Search results for: healthcare interiors

Authors: Yunyong Guo, Sudhakar Ganti, Bryan Guo

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The rapid growth of telehealth Internet of Things (IoT) devices has raised concerns about energy consumption and efficient data processing. This paper introduces an energy-efficient model that integrates telehealth IoT devices with a fog and cloud computing-based platform, offering a sustainable and robust solution to overcome these challenges. Our model employs fog computing as a localized data processing layer while leveraging cloud computing for resource-intensive tasks, significantly reducing energy consumption. We incorporate adaptive energy-saving strategies. Simulation analysis validates our approach's effectiveness in enhancing energy efficiency for telehealth IoT systems integrated with localized fog nodes and both private and public cloud infrastructures. Future research will focus on further optimization of the energy-saving model, exploring additional functional enhancements, and assessing its broader applicability in other healthcare and industry sectors.

Keywords: energy-efficient, fog computing, IoT, telehealth

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Authors: Hanan M. Hassan, Laila Abouzeid, Lamya H. Al-Wahaibi, George S. G. Shehatou, Ali A. El-Emam

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Cancer is a major public health problem and the second leading cause of death worldwide. In 2020, cancer diagnosis and treatment have been negatively affected by the coronavirus 2019 (COVID-19) pandemic. During the quarantine, because of the limited access to healthcare and avoiding exposure to COVID-19 as a contagious disease; patients of cancer suffered deferments in follow-up and treatment regimens leading to substantial worsening of disease, death, and increased healthcare costs. Thus, this study is designed to investigate the molecular mechanisms by which adamantne derivatives attenuate hepatocllular carcinoma experimentally and theoretically. There is a close association between increased resistance to anticancer drugs and defective apoptosis that considered a causative factor for oncogenesis. Cancer cells use different molecular pathways to inhibit apoptosis, BAX and Bcl-2 proteins have essential roles in the progression or inhibition of intrinsic apoptotic pathways triggered by mitochondrial dysfunction. Therefore, their balance ratio can promote the cellular apoptotic fate. In this study, the in vitro cytotoxic effects of seven synthetic adamantyl isothiorea derivatives were evaluated against five human tumor cell lines by MTT assay. Compounds 5 and 6 showed the best results, mostly against hepatocellular carcinoma (HCC). Hence, in vivo studies were performed in male Sprague-Dawley (SD) rats in which experimental hepatocellular carcinoma was induced with thioacetamide (TAA) (200 mg/kg, i.p., twice weekly) for 16 weeks. The most promising compounds, 5 and 6, were administered to treat liver cancer rats at a dose of 10 mg/kg/day for an additional two weeks, and the effects were compared with doxorubicin (DR), the anticancer drug. Hepatocellular carcinoma was evidenced by a dramatic increase in liver indices, oxidative stress markers, and immunohistochemical studies that were accompanied by a plethora of inflammatory mediators and alterations in the apoptotic cascade. Our results showed that treatment with adamantane derivatives 5 and 6 significantly suppressed fibrosis, inflammation, and other histopathological insults resulting in the diminished formation of hepatocyte tumorigenesis. Moreover, administration of the tested compounds resulted in amelioration of EGFR protein expression, upregulation of BAX, and lessening down of Bcl-2 levels that prove their role as apoptosis inducers. Also, the docking simulations performed for adamantane showed good fit and binding to the EGFR protein through hydrogen bond formation with conservative amino acids, which gives a shred of strong evidence for its hepatoprotective effect. In most analyses, the effects of compound 6 were more comparable to DR than compound 5. Our findings suggest that adamantane derivatives 5 and 6 are shown to have cytotoxic activity against HCC in vitro and in vivo, by more than one mechanism, possibly by inhibiting the TLR4-MyD88-NF-κB pathway and targeting EGFR signaling.

Keywords: adamantane, EGFR, HCC, apoptosis

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Authors: Amira A. Alshowkan, Aleya M. Gamal

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Background: Patient safety is a vital element in providing high quality health care. In psychiatric wards, numerous of physical and emotional factors have been found to affect patient safety. In addition, organization, healthcare provider and patients were identified to be significant factors in patient safety. Aim: This study aims to discover nurses' perception of patient safety in psychiatric wards in Saudi Arabian. Method: Date will be collected through semi-structure face to face interview with nurses who are working at psychiatric wards. Data will be analysed thought the used of thematic analysis. Results: The results of this study will help in understanding the psychiatric nurses' perception of patient safety in Saudi Arabia. Several suggestions will be recommended for formulation of policies and strategies for psychiatric wards. In addition, recommendation to nursing education and training will be tailored in order to improve patient safety culture.

Keywords: patient safety culture, psychiatric, qualitative, Saudi Arabia

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Authors: Etaf Alkhlaifat

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This study drew conceptually on Communication Accommodation Theory to describe and analyze conversations between doctors and patients to examine the extent to which patients’ level of literacy represents one of the linguistic obstacles that may adversely influence the quality of healthcare services in Jordan. A thematic qualitative approach was employed to interpret the phenomena under study, which required direct observation and interviews with doctors (n=6) and patients (n=15) in natural Jordanian medical settings. This generated a comprehensive corpus of audio and videotaped data, which revealed that most doctors expressed dissatisfaction with patients’ ability to express themselves and comprehend them as a result of a lack of medical awareness and limited health education. The significance of this study rests on its detailed investigation of the impact of health literacy on patients’ health outcomes and while providing unique insights into how low health literacy could contribute to misunderstanding and potential ill-health.

Keywords: doctor-patient communication, health literacy, medical knowledge, communication accommodation theory, qualitative research

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Authors: Wan Nur'ashiqin Wan Mohamad, Zarina Othman, Mohd Azman Abas, Azizah Ya'acob, Rozmel Abdul Latiff

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Effective doctor-patient interaction is vital to both doctor and patient relationship. It is the cornerstone of good practice and an integral quality of a healthcare institution. This paper presented the hierarchy of the communication elements in doctor-patient interaction during medical consultations in a medical centre in Malaysia. This study adapted The Picker Patient Experience Questionnaire (2002) to obtain the information from patients. The questionnaire survey was responded by 100 patients between the ages of 20 and 50. Data collected were analysed using Rasch Measurement Model to yield the hierarchy of the communication elements in doctor-patient interaction. The findings showed that the three highest ranking on the doctor-patient interaction were doctor’s treatment, important information delivery and patient satisfaction of doctor’s responses. The results are valuable in developing the framework for communication ethics of doctors.

Keywords: communication elements, doctor-patient interaction, hierarchy, Rasch measurement model

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Authors: John Peter Dacanay, Edison Ramos, Cristopher James Dicang

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Waste management is a global concern due to increasing waste production from changing consumption patterns and population growth. Proper waste disposal management is a critical aspect of public health and environmental protection. In the healthcare industry, medical waste is generated in large quantities, and if not disposed of properly, it poses a significant threat to human health and the environment. Efficient waste management conserves natural resources and prevents harm to human health, and implementing an effective waste management system can save human lives. The study aimed to assess the level of awareness and practices on waste disposal management, highlighting the understanding of proper disposal, potential hazards, and environmental implications among Medical Technology students. This would help to provide more recommendations for improving waste management practices in healthcare settings as well as for better waste management practices in educational institutions. From the collected data, a female of 21 years of age stands out among the respondents. With the frequency and percentage of medical technology students' knowledge of laboratory waste management being high, it indicates that all respondents demonstrated a solid understanding of proper disposal methods, regulations, risks, and handling procedures related to laboratory waste. That said, the findings emphasize the significance of education and awareness programs in equipping individuals involved in laboratory practices with the necessary knowledge to handle and dispose of hazardous and infectious waste properly. Most respondents demonstrate positive practices or are highly mannered in laboratory waste management, including proper segregation and disposal in designated containers. However, there are concerns about the occasional mixing of waste types, emphasizing the reiteration of proper waste segregation. Students show a strong commitment to using personal protective equipment and promptly cleaning up spills. Some students admit to improper disposal due to rushing, highlighting the importance of time management and safety prioritization. Overall, students follow protocols for hazardous waste disposal, indicating a responsible approach. The school's waste management system is perceived as adequate, but continuous assessment and improvement are necessary. Encouraging reporting of issues and concerns is crucial for ongoing improvement and risk mitigation. The analysis reveals a moderate positive relationship between the respondents' knowledge and practices regarding laboratory waste management. The statistically significant correlation with a p-value of 0.26 (p-value 0.05) suggests that individuals with higher levels of knowledge tend to exhibit better practices. These findings align with previous research emphasizing the pivotal role of knowledge in influencing individuals' behaviors and practices concerning laboratory waste management. When individuals possess a comprehensive understanding of proper procedures, regulations, and potential risks associated with laboratory waste, they are more inclined to adopt appropriate practices. Therefore, fostering knowledge through education and training is essential in promoting responsible and effective waste management in laboratory settings.

Keywords: waste disposal management, knowledge, attitude, practices

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Authors: Julie Furst-Bowe

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Over the past decade, there has been significant growth in online courses and programs at all levels of education in the United States. This study explores the growth of online and blended (or hybrid) programs offered by the sixteen technical colleges in the Wisconsin Technical College System (WTCS). The WTCS provides education and training programs to more than 300,000 students each year in career clusters including agriculture, business, energy, information technology, healthcare, human services, manufacturing, and transportation. These programs range from short-term training programs that may lead to a certificate to two-year programs that lead to an associate degree. Students vary in age from high school students who are exploring career interests to employees who are seeking to gain additional skills or enter a new career. Because there is currently a shortage of skilled workers in nearly all sectors in the state of Wisconsin, it is critical that the WTCS is providing fully educated and trained graduates to fill workforce needs in a timely manner. For this study, information on online and blended programs for the past five years was collected from the WTCS, including types of programs, course and program enrollments, course completion rates, program completion rates, time to completion and graduate employment rates. The results of this study indicate that the number of online and blended courses and programs is continuing to increase each year. Online and blended programs are most commonly found in the business, human services, and information technology areas, and they are less commonly found in agriculture, healthcare, manufacturing, and transportation programs. Overall, course and program completion rates were higher for blended programs when compared to fully online programs. Students preferred the blended programs over the fully online programs. Overall, graduates were placed into related jobs at a rate of approximately 90 percent, although there was some variation in graduate placement rates by programs and by colleges. Differences in graduate employment rate appeared to be based on geography and sector as employers did not distinguish between graduates who had completed their programs via traditional, blended or fully online instruction. Recommendations include further exploration as to the reasons that blended courses and programs appear to be more effective than fully online courses and programs. It is also recommended that those program areas that are not using blended or online delivery methods, including agriculture, health, manufacturing and transportation, explore the use of these methods to make their courses and programs more accessible to students, particularly working adults. In some instances, colleges were partnering with specific companies to ensure that groups of employees were completing online coursework leading to a certificate or a degree. Those partnerships are to be encouraged in order for the state to continue to improve the skills of its workforce. Finally, it is recommended that specific colleges specialize in the delivery of specific programs using online technology since it is not bound by geographic considerations. This approach would take advantage of the strengths of the individual colleges and avoid unnecessary duplication.

Keywords: career and technical education, online learning, skills shortage, technical colleges

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: Mohammad Tahir Yousafzai, Rubina Qasim

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We assessed Hepatitis B vaccination and its determinants among health care workers (HCW) in Northwest Pakistan. HCWs from both public and private clinics were interviewed about hepatitis B vaccination, socio-demographic, hepatitis B virus transmission modes, disease threat and benefits of vaccination. Logistic regression was performed. Hepatitis B vaccination was 40% (Qualified Physicians: 86% and non-qualified Dispensers:16%). Being Qualified Physician (Adj. OR 26.6; 95%CI 9.3-73.2), Non-qualified Physician (Adj.OR 1.9; 95%CI 0.8-4.6), qualified Dispensers (Adj. OR 3.6; 95%CI 1.3-9.5) compared to non-qualified Dispensers, working in public clinics (Adj. OR 2.5; 95%CI 1.1-5.7) compared to private, perceived disease threat after exposure to blood and body fluids (Adj. OR 1.1; 95%CI 1.1-1.2) and perceived benefits of vaccination (Adj. OR 1.1; 95%CI 1.1-1.2) were significant predictors of hepatitis B vaccination. Improved perception of disease threat and benefits of vaccination and qualification of HCWs are associated with hepatitis B vaccination.

Keywords: Hepatitis B vaccine, immunization, healthcare workers, primary health

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Authors: Nasir Mustafa

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One of the prerequisites required for an efficient diagnosis in a medical practice is to have a strong command of both functional and clinical anatomy. In this study, we introduce a new collaborative approach to the effective teaching of the knee and hip joints. In the present teaching model, anatomists, orthopedists and physical therapists present the anatomy of the hip and knee joints in small groups. Courses for the hip and knee joints were scheduled during the early stages of the medical curriculum. Students of nursing and physical therapy were grouped together to sensitize to the importance of a collaborative effort. The study results clearly demonstrate that nursing students and physical therapy students appreciated this teaching approach. The collaborative approach further proved to be a suitable method to teach both functional and clinical anatomy of the hip and knee joints. Aside from this training, a collaborative approach between medical students and physical therapy students was also successful for a healthcare organization.

Keywords: hip and knee joint anatomy, collaborative, Anatomy teaching, Nursing students, Physiotherapy students

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Authors: Shelley Y. Hawkins

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Introduction/Background: As technology has grown exponentially in healthcare, nurse educators must prepare Advanced Practice Registered Nurse (APRN) graduates with the knowledge and skills in information systems/technology to support and improve patient care and health care systems. APRN’s are expected to lead in caring for populations who lack accessibility and availability through the use of technology, specifically telehealth. The capacity to effectively and efficiently use technology in patient care delivery is clearly delineated in the American Association of Colleges of Nursing (AACN) Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) Essentials. However, APRN’s have minimal, or no, exposure to formalized telehealth education and lack necessary technical skills needed to incorporate telehealth into their patient care. APRN’s must successfully master the technology using telehealth/telemedicine, electronic health records, health information technology, and clinical decision support systems to advance health. Furthermore, APRN’s must be prepared to lead the coordination and collaboration with other healthcare providers in their use and application. Aim/Goal/Purpose: The purpose of this presentation is to establish and operationalize telehealth-focused educational partnerships between one University School of Nursing and two health care systems in order to enhance the preparation of APRN NP students for practice, teaching, and/or scholarly endeavors. Methods: The proposed project was initially presented by the project director to selected multidisciplinary stakeholders including leadership, home telehealth personnel, primary care providers, and decision support systems within two major health care systems to garner their support for acceptance and implementation. Concurrently, backing was obtained from key university-affiliated colleagues including the Director of Simulation and Innovative Learning Lab and Coordinator of the Health Care Informatics Program. Technology experts skilled in design and production in web applications and electronic modules were secured from two local based technology companies. Results: Two telehealth-focused APRN Program academic/practice partnerships have been established. Students have opportunities to engage in clinically based telehealth experiences focused on: (1) providing patient care while incorporating various technology with a specific emphasis on telehealth; (2) conducting research and/or evidence-based practice projects in order to further develop the scientific foundation regarding incorporation of telehealth with patient care; and (3) participating in the production of patient-level educational materials related to specific topical areas. Conclusions: Evidence-based APRN student telehealth clinical experiences will assist in preparing graduates who can effectively incorporate telehealth into their clinical practice. Greater access for diverse populations will be available as a result of the telehealth service model as well as better care and better outcomes at lower costs. Furthermore, APRN’s will provide the necessary leadership and coordination through interprofessional practice by transforming health care through new innovative care models using information systems and technology.

Keywords: academic/practice partnerships, advanced practice nursing, nursing education, telehealth

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Authors: A. Alrasheed, I. Connerton

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Daily provision of high quality food and hygiene to patients is a challenging goal of the healthcare. In Saudi Arabia, matters related to food safety and hygiene are regulated by the Ministry of Health (MOH) and the Saudi Food and Drugs Authority (SFDA). The purpose of this research is to discuss the food safety management inconsistencies and flaws, in particular the ones related to Hazard Analysis and Critical Control Points (HACCP) in Riyadh’s MOH hospitals. As required by law, written HACCP regulations must be implemented, and food handlers need to receive the training accordingly. However, in Saudi hospitals, this is not a requirement, and the food handlers do not need to hold training certificates in food safety or HACCP. Nowadays, the matter of food safety and hygiene have become increasingly important since the decision makers want to align these regulations with the majority of the world and to implement HACCP fully and for this purpose, the SFDA was established. 

Keywords: food safety, patients, hospitals, HACCP, Saudi Arabia

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Authors: Julius Lenaerts, Ahmed Elsaadawy, Mohammed Bashir

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Background Sedated and paralyzed patients have an impaired blink reflex leading to ophthalmic complications such as conjunctivitis, epithelial defects, bacterial keratitis, and more. These are entirely preventable complications through regular eye care. Methods Patients at level 3 or above (intubated/paralyzed) care in the Intensive Care Unit (ICU) were reviewed between February and April. Data was pulled from Metavision and adherence was compared to Royal College of Ophthalmology (RCOphth) recommendations[4]. Using a multi-pronged approach through posters, individual teaching sessions and faculty teaching, we aimed to educate staff about eye care in the ICU. Patients were reaudited in the period July to August. Results Out of 40 patients, only 23% were assessed for eye care needs on admission compared to 77% after teaching; eye care was only delivered 59% of the time it was due, compared to 61%; 2.5% of patients had eyedrops prescribed compared to 41%. This shows an overall increase in meeting RCOphth standards. Key messages Eye care is an overlooked aspect of patient care in the ICU, associated with avoidable ocular complications. Healthcare staff need further rigorous education on the provision and importance of eye care to reduce avoidable complications.

Keywords: ICU, eye care, risk, QIP

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Authors: Alaa Abdellatif, Gabrièle Breda

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Background. Advanced therapy medicinal products (ATMPs) are innovative therapies that mainly target orphan diseases and high unmet medical needs. ATMP includes gene therapy medicinal products (GTMP), somatic cell therapy medicinal products (CTMP), and tissue-engineered therapies (TEP). Since legislation opened the way in 2007, 25 ATMPs have been approved in the EU, which is about the same amount as the U.S. Food and Drug Administration. However, not all of the ATMPs that have been approved have successfully reached the market and retained their approval. Objectives. We aim to understand all the factors limiting the market access to very promising therapies in a systemic approach, to be able to overcome these problems, in the future, with scientific, regulatory and commercial innovations. Further to recent reviews that focus either on specific countries, products, or dimensions, we will address all the challenges faced by ATMP development today. Methodology. We used mixed methods and a multi-level approach for data collection. First, we performed an updated academic literature review on ATMP development and their scientific and market access challenges (papers published between 2018 and April 2023). Second, we analyzed industry feedback from cell and gene therapy webinars and white papers published by providers and pharmaceutical industries. Finally, we established a comparative analysis of the regulatory guidelines published by EMA and the FDA for ATMP approval. Results: The main challenges in bringing these therapies to market are the high development costs. Developing ATMPs is expensive due to the need for specialized manufacturing processes. Furthermore, the regulatory pathways for ATMPs are often complex and can vary between countries, making it challenging to obtain approval and ensure compliance with different regulations. As a result of the high costs associated with ATMPs, challenges in obtaining reimbursement from healthcare payers lead to limited patient access to these treatments. ATMPs are often developed for orphan diseases, which means that the patient population is limited for clinical trials which can make it challenging to demonstrate their safety and efficacy. In addition, the complex manufacturing processes required for ATMPs can make it challenging to scale up production to meet demand, which can limit their availability and increase costs. Finally, ATMPs face safety and efficacy challenges: dangerous adverse events of these therapies like toxicity related to the use of viral vectors or cell therapy, starting material and donor-related aspects. Conclusion. As a result of our mixed method analysis, we found that ATMPs face a number of challenges in their development, regulatory approval, and commercialization and that addressing these challenges requires collaboration between industry, regulators, healthcare providers, and patient groups. This first analysis will help us to address, for each challenge, proper and innovative solution(s) in order to increase the number of ATMPs approved and reach the patients

Keywords: advanced therapy medicinal products (ATMPs), product development, market access, innovation

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Authors: Paveenapat Nithitantiwat, Kwanjai Pataipakaipet

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The purpose of this research was to study the happiness level of nursing students, Boromarajonani College of nursing, Ratchaburi, Thailand. A purposive sampling of 652 first to four-year nursing students was used. This research is descriptive research. The instruments were questionnaires that developed by the researcher. It included the demographic data and nursing student’s perception about healthcare, safety, life security, family, proud of oneself, education and activities, dormitories and environment in college, and how to improve their happiness. Frequencies, percentage, mean, and T-test is used to analysis the data. The results of the research have shown that family and moral value was an important thing in nursing student’s life. In addition, the mean of the happiness level was a high level. The first year nursing students had the higher mean score of the happiness level than the fourth year, second year, and the third year, respectively. Therefore, nursing students would realize that the important things in their life are family and Buddhism’s teaching. In addition, dharma is guideline how to be both academic achievements and successful in life.

Keywords: happiness, nursing students, nursing students’ perceptions, bachelor program

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Authors: P. S. Surya Meghana, K. Lingeshwaran, C. Kannan, V. Raghavendran, C. Priya

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One of the most basic and powerful tools in all of science and medicine is the light microscope, the fundamental device for laboratory as well as research purposes. With the improving technology, the need for portable, economic and user-friendly instruments is in high demand. The conventional microscope fails to live up to the emerging trend. Also, adequate access to healthcare is not widely available, especially in developing countries. The most basic step towards the curing of a malady is the diagnosis of the disease itself. The main aim of this paper is to diagnose Malaria with the most common device, cell phones, which prove to be the immediate solution for most of the modern day needs with the development of wireless infrastructure allowing to compute and communicate on the move. This opened up the opportunity to develop novel imaging, sensing, and diagnostics platforms using mobile phones as an underlying platform to address the global demand for accurate, sensitive, cost-effective, and field-portable measurement devices for use in remote and resource-limited settings around the world.

Keywords: cellular, hand-held, health care, image processing, malarial parasites, microscope

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Authors: Areej Makeineldein Mustafa

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The study evaluates the management processes and healthcare provider compliance with the National Institute for Health and Care Excellence recommendations for constipation management. We aimed to evaluate the adherence to National Institute for Health and Care Excellence guidelines in the management of constipation during the period from February to June 2023. We collected data from a random sample ( 51 patients) over 4 months with inclusion criteria for patients above 60 who were just admitted to the care of the elderly department during this period. Patient age, sex, medical records for constipation, acute or chronic constipation, or opioid-induced constipation, and treatment options were used to identify constipation and the type of treatment given. Our findings indicate that there is a gap between practice and National Institute for Health and Care Excellence guideline steps; only 3 patient was given medications according to National Institute for Health and Care Excellence guidelines in order of combination or steps of escalation. Addressing these gaps could potentially lead to enhanced patient outcomes and an overall improvement in the quality of care provided to individuals suffering from constipation.

Keywords: constipation, elderly, management, patient

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Authors: Tarek M. Alguhane, Ayman H. Khalil, Nour M. Fayed, Ayman M. Ismail

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Early, pre-code, reinforced concrete structures present undetermined resistance to earthquakes. This situation is particularly unacceptable in the case of essential structures, such as healthcare structures and pilgrims' houses. Among these, existing old RC building in Madinah is seismically evaluated with and without infill wall and their dynamic characteristics are compared with measured values in the field using ambient vibration measurements (AVM). After, updating the mathematical models for this building with the experimental results, three dimensional pushover analysis (Nonlinear static analysis) was carried out using SAP 2000 software incorporating inelastic material properties for concrete, infill and steel. The purpose of this analysis is to evaluate the expected performance of structural systems by estimating, strength and deformation demands in design, and comparing these demands to available capacities at the performance levels of interest. The results are summarized and discussed.

Keywords: seismic assessment, pushover analysis ambient vibration, modal update

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Authors: Partha Pratim Kalita

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As sound can be converted to light, light can also be deduced to sound. There are technologies to convert light to sound, but there are not many technologies related to the field where sound can be converted to a distinct vibrational sequence of light. Like the laws under which the principles of sound work, there are principles for the light to become quantum in nature. Thus, as we move from sound to the subtler aspects of light, we are moving from 3D to 5D. Either we will be making technologies of 3D in today’s world, or we will be really interested in making technologies of the 5D, depends on our understanding of how quantum 5D works. Right now, the entire world is talking about quantum, which is about the nature and behavior of subatomic particles, which is 5D. In practice, they are using metals and machines based on atomic structures. If we talk of quantum without taking note of the technologies of 5D and beyond, we will only be reinterpreting relative theories in the name of quantum. This paper, therefore, will explore the possibilities of moving towards quantum in its real essence with the Shoonya ecosystem (zero-point energy). In this context, the author shall highlight certain working models developed by him, which are currently in discussion with the Indian government.

Keywords: quantum mechanics, quantum technologies, healthcare, shoonya ecosystem, energy, human consciousness

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Authors: Ronit Chakraborty, Sugata Banerji

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There has been a marked increase in the reported prevalence of Autism Spectrum Disorder (ASD) among children in the US over the past two decades. This research has analyzed the growth in state-level ASD prevalence against 45 different potentially explanatory factors, including socio-economic, demographic, healthcare, public policy, and political factors. The goal was to understand if these factors have adequate predictive power in modeling the differential growth in ASD prevalence across various states and if they do, which factors are the most influential. The key findings of this study include (1) the confirmation that the chosen feature set has considerable power in predicting the growth in ASD prevalence, (2) the identification of the most influential predictive factors, (3) given the nature of the most influential predictive variables, an indication that a considerable portion of the reported ASD prevalence differentials across states could be attributable to over and under diagnosis, and (4) identification of Florida as a key outlier state pointing to a potential under-diagnosis of ASD there.

Keywords: autism spectrum disorder, clustering, machine learning, predictive modeling

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Authors: Haitham Assiri, Priyadarsi Nanda

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The world is gradually entering the fourth industrial revolution. E-Government services are scaling government operations across the globe. However, as promising as an e-Government system would be, it is also susceptible to malicious attacks if not properly secured. This study found out that, in Saudi Arabia, the e-Government website, Yesser is vulnerable to external attacks. Obviously, this can lead to a breach of data integrity and privacy. In this paper, a Systematic Literature Review was conducted to explore possible ways the Kingdom of Saudi Arabia can take necessary measures to strengthen its e-Government system using Blockchain. Blockchain is one of the emerging technologies shaping the world through its applications in finance, elections, healthcare, etc. It secures systems and brings more transparency. A total of 28 papers were selected for this SLR, and 19 of the papers significantly showed that blockchain could enhance the security and privacy of Saudi’s e-government system. Other papers also concluded that blockchain is effective, albeit with the integration of other technologies like IoT, AI and big data. These papers have been analysed to sieve out the findings and set the stage for future research into the subject.

Keywords: blockchain, data integrity, e-government, security threats

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Authors: Ram Sharan Mehta

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Continuing changes in health and social care policy and practice have affected and changed the way in which nursing is practiced. One of the greatest challenges facing nursing today is to build on the essence of nursing as a caring profession whilst incorporating new technologies, ideas and approaches to future healthcare. The objective of this study was to find out the socio-demographic characteristics of the M.Sc. Nursing students and calculate the association between specialty subjects, caste, age group, and residence with SLC division, BN/BSN division, entrance score, and total nursing experience. Descriptive cross-sectional study design was used to conduct the study among all the 25 M.Sc. Nursing students studying at BPKIHS in 2012. Most of the students (56%) were of age group of 25-30 years, completed his academic courses with first division and succeeded in entrance test in first attempt (96%). Based on the results, it can conclude that most of the subjects were of young age, having high score achievers in SLC, I.Sc., CN, BN/BSN and Entrance test. The demographic characteristics do not influence in the academic scores of the students.

Keywords: profile, postgraduate nursing students, Nepal, influence

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Authors: Sabrina Neururer, Marco Schweitzer, Werner Hackl, Bernhard Tilg, Patrick Raudaschl, Andreas Huber, Bernhard Pfeifer

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History and the current outbreak of Covid-19 have shown the deadly potential of infectious diseases. However, infectious diseases also have a serious impact on areas other than health and healthcare, such as the economy or social life. These areas are strongly codependent. Therefore, disease control measures, such as social distancing, quarantines, curfews, or lockdowns, have to be adopted in a very considerate manner. Infectious disease modeling can support policy and decision-makers with adequate information regarding the dynamics of the pandemic and therefore assist in planning and enforcing appropriate measures that will prevent the healthcare system from collapsing. In this work, an agent-based simulation package named “survival” for simulating infectious diseases is presented. A special focus is put on SARS-Cov-2. The presented simulation package was used in Austria to model the SARS-Cov-2 outbreak from the beginning of 2020. Agent-based modeling is a relatively recent modeling approach. Since our world is getting more and more complex, the complexity of the underlying systems is also increasing. The development of tools and frameworks and increasing computational power advance the application of agent-based models. For parametrizing the presented model, different data sources, such as known infections, wastewater virus load, blood donor antibodies, circulating virus variants and the used capacity for hospitalization, as well as the availability of medical materials like ventilators, were integrated with a database system and used. The simulation result of the model was used for predicting the dynamics and the possible outcomes and was used by the health authorities to decide on the measures to be taken in order to control the pandemic situation. The survival package was implemented in the programming language Java and the analytics were performed with R Studio. During the first run in March 2020, the simulation showed that without measures other than individual personal behavior and appropriate medication, the death toll would have been about 27 million people worldwide within the first year. The model predicted the hospitalization rates (standard and intensive care) for Tyrol and South Tyrol with an accuracy of about 1.5% average error. They were calculated to provide 10-days forecasts. The state government and the hospitals were provided with the 10-days models to support their decision-making. This ensured that standard care was maintained for as long as possible without restrictions. Furthermore, various measures were estimated and thereafter enforced. Among other things, communities were quarantined based on the calculations while, in accordance with the calculations, the curfews for the entire population were reduced. With this framework, which is used in the national crisis team of the Austrian province of Tyrol, a very accurate model could be created on the federal state level as well as on the district and municipal level, which was able to provide decision-makers with a solid information basis. This framework can be transferred to various infectious diseases and thus can be used as a basis for future monitoring.

Keywords: modelling, simulation, agent-based, SARS-Cov-2, COVID-19

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Authors: Khachen Kongpakwattana, Nathorn Chaiyakunapruk

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Background: Decision-analytic models for Alzheimer’s disease (AD) have been advanced to discrete-event simulation (DES), in which individual-level modelling of disease progression across continuous severity spectra and incorporation of key parameters such as treatment persistence into the model become feasible. This study aimed to apply the DES to perform a cost-effectiveness analysis of treatment for AD in Thailand. Methods: A dataset of Thai patients with AD, representing unique demographic and clinical characteristics, was bootstrapped to generate a baseline cohort of patients. Each patient was cloned and assigned to donepezil, galantamine, rivastigmine, memantine or no treatment. Throughout the simulation period, the model randomly assigned each patient to discrete events including hospital visits, treatment discontinuation and death. Correlated changes in cognitive and behavioral status over time were developed using patient-level data. Treatment effects were obtained from the most recent network meta-analysis. Treatment persistence, mortality and predictive equations for functional status, costs (Thai baht (THB) in 2017) and quality-adjusted life year (QALY) were derived from country-specific real-world data. The time horizon was 10 years, with a discount rate of 3% per annum. Cost-effectiveness was evaluated based on the willingness-to-pay (WTP) threshold of 160,000 THB/QALY gained (4,994 US$/QALY gained) in Thailand. Results: Under a societal perspective, only was the prescription of donepezil to AD patients with all disease-severity levels found to be cost-effective. Compared to untreated patients, although the patients receiving donepezil incurred a discounted additional costs of 2,161 THB, they experienced a discounted gain in QALY of 0.021, resulting in an incremental cost-effectiveness ratio (ICER) of 138,524 THB/QALY (4,062 US$/QALY). Besides, providing early treatment with donepezil to mild AD patients further reduced the ICER to 61,652 THB/QALY (1,808 US$/QALY). However, the dominance of donepezil appeared to wane when delayed treatment was given to a subgroup of moderate and severe AD patients [ICER: 284,388 THB/QALY (8,340 US$/QALY)]. Introduction of a treatment stopping rule when the Mini-Mental State Exam (MMSE) score goes below 10 to a mild AD cohort did not deteriorate the cost-effectiveness of donepezil at the current treatment persistence level. On the other hand, none of the AD medications was cost-effective when being considered under a healthcare perspective. Conclusions: The DES greatly enhances real-world representativeness of decision-analytic models for AD. Under a societal perspective, treatment with donepezil improves patient’s quality of life and is considered cost-effective when used to treat AD patients with all disease-severity levels in Thailand. The optimal treatment benefits are observed when donepezil is prescribed since the early course of AD. With healthcare budget constraints in Thailand, the implementation of donepezil coverage may be most likely possible when being considered starting with mild AD patients, along with the stopping rule introduced.

Keywords: Alzheimer's disease, cost-effectiveness analysis, discrete event simulation, health technology assessment

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Authors: David Parmenter, Brian Millar

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Obstructive sleep apnoea is a common condition which is generally under-diagnosed. Poorly managed obstructive sleep apnoea carries serious health risks and can greatly impact on the sufferer's quality of life. This publication covers the aetiology, symptoms, and treatment of sleep apnoea. The treatment of Obstructive Sleep Apnoea is an emerging field, and the useful role of the Dental Team is relatively unknown, therefor this paper will highlight the role of the dental team in its treatment. The concept of mandibular advancement appliances, along with the clinical and laboratory stages for constructing them, are documented. It is the hope of the author that this publication will educate healthcare professionals on the role of dental practitioners in the multidisciplinary team for treating sleep apnoea. Objective: Individuals should be more aware of the demographic of patients at risk of sleep apnoea, how it is diagnosed and which group of sleep apnoea patients are suitable to refer for mandibular appliance therapy. Individuals should also be aware of what a mandibular advancement appliance is and how it helps treat obstructive sleep apnoea.

Keywords: sleep apnoea, snoring, sleep appliances, mandibular advancement appliance

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Authors: Li Jiuen Ong, Magdalin Cheong, Sri Rahayu, Lek Alexander, Pei Ting Tan

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Background: Previous programme evaluations from the diabetes training programme conducted in Changi General Hospital revealed that healthcare professionals (HCPs) are keen to receive advance diabetes training and education, specifically in medical, nutritional therapy. HCPs also expressed a preference for interactive activities over didactic teaching methods to enhance their learning. Since the War on Diabetes was initiated by MOH in 2016, HCPs are challenged to be actively involved in continuous education to be better equipped to reduce the growing burden of diabetes. Hence, streamlining training to incorporate an element of fun is of utmost importance. Aim: The nutrition programme incorporates game play using an interactive board game that aims to provide a more conducive and less stressful environment for learning. The board game could be adapted for training of community HCPs, health ambassadors or caregivers to cope with the increasing demand of diabetes care in the hospital and community setting. Methodology: Stages for game’s conception (Jaffe, 2001) were adopted in the development of the interactive board game ‘Sweet Score™ ’ Nutrition concepts and topics in diabetes self-management are embedded into the game elements of varying levels of difficulty (‘Easy,’ ‘Medium,’ ‘Hard’) including activities such as a) Drawing/ sculpting (Pictionary-like) b)Facts/ Knowledge (MCQs/ True or False) Word definition) c) Performing/ Charades To study the effects of game play on knowledge acquisition and perceived experiences, participants were randomised into two groups, i.e., lecture group (control) and game group (intervention), to test the difference. Results: Participants in both groups (control group, n= 14; intervention group, n= 13) attempted a pre and post workshop quiz to assess the effectiveness of knowledge acquisition. The scores were analysed using paired T-test. There was an improvement of quiz scores after attending the game play (mean difference: 4.3, SD: 2.0, P<0.001) and the lecture (mean difference: 3.4, SD: 2.1, P<0.001). However, there was no significance difference in the improvement of quiz scores between gameplay and lecture (mean difference: 0.9, 95%CI: -0.8 to 2.5, P=0.280). This suggests that gameplay may be as effective as a lecture in terms of knowledge transfer. All the13 HCPs who participated in the game rated 4 out of 5 on the likert scale for the favourable learning experience and relevance of learning to their job, whereas only 8 out of 14 HCPs in the lecture reported a high rating in both aspects. 16. Conclusion: There is no known board game currently designed for diabetes training for HCPs.Evaluative data from future training can provide insights and direction to improve the game format and cover other aspects of diabetes management such as self-care, exercise, medications and insulin management. Further testing of the board game to ensure learning objectives are met is important and can assist in the development of awell-designed digital game as an alternative training approach during the COVID-19 pandemic. Learning through gameplay increases opportunities for HCPs to bond, interact and learn through games in a relaxed social setting and potentially brings more joy to the workplace.

Keywords: active learning, game, diabetes, nutrition

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Authors: Sisira Edirippulige, Anthony C. Smith, Sumudu Wickramasinghe, Nigel R. Armfield

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Background: E-Health is steadily integrating into modern health services, making significant changes in the way health services are traditionally delivered. To work in this new environment, healthcare workers are required to have new knowledge, skills, and competencies specific to e-Health. The aim of this study was to understand the self-reported perceptions of graduates regarding the influence of an e-Health postgraduate program on their professional careers. Methods: All graduates from 2005 to 2015 were surveyed using an online questionnaire that consisted of a mixture of closed and open-ended questions. Results: The number of participants in the study was 32. Response rate was 62%. Graduates thought that the postgraduate e-Health program had an influence on their professional practice. The majority of the participants mentioned that they had worked in the e-Health field since their graduation. Their professional roles mainly involved implementation of e-Health in health service settings and the use of e-Health in clinical practice. Conclusions: While e-Health may be steadily integrating into modern health services, e-Health specific job opportunities are still relatively limited. E-Health workforce development must be given priority.

Keywords: e-health, postgraduate education, clinical practice, curriculum

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Authors: Rachel S. Chang, Samuel P. Massion, Alan Z. Grusky, Heather A. Ridinger

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Introduction Health advocacy is defined as activities that improve access to care, utilize resources, address health disparities, and influence health policy. Advocacy is increasingly being recognized as a critical component of a physician’s role, as understanding social determinants of health and improving patient care are important aspects within the American Medical Association’s Health Systems Science framework. However, despite this growing prominence, educational interventions that address advocacy topics are limited and variable across medical school curricula. Furthermore, few recent studies have evaluated attitudes toward health advocacy among physicians-in-training in the United States. This study examines medical student attitudes towards health advocacy, along with perceived knowledge, ability, and current level of engagement with health advocacy during their clerkships. Methods This study employed a cross-sectional survey design using a single anonymous, self-report questionnaire to all second-year medical students at Vanderbilt University School of Medicine (n=96) in December 2020 during clerkship rotations. The survey had 27 items with 5-point Likert scale (15), multiple choice (11), and free response questions (1). Descriptive statistics and thematic analysis were utilized to analyze responses. The study was approved by the Vanderbilt University Institutional Review Board. Results There was an 88% response rate among second-year clerkship medical students. A majority (83%) agreed that formal training in health advocacy should be a mandatory part of the medical student curriculum Likewise, 83% of respondents felt that acting as a health advocate or patients should be part of their role as a clerkship student. However, a minority (25%) felt adequately prepared. While 72% of respondents felt able to identify a psychosocial need, 18% felt confident navigating the healthcare system and only 9% felt able to connect a patient to a psychosocial resource to fill that gap. 44% of respondents regularly contributed to conversations with their medical teams when discussing patients’ social needs, such as housing insecurity, financial insecurity, or legal needs. On average, respondents reported successfully connecting patients to psychosocial resources 1-2 times per 8-week clerkship block. Barriers to participating in health advocacy included perceived time constraints, lack of awareness of resources, lower emphasis among medical teams, and scarce involvement with social work teams. Conclusions In this single-institutional study, second-year medical students on clerkships recognize the importance of advocating for patients and support advocacy training within their medical school curriculum. However, their perceived lack of ability to navigate the healthcare system and connect patients to psychosocial resources, result in students feeling unprepared to advocate as effectively as they hoped during their clerkship rotations. Our results support the ongoing need to equip medical students with training and resources necessary for them to effectively act as advocates for patients.

Keywords: clerkships, medical students, patient advocacy, social medicine

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Authors: Murad Almadani, Khalil Abu-Hantash, Xinyu Wang, Herbert Jelinek, Kinda Khalaf

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Gait analysis is used by healthcare professionals as a tool to gain a better understanding of the movement impairment and track progress. In most circumstances, monitoring patients in their real-life environments with low-cost equipment such as cameras and wearable sensors is more important. Inertial sensors, on the other hand, cannot provide enough information on angular dynamics. This research offers a method for tracking 2D joint coordinates using cutting-edge vision algorithms and a single RGB camera. We provide an end-to-end comprehensive deep learning pipeline for marker-less gait parameter estimation, which, to our knowledge, has never been done before. To make our pipeline function in real-time for real-world applications, we leverage the AlphaPose human posture prediction model and a deep learning transformer. We tested our approach on the well-known GPJATK dataset, which produces promising results.

Keywords: gait analysis, human pose estimation, deep learning, real time gait estimation, AlphaPose, transformer

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Authors: Dewaram Abhiman Nagdeve

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

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

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