Search results for: patient safety incidents

Authors: Donatien Callon, Ian Lalonde, Mathieu Nadeau, Alexandre Girard

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Patient transfer is a challenging, critical task because it exposes caregivers to injury risks. Available transfer devices, like floor lifts, lead to improvements but are far from perfect. They do not eliminate the caregivers’ risk of musculoskeletal disorders, and they can be burdensome to use due to their poor maneuverability. This paper presents a new motorized floor lift with a single central motorized wheel connected to an instrumented handle. Admittance controllers are designed to 1) improve the device maneuverability, 2) reduce the required caregiver effort, and 3) ensure the security and comfort of patients. Two controller designs, one with a linear admittance law and a non-linear admittance law with variable damping, were developed and implemented on a prototype. Tests were performed on seven participants to evaluate the performance of the assistance system and the controllers. The experimental results show that 1) the motorized assistance with the variable damping controller improves maneuverability by 28%, 2) reduces the amount of effort required to push the lift by 66%, and 3) provides the same level of patient comfort compared to a standard unassisted floor lift.

Keywords: floor lift, human robot interaction, admittance controller, variable admittance

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Authors: Anass Rahouti, Guillaume Salze, Ruggiero Lovreglio, Sélim Datoussaïd

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In healthcare facilities, training the staff for firefighting and evacuation in real buildings is very challenging due to the presence of a vulnerable population in such an environment. In a standard environment, traditional approaches, such as fire drills, are often used to train the occupants and provide them with information about fire safety procedures. However, those traditional approaches may be inappropriate for a vulnerable population and can be inefficient from an educational viewpoint as it is impossible to expose the occupants to scenarios similar to a real emergency. Immersive serious games could be used as an alternative to traditional approaches to overcome their limitations. Serious games are already being used in different safety domains such as fires, earthquakes and terror attacks for several building types (e.g., office buildings, train stations, tunnels, etc.). In this study, we developed an immersive serious game to improve the fire safety skills of staff in healthcare facilities. An accurate representation of the healthcare environment was built in Unity3D by including visual and audio stimuli inspired from those employed in commercial action games. The serious game is organised in three levels. In each of them, the trainee is presented with a specific fire emergency and s/he can perform protective actions (e.g., firefighting, helping non-ambulant occupants, etc.) or s/he can ignore the opportunity for action and continue the evacuation. In this paper, we describe all the steps required to develop such a prototype, as well as the key questions that need to be answered, to develop a serious game for firefighting and evacuation in healthcare facilities.

Keywords: fire safety, healthcare, serious game, training

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Authors: Tadesse Melaku Abegaz

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Background: there was paucity of data on the self-reported adverse drug reactions (ADRs), level of adherence and clinical outcomes with antidepressants among major depressive disorder (MDD) patients in Ethiopia. Hence, the present study sought to determine the level of adherence for and clinical outcome with antidepressants and the magnitude of ADRs. Methods: A prospective cross-sectional study was employed on MDD patients from September 2016 to January 2017 at Gondar university hospital psychiatry clinic. All patients who were available during the study period were included under the study population. The Naranjo adverse drug reaction probability scale was employed to assess the adverse drug reaction. The rate of medication adherence was determined using morisky medication adherence measurement scale eight. Clinical Outcome of patients was measured by using patient health questionnaire. Multivariable logistic carried out to determine factors for adherence and patient outcome. Results: two hundred seventy patients were participated in the study. More than half of the respondents were males 122(56.2%). The mean age of the participants was 30.94 ± 8.853. More than one-half of the subjects had low adherence to their medications 124(57.1%). About 186(85.7%) of patients encountered ADR. The most common ADR was weight gain 29(13.2). Around 198(92.2%) ADRs were probable and 19(8.8%) were possible. Patients with long standing MDD had high risk of non-adherence COR: 2.458[4.413-4.227], AOR: 2.424[1.185-4.961]. More than one-half 125(57.6) of respondents showed improved outcome. Optimal level of medication adherence was found to be associated with reduced risk of progression of the diseases COR: 0.37[0.110-5.379] and AOR: 0.432[0.201-0.909]. Conclusion: Patient reported adverse drug reactions were more prevalent in major depressive disorder patients. Adherence to medications was very poor in the setup. However, the clinical outcome was relatively higher. Long standing depression was associated with non-adherence. In addition, clinical outcome of patients were affected by non-adherence. Therefore, adherence enhancing interventions should be provided to improve medication adherence and patient outcome.

Keywords: adverse drug reactions, clinical outcomes, Ethiopia, prospective study, medication adherence

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Authors: Marketa Kotova, Jana Kolarova, Ludek Zalud, Petr Dobsak

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A game for training of breath (TRABR) for continuous monitoring of pulmonary ventilation during the patients’ therapy focuses especially on monitoring of their ventilation processes. It is necessary to detect, monitor and differentiate abdominal and thoracic breathing during the therapy. It is a fun form of rehabilitation where the patient plays and also practicing isolated breathing. Finally the game to practice breath was designed to evaluate whether the patient uses two types of breathing or not.

Keywords: pulmonary ventilation, thoracic breathing, abdominal breathing, breath monitoring using pressure sensors, game TRABR TRAining of BReath)

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Authors: Pei-Ru Yang, Yu-Chen Lin, Jia-Min Wu

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Background: A 58-year-old man with a history of osteoporosis and diabetes presented with chronic pain in his left knee due to severe knee joint degeneration. The knee replacement surgery was recommended by the doctor. But the patient suffered from low pain tolerance and wondered if virtual reality could relieve acute postoperative wound pain. Methods: We used the PICO (patient, intervention, comparison, and outcome) approach to generate indexed keywords and searched systematic review articles from 2017 to 2021 on the Cochran Library, PubMed, and Clinical Key databases. Results: The initial literature results included 38 articles, including 12 Cochrane library articles and 26 PubMed articles. One article was selected for further analysis after removing duplicates and off-topic articles. The eight trials included in this article were published between 2013 and 2019 and recruited a total of 723 participants. The studies, conducted in India, Lebanon, Iran, South Korea, Spain, and China, included adults who underwent hemorrhoidectomy, dental surgery, craniotomy or spine surgery, episiotomy repair, and knee surgery, with a mean age (24.1 ± 4.1 to 73.3 ± 6.5). Virtual reality is an emerging non-drug postoperative analgesia method. The findings showed that pain control was reduced by a mean of 1.48 points (95% CI: -2.02 to -0.95, p-value < 0.0001) in minor surgery and 0.32 points in major surgery (95% CI: -0.53 to -0.11, p-value < 0.03), and the overall postoperative satisfaction has improved. Discussion: Postoperative pain is a common clinical problem in surgical patients. Research has confirmed that virtual reality can create an immersive interactive environment, communicate with patients, and effectively relieve postoperative pain. However, virtual reality requires the purchase of hardware and software and other related computer equipment, and its high cost is a disadvantage. We selected the best literature based on clinical questions to answer the patient's question and used share decision making (SDM) to help the patient make decisions based on the clinical situation after knee replacement surgery to improve the quality of patient-centered care.

Keywords: knee replacement surgery, postoperative pain, share decision making, virtual reality

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Authors: Galit Harel

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Deborah was referred for psychoanalytic psychotherapy following a suicide attempt and depression. She began a fascinating journey spanning more than 10 years. During therapy, many questions arose concerning the suicidal episode, which she could not register consciously. The author tried to understand the reasons for her depression and the attempted suicide through the unconscious process in the therapeutic relationship and through the music and poetry that she brought to sessions. In this paper, the author describes the process of listening for the signifiers of semiotic and symbolic language, both metaphoric and metonymic, as revealed in poetry and music according to the theories of Kristeva and Lacan. The poetry enabled the patient to retrieve childhood memories, experience the movement from unconscious to conscious, and mourn through the experience of transference and countertransference in the therapeutic relationship. Also illustrated is the transition from singing the music to more symbolic language, turning the patient’s sensory experience into language, and connecting her personal experience with the culture of her past. The patient’s mourning and the lost love objects are discussed through the prism of classical and object relations theories.

Keywords: depression, lost love object, psychoanalytic psychotherapy, suicide attempt, symbolization of desire

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Authors: Etta Conteh, Tracy Macintosh

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Introduction: Restraints are often used in the Emergency Department when it is necessary for a patient to be restrained in order to decrease their agitation and better treat them. Chemical and physical restraints may be used on these patients at the discretion of the medical provider. Racism and injustice are rampant within our country, and medicine and healthcare are not spared. While racism and racial bias in medicine and healthcare have been studied, information on the differences in the use of restraints by race are scarce. Objective: The objective of this study is to determine if African Americans and Hispanic-American patients are restrained at higher rates compared to their White counterparts. Methods: This study will be carried out through a retrospective analysis utilizing the Hospital Corporation of America (HCA) national Emergency Department (ED) and inpatient database with patient visits from 2016-2019. All patient visits, with patients aged 18 years or older, will be reviewed, looking specifically for the race and the use and type of restraints. Other factors, such a pre-existing psychiatric condition, will be used for sub-analysis. Rationale: The outcome of this project will demonstrate the absence or presence of a racial disparity in the use of restraints in the Emergency Department. These results can be used as a foundation for improving racial equity in healthcare treatment.

Keywords: emergency medicine, public health, racism, restraint use

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Authors: Ruzanna Muradyan

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Medical data mining is a crucial field in contemporary healthcare that offers cutting-edge tactics with enormous potential to transform patient care. This abstract examines how sophisticated data mining techniques could transform the healthcare industry, with a special focus on how they might improve patient outcomes. Healthcare data repositories have dynamically evolved, producing a rich tapestry of different, multi-dimensional information that includes genetic profiles, lifestyle markers, electronic health records, and more. By utilizing data mining techniques inside this vast library, a variety of prospects for precision medicine, predictive analytics, and insight production become visible. Predictive modeling for illness prediction, risk stratification, and therapy efficacy evaluations are important points of focus. Healthcare providers may use this abundance of data to tailor treatment plans, identify high-risk patient populations, and forecast disease trajectories by applying machine learning algorithms and predictive analytics. Better patient outcomes, more efficient use of resources, and early treatments are made possible by this proactive strategy. Furthermore, data mining techniques act as catalysts to reveal complex relationships between apparently unrelated data pieces, providing enhanced insights into the cause of disease, genetic susceptibilities, and environmental factors. Healthcare practitioners can get practical insights that guide disease prevention, customized patient counseling, and focused therapies by analyzing these associations. The abstract explores the problems and ethical issues that come with using data mining techniques in the healthcare industry. In order to properly use these approaches, it is essential to find a balance between data privacy, security issues, and the interpretability of complex models. Finally, this abstract demonstrates the revolutionary power of modern data mining methodologies in transforming the healthcare sector. Healthcare practitioners and researchers can uncover unique insights, enhance clinical decision-making, and ultimately elevate patient care to unprecedented levels of precision and efficacy by employing cutting-edge methodologies.

Keywords: data mining, healthcare, patient care, predictive analytics, precision medicine, electronic health records, machine learning, predictive modeling, disease prognosis, risk stratification, treatment efficacy, genetic profiles, precision health

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Authors: Jamie Lynn Co, Mary Shiela Ariola-Ramos

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Myroides are aerobic, yellow-pigmented, non-motile, non-fermenting gram-negative rods. They are commonly found in the environment such as water and soil. Although found in the environment, Myroides are rare pathogens of humans. Myroides spp. primarily infect immunocompromised patients, often with diabetes mellitus, liver cirrhosis, chronic kidney disease, chronic obstructive pulmonary disease or prolonged corticosteroid therapy. We present a case of a 70-year-old immunocompromised patient with diabetes mellitus, chronic renal failure, diagnosed with sepsis caused by Myroides spp. The primary portal and source of infection were the pustules and boils found on the lower extremities of the patient. Susceptibility testing showed that our isolate was only susceptible to ciprofloxacin and meropenem; and following the treatment, the patient recovered. Myroides continues to be a rare pathogen of humans that is prevalent in our environment. It primarily affects immunocompromised patients such as those with uncontrolled diabetes mellitus, chronic kidney disease, etc. Despite their low virulence, physicians should consider this opportunistic pathogen as possible etiologic agent especially in cases wherein there is lack of response to commonly used antibiotics.

Keywords: bacteremia, immunocompromised, gram negative rods, Myroides

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Authors: Rosyellen Rabelo Szvarça, Pedro Fialho, Auristela Duarte de Lima Moser

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Background: New ways of working, such as teleworking or hybrid working, have changed and have impacted both employees and organizations. To understand the individuals' perceptions among different working models, this study aimed to investigate levels of psychological safety among employees working in person, hybrid, and remote environments and the correlation of demographic or professional characteristics. Methods: A cross-sectional survey was distributed electronically. A self-administered questionnaire was composed of sociodemographic data, academic status, professional contexts, working models, and the seven-item instrument of psychological safety. The psychological safety instrument was computed to determine its reliability, showing a Cronbach’s 0.75, considering a good scale when compared to the original, analyzed with 51 teams from a North American company, with a Cronbach's alpha coefficient of 0.82. Results: The survey was completed by 328 individuals, 60% of whom were in-person, 29.3% hybrid, and 10.7% remote. The Chi-Square test with the Bonferroni post-test for qualitative variables associated with the working models indicates a significant association (p 0.001) for academic qualifications. In-person models present 29.4% of individuals with secondary education and 38.1% undergraduate; hybrid present 51% postgraduate and 35.4% undergraduate. This was similar to remote workers, with 48.6% postgraduate and 34.3% undergraduate. There were no significant differences in gender composition between work models (p = 0.738), with most respondents being female in all three work groups. Remote workers predominated in areas such as commerce, marketing, and services; education and the public sector were common in the in-person group, while technology and the financial sector were predominant among hybrid workers (p < 0.001). As for leadership roles, there was no significant association with working models (p = 0.126). The decision on the working model was predominantly made by the organization for in-person and hybrid workers (p < 0.001). Preference for the working model was in line with the workers' scenario at that time (p < 0.001). Kruskal-Wallis test with Bonferroni's post hoc test compared the psychological safety scores between working groups, reveling statistically higher scores in hybrid group x̃ = 5.64 compared to in-person group x̃ = 5, with remote workers showing scores similar to other groups x̃ = 5.43 (p = 0.004). Age demonstrated no significant difference between the working groups (p = 0.052). On the other hand, organization tenure and job tenure were higher in in-person groups compared to the hybrid and remote groups (p < 0.001). The hybrid model illustrates a balance between in-person and remote models. The results highlight that higher levels of psychological safety can be correlated with the flexibility of hybrid work, as well as physical interaction, spontaneity, and informal relationships, which are considered determinants of high levels of psychological safety. Conclusions: Psychological safety at the group level using the seven-item scale is widely employed in comparison to other commonly employed measures. Despite psychological safety having been around for decades, primarily studied in in-person work contexts, the current findings contribute to expanding research with hybrid or remote settings. Ultimately, this investigation has demonstrated the significance of work models in assessing psychological safety levels.

Keywords: hybrid work, new ways of working, psychological safety, workplace, working models

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Authors: Dilsad Akal

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Aim: Companies communicate with each other and with their costumers via call centers. Call centers are defined as stressful because of their uncertain working hours, inadequate relief time, performance based system and heavy workload. In literature, this sector is defined as risky as mining sector by means of health and safety. The aim of this research is to enlight the relatively dark area. Subject and Methods: The collection of data for this study completed during April-May 2015 for the two selected call centers in different parts of Turkey. The applied question mostly investigated the health conditions of call center workers. Electromagnetic field measurements were completed at the same time with applying the question poll. The ratio of employee accessibility noted as 73% for the first call center and 87% for the second. Results: The results of electromagnetic field measurements were as between 371 V/m-32 V/m for the first location and between 370 V/m-61 V/m for the second. The general complaints of the employees for both workplaces can be counted as; inadequate relief time, inadequate air conditioning, disturbance, poor thermal conditions, inadequate or extreme lighting. Furthermore, musculoskeletal discomfort, stress, ear and eye discomfort are main health problems of employees. Conclusion: The measured values and the responses to the question poll were found parallel with the other similar research results in literature. At the end of this survey, a risk map of workplace was prepared in terms of safety and health at work in general and some suggestions for resolution were provided.

Keywords: call center, health and safety, electromagnetic field, risk map

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Authors: M. H. Brandtner-Hafner

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Adhesives have established themselves as an innovative joining technology in the wood industry. The strengths of adhesive bonding lie in the realization of lightweight designs, the avoidance of material weakening, and the joining of different types of materials. There is now a number of ways to positively influence the properties of bonded joints. One way is to add fiber fillers. This leads to an improvement in adhesion, structural integrity, and fracture toughness. In this study, the effectiveness of fiber-modified adhesives for bonding wooden joints is reviewed. A series of experimental tests were performed using the fracture analytical GF-principle to study the adhesive bonding safety and performance of the wood-adhesive interface. Two different construction adhesives based on epoxy and PUR were modified with different fiber materials and applied to bond wooden joints. The results show that bonding efficiency by adding fibrous materials to the bonding matrix leads to significant improvements in structural material properties.

Keywords: fiber-modified adhesives, bonding safety, wood-adhesive interfaces, fracture analysis

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Authors: Upal Barua

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The risk of severe crashes at high-speed right-turns at intersections is a major safety concern these days. The application of a smart right-turn at an intersection is increasing day by day to address is an issue. The design, ‘Smart Right-turn’ consists of a narrow-angle of channelization at approximately 70°. This design increases the cone of vision of the right-tuning drivers towards the crossing pedestrians as well as traffic on the cross-road. As part of the Safety Improvement Program in Austin Transportation Department, several smart right-turns were constructed at high crash intersections where high-speed right-turns were found to be a contributing factor. This paper features the state of the art techniques applied in planning, engineering, designing and construction of this smart right-turn, key factors driving the success, and lessons learned in the process. This paper also presents the significant crash reductions achieved from the application of this smart right-turn design using Empirical Bayes method. The result showed that smart right-turns can reduce overall right-turn crashes by 43% and severe right-turn crashes by 70%.

Keywords: smart right-turn, intersection, cone of vision, empirical Bayes method

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Authors: Jin Hwa Yang, Hwang Bae, Sung Uk Ryu, Byong Guk Jeon, Sung Jae Yi, Hyun Sik Park

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Experimental studies using a large-scale thermal-hydraulic integral test facility, System–integrated Modular Advanced Reactor Integral Test Loop (SMART-ITL), have been carried out to validate the performance of the prototype, SMART. After Fukushima accident, the passive safety systems have been dealt as important designs for retaining of nuclear safety. One of the concerned scenarios for evaluating the passive safety system is a Complete Loss of Coolant Flow (CLOF). The flowrate of coolant in the primary system is maintained by Reactor Coolant Pump (RCP). When the supply of electric power of RCP is shut off, the flowrate of coolant decreases sharply, and the temperature of the coolant increases rapidly. Therefore, the reactor trip signal is activated to prevent the over-heating of the core. In this situation, Passive Residual Heat Removal System (PRHRS) plays a significant role to assure the soundness of the SMART. The PRHRS using a two-phase natural circulation is a passive safety system in the SMART to eliminate the heat of steam generator in the secondary system with heat exchanger submarined in the Emergency Cooling Tank (ECT). As the RCPs continue to coast down, inherent natural circulation in the primary system transfers heat to the secondary system. The transferred heat is removed by PRHRS in the secondary system. In this paper, the progress of the CLOF accident is described with experimental data of transient condition performed by SMART-ITL. Finally, the capability of passive safety system and inherent natural circulation will be evaluated.

Keywords: CLOF, natural circulation, PRHRS, SMART-ITL

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Authors: Gaoguang Yang, Shan Fu

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Human-machine interface (HMI) intermediate system information to human operators to facilitate human ability to manage and control the system. Well-designed HMI would enhance human ability. An evaluation must be performed to confirm that the designed HMI would enhance but not degrade human ability. However, the prevalent HMI evaluation techniques have difficulties in more thoroughly and accurately evaluating the suitability and fitness of a given HMI for the wide variety of uncertainty contained in both the existing HMI evaluation techniques and the large number of task scenarios. The first limitation should be attributed to the subjective and qualitative analysis characteristics of these evaluation methods, and the second one should be attributed to the cost balance. This study aims to explore the connection between objective HMI characters and ergonomic safety and step forward toward solving these limitations with objective, characterized HMI parameters. A simulation experiment was performed with the time needed for human operators to recognize the HMI information as characterized HMI parameter, and the result showed a strong correlation between the parameter and ergonomic safety level.

Keywords: Human-Machine Interface (HMI), evaluation, objective, characterization, simulation

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Authors: Raana Babadi Fathipour

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Street foods hold a significant place in the tapestry of socioeconomic and cultural norms, beloved across the globe. Serving as a convenient and affordable option for city dwellers seeking nourishment, these culinary delights also serve as a vital source of income for vendors, particularly women. Additionally, street food acts as a mirror reflecting traditional local customs and practices, an element that draws tourists to experience the authenticity of a culture firsthand. Despite its many virtues, concerns have emerged regarding the microbiological safety of street food worldwide. Often prepared and sold in subpar conditions without proper oversight or regulation, street food has become synonymous with potential health risks. The presence of elevated levels of fecal indicator bacteria and various pathogens in these unregulated delicacies further perpetuates anxieties surrounding their consumption. This analysis delves into the intricate microbiological intricacies inherent in street food, shedding light on the pertinent safety concerns and prevalent pathogens. Additionally, it elaborates on the worldwide standing of this vital economic endeavor. Moreover, it advocates for the adoption of molecular detection techniques over conventional culture-based methods to gain a more comprehensive grasp of the true microbial risks posed by street cuisine. Acknowledgment marks the initial step towards resolving any given issue.

Keywords: foodborne pathogens, microbiological safety, street food, viruses

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Authors: Umamaheswara Rao Jada, Susmita Mukhopadhyay

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In the present highly complex, dynamic and interdependent organizational environment, employees' ideas, opinions and suggestions which is technically referred to as ‘constructive employee voice’ is increasingly being recognized and valued. Literature has consistently demonstrated the relevance of leadership in employee voicing behavior, however the new form of leadership, ‘empowering leadership’ has not been given much attention. The study, therefore, devotes itself to the effort to explore the impact of this new form of leadership on employee voice behavior and the interplay with leader member exchange (LMX) and psychological safety as mediators in the same. The study utilizes structural equation modeling for analyzing the data collected from 310 Indian service industry employees through the questionnaire developed for the study. The findings of the study demonstrate the significant impact of empowering form of leadership on employees’ constructive voice behavior. Additionally, supporting results were observed for the mediating impact of leader member exchange (LMX) and psychological safety between empowering leadership and employees’ constructive voice behavior. The results of this study provide insights into the intervening mechanisms by linking leaders’ empowering behavior with employees’ constructive voice, while also highlighting the potential importance of LMX relationship in organizations and psychological safety in the context of constructive voice behavior. The study brings forth the relevance of the new form of leadership, ‘empowering leadership’ for fostering the better exchange of ideas, opinions, and suggestions between leaders and followers which tend to benefit the organization, providing empirical evidence of the sequential mediation of LMX and psychological safety. The piece of work is assumed to benefit the leaders in organizations by providing them the basis for adopting empowering form of leadership in light of results displayed.

Keywords: constructive voice, empowering leadership, leader member exchange (LMX), psychological safety, sequential mediation, structural equation modeling

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Authors: T. Benazzouz, K. Auhmani

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This paper presents a Hospital 4.0 Maturity Assessment Model based on the Industry 4.0 concepts. The self-assessment model defines current and target states of digital transformation by considering multiple aspects of a hospital and a healthcare supply chain. The developed model was validated and evaluated on real-life cases. The resulting model consisted of 5 domains: Technology, Strategy 4.0, Human resources 4.0 & Culture 4.0, Supply chain 4.0 management, and Patient journeys management. Each domain is further divided into several sub-domains, totally 34 sub-domains are identified, that reflect different facets of a hospital 4.0 mature organization.

Keywords: hospital 4.0, Industry 4.0, maturity assessment model, supply chain 4.0, patient

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Authors: Claudia Seabra, Elisabeth Kastenholz, José Luís Abrantes, Manuel Reis

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In a world of increasing mobility and global risks, terrorism has, in a perverse way, capitalized on contemporaneous society’s growing interest in travel to explore a world whose national boundaries and distances have decreased. Terrorists have identified the modern tourist flows originated from the economically more developed countries as new appealing targets so as to: i) call attention to the causes they defend and ii) destroy a country’s foundations of tourism, with the final aim of disrupting the economic and consequently social fabric of the affected countries. The present study analyses sensitivity towards risk and travel behaviors in international travel amongst a sample of 600 international tourists from 49 countries travelling by air. Specifically, the sample was segmented according to the Global Peace Index. This index defines country profiles regarding the levels of peace. The indicators used are established over three broad themes: i) ongoing domestic and international conflict; ii) societal safety and security; and iii) militarisation. Tourists were segmented, according to their country of origin, in different levels of peacefulness. Several facets of travel behavior were evaluated, namely motivations, attitude towards trip planning, quality perception and perceived value of the trip. Also factors related with risk perception were evaluated, specifically terrorism risk perception during the trip, unsafety sensation as well as importance attributed to safety in travel. Results contribute to our understanding of the role of previous exposure to the lack of peace and safety at home in the international tourists behaviors, which is further discussed in terms of tourism management and marketing implications which should particularly interest tourism services and destinations more affected by terrorism, war, political turmoil, crime and other safety risks.

Keywords: terrorism, tourism, safety, risk perception

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Authors: Tareq L. Mukattash, Karem H. Alzoubi, Ejlal Abu El-Rub, Anan S. Jarab, Sayyer I. Al-Azzam, Maher Khdour, Mohammed Shara, Yazid N. Alhamarneh

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Background: It has been estimated that up to 50% of any patient population is at least partially non-adherent to their prescribed treatment. Identifying barriers to adherence is required to develop effective interventions for psychiatric patients. Objective: To explore the prevalence and factors of non-adherence among psychiatric patients present at four psychiatric clinics. Method: A cross-sectional questionnaire-based study. A sample of psychiatric patients attending outpatient psychiatric clinics was enrolled between March and April 2011. Results: A total of 243 psychiatric patients took part in this study with the majority of patients (92.5%) being prescribed more than one psychiatric disorder. The majority (64.2%) of the patients was classified as non-adherent according to the Morisky adherence questionnaire and forgetfulness was the most prevalent reason for that. Conclusions: Non-adherence is a common and important issue among psychiatric patients. Polypharmacy, safety concerns and lack of insight towards the prescribed treatment were reported as the main reasons of non-adherence.

Keywords: medication adherence, psychiatric disorders, clinical pharmacy, polypharmacy

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Authors: Lolwa Alansari, Abdelhamid Azhaghdani, Sufia Athar, Hanen Mrabet, Annaliza Cruz, Tamara Alshadafat, Almunzer Zakaria

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Introduction: Improving the patient experience is a fundamental pillar of healthcare's quadruple aims. Recognizing the importance of patient experiences and perceptions in healthcare interactions is pivotal for driving quality improvement. This abstract centers around the Patient Experience Program, an endeavor crafted with the purpose of comprehending and elevating the experiences of patients in the Obstetrics & Gynecology Emergency Department (OB/GYN ED). Methodology: This comprehensive endeavor unfolded through a structured sequence of phases following Plan-Do-Study-Act (PDSA) model, spanning over 12 months, focused on enhancing patient experiences in the Obstetrics & Gynecology Emergency Department (OB/GYN ED). The study meticulously examined the journeys of patients with acute obstetrics and gynecological conditions, collecting data from over 100 participants monthly. The inclusive approach covered patients of different priority levels (1-5) admitted for acute conditions, with no exclusions. Historical data from March and April 2022 serves as a benchmark for comparison, strengthening causality claims by providing a baseline understanding of OB/GYN ED performance before interventions. Additionally, the methodology includes the incorporation of staff engagement surveys to comprehensively understand the experiences of healthcare professionals with the implemented improvements. Data extraction involved administering open-ended questions and comment sections to gather rich qualitative insights. The survey covered various aspects of the patient journey, including communication, emotional support, timely access to care, care coordination, and patient-centered decision-making. The project's data analysis utilized a mixed-methods approach, combining qualitative techniques to identify recurring themes and extract actionable insights and quantitative methods to assess patient satisfaction scores and relevant metrics over time, facilitating the measurement of intervention impact and longitudinal tracking of changes. From the themes we discovered in both the online and in-person patient experience surveys, several key findings emerged that guided us in initiating improvements, including effective communication and information sharing, providing emotional support and empathy, ensuring timely access to care, fostering care coordination and continuity, and promoting patient-centered decision-making. Results: The project yielded substantial positive outcomes, significantly improving patient experiences in the OB/GYN ED. Patient satisfaction levels rose from 62% to a consistent 98%, with notable improvements in satisfaction with care plan information and physician care. Waiting time satisfaction increased from 68% to a steady 97%. The project positively impacted nurses' and midwives' job satisfaction, increasing from 64% to an impressive 94%. Operational metrics displayed positive trends, including a decrease in the "left without being seen" rate from 3% to 1%, the discharge against medical advice rate dropping from 8% to 1%, and the absconded rate reducing from 3% to 0%. These outcomes underscore the project's effectiveness in enhancing both patient and staff experiences in the healthcare setting. Conclusion: The use of a patient experience questionnaire has been substantiated by evidence-based research as an effective tool for improving the patient experience, guiding interventions, and enhancing overall healthcare quality in the OB/GYN ED. The project's interventions have resulted in a more efficient allocation of resources, reduced hospital stays, and minimized unnecessary resource utilization. This, in turn, contributes to cost savings for the healthcare facility.

Keywords: patient experience, patient survey, person centered care, quality initiatives

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Authors: Sanja Šurdonja, Aleksandra Deluka-Tibljaš, Mirna Klobučar, Irena Ištoka Otković

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Roundabouts are a common choice in the case of reconstruction of an intersection, whether it is to improve the capacity of the intersection or traffic safety, especially in urban conditions. The regulation for the design of roundabouts is often related to driving culture, the tradition of using this type of intersection, etc. Individual values in the regulation are usually recommended in a wide range (this is the case in Croatian regulation), and the final design of a roundabout largely depends on the designer's experience and his/her choice of design elements. Therefore, before-after analyses are a good way to monitor the performance of roundabouts and possibly improve the recommendations of the regulation. This paper presents a comprehensive before-after analysis of a roundabout on the country road network near Rijeka, Croatia. The analysis is based on a thorough collection of traffic data (operating speeds and traffic load) and design elements data, both before and after the reconstruction into a roundabout. At the chosen location, the roundabout solution aimed to improve capacity and traffic safety. Therefore, the paper analyzed the collected data to see if the roundabout achieved the expected effect. A traffic microsimulation model (VISSIM) of the roundabout was created based on the real collected data, and the influence of the increase of traffic load and different traffic structures, as well as of the selected design elements on the capacity of the roundabout, were analyzed. Also, through the analysis of operating speeds and potential conflicts by application of the Surrogate Safety Assessment Model (SSAM), the traffic safety effect of the roundabout was analyzed. The results of this research show the practical value of before-after analysis as an indicator of roundabout effectiveness at a specific location. The application of a microsimulation model provides a practical method for analyzing intersection functionality from a capacity and safety perspective in present and changed traffic and design conditions.

Keywords: before-after analysis, operating speed, capacity, design.

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Authors: V. Giacometti, R. Mirabelli, V. Patera, D. Pinci, A. Sarti, A. Sciubba, G. Traini, M. Marafini

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The particle therapy (PT) is a very modern technique of non invasive radiotherapy mainly devoted to the treatment of tumours untreatable with surgery or conventional radiotherapy, because localised closely to organ at risk (OaR). Nowadays, PT is available in about 55 centres in the word and only the 20\% of them are able to treat with carbon ion beam. However, the efficiency of the ion-beam treatments is so impressive that many new centres are in construction. The interest in this powerful technology lies to the main characteristic of PT: the high irradiation precision and conformity of the dose released to the tumour with the simultaneous preservation of the adjacent healthy tissue. However, the beam interactions with the patient produce a large component of secondary particles whose additional dose has to be taken into account during the definition of the treatment planning. Despite, the largest fraction of the dose is released to the tumour volume, a non-negligible amount is deposed in other body regions, mainly due to the scattering and nuclear interactions of the neutrons within the patient body. One of the main concerns in PT treatments is the possible occurrence of secondary malignant neoplasm (SMN). While SMNs can be developed up to decades after the treatments, their incidence impacts directly life quality of the cancer survivors, in particular in pediatric patients. Dedicated Treatment Planning Systems (TPS) are used to predict the normal tissue toxicity including the risk of late complications induced by the additional dose released by secondary neutrons. However, no precise measurement of secondary neutrons flux is available, as well as their energy and angular distributions: an accurate characterization is needed in order to improve TPS and reduce safety margins. The project MONDO (MOnitor for Neutron Dose in hadrOntherapy) is devoted to the construction of a secondary neutron tracker tailored to the characterization of that secondary neutron component. The detector, based on the tracking of the recoil protons produced in double-elastic scattering interactions, is a matrix of thin scintillating fibres, arranged in layer x-y oriented. The final size of the object is 10 x 10 x 20 cm3 (squared 250µm scint. fibres, double cladding). The readout of the fibres is carried out with a dedicated SPAD Array Sensor (SBAM) realised in CMOS technology by FBK (Fondazione Bruno Kessler). The detector is under development as well as the SBAM sensor and it is expected to be fully constructed for the end of the year. MONDO will make data tacking campaigns at the TIFPA Proton Therapy Center of Trento, at the CNAO (Pavia) and at HIT (Heidelberg) with carbon ion in order to characterize the neutron component and predict the additional dose delivered on the patients with much more precision and to drastically reduce the actual safety margins. Preliminary measurements with charged particles beams and MonteCarlo FLUKA simulation will be presented.

Keywords: secondary neutrons, particle therapy, tracking detector, elastic scattering

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Authors: M. Belén Prendes-Gero, Celestino González-Nicieza, M. Inmaculada Alvarez-Fernández

Abstract:

Roof collapse is one of the problems with a higher frequency in most of the mines of all countries, even now. There are many reasons that may cause the roof to collapse, namely the mine stress activities in the mining process, the lack of vigilance and carelessness or the complexity of the geological structure and irregular operations. This work is the result of the analysis of one accident produced in the “Mary” coal exploitation located in northern Spain. In this accident, the roof of a crossroad of excavated galleries to exploit the “Morena” Layer, 700 m deep, collapsed. In the paper, the work done by the forensic team to determine the causes of the incident, its conclusions and recommendations are collected. Initially, the available documentation (geology, geotechnics, mining, etc.) and accident area were reviewed. After that, laboratory and on-site tests were carried out to characterize the behaviour of the rock materials and the support used (metal frames and shotcrete). With this information, different hypotheses of failure were simulated to find the one that best fits reality. For this work, the software of finite differences in three dimensions, FLAC 3D, was employed. The results of the study confirmed that the detachment was originated as a consequence of one sliding in the layer wall, due to the large roof span present in the place of the accident, and probably triggered as a consequence of the existence of a protection pillar insufficient. The results allowed to establish some corrective measures avoiding future risks. For example, the dimensions of the protection zones that must be remained unexploited and their interaction with the crossing areas between galleries, or the use of more adequate supports for these conditions, in which the significant deformations may discourage the use of rigid supports such as shotcrete. At last, a grid of seismic control was proposed as a predictive system. Its efficiency was tested along the investigation period employing three control equipment that detected new incidents (although smaller) in other similar areas of the mine. These new incidents show that the use of explosives produces vibrations which are a new risk factor to analyse in a next future.

Keywords: forensic analysis, hypothesis modelling, roof failure, seismic monitoring

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Authors: Alexandria Carey, Angela Starkweather, Ann Horgas, Hwayoung Cho, Jason Beneciuk

Abstract:

Background/Significance: Over 3.4 million acute axial low back pain (aLBP) cases are treated annually in the United States (US) emergency departments (ED). ED patients with aLBP receive varying verbal and written discharge routine care (RC), leading to ineffective patient self-management. Ineffective self-management increase chronic low back pain (cLPB) transition risks, a chief cause of worldwide disability, with associated costs >$60 million annually. This research addresses this significant problem by evaluating an ED digital pain self-management intervention (EDPSI) focused on improving self-management through improved knowledge retainment, skills, and self-efficacy (confidence) (KSC) thus reducing aLBP to cLBP transition in ED patients discharged with aLBP. The research has significant potential to increase self-efficacy, one of the most potent mechanisms of behavior change and improve health outcomes. Focusing on accessibility and usability, the intervention may reduce discharge disparities in aLBP self-management, especially with low health literacy. Study Questions: This research will answer the following questions: 1) Will an EDPSI focused on improving KSC progress patient self-management behaviors and health status?; 2) Is the EDPSI sustainable to improve pain severity, interference, and pain recurrence?; 3) Will an EDPSI reduce aLBP to cLBP transition in patients discharged with aLBP? Aims: The pilot randomized-controlled trial (RCT) study’s objectives assess the effects of a 12-week digital self-management discharge tool in patients with aLBP. We aim to 1) Primarily assess the feasibility [recruitment, enrollment, and retention], and [intervention] acceptability, and sustainability of EDPSI on participant’s pain self-management; 2) Determine the effectiveness and sustainability of EDPSI on pain severity/interference among participants. 3) Explore patient preferences, health literacy, and changes among participants experiencing the transition to cLBP. We anticipate that EDPSI intervention will increase likelihood of achieving self-management milestones and significantly improve pain-related symptoms in aLBP. Methods: The study uses a two-group pilot RCT to enroll 30 individuals who have been seen in the ED with aLBP. Participants are randomized into RC (n=15) or RC + EDPSI (n=15) and receive follow-up surveys for 12-weeks post-intervention. EDPSI innovative content focuses on 1) highlighting discharge education; 2) provides self-management treatment options; 3) actor demonstration of ergonomics, range of motion movements, safety, and sleep; 4) complementary alternative medicine (CAM) options including acupuncture, yoga, and Pilates; 5) combination therapies including thermal application, spinal manipulation, and PT treatments. The intervention group receives Booster sessions via Zoom to assess and reinforce their knowledge retention of techniques and provide return demonstration reinforcing ergonomics, in weeks two and eight. Outcome Measures: All participants are followed for 12-weeks, assessing pain severity/ interference using the Brief Pain Inventory short-form (BPI-sf) survey, self-management (measuring KSC) using the short 13-item Patient Activation Measure (PAM), and self-efficacy using the Pain Self-Efficacy Questionnaire (PSEQ) weeks 1, 6, and 12. Feasibility is measured by recruitment, enrollment, and retention percentages. Acceptability and education satisfaction are measured using the Education-Preference and Satisfaction Questionnaire (EPSQ) post-intervention. Self-management sustainment is measured including PSEQ, PAM, and patient satisfaction and healthcare utilization (PSHU) requesting patient overall satisfaction, additional healthcare utilization, and pain management related to continued back pain or complications post-injury.

Keywords: digital, pain self-management, education, tool

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Authors: Tamer E. Yared

Abstract:

The use of driving simulators has made laboratory testing easier. It has been proven to be valid for testing driving ability by many researchers. One benefit of using driving simulators is keeping the human subjects away from traffic hazards, which drivers usually face in a real driving environment while performing a driving experiment. In this study, a driving simulator was developed with a navigation system using a game development software (Unity 3D) and C-sharp codes to measure and evaluate driving performance, safety, and workload for different driving tasks. The driving simulator hardware included a gaming steering wheel and pedals as well as a monitor to view the driving tasks. Moreover, driver distraction was evaluated by utilizing an eye-tracking system working in conjunction with the driving simulator. Twenty subjects were recruited to evaluate driver distraction, workload, driving safety, and performance, as well as provide their feedback about the driving simulator. The subjects’ feedback was obtained by filling a survey after conducting several driving tasks. The main question of that survey was asking the subjects to compare driving on the driving simulator with real driving. Furthermore, other aspects of the driving simulator were evaluated by the subjects in the survey. The survey revealed that the recruited subjects gave an average score of 7.5 out of 10 to the driving simulator when compared to real driving, where the scores ranged between 6 and 8.5. This study is a preliminary effort that opens the door for more improvements to the driving simulator in terms of hardware and software development, which will contribute significantly to driving ability testing.

Keywords: driver distraction, driving performance, driving safety, driving simulator, driving workload, navigation system

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Authors: Syue-Wen Lin

Abstract:

Objective:This article reviews the care experience of a 40-year-old male patient who underwent a thoracoscopic right lower lobectomy following a COVID-19 infection. His complex medical history included multiple metastases (lungs, liver, spleen, and left kidney) and lung damage from COVID-19, which complicated the weaning process from mechanical ventilation. The care involved managing cancer treatment, postoperative pain, wound care, and palliative care. Methods:Nursing care was provided from August 16 to August 17, 2024. Challenges included difficulty with sputum clearance, which exacerbated the patient's anxiety and fear of reintubation. Pain management strategies combined analgesic drugs, non-drug methods, essential oil massages with family members, and playing the patient’s favorite music to reduce pain and anxiety. Progressive rehabilitation began with stabilizing vital signs, followed by assistance with sitting on the edge of the bed and walking within the ward. Strict sterile procedures and advanced wound care technology were used for daily dressing changes, with meticulous documentation of wound conditions and appropriate dressing selection. Holistic cancer care and palliative measures were integrated to address the patient’s physical and psychological needs. Results:The interdisciplinary care team developed a comprehensive plan addressing both physical and psychological aspects. Respiratory therapy, lung expansion exercises, and a high-frequency chest wall oscillation vest facilitated sputum expulsion and assisted in weaning from mechanical ventilation. The integration of cancer care, pain management, wound care, and palliative care led to improved quality of life and recovery. The collaborative approach between nursing staff and family ensured that the patient received compassionate and effective care. Conclusion: The complex interplay of emergency surgery, COVID-19, and advanced cancer required a multifaceted care strategy. The care team’s approach, combining critical care with tailored cancer and palliative care, effectively improved the patient’s quality of life and facilitated recovery. The comprehensive care plan, developed with family collaboration, provided both high-quality medical care and compassionate support for the terminally ill patient.

Keywords: multiple metastases, testicular cancer, palliative care, nursing experience

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Authors: Amal A. Qedrah, Sofia A. Malik, Madiha Akbar

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The aim of this article is to share a rare clinical case of pregnancy and surgical delivery in a patient who has undergone augmentation cystoplasty with mitrofanoff channel in the past. Methods: This case report is about a woman who conceived naturally at the age of 27, previously underwent augmentation cystoplasty at the age of 10 years with mitrofanoff procedure using self-clean intermittent catheterization. Furthermore, this pregnancy was complicated by the presence of preeclampsia diagnosed at term and PROM. Following the failure of induction for intrapartum preeclampsia, the patient delivered a healthy baby via low transverse cesarean section at 38 weeks done at Latifa Hospital, Dubai. Conclusion: The procedure is done at a pediatric or young age, after which most patients reach reproductive age. There is no contraindication to pregnancy vaginally or surgically; however, this case was complicated by preeclampsia, due to which this patient was taken for a cesarean section. It is advisable to consult a urologist frequently along with taking regular bacteriological urine samples and blood samples with renal ultrasonography for the evaluation of the kidney. Antibacterial treatment or prophylaxis should be used during pregnancy if necessary and intermittent self-catherization is mostly performed routinely. It is also important to have a urologist on standby during the surgery in order to avoid and/or fix any complications that might come forth.

Keywords: augmentation cystoplasty, cesarean section, delivery, mitrofanoff channel

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Authors: L. R. Ferreira, R. Biscaro, C. C. Danziger, C. M. Galhardi, L. C. Biscaro, R. C. Biscaro, I. S. Vasconcelos, L. C. R. Ferreira, R. Reis, L. H. Oliveira

Abstract:

Introduction: There is a worldwide trend for the employer to be aware of investing in health promotion that goes beyond occupational hygiene approaches with the implementation of a comprehensive program with integration between occupational health and safety, and social/psychosocial responsibility in the workplace. Work accommodation is a necessity in most companies as it allows the worker to return to its function respecting its physical limitations. This study had the objective to verify if the integration of health and safety in the companies, with the inclusion of the concept of TWH promoted by an occupational health service has impacted in the management of absenteeism of workers in work accommodation. Method: A retrospective and paired cohort study was used, in which the impact of the implementation of the Program for the Health/Safety Integration and Total Worker Health Concept (PHSITWHC) was evaluated using the indices of absenteeism, health attestations, days and hours of sick leave of workers that underwent job accommodation/rehabilitation. This was a cohort study and the data were collected from January to September of 2017, prior to the initiation of the integration program, and compared with the data obtained from January to September of 2018, after the implementation of the program. For the statistical analysis, the student's t-test was used, with statistically significant differences being made at p < 0.05. Results: The results showed a 35% reduction in the number of absenteeism rate in 2018 compared to the same period in 2017. There was also a significant reduction in the total numbers of days of attestations/absences (mean of 2,8) as well as days of attestations, absence and sick leaves (mean of 5,2) in 2018 data after the implementation of PHSITWHC compared to 2017 data, means of 4,3 and 25,1, respectively, prior to the program. Conclusion: It can be concluded that the inclusion of the PHSITWHC was associated with a reduction in the rate of absenteeism of workers that underwent job accommodation. It was observed that, once health and safety were approached and integrated with the inclusion of the TWH concept, it was possible to reduce absenteeism, and improve worker’s quality of life and wellness, and work accommodation management.

Keywords: absenteeism, health/safety integration, work accommodation management, total worker health

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Authors: Vasiliki Markantoni, Eftychia Platsidaki, Georgios Chaidemenos, Georgios Kontochristopoulos

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Introduction: Bromhidrosis, also known as osmidrosis, is a common distressing condition with a significant negative effect on patient’s quality of life. Its etiology is multifactorial. It usually affects axilla, genital skin, breasts and soles, areas where apocrine glands are mostly distributed. Therapeutic treatments include topical antibacterial agents, antiperspirants and neuromuscular blocker agents-toxins. In this study, we aimed to evaluate the efficacy and possible complications of topical glycopyrrolate, an anticholinergic agent, for treatment of bromhidrosis. Glycopyrrolate, applied topically as a cream, solution or spray at concentrations between 0,5% and 4%, has been successfully used to treat different forms of focal hyperhidrosis. Materials and Methods: Twenty patients, six males and fourteen females, meeting the criteria for bromhidrosis were treated with topical glycopyrrolate for two months. The average age was 36. Eleven patients had bromhidrosis located to the axillae, four to the soles, four to both axillae and soles and one to the genital folds. Glycopyrrolate was applied topically as a cream at concentration 2%, formulated in Fitalite. During the first month, patients were using the cream every night and thereafter twice daily. The degree of malodor was assessed subjectively by patients and scaled averagely as ‘none’, ‘mild’, ‘moderate’, and ‘severe’ with corresponding scores of 0, 1, 2, and 3, respectively. The modified Dermatology Life Quality Index (DLQI) was used to assess the quality of life. The clinical efficacy was graded by the patient scale of excellent, good, fair and poor. In the end, patients were given the power to evaluate whether they were totally satisfied with, partially satisfied or unsatisfied and possible side effects during the treatment were recorded. Results: All patients were satisfied at the end of the treatment. No patient defined the response as no improvement. The subjectively assessed score level of bromhidrosis was remarkably improved after the first month of treatment and improved slightly more after the second month. DLQI score was also improved to all patients. Adverse effects were reported in 2 patients. In the first case, topical irritation was reported. This was classed as mild (erythema and desquamation), appeared during the second month of treatment and was treated with low-potency topical corticosteroids. In the second case, mydriasis was reported, that recovered without specific treatment, as soon as we insisted to the importance of careful hygiene after cream application so as not to contaminate the periocular skin or ocular surface. Conclusions: Dermatologists often encounter patients with bromhidrosis, therefore should be aware of treatment options. To the best of our knowledge, this is the first study to evaluate the use of topical glycopyrrolate as a therapeutic approach for bromhidrosis. Our findings suggest that topical glycopyrrolate has an excellent safety profile and demonstrate encouraging results for the management of this distressful condition.

Keywords: Bromhidrosis, glycopyrrolate, topical treatment, osmidrosis

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