Search results for: emergency staff department

Authors: Mohammad U. A. Khan, Md. D. Hossain

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Background: Department of Physiology finds difficulty in managing ‘subjects’ in practical procedure. To avoid this difficulty fellow examinees of other group may be used as subjects. Objective: To find out the merits and demerits of using fellow examinees as subjects in the practical procedure. Method: This cross-sectional descriptive study was conducted in the Department of Physiology, Noakhali Medical College, Bangladesh during May-June’14. Forty-two 1st year undergraduate medical students from a selected public medical college of Bangladesh were enrolled for the study purposively. Consent of students and authority was taken. Eighteen of them were selected as subjects and designated as subject-examinees. Other fellow examinees (non-subject) examined their blood pressure and pulse as part of ‘observed structured practical examination’ (OSPE). The opinion of all examinees regarding the merits and demerits of using fellow examinee as subjects in the practical procedure was recorded. Result: Examinees stated that they could perform their practical procedure without nervousness (24/42, 57.14%), accurately and comfortably (14/42, 33.33%) and subjects were made available without wasting time (2/42, 4.76%). Nineteen students (45.24%) found no disadvantage and 2 (4.76%) felt embracing when the subject was of opposite sex. The subject-examinees narrated that they could learn from the errors done by their fellow examinee (11/18, 61.1%). 75% non-subject examinees expressed their willingness to be subject so that they can learn from their fellows’ error. Conclusion: Using fellow examinees as subjects is beneficial for both the non-subject and subject examinees. Funding sources: Navana, Beximco, Unihealth, Square & Acme Pharma, Bangladesh Ltd.

Keywords: physiology, teaching, practical, OSPE

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Authors: Rishi Agarwal

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Digital twins are emerging as a strong technology used to imitate and monitor physical objects digitally in real time across sectors. It is not only dealing with the digital space, but it is also actuating responses in the physical space in response to the digital space processing like storage, modeling, learning, simulation, and prediction. This paper explores the application of digital twins for enhancing physical security in retail stores. The retail sector still relies on outdated physical security practices like manual monitoring and metal detectors, which are insufficient for modern needs. There is a lack of real-time data and system integration, leading to ineffective emergency response and preventative measures. As retail automation increases, new digital frameworks must control safety without human intervention. To address this, the paper proposes implementing an intelligent digital twin framework. This collects diverse data streams from in-store sensors, surveillance, external sources, and customer devices and then Advanced analytics and simulations enable real-time monitoring, incident prediction, automated emergency procedures, and stakeholder coordination. Overall, the digital twin improves physical security through automation, adaptability, and comprehensive data sharing. The paper also analyzes the pros and cons of implementation of this technology through an Emerging Technology Analysis Canvas that analyzes different aspects of this technology through both narrow and wide lenses to help decision makers in their decision of implementing this technology. On a broader scale, this showcases the value of digital twins in transforming legacy systems across sectors and how data sharing can create a safer world for both retail store customers and owners.

Keywords: digital twin, retail store safety, digital twin in retail, digital twin for physical safety

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Authors: Mutshinye Manguvhewa, Maria Florence, Mansoo Yu, Elize Koch, Kamal Kamaloodien

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Substance use among pregnant women is a perennial problem in the Western Cape Province of South Africa. There are many influential factors are associated with substance use among women of childbearing age. The study explored factors associated with substance use among pregnant women using a qualitative research design and the bio-ecological theoretical framework to explore and guide the researcher throughout the study. Participants were selected using purposive sampling. Only participants accessed from the Department of Social Development meeting the inclusion criteria of the study were interviewed using semi structured interviews. Immediate referral for psychological intervention during the interview was available for participants who needed it. Braun and Clarke's six phases of thematic analysis were utilised to analyse the data. The study adheres to ethical guidelines for the participants' protection. Participants were informed about the study before the initiation of the interviews and the details of their voluntary participation were explained. The key findings from this study illustrate that socio-cultural factors, personal factors, emotional response and intimate relationships are the major contributing factors to substance use among pregnant women in this sample. The results outline the preventative measures that pregnant women implement. Lastly, the study reveals the positive and negative perceptions of substance use programmes that participants share. Some of the study findings are similar to the existing literature and some of the findings differed. Recommendations emanating from the study include that the stakeholders, rehabilitation centres, Department of Health and future researchers should act proactively against substance use during pregnancy.

Keywords: substance addiction, antenatal care, pregnancy, substance use

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Authors: Christiana Jonut

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The study addresses tagal as an ecotourism product that is uniquely for Sabah. It is a community based tourism venture that is influenced by the Dusun ethic’s traditional law. The traditional principle of tagal is focused primarily on individual exploitation of riverine resources and it was transformed into a community participation in the riverine conservation to foster the growth or survival of ecotourism. It manages a river into a sustainable manner. A smart partnership system between the community and the authority particularly the Department of Fisheries Sabah, tagal has successfully become an instrument to protect, revive and manage the river fish resources. In 2015, Sabah Fisheries Department added 536 tagal sites. Most tagal sites were turned into a community based tourism venture. They generate income through jobs creation for the purpose of uplifting the local’s economic level. Tagal ecotourism sites also increase environmental awareness of the local people to love their culture, tradition and environment. This venture also promotes the sustainability of the eco-tourism. The objective of this study is to explore the issues and contexts of empowerment of the local people in managing a successful tagal ecotourism. This study further explains how community capacity building is the major influence of empowerment of the local community. The methodology approach used is qualitative where interview is chosen as the data collection method. This is a literature review of exploring empowerment of the local community through various community capacity building initiatives that would motivate the local people to be actively involved in the tagal.

Keywords: capacity building, Tagal, ecotourism, empowerment, Sabah

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Authors: Nur Inayah Ismaniar, Sukri Palutturi, Ansariadi, Atjo Wahyu

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Background: In various countries in the world, the problem of smoking is now considered something serious because of the effects of smoking which can not only lead to addiction but also have the potential to harm health. Public health authorities have concluded that one solution that can be done to protect the public from active smokers is to issue a policy that requires public facilities to be completely smoke-free. The hospital is one of the public facilities that has been designated as a smoke-free area. However, the implementation and maintenance of a successful program based on a smoke-free hospital are still considered an ongoing challenge worldwide due to the very low level of adherence. The low level of compliance with this smoke-free policy is also seen in other public facilities. The purpose of the literature review is to review the level of compliance with the application of the Non-Smoking Area policy, how this policy has succeeded in reducing smoking activity in hospitals, and what factors lead to such compliance in each country in the world. Methods: A literature review of articles was carried out on all types of research methods, both qualitative and quantitative. The sample is all subjects who are in the research location, which includes patients, staff and hospital visitors. Results: Various variations in the level of compliance were found in various kinds of literature. The literature with the highest level of compliance is 88.4%. Furthermore, several determinants that are known to affect the compliance of the Non-Smoking Area policies in hospitals include communication, information, knowledge, perceptions, interventions, attitudes and support. Obstacles to its enforcement are the absence of sanctions against violators of the Non-Smoking Area policy, the ineffectiveness of the function of policymakers in hospitals, and negative perceptions of smoking related to mental health. Conclusion: Violations of the Non-Smoking Area policy are often committed by the hospital staff themselves, which makes it difficult for this policy to be fully enforced at various points in the hospital.

Keywords: health policy, non-smoking area, hospital, implementation

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Authors: Mohammad Ansari, Ahmed Ismail, Satinder Mann

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Overcrowding in Emergency departments (ED) of United Kingdom has become a common problem. Urgent Care centres were developed nearly a decade ago to reduce pressure on EDs. Unfortunately, the development of Urgent Care centres has failed to produce the projected effects. It was thought that nearly 40% patients attending ED would go to Urgent Care centres and these would be staffed by Primary care Physicians. Data reveals that no more than 20% patients were seen by Primary Care Physicians even when the Urgent Care Centre was based in the ED. This study was carried out at the ED of George Eliot Hospital, Nuneaton, UK where the Urgent Care centre was based in the ED and employed Primary Care Physicians with special interest in trauma for nearly one year. This was then followed by a Primary Care Physician and Advanced Nurse Practitioner. We compared the number of patients seen during these periods and the cost-effectiveness of the service.We randomly selected a week of patients seen by Primary Care Physicians with special interest in Trauma and by Primary Care Physicians and the Advanced Nurse Practitioner. We compared the number and type of patients seen during these two periods. Nearly 38% patients were seen by Primary care Physician with special interest in Trauma, whilst only 14.3% patients were seen by the Primary care Physician and Advanced Nurse Practitioner. The Primary Care Physicians with special interest in trauma were paid less. Our study confirmed that unless Primary Care Physicians are able to treat minor trauma and interpret x-rays, the urgent care service is not going to be cost effective. Numerous previous studies have shown that 15 to 20% patients attending ED can be treated by Primary Care Physicians who do not require any investigations for their management. It is advantageous to have Urgent Care Centres within the ED because if the patient deteriorates they can be transferred to ED. We recommend that the Urgent care Centres should be a part of ED. Our study shows that Urgent care Centres in the ED can be helpful and cost effective if staffed by either senior Emergency Physicians or Primary Care Physicians with special interest and experience in the management of minor trauma.

Keywords: urgent care centres, primary care physician, advanced nurse practitioner, trauma

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Authors: Caroline Nnokwe, Iheanyi Eneremadu

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Teachers and principals are vital and integral parts of the educational system. For educational objectives to be met, the role of teachers and the functions of the principals are not to be overlooked. However, the inability of teachers and principals to carry out their roles effectively has impacted the outcome of the students’ performance. The study, therefore, examined teachers’ roles and principal’s administrative functions as correlates of effective academic performance of public secondary school students in Imo state, Nigeria. Four research questions and two hypotheses guided the study. The study adopted a correlation research design. The sample size was 5,438 respondents via the Yaro-Yamane technique, which consists of 175 teachers, 13 principals and 5,250 students using the proportional stratified random sampling technique. The instruments for data collection were a researcher-made questionnaire titled Teachers’ Role/Principals’ Administrative Functions Questionnaire (TRPAFQ) with a Cronbach Alpha coefficient of .82 and student's internal results obtained from the school authorities. Data collected were analyzed using the Pearson product-moment correlation coefficient and simple linear regression. Research questions were answered using Pearson Product Moment Correlation statistics, while the hypotheses were tested at 0.05 level of significance using regression analysis. The findings of the study showed that the educational qualification of teachers, organizing, and planning correlated student’s academic performance to a great extent, while availability and proper use of instructional materials by teachers correlated the academic performance of students to a very high extent. The findings also revealed that there is a significant relationship between teachers’ role, principals’ administrative functions and student’s academic performance of public secondary schools in Imo State, The study recommended among others that there is the need for government, through the ministry of education, and education authorities to adequately staff their supervisory department in order to carry out proper supervision of secondary school teachers, and also provide adequate instructional materials to ensure greater academic performance among secondary school students of Imo state, Nigeria.

Keywords: instructional materials, principals’ administrative functions, students’ academic performance, teacher role

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Authors: Laila Khawaja

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In recent years, an increasing emphasis has been placed on measuring program implementation, in part because of the great variability in how complex interventions are delivered in real-life settings. There is an increased awareness that while conducting process evaluations, one should aim to identify and understand the complexities of intervention if they are to be used for future intervention development or the strategies needed to implement the same intervention in a different setting. Complex interventions are public health interventions that are not drugs or surgical procedures but have many potential active aspects of intervention. In this paper, process evaluations are aligned with MRC guidelines to identify contextual factors related to outcomes to assess the quality of implementation. This paper briefly discusses the perceptions of research team on the implementation of the intervention of ‘Engaging Adolescents in Changing Behaviour’ (EACH-B), a school-based complex intervention study aiming to improve diet and physical activity among adolescents aged 12-13 years. Through qualitative interviews and focus groups with 10 staff members, we aimed to understand their experiences and reflections on implementing the EACH-B trial delivered in 49 Schools around Hampshire, England. Data were uploaded into NVivo, and analysis was conducted using thematic analysis. The investigation revealed two overarching themes: (a) how the communication patterns with teachers were impacted during the delivery of implementation and (b) what were the team’s strategies to keep logistics aligned with the research process that impacted the overall implementation of the trial. The paper informs adaptation strategies used by the research team to establish and maintain effective communication with the teachers as well as the thoughtfulness of the team’s logistic strategy for the successful delivery of the trial.

Keywords: complex interventions, process evaluation, adaptation strategies, randomised controlled trial

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Authors: N. Tal-Alon, O. Shapira-Lishchinsky

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Disability disclosure is one of the most complicated dilemmas that people with invisible disabilities face. There are only a few research studies that have focused on the difficulties and dilemmas of teachers who have different disabilities. In addition, there are currently no research studies focusing specifically on the different aspects of disability disclosure, which are unique to teachers. This research has, therefore, broadened the knowledge base and understanding of the dilemma of disability disclosure among teachers with invisible physical disabilities. In addition, it has shed light on the ways this issue is perceived by different groups: the perspective of school principals, the perspective of colleagues, and the perspective of teachers with physical disabilities themselves. The study sample included 12 teachers with invisible physical disabilities, 10 school principals who employ at least one teacher with an invisible physical disability, and 10 professional colleagues of at least one teacher with an invisible physical disability. This particular research study was conducted using a qualitative approach through the Narralizer computer program based on a series of in-depth interviews. The data analysis was carried out by grouping major points of interest into specific categories and sub-categories. The findings of this research suggest that teachers with disabilities struggle with the dilemma of whether or not to reveal their disability to the school staff and to their students. It was found that there were considerable differences between the issues that faculty members considered regarding this dilemma and the ones that teachers with disabilities considered. While the principals and professional colleagues focused solely on their own interests, the teachers with a disability emphasized more on the ways that they might have a positive influence on their students, as well as their own individual interests. In addition, school principals on a whole tended to view negatively the option of disclosing the disability to the students and were often critical towards teachers who concealed their disability from the school staff. The importance of this research is in its potential to influence policy decisions that can be implemented by the Ministry of Education regarding the support system for teachers with invisible physical disabilities.

Keywords: education, employment, invisible disabilities, teachers

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Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

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Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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Authors: Mehmet Balci, Sakir Tasdemir, Mustafa Altin, Ozlem Bozok

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Our globalizing world has become almost a small village and everyone can access any information at any time. Everyone lets each other know who does whatever in which place. We can learn which social events occur in which place in the world. From the perspective of education, the course notes that a lecturer use in lessons in a university in any state of America can be examined by a student studying in a city of Africa or the Far East. This dizzying communication we have mentioned happened thanks to fast developments in computer technologies and in parallel with this, internet technology. While these developments in the world, has a very large young population and a rapidly evolving electronic communications infrastructure Turkey has been affected by this situation. Researches has shown that almost all young people in Turkey has an account in a social network. Especially becoming common of mobile devices causes data traffic in social networks to increase. In this study, has been surveyed on students in the different age groups and at the Selcuk University Vocational School of Technical Sciences Department of Computer Technology. Student’s opinions about the use of internet and social media has been gotten. Using the Internet and social media skills, purposes, operating frequency, access facilities and tools, social life and effects on vocational education etc. have been explored. Both internet and use of social media positive and negative effects on this department students results have been obtained by the obtained findings evaluating from various aspects. Relations and differences have been found out with statistic.

Keywords: computer technologies, internet use, social network, higher vocational school

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Authors: Thippharat Wongsilarat, Parichat tuntilanon, Chonlakan Prataksitorn

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Recurrent adverse drug reactions are harmful to patients with mild to fatal illnesses, and affect not only patients but also their relatives, and organizations. To compare safe use of medicine among patients before and after using the recurrent adverse drug reaction prevention program . Quasi-experimental research with the target population of 598 patients with drug allergy history. Data were collected through an observation form tested for its validity by three experts (IOC = 0.87), and analyzed with a descriptive statistic (percentage). The research was conducted jointly with a multidisciplinary team to analyze and determine the weak points and strong points in the recurrent adverse drug reaction prevention system during the past three years, and 546, 329, and 498 incidences, respectively, were found. Of these, 379, 279, and 302 incidences, or 69.4; 84.80; and 60.64 percent of the patients with drug allergy history, respectively, were found to have caused by incomplete warning system. In addition, differences in practice in caring for patients with drug allergy history were found that did not cover all the steps of the patient care process, especially a lack of repeated checking, and a lack of communication between the multidisciplinary team members. Therefore, the recurrent adverse drug reaction prevention program was developed with complete warning points in the information technology system, the repeated checking step, and communication among related multidisciplinary team members starting from the hospital identity card room, patient history recording officers, nurses, physicians who prescribe the drugs, and pharmacists. Including in the system were surveillance, nursing, recording, and linking the data to referring units. There were also training concerning adverse drug reactions by pharmacists, monthly meetings to explain the process to practice personnel, creating safety culture, random checking of practice, motivational encouragement, supervising, controlling, following up, and evaluating the practice. The rate of prescribing drugs to which patients were allergic per 1,000 prescriptions was 0.08, and the incidence rate of recurrent drug reaction per 1,000 prescriptions was 0. Surveillance of recurrent adverse drug reactions covering all service providing points can ensure safe use of medicine for patients.

Keywords: recurrent drug, adverse reaction, safety, use of medicine

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Authors: Samuel Mwangi, Josephine K. Mule

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Access control as a security technique regulates who or what can access resources. It is a fundamental concept in security that minimizes risks to the institutions that use access control. Regulating access to institutions of higher learning is key to ensure only authorized personnel and students are allowed into the institutions. The use of biometrics has been criticized due to the setup and maintenance costs, hygiene concerns, and trepidations regarding data privacy, among other apprehensions. Facial recognition is arguably a fast and accurate way of validating identity in order to guard protected areas. It guarantees that only authorized individuals gain access to secure locations while requiring far less personal information whilst providing an additional layer of security beyond keys, fobs, or identity cards. This exploratory study sought to investigate the use of facial recognition in controlling access in institutions of higher learning in Kenya. The sample population was drawn from both private and public higher learning institutions. The data is based on responses from staff and students. Questionnaires were used for data collection and follow up interviews conducted to understand responses from the questionnaires. 80% of the sampled population indicated that there were many security breaches by unauthorized people, with some resulting in terror attacks. These security breaches were attributed to stolen identity cases, where staff or student identity cards were stolen and used by criminals to access the institutions. These unauthorized accesses have resulted in losses to the institutions, including reputational damages. The findings indicate that security breaches are a major problem in institutions of higher learning in Kenya. Consequently, access control would be beneficial if employed to curb security breaches. We suggest the use of facial recognition technology, given its uniqueness in identifying users and its non-repudiation capabilities.

Keywords: facial recognition, access control, technology, learning

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Authors: Lelika Lazarus, Reshma Sookrajh, Kapil S. Satyapal

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Reflecting on teaching is commonly cited as a fundamental practice for personal and professional development. Educational research into the scholarship of teaching and learning anatomy includes engaging in discipline specific literature on teaching, reflecting on individual teaching methods and communicating these findings to peers. The aim of this paper is to formally assess the opinions of senior anatomy instructors regarding the state of anatomical knowledge at their respective institutions. The context of the paper derives from ongoing debates about the perceived decline in standards of anatomical knowledge of medical students and postgraduate learners. An open ended questionnaire was devised consisting of eight direct questions seeking opinions on anatomy teaching, knowledge, and potential educational developments and general thoughts on the teaching of anatomy to medical students. These were distributed to senior anatomy Faculty (identified by the author by their affiliation with the Anatomical Society of Southern Africa) based at the eight national medical schools within the country. A number of key themes emerged. Most senior faculty felt that the standard of medical education at their respective institutions was ‘good.’. However, emphasis was also placed on the ‘quality of teaching’ incorporating clinical scenarios. There were also indications that staff are split into those that are keen to do research and those that are happy to provide teaching to medical students as their primary function. Several challenges were also highlighted such as time constraints within the medical curriculum, the lack of cadavers to reinforce knowledge and gain depth perception and lack of appropriately qualified staff. Recommendations included fostering partnerships with both clinicians and medical scientists into the anatomy curriculum thus improving teaching and research.

Keywords: anatomy, education, reflection, teaching

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Authors: Turki Adnan Kamal, Abdulmajeed Ahmad Alsofiany, Nemer Khidhran Husain Alghamdi, Ali Eissa Hassan Al-Rajhi

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Background:- Health care workers are ranked as one of the most vulnerable groups experiencing violence and aggressive behavior compared to other occupational groups. Objectives:- To estimate the prevalence rate and characteristics and assess the avoidance measures, and notification of the violence among medical staff working in primary health care centers in Taif city. Subject and methods:- A cross-sectional study design was applied among all physicians and a representative sample of nurses working in primary health care centers affiliated with the Ministry of Health (MOH) in Taif city. A predesigned Arabic/English validated self-administered questionnaire was used. Results:- In this study, 56 physicians and 145 nurses responded, giving a response rate of 77.6%. Their age ranged from 25 and 60 years (36.2±8.2), with 59.7% of them aged between 25 and 35 years. Males represent 55.7% of them. More than half of them (52.2%) were Saudis. The prevalence of workplace violence was 30.3%. Verbal abuse was the commonest reported type (86.9%). The absence of security, training on the procedures that must be followed and special uniforms at the workplace were significantly associated with workplace violence. We concluded that workplace violence is a significant problem facing a considerable proportion of HCWs in primary health care centers in Taif, Saudi Arabia. Most violence incidents were verbal. Conclusion:- Findings of this study revealed that HCWs who were dealing with male patients only were at high risk of workplace violence and the absence of measures to avoid workplace violence, particularly security, training on the procedures that must be followed and special uniform at the workplace was significantly associated with workplace violence.

Keywords: violence, workplace, primary health care, prevalence, avoidance

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Authors: Marina Aferiba Tandoh, Elsie Odei

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Peptic Ulcer Disease (PUD) is amongst the commonest gastrointestinal problems that require emergency treatment in order to preserve life. The prevalence of PUD is increasing within the Ghanaian population, deepening the need to identify factors that are associated with its occurrence. This cross-sectional study assessed the nutritional status, socioeconomic and lifestyle factors associated with PUD among patients attending the Out-Patient Department of the Tema General Hospital of Ghana. A food frequency questionnaire and a three-day, 24-hour recall were used to assess the dietary intakes of study participants. A standardized questionnaire was used to obtain information on the participants’ socio-demographic characteristics, lifestyle as well as medical history. The data was analyzed using SPSS version 22. The mean age of study participants was 32.8±15.41years. Females were significantly higher (61.4%) than males (38.6%) (p < 0.001). All participants had received some form of education, with tertiary education being the highest (52.6%). The majority of them managed their condition with medications only (86%), while 10.5% managed it with a combination of medications and diet. The rest were either by dietary counseling only (1.8%), or surgery only (1.8%). or herbal medicines (29.3%), which were made from home (7.2%) or bought from a medical store (10.8%). Most of the participants experienced a recurrence of the disease (42.1%). For those who had ever experienced recurrences of the disease, it happened when they ate acidic foods (1.8%), ate bigger portions (1.8%), starved themselves (1.8%), or were stressed (1.8%). Others also had triggers when they took certain medications (1.8%) or ate too much pepper (1.8%). About 49% of the participants were either overweight or obese with a recurrence of PUD (p>0.05). Obese patients had the highest rate of PUD recurrences (41%). Drinking alcohol was significantly associated with the recurrence of PUD (χ2= 5.243, p=0.026). Other lifestyles, such as weed smoking, fasting, and use of herbal medicine and NSAIDs did not have any significant association with the disease recurrence. There was no significant correlation between the various dietary patterns and anthropometric parameters except dietary pattern one (salty snacks, regular soft drinks, milk, sweetened yogurt, ice cream, and cooked vegetables), which had a positive correlation with weight (p=0.002) and BMI (p=0.038). PUD patients should target weight reduction actions and reduce alcohol intake as measures to control the recurrence of the disease. Nutrition Education among this population must be promoted to minimize the recurrence of PUD.

Keywords: Dietary patterns, lifestyle factors, nutritional status, peptic ulcer disease

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Authors: Gerhard Grebe, Johan Marx

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The aim of the study is to assess the state of operational risk management and the adoption of an appropriate risk culture in Ghanaian banks. The Bank of Ghana (BoG) joined the Basel Consultative Group (BCG) of the Basel Committee on Bank Supervision (BCBS) in 2021 and is proceeding with the implementation of the Basel III international regulatory framework for banks. The BoG’s Directive about risk management encourages, inter alia, the creation of an appropriate risk culture by Ghanaian banks. However, it is not evident how the risk management staff of Ghanaian banks experience the risk culture and the implementation of operational risk management in the banks where they are employed. Ghana is a developing economy, and it is addressing challenges with its organisational culture. According to Transparency International, successive Ghanaian governments claim to be fighting corruption, but little success has been achieved so far. This points to a possible lack of accountability, transparency, and integrity in the environment in which Ghanaian banks operate and which could influence their risk culture negatively. Purposive sampling was used for the survey, and the questionnaire was completed byGhanaian bank personnel who specializesin operational risk management, risk governance, and compliance, bank supervision, risk analyses, as well as the implementation of the operational risk management requirements of the Basel regulatory frameworks. The respondents indicated that they are fostering a risk culture and implementing monitoring and reporting procedures; the three lines of defence (3LOD); compliance; internal auditing; disclosure of operational risk information; and receiving guidance from the bank supervisor in an attempt to improve their operational risk management practices. However, the respondents reported the following challenges with staff members who are not inside the risk management departments(in order of priority), namelydemonstrating a risk culture, training and development; communication; reporting and disclosure; roles and responsibilities; performance appraisal; and technological and environmental barriers. Recommendations to address these challenges are provided

Keywords: ghana, operational risk, risk culture, risk management

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Authors: B. Nageshwar Rao

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Urinary tract infection (UTI) represents the most commonly acquired bacterial infection worldwide, with substantial morbidity, mortality, and economic burden. The objective of the study is to characterize the microbial profiles of uropathogenic in the obstetric population by RTPCR. Study design: An observational cross-sectional study was performed at a single tertiary health care hospital among 50 pregnant women with UTIs, including asymptomatic and symptomatic patients attending the outpatient department and inpatient department of Obstetrics and Gynaecology.Methods: Serotyping and genes detection of various uropathogens were studied using RTPCR. Pulse filed gel electrophoresis methods were used to determine the various genetic profiles. Results: The present study shows that CsgD protein, involved in biofilm formation in Escherichia coli, VIM1, IMP1 genes for Klebsiella were identified by using the RTPCR method. Our results showed that the prevalence of VIM1 and IMP1 genes and CsgD protein in E.coli showed a significant relationship between strong biofilm formation, and this may be due to the prevalence of specific genes. Finally, the genetic identification of RTPCR results for both bacteria was correlated with each other and concluded that the above uropathogens were common isolates in producing Biofilm in the pregnant woman suffering from urinary tract infection in our hospital observational study.

Keywords: biofilms, Klebsiella, E.coli, urinary tract infection

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Authors: Poornima Khadanga, Gaurav Pawar, Madhavi Rairikar

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Background: The COVID 19 pandemic, with its unparalleled mental health repercussions, has impacted people globally and has catalyzed a Mental Health pandemic among the youth. The detrimental effects on mental health needs to be pondered at the earliest. Aims: To study the behavioral problems among children and adolescents visiting Psychiatry Outpatient Department Tertiary Health Care during COVID pandemic and its correlation with socio-demographic profiles. Methods: A cross sectional study was conducted by interviewing 120 participants between 4 to 17 years of age and their parents, visiting Psychiatry OPD. Behavioral problems were assessed using the Strength and Difficulties Questionnaire and diagnosed by DSM-5. Statistical analysis was done by SPSS-21. Results: Male participants showed significant association with conduct (t=2.36, p=0.02) and hyperactive problems (t=5.07, p<0.05). Increase in screen time showed a positive correlation with conduct problems (r=0.22. p=0.02). Attention Deficit Hyperkinetic Disorder (18.3%) was the most commonly diagnosed psychiatric illness. Total difficulty score was significantly associated with difficult temperament (F=68.69, p<0.05). Conclusion: The study brings to light the pattern of behavioral problems that emerged during recent times of uncertainties among the young ones, including those with special needs. The increase in disruptive behaviors with increase screen time needs to be addressed at the earliest.

Keywords: behavioral problems, pandemic, screen time, temperament

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Authors: R. M. Kilonzo, S. Bedingfield, K. Smith, K. Hudgins Smith, K. Couper, R. Ratley, Z. Taylor, A. Engelman, M. Renne

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Introduction: The mental health needs of university students continue to evolve, necessitating a strategic approach to service delivery. The East Tennessee State University (ETSU) Counseling Center developed its inaugural Strategic Plan (2024-2028) to enhance student mental health services. The plan focuses on improving access, quality of care, and service visibility, aligning with the university’s mission to support academic success and student well-being. Aim: This strategic plan aims to establish a comprehensive framework for delivering high-quality, evidence-based mental health services to ETSU students, addressing current challenges, and anticipating future needs. Methods: The development of the strategic plan was a collaborative effort involving the Counseling Center’s leadership, staff, with technical support from Doctor of Public Health-community and behavioral health intern. Multiple workshops, online/offline reviews, and stakeholder consultations were held to ensure a robust and inclusive process. A SWOT analysis and stakeholder mapping were conducted to identify strengths, weaknesses, opportunities, and challenges. Key performance indicators (KPIs) were set to measure service utilization, satisfaction, and outcomes. Results: The plan resulted in four strategic priorities: service application, visibility/accessibility, safety and satisfaction, and training programs. Key objectives include expanding counseling services, improving service access through outreach, reducing stigma, and increasing peer support programs. The plan also focuses on continuous quality improvement through data-driven assessments and research initiatives. Immediate outcomes include expanded group therapy, enhanced staff training, and increased mental health literacy across campus. Conclusion and Recommendation: The strategic plan provides a roadmap for addressing the mental health needs of ETSU students, with a clear focus on accessibility, inclusivity, and evidence-based practices. Implementing the plan will strengthen the Counseling Center’s capacity to meet the diverse needs of the student population. To ensure sustainability, it is recommended that the center continuously assess student needs, foster partnerships with university and external stakeholders, and advocate for increased funding to expand services and staff capacity.

Keywords: strategic plan, university counseling center, mental health, students

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Authors: Haidy Weliam Megaly Gouda

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Dermatology is often a neglected specialty in low-resource settings despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV-positive patients. African countries have the highest HIV infection rates, and skin conditions are frequently misdiagnosed and mismanaged because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve the diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV-positive patients. A literature search within Embassy, Medline and Google Scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff, a list of 15 skin conditions was included, and a booklet was created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions, quality switched ruby laser, skin color river blindness, clinical signs, circularity index, grey level run length matrix, grey level co-occurrence matrix, local binary pattern, object detection, ring detection, shape identification

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Authors: Bency Ann Massinello, Nancy Day, Janet Fellini

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Background: The use of an appropriate mode of communication among the multidisciplinary care team members regarding coordination of care is an extremely complicated yet important patient safety initiative. Effective communication among the team members(nursing staff, medical staff, respiratory therapists, rehabilitation therapists, patient-family services team…) become essential to develop a culture of trust and collaboration to deliver the highest quality care to patients are their families. The inpatient post-acute pediatrics, where children and their caregivers come for continuity of care, is no exceptions to the increasing use of text messages as a means to communication among clinicians. One such platform is the Vocera Communications (Vocera Smart Mobile App called Vocera Edge) allows the teams to use the application and share sensitive patient information through an encrypted platform using IOS company provided shared and assigned mobile devices. Objective: This paper discusses the quality initiative of implementing the transition from Vocera Smartbage to Vocera Edge Mobile App, technology advantage, use case expansion, and lessons learned about a secure alternative modality that allows sending and receiving secure text messages in a pediatric post-acute setting using an IOS device. This implementation process included all direct care staff, ancillary teams, and administrative teams on the clinical units. Methods: Our institution launched this transition from voice prompted hands-free Vocera Smartbage to Vocera Edge mobile based app for secure care team texting using a big bang approach during the first PDSA cycle. The pre and post implementation data was gathered using a qualitative survey of about 500 multidisciplinary team members to determine the ease of use of the application and its efficiency in care coordination. The technology was further expanded in its use by implementing clinical alerts and alarms notification using middleware integration with patient monitoring (Masimo) and life safety (Nurse call) systems. Additional use of the smart mobile iPhone use include pushing out apps like Lexicomp and Up to Date to have it readily available for users for evident-based practice in medication and disease management. Results: Successful implementation of the communication system in a shared and assigned model with all of the multidisciplinary teams in our pediatric post-acute setting. In just a 3-monthperiod post implementation, we noticed a 14% increase from 7,993 messages in 6 days in December 2020 to 9,116messages in March 2021. This confirmed that all clinical and non-clinical teams were using this mode of communication for coordinating the care for their patients. System generated data analytics used in addition to the pre and post implementation staff survey for process evaluation. Conclusion: A secure texting option using a mobile device is a safe and efficient mode for care team communication and collaboration using technology in real time. This allows for the settings like post-acute pediatric care areas to be in line with the widespread use of mobile apps and technology in our mainstream healthcare.

Keywords: nursing informatics, mobile secure texting, multidisciplinary communication, pediatrics post acute care

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Authors: Ikechukwu Ogeze Ukeje, Chinyere Ori Elom, Chukwudum Collins Umoke

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This study explores the challenges in the integration of Artificial Intelligence (AI) and Information and Communication Technology (ICT) practices in enhancing governance and sustainable solution modeling in higher education, focusing on Alex Ekwueme Federal University Ndufu-Alike (AE-FUNAI), Nigeria. In the context of a developing country like Nigeria, leveraging AI and ICT tools presents a unique opportunity to improve teaching, learning, administrative processes, and governance. The research aims to evaluate how AI and ICT technologies can contribute to sustainable educational practices, enhance decision-making processes, and improve engagement among key stakeholders: students, lecturers, and administrative staff. Students are involved to provide insights into their interactions with AI and ICT tools, particularly in learning and participation in governance. Lecturers’ perspectives will offer a view into how these technologies influence teaching, research, and curriculum development. Administrative staff will provide a crucial understanding of how AI and ICT tools can streamline operations, support data-driven governance, and enhance institutional efficiency. This study will use a mixed-method approach to collect both qualitative and quantitative data. The finding of this study is geared towards shaping the future of education in Nigeria and beyond by developing an Inclusive AI-governance Integration Framework (I-AIGiF) for enhanced performance in the system. Examining the roles of these stakeholder groups, this research could guide the development of policies for more effective AI and ICT integration, leading to sustainable educational innovation and governance.

Keywords: university administration, AI, higher education governance, education sustainability, ICT challenges

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Authors: Jianli Jiang, Bai-Chen Xie

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The climate issue has aroused global concern. Achieving sustainable development is a good path for countries to mitigate environmental and climatic pressures, although there are many difficulties. The first step towards sustainable development is to evaluate the environmental efficiency of the energy industry with proper methods. The power sector is a major source of CO2, SO2, and NOx emissions. Evaluating the environmental efficiency (EE) of power systems is the premise to alleviate the terrible situation of energy and the environment. Data Envelopment Analysis (DEA) has been widely used in efficiency studies. However, measuring the efficiency of a system (be it a nation, region, sector, or business) is a challenging task. The classic DEA takes the decision-making units (DMUs) as independent, which neglects the interaction between DMUs. While ignoring these inter-regional links may result in a systematic bias in the efficiency analysis; for instance, the renewable power generated in a certain region may benefit the adjacent regions while the SO2 and CO2 emissions act oppositely. This study proposes a spatial network DEA (SNDEA) with a slack measure that can capture the spatial spillover effects of inputs/outputs among DMUs to measure efficiency. This approach is used to study the EE of China's power system, which consists of generation, transmission, and distribution departments, using a panel dataset from 2014 to 2020. In the empirical example, the energy and patent inputs, the undesirable CO2 output, and the renewable energy (RE) power variables are tested for a significant spatial spillover effect. Compared with the classic network DEA, the SNDEA result shows an obvious difference tested by the global Moran' I index. From a dynamic perspective, the EE of the power system experiences a visible surge from 2015, then a sharp downtrend from 2019, which keeps the same trend with the power transmission department. This phenomenon benefits from the market-oriented reform in the Chinese power grid enacted in 2015. The rapid decline in the environmental efficiency of the transmission department in 2020 was mainly due to the Covid-19 epidemic, which hinders economic development seriously. While the EE of the power generation department witnesses a declining trend overall, this is reasonable, taking the RE power into consideration. The installed capacity of RE power in 2020 is 4.40 times that in 2014, while the power generation is 3.97 times; in other words, the power generation per installed capacity shrank. In addition, the consumption cost of renewable power increases rapidly with the increase of RE power generation. These two aspects make the EE of the power generation department show a declining trend. Incorporation of the interactions among inputs/outputs into the DEA model, this paper proposes an efficiency evaluation method on the basis of the DEA framework, which sheds some light on efficiency evaluation in regional studies. Furthermore, the SNDEA model and the spatial DEA concept can be extended to other fields, such as industry, country, and so on.

Keywords: spatial network DEA, environmental efficiency, sustainable development, power system

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Authors: Rasha Waheeb, Bjorn Andersen, Rafa Shakir

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Purpose The purpose of this study is to avoid delays that occur in emergency reconstruction projects especially in post disaster circumstances whether if they were natural or manmade due to their particular national and humanitarian importance. We presented a theoretical and practical concepts for projects management in the field of construction industry that deal with a range of global and local trails. This study aimed to identify the factors of effective delay in construction projects in Iraq that affect the time and the specific quality cost, and find the best solutions to address delays and solve the problem by setting parameters to restore balance in this study. 30 projects were selected in different areas of construction were selected as a sample for this study. Design/methodology/approach This study discusses the reconstruction strategies and delay in time and cost caused by different delay factors in some selected projects in Iraq (Baghdad as a case study).A case study approach was adopted, with thirty construction projects selected from the Baghdad region, of different types and sizes. Project participants from the case projects provided data about the projects through a data collection instrument distributed through a survey. Mixed approach and methods were applied in this study. Mathematical data analysis was used to construct models to predict delay in time and cost of projects before they started. The artificial neural networks analysis was selected as a mathematical approach. These models were mainly to help decision makers in construction project to find solutions to these delays before they cause any inefficiency in the project being implemented and to strike the obstacles thoroughly to develop this industry in Iraq. This approach was practiced using the data collected through survey and questionnaire data collection as information form. Findings The most important delay factors identified leading to schedule overruns were contractor failure, redesigning of designs/plans and change orders, security issues, selection of low-price bids, weather factors, and owner failures. Some of these are quite in line with findings from similar studies in other countries/regions, but some are unique to the Iraqi project sample, such as security issues and low-price bid selection. Originality/value we selected ANN’s analysis first because ANN’s was rarely used in project management , and never been used in Iraq to finding solutions for problems in construction industry. Also, this methodology can be used in complicated problems when there is no interpretation or solution for a problem. In some cases statistical analysis was conducted and in some cases the problem is not following a linear equation or there was a weak correlation, thus we suggested using the ANN’s because it is used for nonlinear problems to find the relationship between input and output data and that was really supportive.

Keywords: construction projects, delay factors, emergency reconstruction, innovation ANN, post disasters, project management

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Authors: Nisha Harry, Keshia Sing

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Orientation: The Multifactor Leadership Questionnaire (MLF) and the sense of coherence-29 (SCS) is an effective tools to assess the prevalence and underlying structures of empirically based taxonomies related to leadership and wellbeing. Research purpose: The purpose of the study was to test the psychometric properties of the SCS and Multifactor Leadership Questionnaire (MLQ) to screen for psychological wellness indices within the banking industry in South Africa. Motivation for the study: The contribution of these two instruments for the purpose of determining psychological wellness in a banking work environment is unique. Research design, approach, or method: The sample consisted of (N = 150) financial staff employed in a South African banking organisation. The age of the sample was: 37% (30 -40 yrs), 31% (20-30 yrs), 26% (40- 50 yrs), and 6% (50+yrs), of which 52% were males, 48% were females. The white race group was the majority at 29%, African at 26%, Coloured at 23%, and Indian was 22%. Main findings: Results from the exploratory factor analysis revealed a two-factor structure as the most satisfactory. Confirmatory factor analyses revealed the two-factor model displayed better good of-fit indices. Practical implications: The factor structure of the Sense of Coherence-29 scale (SCS), and the Multifactor Leadership Questionnaire (MLQ), have a value-added focus to determine psychological wellness within banking staff. It is essential to take into account these constructs when developing employee wellness interventions. Contribution/value add: Understanding the psychometric properties of the SCS, the self-reported form, and the MLQ questionnaire contributes to screening psychological wellness indices such as coping within the banking industry in a developing country like South Africa. Leaders are an important part of the implementation process of organisational employee wellness practices.

Keywords: factorial structure, leadership, measurement invariance, psychological wellness, sense of coherence

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Authors: Tzay-An Shiau, Kuan-Lin Ho

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This study developed sustainability and quality of life indicators for urban passenger transportation by using Social Construction of Technology (SCOT). The initial indicators were proposed by referring to literatures and were summarized by using impact-based framework. Subsequently, the stakeholders were defined according to their interest, power and then classified into scientific, operational, policy making, policy monitoring and nonprofessional frames. The scientific frame consisted of nine scholars in transportation field. Ten representatives from Taipei Rapid Transit Corporation (TRTC), Taiwan Railways Administration (TRA) and bus operators were grouped into the operational frame. The policy making frame comprised of ten representatives from Department of Transportation, Taipei City Government (DOT, TCG), Department of Railways and Highways, Ministry of Transportation and Communication (DORH, MOTC), Directorate General of Highways, Ministry of Transportation and Communication (DGOH, MOTC) and Institute of Transportation, Ministry of Transportation and Communication (IOT, MOTC). The policy monitoring frame consisted of 15 representatives from Taipei City Councilor, legislator and reporter. The nonprofessional frame comprised of 72 Taipei citizens. The stakeholders were asked to evaluate the relative importance of indicators using Delphi survey method. Social construction of 14 transport sustainability indicators and 12 transport quality of life indicators were obtained.

Keywords: sustainability, quality of life, Social Construction of Technology (SCOT), stakeholder

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Authors: Collen Tebogo Masilo, Erik Schmikl

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The demand for the DataMiner product by customers has presented a great challenge for the vendor in Skyline Communications in deploying its limited resources in the form of human resources, financial resources, and office space, to achieve high organisational performance in all its international operations. The rapid growth of the organisation has been unable to efficiently support its existing customers across the globe, and provide services to new customers, due to the limited number of approximately one hundred employees in its employ. The combined descriptive and explanatory case study research methods were selected as research design, making use of a survey questionnaire which was distributed to a sample of 100 respondents. A sample return of 89 respondents was achieved. The sampling method employed was non-probability sampling, using the convenient sampling method. Frequency analysis and correlation between the subscales (the four themes) were used for statistical analysis to interpret the data. The investigation was conducted into mechanisms that can be deployed to balance the high demand for products and the limited production capacity of the company’s Belgian operations across four aspects: demand management strategies, capacity management strategies, communication methods that can be used to align a sales management department, and reward systems in use to improve employee performance. The conclusions derived from the theme ‘demand management strategies’ are that the company is fully aware of the future market demand for its products. However, there seems to be no evidence that there is proper demand forecasting conducted within the organisation. The conclusions derived from the theme 'capacity management strategies' are that employees always have a lot of work to complete during office hours, and, also, employees seem to need help from colleagues with urgent tasks. This indicates that employees often work on unplanned tasks and multiple projects. Conclusions derived from the theme 'communication methods used to align sales management department with operations' are that communication is not good throughout the organisation. This means that information often stays with management, and does not reach non-management employees. This also means that there is a lack of smooth synergy as expected and a lack of good communication between the sales department and the projects office. This has a direct impact on the delivery of projects to customers by the operations department. The conclusions derived from the theme ‘employee reward systems’ are that employees are motivated, and feel that they add value in their current functions. There are currently no measures in place to identify unhappy employees, and there are also no proper reward systems in place which are linked to a performance management system. The research has made a contribution to the body of research by exploring the impact of the four sub-variables and their interaction on the challenges of organisational productivity, in particular where an organisation experiences a capacity problem during its growth stage during tough economic conditions. Recommendations were made which, if implemented by management, could further enhance the organisation’s sustained competitive operations.

Keywords: high demand for products, high organisational performance, limited production capacity, limited resources

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Authors: Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Jose Tiburcio, Douglas Reich, Vicente Liz

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Violence is defined as an act of physical force that is intended to cause harm and may lead to physical and/or psychological damage. Violence toward healthcare workers (HCWs) is more common in psychiatric settings, emergency departments, and nursing homes; however, healthcare workers in medical setting are not spared from such events. Workplace violence has a huge burden in the healthcare industry and has a major impact on the physical and mental wellbeing of staff. The purpose of this study is to compare the prevalence of patient agitation and violence in medical-surgical settings in BronxCare Hospital (BCH) Bronx, New York, one year before and during the COVID-19 pandemic. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two separate time categories: pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021). We created frequency tables for 19 variables. We used a chi-square test to determine a variable's statistical significance. We tested all variables against “restraint type”, determining if a patient was violent or became violent enough to restrain. The restraint types were “chemical”, “physical”, or both. This analysis was also used to determine if there was a statistical difference between the pre-COVID-19 and COVID-19 timeframes. Our data shows that there was an increase in incidents of violence in COVID-19 era (03/2020-03/2021), with total of 194 (62.8%) reported events, compared to pre COVID-19 era (03/2019-03/2020) with 115 (37.2%) events (p: 0.01). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 era. We then tested the violence marker against restraint type. The result was statistically significant (p: 0.01). This is the first paper to systematically review the prevalence of violence in medical-surgical units in a hospital in New York, pre COVID-19 and during the COVID-19 era. Our data is in line with the global trend of increased prevalence of patient agitation and violence in medical settings during the COVID-19 pandemic. Violence and its management is a challenge in healthcare settings, and the COVID-19 pandemic has brought to bear a complexity of circumstances, which may have increased its incidence. It is important to identify and teach healthcare workers the best preventive approaches in dealing with patient agitation, to decrease the number of restraints in medical settings, and to create a less restrictive environment to deliver care.

Keywords: COVID-19 pandemic, patient agitation, restraints, violence

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Authors: R. K. Yadav, S. Baral, H. R. Paudel, R. Basnet

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The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public healthcare providers in the fight against tuberculosis using international healthcare standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal. A total of 20 respondents participated in the study. Barriers to PPM were identified in the following three themes: 1) Obstacles related to TB case detection, 2) Obstacles related to patients, and 3) Obstacles related to the healthcare system. PPM implementation was challenged by following subthemes that included staff turnover, low private sector participation in workshops, a lack of training, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies. The study concludes that numerous barriers exist in the way of effective implementation of the PPM approach, including TB cases detection barriers such as knowledge of TB diagnosis and treatment, HW attitude, workload, patient-related barriers such as knowledge of TB, self-medication practice, stigma and discrimination, financial status, and health system-related barriers such as staff turnover and poor engagement of the private sector in workshops, training, recording, and re-evaluation. Government stakeholders must work together with private sector stakeholders to perform joint monitoring and supervision. Private practitioners should receive training and orientation, and presumptive TB patients should be given adequate time and counseling as well as motivation to visit a government health facility.

Keywords: barrier, tuberculosis, case finding, PPM, nepal

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