Search results for: patient engagement/involvement

Authors: Nami Matsumoto

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This study explores the experiences of cross-linguistic medical encounters by patients, and their views of receiving language support therein, with a particular focus on Japanese-English cases. The aim of this study is to investigate the reason for the frequent use of a spouse as a communication mediator from a Japanese perspective, through a comparison with that of English speakers. This study conducts an empirical qualitative analysis of the accounts of informants. A total of 31 informants who have experienced Japanese-English cross-linguistic medical encounters were recruited in Australia and Japan for semi-structured in-depth interviews. A breakdown of informants is 15 English speakers and 16 Japanese speakers. In order to obtain a further insight into collected data, additional interviews were held with 4 Australian doctors who are familiar with using interpreters. This study was approved by the Australian National University Human Research Ethics Committee, and written consent to participate in this study was obtained from all participants. The interviews lasted up to over one hour. They were audio-recorded and subsequently transcribed by the author. Japanese transcriptions were translated into English by the author. An analysis of interview data found that patients value relationship in communication. Particularly, Japanese informants, who have an English-speaking spouse, value trust-based communication interventions by their spouse, regardless of the language proficiency of the spouse. In Australia, health care interpreters are required to abide by the national code of ethics for interpreters. The Code defines the role of an interpreter exclusively to be language rendition and enshrines the tenets of accuracy, confidentiality and professional role boundaries. However, the analysis found that an interpreter who strictly complies with the Code sometimes fails to render the real intentions of the patient and their doctor. Findings from the study suggest that an interpreter should not be detached from the context and should be more engaged in the needs of patients. Their needs are not always communicated by an interpreter when they simply follow a professional code of ethics. The concept of relationship-centred care should be incorporated in the professional practice of health care interpreters.

Keywords: health care, Japanese-English medical encounters, language barriers, trust

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Authors: Yi H. Wong, Li L. Chan, Chee O. Leong, Stephen Ambu, Joon W. Mak, Priyadashi S. Sahu

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Background: Acanthamoeba is a free-living opportunistic protist which is ubiquitously distributed in the environment. Virulent Acanthamoeba can cause fatal encephalitis in immunocompromised patients and potential blinding keratitis in immunocompetent contact lens wearers. Approximately 24 species have been identified but only the A. castellanii, A. polyphaga and A. culbertsoni are commonly associated with human infections. Until to date, the precise molecular basis for Acanthamoeba pathogenesis remains unclear. Previous studies reported that Acanthamoeba virulence can be diminished through prolonged axenic culture but revived through serial mouse passages. As no clear explanation on this reversible pathogenesis is established, hereby, we postulate that the epigenetic regulators, DNA-methyltransferases (DNMT) and histone-deacetylases (HDAC), could possibly be involved in granting the virulence plasticity of Acanthamoeba spp. Methods: Four rounds of mouse passages were conducted to revive the virulence potential of the virulence-attenuated Acanthamoeba castellanii strain (ATCC 50492). Briefly, each mouse (n=6/group) was inoculated intraperitoneally with Acanthamoebae cells (2x 105 trophozoites/mouse) and incubated for 2 months. Acanthamoebae cells were isolated from infected mouse organs by culture method and subjected to subsequent mouse passage. In vitro cytopathic, encystment and gelatinolytic assays were conducted to evaluate the virulence characteristics of Acanthamoebae isolates for each passage. PCR primers which targeted on the 2 members (DNMT1 and DNMT2) and 5 members (HDAC1 to 5) of the DNMT and HDAC gene families respectively were custom designed. Quantitative real-time PCR (qPCR) was performed to detect and quantify the relative expression of the two gene families in each Acanthamoeba isolates. Beta-tubulin of A. castellanii (Genbank accession no: XP_004353728) was included as housekeeping gene for data normalisation. PCR mixtures were also analyzed by electrophoresis for amplicons detection. All statistical analyses were performed using the paired one-tailed Student’s t test. Results: Our pathogenicity tests showed that the virulence-reactivated Acanthamoeba had a higher degree of cytopathic effect on vero cells, a better resistance to encystment challenge and a higher gelatinolytic activity which was catalysed by serine protease. qPCR assay showed that DNMT1 expression was significantly higher in the virulence-reactivated compared to the virulence-attenuated Acanthamoeba strain (p ≤ 0.01). The specificity of primers which targeted on DNMT1 was confirmed by sequence analysis of PCR amplicons, which showed a 97% similarity to the published DNA-methyltransferase gene of A. castellanii (GenBank accession no: XM_004332804.1). Out of the five primer pairs which targeted on the HDAC family genes, only HDAC4 expression was significantly difference between the two variant strains. In contrast to DNMT1, HDAC4 expression was much higher in the virulence-attenuated Acanthamoeba strain. Conclusion: Our mouse passages had successfully restored the virulence of the attenuated strain. Our findings suggested that DNA-methyltransferase (DNMT1) and histone deacetylase (HDAC4) expressions are associated with virulence potential of Acanthamoeba spp.

Keywords: acanthamoeba, DNA-methyltransferase, histone deacetylase, virulence-associated proteins

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Authors: Mohammed S. Bhader, Abdullah A. Ghaddaf, Anas Alamoudi, Amal Abualola, Renad Kalantan, Noura Alkhulaifi, Ibrahim Halawani, Mohammed Alhindi

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Background: Noninvasive neurally adjusted ventilatory assist (NAVA) is a relatively new mode of noninvasive ventilation with promising clinical and patient-ventilator outcomes for preterm infants. The aim of this systematic review was to compare NAVA to nasal continuous or positive airway pressure (NCPAP) or intermittent positive airway pressure (NIPP) for preterm infants. Methods: We searched the online databases Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared NAVA to NCPAP or NIPP for preterm infants < 37 weeks gestational age. We sought to evaluate the following outcomes: noninvasive intubation failure rate, desaturation rate, the fraction of inspired oxygen (FiO2), and length of stay in the neonatal intensive care unit (NICU). We used the mean difference (MD) to represent continuous outcomes, while the odds ratio (OR) was used to represent dichotomous outcomes. Results: A total of 11 RCTs that enrolled 429 preterm infants were deemed eligible. NAVA showed similar clinical outcomes to NCPAP or NIPP with respect to noninvasive intubation failure (RR for NAVA versus NCPAP: 0.82, 95% confidence interval (CI): 0.49 to 1.37), desaturation rate (RR for NAVA versus NCPAP: 0.69, 95%CI: 0.36 to 1.29; RR for NAVA versus NIPP: 0.58, 95%CI: 0.08 to 4.25), FiO2 (MD for NAVA versus NCPAP: –0.01, 95%CI: –0.04 to 0.02; MD for NAVA versus NIPP: –7.16, 95%CI: –22.63 to 8.31), and length of stay in the NICU (MD for NAVA versus NCPAP: 1.34, 95%CI: –4.17 to 6.85). Conclusion: NAVA showed similar clinical and ventilator-related outcomes compared to the usual care noninvasive respiratory support measures NCPAP or NIPP for preterm infants.

Keywords: preterm infants, noninvasive neurally adjusted ventilatory assist, NIV-NAVA, non-invasive ventilation, nasal continuous or positive airway pressure, NCPAP, intermittent positive airway pressure ventilation, NIPP, respiratory distress syndrome, RDS

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Authors: Margit Kastner

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To overcome the negative consequences associated with large class sizes and to support students in developing the necessary competences (e.g., critical thinking, problem-solving, or team-work skills) a marketing course has been redesigned by implementing project-based learning with peer assessment (PBL&PA). This means that students can voluntarily take advantage of this supplementary offer and explore -in addition to attending the lecture where clicker questions are asked- a real-world problem, find a solution, and assess the results of peers while working in small collaborative groups. In order to handle this with little further effort, the process is technically supported by the university’s e-learning system in such a way that students upload their solution in form of an assignment which is then automatically distributed to peer groups who have to assess the work of three other groups. Finally, students’ work is graded automatically considering both, students’ contribution to the project and the conformity of the peer assessment. The purpose of this study is to evaluate students’ perception of PBL&PA using an online-questionnaire to collect the data. More specifically, it aims to discover students’ motivations for (not) working on a project and the benefits and problems students encounter. In addition to the survey, students’ performance was analyzed by comparing the final grades of those who participated in PBL&PA with those who did not participate. Among the 260 students who filled out the questionnaire, 47% participated in PBL&PA. Besides extrinsic motivations (bonus credits), students’ participation was often motivated by learning and social benefits. Reasons for not working on a project were connected to students’ organization and management of their studies (e.g., time constraints, no/wrong information) and teamwork concerns (e.g., missing engagement of peers, prior negative experiences). In addition, high workload and insufficient extrinsic motivation (bonus credits) were mentioned. With regards to benefits and problems students encountered during the project, students provided more positive than negative comments. Positive aspects most often stated were learning and social benefits while negative ones were mainly attached to the technical implementation. Interestingly, bonus credits were hardly named as a positive aspect meaning that intrinsic motivations have become more important when working on the project. Team aspects generated mixed feelings. In addition, students who voluntarily participated in PBL&PA were, in general, more active and utilized further course offers such as clicker questions. Examining students’ performance at the final exam revealed that students without participating in any of the offered active learning tasks performed poorest in the exam while students who used all activities were best. In conclusion, the goals of the implementation were met in terms of students’ perceived benefits and the positive impact on students’ exam performance. Since the comparison of the automatic grading with faculty grading showed valid results, it is possible to rely only on automatic grading in the future. That way, the additional workload for faculty will be within limits. Thus, the implementation of project-based learning with peer assessment can be recommended for large classes.

Keywords: automated grading, large classes, peer assessment, project-based learning

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Authors: Toufic Sarieddine

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The current debate on the hegemonic impact of China’s Belt and Road Initiative (BRI) is of two opposing strands: Resilient and absolute US hegemony on the one hand and various models of multipolar hegemony such as bifurcation on the other. Bifurcation theories illustrate an unprecedented division of hegemonic functions between China and the US, whereby Beijing becomes the world’s economic hegemon, leaving Washington the world’s military hegemon and security guarantor. While consensus points to China being the main driver of unipolarity’s rupturing, the debate among bifurcationists is on the location of the first rupture. In this regard, the Middle East and North Africa (MENA) region has seen increasing Chinese foreign direct investment in recent years while that to other regions has declined, ranking it second in 2018 as part of the financing for the Maritime Silk Road Initiative (MSRI). China has also become the top trade partner of 11 states in the MENA region, as well as its top source of machine imports, surpassing the US and achieving an overall trade surplus almost double that of Washington’s. These are among other features outlined in world-systems analysis (WSA) literature which correspond with the emergence of a new hegemon. WSA is further utilized to gauge other facets of China’s increasing involvement in MENA and assess whether bifurcation is unfolding therein. These features of hegemony include the adoption of China’s modi operandi, economic dominance in production, trade, and finance, military capacity, cultural hegemony in ideology, education, and language, and the promotion of a general interest around which to rally potential peripheries (MENA states in this case). China’s modi operandi has seen some adoption with regards to support against the United Nations Convention on the Law of the Sea, oil bonds denominated in the yuan, and financial institutions such as the Shanghai Gold Exchange enjoying increasing Arab patronage. However, recent elections in Qatar, as well as liberal reforms in Saudi Arabia, demonstrate Washington’s stronger normative influence. Meanwhile, Washington’s economic dominance is challenged by China’s sizable machine exports, increasing overall imports, and widening trade surplus, but retains some clout via dominant arms and transport exports, as well as free-trade deals across the region. Militarily, Washington bests Beijing’s arms exports, has a dominant and well-established presence in the region, and successfully blocked Beijing’s attempt to penetrate through the UAE. Culturally, Beijing enjoys higher favorability in Arab public opinion, and its broadcast networks have found some resonance with Arab audiences. In education, the West remains MENA students’ preferred destination. Further, while Mandarin has become increasingly available in schools across MENA, its usage and availability still lag far behind English. Finally, Beijing’s general interest in infrastructure provision and prioritizing economic development over social justice and democracy provides an avenue for increased incorporation between Beijing and the MENA region. The overall analysis shows solid progress towards bifurcation in MENA.

Keywords: belt and road initiative, hegemony, Middle East and North Africa, world-systems analysis

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Authors: Mark P. Mayala, Henry Mayala, Khuzeima Khanbhai

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Background: Heart failure has been a rising concern in Tanzania. New drugs have been introduced, including the group of drugs called Angiotensin receptor Neprilysin Inhibitor (ARNI), but due to their high cost, angiotensin-converting enzymes inhibitors (ACEIs) and Angiotensin receptor blockers (ARBs) have been mostly used in Tanzania. However, according to our knowledge, the efficacy comparison of the two groups is yet to be studied in Tanzania. The aim of this study was to compare the efficacy of ACEIs and ARBs among patients with heart failure. Methodology: This was a hospital-based prospective cohort study done at Jakaya Kikwete Cardiac Institution (JKCI), Tanzania, from June to December 2020. Consecutive enrollment was done until fulfilling the inclusion criteria. Clinical details were measured at baseline. We assessed the relationship between ARBs and ACEIs users with N-terminal pro-brain natriuretic peptide (NT pro-BNP) levels at admission and at 1-month follow-up using a chi-square test. A Kaplan-Meier curve was used to estimate the survival time of the two groups. Results: 155 HF patients were enrolled, with a mean age of 48 years, whereby 52.3% were male, and their mean left ventricular ejection fraction (LVEF) was 37.3%. 52 (33.5%) heart failure patients were on ACEIs, 57 (36.8%) on ARBs, and 46 (29.7%) were neither using ACEIs nor ARBs. At least half of the patients did not receive a guideline-directed medical therapy (GDMT), with only 82 (52.9%) receiving a GDMT. A drop in NT pro-BNP levels was observed during admission and at 1-month follow-up on both groups, from 6389.2 pg/ml to 4000.1 pg/ml for ARB users and 5877.7 pg/ml to 1328.2 pg/ml for the ACEIs users. There was no statistical difference between the two groups when estimated by the Kaplan-Meier curve, though more deaths were observed in those who were neither on ACEIs nor ARBs, with a calculated P value of 0.01. Conclusion: This study demonstrates that ACEIs have more efficacy and overall better clinical outcome than ARBs, but this should be taken under the patient-based case, considering the side effects of ACEIs and patients’ adherence.

Keywords: angiotensin converting enzymes inhibitors, angiotensin receptor blockers, guideline direct medical therapy, N-terminal pro-brain natriuretic peptide

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Authors: Cemile Kütmeç Yilmaz, Güler Duru Asiret, Gulcan Bagcivan

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The aim of this study was to evaluate the reliability and validity of the Turkish version of the Carer’s Assessment of Satisfaction Index (CASI-TR). The study was conducted between the dates of June 2016 and September 2017 at the Training and Research Hospital of Aksaray University with the caregiving family members of the inpatients with chronic diseases. For this study, the sample size was calculated as at least 10 individuals for each item (item number (30)X10=300). The study sample included 300 caregiving family members, who provided primer care for at least three months for a patient (who had at least one chronic disease and received inpatient treatment in general internal medicine and palliative care units). Data were collected by using a demographic questionnaire and CASI-TR. Descriptive statistics, and psychometric tests were used for the data analysis. Of those caregivers, 76.7% were female, 86.3% were 65 years old and below, 43.7% were primary school graduates, 87% were married, 86% were not working, 66.3% were housewives, and 60.3% defined their income status as having an income covering one’s expenses. Care recipients often had problems in terms of walking, sleep, balance, feeding and urinary incontinence. The Cronbach Alpha value calculated for the CASI-TR (30 items) was 0,949. Internal consistency coefficients calculated for subscales were: 0.922 for the subscale of ‘caregiver satisfaction related to care recipient’, 0.875 for the subscale of ‘caregiver satisfaction related to themselves’, and 0.723 for the subscale of ‘dynamics of interpersonal relations’. Factor analysis revealed that three factors accounted for 57.67% of the total variance, with an eigenvalue of >1. assessed in terms of significance, we saw that the items came together in a significant manner. The factor load of the items were between 0.311 and 0.874. These results show that the CASI-TR is a valid and reliable scale. The adoption of the translated CASI in Turkey is found reliable and valid to assessing the satisfaction of caregivers. CASI-TR can be used easily in clinics or house visits by nurses and other health professionals for assessing caregiver satisfaction from caregiving.

Keywords: carer’s assessment of satisfaction index, caregiver, validity, reliability

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Authors: Kristian Bugeja, Upeshala A. Jayawardena, Clarissa Fenech, Mark Zammit Vincenti

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Introduction: Biliary colic, acute cholecystitis, and gallstone pancreatitis are some of the most common surgical presentations at Gozo General Hospital (GGH). National Institute for Health and Care Excellence (NICE) guidelines advise that suitable patients with acute biliary problems should be offered a laparoscopic cholecystectomy within one week of diagnosis. There has traditionally been difficulty in achieving this mainly due to the reluctance of some surgeons to operate in the acute setting, limited, timely access to MRCP and ERCP, and organizational issues. Methodology: A retrospective study was performed involving all biliary pathology-related admissions to GGH during the two-year period of 2019 and 2020. Patients’ files and electronic case summary (ECS) were used for data collection, which included demographic data, primary diagnosis, co-morbidities, management, waiting time to surgery, length of stay, readmissions, and reason for readmissions. NICE clinical guidance 188 – Gallstone disease were used as the standard. Results: 51 patients were included in the study. The mean age was 58 years, and 35 (68.6%) were female. The main diagnoses on admission were biliary colic in 31 (60.8%), acute cholecystitis in 10 (19.6%). Others included gallstone pancreatitis in 3 (5.89%), chronic cholecystitis in 2 (3.92%), gall bladder malignancy in 4 (7.84%), and ascending cholangitis in 1 (1.97%). Management included laparoscopic cholecystectomy in 34 (66.7%); conservative in 8 (15.7%) and ERCP in 6 (11.7%). The mean waiting time for laparoscopic cholecystectomy for patients with acute cholecystitis was 74 days – range being between 3 and 146 days since the date of diagnosis. Only one patient who was diagnosed with acute cholecystitis and managed with laparoscopic cholecystectomy was done so within the 7-day time frame. Hospital re-admissions were reported in 5 patients (9.8%) due to vomiting (1), ascending cholangitis (1), and gallstone pancreatitis (3). Discussion: Guidelines were not met for patients presenting to Gozo General Hospital with acute biliary pathology. This resulted in 5 patients being re-admitted to hospital while waiting for definitive surgery. The local issues resulting in the delay to surgery need to be identified and steps are taken to facilitate the provision of urgent cholecystectomy for suitable patients.

Keywords: biliary colic, acute cholecystits, laparoscopic cholecystectomy, conservative management

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Authors: Debasish Nandy

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India’s foreign policy towards all of her neighbor countries is determinate on the basis of multi-dimensional factors. India’s relations with its South Asian neighbor can be classified into three categories. In the first category, there are four countries -Sri Lanka, Bangladesh, Nepal, and Afghanistan- whose bilateral relationships have encompassed cooperation, irritants, problems and crisis at different points in time. With Pakistan, the relationship has been perpetually adversarial. The third category includes Bhutan and Maldives whose relations are marked by friendship and cooperation, free of any bilateral problems. It is needless to say that Jawaharlal Nehru emphasized on friendly relations with the neighboring countries. The subsequent Prime Ministers of India especially I.K. Gujral had advocated in making of peaceful and friendly relations with the subcontinental countries. He had given a unique idea to foster bilateral relations with the neighbors. His idea is known as ‘Gujral Doctrine’. A dramatical change has been witnessed in Indian foreign policy since 1991.In the post-Cold War period, India’s national security has been vehemently threatened by terrorism, which originated from Pakistan-Afghanistan and partly Bangladesh. India has required a cooperative security, which can be made by mutual understanding among the South Asian countries. Additionally, the countries of South Asia need to evolve the concept of ‘Cooperative Security’ to explain the underlying logic of regional cooperation. According to C. Rajamohan, ‘cooperative security could be understood, as policies of governments, which see themselves as former adversaries or potential adversaries to shift from or avoid confrontationist policies.’ A cooperative security essentially reflects a policy of dealing peacefully with conflicts, not merely by abstention from violence or threats but by active engagement in negotiation, a search for practical solutions and with a commitment to preventive measures. Cooperative assumes the existence of a condition in which the two sides possess the military capabilities to harm each other. Establishing cooperative security runs into a complex process building confidence. South Asian nations often engaged with hostility to each other. Extra-regional powers have been influencing their powers in this region since a long time. South Asian nations are busy to purchase military equipment. In spite of weakened economic systems, these states are spending a huge amount of money for their security. India is the big power in this region in every aspect. The big states- small states syndrome is a negative factor in this respect. However, India will have to an initiative to extended ‘track II diplomacy’ or soft diplomacy for its security as well as the security of this region.Confidence building measures could help rejuvenate not only SAARC but also build trust and mutual confidence between India and its neighbors in South Asia. In this paper, I will focus on different aspects of India’s policy towards it, South-Asian neighbors. It will also be searched that how India is dealing with these countries by using a mixed type of diplomacy – both idealistic and realistic points of view. Security and cooperation are two major determinants of India’s foreign policy towards its South Asian neighbors.

Keywords: bilateral, diplomacy, infiltration, terrorism

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Authors: Lou J. Pino, Mark Campbell, Matthew J. Kennedy, Ashleigh C. Kennedy

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A concussion is complex and nuanced, with cognitive rest being a key component of recovery. Cognitive overexertion during rehabilitation from a concussion is associated with delayed recovery. However, daily living imposes cognitive demands that may be unavoidable and difficult to quantify. Therefore, a portable tool capable of alerting patients before cognitive overexertion occurs could allow patients to maintain their quality of life while preventing symptoms and recovery setbacks. EEG allows for a sensitive measure of cognitive exertion. Clinical 32-lead EEG headsets are not practical for day-to-day concussion rehabilitation management. However, there are now commercially available and affordable portable EEG headsets. Thus, these headsets can potentially be used to continuously monitor cognitive exertion during mental tasks to alert the wearer of overexertion, with the aim of preventing the occurrence of symptoms to speed recovery times. The objective of this study was to test an algorithm for predicting cognitive exertion from EEG data collected from a portable headset. EEG data were acquired from 10 participants (5 males, 5 females). Each participant wore a portable 4 channel EEG headband while completing 10 tasks: rest (eyes closed), rest (eyes open), three levels of the increasing difficulty of logic puzzles, three levels of increasing difficulty in multiplication questions, rest (eyes open), and rest (eyes closed). After each task, the participant was asked to report their perceived level of cognitive exertion using the NASA Task Load Index (TLX). Each participant then completed a second session on a different day. A customized machine learning model was created using data from the first session. The performance of each model was then tested using data from the second session. The mean correlation coefficient between TLX scores and predicted cognitive exertion was 0.75 ± 0.16. The results support the efficacy of the algorithm for predicting cognitive exertion. This demonstrates that the algorithms developed in this study used with portable EEG devices have the potential to aid in the concussion recovery process by monitoring and warning patients of cognitive overexertion. Preventing cognitive overexertion during recovery may reduce the number of symptoms a patient experiences and may help speed the recovery process.

Keywords: cognitive activity, EEG, machine learning, personalized recovery

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Authors: Ecem Deniz Kırkpantur, Ozge Ecmel Onur, Tuba Cimilli Ozturk, Ebru Unal Akoglu

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Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. The occurrence of Moyamoya disease is related to immune, genetic and other factors. There is no curative treatment for Moyamoya disease. Secondary prevention for patients with symptomatic Moyamoya disease is largely centered on surgical revascularization techniques. We present here a 62-year old male presented with headache and vision loss for 2 days. He was previously diagnosed with hypertension and glaucoma. On physical examination, left eye movements were restricted medially, both eyes were hyperemic and their movements were painful. Other neurological and physical examination were normal. His vital signs and laboratory results were within normal limits. Computed tomography (CT) showed dilated vascular structures around both lateral ventricles and atherosclerotic changes inside the walls of internal carotid artery (ICA). Magnetic resonance imaging (MRI) and angiography (MRA) revealed dilated venous vascular structures around lateral ventricles and hyper-intense gliosis in periventricular white matter. Ischemic gliosis around the lateral ventricles were present in the Digital Subtracted Angiography (DSA). After the neurology, ophthalmology and neurosurgery consultation, the patient was diagnosed with Moyamoya disease, pulse steroid therapy was started for vision loss, and super-selective DSA was planned for further investigation. Moyamoya disease is a rare condition, but it can be an important cause of stroke in both children and adults. It generally affects anterior circulation, but posterior cerebral circulation may also be affected, as well. In the differential diagnosis of acute vision loss, occipital stroke related to Moyamoya disease should be considered. Direct and indirect surgical revascularization surgeries may be used to effectively revascularize affected brain areas, and have been shown to reduce risk of stroke.

Keywords: headache, Moyamoya disease, stroke, visual loss

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Authors: Moshe Wasserblat, Jonathan Mamou, Oren Pereg

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Natural Language Processing (NLP) has made a major leap in the last few years, in practical integration into medical solutions; for example, extracting clinical concepts from medical texts such as medical condition, medication, treatment, and symptoms. However, training and deploying those models in real environments still demands a large amount of annotated data and NLP/Machine Learning (ML) expertise, which makes this process costly and time-consuming. We present a practical and efficient method for clinical concept extraction that does not require costly labeled data nor ML expertise. The method includes three steps: Step 1- the user injects a large in-domain text corpus (e.g., PubMed). Then, the system builds a contextual model containing vector representations of concepts in the corpus, in an unsupervised manner (e.g., Phrase2Vec). Step 2- the user provides a seed set of terms representing a specific medical concept (e.g., for the concept of the symptoms, the user may provide: ‘dry mouth,’ ‘itchy skin,’ and ‘blurred vision’). Then, the system matches the seed set against the contextual model and extracts the most semantically similar terms (e.g., additional symptoms). The result is a complete set of terms related to the medical concept. Step 3 –in production, there is a need to extract medical concepts from the unseen medical text. The system extracts key-phrases from the new text, then matches them against the complete set of terms from step 2, and the most semantically similar will be annotated with the same medical concept category. As an example, the seed symptom concepts would result in the following annotation: “The patient complaints on fatigue [symptom], dry skin [symptom], and Weight loss [symptom], which can be an early sign for Diabetes.” Our evaluations show promising results for extracting concepts from medical corpora. The method allows medical analysts to easily and efficiently build taxonomies (in step 2) representing their domain-specific concepts, and automatically annotate a large number of texts (in step 3) for classification/summarization of medical reports.

Keywords: clinical concepts, concept expansion, medical records annotation, medical records summarization

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Authors: Chan Hui-Ya, Ding Shin-Tan

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Background and Aim: The discharge planning is considered helpful to reduce the hospital length of stay and readmission rate, and then increased satisfaction with healthcare for patients and professionals. In order to decrease the waiting time of long-term care and boost the care quality of patients after discharge from the hospital, the Ministry of Health and Welfare department in Taiwan initiates a program “discharge planning connects with long-term care 2.0 services” in 2017. The purpose of this study is to investigate the outcome of the pilot of this program in a medical center. Methods: By purpose sampling, the study chose five wards in a medical center as pilot units. The researchers compared the beds of service, the numbers of cases which were transferred to the long-term care center and transferred rates per month between the pilot units and the other units, and analyze the basic data, the long-term care service needs and the approval service items of cases transfer to the long-term care center in pilot units. Results: From June to September 2017, a total of 92 referrals were made, and 51 patients were enrolled into the pilot program. There is a significant difference of transferring rate between the pilot units and the other units (χ = 702.6683, p < 0.001). Only 20 cases (39.2% success rate) were approved to accept the parts of service items of long-term care in the pilot units. The most approval item was respite care service (n = 13; 65%), while it was third at needs ranking of service lists during linking services process. Among the reasons of patients who cancelled the request, 38.71% reasons were related to the services which could not match the patients’ needs and expectation. Conclusion: The results indicate there is a requirement to modify the long-term care services to fit the needs of cases. The researchers suggest estimating the potential cases by screening data from hospital informatics systems and to hire more case manager according the service time of potential cases. Meanwhile, the strategies shortened the assessment scale and authorized hospital case managers to approve some items of long-term care should be considered.

Keywords: discharge planning, long-term care, case manager, patient care

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Authors: Saima Saleem, Zubair Abbasi, Abdul Hameed, Mansoor Ahmed Khan, Navid Rashid Qureshi, Abid Azhar

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Oral Squamous Cell Carcinoma (OSCC) is the leading cause of death in the developing countries like Pakistan. This problem aggravates because of the excessive use of available chewing products. In spite of widespread information on their use and purported legislations against their use the Pakistani markets are classical examples of selling chewable carcinogenic mutagens. Reported studies indicated that these products are rich in reactive oxygen species (ROS) and polyphenols. TP53 gene is involved in the suppression of tumor. It has been reported that somatic mutations caused by TP53 gene are the foundation of the cancer. This study aims to find the loss of TP53 functions due to mutation/polymorphism caused by genomic alteration and interaction with tobacco and its related ingredients. Total 260 tissues and blood specimens were collected from OSCC patients and compared with age and sex matched controls. Mutations in exons 2-11 of TP53 were examined by PCR-SSCP. Samples showing mobility shift were directly sequenced. Two mutations were found in exon 4 at nucleotide position 108 and 215 and one in exon 7 at nucleotide position 719 of the coding sequences in patient’s tumor samples. These results show that substitution of proline with arginine at codon 72 and serine with threonine at codon 240 of p53 protein. These polymorphic changes, found in tumor samples of OSCC, could be involved in loss of heterozygocity and apoptotic activity in the binding domain of TP53. The model of the mutated TP53 gene elaborated a nonfunctional unfolded p53 protein, suggesting an important role of these mutations in p53 protein inactivation and malfunction. This nonfunctional 3D model also indicates that exogenous tobacco related carcinogens may act as DNA-damaging agents affecting the structure of DNA. The interpretations could be helpful in establishing the pathways responsible for tumor formation in OSCC patients.

Keywords: TP53 mutation/polymorphism, OSCC, PCR-SSCP, direct DNA sequencing, 3D structure

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Authors: Lancer Scott

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Purpose: High quality clinical disaster medicine requires providers working collaboratively to care for multiple patients in chaotic environments; however, many providers lack adequate training. To address this deficit, we created a competency-based, 5-hour Emergency Preparedness Training (EPT) curriculum using didactics, small-group discussion, and kinetic learning. The goal was to evaluate the effect of a short course on improving provider knowledge, confidence and skills in disaster scenarios. Methods: Diverse groups of medical university students, health care professionals, and community members were enrolled between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and two live, multi-patient mass casualty incident (MCI) scenarios. The outcome measures were based on core competencies and performance objectives developed by a curriculum task force and assessed via trained facilitator observation, pre- and post-testing, and a course evaluation. Results: 708 participants completed were trained between November 2011 and August 2014, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% various other healthcare professions. 100% of participants completed the pre-test and 71.9% completed the post-test, with average correct answers increasing from 39% to 60%. Following didactics, trainees met 73% and 96% of performance objectives for the two small group exercises and 68.5% and 61.1% of performance objectives for the two MCI scenarios. Average trainee self-assessment of both overall knowledge and skill with clinical disasters improved from 33/100 to 74/100 (overall knowledge) and 33/100 to 77/100 (overall skill). The course assessment was completed by 34.3% participants, of whom 91.5% highly recommended the course. Conclusion: A relatively short, intensive EPT course can improve the ability of a diverse group of disaster care providers to respond effectively to mass casualty scenarios.

Keywords: clinical disaster medicine, training, hospital preparedness, surge capacity, education, curriculum, research, performance, training, student, physicians, nurses, health care providers, health care

Procedia PDF Downloads 180

Authors: Noorulain Khalid, Unsaar Hayat, Muhammad Chaudhary, Christos Iosifidis, Felipe Dhawahir-Scala, Fiona Carley

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Dry eye disease (DED) is a common condition seen in the emergency eye department (EED) at Manchester Royal Eye Hospital (MREH). However, there is variability in the prescription of lubricating eye drops among different healthcare providers. The aim of this study was to develop an up-to-date, standardized algorithm for the prescription of lubricating eye drops in the EED at MREH based on international and national guidelines. The study also aimed to assess the impact of implementing the guideline on the rate of inappropriate lubricant prescriptions. Primarily, the impact was to be assessed in the form of the appropriateness of prescriptions for patients’ DED. The impact was secondary to be assessed through analysis of the cost to the hospital. Data from 845 patients who attended the EED over a 3-month period were analyzed, and 157 patients met the inclusion and exclusion criteria. After conducting a review of the literature and collaborating with the corneal team, an algorithm for the prescription of lubricants in the EED was developed. Three plan-do-study-act (PDSA) cycles were conducted, with interventions such as emails, posters, in-person reminders, and education for incoming trainees. The appropriateness of prescriptions was evaluated against the guidelines. Data were collected from patient records and analyzed using statistical methods. The appropriateness of prescriptions was assessed by comparing them to the guidelines and by clinical correlation with a specialized registrar. The study found a substantial improvement in the number of appropriate prescriptions, with an increase from 55% to 93% over the three PDSA cycles. There was additionally a 51% reduction in expenditure on lubricant prescriptions, resulting in cost savings for the hospital (approximate saving of £50/week). Theoretical importance: Appropriate prescription of lubricating eye drops improves disease management for patients and reduces costs for the hospital. The development and implementation of a standardized guideline facilitate the achievement of these goals. Conclusion: This study highlights the inconsistent management of DED in the EED and the potential lack of training in this area for healthcare providers. The implementation of a standardized, easy-to-follow guideline for lubricating eye drops can help to improve disease management while also resulting in cost savings for the hospital.

Keywords: lubrication, dry eye disease, guideline, prescription

Procedia PDF Downloads 48

Authors: Pauline Calleja, Brooke Alexander

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In 2010 the College of Emergency Nursing Australasia (CENA) undertook sole administration of the Trauma Nursing Program (TNP) across Australia. The original TNP was developed from recommendations by the Review of Trauma and Emergency Services-Victoria. While participant and faculty feedback about the program was positive, issues were identified that were common for industry training programs in Australia. These issues included didactic approaches, with many lectures and little interaction/activity for participants. Participants were not necessarily encouraged to undertake deep learning due to the teaching and learning principles underpinning the course, and thus participants described having to learn by rote, and only gain a surface understanding of principles that were not always applied to their working context. In Australia, a trauma or emergency nurse may work in variable contexts that impact on practice, especially where resources influence scope and capacity of hospitals to provide trauma care. In 2011, a program review was undertaken resulting in major changes to the curriculum, teaching, learning and assessment approaches. The aim was to improve learning including a greater emphasis on pre-program preparation for participants, the learning environment and clinically applicable contextualized outcomes participants experienced. Previously if participants wished to undertake assessment, they were given a take home examination. The assessment had poor uptake and return, and provided no rigor since assessment was not invigilated. A new assessment structure was enacted with an invigilated examination during course hours. These changes were implemented in early 2012 with great improvement in both faculty and participant satisfaction. This presentation reports on a comparison of participant evaluations collected from courses post implementation in 2012 and in 2015 to evaluate if positive changes were sustained. Methods: Descriptive statistics were applied in analyzing evaluations. Since all questions had more than 20% of cells with a count of <5, Fisher’s Exact Test was used to identify significance (p = <0.05) between groups. Results: A total of fourteen group evaluations were included in this analysis, seven CENA TNP groups from 2012 and seven from 2015 (randomly chosen). A total of 173 participant evaluations were collated (n = 81 from 2012 and 92 from 2015). All course evaluations were anonymous, and nine of the original 14 questions were applicable for this evaluation. All questions were rated by participants on a five-point Likert scale. While all items showed improvement from 2012 to 2015, significant improvement was noted in two items. These were in regard to the content being delivered in a way that met participant learning needs and satisfaction with the length and pace of the program. Evaluation of written comments supports these results. Discussion: The aim of redeveloping the CENA TNP was to improve learning and satisfaction for participants. These results demonstrate that initial improvements in 2012 were able to be maintained and in two essential areas significantly improved. Changes that increased participant engagement, support and contextualization of course materials were essential for CENA TNP evolution.

Keywords: emergency nursing education, industry training programs, teaching and learning, trauma education

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Authors: Floriane Shala, Evangeline Wagner, Yichun Zhao

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Background: Proper educational training and support are proven to be major components of EHR (Electronic Health Record) implementation and use. However, the majority of health providers are not sufficiently trained in EHR use, leading to adverse events, errors, and decreased quality of care. In response to this, students studying Health Information Science, Public Health, Nursing, and Medicine should all gain a thorough understanding of EHR use at different levels for different purposes. The design of a usable and safe EHR system that accommodates the needs and workflows of different users, user groups, and disciplines is required for EHR learning to be efficient and effective. Objectives: This project builds several artifacts which seek to address both the educational and usability aspects of an educational EHR. The artifacts proposed are models for and examples of such an EHR with a configurable UI to be learned by students who need a background in EHR use during their degrees. Methods: Review literature and gather professional opinions from domain experts on usability, the use of workflow patterns, UI configurability and design, and the educational aspect of EHR use. Conduct interviews in a semi-casual virtual setting with open discussion in order to gain a deeper understanding of the principal aspects of EHR use in educational settings. Select a specific task and user group to illustrate how the proposed solution will function based on the current research. Develop three artifacts based on the available research, professional opinions, and prior knowledge of the topic. The artifacts capture the user task and user’s interactions with the EHR for learning. The first generic model provides a general understanding of the EHR system process. The second model is a specific example of performing the task of MRI ordering with a configurable UI. The third artifact includes UI mock-ups showcasing the models in a practical and visual way. Significance: Due to the lack of educational EHRs, medical professionals do not receive sufficient EHR training. Implementing an educational EHR with a usable and configurable interface to suit the needs of different user groups and disciplines will help facilitate EHR learning and training and ultimately improve the quality of patient care.

Keywords: education, EHR, usability, configurable

Procedia PDF Downloads 144

Authors: Ishith Seth, Lyndel Hewitt, Takako Yabe, James Wykes, Jonathan Clark, Bruce Ashford

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Background: Vastus lateralis (VL) can be used to reconstruct defects of the head and neck. Whilst the advantages are documented, donor-site morbidity is not well described. This study aimed to assess donor-site morbidity after VL flap harvest. The results will determine future directions for preventative and post-operative care to improve patient health outcomes. Methods: Ten participants (mean age 55 years) were assessed for the presence of donor-site morbidity after VL harvest. Musculoskeletal (pain, muscle strength, muscle length, tactile sensation), quality of life (SF-12), and lower limb function (lower extremity function, gait (function and speed), sit to stand were assessed using validated and standardized procedures. Outcomes were compared to age-matched healthy reference values or the non-operative side. Analyses were conducted using descriptive statistics and non-parametric tests. Results: There was no difference in muscle strength (knee extension), muscle length, ability to sit-to-stand, or gait function (all P > 0.05). Knee flexor muscle strength was significantly less on the operated leg compared to the non-operated leg (P=0.02) and walking speed was slower than age-matched healthy values (P<0.001). Thigh tactile sensation was impaired in 89% of participants. Quality of life was significantly less for the physical health component of the SF-12 (P<0.001). The mental health component of the SF-12 was similar to healthy controls (P=0.26). Conclusion: There was no effect on donor site morbidity with regards to knee extensor strength, pain, walking function, ability to sit-to-stand, and muscle length. VL harvest affected donor-site knee flexion strength, walking speed, tactile sensation, and physical health-related quality of life.

Keywords: vastus lateralis, morbidity, head and neck, surgery, donor-site morbidity

Procedia PDF Downloads 223

Authors: Mardiana Madjid, Nurpudji Astuti Taslim, Suryani As'ad, Haerani Rasyid, Agussalim Bukhari

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The high level of Urine Urea Nitrogen (UUN) indicates hypercatabolism occurs in hospitalized patients. High levels of Total Lymphocyte Count (TLC) indicates the immune system condition, adequate wound healing, and limit complication. Adequate dietary intake affects to decrease of hypercatabolism status in treated patient’s hospitals. Nitrogen Balance (NB) is simply the difference between nitrogen (N₂) intake and output. If more N₂ intake than output, then positive NB or anabolic will occur. This study aims to evaluate the effect of dietary intake in influencing balance nitrogen and total lymphocyte count. Method: A total of 43 patients admitted to a Wahidin Sudirohusodo Hospital between 2018 and 2019 for 10 days' treats are included. The inclusion criteria were patients who were treated for 10 days and receives food from the hospital orally. Patients did not experience gastrointestinal disorders such as vomiting and diarrhea and experience impair kidney function and liver function and expressed approval to participate in this study. During hospitalization, food intake, UUN, albumin serum, balance nitrogen, and TLC was assessed twice on day 1 and day 10. There is no Physician Clinical Nutritional intervention to correct food intake. UUN is 24 hours of urine collected on the second day after admission and the tenth day. Statistical analysis uses SPSS 24 with observational cohort methods. Result: The Forty-three participants completed the follow-up (27 men and 18 women). The age of fewer than 4 years is 22 people, 45 to 60 years is 16 people, and over 60 years is 4 people. The result of the study on day 1 obtained SGA score A, SGA score B, SGA score C are 8, 32, 3 until day 10 are 8, 31, 4, respectively. According to 24h dietary recalls, the energy intake during observation was from 522.5 ± 400.4 to 1011.9 ± 545.1 kcal/day P < 0.05, protein intake from 20.07 ± 17.2 to 40.3 ± 27.3 g/day P < 0.05, carbohydrates from 92.5 ± 71.6 to 184.8 ± 87.4 g/day, and fat from 5.5 ± 3.86 to 13.9 ± 13.9 g/day. The UUN during the observation was from 6.6 ± 7.3 to 5.5 ± 3.9 g/day, TLC decreased from 1622.9 ± 897.2 to 1319.9 ± 636.3/mm³ value target 1800/mm³, albumin serum from 3.07 ± 0.76 to 2.9 ± 0.57 g/day, and BN from -7.5 ± 7.2 to -3.1 ± 4.86. Conclusion: The high level of UUN needs to correct adequate dietary intake to improve NB and TLC status on hospitalized patients.

Keywords: adequate dietary intake, balance nitrogen, total lymphocyte count, urine urea nitrogen

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Authors: Mary Konadu

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The rectal route for drug administration is becoming attractive to drug formulators because it can avoid hepatic first-pass effects, decrease gastrointestinal side effects and avoid undesirable effects of meals on drug absorption. Suppositories have been recognized as an alternative to the oral route in situations such as when the patient is comatose, unable to swallow, or when the drug produces nausea or vomiting. Effective drug delivery with appropriate pharmaceutical excipient is key in the production of clinically useful preparations. The high cost of available excipients coupled with other disadvantages have led to the exploration of potential excipients from natural sources. Allanblackia floribunda butter, a naturally occurring lipid, is used for medicinal, culinary, and cosmetic purposes. Different extraction methods (solvent (hexane) extraction, traditional/hot water extraction, and cold/screw press extraction) were employed to extract the oil. The different extracts of A. floribunda oil were analyzed for their physicochemical properties and mineral content. The oil was used as a base to formulate Paracetamol and Diclofenac suppositories. Quality control test were carried out on the formulated suppositories. The %age oil yield for hexane extract, hot water extract, and cold press extract were 50.40 ±0.00, 37.36±0.00, and 20.48±0.00, respectively. The acid value, saponification value, iodine value and free fatty acid were 1.159 ± 0.065, 208.51 ± 8.450, 49.877 ± 0.690 and 0.583 ± 0.032 respectively for hexane extract; 3.480 ± 0.055, 204.672±2.863, 49.04 ± 0.76 and 1.747 ± 0.028 respectively for hot water/traditional extract; 4.43 ± 0.055, 192.05±1.56, 49.96 ± 0.29 and 2.23 ± 0.03 respectively for cold press extract. Calcium, sodium, magnesium, potassium, and iron were minerals found to be present in the A. floribunda butter extracts. The uniformity of weight, hardness, disintegration time, and uniformity of content were found to be within the acceptable range. The melting point ranges for all the suppositories were found to be satisfactory. The cumulative drug release (%) of the suppositories at 45 minutes was 90.19±0.00 (Hot water extract), 93.75±0.00 (Cold Pres Extract), and 98.16±0.00 (Hexane Extract) for Paracetamol suppositories. Diclofenac sodium suppositories had a cumulative %age release of 81.60±0.00 (Hot water Extract), 95.33±0.00 (Cold Press Extract), and 99.20±0.00 (Hexane Extract). The physicochemical parameters obtained from this study shows that Allanblackia floribunda seed oil is edible and can be used as a suppository base. The suppository formulation was successful, and the quality control tests conformed to Pharmacopoeia standard.

Keywords: allanblackia foribunda, paracetamol, diclofenac, suppositories

Procedia PDF Downloads 109

Authors: Razieh Zarei, Hassan zm, Abolghasem Ajami, Darush Moslemi, Narges Afsary, Amrollah Mostafa-zade

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Introduction: IL-23 is responsible for the differentiation and expansion of Th17/ThIL-17 cells from naive CD4+ T cells. Therefore, may be IL-23/IL17 axis involve in a variety of allergic and autoimmune diseases, such as RA, MS, inflammatory bowel disease (IBD), and asthma. TGF-β is also share for the differentiation Th17 producing IL-17 and CD4+CD25+Foxp3hiT regulatory cells from naïve CD4+ T cells which are involved in the regulation of immune response, maintaining immunological self-tolerance and immune homeostasis ,and the control of autoimmunity and cancer surveillance. Therefore, T regulatory cells play a key role in autoimmunity, allergy, cancer, infectious disease, and the induction of transplantation tolerance. Vitamin A and it's derivatives (retinoids) inhibit or reverse the carcinogenic process in some types of cancers in oral cavity,head and neck, breast, skin, liver, and blood cells. Shark is a murine organism and its cartilage has antitumor peptides to prevent angiogenesis, in vitro. Our purpose is whether simultaneous oral treatment vitamin A and shark cartilage can modulate IL-23/IL-17 and CD4CD25Foxp3 T regulatory cell/TGF-β pathways and Th1/Th2 immunity in patients with gastric cancer. Materials and Methods: First investigated an imbalanced supernatant of cytokines exist in patients with gastric cancer by ELISA. Associated with cytokines measuring such as IL-23,IL-17,TGF-β,IL-4 and γ-IFN, then flow cytometry was employed to determine whether the peripheral blood mononuclear cells such as CD4+CD25+Foxp3highT regulatory cells in patients with gastric cancer were changed correspondingly. Results: An imbalance between IL-17 secretion and TGF-β/Foxp3 t regulatory cell pathway and so, Th1 immunity (γ-IFN production) and TH2 immunity (IL-4 secretion) was not seen in patients with gastric cancer treated by vitamin A and shark cartilage. But, the simultaneously presented down-regulation of IL-23 indicated, at least cytokine level. Conclusion: Il-23, as a pro-angiogenesis cytokine, probably, help to tumor growth. Hence, suggested that down-regulation of IL-23, at least cytokine level, is useful for anti-tumor immune responses in patients with gastric cancer.

Keywords: IL-23/IL17 axis, TGF-β/CD4CD25Foxp3 T regulatory pathway, γ-IFN, IL-4, shark cartilage and gastric cancer

Procedia PDF Downloads 380

Authors: Rima Al Garni, Emad Al Shdaifat, Sahar Elmetwalli, Mohammad Alzaid, Abdulrahman Alghothayyan, Sara Al Abd Al Hai, Seham Al Rashidi

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Aim: To investigate the prevalence of non-adherence of patients on haemodialysis and explore their perception of the importance of adherence to the therapeutic regime and estimate the predictors for adherence to the therapeutic regime. Background: End-stage renal disease is commonly treated by haemodialysis. Haemodialysis treatment alone is not effective in replacing kidney function. Diet and fluid restrictions, along with supplementary medications, are mandatory for the survival and well-being of patients. Hence, adherence to this therapeutic regimen is essential. However, non-adherence to diet and fluid restrictions, medications, and dialysis is common among patients on haemodialysis. Design: Descriptive cross-sectional method was applied to investigate the prevalence of non-adherence to treatment, including adherence to diet and fluid restrictions, medications, and dialysis sessions. Methods: Structured interviews were conducted using the Arabic version of the End-Stage Renal Disease Adherence Questionnaire. The sample included 230 patients undergoing haemodialysis in the Eastern Region of Saudi Arabia. Data were analysed using descriptive statistics and multiple regressions. Results/Findings: Most patients had good adherence (71.3%), and only 3.9% had poor adherence. The divorced or widowed patient had higher adherence compared with single (P=0.011) and married participants (P=0.045) through using the post hoc test. Patients above 60 years had higher adherence compared to patients below 40 years old (P=0.016) using the post hoc test. For the perception of the importance of adherence to the therapeutic regime subscale, two-thirds of the patients had lower scores (<=11). Conclusion: Adherence to therapeutic regime is high for three fourth of patients undergoing haemodialysis in the Eastern Region of Saudi Arabia; this finding is similar to results abstracted from the local literature. This result would help us highlight the needs of patients who are not compliant with their treatment plans and investigate the consequences of non-adherence on their well-being and general health. Hence, plan individualised therapeutic programmes that could raise their awareness and influence their adherence to therapeutic regimes.

Keywords: adherence to treatment, haemodialysis, end stage renal disease, diet and fluid restrictions

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Authors: Zeina Nasr, Bashar Merheb

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The honey bee is a social insect that had driven the human interest much more than any other organism. Beekeeping practices dated the appearance of Man on earth and now it provides a hobby or a secondary work that contributes to the family revenue and requires a little time engagement and money investment. Honey production is not the only contribution of honey bees to the economy, since honey bees play an important role in the pollination. Bee keeping in Lebanon is an important part of the agricultural economy. However, a growing concern about bees is spreading globally, due to an accelerated decline of bees colonies. This raises the alert to preserve and protect local bee strains against uncontrolled introduction of foreign strains and invasive parasitic species. Mitochondrial DNA (mtDNA) markers are commonly used in studying genetic variation in the Apis mellifera species. The DraI-COI-COII test is based on the analysis of the intergenic region between the two genes COI and COII. The different honey bee strains differ in the presence or absence of the p sequence and the number of Q sequences present. A. m. syriaca belonging to the lineage Z, is the native honey bee subspecies in Lebanon, Syria, Jordan, and Palestine. A. m. syriaca is known for its high defensiveness, even though it has many important advantages. However, commercial breeder strains, such as the Italian (A. m. ligustica), and Carniolan (A. m. carnica) strains, have been introduced by beekeepers and regularly used for honey production. This raises worries about the disappearance of the local subspecies. It is obvious that identifying A. m. syriaca colonies and protecting them against uncontrolled mating with other bee strains is a crucial step to protect and improve the original local strain. This study aims to reveal the existing sub-species of honey bee in Akkar – Lebanon and to assess the influence of introgression on the hybridization of the local strain. This will help to identify areas of pure A.m. syriaca population over this district to be considered in choosing syriaca reserves. We collected samples of bees from different regions of Akkar district in order to perform mtDNA analysis. We determined the restriction fragments length of the intergenic region COI-COII, using the restriction enzyme DraI. The results showed both the C and the Z lineages. Four restriction patterns were identified among the restriction maps of the studied samples. The most abundant mitochondrial lineage is the Z lineage constituting about 60% of the identified samples. Al-Dreib region reported the lowest introgression with foreign mtDNA of 21% making it the most suitable area for a genetic reserve of syriaca in Akkar based on its lowest introgression and suitable environment in addition to the attitude of local beekeepers to conserve the local strain. Finally, this study is the first step in constructing conservation programs for the preservation of the local strain and should be generalized to the whole Lebanese population, consistent with the effort done in neighboring countries.

Keywords: Akkar Lebanon, Apis millefera syriaca, DraI-COI-COII test, mitochondrial DNA

Procedia PDF Downloads 261

Authors: Richa Sinha, Mohammad Irfan Javed, Sanjay Singh

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Introduction: Good antimicrobial prescribing reduces length of stay in hospital, risk of adverse events, antimicrobial resistance, and unnecessary hospital expenditure. The aim of this prospective audit was to identify any problems with antimicrobial prescribing including documentation of the relevant aspects as well as appropriateness of antibiotics use. The audit was conducted on the surgical wards in a teaching hospital in the UK. Methods: Standards included the indication, duration, choice, and prescription of antibiotic should be in line with current Regional Guidelines and should be clearly documented on the prescription chart. There should be an entry in each patients’ medical record of the diagnosis and indication for each acute antibiotic prescription issued. All prescriptions should clearly document the route, frequency and dose of antibiotic. Data collection was done for 2 weeks in the month of March 2014. A proforma including all the questions above was completed for all the patients. The results were analysed using Excel. Results: 35 patients in total were selected for the audit. 85.7% of patients had indication of antibiotic documented on the prescription chart and 68.5% of patients had indication documented in the notes. The antibiotic used was in line with hospital guidelines in 45.7% of patients, however, in a further 28.5% of patients the reason for the antibiotic prescription was microbiology approved. Therefore, in total 74.2% of patients had been prescribed appropriate antibiotics. The duration of antibiotic was documented in 68.6% of patients and the antibiotic was reviewed in 37.1% of patients. The dose, frequency and route was documented clearly in 100% of patients. Conclusion: Overall, prescribing can be improved on the surgical wards in this hospital. Only 37.1% of patients had clear documentation of a review of antibiotics. It may be that antibiotics have been reviewed but this should be clearly highlighted on the prescription chart or the notes. Failure to review antibiotics can lead to poor patient care and antimicrobial resistance and therefore it is important to address this. It is also important to address the appropriateness of antibiotics as inappropriate antibiotic prescription can lead to failure of treatment as well as antimicrobial resistance. The good points from the audit was that all patients had clear documentation of dose, route and frequency which is extremely important in the administration of antibiotics. Recommendations from this audit included to emphasize good antimicrobial prescribing at induction (twice yearly), an antimicrobial handbook for junior doctors, and re-audit in 6 months time.

Keywords: prescribing, antimicrobial, indication, duration

Procedia PDF Downloads 286

Authors: Abdulwahhab Khedr, Tamer Shehata, Hanaa El-Ghamry

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Venlafaxine HCl is a novel antidepressant drug used in the treatment of major depressive disorder, generalized anxiety disorder, social anxiety disorder and panic disorder. Conventional therapeutic regimens with venlafaxine HCl immediate-release dosage forms require frequent dosing due to short elimination half-life of the drug and reduced bioavailability. Hence, this study was carried out to develop sustained-release dosage forms of venlafaxine HCl to reduce its dosing frequency, to improve patient compliance and to reduce side effects of the drug. The polymers used were hydroxypropylmethyl cellulose, xanthan gum, sodium alginate, sodium carboxymethyl cellulose, Carbopol 940 and ethyl cellulose. The physical properties of the prepared tablets including tablet thickness, diameter, weight uniformity, content uniformity, hardness and friability were evaluated. Also, the in-vitro release of venlafaxine HCl from different matrix tablets was studied. Based on physical characters and in-vitro release profiles, certain formulae showing promising sustained-release profiles were subjected to film coating with 15% w/v EC in dichloromethane/ethanol mixture (1:1 ratio) using 1% w/v HPMC as pore former and 30% w/w dibutyl phthalate as plasticizer. The optimized formulations were investigated for drug-excipient compatibility using FTIR and DSC studies. Physical evaluation of the prepared tablets fulfilled the pharmacopoeial requirements for tablet friability test, where the weight loss of the prepared formulae did not exceed 1% of the weight of the tested tablets. Moderate release was obtained from tablets containing HPMC. FTIR and DSC studies for such formulae revealed the absence of any type of chemical interaction between venlafaxine HCl and the used polymers or excipients. Forced swimming test in rats was used to evaluate the antidepressant activity of the selected matrix tablets of venlafaxine HCl. Results showed that formulations significantly decreased the duration of animals’ immobility during the 24 hr-period of the test compared to non-treated group.

Keywords: antidepressant, sustained-release, matrix tablet, venlafaxine hydrochloride

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Authors: Hendri Purwadi, Christine McCloud

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Triage is a complex decision-making process that aims to categorize a victim’s level of acuity and the need for medical assistance. Two common triage systems have been widely used in Mass Casualty Incidents (MCIs) and disaster situation are START (Simple triage algorithm and rapid treatment) and SALT (sort, asses, lifesaving, intervention, and treatment/transport). There is currently controversy regarding the effectiveness of SALT over START triage system. This systematic review aims to investigate and compare the effectiveness between SALT and START triage system in disaster and MCIs setting. Literatures were searched via systematic search strategy from 2009 until 2019 in PubMed, Cochrane Library, CINAHL, Scopus, Science direct, Medlib, ProQuest. This review included simulated-based and medical record -based studies investigating the accuracy and applicability of SALT and START triage systems of adult and children population during MCIs and disaster. All type of studies were included. Joana Briggs institute critical appraisal tools were used to assess the quality of reviewed studies. As a result, 1450 articles identified in the search, 10 articles were included. Four themes were identified by review, they were accuracy, under-triage, over-triage and time to triage per individual victim. The START triage system has a wide range and inconsistent level of accuracy compared to SALT triage system (44% to 94. 2% of START compared to 70% to 83% of SALT). The under-triage error of START triage system ranged from 2.73% to 20%, slightly lower than SALT triage system (7.6 to 23.3%). The over-triage error of START triage system was slightly greater than SALT triage system (START ranged from 2% to 53% compared to 2% to 22% of SALT). The time for applying START triage system was faster than SALT triage system (START was 70-72.18 seconds compared to 78 second of SALT). Consequently; The START triage system has lower level of under-triage error and faster than SALT triage system in classifying victims of MCIs and disaster whereas SALT triage system is known slightly more accurate and lower level of over-triage. However, the magnitude of these differences is relatively small, and therefore the effect on the patient outcomes is not significance. Hence, regardless of the triage error, either START or SALT triage system is equally effective to triage victims of disaster and MCIs.

Keywords: disaster, effectiveness, mass casualty incidents, START triage system, SALT triage system

Procedia PDF Downloads 117

Authors: Reena K., Mamatha H. G., Somshekarayya, P. Kumar

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Objectives: The annual proficiency testing of intermediate reference laboratories is conducted by the National Reference Laboratory (NRL) to assess the efficiency of the laboratories to correctly identify Mycobacterium tuberculosis and to determine its drug susceptibility pattern. The proficiency testing results from 2013 to 2017 were analyzed to determine laboratories that were consistent in reporting quality results and those that had difficulty in doing so. Methods: A panel of twenty cultures were sent out to each of these laboratories. The laboratories were expected to grow the cultures in their own laboratories, set up drug susceptibly testing by all the methods they were certified for and report the results within the stipulated time period. The turnaround time for reporting results, specificity, sensitivity positive and negative predictive values and efficiency of the laboratory in identifying the cultures were analyzed. Results: Most of the laboratories had reported their results within the stipulated time period. However, there was enormous delay in reporting results from few of the laboratories. This was mainly due to improper functioning of the biosafety level III laboratory. Only 40% of the laboratories had 100% efficiency in solid culture using Lowenstein Jensen medium. This was expected as a solid culture, and drug susceptibility testing is not used for diagnosing drug resistance. Rapid molecular methods such as Line probe assay and Genexpert are used to determine drug resistance. Automated liquid culture system such as the Mycobacterial growth indicator tube is used to determine prognosis of the patient while on treatment. It was observed that 90% of the laboratories had achieved 100% in the liquid culture method. Almost all laboratories had achieved 100% efficiency in the line probe assay method which is the method of choice for determining drug-resistant tuberculosis. Conclusion: Since the liquid culture and line probe assay technologies are routinely used for the detection of drug-resistant tuberculosis the laboratories exhibited higher level of efficiency as compared to solid culture and drug susceptibility testing which are rarely used. The infrastructure of the laboratory should be maintained properly so that samples can be processed safely and results could be declared on time.

Keywords: annual proficiency testing, drug susceptibility testing, intermediate reference laboratory, national reference laboratory

Procedia PDF Downloads 168

Authors: Siobhan Hegarty, Michael Bloomfield, Kim Entholt, Dorothy Williams, Helen Kennerley

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Complex Post-Traumatic Stress Disorder (CPTSD) confers greater risk of poor outcomes than does Post-Traumatic Stress Disorder (PTSD). Despite this, the current treatment guidelines for CPTSD aim to reduce only the ‘core’ symptoms of re-experiencing, hyper-vigilance and avoidance, while not addressing the Disturbances of Self Organisation (DSO) symptoms that distinguish this novel diagnosis from PTSD. The Recovering from Child Abuse Programme (RCAP) is a group protocol, based on the principles of cognitive behavioural therapy (CBT). Preliminary evidence suggests the program is effective at reducing DSO symptoms. This pilot study is the first to investigate the potential effectiveness of the RCAP for the specific treatment of CPTSD. This study was conducted as a service evaluation in a secondary care, traumatic stress service. Treatment was delivered once a week, in two-hour sessions, to ten existing female CPTSD patients of the service, who had experienced sexual abuse in childhood. The programme was administered by two therapists and two additional facilitators, following the RCAP protocol manual. Symptom severity was measured before the administration of therapy and was tracked across a range of measures (International Trauma Questionnaire; Patient Health Questionnaire; Community Assessment of Psychic Experience; Work and Social Adjustment Scale) at five time points, over the course of treatment. Qualitative appraisal of the programme was gathered via weekly feedback forms and from audio-taped recordings of verbal feedback given during group sessions. Preliminary results suggest the programme causes a slight reduction in CPTSD and depressive symptom severity and preliminary qualitative analysis suggests that the RCAP is both helpful and acceptable to group members. Final results and conclusions will follow completed thematic analysis of results.

Keywords: Child sexual abuse, Cognitive behavioural therapy, Complex post-traumatic stress disorder, Recovering from child abuse programme

Procedia PDF Downloads 118

Authors: B. Schofield, F. Gul, S. McClean, R. Hoskins, R. Terry, U. Rolfe, A. Gibson, S. Voss, J. Benger

Abstract:

Aim: The aim of this study is to determine whether and how health promotion activities are undertaken by paramedics and emergency department nurses and investigate ways of overcoming potential barriers. Background: Paramedics and emergency department nurses are uniquely placed to reach millions of people and could use these contacts as positive opportunities to help people improve their health by identifying people with risk factors and provide information, brief interventions, and signposting to locally provided services. These interventions can be carried out when the opportunity arises, typically take no more than a few minutes, have a low financial cost and can be a highly efficient method of health promotion. Methodology: Three NHS Emergency Departments and four Ambulance Trusts in England were recruited to the study. A link to an online survey was distributed to paramedics and emergency department nurses at participating sites. Staff were invited to participate in virtual semi-structured interviews. Patients seen, treated, and discharged at the participating sites were invited to virtual semistructured interviews. Findings: A total of 331 survey responses were received, 21 virtual semi-structured staff interviews and 11 patient interviews were completed. Staff reported lack of time to prioritise, lack of knowledge, resources, and confidence as barriers. Receptiveness of patients guided their decision to undertake health promotion activities. They reported a desire to learn how to undertake health promotion conversations. Emergency department nurses felt more supported than paramedics by their organisations to undertake health promotion activities. Patients were not aware of health promotion activities and reported fear and lack of privacy as barriers. Conclusions: These results will guide the development of an intervention to support the provision of health promotion by staff in urgent and emergency care settings. The components of the intervention will be mapped to a framework which will consider the needs of staff working within these settings, patients they treat, and organisational issues and practices related to the implementation of such an intervention.

Keywords: emergency service, hospital, nursing, allied health personnel, emergency medical services, health promotion

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