Search results for: lenght of stay

Authors: Awais Naeem, Osama Shakeel, Aamir Ali Syed, Shahid Khattak

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Introduction: Laparoscopic right hemicolectomy is an advanced cancer surgery in today's era. The aim of this study was to evaluate the surgical and initial oncological outcomes after curative, laparoscopic resection of right sided colonic tumors. Also to compare our results with those of previous randomized trials. Methods And Procedures: We retrospectively analyzed the medical record files of all the patients who presented to our hospital with the diagnosis of right sided colon carcinoma from January 2012 to December 2017 and underwent laparoscopic right hemicolectomy. Demographics, operative findings and histopathological reports were all recorded on a preformed data sheet. All the analysis was performed on SPSS 20. Results: Total of 48 patients were included. There were 37 male and 11 female patients with mean age of 49.7 (range from 25 – 82). Mean hospital stay was 8.25 ± 3.17 days. Blood loss was 80mls and operative mean time was 240 minutes. Eighteen patients had extended right hemicolectomy. Median length of the specimen retrieved was 31cm (range, 14-59cm). Mean size of tumor was 6.44cm + 2.53. Total number of lymph nodes removed was 20.5 + 8.3. All had R0 resection. Post-operatively 2 patients had pelvic collection and there was no 30 day mortality. In 33 patients there was T3 disease, 5 had T2 and 10 had T4 disease. There was distant recurrence in 4 patients with peritoneal metastasis in 3 and liver metastasis in 1 patient. Forty-six patients are still alive and 44 are disease free. The mean follow-up period was 25.31 (12 to 60) months. Conclusion: Our early experience with Laparascopic Right hemicolectomy as a safe and oncologically feasible surgical option. We attained comparable surgical results with curative intent.

Keywords: right hemicolectomy, right sided colonic tumors, laparoscopic, curative intent

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Authors: Eid Alotaibi

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The purpose of this study is to investigate the impact of tourists’ culture on perception and evaluation of hotel service experience and behavioral intentions. Drawing on Hofested’s cultural dimensions, this study seeks to further contribute towards understanding the effect of culture on perception and evaluation of hotels’ services, and whether there are differences between Saudi and European tourists’ perceptions of hotel services evaluation. A descriptive cross-sectional design was used in this study. Data were collected from tourists staying in five-star hotels in Saudi Arabia using the self-completion technique. The findings show that evaluations of hotel services differ from one culture to another. T-test results reveal that Saudis were more tolerant and reported significantly higher levels of satisfaction, were more likely to return and recommend the hotel, and perceived the price for the hotel stay as being good value for money as compared to their European counterparts. The sample was relatively small and specific to only five-star hotel evaluations. As a result, findings cannot be generalized to the wider tourist population. The results of this research have important implications for management within the Saudi hospitality industry. The study contributes to the tourist cultural theory by emphasizing the relative importance of cultural dimensions in-service evaluation. The author argues that no studies could be identified that compare Saudis and Europeans in their evaluations of their experiences staying at hotels. Therefore, the current study would enhance understanding of the effects of cultural factors on service evaluations and provide valuable input for international market segmentation and resource allocation in the Saudi hotel industry.

Keywords: culture, tourist, service experience, hotel industry, Hofested’s cultural dimensions

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Authors: Yassine Bouzouita, Oumaima Belghith, Cyrine Zitoun, Charles Bonneau

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Performance measurement framework (PMF) is an essential tool in any organization to assess the performance of its processes. It guides businesses to stay on track with their objectives and benchmark themselves from the market. With the growing trend of the digital transformation of business processes, led by innovations in artificial intelligence (AI) & Big Data applications, developing a mature system capable of capturing the impact of digital solutions across different industries became a necessity. Based on the conducted research, no such system has been developed in academia nor the industry. In this context, this paper covers a variety of methodologies on performance measurement, overviews the major AI and big data applications in the banking sector, and covers an exhaustive list of relevant metrics. Consequently, this paper is of interest to both researchers and practitioners. From an academic perspective, it offers a comparative analysis of the reviewed performance measurement frameworks. From an industry perspective, it offers exhaustive research, from market leaders, of the major applications of AI and Big Data technologies, across the different departments of an organization. Moreover, it suggests a standardized classification model with a well-defined structure of intelligent digital solutions. The aforementioned classification is mapped to a centralized library that contains an indexed collection of potential metrics for each application. This library is arranged in a manner that facilitates the rapid search and retrieval of relevant metrics. This proposed framework is meant to guide professionals in identifying the most appropriate AI and big data applications that should be adopted. Furthermore, it will help them meet their business objectives through understanding the potential impact of such solutions on the entire organization.

Keywords: AI and Big Data applications, impact assessment, metrics, performance measurement

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Authors: Harini Chakkera

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Background: Inpatient hyperglycemia is an established independent risk factor among several patient cohorts with hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. Methods: Data on first-time solitary kidney transplantations were retrieved between September 2015 to December 2018. Information was linked to the electronic health record to determine a diagnosis of diabetes mellitus and extract glucometeric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on five bootstrapped partitions of the data to ensure statistical significance. Results: The cohort included 1036 patients who received kidney transplantation, and 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average AUC of 77.3% (95% CI 75.30-79.3%). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, and minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia and recipient and donor BMI values as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. Conclusions: Suboptimal glucose metrics during hospitalization after kidney transplantation is associated with an increased risk for 30-day hospital readmission. Optimizing the hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.

Keywords: kidney, transplant, diabetes, insulin

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Authors: Sonia Nemakallu, Pota Kalima

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Introduction: Vancomycin is a glycopeptide antibiotic, commonly used to treat gram-positive bacteraemia. It has been increasingly used in the critical care setting due to an increased awareness of resistant gram positive organisms. In Edinburgh both tertiary hospitals, The Western General Hospital and The Royal Infirmary Of Edinburgh, commonly use Vancomycin for a variety of infections. Administration of Vancomyicn in these hospitals is by continuous infusion as it is thought to maintain serum concentrations easier and is a simpler monitoring system. Purpose: The aim of the study was to evaluate the efficacy and reliability in which Vancomycin is used. Material and Methods: A retrospective study, over a 6-month period from January 2014 to June 2014. 91 admissions were included, all received Vancomycin by continuous infusion during their critical care stay. Results: The number one use for Vancomycin in critical care settings was in the treatment of ventilator or hospital-acquired pneumonia. Only 3% of population had MRSA. 49% of admissions were not therapeutic on day 1 post loading dose. Of those that were therapeutic on day 1 post loading dose, 39% of admissions showed no organisms in any cultures taken, 42% had organisms sensitive to Vancomycin and 19% had only organisms resistant to Vancomycin. Those that were not therapeutic on day 1 showed similar organism sensitivities. 15% of admissions had Vancomycin levels above 25 (levels should be maintained between 15-25). An increase in creatinine was proportionally seen with an increase in Vancomycin levels. Conclusion: Within Edinburgh Vancomycin is being overused in the critical care setting with only 3% of the population having highly resistant organisms. Continuous infusion have not ruled out the complexity of maintaining therapeutic levels, with a large proportion of patients not being therapeutic on day 1. Further research is also required into the nephrotoxic effects of using higher doses of Vancomycin.

Keywords: Vancomycin, continuous infusion, multi resistant organisms, sepsis, renal toxicity

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Authors: Raul G. Angeles

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The Philippine government instituted major reforms in its educational system. The Department of Education pushes the K to 12 program that makes kindergarten mandatory and adds two years of senior high school to the country's basic education. In essence, the students’ stay in basic education particularly those who are supposedly going to college is extended. The majority of the students expressed that they will be taking the Academic Track of the Senior High School curriculum specifically the Science, Technology, Engineering and Mathematics (STEM) and General Academic (GA) strands. Almost certainly, instruction should match the students' styles and thus through this descriptive study a city survey was conducted to explore the teaching strategies preferences of junior high school students and teachers who will be promoted to senior high school during the Academic Year 2016-2017. This study was conducted in selected public and private secondary schools in Metro Manila. Questionnaires were distributed to students and teachers; and series of follow-up interviews were also carried out to generate additional information. Preferences of students are centered on employing innovations such as technology, cooperative and problem-based learning. While the students will still be covered by basic education their interests in science are sparking to a point where the usual teaching styles may no longer work to them and for that cause, altering the teaching methods is recommended to create a teacher-student style matching. Other effective strategies must likewise be implemented.

Keywords: curriculum development, effective teaching strategies, problem-based learning, senior high school, science education, technology

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Authors: Lilla Szabó Hangya, Szilvia Jambori

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The comfort zone is less studied area in the field of psychology. One of the most important definitions is that comfort zone is a psychological state in which things feel familiar to a person with low level of anxiety and stress. But the validity of comfort zone does not confirm till now. The aim of our pilot research is to test which psychological factors could determine how young adults behave during their decision process to stay in one’s comfort zone or to leave it. Every person has a number of comfort zones, so we are not able to measure it directly, only those personality traits which predict if someone leaves his comfort zone easier or harder. In our study at first we wanted to clarify the meaning of comfort zone. 110 young adults (male: 37, female: 73; ages from 18 to 70, average age: 26,6) took part in the study. Beside their demographic datas we asked them what does the comfort zone mean for them. The results showed that the meaning of the comfort zone can be grouped in five dimensions: comfort (49,6 %), leaving it-change (8,1%), ambivalent feelings (10,6%), related to other people (10,6%), pursuit of self-realization (16,8%). Our results demonstrated age related characteristics. For young people at the age of 19 the comfort zone is related to other people, because during adolescents peer relationships become more important. Subjects at the age 20-30 answered that the comfort zone means comfort and stability for them. Their life becomes stable for a while, they are studying or working. But at the age of 25, when they finish university, most of them answered comfort zone means a changing process for them. On the other hand for subjects at the age of 27 the means of the comfort zone is pursuit of self-realization. After that period at the age of 31 when they have families and stable job the stability will also dominant. We saw that the comfort zone has much more meaning besides a pleasant psychological trait. Further we would like to determine which psychological factors relate to comfort zone, and what kind of personality traits could predict leaving or staying in one’s comfort zone. We want to observe the relationship between comfort zone and subjective well-being, life satisfaction self-efficacy or self-esteem.

Keywords: comfort zone, development, personality trait, young adults

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Authors: Edith Esparza-Young, Ángel M. Matos, Yaritza Gonzalez, Kirthana Sugunathevan

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Introduction: This research describes the existing medical school program which supports a multicultural setting and bilingualism. The rise of Spanish speakers in the United States has led to the recruitment of bilingual medical students who can serve the evolving demographics. This paper includes anecdotal evidence, narratives and the latest research on the outcomes of supporting a multilingual academic experience in medical school and beyond. People in the United States will continue to need health care from physicians who have experience with multicultural competence. Physicians who are bilingual and possess effective communication skills will be in high demand. Methodologies: This research is descriptive. Through this descriptive research, the researcher will describe the qualities and characteristics of the existing medical school programs, curriculum, and student services. Additionally, the researcher will shed light on the existing curriculum in the medical school and also describe specific programs which help to serve as safety nets to support diverse populations. The method included observations of the existing program and the implementation of the medical school program, specifically the Accelerated Review Program, the Language Education and Professional Communication Program, student organizations and the Global Health Institute. Concluding Statement: This research identified and described characteristics of the medical school’s program. The research explained and described the current and present phenomenon of this medical program, which has focused on increasing the graduation of bilingual and minority physicians. The findings are based on observations of the curriculum, programs and student organizations which evolves and remains innovative to stay current with student enrollment.

Keywords: bilingual, English, medicine, doctor

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Authors: Pagadaplly Girish, P. V. Manohar

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Introduction: Management of distal femur fractures is challenging. Recently, treatment has evolved towards indirect reduction and minimally invasive techniques. Objectives: To assess the fracture union and functional outcome following open reduction and internal fixation of distal femur fractures with locking compression plate and to achieve restoration of the anatomical alignment of fracture fragments and stable internal fixation. Methodology: Patients with distal femur fracture treated by locking compression during Oct 2011 to April 2013 were assessed prospectively. Patients below 18 years and those with neuro-vascular deficits were excluded. Age, sex of the patient, type of fracture, mechanism of injury, type of implant used, operative time and postoperative complications were analysed. The Neer’s scale was used to assess the outcome of the patients. Results: The total number of patients was 30; 28 males and 2 females; mean age was 41.53 years. Road traffic accidents were the major causes of injury followed by falls. The average duration of hospital stay was 21.3 days. The overall complication rate note was 23.33%. The mean range of movement around the knee joint after 6 months of follow-up was 114.330. The average time for the radiological union was 14 weeks. Excellent to good results were noted in 26 patients (86.6%) and average to poor results were observed in 4 (13.33%) patients. Conclusions: The locking compression plate gives a rigid fixation for the fracture. It also provides a good purchase in osteoporotic bones. LCP is simple and a reliable implant appropriate for fixation of femoral fractures with promising results.

Keywords: distal femur fractures, locking compression plate, Neer’s criteria, neuro-vascular deficits

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Authors: Marion Billard

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This paper will focus on the question of the real relationship between young people and fake news. Fake news is one of today’s main issues in the world of information and communication. Social media and its democratization helped to spread false information. According to traditional beliefs, young people are more inclined to believe what they read through social media. But, the individuals concerned, think that they are more inclined to make a distinction between real and fake news. This phenomenon is due to their use of the internet and social media from an early age. During the 2016 and 2017 French and American presidential campaigns, the term fake news was in the mouth of the entire world and became a real issue in the field of information. While young people were informing themselves with newspapers or television until the beginning of the ’90s, Gen Z (meaning people born between 1997 and 2010), has always been immersed in this world of fast communication. They know how to use social media from a young age and the internet has no secret for them. Today, despite the sporadic use of traditional media, young people tend to turn to their smartphones and social networks such as Instagram or Twitter to stay abreast of the latest news. The growth of social media information led to an “ambient journalism”, giving access to an endless quantity of information. Waking up in the morning, young people will see little posts with short texts supplying the essential of the news, without, for the most, many details. As a result, impressionable people are not able to do a distinction between real media, and “junk news” or Fake News. This massive use of social media is probably explained by the inability of the youngsters to find connections between the communication of the traditional media and what they are living. The question arises if this over-confidence of the young people in their ability to distinguish between accurate and fake news would not make it more difficult for them to examine critically the information. Their relationship with media and fake news is more complex than popular opinion. Today’s young people are not the master in the quest for information, nor inherently the most impressionable public on social media.

Keywords: fake news, youngsters, social media, information, generation

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Authors: Farideh Gheitasi, Amir Hossain Jaberansari, Payam Abedini

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The World Health Organization (WHO) Manifesto for Safe Communities states that "All human beings have an equal right to health and safety". The purpose of a safe Community is to minimize the damages threatening people. It seems that not sufficient attention has been given to relate environment and objectives of the safe Community. The reason for that can be assigned to the lack of enough information about environmental parameters and their relation with indices of the safe community like type and effect time of damages resulting from air pollution. Air pollution can be characterized as one of main environmental problems of Tehran. This problem is mostly due to the special geographic and climate situation, high population density and irregular growth in the number of vehicles. This paper is aimed at investigating the necessity of considering environmental factors to obtain a safe community through determining the effects of environmental pollution, particularly air pollution, on 490000 elders (+65) of Tehran. The methodology used in this study was on the basis of Random sampling and social surveying. The number of questionnaires was determined to be 321 through using Cochran method and the questionnaires were filled out by elders during personal interviews. The analysis of obtained results indicated that elders believe the major effects of air pollution include heart and respiratory diseases, obligation to stay at home on polluted days and its associated mental problems. Moreover, it was found that there is direct link between the number of polluted days and mortality frequency of elders. Having an environmental view may have an appreciable influence on the qualitative and quantitative development of activities and also facilitate obtaining the goals of the Safe Communities. In addition to reduce damages caused by pollutions, this view will encourage friends of the environment to cooperate with authorities of the safe community.

Keywords: air pollution, elderly people, environment, waste management

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Authors: Artitaya Sabangbal, Darawan Augsornwan, Palakorn Surakunprapha, Lalida Petphai

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Background: Srinagarind Hospital Ward 3C has about 180 cases of patients with head and neck cancer per year. Almost all of these patients suffer with pain, fatigue, low self image, swallowing problem and when the tumor is larger they will have breathing problem. Many of them have complication after operation such as pressure sore, pneumonia, deep vein thrombosis. Nursing activity is very important to prevent the complication especially promoting patients early ambulation. The objective of this study was to develop early ambulation protocol for patients with head and neck cancer undergoing operation. Method: this study is one part of nursing system development in patients undergoing operation in Ward 3C. It is a participation action research divided into 3 phases Phase 1 Situation review: In this phase we review the clinical outcomes, process of care, from document such as nurses note and interview nurses, patients and family about early ambulation. Phase 2 Searching nursing intervention about early ambulation from previous study then establish protocol . This phase we have picture package of early ambulation. Phase 3 implementation and evaluation. Result: Patients with head and neck cancer after operation can follow early ambulation protocol 100%, 85 % of patients can follow protocol within 2 days after operation and 100% can follow protocol within 3 days. No complications occur. Patients satisfaction in very good level is 58% and in good level is 42% Length of hospital stay is 6 days in patients with wide excision and 16 day in patients with flap coverage. Conclusion: The early ambulation protocol is appropriate for patients with head and neck cancer who undergo operation. This can restore physical health, reduce complication and increase patients satisfaction.

Keywords: nursing system, early ambulation, head and neck cancer, operation

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Authors: Keisuke Konishi, Yoshinari Hiroshiro, Kento Terashima, Atsushi Tsutsumi

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Imazu Bay plays an important role for endangered species such as horseshoe crabs and black-faced spoonbills that stay in the bay for spawning or the passing of winter. However, this bay is semi-enclosed with slow water exchange, which could lead to eutrophication under the condition of excess nutrient inflow to the bay. Therefore, quantification of nutrient inflow is of great importance. Generally, analysis of nutrient inflow to the bays takes into consideration nutrient inflow from only the river, but that from groundwater should not be ignored for more accurate results. The main objective of this study is to estimate the amounts of nutrient inflow from river and groundwater to Imazu Bay by analyzing water budget in Zuibaiji River Basin and loads of T-N, T-P, NO3-N and NH4-N. The water budget computation in the basin is performed using groundwater recharge model and quasi three-dimensional two-phase groundwater flow model, and the multiplication of the measured amount of nutrient inflow with the computed discharge gives the total amount of nutrient inflow to the bay. In addition, in order to evaluate nutrient inflow to the bay, the result is compared with nutrient inflow from geologically similar river basins. The result shows that the discharge is 3.50×107 m3/year from the river and 1.04×107 m3/year from groundwater. The submarine groundwater discharge accounts for approximately 23 % of the total discharge, which is large compared to the other river basins. It is also revealed that the total nutrient inflow is not particularly large. The sum of NO3-N and NH4-N loadings from groundwater is less than 10 % of that from the river because of denitrification in groundwater. The Shin Seibu Sewage Treatment Plant located below the observation points discharges treated water of 15,400 m3/day and plans to increase it. However, the loads of T-N and T-P from the treatment plant are 3.9 mg/L and 0.19 mg/L, so that it does not contribute a lot to eutrophication.

Keywords: Eutrophication, groundwater recharge model, nutrient inflow, quasi three-dimensional two-phase groundwater flow model, submarine groundwater discharge

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Authors: Odeyemi Ifeoluwayemi, Maha Joushua, Fulani Omoyeni

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In the search for sustainability, over time, architectural approaches to design have moved from just nature inspired design to the study of nature’s principles to produce effective designs that solve the issue of sustainability. Nature has established materials, shapes and processes that are effective right from a minor scale to an enormous scale. A branch of human knowledge that studies nature is called biology. Biology helps us to grasp and understand nature. Biomimicry is a new way of viewing and valuing nature, based not on what we can extract from the natural world but on what we can learn from it. Life has sustained on the earth for the last 3.85 billion years, and it is necessary for us to find out how life has been able to stay sustained for that long. The building must teach the society new ecological morals, thus, a better understanding of how nature works can usefully inspire architectural designs to resolve issues that have already been resolved by nature. This will not only help in creating a healthy environment but will also produce positive environmental impacts. Biomimetic Architecture connects and reproduces the ideologies found in nature in order to create built environment which benefit people and other living creatures as well as preserving it for the future. Understanding the bioprocess would lead to the establishment of ecological approaches that serve as a platform for creating a built environment that goes beyond sustaining current settings but also mimic nature’s regenerative ecosystem. This paper aims to explain these design methods under the name of biomimicry and biomimetic architecture by reviewing literature and research works done by examining these approaches classified as forms, processes and ecosystems. It is expected that this research will provide information that would, therefore, lead to the creation of buildings that are eco-friendly and provide greater comfort to the populaces.

Keywords: biomimetic architecture, biomimicry, ecological design, nature

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Authors: Stephanie Hewitt, Leila Sheldrick, Weston Baxter

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Multidisciplinary by nature, design research brings together varying research fields to answer globally significant questions. Emotional design, a field which helps us create products that influence people’s behaviour, and sports psychology, containing a growing field of recent research which focuses on understanding the emotions experienced through sport and the effects this has on our health and wellbeing, are two research fields that can be combined through design research to tackle global physical inactivity. The combination of these research fields presents an opportunity to build new tools and methods that could help designers create new interventions to promote positive behaviour change in the form of physical activity uptake, ultimately improving people’s health and wellbeing. This paper proposes a framework that can be used to develop new products and services that focus on not only improving the uptake and upkeep of physical activity but also helping people have a healthy emotional relationship with exercise. To develop this framework, a set of comprehensive maps exploring the relationship between human emotions and physical activity across a range of factors was created. These maps were then further evolved through in-depth interviews, which analysed the reasons behind the emotions felt, how physical activity fits into the daily routine and how important regular exercise is to people. Finally, to progress these findings into a design framework, a longitudinal study was carried out to explore further the emotional relationship people of varying sporting abilities have overtime with physical activity. This framework can be used to design more successful interventions that help people to not only become more active initially but implement long term changes to ensure they stay active.

Keywords: design research, emotional design, emotions, intervention, physical activity, sport psychology

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Authors: Nuchjaree Kidjawan, Orapan Thosingha, Pawinee Vaipatama, Prakrankiat Youngkong, Sirinapha Malangputhong, Kitti Thamrongaphichartkul, Phatcharaporn Phetcharat

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NPI uses technology sensorization of things and processed by AI system. The main features are an individual interface pressure sensor system in contact with the mattress and a position management system where the sensor detects the determined pressure with automatic pressure reduction and distribution. The role of NPI is to monitor, identify the risk and manage the interface pressure automatically when the determined pressure is detected. This study aims to evaluate the effects of “Never Pressure Injury (NPI),” an innovative mattress, on the incidence of pressure injuries in critically ill patients. An observational case-control study was employed to compare the incidence of pressure injury between the case and the control group. The control group comprised 80 critically ill patients admitted to a critical care unit of Phyathai3 Hospital, receiving standard care with the use of memory foam according to intensive care unit guidelines. The case group comprised 80 critically ill patients receiving standard care and with the use of the Never Pressure Injury (NPI) innovation mattress. The patients who were over 20 years old and showed scores of less than 18 on the Risk Assessment Pressure Ulcer Scale – ICU and stayed in ICU for more than 24 hours were selected for the study. The patients’ skin was assessed for the occurrence of pressure injury once a day for five consecutive days or until the patients were discharged from ICU. The sample comprised 160 patients with ages ranging from 30-102 (mean = 70.1 years), and the Body Mass Index ranged from 13.69- 49.01 (mean = 24.63). The case and the control group were not different in their sex, age, Body Mass Index, Pressure Ulcer Risk Scores, and length of ICU stay. Twenty-two patients (27.5%) in the control group had pressure injuries, while no pressure injury was found in the case group.

Keywords: pressure injury, never pressure injury, innovation mattress, critically ill patients, prevent pressure injury

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Authors: Chueh Chi-An, Chan Hui-Ya

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Background and Aim: National Health Insurance (NHI) Administration released a new reimbursement policy for hospital patients who received a superior discharge plan on April 1, 2016. Each case could be claimed 1,500 points for fee-of service with related documents. The policy is considered a solution to help reducing the crowding in the emergency department, the length of stay of hospital, unplanned readmission rate and unplanned ER visit. This study aim is to explore the effect of the new reimbursement policy for discharge planning service in a medical center. Methods: The discharge team explained to general wards the new policy and encouraged early assessment, communication and connecting to community care for patients. They stated the benefit from the policy and asked documenting for reimbursement claiming from April to May 2016. The imbursement fee of NHI declaration from June 2015 to October 2017 was collected. The indicators included hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction were analyzed after the policy implemented. Results: The results showed that the amount of service declaration was increasing from 2 cases in February 2016 to 110 cases in October 2017, the application rate was increasing from 0.029% to 1.576% of all inpatient cases, and the average payment from NHI was around 148,500 NT dollars per month in 2017. There are no significant differences in the indicators among hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction. Conclusion: To provide a good discharge plan require a specialized case manager, the new reimbursement policy is too complicated and the total fee-of-service hospital could claim is too limited to hiring one. The results suggest more strategies combine with the new reimbursement policy will be needed.

Keywords: discharge planning, reimbursement, unplanned ER visit, readmission rate

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Authors: Esha Saha, Pradip Kumar Ray

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A hospital inventory comprises of a large number and great variety of items for the proper treatment and care of patients, such as pharmaceuticals, medical equipment, surgical items, etc. Improper management of these items, i.e. stockouts, may lead to delay in treatment or other fatal consequences, even death of the patient. So, generally the hospitals tend to overstock items to avoid the risk of stockout which leads to unnecessary investment of money, difficulty in storing, more expiration and wastage, etc. Thus, in such challenging environment, it is necessary for hospitals to follow an inventory policy considering the stochasticity of demand in a hospital. Statistical analysis captures the correlation of patient condition based on bed occupancy with the patient demand which changes stochastically. Due to the dependency on bed occupancy, the markov model is developed that helps to map the changes in demand of hospital inventory based on the changes in the patient condition represented by the movements of bed occupancy states (acute care state, rehabilitative state and long-care state) during the length-of-stay of patient in a hospital. An inventory policy is developed for a hospital based on the fulfillment of patient demand with the objective of minimizing the frequency and quantity of placement of orders of inventoried items. The analytical structure of the model based on probability calculation is provided to show the optimal inventory-related decisions. A case-study is illustrated in this paper for the development of hospital inventory model based on patient demand for multiple inpatient pharmaceutical items. A sensitivity analysis is conducted to investigate the impact of inventory-related parameters on the developed optimal inventory policy. Therefore, the developed model and solution approach may help the hospital managers and pharmacists in managing the hospital inventory in case of stochastic demand of inpatient pharmaceutical items.

Keywords: bed occupancy, hospital inventory, markov model, patient condition, pharmaceutical items

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Authors: Penina Orenstein

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In today’s world, particularly with COVID-19 a constant worldwide threat, organizations need greater visibility over their supply chains more than ever before, in order to find areas for improvement and greater efficiency, reduce the chances of disruption and stay competitive. The concept of supply chain mapping is one where every process and route is mapped in detail between each vendor and supplier. The simplest method of mapping involves sourcing publicly available data including news and financial information concerning relationships between suppliers. An additional layer of information would be disclosed by large, direct suppliers about their production and logistics sites. While this method has the advantage of not requiring any input from suppliers, it also doesn’t allow for much transparency beyond the first supplier tier and may generate irrelevant data—noise—that must be filtered out to find the actionable data. The primary goal of this research is to build data maps of supply chains by focusing on a layered approach. Using these maps, the secondary goal is to address the question as to whether the supply chain is re-engineered to make improvements, for example, to lower the carbon footprint. Using a drill-down approach, the end result is a comprehensive map detailing the linkages between tier-one, tier-two, and tier-three suppliers super-imposed on a geographical map. The driving force behind this idea is to be able to trace individual parts to the exact site where they’re manufactured. In this way, companies can ensure sustainability practices from the production of raw materials through the finished goods. The approach allows companies to identify and anticipate vulnerabilities in their supply chain. It unlocks predictive analytics capabilities and enables them to act proactively. The research is particularly compelling because it unites network science theory with empirical data and presents the results in a visual, intuitive manner.

Keywords: data mining, supply chain, empirical research, data mapping

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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Authors: G. Kaushik, A. Gupta, S. Lalwani, K. D. Soni, S. Kumar, S. Sagar

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Objective: Alcohol is a leading risk factor associated with the disability and death due to RTI. Present study aims to demonstrate the demographic profile, injury pattern, physiological parameters of victims of trauma following alcohol consumption arriving in the emergency department (ED) and mortality in alcohol intoxicated trauma patients admitted to Apex Trauma Center in Delhi. Design and Methods: Present study was performed in randomly selected 182 alcohol breath analyzer tested RTI patients from the emergency department of Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences, New Delhi for over a period of 3 months started from September 2013 to November 2013. Results: A total 182 RTI patients with blunt injury were selected between 30-40 years of age and equally distributed to male and female group. Of these, 93 (51%) were alcohol negative and 89 (49%) were alcohol positive. In 89 alcohol positive patients, 47 (53%) had Artificial Airway as compared to 17 (18%), (p < 0.001) in the other group. The Glasgow Coma Scale (GCS) score was lower (p < 0.001) and higher Injury Severity Score (ISS) was observed in alcohol positive group as compared to other group (p < 0.03). Increased number of patients (58%) were admitted to Intensive Care Unit (ICU), in alcohol positive group (p < 0.001) and they were in ICU for longer time compare to other group (p < 0.001). The alcohol positive patients were on ventilator support for longer duration as compared to non-alcoholic group (p < 0.001). Mortality rate was higher in alcohol intoxicated patients as compared to non-alcoholic RTI patients, however, the difference was not statistically significant. Conclusion: This study revealed that GCS, mean ISS, ICU stay, ventilation time etc. might have considerable impact on mortality in alcohol intoxicated patients as compared to non-alcoholic group.

Keywords: road traffic injuries, alcohol, trauma, emergency department

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Authors: Kalpeshkumar L. Gupta, Shivali Rathore

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India is home to over 30 crore rural poor, aware of the criticality of the situation that has made to come with an innovative business idea. Entrepreneurship in India is on the verge of explosive growth and which is actually need of an hour for employment generation, poverty elevation at grass root through developmental intervention. India economic progress has started from the development of its small and medium scale enterprises to ensure that the sectors continues to stay competitive and achieve sustained growth in the era of global economy many incubators centers has been established with the mission to give the encouragement to many innovative ideas. If we define an Incubator, it is simply an enclosed apparatus in which premature small babies are placed and which provides a controlled and protective environment for their care this gives them a chance to adjust to outside environment, and grow stronger before they face the outside world. In a similar way the startup entrepreneur’s business idea is incubated in the incubation centers. Entrepreneurship has been conventionally rated as risky career, to break the myth and to augment the supply of new entrepreneurs through education; research training the incubation centers has been established, their goal is to help create and grow young businesses by providing them with necessary support and financial and technical services. The startup companies spend on an average two years in a business incubator during which numerous benefits like funding, office space, equipment’s etc. is provided by the incubators to the startup business. Present paper will study the background, role, objectives of different incubators set up in Indian Institute of Management (IIMs) and Indian Institute of Technology (IITs) for our study.

Keywords: incubation centres, entrepreneurship, Indian Institute of Management, Indian Institute of Technology

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Authors: Mohammad Mohammadi, Mohammad Pashmchi

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Background: Malnutrition commonly develops and worsens following gastric cancer surgery, particularly after discharge, which is associated with adverse outcomes. Former studies have primarily focused on patients during their hospital stay period, and there is limited evidence regarding the recommendation of nutritional interventions for patients after discharge from the hospital following gastric cancer surgery. This review is aimed to evaluate the efficiency of post-discharge dietary counseling with oral nutritional supplements (ONS), and dietary counseling alone on post-surgical nutritional outcomes in patients undergoing gastric cancer surgery. Methods: The four databases of Embase, PubMed, web of science, and google scholar were searched up to November 2022 for relevant randomized controlled trials. The Cochrane Collaboration’s assessment tool for randomized trials was used to evaluate the quality of studies. Results: Compared to patients who only received dietary counseling, patients who received both dietary counseling and ONS had considerably higher SMI, BMI, and less weight loss and sarcopenia occurrence rate. The patients who had received dietary counseling and ONS had significantly lower risk of chemotherapy intolerance. No differences in the readmission rate between the two groups was found. In terms of the quality of life, concomitant dietary advice and ONS significantly was associated with lower appetite loss and fatigue rate, but there was no difference in the other outcomes between the two groups. Conclusions: Post-discharge dietary advice with ONS following gastric cancer surgery may improve skeletal muscle maintenance, nutritional outcomes, quality of life variables, and chemotherapy tolerance. This evidence supports the recommendation of post-discharge dietary advice with ONS for patients who underwent gastric cancer surgery.

Keywords: gastric cancer surgery, oral nutritional supplements, malnutrition, gastric cancer

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Authors: Eman Elsebaie, A. Sedrak, R. Ziada

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Introduction: In the recent decades, heart failure (HF) has become one of the most prevalent cardio-vascular disease (CVDs), especially in the elderly and the main cause of hospitalization in Egypt cardiology departments. By 2030, the prevalence of HF is expected to increase by 25%. Total direct costs will increase to $818 billion, and the total indirect cost in terms of lost productivity is close to $275 billion. The current study was conducted to estimate the economic costs of services delivered for heart failure patients at the cardiology department in Cairo University Hospitals (CUHs). Aim: To gain an understanding of the cost of heart failure disease and its main drivers aiming to minimize associated health care costs. Subjects and Methods: Economic cost analysis study was conducted for a prospective group of all cases of HF admitted to the cardiology department in CUHs from end of March till end of April 2016 and another retrospective randomized sample from patients with HF, during the first 3 months of 2016 to measure estimated average cost per patient per day. Results: The mean age of the prospective group was 48.6 ± 17.16 years versus 52.3 ± 11.5 years for the retrospective group. The median (IQR) of Length of stay was 15 (15) days in the prospective group versus 9 (16) days in the retrospective group. The average HF inpatient cost/day in the cardiology department during April 2016 was 362.32 (255.5) L.E. versus 391.2(255.9) L.E. during January and February 2016. Conclusion: Up to 70% of expenditure in the management of HF is related to hospital admission. The average cost of such an admission was 5540.03 (IQR=7507.8) L.E. and 4687.4 (IQR=7818.8) L.E. with the average cost per day estimated at 362.32 (IQR=255.5) L.E. and 386.2(IQR=255.9) L.E. in prospective and retrospective groups respectively.

Keywords: health care cost, heart failure, hospitalization, inpatient

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Authors: Manal Ahmed, Amal Shehata, Shereen Deeb

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The study's purpose was to determine the effect of the perioperative protocol of care on clinical outcomes among patients undergoing coronary artery bypass graft. Subjects: A sample of 100 adult patients who were planned for coronary artery bypass graft, were selected and divided alternatively and randomly into two equal groups (50 study -50 control).The study was carried out at National heart Institute in Cairo and open heart surgical intensive care unit in Shebin El-Kom Teaching Hospital. Instruments: Four instruments were used for data collection: Interviewing questionnaire, dyspnea analogue scale, Biophysiological measurement instrument, and Compliance assessment sheet. Results: There were statistically significant differences between both groups regarding most respiratory system assessment findings at discharge. More than two-thirds of the study group of the current study had a continuous and regular commitment to diet regimen, which ranked first followed by the compliance of daily living activities then quitting smoking. Conclusions: The perioperative protocol of care has a significant improving effect on respiratory findings, dyspnea degree, duration of mechanical ventilation, length of hospital stay, compliance to diet, therapeutic regimen, daily living activities, and quit smoking among study group undergoing CABG. Recommendations: Perioperative protocol of care should be carried out for CABG patients at open-heart surgical units as well as an illustrative colored booklet about CAD, CABG and perioperative care should be available and distributed to all CABG patients.

Keywords: perioperative, effect, clinical outcomes, coronary artery, bypass graft, protocol of care

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Authors: Hussain Ali, Ahmad Ali, Syed Rashid Ali

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The maternal mortality is one of the basic health issues faced by rural women in Pakistan. There are various structural and socio-cultural determinants which confine women to domestic sphere. Such mobility restriction compels women for home delivery which causes high maternal mortality and morbidity. However, it is hard to find out the research findings and well-organized literature that explain the cultural factors act as determinant to home delivery among Pakhtun women. The overall objective of this research is to study men’s decision making within the household in Pakhtun society as determinant of home delivery among Pakhtun women in Khyber Pakhtunkhwa province of Pakistan. In the present study, researchers used the quantitative research design in which the data are collected through household survey technique from (n=503) ever-married women having reproductive age (15-49 years) by using interview schedule. The data are analyzed through SPSS, and binary logistic regression was applied to draw the association between home as a place of delivery and men’s decision making in the Pakhtun society. The results show that majority (76%) of the husbands are key decision makers about the home delivery due to their superior position within household. Similarly, majority (88%) Pakhtun women prefer to stay in home for their delivery due to their dependency on husband’s decision. The researcher concludes that men are key decision makers in Pakhtun society and their decisions affect women maternal health care. Similarly, the women are in subordinate position, and their limited decision making in the domestic sphere are greatly responsible for home delivery which causing high maternal mortality rate in the study area. In order to achieve Sustainable Development Goal No. 3, the study recommends empowering women in the decision making about accessing and utilizing maternal health care services and given financial autonomy to them.

Keywords: home delivery, men’s decision, Pakhtun women, subordinate position

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Authors: H. A. Algahtani, A. S. Khan, O. Alzahrani, N. Hussein, M. A. Khan, Loudhi Y. I. Soliman

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Objective: To report on the Saudi experience (developing country) of neurological complications from bariatric surgery. The literature on the subject is reviewed. Method: This is a cross sectional study done in King Abdul Aziz Medical City Jeddah, WR, where we reviewed all charts of the patients who underwent bariatric surgery between January 1st, 2009 to December 31st , 2014. Personal and clinical data including age, sex, BMI, comorbidities, type of procedure, duration of stay in hospital, complications and postoperative follow up were collected. In addition follow up visit and remote complication if present were collected. All patients with neurological complications were reviewed in details including their clinical examination, laboratory and imaging results, treatment and prognosis. This report is essentially descriptive with no statistical analysis performed. Results: Fifteen cases were collected in this study (3%). Axonal polyneuropathy was the most frequent neurological complica¬tion, but cases of Wernicke syndrome, vitamin B12 deficiency, Guillain-Barre syndrome and cupper deficiency were also identified. Fourteen patients (93.3%) had full recovery from the neurological signs and symptoms but unfortunately one patient died. Conclusion: Bariatric surgery, a procedure that is continuously increasing in popularity, is not free of potential neurological complications. A clear education, guidelines and follow-up program should be planned and practiced. Facts should be clearly presented to the individual undergoing this type of surgery. Although a clear cause-effect relation cannot be established for the present cases, the cumulative literature on the subject makes it important to warn the patient of the potential risks of this procedure.

Keywords: bariatric surgery, neurological complications, neuropathy, Wenicke syndrome

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Authors: Ayeshmanthe Rathnayake, Siew Goh, Carmel Fenton, Ashutosh Hardikar

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Post-Operative Atrial Fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with reduced survival, increased rates of cognitive changes and cerebrovascular accident, heart failure, renal dysfunction, infection and length of stay, and hospital costs. Cardiac tamponade, although less common, carries high morbidity and mortality. Shed mediastinal blood in the pericardial space is a major source of intrapericardial oxidative stress and inflammation that triggers POAF. The utilisation of a left posterior pericardiotomy aims to shunt blood from the pericardium into the pleural space and have a role in the prevention of POAF as well as cardiac tamponade. 2118 patients had undergone isolated Coronary Artery Bypass Graft (CABG) at Royal Hobart Hospital from 2008-2021. They were divided into pericardiotomy vs control group. Patient baseline demographics, intraoperative data, and post-operative outcomes were reviewed retrospectively. Total incidence of new POAF and cardiac tamponade was 26.1% and 0.75%, respectively. Primary outcome of both the incidence of POAF(22.9% vs27.8%OR 0.77 p<0.05) and Cardiac Tamponade (0% vs 1.1% OR 0.85 p<0.05) were less in the pericardiotomy group.Increasing age, BMI, poor left ventricular function (EF <30%), and return to theatre were independent predictors of developing POAF. There were similar rates of return to theatre for bleeding however, no cases of tamponade in the pericardiotomy group. There were no complications attributable to left posterior pericardiotomy and the time added to the duration of surgery was minimal. Left posterior pericardiotomy is associated with a significant reduction in the incidence of POAFand cardiac tamponade and issafe and efficient.

Keywords: cardiac surgery, pericardiotomy, post-operative atrial fibrillation, cardiac tamponade

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Authors: Yuan Long, Fabrizio Ceschin, David Harrison

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Environmental sustainability is under the threat of excessive single-use plastic packaging waste, and current waste management fails to address this issue. Therefore, it has led to a reidentification of the alternative, which can curb the packaging waste without reducing social needs. Reusable packaging represents a circular approach to close the loop of consumption in which packaging can stay longer in the system to satisfy social needs. However, the implementation of reusable packaging is fragmented and lacks systematic approaches. The product-service system (PSS) is widely regarded as a sustainable business model innovation for embracing circular consumption. As a result, applying PSS to reusable packaging solutions will be promising to address the packaging waste issue. This paper aims at filling the knowledge gap relating to apply PSS to reusable packaging solutions and provide a strategic design tool that could support packaging professionals to design reusable packaging solutions. The methodology of this paper is case studies and workshops to provide a design tool. The respondents are packaging professionals who are packaging consultants, NGO professionals, and entrepreneurs. 57 cases collected show that 15 archetypal models operate in the market. Subsequently, a polarity diagram is developed to embrace those 15 archetypal models, and a total number of 24 experts were invited for the workshop to evaluate the design tool. This research finally provides a strategic design tool to support packaging professionals to design reusable packaging solutions. The application of the tool is to support the understanding of the reusable packaging solutions, analyzing the markets, identifying new opportunities, and generate new business models. The implication of this research is to provide insights for academics and businesses in terms of tackling single-use packaging waste and build a foundation for further development of the reusable packaging solution tool.

Keywords: environmental sustainability, product-service system, reusable packaging, design tool

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Authors: R. Suresh, C. B. Singh, A. K. Sarda

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Background: Over the decades, several surgical techniques have been developed to treat anal fistulas with variable success rates and complications. Large amount of work has been done in radiofrequency excision of the fistula for several years but no work has been done for ablating the tract. Therefore one can consider for obliteration ofanal fistula by Radiofrequency ablation (RFA). Material and Methods: A randomized controlled clinical trial was conducted at Lok Nayak Hospital, where a total of 40 patients were enrolled in the study and they were randomly assigned to Group I (fistulectomy)(n=20) and Group II (RFA) (n=20). Aim of the study was to compare the efficacy of RFA of fistula versus fistulectomy in the treatment of a low anal fistula and to evaluate RFA as an effective alternative to fistulectomy with respect to time taken for wound healing as primary outcome and post-operative pain, time taken to return to work as secondary outcomes. Patients with simple low anal fistulas, single internal and external opening, not more than two secondary tracts were included. Patients with high complex fistula, fistulas communicating with cavity, fistula due to condition like tuberculosis, Crohn's, malignancy were excluded from the study. Results: Both groups were comparable with respect to age, sex ratio, type of fistula. Themean healing time was significantly shorter in group II (41.02 days) than in group I(62.68 days).The mean operative time was significantly shorter in groupII (21.40 min) than in group I(28.50 min). The mean time taken to return to work was significantly shorter in group II(8.30 days)than in group I(12.01 days).There was no significant difference in the post operative hospital stay, mean postoperative pain score, wound infection and recurrence between the two groups. Conclusion: The patients who underwent RFA of fistula had shorter wound healing time, operative time and time taken to return to work when compared to those who underwent fistulectomy and therefore RFA shows outcome comparable to fistulectomy in the treatment of low anal fistula.

Keywords: fistulectomy, low anal fistula, radio frequency ablation, wound healing

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