Search results for: Pediatric intensive care unit

Authors: Chan Hui-Ya, Ding Shin-Tan

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

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

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Authors: Bin Wang, Hengyu Ji, Zhifeng Ye

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Fuel Metering Unit (FMU) in fuel system of an aeroengine sometimes has direct influence on the engine performance, which is neglected for the sake of easy access to mathematical model of the engine in most cases. In order to verify the influence of FMU on an engine model, this paper presents a co-simulation of a stepping motor driven FMU (digital FMU) in a turboshaft aeroengine, using AMESim and MATLAB to obtain the steady and dynamic characteristics of the FMU. For this method, mechanical and hydraulic section of the unit is modeled through AMESim, while the stepping motor is mathematically modeled through MATLAB/Simulink. Combining these two sub-models yields an AMESim/MATLAB co-model of the FMU. A simplified component level model for the turboshaft engine is established and connected with the FMU model. Simulation results on the full model show that the engine model considering FMU characteristics describes the engine more precisely especially in its transition state. An FMU dynamics will cut down the rotation speed of the high pressure shaft and the inlet pressure of the combustor during the step response. The work in this paper reveals the impact of FMU on engine operation characteristics and provides a reference to an engine model for ground tests.

Keywords: fuel metering unit, stepping motor, AMESim/Matlab, full digital simulation

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Authors: Ioana G. Turcan

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reimagined rituals towards unattachment wants to look at an ambiguous loss through the perspective of caregivers, those that accompany us at the beginning and possibly the end of life, those that observe, accumulate, and are impacted by our behavior and needs, but also those that are the witnesses of the human vulnerability. Someone taking care of a patient with dementia experiences ambiguous loss, being in a present of a person partially present, partially absent. The one offering care needs care, not isolation and the aim of the project is to consolidate existing communities or engage other possible ones using performance, storytelling, and other artistic methods. The long-term aim is that with community work, we will manage to co-create rituals in order to help us live with this kind of loss. Looking at them through the lens of different cultures and individuals exercises both the ability to extract the universal essence of a ritual, but also the need and freedom to express the specificity of each situation. To be seen and acknowledged by others, but more importantly, to see oneself from outside with dignity, is very powerful. Oftentimes we forget to express, look and appreciate our own stories, and instead, we choose to outcast them.

Keywords: grief, socio-politics of loss, ambiguous loss, rituals

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Authors: Garima Singh, Kunal Malhotra

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Objective: The expansion of telehealth has been instrumental in increasing access to medical services, especially for underserved and rural communities. In 2020, 14 million patients received virtual care through telemedicine and the global telemedicine market is expected to reach up to $185 million by 2023. It provides a platform and allows a patient to receive primary care as well as specialized care using technology and the comfort of their homes. Telemedicine was particularly useful during COVID-pandemic and the number of telehealth visits increased by 5000% during that time. It continues to serve as a significant resource for patients seeking care and to bridge the gap between the disease and the treatment. Method: As per APA (American Psychiatric Association), Telemedicine is the process of providing health care from a distance through technology. It is a subset of telemedicine, and can involve providing a range of services, including evaluations, therapy, patient education and medication management. It can involve direct interaction between a physician and the patient. It also encompasses supporting primary care providers with specialist consultation and expertise. It can also involve recording medical information (images, videos, etc.) and sending this to a distant site for later review. Results: In our organization, we are using telepsychiatry and serving 25 counties and approximately 1.4 million people. We provide multiple services, including inpatient, outpatient, crisis intervention, Rehab facility, autism services, case management, community treatment and multiple other modalities. With project ECHO (Extension for Community Healthcare Outcomes) it has been used to advise and assist primary care providers in treating mental health. It empowers primary care providers to treat patients in their own community by sharing knowledge. Conclusion: Telemedicine has shown to be a great medium in meeting patients’ needs and accessible mental health. It has been shown to improve access to care in both urban and rural settings by bringing care to a patient and reducing barriers like transportation, financial stress and resources. Telemedicine is also helping with reducing ER visits, integrating primary care and improving the continuity of care and follow-up. There has been substantial evidence and research about its effectiveness and its usage.

Keywords: telehealth, telemedicine, access to care, medical technology

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Authors: Syue-Wen Lin

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Objective: This article explores the nursing experience of a 64-year-old female lung cancer patient who underwent a thoracoscopic left lower lobectomy and treatment. The patient has a history of diabetes. The nursing process included cancer treatment, postoperative pain management, wound care and healing, and family grief counseling. Methods: The nursing period is from March 11 to March 15, 2024. During this time, strict aseptic wound dressing procedures and advanced wound care techniques are employed to promote wound healing and prevent infection. Postoperatively, due to the development of aspiration pneumonia and worsening symptoms, re-intubation was necessary. Given the patient's advanced cancer and deteriorating condition, the nursing team provided comprehensive grief counseling and care tailored to both the patient's physical and psychological needs, as well as the emotional needs of the family. Considering the complexity of the patient's condition, including advanced cancer, palliative care was also integrated into the overall nursing process to alleviate discomfort and provide psychological support. Results: Using Gordon's Functional Health Patterns for assessment, including evaluating the patient's medical history, physical assessment, and interviews, to provide individualized nursing care, it is important to collect data that will help understand the patient's physical, psychological, social, and spiritual dimensions. The interprofessional critical care team collaborates with the hospice team to help understand the psychological state of the patient's family and develop a comprehensive approach to care. Family meetings should be convened, and support should be provided to patients during the final stages of their lives. Additionally, the combination of cancer care, pain management, wound care, and palliative care ensures comprehensive support for the patient throughout her recovery, thereby improving her quality of life. Conclusion: Lung cancer and aspiration pneumonia present significant challenges to patients, and the nursing team not only provides critical care but also addresses individual patient needs through cancer care, pain management, wound care, and palliative care interventions. These measures have effectively improved the quality of life of patients, provided compassionate palliative care to terminally ill patients, and allowed them to spend the last mile of their lives with their families. Nursing staff work closely with families to develop comprehensive care plans to ensure patients receive high-quality medical care as well as psychological support and a comfortable recovery environment.

Keywords: grief counseling, lung cancer, palliative care, nursing experience

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Authors: Chen-Yuan Hsu

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Introduction Elderly is growing and results to live in the long-term care (LTC) and then due to the routine of the facilities in Taiwan, also resulted to losing of those people with environment interaction, so, the self-reliance support (SRS) for those people to experience environment interaction is an essential. Methods This study was recruited samples of a LTC in the central of Taiwan. There was a following research on the SRS group with 20 samples collected and routine care group with 20 samples. A structured questionnaire as the Environment Interaction Dimension, as data collection included demographic information and the dimensions of environment interaction. Data analysis used SPSS 22.0 for Window 2000 to report the finding. Results The Environment Interaction Dimension for Taiwanese is a Chinese version of the containing 8 items. The result of t-test analysis found that environment interaction showed a significant difference between groups (p＜.05), the result recommended that there was a higher score of environment interaction dimension on the SRS group (29.90±5.56) comparing with the routine care group (22.1±5.53). Conclusion This study showed that the SRS group was higher than the routine care group on the environment interaction dimension for Taiwanese elderly living in the LTC. The results can also provide the reference for LTC, to encourage those people to participate in SRS in LTC, and therefore also improving their environment interaction.

Keywords: self-reliance support, environment interaction, long-term care, elderly

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Authors: Saeed Haghnia

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This paper traces the back history of environments in which the elderly who could not stay in private dwellings were accommodated and taken care of in Iran in the 19th century. It investigates the factors impacting on the establishment of the first nursing homes in Iran in 1973. Today in 2020, the nursing home is the only available model of residential care environment for the elderly who cannot stay in private dwellings in Iran. Understanding the evolution of these environments from a socio-political perspective is crucial before studying nursing homes’ response to the elderly and society in Iran and seeking any alternative model specific to the context. However, no study on the evolution of these environments in Iran was found. Thus, this paper, by going through primary and secondary resources and from a socio-political perspective, investigates how the elderly who could not stay in private dwellings were accommodated and taken care of in Iran in the 19th century. Maristan, in the early 19th century in Egypt as a part of Islamic territory, is an example of such spaces in which homeless elderly were kept and taken care of. This study suggests that in the 19th century in Iran in lack of significant governmental influence over people’s social affairs, any potential environments accommodating and taking care of the elderly who could not stay in private dwellings (mainly homeless) in Iran were probably regulated or supported by local figures, specifically clergies, as a response to the need for taking care of the vulnerable members of society.

Keywords: nursing home, ageing, Iran, middle east, Qajar, Pahlavi

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Authors: Su-Lin Yu

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This paper will explore how gender and care discourse are intersected, reformulated and contested in American daughters’ caregiving memoirs. In particular, it will attempt to show how gender structure has worked to regulate a daughter’s response to her mother’s illness. In other words, how do certain cultural notions and class difference affect the ways in which the daughter enacts her caregiving response to her mother’s illness? What is the interrelation of female subjectivity and care practice? To understand care and gender politics in the memoirs, this paper will engage in close readings of five texts: Sandra Bullock Simith’s Trading Places: Becoming My Mother’s Mother: A Daughter’s Memoir (2015),Martha Stettinius’s Inside the Dementia Epidemic: A Daughter’s Memoir (2012), Patricia Thompson Collamer’s Grace on the Ledge: a Caregiver's Memoir, Judith Henry’s The Dutiful Daughter's Guide to Caregiving: A Practical Memoir (2015), and The Daughter's Dilemma: A Survival Guide to Caring for an Aging, Abusive Parent by Emily Wanderer Cohen (2018). By analyzing these texts, this paper will show why adult daughters become the primary caregivers, how gender norms and care practices influence a daughter’s thoughts and actions, and how it affects her self-understanding. Taken as a whole, then, the paper will provide an important examination not only of care and gender politics, but also a contribution to the intersecting discourses of illness, death, and mother-daughter relationship.

Keywords: care ethics, daughter-mother relationship, gender politics, memoirs

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Authors: Tess Howard, Lily Owens, Maneesha De Silva, Russell Hodgson

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Purpose: This study aims to evaluate the cost-effectiveness of laparoscopic common bile duct exploration (CBDE) compared to endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy for the emergency management of common bile duct (CBD) stones. Methodology: A retrospective case note review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE, or ERCP and cholecystectomy at a single centre between January 2014-October 2014. Data on admission and procedural costs, length of hospital stay, postoperative complications and further stone related interventions were analysed. Results: A total of 350 patients were analysed. Among them, 299 patients underwent CBDE at the time of cholecystectomy, while the remaining 51 underwent ERCP either pre-, intra- or post cholecystectomy. CBDE was associated with lower overall costs compared to ERCP with an average hospital stay cost of $13,093 vs $22,930 respectively. This was largely attributed to shorter hospital stays (6.5 vs 10.3 days), decreased need for intensive care unit admission and fewer postoperative interventions within the CBDE group. Notably, single procedure laparoscopic cholecystectomy with CBDE demonstrated decreased operative costs compared to laparoscopic cholecystectomy combined with ERCP pre-/intra- or post-operatively ($3,747 vs. $4,641). Conclusion: Emergent CBDE is a cost-effective alternative to ERCP for managing CBD stones when combined with cholecystectomy. The upfront investment in equipment for CBDE and increased cholecystectomy procedural time is counterbalanced by reduced hospital stay, fewer procedures and subsequent cost savings. Economic considerations, in conjunction with clinical outcomes, should inform the selection of the optimal approach for CBD stone management in emergency settings.

Keywords: choledocolithiasis, management, cost-effectiveness, endoscopic retrograde cholangiopancreatography, ERCP, CBDE, common bile duct exploration

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Authors: Dewaram Abhiman Nagdeve

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The present paper examined the urban-rural differentials and the factors influencing net change in reproductive and child health input, its utilization, and its output during the National Family Health Survey conducted during 1992-93 and 2019-21 in India. The analysis of NFHS data has been done and variables have been grouped into health input regarding antenatal care, postnatal care, and child care, utilization regarding reproductive and child health care, and reproductive and child health outcomes. An analysis was done using bivariate analysis and the chi-square test. The study reveals that there was an increase in health input, utilization, and output during the intra-survey period. Urban-rural disparities in Reproductive and Child Health (RCH) indicators persist, highlighting the need for focused intervention by the Indian government. Key steps should include enhancing RCH programs through robust information and education campaigns and deploying dedicated health personnel to remote and inaccessible rural areas. These initiatives are crucial to reducing both maternal and child mortality rates and ensuring equitable healthcare access nationwide.

Keywords: urban, rural, differentials, reproductive and child health, India

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Authors: Yu Sin Syu

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Objective: The study aimed to improve the patient guidance satisfaction of patients hospitalized in iodine-131 isolation rooms, as well as the patient guidance completion rate for such patients. Method: A patient care guidance checklist and patient care guidance satisfaction questionnaire were administered to 29 patients who had previously been hospitalized in iodine-131 isolation rooms. The evaluation was conducted on a one-on-one basis, and its results showed that the patients’ satisfaction with patient guidance was only 3.7 points and that the completion rate for the patient guidance performed by nurses was only 67%. Therefore, various solutions were implemented to create a more complete patient guidance framework for nurses, including the incorporation of regular care-related training in in-service education courses; the establishment of patient care guidance standards for patients in iodine-131 isolation rooms; the establishment of inpatient care standards and auditing processes for iodine-131 isolation rooms; the creation of an introductory handbook on ward environment; Invite other the care team the revision of iodine-131 health education brochures; the creation of visual cards and videos covering equipment operation procedures; and introduction of QR codes. Results: Following the implementation of the above measures, the overall satisfaction of patients hospitalized in iodine-131 isolation rooms increased from 3.7 points to 4.6 points, and the completion rate for patient guidance rose from 67% to 100%. Conclusion: Given the excellent results achieved in this study, it is hoped that this nursing project can serve as a benchmark for other relevant departments.

Keywords: admission care guidance, guidance satisfaction, integrity, Iodine131 isolation

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Authors: Daidai Shen, Jean Claude Thill, Wenjia Zhang

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This study explores the dynamics of synergy and complementarity within city networks, specifically focusing on the headquarters-subsidiary relations of firms. We begin by defining these two types of networks and establishing their pivotal roles in shaping city network structures. Utilizing the mesoscale analytic approach of weighted stochastic block modeling, we discern relational patterns between city pairs and determine connection strengths through statistical inference. Furthermore, we introduce a community detection approach to uncover the underlying structure of these networks using advanced statistical methods. Our analysis, based on comprehensive network data up to 2017, reveals the coexistence of both complementarity and synergy networks within China’s technology-intensive manufacturing cities. Notably, firms in technology hardware and office & computing machinery predominantly contribute to the complementarity city networks. In contrast, a distinct synergy city network, underpinned by the cities of Suzhou and Dongguan, emerges amidst the expansive complementarity structures in technology hardware and equipment. These findings provide new insights into the relational dynamics and structural configurations of city networks in the context of technology-intensive manufacturing, highlighting the nuanced interplay between synergy and complementarity.

Keywords: city system, complementarity, synergy network, higher-order network

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Authors: Maria Vargas Hernandez, Jose Rojas Suarez, Carmelo Dueñas Castell, Sandra Contreras, Camilo Bello, Diana Borre, Walter Anichiarico, Harold Vasquez, Eduard Perez, Jose Santacruz

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In the last two decades, there have been outbreaks of emerging infectious diseases, with an impact on both the general population and the obstetric population. These infections, which affect the general population, pose a high risk for adverse maternal and perinatal outcomes, taking into account that physiological and immunological changes that occur during pregnancy can increase their risk or severity. Among these, the pandemics of viral infections, Influenza A/H1N1 and SARS-CoV-2/COVID-19, stand out. In 2009, Influenza A/H1N1 infection (H1N1 2009pdm) affected approximately 3,110 obstetric patients, with data reported from 29 countries, including 1,625 (52.3%) cases that were hospitalized, 378 (23.3%) admissions to ICU and 130 (8%) deaths; and since the end of 2019, the Severe Acute Respiratory Syndrome - 2 (SARS-CoV-2) has been identified, causing the COVID-19 pandemic, with global mortality that is around 2-4% for the general population, and higher mortality in patients requiring admission to the intensive care unit. Its impact on the obstetric population is still unknown. Objectives: To evaluate the impact on maternal and perinatal outcomes of COVID-19 infection in reference to influenza A/H1N1 infection in the obstetric population. Methodology: Systematic review of the literature and meta-analysis. Results: Mortality from maternal infection with influenza A/H1N1 appears to be higher (8%) than mortality due to maternal infection with COVID-19 (3%). The rates of ICU admission, hospitalization, the requirement for invasive mechanical ventilation, and fetal death also appear to be higher in the maternal population with A/H1N1 infection, in reference to the maternal population with COVID-19 infection. Within perinatal outcomes, the admission to the neonatal ICU appears to be higher in the infants born to mothers with COVID-19 infection (28% vs. 15% for COVID-19 and A/H1N1, respectively). Conclusion: A/H1N1 infection in the obstetric population seems to be associated with a higher proportion of adverse outcomes in relation to COVID-19 infection. The actual impact of maternal influenza A/H1N1 infection on perinatal outcomes is unknown. More COVID-19 studies are needed to understand the impact of maternal infection on perinatal outcomes in this population.

Keywords: A/H1N1, COVID-19, maternal outcomes, perinatal outcomes

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Authors: Evgeny A. Rybakov, Dmitry P. Starikov

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This article contains information about creating special unit for scanning 3D objects different nature, different materials, for example plastic, plaster, cardboard, wood, metal and etc. The main part of the unit is infrared transducer, which is sends the wave to the object and receive back wave for calculating distance. After that, microcontroller send to PC data, and computer program create model for printing from the plastic, gypsum, brass, etc.

Keywords: clutch, infrared, microcontroller, plastic, shaft, stage

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Authors: Wynne De Jong, Robert Miller, Ross Riggs

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

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

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Authors: Arup Dutta, Badrul Alam, Sayed M. Wazed, Taslima Newaz, Srobonti Dutta

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Background: In today's world, with modern science and contemporary technology, a lot of diseases may be quickly identified and ruled out, but children's fever of unknown origin (FUO) still presents diagnostic difficulties in clinical settings. Any fever that reaches 38 °C and lasts for more than seven days without a known cause is now classified as a fever of unknown origin (FUO). Despite tremendous progress in the medical sector, fever of unknown origin, or FOU, persists as a major health issue and a major contributor to morbidity and mortality, particularly in children, and its spectrum is sometimes unpredictable. The etiology is influenced by geographic location, age, socioeconomic level, frequency of antibiotic resistance, and genetic vulnerability. Since there are currently no known diagnostic algorithms, doctors are forced to evaluate each patient one at a time with extreme caution. A persistent fever poses difficulties for both the patient and the doctor. This prospective observational study was carried out in a Bangladeshi tertiary care hospital from June 2018 to May 2019 with the goal of identifying the epidemiological patterns of fever of unknown origin in pediatric patients. Methods: It was a hospital-based prospective observational study carried out on 106 children (between 2 months and 12 years) with prolonged fever of >38.0 °C lasting for more than 7 days without a clear source. Children with additional chronic diseases or known immunodeficiency problems were not allowed. Clinical practices that helped determine the definitive etiology were assessed. Initial testing included a complete blood count, a routine urine examination, PBF, a chest X-ray, CRP measurement, blood cultures, serology, and additional pertinent investigations. The analysis focused mostly on the etiological results. The standard program SPSS 21 was used to analyze all of the study data. Findings: A total of 106 patients identified as having FUO were assessed, with over half (57.5%) being female and the majority (40.6%) falling within the 1 to 3-year age range. The study categorized the etiological outcomes into five groups: infections, malignancies, connective tissue conditions, miscellaneous, and undiagnosed. In the group that was being studied, infections were found to be the main cause in 44.3% of cases. Undiagnosed cases came in at 31.1%, cancers at 10.4%, other causes at 8.5%, and connective tissue disorders at 4.7%. Hepato-splenomegaly was seen in people with enteric fever, malaria, acute lymphoid leukemia, lymphoma, and hepatic abscesses, either by itself or in combination with other conditions. About 53% of people who were not diagnosed also had hepato-splenomegaly at the same time. Conclusion: Infections are the primary cause of PUO (pyrexia of unknown origin) in children, with undiagnosed cases being the second most common cause. An incremental approach is beneficial in the process of diagnosing a condition. Non-invasive examinations are used to diagnose infections and connective tissue disorders, while invasive investigations are used to diagnose cancer and other ailments. According to this study, the prevalence of undiagnosed diseases is still remarkable, so extensive historical analysis and physical examinations are necessary in order to provide a precise diagnosis.

Keywords: children, diagnostic challenges, fever of unknown origin, pediatric fever, undiagnosed diseases

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Authors: Dhruveshi B. Rana, Nirav P. Vaghela, Jigar N. Mehta

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Objective: To assess the relationships among age, gender, anthropometrics and dynamic balance in 5 to 12 years of children in Anand city. Method: Cross-sectional study was conducted. 150 school going children of 5-12 (75-girls, 75-boys) years were recruited from the school of the Anand city-Shivam English Medium school, Veer Vithalbhai Patel school, Adarsh Primary school. Height, weight, arm length, and foot length were measured in 150 children of 5 to 12 years. Dynamic balance was assessed using Time Up and Go Test, Functional Reach Test, Pediatric Balance Scale. Results: Positive relationship (r = 0.58 and r= 0.77) were found between increasing age and FRT and PBS scores. A negative relationship (r = - 0.46) was observed between age of boys and TUG test. Significant gender by age group difference was observed in FRT. Arm length and height has the strongest influence on FRT, and age, height, foot length; and arm length has the strongest influence on PBS. Conclusions: Age and arm length have the strongest relationship with the dynamic balance (FRT, PBS). Dynamic balance ability is directly related to the age. It helps the pediatric therapists in selecting dynamic balance test according to the age.

Keywords: age, gender, anthropometric, dynamic balance

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Authors: Zied Guidara, Alexander Morgenstern, Aref Maalej

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In this paper, a new desiccant solar unit for air conditioning and desalination is presented first. Secondly, a dynamic modelling study of the desiccant wheel is developed. After that, a simulation study and an experimental investigation of the behaviour of the desiccant wheel are developed. The experimental investigation is done in the chamber of commerce in Freiburg-Germany. Indeed, the variations of calculated and measured temperatures and specific humidity of dehumidified and rejected air are presented where a good agreement is found when comparing the model predictions with experimental data under the considered range of operating conditions. Finally, the study of the compartments of desalination and water condensation shows that the unit can produce an acceptable quantity of water at the same time of the air conditioning operation.

Keywords: air conditioning, desalination, condensation, design, desiccant wheel, modelling, experimental investigation

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Authors: Honey Bryant, Elvina Chu

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Stroke is the leading cause of disability in adults in Canada and directly related to depression, anxiety, and sleep disorders; with an estimated annual cost of $50 billion in health care. Strokes not only impact the individual but society as a whole. Current stroke rehabilitation does not include Music Therapy, although it has success in clinical research in the use of stroke rehabilitation. This study examines the use of neurologic music therapy (NMT) in conjunction with stroke rehabilitation to improve sleep quality, reduce stress levels, and promote neurogenesis. Existing research on NMT in stroke is limited, which means any conclusive information gathered during this study will be significant. My novel hypotheses are a.) stroke patients will become less depressed and less anxious with improved sleep following NMT. b.) NMT will reduce stress levels and promote neurogenesis in stroke patients admitted for rehabilitation. c.) Beneficial effects of NMT will be sustained at least short-term following treatment. Participants were recruited from the in-patient stroke rehabilitation program at Providence Care Hospital in Kingston, Ontario, Canada. All participants-maintained stroke rehabilitation treatment as normal. The study was spilt into two groups, the first being Passive Music Listening (PML) and the second Neurologic Music Therapy (NMT). Each group underwent 10 sessions of intensive music therapy lasting 45 minutes for 10 consecutive days, excluding weekends. Psychiatric Assessments, Epworth Sleepiness Scale (ESS), Hospital Anxiety & Depression Rating Scale (HADS), and Music Engagement Questionnaire (MusEQ), were completed, followed by a general feedback interview. Physiological markers of stress were measured through blood pressure measurements and heart rate variability. Serum collections reviewed neurogenesis via Brain-derived neurotrophic factor (BDNF) and stress markers of cortisol levels. As this study is still on-going, a formal analysis of data has not been fully completed, although trends are following our hypotheses. A decrease in sleepiness and anxiety is seen upon the first cohort of PML. Feedback interviews have indicated most participants subjectively felt more relaxed and thought PML was useful in their recovery. If the hypothesis is supported, larger external funding which will allow for greater investigation of the use of NMT in stroke rehabilitation. As we know, NMT is not covered under Ontario Health Insurance Plan (OHIP), so there is limited scientific data surrounding its uses as a clinical tool. This research will provide detailed findings of the treatment of neuropsychiatric aspects of stroke. Concurrently, a passive music listening study is being designed to further review the use of PML in rehabilitation as well.

Keywords: music therapy, psychotherapy, neurologic music therapy, passive music listening, neuropsychiatry, counselling, behavioural, stroke, stroke rehabilitation, rehabilitation, neuroscience

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Authors: Chukwuka Justus Iwegbu

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Background: A major concern facing the world is providing senior citizens, individuals with disabilities, and other vulnerable groups with high-quality care. This issue is more serious in Nigeria's North Eastern area, where the burden of disease and disability is heavy, and access to care is constrained. This study aims to fill this gap by exploring the roles, challenges and support needs of caregivers, care home management, funding and administration in challenged communities in North Eastern Nigeria. The study will also provide a comprehensive understanding of the current situation and identify opportunities for improving the quality of care and support for caregivers and care recipients in these communities. Methods: A mixed-methods design, including both quantitative and qualitative data collection methods, will be used, and it will be guided by the stress process model of caregiving. The qualitative stage approach will comprise a survey, In-depth interviews, observations, and focus group discussion and the quantitative analysis will be used in order to comprehend the variations between caregiver's roles and care home management. A review of relevant documents, such as care home policies and funding reports, would be used to gather quantitative data on the administrative and financial aspects of care. The data collected will be analyzed using both descriptive statistics and thematic analysis. A sample size of around 200-300 participants, including caregivers, care recipients, care home managers and administrators, policymakers and health care providers, would be recruited. Findings: The study revealed that caregivers in challenged communities in North Eastern Nigeria face significant challenges, including lack of training and support, limited access to funding and resources, and high levels of burnout. Care home management and administration were also found to be inadequate, with a lack of clear policies and procedures and limited oversight and accountability. Conclusion: There is a need for increased investment in training and support for caregivers, as well as a need for improved care home management and administration in challenged communities in North Eastern Nigeria. It also highlights the importance of involving community members in decision-making and planning processes related to care homes and services. The study would contribute to the existing body of knowledge by providing a detailed understanding of the challenges faced by caregivers, care home managers and administrators.

Keywords: caregivers, care home management, funding, administration, challenge communities, North Eastern Nigeria

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Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

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Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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Authors: N. Uaphongsathorn, C. Worawong, S. Thaewpia

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Background and significance: The population is aging in Thai society, the elderly dependent is at great risk of various functional, psychological, and socio-economic problems as well as less access to health care. They may require long term care at home to maximize their functional abilities and activities of daily living and to improve their quality of life during their own age. Therefore, there is a need to develop a home-based long term care to meet the long term care needs of elders dependent. Methods: The research purpose was to develop long term care model among the elderly dependent in Chaiyaphum province in Northeast region of Thailand. Action Research which is composing of planning, action, observation, and reflection phases was used. Research was carried out for 12 months in all sub-districts of 6 districts in Chaiyaphum province. Participants (N = 1,010) participating in the processes of model development were comprised of 3 groups: a) a total of 110 health care professionals, b) a total of 600 health volunteers and family caregivers and c) a total of 300 the elderly dependent with chronically medical illnesses or disabilities. Descriptive statistics and content analysis were used to analyze data. Findings: Results have shown that the most common health problems among elders dependent with physical disabilities to function independently were cardiovascular disease, dementia, and traffic injuries. The development of home-based long term care model among elders dependent in Chaiyaphum province was composed of six key steps. They are: a) initiating policies supporting formal and informal caregivers for the elder dependent in all sub-districts, b) building network and multidisciplinary team, c) developing 3-day care manager training program and 3-day care provider training program d) training case managers and care providers for the elderly dependent through team and action learning, e) assessing, planning and providing care based on care individual’s needs of the elderly dependent, and f) sharing experiences for good practice and innovation for long term care at homes in district urban and rural areas. Among all care managers and care providers, the satisfaction level for training programs was high with a mean score of 3.98 out of 5. The elders dependent and family caregivers addressed that long term care at home could contribute to improving life’s daily activities, family relationship, health status, and quality of life. Family caregivers and volunteers have feeling a sense of personal satisfaction and experiencing providing meaningful care and support for elders dependent. Conclusion: In conclusion, a home-based long term care is important to Thai elders dependent. Care managers and care providers play a large role and responsibility to provide appropriate care to meet the elders’ needs in both urban and rural areas in Thai society. Further research could be rigorously studied with a larger group of populations in similar socio-economic and cultural contexts.

Keywords: elderly people, care manager, care provider, long term care

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Authors: Jadwiga Klukow, Anna Ksykiewicz-Dorota

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An analysis of the distribution of nurses’ working time constitutes vital information for the management in planning employment. The objective of the study was to analyze the distribution of nurses’ working time in an emergency department. The study was conducted in an emergency department of a teaching hospital in Lublin, in Southeast Poland. The catalogue of activities performed by nurses was compiled by means of continuous observation. Identified activities were classified into four groups: Direct care, indirect care, coordination of work in the department and personal activities. Distribution of nurses’ working time was determined by work sampling observation (Tippett) at random intervals. The research project was approved by the Research Ethics Committee by the Medical University of Lublin (Protocol 0254/113/2010). On average, nurses spent 31% of their working time on direct care, 47% on indirect care, 12% on coordinating work in the department and 10% on personal activities. The most frequently performed direct care tasks were diagnostic activities – 29.23% and treatment-related activities – 27.69%. The study has provided information on the complexity of performed activities and utilization of nurses’ working time. Enhancing the effectiveness of nursing actions requires working out a strategy for improved management of the time nurses spent at work. Increasing the involvement of auxiliary staff and optimizing communication processes within the team may lead to reduction of the time devoted to indirect care for the benefit of direct care.

Keywords: emergency nurses, nursing care, workload, work sampling

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Authors: Liesbeth Van Kelst, Jozefiene Jansens

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Background: All care providers within mother and child care are confronted, at some point in their career, with the care for parents who (will) lose or have lost a baby. Obtaining the correct attitude and communicating well during these difficult moments are aspects that many healthcare provides continue to struggle with. Parents still encounter well-intentioned but inappropriate communication from healthcare providers. Aim: To study how communication, both verbal and non-verbal, around the death of a baby during pregnancy, birth, or in the first ten days postnatal was experienced by parents and healthcare providers. Methods: A qualitative study using grounded theory principles was conducted. Data were collected through 22 individual face-to-face in-depth interviews with parents who had lost a baby (n = 12) and intramural caregivers, such as midwives, nurses, gynecologists and neonatologists (n=10). In the first phase, data were analyzed within each group separately (parents and healthcare providers) and in the second phase, findings from both groups were compared and analyzed according to meta-synthesis principles. Results: The themes that emerged from the data demonstrated congruent experiences between the group of the parents and the health care providers. Both strengths and weaknesses in current care were named and suggestions for appropriate communication were formulated. Conclusion: Since most health care providers only occasionally care for parents with a deceased baby, a communication tool can optimize communication between healthcare professionals and parents who lose a baby. This is very important as the words which are said at this difficult period last a lifetime in the heads of parents.

Keywords: communication, death, perinatal loss, stillbirth

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Authors: Rosemary Saunders, Courtney Glass, Karla Seaman, Karen Gullick, Julie Andrew, Anne Wilkinson, Ashwini Davray

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Current literature demonstrates that most Australians receive end-of-life care in a hospital setting, despite most hoping to die within their own home. The necessity for high quality end-of-life care has been emphasised by the Australian Commission on Safety and Quality in Health Care and the National Safety and Quality in Health Services Standards depict the requirement for comprehensive care at the end of life (Action 5.20), reinforcing the obligation for continual organisational assessment to determine if these standards are suitably achieved. Limited research exploring clinical staff perspectives of end-of-life care delivery has been conducted within an Australian private health context. This study aimed to investigate clinical staff member perceptions of end-of-life care delivery at a private hospital in Western Australia. The study comprised of a multi-faceted mixed-methods methodology, part of a larger study. Data was obtained from clinical staff utilising surveys and focus groups. A total of 133 questionnaires were completed by clinical staff, including registered nurses (61.4%), enrolled nurses (22.7%), allied health professionals (9.9%), non-palliative care consultants (3.8%) and junior doctors (2.2%). A total of 14.7% of respondents were palliative care ward staff members. Additionally, seven staff focus groups were conducted with physicians (n=3), nurses (n=26) and allied health professionals including social workers (n=1), dietitians (n=2), physiotherapists (n=5) and speech pathologists (n=3). Key findings from the surveys highlighted that the majority of staff agreed it was part of their role to talk to doctors about the care of patients who they thought may be dying, and recognised the importance of communication, appropriate training and support for clinical staff to provide quality end-of-life care. Thematic analysis of the qualitative data generated three key themes: creating the setting which highlighted the importance of adequate resourcing and conducive physical environments for end-of-life care and to support staff and families; planning and care delivery which emphasised the necessity for collaboration between staff, families and patients to develop care plans and treatment directives; and collaborating in end-of-life care, with effective communication and teamwork leading to achievable care delivery expectations. These findings contribute to health professionals better understanding of end-of-life care provision and the importance of collaborating with patients and families in care delivery. It is crucial that health care providers implement strategies to overcome gaps in care, so quality end-of-life care is provided. Findings from this study have been translated into practice, with the development and implementation of resources, training opportunities, support networks and guidelines for the delivery of quality end-of-life care.

Keywords: clinical staff, end-of-life care, mixed-methods, private hospital.

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Authors: Soo-Bi Lee, Jun Young Jeong, Zehgn Lin, Chenminxi

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Background: In South Korea, a problematic phenomenon has recently arisen whereby adult children continue to receive parentalcaregivingin some cases. These phenomena has been shown to affect the mental health of mothers. Study Goals: The purposes of this study are to verify whether the mediating effects of stress on the relationship between a woman’s care burden for their adult children and depression are moderated by their satisfaction about their husbands’ sharing of the caregiving. Methodology: This study analyzed 3,053 married women with adult children using the most recent data from the “Korean Longitudinal Survey of Women & Families 7th(2018)" conducted at the national level. The analysis was conducted using the SPSS Process Macro Model 7 to verify the moderated mediating effects and subsequently confirm their significance based on the bootstrapping method. Results and Implications: (1) Stress was identified a mediating factor in the relationship between the care burden for adult children and depression; and (2) the mediating effects of stress on depression from the burden of caring for adult children are modulated by the woman's satisfaction with her husband’s sharing of the care burden. In other words, the higher the caring burden of adult children, the higher the mother's stress, which increases depression. At this time, the higher the their satisfaction with the husband's share of care in the path of mother's care burden and stress, the lower the mother's stress and, ultimately, the depression be alleviated. Conclusion: Programs that promote the mental health of married women heavily with the caring burden for their adult children, as well as those that improve social awareness regarding husbands' sharing of the care burden, should be implemented. Also, social welfare policy alternatives are needed at the national level to reduce the caring burden caused by adult children.

Keywords: married women, adult children care burden, stress, depression, satisfaction with husbands sharing of the care

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Authors: Phomid Techi, L. N. Padmasini, Mohan Mathew

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Objective: To evaluate the effectiveness of co-parent support on the duration of exclusive breastfeeding by a randomized control trial. Introduction: The current rates of exclusive breastfeeding for 6 months in India is 46% (NFHS3 2008.). The purpose of the study is to evaluate the effectiveness of co-parenting support on duration of exclusive breastfeeding in primi mothers. Design: RCT: Willing parents of healthy TAGA babies born in our hospital were explained about the study purpose and randomly assigned to either trial or control group. The control group was given the usual care. The intervention group received usual care and in addition the trial intervention. Follow-up data was collected at the end of 6 mon. Intervention: Face to face 30-minute discussion in post partum unit on breast feeding benefits, techniques, and problem-solving information followed up by phone calls to mother every 4 weeks to answer questions/concerns. Outcome measures: Duration of exclusive breastfeeding Baseline demographic variables were measured. Results: After obtaining IEC approval a total of 100 couples were recruited, 100 is each group. In the intervention group, the rate of exclusive breastfeeding was 97.2% while in the control group it was 64% (p-value 0.00). Conclusion: Co-parenting support has an important role in promoting exclusive breastfeeding.

Keywords: co-parenting, exclusive breastfeeding, developing nation, randomised control trial

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Authors: Tania Chalton

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In June 2013, an independent review of the Liverpool Care Pathway (LCP) identified a number of problems with the implementation of the LCP in the UK and recommended that it be replaced by individual care plans for each patient. As a result of the UK findings, in November 2013 the Ministry of Health (MOH) commissioned the Palliative Care Council to initiate a programme of work to investigate an appropriate approach for the care of people in their last days of life in New Zealand (NZ). The Last Days of Life Working Group commenced a process to develop national consensus on the care of people in their last days of life in April 2014. In order to develop its advice for the future provision of care to people in their last days of life, the Working Group (WG) established a comprehensive work programme and as a result has developed a series of working papers. Specific areas of focus included: An analysis of the UK Independent Review findings and an assessment of these findings to the NZ context. A stocktake of services providing care to people in their last days of life, including aged residential care (ARC); hospices; hospitals; and primary care. International and NZ literature reviews of evidence and best practice. Survey of family to understand the consumer perspective on the care of people in their last days of life. Key aspects of care that required further considerations for NZ were: Terminology: clarify terminology used in the last days of life and in relation to death and dying. Evidenced based: including specific review of evidence regarding, spiritual, culturally appropriate care as well as dementia care. Diagnosis of dying: need for both guidance around the diagnosis of dying and communication with family. Workforce issues: access to an appropriate workforce after hours. Nutrition and hydration: guidance around appropriate approaches to nutrition and hydration. Symptom and pain management: guidance around symptom management. Documentation: documentation of the person’s care which is robust enough for data collection and auditing requirements, not ‘tick box’ approach to care. Education and training: improved consistency and access to appropriate education and training. Leadership: A dedicated team or person to support and coordinate the introduction and implementation of any last days of life model of care. Quality indicators and data collection: model of care to enable auditing and regular reviews to ensure on-going quality improvement. Cultural and spiritual: address and incorporate any cultural and spiritual aspects. A final document was developed incorporating all the evidence which provides guidance to the health sector on best practice for people at end of life: “Principles and guidance for the last days of life: Te Ara Whakapiri”.

Keywords: end of life, guidelines, New Zealand, palliative care

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Authors: I. Stathopoulos, V. Syrgiamiotis, E. Karavasilis, A. Ploussi, I. Nikas, C. Hatzigiorgi, K. Platoni, E. P. Efstathopoulos

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Introduction: Brain and central nervous system (CNS) tumors form the second most common group of cancer in children, accounting for 30% of all childhood cancers. MRI is the key imaging technique used for the visualization and management of pediatric brain tumors. Initial characterization of tumors from MRI scans is usually performed via a radiologist’s visual assessment. However, different brain tumor types do not always demonstrate clear differences in visual appearance. Using only conventional MRI to provide a definite diagnosis could potentially lead to inaccurate results, and so histopathological examination of biopsy samples is currently considered to be the gold standard for obtaining definite diagnoses. Machine learning is defined as the study of computational algorithms that can use, complex or not, mathematical relationships and patterns from empirical and scientific data to make reliable decisions. Concerning the above, machine learning techniques could provide effective and accurate ways to automate and speed up the analysis and diagnosis for medical images. Machine learning applications in radiology are or could potentially be useful in practice for medical image segmentation and registration, computer-aided detection and diagnosis systems for CT, MR or radiography images and functional MR (fMRI) images for brain activity analysis and neurological disease diagnosis. Purpose: The objective of this study is to provide an automated tool, which may assist in the imaging evaluation and classification of brain neoplasms in pediatric patients by determining the glioma type, grade and differentiating between different brain tissue types. Moreover, a future purpose is to present an alternative way of quick and accurate diagnosis in order to save time and resources in the daily medical workflow. Materials and Methods: A cohort, of 80 pediatric patients with a diagnosis of posterior fossa tumor, was used: 20 ependymomas, 20 astrocytomas, 20 medulloblastomas and 20 healthy children. The MR sequences used, for every single patient, were the following: axial T1-weighted (T1), axial T2-weighted (T2), FluidAttenuated Inversion Recovery (FLAIR), axial diffusion weighted images (DWI), axial contrast-enhanced T1-weighted (T1ce). From every sequence only a principal slice was used that manually traced by two expert radiologists. Image acquisition was carried out on a GE HDxt 1.5-T scanner. The images were preprocessed following a number of steps including noise reduction, bias-field correction, thresholding, coregistration of all sequences (T1, T2, T1ce, FLAIR, DWI), skull stripping, and histogram matching. A large number of features for investigation were chosen, which included age, tumor shape characteristics, image intensity characteristics and texture features. After selecting the features for achieving the highest accuracy using the least number of variables, four machine learning classification algorithms were used: k-Nearest Neighbour, Support-Vector Machines, C4.5 Decision Tree and Convolutional Neural Network. The machine learning schemes and the image analysis are implemented in the WEKA platform and MatLab platform respectively. Results-Conclusions: The results and the accuracy of images classification for each type of glioma by the four different algorithms are still on process.

Keywords: image classification, machine learning algorithms, pediatric MRI, pediatric oncology

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Authors: Huang Chiung Chiu

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This article is about the nursing experience of assisting an outpatient with premature menopause, osteoporosis and sarcopenia through a multi-discipline care model. The nursing period is from September 22nd, 2020, to December 7th, 2020, collecting data through interviews with the patient, observation, and physical assessment. It was found that the main health problems were insufficient nutrition, less physical need, insomnia, and potentially dangerous falls. As an outpatient nurse, the author observed that in recent years, the age group of women with premature menopause, osteoporosis and sarcopenia had shifted downward. Integrated multi-disciplinary interventions were provided upon the initial diagnosis of osteoporosis and sarcopenia. Under the outpatient care setting, the collaborative team works between the doctors, nutritionists, osteoporosis educators, rehabilitates, physical therapists and other specialized teams were applied to provide individualized, integrated multi-disciplinary care. Through empathy and the establishment of attentive care, companionship and trust, we discussed care plans and treatment guidelines with the case, providing accurate, complete disease information and feedback education to strengthen the patient’s knowledge and motivation for exercise. Nursing guidance regarding the dietary nutrition and adjustment of daily routine was provided to increase the self-care ability, improve the health problems of muscle weakness and insomnia, and prevent falls. For patients with postmenopausal osteoporosis and sarcopenia, it is recommended that the nurses coordinate the multi-discipline integrated care model, adjust patients’ lifestyle and diet, and establish a regular exercise plan so that the cases can be evaluated holistically to improve the quality of care and physical and mental comfort.

Keywords: multi-discipline care model, premature menopause, osteoporosis, sarcopenia, insomnia

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