Search results for: patient decision aid

Authors: İbrahi̇m Kara, Seher Arslankaya

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Frequently preferred in the field of engineering in particular, data mining has now begun to be used in the field of health as well since the data in the health sector have reached great dimensions. With data mining, it is aimed to reveal models from the great amounts of raw data in agreement with the purpose and to search for the rules and relationships which will enable one to make predictions about the future from the large amount of data set. It helps the decision-maker to find the relationships among the data which form at the stage of decision-making. In this study, it is aimed to determine the risk of heart attack at the first stage, to control it, and to make its resource planning with the method of data mining. Through the early and correct diagnosis of heart attacks, it is aimed to reveal the factors which affect the diseases, to protect health and choose the right treatment methods, to reduce the costs in health expenditures, and to shorten the durations of patients’ stay at hospitals. In this way, the diagnosis and treatment costs of a heart attack will be scrutinized, which will be useful to determine the risk of the disease at the first stage, to control it, and to make its resource planning.

Keywords: data mining, decision support systems, heart attack, health sector

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Authors: Elahe Memari, Ahmad Aslizadeh, Ahmad Memari

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Today strategic planning is counted as the most important duties of senior directors in each organization. Strategic planning allows the organizations to implement compiled strategies and reach higher competitive benefits than their competitors. The present research work tries to prepare and rank the strategies form effective factors on strategic planning in fulfillment of the State Road Management and Transportation Organization in order to indicate the role of organizational factors in efficiency of the process to organization managers. Connection between six main factors in fulfillment of State Road Management and Transportation Organization were studied here, including Improvement of Strategic Thinking in senior managers, improvement of the organization business process, rationalization of resources allocation in different parts of the organization, coordination and conformity of strategic plan with organization needs, adjustment of organization activities with environmental changes, reinforcement of organizational culture. All said factors approved by implemented tests and then ranked using fuzzy multivariate decision-making technique.

Keywords: Fuzzy TOPSIS, improvement of organization business process, multivariate decision-making, strategic planning

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Authors: Eunjoo Lee

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Background: As the number of surgeries increases, the incidence of adverse events is likely to become more prevalent. Patients who are somewhat knowledgeable about surgery-related adverse events are more likely to engage in safety initiatives to prevent them. Objectives: To evaluate the impact of a smartphone application developed during the study to enhance patients’ knowledge of surgery-related adverse events during hospitalization. Design: Non-randomized, one group, measured pre- and post-intervention. Participants: Thirty-six hospitalized patients admitted to the orthopedics unit of a general hospital in South Korea. Methods. First, a smartphone application to enhance patients’ knowledge of surgery-related adverse events was developed through an iterative process, which included a literature review, expert consultation, and pilot testing. The application was installed on participants’ smartphones, and research assistants taught the participants to use it. Twenty-five true/false questions were used to assess patients’ knowledge of preoperative precautions (eight items), surgical site infection (five items), Foley catheter management (four items), drainage management (four items), and anesthesia-related complications (four items). Results: Overall, the percentage of correct answers increased significantly, from 57.02% to 73.82%, although answers related to a few specific topics did not increase that much. Although the patients’ understanding of drainage management and the Foley catheter did increase substantially after they used the smartphone application, it was still relatively low. Conclusions: The smartphone application developed during this study enhanced the patients’ knowledge of surgery-related adverse events during hospitalization. However, nurses must make an additional effort to help patients to understand certain topics, including drainage and Foley catheter management. Relevance to clinical practice: Insufficient patient knowledge increases the risk of adverse events during hospitalization. Nurses should take active steps to enhance patients’ knowledge of a range of safety issues during hospitalization, in order to decrease the number of surgery-related adverse events.

Keywords: patient education, patient participation, patient safety, smartphone application, surgical errors

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Authors: Jun-Ho Park, Kwang-Woo Nam, Seung-Mo Hong, Tae-Heon Moon, Sang-Ho Lee, Youn-Taik Leem

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The aim of this study was to build ‘Ubi-Net’, a decision-making support system for systematic establishment in U-City planning. We have experienced various urban problems caused by high-density development and population concentrations in established urban areas. To address these problems, a U-Service contributes to the alleviation of urban problems by providing real-time information to citizens through network connections and related information. However, technology, devices, and information for consumers are required for systematic U-Service planning in towns and cities where there are many difficulties in this regard, and a lack of reference systems. Thus, this study suggests methods to support the establishment of sustainable planning by providing comprehensive information including IT technology, devices, news, and social networking services(SNS) to U-City planners through intelligent searches. In this study, we targeted Smart U-Parking Planning to solve parking problems in an ‘old’ city. Through this study, we sought to contribute to supporting advances in U-Space and the alleviation of urban problems.

Keywords: desigin and decision support system, smart u-parking planning, social network analysis, urban engineering

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Authors: Prem, Norhaya, Vwrene C., Mohammad Harris A., Amarjit, Fazir M.

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Upper limb surgery is a common orthopedic procedure. After surgery, it is necessary to raise the patient's arm to reduce limb swelling and promote recovery. After an injury or surgery, swelling (edema) in the limbs is common. This swelling can be painful, cause stiffness, and affect movement and ability to do daily activities. One of the easiest ways to manage swelling is to elevate the swollen limb. The goal is to elevate the swollen limb slightly above the level of the heart. This helps the extra fluid move back towards the heart for circulation to the rest of the body. Conventional arm sling or pillows are usually placed under the arm to raise it, but in this way the arm cannot be fixed well and easily slide down, without ideal raising effect. Conventional arm sling need experience to tie the sling and this delay in the application process. To reduce the waiting time and cost, modified Norhaya upper limb elevation sling was designed and made readily available. The sling is made from calico fabric, readily available in the ward. Measurements of patients’ arm lengths are obtained, and fabric sizes are cut into the average arm lengths, as well as 1 size above and below. The cut calico fabric is then sewn together with thick sewing threads. Its application is easy and junior most staff or doctor will be able to apply it on patient. The time taken to set up the sling is also reduced. Feedback gathered from ground staff regarding ease of setting up the sling was tremendous and patient also feel comfort in the modified Norhaya sling. The device can freely adjust the raising height of the affected limb and effectively fix the affected limb to reduce its swelling, thus promoting recovery. This device is worthy to be clinically popularized and applied. The Modified Norhaya upper limb elevation sling is the quickest to set up and the delay in elevating the patient’s hand is significantly reduced. Moreover, it is reproducible and there is also significant cost savings.

Keywords: elevate, effective, sling, timely

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Authors: M. N. A. Azman, M. S. S. Ahamad

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The Construction Industry Development Board of Malaysia has been actively promoting the use of precast manufacturing in the local construction industry over the last decade. In an era of rapid technological changes, precast manufacturing significantly contributes to improving construction activities and ensuring sustainable economic growth. Current studies on the location decision of precast manufacturing plants aimed to enhanced local economic development are scarce. To address this gap, the present research establishes a new set of spatial criteria, such as attribute maps and preference weights, derived from a survey of local industry decision makers. These data represent the input parameters for the MCE-GIS site selection model, for which the weighted linear combination method is used. Verification tests on the model were conducted to determine the potential precast manufacturing sites in the state of Penang, Malaysia. The tests yield a predicted area of 12.87 acres located within a designated industrial zone. Although, the model is developed specifically for precast manufacturing plant but nevertheless it can be employed to other types of industries by following the methodology and guidelines proposed in the present research.

Keywords: geographical information system, multi criteria evaluation, industrialised building system, civil engineering

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Authors: Vano Tsertsvadze, Marina Chavchanidze, Lali Khurtsia

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Problem of drug use is often seen as a combination of psychological and social problems, but this problem can be considered as economically rational decision in the process of buying pleasure (looking after children, reading, harvesting fruits in the fall, sex, eating, etc.). Before the adoption of the decisions people face to a trade-off - when someone chooses a delicious meal, she takes a completely rational decision, that the pleasure of eating has a lot more value than the pleasure which she will experience after two months diet on the summer beach showing off her beautiful body. This argument is also true for alcohol, drugs and cigarettes. Smoking has a negative effect on health, but smokers are not afraid of the threat of a lung cancer after 40 years, more valuable moment is a pleasure from smoking. Our hypothesis - unsatisfied pleasure and frustration, probably determines the risk of dependence on drug abuse. The purpose of research: 1- to determine the relative measure unit of pleasure, which will be used to measure and assess the intensity of various human pleasures. 2- to compare the intensity of the pleasure from different kinds of activity, with pleasures received from drug use. 3- Based on the analysis of data, to identify factors affecting the rational decision making. Research method: Respondents will be asked to recall the greatest pleasure of their life, which will be used as a measure of the other pleasures. The study will use focus groups and structured interviews.

Keywords: drug, drug-user, measurement, satisfaction

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Authors: Semire Yekta

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Many online retailers set up manual review teams to overcome the limitations of automated online fraud detection systems. This study critically examines the strategies they adapt in their decision-making process to set apart fraudulent individuals from non-fraudulent online shoppers. The study uses a mix method research approach. 32 in-depth interviews have been conducted alongside with participant observation and auto-ethnography. The study found out that all steps of the decision-making process are significantly affected by a level of subjectivity, personal understandings of online fraud, preferences and judgments and not necessarily by objectively identifiable facts. Rather clearly knowing who the fraudulent individuals are, the team members have to predict whether they think the customer might be a fraudster. Common strategies used are relying on the classification and fraud scorings in the automated fraud detection systems, weighing up arguments for and against the customer and making a decision, using cancellation to test customers’ reaction and making use of personal experiences and “the sixth sense”. The interaction in the team also plays a significant role given that some decisions turn into a group discussion. While customer data represent the basis for the decision-making, fraud management teams frequently make use of Google search and Google Maps to find out additional information about the customer and verify whether the customer is the person they claim to be. While this, on the one hand, raises ethical concerns, on the other hand, Google Street View on the address and area of the customer puts customers living in less privileged housing and areas at a higher risk of being classified as fraudsters. Phone validation is used as a final measurement to make decisions for or against the customer when previous strategies and Google Search do not suffice. However, phone validation is also characterized by individuals’ subjectivity, personal views and judgment on customer’s reaction on the phone that results in a final classification as genuine or fraudulent.

Keywords: online fraud, data mining, manual review, social construction

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Authors: Kamalendu Pal

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This paper describes the main features of a knowledge-based system evaluation method. System evaluation is placed in the context of a hybrid legal decision-support system, Advisory Support for Home Settlement in Divorce (ASHSD). Legal knowledge for ASHSD is represented in two forms, as rules and previously decided cases. Besides distinguishing the two different forms of knowledge representation, the paper outlines the actual use of these forms in a computational framework that is designed to generate a plausible solution for a given case, by using rule-based reasoning (RBR) and case-based reasoning (CBR) in an integrated environment. The nature of suitability assessment of a solution has been considered as a multiple criteria decision making process in ASHAD evaluation. The evaluation was performed by a combination of discussions and questionnaires with different user groups. The answers to questionnaires used in this evaluations method have been measured as a combination of linguistic variables, fuzzy numbers, and by using defuzzification process. The results show that the designed evaluation method creates suitable mechanism in order to improve the performance of the knowledge-based system.

Keywords: case-based reasoning, fuzzy number, legal decision-support system, linguistic variable, rule-based reasoning, system evaluation

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Authors: L. Edirisinghe, Z. Jin, A. W. Wijeratne, R. Mudunkotuwa

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Empty container repositioning is a fundamental problem faced by the shipping industry. The virtual container yard is a novel strategy underpinning the container interchange between carriers that could substantially reduce this ever-increasing shipping cost. This paper evaluates the shipping industry perception of the virtual container yard using chi-square tests. It examines if the carriers perceive that the selected independent variables, namely culture, organization, decision, marketing, attitudes, legal, independent, complexity, and stakeholders of carriers, impact the efficiency and benefits of the virtual container yard. There are two major findings of the research. Firstly, carriers view that complexity, attitudes, and stakeholders may impact the effectiveness of container interchange and may influence the perceived benefits of the virtual container yard. Secondly, the three factors of legal, organization, and decision influence only the perceived benefits of the virtual container yard. Accordingly, the implementation of the virtual container yard will be influenced by six key factors, namely complexity, attitudes, stakeholders, legal, organization and decision. Since the virtual container yard could reduce overall shipping costs, it is vital to examine the carriers’ perception of this concept.

Keywords: virtual container yard, imbalance, management, inventory

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Authors: Kishor Bhagwat, Gayatri Vyas

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Construction industry is earmarked with complex processes depending on the nature and scope of the project. In recent years, developments in this sector are remarkable and have resulted in both positive and negative impacts on the environment and human being. Sustainable construction can be looked upon as one of the solution to overcome the negative impacts since sustainable construction is a vast concept, which includes many parameters, and sometimes the use of multi-criteria decision making [MCDM] tools becomes necessary. The main objective of this study is to determine the weightage of sustainable building parameters with the help of MCDM tools. Questionnaire survey was conducted to examine the perspective of respondents on the importance of weights of the criterion, and the respondents were architects, green building consultants, and civil engineers. This paper presents an overview of research related to Indian and international green building rating systems and MCDM. The results depict that economy, environmental health, and safety, site selection, climatic condition, etc., are important parameters in sustainable construction.

Keywords: green building, sustainability, multi-criteria decision making method [MCDM], analytical hierarchy process [AHP], technique for order preference by similarity to an ideal solution [TOPSIS], entropy

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Authors: Hugo Reis, Isabel Rabiais

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The main purpose of the present study is to understand the nurse’s responsibility in preventing the septic shock in an oncological patient with febrile neutropenia submitted to chemotherapy. In order to do it, an integrative review of literature has been conducted. In the research done in many databases, it was concluded that only 7 out of 5202 articles compiled the entire inclusion standard present in the strict protocol of research, being this made up by all different methodologies. On the research done in the 7 articles it has resulted 8 text macro-units associated to different nursing interventions: ‘Health Education’; ‘Prophylactic Therapy Administration’; ‘Scales Utilization’; ‘Patient Evaluation’; ‘Environment Control’; ‘Performance of Diagnostic Auxiliary Exams’; ‘Protocol Enforcement/Procedure Guidelines’; ‘Antibiotic Therapy Administration’. Concerning the prevalence/result’s division there can be identified many conclusions: the macro-units ‘Patient Evaluation’, ‘Performance of Diagnostic Auxiliary Exams’, and ‘Antibiotic Therapy Administration’ present themselves to be the most prevalent in the research – 6 in 7 occurrences (approximately 85.7%). Next, the macro-unit ‘Protocol Enforcement/Procedure Guidelines’ presents itself as an important expression unit – being part of 5 out of the 7 analyzed studies (approximately 71.4%). The macro-unit ‘Health Education’, seems to be in the same way, an important expression unit – 4 out of the 7 (or approximately 57%). The macro-unit ‘Scales Utilization’, represents a minor part in the research done – it’s in only 2 out of the 7 cases (approximately 28.6%). On the other hand, the macro-units ‘Prophylactic Therapy Administration’ and ‘Environment Control’ are the two categories with fewer results in the research - 1 out of the 7 cases, the same as approximately 14.3% of the research results. Every research done to the macro-unit ‘Antibiotic Therapy Administration’ agreed to refer that the intervention should be strictly done, in a period of time less than one hour after diagnosing the fever, with the purpose of controlling the quick spread of infection – minimizing its seriousness. Identifying these interventions contributes, concluding that, to adopt strategies in order to prevent the phenomenon that represents a daily scenario responsible for the cost´s increase in health institutions, being at the same time responsible for the high morbidity rates and mortality increase associated with this specific group of patients.

Keywords: febrile neutropenia, oncology nursing, patient, septic shock

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Authors: Ahmed Mohamed Alteer

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The purpose of this paper is come up with theoretical model through understanding the causes and motives behind the auditors' sensitive to ethical dilemma through Auditing Students. This study considers the possibility of auditing students’ ethical judgement being affected by two individual factors, namely ethical sensitivity and religiosity. The finding of this study that there are several ethical theories a models provide a significant understanding of ethical issues and supported that ethical sensitivity and religiosity may affect ethical judgement decision among accounting students. The suggestion model proposes that student ethical judgement is influenced by their ethical sensitivity and their religiosity. Nonetheless, the influence of religiosity on ethical judgement is expected to be via ethical sensitivity.

Keywords: asccounting students, ethical sensitivity, religiosity, ethical judgement

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Authors: Thitima Plejai

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The practice in the operating room has been continually performed according to standards of services; however, undesirable incidents from surgical services are found such as surgical complications in the operating room. This participation action research aimed to develop practice guidelines for surgical safety management to reduce undesirable incidents from surgical services in the operating room of Songkhla Hospital. The target population was all 84 members of the multidisciplinary team who were involved in surgical services in the operating room consisting of 28 surgeons from five branches of surgery, 27 anesthetists and nurse anesthetists, and 29 surgical nurses. The data were collected through in-depth interviews, and non-participatory observations. The research instrument was tested by three experts, and the steps of the development consisted of four cycles, each consisting of assessment, planning, practice, practice reflection, and improvement until every step is practicable. The data were validated through triangulation research method, analyzed through content analysis and statistical analysis with number and percentage. The results of the development of practice guidelines surgical safety management to reduce undesirable incidents from surgical services could be concluded as follows. 1) The multidisciplinary team in surgery participated in the needs assessment for development of practice guidelines for surgical patient safety, and agreed on adapting the WHO Surgical Safety Checklists for use. 2) The WHO Surgical Safety Checklists was implemented, and meetings were held for the multidisciplinary team in surgery and the organizational risk committee to improve the practice guidelines to make them more practicable. 3) The multidisciplinary team consisting of surgeons from five branches of surgery, anesthetists, nurse anesthetists, surgical nurses, and the organizational risk committee announced policy on safety for surgical patients; the organizational risk committee designated the Surgical Safety Checklist as an instrument for surgical patient safety. The results of the safety management found that the surgical team members who could follow 100 percent of the guidelines were: professional nurses who checked patient identity and information before taking the patient to the operating room and kept complete records of data on the patients; surgical nurses who checked readiness of the patient before surgery; nurse anesthetists who assessed readiness before administering anesthetic drugs, and confirmed correctness of the patient; and circulating perioperative nurses who gave confirmation to the surgical team after completion of the surgery. The rates of undesirable incidents (surgical complications rates) before and after the implementation of the surgical safety management were 1.60 percent and 0.66 percent, respectively. The satisfaction of the surgery-related teams towards the use of the guidelines was 89 percent. The practice guidelines for surgical safety management to reduce undesirable incidents were taken as guidelines for surgical safety that the multidisciplinary team involved in the surgical process implemented correctly and in the same direction and clearly reduced undesirable incidents in surgical patients.

Keywords: practice guidelines, surgical safety management, reduce undesirable incidents, operating Room

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Authors: Muhammad Fatahillah Akbar

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Criminal Procedural Law is established to protect the society from the abuse of authority. To achieve that purpose, the criminal procedural law shall be established in accordance with the laws of human right and the protection of the society. One of the mechanisms to protect human rights and to ensure the compliance of authorities in criminal procedural law is pre-trial mechanism. In many countries, there are various mechanisms of pre-trial. In the recent cases in Indonesia, pre-trial has been an interesting issue. The issue is also addressed by the Constitutional Court Decision Number 21/PUU-XII/2014 which enhance the competence of pre-trial which includes the suspect determination and the legality of seizure and search. Before that decision, some pre-trial decisions have made landmark decision by enhancing the competence of pre-trial, such as the suspect determination case in Budi Gunawan Case and legality of the investigation in Hadi Purnomo Case. These pre-trial cases occurred because the society needs protection even though it is not provided by written legislations, in this matter, The Indonesian Criminal Procedural Code (KUHAP). For instance, a person can be a suspect for unlimited time because the Criminal Procedural Code does not regulate the limit of investigation, so the suspect enactment shall be able to be challenged to protect human rights. Before the Constitutional Court Decision Suspect Determination cannot be challenged so that the society is not fully protected. The Constitutional Court Decision has provided more protections. Nowadays, investigators shall be more careful in conducting the investigation. However, those decisions, including the Constitutional Court Decision are not sufficient for society to be protected by abuse of authority. For example, on 7 March 2017, a single judge, in a Pre-Trial, at the Surabaya District Court, decided that the investigation was unlawful and shall be terminated. This is not regulated according to the Code and also any decisions in pre-trial. It can be seen that the reform of pre-trial is necessary. Hence, this paper aims to examine how pre-trial shall be developed in the future to provide wide access for society to have social justice in criminal justice system. The question will be answered by normative, historical, and comparative approaches. Firstly, the paper will examine the history of pre-trial in Indonesia and also landmark decisions on pre-trial. Then, the lessons learned from other countries regarding to the pre-trial mechanism will be elaborated to show how pre-trial shall be developed and what the competences of a pre-trial are. The focus of all discussions shall be on how the society is protected and provided access to legally complain to the authority. At the end of the paper, the recommendation to reform the pre-trial mechanism will be suggested.

Keywords: pre-trial, criminal procedural law, society

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Authors: E. Fathallahi Aghdam, V. Hosseini

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Environmental pollution is not limited to a specific region or country; that is why sustainable development, as a necessary process for improvement, pays attention to issues such as destruction of natural resources, degradation of biological system, global pollution, and climate change in the world, especially in the developing countries. According to the World Health Organization, as a developing city, Tehran (capital of Iran) is one of the most polluted cities in the world in terms of air pollution. In this study, three pollutants including particulate matter less than 10 microns, nitrogen oxides, and sulfur dioxide were evaluated in Tehran using data mining techniques and through Crisp approach. The data from 21 air pollution measuring stations in different areas of Tehran were collected from 1999 to 2013. Commercial softwares Clementine was selected for this study. Tehran was divided into distinct clusters in terms of the mentioned pollutants using the software. As a data mining technique, clustering is usually used as a prologue for other analyses, therefore, the similarity of clusters was evaluated in this study through analyzing local conditions, traffic behavior, and industrial activities. In fact, the results of this research can support decision-making system, help managers improve the performance and decision making, and assist in urban studies.

Keywords: data mining, clustering, air pollution, crisp approach

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Authors: Endri Rama, Genci Capi, Shigenori Kawahara

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The mobile robot ability to navigate autonomously in its environment is very important. Even though the advances in technology, robot self-localization and goal directed navigation in complex environments are still challenging tasks. In this article, we propose a novel method for robot navigation based on rat’s brain signals (Local Field Potentials). It has been well known that rats accurately and rapidly navigate in a complex space by localizing themselves in reference to the surrounding environmental cues. As the first step to incorporate the rat’s navigation strategy into the robot control, we analyzed the rats’ strategies while it navigates in a multiple Y-maze, and recorded Local Field Potentials (LFPs) simultaneously from three brain regions. Next, we processed the LFPs, and the extracted features were used as an input in the artificial neural network to predict the rat’s next location, especially in the decision-making moment, in Y-junctions. We developed an algorithm by which the robot learned to imitate the rat’s decision-making by mapping the rat’s brain signals into its own actions. Finally, the robot learned to integrate the internal states as well as external sensors in order to localize and navigate in the complex environment.

Keywords: brain-machine interface, decision-making, mobile robot, neural network

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Authors: Donghee Kang

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Background: Cancer pain is very difficult to control as the mechanism of pain is varied, and the patient has several co-morbidities. The use of Intravenous Patient-Controlled Analgesia (IV-PCA) can effectively control underlying pain and breakthrough pain. Ketamine is used in many pain patients due to its unique analgesic effect. In this study, it was checked whether there was a difference in the amount of analgesic usage, pain control degree, and side effects between patients who controlled pain with fentanyl-based IV-PCA and those who added Ketamine for pain control. Methods: Among the patients referred to this department for cancer pain, IV-PCA was applied to patients who were taking sufficient oral analgesics but could not control them or had blood clotting disorders that made the procedure difficult, and this patient group was targeted. In IV-PCA, 3000 mcg of Fentanyl, 160 mg of Nefopam, and 0.3 mg of Ramosetrone were mixed with normal saline to make a total volume of 100 ml. Group F used this IV-PCA as it is, and group K mixed 250 mg of Ketamine with normal saline to make a total volume of 100 ml. For IV-PCA, the basal rate was 0.5ml/h, the bolus was set to 1ml when pressed once, and the lockout time was set to 15 minutes. If pain was not controlled after IV-PCA application, 500 mcg of Fentanyl was added, and if excessive sedation or breathing difficulties occurred, the use was stopped for one hour. After that, the degree of daily pain control, analgesic usage, and side effects were investigated for seven days using this IV-PCA. Results: There was no difference between the two groups in the demographic data. Both groups had adequate pain control. Initial morphine milligram equivalents did not differ between the two groups, but the total amount of Fentanyl used for seven days was significantly different between the two groups [p=0.014], and group F used more Fentanyl through IV-PCA. In addition, the amount of sleeping pills used during the seven days was higher in Group F [p<0.01]. Overall, there was no difference in the frequency of side effects between the two groups, but the nausea was more frequent in Group F [p=0.031]. Discussion: When the two groups were compared, pain control was good in both groups. This seems to be because Fentanyl-based IV-PCA showed an adequate pain control effect. However, there was a significant difference in the total amount of opioid (Fentanyl) used, which is thought to be the opioid-sparing effect of Ketamine. Also, among the side effects, nausea was significantly less, which is thought to be possible because the amount of opioids used in the Ketamine group was small. The frequency of requesting sleeping pills was significantly less in the group using Ketamine, and it seems that Ketamine also helped improve sleep quality. In conclusion, using Ketamine with an opioid to control pain seems to have advantages. IV-PCA, which can be used effectively when other procedures are difficult, is more effective and safer when used together with Ketamine than opioids alone.

Keywords: cancer pain, intravenous patient-controlled analgesia, Ketamine, opioid

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Authors: Mohamed Naser Zainol, P. P. Angeline Song

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Over the years, the profile of end-stage renal patients placed under The National Kidney Foundation Singapore (NKFS) dialysis program has evolved, with a gradual incline in the number of patients with behavior-related issues. With these challenging profiles, social workers and counsellors are often expected to oversee behavior management, through referrals from its partnering colleagues. Due to the segregation of tasks usually found in many hospital-based multi-disciplinary settings, social workers’ and counsellors’ interventions are often seen as an endpoint, limiting other stakeholders’ involvement that could otherwise be potentially crucial in managing such patients. While patients’ contact in local hospitals often leads to eventual discharge, NKFS patients are mostly long term. It is interesting to note that these patients are regularly seen by a team of professionals that includes doctors, nurses, dietitians, exercise specialists in NKFS. The dynamism of relationships presents an opportunity for any of these professionals to take ownership of their potentials in leading interventions that can be helpful to patients. As such, it is important to have a framework that incorporates the strength of these professionals and also channels empowerment across the multi-disciplinary team in working towards wholistic patient care. This paper would like to suggest a new framework for NKFS’s multi-disciplinary team, where the group synergy and dynamics are used to encourage ownership and promote empowerment. The social worker and counsellor use group work skills and his/her knowledge of its members’ strengths, to generate constructive solutions that are centered towards patient’s growth. Using key ideas from Karl’s Tomm Interpersonal Communications, the Communication Management of Meaning and Motivational Interviewing, the social worker and counsellor through a series of guided meeting with other colleagues, facilitates the transmission of understanding, responsibility sharing and tapping on team resources for patient care. As a result, the patient can experience personal and concerted approach and begins to flow in a direction that is helpful for him. Using seven case studies of identified patients with behavioral issues, the social worker and counsellor apply this framework for a period of six months. Patient’s overall improvement through interventions as a result of this framework are recorded using the AB single case design, with baseline measured three months before referral. Interviews with patients and their families, as well as other colleagues that are not part of the multi-disciplinary team are solicited at mid and end points to gather their experiences about patient’s progress as a by-product of this framework. Expert interviews will be conducted on each member of the multi-disciplinary team to study their observations and experience in using this new framework. Hence, this exploratory framework hopes to identify the inherent usefulness in managing patients with behavior related issues. Moreover, it would provide indicators in improving aspects of the framework when applied to a larger population.

Keywords: behavior management, end-stage renal failure, satellite dialysis, multi-disciplinary team

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Authors: Csaba I. Hencz, István Á. Harmati

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Nowadays the significance of road transport is gradually increasing. All transport companies are working in the same external environment where the speed of transport is defined by traffic rules. The main objective is to accelerate the speed of service and it is only dependent on the individual abilities of the managing members. These operational control units make decisions quickly (in a typically experiential and/or intuitive way). For this reason, support for these decisions is an important task. Our goal is to create a decision support model based on fuzzy signatures that can assist the work of operational management automatically. If the model sets parameters properly, the management of transport could be more economical and efficient.

Keywords: freight transport, decision support, information handling, fuzzy methods

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Authors: Sae-Yeon Seong, EunSun Chung, Dongjoo Chin

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Conflict of interest (COI) is one of the dominant circumstantial factors of moral corruption across various fields. Several management strategies have been proposed to prevent self-interested decision making in COIs. Among these strategies, message persuasion has been considered as a practical and effective approach. Framing and repetition are two of the major factors in the persuasion effect of message. Therefore, their effect on moral decision making in COI should be explored systematically. The purpose of this study was to compare the differential effects of positively framed message and negatively framed message, and secondly, to investigate how the effectiveness of persuasive message changes through repetitive exposures. A total of 63 participants were randomly assigned to one of 3 framing conditions: positive framing, negative framing, and no-message condition. Prior to the online experiment involving a consultation task, the differently framed persuasive message was presented to the participants. This process was repeated four times in a row. The results showed that participants with positive-framing message were less likely to provide self-interested consultation than participants in the no-message condition. Also, a U-shaped quadric relation between repetition and self-interest consultation was found. Implications and limitations are further discussed.

Keywords: conflicts of interest, persuasive message, framing effect, repetition effect, self-interested behavior

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Authors: A. A. Md. Ryhan Uddin, Swarup Das, Rajesh Barua, Joheb Hasan, Rashedul Islam

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Background: The herbicide has toxicological importance because some of them are associated with high mortality rates due to respiratory failure. Organophosphate poisoning (OPC) & Paraquat self-poisoning is a major clinical and public health problems in low and middle-income countries across much of South Asia. Paraquat was not used as a common suicidal agent previously in Bangladesh. We report a case of 15 years old female admitted to the ER with a history of nausea & vomiting after ingestion of an unknown substance in a suicidal attempt, later identified as mixed poisoning- OPC & Paraquat. She was initially asymptomatic but later developed renal shutdown & lung injuries as well as pneumothorax, referred to as Daisley Barton Syndrome. Objective: This case report aims to alert spontaneous pneumothorax in mixed poisoning on uncommon forms of presentation. Pneumothorax in a patient with paraquat poisoning is a less unusual but underdiagnosed finding. It has a high index of early mortality. Case history: The patient's attendant complained about nausea followed by vomiting, which was nonprojectile & contains undigested food materials first, then gastric juice later. After a few hours, she also complains of urinary retention. Her family members treated her with some home remedies for her initial symptoms, but all attempts failed. After admission, the patient was initially asymptomatic. Through repeated history taking, her attendant showed a bottle of OPC in liquid form, which they suspected that she may have ingested some of the liquid from that bottle accidentally or attempted Suicide. So, management started for OPC poisoning. She responded well initially, but on 4th day of admission, the patient's condition became deteriorating. After the workout with the family member, 2nd bottle of Pesticide was discovered, which was Paraquat. Conclusion: Physicians should be aware of the symptoms of mixed poisoning and the timely use of urine dithionate testing for early detection and treatment. Pneumothorax is an early predictor of mortality in patients with paraquat poisoning.

Keywords: pneumothorax, suicide, dithionate, OPC, herbicide

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Authors: Chaliya Wamaloon, Malee Chaisaena, Nusara Prasertsri

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Informal caregivers providing home-based palliative and end-of-life (EOL) care to people with advanced cancer is needed, however, there has not been develop caregiver skills for the EOL in cancer patients. The aim of this research was to study the model development of caregiver skills for the EOL in cancer patients. Mixed methods research was conducted in 3 phases. All subjects were in Ubon Rathchathani Cancer Hospital including 30 EOL cancer patient caregivers, 30 EOL cancer patients, and 111 health care professionals who provided care for the EOL cancer patients and 30 EOL target participants who had been trained to be cancer patient caregivers. The research tools were questionnaires, semi structured interviews, and caregiver skills questionnaires. Data were analyzed by using percentage, mean, standard deviation, pair t-test, and content analysis. The result from this study showed the model development of caregiver skills for cancer patients consisted of 9 domains skills: 1. monitoring, 2. interpreting, 3. making decisions, 4. taking action, 5. making adjustments, 6. providing hands-on care, 7. accessing resources, 8. working together with the ill patients, and 9. navigating the healthcare system. The model composed of skills development curriculum for cancer patient caregivers, Manual of palliative care for caregivers, diary of health care records for cancer patients, and the evaluation model of development of caregiver skills for EOL cancer patients. The results of the evaluation in the development model of caregiver skills for EOL cancer patients showed that the caregivers were satisfied with the model of development for caregiver skills at a high level. The comparison of the caregiver skills before and after obtaining the development of caregivers skills revealed that it improved at a statistically significant level (p < 0.05).

Keywords: caregiver, caregiver skills, cancer patients, end of life

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Authors: Matthew Heidman, Susan Dallabrida, Analice Costa

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For infant caregivers, choosing an infant formula for their child can be a difficult task in an already stressful environment of caring for a newborn. There exist several channels that influence purchasing decision of infant formula such as, friends and family and their experiences, health care professionals, social media influencers, as well as standard media marketing. This study sought to identify the key channels by which caregivers obtain information regarding infant formula and help them make their purchasing decision. A digital survey was issued for 90 days in the US (n=121) and 30 days in Mexico (n=88) targeting respondents with children ≤4 years of age. Respondents were asked two key questions regarding the influences on their purchasing decisions: 1) “When choosing a formula brand, what do you do to help you make your decision?”, and 2) “When choosing a formula brand, what is most important to you?”. A list of potential answers was provided for each question and respondents were asked to select all that apply to them. Lastly, respondents were provided a 5-point Likert scale and asked to respond to the statement 3) “I am more likely to buy a particular formula brand if my pediatrician recommends it to me”. For question 1, in the US and Mexico, 76% and 95% of respondents respectively, selected “I ask my pediatrician” which represented the top selection. For question 2, 52% and 45% of respondents respectively, selected “On package “Pediatrician Recommended” claim…” which also represented the top selection. For statement 3, 82% and 89% of respondents respectively, stated that they either “somewhat agree” or “strongly agree” with the statement. For infant caregivers, the pediatrician is a very important channel of influence when it comes to purchasing decision of infant formula. Caregivers clearly see the pediatrician as the arbiter of their child’s nutrition and seek their recommendations for infant formula use. For infant formula manufacturers, it is important that they see the pediatrician as the gatekeeper to this market, and they put resources into medical marketing communication to this health care professional group to ensure success.

Keywords: infant formula, pediatrician, purchasing driver, caregiver

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Authors: Jeongyeob Hong, Myeonghoon Park, Taeson Yoon

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After the advent of Achaeans which utilize different metabolism pathway and contain conspicuously different cellular structure, they have been recognized as possible materials for developing quality of human beings. Among diverse Achaeans, in this paper, we compared 16s RNA Sequences of four different species of Thermococcus: Achaeans genus specialized in sulfur-dealing metabolism. Four Species, Barophilus, Kodakarensis, Hydrothermalis, and Onnurineus, live near the hydrothermal vent that emits extreme amount of sulfur and heat. By comparing ribosomal sequences of aforementioned four species, we found similarities in their sequences and expressed protein, enabling us to expect that certain ribosomal sequence or proteins are vital for their survival. Apriori algorithms and Decision Tree were used. for comparison.

Keywords: Achaeans, Thermococcus, apriori algorithm, decision tree

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Authors: Carolinda Douglass

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Institutional Effectiveness (IE) is the purposeful integration of functions that foster student success and support institutional performance. IE is growing rapidly within higher education as it is increasingly viewed by higher education administrators as a beneficial approach for promoting data-informed decision-making in campus-wide strategic planning and execution of strategic initiatives. Specific IE tools, including, but not limited to, project management; impactful collaboration and communication; commitment to continuous quality improvement; and accountability through rigorous evaluation; are gaining momentum under the auspices of IE. This research utilizes a case study approach to examine the use of these IE tools, highlight successes of this use, and identify areas for improvement in the implementation of IE tools within higher education. The research includes three case studies: (1) improving upon academic program review processes including the assessment of student learning outcomes as a core component of program quality; (2) revising an institutional vision, mission, and core values; and (3) successfully navigating an institution-wide re-accreditation process. Several methods of data collection are embedded within the case studies, including surveys, focus groups, interviews, and document analyses. Subjects of these methods include higher education administrators, faculty, and staff. Key findings from the research include areas of success and areas for improvement in the use of IE tools associated with specific case studies as well as aggregated results across case studies. For example, the use of case management proved useful in all of the case studies, while rigorous evaluation did not uniformly provide the value-added that was expected by higher education decision-makers. The use of multiple IE tools was shown to be consistently useful in decision-making when applied with appropriate awareness of and sensitivity to core institutional culture (for example, institutional mission, local environments and communities, disciplinary distinctions, and labor relations). As IE gains a stronger foothold in higher education, leaders in higher education can make judicious use of IE tools to promote better decision-making and secure improved outcomes of strategic planning and the execution of strategic initiatives.

Keywords: accreditation, data-informed decision-making, higher education management, institutional effectiveness tools, institutional mission, program review, strategic planning

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Authors: Mohammad H. Yarmohammadian, Masoud Ferdosi, Abbas Haghshenas, Fatemeh Rezaei

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Surgical procedures aim at preserving human life and improving quality of their life. However, there are many potential risk sources that can cause serious harm to patients. For centuries, managers believed that technical competence of a surgeon is the only key to a successful surgery. But over the past decade, risks are considered in terms of process-based safety procedures, teamwork and inter departmental communication. Aims: This study aims to determine how the process- biased surgical risk management should be done in terms of project management tool named ABS (Activity Breakdown Structure). Settings and Design: This study was conducted in two stages. First, literature review and meeting with professors was done to determine principles and framework of surgical risk management. Next, responsible teams for surgical patient journey were involved in following meeting to develop the process- biased surgical risk management. Methods and Material: This study is a qualitative research in which focus groups with the inductive approach is used. Sampling was performed to achieve representativeness through intensity sampling biased on experience and seniority. Analysis Method used: context analysis of interviews and consensus themes extracted from FDG meetings discussion was the analysis tool. Results: we developed the patient journey process in 5 main phases, 24 activities and 108 tasks. Then, responsible teams, transposition and allocated places for performing determined. Some activities and tasks themes were repeated in each phases like patient identification and records review because of their importance. Conclusions: Risk management of surgical departments is significant as this facility is the hospital’s largest cost and revenue center. Good communication between surgical team and other clinical teams outside surgery department through process- biased perspective could improve safety of patient under this procedure.

Keywords: risk management, activity breakdown structure (ABS), surgical department, medical sciences

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Authors: Butta Singh

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This paper presents a chaotic map based approach for secured embedding of patient’s confidential data in electrocardiogram (ECG) signal. The chaotic map generates predefined locations through the use of selective control parameters. The sample value difference method effectually hides the confidential data in ECG sample pairs at these predefined locations. Evaluation of proposed method on all 48 records of MIT-BIH arrhythmia ECG database demonstrates that the embedding does not alter the diagnostic features of cover ECG. The secret data imperceptibility in stego-ECG is evident through various statistical and clinical performance measures. Statistical metrics comprise of Percentage Root Mean Square Difference (PRD) and Peak Signal to Noise Ratio (PSNR). Further, a comparative analysis between proposed method and existing approaches was also performed. The results clearly demonstrated the superiority of proposed method.

Keywords: chaotic maps, ECG steganography, data embedding, electrocardiogram

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Authors: Tippawan Nasawan

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The objective of this study is to find the replenishment policy in Assembly-to-Order manufacturing (ATO) which some of the major components have lead-time longer than customer lead-time. The variety of products, independent component demand, and long component lead-time are the difficulty that has resulted in the overstock problem. In addition, the ordering cost is trivial when compared to the cost of material of the major component. A conceptual design of the Decision Supporting System (DSS) has introduced to assist the replenishment policy. Component replenishment by using the variable which calls Available to Promise (ATP) for making the decision is one of the keys. The Poisson distribution is adopted to realize demand patterns in order to calculate Safety Stock (SS) at the specified Customer Service Level (CSL). When distribution cannot identify, nonparametric will be applied instead. The test result after comparing the ending inventory between the new policy and the old policy, the overstock has significantly reduced by 46.9 percent or about 469,891.51 US-Dollars for the cost of the major component (material cost only). Besides, the number of the major component inventory is also reduced by about 41 percent which helps to mitigate the chance of damage and keeping stock.

Keywords: Assembly-to-Order, Decision Supporting System, Component replenishment , Poisson distribution

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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Background: NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studiesare shortcoming on individual patient experience. The aim of this study was to assess the patient’ssatisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. Methods: For all patients managed with woodcast in our unit, we undertook a structured questionnairethat included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score, and the pain numerical score at the time of injury and six weeks after. Results: 30 patients were initially managed with woodcast.80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. Conclusion: For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Pariscasting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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