Search results for: attribute-based and experience-based review
Commenced in January 2007
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Edition: International
Paper Count: 4404

Search results for: attribute-based and experience-based review

3324 Barrier Membrane Influence Histology of Guided Bone Regenerations: A Systematic Review and Meta-Analysis

Authors: Laura Canagueral-Pellice, Antonio Munar-Frau, Adaia Valls-Ontanon, Joao Carames, Federico Hernandez-Alfaro, Jordi Caballe-Serrano

Abstract:

Objective: Guided bone regeneration (GBR) aims to replace the missing bone with a new structure to achieve long-term stability of rehabilitations. The aim of the present systematic review and meta-analysis is to determine the effect of barrier membranes on histological outcomes after GBR procedures. Moreover, the effect of the grafting material and tissue gain were analyzed. Materials & methods: Two independent reviewers performed an electronic search in Pubmed and Scopus, identifying all eligible publications up to March 2020. Only randomized controlled trials (RCTs) assessing a histological analysis of augmented areas were included. Results: A total of 6 publications were included for the present systematic review. A total of 110 biopsied sites were analysed; 10 corresponded to vertical bone augmentation procedures, whereas 100 analysed horizontal regeneration procedures. A mean tissue gain of 3 ± 1.48mm was obtained for horizontal defects. Histological assessment of new bone formation, residual particle and sub-epithelial connective tissue (SCT) was reported. The four main barrier membranes used were natural collagen membranes, e-PTFE, polylactic resorbable membranes and acellular dermal matrix membranes (AMDG). The analysis demonstrated that resorbable membranes result in higher values of new bone formation and lower values of residual particles and SCT. Xenograft resulted in lower new bone formation compared to allograft; however, no statistically significant differences were observed regarding residual particle and SCT. Overall, regeneration procedures adding autogenous bone, plasma derivate or growth factors achieved in general greater new bone formation and tissue gain. Conclusions: There is limited evidence favoring the effect of a certain type of barrier membrane in GBR. Data needs to be evaluated carefully; however, resorbable membranes are correlated with greater new bone formation values, especially when combined with allograft materials and/or the addition of autogenous bone, platelet reach plasma (PRP) or growth factors in the regeneration area. More studies assessing the histological outcomes of different GBR protocols and procedures testing different biomaterials are needed to maximize the clinical and histological outcomes in bone regeneration science.

Keywords: barrier membrane, graft material, guided bone regeneration, implant surgery, histology

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3323 Principles and Guidance for the Last Days of Life: Te Ara Whakapiri

Authors: Tania Chalton

Abstract:

In June 2013, an independent review of the Liverpool Care Pathway (LCP) identified a number of problems with the implementation of the LCP in the UK and recommended that it be replaced by individual care plans for each patient. As a result of the UK findings, in November 2013 the Ministry of Health (MOH) commissioned the Palliative Care Council to initiate a programme of work to investigate an appropriate approach for the care of people in their last days of life in New Zealand (NZ). The Last Days of Life Working Group commenced a process to develop national consensus on the care of people in their last days of life in April 2014. In order to develop its advice for the future provision of care to people in their last days of life, the Working Group (WG) established a comprehensive work programme and as a result has developed a series of working papers. Specific areas of focus included: An analysis of the UK Independent Review findings and an assessment of these findings to the NZ context. A stocktake of services providing care to people in their last days of life, including aged residential care (ARC); hospices; hospitals; and primary care. International and NZ literature reviews of evidence and best practice. Survey of family to understand the consumer perspective on the care of people in their last days of life. Key aspects of care that required further considerations for NZ were: Terminology: clarify terminology used in the last days of life and in relation to death and dying. Evidenced based: including specific review of evidence regarding, spiritual, culturally appropriate care as well as dementia care. Diagnosis of dying: need for both guidance around the diagnosis of dying and communication with family. Workforce issues: access to an appropriate workforce after hours. Nutrition and hydration: guidance around appropriate approaches to nutrition and hydration. Symptom and pain management: guidance around symptom management. Documentation: documentation of the person’s care which is robust enough for data collection and auditing requirements, not ‘tick box’ approach to care. Education and training: improved consistency and access to appropriate education and training. Leadership: A dedicated team or person to support and coordinate the introduction and implementation of any last days of life model of care. Quality indicators and data collection: model of care to enable auditing and regular reviews to ensure on-going quality improvement. Cultural and spiritual: address and incorporate any cultural and spiritual aspects. A final document was developed incorporating all the evidence which provides guidance to the health sector on best practice for people at end of life: “Principles and guidance for the last days of life: Te Ara Whakapiri”.

Keywords: end of life, guidelines, New Zealand, palliative care

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3322 Towards the Concept of Global Health Nursing

Authors: Nuruddeen Abubakar Adamu

Abstract:

Background: Global health nursing describes health-related work across borders and focuses more on the differences between the nurses’ role between countries and identified why nursing care in particular country differs from another. It also helps in analyzing the health issues and concerns that transcend national borders class, race, ethnicity and culture. The primary objective of this study is to introduce the concept of global health nursing. And the article also argues for the need for global health nursing. Methods This review assesses available evidence, both published and unpublished, on issues relating to the global health nursing and the nurse's role in global health. The review is qualitative based. Results: Globalization, modern technologies, travel, migration and changes in diseases trend globally has made the nursing role to become more diverse and less traditional. These issues change the nurse’s role in the healthcare industry to become enormous and very challenging. This article considers response to issues of emerging global health nursing concept, challenges, purposes, global health nursing activities in both developed and developing countries and the nurse's role globally in maternal-newborn health; preparedness for advocacy in global health within a framework of social justice, equity; and health system strengthening globally. Conclusion: Global health nursing goes beyond the intervention to care for a patient with a particular health problem but, however health is interconnected to political, economic and social context and therefore this explains the need of a multi-professional and multi-sectoral approach to achieve the goal of global health and the need for global health nursing. Global health equity can be promoted and if the profile of nursing and nurses will be raised and enable nurses to be aware of global health issues so as to enable them to work to their full maximum potential, to attain greater health outcome and wellness.

Keywords: global health nursing, double burden of diseases, globalization, health equity

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3321 Silver Nanoparticle Application in Food Packaging and Impacts on Food Safety and Consumer’s Health

Authors: Worku Dejene Bekele, András Marczika Csilla Sörös

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Silver nanoparticles are silver metal with a size of 1-100nm. The most common source of silver nanoparticles is inorganic salts. Nanoparticles can be ingested through our foods and constitute nanoparticles and silver ions, whether as an additive or by migrants and, in some cases, as a pollutant. Silver nanoparticles are the most widely applicable engineered nanomaterials, especially for antimicrobial function. Ag nanoparticles give different advantages in the case of food safety, quality, and overall acceptability; however, they affect the health of humans and animals, putting them at risk of health problems and environmental pollution. Silver nanoparticles have been used widely in food packaging technologies, especially in water treatments, meat and meat products, fruit, and many other food products. This is for bio-preservation from food products. The primary goal of this review is to determine the safety and health impact of Ag nanoparticles application in food packaging and analysis of the human organs more affected by this preservative technology, to assess the implications of a nanoparticle on food safety, to determine the effects of nanoparticles on consumers health and to determine the impact of nanotechnology on product acceptability. But currently, much research has demonstrated that there is cause to believe that silver nanoparticles may have toxicological effects on biological organs and systems. The silver nanoparticles affect DNA expression, gastrointestinal barriers, lungs, and other breathing organs illness. Silver particles and molecules are very toxic. During its application in food packaging, food industries used the thinnest particle. This particle can potentially affect the gastrointestinal tracts-it suffers from mucus production, DNA, lungs, and other breezing organs. This review is targeted to demonstrate the knowledge gap that industrials use in the application of silver nanoparticles in food packaging and preservation and its health effects on the consumer.

Keywords: food preservatives, health impact, nanoparticle, silver nanoparticle

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3320 A Review of Deep Learning Methods in Computer-Aided Detection and Diagnosis Systems based on Whole Mammogram and Ultrasound Scan Classification

Authors: Ian Omung'a

Abstract:

Breast cancer remains to be one of the deadliest cancers for women worldwide, with the risk of developing tumors being as high as 50 percent in Sub-Saharan African countries like Kenya. With as many as 42 percent of these cases set to be diagnosed late when cancer has metastasized and or the prognosis has become terminal, Full Field Digital [FFD] Mammography remains an effective screening technique that leads to early detection where in most cases, successful interventions can be made to control or eliminate the tumors altogether. FFD Mammograms have been proven to multiply more effective when used together with Computer-Aided Detection and Diagnosis [CADe] systems, relying on algorithmic implementations of Deep Learning techniques in Computer Vision to carry out deep pattern recognition that is comparable to the level of a human radiologist and decipher whether specific areas of interest in the mammogram scan image portray abnormalities if any and whether these abnormalities are indicative of a benign or malignant tumor. Within this paper, we review emergent Deep Learning techniques that will prove relevant to the development of State-of-The-Art FFD Mammogram CADe systems. These techniques will span self-supervised learning for context-encoded occlusion, self-supervised learning for pre-processing and labeling automation, as well as the creation of a standardized large-scale mammography dataset as a benchmark for CADe systems' evaluation. Finally, comparisons are drawn between existing practices that pre-date these techniques and how the development of CADe systems that incorporate them will be different.

Keywords: breast cancer diagnosis, computer aided detection and diagnosis, deep learning, whole mammogram classfication, ultrasound classification, computer vision

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3319 Role of Vision Centers in Eliminating Avoidable Blindness Caused Due to Uncorrected Refractive Error in Rural South India

Authors: Ranitha Guna Selvi D, Ramakrishnan R, Mohideen Abdul Kader

Abstract:

Purpose: To study the role of Vision centers in managing preventable blindness through refractive error correction in Rural South India. Methods: A retrospective analysis of patients attending 15 Vision centers in Rural South India from a period of January 2021 to December 2021 was done. Medical records of 10,85,81 patients both new and reviewed, 79,562 newly registered patients and 29,019 review patient’s from15 Vision centers were included for data analysis. All the patients registered at the vision center underwent basic eye examination, including visual acuity, IOP measurement, Slit-lamp examination, retinoscopy, Fundus examination etc. Results: A total of 1,08,581 patients were included in the study. Of the total 1,08,581 patients, 79,562 were newly registered patients at Vision center and 29,019 were review patients. Males were 52,201(48.1%) and Females were 56,308(51.9) among them. The mean age of all examined patients was 41.03 ± 20.9 years (Standard deviation) and ranged from 01 – 113 years. Presenting mean visual acuity was 0.31 ± 0.5 in the right eye and 0.31 ± 0.4 in the left eye. Of the 1,08,581 patients 22,770 patients had refractive error in right eye and 22,721 patients had uncorrected refractive error in left eye. Glass prescription was given to 17,178 (15.8%) patients. 8,109 (7.5%) patients were referred to the base hospital for specialty clinic expert opinion or for cataract surgery. Conclusion: Vision center utilizing teleconsultation for comprehensive eye screening unit is a very effective tool in reducing the avoidable visual impairment caused due to uncorrected refractive error. Vision Centre model is believed to be efficient as it facilitates early detection and management of uncorrected refractive errors.

Keywords: refractive error, uncorrected refractive error, vision center, vision technician, teleconsultation

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3318 Carbohydrate-Based Recommendations as a Basis for Dietary Guidelines

Authors: A. E. Buyken, D. J. Mela, P. Dussort, I. T. Johnson, I. A. Macdonald, A. Piekarz, J. D. Stowell, F. Brouns

Abstract:

Recently a number of renewed dietary guidelines have been published by various health authorities. The aim of the present work was 1) to review the processes (systematic approach/review, inclusion of public consultation) and methodological approaches used to identify and select the underpinning evidence base for the established recommendations for total carbohydrate (CHO), fiber and sugar consumption, and 2) examine how differences in the methods and processes applied may have influenced the final recommendations. A search of WHO, US, Canada, Australia and European sources identified 13 authoritative dietary guidelines with the desired detailed information. Each of these guidelines was evaluated for its scientific basis (types and grading of the evidence) and the processes by which the guidelines were developed Based on the data retrieved the following conclusions can be drawn: 1) Generally, a relatively high total CHO and fiber intake and limited intake of sugars (added or free) is recommended. 2) Even where recommendations are quite similar, the specific, justifications for quantitative/qualitative recommendations differ across authorities. 3) Differences appear to be due to inconsistencies in underlying definitions of CHO exposure and in the concurrent appraisal of CHO-providing foods and nutrients as well the choice and number of health outcomes selected for the evidence appraisal. 4) Differences in the selected articles, time frames or data aggregation method appeared to be of rather minor influence. From this assessment, the main recommendations are for: 1) more explicit quantitative justifications for numerical guidelines and communication of uncertainty; and 2) greater international harmonization, particularly with regard to underlying definitions of exposures and range of relevant nutrition-related outcomes.

Keywords: carbohydrates, dietary fibres, dietary guidelines, recommendations, sugars

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3317 Film Review of 'Heroic Saviours and Survivors': The Representation of Sex Trafficking in Popular Films in India

Authors: Nisha James, Shubha Ranganathan

Abstract:

One of the most poignant forms of organized crime against women, which has rarely made it to the world of Indian cinema, is that of sex trafficking, i.e. the forcible involvement of women in the sex trade through fraud or coercion (Hughes, 2005). In the space of Indian cinema, much of the spotlight has been on the sensational drug trafficking and gang mafia of Bombay. During our research on sex trafficking, the rehabilitated women interviewed often expressed strong criticism about mass media’s naive portrayal of prostitutes as money-minting, happy and sexually driven women. They argued that this unrealistic portrayal ignored the fact that this was not a reality for the majority of trafficked women. Given the gravity of sex trafficking as a human rights issue, it is, therefore, refreshing to see three recent films on sex trafficking in Indian Languages – Naa Bangaaru Talli (2014, Telugu), Mardaani (2014, Hindi) and Lakshmi (2014, Hindi). This paper reviews these three films to explore the portrayal of the everyday reality of trafficking for women. Film analysis was used to understand the representation of psychological issues in the media. The strength of these movies starts with their inspirations which are of true stories and that they are all aimed at bringing awareness about the issue of sex trafficking, which is a rising social evil in Indian society though none of the three films move to portray the next phase of rehabilitation and reintegration of victims, which is a very complex and important process in the life of a survivor. According to findings, survivors of sex trafficking find the rehabilitation and reintegration into society to be a slow and tough part of their life as they continuously face stigma and social exclusion and have to strive to live against all odds of non-acceptance starting from their family.

Keywords: film review, Indian films, sex trafficking, survivors

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3316 Strategies for Tackling Climate Change: Review of Sustainability and Air-Conditioning

Authors: Tosin T. Oye, Keng Goh, Naren Gupta, Toyosi K. Oye

Abstract:

One of the most extreme difficulties confronting humankind in the twenty-first century is the consumption of energy. Non-renewable energy sources have been the fundamental energy assets for human culture. The consumption of energy sources emanating from the use of air-conditioning is still causing and has caused harm to the environment and human health. The request for energy could be double or perhaps triple in the future because of the utilization of air-conditioning systems as the worldwide population develops and emerging districts grow their economics. This has recently raised worries in sustainable development over climate change, global warming, ozone layer reduction, health issues, and possible supply problems. As a result of the improvement of way of life, air-conditioning has generally been applied. Nevertheless, environmental pollutions and health issues related with the use of air-conditioning unfolds more as often as possible. In order to diminish their level of undesirable impact on the environment, it is essential to establish suitable strategies for tackling climate change. Therefore, this paper aims to review and analyze studies in sustainability and air- conditioning and subsequently suggest strategies for combatting climate change. Future perspectives for tackling climate change are likewise suggested. The key findings revealed that it is required to establish sustainability measures to reduce the level of energy consumption and carbon emissions in a bid to effectively tackle climate change and its impact on the environment, and then raise public alertness towards the adverse impact of climate change arising from the use of air-conditioning systems. The research outcome offers valuable awareness to the general public, organizations, policymakers, and the government in making future municipal zones sustainable and more climate resilient.

Keywords: air-conditioning, climate change, environment, human health, sustainability

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3315 A Clinical Study of Tracheobronchopathia Osteochondroplastica: Findings from a Large Chinese Cohort

Authors: Ying Zhu, Ning Wu, Hai-Dong Huang, Yu-Chao Dong, Qin-Ying Sun, Wei Zhang, Qin Wang, Qiang Li

Abstract:

Background and study aims: Tracheobronchopathia osteochondroplastica (TO) is an uncommon disease of the tracheobronchial system that leads to narrowing of the airway lumen from cartilaginous and/or osseous submucosal nodules. The aim of this study is to perform a detailed review of this rare disease in a large cohort of patients with TO proven by fiberoptic bronchoscopy from China. Patients and Methods: Retrospective chart review was performed on 41,600 patients who underwent bronchoscopy in the Department of Respiratory Medicine of Changhai Hospital between January 2005 and December 2012. Cases of TO were identified based on characteristic features during bronchoscopic examination. Results: 22 cases of bronchoscopic TO were identified. Among whom one-half were male and the mean age was 47.45 ±10.91 years old. The most frequent symptoms at presentation were chronic cough (n=14) and increased sputum production (n=10). Radiographic abnormalities were observed in 3/18 patients and findings on computed tomography consistent with TO such as beaded intraluminal calcifications and/or increased luminal thickenings were observed in 18/22 patients. Patients were classified into the following categories based on the severity of bronchoscopic findings: Stage I (n=2), Stage II (n=6) and Stage III(n=14). The result that bronchoscopic improvement was observed in 2 patients administered with inhaled corticosteroids suggested that resolution of this disease is possible. Conclusions: TO is a benign disease with slow progression, which could be roughly divided into 3 stages on the basis of the characteristic endoscopic features and histopathologic findings. Chronic inflammation was thought to be more important than the other existing plausible hypotheses in the course of TO. Inhaled corticosteroids might have some impact on patients at Stage I/II.

Keywords: airway obstruction, bronchoscopy, etiology, Tracheobronchopathia osteochondroplastica (TO), treatment

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3314 Technologies of Isolation and Separation of Anthraquinone Derivatives

Authors: Dmitry Yu. Korulkin, Raissa A. Muzychkina

Abstract:

In review the generalized data about different methods of extraction, separation and purification of natural and modify anthraquinones is presented. The basic regularity of an isolation process is analyzed. Action of temperature, pH, and polarity of extragent, catalysts and other factors on an isolation process is revealed.

Keywords: anthraquinones; isolation; extraction; polarity; chromatography; precipitation; bioactivity; phytopreparation; chrysophanol; aloe-emodin; emodin; physcion.

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3313 The Effect of an Abnormal Prefrontal Cortex on the Symptoms of Attention Deficit/Hyperactivity Disorder

Authors: Irene M. Arora

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Hypothesis: Attention Deficit Hyperactivity Disorder is the result of an underdeveloped prefrontal cortex which is the primary cause for the signs and symptoms seen as defining features of ADHD. Methods: Through ‘PubMed’, ‘Wiley’ and ‘Google Scholar’ studies published between 2011-2018 were evaluated, determining if a dysfunctional prefrontal cortex caused the characteristic symptoms associated with ADHD. The search terms "prefrontal cortex", "Attention-Deficit/Hyperactivity Disorder", "cognitive control", "frontostriatal tract" among others, were used to maximize the assortment of relevant studies. Excluded papers were systematic reviews, meta-analyses and publications published before 2010 to ensure clinical relevance. Results: Nine publications were analyzed in this review, all of which were non-randomized matched control studies. Three studies found a decrease in the functional integrity of the frontostriatal tract fibers in conjunction with four studies finding impaired frontal cortex stimulation. Prefrontal dysfunction, specifically medial and orbitofrontal areas, displayed abnormal functionality of reward processing in ADHD patients when compared to their normal counterparts. A total of 807 subjects were studied in this review, yielding that a little over half (54%) presented with remission of symptoms in adulthood. Conclusion: While the prefrontal cortex shows the highest consistency of impaired activity and thinner volumes in patients with ADHD, this is a heterogenous disorder implicating its pathophysiology to the dysfunction of other neural structures as well. However, remission of ADHD symptomatology in adulthood was found to be attributable to increased prefrontal functional connectivity and integration, suggesting a key role for the prefrontal cortex in the development of ADHD.

Keywords: prefrontal cortex, ADHD, inattentive, impulsivity, reward processing

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3312 The Association between Prior Antibiotic Use and Subsequent Risk of Infectious Disease: A Systematic Review

Authors: Umer Malik, David Armstrong, Mark Ashworth, Alex Dregan, Veline L'Esperance, Lucy McDonnell, Mariam Molokhia, Patrick White

Abstract:

Introduction: The microbiota lining epithelial surfaces is thought to play an important role in many human physiological functions including defense against pathogens and modulation of immune response. The microbiota is susceptible to disruption from external influences such as exposure to antibiotic medication. It is thought that antibiotic-induced disruption of the microbiota could predispose to pathogen overgrowth and invasion. We hypothesized that antibiotic use would be associated with increased risk of future infections. We carried out a systematic review of evidence of associations between antibiotic use and subsequent risk of community-acquired infections. Methods: We conducted a review of the literature for observational studies assessing the association between antibiotic use and subsequent community-acquired infection. Eligible studies were published before April 29th, 2016. We searched MEDLINE, EMBASE, and Web of Science and screened titles and abstracts using a predefined search strategy. Infections caused by Clostridium difficile, drug-resistant organisms and fungal organisms were excluded as their association with prior antibiotic use has been examined in previous systematic reviews. Results: Eighteen out of 21,518 retrieved studies met the inclusion criteria. The association between past antibiotic exposure and subsequent increased risk of infection was reported in 16 studies, including one study on Campylobacter jejuni infection (Odds Ratio [OR] 3.3), two on typhoid fever (ORs 5.7 and 12.2), one on Staphylococcus aureus skin infection (OR 2.9), one on invasive pneumococcal disease (OR 1.57), one on recurrent furunculosis (OR 16.6), one on recurrent boils and abscesses (Risk ratio 1.4), one on upper respiratory tract infection (OR 2.3) and urinary tract infection (OR 1.1), one on invasive Haemophilus influenzae type b (Hib) infection (OR 1.51), one on infectious mastitis (OR 5.38), one on meningitis (OR 2.04) and five on Salmonella enteric infection (ORs 1.4, 1.59, 1.9, 2.3 and 3.8). The effect size in three studies on Salmonella enteric infection was of marginal statistical significance. A further two studies on Salmonella infection did not demonstrate a statistically significant association between prior antibiotic exposure and subsequent infection. Conclusion: We have found an association between past antibiotic exposure and subsequent risk of a diverse range of infections in the community setting. Our findings provide evidence to support the hypothesis that prior antibiotic usage may predispose to future infection risk, possibly through antibiotic-induced alteration of the microbiota. The findings add further weight to calls to minimize inappropriate antibiotic prescriptions.

Keywords: antibiotic, infection, risk factor, side effect

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3311 Evaluation of Railway Network and Service Performance Based on Transportation Sustainability in DKI Jakarta

Authors: Nur Bella Octoria Bella, Ayomi Dita Rarasati

Abstract:

DKI Jakarta is Indonesia's capital city with the 10th highest congestion rate in the world based on the 2019 traffic index. Other than that based on World Air Quality Report in 2019 showed DKI Jakarta's air pollutant concentrate 49.4 µg and the 5th highest air pollutant in the world. In the urban city nowadays, the mobility rate is high enough and the efficiency for sustainability assessment in transport infrastructure development is needed. This efficiency is the important key for sustainable infrastructure development. DKI Jakarta is nowadays in the process of constructing the railway infrastructure to support the transportation system. The problems appearing are the railway infrastructure networks and the service in DKI Jakarta already planned based on sustainability factors or not. Therefore, the aim of this research is to make the evaluation of railways infrastructure networks performance and services in DKI Jakarta regards on the railway sustainability key factors. Further, this evaluation will be used to make the railway sustainability assessment framework and to offer some of the alternative solutions to improve railway transportation sustainability in DKI Jakarta. Firstly a very detailed literature review of papers that have focused on railway sustainability factors and their improvements of railway sustainability, published in the scientific journal in the period 2011 until 2021. Regarding the sustainability factors from the literature review, further, it is used to assess the current condition of railway infrastructure in DKI Jakarta. The evaluation will be using a Likert rate questionnaire and directed to the transportation railway expert and the passenger. Furthermore, the mapping and evaluation rate based on the sustainability factors will be compared to the effect factors using the Analytical Hierarchical Process (AHP). This research offers the network's performance and service rate impact on the sustainability aspect and the passenger willingness for using the rail public transportation in DKI Jakarta.

Keywords: transportation sustainability, railway transportation, sustainability, DKI Jakarta

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3310 Late Presentation of Pseudophakic Macula Edema from Oral Kinase Inhibitors: A Case and Literature Review

Authors: Christolyn Raj, Lewis Levitz

Abstract:

Introduction: Two cases of late presentation ( > five years ) of bilateral pseudophakic macula edema related to oral tyrosine kinase inhibitors are described. These cases are the first of their type in the published literature. A review of ocular inflammatory complications of tyrosine kinase inhibitors in the current literature is explored. Case Presentations(s): Case 1 is an 83-year-old female who has been stable on Ibrutinib (Imbruvica ®) for chronic lymphocytic leukemia (CLL). She presented with bilateral blurred vision from severe cystoid macula edema seven years following routine cataract surgery. She was treated with intravitreal steroids with complete resolution without relapse. Case 2 is a 76-year-old female who was on therapy for polycythemia vera with Ruxolitinib (Jakafi®). She presented with bilateral blurred vision from mild cystoid macula edema six years following routine cataract surgery. She responded well to topical steroids without relapse. In both cases, oral tyrosine kinase inhibitor agents were presumed to be the underlying cause and were ceased. Over the last five years, there have been increasing reports in the literature of the inflammatory effects of tyrosine kinase inhibitors on the retina, uvea and optic nerve. Conclusion: Late presentation of pseudophakic macula edema following routine cataract surgery is rare. Such presentations should prompt investigation of the chronic use of systemic medications, especially oral kinase inhibitors. Patients who must remain on these agents require ongoing ophthalmologic assessment in view of their long-term inflammatory side effects.

Keywords: macula edema, oral kinase inhibitors, retinal toxicity, pseudo-phakia

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3309 Transcranial and Sacral Magnetic Stimulation as a Therapeutic Resource for Urinary Incontinence – A Brief Bibliographic Review

Authors: Ana Lucia Molina

Abstract:

Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique for the investigation and modulation of cortical excitability in humans. The modulation of the processing of different cortical areas can result in several areas for rehabilitation, showing great potential in the treatment of motor disorders. In the human brain, the supplementary motor area (SMA) is involved in the control of the pelvic floor muscles (MAP), where dysfunctions of these muscles can lead to urinary incontinence. Peripheral magnetic stimulation, specifically sacral magnetic stimulation, has been used as a safe and effective treatment option for patients with lower urinary tract dysfunction. A systematic literature review was carried out (Pubmed, Medline and Google academic database) without a time limit using the keywords: "transcranial magnetic stimulation", "sacral neuromodulation", and "urinary incontinence", where 11 articles attended to the inclusion criteria. Results: Thirteen articles were selected. Magnetic stimulation is a non-invasive neuromodulation technique widely used in the evaluation of cortical areas and their respective peripheral areas, as well as in the treatment of lesions of brain origin. With regard to pelvic-perineal disorders, repetitive transcranial stimulation showed significant effects in controlling urinary incontinence, as well as sacral peripheral magnetic stimulation, in addition to exerting the potential to restore bladder sphincter function. Conclusion: Data from the literature suggest that both transcranial stimulation and peripheral stimulation are non-invasive references that can be promising and effective means of treatment in pelvic and perineal disorders. More prospective and randomized studies on a larger scale are needed, adapting the most appropriate and resolving parameters.

Keywords: urinary incontinence, non-invasive neuromodulation, sacral neuromodulation, transcranial magnetic stimulation.

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3308 Sceletium Tortuosum: A review on its Phytochemistry, Pharmacokinetics, Biological and Clinical Activities

Authors: Tomi Lois Olatunji, Frances Siebert, Ademola Emmanuel Adetunji, Brian Harvey, Johane Gericke, Josias Hamman, Frank Van Der Kooy

Abstract:

Ethnopharmacological relevance: Sceletium tortuosum (L.) N.E.Br, the most sought after and widely researched species in the genus Sceletium is a succulent forb endemic to South Africa. Traditionally, this medicinal plant is mainly masticated or smoked and used for the relief of toothache, abdominal pain, and as a mood-elevator, analgesic, hypnotic, anxiolytic, thirst and hunger suppressant, and for its intoxicating/euphoric effects. Sceletium tortuosum is currently of widespread scientific interest due to its clinical potential in treating anxiety and depression, relieving stress in healthy individuals, and enhancing cognitive functions. These pharmacological actions are attributed to its phytochemical constituents referred to as mesembrine-type alkaloids. Aim of the review: The aim of this review was to comprehensively summarize and critically evaluate recent research advances on the phytochemistry, pharmacokinetics, biological and clinical activities of the medicinal plant S. tortuosum. Additionally, current ongoing research and future perspectives are also discussed. Methods: All relevant scientific articles, books, MSc and Ph.D. dissertations on botany, behavioral pharmacology, traditional uses, and phytochemistry of S. tortuosum were retrieved from different databases (including Science Direct, PubMed, Google Scholar, Scopus and Web of Science). For pharmacokinetics and pharmacological effects of S. tortuosum, the focus fell on relevant publications published between 2009 and 2021. Results: Twenty-five alkaloids belonging to four structural classes viz: mesembrine, Sceletium A4, joubertiamine, and tortuosamine, have been identified from S. tortuosum, of which the mesembrine class is predominant. The crude extracts and commercially available standardized extracts of S. tortuosum have displayed a wide spectrum of biological activities (e.g. antimalarial, anti-oxidant, immunomodulatory, anti-HIV, neuroprotection, enhancement of cognitive function) in in vitro or in vivo studies. This plant has not yet been studied in a clinical population, but has potential for enhancing cognitive function, and managing anxiety and depression. Conclusion: As an important South African medicinal plant, S. tortuosum has garnered many research advances on its phytochemistry and biological activities over the last decade. These scientific studies have shown that S. tortuosum has various bioactivities. The findings have further established the link between the phytochemistry and pharmacological application, and support the traditional use of S. tortuosum in the indigenous medicine of South Africa.

Keywords: Aizoaceae, Mesembrine, Serotonin, Sceletium tortuosum, Zembrin®, psychoactive, antidepressant

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3307 Review of State Anti-Trafficking Laws in the United States of America and Their Success in Combating Human Trafficking and Protecting the Victims

Authors: Andrea Marcela Morales Reyes

Abstract:

In the year 2000, the federal government of the United States of America enacted anti-trafficking legislation to prevent human trafficking, prosecute traffickers, and protect the victims. Since then, all 50 states have followed the federal government's example by enacting state-level anti-trafficking legislation. In order to fight human trafficking in the United States, it is paramount that this legislation is not only comprehensively enacted but also enforced. This study reviewed the anti-trafficking laws enacted in each of the 50 states and investigated the success of such laws by reporting the number of trafficking related prosecutions, cases identified, and victims protected. This study reviewed human trafficking reports issued by nonprofits, and state and federal level agencies. An increase in the number of cases investigated since the state laws have been passed reflects a moderate success in the fight against human trafficking in the U.S. This review also found that although every state has passed anti-trafficking legislation, many still lack a comprehensive approach to combat human trafficking; some states lack key provisions to prevent human trafficking, prosecute traffickers, and protect it victims. This, along with the lack of enforcement of the anti-trafficking plans included in each of the state legislations, has meant that the human trafficking cases investigated in fiscal year 2016 are not near the estimated numbers; which in turn suggests that this crime is still greatly unaccounted for. This study concludes that although important steps have been taken at the national and state level to combat human trafficking, the identification and prosecution of human trafficking cases still proves challenging in the United States.

Keywords: enforcement of laws, human trafficking, anti-trafficking legislation, United States

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3306 Water Quality, Safety and Drowning Prevention to Preschool Children in Sub-Saharan Africa

Authors: Amos King'ori Githu

Abstract:

Water safety is crucial for all ages, but particularly for children. In the past decade, preschool institutions in Sub-Saharan Africa have seen the inclusion of swimming as one of the co-curricular activities. However, these countries face challenges in adopting frameworks, staffing, and resources to heighten water safety, quality, and drowning prevention, hence the focus of this research. It is worth noting that drowning is a leading cause of injury-related deaths among children. Universally, the highest drowning rates occur among children aged 1-4 years and 5-9 years. Preschool children even stand a higher risk of drowning as they are active, eager, and curious to explore their environment. If not supervised closely around or in water, these children can drown quickly in just a few inches of water. Thus, this empirical review focuses on the identification, assessment, and analysis of water safety efforts to curb drowning among children and assess the quality of water to mitigate contamination that may eventually pose infection risks to the children. In addition, it outlines the use of behavioral theories and evaluation frameworks to guide the above. Notably, a search on ten databases was adopted for crucial peer-reviewed articles, and five were selected in the eventual review. This research relied extensively on secondary data to curb water infections and drowning-inflicted deaths among children. It suffices to say that interventions must be supported that adopt an array of strategies, are guided by planning and theory as well as evaluation frameworks, and are vast in intervention design, evaluation, and delivery methodology. Finally, this approach will offer solid evidence that can be shared to guide future practices and policies in preschools on child safety and drowning prevention.

Keywords: water quality and safety, drowning prevention, preschool children, sub-saharan Africa, supervision

Procedia PDF Downloads 41
3305 An Integrative Review on the Experiences of Integration of Quality Assurance Systems in Universities

Authors: Laura Mion

Abstract:

Concepts of quality assurance and management are now part of the organizational culture of the Universities. Quality Assurance (QA) systems are, in large part, provided for by national regulatory dictates or supranational indications (such as, for example, at European level are, the ESG Guidelines "European Standard Guidelines"), but their specific definition, in terms of guiding principles, requirements and methodologies, are often delegated to the national evaluation agencies or to the autonomy of individual universities. For this reason, the experiences of implementation of QA systems in different countries and in different universities is an interesting source of information to understand how quality in universities is understood, pursued and verified. The literature often deals with the treatment of the experiences of implementation of QA systems in the individual areas in which the University's activity is carried out - teaching, research, third mission - but only rarely considers quality systems with a systemic and integrated approach, which allows to correlate subjects, actions, and performance in a virtuous circuit of continuous improvement. In particular, it is interesting to understand how to relate the results and uses of the QA in the triple distinction of university activities, identifying how one can cause the performance of the other as a function of an integrated whole and not as an exploit of specific activities or processes conceived in an abstractly atomistic way. The aim of the research is, therefore, to investigate which experiences of "integrated" QA systems are present on the international scene: starting from the experience of European countries that have long shared the Bologna Process for the creation of a European space for Higher Education (EHEA), but also considering experiences from emerging countries that use QA processes to develop their higher education systems to keep them up to date with international levels. The concept of "integration", in this research, is understood in a double meaning: i) between the different areas of activity, in particular between the didactic and research areas, and possibly with the so-called "third mission" "ii) the functional integration between those involved in quality assessment and management and the governance of the University. The paper will present the results of a systematic review conducted according with a method of an integrative review aimed at identifying best practices of quality assurance systems, in individual countries or individual universities, with a high level of integration. The analysis of the material thus obtained has made it possible to grasp common and transversal elements of QA system integration practices or particularly interesting elements and strengths of these experiences that can, therefore, be considered as winning aspects in a QA practice. The paper will present the method of analysis carried out, and the characteristics of the experiences identified, of which the structural elements will be highlighted (level of integration, areas considered, organizational levels included, etc.) and the elements for which these experiences can be considered as best practices.

Keywords: quality assurance, university, integration, country

Procedia PDF Downloads 69
3304 Characterizing Multivariate Thresholds in Industrial Engineering

Authors: Ali E. Abbas

Abstract:

This paper highlights some of the normative issues that might result by setting independent thresholds in risk analyses and particularly with safety regions. A second objective is to explain how such regions can be specified appropriately in a meaningful way. We start with a review of the importance of setting deterministic trade-offs among target requirements. We then show how to determine safety regions for risk analysis appropriately using utility functions.

Keywords: decision analysis, thresholds, risk, reliability

Procedia PDF Downloads 295
3303 Pharmacological Activities and Potential Uses of Cyperus Rotundus: A Review

Authors: Arslan Masood Pirzada, Muhammad Naeem, Hafiz Haider Ali, Muhammad Latif, Aown Sammar Raza, Asad Hussain Bukhari, Muhammad Saqib, Muhammad Ijaz

Abstract:

Cyperus rotundus (Cyperaceae), a medicinal herb, is being traditionally used as a home remedy for the treatment of various clinical conditions like diarrhea, diabetic, pyretic, inflammation, malaria, and for treating stomach and bowel disorders. Its current status is one of the most widespread, troublesome, and economically damaging agronomic weeds, growing wildly in various tropical and sub-tropical regions of the world. Tuber and rhizomes of Cyperus rotundus possess a higher concentration of active ingredients in the form of essential oils, phenolic acids, ascorbic acids and flavonoids, responsible for its remedial properties. Exploitation of any medicinal plant application depends on the crucial and comprehensive information about the therapeutic potential of a plant. Researchers have evaluated and characterized the significance of Cyperus rotundus as an anti-androgenic, anti-bacterial, anti-cancerous, anti-convulsant, anti-diabetic, anti-diarrheal, anti-genotoxic, anti-inflammatory, anti-lipidemic, anti-malarial, anti-mutagenic, anti-obesity, anti-oxidant, anti-uropathogenic, hepato-, cardio-, neuroprotective, and nootropic agent. This paper comprises a broad review to summarize the current state of knowledge about chemical constituents, potential economic uses and therapeutic aspects of Cyperus rotundus that will aid in the development of bioethanol and modern herbal medicine through latest technologies that will promote the ability of this plant in the cure of many clinical disorders.

Keywords: purple nutsedge, chemical composition, economic uses, therapeutic values, future directions

Procedia PDF Downloads 500
3302 Modeling Factors Influencing Online Shopping Intention among Consumers in Nigeria: A Proposed Framework

Authors: Abubakar Mukhtar Yakasai, Muhammad Tahir Jan

Abstract:

Purpose: This paper is aimed at exploring factors influencing online shopping intention among the young consumers in Nigeria. Design/Methodology/approach: The paper adopted and extended Technology Acceptance Model (TAM) as the basis for literature review. Additionally, the paper proposed a framework with the inclusion of culture as a moderating factor of consumer online shopping intention among consumers in Nigeria. Findings: Despite high rate of internet penetration in Nigerian, as well as the rapid advancement of online shopping in the world, little attention was paid to this important revolution specifically among Nigeria’s consumers. Based on the review of extant literature, the TAM extended to include perceived risk and enjoyment (PR and PE) was discovered to be a better alternative framework for predicting Nigeria’s young consumers’ online shopping intention. The moderating effect of culture in the proposed model is shown to help immensely in ascertaining differences, if any, between various cultural groups among online shoppers in Nigeria. Originality/ value: The critical analysis of different factors will assist practitioners (like online retailers, e-marketing managers, website developers, etc.) by signifying which combinations of factors can best predict consumer online shopping behaviour in particular instances, thereby resulting in effective value delivery. Online shopping is a newly adopted technology in Nigeria, hence the paper will give a clear focus for effective e-marketing strategy. In addition, the proposed framework in this paper will guide future researchers by providing a tool for systematic evaluation and testing of real empirical situation of online shopping in Nigeria.

Keywords: online shopping, perceived ease of use, perceived usefulness, perceived enjoyment, technology acceptance model, Nigeria

Procedia PDF Downloads 259
3301 Screening Diversity: Artificial Intelligence and Virtual Reality Strategies for Elevating Endangered African Languages in the Film and Television Industry

Authors: Samuel Ntsanwisi

Abstract:

This study investigates the transformative role of Artificial Intelligence (AI) and Virtual Reality (VR) in the preservation of endangered African languages. The study is contextualized within the film and television industry, highlighting disparities in screen representation for certain languages in South Africa, underscoring the need for increased visibility and preservation efforts; with globalization and cultural shifts posing significant threats to linguistic diversity, this research explores approaches to language preservation. By leveraging AI technologies, such as speech recognition, translation, and adaptive learning applications, and integrating VR for immersive and interactive experiences, the study aims to create a framework for teaching and passing on endangered African languages. Through digital documentation, interactive language learning applications, storytelling, and community engagement, the research demonstrates how these technologies can empower communities to revitalize their linguistic heritage. This study employs a dual-method approach, combining a rigorous literature review to analyse existing research on the convergence of AI, VR, and language preservation with primary data collection through interviews and surveys with ten filmmakers. The literature review establishes a solid foundation for understanding the current landscape, while interviews with filmmakers provide crucial real-world insights, enriching the study's depth. This balanced methodology ensures a comprehensive exploration of the intersection between AI, VR, and language preservation, offering both theoretical insights and practical perspectives from industry professionals.

Keywords: language preservation, endangered languages, artificial intelligence, virtual reality, interactive learning

Procedia PDF Downloads 45
3300 Reliability of Clinical Coding in Accurately Estimating the Actual Prevalence of Adverse Drug Event Admissions

Authors: Nisa Mohan

Abstract:

Adverse drug event (ADE) related hospital admissions are common among older people. The first step in prevention is accurately estimating the prevalence of ADE admissions. Clinical coding is an efficient method to estimate the prevalence of ADE admissions. The objective of the study is to estimate the rate of under-coding of ADE admissions in older people in New Zealand and to explore how clinical coders decide whether or not to code an admission as an ADE. There has not been any research in New Zealand to explore these areas. This study is done using a mixed-methods approach. Two common and serious ADEs in older people, namely bleeding and hypoglycaemia were selected for the study. In study 1, eight hundred medical records of people aged 65 years and above who are admitted to hospital due to bleeding and hypoglycemia during the years 2015 – 2016 were selected for quantitative retrospective medical records review. This selection was made to estimate the proportion of ADE-related bleeding and hypoglycemia admissions that are not coded as ADEs. These files were reviewed and recorded as to whether the admission was caused by an ADE. The hospital discharge data were reviewed to check whether all the ADE admissions identified in the records review were coded as ADEs, and the proportion of under-coding of ADE admissions was estimated. In study 2, thirteen clinical coders were selected to conduct qualitative semi-structured interviews using a general inductive approach. Participants were selected purposively based on their experience in clinical coding. Interview questions were designed in a way to investigate the reasons for the under-coding of ADE admissions. The records review study showed that 35% (Cl 28% - 44%) of the ADE-related bleeding admissions and 22% of the ADE-related hypoglycemia admissions were not coded as ADEs. Although the quality of clinical coding is high across New Zealand, a substantial proportion of ADE admissions were under-coded. This shows that clinical coding might under-estimate the actual prevalence of ADE related hospital admissions in New Zealand. The interviews with the clinical coders added that lack of time for searching for information to confirm an ADE admission, inadequate communication with clinicians, along with coders’ belief that an ADE is a small thing might be the potential reasons for the under-coding of the ADE admissions. This study urges the coding policymakers, auditors, and trainers to engage with the unconscious cognitive biases and short-cuts of the clinical coders. These results highlight that further work is needed on interventions to improve the clinical coding of ADE admissions, such as providing education to coders about the importance of ADEs, education to clinicians about the importance of clear and confirmed medical records entries, availing pharmacist service to improve the detection and clear documentation of ADE admissions and including a mandatory field in the discharge summary about external causes of diseases.

Keywords: adverse drug events, bleeding, clinical coders, clinical coding, hypoglycemia

Procedia PDF Downloads 113
3299 Measuring Quality of Participation Processes: A Literature Review and Case Study to Determine Criteria for the Influence of Digital Tools

Authors: Michaela Kaineder, Beate Bartlmae, Stefan Gaebler, Miriam Gutleder, Marlene Wuerfl

Abstract:

Digital tools and e-participation processes have seen a steady increase in popularity in recent years. While online trends come with the premise of new opportunities and easier participatory possibilities, there are still manifold challenges that smart city initiators and developers need to face. In this paper, innovative quality criteria of citizen participation processes was suggested by defining meaningful and measurable evaluation categories. Considering various developments, including the global megatrend of connectivity, a need for a fundamental examination of the basic structure of citizen participation processes was identified. To this end, the application of methods and tools through different points in the policy cycle is required. In order to provide an overview of the current challenges and problems in the field of participation, this paper analyzes those issues by carrying out a literature review that also focuses on disparities in the civic sector that might hinder residents in their desire for engagement. Additionally, a case study was chosen to demonstrate the potential that e-participation tools offer to planning experts and public authorities when integrating citizen’s creativity and experience at a large scale. This online co-creation process finally leads to offline events – such as local co-design workshops - with professional planners. The findings of this paper subsequently suggest a combination of e-participation and analogue forms to merge the benefits of both worlds, resulting in a broader audience and higher quality for participation processes.

Keywords: citizen participation, disparities, e-participation, integrated urban development, sustainable development goals, sustainable urban development

Procedia PDF Downloads 126
3298 The Role of Fluid Catalytic Cracking in Process Optimisation for Petroleum Refineries

Authors: Chinwendu R. Nnabalu, Gioia Falcone, Imma Bortone

Abstract:

Petroleum refining is a chemical process in which the raw material (crude oil) is converted to finished commercial products for end users. The fluid catalytic cracking (FCC) unit is a key asset in refineries, requiring optimised processes in the context of engineering design. Following the first stage of separation of crude oil in a distillation tower, an additional 40 per cent quantity is attainable in the gasoline pool with further conversion of the downgraded product of crude oil (residue from the distillation tower) using a catalyst in the FCC process. Effective removal of sulphur oxides, nitrogen oxides, carbon and heavy metals from FCC gasoline requires greater separation efficiency and involves an enormous environmental significance. The FCC unit is primarily a reactor and regeneration system which employs cyclone systems for separation.  Catalyst losses in FCC cyclones lead to high particulate matter emission on the regenerator side and fines carryover into the product on the reactor side. This paper aims at demonstrating the importance of FCC unit design criteria in terms of technical performance and compliance with environmental legislation. A systematic review of state-of-the-art FCC technology was carried out, identifying its key technical challenges and sources of emissions.  Case studies of petroleum refineries in Nigeria were assessed against selected global case studies. The review highlights the need for further modelling investigations to help improve FCC design to more effectively meet product specification requirements while complying with stricter environmental legislation.

Keywords: design, emission, fluid catalytic cracking, petroleum refineries

Procedia PDF Downloads 124
3297 A Review on Benzo(a)pyrene Emission Factors from Biomass Combustion

Authors: Franziska Klauser, Manuel Schwabl, Alexander Weissinger, Christoph Schmidl, Walter Haslinger, Anne Kasper-Giebl

Abstract:

Benzo(a)pyrene (BaP) is the most widely investigated representative of Polycyclic Aromatic Hydrocarbons (PAH) as well as one of the most toxic compounds in this group. Since 2013 in the European Union a limit value for BaP concentration in the ambient air is applied, which was set to a yearly average value of 1 ng m-3. Several reports show that in some regions, even where industry and traffic are of minor impact this threshold is regularly exceeded. This is taken as proof that biomass combustion for heating purposes contributes significantly to BaP pollution. Several investigations have been already carried out on the BaP emission behavior of biomass combustion furnaces, mostly focusing on a certain aspect like the influences from wood type, of operation type or of technology type. However, a superior view on emission patterns of BaP from biomass combustion and the aggregation of determined values also from recent studies is not presented so far. The combination of determined values allows a better understanding of the BaP emission behavior from biomass combustion. In this work the review conclusions are driven from the combination of outcomes from different publication. In two examples it was shown that technical progress leads to 10 to 100 fold lower BaP emission from modern furnaces compared to old technologies of equivalent type. It was also indicated that the operation with pellets or wood chips exhibits clearly lower BaP emission factors compared to operation with log wood. Although, the BaP emission level from automatic furnaces is strongly impacted by the kind of operation. This work delivers an overview on BaP emission factors from different biomass combustion appliances, from different operation modes and from the combustion of different fuel and wood types. The main impact factors are depicted, and suggestions for low BaP emission biomass combustion are derived. As one result possible investigation fields concerning BaP emissions from biomass combustion that seem to be most important to be clarified are suggested.

Keywords: benzo(a)pyrene, biomass, combustion, emission, pollution

Procedia PDF Downloads 344
3296 Ageing Patterns and Concerns in the Arabian Gulf: A Systematic Review

Authors: Asharaf Abdul Salam

Abstract:

Arabian Gulf countries have norms and rules different from others: having an exodus of male immigrant labor contract holders of age 20-60 years as a floating population. Such a demographic scenario camouflages population ageing. However, it is observed on examining vigilantly, not only in the native population but also in the general population. This research on population ageing in the Arabian Gulf examines ageing scenario and concerns through analyses of international databases (US Census Bureau and United Nations) and national level databases (Censuses and Surveys) apart from a review of published research. Transitions in demography and epidemiology lead to gains in life expectancy and thereby reductions in fertility, leading to ageing of the population in the region. Even after bringing adult immigrants, indices and age pyramids show an increasing ageing trend in the total population, demonstrating an ageing workforce. Besides, the exclusive native population analysis reveals a trend of expansive pyramids (pre-transitional stage) turning to constrictive (transition stage) and cylindrical (post-transition stage) shapes. Age-based indices such as the index of ageing, age dependency ratio, and median age confirm this trend. While the feminine nature of ageing is vivid, gains in life expectancy and causes of death in old age, indicating co-morbidity compression, are concerns to ageing. Preparations are in demand to cope with ageing from different dimensions, as explained in the United Nations Plans of Action. A strategy of strengthening informal care with supportive semi-formal and supplementary formal care networks would alleviate this crisis associated with population ageing.

Keywords: total versus native population, indices of ageing, age pyramids, feminine nature, comorbidity compression, strategic interventions

Procedia PDF Downloads 79
3295 Establishment of Virtual Fracture Clinic in Princess Royal Hospital Telford: Experience and Recommendations during the First 9 Months

Authors: Tahir Khaleeq, Patrick Lancaster, Keji Fakoya, Pedro Ferreira, Usman Ahmed

Abstract:

Introduction: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Materials and Methods: A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes. Results: In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were felt to have been referred inappropriately. Discussion: BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.

Keywords: virtual fracture clinic, lockdown, trauma and orthopaedics, Covid- 19

Procedia PDF Downloads 185