Search results for: clinical skills

Authors: K. Rowan

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In this paper, the author will discuss how developing a specialized orientation has improved nursing satisfaction and decrease the incidence of incivility among staff. With the predicted shortages in nursing, we must provide an environment that reflects the needs of the current workforce while also focusing on the sustainability of nursing. Each generation has different qualities and methods in which he or she prefers to learn. The Baby Boomer has a desire to share their knowledge. They feel that the quality of undergraduate nursing education has declined. Millennials have grown up with 'helicopter parents' and expect the preceptor to behave in the same manner. This information must be shared with the Baby Boomer, as it is these staff members who are passing the torch of perioperative nursing. Currently, nurse fellows are trained with the Association of periOperative Nurse’s Periop 101 program, with a didactic and clinical observation program. There is no specialized perioperative preceptor program. In creation of a preceptor program, the concept of Novice to Expert, communication techniques, dealing with horizontal violence and generational gap education is reviewed with the preceptor. The fellows are taught communication and de-escalation skills, and generational gaps information. The groups are then brought together for introductions and teamwork exercises. At the program’s core is the knowledge of generational differences. The preceptor training has increased preceptor satisfaction, as well as the new nurse fellows. The creation of a specialized education program has significantly decreased incivility amongst our nurses, all while increasing nursing satisfaction and improving nursing retention. This model of program can translate to all nursing specialties and assist in overcoming the impending shortage.

Keywords: baby boomers, education, generational gap, millennials, nursing, perioperative

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Authors: F. Arıkan, Z. Karakus

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Cancer is a widespread disease in the world and is the third reason of deaths among the chronic diseases. Educating patients and caregivers has a vital role for empowering them in managing disease and treatment's symptoms. Informing of the patients about their disease and treatment process decreases patient's distress and decisional conflicts, improves wellbeing of them, increase success of the treatment and survival. In this era, technological education methods are used for patients that have different chronic disease. Many studies indicated that especially web based patient education such as chronic obstructive lung disease; heart failure is more effective than printed materials. Web based education provide easiness to patients while they are reaching health services. It also has more advantages because of it decreases health cost and requirement of staff. It is thought that web based education may be beneficial method for cancer patient's empowerment in coping with the disease's symptoms. The aim of the study is evaluate the effectiveness of web based education for cancer patients' clinical outcomes.

Keywords: cancer patients, e-learning, nursing, web based education

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Authors: Tamphasana Wairokpam

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Inflammatory myopathies (IMs) have long been recognised as a heterogenous family of myopathies with acute, subacute, and sometimes chronic presentation and are potentially treatable. Necrotizing autoimmune myopathies (NAM) are a relatively new subset of myopathies. Patients generally present with subacute onset of proximal myopathy and significantly elevated creatinine kinase (CK) levels. It is being increasingly recognised that there are limitations to the independent diagnostic utility of muscle biopsy. Immunohistochemistry tests may reveal important information in these cases. The traditional classification of IMs failed to recognise NAM as a separate entity and did not adequately emphasize the diversity of IMs. This review and case report on NAM aims to highlight the heterogeneity of this entity and focus on the distinct clinical presentation, biopsy findings, specific auto-antibodies implicated, and available treatment options with prognosis. This article is a meta-analysis of literatures on NAM and a case report illustrating the clinical course, investigation and biopsy findings, antibodies implicated, and management of a patient with NAM. The main databases used for the search were Pubmed, Google Scholar, and Cochrane Library. Altogether, 67 publications have been taken as references. Two biomarkers, anti-signal recognition protein (SRP) and anti- hydroxyl methylglutaryl-coenzyme A reductase (HMGCR) Abs, have been found to have an association with NAM in about 2/3rd of cases. Interestingly, anti-SRP associated NAM appears to be more aggressive in its clinical course when compared to its anti-HMGCR associated counterpart. Biopsy shows muscle fibre necrosis without inflammation. There are reports of statin-induced NAM where progression of myopathy has been seen even after discontinuation of statins, pointing towards an underlying immune mechanism. Diagnosisng NAM is essential as it requires more aggressive immunotherapy than other types of IMs. Most cases are refractory to corticosteroid monotherapy. Immunosuppressive therapy with other immunotherapeutic agents such as IVIg, rituximab, mycophenolate mofetil, azathioprine has been explored and found to have a role in the treatment of NAM. In conclusion,given the heterogeneity of NAM, it appears that NAM is not just a single entity but consists of many different forms, despite the similarities in presentation and its classification remains an evolving field. A thorough understanding of underlying mechanism and the clinical correlation with antibodies associated with NAM is essential for efficacious management and disease prognostication.

Keywords: inflammatory myopathies, necrotising autoimmune myopathies, anti-SRP antibody, anti-HMGCR antibody, statin induced myopathy

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Authors: Krisztina Bohacs, Klaudia Markus

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To author’s best knowledge we are in absence of studies on cognitive program evaluation and we are certainly short of programs that prove to have high effect sizes with strong retention results. The purpose of our study was to investigate the effectiveness of a comprehensive cognitive training program, namely BrainRx. This cognitive rehabilitation program target and remediate seven core cognitive skills and related systems of sub-skills through repeated engagement in game-like mental procedures delivered one-on-one by a clinician, supplemented by digital training. A larger sample of children with learning disability were given pretest and post-test cognitive assessments. The experimental group completed a twenty-week cognitive training program in a BrainRx center. A matched control group received another twenty-week intervention with Feuerstein’s Instrumental Enrichment programs. A second matched control group did not receive training. As for pre- and post-test, we used a general intelligence test to assess IQ and a computer-based test battery for assessing cognition across the lifespan. Multiple regression analyses indicated that the experimental BrainRx treatment group had statistically significant higher outcomes in attention, working memory, processing speed, logic and reasoning, auditory processing, visual processing and long-term memory compared to the non-treatment control group with very large effect sizes. With the exception of logic and reasoning, the BrainRx treatment group realized significantly greater gains in six of the above given seven cognitive measures compared to the Feuerstein control group. Our one-year retention measures showed that all the cognitive training gains were above ninety percent with the greatest retention skills in visual processing, auditory processing, logic, and reasoning. The BrainRx program may be an effective tool to establish long-term cognitive changes in case of students with learning disabilities. Recommendations are made for treatment centers and special education institutions on the cognitive training of students with special needs. The importance of our study is that targeted, systematic, progressively loaded and intensive brain training approach may significantly change learning disabilities.

Keywords: cognitive rehabilitation training, cognitive skills, learning disability, permanent structural cognitive changes

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Authors: Christina Klippel, Lucia Pezzi, Silvio Neto, Rafael Bertani, Priscila Mendes, Flavio Machado, Aline Szeliga, Maria Cosendey, Adilson Mariz, Raquel Santos, Lys Bendett, Pedro Velasco, Thalita Rolleigh, Bruna Bellote, Daria Coelho, Bruna Martins, Julia Almeida, Juliana Cerqueira

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This project presents a framework for teaching intracranial pressure monitoring (ICP) concepts using a low-cost experimental model in a neurointensive care education program. Data concerning ICP monitoring contribute to the patient's clinical assessment and may dictate the course of action of a health team (nursing, medical staff) and influence decisions to determine the appropriate intervention. This study aims to present a safe method for teaching ICP monitoring to medical students in a Simulation Center. Methodology: Medical school teachers, along with students from the 4th year, built an experimental model for teaching ICP measurement. The model consists of a mannequin's head with a plastic bag inside simulating the cerebral ventricle and an inserted ventricular catheter connected to the ICP monitoring system. The bag simulating the ventricle can also be changed for others containing bloody or infected simulated cerebrospinal fluid. On the mannequin's ear, there is a blue point indicating the right place to set the "zero point" for accurate pressure reading. The educational program includes four steps: 1st - Students receive a script on ICP measurement for reading before training; 2nd - Students watch a video about the subject created in the Simulation Center demonstrating each step of the ICP monitoring and the proper care, such as: correct positioning of the patient, anatomical structures to establish the zero point for ICP measurement and a secure range of ICP; 3rd - Students train the procedure in the model. Teachers help students during training; 4th - Student assessment based on a checklist form. Feedback and correction of wrong actions. Results: Students expressed interest in learning ICP monitoring. Tests concerning the hit rate are still being performed. ICP's final results and video will be shown at the event. Conclusion: The study of intracranial pressure measurement based on an experimental model consists of an effective and controlled method of learning and research, more appropriate for teaching neurointensive care practices. Assessment based on a checklist form helps teachers keep track of student learning progress. This project offers medical students a safe method to develop intensive neurological monitoring skills for clinical assessment of patients with neurological disorders.

Keywords: neurology, intracranial pressure, medical education, simulation

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Authors: Inseon Ryoo, Soo Chin Kim, Hyena Jung, Sangil Suh

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Objectives: The purpose of this study is to evaluate the clinical significance of hyper-intense signal thyroid incidentalomas on the time of flight magnetic resonance angiography (TOF-MRA) using correlation study with ultrasound (US). Methods: We retrospectively reviewed 3,505 non-contrast TOF-MRA performed at an institution between September 2014 and May 2017. Two radiologists correlated the thyroid incidentalomas detected on TOF-MRA with US features which was obtained within three months interval between MRA and US examinations in consensus method. Results: The prevalence of hyper-intense signal thyroid nodules incidentally detected on TOF-MRA was 1.2% (43/3505). Among them, 35 people (81.4%) underwent US examinations, and total 45 hyper-intense signal thyroid nodules were detected on US exams. Of these 45 nodules, 35 nodules (72.9%) were categorized as benign (K-TIRADS category 2) on US exams. Fine needle aspiration was performed on 9 nodules according to the indications recommended by Korean Society of Thyroid Radiology. All except one high-suspicious thyroid nodule were confirmed as benign (Bethesda 2) on cytologic exams. One high-suspicious nodule on US showed a non-diagnostic result (Bethesda 1) on cytologic exam. However, this nodule collapsed after aspiration of thick colloid material. Conclusions: Our study showed that the most hyper-intense signal thyroid nodules detected on TOF-MRA were benign. Therefore, if a hyper-intense signal incidentaloma is found on TOF-MRA, further evaluation, especially invasive biopsy of the nodules could be suspended unless the patient had other symptoms or clinical factors suggesting the need for further evaluation.

Keywords: incidentaloma, thyroid nodule, TOF MR angiography, ultrasound

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Authors: Mohammed Islam

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Graduate employability is a well debated topic by governments, employers, and higher education institutes (HEI) across the world. Much of the focus of these debates have centred around the skills that graduates bring or should bring to the job market, a point echoed by United Arab Emirates (UAE) policy makers and employers. While some research has been carried out on graduates' employability skills, little or no attention has been paid to the forces at play in developing employability policy and its subsequent implementation. The focus of debate has been on a perceived skills gap rather than policy. Recognising a gap in the literature, this paper details a study of UAE employability policy development. Taking a social constructionist approach, this case study views policy as discursive and socially constructed through interactions with key stakeholders. It is within the myriad of interdependent socio-political factors and social practices, particularly power relationships, that this paper explores UAE policy on graduate employability. In doing so, this adds to the debate on graduate employability from the perspective of policy and explores its roots in the interaction between human activity and the ‘system’. Data was collected from two main sources: documentary review and semi-structured interviews. Policies and publicly stated rhetoric on graduate employability were analysed using Critical Discourse Analysis. Semi-structured interviews with representatives from policy makers, HEIs, and employers were reviewed through Thematic Analysis. The theoretical framework for the discussion of findings draws from social practice theories and highlights the factors at play in access to employment for UAE graduates. This case study presents a methodological approach to policy studies that can be applied beyond the context under investigation. Education policy researchers are provided with an opportunity to compare similarities and differences with their own specific contexts.

Keywords: critical discourse analysis, employability, methodology, policy, social constructionism

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Authors: Alexandra Shipley

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Background: Undergraduate paediatric teaching must overcome two major challenges: 1) balancing patient safety with active student engagement and 2) exposing students to a comprehensive range of pathologies within a relatively short clinical placement. Whilst lectures and shadowing on paediatric wards constitute the mainstay of learning, Simulation and Virtual Reality (VR) are emerging as effective teaching tools, which - immune to the unpredictability and seasonal variation of hospital presentations - could expose students to the entire syllabus more reliably, efficiently, and independently. We aim to evaluate the potential utility of Simulation and VR in addressing gaps within the traditional paediatric curriculum from the perspective of medical students. Summary of Work: Exposure to and perceived utility of various learning opportunities within the Paediatric and Emergency Medicine courses were assessed through a questionnaire completed by 5th year medical students (n=23). Summary of Results: Students reported limited exposure to several common acute paediatric presentations, such as bronchiolitis (41%), croup (32%) or pneumonia (14%), and to clinical emergencies, including cardiac/respiratory arrests or trauma calls (27%). Across all conditions, average self-reported confidence in assessment and management to the level expected of an FY1 is greater amongst those who observed at least one case (e.g. 7.6/10 compared with 3.6/10 for croup). Students rated exposure through Simulation or VR to be of similar utility to witnessing a clinical scenario on the ward. In free text responses, students unanimously favoured being ‘challenged’ through ‘hands-on’ patient interaction over passive shadowing, where it is ‘easy to zone out.’ In recognition of the fact that such independence is only appropriate in certain clinical situations, many students reported wanting more Simulation and VR teaching. Importantly, students raised the necessity of ‘proper debriefs’ after these sessions to maximise educational value. Discussion and Conclusion: Our questionnaire elicited several student-perceived challenges in paediatric education, including incomplete exposure to common pathologies and limited opportunities for active involvement in patient care. Indeed, these experiences seem to be important predictors of confidence. Quantitative and qualitative feedback suggests that VR and Simulation satisfy students’ self-reported appetite for independent engagement with authentic clinical scenarios. Take-aways: Our findings endorse further development of VR and Simulation as high-yield adjuncts to paediatric education.

Keywords: paediatric emergency education, simulation, virtual reality, medical education

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Authors: B. Parchem, M. Watanabe, D. Modrakovic, L. Mathew, A. Franklin, M. Cao, R. E. Broudy

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Objective: Executive functioning (EF) deficits underlie several mental health diagnoses including ADHD, anxiety, and depression. Community mental health clinics face extensive waitlists for services with many referrals involving EF deficits. A pilot trial of a four-week group therapy was developed using key components from Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and mindfulness with an aim to improve EF skills and offer low-fee services. Method: Eight adults (M = 34.5) waiting for services at a community clinic were enrolled in a four-week group therapy at an in-house training clinic for doctoral trainees. Baseline EF, pre-/post-intervention ADHD and distress symptoms, group satisfaction, and curriculum helpfulness were assessed. Results: Downward trends in ADHD and distress symptoms pre/post-intervention were not significant. Favorable responses on group satisfaction and helpfulness suggest clinical utility. Conclusion: Preliminary pilot data from a brief group therapy to improve EF may be an efficacious, acceptable, and feasible intervention for adults waiting for services at community mental health and training clinics where there are high demands and limits to services and staffs.

Keywords: executive functioning, cognitive-behavioral therapy, dialectical behavior therapy, mindfulness, adult group therapy

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Authors: Venkat Garigapati

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To date, more than a dozen oligonucleotide products are approved as injectable products for clinical use. However, there is no single oligo nucleotide product approved for clinical use. Oral delivery of oligo nucleotides is patient friendly administration however, many challenges involved in the development of oral formulation. Over the course of last twenty plus years, the research in this space aimed to address these challenges. This paper describes the issues involved in solubility, stability, enzymatic (nuclease) induced degradation, and permeation of nucleotides in the Gastrointestinal (GI) and how to overcome these challenges. Also, the translation of in vitro data to in vivo models hinders the formulation development. This paper describes the challenges involved in the development of Oligo Nucleotide products for oral administration. It also discusses the chemistry and formulation strategies for oral administration of oligonucleotides.

Keywords: oral adminstration, oligo nucleotides, stability, permeation, gastrointestinal tract

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Authors: Esra Danaci, Tugba Kavalali Erdogan, Sevil Masat, Selin Keskin Kiziltepe, Tugba Cinarli, Zeliha Koc

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This study was conducted in a descriptive and cross-sectional manner to determine that factors that influence the self-efficacy and self-sufficiency levels among oncology patients. The research was conducted between January 24, 2017 and September 24, 2017 in the oncology and hematology departments of a university hospital in Turkey with 179 voluntary inpatients. The data were collected through the Self-Sufficiency/Self-Efficacy Scale and a 29-question survey, which was prepared in order to determine the sociodemographic and clinical properties of the patients. The Self-Sufficiency/Self-Efficacy Scale is a Likert-type scale with 23 articles. The scale scores range between 23 and 115. A high final score indicates a good self-sufficiency/self-efficacy perception for the individual. The data were analyzed using percentage analysis, one-way ANOVA, Mann Whitney U-test, Kruskal Wallis test and Tukey test. The demographic data of the subjects were as follows: 57.5% were male and 42.5% were female, 82.7% were married, 46.4% were primary school graduate, 36.3% were housewives, 19% were employed, 93.3% had social security, 52.5% had matching expenses and incomes, 49.2% lived in the center of the city. The mean age was 57.1±14.6. It was determined that 22.3% of the patients had lung cancer, 19.6% had leukemia, and 43.6% had a good overall condition. The mean self-sufficiency/self-efficacy score was 83,00 (41-115). It was determined that the patients' self-sufficiency/self-efficacy scores were influenced by some of their socio-demographic and clinical properties. This study has found that the patients had high self-sufficiency/self-efficacy scores. It is recommended that the nursing care plans should be developed to improve their self-sufficiency/self-efficacy levels in the light of the patients' sociodemographic and clinical properties.

Keywords: oncology, patient, self-efficacy, self-sufficiency

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Authors: Yan Li

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Purpose: There is a lack of suitable recommendation systems to assist engineering teaching. The existing traditional engineering pedagogies lack learning interests for postgraduate students. The knowledge graph-based recommender system aims to enhance postgraduate students’ programming skills, with a focus on programming courses. Design/methodology/approach: The case study will be used as a major research method, and the two case studies will be taken in both two teaching styles of the universities (Zhejiang University and the University of Nottingham Ningbo China), followed by the interviews. Quantitative and qualitative research methods will be combined in this study. Research limitations/implications: The case studies were only focused on two teaching styles universities, which is not comprehensive enough. The subject was limited to postgraduate students. Originality/value: The study collected and analyzed the data from two teaching styles of universities’ perspectives. It explored the challenges of Engineering education and tried to seek potential enhancement.

Keywords: knowledge graph and recommender system, engineering pedagogy, programming skills, postgraduate students

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Authors: Meghana Pandit, Abhishek Chakraborty

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There are a multitude of factors that influence the clinical success of bariatric surgery. This study seeks to determine the efficacy of preoperative weight management education. The Food and Fitness Program at Mount Sinai serves to educate patients on topics such as stress management, sleep habits, body image, nutrition, and exercise 5-6 months before their surgeries to slowly decrease their weight. Each month, patients are weighed, and a different topic is presented. To evaluate the longitudinal effects of these lectures, patient’s weights are evaluated at the first appointment, before an informative lecture is presented. Weights are then reevaluated at the last appointment before the surgery. The weights were statistically analyzed using a paired t-test and the results demonstrated a statistically significant difference (p < .0001, n=55). Thus, it is reasonable to conclude that the education paradigm employed successfully empowered patients to maintain and reduce their gross BMI before clinical intervention.

Keywords: bariatric, surgery, weight, education

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Authors: Muhammad Arif Khan, Haroon Idrees, Imran Aziz, Sidra Mushtaq

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The purpose of this study is to investigate the current level of knowledge mapping skills of the public sector employees in Pakistan. National Institute of Management is one of the premiere public sector training organization for mid-career public sector employees in Pakistan. This study is conducted on participants of fourteen weeks long training course called Mid-Career Management Course (MCMC) which is mandatory for public sector employees in order to ascertain how to enhance their knowledge mapping skills. Methodology: Researcher used both qualitative and quantitative approach to conduct this study. Primary data about current level of participants’ understanding of knowledge mapping was collected through structured questionnaire. Later on, Participant Observation method was used where researchers acted as part of the group to gathered data from the trainees during their performance in training activities and tasks. Findings: Respondents of the study were examined for skills and abilities to organizing ideas, helping groups to develop conceptual framework, identifying critical knowledge areas of an organization, study large networks and identifying the knowledge flow using nodes and vertices, visualizing information, represent organizational structure etc. Overall, the responses varied in different skills depending on the performance and presentations. However, generally all participants have demonstrated average level of using both the IT and Non-IT K-mapping tools and techniques during simulation exercises, analysis paper de-briefing, case study reports, post visit presentation, course review, current issue presentation, syndicate meetings, and daily synopsis. Research Limitations: This study is conducted on a small-scale population of 67 public sector employees nominated by federal government to undergo 14 weeks extensive training program called MCMC (Mid-Career Management Course) at National Institute of Management, Peshawar, Pakistan. Results, however, reflects only a specific class of public sector employees i.e. working in grade 18 and having more than 5 years of work. Practical Implications: Research findings are useful for trainers, training agencies, government functionaries, and organizations working for capacity building of public sector employees.

Keywords: knowledge management, km in public sector, knowledge management and professional development, knowledge management in training, knowledge mapping

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Authors: Besher Gharaibeh

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This article addressed the issue of using physical exam in nursing. Nurses hold different attitudes toward using physical exam in the clinical settings. These attitudes determine to embrace physical examination in practice. So, the aim of the study was to examine registered nurses’ attitudes and practices, identify perceived barriers, and to identify the factors which influence the performance and the attitudes towards physical examinations. Results showed that even though nurses reported performing physical exam often, they had negative attitudes toward it. Stress and performing physical examinations on someone of the opposite gender (n=236; 87.4%) were the main barriers. Nurse's level of education influenced the attitude (t=-4.3; p < .01). These results indicated that RNs recognize the necessity of physical examinations, but they face many barriers and challenges which hinder the performance of the examination. Cultural factors and experience were the most influential barriers which deter performance of the physical examination.

Keywords: physical exam, nursing, barriers, practices, attitudes

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Authors: Ilma Robo, Saimir Heta, Greta Plaka, Vera Ostreni

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Purpose: Drug gingival hyperplasia is an uncommon pathology encountered during routine work in dental units. The purpose of this paper is to present the clinical appearance of gingival hyperplasia caused by medications. There are already three classes of medications that cause hyperplasia and based on data from the literature, the clinical cases encountered and included in this study have been compared. Materials and Methods: The study was conducted in a total of 311 patients, out of which 182 patients were included in our study, meeting the inclusion criteria. After each patient's history was recorded and it was found that patients were in their knowledge of chronic illness, undergoing treatment of gingivitis hypertrophic drugs was performed with a clinical examination of oral cavity and assessment by vertical and horizontal evaluation according to the periodontal indexes. Results: Of the data collected during the study, it was observed that 97% of patients with gingival hyperplasia are treated with nifedipine. 84% of patients treated with selected medicines and gingival hyperplasia in the oral cavity has been exposed at time period for more than 1 year and 1 month. According to the GOI, in the first rank of this index are about 21% of patients, in the second rank are 52%, in the third rank are 24% and in the fourth grade are 3%. According to the horizontal growth index of gingival hyperplasia, grade 1 included about 61% of patients and grade 2 included about 39% of patients with gingival hyperplasia. Bacterial index divides patients by degrees: grading 0 - 8.2%, grading 1 - 32.4%, grading 2 - 14% and grading 3 - 45.1%. Conclusions: The highest percentage of gingival hyperplasia caused by drugs is due to dosing of nifedipine for a duration of dosing and application for systemic healing for more than 1 year.

Keywords: drug gingival hyperplasia, horizontal growth index, vertical growth index

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Authors: Suzan Arslanturk, Mohammad-Reza Siadat, Theophilus Ogunyemi, Ananias Diokno

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Missing data is a common challenge in statistical analyses of most clinical survey datasets. A variety of methods have been developed to enable analysis of survey data to deal with missing values. Imputation is the most commonly used among the above methods. However, in order to minimize the bias introduced due to imputation, one must choose the right imputation technique and apply it to the correct type of missing data. In this paper, we have identified different types of missing values: missing data due to skip pattern (SPMD), undetermined missing data (UMD), and genuine missing data (GMD) and applied rough set imputation on only the GMD portion of the missing data. We have used rough set imputation to evaluate the effect of such imputation on prediction by generating several simulation datasets based on an existing epidemiological dataset (MESA). To measure how well each dataset lends itself to the prediction model (logistic regression), we have used p-values from the Wald test. To evaluate the accuracy of the prediction, we have considered the width of 95% confidence interval for the probability of incontinence. Both imputed and non-imputed simulation datasets were fit to the prediction model, and they both turned out to be significant (p-value < 0.05). However, the Wald score shows a better fit for the imputed compared to non-imputed datasets (28.7 vs. 23.4). The average confidence interval width was decreased by 10.4% when the imputed dataset was used, meaning higher precision. The results show that using the rough set method for missing data imputation on GMD data improve the predictive capability of the logistic regression. Further studies are required to generalize this conclusion to other clinical survey datasets.

Keywords: rough set, imputation, clinical survey data simulation, genuine missing data, predictive index

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Authors: Ezra N. S. Lockhart

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The number of children diagnosed with autism spectrum disorder (ASD) has increased approximately 173% during the last decade making ASD the fastest growing developmental disability in the United States. This rise in prevalence rates indeed has an effect on schools. ASD is overwhelmingly the most reported primary special education eligibility category for students accessing special education, at a national average of 61.3%. ASD is regarded as an urgent public health concern at an estimated annual per capita cost of $3.2 million. Furthermore, considering that ASD is a lifelong disorder estimated lifetime per capita cost reach $35 billion. The resources available to special education programs are insufficient to meet the educational needs of the 6.4 million students receiving special educational services. This is especially true given that there has been and continues to be a chronic shortage of fully certified special education teachers for decades. Reports indicate that 81.1% of students with special needs spend 40% or more in general education classrooms. Regardless of whether support is implemented in the special education or general education classroom the resource demand is obvious. Schools are actively seeking to implement low-cost alternatives and budget saving measures in response to this demand. In public school settings, programs such as Applied Behavior Analysis are challenging to implement and fund at $40,000 per student per year. As an alternative, computer-based interventions are inexpensive, less time-consuming to implement, and require minimal teacher or paraprofessional training to administer. Affordability, pricing schemes, availability, and compatibility of computer-based interventions that support social and emotional skill development in individuals with ASD are discussed.

Keywords: affordability, autism spectrum disorder, computer-based intervention, emotional skills, social skills

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Authors: Wenjie Wu, Peng Cheng, Zehua Zhang, Fei Luo, Feng Wu, Min Zhong, Jianzhong Xu

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Background: There has been limited research into the therapeutic efficacy of rapid diagnosis of spinal tuberculosis complicated with pulmonary tuberculosis. We attempted to discover whether the utilization of a DNA microarray assay to detect multidrug-resistant spinal tuberculosis complicated with pulmonary tuberculosis can improve clinical outcomes. Methods: A prospective study was conducted from February 2006 to September 2015. One hundred and forty-three consecutive culture–confirmed, clinically and imaging diagnosed MDR-TB patients with spinal tuberculosis complicated by pulmonary tuberculosis were enrolled into the study. The initial time to treatment for MDR-TB, the method of infection control, radiological indicators of spinal tubercular infectious foci, culture conversion, and adverse drug reactions were compared with the standard culture methods. Results: Of the total of 143 MDR-TB patients, 68 (47.6%) were diagnosed by conventional culture methods and 75 (52.4%) following the implementation of detection using the DNA microarray. Patients in the microarray group began rational use of the second-line drugs schedule more speedily than sufferers in the culture group (17.3 vs. 74.1 days). Among patients were admitted to a general tuberculosis ward, those from the microarray group spent less time in the ward than those from the culture group (7.8 vs. 49.2 days). In those patients with six months follow-up (n=134), patients in the microarray group had a higher rate of sputum negativity conversion at six months (89% vs. 73%). In the microarray group, the rate of drug adverse reactions was significantly lower (22.2% vs. 67.7%). At the same time, they had a more obvious reduction of the area with spinal tuberculous lesions in radiological examinations (77% vs. 108%). Conclusions: The application of the CapitalBio™ DNA Microarray assay caused noteworthy clinical advances including an earlier time to begin MDR-TB treatment, increased sputum culture conversion, improved infection control measures and better radiographical results

Keywords: tuberculosis, multidrug-resistant, tuberculous spondylitis, DNA microarray, clinical outcomes

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Authors: Meltem Işık, Fatma Gür, İbrahim Kılıç

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This study aims to explore the effects of hemsball shooting techniques on the fine motor skill level of children with hearing disabilities. A total number of 26 children with hearing disabilities, ages ranging between 7 and 11 and which were equally divided into experimental group and control group participated in the study. In this context, an exercise training program dedicated to hemsball shooting techniques was introduced to the experimental group 3 days a week in one hour sessions for a period of 10 weeks. BOT-2 fine motor skills test which includes three dimensions (fine motor accuracy, fine motor task completion, and dexterity) was selected as the data collection method. Descriptive statistics along with two-factor ANOVA which was focused on repetitive measurements of the differences between pretest and posttest scores of both groups were used in the analysis of the data collected. The results of this study showed that hemsball shooting techniques have a statistically significant effect on the fine motor skill level.

Keywords: hemsball shooting techniques, BOT-2 test, fine motor skills, hearing disabilities

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Authors: Renjith George, Preethy Mary Donald

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Use of internet sources to retrieve health care related information among health care professionals has increased tremendously as the accessibility to internet is made easier through smart phones and tablets. Though there are huge data available at a finger touch, it is doubtful whether all the sources providing health care information adhere to evidence based practice. The objective of this survey was to study the prevalence of use of internet sources to get health care information, to assess the mind-set towards the authenticity of health care information available via internet sources and to study the awareness about evidence based practice in health care among medical and dental students in Melaka-Manipal Medical College. The survey was proposed as there is limited number of studies reported in the literature and this is the first of its kind in Malaysia. A cross sectional survey was conducted among the medical and dental students of Melaka-Manipal Medical College. A total of 521 students including medical and dental students in their clinical years of undergraduate study participated in the survey. A questionnaire consisting of 14 questions were constructed based on data available from the published literature and focused group discussion and was pre-tested for validation. Data analysis was done using SPSS. The statistical analysis of the results of the survey proved that the use of internet resources for health care information are equally preferred over the conventional resources among health care students. Though majority of the participants verify the authenticity of information from internet sources, there was considerable percentage of candidates who feels that all the information from the internet can be utilised for clinical decision making or were not aware about the need of verification of authenticity of such information. 63.7 % of the participants rely on evidence based practice in health care for clinical decision making while 34.2 % were not aware about it. A minority of 2.1% did not agree with the concept of evidence based practice. The observations of the survey reveals the increasing use of internet resources for health care information among health care students. The results warrants the need to move towards evidence based practice in health care as all health care information available online may not be reliable. The health care person should be judicious while utilising the information from such resources for clinical decision making.

Keywords: authenticity, evidence based practice, health care information, internet

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Authors: Y. O’Connor, C. Heavin, S. O’ Connor, J. Gallagher, J. Wu, J. O’Donoghue

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Background: To improve the delivery of paediatric healthcare in resource-poor settings, Community Health Workers (CHW) have been provided with a paper-based set of protocols known as Community Case Management (CCM). Yet research has shown that CHW adherence to CCM guidelines is poor, ultimately impacting health service delivery. Digitising the CCM guidelines via mobile technology is argued in extant literature to improve CHW adherence. However, little research exist which outlines how (a) this process can be digitised and (b) adherence could be improved as a result. Aim: To explore how an electronic mobile version of CCM (eCCM) can overcome issues associated with the paper-based CCM protocol (poor adherence to guidelines) vis-à-vis service blueprinting. This service blueprint will outline how (a) the CCM process can be digitised using mobile Clinical Decision Support Systems software to support clinical decision-making and (b) adherence can be improved as a result. Method: Development of a single service blueprint for a standalone application which visually depicts the service processes (eCCM) when supporting the CHWs, using an application known as Supporting LIFE (Low cost Intervention For disEase control) as an exemplar. Results: A service blueprint is developed which illustrates how the eCCM solution can be utilised by CHWs to assist with the delivery of healthcare services to children. Leveraging smartphone technologies can (a) provide CHWs with just-in-time data to assist with their decision making at the point-of-care and (b) improve CHW adherence to CCM guidelines. Conclusions: The development of the eCCM opens up opportunities for the CHWs to leverage the inherent benefit of mobile devices to assist them with health service delivery in rural settings. To ensure that benefits are achieved, it is imperative to comprehend the functionality and form of the eCCM service process. By creating such a service blueprint for an eCCM approach, CHWs are provided with a clear picture regarding the role of the eCCM solution, often resulting in buy-in from the end-users.

Keywords: adherence, community health workers, developing countries, mobile clinical decision support systems, CDSS, service blueprint

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Authors: Kubra Sultan Yuzuncuyil, Aytekin İsman, Berkay Bulus

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With the developments of information and communication technologies, the forms of molding public opinion have changed. In the presence of Internet, the notion of activism has been endowed with digital codes. Activists have engaged the use of Internet into their campaigns and the process of creating collective identity. Activist movements have been incorporating the relevance of new communication technologies for their goals and opposition. Creating and managing activism through Internet is called Online Activism. In this main, Slow Food Movement which was emerged within the philosophy of defending regional, fair and sustainable food has been engaging Internet into their activist campaign. This movement supports the idea that a new food system which allows strong connections between plate and planet is possible. In order to make their voices heard, it has utilized social networks and develop particular skills in the framework online activism. This study analyzes online activist skills of Slow Food Movement (SFM) develop and attempts to measure its effectiveness. To achieve this aim, it adopts the model proposed by Sivitandies and Shah and conduct both qualitiative and quantiative content analysis on social network use of Slow Food Movement. In this regard, the sample is chosen as the official profile and analyzed between in a three month period respectively March-May 2017. It was found that SFM develops particular techniques that appeal to the model of Sivitandies and Shah. The prominent skill in this regard was found as hyperlink abbreviation and use of multimedia elements. On the other hand, there are inadequacies in hashtag and interactivity use. The importance of this study is that it highlights and discusses how online activism can be engaged into a social movement. It also reveals current online activism skills of SFM and their effectiveness. Furthermore, it makes suggestions to enhance the related abilities and strengthen its voice on social networks.

Keywords: slow food movement, Twitter, internet, online activism

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Authors: Sarina Sahmeddini, Fahimeh Safarpour, Forough Pazhuheian

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With the concepts of minimally invasive treatment and preventive dentistry gaining more and more recognition by dentists, there are many published clinical trials comparing the use of the erbium laser with traditional drilling for caries removal. However, the efficacy of the erbium laser is still controversial. The aim of this review study is to compare the effects of tooth preparation by laser irradiation and conventional preparation by bur to identify the best means for cavity preparation and reduction of recurrent caries. Randomized controlled trials, controlled clinical trials, and prospective, and retrospective cohort studies were included in this review. The eligibility criteria included studies in humans’ permanent teeth in which cavities were conducted in their cervical third and proximal surfaces. PubMed, Google scholar, and Scopus about Er:YAG laser and bur prepared cavities were carried out. The studies’ details were organized in four tables according to the groups: (1) Microleakage; (2) Morphological changes; (3) Microhardness; and (4) Bond strength. The initial search resulted in 134 articles, 12 studies published from 2012 up to March 2020 were included in this review. According to the risk of bias evaluation, all studies were classified as high quality. Clinical implications: Er:YAG lasers with the energy levels between 250 to 300 mJ can be proper alternatives to conventional burs, as minimal invasive instruments with no significant differences or better results in microleakage, microhardness, and bond strength compared with conventional burs. In conclusion, Er:YAG laser irradiations accompanied by phosphoric acid etching can reduce the chance of recurrent carries.

Keywords: lasers, drilling, caries, micro leakage

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Authors: Xhevrie Mamaqi

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Organization capacity learning is a process referring to the sum total of individual and collective learning through training programs, experience and experimentation, among others. Today, in-business ongoing training is one of the most important strategies for human capital development and it is crucial to sustain and improve workers’ knowledge and skills. Many organizations, firms and business are adopting a strategy of continuous learning, encouraging employees to learn new skills continually to be innovative and to try new processes and work in order to achieve a competitive advantage and superior business results. This paper uses the Resource Based View and Capacities (RBV) approach to construct a hypothetical relationships model between training and business results. The test of the model is applied on transversal data. A sample of 266 business of Spanish sector service has been selected. A Structural Equation Model (SEM) is used to estimate the relationship between ongoing training, represented by two latent dimension denominated Human and Social Capital resources and economic business results. The coefficients estimated have shown the efficient of some training aspects explaining the variation in business results.

Keywords: business results, human and social capital resources, training, RBV theory, SEM

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Authors: Dave Kenneth Tayao Cayado, Carlo P. Magno

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The most common source of bias detected are those of gender and socioeconomic status. The present study investigated the Differential Item Functioning (DIF) or item bias between public and private school students in a vocabulary test. Studies on DIF were expanded by using the type of school as a source of bias. There were 200 participants in this study. 100 came from a public secondary school and 100 came from a private secondary school. The vocabulary skills of students were measured using a standardized vocabulary test for grade 7 students. Using DIF, specifically the Rasch-Welch approach, it was found that out of 24 items, 12 were biased for a specific group. The vocabulary skills on the use of slang, idiomatic expression, personification, collocations, and partitive relations were biased for private schools while the use of slang and homonymous words were biased for public school students. The analysis debunked the trend that private school students are outperforming public school students in terms of academic achievement. It was revealed that there are some competencies that private school students are having difficulty and vice versa.

Keywords: differential item functioning, item bias, public school students, private school students, vocabulary

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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: Shinta Stri Ayuda Nur Setyaningsih

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Anterior uveitis is often triggered by viral infections such as herpes simplex virus (HSV) and cytomegalovirus (CMV). This study aims to provide an overview of the demographic and clinical characteristics of patients with anterior uveitis caused by CMV and HSV infection at PMN Cicendo Eye Hospital Bandung. This study used a retrospective observational method. Data were collected from the medical records of patients who visited the PMN Infection and Immunology Polyclinic at Cicendo Eye Hospital between February and July 2023. The results showed that anterior uveitis associated with HSV and CMV viruses often occurs in the elderly and more in women. The most common clinical symptoms are red eyes and decreased visual acuity, with a gradual onset of symptoms. Complications that often arise are cataracts and glaucoma. This study provides a deeper understanding of anterior uveitis caused by infection with HSV and CMV viruses.

Keywords: uveitis anterior, cytomegavirus, herpes simplex virus type I ELISA

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Authors: Piyawan Sunasuan, Thiranan Pansuppawat, Mananya Manaratchasak, Maream Nillapun

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This research aims to guide the development of the intensive English program for graduate students. The objectives are 1) to study the English skills in which needed for the graduate students and 2) to study the potential of the current course with the expected proficiency level. The samples are 46 graduate students enrolled in the ENG 102 and ENG 103 courses of the school year of 2019/2020 in semester one from the Silpakorn University, Sanamchandra Palace Campus, and two teachers. The researchers use 1) student survey, 2) teacher interview, and 3) focus group discussion among selected students. The data is analyzed by calculating the mean (x̅), the standard deviation, and document analysis. The findings show that nine skills are in the need of the course development; 1) academic writing 2) occupational purpose writing 3) communicative reading 4) occupational purpose reading 5) academic speaking 6) occupational purpose speaking 7) occupational purpose listening 8) academic listening and 9) communicative listening. The current course does not meet the expectation on a high level but has potential.

Keywords: English for academic purposes, English for communication, English for occupational purposes, intensive English

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Authors: Fatimazahrae Elbakri, Azeddine Ibrahimi, Meryem Lemrani, Dris Belghyti

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Leishmaniasis represents a major public health problem because of the number of cases recorded each year and the wide distribution of the disease. It is a parasitic disease of flagellated protozoa transmitted by the bite of certain species of sandfly, causing a spectrum of clinical pathology in humans ranging from disfiguring skin lesions to fatal visceral leishmaniasis. Cutaneous leishmaniasis due to Leishmania major is a polymorphic disease; in fact, the infection can be asymptomatic, localized, or disseminated. The objective of this work is to determine the genomic diversity that contributes to clinical variability by trying to identify the variation in chromosome number and to extract SNPs and SNPs and InDels; it is based on four sequences (WGS) of Leishmania major available on NCBI in Fastq form, from three countries: Tunisia, Algeria, and Israel, the analysis is set up from a pipeline to facilitate the discovery of genetic diversity, in particular SNP and chromosomal somy.

Keywords: Leshmania major, cutaneous Leishmania, NGS, genomic, somy, variant calling

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