Search results for: Patient record data

Authors: Evagelia Makri, Maria Tsourela, Dimitris Paschaloudis, Dafni M. Nerantzaki

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One of the biggest financial and social problems, which at the same time constitute one of the greater challenges that Greek society faces today, is the illegal avoidance of tax payments. Tax evasion may negate financial data and community budgets, as well as breed financial chaos. This research seeks to reflect Greek reality concerning tax measures. Also, there will be an effort to record the factors surrounding tax evasion. Greek tax system’s data will be rendered in financial terms. Questionnaires will be handed out to tax payers, and interviews will be conducted to taxmen. The quantitative analysis of the questionnaire answers will define the tax payers’ opinion towards the existence of tax evasion. The qualitative analysis of the interviews will reveal the main reason that boosts tax evasion. At the end, there will be some realistic proposals about how to better collect taxes, through the creation of a strong regulatory mechanism.

Keywords: tax evasion, tax collection measures, insurance recovery measures, Greek tax system

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Authors: Samy A. Khalil, U. Ali Rahoma

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The measurements of solar radiation, satellite data has been routinely utilize to estimate solar energy. However, the temporal coverage of satellite data has some limits. The reanalysis, also known as "retrospective analysis" of the atmosphere's parameters, is produce by fusing the output of NWP (Numerical Weather Prediction) models with observation data from a variety of sources, including ground, and satellite, ship, and aircraft observation. The result is a comprehensive record of the parameters affecting weather and climate. The effectiveness of reanalysis datasets (ERA-5) for North Africa was evaluate against high-quality surfaces measured using statistical analysis. Estimating the distribution of global solar radiation (GSR) over five chosen areas in North Africa through ten-years during the period time from 2011 to 2020. To investigate seasonal change in dataset performance, a seasonal statistical analysis was conduct, which showed a considerable difference in mistakes throughout the year. By altering the temporal resolution of the data used for comparison, the performance of the dataset is alter. Better performance is indicate by the data's monthly mean values, but data accuracy is degraded. Solar resource assessment and power estimation are discuses using the ERA-5 solar radiation data. The average values of mean bias error (MBE), root mean square error (RMSE) and mean absolute error (MAE) of the reanalysis data of solar radiation vary from 0.079 to 0.222, 0.055 to 0.178, and 0.0145 to 0.198 respectively during the period time in the present research. The correlation coefficient (R2) varies from 0.93 to 99% during the period time in the present research. This research's objective is to provide a reliable representation of the world's solar radiation to aid in the use of solar energy in all sectors.

Keywords: solar energy, ERA-5 analysis data, global solar radiation, North Africa

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Authors: Khawlah Al-Khalidi

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Prevalence of lower third molar impactions and angulations among Yemeni population The purpose of this study was to look into the prevalence of lower third molars in a sample of patients from Ibb University Affiliated Hospital, as well as to study and categorise their position by using Pell and Gregory classification, and to look into a possible correlation between their position and the indication for extraction. Materials and methods: This is a retrospective, observational study in which a sample of 200 patients from Ibb University Affiliated Hospital were studied, including patient record validation and orthopantomography performed in screening appointments in people aged 16 to 21. Results and discussion: Males make up 63% of the sample, while people aged 19 to 20 make up 41.2%. Lower third molars were found in 365 of the 365 instances examined, accounting for 91% of the sample under study. According to Pell and Gregory's categorisation, the most common position is IIB, with 37%, followed by IIA with 21%; less common classes are IIIA, IC, and IIIC, with 1%, 3%, and 3%, respectively. It was feasible to determine that 56% of the lower third molars in the sample were recommended for extraction during the screening consultation. Finally, there are differences in third molar location and angulation. There was, however, a link between the available space for third molar eruption and the need for tooth extraction.

Keywords: lower third molar, extraction, Pell and Gregory classification, lower third molar impaction

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Authors: Sarinra Thongmee, Adithep Mingsuan, Chanyapak Polkhet, Supattra Wongsuk, Krittaphon Prakobsaeng

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The purposes of this research and development was to develop and evaluation of clinical nursing practice guideline (CNPG) for the prevention of infection during intubation in patient withsuspected or confirmedCOVID-19 patient. This study was developed by using the evidence based practice model of Soukup (2000) as a conceptual framework. The study consisted of 4 steps: 1) situational analysis of intubation service in patients with confirmed COVID-19, 2) development the CNPG, 3) apply the NPG to trial, and 4) evaluation of the NPG. Thesample consisted of 52 nurse anesthetists and 25 infected or suspected COVID-19 patients. The research instrument consisted of 1) CNPG, 2) the nurses anesthetist opinion questionnaire to the guideline, 3) the evaluation practice form, and 4) the nurse anesthetist knowledge test on nursing care of patients infected with COVID-19. Data were analyzed by using descriptive statistics, and Wilcoxon matched-pairs signed rank test. The results found that this developed NPG consists of 4 sections: 1) NPG for Preventing Airborne Infection Prevention2) preparation of anesthetic and intubation equipments 3) roles and duties of the intubation team 4) guidelines for intubation in suspected or confirmed COVID-19patients. The result found that 1) provider: using NPG in providers revealed that nurse anesthetist had higher mean of knowledge scores than before using NPG statistically significant at the 0.05 level (p<0.01) and able to follow the NPG 100% in all activities. The anesthetic team was not infected with COVID-19from intubation outside operating room.2) Client: the patient was safe, no complications from intubation. Summary CNPG to prevent infection in intubation of suspected or confirmedCOVID-19 patient was appropriate and applicable to practice.

Keywords: nursing practice guideline, prevention of infection, endotracheal intubation, COVID-19

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Authors: Kamran Yazdanbakhsh, Somayeh Mahmoudi

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Three reasons make good use of the decision theory in medicine: 1. Increased medical knowledge and their complexity makes it difficult treatment information effectively without resorting to sophisticated analytical methods, especially when it comes to detecting errors and identify opportunities for treatment from databases of large size. 2. There is a wide geographic variability of medical practice. In a context where medical costs are, at least in part, by the patient, these changes raise doubts about the relevance of the choices made by physicians. These differences are generally attributed to differences in estimates of probabilities of success of treatment involved, and differing assessments of the results on success or failure. Without explicit criteria for decision, it is difficult to identify precisely the sources of these variations in treatment. 3. Beyond the principle of informed consent, patients need to be involved in decision-making. For this, the decision process should be explained and broken down. A decision problem is to select the best option among a set of choices. The problem is what is meant by "best option ", or know what criteria guide the choice. The purpose of decision theory is to answer this question. The systematic use of decision models allows us to better understand the differences in medical practices, and facilitates the search for consensus. About this, there are three types of situations: situations certain, risky situations, and uncertain situations: 1. In certain situations, the consequence of each decision are certain. 2. In risky situations, every decision can have several consequences, the probability of each of these consequences is known. 3. In uncertain situations, each decision can have several consequences, the probability is not known. Our aim in this article is to show how decision theory can usefully be mobilized to meet the needs of physicians. The decision theory can make decisions more transparent: first, by clarifying the data systematically considered the problem and secondly by asking a few basic principles should guide the choice. Once the problem and clarified the decision theory provides operational tools to represent the available information and determine patient preferences, and thus assist the patient and doctor in their choices.

Keywords: decision making, medicine, treatment strategies, patient

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

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

Keywords: preeclampsia, incidence, risk factors, maternal

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Authors: Londeka Ntuli, Frasia Oosthuizen

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Background: Tenefovir disiproxil fumarate (TDF) is a nephrotoxic drug and has been proven to contribute to renal insufficiency necessitating intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. TDF is one of the preferred first-line drugs used in combination therapy in most regions. There are estimated 300 000 patients being initiated on the Efavirenz/TDF/Emtricitabine first-line regimen annually in South Africa. It is against this background that this study aims to investigate the effects of TDF on renal sufficiency of HIV positive patients. Methodology: A retrospective quantitative study was conducted, analysing clinical charts of HIV positive patient’s older than 18 years of age and on a TDF-containing regimen for more than 1 year. Data were obtained from the analysis of patient files and was transcribed into Microsoft® Excel® spreadsheet. Extracted data were coded, categorised and analysed using STATA®. Results: A total of 275 patient files were included in this study. Renal function started decreasing after 3 months of treatment (with 93.5% patients having a normal EGFR), and kept on decreasing as time progressed with only 39.6% normal renal function at year 4. Additional risk factors for renal insufficiency included age below 25, female gender, and additional medication. Conclusion: It is clear from this study that the use of TDF necessitates intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. The findings from this study generated pertinent information on the safety profile of the drug TDF in a resource-limited setting of a public health institution. The appropriate management is of tremendous importance in the South African context where the majority of HIV positive individuals are on the TDF containing regimen; thus it is beneficial to ascertain the possible level of toxicities these patients may be experiencing.

Keywords: renal insufficiency, tenefovir, HIV, risk factors

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Authors: Awol Seid Ebrie

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HIV results as an incurable disease, AIDS. After a person is infected with virus, the virus gradually destroys all the infection fighting cells called CD4 cells and makes the individual susceptible to opportunistic infections which cause severe or fatal health problems. Several studies show that the CD4 cells count is the most determinant indicator of the effectiveness of the treatment or progression of the disease. The objective of this paper is to investigate the progression of the disease over time among patient under HAART treatment. Two main approaches of the generalized multilevel ordinal models; namely the proportional odds model and the nonproportional odds model have been applied to the HAART data. Also, the multilevel part of both models includes random intercepts and random coefficients. In general, four models are explored in the analysis and then the models are compared using the deviance information criteria. Of these models, the random coefficients nonproportional odds model is selected as the best model for the HAART data used as it has the smallest DIC value. The selected model shows that the progression of the disease increases as the time under the treatment increases. In addition, it reveals that gender, baseline clinical stage and functional status of the patient have a significant association with the progression of the disease.

Keywords: nonproportional odds model, proportional odds model, random coefficients model, random intercepts model

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Authors: Mahmoud A. Amin, Essam Taman, Ahmed Omran, Mahmoud Shawky, Ahmed Mekawy, Abdallah M. Kotkat, Saber Younes, Nehad N. Ghonemy, Amin Saad, Ezz-Aleslam, Abdullah M. Elosh

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Introduction: TMJ is a one-of-a-kind, complicated synovial joint that helps with masticatory function by allowing the mandible to open and close the mouth. True ankylosis is a situation in which condylar movement is limited by a mechanical defect in the joint, whereas false ankylosis is a condition in which there is a restriction in mandibular movement due to muscular spasm myositis ossificans, and coronoid process hyperplasia. Ankylosis is characterized by the inability to open the mouth due to fusion of the TMJ condyle to the base of the skull as a result of trauma, infection, or systemic diseases such as rheumatoid arthritis (the most common) and psoraisis. Ankylosis causes facial asymmetry and affects the patient psychologically as well as speech, difficult mastication, poor oral hygiene, malocclusion, and other factors. TMJ is a technically challenging joint; hence TMJ ankylosis management is complicated. Case presentation: this case is a male patient 25 years old reported to our maxillofacial clinic in Damietta faculty of medicine, Al-Azhar University with the inability to open the mouth at all, with a history of difficulty of mouth breathing and eating foods, there was a history of falling from height at 2006, and the patient underwent corrective surgery before with no improvement because the ankylosis was relapsed short period after the previous operations with that done out of our hospital inter-incisor distant ZERO so, this condition need mandatory management. Clinical examination and radiological investigations were done after complete approval from the patient and his brother; tracheostomy was done for our patient before the operation. The patient entered the operation in our hospital and drastic improvement in mouth opening was noticed, helping to restore the physical psychological health of the patient.

Keywords: temporomandibular joint, TMJ, Ankylosis, mouth opening, physiotherapy, condylar plate

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Authors: Elzbieta Sikorska-Simmons

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Dementia is a progressive terminal disease. Despite this recognition, research shows that most family caregivers do not know it, and it is unclear how this knowledge affects the quality of patient care. The aim of this qualitative study of 20 family caregivers for patients with advanced dementia is to examine how the caregiver's knowledge about dementia affects the quality of patient care in the context of healthcare decision-making, advanced care planning, and access to adequate support systems. Knowledge about dementia implies family caregivers' understanding of dementia trajectories, common symptoms/complications, and alternative treatment options (e.g., comfort feeding versus tube feeding). Data were collected in semi-structured interviews with 20 family caregivers. The interviews were conducted in person by the author and designed to elicit rich descriptions of family caregivers' experiences with healthcare decision-making and the management of common symptoms/complications of end-stage dementia as patient healthcare proxies. The study findings suggest that caregivers who recognize that dementia is a terminal disease are less likely to opt for life-extending treatments during the advanced stages. They are also more likely to seek palliative/hospice care, and consequently, they are better able to avoid unnecessary hospitalizations or medical procedures. For example, those who know that dementia is a terminal disease tend to opt for "comfort feeding" rather than "tube feeding" in managing the swallowing difficulties that accompany advanced dementia. In the context of advance care planning, family caregivers who know that dementia is a terminal disease tend to have more meaningful advance directives (e.g., Power of Attorney and Do Not Resuscitate orders). They are better prepared to anticipate common problems and pursue treatments that foster the best quality of patient life and care. Greater knowledge about advanced dementia helps them make more informed decisions that focus on enhancing the quality of patient life rather than just survival. In addition, those who know that dementia is a terminal disease are more likely to establish adequate support systems to help them cope with the complex demands of caregiving. For example, they are more likely to seek dementia-oriented primary care programs that offer house visits or respite services. Based on the study findings, knowledge about dementia as a terminal disease is critical in the optimal management of patient care needs and the establishment of adequate support systems. More research is needed to better understand what caregivers need to know to better prepare them for the complex demands of dementia caregiving.

Keywords: dementia education, family caregiver, management of dementia, quality of care

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Authors: Nditsheni Ramakuela, Sonto Maputle, Base Khoza, Augustine Tugli

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Inadequate health literacy can cause difficulties in understanding and compliance to treatment plan. With diabetic condition, self-care activities include behaviours of following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care. Patients with poor health literacy have difficulty interpreting medication warning labels, following directions on a prescription label and identifying their medications. Difficulties in understanding and performing self-care and health-related activities may ultimately lead to poor health outcomes. The study explored and described factors affecting health literacy and self-care to diabetic regimen by female patients at selected hospital in Limpopo Province of South Africa. Qualitative and explorative research design was used. Female patients who were admitted and diagnosed with diabetes in female medical ward constituted the study population. Non-probability, purposive sampling was used to select 20 female patients diagnosed with diabetes, who were above 18 years and admitted during April–November 2014. An in-depth face-to-face, unstructured interview was used to collect data. Data were analysed using open coding method. Measures to ensure trustworthiness and ethical considerations were adhered to. Findings revealed factors affecting health literacy for diabetic self-care activities amongst patients were; patient, family, disease and facility related. Proposed recommendations were; to strengthen diabetes education and patient-provider partnership. This is important and must be transferred to strengthen self-care activities to fully benefit the patient.

Keywords: compliance, diabetes mellitus, diabetic regimen, health literacy, self activities

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Authors: Siti Rajaah Binti Sayed Sultan

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

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

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Authors: Kholood Baron

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Radiologic interventional studies use fluoroscopy imaging guidance to perform both diagnostic and therapeutic procedures. These could result in high radiation doses being delivered to the patients and also to the radiology team. This is due to the prolonged fluoroscopy time and the large number of images taken, even when dose-minimizing techniques and modern fluoroscopic tools are applied. Hence, these procedures are part of the everyday routine of interventional radiology doctors, assistant nurses, and radiographers. Thus, it is important to estimate the radiation exposure dose they received in order to give objective advice and reduce both patient and radiology team radiation exposure dose. The aim of this study was to find out the total radiation dose reaching the radiologist and the patient during an interventional procedure and to determine the impact of certain parameters on the patient dose. Method: The radiation dose was measured by TLD devices (thermoluminescent dosimeter; radiation dosimeter device). Physicians, patients, nurses, and radiographers wore TLDs during 12 interventional radiology procedures performed in two hospitals, Mubarak and Chest Hospital. This study highlights the need for interventional radiologists to be mindful of the radiation doses received by both patients and medical staff during interventional radiology procedures. The findings emphasize the impact of factors such as fluoroscopy duration and the number of images taken on the patient dose. By raising awareness and providing insights into optimizing techniques and protective measures, this research contributes to the overall goal of reducing radiation doses and ensuring the safety of patients and medical staff.

Keywords: dosimetry, radiation dose, interventional radiology procedures, patient radiation dose

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Authors: Joaquim de Almeida Dultra, Daiana Cristina Pereira Santana, Fátima Karoline Alves Araújo Dultra, Liliane Akemi Kawano Shibasaki, Mariana Machado Mendes de Carvalho, Ieda Margarida Crusoé Rocha Rebello

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Defects originating from mandibular resections can cause significant functional impairment and facial disharmony, and they have complex rehabilitation. The aim of this report is to demonstrate the authors' experience facing challenging rehabilitation after mandibular resection in a patient with ameloblastoma. Clinical and surgical steps are described simultaneously, highlighting the adaptation of the final fixed prosthesis, reported in an unprecedented way in the literature. A 37-year-old male patient was seen after a sports accident, where a pathological fracture in the symphysis and left mandibular body was identified, where a large radiolucent lesion was found. The patient underwent resection, bone graft, distraction osteogenesis, rehabilitation with dental implants, prosthesis, and finally, orofacial harmonization, in an interval of six years. Rehabilitation should consider the patient's needs individually and should have as the main objective to provide similar aesthetics and function to that present before the disease. We also emphasize the importance of interdisciplinary work during the course of rehabilitation.

Keywords: ameloblastoma, mandibular reconstruction, distraction osteogenesis, dental implants. dental prosthesis, implant-supported, treatment outcome

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Authors: Arielle Ferdinand

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A plant-based diet focuses on foods from plant sources, limiting or altogether omitting animal products. Some of the most common chronic illnesses seen in primary care are hypertension, hyperlipidemia, and diabetes type II. These common chronic illnesses can often be debilitating, costly, time-consuming, and, when left untreated, can lead to an early death. Treatment and maintenance of care are also labor intensive for the patient. They are often required to have at least four blood pressure checks yearly and a hemoglobin A1C checked quarterly. Though preventative interventions and prevention education should be included in patient visits in the primary care setting, education about dietary interventions, such as a plant-based diet, also yields positive outcomes for patients who already have hypertension, hyperlipidemia, and diabetes mellitus type 2. Evidence will show that incorporating a plant-based diet results in decreased blood pressure, as well as decreased levels of LDL-C, improved post-prandial glucose levels, and a reduction in HbA1C. It is cost-effective for the patient by generally lower grocery costs, and it can either reduce or prevent the need to pay for more office visits and pharmacotherapy. Incorporating this method of dietary changes is an easy intervention during a primary care office visit that would greatly benefit the patient in many ways.

Keywords: plant-based, nutrition, diabetes, hyperlipidemia

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Authors: Aofan Liu, Qianqian Tan, Burra Venkata Durga Kumar

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Data security is of the utmost importance in the healthcare area, as sensitive patient information is constantly sent around and analyzed by many different parties. The use of federated learning, which enables data to be evaluated locally on devices rather than being transferred to a central server, has emerged as a potential solution for protecting the privacy of user information. To protect against data breaches and unauthorized access, federated learning alone might not be adequate. In this context, the application of blockchain technology could provide the system extra protection. This study proposes a distributed federated learning system that is built on blockchain technology in order to enhance security in healthcare. This makes it possible for a wide variety of healthcare providers to work together on data analysis without raising concerns about the confidentiality of the data. The technical aspects of the system, including as the design and implementation of distributed learning algorithms, consensus mechanisms, and smart contracts, are also investigated as part of this process. The technique that was offered is a workable alternative that addresses concerns about the safety of healthcare while also fostering collaborative research and the interchange of data.

Keywords: data privacy, distributed system, federated learning, machine learning

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Authors: Wahyu Purnama Putra, Artono Isharanto

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Thoracic trauma is trauma that hits the thoracic wall or intrathoracic organs, either due to blunt trauma or sharp trauma. Thoracic trauma often causes impaired ventilation-perfusion due to damage to the lung parenchyma. This results in impaired tissue oxygenation, which is one of the causes of acute respiratory distress syndrome (ARDS). These changes are caused by the release of pro-inflammatory mediators, plasmatic proteins, and proteases into the alveolar space associated with ongoing edema, as well as oxidative products that ultimately result in severe inhibition of the surfactant system. This study aims to predict the incidence of acute respiratory distress syndrome (ARDS) through human neutrophil elastase levels. This study examines the relationship between plasma elastase levels as a predictor of the incidence of ARDS in thoracic trauma patients in Malang. This study is an observational cohort study. Data analysis uses the Pearson correlation test and ROC curve (receiver operating characteristic curve). It can be concluded that there is a significant (p= 0.000, r= -0.988) relationship between elastase levels and BGA-3. If the value of elastase levels is limited to 23.79 ± 3.95, the patient will experience mild ARDS. While if the value of elastase levels is limited to 57.68 ± 18.55, in the future, the patient will experience moderate ARDS. Meanwhile, if the elastase level is between 107.85 ± 5.04, the patient will likely experience severe ARDS. Neutrophil elastase levels correlate with the degree of severity of ARDS incidence.

Keywords: ARDS, human neutrophil elastase, severity, thoracic trauma

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Authors: Rhadinia Tayag-Relanes, Felina C. Young

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This study was conducted to analyze the noodle production process at Yan Hu Food Manufacturing for the basis of production improvement. The study utilized the PDCA approach and record review in the gathering of data for the calendar year 2019 from August to October data of the noodle products miki, canton, and misua. Causal-comparative research was used in this study; it attempts to establish cause-effect relationships among the variables such as descriptive statistics and correlation, both were used to compute the data gathered. The study found that miki, canton, and misua production has different cycle time sets for each production and has different production outputs in every set of its production process and a different number of wastages. The company has not yet established its allowable rejection rate/ wastage; instead, this paper used a 1% wastage limit. The researcher recommended the following: machines used for each process of the noodle product must be consistently maintained and monitored; an assessment of all the production operators by checking their performance statistically based on the output and the machine performance; a root cause analysis for finding the solution must be conducted; and an improvement on the recording system of the input and output of the production process of noodle product should be established to eliminate the poor recording of data.

Keywords: production, continuous improvement, process, operations, PDCA

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Authors: Kuei-Chun Liu, Yu-Yu Lai, Ching-Hong Wu

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A good automated testing tool could reduce as much as possible the manual work done by testers. Traditional record-replay testing tool provides an automated testing solution by recording mouse coordinates as test scripts, but it will be easily broken if any change of resolutions. Therefore, more and more testers design multiple test scripts to automate the testing process for different devices. In order to improve the traditional record-replay approach and reduce the effort that the testers spending on writing test scripts, we propose an approach for generating the Android application test scripts based on accessibility service without connecting to a computer. This approach simulates user input actions and replays them correctly even at the different conditions such as the internet connection is unstable when the device under test, the different resolutions on Android devices. In this paper, we describe how to generate test scripts automatically and make a comparison with existing tools for Android such as Robotium, Appium, UIAutomator, and MonkeyTalk.

Keywords: accessibility service, Appium, automated testing, MonkeyTalk, Robotium, testing, UIAutomator

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Authors: Camille Van Eupen, Dirk Maes, Marc Herremans, Kristijn R. R. Swinnen, Ben Somers, Stijn Luca

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In ecology, species distribution models are commonly implemented to study species-environment relationships. These models increasingly rely on opportunistic citizen science data when high-quality species records collected through standardized recording protocols are unavailable. While these opportunistic data are abundant, uncertainty is usually high, e.g., due to observer effects or a lack of metadata. Data quality filtering is often used to reduce these types of uncertainty in an attempt to increase the value of studies relying on opportunistic data. However, filtering should not be performed blindly. In this study, recommendations are built for data quality filtering of opportunistic species occurrence data that are used as input for species distribution models. Using an extensive database of 5.7 million citizen science records from 255 species in Flanders, the impact on model performance was quantified by applying three data quality filters, and these results were linked to species traits. More specifically, presence records were filtered based on record attributes that provide information on the observation process or post-entry data validation, and changes in the area under the receiver operating characteristic (AUC), sensitivity, and specificity were analyzed using the Maxent algorithm with and without filtering. Controlling for sample size enabled us to study the combined impact of data quality filtering, i.e., the simultaneous impact of an increase in data quality and a decrease in sample size. Further, the variation among species in their response to data quality filtering was explored by clustering species based on four traits often related to data quality: commonness, popularity, difficulty, and body size. Findings show that model performance is affected by i) the quality of the filtered data, ii) the proportional reduction in sample size caused by filtering and the remaining absolute sample size, and iii) a species ‘quality profile’, resulting from a species classification based on the four traits related to data quality. The findings resulted in recommendations on when and how to filter volunteer generated and opportunistically collected data. This study confirms that correctly processed citizen science data can make a valuable contribution to ecological research and species conservation.

Keywords: citizen science, data quality filtering, species distribution models, trait profiles

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Authors: K. Mardaleishvili, G. Loladze, G. Shatirishivili, D. Chakhunashvili, A. Vishnevskaya, Z. Kakabadze

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Benign osteoblastoma is a benign tumor of the bone, usually affecting the vertebrae and long tubular bones. It is a rarely seen tumor of the facial bones. The authors present a case of a 28-year-old male patient with a tumor in mandibular body. The lesion was radically resected and histological analysis of the specimen demonstrated features typical of a benign osteoblastoma. The defect of the jaw was reconstructed with titanium implants and decellularized and lyophilized cattle bone matrix with mesenchymal bone marrow stem cells transplantation. This presentation describes the procedures for rehabilitating a patient with decellularized bone scaffold in the region of the face, recovering the facial contours and esthetics of the patient.

Keywords: facial bones, osteoblastoma, stem cells, transplantation

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Authors: Ling-Lang Huang

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Background: The holistic health care should ideally cover physical, mental, spiritual, and social aspects of a patient. With very constrained time in current clinical practice system, medical decisions often tip the balance in favor of evidence-based medicine (EBM) in comparison to patient's personal values. Even in the era of competence-based medical education (CBME), when scrutinizing the items of entrustable professional activities (EPAs), we found that EPAs of establishing doctor-patient relationship remained incomplete or even missing. This phenomenon prompted us to raise this project aiming at advocating value-based medicine (VBM), which emphasizes the importance of patient’s values in medical decisions. A true and effective doctor-patient communication and relationship should be a well-balanced harmony of EBM and VBM. By constructing VBM into current EPAs, we can further promote genuine shared decision making (SDM) and fix the missing link in holistic health care. Methods: In this project, we are going to find out EPA elements crucial for establishing an ideal doctor-patient relationship through three distinct pairs of doctor-patient relationships: patients with pulmonary arterial hypertension (relatively young but with grave disease), patients undergoing surgery (facing critical medical decisions), and patients with terminal diseases (facing forthcoming death). We’ll search for important EPA elements through the following steps: 1. Narrative approach to delineate patients’ values among 2. distinct groups. 3.Hermeneutics-based interview: semi-structured interview will be conducted for both patients and physicians, followed by qualitative analysis of collected information by compiling, disassembling, reassembling, interpreting, and concluding. 4. Preliminarily construct those VBM elements into EPAs for doctor-patient relationships in 3 groups. Expected Outcomes: The results of this project are going to give us invaluable information regarding the impact of patients’ values, while facing different medical situations, on the final medical decision. The competence of well-blending and -balanced both values from patients and evidence from clinical sciences is the missing link in holistic health care and should be established in future EPAs to enhance an effective SDM.

Keywords: value-based medicine, shared decision making, entrustable professional activities, holistic health care

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Authors: Fatima Saeed, Abdullah Mudassar

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Introduction: Patient safety remains a global priority in the ever-evolving healthcare landscape. At the forefront of this endeavor are the International Patient Safety Goals (IPSGs), a standardized framework designed to mitigate risks and elevate the quality of care. Doctors, positioned as primary caregivers, wield a pivotal role in upholding and adhering to IPSGs, underscoring the critical significance of their knowledge and understanding of these goals. This research embarks on a comprehensive exploration into the depth of Doctors ' comprehension of IPSGs, aiming to unearth potential gaps and provide insights for targeted educational interventions. Established by influential healthcare bodies, including the World Health Organization (WHO), IPSGs represent a universally applicable set of objectives spanning crucial domains such as medication safety, infection control, surgical site safety, and patient identification. Adherence to these goals has exhibited substantial reductions in adverse events, fostering an overall enhancement in the quality of care. This study operates on the fundamental premise that an informed Doctors workforce is indispensable for effectively implementing IPSGs. A nuanced understanding of these goals empowers Doctors to identify potential risks, advocate for necessary changes, and actively contribute to a safety-centric culture within healthcare institutions. Despite the acknowledged importance of IPSGs, there is a growing concern that nurses may need more knowledge to integrate these goals into their practice seamlessly. Methodology: A Comprehensive research methodology covering study design, setting, duration, sample size determination, sampling technique, and data analysis. It introduces the philosophical framework guiding the research and details material, methods, and the analysis framework. The descriptive quantitative cross-sectional study in teaching care hospitals utilized convenient sampling over six months. Data collection involved written informed consent and questionnaires, analyzed with SPSS version 23, presenting results graphically and descriptively. The chapter ensures a clear understanding of the study's design, execution, and analytical processes. Result: The survey results reveal a substantial distribution across hospitals, with 34.52% in MTIKTH and 65.48% in HMC MTI. There is a notable prevalence of patient safety incidents, emphasizing the significance of adherence to IPSGs. Positive trends are observed, including 77.0% affirming the "time-out" procedure, 81.6% acknowledging effective healthcare provider communication, and high recognition (82.7%) of the purpose of IPSGs to improve patient safety. While the survey reflects a good understanding of IPSGs, areas for improvement are identified, suggesting opportunities for targeted interventions. Discussion: The study underscores the need for tailored care approaches and highlights the bio-socio-cultural context of 'contagion,' suggesting areas for further research amid antimicrobial resistance. Shifting the focus to patient safety practices, the survey chapter provides a detailed overview of results, emphasizing workplace distribution, patient safety incidents, and positive reflections on IPSGs. The findings indicate a positive trend in patient safety practices with areas for improvement, emphasizing the ongoing need for reinforcing safety protocols and cultivating a safety-centric culture in healthcare. Conclusion: In summary, the survey indicates a positive trend in patient safety practices with a good understanding of IPSGs among participants. However, identifying areas for potential improvement suggests opportunities for targeted interventions to enhance patient safety further. Ongoing efforts to reinforce adherence to safety protocols, address identified gaps, and foster a safety culture will contribute to continuous improvements in patient care and outcomes.

Keywords: infection control, international patient safety, patient safety practices, proper medication

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Authors: Jasmin S. Nurkovic, Ljubisa Dj. Jovasevic, Zana C. Dolicanin, Zoran S. Bajin

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Ruptured muscles and tendons very often must be repatriated by open operation in young persons. In young, muscles are ruptured more often than tendons, at the sane time in older persons are more exposed to rupture than muscles. Ruptured of the calcaneus are the most present of all ruptures. Sometime the rupture is complete, but very often the incomplete rupture can be noticed. During six years, from 2006 to 2012, we treated nineteen male patients and three female patients with the rupture of tendon Achilles. The youngest patient was aged thirty two, and the oldest was also managed sixty four. The youngest female patient was forty one and the oldest was forty six. One of our patients who was under corticosteroid treatment did not take any part in sport activities but she was, as she told us, going for a long walk, the same was with other two patients one man and one woman. We had nineteen male patients age 32 to 64 and three female patients age 41, 44 and 46. Conservative treatment by cast was applied in five patients and very good results were in three of them. In two patients surgical treatment failed in patient’s age 53 and 64. Only one of all patients treated by surgery had healing problems because of necrotic changes of the skin where incision was made. One of our female patients age 45 was under steroid treatment for almost 20 years because of asthmatic problems. We suggested her wearing boots with 8cm long heels by day and by night eight weeks. The final results were satisfactory and all the time she was able to work and to walk. It was the only case we had with bilateral tendon rupture. After eight weeks the cast is removed and psychiatric treatment started, patient is using crutches with partial weight bearing over a period of two weeks. Quite the same treatment conservative treatment, only the cast is not removed after two but after four weeks. Everyday activities after the surgical treatment started ten weeks and sport activities can start after fourteen to sixteen weeks. An increased activity of our patient without previous preparing for forces activity can result, as we already see, with tendon rupture. Treatment is very long and very often surgical. We find that surgical treatment resulted as safer and better solution for patients. We also had a patient with spontaneous rupture of tendon during longer walking but this patient was under prolonged corticosteroid treatment.

Keywords: tendon, Achilles, rupture, sport

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Authors: Sandhya Rao

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Kevin Lynch’s Theory on Imeageability, let on explore a city in terms of five elements, Nodes, Paths, Edges, landmarks and Districts. What happens when we try to record the same data in an Indian context? What happens when we apply the same theory of Imageability to a complex shifting urban pattern of the Indian cities and how can we as Urban Designers demonstrate our role in the image building ordeal of these cities? The organizational patterns formed through mental images, of an Indian city is often diverse and intangible. It is also multi layered and temporary in terms of the spirit of the place. The pattern of images formed is loaded with associative meaning and intrinsically linked with the history and socio-cultural dominance of the place. The embedded memory of a place in one’s mind often plays an even more important role while formulating these images. Thus while deriving an image of a city one is often confused or finds the result chaotic. The images formed due to its complexity are further difficult to represent using a single medium. Under such a scenario it’s difficult to derive an output of an image constructed as well as make design interventions to enhance the legibility of a place. However, there can be a combination of tools and methods that allows one to record the key elements of a place through time, space and one’s user interface with the place. There has to be a clear understanding of the participant groups of a place and their time and period of engagement with the place as well. How we can translate the result obtained into a design intervention at the end, is the main of the research. Could a multi-faceted cognitive mapping be an answer to this or could it be a very transient mapping method which can change over time, place and person. How does the context influence the process of image building in one’s mind? These are the key questions that this research will aim to answer.

Keywords: imageability, organizational patterns, legibility, cognitive mapping

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Authors: Nasib Zaman, Maneesha Kour, Muhammad Rizwan, Fazal Akbar

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Abstract: Chikungunya fever is a re-emerging rapidly spreading mosquito-borne disease cause by Aedes albopictus and Aedes aegypti mosquito vectors. Currently, it is affecting millions of people globally. Objective: This study's main objective was to find the incidence of chikungunya fever in the Swat region and the factors associated with the spread of this infection. Method: This study was carried out in different areas of Swat. Blood samples and data were collected from selected patients, and a questionnaire was filled for each patient. 3-5ml of the specimen was taken from the patient's vein and serum, or plasma was separated by centrifugation. Chikungunya tests were performed for IgG and IgM antibodies. The data was analyzed by SPSS and Graph Paid Prism 5. Results: A total of 169 patients were included in this study, out of which 103 (60.9%) having age less than 30 years were positive for chikungunya infection and 66 (39.1%) having more than 30 years were negative for this infection. Only 1 (0.6%) were positive for both IgG and IgM antibody. About 15 (8.9%) patients have diagnosed with positive IgG antibodies, and 25 (26.6%) patients were positive for IgM positive antibodies. The infection rate was significantly higher in males compared to females 71 (59.6%) vs. 14 (38%) P value=0.088, OR=1.7. Conclusion: This study concludes clinical knowledge and awareness that are necessary for a diagnosis of chikungunya infection properly. Therefore it is important to educate people for the eradication of this infection. Recommendation: This study also recommends investigating the other risk factors associated with this infection.

Keywords: Chikungunya, risk factor, Incidence, antibodies, mosquito

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Authors: Godwin Dennison, Edwin Cooper, George Theobald, Richard Dalton

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We report an unusual case of giant filiform polyposis in a patient with ulcerative colitis, causing a large stricture in the colon. A 62-year-old man was referred to the Bowel Cancer Screening Programme with a positive Faecal Immunochemical Test (FIT). He was known to have UC for 30 years. A CT scan showed a 9 cm stricture in the transverse colon suspicious of malignancy. A colonoscopy was attempted three times, and biopsies confirmed features of ulcerative colitis. A laparoscopic assisted transverse colectomy (Left hemicolectomy) was performed, and the histology revealed giant filiform polyposis. This should be considered in a UC patient presenting with signs of obstruction mimicking a carcinoma. Whilst it is a benign condition, because of the size of the lesion, it often causes obstruction, and surgery is indicated to relieve symptoms.

Keywords: giant inflammatory polyposis, filiform polyposis, ulcerative colitis, inflammatory bowel disease

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Authors: Efi Koutantou

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The foundation of successful therapy is the bond between the psychotherapist and the patient, Psychoanalysis would argue. The present study explores lived experiences of a psychotherapeutic relationship in different moments, initial and final with special reference to the transference love developed through the process. The fight between moments of ‘leaving a self’ behind and following ‘lines of flight’ in the process of creating a new subjectivity and ‘becoming-other’ will be explored. Moments between de-territorialisation – surpassing given constraints such as gender, family and religion, kinship bonds - freeing the space in favor of re-territorialisation – creation of oneself creation of oneself will also be analyzed. The generation of new possibilities of being, new ways of self-actualization for this patient will be discussed. The second part of this study will explore the extent to which this ‘transference love’ results for this specific patient to become ‘the discourse of the other’; it is a desideratum whether the patient finally becomes a subject of his/her own through his/her own self-exploration of new possibilities of existence or becomes alienated within the thought of the therapist. The way in which the patient uses or is (ab)used by the transference love in order to experience and undergo alienation from an ‘authority’ which may or may not sacrifice his/her own thought in favor of satisfying the therapist will be investigated. Finally, from an observer’s perspective and from the analysis of the results of this therapeutic relationship, the counter-transference will also be analyzed, in terms of an attempt of the analyst to relive and satisfy his/her own desires through the life of the analysand. The accession and fall of an idealized self will be analyzed, the turn of the transference love into ‘hate’ will conclude this case study through a lived experience in the therapeutic procedure; a relationship which can be called to be a mixture of a real relationship and remnants from a past object relationship.

Keywords: alienation, authority, counter-transference, hate, transference love

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Authors: Mohammad Javad Esmaeili

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Background: Coagulopathy is one of the complications with end stage renal disease with high prevalence in the world. Thromboelastogram is adynamic test for evaluation of coagulopathy and we have compared our patient's coagulation profiles with the results of TEG. Material and methods: In this study 50 patients with ESRD who were on regular hemodialysis for at least 6 months was selected with simple sampling and their coagulation profile was done with blood sampling and also TEG was done for every patient. Data were analyzed with SPSS and P<0.05 consider significant. Results: Protein s, Protein c and Antithrombin III deficiency was detected in 32%, 16% and 20% of patients and activated protein c resistance was abnormal in 2% of patients. In TEG, R time in 49% and K in 22/5% of patients was lower than normal and a-angle in 26% and maximum amplitude in 36% of patients was upper than normal (Hypercoagulable state). PS with R and ATIII with K have correlation. Conclusion: R time and K in TEG can be a suitable screening test in patients with suspicious to PS and ATIII deficiency.

Keywords: thromboelastography, chronic kidney disease, Coagulating disorder, hemodialysis

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Authors: Anupam Sibal

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Apollo Quality Program(AQP) was launched across the Apollo Group of Hospitals to address the four patient safety areas; Safety during Clinical Handovers, Medication Safety, Surgical Safety and the six International Patient Safety Goals(IPSGs) of JCI. A measurable, online, quality dashboard covering 20 process and outcome parameters was devised for monthly monitoring. The expected outcomes were also defined and categorized into green, yellow and red ranges. An audit methodology was also devised to check the processes for the measurable dashboard. Documented clinical handovers were introduced for the first time at many locations for in-house patient transfer, nursing-handover, and physician-handover. Prototype forms using the SBAR format were made. Patient-identifiers, read-back for verbal orders, safety of high-alert medications, site marking and time-outs and falls risk-assessment were introduced for all hospitals irrespective of accreditation status. Measurement of Surgical-Site-Infection (SSI) for 30 days postoperatively, was done. All hospitals now tracked the time of administration of antimicrobial prophylaxis before surgery. Situations with high risk of retention of foreign body were delineated and precautionary measures instituted. Audit of medications prescribed in the discharge summaries was made uniform. Formularies, prescription-audits and other means for reduction of medication errors were implemented. There is a marked increase in the compliance to processes and patient safety outcomes. Compliance to read-back for verbal orders rose from 86.83% in April’11 to 96.95% in June’15, to policy for high alert medications from 87.83% to 98.82%, to use of measures to prevent wrong-site, wrong-patient, wrong procedure surgery from 85.75% to 97.66%, to hand-washing from 69.18% to 92.54%, to antimicrobial prophylaxis within one hour before incision from 79.43% to 93.46%. Percentage of patients excluded from SSI calculation due to lack of follow-up for the requisite time frame decreased from 21.25% to 10.25%. The average AQP scores for all Apollo Hospitals improved from 62 in April’11 to 87.7 in Jun’15.

Keywords: clinical handovers, international patient safety goals, medication safety, surgical safety

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