Search results for: preoperative geriatric scores

Authors: Adisu Mengesha Assefa

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The field of cardiovascular care is being transformed by the incorporation of Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), collectively known as Extended Reality (XR), into medical education, procedural planning, and patient care. This review examines the state-of-the-art applications of XR in cardiology, emphasizing its role in enhancing the precision of interventional procedures and understanding complex anatomical structures. XR technologies complement conventional imaging methods by enabling immersive three-dimensional interaction that facilitates both preoperative planning and intraoperative guidance. Despite these promising developments, challenges such as harmonizing data, integrating various imaging systems, and addressing the prevalence of cybersickness remain. Ethical considerations, including maintaining physician focus and ensuring patient safety, are crucial when implementing XR in clinical settings. This review summarizes the existing literature and highlights the need for more rigorous future studies to validate therapeutic benefits and ensure safe application. By examining both the potential and the challenges, this paper aims to delineate the current and future roles of XR in cardiovascular care, emphasizing the necessity for continued innovation and ethical oversight to improve patient outcomes.

Keywords: virtual reality, augmented reality, mixed reality, cardiovascular care, education, preprocedural planning, intraoperative guidance, postoperative patient rehabilitation

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Authors: B. Shukir, L. Szivos, D. Kis, P. Barzo

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Glioblastoma is the most malignant brain tumor. In general, the survival rate varies between (14-18) months. Glioblastoma consists a solid and infiltrative part. The standard therapeutic management of glioblastoma is maximum safe resection followed by chemo-radiotherapy. It’s hypothesized that the pretumoral hyperintense region in fluid attenuated inversion recovery (FLAIR) images includes both vasogenic edema and infiltrated tumor cells. In our study, we aimed to define the sensitivity and specificity of hyperintense FLAIR images preoperatively to examine how well it can define the true extent of glioblastoma. (16) glioblastoma patients included in this study. Hyperintense FLAIR region were delineated preoperatively as tumor mask. The infiltrative part of glioblastoma considered the regions where the tumor recurred on the follow up MRI. The recurrence on the CE-T1 images was marked as the recurrence masks. According to (AAL3) and (JHU white matter labels) atlas, the brain divided into cortical and subcortical regions respectively. For calculating specificity and sensitivity, the FLAIR and the recurrence masks overlapped counting how many regions affected by both . The average sensitivity and specificity was 83% and 85% respectively. Individually, the sensitivity and specificity varied between (31-100)%, and (100-58)% respectively. These results suggest that despite FLAIR being as an effective radiologic imaging tool its prognostic value remains controversial and probabilistic tractography remain more reliable available method for identifying the true extent of glioblastoma.

Keywords: brain tumors, glioblastoma, MRI, FLAIR

Procedia PDF Downloads 53

Authors: Emmanuel Iyamuremye, Irenee Ndayambaje

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This study investigated the influence of Concrete Pictorial Abstract (CPA) teaching approach on mathematics achievement based on a sample of eighth-grade students (N = 10,345) from the Rwandan Lower Secondary School quasi-experimental study with pre-test and post-test control group of 2019 (RLSQES19). Key aspects studied included mathematics concept understanding and mathematics concept retention and how these are influenced by teacher's teaching approach. Specifically, the study aimed to a.) investigate students' concept understanding and concept retention in mathematics when exposed to CPA approach and to those exposed to non-CPA approach before and after the intervention, and b.) ascertain the significant difference between the performance of the students exposed to CPA approach and those exposed to non-CPA approach in terms of post-test scores and retention test scores. Two groups (control and experimental) undergone pre-test, post-test, and retention test. The assignment of control and experimental group among senior two classes from 10 schools was done randomly. The materials used to determine the performance of the students is a teacher-made test. Descriptive statistics and ANCOVA were used for the analysis of the study. For determining the improvement in concept understanding of mathematics, Hakes methods of calculating gain were used to analyze the pre-test and post test score. The level of performance of the two groups in the pre-test is below average level. During the post-test and retention test, the performance of students in non-CPA group is on average level, and students in CPA group are on above average level. Hakes methods of calculating gain revealed higher significant performance in the post-test and retention test of CPA group of students than non-CPA group of students.

Keywords: concept understanding, concept retention, performance, teaching approach

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Authors: Tatjana Pekmezovic, Milica Jecmenica-Lukic, Igor Petrovic, Vladimir Kostic

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Background: A group of atypical parkinsonian syndromes (APS) includes a variety of rare neurodegenerative disorders characterized by reduced life expectancy, increasing disability, and considerable impact on health-related quality of life (HRQoL). Aim: In this study we wanted to answer two questions: a) which demographic and clinical factors are main contributors of HRQoL in our cohort of patients with APS, and b) how does quality of life of these patients change over 1-year follow-up period. Patients and Methods: We conducted a prospective cohort study in hospital settings. The initial study comprised all consecutive patients who were referred to the Department of Movement Disorders, Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade (Serbia), from January 31, 2000 to July 31, 2013, with the initial diagnoses of ‘Parkinson’s disease’, ‘parkinsonism’, ‘atypical parkinsonism’ and ‘parkinsonism plus’ during the first 8 months from the appearance of first symptom(s). The patients were afterwards regularly followed in 4-6 month intervals and eventually the diagnoses were established for 46 patients fulfilling the criteria for clinically probable progressive supranuclear palsy (PSP) and 36 patients for probable multiple system atrophy (MSA). The health-related quality of life was assessed by using the SF-36 questionnaire (Serbian translation). Hierarchical multiple regression analysis was conducted to identify predictors of composite scores of SF-36. The importance of changes in quality of life scores of patients with APS between baseline and follow-up time-point were quantified using Wilcoxon Signed Ranks Test. The magnitude of any differences for the quality of life changes was calculated as an effect size (ES). Results: The final models of hierarchical regression analysis showed that apathy measured by the Apathy evaluation scale (AES) score accounted for 59% of the variance in the Physical Health Composite Score of SF-36 and 14% of the variance in the Mental Health Composite Score of SF-36 (p<0.01). The changes in HRQoL were assessed in 52 patients with APS who completed 1-year follow-up period. The analysis of magnitude for changes in HRQoL during one-year follow-up period have shown sustained medium ES (0.50-0.79) for both Physical and Mental health composite scores, total quality of life as well as for the Physical Health, Vitality, Role Emotional and Social Functioning. Conclusion: This study provides insight into new potential predictors of HRQoL and its changes over time in patients with APS. Additionally, identification of both prognostic markers of a poor HRQoL and magnitude of its changes should be considered when developing comprehensive treatment-related strategies and health care programs aimed at improving HRQoL and well-being in patients with APS.

Keywords: atypical parkinsonian syndromes, follow-up study, quality of life, APS

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Authors: Anamika A. Sharma, Arezou Ahmadi R. A., Narendra B. Parihar, Manjusha Sajith

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Introduction: Hemodialysis is the most effective therapeutic technique for patient with ESRD second to renal transplantation. However it is a lifelong therapy which requires frequent hospital, or dialysis centers visits mainly twice and thrice weekly, thus considerably changes the normal way of patient’s living. So this study aimed to Assess Health-Related Quality of life in End-Stage Renal Disease (ESRD) Undergoing Twice and Thrice weekly Hemodialysis. Method: A prospective observational, cross-sectional study was carried out from September 2016 to April 2017 in end-stage renal disease patients undergoing hemodialysis. Socio-demographic and clinical details of patients were obtained from the medical records. WHOQOL-BREF questionnaire was used to Access Health-Related Quality Of Life. Quality of Life scores of Twice weekly and Thrice weekly hemodialysis was analyzed by Kruskal Wallis Test. Results: Majority of respondents were male (72.55%), married (89.31%), employed (58.02%), belong to middle class (71.00%) and resides in rural area (58.78%). The mean ages in the patient undergoing twice weekly and thrice weekly hemodialysis were 51.89 ± 15.64 years and 51.33 ± 15.70 years respectively. Average Quality of Life scores observed in twice weekly and thrice weekly hemodialysis was 52.07 ± 13.30 (p=0.0037) and 52.87 ± 13.47 (p=0.0004) respectively. The hemoglobin of thrice weekly dialysis patients (10.28 gm/dL) was high as compared to twice weekly dialysis (9.23 gm/dL). Patients undergoing thrice weekly dialysis had improved serum urea, serum creatinine values (95.85 mg/dL, 8.32 mg/dL) as compared to twice weekly hemodialysis ( 104.94 mg/dL, 8.68 mg/dL). Conclusion: Our study concluded that there was no significant difference between overall Health-Related Quality Of Life in twice weekly and thrice weekly hemodialysis. Frequent hemodialysis was associated with improved control of hypertension, serum urea, serum creatinine levels.

Keywords: end stage renal disease, health related quality of life, twice weekly hemodialysis, thrice weekly hemodialysis

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Authors: Diane Ghanem, Oscar Covarrubias, Ridge Maxson, Samir Sabharwal, Babar Shafiq

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Introduction: Web-based resources serve as a fundamental educational platform for orthopaedic trauma patients; however, they are notoriously written at a high grade reading level and are often too complicated for patients to benefit from them. The aim of this study is to perform an updated assessment of the readability of the AAOS trauma-related educational articles and compare their readability with that of injury-specific patient education materials developed by the OTA. Methods: All forty-six trauma-related articles on the AAOS patient education website were analyzed for readability. Two independent reviewers used the (1) Flesch-Kincaid Grade Level (FKGL) and the (2) Flesch Reading Ease (FRE) algorithms to calculate the readability level. Mean readability scores were compared across body part categories. One-sample t-test was done to compare mean FKGL with the recommended 6th-grade readability level and the average American adult reading level. Two-sample t-test was used to compare the readability scores of the AAOS trauma-related articles to those of the OTA. Results: The average FKGL and FRE for the AAOS articles were 8.9±0.74 and 57.2±5.8, respectively. All articles were written above the 6th-grade reading level. The average readability of the AAOS articles was significantly greater than the recommended 6th-grade and average American adult reading level. The average FKGL (8.9±0.74 vs 8.1±1.14) and FRE (57.2±5.8 vs 65.6±6.6) for all AAOS articles was significantly greater compared to that of OTA articles. Excellent agreement was observed between raters for the FKGL 0.956 (95%CI 0.922 - 0.975) and FRE 0.993 (95%CI 0.987 – 0.996). Discussion: Our findings suggest that, after almost a decade, the readability of the AAOS trauma-related articles remains unchanged. The AAOS and OTA trauma patient education materials have high readability levels and may be too difficult for patient comprehension. A need remains to improve the readability of these commonly used trauma education materials.

Keywords: american ocademy of orthopaedic surgeons, FKGL, FRE, orthopaedic trauma association, patient education, readability

Procedia PDF Downloads 61

Authors: Jemely M. Punzalan, Christine B. Bernal, Beatrice B. Canonigo, Maria Rosario F. Cabansag, Dennis S. Flores, Paul Joseph T. Galutira, Remedios D. Chan

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Background: Systemic lupus erythematosus (SLE) is one of the most common autoimmune disorders predominates in women of childbearing age. Simple Measure of Impact of Lupus Erythematosus in Youngsters (SMILEY) is the only health specific quality of life tool for pediatric SLE, which has been translated to different languages except in Filipino. Objective: The primary objective of this study was to develop a Filipino translation of the SMILEY and to examine the validity and reliability of this translation. Methodology: The SMILEY was translated into Filipino by a bilingual individual and back-translated by another bilingual individual blinded from the original English version. The translation was evaluated for content validity by a panel of experts and subjected to pilot testing. The pilot-tested translation was used in the validity and reliability testing proper. The SMILEY, together with the previously validated PEDSQL 4.0 Generic Core Scale was administered to lupus pediatric patients and their parent at two separate occasions: a baseline and a re-test seven to fourteen days apart. Tests for convergent validity, internal consistency, and test-retest reliability were performed. Results: A total of fifty children and their parent were recruited. The mean age was 15.38±2.62 years (range 8-18 years), mean education at high school level. The mean duration of SLE was 28 months (range 1-81 months). Subjects found the questionnaires to be relevant, easy to understand and answer. The validity of the SMILEY was demonstrated in terms of content validity, convergent validity, internal consistency, and test-retest reliability. Age, socioeconomic status and educational attainment did not show a significant effect on the scores. The difference between scores of child and parent report was showed to be significant with SMILEY total (p=0.0214), effect on social life (p=0.0000), and PEDSQL physical function (p=0.0460). Child reports showed higher scores for the following domains compared to their parent. Conclusion: SMILEY is a brief, easy to understand, valid and reliable tool for assessing pediatric SLE specific HRQOL. It will be useful in providing better care, understanding and may offer critical information regarding the effect of SLE in the quality of life of our pediatric lupus patients. It will help physician understands the needs of their patient not only on treatment of the specific disease but as well as the impact of the treatment on their daily lives.

Keywords: systemic lupus erythematosus, pediatrics, quality of life, Simple Measure of Impact of Lupus Erythematosus in Youngsters (SMILEY)

Procedia PDF Downloads 443

Authors: Jaehong Yu, Seoung Bum Kim

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Clustering analysis can facilitate the extraction of intrinsic patterns in a dataset and reveal its natural groupings without requiring class information. For effective clustering analysis in high dimensional datasets, unsupervised dimensionality reduction is an important task. Unsupervised dimensionality reduction can generally be achieved by feature extraction or feature selection. In many situations, feature selection methods are more appropriate than feature extraction methods because of their clear interpretation with respect to the original features. The unsupervised feature selection can be categorized as feature subset selection and feature ranking method, and we focused on unsupervised feature ranking methods which evaluate the features based on their importance scores. Recently, several unsupervised feature ranking methods were developed based on ensemble approaches to achieve their higher accuracy and stability. However, most of the ensemble-based feature ranking methods require the true number of clusters. Furthermore, these algorithms evaluate the feature importance depending on the ensemble clustering solution, and they produce undesirable evaluation results if the clustering solutions are inaccurate. To address these limitations, we proposed an ensemble-based feature ranking method with random subspace and multiple-k ensemble (FRRM). The proposed FRRM algorithm evaluates the importance of each feature with the random subspace ensemble, and all evaluation results are combined with the ensemble importance scores. Moreover, FRRM does not require the determination of the true number of clusters in advance through the use of the multiple-k ensemble idea. Experiments on various benchmark datasets were conducted to examine the properties of the proposed FRRM algorithm and to compare its performance with that of existing feature ranking methods. The experimental results demonstrated that the proposed FRRM outperformed the competitors.

Keywords: clustering analysis, multiple-k ensemble, random subspace-based feature evaluation, unsupervised feature ranking

Procedia PDF Downloads 339

Authors: Ali Ashraf, Ghazaleh Aghaee, Sedigheh Samimian, Mohaya Farzin

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Objectives: Previous studies have indicated the positive effect of physical activity and sports on different aspects of health, such as muscle endurance and sleep cycle. However, in university students, particularly medical students, who have limited time and a stressful lifestyle, there have been limited studies exploring this matter with proven statistical results. In this regard, this study aims to find out how regular physical activity can influence the academic performance of medical students during their internship period. Methods: This was a descriptive-analytical study. Overall, 160 medical students (including 80 women and 88 men) voluntarily participated in the study. The Baecke Physical Activity Questionnaire was applied to determine the student’s physical activity levels. The student's academic performance was determined based on their total average academic scores. The data were analyzed in SPSS version 16 software using the independent t-test, Pearson correlation, and linear regression. Results: The average age of the students was 26.0±1.5 years. Eighty-eight students (52.4%) were male, and 142 (84.5%) were single. The student's mean total average academic score was 16.2±1.2, and their average physical activity score was 8.3±1.1. The student's average academic score was not associated with their gender (P=0.427), marital status (P=0.645), and age (P=0.320). However, married students had a significantly lower physical activity level compared to single students (P=0.020). The results indicated a significant positive correlation between student's physical activity levels and average academic scores (r=+0.410 and P<0.001). This correlation was independent of the student’s age, gender, and marital status based on the regression analysis. Conclusion: The results of the current study suggested that the physical activity level in medical students was low to moderate in most cases, and there was a significant direct relationship between student’s physical activity level and academic performance, independent of age, gender, and marital status.

Keywords: exercise, education, physical activity, academic performance

Procedia PDF Downloads 46

Authors: Domenica Tambasco, Riina Bray, Sophia Jaworski, Gillian Grant, Celeste Corkery

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Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and reduced function. Management of symptoms include medications, physical treatments and mindfulness therapies. Myofascial Release is a modality that has been successfully applied in var-ious musculoskeletal conditions. However, to the author’s best knowledge, it is not yet recog-nized as a self-management therapy option in Fibromyalgia. In this study, we investigated whether Self-applied Myofascial Release (SMR) is associated with overall improved function and symptoms in Fibromyalgia. Methods: Eligible adult patients with a confirmed diagnosis of Fibromyalgia at Women’s College Hospital were recruited to SMR. Sessions ran for 1 hour once a week for 7 weeks, led by the same two Physiotherapists knowledgeable in this physical treat-ment modality. The main outcome measure was an overall impact score for function and symp-toms based on the validated assessment tool for Fibromyalgia, the Revised Fibromyalgia Impact Questionnaire (FIQR), measured pre and post-intervention. Both descriptive and analytical methods were applied and reported. Results: We analyzed results using a paired t-test to deter-mine if there was a statistically significant difference in mean FIQR scores between initial (pre-intervention) and final (post-intervention) scores. A clinically significant difference in FIQR was defined as a reduction in score by 10 or more points. Conclusions: Our pilot study showed that SMR appeared to be a safe and effective intervention for our Fibromyalgia participants and the overall impact on function and symptoms occurred in only 7 weeks. Further studies with larger sample sizes comparing SMR to other physical treatment modalities (such as stretching) in an RCT are recommended.

Keywords: fibromyalgia, myofascial release, physical therapy, FIQR

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Authors: Ilyasu G., Ogoina D., Otu AA, Muhammed FD, Ebenso B., Otokpa D., Rotifa S., Tuduo-Wisdom O., Habib AG

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Background: The 2014 Ebola Virus Disease (EVD) outbreak was characterized by fear, misconceptions and irrational behaviors. We conducted a knowledge attitude and practice survey of EVD in Nigeria to inform the institution of effective control measures. Methods: Between July 30th and September 30th 2014, a cross-sectional study on knowledge, attitude and practice (KAP) of Ebola Virus Disease (EVD) was undertaken among adults of the general population and healthcare workers (HCW) in three states of Nigeria, including Kano, Cross River and Bayelsa states. Demographic information and data on KAP were obtained using a self-administered standardized questionnaire. The percentage KAP scores were categorized as good and poor. Independent predictors of good knowledge of EVD were ascertained using a binary logistic regression model. Results: Out of 1035 study participants with a median age of 32 years, 648 (62.6%) were males, 846 (81.7%) had tertiary education and 441 (42.6%) were HCW. There were 218, 239 and 578 respondents from Bayelsa, Cross Rivers, and Kano states, respectively. The overall median percentage KAP scores and interquartile ranges (IQR) were 79.46% (15.07%), 95.0% (33.33%), and 49.95% (37.50%), respectively. Out of the 1035 respondents, 470 (45.4%), 544(52.56%), and 252 (24.35%) had good KAP of EVD defined using 80%, 90%, and 70% score cut-offs, respectively. Independent predictors of good knowledge of EVD were a HCW (Odds Ratio-OR-2.89, 95% Confidence interval-CI of 1.41-5.90), reporting ‘moderate to high fear of EVD’ (OR-2.15, 95% CI-1.47-3.13) and ‘willingness to modify habit’ (OR-1.68, 95% CI-1.23-2.30). Conclusion: Our results reveal suboptimal EVD-related knowledge, attitude and practice among adults in Nigeria. To effectively control future outbreaks of EVD in Nigeria, there is a need to institute public sensitization programs that improve understanding of EVD and address EVD-related myths and misconceptions, especially among the general population.

Keywords: Ebola, health care worker, knowledge, attitude

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Authors: Mengdie Ruan

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The authors investigate how subjective well-being (SWB) and social trust changed in China over the period 2010–2020 by relying on data from six rounds of the China Family Panel Studies (CFPS), then re-examine Easterlin’s hypothesis for China, with a more focus on the role of social trust and estimate income-compensating differentials for social trust. They find that the evolution of well-being is not sensitive to the measures of well-being one uses. Specifically, self-reported life satisfaction scores and hedonic happiness scores experienced a significant increase across all income groups from 2010 to 2020. Social trust seems to have increased based on CFPS in China for all socioeconomic classes in recent years, and male, urban resident individuals with higher income have a higher social trust at a given point in time and over time. However, when we use an alternative measure of social trust, out-group trust, which is a more valid measure of generalized trust and represents “most people”, social trust in China literally declines, and the level is extremely low. In addition, this paper also suggests that in the typical query on social trust, the term "most people" mostly denotes in-groups in China, which contrasts sharply with most Western countries where it predominantly connotes out-groups. Individual fixed effects analysis of well-being that controls for time-invariant variables reveals social trust and relative social status are important correlates of life satisfaction and happiness, whereas absolute income plays a limited role in boosting an individual’s well-being. The income-equivalent value for social capital is approximately tripling of income. It has been found that women, urban and coastal residents, and people with higher income, young people, those with high education care more about social trust in China, irrespective of measures on SWB. Policy aiming at preserving and enhancing SWB should focus on social capital besides economic growth.

Keywords: subjective well-being, life satisfaction, happiness, social trust, China

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Authors: Sudson Sirivaidyapong, Ratthanan Sathienbumrungkit, Nongnapas Ruangpet, Nattanun Uaprayoon, Chawisa Wejjakul

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Many factors initiate mammary gland tumor in female dogs such as age, breed, sex, estrous cycle, birth control and pseudopregnancy. Those factors are mostly associated with canine sex hormone. In this study, questionnaires and direct interviews were used to collect information from owners of female dogs that had been diagnosed as mammary tumors at our veterinary teaching hospital, during January 2015 to October 2016 to compare the prevalence of mammary tumor between nulliparous and multiparous female dogs. 200 dogs (from all 212 mammary tumor patients, some were excluded because of inadequate information) were included in the study, 72.5% were nulliparous and 27.5% were multiparous. The results revealed that breed, age, birth control age and birth control methods were not different in both groups; most dogs in both groups were various purebreds, geriatric age, and low incidence of hormonal contraception while 100% of multiparous dogs and 83.7% of nulliparous dogs had been neutered at over two years old. The significant differences between two groups were the frequency of pseudopregnancy and estrus which were much higher in nulliparous female dogs. It can be concluded from our study that nulliparous dogs may be more likely at higher risk of mammary tumor compared to multiparous dogs from various factors especially, the frequency of estrus and the occurrence of pseudopregnancy which related to more times of sex hormonal contact. This study was a preliminary data for further studies to determine the other risk factors of mammary gland tumors in dogs, and to our knowledge, it is the first report on a significantly higher prevalence of mammary tumor in nulliparous female dogs than that in multiparous dogs. This finding corresponds with the study of breast cancer in women but may be from different causes and factors due to the differences in estrous physiology.

Keywords: canine, female dogs, nulliparous, multiparous, mammary tumor, prevalence

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Authors: Muqadis Shazia Rajpar, Lawrence Mitelberg, Rubaiat S. Ahmed, Jemer Garrido, Rukhsana Hossain, Sergey M. Motov

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Distraction techniques have been used as a means to reduce pain, anxiety, and stress in various healthcare settings to facilitate care and make visits less unpleasant. Using virtual reality (VR) in the pediatric emergency setting can be a valuable, effective, and safe non-pharmacological alternative to the current standard of care for pain and anxiety management in pediatric patients. Our pilot study aimed to evaluate the effectiveness of a VR-based intervention as an alternative distraction modality to alleviate pain and anxiety associated with pediatric emergency department (ED) visits and acute pain conditions. The pilot study period was from November 16 to December 9, 2022, for pediatric ED visits for pain, anxiety, or both. Patients were selected based on a novel VR protocol to receive the VR intervention with the administration of pre and post-intervention surveys concerning pain/anxiety ratings and pain scores (Wong-Baker FACES/NRS). Descriptive statistics, paired t-test, and a Fisher Exact Test were used for data analysis, assuming a p-value of 0.05 for significance. A total of 33 patients (21 females, 12 males), ages 5-20 (M = 10.5, SD = 3.43) participated in this study – 12 patients had pain, 2 patients had anxiety, and 19 patients had both pain and anxiety. There was a statistically significant decrease in post-intervention pain scores of less than one point on the rating scale (6.48 vs. 5.62, p < .001). There was a statistically significant reduction in the percentage of patients suffering from “considerable” or “great” pain after the VR intervention (51.6% to 42.3%, p < .001). Similarly, we noticed an increase in the number of patients with “slight” or “moderate” pain post–VR intervention (48.4% to 57.7%, p < .001). Lastly, we demonstrated a decrease in anxiety among patients after utilizing VR (63.6% vs. 36.4%, p < .001). To conclude, VR can alleviate pain and anxiety in pediatric patients and be a useful non-pharmacological tool in the emergency setting.

Keywords: anxiety, emergency room, pain management, pediatric emergency medicine, virtual reality

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Authors: Ayça Utkan Karasu, Elif Balevi Batur, Gülçin Kaymak Karataş

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The aim of this study was to examine the efficiency of virtual reality exercises with Nintendo Wii system on balance and independence in motor functions. This randomized controlled assessor-blinded study included 23 stroke inpatients with hemiparesis all within 12 months poststroke. Patients were randomly assigned to control group (n=11) or experimental group (n=12) via block randomization method. Control group participated in a conventional balance rehabilitation programme. Study group received a four-week balance training programme five times per week with a session duration of 20 minutes in addition to the conventional balance rehabilitation programme. Balance was assessed by the Berg’s balance scale, the functional reach test, the timed up and go test, the postural assessment scale for stroke, the static balance index. Also, displacement of centre of pressure sway and centre of pressure displacement during weight shifting was calculated by Emed-SX system. Independence in motor functions was assessed by The Functional Independence Measure (FIM) ambulation and FIM transfer subscales. The outcome measures were evaluated at baseline, 4th week (posttreatment), 8th week (follow-up). Repeated measures analysis of variance was performed for each of the outcome measure. Significant group time interaction was detected in the scores of the Berg’s balance scale, the functional reach test, eyes open anteroposterior and mediolateral center of pressure sway distance, eyes closed anteroposterior center of pressure sway distance, center of pressure displacement during weight shifting to effected side, unaffected side and total centre of pressure displacement during weight shifting (p < 0.05). Time effect was statistically significant in the scores of the Berg’s balance scale, the functional reach test, the timed up and go test, the postural assessment scale for stroke, the static balance index, eyes open anteroposterior and mediolateral center of pressure sway distance, eyes closed mediolateral center of pressure sway distance, the center of pressure displacement during weight shifting to effected side, the functional independence measure ambulation and transfer scores (p < 0.05). Virtual reality exercises with Nintendo Wii system combined with a conventional balance rehabilitation programme enhances balance performance and independence in motor functions in stroke patients.

Keywords: balance, hemiplegia, stroke rehabilitation, virtual reality

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Authors: Titap Yazicioglu

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To examine the results of two different surgery in patients with severe ptosis and poor levator function. The records of 10 bilateral congenital ptosis patients, who underwent Whitnall’s sling surgery on one eyelid and frontalis sling surgery on the other were analyzed retrospectively. All patients had severe congenital ptosis(>4mm) and poor levator function (LF<4mm). Data regarding eyelid position, cosmetic outcomes, and postoperative complications were evaluated. All patients were assessed for a minimum of one year with regard to the amount of correction, residual ptosis and lagophthalmos. The study consisted of 10 patients, with an average age of 9.2±2.4 years. Preoperative diagnosis for all patients was noted as, the average LF was 3.4±0.51mm, vertical lid height was 3.5±0.52 mm and margin reflex distance-1 (MRD-1) was 0.4±0.51mm. The mean vertical lid height was measured as 7.1±0.73 mm in the frontalis sling group and 7.2±0.63 mm in the Whitnall’s sling group at the postoperative 1st month control. However, in patients with Whitnall’s sling, revision was performed with frontalis sling surgery due to failure in vertical lid height in the late postoperative period, and an average of 7.5±0.52 mm was achieved. Satisfactory results were obtained in all patients. Although postoperative lagophthalmitis developed in the frontalis sling group, none of them developed exposure keratitis. Granuloma was observed as sling infection in 2(20%) of the patients. Although Whitnall’s sling technique provides a natural look appearance without interfering with the functional result, we did not find it as successful as frontalis sling surgery in severe ptosis.

Keywords: congenital ptosis, frontalis suspension, Whitnall ligament, complications

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Authors: Nneka U. Igboeli, Maxwell O. Adibe

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Iron and folate supplementation in pregnancy are important interventions that prevent maternal anaemia and fetal anomaly. Thus, daily oral doses of iron and folic acid are recommended throughout pregnancy as part of antenatal care. However, low adherence has been a major drawback leading to low effectiveness of these programs. The effect of mobile text message reminders to pregnant women to take their routine medications on adherence was evaluated in this study. The first 100 women who consented to the study were recruited and randomized to either receive a text message reminder on adherence to routine medications or not. Adherence was assessed using the 8-item Modified Morisky Adherence Scale (8-MMAS). The folders of successfully recruited women were tagged with the a study number assigned to each of them. The womens’ phone numbers were collected and these were used to send text messages reminders on adhering to routine drugs only to women in the intervention group. The text messages were sent three times per week for a period of four weeks with an adherence reassessment at the one month follow-up antenatal visit for recruited women. At one month follow-up, the lost to follow-up were 6 (16%) women for the intervention group and 17 (34%) for the control group. The across group mean difference in adherence score was 0.07 (-0.96 – 1.10) at baseline and 0.3 (-0.31 – 0.92) after intervention, both insignificant at p > 0.05. The within group change were increases of 0.58 (0.00 – 1.16) (p = 0.05) from baseline for the intervention group and a 0.35 (-0.51 – 1.20) (p = 0.395) for the control group. Non-significant increase in adherence scores were recorded for both groups. However, the increase in adherence scores of women in the intervention group was greater and may be potentially transformed into more positive results if the study period is increased with possibly reduced study drop-outs shows great promise for more positive results.

Keywords: adherence, mobile phone, pregnant women, reminders

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Authors: Mohammad Ali Tabibi, Farzad Nazemi, Nasrin Salimian

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Background: Peritoneal dialysis (PD) is a prevalent renal replacement therapy for patients with end-stage renal disease. Despite its benefits, PD patients often experience reduced physical activity and physical function, which can negatively impact dialysis adequacy and overall health outcomes. Despite the known benefits of maintaining physical activity in chronic disease management, the specific interplay between physical inactivity, physical function, and dialysis adequacy in PD patients remains underexplored. Understanding this relationship is essential for developing targeted interventions to enhance patient care and outcomes in this vulnerable population. This study aims to assess the impact of physical inactivity on dialysis adequacy and functional health in PD patients. Methods: This cross-sectional study included 135 peritoneal dialysis patients from multiple dialysis centers. Physical inactivity was measured using the International Physical Activity Questionnaire (IPAQ), while physical function was assessed using the Short Physical Performance Battery (SPPB). Dialysis adequacy was evaluated using the Kt/V ratio. Additional variables such as demographic data, comorbidities, and laboratory parameters were collected to control for potential confounders. Statistical analyses were performed to determine the relationships between physical inactivity, physical function, and dialysis adequacy. Results: The study cohort comprised 70 males and 65 females with a mean age of 55.4 ± 13.2 years. A significant proportion of the patients (65%) were categorized as physically inactive based on IPAQ scores. Inactive patients demonstrated significantly lower SPPB scores (mean 6.2 ± 2.1) compared to their more active counterparts (mean 8.5 ± 1.8, p < 0.001). Dialysis adequacy, as measured by Kt/V, was found to be suboptimal (Kt/V < 1.7) in 48% of the patients. There was a significant positive correlation between physical function scores and Kt/V values (r = 0.45, p < 0.01), indicating that better physical function is associated with higher dialysis adequacy. Also, there was a significant negative correlation between physical inactivity and physical function (r = -0.55, p < 0.01). Additionally, physically inactive patients had lower Kt/V ratios compared to their active counterparts (1.3 ± 0.3 vs. 1.8 ± 0.4, p < 0.05). Multivariate regression analysis revealed that physical inactivity was an independent predictor of reduced dialysis adequacy (β = -0.32, p < 0.01) and poorer physical function (β = -0.41, p < 0.01) after adjusting for age, sex, comorbidities, and dialysis vintage. Conclusion: This study underscores the critical role of physical activity and physical function in maintaining adequate dialysis in peritoneal dialysis patients. These findings highlight the need for targeted interventions to promote physical activity in this population to improve their overall health outcomes. Future research should focus on developing and evaluating exercise programs tailored for PD patients to enhance their physical function and dialysis adequacy. The findings suggest that interventions aimed at increasing physical activity and improving physical function may enhance dialysis adequacy and overall health outcomes in this population. Further research is warranted to explore the mechanisms underlying these associations and to develop targeted strategies for enhancing patient care.

Keywords: inactivity, physical function, peritoneal dialysis, dialysis adequacy

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Authors: Florge Francis A. Sy

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Physicians develop emotional and psychological distress after facing a patient’s death. This can result in stress or burnout. Coping mechanisms in dealing with these deaths may be maladaptive. Determining grief, emotional impact, and coping strategies in physicians is necessary to identify those needing intervention. This can be done by employing validated assessment tools such as the Texas Revised Inventory of Grief (TRIG) scale, Impact of Events Scale (IES), and BriefCOPE tool, respectively. This prospective, observational study was done in a private hospital in Cebu City. Fifty-five internal medicine residents were included and tasked to answer a survey based on their most memorable patient death encounter. The TRIG, IES, and BriefCOPE scores were determined. Participants were divided into severe grief and non-severe grief based on TRIG scores, low-impact, moderate-impact, and high-impact based on IES, and low-use, moderate-use, and high-use based on the BriefCOPE. The differences in the groups’ characteristics were statistically determined, and a p-value of < 0.05 was significant. The participants’ average age was 28.45 years. Most were female and single. Most belonged to the non-severe group based on TRIG, a moderate-impact group based on the IES, and high-use group based on the BriefCOPE. However, 21.8% reported severe grief, 27.3% reported high-impact, and 10.9% had low use of coping strategies. The proportion of residents who encountered CPR prior to the patient’s death was greater in the severe group. Proportions of both high-impact and non-high impact groups were comparable. The proportion of female residents was higher in the high-use group. There were a number of residents who reported severe grief, high emotional impact, and low coping strategies. This highlights the need for interventions such as debriefing after CPR or formal training in residency programs in dealing with emotional burden to counteract maladaptive coping behaviors and prevent negative outcomes.

Keywords: residents, grief, emotional impact, coping, patient death

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Authors: Lai Gwen Chan, Yining Ong, Audrey Yoke Poh Wong

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Background. The efficacy of electroconvulsive therapy (ECT) as a form of treatment to a range of mental disorders is well-established. However, ECT is often associated with either temporary or persistent cognitive side-effects, resulting in the failure of wider prescription. Of which, retrograde amnesia is the most commonly reported cognitive side-effect. Most studies found a recalling deficit in autobiographical memories to be short-term, although a few have reported more persistent amnesic effects. Little is known about ECT-related amnesic effects in Asian population. Hence, this study aims to resolve conflicting findings, as well as to better elucidate the effects of ECT on cognitive functioning in a local sample. Method: 12 patients underwent bilateral ECT under the care of Psychological Medicine Department, Tan Tock Seng Hospital, Singapore. Participants’ cognition and level of functioning were assessed at four time-points: before ECT, between the third and fourth induced seizure, at the end of the whole course of ECT, and two months after the index course of ECT. Results: It was found that Global Assessment of Functioning scores increased significantly at the completion of ECT. Case-by-case analyses also revealed an overall improvement in Personal Semantic and Autobiographical memory two months after the index course of ECT. A transient dip in both personal semantic and autobiographical memory scores was observed in one participant between the third and fourth induced seizure, but subsequently resolved and showed better performance than at baseline. Conclusions: The findings of this study suggest that ECT is an effective form of treatment to alleviate the severity of symptoms of the diagnosis. ECT does not affect attention, language, executive functioning, personal semantic and autobiographical memory adversely. The findings suggest that Asian patients may respond to bilateral ECT differently from Western samples.

Keywords: electroconvulsive therapy (ECT), autobiographical memory, cognitive impairment, psychiatric disorder

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Authors: N. J. Nawarathna, N. R. Kmarasinghe, D. Chandrasekara, B. M. R. S. Balasooriya, R. A. A. Shaminda, R. J. K. Senevirathne

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Introduction: Thyroid malignancy associated with hyperthyroidism is considered rare. Retrospective studies have shown the incidence of thyroid malignancy in hyperthyroid patients to be low (0.7-8.5%). To assess the clinical relevance of this association, thyroid status in a cohort of patients with thyroid malignancy were analyzed. Method: Thyroid malignancies diagnosed histologically in 56 patients, over a 18 month period beginning from April 2013, in a single surgical unit at Teaching Hospital Kandy were included. Preoperative patient details and progression of thyroid status were asessed with Thyroid Stimulating Hormone, free Thyroxin and free Triiodothyronine levels. Results: Amongst 56 patients Papillary carcinoma was diagnosed in 44(78.6%), follicular carcinomas in 7(12.5%) and 5(8.9%) with medullary and anaplastic carcinomas. 12(21.4%) were males and 44(78.6%) were females. 20(35.7%) were less than 40years, 29(51.8%) were between 40 to 59years and 7(12.5%) were above 59years. Cross tabulation of Type of carcinoma with Gender revealed likelihood ratio of 6.908, Significance p = 0.032. Biochemically 12(21.4%) were hyperthyroid. Out of them 5(41.7%) had primary hyperthyroidism and 7(58.3%) had secondary hyperthyroidism. Mean age of euthyroid patients was 43.77years (SD 10.574) and hyperthyroid patients was 53.25years(SD 16.057). Independent Samples Test t is -2.446, two tailed significance p =0.018. When cross tabulate thyroid status with Age group Likelihood Ratio was 9.640, Significance p = 0.008. Conclusion: Papillary carcinoma is seen more among females. Among the patients with thyroid carcinomas, those with biochemically proven hyperthyroidism were more among the older age group than those who were euthyroid. Hence careful evaluation of elderly hyperthyroid patients to select the most suitable therapeutic approach is justified.

Keywords: age, hyperthyroidism, thyroid malignancy, thyroid status

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Authors: Conor Mccartney, Mark Lee

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Background: An essential component in ambulatory breast augmentation surgery is good analgesia. The demographic undergoing this operation is usually fit, low risk with few comorbidities. These patients do not require long-term hospitalization and do not want to spend excessive time in the hospital for financial reasons. Opiate analgesia can have significant side effects such as nausea, vomiting and sedation. Reducing volumes of postoperative opiates allows faster ambulation and discharge from day surgery. We have developed two targeted nerve blocks that can be applied by the operating surgeon in a matter of seconds under direct vision, not requiring imaging. Anecdotally we found that these targeted nerve blocks reduced opiate requirements and allowed accelerated discharge and faster return to normal activities. This was then tested in a prospective randomized, double-blind trial. Methods: 20 patients were randomized into saline (n = 10) or Ropivicaine adrenaline solution (n = 10). The operating surgeon and anesthetist were blinded to the solution. All patients were closely followed up and morphine equivalents were accurately recorded. Follow-up pain scores were recorded using the Overall Benefit of Analgesia pain questionnaire. Findings: The Ropivicaine nerve blocks significantly reduced opiate requirements postoperatively (p<0.05). Pain scores were significantly decreased in the study group (p<0.05). There were no side effects attributable to the nerve blocks. Conclusions: Intraoperative targeted nerve blocks significantly reduce postoperative opiate requirements in breast augmentation surgery. This results in faster recovery and higher patient satisfaction.

Keywords: breast augmentation, nerve block, postoperative recovery, opiate analgesia, inter pectoral block, sub serratus block

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Authors: Jodie Bradnam, Mark Edwards, Bruce Watt

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Mobile technologies have emerged as tools to create and sustain social and romantic relationships. The integration of technologies in close relationships has been of particular research interest with findings supporting the positive role of mobile phones in nurturing feelings of closeness and connection. More recently, the use of text messaging to manage conflict has become a focus of research attention. Four hundred and eleven adults in committed romantic relationships completed a series of questionnaires measuring attachment orientation, relationship quality, texting frequencies, attitudes, and response expectations. Attachment orientation, relationship length, texting for connection and disconnection were significant predictors of relationship quality, specifically relationship intimacy. Text frequency varied as a function of attachment orientation, with high attachment anxiety associated with high texting frequencies and with low relationship quality. Sending text messages of love and support was related to higher intimacy and relationship satisfaction scores, while sending critical or impersonal texts was associated with significantly lower intimacy and relationship satisfaction scores. The use of texting to manage relational conflict was a stronger negative predictor of relationship satisfaction than was the use of texting to express love and affection. Consistent with research on face-to-face communication in couples, the expression of negative sentiments via text were related to lower relationship quality, and these negative sentiments had a stronger and more enduring impact on relationship quality than did the expression of positive sentiments. Attachment orientation, relationship length and relationship status emerged as variables of interest in understanding the use of mobile technologies in romantic relationships.

Keywords: attachment, destructive conflict, intimacy, mobile communication, relationship quality, relationship satisfaction, texting

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Authors: O.F. Akinmoladun, F.N. Fon, C.T. Mpendulo, O. Okoh

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The sustainability of livestock production is under threat as a result of water scarcity, fluctuating precipitation, and high environmental temperature. These combined stressors have impacted negatively on general animal production and welfare, necessitating a very reliable and cost-effective management practices, especially in arid and water-limited regions of the world. Instead of the above, this study was designed to investigate the growth performance and physiological response of water-restricted Xhosa ear-lobe goats fed diets supplemented with single or multiple vitamin C (VC) during summer. The total forty-eight goats used for the experiment were balanced for body weight and randomly assigned to the seven treatment groups (seven goats/treatment): GI (W100%); GII (W70%); GIII (W50%); GIV (W70%+3g/day VC); GV ((W50% +3g/day VC); GVI (W70%+3g/d VC+extra 5g on every eight-day); GVII (W50%+3g/d VC+extra 5g on every eight-day). The design was a complete randomized design and VC was administered per os. At the end of the 75-day feeding trial, GIII (W50%) animals were the most affected (P<0.05) and the effect was more pronounced in their body condition scores (BCs). Weight loss and depression in feed intake due to water restriction (P<0.05) were attenuated by VC treated groups (GIV-GVII). Changes in body thermal gradient (BTG) and rectal temperature (RcT) were similar (P>0.05) across the various experimental groups. The attenuation effect of VC was significant in responses to respiratory rate (RR) and cortisol. Supplementation of VC (either single or multiple) did not significantly (P>0.05) improve water restriction effect on body condition scores (BCs) and FAMACHA©. The current study found out that Xhosa ear lobe goats can adapt to the prevailing bioclimatic changes and limited water intake. However, supplementation of vitamin C can be beneficial at modulating these stressful stimuli. Continuous consistencies in the outcome of vitamin C on water-stressed animals can help validate recommendations especially to farmers in the arid and water-limited regions across the globe.

Keywords: vitamin C, Xhosa ear-lobe, thermotolerance, water stress

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Authors: Taekyun Hur, Yoonyoung Kim, Junkyu Lim

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Previous works on leisure activities had been categorizing activities arbitrarily and subjectively while focusing on a single dimension (e.g. active-passive, individual-group). To overcome these problems, this study proposed a Korean leisure activities’ matrix model that considered multidimensional features of leisure activities, which was comprised of 3 main factors and 6 sub factors: (a) Active (physical, mental), (b) Relational (quantity, quality), (c) Expert (entry barrier, possibility of improving). We developed items for measuring the degree of each dimension for every leisure activity. Using the developed Leisure Activities Dimensions (LAD) questionnaire, we investigated the presented dimensions of a total of 78 leisure activities which had been enjoyed by most Koreans recently (e.g. watching movie, taking a walk, watching media). The study sample consisted of 1348 people (726 men, 658 women) ranging in age from teenagers to elderlies in their seventies. This study gathered 60 data for each leisure activity, a total of 4860 data, which were used for statistical analysis. First, this study compared 3-factor model (Activity, Relation, Expertise) fit with 6-factor model (physical activity, mental activity, relational quantity, relational quality, entry barrier, possibility of improving) fit by using confirmatory factor analysis. Based on several goodness-of-fit indicators, the 6-factor model for leisure activities was a better fit for the data. This result indicates that it is adequate to take account of enough dimensions of leisure activities (6-dimensions in our study) to specifically apprehend each leisure attributes. In addition, the 78 leisure activities were cluster-analyzed with the scores calculated based on the 6-factor model, which resulted in 8 leisure activity groups. Cluster 1 (e.g. group sports, group musical activity) and Cluster 5 (e.g. individual sports) had generally higher scores on all dimensions than others, but Cluster 5 had lower relational quantity than Cluster 1. In contrast, Cluster 3 (e.g. SNS, shopping) and Cluster 6 (e.g. playing a lottery, taking a nap) had low scores on a whole, though Cluster 3 showed medium levels of relational quantity and quality. Cluster 2 (e.g. machine operating, handwork/invention) required high expertise and mental activity, but low physical activity. Cluster 4 indicated high mental activity and relational quantity despite low expertise. Cluster 7 (e.g. tour, joining festival) required not only moderate degrees of physical activity and relation, but low expertise. Lastly, Cluster 8 (e.g. meditation, information searching) had the appearance of high mental activity. Even though clusters of our study had a few similarities with preexisting taxonomy of leisure activities, there was clear distinctiveness between them. Unlike the preexisting taxonomy that had been created subjectively, we assorted 78 leisure activities based on objective figures of 6-dimensions. We also could identify that some leisure activities, which used to belong to the same leisure group, were included in different clusters (e.g. filed ball sports, net sports) because of different features. In other words, the results can provide a different perspective on leisure activities research and be helpful for figuring out what various characteristics leisure participants have.

Keywords: leisure, dimensional model, activity, relationship, expertise

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Authors: Karakhalis N. B.

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This study aimed to determine the prevalence of heparin resistance among cardiac surgical pediatric and neonatal patients and identify associated risk factors. Materials and Methods: The study included 306 pediatric and neonatal patients undergoing on-pump cardiac surgery. Patients whose activated clotting time (ACT) targets were achieved after the first administration of heparin formed the 1st group (n=280); the 2nd group (n=26) included patients with heparin resistance. The initial assessment of the haemostasiological profile included determining the PT, aPPT, FG, AT III activity, and INR. Intraoperative control of heparinization was carried out with a definition of ACT using a kaolin activator. A weight-associated protocol at the rate of 300 U/kg with target values of ACT >480 sec was used for intraoperative heparinization. Results: The heparin resistance was verified in 8.5% of patients included in the study. Repeated heparin administration at the maximum dose of≥600 U/kg is required in 80.77% of cases. Despite additional heparinization, 19.23% of patients had FFP infusion. There was reduced antithrombin activity in the heparin resistance group (p=0.01). Most patients with heparin resistance (57.7%) were pretreated with low molecular weight heparins during the preoperative period. Conclusion: Determining the initial level of antithrombin activity can predict the risk of developing heparin resistance. The factor analysis verified hidden risk factors for heparin resistance to the heparin pretreatment, chronic hypoxia, and chronic heart failure.

Keywords: congenital heart disease, heparin, antithrombin, activated clotting time, heparin resistance

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Authors: Nambiar Ritu, Ali Ban, Munawar Farida, Israell Imelda, T. Farouk Eman Rasheeda, Jangalgi Renuka, S. Boma Nellie

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Aim: To define the ultrasonographic endometrial thickness (USG ET) cutoff for evacuation of retained pieces of conception (ERPC). Background: Studies of conservative management of 1st trimester miscarriage have questioned the need for post miscarriage curettage. Therapeutic decision making with transvaginal scan post miscarriage endometrial thickness in patients clinically thought to be incomplete miscarriage is often not clear. Method: Retrospective analysis of all 1ST trimester ERPC at Al Rahba Hospital from June 2012 to July 2013 was done. Total of 164 patients underwent ERPC. All cases were reviewed for pre-operative USG ET and post ERPC histopathological examination. TVS was done to evaluate the maximum ET of the uterine cavity along the long axis of the uterus and features of retained products was noted. All cases without preoperative USG ET measurement were excluded from the study, therefore only 62 out of 164 cases were included in the study. The patients were divided into three groups: o Group A: have retained products within endometrial cavity. o Group B: endometrial thickness equal or more than 20 mm. o Group C: endometrial thickness equal or less than 19.9 mm. o Post ERPC product was sent for HPE and the results were compared. Transvaginal sonographic findings can be used as a deciding factor in the management of patients with 1st trimester miscarriage who need ERPC. Our proposed cutoff in clinically stable patients requiring ERPC is more than 20 mm.

Keywords: ERPC, histopathological examination, long axis of the uterus, USG ET

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Authors: Majid Khan

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Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

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Authors: Nirmal Sugathan, Santosh Maruthy

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Background: A considerable number of studies have evidenced that phonological encoding (PE) and working memory (WM) skills operate differently in adults who stutter (AWS). In order to tap these skills, several paradigms have been employed such as phonological priming, phoneme monitoring, and nonword repetition tasks. This study, however, utilizes a word jumble paradigm to assess both PE and WM using different modalities and this may give a better understanding of phonological processing deficits in AWS. Aim: The present study investigated PE and WM abilities in conjunction with lexical access in AWS using jumbled words. The study also aimed at investigating the effect of increase in cognitive load on phonological processing in AWS by comparing the speech reaction time (SRT) and accuracy scores across various syllable lengths. Method: Participants were 11 AWS (Age range=19-26) and 11 adults who do not stutter (AWNS) (Age range=19-26) matched for age, gender and handedness. Stimuli: Ninety 3-, 4-, and 5-syllable jumbled words (JWs) (n=30 per syllable length category) constructed from Kannada words served as stimuli for jumbled word paradigm. In order to generate jumbled words (JWs), the syllables in the real words were randomly transpositioned. Procedures: To assess PE, the JWs were presently visually using DMDX software and for WM task, JWs were presented through auditory mode through headphones. The participants were asked to silently manipulate the jumbled words to form a Kannada real word and verbally respond once. The responses for both tasks were audio recorded using record function in DMDX software and the recorded responses were analyzed using PRAAT software to calculate the SRT. Results: SRT: Mann-Whitney test results demonstrated that AWS performed significantly slower on both tasks (p < 0.001) as indicated by increased SRT. Also, AWS presented with increased SRT on both the tasks in all syllable length conditions (p < 0.001). Effect of syllable length: Wilcoxon signed rank test was carried out revealed that, on task assessing PE, the SRT of 4syllable JWs were significantly higher in both AWS (Z= -2.93, p=.003) and AWNS (Z= -2.41, p=.003) when compared to 3-syllable words. However, the findings for 4- and 5-syllable words were not significant. Task Accuracy: The accuracy scores were calculated for three syllable length conditions for both PE and PM tasks and were compared across the groups using Mann-Whitney test. The results indicated that the accuracy scores of AWS were significantly below that of AWNS in all the three syllable conditions for both the tasks (p < 0.001). Conclusion: The above findings suggest that PE and WM skills are compromised in AWS as indicated by increased SRT. Also, AWS were progressively less accurate in descrambling JWs of increasing syllable length and this may be interpreted as, rather than existing as a uniform deficiency, PE and WM deficits emerge when the cognitive load is increased. AWNS exhibited increased SRT and increased accuracy for JWs of longer syllable length whereas AWS was not benefited from increasing the reaction time, thus AWS had to compromise for both SRT and accuracy while solving JWs of longer syllable length.

Keywords: adults who stutter, phonological ability, working memory, encoding, jumbled words

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Authors: Lik Hang Gary Wong

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Background: Practice learning is crucial for preparing the healthcare profession to meet the real challenge upon graduation. Students are required to demonstrate their competence in managing interpersonal challenges, such as teamwork with other professionals and communicating well with the service users, during the placement. Such competence precedes clinical practice, and it may eventually affect students' actual performance in a clinical context. Unfortunately, there were limited studies investigating how such competence affects students' performance in practice learning. Objectives: The aim of this study is to investigate how self-rated interpersonal competence affects students' actual performance during clinical placement. Methods: 40 occupational therapy students from Hong Kong were recruited in this study. Prior to the clinical placement (level two or above), they completed an online survey that included the Interpersonal Communication Competence Scale (ICCS) measuring self-perceived competence in interpersonal communication. Near the end of their placement, the clinical educator rated students’ performance with the Student Practice Evaluation Form - Revised edition (SPEF-R). The SPEF-R measures the eight core competency domains required for an entry-level occupational therapist. This study adopted the cross-sectional observational design. Pearson correlation and multiple regression are conducted to examine the relationship between students' interpersonal communication competence and their actual performance in clinical placement. Results: The ICCS total scores were significantly correlated with all the SPEF-R domains, with correlation coefficient r ranging from 0.39 to 0.51. The strongest association was found with the co-worker communication domain (r = 0.51, p < 0.01), followed by the information gathering domain (r = 0.50, p < 0.01). Regarding the ICCS total scores as the independent variable and the rating in various SPEF-R domains as the dependent variables in the multiple regression analyses, the interpersonal competence measures were identified as a significant predictor of the co-worker communication (R² = 0.33, β = 0.014, SE = 0.006, p = 0.026), information gathering (R² = 0.27, β = 0.018, SE = 0.007, p = 0.011), and service provision (R² = 0.17, β = 0.017, SE = 0.007, p = 0.020). Moreover, some specific communication skills appeared to be especially important to clinical practice. For example, immediacy, which means whether the students were readily approachable on all social occasions, correlated with all the SPEF-R domains, with r-values ranging from 0.45 to 0.33. Other sub-skills, such as empathy, interaction management, and supportiveness, were also found to be significantly correlated to most of the SPEF-R domains. Meanwhile, the ICCS scores correlated differently with the co-worker communication domain (r = 0.51, p < 0.01) and the communication with the service user domain (r = 0.39, p < 0.05). It suggested that different communication skill sets would be required for different interpersonal contexts within the workplace. Conclusion: Students' self-perceived interpersonal communication competence could predict their actual performance during clinical placement. Moreover, some specific communication skills were more important to the co-worker communication but not to the daily interaction with the service users. There were implications on how to better prepare the students to meet the future challenge upon graduation.

Keywords: interpersonal competence, clinical education, healthcare professional education, occupational therapy, occupational therapy students

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