Search results for: combined care

Authors: Jefrey Pilusa, Tumisang Seodigeng

Abstract:

This research discusses a South African case study for the potential of utilizing refuse-derived fuel (RDF) obtained from non-burn treatment of health care risk waste (HCRW) as potential feedstock for green energy production. This specific waste stream can be destroyed via non-burn treatment technology involving high-speed mechanical shredding followed by steam or chemical injection to disinfect the final product. The RDF obtained from this process is characterised by a low moisture, low ash, and high calorific value which means it can be potentially used as high-value solid fuel. Due to the raw feed of this RDF being classified as hazardous, the final RDF has been reported to be non-infectious and can blend with other combustible wastes such as rubber and plastic for waste to energy applications. This study evaluated non-burn treatment technology as a possible solution for on-site destruction of HCRW in South African private and public health care centres. Waste generation quantities were estimated based on the number of registered patient beds, theoretical bed occupancy. Time and motion study was conducted to evaluate the logistics viability of on-site treatment. Non-burn treatment technology for HCRW is a promising option for South Africa, and successful implementation of this method depends upon the initial capital investment, operational cost and environmental permitting of such technology; there are other influencing factors such as the size of the waste stream, product off-take price as well as product demand.

Keywords: autoclave, disposal, fuel, incineration, medical waste

Procedia PDF Downloads 159

Authors: Chalermporn Jindapeng

Abstract:

The main objective of the study of the suitable operating conditions of hot water generators combined with central air package units: a case study of Tipco Building Group was to analyze the suitable operating conditions and energy-related costs in each operating condition of hot water generators combined with central air package units which resulted in water-cooled packages. Thermal energy from vapor form refrigerants at high pressures and temperatures was exchanged with thermal energy of the water in the swimming pool that required suitable temperature control for users with the use of plate heat exchangers before refrigerants could enter the condenser in its function to change the status of vapor form refrigerants at high pressures and temperatures to liquid form at high pressures and temperatures. Thus, if this was used to replace heat pumps it could reduce the electrical energy that was used to make hot water and reduce the cost of the electrical energy of air package units including the increased efficacy of air package units. Of the analyses of the suitable operating conditions by means of the study of the elements involved with actual measurements from the system that had been installed at the Tipco Building Group hot water generators were combined with air package units which resulted in water-cooled packages with a cooling capacity of 75 tonnes. Plate heat exchangers were used in the transfer of thermal energy from refrigerants to one set of water with a heat exchanger area of 1.5 m² which was used to increase the temperature of swimming pool water that has a capacity of 240 m³. From experimental results, it was discovered after continuous temperature measurements in the swimming pool every 15 minutes that swimming pool water temperature increased by 0.78 ⁰C 0.75 ⁰C 0.74 ⁰C and 0.71 ⁰C. The rates of flow of hot water through the heat exchangers were equal to 14, 16, 18 and 20 litres per minute respectively where the swimming pool water temperature was at a constant value and when the rate of flow of hot water increased this caused hot water temperatures to decrease and the coefficient of performance of the air package units to increase from 5.9 to 6.3, 6.7, 6.9 and 7.6 while the rates of flow of hot water were equal to 14, 16, 18 and 20 litres per minute, respectively. As for the cooling systems, there were no changes and the system cooling functions were normal as the cooling systems were able to continuously transfer incoming heat for the swimming pool water which resulted in a constant pressure in the cooling system that allowed its cooling functions to work normally.

Keywords: central air package units, heat exchange, hot water generators, swimming pool

Procedia PDF Downloads 241

Authors: Manpreet Kaur, Badaruddoza, Sandeep Kaur Brar

Abstract:

The increasing prevalence of adolescent obesity is one of the major causes to be hypertensive in adulthood. Various statistical methods have been applied to examine the performance of anthropometric indices for the identification of adverse cardiovascular risk profile. The present work was undertaken to determine the significant traditional risk factors through principal component factor analysis (PCFA) among population based Punjabi adolescents aged 10-18 years. Data was collected among adolescent children from different schools situated in urban areas of Punjab, India. Principal component factor analysis (PCFA) was applied to extract orthogonal components from anthropometric and physiometric variables. Association between components were explained by factor loadings. The PCFA extracted four factors, which explained 84.21%, 84.06% and 83.15% of the total variance of the 14 original quantitative traits among boys, girls and combined subjects respectively. Factor 1 has high loading of the traits that reflect adiposity such as waist circumference, BMI and skinfolds among both sexes. However, waist circumference and body mass index are the indicator of abdominal obesity which increases the risk of cardiovascular diseases. The loadings of these two traits have found maximum in girls adolescents (WC=0.924; BMI=0.905). Therefore, factor 1 is the strong indicator of atherosclerosis in adolescents. Factor 2 is predominantly loaded with blood pressures and related traits (SBP, DBP, MBP and pulse rate) which reflect the risk of essential hypertension in adolescent girls and combined subjects, whereas, factor 2 loaded with obesity related traits in boys (weight and hip circumferences). Comparably, factor 3 is loaded with blood pressures in boys and with height and WHR in girls, while factor 4 contains high loading of pulse pressure among boys, girls and combined group of adolescents.

Keywords: adolescent obesity, cvd, hypertension, punjabi population

Procedia PDF Downloads 358

Authors: Sina Keyhanian, Abbas Ahmadi, Behrooz Karimi

Abstract:

We present a multi-objective binary programming model which considers surgical cases are scheduling among operating rooms and the configuration of surgical instruments in limited capacity hospital trays, simultaneously. Many mathematical models have been developed previously in the literature addressing different challenges in health-care logistics such as assigning operating rooms, leveling beds, etc. But what happens inside the operating rooms along with the inventory management of required instruments for various operations, and also their integration with surgical scheduling have been poorly discussed. Our model considers the minimization of movements between trays during a surgery which recalls the famous cell formation problem in group technology. This assumption can also provide a major potential contribution to robotic surgeries. The tray configuration problem which consumes surgical instruments requirement plan (SIRP) and sequence of surgical procedures based on required instruments (SIRO) is nested inside the bin packing problem. This modeling approach helps us understand that most of the same-output solutions will not be necessarily identical when it comes to the rearrangement of surgeries among rooms. A numerical example has been dealt with via a proposed nested simulated annealing (SA) optimization approach which provides insights about how various configurations inside a solution can alter the optimal condition.

Keywords: health-care logistics, hospital tray configuration, off-line bin packing, simulated annealing optimization, surgical case scheduling

Procedia PDF Downloads 258

Authors: Genevieve R. Kan, Jolyon Ford

Abstract:

Background: Caesarean section has become the routine route of delivery for breech fetuses, but breech cesarean deliveries are hypothesized to have poorer immediate neonatal outcomes when compared to cephalic deliveries. In accordance with this, in many Australian hospitals, the pediatric team is routinely required to attend every elective breech cesarean section in case urgent resuscitation is required. Our study aimed to determine whether term elective breech deliveries indeed had worse immediate neonatal outcomes at delivery, which will justify the necessity of pediatric staff presence at every elective breech cesarean delivery and influence the workload for the pediatric team. Objective: Elective breech cesarean deliveries were compared to elective cephalic cesarean deliveries at 37 weeks gestation or above to evaluate the immediate neonatal outcomes (Apgar scores <7 at 5 minutes, and Special Care Nursery admissions on Day 1 of life) of each group. Design: A retrospective cohort study Method: This study examined 2035 elective breech and cephalic singleton cesarean deliveries at term over 5 years from July 2017 to July 2022 at Frankston Hospital, a metropolitan hospital in Melbourne, Australia. There were 260 breech deliveries and 1775 cephalic deliveries. De-identified patient data were collected retrospectively from the hospital’s electronically integrated pregnancy and birth records to assess demographics and neonatal outcomes. Results: Apgar scores <7 at 5 minutes of life were worse in the breech group compared to the cephalic group (3.4% vs 1.6%). Special Care Nursery admissions on Day 1 of life were also higher for the breech cohort compared to the cephalic cohort (9.6% vs 8.7%). Conclusions: Our results support the expected findings that breech deliveries are associated with worse immediate neonatal outcomes. It, therefore, suggests that routine attendance at elective breech cesarean deliveries by the pediatric team is indeed required to assist with potentially higher needs for neonatal resuscitation and special care nursery admission.

Keywords: breech, cesarean section, Apgar scores, special care nursery admission

Procedia PDF Downloads 90

Authors: Anthony Townsend, Robyn Fasser

Abstract:

While complete objectivity is a desirable scientific position from which to conduct a care and contact evaluation (CCE), it is precisely the recognition that we are inherently incapable of operating objectively that is the foundation of ethical practice and skilled assessment. Drawing upon recent research from Daniel Kahneman (2021) on the differences between noise and bias, as well as different inherent biases collectively termed “The Elephant in the Brain” by Kevin Simler and Robin Hanson (2019) from Oxford University, this presentation addresses both the various ways in which our judgments, perceptions and even procedures can be distorted and contaminated while conducting a CCE, but also considers the value of second order cybernetics and the psychodynamic concept of ‘ambivalence’ as a conceptual basis to inform our assessment methodologies to limit such errors or at least better identify them. Both a conceptual framework for ambivalence, our higher-order capacity to allow for the convergence and consideration of multiple emotional experiences and cognitive perceptions to inform our reasoning, and a practical methodology for assessment relying on data triangulation, Bayesian inference and hypothesis testing is presented as a means of promoting ethical practice for health care professionals conducting CCEs. An emphasis on widening awareness and perspective, limiting ‘splitting’, is demonstrated both in how this form of emotional processing plays out in alienating dynamics in families as well as the assessment thereof. In addressing this concept, this presentation aims to illuminate the value of ambivalence as foundational to ethical practice for assessors.

Keywords: ambivalence, forensic, psychology, noise, bias, ethics

Procedia PDF Downloads 72

Authors: Saira Mehnaz, Ali Jafar Abedi, Shazia Farooq Fazli, Sakeena Mushfiq, Zulfia Khan, M. Athar Ansari

Abstract:

Introduction: Public health spending is a necessity in an underdeveloped country like India. The people are already suffering from poverty and that clubbed with out of pocket expenditure leads them to a very catastrophic situation, reducing the overall access to healthcare. Objectives: This study was designed to determine the usual source of medical care opted, the illness pattern, the expenditure incurred on illness and its source of procurement by the study population. It also intended to assess this expenditure as a determinant of access to health care. Methodology: Cities like Aligarh, which are classified as B grade cities in India are thought to be ripe sites for getting livelihood and hence are almost half filled with migrants living in urban slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results and Conclusions: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further being forced with into poverty and indebtedness on account of expenditure on illness. This lead to a significant decrease in access to health. National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.

Keywords: access to healthcare, catastrophic health expenditure, new urban slums, out of pocket expenditure

Procedia PDF Downloads 187

Authors: Yuthapoom Thanakijborisut

Abstract:

This paper studies consumption insurance against the chronic illness in Thailand. The study estimates the impact of household consumption in the chronic illness on consumption growth. Chronic illness is the health care costs of a person or a household’s decision in treatment for the long term; the causes and effects of the household’s ability for smooth consumption. The chronic illnesses are measured in health status when at least one member within the household faces the chronic illness. The data used is from the Household Social Economic Panel Survey conducted during 2007 and 2012. The survey collected data from approximately 6,000 households from every province, both inside and outside municipal areas in Thailand. The study estimates the change in household consumption by using an ordinary least squares (OLS) regression model. The result shows that the members within the household facing the chronic illness would reduce the consumption by around 4%. This case indicates that consumption insurance in Thailand is quite sufficient against chronic illness.

Keywords: consumption insurance, chronic illness, health care, Thailand

Procedia PDF Downloads 224

Authors: A. Erragh, K. Amanzoui, M. Elharit, H. Salem, M. Ababneh, K. Elfakhr, S. Kalouch, A. Chlilek

Abstract:

Guillain-Barre syndrome (GBS) is the most common form of acute polyradiculoneuritis (PRNA). It is a medical emergency in pediatrics that requires rapid diagnosis and immediate assessment of the severity criteria for the implementation of appropriate treatment. Retrospective, descriptive study in 24 patients under the age of 18 who presented with GBS between September 2017 and July 2021 and were hospitalized in the multipurpose pediatric intensive care unit of the Abderrahim EL Harouchi children's hospital in Casablanca. The average age was 7.91 years, with extremes ranging from 18 months and 14 years and a male predominance of 75%. After a prodromal event, most often infectious (80%) and a free interval of 12 days on average, 2 types of motor disorders begin either hypo or arereflectic flaccid paralysis of the lower limbs (45.8%) or flaccid quadriplegia hypo or arereflectic (54.2%). During GBS, the most formidable complication is respiratory distress, which can occur at any time. In our study, respiratory impairment was observed in 70.8% of cases. In addition, other signs of severity, such as swallowing disorders (75%) and dysautonomic disorders (8.33%), were also observed, which justified care in the intensive care unit for all of our patients. The use of invasive ventilation was necessary in 76.5% of cases, and specific treatments based on immunoglobulins were administered in all our patients. Despite everything, the death rate remains high (25%) and is mainly due to complications related to hospitalization. Guillain Barré syndrome is, therefore, a pediatric emergency that requires rapid diagnosis and immediate assessment of severity criteria for the implementation of appropriate treatment.

Keywords: guillain barre syndrome, emergency, children, medical

Procedia PDF Downloads 54

Authors: Phang Moon Leng

Abstract:

Automated Early Warning Scores is a newly developed clinical decision tool that is used to streamline and improve the process of obtaining a patient’s vital signs so a clinical decision can be made at an earlier stage to prevent the patient from further deterioration. This technology provides immediate update on the score and clinical decision to be taken based on the outcome. This paper aims to study the use of an automated early warning score system on whether the technology has assisted the hospital in early detection and escalation of clinical condition and improve patient outcome. The hospital adopted the Modified Early Warning Scores (MEWS) Scoring System and MEWS Clinical Response into Philips IntelliVue Guardian Automated Early Warning Score equipment and studied whether the process has been leaned, whether the use of technology improved the usage & experience of the nurses, and whether the technology has improved patient care and outcome. It was found the steps required to obtain vital signs has been significantly reduced and is used more frequently to obtain patient vital signs. The number of deaths, and length of stay has significantly decreased as clinical decisions can be made and escalated more quickly with the Automated EWS. The automated early warning score equipment has helped improve work efficiency by removing the need for documenting into patient’s EMR. The technology streamlines clinical decision-making and allows faster care and intervention to be carried out and improves overall patient outcome which translates to better care for patient.

Keywords: automated early warning score, clinical quality and safety, patient safety, medical technology

Procedia PDF Downloads 164

Authors: Habtamu Wolde Engudai

Abstract:

Background: Sedation can be provided to facilitate a procedure or to stabilize patients admitted in pediatric intensive care unit (PICU). Sedation is often necessary to maintain optimal care for critically ill children requiring mechanical ventilation. However, if sedation is too deep or too light, it has its own adverse effects, and hence, it is important to monitor the level of sedation and maintain an optimal level. Objectives: The objective is to assess the level of sedation and associated factors among intubated critically ill children admitted to PICU of JUMC, Jimma. Methods: A prospective observation study was conducted in the PICU of JUMC in September 2021 in 105 patients who were going to be admitted to the PICU aged less than 14 and with GCS >8. Data was collected by residents and nurses working in PICU. Data entry was done by Epi data manager (version 4.6.0.2). Statistical analysis and the creation of charts is going to be performed using SPSS version 26. Data was presented as mean, percentage and standard deviation. The assumption of logistic regression and the result of the assumption will be checked. To find potential predictors, bi-variable logistic regression was used for each predictor and outcome variable. A p value of <0.05 was considered as statistically significant. Finally, findings have been presented using figures, AOR, percentages, and a summary table. Result: in this study, 105 critically ill children had been involved who were started on continuous or intermittent forms of sedative drugs. Sedation level was assessed using a comfort scale three times per day. Based on this observation, we got a 44.8% level of suboptimal sedation at the baseline, a 36.2% level of suboptimal sedation at eight hours, and a 24.8% level of suboptimal sedation at sixteen hours. There is a significant association between suboptimal sedation and duration of stay with mechanical ventilation and the rate of unplanned extubation, which was shown by P < 0.05 using the Hosmer-Lemeshow test of goodness of fit (p> 0.44).

Keywords: level of sedation, critically ill children, Pediatric intensive care unit, Jimma university

Procedia PDF Downloads 47

Authors: Seyed-Ahmad Shahidi, Salemeh Kazemzadeh, Mehdi Sharifi Soltani, Azade Ghorbani-HasanSaraei

Abstract:

The kinetics of colour changes of American Pokeweed extract, due to concentration by various heating methods was studied. Three different heating/evaporation processes were employed for production of American Pokeweed extract concentrate. The American Pokeweed extract was concentrated to a final 40 °Brix from an initial °Brix of 4 by microwave heating, rotary vacuum evaporator and evaporating at atmospheric pressure. The final American Pokeweed extract concentration of 40 °Brix was achieved in 188, 216 and 320 min by using microwave, rotary vacuum and atmospheric heating processes, respectively. The colour change during concentration processes was investigated. Total colour differences, Hunter L, a and b parameters were used to estimate the extent of colour loss. All Hunter colour parameters decreased with time. The zero-order, first-order and a combined kinetics model were applied to the changes in colour parameters. All models were found to describe the L, a and b-data adequately. Results indicated that variation in TCD followed both first-order and combined kinetics models. This model implied that the colour formation and pigment destruction occurred during concentration processes of American Pokeweed extract.

Keywords: American pokeweed, colour, concentration, kinetics

Procedia PDF Downloads 478

Authors: Ali Kuzu

Abstract:

There are about 800 thousand chemicals in our environment and the number is increasing more than a thousand every year. While most of these chemicals are used as components in various consumer products, some are faced as industrial waste in the environment. Unfortunately, many of these chemicals are hazardous and affect humans. According to the “International Program on Chemical Safety” of World Health Organization; Among the chronic health effects of chemicals, cancer is of major concern. Many substances have found in recent years to be carcinogenic in one or more species of laboratory animals. Especially with respect to long-term effects, the response to a chemical may vary, quantitatively or qualitatively, in different groups of individuals depending on predisposing conditions, such as nutritional status, disease status, current infection, climatic extremes, and genetic features, sex and age of the individuals. Understanding the response of such specific risk groups is an important area of toxicology research. People with age 65+ is defined as “aged (or elderly)”. The elderly population in the world is about 600 million, which corresponds to ~8 percent of the world population. While every 1 of each 4 people is aged in Japan, the elderly population is quite close to 20 percent in many developed countries. And elderly population in these countries is growing more rapidly than the total population. The negative effects of chemicals on elderly take an important place in health-care related issues in last decades. The aged population is more susceptible to the harmful effects of environmental chemicals. According to the poor health of the organ systems in elderly, the ability of their body to eliminate the harmful effects and chemical substances from their body is also poor. With the increasing life expectancy, more and more people will face problems associated with chemical residues.

Keywords: elderly, chemicals’ effects, aged care, care need

Procedia PDF Downloads 433

Authors: Narges Solaymani

Abstract:

Definition of Nurse: Nurse: A person who is educated and skilled in the field of scientific principles and professional skills of health care, treatment, and medical training of patients. Nursing is a very important profession in the societies of the world. Although in the past, all caregivers of the sick and disabled were called nurses, nowadays, a nurse is a person who has a university education in this field. There are nurses in bachelor's, master's, and doctoral degrees in nursing. New courses have been launched in the master's degree based on duty-oriented nurses. A nurse cannot have an independent treatment center but is a member of the treatment team in established treatment centers such as hospitals, clinics, or offices. Nurses can establish counseling centers and provide nursing services at home. According to the standards, the number of nurses should be three times the number of doctors or twice the number of hospital beds, or there should be three nurses for every thousand people. Also, international standards show that in the internal and surgical department, every 4 to 6 patients should have a nurse.

Keywords: nurse, intensive care, CPR, bandage

Procedia PDF Downloads 46

Authors: Wesley Too, Christine Chesiror

Abstract:

Hypertension is a public health challenge that globally, with the World Health Organization estimating that by 2025, more than 1.5 billion people would have been diagnosed with it. Kenya’s prevalence of hypertension is estimated at 24.6 percent; however, 55% of the affected have uncontrolled blood pressure, which is worst in some parts of the country with different lifestyle: nomads and migratory communities. Kenyan pastoralists comprise 20% of the nation's population and are constantly on the move for search of water, pasture for their herd, and desertification have driven nomadic populations to the brink, given their unique and dynamic challenges. Nomads face myriad of challenges and barriers towards the management of their health care problems. Nomadic area is predominantly rural, with a low population density and a nomadic population. Health care access and quality are further hampered by poor telecommunications, infrastructure, and security. In Kenya, nomadic communities experience the worst health outcomes, disproportionate health disparities, and inequalities due to unresponsive, culturally sensitive health care system to nomad’s lifestyle and their health care needs. Marsabit covering a surface area of 66,923.1 km2, is the second largest county in Kenya, constituting about 2.3 million people of North-Eastern region, with only 2.3 percent and 1.9 percent of Kenya's total number of doctors and nurses in the country. In Kenya, there are scanty research on hypertension managementin this region and, at best, non-existent study on hypertension among nomads-migratory communities of Northern Kenya. Therefore, the purpose seeks to determine the prevalence of hypertension among nomads and document nomads' practices regarding early detections, management, and levels of control of hypertension in one of the Counties in Kenya with high- hypertensive case load per year. Methods: A cross-sectional study design was used to collect data from multiple sites and health facilities. A total of 260 participants were enrolled into the study. The study is currently ongoing. It is anticipated that by September, we will have initial findings & recommendations to share for conference

Keywords: pastoralists, hypertension, health, kenya

Procedia PDF Downloads 94

Authors: Nobuyuki Takemoto, Ai Koyanagi, Masanori Yasuda, Hiroshi Yamamoto

Abstract:

Background: Fluorescence imaging (FI) is one of the methods to identify sentinel lymph nodes (SLNs). However, the procedure is technically complicated and requires procedural skills, as SLN biopsy must be conducted in dim light conditions. As an improved version of this method, we introduced a combined method (Combined mixed dye and fluorescence; CMF) consisting of indigo carmine blue dye and FI. The direct visualization of SLNs under shadowless surgical light conditions is facilitated by the addition of the blue dye. We compared the SLN detection rates of CMF with that of the indocyanine green (ICG) dye method (ICG-D). Methods: A total of 202 patients with stage ≤ IIA breast cancer who underwent breast conservative therapy with separate incision from January 2004 to February 2017 were reviewed. Details of the two methods are as follows: (1) ICG-D: 2ml of ICG (10mg) was used and the green-stained SLNs were resected via a 3-4cm axillary incision; (2) CMF: A combination of 1ml of ICG (5mg) and 1-3ml of indigo carmine (4-12mg) was used. Using Photodynamic Eye (PDE), a 1.5-2 cm incision was made near the point of disappearance of the fluorescence and SLNs with intermediate color of blue and green were resected. Results: There were 92 ICG-D and 110 CMF cases. CMF resulted in a significantly higher detection rate than ICG-D (96.4% vs. 83.7%; p=0.003). This difference was particularly notable in those aged ≥ 60 years (98.3% vs. 74.3%) and individuals with BMI ≥ 25kg/m2 (90.3% vs. 58.3%). Conclusion: CMF is an effective method to identify SLNs which is safe, efficient, and cost-effective. Furthermore, radiation exposure can be avoided, and it can be performed in institutes without nuclear medicine facilities. CMF achieves a high SLN identification rate, and most of this procedure is feasible under shadowless surgical light conditions. CMF can reliably perform SLN biopsy even in those aged ≥ 60 years and individuals with BMI ≥ 25 kg/m2.

Keywords: sentinel lymph node biopsy, identification rate, indocyanine green (ICG), indigocarmine, fluorescence

Procedia PDF Downloads 155

Authors: Dragos Dragomir-Stanciu, Leon Marsh

Abstract:

Background As a response to the gaps identified in recent research in the provision of residential care to address co-occurring health needs, including mental health problems and complexities Gamble Aware has facilitated the possibility to provide a new service which would extend the NGTS provision of residential rehabilitation for gambling disorder with complex and co-morbid presentation. Gordon Moody, together with Adferiad have been successful in securing the tender for this service and this presentation aims to introduce FOLD, the resulting model of treatment developed for the delivery of the service. Setting As a partnership, we have come together to coproduce a model which allows us to share our clinical and industry knowledge and build on our reputations as trusted treatment providers. The presentation will outline our expertise share in development of a unified approach to recovery-oriented models of care, clinical governance, risk assessment and management and aftercare and continuous recovery. We will also introduce our innovative specialist referral portal which will offer referring partners the ability to include the service user in planning their own recovery journey. Outcomes Our collaboration has resulted in the development of the FOLD model which includes three agile and flexible treatment packages aimed at offering the most enhanced and comprehensive treatment in UK, to date, for those most affected by gambling harm. The paper will offer insight into each treatment package and all recovery model stages involved, as well as into the partnership work with NGST providers, local mental health and social care providers and lived experience organisation that will enable us to offer support to more 100 people a year who would otherwise get “lost in the system”. Conclusion FOLD offers a great opportunity to develop, implement and evaluate a new, much needed, whole-person and whole-system approach to counter gambling related harms.

Keywords: gambling treatment, partnership working, integrated care pathways, NGTS, complex needs

Procedia PDF Downloads 112

Authors: Ali A. Bazzi, Ameer Hamza, Riley O’Hara, Kimberly Kado, Karen H. Hagglund, Lamia Fathallah, Robert T. Morris

Abstract:

Introduction: Endometrial Cancer is a common gynecologic malignancy primarily treated with complete surgical staging, which may include complete pelvic and para-aortic lymphadenectomy. The role of lymphadenectomy is controversial, especially the intraoperative indications for the procedure. Three factors are important in decision to proceed with lymphadenectomy: Myometrial invasion, maximum tumor dimension, and histology. Many institutions incorporate these criteria in varying degrees in the decision to proceed with lymphadenectomy. This investigation assesses the use of intraoperatively measured MTD with and without pre-operative histologic grade. Methods: This study compared retrospectively EEC patients with intraoperatively measured MTD ≤2 cm to those with MTD >2 cm from January 1, 2002 to August 31, 2017. This assessment compared those with MTD ≤ 2cm with endometrial biopsy (EB) grade 1-2 to patients with MTD > 2cm with EB grade 3. Lymph node metastasis (LNM), recurrence, and survival were compared in these groups. Results: This study reviewed 222 patient cases. In tumors > 2 cm, LNM occurred in 20% cases while in tumors ≤ 2 cm, LNM was found in 6% cases (p=0.04). Recurrence and mean survival based on last follow up visit in these two groups were not statistically different (p=0.78 and 0.36 respectively). Data demonstrated a trend that when combined with preoperative EB International Federation of Gynecology and Obstetrics (FIGO) grade, a higher proportion of patients with EB FIGO Grade 3 and MTD > 2 cm had LNM compared to those with EB FIGO Grade 1-2 and MTD ≤ 2 cm (43% vs, 11%, p=0.06). LNM was found in 15% of cases in which lymphadenectomy was performed based on current practices, whereas if the criteria of EB FIGO 3 and MTD > 2 cm were used the incidence of LNM would have been 44% cases. However, using this criterion, two patients would not have had their nodal metastases detected. Compared to the current practice, the sensitivity and specificity of the proposed criteria would be 60% and 81%, respectively. The PPV and NPV would be 43% and 90%, respectively. Conclusion: The results indicate that MTD combined with EB FIGO grade can detect LNM in a higher proportion of cases when compared to current practice. MTD combined with EB FIGO grade may eliminate the need of frozen section sampling in a substantial number of cases.

Keywords: endometrial cancer, FIGO grade, lymphadenectomy, tumor size

Procedia PDF Downloads 161

Authors: Meenakshi

Abstract:

Background: The complications during pregnancy are the major cause of morbidity and deaths among women in the reproductive age group. Childbearing is the most important phase in women’s lives that occur mainly in the adolescent and adult years. Maternal health, thus is an important issue as this as this is important phase is also productive time for women as they strive fulfill their capabilities as an individual, mothers, family members and also as a citizen. The objective of the study is to document the coverage of ANC and its determinants among domestic workers. Method: A survey of 300 domestic workers were carried in Delhi. Only respondents in the age group (15-49) and whose recent birth was of 5 years preceding the survey were included. Socio-demographic data and information on maternal health was collected from these respondents Information on ANC was collected from total 300 respondents. Standard of living index were composed based on households assists and similarly autonomy index was computed based on women decision making power in the households taking certain key variables. Cross tabulations were performed to obtain frequency and percentages. Potential socio-economic determinants of utilization of ANC among domestic workers were examined using binary logistic regressions. Results: Out of 300 domestic workers survey, only 70.7 per cent per cent received ANC. Domestic workers who married at age 18 years and above are 4 times more likely to utilize antenatal services during their last birth (***p< 0.01). Comparison to domestic workers with number of living children two or less, domestic workers with number of living children more than two are less likely to utilize antenatal care services (**p< 0.05). Domestic workers belonging to Other Backward Castes are more likely to utilize antenatal care services than domestic workers belonging to scheduled tribes ((**p< 0.05). Conclusion: The level of utilization of maternal health services are less among domestic workers is less, as they spend most of their time at the employers household. Though demonstration effect do have impact on their life styles but utilization of maternal health services is poor. Strategies and action are needed to improve the utilization of maternal health services among this section of workers as they are vulnerable because of no proper labour legislations.

Keywords: antenatal care, domestic workers, health services, maternal health, women’s health

Procedia PDF Downloads 185

Authors: Kathleen Frances Haigh, Mieke Nieder-Heitmann, Somayeh Farzad, Mohsen Ali Mandegari, Johann Ferdinand Gorgens

Abstract:

Lignocellulose can be converted to a range of biochemicals and biofuels. Where this is derived from agricultural waste, issues of competition with food are virtually eliminated. One such source of lignocellulose is the South African sugar industry. Lignocellulose could be accessed by changes to the current farming practices and investments in more efficient boilers. The South African sugar industry is struggling due to falling sugar prices and increasing costs and it is proposed that annexing a biorefinery to a sugar mill will broaden the product range and improve viability. Process simulations of the selected chemicals were generated using Aspen Plus®. It was envisaged that a biorefinery would be annexed to a typical South African sugar mill. Bagasse would be diverted from the existing boilers to the biorefinery and mixed with harvest residues. This biomass would provide the feedstock for the biorefinery and the process energy for the biorefinery and sugar mill. Thus, in all scenarios a portion of the biomass was diverted to a new efficient combined heat and power plant (CHP). The Aspen Plus® simulations provided the mass and energy balance data to carry out an economic assessment of each scenarios. The net present value (NPV), internal rate of return (IRR) and minimum selling price (MSP) was calculated for each scenario. As a starting point scenarios were generated to investigate the production of ethanol, ethanol and lactic acid, ethanol and furfural, butanol, methanol, and Fischer-Tropsch syncrude. The bypass to the CHP plant is a useful indicator of the energy demands of the chemical processes. An iterative approach was used to identify a suitable bypass because increasing this value had the combined effect of increasing the amount of energy available and reducing the capacity of the chemical plant. Bypass values ranged from 30% for syncrude production to 50% for combined ethanol and furfural production. A hurdle rate of 15.7% was selected for the IRR. The butanol, combined ethanol and furfural, or the Fischer-Tropsch syncrude scenarios are unsuitable for investment with IRRs of 4.8%, 7.5% and 11.5% respectively. This provides valuable insights into research opportunities. For example furfural from sugarcane bagasse is an established process although the integration of furfural production with ethanol is less well understood. The IRR for the ethanol scenario was 14.7%, which is below the investment criteria, but given the technological maturity it may still be considered for investment. The scenarios which met the investment criteria were the combined ethanol and lactic acid, and the methanol scenarios with IRRs of 20.5% and 16.7%, respectively. These assessments show that the production of biochemicals from lignocellulose can be commercially viable. In addition, this assessment have provided valuable insights for research to improve the commercial viability of additional chemicals and scenarios. This has led to further assessments of the production of itaconic acid, succinic acid, citric acid, xylitol, polyhydroxybutyrate, polyethylene, glucaric acid and glutamic acid.

Keywords: biorefineries, sugar mill, methanol, ethanol

Procedia PDF Downloads 178

Authors: Rujnan Tuna, Ayse Cil Akinci

Abstract:

Work life takes up an important place in human life, and an employed person faces many stimuli from internal and external environments and is affected by them in a positive or negative way. Also, the handover process, which is the process of sharing information about the patient with other health professionals, is an important criterion to maintain patient care and enhance the quality of care provided. Handover is a key component for sustaining daily basic clinical practices and is also essential to maintain the safe patient care. This investigation followed a descriptive and correlation design in order to establish job stress and the handover efficiency of nurses and the relationship in between. The study was conducted with 192 nurses working in a public hospital in Istanbul between January and March 2017. Descriptive information form, Job Stressors Scale, and Handover Evaluation Scale were used to collect the data of the study. The data were analyzed by using IBM SPSS Statistics 22.0 statistical software. Approvals from participants, managers of institution, and ethics committee were taken for the study. As a result of the research, it was found that job stress was above the median value, and the highest score in the ‘work role conflict’ subdimension. Also, it was found that the effectiveness of the nurses' handover effectiviness was above the median value and the highest score in the ‘quality of information’ subdimension. In the study, there was a negatively weak correlation between ‘work role overload’ subdimension of Job Stressors Scale and ‘interaction and support’ subdimension of Handover Evaluation Scale. There is a need for further study in order to maintain patient safety.

Keywords: handover, job stress, nurse, patient

Procedia PDF Downloads 146

Authors: Jitender Sodhi, Shweta Talati, A. K. Gupta, Pankaj Arora

Abstract:

Background:Equipment donation to hospitals in resource-limited settings can significantly benefit services in these settings albeit requires important ethical, practical and financial issues to be considered before accepting donations. Objective: To understand the decision making process leading to acceptance/ rejection/ deferment of equipment donation from the perspective of a public sector teaching tertiary care hospital. Design: Retrospective, record based study. Setting: 2000-bedded public sector teaching tertiary care hospital in North India. Methods: A total of 30 cases of equipment donation from March 2010-October 2013, were analysed for their decision process leading to acceptance/rejection/deferment.Each case was studied retrospectively and data pertaining to the agenda and decision taken was collected. Results: A total of 30 cases of equipment donation received from March 2010- October 2013 were screened, out of which 17 (56.6%) were for diagnostic purpose and 13 (43.3%) for therapeutic purpose. Out of 30 cases, 16 (53.3%) were accepted and 8 (26.6%) were rejected. The remaining 6 cases included 3 (10%) which required further clarification and other 3 (10%) which were out of the domain of committee. Conclusion: This study highlights the importance of equipment donation in resource limited settings and considerations involved while making decisions for acceptance/rejections/defermentof such donations.

Keywords: equipment donation, teaching hospital, decision-making, North India

Procedia PDF Downloads 277

Authors: Rana F. Obeidat, Suzanne S. Dickerson, Gregory G. Homish, Nesreen M. Alqaissi, Robin M. Lally

Abstract:

Background: Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early stage breast cancer and surgical treatment. Objective: To gain understanding of the diagnosis and surgical treatment experience of Jordanian women diagnosed with early stage breast cancer. Methods: An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology. Results: Fear had a profound effect on Jordanian women’s stories of diagnosis and surgical treatment of early stage breast cancer. Women’s experience with breast cancer and its treatment was shaped by their pre-existing fear of breast cancer, the disparity in the quality of care at various health care institutions, and sociodemographic factors (e.g., education, age). Conclusions: Early after the diagnosis, fear was very strong and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the health care system, surgeons, family, friends, and/or neighbors, and often accepted treatment offered by their surgeons without questioning. Implications for practice: Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and support necessary to help them cope with their illness.

Keywords: breast cancer, early stage, Jordanian, experience, phenomenology

Procedia PDF Downloads 312

Authors: Latha Subbiah, Dhanalakshmi Samiappan

Abstract:

In this paper, we propose denoising Common Carotid Artery (CCA) B mode ultrasound images by a decomposition approach to curvelet thresholding and automatic segmentation of the intima media thickness and adventitia boundary. By decomposition, the local geometry of the image, its direction of gradients are well preserved. The components are combined into a single vector valued function, thus removes noise patches. Double threshold is applied to inherently remove speckle noise in the image. The denoised image is segmented by active contour without specifying seed points. Combined with level set theory, they provide sub regions with continuous boundaries. The deformable contours match to the shapes and motion of objects in the images. A curve or a surface under constraints is developed from the image with the goal that it is pulled into the necessary features of the image. Region based and boundary based information are integrated to achieve the contour. The method treats the multiplicative speckle noise in objective and subjective quality measurements and thus leads to better-segmented results. The proposed denoising method gives better performance metrics compared with other state of art denoising algorithms.

Keywords: curvelet, decomposition, levelset, ultrasound

Procedia PDF Downloads 323

Authors: Maneesha Pahlani, Najmin Sultana

Abstract:

A hospital is one of the most suitable places for acquiring an infection because it harbors a high population of virulent strains of microorganisms that may be resistant to antibiotics, especially the prevalence of Methicillin-Resistant Staphylococcus Aureus (MRSA) infections. The hospital-acquired infection has become a global challenge. In developed countries, healthcare-associated infections occur in 5-15% of hospitalized clients, affecting 9-37% of those admitted to intensive care units (ICU). A non-experimental descriptive study was conducted among 50 nursing officers working in a selected hospital in Bangalore to assess the nursing officers’ level of knowledge regarding the prevention and management of MRSA infections and to associate the pre-test knowledge mean scores of nursing officers with selected socio-demographic variables. Data was collected using a structured questionnaire consisting of socio-demographic data and a structured questionnaire on knowledge regarding the prevention and management of MRSA infections. The data was analyzed in terms of frequencies and percentages for the analysis of demographic variables and computing chi-square to determine the association between knowledge means scores and selected demographic variables. The study findings revealed that the nursing officer had an overall good level of knowledge (63.05%) regarding the prevention and management of MRSA infections, and there is no significant association found between the level of knowledge mean scores for prevention and management of MRSA infection with the selected socio-demographic variables. However, the categorization of knowledge items showed that the nursing officer must thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance for effective nursing care to patients with MRSA infections. The conclusions drawn from the study findings showed that it is necessary that the nursing officer thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance to provide effective nursing care to patients with MRSA infection as they constantly care for the patient who can be at risk for multi-drug resistance organisms to reduce the risk of MRSA infection in hospital care settings as well community settings.

Keywords: MRSA, nursing officers, knowledge, preventive and management

Procedia PDF Downloads 50

Authors: R. Cooper, M. Kurien

Abstract:

Background: Coeliac Disease affects around 1 in 100 people. Untreated, it can result in serious morbidity such as malabsorption and cancers. The only treatment is to adhere to a gluten free diet (GFD). International guidelines recommend that people with the coeliac disease receive follow-up healthcare annually to detect complications early and support their adherence to a GFD. However, there is a finite amount of healthcare in the UK, and as such, not all patients receive follow-up care as recommended by the guidelines. Furthermore, there is an increasing number of patients being diagnosed with coeliac disease. Given the potential severe morbidity that non-adherence to a GFD could result in, alongside reports that the rate of non- GFD adherence could be as high as 91%, it is imperative that action is taken. One potential solution to this would be to provide follow-up care digitally through utilising technology. This abstract reports on a rapid review undertaken to explore the existing evidence in this area. Methods: In June 2020, 11 bibliographic databases were searched to find any pertinent studies. The inclusion criteria required the study to be written in the English language and report on the use of digital healthcare interventions for people with Coeliac Disease. Results: A small amount of evidence (n=8) was found which met our inclusion criteria and pertained to the provision of CD follow-up digitally. These studies focussed either on educating and supporting patients to adhere to a GFD or providing consultation remotely with a focus on detecting complications early. These studies showed that there is potential for digital healthcare interventions to positively impact people with coeliac disease. However, it is suggested that the effectiveness of these interventions may depend on local circumstances, individual knowledge of CD and general attitudes. Conclusion: The above studies suggest that providing follow-up care digitally may offer a potential solution; however, the evidence about how this should be done and in what circumstances this will work for individuals is scarce. In the light of the COVID-19 pandemic, the introduction of digital healthcare interventions appears to be highly topical, and as such, this review may benefit from being refreshed in the future.

Keywords: coeliac disease, follow-up, gluten free diet, digital healthcare interventions

Procedia PDF Downloads 158

Authors: Jamil Jafari, Sharafat Karimi

Abstract:

The Arabic Language has a complicated system of prosody invented by the great grammarian Khalil Ibn Ahmad Farahidi. He could extract 15 meters out of his innovative five circles, which were used in Arabic poetry of the 7th and 8th centuries. Then after a while, his student Akhfash added or compensated another meter to his tutor's meters, so overall, we now have 16 different meters in Arabic poetry. These meters have been formed by various combinations of 8 different feet and each foot is combined of rudimentary units called Sabab and Wated which are combinations of movement (/) and silent (ʘ) letters. On the other hand in English, we are dealing with another system of metrical prosody. In this language, feet are consisted of stressed and unstressed syllables and are of six types: iamb, trochee, dactyl, anapest, spondee, and pyrrhic. Using the descriptive-analytic method, in this research we aim at making a comparison between Arabic and English systems of metrical prosody to investigate their similarities and differences. The results show that both of them are quantitative and both of them rely on syllables in afoot. But unlike Arabic, English is utilizing another rhyme system and the number of feet in a line differs from Arabic; also, its feet are combined of stressed and unstressed syllables, while those of Arabic is a combination of movement and silent letters.

Keywords: Arabic prosody, English prosody, foot, meter, poetry

Procedia PDF Downloads 130

Authors: Najmin Sultana, Maneesha Pahlani

Abstract:

A hospital is one of the most suitable places for acquiring an infection because it harbors a high population of virulent strains of microorganisms that may be resistant to antibiotics, especially the prevalence of Methicillin-Resistant Staphylococcus Aureus (MRSA) infections. The hospital-acquired infection has become a global challenge. In developed countries, healthcare-associated infections occur in 5-15% of hospitalized clients, affecting 9-37% of those admitted to intensive care units (ICU). A non-experimental descriptive study was conducted among 50 nursing officers working in a selected hospital in bengaluru to assess the nursing officers’ level of knowledge regarding the prevention and management of MRSA infections and to associate the pre-test knowledge mean scores of nursing officers with selected socio-demographic variables. Data was collected using a structured questionnaire consisting of socio-demographic data and a structured questionnaire on knowledge regarding the prevention and management of MRSA infections. The data was analyzed in terms of frequencies and percentages for the analysis of demographic variables and computing chi-square to determine the association between knowledge means scores and selected demographic variables. The study findings revealed that the nursing officer had an overall good level of knowledge (63.05%) regarding the prevention and management of MRSA infections, and there is no significant association found between the level of knowledge mean scores for prevention and management of MRSA infection with the selected socio-demographic variables. However, the categorization of knowledge items showed that the nursing officer must thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance for effective nursing care to patients with MRSA infections. The conclusions drawn from the study findings showed that it is necessary that the nursing officer thoroughly receive education on correct guidance and information regarding MRSA infection control policy, including measures and practices on hygiene precautions and information regarding antibiotic resistance to provide effective nursing care to patients with MRSA infection as they constantly care for the patient who can be at risk for multi-drug resistance organisms to reduce the risk of MRSA infection in hospital care settings as well community settings.

Keywords: MRSA, knowledge, nursing officers', prevention and management

Procedia PDF Downloads 44

Authors: Vildan Cırık, Emine Efe

Abstract:

Complementary health approaches are growing in popularity worldwide and play a substantial role in health care. It is very important for paediatric nurses to have knowledge of practices affecting the medical conditions of patients and to communicate with them through integrative nursing care. The purpose of this study was to determine paediatric nurses’ knowledge and experiences of complementary health approaches (CHA) and their personal and professional attitudes to the use of complementary health approaches. This multicentre study was conducted with 1450 paediatric nurses in 18 hospitals in Turkey. Paediatric nurses included in the study were working in the following clinics: Paediatric Service, Paediatric Intensive Care, Paediatric Haematology/Oncology. Data collection focused on the paediatric nurses’ knowledge and experiences of CHA. A high proportion of our sample of paediatric nurses reported that they had used some form of CHA themselves; the most popular choices of CHA were prayer, massage, and vitamins techniques. Paediatric nurses reported positive experiences (drawing/music/art/dance therapies, prayer, herbs, thermal springs, massage, and reflexology) and negative experiences (herbs, thermal springs, prayer, and massage). This study may contribute to increased awareness of the potentially important role of paediatric nurses in the delivery of CHA. Paediatric nurses play important roles in helping patients to use complementary health approaches safely and accurately. Trainings on CHA should be organised, data collection forms including CHA should be created, and evidence-based studies should be focused towards improving the clinical practice of paediatric nurses.

Keywords: complementary health approaches, paediatric nurses, knowledge, experience, attitude, Turkey

Procedia PDF Downloads 180

Authors: Sajia Islam, T. Tahsina, S. Raihana, M. M. Rahman, Q. S. Rahman, T. M. Huda, S. E. Arifeen, M. J. Dibley

Abstract:

Early neonatal sepsis accounts for more than two-thirds of all deaths in the first year of life. This study assessed the counseling during antenatal, perinatal, post natal periods and its association with possible sepsis in rural Bangladesh. Method: Data were collected from a large community-based trial in Bangladesh where pregnant women were enrolled from 2013-2015 covering 29,497 newborns. Sepsis was defined using neonatal danger signs reported by 'The Young-Infants Clinical Science Study Group. 'Result: Signs of sepsis was found among 15% of the neonates. Neonatal sepsis was higher among those who did not receive advice on TT vaccinations (15.4% vs. 11%, p < 0.05) and danger signs (14.8% vs. 12.8%, p < 0.05) during pregnancy. Advice on delivering in well-lit place was significantly associated with lower incidence of sepsis (12.7% vs. 14.8% p < 0.05). Sepsis was lower among neonates whose mothers were counseled on immediate newborn care for bathing after 3 days of delivery (13.4% vs. 15.2% p=0), breastfeeding within 1hr of birth (13.82 % vs. 15.28% p=0), apply nothing on the cord (11.54 vs. 15.06 p=0), immediate drying of child (12.62% vs. 14.89%, p=0). Neonatal sepsis was lower among children whose mothers received 2-4 advice [OR=0.91(95% CI: 0.85-0.97)] compared to neonates whose mothers received only 1 or none. Overall, children to mothers who received ≥ 5 advice had lowest incidence of sepsis [OR=0.83 (95% CI: 0.71-0.97)] Conclusion: Advice on antenatal, prenatal and post natal is significantly reduced with early newborn sepsis. Further research is required to identify specific type of counseling messages that translate into practices and reduce pathways towards early-newborn morbidities.

Keywords: ante natal care, counseling, neonatal sepsis, post natal care

Procedia PDF Downloads 257