Search results for: patient safety culture

Authors: Aruna Bhat

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Culture can be placed within the social structure that embodies both the creation of social groups, and the manner in which they interact with each other. As many critics have pointed out, culture in the Postmodern context has often been considered a commodity, and indeed it shares many attributes with commercial products. Popular culture follows many patterns of behavior derived from Economics, from the simple principle of supply and demand, to the creation of marketable demographics which fit certain criterion. This trend is exemplary visible in contemporary fiction, especially in contemporary science fiction; Cyberpunk fiction in particular which is an off shoot of pure science fiction. William Gibson is one such author who in his works portrays such a scenario, and in his The Bridge Trilogy he adds another level of interpretation to this state of affairs, by describing a world that is centered on industrialization of a new kind – that focuses around data in the cyberspace. In this new world, data has become the most important commodity, and man has become nothing but a nodal point in a vast ocean of raw data resulting into commodification of each thing including Culture. This paper will attempt to study the presence of above mentioned elements in William Gibson’s The Bridge Trilogy. The theories applied will be Postmodernism and Cultural studies.

Keywords: culture, commodity, cyberpunk, data, postmodern

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Authors: Rafael Ricieri, Rogerio Barros

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Objective: This study is to report a case of massive necrotizing enterocolitis in a six-month-old patient, requiring ileostomy and protective jejunostomy as a damage control measure in the first exploratory laparotomy surgery in massive enterocolitis without a previous diagnosis. Methods: This study is a case report of success in making and closing a protective jejunostomy. However, the low number of publications on this staged and risky measure of surgical resolution encouraged the team to study the indication and especially the correct time for closing the patient's protective jejunostomy. The main study instrument will be the six-month-old patient's medical record. Results: Based on the observation of the case described, it was observed that the time for the closure of the described procedure (protective jejunostomy) varies according to the level of compromise of the health status of your patient and of an individual of each person. Early closure, or failure to close, can lead to a favorable problem for the patient since several problems can result from this closure, such as new intestinal perforations, hydroelectrolyte disturbances. Despite the risk of new perforations, we suggest closing the protective jejunostomy around the 14th day of the procedure, thus keeping the patient on broad-spectrum antibiotic therapy and absolute fasting, thus reducing the chances of new intestinal perforations. Associated with the closure of the jejunostomy, a gastric tube for decompression is necessary, and care in an intensive care unit and electrolyte replacement is necessary to maintain the stability of the case.

Keywords: jejunostomy, ileostomy, enterocolitis, pediatric surgery, gastric surgery

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Authors: Seyed Abolhasan Naeini, Elham Ghanbari Alamooti

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Static stability of soil slopes using numerical simulation by a finite element code, ABAQUS, has been investigated, and safety factors of the slopes achieved in the case of static load of a 10-storey building. The embankments have the same soil condition but different loading distance from the slope heel. The numerical method for estimating safety factors is 'Strength Reduction Method' (SRM). Mohr-Coulomb criterion used in the numerical simulations. Two steps used for measuring the safety factors of the slopes: first is under gravity loading, and the second is under static loading of a building near the slope heel. These safety factors measured from SRM, are compared with the values from Limit Equilibrium Method, LEM. Results show that there is good agreement between SRM and LEM. Also, it is seen that by increasing the distance from slope heel, safety factors increases.

Keywords: limit equilibrium method, static stability, soil slopes, strength reduction method

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Authors: Prachi Chavda

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The world, as of today, is smaller than it was for those who lived few decades ago. Internet, media and telecommunications have impacted the world like never before. Culture is the pillar upon which a society mushrooms. A culture develops with human creativity over the years and also by the exchange and intermixing of ideas and way of life across different civilizations and we can say that one of the influencing medium of exchange and intermixing of these ideas is cinema. Cinema has been the wonderful as well as important medium of communication since it has been emerged. Change is the thumb rule of life and so have been Indian cinema. As society has evolved from time to time so has the stories of Indian Cinema and its characters, hence it directly effects to the Indian culture as cinema has been very strong mediator for information exchange. The paper tries to discuss deeply how Indian cinema (reel life) and Indian culture (real life) has been influencing each other that results into a constant modification in both. Moreover, the research tries to deal with the issue with some examples that as a outcome how movies impact the Indian culture positively and negatively on culture. Therefore, it spreads the wave of change in cultural settings of society. The paper also tries to light the psychology of youth of India. Today, children and youth greatly admire the ostentatious materialistic display of outfits and style of the actors in the movies. Also, the movies bearing romanticism and showcasing disputatious issues like pre-marital sex, live-in relationship, homo-sexuality etc. though without highlighting them extensively have indeed inspired the commoners. Pros and cons always exist. Such revelation of issues certainly give a spark in the minds of those who are in their formative years and the effect of which is seen with the passage of time Thus, we can say that emergence of cinema as a strong tool of social change as well as culture as a triggering factor for transformation in cinema. As, a finding we can say that culture and cinema of India are influencing factors for each other. Cinema and culture are two sides of a coin, where both are responsible for evolution of each other.

Keywords: cinema, culture, influence, transformation

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Authors: Tanushree Jaitly, Shailendra Gupta, Leila Taher, Gerold Schuler, Julio Vera

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Genomics-based personalized medicine is a promising approach to fight aggressive tumors based on patient's specific tumor mutation and expression profiles. A remarkable case is, dendritic cell-based immunotherapy, in which tumor epitopes targeting patient's specific mutations are used to design a vaccine that helps in stimulating cytotoxic T cell mediated anticancer immunity. Here we present a computational pipeline for epitope-based personalized cancer vaccines using patient-specific haplotype and cancer mutation profiles. In the workflow proposed, we analyze Whole Exome Sequencing and RNA Sequencing patient data to detect patient-specific mutations and their expression level. Epitopes including the tumor mutations are computationally predicted using patient's haplotype and filtered based on their expression level, binding affinity, and immunogenicity. We calculate binding energy for each filtered major histocompatibility complex (MHC)-peptide complex using docking studies, and use this feature to select good epitope candidates further.

Keywords: cancer immunotherapy, epitope prediction, NGS data, personalized medicine

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Authors: G. Yoga Sairam Teja, K. Harsha Vardhan, A. Vinay Kumar, K. Nithish Kumar, Ch. Shanthi Priyag

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The emergence of the Internet of Things (IoT) has facilitated better device control and monitoring in the modern world. The constant monitoring of a patient would be drastically altered by the usage of IoT in healthcare. As we've seen in the case of the COVID-19 pandemic, it's important to keep oneself untouched while continuously checking on the patient's heart rate and temperature. Additionally, patients with paralysis should be closely watched, especially if they are elderly and in need of special care. Our "IoT BASED PATIENT HEALTH MONITORING SYSTEM" project uses IoT to track patient health conditions in an effort to address these issues. In this project, the main board is an 8051 microcontroller that connects a number of sensors, including a heart rate sensor, a temperature sensor (LM-35), and a saline water measuring circuit. These sensors are connected via an ESP832 (WiFi) module, which enables the sending of recorded data directly to the cloud so that the patient's health status can be regularly monitored. An LCD is used to monitor the data in offline mode, and a buzzer will sound if any variation from the regular readings occurs. The data in the cloud may be viewed as a graph, making it simple for a user to spot any unusual conditions.

Keywords: IoT, ESP8266, 8051 microcontrollers, sensors

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Authors: Roseanne Sharon Borromeo, Mariana Carvalho, Mariia Karizhenskaia

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Healthcare providers need to comprehend cultural diversity for optimal patient-centered care, especially near the end of life. Although a universal method for navigating cultural differences would be ideal, culture’s high complexity makes this strategy impossible. Adding cultural humility, a process of self-reflection to understand personal and systemic biases and humbly acknowledging oneself as a learner when it comes to understanding another's experience leads to a meaningful process in palliative care generating respectful, honest, and trustworthy relationships. This study is a systematic review of the literature on cultural humility in palliative care research and best practices. Race, religion, language, values, and beliefs can affect an individual’s access to palliative care, underscoring the importance of culture in palliative care. Cultural influences affect end-of-life care perceptions, impacting bereavement rituals, decision-making, and attitudes toward death. Cultural factors affecting the delivery of care identified in a scoping review of Canadian literature include cultural competency, cultural sensitivity, and cultural accessibility. As the different parts of the world become exponentially diverse and multicultural, healthcare providers have been encouraged to give culturally competent care at the bedside. Therefore, many organizations have made cultural competence training required to expose professionals to the special needs and vulnerability of diverse populations. Cultural competence is easily standardized, taught, and implemented; however, this theoretically finite form of knowledge can dangerously lead to false assumptions or stereotyping, generating poor communication, loss of bonds and trust, and poor healthcare provider-patient relationship. In contrast, Cultural humility is a dynamic process that includes self-reflection, personal critique, and growth, allowing healthcare providers to respond to these differences with an open mind, curiosity, and awareness that one is never truly a “cultural” expert and requires life-long learning to overcome common biases and ingrained societal influences. Cultural humility concepts include self-awareness and power imbalances. While being culturally competent requires being skilled and knowledgeable in one’s culture, being culturally humble involves the sometimes-uncomfortable position of healthcare providers as students of the patient. Incorporating cultural humility emphasizes the need to approach end-of-life care with openness and responsiveness to various cultural perspectives. Thus, healthcare workers need to embrace lifelong learning in individual beliefs and values on suffering, death, and dying. There have been different approaches to this as well. Some adopt strategies for cultural humility, addressing conflicts and challenges through relational and health system approaches. In practice and research, clinicians and researchers must embrace cultural humility to advance palliative care practices, using qualitative methods to capture culturally nuanced experiences. Cultural diversity significantly impacts patient-centered care, particularly in end-of-life contexts. Cultural factors also shape end-of-life perceptions, impacting rituals, decision-making, and attitudes toward death. Cultural humility encourages openness and acknowledges the limitations of expertise in one’s culture. A consistent self-awareness and a desire to understand patients’ beliefs drive the practice of cultural humility. This dynamic process requires practitioners to learn continuously, fostering empathy and understanding. Cultural humility enhances palliative care, ensuring it resonates genuinely across cultural backgrounds and enriches patient-provider interactions.

Keywords: cultural competency, cultural diversity, cultural humility, palliative care, self-awareness

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Authors: Phontip Kanlahasuth

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This paper presents the environmental safety and occupational health risk assessment of rocket static test by assessing risk level from probability and severity and then appropriately applying the risk control measures. Before the environmental safety and occupational health measures are applied, the serious hazards level is 31%, medium level is 24% and low level is 45%. Once risk control measures are practically implemented, the serious hazard level can be diminished, medium level is 38%, low level is 45% and eliminated level is 17%. It is clearly shown that the environmental safety and occupational health measures can significantly reduce the risk level.

Keywords: rocket static test, hazard, risk, risk assessment, risk analysis, environment, safety, occupational health, acceptable risk, probability, severity, risk level

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Authors: Yogesh Mahor, Subhash Nigam, Abhai Khare

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Road safety education is a composite subject which should be viewed holistically if taken into accoubehavior change communication, safe road infrastructure and low enforcement. Specific and customized road safety education is crucial for each type of road user and learners in the formal and informal teaching and various kind of training programs directly sponsored by state and center government, as they are active contributors to shaping a community and responsible citizens. The aim of this discussion article is to explore a strategy to integrate road safety education into the formal curriculum of schools, higher education institutions, driving schools, skill development centers, various government funded urban and rural development training institutions and their work plans as standing agenda. By applying the desktop research method, the article conceptualizes what the possible focus of road safety education and training should be. The article then explores international common practices in road safety education and training, and considers the necessary synergy between education, road engineering and low enforcement. The article uses secondary data collected from documents which are then analysed in a sectoral way. A well-designed road safety strategy for mainstreaming education and government-sponsored training is urgently needed, facilitating partnerships in various sectors to implement such education in the students and learners in multidisciplinary ways.

Keywords: road safety education, curriculum-based road safety education, behavior change communication, low enforcement, road engineering, safe system approach, infrastructure development consultants

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Authors: Grace Omowunmi Soyebi

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Data Mining is the extraction of information from a large database which helps in predicting a trend or behavior, thereby helping management make knowledge-driven decisions. One principal problem of most hospitals in rural areas is making use of the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved; this may cause an unexpected to happen to the patient. This Data Mining application is to be designed using a Structured System Analysis and design method, which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the Design and Implementation of a Computerized medical record system. This Computerized system will replace the file management system and help to easily retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: data mining, medical record system, systems programming, computing

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Authors: Hacer Kobya Bulut, Kıymet Yeşilçiçek Çalık, Birsel Canan Demirbağ, Hacer Erdöl, Songül Aktaş

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Introduction: As an expression of an emotion which always exists in life, crying is regarded as one of the problematic behaviors of patients by nurses. Towards such patients, nurses may exhibit emotional and behavioral reactions such as feeling helpless, anger, indifferent, defense, and opposition. However crying either meets a need, reduces the tension to cope with problems or helps patient to gain strength. Therefore, nurses must accept that crying is a normal mechanism that reduces emotional tension and should approach a crying patient accordingly. Objective: This study was carried out to evaluate the communicational behaviors of the nurses towards ‘crying patient’. Methods: This descriptive study was conducted with the nurses working at a university hospital in a city in the Eastern Black Sea in June-September 2015. The entire universe was tried to be reached without sampling. 90% of the population was reached and the study was completed with 309 nurses who volunteered to participate in the study. Data were collected through a questionnaire which was prepared reviewing the literature by researchers. Data were evaluated in SPSS analysis program using percentages, numbers and chi-square test with the 95% confidence interval and p <0.05significance level. Findings: The findings showed that the average age of nurses was 31.52 ± 7.96, work experience was 10:09 ± 7.69 and only 22.7% had training about ‘approach to crying patient’ during their education. 97.1% of the nurses often faced with crying patients in their professional lives, 62.8% stated that they faced crying women patients. When they see crying patients, 84.8% of the nurses ‘do not want the patient to cry’, 80.9% wonder ‘why they are crying’, % 79.6 ‘feel uneasiness’,% 79.3 ‘feel sorry’ and 41.4% ‘ feel helpless’. The question ‘Why do you think the patient is crying?’ was answered by 93.5% nurses as ‘they are suffering’, by 86.1% ‘they are helpless’, 80.9% ‘they are sad’, 79.6% ‘they need help’, 54.4% ‘because they feel inadequate,’ and 44.7% ‘they fail to control their crying behavior. ‘How do you approach to your patient when she/he is crying?’ question was answered by 82.5% of nurses as ‘I would console’, 77.3% as ‘I would ask the reason’, 63.1% as ‘I would try to stop her from crying’ all of which are actually inappropriate nursing approaches. However, 92.2% of the nurses stated that ‘I do not judge the crying patient’, ‘87.1% said ‘I allocate time to crying patients’ and 85.8% said ‘ I ask patient whether they want to cry alone’. The study showed that educational background and work experience of the nurses affected the appropriate approach to crying patients (P <0.05). Conclusion: As a result of the study, it was found out that nurses do not want patients to cry, so they exhibit inappropriate approach such as consoling the patients and they have difficulty in approaching crying patients.

Keywords: approach to patient, communication, crying patient, nurse, Turkey

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Authors: Nadir A. Carreon, Christa Sonderer, Aakarsh Rao, Roman Lysecky

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With the advent of complex software and increased connectivity, the security of life-critical medical devices is becoming an increasing concern, particularly with their direct impact on human safety. Security is essential, but it is impossible to develop completely secure and impenetrable systems at design time. Therefore, it is important to assess the potential impact on the security and safety of exploiting a vulnerability in such critical medical systems. The common vulnerability scoring system (CVSS) calculates the severity of exploitable vulnerabilities. However, for medical devices it does not consider the unique challenges of impacts to human health and privacy. Thus, the scoring of a medical device on which human life depends (e.g., pacemakers, insulin pumps) can score very low, while a system on which human life does not depend (e.g., hospital archiving systems) might score very high. In this paper, we propose a medical vulnerability scoring system (MVSS) that extends CVSS to address the health and privacy concerns of medical devices. We propose incorporating two new parameters, namely health impact, and sensitivity impact. Sensitivity refers to the type of information that can be stolen from the device, and health represents the impact on the safety of the patient if the vulnerability is exploited (e.g., potential harm, life-threatening). We evaluate fifteen different known vulnerabilities in medical devices and compare MVSS against two state-of-the-art medical device-oriented vulnerability scoring systems and the foundational CVSS.

Keywords: common vulnerability system, medical devices, medical device security, vulnerabilities

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Authors: Muhammad Tufail, Jawad Hussain, Hammad Hussain, Imran Hafeez, Naveed Ahmad

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Road safety performance index is a composite index which combines various indicators of road safety into single number. Development of a road safety performance index using appropriate safety performance indicators is essential to enhance road safety. However, a road safety performance index in developing countries has not been given as much priority as needed. The primary objective of this research is to develop a general Road Safety Performance Index (RSPI) for developing countries based on the facility as well as behavior of road user. The secondary objectives include finding the critical inputs in the RSPI and finding the better method of making the index. In this study, the RSPI is developed by selecting four main safety performance indicators i.e., protective system (seat belt, helmet etc.), road (road width, signalized intersections, number of lanes, speed limit), number of pedestrians, and number of vehicles. Data on these four safety performance indicators were collected using observation survey on a 20 km road section of the National Highway N-125 road Taxila, Pakistan. For the development of this composite index, two methods are used: a) Principal Component Analysis (PCA) and b) Equal Weighting (EW) method. PCA is used for extraction, weighting, and linear aggregation of indicators to obtain a single value. An individual index score was calculated for each road section by multiplication of weights and standardized values of each safety performance indicator. However, Simple Average technique was used for weighting and linear aggregation of indicators to develop a RSPI. The road sections are ranked according to RSPI scores using both methods. The two weighting methods are compared, and the PCA method is found to be much more reliable than the Simple Average Technique.

Keywords: indicators, aggregation, principle component analysis, weighting, index score

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Authors: Davut Uysal

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Turkish higher education system has experienced some structural changes in recent decades, which resulted in the concentration on English language teaching as a foreign language at high education institutions. However, the number of studies examining the relationship between organizational culture and job satisfaction among language teachers at higher education institutions, who are the key elements of the teaching process, is very limited in the country. The main objective of this study is to find out the perceptions of English language instructors regarding organizational culture and its impact on their job satisfaction at School of Foreign Language, Anadolu University in Turkey. Questionnaire technique was used in data collection, and the collected data was analysed with the help of SPSS data analysis program. The findings of the study revealed that the respondents of the study had positive perceptions regarding current organizational culture indicating satisfaction with co-worker relations and administration, supervision support and the work itself, as well as their satisfaction with the available professional development opportunities provided by their institution. A significant relationship between overall organizational culture and job satisfaction was found in the study. This study also presents some key elements to increase the job satisfaction levels of the language teachers by managing corporate communication and to improve the organisational culture based on the findings of the study as they are two interrelated issues.

Keywords: corporate communication, English teacher, organizational culture, job satisfaction

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Authors: Seyed Abolhassan Naeini, Hamed Yekehdehghan

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One of the factors that affect the constructions adjacent to a slope is stability. There are various methods for the stability of the slopes, one of which is the use of concrete group piles. This study, using FLAC3D software, has tried to investigate the changes in safety coefficient because of the use of concrete group piles. In this research, furthermore, the optimal position of the piles has been investigated and the results show that the group pile does not affect the toe of the slope. In addition, the effect of the piles' burial depth on the slope has been studied. Results show that by increasing the piles burial depth on a slope, the level of stability and as a result the safety coefficient increases. In the investigation of reducing the distance between the piles and increasing the depth of underground water, it was observed that the obtained safety coefficient increased. Finally, the effect of the resistance of the lower stabilizing layer of the slope on stabilization was investigated by the pile group. The results showed that due to the behavior of the pile as a deep foundation, the stronger the soil layers are in the stable part of a stronger slope (in terms of resistance parameters), the more influential the piles are in enhancing the coefficient of safety.

Keywords: safety coefficient, group pile, slope, stability, FLAC3D software

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Authors: Tian Yi Du, Guan Rong Fan, Dong Dong Zou, Di Xue

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Background: The patient satisfaction survey is becoming of increasing importance for hospitals or other providers to get more reimbursement and/or more governmental subsidies. However, when the results of patient satisfaction survey are compared among medical institutions, there are some concerns. The primary objectives of this study were to evaluate patient satisfaction in tertiary hospitals of Shanghai and to compare the satisfaction rating on physician services between patients and observers. Methods: Two hundred outpatients were randomly selected for patient satisfaction survey in each of 28 public tertiary hospitals of Shanghai. Four or five volunteers were selected to observe 5 physicians’ practice in each of above hospitals and rated observed physicians’ practice. The outpatients that the volunteers observed their physician practice also filled in the satisfaction questionnaires. The rating scale for outpatient survey and volunteers’ observation was: 1 (very dissatisfied) to 6 (very satisfied). If the rating was equal to or greater than 5, we considered the outpatients and volunteers were satisfied with the services. The validity and reliability of the measure were assessed. Multivariate regressions for each of the 4 dimensions and overall of patient satisfaction were used in analyses. Paired t tests were applied to analyze the rating agreement on physician services between outpatients and volunteers. Results: Overall, 90% of surveyed outpatients were satisfied with outpatient care in the tertiary public hospitals of Shanghai. The lowest three satisfaction rates were seen in the items of ‘Restrooms were sanitary and not crowded’ (81%), ‘It was convenient for the patient to pay medical bills’ (82%), and ‘Medical cost in the hospital was reasonable’ (84%). After adjusting the characteristics of patients, the patient satisfaction in general hospitals was higher than that in specialty hospitals. In addition, after controlling the patient characteristics and number of hospital visits, the hospitals with higher outpatient cost per visit had lower patient satisfaction. Paired t tests showed that the rating on 6 items in the dimension of physician services (total 14 items) was significantly different between outpatients and observers, in which 5 were rated lower by the observers than by the outpatients. Conclusions: The hospital managers and physicians should use patient satisfaction and observers’ evaluation to detect the room for improvement in areas such as social skills cost control, and medical ethics.

Keywords: patient satisfaction, observation, quality, hospital

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Authors: Nabil Omar, Farah Jibril, Oraib Amjad

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Purpose: Trabecatine is a is a potent marine-derived antineoplastic drug which binds to the minor groove of the DNA, bending DNA towards the major groove resulting in a changed conformation that interferes with several DNA transcription factors, repair pathways and cell proliferation. Trabectedin was approved by the European Medicines Agency (EMA; London, UK) for the treatment of adult patients with advanced stage soft tissue sarcomas in whom treatment with anthracyclines and ifosfamide has failed, or for those who are not candidates for these therapies. The recommended dosing regimen is 1.5 mg/m2 IV over 24 hours every 3 weeks. The purpose of this study was to comprehensively review available data on the safety and efficacy of trabectedin used as indicated for patients at a Tertiary Cancer Center at Qatar. Methods: A medication administration report generated in the electronic health record identified all patients who received trabectedin between November 1, 2015 and November 1, 2017. This retrospective chart review evaluated the indication of trabectedin use, compliance to administration protocol and the recommended monitoring parameters, number of patients improved on the drug and continued treatment, number of patients discontinued treatment due to side-effects and the reported side effects. Progress and discharged notes were utilized to report experienced side effects during trabectedin therapy. A total of 3 patients were reviewed. Results: Total of 2 out of 3 patients who received trabectedin were receiving it for non-FDA and non-EMA, approved indications; metastatic rhabdomyosarcoma and ovarian cancer stage IV with poor prognosis. And only one patient received it as indicated for leiomyosarcoma of left ureter with metastases to liver, lungs and bone. None of the patients has continued the therapy due to development of serious side effects. One patient had stopped the medication after one cycle due to disease progression and transient hepatic toxicity, the other one had disease progression and developed 12 % reduction in LVEF after 12 cycles of trabectedin, and the third patient deceased, had disease progression on trabectedin after the 10th cycle that was received through peripheral line which resulted in developing extravasation and left arm cellulitis requiring debridement. Regarding monitoring parameters, at baseline the three patients had ECHO, and Creatine Phosphokinase (CPK) but it was not monitored during treatment as recommended. Conclusion: Utilizing this medication as indicated with performing the appropriate monitoring parameters as recommended can benefit patients who are receiving it. It is important to reinforce the intravenous administration via central intravenous line, the re-assessment of left ventricular ejection fraction (LVEF) by echocardiogram or multigated acquisition (MUGA) scan at 2- to 3-month intervals thereafter until therapy is discontinued, and CPK and LFTs levels prior to each administration of trabectedin.

Keywords: trabectedin, drug-use evaluation, safety, effectiveness, adverse drug reaction, monitoring

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Authors: Eduardo Costa

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Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent, raising concerns in what respects patient safety. In fact, data shows that mortality rates for patients admitted during strikes are up to 30% higher than for patients admitted in other days. This paper analyses the effects of hospital strikes on patients’ outcomes. Specifically, it analyzes the impact of different strikes (physicians, nurses and other health professionals), on in-hospital mortality rates, readmission rates and length of stay. The paper uses patient-level data containing all NHS hospital admissions in mainland Portugal from 2012 to 2017, together with a comprehensive strike dataset comprising over 250 strike days (19 physicians-strike days, 150 nurses-strike days and 50 other health professionals-strike days) from 135 different strikes. The paper uses a linear probability model and controls for hospital and regional characteristics, time trends, and changes in patients’ composition and diagnoses. Preliminary results suggest a 6-7% increase in in-hospital mortality rates for patients exposed to physicians’ strikes. The effect is smaller for patients exposed to nurses’ strikes (2-5%). Patients exposed to nurses strikes during their stay have, on average, higher 30-days urgent readmission rates (4%). Length of stay also seems to increase for patients exposed to any strike. Results – conditional on further testing, namely on non-linear models - suggest that hospital operations and service levels are partially disrupted during strikes.

Keywords: health sector strikes, in-hospital mortality rate, length of stay, readmission rate

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Authors: Bouchaib Gazzaz, Mounir Mehdi

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In order to ensure consumer food protection, the food industry has a legal obligation to provide food products that comply with the requirements of the legislation in force. National regulations in this area occupy an important place in the food control system in terms of consumer protection. This article discusses the legal and regulatory framework of food safety and consumer protection in Moroccan law. We used the doctrinal research approach by analyzing the judicial normative and bibliographic legal research. As a result, we were able to present the basic principles of consumer food protection by showing to what extent the food safety law provides effective consumer protection in Morocco. We have concluded that there is an impact -in terms of consumer legal protection- of food law reform on the concept of food safety.

Keywords: food safety, Morocco, consumer protection, framework, food law

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Authors: Peter Collett, Mike Pynn, Haseeb Ur Rahman

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For the last few years across the UK there has been a push towards implementing treatment escalation plans (TEP) for every patient admitted to hospital. This is a paper form which is completed by a junior doctor then countersigned by the consultant responsible for the patient's care. It is designed to address what level of care is appropriate for the patient in question at point of entry to hospital. It helps decide whether the patient would benefit for ward based, high dependency or intensive care. They are completed to ensure the patient's best interests are maintained and aim to facilitate difficult decisions which may be required at a later date. For example, a frail patient with significant co-morbidities, unlikely to survive a pathology requiring an intensive care admission is admitted to hospital the decision can be made early to state the patient would not benefit from an ICU admission. This decision can be reversed depending on the clinical course of the patient's admission. It promotes discussions with the patient regarding their wishes to receive certain levels of healthcare. This poster describes the steps taken in the Aneurin Bevan University Health Board (ABUHB) when implementing the TEP form. The team implementing the TEP form campaigned for it's use to the board of directors. The directors were eager to hear of experiences of other health boards who had implemented the TEP form. The team presented the data produced in a number of health boards and demonstrated the proposed form. Concern was raised regarding the legalities of the form and that it could upset patients and relatives if the form was not explained properly. This delayed the effectuation of the TEP form and further research and discussion would be required. When COVID 19 reached the UK the National Institute for Health and Clinical Excellence issued guidance stating every patient admitted to hospital should be issued a TEP form. The TEP form was accelerated through the vetting process and was approved with immediate effect. The TEP form in ABUHB has now been in circulation for a month. An audit investigating it's uptake and a survey gathering opinions have been conducted.

Keywords: acute medicine, clinical governance, intensive care, patient centered decision making

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Authors: Mumtaz Mooncey, Alexander Jolly, Megan Fisher, Kerry Robinson, Robert Lloyd, Dave Fielding

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Introduction: The integration of the WingFactors in-situ simulation programme has transformed the education landscape at the Whittington Health NHS Trust. To date, there have been a total of 90 simulations - 19 aimed at Paediatric trainees, including 2 Child and Adolescent Mental Health (CAMHS) scenarios. The opportunity for joint debriefs provided by clinical faculty and airline pilots, has created a new exciting avenue to explore human factors within psychiatry. Through the use of real clinical environments and primed actors; the benefits of high fidelity simulation, interdisciplinary and interprofessional learning has been highlighted. The use of in-situ simulation within Psychiatry is a newly emerging concept and its success here has been recognised by unanimously positive feedback from participants and acknowledgement through nomination for the Health Service Journal (HSJ) Award (Best Education Programme 2021). Methodology: The first CAMHS simulation featured a collapsed patient in the toilet with a ligature tied around her neck, accompanied by a distressed parent. This required participants to consider:; emergency physical management of the case, alongside helping to contain the mother and maintaining situational awareness when transferring the patient to an appropriate clinical area. The second simulation was based on a 17- year- old girl attempting to leave the ward after presenting with an overdose, posing potential risk to herself. The safe learning environment enabled participants to explore techniques to engage the young person and understand their concerns, and consider the involvement of other members of the multidisciplinary team. The scenarios were followed by an immediate ‘hot’ debrief, combining technical feedback with Human Factors feedback from uniformed airline pilots and clinicians. The importance of psychological safety was paramount, encouraging open and honest contributions from all participants. Key learning points were summarized into written documents and circulated. Findings: The in-situ simulations demonstrated the need for practical changes both in the Emergency Department and on the Paediatric ward. The presence of airline pilots provided a novel way to debrief on Human Factors. The following key themes were identified: -Team-briefing (‘Golden 5 minutes’) - Taking a few moments to establish experience, initial roles and strategies amongst the team can reduce the need for conversations in front of a distressed patient or anxious relative. -Use of checklists / guidelines - Principles associated with checklist usage (control of pace, rigor, team situational awareness), instead of reliance on accurate memory recall when under pressure. -Read-back - Immediate repetition of safety critical instructions (e.g. drug / dosage) to mitigate the risks associated with miscommunication. -Distraction management - Balancing the risk of losing a team member to manage a distressed relative, versus it impacting on the care of the young person. -Task allocation - The value of the implementation of ‘The 5A’s’ (Availability, Address, Allocate, Ask, Advise), for effective task allocation. Conclusion: 100% of participants have requested more simulation training. Involvement of airline pilots has led to a shift in hospital culture, bringing to the forefront the value of Human Factors focused training and multidisciplinary simulation. This has been of significant value in not only physical health, but also mental health simulation.

Keywords: human factors, in-situ simulation, inter-professional, multidisciplinary

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Authors: Darma Putra Sitepu, Dewi Larasati, Yohanes Wolter Hendrik George

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Sepsis is a life-threatening medical emergency frequently observed in intensive care unit (ICU). Surviving Sepsis Campaign in 2018 has recommended the administration of early vasopressor in the first hour of sepsis or septic shock but has not yet included de-resuscitation protocol. De-resuscitation in acute management of septic shock is where patient received active removal of accumulated fluid. It has been proposed by some studies and ongoing clinical trials. Here we present a case with early vasopressor and de-resuscitation. Male, 27 years old presenting to the emergency room with shortness of breath, altered mental status, and widespread blisters on his body and lips started a few hours prior, after receiving non-steroidal anti-inflammatory drug through intravenous injection. Patient was hypotensive, tachycardic, and tachypneic at admission, diagnosed with Steven Johnson Syndrome with Septic Shock. Patient received fluid resuscitation, early vasopressor, and diuresis agent aimed to actively remove fluid after the initial phase of resuscitation. Patient was admitted to ICU and progressively recovering. At day-10, patient was stabilized and was transferred to general ward. Early vasopressor and de-resuscitation are beneficial for the patient.

Keywords: sepsis, shock, de-resuscitation, vasopressor, fluid, case report

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Authors: Dalila Chaid, Yacine Houmel, Mohamed Lamine Belloulou

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Peripheral neuropathy is a rare but worrying complication of peripheral local anaesthesia. It is caused either by needle contact with the nerve root or by the direct toxicity of local anaesthetics, leading to nerve damage, injury or irritation. Although uncommon, it remains a major concern for anaesthetists. The aim of the study was to assess the prevalence of nerve block-associated neuropathy in knee surgery and to identify the contributing factors in order to minimise the occurrence of this complication. The study also assessed the severity and evolution of lesions, as well as the factors leading to neuropathic pain. Methodology: It is a retrospective observational study on cases of neuropathy related to nerve blocks of the lower limb for knee surgery over a period of seven years (2016-2022). The study included a total of 6,000 patients Analyse the anaesthetic and neuropathic pain-related parameters received from these patients to determine the prevalence and severity of neuropathy. Findings: the prevalence of nerve block-related neuropathy in our study is 5.8‰ for the sciatic nerve and 0.9‰ for the femoral nerve. This was higher compared to the reported rates in the literature, which were between 0.0 to 5‰ for the Sciatic nerve and 0.0 to 3.4‰ for the femoral nerve. These findings highlight the importance of identifying and implementing an ideal anesthesia procedure to reduce the risk of neuropathy associated with nerve blocks. Theoretical Importance: The findings of this study contribute to the existing literature on peripheral neuropathy following locoregional anesthesia. By identifying the prevalence and severity of neuropathy related to nerve blocks, as well as the underlying factors, we provide valuable insights for anesthetists to improve patient safety. This study also emphasizes the need for compliance with technical safety rules to minimize the occurrence of neuropathy. Data Collection and Analysis Procedures: For this study, 25 clinics with retrospective data were collected of neuropathy associated with nerve blocks for knee surgery over a span of seven years. Parameters related to anaesthesia and neuropathic pain were analysed to determine prevalence,severity, and progression of neuropathy. Comparison of our results with the existing literature in order to assess their significance. Questions Addressed: This study aims to define the following points: 1. The prevalence of neuropathy associated with nerve blocks for knee surgery. 2. The factors underlying the development of neuropathy after nerve blocks. 3. Reducing the risk of neuropathy by complying with technical safety rules. 4. Assessing the severity and evolution of neuropathic pain in these cases. Conclusion: this study highlights the need for careful consideration and implementation of anesthesia procedures during nerve blocks for knee surgery. The prevalence of neuropathy linked to these blocks was higher compared to the literature, emphasizing the importance of identifying and minimizing contributing factors. Compliance with technical safety rules is crucial to reduce the risk of peripheral neuropathy. This study provides valuable insights to anesthetists and contributes to improving patient safety in the field of locoregional anesthesia.

Keywords: phantom limb, neuropathic pain, lower limb amputee, ultrasound-guided locoreginal anesthesia

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Authors: Reza Davoodi, Hamid Abbasi, Heidar Norouzi, Gholamabbas Alipourian

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A dynamic model shaping a process of knowledge management (KM) culture change is suggested. It is aimed at providing effective KM of employees for obtaining desired results in an organization. The essential requirements for obtaining KM culture change are determined. The proposed model realizes these requirements. Dynamics of the model are expressed by a change of its parameters. It is adjusted to the dynamic process of KM culture change. Building the model includes elaboration and integration of interconnected components. The “Result” is a central component of the model. This component determines a desired organizational goal and possible directions of its attainment. The “Confront” component engenders constructive confrontation in an organization. For this reason, the employees are prompted toward KM culture change with the purpose of attaining the desired result. The “Assess” component realizes complex assessments of employee proposals by management and peers. The proposals are directed towards attaining the desired result in an organization. The “Reward” component sets the order of assigning rewards to employees based on the assessments of their proposals.

Keywords: knowledge management, organizational culture change, employee, result

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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: Kevin Yeo, Christine Hall, Babinchak Tim

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BAT® [Botulism Antitoxin Heptavalent (A,B,C,D,E,F,G)-(Equine)] anti-toxin is a mixture of equine immune globulin fragments indicated for the treatment of symptomatic botulism in adult and pediatric patients. The effectiveness of BAT anti-toxin is based on efficacy studies conducted in animal models. A general explanation of the pivotal animal studies, post market surveillance and outcomes of an observational patient registry for patients treated with BAT product distributed in the USA is briefly discussed. Overall it took 20 animal studies for two well-designed and appropriately powered pivotal efficacy studies – one in which the effectiveness of BAT was assessed against all 7 serotypes in the guinea pig, and the other where efficacy is confirmed in the Rhesus macaque using Serotype A. Clinical Experience for BAT to date involves approximately 600 adult and pediatric patients with suspected botulism. In pre-licensure, patient data was recorded under the US CDC expanded access program (259 adult and pediatric patients between 10 days to 88 years of age). In post licensure, greater than 350 patients to date have received BAT and been followed up by enhanced expanded access program. The analysis of the post market surveillance data provided a unique opportunity to demonstrate clinical benefit in the field study required by the animal rule. While the animal rule is applied because human efficacy studies are not ethical or feasible, a post-marketing requirement is to conduct a study to evaluate safety and clinical benefit when circumstances arise and demonstrate the favourable benefit-risk profile that supported licensure.

Keywords: botulism, threat, clinical benefit, observational patient registry

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Authors: Suheyla Saritas

Abstract:

No matter who we are or where we live, our lives revolve around food, which is much more than a merely sustenance. As a part of the human culture, food carries complex significance and symbolic meanings. Turkish people attribute great value to food and its usage specifically tied to rites of passages of human life. Traditions, especially the ones practiced during rites of passages, such as birth, circumcisions, weddings and funerals, have always been accompanied by food in Turkish culture. Since food celebrates and symbolizes human progress in life in the culture, it also surrounds by aspects of belief, custom, magic, ritual and religion and has always been used in ceremonial context during such rites. Even though that context may be different depending on the religious, economic and social nuances of the various Turkish regions, like wheat, meat and bread, certain kinds of food play key roles during Turkish rites, generally upholding traditions. This paper highlights the sociocultural aspect of food in the rites of passages in the Turkish culture. The importance of this work also is how the ceremonial food represents the identity of Turkish people.

Keywords: food, culture, rites of passages, ritual and identity

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Authors: Sangbok Lee

Abstract:

There has been much effort on process improvement for outpatient clinics to provide quality and acute care to patients. One of the efforts is no-show analysis or prediction. This work analyzes patient no-shows along with patient health conditions. The health conditions refer to clinical symptoms that each patient has, out of the followings; hyperlipidemia, diabetes, metastatic solid tumor, dementia, chronic obstructive pulmonary disease, hypertension, coronary artery disease, myocardial infraction, congestive heart failure, atrial fibrillation, stroke, drug dependence abuse, schizophrenia, major depression, and pain. A dataset from a regional hospital is used to find the relationship between the number of the symptoms and no-show probabilities. Additional analysis reveals how each symptom or combination of symptoms affects no-shows. In the above analyses, cross-classification of patients by age and gender is carried out. The findings from the analysis will be used to take extra care to patients with particular health conditions. They will be forced to visit clinics by being informed about their health conditions and possible consequences more clearly. Moreover, this work will be used in the preparation of making institutional guidelines for patient reminder systems.

Keywords: healthcare system, no show analysis, process improvment, statistical data analysis

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Authors: Mahmoud Hassanin, Roshan Thawale, Kiran Yelamati

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Background: During current practice, intraoperative regular endotracheal cuff pressure monitoring is not routine, despite the significant number of clinicians interested in checking it after intubation to ensure a good seal and adequate ventilation. Aims and objectives: to highlight that the current practice has no guidance related to regular intra-operative monitoring of the endotracheal tube cuff pressure, which can improve patient safety and post-operative experience. Methods: local department survey was done targeting anaesthetists' current practice, measuring their knowledge and problem awareness to improve patient satisfaction and change the current approach. Results: The participants were not using the manometer, despite their interest in ensuring that the cuff pressure was high enough and there was a proper seal. More than 50% of the participant don't know the ideal range of the endotracheal tube cuff pressure range, and 32% don't know whether it is available or not in the theatre. Despite the previous finding, 100% of the participants used different methods to ensure adequate cuff pressure. The collected data revealed that at least 26% of the participant confirmed that they had seen patients having post-intubation complications. Conclusion: There is an increasing importance placed on quality assurance. Clinical practice varies widely among practitioners, with the only consistency being the omission of cuff manometers during routine intra-operative management, despite their proven benefit and efficacy. Encourage the anaesthetists and ODPs to use cuff pressure manometers. The availability of portable pressure manometers can help to maintain safe cuff pressures in patients requiring endotracheal intubation.

Keywords: endotracheal cuff pressure, intra-operative monitoring, current practice, patient satisfaction

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Authors: Shahna K. C., Belay Menon, Taniya Joshua

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As globalization in the era progresses, spatial inequality is turned to be one of the major concerns; the main intent of the Study is to focus on if there is any interdependencies of culture economy and resource availability on creating spatial inequality in cities. The paper tries to establish the relationship between spatial inequality – the quality of life – the DETERMINANT TRIAD (culture, economy, resource availability). Slum area of Dharavi is taken to evaluate the influence of these determinants on the quality of life as spatial inequality is evident there. Interdependencies of the determinants on creating spatial inequality is evaluated. For this, It is understood that these three parameters, i.e., culture, economy, resource availability, are determinants of urban design, each from the social, economic, environmental domains of sustainability, respectively. And there are studies individually on each of these aspects, how they determine the urban spaces, and how influential on the whole process of urbanization. Now extending the study towards the interdependencies of these three so as to find out how these trilogy shapes the urban form and space.

Keywords: spatial inequality, culture, economy, resource availability, quality of life

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