Search results for: rural surgery

Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

Abstract:

Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

Procedia PDF Downloads 129

Authors: Zengmin Tian, Bin Lv, Rui Hui, Yupeng Liu, Chuan Wang, Qing Liu, Hongyu Li, Yan Qi, Li Song

Abstract:

Objective Robot was used for replacement of the frame in recent years. The paper is to investigate the safety and effectiveness of frameless stereotactic surgery in the treatment of children with cerebral palsy. Methods Clinical data of 425 children with spastic cerebral palsy were retrospectively analyzed. The patients were treated with robot-assistant frameless stereotactic surgery of nuclear mass destruction. The motor function was evaluated by gross motor function measure-88 (GMFM-88) before the operation, 1 week and 3 months after the operation respectively. The statistical analysis was performed. Results The postoperative CT showed that the destruction area covered the predetermined target in all the patients. Minimal bleeding of puncture channel occurred in 2 patient, and mild fever in 3 cases. Otherwise, there was no severe surgical complication occurred. The GMFM-88 scores were 49.1±22.5 before the operation, 52.8±24.2 and 64.2±21.4 at the time of 1 week and 3 months after the operation, respectively. There was statistical difference between before and after the operation (P<0.01). After 3 months, the total effective rate was 98.1%, and the average improvement rate of motor function was 24.3% . Conclusion Replaced the traditional frame, the robot-assistant frameless stereotactic surgery is safe and reliable for children with spastic cerebral palsy, which has positive significance in improving patients’ motor function.

Keywords: cerebral palsy, robotics, stereotactic techniques, frameless operation

Procedia PDF Downloads 85

Authors: Naseer Ahmad

Abstract:

This research investigates the intricate dynamics of language policy, ideology, and the choice of educational language as a medium of instruction in rural Pakistan. Focused on addressing the complexities of language practices in underexplored educational contexts, the study employed a case study approach, analyzing interviews with education authorities, teachers, and students, alongside classroom observations in English-medium and Urdu-medium rural schools. The research underscores the significance of understanding linguistic diversity within rural communities. The analysis of interviews and classroom observations revealed that language policies in rural schools are influenced by multiple factors, including historical legacies, societal language ideologies, and government directives. The dominance of Urdu and English as the preferred languages of instruction reflected a broader language hierarchy, where regional languages are often marginalized. This language ideology perpetuates a sense of linguistic inferiority among students who primarily speak regional languages. The impact of language choices on students' learning experiences and outcomes is a central focus of the research. It became evident that while policies advocate for specific language practices, the implementation often diverges due to multifarious socio-cultural, economic, and institutional factors. This disparity significantly impacts the effectiveness of educational processes, influencing pedagogical approaches, student engagement, academic outcomes, social mobility, and language choices. Based on the findings, the study concluded that due to policy and practice gap, rural people have complex perceptions and language choices. They perceived Urdu as a national, lingua franca, cultural, easy, or low-status language. They perceived English as an international, lingua franca, modern, difficult, or high-status language. They perceived other languages as mother tongue, local, religious, or irrelevant languages. This research provided insights that are crucial for theory, policy, and practice, addressing educational inequities and inclusive language policies. It set the stage for further research and advocacy efforts in the realm of language policies in diverse educational settings.

Keywords: language-in-education policy, language ideology, educational language choice, pakistan

Procedia PDF Downloads 66

Authors: Yuan Fang, Wang-Ming Li, Yi-Chen Ruan

Abstract:

Rural healthy old-age care for urban elderly who go to surrounding villages on vacation is a new mode of old-age care in developed coastal areas of China. Such villages that receive urban elderly can be called old-caring villages. Due to the popularity of healthy old-age care in rural areas, more and more urban elderly people participate in the ranks of rural old-age care, resulting in excessive number of tourists in some old-caring villages, exceeding the carrying capacity of the village. Excessive passenger flow may damage the ecological environment, social environment, and facilities environment of the village, and even affect the development potential of the village pension industry. On the basis of on-site investigation and questionnaire survey, this paper summarizes the willingness and behavioral characteristics of the urban elderly population and finds that it will have a certain impact on the old-caring villages in the process of pension vacation in the aspects of ecology, construction, society, and economy. According to the influence of tourists, the paper constructs a system of capacity restriction factors of the old-caring villages, which includes four types: ecological environment capacity, policy environment capacity, perceived congestion capacity, and village service capacity, and fourteen specific indicators. It will provide a theoretical basis for reasonable control of the development scale of the old-caring villages.

Keywords: old-caring villages, restriction factors system, tourists' influence, environmental capacity

Procedia PDF Downloads 142

Authors: Paul J Yazaki, Michael Bouvet, John Shively

Abstract:

Surgery for solid gastrointestinal (GI) cancers such as pancreatic, colorectal, and gastric adenocarcinoma remains the mainstay of curative therapy. Complete resection of the primary tumor with negative margins (R0 resection), its draining lymph nodes, and distant metastases offers the optimal surgical benefit. Real-time fluorescence guided surgery (FGS) promises to improve GI cancer outcomes and is rapidly advancing with tumor-specific antibody conjugated fluorophores that can be imaged using near infrared (NIR) technology. Carcinoembryonic Antigen (CEA) is a non-internalizing tumor antigen validated as a surface tumor marker expressed in >95% of colorectal, 80% of gastric, and 60% of pancreatic adenocarcinomas. Our humanized anti-CEA hT84.66-M5A (M5A) monoclonal antibody (mAb)was conjugated with the NHS-IRDye800CW fluorophore and shown it can rapidly and effectively NIRoptical imageorthotopically implanted human colon and pancreatic cancer in mouse models. A limitation observed is that these NIR-800 dye conjugated mAbs have a rapid clearance from the blood, leading to a narrow timeframe for FGS and requiring high doses for effective optical imaging. We developed a novel antibody-fluorophore conjugate by incorporating a PEGylated sidearm linker to shield or mask the IR800 dye’s hydrophobicity which effectively extended the agent’s blood circulation half-life leading to increased tumor sensitivity and lowered normal hepatic uptake. We hypothesized that our unique anti-CEA linked to the fluorophore, IR800 by PEGylated sidewinder, M5A-SW-IR800 will become the next generation optical imaging agent, safe, effective, and widely applicable for intraoperative image guided surgery in CEA expressing GI cancers.

Keywords: optical imaging, anti-CEA, cancer, fluorescence-guided surgery

Procedia PDF Downloads 146

Authors: Natascha Reich

Abstract:

In colonial Peru, the Spanish crown relied on religious orders, most notably Dominicans, Franciscans, and Jesuits, for accelerating processes of colonization. The dissemination of Christian art, architecture, and music, and most of all, the agency of indigenous people in their production played a key role in facilitating the acceptance of the new religious and political system. Current research on Peruvian colonial music culture and its role as a vehicle for colonization focus on practices in urban centers. The lack of (written) primary sources seems to turn rural areas into a less attractive research territory for musicologists. This paper advocates for a more inclusive approach. By investigating seventeenth-century pipe organs as material remains of Franciscan missionary music culture, it shows how reactions to colonial forces and Christianization in rural Andean locations could follow tendencies different from those in urban areas. Indigenous musicians in cities tried to 'fit' into the European system in order to be accepted by the ruling Spanish elite. By contrast, the indigenous-built pipe organs in the rural Peruvian Colca-Valley show distinctly native-Andean influences. This paper argues that this syncretism can be interpreted as hybridity in Homi K. Bhabha’s sense, as a means of the colonized to undermine the power of the colonizer and to advance reactionary politics. Not only will it show the necessity of considering rural Peruvian music history in modern scholarship for arriving at a more complete picture of colonial culture, but it will also evidence the advantages of a mixed-methodology approach. Historical organology, combined with concepts from ethnomusicology and post-colonial studies, proves as a useful tool in the absence or scarcity of written primary sources.

Keywords: cultural hybridity, music as reactionary politics, Latin American pipe organs, Peruvian colonial music

Procedia PDF Downloads 161

Authors: Conor Mccartney, Mark Lee

Abstract:

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

Procedia PDF Downloads 127

Authors: Ahmed Mudi, Bala Zakar

Abstract:

The paper assesses the impact of safe motherhood initiative on maternal health of women in Gumel Local Government Area of Jigawa State. The work will specifically concentrate on the background on safe motherhood scheme and maternal health of women. The objective of this paper is to assess the level of safe motherhood scheme in Gumel local government area, to find out the level of maternal health in Gumel local government as well as to determine the impact of safe motherhood scheme on maternal health on women in Gumel Local Government Area Jigawa State. Various literature on the topic are reviewed, the paper adopts survey design and use questionnaire to collect data from the respondent. The study comprises 350 women selected from six rural communities in Gumel using random sampling techniques, and the data was analysed by simple frequency and percentage. The research concluded that safe motherhood initiative has a significant impact on the maternal health of women in Gumel Local Government Area of Jigawa State. Finally, suitable recommendations were given on how to improve the scheme to ensure better maternal health in the region.

Keywords: action, assessment, maternal health, safe motherhood, surgery

Procedia PDF Downloads 260

Authors: Davender Kumar, Virender Singh, Rekha Sharma

Abstract:

Correction of skeletal deformities in adult patients with orthodontics is limited. In adult severe cases, the combined approach, orthodontic and orthognathic surgery, is always the treatment of choice, and the results obtained usually ensure a better esthetic, functional, and stable results Orthognathic surgery is the best option for cases when camouflage treatment is questionable and growth modulation is not possible. This case report illustrates the benefit of the team approach in correcting mandible retrusion along with class II skeletal deformity with 100% deep bite. Correction was achieved by anterior repositioning of mandible osteotomy along with orthodontic treatment. The patient's facial appearance was markedly improved along with functional and stable occlusion.

Keywords: camouflage, skeletal, orthognathic, dental

Procedia PDF Downloads 425

Authors: Fatma Ahmed, Heba Mostafa, Bassem Ramdan, Azza El-Soussi

Abstract:

Background: World Health Organization stated that by 2020 cardiac disease will be the number one cause of death worldwide and estimates that 25 million people per year will suffer from heart disease. Cardiac surgery is considered an effective treatment for severe forms of cardiovascular diseases that cannot be treated by medical treatment or cardiac interventions. In spite of the benefits of cardiac surgery, it is considered a major stressful experience for patients who are candidate for surgery. Prehabilitation can decrease incidences of postoperative complications as it prepares patients for surgical stress through enhancing their defenses to meet the demands of surgery. When patients anticipate the postoperative sequence of events, they will prepare themselves to act certain behaviors, identify their roles and actively participate in their own recovery, therefore, anxiety levels are decreased and functional capacity is enhanced. Prehabilitation programs can comprise interventions that include physical exercise, psychological prehabilitation, nutritional optimization and risk factor modification. Physical exercises are associated with improvements in the functioning of the various physiological systems, reflected in increased functional capacity, improved cardiac and respiratory functions and make patients fit for surgical intervention. Prehabilitation programs should also prepare patients psychologically in order to cope with stress, anxiety and depression associated with postoperative pain, fatigue, limited ability to perform the usual activities of daily living through acting in a healthy manner. Notwithstanding the benefits of psychological preparations, there are limited studies which investigated the effect of psychological prehabilitation to confirm its effect on psychological, quality of life and physiological outcomes of patients who had undergone cardiac surgery. Aim of the study: The study aims to determine the effect of prehabilitation interventions on outcomes of patients undergoing cardiac surgeries. Methods: Quasi experimental study design was used to conduct this study. Sixty eligible and consenting patients were recruited and divided into two groups: control and intervention group (30 participants in each). One tool namely emotional, physiological, clinical, cognitive and functional capacity outcomes of prehabilitation intervention assessment tool was utilized to collect the data of this study. Results: Data analysis showed significant improvement in patients' emotional state, physiological and clinical outcomes (P < 0.000) with the use of prehabilitation interventions. Conclusions: Cardiac prehabilitation in the form of providing information about surgery, circulation exercise, deep breathing exercise, incentive spirometer training and nutritional education implemented daily by patients scheduled for elective open heart surgery one week before surgery have been shown to improve patients' emotional state, physiological and clinical outcomes.

Keywords: emotional recovery, clinical recovery, coronary artery bypass grafting patients, prehabilitation

Procedia PDF Downloads 199

Authors: Ana Claudia Muniz Rennó, Karina Nogueira

Abstract:

This study aimed to investigate the in vivo tissue response of the introduction of the bioactive mesh (BM) scaffolds using a model of tibial bone defect implants in rats. Although a previous in vivo study demonstrated a highly positive response of particulate bioactive materials in the morphological and biomechanical properties of the bone callus, the effects of material with superior bioactivity, present in form of meshes have not been studied yet. Eighty male Wistar rats with 3 mm tibial defects were used. Animals were divided into four groups: intact group (IG) – tibia without any injury; bone defect day zero (0dD) – bone defects, sacrificed immediately after injury; bone defect control group (CG) – bone defects without any filler and bone defect filled with BM scaffold. The animals of BM and CG groups were sacrificed 15, 30 and 45 days post-injury to compare the temporal-special effects of the scaffolds on bone healing. The histological analysis revealed an organized newly formed bone at 30 and 45 days post-surgery in the BM. Also, this group presented an increased COX-2 expression on days 15 and 30 post-surgery. Furthermore, the immunohistochemistry analysis revealed that, BM presented a positive immunoexpression of RUNX-2 during all periods evaluated. The biomechanical analysis revealed that at 15 day after surgery, no significant statistically difference was observed between BM and CG and both groups had significantly higher values of maximal load compared to 0dG and significantly lower values than IG. On days 30 and 45 post-surgery, BM presented statistically lower values of maximal load compared to the CG. Nevertheless, at the same periods, BM did not show statistically significant difference compared to the IG maximal load values (p > 0, 05). Our results revealed that the implantation of the BM scaffolds was effective in stimulating newly bone formation.

Keywords: bone, biomaterials, scaffolds, cartilage

Procedia PDF Downloads 339

Authors: M. Sulieman, H. Arabiyat, H. Ali, K. Potiszil, I. Abbas, R. English, P. King, I. Brown, P. Drew

Abstract:

Introduction: The incidence of breast ductal Carcinoma in Situ (DCIS) has been increasing; it currently represents up 20-25% of all breast carcinomas. Some aspects of DCIS management are still controversial, mainly due to the heterogeneity of its clinical presentation and of its biological and pathological characteristics. In DCIS, histological diagnosis obtained preoperatively, carries the risk of sampling error if the presence of invasive cancer is subsequently diagnosed. The mammographic extent over than 4–5 cm and the presence of architectural distortion, focal asymmetric density or mass on mammography are proven important risk factors of preoperative histological under staging. Intracystic papillary cancer (IPC) is a rare form of breast carcinoma. Despite being previously compared to DCIS it has been shown to present histologically with invasion of the basement membrane and even metastasis. SLNB – Carries the risk of associated comorbidity that should be considered when planning surgery for DCIS and IPC. Objectives: The aim of this Audit was to better define a ‘high risk’ group of patients with pre-op diagnosis of non-invasive cancer undergoing breast conserving surgery, who would benefit from sentinel node biopsy. Method: Retrospective data collection of all patients with ductal carcinoma in situ over 5 years. 636 patients identified, and after exclusion criteria applied: 394 patients were included. High risk defined as: Extensive micro-calcification >40mm OR any mass forming DCIS. IPC: Winpath search from for the term ‘papillary carcinoma’ in any breast specimen for 5 years duration;.29 patients were included in this group. Results: DCIS: 188 deemed high risk due to >40mm calcification or a mass forming (radiological or palpable) 61% of those had a mastectomy and 32% BCS. Overall, in that high-risk group - the number with invasive disease was 38%. Of those high-risk DCIS pts 85% had a SLN - 80% at the time of surgery and 5% at a second operation. For the BCS patients - 42% had SLN at time of surgery and 13% (8 patients) at a second operation. 15 (7.9%) pts in the high-risk group had a positive SLNB, 11 having a mastectomy and 4 having BCS. IPC: The provisional diagnosis of encysted papillary carcinoma is upgraded to an invasive carcinoma on final histology in around a third of cases. This has may have implications when deciding whether to offer sentinel node removal at the time of therapeutic surgery. Conclusions: We have defined a ‘high risk’ group of pts with pre-op diagnosis of non-invasive cancer undergoing BCS, who would benefit from SLNB at the time of the surgery. In patients with high-risk features; the risk of invasive disease is up to 40% but the risk of nodal involvement is approximately 8%. The risk of morbidity from SLN is up to about 5% especially the risk of lymphedema.

Keywords: breast ductal carcinoma in Situ (DCIS), intracystic papillary carcinoma (IPC), sentinel node biopsy (SLNB), high-risk, non-invasive, cancer disease

Procedia PDF Downloads 107

Authors: Rassoli Aisa, Abrishami Movahhed Arezu, Faturaee Nasser, Seddighi Amir Saeed, Shafigh Mohammad

Abstract:

Cardiovascular diseases are one of the most common causes of mortality in developed countries. Coronary artery abnormalities and carotid artery stenosis, also known as silent death, are among these diseases. One of the treatment methods for these diseases is to create a deviatory pathway to conduct blood into the heart through a bypass surgery. The saphenous vein is usually used in this surgery to create the deviatory pathway. Unfortunately, a re-surgery will be necessary after some years due to ignoring the disagreement of mechanical properties of graft tissue and/or applied prostheses with those of host tissue. The objective of the present study is to clarify the viscoelastic behavior of human saphenous tissue. The stress relaxation tests in circumferential and longitudinal direction were done in this vein by exerting 20% and 50% strains. Considering the stress relaxation curves obtained from stress relaxation tests and the coefficients of the standard solid model, it was demonstrated that the saphenous vein has a non-linear viscoelastic behavior. Thereafter, the fitting with Fung’s quasilinear viscoelastic (QLV) model was performed based on stress relaxation time curves. Finally, the coefficients of Fung’s QLV model, which models the behavior of saphenous tissue very well, were presented.

Keywords: Viscoelastic behavior, stress relaxation test, uniaxial tensile test, Fung’s quasilinear viscoelastic (QLV) model, strain rate

Procedia PDF Downloads 330

Authors: Keiko Yamauchi, Motoyuki Nakao, Yoko Ishihara

Abstract:

The increase in the number of women with breast cancer in Japan has required hospitals to provide a higher quality of medicine so that patients are satisfied with the treatment they receive. However, patients’ satisfaction following breast cancer treatment has not been sufficiently studied. Hence, we investigated the factors influencing patient satisfaction following breast cancer treatment among Japanese women. These women underwent either breast-conserving surgery (BCS) (n = 380) or total mastectomy (TM) (n = 247). In March 2016, we conducted a cross-sectional internet survey of Japanese women with breast cancer in Japan. We assessed the following factors: socioeconomic status, cancer-related information, the role of medical decision-making, the degree of satisfaction regarding the treatments received, and the regret arising from the medical decision-making processes. We performed logistic regression analyses with the following dependent variables: extreme satisfaction with the treatments received, and regret regarding the medical decision-making process. For both types of surgery, the odds ratio (OR) of being extremely satisfied with the cancer treatment was significantly higher among patients who did not have any regrets compared to patients who had. Also, the OR tended to be higher among patients who chose to play a wanted role in the medical decision-making process, compared with patients who did not. In the BCS group, the OR of being extremely satisfied with the treatment was higher if, at diagnosis, the patient’s youngest child was older than 19 years, compared with patients with no children. The OR was also higher if patient considered the stage and characteristics of their cancer significant. The OR of being extremely satisfied with the treatments was lower among patients who were not employed on full-time basis, and among patients who considered the second medical opinions and medical expenses to be significant. These associations were not observed in the TM group. The OR of having regrets regarding the medical decision-making process was higher among patients who chose to play a role in the decision-making process as they preferred, and was also higher in patients who were employed on either a part-time or contractual basis. For both types of surgery, the OR was higher among patients who considered a second medical opinion to be significant. Regardless of surgical type, regret regarding the medical decision-making process decreases treatment satisfaction. Patients who received breast-conserving surgery were more likely to have regrets concerning the medical decision-making process if they could not play a role in the process as they preferred. In addition, factors associated with the satisfaction with treatment in BCS group but not TM group included the second medical opinion, medical expenses, employment status, and age of the youngest child at diagnosis.

Keywords: medical decision making, breast-conserving surgery, total mastectomy, Japanese

Procedia PDF Downloads 145

Authors: Pius Akindele Adeniyi

Abstract:

Developing countries including Nigeria are greatly saddled with problems emanating from environmental deterioration. These problems are glaringly threatening the existence of mankind. A wide range of factors contribute to environmental problems and prominent among these are: increase in human population, deforestation, industrialization, urbanization, ignorance and socio-economic activities. The economic function of the forest has for quite a long time played a major role in the economic life of the people of Nigeria while the social function such as the recreational use of the forest has until today play very little role in the cultural development of the country. Recreation forest ameliorates the environment, reduces psychological stress, and broadens individual outlook and horizon. Unfortunately domestic tourism of recreational forest is not developed and almost unknown due to poverty and non existence of recreational facilities. Social forestry is seen as a sustainable means of combating ecological problems especially in third world countries such as Nigeria. The programme also provides social and economic benefits to the rural people. As a rural-based activity, people's participation is crucial for its success. There is need to create awareness on recreational forestry and social forestry as well as harness their resources for the country .This paper therefore highlights the constraints in the practice of social and recreational forestry in developing countries and suggests ways to motivate the rural people to participate in the programme. . Attempt has been made to trace the causes and consequences of Nigerian environmental deterioration, while suggestions on possible solutions are proffered .

Keywords: recreational, social, deteriorating, forestry

Procedia PDF Downloads 68

Authors: Sudha Shukla, Bablu Kumar, Gyan Prakash Gupta, U. C. Kulshrestha

Abstract:

Air pollutants emitted from solid biofuels during cooking are the major contributors to poor air quality, respiratory problems, and radiative forcing, etc. in rural areas of most of developing countries. The present study reports the chemical characteristics and sources of ambient aerosols and traces gases during cooking and non-cooking hours emitted during biofuel combustion in a village in North-Central India. Fine aerosol samples along with gaseous species (Sox, NOx, and NH₃) were collected during September 2010-March 2011 at Khairatpur village (KPV) which is located in the Uttar Pradesh state in North-Central India. Results indicated that most of the major ions in aerosols and Sox, NOx, and NH₃ gases were found to be higher during cooking hours as compared to non-cooking hours suggesting that solid biofuel combustion is an important source of air pollution. Results of Principal Component Analysis (PCA) revealed that combustion of solid biofuel, vehicular emissions, and brick kilns were the major sources of fine aerosols and trace gases in the village. A health survey was conducted to find out the relation between users of biofuels and their health effects and the results revealed that most of the women in the village were suffering from diseases associated with biofuel combustion during cooking.

Keywords: ambient aerosols, biofuel combustion, cooking, health survey, rural area

Procedia PDF Downloads 235

Authors: J. Cadby, K. Miyazawa

Abstract:

Information and Communication Technology (ICT) has been widely adopted into the agricultural landscape with advancements of mobile connectivity and data accessibility. In developed nations, mobile-technology is well integrated into marketing transactions, and also plays a crucial role in making data-driven decisions on-farm. In developing nations, mobile banking and access to agricultural extension services allow for informed decision-making and smoother transactions. In addition, the availability of updated and readily available market and climate data provides a negotiation platform, reducing economic risks for farmers worldwide. The total usage of mobile technology has risen over the past 20 years, and almost three-quarters of the world’s population subscribes to mobile technology. This study reviewed mobile technology integration into agricultural systems in developing and developed nations. Data from secondary sources were collected and investigated. The objectives of the study include a review of the success of mobile banking transactions in developing nations, and a review of application and SMS based services for direct marketing in both developed and developing nations. Rural farmers in developing countries with access to diverse m-banking options experienced increased access to farm investment resources with the use of mobile banking technology. Rural farmers involved in perishable crop production were also more likely to benefit from mobile platform sales participation. ICT programs reached through mobile application and SMS increased access to agricultural extension materials and marketing tools for demographics that faced literacy-challenges and isolated markets. As mobile technology becomes more ubiquitous in the global agricultural system, training and market opportunities to facilitate mobile usage in developing agricultural systems are necessary. Digital skills training programs are necessary in order to improve equal global adoption of ICT in agriculture.

Keywords: market participation, mobile banking, mobile technology, rural farming

Procedia PDF Downloads 251

Authors: Zs. Csanádi, A. Szabó Nagy, J. Szabó, J. Erdős

Abstract:

The main objective of this study was to assess the annual concentration and seasonal variation of benzo(a)pyrene (BaP) associated with PM10 in an urban site of Győr and in a rural site of Sarród in the sampling period of 2008–2012. A total of 280 PM10 aerosol samples were collected in each sampling site and analyzed for BaP by gas chromatography method. The BaP concentrations ranged from undetected to 8 ng/m3 with the mean value of 1.01 ng/m3 in the sampling site of Győr, and from undetected to 4.07 ng/m3 with the mean value of 0.52 ng/m3 in the sampling site of Sarród, respectively. Relatively higher concentrations of BaP were detected in samples collected in both sampling sites in the heating seasons compared with non-heating periods. The annual mean BaP concentrations were comparable with the published data of different other Hungarian sites.

Keywords: air quality, benzo(a)pyrene, PAHs, polycyclic aromatic hydrocarbons

Procedia PDF Downloads 388

Authors: Rajib Husain, Munirujzaman Osmani, Mohammad Shamsal Islam

Abstract:

Purpose: To compare the safety, efficacy and visual outcome of phacoemulsification vs. manual small-incision cataract surgery (SICS) for the treatment of cataract in Bangladesh. Objectives: 1. To assess the Visual outcome after cataract surgery 2. To understand the post-operative complications and early rehabilitation 3. To identified which surgical procedure more attractive to the patients 4. To identify which surgical procedure is occurred fewer complications. 5. To find out the socio-economic and demographic characteristics of study patients Setting: Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh. Design: Retrospective, randomised comparison of 300 patients with visually significant cataracts. Method: The present study was designed as a retrospective hospital-based research. The sample size was 300 and study period was from July, 2012 to July, 2013 and assigned randomly to receive either phacoemulsification or manual small-incision cataract surgery (SICS). Preoperative and post-operative data were collected through a well designed collection format. Three follow-up were done; i) during discharge ii) 1-3 weeks & iii) 4-11 weeks post operatively. All preoperative and surgical complications, uncorrected and best-corrected visual acuity (BCVA) and astigmatism were taken into consideration for comparison of outcome Result: Nearly 95% patients were more than 40 years of age. About 52% patients were female, and 48% were male. 52% (N=157) patients came to operate their first eye where 48% (N=143) patients were visited again to operate their second eye. Postoperatively, five eyes (3.33%) developed corneal oedema with >10 Descemets folds, and six eyes (4%) had corneal oedema with <10 Descemets folds for Phacoemulsification surgeries. For SICS surgeries, seven eyes (4.66%) developed corneal oedema with >10 Descemets folds and eight eyes (5.33%) had corneal oedema with < 10 descemets folds. However, both the uncorrected and corrected (4-11 weeks) visual acuities were better in the eyes that had phacoemulsification (p=0.02 and p=0.03), and there was less astigmatism (p=0.001) at 4-11 weeks in the eye that had phacoemulsification. Best-corrected visual acuity (BCVA) of final follow-up 95% (N=253) had a good outcome, borderline 3.10% (N=40) and poor outcome was 1.6% (N=7). The individual surgeon outcome were closer, 95% (BCVA) in SICS and 96% (BCVA) in Phacoemulsification at 4-11 weeks follow-up respectively. Conclusion: outcome of cataract surgery both Phacoemulsification and SICS in CEITC was more satisfactory according to who norms. Both Phacoemulsification and manual small-incision cataract surgery (SICS) shows excellent visual outcomes with low complication rates and good rehabilitation. Phacoemulsification is significantly faster, and modern technology based surgical procedure for cataract treatment.

Keywords: phacoemulsification, SICS, cataract, Bangladesh, visual outcome of SICS

Procedia PDF Downloads 348

Authors: E. N. Jansen van Vuuren

Abstract:

When visiting Foundation Phase (FP) students during their Teaching Practice at schools in rural Mpumalanga, the lack of music education is evident through the absence of musical sounds, with the exception of a limited repertoire of songs that are sung by all classes everywhere you go. The absence of music teaching resources such as posters and music instruments add to the perception that generalist teachers in the FP are not teaching music. Pre-service students also acknowledge that they have never seen a music class being taught during their teaching practice visits at schools. This lack of music mentoring impacts the quality of teachers who are about to enter the workforce and ultimately results in the perpetuation of no music education in many rural schools. The situation in more affluent schools present a contrasting picture with music education being given a high priority and generalist teachers often being supported by music specialists, paid for by the parents. When student teachers start their music course, they have limited knowledge to use as a foundation for their studies. The aim of the study was to ascertain the music knowledge that students gained throughout their school careers so that the curriculum could be adapted to suit their needs. By knowing exactly what pre-service teachers know about music, the limited tuition time at tertiary level can be used in the most suitable manner and concentrate on filling the knowledge gaps. Many scholars write about the decline of music education in South African schools and mention reasons, but the exact music knowledge void amongst students does not feature in the studies. Knowing the parameters of students’ music knowledge will empower lecturers to restructure their curricula to meet the needs of pre-service students. The research question asks, “what is the extent of the music void amongst rural pre-service teachers in a B.Ed. FP course at an African university?” This action research was done using a pragmatic paradigm and mixed methodology. First year students in the cohort studying for a B.Ed. in FP were requested to complete an online baseline assessment to determine the status quo. This assessment was compiled using the CAPS music content for Grade R to 9. The data was sorted using the elements of music as a framework. Findings indicate that students do not have a suitable foundation in music education despite supposedly having had music tuition from grade R to grade 9. Knowing the content required to fill the lack of knowledge provides academics with valuable information to amend their curricula and to ensure that future teachers will be able to provide rural learners with the same foundations in music as those received by learners in more affluent schools. It is only then that the rich music culture of the African continent will thrive.

Keywords: generalist educators, music education, music curriculum, pre-service teachers

Procedia PDF Downloads 65

Authors: Kushal Patel, Manasa Dittakavi, Cyrus Falsafi, Gretchen Lovett

Abstract:

Rural America has seen a surge in opioid addiction rates and overdose deaths in recent years, becoming a significant public health crisis. This may be due to a variety of factors, such as lack of access to healthcare or other economic and social factors that can contribute to addiction such as poverty, unemployment, and social isolation. As the opioid epidemic has disproportionately affected rural communities, pregnant women in these areas may be highly susceptible and face additional difficulties in facing the appropriate care they need. Opioid use disorder has many negative effects on prenatal infants. These include changes in their microbiome, mental health, neurodevelopment and cognition. These can affect how the child performs in various activities in life and how they interact with others. It has been demonstrated that using cognitive behavioral therapy improves not just pain-related results but also mobility, quality of life, disability, and mood outcomes. This indicates that cognitive behavioral therapy (CBT) may be a useful therapeutic strategy for enhancing general health and wellbeing in people with opioid use problems. In terms of treating psychiatric diseases, CBT carries fewer dangers than opioids. One study that illustrates the potential for CBT to promote a reduction in opioid use disorder used self-reported drug use patterns 6 months prior to and during their pregnancy. At the beginning of the study, participants reported an average of 3.78 drug or alcohol use days in the previous 28 days, which decreased to 1.63 days after treatment. The study also found a decrease in depression scores, as measured by IDS scores, from 23.9 to 17.1 at the end of treatment. These and other results show that CBT can have meaningful impacts on pregnant women in Rural America who struggle with an opioid use disorder. This project has been approved by the West Virginia School of Osteopathic Medicine- Office of Research and Sponsored Programs and deemed non-research scholarly work.

Keywords: appalachia, CBT, opiods, pregnancy

Procedia PDF Downloads 87

Authors: Yu-Chieh Chen, Kuei-Feng Shen, Chia-Ling Chao

Abstract:

The purpose of this report was to present the nursing experience and case of an unexpected cerebellar hemorrhagic stroke with acute hydrocephalus patient after lumbar spine surgery. The patient had been suffering from an emergent external ventricular drainage and stayed in the Surgical Intensive Care Unit from July 8, 2016, to July 22, 2016. During the period of the case, the data were collected for attendance, evaluation, observation, interview, searching medical record, etc. An integral evaluation of the patient's physiological 'psychological' social and spiritual states was also noted. The author noticed the following major nursing problems including ineffective cerebral perfusion 'physical activity dysfunction' family resource preparation for disability. The author provided nursing care to maintain normal intracranial pressure, along with a well-therapeutic relationship and applied interdisciplinary medical/nursing team to draft an individualized and appropriate nursing plan for them to face the psychosocial impact of the patient disabilities. We also actively participated in the rehabilitation treatments to improve daily activity and confidence. This was deemed necessary to empower them to a more positive attitude in the future.

Keywords: family resourace preparation inability, hemorrhagic sroke, ineffective tissue cerebral perfusion, lumbar spine surgery

Procedia PDF Downloads 118

Authors: Jayanta Basak, Somprakash Bandyopadhyay, Parama Bhaumik, Siuli Roy

Abstract:

To solve the life and livelihood related problems of socially and economically backward rural women in India, several Women Self-Help Groups (WSHG) are formed in Indian villages. WSHGs are micro-communities (with 10-to 15 members) within a village community. WSHGs have been conceived not just to promote savings and provide credit, but also to act as a vehicle of change through the creation of women micro-entrepreneurs at the village level. However, in spite of huge investment and volume of people involved in the whole process, the success is still limited. Most of these entrepreneurial activities happen in small household workspaces where sales are limited to the inconsistent and unpredictable local markets. As a result, these entrepreneurs are perennially trapped in the vicious cycle of low risk taking ability, low investment capacity, low productivity, weak market linkages and low revenue. Market separation including customer-producer separation is one of the key problems in this domain. Researchers suggest that there are four types of market separation: (i) spatial, (ii) financial, (iii) temporal, and (iv) informational, which in turn impacts the nature of markets and marketing. In this context, a large group of intermediaries (the 'middleman') plays important role in effectively reducing the factors that separate markets by utilizing the resource of rural entrepreneurs, their products and thus, accelerate market development. The rural entrepreneurs are heavily dependent on these middlemen for marketing of their products and these middlemen exploit rural entrepreneurs by creating a huge informational separation between the rural producers and end-consumers in the market and thus hiding the profit margins. The objective of this study is to develop a transparent, online communities of purpose among rural and urban entrepreneurs using internet and web 2.0 technologies in order to decrease market separation and improve mutual awareness of available and potential products and market demands. Communities of purpose are groups of people who have an ability to influence, can share knowledge and learn from others, and be committed to achieving a common purpose. In this study, a cluster of SHG women located in a village 'Kandi' of West Bengal, India has been studied closely for six months. These women are primarily engaged in producing garments, soft toys, fabric painting on clothes, etc. These women were equipped with internet-enabled smart-phones where they can use chat applications in local language and common social networking websites like Facebook, Instagram, etc. A few handicraft experts and micro-entrepreneurs from the city (the 'seed') were included in their mobile messaging app group that enables the creation of a 'community of purpose' in order to share thoughts and ideas on product designs, market trends, and practices, and thus decrease the rural-urban market separation. After six months of regular group interaction in mobile messaging app among these rural-urban community members, it is observed that SHG women are empowered now to share their product images, design ideas, showcase, and promote their products in global marketplace using some common social networking websites through which they can also enhance and augment their community of purpose.

Keywords: communities of purpose, market separation, self-help group, social technologies

Procedia PDF Downloads 251

Authors: Jean Pierre Kabue, Emma Meader, Afsatou Ndama Traore, Paul R. Hunter, Natasha Potgieter

Abstract:

Norovirus is now considered the most common cause of outbreaks of nonbacterial gastroenteritis. Limited data are available for Norovirus strains in Africa, especially in rural and peri-urban areas. Despite the excessive burden of diarrhea disease in developing countries, Norovirus infections have been to date mostly reported in developed countries. There is a need to investigate intensively the role of viral agents associated with diarrhea in different settings in Africa continent. To determine the prevalence and genetic diversity of Norovirus strains circulating in the rural communities in the Limpopo Province, South Africa and investigate the genetic relationship between Norovirus strains, a cross-sectional study was performed on human stools collected from rural communities. Between July 2014 and April 2015, outpatient children under 5 years of age from rural communities of Vhembe District, South Africa, were recorded for the study. A total of 303 stool specimens were collected from those with diarrhea (n=253) and without (n=50) diarrhea. NoVs were identified using real-time one-step RT-PCR. Partial Sequence analyses were performed to genotype the strains. Phylogenetic analyses were performed to compare identified NoVs genotypes to the worldwide circulating strains. Norovirus detection rate was 41.1% (104/253) in children with diarrhea. There was no significant difference (OR=1.24; 95% CI 0.66-2.33) in Norovirus detection between symptomatic and asymptomatic children. Comparison of the median CT values for NoV in children with diarrhea and without diarrhea revealed significant statistical difference of estimated GII viral load from both groups, with a much higher viral burden in children with diarrhea. To our knowledge, this is the first study reporting on the differences in estimated viral load of GII and GI NoV positive cases and controls. GII.Pe (n=9) were the predominant genotypes followed by GII.Pe/GII.4 Sydney 2012 (n=8) suspected recombinant and GII.4 Sydney 2012 variants(n=7). Two unassigned GII.4 variants and an unusual RdRp genotype GII.P15 were found. With note, the rare GIIP15 identified in this study has a common ancestor with GIIP15 strain from Japan previously reported as GII/untypeable recombinant strain implicated in a gastroenteritis outbreak. To our knowledge, this is the first report of this unusual genotype in the African continent. Though not confirmed predictive of diarrhea disease in this study, the high detection rate of NoV is an indication of subsequent exposure of children from rural communities to enteric pathogens due to poor sanitation and hygiene practices. The results reveal that the difference between asymptomatic and symptomatic children with NoV may possibly be related to the NoV genogroups involved. The findings emphasize NoV genetic diversity and predominance of GII.Pe/GII.4 Sydney 2012, indicative of increased NoV activity. An uncommon GII.P15 and two unassigned GII.4 variants were also identified from rural settings of the Vhembe District/South Africa. NoV surveillance is required to help to inform investigations into NoV evolution, and to support vaccine development programmes in Africa.

Keywords: asymptomatic, common, outpatients, norovirus genetic diversity, sporadic gastroenteritis, South African rural communities, symptomatic

Procedia PDF Downloads 189

Authors: Jin Li, Jing Sun, Xiangkun Cai, Lijuanwang, Yanbin Tang, Junsheng Huo

Abstract:

In order to improve the malnutrition of infants and young children in poor rural areas of China, Chinese government implement a project on improvement of children's nutrition in poor rural areas. Each infant or young child aged 6 to 23 months in selected poor rural areas of China was provided a package of Yingyangbao (YYB) per day, which is a full fat soy powder mixed with multiple micronutrient powders. A technical direction to implement this project comprehensively in poor rural areas of China will be provided by assessing the nutritional status of infants and feeding practices of caregiver. The nutritional intervention was conducted using Yingyangbao for infants aged 6 to 23 months in six poor counties of Shanxi, Yunnan and Hubei Provinces. The caregiver or parents of infants were educated on feeding knowledge and practice. A total of 1840 infants were assessed before the intervention and 1789 infants one year later. The length, weight, hemoglobin concentration of infants were measured to evaluate nutritional status before and after the intervention respectively. The questionnaires were designed to collect data for the basic demographic information and feeding practices. The average weight of infants aged 6 to 23 months increased from 9.59 ± 1.54kg to 9.73 ± 1.61kg one years later (p<0.01), and the average length from 76.0±6.0 to 77.0±6.1(p<0.01). The weight and length of infants aged 12 to 17 months had most obviously improving effect among the three age groups. Before the intervention, the hemoglobin concentration value of infants was 11.7±1.2g/L, and the anemia prevalence was 32.9%. One year later, the hemoglobin concentration value of the infants was increased to 12.0±1.1g/dL, and the anemia prevalence was decreased to 26.0%. There were both statistically significant (p <0.01). The anemia prevalence of infants aged 18 to 23 months had most obviously improving effect，which decreased from 25.0% to 17.2%(p<0.01). The proportion of infants aged 6 to 8 months who received solid, semi-solid or soft foods in time was increased from 89.4% to 91.6%, while there was no statistically significant. The proportion of 6-23 month-old infants who received minimum dietary diversity increased from 55.6% to 60.3%(p <0.01). The differences of the proportion of infants who received minimum meal frequency was no statistically significant between before and after the intervention. The nutritional intervention using Yingyangbao showed the significant effect for improving infants aged 6 to 23 months anemia status, weight and length. The feeding practices were improved through education in the process of nutritional intervention, while the effect is not significant. It is need for Chinese government to explore new publicity pattern.

Keywords: nutritional intervention, infants, nutritional status, feeding practice

Procedia PDF Downloads 436

Authors: Khosro Barkhordari, Fateme Sadr, Mina Pashang

Abstract:

Back ground: Blood transfusion is one of the major issues in cardiac surgery patients. Transfusing patients based on fixed cut-off points of hemoglobin is the current protocol in most institutions. The hemoglobin level of 7- 10 has been suggested for blood transfusion in cardiac surgery patients. We aimed to evaluate if blood transfusion based on change in percentage of hematocrit has different outcomes. Methods: In this retrospective cohort study, we investigated the early postoperative outcome of cardiac surgery patients who received blood transfusions at Tehran Heart Center Hospital, IRAN. We reviewed and analyzed the basic characteristics and clinical data of 700 patients who met our exclusion and inclusion criteria. The two groups of blood transfused patients were compared, those who have 30-50 percent decrease in basal hematocrit versus those with 10 -29 percent decrease. Results: This is ongoing study, and the results would be completed in two weeks after analysis of the date. Conclusion: Early analysis has shown no difference in early post-operative outcomes between the two groups, but final analysis will be completed in two weeks. 1-Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IRAN 2- Department of Research, Tehran Heart Center, Tehran, IRAN Quantitative variables were compared using the Student t-test or the Mann‐Whitney U test, as appropriate, while categorical variables were compared using the χ2 or the Fisher exact test, as required. Our intention was to compare the early postoperative outcomes between the two groups, which include 30 days mortality, Length of ICU stay, Length of hospital stay, Intubation time, Infection rate, acute kidney injury, and respiratory complications. The main goal was to find if transfusing blood based on changes in hematocrit from a basal level was better than to fixed cut-off point regarding early post-operative outcomes. This has not been studied enough and may need randomized control trials.

Keywords: post-operative, cardiac surgery, outcomes, blood transfusion

Procedia PDF Downloads 83

Authors: Rafael Ricieri, Rogerio Barros

Abstract:

Objective: This study is to report a case of massive necrotizing enterocolitis in a six-month-old patient, requiring ileostomy and protective jejunostomy as a damage control measure in the first exploratory laparotomy surgery in massive enterocolitis without a previous diagnosis. Methods: This study is a case report of success in making and closing a protective jejunostomy. However, the low number of publications on this staged and risky measure of surgical resolution encouraged the team to study the indication and especially the correct time for closing the patient's protective jejunostomy. The main study instrument will be the six-month-old patient's medical record. Results: Based on the observation of the case described, it was observed that the time for the closure of the described procedure (protective jejunostomy) varies according to the level of compromise of the health status of your patient and of an individual of each person. Early closure, or failure to close, can lead to a favorable problem for the patient since several problems can result from this closure, such as new intestinal perforations, hydroelectrolyte disturbances. Despite the risk of new perforations, we suggest closing the protective jejunostomy around the 14th day of the procedure, thus keeping the patient on broad-spectrum antibiotic therapy and absolute fasting, thus reducing the chances of new intestinal perforations. Associated with the closure of the jejunostomy, a gastric tube for decompression is necessary, and care in an intensive care unit and electrolyte replacement is necessary to maintain the stability of the case.

Keywords: jejunostomy, ileostomy, enterocolitis, pediatric surgery, gastric surgery

Procedia PDF Downloads 79

Authors: Stephen Osei Akyiaw, Divine Kwabena Atta Kyere-Owusu

Abstract:

Malaria has been a worldwide menace of a health condition to human beings for several decades with majority of people on the African continent with most causalities where Ghana is no exception. Therefore, this study employed the use of animation to enhance awareness creation on the spread and prevention of Malaria in Effutu Communities in the Central Region of Ghana. Working with the interpretivist paradigm, this study adopted Art-Based Research, where the AIDA Model and Cognitive Theory of Multimedia Learning (CTML) served as the theories underpinning the study. Purposive and convenience sampling techniques were employed in selecting sample for the study. The data collection instruments included document review and interviews. Besides, the study developed an animation using the local language of the people as the voice over to foster proper understanding by the rural community folks. Also, indigenous characters were used for the animation for the purpose of familiarization with the local folks. The animation was publicized at Health Town Halls within the communities. The outcomes of the study demonstrated that the use of animation was effective in enhancing the awareness creation for preventing and controlling malaria disease in rural communities in Effutu Communities in the Central Region of Ghana. Health officers and community folks expressed interest and desire to practice the preventive measures outlined in the animation to help reduce the spread of Malaria in their communities. The study, therefore, recommended that animation could be used to curtail the spread and enhanced the prevention of Malaria.

Keywords: malaria, animation, prevention, communities

Procedia PDF Downloads 81

Authors: C. Kuoh, C. Lucas, T. Lopes, I. Mechie, J. Yoong, W. Yoong

Abstract:

For all surgeons, there is one preventable but still highly occurring complication – wrong site surgeries. They can have potentially catastrophic, irreversible, or even fatal consequences on patients. With the exponential development of microsurgery and the use of advanced technological tools, the consequences of operating on the wrong side, anatomical part, or even person is seen as the most visible and destructive of all surgical errors and perhaps the error that is dreaded by most clinicians as it threatens their licenses and arouses feelings of guilt. Despite the implementation of the WHO surgical safety checklist more than a decade ago, the incidence of wrong-site surgeries remains relatively high, leading to tremendous physical and psychological repercussions for the clinicians involved, as well as a financial burden for the healthcare institution. In this presentation, the authors explore various factors which can lead to wrong site surgery – a combination of environmental and human factors and evaluate their impact amongst patients, practitioners, their families, and the medical industry. Major contributing factors to these “never events” include deviations from checklists, excessive workload, and poor communication. Two real-life cases are discussed, and systems that can be implemented to prevent these errors are highlighted alongside lessons learnt from other industries. The authors suggest that reinforcing speaking-up, implementing medical professional trainings, and higher patient’s involvements can potentially improve safety in surgeries and electrosurgeries.

Keywords: wrong side surgery, never events, checklist, workload, communication

Procedia PDF Downloads 180

Authors: Rona Lee Suelo-Calanao, Mahmoud Loubani

Abstract:

Objective: Sternal wound infection (SWI) following cardiac operation has a significant impact on patient morbidity and mortality. It also contributes to longer hospital stays and increased treatment costs. SWI management is mainly focused on treatment rather than prevention. This study looks at the effect of closed incision negative pressure therapy (ciNPT) dressing to help reduce the incidence of superficial SWI in high-risk patients after cardiac surgery. The ciNPT dressing was evaluated at 3 cardiac hospitals in the United Kingdom". Methods: All patients who had cardiac surgery from 2013 to 2021 were included in the study. The patients were classed as high risk if they have two or more of the recognised risk factors: obesity, age above 80 years old, diabetes, and chronic obstructive pulmonary disease. Patients receiving standard dressing (SD) and patients using ciNPT were propensity matched, and the Fisher’s exact test (two-tailed) and unpaired T-test were used to analyse categorical and continuous data, respectively. Results: There were 766 matched cases in each group. Total SWI incidences are lower in the ciNPT group compared to the SD group (43 (5.6%) vs 119 (15.5%), P=0.0001). There are fewer deep sternal wound infections (14(1.8%) vs. 31(4.04%), p=0.0149) and fewer superficial infections (29(3.7%) vs. 88 (11.4%), p=0.0001) in the ciNPT group compared to the SD group. However, the ciNPT group showed a longer average length of stay (11.23 ± 13 days versus 9.66 ± 10 days; p=0.0083) and higher mean logistic EuroSCORE (11.143 ± 13 versus 8.094 ± 11; p=0.0001). Conclusion: Utilization of ciNPT as an approach to help reduce the incidence of superficial and deep SWI may be effective in high-risk patients requiring cardiac surgery.

Keywords: closed incision negative pressure therapy, surgical wound infection, cardiac surgery complication, high risk cardiac patients

Procedia PDF Downloads 91