Search results for: patient safety incidents

Authors: Ravi Nandu, Kuldeep Singh

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A helmet is a protective layer that is worn in order to prevent head injury. Helmet is the most important safety gear for two wheeler riders. However, due to carelessness of people, less importance toward safety, lot of causalities is every year. According to National Crime Records Bureau (NCRB) two wheelers claimed 92 lives every day out of which most were due to helmetless drive. The system design will be such that without wearing the helmet the rider cannot start two wheelers. The helmet will be connected to vehicle key ignition systems which will be electronically controlled. The smart helmet will be having proximity sensor fitted inside it, which will act as our switch for ignition and further with wireless connection the helmet sensor circuit will be connected to the vehicle ignition system.

Keywords: helmet, proximity sensor, microcontroller, head injury

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Authors: Mohammed Darwish

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Workplace injuries cost organizations significant amount of money. Causes of injuries at workplace are very well documented in the literature and attributed to variety of reasons. One important reason is the long working-hours. The purpose of this paper is to develop a mathematical model that finds the optimal working-hours at workplace. The developed model minimizes the expected total cost which consists of the expected cost incurred due to unsafe conditions of workplace, the other cost is related to the lost production due to work incidents, and the production cost.

Keywords: 8-hour workday, mathematical model, optimal working hours, workplace injuries

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Authors: Nitesh Kumar, Eoin Twohig, jasparl cheema, Sadiq mawji, Yousif al najjar

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Basal cell carcinoma (BCC) is the commonest cutaneous malignancy affecting humans. Despite this, distant spread is exceptionally rare. Metastatic BCC (mBCC) is estimated to occur in 0.0028 - 0.5%. it aim to illustrate with the aid of histological slides, a case of mBCC occurring in a fit and well 67-year-old. Initial diagnosis of desmoplastic BCC was made in 2006 from a scalp biopsy with the lesion then being excised. Re-excision of local recurrence was undertaken the following year. In 2014 the patient presented with an ipsilateral level 2a mass. Fine Needle Aspiration raised the suspicion of metastatic carcinoma. The patient had excision of two nodes from the left neck alongside pharyngeal tonsillectomy and tongue base biopsies. Histologically, the nodes closely resembled the immunophenotype of the initial scalp lesion. The patient subsequently had a modified radical neck dissection, and residual mBCC was excised from the left Sternocleidomastoid muscle. In 2023 the patient developed haematuria. On further investigation bilateral lung lesions on CT were noted with subsequent biopsy confirming mBCC. Spinal and renal lesions have also been found. Histopathology showed clear resemblance of the lung metastases to both those in the neck and the primary (scalp BCC) – with no squamous differentiation seen. The time span from primary to occurrence of lung metastasis (18 years) affirms the indolent and slow growing nature of BCC.  This case fulfils Lattes and Kessler diagnostic criteria. High risk cases are described as those with advanced local presentation, primary tumour on the Head and Neck and locally recurrent lesions.

Keywords: BCC, metastasis, rare, skin cancer

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Authors: Thammarak Srimarut, Witthaya Mekhum

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This study analysed and developed a model for monk’s food bowl production on occupational health safety and environment at work for the encouragement of Rattanakosin local wisdom at Banbart Community. The process of blowpipe welding was necessary to produce the bowl which was very dangerous or 93.59% risk. After the employment of new sitting posture, the work risk was lower 48.41% or moderate risk. When considering in details, it was found that: 1) the traditional sitting posture could create work risk at 88.89% while the new sitting posture could create the work risk at 58.86%. 2) About the environmental pollution, with the traditional sitting posture, workers exposed to the polluted fume from welding at 61.11% while with the new sitting posture workers exposed to the polluted fume from welding at 40.47%. 3) On accidental risk, with the traditional sitting posture, workers exposed to the accident from welding at 94.44% while with the new sitting posture workers exposed to the accident from welding at 62.54%.

Keywords: occupational health safety, environment at work, Monk’s food bowl, machine intelligence

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Authors: Wieke Ellen Bouwes

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This study aims to unravel which factors enhance accessibility of video consultations (VCs) for patients with low digital literacy. Thirteen in-depth interviews with patients, hospital employees, eHealth experts, and digital support organizations were held. Patients with low digital literacy received in-home support during real-time video consultations and are observed during the set-up of these consultations. Key findings highlight the importance of patient acceptance, emphasizing video consultations benefits and avoiding standardized courses. The lack of a uniform video consultation system across healthcare providers poses a barrier. Familiarity with support organizations – to support patients in usage of digital tools - among healthcare practitioners enhances accessibility. Moreover, considerations regarding the Dutch General Data Protection Regulation (GDPR) law influence support patients receive. Also, provider readiness to use video consultations influences patient access. Further, alignment between learning styles and support methods seems to determine abilities to learn how to use video consultations. Future research could delve into tailored learning styles and technological solutions for remote access to further explore effectiveness of learning methods.

Keywords: video consultations, digital literacy skills, effectiveness of support, intra- and inter-organizational relationships, patient acceptance of video consultations

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Authors: Minho Kwon, Jeonghee Lim, Yeongseok Jeong, Jongyoon Moon, Donghoon Shin, Kiyoung Kim

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In the past, the criteria and procedures for the design of concrete structures were mainly based on the stresses allowed for structural components. However, although the frequency of earthquakes has increased and the risk has increased recently, it has been difficult to determine the safety factor for earthquakes in the safety assessment of structures based on allowable stresses. Recently, limit state design method has been introduced for reinforced concrete structures, and limit state-based approach has been recognized as a more effective technique for seismic design. Therefore, in this study, the limit state of the bridge, which is a structure requiring higher stability against earthquakes, was evaluated. The finite element program LS-DYNA and twenty ground motion were used for time history analysis. The fracture caused by tensile and compression of the pier were set to the limit state. In the concrete tensile fracture, the limit state arrival rate was 100% at peak ground acceleration 0.4g. In the concrete compression fracture, the limit state arrival rate was 100% at peak ground acceleration 0.2g.

Keywords: allowable stress, limit state, safety factor, peak ground acceleration

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Authors: Vittorio Astarita, Giuseppe Guido, Vincenzo Pasquale Giofre, Alessandro Vitale

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Traffic microsimulation has been used extensively to evaluate consequences of different traffic planning and control policies in terms of travel time delays, queues, pollutant emissions, and every other common measured performance while at the same time traffic safety has not been considered in common traffic microsimulation packages as a measure of performance for different traffic scenarios. Vehicle conflict techniques that were introduced at intersections in the early traffic researches carried out at the General Motor laboratory in the USA and in the Swedish traffic conflict manual have been applied to vehicles trajectories simulated in microscopic traffic simulators. The concept is that microsimulation can be used as a base for calculating the number of conflicts that will define the safety level of a traffic scenario. This allows engineers to identify unsafe road traffic maneuvers and helps in finding the right countermeasures that can improve safety. Unfortunately, most commonly used indicators do not consider conflicts between single vehicles and roadside obstacles and barriers. A great number of vehicle crashes take place with roadside objects or obstacles. Only some recent proposed indicators have been trying to address this issue. This paper introduces a new procedure based on the simulation of potential crash events for the evaluation of safety levels in microsimulation traffic scenarios, which takes into account also potential crashes with roadside objects and barriers. The procedure can be used to define new conflict indicators. The proposed simulation procedure generates with the random perturbation of vehicle trajectories a set of potential crashes which can be evaluated accurately in terms of DeltaV, the energy of the impact, and/or expected number of injuries or casualties. The procedure can also be applied to real trajectories giving birth to new surrogate safety performance indicators, which can be considered as “simulation-based”. The methodology and a specific safety performance indicator are described and applied to a simulated test traffic scenario. Results indicate that the procedure is able to evaluate safety levels both at the intersection level and in the presence of roadside obstacles. The procedure produces results that are expressed in the same unity of measure for both vehicle to vehicle and vehicle to roadside object conflicts. The total energy for a square meter of all generated crash can be used and is shown on the map, for the test network, after the application of a threshold to evidence the most dangerous points. Without any detailed calibration of the microsimulation model and without any calibration of the parameters of the procedure (standard values have been used), it is possible to identify dangerous points. A preliminary sensitivity analysis has shown that results are not dependent on the different energy thresholds and different parameters of the procedure. This paper introduces a specific new procedure and the implementation in the form of a software package that is able to assess road safety, also considering potential conflicts with roadside objects. Some of the principles that are at the base of this specific model are discussed. The procedure can be applied on common microsimulation packages once vehicle trajectories and the positions of roadside barriers and obstacles are known. The procedure has many calibration parameters and research efforts will have to be devoted to make confrontations with real crash data in order to obtain the best parameters that have the potential of giving an accurate evaluation of the risk of any traffic scenario.

Keywords: road safety, traffic, traffic safety, traffic simulation

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Authors: Malvina Hoxha, Valerie Capra, Carola Buccellati, Angelo Sala, Clara Cena, Roberta Fruttero, Massimo Bertinaria, G. Enrico Rovati

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Today COXIBs are used in the treatment of arthritis and many other painful conditions in selected patients with high gastrointestinal risk and low CV risk. Previously we found a new mechanism of action of a traditional NSAID (diclofenac) and a COXIB (lumiracoxib) that possess weak competitive antagonism at the TP receptor. We hypothesize that modifying the structure of a known specific inhibitor of cyclooxygenase-2 (COXIB), so that it becomes also a more potent thromboxane antagonist will preserve the anti-inflammatory and gastrointestinal safety typical of COXIBs and prevent the cardiovascular risk associated with long term therapy.

Keywords: cyclooxygenase, inflammation, lumiracoxib, thromboxane A2

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Authors: Melvin Ouma

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Language is one of the most crucial tools in medical interaction. Its importance is as great today as it was many decades ago. Difficulty in openly discussing certain diseases and body parts is one of the challenges in language use in medical contexts. Guided by H. P. Grice’s Cooperative Principle, this paper explores the flouting of the cooperative principles in Swahili speaking medical setting. The paper examines how men flout the maxims using the Swahili language when reporting reproductive health problems to the doctor. The data used was gathered from a qualitative study carried out in a reproductive health clinic in a public facility in Nakuru County, Kenya. All the research protocols were observed by acquiring all the research permits. Respondents' ethical considerations of consent, privacy, and confidentiality were observed. The respondents recruited were men who visited the reproductive health clinic and voluntarily agreed to participate in the study without coercion or compensation. Participant observation was the key data collection tool, with the doctor and patient conversation digitally recorded. The researcher was allowed into the clinic in a socially acceptable role. Male patients flouted the maxims of quantity, quality, relation, and manner in order to describe their reproductive health problems without embarrassment using the Swahili language. The flouting was done through the discursive strategies of narration and circumlocution. Flouting of the maxims was acceptable to the doctor and patient due to the fact that sexual intercourse and private body parts are taboo topics and uncomfortable to talk about. The quality of health care received by the patient depended on the doctor’s patience when all the maxims were flouted. In the reproductive health clinic, flouting of maxims hindered communication and, at the same time, enhanced communication between the doctor and patient.

Keywords: cooperative principle, doctor, men, reproductive health

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Authors: Hengameh Hosseini

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Design of large healthcare facilities – such as hospitals, multi-service line clinics, and nursing facilities - that can accommodate patients with wide-ranging disabilities is a challenging endeavor and one that is poorly understood among healthcare facility managers, administrators, and executives. An even less-understood extension of this problem is the implications of weakly or insufficiently accommodative design of facilities for healthcare workers in physically-intensive jobs who may also suffer from a range of disabilities and who are therefore at increased risk of workplace accident and injury. Combine this reality with the vast range of facility types, ages, and designs, and the problem of universal accommodation becomes even more daunting and complex. In this study, we focus on the implication of facility design for healthcare workers suffering with low vision who also have physically active jobs. The points of difficulty are myriad and could span health service infrastructure, the equipment used in health facilities, and transport to and from appointments and other services can all pose a barrier to health care if they are inaccessible, less accessible, or even simply less comfortable for people with various disabilities. We conduct a series of surveys and interviews with employees and administrators of 7 facilities of a range of sizes and ownership models in the Northeastern United States and combine that corpus with in-facility observations and data collection to identify five major points of failure common to all the facilities that we concluded could pose safety threats to employees with vision impairments, ranging from very minor to severe. We determine that lack of design empathy is a major commonality among facility management and ownership. We subsequently propose three methods for remedying this lack of empathy-informed design, to remedy the dangers posed to employees: the use of an existing open-sourced Augmented Reality application to simulate the low-vision experience for designers and managers; the use of a machine learning model we develop to automatically infer facility shortcomings from large datasets of recorded patient and employee reviews and feedback; and the use of a computer vision model fine tuned on images of each facility to infer and predict facility features, locations, and workflows, that could again pose meaningful dangers to visually impaired employees of each facility. After conducting a series of real-world comparative experiments with each of these approaches, we conclude that each of these are viable solutions under particular sets of conditions, and finally characterize the range of facility types, workforce composition profiles, and work conditions under which each of these methods would be most apt and successful.

Keywords: artificial intelligence, healthcare workers, facility design, disability, visually impaired, workplace safety

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Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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Authors: Inaam Nasrallah, Pascale Salameh, Abbas El-Outa, Assem Alkak, Rihab Nasr, Wafa Toufic Bawab

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Background: Hazardous Waste Management(HWM). is critical to human health outcomes and environmental protection. This study evaluated the knowledge regarding safety measures to be applied when collecting and storing waste in scientific laboratories of two universities in Lebanon.Method: A survey-based observational study was conducted in scientific laboratories of the public university and that of a private university, where a total of 309 participants were recruited.Result: The mean total knowledge score on safety measures of HWM was 9.02±4.34 (maximum attainable score, 13). Significant association (p<0.05) was found between knowledge score and job function, years of experience, educational level, professional status, work schedule, and training on proper HWM. Participants had adequate perceptions regarding the impact of HWM on health and the environment. Linear regression modeling revealed that knowledge score was significantly higher among bachelor level lab workers compared to those with doctoral degrees (p=0.043), full-time schedule workers versus part-timers (p=0.03), and among public university participants as compared to those of the private university (p<0.001).Conclusion: This study showed good knowledge concerning HWM in the scientific laboratoriesof the studied universities in Lebanon and a good awareness of the HWM on health and the environment. It highlights the importance of culture, attitude, and practice on proper HWM in the academic scientific laboratory.

Keywords: hasardous waste, safety measures, waste management, knwoledge score, scientific laboratory workers

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Authors: Erwin L. Descallar

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Food safety is crucial in protecting the health of consumers, maintaining integrity in the entire food industry, and ensuring regulatory compliance. Food is a universal need for survival, and everyone is at risk of engaging in improper food handling, which increases vulnerability to foodborne illnesses. The level of knowledge or awareness and meat storage practices of students are behaviors influenced by various demographic factors. The Health Belief Model examines the relationship of such demographic factors towards the attitude, perception, and actions of individuals on perceived risk. This study aims to analyze and understand the correlation of said behaviors with course programs, prior food poisoning experience, and food handling of university students. The study employed randomized responses from 89 university students (n=89) under the College of Science at the Polytechnic University of the Philippines–Sta. Mesa (Manila). The results were subjected to measures of central tendency for score ranking and inferential statistics. The statistics were compared using Pearson ‘r’ Product Moment Correlation to determine the degree of relationship between the knowledge and practices on meat storage and safety. No statistically significant differences were found between the course program of students, food poisoning experiences, level of knowledge, and awareness regarding proper meat storage practices. However, increased frequency and involvement in meat handling have shown a positive correlation, indicating that there is a correlation between food handling and proper meat storage practices of university students.

Keywords: meat storage practices, food handling, food safety, meat science and technology

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Authors: G. B. M. Carvalho, V. A. C. Vale, E. T. L. Cöuras Ford

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With the aim of increasing the levels of comfort and security structures, the study of dynamic loads on buildings has been one of the focuses in the area of control engineering, civil engineering and architecture. Thus, this work presents a study based on simulation of the dynamics of buildings in the form of portico subjected to wind action, besides presenting an action of passive control, using for this the dynamics of the structure, consequently representing a system appropriated on environmental issues. These control systems are named the dynamic vibration absorbers.

Keywords: dynamic vibration absorber, structure, comfort, safety, wind behavior, structure

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Authors: Chitra Rajagopal, Indra Deo Kumar, Ila Chauhan, Ruchi Joshi, Binoy Bhargavan

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Reliability and safety are essential for the success of mission-critical and safety-critical defense systems. Humans are part of the entire life cycle of defense systems development and deployment. The majority of industrial accidents or disasters are attributed to human errors. Therefore, considerations of human performance and human reliability are critical in all complex systems, including defense systems. Defense systems are operating from the ground, naval and aerial platforms in diverse conditions impose unique physical and psychological challenges to the human operators. Some of the safety and mission-critical defense systems with human-machine interactions are fighter planes, submarines, warships, combat vehicles, aerial and naval platforms based missiles, etc. Human roles and responsibilities are also going through a transition due to the infusion of artificial intelligence and cyber technologies. Human operators, not accustomed to such challenges, are more likely to commit errors, which may lead to accidents or loss events. In such a scenario, it is imperative to understand the human factors in defense systems for better systems performance, safety, and cost-effectiveness. A case study using Task Analysis (TA) based methodology for assessment and reduction of human errors in the Air and Missile Defense System in the context of emerging technologies were presented. Action-oriented task analysis techniques such as Hierarchical Task Analysis (HTA) and Operator Action Event Tree (OAET) along with Critical Action and Decision Event Tree (CADET) for cognitive task analysis was used. Human factors assessment based on the task analysis helps in realizing safe and reliable defense systems. These techniques helped in the identification of human errors during different phases of Air and Missile Defence operations, leading to meet the requirement of a safe, reliable and cost-effective mission.

Keywords: defence systems, reliability, risk, safety

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Authors: Aofan Liu, Qianqian Tan, Burra Venkata Durga Kumar

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Data security is of the utmost importance in the healthcare area, as sensitive patient information is constantly sent around and analyzed by many different parties. The use of federated learning, which enables data to be evaluated locally on devices rather than being transferred to a central server, has emerged as a potential solution for protecting the privacy of user information. To protect against data breaches and unauthorized access, federated learning alone might not be adequate. In this context, the application of blockchain technology could provide the system extra protection. This study proposes a distributed federated learning system that is built on blockchain technology in order to enhance security in healthcare. This makes it possible for a wide variety of healthcare providers to work together on data analysis without raising concerns about the confidentiality of the data. The technical aspects of the system, including as the design and implementation of distributed learning algorithms, consensus mechanisms, and smart contracts, are also investigated as part of this process. The technique that was offered is a workable alternative that addresses concerns about the safety of healthcare while also fostering collaborative research and the interchange of data.

Keywords: data privacy, distributed system, federated learning, machine learning

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Authors: Lamia Bouzgarrou, Amira Omrane, Naima Bouatay, Chaima Harrathi, Samia Machroughl, Ahmed Mhalla

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Background and Aims: Professionals of health care sector are exposed to psychosocial constraints like stress, harassment, violence, which can lead to many mental health problems such as, depression, addictive behavior, and burn-out. Moreover, it’s well established that caregivers affected to intensive care units are more likely to experience such constraints and mental health problems. For these caregivers, the mental health state may affect care quality and patient’s safety. This study aims either to identify occupational psychosocial constraints and their mental health consequences among paramedical and medical caregivers affected to intensive units in Tunisian public hospital. Methods: An exhaustive three months cross-sectional study conducted among medical and paramedical staffs of intensive care units in three Tunisian university hospitals. After informed consent collection, we evaluated work-related stress, workplace harassment, depression, anxious troubles, addictive behavior, and self-esteems through an anonymous self-completed inquiry form. Five validated questionnaires and scales were included in this form: Karasek's Job Content Questionnaire, Negative Acts Questionnaire, Rosenberg, Beck depression inventory and Hamilton Anxiety scale. Results: We included 129 intensive unit caregivers; with a mean age of 36.1 ± 1.1 years and a sex ratio of 0.58. Among these caregivers, 30% were specialist or under-specialization doctors. The average seniority in the intensive care was 6.1 ± 1.2 (extremes=1 to 40 years). Atypical working schedules were noted among 36.7% of the subjects with an imposed choice in 52.4% of cases. During the last 12 months preceding the survey, 51.7% of care workers were absent from work because of a health problem with stops exceeding 15 days in 11.7%. Job strain was objective among 15% of caregivers and 38.33% of them were victims of moral harassment. A low or very low self-esteem was noted among 40% of respondents. Moreover, active smoking was reported by 20% subjects, alcohol consumption by 13.3% and psychotropic substance use by 1.7% of them. According to Beck inventory and Hamilton Anxiety scale, we concluded that 61.7% of intensive care providers were depressed, with 'severe' depression in 13.3% of cases and 49.9% of them present anxious disorders. Multivariate analysis objective that, job strain was correlated with young age (p=0.005) and shorter work seniority (p=0.001). Workplace and moral harassment was more prevalent among females (p=0.009), under-specialization doctor (p=0.021), those affected to atypical schedules (p=0.008). Concerning depression, it was more prevalent among staff in job strain situation (p = 0.004), among smokers caregivers (p = 0.048), and those with no leisure activity (p < 0.001). Anxious disorders were positively correlated to chronic diseases history (p = 0.001) and work-bullying exposure (p = 0.004). Conclusions: Our findings reflected a high frequency of caregivers who are under stress at work and those who are victims of moral harassment. These health professionals were at increased risk for developing psychiatric illness such depressive and anxious disorders and addictive behavior. Our results suggest the necessity of preventive strategies of occupational psychosocial constraints in order to preserve professional’s mental health and maximize patient safety and quality of care.

Keywords: health care sector, intensive care units, mental health, psychosocial constraints

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Authors: Rachel Byrne

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Background: Due to patient and student safety concerns, combined with clinical teachers being redeployed to clinical practice, COVID-19 has resulted in a reduction in face-to-face teaching sessions for medical students. Traditionally such sessions are particularly important for final year medical students, especially in preparing for their final practical exams. A reduced student presence on the wards has also resulted in fewer opportunities for junior doctors to provide teaching sessions. This has implications for junior doctors achieving their own curriculum outcomes for teaching, as well as potentially hindering the development of a future interest in medical education. Aims: The aims of the study are 1) To create a safe face-to-face teaching environment during COVID-19 which focussed on exam preparation for final year medical students, 2) To provide a platform for doctors to gain teaching experience, 3 ) to enable doctors to gain feedback or assessments on their teaching, 4) To create beginners guide to designing a new teaching program for future junior doctors. Methods: We created a program of timed clinical stations consisting of four sessions every five weeks during the student’s medicine attachment. Each session could be attended by 6 students and consisted of 6 stations ran by junior doctors, with each station following social distancing and personal protective equipment requirements. Junior doctors were asked to design their own stations. The sessions ran out-of-hours on weekday evenings and were optional for the students. Results: 95/95 students and 20/40 doctors involved in the programme completed feedback. 100% (n=95) of students strongly agreed/agreed that sessions were aimed at an appropriate level and provided constructive feedback. 100% (n=95) of students stated they felt more confident in their abilities and would recommend the session to peers. 90% (n=18) of the teachers strongly agreed/agreed that they felt more confident in their teaching abilities and that the sessions had improved their own medical knowledge. 85% (n=17) of doctors had a teaching assessment completed, and 83% (n=16) said the program had made them consider a career in medical education. The difficulties of creating such a program were highlighted throughout, and a beginner’s guide was created with the hopes of helping future doctors who are interested in teaching address the common obstacles.

Keywords: COVID-19, education, safety, medical

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Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

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Authors: Yunus Emre Kara, Atilla Kuzu, Levent Cirpici

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Recently, in the interior design of hospitals, the effect of the physical environment on the healing process has been frequently emphasized, and the importance of psychological and behavioral factors has increased day by day. When designing new hospital interiors, it became important to create spaces that not only meet medical requirements but also support the healing process of patients with interior design. In this study, the patient rooms, corridor, atrium area, waiting area, and entrance counter in a hospital were handled with patient-centered design, evidence-based design, and remedial architectural approaches, and it was seen that the healing and reassuring elements in hospitals were extremely important.

Keywords: evidence based design, healing architecture, hospital, organic design, parametric design

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Authors: Kwei Huan Liw, Sashi B. Darshan

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Background: Double eyelid surgery has become one of the most sought-after aesthetic procedures among Asians. Many surgeons perform surgical blepharoplasty and various other methods of non-incisional blepharoplasty. Face-Q is a validated method of measuring patient satisfaction for facial aesthetic procedures. Here we have analyzed the overall eye satisfaction score, the upper eyelid appraisal score and the adverse effect on eyes score Methods: 274 patients (548 eyes), aged between 18 to 40 years old, were recruited from 2015-2018. Each patient underwent a non-incisional double-eyelid blepharoplasty using a single-knotted continuous buried suture. 3 – 5 stab incisions were made depending on the upper eyelid size. A needle loaded with 7-0 nylon is passed from the lateral most wound through the dermis and the conjunctiva in an alternate fashion into the remaining stab wounds. The suture is then tunneled back laterally in the deeper dermis and knotted securely with the suture end. The knot is then buried within the orbicularis oculi muscle. Each patient was required to fill the Face-Q questionnaire before the procedure and 2 weeks post procedure. The results are described based on the percentage of the maximum achievable score. Patients were reviewed after 12 to 18 months to assess the long-term outcome. Results: The overall eye satisfaction score demonstrated a high level of post-operative satisfaction (97.85%), compared to 27.32% pre-operatively. The appraisal of upper eyelid scores showed drastic improvement in perception post-operatively (95.31%) compared to 21.44% pre-operatively. Adverse effect on eyes score showed a very low post-operative complication rate (0.4%) The long-term follow-up showed 6 cases that had developed asymmetrical folds. Only 1 patient agreed for revision surgery. The other 5 patients were still satisfied with the outcome and were not keen for revision surgery. None of the cases had loosening of knots. Conclusion: Modified single-knot continuous buried suture technique is a simple and non-invasive method to create aesthetically pleasing non-surgical double-eyelids, which has long-term effects. Proper patient selection is crucial and good surgical technique is required to achieve a desirable outcome.

Keywords: blepharoplasty, double-eyelid, face-Q, non-incisional

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Authors: Justyna Śniadach, Barbara Bętkowska Korpała, Napoleon Waszkiewicz

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The drinking reduction program is a relatively new form of therapy. A lot has changed in thinking about alcohol problems and effective ways to solve them. Until recently, alcohol consumers were divided into two groups: addicted and "normal" drinkers. In recent years, the existence of a large group of people who drink alcohol harmfully has been noticed: not addicted, but still drinking in a way that brings losses and harms to others. It turned out that most of the problems resulting from drinking alcohol are generated by people who drink harmfully and that showed that it is necessary to build a support system for these people aimed at reducing alcohol consumption. The Drinking Reduction Program currently has 3 versions. There is a Drinking Reduction Program in a standard form, where the patient works stationary, in the therapist's office. Another possibility is the patient's work on Online - Drinking Reduction Program with application in a remote form. Another possibility is the patient's work in Online- Drinking Reduction Program on-line but together with the therapist. In all of this program's exercises are based on the assumptions of behavioral-cognitive therapy and methods of motivational dialogue. The purpose of this research will be to compare three versions of Drinking Reduction Programs in terms of their effectiveness, psychological and sociological variables, as well as the level of motivation to change the drinking pattern.

Keywords: alcohol addiction, addiction therapy, drinking reduction programs, cognitive-behavioral therapy

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Authors: Chenchieh Chang

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Objectives: This study had two objectives. First, it used affective events theory to investigate the relationship between workplace bullying and the intention to resign in nurses, a topic rarely explored in previous studies. Second, according to the conservation of resource theory, individuals encountering work incidents will utilize resources that are at their disposal to strengthen or weaken the effects of the incidents on them. Such resources include social support that comes from their bosses, colleagues, family, and friends. To answer the question of whether different social supports exert distinct effects on alleviating stress experienced by nurses, this study examined the moderating effects of different social supports on the relationship between workplace bullying and nurses’ intention to resign. Method: This study was approved by an institutional review board (code number: 105070) and adopted purposive sampling to survey 911, full-time nurses. Results: Work-related bullying exerted a significant and positive effect on the intention to resign, whereas bullying pertaining to interpersonal relationships and body-related bullying nonsignificantly affected intention to resign. Support from supervisors enhanced the effect of work-related bullying on an intention to resign, whereas support from colleagues and family did not moderate said effect. Research Limitations/Implications: The self-reporting method and cross-sectional research　design adopted in this study might have resulted in common method variance and limited the ability to make causal inferences. This study suggests future studies to obtain measures of predictor and criterion variables from different sources or ensure a temporal, proximal, or psychological separation between predictor and criterion in the collection of data to avoid the common method bias. Practical Implications: First, businesses should establish a friendly work environment and prevent employees from encountering workplace bullying. Second, because social support cannot diminish the effect of workplace bullying on employees’ intention to resign, businesses should offer other means of assistance. For example, business managers may introduce confidential systems for employees to report workplace bullying; or they may establish consultation centers where employees can properly express their thoughts and feelings when encountering workplace bullying.

Keywords: workplace bullying, intention to occupation leave, social supports, nurses

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Authors: Joshua Abraham, Craig Wales

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Abstract—SIGN Guideline 122 recommends that all patients who are admitted to hospital are assessed for venous thromboembolism risk within 24 hours of admission. NHS Greater Glasgow and Clyde provide guidance on this in the form of a proforma. Patients are then subsequently prescribed either thrombo-embolic-deterrent stockings (TEDS)/low molecular weight heparin (LMWH) for the prevention of VTE based on their score. A retrospective casenote audit of a random sample of fifty oncology and trauma inpatients at the QEUH in December 2019 was performed. 90% of patients had a risk assessment conducted as evidenced by a completed proforma. In 78% of these patients, the proforma fully completed. Overall 94% of patients had some for of thromboprophylaxis prescribed in the form of TEDS or LMWH. A lack of 100% compliance against the given standards highlighted potential implications for patient safety, but also medico-legal ramifications for staff. Clinical judgement can only be relied upon if there is written documentation as evidence. Further staff education and the suggestion of a written prompt to the clerk-in documentation will hopefully improve compliance, whilst a repeat audit should demonstrate any improvement.

Keywords: Maxillofacial , Thromboembolism, Thromboprophylaxis , Prescription

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Authors: Wan Shan Chiang, Charn Ting Wang, Wei-Chih Kan, Hui-Chen Huang

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Dialysis patients have risk in Zoster virus because of low immune. Valacyclovir (product name: Valtex) 500mg/tab, an anti-zoster virus medicine, is digested in kidney and it has side-effect of nervous system in patients with malfunction kidneys. Although the clinical basis of the proposed administration, we found that patients still have side effects. So we want to explore the appropriate dose of peritoneal dialysis patients. We read small samples of case reports and analyze 8 cases in our hospital, some patients’ Kt/v, match the standard of dialysis, and still go to the toilet, they still have side effect seriously with 500mg portion. The solution to this includes stopping medicine, reduction of medicine, increase of liquid change and timely hemodialysis and all of them speed up the recovery. The safety of medication needs extra attention of medical care employee. If they can tell the doctor if the patient has urine or not in his or her Kt/v, the doctor can prescribe the medicine accordingly. About the limitation, due to the lack of cases and related pharmacokinetics numbers. Therefore, for peritoneal patients, we think 500mg/48hoursis the saves. We also want to remind pharmaceuticals to revise the portion taken by patients, so that the doctor may judge the use.

Keywords: herpes zoster, Valacyclovir, peritoneal dialysis, health education

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Authors: Georges F. Hatoum, Thomas H. Temple, Silvio Garcia, Xiaodong Wu

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Soft Tissue Sarcomas (STS) represent a diverse group of malignancies with heterogeneous clinical and pathological features. The treatment of extremity STS aims to achieve optimal local tumor control, improved survival, and preservation of limb function. The National Comprehensive Cancer Network guidelines, based on the cumulated clinical data, recommend radiation therapy (RT) in conjunction with limb-sparing surgery for large, high-grade STS measuring greater than 5 cm in size. Such treatment strategy can offer a cure for patients. However, when recurrence occurs (in nearly half of patients), the prognosis is poor, with a median survival of 12 to 15 months and with only palliative treatment options available. The spatially-fractionated-radiotherapy (SFRT), with a long history of treating bulky tumors as a non-mainstream technique, has gained new attention in recent years due to its unconventional therapeutic effects, such as bystander/abscopal effects. Combining single fraction of GRID, the original form of SFRT, with conventional RT was shown to have marginally increased the rate of pathological necrosis, which has been recognized to have a positive correlation to overall survival. In an effort to consistently increase the pathological necrosis rate over 90%, multiple fractions of Lattice RT (LRT), a newer form of 3D SFRT, interdigitated with the standard RT as neoadjuvant therapy was conducted in a preliminary clinical setting. With favorable results of over 95% of necrosis rate in a small cohort of patients, a Phase I/II clinical study was proposed to exam the safety and feasibility of this new strategy. Herein the design of the clinical study is presented. In this single-arm, two-stage phase I/II clinical trial, the primary objectives are >80% of the patients achieving >90% tumor necrosis and to evaluation the toxicity; the secondary objectives are to evaluate the local control, disease free survival and overall survival (OS), as well as the correlation between clinical response and the relevant biomarkers. The study plans to accrue patients over a span of two years. All patient will be treated with the new neoadjuvant RT regimen, in which one of every five fractions of conventional RT is replaced by a LRT fraction with vertices receiving dose ≥10Gy while keeping the tumor periphery at or close to 2 Gy per fraction. Surgical removal of the tumor is planned to occur 6 to 8 weeks following the completion of radiation therapy. The study will employ a Pocock-style early stopping boundary to ensure patient safety. The patients will be followed and monitored for a period of five years. Despite much effort, the rarity of the disease has resulted in limited novel therapeutic breakthroughs. Although a higher rate of treatment-induced tumor necrosis has been associated with improved OS, with the current techniques, only 20% of patients with large, high-grade tumors achieve a tumor necrosis rate exceeding 50%. If this new neoadjuvant strategy is proven effective, an appreciable improvement in clinical outcome without added toxicity can be anticipated. Due to the rarity of the disease, it is hoped that such study could be orchestrated in a multi-institutional setting.

Keywords: lattice RT, necrosis, SFRT, soft tissue sarcoma

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Authors: Matt Stallwood, Michael Spearpoint

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In 2020, the UK government announced that sales of new petrol and diesel cars would end in 2030, and battery-powered cars made up 1 in 8 new cars sold in 2021 – more than the total from the previous five years. The guidance across the UK for the fire safety design of covered car parks is changing in response to the projected rapid growth in electric vehicle (EV) use. This paper discusses the current knowledge on the fire safety concerns posed by EVs, in particular those powered by lithium-ion batteries, when considering the likelihood of vehicle ignition, fire severity and spread of fire to other vehicles. The paper builds on previous work that has investigated the frequency of fires starting in cars powered by internal combustion engines (ICE), the hazard posed by such fires in covered car parks and the potential for neighboring vehicles to become involved in an incident. Historical data has been used to determine the ignition frequency of ICE car fires, whereas such data is scarce when it comes to EV fires. Should a fire occur, then the fire development has conventionally been assessed to match a ‘medium’ growth rate and to have a 95th percentile peak heat release of 9 MW. The paper examines recent literature in which researchers have measured the burning characteristics of EVs to assess whether these values need to be changed. These findings are used to assess the risk posed by EVs when compared to ICE vehicles. The paper examines what new design guidance is being issued by various organizations across the UK, such as fire and rescue services, insurers, local government bodies and regulators and discusses the impact these are having on the arrangement of parking bays, particularly in residential and mixed-use buildings. For example, the paper illustrates how updated guidance published by the Fire Protection Association (FPA) on the installation of sprinkler systems has increased the hazard classification of parking buildings that can have a considerable impact on the feasibility of a building to meet all its design intents when specifying water supply tanks. Another guidance on the provision of smoke ventilation systems and structural fire resistance is also presented. The paper points to where further research is needed on the fire safety risks posed by EVs in covered car parks. This will ensure that any guidance is commensurate with the need to provide an adequate level of life and property safety in the built environment.

Keywords: covered car parks, electric vehicles, fire safety, risk

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Authors: Mozhgan Aliakbari, Sara Moridpour

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In recent years, much attention has been given to truck drivers’ fatigue management. Long working hours negatively influence truck drivers’ physiology, health, and safety. However, there is little empirical research in the heavy vehicle transport sector in Australia to identify the influence of working hours’ management on drivers’ fatigue and consequently, on the risk of crashes and injuries. There is no national legislation regulating the number of hours or kilometres travelled by truck drivers. Consequently, it is almost impossible to define a standard number of hours or kilometres for truck drivers in a safety management system. This paper reviews the existing studies concerning safe system interventions such as tachographs in relation to fatigue caused by long working hours. This paper also reviews the literature to identify the influence of frequency of rest breaks on the reduction of work-related road transport accidents involving trucks. A framework is presented to manage truck drivers’ fatigue, which may result in the reduction of injuries and fatalities involving heavy vehicles.

Keywords: fatigue, time management, trucks, traffic safety

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Authors: Doua AlSaad, Ahmed Awaisu, Samah Elsalem, Palli Valapila Abdulrouf, Binny Thomas, Moza AlHail

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Background: It has been suggested that pyridoxine has an anti-lactogenic effect. Studies of the efficacy of pyridoxine in suppressing lactation have reported conflicting results. The aim of this review is to evaluate the effectiveness and safety of high-dose pyridoxine in postpartum lactation inhibition. Methods: This systematic review included published trials that compared the efficacy and/or safety of pyridoxine to placebo or to other pharmacological agents for the inhibition of postpartum lactation. We searched PubMed, Embase, ScienceDirect, CINAHL, AMED, the Cochrane library, and the clinical trials registry to identify relevant literature. No limit was imposed on the year of publication of the studies, and the review included studies published until 15 January 2016. Two reviewers independently extracted data and assessed the risk of bias. Results: Seven studies were included, with a total of 1155 women, of which 471 women received pyridoxine. Three studies were randomized controlled trials, while the remaining four studies were non-randomized controlled trials. All of the included studies were relatively small (n = 18 – 482). The studies compared pyridoxine with placebo, bromocriptine, and/or stilboestrol. Pyridoxine was given orally, with a total daily dose of 450 – 600 mg for 5 to 7 days. Two trials (n = 349 participants) indicated that pyridoxine was effective in inhibiting lactation in approximately 95% of the enrolled patients. All other studies failed to demonstrate pyridoxine efficacy through either clinical assessment or prolactin level measurements. Pyridoxine safety was assessed by two trials in which no serious untoward side-effects were reported. Overall, the risk of bias for most of the studies was low to moderate. Conclusion: Current evidence supporting the effectiveness of high dose pyridoxine in the inhibition of postpartum lactation is inconsistent and insufficient. Larger randomized trials are needed to confirm the efficacy of pyridoxine in postpartum lactation inhibition. Acknowledgment: This review received a grant from the Medical Research Center of Hamad Medical Corporation in Qatar (grant number: 15100/15).

Keywords: pyridoxine, safety, effectiveness, lactation inhibition

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Authors: Muhammad Faisal Khilji, Rana Shoaib Hamid

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Subdural hematoma (SDH) is an extremely rare complication of immune thrombocytopenic purpura (ITP). We present a case of a 34 years old female who presented to the Emergency department of a tertiary care hospital with complaints of headache, on and off gums bleeding and upper respiratory tract symptoms for the last two weeks. Examination was unremarkable except some purpura over limbs. Investigations revealed zero platelets and peripheral film suggestive of ITP. Computerized tomography (CT) brain revealed bilateral SDH in the frontal areas extending into Falx cerebri. Impression of ITP with SDH was made. Patient was treated with intravenous immunoglobulin (IVIg), methyl prednisolone and initial Platelets transfusion. Patient recovered uneventfully with platelets reaching normal levels within a few days and resolution of SDH without surgery.

Keywords: headache, immune thrombocytopenia, purpura, subdural hematoma

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