Search results for: CARE Model

Authors: Lorho Mary Maheo, Arundhati Maibam Devi

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Background: Maternal and child health (MCH) cares are the health services provided to mothers and children. It includes the health promotion, preventive, curative and rehabilitation health care for mothers and children. Materials and method: The present study sample comprises of 208 women within the age range 15-69 years from two remote villages of Tamenglong District in Manipur. They were randomly chosen for assessing their health as well as the child’s health adopting an interview schedule method. Results: The findings of the study revealed that majority (80%) of the women have their first conception in their first year of married life. A decadal change has been observed with regard to the last pregnancy i.e., antenatal check-up, place of delivery as well as the service provider. However, irrespective of age of the women, home delivery is still preferred though very few are locally trained. Pre- and post-delivery resting period vary depending on the busy schedule of the agricultural works as the population under study is basically agriculturist. Postnatal care remains to be traditional as they are strongly associated with cultural beliefs and practices that continue to prevail in the studied community. Breast feeding practices such as colostrums given, initiation of breastfeeding, weaning was all taken into account.  Immunization of children has not reached the expected target owing to a variety of reasons. Maternal health care also includes use of birth control measures. The health status of women would invariably improve if family planning is meaningfully adopted. Only 10.1% of the women adopted the modern birth control implying its deep-rooted value attached to the children. Based on the self-assessment report on their health treatment a good number of the respondents resorted to self-medication even to the extent of buying allopathic medicine without a doctor’s prescription. One important finding from the study is the importance attributed to the traditional health care system which is easily affordable and accessible to the villagers. Conclusion: The overall condition of maternal and child care is way behind till now as no adequate/proper health services are available.

Keywords: antenatal, breastfeeding, child health, maternal, Tamenglong District

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Authors: Cornelius Ehlers, Lisa Harmatiuk, Sharon Rowland, Michelle Shafers

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The objective of the Street Connect program is to provide client-centered care for the homeless population within the City of Red Deer. The program aims to provide an extended continuum of care (addiction, mental health, and physical health) for high acuity homeless individuals who are not connected to a service provider and/or community service agency. Street Connect includes both primary and secondary streams of service: Overall, Street Connect has demonstrated its ability to support vulnerable populations within the City of Red Deer, specifically those who are homeless and seeking addiction, mental health, and medical assistance. The results from the data extract and chart audit reflect the complexity and vulnerability of the clients enrolled in the Street Connect program. The clients were predominantly male, with an average age of 41 years. The majority did not have a permanent address, and 65% did not have employment. Substance abuse/addiction issues were common, combined with a history of psychiatric diagnoses and previous mental health hospitalizations. The most utilized drugs were street drugs such as methamphetamine, fentanyl, and other opioids.

Keywords: client-centred care, homelessness, mental health, rural

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Authors: Jiwan Kumar, Pooja, Sandeep Negi, Anjum Rouf, Amit Kumar, Naveen Lakra

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In modern times where, health issues are increasing day by day, breast cancer is also one of them, which is very crucial and really important to find in the early stages. Doctors can use this model in order to tell their patients whether a cancer is not harmful (benign) or harmful (malignant). We have used the knowledge of machine learning in order to produce the model. we have used algorithms like Logistic Regression, Random forest, support Vector Classifier, Bayesian Network and Radial Basis Function. We tried to use the data of crucial parts and show them the results in pictures in order to make it easier for doctors. By doing this, we're making ML better at finding breast cancer, which can lead to saving more lives and better health care.

Keywords: Bayesian network, radial basis function, ensemble learning, understandable, data making better, random forest, logistic regression, breast cancer

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Authors: Ayman M. Mansour

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In this paper, we propose an intelligent system that is used for monitoring the health conditions of Patients. Monitoring the health condition of Patients is a complex problem that involves different medical units and requires continuous monitoring especially in rural areas because of inadequate number of available specialized physicians. The proposed system will Improve patient care and drive costs down comparing to the existing system in Jordan. The proposed system will be the start point to Faster and improve the communication between different units in the health system in Jordan. Connecting patients and their physicians beyond hospital doors regarding their geographical area is an important issue in developing the health system in Jordan. The propose system will provide an intelligent system that will generate initial diagnosing to the patient case. This will assist and advice clinicians at the point of care. The decision is based on demographic data and laboratory test results of patient data. Using such system with the ability of making medical decisions, the quality of medical care in Jordan and specifically in Tafial is expected to be improved. This will provide more accurate, effective, and reliable diagnoses and treatments especially if the physicians have insufficient knowledge.

Keywords: GSM, SMS, patient, monitoring system, fuzzy logic, multi-agent system

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Authors: Mekroud Amel

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Emergency departments are known for the workload, the variety of pathologies and the difficulties in their management with the continuous influx of patients The role of our service in the management of patients with two or three mild to moderate organ failures, involving several disciplines at the same time, as well as the effect of this management on the skills and efficiency of our team has been demonstrated Borderline cases between two or three or even more disciplines, with instability of a vital function, which have been successfully managed in the emergency room, the therapeutic procedures adopted, the consequences on the quality and level of care delivered by our team, as well as that the logistical consequences, and the pedagogical consequences are demonstrated. The consequences found are Positive on the emergency teams, in rare situations are negative Regarding clinical situations, it is the entanglement of hemodynamic distress with right, left or global participation, tamponade, low flow with acute pulmonary edema, and/or state of shock With respiratory distress with more or less profound hypoxemia, with haematosis disorder related to a bacterial or viral lung infection, pleurisy, pneumothorax, bronchoconstrictive crisis. With neurological disorders such as recent stroke, comatose state, or others With metabolic disorders such as hyperkalaemia renal insufficiency severe ionic disorders with accidents with anti vitamin K With or without septate effusion of one or more serous membranes with or without tamponade It’s a Retrospective, monocentric, descriptive study Period 05.01.2022 to 10.31.2022 the purpose of our work: Search for a statistically significant link between the type of moderate to severe pathology managed in the emergency room whose problems are multivisceral on the efficiency of the healthcare team and its level of care and optional care offered for patients Statistical Test used: Chi2 test to prove the significant link between the resolution of serious multidisciplinary cases in the emergency room and the effectiveness of the team in the management of complicated cases Search for a statistically significant link : The management of the most difficult clinical cases for organ specialties has given general practitioner emergency teams a great perspective and has been able to improve their efficiency in the face of emergencies received

Keywords: emergency care teams, management of patients with dysfunction of more than one organ, learning curve, quality of care

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Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

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The translation of healthcare technologies is an expensive, complex affair, current healthcare challenges in Asian countries and their efforts to meet Millennium Development Goals (MDGs), necessitates continuous technology advancement to save countless lives, improve the quality of life and for socio-economic development. India’s consistently improving global innovation index (57) demonstrates its innovation potential, but access to health care is asymmetric and lacks priority in India. Therefore, there is utmost need of a robust translation system for point-of-care (POC) solutions, inexpensive, low-maintenance, reliable, and easy-to-use diagnostic technologies. Few cases of POC technologies viz. Elisa based diagnostic kits for regional viral disease, a device for detection of cancerous lesions were studied to understand the process and challenges involved in their translation. Accordingly, the entire translation ecosystem was summarized proposing a nexus of various actors such as technology developer, technology transferor technology receiver, funding entities, government/regulatory bodies and their effect on translation of different medical technologies. This study highlights the role and concerns pertaining to these actors for POC such as unsystematic and unvalidated research roadmap, low profit preposition, unfocused approach of up-scaling, low market acceptability and multiple window regulatory framework, etc. This provides an opportunity to devise solutions to overcome problem areas in translation path.

Keywords: healthcare technologies, point-of-care solutions, public health, translation

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Authors: Le Kang

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According to the nature of the university, as a free and responsible academic community, USR is based on a different foundation —academic responsibility, so the Pyramid and the IC Model of CSR could not fully explain the most distinguished feature of USR. This paper sought to put forward a new model— Ferris Wheel Model, to illustrate the nature of USR and the process of achievement. The Ferris Wheel Model of USR shows the university creates a balanced, fairness and neutrality systemic structure to afford social responsibilities; that makes the organization could obtain a synergistic effect to achieve more extensive interests of stakeholders and wider social responsibilities.

Keywords: USR, achievement model, ferris wheel model, social responsibilities

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Authors: Jessie Fazel, Kristen Smith

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Human trafficking is a multi-billion-dollar criminal industry that affects 24.9 million people around the world. There are several different types of trafficking, the most common being sex trafficking, labor trafficking, and domestic servitude. Survival sex is common in the pediatric population, as they engage in sex for food, a place to sleep, or other basic needs. Statistics show that health care workers are at a unique advantage to help identify victims and get them the help they need, as 88% of trafficked victims encounter a health care worker while being trafficked. Unfortunately, victims don’t usually self-identify that they are being trafficked and the situations they face can vary dramatically. It is imperative to remember that traditional red flags are not always present in the pediatric population. Risk factors and red flags with their history and physical exam are one of the best indicators that health care providers need to be vigilant in looking at. There are numerous barriers for disclosure in the healthcare setting. Periods of time before and after disclosure are often emotionally difficult and could be dangerous for the victim. It is extremely important to have a plan in place for intervention if the victim does disclose trafficking. A trauma informed approach to medical and mental health interventions, that focus on safety, are vital in this population. This is happening where you live and you can make a difference in their lives.

Keywords: human trafficking, public health, emergency medicine, sexual health

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Authors: Sharlene Fernandes

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Literature has shed light on the challenges of mothers of children with ASD, one of which involves sacrificing their professional jobs to fulfill the demands of their caregiving roles. However, the voices of the mothers who pursue employment along with caregiving roles have been overlooked. This study aimed to address this issue by exploring the narratives of Employed Mothers of Children with Autism Spectrum Disorder using the Narrative approach to inquiry. Through the view of Feminist Standpoint Theory, this study attempted to understand the role of sociocultural and systemic factors in shaping the lives of mothers. By employing the theoretical lens of Ethics of Care, this study explored how mothers balance care with their employment responsibilities, which are expected to be balanced seamlessly. Through narrative interviews, the study addressed the mothers' narratives on navigating work and caregiving, delving into their interpretations regarding expectations of care. The study gained valuable insights into the nuanced dynamics of employment, caregiving, and gender roles among mothers of children with Autism in the Indian context, implicating the urgent need for organizational policies, enhanced support systems, better quality therapeutic services, and inclusive school developments.

Keywords: Autism Spectrum Disorder, Caregivers, Employed Mothers, India, Narratives

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Authors: Raheel Shakoor Siddiqui, Sanjay Narayana Murthy, Manikandar Srinivas Cheruvu, Kash Akhtar

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Major trauma is a dynamic public health epidemic that is continuously evolving. Major trauma care services rely on multi-disciplinary team input involving highly trained pre and in-hospital critical care teams. Pre-hospital critical care teams (PHCCTs), major trauma centres (MTCs), trauma units, and rehabilitation facilities all form an efficient and organised trauma system. England comprises 27 MTCs funded by the National Health Service (NHS). Major trauma care entails enhanced resuscitation protocols coupled with the expertise of dedicated trauma teams and rapid radiological imaging to improve trauma outcomes. Literature reports a change in the demographic of major trauma as elderly patients (silver trauma) with injuries sustained from a fall of 2 metres or less commonly present to services. Evidence of an increasing population age with multiple comorbidities necessitates treatment within the first hour of injury (golden hour) to improve trauma survival outcomes. Staffing and funding pressures within the NHS have subsequently led to a shortfall of available physician-led PHCCTs. Thus, there is a strong emphasis on targeted research and funding to appropriately deploy resources to deprived areas. This review article will discuss the current English trauma system whilst critically appraising present challenges, identifying insufficiencies, and recommending aims for an improved future trauma system in England.

Keywords: trauma, orthopaedics, major trauma, trauma system, trauma network

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Authors: Nishimwe Clemence, Mchunu Gugu, Mukamusoni Dariya

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Background: Community health workers and extension workers can play an important role in supporting families to adopt health practices, encourage delivery in a health care facility, and ensure time referral of mothers and newborns if needed. Saving the lives of neonates should, therefore, be a significant health outcome in any maternal and newborn health program that is being implemented. Furthermore, about half of a million mothers die from pregnancy-related causes. Maternal and newborn deaths related to the period of postnatal care are neglected. Some authors emphasized that in developing countries, newborn mortality rates have been reduced much more slowly because of the lack of many necessary facility-based and outreach service. The aim of this review was to critically analyze the implementation and integration process of the maternal and newborn health care program by maternal community health workers, into the health care system, in Africa. Furthermore, it aims to reduce maternal and newborn mortality. We addressed the following review question: (1) what process is involved in the implementation and integration of the maternal and newborn health care program by maternal community health workers during antenatal, delivery and postnatal care into health system care in Africa? Methods: The database searched was from Health Source: Nursing/Academic Edition through academic search complete via EBSCO Host. An iterative approach was used to go through Google scholarly papers. The reviewers considered adapted Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidance, and the Mixed Methods Appraisal Tool (MMAT) was used. Synthesis method in integrative review following elements of noting patterns and themes, seeing plausibility, clustering, counting, making contrasts and comparisons, discerning commons and unusual patterns, subsuming particulars into general, noting relations between variability, finding intervening factors and building a logical chain of evidence, using data–based convergent synthesis design. Results: From the seventeen of studies included, results focused on three dimensions inspired by the literature on antenatal, delivery, and postnatal interventions. From this, further conceptual framework was elaborated. The conceptual framework process of implementation and integration of maternal and newborn health care program by maternal community health workers was elaborated in order to ensure the sustainability of community based intervention. Conclusions: the review revealed that the implementation and integration of maternal and newborn health care program require planning. We call upon governments, non-government organizations, the global health community, all stakeholders including policy makers, program managers, evaluators, educators, and providers to be involved in implementation and integration of maternal and newborn health program in updated policy and community-based intervention. Furthermore, emphasis should be placed on competence, responsibility, and accountability of maternal community health workers, their training and payment, collaboration with health professionals in health facilities, and reinforcement of outreach service. However, the review was limited in focus to the African context, where the process of maternal and newborn health care program has been poorly implemented.

Keywords: Africa, implementation of integration, maternal, newborn

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Authors: Irtaza M. Syed, Kaamran Raahemifar

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This paper presents a model predictive control (MPC) of a utility interactive three phase inverter (TPI) for a photovoltaic (PV) system at commercial level. The proposed model uses phase locked loop (PLL) to synchronize TPI with the power electric grid (PEG) and performs MPC control in a dq reference frame. TPI model consists of boost converter (BC), maximum power point tracking (MPPT) control, and a three leg voltage source inverter (VSI). Operational model of VSI is used to synthesize sinusoidal current and track the reference. Model is validated using a 35.7 kW PV system in Matlab/Simulink. Implementation and results show simplicity and accuracy, as well as reliability of the model.

Keywords: model predictive control, three phase voltage source inverter, PV system, Matlab/simulink

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Authors: Yosi Maria Wijaya, Florisma Arista Riti Tegu

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Background: Hypertension in pregnancy can be prevented by controlling the lifestyle. However, the majority of research on this topic has been conducted on lifestyle in women with normal pregnancy. Few studies of lifestyle have focused on Indonesian pregnant women with hypertension. Aim: The purpose of this study is to determine the association of demographic characteristics and the lifestyle of pregnant women who have hypertension. Methods: In this cross-sectional study, 76 women with hypertension during pregnancy were recruited from primary health care, West Java, Indonesia. Inclusion criteria were gestational age ≥ 28 weeks with the blood pressure systole ≥ 140 mmHg and diastole ≥ 90 mmHg. Data were collected using two instruments: demographic data and Health Promoting Life Style Profile (HPLP II). Data were analyzed with descriptive statistic and linear regression analysis. Results: The majority of participants were married, mean age was 27.96 years old (SD=6.77) with the mean of gestational age 33.21 (SD=3.49), most of them unemployed (94.7%) and more than a half participants have an education less than twelve years (59.2%). The total score of lifestyle was 2.44 (SD=0.34), more than a half participants experience unhealthy lifestyle (59.2%). Lifestyle was predicted by income, education years, occupation, and access to health care services, accounting for 20.8% of the total variance. Conclusion: Pregnant women with hypertension with low income, low level of education, non-occupational and hard to access health care services were related to unhealthy lifestyle. Understanding the lifestyle and associated factors contributes to health care providers ability to design effective interventions intended to improve healthy lifestyle among pregnant women with hypertension.

Keywords: demographic characteristics, hypertension, lifestyle, pregnancy

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Authors: M. R. Akshaya, Veena Rao

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Pet population in India is increasing phenomenally owing to the changes in urban lifestyle with increasing number of single professionals, single parents, delayed parenthood etc. The animal companionship as a means of reducing stress levels, deriving emotional support, and unconditional love provided by dogs are a few reasons attributed for increasing pet ownership. The consequence is the booming of the pet care products and dog care centers catering to the different requirements of rearing the pets. Dog care centers quite popular in tier 1 metros of India cater to the requirement of the dog owners providing space for the dogs in absence of the owner. However, it is often reported that the absence of the owner leads to destructive and exploratory behavior issues; the main being the anxiety disorders. In the above context, it becomes imperative for a designer to design dog boarding centers that help in reducing the separation anxiety in dogs keeping in mind the different interior design parameters. An exploratory research with focus group discussion is employed involving a group of dog owners, behaviorists, proprietors of day care as well as boarding centers, and veterinarians to understand their perception on the significance of different interior parameters of color, texture, ventilation, aroma therapy and acoustics as a means of reducing the stress levels in dogs sent to the boarding centers. The data collected is organized as thematic networks thus enabling the listing of the interior design parameters that needs to be considered in designing dog boarding centers. 

Keywords: behavioral response, design parameters, dog boarding centers, interior environment

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Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

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Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

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Authors: Naphaporn Sapsopha

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Aging population has been growing rapidly in Thailand due to several factors – namely, the declining size of the average Thai family, changing family structure, higher survival rates of women, and job migration patterns – there are fewer working-age citizens who are able to care for and support their aging family members. When a family can no longer provide for their elders, the responsibility shifts to the government. Many non-profit institutional care facilities for older adults have already been established, but having such institutions are not enough. In addition to the provisions that a reliable shelter can provide, older adults also need efficient social services, physical wellness, and mental health, all of which are crucial for successful aging. Yet, to date, there is no consensus or a well-accepted definition of what constitutes successful aging. The issue is further complicated by cultural expectations, and the gendered experience of the older adults. These issues need to be better understood to promote effective care and wellness. This qualitative research investigates the relationship between institutional care and successful aging among the institutionalized Thai older adults at a non-profit facility in Bangkok, Thailand. Specifically, it examines: a) How do institutionalized older adults define successful aging?, b) What factors do they believe contribute to successful aging?, and c) Do their beliefs vary by gender? Data was collected using a phenomenological research approach that included focus groups and in-depth interviews using open-ended questions, conducted on 10 institutionalized older adults (5 men and 5 women) ages 60 or over. Interview transcripts were coded and analyzed using grounded theory methodology. The participants aged between 70-91 years old, and they varied in terms of gender, education, occupation, and life background. The results revealed that Thai institutionalized older adults viewed successful aging as a result of multiple interrelated factors: maintaining physical health, good mental and cognitive abilities. Remarkably, the participants identified as successful aging include independence for self-care and financial support, adhering to moral principles and religious practice, seeing the success of their loved ones, and making social contributions to their community. In addition, three primary themes were identified as a coping strategy to age successfully: self-acceptance by being sufficient and satisfied with all aspects of life, preparedness and adaptation for every stage of life, and self-esteem by maintaining their self. These beliefs are shared across gender and age differences. However, participants highlighted the importance of the interrelationship among these attributes similar to the need for a secure environment, the thoughtfulness and social support of institutional care in order to maintain positive attitude and well-being. With highly increased Thai aging population, many of these older adults will find themselves living in the institutional care; therefore, it is important to intensively understand how older adults viewed successful aging, what constituted successful aging and what could be done to promote it. Interventions to enhance successful aging may include meaningful practice and along with an effective coping strategy in order to lead a better quality of life those living in institutional care.

Keywords: institutional care, older adults, self-acceptant, successful aging

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Authors: Amreth Chandrasehar

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Machine Learning (ML) Models are developed and run in production to solve various use cases that help organizations to be more efficient and help drive the business. But this comes at a massive development cost and lost business opportunities. According to the Gartner report, 85% of data science projects fail, and one of the factors impacting this is not paying attention to Model Observability. Model Observability helps the developers and operators to pinpoint the model performance issues data drift and help identify root cause of issues. This paper focuses on providing insights into incorporating model observability in model development and operationalizing it in production.

Keywords: model observability, monitoring, drift detection, ML observability platform

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Authors: Erin C. Rodenburg, Jennifer McWhirter, Andrew Papadopoulos

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Support workers for adults with developmental disabilities promote the care and wellbeing of a historically underserved population. Poor employment training and low work satisfaction for these disability support workers are linked to low productivity, poor quality of care, turnover, and intention to leave employment. Therefore, to improve the lives of those within disability support homes, both client and caregiver, it is vital to determine where improvements to training and support for those providing direct care can be made. The current study aims to explore disability support worker’s perceptions of the training received in their employment at the residential homes, how it prepared them for their role, and where there is room for improvement with the aim of developing recommendations for an improved training experience. Responses were collected from 85 disability support workers across 40 Ontario group homes. Findings suggest most disability support workers within the 40 support homes feel adequately trained in their responsibilities of employment. For those who did not feel adequately trained, the main issues expressed were a lack of standardization in training, a need for more continuous training, and a move away from trial and error in performing tasks to support clients with developmental disabilities.

Keywords: developmental disabilities, disability workers, support homes, training

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Authors: S. A. Sadegh Zadeh, C. Kambhampati

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Mathematical and computational modellings are the necessary tools for reviewing, analysing, and predicting processes and events in the wide spectrum range of scientific fields. Therefore, in a field as rapidly developing as neuroscience, the combination of these two modellings can have a significant role in helping to guide the direction the field takes. The paper combined mathematical and computational modelling to prove a weakness in a very precious model in neuroscience. This paper is intended to analyse all-or-none principle in Hodgkin-Huxley mathematical model. By implementation the computational model of Hodgkin-Huxley model and applying the concept of all-or-none principle, an investigation on this mathematical model has been performed. The results clearly showed that the mathematical model of Hodgkin-Huxley does not observe this fundamental law in neurophysiology to generating action potentials. This study shows that further mathematical studies on the Hodgkin-Huxley model are needed in order to create a model without this weakness.

Keywords: all-or-none, computational modelling, mathematical model, transmembrane voltage, action potential

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Authors: F. Slaven, M. Uys, Y. Erasmus

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The South African National Mental Health Education Programme (SANMHEP) was a National Department of Health (NDoH) initiative to strengthen mental health services in South Africa in collaboration with the Foundation for Professional Development (FPD), SANOFI and the various provincial departments of health. The programme was implemented against the backdrop of a number of challenges in the management of mental health in the country related to staff shortages and infrastructure, the intersection of mental health with the growing burden of non-communicable diseases and various forms of violence, and challenges around substance abuse and its relationship with mental health. The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary and tertiary levels to improve access to services and reduce stigma associated with mental illness. In order for the provisions of the Act to become a reality, and for the journey of mental health patients through the system to improve, sufficient and skilled health care providers are critical. SANMHEP specifically targeted Medical Doctors and Professional Nurses working within the facilities that are listed to conduct 72-hour assessments, as well as District Hospitals. The aim of the programme was to improve the clinical diagnosis and management of mental disorders/conditions and the understanding of and compliance with the Mental Health Care Act and related Regulations and Guidelines in the care, treatment and rehabilitation of mental health care users. The course used a blended-learning approach and trained 1 120 health care providers through 36 workshops between February and November 2019. Of those trained, 689 (61.52%) were Professional Nurses, 337 (30.09%) were Medical Doctors, and 91 (8.13%) indicated their occupation as ‘other’ (of these more than half were psychologists). The pre- and post-evaluation of the face-to-face training sessions indicated a marked improvement in knowledge and confidence level scores (both clinical and legislative) in the care, treatment and rehabilitation of mental health care users by participants in all the training sessions. There was a marked improvement in the knowledge and confidence of participants in performing certain mental health activities (on average the ratings increased by 2.72; or 27%) and in managing certain mental health conditions (on average the ratings increased by 2.55; or 25%). The course also required that participants obtain 70% or higher in their formal assessments as part of the online component. The 337 participants who completed and passed the course scored 90% on average. This illustrates that when participants attempted and completed the course, they did very well. To further assess the effect of the course on the knowledge and behaviour of the trained mental health care practitioners a mixed-method outcome evaluation is currently underway consisting of a survey with participants three months after completion, follow-up interviews with participants, and key informant interviews with department of health officials and course facilitators. This will enable a more detailed assessment of the impact of the training on participants' perceived ability to manage and treat mental health patients.

Keywords: mental health, public health facilities, South Africa, training

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Authors: A. Gonzalez Aguna, J. M. Santamaria Garcia, J. L. Gomez Gonzalez, R. Barchino Plata, M. Fernandez Batalla, S. Herrero Jaen

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Background: Computer Science is a field that transcends other disciplines of knowledge because it allows to support all kinds of physical and mental tasks. Health centres have a greater number and complexity of technological devices and the population consume and demand services derived from technology. Also, nursing education plans have included competencies related to and, even, courses about new technologies are offered to health professionals. However, nurses still limit their performance to the use and evaluation of products previously built. Objective: Develop a teaching-learning methodology for acquiring skills on designing applications for care. Methodology: Blended learning teaching with a group of graduate nurses through official training within a Master's Degree. The study sample was selected by intentional sampling without exclusion criteria. The study covers from 2015 to 2017. The teaching sessions included a four-hour face-to-face class and between one and three tutorials. The assessment was carried out by written test consisting of the preparation of an IEEE 830 Standard Specification document where the subject chosen by the student had to be a problem in the area of care. Results: The sample is made up of 30 students: 10 men and 20 women. Nine students had a degree in nursing, 20 diploma in nursing and one had a degree in Computer Engineering. Two students had a degree in nursing specialty through residence and two in equivalent recognition by exceptional way. Except for the engineer, no subject had previously received training in this regard. All the sample enrolled in the course received the classroom teaching session, had access to the teaching material through a virtual area and maintained at least one tutoring. The maximum of tutorials were three with an hour in total. Among the material available for consultation was an example of a document drawn up based on the IEEE Standard with an issue not related to care. The test to measure competence was completed by the whole group and evaluated by a multidisciplinary teaching team of two computer engineers and two nurses. Engineers evaluated the correctness of the characteristics of the document and the degree of comprehension in the elaboration of the problem and solution elaborated nurses assessed the relevance of the chosen problem statement, the foundation, originality and correctness of the proposed solution and the validity of the application for clinical practice in care. The results were of an average grade of 8.1 over 10 points, a range between 6 and 10. The selected topic barely coincided among the students. Examples of care areas selected are care plans, family and community health, delivery care, administration and even robotics for care. Conclusion: The applied methodology of learning-teaching for the design of technologies demonstrates the success in the training of nursing professionals. The role of expert is essential to create applications that satisfy the needs of end users. Nursing has the possibility, the competence and the duty to participate in the process of construction of technological tools that are going to impact in care of people, family and community.

Keywords: care, learning, nursing, technology

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Authors: Zdravko Trivic, John Chye Fung, Ruzica Bozovic-Stamenovic

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Within the context of rapidly ageing population in Singapore and the pressing demands on both caregivers and care providers, an integrated approach to ageing-friendly and ability-sensitive enabling environment becomes an imperative. This particularly applies to nursing home environments and their immediate surroundings, as they are becoming one of the main available options of long-term care for many senior adults who are unable to age at home. Yet, despite the considerable efforts to break the still predominant clinical approach to eldercare and to introduce more home-like design and person-centric care model, nursing homes keep being stigmatised and perceived as not so desirable environments to grow old in. The challenges are further emphasised by the associated physical, sensorial, psychological and cognitive declines that are the common consequences of ageing. Such declines have an immense impact on almost all aspects of older adults’ daily functioning, including problems with mobility and spatial orientation, difficulties in communication, withdrawal from social interaction, higher level of depression and decreased sense of independence and autonomy. However, typical nursing home designs tend to neglect the full capacities of balanced and carefully integrated multisensory stimuli as active component of care and ability building. This paper outlines part of a larger multi-disciplinary study of six nursing homes in Singapore, with overarching objectives to create new models of supportive nursing home environments that go beyond the clinical care model and encourage community integration with the nursing home settings. The paper focuses on the largely neglected aspects of sensorial comfort and multi-sensorial properties of nursing homes, including both indoor and immediate outdoor spaces (boundaries). The objective was to investigate the sensory rhythms and explore their role in nursing home users’ daily routine and therapeutic capacities. Socio-sensory rhythms were captured and analysed through a combination of on-site sensory recordings of “objective” quantitative sensory data (air temperature and humidity, sound level and luminance) using multi-function environment meter, perceived experienced data, spatial mapping, first-person observations of nursing home users’ activity patterns, and interviews. This was done in addition to employment of available assessment tools, such as Wisconsin Person Directed Care assessment tool, Dementia Quality of Life [DQoL] instrument, and Resident Environment Impact Scale [REIS], as these tools address the issues of sensorial experience insufficiently and selectively. Key findings indicate varied levels of sensory comfort, as well as diversity, intensity, and customisation of multi-sensory conditions within different nursing home spaces. Sensory stimulation is typically concentrated in communal living areas of the nursing homes or in the areas that often provide controlled or limited access, including specifically designed sensory rooms and outdoor green spaces (gardens and terraces). Opportunities for sensory stimulation are particularly limited for bed-bound senior residents and within more functional areas, such as corridors. This suggests that the capacities of nursing home designs to provide more diverse and better integrated pleasant sensory conditions as integrated “therapeutic devices” to build nursing home residents’ physical and mental abilities, encourage activity and improve wellbeing are far from exhausted.

Keywords: ageing-supportive environment, enabling design, multi-sensory assessment, nursing home environment

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Authors: Nana Benma Osei

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

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

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Authors: Ojochenemi J. Onubi, Debbi Marais, Lorna Aucott, Friday Okonofua, Amudha Poobalan

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Background: Obesity is a worldwide epidemic with major health and economic consequences. Pregnancy is a trigger point for the development of obesity, and maternal obesity is associated with significant adverse effects in the mother and child. Nigeria is experiencing a double burden of under- and over-nutrition with rising levels of obesity particularly in women. However, there is scarcity of data on maternal obesity in Nigeria and other African countries. Aims and Objectives: This project aimed at identifying crucial components of potential interventions for maternal obesity in Nigeria. The objectives were to assess the prevalence, effects, and distribution of maternal obesity; knowledge, attitude and practice (KAP) of pregnant women and maternal healthcare providers; and identify existing interventions for maternal obesity in Nigeria. Methodology: A systematic review and meta-analysis were initially conducted to appraise the existing literature on maternal obesity in Africa. Following this, a quantitative questionnaire survey of the KAP of pregnant women and a qualitative interview study of the KAP of Health Care Workers (HCW) were conducted in seven secondary and tertiary hospitals across Nigeria. Quantitative data was analysed using SPSS statistical software, while thematic analysis was conducted for qualitative data. Results: Twenty-nine studies included in the systematic review showed significant prevalence, socio-demographic associations, and adverse effects of maternal obesity on labour, maternal, and child outcomes in Africa. The questionnaire survey of 435 mothers revealed a maternal obesity prevalence of 17.9% among mothers who registered for antenatal care in the first trimester. The mothers received nutrition information from different sources and had insufficient knowledge of their own weight category or recommended Gestational Weight Gain (GWG), causes, complications, and safe ways to manage maternal obesity. However, majority of the mothers were of the opinion that excess GWG is avoided in pregnancy and some practiced weight management (diet and exercise) during pregnancy. For the qualitative study, four main themes were identified: ‘Concerns about obesity in pregnancy’, ‘Barriers to care for obese pregnant women’, ‘Practice of care for obese pregnant women’, and ‘Improving care for obese pregnant women’. HCW expressed concerns about rising levels of maternal obesity, lack of guidelines for the management of obese pregnant women and worries about unintended consequences of antenatal interventions. ‘Barriers’ included lack of contact with obese women before pregnancy, late registration for antenatal care, and perceived maternal barriers such as socio-cultural beliefs of mothers and poverty. ‘Practice’ included anticipatory care and screening for possible complications, general nutrition education during antenatal care and interdisciplinary care for mothers with complications. HCW offered suggestions on improving care for obese women including timing, type, and settings of interventions; and the need for involvement of other stake holders in caring for obese pregnant women. Conclusions: Culturally adaptable/sensitive interventions should be developed for the management of obese pregnant women in Africa. Education and training of mothers and health care workers, and provision of guidelines are some of the components of potential interventions in Nigeria.

Keywords: Africa, maternal, obesity, pregnancy

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Authors: Eeva Wallenius-Nareneva, Tuula Toivanen-Labiad

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Background: Oral health promotion event was organised for forty Afghanistan, Iraqi and Bangladeshi underage asylum seekers in Finland. The invitation to arrange this coaching occasion was accepted in the Degree Programme in Oral Hygiene in Metropolia. The personnel in the reception center found the need to improve oral health among the youngsters. The purpose was to strengthen the health literacy of the boys in their oral self-care and to reduce dental fears. The Finnish studies, especially the terminology of oral health was integrated to coaching with the help of interpreters. Cooperative learning was applied. Methods: Oral health was interactively discussed in four study group sessions: 1. The importance of healthy eating habits; - Good and bad diets, - Regular meals, - Acid attack o Xylitol. 2. Oral diseases − connection to general health; - Aetiology of gingivitis, periodontitis and caries, - Harmfulness of smoking 3. Tools and techniques for oral self-care; - Brushing and inter dental cleaning. 4. Sharing earlier dental care experiences; - Cultural differences, - Dental fear, - Regular check-ups. Results: During coaching deficiencies appeared in brushing and inter dental cleaning techniques. Some boys were used to wash their mouth with salt justifying it by salt’s antiseptic properties. Many brushed their teeth by vertical movements. The boys took feedback positively when a demonstration with model jaws revealed the inefficiency of the technique. The advantages of fluoride tooth paste were advised. Dental care procedures were new and frightening for many boys. Finnish dental care system was clarified. The safety and indolence of the treatments and informed consent were highlighted. Video presentations and the dialog lowered substantially the threshold to visit dental clinic. The occasion gave the students means for meeting patients from different cultural and language backgrounds. The information hidden behind the oral health problems of the asylum seekers was valuable. Conclusions: Learning dental care practices used in different cultures is essential for dental professionals. The project was a good start towards multicultural oral health care. More experiences are needed before graduation. Health education themes should be held simple regardless of the target group. The heterogeneity of the group does not pose a problem. Open discussion with questions leading to the theme works well in clarifying the target group’s knowledge level. Sharing own experiences strengthens the sense of equality among the participants and encourages them to express own opinions. Motivational interview method turned out to be successful. In the future coaching occasions must confirm active participation of everyone. This could be realized by dividing the participants to even smaller groups. The different languages impose challenges but they can be solved by using more interpreters. Their presence ensures that everyone understands the issues properly although the use of plain and sign languages are helpful. In further development, it would be crucial to arrange a rehearsal occasion to the same participants in two/three months’ time. This would strengthen the adaption of self-care practices and give the youngsters opportunity to pose more open questions. The students would gain valuable feedback regarding the effectiveness of their work.

Keywords: cooperative learning, interactive methods, motivational interviewing, oral health promotion, underage asylum seekers

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

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Authors: Wei-Chih Huang, Pei-Lung Chung, Ching-Heng Lin, Hsuan-Chia Yang, Der-Ming Liou

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Background: In-Hospital Cardiac Arrest (IHCA) threaten life of the inpatients, cause serious effect to patient safety, quality of inpatients care and hospital service. Health providers must identify the signs of IHCA early to avoid the occurrence of IHCA. This study will consider the potential association between early signs of IHCA and the essence of patient care provided by nurses and other professionals before an IHCA occurs. The aim of this study is to identify significant associations between nursing interventions and abnormal early evaluation results of IHCA that can assist health care providers in monitoring inpatients at risk of IHCA to increase opportunities of IHCA early detection and prevention. Materials and Methods: This study used one of the data mining techniques called association rules mining to compute associations between nursing interventions and abnormal early evaluation results of IHCA. The nursing interventions and abnormal early evaluation results of IHCA were considered to be co-occurring if nursing interventions were provided within 24 hours of last being observed in abnormal early evaluation results of IHCA. The rule based methods were utilized 23.6 million electronic medical records (EMR) from a medical center in Taipei, Taiwan. This dataset includes 733 concepts of nursing interventions that coded by clinical care classification (CCC) codes and 13 early evaluation results of IHCA with binary codes. The values of interestingness and lift were computed as Q values to measure the co-occurrence and associations’ strength between all in-hospital patient care measures and abnormal early evaluation results of IHCA. The associations were evaluated by comparing the results of Q values and verified by medical experts. Results and Conclusions: The results show that there are 4195 pairs of associations between nursing interventions and abnormal early evaluation results of IHCA with their Q values. The indication of positive association is 203 pairs with Q values greater than 5. Inpatients with high blood sugar level (hyperglycemia) have positive association with having heart rate lower than 50 beats per minute or higher than 120 beats per minute, Q value is 6.636. Inpatients with temporary pacemaker (TPM) have significant association with high risk of IHCA, Q value is 47.403. There is significant positive correlation between inpatients with hypovolemia and happened abnormal heart rhythms (arrhythmias), Q value is 127.49. The results of this study can help to prevent IHCA from occurring by making health care providers early recognition of inpatients at risk of IHCA, assist with monitoring patients for providing quality of care to patients, improve IHCA surveillance and quality of in-hospital care.

Keywords: in-hospital cardiac arrest, patient safety, nursing intervention, association rule mining

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Authors: Muleya Nqobile, Winston Garira

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We presented a compartmental deterministic multi-scale model which encompass internal plant defensive mechanism and pathogen interaction, then we consider nesting the model into the epidemiological model. The objective was to improve our understanding of the transmission dynamics of within host and between host of Guignardia citricapa Kiely. The inflow of infected class was scaled down to individual level while the outflow was scaled up to average population level. Conceptual model and mathematical model were constructed to display a theoretical framework which can be used for predicting or identify disease pattern.

Keywords: epidemiological model, mathematical modelling, multi-scale modelling, immunological model

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Authors: Fatma Refaat Ahmed, Sally Mohamed Farghaly

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Context: Intensive care unit (ICU) nurses often face pressure and constraints in their work, leading to the rationing of care when demands exceed available time and resources. Observations suggest that ICU nurses are frequently distracted from their core nursing roles by non-core tasks. This study aims to provide evidence on ICU nurses' multitasking activities and explore the association between nurses' personal and clinical characteristics and their time allocation. Research Aim: The aim of this study is to quantify the time spent by ICU nurses on multitasking activities and investigate the relationship between their personal and clinical characteristics and time allocation. Methodology: A self-observation form utilizing the "Diary" recording method was used to record the number of tasks performed by ICU nurses and the time allocated to each task category. Nurses also reported on the distractions encountered during their nursing activities. A convenience sample of 60 ICU nurses participated in the study, with each nurse observed for one nursing shift (6 hours), amounting to a total of 360 hours. The study was conducted in two ICUs within a university teaching hospital in Alexandria, Egypt. Findings: The results showed that ICU nurses completed 2,730 direct patient-related tasks and 1,037 indirect tasks during the 360-hour observation period. Nurses spent an average of 33.65 minutes on ventilator care-related tasks, 14.88 minutes on tube care-related tasks, and 10.77 minutes on inpatient care-related tasks. Additionally, nurses spent an average of 17.70 minutes on indirect care tasks per hour. The study identified correlations between nursing time and nurses' personal and clinical characteristics. Theoretical Importance: This study contributes to the existing research on ICU nurses' multitasking activities and their relationship with personal and clinical characteristics. The findings shed light on the significant time spent by ICU nurses on direct care for mechanically ventilated patients and the distractions that require attention from ICU managers. Data Collection: Data were collected using self-observation forms completed by participating ICU nurses. The forms recorded the number of tasks performed, the time allocated to each task category, and any distractions encountered during nursing activities. Analysis Procedures: The collected data were analyzed to quantify the time spent on different tasks by ICU nurses. Correlations were also examined between nursing time and nurses' personal and clinical characteristics. Question Addressed: This study addressed the question of how ICU nurses allocate their time across multitasking activities and whether there is an association between nurses' personal and clinical characteristics and time allocation. Conclusion: The findings of this study emphasize the need for a lean evaluation of ICU nurses' activities to identify and address potential gaps in patient care and distractions. Implementing lean techniques can improve efficiency, safety, clinical outcomes, and satisfaction for both patients and nurses, ultimately enhancing the quality of care and organizational performance in the ICU setting.

Keywords: motion study, ICU nurse, lean, nursing time, multitasking activities

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Authors: Asfa Hussain, Chee Tang, Mien Nguyen

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Introduction: The safe usage of medications is dependent on clear, well-documented prescribing. Medical drug charts should be regularly checked to ensure that they are fit for purpose. Aims: The purpose of this study was to evaluate whether the Isabel Hospice drug charts were effective or prone to medical errors. The aim was to create a comprehensive palliative care drug chart in line with medico-legal guidelines and to minimise drug administration and prescription errors. Methodology: 50 medical drug charts were audited from March to April 2020, to assess whether they complied with medico-legal guidelines, in a hospice within East of England. Meetings were held with the larger multi-disciplinary team (MDT), including the pharmacists, nursing staff and doctors, to raise awareness of the issue. A preliminary drug chart was created, using the input from the wider MDT. The chart was revised and trialled over 15 times, and each time feedback from the MDT was incorporated into the subsequent template. In the midst of the COVID-19 pandemic in September 2020, the finalised drug chart was trialled. 50 new palliative drug charts were re-audited, to evaluate the changes made. Results: Prescribing and administration errors were high prior to the implementation of the new chart. This improved significantly after introducing the new drug charts, therefore improving patient safety and care. The percentage of inadequately documented allergies went down from 66% to 20% and incorrect oxygen prescription from 40% to 16%. The prescription drug-drug interactions decreased by 30%. Conclusion: It is vital to have clear standardised drug charts, in line with medico-legal standards, to allow ease of prescription and administration of medications and ensure optimum patient-centred care. This closed loop audit demonstrated significant improvement in documentation and prevention of possible fatal drug errors and interactions.

Keywords: palliative care, drug chart, medication errors, drug-drug interactions, COVID-19, patient safety

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