Search results for: hospital employees

Authors: Hengameh Hosseini

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Design of large healthcare facilities – such as hospitals, multi-service line clinics, and nursing facilities - that can accommodate patients with wide-ranging disabilities is a challenging endeavor and one that is poorly understood among healthcare facility managers, administrators, and executives. An even less-understood extension of this problem is the implications of weakly or insufficiently accommodative design of facilities for healthcare workers in physically-intensive jobs who may also suffer from a range of disabilities and who are therefore at increased risk of workplace accident and injury. Combine this reality with the vast range of facility types, ages, and designs, and the problem of universal accommodation becomes even more daunting and complex. In this study, we focus on the implication of facility design for healthcare workers suffering with low vision who also have physically active jobs. The points of difficulty are myriad and could span health service infrastructure, the equipment used in health facilities, and transport to and from appointments and other services can all pose a barrier to health care if they are inaccessible, less accessible, or even simply less comfortable for people with various disabilities. We conduct a series of surveys and interviews with employees and administrators of 7 facilities of a range of sizes and ownership models in the Northeastern United States and combine that corpus with in-facility observations and data collection to identify five major points of failure common to all the facilities that we concluded could pose safety threats to employees with vision impairments, ranging from very minor to severe. We determine that lack of design empathy is a major commonality among facility management and ownership. We subsequently propose three methods for remedying this lack of empathy-informed design, to remedy the dangers posed to employees: the use of an existing open-sourced Augmented Reality application to simulate the low-vision experience for designers and managers; the use of a machine learning model we develop to automatically infer facility shortcomings from large datasets of recorded patient and employee reviews and feedback; and the use of a computer vision model fine tuned on images of each facility to infer and predict facility features, locations, and workflows, that could again pose meaningful dangers to visually impaired employees of each facility. After conducting a series of real-world comparative experiments with each of these approaches, we conclude that each of these are viable solutions under particular sets of conditions, and finally characterize the range of facility types, workforce composition profiles, and work conditions under which each of these methods would be most apt and successful.

Keywords: artificial intelligence, healthcare workers, facility design, disability, visually impaired, workplace safety

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Authors: Paria Baharvand, Mohammad Reza Abbasi, Soha Namazi

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Introduction: Uremic pruritus (UP) is one of the major complaints in hemodialysis patients. The aim of this randomized clinical trial study was the evaluation of the anti-pruritus effect of Melatonin on hemodialysis patients with UP. Methods: This multi-centered double, blinded randomized clinical trial study was conducted on hemodialysis patients with UP that referred to the dialysis department of Imam Khomeini Hospital, Labbafinezhad Hospital and Ghiasi Hospital in Tehran, Iran, in 2018. Forty participants were enrolled and block randomization was performed by using a randomized list and divided into 2 groups of twenty patients. Evaluation of the 12-Item Pruritus Severity Scale (12-PSS), Visual analog scale (VAS), and Calculation of the affected body surface area for pruritus extent (BSA %) was performed every week. The Melatonin group received a 10 mg soft gel capsule, and the placebo group received a soft gel capsule placebo after dinner. For statistical analysis used by SPSS version 21(IRCT20180714040462N1). Results: 38 hemodialysis patients enrolled in this study. The mean age in the placebo group and in the Melatonin group was 55.88 ± 11.70 and 54.52 ± 13.00 years (p> 0.05). Also, 46% of all participants were female. Aspartate transaminase, alanine transaminase and C-reactive protein have significant differences between the two groups (p< 0.05). VAS score reduction in the two groups had a statistically significant (CI 95% = -1.71, P= 0.015(.The results of BSA% showed Melatonin had a significant effect on the decrease of the pruritus extent compared to placebo (CI 95% = -22.82, P= 0.001(. Conclusion: According to the results of this study and the preliminary effects of Melatonin on uremic pruritus, we suggest performing advanced clinical trials studies.

Keywords: Melatonin, Uremic Pruritus, hemodialysis, anti-pruritus

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Authors: Aisha Maroof

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Introduction: Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers and health systems. Severe 2019 novel coronavirus infectious disease (COVID-19) with pneumonia is associated with high rates of admission to the intensive care unit (ICU) and they are at high risk to obtain the hospital acquire bloodstream infection (HAIs) such as central line associated bloodstream infection (CLABSI), catheter associated urinary tract infections (CAUTI) and laboratory confirm bloodstream infection (LCBSI). The chances of infection transmission increase when healthcare worker’s (HCWs) practice is inappropriate. Risk related to hand hygiene (HH) and personal protective equipment (PPE) as regards multidrug-resistant organism transmission: use of multiple gloving instead of HH and incorrect use of PPE can lead to a significant increase of device-related infections. As it reaches low- and middle-income countries, its effects could be even more, because it will be difficult for them to react aggressively to the pandemic. HAIs are one of the biggest medical concerns, resulting in increased mortality rates. Objective: To assess the effect of intervention on compliance of hand hygiene and PPE among HCWs reduce the rate of HAI in COVID-19 patients. Method: An interventional study was done between July to December, 2020. CLABSI, CAUTI and LCBSI data were collected from the medical record and direct observation. There were total of 50 Nurses, 18 doctors and all patients with laboratory-confirmed severe COVID-19 admitted to the hospital were included in this research study. Respiratory tract specimens were obtained after the first 48 h of ICU admission. Practices were observed after and before intervention. Education was provided based on WHO guidelines. Results: During the six months of study July to December, the rate of CLABSI, CAUTI and LCBSI pre and post intervention was reported. CLABSI rate decreasedd from 22.7 to 0, CAUTI rate was decreased from 1.6 to 0, LCBSI declined from 3.3 to 0 after implementation of intervention. Conclusion: HAIs are an important cause of morbidity and mortality. Most of the device related infections occurs due to lack of correct use of PPE and hand hygiene compliance. Hand hygiene and PPE is the most important measure to protect patients, through education it can be improved the correct use of PPE and hand hygiene compliance and can reduce the bacterial infection in COVID-19 patients.

Keywords: hospital acquire infection, healthcare workers, hand hygiene, personal protective equipment

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Authors: Arundhuti Devi, Gitumani Devi, Krishna G. Bhattacharyya

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The goal of this study was to assess the characteristics of the airborne dust created by opencast coal mining and its relation to population hospitalization risk for skin and lung diseases in Margherita Coalfield, Assam, India. Air samples were collected for 24 h in three 8-h periods. For the collection of particulate matter (PM10) and total suspended particulate matter (SPM) samples, respiratory dust samplers with glass microfiber filter papers were used. PM10 was analyzed for Cu, Cd, Cr, Mn, Zn, Ni, Fe and Pb with Flame Atomic Absorption Spectrophotometer (FAAS). SPM and PM10 concentrations were respectively found to be as high as 1,035 and 265.85 μg/m³ in work zone air. The concentration of metals associated with PM10 showed values higher than the permissible limits. It was observed that the average concentrations of the metals Fe, Pb, Ni, Zn, and Cu were very high during the winter month of December, those of Cd and Cr were high during the month of May and Mn was high during February. The morphology of the particles studied with scanning electron microscopy (SEM) gave significant results. Due to opencast coal mining, the air in the work zone, as well as the general ambient air, was found to be highly polluted with respect to dust. More than 8000 patient records maintained by the hospital authority were collected from three hospitals in the area. The highest percentage of people suffering from lung diseases are found in Margherita Civil Hospital (~26.77%) whereas most people suffering from skin diseases reported for treatment in the ESIC hospital (47.47%). Both PM10 and SPM were alarmingly high, and the results were in conformity with the high incidence of lung and other respiratory diseases in the study area.

Keywords: heavy metals, open cast coal mining, PM10, respiratory diseases

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Authors: Nadjet Mekaouche, Hanane Zitouni, Fatma Boudia, Habiba Fetati, A. Saleh, A. Lardjam, H. Geniaux, A. Coubret, H. Toumi

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Medicines have undeniably played a major role in prolonging shelf life and improving quality. The absolute efficacy of the drug remains a lever for innovation, its benefit/risk balance is not always assured and it does not always have the expected effects. Prior to marketing, knowledge about adverse drug reactions is incomplete. Once on the market, phase IV drug studies begin. For years, the drug was prescribed with less care to a large number of very heterogeneous patients and often in combination with other drugs. It is at this point that previously unknown adverse effects may appear, hence the need for the implementation of a pharmacovigilance system. Pharmacovigilance represents all methods for detecting, evaluating, informing and preventing the risks of adverse drug reactions. The most severe adverse events occur frequently in hospital and that a significant proportion of adverse events result in hospitalizations. In addition, the consequences of hospital adverse events in terms of length of stay, mortality and costs are considerable. It, therefore, appears necessary to develop ‘hospital pharmacovigilance’ aimed at reducing the incidence of adverse reactions in hospitals. The most widely used monitoring method in pharmacovigilance is spontaneous notification. However, underreporting of adverse drug reactions is common in many countries and is a major obstacle to pharmacovigilance assessment. It is in this context that this study aims to describe the experience of the pharmacovigilance service at the University Hospital of Oran (EHUO). This is a retrospective study extending from 2011 to 2017, carried out on archived records of declarations collected at the level of the EHUO Pharmacovigilance Department. Reporting was collected by two methods: ‘spontaneous notification’ and ‘active pharmacovigilance’ targeting certain clinical services. We counted 217 statements. It involved 56% female patients and 46% male patients. Age ranged from 5 to 78 years with an average of 46 years. The most common adverse reaction was drug toxidermy. For the drugs in question, they were essentially according to the ATC classification of anti-infectives followed by anticancer drugs. As regards the evolution of declarations by year, a low rate of notification was noted in 2011. That is why we decided to set up an active approach at the level of some services where a resident of reference attended the staffs every week. This has resulted in an increase in the number of reports. The declarations came essentially from the services where the active approach was installed. This highlights the need for ongoing communication between all relevant health actors to stimulate reporting and secure drug treatments.

Keywords: adverse drug reactions, hospital, pharmacovigilance, spontaneous notification

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Authors: Peter Park, Alfonso Ayala, Douglas Saeks, Jordan Miller, Carmen Flores, Karen Nelson

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Introduction Hip fractures account for more than 300,000 hospital admissions every year. Many present as fragility fractures in geriatric patients with multiple medical comorbidities. Standardized protocols for the multidisciplinary management of this patient population have been shown to improve patient outcomes. A hip fracture protocol was implemented at a Level I Trauma center with a focus on pre-operative medical optimization and early surgical care. This study evaluates the efficacy of that protocol, including the early transition period. Methods A retrospective review was performed of all patients ages 60 and older with isolated hip fractures who were managed surgically between 2020 and 2022. This included patients 1 year prior and 1 year following the implementation of a hip fracture protocol at a Level I Trauma center. Results 530 patients were identified: 249 patients were treated before, and 281 patients were treated after the protocol was instituted. There was no difference in mean age (p=0.35), gender (p=0.3), or Charlson Comorbidity Index (p=0.38) between the cohorts. Following the implementation of the protocol, there were observed increases in time to surgery (27.5h vs. 33.8h, p=0.01), hospital length of stay (6.3d vs. 9.7d, p<0.001), and ED LOS (5.1h vs. 6.2h, p<0.001). There were no differences in in-hospital mortality (2.01% pre vs. 3.20% post, p=0.39) and complication rates (25% pre vs 26% post, p=0.76). A trend towards improved outcomes was seen after the early transition period but failed to yield statistical significance. Conclusion Early medical management and surgical intervention are key determining factors affecting outcomes following fragility hip fractures. The implementation of a hip fracture protocol at this institution has not yet significantly affected these parameters. This could in part be due to the restrictions placed at this institution during the COVID-19 pandemic. Despite this, the time to OR pre-and post-implementation was quicker than figures reported elsewhere in literature. Further longitudinal data will be collected to determine the final influence of this protocol. Significance/Clinical Relevance Given the increasing number of elderly people and the high morbidity and mortality associated with hip fractures in this population finding cost effective ways to improve outcomes in the management of these injuries has the potential to have enormous positive impact for both patients and hospital systems.

Keywords: hip fracture, geriatric, treatment algorithm, preoperative optimization

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Authors: M. S. Raza, A. Kapil, Sonu Tyagi, H. Gautam, S. Mohapatra, R. Chaudhry, S. Sood, V. Goyal, R. Lodha, V. Sreenivas, B. K. Das

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Background: Acute bacterial meningitis remains the major cause of mortality and morbidity. More than half of the survivors develop the significant lifelong neurological abnormalities. Diagnosis of the hospital acquired acute bacterial meningitis (HAABM) is challenging as it appears either in the post operative patients or patients acquire the organisms from the hospital environment. In both the situations, pathogens are exposed to high dose of antibiotics. Chances of getting multidrug resistance organism are very high. We have performed this experiment to find out the etiological agents of HAABM and its antibiotics susceptibility pattern. Methodology: A perspective study was conducted at the Department of Microbiology, All India Institute of Medical Sciences, New Delhi. From March 2015 to April 2018 total 400 Cerebro spinal fluid samples were collected aseptically. Samples were processed for cell count, Gram staining, and culture. Culture plates were incubated at 37°C for 18-24 hours. Organism grown on blood and MacConkey agar were identified by MALDI-TOF Vitek MS (BioMerieux, France) and antibiotic susceptibility tests were performed by Kirby Bauer disc diffusion method as per CLSI 2015 guideline. Results: Of the 400 CSF samples processed, 43 (10.75%) were culture positive for different bacteria. Out of 43 isolates, the most prevalent Gram-positive organisms were S. aureus 4 (9.30%) followed by E. faecium 3 (6.97%) & CONS 2 (4.65%). Similarly, E. coli 13 (30.23%) was the commonest Gram-negative isolates followed by A. baumannii 12 (27.90%), K. pneumonia 5 (11.62%) and P. aeruginosa 4(9.30%). Most of the antibiotics tested against the Gram-negative isolates were resistance to them. Colistin was most effective followed by Meropenem and Imepenim for all Gram-negative HAABM isolates. Similarly, most of antibiotics tested were susceptible to S. aureus and CONS. However, E. faecium (100%) were only susceptible to vancomycin and teicoplanin. Conclusion: Hospital acquired acute bacterial meningitis (HAABM) is becoming the emerging challenge as most of isolates are showing resistance to commonly used antibiotics. Gram-negative organisms are emerging as the major player of HAABM. Great care needs to be taken especially in tertiary care hospitals. Similarly, antibiotic stewardship should be followed and antibiotic susceptibility test (AST) should be performed regularly to update the antibiotic patter and to prevent from the emergence of resistance. Updated information of the AST will be helpful for the better management of the meningitis patient.

Keywords: CSF, MALDI-TOF, hospital acquired acute bacterial meningitis, AST

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Authors: Prakash Singh

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The focus of this paper is on the impact of internal organizational factors on the inappropriate job performance and behaviour of employees. The Buffalo City Metropolitan Municipality (BCMM) in South Africa has been experiencing inappropriate job behaviour and performance of some of its workers. They include misappropriation of resources, maladministration, mismanagement, lack of service delivery, fraud, and corruption. Since many workers in this organization have various levels of formal education, such practices are not expected, because the structural-functionalist assumption is that formal education is a solution to societal challenges. Since inappropriate job behaviour and performance continue to be reported in spite of the formal education of BCMM workers, this study seeks to investigate how the two phenomena co-exist. It thus seeks to put into perspective the paradoxical co-existence of formal education with inappropriate job behaviour and performance, by focusing on the BCMM as a case-study. For data collection, this study used the mixed method approach; that is, a combination of qualitative and quantitative methods. The findings revealed structural, systemic and human impediments to labour productivity in the organization. By and large, the unquestioning acceptance of the assumption that the skills shortage is responsible for inappropriate workers’ job performance and behaviour is discredited by the evidence of skilled personnel who exercise their responsibilities in a manner that undermines their occupational requirements. Therefore, this exploratory study affirms that the narrow conception of skills, that privileges job-specific capabilities, is not enough for cultivating a workforce with appropriate job behaviour and performance practices.

Keywords: inappropriate job behaviour, labour productivity, mismanagement, skills shortage

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Authors: Chariya Laohavich, Viboon Bunsrangsuk

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Objective: Bronchoscopy is a common outpatient procedure. The authors compared the patient anxiety level before and after received video-assisted procedural information. Method: One hundred and twenty patients who never received bronchoscopy and scheduled for elective bronchoscopy at outpatient Bronchosope unit at Ramathibodi Hospital, Mahidol University were randomized into control and intervention group. Video-assisted procedural information was given in intervention group. Pre and post procedural anxiety score were recorded and compared between two groups. Paired T-test was used for statistical analysis. Result: There was statistically significant decrease (p < 0.001) for anxiety score in patients who received video assisted procedural information compare with control group. Conclusion: Video-assisted procedural information should be given to patient who will have bronchoscopy to reduce anxiety.

Keywords: anxiety, bronchoscopy, video compact disc (VCD)

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Authors: Florian Engel

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Only with a radical change to an intrinsically motivated project team, through giving the employees the freedom for autonomy, mastery and purpose, it is then possible to develop excellent products. With these changes, combined with using a rapid application development approach, the group of users serves as an important indicator to test the market needs, rather than only as the stakeholders for requirements.

Keywords: intrinsic motivation, requirements elicitation, self-directed work, stakeholder participation

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Authors: Awais Naeem, Osama Shakeel, Aamir Ali Syed, Shahid Khattak

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Introduction: Laparoscopic right hemicolectomy is an advanced cancer surgery in today's era. The aim of this study was to evaluate the surgical and initial oncological outcomes after curative, laparoscopic resection of right sided colonic tumors. Also to compare our results with those of previous randomized trials. Methods And Procedures: We retrospectively analyzed the medical record files of all the patients who presented to our hospital with the diagnosis of right sided colon carcinoma from January 2012 to December 2017 and underwent laparoscopic right hemicolectomy. Demographics, operative findings and histopathological reports were all recorded on a preformed data sheet. All the analysis was performed on SPSS 20. Results: Total of 48 patients were included. There were 37 male and 11 female patients with mean age of 49.7 (range from 25 – 82). Mean hospital stay was 8.25 ± 3.17 days. Blood loss was 80mls and operative mean time was 240 minutes. Eighteen patients had extended right hemicolectomy. Median length of the specimen retrieved was 31cm (range, 14-59cm). Mean size of tumor was 6.44cm + 2.53. Total number of lymph nodes removed was 20.5 + 8.3. All had R0 resection. Post-operatively 2 patients had pelvic collection and there was no 30 day mortality. In 33 patients there was T3 disease, 5 had T2 and 10 had T4 disease. There was distant recurrence in 4 patients with peritoneal metastasis in 3 and liver metastasis in 1 patient. Forty-six patients are still alive and 44 are disease free. The mean follow-up period was 25.31 (12 to 60) months. Conclusion: Our early experience with Laparascopic Right hemicolectomy as a safe and oncologically feasible surgical option. We attained comparable surgical results with curative intent.

Keywords: right hemicolectomy, right sided colonic tumors, laparoscopic, curative intent

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Authors: Harini Chakkera

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Background: Inpatient hyperglycemia is an established independent risk factor among several patient cohorts with hospital readmission. This has not been studied after kidney transplantation. Nearly one-third of patients who have undergone a kidney transplant reportedly experience 30-day readmission. Methods: Data on first-time solitary kidney transplantations were retrieved between September 2015 to December 2018. Information was linked to the electronic health record to determine a diagnosis of diabetes mellitus and extract glucometeric and insulin therapy data. Univariate logistic regression analysis and the XGBoost algorithm were used to predict 30-day readmission. We report the average performance of the models on the testing set on five bootstrapped partitions of the data to ensure statistical significance. Results: The cohort included 1036 patients who received kidney transplantation, and 224 (22%) experienced 30-day readmission. The machine learning algorithm was able to predict 30-day readmission with an average AUC of 77.3% (95% CI 75.30-79.3%). We observed statistically significant differences in the presence of pretransplant diabetes, inpatient-hyperglycemia, inpatient-hypoglycemia, and minimum and maximum glucose values among those with higher 30-day readmission rates. The XGBoost model identified the index admission length of stay, presence of hyper- and hypoglycemia and recipient and donor BMI values as the most predictive risk factors of 30-day readmission. Additionally, significant variations in the therapeutic management of blood glucose by providers were observed. Conclusions: Suboptimal glucose metrics during hospitalization after kidney transplantation is associated with an increased risk for 30-day hospital readmission. Optimizing the hospital blood glucose management, a modifiable factor, after kidney transplantation may reduce the risk of 30-day readmission.

Keywords: kidney, transplant, diabetes, insulin

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Authors: Ali Muhammad

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The study investigates the effect of a number of contextual on the degree of trust within Kuwaiti business organizations. The model used in this study suggests that degree of trust within the organization is determined by four contextual variables, namely, centralization, formalization, role ambiguity, and procedural justice. Organizational trust refers to employee’ positive assumptions in regard to the goal and behaviors of other members in the organization according to organizational duties, relationships, experiences, and interrelatedness. According to the norm of reciprocity, individuals with high perceived organizational justice will be compelled to react positively to the organization in the form of higher degree of trust. The duty to exchange kindness for kindness. Based on the exchange theory, this research proposes that procedural justice, role clarity, and voice in the organization will lead to the perception of an organization’s discretionary positive treatment of employees and, in return enhances their trust in the organization. Survey data were collected from a sample of 206 employees working in Kuwaiti business organizations. Results of multiple regression analysis revealed that both organizational justice and formalization have positive effects on organizational trust. Furthermore, results indicate that lower degree of role ambiguity leads to higher degree of organizational trust. On the other hand, centralization was not found to have a significant effect on organizational trust. Implications of the findings and directions for future research are discussed.

Keywords: centralization, formalization, organizational justice, organizational trust, role ambiguity

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Authors: Bindhiya Thomas, Rehana Hafeez

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Background: The Surgical Ambulatory Unit (SAU) also known as the Same Day Emergency Care (SDEC) is an established part of many hospitals providing same day emergency care service to surgical patients who would have otherwise required admission through the A&E. Prior to Covid, the SAU was functioning as a 12-hour service, but during the Covid crisis this service was transformed to a 24 hour functioning Surgical Ambulatory Assessment unit (SAAU). We studied the effects that this change brought about in-patient care in our hospital. Objective: The objective of the study was to assess the impact of a 24-hour Surgical Ambulatory Assessment unit on patient care during the time of Covid, in particular its role in freeing A&E capacity and delivering effective patient care. Methods: We collected two sets of data retrospectively. The first set was collected over a 6-week period when the SAU was functioning at the Princess Royal University Hospital. On March 23rd, 2020, the SAU was transformed into a 24-hour SAAU. Following this transformation, a second set of patient data was collected over a period of 6 weeks. A comparison was made between data collected from when the hospital had a 12-hour Surgical Ambulatory unit and later when it was transformed into a 24-hour facility. Its effects on the change in the number of patients breaching the four hour waiting period and the number of emergency surgical admissions. Results: The 24-hour Surgical Ambulatory Assessment unit brought significant reductions in the number of patients breaching the waiting period of 4 hours in A&E from 44% during the period of the 12-hour Surgical Ambulatory care facility to 0% from when the 24-hour Surgical Ambulatory Assessment Unit was established. A 28% reduction was also seen in the number of surgical patients' admissions from A&E. Conclusions: The 24-hour SAAU was found to have a profound positive impact on emergency care of surgical patients. Especially during the Covid crisis, it played a crucial role in providing not only effective and accessible patient care but also in reducing the A&E workload and admissions. It thus proved to be a strategic tool that helped to deal with the immense workload in emergency care during the Covid crisis and helped free much needed headspace at a time of uncertainty for the A&E to better configure their services. If sustained, the 24-hour SAAU could be relied on to augment the NHS emergency services in the future, especially in the event of another crisis.

Keywords: Princess Royal University Hospital, surgical ambulatory assessment unit, surgical ambulatory unit, same day emergency care

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Authors: Patcharaporn Sakulpong, Wiriya Phokhwang

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Background: Banpunrug (Love Sharing House) established in 2013 provides a community-based palliative care for patients with cancer from 7 provinces in southern Thailand. These patients come to receive outpatient chemotherapy and radiotherapy at Suratthani Cancer Hospital. They are poor and uneducated; they need an accommodation during their 30-45 day course of therapy. Methods: A community-participatory action research (PAR) was employed to establish a model of palliative care for patients with cancer. The participants included health care providers, community, and patients and families. The PAR process includes problem identification and need assessment, community and team establishment, field survey, organization founding, model of care planning, action and inquiry (PDCA), outcome evaluation, and model distribution. Results: The model of care at Banpunrug involves the concepts of HHHS model, in that Banpunrug is a Home for patients; patients live in a house comfortable like in a Hotel resource; the patients are given care and living facilities similarly to those in a Hospital; the house is a School for patients to learn how to take care themselves, how to live well with cancer, and most importantly how to prepare themselves for a good death. The house is also a humanized care school for health care providers. Banpunrug’s philosophy of care is based on friendship therapy, social and spiritual support, community partnership, patient-family centeredness, Live & Love sharing house, and holistic and humanized care. With this philosophy, the house is managed as a home of the patients and everyone involved; everything is costless for all eligible patients and their family members; all facilities and living expense are donated from benevolent people, friends, and community. Everyone, including patients and family, has a sense of belonging to the house and there is no authority between health care providers and the patients in the house. The house is situated in a temple and a community and supported by many local nonprofit organizations and healthcare facilities such as a health promotion hospital at sub-disctrict level and Suratthani Cancer Hospital. Village health volunteers and multi-professional health care volunteers have contributed not only appropriate care, but also knowledge and experience to develop a distinguishing HHHS community-based palliative care model for patients with cancer. Since its opening the house has been a home for more than 400 patients and 300 family members. It is also a model for many national and international healthcare organizations and providers, who come to visit and learn about palliative care in and by community. Conclusions: The success of this palliative care model comes from community involvement, multi-professional volunteers and distributions, and concepts of HHHS model. Banpunrug promotes a consistent care across the cancer trajectory independent of prognosis in order to strengthen a full integration of palliative

Keywords: community-based palliative care, model, participatory action research, patients with cancer

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Authors: Kalayanee Senasu

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This research investigates Thai people’s happiness based on socioeconomic factors, i.e. region, municipality, gender, age, and occupation. The research data were collected from survey data using interviewed questionnaires. The primary data were from stratified multi-stage sampling in each region, province, district, and enumeration area; and simple random sampling in each enumeration area. These data were collected in 13 provinces: Bangkok and three provinces in each of all four regions. The data were collected over two consecutive years. There were 3,217 usable responses from the 2017 sampling, and 3,280 usable responses from the 2018 sampling. The Senasu’s Thai Happiness Index (THaI) was used to calculate the happiness level of Thai people in 2017 and 2018. This Thai Happiness Index comprises five dimensions: subjective well-being, quality of life, philosophy of living, governance, and standard of living. The result reveals that the 2017 happiness value is 0.506, while Thai people are happier in 2018 (THaI = 0.556). For 2017 happiness, people in the Central region have the highest happiness (THaI = 0.532), which is followed closely by people in the Bangkok Metropolitan Area (THaI = 0.530). People in the North have the lowest happiness (THaI = 0.476) which is close to the level for people in the Northeast (THaI = 0.479). Comparing age groups, it is found that people in the age range 25-29 years old are the happiest (THaI = 0.529), followed by people in the age range 55-59 and 35-39 years old (THaI = 0.526 and 0.523, respectively). Additionally, people who live in municipal areas are happier than those who live in non-municipal areas (THaI = 0.533 vs. 0.475). Males are happier than females (THaI = 0.530 vs. 0.482), and retired people, entrepreneurs, and government employees are all in the high happiness groups (THaI =0.614, 0.608, and 0.593, respectively). For 2018 happiness, people in the Northern region have the highest happiness (THaI = 0.590), which is followed closely by people in the South and Bangkok Metropolitan Area (THaI = 0.578 and 0.577, respectively). People in the Central have the lowest happiness (THaI = 0.530), which is close to the level for people in the Northeast (THaI = 0.533). Comparing age groups, it is found that people in the age range 35-39 years old are the happiest (THaI = 0.572), followed by people in the age range 40-44 and 60-64 years old (THaI = 0.569 and 0.568, respectively). Similar to 2017 happiness, people who live in municipal areas are happier than those who live in non-municipal areas (THaI = 0.567 vs. 0. 552). However, males and females are happy at about the same levels (THaI = 0.561 vs. 0.560), and government employees, retired people, and state enterprise employees are all in the high happiness groups (THaI =0.667, 0.639, and 0.661, respectively).

Keywords: happiness, quality of life, Thai happiness index, socio-economic factors

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Authors: Michel Zaitouni, Mohamed Nassar

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The purpose of this study is first, to explore the effect of employees’ perception of justice on trust in the supervisor in the context of performance appraisal; Second, to assess the role of perceived supervisor support as a mediator between organizational justice and trust in the supervisor in a non-western society such as Kuwait.The survey data consisted of 415 employees working at different hierarchical levels in three major banks in Kuwait. Hierarchical regression analysis was used to test the research hypotheses. Results supported hypothesized relationships between distributive, informational and interpersonal justice and trust in the supervisor but failed to support that procedural justice positively and significantly relate to trust in the supervisor. Moreover, results found that this relationship is partially mediated by perceived supervisor support. A potential limitation of this study is that data were obtained from the same industry which limits the generalizability of this study to other industries. Moreover, a longitudinal research will be helpful to strengthen the mediating relationship. The findings provide valuable information for the development of common perspectives regarding the perception of justice in the context of performance appraisal between the western and non-western societies. The paper has the privilege to explore additional relationships related to justice perceptions in the Kuwaiti banking sector, whereas previous research focused mainly on procedural and distributive justice as predictors of trust in the supervisor.

Keywords: Kuwait, organizational justice, perceived supervisor support, trust in the supervisor

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Authors: Atin Adhikari, Sushma Kurella, Pratik Banerjee, Nabanita Mukherjee, Yamini M. Chandana Gollapudi, Bushra Shah

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Different sharp instruments, drilling machines, and high speed rotary instruments are routinely used in dental clinics during dental cleaning. Therefore, these cleaning procedures release a lot of oral microorganisms including bacteria in clinic air and may cause significant occupational bioaerosol exposure risks for dentists, dental hygienists, patients, and dental clinic employees. Two major goals of this study were to quantify volumetric airborne concentrations of bacteria and to assess overall microbial activity in this type of occupational environment. The study was conducted in several dental clinics of southern Georgia and 15 dental cleaning procedures were targeted for sampling of airborne bacteria and testing of overall microbial activity in settled dusts over clinic floors. For air sampling, a Biostage viable cascade impactor was utilized, which comprises an inlet cone, precision-drilled 400-hole impactor stage, and a base that holds an agar plate (Tryptic soy agar). A high-flow Quick-Take-30 pump connected to this impactor pulls microorganisms in air at 28.3 L/min flow rate through the holes (jets) where they are collected on the agar surface for approx. five minutes. After sampling, agar plates containing the samples were placed in an ice chest with blue ice and plates were incubated at 30±2°C for 24 to 72 h. Colonies were counted and converted to airborne concentrations (CFU/m3) followed by positive hole corrections. Most abundant bacterial colonies (selected by visual screening) were identified by PCR amplicon sequencing of 16S rRNA genes. For understanding overall microbial activity in clinic floors and estimating a general cleanliness of the clinic surfaces during or after dental cleaning procedures, ATP levels were determined in swabbed dust samples collected from 10 cm2 floor surfaces. Concentration of ATP may indicate both the cell viability and the metabolic status of settled microorganisms in this situation. An ATP measuring kit was used, which utilized standard luciferin-luciferase fluorescence reaction and a luminometer, which quantified ATP levels as relative light units (RLU). Three air and dust samples were collected during each cleaning procedure (at the beginning, during cleaning, and immediately after the procedure was completed (n = 45). Concentrations at the beginning, during, and after dental cleaning procedures were 671±525, 917±1203, and 899±823 CFU/m3, respectively for airborne bacteria and 91±101, 243±129, and 139±77 RLU/sample, respectively for ATP levels. The concentrations of bacteria were significantly higher than typical indoor residential environments. Although an increasing trend for airborne bacteria was observed during cleaning, the data collected at three different time points were not significantly different (ANOVA: p = 0.38) probably due to high standard deviations of data. The ATP levels, however, demonstrated a significant difference (ANOVA: p <0.05) in this scenario indicating significant change in microbial activity on floor surfaces during dental cleaning. The most common bacterial genera identified were: Neisseria sp., Streptococcus sp., Chryseobacterium sp., Paenisporosarcina sp., and Vibrio sp. in terms of frequencies of occurrences, respectively. The study concluded that bacterial exposure in dental clinics could be a notable occupational biohazard, and appropriate respiratory protections for the employees are urgently needed.

Keywords: bioaerosols, hospital hygiene, indoor air quality, occupational biohazards

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Authors: Desalegn Feyissa Desu

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Drug therapy problem is a significant challenge to provide high quality health care service for the patients. It is associated with morbidity, mortality, increased hospital stay, and reduced quality of life. Moreover, pediatric patients are quite susceptible to drug therapy problems. Thus this study aimed to assess drug therapy problem and its contributing factors among pediatric patients diagnosed with infectious disease admitted to pediatric ward of Jimma university medical center, from April 1 to June 30, 2018. Prospective observational study was conducted among pediatric patients with infectious disease admitted from April 01 to June 30, 2018. Drug therapy problems were identified by using Cipolle’s and strand’s drug related problem classification method. Patient’s written informed consent was obtained after explaining the purpose of the study. Patient’s specific data were collected using structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug therapy problems occurrence, multiple stepwise backward logistic regression analysis was done. The 95% CI was used to show the accuracy of data analysis and statistical significance was considered at p-value < 0.05. A total of 304 pediatric patients were included in the study. Of these, 226(74.3%) patients had at least one drug therapy problem during their hospital stay. A total of 356 drug therapy problems were identified among two hundred twenty six patients. Non-compliance (28.65%) and dose too low (27.53%) were the most common type of drug related problems while disease comorbidity [AOR=3.39, 95% CI= (1.89-6.08)], Polypharmacy [AOR=3.16, 95% CI= (1.61-6.20)] and more than six days stay in hospital [AOR=3.37, 95% CI= (1.71-6.64) were independent predictors of drug therapy problem occurrence. Drug therapy problems were common in pediatric patients with infectious disease in the study area. Presence of comorbidity, polypharmacy and prolonged hospital stay were the predictors of drug therapy problem in study area. Therefore, to overcome the significant gaps in pediatric pharmaceutical care, clinical pharmacists, Pediatricians, and other health care professionals have to work in collaboration.

Keywords: drug therapy problem, pediatric, infectious disease, Ethiopia

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Authors: Zeplin Jiwa Husada Tarigan, Sautma Ronni Basana, Widjojo Suprapto

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Manufacturing companies in East Java develop their own ERP system or alter the ERP system which is developed by other companies to suit their needs. To make their own system, the companies mostly assign several employees from various departments to create a project team, and the employees are from the departments that are going to utilize the ERP system as the integrated data. The project team decides the making of the ERP system from the preparation stage until the going live implementation process. In designing the business process, the top management is working together with the project team until the project is accomplished. The completion of the ERP projects depends on the project to be undertaken itself, the strategy chosen to complete the project, the work method selection, the measurement system to monitor the project, the evaluation system of the project, and, in the end, the declaration of 'going live' of the ERP project. There is an increase in the business performance for the companies that have implemented the information technology or ERP as they manage to integrate all management functions within their companies. To investigate, some questionnaires are distributed to 100 manufacturing companies, and 90 questionnaires are returned; however, there are only 46 companies that develop their own ERP system, so the response rate is 46%. The result of data analysis using PLS shows that the management competency brings impacts to the project team and the process design. The process design is adjusted to the real process in order to implement the ERP, but it does not bring direct impacts to the business performance. The implementation of ERP brings positive impacts to the company business performance.

Keywords: management competency, project team, process design, ERP implementation, business performance

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Authors: Mohamed Adel Ahmed, Warda Youssef Morsy , Hanaa Ali El Feky

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Background: Literature review cited that sleep is absolutely essential for surviving and reclamation of the quality of life. Critically ill patients often have poor sleep quality with prolonged sleep latency, sleep fragmentation, decreased sleep efficiency and frequent arousals. Nurses have a unique role for the early diagnosis of sleep disorders, decreasing stressors levels and providing the necessary environmental regulations to create a therapeutic ambiance. The aim of the study: to assess perceived sleep quality and identify factors affecting sleep quality among adult critically ill patients At El Manial University Hospital. Research Design: A descriptive exploratory design was utilized. Research questions: a) how do adult critically ill patients perceive sleep quality in the Critical Care Department of El Manial University Hospital? b) What are the factors affecting sleep quality among adult critically ill patients at El Manial University Hospital? Setting: selected critical and cardiac care units at El Manial University Hospital. Sample: A samples of convenience consisting of 100 adult male and female patients were included in the study. Tools of data collection: tool 1: Socio-demographic and Medical Data Sheet, tool 2: Modified St Mary's Hospital Sleep Questionnaire tool 3: Factors Affecting Sleep Quality Questionnaire among ICU Patients Results: The current study revealed that 76.0% of the studied sample had lack of sleep disturbance before hospitalization. However, 84 % had sleep disturbances during ICU stay, of these more than two-thirds (67 %) had moderate sleep disturbance. Presence of strange and bad odors, noise, having pain, fear of death and a loud voice produced by the ICU personnel had the most significant negative impact on patients’ sleep in percentage of 52.4, 50, 61.9, 45.2, 52.4, respectively. Conclusion: Sleep disturbances in the ICU are multifactorial, and ICU patients’ perceived degrees of sleep disturbance as a moderate. Recommendations: Based on findings of the present study, the following are recommended to be done by ICU nurses; create a healing ICU environment that should incorporate noise, light and temperature controls; decrease stimuli during night time hours to promote regulation of the circadian rhythm, allow usage of sleeping aids such as relaxing music, eye patches and earplugs into their daily nursing practice; cluster nursing activities and eliminate non-essential treatments during night time hours to allow uninterrupted sleep periods of at least 90 minutes to complete one sleep cycle , and minimize staff conversation, alarm noise and light during the quiet night time hours.

Keywords: sleep quality, critically ill, patients, perception

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Authors: Oktawia Braniewicz

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The phenomenon of emigration and migration increasingly affects Poland's borders as well. For this reason, it is necessary to examine the level of protection of Human Rights in Polish Centres for Foreigners. The field study covered 11 centers for Foreigners in the provinces Kujawsko-Pomorskie Region, Lubelskie Region, Lodzkie Region, Mazowieckie Region and Podlaskie Region. Photographic documentation of living and social conditions, conversations with center employees and refugees allow to show a comprehensive picture of the situation prevailing in Centres for Foreigners. The object of reflection will be, in particular, the standards resulting from art. 8 and 13 of the Convention for the Protection of Human Rights and Fundamental Freedoms and article 2 of Protocol No. 1 to the Convention for the Protection of Human Rights and Fundamental Freedoms. The degree of realization of the right to education and the right to respect for family and private life will be shown. Issues related to learning the Polish language, access to a professional translator and psychological help will also be approximated. Learning Polish is not obligatory, which causes problems with assimilation and integration with other members of the new community. In centers for foreigners, there are no translators - a translator from an external company is rented if necessary. The waiting time for an interpreter makes the refugees feel anxious, unable to communicate with the employees of the centers (this is a situation in which the refugees do not know either English, Polish or Russian). Psychologist's help is available on designated days of the week. There is no separate specialist in child psychology, which is a serious problem.

Keywords: human rights, Polish centres, foreigners, fundamental freedoms

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Authors: Ledi Neçaj

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Introduction: Cardio-respiratory rehabilitation is the set of coordinated interventions needed to provide the best physical, psychological, and social conditions so that patients with chronic or post-acute cardiopulmonary disease, with their efforts, maintain or resume optimal functioning in society through improved health behaviors. Purpose: To study the effectiveness of the application of Cardio-Respiratory Rehabilitation in the typology of patients with chronic or post-acute cardiomyopathy and chronic respiratory diseases in order to facilitate their therapeutic use and to improve the overall quality of life. Material and Method: This is a prospective study including patients with COPD and cardiac disease who were included in the rehabilitation program during the period January 2019 - November 2021. The study was conducted at the University Hospital Center "Mother Teresa" in Tirana, University Hospital "SHEFQET NDROQI", AMERICAN Hospital, HYGEA Hospital, and "Our Lady of Good Counsel, Tirana". An individual chart was used to collect sociodemographic, physical, clinical, and functional examinations for each patient. Results: The study included 253 patients, with a mean age of 62.1 (± 7.9) years, ranging from 48 to 82 years. (67.6%) of the patients were males, and (32.4%) female. Male patients predominated in all age groups, with a statistically significant difference with females (p<0.01). The most common cardiac pathologies are coronary artery bypass (24%), cerebral stroke (9%), myocardial infarction (17%), Stent placement (8%) (p<0.01). Correlation matrix of risk factors found a significant correlation of alcohol consumption with diabetes, smoking, dyslipidemia, sedentary life, obesity, AVC, and hypertension. Functional capacity estimated by change in metabolic equivalents (MET) improved by 46% from 4. ±2.2 to 7.2± .8 METs (p<0.01). Duration of exercise after rehabilitation was increased by 21% compared to baseline (p<0.01). The mean score of all three subscales of the questionnaire: symptoms (p=0.03), activity (p<0.01), and impact (p<0.01) after rehabilitation, was lower compared to pre-rehabilitation. Conclusions: The rehabilitation program has impacted on improving the quality of life, reducing symptoms, reducing the impact of negative factors on daily life, and reducing dyspnea during daily activities.

Keywords: cardio-respiratory rehabilitation, physical exercise, quality of life, diseases

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Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

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Authors: En-Tzu Wang, Ting-Ann Wang, Yi-Hui Shen, Yu-Min Chou, Chi-Tai Fang, Chin-Hui Yang

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Background and purpose: A mass varicella immunization program was established to provide free 1-dose vaccination for all 1-year-old children throughout Taiwan since 2004. The epidemiological characteristics and disease burden of varicella from 2000 to 2012 was investigated and the results will be essential to refine the national immunization policy. Method: We included patients (n = 17,838–164,245) with ICD-9-CM codes 052 (chickenpox) from the 2000 to 2012 National Health Insurance Database. The age, period, and cohort-specific incidence of varicella were calculated. The hospital admission rate, medical costs and indirect costs from the societal perspective of varicella including travel costs to the medical facility, registration fee, productivity losses of the patients and caregivers were also estimated. Result: There were 979,252 patients for medical treatment due to varicella from 2000 to 2012 in Taiwan. The implementation of a routine childhood varicella vaccination program has resulted in 87% decline in morbidity (881.49 to 115.17 per 100,000). The average age of patients increased from 7.9 years to 16.3 years. The overall varicella-related hospital admission rate was 15.5 per 1000 patients, and peaked in the groups of infants younger than 1 year, adults aged from 20 to 39 years and elders over 70 years. Among patients admitted to hospital, 33.5% of them had one or more complications. Patients with underlying diseases had higher admission rate (241.6 per 1,000) and longer duration of hospital stay (6.61 days vs. 4.76 days). The annual varicella-related medical expense declined after 2002 and the proportion of medical costs for admission has increased to 42%. The annual indirect costs from the societal perspective of varicella were 5.29 to 9.63 times higher than varicella-related medical costs. Every one dollar invested in the varicella immunization program, 2.97 dollars of medical and social costs were saved on average. Conclusion: The dramatic decline in morbidity, hospitalization, medical and social costs of varicella can be directly attributed to the implementation of the mass immunization program. Two-dose vaccination is recommended for both children with underlying diseases and susceptible adults to prevent serious complications and hospitalizations.

Keywords: disease burden, epidemiology, medical and social costs, varicella, varicella vaccine

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Authors: Margaret Denise P. Del Rosario, Geraldine Alcantara

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Background: The declaration of the COVID-19 pandemic has impacted hospital visits of child abuse cases with less consults but more severe injuries. Objective: The study aims to identify the clinical profiles of patients seen in the hospital ng Makati Women and Children Protection Unit before and during the pandemic. Design: A cross-sectional analytic study design through review of records that underwent quantitative analysis. Results: 264 cases pre-pandemic and 208 cases during the pandemic were reviewed. Most reported cases were neglect comprising of 47% of the pre-pandemic cases and 68% of cases during the pandemic. Supervisory neglect was most commonly reported. An equal distribution between males and females were seen among victims and alleged perpetrators. The age group of both victims and alleged perpetrators during the pandemic was significantly younger compared to the pre-pandemic period. Children belonging to larger family groups were commonly encountered with most of them being the eldest amongst siblings. Alleged perpetrators were mostly secondary graduates for both time periods. A significant increase of cases during the pandemic occurred at home. More patients required hospitalization during the pandemic period with 37% compared to the 23% of admissions prior to the pandemic. Furthermore, a three-fold increase of injuries sustained during the pandemic required intensive care. Conclusion: The study reflects increased severity of injuries related to abuse during the pandemic compared to pre-pandemic times. A significant increase in injuries requiring intensive care were also seen despite less reported cases.

Keywords: child abuse, COVID-19, violence against children, WCPU, neglect

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Authors: Edo Shonin, William Van Gordon, Mark D. Griffiths

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Due to its potential to concurrently improve Work-Related Wellbeing (WRW) and job performance; occupational stakeholders are becoming increasingly interested in meditation. Despite this, there is a scarcity of methodologically robust research examining the utility of meditation within occupational contexts. This study conducted the first randomized controlled trial to assess the effects of meditation on outcomes relating to both WRW and job performance. Office-based middle-hierarchy managers (n=152) were allocated to either an eight-week meditation intervention (Meditation Awareness Training: MAT) or an active control intervention. MAT participants demonstrated significant improvements (with strong effect-sizes) over control-group participants in levels of work-related stress, job satisfaction, psychological distress, and employer-rated job performance. It is concluded that MAT appears to be effective for improving both WRW and job performance in middle-hierarchy managers. There are a number of novel implications: (i) meditation can effectuate a perceptual shift in how employees experience their work and psychological environment and may thus constitute a cost-effective WRW intervention, (ii) meditation-based (i.e., present-moment-focused) working styles may be more effective than goal-based (i.e., future-orientated) working styles, and (iii) meditation may reduce the separation made by employees between their own interests and those of the organizations they work for.

Keywords: work-related stress, workplace wellbeing, occupational stress, job performance, meditation awareness training, mindfulness

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Authors: Ashgar Ali Ali Mohamed, Farheen Baig Sardar Baig

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In Malaysia, the Whistle-blower Protection Act 2010 provides protection to a person in an organization who exposes misconduct, alleged dishonest or illegal activity that violates the existing laws, among others. For example, alleged fraud, health and safety violations, and corruption, to name but a few. Undeniable, most whistle-blowers are internal to an organisation who report misconduct of a fellow employee or superior within their company and they frequently face reprisal at the hands of the organisation which they have accused. In fact, many people do not consider blowing the whistle because of fear of retaliation and losing their relationships at workplace. Although whistle-blowers are protected under law from employer retaliation, there have been many cases where punishment for whistleblowing has occurred, such as suspension, demotion, termination, or harsh mistreatment by other employees. Hence, this paper will analyse the adequacy of the legal protection available to employees who whistle-blow on their employers with reference to the Whistle-blower Protection Act 2010. Reference will also be made to the approach taken in other selected jurisdiction with a view of highlighting the adequacy of the Malaysian legislation on this subject besides strengthen employee whistle-blower protection. Further, reference is also made to the Islamic approach on this subject with particular reference to the concept of amr-bil-Ma’roof (ordering for acknowledged virtues) and nahi anil munkar (forbidding from sin). Allah (SWT) says: “And there should be a group amongst you who invite towards good, order for acknowledged virtues, forbid from sin and these it is that are the successful ones” (Al Imran(Chp 3), verse 104).

Keywords: whistleblower protection, employee whistleblower, detrimental and reprisal, Malaysian law

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Authors: Chaiyaporn Yuksen, Tapanawat Chaiwan

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Introduction: Emergency medical service (EMS) care for trauma patients must be provided on-scene assessment and essential treatment and have appropriate transporting to the trauma center. The shock index (SI), reverse shock index Glasgow Coma Scale (rSIG), and National Early Warning Score (NEWS) triage tools are easy to use in a prehospital setting. There is no standardized on-scene triage protocol in prehospital care. The primary objective was to determine the accuracy of SI, rSIG, and NEWS to predict the severity of trauma patients in the emergency department (ED). Methods: This was a retrospective cross-sectional and diagnostic research conducted on trauma patients transported by EMS to the ED of Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand, from January 2015 to September 2022. We included the injured patients receiving prehospital care and transport to the ED of Ramathibodi Hospital by the EMS team from January 2015 to September 2022. We compared the on-scene parameter (SI, rSIG, and NEWS) and ED (Emergency Severity Index) with the area under ROC. Results: 218 patients were traumatic patients transported by EMS to the ED. 161 was ESI level 1-2, and 57 was level 3-5. NEWS was a more accurate triage tool to discriminate the severity of trauma patients than rSIG and SI. The area under the ROC was 0.743 (95%CI 0.70-0.79), 0.649 (95%CI 0.59-0.70), and 0.582 (95%CI 0.52-0.65), respectively (P-value <0.001). The cut point of NEWS to discriminate was 6 points. Conclusions: The NEWs was the most accurate triage tool in prehospital seeing in trauma patients.

Keywords: on-scene triage, trauma patient, ED triage, accuracy, NEWS

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Authors: P. H. Tee, S. M. Zamri, K. M. Kasim, S. K. Tiew

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This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.

Keywords: awareness, knowledge, osteoporosis, practices

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