Search results for: hospital

Authors: Jaana Sepp, Ulvi Kõrgemaa, Kristi Puusepp, Õie Tähtla

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COVID-19 was officially recognized as a pandemic in late 2019 by the WHO, and it has led to changes in the education sector. Educational institutions were closed, and most schools adopted distance learning. Estonia is known as a digitally well-developed country. Based on that, in the pandemic time, nursing education continued, and new technological solutions were implemented. To provide nursing education, special focus was paid on quality and flexibility. The aim of this paper is to present administrative, digital, and technological solutions which support Estonian nursing educators to continue the study process in the pandemic time and to develop a sustainable solution for nursing education for the future. This paper includes the authors’ analysis of the documents and decisions implemented in the institutions through the pandemic time. It is a case study of Estonian nursing educators. Results of the analysis show that the implementation of distance learning principles challenges the development of innovative strategies and technics for the assessment of student performance and educational outcomes and implement new strategies to encourage student engagement in the virtual classroom. Additionally, hospital internships were canceled, and the simulation approach was deeply implemented as a new opportunity to develop and assess students’ practical skills. There are many other technical and administrative changes that have also been carried out, such as students’ support and assessment systems, the designing and conducting of hybrid and blended studies, etc. All services were redesigned and made more available, individual, and flexible. Hence, the feedback system was changed, the information was collected in parallel with educational activities. Experiences of nursing education during the pandemic time are widely presented in scientific literature. However, to conclude our study, authors have found evidence that solutions implemented in Estonian nursing education allowed the students to graduate within the nominal study period without any decline in education quality. Operative information system and flexibility provided the minimum distance between the students, support, and academic staff, and likewise, the changes were implemented quickly and efficiently. Institution memberships were updated with the appropriate information, and it positively affected their satisfaction, motivation, and commitment. We recommend that the feedback process and the system should be permanently changed in the future to place all members in the same information area, redefine the hospital internship process, implement hybrid learning, as well as to improve the communication system between stakeholders inside and outside the organization. The main limitation of this study relates to the size of Estonia. Nursing education is provided by two institutions only, and similarly, the number of students is low. The result could be generated to the institutions with a similar size and administrative system. In the future, the relationship between nurses’ performance and organizational outcomes should be deeply investigated and influences of the pandemic time education analyzed at workplaces.

Keywords: hybrid learning, nursing education, nursing, COVID-19

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Authors: Moumita Chanda, Md. Fazlul Karim Patwary

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Smoking is one of the most popular recreational drug use behaviors, and it contributes to birth defects, COPD, heart attacks, and erectile dysfunction. To completely eradicate this disease, it is imperative that it be identified and treated. Numerous smoking cessation programs have been created, and they demonstrate how beneficial it may be to help someone stop smoking at the ideal time. A tomography meter is an effective smoking detector. Other wearables, such as RF-based proximity sensors worn on the collar and wrist to detect when the hand is close to the mouth, have been proposed in the past, but they are not impervious to deceptive variables. In this study, we create a machine that can discriminate between smokers and non-smokers in real-time with high sensitivity and specificity by watching and collecting the human lung and analyzing the X-ray data using machine learning. If it has the highest accuracy, this machine could be utilized in a hospital, in the selection of candidates for the army or police, or in university entrance.

Keywords: CNN, smoker detection, non-smoker detection, OpenCV, artificial Intelligence, X-ray Image detection

Procedia PDF Downloads 60

Authors: Anita Bajpai, Sarah Duan, Ashlee Erskine, Shehzein Khan, Raymond Kramer

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Introduction: This research focuses on exploring the beneficial effects if any, of Vitamin-D in reducing the need for supplemental oxygen among hospitalized COVID-19 patients. Two questions are investigated – Q1)Doeshaving a healthy level of baselineVitamin-D 25-OH (≥ 30ng/ml) help,andQ2) does administering Vitamin-D therapy after-the-factduring inpatient hospitalization help? Methods/Study Design: This is a comprehensive, retrospective, observational study of all inpatients at RUHS from March through December 2020 who tested positive for COVID-19 based on real-time reverse transcriptase–polymerase chain reaction assay of nasal and pharyngeal swabs and rapid assay antigen test. To address Q1, we looked atall N1=182 patients whose baseline plasma Vitamin-D 25-OH was known and who needed supplemental oxygen. Of this, a total of 121 patients had a healthy Vitamin-D level of ≥30 ng/mlwhile the remaining 61 patients had low or borderline (≤ 29.9ng/ml)level. Similarly, for Q2, we looked at a total of N2=893 patients who were given supplemental oxygen, of which713 were not given Vitamin-D and 180 were given Vitamin-D therapy. The numerical value of the maximum amount of oxygen flow rate(dependent variable) administered was recorded for each patient. The mean values and associated standard deviations for each group were calculated. Thesetwo sets of independent data served as the basis for independent, two-sample t-Test statistical analysis. To be accommodative of any reasonable benefitof Vitamin-D, ap-value of 0.10(α< 10%) was set as the cutoff point for statistical significance. Results: Given the large sample sizes, the calculated statistical power for both our studies exceeded the customary norm of 80% or better (β< 0.2). For Q1, the mean value for maximumoxygen flow rate for the group with healthybaseline level of Vitamin-D was 8.6 L/min vs.12.6L/min for those with low or borderline levels, yielding a p-value of 0.07 (p < 0.10) with the conclusion that those with a healthy level of baseline Vitamin-D needed statistically significant lower levels of supplemental oxygen. ForQ2, the mean value for a maximum oxygen flow rate for those not administered Vitamin-Dwas 12.5 L/min vs.12.8L/min for those given Vitamin-D, yielding a p-valueof 0.87 (p > 0.10). We thereforeconcludedthat there was no statistically significant difference in the use of oxygen therapy between those who were or were not administered Vitamin-D after-the-fact in the hospital. Discussion/Conclusion: We found that patients who had healthy levels of Vitamin-D at baseline needed statistically significant lower levels of supplemental oxygen. Vitamin-D is well documented, including in a recent article in the Lancet, for its anti-inflammatory role as an adjuvant in the regulation of cytokines and immune cells. Interestingly, we found no statistically significant advantage for giving Vitamin-D to hospitalized patients. It may be a case of “too little too late”. A randomized clinical trial reported in JAMA also did not find any reduction in hospital stay of patients given Vitamin-D. Such conclusions come with a caveat that any delayed marginal benefits may not have materialized promptly in the presence of a significant inflammatory condition. Since Vitamin-D is a low-cost, low-risk option, it may still be useful on an inpatient basis until more definitive findings are established.

Keywords: COVID-19, vitamin-D, supplemental oxygen, vitamin-D in primary care

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Authors: Alice Sanwald, Thomas Schober

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We analyze mortality and follow-up costs of heart attack patients using administrative data from Austria (2002-2011). As treatment intensity in a hospital largely depends on whether it has a catheterization laboratory, we focus on the effects of patients' initial admission to these specialized hospitals. To account for the nonrandom selection of patients into hospitals, we exploit individuals' place of residence as a source of exogenous variation in an instrumental variable framework. We find that the initial admission to specialized hospitals increases patients' survival chances substantially. The effect on 3-year mortality is -9.5 percentage points. A separation of the sample into subgroups shows the strongest effects in relative terms for patients below the age of 65. We do not find significant effects on longterm inpatient costs and find only marginal increases in outpatient costs.

Keywords: acute myocardial infarction, mortality, costs, instrumental variables, heart attack

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Authors: Sergei Kosarev

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Wrong treatment tactics for hand and wrist sport-related injuries can lead to the inability to play sports in the future. It is especially important for professional athletes. The members of the Russian Olympic Team are treated in our hospital -Federal Clinical Research Center (Moscow). For their treatment, we use minimally invasive methods such as wrist arthroscopy and also orthobiologics procedures. In 2022 we had cases with scaphoid fracture and TFCC injuries. In all the cases, we were using the arthroscopy technic for treatment. The scaphoid fracture was fixed by K-wires with free bone grafting. For TFCC injures we used transossal sutures. Rehabilitation started the next day after surgery. Rehabilitation included hand therapy and physiotherapy. All athletes returned to the sport after 8-12 weeks after surgery. One of them had pain in the wrist after 12 weeks after surgery, not more than 4 point VAS. Pain syndrome was blocked after 2 PRP injections in the ulnar side of the wrist.

Keywords: sport trauma, wrist arthroscopy, wrist pain, scaphoid fracture

Procedia PDF Downloads 81

Authors: Grace Omowunmi Soyebi

Abstract:

A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved, this may cause an unexpected to happen to the patient. This Data Mining application is to be designed using a Structured System Analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the Design and Implementation of a Computerized medical record system. This Computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, computing, data, innovation

Procedia PDF Downloads 101

Authors: Shamill Amedot Udonwa, Phyllis S. Y. Chong, Lim S. L. Julia, Wee-Joo Chng

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In this paper, we investigated how PRL-3 expression in H929 and U266 cells affects the efficacy of drug treatment. H929 and U266 cells were treated with Bortezomib (BTZ) of different concentrations, and it was observed that H929 cells were resistant to BTZ, while U266 cells were not viable. Investigations into how BTZ targets these cells were conducted, and it was observed that BTZ affects the PARP-Caspase3 pathway as well as PRL-3-Leo1 pathways. These pathways regulate cell proliferation and cell cycle, respectively. Hence, we are able to show the mechanism of how BTZ affects cells and also the role PRL-3 plays on downstream oncogenes such as cyclin-D1 and c-MYC. More importantly, this investigation into PRL-3 in BTZ resistance will be highly applicable in the future as the first clinical trials of PRL-3 antibody (PRL3-zumab) are ongoing at the National University Hospital, Singapore (NUHS). This would mean that understanding the mechanism of resistance through PRL-3, which has yet to be studied, will demonstrate the potential of PRL-3 in developing novel strategies to improve the treatment of MM.

Keywords: drug resistance, hematology, multiple myeloma, oncogene

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Authors: Lamia Bouzgarrou, Amira Omrane, Leila Mrabet, Taoufik Khalfallah

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Background and aims: School accidents are one of the leading causes of morbidity and mortality among pupils and students. Indeed, they may induce an elevated number of lost school days, heavy emotional and physical disabilities, and financial costs on the victims and their families. This study aims to evaluate the annual incidence of school accidents in the central Tunisian governorate of Mahdia and to identify the epidemiological profile of victims and risk factors of these accidents. Methods: A retrospective study was conducted over the period of 5 school years, focusing on school accidents that occurred in public educational institutions (primary, basic, secondary and university) in the governorate of Mahdia (area = 2 966 km² and number of inhabitants in 2014 = 410 812). All accidents declared near the only official insurance of this type of injuries (MASU: Mutual School and University Accidents), and initially taken in charge at the University Hospital of Mahdia were included. Data was collected from the MASU reporting forms and the medical records of emergency and other specialized hospital departments. Results: With 3248 identified victims, the annual incidence of school accidents was equal to 0.69 per 100 pupils and students per year. The average age of victims was 14.51 ± 0.059 years and the sex ratio was 1.58. Pupils aged between 12 and 15 years, were concerned by 46.7% of the identified accidents. The practice of sports was the most relevant circumstances of these accidents (76.2 %). In 56.58 % of cases, falls were the leading mechanism. Bruises and fractures were the most frequent lesions (32.43 % and 30.51 %). Serious school accidents were noted in 28% of cases with hospitalization in 2.27 % of them. The average lost school days, was 12.23±1.73 days. Accidents occurring during sports or leisure activities were significantly more serious (p= 0.021). Furthermore, the frequency of hospitalization was significantly higher among boys (2.81% vs. 1.43%; p= 0.035), students ≤11 years (p= 0.008), and following crush trauma (p= 0.000). In addition, the surgical interventions were statistically more frequent among male victims (p=0.00), accidents occurring during physical education sessions (p=0.000); those associated to falls (p=0.000) and to crushes mechanisms (p=0.002), and injuries affecting lower limbs (p=0.000). Following this Multi-varied analysis concluded that the severity of school accident is correlated to the activity practiced during the trauma and the geographical location of the school. Conclusion: Children and adolescents are one of the most vulnerable groups against incidents with the risk of permanent disability, mainly related to the perturbation of the growth process and physiological limitations. Our five-year study, objectified a real elevate incidence of school accident among children and adolescents, with a considerable rate of severe injuries. In any community, the promotion of adolescents and children’s health is an important indicator of the public health level. Thus, it’s important to develop a multidisciplinary prevention strategy of school accident, based on safety and security rules and adapted to the specificity of our context.

Keywords: children and adolescents, children health, injuries and disability, school accident

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Authors: Sanjaya Humagain, Rajendra Koju

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Background: Rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults. Though declined and almost non-existent in developed nations, RHD is still one of the leading cause for premature death and disability in developing countries. Prevalence of RHD is high in both rural as well as urban area of Nepal. Present study is designed to look at the pattern of valvular involvement and demographic features in RHD. Methods: 326 patients indicated for inj. Benzathine penicillin were selected and echocardiograph performed to see the pattern of vavular involvement. Data analysis was done using SPSS 17. Result: The most common type of lesion was mixed type with mitral valve involvement. MR was the most common isolated lesion. MS was more commonly seen in females whereas AS was more common in males. Secondary prophylaxis was more common than primary prophylaxis. Conclusion: RHD still being a major problem and a preventable disease so extensive screening program is required to identify them early and prevent the complication.

Keywords: acute rheumatic fever, RHD, MS, MR, AS, AR, Inj benzathine penicillin

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Authors: Ashleigh Medina

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Chronic conditions account for the majority of total health care spending both in the United States and globally. Encouraging self-management to improve chronic conditions, which in turn could decrease the strain placed on hospitals, requires resources to address the patient’s social concerns in addition to their medical concerns. Transitional care has been identified as a possible bridge between acutely managing conditions at the hospital to chronically managing conditions in a community setting. The aim of this integrative review was to examine the impact of transitional care on self-management outcomes of chronic conditions in un/underinsured populations. Both transitional care, by assisting with resources such as funding sources for healthcare and medications or identifying a healthcare provider for continued care, and self-management, by increasing responsibility for one’s care through goal setting and taking action, can impact health outcomes while providing health care cost-savings.

Keywords: chronic conditions, self-management, transitional care, uninsured

Procedia PDF Downloads 148

Authors: Shogo Kato, Daisuke Okamoto, Satoko Tsuru, Yoshinori Iizuka, Ryoko Shimono

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Healthcare safety has been perceived important. It is essential to prevent troubles in healthcare processes for healthcare safety. Trouble prevention is based on trouble prediction using accumulated knowledge on processes, troubles, and countermeasures. However, information on troubles has not been accumulated in hospitals in the appropriate structure, and it has not been utilized effectively to prevent troubles. In the previous study, though a detailed knowledge acquisition process for trouble prediction was proposed, the knowledgebase for countermeasures was not involved. In this paper, we aim to propose the structure of the knowledgebase for countermeasures in the knowledge acquisition process for trouble prediction in healthcare process. We first design the structure of countermeasures and propose the knowledge representation form on countermeasures. Then, we evaluate the validity of the proposal, by applying it into an actual hospital.

Keywords: trouble prevention, knowledge structure, structured knowledge, reusable knowledge

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Authors: David Ming Liu, Benjamin Hirsch, Bashir Aden

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Syndromic surveillance is to detect or predict disease outbreaks through the analysis of medical sources of data. Using social media data like tweets to do syndromic surveillance becomes more and more popular with the aid of open platform to collect data and the advantage of microblogging text and mobile geographic location features. In this paper, a Syndromic Surveillance Framework is presented with machine learning kernel using tweets data analytics. Influenza and the three cities Abu Dhabi, Al Ain and Dubai of United Arabic Emirates are used as the test disease and trial areas. Hospital cases data provided by the Health Authority of Abu Dhabi (HAAD) are used for the correlation purpose. In our model, Latent Dirichlet allocation (LDA) engine is adapted to do supervised learning classification and N-Fold cross validation confusion matrix are given as the simulation results with overall system recall 85.595% performance achieved.

Keywords: Syndromic surveillance, Tweets, Machine Learning, data mining, Latent Dirichlet allocation (LDA), Influenza

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Authors: A. Alrasheed, I. Connerton

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Providing patients with safe meals on a daily basis is one of the challenges in the healthcare sector. In Saudi Arabia matters related to food safety and hygiene have been the heart of the Ministry of Health (MOH) and Saudi Food and Drugs Authority (SFDA). The aim of this study is to examine the causes of inadequate implementation of food safety management systems such as HACCP in Riyadh’s MOH hospitals. By the law, food safety must be managed using a documented, HACCP based approach, and food handlers must be appropriately trained in food safety. Food handlers in Saudi Arabia are not required to provide a certificate or attend a food handling training course even in healthcare sectors. Since food safety and hygiene issues are of increasing importance for Saudi Arabian health decision makers, the SFDA has been established to apply food hygiene requirements in all food operations. It should be pointed out that the implications of food outbreaks on the whole society may potentially go beyond individual health impacts but also impact on the Nation’s health and bring about economic repercussions.

Keywords: food safety, patient, hospital, HACCP

Procedia PDF Downloads 851

Authors: Amel Chenafa, Sihem Boulenouar, Linda Aoued, Imane Sediri, Ismahan Djebbar, Mohamed Adil Selka

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Introduction: The specialties intended for adults are often inadequate marketed for pediatric use, such as for a galenic form or in the dosage. For an industrial, development of a pediatric drug is confronted to various problems. So, the hospital pharmacies have to respond to adaptation needs of pharmaceutical forms for pediatric use. The objective of our work is to develop an oral form of prednisone for pediatric use since no adapted form to children is commercialized. Materials and Methods: Therefore an extemporaneous syrup of prednisone was prepared at the concentration of 0,5mg/ml from 5mg tablets and stored in amber glass bottles. Organoleptic and microbiological stability was studied in two temperatures: 5°C and 25°C, and evaluated at D0, D15, and D30. Results: No organoleptic changes have been detected on the syrup conserved at 25 and 5°C. The results show that there is no presence of bacteria, yeasts, and molds in the syrups stored at both temperatures during the analysis period. Conclusion: Sheltered from light, the developed syrup of prednisone remained stable at room temperature and/or refrigerator for 30 days.

Keywords: extemporaneous syrup, pediatric drug, prednisone, stability

Procedia PDF Downloads 362

Authors: Pierre Mintom, Armel Assiene Agamou, Leslie Toukem, William Dakam, Christine Fernande Nyangono Biyegue

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Context: Hyperuricemia, the presence of high levels of uric acid in the blood, is a known precursor to the development of gout. Recent studies have suggested a strong association between hyperuricemia and disorders of lipoprotein metabolism, specifically hypercholesterolemia. Understanding the factors associated with these conditions in gout patients is essential for effective treatment and management. Research Aim: The objective of this study was to determine the prevalence of hyperuricemia, hypercholesterolemia, and the double burden of hyperuricemia-hypercholesterolemia in the gouty population. Additionally, the study aimed to identify the factors associated with these conditions. Methodology: The study utilized a database from a survey of 150 gouty patients recruited at the Laquintinie Hospital in Douala between August 2017 and February 2018. The database contained information on anthropometric parameters, biochemical markers, and the food and drugs consumed by the patients. Hyperuricemia and hypercholesterolemia were defined based on specific serum uric acid and total cholesterol thresholds, and the double burden was defined as the co-occurrence of hyperuricemia and hypercholesterolemia. Findings: The study found that the prevalence rates for hyperuricemia, hypercholesterolemia, and the double burden were 61.3%, 76%, and 50.7% respectively. Factors associated with these conditions included hypertriglyceridemia, atherogenicity index TC/HDL ratio, atherogenicity index LDL/HDL ratio, family history, and the consumption of specific foods and drinks. Theoretical Importance: The study highlights the strong association between hyperuricemia and dyslipidemia, providing important insights for guiding treatment strategies in gout patients. Additionally, it emphasizes the significance of nutritional education in managing these metabolic disorders, suggesting the need to address eating habits in gout patients. Data Collection and Analysis Procedures: Data was collected through surveys and medical records of gouty patients. Information on anthropometric parameters, biochemical markers, and dietary habits was recorded. Prevalence rates and associated factors were determined through statistical analysis, employing odds ratios to assess the risks. Question Addressed: The study aimed to address the prevalence rates and associated factors of hyperuricemia, hypercholesterolemia, and the double burden in gouty patients. It sought to understand the relationships between these conditions and determine their implications for treatment and nutritional education. Conclusion: Findings show that it’s exists an association between hyperuricemia and hypercholesterolemia in gout patients, thus creating a double burden. The findings underscore the importance of considering family history and eating habits in addressing the double burden of hyperuricemia-hypercholesterolemia. This study provides valuable insights for guiding treatment approaches and emphasizes the need for nutritional education in gout patients. This study specifically focussed on the sick population. A case–control study between gouty and non-gouty populations would be interesting to better compare and explain the results observed.

Keywords: gout, hyperuricemia, hypercholesterolemia, double burden

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Authors: Chandra Shekhar Majumder, Shamsul Haque, Khondaker Anower Hossain, Rafiqul Islam

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Introduction: Ocular helminths are parasites that infect the eye or its adnexa. They can be either motile worms or sessile worms that form cysts. These parasites require two hosts for their life cycle, a definite host (usually a human) and an intermediate host (usually an insect). While there have been reports of ocular helminths infecting various structures of the eye, including the anterior chamber and subconjunctival space, there is no previous record of such a case involving the lens. Research Aim: The aim of this case report is to present a rare case of ocular helminth infection in the lens and to contribute to the understanding of this unusual site of infection. Methodology: This study is a case report, presenting the details and findings of an 80-year-old retired policeman who presented with severe pain, redness, and vision loss in the left eye. The examination revealed the presence of a thread-like helminth in the lens. The data for this case report were collected through clinical examination and medical records of the patient. The findings were described and presented in a descriptive manner. No statistical analysis was conducted. Case report: An 80-year-old retired policeman attended the OPD, Faridpur Medical College Hospital with the complaints of severe pain, redness and gross dimness of vision of the left eye for 5 days. He had a history of diabetes mellitus and hypertension for 3 years. On examination, L/E visual acuity was PL only, moderate ciliary congestion, KP 2+, cells 2+ and posterior synechia from 5 to 7 O’clock position was found. Lens was opaque. A thread like helminth was found under the anterior of the lens. The worm was moving and changing its position during examination. On examination of R/E, visual acuity was 6/36 unaided, 6/18 with pinhole. There was lental opacity. Slit-lamp and fundus examination were within normal limit. Patient was admitted in Faridpur Medical College Hospital. Diabetes mellitus was controlled with insulin. ICCE with PI was done on the same day of admission under depomedrol coverage. The helminth was recovered from the lens. It was thread like, about 5 to 6 mm in length, 1 mm in width and pinkish in colour. The patient followed up after 7 days, VA was HM, mild ciliary congestion, few KPs and cells were present. Media was hazy due to vitreous opacity. The worm was sent to the department of Parasitology, NIPSOM, Dhaka for identification. Theoretical Importance: This case report contributes to the existing literature on ocular helminth infections by reporting a unique case involving the lens. It highlights the need for further research to understand the mechanism of entry of helminths in the lens. Conclusion: To the best of our knowledge, this is the first reported case of ocular helminth infection in the lens. The presence of the helminth in the lens raises interesting questions regarding its pathogenesis and entry mechanism. Further study and research are needed to explore these aspects. Ophthalmologists and parasitologists should be aware of the possibility of ocular helminth infections in unusual sites like the lens.

Keywords: helminth, lens, ocular, unusual

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Authors: Grace Omowunmi Soyebi

Abstract:

A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved; this may cause an unexpected to happen to the patient. This data mining application is to be designed using a structured system analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the design and implementation of a computerized medical record system. This computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, data, software development, innovation

Procedia PDF Downloads 66

Authors: Maureen Kamau, Gulnaz Mohamoud, Adelaide Lusambili, Njeri Nyanja

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Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. These multiple chronic conditions are managed with polypharmacy. Polypharmacy has numerous adverse effects including non-adherence, poor compliance to the various medications, reduced appetite, and risk of fall. Studies on polypharmacy and ageing are few and poorly understood especially in low and middle - income countries. The aim of this study was to explore the knowledge, attitudes and beliefs of older people towards polypharmacy. A qualitative study of 15 patients aged 60 years and above, taking more than five medications per day were conducted at the Aga Khan University using Semi-structured in-depth interviews. Three interviews were pilot interviews, and data analysis was performed on 12 interviews. Data were analyzed using NVIVO 12 software. A thematic qualitative analysis was carried out guided by Braun and Clarke (2006) framework. Themes identified; - knowledge of their co-morbidities and of the medication that older persons take, sources of information about medicines, and storage of the medication, experiences and attitudes of older patients towards polypharmacy both positive and negative, older peoples beliefs and their coping mechanisms with polypharmacy. The study participants had good knowledge on their multiple co-morbidities, and on the medication they took. The patients had positive attitudes towards medication as it enhanced their health and well-being, and enabled them to perform their activities of daily living. There was a strong belief among older patients that the medications were necessary for their health. All these factors enhanced compliance to the multiple medication. However, some older patients had negative attitudes due to the pill burden, side effects of the medication, and stigma associated with being ill. Cost of healthcare was a concern, with most of the patients interviewed relying on insurance to cover the cost of their medication. Older patients had accepted that the medication they were prescribed were necessary for their health, as it enabled them to complete their activities of daily living. Some concerns about the side effects of the medication arose, and brought about the need for patient education that would ensure that the patients are aware of the medications they take, and potential side effects. The effect that the COVID 19 pandemic had in the healthcare of the older patients was evident by the number of the older patients avoided coming to the hospital during the period of the pandemic. The relationship with the primary care physician and the older patients is an important one, especially in LMICs such as Kenya, as many of the older patients trusted the doctors wholeheartedly to make the best decision about their health and about their medication. Prescription review is important to avoid the use of potentially inappropriate medication.

Keywords: polypharmacy, older patients, multiple chronic conditions, Kenya, Africa, qualitative study, indepth interviews, primary care

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Authors: Ege Can Onal, Enver Ersen, Meltem Elitas

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Laparoscopy is a surgical operation, well known as keyhole surgery. The operation is performed through small holes, hence, scars of a patient become much smaller, patients can recover in a short time and the hospital stay becomes shorter in comparison to an open surgery. Several tools are used at laparoscopic operations; among them, the laparoscope has a crucial role. It provides the vision during the operation, which will be the main focus in here. Since the operation area is very small, motion of the surgical tools might be limited in laparoscopic operations compared to traditional surgeries. To overcome this limitation, most of the laparoscopic tools have become more precise, dexterous, multi-functional or automated. Here, we present a robotic-assisted laparoscope that is controlled with pedals directly by a surgeon. Thus, the movement of the laparoscope might be controlled better, so there will not be a need to calibrate the camera during the operation. The need for an assistant that controls the movement of the laparoscope will be eliminated. The duration of the laparoscopic operation might be shorter since the surgeon will directly operate the camera.

Keywords: laparoscope, laparoscopy, low-cost, minimally invasive surgery, robotic-assisted surgery

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Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: Karolina Wieczorek, Sophie Wiliams

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Introduction: Patient data is often collected in Electronic Health Record Systems (EHR) for purposes such as providing care as well as reporting data. This information can be re-used to validate data models in clinical trials or in epidemiological studies. Manual validation of automated tools is vital to pick up errors in processing and to provide confidence in the output. Mentioning a disease in a discharge letter does not necessarily mean that a patient suffers from this disease. Many of them discuss a diagnostic process, different tests, or discuss whether a patient has a certain disease. The COVID-19 dataset in this study used natural language processing (NLP), an automated algorithm which extracts information related to COVID-19 symptoms, complications, and medications prescribed within the hospital. Free-text patient clinical patient notes are rich sources of information which contain patient data not captured in a structured form, hence the use of named entity recognition (NER) to capture additional information. Methods: Patient data (discharge summary letters) were exported and screened by an algorithm to pick up relevant terms related to COVID-19. Manual validation of automated tools is vital to pick up errors in processing and to provide confidence in the output. A list of 124 Systematized Nomenclature of Medicine (SNOMED) Clinical Terms has been provided in Excel with corresponding IDs. Two independent medical student researchers were provided with a dictionary of SNOMED list of terms to refer to when screening the notes. They worked on two separate datasets called "A” and "B”, respectively. Notes were screened to check if the correct term had been picked-up by the algorithm to ensure that negated terms were not picked up. Results: Its implementation in the hospital began on March 31, 2020, and the first EHR-derived extract was generated for use in an audit study on June 04, 2020. The dataset has contributed to large, priority clinical trials (including International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) by bulk upload to REDcap research databases) and local research and audit studies. Successful sharing of EHR-extracted datasets requires communicating the provenance and quality, including completeness and accuracy of this data. The results of the validation of the algorithm were the following: precision (0.907), recall (0.416), and F-score test (0.570). Percentage enhancement with NLP extracted terms compared to regular data extraction alone was low (0.3%) for relatively well-documented data such as previous medical history but higher (16.6%, 29.53%, 30.3%, 45.1%) for complications, presenting illness, chronic procedures, acute procedures respectively. Conclusions: This automated NLP algorithm is shown to be useful in facilitating patient data analysis and has the potential to be used in more large-scale clinical trials to assess potential study exclusion criteria for participants in the development of vaccines.

Keywords: automated, algorithm, NLP, COVID-19

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Authors: Jafar Kazemzadeh, Soheila Rabiepoor, Saeedeh Alizadeh

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Introduction: Burn, especially in women, can affect the quality of life and their quality of life due to a change in appearance. This study was designed to investigate the relationship between quality of life and sexual satisfaction in women with burn. Methods: This was a descriptive-analytical cross-sectional study conducted on 101 women with severe burns referring to Imam Khomeini Hospital in Urmia in 2016. The data gathering scales were demographic questionnaire, burn specific health scale-brief (BSHS-B) and index of sexual satisfaction (ISS). The data were analyzed using SPSS software version 16. Results: Mean score of quality of life was 102.94 ± 20.88 and sexual satisfaction was 57.03 ± 25.91. Also, there was a significant relationship between quality of life and its subscales with sexual satisfaction and some demographic variables (p < 0.05). Conclusion: According to the results of this study, it should be noted that interventional efforts for improving sexual satisfaction and thus improving the quality of life in these patients are important. The findings of this study appear to be effective in planning for women with a history of burns.

Keywords: burn, quality of life, sexual satisfaction, women

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Authors: C. Treadgold, S. Sivaraman

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The Starlight Children's Foundation (Starlight) is an Australian non-profit organisation that delivers programs, in partnership with health professionals, to support children, adolescents, and their families who are living with a serious illness. While supporting children and adolescents with life-limiting conditions has always been a feature of Starlight's work, providing a dedicated program, specifically targeting and meeting the needs of the paediatric palliative population, is a recent area of focus. Recognising the challenges in providing children’s palliative services, Starlight initiated a research and development project to better understand and meet the needs of this group. The aim was to create a program which enhances the wellbeing of children, adolescents, and their families receiving paediatric palliative care in their community through the provision of on-going, tailored, positive experiences or 'moments'. This paper will present the results of the formative evaluation of this unique program, highlighting the development processes and outcomes of the pilot. The pilot was designed using an innovation methodology, which included a number of research components. There was a strong belief that it needed to be delivered in partnership with a dedicated palliative care team, helping to ensure the best interests of the family were always represented. This resulted in Starlight collaborating with both the Victorian Paediatric Palliative Care Program (VPPCP) at the Royal Children's Hospital, Melbourne, and the Sydney Children's Hospital Network (SCHN) to pilot the 'Moments' program. As experts in 'positive disruption', with a long history of collaborating with health professionals, Starlight was well placed to deliver a program which helps children, adolescents, and their families to experience moments of joy, connection and achieve their own sense of accomplishment. Building on Starlight’s evidence-based approach and experience in creative service delivery, the program aims to use the power of 'positive disruption' to brighten the lives of this group and create important memories. The clinical and Starlight team members collaborate to ensure that the child and family are at the centre of the program. The design of each experience is specific to their needs and ensures the creation of positive memories and family connection. It aims for each moment to enhance quality of life. The partnership with the VPPCP and SCHN has allowed the program to reach families across metropolitan and regional locations. In late 2019 a formative evaluation of the pilot was conducted utilising both quantitative and qualitative methodologies to document both the delivery and outcomes of the program. Central to the evaluation was the interviews conducted with both clinical teams and families in order to gain a comprehensive understanding of the impact of and satisfaction with the program. The findings, which will be shared in this presentation, provide practical insight into the delivery of the program, the key elements for its success with families, and areas which could benefit from additional research and focus. It will use stories and case studies from the pilot to highlight the impact of the program and discuss what opportunities, challenges, and learnings emerged.

Keywords: children, families, memory making, pediatric palliative care, support

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Authors: Chariya Laohavich

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Background: Some limitations and complications have been found associated with commercial mouthpiece in bronchoscopic procedure. Therefore, we invented the Rama-chest mouthpiece from plastic normal saline bottle. Objective: The aim of this study was to compare user satisfaction in Rama-chest mouthpiece with the commercial mouthpiece. Methods: A prospective randomized controlled trial between commercial mouthpiece and Rama-chest mouthpiece was conducted on patients who were underwent bronchoscopy and required mouthpiece insertion from May to June 2014. The questionnaire about satisfaction was completed by the bronchoscopists, assistant nurses, and patients. Results: Thirty procedures in both groups were investigated. Mean satisfaction scores filled by the bronchoscopists and assistant nurses were not different between both groups. However, higher satisfaction score filled by the patients was found in Rama-chest mouthpiece than the comparator (p=0.011). Complications such as abrasion, pain, and itching were observed in commercial mouthpiece but not found in Rama-chest mouthpiece. Conclusion: We have introduced Rama-chest mouthpiece and proved its usefulness comparable to the commercial mouthpiece.

Keywords: mouthpiece, bronchoscopist, bronchology, pulmonology and respiratory diseases

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Authors: Chia-Feng Lu, Yuh-Jen Wang, Yu-Te Wu, Sui-Hing Yan

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This study aimed at investigating whether the functional brain networks constructed using the initial EEG (obtained when patients first visited hospital) can be correlated with the progression of cognitive decline calculated as the changes of mini-mental state examination (MMSE) scores between the latest and initial examinations. We integrated the time–frequency cross mutual information (TFCMI) method to estimate the EEG functional connectivity between cortical regions, and the network analysis based on graph theory to investigate the organization of functional networks in aMCI. Our finding suggested that higher integrated functional network with sufficient connection strengths, dense connection between local regions, and high network efficiency in processing information at the initial stage may result in a better prognosis of the subsequent cognitive functions for aMCI. In conclusion, the functional connectivity can be a useful biomarker to assist in prediction of cognitive declines in aMCI.

Keywords: cognitive decline, functional connectivity, MCI, MMSE

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Authors: Robert Pintaric, Joze Matela, Stefan Pintaric, Stanka Vadnjal

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Introduction: This work is aimed to represent the use of the OPTI-JET CS MD1 MR prototype for application of neutral electrolyzed oxidizing water (NEOW) in magnetic resonance rooms. Material and Methods: We produced and used OPTI-JET CS MD1 MR aerosolisator whereby was performed aerosolization. The presence of microorganisms before and after the aerosolisation was recorded with the help of cyclone air sampling. Colony formed units (CFU) was counted. Results: The number of microorganisms in magnetic resonance 3T room was low as expected. Nevertheless, a possible CFU reduction of 87% was recorded. Conclusions: The research has shown that the use of EOW for the air and hard surface disinfection can considerably reduce the presence of microorganisms and consequently the possibility of hospital infections. It has also demonstrated that the use of OPTI-JET CS MD1 MR is very good. With this research, we started new guidelines for aerosolization in magnetic resonance rooms. Future work: We predict that presented technique works very good but we must focus also on time capacity sensors, and new appropriate toxicological studies.

Keywords: biocide, electrolyzed oxidizing water (EOW), disinfection, microorganisms, OPTI-JET CS MD1MR

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Authors: H. Boulahyaoui, S. Alaoui Amine, C. Loutfi, H. El Annaz, N. Touil, El M. El Fahim, S. Mrani

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Three Moroccan children fully vaccinated with Rotarix™ have been hospitalized for Rotavirus Gastroenteritis (RVGE) in the pediatric division of the Farabi Hospital, Oujda. Rotavirus G/P genotypes could not be typed because of their delayed crossing threshold (Ct) resolute with a group A rotavirus (RVA) real time RT-PCR. These strains were adapted to cell culture. All viruses replicated and caused extensive cytopathic effects after four or five passages in MA104 cell lines. Significant improvements have been obtained in the amount of viral particles. Each virus multiplied to a high titer (7.5 TCID50/ml). VP7 and VP4 partial gene sequencing revealed distinct genotypes compared to the Rotarix(®) vaccine strain. Two strains were of G2P[4] genotype whereas the third was G9P[8] genotype. Virus isolation while labor intensive, is recommended as a second test, especially when higher sensitivity for conventional RVA genotyping RT-PCR is needed. VP7 antigenic similarities between these strains and Rotarix were determined.

Keywords: esacpe-vaccine, Morocco, Rotarix, G2P[4], G9P[8]

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Authors: Zain Khan, Steve Ahn, Kathy Monypenny, James Fink

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In Australian public hospitals, there were approximately 34,000 reported inpatient falls between 2015 to 2016. The gold standard for diagnosing intracranial injury is non-contrast enhanced brain computed tomography (CTB). Over a three-month timeframe, a total of one hundred and eighty (180) falls were documented between the hours of 4pm and 8am at a large metro hospital. Only three (3) of these scans demonstrated a positive intra-cranial finding. The rationale for scanning varied. The common indications included a fall with head strike, the presence of blood thinning medication, loss of consciousness, reduced Glasgow Coma Scale (GCS), vomiting and new neurological findings. There are several validated tools to aid in decision-making around ordering CTB scans in the acute setting, but no such accepted tool exists for the inpatient space. With further data collection, spanning a greater length of time and through involving multiple centres, work can be done towards generating such a tool that can be utilized for inpatient falls.

Keywords: computed tomography, falls, inpatient, intracranial hemorrhage

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Authors: Boma Nellie S, Nambiar Ritu, K. Kanchanmala, T. Rashida, Israell Imelda, Moul Khusnud, Michael Marina

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Gestational diabetes (GDM) imparts an increased life long risk of developing Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease in women. Once diagnosed with GDM women have up to 74% increased cumulative risk developing T2DM in 10-15 years. Identifying women at increased risk of developing T2DM and offering them pharmacological and lifestyle management interventions will delay or eliminate the development of diabetes in this population. While ADA recommends that all gestational diabetics be offered postnatal screening, worldwide the screening rates from 35-75% and Al Rahba Hospital with a robust universal antenatal screening program for GDM was at a dismal 9% in 2011. A multidisciplinary team was put together involving OB/Gyn Physicians, Midwives, Nurses (ward and OPD) Diabetic Educators, Dietitians, Medical Records, Laboratory & IT with the implementation of multiple strategies to increase the uptake of postpartum screening of the gestational diabetic.

Keywords: GDM, postnatal screening, preventing type 2 diabetes, lifestyle management

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Authors: Lauren G. Coggins

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Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are among the most common healthcare-associated infections (HAI), contributing to prolonged lengths of stay, greater costs of patient care, and increased patient mortality. Evidence-based preventative care bundles exist to establish consistent, safe patient-care practices throughout an entire organization, helping to ensure the collective application of care strategies that aim to improve patient outcomes and minimize complications. The cardiac intensive care unit at a nationally ranked teaching and research hospital in the United States exceeded its annual CAUTI and CLABSI targets in the fiscal year 2019, prompting examination into the unit’s infection prevention efforts that included preventative care bundles for both HAIs. Adherence to the CAUTI and CLABSI preventative care bundles was evaluated through frequent audits conducted over three months, using standards and resources from The Joint Commission, a globally recognized leader in quality improvement in healthcare and patient care safety. The bundle elements with the lowest scores were identified as the most commonly missed elements. Three elements from both bundles, six elements in total, served as key content areas for the educational interventions targeted to bedside nurses. The CAUTI elements included appropriate urinary catheter order, appropriate continuation criteria, and urinary catheter care. The CLABSI elements included primary tubing compliance, needleless connector compliance, and dressing change compliance. An integrated, multi-platform education campaign featured content on each CAUTI and CLABSI preventative care bundle in its entirety, with additional reinforcement focused on the lowest scoring elements. One-on-one educational materials included an informational pamphlet, badge buddy, a presentation to reinforce nursing care standards, and real-time application through case studies and electronic health record demonstrations. A digital hub was developed on the hospital’s Intranet for quick access to unit resources, and a bulletin board helped track the number of days since the last CAUTI and CLABSI incident. Audits continued to be conducted throughout the education campaign, and staff were given real-time feedback to address any gaps in adherence. Nearly every nurse in the cardiac intensive care unit received all educational materials, and adherence to all six key bundle elements increased after the implementation of educational interventions. Recommendations from this implementation include providing consistent, comprehensive education across multiple teaching tools and regular audits to track adherence. The multi-platform education campaign brought focus to the evidence-based CAUTI and CLABSI bundles, which in turn will help to reduce CAUTI and CLABSI rates in clinical practice.

Keywords: education, healthcare-associated infections, infection, nursing, prevention

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