of the participants (96%) were willing to use telehealth services. There were significant associations between female sex and participants living 10 km away from the hospital with their willingness to use telehealth services. There was a significant association between participants' self-perception of good health status with their willingness to use video-conference calls and phone calls to use telehealth services. Seven themes were developed from interview data which are related to predisposing, reinforcing, and enabling factors influencing telehealth services for diabetes care in Nepal. Conclusion: In summary, several factors were found to influence the use of telehealth services for diabetes care in Nepal. For effective implementation of a sustainable telehealth services for adults with diabetes in Nepal, these factors need to be considered.Keywords: contributing factors, diabetes mellitus, developing countries, telemedicine, telecare
Procedia PDF Downloads 67447 Rare DCDC2 Mutation Causing Renal-Hepatic Ciliopathy
Authors: Atitallah Sofien, Bouyahia Olfa, Attar Souleima, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir
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Introduction: Ciliopathies are a spectrum of diseases that have in common a defect in the synthesis of ciliary proteins. It is a rare cause of neonatal cholestasis. Clinical presentation varies extremely, and the main affected organs are the kidneys, liver, and pancreas. Methodology: This is a descriptive case report of a newborn who was admitted for exploration of neonatal cholestasis in the Paediatric Department C at the Children’s Hospital of Tunis, where the investigations concluded with a rare genetic mutation. Results: This is the case of a newborn male with no family history of hepatic and renal diseases, born to consanguineous parents, and from a well-monitored uneventful pregnancy. He developed jaundice on the second day of life, for which he received conventional phototherapy in the neonatal intensive care unit. He was admitted at 15 days for mild bronchiolitis. On clinical examination, intense jaundice was noted with normal stool and urine colour. Initial blood work showed an elevation in conjugated bilirubin and a high gamma-glutamyl transferase level. Transaminases and prothrombin time were normal. Abdominal sonography revealed hepatomegaly, splenomegaly, and undifferentiated renal cortex with bilateral medullar micro-cysts. Kidney function tests were normal. The infant received ursodeoxycholic acid and vitamin therapy. Genetic testing showed a homozygous mutation in the DCDC2 gene that hadn’t been documented before confirming the diagnosis of renal-hepatic ciliopathy. The patient has regular follow-ups, and his conjugated bilirubin and gamma-glutamyl transferase levels have been decreasing. Conclusion: Genetic testing has revolutionized the approach to etiological diagnosis in pediatric cholestasis. It enables personalised treatment strategies to better enhance the quality of life of patients and prevent potential complications following adequate long-term monitoring.Keywords: cholestasis, newborn, ciliopathy, DCDC2, genetic
Procedia PDF Downloads 58446 Self-Inflating Soft Tissue Expander Outcome for Alveolar Ridge Augmentation a Randomized Controlled Clinical and Histological Study
Authors: Alaa T. Ali, Nevine H. Kheir El Din, Ehab S. Abdelhamid, Ahmed E. Amr
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Objective: Severe alveolar bone resorption is usually associated with a deficient amount of soft tissues. soft tissue expansion is introduced to provide an adequate amount of soft tissue over the grafted area. This study aimed to assess the efficacy of sub-periosteal self-inflating osmotic tissue expanders used as preparatory surgery before horizontal alveolar ridge augmentation using autogenous onlay block bone graft. Methods: A prospective randomized controlled clinical trial was performed. Sixteen partially edentulous patients demanding horizontal bone augmentation in the anterior maxilla were randomly assigned to horizontal ridge augmentation with autogenous bone block grafts harvested from the mandibular symphysis. For the test group, soft tissue expanders were placed sub-periosteally before horizontal ridge augmentation. Impressions were taken before and after STE, and the cast models were optically scanned and superimposed to be used for volumetric analysis. Horizontal ridge augmentation was carried out after STE completion. For the control group, a periosteal releasing incision was performed during bone augmentation procedures. Implants were placed in both groups at re-entry surgery after six months period. A core biopsy was taken. Histomorphometric assessment for newly formed bone surface area, mature collagen area fraction, the osteoblasts count, and blood vessel count were performed. The change in alveolar ridge width was evaluated through bone caliper and CBCT. Results: Soft tissue expander successfully provides a Surplus amount of soft tissues in 5 out of 8 patients in the test group. Complications during the expansion period were perforation through oral mucosa occurred in two patients. Infection occurred in one patient. The mean soft tissue volume gain was 393.9 ± 322mm. After 6 months. The mean horizontal bone gains for the test and control groups were 3.14 mm and 3.69 mm, respectively. Conclusion: STE with a sub-periosteal approach is an applicable method to achieve an additional soft tissue and to reduce bone block graft exposure and wound dehiscence.Keywords: soft tissue expander, ridge augmentation, block graft, symphysis bone block
Procedia PDF Downloads 119445 Quantification of Dispersion Effects in Arterial Spin Labelling Perfusion MRI
Authors: Rutej R. Mehta, Michael A. Chappell
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Introduction: Arterial spin labelling (ASL) is an increasingly popular perfusion MRI technique, in which arterial blood water is magnetically labelled in the neck before flowing into the brain, providing a non-invasive measure of cerebral blood flow (CBF). The accuracy of ASL CBF measurements, however, is hampered by dispersion effects; the distortion of the ASL labelled bolus during its transit through the vasculature. In spite of this, the current recommended implementation of ASL – the white paper (Alsop et al., MRM, 73.1 (2015): 102-116) – does not account for dispersion, which leads to the introduction of errors in CBF. Given that the transport time from the labelling region to the tissue – the arterial transit time (ATT) – depends on the region of the brain and the condition of the patient, it is likely that these errors will also vary with the ATT. In this study, various dispersion models are assessed in comparison with the white paper (WP) formula for CBF quantification, enabling the errors introduced by the WP to be quantified. Additionally, this study examines the relationship between the errors associated with the WP and the ATT – and how this is influenced by dispersion. Methods: Data were simulated using the standard model for pseudo-continuous ASL, along with various dispersion models, and then quantified using the formula in the WP. The ATT was varied from 0.5s-1.3s, and the errors associated with noise artefacts were computed in order to define the concept of significant error. The instantaneous slope of the error was also computed as an indicator of the sensitivity of the error with fluctuations in ATT. Finally, a regression analysis was performed to obtain the mean error against ATT. Results: An error of 20.9% was found to be comparable to that introduced by typical measurement noise. The WP formula was shown to introduce errors exceeding 20.9% for ATTs beyond 1.25s even when dispersion effects were ignored. Using a Gaussian dispersion model, a mean error of 16% was introduced by using the WP, and a dispersion threshold of σ=0.6 was determined, beyond which the error was found to increase considerably with ATT. The mean error ranged from 44.5% to 73.5% when other physiologically plausible dispersion models were implemented, and the instantaneous slope varied from 35 to 75 as dispersion levels were varied. Conclusion: It has been shown that the WP quantification formula holds only within an ATT window of 0.5 to 1.25s, and that this window gets narrower as dispersion occurs. Provided that the dispersion levels fall below the threshold evaluated in this study, however, the WP can measure CBF with reasonable accuracy if dispersion is correctly modelled by the Gaussian model. However, substantial errors were observed with other common models for dispersion with dispersion levels similar to those that have been observed in literature.Keywords: arterial spin labelling, dispersion, MRI, perfusion
Procedia PDF Downloads 366444 Polymeric Sustained Biodegradable Patch Formulation for Wound Healing
Authors: Abhay Asthana, Gyati Shilakari Asthana
Abstract:
It’s the patient compliance and stability in combination with controlled drug delivery and biocompatibility that forms the core feature in present research and development of sustained biodegradable patch formulation intended for wound healing. The aim was to impart sustained degradation, sterile formulation, significant folding endurance, elasticity, biodegradability, bio-acceptability and strength. The optimized formulation was developed using component including polymers including Hydroxypropyl methyl cellulose, Ethylcellulose, and Gelatin, and Citric Acid PEG Citric acid (CPEGC) triblock dendrimers and active Curcumin. Polymeric mixture dissolved in geometric order in suitable medium through continuous stirring under ambient conditions. With continued stirring Curcumin was added with aid of DCM and Methanol in optimized ratio to get homogenous dispersion. The dispersion was sonicated with optimum frequency and for given time and later casted to form a patch form. All steps were carried out under under strict aseptic conditions. The formulations obtained in the acceptable working range were decided based on thickness, uniformity of drug content, smooth texture and flexibility and brittleness. The patch kept on stability using butter paper in sterile pack displayed folding endurance in range of 20 to 23 times without any evidence of crack in an optimized formulation at room temperature (RT) (24 ± 2°C). The patch displayed acceptable parameters after stability study conducted in refrigerated conditions (8±0.2°C) and at RT (24 ± 2°C) upto 90 days. Further, no significant changes were observed in critical parameters such as elasticity, biodegradability, drug release and drug content during stability study conducted at RT 24±2°C for 45 and 90 days. The drug content was in range 95 to 102%, moisture content didn’t exceeded 19.2% and patch passed the content uniformity test. Percentage cumulative drug release was found to be 80% in 12h and matched the biodegradation rate as drug release with correlation factor R2>0.9. The biodegradable patch based formulation developed shows promising results in terms of stability and release profiles.Keywords: sustained biodegradation, wound healing, polymers, stability
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