Search results for: clinical profile

Authors: Ankur Kapur, Moosath Vasudevan

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This movie review looks at the depiction of mental illness in popular cinema, using the movie A Beautiful Mind as a case study. It tries to understand cinema and media from a clinical psychology perspective in terms of the portrayal of symptoms and caregiver support. The review aims to analyze the portrayal of schizophrenia in the book and the movie ‘A Beautiful Mind’ on Professor John Nash. It will analyze the differences in portrayal of schizophrenia, under different media and the creative applications of the author, directors and actors in depicting the disorder as closely as it is understood in Clinical Psychology. The differences would be studied for romanticisation of symptoms in the book and the movie. Even within a medium (only the movie), verbal and non-verbal cues of the disorder will be compared for the depiction of schizophrenia. The study will dwell on the comparative description of how the caregivers coped with the patient and his illness. For this, the study will understand it through the lens of Bowen’s Family Systems Theory.

Keywords: caregiver, communication, media, systems theory

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Authors: Michelle Odudu

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Ghana and Nigeria are known for their high levels of Occupational Fraud in public offices. The governments of both countries have emphasised their commitment to reducing the losses caused to the state by pledging their allegiance to the counter-fraud agencies to help tackle Occupational Fraud. Yet it seems that the prosecution of such cases is ineffective as high-profile fraudsters can operate with immunity and their cases remain unprosecuted. This research project was based on in-depth examinations of 50 occupational fraud cases involving high-profile individuals in both countries. In doing so, it established the characteristics of those who were prosecuted; the extent to which prosecutions were effectively managed; the barriers to effective prosecutions; and the similarities or differences between the occurrences in both countries. The aim of the project is to examine the practice of and barriers to prosecution of large-scale occupational fraud of those in senior public positions in Ghana and Nigeria. The study drew on the experiences of stakeholders such as defence and prosecution barristers, academics, and fraud analysts via semi-structured interviews and questionnaires. 13 interviews were conducted in Ghana and in Nigeria, where respondents were recruited using a snowball approach. Questionnaires were physically distributed: 20 of the staff at EOCO and 10 to NGO staff in Ghana; 6 and 5 came back, respectively. The empirical data collected suggests that there is no lack of will on the agencies’ part to at least commence proceedings. However, various impediments hamper a successful completion of prosecution. Challenges were more evident in Nigeria, where agencies are less effective at retrieving stolen assets and changing social norms. This is further compounded by several cultural and political factors, which create limitations leaving many cases ‘still pending’.

Keywords: comparative, prosecution, punishment, international, whitecollar, fraud

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Authors: S. Sudhakar, Geetha Manjunath, Siva Teja Kakileti, Himanshu Madhu

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Diagnosis of breast cancer at early stages has seen better clinical and survival outcomes. Survival rates in developing countries like India are very low due to accessibility and affordability issues of screening tests such as Mammography. In addition, Mammography is not much effective in younger women with dense breasts. This leaves a gap in current screening methods. Thermalytix is a new technique for detecting breast abnormality in a non-contact, non-invasive way. It is an AI-enabled computer-aided diagnosis solution that automates interpretation of high resolution thermal images and identifies potential malignant lesions. The solution is low cost, easy to use, portable and is effective in all age groups. This paper presents the results of a retrospective comparative analysis of Thermalytix over Mammography and Clinical Breast Examination for breast cancer screening. Thermalytix was found to have better sensitivity than both the tests, with good specificity as well. In addition, Thermalytix identified all malignant patients without palpable lumps.

Keywords: breast cancer screening, radiology, thermalytix, artificial intelligence, thermography

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Authors: Mujahid Ali, Wasif Mohammed Ali, Meraj Ahmad

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Background: Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well as in India. The etiology of perforation peritonitis in India continues to be different from its western counterparts. The aim of this study is to evaluate the spectrum of cases of perforation peritonitis at our hospital. Methods: A prospective study conducted includes three hundred thirtysix patients of perforation peritonitis at J. N. Medical College from October 2015 to July 2017. The patients were admitted, resuscitated and underwent emergency laparotomy. Data were collected in terms of demographic profile, clinical presentations, site of perforations, causes and surgical outcomes. Results: In this study, the most common cause of perforation peritonitis was peptic ulcer disease (43%), followed by enteric perforation (12.8%), tubercular perforation (12.5%), traumatic perforation (11.9%), appendicular perforation (9.8%), amoebic caecal perforation (3%), malignant perforation (1.5%), etc. The sites of perforations were stomach in majority (38.3%), ileum (31%), appendix (8%), duodenum (5.%), caecum (4.4%) ,colon (3%), jejunum (8.5%) and gall bladder (2%). The overall mortality was 21% in our study. Age >50 years (p= <0.0001, OR= 3.9260, CI= 2.2 to 6.9), organ failure (p= <0.0001, OR= 29.2, CI= 14.8 to 57.6), shock (p=<0.0001, OR=20.20, CI= 10.56 to 38.6), diffuse peritonitis (p<0.0015, OR= 6.8810, CI= 2.09 to 22.57) and faecal exudates (p<0.0001) were found to be significant factors affecting mortality. The most common complication associated was superficial wound infection (40%), followed by burst abdomen seen in 21% cases, intra-abdominal sepsis in 18% cases, electrolyte imbalances in 15% cases, anastomotic leak in 6% cases. Conclusion: In this study, stomach is the most common site of perforation with peptic ulcer disease being the most common etiology. Older age, presence of shock, organ failure and faecal peritonitis were the risk factors affecting the mortality of the patients. Early recognition, adequate resuscitation and referral of patients can influence outcome and reduces mortality as well as morbidity.

Keywords: etiology, mortality, perforation, spectrum

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Authors: Baljinder Singh, Navneet Sharma

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Chromium is an essential nutrient involved in normal carbohydrate and lipid metabolism. It influences glucose metabolism by potentiating the action as taking part in insulin signal amplification mechanism. A placebo-controlled single blind, prospective study was carried out to investigate the effect of chromium supplementation on blood glucose, HbA1C and lipid profile in newly onset patients with type-2 diabetes. Total 40 newly onset type-2 diabetics were selected and after one month stabilization further randomly divided into two groups viz. study group and placebo group. The study group received 9 gm brewer’s yeast (42 μ Cr) daily and the other placebo group received yeast devoid of chromium for 3 months. Subjects were instructed not to change their normal eating and living habits. Fasting blood glucose, HbA1C and lipid profile were analyzed at beginning and completion of the study. Results revealed that fasting blood glucose level significantly reduced in the subjects consuming yeast supplemented with chromium (197.65±6.68 to 103.68±6.64 mg/dl; p<0.001). HbA1C values improved significantly from 9.51±0.26% to 6.86±0.28%; p<0.001 indicating better glycaemic control. In experimental group total cholesterol, TG and LDL levels were also significantly reduced from 199.66±3.11 to 189.26±3.01 mg/dl; p<0.02, 144.94±8.31 to 126.01±8.26; p<0.05 and 119.19±1.71 to 99.58±1.10; p<0.001 respectively. These data demonstrate beneficial effect of chromium supplementation on glycaemic control and lipid variables in subjects with newly onset type-2 diabetes.

Keywords: type-2 diabetes, chromium, glucose, HbA1C

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Authors: Hussaini Tunde Subairu

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Small and Medium Enterprises (SMEs) sectors serve as catalyst for employment generation, national growth, poverty reduction and economic development in developing and developed countries. However, in Nigeria despite copious and plethora of government policies and stimulus schemes directed at SMEs, the sector is still characterized by high rate of failure and discontinuities. This study therefore investigated owners/managers profile, firms characteristics and external factors as possible determinants of SMEs growth from selected SMEs in Kwara State. Primary data were sourced from 200 SMEs respondents registered with the National Association of Small and Medium Enterprises (NASMES) in Kwara State Central Senatorial District. Multiple Regressions Analysis (MRA) was used to analyze the relationship between dependent and independent variables, and pair wise correlation was employed to examine the relationship among independent variables. The Analysis of Variable (ANOVA) was employed to indicate the overall significant of the model The findings revealed that Analysis of variance (ANOVA) put the value of F-statistics at 420.45 and p-value at 0.000 was significant. The values of R2 and Adjusted R2 of 0.9643 and 0.9620 respectively suggested that 96 percent of variations in employment growth were explained by the explanatory variables. The level of technical and managerial education has t- value of 24.14 and p-value of 0.001, length of managers/owners experience in similar trade with t- value of 21.37 and p-value of 0.001, age of managers/owners with t- value of 42.98 and p-value of 0.001, firm age with t- value of 25.91 and p-value of 0.001, numbers of firms in a cluster with t- value of 7.20 and p-value of 0.001, access to formal finance with t-value of 5.56 and p-value of 0.001, firm technology innovation with t- value of 25.32 and p-value of 0.01, institutional support with t- value of 18.89 and p-value of 0.01, globalization with t- value of 9.78 and p-value of 0.01, and infrastructure with t-value of 10.75 and p-value of 0.01. The result also indicated that initial size has t-value of -1.71 and p-value of 0.090 which is consistent with Gibrat’s Law. The study concluded that owners/managers profile, firm specific characteristics and external factors substantially influenced employment growths of SMEs in the study area. Therefore, policy implication should enhance human capital development of SMEs owners/managers, and strengthen fiscal policy thrust through imposition on tariff regime to minimize effect of globalization. Governments at all level must support SMEs growth radically and enhance institutional support for SMEs growth and radically and significantly upgrading key infrastructure as rail/roads, rail, telecommunications, water and power.

Keywords: external factors, firm specific characteristics, owners / manager profile, small and medium enterprises

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Authors: H. Chabalala, A. Grootboom, M. Tang

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The innovative development, production, and clinical utilisation of African natural medicines requires frameworks from systematisation, innovation, registration. Afrika faces challenges when it comes to these sectors. The opposite is the case as is is evident in ancient Asian (Traditional Chinese Medicine and Indian Ayurveda and Siddha) medical systems, which are interfaced into their respective national health and educational systems. Afrikan Natural Medicines (ANMs) are yet to develop systematisation frameworks, i.e. disease characterisation and medicines classification. This paper explores classical medical systems drawn from Afrikan and Chinese experts in natural medicines. An Afrikological research methodology was used to conduct in-depth interviews with 20 key respondents selected through purposeful sampling technique. Data was summarised into systematisation frameworks for classical disease theories, patient categorisation, medicine classification, aetiology and pathogenesis of disease, diagnosis and prognosis techniques and treatment methods. It was discovered that ancient Afrika had systematic medical cosmologies, remnants of which are evident in most Afrikan cultural health practices. Parallels could be drawn from classical medical concepts of antiquity, like Chinese Taoist and Indian tantric health systems. Data revealed that both the ancient and contemporary ANM systems were based on living medical cosmologies. The study showed that African Natural Healing Systems have etiological systems, general pathogenesis knowledge, differential diagnostic techniques, comprehensive prognosis and holistic treatment regimes. Systematisation models were developed out of these frameworks, and this could be used for evaluation of clinical research, medical application including development of curriculum for high-education. It was envisaged that frameworks will pave way towards the development, production and commercialisation of ANMs. This was piloted in inclusive innovation, technology transfer and commercialisation of South African natural medicines, cosmeceuticals, nutraceuticals and health infusions. The central model presented here in will assist in curriculum development and establishment of Afrikan Medicines Hospitals and Pharmaceutical Industries.

Keywords: African Natural Medicines, Indigenous Knowledge Systems, Medical Cosmology, Clinical Application

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Authors: M. Zeitoun, K. Abdallah, M. Rashwan

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Introduction: A growing body of evidence indicates that apelin, a relatively recent member of the adipokines family, has a potential anti-atherogenic effect. An association between low serum apelin state and coronary artery disease (CAD) was previously reported; however, the relationship between apelin and the atherosclerotic burden was unclear. Objectives: Our aim was to explore the correlation of serum apelin level with coronary calcium score (CCS) as a quantitative marker of coronary atherosclerosis. Methods: This observational cross-sectional study enrolled 100 consecutive subjects referred for cardiac multi-detector computed tomography (MDCT) for assessment of CAD (mean age 54 ± 9.7 years, 51 male and 49 females). Clinical parameters, glycemic and lipid profile, high sensitivity CRP (hsCRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum creatinine and complete blood count were assessed. Serum apelin levels were determined using a commercially available Enzyme Immunoassay (EIA) Kit. High-resolution non-contrast CT images were acquired by a 64-raw MDCT and CCS was calculated using the Agatston scoring method. Results: Forty-three percent of the studied subjects had positive coronary artery calcification (CAC). The mean CCS was 79 ± 196.5 Agatston units. Subjects with detectable CAC had significantly higher fasting plasma glucose, HbA1c, and WBCs count than subjects without detectable CAC (p < 0.05). Most importantly, subjects with detectable CAC had significantly lower serum apelin level than subjects without CAC (1.3 ± 0.4 ng/ml vs. 2.8 ± 0.6 ng/ml, p < 0.001). In addition, there was a statistically significant inverse correlation between serum apelin levels and CCS (r = 0.591, p < 0.001); on multivariate analysis this correlation was found to be independent of traditional cardiovascular risk factors and hs-CRP. Conclusion:To the best of our knowledge, this is the first report of an independent association between apelin and CCS in patients with suspected CAD. Apelin emerges as a possible novel biomarker for CAD, but this result remains to be proved prospectively.

Keywords: HbA1c, apelin, adipokines, coronary calcium score (CCS), coronary artery disease (CAD)

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Authors: Nayera E. Hassan, Sahar A. El-Masry, Rokia A. El Banna, Mones M. Abu Shady, Muhammad Al-Tohamy, Manal Mouhamed Ali, Mehrevan M. Abd El-Moniem, Mona Anwar

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Association between vitamin D, adiponectin and obesity is a matter of debate, as they play important role in linking obesity with different cardiometabolic risk factors. Objectives: Evaluation of the association between metabolic risk factors with both adiponectin and vitamin D levels and that between adiponectin and vitamin D among obese Egyptian children. Subjects and Methods: This case-control cross-sectional study consisted of 65 obese and 30 healthy children, aged 8-11 years. 25-hydroxy vitamin D (25(OH) D) level, serum adiponectin, total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were measured. Results: The mean 25(OH) D levels in the obese and control groups were 29.9± 10.3 and 39.7 ± 12.7 ng/mL respectively (P < 0.001). The mean 25(OH) D and adiponectin levels in the obese were lower than that in the control group (P < 0.0001). 25(OH) D were inversely correlated with body mass index (BMI), triglyceride, total cholesterol and LDL-cholesterol (LDL-C), while adiponectin level were inversely correlated with systolic blood pressure (SBP), and diastolic blood pressure (DBP), and positively correlated with HDL-C. However, there is no relation between 25(OH) D and adiponectin levels among obese children and total sample. Conclusion: In spite of strong association between vitamin D and adiponectin levels with metabolic risk factors and obesity, there is no relation between 25(OH) D and adiponectin levels. In obese children, there are significant negative correlations between 25(OH) D with lipid profile, and between adiponectin levels with blood pressure. At certain adiponectin level, the relation between it and BMI disappears.

Keywords: 25-hydroxy vitamin D, adiponectin, lipid profile, blood pressure, children

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Authors: Amir Reza Heydari, Yaser Jenab

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Coronary artery disease, a common cardiovascular disease, is attributed to the accumulation of cholesterol-based plaques in the coronary arteries, leading to atherosclerosis. This disease is associated with risk factors such as smoking, hypertension, diabetes, and elevated cholesterol levels, contributing to severe clinical consequences, including acute coronary syndromes and myocardial infarction. Treatment approaches such as from lifestyle interventions to surgical procedures like percutaneous coronary intervention and coronary artery bypass surgery. These interventions often employ stents, including bare-metal stents (BMS), drug-eluting stents (DES), and bioresorbable vascular scaffolds (BVS), each with its advantages and limitations. Computational tools have emerged as critical in optimizing stent designs and assessing their performance. The aim of this study is to provide an overview of the computational methods of studies based on the finite element (FE) method in the field of coronary stenting and discuss the potential for development and clinical application of stent devices. Additionally, the importance of assessing the ability of computational models is emphasized to represent real-world phenomena, supported by recent guidelines from the American Society of Mechanical Engineers (ASME). Validation processes proposed include comparing model performance with in vivo, ex-vivo, or in vitro data, alongside uncertainty quantification and sensitivity analysis. These methods can enhance the credibility and reliability of in silico simulations, ultimately aiding in the assessment of coronary stent designs in various clinical contexts.

Keywords: atherosclerosis, materials, restenosis, review, validation

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Authors: Louise Bernier

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Under some jurisdictions (including Canada), eligible patients can request and receive medical assistance in dying (MAiD) through lethal injections, inducing their cardiocirculatory death. Those same patients can also wish to donate their organs in the process. If they qualify as organ donors, a clinical and ethical rule called the 'dead donor rule' (DDR) requires the transplant teams to wait after cardiocirculatory death is confirmed, followed by a 'no touch' period (5 minutes in Canada) before they can proceed with organ removal. The medical procedures (lethal injections) as well as the delays associated with the DDR can damage organs (mostly thoracic organs) due to prolonged anoxia. Yet, strong scientific evidences demonstrate that operating differently and reconsidering the DDR would result in more organs of better quality available for transplant. This idea generates discomfort and resistance, but it is also worth considering, especially in a context of chronic shortage of available organs. One option that could be examined for MAiD’ patients who wish and can be organ donors would be to remove vital organs while patients are still alive (and under sedation). This would imply accepting that patient’s death would occur through organ donation instead of lethal injections required under MAiD’ legal rules. It would also mean that patients requesting MAiD and wishing to be organ donors could aspire to donate better quality organs, including their heart, an altruistic gesture that carries important symbolic value for many donors and their families. Following a patient centered approach, our hypothesis is that preventing vital organ donation from a living donor in all circumstance is neither perfectly coherent with how legal mentalities have evolved lately in the field of fundamental rights nor compatible with the clinical and ethical frameworks that shape the landscape in which those complex medical decisions unfold. Through a study of the legal, ethical, and clinical rules in place, both at the national and international levels, this analysis raises questions on the numerous inconsistencies associated with respecting the DDR with patients who have chosen to die through MAiD. We will begin with an assessment of the erosion of certain national legal frameworks that pertain to the sacred nature of the right to life which now also includes the right to choose how one wishes to die. We will then study recent innovative clinical protocols tested in different countries to help address acute organ shortage problems in creative ways. We will conclude this analysis with an ethical assessment of the situation, referring to principles such as justice, autonomy, altruism, beneficence, and non-malfeasance. This study will build a strong argument in favor of starting to allow vital organ donations from living donors in countries where MAiD is already permitted.

Keywords: altruism, autonomy, dead donor rule, medical assistance in dying, non-malfeasance, organ donation

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Authors: Milan N. A. Van Der Kuil, Anne M. A. Visser-Meily, Andrea W. M. Evers, Ineke J. M. Van Der Ham

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Navigation ability is essential for autonomy and mobility in daily life. In patients with acquired brain injury, navigation impairment is frequently impaired; however, in this study, we tested the effectiveness of a serious gaming training protocol as a tool for cognitive rehabilitation to reduce navigation impairment. In total, 38 patients with acquired brain injury and subjective navigation complaints completed the experiment, with a partially blind, randomized control trial design. An objective navigation test was used to construct a strengths and weaknesses profile for each patient. Subsequently, patients received personalized compensation training that matched their strengths and weaknesses by addressing an egocentric or allocentric strategy or a strategy aimed at minimizing the use of landmarks. Participants in the experimental condition received psychoeducation and a home-based rehabilitation game with a series of exercises (e.g., map reading, place finding, and turn memorization). The exercises were developed to stimulate the adoption of more beneficial strategies, according to the compensatory approach. Self-reported navigation ability (wayfinding questionnaire), participation level, and objective navigation performance were measured before and after 1 and 4 weeks after completing the six-week training program. Results indicate that the experimental group significantly improved in subjective navigation ability both 1 and 4 weeks after completion of the training, in comparison to the score before training and the scores of the control group. Similarly, goal attainment showed a significant increase after the first and fourth week after training. Objective navigation performance was not affected by the training. This navigation training protocol provides an effective solution to address navigation impairment after acquired brain injury, with clear improvements in subjective performance and goal attainment of the participants. The outcomes of the training should be re-examined after implementation in a clinical setting.

Keywords: spatial navigation, cognitive rehabilitation, serious gaming, acquired brain injury

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Authors: Gianluca Castelnuovo, Gian Mauro Manzoni, Giada Pietrabissa, Stefania Corti, Emanuele Giusti, Roberto Cattivelli, Enrico Molinari, Susan Simpson

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Obesity is currently an important public health problem of epidemic proportions (globesity). Moreover Binge Eating Disorder (BED) is typically connected with obesity, even if not occurring exclusively in conjunction with overweight conditions. Typically obesity with BED requires a longer term treatment in comparison with simple obesity. Rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation, due to the growing costs of a limited inpatient approach. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach. The new m health (m-health, mobile health) paradigm, defined as clinical practices supported by up to date mobile communication devices, could increase compliance- engagement and contribute to a significant cost reduction in BED and obesity rehabilitation. Five psychological components need to be considered for successful m Health-based obesity rehabilitation in order to facilitate weight-loss.1) Self-monitoring. Portable body monitors, pedometers and smartphones are mobile and, therefore, can be easily used, resulting in continuous self-monitoring. 2) Counselor feedback and communication. A functional approach is to provide online weight-loss interventions with brief weekly or monthly counselor or psychologist visits. 3) Social support. A group treatment format is typically preferred for behavioral weight-loss interventions. 4) Structured program. Technology-based weight-loss programs incorporate principles of behavior therapy and change with structured weekly protocolos including nutrition, exercise, stimulus control, self-regulation strategies, goal-setting. 5) Individually tailored program. Interventions specifically designed around individual’s goals typically record higher rates of adherence and weight loss. Opportunities and limitations of m health approach in clinical psychology for obesity and BED are discussed, taking into account future research directions in this promising area.

Keywords: obesity, rehabilitation, out-patient, new technologies, tele medicine, tele care, m health, clinical psychology, psychotherapy, chronic care management

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Authors: A. Ibovi Mouondayi, S. Zaher, K. Nassar, S. Janani

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Introduction: Osteoarticular ultrasound has become an essential tool for the investigation and monitoring of osteoarticular pathologies for rheumatologists. It is performed in the clinic, cheap to access than other imaging technics. Important anatomical sites of inflammation in inflammatory diseases such as synovium, tendon sheath, and enthesis are easily identifiable on ultrasound. Objective: The objective of this study was to evaluate the importance of ultrasound for rheumatologists in the development of diagnoses of inflammatory rheumatism in cases of uncertain clinical presentation. Material and Methods: This is a retrospective study conducted in our department and carried out over a period of 30 months from January 2020 to June 2022. We included all patients with inflammatory arthralgia without clinical arthritis. Patients' data were collected through a patient operating system. Results: A total of 35 patients were identified, made up of 4 men and 31 women, with a sex ratio M/F of 0.12. The average age of the patients was 48.8 years, with extremes ranging from 17 years to 83 years. All patients had inflammatory polyarthralgia for an average of 9.3 years. Only two patients had suspicious synovitis on clinical examination. 91.43% of patients had a positive inflammatory assessment with an average CRP of 22.2 mg/L. Rheumatoid factor (RF) was present in 45.7% of patients and anti-CCP in 48.57%, with respective averages of 294.43 and 314.63 international units/mL. Radiographic lesions were found in 54% of patients. Osteoarticular ultrasound was performed in all these patients. Subclinical synovitis was found in 60% of patients, including 23% Doppler positive. Tenosynovitis was found in 11% of patients. Enthesitis was objectified in 3% of patients. Rheumatoid arthritis (RA) was retained in 40% of patients; psoriatic arthritis in 6% of patients, hydroxyapatite arthritis, and osteoarthritis in 3% each. Conclusion: Osteoarticular ultrasound has been an essential tool in the practice of rheumatology in recent years. It is for diagnostic purposes in chronic inflammatory rheumatism as well as in degenerative rheumatism and crystal induced arthropathies, but also essential in the follow-up of patients in rheumatology.

Keywords: ultrasound, skeletal, rheumatoid arthritis, arthralgia

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Authors: Usha Barahmand, Ruhollah Heydari Sheikh Ahmad

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Distress refers to an unpleasant metal state or emotional suffering marked by negative affect such as depression (e.g., lost interest; sadness; hopelessness), anxiety (e.g., restlessness; feeling tense). These negative affect have been mostly suggested to be concomitant of metal disorders such as positive psychosis symptoms and also of proneness to psychotic features in non-clinical population. Psychotic features proneness including hallucination, delusion and schizotypal traits, have been found to be associated with metacognitive beliefs. Metacognition has been conceptualized as ‘thinking about thoughts, monitoring and controlling of cognitive processes’. The aim of the current study was to investigate the role of psychosis proneness in the association of metacognitions and distress. We predicted psychosis proneness would mediate the association of metacognitive beliefs and the distress. A sample of 420 university students was randomly recruited to endorse questionnaires of the study that consisted of DASS-21questionnaire for assessing levels of distress, Cartwright–Hatton & Wells, Meta-cognitions Questionnaire (MCQ-30) for assessing metacognitive beliefs, Launay-Slade Hallucination Scale-revised (LSHS-R), Peters et al. Delusions Inventory, Schizotypal Personality Questionnaire-Brief. Conducting a bootstrapping approach in order to investigate our hypothesis, the result showed that there was no a direct association between metacognitive dimensions and psychological distress and psychosis proneness significantly mediated the association. Finding suggested that individuals with dysfunctional metacognitive beliefs experience high levels of distress if they are prone to psychosis symptoms. In other words, psychosis proneness is a path through which individuals with dysfunctional metacognitions experience high levels of psychological distress.

Keywords: metacognition, non-clinical population, psychological distress, psychosis proneness

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Authors: Chiara Di Tucci, Giulia Galati, Giulia Mattei, Valentina Bonanni, Oriana Capri, Renzo D'Amelio, Ludovico Muzii, Pierluigi Benedetti Panici

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Objective: Infertility is an increasingly frequent health condition, which may depend on female or male factors. Oxidative stress (OS), resulting from a disrupted balance between reactive oxygen species (ROS) and protective antioxidants, affects the reproductive lifespan of men and women. In this review, we examine if alpha lipoic acid (ALA), among the oral supplements currently in use, has an evidence-based beneficial role in the context of female and male infertility. Methods: We performed a search from English literature using the PubMed database with the following keywords: 'female infertility', 'male infertility', 'semen', 'sperm', 'sub-fertile man', 'alpha-lipoic acid', ' alpha lipoic acid', 'lipoid acid', 'endometriosis', 'chronic pelvic pain', 'follicular fluid' and 'oocytes'. We included clinical trials, multicentric studies, and reviews. The total number of references found after automatically and manually excluding duplicates was 180. After the primary and secondary screening, 28 articles were selected. Results: The available literature demonstrates the positive effects of ALA in multiple processes, from oocyte maturation (0.87 ± 0.9% of oocyte in MII vs 0.81 ± 3.9%; p < .05) to fertilization, embryo development (57.7% vs 75.7% grade 1 embryo; p < .05) and reproductive outcomes. Its regular administration both in sub-fertile women and men has been shown to reduce pelvic pain in endometriosis (p < .05), regularize menstrual flow and metabolic disorders (p < .01), and improve sperm quality (p < .001). Conclusions: ALA represents a promising new molecule in the field of couple infertility. More clinical studies are needed in order to enhance its use in clinical practice.

Keywords: alpha lipoic acid, endometriosis, infertility, male factor, polycystic ovary syndrome

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Authors: Alla Ovsyannikova, Oksana Rymar, Elena Shakhtshneider, Mikhail Voevoda

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In Siberia endocrinologists increasingly noted young patients with the course of diabetes mellitus differing from 1 and 2 types. Therefore we did a molecular genetic study for this group of patients to verify the monogenic forms of diabetes mellitus in them and researched the characteristics of this pathology. When confirming the monogenic form of diabetes, we performed a correction therapy for many patients (transfer from insulin to tablets), prevented specific complications, examined relatives and diagnosed their diabetes at the preclinical stage, revealed phenotypic characteristics of the pathology which led to the high significance of this work. Materials and Methods: We observed 5 patients (4 families). We diagnosed MODY (Maturity Onset Diabetes of the Young) during the molecular genetic testing (direct automatic sequencing). All patients had a full clinical examination, blood samples for biochemical research, determination of C-peptide and TSH, antibodies to b-cells, microalbuminuria, abdominal ultrasound, heart and thyroid ultrasound, examination of ophthalmologist. Results: We diagnosed 3 rare types of MODY: two women had MODY8, one man – MODY6 and man and his mother - MODY12. Patients with types 8 and 12 had clinical features. Age of onset hyperglycemia ranged from 26 to 34 years. In a patient with MODY6 fasting hyperglycemia was detected during a routine examination. Clinical symptoms, complications were not diagnosed. The patient observes a diet. In the first patient MODY8 was detected during first pregnancy, she had itchy skin and mostly postprandial hyperglycemia. Upon examination we determined glycated hemoglobin 7.5%, retinopathy, non-proliferative stage, peripheral neuropathy. She uses a basic bolus insulin therapy. The second patient with MODY8 also had clinical manifestations of hyperglycemia (pruritus, thirst), postprandial hyperglycemia and diabetic nephropathy, a stage of microalbuminuria. The patient was diagnosed autoimmune thyroiditis. She used inhibitors of DPP-4. The patient with MODY12 had an aggressive course. In the detection of hyperglycemia he had complaints of visual impairment, intense headaches, leg cramps. The patient had a history of childhood convulsive seizures of non-epileptic genesis, without organic pathology, which themselves were stopped at the age of 12 years. When we diagnosed diabetes a patient was 28 years, he had hypertriglyceridemia, atherosclerotic plaque in the carotid artery, proliferative retinopathy (lacerocoagulation). Diabetes and early myocardial infarction were observed in three cases in family. We prescribe therapy with sulfonylureas and SGLT-2 inhibitors with a positive effect. At the patient's mother diabetes began at a later age (30 years) and a less aggressive course was observed. She also has hypertriglyceridemia and uses oral hypoglycemic drugs. Conclusions: 1) When young patients with hyperglycemia have extrapancreatic pathologies and diabetic complications with a short duration of diabetes we can assume they have one of type of MODY diabetes. 2) In patients with monogenic forms of diabetes mellitus, the clinical manifestations of hyperglycemia in each succeeding generation are revealed at an earlier age. Research had increased our knowledge of the monogenic forms of diabetes. The reported study was supported by RSCF, research project No. 14-15-00496-P.

Keywords: diabetes mellitus, MODY diabetes, monogenic forms, young patients

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Authors: Noorulaine Maqsood, Saeed Khan

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Background: Concern regarding incident reporting and bio-safety training in clinical laboratories in Pakistan has increased remarkably in the last few years due to rapid increase in diagnosis and research on infectious organisms. In order to ensure the safety of employees, this issue needs to be addressed immediately. Bio-safety training sessions and lectures are necessary for the protection of laboratory workers in order to ensure safe practices and minimize the count of incident reporting in the lab. Objective: To carry out an inter-departmental survey in lab regarding the awareness of bio-safety practices among lab employees before and after conducting bio-safety training sessions. Methodology: We conducted a 30 questions survey of laboratory workers in June 2013 (before training session) to gather information related to bio-safety awareness. Afterwards, we conducted another survey after training sessions and workshops related to bio-safety. Result: The survey regarding bio-safety level showed that before the training session 32% of the participants were aware of bio-safety level being used in their lab whereas after the session this percentage increased to 72%. 48% of the participants had information about the proper usage of PPE which increased to 76%. Awareness regarding proper management of hazardous waste increased from 32% to 64%. The incident reporting practice, sample handling and hand hygiene awareness was previously reported to be 40%, 65%, and 52% that increased to 80%, 85% and 88% respectively after the training session was completed. Conclusion: The first survey results showed lack of awareness that suggest nearly all senior scientists, faculty, medical technologist, lab attendant and housekeeping staff working in laboratories are required to have bio-safety training, and required inspection at least twice a year by a bio-safety officer and also required to renew their bio-safety training. After the training session, significant changes in awareness level and attitude of the participants regarding biosafety practices were observed. Therefore, such bio-safety sessions should be carried out regularly in clinical laboratories.

Keywords: biosafety practices, clinical laboratory, Pakistan, survey

Procedia PDF Downloads 420

Authors: Hend Ben Tkhayat , Khaled Al Zahabi, Husam Younes

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Introduction: Vildagliptin (VG), a dipeptidyl peptidase-4 inhibitor (DPP-4), was proven to be an active agent for the treatment of type 2 diabetes. VG works by enhancing and prolonging the activity of incretins which improves insulin secretion and decreases glucagon release, therefore lowering blood glucose level. It is usually used with various classes, such as insulin sensitizers or metformin. VG is currently only marketed as an immediate-release tablet that is administered twice daily. In this project, we aim to formulate an extended-release with a zero-order profile tableted lipid microparticles of VG that could be administered once daily ensuring the patient’s convenience. Method: The spray-congealing technique was used to prepare VG microparticles. Compritol® was heated at 10 oC above its melting point and VG was dispersed in the molten carrier using a homogenizer (IKA T25- USA) set at 13000 rpm. VG dispersed in the molten Compritol® was added dropwise to the molten Gelucire® 50/13 and PEG® (400, 6000, and 35000) in different ratios under manual stirring. The molten mixture was homogenized and Carbomer® amount was added. The melt was pumped through the two-fluid nozzle of the Buchi® Spray-Congealer (Buchi B-290, Switzerland) using a Pump drive (Master flex, USA) connected to a silicone tubing wrapped with silicone heating tape heated at the same temperature of the pumped mix. The physicochemical properties of the produced VG-loaded microparticles were characterized using Mastersizer, Scanning Electron Microscope (SEM), Differential Scanning Calorimeter (DSC) and X‐Ray Diffractometer (XRD). VG microparticles were then pressed into tablets using a single punch tablet machine (YDP-12, Minhua pharmaceutical Co. China) and in vitro dissolution study was investigated using Agilent Dissolution Tester (Agilent, USA). The dissolution test was carried out at 37±0.5 °C for 24 hours in three different dissolution media and time phases. The quantitative analysis of VG in samples was realized using a validated High-Pressure Liquid Chromatography (HPLC-UV) method. Results: The microparticles were spherical in shape with narrow distribution and smooth surface. DSC and XRD analyses confirmed the crystallinity of VG that was lost after being incorporated into the amorphous polymers. The total yields of the different formulas were between 70% and 80%. The VG content in the microparticles was found to be between 99% and 106%. The in vitro dissolution study showed that VG was released from the tableted particles in a controlled fashion. The adjustment of the hydrophilic/hydrophobic ratio of excipients, their concentration and the molecular weight of the used carriers resulted in tablets with zero-order kinetics. The Gelucire 50/13®, a hydrophilic polymer was characterized by a time-dependent profile with an important burst effect that was decreased by adding Compritol® as a lipophilic carrier to retard the release of VG which is highly soluble in water. PEG® (400,6000 and 35 000) were used for their gelling effect that led to a constant rate delivery and achieving a zero-order profile. Conclusion: Tableted spray-congealed lipid microparticles for extended-release of VG were successfully prepared and a zero-order profile was achieved.

Keywords: vildagliptin, spray congealing, microparticles, controlled release

Procedia PDF Downloads 116

Authors: Fossarello Maurizio, Mattana Giorgio, Tatti Filippo.

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The most widely performed surgical procedure in Open-Angle Glaucoma (OAG) is trabeculectomy. Although this filtering procedure is extremely effective, surgical failure and postoperative complications are reported. Due to the its invasive nature and possible complications, trabeculectomy is usually reserved, in practice, for patients who are refractory to medical and laser therapy. Recently, a number of micro-invasive surgical techniques (MIGS: Micro-Invasive Glaucoma Surgery), have been introduced in clinical practice. They meet the criteria of micro-incisional approach, minimal tissue damage, short surgical time, reliable IOP reduction, extremely high safety profile and rapid post-operative recovery. Xen45 Gel Implant (Allergan, Dublin, Ireland) is one of the MIGS alternatives, and consists in a porcine gelatin tube designed to create an aqueous flow from the anterior chamber to the subconjunctival space, bypassing the resistance of the trabecular meshwork. In this study we report the results of this technique as a favorable option in the treatment of OAG for its benefits in term of efficacy and safety, either alone or in combination with cataract surgery. This is a retrospective, single-center study conducted in consecutive OAG patients, who underwent Xen45 Gel Stent implantation alone or in combination with phacoemulsification, from October 2018 to June 2019. The primary endpoint of the study was to evaluate the reduction of both IOP and number of antiglaucoma medications at 12 months. The secondary endpoint was to correlate filtering bleb morphology evaluated by means of anterior segment OCT with efficacy in IOP lowering and eventual further procedures requirement. Data were recorded on Microsoft Excel and study analysis was performed using Microsoft Excel and SPSS (IBM). Mean values with standard deviations were calculated for IOPs and number of antiglaucoma medications at all points. Kolmogorov-Smirnov test showed that IOP followed a normal distribution at all time, therefore the paired Student’s T test was used to compare baseline and postoperative mean IOP. Correlation between postoperative Day 1 IOP and Month 12 IOP was evaluated using Pearson coefficient. Thirty-six eyes of 36 patients were evaluated. As compared to baseline, mean IOP and the mean number of antiglaucoma medications significantly decreased from 27,33 ± 7,67 mmHg to 16,3 ± 2,89 mmHg (38,8% reduction) and from 2,64 ± 1,39 to 0,42 ± 0,8 (84% reduction), respectively, at 12 months after surgery (both p < 0,001). According to bleb morphology, eyes were divided in uniform group (n=8, 22,2%), subconjunctival separation group (n=5, 13,9%), microcystic multiform group (n=9, 25%) and multiple internal layer group (n=14, 38,9%). Comparing to baseline, there was no significative difference in IOP between the 4 groups at month 12 follow-up visit. Adverse events included bleb function decrease (n=14, 38,9%), hypotony (n=8, 22,2%) and choroidal detachment (n=2, 5,6%). All eyes presenting bleb flattening underwent needling and MMC injection. The higher percentage of patients that required secondary needling was in the uniform group (75%), with a significant difference between the groups (p=0,03). Xen45 gel stent, either alone or in combination with phacoemulsification, provided a significant lowering in both IOP and medical antiglaucoma treatment and an elevated safety profile.

Keywords: anterior segment OCT, bleb morphology, micro-invasive glaucoma surgery, open angle glaucoma, Xen45 gel implant

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Authors: Abdolreza Esmaeilzadeh, Mehri Mirzaei

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Objective: Rheumatic disease is a chronic disease that causes pain, stiffness, swelling and limited motion and function of many joints. RA is the most common form of autoimmune arthritis, affecting more than 1.3 million Americans. Of these, about 75% are women. Materials and Methods: This study was formed due to the misconception about ANA test, which is frequently performed with methods based upon solid phase as ELISA. This experiment was conducted on 430 patients, with clinical symptoms that are likely affected with rheumatic diseases, simultaneously by means of ANA and FANA. Results: 36 cases (8.37%) of patients, despite positive ANA, have demonstrated negative results via Indirect Immunofluorescence Assay (IIFA), (false positive). 116 cases (27%) have demonstrated negative ANA results, by means of the ELISA technique, although they had positive IIFA results. Conclusion: Other advantages of IIFA are antibody titration and specific pattern detection that have the capability of distinguishing positive dsDNA results. According to the restrictions and false negative cases, in patients, IIFA test is highly recommended for these disease's diagnosis.

Keywords: autoimmune disease, IIFA, EIA, rheumatic disease

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Authors: Ragy Raafat Gaber Attaalla

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For cardiovascular illness, oral P2Y12 inhibitors including clopidogrel, prasugrel, and ticagrelor are frequently recommended. Each of these medications has advantages and disadvantages. In the absence of genotyping, it has been demonstrated that the stronger platelet aggregation inhibitors prasugrel and ticagrelor are superior than clopidogrel at preventing significant adverse cardiovascular events following an acute coronary syndrome and percutaneous coronary intervention (PCI). Both, nevertheless, come with a higher risk of bleeding unrelated to a coronary artery bypass. As a prodrug, clopidogrel needs to be bioactivated, principally by the CYP2C19 enzyme. A CYP2C19 no function allele and diminished or absent CYP2C19 enzyme activity are present in about 30% of people. The reduced exposure to the active metabolite of clopidogrel and reduced inhibition of platelet aggregation among clopidogrel-treated carriers of a CYP2C19 no function allele likely contributed to the reduced efficacy of clopidogrel in clinical trials. Clopidogrel's pharmacogenetic results are strongest when used in conjunction with PCI, but evidence for other indications is growing. One of the most typical examples of clinical pharmacogenetic application is CYP2C19 genotype-guided antiplatelet medication following PCI. Guidance is available from expert consensus groups and regulatory bodies to assist with incorporating genetic information into P2Y12 inhibitor prescribing decisions. Here, we examine the data supporting genotype-guided P2Y12 inhibitor selection's effects on clopidogrel response and outcomes and discuss tips for pharmacogenetic implementation. We also discuss procedures for using genotype data to choose P2Y12 inhibitor therapies as well as any unmet research needs. Finally, choosing a P2Y12 inhibitor medication that optimally balances the atherothrombotic and bleeding risks may be influenced by both clinical and genetic factors.

Keywords: inhibitors, cardiovascular events, coronary intervention, pharmacogenetic implementation

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Authors: T. Costa, D. Narvaez, K. Melo, M. Villalva

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Installation of micro-generators based on renewable energy in power distribution system has increased in recent years, with the main renewable sources being solar and wind. Due to the intermittent nature of renewable energy sources, such micro-generators produce time-varying energy which does not correspond at certain times of the day to the peak energy consumption of end users. For this reason, the use of energy storage units next to the grid contributes to the proper leveling of the buses’ voltage level according to Brazilian energy quality standards. In this work, the effect of the addition of a photovoltaic solar generator and a store of energy in the busbar voltages of an electric system is analyzed. The consumption profile is defined as the average hourly use of appliances in a common residence, and the generation profile is defined as a function of the solar irradiation available in a locality. The power summation method is validated with analytical calculation and is used to calculate the modules and angles of the voltages in the buses of an electrical system based on the IEEE standard, at each hour of the day and with defined load and generation profiles. The results show that bus 5 presents the worst voltage level at the power consumption peaks and stabilizes at the appropriate range with the inclusion of the energy storage during the night time period. Solar generator maintains improvement of the voltage level during the period when it receives solar irradiation, having peaks of production during the 12 pm (without exceeding the appropriate maximum levels of tension).

Keywords: energy storage, power distribution system, solar generator, voltage level

Procedia PDF Downloads 134

Authors: Hyun-jin Kim, Gumgyung Gu, Dae-Hyun Ko, Woochang Lee, Sail Chun, Won-Ki Min

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Background: Ovarian carcinoma is the fourth most common cause of cancer-related death in women worldwide. HE4, a novel marker for ovarian cancer could be used for monitoring recurrence or progression of disease in patients with invasive epithelial ovarian carcinoma. It is further intended to be used in conjunction with CA 125 to estimate the risk of epithelial ovarian cancer in women presenting with an adnexal mass. In this study, we aim to evaluate the analytical performance and clinical utility of HE4 assay using Architect i 2000SR(Abbott Diagnostics, USA). Methods: The precision was evaluated according to Clinical and Laboratory Standards Institute(CLSI) EP5 guideline. Three levels of control materials were analyzed twice a day in duplicate manner over 20 days. We calculated within run and total coefficient of variation (CV) at each level of control materials. The linearity was evaluated based on CLSI EP6 guideline. Five levels of calibrator were prepared by mixing high and low level of calibrators. For 43 women with adnexal masses, HE4 and CA 125 were measured and Risk of ovarian malignancy (ROMA) scores were calculated. The patients’ medical records were reviewed to determine the clinical utility of HE4 and ROMA score. Results: In a precision study, the within-run and total CV were 2.0 % and 2.3% for low level of control material, 1.9% and 2.4% for medium level and 0.5 % and 1.1% for high level, respectively. The linear range of HE4 was 14.63 to 1475.15pmol/L. Of the 43 patients, two patients in pre-menopausal group showed the ROMA score above the cut-off level (7.3%). One of them showed CA 125 level within the reference range, while the HE4 was higher than the cut-off. Conclusion: The overall analytical performance of HE4 assay using Architect showed high precision and good linearity within clinically important range. HE4 could be an useful marker for managing patients with adnexal masses.

Keywords: HE4, CA125, ROMA, evaluation, performance

Procedia PDF Downloads 334

Authors: Haydar Kepekçi, Baha Zafer, Hasan Rıza Güven

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Noise disturbance is one of the major factors considered in the fast development of aircraft technology. This paper reviews the flow field, which is examined on the 2D NACA0015 and 3D NACA0012 blade profile using SST k-ω turbulence model to compute the unsteady flow field. We inserted the time-dependent flow area variables in Ffowcs-Williams and Hawkings (FW-H) equations as an input and Sound Pressure Level (SPL) values will be computed for different angles of attack (AoA) from the microphone which is positioned in the computational domain to investigate effect of augmentation of unsteady 2D and 3D airfoil region noise level. The computed results will be compared with experimental data which are available in the open literature. As results; one of the calculated Cp is slightly lower than the experimental value. This difference could be due to the higher Reynolds number of the experimental data. The ANSYS Fluent software was used in this study. Fluent includes well-validated physical modeling capabilities to deliver fast, accurate results across the widest range of CFD and multiphysics applications. This paper includes a study which is on external flow over an airfoil. The case of 2D NACA0015 has approximately 7 million elements and solves compressible fluid flow with heat transfer using the SST turbulence model. The other case of 3D NACA0012 has approximately 3 million elements.

Keywords: 3D blade profile, noise disturbance, aeroacoustics, Ffowcs-Williams and Hawkings (FW-H) equations, k-ω-SST turbulence model

Procedia PDF Downloads 201

Authors: Babina Aryal

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Background: The diagnosis of pancreatitis is generally based on clinical and laboratory findings; however, Computed Tomography (CT) is an imaging technique of choice specially Contrast Enhanced Computed Tomography (CECT) shows morphological characteristic findings that allow for establishing the diagnosis of pancreatitis and determining the extent of disease severity which is done along with the administration of appropriate contrast medium. The purpose of this study was to compare Computed Tomography Dose Index (CTDI), Dose Length Product (DLP) and Effective Dose (ED) among male and female patients from Contrast Enhanced Computed Tomography (CECT) Pancreatitis Protocol. Methods: This retrospective study involved data collection based on clinical/laboratory/ultrasonography diagnosis of Pancreatitis and has undergone CECT Abdomen pancreatitis protocol. data collection involved detailed information about a patient's Age and Gender, Clinical history, Individual Computed Tomography Dose Index and Dose Length Product and effective dose. Results: We have retrospectively collected dose data from 150 among which 127 were males and 23 were females. The values obtained from the display of the CT screen were measured, calculated and compared to determine whether the CTDI, DLP and ED values were similar or not. CTDI for females was more as compared to males. The differences in CTDI values for females and males were 32.2087 and 37.1609 respectively. DLP values and Effective dose for both the genders did not show significant differences. Conclusion: This study concluded that there were no more significant changes in the DLP and ED values among both the genders however we noticed that female patients had more CTDI than males.

Keywords: computed tomography, contrast enhanced computed tomography, computed tomography dose index, dose length product, effective dose

Procedia PDF Downloads 104

Authors: Rishana Bilimoria, Selina Tang, Sajni Shah, Marianne Henien, Christopher Sproat

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Temporomandibular disorders (TMD) may affect up to a third of the general population, and there is evidence demonstrating the majority of Myofascial TMD cases improve after education and conservative measures. In 2015 our department implemented a modified care pathway for myofascial TMD patients in an attempt to improve the patient journey. This involved the use of an interactive group therapy approach to deliver education, reinforce conservative measures and promote self-management. Patient reported experience measures from the new group clinic revealed 71% patient satisfaction. This service is efficient in improving aspects of health status while reducing health-care costs and redistributing clinical time. Since its’ establishment, 52 hours of clinical time, resources and funding have been redirected effectively. This Quality Improvement Project was initiated because it was felt that this new service was being underutilised by our surgical teams. The ‘Plan-Do-Study-Act cycle’ (PDSA) framework was employed to analyse utilisation of the service: The ‘plan’ stage involved outlining our aims: to raise awareness amongst clinicians of the unified care pathway and to increase referral to this clinic. The ‘do’ stage involved collecting data from a sample of 96 patients over 4 month period to ascertain the proportion of Myofascial TMD patients who were correctly referred to the designated clinic. ‘Suitable’ patients who weren’t referred were identified. The ‘Study’ phase involved analysis of results, which revealed that 77% of suitable patients weren’t referred to the designated clinic. They were reviewed on other clinics, which are often overbooked, or managed by junior staff members. This correlated with our original prediction. Barriers to referral included: lack of awareness of the clinic, individual consultant treatment preferences and patient, reluctance to be referred to a ‘group’ clinic. The ‘Act’ stage involved presenting our findings to the team at a clinical governance meeting. This included demonstration of the clinical effectiveness of the care-pathway and explaining the referral route and criteria. In light of the evaluation results, it was decided to keep the group clinic and maximize utilisation. The second cycle of data collection following these changes revealed that of 66 Myofascial TMD patients over a 4 month period, only 9% of suitable patients were not seen via the designated pathway; therefore this QIP was successful in meeting the set objectives. Overall, employing the PDSA cycle in this QIP resulted in appropriate utilisation of the modified care pathway for patients with myofascial TMD in Guy’s Oral Surgery Department. In turn, this leads to high patient satisfaction with the service and effectively redirected 52 hours of clinical time. It permitted adoption of a collaborative working style with oral surgery colleagues to investigate problems, identify solutions, and collectively raise standards of clinical care to ensure we adopt a unified care pathway in secondary care management of Myofascial TMD patients.

Keywords: myofascial, quality Improvement, PDSA, TMD

Procedia PDF Downloads 131

Authors: Alyaa Farouk Abdelfattah Ibrahim, Samah Mohamed, Huda Jrady, Mashail Alrashidi, Alaa Mohammad, Fatimah Alotaibi, Maram Almutiri

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Participation in volunteering was associated with better mental and physical health, self-esteem, and life satisfaction. The main motivator for students in particular is the chance to gain work-related experiences, improve skills, and build on qualifications that may help them achieve their educational goals and further their careers. This study aimed to assess the effect of summer training volunteering practices in healthcare on self-confidence of nursing students in Riyadh. In a crossectional study design, 150 nursing students at King Saud bin Abdul-Aziz University for health sciences in Riyadh were included in the study. Bio-socio-demographic, self-confidence, patients’ care and skills questionnaires were used for data collection. Results: Participants’ age ranged between 20 and 26 years. The majority were from the educational level seven (80%). 40.7 % of them reported volunteering in summer training programs; 70.37% of them volunteered at least once and for a duration of at least one month. Nursing students from level 6 were less likely to have self-confidence in their patients’ care skills than those in level 7. Students who volunteered were more likely to be more interested in becoming social, professional, and independent healthcare workers. There was no difference regarding experience in clinical skills and education by volunteering status. Clinical skills improved by a level of education in this group. Conclusion: Professional self-confidence and clinical performance are related in this group of nursing students. Monitoring, arranging, and encouraging volunteering activities for nursing students are important to help them broaden their interests, their self-confidence in their capabilities, and advancement in their chosen profession. Mostly, volunteering enhanced knowledge in patient safety and quality of care and attempts to secure volunteering opportunities should be a priority on the nursing education agenda.

Keywords: volunteering, health care volunteering, nursing students, summer training

Procedia PDF Downloads 201

Authors: Marica Pidor-Quingco, Francis Cabatingan

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Background: One of the essential roles of a physician is to assess a patient’s worth and support them in making decisions regarding their future preferences when it comes to medical care. Advance Directives is a patient-centered approach which is liked to a better-quality treatment at the end of life. General Objective: To assess and describe the knowledge, attitudes and practices of resident physicians regarding advance directive among the resident physicians in Vicente Sotto Memorial Medical Study. Methods: An analytical cross-sectional study was conducted at Vicente Sotto Memorial Medical Center. There was a total of 129 respondents who gave their consent and was given survey questionnaire containing the demographic profile, knowledge, attitude and practices. Categorical variables were presented as frequency and percentage. Chi Square Test was used to determine the association of demographic profile with knowledge and attitude. Man-Whitney U test was utilized for the association of age with knowledge and attitude. Results: Out of 129 respondents, 36.59% were in favor towards self-determination and autonomy. Majority of the revealed an adequate knowledge and positive attitude regarding advance directives. Based on the results, there were no significant correlations between sociodemographic of the residents towards to knowledge and attitude. Over 66.7% of the respondents had used Advance Directives to their patients but 25% were not comfortable about it. Though most of the respondents was able to discuss AD with their patients, 7.0% of them are not willing to open the topic to the family. Conclusion: VSMMC is a tertiary hospital which also caters Hospice, Palliative and Supportive care to the patients. One of the services offered is initiating Advance Directives which may be a factor for a positive knowledge, attitude and practices towards this topic.

Keywords: advance directives, philippines, physicians, palliative

Procedia PDF Downloads 126

Authors: Minhui Chiu

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According to relevant studies, clinical nurses have high work pressure and relatively high job adaptation needs. The nurses who work in oncology wards have more adaptation needs when they face repeating hospitalization patients. The aims of this study were to investigate the job stress adaptation and related factors of nurses in oncology wards and to understand the predictors of job stress adaptation needs. Convenience sampling was used in this study. The nurses in the oncology specialist ward of a regional teaching hospital in southern Taiwan were selected as the research objects. A cross-sectional survey was conducted using a structured questionnaire, random sampling, and the questionnaires were filled out by the participating nurses. A total of 68 people were tested, and 65 valid questionnaires (95.6%). One basic data questionnaire and nurses’ job stress adaptation needs questionnaire were used. The data was archived with Microsoft Excel, and statistical analysis was performed with JMP12.0. The results showed that the average age was 28.8 (±6.7) years old, most of them were women, 62 (95.38%), and the average clinical experience in the hospital was 5.7 years (±5.9), and 62 (95.38%) were university graduates. 39 people (60.0%) had no work experience. 39 people (60.0%) liked nursing work very much, and 23 people (35.3%) just “liked”. 47 (72.3%) people were supported to be oncology nurses by their families. The nurses' job stress adaptation needs were 119.75 points (±17.24). The t-test and variance analysis of the impact of nurses' job pressure adaptation needs were carried out. The results showed that the score of college graduates was 121.10 (±16.39), which was significantly higher than that of master graduates 96.67 (±22.81), and the degree of liking for nursing work also reached a Significant difference. These two variables are important predictors of job adaptation needs, and the R Square is 24.15%. Conclusion: Increasing the love of clinical nurses in nursing and encouraging university graduation to have positive effects on job pressure adaptation needs and can be used as a reference for the management of human resources hospitals for oncology nurses.

Keywords: oncology nurse, job stress, job stress adaptation needs, manpower

Procedia PDF Downloads 107