Search results for: post-recovery satisfaction

Authors: Armando Cartenì, Ilaria Henke

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The perceived public transport quality is an important driver that influences both customer satisfaction and mobility choices. The competition among transport operators needs to improve the quality of the services and identify which attributes are perceived as relevant by passengers. Among the “traditional” public transport quality attributes there are, for example: travel and waiting time, regularity of the services, and ticket price. By contrast, there are some “non-conventional” attributes that could significantly influence customer satisfaction jointly with the “traditional” ones. Among these, the beauty/aesthetics of the transport terminals (e.g. rail station and bus terminal) is probably one of the most impacting on user perception. Starting from these considerations, the point stressed in this paper was if (and how munch) the travel experience of the overall travel (e.g. how long is the travel, how many transport modes must be used) influences the perception of the public transport quality. The aim of this paper was to investigate the weight of the terminal quality (e.g. aesthetic, comfort and service offered) within the overall travel experience. The case study was the extra-urban Italian bus network. The passengers of the major Italian terminal bus were interviewed and the analysis of the results shows that about the 75% of the travelers, are available to pay up to 30% more for the ticket price for having a high quality terminal. A travel experience effect was observed: the average perceived transport quality varies with the characteristic of the overall trip. The passengers that have a “long trip” (travel time greater than 2 hours) perceived as “low” the overall quality of the trip even if they pass through a high quality terminal. The opposite occurs for the “short trip” passengers. This means that if a traveler passes through a high quality station, the overall perception of that terminal could be significantly reduced if he is tired from a long trip. This result is important and if confirmed through other case studies, will allow to conclude that the “travel experience impact" must be considered as an explicit design variable for public transport services and planning.

Keywords: transportation planning, sustainable mobility, decision support system, discrete choice model, design problem

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Authors: Helen Durgante, Mariana F. Sparremberger, Flavia C. Bernardes, Debora D. DellAglio

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Health promotion programmes for retirees, based on Positive Psychology perspectives for the development of strengths and virtues, demand broadened empirical investigation in Brazil. In the case of evidence-based applied research, it is suggested feasibility studies are conducted prior to efficacy trials of the intervention, in order to identify and rectify possible faults in the design and implementation of the intervention. The aim of this study was to evaluate the feasibility of a multicomponent Positive Psychology programme for health promotion of retirees, based on Cognitive Behavioural Therapy and Positive Psychology perspectives. The programme structure included six weekly group sessions (two hours each) encompassing strengths such as Values and self-care, Optimism, Empathy, Gratitude, Forgiveness, and Meaning of life and work. The feasibility criteria evaluated were: Demand, Acceptability, Satisfaction with the programme and with the moderator, Comprehension/Generalization of contents, Evaluation of the moderator (Social Skills and Integrity/Fidelity), Adherence, and programme implementation. Overall, 11 retirees (F=11), age range 54-75, from the metropolitan region of Porto Alegre-RS-Brazil took part in the study. The instruments used were: Qualitative Admission Questionnaire; Moderator Field Diary; the Programme Evaluation Form to assess participants satisfaction with the programme and with the moderator (a six-item 4-point likert scale), and Comprehension/Generalization of contents (a three-item 4-point likert scale); Observers’ Evaluation Form to assess the moderator Social Skills (a five-item 4-point likert scale), Integrity/Fidelity (a 10 item 4-point likert scale), and Adherence (a nine-item 5-point likert scale). Qualitative data were analyzed using content analysis. Descriptive statistics as well as Intraclass Correlations coefficients were used for quantitative data and inter-rater reliability analysis. The results revealed high demand (N = 55 interested people) and acceptability (n = 10 concluded the programme with overall 88.3% frequency rate), satisfaction with the program and with the moderator (X = 3.76, SD = .34), and participants self-report of Comprehension/Generalization of contents provided in the programme (X = 2.82, SD = .51). In terms of the moderator Social Skills (X = 3.93; SD = .40; ICC = .752 [IC = .429-.919]), Integrity/Fidelity (X = 3.93; SD = .31; ICC = .936 [IC = .854-.981]), and participants Adherence (X = 4.90; SD = .29; ICC = .906 [IC = .783-.969]), evaluated by two independent observers present in each session of the programme, descriptive and Intraclass Correlation results were considered adequate. Structural changes were introduced in the intervention design and implementation methods, as well as the removal of items from questionnaires and evaluation forms. The obtained results were satisfactory, allowing changes to be made for further efficacy trials of the programme. Results are discussed taking cultural and contextual demands in Brazil into account.

Keywords: feasibility study, health promotion, positive psychology intervention, programme evaluation, retirees

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Authors: M. Hirani, M. Devine, O. Obisesan, C. Bryant

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Introduction: The use of four or more implants to support a fixed prosthesis in the edentulous mandible is well documented, with high levels of clinical outcomes recorded. Despite this, the use of three implant-supported fixed prostheses offers the potential to deliver a more cost-effective method of oral rehabilitation in the lower arch, an important consideration given that edentulism is most prevalent in low-income subpopulations. The purpose of this study aimed to evaluate the implant and prosthetic survival rate, changes in marginal bone level, and patient satisfaction associated with a three-implant-supported fixed prosthesis for rehabilitation of the edentulous mandible over a follow-up period of at least one year. Methods: A comprehensive literature search was performed to evaluate studies that met the selection criteria. The information extracted included the study design and population, participant demographics, observation period, loading protocol, and the number of implants placed together with the required outcome measures. Mean values and standard deviations (SD) were calculated using SPSS® (IBM Corporation, New York, USA), and the level of statistical significance across all comparative studies described was set at P < 0.05. Results: The eligible studies included a total of 1968 implants that were placed in 652 patients. The subjects ranged in age from 33-89 years, with a mean of 63.2 years. The mean cumulative implant and prosthetic survival rates were 95.5% and 96.2%, respectively, over a mean follow-up period of 3.25 years. The mean marginal bone loss recorded was 1.04 mm, and high patient satisfaction rates were reported across the studies. Conclusion: Current evidence suggests that a three implant-supported fixed prosthesis for the edentulous mandible is a successful treatment strategy presenting high implant and prosthetic survival rates over the short-to-medium term. Further well-designed controlled clinical trials are required to evaluate longer-term outcomes, with supplemental data correlating implant dimensions and prosthetic design.

Keywords: implants, mandible, fixed, prosthesis

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Authors: Mona Almanasef, Angel Chater, Jane Portlock

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Introduction: A 'flipped classroom' uses technology to shift the traditional lecture outside the scheduled class time and uses the face-to-face time to engage students in interactive activities. Aim of the Study: Assess the feasibility, acceptability, and effectiveness of using the 'flipped classroom' teaching format with MPharm students in two pharmacy schools in the UK: UCL School of Pharmacy and the School of Pharmacy and Biomedical Sciences at University of Portsmouth. Methods: An experimental mixed methods design was employed, with final year MPharm students in two phases; 1) a qualitative study using focus groups, 2) a quasi-experiment measuring knowledge acquisition and satisfaction by delivering a session on rheumatoid arthritis, in two teaching formats: the flipped classroom and the traditional lecture. Results: The flipped classroom approach was preferred over the traditional lecture for delivering a pharmacy practice topic, and it was comparable or better than the traditional lecture with respect to knowledge acquisition. In addition, this teaching approach was found to overcome the perceived challenges of the traditional lecture method such as fast pace instructions, student disengagement and boredom due to lack of activities and/or social anxiety. However, high workload and difficult or new concepts could be barriers to pre-class preparation, and therefore successful flipped classroom. The flipped classroom encouraged learning scaffolding where students could benefit from application of knowledge, and interaction with peers and the lecturer, which might, in turn, facilitate learning consolidation and deep understanding. This research indicated that the flipped classroom was beneficial for all learning styles. Conclusion: Implementing the flipped classroom at both pharmacy institutions was successful and well received by final year MPharm students. Given the attention now being put on the Teaching Excellence Framework (TEF), understanding effective methods of teaching to enhance student achievement and satisfaction is now more valuable than ever.

Keywords: blended learning, flipped classroom, inverted classroom, pharmacy education

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Authors: Nuo Xu, Sijing Chen

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Background: Childbirth is considered a critical traumatic event throughout our lives, positively or negatively impacting the mother's physiology, psychology, and even the whole family. Adverse birth experiences, such as labor pain, anxiety, and fear can negatively impact the mother. Studies had shown that the immersive nature of VR can distract attention from pain and increase focus on interventions for pain relief. However, the existing studies that applied VR to maternal delivery were still in their infancy and showed disparate results, and the small sample size is not representative, so this review analyzed the effects of VR in labor, such as on maternal pain and anxiety, with a view to providing a basis for future applications. Search strategy: We searched Pubmed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wan-Fang database from the building to November 17, 2021. Selection Criteria: Randomized controlled trials (RCTs) that intervened the pregnant women aged 18-35 years with gestational >34 weeks and without complications with VR technology were contained within this review. Data Collection and Analysis: Two researchers completed the study selection, data extraction, and assessment of study quality. For quantitative data we used MD or SMD, and RR (risk ratio) for qualitative data. Random-effects model and 95% confidence interval (95% CI) were used. Main Results: 12 studies were included. Using VR could relieve pain during labor (MD=-1.81, 95% CI (-2.04, -1.57), P< 0.00001) and active period (SMD=-0.41, 95% CI (-0.68, -0.14), P= 0.003), reduce anxiety (SMD=-1.39, 95% CI (-1.99, -0.78), P< 0.00001) and improve satisfaction (RR = 1.32; 95% CI (1.10, 1.59); P = 0.003), but the effect on the duration of first (SMD=-1.12, 95% CI (-2.38, 0.13), P=0.08) and second (SMD=-0.22, 95% CI (-0.67, 0.24), P=0.35) stage of labor was not statistically significant. Conclusions: Compared with conventional care, VR technology can relieve labor pain and anxiety and improve satisfaction. However, extensive experimental validation is still needed.

Keywords: virtual reality, delivery, labor pain, anxiety, meta-analysis, systematic review

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Authors: Afzaal Bashir, Sunaina Afzaal

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Background: Facial contour deformities associated with pigmentary changes are of major concern for plastic surgeons, both being important and difficult in treating such issues. No definite ideal treatment option is available to simultaneously address both the contour defect as well as related pigmentation. Objectives: The aim of the current study is to compare the long-term effects of conventional adipose tissue grafting and ex-vivo expanded Mesenchymal Stem Cells enriched adipose tissue grafting for the treatment of contour deformities with pigmentary changes on the face. Material and Methods: In this study, eighty (80) patients with contour deformities of the face with hyperpigmentation were recruited after informed consent. Two techniques i.e., conventional fat grafting (C-FG) and fat grafts enriched with expanded adipose stem cells (FG-ASCs), were used to address the pigmentation. Both techniques were explained to patients, and enrolled patients were divided into two groups i.e., C-FG and FG-ASCS, per patients’ choice and satisfaction. Patients of the FG-ASCs group were treated with fat grafts enriched with expanded adipose stem cells, while patients of the C-FGs group were treated with conventional fat grafting. Patients were followed for 12 months, and improvement in face pigmentation was assessed clinically as well as measured objectively. Patient satisfaction was also documented as highly satisfied, satisfied, and unsatisfied. Results: Mean age of patients was 24.42(±4.49), and 66 patients were females. The forehead was involved in 61.20% of cases, the cheek in 21.20% of cases, the chin in 11.20% of cases, and the nose in 6.20% of cases. In the GF-ASCs group, the integrated color density (ICD) was decreased (1.08×10⁶ ±4.64×10⁵) as compared to the C-FG group (2.80×10⁵±1.69×10⁵). Patients treated with fat grafts enriched with expanded adipose stem cells were significantly more satisfied as compared to patients treated with conventional fat grafting only. Conclusion: Mesenchymal stem cell-enriched autologous fat grafting is a preferred option for improving the contour deformities related to increased pigmentation of face skin.

Keywords: hyperpigmentation, color density, enriched adipose tissue graft, fat grafting, contour deformities, Image J

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Authors: Amira Abdulrazzaq

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This paper is studying the opinion of faculty members and students about the future of education (e-learning) at the University of Bahrain. Through quantitative analysis a distribution of two surveys, one targeting students of IT College, and College of Arts and the other targeting Faculty members of both Colleges. Through the above survey, the paper measures the following factors: awareness and acceptance, satisfaction, usability, and usefulness. Results indicate positive reactions of all above factors.

Keywords: e-learning, education, moodle, WebCT

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Authors: Betsy Hannam

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Background: Staff nurses felt overwhelmed to learn new skills or complete competencies during their shift. Med/Surg units need to provide dedicated, uninterrupted time to complete training and mandatory competencies and practice skills. Purpose: To improve nurse satisfaction and competence by creating a Skills Day with uninterrupted time to complete competencies, brush up on skills, and evaluate skills learned through pre- and post-tests. Methods: The USL and CNL interviewed nurses to obtain input regarding skills needing reinforcement and included mandatory competencies relevant to Med/Surg to create the Skills Day agenda. Content experts from multiple disciplines were invited to educate staff to help address knowledge gaps. To increase attendance, multiple class days were offered. Results: 2018 Skills Day was held for an inpatient unit with 95% participation (n=35 out of 37RNs). The average pretest score, comprised of content questions from topics discussed, was 57%, and post test scoresaveraged 80%. 94% of test scores improved or remained the same. RNs were given an evaluation at the end of the day, where100% of staff noted Skills Day as beneficial, and 97% requested to repeat next year. Another Med/Surg unit asked to join Skills Day in 2019. In 2019, with 89% participation (n=57 out 64 RNs), the average pretest score was 68%, and the average post test score was 85%. 97% of scores improved or remained the same. 98% reported the class as beneficial, and 96% requested to repeat next year. Skills Day 2020-2022 on hold due to COVID. Looking forward to Skills Day 2023. Conclusion: Skills Day allows nurses to maintain competencies and improve knowledge in areas of interest without the stress of a patient assignment. Having unit leaders organize Skills Day, with the involvement of content experts from multiple disciplines, showed to be a successful and innovative team approach to support professional development.

Keywords: education, competency, skills day, medical/surgical

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Authors: Afaf Manzoor, Abdul Hameed

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Children with hearing impairment face several challenges in accessing primary and secondary education in general and higher education in particular in Pakistan. A large number of these children are excluded from formal education system through segregated special institutions. The enrollment rate of these children at school level is very low and it continues decreasing as they move on the ladder of education. Negligible number of students with hearing impairment gets any chance to be enrolled at tertiary or higher education institutes. The segregated system of education at primary and secondary level makes it even more difficult to adjust in an inclusive classroom at a higher level not only for students with hearing impairment but for their teachers and peers as well. A false belief of teachers and parents about low academic profile of students with hearing impairment is one of the major challenges to overcome for their participation at higher education. This case study was conducted to document an innovative step taken by the Department of Special Education Needs, University of Management & Technology, Lahore Pakistan. The prime objective of this study was to assess the satisfaction level of students with hearing impairment in BS 4 Years and MA Special Education programs at Lahore campus. Structured interviews were of 40 students with hearing impairment to assess the satisfaction on service delivery (admission process, classroom pedagogy, content, assessment/results, access to other services centers i.e. library, cafeteria, hostel, co-curricular activities) and campus life. Their peers without disabilities were also interviewed to assess their acceptance level. The findings of the study revealed positive results about their educational as well as social inclusion in the university. The students also shared their fears at the time of admission and how fear eventually faded out with the passage of time due to the proper academic support system. The findings of the study will be shared in detail with the audience during the presentation.

Keywords: students with hearing impairment, higher education, inclusive education, marginalization

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Authors: Jingjing Yan, Gengen He, Anahid Basiri

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The design of an indoor navigation system for fire evacuation support requires not only physical feasibility but also a relatively thorough consideration of the human factors. This study has taken a survey to investigate the fire response performances (FRP) of the indoor occupants in age of 20s, virtually in an environment for their routine life, focusing on the aspects of indoor familiarity (spatial cognition), psychological stress and decision makings. For indoor familiarity, it is interested in three factors, i.e., the familiarity to exits and risky places as well as the satisfaction degree of the current indoor sign installation. According to the results, males have a higher average familiarity with the indoor exits while both genders have a relatively low level of risky place awareness. These two factors are positively correlated with the satisfaction degree of the current installation of the indoor signs, and this correlation is more evident for the exit familiarity. The integration of the height factor with the other two indoor familiarity factors can improve the degree of indoor sign satisfaction. For psychological stress, this study concentrates on the situated cognition of moving difficulty, nervousness, and speed reduction when using a bending posture during the fire evacuation to avoid smoke inhalation. The results have shown that both genders have a similar mid-level of hardness sensation. The females have a higher average level of nervousness, while males have a higher average level of speed reduction sensation. This study has assumed that the growing indoor spatial cognition can help ease the psychological hardness and nervousness. However, it only seems to be true after reaching a certain level. When integrating the effects from indoor familiarity and the other two psychological factors, the correlation to the sensation of speed change can be strengthened, based on a stronger positive correlation with the integrated factors. This study has also investigated the participants’ attitude to the navigation support during evacuation, and the majority of the participants have shown positive attitudes. For following the guidance under some extreme cases, i.e., changing to a longer path and to an alternative exit, the majority of the participants has shown the confidence of keeping trusting the guidance service. These decisions are affected by the combined influences from indoor familiarity, psychological stress, and attitude of using navigation service. For the decision time of the selected extreme cases, it costs more time in average for deciding to use a longer route than to use an alternative exit, and this situation is more evident for the female participants. This requires further considerations when designing a personalized smartphone-based navigation app. This study has also investigated the calming factors for people being trapped during evacuation. The top consideration is the distance to the nearest firefighters, and the following considerations are the current fire conditions in the surrounding environment and the locations of all firefighters. The ranking of the latter two considerations is very gender-dependent according to the results.

Keywords: fire response performances, indoor spatial cognition, situated cognition, survey analysis

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Authors: Chalermsri Sorasit, Siriporn Mongkhonthawornchai, Darawan Augsornwan, Sudthanom Kamollirt

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Background: Although knowledge of pain and pain management is improving, they are still inadequate to patients. The Nursing Division of Srinagarind Hospital is responsible for setting the pain management system, including work instruction development and pain management indicators. We have developed an information technology program for monitoring pain quality indicators, which was implemented to all nursing departments in April 2013. Objective: To study outcomes of acute pain management in process and outcome indicators. Method: This is a retrospective descriptive study. The sample population was patients who had acute pain 24-48 hours after receiving a procedure, while admitted to Srinagarind Hospital in 2014. Data were collected from the information technology program. 2709 patients with acute pain from 10 Nursing Departments were recruited in the study. The research tools in this study were 1) the demographic questionnaire 2) the pain management questionnaire for process indicators, and 3) the pain management questionnaire for outcome indicators. Data were analyzed and presented by percentages and means. Results: The process indicators show that nurses used pain assessment tool and recorded 99.19%. The pain reassessment after the intervention was 96.09%. The 80.15% of the patients received opioid for pain medication and the most frequency of non-pharmacological intervention used was positioning (76.72%). For the outcome indicators, nearly half of them (49.90%) had moderate–severe pain, mean scores of worst pain was 6.48 and overall pain was 4.08. Patient satisfaction level with pain management was good (49.17%) and very good (46.62%). Conclusion: Nurses used pain assessment tools and pain documents which met the goal of the pain management process. Patient satisfaction with pain management was at high level. However the patients had still moderate to severe pain. Nurses should adhere more strictly to the guidelines of pain management, by using acute pain guidelines especially when pain intensity is particularly moderate-high. Nurses should also develop and practice a non-pharmacological pain management program to continually improve the quality of pain management. The information technology program should have more details about non-pharmacological pain techniques.

Keywords: outcome, pain management, acute pain, Srinagarind Hospital

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Authors: Jeongil Kim

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The present study examined the effects of arts-mediated mother-child dyads mindfulness-based intervention for Korean children with attention deficit hyperactivity disorder (ADHD) and their mothers, on behaviors in children and subjective psychological states in mothers. Four elementary school boys with ADHD and their mothers participated in the study. Using a multiple baseline design across four mother-child dyads, data were collected on the target behaviors (disruptive behavior, on-task behavior, and compliance in class) in children using a 10-second partial interval recording system and on the subjective psychological states in mothers using four questionnaires (on perceived stress, burnout, mindfulness, and satisfaction with life). The intervention consisted of a) mindfulness training, b) mindfulness practice, and c) mindful management of body and feeling. The arts activities, making a coiled clay pot and Korean traditional music performance, were utilized to facilitate the environment to help each participant to understand the content and progress of the intervention program. The results showed that all four dyads showed improvement in adaptive behaviors in the children (increase in on-task behavior; decrease in disruptive behavior) and positive change in subjective psychological states in the mothers (increase in scores of mindfulness and satisfaction with life; decrease in scores of perceived stress and burnout). The changes in the children’s behaviors and in the mothers’ subjective psychological states were maintained when the intervention was drawn and generalized in novel settings. The results suggest that arts-mediated mother-child dyads mindfulness-based intervention would be a mutual benefiting strategy to support both children with ADHD and their mothers who experience diverse challenges in behavioral and psychological aspects.

Keywords: mindfulness, attention deficit hyperactivity disorder (ADHD), arts-mediated, behavior, psychological well-being, child-mother

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Authors: Siamak Yaghoubi, Vahideh Rashtchi, Marzieh Khezri, Hamid Kayalha, Monadi Hamidfar

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Background and objectives: Effective postoperative pain management in abdominal surgeries, which are painful procedures, plays an important role in reducing postoperative complications and increasing patient’s satisfaction. There are many techniques for pain control, one of which is Patient-Controlled Analgesia (PCA). The aim of this study was to compare the analgesic effects of morphine, paracetamol and ketorolac in the patients undergoing open cholecystectomy, using PCA method. Material and Methods: This randomized controlled trial was performed on 330 ASA (American Society of Anesthesiology) I-II patients ( three equal groups, n=110) who were scheduled for elective open cholecystectomy in Shahid Rjaee hospital of Qazvin, Iran from August 2013 until September 2015. All patients were managed by general anesthesia with TIVA (Total Intra Venous Anesthesia) technique. The control group received morphine with maximum dose of 0.02mg/kg/h, the paracetamol group received paracetamol with maximum dose of 1mg/kg/h, and the ketorolac group received ketorolac with maximum daily dose of 60mg using IV-PCA method. The parameters of pain, nausea, hemodynamic variables (BP and HR), pruritus, arterial oxygen desaturation, patient’s satisfaction and pain score were measured every two hours for 8 hours following operation in all groups. Results: There were no significant differences in demographic data between the three groups. there was a statistically significant difference with regard to the mean pain score at all times between morphine and paracetamol, morphine and ketorolac, and paracetamol and ketorolac groups (P<0.001). Results indicated a reduction with time in the mean level of postoperative pain in all three groups. At all times the mean level of pain in ketorolac group was less than that in the other two groups (p<0.001). Conclusion: According to the results of this study ketorolac is more effective than morphine and paracetamol in postoperative pain control in the patients undergoing open cholecystectomy, using PCA method.

Keywords: analgesia, cholecystectomy, ketorolac, morphine, paracetamol

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Authors: Mohammad Abbas Nejad

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Tuka Sabz service production company (private shares), with more than 30 years of history, is considered as one of the first holding companies of Tuka Foulad, which takes steps in the direction of increasing service quality and customer satisfaction. Manpower supply is one of the most important activities of Tuka Sabz company, in addition to car supply services; light and heavy transportation services; management of entertainment, sports, tourism and accommodation centers; design, creation and maintenance services of land space; preparing, cooking, distributing and serving all kinds of personal and ceremonial foods; design, construction, repair and reconstruction of non-industrial buildings; industrial laundry services; public and industrial cleaning services are also among other activities of Tuka Sabz. This company has a high capacity of specialized and committed human resources as the main pillar of its success and spent most of its years of activity in Mobarakeh steel company as one of the reliable contractors in the field of automotive service contracts, green space, industrial cleaning, management cultural, recreational and tourism places, consulting, maintenance and repair of buildings and facilities, industrial laundry, management of cooking centers and personnel transportation. The final result of this article states that Tuka Sabz company is trying to get the satisfaction of three main groups of stakeholders, i.e., employees, customers, and shareholders, for this purpose, by improving the competence and competence of employees, trying to establish a system of meritocracy and respecting the human status of employees. On the one hand, the implementation of quality management and assurance to employers with the timely and favorable implementation of contracts takes a step in this direction.

Keywords: Mubarakeh steel company, Tuka Sabz company, human resources, industrial laundry services

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Authors: Seema Dutt Bandhu, Yashi Bansal, Tania Moudgil, Barinder Kaur

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Introduction: Scleral perforation during the passage of suture needle is a known complication of strabismus surgery. The present study was conducted to evolve a safe and easy technique of passing the suture needle through the sclera. A scleral tunnel was created with a 26-guage needle through which the suture needle was passed. The rest of the steps of strabismus surgery were carried out as usual. Material and Methods: After taking clearance from the Institutional Ethics Committee, an interventional study was carried out on twenty patients. The scleral tunnel technique was performed on the patients of strabismus after taking written informed consent. Before passing the suture needle through the sclera during strabismus surgery, a tunnel through approximately half the thickness of the sclera was created with the help of a bent 26-gauge needle. The suture needle was then passed through this tunnel. Rest of the steps of the surgery were carried out in the conventional manner. In a control group of same number of patients, the surgery was performed in the conventional method. Both the groups were followed up for any complications. Ease of passing suture and surgeons’ satisfaction with the technique was noted on a 10-point Likert scale. Results: None of the patients in either group suffered from any complications. Four surgeons participated in the study. The average Likert scale score of the surgeons for satisfaction with the technique was 4.5 on a scale of 5. The score for ease of passage of suture needle was 5 on a score of 5. Discussion: Scleral perforation during passing the sutures through the sclera is a known complication of strabismus surgery. Incidence reported is 7.8% It occurs due to inappropriate engagement of the scleral tissue or passage of the suture needle along a wrong axis during the process of passing the suture needle. The needle track technique eases the passage of passing the suture needle through the sclera as the engagement of the scleral tissue can be done with greater control with a 26-guage needle. The surgeons have reported that they are highly satisfied with the technique and they have reported that the technique eased the passage of the suture needle through the sclera.

Keywords: suture, scleral tunnel, strabismus, scleral perforation

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Authors: Cristina Nieves Perdomo Delgado

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The study consists of the design and use of an application for cell phones called “Me Cuido” that consists of remote control of elderly people who live alone with their families. The objective of the study is to analyze the usability of the application by 40-year-olds using the Questionnaire for User Interaction Satisfaction (QUIS) method. The results highlight that the application has a design adapted to the elderly and that it is easy to use and understand.

Keywords: design, assistive technology, elderly people, independence

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Authors: Suyeon Bae, Abimbola Asojo, Denise Guerin, Caren Martin

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Post-occupancy evaluations (POEs) have been recognized for documenting occupant well-being and responses to indoor environmental quality (IEQ) factors such as thermal, lighting, and acoustic conditions. Sustainable Post-Occupancy evaluation survey (SPOES) developed by an interdisciplinary team at a Midwest University provides an evidence-based quantitative analysis of occupants’ satisfaction in office, classroom, and residential spaces to help direct attention to successful areas and areas that need improvement in buildings. SPOES is a self-administered and Internet-based questionnaire completed by building occupants. In this study, employees in three different office buildings rated their satisfaction on a Likert-type scale about 12 IEQ criteria including thermal condition, indoor air quality, acoustic quality, daylighting, electric lighting, privacy, view conditions, furnishings, appearance, cleaning and maintenance, vibration and movement, and technology. Employees rated their level of satisfaction on a Likert-type scale from 1 (very dissatisfied) to 7 (very satisfied). They also rate the influence of their physical environment on their perception of their work performance and the impact of their primary workspaces on their health on a scale from 1 (hinders) to 7 (enhances). Building A is a three-story building that includes private and group offices, classrooms, and conference rooms and amounted to 55,000 square-feet for primary workplace (N=75). Building B, a six-story building, consisted of private offices, shared enclosed office, workstations, and open desk areas for employees and amounted to 14,193 square-feet (N=75). Building C is a three-story 56,000 square-feet building that included classrooms, therapy rooms, an outdoor playground, gym, restrooms, and training rooms for clinicians (N=76). The results indicated that 10 IEQs for Building A except acoustic quality and privacy showed statistically significant correlations on the impact of the primary workspace on health. In Building B, 11 IEQs except technology showed statistically significant correlations on the impact of the primary workspace on health. Building C had statistically significant correlations between all 12 IEQ and the employees’ perception of the impact of their primary workspace on their health in two-tailed correlations (P ≤ 0.05). Out of 33 statistically significant correlations, 25 correlations (76%) showed at least moderate relationship (r ≥ 0.35). For the three buildings, daylighting, furnishings, and indoor air quality IEQs ranked highest on the impact on health. IEQs about vibration and movement, view condition, and electric lighting ranked second, followed by IEQs about cleaning and maintenance and appearance. These results imply that 12 IEQs developed in SPOES are highly related to employees’ perception of how their primary workplaces impact their health. The IEQs in this study offer an opportunity for improving occupants’ well-being and the built environment.

Keywords: post-occupancy evaluation, built environment, sustainability, well-being, indoor air quality

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Authors: S. Jayasinghe, R. B. N. Dissanayake

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Optimization modelling together with the Network models and Linear Programming techniques is a powerful tool in problem solving and decision making in real world applications. This study developed a mathematical model to optimize the net profit by minimizing the transportation cost. This model focuses the transportation among decentralized production plants to a centralized distribution centre and then the distribution among island wide agencies considering the customer satisfaction as a requirement. This company produces basically 9 types of food items with 82 different varieties and 4 types of non-food items with 34 different varieties. Among 6 production plants, 4 were located near the city of Mawanella and the other 2 were located in Galewala and Anuradhapura cities which are 80 km and 150 km away from Mawanella respectively. The warehouse located in the Mawanella was the main production plant and also the only distribution plant. This plant distributes manufactured products to 39 agencies island-wide. The average values and average amount of the goods for 6 consecutive months from May 2013 to October 2013 were collected and then average demand values were calculated. The following constraints are used as the necessary requirement to satisfy the optimum condition of the model; there was one source, 39 destinations and supply and demand for all the agencies are equal. Using transport cost for a kilometer, total transport cost was calculated. Then the model was formulated using distance and flow of the distribution. Network optimization and linear programming techniques were used to originate the model while excel solver is used in solving. Results showed that company requires total transport cost of Rs. 146, 943, 034.50 to fulfil the customers’ requirement for a month. This is very much less when compared with data without using the model. Model also proved that company can reduce their transportation cost by 6% when distributing to island-wide customers. Company generally satisfies their customers’ requirements by 85%. This satisfaction can be increased up to 97% by using this model. Therefore this model can be used by other similar companies in order to reduce the transportation cost.

Keywords: mathematical model, network optimization, linear programming

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Authors: Line Massé, Claire Baudry, Claudia Verret, Marie-France Nadeau, Anne Brault-Labbé

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Little research has been conducted on educational services adapted for twice exceptional students. Within an action research, a cluster grouping was set up in an elementary school in Quebec, bringing together gifted or doubly exceptional (2E) students (n = 11) and students not identified as gifted (n = 8) within a multilevel class (3ᵣ𝒹 and 4ₜₕ years). 2E students had either attention deficit hyperactivity disorder (n = 8, including 3 with specific learning disability) or autism spectrum disorder (n = 2). Differentiated instructions strategies were implemented, including the possibility of progressing at their own pace of learning, independent study or research projects, flexible accommodation, tutoring with older students and the development of socio-emotional learning. A specialized educator also supported the teacher in the class for behavioural and socio-affective aspects. Objectives: The study aimed to assess the impacts of the grouping on all students, their academic motivation, and their socio-emotional adaptation. Method: A mixed method was used, combining a qualitative approach with a quantitative approach. Semi-directed interviews were conducted with students (N = 18, 4 girls and 14 boys aged 8 to 9) and one of their parents (N = 18) at the end of the school year. Parents and students completed two questionnaires at the beginning and end of the school year: the Behavior Assessment System for Children-3, children or parents versions (BASC-3, Reynolds and Kampus, 2015) and the Academic Motivation in Education (Vallerand et al., 1993). Parents also completed the Multidimensional Student Life Satisfaction Scale (Huebner, 1994, adapted by Fenouillet et al., 2014) comprising three domains (school, friendships, and motivation). Mixed thematic analyzes were carried out on the data from the interviews using the N'Vivo software. Related-samples Wilcoxon rank-sums tests were conducted for the data from the questionnaires. Results: Different themes emerge from the students' comments, including a positive impact on school motivation or attitude toward school, improved school results, reduction of their behavioural difficulties and improvement of their social relations. These remarks were more frequent among 2E students. Most 2E students also noted an improvement in their academic performance. Most parents reported improvements in attitudes toward school and reductions in disruptive behaviours in the classroom. Some parents also observed changes in behaviours at home or in the socio-emotional well-being of their children, here again, particularly parents of 2E children. Analysis of questionnaires revealed significant differences at the end of the school year, more specifically pertaining to extrinsic motivation identified, problems of conduct, attention, emotional self-control, executive functioning, negative emotions, functional deficiencies, and satisfaction regarding friendships. These results indicate that this approach could benefit not only gifted and doubly exceptional students but also students not identified as gifted.

Keywords: Cluster grouping, elementary school, giftedness, mixed methods, twice exceptional students

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Authors: Omid Giahi, Ebrahim Darvishi, Mahdi Akbarzadeh

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Introduction: Occupational low back pain (LBP) is one of the most prevalent work-related musculoskeletal disorders in which a lot of risk factors are involved that. The present study focuses on the relation between personal, psycho-social and occupational risk factors and LBP severity in industrial workers. Materials and Methods: This research was a case-control study which was conducted in Kurdistan province. 100 workers (Mean Age ± SD of 39.9 ± 10.45) with LBP were selected as the case group, and 100 workers (Mean Age ± SD of 37.2 ± 8.5) without LBP were assigned into the control group. All participants were selected from various industrial units, and they had similar occupational conditions. The required data including demographic information (BMI, smoking, alcohol, and family history), occupational (posture, mental workload (MWL), force, vibration and repetition), and psychosocial factors (stress, occupational satisfaction and security) of the participants were collected via consultation with occupational medicine specialists, interview, and the related questionnaires and also the NASA-TLX software and REBA worksheet. Chi-square test, logistic regression and structural equation modeling (SEM) were used to analyze the data. For analysis of data, IBM Statistics SPSS 24 and Mplus6 software have been used. Results: 114 (77%) of the individuals were male and 86 were (23%) female. Mean Career length of the Case Group and Control Group were 10.90 ± 5.92, 9.22 ± 4.24, respectively. The statistical analysis of the data revealed that there was a significant correlation between the Posture, Smoking, Stress, Satisfaction, and MWL with occupational LBP. The odds ratios (95% confidence intervals) derived from a logistic regression model were 2.7 (1.27-2.24) and 2.5 (2.26-5.17) and 3.22 (2.47-3.24) for Stress, MWL, and Posture, respectively. Also, the SEM analysis of the personal, psycho-social and occupational factors with LBP revealed that there was a significant correlation. Conclusion: All three broad categories of risk factors simultaneously increase the risk of occupational LBP in the workplace. But, the risks of Posture, Stress, and MWL have a major role in LBP severity. Therefore, prevention strategies for persons in jobs with high risks for LBP are required to decrease the risk of occupational LBP.

Keywords: industrial workers occupational, low back pain, occupational risk factors, psychosocial factors

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Authors: Pauline Calleja, Brooke Alexander

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In 2010 the College of Emergency Nursing Australasia (CENA) undertook sole administration of the Trauma Nursing Program (TNP) across Australia. The original TNP was developed from recommendations by the Review of Trauma and Emergency Services-Victoria. While participant and faculty feedback about the program was positive, issues were identified that were common for industry training programs in Australia. These issues included didactic approaches, with many lectures and little interaction/activity for participants. Participants were not necessarily encouraged to undertake deep learning due to the teaching and learning principles underpinning the course, and thus participants described having to learn by rote, and only gain a surface understanding of principles that were not always applied to their working context. In Australia, a trauma or emergency nurse may work in variable contexts that impact on practice, especially where resources influence scope and capacity of hospitals to provide trauma care. In 2011, a program review was undertaken resulting in major changes to the curriculum, teaching, learning and assessment approaches. The aim was to improve learning including a greater emphasis on pre-program preparation for participants, the learning environment and clinically applicable contextualized outcomes participants experienced. Previously if participants wished to undertake assessment, they were given a take home examination. The assessment had poor uptake and return, and provided no rigor since assessment was not invigilated. A new assessment structure was enacted with an invigilated examination during course hours. These changes were implemented in early 2012 with great improvement in both faculty and participant satisfaction. This presentation reports on a comparison of participant evaluations collected from courses post implementation in 2012 and in 2015 to evaluate if positive changes were sustained. Methods: Descriptive statistics were applied in analyzing evaluations. Since all questions had more than 20% of cells with a count of <5, Fisher’s Exact Test was used to identify significance (p = <0.05) between groups. Results: A total of fourteen group evaluations were included in this analysis, seven CENA TNP groups from 2012 and seven from 2015 (randomly chosen). A total of 173 participant evaluations were collated (n = 81 from 2012 and 92 from 2015). All course evaluations were anonymous, and nine of the original 14 questions were applicable for this evaluation. All questions were rated by participants on a five-point Likert scale. While all items showed improvement from 2012 to 2015, significant improvement was noted in two items. These were in regard to the content being delivered in a way that met participant learning needs and satisfaction with the length and pace of the program. Evaluation of written comments supports these results. Discussion: The aim of redeveloping the CENA TNP was to improve learning and satisfaction for participants. These results demonstrate that initial improvements in 2012 were able to be maintained and in two essential areas significantly improved. Changes that increased participant engagement, support and contextualization of course materials were essential for CENA TNP evolution.

Keywords: emergency nursing education, industry training programs, teaching and learning, trauma education

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Authors: Zhenzhen Xu, Chunfu Shao, Shengyou Wang, Chunjiao Dong

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To improve the satisfaction of residents' travel, this paper analyzes the characteristics and influencing factors of urban residents' travel behavior. First, a Multinominal Logit Model (MNL) model is built to analyze the characteristics of residents' travel behavior, reveal the influence of individual attributes, family attributes and travel characteristics on the choice of travel mode, and identify the significant factors. Then put forward suggestions for policy improvement. Finally, Support Vector Machine (SVM) and Multi-Layer Perceptron (MLP) models are introduced to evaluate the policy effect. This paper selects Futian Street in Futian District, Shenzhen City for investigation and research. The results show that gender, age, education, income, number of cars owned, travel purpose, departure time, journey time, travel distance and times all have a significant influence on residents' choice of travel mode. Based on the above results, two policy improvement suggestions are put forward from reducing public transportation and non-motor vehicle travel time, and the policy effect is evaluated. Before the evaluation, the prediction effect of MNL, SVM and MLP models was evaluated. After parameter optimization, it was found that the prediction accuracy of the three models was 72.80%, 71.42%, and 76.42%, respectively. The MLP model with the highest prediction accuracy was selected to evaluate the effect of policy improvement. The results showed that after the implementation of the policy, the proportion of public transportation in plan 1 and plan 2 increased by 14.04% and 9.86%, respectively, while the proportion of private cars decreased by 3.47% and 2.54%, respectively. The proportion of car trips decreased obviously, while the proportion of public transport trips increased. It can be considered that the measures have a positive effect on promoting green trips and improving the satisfaction of urban residents, and can provide a reference for relevant departments to formulate transportation policies.

Keywords: neural network, travel characteristics analysis, transportation choice, travel sharing rate, traffic resource allocation

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Authors: Michelle W. T. Cheng, Yau Y.

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Hong Kong continues to be ranked as the least affordable housing market in the world, making co-living a feasible alternative in this high-density city. Although the number of co-living residences has increased in Hong Kong, co-living as a housing typology is still a new concept for many. Little research has been conducted on this new housing typology, let alone the co-living experience. To address this gap, this study targeted student residents in university residential halls as it is a more controlled environment (e.g., with established rules and guidelines regarding the use of communal facilitates and housing management) for studying co-living experiences in Hong Kong. To date, no research study has systematically identified anti-social behavior (ASB) in co-living spaces. Since ASB can be influenced by factors such as social norms and individual interpretation, it has an elastic definition that results in different levels of acceptance. Unlike other types of housing, co-living spaces can be potentially more influenced by the neighborhood as residents share more time and space. As a pilot study, this research targeted one university residential hall to examine student co-living experiences. To clarify, the research question is focused on identifying the social factors that impact the residential satisfaction of those who co-living in residential halls. Quantitative data (n=100) were collected via a structured questionnaire to measure the residential environment, including ASB, social neighboring, community attachment, and perceived hall management efficacy. The survey was distributed at the end of the academic year to ensure that respondents had at least one year of first-hand experience living in a co-living space. To gather qualitative data, follow-up focus group interviews were conducted with 16 participants who completed the survey. The semi-structured interviews aimed to elicit the participants' perspectives on their co-living experience. Through analyzing their co-living experiences, the researcher identified factors that affected their residential satisfaction and provided recommendations to enhance their co-living experience.

Keywords: co-living, university residential hall, anti-social behabiour, neighbour relationship, community attachement

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Authors: Allison Streutker, Josephine Tan

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Universities across Canada have experienced unprecedented growth in international student enrollment from across the world. As cultural diversity in Canada and other countries increases, understanding the social support needs of all students is important for providing them with the assistance they need to thrive psychologically and academically. Those from individualistic cultural orientations tend to seek explicit social support, which involves expressly asking for assistance in times of stress. However, those from collectivistic cultural orientations are more likely to seek implicit social support, where encouragement is obtained from spending time among valued social groups without explicitly talking about problems. This study explored whether the relationship between the type of social support needs (implicit or explicit) and psychological and academic functioning might be moderated by cultural orientations (individualistic, collectivistic) among university students. Participants were 110 university students (70 women, 40 men; mean age = 24.8 years, SD = 6.6). They completed the Individualism and Collectivism Scale (ICS), Perceived Stress Scale (PSS), Interpersonal Support Evaluation List (ISEL) which assesses implicit and explicit social support, Satisfaction with Life Scale (SWLS), Scale of Positive and Negative Experience (SPANE) which yields positive and negative experience scores, Flourishing Scale (FS), and reported their grade point average (GPA) as a measure of academic performance. Moderated regression analysis demonstrated that, for those scoring lower on individualism, reporting lower level of implicit support predicted higher levels of perceived stress. For those scoring higher on individualism, lower levels of explicit social support predicted higher levels of perceived stress and a greater number of negative experiences. Generally, higher levels of implicit support were associated with greater satisfaction with life for all students, with the association becoming stronger among students with higher collectivism scores. No other significant findings were found. The results point to the value of considering the cultural orientations of students when designing programs to maintain and improve their sense of well-being.

Keywords: cultural orientation, social support, university students, well-being

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Authors: Hasti Abbasi

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Creative writers have long followed the tradition of romantic exile, looking inward in an attempt to construct new viewpoints through the power of imagination. The writer, who attempts to resist uncertainty and locate her place in the new country through writing, resists creativity itself. For a writer, certain satisfaction can be achieved through producing a creative art away from the anxiety of the sense of dislocation. Dislocation, whether enforced or self-inflicted, could in many ways be a disaster but it could also cultivate a greater creative capacity and be a source of creative expression. This paper will investigate the idea of the creative writer as exiled self through reflections on the relationship between dislocation and writing.

Keywords: dislocation, creative writing, remaking identity, exile literature

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Authors: Alexandria Carey, Angela Starkweather, Ann Horgas, Hwayoung Cho, Jason Beneciuk

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Background/Significance: Over 3.4 million acute axial low back pain (aLBP) cases are treated annually in the United States (US) emergency departments (ED). ED patients with aLBP receive varying verbal and written discharge routine care (RC), leading to ineffective patient self-management. Ineffective self-management increase chronic low back pain (cLPB) transition risks, a chief cause of worldwide disability, with associated costs >$60 million annually. This research addresses this significant problem by evaluating an ED digital pain self-management intervention (EDPSI) focused on improving self-management through improved knowledge retainment, skills, and self-efficacy (confidence) (KSC) thus reducing aLBP to cLBP transition in ED patients discharged with aLBP. The research has significant potential to increase self-efficacy, one of the most potent mechanisms of behavior change and improve health outcomes. Focusing on accessibility and usability, the intervention may reduce discharge disparities in aLBP self-management, especially with low health literacy. Study Questions: This research will answer the following questions: 1) Will an EDPSI focused on improving KSC progress patient self-management behaviors and health status?; 2) Is the EDPSI sustainable to improve pain severity, interference, and pain recurrence?; 3) Will an EDPSI reduce aLBP to cLBP transition in patients discharged with aLBP? Aims: The pilot randomized-controlled trial (RCT) study’s objectives assess the effects of a 12-week digital self-management discharge tool in patients with aLBP. We aim to 1) Primarily assess the feasibility [recruitment, enrollment, and retention], and [intervention] acceptability, and sustainability of EDPSI on participant’s pain self-management; 2) Determine the effectiveness and sustainability of EDPSI on pain severity/interference among participants. 3) Explore patient preferences, health literacy, and changes among participants experiencing the transition to cLBP. We anticipate that EDPSI intervention will increase likelihood of achieving self-management milestones and significantly improve pain-related symptoms in aLBP. Methods: The study uses a two-group pilot RCT to enroll 30 individuals who have been seen in the ED with aLBP. Participants are randomized into RC (n=15) or RC + EDPSI (n=15) and receive follow-up surveys for 12-weeks post-intervention. EDPSI innovative content focuses on 1) highlighting discharge education; 2) provides self-management treatment options; 3) actor demonstration of ergonomics, range of motion movements, safety, and sleep; 4) complementary alternative medicine (CAM) options including acupuncture, yoga, and Pilates; 5) combination therapies including thermal application, spinal manipulation, and PT treatments. The intervention group receives Booster sessions via Zoom to assess and reinforce their knowledge retention of techniques and provide return demonstration reinforcing ergonomics, in weeks two and eight. Outcome Measures: All participants are followed for 12-weeks, assessing pain severity/ interference using the Brief Pain Inventory short-form (BPI-sf) survey, self-management (measuring KSC) using the short 13-item Patient Activation Measure (PAM), and self-efficacy using the Pain Self-Efficacy Questionnaire (PSEQ) weeks 1, 6, and 12. Feasibility is measured by recruitment, enrollment, and retention percentages. Acceptability and education satisfaction are measured using the Education-Preference and Satisfaction Questionnaire (EPSQ) post-intervention. Self-management sustainment is measured including PSEQ, PAM, and patient satisfaction and healthcare utilization (PSHU) requesting patient overall satisfaction, additional healthcare utilization, and pain management related to continued back pain or complications post-injury.

Keywords: digital, pain self-management, education, tool

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Authors: Karima Maazouz, Habib Benlahmer, Naceur Achtaich

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The realization of mobile payments will make possible new and unforeseen ways of convenience and m-commerce. Mobile payment today benefit from technology and trends. NFC technology is creating a new era of contactless mobile payment. the “M-check” is a mobile payment system provides a new way facilitating transaction with high valued payment and enable new m-commerce. The objective of the paper is to propose a new solution for m-payment. The proposed combination of m-check system and NFC offers acceptable security for payment mobile, client’s satisfaction, and simplifies the process payment between clients and merchants.

Keywords: M-payment, NFC, M-check, M-commerce, security

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Authors: Ahmad Alsaber

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This paper aims to understand the intermediary role of the payment platform applications by analyzing the various factors that can influence the desirability of utilizing said payment services in Kuwait, as well as to determine the effect of the presence of different types of payment platforms on the variables of the “Unified Theory of Acceptance and Use of Technology” (UTAUT) model. The UTAUT model's findings will provide an important understanding of the moderating role of payment platform mobile applications. This study will explore the influence of payment platform mobile applications on customer purchase intentions in Kuwait by employing a quantitative survey of 200 local customers. Questions will cover their usage of payment platforms, purchase intent, and overall satisfaction. The information gathered is then analyzed using descriptive statistics and correlation analysis in order to gain insights. The research hopes to provide greater insight into the effect of mobile payment platforms on customer purchase intentions in Kuwait. This research will provide important implications to marketers and customer service providers, informing their strategies and initiatives, as well as offer recommendations to payment platform providers on how to improve customer satisfaction and security. The study results suggest that the likelihood of a purchase is affected by performance expectancy, effort expectancy, social influence, risk, and trust. The purpose of this research is to understand the advancements in the different variables that Kuwaiti customers consider while dealing with mobile banking applications. With the implementation of stronger security measures, progressively more payment platform applications are being utilized in the Kuwaiti marketplace, making them more desirable with their accessibility and usability. With the development of the Kuwaiti digital economy, it is expected that mobile banking will have a greater impact on banking transactions and services in the future.

Keywords: purchase intention, UTAUT, performance expectancy, social influence, risk, trust

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Authors: Rasha Alhendawi

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This research will give the introductory ideas for cultural adaption of B2C E-Service design in Germany. By the intense competition of E-Service development, many companies have realized the importance of understanding the emotional and cultural characteristics of their customers. Ignoring customers’ needs and requirements throughout the E-Service design can lead to faults, mistakes, and gaps. The term of E-Service usability now is changed not only to develop high quality E-Services, but also to be extended to include customer satisfaction and provide for them to feel local.

Keywords: human computer interaction (HCI), usability, cultural usability, E-Services, business-to-consumer (B2C), e-services

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Authors: Magdalena Chrabąszcz, Teresa Wolniewicz, Cezary Maciejewski, Joanna Czuwara

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BACKGROUND: Dermoscopy is a clinical tool known to improve the early detection of melanoma and other malignancies of the skin. Over the past few years melanoma has grown into a disease of socio-economic importance due to the increasing incidence and persistently high mortality rates. Early diagnosis remains the best method to reduce melanoma and non-melanoma skin cancer– related mortality and morbidity. Dermoscopy is a noninvasive technique that consists of viewing pigmented skin lesions through a hand-held lens. This simple procedure increases melanoma diagnostic accuracy by up to 35%. Dermoscopy is currently the standard for clinical differential diagnosis of cutaneous melanoma and for qualifying lesion for the excision biopsy. Like any clinical tool, training is required for effective use. The introduction of small and handy dermoscopes contributed significantly to the switch of dermatoscopy toward a first-level useful tool. Non-dermatologist physicians are well positioned for opportunistic melanoma detection; however, education in the skin cancer examination is limited during medical school and traditionally lecture-based. AIM: The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard fourth year medical curriculum improves the ability of medical students to distinguish between benign and malignant lesions and assess acceptability and satisfaction with the intervention. METHODS: We performed a prospective study in 2 cohorts of fourth-year medical students at Medical University of Warsaw. Groups having dermatology course, were randomly assigned to:  cohort A: with limited access to dermatoscopy from their teacher only – 1 dermatoscope for 15 people  Cohort B: with a full access to use dermatoscopy during their clinical classes:1 dermatoscope for 4 people available constantly plus 15-minute dermoscopy tutorial. Students in both study arms got an image-based test of 10 lesions to assess ability to differentiate benign from malignant lesions and postintervention survey collecting minimal background information, attitudes about the skin cancer examination and course satisfaction. RESULTS: The cohort B had higher scores than the cohort A in recognition of nonmelanocytic (P < 0.05) and melanocytic (P <0.05) lesions. Medical students who have a possibility to use dermatoscope by themselves have also a higher satisfaction rates after the dermatology course than the group with limited access to this diagnostic tool. Moreover according to our results they were more motivated to learn dermatoscopy and use it in their future everyday clinical practice. LIMITATIONS: There were limited participants. Further study of the application on clinical practice is still needed. CONCLUSION: Although the use of dermatoscope in dermatology as a specialty is widely accepted, sufficiently validated clinical tools for the examination of potentially malignant skin lesions are lacking in general practice. Introducing medical students to dermoscopy in their fourth year curricula of medical school may improve their ability to differentiate benign from malignant lesions. It can can also encourage students to use dermatoscopy in their future practice which can significantly improve early recognition of malignant lesions and thus decrease melanoma mortality.

Keywords: dermatoscopy, early detection of melanoma, medical education, skin cancer

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