Search results for: cancer care services

Authors: Linda P. M. Pluymen, Mariska M. G. Leeflang, I. Stegeman, Henock G. Yebyo, Anne E. M. Brabers, Patrick M. Bossuyt, E. Dekker, Anke J. Woudstra, Mirjam P. Fransen

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Weighing the benefits and harms of colorectal cancer screening can be difficult for individuals. An existing online decision aid was expanded with a benefit-harm analysis to help people make an informed decision about participating in colorectal cancer screening. In a randomized controlled trial, we investigated whether those in the intervention group who used the decision aid with benefit-harm analysis were more certain about their decision than those in the control group who used the decision aid without benefit-harm analysis. Participants were 623 (39% of those invited) men and women aged 45 until 75 years old. Analyses were performed in those 386 participants (62%) who reported to have completed the entire decision aid. No statistically significant differences were observed between intervention and control group in decisional conflict score (mean difference 2.4, 95% CI -0.9, 5.6), clarity of values (mean difference 1.0, 95% CI -4.4, 6.6), deliberation score (mean difference 0.5, 95% CI -0.6, 1.7), anxiety score (mean difference 0.0, 95% CI -0.3, 0.3) and risk perception score (mean difference 0.1, -0.1, 0.3). Adding a benefit-harm analysis to an online decision aid did not improve informed decision making about participating in colorectal cancer screening.

Keywords: benefit-harm analysis, decision aid, informed decision making, personalized decision making

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Authors: R. Tudugala, B. M. A. I. Balasooriya, W. M. Ediri Arachchi, R. W. M. W. K. Rathnayake, T. D. Premaratna

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Brachytherapy involves placing a source of radiation near the cancer site which gives promising prognosis for cervical cancer treatments. The purpose of this study was to evaluate the effect of random variation of treated volumes in between fractions in the 2D image based fractionated high dose rate brachytherapy for cervical cancer at National Cancer Institute Maharagama, Sri Lanka. Dose plans were analyzed for 150 cervical cancer patients with orthogonal radiographs (2D) based brachytherapy. ICRU treated volumes was modeled by translating the applicators with the help of “Multisource HDR plus software”. The difference of treated volumes with respect to the applicator geometry was analyzed by using SPSS 18 software; to derived patient population based estimates of delivered treated volumes relative to ideally treated volumes. Packing was evaluated according to bladder dose, rectum dose and geometry of the dose distribution by three consultant radiation oncologist. The difference of treated volumes depends on types of the applicators, which was used in fractionated brachytherapy. The means of the “Difference of Treated Volume” (DTV) for “Evenly activated tandem (ET)” length” group was ((X_1)) -0.48 cm3 and ((X_2)) 11.85 cm3 for “Unevenly activated tandem length (UET) group. The range of the DTV for ET group was 35.80 cm3 whereas UET group 104.80 cm3. One sample T test was performed to compare the DTV with “Ideal treatment volume difference (0.00cm3)”. It is evident that P value was 0.732 for ET group and for UET it was 0.00 moreover independent two sample T test was performed to compare ET and UET groups and calculated P value was 0.005. Packing was evaluated under three categories 59.38% used “Convenient Packing Technique”, 33.33% used “Fairly Packing Technique” and 7.29% used “Not Convenient Packing” in their fractionated brachytherapy treatments. Random variation of treated volume in ET group is much lower than UET group and there is a significant difference (p<0.05) in between ET and UET groups which affects the dose distribution of the treatment. Furthermore, it can be concluded nearly 92.71% patient’s packing were used acceptable packing technique at NCIM, Sri Lanka.

Keywords: brachytherapy, cervical cancer, high dose rate, tandem, treated volumes

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Authors: Ine Huybrechts, Anja Declercq, Emily Verté, Peter Raeymaeckers, Sibyl Anthierens

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Goal-oriented care is a concept gaining increased interest as an approach to go towards more coordinated and integrated primary care. It places patients’ personal life goals at the core of health care support, hereby shifting the focus from “what’s the matter with this patient” to “what matters to this patient.” In Flanders/Belgium, various primary care providers, health and social care organizations and governmental bodies have picked up this concept and have initiated actions to facilitate this approach. The implementation of goal-oriented care not only happens on the micro-level, but it also requires efforts on the meso- and macro-level. Within implementation research, there is a growing recognition that the context in which an intervention takes place strongly relates to its implementation outcomes. However, when investigating contextual variables, the external context and its impact on implementation processes is often overlooked. This study aims to explore how we can better identify and understand the external context and how it relates to the mechanism of change within the implementation process of goal-oriented care in Flanders/Belgium. Results can be used to support and guide initiatives to introduce innovative approaches such as goal-oriented care inside an organization or in the broader primary care landscape. We have conducted qualitative research, performing in-depth interviews with n=23 respondents who have affinity with the implementation of goal-oriented care within their professional function. This lead to in-depth insights from a wide range of actors, with meso-level and/or macro-level perspectives on the implementation of goal-oriented care. This means that we have interviewed actors that are not only involved with initiatives to implement goal-oriented care, but also actors that actively give form to the external context in which goal-oriented care is implemented. Data were collected using a semi-structured interview guide, audio recorded, and analyzed first inductively and then deductively using various theories and concepts that derive from organizational research. Our preliminary findings suggest t Our findings can contribute to further define actions needed for sustainable implementation of goal-oriented primary care. It gives insights in the dynamics between contextual variables and implementation efforts, hereby indicating towards those contextual variables that can be further shaped to facilitate the implementation of an innovation such as goal-oriented care. hat organizational theories can help understand the mechanism of change of implementation processes with a macro-level perspective. Institutional theories, contingency theories, resources dependency theories and others can expose the mechanism of change for an innovation such as goal-oriented care. Our findings can contribute to further define actions needed for sustainable implementation of goal-oriented primary care. It gives insights in the dynamics between contextual variables and implementation efforts, hereby indicating towards those contextual variables that can be further shaped to facilitate the implementation of an innovation such as goal-oriented care.

Keywords: goal-oriented care, implementation processes, organizational theories, person-centered care, implementation research

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Authors: Saeed M. Al Qahtani, Alaa Eldin A. Ayoub

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The study aimed to develop a battery of measures to assessment gifted initiatives in Saudi Arabia. The battery consisted of 17 measures developed in light of Saudi Arabia's future vision objectives for gifted education. A battery was applied to 193 gifted students who benefit from gifted initiatives and programs, 42 teachers of gifted as well as, 40 experts of gifted. Samples were taken from three main regions: Riyadh, Sharqia, Gharbia in Saudi Arabia. The results indicated that battery measures have a reliability and stability index ranging from 0.6 to 0.87. Besides that, results showed that the educational environment lacks many basic components such as facilities, laboratories, and activities that may stimulate creativity and innovation. Furthermore, results showed that there is a weakness in private sector involvement in the construction of educational buildings, special centers for gifted people and the provision of certain facilities that support talented programs. The recommendations of the study indicate the need for the private sector participation in the provision of services and projects for the care of gifted students in Saudi Arabia.

Keywords: battery of measures, gifted care initiatives, Saudi future vision, gifted student

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Authors: Kristine Demilou D. Santiago

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An access to a high-quality health care system is what sets apart industrialized nations, such as the United States from other developing countries, which in this case is specifically pertaining to their older population. But what was the underrated factor in the sphere of quality healthcare rendered to elderly people in the Western context? Will this salient factor could push conviction to prorogue the existing gaps between self-denial patient-client and cheek by jowl medications? Are the natural socio-environmental approaches of caregiving the protracted remedy to healthcare disparities for aging population considering their day to day living? The conceptual framework of this model is primarily associated with addressing health and illness of human beings considering the biological, psychological and socio-environmental factors around them. The relevance of biopsychosocial formulation advancing each of the characteristics in the Biopsychosocial (BPS) model in a balance contemplation is the tumult of this study in an attempt to respond to prevailing disparities in caregiving services for old-aged patients on a day to day living. Caregiving services have been the medium path connecting between the patient and its prescribed medications. Moreover, caregivers serve as positive reinforcers in a patient’s environment. Therefore, caregivers play an important role in healthcare delivery to patients. They are considered significant people whom their acts will give an impact to a patient’s view in life. This research study intends to present the supreme importance of biopsychosocial assessment to old-aged patients with mental health illness and conditions. Biopsychosocial assessment will secure the quality of full medication to an old-aged adult suffering from a mental illness. This is because it offers a recognizably wholesome approach to medical healing of old-aged adult patients. The principle of biopsychosocial supersedes the biomedicine being offered to old-aged adults having mental illness, but it does not take away the high relevance of scientific biomedicine in healing patients. The framework presented an overlapping participation of each of its factors in its BPS model that affects in general a person’s health. The correlation between the biological (physiological), psychological (mental) and social (environment) in a person’s health condition requires equal attention according to BPS, and it always coexist with each other. Indisputably said, bio-medicine has been and is being in its unceasing endeavor to provide scientifically proven health care medications for every individual seeking medical treatments. As we grow older and eventually reach the other side of the median population, not only our physiological aspects change, our psychological and socio-environmental changes happen too. Caregiving is a salient responsibility taking place on these inevitable changes.

Keywords: biopsychosocial formulation, caregiving through natural approaches, US health care, BPS in caregiving, caregiving for aging population

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Authors: O. Davies, K. Veravalli, P. Panwalkar, M. Tofighi, P. Butterick, B. Healy, A. Mofidi

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Vancomycin resistant enterococcus infection is a condition that usually impacts ICUs, transplant, dialysis, and cancer units, often as a nosocomial infection. After an outbreak in the acute trauma and orthopaedic unit in Morriston hospital, we aimed to access the conditions that predispose VRE infections in our unit. Thirteen cases of VRE infection and five cases of VRE colonisations were identified in patients who were treated for orthopaedic care between 1/1/2020 and 1/11/2021. Cases were reviewed to identify predisposing factors, specifically looking at age, presenting condition and treatment, presence of infection and antibiotic care, active haemo-oncological condition, long term renal dialysis, previous hospitalisation, VRE predisposition, and clearance (PREVENT) scores, and outcome of care. The presenting condition, treatment, presence of postoperative infection, VRE scores, age was compared between colonised and the infected cohort. VRE type in both colonised and infection group was Enterococcus Faecium in all but one patient. The colonised group had the same age (T=0.6 P>0.05) and sex (2=0.115, p=0.74), presenting condition and treatment which consisted of peri-femoral fixation or arthroplasty in all patients. The infected group had one case of myelodysplasia and four cases of chronic renal failure requiring dialysis. All of the infected patient had sustained an infected complication of their fracture fixation or arthroplasty requiring reoperation and antibiotics. The infected group had an average VRE predisposition score of 8.5 versus the score of 3 in the colonised group (F=36, p<0.001). PREVENT score was 7 in the infected group and 2 in the colonised group(F=153, p<0.001). Six patients(55%) succumbed to their infection, and one VRE infection resulted in limb loss. In the orthopaedic cohort, VRE infection is a nosocomial condition that has peri-femoral predilection and is seen in association with immunosuppression or renal failure. The VRE infection cohort has been treated for infective complication of original surgery weeks prior to VRE infection. Based on our findings, we advise avoidance of infective complications, change of practice in use of antibiotics and use radical surgery and surveillance for VRE infections beyond infective precautions. PREVENT score shows that the infected group are unlikely to clear their VRE in the future but not the colonised group.

Keywords: surgical site infection, enterococcus, orthopaedic surgery, vancomycin resistance

Procedia PDF Downloads 129

Authors: Olukayode Bamgbose, Feyisola Agboola, Adewale M. Taiwo, Olanrewaju Olujimi Oluwole Terebo, Azeez Soyingbe, Akeem Bamgbade

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The present study evaluated the contents and health risk assessment of metals determined in milk and milk product samples collected from the Abeokuta market. Forty-five milk and milk product (yoghurt) samples were digested and analysed for selected metals using Atomic Absorption Spectrophotometric method. Health risk assessment was evaluated for hazard quotient (HQ), hazard index (HI), and cancer risk (CR). Data were subjected to descriptive and inferential statistics. The concentrations of Zn, which ranged from 3.24±0.59 to 4.35±0.59 mg/kg, were the highest in the samples. Cr and Cd were measured below the detection limit of the analytical instrument, while the Pb level was higher than the Codex Alimentarius Commission value of 0.02 mg/kg, indicating unsafe for consumption. However, the HQ of Pb and other metals in milk and milk product samples was less than 1.0, thereby establishing no adverse health effects for Pb and other metals. The distribution pattern of metals in milk and milk product samples followed the decreasing order of Zn > Fe > Ni > Co > Cu > Mn > Pb > Cd/Cr. The CR levels of meals were also less than the permissible limit of 1.0 x 10-4, establishing no possible development of cancer. Keywords: adverse effects, cancer, metals, milk, milk product, the permissible limit.

Keywords: adverse effects, cancer, metals, milk, milk product, permissible limit

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Authors: Aileen F. Wang

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Mammography has been one of the most reliable methods for early detection and diagnosis of breast cancer. However, mammography misses about 17% and up to 30% of breast cancers due to the subtle and unstable appearances of breast cancer in their early stages. Recent computer-aided diagnosis (CADx) technology using Zernike moments has improved detection accuracy. However, it has several drawbacks: it uses manual segmentation, Zernike moments are not robust, and it still has a relatively high false negative rate (FNR)–17.6%. This project will focus on the development of a novel breast cancer detection algorithm to automatically segment the breast mass and further reduce FNR. The algorithm consists of automatic segmentation of a single breast mass using Point Region Growing Segmentation, reconstruction of the segmented breast mass using Pseudo-Zernike moments, and classification of the breast mass using the root mean square (RMS). A comparative study among the various algorithms on the segmentation and reconstruction of breast masses was performed on randomly selected mammographic images. The results demonstrated that the newly developed algorithm is the best in terms of accuracy and cost effectiveness. More importantly, the new classifier RMS has the lowest FNR–6%.

Keywords: computer aided diagnosis, mammography, point region growing segmentation, pseudo-zernike moments, root mean square

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Authors: Jonathan Turner, Julie Doyle, Laura O’Philbin, Dympna O’Sullivan

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People living with dementia should be at the centre of decision-making regarding goals for daily living. These goals include basic activities (dressing, hygiene, and mobility), advanced activities (finances, transportation, and shopping), and meaningful activities that promote well-being (pastimes and intellectual pursuits). However, there is limited involvement of people living with dementia in the design of technology to support their goals. A project is described that is co-designing intelligent computer-based support for, and with, people affected by dementia and their carers. The technology will support self-management, empower participation in shared decision-making with carers and help people living with dementia remain healthy and independent in their homes for longer. It includes information from the patient’s care plan, which documents medications, contacts, and the patient's wishes on end-of-life care. Importantly for this work, the plan can outline activities that should be maintained or worked towards, such as exercise or social contact. The authors discuss how to integrate care goal information from such a care plan with data collected from passive sensors in the patient’s home in order to deliver individualized planning and interventions for persons with dementia. A number of scientific challenges are addressed: First, to co-design with dementia patients and their carers computerized support for shared decision-making about their care while allowing the patient to share the care plan. Second, to develop a new and open monitoring framework with which to configure sensor technologies to collect data about whether goals and actions specified for a person in their care plan are being achieved. This is developed top-down by associating care quality types and metrics elicited from the co-design activities with types of data that can be collected within the home, from passive and active sensors, and from the patient’s feedback collected through a simple co-designed interface. These activities and data will be mapped to appropriate sensors and technological infrastructure with which to collect the data. Third, the application of machine learning models to analyze data collected via the sensing devices in order to investigate whether and to what extent activities outlined via the care plan are being achieved. The models will capture longitudinal data to track disease progression over time; as the disease progresses and captured data show that activities outlined in the care plan are not being achieved, the care plan may recommend alternative activities. Disease progression may also require care changes, and a data-driven approach can capture changes in a condition more quickly and allow care plans to evolve and be updated.

Keywords: care goals, decision-making, dementia, self-care, sensors

Procedia PDF Downloads 155

Authors: Johnnie Hay

Abstract:

New Zealand is well known for its natural beauty, diversity of people but also for its strong focus on mental health through the provision of a vast network of psycho-social support services. South African-trained psychologists often make New Zealand their new home when emigrating - as it is relatively simple to slot into the well-established mental health system. South Africa is bigger in size, population, GDP and probably people diversity than New Zealand but struggles to provide adequate educational and psychological support services to schools. This is mainly due to budgetary pressures brought about by the imperative to first ensure that the approximately 13 million learners all have a teacher in front of their classes and at an average ratio of not more than 40 learners per class. In this paper, perspectives on educational and psychological support in New Zealand and South African schools will be shared. Through basic qualitative research encompassing semi-structured interviews with two South African educational psychologists who returned from New Zealand, supplemented by document analysis, the New Zealand situation will be scrutinized. South African perspectives will be obtained through a number of semi-structured interviews and questionnaires administered by education support services specialists working in district-based support teams in three provinces of the country. This research is in process, but preliminary findings indicate large disparities between the two countries' emphasis, funding, post provisioning and structure regarding educational and psychological support services.

Keywords: educational psychological support services, support for learners experiencing special needs, education support services, diverse learner population

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Authors: D. I. Yani, S. Isaramalai, C. Kritpracha

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Adherence to health behaviors is essential to achieve successful TB treatment. This study aimed to examine the effect of a family-based DOTS support program on adherence to health behaviors in patients with pulmonary TB. Sixty TB patients and their families were selected using cluster randomization of community health centers. The subjects were assigned into a control group, who received the routine care, and an experimental group, who received both routine care and care from the family-based DOTS support program. Paired t-test and the independent t-test were applied. The total score of adherence to health behaviors in the experimental group was significantly higher after receiving care from the family-based DOTS support program than the pretest score (t = -10.34, p < .001). Suggestions were made to expand the application of this program in various contexts and to extend knowledge for nursing practices and research.

Keywords: self-care deficit nursing theory, family-based DOTS program, pulmonary tuberculosis, adherence, health behaviors

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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: Mushtaq Ahmad, Bashir Rahman, Taqweem-ul-Haq, Fazal Jalil, Aftab Ali Shah

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Single nucleotide polymorphisms (SNPs) in genes coding for microRNAs (miRNAs) play a pivotal role in the progression of breast cancer (BC). We investigated the association of miR-146a rs2910164 G/C polymorphism with the risk of BC in the Pakistani population. The miR-146a rs2910164 polymorphism was genotyped in 300 BC-cases and 300 age- and gender-matched healthy controls using T-ARMS-PCR. Genotype and allele frequencies were calculated, and the association between genotypes and the risk of BC was calculated by odds ratios (OR) and confidence intervals (95%). A significant difference in genotypic frequencies (χ2=63.10; p ≤ 0.0001) and allelic frequencies (OR=0.3955 (0.3132-0.4993); p ≤ 0.0001) was observed between cases and controls. Furthermore, we also found that miR-146 rs2910164 CC homozygote increased the risk of breast cancer in the dominant (OR=0.2397 (0.1629-0.3526); p=0.0001; GG vs GC+CC) and recessive (OR=2.803 (1.865- 4.213); P ≤ 0.0001; CC vs GC+GG) inheritance models. In summary, miR-146a rs2910164 G/C is significantly associated with BC in the Pakistani population. To our knowledge, this is the first study that assessed MIR146a rs2910164 G > C SNP in Pakistani population. By analyzing the secondary structure of MIR146A variant, a significant structural modification was noted. Study with a larger sample size is needed to further confirm these findings.

Keywords: breast cancer, MIR146A, microRNA, SNP

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Authors: Hailemeleak Regassa

Abstract:

Traditional medicines use medicinal plants as a source of ingredients, and many modern medications are indirectly derived from plants. Consumers in affluent nations are growing disenchanted with contemporary healthcare and looking for alternatives. Oxidative stress is the primary cause of multiple diseases, and exogenous antioxidant supplementation or strengthening the body's endogenous antioxidant defenses are potential ways to counteract the negative effects of oxidative damage. Plants can biosynthesize non-enzymatic antioxidants that can reduce ROS-induced oxidative damage. Aging often aids the propagation and development of carcinogenesis, and older animals and older people exhibit increased vulnerability to tumor promoters. Cancer is a major public health issue, with several anti-cancer medications in clinical use. Potential drugs such as flavopiridol, roscovitine, combretastatin A-4, betulinic acid, and silvestrol are in the clinical or preclinical stages of research. Methodology: Microbial Growth media, Dimethyl sulfoxide (DMSO), methanol, ethyl acetate, and n-hexane were obtained from Himedia Labs, Mumbai, India. plant were collected from the Herbal Garden of Shoolini University campus, Solan, India (Latitude - 30.8644° N and longitude - 77.1184° E). The identity was confirmed by Dr. Y.S. Parmar University of Horticulture and Forestry, Nauni, Solan (H.P.), India, and documented in Voucher specimens - UHF- Herbarium no. 13784; vide book no. 3818 Receipt No. 086. The plant materials were washed with tap water, and 0.1% mercury chloride for 2 minutes, rinsed with distilled water, air dried, and kept in a hot air oven at 40ºc on blotting paper until all the water evaporated and became well dried for grinding. After drying, the plant materials were grounded using a mixer grinder into fine powder transferred into airtight containers with proper labeling, and stored at 4ºc for future use (Horablaga et al., 2023). The extraction process was done according to Altemimi et al., 2017. The 5g powder was mixed with 15 ml of the respective solvents (n-hexane, ethyl acetate, and methanol), and kept for 4-5 days on the platform shaker. The solvents used are based on their increasing polarity index. Then the extract was centrifuged at 10,000rpm for 5 minutes and filtered using No.1 Whatman filter paper.

Keywords: cancer, phytomedicine, medicinal plants, oncology

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Authors: Ibragim Issabekov, Byron Crape, Lyazzat Toleubekova

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Background: Palliative care substantially improves the quality of life of terminally-ill patients. Symptom control is one of the keystones in the management of patients in palliative care settings, lowering distress as well as improving the quality of life of patients with end-stage diseases. The most common symptoms causing significant distress for patients are pain, nausea and vomiting, increased respiratory secretions and mental health issues like depression. Aims are: 1. to identify best practices in symptom management in palliative patients in accordance with internationally approved guidelines and compare aforementioned with actual practices in Kazakhstan; to evaluate the criteria for assessing symptoms in terminally-ill patients, 2. to review the availability and utilization of pharmaceutical agents for pain control, management of excessive respiratory secretions, nausea, and vomiting, and delirium and 3. to develop recommendations for the systematic approach to end-of-life symptom management in Kazakhstan. Methods: The use of qualitative research methods together with systematic literature review have been employed to provide a rigorous research process to evaluate current approaches for symptom management of palliative patients in Kazakhstan. Qualitative methods include in-depth semi-structured interviews of the healthcare professionals involved in palliative care provision. Results: Obstacles were found in appropriate provision of palliative care. Inadequate education and training to manage severe symptoms, poorly defined laws and regulations for palliative care provision, and a lack of algorithms and guidelines for care were major barriers in the effective provision of palliative care. Conclusion: Assessment of palliative care in this medium-income transitional-economy country is one of the first steps in the initiation of integration of palliative care into the existing health system. Achieving this requires identifying obstacles and resolving these issues.

Keywords: end-of-life care, middle income country, palliative care, symptom control

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Authors: Jenny Fairthorne, Yuka Mori, Helen Leonard

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Background: Primary care-givers of children with autism spectrum disorder (ASD) or intellectual disability (ID) have poorer health and quality of life (QoL) than primary care-givers (hereafter referred to as just care-givers) of typically developing children. We aimed to review original research which described factors impacting the health of care-givers of children with ASD or ID and to discuss how these factors might influence care-giver health. Methods: We searched Web of Knowledge, Medline, Scopus and Google Scholar using selections of words from each of three groups. The first comprised terms associated with ASD and ID and included autism, pervasive development disorder, intellectual disability, mental retardation, disability, disabled, Down and Asperger. The second included terms related to health such as depression, physical, mental, psychiatric, psychological and well-being. The third was terms related to care-givers such as mother, parent and care-giver. We included an original paper in our review if it was published between 1st January 1990 and 31st December, 2016, described original research in a peer-reviewed journal and was written in English. Additional criteria were that the research used a study population of 15 persons or more; described a risk or protective factor for the health of care-givers of a child with ASD, ID or a sub-type (such as ASD with ID or Down syndrome). Using previous research, we developed a simple and objective five-level tool to assess the strength of evidence provided by the reviewed papers. Results: We retained 33 papers. Factors impacting primary care-giver health included child behaviour, level of support, socio-economic status (SES) and diagnostic issues. Challenging child behaviour, the most commonly identified risk factor for poorer care-giver health and QoL was reported in ten of the studies. A higher level of support was associated with improved care-giver health and QoL. For example, substantial evidence indicated that family support reduced care-giver burden in families with a child with ASD and that family and neighbourhood support was associated with improved care-giver mental health. Higher socio-economic status (SES) was a protective factor for care-giver health and particularly maternal health. Diagnostic uncertainty and an unclear prognosis are factors which can cause the greatest concern to care-givers of children with ASD and those for whom a cause of their child’s ID has not been identified. We explain how each of these factors might impact caregiver health and how they might act differentially in care-givers of children with different types of ASD or ID (such as Down syndrome and ASD without ID). Conclusion: Care-givers of children with ASD may be more likely to experience many risk factors and less likely to experience the protective factors we identified for poorer mental health. Interventions to reduce risk factors and increase protective factors could pave the way for improved care-giver health. For example, workshops to train care-givers to better manage challenging child behaviours and earlier diagnosis of ASD (and particularly ASD without ID) would seem likely to improve care-giver well-being. Similarly, helping to expand support networks might reduce care-giver burden and stress leading to improved health.

Keywords: autism, caregivers, health, intellectual disability, mothers, review

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Authors: Amina Aquil, Abdeljalil El Got

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Background: Sleep quality is one of the most important indicators related to the quality of life of patients suffering from cancer. Many factors could affect this quality of sleep and then be considered as associated predictors. Methods: The aim of this study was to assess the prevalence of sleep disorders and the associated factors with impaired sleep quality in Moroccan women with gynecological cancer. A cross-sectional study was carried out within the oncology department of the Ibn Rochd University Hospital, Casablanca, on Moroccan women who had undergone radical surgery for gynecological cancer (n=100). Translated and validated Arabic versions of the following international scales were used: Pittsburgh sleep quality index (PSQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's self-esteem scale (RSES), and Body image scale (BIS). Results: 78% of participants were considered poor sleepers. Most of the patients exhibited very poor subjective quality, low sleep latency, a short period of sleep, and a low rate of usual sleep efficiency. The vast majority of these patients were in poor shape during the day and did not use sleep medication. Waking up in the middle of the night or early in the morning and getting up to use the bathroom were the main reasons for poor sleep quality. PSQI scores were positively correlated with anxiety, depression, body image dissatisfaction, and lower self-esteem (p < 0.001). Conclusion: Sleep quality and its predictors require a systematic evaluation and adequate management to prevent sleep disturbances and mental distress as well as to improve the quality of life of these patients.

Keywords: body image, gynecological cancer, self esteem, sleep quality

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Authors: Jelena Zivkovic, Haidar Mohammed, Elaf Saeed

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Student affairs services play a critical role in contributing to the wholistic development and success of students as they progress through their academic careers. The study encompasses a multifaceted examination of student affairs service offerings amongst 10 private and 3 public Baghdad universities. Student affairs administrators (13) were surveyed along with over 300 students to determine university-sponsored services and student satisfaction and awareness. The student affairs service research findings varied significantly between private and public institutions and those that followed a national and international curriculum. Universities need to persist to adapt to changing demographics and technological advancements to enhance students' personal and academic successes, and student affairs services are key to preparing graduates to thrive in a diverse global world.

Keywords: student affairs, student success, higher education, Iraq, universities, Baghdad

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Authors: Maryam Tabrizi, Shahrzad Aarup

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Objectives- Understanding the close association between oral health and overall health for older adults at the right time and right place, a person, focus treatment through Project ECHO telementoring. Methodology- Data from monthly ECHO telementoring sessions were provided for three years. Sessions including case presentations, overall health conditions, considering medications, organ functions limitations, including the level of cognition. Contributions- Providing the specialist level of providing care to all elderly regardless of their location and other health conditions and decreasing oral health inequity by increasing workforce via Project ECHO telementoring program worldwide. By 2030, the number of adults in the USA over the age of 65 will increase more than 60% (approx.46 million) and over 22 million (30%) of 74 million older Americans will need specialized geriatrician care. In 2025, a national shortage of medical geriatricians will be close to 27,000. Most individuals 65 and older do not receive oral health care due to lack of access, availability, or affordability. One of the main reasons is a significant shortage of Oral Health (OH) education and resources for the elderly, particularly in rural areas. Poor OH is a social stigma, a thread to quality and safety of overall health of the elderly with physical and cognitive decline. Poor OH conditions may be costly and sometimes life-threatening. Non-traumatic dental-related emergency department use in Texas alone was over $250 M in 2016. Most elderly over the age of 65 present with at least one or multiple chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) are at higher risk to develop gum (periodontal) disease, yet they are less likely to get dental care. In addition, most older adults take both prescription and over-the-counter drugs; according to scientific studies, many of these medications cause dry mouth. Reduced saliva flow due to aging and medications may increase the risk of cavities and other oral conditions. Most dental schools have already increased geriatrics OH in their educational curriculums, but the aging population growth worldwide is faster than growing geriatrics dentists. However, without the use of advanced technology and creating a network between specialists and primary care providers, it is impossible to increase the workforce, provide equitable oral health to the elderly. Project ECHO is a guided practice model that revolutionizes health education and increases the workforce to provide best-practice specialty care and reduce health disparities. Training oral health providers for utilizing the Project ECHO model is a logical response to the shortage and increases oral health access to the elderly. Project ECHO trains general dentists & hygienists to provide specialty care services. This means more elderly can get the care they need, in the right place, at the right time, with better treatment outcomes and reduces costs.

Keywords: geriatric, oral health, project echo, chronic disease, oral health

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Authors: Nicole Ramlachan, Samuel Mark West

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Lung cancer is the leading cause of cancer-associated deaths in North America, with the vast majority being non-small cell lung cancer (NSCLC), with a five-year survival rate of only 24%. Non-invasive discovery of biomarkers associated with early-diagnosis of NSCLC can enable precision oncology efforts using liquid biopsy-based multiomics profiling of plasma. Although tissue biopsies are currently the gold standard for tumor profiling, this method presents many limitations since these are invasive, risky, and sometimes hard to obtain as well as only giving a limited tumor profile. Blood-based tests provides a less-invasive, more robust approach to interrogate both tumor- and non-tumor-derived signals. We intend to examine 30 stage III-IV NSCLC patients pre-surgery and collect plasma samples.Cell-free DNA (cfDNA) will be extracted from plasma, and next-generation sequencing (NGS) performed. Through the analysis of tumor-specific alterations, including single nucleotide variants (SNVs), insertions, deletions, copy number variations (CNVs), and methylation alterations, we intend to identify tumor-derived DNA—ctDNA among the total pool of cfDNA. This would generate data to be used as an accurate form of cancer genotyping for diagnostic purposes. Using liquid biopsies offer opportunities to improve the surveillance of cancer patients during treatment and would supplement current diagnosis and tumor profiling strategies previously not readily available in Trinidad and Tobago. It would be useful and advantageous to use this in diagnosis and tumour profiling as well as to monitor cancer patients, providing early information regarding disease evolution and treatment efficacy, and reorient treatment strategies in, timethereby improving clinical oncology outcomes.

Keywords: genomics, multiomics, clinical genetics, genotyping, oncology, diagnostics

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Authors: Sayed Hadi Sadeghi

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This research study examines the current state of support services for e-network practice in an Australian and an American university. It identifies information that will be of assistance to Australian and American universities to improve their existing online programs. The study investigated the two universities using a quantitative methodological approach. Participants were students, lecturers and admins of universities engaged with online courses and learning management systems. The support services for e-network practice variables, namely academic support services, administrative support and technical support, were investigated for e-practice. Evaluations of e-network support service and its sub factors were above average and excellent in both countries, although the American admins and lecturers tended to evaluate this factor higher than others did. Support practice was evaluated higher by all participants of an American university than by Australians. One explanation for the results may be that most suppliers of the Australian university e-learning system were from eastern Asian cultural backgrounds with a western networking support perspective about e-learning.

Keywords: support services, e-Network practice, Australian universities, United States universities

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Authors: Mualla McManus, Jenna Luche Thaye

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World Health Organisation International Classification of Disease codes were created to define disease including infections in order to guide and educate diagnosticians. Most infectious diseases such as syphilis are clearly defined by their ICD 10 codes and aid/help to educate the clinicians in syphilis diagnosis and treatment globally. However, current ICD 10 codes for relapsing fever Borreliosis and Lyme disease are less clearly defined and can impede appropriate diagnosis especially if the clinician is not familiar with the symptoms of these infectious diseases. This is despite substantial number of scientific articles published in peer-reviewed journals about relapsing fever and Lyme disease. In the USA there are estimated 380,000 people annually contacting Lyme disease, more cases than breast cancer and 6x HIV/AIDS cases. This represents estimated 0.09% of the USA population. If extrapolated to the global population (7billion), 0.09% equates to 63 million people contracting relapsing fever or Lyme disease. In many regions, the rate of contracting some form of infection from tick bite may be even higher. Without accurate and appropriate diagnostic codes, physicians are impeded in their ability to properly care for their patients, leaving those patients invisible and marginalized within the medical system and to those guiding public policy. This results in great personal hardship, pain, disability, and expense. This unnecessarily burdens health care systems, governments, families, and society as a whole. With accurate diagnostic codes in place, robust data can guide medical and public health research, health policy, track mortality and save health care dollars. Better defined ICD codes are the way forward in educating the diagnosticians about relapsing fever and Lyme diseases.

Keywords: WHO ICD codes, relapsing fever, Lyme diseases, World Health Organisation

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Authors: Arne Koschel

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This article discusses event monitoring options for heterogeneous event sources as they are given in nowadays heterogeneous distributed information systems. It follows the central assumption, that a fully generic event monitoring solution cannot provide complete support for event monitoring; instead, event source specific semantics such as certain event types or support for certain event monitoring techniques have to be taken into account. Following from this, the core result of the work presented here is the extension of a configurable event monitoring (Web) service for a variety of event sources. A service approach allows us to trade genericity for the exploitation of source specific characteristics. It thus delivers results for the areas of SOA, Web services, CEP and EDA.

Keywords: event monitoring, ECA, CEP, SOA, web services

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Authors: Nurunnahar Akter, Elena Kulinskaya, Nicholas Steel, Ilyas Bakbergenuly

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Although Hormone Replacement Therapy (HRT) is an effective treatment in ameliorating menopausal symptoms, it has mixed effects on different health outcomes, increasing, for instance, the risk of breast cancer. Because of this, many symptomatic women are left untreated. Untreated menopausal symptoms may result in other health issues, which eventually put an extra burden and costs to the health care system. All-cause mortality analysis may explain the net benefits and risks of the HRT therapy. However, it received far less attention in HRT studies. This study investigated the impact of HRT on all-cause mortality using electronically recorded primary care data from The Health Improvement Network (THIN) that broadly represents the female population in the United Kingdom (UK). The study entry date for this study was the record of the first HRT prescription from 1984, and patients were followed up until death or transfer to another GP practice or study end date, which was January 2017. 112,354 HRT users (cases) were matched with 245,320 non-users by age at HRT initiation and general practice (GP). The hazards of all-cause mortality associated with HRT were estimated by a parametric Weibull-Cox model adjusting for a wide range of important medical, lifestyle, and socio-demographic factors. The multilevel multiple imputation techniques were used to deal with missing data. This study found that during 32 years of follow-up, combined HRT reduced the hazard ratio (HR) of all-cause mortality by 9% (HR: 0.91; 95% Confidence Interval, 0.88-0.94) in women of age between 46 to 65 at first treatment compared to the non-users of the same age. Age-specific mortality analyses found that combined HRT decreased mortality by 13% (HR: 0.87; 95% CI, 0.82-0.92), 12% (HR: 0.88; 95% CI, 0.82-0.93), and 8% (HR: 0.92; 95% CI, 0.85-0.98), in 51 to 55, 56 to 60, and 61 to 65 age group at first treatment, respectively. There was no association between estrogen-only HRT and women’s all-cause mortality. The findings from this study may help to inform the choices of women at menopause and to further educate the clinicians and resource planners.

Keywords: hormone replacement therapy, multiple imputations, primary care data, the health improvement network (THIN)

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Authors: Wooseok Byon, Eunyoung Kim, Junseong Kwon, Byung Joo Song, Chan Heun Park

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Purpose: 18F Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a noninvasive imaging modality that can identify nodal metastases in women with primary breast cancer. The aim of this study was to compare the accuracy of FDG-PET with MRI and sonography scanning to determine axillary lymph node status in patients with breast cancer undergoing sentinel lymph node biopsy or axillary lymph node dissection. Patients and Methods: Between January and December 2012, ninety-nine patients with breast cancer and clinically negative axillary nodes were evaluated. All patients underwent FDG-PET, MRI, ultrasound followed by sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Results: Using axillary lymph node assessment as the gold standard, the sensitivity and specificity of FDG-PET were 51.4% (95% CI, 41.3% to 65.6%) and 92.2% (95% CI, 82.7% to 97.4%) respectively. The sensitivity and specificity of MRI and ultrasound were 57.1% (95% CI, 39.4% to 73.7%), 67.2% (95% CI, 54.3% to 78.4%) and 42.86% (95% CI, 26.3% to 60.7%), 92.2% (95% CI, 82.7% to 97.4%). Stratification according to hormone receptor status showed an increase in specificity when negative (FDG-PET: 42.3% to 77.8%, MRI 50% to 77.8%, ultrasound 34.6% to 66.7%). Also, positive HER2 status was associated with an increase in specificity (FDG-PET: 42.9% to 85.7%, MRI 50% to 85.7%, ultrasound 35.7% to 71.4%). Conclusions: The sensitivity and specificity of FDG-PET compared with MRI and ultrasound was high. However, FDG-PET is not sufficiently accurate to appropriately identify lymph node metastases. This study suggests that FDG-PET scanning cannot replace histologic staging in early-stage breast cancer, but might have a role in evaluating axillary lymph node status in hormone receptor negative or HER-2 overexpressing subtypes.

Keywords: axillary lymph node metastasis, FDG-PET, MRI, ultrasound

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Authors: Jyoti Srivastava, Sandhya S. Kaushik, Mallika Tewari, Hari S. Shukla

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Little information is available about the development of psychological well being over time among women who have been undergoing treatment for breast cancer. The aim of this study was to identify the trajectories of depression anxiety and stress among women with early-stage breast cancer. Of the 48 Indian women with newly diagnosed early-stage breast cancer recruited from surgical oncology unit, 39 completed an interview and were assessed for depression anxiety and stress (Depression Anxiety Stress Scale-DASS 21) before their first course of chemotherapy (baseline) and follow up interviews at 3, 6 and 9 months thereafter. Growth mixture modeling was used to identify distinct trajectories of Depression Anxiety and Stress symptoms. Logistic Regression analysis was used to evaluate the characteristics of women in distinct groups. Most women showed mild to moderate level of depression and anxiety (68%) while normal to mild level of stress (71%). But one in 11 women was chronically anxious (9%) and depressed (9%). Young age, having a partner, shorter education and receiving chemotherapy but not radiotherapy might characterize women whose psychological symptoms remain strong nine months after diagnosis. By looking beyond the mean, it was found that several socio-demographic and treatment factors characterized the women whose depression, anxiety and stress level remained severe even nine months after diagnosis. The results suggest that support provided to cancer patients should have a special focus on a relatively small group of patient most in need.

Keywords: psychological well being, growth mixture modeling, logistic regression analysis, socio-demographic factors

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Authors: Mahya Naghipoor

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Purpose: Non-small cell lung cancer (NSCLC) is the most common lung cancer type. Epidermal growth factor receptor (EGFR) mutation is the main reason which causes NSCLC. Computed tomography (CT) is used for diagnosis and prognosis of lung cancers because of low price and little invasion. Semantic analyses of qualitative CT features are based on visual evaluation by radiologist. However, the naked eye ability may not assess all image features. On the other hand, radiomics provides the opportunity of quantitative analyses for CT images features. The aim of this review study was comparing accuracy of semantic and radiomics features in prognosis of EGFR mutation in NSCLC. Methods: For this purpose, the keywords including: non-small cell lung cancer, epidermal growth factor receptor mutation, semantic, radiomics, feature, receiver operating characteristics curve (ROC) and area under curve (AUC) were searched in PubMed and Google Scholar. Totally 29 papers were reviewed and the AUC of ROC analyses for semantic and radiomics features were compared. Results: The results showed that the reported AUC amounts for semantic features (ground glass opacity, shape, margins, lesion density and presence or absence of air bronchogram, emphysema and pleural effusion) were %41-%79. For radiomics features (kurtosis, skewness, entropy, texture, standard deviation (SD) and wavelet) the AUC values were found %50-%86. Conclusions: In conclusion, the accuracy of radiomics analysis is a little higher than semantic in prognosis of EGFR mutation in NSCLC.

Keywords: lung cancer, radiomics, computer tomography, mutation

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Authors: Tanushree Jaitly, Shailendra Gupta, Leila Taher, Gerold Schuler, Julio Vera

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Genomics-based personalized medicine is a promising approach to fight aggressive tumors based on patient's specific tumor mutation and expression profiles. A remarkable case is, dendritic cell-based immunotherapy, in which tumor epitopes targeting patient's specific mutations are used to design a vaccine that helps in stimulating cytotoxic T cell mediated anticancer immunity. Here we present a computational pipeline for epitope-based personalized cancer vaccines using patient-specific haplotype and cancer mutation profiles. In the workflow proposed, we analyze Whole Exome Sequencing and RNA Sequencing patient data to detect patient-specific mutations and their expression level. Epitopes including the tumor mutations are computationally predicted using patient's haplotype and filtered based on their expression level, binding affinity, and immunogenicity. We calculate binding energy for each filtered major histocompatibility complex (MHC)-peptide complex using docking studies, and use this feature to select good epitope candidates further.

Keywords: cancer immunotherapy, epitope prediction, NGS data, personalized medicine

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Authors: Yeasir Arafat Alve, Nazmun Nahar, Salma BeguM

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Introduction / Rationale: Caregivers of stroke survivors have experienced financial, emotional, physical and mental anxiety and have influence of family bonding and social customs, where 80% of caregivers were women and majority of the patients were cared for by immediate family members for example a spouse, son/daughter, son-in-law, daughter-in-law, siblings and they are significantly feel burden as a caregiver. In Bangladeshi context, there has a limitation of knowledge about the level of caregiver burden. This study could be suggested the health professional to focus on the care giving stress to provide a better support to them and also it will be advisable to provide equivalent services for caregivers and their families. Objectives: The study finds out the socio-demographic image of caregivers of stroke survivors in Bangladesh as well as discovers the level of burden of caregiver of stroke survivor in relation to general strain, isolation, disappointment, emotional involvement and environment. The study will find out the association between level of burden among caregivers and onset of stroke of survivors & duration of care giving. As well as to determine the association between level of burden among caregivers and caregiver’s age, gender, occupation and caregiver’s relationship with stroke survivors. Method / Approach: The study is a non experimental cross-sectional study design where 151 participants were selected through purposive comprehensive sampling. Data were selected from occupational therapy outdoor and stroke rehab unit, CRP (Savar & Mirpur) where using the Caregiver Burden Scale (a structured questionnaire) with face to face interview. Results: Most of the caregivers (78.8%) of stroke survivors faced moderate level of burden in general strain (37.7%), isolation (27.2%) but in case of disappointment (60.3%) feel higher burden and lower burden in emotional involvement (9.9%) and environment (0.7%). Caregiver burden level was significantly associated with caregivers’ age (P=0.006), sex (P=0.002), occupation (p= 0.04), relationship with stroke survivors (P=0.02), care giving duration (P=0.000), care giving hours (P=0.009), and onset of stroke (P=0.000) of stroke survivors. Conclusion: The study findings revealed that most of the caregivers faced moderate burden where no environmental burden for them, this is possibly in case of Bangladeshi culture where people hospitable. Through this study, it was also found that there is a possibility to have the higher burden. Finally, it is being also suggested that appropriate advice and support may preserve care giving which eventually enables the survivors to live a longer and more fulfilling life in the community.

Keywords: caregiver, level of caregiver burden, stroke survivor, stroke rehab unit

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Authors: Alejandro Salicrup, Riacrdo Gelhman, Geetha Gopalakrishna

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The main aim of this session is to have a panel to discuss specific steps for the integration of traditional, complementary and alternative medicine (TCAM) with conventional oncology for enhancing treatment practices at the global level, specifically in low-and-middle-income-countries (LMICs). Concrete current and required programs for strengthening Integrative Oncology research in LMICs will also be discussed. Case Studies from Latin America, Asia, Europe and Africa will discuss and highlight 1) What is working regarding treatment practices in integrative oncology in their countries/regions providing concrete examples 2) What is not working on this integration for cancer treatment in their countries/regions with concrete examples and 3) What are the challenges and opportunities for research related to integrative oncology treatment. Discussion will include potential next steps and potential mechanisms to enhance global integrative oncology research aimed to enhance the use of TCAM therapies and strengthening cancer treatment in LMICs.

Keywords: global cancer treatment, integrative oncology research, low and middle income countries, traditional, complementary and alternative medicines

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