Search results for: patient management

Authors: Ayami Umemura

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The purpose of this paper is to examine the meaning of verbalization in clinical practice using the keywords silence and singularity. A patient's experience of illness and treatment is singular, irreplaceable, and irreproducible and ultimately cannot be compared with that of others. In his book Difference and Repetition, Gilles Deleuze positioned irreplaceable singularity as the opposite concept of particularity as a generalizable and substitutable property and matched the former with universality. He also said that singularity could not be represented because of its irreplaceable nature. Representation or verbalization is a procedure that converts an irreplaceable, idiosyncratic reality into something that can be substituted. Considering the act of verbalizing medical diagnosis based on this, it can be said that diagnosis is the practice of decontextualizing and generalizing the suffering embedded in the patient's irreplaceable life history as a disease. This paper examines the above with the key concept of the practice of "non-verbalization" in traditional medical practices in Sri Lanka. In the practice of Sri Lankan traditional medicine and the inheritance of medical knowledge and care techniques, there is a tendency to avoid verbalizing specific matters or stating them aloud. Specifically, the following should be avoided. The healer informs the patient of the name of the disease, mentions the name of the herb used in front of the patient, explains the patient's condition to the healer, and referring the names of poisonous animals, such as poisonous snakes that have been damaged. And so on. Furthermore, when passing on medical knowledge and skills, it is also possible to avoid verbalizing knowledge of medicinal herbs and medical treatment methods and explaining them verbally. In addition to the local belief that the soul of language in Sri Lanka is deeply involved in this background, Sri Lankan traditional medicine has a unique view of the human body and personality that is rooted in the singularity that appears in the relationship with the movement of celestial bodies and the supernatural realm. It can be pointed out that it is premised on the view. In other words, the “silence” in Sri Lankan indigenous medicine is the reason for emphasizing specificity. Furthermore, we can say that "non-verbalization" is a practice aimed at healing. Based on these discussions, this paper will focus on the unique relationships between practitioners and patients that become invisible due to verbalization, which is overlooked by clinical medicine, where informed consent, ensuring transparency, and audit culture is dominant. We will examine the experience of treatment and aim to relativize clinical medicine, which is based on audit cultures.

Keywords: audit cultures, indigenous medicine, singularity, verbalization

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Authors: Helga Martins, Idália Matias

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Background: Dementia is an important research topic since that life expectancy worldwide is increasing, so people are getting older. The aging of populations has a major impact on the increase in dementia, and nurses play a major role in taking care of these patients. Therefore, the implementation of nursing interventions based on evidence is vital so that we are aware of what we can do in clinical practice in order to provide patient cantered care to patients with dementia. Aim: To identify the nurse´s interventions in patients with dementia during clinical practice. Method: Literature review grounded on an electronic search in the EBSCOhost platform (CINAHL Plus with Full Text, MEDLINE with Full Text, and Nursing & Allied Health Collection), using the search terms of "dementia" AND "nurs*" AND “interventions” in the abstracts. The inclusion criteria were: original papers published up to June 2021. A total of 153 results after de duplicate removal we kept 104. After the application of the inclusion criteria, we included 15 studies This literature review was performed by two independent researchers. Results: A total of 15 results about nurses’ interventions in patients with dementia were included in the study. The major interventions are therapeutic communication strategies, environmental management of stressors involving family/caregivers; strategies to promote patient safety, and assistance in activities of daily living in patients who are clinically deteriorated. Conclusion: Taking care of people with dementia is a complex and demanding task. Nurses are required to have a set of skills and competences in order to provide nursing interventions. We highlight that is necessary an awareness in nursing education regarding providing nursing care to patients with dementia.

Keywords: dementia, interventions, nursing, review

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Authors: Anmol Patel

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Cardiopulmonary resuscitation is medical intervention which should be considered for all inpatients; with a patient centred approach, open communication and accurate documentation of clinical decisions. National enquiries have shown that in a significant number of cases CPR was attempted when it was considered inappropriate. In these circumstances attempting to prevent a natural death and subjecting a patient to trauma at the end of life would deprive them of a dignified death. Anticipatory “do not attempt CPR (DNACPR)” decisions aim to prevent this for those considered appropriate. As a legal document, these forms are required to be completed accurately and thoroughly. The aim of this study was to evaluate the difference in quality of DNACPR forms completed using electronic versus paper formats. A retrospective review of DNACPR forms and related documentation was completed in two District General Hospitals in South-East England, one of which uses electronic forms, while the other uses paper red forms. 50 completed forms from each hospital were analysed to assess for legibility, and quality of completion of all subsections of the form, including communications with family, relatives and the Multidisciplinary team. The hospital using paper forms showed a 40-44% rate of completion of sections relating to communication with patients and family, compared to 70% with the hospital using electronic forms. Similar trends were observed with other sections of the form. Conclusion: This study suggests that the implementation of electronic DNACPR forms significantly improves clinical practice and promotes better open communication with patients, family and the MDT.

Keywords: DNACPR, resuscitation, DNAR, patient communication

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Authors: L. Hoade, O. O. Onafowokan, K. Anderson, G. E. Bartlett, E. D. Fern, M. R. Norton, R. G. Middleton

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Aims: Femoroacetabular impingement (FAI) was first recognised as a potential driver for hip pain at the turn of the last millennium. While there is an increasing trend towards surgical management of FAI by arthroscopic means, open surgical hip dislocation and debridement (SHD) remains the Gold Standard of care in terms of reported outcome measures. (1) Long-term functional and survivorship outcomes of SHD as a treatment for FAI are yet to be sufficiently reported in the literature. This study sets out to help address this imbalance. Methods: We undertook a retrospective review of our institutional database for all patients who underwent SHD for FAI between January 2003 and December 2008. A total of 223 patients (241 hips) were identified and underwent a ten year review with a standardised radiograph and patient-reported outcome measures questionnaire. The primary outcome measure of interest was survivorship, defined as progression to total hip arthroplasty (THA). Negative predictive factors were analysed. Secondary outcome measures of interest were survivorship to further (non-arthroplasty) surgery, functional outcomes as reflected by patient reported outcome measure scores (PROMS) scores, and whether a learning curve could be identified. Results: The final cohort consisted of 131 females and 110 males, with a mean age of 34 years. There was an overall native hip joint survival rate of 85.4% at ten years. Those who underwent a THA were significantly older at initial surgery, had radiographic evidence of preoperative osteoarthritis and pre- and post-operative acetabular undercoverage. In those whom had not progressed to THA, the average Non-arthritic Hip Score and Oxford Hip Score at ten year follow-up were 72.3% and 36/48, respectively, and 84% still deemed their surgery worthwhile. A learning curve was found to exist that was predicated on case selection rather than surgical technique. Conclusion: This is only the second study to evaluate the long-term outcomes (beyond ten years) of SHD for FAI and the first outside the originating centre. Our results suggest that, with correct patient selection, this remains an operation with worthwhile outcomes at ten years. How the results of open surgery compared to those of arthroscopy remains to be answered. While these results precede the advent of collison software modelling tools, this data helps set a benchmark for future comparison of other techniques effectiveness at the ten year mark.

Keywords: femoroacetabular impingement, hip pain, surgical hip dislocation, hip debridement

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Authors: Angelis P. Barlampas

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Purpose of Learning Objective: This case depicts the need for cooperation between the emergency department and the radiologist to achieve the best diagnostic result for the patient. The clinical picture must correlate well with the radiology report and when it does not, this is not necessarily someone’s fault. Careful interpretation and good knowledge of the limitations, advantages and disadvantages of each imaging procedure are essential for the final diagnostic goal. Methods or Background: A patient was brought to the emergency department by their relatives. He was suddenly confused and his mental status was altered. He hadn't any history of mental illness and was otherwise healthy. A computing tomography scan without contrast was done, but it was unremarkable. Because of high clinical suspicion of probable neurologic disease, he was admitted to the hospital. Results or Findings: Another T was done after 48 hours. It showed a hypodense region in both thalamic areas. Taking into account that the first CT was normal, but the initial clinical picture of the patient was alerting of something wrong, the repetitive CT exam is highly suggestive of a probable diagnosis of bilateral thalamic infractions. Differential diagnosis: Primary bilateral thalamic glioma, Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Wilson disease, Leigh disease, West Nile encephalitis, Greutzfeldt Jacob disease, top of the basilar syndrome, deep venous thrombosis, mild to moderate cerebral hypotension, posterior reversible encephalopathy syndrome, Neurofibromatosis type 1. Conclusion: As is the case of limitations for any imaging procedure, the same applies to CT. The acute ischemic attack can not depict on CT. A period of 24 to 48 hours has to elapse before any abnormality can be seen. So, despite the fact that there are no obvious findings of an ischemic episode, like paresis or imiparesis, one must be careful not to attribute the patient’s clinical signs to other conditions, such as toxic effects, metabolic disorders, psychiatric symptoms, etc. Further investigation with MRI or at least a repeated CT must be done.

Keywords: CNS, CT, thalamus, emergency department

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Authors: Emin Gundogar, Aysegul Yilmaz

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Strategic performance scoring is a significant procedure in management. There are various methods to improve this procedure. This study introduces an information system that is developed to score performance for municipal management. The application of the system is clarified by exemplifying municipal processes.

Keywords: management information system, municipal management, performance scoring

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Authors: Felipa De Mello-Sampayo

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Background: The aim of this study is to undertake, from a patient perspective, an economic analysis of presurgical teledermatology, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e., costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and the opportunity cost of time spent in visits. Method: Patients’ out-of-pocket expenses-effectiveness of presurgical teledermatology were analyzed in the setting of a public hospital during two years. The mean delay in surgery was used to measure effectiveness. The teledermatology network covering the area served by the Hospital Garcia da Horta (HGO), Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits, travel costs, and visits’ fee of each presurgical modality (teledermatology and conventional referral), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated from initial primary care visit until surgical intervention. Two groups of patients: those with squamous cell carcinoma and those with basal cell carcinoma were distinguished in order to compare the effectiveness according to the dermatoses. Results: From a patient perspective, the conventional system was 2.15 times more expensive than presurgical teledermatology. Teledermatology had an incremental out-of-pocket expenses-effectiveness ratio of €1.22 per patient and per day of delay avoided. This saving was greater in patients with squamous cell carcinoma than in patients with basal cell carcinoma. Conclusion: From a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses-effectiveness than the conventional referral system, especially for patients with severe dermatoses.

Keywords: economic analysis, out-of-pocket expenses, opportunity cost, teledermatology, waiting time

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Authors: Bheeshma B., Mathivanan N., Manoj Deepak M., Prabhu Thangaraju, K. Venkatachalam

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This study involves the effect of autologous blood injection for patients who had degeneration of the origin of extensor carpi radialis brevis which was confirmed radio logically and by ultrasound examination and failed cortisone injections to the lateral epicondylitis. In this prospective longitudinal series involves pre-injection assessment of grip strength, pain, and function, using the patient-rated tennis elbow evaluation. In this study, blood from the contralateral limb is taken and injected into the affected limb with the help of ultrasound guidance and then the patient wore a customized wrist support for five days, after which they were commenced with stretching, strengthening, and massage programme with an occupational therapist. In these patients assessment was done after six months and then finally at 12 months after injection, using the patient-rated tennis elbow evaluation. 50 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Our study thus concludes that autologous blood injection show significant improvement in pain and function in patients with chronic lateral epicondylitis, who did not have relief with cortisone injection.

Keywords: lateral epicondylitis, autologous blood injection, conservative treatment, plasma-rich proteins (PRPs)

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Authors: Makda Aamir, Sood Aayushi, Syed Omar, Nihan Khuld, Iskander Peter, Ijaz Naeem, Sharma Nishant

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Introduction:Glycogen Storage Disease Type-1 (GSD-1) is a rare phenomenon primarily affecting the liver and kidney. Excessive accumulation of glycogen and fat in liver, kidney, and intestinal mucosa is noted in patients with deficiency of Glucose-6-phosphatase deficiency. Patients with GSD-1 have a wide spectrum of symptoms, including hepatomegaly, hypoglycemia, lactic acidemia, hyperlipidemia, hyperuricemia, and growth retardation. Age of onset, rate of disease progression and its severity is variable in this disease.Case:An 18-year-old male with GSD-1a, Von Gierke’s disease, hyperuricemia, and hypertension presented to the hospital with nausea and vomiting. The patient followed an hourly cornstarch regimen during the day and overnight through infusion via a PEG tube. The complaints started at work, where he was unable to tolerate oral cornstarch. He washemodynamically stable on arrival. ABG showed pH 7.372, PaCO2 30.3, and PaO2 92.2. WBC 16.80, K+ 5.8, HCO3 13, BUN 28, Cr 2.2, Glucose 60, AST 115, ALT 128, Cholesterol 352, Triglycerides >1000, Uric Acid 10.6, Lactic Acid 11.8 which trended down to 8.0. CT abdomen showed hepatomegaly and fatty infiltration with the PEG tube in place.He was admitted to the ICU and started on D5NS for hypoglycemia and lactic acidosis. Per request by the patient’s pediatrician, he was transitioned to IV D10/0.45NS at 110mL/Hr to maintain blood glucose above 75 mg/L. Frequent accuchecks were done till he could tolerate his dietary regimen with cornstarch. Lactic acid downtrend to 2.9, and accuchecks ranged between 100-110. Cr improved to 1.3, and his home medications (Allopurinol and Lisinopril) were resumed. He was discharged in stable condition with plans for further genetic therapy work up.Discussion:Mainstay therapy for Von Gierke’s Disease is the prevention of metabolic derangements for which dietary and lifestyle changes are recommended. A low fructose and sucrose diet is recommended by limiting the intake of galactose and lactose to one serving per day. Hypoglycemia treatment in such patients is two-fold, utilizing both quick and stable release sources. Cornstarch has been one such therapy since the 1980s; its slow digestion provides a steady release of glucose over a longer period of time as compared with other sources of carbohydrates. Dosing guidelines vary from age to age and person to person, but it is highly recommended to check BG levels frequently to maintain a BG > 70 mg/dL. Associated high levels of triglycerides and cholesterol can be treated with statins, fibrates, etc. Conclusion:The management of hypoglycemia in GSD 1 disease presents various obstacles which could prove to be fatal. Due to the deficiency of G6P, treatment with a specialized hypoglycemic regimen is warranted. A D10 ½ NS infusion can be used to maintain blood sugar levels as well as correct metabolic or lactate imbalances. Infusion should be gradually weaned off after the patient can tolerate oral feeds as this can help prevent the risk of hypoglycemia and other derangements. Further research is needed in regards to these patients for more sustainable regimens.

Keywords: von gierke, glycogen storage disease, hypoglycemia, genetic disease

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Authors: Raghuveer Kaur, Kartikay Sharma, Ashu Khanna

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Earnings management has been present from times immemorial. The recent downfall of giant enterprises like Enron, Satyam and WorldCom has brought a lot of focus on the study and detection of earnings management. The present study is an attempt to study earnings management in one of the fastest emerging economy - India. The study makes an attempt to understand earnings management in different sectors of the economy. The paper first tests a hypothesis to check whether different sectors of India are engaged in earnings management or not. In the later section the paper aims to study the level of earnings management in 6 popular sectors of India: IT&BPO, Retail, Telecom, Biotech, Hotels and coffee. To measure earnings management two popular techniques of detecting earnings management has been employed: Modified Jones Model and Beniesh M Score. A total of 332 companies were studied. Publicly available data from Capitaline database has been used. The paper also classifies the top and bottom five performers on the basis of sales turnover in each sector and identifies whether they manage their earnings or not.

Keywords: earnings management, India, modified Jones model, Beneish M score

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Authors: Anastasia Constantinou, Stephen Morris

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Background: The adoption of synchronous and asynchronous telemedicine modalities for primary care consultations has exponentially increased since the COVID-19 pandemic. However, there is limited understanding of how virtual consultations influence healthcare resource utilization and other quality measures including safety, timeliness, efficiency, patient and provider satisfaction, cost-effectiveness and environmental impact. Aim: Quantify the rate of follow-up visits, emergency department visits, hospitalizations, request for investigations and prescriptions and comment on the effect on different quality measures associated with different telemedicine modalities used for primary care services and primary care referrals to secondary care Design and setting: Systematic review in primary care Methods: A systematic search was carried out across three databases (Medline, PubMed and Scopus) between August and November 2023, using terms related to telemedicine, general practice, electronic referrals, follow-up, use and efficiency and supported by citation searching. This was followed by screening according to pre-defined criteria, data extraction and critical appraisal. Narrative synthesis and metanalysis of quantitative data was used to summarize findings. Results: The search identified 2230 studies; 50 studies are included in this review. There was a prevalence of asynchronous modalities in both primary care services (68%) and referrals from primary care to secondary care (83%), and most of the study participants were females (63.3%), with mean age of 48.2. The average follow-up for virtual consultations in primary care was 28.4% (eVisits: 36.8%, secure messages 18.7%, videoconference 23.5%) with no significant difference between them or F2F consultations. There was an average annual reduction of primary care visits by 0.09/patient, an increase in telephone visits by 0.20/patient, an increase in ED encounters by 0.011/patient, an increase in hospitalizations by 0.02/patient and an increase in out of hours visits by 0.019/patient. Laboratory testing was requested on average for 10.9% of telemedicine patients, imaging or procedures for 5.6% and prescriptions for 58.7% of patients. When looking at referrals to secondary care, on average 36.7% of virtual referrals required follow-up visit, with the average rate of follow-up for electronic referrals being higher than for videoconferencing (39.2% vs 23%, p=0.167). Technical failures were reported on average for 1.4% of virtual consultations to primary care. When using carbon footprint estimates, we calculate that the use of telemedicine in primary care services can potentially provide a net decrease in carbon footprint by 0.592kgCO2/patient/year. When follow-up rates are taken into account, we estimate that virtual consultations reduce carbon footprint for primary care services by 2.3 times, and for secondary care referrals by 2.2 times. No major concerns regarding quality of care, or patient satisfaction were identified. 5/7 studies that addressed cost-effectiveness, reported increased savings. Conclusions: Telemedicine provides quality, cost-effective, and environmentally sustainable care for patients in primary care with inconclusive evidence regarding the rates of subsequent healthcare utilization. The evidence is limited by heterogeneous, small-scale studies and lack of prospective comparative studies. Further research to identify the most appropriate telemedicine modality for different patient populations, clinical presentations, service provision (e.g. used to follow-up patients instead of initial diagnosis) as well as further education for patients and providers alike on how to make best use of this service is expected to improve outcomes and influence practice.

Keywords: telemedicine, healthcare utilisation, digital interventions, environmental impact, sustainable healthcare

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Authors: Merrick Lopez, Aashish Abraham, Melissa Egge, Marissa Hood, Jui Shah

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A 3 year old male with unknown medical history presented initially with encephalopathy, intubated for respiratory failure, and admitted to the pediatric intensive care unit (PICU) with refractory shock. During resuscitation in the emergency department, he was found to be in severe metabolic acidosis with a pH of 7.03 and escalated on vasopressor drips for hypotension. His initial sodium was 174. He was noted to have burn injuries to his scalp, forehead, right axilla, bilateral arm creases and lower legs. He had rhabdomyolysis (initial creatinine kinase 5,430 U/L with peak levels of 62,340 normal <335 U/L), cardiac injury (initial troponin 88 ng/L with peak at 145 ng/L, normal <15ng/L), hypernatremia (peak 174, normal 140), hypocalcemia, liver injury, acute kidney injury, and neuronal loss on magnetic resonance imaging (MRI). Soft restraints and a shock collar were found in the home. He was critically ill for 8 days, but was gradually weaned off drips, extubated, and started on feeds. Discussion Electrical injury, specifically lightning injury is an uncommon but devastating cause of injury in pediatric patients. This patient with suspected abusive use of a dog shock collar presented similar to a lightning strike. Common entrance points include the hands and head, similar to our patient with linear wounds on his forehead. When current enters, it passes through tissues with the least resistance. Nerves, blood vessels, and muscles, have high fluid and electrolyte content and are commonly affected. Exit points are extremities: our child who had circumferential burns around his arm creases and ankles. Linear burns preferentially follow areas of high sweat concentration, and are thought to be due to vaporization of water on the skin’s surface. The most common cause of death from a lightning strike is due to cardiopulmonary arrest. The massive depolarization of the myocardium can result in arrhythmias and myocardial necrosis. The patient presented in cardiogenic shock with evident cardiac damage. Electricity going through vessels can lead to vaporization of intravascular water. This can explain his severe hypernatremia. He also sustained other internal organ injuries (adrenal glands, pancreas, liver, and kidney). Electrical discharge also leads to direct skeletal muscle injury in addition to prolonged muscular spasm. Rhabdomyolysis, the acute damage of muscle, leads to release of potentially toxic components into the circulation which could lead to acute renal failure. The patient had severe rhabdomyolysis and renal injury. Early hypocalcemia has been consistently demonstrated in patients with rhabdomyolysis. This was present in the patient and led to increased vasopressor needs. Central nervous system injuries are also common which can include encephalopathy, hypoxic injury, and cerebral infarction. The patient had evidence of brain injury as seen on MRI. Conclusion Electrical injuries due to lightning strikes and abusive use of a dog shock collar are rare, but can both present in similar ways with respiratory failure, shock, hypernatremia, rhabdomyolysis, brain injury, and multiorgan damage. Although rare, it is essential for early identification and prompt management for acute and chronic complications in these children.

Keywords: cardiogenic shock, dog shock collar, lightning strike, rhabdomyolysis

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Authors: Eda Kocakaya, Sebahat Seker, Dogan Argun

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The aim of this study is to determine the process of information technologies and the connections between concepts in accounting management services in Turkey. The objective of this study is to determine the adaptation and evaluation process of information technologies and the connections between concepts and differences in accounting management services in Turkey. The situation and determination of the IT applications of Accounting Management were studied. The applications of • Billing • Order Processing • Accounts Receivable/Payable Management • Contract Management • Bank Account Management Were discussed in this study. The IT applications were demonstrated and realized in actual accounting services. The sectoral representative's companies were selected, and the IT application was searched by bibliometric analysis.

Keywords: management, accounting, information technologies, adaptation

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Authors: Markus Feufel, Friederike Kendel, Caren Hilger, Selamawit Woldai

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Since the corona pandemic, the use of video consultation has increased remarkably. For vulnerable groups such as oncological patients, the advantages seem obvious. But how does video consultation potentially change the doctor-patient relationship compared to face-to-face consultation? Which barriers may hinder the effective use of this consultation format in practice? We are presenting first results from a mixed-methods field study, funded by Federal Ministry of Health, which will provide the basis for a hands-on guide for both physicians and patients on how to improve the quality of video consultations. We use a quasi-experimental design to analyze qualitative and quantitative differences between face-to-face and video consultations based on video recordings of N = 64 actual counseling sessions (n = 32 for each consultation format). Data will be recorded from n = 32 gynecological and n = 32 urological cancer patients at two clinics. After the consultation, all patients will be asked to fill out a questionnaire about their consultation experience. For quantitative analyses, the counseling sessions will be systematically compared in terms of verbal and nonverbal communication patterns. Relative frequencies of eye contact and the information exchanged will be compared using 𝝌2 -tests. The validated questionnaire MAPPIN'Obsdyad will be used to assess the expression of shared decision-making parameters. In addition, semi-structured interviews will be conducted with n = 10 physicians and n = 10 patients experienced with video consultation, for which a qualitative content analysis will be conducted. We will elaborate the comprehensive methodological approach we used to compare video vs. face-to-face consultations and present first evidence on how video consultations change the doctor-patient interaction. We will also outline possible barriers of video consultations and best practices on how they may be overcome. Based on the results, we will present and discuss recommendations outlining best practices for how to prepare and conduct high-quality video consultations from the perspective of both physicians and patients.

Keywords: video consultation, patient-doctor-relationship, digital applications, technical barriers

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Authors: Rosa L. Figueroa, Joselyn A. Hernández

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During the last couple of years, the Ministry of Health have been developing new health policies in order to regulate and improve in benefit of the patient the pharmaceutical system in our country. However, there are still some deficiencies in how medicines have been accessed, distributed, and sold. Therefore, it is necessary to empower the patient by offering new instances to improve access to drug information. This work introduces ‘the bioequivalent’ a medical drug search tool created to increase both diffusion and getting information about the therapeutic equivalence of medicines for the patient. The development of the search tool started with a study on the availability of sources of drug information accessible to the patient where advantages and disadvantages were analyzed. The information obtained was used to feed the functional design of the new tool. The design of the new tool shows an external interface that includes a header, body, sidebar and footer. The header has a menu containing ‘Home,’ ‘Who we are,’ and ‘Mission and vision.’ The Body contains the medical drug search tool, and the Sidebar is for the user logging in. It could be anonym, registered user, as well as, administrator. Anonym user could only use the tool. Registered users could add some information on existing medicines in the database; however, adding information will be restricted and limited to specific items and subject to administrator approval because the information added must be endorsed by the Chilean Public Health Institute. On the other hand, the administrator will have all the privileges, including creating or deleting drugs or information about them. The Bioequivalent was tested on different mobile devices, and no fails have been found. Moreover, a small survey was answered by ten people who tested the tool, and all of them agree that the tool was useful to get information about bioequivalent drugs, and they would recommend the tool to others. Nevertheless, an 80% of people who tested the tool says it was easy to use, and a 70% indicates that additional help is not required. These results are evidence that ‘the Bioequivalent’ may contribute to the knowledge about the therapeutic bioequivalence and bioequivalent drugs existing in Chile. As future work, the tool will be developed to make it available to the public for a first testing stage in a more massive scenario.

Keywords: collaborative database, bioequivalent drugs, search tool, web platform

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Authors: Rania Mustafa, Anfal Gadour

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Specialty area: Manchester University NHS Foundation Trust, Wythenshawe Hospital Accident and Emergency Department. About, Documentation of verbal and written head injury advice given to all adults presenting following a head injury. Our aim was to assess verbal & written head injury advice for an adult patient attending ED in Wythenshawe hospital during the period from January 2022 to May 2022, with a view to evaluating the NICE head injury guidelines concerning discharge advice and also to review the clinical notes to ensure that all adult patients presenting with a head injury are documented to have received both verbal & written head injury advice as per the NICE guidelines. Here we collected data from a random sample over a 1 month period. This data was furtherly filtered to include the adult patient >16 years and resulted in 54 patients with head injuries attending ED during this time period; then patient’s age, sex and hospital number were used to identify the discharge advice for the purpose of chart review and to assess the documentation of head injuries compliance with recommendation for NICE assessment. Data were checked between January 2022 up to May 2022 to allow more intervals for better assessment. Our finding indicates that documentation of verbal advice, 26% of patients were not recorded to have received this in January compared to only 3% in May & Written advice was not recorded in 44% of patients studied in January compared to 1% in May.

Keywords: head, injuries, advice, leaflets

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Authors: Alexander Kelíšek, Denisa Janasová, Veronika Mitašová

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Weak signals using is often associated with early warning. It is possible to find a link between early warning, respectively early problems detection and risk management. The idea of early warning is very important in the context of crisis management because of the risk prevention possibility. Weak signals are likened to risk symptoms. Nowadays, their usefulness as a tool of proactive problems solving is emphasized. Based on it, it is possible to use weak signals not only in strategic planning, project management, or early warning system, but also as a subsidiary element in risk management. The main question is how to effectively integrate weak signals into risk management. The main aim of the paper is to point out the possibilities of weak signals using in small and medium enterprises risk management.

Keywords: early warning system, weak signals, risk management, small and medium enterprises (SMEs)

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Authors: Pim Terachinda, Witaya Wannasuphoprasit, Wasuwat Kitisomprayoonkul, Anan Srikiatkhachorn

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Restoration of hand function and dexterity remain challenges in rehabilitation after stroke. We have developed soft exoskeleton hand robot in which using tendon-driven mechanism. Finger flexion and extension can be triggered by a foot switch and force can be adjusted manually depending on patient’s grip strength. The objective of this study is to investigate feasibility and safety of this device. The study was done in 2 stroke patients with the strength of the finger flexors/extensors grade 1/0 and 3/1 on Medical Research Council scale, respectively. Grasp and release training was performed for 30 minutes. No complication was observed. Results demonstrated that the device is safe, and therapy can be tailored to individual patient’s need. However, further study is required to determine recovery and rehabilitation outcomes after training in patients after nervous system injury.

Keywords: hand, rehabilitation, robot, stroke

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Authors: Dalila Chaid, Bennameur Fedilli, Mohammed Amine Bellelou

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The study focuses on the experience of lower-limb amputees, who face both physical and psychological challenges due to their disability. Chronic neuropathic pain and various types of limb pain are common in these patients. They often require orthopaedic interventions for issues such as dressings, infection, ulceration, and bone-related problems. Research Aim: The aim of this study is to determine the most suitable anaesthetic technique for lower-limb amputees, which can provide them with the greatest comfort and prolonged analgesia. The study also aims to demonstrate the effectiveness and cost-effectiveness of ultrasound-guided local regional anaesthesia (LRA) in this patient population. Methodology: The study is an observational analytical study conducted over a period of eight years, from 2010 to 2018. It includes a total of 955 cases of revisions performed on lower limb stumps. The parameters analyzed in this study include the effectiveness of the block and the use of sedation, the duration of the block, the post-operative visual analog scale (VAS) scores, and patient comfort. Findings: The study findings highlight the benefits of ultrasound-guided LRA in providing comfort by optimizing post-operative analgesia, which can contribute to psychological and bodily repair in lower-limb amputees. Additionally, the study emphasizes the use of alpha2 agonist adjuvants with sedative and analgesic properties, long-acting local anaesthetics, and larger volumes for better outcomes. Theoretical Importance: This study contributes to the existing knowledge by emphasizing the importance of choosing an appropriate anaesthetic technique for lower-limb amputees. It highlights the potential of ultrasound-guided LRA and the use of specific adjuvants and local anaesthetics in improving post-operative analgesia and overall patient outcomes. Data Collection and Analysis Procedures: Data for this study were collected through the analysis of medical records and relevant documentation related to the 955 cases included in the study. The effectiveness of the anaesthetic technique, duration of the block, post-operative pain scores, and patient comfort were analyzed using statistical methods. Question Addressed: The study addresses the question of which anaesthetic technique would be most suitable for lower-limb amputees to provide them with optimal comfort and prolonged analgesia. Conclusion: The study concludes that ultrasound-guided LRA, along with the use of alpha2 agonist adjuvants, long-acting local anaesthetics, and larger volumes, can be an effective approach in providing comfort and improving post-operative analgesia for lower-limb amputees. This technique can potentially contribute to the psychological and bodily repair of these patients. The findings of this study have implications for clinical practice in the management of lower-limb amputees, highlighting the importance of personalized anaesthetic approaches for better outcomes.

Keywords: neuropathic pain, ultrasound-guided peripheral nerve block, DN4 quiz, EMG

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Authors: Matthew T. McCarthy, Sarah Janse, Natalie M. Pizzimenti, Anthony K. Savino, Brian Crosser, Sean C. Rose

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Concussion is diagnosed clinically using a comprehensive history and exam, supported by ancillary testing. Frequently, symptom checklists are used as part of the evaluation of concussion. Existing symptom scales are based on a subjective Likert scale, without relation of symptoms to clinical or functional impairment. This is a retrospective review of 133 patients under age 30 seen in an outpatient neurology practice within 30 days of a probable or definite concussion. Each patient completed 2 symptom checklists at the initial visit – the SCAT-3 symptom evaluation (22 symptoms, 0-6 scale) and a scale based on the degree of clinical impairment for each symptom (22 symptoms, 0-3 scale related to functional impact of the symptom). Final clearance date was determined by the treating physician. 60.9% of patients were male with mean age 15.7 years (SD 2.3). Mean time from concussion to first visit was 6.9 days (SD 6.2), and 101 patients had definite concussions (75.9%), while 32 were diagnosed as probable (24.1%). 94 patients had a known clearance date (70.7%) with mean clearance time of 20.6 days (SD 18.6) and median clearance time of 19 days (95% CI 16-21). Mean total symptom score was 27.2 (SD 22.9) on the SCAT-3 and 14.7 (SD 11.9) for the functional impairment scale. Pearson’s correlation between the two scales was 0.98 (p < 0.001). After adjusting for patient and injury characteristics, an equivalent increase in score on each scale was associated with longer time to clearance (SCAT-3 hazard ratio 0.885, 95%CI 0.835-0.938, p < 0.001; functional impairment scale hazard ratio 0.851, 95%CI 0.802-0.902, p < 0.001). A concussion symptom scale based on degree of functional impairment correlates strongly with the SCAT-3 scale and demonstrates a similar association with time to clearance. By assessing the degree of impact on clinical functioning, this symptom scale reflects a more intuitive approach to rating symptoms and can be used in the management of concussion.

Keywords: checklist, concussion, neurology, scale, sports, symptoms

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Authors: Mustafa Cam, Nedim Ongun, Ufuk Kutluana

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Introduction: Restless LegsSyndrome (RLS) is a common, under-recognized disorder disrupts sleep and diminishes quality of life (1). The most common conditions highly associated with RLS include renalfailure, iron and folic acid deficiency, peripheral neuropathy, pregnancy, celiacdisease, Crohn’sdiseaseandrarelymalignancy (2).Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficientanemic populations is unknown (2). We report here a case of RLS due to iron deficiency in the setting of neuroendocrinetumor. Report of Case: A 35 year-old man was referred to our clinic with general weakness, weight loss (10 kg in 2 months)and 2-month history of uncomfortable sensations in his legs with urge to move, partially relieved by movement. The symptoms were presented very day, worsening in the evening; the discomfort forced the patient to getup and walk around at night. RLS was severe, with a score of 22 at the International RLS ratingscale. The patient had no past medical history. The patient underwent a complete set of blood analyses and the following ab normal values were found (normal limitswithinbrackets): hemoglobin 9.9 g/dl (14-18), MCV 70 fL (80-94), ferritin 3,5 ng/mL (13-150). Brain and spinemagnetic resonance imaging was normal. The patient consultated with gastroenterology clinic and gastointestinal systemendoscopy was performed for theetiology of the iron deficiency anemia. After the gastricbiopsy, results allowed us to reach the diagnosis of neuroen docrine tumor and the patient referred to oncology clinic. Discussion: The first important consideration from this case report is that the patient was referred to our clinic because of his severe RLS symptoms dramatically reducing his quality of life. However, our clinical study clearly demonstrated that RLS was not the primary disease. Considering the information available for this patient, we believe that the most likely possibility is that RLS was secondary to iron deficiency, a very well-known and established cause of RLS in theliterature (3,4). Neuroendocrine tumors (NETs) are rare epithelial neoplasms with neuroendocrine differentiation that most commonly originate in the lungs and gastrointestinal tract (5). NETs vary widely in their clinical presentation; symptoms are often nonspecific and can be mistaken for those of other more common conditions (6). 50% of patients with reported disease stage have either regional or distant metastases at diagnosis (7). Accurate and earlier NET diagnosis is the first step in shortening the time to optimal care and improved outcomes for patients (8). The most important message from this case report is that RLS symptoms can sometimes be thesign of a life-threatening condition. Conclusion: Careful and complete collection of clinical and laboratory data should be carried out in RLS patients. Inparticular, if RLS onset coincides with weight loss and iron deficieny anemia, gastricendos copy should be performed. It is known about that malignancy is a rare etiology in RLS patients and to our knowledge; it is the first case with neuro endocrine tumor presenting with RLS.

Keywords: neurology, neuroendocrine tumor, restless legs syndrome, sleep

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Authors: Olaniyi O. Omoyajowo

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To be successful in today’s competitive global environment, manufacturing industry must be able to respond quickly to changes in technology. These changes in technology introduce new risks and hazards. The management of risk/hazard in a manufacturing process recommends method through which the success rate of an organization can be increased. Thus, there is a continual need for manufacturing industries to invest significant amount of resources in risk management, which in turn optimizes the production output and profitability of any manufacturing industry (if implemented properly). To help improve the existing risk prevention and mitigation practices in Small and Medium Enterprise (SME) in Nigeria Manufacturing Industries (NMI), the researcher embarks on this research to develop a systematic Risk Management process.

Keywords: manufacturing management, risk, risk management, SMEs

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Authors: Haya Salah, Srinivas Sharan

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Healthcare facilities use appointment systems to schedule their appointments and to manage access to their medical services. With the growing demand for outpatient care, it is now imperative to manage physician's time effectively. However, high variation in consultation duration affects the clinical scheduler's ability to estimate the appointment duration and allocate provider time appropriately. Underestimating consultation times can lead to physician's burnout, misdiagnosis, and patient dissatisfaction. On the other hand, appointment durations that are longer than required lead to doctor idle time and fewer patient visits. Therefore, a good estimation of consultation duration has the potential to improve timely access to care, resource utilization, quality of care, and patient satisfaction. Although the literature on factors influencing consultation length abound, little work has done to predict it using based data-driven approaches. Therefore, this study aims to predict consultation duration using supervised machine learning algorithms (ML), which predicts an outcome variable (e.g., consultation) based on potential features that influence the outcome. In particular, ML algorithms learn from a historical dataset without explicitly being programmed and uncover the relationship between the features and outcome variable. A subset of the data used in this study has been obtained from the electronic medical records (EMR) of four different outpatient clinics located in central Pennsylvania, USA. Also, publicly available information on doctor's characteristics such as gender and experience has been extracted from online sources. This research develops three popular ML algorithms (deep learning, random forest, gradient boosting machine) to predict the treatment time required for a patient and conducts a comparative analysis of these algorithms with respect to predictive performance. The findings of this study indicate that ML algorithms have the potential to predict the provider service time with superior accuracy. While the current approach of experience-based appointment duration estimation adopted by the clinic resulted in a mean absolute percentage error of 25.8%, the Deep learning algorithm developed in this study yielded the best performance with a MAPE of 12.24%, followed by gradient boosting machine (13.26%) and random forests (14.71%). Besides, this research also identified the critical variables affecting consultation duration to be patient type (new vs. established), doctor's experience, zip code, appointment day, and doctor's specialty. Moreover, several practical insights are obtained based on the comparative analysis of the ML algorithms. The machine learning approach presented in this study can serve as a decision support tool and could be integrated into the appointment system for effectively managing patient scheduling.

Keywords: clinical decision support system, machine learning algorithms, patient scheduling, prediction models, provider service time

Procedia PDF Downloads 118

Authors: Ki Hwa Lee, Eunsu Kang, Jae Hong Park

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Background: Interventional neuroradiology (INR) has been a rapidly growing and evolving neurosurgical part during the past few decades. Sevoflurane and propofol are both suitable anesthetics for INR procedure. Monitoring of depth of anesthesia is being used very widely. SEDLine™ monitor, a 4-channel processed EEG monitor, uses a proprietary algorithm to analyze the raw EEG signal and displays the Patient State Index (PSI) values. There are only a fewer studies examining the PSI in the neuro-anesthesia. We aimed to investigate the difference of PSI values and hemodynamic variables between sevoflurane and propofol anesthesia during INR procedure. Methods: We reviewed the medical records of patients who scheduled to undergo embolization of non-ruptured intracranial aneurysm by a single operator from May 2013 to December 2014, retrospectively. Sixty-five patients were categorized into two groups; sevoflurane (n = 33) vs propofol (n = 32) group. The PSI values, hemodynamic variables, and the use of hemodynamic drugs were analyzed. Results: Significant differences were seen between PSI values obtained during different perioperative stages in both two groups (P < 0.0001). The PSI values of propofol group were lower than that of sevoflurane group during INR procedure (P < 0.01). The patients in propofol group had more prolonged time of extubation and more phenylephrine requirement than sevoflurane group (p < 0.05). Anti-hypertensive drug was more administered to the patients during extubation in sevoflurane group (p < 0.05). Conclusions: The PSI can detect depth of anesthesia and changes of concentration of anesthetics during INR procedure. Extubation was faster in sevoflurane group, but smooth recovery was shown in propofol group.

Keywords: interventional neuroradiology, patient state index, propofol, sevoflurane

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Authors: Perminderjit Singh, Sukhvir Singh

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Total Quality Management (TQM) refers to management methods used to enhance quality and productivity in business organizations. Total Quality Management (TQM) has become a frequently used term in discussions concerning quality. Total Quality management has brought rise in demands on the organizations policy and the customers have gained more importance in the organizations focus. TQM is considered as an important management tool, which helps the organizations to satisfy their customers. In present research critical success factors includes management commitment, customer satisfaction, continuous improvement, work culture and environment, supplier quality management, training and development, employee satisfaction and product/process design are studied. A questionnaire is developed to implement these critical success factors in implementation of total quality management in Indian industry. Questionnaires filled by consulting different industrial organizations. Data collected from questionnaires is analyzed by descriptive and importance indexes.

Keywords: total quality management, critical success factor, employee satisfaction, supplier quality management, customer focus, quality information, quality measurement

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Authors: Avantika Verma

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Diabetic retinopathy (DR) and Central serous retinopathy (CSR) are 2 distinct entities, with difference in age of presentation, eitiopathogenesis and clinical features, but when occurring together, can be a diagnostic dilemma and requires careful evaluation. Case study of 3 patients with long standing diabetes (>15yrs) and features of Central serous retinopathy was done at Bangalore West Lions Superspeciality Eye Hospital, Bangalore, India in 2013. Even though diabetic retinopathy and CSR have different pathologies, they can coexist. The reason for coexistence could be the following: A patient with CSR as a young adult could develop DR in later years. Stress could be the contributing factor in older patient with diabetes.Stress could be a common factor for both, as it is one of the important factors in the pathogenesis of Maturity Onset Diabetes Miletus (MODY). In any situation, a careful evaluation is necessary to differentiate the cause of fundus picture, as treatment differs for the two diseases.

Keywords: central serous retinopathy, diabetic retinopathy, existence, stress

Procedia PDF Downloads 221

Authors: Ya-Yi Yen

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The operating room is a medical environment full of high-risk, high-complexity and high-cost. In addition to assuring patient safety, the operating room should effort on the efficient and safe medical quality for the surgical patients of high risk, elders, and children. If the nursing staffs of operation room carry on the pre-operative visiting prior to surgery, the patient's anxiety and complications are expected to be alleviated, and the hospitalization days may also be shortened. Purpose: Applying the information system to enhance pre-operative visiting, case tracking, and effectiveness recording Method: (I) Application the information system to screen cases by integrating the operation scheduling, and linking the severe surgery codes, for to shorten the time to track cases of operative visiting. Through the improvement, the time required decreased to 1.5 minutes per day from 20 minutes per day, and nursing staffs’ satisfaction with satisfaction for tracking and visiting procedure of case increased to 86% from 54%. (II)The electronic establishment of the operative visiting record enhanced the integrity of the operative visiting record. The integrity rate was rise to 92% from 66%, while nursing staffs’ satisfaction with the visiting record increased to 82% from 61.3%. Since information technology continues evolving, the application of information technology is helpful to the integration of nursing information, simplification of processes, and saving of man-hours. This article introduces the application of information systems to simplify the processes and improve the effectiveness of operation visiting and tracking, including the saving of time, improving the integrity rate of record, and improving the satisfaction of nursing staffs.

Keywords: effectiveness, information system, perioperative nursing, pre-operative visiting

Procedia PDF Downloads 139

Authors: Maria Luisa T. Uayan

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The global need for qualified nurses to take care of the clients with various health needs is an incessant occurrence that persistently cause migration of nurses from developing to developed countries. The pull-push theory of migration greatly affects health care delivery systems of sending countries which is the same way affects nursing management. The exodus of nurses prepared to provide the much needed leadership at the bedside leaves the country in clusters giving health care institutions limited time to develop the next front-line managers that will assure quality patient care. This paper focuses on the extent and consequences of the massive recurring migration phenomena that is felt ONLY IN THE PHILIPPINE health care arena. It deals with the causes, problems, and effects of the cyclical loss of competent Filipina nurses in terms of emigration. Also, it will highlights the difficulties confronted by nursing service departments and health care teams when more experienced nurses set out for the “greener pastures” and patients are placed under the care of novice nurses. Fundamentally, it will emphasize the impact of suffering the loss of competent nurse managers in the Philippine health care institutions and provide contemporary recommendations on how to responsd accordingly to this very timely issue.

Keywords: Migration, Nurse Manager, Philippines

Procedia PDF Downloads 357

Authors: Jui-Hung Hung, Ching-Liang Hsieh, Yi-Wen Lin

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Modern medicine highly emphasizes the importance of palliative treatment. The inception of palliative and hospice care recently developed into the concept of caring for the patients’ and families’ physical, psychological and spiritual problems. There are several benefits related to palliative care such as reducing medical expenses, decreasing patients’ suffer, and supporting patient go through the finale of the life. Nowadays, in Taiwan, over 60-70% terminal cancer patients were covered in hospice care, and the coverage rate increased annually. Acupuncture is a well-known therapy used more than thousand years to relieve symptoms of cancer patient. Many reports showed that, even in the Western society, many reputable medical centers can provide Acupuncture therapy for patients. Accordingly, using Acupuncture for cancer patient care is a global trend. There are increased evidences indicate that Acupuncture can relieve the symptoms for cancer patients including pain, reduce the dosage of anesthetic, improve the cancer-related fatigue, relieve the chemotherapy-related nausea and vomiting, ease anxiety mood and even improving the quality of life. Furthermore, some trials show that Acupuncture may help relieve xerostomia, hot flash, sleep disorders, and some GI discomfort and so on. Acupuncture therapy has many advantages for clinical use with effective, low-cost, minimal side effect, suitable for cancer patients and even for elderly population. Especially in nowadays, there are more diversified challenges in modern medicine, all of them will make the higher medical budget. We suggest that Acupuncture will be one of methods for palliative care for cancer patients.

Keywords: Acupuncture, cancer, integrative medicine, palliative care

Procedia PDF Downloads 349

Authors: Mohammad Alqattan, Tala Alkhunani, Reema Al, Aldawish, Felwa Almurshard, Abdullah Alzahrani

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: Poland’s Syndrome is a congenital anomaly with two clinical features : unilateral agenesis of the pectoralis major and ipsilateral hand symbrachydactyly. Case presentation: We report a rare case of bilateral Poland’s syndrome with several unique features. Discussion: Poland’s syndrome is thought to be due to a vascular insult to the subclavian axis around the 6th week of gestation. Our patient has multiple rare and unique features of Poland’s syndrome. Conclusion: To our best knowledge, for the first time in the literature we associate Poland’s syndrome with cone-shaped epiphysis of the metacarpals of all fingers. Bilaterality, cleft hand deformity, and dextrocardia, were also rare features in our patient.

Keywords: Poland's syndrome, cleft hand deformity, bilaterality, dextrocardia, cone-shaped epiphysis

Procedia PDF Downloads 119