Search results for: general hospital

Authors: Masih Nikgou

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ICU nurses or intensive care nurses are highly specialized and trained healthcare personnel. These nurses provide nursing care for patients with life-threatening illnesses or conditions. They provide the experience, knowledge and specialized skills that patients need to survive and recover. Intensive care nurses (ICU) are trained to make momentary decisions and act quickly when the patient's condition changes. Their primary work environment is in the hospital in intensive care units. Typically, ICU patients require a high level of care. ICU nurses work in challenging and complex fields in their nursing profession. They have the primary duty of caring for and saving patients who are fighting for their lives. Intensive care (ICU) nurses are highly trained to provide exceptional care to patients who depend on 24/7 nursing care. A patient in the ICU is often equipped with a ventilator, intubated and connected to several life support machines and medical equipment. Intensive Care Nurses (ICU) have full expertise in considering all aspects of bringing back their patients. Some of the specific responsibilities of ICU nurses include (a) Assessing and monitoring the patient's progress and identifying any sudden changes in the patient's medical condition. (b) Administration of drugs intravenously by injection or through gastric tubes. (c) Provide regular updates on patient progress to physicians, patients, and their families. (d) According to the clinical condition of the patient, perform the approved diagnostic or treatment methods. (e) In case of a health emergency, informing the relevant doctors. (f) To determine the need for emergency interventions, evaluate laboratory data and vital signs of patients. (g) Caring for patient needs during recovery in the ICU. (h) ICU nurses often provide emotional support to patients and their families. (i) Regulating and monitoring medical equipment and devices such as medical ventilators, oxygen delivery devices, transducers, and pressure lines. (j) Assessment of pain level and sedation needs of patients. (k) Maintaining patient reports and records. As the name suggests, critical care nurses work primarily in ICU health care units. ICUs are completely healthy and have proper lighting with strict adherence to health and safety from medical centers. ICU nurses usually move between the intensive care unit, the emergency department, the operating room, and other special departments of the hospital. ICU nurses usually follow a standard shift schedule that includes morning, afternoon, and night schedules. There are also other relocation programs depending on the hospital and region. Nurses who are passionate about data and managing a patient's condition and outcomes typically do well as ICU nurses. An inquisitive mind and attention to processes are equally important. ICU nurses are completely compassionate and are not afraid to advocate for their patients and family members. who are distressed.

Keywords: nursing, intensive care unit, pediatric intensive care unit, mobile intensive care unit, surgical intensive care unite

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Authors: O. Elkana, O Heyman, S. Hamdan, M. Franko, J. Vatine

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Objective: To investigate whether a direct link exists between perceived pain (PP) and executive functions (EF), above and beyond the influence of depression symptoms, in the context of medical rehabilitation. Design: Cross-sectional study. Setting: Rehabilitation Hospital. Participants: 125 medical records of hospitalized patients were screened for matching to our inclusion criteria. Only 60 patients were found fit and were asked to participate. 19 decline to participate on personal basis. The 41 neurologically intact patients (mean age 46, SD 14.96) that participated in this study were in their sub-acute stage of recovery, with fluent Hebrew, with intact upper limb (to neutralize influence on psychomotor performances) and without an organic brain damage. Main Outcome Measures: EF were assessed using the Wisconsin Card Sorting Test (WCST) and the Stop-Signal Test (SST). PP was measured using 3 well-known pain questionnaires: Pain Disability Index (PDI), The Short-Form McGill Questionnaire (SF-MPQ) and the Pain Catastrophizing Scale (PCS). Perceived pain index (PPI) was calculated by the mean score composite from the 3 pain questionnaires. Depression symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Results: The results indicate that irrespective of the presence of depression symptoms, PP is directly correlated with response inhibition (SST partial correlation: r=0.5; p=0.001) and mental flexibility (WSCT partial correlation: r=-0.37; p=0.021), suggesting decreased performance in EF as PP severity increases. High correlations were found between the 3 pain measurements: SF-MPQ with PDI (r=0.62, p<0.001), SF-MPQ with PCS (r=0.58, p<0.001) and PDI with PCS (r=0.38, p=0.016) and each questionnaire alone was also significantly associated with EF; thus, no specific questionnaires ‘pulled’ the results obtained by the general index (PPI). Conclusion: Examining the direct association between PP and EF, beyond the contribution of depression symptoms, provides further clinical evidence suggesting that EF and PP share underlying mediating neuronal mechanisms. Clinically, the importance of assessing patients' EF abilities as well as PP severity during rehabilitation is underscored.

Keywords: depression, executive functions, mental-flexibility, neuropsychology, pain perception, perceived pain, response inhibition

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Authors: Mohammad Mohammadi, Mohammad Pashmchi

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Background: Malnutrition commonly develops and worsens following gastric cancer surgery, particularly after discharge, which is associated with adverse outcomes. Former studies have primarily focused on patients during their hospital stay period, and there is limited evidence regarding the recommendation of nutritional interventions for patients after discharge from the hospital following gastric cancer surgery. This review is aimed to evaluate the efficiency of post-discharge dietary counseling with oral nutritional supplements (ONS), and dietary counseling alone on post-surgical nutritional outcomes in patients undergoing gastric cancer surgery. Methods: The four databases of Embase, PubMed, web of science, and google scholar were searched up to November 2022 for relevant randomized controlled trials. The Cochrane Collaboration’s assessment tool for randomized trials was used to evaluate the quality of studies. Results: Compared to patients who only received dietary counseling, patients who received both dietary counseling and ONS had considerably higher SMI, BMI, and less weight loss and sarcopenia occurrence rate. The patients who had received dietary counseling and ONS had significantly lower risk of chemotherapy intolerance. No differences in the readmission rate between the two groups was found. In terms of the quality of life, concomitant dietary advice and ONS significantly was associated with lower appetite loss and fatigue rate, but there was no difference in the other outcomes between the two groups. Conclusions: Post-discharge dietary advice with ONS following gastric cancer surgery may improve skeletal muscle maintenance, nutritional outcomes, quality of life variables, and chemotherapy tolerance. This evidence supports the recommendation of post-discharge dietary advice with ONS for patients who underwent gastric cancer surgery.

Keywords: gastric cancer surgery, oral nutritional supplements, malnutrition, gastric cancer

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Authors: Muhammad Jum’at Dasuki

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This study investigates the ethical implications of post-fuel subsidy removal support initiatives in Kwara State, Nigeria, with a focus on the application of Islamic principles. The contentious issue of subsidy removal carries significant social and economic consequences, emphasizing the crucial role of ethical considerations in policy implementation. The research provides a comprehensive background on fuel subsidy removal in Nigeria and its implications. Examining post-fuel subsidy removal palliative measures in Kwara State, the study focuses on design and implementation challenges, ethical considerations, transparency, equity, and public trust. Utilizing a case study approach offers insights and best practices. The methodology includes primary sources through in-depth oral interviews and secondary sources like textbooks and journals, aiming for a holistic understanding of the ethical dimensions of support initiatives within the context of Islamic principles in Kwara State. The objective is to contribute to policy decisions and community development. The study recommends an ethically sound implementation of post-fuel subsidy removal support initiatives, emphasizing transparency, accountability, and inclusivity. It advocates for the inclusiveness of governmental palliatives, reaching both civil servants and common individuals in the state. Continuous distribution during fuel subsidy removal challenges is deemed vital. Additionally, extending free or subsidized transportation beyond higher institutions to the general populace is suggested. Consideration should also be given to reducing governmental hospital bills or providing free health services. The study underscores the importance of Islamic ethics in Nigerian governance and employs a case study approach to assess palliative measures in Kwara State, offering practical insights for policymakers and stakeholders.

Keywords: considerations, ethical, palliative, post-fuel subsidy removal

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Authors: Adedolapo Ayoade, John the Beloved Dada

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This study identified the phytoplankton assemblage of the Dandaru Lake (that received effluents from a zoological garden and hospital) as bioindicators of water quality. Physicochemical parameters including Dissolved Oxygen (DO), biochemical oxygen demand, nitrate, phosphate and heavy metals were also determined. Samples of water and plankton were collected once monthly from April to September, 2015 at five stations (I – V). The mean physicochemical parameters were within the limits of National Environmental Standards and Regulations Enforcement Agency (NESREA) and USEPA except Lead, 0.02 ± 0.08 mg/ L; Manganese, 0.46 ± 1.00 mg/ L and Zinc, 0.05 ± 0.17 mg/ L. Means of DO, alkalinity, and phosphate were significantly different between the stations at p < 0.05. While highest mean DO (6.88 ± 1.34 mg/L) was recorded in station I with less anthropogenic activities, highest phosphate concentration (0.28 ± 0.28 mg/L) occurred in station II, the entry point of wastewater from hospital and zoological garden. The 147 phytoplankton species found in the lake belonged to six classes: Chlorophyceae (50), Euglenophyceae (40), Bacillariophyceae (37), Cyanophyceae (17), Xanthophyceae and Chrysophyceae (3). The order of abundance for phytoplankton was Euglenophyceae (49.77%) > Bacillariophyceae (18.00%) > Cyanophyceae (17.39%) > Chlorophyceae (13.7%) > Xanthophyceae (1.06%) > Chrysophyceae (0.02%). The stations impacted with effluents were dominated by members of Euglenophyceae (Station III, 77.09%; IV, 50.55%) and Cyanophyceae (Station II, 27.7%; V, 32.57%). While station I was dominated by diatoms (57.98%). The species richness recorded was 0.32 – 4.49. Evenness index was highest in station I and least in station III. Generally, pollution tolerant species (Microcystis, Oscillatoria, Scenedesmus, Anabaena, and Euglena) showed greater density in areas impacted by human activities. The phytoplankton assemblage and comparatively low biotic diversity in Dandaru Lake could be attributed to perturbations in the water column that exerted selective effects on the biological assemblage.

Keywords: manmade lake, Nigeria, phytoplankton, water quality

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Authors: Pooja Mishra, Chris Pollett

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This paper explores efficient ways to implement various media-updating features like news aggregation, video conversion, and bulk email handling. All of these jobs share the property that they are periodic in nature, and they all benefit from being handled in a distributed fashion. The data for these jobs also often comes from a social or collaborative source. We isolate the class of periodic, one round map reduce jobs as a useful setting to describe and handle media updating tasks. As such tasks are simpler than general map reduce jobs, programming them in a general map reduce platform could easily become tedious. This paper presents a MediaUpdater module of the Yioop Open Source Search Engine Web Portal designed to handle such jobs via an extension of a PHP class. We describe how to implement various media-updating tasks in our system as well as experiments carried out using these implementations on an Amazon Web Services cluster.

Keywords: distributed jobs framework, news aggregation, video conversion, email

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Authors: Adam Abate, Elham Rasti, Philip Romero

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Beta-glucosidase is the key enzyme component present in cellulase and completes the final step during cellulose hydrolysis by converting the cellobiose to glucose. The regulatory properties of beta-glucosidases are most commonly found for the retaining and inverting enzymes. Hydrolysis of a glycoside typically occurs with general acid and general base assistance from two amino acid side chains, normally glutamic or aspartic acids. In order to obtain more detailed information on the dynamic events origination from the interaction with enzyme active site, we carried out molecular dynamics simulations of beta-glycosidase in protonated state (Glu-H178) and deprotonated state (Glu178). The theoretical models generated from our molecular dynamics simulations complement and advance the structural information currently available, leading to a more detailed understanding of Beta-glycosidase structure and function. This article presents the important role of Asn307 in enzyme activity of beta-glucosidase

Keywords: Beta-glucosidase, GROMACS, molecular dynamics simulation, structural parameters

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Authors: Mehak Nagpal, T. S. Sathyanarayan Rao

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Background: Sexual functioning is a neglected aspect of health in women with diabetes, though it contributes greatly towards quality of life and feeling of wellbeing. Also women with DM are at higher risk than men of developing sexual dysfunction and depression. Materials and Methods: Cross-sectional comparison study. Sample size: 100 previously diagnosed type 2DM patients attending Outpatient Diabetic Clinic at Medicine department JSS Hospital Mysore; aged 20-65 years and 60 normal healthy female subjects for Control group. Data was collected with ethical approval over a period of 2 years. Tools Used: 1) Hamilton Depression Rating Scale (HAMD – 17 item) 2) Female Sexual Functioning Index (FSFI) 3) Arizona Sexual Experience Scale (ASEX-F) for female-for screening. 4) The Appraisal of Diabetes Scale (ADS). Results: Statistically significant differences were observed in prevalence rate and severity of depression between diabetic group (45% vs 11% syndromal depression) and controls. Depression scores correlated significantly with glycaemic control, adherence to treatment, BMI and the cognitive appraisal of diabetes. There was significantly greater impairment in the sexual functioning of women with type 2 diabetes mellitus as compared to controls; both prevalence (62% vs 38.3%) and severity (p value < 0.01). Arousal (74.2% vs 53.3%), Desire (76.3% vs 50%) and Satisfaction (76.7% vs 63.7%) were most affected and 64.5% were affected in 2 or more domains. A negative illness appraisal on ADS correlated significantly with poor glycaemic control, higher rates of depression and also more severe female sexual dysfunction (p value < 0.05). Conclusion: Diabetes specific factors that correlated significantly with FSD in this study included the psychological appraisal of diabetes, duration of diabetes, presence of complications and BMI.

Keywords: depression, female sexual dysfunction, India, type 2 diabetes mellitus

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Authors: Abdurrauf M. Gusbi, Mahmud H. Arhima, Abdurrahim A. Elouzi, Ebtisam A. Benomran, Salsabeela Elmezwghi, Aram Elhatan, Nafesa Elgusbi

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Mass poisonings with methanol are rare but occur regularly both in developed and in non-developing countries. As a result of the tragedy that happened in the city of Tripoli Libya in March during year 2013 a number of patients were admitted to Tripoli Medical Center and Tripoli Central Hospital suffering from poisoning following ingestion of methanol by mistake. Our aims have been formulated to collect Information about those cases as much as we can from the archiving departments from the two hospitals including the number of cases that had been admitted, recovered patients and died victims. This retrospective study was planned to find out the reasons which allow those patients to drink methanol in our Muslim community and also the role of pharmacist to prevent such a disaster that claimed the lives of many people. During this tragedy 291 ospitalized patients their ages between 16-32 years old were admitted to both hospitals, total number of died 189 (121 at Tripoli medical center) and (68 at Tripoli central hospital), demographic data also shows that most of them are male (97%) and (3% female), about 4% of the patients foreigners and 96% were Libyans. There were a lot of obstacles and poor facilities at the time of patient admission as recognized in many cases including lack of first line of treatment. The morbidity was high due to the lack of antidote and availability of dialysis machines at this two main hospitals in Tripoli also according to survey done to the medical staff and also a random number of medical students shows about 28% have no idea about the first aid procedure used for methanol poisoning cases and this due to the absence of continuing education for all medical staff through the establishment of training courses on first aid, rapid diagnosis of poisoning and follow the written procedures to dealing with such cases.

Keywords: ethanol, fomepizole, methanol, poisoning

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Authors: Narottam Puri, Gurvinder Kaur

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Background: The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is India’s apex standard setting accrediting body in health care which evaluates and accredits healthcare organizations. NABH requires accredited organizations to become reaccredited every three years. It is often though that once the initial accreditation is complete, the foundation is set and reaccreditation is a much simpler process. Fortis Hospital, Shalimar Bagh, a part of the Fortis Healthcare group is a 262 bed, multi-specialty tertiary care hospital. The hospital was successfully accredited in the year 2012. On completion of its first cycle, the hospital underwent a reaccreditation assessment in the year 2015. This paper aims to gain a better understanding of the challenges that accredited hospitals face when preparing for a renewal of their accreditations. Methods: The study was conducted using a cross-sectional mixed methods approach; semi-structured interviews were conducted with senior leadership team and staff members including doctors and nurses. Documents collated by the QA team while preparing for the re-assessment like the data on quality indicators: the method of collection, analysis, trending, continual incremental improvements made over time, minutes of the meetings, amendments made to the existing policies and new policies drafted was reviewed to understand the challenges. Results: The senior leadership had a concern about the cost of accreditation and its impact on the quality of health care services considering the staff effort and time consumed it. The management was however in favor of continuing with the accreditation since it offered competitive advantage, strengthened community confidence besides better pay rates from the payors. The clinicians regarded it as an increased non-clinical workload. Doctors felt accountable within a professional framework, to themselves, the patient and family, their peers and to their profession; but not to accreditation bodies and raised concerns on how the quality indicators were measured. The departmental leaders had a positive perception of accreditation. They agreed that it ensured high standards of care and improved management of their functional areas. However, they were reluctant in sparing people for the QA activities due to staffing issues. With staff turnover, a lot of work was lost as sticky knowledge and had to be redone. Listing the continual quality improvement initiatives over the last 3 years was a challenge in itself. Conclusion: The success of any quality assurance reaccreditation program depends almost entirely on the commitment and interest of the administrators, nurses, paramedical staff, and clinicians. The leader of the Quality Movement is critical in propelling and building momentum. Leaders need to recognize skepticism and resistance and consider ways in which staff can become positively engaged. Involvement of all the functional owners is the start point towards building ownership and accountability for standards compliance. Creativity plays a very valuable role. Communication by Mail Series, WhatsApp groups, Quizzes, Events, and any and every form helps. Leaders must be able to generate interest and commitment without burdening clinical and administrative staff with an activity they neither understand nor believe in.

Keywords: NABH, reaccreditation, quality assurance, quality indicators

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Authors: Hitesh Gupta, Surender Dabas

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TORS is increasingly gaining widespread use and has been explored as minimally invasive surgery for the treatment of supraglottic cancer (SGC). Being a central critical role of Supraglottis in deglutition, swallowing outcomes post TORS remain a most important factor. Available published studies show inconsistent swallowing outcomes and are deficient in standardized outcome measures, description of swallowing recovery and rehabilitation. So, the objective of this study is to find out swallowing outcomes in SGC patients after TORS provided with early dysphagia management using standardized measures. Prospectively 16 patients were recruited in the study who underwent TORS for primary tumor of Supraglottis, involving one or more sub-sites or invading to sites other than Supraglottis at the BLK Super Specialty Hospital, New Delhi from March 2019 to June 2020. All patients were evaluated for dysphagia with subsequent swallowing rehabilitation on post operative day 3 in the hospital or at the time of discharge, whichever was earlier. Functional oral intake scale (FOIS) and penetration-aspiration score (PAS) were used as outcome measures to quantify swallowing recovery at one month and six month post operatively. Post TORS, patients achieved functional swallow in less than one month, where resection was limited to Supraglottis, while the recovery was delayed in patients with extended resection to tongue base or hypopharynx. Overall, out of Total 16 cases including all supraglottis sub-catagories, 13 (81%) could remove their NG tube (FOIS ≥5 and PAS=1 ) within 6 months. In which 8 cases(62%) achieved functional swallow in less than one month. Swallowing outcomes post TORS supraglottic laryngectomy are favorable if provided with early dysphagia management (or swallowing rehabilitation).

Keywords: dysphagia, supraglottic cancer, swallowing, TORS

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Authors: Derek Brandon G. Yu, Clyde Vincent O. Pilapil, Christine F. Peña

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College students of Cebu province have been indoors since March 2020, and a challenge encountered is the sudden shift from face to face to online learning and with the lack of empirical data on online learning on Higher Education Institutions (HEIs) in the Philippines. Sentiments on face to face and online learning will be collected from University of San Carlos (USC), School of Arts and Sciences (SAS) students regarding Mathematics in the Modern World (MMW), a General Education (GE) course. Natural Language Processing with machine learning algorithms will be used to classify the sentiments of the students. Results of the research study are the themes identified through topic modelling and the overall sentiments of the students in USC SAS

Keywords: natural language processing, online learning, sentiment analysis, topic modelling

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour, Parisa Hasankhani Tehrani

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Background And Objective: Haematopoietic stem cell transplant is a potentially curative treatment option in various benign and malignant haematological diseases. Patients undergoing stem cell transplant procedure require blood transfusion on a daily basis. Currently, there is paucity of data from developing countries on transfusion practices. This audit was undertaken to determine the consumption of packed red blood cells (PRBCs) transfusion in the bone marrow transplant unit of the Shahid Ghazi Tabatabaei Hospital, Tabriz, Iran. Subjects And Methods: A retrospective audit was conducted for packed red cell transfusion ordering practice over a period from March 2017 to march 2018. All consecutive patients admitted for stem cell transplant procedure for various underlying diseases were included. Outcome measures used in this study were (i) cross match to transfusion (C: T) ratio and (ii) transfusion trigger. Results: During the study period, n=13 patients underwent a haematopoietic stem cell transplant. There were n=10 males and n=3 females. One patient was less than 15 years of age, while rests were adults. Median age±SD was 26.5±14.5 years (12∼54 years). The underlying diagnosis included Aplastic anemia (n=4), Thalassemia major (n=1), Multiple Myeloma (n=3), Acute leukemia (n=3), Hodgkin's lymphoma (n=1), PRCA (n=1). Grand total consumption of PRBCs during the study period was 204, while 258 products were crossmatch. The C:T ratio was 1.26. The transfusion trigger was Hb level of less than 8 gr/dl. Conclusion: The results of our BMT unit indicate that the C:T ratio and transfusion trigger is comparable to the international criteria and pioneer country in BMT transplantation. Also, we hope that our blood consumption become less than it is now.

Keywords: blood consumption, C: T ratio, PRBCs, stem cell transplant, tabriz, Iran

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Authors: Lemi Tolu

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Background: Postpartum family planning (PPFP) focuses on the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth. Objective: This study assesses the barriers to uptake of long-term and permanent family planning methods among immediate post-partum mothers at Saint Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. Methodology: An institution-based cross-sectional study was conducted from January 1 to June 30, 2017. The six months of study were used as strata, and systematic sampling used to select participants in each month. Post-partum mothers were interviewed using pretested structured questionnaires. Data entry and analysis were done using SPSS version 17. Bivariate and multivariable logistic regressions were fitted to identify determinants of post-partum family planning uptake. An OR with 95% CIs was calculated, and p values set at 005 were used to determine the statistical significance of associations. Results: Four hundred and twenty-two post-partum women were interviewed. Two hundred sixty-eight (63%) women received counselling on family planning, and 241 (66.8 %) got information about contraception. One hundred and fifty-two (45%) of the women accepted long-term and permanent contraception on their immediate postpartum period before discharge. Contraceptive counselling (OR = 2.13, 95% CI 1.004-3.331), getting information from the health facility (OR = 15.15, 95% CI 1.848-19.242), and partner support (OR = 1.367, 95% CI 1.175-2.771) were significantly associated with long-term and permanent contraception uptake. Conclusion: Postpartum counselling on family planning and provision of contraception information improve immediate postpartum FP acceptance, and, hence postpartum programs need to strengthen such services.

Keywords: contraception, immediate postpartum, long-term family planning, post-partum family planning

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Authors: Manal Ahmed, Amal Shehata, Shereen Deeb

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The study's purpose was to determine the effect of the perioperative protocol of care on clinical outcomes among patients undergoing coronary artery bypass graft. Subjects: A sample of 100 adult patients who were planned for coronary artery bypass graft, were selected and divided alternatively and randomly into two equal groups (50 study -50 control).The study was carried out at National heart Institute in Cairo and open heart surgical intensive care unit in Shebin El-Kom Teaching Hospital. Instruments: Four instruments were used for data collection: Interviewing questionnaire, dyspnea analogue scale, Biophysiological measurement instrument, and Compliance assessment sheet. Results: There were statistically significant differences between both groups regarding most respiratory system assessment findings at discharge. More than two-thirds of the study group of the current study had a continuous and regular commitment to diet regimen, which ranked first followed by the compliance of daily living activities then quitting smoking. Conclusions: The perioperative protocol of care has a significant improving effect on respiratory findings, dyspnea degree, duration of mechanical ventilation, length of hospital stay, compliance to diet, therapeutic regimen, daily living activities, and quit smoking among study group undergoing CABG. Recommendations: Perioperative protocol of care should be carried out for CABG patients at open-heart surgical units as well as an illustrative colored booklet about CAD, CABG and perioperative care should be available and distributed to all CABG patients.

Keywords: perioperative, effect, clinical outcomes, coronary artery, bypass graft, protocol of care

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Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria

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Information technology has long served the needs of individuals for learning and entertainment, but much less for children in sickness. The aim of the proposed online video game is to provide immersive learning opportunities as well as essential social and emotional scenarios for hospital-bound children with long-term illness. Online self-paced courses on chosen school subjects, including specialised software and multisensory assessments, aim at enhancing children’s academic achievement and sense of inclusion, while doctor minigames familiarise and educate young patients on their medical conditions. Online ethical dilemmas will offer children opportunities to contemplate on the importance of medical procedures and following assigned medication, often challenging for young patients; they will therefore reflect on their condition, reevaluate their perceptions about hospitalisation, and assume greater personal responsibility for their progress. Children’s emotional and psychosocial needs are addressed by engaging in social conventions, such as interactive, daily, collaborative mini games with other hospitalised peers, like virtual competitive sports games, weekly group psychodrama sessions, and online birthday parties or sleepovers. Social bonding is also fostered by having a virtual pet to interact with and take care of, as well as a virtual nurse to discuss and reflect on the mood of the day, engage in constructive dialogue and perspective taking, and offer reminders. Access to the platform will be available throughout the day depending on the patient’s health status. The program is designed to minimise escapism and feelings of exclusion, and can flexibly be adapted to offer post-treatment and a support online system at home.

Keywords: long-term illness, children, hospital, interactive games, cognitive, socioemotional development

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Authors: Gwo-Hwa Wan, Tai-Ho Hung, Fen-Fang Chung, Wan-Ying Lee, Hui-Ching Yang

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Air pollutant exposure results in elevated concentrations of oxidative stress and inflammatory biomarkers in general populations. Increased concentrations of inflammatory biomarkers in pregnant women would be associated with preterm labor and low birth weight. To our best knowledge, the associations between air pollutants exposure and inflammation in pregnant women and fetuses are unknown, as well as their effects on fetal growth. This study aimed to evaluate the influences of outdoor air pollutants in northern Taiwan areas on the inflammatory biomarker (high sensitivity C-reactive protein, hs-CRP) concentration in the blood of healthy pregnant women and how the biomarker impacts fetal growth. In this study, 38 healthy pregnant women who are in their first trimester and live in northern Taiwan area were recruited from the Taipei Chang Gung Memorial Hospital. Personal characteristics and prenatal examination data (e.g., blood pressure) were obtained from recruited subjects. The concentrations of inflammatory mediators, hs-CRP, in the blood of healthy pregnant women were analyzed. Additionally, hourly data of air pollutants (PM10, SO2, NO2, O3, CO) concentrations were obtained from air quality monitoring stations in Taipei area, established by the Taiwan Environmental Protection Administration. The definition of lag 0 and lag 01 are the exposure to air pollutants on the day of blood withdrawal, and the average exposure to air pollutants one day before and on the day of blood withdrawal, respectively. The statistical analyses were conducted using SPSS software version 22.0 (SPSS, Inc., Chicago, IL, USA). This analytical result indicates that the healthy pregnant women aged between 28 and 42 years old. The body mass index before pregnancy averaged 21.51 (sd = 2.51) kg/m2. Around 90% of the pregnant women had never smoking habit, and 28.95% of them had allergic diseases. Approximately around 84% and 5.26% of the pregnant women worked at indoor and outdoor environments, respectively. The mean hematocrit level of the pregnant women was 37.10%, and the hemoglobin levels were ranged between 10.1 and 14.7 g/dL with 12.47 g/dL of mean value. The blood hs-CRP concentrations of healthy pregnant women in the first trimester ranged between 0.32 and 32.5 mg/L with 2.83 (sd = 5.69) mg/L of mean value. The blood hs-CRP concentrations were positively associated with ozone concentrations at lag 0-14 (r = 0.481, p = 0.017) in healthy pregnant women. Significant lag effects were identified in ozone at lag 0-14 with a positive excess concentration of blood hs-CRP.

Keywords: air pollutant, hs-CRP, pregnant woman, ozone, first trimester

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Authors: Tahra AlMahmoud, Sameeha Mohamed Al Hadhrami, Mohamed Elhanan, Hanan Naser Alshamsi, Fikri Abu-Zidan

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Background: To the best of the author(s)’ knowledge there are no epidemiological studies for traumatic eye injuries in UAE, neither data on groups at risk or mechanisms for ocular trauma. Purpose: To report the epidemiology of eye injuries that required hospital admission and surgery at a referral center at the eastern part of Abu Dhabi. Method: Retrospective charts review of all patients who had suffered an eye injury that required surgical intervention between 2012 and 2017 at Al Ain Hospital. Demographic data, place of occurrence, the cause of injury, visual acuity (VA) before and after treatment, number of admission days and follow up were extracted. Data were tabulated and presented as number (%), mean (SD), or median (range) as appropriate. Wilcoxon signed rank test was used for VA outcome. Results: One hundred forty-one patients were identified, 96 eyes with open-globe and 48 other types of injuries. The mean age of the patients was 26±15.5 years, and 89% were male. Majority of injuries occurred at the workplace (50.4%) followed by home (31.2%). Trauma with a sharp object (24.1%), blunt object (16.3%), nail (11.3%), and hammer on metal (7.8%) were the most common etiologies of injury. Corneas injuries (48.2%) was the most frequent cause for visual acuity limitation followed by lens/cataract (23.4%). Among the traumatized eyes, 30 eyes (21.3%) retained intraocular foreign body, Mean admission days was 3.16± 2.81days (1-16) and a number of follow up visit was 3.17± 4.11times (0-26). Conclusion: Ocular trauma requiring surgical intervention is an area of concern in particular for occupations involving work with metals. This work may give insight into the value and necessity of implementing preventive measures.

Keywords: epidemiology, Middle Eastern area, occupational injury, ocular traumas

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Authors: Mohamed Abo El Nasr, Mohamed Shoeib, Abdelhamid Abdelkhalik, Amro Serag

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Background: Early assessment of severity of chest trauma, either blunt or penetrating is of critical importance in prediction of patient outcome. Different trauma scoring systems are widely available and are based on anatomical or physiological parameters to expect patient morbidity or mortality. Up till now, there is no ideal, universally accepted trauma score that could be applied in all trauma centers and is suitable for assessment of severity of chest trauma patients. Aim: Our aim was to compare various trauma scoring systems regarding their predictability of morbidity and mortality in chest trauma patients. Patients and Methods: This study was a prospective study including 400 patients with chest trauma who were managed at Tanta University Emergency Hospital, Egypt during a period of 2 years (March 2014 until March 2016). The patients were divided into 2 groups according to the mode of trauma: blunt or penetrating. The collected data included age, sex, hemodynamic status on admission, intrathoracic injuries, and associated extra-thoracic injuries. The patients outcome including mortality, need of thoracotomy, need for ICU admission, need for mechanical ventilation, length of hospital stay and the development of acute respiratory distress syndrome were also recorded. The relevant data were used to calculate the following trauma scores: 1. Anatomical scores including abbreviated injury scale (AIS), Injury severity score (ISS), New injury severity score (NISS) and Chest wall injury scale (CWIS). 2. Physiological scores including revised trauma score (RTS), Acute physiology and chronic health evaluation II (APACHE II) score. 3. Combined score including Trauma and injury severity score (TRISS ) and 4. Chest-Specific score Thoracic trauma severity score (TTSS). All these scores were analyzed statistically to detect their sensitivity, specificity and compared regarding their predictive power of mortality and morbidity in blunt and penetrating chest trauma patients. Results: The incidence of mortality was 3.75% (15/400). Eleven patients (11/230) died in blunt chest trauma group, while (4/170) patients died in penetrating trauma group. The mortality rate increased more than three folds to reach 13% (13/100) in patients with severe chest trauma (ISS of >16). The physiological scores APACHE II and RTS had the highest predictive value for mortality in both blunt and penetrating chest injuries. The physiological score APACHE II followed by the combined score TRISS were more predictive for intensive care admission in penetrating injuries while RTS was more predictive in blunt trauma. Also, RTS had a higher predictive value for expectation of need for mechanical ventilation followed by the combined score TRISS. APACHE II score was more predictive for the need of thoracotomy in penetrating injuries and the Chest-Specific score TTSS was higher in blunt injuries. The anatomical score ISS and TTSS score were more predictive for prolonged hospital stay in penetrating and blunt injuries respectively. Conclusion: Trauma scores including physiological parameters have a higher predictive power for mortality in both blunt and penetrating chest trauma. They are more suitable for assessment of injury severity and prediction of patients outcome.

Keywords: chest trauma, trauma scores, blunt injuries, penetrating injuries

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Authors: Swati Kapoor, Rajeev Upreti, Monica Mahajan, Abhaya Indrayan, Dinesh Srivastava

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Enteric Fever is caused by gram negative bacilli Salmonella typhi and paratyphi. It is associated with high morbidity and mortality worldwide. Timely initiation of treatment is a crucial step for prevention of any complications. Cultures of body fluids are diagnostic, but not always conclusive or practically feasible in most centers. Moreover, the results of cultures delay the treatment initiation. Serological tests lack diagnostic value. The blood counts can offer a promising option in diagnosis. A retrospective study to find out the relevance of leucopenia and eosinopenia was conducted on 203 culture proven enteric fever patients and 159 culture proven non-enteric fever patients in a tertiary care hospital in New Delhi. The patient details were retrieved from the electronic medical records section of the hospital. Absolute eosinopenia was considered as absolute eosinophil count (AEC) of less than 40/mm³ (normal level: 40-400/mm³) using LH-750 Beckman Coulter Automated machine. Leucopoenia was defined as total leucocyte count (TLC) of less than 4 X 10⁹/l. Blood cultures were done using BacT/ALERT FA plus automated blood culture system before first antibiotic dose was given. Case and control groups were compared using Pearson Chi square test. It was observed that absolute eosinophil count (AEC) of 0-19/mm³ was a significant finding (p < 0.001) in enteric fever patients, whereas leucopenia was not a significant finding (p=0.096). Using Receiving Operating Characteristic (ROC) curves, it was observed that patients with both AEC < 14/mm³ and TCL < 8 x 10⁹/l had 95.6% chance of being diagnosed as enteric fever and only 4.4% chance of being diagnosed as non-enteric fever. This result was highly significant with p < 0.001. This is a very useful association of AEC and TLC found in enteric fever patients of this study which can be used for the early initiation of treatment in clinically suspected enteric fever patients.

Keywords: absolute eosinopenia, absolute eosinophil count, enteric fever, leucopenia, total leucocyte count

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Authors: Eryati Darwin, Arina Widya Murni, Adnil Edwin Nurdin

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Background: Functional dyspepsia (FD) is a highly prevalent and heterogeneous disorder. Most patients with FD complain of symptoms related to the intake of meals. Psychological stress may promote peptic ulcer and had an effect on ulcers associated Hp, and may also trigger worsen symptoms in inflammatory disorders of the gastrointestinal. Cells in mucosal gastric stimulate the production of several cytokines, which might associated with Helicobacter pylori infection. The cascade of biological events leading to stress-induced FD remains poorly understood. Aim of Study: To determine the prion-flammatory cytokine IL-6, and Helicobacter pylori activity on mucosal gastric of FD and their association with psychological stress. Methods: The subjects of this study were dyspeptic patients who visited M. Djamil General Hospital and in two Community Health Centers in Padang. On the basis of the stress index scale to identify psychological stress by using Depression Anxiety and Stress Scale (DASS 42), subjects were divided into two groups of 20 each, stress groups and non-stress groups. All diagnoses were confirmed by review of cortisol and esophagogastroduodenoscopy reports. Gastric biopsy samples and peripheral blood were taken during diagnostic procedures. Immunohistochemistry methods were used to determine the expression of IL-6 and Hp in gastric mucosal. The data were statistically analyzed by univariate and bivariate analysis. All procedures of this study were approved by Research Ethics Committee of Medical Faculty Andalas University. Results: In this study, we enrolled 40 FD patients (26 woman and 14 men) in range between 35-56 years old. Cortisol level of blood FD patients as parameter of stress hormone which taken in the morning was significantly higher in stress group than non-stress group. The expression of IL-6 in gastric mucosa was significantly higher in stress group in compared to non-stress group (p<0,05). Helicobacter pylori activity in gastric mucosal in stress group were significantly higher than non-stress group. Conclusion: The present study showed that psychological stress can induce gastric mucosal inflammation and increase of Helicobacter pylori activity.

Keywords: functional dyspepsia, Helicobacter pylori, interleukin-6, psychological stress

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Authors: Wahid Ahmad Dar, Irshad Ahmad Najar

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The influence of social media is percolating to every corner of our social life. It is also changing the social sphere of the classroom in particular and education in general. This paper tries to explore the ways in which social media is influencing student-teacher relationship. Differences have been found in student’s ability to draw benefits from using ICT. Besides digital divides in access and usage, there are attitudinal differences among students towards ICT aligned with traditional forms of social differences. The paper particularly focusses on how students from diverse backgrounds are using social media to interact with their teachers and how such interactions differ on the basis of social class, gender and residential background of students. A qualitative research methodology has been used for answering these questions. Open-ended questionnaire has been designed and administered to a sample of postgraduate students from University of Kashmir drawn purposively ensuring optimum number of subjects from all backgrounds. The data were analyzed by content analysis, deciphering general patterns in the data.

Keywords: social media, student-teacher relationship, social class, gender

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Authors: Hefzollah Mohammadian, Ensieh Hajeb, Mohamad Baqer Heidari

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In this paper, for the protection and safety of tanks gases (flammable materials) and also due to the considerable economic value of the reservoir, the new system for the protection, the conservation and fire fighting has been cloned. The system consists of several parts: the Sensors to detect heat and fire with Nanotechnology (nano sensor), Barrier for isolation and protection from a range of two electronic zones, analyzer for detection and locating point of fire accurately, Main electronic board to announce fire, Fault diagnosis in different locations, such as relevant alarms and activate different devices for fire distinguish and announcement. An important feature of this system, high speed and capability of fire detection system in a way that is able to detect the value of the ambient temperature that can be adjusted. Another advantage of this system is autonomous and does not require human operator in place. Using nanotechnology, in addition to speeding up the work, reduces the cost of construction of the sensor and also the notification system and fire extinguish.

Keywords: analyser, barrier, heat resistance, general fault, general alarm, nano sensor

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Authors: M. A. Brown, K. Hugill, D. Meredith

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Since the establishment of midwifery, as a professional identity in its own right, in the early years of the 20th century, midwifery-led models of childbirth have prevailed in many parts of the world. However, in many locations midwives’ scope of practice remains underdeveloped or absent. In Qatar, all births take place in hospital and are under the professional jurisdiction of obstetricians, predominately supported by internationally trained nurse-midwives and obstetric nurses. The strategic vision for health services in Qatar endorsed a desire to provide women with the ‘Best Care Always’ and the introduction of midwifery was seen as a way to achieve this. In 2015 the process of recruiting postgraduate educated Clinical Midwife Specialists from international sources began. The midwives were brought together to initiate an in hospital and community service transformation plan. This plan set out a series of wide-ranging actions to transform maternity and neonatal services to make care safer and give women more health choices. Change in any organization is a complex and dynamic process. This is made even more complex when multifaceted professional and cross cultural factors are involved. This presentation reports upon the motivations and challenges that exist and the progress around introducing a multicultural midwifery model of childbirth care in the state of Qatar. The paper examines and reflects upon the drivers and unique features of childbirth in the country. Despite accomplishments, progress still needs to be made in order to fully implement sustainable changes to further improve care and ensure women and neonates get the ‘Best Care Always’. The progress within the transformation plan highlights how midwifery may coexist with competing models of maternity care to create an innovative, eclectic and culturally sensitive paradigm that can best serve women and neonatal health needs.

Keywords: culture, managing change, midwifery, neonatal, service transformation plan

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Authors: Changaiz Khan

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Pakistan has the highest rates of maternal mortality in South Asia. From the year 2000 to 2017 the global rate of maternal mortality has decreased up to 39 %. In the context of South Asia, it has decreased by 59% since 2000s. Pakistan has also reduced the rate of maternal mortality, but there is a difference on the provincial level. According to the report of the National Institute of Population Studies (NIPS) conducted in 2020, the MMR in Balochistan has crossed the ratio of most of the South Asian countries, i.e., 298 maternal deaths per 100,000 live births. In comparison, the province of Punjab has the lowest maternal mortality rate i.e. 157 deaths (per 100,000 live births). The rate of maternal mortality is much higher in Balochistan as compared to the other provinces. This research is aimed to discuss the supply side barriers and utilization of maternal healthcare services in the District Gwadar. Likert scale survey method has been used to collect data from the Healthcare Professionals from hospitals -private and government- and the maternal healthcare receiver, that is patient. Semi-structured interviews of healthcare professionals such as doctors, nurses, and Lab technicians have also been conducted. It has been found in this research study that the hospitals in Gwadar district are lagging behind in providing modern maternal healthcare to women due to the lack of staff training, medicine supply, and Laboratories. Moreover, the system of the lady health worker is also not catering to the needs of the women in District Gwadar. It has been recommended in the study that first of all the government should fulfill the supply of the medicine in the hospital. Secondly, the government should open laboratories in the hospitals. Thirdly, the government should increase the funding of the government hospital and the allocation of lady health workers in District Gwadar, Balochistan should be increased.

Keywords: maternal mortality, neonatal, postnatal, supply barriers, patients, healthcare professionals, laboratory, medical supply, training

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Authors: Vineetha Bettaiah, Heggere S. Ranganath

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This paper presents a Hierarchical Piecewise Linear Approximation (HPLA) for the representation of time series data in which the time series is treated as a curve in the time-amplitude image space. The curve is partitioned into segments by choosing perceptually important points as break points. Each segment between adjacent break points is recursively partitioned into two segments at the best point or midpoint until the error between the approximating line and the original curve becomes less than a pre-specified threshold. The HPLA representation achieves dimensionality reduction while preserving prominent local features and general shape of time series. The representation permits course-fine processing at different levels of details, allows flexible definition of similarity based on mathematical measures or general time series shape, and supports time series data mining operations including query by content, clustering and classification based on whole or subsequence similarity.

Keywords: data mining, dimensionality reduction, piecewise linear representation, time series representation

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Authors: Nditsheni Ramakuela, Sonto Maputle, Base Khoza, Augustine Tugli

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Inadequate health literacy can cause difficulties in understanding and compliance to treatment plan. With diabetic condition, self-care activities include behaviours of following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care. Patients with poor health literacy have difficulty interpreting medication warning labels, following directions on a prescription label and identifying their medications. Difficulties in understanding and performing self-care and health-related activities may ultimately lead to poor health outcomes. The study explored and described factors affecting health literacy and self-care to diabetic regimen by female patients at selected hospital in Limpopo Province of South Africa. Qualitative and explorative research design was used. Female patients who were admitted and diagnosed with diabetes in female medical ward constituted the study population. Non-probability, purposive sampling was used to select 20 female patients diagnosed with diabetes, who were above 18 years and admitted during April–November 2014. An in-depth face-to-face, unstructured interview was used to collect data. Data were analysed using open coding method. Measures to ensure trustworthiness and ethical considerations were adhered to. Findings revealed factors affecting health literacy for diabetic self-care activities amongst patients were; patient, family, disease and facility related. Proposed recommendations were; to strengthen diabetes education and patient-provider partnership. This is important and must be transferred to strengthen self-care activities to fully benefit the patient.

Keywords: compliance, diabetes mellitus, diabetic regimen, health literacy, self activities

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Authors: Meng Qing Feng, Otsile Morake

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Background: Successful implementation of the COVID-19 vaccination ensures the prevention of virus infection. Postponement and refusal of the vaccination will threaten public health, which is now common among the general public across the world. In addition, an acceptance of the COVID-19 vaccine appears as a decisive factor in controlling the COVID-19 pandemic. Purpose: This study's objective is to explore the factors influencing the public intention to be vaccinated (ITBV). Design/methodology/approach: The web-based survey included socio-demographics and questions related to the theory of planned behavior (TPB) and the health belief model (HBM). An online survey was administered using Google Form to collect data from participants of Botswana. The sample included 339 participants, half-half of the participants were female. Data analysis was run using the Statistical Package for the Social Sciences (SPSS). Findings: The study results highlight that perceived severity, perceived barriers, health motivation, and attitude have a positive and significant effect on ITBV, while perceived susceptibility, benefits, subjective norms, and perceived behavior control do not affect ITBV. Among all of the predictors, perceived barriers have the most significant influence on ITBV. Conclusion: Theoretically, this research stated that both HBM and TPB are effective in predicting and explaining the general public ITBV. Practically, this study offers insights to the government and health departments to arrange and launch health awareness programs and provide a better guide to vaccination so that doubts about vaccine confidence and the level of uncertainty can be decreased.

Keywords: COVID-19, Omicron, intention to be COVID-19 vaccine, health behavior model, theory of planned behavior, Botswana

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Authors: Chung-Yuan Wang, Kai-Chun Lee, Min-Hung Wang, Yu-Ren Chen, Hung-Sheng Lin, Sen-Shan Fan

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Taiwan National Health Insurance (NHI) was launched in 1995. It is an important social welfare policy in Taiwan. Regardless of the diversified social and economic status, universal coverage of NHI was assured. In order to regain better self-care performance, stroke people received in-patient and out-patient rehabilitation. Though NHI limited the rehabilitation frequency to one per day, the cost of rehabilitation still increased rapidly. Through the intensive rehabilitation during the post-stroke rehabilitation golden period, stroke patients might decrease their disability and shorten the rehabilitation period. Therefore, the aim of this study was to investigate the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. This study was started from 2014/03/01. The stroke patients who were admitted to our hospital or medical center were indicated to the study. The neurologists would check his modified Rankin Scale (mRS). Only patients with their mRS score between 2 and 4 were included to the study. Patients with unclear consciousness, unstable medical condition, unclear stroke onset date and no willing for 3 weeks in-patient intensive rehabilitation were excluded. After the physiatrist’s systemic evaluation, the subjects received intensive rehabilitation programs. The frequency of rehabilitation was thrice per day. Physical therapy, occupational therapy and speech/swallowing therapy were included in the programs for the needs of the stroke patients. Activity daily life performance (Barthel Index) and functional balance ability (Berg Balance Scale) were used to measure the training effect. During 3/1 to 5/31, thirteen subjects (five male and eight female) were included. Seven subjects were aged below 60. Three subjects were aged over 70. Most of the subjects (seven subjects) received intensive post-stroke rehabilitation for three weeks. Three subjects drop out from the programs and went back home respectively after receiving only 7, 10, and 13 days rehabilitation. Among these 13 subjects, nine of them got improvement in activity daily life performance (Barthel Index score). Ten of them got improvement in functional balance ability (Berg Balance Scale). The intensive post-acute stroke rehabilitation did help stroke patients promote their health in our study. Not only their functional performance improved, but also their self-confidence improved. Furthermore, their family also got better health status. Stroke rehabilitation under per diem payment was noted in long-term care institution in developed countries. Over 95% populations in Taiwan were supported under the Taiwan's National Health Insurance system, but there was no national long-term care insurance system. Most of the stroke patients in Taiwan live with his family and continue their rehabilitation programs from out-patient department. This pilot study revealed the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. The number of the subjects and the study period were limited. Thus, further study will be needed.

Keywords: rehabilitation, post-acute stroke, per diem payment, NHI

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Authors: Sittichai Charoensettasilp, Chong Wu

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This study employs sampling of 400 Thai people who live in Bangkok and have used air transportation to travel. A random convenience sampling technique is used to collect data. The results found that at 0.05 significance level the differences of means of Thai consumers’ expectations (before) and satisfaction (after) receiving services in the service marketing mix, the results of all aspects are different both in general and for each aspect of the service marketing mix. Average levels of expectations before receiving services are higher than satisfaction after receiving services in all aspects, as well. When analyzing further to the correlation between average means, the means of expectations before receiving services are higher than those of satisfaction after receiving services in general. As in all aspects of the service marketing mix, any aspect that has a big difference between expectations before receiving services and satisfaction after receiving services has low correlation.

Keywords: domestic low-cost airlines, Thai consumers, relationship, expectation before receiving services, satisfaction after receiving services

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