Search results for: healthcare organisations

Authors: Antonio Espingardeiro

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It is likely that robots will cross the boundaries of industry into households over the next decades. With demographic challenges worldwide, the future ageing populations will require the introduction of assistive technologies capable of providing, care, human dignity and quality of life through the aging process. Robotics technology has a high potential for being used in the areas of social and healthcare by promoting a wide range of activities such as entertainment, companionship, supervision or cognitive and physical assistance. However, such close Human Robotics Interactions (HRIs) encompass a rich set of ethical scenarios that need to be addressed before Socially Assistive Robots (SARs) reach the global markets. Such interactions with robots may seem a worthy goal for many technical/financial reasons but inevitably require close attention to the ethical dimensions of such interactions. This article investigates the current HRI benchmark of social success. It revises it according to the ethical principles of beneficence, non-maleficence and justice aligned with social care ethos. An extension of such benchmark is proposed based on an empirical study of HRIs with elderly groups.

Keywords: HRI, SARs, social success, benchmark, elderly care

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Authors: Varsha Reddy Jayar

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Background: Our elderly family members deserve our best care. It's our responsibility to ensure they're healthy and safe. The population of India is increasing rapidly. People are literally being born in the streets, and there is a high growth on taxes and healthcare costs. Indian families are challenged with taking care of everyone. When you have elderly parents and a demanding job, it can be difficult to take care of them. You might not have enough time to care for them when you're already working or dealing with emotional difficulties. Living alone in old age can cause older individuals to face many health risks. Many seniors find living and caring for themselves challenging when they live by themselves. This study explored the factors that affect whether or not elderly people choose to live in old age homes. Methods: This study was carried out on 123 elderly people living in different old age homes in Karnataka, India. The reason for their residence at the home was explored using an interview. Results: It was found that the most common reason for living in an old age home is due to abuse from children and grandchildren; the majority reported were Daughter in law issues in the family specific to the adjustment and understanding amongst them. Conclusion: More and more elderly people in India are choosing to stay in old age homes as they get older. The government and voluntary agencies must have some sort of arrangements for institutional support.

Keywords: old age home, elderly, Aging, challenges of aging

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Authors: B. Alajmi, L. Marouf, A. S. Chaudhry

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In recent years, increasing emphasis has been placed upon issues concerning the evaluation of health care. In this regard, knowledge management has also been considered an important component of the evaluation process. KM facilitates the transfer of existing knowledge or the development of new knowledge among healthcare staff and patients. This research aimed to examine how hospitals in Kuwait employ knowledge management practices, including capturing, sharing, and generating, and the perceived impact of KM practices on performance of hospitals in Kuwait. Through adopting a quantitative survey method with 277 sample of doctors, the study found that in terms of the three major knowledge management practices – knowledge capturing, sharing, and generating – the adoption of KM practices were rated very low in the sampled hospitals in Kuwait. Hospitals paid little attention to the main activities that support the transfer of expertise among doctors in hospitals. However, as predicted by previous studies, knowledge management practices were perceived to have an impact on hospitals’ performance. Through knowledge capturing, sharing, and generating, hospitals could improve the services they provide through documenting best practices, transforming their hospitals into learning organizations in which lessons learned are captured, stored, and made available for others to learn from.

Keywords: knowledge management, hospitals, knowledge management practices, knowledge management tools, performance

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Authors: O. E. Akinyemi, P. O. Alege, O. O. Ajayi, L. A. Amaghionyediwe, A. A. Ogundipe

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Nigeria as an oil-producing developing country in Africa is one of the many countries that had been subsidizing consumption of fossil fuel. Despite the numerous advantage of this policy ranging from increased energy access, fostering economic and industrial development, protecting the poor households from oil price shocks, political considerations, among others; they have been found to impose economic cost, wasteful, inefficient, create price distortions discourage investment in the energy sector and contribute to environmental pollution. These negative consequences coupled with the fact that the policy had not been very successful at achieving some of its stated objectives, led to a number of organisations and countries such as the Group of 7 (G7), World Bank, International Monetary Fund (IMF), International Energy Agency (IEA), Organisation for Economic Co-operation and Development (OECD), among others call for global effort towards reforming fossil fuel subsidies. This call became necessary in view of seeking ways to harmonise certain existing policies which may by design hamper current effort at tackling environmental concerns such as climate change. This is in addition to driving a green growth strategy and low carbon development in achieving sustainable development. The energy sector is identified to play a vital role. This study thus investigates the prospects of using fuel subsidy reform as a viable tool in driving an economy that de-emphasizes carbon growth in Nigeria. The method used is the Johansen and Engle-Granger two-step Co-integration procedure in order to investigate the existence or otherwise of a long-run equilibrium relationship for the period 1971 to 2011. Its theoretical framework is rooted in the Environmental Kuznet Curve (EKC) hypothesis. In developing three case scenarios (case of subsidy payment, no subsidy payment and effective subsidy), findings from the study supported evidence of a long run sustainable equilibrium model. Also, estimation results reflected that the first and the second scenario do not significantly influence the indicator of environmental quality. The implication of this is that in reforming fuel subsidy to drive environmental quality for an economy like Nigeria, strong and effective regulatory framework (measure that was interacted with fuel subsidy to yield effective subsidy) is essential.

Keywords: environmental quality, fuel subsidy, green growth, low carbon growth strategy

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Authors: Ahasanul Haque, Noor Hazilah Abd Manaf, Zohurul Anis, Tarekol Islam

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Sustainable community health (SCH) is an example of a new healthcare concept formed from applying the Maqasid al-Shariah principle to hospital management and delivery services. Because the idea is novel, it needs comprehensive and ongoing investigation to be improved. However, there is a lack of research on the necessity of developing sustainable community health (SCH), particularly its organizational structure. Furthermore, there is a misconception about the order of components in Maqasid al-Shariah, particularly in a hospital setting. Furthermore, the use of medicines and treatment by conventional recommendations to carry out the treatment by the Maqasid al Shariah. As such, this study focuses on the essential prerequisite for establishing a sustainable community health system based on Maqasid al-Shariah. This study discusses the use of Maqasid al-Shariah in administration and treatment. In this qualitative research approach, a literature search and interviews with specialists are conducted. The gathered data is examined using content analysis, emphasizing inductive and deductive reasoning. The research reveals that the Shariah Advisory Council and Shariah Critical Point are necessary for sustainable community health. In conclusion, by discussing the causes for each instance, this research adds to the creation of methods for determining the level of Maasid al-Shariah in-hospital care.

Keywords: empowering, sustainability, community health, maqasid al shariah, hospital and malaysia

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Authors: Irfan Arikan, George Christian Steckenbauer

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Turkey and Austria are examples for highly developed tourism destinations, where tourism providers use cultural heritage and regional natural resources to develop modern tourism products in order to be successful on increasingly competitive international tourism markets. The use and exploitation of these resources follow on the one hand international standards of tourism marketing (as ‘sustainability’). Therefore, we find highly comparable internationalized products in these destinations (like hotel products, museums, spas etc.). On the other hand, development standards and processes strongly depend on local, regional and national cultures, which influence the way how people work, cooperate, think and create. Thus, cultural factors also influence the attitude towards cultural heritage and natural resources and the way, how these resources are used for the creation of tourism products. This leads to differences in the development of tourism products on several levels: 1. In the selection of cultural heritage and natural resources for the product development process 2. In the processes, how tourism products are created 3. In the way, how providers and marketing organisations work with tourism products based on cultural heritage or natural resources. Aim of this paper is to discover differences in these dimensions by analysing and comparing examples of tourism products in Turkey and Austria, both countries with a highly developed, high professional tourism industry and rich experience of stakeholders in tourism industry in the field of product development and marketing. The cases are selected from the following fields: + Cultural tourism / heritage tourism + City tourism + Industrial heritage tourism + Nature and outdoor tourism + Health tourism The cases are analysed based on available secondary data (as several cases are scientifically described) and expert interviews with local and regional stakeholders of tourism industry and tourism experts. The available primary and secondary data will be analysed and displayed in a comparative structure that allows to derive answers to the above stated research question. The result of the project therefore will be a more precise picture about the influence of cultural differences on the use and exploitation of resources in the field of tourism that allows developing recommendations for tourism industry, which must be taken into consideration to assure cultural and natural resources are treated in a sustainable and responsible way. The authors will edit these culture-cross recommendations in form of a ‘check-list’ that can be used as a ‘guideline’ for tourism professionals in the field of product development and marketing and therefore connects theoretical research to the field of practical application and closes the gap between academic research and the field of tourism practice.

Keywords: cultural heritage, natural resources, Austria, Turkey

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Authors: Melina Kopke, Jelle Van Dijk

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Persons with cognitive disabilities, such as Autism Spectrum Disorder (ASD) are often dependent on some form of professional support. Recent transformations in Dutch healthcare have spurred institutions to apply new, empowering methods and tools to enable their clients to cope (more) independently in daily life. Assistive Technologies (ATs) seem promising as empowering tools. While ATs can, functionally speaking, help people to perform certain activities without human assistance, we hold that, from a design-theoretical perspective, such technologies often fail to empower in a deeper sense. Most technologies serve either to prescribe or to monitor users’ actions, which in some sense objectifies them, rather than strengthening their agency. This paper proposes that theories of embodied interaction could help formulating a design vision in which interactive assistive devices augment, rather than replace, human agency and thereby add to a persons’ empowerment in daily life settings. It aims to close the gap between empowerment theory and the opportunities provided by assistive technologies, by showing how embodiment and empowerment theory can be applied in practice in the design of new, interactive assistive devices. Taking a Research-through-Design approach, we conducted a case study of designing to support independently living people with ASD with structuring daily activities. In three iterations we interlaced design action, active involvement and prototype evaluations with future end-users and healthcare professionals, and theoretical reflection. Our co-design sessions revealed the issue of handling daily activities being multidimensional. Not having the ability to self-manage one’s daily life has immense consequences on one’s self-image, and also has major effects on the relationship with professional caregivers. Over the course of the project relevant theoretical principles of both embodiment and empowerment theory together with user-insights, informed our design decisions. This resulted in a system of wireless light units that users can program as a reminder for tasks, but also to record and reflect on their actions. The iterative process helped to gradually refine and reframe our growing understanding of what it concretely means for a technology to empower a person in daily life. Drawing on the case study insights we propose a set of concrete design principles that together form what we call the embodied empowerment design framework. The framework includes four main principles: Enabling ‘reflection-in-action’; making information ‘publicly available’ in order to enable co-reflection and social coupling; enabling the implementation of shared reflections into an ‘endurable-external feedback loop’ embedded in the persons familiar ’lifeworld’; and nudging situated actions with self-created action-affordances. In essence, the framework aims for the self-development of a suitable routine, or ‘situated practice’, by building on a growing shared insight of what works for the person. The framework, we propose, may serve as a starting point for AT designers to create truly empowering interactive products. In a set of follow-up projects involving the participation of persons with ASD, Intellectual Disabilities, Dementia and Acquired Brain Injury, the framework will be applied, evaluated and further refined.

Keywords: assistive technology, design, embodiment, empowerment

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Authors: António J. R. Neves, Rui Garcia, Paulo Dias, Alina Trifan

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With the aging of the world population and the continuous growth in technology, service robots are more and more explored nowadays as alternatives to healthcare givers or personal assistants for the elderly or disabled people. Any service robot should be capable of interacting with the human companion, receive commands, navigate through the environment, either known or unknown, and recognize objects. This paper proposes an approach for object recognition based on the use of depth information and color images for a service robot. We present a study on two of the most used methods for object detection, where 3D data is used to detect the position of objects to classify that are found on horizontal surfaces. Since most of the objects of interest accessible for service robots are on these surfaces, the proposed 3D segmentation reduces the processing time and simplifies the scene for object recognition. The first approach for object recognition is based on color histograms, while the second is based on the use of the SIFT and SURF feature descriptors. We present comparative experimental results obtained with a real service robot.

Keywords: object detection, feature, descriptors, SIFT, SURF, depth images, service robots

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Authors: Merita Dauti, Edita Alili-Idrizi, Sihana Ahmeti –Lika, Ledjan Malaj

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The extermination and proper disposal of pharmaceutical wastes from expired and unused medications remains a disputable issue due to their specific nature and characteristics. Even though the hazards from these wastes are already well known in terms of environment and human health, people still treat them as usual wastes. At a national level, in many countries the management of pharmaceutical and medical wastes has been one of the main objectives in order to protect people’s health and the environment. Even though many legal regulations exist in this respect, there has not been a single law that would clearly explain the procedures of returning medicines, ways of selection, treatment and extermination of pharmaceutical wastes. This paper aims at analyzing the practices of pharmaceutical waste management and treatment in some European countries as well as a review of the legislation and official guidelines in managing these kinds of wastes and protecting the environment and human health. A suitable treatment and management of expired medications and other similar wastes would be in the interest of public health in the first place, as well as in the interest of healthcare institutions and other bodies engaged in environment protection.

Keywords: pharmaceutical waste, legal regulation, proper disposal, environment pollution

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Authors: J. N. Bardi, N. Wright, S. Timmons, P. Crawford

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Introduction: In the United Kingdom (UK), the transfer of care from the asylums to the community has meant that some people with mental health problems (MHP) may not have access to suitable or adequate statutory community mental health services (CMHS). However, in addition to statutory CMHS, there are informal CMHS that provide spaces where people with MHP can attend such as faith communities, clubhouses, user-led organisations, day centres including drop-in-centres and community hubs and community mental health cafés (CMHCs). Aim: To qualitatively understand what happens in a community mental health café in relation to the place, people and processes, from the participant's perspective. Methodology: Ethnography Methods: Data collection will be field notes from observations written as thick description and interviews with participants. Data analysis will be thematic and narrative analysis. Relevance: The study seeks to observe what happens in a user-led community mental health café and explore if it provides the services that it claims to offer. Therefore, a literature review was conducted to examine the research evidence related to informal CMHS, focusing on similarities and differences. Results indicated that informal CMHS differ with regards to why, how, who set them up and who funds them, but they are similar because people with MHP who attend them report related psychological, vocational, and social interaction benefits. In addition to the differences listed above, CMHCs differ in their adoption of the commercial café model of social space and some CMHCs claim to address needs of social isolation and loneliness which they assert are not properly addressed by statutory CMHS and some informal CMHS. Therefore, CMHCs explicitly differentiate themselves from statutory CMHS and some informal CMHS such as day centres, hospitals and social services. However, CMHCs were found to be like drop-in-centres and community hubs which are also free for MHP to attend without the need for assessments, membership or appointments. To situate community mental health café within other informal CMHS and provide a rationale for the proposed study a scoping review was conducted to determine the scope of available research evidence on CMHCs. Findings from the scoping review reflected the literature review findings with regards to the benefits of attending informal CMHCs for people with MHP. Of the ten studies included in the scoping review, seven were on CMHCs for people living with dementia and two were on CMHCs for people with a broader range of MHP. The researcher hopes that findings from the proposed PhD study will build on the existing understanding of informal CMHS, extend the research evidence on CMHCs and address any gap in the literature.

Keywords: cafe, community, ethnography, mental health

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Authors: Aicha Akrout, Amira Echtioui, Mohamed Ghorbel

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Pneumonia remains a significant global health concern, posing a substantial threat to human lives due to its contagious nature and potentially fatal respiratory complications caused by bacteria, fungi, or viruses. The reliance on chest X-rays for diagnosis, although common, often necessitates expert interpretation, leading to delays and potential inaccuracies in treatment. This study addresses these challenges by employing transfer learning techniques to automate the detection of lung diseases, with a focus on pneumonia. Leveraging three pre-trained models, VGG-16, ResNet50V2, and MobileNetV2, we conducted comprehensive experiments to evaluate their performance. Our findings reveal that the proposed model based on VGG-16 demonstrates superior accuracy, precision, recall, and F1 score, achieving impressive results with an accuracy of 93.75%, precision of 94.50%, recall of 94.00%, and an F1 score of 93.50%. This research underscores the potential of transfer learning in enhancing pneumonia diagnosis and treatment outcomes, offering a promising avenue for improving healthcare delivery and reducing mortality rates associated with this debilitating respiratory condition.

Keywords: chest x-ray, lung diseases, transfer learning, pneumonia detection

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Authors: Danielle Page

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Foregoing studies, statistics, and medical evaluations have established a relationship between Posttraumatic stress disorder (PTSD) and criminal justice involvement in Vietnam veterans. War is highly trauma inducing and can leave combat veterans with mental disorders ranging from psychopathic thoughts to suicidal ideation. The majority of those suffering are unaware that they have PTSD, and as a coping mechanism, they often turn to self isolation. Beyond isolation, many veterans with symptomatic PTSD turn to aggression and substance abuse to cope with their internal agony. The most common crimes committed by veterans with PTSD fall into the assault and drug/alcohol abuse categories. Thus, a relationship is established between veteran populations and the criminal justice system. This dissertation aims to define the relationship between PTSD and criminal justice involvement in veterans, explore the mediating factors in this relationship, and analyze numerous court cases in this subject area. Further, it will examine the ways in which crime rates can be reduced for veterans with symptoms of PTSD. This ranges from the improvement of healthcare systems to the implementation of special courts to handle veteran cases.

Keywords: psychotraumatology, forensic psychology, PTSD, vietnam veterans

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Authors: Ian Walmsley

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The aim of this paper is to explore the influence of time and temporality on the experience of coming off heroin in prison. The presentation draws on qualitative data collected during a small-scale pilot study of the role of self-care in the process of coming off drugs in prison. Time and temporality emerged as a key theme in the interview transcripts. Drug dependent prisoners experience of time in prison has not been recognized in the research literature. Instead, the literature on prison time typically views prisoners as a homogenous group or tends to focus on the influence of aging and gender on prison time. Furthermore, there is a tendency in the literature on prison drug treatment and recovery to conceptualize drug dependent prisoners as passive recipients of prison healthcare, rather than active agents. In building on these gaps, this paper argues that drug dependent prisoners experience multiple temporalities which involve an interaction between the body-times of the drug dependent prisoner and the economy of time in prison. One consequence of this interaction is the feeling that they are doing, at this point in their prison sentence, double prison time. The second part of the argument is that time and temporality were a means through which they governed their withdrawing bodies. In addition, this paper will comment on the challenges of prison research in England.

Keywords: heroin withdrawal, time and temporality, prison, body

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Authors: Mokgadi Julia Ngoepe-Ntsoane

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The article aims to make a case for a legislative framework for the fire sector in South Africa. Robust legislative framework is essential for empowering those with obligatory mandate within the sector. This article contributes to the body of knowledge in the field of policy reviews particularly with regards to the legal framework. It has been observed overtime that the scholarly contributions in this field are limited. Document analysis was the methodology selected for the investigation of the various legal frameworks existing in the country. It has been established that indeed the national legislation on the fire industry does not exist in South Africa. From the documents analysed, it was revealed that the sector is dominated by cartels who are exploiting the new entrants to the market particularly SMEs. It is evident that these cartels are monopolising the system as they have long been operating in the system turning it into self- owned entities. Commitment to addressing the challenges faced by fire services and creating a framework for the evolving role that fire brigade services are expected to execute in building safer and sustainable communities is vital. Legislation for the fire sector ought to be concluded with immediate effect. The outdated national fire legislation has necessitated the monopolisation and manipulation of the system by dominating organisations which cause a painful discrimination and exploitation of smaller service providers to enter the market for trading in that occupation. The barrier to entry bears long term negative effects on national priority areas such as employment creation, poverty, and others. This monopolisation and marginalisation practices by cartels in the sector calls for urgent attention by government because if left attended, it will leave a lot of people particularly women and youth being disadvantaged and frustrated. The downcast syndrome exercised within the fire sector has wreaked havoc and is devastating. This is caused by cartels that have been within the sector for some time, who know the strengths and weaknesses of processes, shortcuts, advantages and consequences of various actions. These people take advantage of new entrants to the sector who in turn find it difficult to manoeuvre, find the market dissonant and end up giving up their good ideas and intentions. There are many pieces of legislation which are industry specific such as housing, forestry, agriculture, health, security, environmental which are used to regulate systems within the institutions involved. Other regulations exist as bi-laws for guiding the management within the municipalities.

Keywords: sustainable job creation, growth and development, transformation, risk management

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Authors: Shaoyi Lu

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Background: Traditional Chinese medicine has been used to treat stroke, which is a major cause of morbidity and mortality. There is, however, no clear agreement about the optimal timing, population, efficacy, and predictive prognosis factors of traditional Chinese medicine supplemental therapy. Method: In this study, we used a retrospective analysis with data collection from stroke patients in Stroke Registry In Chang Gung Healthcare System (SRICHS). Stroke patients who received traditional Chinese medicine consultation in neurology ward of Keelung Chang Gung Memorial Hospital from Jan 2010 to Dec 2014 were enrolled. Clinical profiles including the neurologic deficit, activities of daily living and other basic characteristics were analyzed. Through propensity score matching, we compared the NIHSS and Barthel index before and after the hospitalization, and applied with subgroup analysis, and adjusted by multivariate regression method. Results: Totally 115 stroke patients were enrolled with experiment group in 23 and control group in 92. The most important factor for prognosis prediction were the scores of National Institutes of Health Stroke Scale and Barthel index right before the hospitalization. Traditional Chinese medicine intervention had no statistically significant influence on the neurological deficit of acute stroke patients, and mild negative influence on daily activity performance of acute hemorrhagic stroke patient. Conclusion: Efficacy of traditional Chinese medicine as a supplemental therapy for acute stroke patients was controversial. The reason for this phenomenon might be complex and require more research to comprehend. Key words: traditional Chinese medicine, acupuncture, Stroke, NIH stroke scale, Barthel index, predictive factor. Method: In this study, we used a retrospective analysis with data collection from stroke patients in Stroke Registry In Chang Gung Healthcare System (SRICHS). Stroke patients who received traditional Chinese medicine consultation in neurology ward of Keelung Chang Gung Memorial Hospital from Jan 2010 to Dec 2014 were enrolled. Clinical profiles including the neurologic deficit, activities of daily living and other basic characteristics were analyzed. Through propensity score matching, we compared the NIHSS and Barthel index before and after the hospitalization, and applied with subgroup analysis, and adjusted by multivariate regression method. Results: Totally 115 stroke patients were enrolled with experiment group in 23 and control group in 92. The most important factor for prognosis prediction were the scores of National Institutes of Health Stroke Scale and Barthel index right before the hospitalization. Traditional Chinese medicine intervention had no statistically significant influence on the neurological deficit of acute stroke patients, and mild negative influence on daily activity performance of acute hemorrhagic stroke patient. Conclusion: Efficacy of traditional Chinese medicine as a supplemental therapy for acute stroke patients was controversial. The reason for this phenomenon might be complex and require more research to comprehend.

Keywords: traditional Chinese medicine, complementary and alternative medicine, stroke, acupuncture

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Authors: Oluwaseun Ijiwade, Chris Davison, Kelvin Gregory

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In Australia, like other parts of the world, the debate on how to enhance teachers using assessment data to inform teaching and learning of English as an Additional Language (EAL, Australia) or English as a Foreign Language (EFL, United States) have occupied the centre of academic scholarship. Traditionally, this approach was conceptualised as ‘Formative Assessment’ and, in recent times, ‘Assessment for Learning (AfL)’. The central problem is that teacher-made tests are limited in providing data that can inform teaching and learning due to variability of classroom assessments, which are hindered by teachers’ characteristics and assessment literacy. To address this concern, scholars in language education and testing have proposed a uniformed large-scale computer-based assessment program to meet the needs of teachers and promote AfL in language education. In Australia, for instance, the Victoria state government commissioned a large-scale project called 'Tools to Enhance Assessment Literacy (TEAL) for Teachers of English as an additional language'. As part of the TEAL project, a tool called ‘Reading and Vocabulary assessment for English as an Additional Language (RVEAL)’, as a diagnostic language assessment (DLA), was developed by language experts at the University of New South Wales for teachers in Victorian schools to guide EAL pedagogy in the classroom. Therefore, this study aims to provide qualitative evidence for understanding beliefs about the diagnostic language assessment (DLA) among EAL teachers in primary and secondary schools in Victoria, Australia. To realize this goal, this study raises the following questions: (a) How do teachers use large-scale assessment data for diagnostic purposes? (b) What skills do language teachers think are necessary for using assessment data for instruction in the classroom? and (c) What factors, if any, contribute to teachers’ beliefs about diagnostic assessment in a large-scale assessment? Semi-structured interview method was used to collect data from at least 15 professional teachers who were selected through a purposeful sampling. The findings from the resulting data analysis (thematic analysis) provide an understanding of teachers’ beliefs about DLA in a classroom context and identify how these beliefs are crystallised in language teachers. The discussion shows how the findings can be used to inform professional development processes for language teachers as well as informing important factor of teacher cognition in the pedagogic processes of language assessment. This, hopefully, will help test developers and testing organisations to align the outcome of this study with their test development processes to design assessment that can enhance AfL in language education.

Keywords: beliefs, diagnostic language assessment, English as an additional language, teacher cognition

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Authors: James Pietris

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Glaucoma is a collection of irreversible optic neuropathies which, if left untreated, lead to severe visual field loss. These diseases are a leading cause of blindness across the globe and are estimated to affect approximately 80 million people, particularly women and people of Asian descent.1This represents a major burden on healthcare systems worldwide. Recently, there has been increasing interest in the potential of nicotinamide (vitamin B3) as a novel option in the management of glaucoma. This review aims to analyse the currently available literature to determine whether there is evidence of an association between nicotinamide adenine dinucleotide (NAD+) and glaucomatous optic neuropathy and whether nicotinamide has the potential to prevent or reverse these effects. The literature showed a strong connection between reduced NAD+ levels and retinal ganglion cell dysfunction through multiple different studies. There is also evidence of the positive effect of nicotinamide supplementation on retinal ganglion cell function in models of mouse glaucoma and in a study involving humans. Based on the literature findings, a recommendation has been made that more research into the efficacy, appropriate dosing, and potential side effects of nicotinamide supplementation is needed before it can be definitively determined whether it is appropriate for widespread prophylactic and therapeutic use against glaucoma in humans.

Keywords: glaucoma, nicotinamide, vitamin B3, optic neuropathy

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Authors: Elzbieta Sikorska-Simmons

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Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.

Keywords: advanced dementia, family caregiver, medical decision-making, symptom management

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Authors: Jessie Fazel, Kristen Smith

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Human trafficking is a multi-billion-dollar criminal industry that affects 24.9 million people around the world. There are several different types of trafficking, the most common being sex trafficking, labor trafficking, and domestic servitude. Survival sex is common in the pediatric population, as they engage in sex for food, a place to sleep, or other basic needs. Statistics show that health care workers are at a unique advantage to help identify victims and get them the help they need, as 88% of trafficked victims encounter a health care worker while being trafficked. Unfortunately, victims don’t usually self-identify that they are being trafficked and the situations they face can vary dramatically. It is imperative to remember that traditional red flags are not always present in the pediatric population. Risk factors and red flags with their history and physical exam are one of the best indicators that health care providers need to be vigilant in looking at. There are numerous barriers for disclosure in the healthcare setting. Periods of time before and after disclosure are often emotionally difficult and could be dangerous for the victim. It is extremely important to have a plan in place for intervention if the victim does disclose trafficking. A trauma informed approach to medical and mental health interventions, that focus on safety, are vital in this population. This is happening where you live and you can make a difference in their lives.

Keywords: human trafficking, public health, emergency medicine, sexual health

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Authors: Mehrnaz Mostafavi, Mahtab Shabani, Alireza Azani, Fatemeh Ghafari

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Artificial intelligence (AI) can transform breast cancer diagnosis and therapy by providing sophisticated solutions for screening, imaging interpretation, histopathological analysis, and treatment planning. This literature review digs into the many uses of AI in breast cancer treatment, highlighting the need for collaboration between AI scientists and healthcare practitioners. It emphasizes advances in AI-driven breast imaging interpretation, such as computer-aided detection and diagnosis (CADe/CADx) systems and deep learning algorithms. These have shown significant potential for improving diagnostic accuracy and lowering radiologists' workloads. Furthermore, AI approaches such as deep learning have been used in histopathological research to accurately predict hormone receptor status and categorize tumor-associated stroma from regular H&E stains. These AI-powered approaches simplify diagnostic procedures while providing insights into tumor biology and prognosis. As AI becomes more embedded in breast cancer care, it is crucial to ensure its ethical, efficient, and patient-focused implementation to improve outcomes for breast cancer patients ultimately.

Keywords: breast cancer, artificial intelligence, cancer diagnosis, clinical practice

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Authors: Danika Tynes

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Innovations in technology have implications for sustainable development in health and wellness. Remote monitoring is one innovation for which the evidence-base has grown to support its viability as a quality healthcare delivery adjunct. This research reviews global data on telehealth adoption, in particular, remote monitoring, and the conditions under which its success becomes more likely. System-level indicators were selected to represent four constructs of DoI theory (relative advantage, compatibility, complexity, and observability) and assessed against 5 types of Telehealth (Teleradiology, Teledermatology, Telepathology, Telepsychology, and Remote Monitoring) using ordinal logistic regression. Analyses include data from 84 countries, as extracted from the World Health Organization, World Bank, ICT (Information Communications Technology) Index, and HDI (Human Development Index) datasets. Analyses supported relative advantage and compatibility as the strongest influencers of remote monitoring adoption. Findings from this research may help focus on the allocation of resources, as a sustainability concern, through consideration of systems-level factors that may influence the success of remote monitoring adoption.

Keywords: remote monitoring, diffusion of innovation, telehealth, digital health

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Authors: Everard van Kemenade

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Many quality improvement activities are planned. Leaders are strongly involved in missions, visions and strategic planning. They use, consciously or unconsciously, the PDCA-cycle, also know as the Deming cycle. After the planning, the plans are carried out and the results or effects are measured. If the results show that the goals in the plan have not been achieved, adjustments are made in the next plan or in the execution of the processes. Then, the cycle is run through again. Traditionally, the PDCA-cycle is advocated as a means to an end. However, PDCA is especially fit for planned, ordered, certain contexts. It fits with the empirical and referential quality paradigm. For uncertain, unordered, unplanned processes, something else might be needed instead of Plan-Do-Check-Act. Due to the complexity of our society, the influence of the context, and the uncertainty in our world nowadays, not every activity can be planned anymore. At the same time organisations need to be more innovative than ever. That provides leaders with ‘wicked tendencies’. However, that raises the question how one can innovate without being able to plan? Complexity science studies the interactions of a diverse group of agents that bring about change in times of uncertainty, e.g. when radical innovation is co-created. This process is called emergence. This research study explores the role of leadership in the emergence paradigm. Aim of the article is to study the way that leadership can support the emergence of innovation in a complex context. First, clarity is given on the concepts used in the research question: complexity, emergence, innovation and leadership. Thereafter a literature search is conducted to answer the research question. The topics ‘emergent leadership’ or ‘complexity leadership’ are chosen for an exploratory search in Google and Google Scholar using the berry picking method. Exclusion criterion is emergence in other disciplines than organizational development or in the meaning of ‘arising’. The literature search conducted gave 45 hits. Twenty-seven articles were excluded after reading the title and abstract because they did not research the topic of emergent leadership and complexity. After reading the remaining articles as a whole one more was excluded because the article used emergent in the limited meaning of ‗arising‘ and eight more were excluded because the topic did not match the research question of this article. That brings the total of the search to 17 articles. The useful conclusions from the articles are merged and grouped together under overarching topics, using thematic analysis. The findings are that 5 topics prevail when looking at possibilities for leadership to facilitate innovation: enabling, sharing values, dreaming, interacting, context sensitivity and adaptivity. Together they form In Dutch the acronym Medusa.

Keywords: complexity science, emergence, leadership in the emergence paradigm, innovation, the Medusa principles

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Authors: Jawaher Bakheet Almudarra

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The Saudi Arabian educational system shared the philosophical principles, in its foundation, which concentrated on the achievement of goals, thereby taking up authoritative styles of leadership. However, organisations are beginning to be more liberal in today’s environment than in the 1940s and 1950s, and appealing to emotional intelligence as a tool and skill are needed for effective leadership. In the Saudi Arabian case, such developments are characterised by changes such as that of the educational supervisor having the role redefined to that of a director. This review tracks several parts: the first section helps western reader to understand the subtleties, complexities, and intricacies of the Saudi Arabia education system and its approach to leadership system of education, history, culture and political contribution. This can lead to the larger extent understand if emotional intelligence is a provocation for better leadership of Saudi Arabian education sector or not. The second part is the growth of educational supervision in Saudi Arabia, focusing on the education system, and evaluates the impact of emotional intelligence as a necessary skill in leadership. The third section looks at emotions and emotional intelligence, gender roles, and contributions by emotional intelligence in the education system. The education system of Saudi Arabia has undergone significant transformation. To fully understand the current climate of Saudi Arabia, it is essential to review this process of transformation in terms of the historical, cultural, political and social positions and transformations. Over the years, the education system in Saudi Arabia has undergone significant metamorphosis. The Saudi government has instituted a wide range of reforms in an attempt to improve education standards and outcomes, facilitate improvements and ensure that high standards of education standards are upheld to keep pace with the global environment and knowledge economy. Leadership itself has become an increasingly prominent aspect of educational reform worldwide. Emotional intelligence is often considered a significant aspect of leadership, but it is in its early stages in Saudi Arabia. Its recognition and adoption may improve leadership practices, particularly among educational supervisors and contribute to national and international understandings of leadership in Saudi Arabia. Studying leadership in the Saudi Arabian context is imperative as the new generation of leaders need to cultivate pertinent skills that will allow them to become fundamentally and positively involved in the regions’ decision making processes in order to impact the progression of the Saudi Arabian education system. Understanding leadership in the education context will allow for suitable inculcation of leadership skills. These skills include goal-setting, sound decision-making as well as problem-solving within the education system of Saudi Arabia.

Keywords: educational supervision, educational administration, emotional intelligence, educational leadership

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Authors: Caroline Smith, Professor Debi Bhattacharya, Sion Scott

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Introduction: Oropharyngeal Dysphagia (OD) effects around 15% of older people, however it is often unrecognised and under diagnosed until they are hospitalised. There is a need for primary care healthcare practitioners (HCPs) to assume a proactive role in identifying and managing OD to prevent adverse outcomes such as aspiration pneumonia. Understanding the determinants of primary care HCPs undertaking this new behaviour provides the intervention targets for addressing. This realist review, underpinned by the Theoretical Domains Framework (TDF), aims to synthesise relevant literature and develop programme theories to understand what interventions work, how they work and under what circumstances to facilitate HCPs to prevent harm from OD. Combining realist methodology with behavioural science will permit conceptualisation of intervention components as theoretical behavioural constructs, thus informing the design of a future behaviour change intervention. Furthermore, through the TDF’s linkage to a taxonomy of behaviour change techniques, we will identify corresponding behaviour change techniques to include in this intervention. Methods & analysis: We are following the five steps for undertaking a realist review: 1) clarify the scope 2) Literature search 3) appraise and extract data 4) evidence synthesis 5) evaluation. We have searched Medline, Google scholar, PubMed, EMBASE, CINAHL, AMED, Scopus and PsycINFO databases. We are obtaining additional evidence through grey literature, snowball sampling, lateral searching and consulting the stakeholder group. Literature is being screened, evaluated and synthesised in Excel and Nvivo. We will appraise evidence in relation to its relevance and rigour. Data will be extracted and synthesised according to its relation to Initial programme theories (IPTs). IPTs were constructed after the preliminary literature search, informed by the TDF and with input from a stakeholder group of patient and public involvement advisors, general practitioners, speech and language therapists, geriatricians and pharmacists. We will follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and publication standards to report study results. Results: In this ongoing review our search has identified 1417 manuscripts with approximately 20% progressing to full text screening. We inductively generated 10 IPTs that hypothesise practitioners require: the knowledge to spot the signs and symptoms of OD; the skills to provide initial advice and support; and access to resources in their working environment to support them conducting these new behaviours. We mapped the 10 IPTs to 8 TDF domains and then generated a further 12 IPTs deductively using domain definitions to fulfil the remaining 6 TDF domains. Deductively generated IPTs broadened our thinking to consider domains such as ‘Emotion,’ ‘Optimism’ and ‘Social Influence’, e.g. If practitioners perceive that patients, carers and relatives expect initial advice and support, then they will be more likely to provide this, because they will feel obligated to do so. After prioritisation with stakeholders using a modified nominal group technique approach, a maximum of 10 IPTs will progress to test against the literature.

Keywords: behaviour change, deglutition disorders, primary healthcare, realist review

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Authors: Chau-Kuang Chen, Juanita Buford, Colette Davis, Raisha Allen, John Hughes, James Tyus, Dexter Samuels

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During the post-Civil War era, the city of Nashville, Tennessee, had the highest mortality rate in the country. The elevated death and disease among ex-slaves were attributable to the unavailability of healthcare. To address the paucity of healthcare services, the College, an institution with the mission of educating minority professionals and serving the under served population, was established in 1876. This study was designed to assess if the College has accomplished its mission of serving under served communities and contributed to the elimination of health disparities in the United States. The study objective was to quantify the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities, which, in turn, was significantly associated with a health professional shortage score partly designated by the U.S. Department of Health and Human Services. Various statistical methods were used to analyze the alumni data in years 1975 – 2013. K-means cluster analysis was utilized to identify individual medical and dental graduates into the cluster groups of the practice communities (Disadvantaged or Non-disadvantaged Communities). Discriminant analysis was implemented to verify the classification accuracy of cluster analysis. The independent t test was performed to detect the significant mean differences for clustering and criterion variables between Disadvantaged and Non-disadvantaged Communities, which confirms the “content” validity of cluster analysis model. Chi-square test was used to assess if the proportion of cluster groups (Disadvantaged vs Non-disadvantaged Communities) were consistent with that of practicing specialties (primary care vs. non-primary care). Finally, the partial least squares (PLS) path model was constructed to explore the “construct” validity of analytics model by providing the magnitude effects of socioeconomic status and adverse health outcome on primary care professionals serving disadvantaged community. The social ecological theory along with statistical models mentioned was used to establish the relationship between medical and dental graduates (primary care professionals serving disadvantaged communities) and their social environments (socioeconomic status, adverse health outcome, health professional shortage score). Based on social ecological framework, it was hypothesized that the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities could be quantified. Also, primary care professionals serving disadvantaged communities related to a health professional shortage score can be measured. Adverse health outcome (adult obesity rate, age-adjusted premature mortality rate, and percent of people diagnosed with diabetes) could be affected by the latent variable, namely socioeconomic status (unemployment rate, poverty rate, percent of children who were in free lunch programs, and percent of uninsured adults). The study results indicated that approximately 83% (3,192/3,864) of the College’s medical and dental graduates from 1975 to 2013 were practicing in disadvantaged communities. In addition, the PLS path modeling demonstrated that primary care professionals serving disadvantaged community was significantly associated with socioeconomic status and adverse health outcome (p < .001). In summary, the majority of medical and dental graduates from the College provide primary care services to disadvantaged communities with low socioeconomic status and high adverse health outcomes, which demonstrate that the College has fulfilled its mission.

Keywords: disadvantaged community, K-means cluster analysis, PLS path modeling, primary care

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Authors: Norhanim Nordin, Rosnah Shamsudin, Azrina Azlan, Mohammad Effendy Ya’acob

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An environmental friendly approach for disposal of voluminous durian husk waste could be implemented by substituting them into various valuable commodities, such as healthcare and biofuel products. Thus, the study of composition value in each segment of durian husk was very crucial to determine the suitable proportions of nutrients that need to be added and mixed in the product. A total of 12 ‘Durian Kampung’ fruits from Sg Ruan, Pahang were selected and each fruit husk was divided into four segments and labelled as P-L (thin neck area of white inner husk), P-B (thick bottom area of white inner husk), H (green and thorny outer husk) and W (whole combination of P-B and H). Four experiments have been carried out to determine the dry matter, moisture, ash and crude fibre content. The results show that the H segment has the highest dry matter content (30.47%), while the P-B segment has the highest percentage in moisture (81.83%) and ash (6.95%) content. It was calculated that the ash content of the P-B segment has a higher rate of moisture level which causes the ash content to increase about 2.89% from the P-L segment. These data have proven that each segment of durian husk has a significant difference in terms of composition value, which might be useful information to fully utilize every part of the durian husk in the future.

Keywords: durian husk, crude fibre content, dry matter content, moisture content

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Authors: R. Schweighoffer, N. Nagy, E. Reeves, B. Liebig

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Due to aging populations, the need for seamless palliative care provision is of central interest for western societies. An essential aspect of palliative care delivery is the quality of collaboration amongst palliative care providers. Therefore, the current research is based on Bainbridge’s conceptual framework, which provides an outline for the evaluation of palliative care provision. This study is the first one to investigate the predictive validity of spatial distribution on the quantity of interaction amongst various palliative care providers. Furthermore, based on the familiarity principle, we examine whether the extent of collaboration influences the perceived quality of collaboration among palliative care providers in urban versus rural areas of Switzerland. Based on a population-representative survey of Swiss palliative care providers, the results of the current study show that professionals in densely populated areas report higher absolute numbers of interactions and are more satisfied with their collaborative practice. This indicates that palliative care providers who work in urban areas are better embedded into networks than their counterparts in more rural areas. The findings are especially important, considering that efficient collaboration is a prerequisite to achieve satisfactory patient outcomes. Conclusively, measures should be taken to foster collaboration in weakly interconnected palliative care networks.

Keywords: collaboration, healthcare networks, palliative care, Switzerland

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Authors: Robert John Godby

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To be responsive now and in the future, workplaces must address the demands of multicultural teams as they become more common elements of the global labor force. This is especially the case for aged care due to the aging population, industry growth and migrant recruitment. This research identifies influences on and improvements for learning in these environments. Its unique contribution is to illuminate how culturally diverse workplaces can work and learn together more effectively. A mixed-methods approach was used to gather data about this topic in two phases. Firstly, the research methods included a survey of 102 aged care workers around Australia from two multi-site aged care organisations. The questionnaire elicited both quantitative and qualitative data about worker characteristics and perspectives on working and learning in aged care. Secondly, a case study of one aged care worksite was formulated drawing on worksite information and interviews with workers. A review of the literature suggests that learning in multicultural work environments is influenced by three main factors: 1) the individual workers themselves, 2) their interaction with each other and 3) the environment in which they work. There are various accounts of these three factors, how they are manifested and how they lead to a change in workers’ disposition, knowledge, or expertise when confronted with new circumstances. The study has found that a key individual factor influencing learning is cultural background. Their unique view of the world was shown to affect their approach to both their work and co-working. Interactional factors suggest that the high requirement for collaboration in aged care positively supports learning in this context; however, it can be hindered by cultural bias and spoken accent. The study also found that environmental factors, such as disruptions caused by the pandemic, were another key influence. For example, the need to wear face masks hindered the communication needed for workplace learning. This was especially challenging due to the diverse language backgrounds and abilities within the teams. Potential improvements for learning in multicultural aged care work environments were identified. These include more frequent and structured inter-peer learning (e.g. buddying), communication training (e.g. English language usage for both native and non-native speaking workers) and support for cross-cultural habitude (e.g. recognizing and adapting to cultural differences). Workplace learning in cross-cultural aged care environments is an area that is not extensively dealt with in the literature. This study addresses this gap and holds the potential to contribute practical insights to aged care and other diverse industries.

Keywords: cross-cultural learning, learning in aged care, migrant learning, workplace learning

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Authors: Komal K., Cleary F., Wells J S.G., Bennett L

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Smart fabric garments enable various monitoring applications across sectors such as healthcare, sports and fitness, and the military. Healthcare smart garments monitoring EEG, EMG, and ECG rely on the use of electrodes (dry or wet). However, such electrodes, when used for long-term monitoring, can cause discomfort and skin irritation for the wearer because of their inflexible structure and weight. Ongoing research has been investigating textile-based electrodes (textrodes) in order to provide more comfortable and usable fabric-based electrodes capable of providing intuitive biopotential monitoring. Progress has been made in this space, but they still face a critical design challenge in maintaining consistent skin contact, which directly impacts signal quality. Furthermore, there is a lack of an ISO-based testing framework to validate the electrode design and assess its ability to achieve enhanced performance, strength, usability, and durability. This study proposes the development and evaluation of an ISO-compliant testing framework for standard 2D and advanced 3D embroidered textrodes designs that have a unique structure in order to establish enhanced skin contact for the wearer. This testing framework leverages ISO standards: ISO 13934-1:2013 for tensile and zone-wise strength tests; ISO 13937-2 for tear tests; and ISO 6330 for washing, validating the textrode's performance, a necessity for wearables health parameter monitoring applications. Five textrodes (C1-C5) were designed using EPC win digitization software. Varying patterns such as running stitches, lock stitches, back-to-back stitches, and moss stitches were used to create various embroidered tetrodes samples using Madeira HC12 conductive thread with a resistivity of 100 ohm/m. The textrode designs were then fabricated using a ZSK technical embroidery machine. A comparative analysis was conducted based on a series of laboratory tests adhering to ISO compliance requirements. Tests focusing on the application of strain were applied to the textrodes, and these included: (1) analysis of the electrode's overall surface area strength; (2) assessment of the robustness of the textrodes boundaries; and (3) the assignment of fault test zones to each textrode, where vertical and horizontal slits of 3mm were applied to evaluate the performance of textrodes and its durability. Specific ISO-compliant tests linked to washing were conducted multiple times on each textrode sample to assess both mechanical and chemical damage. Additionally, abrasion and pilling tests were performed to evaluate mechanical damage on the surface of the textrodes and to compare it with the washing test. Finally, the textrodes were assessed based on morphological and surface resistance changes. Results demonstrate that textrode C4, featuring a 3-D layered structure consisting of foam, fabric, and conductive thread layers, significantly enhances skin-electrode contact for biopotential recording. The inclusion of a 3D foam layer was particularly effective in maintaining the shape of the electrode during strain tests, making it the top-performing textrode sample. Therefore, the layered 3D design structure of textrode C4 ranks highest when tested for durability, reusability, and washability. The ISO testing framework established in this study will support future research, validating the durability and reliability of textrodes for a wide range of applications.

Keywords: smart fabric, textrodes, testing framework, ISO compliant

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Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

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Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

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