Search results for: heart failure patient

Authors: Adel A. Ghobbar

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The airline industry is continuously challenging how to safely increase the service life of the aircraft with limited maintenance budgets. Operators are looking for the most qualified maintenance providers of aircraft components, offering the finest customer service. Component owner and maintenance provider is offering an Abacus agreement (Aircraft Component Leasing) to increase the efficiency and productivity of the customer service. To increase the customer service, the current focus on No Fault Found (NFF) units must change into the focus on Early Failure (EF) units. Since the effect of EF units has a significant impact on customer satisfaction, this needs to increase the reliability of EF units at minimal cost, which leads to the goal of this paper. By identifying the reliability of early failure (EF) units with regards to No Fault Found (NFF) units, in particular, the root cause analysis with an integrated cost analysis of EF units with the use of a failure mode analysis tool and a cost model, there will be a set of EF maintenance improvements. The data used for the investigation of the EF units will be obtained from the Pentagon system, an Enterprise Resource Planning (ERP) system used by Fokker Services. The Pentagon system monitors components, which needs to be repaired from Fokker aircraft owners, Abacus exchange pool, and commercial customers. The data will be selected on several criteria’s: time span, failure rate, and cost driver. When the selected data has been acquired, the failure mode and root cause analysis of EF units are initiated. The failure analysis approach tool was implemented, resulting in the proposed failure solution of EF. This will lead to specific EF maintenance improvements, which can be set-up to decrease the EF units and, as a result of this, increasing the reliability. The investigated EFs, between the time period over ten years, showed to have a significant reliability impact of 32% on the total of 23339 unscheduled failures. Since the EFs encloses almost one-third of the entire population.

Keywords: supportability, no fault found, FMEA, early failure, availability, operational reliability, predictive model

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Authors: Sabah Mohammed, Jinan Fiaidhi, Darien Sawyer

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Describing clinical cases according to a clinical charting standard that enforces interoperability and enables connected care services can save lives in the event of a medical emergency or provide efficient and effective interventions for the benefit of the patients through the integration of bedside and bench side clinical research. This article presented a multi-tenant extension to the problem-oriented medical record that we have prototyped previously upon using the GraphQL Application Programming Interface to represent the notion of a problem list. Our implemented extension enables physicians and patients to collaboratively describe the patient case via using multi chatbots to collaboratively describe the patient case using the SOAP charting standard. Our extension also connects the described SOAP patient case with the HL7 FHIR (Health Interoperability Resources) medical record for connecting the patient case to the bench data.

Keywords: problem-oriented medical record, graphQL, chatbots, SOAP

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Authors: L. C. Prasanna, Antony Sylvan D’Souza, Kumar M. R. Bhat

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Although life as a conjoined twin would seem intolerable, there has recently been an increased interest in this subject because of the increasing number of cases where attempts have been made to separate them surgically. We have reviewed articles on cardiovascular anomalies in conjoined twins and presenting rarest anomaly in dicephalus parapagus fetus having two heads attached to one body from the neck or upper chest downwards, with a pair of limbs and a set of reproductive organs. Both the twins shared a common thoracic cavity with a single sternum. When the thoracic cavity was opened, a common anterior mediastinum was found. On opening the pericardium, two separate, closely apposed hearts were exposed. The two cardia are placed side by side. The left heart was slightly larger than the right and were joined at the atrial levels. Four atrial appendages were present, two for each twin. The atrial complex was a common chamber posterior to the ventricles. A single large tributary which could be taken as inferior vena cava drains into the common atrial chamber. In this case, the heart could not be assigned to either twin and therefore, it is referred to as the shared heart within a common pericardial sac. The right and left descending thoracic aorta have joined with each other just above the diaphragm to form a common descending thoracic aorta which has an opening in the diaphragm to be continued as common abdominal aorta which has a normal branching pattern. Upon an interior dissection, it is observed that the two atria have a wide communication which could be a wide patent foramen ovale and this common atrial cavity has a communication with a remnant of a possible common sinus venosus.

Keywords: atrium, congenital anomaly, conjoined twin, sinus venosus

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Authors: Kanchan Mondal, Dasharath Koulage, Dattatray Manerikar, Asmita Ghate

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This paper presents an additive reliability model using warranty data and Finite Element Analysis (FEA) data. Warranty data for any product gives insight to its underlying issues. This is often used by Reliability Engineers to build prediction model to forecast failure rate of parts. But there is one major limitation in using warranty data for prediction. Warranty periods constitute only a small fraction of total lifetime of a product, most of the time it covers only the infant mortality and useful life zone of a bathtub curve. Predicting with warranty data alone in these cases is not generally provide results with desired accuracy. Failure rate of a mechanical part is driven by random issues initially and wear-out or usage related issues at later stages of the lifetime. For better predictability of failure rate, one need to explore the failure rate behavior at wear out zone of a bathtub curve. Due to cost and time constraints, it is not always possible to test samples till failure, but FEA-Fatigue analysis can provide the failure rate behavior of a part much beyond warranty period in a quicker time and at lesser cost. In this work, the authors proposed an Additive Weibull Model, which make use of both warranty and FEA fatigue analysis data for predicting failure rates. It involves modeling of two data sets of a part, one with existing warranty claims and other with fatigue life data. Hazard rate base Weibull estimation has been used for the modeling the warranty data whereas S-N curved based Weibull parameter estimation is used for FEA data. Two separate Weibull models’ parameters are estimated and combined to form the proposed Additive Weibull Model for prediction.

Keywords: bathtub curve, fatigue, FEA, reliability, warranty, Weibull

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Authors: Deliou Adel, Saadalah Younes, Belkaid Khmissi, Dehbi Meriem

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Composite materials, in the most common sense of the term, are a set of synthetic materials designed and used mainly for structural applications; the mechanical function is dominant. The mechanical behaviors of the composite, as well as the degradation mechanisms leading to its rupture, depend on the nature of the constituents and on the architecture of the fiber preform. The profile is required because it guides the engineer in designing structures with precise properties in relation to the needs. This work is about studying the mechanical behavior of unidirectional composite laminates according to different failure criteria. Varying strength parameter values make it possible to compare the ultimate mechanical characteristics obtained by the criteria of Tsai-Hill, Fisher and maximum stress. The laminate is subjected to uniaxial tensile membrane forces. Estimates of their ultimate strengths and the plotting of the failure envelope constitute the principal axis of this study. Using the theory of maximum stress, we can determine the various modes of damage of the composite. The different components of the deformation are presented for different orientations of fibers.

Keywords: unidirectional kevlar/epoxy composite, failure criterion, membrane stress, deformations, failure envelope

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Authors: Taweesak Janyacharoen, Lalita Pradubgool, Lalita Wongsorn, Pitchayapa Janyacharoen

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Street dance is a form of exercise that is classified as aerobic and is very suitable for teenagers. Street dance is a dance that can create new dance moves all the time. It often incorporates elements from gymnastics and is accompanied by fast-paced music that emphasizes excitement and energy. It is a combination of high-intensity and low-intensity activities. Few studies have looked at the effects of street dance on cardiovascular endurance, and previous studies have long-term effects. However, no research study in Thailand has studied acute effects before. This study was to investigate the acute effect of street dance exercise on blood pressure, heart rate, oxygen saturation and physical fitness in sedentary subjects. Subjects were divided into 2 groups: the control group (n=15) received health education and rest, and the experimental group (n=15) received street dance exercise. Both groups will measure their blood pressure (BP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO₂) and six-minute walk test (6MWT) before and after completing the program. The results found that both groups had significantly different HR when comparing before and after the program (p<0.05). MAP, HR and SpO₂ had significantly different (p<0.05) when compared between groups. This study concluded that the acute effect of street dance exercise could be increased in HR while the SpO₂ decreased. In clinical, it was seen that the values that were changed are still within the range that is considered normal. Therefore, street dance exercises can be used as one choice of alternative exercise.

Keywords: street dance, exercise, blood pressure, heart rate, oxygen saturation

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Authors: Darren Edwards, Thomas Pinna

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Background: Interoception and heart rate variability have been found to predict outcomes of mental health and well-being. However, these have usually been investigated independently of one another. Objectives: This review aimed to explore the associations between interoception and heart rate variability (HRV) with emotion regulation (ER) and ER strategies within the existing literature and utilizing systematic review methodology. Methods: The process of article retrieval and selection followed the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. Databases PsychINFO, Web of Science, PubMed, CINAHL, and MEDLINE were scanned for papers published. Preliminary inclusion and exclusion criteria were specified following the patient, intervention, comparison, and outcome (PICO) framework, whilst the checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS) framework was used to help formulate the research question, and to critically assess for bias in the identified full-length articles. Results: 237 studies were identified after initial database searches. Of these, eight studies were included in the final selection. Six studies explored the associations between HRV and ER, whilst three investigated the associations between interoception and ER (one of which was included in the HRV selection too). Overall, the results seem to show that greater HRV and interoception are associated with better ER. Specifically, high parasympathetic activity largely predicted the use of adaptive ER strategies such as reappraisal, and better acceptance of emotions. High interoception, instead, was predictive of effective down-regulation of negative emotions and handling of social uncertainty, there was no association with any specific ER strategy. Conclusions: Awareness of one’s own bodily feelings and vagal activation seem to be of central importance for the effective regulation of emotional responses.

Keywords: emotional regulation, vagal tone, interoception, chronic conditions, health and well-being, psychological flexibility

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Authors: Mohammad H. Yarmohammadian, Reza Safdari, Mahmoud Keyvanara, Nahid Tavakoli

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One of the greatest challenges in disaster and emergencies is patient tracking. The concept of tracking has different denotations. One of the meanings refers to tracking patients’ physical locations and the other meaning refers to tracking patients ‘medical needs during emergency services. The main goal of patient tracking is to provide patient safety during disaster and emergencies and manage the flow of patient and information in different locations. In most of cases, there are not sufficient and accurate data regarding the number of injuries, medical conditions and their accommodation and transference. The objective of the present study is to survey on patient tracking issue in natural disaster and emergencies. Methods: This was a narrative study in which the population was E-Journals and the electronic database such as PubMed, Proquest, Science direct, Elsevier, etc. Data was gathered by Extraction Form. All data were analyzed via content analysis. Results: In many countries there is no appropriate and rapid method for tracking patients and transferring victims after the occurrence of incidents. The absence of reliable data of patients’ transference and accommodation, even in the initial hours and days after the occurrence of disasters, and coordination for appropriate resource allocation, have faced challenges for evaluating needs and services challenges. Currently, most of emergency services are based on paper systems, while these systems do not act appropriately in great disasters and incidents and this issue causes information loss. Conclusion: Patient tracking system should update the location of patients or evacuees and information related to their states. Patients’ information should be accessible for authorized users to continue their treatment, accommodation and transference. Also it should include timely information of patients’ location as soon as they arrive somewhere and leave therein such a way that health care professionals can be able to provide patients’ proper medical treatment.

Keywords: patient tracking, challenges, disaster, emergency

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Authors: Hafid Nadia, Meziane Toufik

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The aim of this study was the characterization of the goat meat by the determination of quantity and the quality in Batna region. The first part was the evaluation of production and consumption. The investigations show that the goat meat third after mutton and beef, it’s especially consumed by the indigenous population located in the Mountain and steep area. The second part of this review treats nutritional quality of this meat by the quantification of the chemical composition, including fat profile, and establishes a link between animal age and the values of these parameters. Moisture, fat contents, and cholesterol levels varied with age. Because of the decreasing level of cholesterol in the Chevon meat, it is more recommended for consumption to prevent or reduce the incidence of coronary disease and heart attack.

Keywords: biochemical composition, cholesterol, goat meat, heart attack

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Authors: Tesnim Charrad, Kaouther Nouira, Ahmed Ferchichi

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In order to reduce the number of deaths due to heart problems, we propose the use of Hierarchical Temporal Memory Algorithm (HTM) which is a real time anomaly detection algorithm. HTM is a cortical learning algorithm based on neocortex used for anomaly detection. In other words, it is based on a conceptual theory of how the human brain can work. It is powerful in predicting unusual patterns, anomaly detection and classification. In this paper, HTM have been implemented and tested on ECG datasets in order to detect cardiac anomalies. Experiments showed good performance in terms of specificity, sensitivity and execution time.

Keywords: cardiac anomalies, ECG, HTM, real time anomaly detection

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Authors: Kewei Fan, Sihong Liu, Yi Pik Cheng

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This paper aims to analyse the failure behaviour of the retaining wall constructed with soil bags that are formed by filling river sand into woven bags (geosynthetics). Model tests were conducted to obtain the failure mode of the wall, and shear tests on two-layers and five-layers of soil bags were designed to investigate the mechanical characteristics of the interface of soil bags. The test results show that the slip surface in the soil bags-constructed retaining wall is ladder-like due to the inter-layer insertion of soil bags, and the wall above the ladder-like surface undergoes a rigid body translation. The insertion strengthens the shear strength of two-layer staggered-stacked soil bags. Meanwhile, it affects the shape of the slip surface of the five-layer staggered-stacked soil bags. Finally, the interlayer resisting friction of soil bags is found to be related to the shape of the slip surface.

Keywords: geosynthetics, retaining wall, soil bag, failure mode, interface, shear strength

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Authors: Saira Baloch, Mohsin Ali Baloch

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Background: Malaria is a potentially life-threatening disease and also a major public health problem in Pakistan. Renal failure is an emerging problem correlated with morbidity and mortality, however can be diagnosed and treated in the early stages. Objectives: To elucidate the biochemical renal parameters in patients with falciparum malaria and comparison with healthy control subjects. Method: 80 patients, who were diagnosed to be affected by falciparum malaria. Detailed history, general physical and systemic examination and necessary pathological, biochemical renal laboratory parameters and investigations were done. Results: Among the 80 patients, 43 were males and 37 were females. All patients were infected with P. falciparum. All patients had increased serum creatinine and urea levels and urine output of less than 400 ml/day were categorized as suffering from renal failure. Conclusion: Patients infected with P. falciparum are at an increased risk of developing renal failure when compared to patients infected with other complications. P. vivax has massive potential to cause life threatening complications and even death. Further research is required to understand the exact pathogenesis of various complications encountered in vivax malaria.

Keywords: falciparum malaria, renal failure, biochemical parameters, pathogenesis

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Authors: Sait Ozsoy, Asude Gokmen, Mehtap Yondem, Hanife A. Alkan, Gulnaz T. Javan

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Deep neck infection often develops due to upper respiratory tract and odontogenic infections. Gastrointestinal System perforation can occur for many reasons and is in need of the early diagnosis and prompt surgical treatment. In both cases late or incorrect diagnosis may lead to increase morbidity and high mortality. A patient with a diagnosis of deep neck abscess died while under treatment due to sepsis and multiple organ failure. Autopsy finding showed duodenal ulcer and this is reported in the literature.

Keywords: peptic ulcer perforation, peritonitis, retropharyngeal abscess, sepsis

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Authors: Wynne De Jong, Robert Miller, Ross Riggs

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Beyond the number of nurses providing care for patients, having nurses with the right skills, experience and education is essential to ensure the best possible outcomes for patients. Research studies continue to link nurse staffing and skill mix with nurse-sensitive patient outcomes; numerous studies clearly show that superior patient outcomes are associated with higher levels of regulated staff. Due to the limited number of tools and processes available to assist nurse leaders with staffing models of care, nurse leaders are constantly faced with the ongoing challenge to ensure their staffing models of care best suit their patient population. In 2009, several hospitals in Ontario, Canada participated in a research study to develop and evaluate an RN/RPN utilization toolkit. The purpose of this study was to develop and evaluate a toolkit for Registered Nurses/Registered Practical Nurses Staff mix decision-making based on the College of Nurses of Ontario, Canada practice standards for the utilization of RNs and RPNs. This paper will highlight how an organization has further developed the Patient Care Needs Assessment (PCNA) questionnaire, a major component of the toolkit. Moreover, it will demonstrate how it has utilized the information from PCNA to clearly identify patient and family care needs, thus providing evidence-based results to assist leaders with matching the best staffing skill mix to their patients.

Keywords: nurse staffing models of care, skill mix, nursing health human resources, patient safety

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Authors: Narottam Puri, Bishnu Panigrahi, Narayan Pendse

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Background: Clinical Outcomes are the globally agreed upon, evidence-based measurable changes in health or quality of life resulting from the patient care. Reporting of outcomes and its continuous monitoring provides an opportunity for both assessing and improving the quality of patient care. In 2012, International Consortium Of HealthCare Outcome Measurement (ICHOM) was founded which has defined global Standard Sets for measuring the outcome of various treatments. Method: Monitoring of Clinical Outcomes was identified as a pillar of Fortis’ core value of Patient Centricity. The project was started as an in-house developed Clinical Outcomes Reporting Portal by the Fortis Medical IT team. Standard sets of Outcome measurement developed by ICHOM were used. A pilot was run at Fortis Escorts Heart Institute from Aug’13 – Dec’13.Starting Jan’14, it was implemented across 11 hospitals of the group. The scope was hospital-wide and major clinical specialties: Cardiac Sciences, Orthopedics & Joint Replacement were covered. The internally developed portal had its limitations of report generation and also capturing of Patient related outcomes was restricted. A year later, the company provisioned for an ICHOM Certified Software product which could provide a platform for data capturing and reporting to ensure compliance with all ICHOM requirements. Post a year of the launch of the software; Fortis Healthcare has become the 1st Healthcare Provider in Asia to publish Clinical Outcomes data for the Coronary Artery Disease Standard Set comprising of Coronary Artery Bypass Graft and Percutaneous Coronary Interventions) in the public domain. (Jan 2016). Results: This project has helped in firmly establishing a culture of monitoring and reporting Clinical Outcomes across Fortis Hospitals. Given the diverse nature of the healthcare delivery model at Fortis Network, which comprises of hospitals of varying size and specialty-mix and practically covering the entire span of the country, standardization of data collection and reporting methodology is a huge achievement in itself. 95% case reporting was achieved with more than 90% data completion at the end of Phase 1 (March 2016). Post implementation the group now has one year of data from its own hospitals. This has helped identify the gaps and plan towards ways to bridge them and also establish internal benchmarks for continual improvement. Besides the value created for the group includes: 1. Entire Fortis community has been sensitized on the importance of Clinical Outcomes monitoring for patient centric care. Initial skepticism and cynicism has been countered by effective stakeholder engagement and automation of processes. 2. Measuring quality is the first step in improving quality. Data analysis has helped compare clinical results with best-in-class hospitals and identify improvement opportunities. 3. Clinical fraternity is extremely pleased to be part of this initiative and has taken ownership of the project. Conclusion: Fortis Healthcare is the pioneer in the monitoring of Clinical Outcomes. Implementation of ICHOM standards has helped Fortis Clinical Excellence Program in improving patient engagement and strengthening its commitment to its core value of Patient Centricity. Validation and certification of the Clinical Outcomes data by an ICHOM Certified Supplier adds confidence to its claim of being leaders in this space.

Keywords: clinical outcomes, healthcare delivery, patient centricity, ICHOM

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Authors: A. M. Bumbea, A. Musetescu, P. Ciurea, A. Bighea

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Objectives: The authors present a Parsonage Turner syndrome, a rare disease characterized by onset in apparently healthy person with shoulder and/or arm pain, sensory deficit, motor deficit. The causes are not established, could be determinate by vaccination, postoperative, immunologic disease, post traumatic etc. Methods: The authors present a woman case, 32 years old, (in 2006), no medical history, with arm pain and no other symptom. The onset was sudden with pain at very high level quantified as 10 to a 0 to 10 scale, with no response to classical analgesic and corticoids. The only drugs which can reduce the intensity of pain were oxycodone hydrochloride, 60 mg daily and pregabalinum150 mg daily. After two weeks the intensity of pain was reduced to 5. The patient started a rehabilitation program. After 6 weeks the patient associated sensory and motor deficit. We performed electromyography for upper limb that showed incomplete denervation with reduced neural transmission speed. The patient receives neurotrophic drugs and painkillers for a long period and physical and kinetic therapy. After 6 months the pain was reduced to level 2 and the patient maintained only 150 mg pregabalinum for another 6 months. Then, the evaluation showed no pain but general amiotrophy in upper limb. Results: At the evaluation in 2009, the patient developed a rheumatoid syndrome with tender and swelling joints, but no positive inflammation test, no antibodies or rheumatoid factor. After two years, in 2011 the patient develops an increase of antinuclear antibodies. This context certifies the diagnosis of lupus and the patient receives the specific therapy. Conclusions: This case is not a typical case of onset of lupus with PTS, but the onset of PTS could include the onset of an immune disease.

Keywords: lupus, arm pain, patient, swelling

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Authors: Peri Harish Kumar, Rafique Umer Harvitkar

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Background: The emergency department mandates maximum efficacy in the utilization of the available resources. Non-urgent patient visits pose a serious concern to the treatment, patient triage, and resources available. Aims and Objectives: We conducted a retrospective case-control study of the emergency department patient list from October 2019 to November 2022. A total of 839 patients formed part of the study. Somatic complaints, vital signs, diagnostic test results, admission to the hospital, etc., were some of the criteria used for the categorization of patients. Results: The proportion of non-urgent visits varied from 7.2% to 43%, with a median of 21%. Somatic complaints were the least associated with further hospital admissions (n=28%), while diagnostic test results were the most significant indicator of further hospital admissions (n=74%). Effective triage helped minimize emergency department admissions by 36%. Conclusion: Our study shows that effective triaging, patient counselling, and round-the-clock consumable monitoring helped in the effective management of patients admitted and also significantly helped provide treatment to the patients most in need.

Keywords: urgent visits, non-urgent visits, traiging, emergency department admissions

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Authors: Salem Alsanusi, Abdulla Alakad

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An experimental investigation to study the behaviour of under flexure reinforced concrete T-Beams. Those Beams were loaded to pre-designated stress levels as percentage of calculated collapse loads. Repairing these beans by either reinforced concrete jacket, or by externally bolted steel plates were utilized. Twelve full scale beams were tested in this experimental program scheme. Eight out of the twelve beams were loaded under different loading levels. Tests were performed for the beams before and after repair with Reinforced Concrete Jacket (RCJ). The applied Load levels were 60%, 77% and 100% of the calculated collapse loads. The remaining four beams were tested before and after repair with Bolted Steel Plate (BSP). Furthermore, out previously mentioned four beams two beams were loaded to the calculated failure load 100% and the remaining two beams were not subjected to any load. The eight beams recorded for the RCJ test were repaired using reinforced concrete jacket. The four beams recorded for the BSP test were all repaired using steel plate at the bottom. All the strengthened beams were gradually loaded until failure occurs. However, in each loading case, the beams behaviour, before and after strengthening, were studied through close inspection of the cracking propagation, and by carrying out an extensive measurement of deformations and strength. The stress-strain curve for reinforcing steel and the failure strains measured in the tests were utilized in the calculation of failure load for the beams before and after strengthening. As a result, the calculated failure loads were close to the actual failure tests in case of beams before repair, ranging from 85% to 90% and also in case of beams repaired by reinforced concrete jacket ranging from 70% to 85%. The results were in case of beams repaired by bolted steel plates ranging from (50% to 85%). It was observed that both jacketing and bolted steel plate methods could effectively restore the full flexure capacity of the damaged beams. However, the reinforced jacket has increased the failure load by about 67%, whereas the bolted steel plates recovered the failure load.

Keywords: rehabilitation, strengthening, reinforced concrete, beams deflection, bending stresses

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Authors: Manjit Singh

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Multiscale entropy (MSE) is an extensively used index to provide a general understanding of multiple complexity of physiologic mechanism of heart rate variability (HRV) that operates on a wide range of time scales. Accurate selection of electrocardiogram (ECG) sampling frequency is an essential concern for clinically significant HRV quantification; high ECG sampling rate increase memory requirements and processing time, whereas low sampling rate degrade signal quality and results in clinically misinterpreted HRV. In this work, the impact of ECG sampling frequency on MSE based HRV have been quantified. MSE measures are found to be sensitive to ECG sampling frequency and effect of sampling frequency will be a function of time scale.

Keywords: ECG (electrocardiogram), heart rate variability (HRV), multiscale entropy, sampling frequency

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Authors: Michelle Themalil, Celia Bueno, Rulla Al- Araji

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Objective and Study: There are no established guidelines for antibiotic prophylaxis in children with central venous catheters (CVCs) on home parenteral nutrition (HPN), leading to varying practices across UK Centres. We hypothesize that children with intestinal failure are at increased risk for bacteraemia due to altered anatomy, dysmotility, inflammation, biofilm formation in long-term CVCs, and the use of central lines during procedures. Given the bacteraemia rates of up to 8% in upper and 25% in lower endoscopy for adults without central lines, we argue that prophylactic antibiotics are reasonable, given the increased risks faced by this high-risk group of children. Methods: We conducted a five-year review of patients with central venous access receiving home parenteral nutrition (HPN) who underwent endoscopies with antibiotic prophylaxis at our center (tertiary). We documented and analyzed post-procedure infections and their associated risk factors. Results: A total of 15 patients on HPN underwent 29 endoscopic procedures, including 4 upper, 9 combined upper and lower, and 16 combined upper, lower, and ileoscopy. Confirmed infection rates remained at 0% up to 28 days post-procedure. The agreed-upon prophylaxis regimen was implemented, with ciprofloxacin and metronidazole administered as the primary antibiotics. Notably, only 51.7% of patients received a peripheral cannula despite recommendations to avoid central line use during anesthesia, and 20.6% had small intestinal bacterial overgrowth. Conclusions: This study is the first to investigate post-endoscopy infection rates in pediatric patients on HPN. Despite a small sample size, we observed a 0% infection rate, significantly lower than reported rates in adults. These findings suggest that further research is warranted to explore the implications of antibiotic prophylaxis in this unique patient cohort and to establish guidelines that may enhance patient safety during endoscopic procedures.

Keywords: post endosopy infections, central venous access, home parenteral nutrition, intestinal failure

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Authors: Matt Stichter

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Moral development requires learning from one’s failures, but that turnsout to be especially challenging when dealing with moral failures. The distress prompted by moral failure can cause responses ofdefensiveness or disengagement rather than attempts to make amends and work on self-change. The most potentially distressing response to moral failure is a shame. However, there appears to be two different senses of “shame” that are conflated in the literature, depending on whether the failure is appraised as the result of a global and unalterable self-defect, or a local and alterable self-defect. One of these forms of shame does prompt self-improvement in response to moral failure. This occurs if one views the failure as indicating only a specific (local) defect in one’s identity, where that’s something repairable, rather than asanoverall(orglobal)defectinyouridentity that can’t be fixed. So, if the whole of one’s identity as a morally good person isn’t being called into question, but only a part, then that is something one could work on to improve. Shame, in this sense, provides motivation for self-improvement to fix this part oftheselfinthe long run, and this would be important for moral development. One factor that looks to affect these different self-attributions in the wake of moral failure can be found in mindset theory, as reactions to moral failure in these two forms of shame are similar to how those with a fixed or growth mindset of their own abilities, such as intelligence, react to failure. People fall along a continuum with respect to how they view abilities – it is more of a fixed entity that you cannot do much to change, or it is malleable such that you can train to improve it. These two mindsets, ‘fixed’ versus ‘growth’, have different consequences for how we react to failure – a fixed mindset leads to maladaptive responses because of feelings of helplessness to do better; whereas a growth mindset leads to adaptive responses where a person puts forth effort to learn how to act better the next time. Here we can see the parallels between a fixed mindset of one’s own (im)morality, as the way people respond to shame when viewed as indicating a global and unalterable self-defect parallels the reactions people have to failure when they have a fixed mindset. In addition, it looks like there may be a similar structure to pride. Pride is, like shame, a self-conscious emotion that arises from internal attributions about the self as being the cause of some event. There are also paradoxical results from research on pride, where pride was found to motivate pro-social behavior in some cases but aggression in other cases. Research suggests that there may be two forms of pride, authentic and hubristic, that are also connected to different self-attributions, depending on whether one is feeling proud about a particular (local) aspect of the self versus feeling proud about the whole of oneself (global).

Keywords: emotion, mindset, moral development, moral psychology, pride, shame, self-regulation

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Authors: Devieta Romadhon Saendardy

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Introduction: The case of aneurysmal subarachnoid hemorrhage (SAH) associated with intraventricular hemorrhage (IVH) in many way. In general, the anterior communicating artery and posterior circulation aneurysms cause Intraventricular Hemorrhage. The development of intraventricular hemorrhage (IVH) in aneurysmal subarachnoid hemorrhage (aSAH) is linked with higher mortality and poor neurological recovery. Case: This case report presents a 51-year-old female patient who developed IVH following SAH. The patient's Glasgow Coma Scale score was 14, the patient has a severe headache, and there were right extremity hemipharese neurological deficits. A non-contrast head CT scan revealed a massive intraventricular haemorrhage. In an hour, the patient got her headache and pharese worse. Discussion: Intraventricular hemorrhage is a serious complication of subarachnoid hemorrhage, necessitating prompt recognition and management. This case highlights the importance of a time management, medical management and surgical intervention to optimize outcomes in patients with intraventricular hemorrhage caused by subarachnoid hemorrhage. Placement of a shunt system improves clinical outcome in intraventricular hemorrhage.

Keywords: Intraventricular hemorrhage, subarachnoid hemorrhage, shunt, time

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Authors: Aboozar Aghaei

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In the present work, the dissimilar Monel400 and SS316 were joined by friction stir welding (FSW). The applied rotating speed was 400 rpm, whereas the traverse speed varied between 50 and 150 mm/min. At a constant rotating speed, the sound welds were obtained at the welding speeds of 50 and 100 mm/min. However, a groove-like defect was formed when the welding speed exceeded 100 mm/min. The mechanical properties of the joints were evaluated using tensile and fatigue tests. The fatigue strength of dissimilar FSWed specimen was higher than that of both Monel400 and SS316. To study the failure behavior of FSWed specimens, the fracture surfaces were analyzed using scanning electron microscope (SEM). The failure analysis indicates that different mechanisms may contribute to the fracture of welds. This was attributed to the dissimilar characteristics of dissimilar materials exhibiting different failure behaviors.

Keywords: mechanical properties, stainless steel, frictions, monel

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Authors: Ayodele James Akinola

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This study examines how social and linguistic variables influenced communication between neurologists and patients in selected university teaching hospitals (UTHs) in southwestern Nigeria. Jacob Mey’s Pragmatic Acts, complemented by Emanuel and Emanuel’s model of doctor-patient relationship, served as the theoretical framework. Data comprising 22 audio-recorded neurologist-patient interactions were collected from two UTHs in the southwestern region of Nigeria. Data revealed that educational attainment of patients has insignificant influence on the interaction where the linguistic prowess of the patient has been impaired for consultative communication. However, the status influenced the degree of attention paid to patients by neurologists and determines the amount of time 'trying to help patients to communicate'. Patients with lower educational status and who could not communicate in English spent more time narrating their ailment to neurologists. Patients with higher educational status and could communicate in English saves consultation time as they express themselves briefly unlike those who were of little or no education in the clinics. Through this, diagnoses and therapeutic processes took eight to 12 minutes. 20 minutes was the longest duration recorded. Neurologist-patient interaction in the observed hospitals is shaped by neurologists’ experience, patients’ social variables and language.

Keywords: medical pragmatics, neurologist-patient interaction, nigeria, socio-linguistic influence

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Authors: Shohra Qaderi

Abstract:

Introduction: Tetanus is a severe infection characterized by the spasm of skeletal muscles that often progresses toward respiratory failure. Acute Renal failure (ARF) is an important complication associated Tetanus infection, occurring in 15%-39% of cases. Presentation of cases: A previous healthy 14-year-old boy was admitted to the Tetanus ward of a hospital in Kabul, presenting with severe muscle spasms. On day four of admission, he started having cola-colored urine with decreased urine output. Due to lack of peritoneal dialysis, he went under hemodialysis in view of rapidly raising in blood urea (from baseline 32 mg/dl to 150 mg/dl) and creatinine from (baseline 0.9 mg/dl to 6.2g/dl). Despite all efforts, he had a sudden cardiac arrest and passed away on day 6 of admission. Discussion: ARF is a complication of tetanus, reported to be mild and non-oliguric. Suggested pathological mechanisms include autonomic dysfunction and rhabdomyolysis, owing to uncontrolled muscle spasms. Autonomic dysfunction, most evident in the first two weeks of infection. Conclusion: The prevalence and mortality of tetanus is high in Afghanistan. Physicians and pediatricians need to be aware of this complication of tetanus so as to take appropriate preventive measures and recognize and manage it early.

Keywords: afghanistan, acute renal failure, child, mortality

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Authors: Nana Benma Osei

Abstract:

Patient discharge can be a hectic process. Patients are sometimes sent to the wrong location or forgotten in lounges in the waiting room. This ends up compromising patient care because the delay in picking the patients can affect how they adhere to medication. Patients may fail to take their medication, and this will lead to negative outcomes. The situation highlights the demands of modern-day healthcare, and the use of technology can help in reducing such challenges and in enhancing the patient’s experience, leading to greater satisfaction with the care provided. The paper contains the proposed changes to a healthcare facility by introducing the clinical decision support system, which will be needed to improve coordination and communication during patient discharge. This will be done under Kurt Lewin’s Change Management Model, which recognizes the different phases in the change process. A pilot program is proposed initially before the program can be implemented in the entire organization. This allows for the identification of challenges and ways of managing them. The paper anticipates some of the possible challenges that may arise during implementation, and a multi-disciplinary approach is considered the most effective. Opposition to the change is likely to arise because staff members may lack information on how the changes will affect them and the skills they will need to learn to use the new system. Training will occur before the technology can be implemented. Every member will go for training, and adequate time is allocated for training purposes. A comparison of data will determine whether the project has succeeded.

Keywords: patient discharge, clinical decision support system, communication, collaboration

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Authors: Hokuma Isgandarova, Khalil Aryanfar

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The patient's rights include all care items that the patient has the right to receive. Considering the growing importance of this important issue and its effect on improving treatment results and customer satisfaction, the present study was conducted with the aim of investigating the level of respect for patient rights in the physiotherapy clinic of the Faculty of Medicine University of Medical Sciences in 2023. In this study, the patients or companions who were referred to the clinic answered questions about the performance status of the clinic with respect to various aspects of the patient's rights. The aspects that were studied: choosing the service provider, having authority, respect, safety, prevention and access were found to have inappropriate performance scores. However, communication and interaction, continuity of service, quality of basic facilities and facilities, timely and immediate attention and trust had appropriate performance. Also, the results of the data analysis showed that there is no significant relationship between the total performance score and any of the demographic variables.

Keywords: compliance, patients' rights, physiotherapy clinic, performance level

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Authors: Shilpa Sondkar, Maithili Patil, Atharva Potnis

Abstract:

The current health care landscape desires efficiency and patient satisfaction for optimal performance. Medical appointment booking apps have increased the overall efficiency of clinics, hospitals, and e-health marketplaces while simplifying processes. These apps allow patients to connect with doctors online. Not only are mobile doctor appointment apps a reliable and efficient solution, but they are also the future of clinical progression and a distinct new stage in the patient-doctor relationship. Compared to the usual queuing method, the web-based appointment system could significantly increase patients' satisfaction with registration and reduce total waiting time effectively.

Keywords: appointment, patient, scheduling, design and development, Figma

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Authors: Shivdayal Patel, Suhail Ahmad

Abstract:

Safety assurance and failure prediction of composite material component of an offshore structure due to low velocity impact is essential for associated risk assessment. It is important to incorporate uncertainties associated with material properties and load due to an impact. Likelihood of this hazard causing a chain of failure events plays an important role in risk assessment. The material properties of composites mostly exhibit a scatter due to their in-homogeneity and anisotropic characteristics, brittleness of the matrix and fiber and manufacturing defects. In fact, the probability of occurrence of such a scenario is due to large uncertainties arising in the system. Probabilistic finite element analysis of composite plates due to low-velocity impact is carried out considering uncertainties of material properties and initial impact velocity. Impact-induced damage of composite plate is a probabilistic phenomenon due to a wide range of uncertainties arising in material and loading behavior. A typical failure crack initiates and propagates further into the interface causing de-lamination between dissimilar plies. Since individual crack in the ply is difficult to track. The progressive damage model is implemented in the FE code by a user-defined material subroutine (VUMAT) to overcome these problems. The limit state function is accordingly established while the stresses in the lamina are such that the limit state function (g(x)>0). The Gaussian process response surface method is presently adopted to determine the probability of failure. A comparative study is also carried out for different combination of impactor masses and velocities. The sensitivity based probabilistic design optimization procedure is investigated to achieve better strength and lighter weight of composite structures. Chain of failure events due to different modes of failure is considered to estimate the consequences of failure scenario. Frequencies of occurrence of specific impact hazards yield the expected risk due to economic loss.

Keywords: composites, damage propagation, low velocity impact, probability of failure, uncertainty modeling

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Authors: Mohammad A. Obeidat, Ayman M. Mansour

Abstract:

Capturing the dynamic behavior of the heart to improve control performance, enhance robustness, and support diagnosis is very important in establishing real time models for the heart. Control Techniques and strategies have been utilized to improve system costs, reliability, and estimation accuracy for different types of systems such as biomedical, industrial, and other systems that required tuning input/output relation and/or monitoring. Simulations are performed to illustrate potential applications of the technology. In this research, a new control technology scheme is used to enhance the performance of the Af system and meet the design specifications.

Keywords: atrial fibrillation, dynamic behavior, closed loop, signal, filter

Procedia PDF Downloads 420