Search results for: surgical tool

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic, biopsy, diabetic foot

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Authors: Suvorov Vasyl, Filipchuk Viktor

Abstract:

Background: If non-surgical treatment of developmental dysplasia of the hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases. The objectives of this study were to assess the results after SPO, evaluate risk factors, and reveal those radiological parameters that may correlate with the results. Mid- and long-term postoperative results after SPO in 17 patients (22 hip joints) were analyzed. Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction, we referred distance "d" and the lateral rotation angle. Results: SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient’s age and higher preoperative AI values (p < 0.05). The risk factor that depends on the surgeon was the amount of AI correction (p < 0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p < 0.05). Conclusion: In older patients with a higher preoperative AI value, the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values).

Keywords: developmental dysplasia of the hip, results, risk factor, pelvic osteotomy, salter osteotomy

Procedia PDF Downloads 131

Authors: M. Ridwanul Hassan, Samuel George

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Aims: Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Methods: We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results: On examination, she had a 0.5 cmx1 cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout, and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one month following her operation. Conclusions: This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.

Keywords: hand surgery, complication, rare, carpal tunnel syndrome

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Authors: Puntarikorn Rungrattanakasin

Abstract:

Objectives: To develop the trigger tool to warn about the risk of bleeding as an adverse event from warfarin drug usage during admission in Medical Wards of Chumphae Hospital. Methods: A retrospective study was performed by reviewing the medical records for the patients admitted between June 1st,2020- May 31st, 2021. ADEs were evaluated by Naranjo’s algorithm. The international normalized ratio (INR) and events of bleeding during admissions were collected. Statistical analyses, including Chi-square test and Reciever Operating Characteristic (ROC) curve for optimal INR threshold, were used for the study. Results: Among the 139 admissions, the INR range was found to vary between 0.86-14.91, there was a total of 15 bleeding events, out of which 9 were mild, and 6 were severe. The occurrence of bleeding started whenever the INR was greater than 2.5 and reached the statistical significance (p <0.05), which was in concordance with the ROC curve and yielded 100 % sensitivity and 60% specificity in the detection of a bleeding event. In this regard, the INR greater than 2.5 was considered to be an optimal threshold to alert promptly for bleeding tendency. Conclusions: The INR value of greater than 2.5 (>2.5) would be an appropriate trigger tool to warn of the risk of bleeding for patients taking warfarin in Chumphae Hospital.

Keywords: trigger tool, warfarin, risk of bleeding, medical wards

Procedia PDF Downloads 148

Authors: Mohammed Usman Sani

Abstract:

Worldwide it is observed that sport plays an important role in our communities and is capable of bringing about the need for peaceful coexistence within and among nations which include tolerating one another, building team spirit, showing loyalty and fair play. In addition, sport builds character and the development of skills, which are necessary in fulfilling a desirable and happy life among nations. Sport builds discipline, endurance, courage and self-motivation among nations. Sports for Peace was set up to answer the question of whether sport can foster common ideals. In sports as a powerful tool in building peace, athletes all over the world come together to promote the core values of sport, such as fair play, tolerance, the Olympic ideal of freedom and intercultural understanding. Sport as a powerful tool is used to address varieties of social issues that is widely accepted in countries mostly affected by poverty, violence and conflict. In building peace through sports among nations, a wide range of individuals and nonprofit organizations which includes the United Nations (UN) and international development agencies have accepted sport as an important social catalyst. This paper therefore seeks to define sports, sports and its fundamental rights, sports as a powerful tool, and ways in which sport may bring about peace building among countries and finally the status of Sport Development and Peace initiatives in Nigeria. It concluded that the international community has acknowledged the importance of sport in peace building efforts among nations. It further recommended that countries should engage in the design and delivery of sports, adhering to generally accepted principles of openness and sustainability through sports collaboration, sports partnerships and coordinated effort.

Keywords: building, peace, powerful tool, sports

Procedia PDF Downloads 273

Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 103

Authors: Suehyun Cho, Darrell Harrington, Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Alex Kiselyov, Michael Shpigelmacher

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The Dandy-Walker malformation (DWM) represents a clinical syndrome manifesting as a combination of posterior fossa cyst, hypoplasia of the cerebellar vermis, and obstructive hydrocephalus. Anatomic hallmarks include hypoplasia of the cerebellar vermis, enlargement of the posterior fossa, and cystic dilatation of the fourth ventricle. Current treatments of DWM, including shunting of the cerebral spinal fluid ventricular system and endoscopic third ventriculostomy (ETV), are frequently clinically insufficient, require additional surgical interventions, and carry risks of infections and neurological deficits. Bionaut Labs develops an alternative way to treat Dandy-Walker Malformation (DWM) associated with non-communicating hydrocephalus. We utilize our discreet microsurgical Bionaut™ particles that are controlled externally and remotely to perform safe, accurate, effective fenestration of the Dandy-Walker cyst, specifically in the posterior fossa of the brain, to directly normalize intracranial pressure. Bionaut™ allows for complex non-linear trajectories not feasible by any conventional surgical techniques. The microsurgical particle safely reaches targets in the lower occipital section of the brain. Bionaut™ offers a minimally invasive surgical alternative to highly involved posterior craniotomy or shunts via direct fenestration of the fourth ventricular cyst at the locus defined by the individual anatomy. Our approach offers significant advantages over the current standards of care in patients exhibiting anatomical challenge(s) as a manifestation of DWM, and therefore, is intended to replace conventional therapeutic strategies. Current progress, including platform optimization, Bionaut™ control, and real-time imaging and in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of ovine models, will be discussed.

Keywords: Bionaut™, cerebral spinal fluid, CSF, cyst, Dandy-Walker, fenestration, hydrocephalus, micro-robot

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Authors: Arenca Trashani

Abstract:

20 years after its first entrance in a General Assembly of the United Nation’s Resolution, human security has became a very important tool in a global debate affecting directly the whole main rules and regulations in international law and more closely in international human rights law. This paper will cover a very important issue of today at how the human security has its impact to the development of international human rights law, not as far as a challenge as it is seen up now but a tool of moving toward development and globalization. In order to analyze the impact of human security to the global agenda, we need to look to the main pillars of the international legal order which are affected by the human security in itself and its application in the policy making for this international legal order global and regional ones. This paper will focus, also, on human security, as a new and very important tool of measuring development, stability and the level of democratic consolidation and the respect for human rights especially in developing countries such as Albania. The states are no longer capable to monopolize the use of human security just within their boundaries and separated from the other principles of a functioning democracy. In this context, human security would be best guaranteed under the respect of the rule of law and democratization. During the last two decades the concept security has broadly developed, from a state-centric to a more human-centric approach: from state security to respect for human rights, to economic security, to environmental security as well. Last but not least we would see that human rights could be affected by human security not just at their promotion but also at their enforcement and mainly at the international institutions, which are entitled to promote and to protect human rights.

Keywords: human security, international human rights law, development, Albania, international law

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Authors: Paawani Tewari, Oishik Dasgupta

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Cinema and politics have often intertwined in India. Movies have become a mainstream method of communication with audiences and voters subliminally and directly. Indian film industry on average produces over a thousand films in a year, and during the election year of 2019, India witnessed the release of several highly political movies. Movies such as Uri: The Surgical Strike, Accidental Prime Minister, and PM Modi, et cetera, which are the sample of this study have tried to depict an ideal character of political stalwart leaders with the plausibility to inspire and aiming to change ideological orientations of viewers and the potent voters. This study tries to understand the major links between nationalism, its representation, and its manifestation in Indian cinema and how it is instrumental in shaping the character and orientations of its citizens towards nation, nationalism, and nationhood. Our work aims to highlight how nationalistic assumptions that are swaddled in the Hindi movies released during January 2019 – May 2019 affect the political mood of the nation and, in totality, the democratic system. The authors also try to throw light on how films being a powerful tool, are now being used to shape ideas, brainwashing and swaying opinions for political mileage. Hence it becomes essential for us to explore the dynamics between the quintessential definitions of what nationalism is for a common man in India versus of what has been represented in cinema, especially during the time of the elections.

Keywords: political governance and political analysis, political and public administration, election, public choice

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Authors: Nadeem Hassan, Farooq Ahmad

Abstract:

The quality of education has a direct impact on individual, family, society, economy in general and the mankind as a whole. Because of that thousands of research papers and articles are written on the quality of education, billions of dollars are spent and continuously being spent on research and enhancing the quality of education. Academic programs accredited agencies define the various criterion of quality of education; academic institutions obtain accreditation from these agencies to ensure degree programs offered at their institution are of international standards. This R&D aims to build a web based analytical tool (OptiBaha) that finds the gaps in AlBaha University education system by taking input from stakeholders, including students, faculty, staff and management. The input/online-data collected by this tool will be analyzed on core areas of education as proposed by accredited agencies, CAC of ABET and NCAAA of KSA, including student background, language, culture, motivation, curriculum, teaching methodology, assessment and evaluation, performance and progress, facilities, availability of teaching materials, faculty qualification, monitoring, policies and procedures, and more. Based on different analytical reports, gaps will be highlighted, and remedial actions will be proposed. If the tool is implemented and made available through a continuous process the quality of education at AlBaha University can be enhanced, it will also help in fulfilling criterion of accreditation agencies. The tool will be generic in nature and ultimately can be used by any academic institution.

Keywords: academic quality, accreditation agencies, higher education, policies and procedures

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Authors: S. Ghorbani, N. I. Polushin

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In this study, an approach to identify factors affecting on surface roughness in a machining process is presented. This study is based on 81 data about surface roughness over a wide range of cutting tools (conventional, cutting tool with holes, cutting tool with composite material), workpiece materials (AISI 1045 Steel, AA2024 aluminum alloy, A48-class30 gray cast iron), spindle speed (630-1000 rpm), feed rate (0.05-0.075 mm/rev), depth of cut (0.05-0.15 mm) and tool overhang (41-65 mm). A single decision tree (SDT) analysis was done to identify factors for predicting a model of surface roughness, and the CART algorithm was employed for building and evaluating regression tree. Results show that a single decision tree is better than traditional regression models with higher rate and forecast accuracy and strong value.

Keywords: cutting condition, surface roughness, decision tree, CART algorithm

Procedia PDF Downloads 375

Authors: Payal Abichandani, Rishi Prakash, Paras Nath Barwal, B. K. Murthy

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Information generated from various computerization processes is a potential rich source of knowledge for its designated community. To pass this information from generation to generation without modifying the meaning is a challenging activity. To preserve and archive the data for future generations it’s very essential to prove the authenticity of the data. It can be achieved by extracting the metadata from the data which can prove the authenticity and create trust on the archived data. Subsequent challenge is the technology obsolescence. Metadata extraction and standardization can be effectively used to resolve and tackle this problem. Metadata can be categorized at two levels i.e. Technical and Domain level broadly. Technical metadata will provide the information that can be used to understand and interpret the data record, but only this level of metadata isn’t sufficient to create trustworthiness. We have developed a tool which will extract and standardize the technical as well as domain level metadata. This paper is about the different features of the tool and how we have developed this.

Keywords: digital preservation, metadata, OAIS, PDI, XML

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Authors: C. A. Barros, Ana P. Barroso

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Any industrial company needs to determine the amount of variation that exists within its measurement process and guarantee the reliability of their data, studying the performance of their measurement system, in terms of linearity, bias, repeatability and reproducibility and stability. This issue is critical for automotive industry suppliers, who are required to be certified by the 16949:2016 standard (replaces the ISO/TS 16949) of International Automotive Task Force, defining the requirements of a quality management system for companies in the automotive industry. Measurement System Analysis (MSA) is one of the mandatory tools. Frequently, the measurement system in companies is not connected to the equipment and do not incorporate the methods proposed by the Automotive Industry Action Group (AIAG). To address these constraints, an R&D project is in progress, whose objective is to develop a web and cloud-based MSA tool. This MSA tool incorporates Industry 4.0 concepts, such as, Internet of Things (IoT) protocols to assure the connection with the measuring equipment, cloud computing, artificial intelligence, statistical tools, and advanced mathematical algorithms. This paper presents the preliminary findings of the project. The web and cloud-based MSA tool is innovative because it implements all statistical tests proposed in the MSA-4 reference manual from AIAG as well as other emerging methods and techniques. As it is integrated with the measuring devices, it reduces the manual input of data and therefore the errors. The tool ensures traceability of all performed tests and can be used in quality laboratories and in the production lines. Besides, it monitors MSAs over time, allowing both the analysis of deviations from the variation of the measurements performed and the management of measurement equipment and calibrations. To develop the MSA tool a ten-step approach was implemented. Firstly, it was performed a benchmarking analysis of the current competitors and commercial solutions linked to MSA, concerning Industry 4.0 paradigm. Next, an analysis of the size of the target market for the MSA tool was done. Afterwards, data flow and traceability requirements were analysed in order to implement an IoT data network that interconnects with the equipment, preferably via wireless. The MSA web solution was designed under UI/UX principles and an API in python language was developed to perform the algorithms and the statistical analysis. Continuous validation of the tool by companies is being performed to assure real time management of the ‘big data’. The main results of this R&D project are: MSA Tool, web and cloud-based; Python API; New Algorithms to the market; and Style Guide of UI/UX of the tool. The MSA tool proposed adds value to the state of the art as it ensures an effective response to the new challenges of measurement systems, which are increasingly critical in production processes. Although the automotive industry has triggered the development of this innovative MSA tool, other industries would also benefit from it. Currently, companies from molds and plastics, chemical and food industry are already validating it.

Keywords: automotive Industry, industry 4.0, Internet of Things, IATF 16949:2016, measurement system analysis

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Authors: Sujata Chaturvedi, Ishita Pant, Deepak Kumar Jha, Vinod Kumar Singh Gautam, Chandra Bhushan Tripathi

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Objective: To describe clinical, histopathological and immunohistochemical profile of glioblastoma in patients and to correlate these findings with patient survival. Material and methods: 30 cases of histopathologically diagnosed glioblastomas were included in this study. These cases were analysed in detail for certain clinical and histopathological parameters. Immunohistochemical staining for p53, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), mouse double minute 2 homolog (MDM2) and Ki67 was done and scores were calculated. Results of these findings were correlated with patient survival. Results: A retrospective analysis of the histopathology records and clinical case files was done in 30 cases of glioblastoma (WHO grade IV). The mean age of presentation was 50.6 years with a male predilection. The most common involved site was the frontal lobe. Amongst the clinical parameters, age of the patient and extent of surgical resection showed a significant correlation with the patient survival. Histopathological parameters showed no significant correlation with the patient survival, while amongst the immunohistochemical parameters expression of MDM2 showed a significant correlation with the patient survival. Conclusion: In this study incorporating clinical, histopathological and basic panel of immunohistochemistry, age of the patient, extent of the surgical resection and expression of MDM2 showed significant correlation with the patient survival.

Keywords: glioblastoma, p53, EGFR, VEGF, MDM2, Ki67

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Authors: S. Sulaiman, M. A. Razak, M. R. Ibrahim, A. A. Khan

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An experimental work on the effect of different current and pulse duration on performance of EDM process of Allegheny Ludlum D2 Tool Steel (UNS T30402). The effect of varying the machining parameters on the machining responses such as material removal rate (MRR), electrode wear rate (EWR), and surface roughness (Ra) have been investigated. In this study, triangular shape and circular shape of copper was used as an electrode with surface area of 100 mm². The experiments were repeated for three different values of pulse duration (100 µs, 200 µs and 400 µs) with combination of three different values of discharge current (12 A, 16 A and 24 A). It was found that the pulse duration and current have significant effect on MRR, EWR and Ra. An increase in the pulse durations causes an increase in the MRR and Ra, but a decrease in the EWR. Meanwhile, the effect of currents on EDM performance shows that the increasing currents lead to an increase in the MRR, EWR and Ra.

Keywords: allegheny ludlum D2 tool steel, current, EDM, surface roughness, pulse duration

Procedia PDF Downloads 379

Authors: Shadan Dwairi

Abstract:

Defining proper requirements is one of the key factors for a successful construction projects. Although there have been many attempts put forward in assist in identifying requirements, but still this area is under developed. In Buildings Information Modelling (BIM) projects. The Employer Information Requirements (EIR) is the fundamental requirements document and a necessary ingredient in achieving a successful BIM project. The provision on full and clear EIR is essential to achieving BIM Level-2. As Defined by PAS 1192-2, EIR is a “pre-tender document that sets out the information to be delivered and the standards and processes to be adopted by the supplier as part of the project delivery process”. It also notes that “EIR should be incorporated into tender documentation to enable suppliers to produce an initial BIM Execution Plan (BEP)”. The importance of effective definition of EIR lies in its contribution to a better productivity during the construction process in terms of cost and time, in addition to improving the quality of the built asset. Proper and clear information is a key aspect of the EIR, in terms of the information it contains and more importantly the information the client receives at the end of the project that will enable the effective management and operation of the asset, where typically about 60%-80% of the cost is spent. This paper reports on the research done in developing the Ontology-based tool for Employer Information Requirements (OntEIR). OntEIR has proven the ability to produce a full and complete set of EIRs, which ensures that the clients’ information needs for the final model delivered by BIM is clearly defined from the beginning of the process. It also reports on the work being done into transforming OntEIR into a smart tool for Defining Employer Information Requirements (smartEIR). smartEIR transforms the OntEIR tool into enabling it to develop custom EIR- tailored for the: Project Type, Project Requirements, and the Client Capabilities. The initial idea behind smartEIR is moving away from the notion “One EIR fits All”. smartEIR utilizes the links made in OntEIR and creating a 3D matrix that transforms it into a smart tool. The OntEIR tool is based on the OntEIR framework that utilizes both Ontology and the Decomposition of Goals to elicit and extract the complete set of requirements needed for a full and comprehensive EIR. A new ctaegorisation system for requirements is also introduced in the framework and tool, which facilitates the understanding and enhances the clarification of the requirements especially for novice clients. Findings of the evaluation of the tool that was done with experts in the industry, showed that the OntEIR tool contributes towards effective and efficient development of EIRs that provide a better understanding of the information requirements as requested by BIM, and support the production of a complete BIM Execution Plan (BEP) and a Master Information Delivery Plan (MIDP).

Keywords: building information modelling, employer information requirements, ontology, web-based, tool

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Authors: Thirasak Panyaphirawat, Pairoj Sapsmarnwong, Teeratas Pornyungyuen

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This paper presents the findings of an experimental investigation of important machining parameters for the horizontal boring tool modified to mouth with a horizontal lathe machine to bore an overlength workpiece. In order to verify a usability of a modified tool, design of experiment based on Taguchi method is performed. The parameters investigated are spindle speed, feed rate, depth of cut and length of workpiece. Taguchi L9 orthogonal array is selected for four factors three level parameters in order to minimize surface roughness (Ra and Rz) of S45C steel tubes. Signal to noise ratio analysis and analysis of variance (ANOVA) is performed to study an effect of said parameters and to optimize the machine setting for best surface finish. The controlled factors with most effect are depth of cut, spindle speed, length of workpiece, and feed rate in order. The confirmation test is performed to test the optimal setting obtained from Taguchi method and the result is satisfactory.

Keywords: design of experiment, Taguchi design, optimization, analysis of variance, machining parameters, horizontal boring tool

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Authors: Imam Asrowardi, Septafiansyah Dwi Putra, Eko Subyantoro

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Process assessments can improve IT service management system (IT SMS) processes but the assessment method is not always transparent. This paper outlines a project to develop a solution- mediated process assessment tool to enable transparent and objective SMS process assessment. Using the international standards for SMS and process assessment, the tool is being developed following the International standard approach in collaboration and evaluate by expert judgment from committee members and ITSM practitioners.

Keywords: SMS, tools evaluation, ITIL, ISO service

Procedia PDF Downloads 480

Authors: Li-Ting Kung, Hui-Zhu Chen, Hsin-Tzu Lee, Wan-Yin Hsu

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Patients with spinal cord injury combined with diabetic nephropathy may under a lot of painful conditions due to complications related to the illness itself or treatments, such as recurrent pressure ulcers, autonomic and peripheral neuropathy, as well as dialysis, for long term. This case report illustrated the nursing experience of transferring a spine cord injure patient who received hemodialysis due to adverse lifestyle-induced diabetic nephropathy to the hospice ward. Nursing care was provided in this patient from July 25th to August 30th, 2015. The tool of 'Gordon’s 11-item functional health assessment' and clinical observation, interviews as well as physical examination were used as data collections. Based on results of health assessment as above, the patient’s health problems were identified as the following: impaired skin integrity, chronic pain, and hopeless. Besides to relieve the symptom of pain due to disease or the treatment of hemodialysis and provide wound care, the first author also played a role to assist the patient to achieve his goal of receiving the hospice palliative care. Finally, with much effort of nurses to communicate with medical teams between the surgical and hospice wards, the patient was transferred to the hospice ward to have fulfilled his last wish of having a good death. We hope this nursing experience can be applied to other similar cases in the future.

Keywords: diabetic nephropathy, hospice care, palliative care, spinal cord injury

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Authors: B. Adini, M. Oren

Abstract:

Introduction: Communicable diseases and pandemics pose a growing threat to the well-being of the global population. A vital component of protecting the public health is the creation and sustenance of a continuous preparedness for such hazards. A joint Israeli-German task force was deployed in order to develop an advanced tool for self-evaluation of emergency preparedness for variable types of biological threats. Methods: Based on a comprehensive literature review and interviews with leading content experts, an evaluation tool was developed based on quantitative and qualitative parameters and indicators. A modified Delphi process was used to achieve consensus among over 225 experts from both Germany and Israel concerning items to be included in the evaluation tool. Validity and applicability of the tool for medical institutions was examined in a series of simulation and field exercises. Results: Over 115 German and Israeli experts reviewed and examined the proposed parameters as part of the modified Delphi cycles. A consensus of over 75% of experts was attained for 183 out of 188 items. The relative importance of each parameter was rated as part of the Delphi process, in order to define its impact on the overall emergency preparedness. The parameters were integrated in computerized web-based software that enables to calculate scores of emergency preparedness for biological events. Conclusions: The parameters developed in the joint German-Israeli project serve as benchmarks that delineate actions to be implemented in order to create and maintain an ongoing preparedness for biological events. The computerized evaluation tool enables to continuously monitor the level of readiness and thus strengths and gaps can be identified and corrected appropriately. Adoption of such a tool is recommended as an integral component of quality assurance of public health and safety.

Keywords: biological events, emergency preparedness, bioterrorism, natural biological events

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Authors: Subramanyam Devarakonda Hanumantharao, Udayendu Prakash Sharma, Mahesh Garg

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Introduction: Gomabai Netralaya a reputed eye hospital is located in Neemuch a small city of Madhya Pradesh, India. The hospital is established in 1992 by Late. G.D Agrawal a renowned educationist, freedom fighter and philanthropist. The eye hospital was established to serve all sections of the society in affordable manner. To provide comprehensive eye care services to the rural poor the hospital started organizing outreach camps since 1994. Purpose: To study the cost effectiveness of outreach eye camps for addressing the sustainability issues of the outreach program. Methods: One year statistics of outreach eye camps were collected from Hospital Management Information System software to analyze the productivity of camps. Income and expenses report was collected from outreach department records to analyze per camp expenses and per patient expenses against the income generated. All current year records were analyzed to have accuracy of information and results. Information was collected in two ways: 1)Actual camp performance records and expenses from book of accounts. 2)Cross verification was done through one to one discussion with outreach staff. Results: Total 17534 outpatients were examined through 52 outreach eye camps. Total 6042 (34% of total outpatients) patients were advised with cataracts and 4651 (77% of advice) operations were performed. The average OPD per camp was 337 and per camp 116 patients was advised for cataract surgery and 89 surgeries were performed per camp. Total 18200 US$ incurred on organizing 52 outreach camps in the radius of 100 k.ms. Considering the total outpatients screened through camps the screening cost per patient was 1.00 US$ and considering the surgical output the per surgery expenses was 4.00 US$. The cost recovery of the total expenses was through Government grant of US$ 16.00 per surgery (that includes surgical grant). All logistics cost of camps and patients transportation cost was taken care by local donors. Conclusion: The present study demonstrates that with people’s participation, successful high volume outreach eye camps can be organized. The cost effectiveness of the outreach camps is totally depended on volume of outpatient’s turn-up at camp site and per camp surgical output. The only solution to sustainability of outreach eye camps is sharing of cost with local donors and increasing productivity.

Keywords: camps, outreach, productivity, sustainable

Procedia PDF Downloads 171

Authors: Santosh Sharma Parajuli, Diwas Manandhar

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Background: Perioperative pain management plays an integral part in patients undergoing cardiac surgery. We studied the effect of Erector Spinae Plane block on acute postoperative pain reduction and 24 hours opioid consumption in adult cardiac surgical patients. Methods: Twenty-five adult cardiac surgical patients who underwent cardiac surgery with sternotomy in whom ESP catheters were placed preoperatively were kept in group E, and the other 25 patients who had undergone cardiac surgery without ESP catheter and pain management done with conventional opioid injection were placed in group C. Fentanyl was used for pain management. The primary study endpoint was to compare the consumption of fentanyl and to assess the numeric rating scale in the postoperative period in the first 24 hours in both groups. Results: The 24 hours fentanyl consumption was 43.00±51.29 micrograms in the Erector Spinae Plane catheter group and 147.00±60.94 micrograms in the control group postoperatively which was statistically significant (p <0.001). The numeric rating scale was also significantly reduced in the Erector Spinae Plane group compared to the control group in the first 24 hours postoperatively. Conclusion: Erector Spinae Plane block is superior to the conventional opioid injection method for postoperative pain management in CABG patients. Erector Spinae Plane block not only decreases the overall opioid consumption but also the NRS score in these patients.

Keywords: erector, spinae, plane, numerical rating scale

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Authors: Bang Haeyong

Abstract:

Purpose: The objectives of this study were to determine the prevalence, incidence, and risk factors for postoperative fever after lumbar fusion. Methods: This study was a retrospective chart review of 291 patients who underwent lumbar fusion between March 2015 and February 2016 at the Asan Medical Center. Information was extracted from electronic medical records. Postoperative fever was measured at Tmax > 37.7 ℃ and Tmax > 38.3 ℃. The presence of postoperative fever, blood culture, urinary excretion, and/or chest x-ray were evaluated. Patients were evaluated for infection after lumbar fusion. Results: We found 222 patients (76.3%) had a postoperative temperature of 37.7 ℃, and 162 patients (55.7%) had a postoperative temperature of 38.3 ℃ or higher. The percentage of febrile patients trended down following the mean 1.8days (from the first postoperative day to seventh postoperative day). Infection rate was 9 patients (3.1%), respiratory virus (1.7%), urinary tract infection (0.3%), phlebitis (0.3%), and surgical site infection (1.4%). There was no correlation between Tmax > 37.7℃ or Tmax > 38.3℃, and timing of fever, positive blood or urine cultures, pneumonia, or surgical site infection. Risk factors for increased postoperative fever following surgery were confirmed to be delay of defecation (OR=1.37, p=.046), and shorten of remove drainage (OR=0.66, p=.037). Conclusions: The incidence of fever was 76.3% after lumbar fusion and the drainage time was faster in the case of fever. It was thought that the bleeding was absorbed at the operation site and fever occurred. The prevalence of febrile septicemia was higher in patients with long bowel movements before surgery than after surgery. Clinical symptoms should be considered because postoperative fever cannot be determined by fever alone because fever and infection are not significant.

Keywords: lumbar surgery, fever, postoperative, risk factor

Procedia PDF Downloads 249

Authors: Sarbjit Singh

Abstract:

This framework development explored the status of GSCM in manufacturing SMEs and concluded that there was a significant gap w.r.t carbon emissions measurement in the supply chain activities. The measurement of carbon emissions within supply chains is important green initiative toward its reduction. The majority of the SMEs were facing the problem to quantify the green house gas emissions in its supply chain & to make it a low carbon supply chain or GSCM. Thus, the carbon management initiatives were amalgamated with the supply chain activities in order to measure and reduce the carbon emissions, confirming the GHG protocol scopes. Henceforth, it covers the development of carbon management software (CMS) tool to quantify carbon emissions for effective carbon management. This tool is cheap and easy to use for the industries for the management of their carbon emissions within the supply chain.

Keywords: w.r.t carbon emissions, carbon management software, supply chain management, Indian Industry

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Authors: T. C. Bera, A. Bansal, D. Nema

Abstract:

During performing turning operation, cutting force plays a significant role in metal cutting process affecting tool-work piece deflection, vibration and eventually part quality. The present research work aims to develop a mechanistic cutting force model and to study the mechanistic constants used in the force model in case of turning operation. The proposed model can be used for the reliable and accurate estimation of the cutting forces establishing relationship of various force components (cutting force and feed force) with uncut chip thickness. The accurate estimation of cutting force is required to improve thin-walled part accuracy by controlling the tool-work piece deflection induced surface errors and tool-work piece vibration.

Keywords: turning, cutting forces, cutting constants, uncut chip thickness

Procedia PDF Downloads 522

Authors: Langhit Kurar, Loren Charles

Abstract:

Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

Procedia PDF Downloads 180

Authors: Hashim Chunpir

Abstract:

Support processes play an important role to facilitate researchers (users) to accomplish their research activities with the help of cyber-infrastructure(s). However, the current user-support process in cyber-infrastructure needs a feasible tool to support users. This tool must enable the users of a cyber-infrastructure to communicate efficiently with the staffs of a cyber-infrastructure in order to get technical and scientific assistance, whilst saving resources at the same time. This research paper narrates the real story of employing various forms of tools to support the user and staff communication. In addition, this paper projects the lessons learned from an exploration of the help-desk tools in the current state of user support process in Earth System Grid Federation (ESGF) from support staffs’ perspective. ESGF is a climate cyber-infrastructure that facilitates Earth System Modeling (ESM) and is taken as a case study in this paper. Finally, this study proposes a need for a tool, a framework or a platform that not only improves the user support process to address support servicing needs of end-users of e-Science infrastructures but also eases the life of staffs in providing assistance to the users. With the help of such a tool; the collaboration between users and the staffs of cyber-infrastructures is made easier. Consequently, the research activities of the users of e-Science infrastructure will thrive as the scientific and technical support will be available to users. Finally, this results into painless and productive e-Research.

Keywords: e-Science User Services, e-Research in Earth Sciences, Information Technology Services Management (ITSM), user support process, service desk, management of support activities, help desk tools, application of social media

Procedia PDF Downloads 473

Authors: A. Saimen, E. Armstrong, C. Manitshana

Abstract:

Intimate partner violence (IPV) has been recognised as a global human rights violation. It is universally under diagnosed and the institution of timeous multi-faceted interventions has been noted to benefit IPV victims. Currently, the concept of using a screening tool to detect IPV has not been widely explored in a primary healthcare setting in South Africa, and it was for this reason that this study has been undertaken. A systematic random sampling of 1 in 8 women over a period of 3 months was conducted prospectively at the OPD of a Level 1 Hospital. Participants were asked about their experience of IPV during the past 12 months. The WAST-short, a two-question tool, was used to screen patients for IPV. To verify the result of the screening, women were also asked the remaining questions from the WAST. Data was collected from 400 participants, with a response rate of 99.3%. The prevalence of IPV in the sample was 32%. The WAST-short was shown to have the following operating characteristics: sensitivity 45.2%, specificity 98%,positive predictive value 98%, negative predictive value 79%. The WAST-short lacks sufficient sensitivity and therefore is not an ideal screening tool for this setting. Improvement in the sensitivity of the WAST-short in this setting may be achieved by lowering the threshold for a positive result for IPV screening, and modification of the screening questions to better reflect IPV as understood by the local population.

Keywords: domestic violence, intimate partner violence, screening, screening tools

Procedia PDF Downloads 305

Authors: Bjørn Salskov, Nicolaj Bang, Charlotte Falko

Abstract:

Future labour markets demand employees that can carry out a non-linear task which is still not possible for computers. This means that employees must have well-developed soft-skills to perform at high levels in such a work environment. One of these soft-skills is presenting a message effectively. To be able to present a message effectively, one needs to practice this. To practice effectively, the trainee needs feedback on the current performance. Here VR environments can be used as a practice tool because it gives the trainee a sense of presence and reality. VR environments are becoming a cost-effective training method since it does not demand the presence of an expert to provide this feedback. The research article analysed in this study suggests that VR environment can be used and are able to provide the necessary feedback to the trainee which in turn will help the trainee become better at the task. The research analysed in this review does, however, show that there is a need for a study with larger sample size and a study which runs over a longer period.

Keywords: training, presentation, presentation skills, VR training, VR as a training tool, VR and presentation

Procedia PDF Downloads 122

Authors: Alimohamad Asghari, Ahmad Daneshi, Mohammad Farhadi, Arash Bayat, Mohammad Ajalloueyan, Marjan Mirsalehi, Mohsen Rajati, Seyed Basir Hashemi, Nader Saki, Ali Omidvari

Abstract:

Evidence suggests that Cochlear Implantation (CI) is a beneficial approach for auditory and speech skills improvement in children with severe to profound hearing loss. However, it remains controversial if implantation in children <12 months is safe and effective compared to older children. The present study aimed to determine whether children's ages affect surgical complications and auditory and speech development. The current multicenter study enrolled 86 children who underwent CI surgery at <12 months of age (group A) and 362 children who underwent implantation between 12 and 24 months of age (group B). The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were determined pre-impanation, and "one-year" and "two-year" post-implantation. Four complications (overall rate: 4.65%; three minor) occurred in group A and 12 complications (overall rate: 4.41%; nine minor) occurred in group B. We found no statistically significant difference in the complication rates between the groups (p>0.05). The mean SIR and CAP scores improved over time following CI activation in both groups. However, we did not find significant differences in CAP and SIR scores between the groups across different time points. Cochlear implantation is a safe and efficient procedure in children younger than 12 months, providing substantial auditory and speech benefits comparable to children undergoing implantation at 12 to 24 months of age. Furthermore, surgical complications in younger children are similar to those of children undergoing the CI at an older age.

Keywords: cochlear implant, Infant, complications, outcome

Procedia PDF Downloads 108