Search results for: early childhood care and development (ECCD)

Authors: Sadia Munir, Diana White, Aya Albahri, Pratiwi Hastania, Eltahir Mohamed, Mahmood Khan, Fathima Mohamed, Ayat Kadhi, Haila Saleem

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Preeclampsia is a major complication of pregnancy. Prediction and management of preeclampsia is a challenge for obstetricians. To our knowledge, no major progress has been achieved in the prevention and early detection of preeclampsia. There is very little known about the clear treatment path of this disorder. Preeclampsia puts both mother and baby at risk of several short term- and long term-health problems later in life. There is huge health service cost burden in the health care system associated with preeclampsia and its complications. Preeclampsia is divided into two different types. Early onset preeclampsia develops before 34 weeks of gestation, and late onset develops at or after 34 weeks of gestation. Different genetic and environmental factors, prognosis, heritability, biochemical and clinical features are associated with early and late onset preeclampsia. Prevalence of preeclampsia greatly varies all over the world and is dependent on ethnicity of the population and geographic region. To authors best knowledge, no published data on preeclampsia exist in Qatar. In this study, we are reporting the incidence of preeclampsia in Qatar. The purpose of this study is to compare the incidence and risk factors of both early onset and late onset preeclampsia in Qatar. This retrospective longitudinal cohort study was conducted using data from the hospital record of Women’s Hospital, Hamad Medical Corporation (HMC), from May 2014-May 2016. Data collection tool, which was approved by HMC, was a researcher made extraction sheet that included information such as blood pressure during admission, socio demographic characteristics, delivery mode, and new born details. A total of 1929 patients’ files were identified by the hospital information management when they apply codes of preeclampsia. Out of 1929 files, 878 had significant gestational hypertension without proteinuria, 365 had preeclampsia, 364 had severe preeclampsia, and 188 had preexisting hypertension with superimposed proteinuria. In this study, 78% of the data was obtained by hospital electronic system (Cerner) and the remaining 22% was from patient’s paper records. We have gone through detail data extraction from 560 files. Initial data analysis has revealed that 15.02% of pregnancies were complicated with preeclampsia from May 2014-May 2016. We have analyzed difference in the two different disease entities in the ethnicity, maternal age, severity of hypertension, mode of delivery and infant birth weight. We have identified promising differences in the risk factors of early onset and late onset preeclampsia. The data from clinical findings of preeclampsia will contribute to increased knowledge about two different disease entities, their etiology, and similarities/differences. The findings of this study can also be used in predicting health challenges, improving health care system, setting up guidelines, and providing the best care for women suffering from preeclampsia.

Keywords: preeclampsia, incidence, risk factors, maternal

Procedia PDF Downloads 116

Authors: Mina Salamatmanesh, Elizabeth Fitzpatrick, Tim Ramsay, Josee Lagacé, Lindsey Sikora, JoAnne Whittingham

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Introduction: Hearing loss (HL) is one of the most common disorders that presents at birth and in early childhood. Universal newborn hearing screening (UNHS) has been adopted based on the assumption that with early identification of HL, children will have access to optimal amplification and intervention at younger ages, therefore, taking advantage of the brain’s maximal plasticity. One particular challenge for parents in the early years is achieving consistent hearing aid (HA) use which is critical to the child’s development and constitutes the first step in the rehabilitation process. This study examined the consistency of hearing aid use in young children based on data logging information documented during audiology sessions in the first three years after hearing aid fitting. Methodology: The first 100 children who were diagnosed with bilateral HL before 72 months of age since 2003 to 2015 in a pediatric audiology clinic and who had at least two hearing aid follow-up sessions with available data logging information were included in the study. Data from each audiology session (age of child at the session, average hours of use per day (for each ear) in the first three years after HA fitting) were collected. Clinical characteristics (degree of hearing loss, age of HA fitting) were also documented to further understanding of factors that impact HA use. Results: Preliminary analysis of the results of the first 20 children shows that all of them (100%) have at least one data logging session recorded in the clinical audiology system (Noah). Of the 20 children, 17(85%) have three data logging events recorded in the first three years after HA fitting. Based on the statistical analysis of the first 20 cases, the median hours of use in the first follow-up session after the hearing aid fitting in the right ear is 3.9 hours with an interquartile range (IQR) of 10.2h. For the left ear the median is 4.4 and the IQR is 9.7h. In the first session 47% of the children use their hearing aids ≤5 hours, 12% use them between 5 to 10 hours and 22% use them ≥10 hours a day. However, these children showed increased use by the third follow-up session with a median (IQR) of 9.1 hours for the right ear and 2.5, and of 8.2 hours for left ear (IQR) IQR is 5.6 By the third follow-up session, 14% of children used hearing aids ≤5 hours, while 38% of children used them ≥10 hours. Based on the primary results, factors like age and level of HL significantly impact the hours of use. Conclusion: The use of data logging information to assess the actual hours of HA provides an opportunity to examine the: a) challenges of families of young children with HAs, b) factors that impact use in very young children. Data logging when used collaboratively with parents, can be a powerful tool to identify problems and to encourage and assist families in maximizing their child’s hearing potential.

Keywords: hearing loss, hearing aid, data logging, hours of use

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Authors: Kausik Halder, Nabendu Chaki, Ranjan Dasgupta

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We present a modelling framework that supports the engineering of early requirements specifications for design of learner centric dynamic Learning Management System. The framework is based on i* modelling tool and Means End Analysis, that adopts primitive concepts for modelling early requirements (such as actor, goal, and strategic dependency). We show how pedagogical and computational requirements for designing a learner centric Learning Management system can be adapted for the automatic early requirement engineering specifications. Finally, we presented a model on a Learner Quanta based adaptive Courseware. Our early requirement analysis shows that how means end analysis reveals gaps and inconsistencies in early requirements specifications that are by no means trivial to discover without the help of formal analysis tool.

Keywords: adaptive courseware, early requirement engineering, means end analysis, organizational modelling, requirement modelling

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Authors: Novita Verayanti Manalu, Alvin Salim

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Background: Palliative care is caring holistically for patients and families to improve their quality of life. Experts stated that palliative care could be applied not only for terminally ill cases but also for acute illnesses. Therefore, this study wants to find out the level of knowledge about palliative care of the nurses along with the relationship with attitude and performance. Method: This study applies a cross-sectional survey design and allows the respondents to fill two questionnaires to determine the level of knowledge and attitude toward palliative care, while one questionnaire is filled out by the head nurse to evaluate nurses’ performance. The relationship was analyzed by Spearman rho’s correlation in alpha < 0,05 by SPSS. Results: The majority of respondents were females, aged above 25 years old, and married. Most of the nurses are staff nurses and the ratio of education level is not significantly different. The knowledge level is poor, while the attitude and performance are at an adequate level. Knowledge may affect attitude, but it doesn’t happen toward performance. Conclusion: There is a need for increased knowledge about palliative care to improve attitude and work performance. Future researchers might use this finding as a reference to conduct further study in improving knowledge of palliative care.

Keywords: knowledge, attitude, work performance, palliative care

Procedia PDF Downloads 167

Authors: Fazel Zinat Motlagh, Reza Chaman, Rashid Ghafari, Zahra Behzad, Ahmad Ali Eslami

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Background: Chronic disease management requires the individual to perform several self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy and self-care behaviors related to hypertension. Methods: In this cross-sectional study, conducted in Kohgiluye Boyer Ahmad province, the south of Iran, a total of 1836 hypertension patients, were randomly selected and participated in the study. Self-care behavior was measured with using H-SCALE (Hypertension Self-Care Activity Level Effects). Logistic regression conducted to detect correlation between self-efficacy and adherence to hypertension self-care behaviors. Results: Less than half (40.8%) of the participants reported that they have good self-efficacy to manage hypertension. Good self-efficacy was significantly associated with improve in adherence to medication (95% CI: 1.68, 1.83), eating a low-salt diet (95% CI: 1.44–1.73), physical activity (95% CI: 1.39–1.55), quit smoking (95% CI: 0.38–0.47), and weight management techniques (95% CI: 0.66–0.82). Conclusion: Hypertension self-efficacy was associated with adherence to self-care behaviors among adult with hypertension. According to our finding hypertension is a manageable condition. Self-efficacy is important factor in adherence with self-care behaviors related with hypertension.

Keywords: self-efficacy, hypertension, self-care, Iran

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Authors: Sathapath Kilaso

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Nowadays people who live in the city tend to have a pet in order to relief the loneliness more than usual. It can be observed by the growth of the local pet industry. But the essentials of lifestyle of the urban people which is restricted by time and work might not allow the owner to take care of the pet properly. So this article will be about how to develop the prototype of pet care monitoring with Arduino Microcontroller. This prototype can be used to monitor the pet and its environment around the pet such as temperature (both pet’s temperature and outside temperature), humidity, food’s quantity, air’s quality and also be able to reduce the stress of the pet. This prototype can report the result back to the owner via online-channel such as website etc.

Keywords: pet care, Arduino Microcontroller, monitoring, prototype

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Authors: K. Shaloom Mbambu, M. Pascal Tshimbalanga, K. Ruth Mutala, K. Roger Kabuya, N. Dieudonné Kabeya, Y. L. Kabeya Mukeba

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In this article, the authors examine the even more worrying situation of girls in sub-Saharan Africa. Two-girls on five are private of Global Education, which represents a real loss to the development of communities and countries. Cultural traditions, poverty, violence, early and forced marriages, early pregnancies, and many other gender inequalities were the causes of this cancer development. Namely, "it is no more efficient development tool that is educating girls." The non-schooling of girls and their lack of supervision by liberal professions have serious consequences for the life of each of them. To improve the conditions of their inferior status, girls to men introduce poverty and health risks. Raising awareness among parents and communities on the importance of girls' education, improving children's access to school, girl-boy equality with their rights, creating income, and generating activities for girls, girls, and girls learning of liberal trades to make them self-sufficient. Organizations such as the United Nations Organization can save the children. ASEAD and the AEDA group are predicting the impact of this cancer on the development of a nation's future generation must be preserved.

Keywords: young girl, Sub-Saharan Africa, higher and vocational education, development, society, environment

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Authors: Vignesh Ratnaraj, Daniel Marascia, Kelly Ruecker

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Purpose: Pulmonary embolism (PE) is a major cause of morbidity and mortality in trauma patients. Data suggests PE is occurring earlier in trauma patients, with attention being turned to possible de novo events. Here, we examine the incidence of early PE at a level 1 trauma center and examine the relationship with a chest injury. Method: A retrospective analysis was performed from a prospective trauma registry at a level 1 trauma center. All patients admitted from 1 January 2010 to 30 June 2019 diagnosed with PE following trauma were included. Early PE was considered a diagnosis within 72 hours of admission. The severity of the chest injury was determined by the Abbreviated Injury Score (AIS). Analysis of severe chest injury and incidence of early PE was performed using chi-square analysis. Sub-analysis on the timing of PE and PE location was also performed using chi-square analysis. Results: Chest injury was present in 125 of 184 patients diagnosed with PE. Early PE occurred in 28% (n=35) of patients with a chest injury, including 24.39% (n=10) with a severe chest injury. Neither chest injury nor severe chest injury determined the presence of early PE (p= > 0.05). Sub-analysis showed a trend toward central clots in early PE (37.14%, n=13) compared to late (27.78%, n=25); however, this was not found to be significant (p= > 0.05). Conclusion: PE occurs early in trauma patients, with almost one-third being diagnosed before 72 hours. This analysis does not support the paradigm that chest injury, nor severe chest injury, results in statistically significant higher rates of early PE. Interestingly, a trend toward early central PE was noted in those suffering chest trauma.

Keywords: trauma, PE, chest injury, anticoagulation

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Authors: L. Lamola, E. Manolas, A. Krause

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Background: The incidence of childhood cancer incidence is increasing gradually in low-middle income countries, such as South Africa. Globally, there is an extensive range of familial- and hereditary-cancer syndromes, where underlying germline variants increase the likelihood of developing cancer in childhood. Next-Generation Sequencing (NGS) technologies have been key in determining the occurrence and genetic contribution of germline variants to paediatric cancer development. We aimed to design and evaluate a candidate gene panel specific to inherited cancer-predisposing genes to provide a comprehensive insight into the contribution of germline variants to childhood cancer. Methods: 32 paediatric patients (aged 0-18 years) diagnosed with a malignant tumour were recruited, and biological samples were obtained. After quality control, DNA was sequenced using an ion Ampliseq 50 candidate gene panel design and Ion Torrent S5 technologies. Sequencing variants were called using Ion Torrent Suite software and were subsequently annotated using Ion Reporter and Ensembl's VEP. High priority variants were manually analysed using tools such as MutationTaster, SIFT-INDEL and VarSome. Putative identified candidates were validated via Sanger Sequencing. Results: The patients studied had a variety of cancers, the most common being nephroblastoma (13), followed by osteosarcoma (4) and astrocytoma (3). We identified 10 pathogenic / likely pathogenic variants in 10 patients, most of which were novel. Conclusions: According to the literature, we expected ~10% of our patient population to harbour pathogenic or likely pathogenic germline variants, however, we reported about 3 times (~30%) more than we expected. Majority of the identified variants are novel; this may be because this is the first study of its kind in an understudied South African population.

Keywords: Africa, genetics, germline-variants, paediatric-cancer

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Authors: Ayala Amir

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The paper presents interdisciplinary research which draws on the literary study and the cultural study of photography to explore a literary genre defined by nostalgia – the photographed book for children. This genre, which was popular in the second half of the 20th century, presents the romantic, nostalgic image of childhood created in the visual arts in the 18th century (as suggested by Ann Higonnet). At the same time, it capitalizes on the nostalgia inherent in the event of photography as formulated by Jennifer Green-Lewis: photography frames a moment in the present while transforming it into a past longed for in the future. Unlike Freudian melancholy, nostalgia is an effect that enables representation by acknowledging the loss and containing it in the very experience of the object. The representation and preservation of the lost object (nature, childhood, innocence) are in the center of the genre of children's photography books – a modern version of ancient pastoral. In it, the unique synergia of word and image results in a nostalgic image of childhood in an era already conquered by modernization. The nostalgic effect works both in the representation of space – an Edenic image of nature already shadowed by its demise, and of time – an image of childhood imbued by what Gill Bartholnyes calls the "looking backward aesthetics" – under the sign of loss. Little critical attention has been devoted to this genre with the exception of the work of Bettina Kümmerling-Meibauer, who noted the nostalgic effect of the well-known series of photography books by Astrid Lindgren and Anna Riwkin-Brick. This research aims to elaborate Kümmerling-Meibauer's approach using the theories of the study of photography, word-image studies, as well as current studies of childhood. The theoretical perspectives are implemented in the case study of photography books created in one of the most innovative social structures in our time – the Israeli Kibbutz. This communal way of life designed a society where children will experience their childhood in a parentless rural environment that will save them from the fate of the Oedipal fall. It is suggested that in documenting these children in a fictional format, photographers and writers, images and words cooperated in creating nostalgic works situated on the border between nature and culture, imagination and reality, utopia and its realization in history.

Keywords: nostalgia, photography , childhood, children's books, kibutz

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Authors: Andrea Zielke-Nadkarni

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Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: pain management, migrants, sociocultural context, palliative care

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Authors: Hanan Bin Nakhi, Asaad M. Albadrawi, Maged Al Shahat, ‎Entesar Mandani

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Background:‎ Kawasaki disease (KD) is one of the most common vasculitis of childhood. ‎It is considered the leading cause of acquired heart disease in children. The ‎peak age of occurrence is 6 to 24 months, with 80% of affected children being ‎less than 5 years old. There are only a few reports of KD in infants younger ‎than 6 months. Infants had a higher incidence of atypical KD and of coronary ‎artery complications. This case report from Kuwait will reinforce considering ‎atypical KD in case of sepsis like condition with negative cultures and ‎unresponding to systemic antibiotics. Early diagnosis allows early treatment ‎with intravenous immune globulin (IVIG) and so decreases the incidence of ‎cardiac aneurysm.‎ Case Report:‎ A 2 month old female infant, product of full term normal delivery to ‎consanguineous parents, presented with fever and poor feeding. She was ‎admitted and treated as urinary tract infection as her urine routine revealed ‎pyurea. The baby continued to have persistent fever and hypoactivity inspite ‎of using intravenous antibiotics. Latter, she developed non purulent ‎conjunctivitis, skin mottling, oedema of the face / lower limb and was treated ‎in intensive care unit as a case of septic shock. In spite of her partial general ‎improvement, she continued to look unwell, hypoactive and had persistent ‎fever. Septic work up, metabolic, and immunologic screen were negative. KD ‎was suspected when the baby developed polymorphic erythematous rash and ‎noticed to have peeling of skin at perianal area and periangular area of the ‎fingers of the hand and feet. IVIG was given in dose of 2 gm/kg/day in single ‎dose and aspirin 100 mg/kg/day in four divided doses. The girl showed marked ‎clinical improvement. The fever subsided dramatically and the level acute ‎phase reactant markedly decreased but the platelets count increased to ‎‎1600000/mm3. Echo cardiography showed mild dilatation of mid right ‎coronary artery. Aspirin was continued in a dose of 5 mg/kg/d till repeating ‎cardiac echo. ‎Conclusion:‎ A high index of suspicion of KD must be maintained in young infants with ‎prolonged unexplained fever. Accepted criteria should be less restrictive to ‎allow early diagnosis of a typical KD in infants less than 6 months of age. ‎Timely appropriate treatment with IVIG is essential to avoid severe coronary ‎sequels.‎

Keywords: Kawasaki disease, atypical Kawasaki disease, infantile Kawasaki disease, hypo activity‎ ‎

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Authors: Zijiao Chai, Wangming Li

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Hangzhou is one of the cities with the most serious aging in China. Community home-based care for the aged is an important solution to old-age care in aging society. In this aspect, Europe, the United States and Japan are on the top in the world. As an East Asian country, Japan has similar cultural traditions in pension with China. So, there is much enlightenment China can get from Japan in the mode of community home-based care for the aged. This paper introduces the mode of community home-based care for the aged in Kishiwada, Japan and Hangzhou, China. Then compare the two modes in the aspects of insurance system for the aged, community service and facilities, support system and so on. Thereby the success experience of Kishiwada and weaknesses of Hangzhou are summarized. At last, the improvement strategy of facility plan and service mode of community home-based care for the aged in China are also proposed.

Keywords: community, comparison, elderly-oriented, home-based care for the aged, support system

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Authors: Rungnapa Chantra

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As health care rapidly changes, the nursing profession is also evolving to improve quality of care while maintaining competency in their practice. The purpose of this study was to investigate the factors of disaster nurse competencies and investigate the predictable variables in disaster nurse competencies in Suratthani Province, Thailand. The sample consisted of 305 nurses who were recruited by simple random sampling. The development questionnaires from ICN Framework and research contains Pre/Mitigation, Preparedness, Response and Recovery/Rehabilitation Competencies (α=0.87). The data were analyzed using Principle Components Extraction and Orthogonal Rotation with Varimax Method. The findings were as follows; four significant factors of disaster nurse competencies in Suratthani Province, Thailand were identified. These factors were described by 62 variables that accounted for 50.01% of the total variance. The results of this study could be for agencies that are responsible for the development of nursing competencies and should be aware of the development of knowledge and skills in disaster management.

Keywords: disaster nursing competency of nurses, nursing informatics, health science, medical

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Authors: Alexis Piedrahita, Ludi Valencia, Aura Gutierrez

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The migration crisis that is currently being experienced in the world is a continuous phenomenon that has had solutions in form but not in substance, violating the international humanitarian law of people who are in transit through countries foreign to their roots, especially women of age reproductive, this has caused different governments and organizations worldwide to meet around this problem to define concise actions to protect the rights of migrant women in the world. This research compiles the stories of migrant women who arrive in Colombia seeking better opportunities, such as accessibility to comprehensive and quality health services, including primary health care. This is the gateway to the offer of health promotion and disease prevention services.

Keywords: accessibility, primary health care, sexual and reproductive health, sustainable development goals, women migrant

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Authors: Memnun Seven, Aygül Akyüz

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Having a baby, giving birth and being a mother are generally considered happy events, especially for women who have had a history of infertility and may have suffered emotionally, physically and financially. Although the transition from the prenatal period to the postnatal period is usually desired and planned, it is a developmental and cognitive transition period full of complex emotional reactions. During this period, common mood disorders for women include maternity blues, postpartum depression and postpartum psychosis. Postpartum depression is a common and serious mood disorder which can jeopardize the health of the mother, baby and family within the first year of delivery. Knowing the risks factors is an important issue for the early detection and early intervention of postpartum depression. However, knowing that a history of infertility may contribute to the development of postpartum depression, there are few studies assessing the effects of infertility during the diagnosis and treatment of depression. In this review, the effects of infertility on the development of postpartum depression and nurse/midwives’ roles in this issue are discussed in light with the literature.

Keywords: infertility, postpartum depression, risk factors, mood disorder

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Authors: Dilara Usta, Fatos Korkmaz

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Background: Individuals who utilise health services maintain relationships with health professionals, insurers and institutions. The nature of these relationships requires service receivers to have trust in the service providers because maintaining health services without reciprocal trust is very difficult. Therefore, individual evaluations of trust within the scope of health services have become increasingly important. Objective: To investigate patients’ trust in the health-care system and their relevant socio-demographical characteristics. Methods: This research was conducted using a descriptive design which included 493 literate patients aged 18-65 years who were hospitalised for a minimum of two days at public university and training&research hospitals in Ankara, Turkey. Patients’ trust in health-care professionals, insurers, and institutions were investigated. Data were collected using a demographic questionnaire and the Multidimensional Trust in Health-Care Systems Scale between September 2015 and April 2016. Results: The participants’ mean age was 47.7±13.1; 70% had a moderate income and 69% had a prior hospitalisation and 63.5% of the patients were satisfied with the health-care services. The mean Multidimensional Trust in Health-Care Systems Scale score for the sample was 61.5±8.3; the provider subscale had a mean of 38.1±5, the insurers subscale had a mean of 12.9±3.7, and institutions subscale had a mean of 10.6±1.9. Conclusion: Patients’ level of trust in the health-care system was above average and the trust level of the patients with higher educational and socio-economic levels was lower compared to the other patients. Health-care professionals should raise awareness about the significance of trust in the health-care system.

Keywords: delivery of health care, health care system, nursing, patients, trust

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Authors: Mazlynda Md Yusuf, Wafa' Mahadzir, Mohamad Yazis Ali Basah

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Nowadays, financing long-term care for elderly people is a crucial issue, either towards the family members or the care institution. Corresponding with the growing number of ageing population in Malaysia, there’s a need of concern on the uncertaintiness of future family care and the need for long-term care services. Moreover, with the increasing cost of living, children feels the urge of needing to work and receive a fixed monthly income that results to sending their elderly parents to care institutions. Currently, in Malaysia, the rates for private nursing homes can amount up to RM 4,000 per month excluding medical treatments and other recurring expenses. These costs are expected to be paid using their Employees Provident Fund (EPF) savings that they accumulate during their working years, especially for those working under private sectors. Hence, this study identifies the adequacy of EPF in funding the cost of long-term care service during old age. This study used a hypothetical simulation model to simulate different scenarios. The findings of this study could be used for individuals to prepare on the importance of planning for retirement, especially with the increasing cost of long-term care services.

Keywords: long-term care cost, employees provident fund Malaysia, ageing population, Malaysian elderly

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Authors: M. A. Brown, K. Hugill, D. Meredith

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Since the establishment of midwifery, as a professional identity in its own right, in the early years of the 20th century, midwifery-led models of childbirth have prevailed in many parts of the world. However, in many locations midwives’ scope of practice remains underdeveloped or absent. In Qatar, all births take place in hospital and are under the professional jurisdiction of obstetricians, predominately supported by internationally trained nurse-midwives and obstetric nurses. The strategic vision for health services in Qatar endorsed a desire to provide women with the ‘Best Care Always’ and the introduction of midwifery was seen as a way to achieve this. In 2015 the process of recruiting postgraduate educated Clinical Midwife Specialists from international sources began. The midwives were brought together to initiate an in hospital and community service transformation plan. This plan set out a series of wide-ranging actions to transform maternity and neonatal services to make care safer and give women more health choices. Change in any organization is a complex and dynamic process. This is made even more complex when multifaceted professional and cross cultural factors are involved. This presentation reports upon the motivations and challenges that exist and the progress around introducing a multicultural midwifery model of childbirth care in the state of Qatar. The paper examines and reflects upon the drivers and unique features of childbirth in the country. Despite accomplishments, progress still needs to be made in order to fully implement sustainable changes to further improve care and ensure women and neonates get the ‘Best Care Always’. The progress within the transformation plan highlights how midwifery may coexist with competing models of maternity care to create an innovative, eclectic and culturally sensitive paradigm that can best serve women and neonatal health needs.

Keywords: culture, managing change, midwifery, neonatal, service transformation plan

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Authors: Taiwo Hassanat Bawa-Muhammad, Opeoluwa Hope Adegoke

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Introduction: This study aims to examine the knowledge and perceptions of preconception care among healthcare workers in Nigeria, recognizing its crucial role in ensuring safe pregnancies. Despite its significance, awareness of preconception care remains low in the country. The study seeks to assess the understanding of preconception services and identify the barriers that hinder their efficacy. Methods: Through semi-structured interviews, 129 healthcare workers across six states in Nigeria were interviewed between January and March 2023. The interviews explored the healthcare workers' knowledge of preconception care practices, the socio-cultural influences shaping decision-making, and the challenges that limit accessibility and utilization of preconception care services. Results: The findings reveal a limited knowledge of preconception care among healthcare workers, primarily due to inadequate information dissemination within the healthcare system. Additionally, cultural beliefs significantly influence perceptions surrounding preconception care. Furthermore, financial constraints, distance to healthcare facilities, and poor health infrastructure disproportionately restrict access to preconception services, particularly for vulnerable populations. The study also highlights insufficient skills and outdated training among healthcare workers regarding preconception guidance, primarily attributed to limited opportunities for professional development. Discussion: To improve preconception care in Nigeria, comprehensive education programs must be implemented, taking into account the societal influences that shape perceptions and behaviors. These programs should aim to dispel myths and promote evidence-based practices. Additionally, training healthcare workers and integrating preconception care services into primary care settings, with support from religious and community leaders, can help overcome barriers to access. Strategies should prioritize affordability while emphasizing the broader benefits of preconception care beyond fertility concerns alone. Lastly, widespread literacy campaigns utilizing trusted channels are crucial for effectively disseminating information and promoting the adoption of preconception practices in Nigeria.

Keywords: preconception care, knowledge, healthcare workers, Nigeria, barriers, education, training

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team

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Authors: Calvin Chiu, Samar Saade Needham

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The factors associated with the development of major depressive disorder (MDD) have been an ongoing area of concern within the field of psychopathology. Among parents, the rise in stress factors for individuals receiving less social support contributes to an increase in MDD cases. Understanding the causal aspects of MDD through the interworking of stress development within social support disparities provides critical insights into preventive measures for depressive symptoms. The present study seeks to assess the impact of social support on stress formation within MDD. Such that single parents lacking social support prompt an increase in stress formation, which proliferates the progression of MDD. Participants in this study were 450 ethnic minority mothers and fathers experiencing health inequities during pregnancy and early childhood. Perceived stress, social support, and depression are assessed by multi-item questionnaires that produce score ranges for general findings. Results indicated that lower social support scores resulted in higher depression scores, and higher perceived stress scores produced higher depression scores. Furthermore, single parents reported higher depression scores. These findings overlap with studies on paternal depression and suggest that MDD is a product of stress accumulation due to declining social support systems. Future studies may specify effective social support systems for decreasing stress accumulation in MDD formation in preventive strategies.

Keywords: major depressive disorder, stress formation, cognitive-behavioral outcomes, deficit-based behaviors

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Authors: Patcharaporn Sakulpong, Wiriya Phokhwang

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Background: Banpunrug (Love Sharing House) established in 2013 provides a community-based palliative care for patients with cancer from 7 provinces in southern Thailand. These patients come to receive outpatient chemotherapy and radiotherapy at Suratthani Cancer Hospital. They are poor and uneducated; they need an accommodation during their 30-45 day course of therapy. Methods: A community-participatory action research (PAR) was employed to establish a model of palliative care for patients with cancer. The participants included health care providers, community, and patients and families. The PAR process includes problem identification and need assessment, community and team establishment, field survey, organization founding, model of care planning, action and inquiry (PDCA), outcome evaluation, and model distribution. Results: The model of care at Banpunrug involves the concepts of HHHS model, in that Banpunrug is a Home for patients; patients live in a house comfortable like in a Hotel resource; the patients are given care and living facilities similarly to those in a Hospital; the house is a School for patients to learn how to take care themselves, how to live well with cancer, and most importantly how to prepare themselves for a good death. The house is also a humanized care school for health care providers. Banpunrug’s philosophy of care is based on friendship therapy, social and spiritual support, community partnership, patient-family centeredness, Live & Love sharing house, and holistic and humanized care. With this philosophy, the house is managed as a home of the patients and everyone involved; everything is costless for all eligible patients and their family members; all facilities and living expense are donated from benevolent people, friends, and community. Everyone, including patients and family, has a sense of belonging to the house and there is no authority between health care providers and the patients in the house. The house is situated in a temple and a community and supported by many local nonprofit organizations and healthcare facilities such as a health promotion hospital at sub-disctrict level and Suratthani Cancer Hospital. Village health volunteers and multi-professional health care volunteers have contributed not only appropriate care, but also knowledge and experience to develop a distinguishing HHHS community-based palliative care model for patients with cancer. Since its opening the house has been a home for more than 400 patients and 300 family members. It is also a model for many national and international healthcare organizations and providers, who come to visit and learn about palliative care in and by community. Conclusions: The success of this palliative care model comes from community involvement, multi-professional volunteers and distributions, and concepts of HHHS model. Banpunrug promotes a consistent care across the cancer trajectory independent of prognosis in order to strengthen a full integration of palliative

Keywords: community-based palliative care, model, participatory action research, patients with cancer

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Authors: Chiou-Shiue Ko

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As is explicitly stipulated in Article 7 of the Enforcement Rules of the Special Education Act as amended in 1998, "in principle, children with disabilities should be integrated with normal children for preschool education". Since then, all cities and counties have been committed to promoting preschool inclusive education. The Education Department, New Taipei City Government, has been actively recruiting advisory groups of professors to assist in the implementation of inclusive education in preschools since 2001. Since 2011, the author of this study has been guiding Preschool Rainbow to implement inclusive education. Through field observations, meetings, and teaching demonstration seminars, this study explored the process of how inclusive education has been successfully implemented in collaboration with teachers of special education classes and regular classes in Preschool Rainbow. The implementation phases for inclusive education in a single academic year include the following: 1) Preparatory stage. Prior to implementation, teachers in special education and regular classes discuss ways of conducting inclusive education and organize reading clubs to read books related to curriculum modifications that integrate the eight education strategies, early treatment and education, and early childhood education programs to enhance their capacity to implement and compose teaching plans for inclusive education. In addition to the general objectives of inclusive education, the objective of inclusive education for special children is also embedded into the Individualized Education Program (IEP). 2) Implementation stage. Initially, a promotional program for special education is implemented for the children to allow all the children in the preschool to understand their own special qualities and those of special children. After the implementation of three weeks of reverse inclusion, the children in the special education classes are put into groups and enter the regular classes twice a week to implement adjustments to their inclusion in the learning area and the curriculum. In 2013, further cooperation was carried out with adjacent hospitals to perform development screening activities for the early detection of children with developmental delays. 3) Review and reflection stage. After the implementation of inclusive education, all teachers in the preschool are divided into two groups to record their teaching plans and the lessons learned during implementation. The effectiveness of implementing the objective of inclusive education is also reviewed. With the collaboration of all teachers, in 2015, Preschool Rainbow won New Taipei City’s “Preschool Light” award as an exceptional model for inclusive education. Its model of implementing inclusive education can be used as a reference for other preschools.

Keywords: collaboration, inclusive education, preschool, teachers, special education classes, regular classes

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Authors: Yen-Hsia Lin, Ya-Fang Cheng, Hui-Zhu Chen, Chi-Hui Tiao

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This is a case study of a 70-year-old man suffering from Type 2 diabetes mellitus and hyperglycemia hyperosmolarity state. He was admitted into the intensive care unit from the 20th to 26th of October, 2015. After receiving relevant information through open-ended conversations, observation, and physical assessment, as well as the psychological, social and spiritual holistic nursing assessment, several clinical health problems such as unstable blood sugar, impaired skin integrity and lack of self-care management knowledge were identified by the author. During the period of care, the patient was encouraged to share and express his feelings, an active listening and initiating approach from the nursing team had led to the understanding of why the patient refused to use insulin. This knowledge enabled the nursing team to manage patient care by educating the patient with self-care management skills, such as foot wound care and insulin injection skills to slow the deterioration of complications. Also, the implementation of appropriate diet and exercise routine to improve patients’ style. By enhancing self-care ability in diabetic patients, they are able to return home with the skill to improve better quality life style.

Keywords: hyperglycemia hyperosmolar state, type2 diabetes Mellitu, diabetes Mellitu foot care, intensive care

Procedia PDF Downloads 127

Authors: Dr. Jenit Gandhi, Dr. Manojith SS, Dr. Nakul GV, Dr. Sharath Honnani, Dr. Shaurav Ghosh, Dr. Neel Shetty, Dr. Nagabhushan JS, Dr. Manish Joshi

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Introduction: Acute pancreatitis is an inflammatory condition of the pancreas which begins in pancreatic acinar cells and triggers local inflammation that may progress to systemic inflammatory response (SIRS) and causing distant organ involvement and its function and ending up with multiple organ dysfunction syndromes (MODS). Aim: A comparative study in acute pancreatitis to find out the effectiveness of early addition of Ulinastatin to current standard care in Indian subjects . Methodology: A current prospective observational study is done during study period of 1year (Dec 2018 –Dec 2019) duration to evaluate the effect of early addition of Ulinastatin to the current standard treatment and its efficacy to reduce the early complication, analgesic requirement and duration of hospital stay in patients with Acute Pancreatitis. Results: In the control group 25 were males and 05 were females. In the test group 18 were males and 12 females. Majority was in the age group between 30 - 70 yrs of age with >50% in the 30-50yrs age group in both test and control groups. The VAS was median grade 3 in control group as compared to median grade 2 in test group , the pain was more in the initial 2 days in test group compared to 4 days in test group , the analgesic requirement was used for more in control group (median 6) to test group( median 3 days ). On follow up after 5 days for a period of 2 weeks none of the patients in the test group developed any complication. Where as in the control group 8 patients developed pleural effusion, 04-Pseudopancreatic cyst, 02 – patient developed portal vein and splenic vein thrombosis, 02 patients – ventilator with ARDS which were treated symptomatically whereas in test group 02 patient developed pleural effusions and 01 pseudo pancreatic cyst with splenic artery aneurysm, 01 – patient with AKI and MODS symptomatically treated. The duration of hospital stay for a median period of 4 days (2 – 7 days) in test group and 7 days (4 -10 days) in control group. All patients were able to return to normal work on an average of 5days compared 8days in control group, the difference was significant. Conclusion:The study concluded that early addition of Ulinastatin to current standard treatment of acute Pancreatitis is effective in reducing pain, early complication and duration of hospital stay in Indian subject

Keywords: Ulinastatin, VAS – visual analogue score , AKI – acute kidney injury , ARDS – acute respiratory distress syndrome

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Authors: Siti Rajaah Binti Sayed Sultan

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Managing the code blue event is stressful for nurses, the patient, and the patient's families. The rapid response from the first and second responders in the code blue event will improve patient outcomes and prevent tissue hypoxia that leads to brain injury and other organ failures. Providing 1 minute for the cardiac massage and 2 minutes for defibrillation will significantly improve patient outcomes. As we know, the American Heart Association came out with guidelines for managing cardiac arrest patients. The hospital must provide competent staff to manage this situation. It can be achieved when the staff is well equipped with the skill, attitude, and knowledge to manage this situation with well-planned strategies, i.e., clear guidelines for managing the code blue event, competent staff, and functional equipment. The code blue simulation (CBS) was chosen in the training program for code blue management because it can mimic real scenarios. Having the code blue simulation module will allow the staff to appreciate what they will face during the code blue event, especially since it rarely happens in that area. This CBS module training will help the staff familiarize themselves with the activities that happened during actual events and be able to operate the equipment accordingly. Being challenged and independent in managing the code blue in the early phase gives the patient a better outcome. The CBS module will help the assessor and the hospital management team with the proper tools and guidelines for managing the code blue drill accordingly. As we know, prompt action will benefit the patient and their family. It also indirectly increases the confidence and job satisfaction among the nurses, increasing the standard of care, reducing the complication and hospital burden, and enhancing cost-effective care.

Keywords: code blue simulation module, development of code blue simulation module, code blue response time, code blue drill, cardiorespiratory arrest, managing code blue

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Authors: Kim Toyer, Belinda Thompson, Louise Koelmeyer

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Lymphoedema is a chronic condition caused by dysfunction of the lymphatic system, which limits the drainage of fluid and tissue waste from the interstitial space of the affected body part. The normal physiological changes in pregnancy cause an increased load on a normal lymphatic system which can result in a transient lymphatic overload (oedema). The interaction between lymphoedema and pregnancy oedema is unclear. Women with pre-existing lymphoedema require accurate information and additional strategies to manage their lymphoedema during pregnancy. Currently, no resources are available to guide women or their healthcare providers with accurate advice and additional management strategies for coping with lymphoedema during pregnancy until they have recovered postnatally. This study explored the experiences of Australian women with pre-existing lymphoedema during recent pregnancy and the early postnatal period to determine how their usual lymphoedema management strategies were adapted and what were their additional or unmet needs. Interactions with their obstetric care providers, the hospital maternity services, and usual lymphoedema therapy services were detailed. Participants were sourced from several Australian lymphoedema community groups, including therapist networks. Opportunistic sampling is appropriate to explore this topic in a small target population as lymphoedema in women of childbearing age is uncommon, with prevalence data unavailable. Inclusion criteria were aged over 18 years, diagnosed with primary or secondary lymphoedema of the arm or leg, pregnant within the preceding ten years (since 2012), and had their pregnancy and postnatal care in Australia. Exclusion criteria were a diagnosis of lipedema and if unable to read or understand a reasonable level of English. A mixed-method qualitative design was used in two phases. This involved an online survey (REDCap platform) of the participants followed by online semi-structured interviews or focus groups to provide the transcript data for inductive thematic analysis to gain an in-depth understanding of issues raised. Women with well-managed pre-existing lymphoedema coped well with the additional oedema load of pregnancy; however, those with limited access to quality conservative care prior to pregnancy were found to be significantly impacted by pregnancy, including many reporting deterioration of their chronic lymphoedema. Misinformation and a lack of support increased fear and apprehension in planning and enjoying their pregnancy experience. Collaboration between maternity and lymphoedema therapy services did not happen despite study participants suggesting it. Helpful resources and unmet needs were identified in the recent Australian context to inform further research and the development of resources to assist women with lymphoedema who are considering or are pregnant and their supporters, including health care providers.

Keywords: lymphoedema, management strategies, pregnancy, qualitative

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Authors: Theophilus O. Odunlami, Hasan Haroglu, Nader Saleh-Matter

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The challenges facing the construction industry are often worsened by the compounded nature of projects coupled with the complexity of key stakeholders involved at different stages of the project. Projects are planned to achieve outlined benefits in line with the business case; however, a lack of effective management of key stakeholders can result in unrealistic delivery aspirations, unnecessary re-works, and overruns. The aim of this study is to examine the early stages of a project lifecycle and investigate the stakeholder management and involvement processes and their impact on the successful delivery of the project. The research engaged with conventional construction organisations and project personnel and stakeholders on diverse projects, using a research strategy to analyse existing project case studies, narrative enquiries, interviews, and surveys using a combined qualitative, quantitative, and mixed method of analysis. Research findings have shown that the involvement of stakeholders at different levels during the early stages has pronounced effects on project delivery; it helps to forge synergy and promotes a clear understanding of individual responsibilities, strengths, and weaknesses. This has often fostered a positive sense of productive collaboration right through the early stages of the project. These research findings intend to contribute to the development of a process framework for stakeholder and project team involvement in the early stages of a project. This framework will align with the selection criteria for stakeholders, contractors, and resources, ultimately contributing to the successful completion of projects. The primary question addressed in this study is stakeholder involvement and management of the early stages of a building project life cycle impacts project delivery. Findings showed that early-stage stakeholder involvement and collaboration between project teams and contractors significantly contribute to project success. However, a strong and healthy communication strategy would be required to maintain the flow of value-added ideas among stakeholders at the early stages to benefit the project at the execution stage.

Keywords: early stages, project lifecycle, stakeholders, decision-making strategy, project framework

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Authors: Mohd Said Nurumal, Sarah Sheikh Abdul Karim

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Information regarding out of hospital cardiac arrest incidence include outcome in Malaysia is limited and fragmented. This study aims to identify incidence and adherence to protocol of out of hospital cardiac arrest and also to explore the issues faced by the pre-hospital personnel in regards managing cardiac arrest victim in Kuala Lumpur, Malaysia. A mixed method approach combining the qualitative and quantitative study design was used. The 285 pre-hospital care data sheet of out of hospital cardiac arrest during the year of 2011 were examined by using checklists for identify the incidence and adherence to protocol. Nine semi-structured interviews and two focus group discussions were performed. For the incidence based on the overall out of hospital cardiac arrest cases that occurred in 2011 (n=285), the survival rates were 16.8%. For adherence to protocol, only 89 (41.8%) of the cases adhered to the given protocol and 124 did not adhere to such protocol. The qualitative information provided insight about the issues related to out of hospital cardiac arrest in every aspect. All the relevant qualitative data were merged into few categories relating issues that could affect the management of out of hospital cardiac arrest performed by pre-hospital care team. One of the essential elements in the out of hospital cardiac arrest handling by pre-hospital care is to ensure increase of survival rates and excellent outcomes by adhering to given protocols based on international standard benchmarks. Measures are needed to strengthen the quick activation of the pre-hospital care service, prompt bystander cardiopulmonary resuscitation, early defibrillation and timely advanced cardiac life support and also to tackle all the issues highlighted in qualitative results.

Keywords: pre-hospital care, out of hospital cardiac arrest, incidence, protocol, mixed method research

Procedia PDF Downloads 393